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2012 Model Practice Application (Public)Application Name: 2012 Model Practice Application (Public) : Lowcountry Regional Public Health - SC DHEC : The Point - It's All About You Applicant Name: Ms. Stephanie Friesner Application Title: The Point - It's All About You Please enter email addresses you would like your confirmation to be sent to. friesnsi@dhec.sc.gov Submitting LHD/Agency/Organization The Point/SC DHEC/Region 7 Public Health Head of LHD/Agency/Organization John Simkovich Street Address 4050 Bridgeview Drive Practice Contact Person Stephanie Friesner Title Family Planning Program Manager Submitting LHD/Agency/Organization Web Address (if applicable) Provide a brief summary of the practice in this section. This overview will be used to introduce the model or promising practice in the Model Practices Database. Although this section is not judged, the judges use it to get an overall idea about your practice. You must include answers to the following questions in your response:
• Size of population in your health department’s jurisdiction
• Who is your target population/audience, for this practice
• Size of target population/audience, if applicable
• The number or percentage of the target population/audience reached, if applicable
• Describe the nature and gravity of the public health issue addressed
• List the goal’s and objective(s) of the practice and clearly link them to the problem or issue the practice is addressing. Briefly indicate what the practice intends to accomplish overall.
• When (month and year) the practice was implemented.
• Briefly describe how the practice was implemented, what were major activities, and any start-up and in-kind costs and funding services.
• Outcomes of practice (list process milestones and intended/actual outcomes and impacts.
• Were all of the objectives met?
• What specific factors led to the success of this practice?
• Lessons learned from the practice The South Carolina Department of Health (DHEC) Region 7 serves approximately 560,000 residents living in Charleston, Dorchester and Berkeley Counties. The region provides both direct clinical services (WIC, Family Planning, STI, HIV, Immunizations and Nutrition) and community based health education and health promotion activities. DHEC Region 7 served 11,723 unduplicated clients in the Family Planning Clinics during fiscal year (FY) 2011. Of the clients served, 6,845 clients received their services in a Charleston County Public Health Department. In 2008, DHEC Region 7 received funding from the Office of Population Affairs, the New Morning Foundation, and the National Association of City and County Health Officials (NACCHO) to provide reproductive health services in a confidential environment on Johns Island, South Carolina.
The Point, in Charleston County South Carolina, is a comprehensive adolescent health clinic-serving teenagers ages 15 to 24 on Johns Island. The clinic was originally established in January 2009 to focus on preventing teen pregnancy specifically on Johns and Wadmalaw Islands. There are 883 high-school aged youth living in this area. There are an additional 938 students enrolled in grades 5-8. Approximately 18% of these young people are living below the poverty level. There were 30 teen pregnancies in 2005, which represents 4% of all the teen pregnancies in Charleston County at this time. Twenty-eight percent of those teen pregnancies were repeat teen pregnancies. There are 344 students enrolled at St. Johns High School, which is the target population for The Point. Based upon self-report school surveys conducted by CIS staff, approximately 172, or 55% of the students are sexually active. About half of those are females. Our surveys also indicate that approximately 40% are currently using hormonal forms of birth control. Approximately 60% are using condoms. Based upon experience and survey reports, 40% of young people are unprotected. This survey also indicates that, of those girls who are not sexually active, approximately 40% of them are thinking about becoming sexually active soon.
Overflow: Please finish the response to the question above by using this text area. Please be mindful of the word limits. The goal of The Point is to provide comprehensive services on John’s Island with the collaborative efforts between the South Carolina Department of Health and Environmental Control (SC DHEC) Region 7 Family Planning program and Communities in Schools of the Charleston Area, Inc (CIS). The project aims to assist adolescent females and males access services that will enhance their ability to make responsible reproductive health choices. The SC DHEC Region 7 Family Planning Program and CIS collaboration identified the following project objectives:
· To provide confidential reproductive health services to at least 250 adolescents annually.
· To decrease teen pregnancy rates of clients served at The Point from Johns and Wadmalaw Islands by 5% within 5 years of project implementation.
· To decrease the STI incidence of clients served at The Point from Johns and Wadmalaw Islands by 5% within 5 years of project implementation.
The Point has exceeded the expectations of the project goals and objectives. The Point provides services to approximately 350 teens annually in a confidential setting, which is 102% of the target population. From 2009 to 2010 STI rates at St. Johns High Schools was reduced from 24% to 10%; and pregnancy rates reduced from 30 pregnancies in 2005 to 2 pregnancies in 2010, which is a 93% reduction in unintended pregnancies. The success of the project is contributed to multiple factors including: consistent, adolescent friendly staff; client-centered, confidential reproductive health services to include on-site contraceptive methods; collaborative efforts between public health and a school-based organization; and building community awareness through on-site events to include adolescents and parents. Success of project is also attributed to the confidential marketing strategy to branding the clinic The Point based on client feedback.
Describe the public health issue that this practice addresses. (350 word limit)
In 2007 there were 254 reported pregnancies between 14 to 17 year old girls in Charleston County resulting in 177 lives births. Among South Carolina counties, at the time Charleston county ranked second for the number of teen pregnancies per 1000 females in the target age range (15 to 19 year old's). Communities in Schools (CIS), a national non-profit agency dedicated to reducing the high school dropout rate, recognized the major part that teen pregnancy was playing in the high dropout rate in Charleston County schools. CIS chose to focus on Johns and Wadmalaw Islands, a rural area of the county where there is a vast disparity between white and minority residents in terms of income, education, and employment. St. Johns High School serves both islands. Approximately 18% of these young people live below the poverty level. Based on surveys conducted by CIS, approximately 55% of the students were sexually active, yet about 40% of those who were sexually active were not using any type of birth control. The survey also found that of the girls who were not currently sexually active, 40% were thinking about becoming active soon. Another key issue other than cost and access discouraged young women from seeking sexual health services was lack of confidentiality. This is a rural community in which many families are related and extended families are very involved. There was only one local provider, who employed local staff. That provider does not see youth under the age of 16 without parental consent, yet the average age of initiation of sexual activity among these youth is 13. What process was used to determine the relevancy of the public health issue to the community? (350 word limit) Because of the identified issues that needed to be addressed, CIS was prompted to get involved with teen pregnancy prevention and began working with the federal Medicaid Adolescent Pregnancy Prevention Services program. That effort enabled CIS to identify students within the school based on certain risk factors. Once identified, these students began to receive weekly individual and group education sessions regarding healthy choices, decision-making, self-esteem, abstinence, family planning, and STI’s including HIV. But, CIS recognized that education is only one piece of teen pregnancy prevention; that they also needed to increase the student’s access to reproductive health services to be truly effective. That led to a partnership with DHEC Region 7 and together created a teen friendly reproductive health clinic simply called The Point. The Point has been instrumental in helping teens across Charleston County avoid unplanned pregnancy. While the original mission of The Point was to prevent unintended pregnancy through the provision of family planning, sexual health prevention, and educational services, as more clients came to the clinic, it became clear that more services were needed and The Point became the interdisciplinary clinic it is today. How does the practice address the issue? . In addition to the family planning and sexually transmitted infection services, we take a complete individual and family history, provide lab testing for hemoglobin, offer immunizations, and conduct a physical exam that assesses for cardio and respiratory health, thyroid problems, skin exam and checking the abdomen for distention. If additional screening is indicated, referrals are made to free and low cost clinics. Future plans include initiating healthy weight and exercise education and activities. Is the practice new to the field of public health? If so, answer the following questions. What process was used to determine that the practice is new to the field of public health? Please provide any supporting evidence you may have, e.g. literature review. Counseling adolescent clients about responsible sexual behavior, including abstinence and proper use of regular and emergency contraception is effective in decreasing the incidence of unintended pregnancy (Journal of the American Academy of Pediatrics, 102 (5), November 1998). Prevention efforts must focus on changes in sexual behavior and changes in contraceptive use. Easy access to contraceptives and other reproductive health services contributes to better contraceptive use and therefore lowering teenage pregnancy and STI rates. Easy access means that adolescents know where to obtain information and services, can reach a provider easily, are assured of receiving confidential, nonjudgmental care and can obtain services and contraceptive supplies at little or no cost. How does this practice differ from other approaches used to address the public health issue? The focus groups also came up with a name: The Point, because The Point is You. They also recommended types of furniture and artwork, what colors to use to decorate, having a television, a Wii, a DVD player, and a computer. And due to the grant funds from NACCHO, their requests were implemented. Word of The Point spread among teenagers and the clinic has become a comfortable, interactive and confidential site for the teens from all over Charleston County. The Point is the first stand alone adolescent family planning clinic in the State of South Carolina. The Point has proven to be very popular with young people. Because of how well the teen clinic has been received, DHEC Region 7 recently secured grant funding from the SC Campaign to Prevent Teen Pregnancy to replicate The Point at a location in North Charleston and Berkeley County. Is the practice a creative use of an existing tool or practice? If so, answer the following questions. No What tool or practice (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, etc.); did you use in a creative way to create your practice? (if applicable) (300 word limit total)
a. Is it in NACCHO’s Toolbox; (if not, have you uploaded it in the Toolbox)?
b. If you used a tool or practice to implement your practice, how was your approach to implementing the tool unique and innovative for your target area/population?
The Point utilized the following tool: Kiss and Tell What Teens Say about Love, Trust, and Other Relationship Stuff; and Family Planning Services at Denver Metro Health Clinic (DMHC). In addition, The Point and CIS host two Teen-Parent events annually. The goal of the events is to facilitate open conversation between teens and parents regarding reproductive health, teen pregnancy prevention and responsible decision-making. A guest speaker is invited to each event to discuss the importance of responsibility in all aspects of life including relationships, role models, school and goal setting What process was used to determine that the practice is a creative use of an existing tool or practice? Please provide any supporting evidence you may have, for example, literature review. How does this practice differ from other approaches used to address the public health issue? The mission of The Point is to provide family planning and sexual health preventive functions through the provision of clinical and educational services designed to prevent unintended pregnancies. As more clients came to the clinic, it became clear that more services were needed. In addition to the sexual health based services, clients at The Point now can take advantage of mental health and some primary care services. In addition to the family planning and sexually transmitted infection services, we take a complete individual and family history, provide lab testing for hemoglobin, offer immunizations, and conduct a physical exam that assesses for cardio and respiratory health, thyroid problems, skin exam and checking the abdomen for distention. If additional screening is indicated, referrals are made to free and low cost clinics. Future plans include initiating healthy weight and exercise education and activities. Staffing for The Point now includes an Advanced Practice Registered Nurse (APRN), administrative support, a health educator, and a Licensed Professional Counselor (one of the six types of licensed mental health professionals who provide psychotherapy in the United States).
The Point is open only to teens. Both males and females are welcome and clients can call for an appointment or just walk-in for service. No teen is turned away. Clients are provided with the cell phone number of the APRN so they can text her with questions. The partnership hosts annual activities such as a back-to-school celebration, a March Madness Drawing and a Mother-Daughter; Father-Son dinner and lecture.
The Point is similar to Family Planning Services at Denver Metro Health Clinic. Although The Point provides family planning services to at-risk youth, the practice enhances its services by collaborating with vested stakeholders to provide a community based approach to promote adolescent health services in the school and community to youth and families on Johns Island to enhance access to services. Who were the primary stakeholders in the practice? SC DHEC Region 7, Communities In Schools of the Charleston Area, Inc. (CIS), and New Morning Foundation What is the LHD's role in this practice? The responsibilities of The Point (LHD) are as follows:
a. DHEC Region 7 will contribute an Advanced Practice Registered Nurse and administrative support staff to provide comprehensive Title X Family Planning and STI services utilizing DHEC policy and procedures.
b. DHEC Region 7 will provide supplies to include furniture and equipment, laboratory testing and on-site contraceptive methods.
c. DHEC Region 7 will maintain provision of education, training, data and technology requirements.
What is the role of stakeholders/partners in the planning and implementation of the practice? The responsibilities of CIS are as follows:
a. CIS will financially support through funding from The New Morning Foundation a facility on Johns Island, which accommodates the following elements, to support DHEC Region 7 clinical services:
i. Supply/Equipment Storage
ii. Computer/Internet access/router
iii. Telephone access in service area
iv. Biohazard accommodations
v. Accommodate HIPAA regulations
vi. Exam/counseling room(s), administrative office, waiting area, laboratory and bathroom
What does the LHD do to foster collaboration with community shareholders? Describe the relationship(s) and how it furthers the practice's goals. The collaboration with public health and a school-based organization is a critical strategy to implement effective teen pregnancy and STI prevention efforts. Counseling adolescent clients about responsible sexual behavior, including abstinence and proper use of regular and emergency contraception is effective in decreasing the incidence of unintended pregnancy (Journal of the American Academy of Pediatrics, 102 (5), November 1998). Prevention efforts must focus on changes in sexual behavior and changes in contraceptive use. Easy access to contraceptives and other reproductive health services contributes to better contraceptive use and therefore lowering teenage pregnancy and STI rates. Easy access means that adolescents know where to obtain information and services, can reach a provider easily, are assured of receiving confidential, nonjudgmental care and can obtain services and contraceptive supplies at little or no cost. Describe lessons learned and barriers to developing collaborations The partnership of CIS and DHEC was one of five awardees nationally in 2008 for grant funding from the National Association of City and County Health Officials (NACCHO). This grant was to address reducing teen pregnancies and the rate of sexually transmitted infections. While conducting the grant activities the team identified two key barriers: a lack of a facility and a funding source for staffing the facility. To overcome these barriers, Region 7 of SCDHEC applied for and received special initiative grant funding for the Office of Population Affairs within the U.S. Department of Health and Human Services (DHHS). Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.
Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
List up to three primary objectives for the practice. For each objective, provide the following information: (750 word limit per objective)
· To provide confidential reproductive health services to at least 250 adolescents annually.
· To decrease teen pregnancy rates of clients served at The Point from Johns and Wadmalaw Islands by 5% within 5 years of project implementation.
· To decrease the STI incidence of clients served at The Point from Johns and Wadmalaw Islands by 5% within 5 years of project implementation.
• Performance measures used to evaluate the practice: List the performance measures used in your evaluation. Depending on the type of evaluation conducted, these might be measures of processes (e.g., number of meetings held, number of partners contacted), program outputs (e.g., number of clients served, number of informational flyers distributed), or program outcomes (e.g., policy change, change in knowledge or attitude, change in a health indicator)
• Data: List secondary and primary data sources used for the evaluation. Describe what primary data, if any were collected for each performance measure, who collected them, and how.
• Evaluation results: Summarize what the LHD learned from the process and/or outcome evaluation. To what extent did the LHD successfully implement the activities that supported that objective? To what extent was the objective achieved?
• Feedback: List who received the evaluation results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings.
Objective 1: To provide confidential reproductive health services to at least 250 adolescents annually.
Performance Measures: Demographic information, unduplicated clients, total clients and visit types are measured.
Data Collection: face-to face interviews and pre-post survey
Evaluation Results: During 2010, Average participant age is 17.6 years old, which 17% in 10th grade, 30% in 11th grade, 28% in 12th grade and 25% not in school. Seventy-four percent of the clients served are African American, 21% Caucasian, 4% Latino and 1% other, with 93% female population. Of the clients served, 133 are new patients, while over half of the patients return to the clinic greater than 2.1 times per year.
Feedback: Evaluation results are reviewed by the DHEC Region 7 Family Planning Program Manager and CIS Program Manager. As a result of greater than 2.1 visits per patients annually, the project determined the need to provide long-acting reversible contraception (LARC) to ensure contraceptive compliance by limiting the # of visits per year per patients. Decreasing the visits per year per patient also increases capacity to serve more new patients annually.
Overflow (Objective 1): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Objective 2: To decrease teen pregnancy rates of clients served at The Point from Johns and Wadmalaw Islands by 5% within 5 years of project implementation.
Performance Measures: Pregnancy tests, pregnancy test results, contraceptive methods, and number of surveys completed at the annual Mother/Daughter Dinner.
Data Collection: Face-to face interviews, laboratory results, survey results
Evaluation Results: During 2010, 283 pregnancy tests were performed. Of the pregnancy tests performed, 15 results were positive. Of the 15 positive test results, 2 of the patients were from St. Johns High School. Of the unduplicated patients served, use the following contraceptive methods: oral contraception – 64; injection – 59; implant – 8; IUD – 2; and other – 129.
CIS and DHEC collaborate annually for a Mother/Grandmother and Daughter Dinner in honor of both Mother’s Day and of the National Day to Prevent Teen Pregnancy. The goal of the dinner is to facilitate open conversation between mothers and daughters regarding reproductive health and teen pregnancy prevention. Both the mother/grandmother and daughters were asked to complete a short survey prior to the dinner and after the dinner asking about comfort levels in talking about sexuality. Overall, 38 people attended the dinner, and nine (9) mothers/grandmothers and 15 daughters completed the surveys.
While all the mothers/grandmothers said they had talked to their daughters or granddaughters about sex and would do so in the future, after the dinner more mothers felt that their daughters would also be comfortable doing so. All but four of the daughters who completed the survey reported that they had talked to their mothers/grandmothers about sex. Overall, there was an increase in the number of daughters who said they would be comfortable talking to their mothers/grandmothers about sex, and that their mothers/grandmother would be more comfortable talking to them about the subject.
Feedback: Evaluation results are reviewed by the DHEC Region 7 Family Planning Program Manager and CIS Program Manager. The project has been successful at decreasing the pregnancy rate from 2005 to 2010 of the patients served at The Point from Johns and Wadamalaw Islands. The Point needs to continue to emphasize establishing a reproductive life plan to patients and offering LARCs as indicated. Overflow (Objective 2): Please finish the response to the question above by using this text area. Please be mindful of the word limits. Feedback from the Mother/Daughter Dinner surveys reflected the need to continue to re-enforce parent communication to reduce unintended pregnancy.
Objective 3: Objective 3: To decrease the STI incidence of clients served at The Point from Johns and Wadmalaw Islands by 5% within 5 years of project implementation.
Performance Measures: STI incidence/prevalence among patients served
Data Collection: Laboratory results
Evaluation Results: During 2010, 291 STI tests were performed. Of the STI tests performed, 55 results were positive. Of the 55 positive test results, 24 of the patients were from St. Johns High School. From 2009 to 2010 STI rates at St. Johns High Schools was reduced from 24% to 10%;
Feedback: Evaluation results are reviewed by the DHEC Region 7 Family Planning Program Manager and CIS Program Manager. The project has been successful at decreasing the STI rate from 2009 to 2010 of the patients served at The Point from Johns and Wadamalaw Islands. The Point needs to continue to emphasize condom use and STI prevention messages.
Overflow (Objective 3): Please finish the response to the question above by using this text area. Please be mindful of the word limits. What are the specific tasks taken that achieve each goal and objective of the practice? Within 30 days of receiving the grant award, a memorandum of agreement was signed between DHEC Region 7 and CIS. These partners accommodated the following needs to ensure successful implementation within 60 days of the grant award.
· Staffing
· Facility and Supply/Equipment storage
· Computer/Internet access/router
· Telephone access in service areas
· Biohazard accommodations/transport
· Facility to accommodate HIPAA regulations
· Exam/counseling room(s), administrative office, laboratory, bathroom
· Exam table
· Office/waiting room furniture
With everything falling into place, the two organizations moved swiftly to get a facility up and running. During the 60 days of recruiting staff and securing operations, focus groups were held with students from the high school. Among the topics addressed were why the young women in the area were not using reproductive health services, the need for a reproductive health facility, what to call the clinic, and what would make it teen friendly. A great deal of progress resulted from the focus groups.
Promotion activities began once the clinic opened in January 2009, which are on-going and highlighted during Teen Pregnancy Prevention Month. DHEC Region 7 and CIS also partnered with local media outlets (radio, television, newspapers) to promote The Point and the National Day to Prevent Teen Pregnancy using the available PSAs. DHEC Region 7 also partnered with other local organizations such as Darkness to Light and SC Campaign to Prevent Teen Pregnancy to promote prevention efforts. The Point provides a computer with Internet capability for use by adolescents while waiting for services to access reproductive health information. This computer has shortcuts to the National Campaign to Prevent Teen Pregnancy website, SC Campaign to Prevent Teen Pregnancy, and related websites such as the CDC and local prevention organizations. What was the timeframe for carrying out these tasks? The Point is open only to teens. The clinic is open on Tuesdays and Thursdays from 9:00 a.m. – 5:30 p.m. Both males and females are welcome and clients can call for an appointment or just walk-in for service. No teen is turned away. CIS provides transportation for the adolescents with parental consent. Clients are provided with the cell phone number of the APRN so they can text her with questions. And many patients come just to talk about issues. The partnership hosts activities such as a back-to-school celebration, a March Madness Drawing, a Mother-Daughter and Wise Guys dinner and lecture.
Mother/Grandmother and Daughter Dinner and Lecture in honor National Day to Prevent Teen Pregnancy is held annually in May. Approximately 100 Mothers/Daughters attend annually. The goal is to facilitate open conversation between mothers and daughters regarding reproductive health and teen pregnancy prevention. “Rock da House” Back to School Bash is held annually in August. Approximately 75 attend the open house. The Point distributions condoms and provides reproductive health education. The following community partners are invited: People Against Rape, South Carolina Contraceptive Initiative, Centura College and US Army. Wise Guys Dinner is held annually in November. Approximately 75 males attend annually. The goal is to facilitate open conversation between fathers and sons regarding responsible decision-making to include graduating high-school, reproductive health, fatherhood, and goal setting.
Is there sufficient stakeholder commitment to sustain the practice? Describe how this commitment is ensured. OPA has a vested interest in Title X reproductive health services. Adolescents and low-income women are the target populations for Family Planning services. OPA funding supports personnel and supplies need for operations. The New Morning Foundation provides funding to CIS for the facility in which The Point on Johns Island operates. The New Morning Foundation is a private-sector long-term initiative to improve young people’s reproductive health education, counseling, and clinical services throughout South Carolina. The mission is to decrease the number of unintended pregnancies among people under 30 and limit the spread of HIV/AIDS and sexually transmitted infections. The New Morning Foundation provides funding for community-based programs that empower people under 30 to make responsible decisions. The mission of The Point is consistent with the mission of The New Morning Foundation. Describe plans to sustain the practice over time and leverage resources. The Point has proven to be very popular with young people. Because of how well the teen clinic has been received, SCDHEC has recently secured grant funding from the SC Campaign to Prevent Teen Pregnancy to replicate The Point at a location in North Charleston and Berkeley County. The North Charleston and Berkeley County locations are sustainable through the county budgets for facilities maintenance. All services are sustainable through the SC DHHS State Plan Amendment. Effective January 2011, the program began providing family planning coverage for males and females with a family income at or below 185% Federal Poverty Level (FPL) regardless of age. Billable services to family planning Medicaid include the clinic visit, procedures, contraceptive supplies, treatment drugs, alcohol/drug assessments and referrals and family support services. As a result of stakeholder interest in reproductive health, which is one of the leading public health issues, The Point is a sustainable entity for adolescents in Charleston and Berkeley Counties. Practice Category Choice 1: Access to and/or Equality of Care Practice Category Choice 1, Part 2: Maternal and Child Health (Teen pregnancy, Mother to Child transmission of HIV and AIDS) Practice Category Choice 2: Health Disparities Practice Category Choice 2, Part 2: Maternal and Child Health (Teen pregnancy, Mother to Child transmission of HIV and AIDS) Practice Category Choice 3: Infectious Disease (HIV) Practice Category Choice 3, Part 2 Check all that apply. Colleague in my health department |
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