1. family and parenting

Center for Research on Women
Examining Issues of Gender and Social Inequality
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Center for Research on Women
CONTENTS
Prepared By:
Ace F. Madjlesi, M.A.
Sarah Hoover
Lynda M. Sagrestano, Ph.D.
Ruthbeth Finerman, Ph.D.
Joy Clay, Ph.D.
Published by:
Center for Research on Women
337 Clement Hall
Memphis, TN 38152
901-678-2770
[email protected]
www.memphis.edu/crow
April 2014
Layout and Design by:
Mindy Schaper and
Ace F. Madjlesi
Introduction.....................................................................................................................3
Description of Program................................................................................................4
Description of Participants.......................................................................................... 6
Case Study: Alisa............................................................................................................ 7
Evaluation Findings and Recommendations
Mechanisms of Service Delivery
Individualized Support...................................................................................8
Peer Support.....................................................................................................9
Case Study: Paul...........................................................................................................10
Material Support............................................................................................. 11
Case Study: Simone..................................................................................................... 12
Referrals..............................................................................................................13
Goals of Service Delivery
Healthcare.........................................................................................................14
Education......................................................................................................... 15
Parenting...........................................................................................................17
Case Study: Calvin........................................................................................................18
External Challenges................................................................................................. 19
Implementation Challenges..................................................................................20
Recommendations for Program Sustainability................................................21
Appendices
Appendix A: Summary of Research Methods.................................................. 22
Appendix B: Summary of Tracking Data Extracted from
ShelbyConnect...................................................................................23
Appendix C: Summary of Housing, Transportation, and Food Security
Survey Data........................................................................................26
Appendix D: Summary of Interview Data.......................................................... 30
Appendix E: Summary of Focus Group Data....................................................33
References...................................................................................................................... 35
Acknowledgements:
The Center for Research on Women would like to thank the numerous
individuals whose help was integral to our work. Most importantly, we wish
to thank the pregnant and parenting teens as well as the service providers
and administrators who participated in this study. We would also like to
acknowledge the tremendous community contribution made by the tireless
efforts of Success Coaches funded by this project. Special thanks to Lydia
Walker, Johnnie Hatten, Connie Booker, Janon Wilson-Wilbourn, and Tameka
Daniel for facilitating data collection. Thanks also to Tiffany Lewis and Charlie
Caswell at Rangeline CDC for providing pictures for this report.
This project is funded by the US Department of Health and Human Services
Office of Adolescent Health, Grant # SP1AH000018-02-00, through the State
of Tennessee Department of Maternal Child Health.
2 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Center for Research on Women
INTRODUCTION
Adolescent pregnancy significantly impacts the educational attainment, economic security, and well-being of
teen parents and their children (Hoffman & Maynard, 2008). In 2009, over 15% of all Shelby County births
were delivered by women under the age of 19, totaling an estimated public cost of $10,179,826 (Ciscel, 2011).
In addition to its prevalence, teen pregnancy has demonstrable longitudinal effects on a woman’s ability to
achieve economic security (Hoffman & Maynard, 2008) and contributes to systemic issues related to poverty
in Shelby County (Ciscel, 2011). Eliminating teen pregnancy presents a complex challenge for any community.
However, due to its documented economic significance to individuals, families, and society at large, this goal
should remain a priority for Shelby County to systematically address.
In 2011, Tennessee was one of 17 states that received funding from the US Department of Health and Human
Services, Office of Adolescent Health to design, implement, and evaluate a program aimed at supporting and
improving outcomes for pregnant and parenting teens. The resulting project, Teen Pregnancy and Parenting
Success (branded as Teen+, based on input from local teens), was coordinated by the Shelby County Office of
Early Childhood and Youth (SCOECY) and designed to be a system of care that connected schools, faith-based
organizations, healthcare facilities, and social service providers. The success of Teen+ was to be facilitated by
ShelbyConnect, an electronic shared-data system that would allow Success Coaches (social workers employed
through various grantee agencies to work directly with teen participants) to make seamless referrals, thus
creating a continuum of care for teen parents across Shelby County. Primary goals of the grant included
improved health, educational, and parenting outcomes for Teen+ participants.
As part of this initiative, The University of Memphis Center for Research on Women (CROW) was tasked with
first conducting a preliminary needs assessment that would inform the design of the system of care, followed
by an outcome evaluation after Year 3, based on data entered into the ShelbyConnect system by grantee
partners. Several barriers to implementation of the shared data system emerged throughout the project,
making an outcome evaluation at the end of Year 3 unfeasible. Instead, this evaluation includes a summary of
the data available in ShelbyConnect as of December 2013, but relies on the primary qualitative and quantitative
data collected by CROW, with a special emphasis on programming recommendations that can be used to
strengthen Teen+ in Year 4. The outcome evaluation using data from ShelbyConnect will be the focus of a
report addendum to be completed at the end of Year 4, pending resolution of challenges to the shared data
system.
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DESCRIPTION OF PROGRAM
Administered by the Shelby County Office of Early Childhood and Youth (SCOECY), and facilitated by local
consultants from Consilience Group, LLC, the Teen+ implementation team included multiple agencies with
Success Coaches and/or Baby Stores. Agencies and individual Success Coaches recruited pregnant and
parenting teens, and the program was advertised publicly throughout Shelby County. Teens could contact an
agency directly or contact the SCOECY to be assigned to a provider. Teens who were enrolled in the Memphis
City Schools worked with on-site Success Coaches dedicated to Teen+ (see Diagram 1), whereas teens
who were not in school worked with Success Coaches through one of four community-based partners (see
Diagram 2): AGAPE Child & Family Services, Cathedral of Faith, Rangeline CDC, or South Memphis Alliance.
Success Coaches worked directly with teens to provide case management services and identify individually
tailored needs and goals. In addition to entering a Teen+ participant’s demographic and household
information into the ShelbyConnect system, Success Coaches entered needs and made referrals across
agencies registered on ShelbyConnect. As teens completed specific tasks demonstrated to contribute to
goal-centered success (e.g., receiving prenatal care, attending parenting classes, maintaining good grades),
they earned points which could then be used in Baby Stores to purchase items for their children (e.g.,
bottles, diapers, clothing, strollers). Baby Stores were administered by several community partners, including
Cathedral of Faith, Hickory Hill Community Redevelopment Corporation, Rangeline CDC, South Memphis
Alliance, and Impact Baptist Ministries. Teen+ also convened a teen advisory committee that provided teenbased feedback on the system of care, helped develop the name and recruitment materials, and helped to
plan a large community-based event open to all Teen+ participants, which drew over 250 teens and raised
awareness of the Teen+ system of care in the community.
Very importantly, the various services and agencies participating in Teen+ were linked through a “continuum
of care” principle. The continuum of care component focused on the VanDenBerg or “wraparound” process,
which is characterized by an individualized, needs-driven, and family-centered approach to community-based
service provision, and relies on cooperation among multiple agencies and stakeholders (VanDenBerg, Bruns,
& Burchard, 2008). This principle was agreed to by all partner agencies, who went through extensive training
on providing services using this model.
4 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Center for Research on Women
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 5
The University of Memphis
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DESCRIPTION OF PARTICIPANTS
The CROW evaluation team coded and analyzed data entered by Success Coaches into the ShelbyConnect
system. A full analysis of this data can be found in Appendix B. As of December 2013, 603 client records
were input into the ShelbyConnect system. Although participant records were often incomplete (i.e., missing
items), a review of ShelbyConnect records reveals some information about the Teen+ participant population.
Demographics
The majority of Teen+ participants (89%) were girls and 92% of participants were African American. The
average age of participants in 2013 was almost 18 years old. The majority of Teen+ participants with data in
ShelbyConnect were served by Memphis City Schools (70%; with consolidation, now Shelby County Schools).
This was followed by Cathedral of Faith (15%), AGAPE (14%), and South Memphis Alliance (1%).
Educational Attainment
The majority of Teen+ participants with data in ShelbyConnect were enrolled in school (83%), whereas 11%
were not enrolled in school. Of the 603 cases in ShelbyConnect, 3% were reported as enrolled in elementary
or middle school, 59% were in high school, 5% had a high school diploma, and 1% had completed some
college.
Pregnancy and Parenting Overview
Of the 603 Teen+ cases entered into ShelbyConnect, 42% were pregnant at the time of enrollment in Teen+,
and 57% were parents at the time of enrollment. The majority of parenting teens (n=344) in Teen+ had
one child (69%) and 8% had two children. Almost all of the pregnant participants in the program reported
receiving prenatal care (93%).
The ShelbyConnect system included birth outcomes data reported by parenting teens, as well as some data
for pregnant teens that gave birth while working with a Success Coach. Overall, birthdates were entered for
182 babies, birth weights for 159 babies, and gestational ages for 114 babies. Of the 159 babies with birth
weight outcomes data entered, 23 babies (14%) were born at low birth weight (less than 5.5 pounds). Of
the 114 babies with gestational age data entered, 8 babies (7%) were born preterm (less than 37 weeks). Of
note, the majority of these babies were born before their mothers entered Teen+.
Goal Data
Each participant in Teen+ was asked by Success Coaches to set goals. Ten categories of goals were
identified in the system, and within each category there were several specific goals that teens could select
as a priority. Teens could have multiple goals in one or more category, but were not expected to have goals
in all categories. The ten categories of goals were economic, education, employment, financial stability,
health, housing stability, interpersonal relationships, mental health treatment, self-sufficiency, and social
development.
The vast majority of goals identified by Teen+ participants in the ShelbyConnect system were related
to education (73%), in part because the Success Coaches working in the schools focused primarily
on identifying educational goals, whereas Success Coaches outside the school system tended to help
teens identify a broader range of goals. Most teens identifying educational goals were working toward
graduating from high school or obtaining their GED (92%). Among those who identified non-educational
goals, employment (n=28), and housing (n=17) were the areas in which teens were most likely to seek
improvement.
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Case Study: Alisa
Alisa was fifteen years old when she found out she was
pregnant. She was afraid to acknowledge that her symptoms
might point to pregnancy, so she did not schedule an
appointment with a doctor until she was in her seventh
month of pregnancy. She worried about how her father, who
she described as “hard on her,” would react, so she did not
tell anyone about her condition. She recalled that her family
and friends discovered her pregnancy after her eating habits
changed and her pregnancy showed. “I was hiding it from
everybody. They knew about it though. My dad was the first
one that said something. He was like, ‘I know she pregnant.
She be eating all night!’”
After facing complications during her pregnancy, resulting in
an induced labor, Alisa gave birth to a boy. Her son is now
two years old and she is currently trying to gain employment
through Job Corps. Alisa found out about Teen+ through
a friend, and began working with a Success Coach who
worked to help her re-enroll in high school at the Adolescent
Parenting Program (APP) in downtown Memphis. After a
lifetime of unstable living arrangements, Alisa faced “a big
confusion” in regards to identification documents needed
to re-enroll in school and couldn’t access sufficient childcare
and transportation to sort it out. Eventually, she gave up
on returning to school. Alisa has already identified a potential employment opportunity and received bus
passes through Teen+ to help her obtain the identification necessary to start working. She would like
to apply for childcare subsidies through Families First, but does not qualify as she remains classified as a
dependent on her grandmother’s Department of Human Services case.
Teen+ has helped Alisa learn how to parent her son more effectively, and to handle stressful situations in
constructive ways. She noted that she also benefitted from access to the Baby Stores and referrals to Job
Corps and WIC. She said, however, that she still needs assistance to move out of her grandmother’s home
and into a place of her own. Alisa hopes to become more independent, and to provide the care her child
needs. This has proven to be a challenge, as both her father and her child’s father have passed away, and
she does not get along with her mother.
Many teen parents like Alisa find themselves in situations in which they feel alone. “So it’s like I’m just on
my own, then his [her son’s father] folks’ll get mad at me about something, and they’ll take it out on the
baby. … So I be just on my own, doing it by myself and stuff.” Although Alisa has faced hardships over the
past two years, she expressed gratitude for the support provided by the Success Coaches who worked with
her through the Teen+ Program. “I just need some help, that’s all.”
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EVALUATION FINDINGS AND RECOMMENDATIONS
The following sections represent findings of the evaluation team’s primary data collection, based on
structured surveys, interviews, and focus groups with Teen+ participants, Success Coaches, partner agency
staff, and/or program administrators. Data collection methods are described in Appendix A. This section is
organized by six key themes that relate to service delivery and program goals. Strengths and challenges are
noted throughout, and focused recommendations are made related to each theme.
Mechanisms of Service Delivery
Individualized Support
Pregnancy and childbirth can be an isolating
experience for teens. Among Teen+ participants,
pregnant and parenting girls in particular reported
experiencing shame, stigma, and social isolation.
Girls also report more frequent voluntary or
involuntary withdrawal from peer networks and
social engagements in order to focus on parenting
responsibilities. The issue of isolation was especially
significant for children in foster care as these teens
are less likely to have consistent family support.
“What we’ve found is the majority of our teens just like the
fact that we are encouraging them. That they have now
a relationship with someone that has bought into that, “I
can do this and she believes that I can do it, and so I am
going to do this.” Relationship for us has been very, very
important with our teens.”
- Success Coach
Boys also experienced some form of social isolation, although they were more likely to report withdrawal
from school and/or social activities as a result of pressure to seek work and provide financially for offspring.
Teen+ participants interviewed by the CROW evaluation team cited two primary sources of support: Success
Coaches and pregnant or parenting peers.
The overwhelming majority of teens interviewed expressed appreciation for their relationship with
Success Coaches. They stressed that Coaches often went above and beyond their prescribed program
responsibilities. In addition to connecting teens to resources, many Success Coaches provided emotional
support and cultivated rapport with the teens, offering a relationship that many teens lacked with their own
family and peers. Teens professed gratitude for the opportunity to speak openly without fear or shame,
and with the assurance that Coaches would
maintain confidentiality. Service providers
also acknowledged the importance of
individualized support in working with teens.
A few teens did not seem to forge strong
relationships with their Success Coaches.
These teens attributed the problem to lack
of communication and/or not seeing their
Success Coaches as often as they would have
liked. Similarly, providers explained that they
regretted not being able to provide consistent
extended support for their clients due to their
large case loads.
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Recommendations (Individualized Support)
•
•
•
•
•
•
•
Consider the capacity of caseloads for individual Success Coaches and set standards/expectations for each
agency based on the number of Success Coaches funded by the program.
Take into account time needed to effectively provide and sustain the personalized services and support
teens need.
Take into account the time needed to manage case records and input data into ShelbyConnect.
Connect teens to the Memphis Crisis Center, 901-274-7477 (CRISIS-7), which offers a 24/7 hotline for
parents in distress.
Use the Memphis Crisis Center hotline as an after-hours resource when Success Coaches are not
available.
Contract with CRISIS-7 to provide a Teen+ hotline with standardized materials relevant to the core goals
of the program.
Consider creating a 24/7 hotline specific to Teen+, which could be staffed by alternating “on-call” Success
Coaches. Peer Support
Along with support provided by community connectors, teens
and Success Coaches stressed the importance of peer support
provided by other teens in Teen+. Many teens expressed the
need for increased networking among Teen+ participants,
explaining that friendships among teen parents who were
experiencing similar situations provided a level of support and
information exchange that could not be found in other parts of
their lives. Teens also enjoyed the social component provided
by Teen+, such as the book signing event, and requested more
opportunities such as these.
“I like coming together with different girls,
and hearing their side of the story, and what
they go through, and you know, learning
new things. Like, everybody pitch in, and
we talk about things. Something I might
not know that she knew, that she said that
was helpful to me.”
- Teen
“I’ve got plenty of friends and
A few teens interviewed by the evaluators were also participants in another
family, don’t get me wrong, but
local program, Centering Pregnancy, which delivers prenatal care in a
sometimes I feel [alone] through
group setting. These teens reported satisfaction with the program’s social
this whole thing.”
dynamic.
- Teen
Recommendations (Peer Support)
•
•
•
•
Provide more opportunities for peer networking through group-based programming and social events for
pregnant and parenting teens.
Capitalize on the groups formed when administering the ACT curriculum in schools, and follow up with
another relevant curriculum such as Nurturing Parent or Community Voice to keep teens engaged with
each other while providing additional group-based support.
Form a “mother-to-mother” group in which teen mothers can come together to share advice and develop
bonds with each other.
Utilize existing local and national web and mobile resources that connect teens to support networks and
information resources (e.g., B4BABYLIFE and BABY2SLEEP mobile apps from the Shelby County Health
Department).
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 9
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Case Study: Paul
Paul is a notable Teen+ success story. He is seventeen
years old, and recalls that when he found out his
girlfriend was pregnant, he wasn’t ready to have a child.
He wanted to wait at least until after high school before
starting a family. Even so, Paul was happy to be a father
and enthusiastic about taking on the responsibility
of parenthood. “It happened, it’s a miracle, and it’s a
blessing, and so I’m happy I got [her].”
Paul and his girlfriend enrolled in Teen+ when she was in
her fifth month of pregnancy. Throughout the pregnancy,
Paul supported his girlfriend. He was told by doctors,
among others, that they rarely see teen fathers who are
so involved. “Everybody said that’s good, because mostly
every father don’t go to all the appointments, they glad to
see a young man to be at all her appointments and stuff.”
Paul was grateful for Teen+, especially for the material
support they accessed through the baby stores. He is
motivated to continue in Teen+ even when his girlfriend
withdraws next year, since she will be attending college.
Paul and his girlfriend’s Success Coach helped reduce
the burden of completing a pregnancy and managing a
child in their teen years. The relationship that Paul and
his girlfriend have with their Success Coach has been
supportive and encouraging. “She helps us out when
we need help, and she gives us rides to the meetings.
She told us to call her when we need anything, she’ll do
it.” He also learned about caring for his child from the
parenting classes they attended through the program.
Paul and his girlfriend’s initial plans are to secure jobs, and move out of their parents’ homes and into
an apartment together. Teen+ is helping him work towards their goal, not only through material support,
but also by providing opportunities to develop independent life skills. He plans to attend college after
completing high school, and is hopeful that his athletic abilities will secure admission, and his aspirations
will help him achieve success. He explained, “I got plenty of college recruiters looking at me. [The University
of Memphis] came to me my tenth grade year and liked how I played, so I’m trying to come over here so I
won’t go far from my family… I want to be the first one to graduate out of my family and go to college, play
football so I can go pro, help my family out.”
It is important to Paul to stay close to his girlfriend and daughter, and to provide a better life for them. “My
favorite part about being a parent is taking care of my child, and seeing the smile on her face, cause she
shows – she smiles every day… like she gonna be a daddy’s girl. But, I hope she do. But, right now, I’m still
trying to go to college and go pro and stuff, so she can have a beautiful future for herself.”
10 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
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Material Support
Teen pregnancy is strongly correlated with poverty, and nearly 80% of Shelby County teen mothers live in
households with incomes below $10,000 per year (Sagrestano, Finerman, Clay, Diener, Edney, & Madjlesi,
2012). Many teen parents in Shelby County grow up in low-income neighborhoods and remain there
after giving birth (Sagrestano et al., 2012 ). As a result, the task of meeting their children’s material needs
may be disproportionately difficult for teen parents. Teen+ sought to mitigate this burden through the
Baby Stores, which was among the most popular aspects of Teen+. As teens completed specific evidencebased tasks shown to contribute to goal-centered success (e.g., receiving prenatal care, attending parenting
classes, maintaining good grades), they earned “points” which could be used to purchase items in affiliated
Baby Stores (e.g., bottles, diapers, clothing, strollers). No cash was exchanged in Baby Stores. Almost all
teens interviewed by the CROW evaluation team expressed gratitude for this service, stressing that they
could spend their limited incomes on essentials like rent, transportation, or nutritious food. When asked in
interviews about their favorite aspects of Teen+, teens almost always listed the baby stores first.
The point system used by the Baby Stores likely provided additional long-term benefits as the activities
teens completed to earn points have been demonstrated to improve outcomes for parents and children.
Baby Stores were situated in five different areas of Memphis: Cathedral of Faith in Midtown, Hickory Hill
CRC in Hickory Hill/East Memphis, Impact Baptist Ministries in Northhaven, Rangeline CDC in Frayser, and
South Memphis Alliance in South Memphis. Most teens interviewed were satisfied with the Baby Stores in
terms of location, hours of operation, selection of products, and staff, and only a few reported difficulties in
accessing Baby Stores.
Some service providers expressed confusion in the protocol for awarding points, as well as the verification
and tracking process for earning and spending points. Many Teen+ participants have children up to the age
of five and initially reported that most Baby Store merchandize was designed for newborns and infants.
Teen+ administrators amended subsequent supply purchases to reflect this feedback from Success Coaches
and participants. Success Coaches also reported that some of the unique challenges faced by pregnant and
parenting teens (e.g., medically-ordered bed rest, transportation, childcare, or the health risks associated
with lifting or carrying heavier items while pregnant) complicated participants’ access to Baby Stores.
Since the initial funding of the Teen+ program has ended, representatives from each Baby Store, along
with additional service providers, have formed a “Baby Store Consortium,” which represents an important
sustainability component for Teen+.
Recommendations (Material Support)
•
•
•
Develop the protocol for point verification and train
all Success Coaches and Baby Store employees
(including volunteers) on this protocol prior to system
implementation.
Offer Baby Store ordering options online or over the
phone, using a personal password system.
Utilize Baby Store visits as teaching opportunities for core
messaging. Stock the physical sites with standardized
materials on health, education, parenting, and other
relevant information.
“It is very, very, very helpful, and it
relieves a lot of stress.”
- Teen
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Case Study: Simone
Simone is a sixteen-year-old mother with a
five-month-old daughter. She is a junior in
high school, and has been able to continue
her education despite having a child, at least
partially because she has managed to access
childcare through a combination of Families
First subsidies and financial support from her
mother. Simone often worries about the burden
her pregnancy might place on her mother, with
whom she lives. “I don’t want to depend on my
momma, because it’s not her fault that I have
a baby, it’s mine, so it’s pretty much that I ain’t
got no job, and I ain’t got no money to take care
of her.” The father of Simone’s daughter is four
years older than Simone. During her pregnancy,
Simone found it difficult to communicate with
her child’s father and his family because his
step-mother denied that the child could be
his. After a DNA test, however, paternity was
confirmed, and he and his family are beginning
to play a more active role in caring for the baby.
Initially, Simone was afraid to tell her mother
that she might be pregnant; instead she told
an older cousin who took her to a doctor
who verified her status. She then informed
her mother and received prenatal healthcare.
After discovering that she was pregnant,
Simone enrolled in Teen+, but health problems
experienced during her pregnancy made it
difficult for her to earn enough points to get everything she needed from the Baby Store when she “had to
go back and forth to the hospital.” It is common for teen parents to juggle high-risk pregnancies while trying
to balance other demands on their time and attention.
Simone did benefit from Teen+ despite the difficulty she had with earning points. In particular, she learned
parenting techniques that will help her raise her daughter. “It helped me… learn how to bond with my baby
and cope and all that stuff.” She asserted that the parenting classes taught her and other teen parents “how
to play with your baby, the difference between discipline… and punishment, and … not to let them look at
TV all day. Get them to play with games, like learning games.”
Simone also found that Teen+ helped her change behaviors that were not conducive to nurturing her child.
“It helped me become a better mother. I don’t party; I don’t go to clubs no more. I basically stay in the
house with my baby. … Because I like being with her, it makes me happier than out there, fighting and stuff
like that.”
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Referrals
Connecting teens to existing resources and helping teens navigate barriers to these services throughout
Shelby County is a major goal of Teen+. Such resources include healthcare for pregnant teens and their
children, parenting classes, home visitation programs, childcare, employment opportunities, and subsidy
programs such as WIC. The wraparound component of the Teen+ model is reflected in the referral system
structure intended to make these connections across Shelby County. This model was facilitated by the Early
Success Coalition Network (ESCN), which includes a network of community-based agencies and providers
who are available for referrals across a range of potential needs.
Teen+ Success Coaches worked with teens to identify needs and then made a referral based on expressed
needs to the appropriate agency within ShelbyConnect. These actions were designed to facilitate tracking of
the referral by the Success Coach, the agency or individual to which the teen was referred, and the evaluation
team. The internal referral system was designed to ensure that referrals are followed-up on, that teens’ needs
are appropriately addressed, and that evaluators can measure the success of referrals. However, this internal
system can only work with all partners on board, and several anticipated partners did not join ShelbyConnect,
or joined at a late date, leaving service providers confused as to who was available for referrals or which
technological mechanisms should be used for communication. As a result, the majority of referrals were
made outside of ShelbyConnect, making them difficult to track.
“I’ve been waiting for them for
the longest to call me, and this all
happened, like I said, my phone and
getting turned off, I lost connections,
and I never heard from anyone there
again.”
- Teen
Most teens interviewed indicated they did not receive a referral ,
but those who did receive referrals reported little or no difficulty in
accessing the resources to which they were referred, as that service
was most often a home visitation program. In only a few cases, teens
were aware of a referral being made, but were not able to access that
referral, for a variety of reasons.
Recommendations (Referrals)
•
•
•
•
Develop comprehensive and consistently reviewed lists
of available referral partners and ensure partners can
easily access this information.
Encourage all Early Success Coalition Network providers
to join the ShelbyConnect system, including providers
of ancillary services.
Develop a mechanism for all referral agencies that do
not purchase seats on ShelbyConnect to participate in
the referral feedback loop.
Provide incentives to Success Coaches and/or their
agencies for making referrals and following them
through to completion.
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Goals of Service Delivery
Healthcare
Prenatal care is a crucial component of a healthy pregnancy and research suggests that teen parents are
less likely than adults to receive prenatal care (Harville, Madkour, & Xie, 2012). However, all of the teens
interviewed reported that they or their pregnant partner received some form of prenatal care. Even so, few
teens were connected to their prenatal care provider through Teen+, usually because they began receiving
care prior to their enrollment in Teen+ or enrolled in Teen+ after the birth of their children.
Teens who received prenatal care followed different healthseeking trajectories: Some teens (or their mothers) suspected
a pregnancy and went directly to an OB-GYN, based on their
previous pregnancy experiences or those of their mothers and/
or friends. Other teens experienced symptoms associated
with pregnancy and visited a primary care physician, who then
provided prenatal care or referred them to an OB-GYN. A few teens sought care from the Regional Medical
Center at Memphis (The MED), where they were automatically enrolled in prenatal care. Relatively equal
numbers of teens expressed satisfaction and dissatisfaction with their prenatal care providers.
“I went to the doctor, because I had an
infection somewhere, I thought. The test came
back that I was actually pregnant.”
- Teen
Some teens reported transportation as a barrier to
accessing prenatal care, but many agency supervisors
and administrators believed that late disclosures
of pregnancy was the primary reason teens did not
receive prenatal care. The issue of late disclosures
was especially true for teens within the school system
who had the opportunity to receive prenatal care from
internal school-based healthcare services, but disclosed
their pregnancy after the deadline to qualify for such
services. Of the 51 teens interviewed, 33 reported
finding out about their or their partner’s pregnancy
during the first trimester, 8 during the second trimester,
and 4 during the third trimester (6 teens interviewed
did not disclose this information).
“We catch the teens late in their pregnancies. When
we engage them, everything is an emergency.”
- Agency Supervisor
“I know that since we have started, we’ve had one
premature baby delivered, and one still birth, still born
baby. Again, those teens, we did not have access to
until their eighth and ninth month of pregnancy.”
- Succcess Coach
When asked what kinds of activities teens completed in order to earn points, many participants mentioned
that attending doctor’s appointments for themselves and/or their children was a major point-earning activity.
This may be listed as a success of the program as it incentivizes sustained compliance with prenatal and postnatal healthcare appointments.
In addition to increasing pregnant teens’ access to prenatal care, another goal of Teen+ was to postpone
subsequent pregnancies, specifically through education and contraception. Some program grantees
partnered with local programs (e.g., Free Condom Memphis, A Step Ahead Foundation) to ensure that
participants had access to contraception after childbirth. Some partners were unable or unwilling to discuss
contraception with teens, as per agency policies. Some Success Coaches also felt unprepared to converse
with teens about birth spacing strategies, as they were not trained healthcare providers or educators.
14 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Center for Research on Women
Recommendations (Healthcare)
•
•
•
•
•
•
•
Develop core messages related to healthcare, based on grant goals.
Provide Success Coaches with a standardized set of information and trainings based on these core
messages and make resources based on core messages available to teens, through online and mobile
resources.
Make print materials related to core messaging available in Baby Stores.
Provide standardized training to all program partners to increase content knowledge and comfort
discussing healthy sexuality and contraception.
Continue incentivizing healthcare visits, and expand this to include behaviors that encourage pregnancy
prevention and good interconception health, including birth spacing.
Create new opportunities to discuss healthy sexuality topics within programming that participants already
receive.
Require funded partners to fully enact the core programmatic goals.
Education
Educational attainment is often problematic for pregnant
and parenting teens. Pregnancy or childbirth can prevent a
teen from attending school due to the sociocultural stigma
associated with teen pregnancy, healthcare issues, or lack of
childcare. One of the goals of Teen+ was to help teen parents
stay in school. Many teens were able to accomplish their
educational goals, sometimes due to the personalized services
provided to teens through their Success Coaches. Many of
the teens interviewed had recently graduated high school, and
others were looking forward to graduation in the near future.
A few were enrolled in local colleges whereas others were not
attending school, but reported plans to return to high school,
obtain a GED, or enroll in college. Few participants interviewed
had not obtained a high school diploma or GED, were not
attending school, and had no plans to re-enroll in school.
Overall, teens were optimistic about their educational goals.
“She [Success Coach] has changed my life
about me going back to school, because at
first I didn’t want to go back to school, I just
wanted to get a job and just settle down and
be on my own. But she told me that going
back to school would help me succeed more,
so now she’s helping me get back into [school]
so I can better myself.”
- Teen
“Most of us don’t have babysitters. And most folks
don’t trust a lot of people with their babies, and
sometimes they don’t want go to school no more,
because they don’t trust other people.”
- Teen
“Well, the only reason I haven’t put her in
daycare, I saw this daycare on Facebook. The
little boy was kicking the babies in the head, and
he was shaking them.”
- Teen
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 15
The University of Memphis
Center for Research on Women
The primary barrier to attending school reported by teens
was childcare. Many teen parents rely on family members for
childcare, which can be inconsistent and/or contingent on volatile
relationships. Because teens living in poverty are often considered
dependents of their parents, they may not be eligible for their own
case with Department of Human Services, which disqualifies them
from subsidized childcare services. Teens and service providers
acknowledged that in some cases, childcare is a barrier because teens
do not trust center-based care and so opt to stay home from school if
they cannot secure childcare from a family member.
“What became a problem with quite
a few of my students is, ‘Well, I don’t
have anyone to watch my child, so I
couldn’t come to school today.”
- Success Coach
Other barriers to education reported included lack of support from family members, the fatigue associated
with managing school and parenting, transportation, lack of school uniforms that fit pregnant teens, and
bullying or harassment from classmates in regards to their pregnancy. For some teens, the barriers to
completing high school were mitigated by the SCS Adolescent Parenting Program, which provides on-site
childcare. Other teens reported that Teen+ incentivized their success in school by rewarding points for
reports of good behavior and/or grades. One Success Coach in particular worked to make college recruiters
aware of the special needs of teen parents who want to go to college. Other Success Coaches provided
resources and support that helped teens re-enroll or encouraged them to stay in school, obtain their GEDs, or
fill out college applications.
Recommendations (Education)
•
•
•
•
•
•
•
Create standardized materials and resources about quality
childcare and the Tennessee childcare rating system to
address distrust in public childcare facilities. Include
information that empowers parents to make informed
decisions about childcare options.
Request input from the Department of Human Services to
develop toolkits that allow Success Coaches to help teens
more successfully navigate the childcare subsidy application
process. Invite DHS to train Success Coaches on the
childcare subsidy application process.
Facilitate a discussion with the Department of Human
Services to review policies that do not accommodate the
unique circumstances of teen parents.
Regularly assess barriers to educational goals.
Invest resources in the Adolescent Parenting Program (APP)
to increase accessibility of the program. Allow students to
complete their high school degree (or equivalent) at the
APP. Provide transportation to increase the range of students who are able to attend this school.
Increase the support and safety net around kids who are in school to help keep them continuously
enrolled and progressing and reduce barriers to re-enrollment for students who drop out after a
pregnancy/birth.
Expand access to high quality, subsidized childcare on school grounds so that teen parents can attend
classes while remaining on-site with their children.
16 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Parenting
Center for Research on Women
“I already know about parenting. My
mom got nine kids. My auntie got nine
right behind her. I know about kids.”
- Teen
Becoming pregnant and having a child at a young age forces a
teen to assume adult responsibilities at an earlier age than they
would otherwise. Some teens have prior experience caring for
younger siblings or other children, but many are unprepared for the
challenges of parenting. To address this issue, Teen+ included “They are watching their parents, and they are
a focus on connecting teens to existing parenting programs,
parenting the way they have been parented,
although there were a range of service delivery experiences.
which is not always the best.”
- Success Coach
Programming for Teen+ participants enrolled through SCS
focused almost exclusively on the Adults and Children
Together Against Violence (ACT) curriculum, an evidencebased, primary prevention program designed for caregivers. Non-SCS
“It’s helping me learn about more
participants received either individualized parenting counseling with their
about her and how her mind
Success Coaches, classes offered by the Teen+ agency with which they
works …The parent’s class—it
were enrolled, or were referred to parenting classes provided by partner
broadened my horizon.”
agencies in Shelby County. Such programs ranged from group-based
- Teen
curricula to home visitations. Some examples of non-Teen+ parenting
class providers include LeBonheur Children’s Hospital, Porter-Leath, and
the Healthy Start Initiative.
Specific parenting skills that teens reported learning included the benefits of and strategies for successful
breastfeeding, promoting cognitive development, and infant mortality prevention. Students who received the
ACT curriculum primarily reported learning about discipline techniques and violence prevention.
In addition to parenting skills, an emergent area for Teen+ to address, as reported by teens and service
providers, was support for cultivating independent living skills and strategies for teens to grow into
responsible adults. Success Coaches accomplished this through personalized services, guiding teens through
activities such as balancing a budget or preparing for higher education. Teens could also attend healthy
cooking classes provided by partner agencies. Incentivizing school attendance and health-seeking behaviors
with points that could be spent at Baby Stores imparted lessons on responsibility and budgeting.
Recommendations (Parenting)
• Identify relevant partners for life skills training referrals (e.g., financial literacy,
nutrition) and include them in ShelbyConnect.
• Create a standardized list of skills that each teen should master, assess during
intake, and refer to appropriate partners for skills that need support.
• Identify culturally-relevant curricula that address a wider variety of needs and are
specific to programming goals.
• Based on programmatic goals, develop standardized messaging about parenting
and provide training and resources to Success Coaches.
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 17
The University of Memphis
Center for Research on Women
Case Study: Calvin
Calvin is nineteen years old, and he and his girlfriend
have one child. After enrolling in Teen+, they
benefitted from the point system and the material
support offered by the Baby Stores. This helped
them manage their newborn’s immediate material
needs, “like getting things outta the way, like, big
things … we had got mostly things like baby seat, car
seats, and strollers, and stuff like that. We basically
got the big stuff out the way now… So it’s basically
really helpful. It’s a good program.”
Calvin is not currently attending school, but he hopes
to enroll in a trade school in the near future, saying
“it kind of sounds hard, but I know I can do it.” He
is on probation at the moment, and is struggling
with finding employment to support himself and his
family. When asked to identify the most difficult part
of being a young parent, he responded “When you’re
unemployed, the hardest thing is getting a job. That’s
basically the hardest thing. I mean, you can do all
this old application stuff, it just don’t work no more.”
Problems at home add to the stress of Calvin’s life
as a teen parent. He and his girlfriend live apart with
their respective families, and he explained that their
housing conditions are neither ideal nor conducive
to raising a healthy family. However, he finds
encouragement in his interactions with their Success
Coach, and in the education he receives from the
Coach and the Teen+ parenting classes. “She asks
us what we need and we just work it out from there. She makes sure everything go as planned, she makes
sure we working, makes sure we’re doing our part as a parent.”
Despite the barriers Calvin and his girlfriend face, Teen+ has provided a support system that increases
the prospects that they will achieve their goals as a family and Calvin is grateful for new opportunities to
succeed. “It’s a good program, love the program. It’s one of the best programs I’ve ever been in, really.… I
just want to say thank y’all. … Thank you, and thank you again, and thank you some more.”
18 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Center for Research on Women
External Challenges
Teen pregnancy and parenting strongly correlate with poverty. Research indicates that nearly all teenagers
giving birth in Shelby County in 2009 lived in poverty (Sagrestano et al., 2012). Success Coaches provided
feedback which indicated the ways in which issues related to poverty impacted the implementation of
Teen+. Based on this feedback, the evaluation team designed survey measures to assess levels of housing,
transportation, and food security among a non-random sample of program participants. The survey was
completed by 50 Teen+ participants and the full results of this data can be found in Appendix C. Teens also
reported information on this topic in interviews. A summary of interview data can be found in Appendix D.
Almost half of survey respondents (46%) reported that their families supported them, and a quarter (24%)
relied on Families First as their main source of income. Teens and service providers often reported that teen
parents have significant financial and employment concerns. In interviews, 14 teens expressed a need for
employment assistance, with several others reporting that they experienced transportation and/or childcare
barriers to employment. Only 36% of teens responding to the survey reported consistent access to reliable
transportation. In interviews, many teens indicated that they received transportation assistance from family
members or their Success Coach, but 21 teens specifically reported needing
“You’re dealing with the inner
help securing reliable transportation. Teens and Success Coaches noted
city. Transportation is a huge
that transportation vouchers provided by grantee agencies alleviated some
problem, huge.”
transportation barriers, but the need was not addressed systematically by
- Success Coach
Teen+.
A series of survey items asked teens about their experiences with housing and housing
“Safe housing is
insecurity. Although the majority (76%) reported that they always had a regular, safe,
one issue, because
and secure place to live, fully 24% reported at least some experience with housing
out of the whole
insecurity, and only 58% of the teens reported that they never worried about losing
week, I’ve heard
their housing. In addition, almost half of teens indicated on the survey that they were
gunshots across
forced to move out of their family home because of pregnancy or the birth of a child,
my door, back-toand 30% felt unsafe in their current neighborhood. Finally, 6% had spent the night in
back.”
a shelter and 8% had spent the night outside or on the street. Although not every teen
- Teen
disclosed their current living arrangements during interviews, many teens discussed the
insecurity of their housing arrangements. Some teens remained in foster care, but the
majority of teens interviewed lived with family members other than their partners, although many of these
expressed the desire to live with their partner and child in a single-family housing arrangement. During
interviews, 4 teens described being forced to move due to their pregnancy and 14 teens expressed an explicit
need related to housing.
More than a quarter of the teens in the survey sample reported worrying about their safety or the safety of
their children because of someone close to them. This suggests that the link between interpersonal violence
(IPV) and housing insecurity found in other samples may be partially responsible for housing difficulties
experienced by some of the teens in Teen+.
“I think the most difficult thing
for me is ... being stable enough
for my baby. Having a stable
place to stay, a stable job, stable
transportation and reliable
transportation.”
- Teen
Food insecurity was more prevalent than housing insecurity in the sample of
teens surveyed. More than half (54%) reported running out of food before
they had money or food stamps, at least some of the time. One quarter
(26%) cut the size of their meals because there was not enough food in
the household. Finally, at least one fifth reported worrying that they or their
children were not receiving the amount of food needed.
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 19
The University of Memphis
Center for Research on Women
Other external challenges proved to be less tangible. Both teens and
“They [family members] expected
service providers spoke about the sociocultural stigma related to moral
for me to just go to school and go
characterizations of teen pregnancy. Pregnant and parenting teens
to college without children. And
sometimes experienced verbal harassment from peers, relatives, and/
then, when they found out I was
or community members in regards to their pregnant or parenting
pregnant… they just act like they
status. The stigma related to teen pregnancy was also experienced
didn’t trust me no more.”
as an internalization of others’ unexpressed perceptions or a fear of
- Teen
anticipated rejection or harassment. In the experiences of teens and
service providers, pregnant teens often wait to disclose their pregnancy
status due to this fear. Teens may tell a friend or their sexual partner about their pregnancy, but wait to tell
other relatives or peers. Out of 51 teens interviewed, several mentioned negative perceptions or stereotypes
of teen parents, and 17 teens indicated that they waited to tell an adult that they were pregnant. In some
cases, teens faced consequences for their disclosure, including loss of housing or financial support from
parents or other family members. This delay in disclosure can result in a subsequent delay in seeking
prenatal care and/or exclusion from programs like Centering Pregnancy, which require women to enroll
during their first trimester.
“What I like about Teen+ is that it gives
young ladies my age range a look at what
we can do. And, it also help us as young
women to grow older and know what’s
best for us in life.”
- Teen
Teen+ was effective in mitigating some of the stigma experienced
by participants through support from Success Coaches and peers.
Some interviewees voiced surprise that anyone would help teen
parents, especially to do so without judgment, and were grateful
for the safe spaces that Teen+ created.
Recommendations (External Challenges)
•
•
•
Screen regularly for housing, transportation, and food insecurity as well as for interpersonal violence.
Allow ample time to identify and respond to external challenges when developing a system of care.
Financially structure grant proposals to address external challenges that have a significant impact on
teens’ pregnancy and parenting experiences. Implementation Challenges
Pilot Programs require continuous appraisal and adjustment to produce more efficient and effective
programming. During the first three years of Teen+, issues related to process and communication emerged
as barriers to successful implementation. Some of these issues were outside the control of program
administrators or service providers, but merit coverage in this evaluation.
Multiple levels of bureaucracy resulted in delayed funds, which stalled the process of program design and
delivery. Insufficient time allocated for planning before implementation led to simultaneous design and
implementation of the system of care, which in turn led to policies and trainings for service providers being
developed or changed throughout implementation. Success Coaches requested standardization related
to messaging around core goals, policies, and trainings to facilitate a more standardized experience for
participants and ensure quality control.
20 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Within Teen+, some service providers reported
communication challenges among other service providers
and administrators. Success Coaches expressed frustration
with policies regarding enrollment territory and noted overlap
in case management services provided to participants.
Service providers also described the ShelbyConnect system
as “not user-friendly at all” and the first three years of
implementation focused on inputting information into
ShelbyConnect as opposed to using the system as a service
provision tool. A few Success Coaches added concerns about
wording within the system.
Center for Research on Women
“How does that information get back to the
case manager? Do I know the case manager
well enough? Do I send an email? What
happens with their care beyond that? Who is
the person who signed this point sheet? Do I
have their email address when I send it? Do
we actually follow up?”
- Success Coach
“I feel like it just never was taken into
account what we, the field people,
hands-on, are actually experiencing.”
- Success Coach
It should also be noted that the overwhelming majority of program
participants were female, although efforts were made to recruit more
teen fathers. This disparity in enrollment may reflect age-discordant relationships, in which the fathers of
children born to teen mothers are older. In addition, the gendered context of teen pregnancy results in girls
disproportionately shouldering the burden of responsibility, both physically and socio-culturally (Sagrestano et
al., 2012). As one teen boy remarked in an interview, “Pregnancy is for the ladies, and Teen+ is for the ladies.”
Recommendations (Implementation Challenges)
•
•
•
•
•
•
Develop standardized messaging on all core goal topics, accompanied by training, outreach materials, and
web-based resources.
Create greater specificity with respect to action-based protocols for Success Coaches in the system of care
manual and flowcharts.
Establish clear communication guidelines among partners.
Facilitate peer networking among Success Coaches to provide mutual support and insight.
Hire both men and women as Success Coaches to increase likelihood of teen father participation.
Recruit program participants directly from community-based organizations or programs geared specifically
towards young men. Recommendations for System Sustainability
Teen+ has made progress towards addressing teen pregnancy and parenting in Shelby County. Over 600
teens were served, with many reporting satisfaction with their experiences. As the system transitions into its
last funded year, grantees should consider plans for the future.
The following are recommendations from the evaluation team in regards to sustainability:
•
•
•
•
•
Develop sustainability/transition plans as part of program design and implement in the last year of
funding.
Facilitate networks of service providers that build partnerships that can continue post-funding.
Consider scaling down and providing all coaching in the context of the Baby Stores.
Standardize policies, protocols, and training.
Develop infrastructure that allows agencies to continue programming after start-up money is depleted.
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 21
The University of Memphis
Center for Research on Women
APPENDIX A: SUMMARY OF RESEARCH METHODS
The evaluation team used multiple methods to collect primary and secondary data on the Teen+ Program in Shelby
County. Primary methods included surveys, interviews, and focus groups. Secondary data was also collected from
the ShelbyConnect system. For all methods, the evaluation team collaborated with grant partners in designing
and executing collection protocols. Participation in the evaluation did not affect the services received by Teen+
participants, although Teen+ enrollees who participated in the evaluation did receive incentives from CROW in the
form of gift cards, as well as an incentive from the Teen+ program in the form of Baby Store points. Parental Consent
was obtained for all participants under the age of 18. Participants over the age of 18 gave consent for themselves,
and all participants provided informed consent. All methodologies were reviewed and approved by the University of
Memphis Institutional Review Board for the protection of confidentiality and the rights of participants. All data and
recordings are securely stored in locked cabinets accessible only to the research team, and all identifying information
has been removed.
Secondary Data. The evaluation team received training for the ShelbyConnect system and was granted access to
data entered by all grantee agencies. CROW received data from system administrators, which was then coded and
analyzed by the evaluation team using statistical software.
Survey. A 10-page, self-administered survey was given to 50 teens enrolled in the Teen+ program. The survey
included eight pages that were used during the Shelby County Teen Pregnancy and Parenting Needs Assessment,
which elicited a broad range of information from teens, including demographic and background information, sexual
history and behavior, pregnancy and parenting history, family dynamics, and mental health factors. The evaluation
team developed two additional pages for the evaluation survey, which included measures of housing, transportation,
and food security based on measurements used by the U.S. Department of Housing and Urban Development. Teens
were recruited in by Success Coaches in Summer 2013 for interviews and surveys, and surveys were completed
while teens waited to be interviewed. Collection sites were determined collaboratively by the evaluation team and
Success Coaches. Names were not associated with surveys in any way. Survey participants received a $10 gift card
immediately upon completing the survey.
Survey data was processed, coded, and analyzed by the evaluation team using statistical software.
Teen+ Participant Interviews. Semi-structured, one-on-one interviews with Teen+ enrollees were conducted by
trained members of the evaluation team. Interview measures were designed to elicit information from teens in
regards to both their pregnancy experiences and their experiences in the Teen+ program. Teens were asked to
provide direct feedback on the successes and challenges of the program and recommendations for improvement. A
total of 55 interviews were conducted. Interviews were digitally recorded with consent from teens. Names were not
used in recordings or transcriptions of interviews. Teens who were interviewed received a $25 gift card immediately
upon completing the interview. Interview data was transcribed, coded, and analyzed by the evaluation team using
qualitative analysis.
Focus Groups. Two focus groups were conducted simultaneously with participants separated into direct service
providers (i.e., Success Coaches) and administrators. The administrative group included agency supervisors and
program administrators. An additional focus group was conducted on a different date with Shelby County School
system Success Coaches. Focus group participants were asked to provide their understanding of the program,
perspectives on the strengths and challenges of the program, and recommendations for improvement. Names were
not used in focus group transcripts and responses were kept confidential. Focus group data was transcribed and
analyzed by the evaluation team using qualitative analysis. A total of n participants participated in the three focus
groups.
Online Satisfaction Survey. A survey regarding user satisfaction with the ShelbyConnect system was created using
Qualtrics survey software. An individualized link was distributed to all funded partners via e-mail on five separate
occasions over the course of a month. The survey could be taken only once and respondents provided their initials to
indicate informed consent. No names were attached to the survey and responses were kept confidential. However,
only 10 grantee partners responded to the survey so those results were regarded with caution. 22 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
Center for Research on Women
The University of Memphis
APPENDIX B: SUMMARY OF TRACKING DATA EXTRACTED FROM
SHELBYCONNECT
Data from the ShelbyConnect data system was downloaded on December 9, 2013, and included all entered
cases for teens enrolled in Teen+ from implementation through August 31, 2013, or 603 cases. The variables
selected for presentation include basic demographic information, provider information, pregnancy and
parenting information, educational information, and goals identified by teens. Participants for whom data had
not been entered into the ShelbyConnect system are listed as missing.
Demographic Data
Participants included 603 teens aged 19 and under at the time of enrollment. The demographics of the
sample are as follows:
•
•
•
Gender: 89% girls, 8% boys
Race: 92% African American, .5% White, 3% other
Average Age in 2013: 17.9 years
DEMOGRAPHIC INFORMATION
600
555
535
TEEN YEAR OF BIRTH
200
173
180
160
500
NUMBER OF TEENS
140
400
121
120
101
100
300
80
200
64
60
45
39
40
100
48
20
19
8
20
White
Missing
20
Boys
Missing
African
American
Other
17
4
2
0
0
Girls
30
6
1992
(21)
1993
(20)
1994
(19)
1995
(18)
1996
(17)
1997
(16)
1998
(15)
1999
(14)
2000
(13)
1
2003 Out of Missing
(10) Range
Success Coach Information
The majority of Teen+ participants with data in ShelbyConnect were served by the Memphis City Schools
(70%; now Shelby County Schools). This was followed by Cathedral of Faith (15%), Agape (14%), and South
Memphis Alliance (1%).
NUMBER OF TEENS
ENROLLMENT BY AGENCY
450
400
350
300
250
200
150
100
50
0
425
83
88
Agape
Cathedral of
Faith
7
MCS/SCS
South
Memphis
Alliance
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 23
Center for Research on Women
The University of Memphis
Educational Outcomes
The majority of Teen+ participants with data in ShelbyConnect were enrolled in school (83%), whereas 11%
were not enrolled in school. Of the 603 Teen+ participants, 3% were in elementary or middle school, 59%
were in high school, 5% had a high school diploma, and 1% had some college.
200
CURRENT EDUCATIONAL ATTAINMENT
188
180
SCHOOL ENROLLMENT
160
600
140
499
NUMBER OF TEENS
NUMBER OF TEENS
500
169
400
300
200
120
100
92
80
60
69
100
34
0
In School
Not in School
49
48
40
20
Missing
30
19
6
Missing
Some
college/
college
degree
HS
diploma
12th (no
diploma)
11th
10th
9th
5th-8th
0
Pregnancy, Parenting, and Birth Outcomes
Of the 603 Teen+ participants entered into the ShelbyConnect system, 42% were pregnant at the time of
enrollment in Teen+, and 57% were parents at the time of enrollment. The majority of parenting teens
(n=344) in Teen+ had one child (69%), whereas 8% had 2 children. Almost all of the pregnant participants
in the program were receiving prenatal care (93%).
PREGNANCY AND PARENTING STATUS
254
290
Pregnant
NUMBER OF TEENS WITH CHILDREN
59
250
238
213
Parenting
Yes
46
No
Missing
0
150
100
77
50
235
13
6
Prenatal Care
(pregnant only, n=254)
NUMBER OF TEENS
200
344
28
0
One Child
100
200
300
Two Children
400
NUMBER OF TEENS
24 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
Missing
The University of Memphis
Center for Research on Women
The ShelbyConnect system included birth outcomes data reported by parenting teens, as well as some data
for pregnant teens that gave birth while working with a Success Coach. Because it is unclear how many
children should be represented in the system, it is impossible to accurately calculate percentages, however,
there were birthdates for 182 babies, birth weights for 159 babies, and gestational ages for 114 babies. Of
those with birth outcome data entered, 23 babies (14%) were born low birth weight (less than 5.5 pounds),
and 8 babies (7%) were born preterm (less than 37 weeks), although the majority of these babies were born
before their mothers entered Teen+.
NUMBER OF CASES WITH CHILD BIRTH
DATE, BIRTH WEIGHT, AND GESTATIONAL
AGE INFORMATION IN SHELBYCONNECT
200
182
180
159
NUMBER OF CASES
160
140
114
120
100
80
60
40
23
8
20
0
Birth Date
Birth Weight
Gestational
Age
LBW (<5.5 Preterm (<37
lbs)
weeks)
Goal Data
Each participant in Teen+ was asked to set goals. Ten categories of goals were identified in the system,
and within each category there were several specific goals upon which teens could choose to work. Teens
were not expected to have goals in all categories. The ten categories of goals were economic, education,
employment, financial stability, health, housing stability, interpersonal relationships, mental health treatment,
self-sufficiency, and social development.
The vast majority of goals identified by Teen+ participants in the ShelbyConnect system were related
to education (73%), in part because the Success Coaches working in the schools focused primarily on
identifying educational goals, whereas other Success Coaches helped teens identify a broader range of goals.
Most teens identifying educational goals were working toward graduating from high school or obtaining their
GED (92%). Among those who identified non-educational goals, employment and housing were the areas
teens were most likely to want to improve.
GOAL CLASSIFICATION
EDUCATIONAL GOALS
513
500
400
300
200
100
0
121
1
28
3
5
17
2
3
6
2
NUMBER OF RESPONSES
NUMBER OF GOALS
600
500
458
400
300
200
100
0
4
Re-enroll in
HS
Graduate HS
13
7
Get GED
Enroll in
classes
27
Graduate
College
2
2
Improve
Educational
Achievement
Improve
Attendance
Over School
Term
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 25
The University of Memphis
Center for Research on Women
APPENDIX C: SUMMARY OF HOUSING, TRANSPORTATION,
AND FOOD SECURITY SURVEY DATA
The CROW housing survey was completed by 50 Teen+ participants at the time of their qualitative interview.
Because the majority of the sample (90%) was girls, comparisons were not made by sex. The sample is not
a random sample of the teens that participated in Teen+, and should not be considered representative of all
teens participating in the program.
Demographic and Background Data
Participants included 50 adolescents aged 19 and under. The demographics of the sample are as follows:
•
Gender: 90% girls, 10% boys
•
Race: 96% African American, 2% Hispanic, 2% other
•
Sexual Orientation (self-identified): 96% heterosexual, 2% bisexual
•
Employment: 22% currently employed, 44% had been employed at some point in their lifetime
Almost half of the sample (46%) reported that their families supported them, and a quarter (24%) relied on
Families First as their main source of income (Note: Participants could choose more than one main source of
income). Only 36% of teens reported consistent access to reliable transportation.
MAIN SOURCE OF INCOME
50
46
45
40
Percent
35
30
24
25
20
14
15
10
10
10
10
6
5
0
Full-time job Part-time job Families First
SSI/SSDI
Partner
Family
Other
HOW OFTEN CAN YOU ACCESS
RELIABLE TRANSPORTATION
WHEN YOU NEED IT?
40
30
Percent
36
32
26
20
10
6
0
Never
Sometimes
Often
Always
26 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
Center for Research on Women
The University of Memphis
Housing Security
A series of items asked teens about their experiences with housing and housing insecurity. Although the
majority (76%) reported that they always had a regular, safe, and secure place to live, 24% reported at least
some experience with housing insecurity, and only 58% of the teens reported that they never worried about
losing their housing. In addition, 22 teens (44%) were forced to move out of their family home because of
pregnancy or birth of a child, and 30% felt unsafe in their current neighborhood. Finally, 6% have spent the
night in a shelter and 8% have spent the night outside or on the street at least once.
HOW OFTEN DO YOU HAVE A REGULAR, SAFE,
AND SECURE PLACE TO LIVE, WITHOUT FEAR OF
BECOMING HOMELESS IN THE NEAR FUTURE?
80
76
70
60
Percent
50
40
30
20
10
0
14
4
Never
6
Sometimes
Often
Always
HOW WORRIED ARE YOU THAT YOU
MAY LOSE YOUR CURRENT HOUSING
BECAUSE YOU CAN'T AFFORD IT?
70
60
58
Percent
50
40
30
22
20
10
10
10
Very worried
Don't Know
0
Not worried
Somewhat worried
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 27
The University of Memphis
Center for Research on Women
HOUSING SECURITY EXPERIENCES
74
Were you forced to move out of your family's
home because of pregnancy or birth of a child?
22
66
Are you currently staying in a neighborhood
that you think is unsafe?
30
No
92
Have you ever spent the night in a shelter?
6
Have you ever spent the night outside or on the
street because you didn't have any place else to
go?
Yes
92
8
0
10
20
30
40
50
60
70
80
90 100
Percent
More than a quarter of the teens in the sample reported worrying about their safety or the safety of their child
because of someone close to them. This suggests that the link between interpersonal violence (IPV) and
housing insecurity found in other samples may be partially responsible for housing difficulties experienced by
some of the teens in Teen+.
Percentage Responding Yes
HOW WORRIED ARE YOU ABOUT THE
SAFETY OF YOU OR YOUR CHILD BECAUSE
OF SOMEBODY CLOSE TO YOU?
80
70
60
50
40
30
20
10
0
72
22
Not worried
Somewhat worried
4
2
Very worried
Don't Know
28 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
Center for Research on Women
The University of Memphis
Food Security
Food insecurity is more prevalent than housing insecurity in this sample in this sample of teens. More than
half (54%) reported running out of food before they had money or food stamps at least some of the time.
A quarter (26%) cut the size of their meals because there was not enough food in the household. Finally, at
least a fifth reported worrying that they or their children were not receiving the amount of food needed.
FOOD SECURITY EXPERIENCES
4
How often do you run out of food
before you have the money or
foodstamps to buy more?
12
38
46
Always
Often
2
How often do you cut the size of your
meals because there is not enough food
for everyone in the house?
Sometimes
4
Never
18
74
0
10
20
30
40
50
60
70
80
Percent
Percent
HOW WORRIED ARE YOU THAT YOU OR
YOUR CHILD IS NOT RECEIVING THE
AMOUNT OF FOOD S/HE NEEDS?
90
80
70
60
50
40
30
20
10
0
78
Not worried
10
10
Somewhat worried
Very worried
2
Don't Know
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 29
The University of Memphis
Center for Research on Women
APPENDIX D: SUMMARY OF INTERVIEW DATA
Interviews were conducted with 55 Teen+ participants by trained members of the evaluation team. Interviews
were recorded and transcribed and qualitative analysis was performed on the data. Four recordings were lost
due to technological issue. The summary included here represents 51 interviews with 46 girls and 5 boys.
Although this sample size represents about 10% of the number of teens enrolled in Teen+, interviews were
conducted with a non-random sample of participants recruited for interviewing by Success Coaches. Thus, the
representativeness of this data should be regarded with caution.
Individualized Support
Many teens reported that a lack of support from their partner or families was one of the most significant
hardships they or other teen parents faced. The majority of teens expressed high levels of satisfaction with
the relationship they had with their Success Coaches and often referred to this relationship as a major source
of support in their lives. Teens sometimes used familial terms to describe their Success Coaches, especially
in instances where teens had little or no support from their biological families, as was often the case with
teens in foster care. Teens reported receiving tangible attention or support from their Success Coach in the
form of home visits, teaching parenting skills, or assistance applying for schools, jobs, and/or a variety of social
services. Teens also reported receiving emotional support from Success Coaches in the form of listening and
advisement or encouragement. All but one teen interviewed described their Success Coach in positive terms.
Peer Support
When asked to describe their favorite aspects of the Teen+ program, teens often spoke about the peer support
they received during group-based programming. Teens explained that they often felt judged or rejected by
peers or relatives due to their pregnancy status and that Teen+ provided a space free of judgment. In addition
to feeling comfortable around teens with similar experiences, interviewed teens stated that they exchanged
information about parenting strategies and resources with other pregnant and parenting teens. Increasing
social networking opportunities among teen participants was a top suggestion from teens for programmatic
improvement. Teen mothers specifically requested “mother-to-mother” groups and programming to which
they could bring their children.
Food Security
Food insecurity is more prevalent than housing insecurity in this sample of teens. More than half (54%)
reported running out of food before they had money or food stamps at least some of the time. A quarter
(26%) cut the size of their meals because there was not enough food in the household. Finally, at least a fifth
reported worrying that they or their children were not receiving the amount of food needed.
Material Support
Teens expressed a high level of satisfaction with the material support they received from Baby Stores and
generally regarded Baby Store products to be of high quality, while also acknowledging that Baby Store
inventories were limited in their offerings for children older than one year. Very few teens reported difficulties
in accessing the Baby Stores and these difficulties were typically related to hours of operation. Baby Stores were
overwhelmingly reported to be the most popular aspect of the program and the component that distinguished
Teen+ from other programs available to teen parents. Many teens indicated that they did not think they would
have been able to meet their children’s needs without this source of material support.
30 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Center for Research on Women
Referrals
Teens were asked about referrals made through Teen+. Many teens were unfamiliar with the referral process
and almost no teens reported receiving a referral from Teen+, although this may be due to a lack of familiarity
with the terminology used during interviews. The few teens who reported a referral indicated that they had
been referred to services or programming from Porter Leath. Some teens reported that their Success Coach
had helped them enroll in WIC or Families First, although many were already connected to such services.
Program Enrollment and Outreach. About half of all teens interviewed enrolled in Teen+ after being referred by
a friend, family member, classmate, or partner. Twelve teens interviewed said they enrolled through a school
staff member, with some of those reporting that they were called to the school office to discuss Teen+.
Teens who were called to the school office were not sure how the counselor knew they were pregnant or why
they had been called. Teens also reported hearing about Teen+ from a DCS caseworker, direct contact from
a Success Coach or grantee agency, or a healthcare facility. One teen interviewed reported seeing a Teen+
advertisement on a bus. Some teens felt that not enough people knew about Teen+ and that the program
needed wider outreach and advertisement. Although some interviews did not include this topic, the majority
of teens said they either had referred Teen+ to other teens or that they would do so, given the opportunity. No
teen said that they would NOT recommend Teen+ to others.
Healthcare
Although 11 teens did not disclose how they found out they (or their partner) were pregnant, other teens
reported a variety of mechanisms for confirming a pregnancy. Of the 51 teens interviewed, 31 reported seeking
medical care after experiencing physiological indicators of pregnancy (e.g., nausea, fatigue) although many
did not initially recognize these as pregnancy symptoms, and 12 of the 31 teens reported that their mothers
took them to their initial doctor visits. Five girls indicated that they were told they were pregnant during a
routine checkup and 2 girls said they experienced no symptoms but intuited they were pregnant and sought
confirmation from a doctor. One girl interviewed reported seeking medical care after being raped and one girl
reported that school personnel instructed her to take a pregnancy test at the school clinic. Of the 51 teens
interviewed, 33 reported finding out about their pregnancy during the first trimester, 8 during the second
trimester, and 4 during the third trimester. Six teens interviewed did not disclose this information.
All teens interviewed reported receiving some form of prenatal care. Teens did not access prenatal care through
Teen+ because they began prenatal care prior to enrollment in Teen+. In instances where teens initially sought
care at The Med, teens reported being automatically enrolled in prenatal care as well as various other prenatal
and parenting programs offered by The Med. A small number of teens reported transportation as an occasional
barrier to accessing healthcare, but no other barriers were reported. Teens indicated that they received points
for doctor visits for themselves and their children.
Education
Teens who were interviewed reported a range of educational attainment and goals. The majority of teens
interviewed said they were able to stay in school and/or graduate high school because they received
accommodations or attended the Adolescent Parenting Program. Some teens also attributed their academic
successes to the support, assistance, and/or encouragement they received from their Success Coach. Teens
most commonly listed childcare as a barrier to education, with several reporting that they had to drop out
because of childcare concerns. Teens enrolled at the Adolescent Parenting Program expressed satisfaction
with being able to have their children on-site with them while they attended classes. In addition to childcare,
a few teens listed transportation and financial barriers to education; the latter was reported by teens pursuing
post-secondary education.
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 31
The University of Memphis
Center for Research on Women
Parenting
Teens who were interviewed often mentioned parenting classes offered through Teen+ partners as a primary
source for earning Baby Store points. Participants listed breastfeeding, discipline techniques, anger management,
infant mortality prevention, and cooking nutritious foods as topics they recalled covering during classes. Some
teens said they were exposed to parenting techniques and information prior to Teen+ enrollment. These
teens had cared for younger siblings or other relatives, or enrolled during a second pregnancy. Some teens
reported struggling with independent living skills and indicated that their Success Coach had helped them
meet a variety of needs outside of parenting skills. Teens also noted that their involvement with Teen+ had
led to a change in attitude as well as certain behaviors. Behavioral changes listed by teens included smoking
cessation, eating more nutritious foods, reconsidering breastfeeding when they had previously decided against
it, and engaging more directly with their child’s early cognitive development.
External Challenges
Teens listed several unmet needs in their lives, most commonly housing, transportation, employment, and
childcare. Although not every teen disclosed their current living arrangements during interviews, many teens
discussed the variability of their housing arrangements. Some teens remained in foster care, but the majority
of teens interviewed lived with family members other than their partners, although many of these expressed
the desire to live with their partner and child in a single-family housing arrangement. Four teens reported
being forced to move due to their pregnancy and 14 teens expressed an explicit need related to housing. In
interviews, many teens indicated that they received transportation assistance from family members or their
Success Coach, but 21 teens interviewed specifically reported needing help securing reliable transportation.
Teens often reported experiencing significant financial and/or employment concerns and 14 teens interviewed
indicated they were actively seeking jobs whereas several others reported they faced transportation and/or
childcare barriers to full-time employment.
Childcare was listed as a barrier to both education and employment. Teens acknowledged that they and/or
other teen parents they knew were wary of center-based childcare and did not trust their child’s care to nonfamily members. However, although many teens indicated that they received childcare assistance from family
members, this assistance was sometimes seen as problematic because it depended on a volatile relationship
or an otherwise unstable arrangement. Teen parents who did want to enroll their children in center-based
daycare reported difficulties applying for Families First childcare subsidies. Some teens indicated that they
needed assistance with the application process and others indicated that they could not qualify for these
benefits while still considered a dependent of a relative who already received Families First funding.
Stigma
During interviews, teens discussed certain sociocultural stigmas associated with teen pregnancy. Some
teens reported experiencing harassment from peers, relatives, and/or community members in regards to
their pregnancy. Some teens reported feeling fear or anxiety of rejection or harassment. Out of 51 teens
interviewed, 17 indicated that they waited to tell an adult they were pregnant because of this fear. In some
cases, teens faced consequences for their disclosure, including loss of housing or financial support from
parents or other family members. Teens also said that they or teen parents they knew sometimes avoided
school or other social interactions because they were concerned about other’s perceptions of teen pregnancy.
Some teens suggested that Teen+ publicize their stories as a means of changing negative stereotypes of teen
parents.
32 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Center for Research on Women
APPENDIX E: SUMMARY OF FOCUS GROUP DATA
Three focus groups were conducted: one with Teen+ administrators, one with Success Coaches who work
in the Shelby County School (SCS) system, and one with Success Coaches who work in non-SCS partner
agencies. Data collected during focus groups revealed key themes related to the successes and challenges
of the Teen+ program, according to both those who oversee the program and those who work directly with
participants.
Individualized Support
Success Coaches explained that they actively individualized their interactions with teens and that this allowed
them to go above and beyond their standard duties as social workers. The relationships built between the
Success Coaches and their teen clients provided teens with a support system that they may not otherwise
have had in their lives. Coaches wanted to be able to provide this type of support for every teen they served,
but they explained that their large caseloads make this difficult. It was suggested that the Teen+ Program
hire more social workers in order to decrease each worker’s case load and allow them to provide increased
individualized support for each client. Administrators also voiced concerns about increasing buy-in from the
parents of teens in Teen+ in order to include parental interaction in the teen-coach relationship.
User Experiences of ShelbyConnect Data System
Focus group participants agreed that the shared data system was useful in theory, but had not been successfully
implemented or utilized during the grant period. Agency supervisors and Success Coaches both reported that
in their experiences, the system was not user-friendly, was difficult to navigate, and contained technological
glitches that made communication between partners frustrating and sometimes impossible. Success Coaches
were tasked with entering what they sometimes perceived as a large amount of information for each teen.
Focus group participants voiced concerns that issues with the system’s design required Success Coaches to
enter information multiple times, which slowed down Success Coach productivity. Other technical difficulties
reported included printing problems and the absence of an auto-fill feature on repetitive forms. Service
providers suggested that Baby Store points be tracked by the system and made accessible to all relevant users,
including Baby Store workers. This would prevent forgery on handwritten point sheets and improve the overall
process for Baby Store workers and customers as well as all providers involved with a teen’s services.
Impact of Service Delivery
Focus group discussions included the perceived impact of Teen+ participation in teens’ lives. Focus groups
participants showed satisfaction with the progress they saw teens make towards a variety of goals, but
especially in regards to educational goals and attainment. Success Coaches reported concerns over teens’
ability to secure employment, due to both a lack in skills or training and to the local availability of employment.
Success Coaches also reported that teens need training on life skills outside the scope of programmatic focus,
specifically financial literacy and other independent living skills.
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 33
The University of Memphis
Center for Research on Women
Experiences with Implementation
The majority of focus group discussions focused on programmatic implementation. Participants explained
that they were satisfied with the networking that occurred among their agencies because of Teen+
and discussed how these networks allowed them to more efficiently connect teens to resources in the
community. Success Coaches expressed a desire for more opportunities to network across agencies and
share information and resources with other Success Coaches. To better serve the diverse and dynamic
needs of pregnant and parenting teens, respondents also recommended a closer relationship with the local
Department of Human Services and programmatic curricula that is more relevant to teens, both culturally
and in terms of literacy levels.
A common problem reported by focus group participants was a general disconnect between program
administrators and Success Coaches, which was attributed to communication issues. Communication issues
were sometimes exacerbated by technological problems.
Many Success Coaches felt they did not receive adequate training to carry out their jobs, both in regards to
technical skill using the ShelbyConnect data system and in terms of content knowledge on specific topics
such as birth spacing and contraception.
Focus group participants expressed strong concerns about the non-uniform quality of Teen+. Respondents
explained that the various names that Teen+ was known by throughout the county (e.g., TPPS and then
Teen+) made it difficult for teens to understand what program in which they were actually participating. It
also created a barrier to raising awareness about Teen+ and to recruit teens who did not fully understand
the purpose. It was suggested that the name, procedures, and educational information be standardized in
order to create a more cohesive vision to present to the community, and to ensure that all teens receive the
same services and education, no matter when or where they enroll.
34 | Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation
The University of Memphis
Center for Research on Women
REFERENCES
Ciscel, D. (2011). The economic impact of teen pregnancy in Memphis/Shelby County, TN. Memphis, TN:
Memphis Teen Vision.
Harville, E. W., Madkour, A. S., & Xie, Y. (2012). Predictors of birth weight and gestational age among
adolescents. American Journal of Epidemiology, 176(7), S150-S163.
Hoffman, S., & Maynard, R. A. (Eds.). (2008). Kids Having Kids: The Economic and Social Costs of Teenage
Pregnancy (2nd ed.) Washington, DC: Urban Institute Press.
Sagrestano, L. M., Finerman, R., Clay, J., Diener, T., Edney, N., & Madjlesi, A. F. (2012). Shelby County Teen
Pregnancy and Parenting Needs Assessment. Memphis, TN: Center for Research on Women, The
University of Memphis.
VanDenBerg, J., Bruns, E. J., & Burchard, J. (2008). History of the wraparound process. In E. J. Bruns & J.
S. Walker (Eds.), The resource guide to wraparound (pp. 1-5). Portland, OR: National Wraparound
Initiative, Research and Training Center for Family Support and Children’s Mental Health.
Shelby County Teen Pregnancy and Parenting Success Outcome Evaluation | 35
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Current Research Agenda
Child Care
Poverty
Teen pregnancy and sexual risk-taking
Sexual harassment in middle and high school
Infant mortality
Transportation
Center Staff
Lynda M. Sagrestano, Ph.D., Director
Ace F. Madjlesi, M.A., Research Associate
Sarah Hoover, Graduate Assistant
Adriane M. F. Sanders, M.S., Graduate Assistant
Alicia Clark, Graduate Assistant
Mindy Schaper, Undergraduate Assistant
Center for Research on Women
University of Memphis
337 Clement Hall
Memphis, TN 38152
901-678-2770
[email protected]
http://memphis.edu/crow
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