By Kyle Stewart, MD

Dr. Stewart with Teen Parent Family

To say that Oklahoma has a teen pregnancy problem is a vast understatement. Oklahoma has the second highest teen birth rate in the U.S., nearly twice the national rate. Nearly one in five teen births is a repeat birth. This is critical; with one child, a teen parent can still go on to finish high school, possibly go on to college and enter the workforce. In my experience, a second child tips the scales and makes it nearly impossible for that teen parent to meet education and employment goals. It doesn’t make sense to me that we’d be willing to settle on being the second worst state in the nation in this regard. This doesn’t reflect the greatness of the Oklahoma I know.

I looked at national models for teen pregnancy and the care of adolescent-headed families. I found very little in the way of resources for teen parents in Central Oklahoma. However, I was inspired by the work of Dr. Deb Shropshire with her focus on children in foster care. She encouraged me to begin to find ways to enrich the treatment of teen parents in my practice and career.

This focus on teen parents eventually led me to Variety Care, Oklahoma’s largest Community Health Center (CHC), whose 16 clinics served 51,404 people in 2015, nearly half of whom are age 18 and younger. In Variety Care, I found an organization that fit the heart of what I was trying to accomplish.
Variety Care is actively involved in teen pregnancy prevention. (Central Oklahoma Teen Pregnancy Prevention Collaboration report) However, I saw a need to create a program focusing on teens who were already pregnant. Grant funding for pilot programs is hard to find, and we were unsuccessful until we applied to AAP for a $20,000 grant. This funding was essential to getting things started.

In addition to providing clinical care for teen parents and their children, we developed a partnership with the Oklahoma City Public Schools and share a staff person who works directly in the school to recruit teen parents to the program. We have enrolled 211 teen parents and provided 1,017 medical, dental, and health visits. Of the 140 babies born to program participants, 46% of mothers entered prenatal care in the first trimester. We created a teen parent registry in our electronic health record, and have developed collaborations with adolescent-supportive programs within the community. At the two primary schools in which we work, teen parent graduation rates are 73% and 89% respectively, and repeat pregnancy rates have dropped. Our three primary goals are: 1) Secondary pregnancy prevention; 2) High school graduation; and 3) Father inclusiveness.
“The program has given students someone on their side, someone who believes in them and is there to push them to succeed in life. The program gives a voice to these students in the community, and has brought awareness to the rise of teen pregnancy and the lack of recourses available to teen parents. In spite of being teen parents, these students are amazing and doing wonderful things in and out of school to be successful,” said Katie Morgan, RN, BSN, Teen Parent Coordinator.

• Some of the lessons I have learned are:
  Teen parents don’t know what they don’t know so we can’t rely on their questions to drive the visit. When we walk into a well child check and ask if things are going okay, and the parents say yes, or we ask if they have questions, and they say no – it could mean it’s going poorly but they don’t even know that. Give them the long version on everything if you can.
• Consider home visitation programs available from health departments or local school districts.
• Discuss family planning at every visit, and ask specifically, “When do you want to have your next child?”
• Consider offering long acting reversible contraception (LARC ) within your practice, or finding a teen-friendly referral source.
• Involve the father in any and every way possible.
  Watch for gatekeeping from mom’s parents and try to advocate for the father’s role as much as possible. Offer to make yourself available to help him in any way you can. When we think about fatherless kids, we often assume the dads are uninvolved out of choice. In reality, the dad has often missed critical components of the process; he may not have attended prenatal visits or been present at delivery and doesn’t bond with the child early on. Mom’s parents often do not want the father around. It’s not that he didn’t want to be involved; he just missed those steps. Now that he wants to be involved, he may run into obstacles.
• Discuss educational plans early and often and work with a teen-parent friendly advocate within the local school.
• See your teen parents as future indigenous leaders in your community; you’ll see it before they will.
• Developmental delay, obesity, and dental caries are more prevalent in adolescent-headed families. We need to spend extra time working on prevention of these issues.
• Don’t forget faith-based organizations and local churches as sources of mentoring and social capital.

Creating a teen parent program is a great opportunity for collaboration between the medical and educational communities.  Thirty percent of high school dropouts state pregnancy as the reason. In addition, teens who have dropped are more likely to become pregnant or have a second pregnancy.  It’s going to take all of us to reverse the high rates of teen pregnancy in Oklahoma: the medical community, education, faith community, neighborhood, local partners, grandparents, and coaches.  My hope is that Oklahoma’s turn around in the teen birth rate raises eyebrows and makes people ask, “How did you do that so well?”

If you’d like to discuss teen pregnancy prevention or providing medical homes for adolescent-headed families, please don’t hesitate to email me at kstewart@varietycare.org.

Dr. Kyle Stewart is the Medical Director for Pediatrics at Variety Care and an OKAAP Chapter Member.  In 2014, Dr. Stewart utilized a $20,000 grant from the AAP Friends of Children Healthy People 20/20 Grant Program for Chapters to develop the teen parent project.  Later that year, OKAAP and AAP awarded Dr. Stewart with a Special Achievement Award for Individual Chapter Members for his efforts and accomplishments in this initiative.