Young, Pregnant, and Underinsured: Growing Demand Calls for Cost-Effective Collaboration between Health and Social Workers

Abstract

Policymakers, public health practitioners, and social workers share a pressing sense of concern about the recent rise in teenage birthrates across the nation. It is well documented that without effective intervention, the repercussions of teenage parenting reach far beyond individuals and families to affect society at large. Negative outcomes include school dropout, strain on public health and welfare systems, low-birthweight babies, increased medical costs, poverty, stunted workforce development, child abuse and neglect, and developmental delays and disabilities among infants and children (Hoffman & Maynard, 2008).With experts projecting future increases in teenage birthrates (Sayegh, Castrucci, Lewis, & Hobbs-Lopez, 2009), it is imperative that communities invest wisely in support programs for adolescent parents. The Tandem Teen Prenatal and Parenting Program was founded in 1998, when a group of nurse practitioners and a social worker at People's Community Clinic in Austin, Texas, recognized that prenatal care alone was insufficient to deal with the complexities of teenage parenting. Grounded in a youth development framework, Tandem operates on the understanding that the challenges associated with teenage parenting are multidimensional and long term in nature and, thus, require a comprehensive continuum of care. The program has evolved into an interagency collaboration that integrates home and school visitation with the medical home model in the provision of medical, mental health, and educational and vocational services to teenagers and their children. At a relatively low cost, Tandem has been effective in improving the health and well-being of teenage parents and their children and has more than halved the national subsequent pregnancy rate of 24 percent among its clients by more than half (Schelar, Franzetta, & Manlove, 2007;Watt, 2008). HIGH-RISK POPULATION Tandem serves approximately 120 high-risk teenage mothers annually and accepts approximately 40 new clients each year. Clients remain in services until their children reach age three, they decline further participation, or the staff deems them no longer in need. On average, clients stay in services for 12 to 18 months. At any given time, approximately 25 percent to 35 percent of ongoing Tandem clients are pregnant, and the remaining 65 percent to 75 percent are parenting. The majority (76 percent) of Tandem's participants are Hispanic and between ages 14 and 16. Recent years have seen an increase in clients age 13 and younger. Most Tandem participants (90 percent) live in poor, high-risk neighborhoods. At intake almost 40 percent of these pregnant teenagers have dropped out of or are no longer attending school. Typically, those officially enrolled in school have significant attendance and academic problems. Most clients come from single-parent homes or live with their partner, his family, or other relatives. Approximately 30 percent of participants are primarily Spanish-speaking and come from immigrant backgrounds. All of these factors make Tandem's population one of the youngest and neediest among pregnant adolescent cohorts in the country. COORDINATING INTENSIVE CASE MANAGEMENT IN A MEDICAL HOME To help clients address these challenges, Tandem emphasizes a comprehensive, client-centered approach delivered by a multidisciplinary team. Culturally sensitive, bilingual services are offered to a growing Spanish-speaking population. Priorities for each client include the development of a long-term, close, and sustained relationship with a nonjudgmental, caring, and reliable case manager; client-driven goal setting; positive health outcomes for parent and child; improved emotional wellness; strengthened social support networks; delayed subsequent pregnancies; and progress toward educational goals and self-sufficiency. Tandem's partners are four agencies and seven staff members. The lead agency, People's Community Clinic, provides Tandem with its director (a licensed clinical social worker) and a nurse practitioner. …