Ms. Weiss is a Santa Monica, CA-based healthcare consultant.
As the teen pregnancy rate rises each year, America's hospitals are taking a leadership role in dealing with the growing challenges associated with children having children. Many are sponsoring pregnancy prevention and support services. I report on two such hospitals.
Teen Pregnancy Prevention
Collaboration Is Essential
Results of community needs assessments and other data served as the impetus for the Teen Health Project, spearheaded by St. Joseph Hospital, Polson, MT. In the Polson area in 1995, 16.8 percent of all live births were to teen mothers; the rate for the state and the nation was 12 percent.
The groups involved in the Teen Health Project hope to reduce teen pregnancy rates in the area, raise awareness of the problem, and build alliances that can be called on when other complex social and health problems arise.
Along with St. Joseph Hospital, the area school district and county health department established the project this year. Funding comes from the Sisters of Providence at St. Joseph, Montana Consortium for Excellence in Health Care, Project Connect at the University of Colorado, the school district, and the county's health and family planning department.
Through a steering committee that meets each month, members of the community are also involved in the Teen Health Project. The project is guided by teens, parents, teachers, counselors, representatives of the Confederated Salish and Kootenai tribes, medical personnel, family crisis workers, and school officials.
"The days are long gone when one single agency or institution is capable of addressing the overwhelming and complex social problem of teen pregnancy," says Maureen Moriarty, St. Joseph Hospital's Teen Health Project coordinator. "Because of limited resources — both human and financial — coalitions that unite institutions and agencies around common objectives and problems may provide some answers."
Real-World Experience The Teen Health Project's key approach to preventing teen pregnancy is to provide teens with an experience similar to real-world parenting. "Baby Think It Over" dolls give teens an opportunity to "parent."
The dolls (recently introduced in high school home economic courses) are lifelike — realistically weighted, anatomically correct, and programed to produce an infant's piercing cry every two to four hours. To stop the crying, teens must appropriately "tend" the "baby" by inserting a key and holding it for 10 to 35 minutes, the time it would take for a feeding. The doll can be adjusted to simulate a colicky infant. To monitor teens' response to the crying doll, a microprocessor inside records how long it had been crying before being "fed."
"As one might imagine, teens usually have an attitude change about what it takes to parent an infant after two or three days with Baby Think It Over," states Moriarty.
Adopt a Baby The success with Baby Think It Over led to the launching of the Adopt a Baby program. The program gives local organizations the opportunity to grant the high school $220 to purchase an additional Baby Think It Over doll.
The Teen Health Project has made Adopt a Baby presentations to nearly every service organization in Polson, including the Lions Club, Rotary, Soroptimists, Kiwanis, Ministerial Association, hospital board and auxiliary, and Chamber of Commerce. No groups have turned down the project's invitation to buy a Baby Think It Over doll for the high school.
Moriarty points out, "We generate community awareness for the teenage pregnancy problem in Polson and stimulate interest in and commitment to the project."
A Winner The Teen Health Project, recent winner of the Montana Hospital Association Innovations in Healthcare Award, is comprehensive in its scope. For the first time, Polson area schools have adopted a curriculum, deterrent methods, and other educational tools on teen pregnancy. Plans are under way to add curriculum components for parents, teachers, and peer-to-peer education and support.
An offshoot of the Teen Health Project is the Chamber of Health, based on the Chamber of Commerce model. The Chamber of Health acts as a focal point for coalitions to address health issues. Members are currently designing an AIDS awareness campaign for the community. John LaTrielle, PhD, director of St. Joseph's home health program and a founder of the Teen Health Project, explains, "With the Chamber of Health, we believe we have succeeded in uniting the community around common objectives and created a new, diverse healthcare coalition poised to address future health issues and concerns and more effectively utilize financial and human resources."
Teen Pregnancy Support
Teenagers who become pregnant need ongoing support systems. One such comprehensive program is the Expectant Teen Clinic (ETC) in Massillon, OH, which opened in early 1994 with the support of Doctors Hospital and the county health department.
Sponsorship of ETC demonstrates the hospital's desire to be socially accountable and further advances it mission as a leader in the community. ETC operates out of the Doctors Hospital Nurse Midwifery Practice, offering teens after-school appointments. ETC's goal is to educate teens about their pregnancies and give them guidelines to follow throughout. Teens are often noncompliant with prenatal care, notes Dee Frank, parent educator at Doctors Hospital. She points out that almost 50 percent of pregnant teens do not receive first trimester care, putting themselves and their babies at risk. "We realize that the community's healthcare dollars are more wisely spent on prenatal care than on high-risk pregnancies," says Frank. "Prenatal care can prevent low-birthweight babies and expensive medical care."
Services include physical examinations; regular checkups; nutritional evaluations; laboratory tests; counseling; and personalized health education that focuses on exercise, nutrition, and fetal growth development.
Certified registered nurse midwives staff ETC. They are affiliated with a physician who is available for consultation as needed. Doctors Hospital nurses, a social worker, clinic aide, nutritionist, and health educator also provide services.
ETC is open to all young women aged 18 or younger. Services are offered on a sliding-fee scale, based on ability to pay.
"ETC is a safety area — we're nonjudgmental here," explains Frank. "We encourage teen clients to have goals and we emphasize the need to complete school," she adds.
Communication Equals Success Much of ETC's success is attributed to Doctors Hospital's communication strategies. The hospital recently received a Touchstone Award from the American Hospital Association's American Society for Health Care Marketing and Public Relations. In addition, the Ohio Society for Healthcare Public Relations presented it with two gold Reach for the Stars awards.
At a total cost of only $2,000, ETC heightened the community's awareness of its services through bright posters (with detachable tags providing ETC's telephone number); brochures; direct mail geared to teens and referral agencies; media coverage; and articles in the hospital's physician, employee, and community newsletters.
"We took a direct mail approach to let area professionals such as social workers, school counselors, and clergy know that experts from Doctors Hospital were available to provide special care to this underserved population," explains Mary Biber, assistant director of public relations at Doctors Hospital.
To ensure the material on ETC would attract teens' attention, the hospital's graphic artist pored over teen magazines to develop a modern, youthful look. Promotional material communicated that prenatal care is available in a safe, friendly, and nonjudgmental place, especially to girls for whom such care might be a financial hardship.
A week after the promotion began, the hospital was flooded with requests for assistance from school counselors, city health department staff, and representatives of several agencies. One local high school, noting that 70 of its students were pregnant, requested 100 brochures. An additional 220 brochures were mailed to various groups.
Organizations such as the YMCA requested additional promotional material, reporting that all the tags with ETC's telephone number had been taken from the posters in their lobbies. The requests for literature were so overwhelming, reports Biber, that an additional 5,000 brochures were printed. At the conclusion of the initial promotional period, ETC reported that the number of teenagers seen at the clinic had doubled.
"As a result of the promotional efforts, hundreds of professionals are aware of this vital service," says Candy Lautenschleger, director of public relations at Doctors Hospital. "The promotion fulfilled its goals of creating awareness about ETC, increasing referrals of teens to Doctors Hospital, positioning midwives as efficient and cost effective, and communicating a favorable image of our hospital's leadership actions to meet community needs."
For additional information on the Teen Health Project at St. Joseph Hospital in Polson, MT, call Maureen Moriarty at 406-883-5377.
For additional information on the Expectant Teen Clinic at Doctors Hospital Midwifery Practice in Massillon, OH, call Mary Biber at 216-837-7311.
Copyright © 1995 by the Catholic Health Association of the United States
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