HORIZON INTERNATIONAL SOLUTIONS SITE

Problem Overview:

Prevention of unwanted teenaged pregnancy and sexually transmitted infections

Helping youth avoid unwanted pregnancies and sexually transmissible infections is a challenge that faces communities around the world. Children having children is a problem with dire consequences for both the young people themselves and for society as a whole. Young people with children have sharply reduced education and employment opportunities and a poorer quality of life. Meeting their needs places a severe burden on both families and public resources. Moreover, sexually active teens are at great risk of contracting AIDS and other sexually transmitted diseases.

The United States has the highest rate of teen pregnancy of any industrialized nation...twice as high as England, France and Canada, and nine times as high as the Netherlands and Japan. More than one million teenage girls become pregnant each year in the U.S. -- 11% of all women aged 15-19 -- with over 40% of all females under 20 having at least one pregnancy. Over three fourths of teen pregnancies are unplanned, accounting for about one fourth of all accidental pregnancies each year. About 55% of teen pregnancies end in birth, 31% in abortion, and 14% in miscarriages. Of those teenage women who choose to become mothers, one out of four will have a second child within two years of their first.

Young people also have a high incidence of sexually transmissible infections. More than 25% of sexually active adolescents in the U.S.-- over three million teens -- acquire a sexually transmitted disease each year, threatening their ability to have children and increasing their risk of cancer and infection with the HIV/AIDS virus. In a single act of unprotected sex with an infected partner, a teenage woman has a 1% risk of acquiring HIV, a 30% risk of getting genital herpes, and a 50% chance of contracting gonorrhea. While the risk of acquiring HIV is lower than that for other sexually transmissible infections, AIDS is the sixth leading cause of death among 14 to 25 year-olds, and the leading cause of death among 25 to 44 year-olds, in the U.S. today.

Background:

It is a well-established fact that young people listen to and are influenced by other young people. While peer counseling programs for teens are becoming more and more common, clinics that provide birth control information by and for teens are relatively rare. One such program has been operating successfully at the Valley Community Clinic (VCC) in North Hollywood, CA, where it was established in 1992 as a demonstration project funded under Gov. Pete Wilson's Teen Pregnancy Prevention Initiative.

The VCC Teen Clinic maintains the philosophy that teens tend to better understand and place more value on information about sexuality issues if it is presented to them by their peers. Designed with the help of a Teen Advisory Committee, the clinic is run by teen staff under professional supervision. The staff are graduates of the VCC's AIDS Education and Prevention Peer Health Educator Project with forty hours of training that covers birth control and pregnancy, HIV/AIDS and other sexually transmissible infections, skills for dealing with peer pressure, and effective communication. They have also been taught clinic procedures and how to take medical histories and blood pressure. They are certified as Community Health Workers through the California Family Planning Council.

The Teen Clinic is open for four hours after school on Mondays and Wednesdays and six hours on Saturdays. During these hours the entire Community Clinic is dedicated to teens, who are made to feel as comfortable as possible. The television set in the lobby is tuned to popular programs such as MTV. Teens receive a wide range of medical services including free and anonymous HIV testing, complete gynecological exams, birth control supplies, and pregnancy testing. The teen staff provide counseling on birth control and sexually transmissible diseases, take vital signs, and perform lab tests. They also operate a Teens Helping Teens Hotline to schedule appointments and provide information and referrals. All clinic visits and birth control supplies are free.

Initially there was some resistance from the older clinic staff about having teens staff the Monday and Saturday clinics, but over time the teens proved themselves by demonstrating responsibility, initiative and proficiency in working with clients and by thoroughly completing paperwork. Other problems encountered include the fluctuation in demand for services as a result of school activities and vacations, and the lack of good transportation alternatives for those teens who do not drive and had to travel great distances by bus to the clinic. Although the clinic has been able to obtain and distribute some taxi vouchers, transportation continues to be an important issue. The demand fluctuations, while not overly detrimental to clinic operations, had to be taken into consideration when planning outreach activities and developing staff schedules.

Community outreach is an important part of Teen Clinic operations. The Teen Clinic's two full-time Health Educators make presentations at high schools, youth groups and shelters, adolescent psychiatric units, and Juvenile Hall. Teachers frequently call on the Health Educators for assistance with their reproductive health curriculum, and schools regularly refer teens with reproductive health concerns to the clinic. A strong emphasis has been placed on reaching adolescent males, who are frequently neglected. "Materials overlook males," says one male peer counselor. "And a lot of the information they get regarding pregnancy and sexually transmitted diseases, they get from their friends, and a lot of that information is wrong." The clinic's Adolescent Male One-on-One Outreach Program provides male teens with the knowledge, skills and tools to become equal partners in sexual responsibility. Adolescent males are also given the same consideration as adolescent female clinic patients -- individual attention, confidentiality and, above all, respect.

Implementation:

Both teen patients and their peer counselors are benefitting from the program. During the first three years of Teen Clinic operation, first-time teen visits increased 326%, and total teen visits increased 240%. Moreover, the teen pregnancy rate at the clinic dropped from 30% to 6%, and down to 2.7% for those in the clinic's special follow-up program. In addition to reducing teen pregnancy, the clinic provides extensive job training, meaningful employment, and educational incentives for those teens fortunate enough to be given the opportunity to serve their peers and their community. As one teen counselor observes, "It's all about knowledge and being able to help friends."

In 1995, the California Wellness Foundation approved a grant of $5 million over four years to Los Angeles-based California Family Health Council (CFHC) to replicate the VCC Teen Clinic model. Four sites were chosen in 1996 to receive funding -- East Valley Community Health Center in Pomona, EOC Health Services in San Luis Obispo, Tri-City Health Center in Fremont, and Vista Community Clinic in Vista. Funding to the Valley Community Clinic was also continued. Each of the new sites met the requirements of having a demonstrated need in the community and a history of working with teenagers. The clinics each recruited five to ten teen workers who were trained as medical assistants and required to pass the CFHC's Basic Health Worker Exam. Sixty teen staff members also attended an orientation retreat. "We made it clear that we were not looking for just the straight-A students," says Faye Weinstein, CFHC Project Coordinator. "We also wanted to hire students who reflected the general community around the clinics."

As the teens began working at the clinics, they developed a sense of pride in their efforts. Unlike the Valley Community Clinic, the replication clinics do not allow adults in the waiting room during teen clinic hours. In keeping with the VCC model, recent high school graduates also conduct community outreach aimed at adolescents and parents as well as one-on-one educational sessions with male teens. Outreach workers address issues such as sexually transmitted infections, birth control, repreductive anatomy, and decisionmaking. According to many sources involved with the clinic, males feel more comfortable in one-on-one situations.

A multi-site evaluation of the four new clinics conducted after two years showed the results to be promising. The study was conducted by Laura Mamo of the University of California, San Francisco. She reported that "within one year, there were over 3,000 new teen clients enrolled in the teen clinics, 18% of whom were male.... We are also seeing a strong impact on the lives of the teen staff. Their peer group is looking to them as lay experts and they feel more power in their lives. Many are exploring careers in the health care field or social work. Comments from the teen staff affirm Mamo's observations. "I like it that a lot of teens look up to me, asking for my advice. It feels good when they call the clinic and ask for me when they have questions," says one female staff member at the Vista Community Clinic who hopes to be a nurse practitioner one day. Another young woman who started working at the Valley Community Clinic four years ago observed: "The fact that I started working here at such a young age has helped me a lot. It makes me feel that I have much more of a head start in life."

Documentation:

A formal evaluation of all five teen clinics is being undertaken by the Institute for Health Policy Studies at the University of California, San Francisco.

The VCC Teen Clinic will be featured in a one-hour television documentary and home video, Sensible-Sex: Reducing Teen Risk, being produced by HORIZON International.

Submitted by:

Valley Community Clinic
Diane Chamberlain, Associate Director
Tel: (818) 763 8836 - USA
Fax: (818) 763 7231