MVNA Minneapolis Teen Parent Program

Transcription

1 MVNA Minneapolis Teen Parent Program A multi-year evaluation of program outreach, participant engagement, and outcomes for teen mothers and their babies M A R C H

2 MVNA Minneapolis Teen Parent Program A multi-year evaluation of program outreach, participant engagement, and outcomes for teen mothers and their babies March 2011 Prepared by: Jennifer Valorose and Richard Chase Wilder Research 451 Lexington Parkway North Saint Paul, Minnesota

3 Contents Summary and implications... 1 Background Evaluation methods Findings Program outreach Program engagement Program outcomes MVNA Teen Parent Program Wilder Research, March 2011

4 Figures 1. MVNA Minneapolis teen parent connection Characteristics of Minneapolis teen giving birth, by MVNA involvement MVNA program participation, January 2008 July Characteristics of Minneapolis teen births, January 2008 July Demographic characteristics of MVNA teens joining January 2008 to July 2010, by time of first visit Reasons for inactive status for clients with a first visit January 2008 to July Profile of MVNA teens by active status Visits received by pregnant and parenting teens Service duration (for inactive families) Age of baby at time of exit (or currently, for teens who are still involved) Referrals provided to clients with a first visit January 2008 to June Teens responses to trust, feedback on program, and perceived impacts Birth outcomes of Minneapolis teens giving birth from January 2008 to July 2010 by time of first MVNA home visit Birth outcomes of MVNA teens by number of prenatal MVNA visits Children s developmental progress by skill area (ASQ and ASQ:SE) Children s immunization, well-child check-ups and growth patterns Positive parenting (HOME scores) Legal system involvement Prenatal care of Minneapolis teens giving birth from January 2008 to July 2010 by cohort Health care status of mothers and babies Housing and employment status Education status School year progress of MVNA teens enrolled in MPS, Educational status at the end of the school year School attendance of teens giving birth in Minneapolis Teens with a second birth between January 2008 and July MVNA Teen Parent Program Wilder Research, March 2011

5 Acknowledgments We want to thank the Minnesota Visiting Nurse Agency staff for their help in developing the evaluation plan and tracking systems, and collecting the data for program evaluation. Thank you to the MVNA Public Health home visiting nurses who balanced the demands of clinical practice with the need for data collection. We also thank the Minneapolis Department of Health and Family Support who provided financial support for the external evaluation. We also wish to thank the following partner organizations for providing comparative data: Minnesota Center for Health Statistics; The Minn-LInK project at the Center for Advanced Studies in Child Welfare at the University of Minnesota School of Social Work; The Healthy Youth Development Prevention Research Center at the University of Minnesota; and Minneapolis Public Schools. Finally, thanks to all the Wilder Research staff whose efforts contributed to this report. MVNA Teen Parent Program Wilder Research, March 2011

6 Summary and implications The Minnesota Visiting Nurse Agency (MVNA) Teen Parent program provides public health nurse home visits to low-income pregnant and parenting teens in Minneapolis. The program goals are: babies have healthy births and optimal growth and development, and teen parents demonstrate positive parenting and increase their economic selfsufficiency. This report is an evaluation of the program s impact for Minneapolis teens and their babies served from January 2008 to July In 2008, the City of Minneapolis challenged MVNA s Teen Parent Program to serve all its pregnant and parenting teens (age 19 and younger). The program aims to reach teens before the third trimester (28 weeks). The program provides nursing care to pregnant and parenting teens and their babies in Minneapolis and greater Hennepin County through outreach and coordination with school support teams; public health nurse visits, the MELD and Promoting Maternal Mental Health Curricula, and Club 100 that provides supplies that support child and family development based on the needs of the family. Program outreach Births to Minneapolis teens From January 1, 2008, to July 23, 2010, there were 1,318 births to 1,253 Minneapolis teens. The teens are nearly age 18, on average. The largest proportion (44%) is African American, and a quarter (24%) is Hispanic. A quarter (23%) is foreign-born. 82 percent of the teens are first-time mothers. Outreach and referrals to MVNA MVNA reaches teens through referrals from such agencies as: hospitals, social assistance programs, local high schools, and community clinics. From April 2008 to June 2010: 1,296 pregnant and parenting teens were referred to the program. MVNA attempted to locate and contact all referred teens. 766 (59%) of these teens accepted a visit from an MVNA nurse. 33% did not receive a visit because they were unable to be reached. MVNA Teen Parent Program 1 Wilder Research, March 2011

7 Profile of parenting teens visited and not visited The MVNA Teen Parent program strives to reach all pregnant teens in Minneapolis before their 3 rd trimester (28 weeks). Of the 1,253 Minneapolis teens giving birth during this time period, 968 (77%) were referred to MVNA for services. About 4 out of 5 (78%) teens receiving a referral for MVNA services were served. With regard to serving all teens giving birth in Minneapolis, MVNA served 61 percent overall. Sixty-three percent started receiving visits from an MVNA nurse after 28 weeks of pregnancy. 1. MVNA Minneapolis teen parent connection * Some women may have been referred or accepted a visit after the study concluded. Compared to all teens giving birth in Minneapolis, MVNA teens are somewhat more likely to be: younger (average age 17.5), unmarried, first-time mothers, have less than 12 years of education, and Hispanic, and/or foreign-born. MVNA Teen Parent Program 2 Wilder Research, March 2011

8 2. Characteristics of Minneapolis teen giving birth, by MVNA involvement Unmarried First time mother 95% 93% 92% 86% 80% 76% Less than 12 years of education 37% 49% 63% Foreign-born Homeless 26% 16% 20% 15% 16% 4% MVNA teens Referred teens Unknown teens African/ African American 44% 51% 36% Hispanic 17% 17% 29% Asian American Indian White Multiple 8% 8% 9% 7% 7% 13% 7% 9% 17% 5% 6% 8% MVNA Teen Parent Program 3 Wilder Research, March 2011

9 Program engagement Acceptance From January 2008 to July 2010, the program served 954 teens. Half (50%) were 18 or 19; 14 percent were years old. The largest proportion (45%) is African American, though a quarter (27%) is Hispanic. A large majority (83%) speak English as their primary home language, though Spanish was the primary language for 13 percent. Almost two-thirds (64%) of the MVNA teens started receiving home visits during their pregnancy. These teens were younger (16.7 compared to 17.8 years of age), and more likely to speak English as their primary home language, be African American and less likely to be Latina/Hispanic than teens who received home visits starting after their pregnancy. Additional visits and reasons for inactive status As of August 5, 2010, 326 of the 954 teens (34%) who had enrolled were still active clients. Of the inactive cases, 80 percent either refused or were unable to be located for additional visits. Active teens were slightly younger, and more likely to be Hispanic. Inactive teens were more likely to be American Indian or White. 54 percent of active teens received Club 100 materials. Through July 2010, active teen had received 16 visits, on average. In comparison, inactive teens had 5 to 7 visits, and were no longer being seen by the time their babies were seven and half months old and after 5 to 7 visits. 45 percent of inactive teens participated for less than 6 months, which is comparable to other metro area home visiting programs during the same time period. MVNA Teen Parent Program 4 Wilder Research, March 2011

10 3. MVNA program participation, January 2008 July 2010 Note: Based on participants status as of August 5, Connection to resources Twelve percent were already involved with a community resource. Sixty-nine percent of teens received referrals to community resources, with referrals to WIC, basic needs or other social services being the most common. Club 100 materials were distributed to 458 families (47%). Teen trust and satisfaction Those teens completing feedback questionnaires (approximately 18%) indicated a high level of trust with their nurse, had positive feedback on the program, and indicated the program had positive impacts on their lives. More than 90 percent of teens reported frequently enjoying spending time with her nurse, and considering her nurse s point of view. More than 90 percent of teens gave positive feedback about the program and their nurses in all aspects of the program. More than 90 percent agreed the program improved their parenting skills. MVNA Teen Parent Program 5 Wilder Research, March 2011

11 Three out of four teens (76%) agreed the program helped them succeed in school. Nine out of 10 teens (92%) would recommend the program to others. Program outcomes Healthy births Based on birth record data obtained for all teens giving birth in Minneapolis, teens who are involved with MVNA have better birth outcomes, especially those who have six or more prenatal visits from an MVNA nurse. 96 percent of teens who had 6 or more MVNA visits prenatally had babies with a healthy birth weight (compared to 93% of all MVNA teens, and 91% of all Minneapolis teen births), and 95 percent of teens who had 6 or more MVNA visits prenatally carried their babies to full term (compared to 93% of all MVNA teens, and 90% of all Minneapolis teen births). 76 percent of MVAN teens who started receiving home visits during their first or second trimester received adequate or better prenatal care (compared to 68 percent of all teens giving birth in Minneapolis). Optimal child growth and development Almost all babies (92% and over) born to MVNA teens demonstrated age-appropriate behaviors on their initial ASQ and ASQ:SE assessments. According to the ASQ, 17 percent of babies required follow-up in one or more developmental area, and 8 percent indicated a need for follow-up on social-emotional development based on the ASQ:SE. Of the few who were not at their developmental age initially, several have already improved (two to nine babies, depending on the skill area). Almost all (96-99%) were up-to-date on their immunizations and well-child check-ups within 30 days of birth; rates were also very high (95-97%) at follow-up (60 or more days later). Positive parenting Teens are providing care for their children and not involved with child protection, but do have some room for improvement in the areas of supportive home environment and bonding with their babies. MVNA Teen Parent Program 6 Wilder Research, March 2011

12 57 percent were maintaining a supportive home environment as observed by MVNA staff using the HOME Inventory, of which about a fifth (17%) had improved. 63 percent were demonstrating responsiveness to their baby as observed by MVNA staff using the HOME Inventory; 12 percent had improved. 11 percent of Minneapolis teen mothers had an accepted report of child maltreatment concerns and a subsequent service case opening (this did not necessarily result in a determination that child maltreatment occurred). This did not vary by whether the teen was involved with MVNA. Family self-sufficiency The program s impact on teens longer-term self-sufficiency varies by measure. 9 out of 10 mothers and babies (89-99%) had health insurance and a primary care provider at the most recent follow-up. 80 percent of families are not using the ER for non-emergency care. 74 percent of teens indicate they have very stable housing; though 17 percent improved their housing, a similar proportion had less stable housing at the most recent follow-up. 3-5 percent of Minneapolis teens had two or more births between January 2008 and July 2010, which did not differ significantly among MVNA teens and non-mvna teens. Education Among all Minneapolis teens giving birth, over 60 percent of MVNA teens were enrolled at the end of the school year compared to less than half of the teens not involved with MVNA. Among MVNA teens enrolled in Minneapolis Public Schools, 10 percent had regular attendance during the school year (attended 85% or more of enrolled days). Teens with more involvement with MVNA (10 or more visits) are more likely to have graduated or be continuing in Minneapolis Public Schools than those with less than 10 MVNA visits (77% vs. 56%). 6 MVNA teens (5%) self-reported receiving their diploma while in the program. MVNA Teen Parent Program 7 Wilder Research, March 2011

13 Though only about a third of parenting teens in Minneapolis attend school regularly, more MVNA teens attend school at least half of enrolled days compared to parenting teens that are not known to MVNA (81-91% vs. 61%). Implications and recommendations MVNA has been moderately successful in reaching the City s bold goal of serving all pregnant and parenting teens in Minneapolis. MVNA is reaching very high-risk teen mothers, many of them under age 18, lacking a high school education, and living in poverty. Moreover, MVNA is serving many teens who would be left un-served by other home visiting programs who restrict their services to first-time mothers in their first or second trimester of pregnancy. When MVNA reaches teens early in their pregnancies, MVNA achieves promising outcomes with regard to prenatal care use and healthy births. Through its nursing visits, referrals to other types of needed services, and Club 100 resources, MVNA also achieves promising initial results with regard to basic needs being met, access to health care, wellbaby visits, and newborn/infant health and development. MVNA has room to improve in its goals related to educational outcomes for the teens and their children, which require teens to stay engaged until they graduate high school or the equivalent or their babies reach age 2. About half of teens (45%) left after 6 months in the program when their children were less than a year old, primarily due to MVNA losing contact with these highly mobile families. Other home visiting programs have similar struggles; for example, according to participation data from Metro Alliance for Healthy Families in 2008 and 2009, 41 percent of teens became inactive within the first six months. MVNA currently works to build connections with highly mobile teens by using multiple modes of communication, including calling, texting, door-knocking, and leaving notes. MVNA may consider providing cell phones or minutes to teens through Club 100 to help teens stay connected. MVNA may also consider building on existing partnerships with Hennepin County Medical Center to encourage pediatricians to re-refer teens when they are seen for well-baby visits. Finally, MVNA may also wish to encourage Hennepin County to assist with locating teens through the County s MAXIS database or A-GRAD program. For MVNA to fully achieve its two-generation self-sufficiency goals, MVNA may consider encouraging Hennepin County to develop a model similar to that being used in Ramsey County, which offers the teen mothers incentives to stay in school as well as having the authority to sanction them for not complying with their MFIP educational requirements. MVNA Teen Parent Program 8 Wilder Research, March 2011

14 This evaluation of the MVNA Teen Parent program demonstrates that having a Public Health nurse visit pregnant and parenting teens has positive short-term impacts on babies. While research indicates that the teens and babies are best served when visited through the child s second birthday, teens who engage for less than two years benefit from healthy births, healthy infant development, secure attachment, and positive home environments. As such, the MVNA Teen Parent program should continue providing intensive home visiting services during the pregnancy and postpartum periods. MVNA Teen Parent Program 9 Wilder Research, March 2011

15 Background The Minnesota Visiting Nurse Agency (MVNA) provides nursing care to pregnant teens and their babies prenatally through all stages of life. The Teen Parent program focuses on providing public health nurse home visits to low-income (incomes below 200% of poverty) pregnant and parenting teen moms (age 19 and younger) in Minneapolis and greater Hennepin County through four components: 1. Public health nurse visits, 2. Outreach and coordination with school support teams and other community partners, 3. The MELD and Promoting Maternal Mental Health Curricula, and 4. Club 100 that provides supplies that support child and family development based on the needs of the family. In 2008, the City of Minneapolis challenged MVNA s Teen Parent Program to serve all its pregnant and parenting teens (age 19 and younger), an estimated 500 per year. The program aims to reach teens before the third trimester (28 weeks), and serve teens through their child s second birthday. The program goals are: babies have healthy births and optimal growth and development, and teen parents demonstrate positive parenting and increase their economic self-sufficiency. This report is an evaluation of the program s impact for Minneapolis teens and their babies served from January 2008 to July Theory of change The program s theory of change assumes that: If the MVNA Teen Parent Program reaches and engages pregnant and parenting teens; public health nurses provide the teens health, mental health, and parenting education, and emotional and social support; Club 100 provides needed resources tailored to support child development and self-sufficiency; and the public health nurse and the teen develop a trusting and caring relationship then, as a result of program participation, pregnant and parenting teens will increase and improve their connection to community resources, parenting skills, and healthy choices and then, children and families will derive these outcomes: healthy births (of babies born to teens enrolled before third trimester) children demonstrating optimal growth and development positive parenting family economic self-sufficiency MVNA Teen Parent Program 10 Wilder Research, March 2011

16 And the program will achieve these community-level outcomes: teen mothers complete or make progress towards completing high school a reduction in the number and rate of subsequent births to teens in Minneapolis early identification of growth and development delays in children of teen parents and referrals to appropriate resources Ultimately, children will be prepared for kindergarten, demonstrating physical, cognitive, and social-emotional development and skills as expected for their age and ability. Evaluation methods This is organized in two parts: program outreach and engagement, and program outcomes. Data for both sections are collected using numerous tools from multiple sources. Data collected by MVNA nurses are entered into MVNA s e-record and sent to Wilder Research for analysis. MVNA nurses record information on the teen mother and her baby (and other children, if applicable) after each visit. In addition, the nurses administer the following standardized tools at regular intervals: Prenatal Risk Overview (PRO) and Postpartum Risk Overview (PPRO), the Infant Development Inventory (IDI), the Ages & Stages Questionnaires (ASQ) and Ages & Stages Questionnaires : Social-Emotional (ASQ:SE), and the Home Observation for Measurement of the Environment (HOME) Inventory (Bradley and Caldwell, 1988). MVNA also collects data from participating teens using a trusting relationship and satisfaction tool developed by Wilder Research, based on the Trusting Relationship Questionnaire. 1 MNVA nurses distributed the forms to teens at visits with postage paid mailing envelopes for them to mail to Wilder for processing after every 6 months in the program. A gift card drawing was offered during the second year to boost response rates. Education data were provided by Minneapolis Public Schools for pregnant and parenting teens being served by MVNA, and by Minn-LInK, which also provided child protection data, for teens giving birth from July 2008 to September Mustillo, S.A., Dorsey, S. and Farmer, E.M.Z. (2005). Quality of relationships between youth and community service providers: Reliability and validity of the Trusting Relationship Questionnaire. Journal of Child and Family Studies, 14, No. 4. pp The Minn-LInK project at the Center for Advanced Studies in Child Welfare at the University of Minnesota School of Social Work relies on secondary administrative data obtained from the Minnesota Department of Human Services, which oversees the state child protection system in Minnesota, and student public school education records from the Minnesota Department of Education. Data has been used within legal guidelines between these agencies to protect personal privacy. MVNA Teen Parent Program 11 Wilder Research, March 2011

17 Using birth data from the state on births to teens residing in Minneapolis at the time of the birth, Wilder Research compared participants engaged with MVNA, teens referred but were never visited, and teens who were not located by MVNA. Finally, MVNA maintains a referral tracking form documenting the number of pregnant and parenting teens referred by various organizations. MVNA Teen Parent Program 12 Wilder Research, March 2011

18 Findings Program outreach Outreach and referrals to MVNA MVNA receives referrals from many local agencies through two approaches. Some agencies provide lists of pregnant and parenting teens they serve, whom MVNA contacts to invite them to participate in their program. Other organizations ask their teens if they are interested in MVNA s Teen Parent Program, and only refers those teens who provide consent. All told, MVNA received 2,294 referrals from April 2008 through June 2010, for 1,296 pregnant and parenting teens. In many cases, teens were referred multiple times by different agencies. Eighty percent of the referrals came from the following 12 agencies: Women Infants and Children (WIC) program Hennepin County Medical Center Hospital Broadway High School Minnesota s UCare health care plans Fairview University Hennepin County s 72-hour birth to minor report Minnesota Family Investment Program for 18 and 19 year olds North Point clinic Hennepin County Medical Center s Ob/Gyn and Nurse Midwife clinics Abbott Northwestern Hospital Henry High School Hennepin County Medical Center s Family Medical Center clinics MVNA Teen Parent Program 13 Wilder Research, March 2011

19 Connecting with teens and reasons for not connecting Of the 1,296 teens referred from April 2008 through June MVNA attempted to locate and contact all referred teens. As of June 30,2010, 766 (59%) received one or more visit(s) with a nurse. The others were not served by MVNA for the following reasons: The teen was unable to be reached (33%). The teen refused services either permanently or until the birth of her baby (6%). Other reasons (3%). Profile of parenting teens visited and not visited From January 1, 2008, to July 23, 2010, there were 1,318 births to 1,253 Minneapolis teens 3 (based on mother s place of residence at the time of the birth). 968 (77%) were referred to MVNA for services for their first birth (one additional teen who was not referred for her first birth, was referred for her second). 758 (78%) of those referred to MVNA had at least one MVNA visit either during their pregnancy or after they delivered for their first birth (three additional teens were not seen for their first birth but were for their second births). MVNA public health nurses visits 61 percent of Minneapolis teens giving birth during this study period. MVNA is successful at reaching teens from all cross sections of the population of pregnant and parenting teens; the characteristics of these teens does vary somewhat from other pregnant and parenting teens in Minneapolis (see Figure 4). Teens accepting visits were more likely to be Hispanic and/or foreign-born; and first-time mothers. MVNA teens were also less likely to be married, have 12 or more years of education and/or graduated from high school, and use tobacco. The average age for teens accepting visits was slightly younger (17.5) than those referred or unknown to MVNA (18). Teens referred to MVNA that did not accept a visit were more likely to be African/African American. They were less likely to be foreign-born, first time mothers, and Hispanic. Teens who were not known to MVNA were more likely to be married, have 12 or more years of education and/or graduated from high school, and tobacco users. They were less 3 There were 14 sets of twins (28 births), and 51 subsequent births to teens. MVNA Teen Parent Program 14 Wilder Research, March 2011

20 likely to be African/African American, Hispanic, and more likely to be white or American Indian. MVNA is having the most success at reaching younger teens who are first time mothers with less than 12 years of education. MVNA is also successful at engaging teens of color, and/or foreign-born teens. Teens who are unknown to MVNA are more likely to be older teens, have graduated from high school, having a second or third child, and white or American Indian. About 4 out of 5 (78%) teens receiving a referral for MVNA services were served. With regard to serving all teens giving birth in Minneapolis, MVNA served 61 percent overall. Sixty-three percent started receiving visits from an MVNA nurse after 28 weeks of pregnancy. In addition, rates of referrals and enrollment increased over time. Sixty percent of Minneapolis teens giving birth in 2008 received visits by an MVNA nurse, and a third where unknown to MVNA; whereas 63 percent of those giving birth in 2010 enrolled, and only 12 percent were unknown to MVNA. 4. Characteristics of Minneapolis teen births, January 2008 July 2010 (based on time of first birth) a MVNA Teens Referred, no visit Unknown to MVNA All teens Characteristic (birth records) ,190-1,253 Marital status married 5% 7% 8% 6% Average age at birth (mean) Education (12 or more years of education) 37% 51% 62% 45% Tobacco use 9% 12% 15% 11% Drug use 4% 7% 5% 5% First-time mother (delivered first child) 86% 80% 76% 82% Foreign-born 26% 16% 20% 23% Race (birth records) African/African American 44% 51% 36% 44% Hispanic 29% 17% 17% 24% White 7% 9% 17% 9% American Indian 7% 7% 13% 8% Asian 8% 8% 9% 8% Multiple races 5% 6% 8% 6% MVNA Teen Parent Program 15 Wilder Research, March 2011

21 4. Characteristics of Minneapolis teen births, January 2008 July 2010 (based on time of first birth) a (continued) MVNA Teens Referred, no visit Unknown to MVNA All teens Other demographics b Graduated prior to birth 5% 10% 17% 9% Eligible for free and reduced lunch 83% 89% 74% 82% Homeless 15% 16% 4% 13% a Referred, no visit does not include teens who were referred prior to April 2008 when MVNA started tracking referrals. Sample sizes vary because some data in the birth records were missing. Teens with 12 or more years of education do not necessarily have diplomas or GED s. These data are not intended to measure outcomes, but to describe differences between teens who accept MVNA visits and those who do not. First-time mother does not include teens who gave birth previously but is not parenting that child. prior to January Race data were not reported as part of birth records in early b These demographic data are from Minnesota Department of Education and represent teens giving birth January 2008 through September 2009 who attended Minnesota public schools during school years to The schools use the McKinney Act (P.L , sec 103(2)(1)) definition of homeless: An individual who (1) lacks a fixed, regular, and adequate nighttime residence and (2) has a primary nighttime residence that is (a) a supervised, publicly or privately operated shelter designed to provide temporary living accommodations (including welfare hotels, congregate shelters, and transitional housing for the mentally ill), (b) an institution that provides a temporary residence for individuals intended to be institutionalized, or (c) a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings. Program engagement Acceptance Between January 2008 and July 2010, the MVNA Teen Parent program served 954 teens, 4 and 769 babies who were born during that time period. 5 Almost two-thirds (64%) of the teens started receiving visits from an MVNA nurse prenatally. Data on the characteristics of clients are in Figure 5. Half were 18 or 19, while 14 percent were years old. The largest proportion (45%) is African American, though a quarter (27%) is Hispanic. A large majority (83%) speak English as their primary home language, though Spanish was the primary language for 13 percent. Compared to teens who were first seen after their babies were born, the teens who had a first visits prenatally were younger (16.7 compared to 17.8 years of age), and more likely 4 5 Most joined Jan 1, 2008 or later, though a few were served in late A majority of the other 185 teens either had not yet given birth; a few dropped out before giving birth. MVNA Teen Parent Program 16 Wilder Research, March 2011