Generations

Developers
Tina Cheng, MD, Johns Hopkins University; Amy Lewin, PsyD, School of Public Health, University of Maryland, College Park; Tininka Rahman, MS, Children’s National Health System; Stacy Hodgkinson, PhD, Children’s National Health System; Lee Beers, MD, Children’s National Health System; Kristine Schmitz, MD, Children’s National Health System.
Program Summary
Generations is a family-centered medical home program that provides integrated medical care, including pregnancy prevention, mental health care, and social work services for teen parent families. Teen parents and their children receive care from the same medical provider, often in the same visit. Additionally, families receive comprehensive support, including primary care, social work services, mental health and developmental screenings, and mental health services if needed, all at the same medical facility. The program aims to improve mental and physical health outcomes for teen parents and their children, and to reduce repeat pregnancies.
Intended Population
The Generations program was designed for teen mothers, aged 19 or younger, and their children. The program was evaluated with teen mothers who were an average age of 18 at the one-year follow-up.
Program Setting

The Generations program was designed to be delivered in a primary-care setting. The program was evaluated in community-based primary health care clinics serving a largely urban, low-income, African American population.

Contact and Availability Information
Tininka Rahman, Director of Operations, Generations, Children’s National Health System 111 Michigan Avenue, NW, Washington, DC 20010, (202) 476-5794, email: trahman@childrensnational.org
Tininka Rahman, Director of Operations, Generations, Children’s National Health System 111 Michigan Avenue, NW, Washington, DC 20010, (202) 476-5794, email: trahman@childrensnational.org
Sample of curriculum available for review prior to purchase
Yes
Adaptation guidelines or kit available
No
Languages available
English
Program Core Components
Category Component Core Component Component present Notes Lesson number(s) / activities where present
Content School engagement No
Content Anatomy/physiology No
Content Other No
Content Volunteering/civic engagement No
Content Spirituality No
Content Morals/values No
Content Identity development No
Content Social support/capital No
Content Social influence/actual vs. perceived social norms No
Content Social competence No
Content Parenting skills No
Content Normative beliefs No
Content Leadership No
Content Gender roles No
Content Gender identity No
Content Cultural values No
Content Connections with trusted adults No
Content Conflict resolution/social problem solving No
Content Communication skills No
Content Child development No
Content Boundary setting/refusal skills No
Content Substance use cessation No
Content Substance use - Other drugs No
Content Substance use - Alcohol No
Content Substance use - Abstinence No
Content Brain development and substance use No
Content Vocational/skills training No
Content Supplemental academic services No
Content Graduating from high school Yes Yes (both versions)
Content College preparation No
Content Alternative schooling No
Content Self-regulation No
Content Self-esteem No
Content Self-efficacy/empowerment No
Content Resilience No
Content Sexual health No
Content STIs - Treatment Yes Yes (both versions)
Content STIs - Screening Yes Yes (both versions)
Content STIs - Prevention No Yes (both versions)
Content STIs - Information No Yes (both versions)
Content Sexual risk reduction Yes Yes (both versions)
Content Sexual risk discontinuation No
Content Sexual risk avoidance No
Content Personal vulnerability No
Content Maternal health Yes Yes (both versions)
Content Contraception - Condoms Yes Yes (both versions)
Content Contraception - Long-acting reversible contraceptives Yes Yes (both versions)
Content Contraception - Other Yes Yes (both versions)
Content Contraception - Pills, patches, rings, and shots Yes Yes (both versions)
Content Reproduction No
Program Objectives
The Generations Program aims to provide comprehensive medical care and support for young parents and their children. The goals of the program are to prevent repeat pregnancies and strengthen the mental and physical health and well-being of teen parent families.
Program Content

The Generations program is a multidisciplinary, family-centered, integrated model of health care service delivery for teen parents and children within the primary care setting. There are three primary components of the Generations program:

  1. Well Woman/Well Child Care: where teen mothers, fathers, and their child(ren) receive medical care from the same provider, in the same setting, and during the same medical visit (e.g., a mother can receive reproductive health services when she brings her child for a well-child visit).
  2. Intensive Social Work Services: Each teen parent family is assigned a social worker who supports the family, and provides services during medical visits and between visits as needed. The social worker conducts needs assessments and addresses the many social determinants that are often barriers to health among teen parents.
  3. Mental Health Screening and Treatment: Every teen parent undergoes a battery of mental health screenings to address a range of psychological concerns, including mood, trauma, and interpersonal violence exposure. These screenings, as well as developmental and behavioral health screening of  their children, are conducted as a routine part of medical care. Brief and long-term mental health treatment, parent coaching and support, are provided by licensed social workers and psychologists on staff as needed.
Program Methods
The Generations program is not a curriculum-based intervention. The Generations program offers services at a family-centered clinic, through regular medical check-ups for both the child and mother in the same visit. Comprehensive social work services and mental health screening and treatment are provided at the same medical clinic both during and between medical visits as needed. 
Program Structure and Timeline
The Generations program is a family-centered medical home model, designed to provide integrated pediatric care, reproductive health care, mental health care, and social work services to teen parent families. Program entry is typically soon after an infant is born, and program services for a family until the teen parent’s 22nd birthday. Participants have appointments every two to 12 months depending on the age of their child. Both parents and their children receive preventive health care at the recommended Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) intervals. In addition, the program is designed to provide individualized services to adolescent-headed families beyond the recommended preventive care as determined by individual family needs assessments.
Staffing
The Generations Model is ideal for health care settings where multidisciplinary services can be integrated and co-located. The following staff positions and credentials are necessary to implement the Generations program, but the number of staff members needed will vary based on the size of the setting and patient population: (1) one or more medical providers, which can be physicians and/or nurse practitioners; (2) one or more clinically licensed social workers; (3) one or more mental health providers, which can be licensed psychologists (preferred) or licensed social workers; (4) a fathers counselor is optional but is beneficial if programs intend to provide services to young fathers.
Program Materials and Resources
Generations utilizes an electronic medical record system and separate program database to collect and store patient assessments, screens, and provider contact. These systems are reviewed monthly and process data are discussed during monthly multidisciplinary meetings. Patient outcomes are monitored with an outcome evaluation tool administered annually to participants.
Additional Needs for Implementation
Generations needs to be delivered in an integrated care setting, where the family of the teen mother has access to multiple providers (physicians, social workers, mental health providers) in one location.
Fidelity
Fidelity of implementation is typically assessed through review of electronic medical records data. However, this can be adapted for organizations that don’t have adequate EMR capacity. The Generations team will oversee assessment and reporting of fidelity indicators during the early phases of implementation through a process of consultation and reporting.
Staff Training
A two-day onsite training provided by the Generations implementation team is required. The cost of the training will vary depending upon the size and location of the organization, but will be based upon the cost of staff time and travel to the site. Following the two-day training, monthly phone-based consultation will be provided for at least 6 months after implementation.
Technical Assistance and Ongoing Support
Monthly phone-based consultation will be provided following program implementation. Additional phone-based consultation is available as needed.
Allowable Adaptations
Adapting the Generations program can be discussed in consultation with members of the Generations implementation team.
Reviewed Studies
Citation High-Quality Randomized Trial Moderate-Quality Randomized Trial Moderate-Quality Quasi-experiment Low Study Rating Did Not Meet Eligibility Criteria

Lewin et al. 2015

Lewin et al. 2016

Lewin et al. 2019
Study Characteristics
Citation Setting Majority Age Group Majority Racial/Ethnic Group Gender Sample Size

Lewin et al. 2015

Lewin et al. 2016

Lewin et al. 2019

 		Health clinic or medical facility 14 to 17 African American or Black Young women 124
Study Findings

Evidence by Outcome Domain and Study

Citation Sexual Activity Number of Sexual Partners Contraceptive Use STIs or HIV Pregnancy

Lewin et al. 2015

Lewin et al. 2016

Lewin et al. 2019

 		n.a. n.a. Favorable evidence n.a. n.a.
Detailed Findings
Citation Details

Lewin et al. 2015

Lewin et al. 2016

Lewin et al. 2019

 		The study examined the effectiveness of the program using a quasi-experimental design conducted in six community-based primary health care clinics serving primarily urban, low-income, African-American patients in the Washington, D.C., area. The study compared the outcomes of 74 teen-mothers seeking services in three intervention sites that implemented the Generations program with the outcomes of 50 teen mothers seeking services in three comparison sites that did not offer the program but provided standard community-based pediatric primary care. Outcomes were measured 12 and 24 months after baseline.

The study found that 12 months after study enrollment, mothers in the intervention group were more likely to report using effective contraception the last time they had sex. Mothers in the intervention group were also more likely to report using a condom the last time they had sex. Findings at the 24-month follow-up received a low rating because the study did not demonstrate that the treatment and control groups in the sample at this follow-up were sufficiently similar before the introduction of the program.

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample. A blank cell indicates the study did not examine any outcome measures within the particular outcome domain or the findings for the outcome measures within that domain did not meet the review evidence standards.

Information on evidence of effectiveness is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.