Youth Preferences for Prenatal and Parenting Teen Services

J Pediatr Adolesc Gynecol (2005) 18:167–174 Original Studies Youth Preferences for Prenatal and Parenting Teen Services Joanne E. Cox, MD1, Laura Bevill, BS1, Jessica Forsyth, MPH2, Sylvia Missal, MSW, LICSW, MBA1, Mollie Sherry, MSW, LICSW1, and Elizabeth R. Woods, MD, MPH2 1 Division of General Pediatrics, 2Division of Adolescent Medicine, Children’s Hospital Boston, Boston, Massachusetts Abstract. Study Objective: Parenting teens served by a teen-tot program and teens from a prenatal clinic participated in focus groups to explore their perceptions of medical care, social services, and psycho-educational parenting groups. Design: The teens met in four focus groups, two prenatal and two postnatal. Setting: Teens receiving care from a teen-tot program and associated prenatal clinic in a large metropolitan area in New England. Participants: A total of 16 pregnant (n ⫽ 6) and parenting (n ⫽ 10) teens ages ranging from 16 to 21 years (13 African American, 2 Latina, and 1 Haitian) participated in the four focus groups. Methods: A qualitative focus group study was performed. Structured, culturally sensitive questions guided the discussion based on a hypothetical case scenario. Themes were identified through grounded theory with three coders and differences were reconciled. Results: The groups revealed prenatal and postnatal mothers valued medical and social services provided in a teen-focused hospital clinic. Prenatal teens looked to providers for health education services and group support. Parenting teens requested consistent doctors for their children and social supports for themselves. Both groups desired assistance with social services, education, housing, and finances as well as educational services for fathers. Conclusions: Teen parents’ perceptions and suggestions for services are critical to program development that meets the needs of participants. Key Words. Focus groups—Parenting teens—Prenatal teens—Parenting groups—Teen-tot model Address correspondence to: Joanne E. Cox, MD, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115; E-mail: Joanne.cox@childrens.harvard.edu 쑖 2005 North American Society for Pediatric and Adolescent Gynecology Published by Elsevier Inc. Introduction Despite major declines in teen pregnancy rates in the last decade, 43 out of 1,000 teens between the ages of 15 and 19 years gave birth during 2002.1,2 During pregnancy, teens are at risk for poor compliance with prenatal care, and teens under age 17 years have higher incidence of medical complications.3,4 After delivery, teen parents face significant socioeconomic risk, and their children have higher incidence of development delay and academic failure.3 Programs have been developed that include medical services, mental health assistance, parenting groups, and advocacy.5 Studies have shown that specialized prenatal and postnatal parenting programs can enhance prenatal care compliance,6 improve parenting abilities, and decrease family stress.7 Along with medical and social services, parenting groups are a modality used to enhance teens’ personal development and child rearing abilities. Groups educate parenting teens on many topics they have not yet learned because of their young age.8,9 Psychoeducational groups for prenatal and parenting teens focus on infant care, child development, medical health, the maternal/child relationship, and emotional wellbeing. Talking with other teen mothers enhances support and decreases isolation.10 Group participation may provide teens with skills to overcome difficult personal experiences and decrease repeat pregnancies.8 Interventions must be fine tuned to the specific needs of the population. Conducting focus groups is a well-known qualitative method of assessing a population’s needs and evaluating a program.11 Research has shown that focus groups can be successful in gathering health care perspectives from teens.12 Young people’s perceptions of care may improve the mode of health care and the responsiveness of the recipients to the care.13 The objective of this study was to explore 1083-3188/05/$22.00 doi:10.1016/j.jpag.2005.03.003 168 Cox et al: Youth Preferences in Teen Services the perceptions and preferences of parenting and pregnant teens cared for in a teen-tot program and an affiliated prenatal program concerning services they have received or would ideally like to receive from the program. Suggestions were elicited early in the development of a new program to help shape the services offered to young parents. (Table 1). Only one participant was multiparous. Prenatal program staff recruited pregnant teens from within their teen-focused prenatal clinic. Teen-tot clinic staff recruited parenting teens to participate in the focus groups. Participants were telephoned and approached during clinic visits. Each subject read, understood, and signed an informed consent that had been approved by Children’s Hospital Boston’s Institutional Review Board. Methods Setting The focus groups were conducted in two collaborating hospital-based comprehensive programs, one for prenatal teens and the other for parenting teens. At the prenatal program, nurse midwives and a social worker provide comprehensive psycho-social and obstetrical care that encourages compliance with prenatal care, good nutrition, STD/HIV prevention, and breastfeeding. The social worker connects teens with community services, including housing, education, and home visiting services. At birth, mother and baby are visited in hospital by a pediatric nurse practitioner who identifies concerns and provides well-baby care education. She coordinates the transition of care to a teen-tot program where a multidisciplinary team provides comprehensive, family-centered health care to both young parents and their children. Within the first week, the teen mother meets her primary health care team of nurse, social worker, and medical provider who follow her for the first three years of her child’s life. The social worker begins an assessment of her history, family situation, school situation, relationship to baby’s father, and outstanding needs and provides ongoing support. The nurse provides individual health education and careful follow-up of any medical issues of mother or child. The father of the child, if present, is offered a range of services as well. A social worker and nurse practitioner team conducts both prenatal and postnatal psycho-educational groups. These groups using an array of interactive activities, foster compassionate, empathetic, and appropriate relationships among teens participating in the parenting groups.14,15 Group topics are structured to fit the appropriate educational needs of the teens either prenatal or parenting and are based on the Nurturing Curriculum.16,17 Population Teen mothers were eligible to participate in the focus groups if they were (1) less than 19 years old at delivery, (2) attended the prenatal program and/or the teentot program, and (3) spoke English. The ethnic and socioeconomic status of the teens that participated in the focus groups was reflective of the clinic populations Data Collection Four focus groups (two prenatal and two parenting) were conducted within a 6-month span between December of 2001 and May of 2002. A trained facilitator used a structured moderator’s guide that was developed from conceptualization by the multidisciplinary service delivery team (made up of nurses, social workers, and physicians). The teens were given a culturally sensitive, hypothetical case scenario describing a 16year-old teen carrying a child to term or parenting a healthy newborn baby, depending on the type of group (Table 2). The facilitator posed questions about services the hypothetical teen parent, the child, and others involved would need in the described circumstances. The audiotapes from three of the focus groups were transcribed verbatim without names or identifiers. A separate recorder took detailed notes as well to capture verbal and nonverbal communications. From the fourth group, only detailed notes were available, due to a tape recorder malfunction. Demographic data were collected from an intake questionnaire administered at the time the teens initiated services. Participants were provided cab rides to and from the hospital, $10 reimbursement, childcare during group sessions, and nutritious snacks. Data Analysis Three authors (LB, SM, ERW) independently manually coded the transcription text for underlying themes. Initially, descriptive open coding was used. As themes emerged, coding strategies were modified and refined using grounded theory techniques.18–20 Interpretive coding was verified by comparing back to focus group transcript. Main themes that linked the Table 1. Age and Race of Participants (n ⫽ 16) Age Average Age Age Range Race African American Latina Haitian Prenatal (n ⫽ 6) Parenting (n ⫽ 10) 18.0 years 16–20 years 18.9 years 18–21 years 5 1 0 8 1 1 Cox et al: Youth Preferences in Teen Services 169 Table 2. Focus Group Questions Prenatal Group Questions Case scenario: Juanita is a 16-year-old girl who is six months pregnant for the first time. She has had a healthy pregnancy so far. She is attending school currently. What will help her do the best for herself, the pregnancy and her family? What will be helpful in terms of health services? Who else needs services? What other services would be helpful to Juanita like food, money, jobs, housing, and breastfeeding? What would you like or dislike about parenting groups? What would you do? Postnatal Group Questions Case scenario: Juanita is a 16-year-old girl who has a healthy, newborn baby. She would like to go back to school. The father of the baby visits often. What will help Juanita do the best for herself, her baby, and her family? What kind of health services is necessary for her and her baby? What about services besides health care can a hospital offer Juanita, like food, housing, money, school, and jobs? If you could have one wish, for you, your baby and your family, what would it be? What would you like or dislike about parenting groups? What would you do? categories were then developed in the final analyses, and are presented here with a representative range of youth comments. Results A total of 16 teens participated in the focus groups, with ten parenting teens and six prenatal teens (Table 1). Participants’ ethnic backgrounds consisted of African American, Latina, and Haitian. The young women’s ages ranged between 16 and 21 years. Participants were low-income, indicated by eligibility for Medicaid. All prenatal teens were in the second or third trimester. Of the parenting teens attending focus groups, 30% were parents of more than one child. Perceptions of Medical Health Care As the focus group discussion progressed, it became clear that the teens valued comprehensive medical services that were hospital based. Prenatal and postnatal groups commonly desired comprehensive health services in a hospital setting. Their greatest expectation from a hospital was primary health care for themselves and their children. Teens felt most cared for and comfortable if they saw the same provider at each visit. The two groups’ secondary preferences did differ, as prenatal teens desired services that fostered exercise and socialization around their pregnancy. One prenatal teen indicated the importance of exercise for delivery: “A lot of people don’t get the exercise they are supposed to. If you do a lot of walking, your pelvic area is more loose and when you get ready to push your baby out, it’s not that painful.” Another said, “They should just have a building where there are only pregnant women’s programs. All they (doctors) tell you is do a lot of exercises. What type of exercise? You don’t know really what to do because you have never been to a program like that.” Another identified the positive support that exercise could provide:“Being pregnant you get depressed. Your body is all out of shape. Your chest is huge. So by you doing something that makes you feel good about yourself, it lifts your self esteem a lot.” When asked the purpose of their prenatal care visits, multiple prenatal teens mentioned basic reproductive information and prenatal medical health: “See how far along they are and they need their prenatal pills and their monthly check-ups.” Another felt that education about fetal development was especially important: “Where the baby comes from. How it all gets started and the sperm traveling to the egg.” All parenting teens desired high quality care for their children. They greatly valued the direct referral services in a hospital and access to specialists within the hospital if there was a complication regarding their child’s health: “I want nothing but the best for my son.” Another mother said, “It’s better in a hospital. Everything you need is right here. I didn’t have to go to another hospital if my daughter is sick.” Parenting teens with older children receiving longer term care spoke openly regarding their desire for consistent doctors accessible for regular health care visits for themselves and especially for their children. The parenting teens felt exasperated when providers to whom they were attached left the program. Several teens emphasized the need for: “A doctor who doesn’t leave.” Another complained, “Every time I came in they just gave me the first doctor they had in.” Because prenatal teens obtain a shorter duration of services, there were fewer concerns about staff turnover. A few parenting teens were suspicious of private doctors in private practices or of home visiting professionals. The teens placed greater confidence in the hospital establishment more than an independent practice: “Private doctors are not as good as a clinic. They just want to get paid and bounce.” Another said, “Who are they to call themselves private doctors, you know? They have a diploma, whatever. But I am not sure what they do.” 170 Cox et al: Youth Preferences in Teen Services Birth Control Prenatal and parenting teens collectively wanted doctors to be honest and detailed in their descriptions of birth control options. The teens wanted to know all options available along with a doctor’s recommendation: “It’s nice to know all your different options and things that you can use.” Ultimately, they desired to make their own choice: “My doctor can say, ‘Okay, I think the pill would be best for you. But just in case, if you or your mom want to look over anything else, here’s everything and every side effect.” Sexually Transmitted Diseases Prenatal teens wanted doctors to be upfront about potential sexually transmitted diseases that could impact their child. One teen shared: “I think they (the doctor) should just offer the test to you, instead of waiting for you to be like, ‘Do you want to check me for syphilis?’ Be more informative that when they do the pap smear (pelvic exam), it only shows for gonorrhea, chlamydia and cervical cancer. It’s information that you need.” Compared to prenatal teens, parenting teens were not as concerned about sexually transmitted diseases. Prenatal teens also felt it was difficult to find out personal information regarding their health and their pregnancy. “Not just pregnancy, but about sex, and health, like all different diseases. Or sometimes you might not want to be at the library if it’s packed. It’s so hard to find privacy. Sometimes it’s hard to read at your house because your mom might see. She’ll trip out.” Multiple prenatal teens thought pamphlets in doctors’ offices and in clinic rooms would be a private way to gather information about their bodies and pregnancies without disclosing personal information to their family and friends. Social Services Including Mental Health Care Prenatal teens did not express as much emotional stress as did parenting teens. One prenatal teen expressed the need for support during the initial stages of acceptance of her pregnancy as well as other family members’ acceptance of the pregnancy. The prenatal teens would have liked the hospital to foster relationships with other pregnant teens as the prenatal groups did or other venues such as exercise groups in preparation for labor and delivery as well as keeping fit and healthy for their unborn child. Many prenatal teens felt social services were not taken full advantage of due to suspicion of the outcome of disclosure of personal issues. One teen honestly shared: “Maybe they are not truthful about the services they need because they feel like ‘If I don’t have the right housing, somebody might try to take my baby away.’ I used to think like that. My mother had problems with DSS and we got taken away when we were younger.” All parenting teens expressed with a strong, common voice how much they depended on the social workers they were assigned in the teen-tot model for emotional support. Numerous teens stated they would not be as emotionally healthy as they were at the point of the focus group without the empathetic support of their social worker to help them cope with their life situations. Parenting teens expressed that this was the next most important service needed from a hospital clinic after basic medical health services: “I am not in school so everything I get is from YPP (The Young Parent’s Program). All my support is from my mother or YPP.” Another confided, “Even though right now I have a lot of support, [from social worker and others] sometimes it is too much for me. I cry in a corner. It’s like, I can’t handle it.” Another pointed out the importance of mental health support as part of the medical visit: “How you feel mentally will affect you physically. But if you workin’ you don’t have time to go here and there to get help. That’s why I like YPP ‘cause they meet you half way and give you everything you need.” Some teens with emotional issues did not go to their social workers for help but sought help elsewhere but felt it was difficult to find. Few expressed reliance upon their own parents and neighbors for social support. At times, teens felt unsupported emotionally by local social service agencies, school counselors, and other case managers. The teens felt these people didn’t help, were too busy, or were not welcoming. They unanimously agreed that help in the community was not available for their specific needs. Assistance with Primary Needs Both prenatal and parenting teens commonly expressed a need for help finding housing, jobs, childcare, education, and food. Teens found housing in the urban area to be a challenge, with long waiting lists and placement locations far from the urban center from which they were accustomed. “If you do (get housing), you have to wait two to five years. Start getting on the waiting list!” Transportation is a major issue for young parents when placed outside of the city: “Everything is close, hospital and everything for my kids. I don’t want to leave here. I know they are sending everybody to [a neighboring community]. I can’t be taking bus and train with my two babies.” Local community housing services are overwhelmed and are not able to meet the needs of teen families. Teens would either enjoy more assistance in this area from the hospitals or are already taking advantage of their social worker’s connections within the community to gain housing. “Can someone help me with housing?” Both prenatal and parenting teens also felt they needed support to finish their high school education Cox et al: Youth Preferences in Teen Services and seek opportunities for their futures. They felt overwhelmed navigating the educational systems while pregnant or while caring for their children. Both groups expressed desires for assistance to continue their education from social workers at the hospitals. “It’s so hard. You only get minimum wage if you don’t have a GED. But I want to be home with my babies while they are young. When they get older, I’ll do something.” Another stated, “It’s overwhelming. How do I pay for college?” In addition, parenting teens would like assistance with childcare. Some parenting teens had taken advantage of their social worker’s assistance finding childcare to go back to school. Prenatal teens had not actively pursued this issue and therefore did not have comments to make. Nutrition Prenatal teens used nutritional services at the hospital to learn about healthy eating habits. Parenting teens did not have such services as easily available. Parenting teens wanted a doctor/nutritionist’s help with weight control. Both groups struggled to make healthy eating a habit using WIC (Federal nutritional supplemental program). They felt WIC did not offer a diversity of foods or even foods recommended by the hospital to eat. Both teen groups responded with heated frustration: “They don’t provide the type of food you are supposed to eat. They just give you milk.” Teens felt that WIC should offer a greater range of foods: “They show you all these types of products you can eat. Why can’t they provide those to us. If they say, ‘Eat a lot of fruit.’ Why can’t they provide fruits to us?” Both groups felt WIC did not offer them enough food to eat for themselves whether pregnant or breastfeeding, or their growing children. Teens agreed that it would be helpful if hospitals provided vouchers for local markets: “Why couldn’t they just provide stuff that we like to eat? Like give us a certificate for Stop & Shop where we could get whatever we need to get.” They would like more assistance in this area from their social worker and/or nutritionist. Services to Others Including Fathers When the topic of relationships with fathers was introduced, prenatal and parenting teens alike were reluctant to include them in the parenting groups. A few parenting teens were often outright angry at the mention of their children’s fathers. “Please! The father? I ain’t worried about him. If he wants to frolic, let him frolic!” Once the teens calmed down, they did agree relationships with fathers would be a good topic to discuss in a parenting group: “Relationships should be discussed because whatever you do in your house will affect your child.” 171 When asked if the fathers should receive social services also, teens mostly agreed. When prompted by the moderator, teens suggested health care for their children’s fathers and parenting groups separate from the mothers but with similar group topics. Most parenting teens did not support regular participation by the fathers in the same parenting groups: “Well, nothing happens between parents, no communication, no point to have parents together.” They felt it would detract from the teen mothers’ bonding with each other and with the group leaders. Having fathers present would not allow the mothers to be as open when asking personal questions. Teens also felt fathers would feel the same fear of exposure while participating in groups with other teen mothers: “I don’t want to be here with them (fathers).” A few parenting teens strongly opposed the idea of providing services for fathers: “A sperm donor don’t mean nothing. To be a father is different.” Contrary to the parenting teens’ opinions, prenatal teens were receptive to the idea of including the fathers in one of the ten parenting group sessions to discuss development, child bonding, or relationships. The prenatal teens also suggested that a support group for their own caregivers, such as their parents or grandparents, would be helpful as well. Resources Prenatal teens were very interested in prenatal and postnatal resources concerning development and child rearing. The prenatal teens expressed a desire for more materials to educate themselves on their pregnancy, health, and child bearing experiences to come. They requested books such as What to Expect When You Are Expecting. A prenatal teen suggested that information should be presented in steps: “And just like, step-by-step, week-by-week, month-by-month. Like pictures and charts and stuff like that would be helpful so that people can see it.” With regard to resources for parenting such as books, tapes, or videos, most parenting teens acknowledged the educational gifts they received were helpful. A few teens admitted they did not have the resources such as a television, VCR, or simply time to use the videos. Prenatal and parenting teens alike expressed frustration with limited resources, education, housing, and employment. They did not receive much help from the hospital with these issues and could use more assistance. The financial challenges of teen parenting were evident in the discussions: “Can you guys help me with an apartment because I live in a one bedroom apartment. I have two kids. I had to sell my living room set so I could put my bedroom set there so I could take the bedroom and split it half for girl and half for boy.” Another prenatal teen explained: “My mother told me that I couldn’t get an upgrade on my food stamps 172 Cox et al: Youth Preferences in Teen Services until after I had the baby. I am like, eating like a horse, and I only get this much. I am not trying to be greedy, like selfish, but that goes quick.” They turn to adults for guidance about management of their meager resources: “They should have a housing advocate,” or another said,“…They should kind of let you know what you should be buying for the baby once it comes.” Others asked for: “Someone to talk to, you know, an advocate, a mentor,” or another asked,“…A role model, somebody that, you know, advice, that can give you advice.” The parenting teens had generous solutions to creatively extend their resources such as food drives and second hand stores where they can obtain used clothing and furniture and donate these items in good condition. One suggested providing“…housing, furniture, food. You know how the old people have food drives or whatever. That would be good, you know what I mean? Bags of food, all that stuff donated?” Another recommended developing “Like a program after we give birth and the baby has grown out of all these stuff, we could bring them to that program….” Prenatal and Parenting Groups Both prenatal and parenting focus groups wanted to discuss development of the fetus or newborn child and relationships with their child’s father in a psychoeducational group series. In addition, parenting teens desired group discussions on parenting stresses. All participants expressed interest in fathers’ education in the area of development and bonding with their children. Teens felt it was a good idea for fathers to become educated in a child’s development and participate in one session on that topic. Prenatal teens were more eager to educate and incorporate their child’s father into the services: “He is a good father but he needs parenting classes too. Not just me. He needs to learn what he has to do with an infant.” Another suggested, “I think we should have a group together so that we can let them know what we want and what we need. What we would like them to do to participate with the newborn.” Teens did not have a preference of persons with certain degrees leading parenting groups. They preferred someone who was approachable and knowledgeable: “Someone with experience.” Both prenatal and parenting teens had very positive views of educational and support groups. Support groups of all kinds were appealing to focus group participants. “I guess just being able to meet with other girls that were going through the same thing as me. That made me want to come to group. And group, for me, was really a lot of fun. I really enjoyed group.” Another agreed, “I found out there was a lot of girls my age, thinking about the same thing, pregnant, going through different things. So I don’t feel like I was alone.” Doing something new and different was important to another, “So it is something that you can get out of the house and just smell fresh air and do something instead of laying around all day and feeling sorry for yourself.” Teens suggested that reasons to participate in a parenting group included friendship with other teens in similar situations, interesting topics of discussion, informed leaders, childcare, and free transportation. Teens that participated in parenting groups viewed food and gifts provided at each meeting as less important for attendance then transportation. Discussion Through focus groups, teens shared their perceptions and made recommendations concerning health care services provided to themselves and their children in a hospital setting. Topics suggested for health education included medical health care, STDs, growth and development, and birth control. Recommended services beyond medical care included social services and mental health support, and advocacy for healthy nutrition, exercise, housing, school and employment. Other requested resources were services to fathers, and grandparents including participation in selected sessions as part of a parenting group curriculum. There were small but significant differences in services identified by prenatal versus postpartum teens. A limitation of the study is that focus group participation was based on self-selection. Participants were recruited from the site where they received care so that their observations and suggestions reflect their experience at the program. Teens who did not have a sense of connectedness or confidentiality within the clinic may not have wanted to participate. Overall, the feedback from participants was extremely positive, perhaps limiting the generalizability of the findings. In addition, parenting teens were only English speaking and primarily African American from a large urban area. Their impressions may not reflect the needs of other populations of parenting teens in other medical settings or locations of care. Both groups requested the same providers for clinic visits. This is consistent with other research studies21 that demonstrate teens’ desire for a close relationship with one person, be it a medical provider, teacher, mentor or relative who may greatly influence their decision-making. Parenting teens were more outwardly vocal about seeing the same provider than prenatal teens based on their experiences of prior providers leaving over time, once the teens became attached. Many urban teens have had many transitions in their lives, are not in school, and feel isolated.22 Though unaware of it themselves, they may desire a role model to consistently encourage them in their child’s and their own welfare.21 Cox et al: Youth Preferences in Teen Services Prenatal teens looked to their providers for education about fetal conception and development, pregnancy, health risks, and well-being. As in previous studies, the prenatal teens’ attitudes also parallel parenting teens’ desire for information regarding birth control options and STD risks.13,21 Teens preferred a style of communication that afforded them respect, education, and control over their bodies and their decisions. After medical services, mental health was most valued by parenting teens. Previous authors suggested that adolescents feel connected and cared for through family and social intimacy.23,24 Research also demonstrates social support interventions with at-risk African American women may increase birth weight of newborns.25 After birth, teens’ child rearing responsibilities, adulthood expectations, and familial relationships are interrelated. With multiple demands, parenting teens remain at high risk for depression.26,27 Parenting teens participating in the focus groups have learned to successfully reach out to mental health workers for assistance. Prenatal teens did not yet have responsibilities of child rearing, thus did not express need for as much emotional support. Prenatal and parenting teens both requested help with primary needs such as housing, education, and childcare. Prenatal teens responded in anticipation of future needs. Parenting teens reacted in more emotionally charged ways that conveyed immediate need. Parenting teens were on long housing waiting lists, had been out of school for many reasons and lengths of time, experienced poor child care choices, and had been frustrated with insufficient funds for basic needs such as healthy nutrition. Previous research reports that fathers are the second most frequent child care providers after mothers in low income, single parent families.28 Father involvement benefits the child; therefore, teen parents are encouraged to value dual child rearing responsibilities apart from their romantic relationship.29 As many fathers did not live with their children and were often found to struggle in their parenting roles,30 teens were also asked how to foster strong paternal relationships with their children. They were also asked how to encourage fathers in their own medical care. Parenting teens’ suggestions regarding medical and mental health care to fathers was mixed. The nature of each mother’s relationship with the father; and, his involvement at the time of the focus groups may have greatly influenced teen’s responses to fathers’ services. Parenting teens had more time for the relationship with their child’s father to develop or deteriorate as life’s demands increased with child rearing and other adult responsibilities. Thus, these mothers had more to say about father’s involvement in the child rearing process. Overall, mothers would have liked their child’s father 173 to know more about child development and participate in care taking. Prenatal teens felt similarly that they were more aware of their child and their bodies than their partners and wanted the fathers to gain similar knowledge. Though admitting difficulty at times, both groups valued the fathers’ relationships with their children and felt encouragement in this area to be important considerations for future program development.5,31 The previous positive experience of participating in parenting groups was a large incentive for focus group participation. The teens valued the discussions they had with group leaders and other teens. Often, parenting teens are isolated,32 come from difficult home settings,33 and do not have many friendship building skills. Previous studies have shown that the relationships the teens made in the groups were the most rewarding part of participation.34,35 Like other studies about youth development programs,36 teens valued free transportation to parenting groups as the second most important benefit of the groups. They were appreciative of food and gifts provided at groups but did not believe these incentives were essential. Focus groups proved to be valuable for evaluation of a comprehensive teen pregnancy and parenting program that included psychoeducational groups. Teens clearly valued consistent, supportive relationships with program staff, a one-stop shopping model for medical care, social services and parenting education. The teens face formidable obstacles especially after delivery. Development and refining of services using patient feedback is critical to meeting the needs of young, at risk families. Acknowledgments: We would like to thank the staff and participants of the Young Parents Program, Children’s Hospital Boston and the Brigham and Women’s Hospital. We would like to thank Jennifer Valenzuela for teen recruitment and Anna Michonski for organizing transportation, food, and babysitting for the groups. This work was supported in part by the Office of Adolescent Pregnancy Programs. Grant # 5AP PA 002033-02-C, and Leadership Education in Adolescent Health grant # 5T71 MC 00009-11 Maternal and Child Health Bureau (Title 5, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. This work was presented in part to the Eastern Region for Pediatric Research, Greenwich, CT, March 19, 2003. References 1. Ventura SJ, Mosher WD, Curtin SC, et al: Trends in pregnancy rates for the United States, 1976–97: An update. National Center of Health Statistics. Vital Health Statistics 49(4). Retrieved November 15, 2002, from www.cdc.gov/ nchs/releases/01new/trendprg.htm 2. National Vital Statistic Reports, December 17, 2003, Vol. 52, No. 10 174 Cox et al: Youth Preferences in Teen Services 3. Felice M, Feinstein RA, Fisher MM, et al: Adolescent Pregnancy-current trends and issues. Pediatrics 1998; 103:516 4. Fraser AM, Brockert JE, Ward RH: Association of young maternal age with adverse reproductive outcomes. 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