Teen Pregnancy Guidelines of Care A Guide for Prenatal Providers CPSP Annual Meeting November 14, 2013

1. Teen Pregnancy Guidelines of CareA Guide for Prenatal ProvidersCPSP Annual MeetingNovember 14, 2013

2. Introduction • Kelley Cooper, MPH, CHES • Tanya Wicks, MPH

3. PAC/LAC (Perinatal Advisory Council: Leadership, Advocacy, and Consultation) is a non-profit maternal and child health organization that improves pregnancy and birth outcomes through partnerships with professionals and health systems that care for pregnant women and their families. 

5. Purpose of Teen Guidelines • Teen Friendly Enhancement Program (1997) • Clinical focus • Teen Pregnancy Guidelines of Care (2014) • The CA Wellness Foundation (TCWF) grant • Public health focus • Target audience • Region: LA, Ventura and SB Counties • Statistics for programs • Engage and involve • Strength-based

6. Objectives Upon completion of the presentation, participants will be able to: • Identify tools for assessing developmental stage of pregnant teen. • Utilize the four support systems for creating a teen-friendly environment. • Relate the tri-county special populations to special populations in your region. • Design activities and programs for teens in your region.

7. Tanya’s Pregnancy • Married • Second child • Childcare • Education • Housing • Transportation • Insurance • Friends and family • Resources • Empowered

8. Teen-Friendly Environment 4-Prong Approach

9. Developmental Assessment Communication • Cognitive • How will life change after the baby is born • What information is used to make decisions related to pregnancy • Sexual behavior • Nature of the relationship in which pregnancy occurred • Issues related to sexual identity or orientation • Social support • Current living situation • Expectations for parenting support • Body image • Identity • Autonomy

10. Developmental Assessment Health Education Tools • PREP- Parenting Responsibility Emotional Preparedness Screening Tool (3-Item Screen that Identifies Teen Mothers at High Risk for Nonoptimal Parenting) • PSC-Y- Pediatric Symptoms Checklist • RAAPS- Rapid Assessment for Adolescent Preventive Services

11. Clinical Environment • Waiting Room/Exam Room • “I don’t care what's in the waiting room. I don’t like making an appointment and then waiting like 2 hours to see the Doctor. Sometimes Iwait 2 hours and then they tell me the Drs. not in, an emergency. I missed school for this.” • “I don’t like waiting with all the eyes in the waiting room. All these older women judging us. I go to check in and they don’t use my name, they just announce my birthdate, it always gets real quiet then.”

12. Clinical Environment • Tech Strategies • 85% of teens own a cellphone/smartphone • Confidentiality • Consent to share pregnancy with parent • Rights of a minor • Source: www.teenhealthlaw.org

13. Clinical Environment • Strength-based • Reflective Practice • Motivational Interviewing • RESPECT

14. Social Environment • Family Contract • Clothing and Dressing (example): • The minor parent will be responsible for dressing the infant in the morning before school or other functions. Minor parent will also be responsible for any clothing changes that occur in the evening, night and on weekends. • If the infant is in daycare, minor parent will be responsible for providing them with additional clothes for accidents. • Minor parent acknowledges that infants may have more sensitive skin and agrees to separately launder the infant’s clothes. • The _____________ caregiver will do all necessary clothing changes while the infant is in their care. _____________ caregiver acknowledges that minor parent requests no bows or barrettes be placed in the infants hair to reduce choking hazards. • Additional support needed: infant neck support and how to pack a diaper bag. • When there is a concern ___________will discuss with ___________. If no resolution can be reached ____________ will contact ___________ for additional help.

15. Social Environment • Partner support • Teen fathers view providers as unsupportive • Involve in discussion / answer questions • Linked to decreased stress and depression for teen mothers • Insurance • Medi-Cal Minor Consent Program – confidential care • Childcare • CA School Age Families Education Program (Cal-SAFE) – focus is to keep teens enrolled in school

16. Mental Health Environment • Adverse Childhood Experiences (ACEs) • Trauma-informed care

17. Mental Health Environment • Depressive Disorders • Depression is more prevalent in teen moms • Childbearing does not cause depression • Low screening rates

18. Legal Environment • Legal Documents • Naming the Baby • 10 days then “baby boy/girl” • Custody • Teen can maintain custody • Courts do not consider immigration status • Child Support • Courts do not consider immigration status

19. Legal Environment • Legal Documents • Birth Certificate • Confusion • Purpose • Social Security Card • Significance • Identity Protection • Establishing Paternity and Father’s Rights • State law requires both parents’ signatures • Hospital Paperwork

20. Special Populations • Foster Youth • 50% of foster youth become pregnant by age 19 • Two times more likely to have children in foster care system • Homeless teens • 4 times more likely to become pregnant • Linkage to resources

21. Special Populations • LGBTQ • 2-10 higher pregnancy rates than heterosexual peers • Same gender or both gender partners • 1 in 3 teen fathers / 1 in 8 teen mothers • Risk factors • Mixtec teens • Native Oaxacan , southern Mexico • Communication barriers • Cultural norms • Age difference between couple – avoid Child Welfare Services • Lack of prenatal care • Farmworkers

22. Next Steps • Increase access to prenatal care • Address risk factors • Screen for depression during pregnancy • Encourage legal counseling • Promote involvement of baby’s father (if safe) • Avoid disruption of educational goals • Services that promote positive parenting / peer support • Purpose of appointment and which provider (return for next appointment) • Discuss confidentiality (not doing so - 11 pregnancies for every 100 teen females) • Opportunity to speak alone with provider (accompanied by parent /baby’s father) • Not a crisis (information on keeping the baby/ before adoption or abortion) • Appointments (mindful of school schedule and transportation barriers)

23. Thank You • Contact Information • Tanya Wicks: trwicks@paclac.org • Kelley Cooper: kcooper@paclac.org • Web site • www.paclac.org