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Full Service Reproductive Health in a School-Based Health Clinic

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Full Service Reproductive Health in a School-Based Health Clinic FullFull ServiceService ReproductiveReproductive HealthHealth inin aa SchoolSchool--BasedBased HealthHealth ClinicClinic Bridging the Access Gap for Youth Tom Sincic, MSN, FNP [email protected] GoalsGoals forfor TodayToday z Define the Contraceptive Access Gap z Advantages of providing on site contraception. z Components of an individualized contraceptive plan. z Overcoming barriers to on site dispensing z ? DefiningDefining thethe AccessAccess GapGap z “Inability to get contraceptive of choice when needed” z Contributors ¾Communities ¾Schools and School Boards ¾Families ¾Social Workers ¾Health Care Providers ScenarioScenario 11 15 year old female walks into clinic requesting pregnancy test. First sexual intercourse was 2 days ago with a condom that “broke”. Menses are irregular with last menstrual period “awhile ago”. ScenarioScenario 22 First visit for 17 year old male is in asthma evaluation. Twice daily use of Albuterol inhaler but ran out a couple of days ago. Has had sexual intercourse with two female partners. Once with a condom and once without because “I didn’t have one”. ScenarioScenario 33 16 year old female in clinic for routine sports physical. Has boyfriend of one year. Never sexual intercourse. Has had a “close call”. Will have sex “when ready”. ScenarioScenario 44 16 year old female walks into the clinic a speaks to receptionist about needing “a test”. When in exam room states that shes been having six with boyfriend of six months for 2-3 months. Using condoms “mostly”. Now noticing some vaginal discharge. Last sexual intercourse two weeks ago. Last menstrual period 5 days ago for 3 days. ScenarioScenario 55 14 year old female for first visit with a sore throat. Lives in foster care. Has history of abuse but has never really been in counseling. Has had 4 sexual partners. LMP was 4 weeks ago. Last sexual intercourse was 2 months ago with 17 year old boyfriend of 2 months. CommunitiesCommunities z Attitudes and Policies ¾Age of Consent and Medical Consent ¾Confidentiality Laws ¾Plan B access ¾Others Sexual Consent Age Laws (USA) http://www.coolnurse.com/consent.htm USA by State: Female/Male Male/Male Female/Female Alabama 16 illegal illegal Arizona 18 illegal illegal California 18 18 18 Colorado 17 17 17 Connecticut 16 no current law no current law Delaware 16 (f)18 (m) no current law no current law Georgia 16 16 16 Idaho 16 (f) 18 (m) illegal illegal Indiana 16 16 16 Iowa 14(f) 18(m) no current law no current law Kentucky 16 no current law no current law Montana 16 (f) 18 (m) 18 18 New 17 16 16 Mexico North Carolina 16 illegal illegal 18 18 18 Oregon South 14 (f) 16 (m) illegal illegal Carolina Texas 17 illegal illegal Utah 16 - f 18 (m) illegal illegal Virginia 18 illegal illegal West 16 no current law no current law Virginia US Military 16 don't ask, don't tell don't ask, don't tell MedicalMedical ConsentConsent LawsLaws andand ConfidentialityConfidentiality ¾ Allow Consent—26 states ¾ No law—25 states Consent does not equal confidentiality http://www.guttmacher.org/graphics/gr030406_f1.html PlanPlan BB AccessAccess z Plan B Battles Embroil States By Marc Kaufman Washington Post Staff Writer Monday, February 27, 2006; Page A01 z Legislation in New Hampshire, for instance, would require parental notification before the drug is dispensed, and more than 20 other states will consider bills that give pharmacies the right not to stock the drug and pharmacists the right not to dispense it, even to women with valid prescriptions. PlanPlan BB AccessAccess z Passage last year of a Texas bill that eliminated the drug from a demonstration family-planning program, and to an Arkansas bill that kept emergency contraception off a list of covered contraceptives. SchoolsSchools andand SchoolSchool BoardsBoards z Attitudes and Policies ¾Can’t excuse self from school for medical visits ¾Allow reproductive health without condoms ¾Others DoDo youyou knowknow thisthis person?person? MeetMeet JenniferJennifer JackoJacko The Oregonian Sunday, May 14, 2006 Background: In 1993, Jennifer Jako, then 20, was featured in an article about women infected with the virus that causes AIDS. At the time, the Lake Oswego woman was measuring her life expectancy in months, or perhaps a few years. SchoolsSchools andand SchoolSchool BoardsBoards Lake Oswego Review 01/12/06 http://www.lakeoswegoreview.com/article/9903_2 No go on condom survey According to the students, Principal Bruce Plato did not favor the idea, because he felt providing condom machines would send the wrong message to students and the community. Superintendent Bill Korach told board members that he felt the survey was “inappropriate” and that the school board’s decision to proceed down this road “could be viewed by individuals as supporting or encouraging student sexual behavior.” FamiliesFamilies • Attitudes ¾Belief that access=permissiveness ¾Need to know ¾Control issues ParentsParents NeedNeed toto KnowKnow 2002 REPORT CARD The Ethics of American Youth Press Release and Data Summary http://www.josephsoninstitute.org/Survey2002/survey2002- pressrelease.htm 9 Lying to parents. Though one would expect a high percentage of young people to admit lying to their parents in the past year, the increase from 1992 to 2002 is substantial (83% vs. 93%). 9 Students attending religious schools were more likely to lie to a parent (95% vs. 91%) but students with personal religious convictions lied at the same rate as the national average. 9 The percentage of students who admit lying to their parents two or more times increased from 70% in 1992 to 81% in 2002. SocialSocial WorkersWorkers andand FosterFoster CareCare ¾ Time ¾ Fail to get kids into preventive service ¾ No specific plan for pregnancy prevention ¾ 50% pregnant by age 19 in one study ¾ 59% said their program does not have a specific plan for teen pregnancy prevention. ¾ 72% report their program in programs for youth who are not pregnant or parenting ¾ 37%of staff in programs designed for pregnant and parenting teens in avoiding pregnancy. ¾ Others http://www.teenpregnancy.org/ http://www.teenpregnancy.org/resources/reading/foster_care/default.asp Fostering Hope: Preventing Teen Pregnancy Among Youth in Foster Care HealthHealth CareCare ProvidersProviders ¾ Privacy Issues ¾ Access to timely care—what happens when you call for appointment- ¾ “I tried to get her in put they needed to get the records first” ¾ Public—locations not adolescent oriented and still often with parent/guardian accompaniment ¾ Planned Parenthood—follow up, location, problem focused rather than client focused. InsurersInsurers (Both(Both publicpublic andand private)private) ¾ Limited Coverage—costs ¾ Select providers ¾ Constant refills—frequently refills often less than monthly TheThe ProblemProblem withwith thethe AccessAccess GapGap LessonsLessons learnedlearned from:from: TheThe HolyHoly Bible:Bible: GenesisGenesis ChapterChapter 33 RomeoRomeo andand Juliet,Juliet, ActAct 2,2, SceneScene 22 by William Shakespeare BrokenBroken WingsWings by Kahlil Gibran Bundling:Bundling: ItsIts Origin,Origin, ProgressProgress && DeclineDecline InIn AmericaAmerica by Henry Stiles, M.D. Lessons learned from: Holy Bible: Genesis Chapter 3 Now the serpent was more subtile than any beast of the field which the LORD God had made. And he said unto the woman, Yea, hath God said, Ye shall not eat of every tree of the garden? 2 And the woman said unto the serpent, We may eat of the fruit of the trees of the garden: 3 but of the fruit of the tree which is in the midst of the garden, God hath said, Ye shall not eat of it, neither shall ye touch it, lest ye die. 4 And the serpent said unto the woman, Ye shall not surely die: 5 for God doth know that in the day ye eat thereof, then your eyes shall be opened, and ye shall be as gods, knowing good and evil. 6 And when the woman saw that the tree was good for food, and that it was pleasant to the eyes, and a tree to be desired to make one wise, she took of the fruit thereof, and did eat, and gave also unto her husband with her; and he did eat. Lessons learned from: Romeo and Juliet, Act 2, Scene 2 by William Shakespeare JULIET O Romeo, Romeo! Where fore art thou Romeo? (2.2.33) Deny thy father and refuse thy name; (2.2.34) Or, if thou wilt not, be but sworn my love, And I'll no longer be a Capulet. JULIET How camest thou hither, tell me, and wherefore? The orchard walls are high and hard to climb, And the place death, considering who thou art, If any of my kinsmen find thee here. ROMEO With love's light wings did I o'er-perch these walls; (2.2.66) For stony limits cannot hold love out, And what love can do, that dares love attempt; Therefore thy kinsmen are no stop to me. (2.2.69) JULIET If they do see thee, they will murder thee. ROMEO A lack, there lies more peril in thine eye Than twenty of their swords! Look thou but sweet, And I am proof against their enmity. (2.2.73) JULIET I would not for the world they saw thee here. (2.2.74) ROMEO I have night's cloak to hide me from their sight; And but thou love me, let them find me here: My life were better ended by their hate, Than death prorogued, wanting of thy love. (2.2.78) Lessons learned from: Broken Wings by Kahlil Gibran I was eighteen years of age when love opened my eyes with its magic rays and touched my spirit for the first time with its fiery fingers, and Selma Karamy was the first woman who awakened my spirit with her beauty and led me into the garden of high affection, where days pass like dreams and nights like weddings. It is wrong to think that love comes from long companionship and persevering courtship.
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