Implementing Early Intervention Program for Adolescent Mothers

The Early Intervention Program (EIP) for Adolescent Mothers was designed to help young mothers gain social competence and achieve model objectives by teaching self-management skills, techniques for coping with stress and depression, and skills to communicate effectively with partners, family, peers, and social agencies.

EIP was developed by researchers at the University of California at Los Angeles (UCLA) School of Nursing. The model developer and director provided implementation support. EIP was initially implemented as a collaborative demonstration project between the developer and the San Bernardino County Department of Public Health, Division of Community Health Services.

No information was available about technical assistance.

EIP served pregnant adolescents from underserved minority groups who were referred to the county health department or another health services agency for nursing care. Women were eligible for EIP if they were 14 to 19 years old; at 26 weeks gestation or less; pregnant with their first child; and planning to keep the infant. Expectant mothers who were chemically dependent or had serious medical or obstetric problems were ineligible. Although EIP initially targeted adolescents, young mothers out of adolescence also may have benefited from the model.

EIP was designed to improve maternal health behaviors during and after pregnancy; improve birth outcomes and mother and infant health; build maternal caretaking skills and improve the quality of mother-child interaction; prevent rapid repeat pregnancy; increase educational achievement; and build social competence.

Nurse home visitors delivered EIP services using a case management approach. During home visits, nurse home visitors covered five main content areas: (1) health, (2) sexuality and family planning, (3) maternal role, (4) life skills, and (5) social support.

Prenatal visits focused on the use of prenatal health care, preparation for childbirth, and self-care during pregnancy. In addition, nurse home visitors conducted four classes focusing on the transition to motherhood, fetal development, parent-child communication, and maternal health.

During the postpartum visits, nurse home visitors provided mothers with information on family planning; infant care and development; well-baby health care; education attainment; substance use; mental health issues, such as handling emotions; and referrals for mental health counseling, family planning, and child care. For example, EIP addressed the prevention of sexually transmitted diseases (such as HIV/AIDs), contraceptive options, school readiness preparations (such as reading to children), and prevention of lead poisoning. Nurse home visitors also helped mothers improve communication skills and learn how to assess their infants’ needs, respond to infant distress, and interact reciprocally with their infants. To help mothers improve their infant interaction and nurturing skills, nurse home visitors used videotherapy, in which they videotaped a mother interacting with her infant and subsequently solicited the mother’s opinion about the quality of the interaction.

Nurse home visitors implemented all aspects of the model using standardized protocols to ensure uniformity. The EIP protocols were organized based on the nursing process and covered each of five content areas. Examples of worksheets used to facilitate learning and behavior change included “Psychological Aspects of Appetite and Food,” “Danger Signals During Pregnancy,” “Prenatal Rest, Exercise, and Activity,” and “I Want to Change.” Another worksheet (called “What Do I Do?”) was used when the mother needed help solving a problem. Protocols incorporated several teaching techniques, such as examining educational and vocational goals and options, completing problem-solving worksheets, and letter writing.

EIP included home visits from mid-pregnancy through the end of the child’s first year. The model included 17 home visits—2 prenatal and 15 postpartum—each lasted 1.5 to 2.0 hours. Postnatal visits occurred when the child was one, four, and six weeks old and at monthly intervals between the child’s 2nd and 12th months. In addition, EIP offered four “preparation for motherhood” classes.

No information was available about model adaptations or enhancements.

EIP was originally implemented collaboratively by the UCLA School of Nursing and the San Bernardino County Department of Public Health, Division of Community Health Services. The model could have been administered by other health service agencies.

No information was available about the fidelity guidelines that implementing programs or nurse home visitors were required to meet.

Public health nurses from local health departments or nurses from other health service agencies conducted home visits and classes. A supervisor guided and monitored their implementation. In the initial demonstration of EIP, nurse home visitors were employed by the county health department and contracted by the university to deliver EIP services, and the model also employed recruiters.

No information was available on the staff education and experience requirements. In the initial demonstration of EIP, nurse home visitors had, on average, five years of experience with the county health department, a bachelor’s degree in nursing, and a public health nursing certificate from the state of California.

No information was available on supervision requirements.

This model required that the nurse home visitors participate in pre-service training. EIP required on-site staff training from the model developer and director. For the demonstration, pre-service training for nurse home visitors was approximately 60 hours.

No information was available on ongoing professional development requirements.