District of Columbia Department of Health: Reducing Rapid Repeat Pregnancies and One Young Mother’s Journey to Success
By Margaret G. Copemann, BS, CHES, CCHC
Public Health Advisor
District of Columbia Department of Health, Community Health Administration, Child, Adolescent and School Health Bureau
Located within a District of Columbia (DC) Public High School, the Woodson Adolescent Wellness Center (WAWC) provides services on average to 475 teens per year. The Title V funded center is a collaborative project of the Community Health Administration of the DC Department of Health and DC Public Schools. Established in 1994 to provide comprehensive health care services to adolescents; promote pregnancy prevention; and to assist in health education of students who attend HD Woodson Senior High School. The WAWC has four specific objectives: (1) to promote health maintenance among adolescents; (2) to motivate students to avoid risky behaviors and adopt healthy lifestyles; (3) to provide convenient health services; and (4) to educate students on how to utilize services in the DC’s health care system.
HD Woodson Senior High School is located in the second most impoverished of DC’s eight city wards: Ward 7. Its geographical location at the eastern-most tip of the city accentuates the vulnerability of its predominantly African-American population; 30 percent of Ward 7 residents are youth ages 19 and under. According to the latest demographic data, 63 percent of mothers receive inadequate prenatal care, 82.6 percent are single mothers and 7.7 percent of these single mothers are younger than 17 years old. At HD Woodson Senior High School, 93 percent of the student population is eligible for the free/reduced lunch program, 27 percent are in the Special Education program and a high percentage live in single-parent households, foster and kinship care or are homeless.
In the interest of reducing the percentage of repeat births for teens less than 19 years of age, which currently stands at 12 percent, the WAWC continues to pay particular attention to teen moms and dads. The Woodson Adolescent Wellness Center is guided by research that says teen pregnancy is less likely when boys and girls have a sense of belonging; get health care they need; have close, caring relationships with trustworthy adults; and feel connected to their families, schools and neighborhoods.
A Real Success Story
Joniqua is a 17-year-old senior at HD Woodson Senior High School and the mother of a two-year-old son. She is a long time client of the WAWC and has been steadfast in implementing the counseling, education and encouragement she has received from the WAWC staff with the intention of not repeating a pregnancy before completing her education. She will graduate in June 2011 and will begin her freshman year at North Carolina Central University in the fall of 2011 where she plans to major in forensic science and minor in anthropology. She has always loved science and was influenced in the selection of her major and minor by a member of the scientific community who mentored her during her 2010 summer job at the National Institutes of Health. Adding to her list of outstanding accomplishments, Joniqua was selected to be the recipient of the Florence Crittenden “Outstanding Teen Parent” award. In preparation for college, she has already secured a summer job with a schedule that will allow her to spend real quality time with her son.
She attributes her success in avoiding a repeat pregnancy to the loving support of her mother, grandparents and to the connection she feels with her school community. She also credits her trusting relationship with the WAWC staff, and has a committed dream of providing a better life for herself and her son.
Although numerous teen moms and dads have participated in the WAWC and graduated without becoming a repeat parent, the Woodson Adolescent Wellness Center does not have the capacity to follow-up to determine if this remains the case prior to achieving life goals.
Embracing a Positive Youth Development Framework to Reduce Adolescent Pregnancies in Idaho
By Mercedes Muñoz, MPA
State Adolescent Health Coordinator
Program Manager, Adolescent Pregnancy Prevention & Sexual Violence Prevention
Bureau of Community & Environmental Health
Idaho Department of Health and Welfare
Idaho’s Adolescent Pregnancy Prevention (APP) Program utilizes evidence-based or evidence-informed strategies to prevent unplanned pregnancies among adolescents; however, the APP Program has augmented its strategies to be more holistic by incorporating a positive youth development framework for pregnancy prevention.
The APP Program has contracts with Idaho’s seven public health districts to implement Reducing the Risk (RTR), an evidence-based curriculum. Through this partnership, the APP Program has implemented RTR around the state. Reducing the Risk focuses on developing participants’ skills such as refusal skills, delay tactics and the ability to assess and abstain from risk. Most recently, the APP Program received Personal Responsibility Education Program (PREP) grant funds from the Health and Human Services to expand implementation of the RTR curriculum in Idaho schools and begin implementation of Cuídate, a culturally-based program for Latino youth.
The APP Program is also working with the Idaho Coalition Against Sexual and Domestic Violence to implement Wise Guys, an evidence informed male-oriented pregnancy prevention curriculum. Wise Guys focuses on engaging males in pregnancy prevention efforts and providing participants with a healthy framework around masculinity, healthy relationships and goal setting. Participants of this curriculum have the opportunity to participate in youth driven service-learning projects.
We are also in the process of conducting a community needs assessment at Idaho State University (ISU) to identify effective local strategies to reduce unplanned pregnancies among 17 to 19-year-olds, which account for Idaho’s highest number of adolescent pregnancies. ISU is our first pilot site and we hope to expand to other institutions of higher learning.
Recently, the State Adolescent Health, Resource Center, Konopka Institute for Best Practices in Adolescent Health provided Idaho’s APP partners and contractors with a daylong training on adolescent development and how it intersects with pregnancy prevention. This training was a catalyst in moving our contactors toward the incorporation of a positive youth development framework in their work.
The APP Program staff acknowledges that we are in a unique position, having the opportunity to work with a diverse and dynamic population that is in transition - adolescents. We look forward to continue our support of young people as they transition into adulthood in a more holistic way.
Replicating the Teen Outreach Program in Rural Missouri
By Jennifer Farmer
Health Educator II
Adolescent Health Program
Missouri Department of Health and Senior Services
Over the last eight years, the Missouri Department of Health and Senior Services (DHSS) and community partners have replicated the Teen Outreach Program (TOP) in targeted rural counties. Maternal and Child Health Title V Block Grant funding has and continues to support local programs. DHSS has experienced tremendous success by contracting with local health departments to coordinate and expand TOP replication in their respective counties.
TOP was originally developed in Missouri. Wyman in St. Louis holds the copyright and provides resources for replication. Nationally, TOP is one of the most popular evidence-based teen pregnancy prevention program models selected for replication with federal grant funds. Wyman’s TOP is one of the few youth development initiatives proven to be highly effective in preventing risk factors of school dropout, academic failure, and teen pregnancy. The program addresses needs of culturally diverse adolescents in grades 6-12, ages 12-19. Most importantly, TOP develops life skills, healthy behaviors, and a sense of purpose that youth can apply now and throughout their lives.
TOP participants meet weekly over 9 months to participate in curriculum-guided discussions, and complete at least 20 hours of community service learning. DHSS contractors typically begin TOP replication with a sixth grade after-school club and continue to add additional clubs each year so youth can be involved in TOP through middle school and high school years.
Missouri rural counties have embraced TOP for multiple reasons: 1) TOP youth have become actively involved in their communities through service learning projects; 2) TOP provides an alternative activity for youth who are not involved in other programs; 3) TOP focuses on relevant adolescent health issues including sexuality education; and 4) TOP positively impacts academic performance and attendance.
There are several essential components to ensure TOP is successfully implemented with fidelity in a rural setting:
· Identify a local champion to coordinate the program who is passionate about positive youth development and who has many community connections to leverage local resources.
· Recruit, train, and retain TOP facilitators (“kid magnets”) who are approachable positive mentors dedicated to serving youth and who youth respect.
· Provide TOP coordinators and facilitators with ongoing training and technical assistance, as well as opportunities to network with others who are implementing TOP.
· Consider potential barriers (e.g., transportation and other competing afterschool activities) and identify resources and other strategies to encourage and recognize youth participation.
For more information, contact: Jennifer Farmer, Jennifer.firstname.lastname@example.org, (573) 751-6212.
Reducing Hispanic Pregnancy Rates: New York’s Comprehensive Adolescent Pregnancy Prevention (CAPP) Initiative
By Barbara Leo, MS, FNP
Director, Adolescent Health Unit
Bureau of Maternal and Child Health
New York State Department of Health
Bureau of Maternal and Child Health
New York State (NYS) has made significant progress in reducing adolescent pregnancy rates, with a 40% decline in rates since 1993. However, the racial and ethnic disparities in sexual health outcomes for Hispanic teens remain a serious public health issue. From 2001 to 2008, in stark contrast to significant declines in pregnancy rates among white (23%) and black (19%) teens, pregnancy rates among Hispanic teens increased by nearly 5%. Reducing these disparities is a priority within NYS Department of Health (NYSDOH) adolescent sexual health programming.
In 2009 NYSDOH, in conjunction with the DOH-funded Assets Coming Together (ACT) for Youth Center of Excellence (COE), held an Adolescent Sexual Health Symposium. The symposium brought together state agency staff, national experts on adolescent sexual health, key stakeholders and a youth panel to review data, research and best practices, and make recommendations, including specific needs and strategies related to reducing disparities. Additionally, 27 youth focus groups, including racially and ethnically diverse groups, were conducted to learn more about how young people acquire information about sexual health and to share their ideas on how to improve adolescent sexual health care and public health programs. Reports from the symposium and the youth focus groups are available on the ACT for Youth COE website.
Building on the lessons learned from the symposium and focus groups, NYSDOH has undertaken a new statewide Comprehensive Adolescent Pregnancy Prevention (CAPP) initiative. CAPP includes a significant focus on reducing racial and ethnic disparities. An Adolescent Sexual Health Needs Index (ASHNI) was developed to identify eligible target communities and prioritize the selection of CAPP projects. The ASHNI is a ZIP code-level multidimensional measure that incorporates multiple key factors related to adolescent sexual health outcomes, including burden (number) of adolescent pregnancies and STD cases and demographic and community factors (education, economic, and race/ethnicity indicators) that are significantly associated with adverse sexual health outcomes. The ASHNI further supports targeting public health resources to areas of highest need and reducing disparities.
Through the CAPP initiative, NYSDOH has awarded more than $17.5 million in state grants to 50 community-based organizations. To further address disparities, preference was given to organizations that have staff and Boards representative of racial and ethnic populations they serve and experience serving minority populations. The community projects focus on the prevention of pregnancies, STDs and HIV among male and female adolescents ages 10 to 21 years. Projects implement evidence-based sexuality education; ensure access to reproductive healthcare services; expand educational, social, vocational and economic opportunities; and engage adults to advance comprehensive and sustainable local community efforts to improve environments for young people. Over twenty CAPP grantees include a specific focus on serving Hispanic youth in their projects.
NYSDOH will be working with the COE to evaluate the CAPP initiative to determine the effectiveness of the CAPP interventions and future policy changes, including a continued focus on reducing disparities among Hispanic populations.