1. Teen Pregnancy in Lake County
Nurs 340
Team “2”
Joseph Benac, Holly Cole, Krishanda Decker, Jennifer Discher and Eric Johnson

2. Introduction
According to the 1995 National Survey of Family and Growth, approximately 50% of teens aged 15–19 years have had sexual intercourse. (Chang, Chisholm, Bennet, Mcvie, 1998)
When reviewing the statistics of Lake County Michigan, it was easily noted that the number of teenage pregnancies was much higher in this county as compared to the State of Michigan as a whole, causing concern.

3. Assessment Findings: Rates of Teen Pregnancy
(U.S. Department of Health and Human Services, 2014)

4. Groups most affected (by race)
Birth rates per 1,000 adolescent females ages in the year 2012 :
Hispanic: 46.3%
Black: 43.9%
White: 20.5%
(U.S. Department of Health and Human Services, 2014)

5. Teen Pregnancy Rates: Lake County vs. State of Michigan

6. Contributing Factors For Teenage Pregnancies
Poor performance in school
Aggressive behavior, engaging in other risky behavior (including using drugs and alcohol)
Dating at a young age
Dating older partners
Not being well-liked by peers
Teens who experience puberty at an early age
Adolescents who have experienced sexual abuse or pressure

7. Why do problems still exist?
Extreme Poverty
Poor Education: In 2010, Lake County had 45% of 8th graders and 70% of 11th graders who were not proficient in math (Kids Count in Michigan, 2011)
Transportation: “Food pantries, social service agencies and other programs are harder for rural residents to access because they often lack transportation,  it’s often difficult for people to access nutritional food” (Shellenbarger, 2014)
Poverty, poor education, lack of transportation, etc. can all be attributed to people in Lake County not taking advantage of community health care. Inability to travel to locations for appointments hampers the ability for public health services to meet the needs of people in Lake County, such as teens that need birth control.

8. (The National Campaign to Prevent Teen and Unplanned Pregnancy, 2014)
Risk Factors:
“Teen mothers are nearly twice as likely to forgo prenatal care in the first trimester compared to older mothers”
“Daughters of teen mothers are 3x more likely to become teen mothers themselves compared to mothers who had a child at age 20-21”
Just 38% of teen girls who have a child before age 18 get a high school diploma”
(The National Campaign to Prevent Teen and Unplanned Pregnancy, 2014)
The fact that the emphasis on teens in Lake County is to not succeed in school, yet follow in their parent’s foot steps, makes this battle harder. These facts just reiterate how hard it is to stop history from happening over and over again.

9. Community Strengths Low Violence Community Tourism Outdoor recreation
Idlewild
Blessing of the Bikes
Big Star Lake (cottages & summer homes)
Outdoor recreation
Wildlife, lakes, streams and wood
Peer Marquette River
Small Communities
Crime rates in Lake County are 344 per 100,000 people. Lake County violence is significantly less compared to Michigan or the United States. (Hill, M., Mullins, M., Warner, L., & Van Ark, L., 2011)
Idlewild for many years was a place African Americans could vacation and purchase property. “From 1912 through the mid-1960s, Idlewild was an active year-round community and was visited by well-known entertainers and professionals from throughout the country” (Idlewild African American Chamber of Commerce, 2014). Idlewild now has several tourist events throughout the year, such as: Idelwild parade and cabaret, centennial music fest, and the jazz and blues festival.
Lake county, Michigan’s Outdoor Recreation Paradise, home to 200,000 acres of public-owned land. Over 100 lakes within the county. Over 300 miles of snowmobile trails. (Lake County Chamber of Commerce, 2014)

10. Community Weaknesses
Teen (ages 15-18) births in Lake County accounts for 13% of teen births in Michigan
Repeat teen births in Lake County are at a rate of 28.6%
High poverty rates in Lake County
Low high school graduation rates
Child Abuse/Neglect Rates
Teen births are slightly higher in Lake county compared to Michigan or the U.S. In Lake County, repeat teens births are much higher than the state or national average, where more than one-fourth (28.6%) of teens aged give birth more than once. (Hill, M., Mullins, M., Warner, L., & Van Ark, L., 2011)
“Approximately one in five families with children in Lake County live in poverty. The county exceeds both the state and nation in families living in poverty with children under 18 years of age. In fact, for single female families with children under 18, almost half (48.8%) live in poverty” (Hill, M., Mullins, M., Warner, L., & Van Ark, L., 2011)
3 in 10 Lake county residents have not graduated from high school, regardless of gender.
Child abuse and neglect rates more than double the rates of abuse and neglect in Michigan.

11. What is Public Health Care?
This is taken from the District Health Department #10’s website, which explains public health care.

12. Existing Resources & Supporting Disciplines
District Health Department #10
Plan First!
Education sessions on Birth Control Options
Pregnancy Testing
Free/Cost Reduced Birth Control
Free Condom Supplies
Pelvic Exams and Pap Smears
Counseling and Education
For Women of Childbearing Age (19-44)who are:
Not Medicaid Eligible
Family income ≤ 185% of the federal poverty level
Reside in Michigan
Physical Exams
Contraceptive Management
The local Health Department for Lake County offers education on birth control, pregnancy testing, free and reduced cost birth control based on income, free condoms, pelvic exams and pap smears, counseling and education on family planning. They also offer specific programs for teens.
Plan First! Is a family planning service that no longer accepts new enrollees. It was a five year program designed for eligible women, but with the Affordable Care Act, no longer gets reimbursement.

13. Supporting Community Groups
Lake County Community Foundation
Spectrum Health Reed City Hospital
Baldwin Family Health Care
“We offer family practice, dental, laboratory, x-ray, full service retail pharmacies, medical social work, health education, perinatal, and school-based teen health centers in Baldwin, Grant and White Cloud” (2010)
Department of Health and Human Services (HHS) offers tokens for transportation, and rent-free office space for social service efforts (Shellenbarger, 2014)
Lake County Community Foundation has the ability to donate money to non-profit organizations in Lake County for such things as human services, education, environmental and arts and culture needs (2014). Spectrum Health Reed City Hospital offers some pregnancy and birth control education and counseling, though it seems most classes that are offered are not available at the Reed City campus. Baldwin Family Health Care is a “one-stop-shopping” medical facility that offers classes, examinations, counseling and birth control to at-need members of Lake County.
The DHS is making efforts to overcome the difficulties of poverty-stricken Lake County by assisting in transportation and making it affordable for other social service efforts to be available (such as a domestic violence center, housing assistance and a parenting education program).

14. Supporting Community Groups
Lake County Health Department
Baldwin Teen Health Clinic
Satellite Health Clinic
Lake County Chamber of Commerce
The Lake County Health Department offers services such as immunizations, WIC, and family planning.
The Baldwin Family Health center is a place that is centrally located within Lake County.

15. Evidence to support Community Nursing Interventions
Lake County is one of the poorest counties in Michigan
Free services are likely to be the only services used
The local Health Department has greatest opportunity for education and counseling
The local health department is a free or reduced cost way for teens in Lake County to receive both birth control sex education and counseling if they become pregnant.

16. Existing Agencies: Potential Partners for Interventions
District Health Department #10
Spectrum Health – Reed City Hospital
The Health Centers of Family Health Care (A Child & Adolescent Health Center)
The District Health Department #10 was established in October of The DHD #10 covers 5,796 square miles. DHD#10 is the consolidation of four health departments into one organization. It is the largest geographical health department in Michigan and is the tenth largest based upon population. (District Health Department #10, 2011)
Reed City hospital is located in Osceola County. Their primary targets are the citizens of Osceola and Lake county. Increasing availability of primary care physicians, annual physicals, and other educational opportunities.
Reed City Hospital is also trying to increase the awareness of their financial assistance program, allowing people of Lake County to afford healthcare bills.
(Spectrum Health, 2013)

17. Possible Barriers to Successful Interventions
Access to clinics
Cultural/Language barriers
Lack of access to specialists
Lack of awareness of existing services
Lack of insurance coverage
Low income population/cost of care
Transportation barriers
There is no hospital in lake County.
High percentage of population is on medicare and Medicaid.
(Hill, M., Mullins, M., Warner, L., & Van Ark, L., 2011)
(I feel like many of these bullet points are pretty self explanatory and don’t need a note with them.)

18. Problem Statement Risk of pregnancy and repeat pregnancy
Among teenage girls ages 15-19
Related to low socioeconomic status with high rates of poverty, low access to health care, high childhood abuse & neglect
As demonstrated in rates of teen pregnancy in Lake County being at 64.8 per 1,000 and repeat teen pregnancy rates at 28.6%
(Hill, Mullins, Warner, & VanArk, 2011)

19. Causative Factors & Measurable Indicators
Poverty level (income)
Socioeconomic status
Access to health care
Preventative exams/primary care
Lack of education
Peer pressure
Measurable Indicators
Direct
Pregnancy rates among teens
Repeat pregnancy rates
Indirect
Poverty level (income)
Education level
Family dynamics/household configuration
Causative factors include things that likely play a role in the teen pregnancy rates. These include income (poverty, seeking ways to qualify for assistance like WIC), socioeconomic status (education level, occupation, finances), access to health care (lower rates may indicate lack of preventative exams, lack of education or access to birth control), lack of sexual education (either in school or from physician/provider), and peer pressure to have sex
Measurable indicators of those things we can measure over time to see if our interventions are working. Teen pregnancy rates and repeat pregnancy rates can be measured yearly and then trended. Indirect indicators are things that can also be measured and trended, but indirectly play a role in the pregnancy rates.

20. Planning Specifics Who: Females ages 15-19 years old
What: Reducing pregnancy rates & repeat pregnancy rates by 50% (to 32.4 and 14.3 % respectively)
When: Measured yearly over the next 6 years
Where: Lake County, Michigan
Why: Pregnancy rates among teenage girls are significantly higher than the Michigan average
How: Trending of teen pregnancy rates annually over the next 6 years; information gathered can be shared with local schools, medical providers, Teen Health Centers, and District#10 Health Department to encourage implementation of sex education and pregnancy prevention programs
Measuring yearly for the next 6 years (including 2014) will bring us through 2020.
Healthy People 2020 indicator is to have rates of pregnancy among year olds at 36.2, so our goal would be below that indicator.

21. SMART Goal
The pregnancy rates & repeat pregnancy rates of teen girls in Lake County (ages 15-19) will be reduced by 50% by the year Goal pregnancy rate: 32.4 per 1000 births Goal repeat pregnancy rate: 14.3%

22. Ecological Model
Based on the idea that “all processes occurring within individual people should be viewed as interdependent” (Harkness & DeMarco, 2012, p 79)
“Behavior change in people needs to be considered in a broader social context, including…” (Harkness & DeMarco, 2012, p 79)
Developmental history
Psychological characteristics
Interpersonal relationships
Physical environment
Culture
Ecological model based on the idea that social influences, knowledge, and personal values play a major role in behaviors

23. Evidence Based Practice
Teen Outreach Program Plus Text (U.S. Department of Health & Human Services, 2012)
1-hour weekly sessions, over 25 weeks plus 20 hours of community service
Youth programming
Focus on: goal setting, healthy relationships & boundaries, sexuality, community involvement
Involvement of social media & text messaging
Encouragement, polls, quizzes
Prime Time (Sieving, et al., 2011)
Intervention for high-risk, adolescent girls (ages 13-17)
Must meet 1 or more risk criteria
Clinic visit with negative pregnancy test or treatment for STI, young age, high risk sexual &/or contraceptive behaviors, aggressive or violent behaviors, behaviors relevant to school disconnection
Case managers led programming aimed to change social, environmental, and behavioral attitudes
Monthly 1-on-1 visits attempted
Focused on emotional skills, family/school involvement, positive relationships, responsible sexual behaviors
Peer leadership groups
Skill-building
Role-playing
Encourages peer relationships
Two examples of community-based (EBP) pregnancy prevention programs aimed at teenagers.
Focus on face-to-face interaction; goals of strengthening relationships, positive sexual behaviors.
Involves social media and different platforms for engaging at-risk youth.

24. EBP & Lake County
Applying previous research & pregnancy prevention programs to Lake County
Similarities
At-risk youth
Low socioeconomic status
Differences
High percentage of participants were African American
Programming implemented at school
Females are the main participants

25. Interventions
Assess attitudes, behaviors, and beliefs of teenagers (13-19 years old) in regards to sexual behaviors and pregnancy
Inquire about their exposure to prevention activities and education prior to implementation of new interventions
Collaborate with local schools to provide sex education
responsible sexual behaviors
pregnancy prevention
Healthy living & preventative care
Implement pregnancy prevention programs in schools, physician offices, Teen Centers, and youth groups
Positive peer relationships
Role-playing with constructive feedback
Organize health fairs in schools and Teen Centers
Education regarding pregnancy prevention, importance of preventative care, contraception availability
Distribute information on community resources for pregnant women
Using social media
Provide information on Medicaid, WIC, and programs available through local health departments
Encourage funding and donations from community partners
Funds to provide pregnancy prevention programming in schools, physician offices, and Teen Centers
Extra funds to assist with emergency needs of pregnant mothers (transportation, diapers, formula)
Establish focus groups to continually evaluate effectiveness and encourage feedback from local teens
Request feedback on success of programs
inquire about ideas teens have for program success or additional topics of concern to teens
Collaborate with District Health Department#10 when yearly statistics are released

26. Primary Prevention
“When an individual person or group is considered in good health and shows no signs or symptoms of disease or physical challenges…” (Harkness & DeMarco, 2012, p 71)
Examples:
Educate teens on contraceptive use and effectiveness
One-on-one counseling between health providers and teenage girls
Encouraging healthy friendships and relationships
Publicizing current pregnancy statistics in Lake County
Guest speakers (schools, community groups, physician offices, Teen Center) to discuss the impact of teen pregnancy on their lives
Attempt to educate teens on the importance of responsible sexual behaviors
Being very “real” with teens on the incidence of pregnancy with sexual intercourse, encourage contraception
Encourage well-child (teenage) check-ups with physicians, including counseling, STD checks, pelvic exams

27. Secondary Prevention
“Planned effort to minimize the impact of disease and injury once it is realized” (Harkness & DeMarco, 2012, p 72)
Examples:
Early detection of pregnancy
Provide assistance and community resources to pregnant teens (WIC)
Provide health counseling for pregnant females
Encourage behavioral goal-setting with pregnant mothers
Attempt to reduce repeat pregnancy
Early intervention to change behaviors
Encouragement of continuing education, seeking employment, pre-natal and post-natal care
Provide community resources (WIC, local health department) to assist with finances, food/formula/diapers, etc.

28. Evaluation
Create focus groups with local teens to encourage feedback on receptivity of programming on teens
Overall intervention effectiveness based on annual DHD#10 reports
Exit interviews with teenage participants to determine effectiveness of programs
Development of committee to represent teenage pregnancy prevention programs in Lake County
Secures funding within community, ensures programs are implemented, acts as “point person” for further program development

29. References
Chang, P. Chisholm, R., Bennett, N., McVie, M. (1998). American Medical Student Association National Initiative on Teenage Pregnancy. Retrieved from: mittee_Docs/teen_pregnancy.sflb.ashx
Devine, S., Bull, S., Dreisbach, S., & Shlay, J. (2013). Enhancing a teen pregnancy prevention program with text messaging: engaging minority youth to develop TOP plus text. Journal of Adolescent Health, 54(3), S78-S83. Retrieved from X%2813% /fulltext

30. References
Department of Health and Human Services (2014). Trends in Teen Pregnancy Childbearing. Retrieved from: topics/reproductive-health/teen-pregnancy/trends.html.
District Health Department #10. (2011). About dhd #10. In District Health Department #10. Retrieved from
District Health Department #10. (2013). Health profile chartbook Retrieved from _2014.pdf
Harkness, G. A., & DeMarco, R. F. (2012). Community and public health nursing: evidence for practice. Philadelphia, PA: Lippincott, Williams & Wilkins.

31. References
Hill, M., Mullins, M., Warner, L., & Van Ark, L. (2011). Health and health care landscape of Osceola and Lake counties: Research results from the 2011 community-wide health needs assessment. In Spectrum Health. Retrieved from ceola_and_Lake_Counties_CHNA.pdf

32. References
Idlewild African American Chamber of Commerce. (2014). In Idlewild African American Chamber of Commerce. Retrieved from
Lake County Chamber of Commerce. (2014). the lake county chamber of commerce welcomes you to Michigan's outdoor recreating paradise. In Welcome to Lake County, Michigan. Retrieved from
Office of Disease Prevention and Health Promotion. (2014). Family planning FP-8.1. Retrieved from #4467

33. References
Sieving, R.E., McMorris, B.J., Beckman, K.J., Pettingell, S.L., Secor- Turner, M., Kugler, K.,…Bearinger, L.H. (2011). Prime time: 12-month sexual health outcomes of a clinic-based intervention to prevent pregnancy risk behaviors. Journal of Adolescent Health, 49(2), doi: /j.jadohealth
Spectrum Health. (2013). Implementation plan for needs identified in community health needs assessment for Reed City Hospital corporation d/b/a Spectrum Health Reed City Hospital. In Spectrum Health. Retrieved from Implementation_Plan.pdf
U.S. Department of Health and Human Services. (2012). Pregnancy prevention intervention implementation report. Retrieved from: initiatives/teen_pregnancy/db/programs/teen_outreach_pro gram.pdf