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Enhancing a Home Visiting Program to Address Repeat Adolescent Pregnancy: The Longer-Term Impacts of Steps to Success

October 24, 2019
Topics:
Youth Services, Home Visiting
Projects:
Personal Responsibility Education Program (PREP) Multi-Component Evaluation, 2011-2018 | Learn more about this project
Types:
Reports
Enhancing a Home Visiting Program to Address Repeat Adolescent Pregnancy: The Longer-Term Impacts of Steps to Success Cover
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  • File Size 2mb
  • Pages 64
  • Published 2019

Introduction

This report presents evidence on the impacts of the Steps to Success home visiting program for adolescent mothers in San Angelo, Texas. Despite declines in adolescent pregnancy over the past three decades, many young women still have children before they turn 20 years old. Repeat pregnancies during adolescence can further compound the adverse outcomes associated with a teen birth. A small but growing body of evidence suggests that interventions for adolescent mothers can promote healthy birth spacing by providing a combination of individualized support services and improved access to effective contraception. To build on this promising research, the Administration for Children and Families within the U.S. Department of Health and Human Services funded a rigorous evaluation of Steps to Success in San Angelo, Texas. Using federal funding from the Personal Responsibility Education Program (PREP) Competitive Grant program, Healthy Families San Angelo (HFSA) developed Steps to Success by enhancing a traditional home visiting program. While the traditional home visiting program focused on child development and parenting, the enhanced program included additional program 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. To test the impacts of these enhancements, this study compares outcomes for a program group that received Steps to Success and a control group that received the traditional home visiting program.

Primary Research Questions

  1. 1 Compared with the traditional home visiting program, did Steps to Success promote healthy birth spacing?
  2. 2 Compared with the traditional home visiting program, did Steps to Success increase fathers’ involvement with their children or mothers’ education and career aspirations?
  3. 3 Compared with the traditional home visiting program, was Steps to Success more or less successful at improving mothers’ parenting behavior?

Purpose

This report is the last in a series on the implementation and impacts of Steps to Success. It presents evidence on the program’s longer-term impacts relative to HFSA’s traditional home visiting program focused on parenting and child development. The report discusses outcomes measuring the use of contraception; repeat pregnancy; attitudes toward repeat pregnancy; knowledge of pregnancy prevention; co-parenting; fathers’ engagement with their children; and mothers’ school enrollment, career goals, and engagement with their children. The report also provides information on program costs and documents the study’s methods. Earlier reports presented evidence on the program’s shorter-term impacts and described the design and implementation of Steps to Success.

Key Findings and Highlights

  • After two years, mothers in the Steps to Success and traditional home visiting groups had similar rates of repeat pregnancy.
  • There is some evidence that Steps to Success improved other outcomes related to healthy birth spacing.
    • The evidence suggests that mothers in the Steps to Success group were more likely to use LARC methods than were mothers in the traditional home visiting group. This difference was driven by younger adolescent mothers (who were ages 14 to 18 at program enrollment).
    • For younger adolescent mothers, Steps to Success also decreased the incidence of unprotected sex.
  • There is no evidence that Steps to Success increased fathers’ involvement with their children at the time of the two-year follow-up survey.
  • After two years, mothers in the Steps to Success and the traditional home visiting groups had similar educational and career aspirations.
  • Mothers in the Steps to Success and the traditional home visiting groups gave similar reports of their own parenting behavior at the time of the two-year follow-up survey.

Methods

The study team used a random assignment design to test the efficacy of Steps to Success compared to 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. Data from the two-year follow-up survey are the focus of this report.

Citation

Rotz, Dana, Menbere Shiferaw, and Robert G. Wood (2019). Enhancing a home visiting program to address repeat adolescent pregnancy: The longer-term impacts of Steps to Success, OPRE Report # 2019-96, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Glossary

HFSA
Healthy Families San Angelo
LARC
long-acting reversible contraceptive
PREP
Personal Responsibility Education Program
Last Reviewed: October 28, 2019