Final Impacts of a Home Visiting Program in Texas Designed to Reduce Repeat Pregnancies

Steps to Success shows promise for younger adolescent mothers
Oct 24, 2019

Preventing Repeat Adolescent Pregnancy (PREP)

Young women who have already had a baby account for one in six teen births. Rapid repeat pregnancies can have adverse consequences for young mothers and their children and can compound the negative effects of adolescent childbearing. A small but growing body of evidence suggests that interventions for adolescent mothers can promote healthy birth spacing by providing individualized support services and improved access to effective contraception. To help build the evidence base on programs designed to help these young women, Mathematica, with funds from the Administration for Children & Families (ACF) within the U.S. Department of Health and Human Services, conducted a rigorous evaluation of Steps to Success, a home visiting program for adolescent mothers that offers counseling on contraception, adequate birth spacing, parenting skills, and child development. The program placed a particular emphasis on the use of long-acting reversible contraceptives (LARCs). It also encouraged father involvement and supported mothers’ education and career aspirations.

A final report presents evidence on the long-term impacts of the Steps to Success home visiting program for adolescent mothers in San Angelo, Texas. The program is being operated as part of a research study in which young mothers are randomly assigned to receive one of two home visiting interventions: Steps to Success or a traditional home visiting program focused only on parenting skills and child development. The report is part of a multicomponent evaluation of the Personal Responsibility Education Program led by Mathematica for ACF.

The report examines early impacts of Steps to Success measured at the end of the two-year program. The study found the following:

  • After two years, mothers in the Steps to Success and traditional home visiting groups had similar rates of repeat pregnancy.
  • However, the evidence suggests that mothers in the Steps to Success group were more likely to use LARC methods than mothers in the traditional home visiting group.
  • This increase in LARC use was driven by effects on the youngest mothers served by the program, those who were 14 to 18 years old at program enrollment. For this younger group, Steps to Success also decreased the incidence of unprotected sex. There were no effects on LARC use or unprotected sex for adolescent mothers who were 19 or 20 when they entered the program.
  • Compared with traditional home visiting, Steps to Success did not improve outcomes related to father involvement, mothers’ education and career aspirations, or mothers’ parenting behavior.

This report is the final in a series of implementation and impacts of Steps to Success in San Angelo. An earlier process study report described the design and implementation of Steps to Success. An interim report described the early impacts of Steps to Success relative to the traditional home visiting program.


Related Projects
  • Personal Responsibility Education Program (PREP)

    To help reduce the risks of pregnancy, sexually transmitted infections, and associated risk behaviors among teenagers, Congress authorized PREP as part of the 2010 ACA. Mathematica's evaluation is documenting how PREP-funded programs are operationalized and assessing selected programs’ effectiveness....

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