Evaluating an Enhanced Home Visiting Program to Prevent Rapid Repeat Pregnancy Among Adolescent Parents

Publication Date: May 20, 2020
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  • Published: 2020


This brief summarizes key findings from a random assignment impact study of Steps to Success, a home visiting program in San Antonio, Texas, designed to reduce rapid repeat pregnancy among young mothers. A small but growing body of evidence suggests a combination of individualized support services and improved access to effective contraception can promote healthy birth spacing among adolescent mothers. To build on this promising research, the Administration for Children and Families partnered with Mathematica to conduct an evaluation of Steps to Success. Healthy Families San Angelo (HFSA) developed this intervention by enhancing its traditional home visiting program, which focused on child development and parenting, to include additional components designed to (1) promote healthy birth spacing, with an emphasis on increasing the use of long-acting reversible contraceptives (LARCs); (2) encourage father involvement; and (3) support mothers’ education and career aspirations.


This brief provides a final summary of key implementation and impact findings from the evaluation of Steps to Success. Details on the program’s implementation, cost, and impacts are presented in a series of three implementation and impact reports.

Key Findings and Highlights

  • On average, Steps to Success families received 32 home visits each, compared with about 20 visits for families in the traditional program.
  • After two years, mothers in the Steps to Success and traditional home visiting groups had similar rates of repeat pregnancy.
  • There was some evidence that Steps to Success improved other outcomes related to healthy birth spacing.
    • Mothers in Steps to Success were more likely to use LARC methods, particularly younger adolescent mothers (those ages 14 to 18 at program enrollment).
    • Steps to Success also decreased the incidence of unprotected sex for younger adolescent mothers.
  • There is no evidence that Steps to Success improved fathers’ involvement with their children, mothers’ education and career aspirations, or mothers’ parenting behavior at the time of the two-year follow-up survey.
  • Steps to Success cost about $2,500 more than the traditional program to deliver per participant ($7,689 versus $5,140).


The study team used a random assignment design to test the efficacy of Steps to Success compared with the traditional home visiting program. HFSA staff recruited pregnant and recently postpartum adolescent mothers, ages 14 to 20, on a rolling basis for the evaluation from May 2013 through May 2016. Mothers were randomly assigned to a program group that received the Steps to Success home visiting program or a control group that received the traditional home visiting program. Mothers in both research groups completed a baseline survey upon enrolling in the study and follow-up surveys one and two years later.


Shiferaw, Menbere, Dana Rotz, and Robert G. Wood (2020). Evaluating an Enhanced Home Visiting Program to Prevent Rapid Repeat Pregnancy Among Adolescent Parents. OPRE Report #2020-39. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.


Healthy Families San Angelo
long-acting reversible contraceptive
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