Tagged Children’s Health

Uno de cada 5 niños detenidos en la frontera tiene menos de 13 años

La administración Trump ha detenido a 2,322 menores de 13 años en medio de las acciones en la frontera, dijo el miércoles 20 de junio un funcionario del Departamento de Salud y Servicios Humanos (HHS) a Kaiser Health News. Representan casi el 20% de los niños inmigrantes que actualmente están bajo custodia del gobierno de los Estados Unidos, mientras avanza la política de “tolerancia cero”.

Su bienestar está siendo supervisado por una pequeña división del Departamento de Salud y Servicios Humanos, la Oficina de Reasentamiento de Refugiados (ORR), que tiene poca o ninguna experiencia en el cuidado de niños pequeños.

El número de niños bajo custodia se ha disparado en las últimas seis semanas, desde que la administración Trump comenzó a detener a los padres y a sus hijos en la frontera de los Estados Unidos, separándolos y enviándolos a diferentes instalaciones. Un total de 11.786 menores de 18 años están detenidos actualmente, dijo el funcionario.

El presidente Donald Trump firmó una orden ejecutiva el miércoles 20 de junio para que se detenga a los padres y a sus hijos juntos.  La orden también pasa la supervisión de este proceso del HHS al Departamento de Seguridad Nacional. Pero no está claro cuándo los niños se reunirán con sus padres, y si esta orden cumplirá con los estandares para el tratamiento de niños bajo custodia, conocido como el acuerdo Flores.

Desde 2003, la ORR ha estado a cargo de albergar y encontrar hogares adecuados para “niños extranjeros no acompañados”, generalmente inmigrantes adolescentes que llegan a los Estados Unidos sin un padre o tutor.

Pero sus responsabilidades han cambiado y han aumentado exponencialmente desde abril por las nuevas políticas migratorias, lo que significa que la oficina ahora es responsable de tener bajo custodia no solo a más niños, sino también a niños mucho más pequeños que los que llegaron en el pasado, dijeron expertos.

Más allá de la atención médica especializada, los niños más pequeños tienen diferentes necesidades de alimentos y vivienda, y requieren una atención personalizada.

“Los niños son más chiquitos y estarán allí por un tiempo más prolongado, y están profundamente traumatizados al ser separados de sus padres por la fuerza”, dijo Mark Greenberg, ex funcionario de la Administración para Niños y Familias del HHS, que supervisa la ORR. “Todo eso hace que sea mucho más difícil operar el programa”.

La compleja crisis se magnifica por la inexperiencia de algunos de los responsables políticos que lideran estas acciones, dijeron los críticos, entre ellos ex funcionarios de las administraciones republicana y demócrata de la última década.

Scott Lloyd, director de la ORR, es un abogado cuya carrera se ha centrado en impulsar estrategias contra el aborto. Fue el que dirigió los esfuerzos legales de la administración Trump para prohibir abortos en inmigrantes adolescentes detenidas. La principal experiencia de inmigración de Lloyd antes de liderar la ORR fue la investigación para un informe sobre refugiados realizada para los Knights of Columbus, una organización católica con una postura antiabortista, según una declaración en una demanda presentada por la Unión de Libertades Civiles de los Estados Unidos.

Kenneth Wolfe, el vocero de HHS que proporcionó las cifras de menores detenidos, se negó a contestar preguntas sobre cuántas personas trabajan actualmente en la ORR o si la oficina ha asegurado personal adicional o la experiencia necesaria para hacer frente a la afluencia de niños pequeños. Tampoco dijo cuántos de los 2,322 niños menores de 13 años han sido separados de sus familias.

Antes, la administración se había negado a proporcionar las edades de los niños separados de sus familias, diciendo solamente que alrededor de 2,300 niños han sido separados y detenidos desde que la política entró en vigencia.

Las condiciones de detención, que incluyen a niños retenidos en corrales y tiendas de campaña, han encendido una tormenta política sobre posibles abusos en el tratamiento de niños de tan solo 4 años. Algunos de estos niños, incluidos los más pequeños, están siendo enviados a refugios especiales para niños pequeños, según informes de medios. La atención también es costosa: solo las tiendas le cuestan al HHS $775 por persona por día, según estos reportes.

Los republicanos, incluida la ex primera dama Laura Bush, han pedido a la administración que ponga un freno a estas acciones. El presidente Donald Trump ha culpado al Congreso por las detenciones, pero los principales asesores de la Casa Blanca han promovido activamente las separaciones familiares como un cambio de política.

Los informes de noticias han descrito a los niños de hasta 5 años siendo regañados por jugar, un adolescente enseñando a otros cómo cambiar el pañal de un niño pequeño, y cuidadores a los que no se les permite tocar a los niños. ProPublica informó que más de 100 niños detenidos son menores de 4 años.

La ORR, agregan los expertos, ya está en desventaja.

“Es muy difícil y costoso crear esa capacidad”, señaló Robert Carey, ex director de la ORR durante la administración Obama. “Todos los aspectos de la atención son dramáticamente diferentes en función de la edad… se necesitan personas capacitadas en el desarrollo o cuidado de la primera infancia”.

Esa es una carga pesada para una oficina que, insisten expertos, nunca fue pensada para servir como un sistema de vivienda a largo plazo.

Carey y otros dijeron que no está claro si la administración tuvo suficiente tiempo o apoyo para adaptarse.

Muchos empleados de la ORR, agregó Carey, son personal de carrera con amplios conocimientos sobre inmigración y bienestar infantil, con quienes él mismo trabajó frecuentemente durante su mandato.

“Los niños están bajo la custodia de la ORR sin los recursos adecuados”, dijo Shadi Houshyar, quien dirige las iniciativas de primera infancia y bienestar infantil en Families USA, un grupo de defensa. “Definitivamente va a dar lugar a que se tomen decisiones potencialmente perjudiciales”. La capacidad, el entrenamiento y la orientación fundamentales, como la comprensión de las necesidades de los niños, no es la orientación que tiene la ORR”.

Mientras la ORR tiene un historial de ubicar a adolescentes que llegan solos con parientes en los Estados Unidos, ese desafío crece por la política de separar a los niños, que son pequeños y pueden entender muy poco sobre esta experiencia, o pueden no ser capaces de identificar a los familiares que podrían acogerlos.

Para complicar más las cosas, cuando las familias están separadas, los padres e hijos son monitoreados por diferentes agencias federales: los padres por el Departamento de Seguridad Nacional y los niños por la ORR. A los niños pequeños se los trata de la misma manera que a los menores que llegaron por su cuenta. Todo esto hace que la reunificación sea más difícil. Y ese es un problema que preocupa a los expertos, incluso si se termina con las separaciones familiares.

“No parece que hayan encontrado una solución a este proceso”, dijo un ex funcionario de HHS, que solicitó el anonimato porque podría enfrentar problemas profesionales por hablar en público. Como resultado, agregó, “el tiempo que el niño permanece en la ORR podría ser significativamente más prolongado”, lo que a su vez aumenta el trauma y causa otros problemas a largo plazo.

La cobertura de KHN de los problemas de salud de los niños es apoyada en parte por la Heising-Simons Foundation.

1 In 5 Immigrant Children Detained During ‘Zero Tolerance’ Border Policy Are Under 13

The Trump administration has detained 2,322 children 12 years old or younger amid its border crackdown, a Department of Health and Human Services official told Kaiser Health News on Wednesday. They represent almost 20 percent of the immigrant children currently held by the U.S. government in the wake of its latest immigrant prosecution policy.

Their welfare is being overseen by a small division of the Department of Health and Human Services — the Office of Refugee Resettlement (ORR) — which has little experience or expertise in handling very young children.

The number of children has exploded in the past six weeks since the Trump administration moved to stop parents and their children at the U.S. border and separate and detain them in different facilities. A total of 11,786 children under age 18 are currently detained, the official said.

Since 2003, ORR has been charged with sheltering and finding suitable homes for “unaccompanied alien children” — generally teenaged immigrants who reach the United States without a parent or guardian.

But its responsibilities have morphed and multiplied since April because the immigration crackdown means that the ORR is now responsible for detaining not only more children, but minors who are far younger than those who had arrived in the past, experts said.

Beyond specialized medical care, younger children have different food and housing needs, and require more personal attention.

“The children are younger and will be there for a longer time and are deeply traumatized by being forcibly separated from their parents,” said Mark Greenberg, a former administration official at HHS’ Administration for Children and Families, which oversees the ORR. “All of that makes it much more difficult to operate the program.”

The complex crisis is magnified by the inexperience of some of the political appointees leading the response, said critics who include former officials from both Republican and Democratic administrations of the past decade.

ORR Director Scott Lloyd is a lawyer whose career has been focused on anti-abortion efforts. He led the Trump administration’s legal efforts to prevent abortions for detained teen immigrants. Lloyd’s main immigration experience before leading ORR was research for a report on refugees for the Knights of Columbus, a Catholic service organization with an anti-abortion stance, according to a deposition he gave in lawsuit filed by the American Civil Liberties Union.

Kenneth Wolfe, the HHS spokesman who provided the figures, declined to address how many people are currently working at ORR or whether ORR had secured additional staff or expertise to cope with the influx of young children. He also would not say how many of the 2,322 children 12 and younger have been separated from their families.

The administration had previously refused to provide the ages of the children separated from their families — saying only that about 2,300 children have been separated and detained since the policy took effect.

The detention conditions, which include children being held in chain-link holding pens and “tent cities,” have ignited a political firestorm over possible abuse in the treatment of children as young as 4. Some of these younger children — including toddlers — are being sent to “tender age” shelters, according to media reports. The care is also costly: Tents alone cost HHS $775 per person per day, according to media reports.

Republicans, including former first lady Laura Bush, have called on the administration to stop the policy. President Donald Trump has blamed Congress for the detentions, but top White House advisers were actively promoting family separations as a policy shift.

News reports have described children as young as 5 being scolded for playing, one teenager teaching others how to change a small child’s diaper, and caretakers not being permitted to touch children. ProPublica reported that more than 100 children detained are younger than 4.

ORR, experts add, is already at a disadvantage.

“It’s significantly challenging to create that capacity, and quite expensive,” noted Robert Carey, a former ORR director from the Obama administration. “All the aspects of care are dramatically different based on age. … You need people who are trained in early childhood development or care.”

That’s a heavy lift for an office that, experts stress, was never built to serve as a long-term housing system.

It’s not clear, Carey and others said, that the administration has had sufficient time or support to adapt.

Many ORR employees, Carey added, are career staffers with deep knowledge about immigration and child welfare, with whom he frequently worked while in office.

“The kids are going into the custody of ORR without adequate resources,” said Shadi Houshyar, who directs early childhood and child welfare initiatives at Families USA, an advocacy group. “It’s definitely going to result in some potentially damaging decisions being made. The capacity, training and fundamental orientation — while understanding the needs of children — is not the orientation that ORR has.”

While ORR has a history of placing teenagers who arrive on their own with relatives of families in the U.S., that challenge is heightened by the policy of separating children, who are young and may understand little of the experience or be able to identify relatives who could take them in.

Making matters more complicated, when families are separated, parents and children are tracked by different federal agencies — the parents by the U.S. Department of Homeland Security, and the children by ORR. Children are also tracked and treated the same as minors who arrived on their own. Together, that makes reunification more difficult. And that’s a problem experts worry will persist, even if family separations cease.

“It does not look like they’ve figured out this process,” said a former HHS official, who requested anonymity because she could face professional ramifications for speaking publicly. As a result, she added, “the time the child stays in ORR could be significantly longer” — which in turn adds to trauma and causes other long-term problems.


KHN’s coverage of children’s health care issues is supported in part by the Heising-Simons Foundation.

In New Hampshire, Even Mothers In Treatment For Opioids Struggle To Keep Children

Jillian Broomstein starts to cry when she talks about the day her newborn son Jeremy was taken from her by New Hampshire’s child welfare agency. He was 2 weeks old.

“They came into the house and said they would have to place him in foster care and I would get a call and we would set up visits,” she said. “It was scary.”

Broomstein, who was 26 at the time, had not used heroin for months and was on methadone treatment, trying to do what was safest for her child. The clinic social worker told her that since Jeremy would test positive for methadone when he was born, she would need to find safe housing or risk losing custody.

Broomstein moved in with a friend and her kids — but it turned out that friend had her own legal battles with the state’s Division of Children, Youth and Families, known as DCYF. The friend’s home would not pass muster as “safe housing” because of that.

Since Broomstein grew up in foster care and had no family to take her in, Jeremy was taken from her. She had 12 months to try to get her son back or lose her parental rights permanently.

To get their children back from the foster care system in New Hampshire, parents struggling with addiction are required to be compliant in drug treatment and have a safe place to live. If they can’t find housing or if they relapse, the clock does not stop ticking.

“I cannot stress enough that 12 months is a really short window for somebody who’s in early recovery,” said Courtney Tanner, who runs Hope On Haven Hill, one of the few places in New Hampshire where pregnant women and new mothers can live with their children and get treated for addiction. But with just eight beds here, the waitlists can be long.

There are more than 430,000 children in foster care in the U.S., according to the latest government figures. The opioid crisis is definitely a factor in an increasing trend of more children being removed from the home, but the scope of the problem is hard to measure due to poor tracking.

New Hampshire has some of the highest rates of opioid abuse in the country. One of the fastest-growing groups of heroin users is women of childbearing age. In the past few years the number of children taken into state custody has more than doubled, according to DCYF. Last year, New Hampshire spent $36 million for foster care.

“Here in New Hampshire, what I have seen is a mom can be enrolled in this program and compliant in treatment and they are giving birth to a child and that child is still being removed and put into foster care,” said Tanner.

In 2012 state legislators made major budget cuts to DCYF — and those dollars have not been restored. Child welfare workers in New Hampshire have more than triple the caseloads than in many other states, according to the agency’s director Joseph Rispam. Also as a result of the budget cuts, DCYF can only engage a family once case workers have opened a legal case of abuse and neglect. There’s little money to support parents before that happens.

“The result of that is … that more children coming into the foster care system that otherwise might not if we had the capacity to serve families more holistically up front,” said Ripsam.

After her son Jeremy was placed into foster care, Jillian Broomstein continued her methadone treatment and her parenting classes.

She was determined to get her son back. She finally got off a waiting list and got a bed at one of the residential treatment centers for young mothers. After a few months she was reunited with Jeremy. But she was told that her case was unusual.

“They said in court that it was an odd case that they gave me my child back so quickly,” Broomstein said. “It made me want to cry.”

“I knew it was going to be hard,” she said. “Not everybody tries to get their children back. A lot of people I’ve known just give up; they just resort back to drugs again.”

This story is part of a reporting partnership that includes NPR and Kaiser Health News.


KHN’s coverage of these topics is supported by
Heising-Simons Foundation
and
The David and Lucile Packard Foundation

When Erratic Teenage Behavior Means Something More

Mary Rose O’Leary has shepherded three children into adulthood, and teaches art and music to middle-school students.

Despite her extensive personal and professional experience with teens, the Eagle Rock, Calif., resident admits she’s often perplexed by their behavior.

“Even if you have normal kids, you’re constantly questioning, ‘Is this normal?’” says O’Leary, 61.

Teenagers can be volatile and moody. They can test your patience, push your buttons and leave you questioning your sanity — and theirs.

I’m not being flip. Mental health challenges are a serious — and growing — problem for teenagers: Teen and young-adult suicide has nearly tripled since the 1940s. The rate of 12- to 17-year-olds who struggled with clinical depression increased by 37 percent in a decade, according to a recent study.

And schizophrenia and other psychotic disorders often manifest themselves in adolescence.

In fact, half of all mental health conditions emerge by age 14, and three-quarters by 24, says Dr. Steven Adelsheim, director of the Stanford Center for Youth Mental Health and Wellbeing, part of the university’s psychiatry department.

For parents, it’s often hard to separate the warning signs of mental illness from typically erratic teenage behavior.

When O’Leary’s son, Isaac, now 23, was a teen, he had two run-ins with police — once for hosting a wild party while his mom was away, and again when he and a friend climbed up on the roof and challenged each other to shoot BB guns.

O’Leary dismissed those incidents as teenage pranks. But she did start to worry when she was in the midst of divorce proceedings with her then-husband and noticed that Isaac started exhibiting some unusual behavior. He complained of stomachaches and racked up absences from school.

That’s when she decided it was time for the family to see a therapist. “It’s a question of what’s normal for my kids,” she explains.

O’Leary is right. Mental health experts say the first step in recognizing possible mental illness in your children is to know their habits and patterns — to spot when they deviate from them — and to create an environment in which they feel comfortable talking with you.

Instead of asking your teen to talk, share an activity that will give your child the chance to open up: Cook dinner together, walk the dog, take a drive, says Tara Niendam, an associate professor in psychiatry at the University of California-Davis.

“You just want to know how they’re doing as a person. How are things going at school? How are their friends? How are they sleeping?” she explains.

As part of getting to know your teen, monitor and limit your child’s social media activity, says Dr. Amy Barnhorst, vice chair for community mental health in the UC-Davis psychiatry department.

“Social media gives us this important window into what’s going on in teenagers’ lives,” she says.

Once you know your child’s baseline, you’ll be more attuned to signs of mental illness: persistent changes in your child’s everyday life that last more than a week or two.

Be aware of disruptions in sleep, appetite, grades, weight, friendships — even hygiene.

Maybe your son is spending even more time alone in his room. Perhaps your daughter, who is particular about her appearance, stops wearing makeup and isn’t showering.

“It’s really when you see kids falling off the curve in every sphere of their lives,” Barnhorst says. “They’re having problems with their academics, problems with their family, problems with their friends, problems with their activities.”

Essentially, take note when “there’s a lot of shifting and chaos” in their lives, she adds.

Remember, you’re looking for changes in many aspects of your child’s life that last for a few weeks, not the typical — but temporary — sadness that comes with a breakup or the unfortunate mouthing off you get when you ask your kid to clean his room.

If your child still has the same friends and is participating in the same activities, unpleasant behavior “is not necessarily something to worry about,” Barnhorst says. “That could just be teenagers going through growing pains.”

But some behavioral changes could indicate a deeper problem. For instance, teenagers with depression may be more irritable than usual, Adelsheim says. They might snap at friends or even the family dog, he says.

“Young people will talk about their fuse being shorter than normal,” Adelsheim says. “Things that normally wouldn’t bother them do bother them.”

When you become worried that your child’s behavior may indicate something more serious, offer your child love and support — and seek help, experts say.

(And avoid phrases like “What’s wrong with you?” and “Snap out of it” when talking with your kids, Niendam advises.)

If your child threatens suicide, or you think he’s in imminent danger, take him to the emergency room.

If there’s no immediate danger, start with your child’s pediatrician or primary care physician. In some cases, the pediatrician will be able to address the problem directly — or may refer you to a mental health specialist.

This is where it could get tricky.

You may face a long wait for a specialist — especially if you live in a rural area — and may find that many aren’t accepting new patients. Barnhorst suggests calling your health insurance plan and asking for a list of in-network therapists, psychologists and psychiatrists. Then hit the phone and hope for the best.

“One of the most serious problems we have in this country on the mental health front is the lack of access to care,” says Dr. Victor Schwartz, chief medical officer of the Jed Foundation, a New York-based organization that works to prevent suicides in teens and young adults. “We haven’t trained enough professionals. They’re not distributed well enough across the country.”

Another option, he says, is to check with nearby universities to see if they have mental health clinics that train students and see patients.

While you’re seeking medical help, don’t forget to contact your child’s school, which may be able to make accommodations such as offering your child extra time for testing, Niendam says.

She also suggests connecting with your local chapter of NAMI California (namica.org), a grass-roots organization of people whose lives have been affected by serious mental illness.

“If you’re struggling, you can meet other parents and ask their advice,” she says.


KHN’s coverage of these topics is supported by
Heising-Simons Foundation
and
California Health Care Foundation

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

When Erratic Teenage Behavior Means Something More

Mary Rose O’Leary has shepherded three children into adulthood, and teaches art and music to middle-school students.

Despite her extensive personal and professional experience with teens, the Eagle Rock, Calif., resident admits she’s often perplexed by their behavior.

“Even if you have normal kids, you’re constantly questioning, ‘Is this normal?’” says O’Leary, 61.

Teenagers can be volatile and moody. They can test your patience, push your buttons and leave you questioning your sanity — and theirs.

I’m not being flip. Mental health challenges are a serious — and growing — problem for teenagers: Teen and young-adult suicide has nearly tripled since the 1940s. The rate of 12- to 17-year-olds who struggled with clinical depression increased by 37 percent in a decade, according to a recent study.

And schizophrenia and other psychotic disorders often manifest themselves in adolescence.

In fact, half of all mental health conditions emerge by age 14, and three-quarters by 24, says Dr. Steven Adelsheim, director of the Stanford Center for Youth Mental Health and Wellbeing, part of the university’s psychiatry department.

For parents, it’s often hard to separate the warning signs of mental illness from typically erratic teenage behavior.

When O’Leary’s son, Isaac, now 23, was a teen, he had two run-ins with police — once for hosting a wild party while his mom was away, and again when he and a friend climbed up on the roof and challenged each other to shoot BB guns.

O’Leary dismissed those incidents as teenage pranks. But she did start to worry when she was in the midst of divorce proceedings with her then-husband and noticed that Isaac started exhibiting some unusual behavior. He complained of stomachaches and racked up absences from school.

That’s when she decided it was time for the family to see a therapist. “It’s a question of what’s normal for my kids,” she explains.

O’Leary is right. Mental health experts say the first step in recognizing possible mental illness in your children is to know their habits and patterns — to spot when they deviate from them — and to create an environment in which they feel comfortable talking with you.

Instead of asking your teen to talk, share an activity that will give your child the chance to open up: Cook dinner together, walk the dog, take a drive, says Tara Niendam, an associate professor in psychiatry at the University of California-Davis.

“You just want to know how they’re doing as a person. How are things going at school? How are their friends? How are they sleeping?” she explains.

As part of getting to know your teen, monitor and limit your child’s social media activity, says Dr. Amy Barnhorst, vice chair for community mental health in the UC-Davis psychiatry department.

“Social media gives us this important window into what’s going on in teenagers’ lives,” she says.

Once you know your child’s baseline, you’ll be more attuned to signs of mental illness: persistent changes in your child’s everyday life that last more than a week or two.

Be aware of disruptions in sleep, appetite, grades, weight, friendships — even hygiene.

Maybe your son is spending even more time alone in his room. Perhaps your daughter, who is particular about her appearance, stops wearing makeup and isn’t showering.

“It’s really when you see kids falling off the curve in every sphere of their lives,” Barnhorst says. “They’re having problems with their academics, problems with their family, problems with their friends, problems with their activities.”

Essentially, take note when “there’s a lot of shifting and chaos” in their lives, she adds.

Remember, you’re looking for changes in many aspects of your child’s life that last for a few weeks, not the typical — but temporary — sadness that comes with a breakup or the unfortunate mouthing off you get when you ask your kid to clean his room.

If your child still has the same friends and is participating in the same activities, unpleasant behavior “is not necessarily something to worry about,” Barnhorst says. “That could just be teenagers going through growing pains.”

But some behavioral changes could indicate a deeper problem. For instance, teenagers with depression may be more irritable than usual, Adelsheim says. They might snap at friends or even the family dog, he says.

“Young people will talk about their fuse being shorter than normal,” Adelsheim says. “Things that normally wouldn’t bother them do bother them.”

When you become worried that your child’s behavior may indicate something more serious, offer your child love and support — and seek help, experts say.

(And avoid phrases like “What’s wrong with you?” and “Snap out of it” when talking with your kids, Niendam advises.)

If your child threatens suicide, or you think he’s in imminent danger, take him to the emergency room.

If there’s no immediate danger, start with your child’s pediatrician or primary care physician. In some cases, the pediatrician will be able to address the problem directly — or may refer you to a mental health specialist.

This is where it could get tricky.

You may face a long wait for a specialist — especially if you live in a rural area — and may find that many aren’t accepting new patients. Barnhorst suggests calling your health insurance plan and asking for a list of in-network therapists, psychologists and psychiatrists. Then hit the phone and hope for the best.

“One of the most serious problems we have in this country on the mental health front is the lack of access to care,” says Dr. Victor Schwartz, chief medical officer of the Jed Foundation, a New York-based organization that works to prevent suicides in teens and young adults. “We haven’t trained enough professionals. They’re not distributed well enough across the country.”

Another option, he says, is to check with nearby universities to see if they have mental health clinics that train students and see patients.

While you’re seeking medical help, don’t forget to contact your child’s school, which may be able to make accommodations such as offering your child extra time for testing, Niendam says.

She also suggests connecting with your local chapter of NAMI California (namica.org), a grass-roots organization of people whose lives have been affected by serious mental illness.

“If you’re struggling, you can meet other parents and ask their advice,” she says.


KHN’s coverage of these topics is supported by
Heising-Simons Foundation
and
California Health Care Foundation

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

‘Where The Need Is:’ Tackling Teen Pregnancy With A Midwife At School

The student comes in for a pregnancy test — the second time she has asked for one in a matter of weeks.

She’s 15. She lives with her boyfriend. He wants kids — he won’t use protection. She loves him, she says. But she doesn’t want to get pregnant. She knows how much harder it would be for her to finish high school.

At many schools, she would have gotten little more than some advice from a school nurse. But here at Anacostia High School in Washington, D.C., she gets a dose of midwife Loral Patchen.

Patchen asks her bluntly what she’s going to do about it. Because one of these days, the test is going to show a positive.

Patchen talks her through a range of birth control methods. There’s a shot you take every few months, an IUD, or a small implant that goes into your arm, which can prevent pregnancy for years. And, of course there are birth control pills. The student opts for pills, and leaves Patchen’s office with a one-month supply with a standing order for refills through the school clinic.

The hope is that this interaction will mean one fewer teen pregnancy in the city. In the Washington, D.C., neighborhood where this student lives, her chance of getting pregnant is nearly three times the national average.

While U.S. teen pregnancy rates overall have trended steadily downward in the past decade, they remain high in some communities. The rates for black and Latina teens is around twice that of whites, and kids from low-income families tend to have higher rates.

Patchen has been a midwife for 20 years and is the founder of the Teen Alliance for Prepared Parenting, or TAPP, at MedStar Washington Hospital Center. (Meredith Rizzo/NPR)

Anacostia High School’s midwife program is a novel approach that’s showing promise in tackling the problem.

Patchen had been trying to combat the city’s teen pregnancy rates for 20 years as the founder of the Teen Alliance for Prepared Parenting, or TAPP, at MedStar Washington Hospital Center. She was happy with what they accomplished, but she wanted more access to the young people who needed her. Her organization received a 2015 grant from the CareFirst BlueCross BlueShield health insurer to start working in two schools. Now she’s one of a handful of school midwives in the country, she said.

“It’s much better to go where the need is rather than to sit back and wait for the need to come to you,” she said.

And her role goes beyond providing prenatal care for the five to eight pregnant students who get care in the school clinic each year. Being at the school gives her a chance to help prevent pregnancies in the first place. “I wouldn’t have seen these youth in any other setting — not easily, anyway,” she said.

As the school midwife, Patchen can be an informal — and reliable — resource for students’ questions about sex and contraception and relationships.

“I love it when I’m walking in or in the hall during lunch because I see people and they recognize me,” Patchen said. “And they come in to ask me a question and they’ve got their two girlfriends with them. And we’ll talk about condom use or a side effect of a particular method or they’ll say ‘I heard …’”

If she were in a hospital, seeing young people only after they’re pregnant, she would never get this kind of interaction, Patchen said. Plus, the information she gives them spreads through their circle of friends.

At the school, Patchen keeps her schedule flexible to leave room for informal interactions and walk-in appointments, alongside her regular appointments with students.

When a student comes in, Patchen can offer counseling and immediate options. If a student decides she wants an IUD, Patchen can insert it on the spot. She can prescribe birth control pills and then hand the student a packet.

Patchen consults with a student about available pregnancy prevention options. (Meredith Rizzo/NPR)

The CareFirst grant pays for the services and any contraception the students request, so students don’t have to rely on insurance to cover them.

“I feel really good about the fact that we offer the full range of options and we have very, very low removal rates,” Patchen said. She said that she talks students through the different methods and their adverse effects, and leaves the decision about which — if any — method they want to use. “And if the decision is ‘yes,’ it’s a very informed and well-grounded decision,” she said.

In the three years that she’s been working out of Anacostia High School, Patchen said, no students participating in the program have had a subsequent pregnancy. And after choosing a long-term birth control method like an IUD, 85 percent of Anacostia students are still using it one year later.

Patchen discusses a long-term implant as a birth control option. A grant pays for the cost of contraceptives that students ask for. (Meredith Rizzo/NPR)

Patchen can also test for sexually transmitted diseases, or STDs, including doing rapid HIV tests in the school clinic’s lab.

Just as critical, she said, is the ability to spend time talking with students about their lives — from deciding not to have sex, to navigating relationships.

For instance, she asks: “‘Who makes a good girlfriend or a boyfriend? What is that kind of person? How do you make decisions together? What do you do when you have conflict?’”

The other part of Patchen’s job is on-site prenatal care for students who do get pregnant.

Last year, one of those students was Kiera — we’re using students’ first names only, to protect their privacy. When Kiera got pregnant, she was 15 — and scared.

D’Monte and Kiera stop by the clinic because their daughter is running a fever. (Meredith Rizzo/NPR)

“When I met Loral and she started taking care of me in my pregnancy, she made me feel happier about being a parent,” Kiera said. “She helped me out a lot.”

Patchen said being in the school made it easy for Kiera to come in many times throughout her pregnancy, and talk about things like getting a required blood glucose test, or the benefits of breastfeeding — and also about her relationship with the baby’s father, D’Monte.

Since D’Monte is also a student at the school, Patchen could talk to them about parenting together. And even since Kiera and D’Monte broke up, Patchen still helps them figure out how to maintain a relationship so their daughter will have two parents.

Patchen was there, along with D’Monte and Kiera’s mother, when Kiera gave birth to her daughter last January.

“All I saw was excitement on [Patchen’s] face,” D’Monte recalled. “She was just so excited and she was so proud. So I couldn’t let her down.”

The baby is now a toddling 1-year-old who goes to the day care on-site at the high school. Kiera can bring her by the school clinic whenever she needs a visit with the pediatrician, or just to say hi.

“I love it when they come to the office because her daughter is laughing and she’s responsive to things and they’re responsive to her. And it’s a beautiful thing,” Patchen said.

New parents Kiera and D’Monte attend the same school and Patchen uses every chance to talk to them together about issues they’re facing. (Meredith Rizzo/NPR)

The fact that this is a happy, communicative family is not an accident, Patchen said. There were times of frustration, times of disagreement — it could have gone badly. But everyone — the TAPP team, the school clinic staff and the student parents — put in a lot of hard work to do the best they could by this child.

Midwife Loral Patchen wants to be clear: She is by no means saying that teen pregnancy is a great thing. But Patchen feels strongly that once pregnant, a student needs real, steady support.

“Youth that are pregnant, they are very aware of all the judgment, the assumption they will fail: ‘You won’t be able to. Now you can’t.’” Patchen said. “It’s our mandate to make sure they still see themselves as having a future and an opportunity. And that means not buying in to the fact that they will fail with the next 60 years of their lives.”

She said a lot of people tell her her job sounds “dire” — working with young people facing the challenge of dealing with parenthood and high school at the same time. She said that’s not her experience.

Patchen works in two D.C.-area schools. She says she believes she’s one of a very few school midwives in the nation. (Meredith Rizzo/NPR)

“My day at the school health center is the highlight of my week,” Patchen said. “I see young people be brave every single day that I show up there. And I see people willing to figure out how to do really hard things. What’s better than that?”

She wants more — more days in the school clinic, more schools in the program, more staff — to meet the need she sees every day she’s there. She thinks this is one of the few interventions that could have a direct impact on bringing down the high rate of teen pregnancy for these young women in the district.

This story is part of NPR’s reporting partnership with Kaiser Health News.