Adolescent and Adult Clients in Prenatal Case Management: Differences in Problems and Interventions Used

This study sought to characterize differences between pregnant adolescents and adults in the types of problems addressed by case managers, and to assess subsequent differences in the types of interventions used with both groups.

Data stem from 3947 client encounters, provided by 223 case managers in 92 Medicaid-reimbursed prenatal case management programs; the clients were confirmed to be either adolescents (<20 years of age) or adults. Case managers provided information on each client encounter that occurred during 10 workdays over a 20 workday period using the Case Management Intervention Record , a data collection tool. The Chi square test and the Mann-Whitney U test were used to compare the types and number of problems, the types of intervention received, and the mean number of intervention minutes between adolescents and adults.

Adolescents experienced an average of 3.9 problems whereas adults experienced an average of 3.2 problems (p < 0.001). Compared to adults, adolescents were significantly more likely to experience problems in the areas of pregnancy health, family, education/job, transportation, and housing. With respect to breadth of interventions, adolescent clients were significantly more likely to receive support, clinical acts, and to be given tangible items compared to adult clients. On average, case managers spent significantly more time per encounter with adolescents than with adults overall (mean 56.6 vs. 50.3 min), and on educating, assessing, coaching, and monitoring.

Age related differences have both programmatic and provider implications. The intervention typology can be used to evaluate PCM programs serving high risk population.