A National Strategy to Prevent Teen Pregnancy: Annual Report 1997-98

Introduction

Despite the recent decline in the teen birth rates, teen pregnancy remains a significant problem in this country. It is a problem that impacts nearly every community. Thus, the responsibility to solve this problem lies with all of us, including families, communities, and young people themselves.

The President and Congress called on HHS to develop a National Strategy to address this serious challenge and to assure that at least 25 percent of communities in this country have teen pregnancy prevention programs in place--as mandated under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. The Department responded to this call by releasing a National Strategy to Prevent Teen Pregnancy in January of 1997. This Strategy presented a comprehensive new plan to prevent teen pregnancies in the United States by strengthening, integrating, and supporting teen pregnancy prevention and other youth-related activities in communities across this country.

The Department is required by this law to report to the Congress by June 30^th of each year on progress made with the Strategy. This represents our first Report to the Congress on the National Strategy to Prevent Teen Pregnancy. In this document, we also report that in FY 1997, HHS funded teen pregnancy prevention programs in at least 31% of the communities in the country. This is a conservative number as it only includes HHS funds that flow directly to the communities.

Good News. Statistics and data demonstrate some encouraging trends:

• From 1991 through 1996, HHS reported that teen birth rates declined for white, black, American Indian, Asian or Pacific Islander and Hispanic women ages 15-19.
• The birth rate for black teens demonstrated the largest decline-down a fifth from 1991 to 1996-reaching the lowest birth rate ever reported for blacks.
• Teen birth rates have decreased in every state.
• The teen pregnancy rate has also declined by 8 percent from 1991 to 1994.

Our Charge and the Work Ahead. While these data indicate that concerted efforts to reduce teen pregnancy may be succeeding, we still have a long way to go. The Federal government, the private sector, parents and other caring adults are all helping send the same message:
Don't become a parent until you are truly ready to support a child.

Key Principles. In implementing this National Strategy, we have adhered to and advanced the five principles highlighted in the January 1997 report. According to research and experience, these five principles are essential to community efforts.

The Five Principles

1. Parents and other adult mentors must play key roles in encouraging young adults to avoid early pregnancy and to stay in school.
2. Abstinence and personal responsibility must be the primary messages of prevention programs.
3. Young people must be given clear connections and pathways to college or jobs that give them hope and a reason to stay in school and avoid pregnancy.
4. Public and private-sector partners throughout communities-including parents, schools, business, media, health and human service providers, and religious organizations-must work together to develop comprehensive strategies.
5. Real success requires a sustained commitment to the young person over a long period of time.

Reporting Our Progress. We hope that this annual report-and those that follow-will provide useful information on the efforts of the Department of Health and Human Services. We also hope to complement the efforts of others, such as those of the non-profit National Campaign to Prevent Teen Pregnancy, individual states and communities, foundations, other non-governmental entities, parents, youth, and other caring adults.

Trends in Teen Births & Pregnancies

Declining Teen Birth Rates. According to several reports from HHS's National Center for Health Statistics (NCHS), teen birth rates have decreased nationally and in all states since 1991.

Birth rates for teenagers 15-19 years declined between 1991 and 1996 in all states and the District of Columbia, echoing the national trends during this time. (Declines in three states were not statistically significant.) The reductions in state-specific teen birth rates reflect, and in many cases, exceed those reported for the country as a whole. Between 1991 and 1996:

• The U.S. teen birth rate fell 12 percent.
• Teen birth rates fell by 12 percent or more in 28 states.
• Teen birth rates dropped by 16 percent or more in 13 states.
• Declines in four states exceeded 20 percent.

Trends by Age. Though teenage childbearing patterns differ considerably by age, birth rates for all age groups have declined in the 1990's, partly reversing the 24 percent rise in the overall birth rate from 1986 to 1991.

• The U.S. birth rate for teenagers in 1996 was 54.4 live births per 1,000 women aged 15-19 years, down 4 percent from 1995 and 12 percent from 1991.
• The birth rate for teens aged 15-17 was 13 percent lower than in 1991. Half of the recent decline occurred between 1995 and 1996.
• The birth rate for older teens 18-19 years dropped 9 percent between 1991 and 1996; the decline between 1995 and 1996 was 3 percent.

The figure below illustrates the trends in teenage birth rates from 1980 to 1996, offering a comprehensive picture of the last two decades.

Trends by Race. Birth rates for black teens have dropped sharply. The largest declines, measured by race, since 1991 were black women.

• The overall birth rate for black teenagers 15-19 years fell 21 percent between 1991 and 1996.
• The birth rate for young black teenagers, 15-17 years, declined 23 percent between 1991 and 1996, while the birth rate for older black teenagers, 18-19 years, fell 16 percent.

Despite the sharp decline in the birth rates for black teenagers, their birth rates and the birth rates for Hispanic teenagers remain higher than for other groups. The birth rate for Hispanic teens declined in 1996 after being stable through the early 1990's. The declines among teen women's birth rates are outpacing the declines among birth rates for women of all ages.

Data Collection and Analysis. Accurate and timely reporting of trends and patterns of teen birth rates is based on information reported on the birth certificates for all babies born in the United States. This information is provided by state health departments to the National Center for Health Statistics (NCHS) through the Vital Statistics Cooperative Program. NCHS and the states share the costs for collecting and processing the data.

Teen birth data from the vital statistics system have been reported more quickly in the last year and a half. NCHS has inaugurated a new statistical series, taking advantage of faster data collection and processing at the state level and by NCHS.

The preliminary file provides snapshot information based on a very large sample. Data from the 1996 file, based on 94 percent of U.S. births, were published in September 1997, just nine months after the end of the year. Findings from the preliminary 1995 and 1996 files (published October 1995 and September 1996, respectively) were validated with the final birth file (published in June 1997 and June 1998).

For more information on the collection and analysis of teen birth data, see Appendix I.

Trends in Teen Pregnancies

Declining Teen Pregnancy Rates. The estimated teen pregnancy rate for 1994 is 108 pregnancies per thousand women aged 15-19 years; this reflects an 8 percent decline from 1991.² While this is the most recent national level data, in June 1998, the Centers for Disease Control and Prevention (CDC) issued a report presenting the latest data showing adolescent pregnancy rates by state for 1992-1995. In each of the 42 states (plus District of Columbia) with available data, adolescent pregnancy rates for females aged 15-19 decreased between 1992 and 1995. This report presents the first data to show that fewer teens became pregnant during that time frame. In the same time period, teen abortion rates also declined in 40 of 43 reporting states.

According to the report, pregnancy rates varied widely by state. In 1995, state pregnancy rates ranged from 56 per 1,000 15 to 19-year-old adolescents in North Dakota, to 117 per 1,000 in Nevada. The pregnancy rate in the District of Columbia, also measured in the report, was 230 per 1,000. Decreases in the pregnancy rates ranged from 3 percent in Arkansas to 20 percent in Vermont.

Decreases in teen pregnancy rates were greater among blacks than among whites, although teen pregnancy rates remained higher for blacks than for whites. Pregnancies are estimated as the sum of live births, legally induced abortions, and estimated fetal losses such as spontaneous abortion or stillbirth among adolescents 19 and younger.

States not reporting data to CDC and thus not included in today's report are Alaska, California, Delaware, Florida, Illinois, Iowa, New Hampshire, and Oklahoma. Reporting of these data to CDC is voluntary by states.³

Building Partnerships

Building partnerships is a critical aspect of the Department's National Strategy to Prevent Teen Pregnancy. The Department seeks to build partnerships among all concerned citizens: national, state, and local organizations; schools; health and social services; business; religious institutions; Federal, state, and local governments; tribes and tribal organizations; parents; other family members; and adolescents. Our goal is to build new partnerships that promote communities' efforts to prevent teen pregnancy, and strengthen and broaden existing partnerships. Since the Strategy was released in January 1997, the Department has initiated a broad partnership-building process.

Value. Those involved in the prevention of teen pregnancy, violence, alcohol and drug use, and other complex social problems have recognized the value of involving a variety of community institutions and creatively mobilizing community-wide resources. Many government and private funders interested in reducing duplication, increasing cooperation, and leveraging resources have required collaborative approaches to programs in health and human services, housing, justice, and the environment. Partnerships help pool resources, share risks, and increase efficiency. They also integrate and coordinate services to help build communities.

Challenges. Partnerships, particularly at the community-level, take a long time to establish and require considerable energy to maintain. They demand skilled staffing and support to be managed successfully. Establishing true community consensus on controversial issues is a difficult, time-intensive process. Collaboration is particularly challenging when partners come from different racial, ethnic, linguistic, class and/or educational backgrounds-yet it is exactly this cross-sectional involvement that is the most valuable product of collaboration.

Community Partnerships

HHS is working collaboratively to provide useful information to community members who are working to prevent teen pregnancy. The following are highlights of our efforts to build and strengthen partnerships within communities and provide technical assistance to communities for their own partnership development.

The Teen Pregnancy Prevention Tool-Kit. Together with the National Campaign to Prevent Teen Pregnancy, HHS is preparing a tool-kit for states and communities on teen pregnancy prevention. This tool-kit will:

• Provide readers with practical, relevant advice and program examples that explain and demonstrate how to initiate and strengthen a wide range of teen pregnancy prevention activities.
• Focus on such areas as community organizing, state and local needs, and building long-term support for teen pregnancy prevention through the support of youth, the business sector, the faith community, and others.
• Have a section in each chapter pointing the reader to further resources.

The Teen Pregnancy Prevention Tool-Kit is expected to be completed in late 1998 or early 1999.

Strategy for Boys and Young Men. Another effort is the development of a strategy to disseminate information to state and community leaders on prevention programs for boys and young men. This project will involve:

• Consulting with public officials and representatives of key national organizations to identify information needs.
• Reviewing material on prevention and abstinence programs.
• Developing an information packet for state and local decision makers.
• Testing the information packet and regional roundtable format to disseminate information.

The Office of the Assistant Secretary for Planning and Evaluation (ASPE), the Office of Population Affairs (OPA), and the Agency for Health Care Policy and Research (AHCPR) are collaborating on this project, expected to be completed in late spring of 1999.

Funding Promising Approaches. The Department is funding grants in two areas where partnerships are a critical component. These partnerships are briefly described below; more details about the entire effort are included in the section entitled "Supporting Promising Approaches."

• The Centers for Disease Control and Prevention Community Coalition Partnership Programs for the Prevention of Teen Pregnancy supports demonstration grants for the prevention of teen pregnancies in thirteen communities in eleven states. Coalitions of local public and private agencies and organizations in communities with high rates of teen pregnancy have been working over the last two years, with CDC financial and technical support, to develop community action plans, coordinate efforts to reduce teen pregnancy, identify gaps in current programs and services, target existing resources, and design evaluation plans.
• Girl Neighborhood Power!-Building Bright Futures for Success (GNP) is challenging America's communities to become active partners in assisting 9- to 14-year-old girls to successfully navigate adolescence and achieve maximum potential. GNP, administered by the Health Resources and Services Administration, is implemented nationally by Healthy Mothers, Healthy Babies Coalition (HMHB) and by four community-based partners. (See page 16 for a more detailed description of this effort.)

HHS Partnerships

Along with providing support and information to communities, building and sustaining partnerships is a critical task of the Department. Partnership development is performed throughout the Department, and focuses on many activities related to youth. Highlights of partnership efforts that have occurred over the past year include:

A Working Meeting with National Organizations. This meeting, held on July 29, 1997, sought to strengthen the collective efforts of HHS, other Federal agencies, and national organizations in reducing early childbearing and building real opportunities for youth. In addition to working sessions on the key components of the National Strategy, the day was spent discussing strategic alliances and/or partnerships among multiple sectors. Discussion focused on examples of effective teen pregnancy prevention partnerships and how these partnerships served as useful vehicles for pregnancy prevention activities. Barriers, successful approaches to overcoming these barriers, and sustaining partnerships were also discussed. One workshop helped the partners understand the importance of good, reliable data for evaluating programs and interpreting trends.

Joint Work Group on School-Based Teen Pregnancy Prevention. A group of national, nongovernmental organizations are working together with HHS to explore the role that state and local education and health policymakers, administrators, and school personnel can play in preventing teen pregnancy. These organizations include the American Association of School Administrators (AASA), the Association of State and Territorial Health Officials (ASTHO), the Council of Chief State School Officers (CCSSO), the National Association of State Boards of Education (NASBE), the National Conference of State Legislatures (NCSL), the National Education Association (NEA), and the National School Boards Association (NSBA).

Convened as the Joint Work Group on School-Based Teen Pregnancy Prevention, these organizations seek to develop a coordinated plan to assist their respective constituents to develop and implement pregnancy prevention policies and programs. Currently, Work Group members are coordinating formative research efforts to determine the information and technical assistance needs of state and local board members, health and education chiefs, legislators, administrators and school personnel. The Work Group's effort will also will be informed by current research, and by the work of The National Strategy to Prevent Teen Pregnancy and The National Campaign To Prevent Teen Pregnancy, among others. Financial and technical support for the Work Group is provided by the Centers for Disease Control and Prevention.

The Girl Power! Campaign. This multiple-phase, multimedia, public education campaign is designed to encourage and empower girls between the ages of 9 and 14 to make the most of their lives. Studies show that girls tend to lose self-confidence and self-worth during this pivotal age, becoming less physically active and neglecting their own interests and aspirations. During these years, girls become more vulnerable to negative outside influences and to mixed messages about risky behaviors.

Girl Power! puts the emphasis on providing opportunities for girls to build skills and self-confidence in academics, arts, sports, and other endeavors. The Girl Power! campaign takes a comprehensive approach, addressing not only a range of health issues, but also the erosion of self confidence, motivation, and opportunity that is all too typical for many girls during the transitional period of 9 to 14 years of age. This campaign is designed to assist girls to develop the tools and sense of self to move forward with their lives in a manner that decreases the likelihood that they will participate in behaviors and health practices that might damage their short and long term potentials.

A number of other initiatives across HHS offices have occurred. SAMHSA has developed generic messages and materials for Girl Power! as well as ones specifically directed at substance abuse prevention. In particular, a new public service announcement featuring Olympic gymnast Dominique Dawes was released in May 1998 encouraging young girls to build self-confidence, to keep active, and to make healthy decisions. Girl Power! has already built partnerships with organizations such as the Girl Scouts and has been endorsed by a myriad of nonprofit groups which support the mission of Girl Power!

State and Local Partners. Through its regional offices, HHS has engaged partners at the state and local levels on issues related to adolescents and pregnancy prevention. Several activities at the regional level highlight this role.

• Region VI (Arkansas, Louisiana, New Mexico, Oklahoma, and Texas), together with co-sponsors from the university and medical communities, and the National Campaign on Teen Pregnancy Prevention, held a satellite conference to address the issues of teen pregnancy prevention in the Hispanic community. The focus of the conference was on building community partnerships-local communities identifying and solving problems. The program included topics such as new ideas on teen pregnancy prevention, the role of adults in building a good society for children, statistical information on trends in teen pregnancy, and developing an effective community sanctioned public awareness message.
• Region IV (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) has taken a leadership role in teen pregnancy prevention. In collaboration with the Emory University Regional Training Center, the Region has established a project to assist community-based and community-supported activities that focuses on the reduction of teenage pregnancy rates. This grant program is expected to strengthen the partnerships with traditional family planning clinical service providers within an area. The Region is also enhancing community capacities to develop, direct, and evaluate community projects.
  
  As a supplement to these specific community-based projects, the Region conducts approximately three to four Teen Power workshops per year through various media to large cities throughout the Region, e.g. Columbia, SC, Knoxville, TN, Jackson, MS. These are one-day events with panels of teens, policy makers, public affairs specialists, and local programs and projects engaged in the breadth of issues facing teens.
• Region V (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin) is emphasizing the theme of boys and young men abstaining from sexual activity and postponing fatherhood. This project addresses: the dilemma of unplanned pregnancy; male involvement and child support; the consequences of early childbearing; and public policy and pregnancy prevention. One of this project's first events was a community forum in Chicago where the theme of abstaining from sexual activity and postponing fatherhood was incorporated. Projects and models that address pregnancy prevention were also included. Teen pregnancy prevention workshops were held at the last two annual conferences on runaway and homeless youth.
• Region X (Alaska, Idaho, Oregon, and Washington), together with a private, non-profit organization, co-sponsors an annual conference, Advancing Solutions for Adolescent Pregnancy. This conference draws between 200-300 people. The conference presents workshops on pregnancy prevention for both professionals and teens and includes research, best practices, and presentations by teens.

Supporting Promising Approaches

HHS recognizes that the responsibility to solve the problem of teen pregnancy lies with everyone, including families, communities, and young people themselves. It is important that every community-large or small, urban or rural-works to find solutions to this problem.

Community Programs. The Department of Health and Human Services assured that at least 25 percent of communities had teen pregnancy prevention programs in place-as mandated by section 905 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. This was reported in the National Strategy to Prevent Teen Pregnancy, released in January of 1997. In fact, based on data available at that time, HHS estimated that at least 30 percent of communities had HHS-funded teen pregnancy prevention programs in place in FY 1995.

For this first annual report, the Department prepared estimates of the proportion of communities with HHS-funded programs for fiscal years (FY) 1996 and 1997. In FY 1996, at least 30 percent of communities had teen pregnancy prevention programs in place, and in FY 1997, the proportion increased to at least 31 percent of communities (or 1,470 of 4,752 communities) with programs.

The estimate clearly shows that at least 25 percent of communities had teen pregnancy prevention programs in place. It is a conservative number because it represents HHS-funded programs that flow directly to communities. HHS also supports other teen pregnancy prevention efforts through its various state block grant programs. In addition, there are numerous activities supported by funding sources outside of HHS. Many private and other public-sector agencies are supporting a broad range of prevention activities from life-skills education, school-based curricula and clinics, abstinence education, to family planning. (See Appendix II for more detail about the measurements.)

Highlights of HHS Activities. HHS supports promising approaches to preventing teen pregnancy in a variety of ways. One of our most important roles is providing funds to states and localities to support teen pregnancy prevention programs. HHS is committed to using its resources to strengthen, integrate, and support additional teen pregnancy prevention activities, and other youth-related activities in communities across the country. We will work with our partners to identify additional promising efforts and disseminate information about them to other communities.

State Children's Health Insurance Program (CHIP). One of the most significant accomplishments for this year was the passage of the state Children's Health Insurance Program (CHIP). Established by the Balanced Budget Act of 1997 under Title XXI of the Social Security Act, this new $24 billion program enables states to provide health insurance coverage to uninsured, low-income children. The law allows states to expand coverage for children in three ways: through the Medicaid program, through a separate child health insurance program, or through a combination of these programs. States have the opportunity to involve communities as they design and implement their CHIP programs, allowing new programs, including teen pregnancy prevention programs, to serve as additional sources of services and support for adolescents at risk.

Outreach to inform and enroll those eligible for health insurance coverage under CHIP is a priority for the Health Resources and Services Administration (HRSA) and the Health Care Financing Administration. This initiative should result in increased adolescent enrollment in CHIP, thereby assuring enrolled adolescents' eligibility for a variety of covered services related to pregnancy prevention.

State and Community Program Activities. HHS provides funding to states and communities to support specific program activities. The following are highlights of a number of these activities that have occurred this past year.

• Local Coalitions. Coalitions of local public and private agencies and organizations, with support from CDC through the Community Coalition Partnership Program for the Prevention of Teen Pregnancy, have been working together over the last two years in 13 communities with high rates of teen pregnancy. These coalitions develop community action plans, coordinate efforts to reduce teen pregnancy, identify gaps in current programs and services, target existing resources, and design evaluation plans. Using models developed to reduce teen pregnancy, the community action plans are designed to incorporate each community's needs, assets, values, and expectations regarding youth.
  
  In FY 1997, funding was made available in these communities to help implement and evaluate their action plans. Six of the thirteen communities have received funds to conduct enhanced evaluations of their programs, either by monitoring specific outcome indicators or assessing the impact of a specific intervention undertaken as part of their community action plan. Since these Federal funds are not used for direct service delivery and will be phased out in five years, the communities are also working on financial sustainability plans.
• Girl Neighborhood Power!-Building Bright Futures for Success (GNP). This program is challenging America's communities to become active partners in assisting 9 to 14-year-old girls to successfully navigate adolescence and achieve their maximum potential. The initiative, administered by the Health Resources and Services Administration, strives to combine several elements, including strong "no-use" messages about tobacco, alcohol, and illicit drugs with an emphasis on promoting physical activity, nutrition, abstinence, mental health, social development, and future careers. The approach is designed to enable young girls to become successful adults by exercising responsible reproductive health; achieving gender-specific empowerment; stressing the importance of family, community and volunteerism; and maturing as skilled navigators, safe passengers, and productive citizens.
  
  GNP, funded at $1 million a year, is implemented nationally by Healthy Mothers, Healthy Babies Coalition (HMHB) and by four community-based partners. The communities with funded projects include: York, PA; Rapid City, SD; Memphis, TN; and Madison, WI. Our community partners match the Federal funds. Each community-based grantee shares similar program elements such as before/after school activities, career development, community service, health education, journal writing, and mentoring. Through a variety of creative approaches, each of these sites strives to prevent teen pregnancy and high-risk behaviors, while developing self-esteem.
• Abstinence Only Education Program. This program enables states to provide abstinence education that focuses on young people most likely to bear children out of wedlock. Passed as part of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, the program has a mandatory appropriation of $50 million for each Fiscal Year from 1998 through 2002. Funds were awarded to all states in November 1997, based upon the ratio of low-income children in the state to the total number of children in each state and jurisdiction. States are required to match every four dollars they receive in Federal assistance with three dollars in state funds. The program is administered by the Health Resources and Services Administration.
• Adolescent Family Life Program (AFL). This program supports prevention projects that promote abstinence from sexual activity as the most effective way to prevent adolescent pregnancy. The AFL program also has projects to establish comprehensive and integrated approaches to the delivery of services to pregnant adolescents, adolescent parents, and their children. The AFL program, administered by the Office of Population Affairs, was funded at $14.2 million in FY 1997 (reflecting a $4.5 million increase from FY 1996). Nine million dollars of the total appropriation is being used for prevention grants utilizing the abstinence-only definition contained in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. HHS funded sixty-six projects under this requirement. Another $2.8 million continued support for seventeen previously funded prevention and care projects and $0.7 million supported four research projects.
• Family Planning Program. HHS also provides family planning education, counseling, and clinical services to persons who want them, with priority given to low-income persons. The Title X (of the Public Health Service Act) Family Planning Program, administered by the Office of Population Affairs, has always played an important role in adolescent pregnancy prevention. Approximately 30 percent of the nearly five million persons served each year are under 20 years of age. The program includes counseling to encourage continued postponement of sexual activity for adolescent clients.
  
  Within the Family Planning Program, there have been several, special teen pregnancy prevention initiatives sponsored through our Regional Offices. For example, since FY 1996, all ten HHS regional offices have been supporting demonstration projects in family planning clinics with a focus on the male role in pregnancy prevention. These projects are designed to increase male responsibility with respect to reproductive health and family planning, and to enhance young men's futures through training and employment. Selected clinics employ adolescent males, as well as provide training in various aspects of clinic operation, family planning, and reproductive health education.
• Community-Based Organizations Reaching Young Men. We supported community-based organizations in developing, implementing, and testing approaches for involving young men in family planning education and reproductive health service programs. Despite the data and research showing that young men recognize unintended pregnancy as a serious problem and its prevention as a joint responsibility, experience has shown that drawing them into family planning/reproductive health related information and service programs is difficult. In FY 1998, the Office of Population Affairs awarded ten grants totaling nearly $2 million toward the addition of family planning service and education components to programs where young males already receive other health, education, and social services.

The Department of Health and Human Services will continue to look for ways to assist communities to reach their goals for reducing teen pregnancy and promoting positive and healthy youth development. A complete listing of HHS programs that support youth is listed in Appendix III.

Increasing Opportunities Through Welfare Reform

The Department is addressing teen pregnancy prevention through implementation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). Along with the $50 million allocated to states for abstinence-only education efforts, the law replaced the Aid to Families with Dependent Children (AFDC) program with a new block grant, Temporary Assistance for Needy Families (TANF). Several provisions within TANF target or influence teens, particularly teen parents. These provisions send a clear message to teens that personal responsibility, self-sufficiency, education, and work are priorities-and that welfare assistance is time-limited.

There are two primary provisions under TANF designed to directly impact teen behavior and their access to welfare assistance; in order to receive assistance, teens 1) must stay in school, and 2) must live in an adult supervised setting. While states are required to meet this mandate, there is flexibility in how they design their programs. A summary of state teen parent provisions is included in Appendix IV.

School Attendance Requirement

Under TANF, states may not provide financial assistance to unmarried, minor, custodial parents who do not have a high school diploma or its equivalent unless they are attending school. This provision was included to make clear to young parents that having a child does not release them from responsibility for completing their education; instead, having a child obligates them to complete their education in order to be more self-sufficient, prepared for work, and a responsible parent and role model for their child.

Innovative Approaches. Some states are meeting the school attendance requirement with innovative educational programs that improve academic skills and assist teens in being better parents and decreasing the risk of repeat pregnancies. These approaches, identified in the state plans, include:

Using community-based programs to assist teen parents to achieve education and self-sufficiency goals, including life skills, money management, parenting, nutrition, conflict resolution, interpersonal relationships, and job searching.

• Considering skills training and education directly related to employment and satisfactory attendance in a high school as work activities for teen household heads.
• Requiring minor parents and pregnant teens to complete an Agreement of Mutual Responsibility, which describes the steps the recipient must take to gain self-sufficiency.
• Requiring minor parents to participate in an infant and child wellness program, as well as twenty hours of additional traditional classroom educational activities.

Lessons Learned. Because the new welfare reform law took effect in all states just over a year ago, there is limited information to help us understand how this provision has affected teen parents. However, a recent report, Implementing Welfare Reform Requirements for Teenage Parents: Lessons from Experience in Four States, funded by HHS, synthesizes lessons learned from four states that implemented similar provisions under waiver experiments. This report helps us understand some of the challenges and successes of implementing this and other teen provisions, and provides lessons for future planning.

Several lessons have emerged from the experiences of the four study states in implementing school attendance requirements. Those that impact teen parents include:

• 1. Child care issues are important. Programs must not only insure that child care is available, but also address teenage parents' reluctance to use child care. All state and local offices visited for the study reported that many teenage parents do not like to use formal child care arrangements and prefer to rely on relatives for care. Most teenage parents are not well-informed consumers of child care; thus, they are insecure about judging the quality of care and asserting their rights as consumers.

  2. A range of education options is important for meeting the educational needs of teenage parents. Responsibilities of child-rearing, lack of support from families and friends for their efforts to stay in school, and their own immaturity can all make it difficult for teenage parents to stay in school. Findings also emphasized the importance of establishing a safe atmosphere where teenage parents can meet clear expectations and draw support from staff and peers. Programs providing both educational activities and life skills training, as well as counseling and case management, are helpful for teen parents. Educational activities include GED preparation classes, remedial adult basic education classes, and job readiness and job skills classes. Life skills classes cover such topics as the health and nutrition of the young mother and her child, child development, good parenting skills, and family planning.

  3. Offering GED programs is important. It is useful to offer such programs specifically for public assistance recipients, rather than relying solely on existing GED programs that are designed for other populations. The study found that many at-risk students and school dropouts entered GED programs from alternative high schools.

Living Arrangement Requirement

Another important provision affecting teen parents requires unmarried, minor parents who receive welfare assistance to live with a parent, adult relative, legal guardian, or, with some exceptions, in another approved adult-supervised setting. This provision is designed to ensure that teen parents have appropriate adult support and role models to assist them to be responsible parents. In some cases, states require that the teen parent's assistance be paid not directly to the teen parent, but to an alternative payee, typically the parent, guardian, or other approved adult caregiver.

Exceptions. Although most teen parents do, in fact, live at home with a parent or legal guardian, the legislation does make exceptions for teen parents whose home environment is not conducive to their health and safety or that of their child. The new law describes group homes, in particular Second Chance Homes, for minor parents. It also requires that the state welfare agency provide for or assist minor parents in locating a group home or other alternative adult-supervised setting, when they are unable to live with an adult relative or guardian. These provisions are expected to provide teen parents with the skills they need to become good role models and providers for their children, giving them guidance in parenting, child development, family budgeting, proper health and nutrition, and in avoiding repeat pregnancies. The four-state study cited above revealed, however, that even when group homes are provided, there is limited use of them to date.

Overall, the four-state study found that this requirement should be somewhat flexible and try to preserve any existing living arrangements that are stable and beneficial. If a state imposes a very restrictive living arrangement requirement, it may encounter local agency opposition and other difficulties.

Additional State Incentives

Bonus to Reward Decrease in Illegitimacy Ratio. Welfare reform included certain required provisions affecting teen parents, but it also provided an incentive for states to reduce the number of out-of-wedlock births. The Bonus to Reward Decrease in Illegitimacy Ratio will award bonuses to up to eight states (including Guam, American Samoa, and the Virgin Islands) to reward them for reducing out-of-wedlock childbearing among all women without increases in the abortion rate and encourage the development of new approaches to pregnancy prevention. The bonus will be awarded in FY 1999 contingent on data releases from NCHS. This provision is targeted toward all women, not just teenage mothers; however, in measuring state decreases in out-of-wedlock births, this measure would also include births among unmarried teens. The proposed rule for the bonus was published in the Federal Register on March 2, 1998. The comment period ended on May 1, 1998. HHS is currently in the process of developing a final rule.

This bonus serves as an incentive for states to establish goals and develop a strategy for the reduction of out-of-wedlock births, including births to teens. About one third of the states have reported goals to reduce out-of-wedlock births in their state PRWORA plans. HHS will continue to track state and community-based efforts to provide programs that seek to support teen parents in preventing second births and reduce out-of-wedlock births to teens.

Other Provisions in TANF. TANF included other provisions that are not directly focused on teens, but change resources available to teen parents or may provide new opportunities for teen parents.

• Time Limit. Teen parents who are the heads of households, for instance, will be subject to a 60-month time limit to assistance.
• Child Support. Child support enforcement efforts may affect teen parents. States are also given the option to develop special voluntary paternity procedures for teens. In addition, states are encouraged to require non-custodial teen parents under 18 years of age to "fulfill community work obligations." Another state option allows states to establish "grandparent liability" policies under which child support may be collected from the parent of a non-custodial, minor teen parent.
• Medicaid. A state may terminate Medicaid to recipients of cash assistance who refuse to work, including minor parents who are heads of households.

These changes in welfare may provide incentives for teens to be responsible parents and may also act as deterrents toward becoming a teen parent.

Continued Information Gathering

The lessons learned through waiver demonstrations and early implementation of welfare reform have been disseminated to the states by HHS. The Department has conducted briefings on how the new welfare reform law will impact teen parents, as well as the opportunity it provides to reducing teen pregnancy.

Efforts are being made by the Administration for Children and Families (ACF) to collect additional, more current information from each state on how TANF provisions are being implemented. A plan for collecting this information has been developed and is currently being used in the HHS Regional Offices.

HHS will continue to work with states to capture lessons learned from early experiences implementing the provisions related to school attendance and living arrangement requirements, and other provisions in welfare reform. The Department is committed to gathering this information to find the most successful way to support the needs of teen parents; encourage their development as responsible, educated adults who are prepared to work, be self sufficient, and raise healthy children; and reduce the number of second pregnancies among teen parents.

Research and Evaluation Activities

What the Research Tells Us. In the past year, the Department has supported research related to teen pregnancy that provides or will provide new information regarding the role of:

• Parents,
• Trends in contraception,
• First sexual intercourse,
• Media,
• Youth development programs, and
• How adolescents make decisions.

The Department has also taken steps in developing new demonstration programs and evaluation efforts. Below is a sampling of this work.

Connections Count. Parents play influential roles in their children's sexual behaviors. Connections count, and young people who feel more integrated into their families and communities are less likely to engage in a number of risky behaviors.

According to the National Longitudinal Study of Adolescent Health (AddHealth)⁴, adolescents who report a sense of connection to parents, family, and school, and who have a higher grade point average, are more likely than their peers to delay having sexual intercourse. Adolescents who delay first intercourse are also more likely to have taken a pledge to remain virgins until they are married, and to report that their parents disapprove of their having sex and using contraception. Compared to those who have been pregnant, sexually experienced girls who have not been pregnant are more likely to report being more involved in activities with their parents.

AddHealth is a school-based study of the health-related behaviors of adolescents in grades 7-12. It provides the first comprehensive view of the health and health behaviors of adolescents and the antecedents-personal, interpersonal, familial, and environmental-of these outcomes. Over eighty investigators are using the AddHealth data to examine a wide range of adolescent health risks and behaviors. The research on connection was published in a Fall 1997 article in the Journal of the American Medical Association. AddHealth was funded by the National Institute of Child Health and Human Development and seventeen other Federal agencies.

Adolescent Decision Making. The Department funded the National Academy of Sciences to hold a workshop of national experts to identify the major lessons learned from the last decade of research on adolescent decision making- particularly as they bear on efforts to reduce high-risk behaviors among adolescents. Attendees discussed the results of research on efforts to intervene in adolescent high-risk behaviors, and discussed the implications of this research for alternative approaches to reducing high-risk behavior among the nation's youth, especially in the areas of substance abuse, smoking, and sexuality. A summary of this workshop will be available later this year.

Sexual Activity of Males and Females. There was no increase between 1988 and 1995 in the proportion of male and females ages 15 to 19 who have ever had sexual intercourse. In fact, when data sets for female and male teens are combined, there was a statistically significant decline in this proportion.

Based on data on 15- to 19-year-old teens from the National Survey of Family Growth (NSFG) and the National Survey of Adolescent Males (NSAM), recent research shows that 50 percent of female teens and 55 percent of male teens report they have had sexual intercourse at least once. While the proportion of female teens reporting initiating sexual intercourse before age 15 has risen from 11 percent to 19 percent, current sexual activity-the proportion of teens who have had sex in the last three months-has dropped for female and male teens. Recent analysis shows that although 55 percent of male teens and 50 percent of female teens were categorized as sexually experienced in 1995, the proportion who had intercourse in the last three months was 38 percent for both males and females.⁵

Further research is underway to determine the factors associated with these patterns, including frequency and regularity of sex. NSAM is also looking at the sexual behavior of young men in their twenties, whose partners are likely to be teenagers.

The National Survey of Family Growth (NSFG) is a multipurpose survey based on personal interviews with a national sample of women 15-44 years of age in the civilian, non-institutionalized population of the United States. Its main function is to collect data on factors affecting pregnancy and women's health in the United States. The NSFG is conducted by the National Center for Health Statistics (NCHS). The National Survey of Adolescent Males (NSAM), conducted by the Urban Institute and supported by NICHD, provides unique data on the contraceptive and sexual behavior of males aged fifteen to nineteen, complementing data on teenage women available from the NSFG.

The next NSFG is scheduled for 2000. NCHS, NICHD, OPA, the CDC HIV program, and ACF's Children's Bureau are funding this effort. About 11,800 females ages 15-44 will be interviewed. NCHS plans to increase the size of the sample of females aged 15-19 from 1,400 interviews in 1995 to 2,500 interviews in the year 2000. In addition, if sufficient funds are obtained, 1,600 interviews with males aged 20-24 are planned. Having male and female teens in the same data set is expected to ease the task of analyzing teen sexual experience and contraceptive use.

Trends in Contraceptive Use. According to analysis of the NSFG, the principal trend in contraceptive method choice in 1988-1995 was an increase in condom use, especially among black, Hispanic, or unmarried women who were younger than 25. Use of the condom at first intercourse dramatically increased in the 1980s and 1990s. Furthermore, the increase in condom use was accompanied by a decrease in use of other methods that do not prevent HIV and STDs.

Eight percent of all black teens were using injectable or implant contraception, which are very effective against pregnancy but not against STDs. The use of injectable and implant contraception and the sharp increase in condom use at first intercourse and afterward may explain the decline in the birth rates for black teens.⁶

For white teens, declines in current sexual activity as well as the increases in condom use may be significant factors in declines in birth rates.

Other research from the NSFG identified predictors of inconsistent contraceptive use. While 85 percent of pill users rely solely on the pill, 15 percent also use another method. Overall, 16 percent of users are inconsistent in their pill-taking. Among users of the pill only, Hispanic and non-Hispanic black women have a significantly greater likelihood of inconsistent use, as do those who recently began use and those who have had an unintended pregnancy. For dual method users, the odds are significantly elevated among women whose income is less than 250 percent of the Federal poverty level and among new users. This suggests that service providers may need to better address consistency of pill-taking among women who have characteristics associated with inconsistent use.⁷

Young Women's First Intercourse. Twenty-four percent of women aged 13 or younger at the time of their first premarital intercourse report the experience to have been nonvoluntary, compared with 10 percent of those aged 19-24 at first premarital intercourse. However, researchers have found that women's experiences are more complex than simply voluntary or nonvoluntary. Researchers asked women to rate how much they wanted their first intercourse to occur on a scale of 1-10. Using the NSFG, NCHS and other researchers found that about one-quarter of respondents who reported their first intercourse as voluntary gave a low value to how much they had wanted the experience to occur. Women whose first partner was seven or more years older than themselves were more than twice as likely as those whose first partner was the same age or younger to choose a low value (36 percent vs. 17 percent).

Women whose partner had been seven or more years older were also less likely than other women to have used contraceptives at first intercourse. This important research suggests that measures that take into account degrees of wantedness may help elucidate relationships between sexual initiation, contraceptive use, and teenage pregnancy. This research was conducted by staff at the National Center for Health Statistics and Child Trends, Inc. ⁸

Focusing on Boys and Young Men. The Department is supporting a study to identify abstinence-based pregnancy prevention programs that target boys or both boys and girls. Traditionally, adolescent pregnancy prevention research and programs have focused on adolescent girls. It is becoming increasingly apparent, however, that adolescent boys and young men must share that focus. To date, there is limited information about the abstinence models that exist, especially for boys. Identified programs and teen pregnancy prevention literature will be used to develop a framework to assess the types of programs and their impacts. Information on strategies will be disseminated to state, local and community policy-makers. This project is funded by the Office of the Assistant Secretary for Planning and Evaluation.

Abusive Intimate Relationships Among Adolescents. This study on preventing abusive intimate relationships among adolescents will involve a literature review as well as analysis of data sets concerning adolescent partner violence. Focused discussion groups will include health care providers, experts on adolescents, and teens to identify promising approaches to prevention and intervention concerning abusive adolescent relationships. The study will also identify data needs in this area. This project will be completed in January 1999. It is funded by the Office of the Assistant Secretary for Planning and Evaluation and the Administration for Children and Families.

HHS Support for Evaluation

Learning what approaches have an effect on teen pregnancy and its related antecedents is a critical part of designing effective interventions. Several efforts are underway to expand our knowledge base in this area.

Conducting Evaluations. The Department is responsible for conducting an evaluation of the state abstinence-only education grants described in the Promising Approaches section of this report. The Balanced Budget Act of 1997 set aside funding to evaluate a select number of sites receiving funding from this program.

The evaluation will focus on six sites: five sites will involve random assignment experiments of particular programs and one site will involve a rigorous evaluation of a comprehensive community approach to abstinence-only education. Outcomes of interest will include-but will not be limited to-the four performance measures identified in the Department's program guidance. These four performance measures include the rate of pregnancy to teenagers aged 15 to 17; the proportion of adolescents aged 17 years and younger who engage in sexual intercourse; the incidence of sexually transmitted diseases among youths aged 15 to 19; and the rate of births to teenagers aged 15 to 17. The evaluator will be required to document the activities undertaken by the program, as well as, to the extent possible, other influences on the subjects of the study. This evaluation is being overseen by the Office of the Assistant Secretary for Planning and Evaluation, in partnership with the National Institutes of Child Health and Development, the Health Resources and Services Administration, and the Office of Population Affairs.

Also, the Office of the Assistant Secretary for Planning and Evaluation issued a grant announcement on May 6, 1998, seeking applications for funding to augment existing teen pregnancy prevention program evaluations that are rigorous in design and already have funding. The primary goal of the proposed grants is to further the understanding of teen pregnancy prevention interventions and the extent to which these interventions meet their goal of reducing teen pregnancies. It is anticipated that two to three one-year grants will be awarded with approximately $100,000 to $150,000 for each grant.

Supporting Demonstrations. Demonstration projects are an important tool for learning about innovative interventions and approaches. Several demonstration efforts are described in other parts of this report. For information on the community collaboration projects, see the Promising Approaches section.

The implementation and evaluation of a home visiting initiative targeted to teenage parents on welfare was supported by the Administration for Children and Families (ACF), in partnership with the Henry J. Kaiser Family Foundation. Demonstration activities were intended to: (1) strengthen family life and help AFDC (now TANF) families achieve the maximum self-support consistent with the maintenance of parental care and protection of children; and (2) add to current knowledge regarding the effectiveness of strategies designed to improve social, personal, health, and economic outcomes among welfare-dependent teenage parents and their children. Research findings on early lessons from the Home Visiting Demonstration are expected by fall of 1998 with final impact findings to be available by the end of 1998.

In addition, the Department is supporting an initiative on teen parents and welfare reform that generates knowledge on the effects of welfare reform on parenting teens, and measures the effects of preventive interventions on teen parents and their children. The four objectives in support of this goal are: (1) prevention or reduction of alcohol, tobacco, and drug use; (2) improvement in academic performance; (3) reduction of subsequent pregnancies; and (4) improvement in life skills and general well-being. The Substance Abuse and Mental Health Services Administration (SAMHSA) plans to award approximately nine cooperative agreements later this fiscal year.

Getting the Word Out

While the data, evaluation, and research findings described above are making major contributions to our knowledge base, their value is limited if they are not available to those who can benefit from them. The Department has undertaken several efforts to disseminate and provide access to the research it supports and the data it collects, including:

• At the July 29,1997, Building Partnerships meeting, a session was held on how to use data. Participants included researchers; those involved in teenage pregnancy prevention programs at the national, state, and local level; and representatives from non-profit organizations with programs on teen pregnancy. In addition, NSFG staff have made twelve university presentations to describe their data set and encourage academic and other researchers to use these data.
• Many of the findings described above were presented at professional meetings in a variety of disciplines. Such meetings included the 1997 and 1998 Population Association of America Meetings, the 1997 American Public Health Association Meeting, and meetings of the Society for Research on Adolescence, and the Society for Adolescent Medicine.
• Journals and other scholarly publications are mechanisms to reach wide audiences. A few examples of this include the 1997 article in the Journal of the American Medical Association (JAMA) on the Findings of the AddHealth Study and the January/February 1998 issue of Family Planning Perspectives devoted entirely to articles using the 1995 NSFG.
• The principal investigators for AddHealth gave two well-received Congressional briefings-one for Senate staff and one for House staff in early 1998.
• The Internet is a fast growing resource for information. Many of the aforementioned studies are available on the Internet. The FastStats web site (http://www.cdc.gov/nchswww/faststats/faststats.htm) provides easy information from the vital statistics and the NSFG. The AddHealth web site (http://www.cpc.unc.edu/addhealth) provides a guide to this survey and related research. The YouthInfo web site (http://youth.hhs.gov) provides links to all youth related activities in the Department.

Appendix I. Teenage Birth Rates in the US: National and State Trends, 1990-96

Visist these NCHS sites for details:

Teen Birth Rates Down in All States

Teenage Births in the United States: State Trends, 1991-96, an Update

Appendix II. Measuring the Proportion of Communities With Teen Pregnancy Prevention Programs

Measuring the Proportion of Communities with Teen Pregnancy Prevention Programs

Recent declines in the teen birth rate, and indications of further declines in the teen pregnancy rate, suggest that the numerous public- and private-sector efforts across the country to prevent teen pregnancy are having a positive impact. Measuring all the factors that help adolescents postpone premature sexual activity and avoid pregnancy is difficult, however, since individual, family, and community characteristics are all influential. Nevertheless, measuring the total proportion of communities that have at least one teen pregnancy prevention program in place (estimated by dividing the number of such communities by the number of communities in the United States) provides a rough sense of how many communities are responding to this problem with specific, targeted prevention efforts. In 1995, at least 30 percent of communities had HHS-supported teen pregnancy prevention and related programs.

To develop a sound, albeit conservative, estimate of the proportion of communities with teen pregnancy prevention programs, the estimate includes only those programs supported by the Department of Health and Human Services (HHS). HHS-supported programs that include teen pregnancy prevention services as a component are diverse, ranging from comprehensive health and social services to substance abuse treatment and HIV prevention education. In this report, the number of teen pregnancy prevention programs funded by HHS includes those programs funded in the years FY 1996 and FY 1997 (including the latest year for which complete information on grants awarded is available).

To determine how many communities have at least one program, the location of each program was identified based on the site of the services provided and/or the location of the grant recipient. Any individual community with more than one program was counted only once. The estimate excludes HHS funding provided directly to states (e.g., Medicaid, Maternal and Child Health Block Grant) which states may use to fund activities in multiple communities.

Since there is no single standard definition for community in the United States, the estimate uses a definition of community based on areas identified by the Commerce Department's Bureau of the Census. This definition includes all incorporated places with a population of 10,000 individuals or more (2,673) and all counties where, excluding these incorporated places, the remaining population reaches 10,000 or more (2,079), for a total of 4,752 communities. Under this definition, for example, Montgomery County, Maryland would consist of four communities, including three incorporated places of 10,000 or more inhabitants (Gaithersburg, Rockville, and Takoma Park) and one community representing the balance of the county's population, which exceeds 10,000.

Using the above calculations, the resulting estimate of the proportion of communities in the United States with HHS-supported teen pregnancy prevention and related programs is at least 30 percent for FY 1996 and at least 31 percent for FY 1997. In FY 1996, there were programs in about 1450 communities across the country, and in FY 1997, there were programs in about 1470 communities.

Appendix III. HHS Activities

HHS Activities

The Department of Health and Human Services supports a variety of efforts to help communities develop comprehensive teen pregnancy prevention strategies that reflect five principles: parental and adult involvement, abstinence and personal responsibility, clear strategies for the future, community involvement, and a sustained commitment.

HHS Programs

State Children's Health Insurance Program (CHIP) was established by the Balanced Budget Act of 1997 under Title XXI of the Social Security Act. This program administered by the Health Care Financing Administration (HCFA) and Health Resources and Services Administration (HRSA) enables states to provide health insurance coverage to uninsured targeted low-income children. States have the opportunity to involve communities as they design and implement their CHIP programs so that the new programs may be an additional avenue to provide services to adolescents at risk, including teen pregnancy prevention programs.

The Abstinence Only Education Program was part of the Personal Responsibility and Work Opportunity Act of 1996 to enable states to provide abstinence education through activities such as mentoring, counseling, and adult supervision designed to promote abstinence from sexual activity until marriage. The program, administered by the Health Resources and Services Administration (HRSA), has a mandatory appropriation of $50 million for each Fiscal Year from 1998 through 2002.

The Girl Neighborhood Power! - Building Bright Futures for Success is challenging America's communities to become active partners in assisting 9- to 14-year-old girls to successfully navigate adolescence and achieve maximum potential. The initiative, administered by HRSA, strives to combine several elements including strong "no use" messages about tobacco alcohol, and illicit drugs with an emphasis on physical activity, nutrition, abstinence, mental health, social development, and future careers.

The Center for Disease Control's Community Coalition Partnership Program for the Prevention of Teen Pregnancy supports demonstration grants for the prevention of teen pregnancies in 13 communities in 11 states since 1995. Coalitions of local and public and private agencies and organizations in communities with high rates of teen pregnancy have been working over the last two years to develop community action plans, coordinate efforts to reduce teen pregnancy, identify gaps in current programs and services, target existing resources, and design evaluation plans. CDC, which administers the program, awarded approximately $250,000 per year for two years to 13 communities in 11 states to help these communities mobilize and organize their resources to support effective and sustainable teen pregnancy prevention programs. For FY 1998, a total of $13.7 million was made available to help the 13 community coalition partnerships implement their action plans and evaluate their impact, as well as to support related data collection, evaluation, and dissemination activities.

Reproductive Health and Family Planning Services (under Title X of the Public Health Service Act) are provided to nearly 5 million persons each year, nearly one third of whom are under 20 years of age. Abstinence counseling and education are an important part of the Title X service protocol for adolescent clients. These services are provided by 84 grantees with more than 4,000 clinic locations. These sites offer reproductive health services including pregnancy prevention, family planning, and diagnosis of sexually transmitted diseases, either on site or by referral. The program has also launched an adolescent male initiative called the "Young Men/Family Planning Partnership Training Program." Under this initiative, Title X clinics employ male high school students as interns while also providing training in clinic operation and peer education; assisting in identifying career paths in allied health and related occupations; and increasing their use of services in a family planning setting.

Healthy Schools, Healthy Communities, a Health Resources and Services Administration program created in 1994, has established school-based health centers in 26 communities in 20 states to serve the health and education needs of children and youth at high risk for poor health, teenage pregnancy, and other problems. For the first three years of the program, $1 million each year was provided to fund health education and promotion programs that were coordinated with the health services grants.

The Social Services Block Grant (SSBG) (under Title XX of the Social Security Act) provides funding to prevent, reduce, or eliminate dependency; achieve or maintain self-sufficiency; prevent neglect, abuse, or exploitation of children and adults; prevent or reduce inappropriate institutional care; and provide admission or referral for institutional care when other forms of care are inappropriate. SSBG Grants are made directly to the 50 states, the District of Columbia, Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands to fund social services tailored to meet the needs of individuals and families residing within each jurisdiction.

The Community Services Block Grant, which operates in all 50 states, the District of Columbia, and the territories, enables local community agencies to provide low-income populations, including youth at risk, with job counseling, summer youth employment, GED instruction, crisis hotlines, information and referral to health care, and other services.

The Independent Living Program, run by the Administration for Children and Families, provides funds to states to support activities ranging from educational programs to programs that help young people who are making the transition from foster care to independent living to avoid early parenthood. This program supports activities in all 50 states and the District of Columbia.

Youth Programs including Runaway and Homeless Youth Programs, Transitional Living Programs, and the Youth Sports Program, address a wide range of risk factors for teen pregnancy. Together, these programs operate in 500 communities in 50 states and the District of Columbia.

HRSA's Healthy Start program has 62 projects to reduce infant mortality in the highest-risk areas and to improve the health and well-being of women, infants, and their families. Among a broad array of services provided (including state prenatal hotlines), thousands of teenagers participate in prevention programs exclusively designed for adolescents. The programs encourage healthy lifestyles, youth empowerment, sexual responsibility, conflict resolution, goal setting, and the enhancement of self-esteem.

Maternal and Child Health Services Block Grant (Title V) funds support a variety of adolescent health programs in 57 states and jurisdictions, including adolescent pregnancy prevention programs, state adolescent health coordinators, family planning, technical assistance, and other prevention services.

The Adolescent Family Life Program (AFL), created in 1981, supports research into the causes and consequences of adolescent pregnancy; demonstration projects that provide health, education, and social services to pregnant and parenting adolescents, their children, male partners, and families; and programs aimed at promoting abstinence among pre-adolescents and adolescents as the most effective way of preventing adolescent pregnancies, sexually transmitted diseases, and HIV/AIDS. In FY 1997, the AFL program funded 83 projects in 37 states and the District of Columbia. AFL is administered by the Office of Population Affairs.

Empowerment Zones and Enterprise Communities in 105 rural and urban areas in 43 states and the District of Columbia have been awarded grants to stimulate economic and human development and to coordinate and expand support services. As they implement their strategic plans, some sites are including a focus on teenage pregnancy prevention and youth development.

Health Education in Schools supports the efforts of every state and territorial education agency to implement local school health programs to prevent the spread of HIV and sexually transmitted diseases (STDs). Assistance is also provided to 13 states to build an infrastructure for school health programs. Efforts are targeted at preventing early sexual activity, STDs, HIV, drug and alcohol abuse, tobacco use, and injuries.

Community and Migrant Health Centers, including family and neighborhood health centers, operate in 3,032 community-based sites through 685 center grantees in all 50 states, the District of Columbia, and six territories. The centers provide primary and specialized health and related services to medically-underserved adolescents. Some centers include special hours or clinics for adolescent patients.

Indian Health Service (IHS) provides a full range of medical services for American Indians and Alaska Natives. IHS supports projects targeted at preventing teenage pregnancy, and its prevention and treatment programs also have a special emphasis on youth substance abuse, child abuse, and women's health care.

Drug Treatment and Prevention Programs include services to prevent first time and repeat pregnancies among teenagers. One hundred twenty-two residential substance abuse treatment programs for pregnant and postpartum women, as well as for women with dependent children, receive support to provide family planning, education, and counseling services in 39 states, the District of Columbia, and the Virgin Islands. Also, 25 programs to prevent substance use and other adverse life outcomes serve high-risk female teens in 13 states and the District of Columbia.

Health Care and Promotion under Medicaid provides Medicaid-eligible adolescents under age 21 with access to a comprehensive range of preventive, primary, and specialty services within its Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program.

The Medicaid program also funds family planning services at an enhanced match rate for states. The Federal government pays 90 percent of state expenditures for Medicaid family planning services, while the state funds the remaining 10 percent. The enhanced match encourages states to fund family planning programs which include patient counseling and education concerning pregnancy prevention and reproductive health. Outreach is a priority for HCFA for informing and enrolling those who are eligible for Medicaid as well as those who are not eligible for Medicaid but will be eligible for coverage under the Children's Health Insurance Program (CHIP). This initiative should result in more adolescents being enrolled in Medicaid and CHIP, thereby ensuring access for covered services related to pregnancy prevention.

APPENDIX IV: Teen Parent Provisions (As described in state TANF plans)

Note: State TANF plans vary greatly in their format and in the amount of detail they provide. The fact that a state plan does not discuss a requirement, or does not explicitly refer to exemption criteria, should not be taken to mean that such provisions are not in effect in the state program funded under TANF.

Teen Parent Provisions

State	Living Arrangement Requirements	School Attendance Requirements	Goals for Reductions in Teen and Out-of-Wedlock Births
Ala.	Alabama will continue the ASSETS demonstration provisions regarding the conditions when teen parents are not required to live with a specified relative.	Teen parents must meet work requirement, which for teens who are 16 but not yet 18 includes attending school or its equivalent full-time.	Not specified.
Alaska	Minor parents, defined as individuals under the age of 18 who are not married or emancipated, must live with an adult relative, a legal guardian, or in an approved living arrangement. The adult will receive the minor parent's ATAP payment.	Minor parents without a diploma must meet high school, GED or state-approved alternative education or training requirements. Satisfactory attendance is meeting the school's attendance requirements or by attending GED classes.	Not specified.
Ariz	In order to receive assistance, teen parents must reside with their parent or other responsible adult relative. Based on its waiver, Arizona indicates that it will not provide or assist the teen parent in locating a second-chance home, maternity home, or other appropriate adult-supervised supportive living arrangement.	Teen parents aged 13-16 are required to attend school or participate in another educational program as their work requirement.	Arizona has established the goal of reducing out-of-wedlock births to no more than 37.5% of all births by 2005. Arizona's goal for the under 15 age group is to maintain the birth rate at less than 1 percent; for the 15-17 age group, to lower the birth rate to 3.5 percent; and for the 18-19 age group, to lower the birth rate to 8.5 percent.
Ark.	Unmarried parents under age 18 must reside in a home maintained by a parent, legal guardian or other adult relative unless they meet the specified exemption criteria.	The minor parent program will ensure that participants are enrolled in either basic education or some kind of training, getting basic skills and education or work experience.	Not specified.
Calif.	Pregnant or parenting teens will be required to live at home, with good cause exceptions, if they are to receive financial assistance.	Not specified.	Not specified.
Colo.	Teen parents under age 18 and not married must live with a parent or adult relative or guardian, or in a supervised setting, with exceptions for good cause.	Minor parents who have not completed high school or its equivalent must attend high school, work on a GED, or be in an alternative education or training program approved by the state. Teen parents will be considered satisfactorily attending an educational program unless they have dropped out.	County departments will include in their county plan a provision designed to reduce out-of-wedlock births. Each plan shall have a goal of a reduction of at least 1 percent from the 1995 levels.
Conn.	Minor parents must live with a parent, stepparent or legal guardian, unless they have good cause, even if they have lived apart for a year prior to the birth of the child or application for AFDC. Living with spouse is considered good cause for married minors. If good cause exists, the minor parent must live with other relatives or in a supervised living arrangement if available. Connecticut identifies this as a point of inconsistency between its waiver and TANF. The payment will be made to the adult relative, on behalf of the minor parent and child.	Under Connecticut's waiver, school attendance for minor parents is considered a work participation requirement. The penalty for failure to comply is the same as for any other mandatory participant who fails to comply (increasing sanctions, leading to full-family sanction). Connecticut identifies this as a point of inconsistency between its waiver and TANF.	Goal is to reduce the teen pregnancy rate to 23 births per 1,000 girls aged 10 to 17 by the year 2000.
Del.	Effective October 1, 1999, Delaware will end assistance to teen parents. In lieu thereof, Delaware will provide alternative support services and benefits. The caretaker of a teen parent who is not a parent must demonstrate why the teen is not living with a parent and must agree to be a party to the Contract of Mutual Responsibility and fulfill the same responsibilities thereunder as a parent.	Teenage mothers must stay in school, immunize their children, and participate in parenting education. Note: Delaware indicates that its family cap will apply to children who are the first-born children of teens who are receiving TANF as dependent children.	For the three year period April 1, 1997 to March 31, 2000, Delaware has the following goals: to increase the percentage of adolescents choosing abstinence; to reduce the rate of unintended pregnancies to residents age 15-44 by 3 percent; to reduce the rate of pregnancies to residents under age 15 by 5 percent a year; to reduce the rate of pregnancy for adolescents age 15-19 by 5 percent a year (from the projected rate of 61.64 for FY 96 to 58.59 for FY 97); and to reduce the repeat pregnancy rate among adolescents under age 19.
D.C.	Pregnant or parenting teens who have never been married are eligible for assistance only if the applicant and the applicant's child reside in a residence maintained by the applicant's parent or legal guardian, or in another living arrangement where an adult assumes responsibility for the care and control of the minor parent and dependent child or supportive services are provided. Exceptions are made when the applicant has no living parent or guardian whose whereabouts are known, the applicant has lived apart from her parent or guardian for at least one year before either the birth of the child or the application for assistance, or there is other good cause.	A pregnant or parenting teen shall be required to attend school regularly each semester and experience no more than 10 full school days or 20 half days of unexcused absences in one school semester. The penalty for failure to do so is a $50 reduction in the benefit amount. A pregnant or parenting teen who fails to meet these requirements shall be provided with counseling, tutoring or other supportive services deemed appropriate. These requirements shall not apply to the caretaker of a child under 90 days old.	Not specified.
Fla.	In order for a teen parent and his or her child to be eligible for assistance, the teen parent must reside with a parent, guardian or other adult caretaker relative. The income and resources of the parent will be included in calculating the assistance available to a teen parent. This requirement is waived if the Department determines that the teen parent has suffered or might suffer harm in the home of the parent, guardian or caretaker relative, or that it is not in the best interest of the teen parent or the child to reside there. In that event, the Department shall provide or assist the teen parent in finding an appropriate adult-supervised living arrangement. Temporary assistance may not be paid directly to the teen parent, but must be paid to an alternative payee.	In order for a teen parent and his or her child to be eligible for assistance, the teen parent must attend school or an approved alternative training program, unless the child is less than 12 weeks old or the teen parent has completed high school. The teen parent must also attend parenting and family classes.	Florida sets a target of reducing annual out-of-wedlock births by about 5,000 births and the percentage of out-of-wedlock births by 3 percentage points by 2005.
Ga.	Teen parents will be required to live in an adult-supervised setting unless DHR determines it would be detrimental to the child or parent to impose this requirement.	Minor parents must attend school or other equivalent training program in order to be eligible for assistance.	Not specified.
Hawaii	Hawaii cites as a point of inconsistency between its waiver and TANF that teen heads of household shall be eligible for assistance even if not living in an adult-supervised setting.	Teen parents who lack a high school diploma or GED must participate in appropriate educational activities. Under the waiver terms and conditions, the sanction for noncompliance was the regular JOBS sanction.	Not specified.
Idaho	Unmarried minors with children must live at home with the minor's parents unless good cause exists.	Not specified.	Same as the national Year 2000 objective: to reduce to no more than 30 percent the proportion of all pregnancies that are unintended.
Ill.	Unmarried parents under the age of 18 and their children living with them will be assisted only if residing with their parent or other supervising adult, unless specified exemptions are met. Illinois finds it in the best interest of the minor parent and child to waive this requirement when the minor parent has lived apart from the parent or guardian for at least 1 year before the child's birth or applying for TANF.	Minor parents under 20, married or unmarried, with no child under the age of 12 weeks, may receive assistance only if they have completed high school, have a GED, or are attending school. If not, their children may still receive assistance.	Not specified.
Ind.	Minor parents must live with a parent or other legally responsible guardian, and may only receive assistance as the dependent child of that adult. These provisions do not apply to a minor parent who is married or a high school graduate, or if the minor parent does not have a living parent or guardian, or if her physical health and safety or her child's would be in danger.	Teen parents are subject to the same requirements as other minor children. Continued non-attendance will be sanctioned by a removal of the student's needs from the grant. If the parent does not cooperate in resolving the problem, his or her needs may also be removed from the grant.	Not specified.
Iowa	When the parent of the dependent child is under 18 and never married (or marriage was annulled), the minor parent must live with an adult parent or legal guardian, or establish good cause for not doing so.	Not specified.	Not specified.
Kan.	Not specified.	Not specified.	Not specified.
Ky.	No assistance is available to an unmarried minor parent who does not live in an adult-supervised setting. In the absence of such a setting, a referral will be made to the Department of Social Services to protect the well-being of the minor parent and the child. This requirement may be waived in accordance with 42 USC 608. Teen parents in families already receiving assistance will not be established as separate families for payment.	To participate in K-TAP, teenage parents under age 18 must attend high school or other equivalence programs in accordance with Federal guidelines. Parents of a child under 12 weeks of age will not be penalized for failure to attend school. If the minor parent is denied assistance, protective payments may be made on behalf of the child. As funding permits, incentives will be used to encourage teen parents to stay in school and graduate.	Goals are established to reduce the out-of-wedlock birth rate by 2 percent in each of 1996 and 1997, by 1.5 percent in 1998, and by 1 percent annually from 1999 to 2002.
La.	Minor unmarried parents and their children must, with certain exceptions, reside in the home of the minor's parent, legal guardian, other qualified adult relative, or in a foster home, maternity home or other adult-supervised environment. Where possible, aid will be provided to the parent, guardian or other adult relative on behalf of the minor and dependent child.	Annual participation in a Parenting Skills Training program will be a mandatory requirement for recipients under the age of 20 who have a child. Failure to meet this requirement, without good cause, will result in removal of the parent's needs from the budget group until compliance is demonstrated.	Not specified.
Maine	All minor parents and pregnant women under age 18 must receive benefits as voucher or vendor payments instead of cash payment. Unmarried minor parents must live with parents, other adult relatives, or in an adult-supervised supportive living arrangement unless good cause reasons exist.	Not specified.	The Department plans to reduce the pregnancy rate as follows: for 10-14 year olds, from 0.7 (in 1992) to 0 per 1,000 females for 15-17 year olds, from 37.9 (in 1992) to 30 per 1,000 females for 18-19 year olds, from 101.4 (in 1992) to 80 per 1,000 females by 2005.
Md.	In order to receive assistance, an unmarried parent or pregnant minor must reside in the household of the minor's parents, legal guardian, other adult relative, or in a supportive living arrangement.	In order to receive assistance, teen parents must be in an educational activity directed at the attainment of a high school diploma or its equivalent. Teen parents who have not finished secondary school will not be exempted to care for a child younger than 12 months.	Maryland's goal is to reduce the incidence of out-of-wedlock births by 1 percent by 1997 and to continue to reduce it over time.
Mass.	Parents under the age of 20 must live in the home of a parent or adult relative, or if there is abuse or neglect at home, in a supervised, structured setting, unless they meet the Department's criteria to live independently.	Parents under the age of 20 must have a high school diploma or GED or be in a program to obtain one. Failure of a teen parent to comply with the school/training attendance requirement will be sanctioned by a reduction in the grant by an amount equal to the teen parent's needs, for the first instance. If the noncompliance continues beyond 30 days, and for subsequent instances of noncompliance, the teen parent and his/her child will both be ineligible.	Not specified.
Mich.	A minor parent living with a parent or stepparent may not receive assistance on her own behalf, but must be the dependent child of her parent or stepparent. Minor parents who are not living with a parent, stepparent or legal guardian must be referred to Services for a good cause determination, even if the minor parent and child are living with another adult relative. If the client has good cause, she must live with an adult relative or in an approved adult-supervised living arrangement.	Minor parents who have not completed high school must attend school as a condition of eligibility. Michigan will not deny FIP assistance to a minor parent with a child under the age of 12 weeks for the failure of the minor parent to attend school.	Not specified.
Minn.	Not specified.	Minor caregivers under the age of 20 who have not received a high school diploma or its equivalent will be required to engage in appropriate educational programs.	Not specified.
Miss.	Mississippi will deny TANF benefits to teenage parents not living in an adult-supervised setting without good cause.	Mississippi will deny TANF benefits to teenage parents without a high school education or equivalent who do not attend school or an equivalent training program, without good cause.	Not specified.
Mo.	Teen parents must live with their own parents, an adult relative, or in another adult-supervised supportive living arrangement. Certain exceptions are allowed. Teen parents may establish themselves and their dependent children as a separate assistance unit, and the state will disregard grandparents' income up to 100 percent of the poverty line, if they are not included in the assistance unit.	Not specified. Missouri will disregard earned income of parent caretakers under age 19 who are full-time students for purposes of eligibility and benefit determination.	Not specified.
Mont.	In order to receive cash assistance, teen parents must live in an adult-supervised setting, as defined by the state.	In order to receive cash assistance, teen parents must attend high school or other equivalent training program.	Not specified.
Neb.	Not specified.	Not specified.	Not specified.
Nev.	An unmarried minor parent must live with a birth or adoptive parent, other adult relative, or in an adult-supervised supportive living arrangement, unless she meets one of the good cause exemptions set by the state. When a minor parent alleges good cause to not live with parents, a social worker will determine the appropriateness of the living arrangement and assist the minor parent with a second-chance home, as necessary.	The Personal Responsibility Plan for pregnant and parenting teens includes the requirement that minor parents stay in school. Community-based programs will be used in assisting teen parents to achieve education and self-sufficiency goals, including life skills, money management, parenting, nutrition, conflict resolution, interpersonal relationships, and job search. Incentives may be used to encourage parenting teen participation in work activities.	Not specified.
N.H.	Parents under the age of 18 who are not married must live with their parent, legal guardian, other adult relative, or in another adult-supervised supportive living arrangement in order to receive assistance for themselves and their children. Exemptions form this requirement are made if the parents are dead, can not be located, or refuse to let the minor parent live with them, if they would pose harm to the minor parent and/or the child, or if the unwed minor parent has lived independently for at least one year.	Not specified.	New Hampshire's goals are, by 2005, to reduce the non-marital teen birth rate to 21.0 per 1,000 (1994 baseline 22.3 per 1,000) and the non-marital birth rate among women ages 20 to 24 to 33.0 per 1,000 (baseline 35.1 per 1,000).
N.J.	TANF will provide assistance to unmarried teen parents who live at home or independently until pending legislation is enacted. Under pending Work First NJ legislation, teen parents must live at home or in an adult-supervised living arrangement, with exceptions for good cause. Failure to do so will result in denial of assistance.	Teens under the age of 20 must participate in educational activities directed at receiving a high school diploma or GED, or must participate in an alternative program approved by the state. Failure to participate in these activities will result in sanctioning of the teen parent.	Not specified.
N.M.	To be eligible for PROGRESS benefits, an unmarried unemancipated teen parent (under age 18) must be living with a parent, a responsible relative, or in an approved adult-supervised setting.	For teen household heads, job skills training and education directly related to employment and satisfactory attendance in a high school are considered as work activities.	Not specified.
N.Y.	As under former AFDC program, unmarried minor parents and their children must reside in the household of a parent, legal guardian, or other adult household, or in an adult-supervised supportive living arrangement, unless they have good cause not to, or meet other specified conditions.	Not specified.	Not specified.
N.C.	To be eligible for benefits, teen parents under age 18 must live at home in or another approved adult-supervised environment. Minor parents may not receive assistance directly; payments may be made to the adult with whom the minor parent lives, or to a protective or substitute payee. If no home is available, or if the caseworker determines that a teen mother or her child has been or will be physically or sexually abused, the caseworker will help the underage mother find a second chance home or maternity home, or other approved living arrangement, and require her to live there as a condition of assistance. The state may recognize as adults parents under age 18 who are legally emancipated or who are serving or have served in the armed forces.	As part of the personal responsibility contract, parents must make sure that teen parents under age 18 stay in school. To be eligible for benefits, teen parents must stay in school to complete their high school education or equivalent.	Not specified.
N.D.	Minor parents must live with their parents or in an approved adult-supervised setting to receive assistance through TANF.	Minor parents will be required to stay in school. Based on assessments, they may also be required to receive training on issues such as parenting and food and nutrition education.	The state's goal is to continue the downward trend in out-of-wedlock births (from 2,257 in 1993 to 2,209 in 1994) by 2 percent per year, allowing for adjustments based on future births and trends.
Ohio	Not specified.	Recipients who are pregnant or parents under the age of 20 must attend school or a program leading to a high school diploma or equivalent.	Not specified.
Okla.	Not specified.	Not specified.	OK has as its goal to reduce unintended births in 1996 and 1997 by the same percentage as they were reduced between 1994 and 1995. The state anticipates setting as a goal for future years a 1 percent annual reduction in out-of-wedlock births.
Ore.	The income (but not the resources) of the parents of a minor parent are deemed if they are living together and the minor parent is under 17, never married, and not legally emancipated. This includes the parents of a pregnant minor. The income is deemed after deductions for the parents' needs at the ADC standard. Minor parents may apply separately with their dependent children when they live with an adult relative who is not their parent.	Standards for satisfactory attendance are to be developed by educational institutions or training programs and approved by the state or local education agency and the state welfare agency. Standards must include both qualitative measures of progress (such as grades or competency gains) and quantitative measures (such as a time limit for completion.)	The target is 8 pregnancies for every 1,000 minor females by the year 2000, remaining the same through 2010. Data from 1995 shows that figure now stands at 19.2 pregnancies per 1,000 minor females in Oregon, resulting in 12.2 live births.
Pa.	An individual who is under age 18, is not married, and has a minor child in his or her care or is pregnant must reside in a place of residence maintained by a parent, legal guardian, other adult relative, or other appropriate adult-supervised supportive arrangement unless one of several exemptions is met. If the minor parent cannot return to the home of a parent, legal guardian, or other relative, the Department will provide assistance in locating an adult-supervised supportive arrangement, unless the agency determines that the minor parent's living situation is appropriate.	Minor parents and pregnant teens must complete an Agreement of Mutual Responsibility, which describes the steps the recipient must take to gain self-sufficiency, the penalties for failure to comply, and the actions to be taken by the Department to support the recipient's efforts. Effective March 3, 1997, refusal to sign the agreement will result in ineligibility.	Pennsylvania proposes to reduce the fraction of out-of-wedlock births which are to women aged 19 or younger to 28.15 percent in 1998 (one percentage point lower than the average of 1994-1995).
R.I.	Minor parents must live at home with the parents, a relative or legal guardian to be eligible for cash assistance. Unless otherwise authorized, the payment will be made to the adult on the minor parent's behalf. When there is good cause for the minor not to live at home, the minor parent must live in an adult-supervised supportive living arrangement.	Minor parents must stay in school.	Not specified.
S.C.	Not specified.	Family Independence recipients under the age of 18 must be enrolled in school and maintain satisfactory attendance, as defined by the South Carolina Department of Education, as a condition of eligibility for benefits.	For 1996, SC set as its goal the reduction of the state's illegitimacy rate by 0.25 percent. The goals for reduction of the illegitimacy rate in 1997-2005 will be submitted in an amendment to the state plan.
S.D.	Not specified.	Not specified.	Not specified.
Tenn.	Unmarried teen parents and pregnant teens must live in the home with a parent, relative or guardian, unless good cause exists.	Teen parents must attend school. This is one element of the personal responsibility plan. The teen shall be sanctioned for failure to attend school by removal of her needs from the benefit calculation.	Not specified.
Texas	In order to be eligible for TANF cash assistance, unmarried teen parents must reside with a parent, legal guardian or other adult relative, unless good cause is established by one of the following reasons: parent(s), legal guardian or other adult relative(s) are deceased, their whereabouts are unknown, they will not allow the minor to live with them, the state determines substantial evidence of risk of harm if the minor were to live with the adult relative, or state otherwise determines that it is in the child's best interest to waive the requirement.	Not specified.	Not specified.
Utah	Teen parents who have a de-pendent child in their care must reside with their parent(s), step-parent(s), or legal guardians to be eligible for Family Employment Program, unless the teen parent has good cause to live separately. In cases where good cause is approved, the teen parent must still reside in a suitable adult-supervised living arrangement in order to be eligible. If a single minor parent resides with his or her parent, the income and assets of the senior parent shall be counted in determining eligibility. If the minor parent does not live with his or her parent, the office shall seek an order requiring the senior parent to pay for the minor parent's support.	Single minor parents must participate in education for parenting and life skills, participate in infant and child wellness programs and, for at least 20 hours per week, must attend high school or an alternative, if they do not have a high school diploma, participate in education or training, or participate in employment.	Utah aims to reduce the teenage birth rate by 3 percent per year through 2002.
Vt.	Pregnant and parenting minors who are not emancipated minors must live with a parent or in an approved supervised living arrangement, subject to good cause exceptions. The sanction for failure to do so may not be more stringent than the sanctions for failure to comply with work requirements. Teen parents who live with their parents may have their eligibility and benefits calculated without respect to their parents' income.	Pregnant and parenting minors must attend school or an appropriate alternative education or training activity. Their Family Development Plan must include a requirement to participate in a case-managed support, education and training program.	Not specified.
Va.	A minor mother must live with her parent or a person standing in loco parentis in order to receive benefits. Assistance is denied if this requirement is not met. There are exceptions if the minor parent is married, the minor parent has no parent who is living or whose whereabouts are known, there is no appropriate person willing to assume the responsibility, or the physical or emotional health and safety of the minor parent or dependent child would be jeopardized if they lived with the parent or other adult.	Minor parents under age 18 must comply with compulsory school attendance requirements in order to be eligible for assistance.	Not specified.
Wash.	The Department shall determine, after consideration of all relevant factors and in consultation with the applicant, the most appropriate living situation for applicants under age 18, unmarried, and either pregnant or with a de-pendent child. Appropriate living situations shall include a place of residence maintained by the applicant's parent, legal guardian, or other adult relative as their own home, or other appropriate adult-supervised supportive living arrangement. An applicant under the age of 18 who is not living in such a situation shall be presumed to be unable to manage adequately the funds paid on behalf of the dependent child, and unless the teen parent demonstrates otherwise, shall be subject to protective payee requirements.	Custodial parents age 19 or younger who have not completed high school or equivalent will be assigned to basic educational activities as their JOBS activities. Non-participants will be subject to JOBS sanctions.	Not specified.
W.Va.	Minor parents are required to live with their parents or in an adult-supervised setting.	As part of their Personal Responsibility Contract, teen parents must agree to stay in an educational activity to complete high school, get a GED, or get vocational training and make satisfactory progress without getting into trouble. They may also be required to attend parenting classes and/or participate in a mentoring program.	FPP will have as its goal to increase the availability of contraceptive services and pregnancy prevention education to adolescents by 5 percent from 1996 to 2005. RFTS will have as its goal to prevent subsequent teen pregnancies and/or illegitimate pregnancies by 2 percent of the total births from 1996 to 2005.
Wis.	Minor parents are not eligible for program benefits, except child care, health care, and case management services. Minor parents must live in an adult-supervised living arrangement, usually with their parent(s). If the W-2 agency determines that the minor or his/her child is in an unsafe living environment, a referral will be made to the county child welfare office.	Minor parents who are part of a W-2 group are subject to the same provisions as other children. This includes meeting school attendance requirements, as defined by the state. The sanction for noncompliance is $50 per month.	Not specified.
Wyo.	Not specified.	Not specified.	The goal is to reduce out-of-wedlock pregnancies by 1 percent per year based on the 1995 statistics.

End Notes

1Ventura SJ, Mathews TJ, Curtin SC. Teenage Births in the United States: State Trends, 1991-96, An Update. Monthly Vital Statistics Report; Vol. 45, No. 11, Supplement 2. Hyattsville, Maryland: National Center for Health Statistics. 1998.

2 Ventura SJ, Curtin SC, Mathews TJ. Teenage Births in the United States: National and State Trends, 1990-96. National Vital Statistics System. Hyattsville, Maryland: National Center for Health Statistics. 1998.

3 CDC. State-Specific Pregnancy Rates Among Adolescents—United States, 1992-1995. MMWR 47:497-504. 1998.

4 Resnick MD, Bearman PS, Blum RW, Bauman K, Harris K, Jones J, Tabor J, Beuhring T, Sieving R, Shew M, Ireland M, Bearinger L, Udry JR. Protecting Adolescents from Harm: Findings from the National Longitudinal Study on Adolescent Health. JAMA 278(10):823-32. 1997.

5 Abma JC, Chandra A, Mosher WD, Peterson LS, Piccinino LJ. Fertility, Family Planning, and Women’s Health: New Data from the 1995 National Survey of Family Growth. National Center for Health Statistics. Vital and Health Statistics, Series 23, No.19. 1997.

Abma JC, Sonenstein FL. Teenage Sexual Behavior and Contraceptive Use: An Update. Paper presented at Conference "Teenage Sexual Activity and Contraceptive Use: An Update," at the American Enterprise Institute Welfare Reform Academy, May 1, 1998.

6 Sonenstein FL, Ku L, Lindberg LD, Turner DF, Pleck JH. Changes in Sexual Behavior and Condom Use Among Teenaged Males: 1988 to 1995. AJPH 88(6): 956-959, 1998.

7 Piccinino LJ, Mosher WD. Trends in Contraceptive Use in the United States: 1982-1995. Family Planning Perspectives 30(1):4-10, 46. 1998.