title: Adolescent and Adult Clients in Prenatal Case Management: Differences in Problems and Interventions Used.
abstract: OBJECTIVE
  This study sought to characterize differences between pregnant adolescents and adults in the types of problems addressed by case managers, and to assess subsequent differences in the types of interventions used with both groups.
  
  
  METHODS
  Data stem from 3947 client encounters, provided by 223 case managers in 92 Medicaid-reimbursed prenatal case management programs; the clients were confirmed to be either adolescents (<20 years of age) or adults. Case managers provided information on each client encounter that occurred during 10 workdays over a 20 workday period using the Case Management Intervention Record , a data collection tool. The Chi square test and the Mann-Whitney U test were used to compare the types and number of problems, the types of intervention received, and the mean number of intervention minutes between adolescents and adults.
  
  
  RESULTS
  Adolescents experienced an average of 3.9 problems whereas adults experienced an average of 3.2 problems (p < 0.001). Compared to adults, adolescents were significantly more likely to experience problems in the areas of pregnancy health, family, education/job, transportation, and housing. With respect to breadth of interventions, adolescent clients were significantly more likely to receive support, clinical acts, and to be given tangible items compared to adult clients. On average, case managers spent significantly more time per encounter with adolescents than with adults overall (mean 56.6 vs. 50.3 min), and on educating, assessing, coaching, and monitoring.
  
  
  CONCLUSIONS
  Age related differences have both programmatic and provider implications. The intervention typology can be used to evaluate PCM programs serving high risk population.
authors.affiliation: Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA. Michele.issel@uncc.edu.
authors.forename: L Michele
authors.initials: LM
authors.lastname: Issel
authors.affiliation: Division of Community Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Gilmet
authors.affiliation: Division of Community Health Sciences, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Izumi
authors.initials: I
authors.lastname: Chihara
authors.affiliation: Doctoral Nursing Department, and Department of Epidemiology & Biostatistics, Drexel University, Philadelphia, PA, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Slaughter-Acey
mesh_terms: D000293:Adolescent; D000328:Adult; D019090:Case Management / Q000639:trends*; D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000639:trends; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D014481:United States
keywords: Adolescent; Case management; Home visiting; Interventions; Prenatal; Problems