18 and Under When Child Was Born for Mothers, 25 and Under When Child Was Born for Fathers, Adolescents
Conditions
Brief summary
1\. Specific Aims 1. To evaluate the effects of life skills/parenting groups that are embedded within a comprehensive multidisciplinary clinic for adolescent parents (the Young Parents Program), using a randomized control design. Specifically, the effect of group participation on the following adolescent parent outcomes will be investigated: * Parenting attitudes and skills including empathy, non-violent discipline, role appropriateness and developmentally appropriate expectations. * Skills of daily living, social relationships, and work/study at follow-up, as measured by the Ansell-Casey Life Skills Assessment Scale. * Depression and perceived social support using the CESD-C and Duke Social Support scale. * Repeat pregnancy rates at 12 and 24 months after first delivery. 2. To evaluate the overall Young Parents Program service delivery as required by the Office of Adolescent Pregnancy Programs (project funder) using a cross cutting evaluation of health services utilization, social needs and work/educational outcomes.
Detailed description
The Young Parents Program (YPP), a specialty clinic within Children's Hospital Primary Care Center, provides comprehensive medical care, mental health services, and advocacy to high risk, urban teen parents and their young children through a teen-tot model. YPP serves 152 teenage mothers and their babies annually with a multi-disciplinary team knowledgeable in the medical, social, and developmental issues of adolescence and early childhood. Project Connect is an evaluation of both the medical and social services provided by YPP and a randomized controlled trial of an intensive educational arm of YPP. YPP serves the population that economically, ethnically, and geographically represents the highest rates of subsequent pregnancies and the greatest risk for poor birth outcomes. The staff of physicians, nurse practitioners, social workers, and nurse consists of experienced professionals work with parents, adolescents, and children. YPP has cooperative relationships with Boston area education and job training sites, Early Intervention Programs, the Massachusetts Department of Revenue, community agencies, mental health services, and teen living programs. By providing an integrated family based comprehensive medical home and a randomized controlled trial of intensive parenting/life skills training, Project Connect enhances teen parents' connections to child, family, peers, partners, medical care, and mental health. Medical care, home visiting, child/adolescent health services, mental health, and fathers' programming are all linked into a continuous program. Goals of the intensive intervention are to enhance parenting and life skills, help participants optimize family interactions, and build self-efficacy. Project Connect brings together YPP at Boston Children's Hospital (BCH), Healthy Baby/Healthy Child (HB/HC) nurse home visiting program and Families First, a parenting education agency, to provide a state-of-the art model of care for parenting teens in Boston. The model builds on lessons learned and strengths of each program, adding critical new elements of randomized control trial of parenting/life skills modules, and home visiting. Prenatal services will encourage breast-feeding, and support infant care and parenting. YPP provides a medical home with coordinated, continuous health care services, psychosocial support, parenting/life skills modules and individual services for teen mothers and fathers. Integrated fathers' services emphasize male parenting roles, communication, life skills training, violence prevention and positive youth development.
Interventions
BEHAVIORALParenting/Life Skills Intervention
Modules adapted from the Ansell-Casey Life Skills Assessment Curriculum, the Women's Negotiation Project Curriculum for Teen Mothers and the Nurturing Curriculum. Goal is to help teen mothers develop positive parenting skills, decrease repeat pregnancy and acquire skills of daily living. The series of five, one-hour long, structured, one-on-one interactive modules aims to help teens build positive, empathetic relationships with their children, while enhancing self-efficacy and increasing the sense of self- worth for parents and children. Domains addressed include child development/discipline, safety, house/money management, social relationships, career planning, substance abuse and community and interpersonal violence.
OTHERTeen-tot medical home
Medical, mental health, and social services provided to teen parents and their children
Sponsors
Department of Health and Human Services
Boston Children's Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
13 Years to 25 Years
Healthy volunteers
Yes
Inclusion criteria
* Must be able to speak and read in English * Mothers must be 18 or under when baby is born * Fathers must be 25 or under when baby is born * Child must be seen in YPP * Willing to complete computer surveys 6 times over 36 months * Ability to complete computer assisted data collection
Exclusion criteria
* If parent does not have custody of children * If children are no longer receiving care at YPP
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Rapid Repeat Pregnancy | 12 months follow-up | Number and percent with any repeat pregnancy by each follow-up time point. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Maternal Parenting Self-esteem Total Score | 12-month follow-up | Total score from the widely used Maternal Self-Report Inventory (MSRI) (Shea E & Tronick EZ, 1988). The measure is comprised of 26 items with response items completely false, mainly false, uncertain or neither true or false, mainly true, and completely true. The item response scale ranged from 1-5, with higher scores indicating higher maternal self-esteem. The total score is a sum of all items, thus the minimum/maximum possible scores are 26-130. Higher scores indicate higher maternal self-esteem. |
| Parenting Profile - Parent-Child Role Responsibilities | 12-month follow-up | Subscale sten score from the 40-item Adult-Adolescent Parenting Inventory-2 (Bavolek SJ & Keene RG). Min/max score range = 1-10. Higher scores indicate better parenting and lower risk for child maltreatment. |
| Life Skills Score | 12-month follow-up | Total raw score on Ansell-Casey Life Skills (ACLS) Assessment assessing skills of daily living, communication, and relationships. Min/max score range = 37-111. Higher scores indicate higher life skills. |
| Depressive Symptoms Score | 12-month follow-up | Total score on the 20-item Centers for Epidemiologic Studies Depression Scale for Children (CES-DC). Min/max score range = 0-60. Higher scores indicate higher depressive symptoms. Scores over 15 indicate significant level of depressive symptoms. |
Countries
United States
Participant flow
Recruitment details
The study was conducted in a teen-tot program (Young Parents Program) within a pediatric hospital. Eligibility criteria included maternal age \<19 years at delivery and infant age \<12 months old. At the first infant visit, every patient seen was asked to enroll in the study by trained program staff. assignment.
Pre-assignment details
Of 152 eligible patients who received care in the Young Parents Program who were invited to participate in the randomized trial, 12 declined to participate and were never enrolled into the study, but continued to receive care in the program.
Participants by arm
| Arm | Count |
|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules Patient takes part in modules that were developed using the Ansell-Casey Life Skills Assessment Curriculum and The Women's Negotiation Project Curriculum for Teen Mothers. The Nurturing Curriculum has been shown in our past program to be associated with increased parenting skills, maternal self-esteem and decreased life hassles. This curriculum is integrated with the Ansell-Casey life skills Curriculum and The Women's Negotiation Project Curriculum to help teen mothers develop the skills and communication needs of daily living. The series of five, one-hour long, structured, one-on-one interactive modules aims to help teens build positive, empathetic relationships with their children, while enhancing self-efficacy and increasing the sense of self- worth for parents and children. Domains addressed include child development/discipline, safety, house/money management, social relationships, career planning, substance abuse and community and interpersonal violence. | 72 |
| Young Parents Program Usual Care Those in the control group receive the YPP standard of care including comprehensive multi-disciplinary team medical and mental health support and toddler educational family forums during year 2. No intervention. | 68 |
| Total | 140 |
Baseline characteristics
| Characteristic | Young Parents Program Plus Parenting/Life Skills Modules | Young Parents Program Usual Care | Total |
|---|---|---|---|
| Age, Continuous | 17.4 years STANDARD_DEVIATION 1 | 17.3 years STANDARD_DEVIATION 1.2 | 17.3 years STANDARD_DEVIATION 1.1 |
| Race/Ethnicity, Customized Black non-Hispanic | 28 participants | 18 participants | 46 participants |
| Race/Ethnicity, Customized Hispanic/Latina | 39 participants | 44 participants | 83 participants |
| Race/Ethnicity, Customized Not reported | 2 participants | 0 participants | 2 participants |
| Race/Ethnicity, Customized Other non-Hispanic | 3 participants | 6 participants | 9 participants |
| Sex: Female, Male Female | 72 Participants | 68 Participants | 140 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 12 | 0 / 72 | 0 / 68 |
| other Total, other adverse events | 0 / 12 | 0 / 72 | 0 / 68 |
| serious Total, serious adverse events | 0 / 12 | 0 / 72 | 0 / 68 |
Outcome results
Primary
Rapid Repeat Pregnancy
Number and percent with any repeat pregnancy by each follow-up time point.
Time frame: 12 months follow-up
Population: Participants with pregnancy data available at 12 months follow-up
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Rapid Repeat Pregnancy | 8 Participants |
| Young Parents Program Usual Care | Rapid Repeat Pregnancy | 16 Participants |
Comparison: Multiple logistic regression modeling used to compute adjusted odds ratios for 12-month follow-up data.p-value: 0.03795% CI: [0.07, 0.92]Regression, Logistic
Primary
Rapid Repeat Pregnancy
Number and percent with any repeat pregnancy by each follow-up time point.
Time frame: 24 months follow-up
Population: Participants with pregnancy data available at 24 months follow-up
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Rapid Repeat Pregnancy | 17 Participants |
| Young Parents Program Usual Care | Rapid Repeat Pregnancy | 24 Participants |
p-value: 0.02995% CI: [0.07, 0.86]Regression, Logistic
Primary
Rapid Repeat Pregnancy
Number and percent with any repeat pregnancy by each follow-up time point.
Time frame: 36 months follow-up
Population: Participants with pregnancy data available at 36 months follow-up
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Rapid Repeat Pregnancy | 22 Participants |
| Young Parents Program Usual Care | Rapid Repeat Pregnancy | 32 Participants |
p-value: 0.01795% CI: [0.06, 0.75]Regression, Logistic
Secondary
Depressive Symptoms Score
Total score on the 20-item Centers for Epidemiologic Studies Depression Scale for Children (CES-DC). Min/max score range = 0-60. Higher scores indicate higher depressive symptoms. Scores over 15 indicate significant level of depressive symptoms.
Time frame: 36-month follow-up
Population: Number that completed the CES-DC at 36-months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Depressive Symptoms Score | 16.4 score on a scale | Standard Error 1.4 |
| Young Parents Program Usual Care | Depressive Symptoms Score | 17.0 score on a scale | Standard Error 1.7 |
p-value: 0.591Mixed Models Analysis
Secondary
Depressive Symptoms Score
Total score on the 20-item Centers for Epidemiologic Studies Depression Scale for Children (CES-DC). Min/max score range = 0-60. Higher scores indicate higher depressive symptoms. Scores over 15 indicate significant level of depressive symptoms.
Time frame: 12-month follow-up
Population: Number that completed the CES-DC at 12-months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Depressive Symptoms Score | 21.2 score on a scale | Standard Error 1.9 |
| Young Parents Program Usual Care | Depressive Symptoms Score | 17.6 score on a scale | Standard Error 1.7 |
p-value: 0.803Mixed Models Analysis
Secondary
Depressive Symptoms Score
Total score on the 20-item Centers for Epidemiologic Studies Depression Scale for Children (CES-DC). Min/max score range = 0-60. Higher scores indicate higher depressive symptoms. Scores over 15 indicate significant level of depressive symptoms.
Time frame: 24-month follow-up
Population: Number that completed the CES-DC at 24-months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Depressive Symptoms Score | 18.0 score on a scale | Standard Error 1.6 |
| Young Parents Program Usual Care | Depressive Symptoms Score | 14.5 score on a scale | Standard Error 1.2 |
p-value: 0.347Mixed Models Analysis
Secondary
Life Skills Score
Total raw score on Ansell-Casey Life Skills (ACLS) Assessment assessing skills of daily living, communication, and relationships. Min/max score range = 37-111. Higher scores indicate higher life skills.
Time frame: 12-month follow-up
Population: Number that completed the ACLS at 12-months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Life Skills Score | 83.0 score on a scale | Standard Error 2 |
| Young Parents Program Usual Care | Life Skills Score | 81.4 score on a scale | Standard Error 2.5 |
p-value: 0.354Mixed Models Analysis
Secondary
Life Skills Score
Total raw score on Ansell-Casey Life Skills (ACLS) Assessment assessing skills of daily living, communication, and relationships. Min/max score range = 37-111. Higher scores indicate higher life skills.
Time frame: 36-month follow-up
Population: Number that completed the ACLS at 36-months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Life Skills Score | 90.6 score on a scale | Standard Error 2.1 |
| Young Parents Program Usual Care | Life Skills Score | 87.5 score on a scale | Standard Error 2.7 |
p-value: 0.205Mixed Models Analysis
Secondary
Life Skills Score
Total raw score on Ansell-Casey Life Skills (ACLS) Assessment assessing skills of daily living, communication, and relationships. Min/max score range = 37-111. Higher scores indicate higher life skills.
Time frame: 24-month follow-up
Population: Number that completed the ACLS at 24-months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Life Skills Score | 87.0 score on a scale | Standard Error 2.2 |
| Young Parents Program Usual Care | Life Skills Score | 83.4 score on a scale | Standard Error 2.3 |
p-value: 0.121Mixed Models Analysis
Secondary
Maternal Parenting Self-esteem Total Score
Total score from the widely used Maternal Self-Report Inventory (MSRI) (Shea E & Tronick EZ, 1988). The measure is comprised of 26 items with response items completely false, mainly false, uncertain or neither true or false, mainly true, and completely true. The item response scale ranged from 1-5, with higher scores indicating higher maternal self-esteem. The total score is a sum of all items, thus the minimum/maximum possible scores are 26-130. Higher scores indicate higher maternal self-esteem.
Time frame: 36-month follow-up
Population: Number that completed the MSRI at 36 months follow-up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Maternal Parenting Self-esteem Total Score | 108.5 score on a scale | Standard Error 2.6 |
| Young Parents Program Usual Care | Maternal Parenting Self-esteem Total Score | 99.4 score on a scale | Standard Error 3.1 |
p-value: 0.011Mixed Models Analysis
Secondary
Maternal Parenting Self-esteem Total Score
Total score from the widely used Maternal Self-Report Inventory (MSRI) (Shea E & Tronick EZ, 1988). The measure is comprised of 26 items with response items completely false, mainly false, uncertain or neither true or false, mainly true, and completely true. The item response scale ranged from 1-5, with higher scores indicating higher maternal self-esteem. The total score is a sum of all items, thus the minimum/maximum possible scores are 26-130. Higher scores indicate higher maternal self-esteem.
Time frame: 12-month follow-up
Population: Number that completed the MSRI at 12 months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Maternal Parenting Self-esteem Total Score | 116.2 score on a scale | Standard Error 1.8 |
| Young Parents Program Usual Care | Maternal Parenting Self-esteem Total Score | 112.8 score on a scale | Standard Error 1.7 |
p-value: 0.217Mixed Models Analysis
Secondary
Maternal Parenting Self-esteem Total Score
Total score from the widely used Maternal Self-Report Inventory (MSRI) (Shea E & Tronick EZ, 1988). The measure is comprised of 26 items with response items completely false, mainly false, uncertain or neither true or false, mainly true, and completely true. The item response scale ranged from 1-5, with higher scores indicating higher maternal self-esteem. The total score is a sum of all items, thus the minimum/maximum possible scores are 26-130. Higher scores indicate higher maternal self-esteem.
Time frame: 24-month follow-up
Population: Number that completed the MSRI at 24 months follow-up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Maternal Parenting Self-esteem Total Score | 112.8 score on a scale | Standard Error 1.9 |
| Young Parents Program Usual Care | Maternal Parenting Self-esteem Total Score | 110.4 score on a scale | Standard Error 2.4 |
p-value: 0.444Mixed Models Analysis
Secondary
Parenting Profile - Parent-Child Role Responsibilities
Subscale sten score from the 40-item Adult-Adolescent Parenting Inventory-2 (Bavolek SJ & Keene RG). Min/max score range = 1-10. Higher scores indicate better parenting and lower risk for child maltreatment.
Time frame: 12-month follow-up
Population: Number that completed the AAPI-2 at 12-months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Parenting Profile - Parent-Child Role Responsibilities | 5.9 score on a scale | Standard Error 0.4 |
| Young Parents Program Usual Care | Parenting Profile - Parent-Child Role Responsibilities | 5.6 score on a scale | Standard Error 0.3 |
Secondary
Parenting Profile - Parent-Child Role Responsibilities
Subscale sten score from the 40-item Adult-Adolescent Parenting Inventory-2 (Bavolek SJ & Keene RG). Min/max score range = 1-10. Higher scores indicate better parenting and lower risk for child maltreatment.
Time frame: 36-month follow-up
Population: Number that completed the AAPI-2 at 36-months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Parenting Profile - Parent-Child Role Responsibilities | 5.1 score on a scale | Standard Error 0.3 |
| Young Parents Program Usual Care | Parenting Profile - Parent-Child Role Responsibilities | 3.7 score on a scale | Standard Error 0.4 |
p-value: 0.024Mixed Models Analysis
Secondary
Parenting Profile - Parent-Child Role Responsibilities
Subscale sten score from the 40-item Adult-Adolescent Parenting Inventory-2 (Bavolek SJ & Keene RG). Min/max score range = 1-10. Higher scores indicate better parenting and lower risk for child maltreatment.
Time frame: 24-month follow-up
Population: Number that completed the AAPI-2 at 24-months follow-up.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Young Parents Program Plus Parenting/Life Skills Modules | Parenting Profile - Parent-Child Role Responsibilities | 5.4 score on a scale | Standard Error 0.4 |
| Young Parents Program Usual Care | Parenting Profile - Parent-Child Role Responsibilities | 4.8 score on a scale | Standard Error 0.4 |
p-value: 0.758Mixed Models Analysis