Adolescent Parenting Program (APP)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Adolescent Parenting Program (APP) has been rated by the CEBC in the area of: Teen Pregnancy Services.

Target Population: First-time pregnant and parenting youth aged 12 to 19 years old, and who must be enrolled in school or a GED-completion program and their children ages birth to 5 years old.

For children/adolescents ages: 0 – 5

For parents/caregivers of children ages: 0 – 5

Brief Description

APP provides support to first-time pregnant and parenting teens through intensive home visiting and peer group education. Each APP serves a caseload of 15-25 teens that may enter the program at any time during their pregnancy or after their child’s birth. Participants in the program receive monthly home visits using either the Partners for a Healthy Baby or Parents as Teachers home-visiting curriculum, along with 24 hours of prescriptive group education with their peers. Supporting adolescent parents to prevent a repeat pregnancy, complete their high school education, acquire job skills, and improve their parenting skills helps them become self-sufficient and better able to support themselves and their families. It also establishes a strong, stable foundation upon which their child will be raised. By investing in teen parents today, APP strives to protect the future of two generations - the young parents themselves and their babies.

Program Goals:

The goals of the Adolescent Parenting Program (APP) include:

  • Increase the self-sufficiency outcomes for APP participants by:
    • Increasing the delay of a subsequent pregnancy
    • Increasing graduation from high school with diploma or completion of GED
    • Increasing successful transition to adulthood including enrollment in post-secondary education, vocational training, or employment at a livable wage, and living in safe and stable housing after graduation from APP
  • Improve developmental outcomes for the children of APP participants by:
    • Increasing healthy births
    • Increasing incidence of appropriate discipline, of nurturing behavior, and of children who are well-cared for
    • Increasing age-appropriate physical, emotional, cognitive, and social development, including readiness for school success.

    These goals are evaluated using the following outcome objectives:

    • Less than 3% of APP participants will experience a subsequent pregnancy while participating in APP.
    • Less than 5% of APP participants will drop out of school.
    • More than 65% of APP participants will plan to enroll in post-secondary education or training.

    Essential Components

    The essential components of the Adolescent Parenting Program (APP) consist of:

    • Home visiting services, using either the Parents as Teachers or Partners for a Healthy Baby curriculum.
      • Minimum of 1 monthly contact for at least one hour
      • Four of these twelve contacts must take place in the teen’s home
    • Case management services to each participant through individualized goal planning
    • Peer group education sessions
      • Minimum of 24 hours of annual peer group education
      • Sessions organized based on a structured logic model
      • Sessions with 15-25 teen participants, with smaller sessions on particular issues not affecting all participants (e.g., breastfeeding education and/or support)
    • Community Advisory Council (CAC), which serves as a guiding body in the implementation of APP for each local program. Meets quarterly, and consists of representatives from at least five public and private community agencies, such as local health departments, public school systems, departments of social services, mental health services, local corporations, consumers and businesses, media, and other organizations that serve youth.

    Child/Adolescent Services

    Adolescent Parenting Program (APP) directly provides services to children/adolescents and addresses the following:

    • Risk for delayed school readiness among the children of teen parents and risk for child maltreatment among teen parents

    Parent/Caregiver Services

    Adolescent Parenting Program (APP) directly provides services to parents/caregivers and addresses the following:

    • First-time pregnant teen or teen parent
    • Risk of repeat teen pregnancy
    • Risk of dropping out of school
    • Risk of living in poverty
    • Risk of unhealthy relationships
      • Incidence of sexual abuse among pregnant/parenting teen girls
      • Risk for future IPV or domestic violence
      • Risk for reproductive coercion
    • Risk for child maltreatment among teen parents
      • Inappropriate parental expectations
      • Lack of empathy for children’s needs
      • Reliance on corporal punishment for discipline
      • Oppression of children’s independence
    Services Involve Family/Support Structures:

    This program involves the family or other support systems in the individual's treatment: Families and other support systems are involved in the teen’s direct services at both home visits and group education sessions. For example, the father or mother of the participant’s child may participate in home visits, or attend peer group education sessions. The participant’s parents or guardians may also be involved in direct service encounters, as well as with any legal issues the teen may encounter (i.e., child custody).

    Delivery Settings

    This program is typically conducted in a(n):

    • Birth Family Home
    • Community Agency
    • Foster/Kinship Care
    • School

    Homework

    This program does not include a homework component.

    Languages

    Adolescent Parenting Program (APP) does not have materials available in a language other than English.

    Resources Needed to Run Program

    The typical resources for implementing the program are:

    Each APP has at least one full-time coordinator to provide home visiting services and facilitate peer group education sessions. If the coordinator’s caseload exceeds 20 participants, it is recommended that an assistant coordinator be hired. For every 5 participants in the program beyond a caseload of 20, 10 additional hours of staff time are recommended to appropriately implement APP. Coordinators need adequate space to conduct peer group education sessions, either at their agency our through in-kind resources. Transportation issues are often reported by coordinators serving rural populations, and coordinators should consider renting passenger vans or subcontracting with a transportation provider to get participants to and from peer group education sessions. Coordinators also need their own means of transportation to conduct monthly home visits with participants.

    Minimum Provider Qualifications

    Service providers must have a demonstrated history of working with at-risk youth and be trained in either the Partners for a Healthy Baby or Parents as Teachers home visiting curriculum. Staff must also complete at least 18 hours of professional development training annually, aimed at improving program outcomes.

    Education and Training Resources

    There is a manual that describes how to implement this program; but there is not training available for this program.

    Implementation Information

    Since Adolescent Parenting Program (APP) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

    Show implementation information...

    Pre-Implementation Materials

    There are no pre-implementation materials to measure organizational or provider readiness for Adolescent Parenting Program (APP).

    Formal Support for Implementation

    There is no formal support available for implementation of Adolescent Parenting Program (APP).

    Fidelity Measures

    There are no fidelity measures for Adolescent Parenting Program (APP).

    Implementation Guides or Manuals

    There are implementation guides or manuals for Adolescent Parenting Program (APP) as listed below:

    The APP Manual covers all components of program implementation including: Staffing, fidelity to the home visiting models, process and outcome evaluation, community collaborations, and budget. It is available at http://www.teenpregnancy.ncdhhs.gov/docs/app/APP-PolicyManual-July2012.pdf.

    Research on How to Implement the Program

    Research has not been conducted on how to implement Adolescent Parenting Program (APP).

    Relevant Published, Peer-Reviewed Research

    This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

    Child Welfare Outcome: Child/Family Well-Being

    Show relevant research...

    Sangalang, B. B., & Rounds, K. (2006). Differences in health behaviors and parenting knowledge between pregnant adolescents and parenting adolescents. Social Work in Health Care, 42(2), 1-22.

    Type of Study: One group pretest-posttest
    Number of Participants: 91

    Population:

    • Age — 12-18 years
    • Race/Ethnicity — 65% Black, 26% White, and 9% Native American, Asian American, or other racial and ethnic groups
    • Gender — 100% female
    • Status — Participants were pregnant and parenting adolescent mothers.

    Location/Institution: North Carolina

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This article examined substance use, contraceptive behavior, and parenting knowledge among first-time pregnant and parenting adolescents enrolled in the Adolescent Parenting Program. Measures utilized include the Adult-Adolescent Parenting Inventory (AAPI-2) and the Knowledge of Infant Development Inventory (KIDI). Results indicated that after one year of program participation, pre- and post-test comparisons indicated improvements in contraception use and parenting knowledge, and increases in reported use of cigarettes, alcohol and other drugs among both groups. Adolescents who entered the program while pregnant experienced greater benefit than adolescents who entered the program already parenting. Limitations included lack of comparison group and possible bias due to self-selection into the program.

    Length of postintervention follow-up: None.

    Sangalang, B. B. (2006). Teenage mothers in parenting programs: Exploring welfare outcomes during early transition to parenthood. Families in Society: The Journal of Contemporary Social Services, 87(1), 105-111.

    Type of Study: Nonequivalent control group design
    Number of Participants: 1549

    Population:

    • Age — 12-19 years
    • Race/Ethnicity — Control Group: 77.1% Black, 18.4% White, and 4.5% Hispanic; Comparison Group: 63% Black, 31.1% White, and 5.9% Hispanic
    • Gender — 100% Female
    • Status — Participants were pregnant and parenting adolescent mothers.

    Location/Institution: North Carolina

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This article compares welfare participation and economic well-being among teenage mothers who received case management services from the North Carolina Adolescent Parenting Program (APP) with a comparison sample of teenage mothers. Information on receipt of welfare cash assistance was obtained from state databases. Results reported no significant association between APP participation and the likelihood of longer welfare dependence of more than 36 months. Limitations included non-randomization of subjects and possible selection bias.

    Length of postintervention follow-up: None.

    Sangalang, B. B., Barth, R., & Painter, J. S. (2006). First birth outcomes and timing of second births: A statewide case management program for adolescent mothers. Health Social Work, 31(1), 54-63. doi:10.1093/hsw/31.1.54

    Type of Study: Retrospective nonequivalent control group design
    Number of Participants: 2520

    Population:

    • Age — 12-19 years
    • Race/Ethnicity — Program group: 70.2% Black, 23.8% White, and 5.9% Hispanic/Other; Comparison group: 48.4% Black, 42.5% White, and 9.2% Hispanic/Other
    • Gender — 100% Female
    • Status — Participant were pregnant and parenting adolescent mothers.

    Location/Institution: North Carolina

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This study examines the impact of the Adolescent Parenting Program (APP) on prenatal care utilization, birthweight, gestational age, and time until second birth for a sample of first-time pregnant and parenting adolescents, compared to a sample of pregnant and parenting adolescents not enrolled in the APP program. The measure utilized was the Adequacy of Prenatal Care Utilization (APNCU) Index. The groups had similar rates of prenatal care use. Results indicate participation in APP, however, was associated with an increased likelihood of normal birth weight and full-term birth. Results also indicated adolescents ages 12 to 16 in the APP group also delayed second births significantly longer than the non-APP group. Study implications point to case management and direct services provided by social workers and health service professionals as instrumental to helping adolescent mothers achieve favorable birth outcomes and postpone subsequent births during adolescence. Limitations included the lack of randomization and possible bias due to self-selection.

    Length of postintervention follow-up: Not specified.

    Gruber, K. J. (2012). A comparative assessment of early adult life status of graduates of the North Carolina adolescent parenting program. Journal of Child and Adolescent Psychiatric Nursing, 25, 75-83.

    Type of Study: Nonequivalent control group design
    Number of Participants: 35

    Population:

    • Age — 18-24 years
    • Race/Ethnicity — 27 African American, 2 Hispanic, 2 White, and 4 Biracial
    • Gender — 100% Female
    • Status — Participants were pregnant and parenting adolescent mothers.

    Location/Institution: Greensboro, North Carolina

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This study examined the effectiveness of the North Carolina Adolescent Pregnancy Prevention (APP) program. Graduates of the NC AAP were compared to a sample of adolescent parent peers identified by the graduates. Measures include Parenting Sense of Competence Scale, the Parenting Opinions Questionnaire, and the Student Life Satisfaction Scale, a subset of the Multidimensional Students’ Life Satisfaction Scale, the 10-item Rosenberg Self-Esteem Scale and the Young Female Parent Life Status Assessment Form. Results indicated that NC AAP graduates were on a more positive life course: greater primary responsibility for housing and utilities, greater higher education enrollment, more job stability, and greater focus on career goals. Limitations include small sample size, non-randomization of participants, and comparison group not from the same population pool.

    Length of postintervention follow-up: None.

    References

    No reference materials are currently available for Adolescent Parenting Program (APP).

    Contact Information

    Name: Audrey Loper, MPH, MS
    Agency/Affiliation: North Carolina Department of Health & Human Services
    Website: www.teenpregnancy.ncdhhs.gov
    Email:
    Phone: (919) 707-5688
    Fax: (919) 870-4827

    Date Research Evidence Last Reviewed by CEBC: September 2016

    Date Program Content Last Reviewed by Program Staff: April 2014

    Date Program Originally Loaded onto CEBC: March 2013