TEEN PREGNANCY IN LAKE COUNTY Community Plan of Care Project: By: Sarah Bricker Josha Harvey Amy Roelse Erin Scarbrough- Raden Jody Van Halsema

Introduction  With a population of 11,498 (District Health Department #10, 2013, p.3), Lake County is a smaller rural community that is most known for its wildlife, motorsports, fishing, annual summer events, tourism, and outdoor activities. Located in the northwestern part of Michigan’s lower peninsula (Lake County Chamber of Commerce [LCCC], 2014). Despite those attractions, there is a high prevalence of teenage pregnancy, high rates of poverty, and low levels of education.

Community Strengths Community Assets: Beautiful scenery, many lakes, wildlife and natural resources Safe community with low violent crime rates Coordination between providers Existing Services Lake County Community Foundation Teen Pregnancy Prevention Initiative Lake County Health Department Spectrum Health Reed City Hospital Baldwin Family Health Center United Way Baldwin Teen Health Clinic

Community Weaknesses Areas of Concern Teen (ages 15-19) pregnancy rate of 64.8 in 1,000 females (District Health Department #10 [DHD10], 2013) Teen (ages 15-19) repeat pregnancy rate of 28.6% (Hill et al., 2011, p. 43) Low rates of high school graduation High rates of child abuse and neglect High rate of single parent households High poverty and unemployment rates High probability of students perpetuating the cycle of poverty by not graduating high school or completing higher levels of education High rates of under/uninsured, use of Medicaid and WIC

Community Weaknesses Continued Lack of resources Few OBGYN’s and no pediatricians, specialists, youth services, chronic disease prevention services, mental health services, or substance abuse services in the area No hospital in Lake County; no labor and delivery or neonatal care in the area Very few primary care physicians resulting in long wait times and difficulty getting timely appointments due to high ratio of patients per physician No public transportation High rate of under/uninsured, high levels of children in households who receive WIC

Analysis  Causative Factors: Changeable: Low education levels, poverty, peer pressure and influence, glamorization of teen pregnancy, parental involvement, lack of knowledge surrounding teen pregnancy/reproduction/contraceptive use, substance abuse, lack of healthcare and pregnancy prevention resources, being a child of teen parents (changeable in the future), product of child abuse/neglect (changeable in the future) lack of extracurricular activities Unchangeable: Rural area  Direct and Indirect Measures: Direct Measures: Teen pregnancy rates and repeat pregnancy rates among females ages Indirect Measures: Unemployment rates, high school and college graduation rates, poverty levels, knowledge of reproduction and sexual health, sexual education program rates in the area schools and health departments, child abuse/neglect rates

Community Diagnosis  Teenagers in Lake County are at risk for becoming pregnant due to low levels of education, poverty, increased rates of child abuse and neglect, lack of access to pregnancy prevention and healthcare resources, children living in single parent households, and being a child of a teen parent(s),and living in a rural environment as evidenced by a teen pregnancy rate of 64.8 in 1,000 females (DHD10, 2013) and repeat teen births of 28.6% (Kids Count, 2013)

Goal and Mission Statement Mission Statement – To equip students with the knowledge and skills necessary to develop healthy relationships, make responsible and healthy life choices, and to avoid behavior which places them at risk for sexually transmitted diseases and unplanned pregnancies.

Transtheoretical Model of Change 1. Pre contemplation: Teens are engaging in risky behaviors (having unprotected sex) that could lead to pregnancy and do not see the need for change. 2. Contemplation: Teens begin thinking about abstinence or talking to their partner about contraceptives and start looking for places that provide pregnancy prevention resources, counseling, etc. 3. Preparation: Teens develop a plan to use contraceptives or to remain abstinent. 4. Action: Teens are engaging in safe sex or abstinence. 5. Maintenance: Teens consistently using contraception or practicing abstinence and plan to continue.

Group Project Overview Issue of concern: Teen pregnancy and repeat pregnancy rate in Lake County, MI Diagnosis: Higher than state and national average teen pregnancy rates and repeat pregnancy rates Target group: Teens in Lake County, MI ages Unmet Needs vs. Existing Services: Currently has Baldwin Family Health Care with Baldwin Teen Health Center; good collaboration between healthcare providers. However, there is a lack of funding and financial limitation. Need for more community involvement and long term planning. Evidence Based Practice: With teens as the target group, evidence based programs must be implemented and continually funded. Investment should be made in primary prevention. Planning and Implementation: A task force of key stakeholders must identify areas of need, especially a need for sexual education programs and pregnancy resource centers in Lake County. Areas of need require state and federal funding in order further implement vital programs in the area. Good use of existing resources and collaboration among schools, healthcare providers and members of the community to strengthen awareness and prevention.

Planning Target population: All teens ages (pregnant or not) in Lake County, District Health Department #10 Goal: Reduce teen pregnancy for females under the age of 19 in Lake County from 64.8% to meet the Healthy People (HP, 2014) 2020 goal of 36.2 per 1,000 births by Solutions: Teen pregnancy and repeat pregnancy rates can be improved through reproductive health and pregnancy prevention education; state and local funding for improved access to health services; collaboration between schools, clinics, physicians, and other educational and healthcare sources; hangouts that are safe for teens in the area to provide extracurricular activities; and increasing access and education revolving contraceptive devices and risks of sexual activity. Resources Needed: Key stakeholders and members from different disciplines to form a planning group that identifies needs, implements sustainable programs/services, assists in the allocation of resources needed, and evaluation of results (Hill et al., 2011, p. 10). Grants and other funding for pregnancy prevention programs and education.

Planning Administer anonymous pre-test on reproductive health, pregnancy prevention, substance abuse, healthcare resources, pregnancy prevention resources, counseling resources to male and female high school students. Education – Reproductive health, Pregnancy prevention, Substance abuse effect on judgment, Healthcare resources available, Pregnancy prevention resources available, Counseling resources available Administer anonymous post-test on reproductive health, pregnancy prevention, substance abuse, healthcare resources, pregnancy prevention resources, counseling resources to male and female high school students.

Interventions Education includes:  Recognizing risky behavior and students at increased risk  Lectures with power point presentations, Handouts, Technology resources (websites –.edu,.gov,.org), and Question & Answer time (private and public)  Reproductive health – Basic information and Healthy relationships  Pregnancy prevention – Abstinence and Contraceptives available  Substance abuse effect on judgment – Alcohol and Drugs  Support and open communication among parents, students, educators, and healthcare providers  Parent involvement  Using other teen mothers as mentors or speakers  Providing real statistics and data about Lake County’s striking teen pregnancy rates  Healthcare available – Clinics and Local Health Department  Pregnancy prevention resources available – Local Health Department and Pregnancy Resource Center  Counseling available – Network 180 and School Counselors

Reproductive Health in Schools Reproductive Health – The state of an individual’s well- being which involves the reproductive system and its physiological, psychological, and endocrinological functions. The state of Michigan requires schools to teach the Michigan Health Model A – K approved by the Michigan Department of Community Health.

Michigan Health Model A-K A – K Model – Pregnancy Resource Center (2014) describes them as follows: A. Teach the benefits of abstaining from sex until marriage. Teach the benefits of ceasing sex, if a student is already sexually active. B. Discuss possible emotional, economical, and legal consequences of sex. C. Discuss how unplanned pregnancy and sexually transmitted diseases are serious consequences that are not fully preventable, except by abstinence. D. Advise students of the laws pertaining to their responsibility as parents to children born in and out of wedlock. E. Ensure that students are not taught in a way that condones violating the laws of this state pertaining to sexual activity, including those relating to: sodomy, indecent exposure, gross indecency, and criminal sexual conduct.

Michigan Health Model A-K F. Teach students how to say ‘no’ to sexual advances and that it is wrong to take advantage of, harass, or sexually exploit another person. G. Teach refusal skills and encourage students to resist pressures to engage in risky behavior. H. Discuss how the student has the power to control personal behavior. Students shall be taught to base their actions on reasoning, self-discipline, a sense of responsibility, self-control, and ethical considerations such as respect for self and others. I. Provide instruction on healthy dating relationships, how to set limits, and recognize a dangerous environment. J. Provide information for students about how young parents can learn more about adoption services and about the provisions of the safe delivery of newborns law. K. Inform students that having sex or sexual contact with an individual under the age of 16 is a crime punishable by imprisonment and that one of the other results of being convicted of this crime is to be listed on the sex offender registry for up to 25 years.

Pregnancy Prevention in Schools Pregnancy Prevention – Compare and contrast the pros and cons of methods used for pregnancy prevention, including abstinence and use of contraception. Sexually Transmitted Infection Prevention – Compare and contrast the pros and cons of methods used for sexually transmitted infection prevention, including abstinence and use of contraception. Abstinence – The practice of refraining from some or all aspects of sexual activity for medical, psychological, legal, social, financial, philosophical, moral, or religious reasons. Contraception – Birth control and fertility control which uses methods or devices to prevent pregnancy.

Forms of Contraception Forms of Contraception – Planned Parenthood (2014) describes them as follows: Abstinence – The practice of refraining from some or all aspects of sexual activity for medical, psychological, legal, social, financial, philosophical, moral, or religious reasons. Birth Control Implant – A matchstick-sized rod that is inserted in the arm to prevent pregnancy Birth Control Patch – A small patch that sticks to your skin to prevent pregnancy Birth Control Pills – A pill taken each day to prevent pregnancy Birth Control Shot – A shot in the arm that prevents pregnancy Birth Control Sponge – A foam sponge inserted into the vagina to prevent pregnancy Birth Control Vaginal Ring – A small ring put in the vagina once a month for three weeks to prevent pregnancy Breastfeeding – Lactational Amenorrhea Method – A natural way to prevent pregnancy after giving birth Cervical Cap – A silicone cup inserted into the vagina to prevent pregnancy Condom – A latex or plastic sheath worn on the penis to prevent pregnancy and the transmission of sexually transmitted infections

Forms of Contraception Diaphragm – A shallow silicone cup inserted into the vagina to prevent pregnancy Female Condom – A pouch inserted into the vagina to prevent pregnancy and reduce the risk of sexually transmitted infections Fertility Awareness-Based Methods – Charting fertility to help prevent pregnancy IUD – A small T-shaped device inserted into the uterus to prevent pregnancy Morning-After Pill – A birth control pill taken to prevent pregnancy up to five days after unprotected sex Outercourse – Sex play that keeps sperm out of the vagina to prevent pregnancy Spermicide – A substance that prevents pregnancy by stopping sperm from moving Sterilization for Women (Tubal) – A surgical procedure that prevents pregnancy Sterilization for Men (Vasectomy) – A surgical procedure that prevents pregnancy Withdrawal (Pull Out Method) – Removing the penis from the vaginal to prevent pregnancy

Interventions Continued Assessing knowledge, behaviors and attitudes about sex before and after educational program completion.  Administer anonymous pre and post-assessments about risks, behaviors, attitudes, and knowledge revolving sex, contraceptives, effects of substance abuse and reproduction. Use and expansion of existing sexual education programs in the area  A multidisciplinary team approach consisting of nurse practitioners, school nurses, educators, social service workers, and other professionals to meets the needs of the community  Baldwin Teen Health Center in Lake County  Teen Pregnancy Prevention Program for District Health Department #10  Education within area schools  Federal sources such as Family Planning Program, the Maternal and Child Health Block Grant, Medicaid, the State Children’s Health Insurance Program, the Social Services Block Grant, and the CDC (Harkness & DeMarco, 2012, p.441).

Interventions Continued Provide education within the community aimed at teens and parents such as conventions, workshops, health fairs, parent outreach and other venues aimed at teens  Use of Baby Think it Over stimulators  Use of teenage mothers as speakers and mentors  Discuss pitfalls of teen pregnancy and costs of raising a child  Emphasize importance of education and the interference teen pregnancy has on this Safe hangout places and activities for teens to participate in outside of school Increase healthcare accessibility for teens, including pregnant teens in the area  Safe, easy, and confidential access to contraceptives, gynecological care, counseling, and primary care  Annual screenings

Evaluation  Review pre-test on reproductive health, pregnancy prevention, substance abuse, healthcare resources, pregnancy prevention resources, counseling resources.  Review post-test on reproductive health, pregnancy prevention, substance abuse, healthcare resources, pregnancy prevention resources, counseling resources.  Compare the difference between the two tests to evaluate the effectiveness of the education intervention of the pregnancy prevention project.  Annual teen pregnancy and repeat pregnancy rates in Lake County  Interviews about attitudes and beliefs of teens and parents toward teen pregnancy after pregnancy project implementation  Use of and presence of pregnancy prevention resources/programs

References Baldwin Family Healthcare. (2014). Family Healthcare, Baldwin. Retrieved from District Health Department #10. (2013). Health profile chartbook 2013: Lake County. Retrieved from District Health Department #10. (2014). Teen pregnancy prevention. Retrieved from Frost, J. J., & Forrest, J. D. (1995). Understanding the Impact of Effective Teenage Pregnancy Prevention Programs. Family Planning Perspectives, 27(5), doi: / Harkness, G., & DeMarco, R. (2012). Community and public health nursing: Evidence for practice. Lippincott Williams & Wilkins. Hill, M., Mullins, M., Warner, L., & VanArk, L. (2011). Health and healthcare landscape of Osceola and Lake counties: Research results from the 2011 community-wide health needs assessment. Hope College, The Carl Frost Center for Social Science Research: A research project for Spectrum Health reed City Hospital. Retrieved from Lake County Chamber of Commerce. (2014). History. Retrieved from Lake County Chamber of Commerce. (2014). The Lake County Chamber of Commerce welcomes you to Michigan’s outdoor paradise. Retrieved from

References Continued Michigan League for Public Policy: Kids Count in Michigan. (2013). Family income erodes, child abuse and neglect rises: Kids Count report seeks to improve Michigan child well-being. Retrieved from Michigan League for Public Policy: Kids Count in Michigan Data Book (2012). Retrieved from content/uploads/2012/11/KC2012-Narrative-and-Data-Notes.pdf Office of Disease Prevention and Health Promotion. (2014). Healthy People Family Planning. Retrieved from Planned Parenthood. (2014). Birth control methods – Birth control options. Retrieved from controlhttp:// control Pregnancy Resource Center. (2014). Willing to wait curriculum. Grand Rapids, Michigan: PRC The Annie E. Casey Foundation. (2014). Kids Count Data Center. Teen pregnancies ages Retrieved from /false/867,133,38,35,18/any/13099,13107 United States Census Bureau. (2014). State and county quick facts: Lake county, Michigan. Retrieved from