A Parenting and Life Skills Intervention for Teen Mothers: A Randomized Controlled Trial Joanne E. Cox, MD,a,b,c Sion Kim Harris, PhD,b,c Kathleen Conroy, MD, MS,a,c Talia Engelhart, MHS,a Anuradha Vyavaharkar, MSW, MPH,a Amy Federico, BSN,a Elizabeth R. Woods, MD, MPHb,c BACKGROUND: Teen mothers often present with depression, social complexity, and inadequate abstract parenting skills. Many have rapid repeat pregnancy, which increases risk for poor outcomes. We conducted a randomized controlled trial of a parenting and life skills intervention for teen mothers aimed at impacting parenting and reproductive outcomes. METHODS: Teen mothers were recruited from a teen-tot clinic with integrated medical care and social services. Participants were randomly assigned 1:1 to receive (1) teen-tot services plus 5 interactive parenting and life skills modules adapted from the Nurturing and Ansell-Casey Life Skills curricula, delivered by a nurse and social worker over the infant’s first 15 months or (2) teen-tot services alone. A computerized questionnaire was self-administered at intake, 12, 24, and 36 months. Outcomes included maternal self-esteem, parenting attitudes associated with child maltreatment risk, maternal depression, life skills, and repeat pregnancy over a 36-month follow-up. We used generalized linear mixed modeling and logistic regression to examine intervention effects. RESULTS: Of 152 invited, 140 (92%) participated (intervention = 72; control = 68). At 36 months, maternal self-esteem was higher in the intervention group compared with controls (P = .011), with higher scores on preparedness for mothering role (P = .011), acceptance of infant (P = .008), and expected relationship with infant (P = .029). Repeat pregnancy by 36 months was significantly lower for intervention versus control participants. CONCLUSIONS: A brief parenting and/or life skills intervention paired with medical care for teens and their children has positive effects on maternal self-esteem and repeat pregnancy over 36 months. ’ Divisions of aGeneral Pediatrics and bAdolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, WHAT S KNOWN ON THIS SUBJECT: Teen parents and their Massachusetts; and cDepartment of Pediatrics, Harvard Medical School, Harvard University, Boston, children face multiple medical and social challenges. Massachusetts Promising interventions include home visiting, school-based interventions, and medical homes. Intervention outcomes Dr Cox conceptualized and designed the study, participated in design of the data collection include optimal medical care delivery, decreased repeat instruments, supervised the implementation of the protocol, drafted the initial manuscript, and pregnancy, and improved parenting skills. reviewed and revised the manuscript; Dr Harris performed the data analysis and reviewed and revised the manuscript; Dr Conroy supervised data collection, critically reviewed the manuscript for WHAT THIS STUDY ADDS: Longitudinal outcomes for important intellectual content, and revised the manuscript; Ms Engelhart coordinated and interventions used to target teen mothers and their children supervised data collection and reviewed and revised the manuscript; Ms Vyavaharkar and Ms have not been extensively studied. Our findings suggest that Federico participated in study design and implementation and revised and reviewed the a teen-tot model plus an enhanced parenting and life skills manuscript; Dr Woods conceptualized and designed the study, supervised study implementation, intervention shows promise for improving parenting and reviewed and revised the manuscript; and all authors approved the final manuscript as attributes and reducing repeat pregnancy. submitted and agree to be accountable for all aspects of the work. This trial has been registered at www.clinicaltrials.gov (identifier NCT01379924). To cite: Cox JE, Harris SK, Conroy K, et al. A Parenting and Life Skills Intervention for Teen Mothers: A Randomized DOI: https://doi.org/10.1542/peds.2018-2303 Controlled Trial. Pediatrics. 2019;143(3):e20182303 Downloaded from www.aappublications.org/news by guest on September 24, 2021 PEDIATRICS Volume 143, number 3, March 2019:e20182303 ARTICLE Although the rates of teen pregnancy interventions include school- prenatal clinics and community-based have declined nationally over the last based16,17 or home-visiting agencies between February 2008 and – – 25 years, socioeconomic and racial programs18 20 and mentoring.21 23 February 2012. At the first infant disparities persist. Teen pregnancy Other successful interventions have visit, every patient seen was asked to and parenting remain a challenge in used the medical home or teen-tot enroll in the study by trained – communities with high rates of model.24 27 program staff. Those agreeing to poverty, low social capital, and participate (140 of 152; 92%) were The Adolescent Family Life (AFL) inadequate access to contraception randomly assigned by the research demonstration projects, organized and among certain racial and/or assistant to the parenting and/or life through the Office of Adolescent ethnic populations.1,2 Teen parenting skills intervention or control using Pregnancy Programs (OAPP), are is associated with risk of depression, a unique numeric identification aimed to support young families poor social supports, school failure, number and computerized random through social support and medical conflicted relationships, and – number generator to determine care.28 31 The AFL funding required inadequate family and community assignment. It was indicated in power – programs to deliver 10 core services, support.3 6 Women who were teen analysis that a sample of 48 including pregnancy testing, adoption parents complete less education participants in each arm had 80% counseling, preventive and prenatal and are more likely to live in power to detect a group difference in referrals for teens, nutritional poverty.4 Teens with children are mean Maternal Self-Report Inventory counseling, well infant care, sexually often unprepared for the stresses of (MSRI) total scores as found in our transmitted infection screening, raising young children; and those previous study.27 family life counseling, educational or with histories of social isolation, vocational services, mental health Teens received $10 plus violence, or other sources of toxic services, and referrals for family transportation for each intervention stress are more likely to parent planning. A multisite evaluation, visit and study assessment, which using harsh, authoritarian – which included our program, were completed in the clinic. The methods.7 10 Their children lag revealed increased use of long-acting majority of participants lived in the developmentally and are at risk for contraceptives, child care, and nearby neighborhoods where poor educational outcomes that 32 – decreased repeat pregnancy at 12 poverty reached 36%. All study persist into adolescence.6,11 13 months.30 However, there is a paucity participants attended the teen-tot Interventions for teen parents often of scientific studies examining longer- clinic, receiving preventive care, focus on decreasing both repeat term outcomes of these programs. urgent care, gynecologic services, pregnancy and negative parenting Our aim with this study was to test and integrated social work. A nurse behaviors associated with teen the hypothesis that compared with offered contraceptive counseling, parents that place children and their the teen-tot model alone, adding and social workers provided brief mothers at risk for adverse long-term a structured, comprehensive check-ins plus intensive family outcomes. Repeat teen pregnancy parenting curriculum to an AFL- support services when needed.24 multiplies risk for both parental funded teen-tot model would increase All required AFL core services as stress and harsh parenting that parenting self-esteem and reduce outlined in Title XX were offered,31 negatively affect child outcomes.14 parenting attributes associated with and the Institutional Review Board In addition, the children are more child maltreatment, maternal of Boston Children’sHospital likely to have behavioral problems. depression, and repeat pregnancy approved the study with a waiver Educational and employment over a 36-month follow-up. of parental consent. outcomes are better for teens without another pregnancy.8,14 Yet, almost METHODS Intervention 20% of teen births are repeat Because of broad OAPP goals for births.15 Setting and Participants improving teen parenting while Comprehensive programs have been This study was set in Boston, enhancing youth and family aimed to address family planning Massachusetts, in a teen-tot program development, elements of 3 validated while providing parenting and social within a pediatric hospital.24 curricula were incorporated into the support.16 Programs are used to Eligibility criteria included maternal intervention, which then underwent address parenting behaviors, age ,19 years at delivery and structured expert content review and maternal attachment to the infant, willingness to receive maternal and pilot testing. Psychoeducational and teen life skills to enhance child infant care in a teen-tot program. modules that were one-on-one used developmental outcomes and teen Teens with infants $12 months were the Ansell-Casey Life Skills self-sufficiency.11,16–18 Promising excluded. They were referred from Assessment Curriculum,33, the Downloaded from www.aappublications.org/news by guest on September 24, 2021 2 COX et al Women’s Negotiation