Title: Healthy Outcomes and Self-Sufficiency for Pregnant and Parenting Teens Receiving TANF Cash Assistance in Ramsey County, Minnesota
1Healthy OutcomesandSelf-Sufficiency for
Pregnant and Parenting Teens Receiving TANF Cash
Assistance in Ramsey County, Minnesota
2Minnesotas Public Health System
- Organized into 56 Community Health Boards
- Nationally recognized because of unique
organization, State-Local partnership, and
innovations
3Ramsey 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
4Saint 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
5Healthy 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
6Home 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.
7Teen 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
8Home 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
9Home 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
10Home 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
11Home 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
12Home 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
13Home Visiting Services cont
- Cognition/educational needs
- Past or present learning difficulties
- Attitudes towards school
- Initiate special ed assessments
- Future educational/career goals
14Home 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
15Home 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
16Home Visiting Services cont
- Assess knowledge of community resources and
support - Assist and support to access resources
- Referrals, as appropriate
17Home 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
18Home 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
19Home 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
20Minnesotas Program for TANF Clients
- Called MFIP (pronounced m-fip) Minnesota Family
Investment Program - Workforce Solutions, a Ramsey County department,
administers the MFIP employment services
21Teen 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
22Minnesotas 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
23Public 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
24PHNs 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
25Evaluation 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
26Evaluation 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
27Year 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
28Year One Results
- Increased communication between service
providers-a cross department team feeling has
occurred - All MFIP teens received a comprehensive
assessment and increased services
29Lessons 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
30Lessons 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
31Lessons Learned
- Even during the implementation phase, continued
emphasis needs to be placed on public health
practice issues and support for staff
32Implications 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
33Implications 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
34Implications 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
35Implications 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
36Contacts
- 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