Teen study poses dilemma

LAWRENCE - There were audible gasps in the conference room at Healthy Families when staff members realized that in order to prove they were truly helping teen mothers they would have to turn some of the young women away.

But as their bosses explained that a scientific study of their work could lead to more funding and recognition, the gasps turned to nods of acceptance.

Like doctors and educators before them, social service workers are increasingly being asked to measure their accomplishments and prove that what they do works. But conducting a scientific study requires a "control group" of people who get limited or no services - and that presents an ethical quandary for people who have devoted their lives to helping others.

For the study, conducted by Tufts University researchers, about 300 of the roughly 3,000 teens who want to participate in Healthy Families Massachusetts during the study period will be referred to other agencies instead, and sent a monthly packet of information. The rest of the teens will receive Healthy Families' usual services, including regular home visits until their child turns 3.

Joanne Dunphy, coordinator of the program's Plymouth site, said it's unacceptable to force those 300 teens to ask for help a second time.

"If you turn a teenager down, what're they going to say? 'Nobody cares and nobody's going to help me,' " said Dunphy, a social worker for nearly 30 years. "The chip on their shoulder grows bigger and bigger - 'My mother threw me out. I called for help, the social worker gave me this number, and you know what they said? Forget it.' "

Worse, she said, the organization's employees would not be able to follow up - as they do now - to ensure that the teens they refer elsewhere seek out and get other assistance.

Dunphy said she would resign if her site is added to the 18 Healthy Families programs included in the study, because she cannot refuse to help teen mothers in need.

Tufts researchers say they need to follow the teens for about two years, tracking the progress of as many as 800 mothers - 500 of whom will randomly be assigned Healthy Families' services and 300 who will not. Only teens 16 and older will be part of the study, which will show researchers whom the program most benefits and where it needs improvement.

Researchers will track rates of child abuse and neglect, whether mothers pursue further education or job training, repeat pregnancies, and other factors, between the two groups.

The program will continue to serve roughly the same number of teens during the study period, said Suzin Bartley, executive director of the Children's Trust Fund, the parent organization of Healthy Families. The publicly funded program can only afford to serve about 40 percent of the state's first-time pregnant teens each year. Other teen mothers are already put on waiting lists or referred to other, often financially strapped, agencies.

"I know that it is very hard when you're sitting in the field," Bartley said. "But . . . we would never have been able to reach all of the teen parents out there - it's not a capacity issue. We are beyond capacity here."

Completing an evaluation that proves the program is effective could open up funding opportunities to help expand the program, she said, noting that the study was deemed ethical by a Tufts review board.

For instance, the federal Administration for Children and Families recently authorized more than $8 million for home visitation programs such as Healthy Families - money contingent on strong evidence-based research results.

"What I know about this program is that it's extraordinary," said Carol Trust, executive director of the Massachusetts chapter of the National Association of Social Workers. "But that's anecdotal. . . . If they can have that evidence, they can be eligible for lots of funding - and in the long run that's really going to be beneficial."

Groups that fund social service programs have been moving toward such measurement since the evidence-based studies of preschoolers in the 1960s, welfare-to-work programs in the '80s, and Early Head Start and other education-related programs earlier this decade, said Jon Baron, executive director of the nonprofit Coalition for Evidence-Based Policy.

"If it is done right, if it's explained to social workers and others right, they can see that rigorous testing is the ethical thing to do," he said, "because otherwise . . . you don't know" whether the program is truly effective or if another program might work better.

For example, University of Washington researchers published a study in June in the Journal of Adolescent Health that found that scientifically tested juvenile delinquency programs worked better than untested programs.

One of the only studies conducted on a program similar to Healthy Families' was started in 1977, with nurses visiting first-time parents. That research proved that home visits can be effective. Now, Healthy Families needs to show that its brand of home visits works well, said Sarita Rogers, director of home visiting for the Children's Trust Fund.

"We do think there is something about a home visitor that is special," she told the women gathered in the conference room in Lawrence last week. "But nobody really knows yet what it is about a home visitor that makes a difference."

Part of it, Dunphy said, is helping a child in need - and not turning them away when they seek help. Cynthia Poyant, a licensed clinical social worker who is not affiliated with Healthy Families, said she agreed.

"I understand it in theory," she said. "But I would have great difficulty not providing services to a teen who came to me for help."