Enhancing a Home Visiting Program to Address Repeat Adolescent Pregnancy: The Early Impacts of Steps to Success

Introduction

This report presents evidence on the early impacts of the Steps to Success home visiting program for adolescent mothers in San Angelo, Texas. Rapid repeat pregnancies can have adverse consequences for young mothers and their children and can compound the negative effects of adolescent childbearing. A small but growing body of evidence suggests that interventions for adolescent mothers can promote healthy birth spacing by providing a combination of individualized support services and improved access to effective contraception. To build on the promising research in this area, the Administration for Children and Families within the U.S. Department of Health and Human Services funded a rigorous evaluation of Steps to Success in San Angelo, Texas. Using federal funding from the Personal Responsibility Education Program (PREP) Competitive Grant program, Healthy Families San Angelo (HFSA) developed Steps to Success by enhancing a traditional home visiting program. While the traditional home visiting program focused on child development and parenting, the enhanced program included additional program components designed to (1) promote healthy birth spacing, with an emphasis on increasing the use of long-acting reversible contraceptives (LARCs); (2) encourage father involvement; and (3) support mothers’ education and career aspirations. To test the impacts of these enhancements, this study compares outcomes for a program group that received Steps to Success and a control group that received the traditional home visiting program.

Primary Research Questions

• Compared with the traditional home visiting program, did Steps to Success promote healthy birth spacing?
• Compared with the traditional home visiting program, did Steps to Success increase fathers’ involvement with their children or mothers’ education and career aspirations?
• Compared with the traditional home visiting program, was Steps to Success more or less successful at improving mothers’ parenting behavior?

Purpose

This report is the second in a series on the implementation and impacts of Steps to Success in San Angelo, Texas. It presents evidence on the program’s interim impacts, measured about one year into the two-year program. It also documents the study methods. An earlier process study report described the design and implementation of Steps to Success. A future report will present evidence on the program’s longer-term impacts, measured after mothers have received the entire two-year home visiting program.

This report presents evidence on the early impacts of Steps to Success on use of contraception; repeat pregnancy; attitudes toward repeat pregnancy; knowledge of pregnancy prevention; co-parenting; fathers’ engagement with their children; and mothers’ school enrollment, career goals, and engagement with their children.

Methods

The study team used a random assignment design to test the efficacy of Steps to Success compared to the traditional home visiting program. HFSA staff recruited pregnant and recently postpartum adolescent mothers, ages 14 to 20, on a rolling basis for the evaluation from May 2013 through May 2016. Mothers were randomly assigned to a program group that received the Steps to Success home visiting program or a control group that received the traditional home visiting program. Mothers in both research groups completed a baseline survey upon enrolling in the study and follow-up surveys one and two years later. Data from the one-year follow-up survey are the focus of this report.