Program provides integrated, trauma-informed care for pregnant and parenting adolescents

The pregnancy and post-partum experience is stressful, but for pregnant adolescents the barriers to accessing supportive care can have fatal consequences.

A recent study from The Hospital for Sick Children (SickKids) identified that compared with those who had no teen pregnancy, teenagers in Ontario who experienced a pregnancy were at a 50 percent higher risk of premature death before the age of 31. This risk was even higher for people who had two or more teen pregnancies and among those who were pregnant before 16 years of age.

Published in JAMA Network Open, the study also found that those who experience teen pregnancy were more likely to reside in lower-income neighborhoods and areas with lower completion rates for high school education.

At SickKids, the Young Prenatal Program (YPP) and Young Families Program (YFP) are working to bridge the care gaps experienced by adolescent parents and provide them with integrated physical, mental, and developmental care from pregnancy through their early parenting experience.

"It's essential that we recognize how the social determinants of health are embedded within people's lives and implement trauma-informed programs that meet people where they are at," says Dr. Ashley Vandermorris, Staff Physician in the Division of Adolescent Medicine and co-author on the study. "Our goal is to improve outcomes for adolescents, from pregnancy to parenthood ultimately, and for their child."

Expanding the conversation on adolescent pregnancy and parenthood

The pregnancy experience can vary greatly, especially for adolescents. How do you get to your appointment when you don't have a car, when you can't access or afford public transit, when the clinic closes at 4 p.m., and you're still in school?

The YPP/YFP recognizes that the experiences and environment of each parent are unique. By working with each person to identify their goals and barriers, the coordinated programs can offer centralized prenatal, postnatal, pediatric, sexual, and mental health care. They also offer referrals to other services and resources in the community, like housing and education programs.

"Adolescents entering the program come from a variety of backgrounds. What we provide is more than medical care, but an integrated model that takes into consideration the situation of each person we support," says Jasmine Saleh, a Social Worker at SickKids. "We hope to help expand the conversation about what it means to be a parent and be a resilient, loving caregiver."

After birth, many of the YPP parents transition into the Young Families Program (YFP), a health care service for adolescent parents and their children that provides a comprehensive and integrated model of care to support both the parent and their child up to two years of age.

"For many of these parents, pregnancy offers the first real opportunity to engage with the health care system regularly. Our goal is to support these adolescents along the entire continuum of care and change their relationship with the health care system and care providers," says Gillian Thompson, Nurse Practitioner in the YFP.

Data support need for more integrated care models

The research team, led by Dr. Joel Ray, a clinician-scientist at St. Michael's Hospital, and co-led by Dr. Eyal Cohen, Staff Physician, Senior Scientist and Program Head of the Child Health Evaluative Sciences program, used administrative data to capture all teen pregnancies (defined as pregnancy between 12 and 19 years of age) and deaths among 2.2 million people assigned female at birth who were alive at 12 years of age from 1991 to 2021.

"The longer-term risk of premature death, whether injury or noninjury-related, is significantly increased for pregnant teenagers," says Cohen, who is the Co-Executive Director of the Edwin S.H. Leong Centre for Healthy Children. "We need programs that address the interconnectedness of health care and social determinants of health."

While the YPP and YFP at SickKids offer important services to pregnant adolescents and parents, the team hopes that this study will support the development of more community-based programs that employ a strengths-based approach that respects the autonomy and resilience of young parents.