The Department of Health and Human Services supports a variety of efforts to help communities develop comprehensive teen pregnancy prevention strategies that reflect five principles: parental and adult involvement, abstinence and personal responsibility, clear strategies for the future, community involvement, and a sustained commitment.
State Children's Health Insurance Program (CHIP) was established by the Balanced Budget Act of 1997 under Title XXI of the Social Security Act. This program, administered by the Health Care Financing Administration (HCFA) and Health Resources and Services Administration (HRSA), enables states to provide health insurance coverage to uninsured targeted lowincome children. States have the opportunity to involve communities as they design and implement their CHIP programs so that the new programs, including teen pregnancy prevention programs, may be an additional avenue to provide services to adolescents at risk. All 54 states, territories, and the District of Columbia have submitted CHIP plans which have been approved.
The Abstinence Only Education Program was part of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to enable states to provide abstinence education through activities such as mentoring, counseling, and adult supervision designed to promote abstinence from sexual activity until marriage. The program, administered by the Health Resources and Services Administration (HRSA), has a mandatory appropriation of $50 million for each Fiscal Year from 1998 through 2002.
The Girl Neighborhood Power! Building Bright Futures for Success is challenging America's communities to become active partners in assisting 9 to 14yearold girls to successfully navigate adolescence and achieve maximum potential. The initiative, administered by HRSA, strives to combine several elements including strong "no use" messages about tobacco alcohol, and illicit drugs with an emphasis on physical activity, nutrition, abstinence, mental health, social development, and future careers.
The Center for Disease Control's Community Coalition Partnership Program for the Prevention of Teen Pregnancy has supported demonstration grants for the prevention of teen pregnancies in 13 communities in 11 states since 1995. Coalitions of local and public and private agencies and organizations in communities with high rates of teen pregnancy have been working over the last two years to develop community action plans, coordinate efforts to reduce teen pregnancy, identify gaps in current programs and services, target existing resources, and design evaluation plans. CDC awarded approximately $250,000 per year for two years to 13 communities in 11 states to help these communities mobilize and organize their resources to support effective and sustainable teen pregnancy prevention programs. For FY 1998, a total of $13.7 million was made available to help the 13 community coalition partnerships implement their action plans and evaluate their impact, as well as to support related data collection, evaluation, and dissemination activities.
Reproductive Health and Family Planning Services (under Title X of the Public Health Service Act) are provided to nearly 5 million persons each year, nearly one third of whom are under 20 years of age. Abstinence counseling and education are an important part of the Title X service protocol for adolescent clients. These services are provided by 84 grantees with more than 4,000 clinic locations.
These sites offer reproductive health services including pregnancy prevention, family planning, and diagnosis of sexually transmitted diseases, either on site or by referral. The program has also launched an adolescent male initiative called the "Young Men/Family Planning Partnership Training Program." Under this initiative, Title X clinics employ male high school students as interns while also providing training in clinic operation and peer education; assisting in identifying career paths in allied health and related occupations; and increasing their use of services in a family planning setting.
Healthy Schools, Healthy Communities, a Health Resources and Services Administration program created in 1994, has established schoolbased health centers in 26 communities in 20 states to serve the health and education needs of children and youth at high risk for poor health, teenage pregnancy, and other problems. For the first three years of the program, $1 million each year was provided to fund health education and promotion programs that were coordinated with the health services grants.
The Social Services Block Grant (SSBG) (under Title XX of the Social Security Act) provides funding to prevent, reduce, or eliminate dependency; achieve or maintain selfsufficiency; prevent neglect, abuse, or exploitation of children and adults; prevent or reduce inappropriate institutional care; and provide admission or referral for institutional care when other forms of care are inappropriate. SSBG Grants are made directly to the 50 states, the District of Columbia, Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands to fund social services tailored to meet the needs of individuals and families residing within each jurisdiction.
The Community Services Block Grant, which operates in all 50 states, the District of Columbia, and the territories, enables local community agencies to provide lowincome populations, including youth at risk, with job counseling, summer youth employment, GED instruction, crisis hotlines, information and referral to health care, and other services.
The Independent Living Program, run by the Administration for Children and Families, provides funds to states to support activities ranging from educational programs to programs that help young people who are making the transition from foster care to independent living to avoid early parenthood. This program supports activities in all 50 states and the District of Columbia.
Youth Programs including Runaway and Homeless Youth Programs, Transitional Living Programs, and the Youth Sports Program, address a wide range of risk factors for teen pregnancy. Together, these programs operate in 500 communities in 50 states and the District of Columbia.
Healthy Start, administered by HRSA, has 62 projects to reduce infant mortality in the highestrisk areas and to improve the health and wellbeing of women, infants, and their families. Among a broad array of services provided (including state prenatal hotlines), thousands of teenagers participate in prevention programs exclusively designed for adolescents. The programs encourage healthy lifestyles, youth empowerment, sexual responsibility, conflict resolution, goal setting, and the enhancement of selfesteem.
Maternal and Child Health Services Block Grant (Title V) funds support a variety of adolescent health programs in 57 states and jurisdictions, including adolescent pregnancy prevention programs, state adolescent health coordinators, family planning, technical assistance, and other prevention services.
The Adolescent Family Life Program (AFL), created in 1981, supports research into the causes and consequences of adolescent pregnancy; demonstration projects that provide health, education, and social services to pregnant and parenting adolescents, their children, male partners, and families; and programs aimed at promoting abstinence among preadolescents and adolescents as the most effective way of preventing adolescent pregnancies, sexually transmitted diseases, and HIV/AIDS. In FY 1997, the AFL program funded 83 projects in 37 states and the District of Columbia. AFL is administered by the Office of Population Affairs.
Empowerment Zones and Enterprise Communities in 105 rural and urban areas in 43 states and the District of Columbia have been awarded grants to stimulate economic and human development and to coordinate and expand support services. As they implement their strategic plans, some sites are including a focus on teenage pregnancy prevention and youth development.
Health Education in Schools supports the efforts of every state and territorial education agency to implement local school health programs to prevent the spread of HIV and sexually transmitted diseases (STDs). Assistance is also provided to 13 states to build an infrastructure for school health programs. Efforts are targeted at preventing early sexual activity, STDs, HIV, drug and alcohol abuse, tobacco use, and injuries.
Community and Migrant Health Centers, including family and neighborhood health centers, operate in 3,032 communitybased sites through 685 center grantees in all 50 states, the District of Columbia, and six territories. The centers provide primary and specialized health and related services to medicallyunderserved adolescents. Some centers include special hours or clinics for adolescent patients.
Indian Health Service (IHS) provides a full range of medical services for American Indians and Alaska Natives. IHS supports projects targeted at preventing teenage pregnancy, and its prevention and treatment programs also have a special emphasis on youth substance abuse, child abuse, and women's health care.
Drug Treatment and Prevention Programs include services to prevent first time and repeat pregnancies among teenagers. One hundred twentytwo residential substance abuse treatment programs for pregnant and postpartum women, as well as for women with dependent children, receive support to provide family planning, education, and counseling services in 39 states, the District of Columbia, and the Virgin Islands. Also, 25 programs to prevent substance use and other adverse life outcomes serve highrisk female teens in 13 states and the District of Columbia.
Health Care and Promotion under Medicaid provides Medicaideligible adolescents under age 21 with access to a comprehensive range of preventive, primary, and specialty services within its Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program.
The Medicaid program also funds family planning services at an enhanced match rate for states. The federal government pays 90 percent of state expenditures for Medicaid family planning services, while the state funds the remaining 10 percent. The enhanced match encourages states to fund family planning programs which include patient counseling and education concerning pregnancy prevention and reproductive health.