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1、DANA SCHULTZ,DIONNE BARNES-PROBY,INGRID ESTRADA-DARLEY,YOSELIN MAYORAL,MADISON WILLIAMS,RUSSELL HANSON,AARON KOFNERA Guide to Effective Strategies for Supporting Expectant Transition-Age Foster YouthGuideFor more information on this publication,visit www.rand.org/t/TLA3475-1.About RANDRAND is a rese

2、arch organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure,healthier and more prosperous.RAND is nonprofit,nonpartisan,and committed to the public interest.To learn more about RAND,visit www.rand.org.Research IntegrityOur

3、 mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior.To help ensure our research and analysis are rigorous,objective,and nonp

4、artisan,we subject our research publications to a robust and exacting quality-assurance process;avoid both the appearance and reality of financial and other conflicts of interest through staff training,project screening,and a policy of mandatory disclosure;and pursue transparency in our research eng

5、agements through our commitment to the open publication of our research findings and recommendations,disclosure of the source of funding of published research,and policies to ensure intellectual independence.For more information,visit www.rand.org/about/research-integrity.RANDs publications do not n

6、ecessarily reflect the opinions of its research clients and sponsors.Published by the RAND Corporation,Santa Monica,Calif.2025 RAND Corporation is a registered trademark.Cover:Damircudic/Getty ImagesLimited Print and Electronic Distribution RightsThis publication and trademark(s)contained herein are

7、 protected by law.This representation of RAND intellectual property is provided for noncommercial use only.Unauthorized posting of this publication online is prohibited;linking directly to its webpage on rand.org is encouraged.Permission is required from RAND to reproduce,or reuse in another form,an

8、y of its research products for commercial purposes.For information on reprint and reuse permissions,please visit www.rand.org/about/publishing/permissions.iiiAbout This GuideTransition-age youth(TAY),defined as individuals aged 14 to 26 years transitioning from adolescence to adulthood,face unique c

9、hallenges,particularly those who have been in foster care.The Conrad N.Hilton Foundation has initiated efforts to support TAY through its Foster Youth Initiative,which operates via stra-tegic investments and partnerships in Atlanta,Los Angeles County,and New York City.These efforts aim to address th

10、e critical gaps and opportunities in programming for expectant transition-age foster youth.This guide by RAND researchers presents the evidence surrounding perinatal programs,services,and supports that could improve outcomes for TAY who are expectant parents.It highlights the unique chal-lenges face

11、d by pregnant or expectant TAY exiting foster care,who often encounter multiple,concurrent risk factors across health,mental health,education,employment,and social services sectors.These challenges are compounded by a lack of awareness and barriers to accessing existing resources.Social service agen

12、cies and providers also face difficulties in identifying these youth and coordinating care.The guide provides an in-depth analysis of the landscape of programs available for expectant TAY in Los Angeles County and presents evidence on how high-quality,culturally appropriate,and client-centered care

13、and advocacy can mitigate the impacts of systemic barriers,including racism and racial bias.There is con-siderable potential for large-scale positive intervention to improve critical life outcomes for these young indi-viduals by identifying and learning from existing programs.The development of this

14、 guide was sponsored by the Conrad Hilton Foundation.An annex to this guide,with details on the literature review conducted in building this guide,is available at www.rand.org/t/TLA3475-1.Social and Behavioral Policy ProgramRAND Social and Economic Well-Being is a division of RAND that seeksto activ

15、ely improve the health and social and economic well-being of populations and communitiesthroughout the world.This research was conducted in the Social and BehavioralPolicy Program within RAND Social and Economic Well-Being.The program focuses onsuch topics as risk factors and prevention programs,soc

16、ial safety net programs and other socialsupports,poverty,aging,disability,child and youth health and well-being,and quality of life,as well as other policy concerns that are influenced by social and behavioral actions and systemsthat affect well-being.For more information,emailsbprand.org.Acknowledg

17、mentsWe thank the service providers listed below and the TAY in Los Angeles County who shared their perspec-tives on the needs of expectant TAY.We are also grateful for the input and guidance from Eundria Hill-Joseph and Angela LoBue from the Conrad N.Hilton Foundation who oversaw this project.We al

18、so appre-ciate the careful review and feedback provided by Rhoda Smith of the Erikson Institute and Kortney Floyd James of RAND.Service providers interviewed(in alphabetical order)are as follows:Alliance for Childrens Rights Care Net Womens Resource Center of North County Childrens CollectiveA Guide

19、 to Effective Strategies for Supporting Expectant Transition-Age Foster Youthiv Childrens Hospital Los Angeles Clnica Monseor Oscar A.Romero Coalition for Responsible Community Development Court Appointed Special Advocates of Los Angeles Los Angeles County Department of Child and Family Services,Bur

20、eau of Clinical Resources and Ser-vices Los Angeles County Department of Mental Health,Roybal-Young Mothers and Babies Full-Service Partnership Program Los Angeles County Department of Public Health,Division of Maternal,Child,and Adolescent Health,African American Infant and Maternal Mortality Doula

21、 Program Los Angeles Unified School District,Nurse Family Partnership Program Marys Path My Friends Place New Familia Health Support Services Penny Lane Centers Public Counsel Safe Place for Youth South Bay Center for Counseling St.Annes Family Services University Muslim Medical Association HealthvC

22、ontentsAbout This Guide.iiiFigures and Tables.viiCHAPTER 1Context and Development of This Guide.1Who Are Expectant Transition-Age Youth?.1What Is the Hilton Foster Youth Initiative?.1What Is This Guide Designed to Do?.2How to Use This Guide.2CHAPTER 2National and State Landscape and Policy Context f

23、or Transition-Age Youth in Foster Care.3Transition-Age Youth in Foster Care.3Expectant and Parenting Transition-Age Youth.4Policy Context.4CHAPTER 3Perinatal Programs,Services,and Supports.7Health Care.8Health Promotion and Education.10Behavioral Health Care.12Literature Review Summary.14CHAPTER 4Pr

24、ogramming Gaps and Opportunities for Expectant Transition-Age Youth in Foster Care in Three Geographies.17Availability of Programs,Services,and Supports in the Atlanta Metro Region.17Availability of Programs,Services,and Supports in Los Angeles County.20Availability of Programs,Services,and Supports

25、 in New York City.24Distribution of Programs,Services,and Supports for Pregnancy Across the Three Geographies.27CHAPTER 5Key Features of Existing Perinatal Programs in Los Angeles County.29Perspectives from Service Providers.29Perspectives from Transition-Age Youth.35Solutions.40CHAPTER 6Opportuniti

26、es for Supporting Expectant Transition-Age Youth in Atlanta,Los Angeles County,and New York City.43Recommendations for Expanding Program Availability for Transition-Age Youth in Foster Care in Each Geography.43Broad Recommendations for Supporting Transition-Age Youth in Foster Care.44 Abbreviations.

27、47References.49viiFigures and TablesFigures 1.1.How to Navigate the Guide.2 3.1.Literature Review Categories.7 4.1.Mapping of Programs,Services,and Supports for Pregnancy in Atlanta Metro Region.19 4.2.Mapping of Programs,Services,and Supports for Pregnancy in Los Angeles County.23 4.3.Mapping of Pr

28、ograms,Services,and Supports for Pregnancy in New York City.26 5.1.Mapping of Service Providers Included in Los Angeles County Case Study.30Tables 2.1.Population of TAY in Foster Care by State.3 2.2.Percentage of Young Adults Ages 14 to 20 Exiting Foster Care by State and Race/Ethnicity.4 2.3.Percen

29、tage of Young Adults Ages 18 to 24 Who Are Parents by Race/Ethnicity.5 2.4.State Policy Context for Select Pregnancy Supports with Legislative Activity.6 3.1.Reproductive Care Literature Review.9 3.2.Group Prenatal Care Literature Review.9 3.3.Care Coordination Literature Review.9 3.4.Doula Care Lit

30、erature Review.10 3.5.Home-Visiting Literature Review .11 3.6.Prenatal Education Literature Review.12 3.7.Breastfeeding and Nutrition Education Literature Review.12 3.8.Mental Health Treatment Literature Review.13 3.9.Substance and Alcohol Use Treatment Literature Review.14 4.1.Demographic Character

31、istics of Population Aged 15 to 24 Years,by Geography in Atlanta Metro Region.17 4.2.Programs,Services,and Support for Pregnancy in the Atlanta Metro Region.18 4.3.Programs by Type per 100,000 TAY in Atlanta Metro Region.19 4.4.Demographic Characteristics of Population Aged 15 to 24 Years,by Geograp

32、hy in Los Angeles City.21 4.5.Programs,Services,and Support for Pregnancy in Los Angeles County.21 4.6.Programs per 100,000 TAY in Los Angeles County.22 4.7.Demographic Characteristics of Population Aged 15 to 24 Years,by Geography in New York City.24 4.8.Programs,Services,and Support for Pregnancy

33、in New York City.25 4.9.Programs per 100,000 TAY in New York City.25 4.10.Percentage of Programs,Services,and Supports for Pregnancy by Geography.27 5.1.Programs,Services,and Supports Provided by the Organizations Interviewed.311CHAPTER 1Context and Development of This GuideWho Are Expectant Transit

34、ion-Age Youth?Transition-age youth(TAY)refers to individuals aged 14 to 26 years who are transitioning from adolescence to adulthood.Entering adulthood can be a difficult phase for anyone,but it is especially tough for older foster youth.They often face this transition without the essential support

35、systems and resources needed to thrive.The situation is compounded for expectant TAY exiting foster care who face multiple and concurrent risk factors spanning health,mental health,education,employment,social services,and other sectors.Often,these expectant TAY do not have knowledge of existing prog

36、rams,services,and supports for pregnancy or do not know how to navigate accessing these kinds of resources.Furthermore,the agencies and service pro-viders within the relevant sectors often face difficulties in identifying these youth,coordinating care and support across systems,and tailoring service

37、s and supports to their unique needs.This fracture of program design and service delivery has resulted in stark disparities for expectant and parenting TAY who are or were formerly in foster care,particularly for youth of color.These disparities are partly the result of organizational barriers,such

38、as a lack of available service providers,poor interagency collaboration,and access inequities(McCarthy et al.,2024;Radney et al.,2024).Programs,services,and supports of high quality can enhance significant life outcomes and may help mitigate the effects of racism and racial bias on pregnant individu

39、als of color by offering personalized,culturally relevant,and client-focused care and advocacy.There is a poten-tial for positive,large-scale intervention by identifying and learning from existing programs.What Is the Hilton Foster Youth Initiative?The Foster Youth Initiative of the Conrad N.Hilton

40、Foundation aims to assist TAY who have experienced foster care in leading healthy,fulfilling lives filled with choices.The initiative functions through targeted investments and collaborations in Atlanta,Los Angeles County,and New York City,affecting around one in ten foster youth aged 14 to 20 years

41、 across the country.Central to its mission is a focus on directly engaging foster youth,their caregivers,and the broader community to dismantle racial and social inequities present in the foster care system.A significant component of the initiative is its emphasis on expectant and parenting TAY,espe

42、cially within Black,Indigenous,and People of Color(BIPOC)and lesbian,gay,bisexual,transgender,queer or questioning,intersex,and asexualplus(LGBTQIA+)communities.By providing these young individuals with necessary social,emotional,and economic supports,the initiative aims to bridge the gap to adultho

43、od,ensuring they have access to education,career opportunities,and stable living conditions.The initiative also prioritizes caregiver recruitment and support,national field building,and robust research and evaluation.Through these initiatives,the Hilton Foundation aims to eliminate disparities in ed

44、ucation,employment,and well-being,creating a supportive environment where expectant TAY can flourish in Atlanta,Los Ange-les,and New York City.A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth2What Is This Guide Designed to Do?This guide is intended to be a startin

45、g point for those who are considering developing promising strategies for supporting expectant TAY.The guide can be adapted for the unique circumstances of foster TAY and their children or for those who currently operate a program supporting that population and would like additional information to h

46、elp improve or expand it.Although the guide is primarily focused on the three geographies,it also offers some national and federal context and framing for a broader audience.Specifically,the guide starts by outlining the national and state landscape and policy context for TAY in foster care(Chapter

47、2).Next,the guide provides a summary of the perinatal programs,services,and supports that have the potential to improve outcomes for transition-age foster youth who are expectant parents(Chapter 3)and describes the gaps and opportunities for programming for transition-age foster youth who are expect

48、ing in Atlanta,Los Angeles County,and New York City(Chapter 4).In addition,the guide illustrates the key features of differ-ent types of programs in Los Angeles County for local expectant TAY(Chapter 5).The guide ends with key learnings and opportunities for the Hilton Foundation in its future work

49、to strengthen support for expectant TAY in foster care in Atlanta,Los Angeles County,and New York City(Chapter 6).How to Use This GuideBecause not all readers enter with the same knowledge or interests in the information,the guide is designed to be flexible so users can navigate to the information t

50、hat is most useful to them.Figure 1.1 provides a chart to help with this navigation.FIGURE 1.1How to Navigate the GuideBackground on TAY in the threegeographiesGo to Chapter 2 forEvidence review of programs,services,andsupports for pregnancyGo to Chapter 3 forSystem mapping of programs,services,ands

51、upports for expectant TAY in the three geographiesGo to Chapter 4 forIn-depth exploration of the landscape forexpectant TAY in Los Angeles CountyGo to Chapter 5 forLearnings and opportunities for strengtheningsupport for expectant TAY in the three geographies Go to Chapter 6 forAdditional resourcesG

52、o to Chapter 7 for3CHAPTER 2National and State Landscape and Policy Context for Transition-Age Youth in Foster CareThis chapter offers an overview of the dynamics of TAY in foster care,including exit rates,emancipation,and support services across Georgia,California,and New York.Additionally,this cha

53、pter explores the prevalence of teen births and young parents,providing insights into the factors influencing these trends.It concludes with an analysis of federal and state policy contexts,highlighting initiatives and legislative measures that support expectant and parenting TAY,particularly in rep

54、roductive health and parenting.It is important to note that different data sources use varying age ranges for TAY,such as 15 to 24 years of age or 14 to 20 years of age,depending on the specific dataset.This background sets the stage for understanding the challenges and opportunities that TAY face i

55、n these regions.Transition-Age Youth in Foster CareThe data on TAY in foster care across the three states highlight notable differences in foster care dynamics among these states(Table 2.1).California has the highest percentage of individuals between 14 and 20 years of age exiting foster care,exitin

56、g foster care who were emancipated,and receiving independent living services,reflecting its larger population and foster care system.In comparison,Georgia and New York report lower numbers across all three populations of TAY.Although data on TAY in foster care were not available at the TABLE 2.1Popu

57、lation of TAY in Foster Care by StateDemographicGeorgiaPercentage of TAY Population in StateCaliforniaPercentage of TAY Population in StateNew YorkPercentage of TAY Population in State1420-year-olds exiting foster carea0.26 (n=1,399)0.33(n=4,460)0.21(n=2,315)1420-year-olds exiting foster care who we

58、re emancipateda0.10(n=555)0.21(n=2,887)0.12(n=1,321)1426-year-olds receiving independent living servicesb0.70 (n=3,808)1.09(n=14,862)0.40(n=4,492)SOURCES:Office of the Administration for Children and Families,undated-b;Office of the Administration for Children and Families,undated-a.a Features fisca

59、l year(FY)2022 data Office of the Administration for Children and Families,undated-b.b Features FY 20182022 data from Office of the Administration for Children and Families,undated-a.A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth4county level,these figures under

60、score the scale and scope of foster care systems and support services across these states.The race and ethnicity data for youth exiting foster care reveal distinct patterns across the three states(Table 2.2).In Georgia and New York,Black or African American youth compose a significant portion of tho

61、se exiting foster care,each at 36 percent.In contrast,California has a higher proportion of Hispanic youth exiting foster care(57 percent),reflecting the states diverse demographics.White youth make up the larg-est group in Georgia(48 percent),whereas they represent 20 percent in California and 28 p

62、ercent in New York.Other racial groups,such as American Indian or Alaska Native and Asian,have minimal representa-tion across all states;however,there is acknowledgment that American Indian or Alaska Native youth are overrepresented in the child welfare system relative to their numbers in the state.

63、Youth identifying with two or more races account for a small percentage,ranging from 5 percent in California to 8 percent in Georgia.These differences highlight the varied racial and ethnic compositions of foster care populations in each state.Expectant and Parenting Transition-Age YouthThe national

64、 teen birth rate stands at 19 births per 1,000 females,reflecting a broad spectrum of state-specific rates(County Health Rankings and Roadmaps,undated).Georgias rate is slightly above the national average at 23 births per 1,000 females,while California and New York report lower rates of 16 and 13 bi

65、rths per 1,000 females,respectively.Other available data on young parents(aged 18 to 24)highlight differences across the three states(Table 2.3).In Georgia,6 percent of young adults are parents,with higher percentages among American Indian or Alaska Native(9 percent)and Black or African American(8 p

66、ercent)aged 18 to 24.California and New York both report a lower overall percentage of young parents(4 percent),with similar racial and ethnic distributions.Among 17-year-olds in foster care,a small percentage report having children:Georgia reports 5 percent,slightly higher than California and New Y

67、ork,both at 4 percent.Policy ContextFederal initiatives to assist expectant and parenting TAY in foster care were greatly strengthened by the Family First Prevention Services Act(Family First),which was enacted in 2018.This legislation provides states with the ability to claim Title IV-E reimburseme

68、nt for services designed to prevent the children of preg-TABLE 2.2Percentage of Young Adults Ages 14 to 20 Exiting Foster Care by State and Race/EthnicityRace/EthnicityGeorgiaCaliforniaNew YorkAmerican Indian or Alaska Native010Asian021Black or African American36 1636Hispanic(of any race)75726White4

69、82028Two or more races857SOURCE:Features FY 2022 data Office of the Administration for Children and Families,undated-b.National and State Landscape and Policy Context for Transition-Age Youth in Foster Care5nant and parenting youth in foster care from entering care themselves,even if not at imminent

70、 risk.Eligible services encompass mental health and substance use prevention and treatment,along with in-home,skill-oriented parent programs,such as parenting skills training and family counseling.These services must be grounded in evidence and comply with the standards established by the Childrens

71、Bureau.In addition,the Fostering Connections to Success and Increasing Adoptions Act of 2008(Fostering Connections)(National Center for Homeless Education,undated)allows states to extend care and support provided to youth in foster care from age 18 to 21 under certain conditions.Georgia,California,a

72、nd New York all offer extended foster care through age 21.Fostering Connections also facilitates transition from foster care to independence by requiring child welfare caseworkers and other appropriate representatives to assist TAY in foster care in cre-ating a personal transition plan that outlines

73、 specific options for housing,health insurance,education,men-toring,support services,workforce assistance,and employment services.In tandem with Family First and Fostering Connections,the U.S.Department of Health and Human Services(HHS)funds such initiatives as the John H.Chafee Foster Care Program

74、for Successful Transition to Adulthood and the Adolescent Pregnancy Prevention programs.These programs facilitate a healthy tran-sition to adulthood through a Positive Youth Development approach,emphasizing self-sufficiency,trauma-informed care,and the prevention of teen pregnancy and sexually trans

75、mitted infections.The Family and Youth Services Bureau further supports these goals by promoting medically accurate and culturally relevant education to prevent teen pregnancy and sexually transmitted infections.State-level initiatives for expectant TAY in foster care in the three geographies differ

76、 considerably (McKlindon et al.,2023).California has implemented several policy measures to support expectant and par-enting foster youth.The 2021 to 2022 state budget introduced the Expectant Parent Payment,offering finan-cial support to expectant youth in out-of-home placements during the third tr

77、imester.The 2022 to 2023 budget allocated$35 million to expand the Emergency Child Care Bridge Program,which provides child care vouchers and navigator services to parenting foster youth.Collaborative efforts by such organizations as the Reproductive Health Equity Project and the Childrens Law Cente

78、r have focused on such legislation as SB 89 and AB 670,which mandate reproductive health education for foster youth and support parenting minors during child welfare investigations,respectively(Los Angeles Reproductive Health Equity Program,undated;California Legislative Information,2019).In terms o

79、f broader pregnancy support,California offers enhanced Medicaid reimbursement for group prenatal care and allows local health departments to use California Peri-natal Equity Initiative funds for such programs(Table 2.4).However,a bill to fund evidence-based home-visiting models failed to pass.The st

80、ate has allowed reimbursement for community-based doula services TABLE 2.3Percentage of Young Adults Ages 18 to 24 Who Are Parents by Race/EthnicityRace/EthnicityGeorgiaCaliforniaNew YorkAmerican Indian or Alaska Native955Asian or Pacific Islander111Black or African American865Hispanic or Latino865N

81、on-Hispanic White634Two or more races644Total644SOURCE:Features 20182022 data from KIDS Count Data Center,undated.A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth6under Medicaid since January 1,2023,and passed legislation in 2024 that requires at least one mental

82、health screening during pregnancy and the postpartum period.New York has expanded access to reproductive health and parenting supports through budget increases and initiatives,although none are specifically targeted at TAY or foster youth.The FY 2023 budget expanded child care subsidy eligibility,in

83、vested in child care centers at the State University of New York and City Uni-versity of New York campuses,and allocated$1.1 billion for universal pre-K.For programs,services,and supports for pregnancy,New York acknowledges group prenatal care as an effective approach but has no legislative efforts

84、to enhance it(Table 2.4).Several bills aimed at improving access to home-visiting programs failed to pass.However,New York has enacted legislation to provide Medicaid coverage for doula services.In New York City,the Citywide Doula Initiative provides free doula services to birthing families to reduc

85、e health inequities.Georgia has extended Medicaid eligibility for family planning services through a federal waiver.In 2023,the Georgia General Assembly passed laws to support pregnancy,including extending Medicaid coverage for low-income mothers up to one year postpartum,expanding home visiting in

86、rural communities,and increas-ing access to Temporary Assistance for Needy Families for pregnant people without children.However,for specific programs,services,and supports for pregnancy,Georgia has no legislative efforts to enhance group prenatal care but funded a pilot program for home visiting in

87、 at-risk and underserved rural communities(Table 2.4).There are no legislative efforts to support community-based doulas.These state-level initiatives highlight the varying approaches and scope of pregnancy support across Cali-fornia,New York,and Georgia;California is the only state with specific po

88、licies for TAY and foster youth.TABLE 2.4State Policy Context for Select Pregnancy Supports with Legislative ActivityPregnancy SupportGeorgiaCaliforniaNew YorkCommunity-based doulas No legislative efforts to support community-based doulas Reimburses for community-based doula services under Medicaid

89、Enacted legislation to provide Medicaid coverage for doula servicesGroup prenatal care No legislative efforts to enhance group prenatal care Offers enhanced Medicaid reimbursement for group prenatal care Allows local health departments to use California Perinatal Equity Initiative funds for group pr

90、enatal care programs No legislative efforts to enhance group prenatal care Recognizes group prenatal care as an effective approach to enhancing maternal and child health outcomesHome visiting Supported a pilot program aimed at delivering home-visiting services in at-risk and underserved rural commun

91、ities during pregnancy and early childhood Failed to pass a bill requiring funding for local health departments to implement evidence-based home-visiting models Failed to pass several bills aimed at improving access to home-visiting programsMental health No legislative efforts to support maternal me

92、ntal health Passed legislation requiring maternal mental health screening during pregnancy and the postpartum period Introduced legislation related to maternal mental health screeningSOURCES:Features information from Prenatal-to-3 Policy Impact Center,undated;Policy Center for Maternal Mental Health

93、,undated.7CHAPTER 3Perinatal Programs,Services,and SupportsOur review of literature from 2012 to 2022focusing on models,programs,services,and supports for the perinatal period in the United Statesprovided crucial insights into the existence of various programs and services.This broad reviewnot limit

94、ed to the Atlanta Metro area,Los Angeles County,and New York Cityhelped identify gaps and highlight opportunities relevant to these regions.This review involved com-prehensive keyword searches in academic databases and gray literature so we could explore links between birth outcomes and various inte

95、rventions.We also examined efforts to adapt and customize programming for TAY and foster youth,as well as subpopulations that are overrepresented in the foster care system,such as BIPOC youth.Examples of these efforts are bolded throughout this section.See the annex(Schultz et al.,forthcoming)for de

96、tailed information about the methods for our literature review.There are many ways to address the factors that lead to poor pregnancy and birth outcomes,which we grouped into three broad categories for the purpose of this literature review:health care,health promotion and education,and behavioral he

97、alth care(Figure 3.1).The programs,services,and supports within these categories are numerous and have varying levels of supporting evidence.Some strategies may overlap among the three categories;for example,group prenatal care might include mental health screenings and patient education.Additionall

98、y,some community-wide initiatives may involve activities spanning these categories.Furthermore,although specific data on pregnancy outcomes for TAY and foster youth are limited,existing literature suggests that these populations may face unique challenges that contribute to poorer outcomes compared

99、with their peers.Because of the scarcity of programs specifically for pregnant TAY,we included relevant programs from places beyond the three target geographies to provide a more comprehensive review.In each section below,we provide a table that summarizes the evidence from our literature in the fir

100、st column and models or approaches we identified in the second column.See Appendix B for a complete description of each approach.FIGURE 3.1Literature Review CategoriesHealth careHealthpromotionandeducationBehavioralhealth careA Guide to Effective Strategies for Supporting Expectant Transition-Age Fo

101、ster Youth8Health CareMedical approaches or programs include care provided before,during,and after pregnancy.Although health care providers deliver most of these types of clinical care,some specific reproductive or postpartum services may be offered by community-based organizations.Reproductive care

102、 encompasses a broad spectrum of services aimed at providing individuals with the necessary information to make informed decisions about their reproductive goals.Robust preconception counseling,standardized prompts,and contra-ceptive counseling interventions have been shown to improve pregnancy heal

103、th outcomes and increase knowledge and intent(Table 3.1).Digital approaches,such as apps or websites,can also increase contraception use,though they are only applicable for youth who have access to such technology as cell phones,tablets,or laptops.Such tools as self-reported questionnaires and apps(

104、Bedsider and MiPlan)are effective in these areas,particularly for TAY and African American and Hispanic pregnant people(Bedsider,undated;Hebert et al.,2018).Group prenatal care integrates patient education,social support,and comprehensive health screen-ings in group sessions with those at the same s

105、tage of pregnancy.Group prenatal care can enhance knowl-edge about pregnancy,readiness for childbirth,patient satisfaction,and breastfeeding options(Table 3.2).For high-risk individuals,it can lead to fewer pre-term births and better prenatal care attendance.Such models as CenteringPregnancy have sh

106、own significant positive outcomes,including increased breastfeeding rates and reduced caesarean-section(c-section)births and depressive symptoms.However,these programs may not specifically target issues of pregnancy and childbirth for TAY foster youth,which could place an undue burden on participant

107、s who may be unwilling to disclose their foster care status,potentially discouraging attendance and participation.Care coordination involves case management,referrals,and patient education to reduce adverse pregnancy outcomes and improve prenatal care.Care coordination components can reduce low birt

108、hweight and preterm births,and Medicaid-covered care coordination has reduced infant mortality in some states(Table 3.3).For teens,clinic-based care coordination increases compliance with clinical care and reduces repeat preg-nancies,particularly among Black and Hispanic teens.Culturally tailored re

109、productive care tools and counseling interven-tions improve reproductive health outcomes for Black and Hispanic populations,yielding significant positive results.Group prenatal care effectively reduces neo-natal intensive care unit(NICU)days and repeat pregnancies while improving pre-natal care comp

110、liance and weight manage-ment,particularly through such models as CenteringPregnancy,which integrate cul-turally sensitive care for Black and Hispanic women.Care coordination increases com-pliance with clinical care and reduces repeat pregnancies,espe-cially among Black and Hispanic teens.Medicaid-c

111、overed efforts lead to improved pregnancy out-comes and reduced infant mortal-ity for high-risk populations.Perinatal Programs,Services,and Supports9TABLE 3.1Reproductive Care Literature ReviewEvidenceApproaches Robust preconception counseling can improve pregnancy health outcomes(Ren et al.,2023).S

112、tandardized prompts can lead to more screening and counseling(Allen et al.,2017).Contraceptive counseling interventions can increase knowledge and intent(Dehlendorf et al.,2019;Holt et al.,2020;Hebert et al.,2018;Sonalkar et al.,2018).Digital approaches can increase contraception use(Sze et al.,2023

113、).Self-reported questionnaires,provider tools or prompts,or counseling(e.g.,the Reproductive Health Self-Assessment Tool and the One Key Question patient prompt)can provide data for providers.Several websites or apps,such as Bedsider and MiPlan,have been developed specifically for pregnant TAY and t

114、hose who are African American and Hispanic,though their effectiveness depends on access to technology(Bedsider,undated;Hebert et al.,2018).TABLE 3.2Group Prenatal Care Literature ReviewEvidenceApproaches Some studies show positive effects on reducing preterm births and depressive symptoms and increa

115、sing prenatal care visits,breastfeeding,and pregnancy knowledge for those at high risk during pregnancy(Byerley and Haas,2017;Felder et al.,2017).Other studies show no effect on preterm births,low birthweight,and breastfeeding(Liu et al.,2021).For teens and young adults,there is some evidence of few

116、er NICU days and repeat pregnancies,increased compliance with prenatal visits,more appropriate weight gain and uptake of effective contraception,and decreased small-for-gestational-age infants(Fairchild et al.,2022;Trotman et al.,2015;Ickovics et al.,2016).CenteringPregnancy,the most well-known and

117、studied group prenatal care model,includes health care assessment,education,and support.Groups of 8 to 12 participants with similar due dates meet for 90 to 120 minutes about ten times during their pregnancies(Byerley and Haas,2017).Other promising programs include Expect with Me,which includes up t

118、o ten 120-minute group sessions(Cunningham et al.,2017)and Expecting and Connecting,which consists of two-hour sessions for groups of 8 to 12 women(Craswell,Kearney,and Reed,2016).TABLE 3.3Care Coordination Literature ReviewEvidenceApproaches Elements of care coordination,such as case management,ref

119、errals,and patient education,have the potential to decrease the incidence of low birthweight and preterm births(Kroll-Desrosiers et al.,2016;Garite and Manuck,2023).In some states,care coordination covered by Medicaid resulted in reduced infant mortality for high-risk pregnancies(Hollingsworth,Kranz

120、,and Freund,2020).For teens,clinic-based care coordination and case management programs have been shown to increase compliance with clinical care and reduce repeat pregnancies,particularly for Black and Hispanic teens(Corcoran and Pillai,2007;Blank et al.,2010;Kan et al.,2012).Prenatal care coordina

121、tion efforts funded by Title V Maternal and Child Health Block Grants are common for state Medicaid-covered pregnancy care.Georgias Perinatal Health Program provides comprehensive perinatal health care services through a network of clinics,centers,providers,and hospitals(Georgia Department of Public

122、 Health,2022).In California,the Comprehensive Perinatal Services Program offers enhanced psychosocial support,health education,and nutrition guidance to Medi-Cal beneficiaries from conception to 60 days postpartum(California Department of Public Health,2024).In 2022,New York updated its Medicaid Per

123、inatal Care Standards to guide perinatal care providers in care coordination,risk assessments,care plans,home visits,postpartum visits,and breastfeeding education for pregnant Medicaid patients(New York State Department of Health,2022).For TAY in foster care,Illinois offers comprehensive support thr

124、ough the Teen Parenting Service Network,which includes counseling,coaching,and doula services,while the Partners in Parenting program uses a case management approach to connect pregnant or parenting youth to essential services and resources(Wilson et al.,2011).A Guide to Effective Strategies for Sup

125、porting Expectant Transition-Age Foster Youth10Health Promotion and EducationHealth promotion and education strategies are designed to improve knowledge,attitudes,and behaviors related to maternal and infant health to attack the underlying causes of negative pregnancy and birth out-comes.These activ

126、ities can be conducted in group settings or individually and may take place in community organizations,in health care facilities,or in placement settings for TAY in foster care.Doula care offers essential support throughout pregnancy,childbirth,and the postpartum period by providing emo-tional,physi

127、cal,and educational assistance.Doulas operate in various settings,including in hospitals,in clinics,and through community-based programs,often integrating their services with other family support programs.Doula care has been asso-ciated with reduced c-sections,increased attendance at child-birth edu

128、cation classes,and higher breastfeeding initiation rates,although effects on such outcomes as preterm births and NICU admissions are mixed(Table 3.4).For teens,doula care has shown promise in reducing c-sections and improving breastfeeding rates.Home-visiting programs provide direct education,assess

129、-ments,and referrals through visits conducted at participants homes or places of choice.These programs,typically delivered by such professionals as nurses,social workers,or early child-hood specialists,vary in content and duration,addressing vari-ous needs through educational guidance,coaching,and s

130、ervice coordination.Home-visiting models,such as Nurse-Family Partnership,Healthy Families America,and Parents as Teachers,TABLE 3.4Doula Care Literature ReviewEvidenceApproaches Doula care has been shown to reduce c-section births,preterm births,low birthweight,and NICU admission and increase the l

131、ikelihood of attending childbirth education classes and initiating breastfeeding in the hospital(Bohren et al.,2017;Hans,Edwards,and Zhang,2018;Pan et al.,2020).Although some studies found no significant effect on rates of low birthweight,preterm births,c-sections,NICU admissions,or newborn hospital

132、 stay lengths,doula care has been associated with increased breastfeeding initiation(Hans,Edwards,and Zhang,2018;Acquaye and Spatz,2021).For teens,doula care has been effective in reducing c-section,premature birth,and epidural anesthesia rates for vaginal births(Everson,Cheyney,and Bovbjerg,2018).D

133、oula care can be provided through independent stand-alone programs or incorporated into home visiting or other programs.State efforts to increase access include California providing Medicaid reimbursement for doula services New York seeking approval for Medicaid doula coverage starting in 2024 Georg

134、ia introducing legislation for Medicaid doula coverage,although it stalled.One evidence-based model supports the development of community-based doula programs to provide parenting education,pregnancy and childbirth education,and breastfeeding support(HealthConnect One,undated).Community-based doula

135、programs,such as SisterWeb in San Francisco and the Los Angeles County African American Infant and Maternal Mortality Prevention Initiative,provide comprehensive support to low-income and BIPOC women,enhancing maternal health outcomes through physical,emotional,and informational care during prenatal

136、,birthing,and postpartum periods(SisterWeb,2023;Black Infants and Families Los Angeles,undated).Tailored home-visiting programs for teens show benefits in various domains,addressing the cultural and linguistic needs of Black and Hispanic families and demonstrat-ing positive outcomes in maternal and

137、child health.Doula care reduces c-section rates,premature births,and epidural anesthesia use for vaginal births among teens.Community-based initiatives provide culturally rel-evant support that improves birth outcomes.Perinatal Programs,Services,and Supports11have shown benefits in reducing child ma

138、ltreatment and improving child development and maternal health(Table 3.5).Programs specifically for teens have also shown promising results.Prenatal education programs are designed to prepare expectant parents for pregnancy,childbirth,and parenting by enhancing knowledge and developing skills relate

139、d to pregnancy changes,labor pain,safe sleep practices,and effective parent-ing techniques.They can be delivered in such formats as classes,workshops,digital platforms,or home visits.Prenatal education can lead to reduced c-section births,decreased use of epidural anesthesia,and improved self-effica

140、cy(Table 3.6).Such pro-grams as Moms2B and Growing Great Kids have shown positive outcomes,particularly in reducing stress levels and improving coping behaviors during childbirth.Breastfeeding and nutrition education programs focus on initiating and sustaining breastfeeding and ensuring a nutritious

141、 diet during pregnancy and the postpartum period.They can be stand-alone programs or integrated into other such programs as home visiting.Educational and counseling interventions,home vis-iting,and peer support have been effective in increas-ing breastfeeding initiation,duration,and exclusivity(Tabl

142、e 3.7).Such programs as the Special Supple-mental Nutrition Program for Women,Infants,and Children(WIC)and Healthy Start provide compre-hensive support.WIC offers nutrition education and breastfeeding support that has led to increased breast-feeding rates among participants,and Healthy Start improve

143、s birth outcomes through home-visiting pro-grams that enhance breastfeeding initiation and con-tinuation.Specific interventions,such as Ready,Set,BABY,improve breastfeeding intentions and knowledge of infant care practices.Lactation Advice Through Texting Can Help(LATCH),a web-based texting inter-ve

144、ntion promoting breastfeeding among WIC recipients,has also shown promising results.TABLE 3.5Home-Visiting Literature Review EvidenceApproaches HHSs annual Home Visiting Evidence of Effectiveness review identified 27 models that met criteria for having evidence of effectiveness on a range of outcome

145、s(Home Visiting Evidence of Effectiveness,2023).Evidence-based models,such as Nurse-Family Partnership,Healthy Families America,and Parents as Teachers,are part of the HHS Maternal and Child Health Bureaus Maternal,Infant,and Early Childhood Home Visiting Program and are widely implemented(Home Visi

146、ting Evidence of Effectiveness,2023).Healthy Start,a widely implemented federal grant program,provides such services as community outreach,case management,health education,and depression screening.There is emerging evidence of its effectiveness that does not yet meet HHS criteria.Several programs ha

147、ve been developed specifically for teens;one of meets the HHS criteria(Early Intervention Program for Adolescent Mothers)and the others have not yet been evaluated.For TAY in foster care,a pilot effort with a subset of the Healthy Family Illinois program provided home visiting to foster youth(Dworsk

148、y,Gitlow,and Ethier,2018).Targeted prenatal education on health,childbirth,breastfeed-ing,and newborn care for teens enhances knowledge and prepared-ness,as demonstrated by programs like Starting Out Right.Breastfeeding and nutrition education programs addressing systemic racism and focusing on self

149、-efficacy effectively increase breastfeeding rates among African American women,promoting better maternal and infant health outcomes.A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth12Behavioral Health CareInterventions and supports designed to address behavioral h

150、ealth issues are available through community-based orga-nizations or can be provided within medical care settings.Prenatal mental health treatment programs offer assis-tance and care for pregnant individuals dealing with such issues as depression or anxiety.These programs can be run by health care p

151、rofessionals,such as psychiatrists or psy-chologists,or community organizations and may include one-on-one or group therapy,medication,or other psycho-social treatments.Psychosocial and counseling interven-TABLE 3.7Breastfeeding and Nutrition Education Literature ReviewEvidenceApproaches Several sys

152、tematic reviews found that supportive educational and counseling interventions,home visiting,and peer support increase breastfeeding initiation,duration,and exclusivity(Yas et al.,2023;Patnode et al.,2016;Shealy et al.,2005).Prenatal breastfeeding education has been found to enhance breastfeeding kn

153、owledge and increase postpartum breastfeeding(Kehinde,ODonnell,and Grealish,2023).Psychosocial breastfeeding programs,particularly those focusing on self-efficacy and addressing systemic racism,have shown some success in increasing breastfeeding initiation among African American women(Johnson et al.

154、,2015).Two federally funded programs exists:WIC provides low-income expectant mothers with breastfeeding support and nutrition education,in addition to access to nutritious foods.The Healthy Start home-visiting program provides breastfeeding education.Other evidence-based or promising breastfeeding

155、education and support programs include the Ready,Set,BABY curriculum,which can be delivered in hospitals,community clinics,or independently in the community,and LATCH,a web-based texting intervention for WIC recipients.For teens,the Supportive Needs of Adolescents During Childbirth program in Texas

156、provides intrapartum nursing support focused on labor,breastfeeding,and skin-to-skin contact with evidence that the intervention increased breastfeeding initiation within the first hour of birth(Grassley and Sauls,2012).TABLE 3.6Prenatal Education Literature ReviewEvidenceApproaches One systematic r

157、eview found positive effects,such as decreased c-section births,use of epidural anesthesia,and stress levels,but no effect on birthweight and gestational age at birth(Hong et al.,2021).Another systematic review found that prenatal education enhanced self-efficacy and coping behaviors during childbir

158、th(Demirci,Kochan,and Kabukcuoglu,2023).There are few common models but some promising programs,including Moms2B,a community-based prenatal education program for low-income pregnant women,and Growing Great Kids,a skills-based curriculum for home-visiting programs that spans the prenatal period throu

159、gh age 3(Ateah,2013).For teens,Starting Out Right offers eight in-person sessions on such topics as prenatal health,childbirth,breastfeeding,newborn care,and contraceptive methods(Root et al.,2023).For TAY in foster care,Inwood House in New York City provides comprehensive support to foster youth wh

160、o are pregnant or parenting,enhancing self-sufficiency,education,and health outcomes(Lieberman,Bryant,and Boyce,2015),and the Personal Best curriculum,adapted for pregnant and parenting foster youth,offers 22 sessions on life skills and child development(Ackerman Institute for the Family,undated).Cu

161、lturally sensitive psychosocial and counseling interventions reduce post-partum depression in Black and His-panic women,leading to improved emo-tional well-being during the perinatal period.Perinatal Programs,Services,and Supports13tions can decrease postpartum depression(Table 3.8).Such screening t

162、ools as the Patient Health Question-naire9 identify mental health concerns,and such interventions as cognitive behavioral therapy have shown effectiveness in reducing mental health concerns during pregnancy.Prenatal substance or alcohol use treatment programs provide help and treatment for those str

163、uggling with substance use or alcohol addiction during pregnancy.These programs can be facilitated by health care providers,such as addiction specialists or obstetricians,or community organizations and may involve individual or group therapy,medication-assisted treatment,or other therapeutic approac

164、hes.Motivational inter-viewing,cognitive behavioral therapy,and contingency man-agement therapies can reduce harmful effects of substance use(Table 3.9).Such programs as Ohios Maternal Opioid Medical Support have shown effectiveness in treating opioid use during pregnancy.However,there is a need for

165、 programs with a cul-turally sensitive focus to effectively address substance use among African American and Hispanic pregnant TAY youth,ensuring that interventions are tailored to the specific cultural and social contexts of these popu-lations.Various screening tools are available for detecting sub

166、stance and alcohol use.TABLE 3.8Mental Health Treatment Literature ReviewEvidenceApproaches Psychosocial and counseling interventions can decrease postpartum depression(OConnor et al.,2019).A systematic review of psychosocial interventions for pregnant and parenting teens found small to moderate ben

167、eficial effects on positive mental health but limited effects on depression,anxiety,substance use,and other behaviors(Laurenzi et al.,2020).Another systematic review of postpartum depression prevention for teens found that home visiting and cognitive behavioral therapy can reduce rates of postpartum

168、 depression(Sangsawang,Wacharasin,and Sangsawang,2019).Multiple evidence-based mental health screening tools are available for use during pregnancy(Patient Health Questionnaire9,Center for Epidemiologic Studies Depression Scale Revised)with one specifically designed for use during pregnancy(4Ps Plus

169、)and one designed for teens(Beck Depression InventoryFastScreen).Treatment options for addressing mental health concerns during pregnancy include psychosocial interventions,individual treatment,and group treatment approaches with evidence-based interventions within each type.Counseling interventions

170、 effectively reduce alcohol use among preg-nant teens;culturally competent approaches have demonstrated suc-cess in decreasing substance and alcohol use among pregnant Black and Hispanic women.A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth14Literature Review Sum

171、maryThis synthesis found some evidence-based interventions that effectively support teens,TAY,and foster youth,as well as Black,Hispanic,and other specific subpopulations during the perinatal period.Although most programs,services,and supports were originally developed for the general population,som

172、e have been specifically studied and adapted to meet the unique needs of diverse groups.By exploring such approaches as group prenatal care,care coordination,doula care,and culturally tailored programs,we identified strategies that improve pregnancy and birth outcomes.Summary of What Works for Teens

173、 and Pregnant Transition-Age YouthThe following list summarizes what our analysis suggests works for teens and pregnant TAY:Group prenatal care is effective in reducing NICU days and repeat pregnancies and improving prenatal care compliance and weight management.Care coordination increases complianc

174、e with clinical care and reduces repeat pregnancies,particularly among Black and Hispanic teens.Doula care reduces c-section rates,premature births,and epidural anesthesia use for vaginal births among teens.Home-visiting programs tailored for teens have shown benefits in various domains.Prenatal edu

175、cation includes such programs as Starting Out Right,which offers targeted education on prenatal health,childbirth,breastfeeding,and newborn care for teens.Substance and alcohol use treatment counseling interventions have shown some effectiveness in reduc-ing alcohol use among pregnant teens.Investin

176、g in these areas can enhance support for expectant TAY and improve pregnancy and birth out-comes in the Atlanta Metro area,Los Angeles County,and New York City.TABLE 3.9Substance and Alcohol Use Treatment Literature ReviewEvidenceApproaches Motivational interviewing,cognitive behavioral therapy,and

177、contingency management therapies can reduce the harmful effects of substance use,although they have not been widely studied in pregnancy(Forray,2016).A systematic review found that online health interventions are effective in reducing substance use during pregnancy(Silang et al.,2021).For substance

178、use disorder treatment,methadone maintenance and buprenorphine can be effective in treating opioid use during pregnancy(Forray,2016).For alcohol use treatment,some studies found that psychosocial interventions increased abstinence and decreased postpartum alcohol consumption(Gomez et al.,2021),while

179、 others found no significant differences(Stade et al.,2009).Counseling interventions have shown some effectiveness in reducing alcohol use among pregnant teens(OConnor et al.,2018),although other reviews found no effect(Bottorff et al.,2014).Multiple evidence-based substance and alcohol use screenin

180、g tools are available for use during pregnancy(“Cutting Down,”“Annoyed by Criticism,”“Guilty Feelings,”and“Eye-Opener”or CAGE;Alcohol Use Disorders Identification Test;Alcohol,Smoking and Substance Involvement Screening Test;and Drug Abuse Screening Test),and the 4Ps Plus tool is specifically design

181、ed for and particularly applicable to pregnant individuals,addressing the unique needs of this population.Several substance use treatment programs for opioid use disorder have been developed specifically for pregnancy,such as Ohios Maternal Opioid Medical Support program,which uses a maternal medica

182、l home model to coordinate behavioral health and prenatal care for pregnant Medicaid recipients with opioid use disorder in their third trimester(Crane et al.,2019).Other approaches to addressing opioid use disorder in pregnancy focus on provider and practice changes,such as quality improvement chec

183、klists,learning collaboratives,and toolkits(Goodman et al.,2019).Perinatal Programs,Services,and Supports15Summary of What Works for Diverse PopulationsThe following list summarizes what our analysis suggests works for diverse populations:Culturally tailored reproductive care tools and counseling in

184、terventions designed specifically for Black and Hispanic populations,such as the Reproductive Health Self-Assessment Tool and MiPlan,have been effective in improving reproductive health knowledge and behaviors.Group prenatal care models,such as CenteringPregnancy,which integrates culturally sensitiv

185、e care,have shown significant positive outcomes for Black and Hispanic women.Care coordination and Medicaid-covered care coordination efforts have led to improved pregnancy out-comes and reduced infant mortality for high-risk Black and Hispanic women.Community-based doula care initiatives that provi

186、de culturally relevant support have been successful in improving birth outcomes and maternal engagement in health care.Home-visiting programs,such as Early Intervention Program for Adolescent Mothers,that address the cultural and linguistic needs of Black and Hispanic families have shown positive ou

187、tcomes in maternal and child health.Breastfeeding and nutrition education programs,such as Healthy Start,address systemic racism and focus on self-efficacy and have been effective in increasing breastfeeding rates among African Ameri-can women.Mental health treatment via culturally sensitive psychos

188、ocial and counseling interventions,which are tailored to address the unique cultural and social contexts of diverse populations,have shown effective-ness in reducing postpartum depression for Black and Hispanic women.Substance and alcohol use treatment via culturally competent counseling interventio

189、ns have dem-onstrated some success in reducing substance and alcohol use among pregnant Black and Hispanic women,although there is limited information about their effectiveness for pregnant TAY and TAY in foster care,specifically.Investing in these culturally tailored programs and approaches can sig

190、nificantly enhance support for diverse populations,leading to improved pregnancy and birth outcomes.17CHAPTER 4Programming Gaps and Opportunities for Expectant Transition-Age Youth in Foster Care in Three GeographiesThis chapter provides the results of our system mapping and offers an analysis of th

191、e programs,services,and supports available to TAY in the Atlanta Metro area,Los Angeles County,and New York City.An opportu-nity and gap analysis concludes this chapter,highlighting the types of programs by geography and identify-ing areas with relatively few programs in categories where evidence-ba

192、sed options exist.It is important to note that our approach to the system mapping is limited by the programs we could find through internet searches,existing directories and lists,and program locator websites,which may not capture all available resources.Nonetheless,this analysis aims to offer insig

193、hts and recommendations for enhancing support for TAY across the three geographies.See Appendix A for a description of the methods for the system mapping and gap analysis.Availability of Programs,Services,and Supports in the Atlanta Metro RegionThe Georgia Department of Family and Children Services

194、defines the Atlanta Metro region as including Clayton,Cobb,DeKalb,Fulton,and Gwinnett counties.The TAY population,aged 15 to 24,in this region is nearly 550,000(Table 4.1).The demographic characteristics of this population highlight a diverse composi-TABLE 4.1Demographic Characteristics of Populatio

195、n Aged 15 to 24 Years,by Geography in Atlanta Metro RegionGeographyTotal PopulationPercentage FemalePercentage Black Non-HispanicPercentage HispanicPercentage Other RacePercentage White Non-HispanicAtlanta Metro540,5705040181329Clayton County42,42751691984Cobb County107,6964928201141DeKalb County95,

196、6595154141221Fulton County154,1765142101335Gwinnett County140,6124929291725SOURCE:Features April 1,2010,to July 1,2020,data from U.S.Bureau of the Census,20102020.NOTE:Census data are available for the 15-to 24-year-old age group,which largely overlaps with the 14-to 26-year-old age range for TAY.Th

197、e“Other Race”category includes American Indian or Alaskan Native alone,Asian alone,Native Hawaiian and Other Pacific Islander alone,some Other Race alone,and population of two or more races.A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth18tion across its counties

198、.The overall TAY population in the region is evenly split by gender,with 50 percent female representation.Racially,the area is predominantly Black non-Hispanic(40 percent),followed by White Non-Hispanic(29 percent)and Hispanic(18 percent)populations.Within the counties,Clayton County has a notably h

199、igh Black Non-Hispanic population(69 percent)and a very small White Non-Hispanic commu-nity(4 percent).In contrast,Cobb County has a significant White Non-Hispanic population(41 percent),with a more balanced mix of Black Non-Hispanic and Hispanic communities.DeKalb County features a majority Black N

200、on-Hispanic population(54 percent),while Gwinnett County is characterized by a diverse mix with equal proportions of Black Non-Hispanic and Hispanic populations(both 29 percent).These dif-ferences underscore the varied cultural and racial landscape within the Atlanta Metro area,influencing the need

201、for tailored programs and services.Fulton and Gwinnett counties hold the largest shares of the TAY population,at 29 percent and 26 percent respectively,while Cobb and DeKalb counties each account for about one-fifth(Table 4.2).Clayton County comprises just 8 percent of the TAY population.We identifi

202、ed 142 programs,services,and supports for expectant TAY in the Atlanta Metro region.Notably,DeKalb County has a higher proportion of programs relative to its TAY population,whereas Gwinnett County has a lower proportion.This distribution is particu-larly interesting given the demographic characteris

203、tics,as DeKalbs majority Black Non-Hispanic popula-tion and Gwinnetts diverse mix,including significant Black Non-Hispanic and Hispanic communities,may influence program demand and availability.The Atlanta Metro region has an estimated total of 26.27 programs per 100,000 TAY(Table 4.3).This rep-rese

204、nts the lowest overall rate among the three geographies examined.Benefit programssuch as WIC and Georgias Perinatal Health Program,which presumes Medicaid eligibility for those who are pregnant and in need of health careare the most prevalent with a rate of 6.10 per 100,000 TAY.Prenatal education an

205、d breastfeeding and nutrition education programs are also prevalent,with rates of 4.44 and 4.81 per 100,000 TAY,respectively.Much of the breastfeeding and nutrition education is provided through WIC offices in the region.There are some reproductive care(3.88),group prenatal care(2.40),and home-visit

206、ing programs(2.40).The home-visiting programs include the evidence-based Parents as Teachers and Healthy Families models.Community-based doula programs,behavioral health treatment,and care coordination services are notably scarce,with rates of 0.18,0.92,and 1.11,respectively.It is important to note

207、that more care coordina-tion and behavioral health treatment programs likely exist but may not have been identifiable through our TABLE 4.2Programs,Services,and Support for Pregnancy in the Atlanta Metro RegionCountyPercentage of TAY Population in County(n=540,570)Percentage of Programs in County(n=

208、142)Clayton County88Cobb County2018DeKalb County1832Fulton County2934Gwinnett County268SOURCE:Features April 1,2010,to July 1,2020,data from U.S.Bureau of the Census,20102020.NOTE:In these data,TAY is defined as those 15 to 24 years of age.Programming Gaps and Opportunities for Expectant Transition-

209、Age Youth in Foster Care in Three Geographies19TABLE 4.3Programs by Type per 100,000 TAY in Atlanta Metro RegionProgram TypeNumber of ProgramsRate per 100,000 TAYReproductive care213.88Group prenatal care132.40Care coordination and case management61.11Community-based doula program10.18Home visiting

210、program132.40Prenatal education program244.44Breastfeeding and nutrition education program264.81Behavioral health treatment program50.92Benefit program336.10Total14226.27FIGURE 4.1Mapping of Programs,Services,and Supports for Pregnancy in Atlanta Metro RegionCartersvilleEmersonlasDouglasvilleMableto

211、nEast PoiDecaturForest ParkUnion CityRiverdaleStockbridgeOxfordCovingtonSouth FultonStonecrestConyersSmyrnaMariettaSandy SpringsRoswellJohns CreekDunwoodyAlpharettaPeachtreeCornersLawrencevilleSnellvilleLoganville296298119BufordBrookhavenTuckerWoodstockKennesawCobb CountyGwinnett CountyDeKalb County

212、AtlantaClayton CountyFulton County12075858520208585985752857081Reproductive careGroup prenatal careCare coordination/case managementCommunity-based doula programHome visiting programPrenatal education programBehavioral health treatment programBeneft programBreastfeeding/nutrition education programA

213、Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth20search methods,as these programs often do not explicitly mention their focus on teens or pregnancy.This suggests potential gaps in visibility and accessibility of critical services for pregnant TAY in the region.Figu

214、re 4.1 shows the distribution of programs,services,and supports for pregnancy in the five-county Atlanta Metro regionmany of them concentrated around the city of Atlanta.Fulton and DeKalb coun-ties offer a comprehensive variety of program types:reproductive care,group prenatal care,community-based d

215、oula programs,and more.In contrast,Clayton County lacks reproductive care,group prenatal care,and community-based doula programs.Similarly,Gwinnett County does not have group prenatal care,care coordination and case management,community-based doula programs,home-visiting programs,or behav-ioral heal

216、th treatment focused on pregnancy.Cobb County appears to have limited group prenatal care,care coordination and case management,and behavioral health treatment specifically for pregnancy.Availability of Programs,Services,and Supports in Los Angeles CountyLos Angeles County is divided into eight serv

217、ice-planning areas(SPAs)to effectively manage resources for its nearly 1.4 million TAY population.The overall demographic is predominantly Hispanic(58 percent)with smaller proportions of Black Non-Hispanic(7 percent)and White Non-Hispanic(18 percent)populations(Table 4.4).Notably,SPA 6(south)has a h

218、igh Hispanic population(73 percent)and a significant Black Non-Hispanic community(17 percent),while SPA 5(West)has a larger White Non-Hispanic population(46 per-cent).SPA 7(East)stands out with the highest Hispanic representation(81 percent).These demographic variations highlight the diverse needs a

219、cross the SPAs,necessitating tailored services and resources.Los Angeles Countys distribution of 825 programs reveals notable disparities across its SPAs(Table 4.5).SPA 4(Metro Los Angeles)stands out with a higher concentration of facilities and programs at 22 percent,despite only representing 10 pe

220、rcent of the TAY population.This area predominantly comprises Hispanic youth(60 percent).In contrast,SPAs 2(San Fernando Valley),3(San Gabriel Valley),and 8(South Bay)have fewer programs relative to their larger TAY populations of 21,18,and 15 percent,respectively.These SPAs feature diverse demograp

221、hics with significant Hispanic populations ranging from 50 to 55 percent.Such dis-parities highlight potential differences in program availability and underscore the need for a more equitable distribution of resources to effectively serve the diverse TAY population across the SPAs.Los Angeles County

222、 has an estimated total of 60.68 programs per 100,000 TAY,which is the highest over-all rate among the three geographies(Table 4.6).The most prevalent programs are prenatal education and BOX 4.1Pregnancy-Related Resources in Georgias Atlanta Metro Area Find Help Georgia,Georgia Department of Childre

223、n and Family Services Regional Perinatal Centers,Georgia Department of Public Health Title V Programs,Georgia Department of Public Health Georgia State Agency Policies and Resources for Transition-Age Youth and Young Adults Healthy Mothers,Healthy Babies Coalition of Georgia United Way of Greater At

224、lantaProgramming Gaps and Opportunities for Expectant Transition-Age Youth in Foster Care in Three Geographies21TABLE 4.4Demographic Characteristics of Population Aged 15 to 24 Years,by Geography in Los Angeles CityGeographyTotal PopulationPercentage FemalePercentage Black Non-HispanicPercentage His

225、panicPercentage Other RacePercentage White Non-HispanicLos Angeles County1,359,587497581718SPA 1:Antelope Valley63,463491562815SPA 2:San Fernando Valley281,561494501531SPA 3:San Gabriel Valley238,333493552912SPA 4:Metro Los Angeles131,935505601718SPA 5:West90,728535212846SPA 6:South166,34950177364SP

226、A 7:East188,0444938197SPA 8:South Bay199,0754912521916SOURCE:Features April 1,2010,to July 1,2020,data from U.S.Bureau of the Census,20102020.NOTE:Census data are available for the 15-to 24-year-old age group,which largely overlaps with the 14-to 26-year-old age range for TAY.The Other Race category

227、 includes American Indian or Alaskan Native alone,Asian alone,Native Hawaiian and Other Pacific Islander alone,some Other Race alone,and population of two or more races.TABLE 4.5Programs,Services,and Support for Pregnancy in Los Angeles CountySPAPercentage of TAY Population in SPA(n=1,359,587)Percen

228、tage of Programs in SPA(n=825)SPA 1:Antelope Valley53SPA 2:San Fernando Valley2117SPA 3:San Gabriel Valley1814SPA 4:Metro Los Angeles1022SPA 5:West74SPA 6:South1213SPA 7:East1416SPA 8:South Bay1511SOURCE:Features April 1,2010,to July 1,2020,data from U.S.Bureau of the Census,20102020.NOTE:In these d

229、ata,TAY is defined as those 15 to 24 years of age.A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth22breastfeeding and nutrition education,with rates of 19.71 and 21.92,respectively.Many of the programs for both types are provided through the California Department

230、of Public Healths Comprehensive Perinatal Ser-vices Program,which is a Medi-Cal benefit for pregnancy and the first 60 days after birth.Breastfeeding and nutrition education is also provided through WIC offices throughout the county.There is a moderate pres-ence of home-visiting and behavioral healt

231、h treatment programs,with rates of 5.52 and 5.81.Evidence-based home-visiting models found in the county include Early Head Start,Welcome Baby,and Healthy Families America.For behavioral health treatment,most of the programs are funded through the Los Angeles County Department of Public Healths Subs

232、tance Abuse Prevention and Control Program,which has contracts with community-based organizations to provide a full range of treatment services.There are few group prenatal care programs in Los Angeles County with a rate of just 0.59.All of them use the CenteringPregnancy model.Similarly,we found a

233、limited number of community-based doula programs.Although reproductive care and care coordination are available across the county,their rates are low at 1.91 and 2.43,respectively.Despite Los Angeles Countys high overall program availability compared with the other geographies,there is a relatively

234、limited presence of group prenatal care and community-based doula programs,both of which have strong TABLE 4.6Programs per 100,000 TAY in Los Angeles CountyProgram TypeNumber of ProgramsRate per 100,000 TAYReproductive care261.91Group prenatal care80.59Care coordination and case management332.43Comm

235、unity-based doula program60.44Home-visiting program755.52Prenatal education program26819.71Breastfeeding and nutrition education program29821.92Behavioral health treatment program795.81Benefit program322.35Total82560.68BOX 4.2Pregnancy-Related Resources in Californias Los Angeles Area BreastfeedLA C

236、alifornia Department of Public Healths Comprehensive Perinatal Services Program First 5 LA Los Angeles County Department of Children and Family Services,Teen Parenting Resources Page Los Angeles County Department of Public Health,Service and Bed Availability Tool Los Angeles County Department of Hum

237、an Resources Los Angeles County Department of Mental Health Los Angeles County Perinatal and Early Childhood Home Visitation Consortium National Health Law Programs Resources for California Foster Youth:Sexual,Reproductive,and Mental Health Medi-Cal Services Programming Gaps and Opportunities for Ex

238、pectant Transition-Age Youth in Foster Care in Three Geographies23evidence of effectiveness.This highlights a potential gap in service offerings,suggesting areas for further development to better support expectant TAY in Los Angeles County.Figure 4.2 shows the distribution of programs,services,and s

239、upport for pregnancy in Los Angeles County.Several SPAs had representation across all program types except for one,including SPAs 4 and 6 where we found no community-based doula programs and SPA 8 where we found no group prenatal care.For SPAs 1,2,and 7,we found no group prenatal care or community-b

240、ased doula programs and very little care coordination and case management.In SPA 3 we found no group prenatal care and little reproductive care,care coordination and case management,and community-based doula programs.Overall,the availability of comprehensive pregnancy-related services varies signifi

241、cantly across different SPAs in Los Angeles County.FIGURE 4.2Mapping of Programs,Services,and Supports for Pregnancy in Los Angeles CountyPalmdaleSanta MonicaSanta AnaAnaheimComptonTorranceLAXLong Beach405710210210210555138Thousand OaksmoreSanta ClaritaBurbankGlendalePomonaOntarSPA#2SPA#1SPA#3SPA#7S

242、PA#8SPA#6SPA#4SPA#5Lake LosAngelesLos AngelesLancasterAngelesNational forestReproductive careGroup prenatal careCare coordination/case managementCommunity-based doula programHome visiting programPrenatal education programBehavioral health treatment programBeneft programBreastfeeding/nutrition educat

243、ion programA Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth24Availability of Programs,Services,and Supports in New York CityNew York City comprises five boroughs,each with distinct TAY demographics among its approximately 1.1 million youth(Table 4.7).The citys ove

244、rall TAY population is diverse with 21 percent Black Non-Hispanic,33 percent Hispanic,and 26 percent White Non-Hispanic.In the Bronx,the TAY population is predominantly Hispanic(58 percent),while Brooklyn has a more balanced demographic with 27 percent Black Non-Hispanic and 31 percent White Non-His

245、panic.Manhattan features a higher proportion of White Non-Hispanic youth(40 percent),and Queens has a significant Hispanic population(33 percent)alongside a diverse mix of other races.Staten Island stands out with a majority White Non-Hispanic population(49 per-cent).These demographic differences hi

246、ghlight the varied cultural landscape across the boroughs,influenc-ing the need for tailored programs and services.We identified 354 programs,services,and supports distributed throughout New York Citys boroughs(Table 4.8).Manhattan stands out with a higher proportion of facilities and programs,compr

247、ising 27 percent of the total despite having only 19 percent of the TAY population,which is predominantly 12 percent Black Non-Hispanic and 27 percent Hispanic.Conversely,Queens,with 26 percent of the TAY population,has only 16 percent of the programs,reflecting its diverse demographic of 17 percent

248、 Black Non-Hispanic and 33 per-cent Hispanic.The Bronx and Brooklyn show relatively balanced distributions between their TAY popula-tions and program availability,while Staten Island maintains a close alignment between its TAY population and programs.These findings highlight potential areas for impr

249、ovement,particularly in Queens,to ensure equitable access to services for all TAY across the boroughs.New York City has an estimated total of 31.51 programs per 100,000 TAY(Table 4.9).Breastfeeding and nutrition education programs are the most prevalent,with a rate of 10.06,followed by benefit progr

250、ams at 8.37.Like the other geographies,WIC is included in both categories.Home-visiting programs are moderately available,with a rate of 4.99,and include such evidence-based models as Nurse Family Partnership,Healthy Families,and Early Head Start programs,as well as independent programs.In contrast,

251、care coordination and case management is notably limited,with a rate of just 0.45.Reproductive care and group prenatal care also have low rates,at 0.80 and 0.53,respectively.Community-based doula programs and behavioral health treatment programs are present,with rates of 1.69 and 2.14.Overall,the sc

252、arcity of reproductive care,group prenatal care,and care coordination services suggests a potential area for enhancement to better support the needs of expectant TAY in New York City.TABLE 4.7Demographic Characteristics of Population Aged 15 to 24 Years,by Geography in New York CityGeographyTotal Po

253、pulationPercentage FemalePercentage Black Non-HispanicPercentage HispanicPercentage Other RacePercentage White Non-HispanicNew York City1,123,3305121332126Bronx212,18849275888Brooklyn(Kings County)347,2745027221931Manhattan(New York County)212,6165612272140Queens 287,7744917333317Staten Island(Richm

254、ond County)63,4784811251549SOURCE:Features April 1,2010,to July 1,2020,data from U.S.Bureau of the Census,20102020.NOTE:Census data are available for the 15-to 24-year-old age group,which largely overlaps with the 14-to 26-year-old age range for TAY.The Other Race category includes American Indian o

255、r Alaskan Native alone,Asian alone,Native Hawaiian and Other Pacific Islander alone,some Other Race alone,and population of two or more races.Programming Gaps and Opportunities for Expectant Transition-Age Youth in Foster Care in Three Geographies25Figure 4.3 shows the distribution of programs for p

256、regnancy in New York City.Programs are concen-trated in Manhattan and parts of the Bronx.In Manhattan,we found representation across all the program types.In contrast,we found no reproductive care programs in the Bronx and Staten Island and little or no group prenatal care,care coordination and case

257、 management,and community-based doula programs in those boroughs.In Queens,we were not able to locate group prenatal care and care coordination and case management and found little reproductive care,prenatal education,and community-based doula programs.For Brooklyn,we did not find any group prenatal

258、 care or community-based doula programs and found little care coordination and case management.Overall,the distribution of pregnancy-related programs in New York City shows significant disparities;certain boroughs have more comprehensive services than others.TABLE 4.8Programs,Services,and Support fo

259、r Pregnancy in New York CityBorough(County)Percentage of TAY Population in County (n=1,123,330)Percentage of Programs in County (n=354)Bronx1921Brooklyn(Kings County)3129Manhattan(New York County)1927Queens 2616Staten Island(Richmond County)68SOURCE:Features April 1,2010,to July 1,2020,data from U.S

260、.Bureau of the Census,20102020.NOTE:In these data,TAY is defined as those 15 to 24 years of age.TABLE 4.9Programs per 100,000 TAY in New York CityProgram TypeNumber of ProgramsRate per 100,000 TAYReproductive care90.80Group prenatal care60.53Care coordination and case management50.45Community-based

261、doula program561.69Home visiting program284.99Prenatal education program282.49Breastfeeding and nutrition education program11310.06Behavioral health treatment program242.14Benefit program948.37Total35431.51A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth26FIGURE 4

262、.3Mapping of Programs,Services,and Supports for Pregnancy in New York CityMount VernonValley StreamLong BPatersonCliftonBloomfeldOrangeNewarkManhattanQueensNew YorkBrooklynStaten IslandabethEWR78952784959580695JFKThe BronxGateway NationalRecreation AreaReproductive careGroup prenatal careCare coordi

263、nation/case managementCommunity-based doula programHome visiting programPrenatal education programBehavioral health treatment programBeneft programBreastfeeding/nutrition education programBOX 4.3Pregnancy-Related Resources in New Yorks New York City Area Health Information Tool for Empowerment New Y

264、ork City Office of Health New York City 988 Suicide and Crisis Lifeline Maternal and Infant Community Health Collaboratives,New York State Department of Health Pregnant or Parenting Families,New York State Department of Health Public Health Solutions Programming Gaps and Opportunities for Expectant

265、Transition-Age Youth in Foster Care in Three Geographies27Distribution of Programs,Services,and Supports for Pregnancy Across the Three GeographiesA look at the distribution of programs,services,and support for pregnancy across the Atlanta Metro Area,Los Angeles County,and New York City reveals dist

266、inct patterns and differences(Table 4.10).Atlanta has a higher proportion of reproductive care,group prenatal care,and benefit programs compared with the overall distribution across all geographies.However,it offers fewer prenatal and breastfeeding and nutrition educa-tion programs.Los Angeles Count

267、y stands out with relatively more prenatal education programs but has a lower percentage of benefit programs.New York City shows a strong presence of home-visiting and benefit programs,yet it lags in prenatal education offerings.These variations highlight regional priorities and poten-tial gaps in s

268、ervice provision,reflecting differing needs and resource allocations across the three geographies.Using these findings,we offer several recommendations to improve the availability of programs,services,and support for expectant TAY.In Atlanta,we recommend increasing the availability of proven or prom

269、is-ing prenatal and breastfeeding and nutrition education programs that could address existing gaps and better support TAY.Los Angeles County might benefit from expanding benefit programs to provide more compre-hensive support.For New York City,enhancing evidence-based prenatal education offerings c

270、ould comple-ment the existing strong presence of home-visiting and benefit programs.Overall,a balanced approach that considers the specific needs and existing strengths of each geography can lead to more equitable and effective support for TAY across these regions.TABLE 4.10Percentage of Programs,Se

271、rvices,and Supports for Pregnancy by GeographyProgram TypePrograms Across All GeographiesPrograms in Atlanta Metro AreaPrograms in Los Angeles CountyPrograms in New York CityReproductive care41533Group prenatal care2912Care coordination and case management3441Community-based doula program2115Home vi

272、siting program119916Prenatal education program2417328Breastfeeding and nutrition education program33183632Behavioral health treatment program84107Benefit program1223427SOURCE:Features April 1,2010,to July 1,2020,data from U.S.Bureau of the Census,20102020.A Guide to Effective Strategies for Supporti

273、ng Expectant Transition-Age Foster Youth28BOX 4.4Additional Pregnancy-Related Resources Association of Maternal and Child Health Programs Maternal and Child Health Innovations Database CenteringPregnancy Program Locator Child Welfare Information Gateway Head Start Center Locator Health Resources and

274、 Services Administrations Home Visiting Locator Healthy Families America Site Finder Healthy Start Grant Awards La Leche League Locator Nurse-Family Partnership Program Locator Parents as Teachers Program Locator Planned Parenthood Sexual and Reproductive Health Resource Explorer Special Supplementa

275、l Nutrition Program for Women,Infants,and Children 29CHAPTER 5Key Features of Existing Perinatal Programs in Los Angeles CountyIn this section,we provide a more detailed look at the existing landscape of programs,services,and supports for expectant TAY in Los Angeles County.We selected Los Angeles C

276、ounty in collaboration with the Conrad Hilton Foundation for this more in-depth look at existing services because this is one of the key investment areas.This case study included interviews with service providers and focus groups with new or expectant TAY.Through these interviews and focus group dis

277、cussions,we aimed to learn how TAY access and engage in perinatal programs,services,and supports.Specifically,we inquired about service availability,interac-tions between care providers,pathways to access care,facilitators,barriers and potential solutions to access to care,the quality of care,and th

278、e effects of the coronavirus disease 2019(COVID-19)pandemic on service availability and accessibility.Through our system mapping of programs,services,and supports for pregnancy,we developed the fol-lowing three categories to characterize organizations providing services to expectant TAY in Los Angel

279、es County:1.nonprofit organizations offering perinatal services for all ages,including TAY or TAY in foster care clients2.nonprofit organizations offering perinatal services aimed specifically at expectant TAY or TAY in foster care clients3.government-led perinatal services for all ages,TAY,or TAY i

280、n foster care clients.These categories guided our selection of organizations for interviews,ensuring a comprehensive under-standing of the diverse programmatic approaches to caring for expectant TAY.We also only sought to include organizations that provided the different types of programs,services,a

281、nd supports identified in our litera-ture review,including health care,behavioral health care,and health promotion and education.(See Appen-dix A for more details on our approach for this case study.)Perspectives from Service ProvidersService Provider Profiles We conducted interviews with staff from

282、 20 organizations or programs across Los Angeles County that pro-vide perinatal services,including specialized programs for expectant TAY or TAY in foster care.Typically,interviews involved a single staff member identified as best suited to discuss perinatal services for TAY or TAY in foster care cl

283、ients.However,some organizations included multiple staff members;the largest group comprised seven individuals.In total,we spoke with 32 professionals,half of whom held management roles,such as executive directors and program managers.Over one-quarter of participants were social workers,half of whom

284、 were licensed clinical social workers.Other roles included nurses,medical assistants,doulas,A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth30home visitors,substance use disorder counselors,community outreach workers,case workers,family advo-cates,and teen parent

285、ing specialists.The qualitative themes discussed below were analyzed at the organiza-tional level rather than the individual participant level.Our interviews encompassed the following:six nonprofit organizations offering general perinatal services for all ages ten nonprofit organizations providing p

286、erinatal services for TAY and TAY in foster care clients four government-funded perinatal programs serving all ages,TAY,or TAY in foster care.Notably,95 percent(n=19)of these service providers identified TAY as a key client group and 60 percent(n=12)prioritized serving foster youth or former foster

287、youth.Most service providers(75 percent,or n=15)operated county-wide without restrictions to specific cities or SPAs.The remaining 25 percent(n=5)were limited to the respective SPAs in which they were located.Figure 5.1 illustrates locations of these service pro-viders throughout Los Angeles County.

288、Although we reached out to organizations in all eight SPAs,we were not able to conduct interviews in every area due to non-response from some service providers.Table 5.1 provides an overview of the types of programs,services,or supports offered by the three categories of organizations.Care coordinat

289、ion and case management are the most commonly provided services across all categories out of 20 organizations,highlighting the importance of these services in sup-FIGURE 5.1Mapping of Service Providers Included in Los Angeles County Case StudySanta ClaritaSimi ValleyThousand OaksEI MonteSanGabrielMo

290、untainsAnaheimSanta AnaOHuntingtonBeachLong BeachSPA 8SPA 7SPA 6SPA 3SPA 5SPA 2SPA 4SPA 1Redondo BeachSanta MonicaLos AngelesLakePalmdale141262102LancasterAnteloAntelopeValleyService provider interviewService provider interview and TAY focus groupKey Features of Existing Perinatal Programs in Los An

291、geles County31porting expectant youth.General prenatal services and prenatal services for TAY and TAY in foster care frequently include basic needs provision and housing support,with a notable emphasis on addressing the immediate necessities of expectant parents and their families.Government-led ser

292、vices show a focus on breastfeeding and nutrition education,group prenatal care,prenatal education,and home visiting,reflect-ing public health priorities.Our thematic findings,based on insights from service providers,are organized into two main sections:presenting needs and access to care and barrie

293、rs to care.Each section highlights critical issues and poten-tial opportunities for improvements within the system of care for expectant TAY and foster youth in Los Angeles County.Presenting Needs and Access to CareService providers in Los Angeles County identified several critical needs for expecta

294、nt and foster TAY,including housing,mental health services,basic needs related to pregnancy and parenthood(such as diapers,clothes,and baby supplies),child care,and transportation.They reported facing challenges when connect-ing clients to such services as emergency and affordable permanent housing,

295、mental health services for such issues as perinatal and postpartum depression and anxiety,affordable child care,and reliable transportation.TABLE 5.1Programs,Services,and Supports Provided by the Organizations InterviewedType of Program,Service,or SupportGeneral Perinatal ServicesPerinatal Services

296、for TAY or TAY in Foster CareGovernment-Funded Perinatal ServicesHealth careReproductive care3(15%)1(5%)0(0%)Group prenatal care2(10%)0(0%)2(10%)Care coordination and case management6(30%)10(50%)4(20%)Health promotion and educationCommunity-based doula care2(10%)0(0%)1(5%)Home visiting3(15%)2(10%)2(

297、10%)Prenatal education5(25%)1(5%)2(10%)Breastfeeding and nutrition education5(25%)2(10%)3(15%)Behavioral health careBehavioral health treatment1(5%)0(0%)1(5%)Substance use or alcohol use treatment1(5%)0(0%)0(0%)OtherHousing for expectant parents4(20%)3(15%)0(0%)Basic needs for expectant parents and

298、infants4(20%)4(20%)1(5%)Other services4(20%)9(45%)2(10%)NOTE:The Other category added here(to our three overarching perinatal service categories of health care,health promotion and education,and behavioral health care)highlights services that were not in our original list of perinatal services but w

299、ere often offered to by expectant TAY and TAY in foster care by the interviewed organizations.The other services subcategory refers to nonperinatal services,such as emergency financial assistance,legal advocacy,or legal representation that were specifically offered to expectant TAY and TAY in foster

300、 care by interviewed service providers.A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth32Pregnancy and parenting basic needs.Various service providers reported that most of their clients pres-ent with basic needs typical during pregnancy and the early years of par

301、enting,such as diapers,formula,clothes,and infant equipment(cribs,strollers,and car seats).Many service providers were able to meet the need for such necessities as diapers,clothes,and baby supplies through a partnership with Baby2Baby,a national nonprofit organization that supports families with ch

302、ildren living in poverty or through personal donations from funders and supporters.A few organizations had other community partners or funders sup-port their efforts to provide these needed supplies.Although community partners and funders help these organizations provide much needed supplies to expe

303、ctant TAY and TAY in foster care,service providers pointed out that the demand always exceeds the supply,especially for such larger items as cribs and strollers:I would say like the primary service or request that our moms have is groceries and food or being con-nected with organizations that can fu

304、lfill those regular needs.Connecting them with organizations that can help them is a challenge.we try to offset that by providing them diapers and wipes.You know,if they dont have to spend on diapers,wipes and formula,then theyll have extra money for groceries and for gas and items like that.It is o

305、ne of the things that I encounter the most.For pregnant moms,in particular,theres always a need for formula,diapers,wipes,and baby hygiene prod-ucts.If they dont enroll in our program,which is our“Earn While You Learn”program where they get points for every class they complete with us,we have to ref

306、er them out to community partners that provide resources.We do have instances where we give out diapers and formula on an emergency basis,but thats only a one-time thing.Its not a continual thing because they have to enroll in our parenting classes to get those free services.Housing needs.Expectant

307、TAY and TAY in foster care often require rapid and long-term housing solu-tions,but there are a lack of available options and strict eligibility requirements that must be met to qualify for housing services.This urgency is exacerbated by long wait times,which can dramatically impact clients lives.So

308、me service providers highlight these issues as follows:I would say housing and mental health specifically because theres generally such an urgent need.Its even more highlighted when theres a long wait because it impacts the client so dramatically whether they have it or not.For the more subsidiary s

309、upportive services,its not generally a dire crisis if they dont have it.But housing and mental health really are.Their life can come apart if those things dont happen in the time-frame they are dependent on.Those are two of the biggest for sure.One type of service where that happens often more than

310、others is housing.Yeah,housing is like number one,so its very frustrating and sometimes we have to exhaust some of our resources to help with that tran-sition for people because we dont want any of our participants on the street.Theres also a need for emergency housing for pregnant and parenting you

311、th because we get a lot of referrals where people who are fleeing domestic violence but dont want to go to a domestic violence shelter.Mental health services.Access to general mental health services is hindered by long wait lists,and there is a notable lack of specialty perinatal programs and Spanis

312、h-speaking providers.This is particularly chal-lenging for Latina women experiencing postpartum and perinatal depression and anxiety.Ive reached out to so many women,especially those that are Latina,who are behavioral health specialists,and theyre just so busy with waiting lists,especially with the

313、pandemic.They have no capacity to see any of our moms.We see our women experiencing postpartum depression,perinatal depression,and anxiety.Its huge.Key Features of Existing Perinatal Programs in Los Angeles County33Ive experienced barriers getting mental health services out here because if you dont

314、have Medi-Cal,its hard to get mental health services due to the high costs.Mental health,Id love to refer as much as I could,but everybody has a waiting list,including our clinic.Its like four to six months.Child care and transportation.These services are essential as they act as a bridge to other s

315、ervices but are often hard to access.The pandemic further reduced child care availability,impacting young parents ability to return to school or work.Additionally,transportation challenges are prevalent;some organizations use their own budgets to provide transportation support:Lack of availability f

316、or child care.The pandemic did horrible damage to availability of the child care and that could cause a problem with getting back to school.Lets say theyre 17 and they want to go back to school,but their current caregiver doesnt want to provide child care for the baby.Getting from point A to point B

317、 is very difficult.Another thing that we do is,once the student has delivered and is thinking of coming back to school,making sure that they have a daycare where they can take their kids.A lot of times,what prevents the stu-dent going back to school is that they dont have a daycare.Transportation is

318、 a barrier.Also,a waitlist for child care.that is a big one.especially when they first give birth,they do not have a lot of support networks.Barriers to CareSeveral significant barriers to accessing services for expectant TAY and TAY in foster care in Los Ange-les County have been identified using i

319、nsights from service providers.These barriers are multifaceted and deeply affect the ability of TAY to engage with necessary services effectively.The service providers high-lighted five primary themes:service navigation,fear and distrust,low-quality health care,accessing services,and pandemic-relate

320、d challenges.Service navigation.Expectant TAY often find themselves overwhelmed by the number of service provid-ers and the complexity of navigating available resources.This can lead to unresponsiveness and difficulty in engaging with the necessary support systems.Service providers also described ho

321、w the communication preferences of TAY,such as a preference for text messaging over phone calls,further complicate interactions with service providers:It can be overwhelming.And then especially for the foster youth or the youth that are transitioning out,they have resources available to them,but it

322、sometimes is a little bit hard to navigate or to understand what they have available to them.I think there are a lot of people who are trying to support young parenting youth,and oftentimes I think its overwhelming for them.On top of school counselors and other things.And so oftentimes I think they

323、can feel overwhelmed and theyre like,OK,whos trying to talk to me about what?A client can get so frustrated that they dont want the offered service anymore.Our girls,by nature of their trauma and lived experience,are very impulsive and want things done quickly.Its understandable for their age and de

324、velopmental range.Fear and distrust.Many expectant TAY,particularly those who are current or former foster youth,harbor fear and distrust toward service providers because of past negative experiences.These experiences may include interactions with law enforcement,child protective services,or nonprof

325、it organizations that A Guide to Effective Strategies for Supporting Expectant Transition-Age Foster Youth34have led to feelings of stigmatization and discrimination.Such distrust creates a significant barrier because TAY may be reluctant to seek help or accept support,fearing additional system invo

326、lvement:Theyve learned through life experience that the more professionals involved,the higher the risk of system involvement.Our girls are raising their babies surrounded by 40 mandated reporters every day,and thats an intense level of stress that most parents dont have to live with.A lot of times

327、its the trust.it takes them a while to trust me to come into their homes.I need to start meeting them at school and once they start getting more comfortable and seeing that Im there to assist them,then they will allow me to come into their home and meet the rest of the family.Trust is a huge issue.O

328、versurveillance and this valid distrust that becomes this vicious cycle because its kind of scary to reach out for help and accept support,if you think theyre going to break up your family.Low-quality health care.Service providers noted that expectant TAY often face low-quality care in health care s

329、ettings,which can discourage them from receiving ongoing prenatal care.Such issues as a lack of trauma-informed care,biases against certain populations,and dismissive attitudes from medical provid-ers contribute to this problem.These experiences can lead to expectant TAY avoiding medical appointment

330、s,which poses significant risks to their health and well-being:I spoke to one lady a couple of weeks ago who said she only had a couple of prenatal visits in the beginning.It was such an unpleasant experience that she just waited until it was time to have the baby and went to the hospital.One big ba

331、rrier Im noticing,especially with our population,is the lack of trauma-informed care with pro-fessionals,whether its in the hospital setting,a doctors office,or specialty ultrasound.They dont under-stand how to respond to the trauma responses that the girls will get triggered by.I do feel like the m

332、edical providers dont take my clients seriously because of the population I work with.Its all Hispanic,so theres an internal bias.My clients might not speak English fluently,so they arent taken seriously.Anytime theyre dealing with the Department of Children and Family Services or doctors,you can se

333、e that bias.When I step in as a professional,they change their behavior.Accessing services.The lack of services close to home,lengthy wait times,and complicated eligibility requirements are particularly discouraging for expectant TAY and foster youth,especially in rural areas of Los Angeles County.These barriers are prevalent in accessing prenatal care,mental health services,and housing support.Th