The use of EPSDT and other health care services by children enrolled in Medicaid: the impact of OBRA'89.

To increase the participation of Medicaid children in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program and to improve their health, Congress included several provisions in the Omnibus Budget Reconciliation Act of 1989 (OBRA'89) that addressed problematic program features. The impact of these provisions on children's health service use was investigated in a study funded by the Health Care Financing Administration. After conducting site visits to four states, the authors analyzed claims data for the children residing there and found evidence that, in 1992, these states placed a higher priority on improving the effectiveness of EPSDT than they did before 1989. The states' efforts to expand the EPSDT provider base and to enhance outreach and service provision were either directly or indirectly inspired by OBRA'89. The authors also found evidence of a significant impact on provider participation and caseloads and on children's use of both preventive care and diagnostic and treatment services. However, the effects were modest in comparison to the size of the progress that is required.

A comparison of Medicaid and non-Medicaid obstetrical care in California.

The use of prenatal care and rates of low birth weight were examined among four groups of women who delivered in California in October 1983. Medicaid paid for the deliveries of two groups, and two groups were not so covered. The analyses suggest that longer Medicaid enrollment improved the use of prenatal care. The association between prenatal care and birth weight was less clear. For women under Medicaid, measures of infant and maternal morbidity, hospital characteristics, and Medicaid eligibility were all statistically related to charges, payments, and length of stay for the delivery hospitalization.

Family planning for teens: strategies for improving outreach and service delivery in public health settings.

The persistent underuse of family planning services by inner-city, low-income, sexually active youth underscores the importance of testing innovative programs that maximize participation. Presented in this paper is an analysis of a Chicago public health clinic's special program for adolescents that originated from the staff's observations of the scheduling, educational, and support needs of teens seeking family planning services from a traditionally managed public health facility. Between December 1982, when the special program--the Teen Clinic--was implemented, and March 1985, more than 600 adolescents sought social support and contraceptive services--an 82 percent increase in new-patient registration compared with the enrollment before the program began. In contrast, two neighboring public health department facilities without special family planning programs for teens experienced either a small increase, 4 percent, or a modest decrease, 17 percent, in utilization by teenagers during the same period. The increased use of the study facility by teens, coupled with patients' self-reported nonuse of alternative sources of care and referral patterns, suggests that the new program was successful in recruiting sexually active teens who had previously been inadequately protected against pregnancy. The perceived institutional and interpersonal factors influencing 153 teens' initial and repeated use of the Teen Clinic, as measured by a structured survey, echo the findings of previous research. Strategies suggested by the study's findings for improving outreach and service delivery are described.

Family life education for young inner-city teens: identifying needs.

PIP: Sexual decision making, perceptions of responsibility for birth control and pregnancy, and knowledge of contraception and the consequences of teenage pregnancy were assessed among 251 high-risk 7th and 8th grade black, US inner-city adolescents to determine their need for information. Survey results indicate that these adolescents are aware of contraceptive methods, but lack practical information about requirements for obtaining them or method effectiveness. Many students are uniformed about the circumstances under which pregnancy can occur. Males indicate a willingness to have intercourse regardless of the contraceptives used, if any, and believe responsibility for the use of a birth control method belonges to females. Females believe themselves to be responsible for contraceptive utilization and prefer intercourse with adequate protection. Both genders endorse the notion of mutual responsibility for unplanned pregnancies and related decisions. More systematic research assessing the effectiveness of a variety of curricula for enhancing skills in decision-making and moral reasoning in young teens is needed.^ieng

Correlates of adolescent parenting.

A self-selected sample of 177 teenage parents participated in a study of the correlates of teenage parenting. An ecological model of the predictors of parenting behavior was used to define factors which potentially influence teenage parents' parenting skills as measured by the Home Observation for Measurement of the Environment (HOME). The factors tested include level of punitiveness toward child rearing, knowledge of developmental milestones, level of depression, perceived social support, parental age, and parental race. The results of a stepwise hierarchical regression analysis found that parental race, punitive attitudes toward child rearing, and parental age were statistically significant predictors of total HOME scores. The older, white adolescent mother with less punitive attitudes toward child rearing and child discipline scored the highest on parenting skills. The relevance of these findings to program planners and service providers involved in teenage parent support and education programs is discussed.

PIP: This study of correlates of teenage parenting involving 177 US teenage parents identified parental race, punitive attitudes toward child rearing, and age as significantly related to parenting behavior. An ecological model of the predictors of parenting behavior was used to define factors which potentially influence teenage parents' skills as measured by the Home Observation for Measurement of the Environment (HOME). The factors tested include level of punitiveness toward child rearing, knowledge of developmental milestones, level of depression, perceived social support, parental age, and parental race. The results of a stepwise hierachical regressions analysis found that punitive attitudes, parental race, and age were significant predictors of total HOME scores. The older, white adolescent parent with less punitive attitudes toward child rearing and discipline scored the highest on the parenting skills. The average total HOME score for the white teenage mothers is comparable to the standing of other groups of parents. The mean HOME score for the black parents participating is lower than that reported for other samples. The prominent role of race needs further study and may be of special interest to program planners.

Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale.

The factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale was examined for a sample of 116 parents who were participating in family support programs designed to prevent child abuse and neglect. Participants' self-reports of depressive symptoms as measured by the CES-D were analyzed in relation to their self-esteem (measured with the Rosenberg Self-Esteem scale) and state and trait anxiety (measured with Spielberger's State-Trait Anxiety Inventory). Factorial validity was adequate, and results indicated a moderate correlation between the CES-D and self-esteem and state anxiety. However, a high correlation was obtained between the CES-D and trait anxiety, which suggests that the CES-D measures in large part the related conceptual psychological domain of predisposition for anxiousness.

Family life education for young teens: an assessment of three interventions.

The impact of three variations of a family life education (FLE) program for 172 inner-city, junior-high-level students was investigated. Variations in exposure time, instructional methods, and teacher quality led to the classification of each intervention on a general intensity dimension. Separate pretest-posttest nonequivalent comparison group designs were utilized to assess program impact along seven knowledge and attitudinal dimensions. Survey results revealed that, in comparison to no-treatment groups, the more intensive the program (a) the greater the gains in knowledge about reproductive physiology, contraception, and the consequences of teen pregnancy and parenthood (especially among experimental group females); and (b) the more birth control methods participants became familiar with over time. Changes in personal acceptance of premarital intercourse and perceived responsibility for contraception were observed only in the study examining the most intensive treatment. The results of the evaluations point to the combined importance of instructional methods, teacher quality, and in-class exposure time for producing change in young adolescents' knowledge of and attitudes toward sexuality. Further potential for the impact of school-based sex education programs on knowledge and attitudes is discussed within the broader context of the young adolescent's social environment.

Family life education in Chicago schools: a study of programs implemented by nonschool agencies.

Although nonschool agencies provide important complementary courses on family life education (FLE) in public and private schools, little is known about the scope and content of such curricula. This paper describes a study documenting the types of school-based family life education programs implemented by nonschool agencies in Chicago. Semistructured telephone interviews were conducted with professionals from 26 health care and social service agencies, identified as offering FLE courses in the metropolitan area. The surveyed organizations provided FLE programs in almost 100 public and private schools in Chicago during the 1982-83 and 1983-84 school years. Most programs were relatively short, utilized few interactive teaching techniques (e.g., role-playing, exercises), covered a wide variety of topics, and were integrated into other curricula units rather than implemented as separate courses. Agency personnel covered topics viewed as important by school administrators and teachers, most notably information on contraception and sexual decision making.

PIP: Although nonschool agencies in the US provide important complementary courses on family life education (FLE) in public and private schools, little is known about the scope and content of such curricula. This paper describes a study documenting the types of school-based FLE programs implemented by nonschool agencies in Chicago. Semistructured telephone interviews were conducted with professionals from 26 health care and social service agencies identified as offering FLE courses in the metropolitan area. The surveyed organizations provided FLE programs in almost 100 public and private schools in Chicago during the 1982-83 and 1983-84 school years. Most programs were relatively short, utilized few interactive teaching technics (e.g., role-playing, exercises), covered a wide variety of topics, and were integrated into other curricula units rather than implemented as separate courses. Agency personnel covered topics viewed as important by school administrators and teachers, most notably information on contraception and sexual decision making.

Family life education for young adolescents: a quasi-experiment.

The impact of a family life education program for inner-city, minority elementary-school students was investigated. 2 randomly assigned groups of 7th and 8th graders (balanced for gender) completed a self administered survey, both before and after program implementation. In comaprison to the control group, program participants displayed (a) improved knowledge about contraception, reproductive physiology, an adolescent pregnancy outcomes; (b) increased awareness of the existence of specific birth control methods; (c) among 7th gradres, more conservative attitudes toward circumstances under which sexual intercourse was viewed as personally acceptable, and among8th graders, a shift toward more liberal attitudes; and (d) a greater tendency to acknowledge mutual responsibility for contraception. The impact of this intervention and school-based sex education programs in general is discussed within the broader context of the young adolescent's social environment.