Ci3 Intern Receives Two-Year Fellowship for Work With LGBTQ Youth

Kara Ingelhart headshot

Ci3 intern Kara Ingelhart, a third-year student at The University of Chicago Law School, has been awarded a Skadden Fellowship. The prestigious two-year fellowship will support Ingelhart’s work with LGBTQ youth with juvenile or criminal records by addressing the many barriers they face in housing, employment and educational opportunities. The Skadden Fellowship Program was established in 1988 to commemorate the law firm’s 40th anniversary, and has been described as a “legal Peace Corps.”

At Ci3, Ingelhart works with Executive Director Dr. Brandon Hill on the Transgender Military Mental Health project. Her internship is supported by the Quern Endowment, a fellowship through the Graduate Program in Health and Administration Policy that supports projects aimed at developing students’ leadership skills in the fields of health policy and management.

Congratulations, Kara!

Tomorrow – Free Webinar for Family Planning and Primary Care Providers

Photo courtesy of nih.gov.

Photo courtesy of nih.gov.

The Illinois Medicaid Program recently released a major new policy on family planning, including increased rates for certain procedures. Illinois Healthcare and Family Services is offering a free webinar on Wednesday, December 3 at 1 p.m CST. This interactive session will assist both family planning and primary care providers to take advantage of this new policy for their clients by synthesizing and presenting the most valuable current data and best practices in family planning. Register now.

South Side Stories Spotlight, November 2014: Sexual Coercion

South Side Stories November

Each month, Ci3’s South Side Stories project features digital stories that spotlight the lives of adolescents and young adults from the South Side of Chicago.

November’s South Side Spotlight focuses on sexual coercion, a critical topic for adolescents. Sexual coercion refers to the act of making another person engage in sexual activity against their will (Brousseau, Bergeron, Hébert & McDuff, 2011). This term includes rape and sexual assault, as well as acts that persuade someone to engage in unwanted sexual activity, such as using pressure, drugs or alcohol. Sexual violence is achieved through physical force, threats, emotional manipulation, consistent pressure, fear or coercion.

Two stories are presented, one from a young man, who experienced childhood sexual abuse, and another from a young woman, who experienced rape. In The Unveiling, the male narrator is just beginning to talk about his sexual trauma, although several years have passed since the event occurred. I was 10 and barely knew about sex. But this tragic process was continuously repeated.  And I? …Remained silent.  It’s seven years later and I’m finally starting to confront my feelings, I am wondering why it has taken so long.

In his story, the narrator discusses a challenge common to many victims of sexual assault: the difficulty of telling people what has happened, which may be especially hard for boys and men. Who could I have turned to? he asks. Family? Friends? Someone at school…where teachers are too busy and social workers switch year after year? The silence that shrouds his experience is depicted by the word “Shhh” on the blackboard. His comments highlight the importance of ensuring that youth have trusting relationships with adults with whom they can share their experiences regarding sexual violence. Despite this violence, he ends his story on a hopeful note, with the declaration that he still “deserves love and care.”

The second story, Untitled, recounts the experience of a young woman who was raped by a man. The narrator shares her memories of the event and how she felt disassociated from her experience with sexual violence: I am watching the situation as if it isn’t even me. Watching her underneath him. Panting. Crying. Pleading for him to stop. Too weak to fight, too scared to scream. I want to ask her: How did you get into this situation? I want to ask him: If she’s so beautiful… how could you do this?

Remembering the event trigger[s] memories that leave you feeling stuck. We also hear the narrator’s disappointment at not having experienced first love in the way she imagined: Her first love, her first kiss, it should be a positive thing, but that’s not her story. Though impacted by her experience, she is aware that she can move past this. There’s this beautiful girl trapped inside of me, who is not running, or scared of her dreams.

We thank the authors for sharing their stories and honor their courage.

The following are national resources available to victims of sexual violence:

Rape, Abuse and Incest National Network (RAINN)

1 (800) 656-HOPE

https://www.rainn.org/get-help/national-sexual-assault-hotline

Department of Defense Hotline

(877) 995-5247

https://www.safehelpline.org/ 

Stop It Now

If you need immediate assistance, please contact either your local police, 911 or hospital. You can also contact ChildHelp at 1.800.4ACHILD (1.800.422.4453).

(413) 587-3500

http://www.stopitnow.org/warning_signs_child_behavior

Men Can Stop Rape

(202) 265-6530

http://www.mencanstoprape.org/

National Sexual Violence Resource Center

(717) 909-0710 Phone
(877) 739-3895 Toll Free

http://www.nsvrc.org/bystander-intervention-campaigns-and-programs

The following resources are available to victims of sexual violence in the Greater Chicago Metropolitan area.

Rape Crisis Hotline

Call (888) 293-2080 in Chicago Metropolitan Area
Call (630) 971-3927 in DuPage County
Call (708) 748-5672 in the South Suburbs

http://www.ywcachicago.org/site/c.fmJWKcOZJkI6G/b.8243031/k.F95D/Rape_Crisis_Hotline.htm

Rape Victim Advocates (RVA)

(312) 443-9603

http://www.rapevictimadvocates.org

Young Women’s Association of Metropolitan Chicago (YWCA)

(312) 733-2102, ext. 2146

http://www.ywcachicago.org/

Click here for a full Spotlight including broader research and policy implications.

South Side Stories is made possible through the generous support of the Ford Foundation.

Three new studies focus on lowering clinic barriers to help women obtain desired contraceptive method

Contraception is the cornerstone of pregnancy prevention and the intrauterine device (IUD) is one of the most effective methods available. IUDs require little user maintenance, last between 7 and 12 years, and are more than 99 percent effective at preventing pregnancy. Thus, it is critical to remove unnecessary obstacles that prevent women from receiving a desired IUD.

The University of Chicago Section of Family Planning (the Section) has published three articles that discuss research on implementing interventions to the systematic barriers to IUD care. This research was funded by the Office of Population Affairs.

In collaboration with three Planned Parenthood of Illinois clinics, the research began with an in depth evaluation of all aspects of IUD service delivery called Failure Modes Effects and Criticality Analysis (FMECA). Health care providers and patients were interviewed to see the way in which the system could be redesigned to better deliver care. This step-by-stop process identified “failures” using qualitative and quantitative data, and determined the frequency and impact in order to prioritize redesign and improvements.

A systematic approach to improving intrauterine device services in family planning clinics appeared in Contraception. This publication outlines the Section’s analysis of the FMECA approach and identification of three main failures during the scheduling and intake processes: 1) The patient does not show up for appointment or cancels; 2) The patient recently had unprotected intercourse; and 3) Limited time for counseling, informing, and placing IUDs.

After reviewing the FMECA data, the research and clinical care teams created two solutions to the identified failures: implementing a revised scheduling call script, and developing an iOS counseling app to be used in the waiting room.

Impact of a revised appointment scheduling script on IUD service delivery in three Title X family planning clinics, also published in Contraception, discusses the implementation of the revised scheduling script.

Mindful of the systems-level barriers identified by the FMECA, Section researchers created a simple and scalable intervention: revising the appointment-scheduling call script. Along with the revised script, visual tools reminded schedulers to explain behavior prerequisites such as “Do not have unprotected sex at least two weeks prior to an appointment” and “Continue to use pills, patches, or rings up until the appointment.” The script also prompted schedulers to communicate logistical requirements such as bringing an ID, proof of insurance or cash to pay for the procedure, and instructions to call and cancel an appointment if necessary.

Through implementation of the revised script, no-show rates decreased from 40 to 23 percent, and in particular, young women were more likely to keep their scheduled appointment.

Development and Testing of an iOS Waiting Room “App” for Contraceptive Counseling in a Title X Family Planning Clinic, published in the American Journal of Obstetrics and Gynecology, describes the Section’s development and testing of a theory-based behavioral app. The app, developed with young women, features young women describing their contraceptive experiences. Testers were highly satisfied with the app and found it easy to use. A brief (<15 min) app session significantly improved women’s knowledge scores on the relative effectiveness of LARC compared with other methods.

The Section continues to research the app for comprehensive contraceptive counseling.

The research team has also developed an online toolkit describing processes, procedures, and tools for an FMECA and shared with Title X clinics nationally.

For more about recent Section research and publications, visit familyplanning.uchicago.edu or our Sexual and Reproductive Health and Justice blog.

Special thanks to the Office of Population Affairs and Planned Parenthood of Illinois for their support.

2014 North American Forum on Family Planning

Last month, several of our Section faculty and staff traveled to Miami for the 2014 North American Forum on Family Planning.

The Forum gathered nearly 700 clinicians, researchers, and clinical staff to present, discuss, and learn the latest on family planning and how evidence can inform both policy and practice.

The agenda included daily panels covering sexual and reproductive health and justice issues. Section Chief Dr. Melissa Gilliam served on the panel, Addressing disparities in Family Planning: Why provider diversity matters. Dr. Gilliam also moderated a panel that covered Reproductive Justice, health disparities, and incarcerated women in the U.S  This session echoed our policy brief on this topic — that a right to abortion while behind bars is meaningless without access. As a panelist said, “What happens to women behind bars is a microcosm of the politicization of reproduction in our society.”

Dr. Gilliam also contributed to a timely and important discussion, The continuing debate on the Medicaid sterilization policy: The advocacy community’s perspective. This session took into account the full, diverse experiences of women seeking to end fertility and reminders to support reproductive autonomy.

Other Forum sessions from Section faculty included a presentation by Dr. Amy Whitaker called Postpartum IUD insertion: From research to reality.

ryancenterforum

Dr. Sabrina Holmquist and Clinic Administrator Brie Anderson presented at the Ryan Program meeting.

 

Many of our faculty and staff had posters accepted at the Forum as well.

amyforum

 

Dr. Whitaker’s poster presented her research on motivational interviewing to improve post-abortive uptake of LARC methods. Dr. Whitaker’s research shows that motivational interviewing is a promising approach to address health behavior issues, including repeat abortion and contraceptive counseling, as it is theory based, directive, and patient centered. Click here to view a PDF of the poster.

 

Section faculty Dr. Julie Chor’s poster discussed her research on the prevalence and correlates of women presenting for abortion having a regular provider. julieforumDr. Chor’s study found that a history of abortion did not increase the likelihood of a woman having a regular  provider, and so an abortion visit is a good opportunity to engage women in the healthcare system. Click here to view a PDF of the poster.

 

Other posters presented at the Forum included:

  • Shared negative experiences with long-acting reversible contraception and their impact on contraception counseling: A mixed methods study (Authors include OBGYN resident Dr. Benjamin Brown and Dr. Amy Whitaker). Click here for PDF.
  • Risk Factors for Feelings of Shame and Guilt at the Time of Abortion (Authors include Dr. Julie Chor, Dr. Amy Whitaker, and Policy Coordinator Lee Hasselbacher). Click here for PDF.
  • Reproductive health characteristics associated with unwanted or ambivalent first sexual experience among reproductive-aged men in the United States: An analysis of the National Survey of Family Growth, 2006-2010 (Authors include Dr. Melissa Gilliam, Dr. Amy Whitaker, and former fellow Dr. Elisabeth Woodhams). Click here for PDF.
  • Also spotted: Is LARC for everyone? Socio-cultural perceptions and barriers to contraception among refugees in Ethiopia.  Dr. AuTumn Davidson conducted this research during her fellowship in family planning. Authors include Dr. Gilliam and Research Specialists Dr. Camille Fabiyi, Dr. Brandon Hill, and Erin Jaworski.

autumnposter

Ci3 Profiled in Windy City Times

 

20121113_Ci3_8813

Ci3 and Executive Director Dr. Brandon Hill were recently profiled in the Windy City Times. Dr. Hill spoke of Ci3’s efforts “to really give voice to racial and sexual minorities, with the goal of policy implications.” Dr. Hill spotlights Ci3’s digital storytelling project South Side Stories.

Read the full article here.

South Side Stories Spotlight, October 2014: Cultural Identity

SSS October

Each month, South Side Stories features digital stories that spotlight the lives of adolescents and young adults from the South Side of Chicago.

This month’s theme is cultural identity. These four young women explore language, music and social customs, both their own and those of others, reflecting upon how these discoveries enrich their own identities.

Click here for a full version of the October Spotlight, including broader implications and a resource guide.

In Bald and Beautiful, Jakina narrates the process of overcoming insecurity and acquiring a more positive self-image. Jakina, who has alopecia (hair loss), recalls teasing and bullying from other children in her neighborhood and school. As a young adult, she decides to embrace her baldness and go without a wig. “No longer will I allow hair to define my beauty. No longer will I be submitted to wear wigs because society wants me to have hair.”

 

 

The second story, Manifest, chronicles a young woman’s first concert experience. Gabrielle is excited to see her favorite group, but is overwhelmed by the sounds, smells and collective energy of the crowd surrounding her. Finally, she remembers why she came to the show and realizes she is part of something much larger. “Pushing through the crowd, closer to the stage, just feet away…I’m lost in the music.”

 

 

In Outsider, Kyla describes her “sheltered” childhood on Chicago’s South Side. “My whole life had been set up to please others and not myself.” While Kyla embraces both the North and South Side cultures, she is surprised when her peers are less understanding of her outlook. Kyla’s story demonstrates the complexity of balancing the expectations of her peers with her own identity development.

 

 

In the final story, Ringtones, Darnisha explains the origins and implications of her fascination with Korean culture. She finds that learning about another culture has only enriched her own African American identity. “My skin, my hair, the food I eat, my identity as a Black girl, a granddaughter, a friend, and an optimist, I still carry with me, so people understand that you,we, can be the best of both worlds.”

 

 

Together, these stories illustrate the sense of identity, gleaned from pushing boundaries, asking questions and navigating new environments in pursuit of a fuller human experience. We thank the authors for sharing their stories and honor their curiosity, intelligence and honesty.

South Side Stories is made possible through the generous support of the Ford Foundation.

New Section research promotes parent–daughter communication about abortion before pregnancy occurs

parent_daughters

Press Release

Published: 13 October 2014

 

Discussing sexuality and reproductive health is a complex issue for parents and their daughters. Parents often feel ill-prepared to initiate these talks, and their daughters often fear a negative reaction or perceive judgment for their sexual activity. Yet, numerous studies have shown that, in general, parent-daughter communication leads to positive sexual health outcomes with regards to pregnancy and STI/HIV prevention.

New Section research, published online ahead of print in the Journal of Adolescent Health, discusses the role and potential impact of parent-daughter communication about abortion among non-pregnant adolescents. These conversations, the authors suggest, may decrease pregnancies and abortion and obviate the need for forced communication.

Currently, 38 states legislate communication between abortion-seeking minors and their parents via Parental Involvement (PI) laws, which require minors 18 years old and under to notify or obtain consent from a parent(s) or guardian before obtaining an abortion. PI supporters argue that these laws promote communication and provide young women with family support. PI opponents maintain that forced communication during the time of crisis can harm young women and delay treatment, increasing the medical risk of a procedure. Furthermore, studies show that most adolescents voluntarily involve parents in their decisions about pregnancy resolution, especially when they anticipate support.

Our qualitative study found that only 43 percent of nonpregnant African-American adolescent females had ever discussed abortion with a parent. Almost half were sexually active, and the vast majority stated they would voluntarily tell a parent of an abortion decision “as soon as possible” or “within one to two weeks.” However, nearly 20 percent acknowledged risk and expressed fears of hurt, punishment, and eviction if their parent learned about an abortion.

The study identified several correlates of parent-daughter communication about abortion. Parents who had had talked about other sexual health topics (e.g. birth control and STIs) were more likely to have discussed abortion with their daughter. If daughters perceived parental acceptance of sexual activity, they were more likely to have an abortion communication. A mother’s experience with teenage pregnancy was positively associated with abortion communication, although the study did not assess the positive or negative quality of the communication. Of concern, sexually active adolescents were less likely to communicate about abortion.

Ultimately, this study found that rather than mandating communication at the time of abortion, policies should focus on general parent-daughter communication about sexual health. Policies that force communication at the time of abortion appear misplaced.

Read the full article here.

Reference

Sisco K, Martins S, Kavanaugh E, Gilliam M. Parent-Daughter Communication About Abortion Among Nonpregnant African-American Adolescent Females. Journal of Adolescent Health. Published online ahead of print September 27, 2014: DOI: 10.1016/j.jadohealth.2014.07.010

 

Section study finds young women involve a parent in abortion when they anticipate support

‘Cause it’s like, ‘man what are they going to think’ and ‘are they going to hate me for this?’ That is what goes through your mind.

When a young woman seeks to terminate a pregnancy, how does she decide whether to talk to a parent? A recent study from the Section of Family Planning and Contraceptive Research at the University of Chicago found that pregnant teens will turn to parents and adults who are engaged in their lives and who will offer support, regardless of her decision. Young women will avoid talking with parents who are less involved or may try to prevent them from seeking care.

The study, recently published online ahead of print in the American Journal of Public Health, explored the factors young women under age 18 consider when deciding to involve a parent. Researchers conducted interviews with 30 minors seeking abortion in Illinois, prior to implementation of a parental notice law in 2013. Currently, there are 38 states with laws requiring a parent provide consent or receive notification before a minor can access abortion.

Image courtesy of the Illinois Caucus for Adolescent Health (icah.org)

Image courtesy of the Illinois Caucus for Adolescent Health (icah.org)

“There’s a commonly accepted idea that teens will try to hide their pregnancy or abortion decision. However, pregnant young women actually do turn to parents in the majority of cases. In our study, 70% of the young women involved a parent or guardian. They thought carefully about which parents and adults in their lives they could turn to for help in making their decision,” said Lee Hasselbacher, policy researcher at the Section of Family Planning.

While each young woman’s family circumstance was different, there were several common motivations for involving a parent. Factors in favor included close and supportive relationships, need for help with logistics like travel or payment, or experiences that made discovery of the pregnancy seem inevitable.

I mean, I wouldn’t normally tell my dad but it came to a point where I needed another $50 for the abortion to be done and so I relied on daddy.

Minors expressed a range of motivations for not telling a parent about their abortion as well. Some teens worried that if their parent learned of their decision, it would dramatically change their relationship or feared it would even lead to anger or harm. Young women also discussed the lack of a relationship or presence as a reason they did not want to involve a parent.

To me that [disclosing pregnancy and abortion] would start a whole lot of drama and right now um, our relationship is like- is kind of on good terms but it’s not so for me telling her this um, I think it like would go back down the drain.

One of the strongest findings was that among those young women who did not involve either parent, most were concerned that one or both parents would directly interfere with their decision to get an abortion.

She just told me, like, it’s not right… and she told me like, if I did get pregnant, like, she told me she wouldn’t let me have one. She said it’s my responsibility.

“This study reveals the complicated lives of pregnant young women and suggests that young women, not policymakers, are the ones best able to identify those people in their lives who can help them deal with a pregnancy. This study reinforces the need to listen to these young women and support policies that encourage family communication long before a pregnancy or abortion decision,” said Dr. Melissa Gilliam, Chief of the Section of Family Planning and Contraceptive Research and author on the study.

Reference

Hasselbacher LA, Dekleva A, Tristan S, Gilliam ML. Factors Influencing Parental Involvement Among Minors Seeking an Abortion: A Qualitative Study. Am J Public Health. Published online ahead of print September 11, 2014: e1-e5. Doi:10.2105/AJPH.2014.302116.

Press

Jersey Tribune

Medical Xpress

Science Daily

Science Newsline

 

 

Dr. Melissa Gilliam Featured in AP News Story on Contraception Access

AP Photo

Section Chief Dr. Melissa Gilliam was featured and quoted in an Associated Press news story regarding Illinois’ recent effort to ensure comprehensive and continuous birth control coverage for those with Medicaid.

The story, which has been picked up by outlets nationwide including CBS News, discusses a plan from Illinois Gov. Pat Quinn’s administration to improve access to family planning services for individuals with Medicaid, including long-acting birth control methods, by increasing reimbursement and education. The plan was announced at last month’s Illinois Contraceptive Equity Summit, an event hosted by the Section and EverThrive Illinois. The public is invited to comment on the plan until September 15.

According to the article, the current Illinois Medicaid payment system creates a financial barrier to doctors for offering LARC methods. For example, IUDs cost doctors’ offices between $300 and $800 each to keep in stock. Clinics pay the upfront cost of an IUD and absorb the loss of denied or delayed Medicaid claims. By implementing the Illinois Family Planning Action Plan,  the state would double doctors’ reimbursement rates for inserting IUDs and performing vasectomies, thus alleviating the cost for both patient and provider.

Dr. Gilliam commented on access to contraceptive methods within Medicaid, saying that “for some providers, [the state’s plan] will make a very big difference and will be a very welcome change.”

Photo: M. Spencer Green, AP