United States General Accounting Office

GAO Report to the Ranking Minority Member,

Committee on Finance, U.S. Senate

May 1995 WELFARE

DEPENDENCY

Coordinated

Community Efforts

Can Better Serve

Young At-Risk Teen

Girls

GAO/HEHS/RCED-95-108

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

B-254030 

May 10, 1995

The Honorable Daniel Patrick Moynihan

Ranking Minority Member

Committee on Finance

United States Senate

Dear Senator Moynihan:

In recent years, concerns about rising caseloads and long-term

dependence on welfare programs, such as Aid to Families with Dependent

Children (AFDC), have focused attention on the nation’s welfare system. In

1993, AFDC supported almost 5 million low-income families across the

United States and was projected to cost over $26 billion in federal and

state funds in fiscal year 1995. Increasingly, concerns have centered on the

rising number of teenage mothers, and particularly on the high public

costs associated with their dependence on programs such as AFDC.

The forces that place a young teen girl at serious risk of long-term welfare

receipt begin very early. Recent reports have noted the positive

association between growing up in an adverse environment, such as an

abusive family or an impoverished neighborhood, and future cognitive,

behavioral, and physical functioning.1

 However, the current mix of

education, health, and social support programs has been unable to

mitigate the effects of multiple family problems and deteriorating

neighborhoods on the children being raised in these environments,

particularly young teen girls. While many federal, state, and local human

service programs target at-risk children and their families, the programs

are not configured and services are not delivered in ways that maximize

their impact on multiple family problems.

Because of these concerns, you asked us for information about young teen

girls who may be at risk for AFDC dependency.2

 Specifically, our focus was

the following:

1

Starting Points: Meeting the Needs of Our Youngest Children (New York: Carnegie Corporation of

New York, 1994); and Losing Generations: Adolescents in High Risk Settings, National Research

Council (Washington, D.C.: National Academy Press, 1993).

2

For the purpose of this report, we defined young at-risk teen girls as those who (1) have poor general

life circumstances (such as poverty) or exhibit problematic behavior (such as early sexual activity)

that is associated with problems such as teen pregnancy or illegal drug use, and (2) generally fall into

the age group of 10 to 15 years old.

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• describe the health and well-being of young at-risk teen girls and their

families, and the condition of the urban neighborhoods where they live;

• obtain the local service providers’ perspectives on the needs of these girls,

how they are addressing those needs, and what obstacles service

providers face in working with the girls, their families, and their

communities; and

• describe how the communities where these girls live are responding to the

service needs of this group.

To develop this information, we reviewed the relevant literature,

contacted experts on services for at-risk adolescents, analyzed data

collected by the Bureau of the Census, and conducted site visits in three

urban neighborhoods—Ward 7 in Washington, D.C.; Boyle Heights in Los

Angeles, California; and West Oakland in Oakland, California. In addition,

we visited a community redevelopment project in Detroit, Michigan. (A

complete discussion of our methodology and descriptions of the

neighborhoods appear in apps. I and II.) We did our work in accordance

with generally accepted government auditing standards.

Results in Brief The forces of poverty—eroding the foundations of individuals, families,

and communities—can show some of their most debilitating effects on

young at-risk teen girls. Service providers in the neighborhoods we visited

characterized many of the 10- to 15-year-old girls they serve as detached

and isolated from their families and communities, sexually abused and

neglected, and threatened by violence. A combination of poor economic

and social conditions—(1) poverty and deteriorating neighborhoods,

(2) dysfunctional families, and (3) poor self-image of the young teen girls

themselves—has created a population of adolescents with multiple

problems who have characteristics, such as early parenthood, associated

with long-term public dependency.

Generally, community service providers told us that services for at-risk

girls aged 10 to 15 were limited, and the services that were available were

often provided after problems reached the crisis stage. The services that

did exist in the neighborhoods we visited were not coordinated, and they

focused only on the teen and a specific problem, ignoring, for example, the

positive influence a parent could have and, conversely, the negative

impact of a dysfunctional family. We also found that these girls

(1) received a lower level of services than other at-risk groups, (2) were

offered few preventive services, and (3) had limited access to the array of

health and support services, provided in a safe environment, that experts

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agree are needed by young at-risk teen girls. Community service providers

told us that the services needed to address sexual abuse and exploitation,

psychological and physical neglect, and drug and alcohol dependency

were nonexistent, unknown or ignored by those in need, or located far

from neighborhoods.

To better serve and reach more area residents, including young girls, some

neighborhoods are organizing coalitions, led by local providers, often with

assistance from private organizations and public agencies. In some cases,

these efforts at integrating services have had a positive effect on

neighborhood children. Some providers, often working in middle schools,

have expanded their role in the community to better integrate services for

at-risk teens and their families. Providers working in these coalitions told

us they believed the emergence of neighborhood leadership is critical to

the long-term success of the coalitions. New service delivery strategies

being tried include identifying and providing multiple preventive services

and activities, contacting parents or guardians and encouraging them to

become involved in their children’s activities, and increasing the

community’s participation and commitment to the initiative.

Background There is growing concern among program providers and policymakers that

large numbers of our nation’s adolescents—particularly young girls

between the ages of 10 and 15—are at great risk for a number of problems

including pregnancy, alcohol and drug abuse, and school failure. Many of

these young teens live in poor neighborhoods.3

 According to the 1992

Current Population Survey (CPS), there were over 7 million girls under 18

years old living in poverty, with over 2.5 million residing in poor

neighborhoods. In addition, as many as half of all adolescents aged 10 to

15 are reported to be at moderate or high risk of school failure, early

sexual activity, drug and alcohol use, or criminal behavior.4

 Among the

most far reaching and costly of all negative outcomes for young at-risk

girls is early parenthood. In 1990, about 361,000 babies were born to

unmarried teenagers—approximately 9 percent of all births in that year.5

3

A “poverty neighborhood” is defined as a census tract with a poverty rate of 20 percent or more based

on the 1980 census.

4

At-Risk Youth, The Urban Institute Policy and Research Report, Vol. 23, No. 1 (Washington, D.C.:

Winter/Spring 1993).

5

Kids Count Data Book 1993: State Profiles of Child Well-Being (Washington, D.C.: Center for the Study

of Social Policy, 1993).

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Teen Births Rising and

Costly

From 1960 to 1992, the birth rate for all teens increased from 15.3 to 44.6

births per thousand. While the number of births to the very young—aged

15 and younger—is not large, this group is experiencing the greatest rate

of increased births.6

 Pregnancy rates for all girls under 15 years old rose

4.1 percent in the United States during the period between 1980 and

1988—higher than any other teen age group. In addition, these young

mothers often have other characteristics that are associated with

long-term welfare dependency and other long-term problems, such as

deficient education and employment skills and histories of child abuse and

neglect.

The public costs of teen mothers are high. According to the most recent

Census data available, nearly one-half of all women receiving AFDC from

1976 to 1992 were or had been teenage mothers (see fig. 1). In addition,

these women were more likely to be the least educated and have larger

families, thus making them the least likely to leave AFDC and become

self-sufficient.7

 The Center for Population Options estimated that in 1992

the federal government spent over $34 billion on AFDC, Medicaid, and Food

Stamps to support families begun by teens.

6

A State-by-State Look at Teenage Childbearing in the U.S. (Flint, MI: Charles Stewart Mott

Foundation, 1991).

7

Families on Welfare: Focus on Teenage Mothers Could Enhance Welfare Reform Efforts

(GAO/HEHS-94-112, May 31, 1994).

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Figure 1: Proportion of Women Who

Gave Birth as Teenagers Is Nearly Half

of All Single Women Receiving AFDC

• 5.3%

Women Who Are Currently

Teenage Mothers

36.3% • Women Who Were Teenage

Mothers 58.4%•

Women Who Did Not Give Birth as

Teenagers

Source: CPS, 1992.

Past Prevention Programs

Have Shown Little Success

Generally, teen pregnancy prevention projects have produced less than

encouraging results, whether programs were targeted to prevent teens

from their first pregnancy or additional pregnancies. For example, the

Office of Technology Assessment (OTA) reviewed pregnancy prevention

programs that attempted to (1) increase teens’ knowledge about

reproduction, (2) improve access to contraceptives, or (3) broaden teens’

life options. OTA concluded that despite some promising approaches, no

evidence existed of significantly reduced pregnancy rates among teen girls

when the approaches were applied independently.

Intervening after teens have become sexually active or after they have

given birth appears to be too late for positive impacts, regardless of the

type of program. For example, a national demonstration project that

provided education and employability development as well as other

supportive services to teen mothers was unsuccessful at reducing the rate

of second pregnancies among teen mothers. The developers of this effort

recognized the difficulty of overcoming “serious obstacles to

advancement, some psychological in nature, others related to

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dysfunctional families, dangerous schools and neighborhoods, and other

factors in their social, physical, and economic environments.”8

Historically, federal initiatives to address the individual problems of

youths, their families, and teen pregnancy have generally resulted in

“single-problem” programs and reactive, crisis-oriented service strategies

by local providers. A Congressional Research Service (CRS) study

concluded that some federal programs aimed at reducing the incidence of

teen pregnancy disagree on the federal role, resulting in a patchwork of

differing goals ranging from promoting abstinence to encouraging the use

of pregnancy planning among sexually active teens.9

 Consequently, federal

programs often support local projects that target one of these goals at the

exclusion of others.

Poor, Dysfunctional

Families and

Deteriorating

Neighborhoods

Impact on Young

At-Risk Teen Girls

In neighborhoods with high concentrations of poor families, many 10- to

15-year-old girls have multiple problems. The combination of abuse and

neglect in young teens’ households and dangerous and decaying

neighborhoods has increased the numbers of young teen girls with the risk

characteristics associated with long-term welfare dependency, education

deficits, and early parenthood. These girls are growing up under

circumstances that often compromise their health, impair their sense of

self, limit their development potential, and generally restrict their chances

for independent and productive lives.

Family Abuse and Neglect

Leave Young Teen Girls

Isolated and Vulnerable

In the neighborhoods we visited, family poverty combined with parental

substance abuse and sexual or physical abuse of children makes growing

up a significant challenge for many young girls. Many of the girls in these

communities lived in households where the income was below the poverty

level.10 In Washington, D.C.’s, Ward 7, for example, according to the 1990

census, 18 percent of the households were considered to be poor.11 In

addition, many of the girls in the communities we visited lived in

8

New Chance: Interim Findings on a Comprehensive Program for Disadvantaged Young Mothers and

Their Children (New York: Manpower Demonstration Research Corporation, Sept. 1994).

9

Welfare Reform: Adolescent Pregnancy Issues (CRS, 1994).

10In 1993, the federal poverty level for a family of three was $11,521.

11The city of Washington, D.C., is split into eight political wards.

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single-parent households, typically headed by their mothers.12 These

households, as characterized by providers, lacked parental supervision

and left young girls isolated from family members as well as from their

neighborhoods. The principal of a middle school in West Oakland told us

that many of her female students’ parents were abusing drugs or alcohol,

and crime and violence proliferated in their neighborhoods; one or both

parents were often absent; and many of the adults in the homes did not

have the skills and abilities to function as parents.

Families living in poverty are stressed and constrained by the normal

activities of daily life, which can make parents and children feel hopeless

and helpless. In our interviews with service providers and our reviews of

recent studies, we found (1) high rates of substance abuse among the

parents of young teen girls, (2) widespread physical and sexual abuse of

teen girls, and (3) many young girls that were left unattended for long

periods of time and who often assumed adult responsibilities in their

homes.

Factors associated with family dysfunction, such as substance abuse, were

prevalent in all the communities we visited. Nationally, rates of drug and

alcohol abuse among women living in poverty and AFDC recipients, for

example, have been estimated to range from more than 15 percent to

almost 30 percent.13 Drug and alcohol abuse among parents was seen as a

widespread, serious problem by many neighborhood providers, as well as

by the young teen girls themselves. For example, in the West Oakland

neighborhood we visited, the arrest rate for narcotics was more than

double that for all of Oakland. Boyle Heights in Los Angeles registered

almost three times the rate of alcohol-related arrests as Los Angeles as a

whole between 1991 and 1993. The Ward 7 community was no different.

The Director of Recreation for Washington, D.C., said that many of the

young girls the Department of Recreation serves witness daily alcohol and

drug abuse.

Physical and sexual abuse were also reported by community providers as

significant problems. In West Oakland, where the reported number of

sexual abuse incidents rose from 49 in 1992 to 91 in 1993, the Adolescent

12Nationally, the percentage of children under 18 living with a single parent rose from 12 percent in

1970 to 27 percent in 1993. More notable, however, is that of those children living with one parent, the

proportion of those living in a never-married household rose from 24 percent in 1983 to 35 percent in

1993. Marital Status and Living Arrangements, Bureau of the Census, Series P20-478 (Washington, D.C.:

Government Printing Office (GPO), Mar. 1993).

13Substance Abuse and Women on Welfare, Center on Addiction and Substance Abuse at Columbia

(New York: Columbia University, June 1994); and Substance Abuse Among Women and Parents

(Washington, D.C.: Department of Health and Human Services, July 1994).

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Family Life Director believed that as many as 65 percent of the young girls

the office serves have been sexually abused. Some providers reported that

young victims of abuse—characteristically passive, lacking self-esteem,

and pressured into early sex by extended family members and older

men—have few options or role models and often follow what are seen as

common practices in their neighborhoods. Providers in residential care

facilities for parenting teens reported that most of their clients were

victims of abuse. Recent research confirms their observations. Studies

reported that as many as 68 percent of teen mothers were sexually abused

as children.14

According to community providers, young girls are often unsupervised or

on their own for extended periods of time and essentially parenting

themselves, which isolates them from their families and communities and

makes them vulnerable to outside influences. Local providers believed

that many of these girls become the functioning adult in the household and

assume the responsibility of caring for younger family members.

Neighborhoods Often

Dangerous and Decaying

The condition of the neighborhoods where these girls live induces fear and

apprehension throughout the community. Their high crime rate,

deteriorating infrastructure, and scarcity of commercial ventures threatens

neighborhood children and provides them with few positive examples of

future livelihoods. The areas we visited also had high numbers of declining

public and private residential housing units. Each of these areas started

out as a vibrant section of the city, but a variety of socioeconomic factors

over time has caused these areas to deteriorate, leaving vacant and

dilapidated buildings and reduced community resources. (Fig. 2 contains

photographs of the neighborhoods we visited.)

Crime is an important contributor to the destruction of a community.

Young teen girls in the neighborhoods we visited feared for their safety

and saw few places of refuge. In Boyle Heights, gang violence is a serious

problem. Providers told us that the approximately 30 gangs in the area had

a membership of about 15,000. In 1993, the police reported 763

gang-related crimes in the Boyle Heights area alone. Service providers told

us that the teen girls in the area are at risk of joining gangs—one provider

estimated that about 60 percent of the teen girls are already in gang-related

14Debra Boyer and David Fine, “Sexual Abuse as a Factor in Adolescent Pregnancy and Child

Maltreatment,” Family Planning Perspectives, Vol. 24, No. 1 (Jan./Feb. 1992); J. Butler and L. Burton,

“Rethinking Teenage Childbearing: Is Sexual Abuse a Missing Link?” Family Relations, Vol. 39, No. 73

(1990); H. Gershenson and others, “The Prevalence of Coercive Sexual Experience Among Teenage

Mothers,” Journal of Interpersonal Violence, Vol. 4, No. 204 (1989).

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activities. Although gang-related crimes were not reported to be high in

Washington, D.C., the homicide rate in 1993 for Ward 7 was more than

double that for the whole city. The girls we spoke with said that they

feared going outside and preferred to stay at home. One girl told us that

she feels “paranoid . . . wondering which way the bullet will go.”

The physical and economic infrastructure of the neighborhoods we visited

paralleled the social conditions. The neighborhoods were characterized by

high numbers of public housing units—Washington, D.C.’s Ward 7 had the

highest concentration of public housing units in the city. This

neighborhood once had a solid middle-class residential and small business

presence. Today, although the area continues to be residential with over

70,000 residents, 25.8 percent of the households were poor in 1990. In

addition, although the area once had a substantial number of small

businesses and stores, it now has no restaurants, except for fast-food

places, and few opportunities for cultural activities. Boyle Heights, once

an affluent suburb, is a mixture of aging commercial and industrial

sections and subsidized housing. West Oakland has no drug stores, banks,

or major grocery stores to serve its more than 15,000 residents.

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Figure 2: Neighborhoods GAO Visited

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Young Girls in These

Neighborhoods Are at Risk

for Multiple Problems

The interplay of family poverty—often with parental substance abuse and

child neglect and abuse—and neighborhoods with few resources leaves

young teen girls at risk for many problems and dangerous behaviors.

Research studies and reviews have noted the relationship between adverse

living conditions and outcomes that seriously impede teens’ growth to

self-sufficiency.

Family poverty and parental dysfunction are associated with a number of

problems among the children in the household. First, the relationship

between teen births and poverty is clear. Nearly half of the AFDC caseload

is made up of women who gave birth during their teens, and these women

are also less likely to have completed their high school education. Their

children are in poorer overall health and can, as a result, suffer

developmentally—increasing the likelihood of poor school performance.

Parental drug and alcohol abuse has been shown to significantly increase

the odds that an adolescent will become a substance abuser. Likewise,

research has demonstrated a relationship between a woman’s being

abused as a child and her becoming a teen mother.

Neighborhoods with high concentrations of poor families generally have

poor quality schools that, in addition to family economic stresses, increase

the chance that children will fail in school or drop out. Children in poor

neighborhoods also run a high risk of becoming both victims and

perpetrators of crimes. Compounding the problem, because high numbers

of youths and adults in these communities exhibit negative and antisocial

behavior, positive community role models are scarce or absent. These

distressed communities, with large numbers of children at risk, challenge

the limited number of service providers and the poorly coordinated overall

system of care.

Complex Needs

Rarely Reflected in

Services for Young

Teen Girls

Communities with high numbers of young at-risk teen girls have had

limited success in designing services and approaches that would help the

most vulnerable of these young teens. The few services for these girls and

their families are typically offered only when problems reach the crisis

state. Neighborhood residents see providers and services open and close

as funding appears and disappears. Providers believed that the services

available generally ignore the positive role a parent can play in a child’s

development, as well as the negative impact of a dysfunctional family.

Services designed to help dysfunctional families, such as mental health

and substance abuse treatment, are either in short supply or far from the

neighborhoods. Many experts agree that young at-risk teen girls could be

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better served if traditional approaches were modified to include early

identification and treatment, long-term program commitment, and greater

community involvement.

Neighborhood Services

Not Designed to Meet

Multiple Problems of

At-Risk Teens

Many of the providers in the neighborhoods we visited said that supportive

services were often provided too late and lacked continuity. Most of the

human services available to at-risk teens were crisis-oriented—provided

only after a problem had occurred. For example, the schools in all

communities we visited had specialized programs for teens who were

either pregnant or already parents of very young children. Oakland’s

school-based Adolescent Family Life Program provided health and

supportive services, parent education, job training, and counseling to teen

girls under 17 years. However, to be eligible, a girl must be either pregnant

or a parent. Providers saw the need for a more continuous approach to

avoid early parenthood, such as offering early instruction and counseling

or beginning career orientation programs in primary school. Early

instruction and counseling is needed, they believed, because of the

shortage of positive adult role models and the fact that these girls live in

neighborhoods that often condone dependency and submissiveness. In

West Oakland, a middle school counselor told us that any positive effects

on young girls that a program supplying mental health workers to an

elementary school had were eroded when the program was not continued

in high school.

In addition, service providers cited a number of critical services needed by

young teen girls that were either scarce or nonexistent. These include

preventive services, such as strategies to avoid early sexual activity and

pregnancy, resist drug use, and avoid gang membership; after-school

recreational activities in a safe environment; and ways to identify early

signs of school failure. A counselor at the Boyle Heights Boys and Girls

Club saw young girls as the “forgotten majority.” As their performance in

school falters or they leave school because they are pregnant, they are

barely missed by the community institutions, unlike the highly visible and

sometimes violent young boy. Through our visits to neighborhoods and

local inventories of existing services in those neighborhoods, we found

few service providers who offered preventive care to young teen girls. For

example, in the Boyle Heights neighborhood, we found only one

prevention program targeting young girls—Education Now and Babies

Later. Safe and secure locations where young girls could find recreational

activities before and after school and on weekends were very rare in these

communities. Violent gang activity, especially in the Boyle Heights

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neighborhood, where there are reportedly 30 separate gangs, creates an

environment of fear. Several of the young teens we interviewed said that

they felt unsafe walking in their own neighborhood and often were afraid

to come out of their home.

Few Services Offered to

Dysfunctional Families

In the neighborhoods we visited, the number and scope of mental health

services, including substance abuse treatment, supportive services

designed to identify potentially abusive parents, and efforts to prevent

abuse from occurring, fell far short of addressing the communities’

problems. According to providers, community-based treatment and

prevention programs geared to dysfunctional families, especially those

emphasizing mental health and substance abuse issues, were either not

available, in short supply, or located far from the neighborhoods.

Community service providers believe that family dysfunction adversely

affects the growth and development of young teen girls and can lead to

long-term dependency on public assistance. While providers reported the

need for and lack of mental health services for the young girls in their

communities, they also said that the parents are, at best, not prepared for

their role as a parent and, at worst, need clinical treatment themselves.

Even when the programs exist, providers said that difficulty in getting

parents involved in their children’s activities is a significant barrier to

serving at-risk teen girls. According to providers, parents are often

unaware of their children’s activities; may condone early sexual activity

and childbearing; and give little attention and support to their children.

Providers told us that often these characteristics are a function of

long-standing and established patterns of parenting in the neighborhood

and a general sense of hopelessness in the community. For example,

counselors from a West Oakland middle school estimated that “75 percent

of the mothers are not there for their children.” In this school, children

were reluctant to have a day to honor their mothers, and preferred to have

their teachers attend. In about half the cases, according to a middle school

principal, by the time a young girl reaches middle school, her household

has dissolved and she is living with a grandparent.15

15In 1993, 5 percent of all children were living in a household with grandparents present (3.7 percent of

white children, 12.1 percent of black children, and 5.9 percent of Hispanic children). Of the

households, 30 percent have only grandparents present—24.9 percent of white households,

38.7 percent of black households, and 22.8 percent of Hispanic households.. See Marital Status and

Living Arrangements.

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Adolescent Services Can

Improve With Changes in

Approach and Scope

Research on the problems of adolescents and their service needs has

reached a number of conclusions about the best approaches to meeting

this population’s multiple needs. For example, OTA’s study on adolescent

health—a comprehensive synthesis of the research findings—notes

growing consensus on key components to successful preventive services

for teens.16 Recognizing along with other researchers that many

adolescents’ needs for health and related services are not being met with

mainstream primary care, OTA concluded that school or community-based

centers can offer comprehensive and accessible services. Others have

joined in reexamining both programmatic and larger system strategies for

addressing the problems of at-risk teens generally and teen pregnancy

prevention specifically. They concluded that certain programmatic

changes, moving toward a more comprehensive approach to care, can lead

to greater success.17 For example, the Urban Institute’s review of program

practices designed for at-risk adolescents cited the following components

for a successful program:

• early identification and intervention;

• long-term and consistent intervention;

• individualized attention, instruction, and counseling;

• emphasis on skills enhancement, life options, and vocational orientation;

• development of multiple channels of influence, including parents,

churches, and community organizations; and

• service delivery in a safe physical environment.18

Techniques suggested by experts to better integrate community services

include collocating multiple service providers, joint planning among

providers, and new local-level funding strategies.19

“System” changes involve trying new service delivery approaches and

attempting to reduce conflicts among programs by removing

inconsistencies in program rules and requirements. In our previous work,

we found that to accomplish these changes, public and private service

16Adolescent Health, Vols. I, II, III, OTA (Washington, D.C.: GPO, 1990).

17Risking the Future: Adolescent Sexuality, Pregnancy, and Childbearing, Volume I, National Academy

of Sciences, National Research Council Commission on Behavioral and Social Sciences and Education,

Committee on Child Development Research and Public Policy, Panel on Adolescent Pregnancy and

Childbearing, ed. C.D. Hayes (Washington, D.C.: National Academy Press, 1987); and J. Dryfoos,

Adolescents At Risk: Prevalence and Prevention (New York: Oxford University Press, 1990).

18Martha R. Burt and Gary Resnick, Youth At Risk: Evaluation Issues (Washington, D.C.: Urban

Institute, 1992).

19Sharon L. Kagan and Peter R. Neville, Integrating Human Services: Understanding the Past to Shape

the Future (New Haven and London: Yale University Press, 1993).

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agencies need to reorganize administrative structures around common

populations or problems, use more flexible funding approaches, and

create coordinated service planning at different levels of government.20

New Service

Approaches Depend

on Increased

Community

Leadership and

Involvement

A community’s ability to address the problems of at-risk teen girls depends

on more than a collection of programs and service providers. Residents

and providers in the neighborhoods we visited are becoming increasingly

aware that a coordinated, integrated, and comprehensive network of

services is needed to address the problems of teen girls. To do this,

neighborhoods may have to overcome deficiencies in their own leadership

and organization.

Community service providers in the neighborhoods we visited viewed the

emergence of local leadership as an important ingredient in the

development of new service strategies. They told us that identifying local

leaders to initiate community action, sustain community support, and help

residents gain control over their problems is key to the organization of

better services for young teen girls as well as adolescents in general. In

Ward 7, West Oakland, and Detroit, for example, coalitions and networks

of local service providers are being developed to improve the capacity to

address community needs and problems. Neighborhood coalitions can

take various forms. The neighborhoods we visited showed that these

service coalitions can be informal—a network consisting of frequent

working relationships among various providers; or they can be a formal,

comprehensive planning and implementation effort that incorporates

residents, merchants, service providers, and the area’s public agencies.

Throughout these cooperative efforts, similar themes shape their goals and

objectives. Providers believed they have to work collaboratively with local

residents and businesses to deal with the needs and problems of not only

teen girls but also the families and the communities as a whole. Most

importantly, these communities realized that the strategies and solutions

to their problems must come from within.

Local providers also found that they have to coordinate community

activities with one another as well as with other entities in the community.

For example, providers in Detroit’s North High School neighborhood saw

that they needed to link various activities in order to address the needs

and problems facing adolescents, their families, and the surrounding

neighborhood. Through a major private philanthropic organization in

20See Integrating Human Services: Linking At-Risk Families With Services More Successful Than

System Reform Efforts (GAO/HRD-92-108, Sept. 24, 1992).

Page 16 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
B-254030 

Michigan, the Kellogg Foundation, a comprehensive 20-year planning and

coordination effort was developed jointly by the foundation and local

providers and residents. Other efforts are more informal. For example, the

Teen Life Choices program in Washington, D.C., established monthly lunch

meetings that included many of the youth service providers in the

community.21 These meetings served as a way to get neighborhood

providers to better understand each other’s services, activities, and

program procedures.

Local providers are also leading efforts to build coalitions with area

schools as a strategy to deliver coordinated programs to the right age

groups. In all the neighborhoods we visited, junior high or middle schools

have emerged as major “catchments” for programs serving at-risk teen

girls. For example, West Oakland’s Lowell Middle School and Washington,

D.C.’s Evans Junior High School are working with nonprofit agencies to

deliver case management-style programs in the schools to serve their teen

populations. Oakland’s Lowell Middle School provided on-site case

management and support services for students and their families. These

services included individual and family counseling, home visits, crisis

intervention, and community service referrals. Also, a West Oakland

middle school principal is planning a program to include students, parents,

and the community at large. The program would operate between 4:00

p.m. and 10:00 p.m. and would provide a fitness lab, computer/job skills

training, medical information, mental health services, and parenting

courses. Evans Junior High School’s Turning Points program provided

individual counseling and group activities to students as well as attempted

to include parents by developing adult activities and hiring parents as

Turning Points staff. 22

The collaborative school-based efforts we observed in Detroit and West

Oakland were achieving positive outcomes. A preliminary evaluation by

the University of California of school-based projects in West Oakland

identified successes in the start-up of the school-based programs. These

programs were seeing positive responses from teachers and school

officials as well as increased involvement from teens and their families.

West Oakland found that these efforts reduced the number of discipline

hearing procedures and the number of suspensions for students in schools

receiving the services, when these students were compared with students

in schools not receiving the services. In Detroit, the community, along with

21Teen Life Choices ceased operation on Octorber 1, 1994, as a result of city budget cuts.

22In February 1995, the Turning Points Program at Evans Junior High School and 14 other middle and

elementary schools in Washington, D.C., was eliminated as a result of the city’s budget cuts.

Page 17 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
B-254030 

the Kellogg Foundation and Henry Ford Hospital, created a teen health

clinic within Hutchins Middle School. The project reported a reduction in

teen pregnancies from 14 in 1991 to 1 in 1993, immunization for all

children in the school, and improved standardized achievement test scores

over 2 years in both reading and math.

Both the literature and neighborhood providers told us that key to the

development of any school-based program is the acceptance and approval

of the school’s principal.23 Principals hold significant leverage over school

curriculum and physical space. In addition, school principals are well

informed about what is going on in school neighborhoods because they

participate in various neighborhood activities and coordinating councils.

Neighborhood providers and school officials we interviewed agreed that a

program’s success depends on the principal’s acceptance of it. In some

cases, programs have to overcome the reluctance of principals and

teachers, who may try to “wait out” new initiatives. Providers told us that

principals and school staff view new programs as politically motivated,

claiming overly optimistic results, or requiring school time and physical

space that could crowd out other programs and curricula.

Conclusions The conditions that surround many young at-risk teen girls, which have

replaced the traditional supports provided by functioning families and safe

neighborhoods, have created a group of children with few options for

future success. These children are among the most vulnerable and least

visible residents of our urban areas, and are extremely difficult to serve.

Often last in line for services delivered from a taxed and fragmented

delivery system, at-risk teen girls—if left unserved—will continue to use

scarce public resources and remain waiting to join the rolls of long-term

welfare recipients. Individual programs alone, while well-intended and

innovative in their approaches, have had little effect on the overwhelming,

complex problems of this population. Community-designed and -directed

initiatives that coordinate human service programs have shown promise in

some urban neighborhoods in attacking the broader influences that place

the well-being of these children and their families at risk. These initiatives

need to facilitate collaborative planning, problem-solving, and program

development at the neighborhood level. The challenge for both

policymakers and program officials is to develop and implement national

23School-Linked Human Services: A Comprehensive Strategy for Aiding Students at Risk of School

Failure (GAO/HRD-94-21, Dec. 30, 1993); and The Future of Children: School-Linked Services, Volume

2, No. 1 (Los Altos, CA: The Center for the Future of Children, David and Lucille Packard Foundation,

1992).

Page 18 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
B-254030 

strategies that will support local leadership and at the same time foster

cooperative ventures among local service providers.

Because this report focuses on local responses to at-risk teens and their

families, we did not obtain agency comments. We did discuss, as a part of

our field work, our observations with local providers and program

officials.

We are sending copies of this report to relevant congressional committees

and other interested parties. Copies will also be made available to others

upon request.

This work was done under the direction of David D. Bellis. If you or your

staff have any questions concerning this report, please call him on

(202) 512-7278 or me on (202) 512-7215. Other major contributors are

listed in appendix III.

Sincerely yours,

Jane L. Ross

Director, Income Security Issues

Page 19 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Contents

Letter 1

Appendix I 

Scope and

Methodology

22

Appendix II 

Profiles of the Three

Neighborhoods

Reviewed

23

Boyle Heights, Los Angeles, California 23

West Oakland, Oakland, California 25

Ward 7, Washington, D.C. 29

Appendix III 

GAO Contact and Staff

Acknowledgments

32

Related GAO Products 36

Figures Figure 1: Proportion of Women Who Gave Birth as Teenagers Is

Nearly Half of All Single Women Receiving AFDC

5

Figure 2: Neighborhoods GAO Visited 10

Figure II.1: Boyle Heights, Los Angeles, California 24

Figure II.2: West Oakland, Oakland, California 27

Figure II.3: Ward 7, Washington, D.C. 30

Abbreviations

AFDC Aid to Families with Dependent Children

CPS Current Population Survey

CRS Congressional Research Service

OTA Office of Technology Assessment

Page 20 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Page 21 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix I 

Scope and Methodology

To develop the information for this report, we collected and reviewed the

literature on adolescent health and service approaches to at-risk teens. In

addition, we reviewed studies on teen pregnancy and prevention and

analyzed data collected by the Bureau of the Census. We also contacted

program officials from federal agencies and representatives from

organizations who were familiar with this population and its service needs.

We visited three urban neighborhoods for close review—Ward 7 in

Washington, D.C.; Boyle Heights in Los Angeles, California; and West

Oakland in Oakland, California—to document the availability of human

services for at-risk teen girls; the barriers to serving this population; and

how communities are responding to this population’s service needs. We

selected these neighborhoods because they had (1) high numbers of

at-risk teens who had characteristics such as high rates of poverty, teen

births, and crime; and had (2) some services for young adolescents. In

addition, we visited a community development program in Detroit,

Michigan, that was supported by a private foundation. We interviewed

local officials, service providers, and young teen girls served by service

providers to identify the programs and problems in these neighborhoods.

We did our work between September 1993 and December 1994 in

accordance with generally accepted government auditing standards.

Page 22 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix II 

Profiles of the Three Neighborhoods

Reviewed

Boyle Heights, Los

Angeles, California

Boyle Heights, located east of downtown Los Angeles, is one of the oldest

communities in the city. Since the 1940s, Boyle Heights has been

populated by first-, second-, and third-generation families of

predominantly Mexican heritage. The community has become an

important point of entry for thousands of new immigrants since the 1970s.

Boyle Heights has a population of over 94,000, and 94 percent are of

Hispanic origin.

The majority of the area’s housing was built in the 1920s. Single family

houses compose 43 percent of the residential area. Six of the 21 public

housing projects in Los Angeles are located in Boyle Heights, which

include 2,166 units for about 8,300 residents. Commercial and industrial

corridors in the area were developed in the 1920s and 1930s and currently

include clothing and fabricated metal production. The predominant retail

trade businesses are restaurants, groceries, and clothing stores.

Almost 70 percent of the households are low income, and the area has a

poverty rate of about 30 percent, compared with a citywide rate of

19 percent. In 1990, the unemployment rate was almost 14 percent,

8 percent citywide. Approximately 3,000 of the area’s 14,500 school-age

children are in AFDC households, and the area has the 11th highest number

of children receiving free and reduced-price meals in Los Angeles County.

The crime rate in Boyle Heights is higher than in the city as a whole, with

homicide at almost twice that of all of Los Angeles; 1991-93 averages were

13 homicides per 10,000 versus 7 per 10,000 for the whole city. Gang

violence is a serious problem. Local providers estimate that about 30 gangs

operate in the Boyle Heights neighborhood. According to Los Angeles

Police Department data, 763 gang-related crimes were committed in the

district covering Boyle Heights in 1993.

Page 23 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix II 

Profiles of the Three Neighborhoods

Reviewed

Figure II.1: Boyle Heights, Los Angeles, California

Southern California

Page 24 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix II 

Profiles of the Three Neighborhoods

Reviewed

Contacts Made in Boyle

Heights Neighborhood

Aliso Pico Multipurpose Center

Barrio Action Group

Booth Memorial Center (residential care for pregnant teens)

Boyle Heights Continuation High School

Catholic Charities Brown House

City of Los Angeles, Department of City Planning

City of Los Angeles, Housing Authority

County of Los Angeles, Adolescent Family Life Program

County of Los Angeles, Department of Children’s Services

County of Los Angeles, Department of Health Services

County of Los Angeles, Division of Alternative Education

Eastside Revitalization, Community Redevelopment Agency

El Centro (mental health services)

Hollenbeck Junior High School

Hollenbeck Youth Center

Latino Family Preservation Project

Los Angeles Department of Public Social Service, GAIN Division

Los Angeles Police Department

Los Angeles Unified School District

Ramona Gardens Community Service Center

Ramona Junior High School

Ramona High School

Roosevelt High School

Salesian Boys and Girls Club

St. Anne’s Maternity Home

United Way

Variety Boys and Girls Club

West Oakland,

Oakland, California

Over the past 40 years, West Oakland has declined from a vibrant

working-class community to a decaying neighborhood. Neighborhood

conditions began to deteriorate after World War II, when houses built for

wartime workers were torn down as defense-related jobs dwindled. Also,

large public construction projects, such as the Cypress Freeway, a Bay

Area Rapid Transit station, and a main postal facility, displaced families,

destroyed homes, and separated commercial activity from the

neighborhood. Since the 1970s, the neighborhood has been unable to

regain the local businesses it once had—the neighborhood has no drug

stores, banks, or major grocery stores.

Page 25 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix II 

Profiles of the Three Neighborhoods

Reviewed

West Oakland has 12 public housing projects and one of the city’s highest

concentrations of Section 8 housing assistance recipients. In addition,

39 percent of all housing units in West Oakland are assisted housing, in

contrast to 10 percent for the entire city of Oakland.

West Oakland has poverty and unemployment rates that far exceed those

of Oakland as a whole. About 34 percent of West Oakland residents live in

poverty, almost double the city average of 19 percent. Moreover, more

than half (55 percent) of the youths living in West Oakland are poor,

compared with 30 percent citywide.

West Oakland is a dangerous neighborhood. West Oakland’s crime rates

exceed those in the rest of the city, with a homicide rate that is more than

double the citywide average, and rape and burglary rates that are almost

150 percent higher.

Page 26 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix II 

Profiles of the Three Neighborhoods

Reviewed

Figure II.2: West Oakland, Oakland, California

Northern California

Page 27 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix II 

Profiles of the Three Neighborhoods

Reviewed

Contacts Made in West

Oakland Neighborhood

Adolescent Family Life Program

Alameda County Housing Authority

Alameda County Welfare Department

Bananas (teen parent services)

Big Brothers and Big Sisters

Carter Middle School

Catholic Charities

Child Health and Disability Prevention

Child Protective Services (foster care)

Children’s Hospital

Comprehensive Teenage Pregnancy and Parenting Program

Court Appointed Special Advocate

Dream West (education program)

East Bay Omega Club

East Bay Perinatal Council, Adolescent Family Life Program

Education Now, Babies Later

Emergency Services Network

Florence Crittenton Services

George Schnotlan Youth and Family Center

Girls Incorporated (community organization/center)

Gladman Memorial Hospital

Hillcare Health Services

Imani House (community organization/center)

Lowell Middle School

Marcus A. Foster Educational Institute

McClymonds High School

Mental Health Services for Children and Youth

National Runaway Switchboard

Pregnancy Crisis Center

Oakland Birth to Schools

Oakland Housing Authority

Oakland Office of Health and Human Services

Oakland Parent Child Center

Oakland Parks and Recreation

Oakland Unified School District (Comprehensive Health and Safety

 Program)

Teen Counseling Helpline

Thurgood Marshall Family Resource Center

United Way

Urban Strategies Council (community organization/center)

We Speak

West Oakland Health Center (teen clinic)

Page 28 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix II 

Profiles of the Three Neighborhoods

Reviewed

West Oakland Mental Health Center

Youth Crisis Runaway Hotline

Ward 7, Washington,

D.C.

Ward 7 is the easternmost ward in Washington, D.C., and it is physically

separated from the central and western sections of the city by the

Anacostia River. Although it was never among the wealthiest of the

District’s communities, Ward 7 once had a solid base of middle-class

families, as well as a substantial number of small businesses and retail

establishments. However, the out-migration of many middle-income

families and businesses, which began in the 1970s, has helped to

destabilize the ward.

Ward 7 has the highest concentration of public housing stock in the city,

one-third of the city’s total stock—or about 2,880 units. In 1990, Ward 7

had a population of about 73,000, as compared with over 86,000 in 1980.

The neighborhood in Ward 7 we visited had about 43,000 residents. Over

25 percent of the Ward’s residents live in poverty. In contrast, about

17 percent of the total Washington, D.C., population lives in poverty.

Forty-six percent of the neighborhood’s 32,473 adult residents (16 and

older) were either not in the labor force or not employed.

Nearly 5,300 families, or 67 percent of the Ward’s families with children,

were headed by a single parent. Further, 26 percent of its population was

under 18 years of age in 1990. About 20 percent of all births in the

neighborhood were to females under age 20.

In 1993, the Ward 7 neighborhood accounted for 64, or about 14 percent,

of the city’s 453 homicides and 11 percent of the reported rapes that

occurred in the city.

Page 29 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix II 

Profiles of the Three Neighborhoods

Reviewed

Figure II.3: Ward 7, Washington, D.C.

Page 30 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix II 

Profiles of the Three Neighborhoods

Reviewed

Contacts Made in Ward 7 African Heritage Dancers and Drummers

Ballou High School (Project We Care)

Best Friends (mentoring program)

Center for Law and Social Policy

Center for Substance Abuse Prevention

Center for Youth Services

Children’s Trust Neighborhood Initiative (case management and social

 support)

Columbia Hospital Teen Center

Community Health Care, Inc.

D.C. Bureau of Training and Employment, JOBS Program

D.C. Department of Child Protective Services

D.C. Department of Recreation

D.C. Department of Human Services, Office of Maternal and Child Health

D.C. Healthy Start

D.C. Mayor’s Youth Initiative

East Capitol Dwellings

East of the River Health Clinic

Edward Mazique Parent/Child Center

Greater Washington Boys and Girls Club—Jelleff House (residential

 program)

Greater Washington Urban League

James Bell and Associates

Kenilworth-Parkside Recreation Center

Marshall Heights Community Development Organization

Metropolitan Police Boys and Girls Clubs

People’s House (hotline and referral service)

Planned Parenthood of the Metropolitan Washington Area

Richardson Elementary School

Roving Leaders Program (counseling and referral service)

Sasha Bruce Youthwork

SYNERGY (adolescent health community coalition)

Teen Life Choices

Turning Points Program at Evans Junior High School

United Black Fund

U.S. Department of Justice, Office of Juvenile Justice Programs

Page 31 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix III 

GAO Contact and Staff Acknowledgments

GAO Contact David Bellis, Project Manager, (202) 512-7278

Acknowledgments The following individuals also made important contributions to this report:

Valerie Rogers, Evaluator; John Vocino, Senior Evaluator; Lisa Shibata,

Evaluator; Pamela Brown, Evaluator; and Margie Shields, Senior

Evaluator.

Page 32 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix III 

GAO Contact and Staff Acknowledgments

Page 33 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix III 

GAO Contact and Staff Acknowledgments

Page 34 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Appendix III 

GAO Contact and Staff Acknowledgments

Page 35 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
Related GAO Products

Community Development: Comprehensive Approaches Address Multiple

Needs but Are Challenging to Implement (GAO/RCED/HEHS-95-69, Feb. 8, 1995).

Families on Welfare: Teenage Mothers Least Likely to Become

Self-Sufficient (GAO/HEHS-94-115, May 31, 1994).

Families on Welfare: Focus on Teenage Mothers Could Enhance Welfare

Reform Efforts (GAO/HEHS-94-112, May 31, 1994).

Foster Care: Parental Drug Abuse Has Alarming Impact on Young Children

(GAO/HEHS-94-89, Apr. 4, 1994).

Residential Care: Some High-Risk Youth Benefit, But More Study Needed

(GAO/HEHS-94-56, Jan. 28, 1994).

School-Linked Human Services: A Comprehensive Strategy for Aiding

Students at Risk of School Failure (GAO/HRD-94-21, Dec. 30, 1993).

Integrating Human Services: Linking At-Risk Families With Services More

Successful Than System Reform Efforts (GAO/HRD-92-108, Sept. 24, 1992).

Child Abuse: Prevention Programs Need Greater Emphasis (GAO/HRD-92-99,

Aug. 3, 1992).

Public And Assisted Housing: Linking Housing and Supportive Services to

Promote Self-Sufficiency (GAO/RCED-92-142BR, Apr. 1, 1992).

(118931) Page 36 GAO/HEHS/RCED-95-108 At-Risk Teen Girls
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