Many features of the demonstration programs are congruent with the needs of the these disadvantaged young women, while other aspects of the program design could be improved. Specific recommendations for effective mandatory, broad-coverage programs include the following:
- Tailor services to participant needs
- Allow variation in participation intensity based on individual circumstances
- Have a strong case management component
- Consider team approaches for managing some cases
- Use home visits and other means to promote participation
- Conduct and use intake assessments
- Provide world-of-work training
- Emphasize family planning
- Provide education on HIV and other sexually transmitted diseases
- Include a life skills component
- Provide child care assistance
- Address psychological barriers to self-sufficiency
- Tailor Services to Participant Needs. The diversity of the teenage parent population suggests the desirability of an individualized plan. For certain young mothers, such as high school dropouts, a strong, supportive intervention with close monitoring of progress seems especially appropriate. For others periodic monitoring is likely to be sufficient. Welfare agencies might want to consider developing special in-house services, such as the individualized on-site GED programs operated at two of the sites, for the most disadvantaged groups. In other cases, referrals to specialized, comprehensive community programs for school dropouts, such as the Work Group program, appear to be appropriate.
In planning an intervention for young mothers, special thought should be given to what the treatment will be for those who are functioning cognitively at very low levels. For some young mothers, the attainment of a high school diploma or GED certificate is not a realistic goal. Serving this group poses a severe challenge to program staff.
- Varying Intensity of Participation Based on Individual Circumstances. By design, the enhanced services program was intended to involve program participants in"full-time" activities (30 hours per week). However, in practice, the schedule requirements were more flexible. The In-Depth Study suggests that engaging young mothers in activities for even 10 hours per week might be beneficial. For the young women most at risk of becoming entrenched in welfare, involvement in a structured, out-of-home activity appears to reduce the risk of becoming accustomed to just staying home. Demanding an abrupt change to a full-time schedule may be unrealistic, especially for teenagers who have been out of school for many months. Moreover full-tie structured activities for high school dropouts are not widely available in most communities. GED program typically operate on a very limited basis, often between 5 and 15 hours per week. For high school dropouts who are not ready for a rigorous schedule, the most effective strategy might be to place incremental demands on them over time.
- Have a Strong Case Management Component. Case managers can play a critical role in addressing some of the underlying barriers to self-sufficiency that young mothers face and in giving them needed encouragement and support. As suggested above, services to young welfare mothers need to be individualized to the extent possible, with the nature and intensity of the program services varying for different subgroups of young mothers. Such individualization can best be accomplished if a single staff person -- a case manager or continuous counselor -- becomes familiar with the teenager and has ongoing responsibility for putting the necessary pieces in place.
"Strong" case management requires that caseloads be sufficiently low that adequate time ca be devoted to monitoring and addressing the needs of individual cases(4). Unfortunately, no magic number regarding optimal and realistic caseload size exists. An appropriate ratio of case managers to young mothers depends on the characteristics of the caseload, and how the caseload is organized. Assuming that the difficult cases are evenly distributed across case managers, and that between 30 percent and 40 percent of the caseload comprises high school dropouts, a caseload of about 75 to 80 teenagers would be the largest caseload size feasible for providing the individualized attention needed by these teenagers. Caseloads of around 50 teenagers would be far preferable.
The young mothers in our sample responded especially well to case mangers who were warm and caring but firm in their expectations, non-judgmental and open-minded about the teenager's lifestyles, good listeners who enjoyed working with teenagers, and good role models. Male case managers, by providing a positive male role model, were a valuable resource to the programs. To the extent possible, staff with a high probability of remaining with the program should be sought, since staff turnover can undermine the development of trust and the continuity of support that seem so critical to the success of the intervention(5).
- Consider Team Approaches for Managing Some Cases. With a team approach, case managers could obtain support and advice from other staff members, such as the project director or program specialists, in addressing the most stubborn barriers to the teenagers' participation. The team approach also provides the teenager with multiple role models and alternative adults with whom she could develop relationships, if she and her case manager were not perfectly compatible. Thus, a team approach can help to lessen the burden on individual managers and can minimize the importance of successfully "matching" case mangers and clients. To work well, the team approach requires excellent staff cooperation and communication and case managers who will not become "possessive" about their clients and disgruntled if their clients become attached to other staff members.
- Use Home Visits and Other means to Promote Participation. Those who resist compliance with program requirements are likely to be teenagers who are in greatest need of the program services, such as high school dropouts with limited personal or family resources. however, these young mothers often will respond to the personalized attention of a home visit. programs not able to undertake home visits should attempt to communicate with non-compliant teenagers in other ways. In particular, they should continue to communicate with teenagers during sanction periods to encourage them to return for services and to remind them that their grant will be increased if they will cooperate. Welfare recipients' grants are often adjusted for a number of reasons, and those who are sanctioned do not always understand the cause of the reduction. Personal communications (by phone or in person) can minimize communication problems.
- Conduct Intake Assessments. Case managers need information about the participants to develop appropriate individualized plans. Case managers should, for example, have the opportunity to test the aptitudes and basic skills of young women whose ability to complete a standard program is questionable. (The routine testing of all participants is advisable and would diminish any possible stigma associated with the testing). Young women suspected of being mentally retarded, or close to it, may never be able to obtain a diploma or GED certificate and may become completely frustrated if they are placed in a regular program. Other methods of assessment, such as home visits to assess the teenagers' family situation and support, should also be available so that the case managers can better understand the barriers their clients face (see, for example, Maynard 1992).
- Provide World-of-Work Training. Many of these young mothers need to develop better skills in getting along with others at the workplace and accepting supervision. Many expressed animosity toward their supervisors, admitting that they did not like being told what to do. These young women will not be able to keep a stable job if they fail to understand the nature of employee-employer relationships, or how to handle conflict or miscommunication on the job. Since these young women typically do not respond well to didactic instruction, a mode of instruction that includes extensive role-playing and permits the group to help to reinforce the norms regarding appropriate employee-supervisor relations is likely to be most effective.
Young mothers also need assistance in selecting a career path. Many of them are likely to insist on jobs in data entry or word processing without fully understanding what these jobs entail. Thus, these young mothers, who are likely to be supporting themselves and their children for many years, need exposure to career options that include jobs with fringe benefits and high wages, including careers that are nontraditional for women. However, we found that relatively few of these women were interested in nontraditional jobs.
- Emphasize Family Planning. Young welfare mothers typically express strong desires to avoid having another child in the near future, yet many of them experience a repeat pregnancy within two years of their first birth. The importance of lifetime fertility control in this population in terms of economic outcomes has been documented(6). Helping young women who have already had one pregnancy to avoid subsequent pregnancies is an admittedly difficult task. No rigorous studies of interventions that have been successful in helping young mothers to postpone an early subsequent pregnancy exist, and few interventions have focused on this issue in a systematic way. Program staff need to be made aware of just how challenging and important this issue is. Nevertheless, programs should take steps to address this issue. Staff selected for the program should be comfortable talking about sexuality and contraception with teenagers. If staff members are uncomfortable with these topics, the teenagers will not share any relevant problems with them. In addition, case managers should address this issue continuously, with the expectation that problems will arise.
- Provide Education on HIV and Other Sexually Transmitted Diseases. The forms of contraceptives that these young women typically use provide no protection against HIV and other sexually transmitted diseases. Since these young mothers often have had several sexual partners or are in relationships with men who have had several sexual partners and/or are drug users, the risk of HIV in this population needs to be taken very seriously. The demonstration documented one model of sex education that includes role-playing experiences in helping the young women to discuss condoms with their boyfriends and encourage their use may help them escape HIV and other sexually transmitted diseases (Hershey and Nagatoshi, 1989).
- Include a Life Skills Component. Disadvantaged teenage mothers are often hampered in their efforts to achieve self-sufficiency by their limited world view and the absence of skills that most adults in our society take for granted. Among the skills they need are the ability to use standard English on the job or at a job interview, no matter what linguistic style they prefer in their homes; a driver's license; familiarity with the world outside their neighborhoods; a better understanding of the values and norms of the larger society; and improved interpersonal skills.
- Provide Child Care Assistance. Child care services need to be made available to young mothers participating in self-sufficiency-oriented programs, even though many will initially resist using them. The young mothers greatly valued and appreciated on-site care because of its convenience and their ability to monitor the care. Moreover, many of them used and benefitted from help in understanding what to look for when selecting a child care arrangement.
Young mothers in need of child care assistance should not just be handed a list of available providers, because they are likely to resist selecting from a list of "strangers". It can be helpful for program staff to accompany the teenagers on visits to prospective providers or at least be sufficiently knowledgeable about potential providers that they can give the young mother information in response to the questions she is likely to raise.
Staff also need to continuously evaluate the teenagers' child care situation. Arrangements with relatives often fall apart, either because of family conflicts, changes in living arrangements, changes in family members' employment situation, or an evolving unwillingness to babysit as the child matures and requires greater vigilance. Fortunately, it may become easier to persuade the young mothers to use nonrelative care as their children get older, since their children's ability to communicate appears to play a role in how the mothers feel about using a formal provider (Kisker, et al, 1990).
- Address Psychological Barriers. While some of the psychological barriers that adolescent mothers face can be addressed effectively through public policy initiatives, others can more readily be address through the design of effective programs. The atmosphere of the demonstration programs was one in which the young mothers felt cared for and respected -- an atmosphere that was helpful in breaking barriers related to limited self-confidence and distrustfulness. To promote the young mothers' transitions to self-sufficiency, program staff need to offer activities to help young mothers develop or strengthen their social support network and make use of available community resources during transitional periods, including mental health services and drug treatment programs.