The Physician as Advocate for Adolescent Reproductive Health

2. The Physician as Advocate for Adolescent Reproductive Health

3. Outline • The Need: Why Adolescents Need Physicians to Advocate on Their Behalf • Advocacy on 4 Levels: Which Is Right for You? • Practice • Community • Media • Legislative and Policy

4. Adolescence • Transition between childhood and adulthood • Characterized by: • Physical, emotional, and developmental changes • Emerging sexuality • Awareness of gender identification and sexual orientation • Shaped by race, ethnicity, religion, socioeconomic status, family/peers, and other factors

5. Sexual Development Intend no more children First intercourse Spermarche First marriage First birth MEN 33.2 26.7 14.0 28.5 16.9 AGE 10 15 20 25 30 35 30.9 25.1 26.0 17.4 12.6 WOMEN Menarche First intercourse Intend no more children First marriage First birth Guttmacher Institute, 2005

6. Japan Teen Pregnancy Rates Worldwide, 2000(per 1000) United States

7. Pregnancy Outcomes for Teenagers 15-19 Years by Race and Hispanic Origin, 1990 and 2002 Rates per 1,000 women 223.8 134.2 169.1 131.5 116.3 98.8 75.4 65.0 Hispanic All Races White Black

8. Scope of Sexually Transmitted Infections • 18.9 million new cases of STIs each year • ½ of which occur in people ages 15-24 • Most are asymptomatic and remain undiagnosed • By age 25, at least 1 in 2 sexually active people will have contracted an STI • Economic costs of treatment ~ $6.5 billion/ yr

9. Advocacy

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

11. 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 in youth of color

12. More 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

13. Why Should Healthcare Providers Become Advocates? 1. Physicians Are Leaders in the Community When doctors speak out, people listen • Providers have a unique voice as medical experts • Providers’ voices are a critical advocacy tool to promote access to comprehensive reproductive healthcare services for their patients and their community at large • Providers’ views are influential in changing or shaping legislation or other issues

14. Why Should Healthcare Providers Become Advocates? 2. It Is a Residency Requirement ACGME Core Competency: SYSTEMS-BASED PRACTICE • Residents must demonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is of optimal value. • Residents are expected to: • Understand how their patient care and other professional practices affect other healthcare professionals, the healthcare organization, and the larger society and how these elements of the system affect their own practice • Advocate for quality patient care and assist patients in dealing with system complexities

15. Doctors as Advocates: The Role of Professional Organizations

16. Doctors as Advocates: Physicians for Reproductive Choice and Health • Physicians for Reproductive Choice and Health exists to ensure that all people have the knowledge, access to quality services, and freedom to make their own reproductive health decisions. PRCH mobilizes pro-choice physicians to promote, educate, and advocate about the importance of comprehensive reproductive healthcare.

17. Doctors as Advocates: The American Academy of Pediatrics • The law ought to protect the health and well-being of children just as arduously as pediatricians do • The AAP Division of State Government Affairs: • Provides assistance to AAP state chapters as they advocate for children • Offers resources for advocates on vital children’s health issues like Medicaid, injury and violence prevention, immunizations, and many others • Advocacy materials cover the legislative, research, and strategic dimensions of an issue • Bill watch: The AAP keeps constant watch of children’s health issues in all states, and stores laws and pending or recently defeated bills on pediatric advocacy issues

18. Doctors as Advocates: The American College of Obstetricians and Gynecologists (ACOG) • ACOG works primarily in 4 areas: • Serving as a strong advocate for quality healthcare for women • Maintaining the highest standards of clinical practice and continuing education for its members • Promoting patient education and stimulating patient understanding of and involvement in medical care • Increasing awareness among its members and the public of the changing issues facing women’s healthcare

19. First Step to Becoming an Advocate: Identify an Issue of Importance to Your Patients, Your Community, and You!

20. Assessing Need in Your Community • A healthcare need may be a: • Risk factor • Screening finding • Disease symptom • Condition or disease diagnosis • Consequence of a disease

21. Assessing Need in Your CommunityExample: Teen Pregnancy • Teen pregnancy can be addressed at the following levels • Risk factors • Knowledge of reproductive physiology • Knowledge or practice of sexual behaviors • Knowledge of and use of contraception • Symptomatic condition • Pregnancy • Complication • School absenteeism • Need for parenting skills

22. Assessing Need in Your Community • Sexuality education • Do local schools provide comprehensive sex education to their students? • After-school programs • Are there programs in your community that keep teens active and involved after school? • Condom and contraceptive accessibility • Can adolescents in your community obtain contraceptive services in a confidential setting?

23. Levels of Advocacy: Practice-Level Advocacy

24. How to Advocate for Your Adolescent Patients at the Practice Level • Identify your office as a safe space for adolescents • Train staff in confidentiality requirements, appropriate communication skills, and cultural competency • Utilize culturally competent intake forms • Display adolescent-appropriate, comprehensive health education materials • Conduct a comprehensive patient interview, assessing risk behavior and providing medically factual information to counter myths

25. How to Advocate for Your Adolescent Patients at the Practice Level • Have resources available to help patients navigate insurance, Medicaid, and billing process • 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

26. Levels of Advocacy Community Advocacy: Community-Oriented Primary Care

27. What Is Community-Oriented Primary Care? COPC is a continuous process by which primary care is provided to a defined community on the basis of its assessed health needs through the planned integration of public health practice with the delivery of primary healthcare services.

28. Why COPC? • Physicians have an impact on the health of individuals • Public health professionals have an impact on the health of communities • COPC allows for both physicians and public health professionals to collaborate in programs that benefit both patients and communities

29. Working Components • Assessing Capacity • Define the Community • Assess Partnerships • Identifying Priority Health Needs • Identify risk and protective factors • Assessing Target Population Readiness • Develop Intervention • Evaluating

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

31. Assessing Community Resources • Identify programs and other assets that have the potential to prevent teenage pregnancy and increase reproductive health • Directly or indirectly: •  Reduce risk factors •  Enhance protective factors

32. First Steps: Assessing Capacity • Community capacity is a comprehensive set of data that can be used to set short- and long-term 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 • Town meetings, interviews with stakeholders

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

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

35. Making Your Voice Heard: Using the Media to Advocate for Adolescent Health

36. Why Use the 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

37. Newspaper (local, regional, national) Op-Ed (700–800 words) Letters to the Editor (250–300 words) Newsletters (agencies, nonprofit organizations, professional associations, hospitals) Information Piece Case/Story Journals Letters to the Editor Editorial Web-Based Magazines Health column Letters Opinion pieces Types of Media: Print

38. Types of Media: Broadcast • Television • Radio • Internet • Niche Media • Spanish-Language Stations • LGBT Media

39. Planning the Message • Clearly highlight a discrete problem • Example: The teen pregnancy rate in your local school district • Provide a narrow solution • Example: Comprehensive sex education in public school health classes • Prepare sound bites • Prepare a brief summary of information that you want to convey

40. Disseminating the Message • Contact the media or they will contact you • 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

41. Taking It to the Next Level: Advocating for Adolescent Health at the Policy Level

42. Why Should Physicians Become Advocates at the National Policy Level? • When physicians lobby for change, legislators listen • Physicians’ voices are critical advocacy tools advancing the issues of access to comprehensive reproductive healthcare services • Physicians’ views are influential

43. The Medical Provider’s Role • As a healthcare provider, you have an important role in healthcare policymaking • 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

44. Approaching Policymakers:The Basics • Introduce yourself as a healthcare provider, including your medical specialty and where you practice • Explain the overall purpose of your communication • Explain why you have contacted them specifically: what professional and personal reasons have brought you to their office—e.g., you are a constituent, the legislator has been a leader on the issue, etc.

45. The Realities of Politics • No decision by a legislator is straightforward • Legislators need to balance competing interests • Constituents • Party and legislative leaders • Future political ambitions • Self-interest • Positioning in the public eye

46. The Realities of Politics • Meeting with the legislator’s staff: • 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

47. Communicating with Legislators • Share personal experiences and patient stories • This is essential • Highlight how this legislation would affect: • Your work as a healthcare provider • The lives of your patients • Public health in general

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

49. Communicating with Legislators • Keep it simple. • Implications of the bill • Reasons for your views • Technical medical explanations • Explain the medicine and science clearly and simply • Emphasize its relevance to the legislation

50. Communicating with Legislators • Be concise • Legislators have limited time • Be clear • Tell them what you want and why • Follow up • Thanks • Keeping promises