Healthy Outcomes and Self-Sufficiency for Pregnant and Parenting Teens Receiving TANF Cash Assistance in Ramsey County, Minnesota - PowerPoint PPT Presentation

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Healthy Outcomes and Self-Sufficiency for Pregnant and Parenting Teens Receiving TANF Cash Assistance in Ramsey County, Minnesota

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Title: Saint Paul Ramsey County Department of Public Health Author: Sue.Mitchell Last modified by: Default Created Date: 7/19/2004 10:23:20 PM – PowerPoint PPT presentation

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Title: Healthy Outcomes and Self-Sufficiency for Pregnant and Parenting Teens Receiving TANF Cash Assistance in Ramsey County, Minnesota


1
Healthy OutcomesandSelf-Sufficiency for
Pregnant and Parenting Teens Receiving TANF Cash
Assistance in Ramsey County, Minnesota
2
Minnesotas Public Health System
  • Organized into 56 Community Health Boards
  • Nationally recognized because of unique
    organization, State-Local partnership, and
    innovations

3
Ramsey County
  • East side of the Minneapolis/St. Paul Twin Cities
  • Most densely populated county
  • Pop. 525,000
  • Increasing numbers of Hmong, Somalian immigrants
  • 1 in 3 English as a Second Language learners in
    St. Paul

4
Saint Paul Ramsey County Department of Public
Health
  • 301 employees
  • Organized into Sections
  • Administration
  • Correctional Health
  • Enviornmental Health
  • Healthy Communities
  • Epidemiology, Policy, Planning and Preparedness
  • Preventive Health
  • Screening and Case Mangement
  • WIC
  • Healthy Families

5
Healthy Families Section
  • Adolescent Parent Program
  • Home visiting and case management for pregnant
    and parenting teens under 17 yrs
  • REACH Young Parents Program
  • Home visiting and case management for pregnant
    and parenting teens 17 19 yrs who have not
    completed high school

6
Home Visits to Pregnant/Parenting Teens
  • In 2000, large influx of TANF from feds,
    through MN Dept. of Health, increased emphasis on
    self-sufficiency of adolescents along with
    promotion of healthy outcomes for families.

7
Teen Home Visiting Staff
  • Public Health Nurses (PHN)
  • Minimum of 4 yr nursing degrees with public
    health certification, some with masters degrees
  • Social Workers
  • Licensed SWs and LICSW
  • Health Education Program Assistants
  • Health para professionals with 2 year degrees
  • Nutritionist
  • 4 year degree

8
Home Visits to Pregnant/Parenting Teens
  • Services provided to both male and female teen
    parents
  • Information collected, nursing diagnosis
    determined, individualized plan of care developed
  • Implement or refer for interventions
  • Track outcomes

9
Home Visiting Services
  • Physical health assessment of mom, dad(if
    present) and child(ren)
  • Health histories, vital signs, and direct
    observations
  • Notify MD when needed for health concern
  • Ensure all family members are hooked up with a
    primary care clinic, dentist, and psychiatrist
    (if needed)
  • Ensure health insurance is active all paperwork
    processed

10
Home Visiting Services cont
  • Mental health
  • Assessments
  • Past/present domestic violence
  • Past/present abuse/neglect
  • Past/present symptoms or diagnoses
  • Past/present self-mutilation
  • Referrals for psych evals and medication
  • Referrals for counseling and support groups
  • Assist with obtaining county MH case manager

11
Home Visiting Services cont
  • Child Health Assessments
  • Assess for growth and development norms
    established by national pediatric standards
  • Nutritional assessment
  • Past health history/dental history
  • Daily living routines
  • Elevated lead, PICA
  • Past or current risk of abuse/neglect
  • Parent/child attachment

12
Home Visiting Services cont
  • Housing assessment and assistance
  • Safety issues
  • Home Safety Checklist tool
  • Financial situation, money management
  • History or risk of homelessness
  • Goals for living independent living

13
Home Visiting Services cont
  • Cognition/educational needs
  • Past or present learning difficulties
  • Attitudes towards school
  • Initiate special ed assessments
  • Future educational/career goals

14
Home Visiting Services cont
  • Pre-natal education, teaching and monitoring
  • Breastfeeding promotion and support
  • Previous pregnancy history
  • Current status
  • Feelings about pregnancy
  • Partner involvement
  • Nutrition, vital signs
  • Smoking or chemical use
  • Preparation for newborn
  • Meds or treatments ordered by MD

15
Home Visiting Services cont
  • Post-partum education, teaching and monitoring
  • Assessment of physical status of mom and baby
  • Breastfeeding promotion and support
  • Post-partum depression identification and
    referral

16
Home Visiting Services cont
  • Assess knowledge of community resources and
    support
  • Assist and support to access resources
  • Referrals, as appropriate

17
Home Visiting Services cont
  • Womens health
  • Family health history
  • Personal health history
  • Previous pregnancy outcomes
  • Family planning
  • Chemical use
  • Mental/emotional/abuse history
  • Clients assets
  • Medical care Early Childhood years
  • Insurance Support Systems
  • Dental care Transportation
  • WIC food program

18
Home Visiting Services cont
  • Caretaking and parenting
  • Assess strengths and weaknesses
  • Parenting practices of clients parent(s)
  • Risk of abuse/neglect to self or child
  • Attachment and interaction
  • Childs behavior
  • Current discipline practices

19
Home Visiting Services, cont
  • Clinical medical record kept for each client
  • For each category, client knowledge, behavior and
    status(KBS) is assessed
  • Interventions are implemented
  • KBS ratings are tracked for improvement

20
Minnesotas Program for TANF Clients
  • Called MFIP (pronounced m-fip) Minnesota Family
    Investment Program
  • Workforce Solutions, a Ramsey County department,
    administers the MFIP employment services

21
Teen Parents on MFIP
  • More than 70 of teen parents end up on welfare
    at some point in their lives
  • More than 53 of MFIP families in Minnesota began
    with a birth to a teen mom
  • Only 41 of mothers who have children before age
    18 ever complete high school

22
Minnesotas Program for MFIP Clients
  • Each client assigned a job counselor to provide
    Employment Services (ES)
  • Assists clients in obtaining self-sufficiency by
    developing employment plan
  • Teens develop a school plan in place of
    employment plan
  • Ensures clients follow mandates
  • Ability to sanction cash grant if out of
    compliance

23
Public Health Nurses(PHNs) as ES Counselors
  • Because of our positive outcomes, Workforce
    Solutions contracted with Public Health for ES
    services to teens
  • Prior to July 03, home visiting program was
    voluntary
  • Only 1/3 of teens on MFIP received home visiting
    services, now all are mandated

24
PHNs as ES Counselors
  • Began July 2003
  • Now have ability/responsibility to sanction and
    approve child care payments
  • ES chart added to clinical medical record
  • PHNs have matched caseloads with Financial
    Workers and Child Care Workers in other county
    departments
  • Unique collaboration with child support
    enforcement department

25
Evaluation combining PHN and ES Counselor Roles
  • Continue to track all outcomes including
  • Client satisfaction
  • Health status of families
  • Graduation rates
  • Positive attachment to children
  • Housing stability
  • Children will have
  • Well child exams
  • Health insurance
  • Up-to-date immunization
  • Normal growth and development
  • Reduction in unintentional injury

26
Evaluation combining PHN and ES Counselor Roles
  • Additional study of mandatory vs. voluntary
    participation and its effect on health and
    self-sufficiency outcomes
  • Saint Paul Ramsey County Department of Public
    Health selected to be in CityMatch Data Institute
    to study MFIP Teen Program

27
Year One Results
  • MFIP Teens received more coordinated, consistent,
    intensive, and comprehensive services
  • Developed a unique collaboration with several
    county departments and the school district
  • Improved service delivery and efficiency of
    services

28
Year One Results
  • Increased communication between service
    providers-a cross department team feeling has
    occurred
  • All MFIP teens received a comprehensive
    assessment and increased services

29
Lessons Learned
  • It is a difficult balancing act between the dual
    roles of public health home visitor and MFIP
    enforcers
  • Holding clients accountable to MFIP
    rules(sanctioning) is difficult for staff who
    have served in a service provider role

30
Lessons Learned
  • More up front training to PHNs on the rules and
    regulations of MFIP was needed
  • A sanction review team was implemented for
    consultation, evaluation and consistency of
    practice
  • Nurses now tell clients that the committee made
    the sanction decision rather than the individual
    nurse who visits the home

31
Lessons Learned
  • Even during the implementation phase, continued
    emphasis needs to be placed on public health
    practice issues and support for staff

32
Implications for Practice
  • There may be safety concerns for home visitors
    who have the responsibility to sanction cash
    grants
  • Programs with mandatory enrollment/service
    requirements affect relationships
  • Continued emphasis on public health practice (as
    well as learning the new employment services
    counselor role) is vital

33
Implications for Practice
  • Matched caseloads among PHNs, financial workers,
    and child care workers are essential
  • Have representatives from front line public
    health staff involved in all aspects of program
    design and implementation

34
Implications for Practice
  • Successful public health strategies can be
    adapted for use by agencies and departments with
    differing missions
  • Decreasing the number of county staff involved
    with teens
  • improves communication, coordination, quality,
    and client satisfaction of services
  • promotes healthier outcomes

35
Implications for Practice
  • Relationship based services that hold teens
    accountable for the rules they need to follow in
    order to receive MFIP cash assistance promotes
    client responsibility
  • Comprehensive services delivered by a
    multi-disciplinary team increases positive
    outcomes

36
Contacts
  • Sue Mitchell, MPH 651-266-2428
  • sue.mitchell_at_co.ramsey.mn.us
  • Linda Wagner, PHN, MPH 651-766-4063
  • linda.Wagner_at_co.ramsey.mn.us
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