National problems, local solutions: comprehensive services for pregnant and parenting adolescents.

This study identifies a number of factors associated with the successful development and maintenance of local comprehensive adolescent pregnancy programs in the US. The comprehensive programs were located in communities with relatively well-developed social welfare infrastructures. They received basic state support and were able to tap a wide variety of federal, state, and local resources. These comprehensive programs were managed by skillful administrators and drew upon a broad range of leadership talents. Only a minority of exceptional communities possess the essential prerequisites. Within states, grant mechanisms favor those few localities that can put together the winning proposal or that have the organizational capacity to draw on a variety of funding sources. They are not always the communities with the greatest need. Within communities, even the most comprehensive programs served only a small proportion of the potential clientele. They reflected a brief crisis intervention orientation to a problem that is complex and long-lasting in its origin and consequences. National evaluations and comprehensive programs have found that their benefits are limited and short-lived. The study further demonstrates the political vulnerability of local services for stigmatized and powerless groups in the absence of a strong national mandate. Service providers kept a low profile to avoid the attention of potential opponents. A national strategy based on the sponsorship of a limited number of demonstration projects and the dissemination of information about exceptional, exemplary programs is unlikely to accomplish very much. The evidence suggests that the lack of a national policy commitment to pregnancy prevention contributes to the high rate of adolescent pregnancies.