Special Health Conditions: Adolescent Pregnancy

Recent data (2011, 2008) reflects that Texas ranks 3rd of 51 (50 states and the District of Columbia) in pregnancies among women aged 15-19, and 5th of 51 in births to teens aged 15-19. At 46.9 births per 1000, the Texas birth rate to women aged 15-19 exceeds the U.S. rate of 31.3. Similarly, the Texas birth rate to teens 15-17 exceeds the U.S. rate (25.6 compared to 15.4) (http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/states/tx.html).

2013-2014-chart-27

For identified pregnant students, the goal of school-based nursing case management services is to support a healthy pregnancy to full term delivery, followed by the continuation of the teen mother in school. Pregnancy-related case management services include regularly scheduled contacts with the student to provide pregnancy education and support, linkage to a primary provider, public health insurance and social service referrals as needed, school attendance monitoring, communication with the provider as needed, infant care education and infant immunization support.

A Program of Children’s Health Express

A Health Resources and Services Administration (HRSA) grant has allowed the Children’s Health Express mobile health clinic (CHE) to provide medical and social work services to pregnant/parenting students at 4 high need high schools. Dell Children’s Medical Center of Central Texas is concluding its fifth year of partnership with the Austin Independent School District serving pregnant and parenting (PEP) students. This signature program is providing a campus-based medical home for PEP students and their children by sending the Dell Children’s Health Express (CHE) Mobile Health Unit to Reagan, Travis, Eastside Memorial/International and Crockett High Schools. The goals are two-fold: to improve health outcomes for the PEP students and their children while reducing unexcused school absences for the students. Students and their children were assisted in obtaining well child, pediatric, WIC, Medicaid and related care without needing to travel, reducing out of school time. Goals for the program have been to increase the graduation rate among pregnant/parenting students and to increase immunization rates for their infants. Maternal depression screening is an aspect of the service model, with service referral for those in need. A total of 1015 patient visits have been provided to 336 PEP students and their children over the past five years of the grant.

2013-2014-chart-28

A previously identified pregnant student is one who is identified in one school year and returns to school the following term, continuing pregnancy related services. A newly identified pregnant student is one who is identified during the current school year. The number of reported student pregnancies increased steadily from SY 2005-06 through SY 2010-11. The decline in reported pregnancies begun in SY 2011-12 continued in SY 2013-14, with 236 newly diagnosed student pregnancies. This is a reduction in identified student pregnancies of 31% from the prior year and 48% from the peak in 2010-11.

2013-2014-chart-29

Pregnancies among middle school students have also declined over the past four years. Previously, middle school pregnancies were fairly evenly distributed across the majority of campuses. During School Year 2013-14 two campuses accounted for the majority of student pregnancies.

2013-2014-chart-30

While the decline in student pregnancies is an encouraging trend, an area of concern has been the multiyear increase in students whose pregnancy is not identified until the third trimester. Delays in identification may also reflect delays in access to adequate medical care to help insure a safe, healthy delivery. School Year 2013-14 marked a reversal of that trend, with slightly more than half of all pregnant students being identified in the first trimester. The performance benchmark has been that 50% of students will be identified in their first trimester.

2013-2014-chart-31

School outcomes were available for 130 pregnant students by the end of the school year, and birth outcomes were available for 106 students. It is possible that a pregnant student could have graduated before giving birth, which helps to explain the discrepancy in outcome information. In SY 2013-14, for those students whose outcomes could be identified, 76.4% of student pregnancies resulted in full term deliveries. Still, 8.5% of student births were preterm, an area of concern. Preterm births have been declining from the peak of 11.3% in SY 2011-12. Preterm is defined as birth prior to 38 weeks gestation.

2013-2014-chart-32

School outcomes for pregnant/parenting students could be identified for 130 students in SY 2013-14. Of these, 87 (67%) of students were known to have returned to school or graduated post-pregnancy. An additional 31 students withdrew from school; fewer than 6 did not return to school.

2013-2014-chart-33

Two Programs of AISD: Human Sexuality Curriculum and REAL Talk

The AISD health education curriculum which is comprehensive, taught K-12, is aligned with best practices and age appropriate. The District’s human sexuality curriculum teaches abstinence as the preferred method to prevent unintended pregnancy and sexually transmitted diseases. In addition to promoting abstinence, the curriculum educates students on goal setting, emotional supports, risk reduction, and addressing peer pressure in an effort to prevent pregnancy and sexually transmitted infections/diseases (STDs).

In addition to the comprehensive health curriculum, the grant-funded evidence-based program Risk Reduction Education for Adolescent Life (REAL Talk) constitutes an additional key effort to prevent adolescent pregnancy in AISD schools. There is a significant need within Austin ISD and Travis County to address the high rates of teen pregnancies and rates of sexually transmitted infections among our adolescent population through increased sexual health education for adolescents and their parents. Middle school and high school campuses with the highest rates of teen pregnancies are targeted, and parental consent is required for participation in REAL Talk. Parent involvement activities, service learning projects, and individual mentoring are provided to participants. The outcome goals of the AISD REAL Talk program include increased knowledge of issues relevant to sexual health and decision-making. Additional areas that could be assessed, with district approval, include changes in sexual behavior, changes in high risk behavior, and changes in intention (e.g. to delay initiation of sexual activity).