LINKING COURT-INVOLVED FOSTER-CARE YOUTH TO CONTRACEPTIVE COUNSELING AND SERVICES

• Published in: Journal of adolescent health Vol. 64; no. 2S; p. S123
• Main Authors: Richardson, Eprise Armstrong, Hunt, Abby, Zaban, Leigh S, Ott, Mary, Reuter, Amanda
• Format: Journal Article
• Language: English
• Published: New York Elsevier BV 01.02.2019
• Subjects: Access; Adolescents; African Americans; At risk populations; Birth control; Checklists; Childbirth & labor; Children & youth; Clinical medicine; Condoms; Contraceptive services; Counseling; Counseling services; Educational needs; Evaluation; Foster care; Health behavior; Health care access; Health education; Health needs; Health services; High risk; Internet; Intervention; Interviews; Judges & magistrates; Juvenile courts; Polls & surveys; Preventive medicine; Referrals; Reproductive health; Research methodology; Secondary education; Teenage pregnancy; Training; Trauma; Unwanted pregnancy; Youth
• ISSN: 1054-139X; 1879-1972

Purpose: Foster care youth have low rates of contraceptive use and high rates of unintended pregnancy. This is due to limited and often inconsistent access to reproductive health care. Court-based interventions have the potential to address this gap. We conducted a mixed methods implementation evaluation of a court-based adolescent health navigator program providing contraceptive counseling and linking foster-care youth to contraceptive services. Methods: After IRB approval 14-19 year olds were recruited through referrals by the juvenile court. We recruited 100 consecutive foster care youth for a pilot intervention where adolescent health navigator(s) provided education and counseling on pregnancy, STI, and HIV prevention, and linkages to reproductive health services. Youth completed a checklist self-reporting reproductive health interests and needs. Their health needs and behaviors were assessed to provide tailored trauma-informed education and referrals to reproductive health services. Mixed methods evaluation included: data from intake and counseling session (youth checklist, sexual/contraceptive behaviors, and content of counseling); a web-based follow-up survey 3 months later assessing whether services had been accessed; and in-depth qualitative interviews with stakeholders (n=7). Quantitative data were analyzed using descriptive statistics. Interview data were audio recorded, transcribed, and coded using thematic analysis. Results: Participants were 72% female, 62% African American, 13% sexual minority, with a mean age 15.7 (SD1.2) years. 28% expressed interest in learning more about birth control. Among females, 35% reported having ever used birth control (29% to prevent pregnancy, 6% "just in case", 6% to regulate periods). Participants reported a high rate of LARC usage (13%). Among all genders, 28% used condoms, and 11% reported unprotected sex. Only one scheduled a provider appointment for birth control, but did not attend. In interviews, successes included tailored counseling for high risk youth, building bridges between court staff and counseling staff, high level of satisfaction by youth after counseling, and shifting the culture of the court to considering reproductive health needs (and other social, health and educational needs). A major challenge was difficulty linking youth to reproductive health services. It was voluntary, and there was very low uptake. This was due in part to the high proportion already on contraceptives, and relunctance of foster families to access purely voluntary (rather than mandated) services. Proposed solutions included expanding to more at-risk population (e.g. dual system involved youth), training youth in how to access services, on-site services, and moving the counseling and referral to reproductive health to a different point in the court process. Referrals sources were expanded from magistrates to include community partners (such as residential programs serving foster youth). Conclusions: This evaluation guided the adaptation of a court-navigator intervention for foster care youth. Though the program did not meet its primary objective (linkage to clinical services), secondary objectives such as tailored education and training in access were achieved, and relationships between court and community partners were strengthened. These findings highlight the importance of implementation sciences in the development of services for foster care youth.