home visiting for the pregnant and parenting teen

J Pediatr Adolesc Gynecol (2006) 19:57–58

Perspectives on Pediatric and Adolescent

Gynecology from the Allied Health

Care ProfessionalSection Editors: Angela Nicoletti, RN(C), WHNP, Margaret Tonelli, NPBrigham and Women’s Hospital, Boston, Massachusetts, USA

Home Visiting for the Pregnant and Parenting Teen

Author: Margaret Tonelli, NPBrigham and Women’s Hospital, Boston, Massachusetts, USA

Introduction

When I saw Lori’s name on my schedule as a newobstetrical patient, I gave a resigned sigh. Lori’s firstbaby was less than a year old and I remembered Lorinot for how often I had seen her for prenatal care, butbecause I had seen her only three times and she hadbeen lost to follow up after her delivery.

In her first pregnancy, Lori, then 17 years old, hadbeen homeless, depressed, and living with an ex-tremely abusive boyfriend, not her baby’s father,who had also been abusive. She had no social sup-ports. She had been removed from her own mother’scare at age 8 and reported too many foster homes toremember. Though she had great difficulties keepingappointments, she called frequently and she agreedto a home visitor, who had seen her often.

Since the beginning of the Adolescent Reproduc-tive Health Service (ARHS) at Brigham and Women’sHospital, we have been a multidisplinary team ofnurse practitioners, clinical nurse midwives, socialworkers, nutritionists, with a strong liaison with homevisiting agencies, particularly Boston Public Health’sHealthy Baby program. We have always valued ourhome visiting component. and have been fortunate tohave consistent nurse and paraprofessional staff fromBoston Public Health allowing us to meet weekly todiscuss and mutually plan care for patients.

In 1997, Healthy Families of Massachusetts (HFM)began a statewide initiative, modeled on the HealthyFamily America home visiting program. It was

Address correspondence to: Margaret Tonelli, NP, Brigham andWomen’s Hospital, 75 Francis St., Boston, MA 02115; E-mail:

mtonelli@partners.org

� 2006 North American Society for Pediatric and Adolescent GynecologyPublished by Elsevier Inc.

designed to be available to all families in which themother is a first-time parent and under the age of 21.

Services are initiated prenatally, at birth, or withinthe child’s first year and may continue until the child’sthird birthday. Although services vary from site tosite, they are located within the community and usu-ally include home visits, groups, and referral services.The main goals of the program:

� prevent child abuse and neglect by supportingpositive, effective parenting skills and a nurturinghome environment;

� achieve optimal health, growth, and developmentin infancy and early childhood;

� promote maximum parental educational attain-ment and economic self sufficiency;

� Prevent repeat teen pregnancy.1

HFM provided ARHS with the additional resourcesto offer home visiting to all our young pregnant andparenting mothers wherever they lived. The home vis-itor is an invaluable link between prenatal care andthe teens’ home environment and community. Thehome visitor has the unique opportunity to assesssocial and environmental risk factors early in thepregnancy and allow time for hopefully effective in-terventions prior to the baby’s birth.

For example, a teen will report a grandmother asher primary support, failing to mention the grand-mother may be wheelchair bound or have serioushealth needs of her own. A home visitor can increasehealthcare utilization by helping the teen to re-establish health care when aspects of her socialenvironment impede keeping scheduled appointments.They are effective in helping teens continue theireducational goals; 83% of HFM mothers are in schoolor have graduated.2

1083-3188/06/$22.00doi:10.1016/j.jpag.2005.11.009

58 Tonelli: Home Visiting for the Pregnant and Parenting Teen

Most important, a consistent home visitor allowsthe young teen to establish a relationship during herpregnancy that can continue through the postpartumperiod, early infancy and childhood, providing herwith continued support and education on childdevelopment.

In April 2005, the Massachusetts Healthy FamilyEvaluation (MHFE) was published. Many of its find-ings were consistent with what we had known anec-dotally. Primarily, young mothers like the program,and the relationship and/or connection with the homevisitor is what keeps the young mother involved. Theyoften see the home visitor as a ‘‘friendship or a sib-ling.’’3 Teens often lack sufficient social support dur-ing pregnancy and early parenting; many reportconflicted relationships with the fathers of their babiesand their own mothers. The home visitor often fillsthis adult void.

Teens expressed the greatest interest in gainingknowledge of child development and the MHFE dem-onstrated that teens in the program gained a significantincrease in knowledge. Not surprisingly, MHFE iden-tified two ongoing challenges for this population: (1)the unacceptable high rates of depression in theseyoung moms, 45%, with 27% reported as chronic

depression; and (2) failing to impact the repeat preg-nancy rate for teens. With the known sequelae of de-pression and repeat teen pregnancies, both warrantcontinued efforts to impact needed change.

Though Lori was pregnant with her second child inless than a year, she initiated prenatal care at 8 weeks.She had recently returned to Boston after living ina teen living program in the western part of the state.She was involved in a new relationship, denying inti-mate partner violence, and reported a stable living sit-uation with support from her boyfriend’s family. Oneof her first questions for me was, ‘‘Is Leslie stillhere?’’ Leslie had been her home visitor. ‘‘She helpedme with so much last time, you know, emotionally,too.’’

References

1. Jacobs FH, Easterbrooks MA, Brady AE, et al: HealthyFamilies of Massachusetts Final Evaluation Report: January1998- June 2002. [Executive Summary, p 1]. Medford, MA,Massachusetts Healthy Families Evaluation, Tufts Univer-sity, 2005

2. Ibid, Chapter 9. p 1233. Ibid. Chapter 9. p 121