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

1. Healthy OutcomesandSelf-Sufficiency for Pregnant and Parenting Teens Receiving TANF Cash Assistance in Ramsey County, Minnesota

2. Minnesota�s 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 SW�s 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 con�t 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 con�t 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 con�t 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 con�t Cognition/educational needs Past or present learning difficulties Attitudes towards school Initiate special ed assessments Future educational/career goals

14. Home Visiting Services con�t 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 con�t 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 con�t Assess knowledge of community resources and support Assist and support to access resources Referrals, as appropriate

17. Home Visiting Services con�t Womens health Family health history Personal health history Previous pregnancy outcomes Family planning Chemical use Mental/emotional/abuse history Client�s assets Medical care Early Childhood years Insurance Support Systems Dental care Transportation WIC food program

18. Home Visiting Services con�t Caretaking and parenting Assess strengths and weaknesses Parenting practices of client�s parent(s) Risk of abuse/neglect to self or child Attachment and interaction Child�s behavior Current discipline practices

19. Home Visiting Services, con�t 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. Minnesota�s 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. 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 Minnesota�s Program for MFIP Clients

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. 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 Implications for Practice

36. Contacts Sue Mitchell, MPH 651-266-2428 sue.mitchell@co.ramsey.mn.us Linda Wagner, PHN, MPH 651-766-4063 linda.Wagner@co.ramsey.mn.us