Child and Adolescent Social Work Journal

, Volume 28, Issue 6, pp 439–458

The Effects of a Healthy Families Home Visitation Program on Rapid and Teen Repeat Births



The prevention of Rapid Repeat Births (RRBs) and Teen Repeat Births (TRBs) is an important indicator of the effectiveness of home visitation programs that serve mothers who are at-risk for child maltreatment. This study examined the effects on RRBs and TRBs of a rural/small town home visitation program based on the Healthy Families America (HFA) model. The participants in this study were referred between 1999 and 2007 and included a Treatment Group of 140 at-risk mothers who met minimum engagement criteria and a Comparison Group of 241 at-risk mothers who were referred for services but not enrolled due to limits on program capacity. In addition, county-wide TRB data was used as the basis for a static group comparison. With regard to RRBs, the rates for the Treatment (18%) and Comparison (30%) groups were compared using a Chi-Square test of homogeneity. The null hypothesis that there would be no difference between the rates for the two groups was rejected at the .05 level. Similarly, with regard to TRBs, the null hypothesis that there would be no difference between the rates for the Treatment (9%) and Comparison (27%) groups was rejected at that .01 level. Furthermore, using a Chi-Square test of independence, this investigation tested the null hypothesis that the rates for the two groups would not differ from the county-wide rate (24%). This hypothesis was also rejected at the .01 level. Overall, these results of this inquiry support the conclusion that participants in a rigorously implemented HFA program show significantly lower rates of RRB and TRB when compared to a comparable group of at-risk nonparticipants. They also appear to have a significantly lower incidence of TRB than teen mothers in the general population.


Rapid repeat birth Adolescent birth Home visiting Healthy families America 


  1. Barnet, B., Liu, J., DeVoe, M., Alperovitz-Bichell, K., & Duggan, A. (2007). Home visiting for adolescent mothers: Effects on parenting, maternal life course, and primary care linkage. Annals of Family Medicine, 5(3), 224–232.PubMedCrossRefGoogle Scholar
  2. Baydar, N., Brooks-Gunn, J., & Furstenberg, F. (1993). Early warning signs of functional illiteracy: Predictors in childhood and adolescence. Child Development, 64(3), 815–829.PubMedCrossRefGoogle Scholar
  3. Baydar, N., & Greek, A. (1997). A longitudinal study of the effects of the birth of a sibling during the first six years of life. Journal of Marriage and the Family, 59, 939–956.CrossRefGoogle Scholar
  4. Benedict, M., White, R., & Cornely, D. (1985). Maternal and perinatal risk factors and child abuse. Child Abuse & Neglect, 9, 217–224.CrossRefGoogle Scholar
  5. Black, M. M., Bentley, M. E., Papas, M. A., Oberlander, S., Teti, L. O., McNary, S., et al. (2006). Delaying second births among adolescent mothers: A randomized, controlled trial of a home-based mentoring program. Pediatrics, 118, e1087–e1099.PubMedCrossRefGoogle Scholar
  6. Black, D., Heyman, R., & Slep, A. (2001). Risk factors for child physical abuse. Aggression and Violent Behavior, 6(2), 121–188.CrossRefGoogle Scholar
  7. Blankson, M. L., Cliver, S. P., Goldenberg, R. L., Hickey, C. A., Jin, J., & Dubard, M. B. (1993). Health behavior and outcomes in sequential pregnancies of black and white adolescents. The Journal of the American Medical Association, 269, 1401–1403.CrossRefGoogle Scholar
  8. Britt, E., Hudson, S., & Blampied, N. (2004). Motivational interviewing in health settings: A review. Patient Education and Counseling, 53(2), 147–155.PubMedCrossRefGoogle Scholar
  9. Brody, D. J., & Bracken, M. B. (1987). Short interpregnancy interval: A risk factor for low birthweight. American Journal of Perinatology, 4, 50–54.PubMedCrossRefGoogle Scholar
  10. Campbell, D., & Stanley, J. (1963). Experimental and quasi-experimental designs for research. Boston: Houghton-Mifflin Company.Google Scholar
  11. Carolina State Center for Health Statistics. (2000–2007). Basic automated birth yearbook: BABYBOOK. Retrieved January 10, 2010 from
  12. Conde-Agudelo, A., Rosas-Bermúdez, A., & Kafury-Goeta, A. C. (2006). Birth spacing and risk of adverse perinatal outcomes: A meta-analysis. The Journal of the American Medical Association, 295(15), 1809–1823.CrossRefGoogle Scholar
  13. Dailard, C. (2000). Reviving interest in policies and programs to help teens prevent repeat births. Guttmacher Report on Public Policy, 3(3), 1–2.Google Scholar
  14. Dangal, G. (2005). An update on teenage pregnancy. The Internet Journal of Gynecology and Obstetrics, 5(1). Retrieved May 17, 2010, from
  15. DeFranco, E. A., Stamilio, D. M., Boslaugh, S. E., Gross, G. A., & Muglia, L. J. (2007). A short interpregnancy interval is a risk factor for preterm birth and its recurrence. American Journal of Obstetrics & Gynecology, 197(3), 264.e1–264.e6.CrossRefGoogle Scholar
  16. DePanfilis, D., & Zuravin, S. (2002). The effect of services on the recurrence of child maltreatment. Child Abuse and Neglect, 26(2), 187–205.PubMedCrossRefGoogle Scholar
  17. Diaz, J., Oshana, D., & Harding, K. (2004). Healthy Families America: 2003 profile of program sites. Chicago: Prevent Child Abuse America.Google Scholar
  18. Downey, D. B., Powell, B., Steelman, L. C., & Pribesh, S. (1999). Much ado about siblings: Change models, sibship size, and intellectual development. American Sociological Review, 64, 193–198.CrossRefGoogle Scholar
  19. Dubow, E., & Luster, T. (1990). Adjustment of children born to teenage mothers: The contribution of risk and protective factors. Journal of Marriage & the Family, 52(2), 393–404.CrossRefGoogle Scholar
  20. Dunn, J., & Kendrick, C. (1980). The arrival of a sibling: Changes in patterns of interaction between mother and first-born child. Journal of Child Psychology and Psychiatry, 21(2), 119–132.PubMedCrossRefGoogle Scholar
  21. El-Kamary, S., Higman, S., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. (2004). Hawaii’s Healthy Start home visiting program: Determinants and impact of rapid repeat birth. Pediatrics, 114(3), e317–e326.PubMedCrossRefGoogle Scholar
  22. Field, T., Widmayer, S., Greenberg, R., & Stoller, S. (1982). Effects of parent training on teenage mothers and their infants. Pediatrics, 69, 703–707.PubMedGoogle Scholar
  23. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation research: A synthesis of the literature (pp. 24–560). Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).
  24. Fraenkel, J. R., & Wallen, N. E. (2006). How to design and evaluate research in education (6th ed.). Boston: McGraw-Hill.Google Scholar
  25. Fraenkel, J., & Wallen, N. (2009). How to design and evaluate research in education (7th ed.). New York: McGraw-Hill.Google Scholar
  26. Frankel, S., Friedman, L., Johnson, A., Thies-Huber, A., & Zuiderveen, S. (2000). Appendix A: The critical elements. In A. Johnson (Ed.), Healthy families America site development guide (pp. 173–209). Chicago, IL: Prevent Child Abuse America.Google Scholar
  27. Fuentes-Afflick, E., & Hessol, N. A. (2000). Interpregnancy interval and the risk of premature infants. Obstetrics and Gynecology, 95(3), 383–390.PubMedCrossRefGoogle Scholar
  28. Furstenberg, F., Brooks-Gunn, J., & Morgan, S. (1987). Adolescent mothers in later life. New York, NY: Cambridge University Press.CrossRefGoogle Scholar
  29. Gilbert, W., Jandial, D., Field, N., Bigelow, P., & Danielsen, B. (2004). Birth outcomes in teenage pregnancies. The Journal of Maternal-Fetal and Neonatal Medicine, 16(5), 265–270.CrossRefGoogle Scholar
  30. Gortzak-Uzan, L., Hallak, M., Press, F., Katz, M., & Shoham-Vardi, I. (2001). Teenage pregnancy: Risk factors for adverse perinatal outcome. The Journal of Maternal-Fetal Medicine, 10(6), 393–397.PubMedCrossRefGoogle Scholar
  31. Grisaru-Granovsky, S., Gordon, E. S., Haklai, Z., Samueloff, A., & Schimmel, M. M. (2009). Effect of interpregnancy interval on adverse perinatal outcomes—a national study. Contraception, 80(6), 512–518.PubMedCrossRefGoogle Scholar
  32. Groothuis, J. R., Altemeier, W. A., Robarge, J. P., O’Connor, S., Sandler, H., Vietze, P., et al. (1982). Increased child abuse in families with twins. Pediatrics, 70(5), 769–773.PubMedGoogle Scholar
  33. Gueorguieva, R., Carter, R., Ariet, M., Roth, J., Mahan, C., & Resnick M. (2001). Effect of teenage pregnancy on educational disabilities in kindergarten. American Journal of Epidemiology, 154, 212–220.PubMedCrossRefGoogle Scholar
  34. Harris, K. M. (1996). Life after welfare: Women, work, and repeat dependency. American Sociological Review, 61, 407–426.CrossRefGoogle Scholar
  35. Hayes, H., Luchok, K., Martin, A. B., McKeown, R. E., & Evans, A. (2006). Short birth intervals and the risk of school unreadiness among a medicaid population in South Carolina. Child: Care, Health and Development, 32(4), 423–430.CrossRefGoogle Scholar
  36. Heaman, M., Chalmers, K., Woodgate, R., & Brown, J. (2006). Early childhood home visiting programme: Factors contributing to success. Journal of Advanced Nursing, 55(3), 291–300.PubMedCrossRefGoogle Scholar
  37. Horwitz, S. M., Klerman, L. V., Kuo, H. S., & Jekel, J. F. (1991). School age mothers: Predictors of long-term educational and economic outcomes. Pediatrics, 87, 862–868.PubMedGoogle Scholar
  38. Key, J. D., Gebregziabher, M. G., Marsh, L. D., & O’Rourke, K. M. (2008). Effectiveness of an intensive, school-based intervention for teen mothers. Journal of Adolescent Health, 42, 394–400.PubMedCrossRefGoogle Scholar
  39. Kitzman, H., Olds, D. L., Henderson, C. R., Hank, C., Cole, R., Tatelbaum, R., et al. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: A randomized controlled trial. The Journal of the American Medical Association, 278(8), 644–652.CrossRefGoogle Scholar
  40. Klerman, L. V. (2004). Another chance: Preventing additional births to teen mothers. Washington, DC: National Campaign to Prevent Teen Pregnancy.Google Scholar
  41. Klerman, L. V., Baker, B. A., & Howard, G. (2003). Second births among teenage mothers: Program results and statistical methods. Journal of Adolescent Health, 32, 452–455.PubMedCrossRefGoogle Scholar
  42. Koniak-Griffin, D., Anderson, N., Brecht, M., Verzemnieks, I., Lesser, J., & Kim, S. (2002). Public health nursing care for adolescent mothers: Impact on infant health and selected maternal outcomes at 1 year postbirth. Journal of Adolescent Health, 30(1), 44–54.PubMedCrossRefGoogle Scholar
  43. Koniak-Griffin, D., Verzemnieks, I., Anderson, N., Brecht, M., Lesser, J., Kim, S., et al. (2003). Nurse visitation for adolescent mothers: Two-year infant health and maternal outcomes. Nursing Research, 52(2), 127–136.PubMedCrossRefGoogle Scholar
  44. Malamitsi-Puchner, A., & Boutsikou, T. (2006). Adolescent pregnancy and perinatal outcome. Pediatric Endocrinology Reviews, 3(1), 170–171.PubMedGoogle Scholar
  45. Manlove, J., Mariner, C., & Papillo, A. R. (2000). Subsequent fertility among teen mothers: Longitudinal analyses of recent national data. Journal of Marriage and the Family, 62, 430–448.CrossRefGoogle Scholar
  46. Maynard, R. (Ed.) (1996). Kids having kids: A Robin Hood Foundation special report on the costs of adolescent childbearing. New York: The Robin Hood Foundation.Google Scholar
  47. Menacker, F., Martin, J. A., MacDorman, M. F., & Ventura, S. J. (2004). Births to 10–14 year-old mothers, 1990–2002: Trends and health outcomes. National vital statistics reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, 53(7), 1–18.Google Scholar
  48. Miller, J. E. (1991). Birth intervals and perinatal health: An investigation of three hypotheses. Family Planning Perspectives, 23, 62–70.PubMedCrossRefGoogle Scholar
  49. Moore, K. A., Driscoll, A. K., & Lindberg, L. D. (1998). A statistical portrait of adolescent sex, contraception, and childbearing. Washington, DC: National Campaign to Prevent Teen Pregnancy.Google Scholar
  50. Murphy, S., Orkow, B., & Nicola, R. (1985). Prenatal prediction of child abuse and neglect: A prospective study. Child Abuse and Neglect, 9, 225–235.PubMedCrossRefGoogle Scholar
  51. Nathens, A. B., Neff, M., Goss, C., Maier, R., & Rivara, F. (2000). Effect of an older sibling and birth interval on the risk of childhood injury. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention, 6(3), 219–222.CrossRefGoogle Scholar
  52. Norr, K., Crittenden, K., Lehrer, E., Reyes, O., Boyd, C., Nacion, K., et al. (2003). Maternal and infant outcomes at one year for a Nurse-Health Advocate Home Visiting Program serving African-Americans and Mexican-Americans. Public Health Nursing, 20(3), 190–203.PubMedCrossRefGoogle Scholar
  53. Olds, D. L. (2002). Prenatal and infancy home visiting by nurses: From randomized trials to community replication. Prevention Science, 3(3), 153–172.PubMedCrossRefGoogle Scholar
  54. Olds, D., Henderson, C., Kitzman, H., Eckenrode, J., Cole, R., & Tatelbaum, R. (1998). The promise of home visitation: Results of two randomized trials. Journal of Community Psychology, 26(1), 5–21.CrossRefGoogle Scholar
  55. Olds, D. L., Henderson, C. R., Tatelbaum, R., & Chamberlin, R. (1988). Improving the life-course development of socially disadvantaged mothers: A randomized trial of nurse home visitation. American Journal of Public Health, 78, 1436–1445.PubMedCrossRefGoogle Scholar
  56. Omar, H. A., Fowler, A., & McClanahan, K. K. (2008). Significant reduction of repeat teen pregnancy in a comprehensive young parent program. Journal of Pediatric and Adolescent Gynecology, 21, 283–287.PubMedCrossRefGoogle Scholar
  57. Orkow, B. (1985). Implementation of a family stress checklist. Child Abuse and Neglect, 9, 405–410.PubMedCrossRefGoogle Scholar
  58. Petersen, R., Albright, J., Garrett, J., & Curtis, K. (2007). Pregnancy and STD prevention counseling using an adaptation of motivational interviewing: A randomized controlled trial. Perspectives on Sexual and Reproductive Health, 39(1), 21–28.PubMedCrossRefGoogle Scholar
  59. Powell, B., & Steelman, L. C. (1990). Beyond sibship size: Sibling density, sex composition, and educational outcomes. Sociological Forces, 69, 181–206.Google Scholar
  60. Powell, B., & Steelman, L. (1993). The educational benefits of being spaced out: Sibship density and educational progress. American Sociological Review, 58(3), 367–381.CrossRefGoogle Scholar
  61. Reime, B., Schücking, B. A., & Wenzlaff, P. (2008). Reproductive outcomes in adolescents who had a previous birth or an induced abortion compared to adolescents’ first pregnancies. BMC Pregnancy Childbirth, 8, 4.PubMedCrossRefGoogle Scholar
  62. Rutter, M., & O’Connor, T. (1999). Implications of attachment theory for child care policies. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications. New York: Guilford Press.Google Scholar
  63. Sangalang, B., Barth, R., & Painter, J. (2006). First-birth outcomes and timing of second births: A statewide case management program for adolescent mothers. Health and Social Work, 31(1), 54–63.PubMedGoogle Scholar
  64. Smith, G. C. S., & Pell, J. P. (2001). Teenage Pregnancy and risk of adverse perinatal outcomes associated with first and second births: Population based retrospective cohort study. British Medical Journal, 323, 476–481.PubMedCrossRefGoogle Scholar
  65. Smits, L., Pedersen, C., Mortensen, P., & van Os, J. (2004). Association between birth intervals and schizophrenia in the offspring. Schizophrenia Research, 70, 49–56.PubMedCrossRefGoogle Scholar
  66. Sprang, G., Clark, J., & Bass, S. (2005). Factors that contribute to child maltreatment severity: A multi-method and multidimensional investigation. Child Abuse and Neglect, 29(4), 335–350.PubMedCrossRefGoogle Scholar
  67. Sroufe, L., Carlson, E., Levy, A., & Egeland, B. (1999). Implications of attachment theory for developmental psychopathology. Development and Psychopathology, 11, 1–13.PubMedCrossRefGoogle Scholar
  68. Steelman, L. C., Powell, B., Werum, R., & Carter, S. (2002). Reconsidering the effects of sibling configuration: Recent advances and challenges. Annual Review of Sociology, 28, 243–269.CrossRefGoogle Scholar
  69. Stevens-Simon, C., Kelly, L., & Singer, D. (1991). Preventing repeat adolescent pregnancies with early adoption of the contraceptive implant. Family Planning Perspectives, 31(2), 88–93.CrossRefGoogle Scholar
  70. Stevens-Simon, C., Nelligan, D., & Kelly, L. (2001). Adolescents at risk for mistreating their children. Part II: A home- and clinic-based prevention program. Child Abuse and Neglect, 25(6), 753–769.PubMedCrossRefGoogle Scholar
  71. Stewart, J., & Dooley, M. (1999). The duration of spells on welfare and off welfare among lone mothers in Ontario. Canadian Public Policy, 25, 47–72.CrossRefGoogle Scholar
  72. Stewart, R., Mobley, L., Van Tuyl, S., & Salvador, M. (1987). The firstborn’s adjustment to the birth of a sibling: A longitudinal assessment. Child Development, 58(2), 341–355.PubMedCrossRefGoogle Scholar
  73. Todoroff, K., & Shaw, G. M. (2000). Prior spontaneous abortion, prior elective termination, interpregnancy interval, and risk of neural tube defects. American Journal of Epidemiology, 151(5), 505–511.PubMedGoogle Scholar
  74. Trause, M. (1978). Birth in the hospital: The effect on the sibling. Birth & the Family Journal, 5(4), 207–210.CrossRefGoogle Scholar
  75. U. S. Census Bureau. (2000). Fact sheet: Burke county, North Carolina. Retrieved January 6, 2010 from
  76. U.S. Department of Health and Human Services. (2000). Family planning. In: Healthy people 2010: Understanding and improving health (2nd ed.) Washington, DC: U.S. Government Printing Office. Retrieved November 19, 2008
  77. Zajonc, R. B. (2001). The family dynamics of intellectual development. American Psychologist, 56, 490–496.PubMedCrossRefGoogle Scholar
  78. Zhu, B., Rolfs, R. T., Nangle, B. E., & Horan, J. M. (1999). Effect of the interval between pregnancies on perinatal outcomes. The New England Journal of Medicine, 340(8), 589–594.PubMedCrossRefGoogle Scholar
  79. Zhu, B., Rolfs, R. T., Nangle, B. E., & Horan, J. M. (2001). Effect of interval between pregnancies on perinatal outcomes among white and black women. American Journal of Obstetrics and Gynecology, 185, 1403–1410.PubMedCrossRefGoogle Scholar
  80. Zuravin, S. (1988). Fertility patterns: Their relationship to child physical abuse and child neglect. Journal of Marriage & the Family, 50(4), 983–993.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Catawba Valley Healthy FamiliesBarium Springs Home for ChildrenStatesvilleUSA
  2. 2.Institute for Health and Human ServicesBooneUSA

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