New research by Professor James Jaccard, Ph.D., and Nicole Levitz, M.P.H., of the New York University Silver School of Social Work and its Center for Latino Adolescent and Family Health (CLAFH) has led them to suggest 12 evidence-based principles that can be used to improve contraceptive counseling of adolescents in U.S. health care clinics, doctor's offices, and health service organizations.
Jaccard and Levitz write in the article – "Counseling Adolescents About Contraception: Towards the Development of an Evidence-Based Protocol for Contraceptive Counselors," just published in the Journal of Adolescent Health – that developing an effective counseling protocol that takes into account the unique developmental status of adolescents is important. This includes the nature of romantic relationships during adolescence (they are short-lived and often emotionally intense) and the fact that adolescents are still developing cognitively, socially, emotionally, physically, and morally. The principles the researchers offer for effective counseling are derived from bodies of scientific literature on both adolescent development and contraceptive decision-making.
"We offer these in the spirit of creating an initial skeleton of a contraceptive counseling protocol for use with adolescents that can be subjected to future empirical evaluation," write Jaccard and Levitz.
The principles the authors recommend include ensuring that counselors establish with their clients the "three key" attributes of expertise, trustworthiness and accessibility; directly address matters of confidentiality with the adolescent; use specialized active learning strategies to engage the patient in learning and remembering important points; address four facets of contraception – method choice (choosing the most effective method that fits the adolescent's lifestyle), correct use of the method, consistent use of the method, and issues surrounding method switching; and be sure that a staff member follows up to see how things are going. Jaccard and Levitz address issues of directive and non-directive counseling and strategies that can be used to help adolescents deal with "information overload" when it comes to making contraceptive choices. With over a dozen methods that differ on over a dozen different characteristics (such as effectiveness, side effects, privacy, STD protection, cost, convenience, impact on pleasure), the task of choosing one of them in a short counseling session is daunting to many clients. Jaccard and Levitz suggest procedures for making the task more manageable.
Although adolescent pregnancies in the U.S. have been declining since the 1990s, they are still high. With nearly 750,000 pregnancies among women younger than 20 years old annually in the U.S., the teen pregnancy rate in the U.S. remains the highest of all developed countries, according to the authors.
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