Health Care Providers and Organizations

HEALTH CARE PROVIDERS & ORGANIZATIONS

Health care providers are in a unique position to impact teen pregnancy prevention, from providing and advocating for greater access to preventive health care services to changing policies to promote access to medically-accurate information in school settings.

WHAT WE KNOW WORKS

The American Academy of Pediatrics recommends reducing health disparities across a number of health indicators by expanding access to Medicaid or other health insurance for children and families. Texas is one of just 12 states that has not accepted Medicaid Expansion dollars. Additional measures that can be taken by health care education and clinical provider organizations include: Deliberately creating teen-friendly clinic environments » Expanding access to clinics by adjusting hours, increasing locations and access by available transportation » Training providers that provide education to youth and work with caregivers of children and teens to maximize care » Supporting parents and caregivers as the primary sexuality educators of their children, assisting them as they learn to communicate their family’s values to their teen(s) » Training health care professionals to become active listeners when teens have questions, and know how to refer them to local resources for education, and mental health care » Understanding racial history with reproductive health care » Learning to provide anti-racist health care » Being culturally and historically responsive

WHERE WE ARE

Health care providers are on the front lines of the teen pregnancy crisis in Dallas. When surveyed for Ntarupt’s needs assessment completed by the Texas Woman’s University, health care providers acknowledged the role of other community resources and wanted to see better education, better healthy relationship information and support, better parental support, and better sex education for youth.

Addressing clinical resources, 78% cited a lack of contraceptive use as the greatest risk for unintended pregnancy, while 88% cited a lack of education about contraceptive use as the greatest risk for unintended pregnancy. Many (60%) felt that a lack of career/education goals put teens at greatest risk for unintended pregnancy. A lack of parents and other caregiver support was cited for keeping health care service and education providers from reaching youth. Providers also frequently cited the lack of public transportation options in Dallas as a barrier to accessing health care services.

“Transportation is always a barrier, when the resources are available. So, for example, you know you have kids who unfortunately are also working adults to a degree or have activities that they’re doing and that sort of thing. So, when (transportation is not) available to them can be a barrier.” –Health Care Provider, Ntarupt Community Readiness Assessment, 2019

While there are Title X clinics and HHSC clinics near some of the most economically affected areas, the community needs more information. In Ntarupt’s 2019 clinic mapping project, we mapped access to reproductive health care throughout the City. We analyzed 1) Clinics with hours after 5pm; 2) Clinics with weekend hours; 3) Clinics that provide all forms of contraception; 4) Zip codes shaded by density of poverty among women aged 15-19 - a proxy for demand; 5) Travel time to HHSC clinics by zip code; 6) Travel time to Title X clinics by zip code. Here are the findings with respect to clinics in the four of the zip codes we are targeting:

CLINIC MAPPING DATA, ANALYZED

Zip Code

75203 75208 75210 75215

Teens in poverty per square mile

40 34 62 21

Travel Time to nearest Clinic

Title X Clinic

12.5 min 8.1 min 5.2 min 5.2 min

HHSC Clinic

12.4 min 8.2 min 5.2 min 8.8 min

Evening and Weekend Hours

After 5 PM

0 0 0 2 hrs/week

Weekends

0 0 0 0

Clinics having all forms of contraception?

No No adjacent to 75215 Yes

Given the findings above, the need for clinics with late or weekend hours and to be able to offer all forms of contraception stand out as the most obvious needs.

Additionally, given that race is a social determinant of health, it is critically important that medical caregivers be at a minimum culturally competent, and understand how the history of medical experimentation and bias has impacted Black and LatinX people in Dallas. Data shows strong evidence that implicit bias plays a role in disproportionately high maternal and infant mortality, and likely affects many other poor health outcomes. Black and LatinX women are too often not being heard by providers, which can lead to them not receiving necessary medical treatment. Providers must work to address any biases they have and work to address persistent issues of mistrust in the Black and LatinX communities.

The World Health Organization worked to pioneer the concept of youth-friendly clinics nearly a decade ago, identifying that five key dimensions were necessary. These clinics needed to offer services that were: equitable, accessible, acceptable, appropriate and effective.14 Over time, these have become the building blocks of a Youth-Friendly Clinic Initiative that has been widely adopted around the country. Youth who receive health care services delivered in a way that meets the unique needs of adolescents ultimately develop into healthier adults who also have a higher likelihood of having healthier children should they become parents one day. The thirteen items outlined in the table that follows allow organizations to determine how youth-friendly they are.

FIGURE 9: YOUTH-FRIENDLY HEALTH CLINIC CHARACTERISTICS, MICHIGAN ADOLESCENT HEALTH INITIATIVE

WHERE WE ARE GOING & NECESSARY PARTNERS

Since COVID-19, healthcare providers’s attention has been diverted. Ntarupt will keep the following goals on the very necessary to-do list as they become feasible for the medical community. Like other projects, moving this forward will take concentrated personnel who can work individually with clinics and collaborate with the important partners listed on below

Partner Role

Dallas ISD School Health Clinics

Work to establish clear DISD/Parkland policies to ensure reproductive health care is available to teens at school based clinics, and that the community is aware of the resource Expand hours and reproductive health care (including all contraceptive methods) to at least one schoolbased clinic in the Southern Sector Work to establish clear DISD polices that allow, train and encourage all school nurses to address questions about reproductive health and contraception and provide condoms

Secondary

Encourage stronger messaging to DallasISD families about the availability of its School Health Clinics

Parkland Women’s Clinics

Continue to receive and track youth referrals from Ntarupt Provide information/data on contraceptive youth with teens Participate in Youth Friendly Clinic initiative (training and make necessary changes Participate/conduct training for providers on historical and cultural factors affecting health care in Black and LatinX patients

Dallas County Health Services

Continued access to STI testing Partner for contraception education delivery (MOU in place) Share messaging for Talk About It Dallas campaign Continue to provide outreach staff to talk to Ntarupt teen classes Share teen birth data with Ntarupt

Provide site for contraceptive counseling as safety allows

Child Poverty Action Lab (CPAL)

Expand access to contraception at local clinics Assist and expand locations that offer all types of contraception Provide funding for long acting reversible contraception to clinics Work with Parkland on pilot to provide immediate post-partum patients with same day access to long acting reversible contraception Support messaging about contraceptive options and use Launching “Trust Her” to share best practices with clinicians, partners and medical providers

Children’s Health Adolescent Clinic and Planned Parenthood Clinics

Continue providing teen friendly adolescent reproductive health care Participate in Youth Friendly training Participate in collaborative researchReceive/ conduct training on historical and cultural factors affecting health care in Black and LatinX patients

Other local clinics (Foremost, Agape, Los Barrios Unidos)

The Texas Campaign to Prevent Teen Pregnancy

Ensure access to reproductive health care and ability to provide all contraceptive choices for teens Implement youth friendly care Implement culturally competent care

Conduct the Youth Friendly Initiative training and evaluation Coordinate with the Michigan Adolescent Health Initiative