Adolescent and Adult Prenatal Case Management Clients: Differences in Problems and Interventions Received

Background: Prenatal case management (PCM), also called home visiting, is delivered in the community, as a health-related service for medically or socially high-risk pregnant women to improve birth and early infancy outcomes. This study describes differences between adolescent and adult clients in their health and social problems, and in the types of interventions they received.

Methods: A 2007-2008 national census survey yielded data on a sample of Medicaid reimbursed PCM programs. Case managers provided information on all client encounters that occurred on each of 10 work days over 20 work days, recording the number of minutes spent on each of the eight types of nursing interventions. Clients under 20 years of age were coded as adolescents. The dataset includes 3,947 client encounters, provided by 223 case managers in 92 programs.

Results: The largest category of client problems was pregnancy health concerns (44.3%, n=1749). Chi-square tests revealed differences between the number of client problems for adolescents and adults in pregnancy health (p =.01), family problems (p <0.01), education/job (p <0.01), transportation (p <0.01), and housing (p =.03). Among the 1,025 adolescent clients, the most frequently recorded problem was education/job skills (50.5%, n= 518), and the most time was spent in education (mean of 17.9 minutes, n=847), just slightly more than on assessment (mean of 16.0 minutes, n=840).

Conclusions: Results highlight the need for PCM interventions that are appropriate to the context of adolescence. Prenatal care that is designed to meet the unique needs of adolescent mothers can have substantial benefits.