15.17 1 OF 7 I PURPOSE To establish a uniform process for screening and managing pregnant females at the Youth Study Center YSC, that ensures the female residents will receive adequate support in accepting and acknowledging their pregnancy. It is to initiate the counseling process so that the female resident can make informed decisions about their pregnancy, such as choosing to have and care for the baby, to place the baby in foster care, to allow an adult relative or friend to care for the baby, to place the baby for adoption, or to terminate the pregnancy. It is also to guarantee that pregnant females during their brief stay at the Center receive prenatal education and health care services to support their pregnancy; and make sure the females who decide to terminate their pregnancy while at the YSC will receive necessary post-operation counseling and information regarding safe sex, contraception, and family planning. II BACKGROUND Based on physical, emotional, social and cognitive immaturity, pregnant teen girls are extremely vulnerable. They require enhanced support and protections to help them cope with and manage their pregnancy. The decisions they make will impact them life long Upon admission, minors can consent to pregnancy testing and prenatal care. They can also obtain contraception and testing and treatment of sexually transmitted diseases without parental consent and involvement. These are easy tasks compared to dealing with the emotional, physical and mental stress experienced by girls in learning of a pregnancy. Youth Study Center staff must provide an environment which enhances a girl s decisional capacity to understand her situation, weigh the risks and benefits of her choices, compare choices, incorporate her own values in the final decision, and make a decision that is not overly affected by the opinion of others (Dellinger, 2002, 26). Pregnancy options counseling is method of informing a girl of all of her choices associated with her pregnancy. It is a non-directive process which entails providing medically accurate and factual information on prenatal care and parenting, pregnancy termination, adoption and other transfer of custody. Staff should not allow their personal beliefs and values to interfere with counseling a girl (Dellinger, 2002). Pregnant girls have five options: (1) give birth and parent their child; (2) place child in foster care; (3) place child with an adult relative or friend; (4) put child up for adoption; or (5) terminate the pregnancy. III DEFINITIONS A Child Birth and Parenting: Consistent with the Council on Accreditation Guidelines for Pregnancy Options/Birth Options Counseling PA-PS 6.04 (2008), individuals should receive the following information on the implications of parenting: 1 Responsibilities associated with parenting; 2 Child care; 3 Living arrangements;
15.17 2 OF 7 4 Costs associated with raising a child; 5 How parenting will impact the expectant parents goals and plans for the future; 6 Whether family members or friends will be willing to help the expectant parents; 7 The role that the birth father will play; and 8 Single parenting or the possibility of marriage Young ladies should also be informed that a judge can determine if she keeps custody of the baby and that resources to place her with her baby are very limited. B Foster Care: Foster care affords a girl with a short term opportunity to place her baby with licensed foster parents while she prepares to resume custody of her baby. While in foster care, the Department of Human maintains custody of the child and outlines certain tasks that the girl has to complete in order to regain custody of her child. According to federal law, a parent generally has 2 years to complete the tasks before the Department begins to arrange for adoption. Maintaining visits and bonding with the child are extremely important considerations for the court in returning a child to her mother. While this is a relatively easy option to facilitate, it is often difficult to regain custody of young children placed in foster care. C Placement with an Adult Relative or Friend: Girls can also decide to informally place their babies with an adult relative or friend. In this instance, most often there is no social service agency ensuring the safety of the child in the home. Custody orders from Family Court, Domestic Relations Division, are needed so that the care taker can obtain welfare benefits and authorize care and treatment of the baby. Family Court hearings will also be necessary to resolve disputes over custody. In this instance as well, maintaining visits and bonding with the child are extremely important considerations for the court in returning a child to her mother. D Labor: The period of time before birth during which contractions are of sufficient frequency, intensity and duration to bring about effacement and progressive dilation of the cervix. The determination of when labor has commenced shall solely rest with the YSC medical. E Adoption: Adoption is a legal arrangement that places a child permanently in the care and custody of an adoptive family. A girl placing her child up for adoption has no rights to visit or care for the child. This is a permanent arrangement and cannot be changed. Adoptions are facilitated through adoption agencies. F Restraint: Any hold or mechanical device used to control the movement of the youth s body and limbs. G Termination of Pregnancy: Girls under the age of 18 cannot terminate their pregnancy without parental consent unless she has a judicial decree of emancipation or a court order authorizing consent.
15.17 3 OF 7 If a girl does not want her parents to know about her pregnancy or a parent refuses to consent, she can seek a court order (process is termed a judicial bypass) to gain the authority to consent to the procedure herself. It is a closed, confidential proceeding. A petition must be filed with the Court of Common Pleas, Family Court, Juvenile Division. In general, the court is looking to determine that the girl is mature, capable of making informed consent without parental involvement; or that termination is in the girl s best interest. All information related to girl s pregnancy, prenatal care, requests for termination, contraceptive use, and diagnosis and treatment of sexually transmitted diseases is confidential. This information can only be shared with a release of information executed by the girl. IV PROCEDURE: A Intake/Screening/Testing: Upon admission, all girls receive pregnancy tests administered by Prison Health. B Counseling Support: 1 If a youth tests positive for pregnancy, she is seen within 24 hours by YSC physician for a prenatal consultation. 2 Formal pregnancy options counseling will be done through YSC Social Work staff. Staff is expected to outline all options and inquire about the girl s desire to contact her parents for additional support and counseling. See attached Pregnancy Options Counseling Guidelines Adopted from the Council on Accreditation (2008) 3 Youth Study Center staff are expected to be informative and non-judgmental in communicating with pregnant girls. All conversations should be done in private and kept confidential. If you are presented with a question that you cannot answer accurately, refer the girl to the appropriate resource. 4 CHOICE, Concern for Health Options: Information, Care and Education Hotline can be contacted for additional information regarding pregnancy, prenatal care, adoption, foster care, termination, contraception, HIV/AIDS and sexually transmitted diseases. Staff must afford girls with an opportunity to contact them when needed. CHOICE can also identify and connect the girls with resources reflective of any decision that they make. CHOICE (215) 985-3300 (English) (215) 985-3350 (Spanish) (215) 985-3309 (Hearing Impaired) Monday-Thursdays, 8:30 a.m.-7:30 p.m. Fridays, 8:30 a.m. 5:00 p.m. Saturdays, 9 a.m. 1p.m.
15.17 4 OF 7 5 The Mental Health Unit serviced by Consortium can provide professional support and guidance for girls at any point in their decision making process through their staff of psychologists and therapists. They will assist them in processing information provided, interpreting their feelings, and resolving any conflict associated with managing their pregnancy and making decisions. C Medical Care: 1 Prenatal appointments are scheduled through YSC s Medical Department. In most instances, a youth will be referred to an Obstetrics/Gynecology Clinic. Whenever possible, the young lady will continue to see her current physician for prenatal care. YSC staff will transport and accompany all youth to their medical appointments. Transportation should be arranged through the Transportation Coordinator at the Youth Study Center (215) 683-9114/13. 2 Medical staff is responsible for ensuring that all medically prescribed instructions concerning prenatal care or termination are adhered to while the resident is at the YSC. 3 Residents will be transported to the nearest emergency room whenever unforeseen complications arise during the pregnancy. If this is done after hours, the Shift Manager YSC Medical staff is responsible for contacting and following up with prenatal care provider. 4 In accordance with the Act 45 amends Title 61, pregnant females who are in labor will not be restrained, unless the failure to restrain would likely result in risk of imminent flight or jeopardize the safety of the youth, facility or medical staff, other youth or the public. 5 Reporting Procedures: a In accordance with Act 45, the Shift Manager on duty will report each restraint applied to known pregnant females. b The report must be submitted on the Pregnant Females Restraint Reporting Form located on the shift manager s group drive. The form must be submitted to the Southeast Regional Office of Children, Youth & Families via email or fax (215) 650-6893 within 24 hours of the occurrence of the restraint. And a copy placed in the resident s record. c The report must include: (1) The description of the circumstances that led to the restraint (2) Type(s) of restraint applied (3) Narrative description of the restraint applied
15.17 5 OF 7 (4) Date, time, duration of restraint or restraints and location of where restraint or restraints occurred. (5) Name of staff person(s) who applied the restraint or restraints. (6) Name of staff persons(s) who observed the child during the restraint or restraints. (7) Child s condition following the restraint or restraints (8) Medical treatment, if provided (9) Debriefing activities (10) Plan for intervention to reduce or eliminate restraints for the known pregnant female youth. D Release of Information/Case Planning/Continuity of Care: 1 Consistent with current practice, YSC social work staff must ensure that juvenile probation officers are aware of their client s medical condition(s) in order to develop dispositional plans designed to meet their needs. This involves notifying the probation officer immediately when a young lady decides to carry her child to term. Probation officers should also be notified if their clients terminate their pregnancies while at the Youth Study Center to make sure that the placement providers monitor the emotional and physical well-being of their clients. 2 YSC s Medical Department is responsible for obtaining medical records/treatment information prior to detention, securing outside prenatal care for girls at YSC, and ensuring that girls are discharged with adequate medication, current reports and assessments regarding medical treatment while at the Center. E Termination of Pregnancy: In order for a young lady to terminate her pregnancy, she must receive pre-termination counseling consistent with the Abortion Control Act to ensure that she is making an informed decision. YSC Social Work staff will contact the CHOICE hotline (215) 985-3300 to identify a provider and schedule an appointment for the counseling session. Once a young lady determines that she wants to terminate her pregnancy, there are three ways that she can establish valid consent for the procedure: 1 She has a judicial decree of emancipation, which allows her to consent to the procedure; or 2 The parent or legal guardian is willing to consent to the procedure; or 3 The court has issued an order through a process called judicial bypass, which allows her to consent to the procedure.
15.17 6 OF 7 F Judicial Bypass Process: 1 Contact the CHOICE hotline to identify a provider and schedule an appointment for a pregnancy termination counseling session; 2 If termination is still desired following the counseling session, please contact Barbara Bailey, Esquire at the Philadelphia Defender s Association to request a judicial bypass hearing. She can be reached at (267) 765-6516. 3 Ms. Bailey and/or her representative will first meet with the girl and then file a petition requesting judicial bypass. 4 Within three days of filing the petition, a court hearing will be held to determine if the court will grant the girl authorization to consent to terminate her pregnancy. 5 If the court grants the request, an order will be issued and the young lady can consent to terminate her pregnancy. V PREGNANCY OPTIONS COUNSELING GUIDELINES ADOPTED FROM THE COUNCIL ON ACCREDITATION (2008): A Individuals have the option to be counseled and fully-informed about all possible options for the pregnancy. B Counseling is nondirective and nonjudgmental, and helps individuals make the best decisions for their particular circumstances. C Individuals have the opportunity to receive information and counseling regarding the implications of parenting that addresses: 1 responsibilities associated with parenting; 2 child care; 3 living arrangements; 4 costs associated with raising a child; 5 how whether family members or friends will be willing to help the expectant parents; 6 the role that the birth father will play; and single parenting or the possibility of marriage parenting will impact the expectant parents goals and plans for the future; D Individuals have the opportunity to receive information and counseling regarding the implications of adoption or other transfer of custody that addresses: 1 types of available adoption and guardianship services, and the range of openness in adoption;
15.17 7 OF 7 2 parents legal rights and the rights termination process; 3 financial assistance that may be available; 4 separation from the child, and grief and loss; 5 long-term implications of the decision; and 6 making plans for the immediate future. E Individuals have the opportunity to receive information and counseling regarding the implications of termination that addresses: 1 attitudes toward pregnancy termination, including personal religious beliefs; 2 emotional issues related to grief and loss, and the finality of the decision; 3 types of procedures available; 4 costs of the procedure; and 5 legal issues for minors (such as parental notification, parental consent, and judicial bypass), if applicable. F Individuals are helped to carry out their decisions about the pregnancy and obtain any other needed services, directly or by referral. G To help individuals stay healthy and prevent subsequent unintended pregnancies, the agency: 1 provides information and education about the prevention and treatment of diseases, including HIV/AIDS and other sexually transmitted diseases; 2 provides information and education about pregnancy prevention, pregnancy planning, and the spacing of children; and links individuals to family planning services. VI REFERENCES: A Council on Accreditation. (2008). Pregnancy Support : Pregnancy Options Counseling/Birth Options Counseling Standards. (available at http://www.coastandards.org/standards.php?navview=public&core_id=133) B Dellinger, A. (2002). Social for Pregnant and Parenting Adolescents: A Legal Guide. Institute for Government, University of North Carolina at Chapel Hill. http://www.unc.edu/iogtest/programs/app/pdf/appbook2.pdf) Questions regarding this policy guide may be referred to: Timene Farlow, 3-4265
Effective Date 15/ Medical and Health Care Pregnancy Screening and 15.17 ANNUAL REVIEW Director of Professional Date Director of Professional Date Director of Professional Date