Manuscript Details

Source

Barnet, B., Rapp, T., DeVoe, M., & Mullins, C. D. (2010). Cost-effectiveness of a motivational intervention to reduce rapid repeated childbearing in high-risk adolescent mothers: A rebirth of economic and policy considerations. Archives of Pediatrics and Adolescent Medicine, 164(4), 370-376.

High rating
Author Affiliation

Beth Barnet, a study author, is a developer of this model.

Funding Sources

Department of Health and Human Services, Office of Population Affairs, Office of Adolescent Pregnancy Programs, Grant APRPA006010.

Study Design

Design Attrition Baseline equivalence Confounding factors Valid, reliable measures?
Randomized controlled trial Low Not applicable None
Study Participants

Pregnant teenagers were recruited from urban medical clinics that provided prenatal care to women without insurance or who were insured by Medicaid. The teens were assigned randomly to one of two intervention groups (CAMI and CAMI+) or a control group. Initially 235 pregnant teenagers were randomly assigned, 167 to the treatment groups (87 to CAMI and 80 to CAMI+) and 68 to the comparison group. Most were poor, African American, and unmarried. Mothers ranged in age from 12 to 18 years old at intake (24 weeks or more gestation). Ninety-seven percent of the mothers were African American. Participants were followed for 27 months.

Setting

The study was conducted in Baltimore, Maryland.

Home Visiting Services

The intervention included two home-based treatment groups: CAMI and CAMI+. The CAMI intervention began after the delivery of the participant’s child and sessions were held every three months until the child turned 2 years old. A participant assigned to the CAMI group met with her counselor to assess her current behaviors and to receive “motivational interview counseling” that encouraged the participant to use contraception and avoid future rapid subsequent pregnancies. The participant and counselor worked together to establish short- and long-term goals. Adolescents assigned to the CAMI+ intervention received all the services given to those in the CAMI group plus more intensive services. These services included additional monthly home visits with a CAMI counselor, which involved case management and education on effective parenting. Participants received a maximum of nine home visits by a CAMI counselor.

Comparison Conditions

Comparison group members received usual care at their prenatal care sites.

Study Participants

Pregnant teenagers were recruited from urban medical clinics that provided prenatal care to women without insurance or who were insured by Medicaid. The teens were assigned randomly to one of two intervention groups (CAMI and CAMI+) or a control group. Initially 235 pregnant teenagers were randomly assigned, 167 to the treatment groups (87 to CAMI and 80 to CAMI+) and 68 to the comparison group. Most were poor, African American, and unmarried. Mothers ranged in age from 12 to 18 years old at intake (24 weeks or more gestation). Ninety-seven percent of the mothers were African American. Participants were followed for 27 months.

Setting

The study was conducted in Baltimore, Maryland.

Home Visiting Services

The intervention included two home-based treatment groups: CAMI and CAMI+. The CAMI intervention began after the delivery of the participant’s child and sessions were held every three months until the child turned 2 years old. A participant assigned to the CAMI group met with her counselor to assess her current behaviors and to receive “motivational interview counseling” that encouraged the participant to use contraception and avoid future rapid subsequent pregnancies. The participant and counselor worked together to establish short- and long-term goals. Adolescents assigned to the CAMI+ intervention received all the services given to those in the CAMI group plus more intensive services. These services included additional monthly home visits with a CAMI counselor, which involved case management and education on effective parenting. Participants received a maximum of nine home visits by a CAMI counselor.

Comparison Conditions

Comparison group members received usual care at their prenatal care sites.

Findings that rate moderate or high in this manuscript

Maternal health
Outcome measure Timing of follow-up Rating Direction of Effect Effect size (absolute value) Stastical significance Sample size Sample description
Repeat birth 24 months postpartum High
0.44 Statistically significant, p=0.01 148 mothers CAMI+ vs. control
Repeat birth 24 months postpartum High
0.29 Not statistically significant, p=0.08 148 mothers CAMI vs. control
Effect rating key
Favorable finding / Statistically significant
UnFavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Black or African American
97%
Unknown
3%

Maternal Education

Less than a high school diploma
42%
Unknown
58%

Other Characteristics

Enrollment in means-tested programs
86%