Colorado Adolescent Maternity Program

About the program

The Colorado Adolescent Maternity Program (CAMP) is a prenatal, delivery and postnatal care program.

It combines clinic appointments and home visits. It integrates the support of various health care providers, including obstetrician, paediatrician, social worker, and dietician.

The program aims to:

• prevent adverse maternal and child outcomes directly by simplifying access to preventative health care and social services
• support teenage parents to graduate high school and pursue careers
• Enhance family support
• Promote links between community service agencies
• address the specific behaviours and attitudes that put teenage parents at increased risk for maltreating their children.
• Promote maternal competency and nurturing parenting behaviour

Who does it work for?

CAMP was designed for adolescent mothers at risk of maltreating their children.

The Colorado Adolescent Maternity Program has only been evaluated in the USA (Stevens-Simon et al. 2001). A randomised control trial was conducted with 145 people (58 in the intervention group and 87 in the control group). It has only been evaluated with mothers who attended the CAMP clinic. Mothers were 13-19 years old (average age = 17.5). Most of the mothers were White (49%), Black (28%) and Hispanic (20%) and from low-income families.

The program has not been evaluated in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

• Child abuse reports (substantiated/unsubstantiated - neglect): mothers who participated in CAMP were less likely to be reported for child neglect, compared to mothers who did not participate in the program.

No effect:

• Child abuse reports (substantiated/unsubstantiated): the program did not have an effect on the number of child abuse reports.
• Child's medical care: the program did not have an effect on health care utilisation, hospitalisations, immunisations etc.
• Removal of child from care giver: the program did not have an effect on removal rates of children from caregivers.

Negative outcomes:

• No negative effects were found.

How effective is it?

Overall, the program had a mixed effect on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects)

• At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
• An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

The Colorado Adolescent Maternity program has two key components: Clinic appointments and home visits.

The home visitation component of the program was designed to supplement the care provided in the clinic.

Clinic appointments are conducted monthly for the first 6 months, every other month for 6 months, then at 3-month intervals until the child is 2 years old.

Home visits are conducted weekly for the first 16 postpartum weeks. The visits typically last 1-2 hours. After the first 16 weeks, the frequency of these visits is reduced depending on the needs of the family. However, they are never more than 6 weeks apart. Visits are also supplemented with telephone calls to ensure families are contacted at least twice a month.

The home visitor serves as a link between the clinic staff, the teenage parent and her family and any necessary social and mental health service providers. The home visitor works with the teenage parents and their families to develop individualised programs. These programs seek to address the specific behaviours and attitudes that put them at increased risk for maltreating their children. Each visit includes extensive counselling, pre-emptive guidance and medical, educational, and social service referrals as needed.

The home visitor draws on their own experience as a mother, and a parenting curriculum created by the CAMP staff to ensure that all teenage parents receive the information they needed to develop adequate parenting and childcare skills. Specifically, the visit protocols include:

• assessing individual and environmental strengths and weaknesses, and identifying attitudes and behaviours that indicate child abuse and neglect, repeat conception, and school dropout may occur
• helping the teenage parents develop a sense of competency and self-efficacy by identifying small achievable objectives, to build their confidence and motivate them to actively manage their lives
• presenting instructive material about:
  • age-appropriate ways to enhance child development and discipline children
  • well and sick childcare
  • peaceful, adaptive techniques for managing stress
• helping the teenage parents appreciate and manage individual differences in infant temperament (e.g., teenage parents often misinterpret their infants’ crying as a care-giving failure on their part or as an indication that the infants are intentionally trying to disrupt their lives)
• enhancing informal support from family and friends. Family involvement is strongly encouraged to ensure prevention messages are constant and long lasting. This also seeks to ensure the messages teenagers receive from the home visitor and the clinic staff did not conflict with the messages they received at home.
• coordinating referrals to social service agencies, and educational and vocational training programs
• monitoring and promoting appropriate use of medical services and clarifying and re-enforcing health care providers’ instructions and recommendations. This includes emphasising the importance of keeping health and contraception maintenance appointments in the CAMP clinic and calling the clinic rather than dropping in or using the emergency department.

How much does it cost?

Not reported.

What else should I consider?

Home visitors were middle-aged, college-educated women. They also served as paraprofessional health educators in the CAMP prenatal clinic.

The home visitor was always present in the waiting room at the prenatal clinic to meet with patients individually and in small groups to provide anticipatory parenting instruction and support. This enabled the home visitor to introduce concepts and information they planned to cover in detail after delivery, at a time when prevention rather than problem detection could be emphasised, and when the teenage parents were most open to new information about child rearing.

As such, by delivery the home visitor had established a close, friendly, working relationship with most families.

The home visitor worked in close collaboration with other members of the CAMP staff, meeting weekly with them to develop strategies for addressing identified problems. This multidisciplinary approach ensured that young mothers had several supportive adults in their social support networks. It also ensured the home visitor had access to the resources and services the teenagers needed to achieve their goals.

Where does the evidence come from?

1 RCT conducted in the USA with a sample of 145 people (Stevens-Simon et al. 2001).

Further resources

Stevens-Simon, C, Nelligen, D, Kelly, K (2001), ‘Adolescents at risk for mistreating their children Part II: a home- and clinic-based prevention program’, Child Abuse & Neglect, vol. 6, pp. 753-769.