Lessons for prevention and intervention in adolescent pregnancy: a five-year comparison of outcomes of two programs for school-aged pregnant adolescents.

Adolescent fertility control has been linked with educational completion and long-term economic success. This study evaluated the effect of short-term prenatal intervention on selected maternal and child indexes with first-time pregnant adolescents. Birth patterns were examined over a 5-year period for three groups (N = 216) of adolescents who received varying amounts of prenatal intervention for the index birth. No significant differences between groups were found on number of subsequent births within 5 years, mean time between births, graduation from high school, gestational age, or mean birth weight of infants. Age at first birth was a predictor of the number of subsequent births and subsequent graduation from high school. Grade in school at first pregnancy and total number of births in 5-years were related to high school graduation. Findings support the need for continued intensive community-based collaborative intervention for adolescent mothers during the 5 years after the index birth, the peak childbearing years for these women.

PIP: The authors evaluated the effect of short-term prenatal intervention upon selected maternal and child indexes among 216 first-time pregnant adolescents. Birth patterns over a five-year period were examined in the group of exclusively African American, single females of low socioeconomic status who were younger than 18 years old at the time of their respective index birth during 1984-85. 37 subjects attended one community clinic and participated in eight or more lessons of prenatal education programming through the Lifespan Program, 71 received prenatal care and educational programming for varying amounts of time through the school district's alternative school during fall semester 1984-85, and 108 received prenatal care in the same community clinic as the Lifespan group, but before the launching of the Lifespan Program. No significant differences were identified between groups in the number of subsequent births within five years, mean time between births, graduation from high school, gestational age, or mean birth weight of infants. Lower age at first birth, however, predicted an higher number of subsequent births and failure to graduate from high school. One-third of the girls bore a third or fourth child within five years of the index birth. Lower grade in school at first pregnancy and relatively high total number of births during the follow-up period were related to a failure to graduate from high school. These findings support the need for continued intensive community-based collaborative intervention for adolescent mothers during the five years after the index birth.

Prenatal education outcomes for pregnant adolescents and their infants using trained volunteers.

This study evaluated the effects of lessons taught by trained nonprofessional volunteers in community prenatal clinics. Project participants (n = 210) and comparison subjects (n = 189) were pregnant women, aged 18 years or younger. Participants were divided according to those who attended eight or more lessons (high treatment, n = 94) and those who attended fewer lessons (n = 116). A system of rewards for attendance was used. The number of prenatal visits was significantly different between the three groups (p less than 0.001), with the high-treatment participants having a significantly greater number of visits than the other groups. The groups differed on gestational age at delivery (p less than 0.006), favoring the infants of high-treatment participants; however, only 8% of gestational age variance was attributable to prenatal visits. A significantly greater proportion of high-treatment participants returned for postpartum care (p less than 0.011 vs. low-treatment participants, p less than 0.002 vs. comparison subjects). Postpartum return was not improved by a hospital visit by a volunteer. Regardless of treatment, most (99%) accepted a contraceptive method at their postpartum visit. The groups did not differ on their return for method check at 3 months. However, a significantly greater proportion of the high-treatment participants returned for an annual family planning evaluation (p less than 0.015 vs. low-treatment participants, p less than 0.005 vs. comparison subjects). Both the high- and low-treatment participants differed significantly from the comparison subjects on having taken their infants for at least one well-child visit during the first year (p less than 0.001 for both tests).(ABSTRACT TRUNCATED AT 250 WORDS)

Physician extender services in family planning agencies: issues in Medicaid reimbursement.

PIP: The US Social Security Amendments of 1972 mandated the inclusion of family planning services in state Medicaid plans, authorized 90% of reimbursements for family planning care, and imposed financial penalties for failure to provide these services to Medicaid-eligible clients. On the other hand, many states have retrictive policies regarding Medicaid reimbursements to family planning agencies for services provided by physician extenders (e.g.s nurse practitioners and physician assistants). There is concern that such restrictions greatly reduce accessibility to family planning services. Reasons that hae been suggested as causes of such restrictive policies include physician concern over loss of income, the uncertain status of physician extenders in some states, a fear that this step will lead to a demand for reiimbursement for the services of other allied health care providers such as social workers, and concern that care for the indigent will lead to an expensive increase in state reimbursement for family planning services. However, a review of relevant federal law and regulations indicates that Medicaid reimbursement for services provided to eligible patients by physician extenders has never been prohibited or discouraged. Physician supervision is required in reimbursement cases, but this does not mean that a physician must be on the premises while services are delivered. The Medicaid program actually allows significant latitude in establishing administrative policies and procedures. Rather, problems faced by family planning agencies in receiving Medicaid reimbursements for physician extenders' services are due to restrictions in state laws and staff misinterpretations of policy. Research has demonstrated that physcian extenders can contribute significantly to cost effectiveness, while providing types of care in localities such as rural areas that physicians tend to avoid. Given the importance of family planning services to Medicaid-eligible clients, unwarranted policy restrictions contrary to congressional intent should be eliminated.^ieng

Subsidized family planning services in Texas.

PIP: The following major federal funding resources that have subsidized family planning services in Texas in recent years are described: Title 5 of the Social Security Act; Title 19 of the Social Security Act; Title 20 of the Social Security Act; Title 10 of the Public Health Service Act; and other family planning funding. Total funding, need, and patients served are reviewed. An estimated $34.4 million were expended for services to approximately 474,752 of the 784,000 low income women in Texas estimated to be in need. Title 5 was amended in 1967 to require that not less than 6% of total federal appropriations for Title 5 be expended for family planning services, and that each state develop a family planning demonstration project and a program of family planning projects. The Texas Department of Health initiated Title 5 family planning services in 1968, and at this time services are provided through several independent local health departments. The Texas Department of Health has historically opted to utilize substantially more than 6% of its Title 5 funds for family planning. In federal fiscal year 1980 it reported expending $5.4 million (29.2%) of its allocated $18.5 million to provide family planning services to 77,787 patients. In state fiscal year 1980 the Medicaid Program, Title 19 of the Social Security Act, expended $3.6 million for family planning services to 31,582 patients, all of whom were or had recently been recipients of cash welfare assistance. Title 20 (now the Social Services Block Grant) is the social services component of the Social Security Act and functions much as Title 19 in that reimbursements are paid to providers for services already rendered. In state fiscal year 1980 Texas expended $14.8 million (including state and local matching funds) to serve 205,000 patients. The annual state Title 20 Plan has heretofore disallowed fees to be charged to any patients receiving Title 20 aid, but this policy may be modified in the near future. Title 10 is the only federal legislation which relates solely to family planning, including medical and social services, training, and research. In Federal fiscal year 1980 Texas agencies received a total of $9.9 million in Title 10 funds. These funds required a 10% local match. Eligibility under Title 10 for totally subsidized services is limited to low income families whose income does not exceed 100% of poverty. In 1980 approximately $3.4 million in state and local public monies were allocated as matching funds to provide subsidized family planning in services to low income persons, while approximately $0.3 million in private funds were donated to match federal funds. In Texas a total of 99 agencies currently provide medical family planning services directly to low income persons in Texas.^ieng