Submitted to:U.S. Department of Health and Human Services
Assistant Secretary for Planning and Evaluation (ASPE)
Rm. 404E, HHH Bldg.
200 Independence Ave., SW
Washington, DC 20201
Project Officer: Reuben Snipper (email@example.com), Ph.D.
Submitted by:Mathematica Policy Research, Inc.
P.O. Box 2393
Princeton, NJ 08543-2393
Project Director: Rebecca A. Maynard, Ph.D.
Contract No.: HHS-100-86-0045
MPR Reference No.: 7700-925
Many people contributed to the successful completion of this study. Dr. Ellen Kisker and Ms. Rhoda Cohen participated in the design of the overall study. They contributed enormously to the information gathering -- including selecting and tracking the sample, recruiting and training interviewers, and conducting focus groups and case conferences. Both also co-authored a preliminary report on barriers to self-sufficiency among teenage parents, based on an initial round of focus groups. Kathy Abbott, Teen Progress supervisor in Camden, Melba McCarty, Director of Project Advance in Chicago, and Yvonne Johnson, Teen Progress supervisor in Newark, were extremely helpful in identifying and recruiting participants for the focus groups, helping with logistical arrangements for the meetings, and in organizing the case conferences. The case managers in all three sites generously gave their time to participate in conferences to review, in depth, the case histories of a sample of their cases. Dr. Reuben Snipper, the federal project office for the evaluation, and Nancye Campbell and Judith Reich, federal project officers for the demonstration, provided valuable ongoing support for this study, including providing thoughtful and timely review of design plans and draft reports. Dr. Rebecca Maynard, project director for the overall evaluation of the Teenage Parent Demonstration, provided overall guidance throughout the study design and implementation and played a critical role in broadening the data collection efforts to include the case conference component. Finally, this study was critically dependent on the teenage parents who so generously gave their time to participate in the focus groups and in-depth interviews.
Young women who give birth during their teenage years are more likely than those who postpone childbearing to have low educational attainment and low life-time earnings. Consequently, they are at high risk of long spells of welfare dependency and living in persistent poverty. Recognition of teenage childbearing as a major social problem helped to lay the groundwork for recent policy innovations designed to assist young welfare mothers.
This report, which was prepared as part of the Demonstration of Innovative Approaches to Reduce Welfare Dependency Among Teenage Parents (for short, the Teenage Parent Demonstration (TPD), presents an in-depth look at the lives of poor, welfare-dependent, teenage mothers living in Chicago, Illinois, and in Camden and Newark, New Jersey. It examines the barriers to achieving self-sufficiency for many young mothers and their experiences in addressing them. It does so in the context of an intervention that required teenage parents to work toward self-sufficiency as a condition of their welfare eligibility and provided case management and a wide array of other services to facilitate compliance.
Through focus groups, in-depth semistructured interviews, and case conferences with program staff who had worked with teenage parents in the demonstration programs, we gained substantial insight into the barriers these young mothers faced and their personal strengths to mitigate them. The prospects for success and the strategies for intervention varied, depending on the school status of the mothers at the time they were enrolled in the demonstration, and the resources available to support their efforts to achieve self-sufficiency.
Teenage Parent Demonstration
The Teenage Parent Demonstration was sponsored by the U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Planning and Evaluation (ASPE), and the Office of Family Assistance (OFA). It tested the feasibility and effects of imposing obligations on teenage-parent AFDC recipients to engage in activities designed to enhance their self-sufficiency as a condition of their continued eligibility for welfare, while offering assistance to help them fulfill these obligations. The cornerstone of the demonstration programs was case management services. Case managers helped teenagers develop and fulfill self-sufficiency plans and monitored their compliance. The plans focused on education, training, and employment-related services designed to improve teenagers' long-run prospects for self-sufficiency. They also offered support services to facilitate adherence to the plans -- notably, child care and transportation assistance. The demonstration was timely, providing considerable guidance to states implementing programs in response to the adolescent parent provisions of the Family Support Act of 1988.
The public welfare agencies in the states of Illinois and New Jersey received grants in 1986 to design and implement the demonstration programs. The Illinois program (Project Advance) operated in the south side of Chicago, and the New Jersey program (Teen Progress) operated in the cities of Newark and Camden. The programs began serving clients in mid-1987 and continued operations through mid-1991.
The overall demonstration evaluation involved five components:
- An analysis of the effects of the program on those who participated, involving the random assignment of eligible mothers in the three sites to participant (enhanced-services) or nonparticipant (regular AFDC services) groups;
- A process and implementation evaluation to document the nature of the demonstration and provide guidelines for its replication;
- A study of child care supply and demand in the demonstration sites;
- A study of the impacts of the program on child care needs and use; and,
- This in-depth study of the experiences, motivations, and personal circumstances of program participants.
This in-depth study provides intensive, qualitative information about the experiences, characteristics, and problems of the young mothers in the demonstration and their efforts to deal with program participation requirements. The underlying question is: What is it about these young mothers' lives that drives them toward long-term welfare dependency, and what are the possibilities for diverting them from this path?
The study used focus group interviews, personal in-depth interviews, and case conferences with case managers and other program staff to discuss specific cases, probing deeply into areas that are difficult to tap through standard survey procedures. These areas included the motivations these young women have to become self-sufficient; their attitudes toward work, welfare, marriage, and child rearing; their expectations and goals for the future; the barriers they encounter in attempting to achieve those goals; and their patterns of response to the program obligations and services.
Fifteen focus groups were conducted in late 1988 with young mothers drawn from the larger Teenage Parent Demonstration research sample of nearly 6,000 young mothers: six in Chicago, five in Camden, and four in Newark. In addition, one focus group was conducted with fathers of children whose mothers were in the primary research sample.
In the fall of 1989, in-depth, semistructured interviews were conducted with 70 sample members in Chicago and Camden (35 per site) -- generally in the young mothers' homes. To the extent possible, respondents were recruited from those participating in focus groups the previous year.
The final major source of information for the in-depth study was derived from an intensive review early in 1991 of 12 to 15 cases from the enhanced-services group in each of the three sites. We first reviewed fully all materials in the case files of those selected. Then, we convened two-day case conference sessions at each site to discuss the selected cases in detail with members of the program staff. The cases selected for review were chosen to ensure that they represented a variety of experiences and circumstances and included young mothers whose lives had been redirected by the programs, as well as clients whom the programs did not seem to help.
Although the young women in the in-depth study were not randomly selected from the larger research sample, their background characteristics were generally very similar. In all samples, the majority of teenagers were never-married, black mothers who had become pregnant prior to their eighteenth birthday and had not yet completed high school. The average reading score for all groups was below the eighth-grade level. The focus-group and in-depth interview subsamples tended to over-represent sample members in less adverse circumstances -- probably because participation in the in-depth study was voluntary and demanded significant time commitments. Conversely, the case conference subsample tended to over-represent highly disadvantaged teens, probably because the program staff were explicitly asked to include some cases with whom they judged they had been "unsuccessful."
Barriers to Self-Sufficiency and Personal Strengths
The teenagers' entering the programs differed widely with regard to personal characteristics that appear related to their level of program participation and are likely to be related to their eventual self-sufficiency -- factors such as motivation, cognitive skills, self-esteem, and social support. In-school youth tended to have the strongest personal resources, and dropouts tended to have the weakest, but there was variation in all groups with respect to their initial personal resources (see Exhibit 1).
Despite considerable diversity in the barriers to self-sufficiency facing these young mothers, virtually all of them faced at least some. All lived in poverty, often in dangerous neighborhoods where the norms do not promote self-sufficiency and with families whose adult members were themselves struggling to cope with personal crises. In addition, the teenagers in the demonstration programs were young, often lacking concrete goals and direction, and in some cases extremely immature.
PROFILES OF WELFARE-DEPENDENT TEENAGE PARENTS:
DROPOUTS -- WITH AND WITHOUT SUPPORT
|Yolanda was a 16-year-old Hispanic teenager who had dropped out of school in the ninth grade and who had no work experience. She enrolled in the program in late 1987 while she was still pregnant. She lived with her mother, who was very supportive, and a younger sister. Although Yolanda was shy, she appeared very motivated to get off welfare and was always very cooperative with program staff. In early 1988 she enrolled in a GED preparation program and then later the same year enrolled in a program to learn word processing. She has taken the GED test twice without passing it but has not become discouraged (perhaps in part because her performance on the test improved). Yolanda has continued to study for the GED test and, in the meantime, also took a part-time clerical job in a hospital, earning $4.50 per hour. She did so well on the job that she was offered a full-time position in December 1990. But, she decided to wait until she obtained her GED certificate. She was scheduled for a retest in spring 1991. Her case manager feels that Yolanda might have eventually succeeded in finishing school and obtaining employment without the program but would probably have taken many more years to accomplish these goals on her own.||Yvette was an 18-year-old dropout who had been out of school for about 18 months when she entered the program in October 1987. At that time, she was pregnant with a second child; her first child was three. Yvette came from a family with a history of problems. She herself had spent several years in foster care and had been reported to the state child welfare agency for alleged neglect of her own child. Yvette had reading test scores at about the ninth-grade level, higher than the average for the sample, but had little motivation to comply with the program or to participate in any activities. After program entry, her case was temporarily deferred because of her pregnancy. Once the deferral was removed, Yvette failed to comply with the program requirements, even though program staff made several home visits and offered to pick her up so that she could attend program workshops. She was sanctioned in early 1988 and has remained sanctioned ever since. Program staff feel that the sanction has no great relevance to Yvette; they suspect that she may be earning money on the side through prostitution.|
IN SCHOOL -- BUT LOW BASIC SKILLS
|Miranda was 14 years old and in the sixth grade. She was living with her 30-year-old mother, her stepfather, and a 13-year-old brother. Her basic skills scores were extremely low (third-grade level). Miranda was very uncooperative with the program initially and made it clear that she did not want to participate. She received five warnings for failure to comply with program requirements in the next year and then was finally sanctioned in fall 1989 when she dropped out of school. The sanction remained until Miranda returned to the program in fall 1990 and asked to have her sanction lifted. In the meantime, she had a second baby and experienced a number of serious family problems. When she came back to the program, Miranda was put into the life skills workshop, where she became very attached to and inspired by the instructor. Staff agree that Miranda subsequently matured considerably: her attitude, appearance, and motivation all improved. She completed all of the program workshops and was participating regularly in the program's on-site adult basic education program.||Daniella was a 17-year-old junior in high school. She had lived with her grandmother since age three, when her mother died. She dropped out of school shortly after intake and had a history of irregular compliance with program requirements. She was sanctioned for the first time two months after intake for failure to attend the assessment interview and program workshops and has subsequently been sanctioned on several occasions. In fall 1990, Daniella enrolled in the program's on-site GED program, where she continued to be enrolled at the time of the case conference session. She was sanctioned in January 1991 for nonattendance, but after the sanction was imposed her attendance improved.
Daniella's long-range prospects are not promising. At intake, Daniella performed poorly on the Test of Adult Basic Skills (reading at the fifth-grade level), and she is in the low end of the GED class. She had a second child in March 1990 and is believed to now be living with her boyfriend, who allegedly abuses her. Program staff describe Daniella as a very needy and demanding person who might have an alcohol and drug problem. She is described by the staff as "feisty," "aggressive," "volatile," and "manipulative." In school, she is the "class clown." Although program staff are not sure about her ability to finish her GED or become employed, they believe she would simply be sitting around "watching soaps" without the program.
GRADUATES -- SUCCESS AND FAILURES
|Zelda was 19 years old and attending college when she entered the program in December 1988. She had already completed a two-year medical assistant program and had an A.A. degree but was continuing her education in a four-year program at the University of Illinois. Her goal is to become a doctor, and program staff believe she has both the ability (she had perfect scores on all her basic skills tests) and the determination to achieve this goal; she also has excellent family support. Zelda complied with all program requirements, such as workshop attendance. The program provided her with both transportation and child care assistance, which further facilitated her school attendance. In mid-1989 Zelda told her case manager that she wanted to earn some money. The case manager suggested that she take a civil service test, which she passed, and she secured a full-time job in the post office earning $11.26 per hour with full benefits. Her case was closed in July 1989 as a result of her employment. At last contact, Zelda was both working full-time and going to college.||Emma entered the program in November 1987, when she was 18 years old. She had graduated the previous June as a special education student in sewing, which she had hated. According to test scores, she was reading at the third-grade level. At intake, she was still involved with the father of her baby (who was reputedly a drug dealer and had children with other women). After entering the program, Emma enrolled in a cosmetology school, attended regularly, and graduated in June 1989. However, she gave birth to her second child shortly afterwards, in August 1989. After taking the exam for her cosmetology license in April 1990, Emma learned that she had not passed and was unwilling to try again; staff believe that she probably failed the reading portion of the test and might never be able to pass it. At the time of the case conference, she was "not doing much of anything," although she continued to participate in some job search activities without much enthusiasm. Program staff believe that she is no longer motivated, in part because of discouragement and in part because her boyfriend is a "bad influence" whose financial assistance, at least in the short run, makes the threat of a sanction less relevant to Emma than it might be to others.|
The majority of the teenagers expressed an interest in employment (and a corresponding hatred of welfare), but many had extremely weak reading and language skills that are incompatible with the types of jobs to which they aspired. Moreover, despite a generally positive orientation toward education in the abstract, many had had negative experiences in traditional school settings.
|I'm happy I got a job because I was on welfare and I was tired of staying home waiting for the first of the month check, and there wasn't enough for me and my child. Then when I got a job I was happy because it keeps me out of being bored and being responsible for my kid. I'm making money and supporting my kid. It shows me to be more responsible.|
Perceptions of Child Care as a Major Barrier
A major barrier to participation in the demonstration programs was the teenagers' child care needs. Although the program helped participants find and pay for child care, resistance to care by nonrelatives was high, primarily because the young mothers felt they could never trust a stranger to care for their children. In the end, most were able to rely on relatives to care for their babies, and they were generally satisfied with these arrangements.
|I have to know the person real good to let them take care of the baby, because these days you can't trust a lot of people taking care of babies. I would be scared because these days babysitters abuse little kids and you don't know it until you find out for yourself.
Kids get kidnapped. Or you come to pick your kid up and he's dead or he's hurt real bad. I don't trust people that openly. There are some things you can trust people with, but you can't really trust people that quickly when it comes to your child.
On the news they say that there are kids that are molested by the people in day care. I'm not saying it won't happen with relatives 'cause I know it happens with relatives, too. I don't trust nobody with my kids.
I won't until I know she can talk. If she can talk to me and tell me, if she goes to school and somebody touches her or hits her and she can tell me, "Mommy, this such-and-such pulled my hair. Mommy, this such-and-such touched me there." If she can tell me, okay, but otherwise I wouldn't let her go.
Repeat Pregnancies Undermined Progress Toward Self-Sufficiency
There was considerable agreement among these young mothers that future childbearing should either be postponed for a considerable period of time or avoided altogether. The young mothers who wanted to postpone their next pregnancies generally said that they wanted to wait until they were more financially secure.
|I might have a child years from now. My daughter will probably be in high school by then. I want to get my life together. I want to be married, have a good husband, a good home, and know I could afford another one.
I don't think I could handle it. Maybe when I'm 30 or 25, but right now it would be too much to handle. I'd probably commit suicide.
Many young mothers, however, acknowledged having problems with birth control and, by the time of the in-depth interviews (roughly 18 to 24 months after sample enrollment), about one-third in the sample had had a repeat pregnancy. These repeat pregnancies, like the first ones, were almost never intentional. The young mothers, who often had a fatalistic outlook, indicated that their pregnancies had "just happened."
|They (the boyfriends) are not the ones staying home with them. They like having them, but they're not going to take care of them. They'll tell me, "Oh, I want to have another baby." Mine's said that to me many a time. But I wouldn't listen. I'm not stupid.
I didn't plan it, and then again I kind of knew that it was going to happen because I wasn't like really taking the pills like I was supposed to. I couldn't remember every day to take a pill. And I still don't.
I really don't want to take time off for no more children right now. I'm not ready for it now. But I'm allergic to birth control pills. So I'm not having sex as often as I used to. I want my boyfriend to use a condom.
Resources Facilitating Program Participation
Many of the young mothers appeared to be very resilient. In spite of the difficult circumstances in which they were living, many were highly motivated both to better themselves and to provide their children with a better childhood than they had been given. Furthermore, many had family support that enabled them to move forward with their lives despite their parenting responsibilities.
|I have to get out of here. I can't stand it. No matter where you turn, all you see is this guy and that guy trying to sell drugs. I don't want my son to grow up with them. Sometimes little boys let other people influence them, and I don't want him to be growing up thinking that that's something that he has to do to make money.|
Almost none of the young mothers envisioned that they would become permanently dependent on welfare. There was a strong and almost universal hatred of welfare. According to most of these teenagers, women on welfare become addicted to receiving public assistance and, over time, their motivation and ability to become self-sufficient erodes.
|It's like a drug or something. They get lazy, and they depend on it. They don't have to work or do nothing 'cause they just wait in their house for the check to come. They let years go past, and they have no experience.
I started to feel lazy. You start depending on it. You sit there every month, first of the month, waiting for your check. And I'm not going to be home sitting like that. I've got to keep doing something.
Parenthood: Highly Rewarding, the Most Important "Job"
Most of the young mothers emphasized the positive aspects of having a child. Their children provided a source of love and affection, enhanced their self-esteem, and made them feel more mature and responsible. Given the limited rewards that many of these teenagers derive from other aspects of their lives, the benefits of motherhood seem quite powerful.
|I like being a mom. I love my son, nothing could change that. He's, how can I say it? I don't know, he's everything to me anyway. I don't care about nothing else but him, how he is.|
For some of these mothers, regular employment and participation in activities geared toward self-sufficiency were perceived as interfering with their parenting responsibilities. Most teenagers, however, felt it was not only acceptable but desirable to work before their children started school, primarily because of their desire to provide for their children's material needs.
|I think they should be about one year old, so they'll know who their mother is.
I think mothers should work. For one thing, your child gets to learn how to be with other children. And they learn to do little things that maybe you don't have time to teach them at home. So I think she should work, even just to help the child out a little.
Low Compliance with Child Support Enforcement Agency
Only a handful of mothers in the samples cooperated with the state child support enforcement agency. About half in the in-depth interview sample indicated that they continued to receive some type of assistance from the fathers of their babies, typically in the form of material goods (groceries, diapers, baby clothes) or small amounts of cash. Yet, those who received even modest informal support from the fathers generally felt it was in their best interest to resist cooperation. Many who received no child support stated their preference for having nothing further to do with their babies' fathers.
|He gives me $30 a week. That's a lot better than welfare would give me.
Well, the thing I don't like about it is they sent me a letter, take him to court. But see, I didn't want to take him to court because he was doing for the child. Then that makes the fathers think that you're making them, like you got something against them. Because that's the way my baby's father took it. And then I was saying, "Why do he have to pay, since he's already doing for her?" I could see if he wasn't doing nothing for her and you wanted him to pay. See, I don't understand."
That almost broke me and my baby's father up. We almost broke up because of that. I mean, because when I told him, he was like, "But why do you want to take me to court for child support?" I'm like, "I'm not, it's Public Aid." And you know, we were gonna end up breaking up because of Public Aid.
Designing Services to Promote Self-Sufficiency
Some young welfare mothers are able to become self-sufficient without intervention. For many of them, however, the odds against success are great because of the multiple barriers they face. This study highlighted several lessons related to designing effective programs and policies for welfare-dependent young mothers.
Mandatory Programs Are Feasible and May Be Critical
This study indicated clearly that mandatory programs for teenage mothers on welfare could be implemented without appearing to be punitive. Negative comments about the program were rare. Some young mothers did not need the welfare grant and so accepted the sanction or left AFDC rather than participate in the program. The more typical response, however, was to acknowledge that the program gave them a needed "push" to get out of the house and work toward self-sufficiency. Program staff also came to view the monetary incentive as a critical tool that enabled them to provide services to teenagers who might otherwise not have sought these services.
|I was supposed to report to this school. First I started going, but then I stopped, so if you stop, automatically you already know that your check is going to be reduced. So it was nobody's fault but mine.
To me, I really didn't need it, you know. I needed it, but I didn't need it, you understand. It wasn't like, "Oh, my God, if I don't get this check." It was like, "You can keep the check and everything else that comes with it." 'Cause you know, I was never down out struggling.
I like this program because it helped me out and it's given me the opportunity to start again, just like that little push that you need to get back on your feet. Because you know, when I had him, after you have your baby you don't want to go back to school. You want to sit home with your kid.
Financial sanctions are a powerful motivating tool. One method of influencing teenagers' adherence to their self-sufficiency plans was the use of financial sanctions. A substantial minority of teenagers in the in-depth study samples had been sanctioned (typically for a relatively brief period of time) or warned that they would be sanctioned if they continued to be noncompliant. Although the teenagers were able to manage during the months when their grants were reduced, they reported that the sanctions (or the threats of sanctions) affected their behavior. Program staff generally viewed sanctions as a useful tool for motivating teenagers to come forward for the needed services. The sanctions were the prods that enabled staff to show the teenagers the "carrots" the program had to offer, including child care and transportation assistance, peer support, program workshops, and case management.
|The first time they sent me a letter, I looked at it and threw it away. The second time, I looked at it and threw it away again. And then they cut my check and I said, "Uh, oh, I'd better go." I was like, "Oh my goodness, these people really mean business. And I'd better go down there and see what this is all about."|
Young welfare mothers should be expected to participate in programs to enhance their self-sufficiency soon after their babies are born. Delays in providing teenage mothers with needed services or in helping them to formulate long-range goals may well foster their welfare dependency. The personal resources available to many are often fragile and may erode over time.
Sanctions alone are unlikely to prove effective in promoting active program participation or changing behavior. Although many of the young mothers responded positively to the sanctions, continuous, active participation required considerable monitoring and assistance from program staff. Sample members reported that they especially appreciated the program staff's care, nurturance, and willingness to work with them as individuals.
|At first I didn't go. They used to send me letters and call me. I still wouldn't go. And then they sent this man [a case manager] out to my house. And I was like, I'll go and see what it was about. Then the first time I went I didn't like it, because they would ask me little personal questions. Then after I did that I never came back and they came out to my house again and called. "Could you please come to the program." And I finally went, and then after I went I liked it then. I really liked it then.|
Service Needs Differ Substantially
Because the population is quite diverse the programmatic response could well be different for different teenagers, especially when resources are constrained. For certain groups -- especially high school dropouts -- a strong, supportive intervention with close monitoring of progress seems especially appropriate. For others, periodic monitoring may be sufficient.
High school dropouts may be most in need of intervention. The data from the in-depth study suggest that those young women who were high school dropouts when they entered the enhanced-services program were extremely needy and at highest risk of becoming entrenched in long-term welfare dependency. It appears that other teenagers who were enrolled in school at intake were likely to make progress toward self-sufficiency on their own -- although many of these young women also appeared to benefit from the program's assistance.
Out-of-school young mothers proved to be the most difficult subgroup to serve successfully. A major responsibility of case managers was to identify appropriate educational or training placement or employment. Program staff often had problems placing school dropouts, who sometimes had a checkered pattern of starting and stopping different programs or activities prior to completion. For high school graduates, postsecondary and job-training options were generally easier to identify than employment opportunities.
Early Repeat Pregnancies: An Ongoing Concern
Helping young women who have already had one pregnancy avoid subsequent pregnancies is challenging but very important. These young women typically assert that they do not want another child in the near future. But a sizable percentage experience a repeat pregnancy within two years of their first child's birth. Programs should endeavor to hire staff who are comfortable talking about sexuality and contraception with teenagers and address this issue continuously.
Addressing Limited Life Skills
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. To become mainstreamed into our society, these young mothers need to acquire the broader life skills that employers and other institutions expect.
Programs should address psychological barriers to self-sufficiency. Limited self-confidence and distrustfulness, which are common among welfare-dependent teenage parents, often can be addressed through the creation of a program atmosphere in which the teenagers feel cared for and respected. The psychological barriers faced by many of these young mothers, however, are far too complex and profound for program staff to address. Programs need to develop linkages with mental health services and drug treatment programs so that severe problems can be referred to trained professionals.
A Special -- and Separate -- Intervention
Teenagers are most likely to respond to an intervention that is developmentally appropriate -- one recognizing that these young mothers are barely more than children and require considerable structure and discipline in their lives. Although welfare mothers of all ages share many things with respect to the barriers they face in achieving self-sufficiency, young mothers need special help to surmount those barriers. Their needs are likely to get lost if they are integrated into an adult program.
Strong Case Management Is Essential
Because of the complex needs and diversity of this population, strong case management appears to be an essential feature of a successful intervention strategy. Services for young welfare mothers need to be individualized and modified over time. This individualization can best be accomplished if a single staff person -- a case manager or continuous counselor -- becomes familiar with and has ongoing responsibility for the teenager.
Case management services were almost universally appreciated by the young mothers. Despite the fact that many young mothers had been sanctioned or warned that they would be sanctioned, their feelings about the program were generally extremely positive. Praise for the personal and caring attention of case managers and other program staff was especially high. Case managers linked the teenagers to the services they needed, monitored their progress in the program, offered advice and guidance for personal problems, and provided much-needed support and encouragement. For many young mothers, the case managers served as role models or surrogate parents.
|When I go to Project Advance, they know me, they speak to me. Some of the people there were on a first-name basis. It's another part of home. If I do something that's stupid, they know it, they tell me. When I do something good, they all praise you for it.
It is the one program that actually motivates someone to do something. There was always something going on even if you weren't working. You didn't have to be in the street, and you didn't have to sit in your house.
Addressing Fears and Concerns
Many of the young mothers in the enhanced-services program took advantage of child care that was paid for through program funds, but others did not. By preference, the majority of the teenagers in the in-depth sample who were active participants in a program component relied on unpaid relative care.
Program staff should assist the teenagers in understanding what to look for when they are selecting a child care arrangement. Then, when possible, they should offer to accompany the teenager on a visit to the provider, or at least be sufficiently knowledgeable about potential providers to give information or respond to questions. Program staff also need to evaluate the teenagers' child care situation continuously. Arrangements with relatives often break down for a variety of reasons, and alternate arrangements may need to be found.
View of a Young Mother
Lorissa -- Youth Ambassador
I am lucky to have been selected to be a part of Project Advance. This program has given me hope for a better life. They have helped me to learn a lot about life: how to make goals and work toward them, the importance of birth control, and child support from my children's father. . . . My case manager is a delightful lady, who is a lot like my mother, in fact I think of her as a second mother. She constantly encourages me to go forward, not backwards, and reminds me that no matter how hard it is I can advance my goals. It seems as though we have always been friends because I can count on her for needed child care, transportation, help in making decisions, and just to be there when I need her. To top it off, she is also a lot of fun. I need that when I am sad.
The need for strategies to reduce welfare dependence is increasingly urgent, as governments at all levels face mounting budget deficits and rising welfare costs. This in-depth assessment of barriers to self-sufficiency and avenues to success among demonstration participants, combined with our implementation and process analysis of the demonstration, suggests several lessons regarding effective policies for addressing the problems associated with teenage mothers on welfare, as well as some lessons regarding the design and operation of programs servicing welfare dependent teenage parents.
This study, in combination with our implementation and process evaluations, underscores the feasibility and desirability of changing public policy to promote self-sufficiency among welfare dependent teenage parents and, thus, to break the "cycle of poverty":
- Intervene early. Teenage mothers with young children should be expected to participate in programs designed to enhance their self-sufficiency relatively soon after their babies are born.
- Make pregnancy prevention a priority. Policies to prevent out-of-wedlock pregnancies among teenagers at high risk of welfare dependency should be a high priority.
- Tailor services to the needs of young mothers.
- Pay special attention to dropouts.
- Consider truly mandatory programs.
- Provide active case monitoring and management. Sanctions alone are unlikely to prove effective in engaging the teenagers' active participation or changing their behavior.
- Child care services are essential in mandatory programs for young mothers with infants, but the take-up rates are unlikely to be high.
- Consider ways to prolong health coverage. Health care benefits are an especially critical feature of the welfare program for this population -- far more important than cash assistance.
- Provide incentives to cooperate with child support enforcement.
- Intervene Early. Teenage mothers are known to be at especially high risk of long-term welfare dependency. Delays in providing them with needed services or in helping them to formulate long-range goals may foster or hasten their "addiction" to welfare dependency. The personal resources available to many of these young mothers are often fragile and may erode over time: Their motivation and self-confidence may decline; the lack of routine, structured activities may become more firmly established; and the willingness of family members to assist with child care may diminish. Moreover, if welfare agencies postpone some type of intervention until the babies are older (for example, until they are 3 years old), these young mothers are very likely to bear additional children, thereby lengthening the period during which the "addiction" may take hold. Targeting these young women with services soon after their first births seems feasible and, in some respects, desirable. The young mothers are likely to lose a lot of ground during such periods if deferrals are granted early in the pregnancy.
- Make Pregnancy Prevention a Priority. Some teenagers plan their pregnancies, but the overwhelming majority do not. Despite the emergence of the view that pregnancy among disadvantaged teenagers is an adaptive response to poverty,(1) little research suggests that early childbearing is the desired outcome of a rational choice among poor young women(2). However, teenage parenthood is unlikely to be viewed as a disastrous situation to those whose future prospects seem relatively bleak anyway. Considerably more research is needed to help us understand "what works" in delaying sexual activity and preventing unprotected intercourse among teenagers(3).
- Tailor Programs to the Teenagers' Needs. While welfare mothers of all ages face similar barriers to self-sufficiency, young mothers have special needs that may not get addressed if they are integrated into an adult program. Teenagers are most likely to respond favorably to an intervention that is developmentally appropriate and recognizes their youth. Teenage mothers require considerable structure and discipline, as well as more individualized attention than older women. Furthermore, a program aimed at younger welfare mothers has a greater opportunity of creating a group norm that encourages self-sufficiency, since the young mothers are less likely than older women to have given up hope for a better life for themselves and their children. Thus, there are benefits to operating specialized programs for teenage parents, or, where separate programs are not feasible, assigning separate case workers who enjoy working with teenagers to young mothers and allowing these case workers to maintain somewhat lower caseloads.
- Pay Special Attention to Dropouts. Those young mothers who were high school dropouts when they entered the program were extremely needy and most at risk of becoming entrenched as long-term welfare recipients. These teenagers appeared to be less likely to make progress toward self-sufficiency on their own. Despite the numerous barriers and problems that the dropouts brought to the program, the staff often were successful in engaging them in some type of self-sufficiency-oriented activity.
- Consider Truly Mandatory Programs. Mandatory programs for teenage mothers on welfare can be implemented without being punitive. The vast majority of mothers (including the high school dropouts)reported that they liked the enhanced services program. Negative comments about the program were rare, even though many had their grants reduced for at least brief periods or were threatened with such reduction. Several of the teenagers acknowledged that the program gave them a needed "push", noting that, without such a push, they would not have done anything to become self-sufficient. Program staff also came to view the monetary incentive as a critical tool that enabled them to provide services to teenagers who might otherwise not have come forward for them.
- Provide Strong Case Monitoring and Management. Sanctions alone are unlikely to prove effective in engaging the teenagers active participation or changing their behavior. Although many of the young mothers responded positively to the sanctions, this In-Depth Study suggests that continuous active participation requires considerable monitoring and assistance from program staff. The young women in the in-depth samples especially appreciated the program staff's care, nurturance, and willingness to work with them as individuals. Because of their complex lives and multiple barriers, the teenagers' progress toward self-sufficiency was often uneven; many of them started and stopped several activities and required ongoing guidance and support through the transitions.
- Provide Child Care Assistance. Many of the young mothers in the enhanced services program took advantage of the child care paid for through program funds, but many others did not. By preference, the majority of the teenagers in the in-depth samples who were active participants in a program component relied on unpaid relative care. While the special child care study conducted for the evaluation showed that the enhanced services program increased the use of formal child care arrangements, the teenagers in the in-depth samples expressed considerable concern about placing their child with a provider whom they did not know and trust. When reliable and convenient child care is available informally, these young mothers may well feel more at ease about engaging in a mandated activity, and compliance may therefore be heightened. However, family conflicts and other demands on family members (including demands that they participate in JOBS, if they are welfare recipients) may mean that relative care is unavailable or undependable for many of these young mothers.
- Consider Ways to Prolong Health Coverage. Policies to promote self-sufficiency among teenage mothers need to consider these young mother's needs for regular health care for themselves and their children and recognize that they cannot afford to pay for such care themselves. One option, consistent with the Family Support Act of 1988, is to extend medical benefits beyond the period when the women receive cash assistance [This is current policy].
- Provide Incentives for Young Mothers to Cooperate with Child Support Efforts. The majority of young mothers on welfare resist the efforts of the child support enforcement agency to establish paternity and collect child support payments, especially if the father is already contributing financially to the child's support. To these young mothers, the child support agency represents just one more hassle with which they must contend as welfare recipients. Moreover, the young mothers who get assistance from the fathers generally view cooperation with the agency as harmful to their self-interests. However, the father's provision of financial assistance typically declines over time, and it is primarily the mothers who are getting no assistance who are most willing to comply. Therefore, periodic reviews of these cases by the child support agency may be warranted.
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.
1. See for example, A. T. Geronimus, "On teenage Childbearing in the United States," Population and Development Review, 1987, vol. 13, pp. 245-279; A. T. Geronimus, "Teenage Childbearing and Social Reproductive Disadvantage: The Evolution of Complex Questions and the Demise of Simple Answers," Family Relations, 1991, vol. 40. pp. 463-471; and M. Vinovskis, An "Epidemic" of Adolescent Pregnancy? Some Historical and Policy Considerations. New York: Oxford University Press, 1988.
2. See F. F. Furstenberg, "As the Pendulum Swings: Teenage Childbearing and Social Concern. Family Relations, 1991, vol. 40, pp. 139-147.
3. There are a few preventive interventions for which the early evaluation data appear quite encouraging, particularly for young teenagers who are not yet sexually active. These include Marion Howard's "Postponing Sexual Involvement" program (see M. Howard and J. McCabe, "Helping Teenagers Postpone Sexual Involvement," Family Planning Perspectives, 1990, vol. 22, pp.21-26) and the "Reducing the Risk" curriculum of R. Barth, Reducing the Risk: Building Skills to Prevent Pregnancy. Santa Cruz, CA: Network Publications, 1989.
4. Caseload size and other aspects of "strong" case management are discussed in another demonstration monograph, Case Management for Teenage Parents: Lessons from the Teenage Parent Demonstration (Hershey, 1991).
5. Staff turnover was quite low in the demonstration programs; the case managers who were hired generally found their jobs rewarding and were pleased to have been selected to work in the program.
6. F. F. Furstenberg, J. Brooks-Gunn, and S.P. Morgan. Adolescent Mothers in Later Life. New York, NY: Cambridge University Press, 1987, S.M. Horwitz, et al, "School-Aged Mothers: Predictors of Long-Term Educational and Economic Outcomes", Pediatrics, 1991, vol. 87, pp. 862-868, and D.F. Polit and C.M. White, The Lives of Young Disadvantaged Mothers: The 5-Year Follow-Up of the Project Reduction Sample. Saratoga Springs, NY: Humanalysis, 1988.