"They Show Us That We're Important": Facilitators to Pregnancy and Parenting Service Utilization As Perceived By Stakeholders and Young Parents with Foster Care Histories

Background and Purpose: Nationally, the number of parents aging out of foster care continues to grow despite the overall decline in teen pregnancies. The birth rate is nearly 2.5% higher for foster care-involved youth relative to those not in care. With the emergence of the Family First Prevention and Services Act (FFPSA), agencies face new opportunities to support pregnant and parenting foster youth/young adults. Research identifies systemic barriers, and risks and protective factors affecting pregnant and parenting youth in foster care. Less is known about the facilitators to service utilization among this population. Therefore, we explored pregnant and parenting youth/young adults and providers’ perceptions regarding facilitators to service utilization. Two research questions guided our study: 1) What service provider characteristics facilitate service utilization among system-involved pregnant and parenting youth/young adults?; 2) What agency characteristics facilitate service utilization among system-involved pregnant and parenting youth/young adults?

Methods: This research was conducted as part of a needs assessment for a pregnancy assistance program in an urban county within a Southwestern state. The purposeful sample was comprised of system-involved pregnant and parenting youth/young adults, and service providers. Data collection included five face-to-face interviews with service providers and four interviews with pregnant and parenting youth/young adults ages 12-24. We also conducted focus groups with service providers (n=23) and with pregnant and parenting youth/young adults (n=7). Semi-structured interviews addressed strengths of workers, agencies and service networks in delivering pregnant and parenting services (e.g., “What are the strengths of [County name] in delivering services that are helpful to system-involved expectant and parenting young people?”). Providers were predominately female (75%) and white (60.71%). Most youth and young adult respondents were female (72.70%), and 27.3% identified as Latina/o, 27.3% as white, and 27.3% as mixed race; their mean age was 19.6 years. Interviews and focus groups were audio-recorded, then transcribed and analyzed using open and axial coding until themes emerged.

Results: Themes emerged in three categories: individual worker capacities, agency capacities, and service network capacities. Worker-related capacities were empathy and trustworthiness, well-informed navigation, and youth-centeredness. Agency capacities included representative diversity and inclusivity, trauma-informed training and practice, and availability of tangible supports such as childcare and transportation. Network system capacities included variety of service providers, systems integration, and co-location.

Conclusions and Implications: In light of FFSPA, service systems may implement new interventions addressing the disproportionate rate of pregnancy among system-involved youth in foster care. Our findings suggest that emerging programs may be more likely to be used when: workers display interpersonal empathy, are knowledgeable about available services, and validate youth/young adults experiences; agencies recruit a workforce representative of the diversity of their clients, provide trauma-informed care, and offer tangible supports; and service networks coordinate services and consider co-locating programs. More research is warranted on designing and implementing pregnant and parenting services and whether increased service use leads to better outcomes for youth/young adults with foster care histories.