The Physician as Advocate for Adolescent Reproductive Health

1. The Physician as Advocatefor Adolescent Reproductive Health

2. Adolescents Need Physicians to Advocate on Their Behalf

3. Adolescents Need Physicians to Advocate on Their Behalf • Adolescence is a unique time in life requiring special attention • Characterized by: • Physical, emotional, and developmental changes • Emerging sexuality • Awareness of gender identification and sexual orientation

4. Factors Shaping Adolescence Race Ethnicity Religion Socio-economic status Peers Family

5. Advocacy Can Improve Adolescent Health • The major causes of adolescent morbidity and mortality are preventable • Physician advocacy can address the factors that contribute to negative health outcomes.

6. What Is Advocacy? • Definition: • Application of information and resources • The action of advocating, pleading for, or supporting a cause or proposal

7. Examples of Advocacy • Placing educational literature in your office space to educate and inform patients • Developing a community health behavior change program that addresses STIs among youth

8. Examples of Advocacy • Giving expert testimony to the local school board regarding comprehensive sex education • Writing a letter to a national or local newspaper regarding risk factors for teen pregnancy • Testifying before Congress to advocate for expanded Medicaid coverage for contraception

9. Why Should Providers Become Advocates? • Physicians are leaders in the community • It is a residency requirement

10. Steps to Advocating for Adolescents • Identify a need • Assess community resources • Choose a level of advocacy

11. Identify a Healthcare Need • A healthcare need may be a: • Risk factor • Screening finding • Disease symptom • Condition or disease diagnosis • Consequence of a disease

12. Example: Teen Pregnancy • Teen pregnancy is a major public health concern.

13. Teen Pregnancy Rates Worldwide, 2000 Per 1000

14. Teen Mothers Are…. • Less likely to: • Receive adequate prenatal care • Graduate from high school • More likely to: • Die in childbirth • Be poor as adults • Have symptoms of depression • Lack resources to foster their children’s development

15. Teen Fathers Have… • Poor academic performance • Higher school dropout rates • Limited financial resources • Decreased income capacity • Difficulties staying involved in children’s lives

16. Infants of Teens Are... • Over 2 times more likely to be low birth weight • Over 2 times more likely to be born premature • Almost 3 times more likely to die in the first month of life

17. Children of Teens Have… risk of childhood health problems risk of being hospitalized risk of developmental delay risk of school problems risk of behavior problems risk of substance abuse risk of becoming a teen parent

18. Addressing Teen Pregnancy Teen Pregnancy Can Be Addressed on Several Levels Symptomatic condition Condition antecedents Complication • Decreasing teenage sexual activity • Increasing teen knowledge of contraceptives and condoms • Ensuring improved prenatal care • Reduction in substance use and risk behaviors • Providing parenting skills training • Enabling continued maternal education

19. Choosing an Area of Focus • Sexually Education • Do local schools provide comprehensive sexuality education? • After-school programs • Are there programs in your community to keep teens active and involved after school? • Condom and contraceptive accessibility • Are condoms and contraceptives available confidentially? If not, how can you play a role in filling these voids?

20. On which level will you choose to advocate? Practice Community Media Legislative and Policy

21. Choosing a Level of Advocacy • Identify your office as a safe space • Conduct a comprehensive patient interview, assessing risk behavior and providing medically factual information to counter myths • Have resources available to help patients navigate insurance, Medicaid, and billing process

22. What Do You Need to Know? • Be aware of state laws regarding minors’ legal rights to comprehensive care • Be knowledgeable about local resources for referrals to provide services beyond the scope of your practice

23. Choosing a Level of Advocacy Community • Steps to providing community oriented primary care • Assessing community capacity • Identifying health priorities • Assessing population readiness • Develop Intervention • Evaluation

24. Why Is Defining theCommunity Vital? Community • Adolescent reproductive health indicators differ by region, state, city, and community • It is crucial to tailor interventions to the needs of community members

25. Assessing Community Resources Community • Identify programs and local, faith based, and/or national organizations that have the potential to prevent teenage pregnancy and increase reproductive health • Directly or indirectly: •  Reduce risk factors •  Enhance protective factors

26. Assessing Capacity Community • Community capacity is a comprehensive set of data that can be used to set objectives • Assessment may include: • Compilation of demographic data from census records • Results of surveys conducted by others • Responses by partnership members to questions about the community they serve • Focus group discussions, interviews with stakeholders

27. Community-Oriented Intervention Community • Develop intervention based on: • Community Assessment • Community Partners and Resources • Personal and Organization Resources and Abilities • Even the simplest intervention can make a difference!

28. Evaluation Community • Decide specific measures of success based on community assessment and intervention initiative • Baseline • Measures • Targets • Outcomes

29. Choosing a Level of Advocacy Media • The media can: • Get the attention of community/laypersons, colleagues/institutions, and policymakers • Offer opportunities to provide scientifically sound and accurate information • Disseminate research

30. Newspapers Op-Ed (700–800 words) Letters to the Editor (250–300 words) Newsletters Agencies, nonprofit organizations professional associations hospitals Journals Letters to the Editor Editorial Web-Based Magazines Health column Letters Opinion pieces Print Media Media

31. Broadcast Media Media • Television • Radio • Internet • Niche Media • Spanish-Language Stations • LGBT Media

32. Planning the Message Media • Clearly highlight a discrete problem • Provide a narrow solution • Prepare sound bites • Prepare a brief summary of information that you want to convey

33. Disseminating the Message Media • Contact the media • Call the newsroom at your local paper and find out how to submit a letter or Op-Ed • Join a national advocacy organization, such as Physicians for Reproductive Choice and Health, and identify yourself as able and willing to talk to the media

34. Choosing a Level of Advocacy Legislation and Policy • Your knowledge and expertise can be used in a number of ways, including: • Providing oral or written testimony at hearings or other public forums • Educating legislators and their staff members • Following up when information is requested from you • Thanking legislators who vote in a manner with which you agree

35. Approaching Policymakers Legislation and Policy • Introduce yourself as a healthcare provider • Explain the overall purpose of your communication and why specifically you are bringing this issue to their attention

36. The Realities of Politics Legislation and Policy • No decision by a legislator is straightforward • Legislators need to balance competing interests

37. Meeting With Legislators’ Staff Legislation and Policy • Know the details of the issue the best • Significant influence on the legislator • More likely to give helpful information • Deserve equal respect • Don’t be disappointed

38. Share Personal Experiences Legislation and Policy • Highlight how this legislation would affect: • Your work as a healthcare provider • The lives of your patients • Public health in general

39. Communicating with Legislators Legislation and Policy • Know what you want to accomplish • Prior to the meeting • With your testimony • From your letter • Develop talking points • Stick to them

40. Communicating with Legislators Legislation and Policy • Keep it simple • Implications of the bill • Reasons for your views • Avoid technical medical explanations • Be patient, positive, and flexible • Be clear and concise • Follow up

41. Your Legislator’s Stance • Solidly in support of your issue • Mixed on your issue • Entirely opposed to your issue Legislation and Policy

42. Supportive Legislators • Thank the legislator • Mention recent votes or comments the legislator made about your issue and how much you (and your patients) appreciate this support • Express the importance of the legislation • Reaffirm the importance of vocal legislators Legislation and Policy

43. Mixed Level of Support • Focus on a specific piece of legislation • Remember your goal: passage or elimination of one bill • Stress the medical necessity and benefits to the medical community and patients • Reaffirm the importance of vocal legislators Legislation and Policy

44. Opposition Stance • Acknowledge the legislator’s point of view • Highlight aspects of the legislation that would best influence the legislator’s vote • Highlight the medical and scientific facts • Emphasize how the bill would secure the health of your patients • Use logic to combat any emotionally charged language or reasoning Legislation and Policy

45. How Can Physicians Advocate? • Ask questions and get involved • Organize and speak out when necessary • Push for stronger standards of care for reproductive health services in your practice and institution • Contact the media; write a letter to the editor for the local newspaper • Write to or visit your public officials • Get involved with your medical association and Physicians for Reproductive Choice and Health!

46. Please Complete Your Evaluations Now

47. Provider Resources: • Resources: • www.prch.org - Physicians for Reproductive Choice and Health • www.aap.org - The American Academy of Pediatrics • www.acog.org - The American College of Obstetricians and Gynecologists • www.adolescenthealth.org - The Society for Adolescent Medicine • www.aclu.org/reproductiverights/ - The Reproductive Freedom Project of the American Civil Liberties Union • www.advocatesforyouth.org – Advocates for Youth • www.guttmacher.org – Guttmacher Institute • www.cahl.org/ - Center for Adolescent Health and the Law • www.gynob.emory.edu - The Jane Fonda Center of Emory University • www.siecus.org - The Sexuality Information and Education Council of the United States • www.arhp.org - The Association of Reproductive Health Professionals

48. Provider Resources: • PRCH’s Minors’ Access to Confidential Reproductive Healthcare Cards and Emergency Contraception: A Practitioner’s Guide • ARHP Reproductive Health Model Curriculum • AMA Guidelines for Adolescent Preventive Services (GAPS) • The American College of Obstetricians and Gynecologists: • Confidentiality in Adolescent Health Care • Primary and Preventive Health Care for Female Adolescents • Tool Kit for Teen Care—available at: • http://www.acog.org/bookstore/Tool_Kit_for_Teen_Care_P348C84.cfm • For emergency contraception, call 1-888-NOT-2-LATE

49. Provider Resources • Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines 2002: www.cdc.gov/std/treatment/rr5106.pdf • Building Emergency Contraception Awareness Among Adolescents, A ToolKit, Academy for Educational Development: http://www.aed.org/Publications/upload/ECtoolkit3283.pdf • Henry J. Kaiser Family Foundation: public health policy, broken down by area (e.g., reproductive, state-specific, Medicaid, HIV/AIDS): www.kff.org. • The Young Men’s Clinic of Columbia University: http://www.cumc.columbia.edu/dept/sph/popfam/ • Mount Sinai Adolescent Health Center: http://www.mountsinai.org/msh/msh_program.jsp?url=clinical_services/ahc.htm