Public Health Nursing community partnerships and systems-focused interventions: Improving healthy outcomes, high school graduation and GED completion rates, and self-sufficiency for pregnant and parenting teens

Sharon Cross, RN, MSPH¹, Deborah L. Hendricks, RN, MPH¹, and Mary Elizabeth Berglund, BSN². (1) Healthy Families Section, St. Paul-Ramsey County Public Health Department, 70 West County Road B-2, St. Paul, MN 55117, 651-766-4063, sharon.cross@co.ramsey.mn.us, (2) Healthy Families Section, St. Paul-Ramsey County Department of Public Health, 70 West County Road B-2, St. Paul, MN 55117

As Ramsey County welfare reform committees met to examine the populations served by TANF/MFIP (Temporary Assistance for Needy Families/Minnesota Family Investment Program) and the Minnesota Department of Human Services released its five-year longitudinal special report on teen mothers, data supported the need to examine new program strategies to address the needs of pregnant and parenting adolescents. Study findings indicated that more than 70% of teen parents receive MFIP assistance at some point in their adult lives; over 50% of families on MFIP in 2001 began with a birth to a teen mother; and only 41% of mothers who have children before age 18 completed high school. Additionally, although policy makers and administrators valued teen parent services, program priorities were unclear, services were fragmented, and outcome evaluations were inadequate. While previous national and program evaluation data indicated that teen parents benefit from public health home visiting services, only about one-third of teen parents on MFIP received PHN services. Collaborative funding and program efforts resulted in the development of a program that integrates PHN's assessment and interventions promoting healthy teen outcomes, enhancing parent/child interaction, healthy child growth and development, and child spacing with monitoring school attendance and progression, and authorizing child care. PHN's and SW's partner with county financial assistance workers, child care staff, school personnel, and other community resources to develop case plans that are strength-based and focus on healthy teen and child outcomes while reducing barriers to school attendance, improving teen decision-making skills, and interrupting the cycle of intergenerational poverty. After two years of program development and implementation, evaluation data reflect improved teen parent health and educational outcomes, and significant, ongoing systems-focused change including a legislative waiver to simplify childcare eligibility and access, streamlining the MFIP policies for teens, developing criteria and protocol for teen living arrangement assessments, matching PHN/Financial worker caseloads, and establishing a system for effective attendance monitoring. Although it is anticipated that individual/family interventions will continue to improve individual teen parent outcomes, it is expected that ongoing system's changes will address the issues that currently influence teen parent's successful high school graduation and life long self sufficiency.