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Stable sources of funding are essential to make child care that promotes school readiness available for the children of teen parents. In some areas of the country, infant spaces in child care centers are so limited that expectant parents must apply during the first trimester of pregnancy in order for the child to have a chance for admission by the age of one. Without reliable child care, the goals of completing high school and obtaining the skills to be self-supporting will remain elusive for many parenting teens.
Students at Paquin are eligible to put their children in child care. However, the program can accommodate only 54 children (including 12 infants), while between 600 and 800 pregnant and parenting teens attend the Paquin School during the course of a year. Gracie Dawkins, an administrator at Paquin, explained that the school can refer teen parents to other providers of child care, but it cannot cover the cost of the care.
High-quality child care makes a significant difference for young children's school readiness, and higher quality care is associated with better mother-child relationships, especially for low income mothers and their children.(29) However, studies have documented the scarcity of high quality care, especially for infants and toddlers. A study of 400 child care centers in four states found that 40 percent of the infant room were low quality, not meeting basic health and safety standards, and only 8 percent of infant classrooms were good or excellent. The quality of child care was related to the education and training of staff, and only 36 percent of teachers in 400 centers studied had college degrees.(30) The NICHD study found that only 18 percent of their child care providers had college degrees and only a third had any specialized training.(31)
Attracting and keeping educated workers will continue to be difficult as long as wage and benefit levels for child care workers remain among the lowest in the nation. Teachers in the child care centers studied in five cities earned an average wage of $7.50 an hour, and teaching assistants earned between $6 and $7 an hour. A study of child care centers in 5 cities found annual staff turnover rates of 27 percent among teachers and 39 percent among teaching assistants(32), forcing children to continually adapt to different caregivers and preventing the close relationships with adults that children need for social, emotional, and cognitive development.
Conference participants also urged states to remove age restrictions and to reconsider other policies that limit the eligibility of teen parents for child care subsidies. "New Mexico needs child care desperately," said Sharon Waggoner of Eastern New Mexico University. While the state has the third highest teen birth rate in the nation, it only provides limited child care benefits to teen parents who are under the age of 18.
In the wake of the PRWORA, conference participants noted, some teen parents will lose their eligibility for child care subsidies if they do not receive TANF—no matter how poor they are. In Maryland, for example, the new policy for child care subsidies moves teen parents who are neither working nor receiving TANF to the end of the subsidy priority queue.
Families who do not receive TANF are not necessarily well off. At Paquin, nearly all of the pregnant and parenting students come from low-income families, but only half receive TANF. Child care is subsidized for teen parents who receive TANF, but other families have to shoulder these costs on their own. This problem may grow in magnitude under the PRWORA, since fewer teen parents will live independently of their parents, who may be earning just enough to stay off welfare themselves.
Conference participants urged schools serving teen parents to arrange for on-site child care, whether or not they operate the centers themselves. Like companies which offer work-site child care, school systems may choose to supply space, utilities, and maintenance while a licensed provider of child care takes charge of administration and services.
Although individual centers may operate best on a relatively small scale, total capacity must expand to relieve a critical shortage. Among the benefits, conference participants believed that school attendance would improve considerably if adolescent mothers could bring their children with them to school each day. School child care centers may also be able to offer better environments for the children's development and learning. In the best models, teachers are certified in early childhood education, and staff closely monitors the children for health and developmental problems, with special services arranged on-site if the need exists.
States should consider devoting a portion of their average daily attendance (ADA) funding to pay for child care. In Florida and Oregon, children of parents enrolled in the pregnant/parenting teen programs are also voluntarily enrolled in order to leverage funding for the child care component of the program. Revenue is generated based upon the ADA. In California, a bill was introduced in the state legislature to restructure existing programs for these students and their children using a similar funding structure.
While alternative schools serving pregnant and parenting teens strive to facilitate child care, conference speakers noted that many public high schools resist providing such services. This resistance may reflect beliefs that caring for the babies at school is a tacit endorsement of teen pregnancy and sets a bad example for non-pregnant teens. Canessa suggested that schools could avoid the appearance of favored treatment by establishing child care centers that are open to the children of their employees as well.
Teen parents' needs for child care will continue after they complete school, conference participants also noted. Some alternative schools, like Paquin, allow the children of their graduates to remain at the child care center until they are ready for elementary school. Jackie Gibson, a graduate of the Young Fathers Program, has sole custody of his 4-year-old daughter. As a single parent, he considers the health and child care services available to his daughter at Paquin even though he has graduated as an extremely valuable benefit. While such continuity is desirable for both children and parents, school-based centers will find it difficult to accommodate the children of their graduates as long as child care slots are in such short supply.
School systems should explore new initiatives to improve retention and graduation rates. Without a high school education, teen parents severely limit their earnings potential and their prospects of keeping their families off welfare. Many pregnant teenagers drop out of high school prior to giving birth. Others fail to return or maintain sufficient progress to remain in school after their children are born. Some teen parents consider their public schools dangerous and disruptive places where they do not learn much anyway.
The problem extends beyond the teen parent population, noted Wolf. "In Philadelphia, 50 percent of ninth-graders failed that grade, and the percentages of seventh- and eighth-graders who [get promoted to the next grade] aren't much better. High schools are not meeting the needs of lots of students, not just teen parents." Enright reported that the state's eight largest school districts have a dropout rate of 58 percent.
Pregnant and parenting teens may find the environment of public schools particularly inhospitable. Some teens who become pregnant had reputations as "bad examples" beforehand, known as troublemakers or as poor students because they had already failed at least one grade. Rigid policies about absences and course requirements based on a semester system work against them. In some school systems, "catering" to the needs of teen parents with more flexible approaches or special services is seen as condoning teen pregnancy, the wrong message to send to other students.
Speakers also identified the need to educate the parents of pregnant and parenting teens about the importance of staying in school and completing the requirements for a high school diploma. Families differ widely in their expectations about the level of education that their daughters can attain. Sometimes these are reinforced by cultural norms in communities that have not traditionally placed a strong emphasis on girls completing school.
The PRWORA exempts teen parents who receive TANF from the time limits if they are attending school full time, as long as they are also below the age of 18 and not the heads of their households. If all three conditions are not met, the determination appears to be ambiguous. To encourage teen parents to remain in high school until they receive their diploma, which may extend beyond the time they turn 18, states can specify that full-time school attendance exempts teen parents from the time limits.
Conference participants recommended a campaign to inform schools, students, and parents about Title IX requirements so that pregnant and parenting teens are not denied educational opportunities, including the choice of remaining in their home public schools.
Pregnant and parenting teens have a range of academic backgrounds. Some have histories of school failure, while others are strong students in college preparatory classes. Some pregnant and parenting teens receive a good education and valuable supportive services from alternative high schools, but these schools are not the best settings for everyone. Alternative schools may only offer a two-year curriculum, and they may lack higher level courses as well as specialized vocational programs offered at regular high schools.
Title IX of the Education Amendments of 1972 prohibits sex discrimination in schools that receive federal funds. Regulations explicitly forbid certain forms of differential treatment of pregnant and parenting teens, including expelling pregnant students from school, excluding them from classes or extracurricular activities, and harassing or stigmatizing unmarried teenage mothers. The regulations also require schools to grant medical leave to pregnant students whose doctors deem it necessary and to reinstate such students at the end of their leaves.
Despite Title IX requirements, some schools continue to push pregnant and parenting teens out of their doors. Conference participants offered many examples, some blatant, some subtle. For example, a student who delivers a baby in April is told that her year is over and given no opportunity to finish the remaining course work. "Other students miss school for a medical reason and can get make up assignments," said Wolf. "If home instruction is made available to other people who are absent from school because of a prolonged medical reason, this pregnant teen [should] qualify for that as well."
In many districts, pregnant and parenting teens are steered to alternative schools, regardless of their preferences. While these students have the right to participate in special programs, they must volunteer. They "cannot be coerced into that alternative school," said Wolf.
But sometimes they are. "There are a lot of ways to make someone unwelcome in your school besides telling them they cannot come back," said Dr. Sally Hodson of the Florence Crittenton School in Denver. "It is done kind of covertly... Middle school and elementary school principals do not want pregnant girls walking the halls because they are more afraid of what the parents have to say than they are [afraid] of Title IX." "Some of these students were considered troublesome to begin with," added Burns, explaining that it may do them no good to insist on their legal rights. "They face a toxic environment if they stay."
Middle schools are least likely to provide services to pregnant teens and often least comfortable about keeping them in school. Sometimes, the schools respond with "social promotions" of such students, shipping them off to high school whether or not they are ready academically.
School districts should apply lessons learned from alternative schools and provide more supportive learning environments for pregnant and parenting teens and for other at-risk students. Competency-based methods, home schooling, summer sessions, partial credit for work accomplished, and arranging for students to transfer or take courses at other schools can help students at risk of dropping out. Administrative flexibility is important as well. Compressed class schedules leave more room for appointments related to parenting during the day. And absence policies typically must be adjusted to allow pregnant and parenting teens to care for ill children as well as meet their own needs for medical care.
At their current capacity, alternative schools can educate only a fraction of the pregnant and parenting teen population. Wolf noted that in Philadelphia, 3,300 girls under the age of 18 give birth in a year; counting teen parents from prior years, the city may have 9,000 girls in need of services. Alternative schools accommodate only several hundred students at any one time. New York City, with five times as many girls in need of services as Philadelphia, reaches only 600 with alternative education programs. The Paquin School in Baltimore, serving over 300 per semester, is one of the nation's largest.(33)
Cities anticipate large influxes of students to their high schools in response to the requirement of the PRWORA that teenage mothers receiving TANF return to school. In New York City, according to the comptroller's office, 4,500 to 10,000 additional students could seek to enroll once the new welfare rules are fully implemented.(34) Appendix D (not available in the Web version) explains this issue in detail. Even with expansions in capacity, alternative schools cannot do it alone. Public school systems can use alternative schools and other special programs for pregnant and parenting teens as "learning labs," to identify successful methods of teaching and encourage their use in regular high schools.
The Florence Crittenton School in Denver is an alternative middle and high school. Typically, in a year, the school provides classroom instruction, job training, and parenting education to 250 mothers (aged 12 through 19) and 60 fathers. Its on-site nursery accommodates 110 babies. Social services are also provided on the school's campus. "Our goal is a very seamless integrated service delivery system," said Hodson. "Teens are really hard to track. They have all these people working with them all over the city and they do not have any way to get there. We are trying to get people to come to them."
The Crittenton School allows students to enter at four different times of year. This policy, along with competency-based learning methods, enables students to complete a semester's work in a shorter time. "We [are] looking at how women learn best," said Hodson. "Our school is very interactive. The girls sit at tables rather than at desks. Our classes are small and personal. A lot of students who have done really poorly suddenly feel like they are competent learners."
When teenage mothers lack basic skills, the school attempts to remedy these gaps. Literacy and math skills receive major emphasis at Crittenton. Because each student is encouraged to work at her own pace, some will progress to much more advanced courses of study. "We follow our seniors with...intensity. We want them graduating, and we want them going on to post-secondary ed[ucation]," Hodson said. "We [prepare] them to make the school-to-work transition. If they do not get help, whether they are transitioning back to their home school or...to the work world or to college, it is very difficult."
School-based and school-linked programs can facilitate access to health services for pregnant teens, including prenatal care that begins in the first trimester of pregnancy, and health care, developmental screenings, and follow-up services for their children. Care providers should also seek to improve teens' knowledge about nutrition, general health habits, and family planning, as well as help pregnant teens to quit smoking and end substance abuse.
The health needs of pregnant and parenting teens sometimes receive inadequate attention from the health care system and from teens themselves. Prenatal care and good nutritional habits should begin early during pregnancy. For many reasons, however, pregnant teens may avoid or fail to keep prenatal appointments. Some have never received gynecological care before; others lack transportation. And as the more sensational cases make plain, some teens spend their pregnancies in a state of denial or immobilized by fear of what parental or peer reaction will be once their condition is disclosed.
"Obviously, the kids who do not find out about their pregnancy or do not acknowledge their pregnancy until much later...have not had the opportunity to take care of themselves during their pregnancy," said Jaenike. "So they are going to have poorer outcomes." In her area of Texas, "anywhere between 25 to 32 percent of all teens have low birth weight [babies], have no prenatal care or none until their sixth month." Nearly one-third of teen mothers in her area became pregnant again with "their second, third, fourth, or fifth children," she further noted. In part she attributed such findings to poverty and also to the power of "magical thinking." When the attitude is "it cannot happen to me...we have a difficult time getting [adolescents] the information they need to stay healthy."
While a clear medical link exists between cigarette smoking during pregnancy and delivering a low-birth weight baby, prenatal care does not necessarily focus on this problem. According to a study commissioned by the David and Lucile Packard Foundation, 20 percent of all low birth weight births would not occur if pregnant women did not smoke. Medical researchers cite low maternal weight gain and low weight prior to pregnancy as additional risk factors which, along with smoking, account for close to two-thirds of growth-retarded babies.
"Many teens smoke because they want to lose weight," observed Jaenike. Without strenuous efforts to get them to stop, she noted, many pregnant teens will continue to smoke and attempt to lose weight despite the enormous risks to their babies.(35)
Burns reported that 75 percent of the pregnant teens referred to the Youth Health Service program in West Virginia receive prenatal care during the first trimester. She credits this achievement to an "open door policy" about referrals and strong links to family. "Most of our teens come in with their mothers or their family members and get that pregnancy test or get some follow-up after they have had a pregnancy test," she added. "The girls who did come to our program kept appointments and had lower rates of low birth weight and pregnancy complications altogether."
The Paquin School in Baltimore has a health center on its campus. According to Charlene Ndi, the center's manager, 20 percent of the students receive health services on-site and the rest are closely monitored. In the past four years, Ndi reported, "very few" of the pregnancies at Paquin involved medical complications and "not many" of the infants failed to thrive.
The Gundersen Lutheran Teen Health Service, a school-linked program in LaCrosse, Wisconsin, is located in the Gundersen Lutheran Hospital. Though begun with federal funds, the LaCrosse program is currently financed entirely by the hospital. In addition to providing health services to teens, mainly through the hospital's clinic, the program emphasizes outreach activities at the schools in its district. With the help of school counselors, program staff offer social services to pregnant and parenting teens, including assistance with child care. Staff teams also work through high school coaches to get information about family planning and prevention to teenage males.
"What's most effective in preventing problem pregnancies is early and frequent contact with the health care system," said Bruce Theiler, director of the LaCrosse program. "If [teens] come in during the first trimester, they'll have 10 to 14 visits with us, on average." He added that the clinic stays open until 7 p.m. once a week to facilitate teen appointments after school. All of the program's services, including prenatal care, are free. Obstetrical and other physician services are billed to insurance or Medicaid.
Even at the La Crosse program, with its focus on access to health care, some of the teens served have problem pregnancies. In 1996, the program reached 97 teens. The average client, aged 17, had a dozen prenatal visits to the clinic, and delivered a baby weighing more than 7 pounds. However, seven clients that year did not receive prenatal care until late in the pregnancy, and six of the babies born to teens in the program were premature.(36) Although, according to records supplied by the program, most teens choose some form of birth control when discharged, twelve of the 1996 cases were repeat pregnancies, an unusually high proportion at this clinic.
Programs with links to comprehensive health services are the exception, however. Theiler believes the LaCrosse program, which has yet to be replicated elsewhere in Wisconsin, is unique in the Midwest.
Conference participants praised the efforts of school-based clinics to focus on the health needs of adolescents. But because teens are their primary mission, most of these clinics are neither prepared nor equipped to offer services to the children of adolescents. In New York City, however, the LYFE program provides technical assistance to high schools with child care centers. The program arranges pediatric care for the children of teen parents who attend these centers. It also provides regular checkups, immunizations, and developmental screenings on-site. When these examinations and screenings identify medical or developmental problems, the centers bring in specialists. Hearing, vision, and physical therapists are the main ones children need, explained Davis. When these services are provided on-site, the child's mother can be excused from class for a short time to meet with the therapist without major disruption to the school day.
Programs must reflect the linkages among domestic violence, substance abuse, and teen pregnancy, so that timely actions can be undertaken to reduce risks to teens. Many teen parents experienced violence as children, and many become pregnant through sexual encounters that occur while they are drunk or on drugs. "We do a lot of work with girl gangs," said Jaenike, "because one of the initiation factors in the girl gangs in our area is multiple sexual encounters in a very short period of time."
Canessa observed that many of the young women who will bear children as teenagers have come to the attention of public agencies beforehand. Based on her review of caseloads, over 1,600 per year, Canessa said, "Eighty percent were suspended at least once because they were involved in fights at school. The teachers knew about them...They have exhibited problems." Others, with histories of physical or sexual abuse, "are familiar to the child protective systems," she added. "The police have come to their homes many times." When the parents of the teens are alcoholics or drug addicts, the families are "known in the system" as well.
Safe housing for teen mothers and their children is a major problem which few programs are able to address. The Lula Belle Stewart Center in Detroit offers transitional housing to mothers aged 17 to 21 while they complete school or job training. Plans to open a second house for 16- and 17-year-olds and their children are underway. The new facility will function like an emergency shelter, explained Sharon Stewart of the center. "These are young people who just have nowhere to go with their child...They will get other services while there, but the primary service would be meeting the emergency housing need."
Given the scarcity of "second chance" housing, conference participants also raised concerns about how hardship cases will be handled under the PRWORA. Some speculated that exceptions to the requirement that minor teen parents live with their parents or another adult relative would prove difficult to obtain.
Conference participants encouraged programs to reduce the size of caseloads and improve coordination so that families do not have to deal with a multitude of caseworkers from different agencies or a different caseworker for each family member. Susan Batten of the Center for Assessment and Policy Development listed the following functions as vital to comprehensive approaches to improving outcomes for teen parents and their children:
Footnotes:
(29) The NICHD Study of Early Child Care with 1,364 children has reported child outcomes of child care up to age 3.
(30) Cost, Quality, and Child Outcomes Study team, Cost, Quality, and Child Outcomes in Child Care Centers Public Report, 1995.
(31) NICHD, The Study of Early Child Care, 1998.
(32) Center for the Early Childhood Workforce, Worthy Work, Unlivable Wages: The National Child Care Staffing Study, 1988-1997, 1998.
(33) Data provided by Wendy Wolf, Center for Assessment and Policy Development, December 9, 1997.
(34) Felicia R. Lee, "Classrooms Brace for Teen-Age Parents, and Babies," The New York Times, January 10, 1998.
(35) Low Birth Weight, op. cit., pp. 5-8.
(36) Based on records compiled by the Gundersen Lutheran Teen Health Service, it is not clear whether the pre-term deliveries and the cases of late prenatal care are the same.
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