2007 Model Practice Application (Public)

Prenatal Care Guidance's Probation Outreach Project ("POP")

Los Angeles County Department of Health Services - Public Health

Prenatal Care Guidance's Probation Outreach Project targets pregnant minors who are in detention in Los Angeles County Juvenile Detention facilities. Minors who are pregnant and detained are considered to be at VERY high risk for adverse outcomes of pregnancy, poor parenting and life course development. They often they lack the knowledge, resources and awareness needed in order to help ensure that their offspring are born healthy and receive the needed parental support to remain healthy and develop optimally during their critical first few years of life.

Detained and pregnant minors have multiple social and physical issues that put them at risk for poor pregnancy outcomes and disrupted child rearing. The Probation Outreach Project (POP) goals are to identify, intervene and ensure that all pregnant and detained minors obtain the needed support to ensure healthy pregnancies and develop effective and safe parenting skills. The outcomes are to: 1) increase their knowledge on pregnancy related issues and resources for care; 2) connect discharged juveniles to case management programs (such as the Department of Public Health's Nurse-Family Partnership [NFP] program) that can assist with their community prenatal case management and provide parenting support that prepares the family to optimize development and safety during early childhood; and 3) assist pregnant minors assess perinatal health care services upon their discharge.

In the first year of practice, 365 pregnant minors were identified and the PHN assessed 68% (250) of them. (Some were released prior to an assessment being made.) Of these, 68% were assessed, and 21% were referred to and enrolled in the DPH NFP program upon release. Some of the minors who were referred to home/community support programs chose not to participate, but they were given resources for prenatal care and community support in case they decided differently later on.

Because of the increase in the number of adolescent girls entering the juvenile justice system, there is a need for better “gender specific programming” to address their unique health care needs. Adolescent girls who are pregnant are, by the nature of age alone, at risk of poor pregnancy outcomes, and often have compounding health and mental health issues that have not been successfully addressed prior to their pregnancies. Many of the issues facing these pregnant juveniles are related to their histories of past trauma including childhood sexual or physical abuse and exploitation, poor parenting with possible neglect, and living in families with mental health, behavioral or social issues. These events impacted their life course trajectories, and many of these adolescents exhibit substance abuse difficulties, mental illness, and behavioral disorders at much greater frequencies than in the general population of teens. National statistics show that arrests of adolescent girls for drug abuse violations have increased, and in some cities, 60 to 70 percent of young women ages 15-20 test positive for drugs at the time of their arrest, with 60 to 87 percent needing substance abuse treatment. This number is significant, as drugs—and more significantly, alcohol abuse—has been shown to cause severe adverse birth and child outcomes, and is one of the major underlying factors for children’s placement into protective care services. The Department of Probation has realized the need to have a more comprehensive program for these adolescents who have special health care needs, and quickly realized that in order to be successful in transitioning the young woman into an adult life without crime, intervention for depression, traumatic stress, drug and alcohol abuse, parenting skills and health-risking sexual behaviors had to be effectively addressed.

When approached by a Deputy Probation Officer to assist with a pregnant minor case, the DPH nursing staff identified a medically underserved and at risk population within the Probation system. Understaffed, with frequent turn-over of old staff leaving and new staff entering made the system very chaotic. Knowing that the health care funding for minors who were detained was an issue because it did not come from Medi-Cal benefits, DPH staff identified only one program, the PCG "outreach" Program, that could pull down State funds to subsidize part of their salary for the work which helped pregnant minors understand the need for, and have the resources to access health care services upon their discharge from detention. There was no tool available or applicable at the time this program was conceived, and this targeted outreach to the highest of risk minors was never before supported with data collection and a dedicated full-time PHN on site within the facility.

The role of the LHD was to provide staff support to develop a computerized system and perform data entry regarding the number of pregnant minors seen, the type of health issues addressed, and the outcome of their referrals. Using the DPH's Maternal, Child and Adolescent Health (MCAH) Program staff for support, the PHN obtains literature, provider resources via the Comprehensive Perinatal Services Program (CPSP), and has most of the clerical needs supplied by this staff. The administrative staff of MCAH negotiated the MOU contract with the Department of Probation, working out an arrangement that had never before been accomplished; the ability to have a DPH nurse access the intake records for all three Halls and Camps to identify pregnant minors, permission to review their medical records and meet with them individually within the confines of the detention facilities prior to their discharge back into the community. Collaboration between all involved entities is encouraged through the MOU, but successful primarily due to the relationship development between the PHN and those with whom she works.

Los Angeles County, Department of Public Health provides funding with an approximate 75% State match on funding used for the express purpose of "outreach" for Medi-Cal services. Program costs total approximately $30,000 per year.

The PHN first needed to determine how the Probation system worked, as the three major Halls and Camps functioned differently. A relationship was established with the other workers within the Central and outlying facilities, such as those working in the Department of Mental Health's assessment center, the Department of Health's health care workers, and those who provided oversight to the detained children (Probation Department), to learn more about their particular system's functioning. It took approximately six months to determine key points of contact and methods for meeting with the pregnant minors. The MOU allowed the PHN to access the minors directly within the detention Halls and Camps, and allowed access to their health records. Working with the other involved departments allowed for better maintenance of data on the detained pregnant juveniles, and to educate them directly regarding their health care needs. The PHN used the NFP Program supervisory and nursing staff to identify community resources for referrals. Over the first year of functioning, data collection processes were established to better assess and address the health care needs of the minors.

The Department of Probation, and the Juvenile Health Services Section (run by the Department of Health Services), has expressed much gratitude and appreciation for the data and assistance this POP program has provided to their most at risk minors. Community participation from shelters and other homes for pregnant teens has provided stable housing and support for these at risk minors. Commitment is ensured through the sharing of data and partnership that lessens their workload while the collaborative ties with community afford greater case management services for those in need. Over time, the PCG program will seek additional funding via foundation grants or through the Mental Health Services Act to add another nurse who can facilitate contacting minors who are in outlying facilities.

The goal of the practice is to identify, intervene, and ensure that all pregnant and detained minors obtain the needed support to ensure healthy pregnancies and develop effective and safe parenting skills.

Objective 1: Identify high risk pregnant minors who are detained Probation Camps and Halls.

Performance Measures: Assessed movement of minors through the system and within the facilities. Located detention and health information on identified pregnant minors.

Outcomes: Since inception, the PHN has identified 365 pregnant minors, assessed 68% (250) of them, and referred 50% (126) to DPH support programs.

Objective 2: Interview/assess pregnant minors and determine the need for community-based support services.

Performance Measures: PHN identified location of minors and made arrangements to meet with each one of them individually to assess their need for services. PHN worked collaboratively with the detained minor to ensure their understanding and willingness to participate in supportive services.

Objective 3: Refer and provide follow-up to ensure that needed supports are obtained post discharge from detention.

Performance Measures: PHN provided education, literature, and referral resources to all minors who she interviewed and assessed.

Lessons learned include:

• The PHN received the data results and coorelated them with data available through the DHS Health Care services. It was learned that data keeping is not a focus of participating departments, and our records were the only record of the full number of detained minors on any given day.
  
  
• The data has not yet been made available for general use, but is kept daily by the PHN and entered into our main data system. The difficulty of locating the minors following their full release has created difficulty in following their cases, and collaboration with Probation continues to resolve this issue.