In 2022, 537 infants—or 11.2 infants per 1,000 childbearing persons ages 15 to 19 years—were born to adolescents in Orange County, Florida (Bureau of Community Health Assessment, 2022). Adolescent pregnancy is associated with numerous maternal and child health risks that pose significant public health concern (Flaviano & Harville, 2020) and a strong dose-response relationship exists between the number of adverse childhood experiences (ACEs) and adolescent pregnancy with teen pregnancy risk increasing incrementally with increasing number of ACEs (Hillis et al., 2004).
Funding secured through this grant will be used in partnership with the Orange County Public School System to pilot a trauma-informed school-based adolescent pregnancy prevention program introduced to 6th and 7th grade students at Memorial Middle School and freshmen and sophomores at Jones High School. The program will include trauma training for school staff, updates to school policies and procedures, and a trauma-informed pregnancy prevention curriculum introduced over the course of one school year in nine monthly sessions. The adolescent pregnancy prevention curriculum will incorporate social cognitive theory constructs to improve participants’ communication and negotiation skills through modeling and role play (LaChausse, 2016) and include education about common stress reactions, training in relaxation and mindfulness, practice with social problem-solving skills, and application of evidence-based cognitive-behavioral strategies (Martin et al., 2017).
Students of childbearing potential participating in this program will gain knowledge about common reactions to stress or trauma, develop coping skills through relaxation training, mindfulness exercises, and social problem-solving practice to better respond to traumatic or otherwise triggering events, and rehearse adaptive behaviors through role play and peer mentoring interactions within their groups (Martin et al., 2017). By understanding and acknowledging the association between ACEs and risk of adolescent pregnancy, and designing and providing programming that is welcoming, empowering, collaborative, supportive of student choice and control, and culturally sensitive (Martin et al., 2017), we will more sympathetically, comprehensively, and effectively tackle this public health concern.
Levels of Social Ecological Model
McLeroy’s social ecological model includes five levels: individual, interpersonal, organizational, community, and policy (McLeroy et al., 1988). This project will include interventions targeting the individual, interpersonal, and organizational levels of this model. At the individual level, school-based group sessions will help adolescents increase self-efficacy and develop coping skills to better respond to traumatic or otherwise triggering events. At the interpersonal level, participants will have the opportunity to rehearse adaptive behaviors through role play and peer mentoring interactions within their group sessions and interactions between students and school staff will be improved by a deeper understanding of trauma. At the organizational level within the school system, policies and procedures will be reviewed and revised to ensure the integration of a trauma-informed approach throughout (Martin et al., 2017).
Trauma-Informed Principles
The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines six key principles of a trauma-informed approach and 10 implementation domains to guide specific areas where trauma-informed principles can be operationalized (SAMHSA, 2014). Our program will incorporate principles of safety, peer support, and empowerment, voice, and choice and utilize implementation domains of engagement and involvement, training and workforce development, and policy.
One important aspect of the principle of safety is prioritizing safety as defined by the target population (SAMSHA, 2014), so early screening for traumatic experiences and establishment of ground rules for group sessions will be critical to creating a safe environment for all students, inclusive of trauma survivors. Our intervention will also create a safe environment for faculty and staff by ensuring that training, support, and protections are established for all personnel through institutional policy and procedure changes. The principle of peer support and mutual self-help are a cornerstone of this program. Interactive group sessions will allow students a safe space to share strategies and practice social problem-solving skills through role play. Further, young adult graduates serving as community mentors on the program steering committee and within these student sessions will provide opportunities for relatable and supportive adult relationships. Family members of trauma survivors also provide peer support (SAMHSA, 2014); this program includes parent sessions designed to improve understanding and build resilience and parenting skills. By building a steering committee of student leaders, integrating peer mentors throughout the educational and skill building sessions, and focusing early sessions on establishing rapport and safety within small groups, our intervention focuses on the principle of student empowerment, voice, and choice.
Trauma-informed strategies have also been integrated into the implementation of this program, specifically within the domains of engagement and involvement, training and workforce development, and policy (SAMHSA, 2014). Regarding engagement and involvement, the adolescents to whom the program is targeted play a key role in all levels of decision making from representation on the steering committee to mentorship during the sessions to guiding program evaluation and improvement efforts (Philanthropy Network Greater Philadelphia et al., 2018). Regarding training and workforce development, all school staff that interacts with students will receive initial and ongoing training, professional development, and support services to address secondary traumatic stress, vicarious trauma, and compassion fatigue (Philanthropy Network Greater Philadelphia et al., 2018). Regarding policy, the trauma-informed approach will be incorporated into school culture through revision of school policies and procedures (Philanthropy Network Greater Philadelphia et al., 2018).
Public Health Framework
Recognizing that childhood trauma is a risk factor for adolescent pregnancy, our project employs both primary and secondary prevention strategies. Most of our efforts will be focused on secondary prevention strategies to reduce the impact and downstream consequences of traumatic experiences once they have already occurred (Philanthropy Network Greater Philadelphia et al., 2016). All students of childbearing potential enrolled in the curriculum will be screened for ACEs during the first session and actively participate in training and role-playing exercises, experience and analyze modeling, and develop cognitive-behavioral strategies throughout the monthly sessions. These efforts aim to reduce the incidence of adverse outcomes associated with ACEs by identifying and quickly intervening with psychological first aid to reduce the psychosocial impact of traumatic experiences (Oral et al., 2015).
Other aspects of our project, including parent sessions aimed to build resilience and parenting skills, trauma training for all staff that may interact with students, and intentional implementation of trauma-informed policies and procedures into the school system, are part of a primary prevention strategy to increase family, institutional, and community stability and resilience (Oral et al., 2015; Philanthropy Network Greater Philadelphia et al., 2016). Additionally, interactive student sessions may end up bringing to light risky sexual health behaviors in which students are engaging, many of which are known to be increased with exposure to trauma. As a result, our program has potential to additionally engage in tertiary prevention strategies to identify and reduce these high-risk behaviors associated with ACEs (Oral et al., 2016).
References
Bureau of Community Health Assessment. (2022). Birth Indicators Query System. [Data set]. Division of Public Statistics and Performance Management. Florida Department of Health. https://www.flhealthcharts.gov...ort=Birth.Dataviewer
Flaviano, M., & Harville, E. W. (2020). Adverse Childhood Experiences on Reproductive Plans and Adolescent Pregnancy in the Gulf Resilience on Women's Health Cohort. International journal of environmental research and public health, 18(1), 165. https://doi.org/10.3390/ijerph18010165
Hillis, S. D., Anda, R. F., Dube, S. R., Felitti, V. J., Marchbanks, P. A., & Marks, J. S. (2004). The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics, 113(2), 320–327. https://doi.org/10.1542/peds.113.2.320
LaChausse R. G. (2016). A Clustered Randomized Controlled Trial of the Positive Prevention PLUS Adolescent Pregnancy Prevention Program. American journal of public health, 106(S1), S91–S96. https://doi.org/10.2105/AJPH.2016.303414
Martin, S. L., Ashley, O. S., White, L., Axelson, S., Clark, M., & Burrus, B. (2017). Incorporating Trauma-Informed Care Into School-Based Programs. The Journal of school health, 87(12), 958–967. https://doi.org/10.1111/josh.12568
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health education quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., Benoit, J., & Peek-Asa, C. (2016). Adverse childhood experiences and trauma informed care: the future of health care. Pediatric research, 79(1-2), 227–233. https://doi.org/10.1038/pr.2015.197
Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, & United Way of Greater Philadelphia and Southern New Jersey. (2016). Trauma Informed Philanthropy: A Funder’s Resource Guide for Supporting Trauma-Informed Practice in the Delaware Valley [pdf]. https://www.scattergoodfoundat...anthropy-volume-one/
Philanthropy Network Greater Philadelphia, Thomas Scattergood Behavioral Health Foundation, & United Way of Greater Philadelphia and Southern New Jersey. (2018). Trauma Informed Philanthropy Volume Two: Leveraging resources and relationships to advance trauma-informed practice and move from knowledge to action. [pdf]. https://www.scattergoodfoundat...anthropy-volume-two/
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. SAMHSA. https://ncsacw.acf.hhs.gov/use...es/SAMHSA_Trauma.pdf
Comments (0)