1. Sarah Knoll William Russell Shannon Sheffer Jennifer Smith

2. Teen Birth rates, 2011 Michigan United States
Females under 20 years of age , ,772
Females aged: Michigan United States
Under ,974
, ,538
, ,234
, ,772
Mother's race/ethnicity Michigan United States
Non-Hispanic white , ,198
Non-Hispanic black , ,936
American Indian or Alaska Native ,897
Asian or Pacific Islander ,773
Hispanic ,236
(Access Kent, 2013)
Age group at highest risk: 15-19
Ethnic groups with the highest birth rates for Kent County, Michigan are non-hispanic whites and non-Hispanic blacks
Data collected from 2011
For the purposes of this paper, we researched females age years old. Please note the rates for Michigan of 9658 births reported, both live births and deaths are accounted for, in comparison with the national average of 329, 772 births within this range. This provides an average of 6596 births per state, which Michigan has exceeded.

3. Michigan & Kent County Rates
The teen pregnancy rates for Michigan and Kent County demonstrate a decline from While it shows a declining trend, rates in Kent County compared to state and national data remain significant for this area.
(Michigan Department of Community Health, 2012)

4. Kent County Statistics, 2011
Race of Mother
All Ages
< 15
15-19
20-24
Total
8801 7
663
1942
White
7167 4
436
1418
African Americans
1254 3
200
453
American Indian 48 - 6 16
Asian and Pacific Islander
246 9 28
 (Access Kent, 2013)
We continued our analysis by reviewing this graph which looks at live births in Kent County. The numbers support the findings that teen females age have the highest numbers of live births and show non-Hispanic whites leading the teen pregnancy rates in Kent County.

5. Social Determinants of teen Pregnancy
Single-parent homes
Low socio-economic status
Social Norms:  Peer pressure
Substance Abuse
Geographical location: urban
There are many social determinants that contribute to increased rates of teen pregnancy: teens living in single parent homes, low socio-economic status, social norms of peer pressure, substance abuse, and geographical location: especially urban. There is a perceived and actual lack of economic opportunity among those living in poverty or a lower socio-economic status (Kearney & Levine, 2012). Teen girls choose non-marital motherhood at a young age because they feel they have little chance of advancement. (Kearney & Levine, 2012).
(Kearney & Levine, 2012)

6. Contributing Factors
This graph demonstrates a visual presentation of factors contributing to high teen pregnancy rates. Children living in poverty, single-parent homes, unemployment and teen pregnancy rates are compared between Kent County, Michigan, and National. The rates are noted to be higher in Kent County and in the state of Michigan than Nationally. According to Lavin and Cox (2012), poverty is strongly associated with risk for teenage pregnancy. This helps to explain some of the contributing factors that are affecting rates in Kent County, Michigan. One of the key points in current perspectives of teen pregnancy prevention are that significant disparities exist between states and regions due to social and economic factors (Lavin & Cox, 2012).
(County Health Rankings, 2013)

7. Community Strengths
Kent County has multiple resources available for teens regarding sexuality at a local, state, and national level. The Kent County Health Department is located in Grand Rapids which is the largest area of population and provides the majority of health care services in the County.
(Kent County Michigan, 2013)
The Kent County Health Department is one of the better known resources in the community for providing medical care to clients who are uninsured, looking for assistance, and without a primary care physician. There are five clinics located in Kent County. This is one avenue for addressing teens in the community about safe sex practices and responsibilities associated with sexual activity.

8. Teen Pregnancy Prevention Initiative
Michigan has instituted the Teen Pregnancy Prevention Initiative (TPPI) program that consists of the implementation of comprehensive, evidence-based interventions that target the sexual and non-sexual factors that lead to delayed initiation of sex and increased condom or other contraception use. TPPI targets youth between the ages of 10 and 18 (up to 21 for special education populations) and their parents/adults/caregivers.
(Centers for Disease Control and Prevention, 2013)
The Teen Pregnancy Prevention Initiative is funded by Michigan Department of Community Health through Healthy Michigan Funds and focuses on evidence-based interactions and interventions with teens at risk. An important distinction about this group is that they engage not only the teen but parents and caregivers as well.

9. Teen Pregnancy Prevention Initiative (can't)
Program Goal:
To reduce the rate of teen pregnancy in Michigan for youth ages (up to 21 years for special education populations).
(Centers for Disease Control and Prevention, 2013)
Read Goal

10. Community Agencies/programs
Reducing the Risk Curriculum
Safer Choices Project
Planned Parenthood of West and Northern Michigan, Inc.
National Campaign to Prevent Teen Pregnancy
Teen Pregnancy Prevention
(Access Kent, 2013)
(Planned Parenthood of America, 2013)
Reducing the Risk Curriculum is a 16-session research-based curriculum designed to reduce the rate of teenage pregnancy and exposure to sexually transmitted diseases (Access Kent, 2013). The curriculum is targeted to youth between the ages of 14 and 18 and focuses on delaying or reducing the frequency of intercourse and increasing the use of contraception and condoms.
The Safer Choices Project provides young people with the information, skills, and support they need to develop healthy relationships; prevent early, unprotected intercourse and unintended pregnancy, as well as sexually transmitted infections and increase communication with their parents (Planned Parenthood of America, 2013). Planned Parenthood provides teens with counseling, support, as well as education about birth control, sexually transmitted diseases, and the use of contraceptive devices.
The National Campaign to Prevent Teen Pregnancy is a national initiative to support responsible values and behaviors by both men and woman and responsible policies in both public and private sectors.
Teen Pregnancy Prevention is a federally funded program aimed at preventing teen pregnancy by implementing multilevel evidence based interventions community wide, with interventions tailored to each community to reduce teen pregnancy and birth rates, especially in communities with the highest rates.

11. Betty Neuman’s Theory
Betty Neuman’s theory has been selected as the model used for this research. Neuman views the patient as a whole person and an open system. Open systems receive messages from many areas in life. These messages can be  spiritual, psychological, sociocultural and physiological. The subjects of this research certainly experience stressors from all of the ways mentioned above. The environment in which a teen matures has a profound impact on the rates of teenage pregnancy in Kent County and other parts of the country.
(Center, 2011)

12. Neuman’s Theory as it relates to Teen Pregnancy Prevention
Neuman viewed human beings as an open system that interacts with both internal and external environmental forces or stressors. She believed that one’s environment largely plays a roll in their actions, behavior, and health. Teens have many pressures that contribute to the decisions they make surrounding sexual activity and protection. Neuman believed in taking all factors into consideration when caring for patients which will allow for all encompassing care and better meet the needs of the patient (Center, 2011)

13. Problem Statement
High incidence of teen pregnancy among females ages in Kent County, Michigan related to lack of sexual education, lack of social support, low socio-economic status, and barriers to contraception as evidenced by…
The purpose of this community change is to address the need for intervention surrounding the rates of teen pregnancy in Kent County.   While we acknowledge that the rates have decreased, they still remain high. We find that there is an opportunity for teaching amongst females between the ages of 15 to 19 years old as teen pregnancy does not discriminate by race, age, economical status, or education.  Addressing this population will promote responsibility with sexual activity, empower young women at a younger age , and aim at decreasing the amount of unwanted pregnancies.

14. Comparison birth rates
Kent County, MI
Michigan
National
Benchmark
Teen birth rate per 1,000 female population, ages 15-19 42 35 22
The Kent County teen pregnancy rate is higher than Michigan and all comparison counties. The Kent County teen birth rate per 1,000 females ages is nearly twice that of the national benchmark.
(Kent County, 2011)

15. Barriers Access to Birth Control Socioeconomic Status Education Level
Transportation
Internet access to available healthcare options
Peer Pressure
Lack of Social Support
Some of the barriers to prevent teenage pregnancy are inconsistent use of birth control, socioeconomic status of the teen and their family, and the education on pregnancy and prevention. Some of the socio-economic issues that may be a catalyst for teen pregnancy prevention is being at or below poverty level income as it relates to lack of medical care. In Kent County, 12.69% of the residents are below poverty level and 36.2% of whom are under the age of 18 (Michigan Health, 2012). The educational hurdle for teens is one of becoming aware and informed on abstinence, birth control options and usage, and the ramifications of becoming pregnant.
“Successful strategies for preventing adolescent pregnancy vary from responsible sexual behavior education, which includes abstinence education, to improved contraceptive counseling and confidential reproductive services” (Harkness & DeMarco, 2012).
(Planned Parenthood of America Inc., 2013)

16. Causative/modifiable factors
Lack of sexual education
Availability of birth control
Transportation issues
Poor social support
Number of teens engaging in sexual intercourse
There are many causative/modifiable factors contributing to teen pregnancy: lack of sexual education regarding abstinence and contraceptive use, availability of birth control including cost, transportation issues to clinics or physicians, poor social support (single parent homes), and social norms of the number of teens engaging in sexual intercourse.
(Harkness & DeMarco, 2012)
(Lavin & Cox, 2012)

17. Non-modifiable factors
Race/ethnicity
Demographic Characteristics
Geographic Characteristics
Religious Denominations
There are some non-modifiable factors that affect teen pregnancy: race/ethnicity, demographic characteristics, geographic characteristics , and religious denominations. Community health nurses have an opportunity to complete a thorough community assessment to understand the cultural characteristics of the population to develop programs and interventions to successfully decrease teen pregnancy rates.

18. Interventions Teen Programs
Conducting Parent /friend/teen conversations.
Education for Parents
Evidence Based Approach: clinical, school linked, and school based.
Parent/Teen Programs
Youth Development Programs
(Pregnancy, 2009) (Lavin & Cox, 2012)
1. According to the Center for Disease Control and National Vital Statistics System, among the 367,000 births in 2010 to teen mother’s ages years, 18.3% were repeat pregnancies or 1 in 5 births (Barfield, et al., 2013).
Engaging pregnant and parenting teens in programs to effectively reduce teen pregnancy like Planned Parenthood, Reducing the Risk programed offered by Kent County health department,  offering home visits from the health department and community nurses, getting teens involved in programs offered by churches, and having support by friends and family can all be ways of helping prevent future teen pregnancies. Also offering counseling through the health department about birth spacing, contraception options and usage, and among women wishing to delaying or avoiding future pregnancies.
2. Conducting Parent /friend/teen conversations.
When parents and teens have serious, open conversations about sexual behavior and activities teen pregnancy rates can drop. Parents and others teen have relationships with can have a substantial influence on the rate of teen pregnancy. According to The National Campaign to Prevent Teen and Unplanned Pregnancy (2013), Parents and friends comprise 63% of most the most influential people in teens lives when it comes to dating.
3.According to the Department of Public Health, education in various is one of the best ways reduce teenage pregnancy.
Curriculum based sex and STD/HIV programs
Health office based programs
Parent/teen programs
Multiple sub-categories are also included in these educational programs.
4. These programs share common characteristics:  longer appointments, individual counseling, educational programs, confidential services, contraceptives, free-cost or low-cost services, referrals and active outreach.
a.  Comprehensive evidence-based education programs focus on educating teens about healthy relationships, safe sex and contraception.
b.  Increased sexuality education school programs were associated with lower birth rates.
5. Involve both parents and adolescents where parties seek to improve parent-child communication, particularly on sex and related topics. These programs are usually offered in a community-based setting, and are targeted to moms, dads, or both.  This program teaches parents how to effectively talk to their child about sex, sexuality, and safe sex practices
6. This program takes a very broad approach; effective particularly with girls.  It combines healthcare, academic assistance, sex education, participation in performing arts and individual sports, and employment assistance. All of these activities are designed to encourage participants to think and plan for their future

19. Interventions: who Schools Parents Nurses Media Churches
Target Population:
Kent County Teens
age 15-19
Community
Groups
Schools
Parents
Nurses
Media
Churches
There are many key participants and community groups needed to initiate a community change to decrease teen pregnancy for Kent County: Big Brothers and Sisters to sponsor teens to improve social support systems, Planned Parenthood of Northern Michigan and the Kent County Community Health Department for contraceptive counseling and access to birth control, schools for evidence-based comprehensive educational programs, parents to have crucial conversations to improve communication and social support, nurses to develop and monitor culturally competent interventions aimed at decreasing teen pregnancy, media to increase awareness about the community issues and churches as support and access to teens.

20. Michigan's Teen Pregnancy Prevention Initiative
Interventions: What
Social Media
Talk Early & Talk Often
Michigan's Teen Pregnancy Prevention Initiative
Reducing the Risk
Teen education programs have been used to effectively reach teenagers that engage in risk taking behaviors such as drinking, drug use, and those whom are sexual active. In a study from the 2011 Kent County Health Needs Assessment (2011), 22.8% of 9th through 11th grade students reported in having at least 1 alcoholic drink in the last 30 days and 31.3% of these high school students reported having sex. Engaging these teens in the above listed resources could greatly improve relationships and communication between adults and teens, thus decreasing these statistics. These resources would also provide a safe environment for the community nurse to distribute information about pregnancy prevention, contraceptives, and sexual activity.
(Kent County Michigan, 2013)

21. Interventions: where
County
Kent
Programs
School
Community
Setting
Home
Doctors office/
Hospital
Community nurses work through outreach programs like the above listed to help form relationships with teens by providing education on sex, contraceptives, abstinence, and personal health. The social media used would be able to reach teens through possible community programs, resources, and clinics
School Programs: School Programs provide reliable, evidence-based approach to sexual education and safe sex.
Community Setting: Programs available in the community, such as KCHD, Planned Parenthood, and educational seminars for teens, caregivers, and parents all contribute to safe sex practices and provide tools to reduce the risk for teen pregnancy.
Doctors Office: Care provided in a controlled medical setting provide confidential care to teens interested in safe sex and birth control availability.
Home: Responsibility for starting education abut sex, birth control, and safe sex may be discussed in the home with the hopes of starting young and setting a foundation for change.
(National Campaign to Prevent Teen and Unplanned Pregnancy , 2013)

22. Interventions: When Planning: January 14th, 2014
May 1st, 2013
Implementation:
Evaluation: Vital Statistics & Michigan Youth Risk Behavior Survey (YRBS)
Strategic planning for an effective community initiative takes a multi-faceted team. Planning for this project will take place on January 14th, This will include identifying community agencies, sponsors, schools, and healthcare providers; determining interventions, setting goals, and determining indicators of success. The implementation date is May 1st, Evaluation includes monitoring Kent County’s Vital Statistics annually for teen pregnancy rates and reviewing the annual results of the YRBS to evaluate the effectiveness of the interventions.
(Michigan Department of Education, 2013)

23. Reduce the rates of pregnancies and births to youth in Kent County.
Interventions: WHY
WHY?
Reduce the rates of pregnancies and births to youth in Kent County.
Increase youth access to evidence-based and evidence-informed programs to prevent teen pregnancy.
Increase linkages between teen pregnancy prevention programs and community-based clinical services.
Educate stakeholders about relevant evidence-based and evidence-informed strategies to reduce teen pregnancy and data on needs and resources in target communities.
To achieve these goals for FY 2011–2015, state and community based programs, and five national organizations were funded through the cooperative agreement, Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies Through Communitywide Initiatives. These awards were made through two competitive funding opportunity announcements (FOA): one through a joint FOA from the Office of Adolescent Health (OAH) and CDC, and one from a joint Office of Population Affairs and CDC FOA.
The national organizations will provide training and technical assistance to all funded organizations within this initiative. The state- and community-based grantees will provide training and technical assistance to youth-serving organizations and partners to implement the Key Components described below.
(Centers for Disease Control and Prevention [CDC], 2013)

24. Short Term Outcomes
Increase availability of comprehensive sexual education programs
Parent education
Improved contraception counseling
Healthcare Providers education
Referral information for teens
Increased access to confidential reproductive services
Community awareness
(Plan for assessment within one year of implementation and annually to reexamine efficacy of goals)
(Harkness & DeMarco, 2012)
Short-term outcomes to teen pregnancy prevention includes increasing availability of comprehensive sexual education programs to include promoting abstinence while also education about contraception and sexually transmitted infections.  Parent participation, support, and education regarding the importance of discussing sexual information with their adolescents is a vital part of decreasing teen pregnancy.  Parents need tools to communicate with their adolescent about this important topic.  Teens also need access to confidential reproductive services.  Increasing community awareness in Kent County about the rates of teen pregnancy can allow for multi-level, multidisciplinary approaches to decrease the rates of pregnancy.

25. Desired Outcomes (outlook of 1 year for behavioral modification)
Decrease the number of teen pregnancies
Increase resource availability
Increase the awareness of teen pregnancy
The number one desired outcome is to decrease the number of teen pregnancies in Kent County for the age group of year olds. Another outcome is to increase the resource availability through education and accessibility of Planned Parenthood, the Teen Pregnancy Initiative, birth control options, and support groups. Increasing the awareness of teen pregnancy is also a desired outcome to achieve through the previously listed interventions. This can be accomplished by educating the members of Kent County about teen pregnancy, the rise in teen pregnancy rates, at risk teens, and the availability of resources to teens.
(Kent County Michigan,2013)

26. Long term Outcomes
Conduct statewide focus groups for teen parents to determine what interventions would be useful in preventing teen pregnancies.
Engage local communities to actively participate in pregnancy prevention activities.
(Plan for re-evaluation within five years of goal implementation)
Provide age appropriate, competent education to teens regarding safe sex practices.
Ensure access to teen-friendly healthcare services regarding pregnancy prevention.
Engage teen parents, both mothers and fathers on making healthy choices for themselves and their children.
Teach parents how to talk to their teens about sex.
Assist organizations seeking funding for teen pregnancy prevention programs.
(National Campaign to Prevent Teen and Unplanned Pregnancy, 2013).
Teen pregnancy prevention is an all encompassing approach that will take the support of family, friends, and educators in order to be successful. By providing a safe place for education, resources, medical care and attention we are proposing a realistic change regarding teen pregnancy.

27. Evaluation
Kent County has many resources, including the Health Department, as mentioned in this plan. The Health Department could be used as a center for activities for our initiatives. The Kent County Health Department provides contraceptives and delivers counseling to sexually active teens and those at risk of becoming sexually active. This plan is anchored in the Teen Pregnancy Prevention Initiative. This Initiative, along with the other agencies and community groups, can assist in compiling a program aimed at decreasing teen pregnancy by 2015.
The goal of teen pregnancy prevention is a forefront concern in Kent County. Measures, such as education programs in school and the community, as well as clinics in the community and Health Department have been set up to aid in teen pregnancy prevention. By acknowledging and addressing this vulnerable population the plan for change and reduction of unwanted teen pregnancies in Kent County has been implemented. With the support of parents, educators, caregivers, and healthcare providers a goal of teen pregnancy reduction by 2015 has been established.
(Kent County Michigan,2013)

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30. references