2. MEGHAN BROWN, CAITLIN BUREN, STEFANIE LOMBARD, CHARITY MCKINNON, KATIE MORELL, STEPHAINE RYAN Inadequate Prenatal Care Among African American Teens Ages 15-19 in Kent County

3. Teen Birth Rates Race2012 All Races29.4 /1,000 Non-Hispanic White20.5/1,000 Non-Hispanic Black43.9 American Indian/Native Alaskan34.9 Asian/Pacific Islander9.7 Hispanic46.3 (Martin, Hamilton, Osterman, Mathews, 2013 ) US Birth Rates per 1,000 Live Births for Mothers 15-19 Michigan teen pregnancy rate 53.6 Kent County teen pregnancy rate 61.5 (MPHI,2011)

4. Infant Mortality Rates (IMR) 2010 Total US IMR 6.14 2010 US IMR for Non-Hispanic Blacks 11.46 (Mathews & MacDorman, 2013) 2010 Michigan IMR 7.1 “Michigan’s African American IMR is approximately three times greater than the white, non-Hispanic rate” (MPHI, 2011).

5. Community Problem Diagnosis Risk of inadequate prenatal care among 15-19 year old African American females in Kent County related to cost and availability as evidence by higher than average infant mortality rates (IMR).

6. Existing Services Available in Kent County There are many existing centers available to help pregnant teens.  Alpha’s Women’s Center  Paired with a Mentor  Attend classes on pregnancy, nutrition and parenting to earn points  Use points to “buy” baby supplies (Alpha Women’s Center, 2014)  Kent County Health Department  WIC  Medicaid  Nurse, Social Worker and Nutritionist available (KCHD, 2014)

7. Existing Services Available in Kent County  Grand Rapids African American Health Institute  “Strong Beginnings” Referrals to prenatal care Support and education for teens and their family (GRAAHI, 2013)  D.A. Blodgett- St. Johns Center  Counseling  Food assistance  Help signing up for Medicaid (D.A. Blodgett, nd)

8. Existing Services Available in Kent County Planned Parent Hood Irwin/Martin Health Center  Confidential services  “Teens-only walk-in appointments accepted Tuesdays, 3:00pm- 6:00pm”  Pregnancy education, prenatal care, and family planning.  No insurance necessary. “With or without insurance, you can always come to us for your health care” (Planned Parenthood, 2014).

9. Established Interventions Initiated by Kent County Kent County intervention programs to reduce disparities  Reducing the Risk – Kent County Health Education Programs  Designed to reduce the rate of teen pregnancy and exposure to STD’s  Supplements existing health and sex education curriculum (County of Kent, 2014).  Kent County Infant Health Initiative  Designed to reduce infant mortality and eliminate racial health disparities.  Interconception care program Targets African American women with poor pregnancy outcomes.  Brush up for Baby  Family Planning Services  Financial Assistance  Case management  Home visits with a community nurse  Risk screening (Kent County Health Department, 2010).

10. Established Interventions Initiated by Kent County  Maternal Infant Health Program  Perinatal and postpartum home visits  Free Service (Kent County, 2014).  Other strategies implemented by Kent County  “Early and Often” prenatal care messaging  Emergency Department prenatal scheduling before discharge  Health disparity education for providers  Enrollment assistance for : Healthy Kids Medicaid, MIChild, Maternity Outpatient Medical Services, and Plan First. (MPHI, 2012).

11. What needs to change? An intervention that targets African American teens, age 15-19 Partnership with schools and public health services Offers education and resources at little to no cost “Recognizing that teen populations respond to pregnancy prevention programs that are sensitive to their cultural backgrounds and varying lifestyles is crucial to developing and implementing successful programs” (National Conference of State Legislatures, 2009).

12. Proposed Primary Intervention Teen Pregnancy Resource Center  Offers on site and out reach programs Providers:  Social Workers  Nurses  Physicians  Volunteers Mission & Vision The resource center will allow high risk teens to develop relationships with healthcare providers and peers in a non-judgmental environment. The resource center will provide high risk teens with education, emotional support, and the resources necessary for a healthy pregnancy.

13. Resource Center: On Site Services Providers Social Workers  Case management system  Life skill education  Strengthen social behavioral support  Provide continuing education  Assist with workforce referrals (Patchen, et al., 2013). Nurses  Educate teens within individual and group settings.  Anonymous question/answer sessions

14. Resource Center On: Site Services Physician’s  Primary Care Providers  Obstetrician  Psychologists  Mental Health Professionals Volunteers  Community members with: similar backgrounds similar life stories able to relate on a personal level

15. Resource Center: Out Reach Program The Resource Center will assist the Kent County public high schools with the highest African American enrollment to provide a once a semester pregnancy prevention and education course during school hours. Target High Schools Kent County Public High School Total StudentsMinority % Majority Race of Minority Population City Middle/High School 68940%Black and Hispanic Creston High School 66083%Black East Kentwood High School 198555%Black Kelloggsville High School 57059%Black (publiceschoolreview.com, 2014)

16. Desired Outcomes 1. Increase the amount of African American teens who recieve adequate prenatal care. 2. Decreased Kent County African American teen pregnancy rates. 3. Educate on the health disparity of teen pregnancy and increased infant mortality. 4. Improve cost and availability of prenatal care for African American teens through community and government funding.

17. Intervention Evaluation Increased number of Kotelchuck Indexes* recorded in Kent County within the adequate prenatal care range.  “Kotelchuck Index : An index of adequacy of prenatal care based upon 1) month of entry, 2) number of prenatal visits and 3) gestational age of infant at birth. Uses ACOG standards for number of visits” (IDPH, nd). Decreased Kent County African American teen pregnancy rates on annual Michigan Department of Community Health reports. Post course survey of teens enrolled in the out reach program. Increased amount of annual community funding and governmental grants.

18. Theory: Maternal Role Attainment: Becoming a Mother Becoming a mother: Research on Maternal Identity from Rubin to the Present Author: Ramona T. Mercer PhD, RN, FAAN “The kind of help or care a woman receives during pregnancy and over the first year following birth can have long term effects for her and her child. Nurses in maternal child settings play a sizeable role in providing both care and information during this period” (Tomey & Alligood, 2006, p. 611).

19. Theory: Maternal Role Attainment: Becoming a Mother This theory encompasses the target population of African American females 15-19 years of age in Kent County. This model “can also be generalized to all women during pregnancy through the first year after birth, regardless of age, parity, or environment” (Tomey & Alligood, 2006, p. 618).

20. References Alpha Women’s Center of Grand Rapids. (2014). We’re here to help. Retrieved from http://www.optionsforyou.orgCenters for Disease Control. (2012). About teen pregnancy. Retrieved from http://www.cdc.gov/TeenPregnancy/AboutTeenPreg.htm.http://www.cdc.gov/TeenPregnancy/AboutTeenPreg.htm American Academy of Child & Adolescent Psychiatry. (2012). Facts for families: When children have children. Retrieved from: http://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/When_Children_Have_Children_31.aspx County of Kent. (2014). Health education programs. Retrieved from http://www.accesskent.com/Health/HealthPromo/ed_program.htm#rr http://www.accesskent.com/Health/HealthPromo/ County of Kent. (2014). Pregnancy & parenting support services. Retrieved from http://www.accesskent.com/Health/PregnancyParenting/default.htm. http://www.accesskent.com/Health/PregnancyParenting/default.htm D.A. Blodgett- St. Johns. (n.d.). For pregnant women. Retrieved from http://www.dablodgettstjohns.org/what-we-do/therapy- supportive-services/pregnant-women.http://www.dablodgettstjohns.org/what-we-do/therapy- supportive-services/pregnant-women Grand Rapids African American Health Institute (GRAAHI). (2013). Strong beginnings. Retrieved from http://www.graahi.org/Advocacy/StrongBeginnings.aspx. http://www.graahi.org/

21. References Iowa Department of Public Health (IDPH). (nd). Definition of terms. Retrieved from: https://www.idph.state.ia.us/IdphDefinitions/List.aspx?term=Kotelchuck%20index Kent County Health Department(KCHD). (2010). Kent county infant health initiative: interconception care program final report 2009. Retrieved from http://www.accesskent.com/Health/HealthPromo/pdfs/KCIHI_2009_AnnualReport.pdf Kent County Health Department (KCHD). (2014). Pregnancy & parenting support services. Retrieved from http://www.accesskent.com/Health/PregnancyParenting/default.htm. http://www.accesskent.com/Health/PregnancyParenting/default.htm Martin, J., Hamilton, B., Osterman, M., Curtin, S., Mathews, T.J. (2013) Vital statistics reports. Births: Final data for 2012 (vol. 62 No. 9). Retrieved from: http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf#table01http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf#table01 Mathews, T.J. & MacDorman, M. (2013)Vital statistics Reports. Infant mortality statistics from the 2010 period linked birth/infant death data set (Vol. 62 No.8). Retrieved from: http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_08.pdf Michigan Department of Community Health (MDCH). (2012). Estimated teen pregnancy rates & population. Retrieved from http://www.mdch.state.mi.us/pha/osr/chi/births/teenpreg/PREGCO.asp?DxId=1&CoCode=41

22. References Michigan Public Health Institute (MPHI). (n.d.). Kent county 2012 health improvement plan. Retrieved from http://www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf National Conference of State Legislatures (2009). Teen pregnancy prevention. Retrieved from: www.ncls.org/documents/health/teenpregnancy09.pdf Patchen,L., LeTourneau, K., & Berggren, E. (2013). Evaluation of an Integrated Services Program to Prevent Subsequent Pregnancy and Birth Among Urban Teen Mothers. Social Work in Health Care,52(7), 642-655. doi:10.1080/00981389.013.797538 Planned Parenthood of West and Northern Michigan, Inc. (2014). Irwin/Martin Health Center - Grand Rapids, MI. Retrieved from: http://www.plannedparenthood.org/health-center/centerDetails.asp?f=3295 http://www.plannedparenthood.org/health-center/centerDetails.asp?f=3295 Publicschoolsreview.com (2014). Kent County High Schools. Retrieved from: http://www.publicschoolreview.com/school_ov/school_id/41022 Tomey, A. M., & Alligood, M. R. (2008). Nursing theorists and their work (6th ed.). St. Louis, MO : Mosbys