National problems, local solutions: comprehensive services for pregnant and parenting adolescents.

PIP: This study identifies a number of factors associated with the successful development and maintenance of local comprehensive adolescent pregnancy programs in the US. The comprehensive programs were located in communities with relatively well-developed social welfare infrastructures. They received basic state support and were able to tap a wide variety of federal, state, and local resources. These comprehensive programs were managed by skillful administrators and drew upon a broad range of leadership talents. Only a minority of exceptional communities possess the essential prerequisites. Within states, grant mechanisms favor those few localities that can put together the winning proposal or that have the organizational capacity to draw on a variety of funding sources. They are not always the communities with the greatest need. Within communities, even the most comprehensive programs served only a small proportion of the potential clientele. They reflected a brief crisis intervention orientation to a problem that is complex and long-lasting in its origin and consequences. National evaluations and comprehensive programs have found that their benefits are limited and short-lived. The study further demonstrates the political vulnerability of local services for stigmatized and powerless groups in the absence of a strong national mandate. Service providers kept a low profile to avoid the attention of potential opponents. A national strategy based on the sponsorship of a limited number of demonstration projects and the dissemination of information about exceptional, exemplary programs is unlikely to accomplish very much. The evidence suggests that the lack of a national policy commitment to pregnancy prevention contributes to the high rate of adolescent pregnancies.^ieng

Participatory management in public welfare: what are the prospects?

The author analyzes the experience of a state public welfare agency in developing a series of changes in social services using participatory techniques to involve frontline staff. Based on a survey of administrators, social service workers and supervisors, the study reveals staff attitudes toward policy innovation in the agency and their role in it. Staff unanimously want more of a voice in shaping the policies and procedures which govern their work, but efforts to secure their involvement are frequently unnoticed or unappreciated. The author identifies a number of constraints to implementing a participatory approach.

Limits of the comprehensive services model: the case of adolescent pregnancy programs.

During the past 15 to 20 years a comprehensive services model, incorporating health, social, and educational components, has been the preferred mechanism for addressing the problems associated with adolescent pregnancy. This paper offers an assessment of the model based on a study of ten communities in four states. The widely recognized service needs of pregnant teenagers give the model a compelling logic, but we find inherent obstacles that seriously constrain its implementation. These constraints are exacerbated in an era of social welfare cutbacks. We conclude that short-term local service programs, although better than no services at all, are unlikely to meet their objectives.

Working conditions in home care: a survey of Washington state's home care workers.

Home care services make it possible for millions of older Americans to continue living in the community. Such services may enhance the recipients' quality of life while providing essential respite to family caregivers. But while there has been increasing recognition of the burden borne by the predominantly female family caregivers, there has been less attention to the plight of the home care workforce. With the growth of the home care industry, the burden of care has to some extent shifted from one category of female caregivers to another. This paper, based on a survey of 16 agencies and 1,900 workers, examines the employment conditions of home care workers in Washington state. The study reveals a pattern of harsh working conditions, low wages, and few benefits. The findings raise questions about the ethics and efficacy of government policies that are based on the exploitation of home care workers.

Comprehensive programs for pregnant teenagers and teenage parents: how successful have they been?

PIP: A number of recent studies have raised questions about the effectiveness of comprehensive service programs designed to respond to the problem of teenage pregnancy and childbearing in the US. All the programs studied fell short in some respects of the ideal represented by the comprehensive model. Even the very best were limited in geographic coverage, numbers served, scope, duration and intensity of services offered. Nonetheless, there were notable differences between those programs that met the criteria of comprehensiveness and those that failed to do so. The more resource-rich, better-served communities are the most likely to be able to overcome the constraints and to develop comprehensive programs. State policies, backed with program funds, were found to be a crucial determinant of program development. However, they tend to be awarded to localities that in some ways need them the least. The current federal legislation erroneously assumes that dissemination of various comprehensive program models will bring about their local adoption, even without government assistance. Federal incentive grants to states, based on some measure of need and capacity, could spur the development of programs in regions of the country that are otherwise unlikely to be able to afford them. School-based program models have considerable appeal. However, this evaluation revealed the significant obstacles such programs face. An alternative approach would have to start with improved health and welfare services similar to those found in most other advanced, industrial nations. Comprehensive programs, despite their many virtues, are not the magic bullets that will solve the problems associated with unintended teenage pregnancy and parenthood. The empirical evidence of the past 15 years suggests that there is no single solution to the problems associated with adolescent sexuality, pregnancy and parenthood. While family planning and abortion services have proven significant in limiting adolescent pregnancies and births, a more informed policy approach would seek to provide a broader range of services.^ieng