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Pregnancy Prevention in Foster Care


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This Georgia Child Welfare Legal Academy explores the laws and policies regarding the prevention of pregnancy for teens in foster care.

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Pregnancy Prevention in Foster Care

  1. 1. Taylor Dudley Barton Child Law & Policy Center August 9, 2011
  2. 2.  Review the unique needs and common outcomes among court involved children related to reproductive health.  Review the legal authority and policies that support the delivery of reproductive health care and educational information to court involved youth. ◦ Prevention ◦ Parental Notification Act ◦ The Right to Parent
  3. 3.  Preventing pregnancy is a matter of child welfare ◦ Child health, bodily integrity/dignity, human development ◦ Control over reproductive outcomes ◦ Child well-being (emotional, physical, mental health) ◦ Positive outcomes, success, opportunity ◦ Societal impact  $10.9 billion in 2008 / $2.8 billion child welfare costs  $12,000 = Medicaid Birth / $200 = contraception  Principles apply to all court involved children ◦ Boys/girls ◦ Juvenile Justice/Child Welfare ◦ LGBTQ youth ◦ Developmentally disabled youth 3
  4. 4.  By 19, nearly 50% of female youth in foster care have been pregnant.  Female youth in foster care are 2.5 times more likely than those not in foster care to have been pregnant by age 19.  46% of teen girls in foster care who have been pregnant have had a subsequent pregnancy, compared to 29% of their peers outside the system.  50% of 21-year-old men aging out of foster care reported they had gotten someone pregnant, compared to 19% of their peers who were not in foster care. 4
  5. 5.  A Crucial Connection: Pregnancy in Foster Care  Early parenting compounds the challenges faced by court involved children and increases the likelihood of poor outcomes: ◦ Limited educational opportunities ◦ Income disparity/poverty ◦ Poor health outcomes ◦ Higher rates of incarceration  Babies born to teen mothers face poor outcomes ◦ Cycle: Removal  Foster Care  Poor Outcomes  Teen pregnancies are often high risk for mother and baby ◦ Lack of prenatal care 5
  6. 6. 6 “We can provide youth in care with all the contraception in the world, but pregnancy rates among this population will remain exceptionally high unless the factors that motivate so many of these adolescents to become pregnant are addressed. For some youth in foster care, having a child may be seen as a way to create a family of their own, a family who will love them and who they can love, or to demonstrate that they can do a better job of parenting than their birth parents had. Addressing these motivations means giving teens in foster care a reason to delay pregnancy and childbearing. They need to believe that they can complete their education, find a good job and succeed in life.” –Amy Dworsky, Chapin Hall-University of Chicago
  7. 7. 1. Abuse and Dysfunction 2. Few positive alternatives 3. Meaning in being a parent 4. Lack of positive family influence 5. Family planning and sex education 6. Ambivalence and fatalism 7
  8. 8.  Physical and Sexual Abuse ◦ American Academy of Pediatrics: A significantly higher incidence of childhood sexual or physical abuse has been reported in the backgrounds of teens who become pregnant.  Family Dysfunction ◦ Domestic violence ◦ Incarceration of family members ◦ Household substance abuse ◦ House hold mental illness
  9. 9.  Lacking Opportunities  Lacking Hope
  10. 10.  Family  Love  A chance to raise a family “the right way”
  11. 11.  Family background ◦ Mom was a teen mother  Absent Parents ◦ 46% of teens say their parents “most influence” their decisions about sex.
  12. 12.  Lack of Knowledge  Lack of Access  Inconsistent Use
  13. 13.  “It doesn’t matter if it happens…”  “It will happen when it happens…”
  14. 14. BREAK
  15. 15.  State Law  DFCS Policies  Juvenile Court Rules  Federal Law: Fostering Connections
  16. 16.  OCGA § 49-5-3(12)(c) ◦ “Legal custody” means a legal status created by a court order embodying… the responsibility to provide the child with… ordinary medical care.  DFCS Policy § 1011.4: Upon entering care, children are required to have a “health check” within ten days.  A health check consists of: A comprehensive unclothed physical examination, a comprehensive health and developmental history, developmental assessment, anticipatory guidance, measurements, vision and hearing tests, certain laboratory procedures and lead risk assessment.  DFCS Policy § 1011.2: All of the age appropriate components must be completed for each screening visit.  The American Academy of Pediatrics recommends reproductive health screenings/education as early as age 11.
  17. 17.  § 1011.2: Case manager responsibilities ◦ Arrange appropriate and timely medical care ◦ Follow-up on doctor’s recommendations ◦ Help children and teens learn about sexual development and sexuality ◦ Collaborate with foster family/provider to arrange medical services the child needs  § 1015.18: Major Decisions Exception for Foster Families ◦ Seek consultation and approval from case manager; involve parent if rights have not been terminated  Dating  Contraception
  18. 18.  Section 20, Rule 20.1: Physical and Mental Examinations By Court Order ◦ OCGA 15-11-12(b): “During the pendency of any proceeding, the court may… order the child to be examined at a suitable place by a physician…”
  19. 19.  OCGA § 31-9-2(a)(5): Consent ◦ “Females, regardless of age, are authorized to consent on their own behalf with respect to medical procedures or treatment in connection with pregnancy, prevention of pregnancy, or childbirth.  Exception: Termination of pregnancy  OCGA § 31-17-7(b): Confidentiality ◦ The treating physician/medical staff may inform the minor’s custodian as to the treatment given or needed. The minor patient’s consent is not required.  HIPAA: Not implicated—Parent/custodian may have access to records when provided for by state law.  Title X Clinics
  20. 20.  17+: Plan B, Plan B One-Step, and their generic versions are approved by the FDA for OTC distribution to youth 17+.  16 and under: Plan B, Plan B One-Step, and their generic versions are available by prescription only for youth 16 and under, per the FDA. 20
  21. 21.  Requires states to develop a plan for ongoing oversight and coordination of health services.  Provides opportunities for prevention by way of: ◦ Education ◦ Health Care
  22. 22. Section Application 202: Transition Plan for Children Aging Out of Care •Health education and services in the transition plan. •Encourage case workers to distribute resources on health care, healthy relationships, and the consequences of early pregnancy. 203: Short Term Training Reimbursement •Training for staff and guardians to increase their ability to discuss health education and locate community resources. 205: Health Oversight and Coordination Plan •Regularly scheduled, age appropriate physical exams with appropriate doctor.
  23. 23.  Review your client’s case files for documentation of a comprehensive assessment of health at entry and periodically.  If lacking, ask the court to order.  Expect inquiries from the court about the health of your client or ask for an inquiry.  Repeat Pregnancies
  24. 24.  OCGA §§ 15-11-110 to 15-11-118; Juvenile Court Rule Section 23: ◦ Parental Notification ◦ Judicial Bypass  Requirements  Mature + Well Informed  Notice is not in the minor’s best interests  Case Law  In re E.H., 240 Ga.App. 91 (1999).
  25. 25.  Title IV-E Funding ◦ Mom (foster care) / Baby  Placed together ◦ Mom (foster care) / Baby (foster care)  Placed together ◦ Mom (foster care) / Baby (foster care)  Placed separately  DFCS Policy: “The IV-E program allows a state to claim IV-E reimbursement for the cost of an infant living in the same placement as his/her minor parent. This provision does NOT require DFCS to obtain custody of the child.” ◦ NOTE: The child shall remain in the custody of his or her minor parent, unless it is otherwise determined by the SSCM that the minor parent’s protective capacities places the infant in danger of imminent harm and that the placement resource’s protective capacities are not sufficient to mitigate the risk of harm.
  26. 26.  GA Campaign for Adolescent Pregnancy Prevention   The National Campaign to Prevent Teen Pregnancy   American Bar Association  h_for_teens_in_care.pdf
  27. 27.  Ask the court to order education/health care/anticipatory guidance ◦ High risk cases ◦ No birth control mandates  Counsel case workers  Convene a community action group  Direct youth and case workers to resources
  28. 28.  Questions  Contact Info ◦ ◦ 404-727-3970