Impacts of the Positive Youth Development Program for Expectant and Parenting Teens in California

Mathematica Policy Research

Status: Completed

Conditions: Teen Pregnancy Prevention

Treatments: Behavioral: Adolescent Family Life Program Positive Youth Development (PYD) program; Behavioral: Adolescent Family Life Program (AFLP)

Study type: Interventional

Funder types: Other

Identifiers

NCT04181034

50023-CA

Details and patient eligibility

About

Under contract to the U.S. Department of Health and Human Services (DHHS), Mathematica is conducting an impact study of California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health's (MCAH) Adolescent Family Life Program Positive Youth Development (PYD) program for a Federal Evaluation of Programs for Expectant and Parenting Youth (PEPY). The impact study will be designed to address the impact of PYD, compared to the business-as-usual condition, AFLP, in delaying repeat pregnancies, completing high school, improving health of the parent and child, and improving linkages and networks of support for expectant and parenting teens.

Full description

The Adolescent Family Life Program (AFLP) has been used by MCAH for more than 3 decades. The program was recently enhanced with a positive youth development component, referred to as Adolescent Family Life Program Positive Youth Development (PYD) program. The enhanced program is a shorter, more intensive program that requires case managers to use motivational interviewing to guide participating youth through a prescribed set of activities designed to set achievable goals for life planning and building self-sufficiency. A random assignment design will be used to assess the program's impact on exposure to program content and short term outcomes.

The evaluation includes two sub-studies, each with a distinct design. In the first sub-study, individuals were randomly assigned as part of the enrollment process within two provider sites to receive either PYD or AFLP. These two provider sites could support individual random assignment because they had enough case managers and clients to support both study conditions (PYD and AFLP). In the second sub-study, 13 provider sites, each with a smaller number of case managers and clients, were randomly assigned to PYD or AFLP. In this second sub-study, participants enrolled after sites were randomly assigned. Potential study participants were recruited between December 2014 and January 2017, and were considered eligible for participation if they were they (1) were interested in the program, (2) were pregnant or parenting, (3) had not been served at the site in the prior six months, (4) spoke either English or Spanish, (5) were between ages 14 and 18, and (6) were not enrolled in Nurse Family Partnerships.

For sub-study 1, potential participants who were eligible were randomly assigned to (1) a treatment group that was eligible for PYD or (2) a control group that received AFLP. Random assignment was conducted within two blocks determined by random assignment site and whether study participants were pregnant at the time of random assignment or were parenting at the time of random assignment. After random assignment, the study enrollment manager assigned the young mother to a case manager delivering the program to which she was assigned. The assigned case manager then tried to locate and conduct a first visit with each randomized youth mother, but not all could be found. For most who were found and visited, case managers were instructed to follow a script that described the program in general terms (without differentiating between AFLP and PYD) and the study in detail. The script did not reveal the group to which the young mother was assigned. As part of the scripted interaction, case managers sought study consent from young mothers to participate in the study data collection.

For sub-study 2, provider sites were first randomized to either the PYD or AFLP. Young mothers were then referred to sites in the same manner as in the first sub-study, went through the same initial eligibility screening process. Eligible mothers were assigned a case manager. The assigned case manager then tried to locate and conduct a first visit with each eligible youth mother, but not all could be found. For most who were found and visited, case managers were instructed to follow a script that described the program in general terms (without differentiating between AFLP and PYD) and the study in detail. The script did not reveal the group to which the young mother was assigned. As part of the scripted interaction, case managers sought study consent from young mothers to participate in the study data collection.

The study draws on data from LodeStar, MCAH's administrative records on service receipt, a baseline survey administered after enrollment into the study, a follow-up survey administered approximately 12 months after enrollment and a follow up survey administered approximately 24 months after enrollment.

Enrollment: 1,330 patients

Sex: Female

Ages: 14 to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• must be expectant or parenting

Exclusion criteria

• Served by enrollment site in six months prior to random assignment
• Enrolled in Nurse Family Partnership program at time of random assignment
• younger than 14 years of age or older than 18 years of age
• Primary language is neither English nor Spanish

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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1,330 participants in 2 patient groups

PYD

Experimental group

Description:

Case managers meet with participating pregnant and parenting females at least two times a month over 12 months. In the short term, the program seeks to improve social competence, problem-solving skills, autonomy, increased sense of purpose, improved knowledge and use of contraceptives, increased linkages and support networks, improved quality of relationships, increased access to and strengthen relationship with a trusted adult, increased knowledge of and access to healthcare and improved health and well-being of expectant or parenting mother. In the long term, the program aims to delay subsequent pregnancy and reduction in health risk behaviors, improved health and well-being of parent and child, improved educational and employment outcomes and increased self-sufficiency.

Treatment:

Behavioral: Adolescent Family Life Program Positive Youth Development (PYD) program

AFLP

Active Comparator group

Description:

Case managers meet with participating pregnant and parenting females once a month over 24 months to deliver older, business-as-usual version of the program that does not have positive youth development component.

Treatment:

Behavioral: Adolescent Family Life Program (AFLP)