Challenges help teens deal with health risks
How can you reach male adolescents with positive messages about how to reduce reproductive health risks?
Challenge them through a "men-only" comprehensive health risk reduction program, an approach taken by the Adolescent Male Involvement Program (AMIP) in Gettysburg, PA. Sponsored by the Family Planning and Health Center in Gettysburg and funded through a grant provided by the Family Health Council of Southcentral Pennsylvania, the program takes an innovative approach, using an outdoor challenge course to help understand and build risk reduction skills, visiting a family planning/STD clinic to acquaint teens with services, and using a team of male mentors that include firefighter paramedics and a physician. Members of the AMIP team recently presented information on the program at the national Advocates for Youth conference in Washington, DC.
Classroom approaches to such sensitive topics as contraceptives and sexually-transmitted diseases (STDs) can make young male teens’ eyes glaze over. By using "cool" activities, such as a rope-climbing course led by men who take risks for a living, teens build self-esteem, understand the importance of planning in taking risks, and develop respect for others.
It is important that young men understand the importance of reducing sexual health risks. Teens are more likely to have multiple sex partners and engage in unprotected sexual intercourse, and their partners are at higher risk for sexual infection.1 If young men are to choose wisely in protecting themselves from STDs and early parenthood, they must understand the risks and develop strategies to reduce them.
The program, which began in 1995, metamorphosed into its present state when program facilitators quickly learned that approaches used during female counseling sessions were not effective, says Marianne Crouthamel, its coordinator.
"As much as we would like to see it, female program strategies don’t translate well to male programs, especially when you are working with male adolescents," notes Crouthamel, who also works with breast cancer health issues and HIV education at the Gettysburg clinic.
The AMIP program focus is on young men ages 16 to 18 from MANITO Inc., a community-based day treatment/alternative education program. Each workshop meets weekly for a total of seven sessions and is limited to 12 participants. Bruce Harlan, an alternative education specialist with MANITO, serves as one of the AMIP program consultants.
Seek risk-takers as mentors
What is the best approach to reach this at-risk group? For mentoring ideas, Crouthamel looked to the Special Friends program developed by the Phoenix-based Planned Parenthood of Central and North Arizona, which enlists the aid of law enforcement officers as mentors. The Gettysburg program chose male firefighter paramedics, and included a local physician, Kenneth R. Stephan, DO, who practices at Biglerville (PA) Family Practice and also works with the state STD clinic in Gettysburg.
"We wanted men who had very sound medical backgrounds, as well as those who were used to taking risks," Crouthamel notes.
For teaching the tenets of risk-taking, personal responsibility, and respect for others, AMIP adapted the active approach used by the Boys to Men program from Planned Parenthood of Austin, which pairs father-son teams on rope-climbing courses.
A local education facility, Gettysburg College, already offered an outdoor challenge course, and its assistant director of student development, John Regentin, was certified in adventure learning training by Project Adventure, a Hammond, MA-based agency. Regentin now serves as consultant for the experiential portion of the program, helping to frame the learning process in a three-dimensional, action-oriented format.
For the young men in the AMIP program, it is important to first build self-esteem so that participants can see that their future is worth protecting. The challenge course provides the perfect setting for this goal, says paramedic Scott Anderson, who joins Jon Bjork as one of the program’s two paramedic facilitators.
By learning teamwork skills and practicing safe and protective techniques on the course, participants keep themselves and each other from risky situations and develop respect for their abilities, notes Anderson. Once they see that they can make a difference, the young men are ready to accept ideas and information on risk reduction behaviors.
Mentors may then bring a tackle box filled with male and female condoms, birth control pills, and spermicide to the course for a class on choosing contraceptives and STD protection. An exercise known as "the minefield" is used to illustrate the risks teens may encounter in life:
The challenge course leader holds a bag full of different items, ranging from stuffed animals to mousetraps. As the leader pulls each article out the bag, the teens label each one as items of risk, such as an STD or a drug needle. All of these are randomly placed in an area known as "the minefield." The teens join together as partners, with one blindfolded and placed in the minefield, and are guided around the items of risk from the unblindfolded partners. Each time an item is touched, points are accessed, and at the end of the exercise, points and percentages are tallied. Most of the time, about 20% have acquired an STD, which illustrates the information covered in the contraceptive/STD session.
Clinic visits open the door
The AMIP program includes a tour of the family planning clinic during nonclinic hours so participants can meet the staff and learn about the services provided during its teen-only hours, as well as a tour of the state STD clinic in downtown Gettysburg, which provides male testing for STD infections. The young men may take advantage of health services at this time, but if they feel uncomfortable, they are told they are welcome back anytime to get needed attention.
Raising the teens’ comfort level about medical services is an important aspect of the AMIP program, says Stephan. By getting to meet the teens in a nonthreatening environment, barriers are broken down to resistance in seeking reproductive health services.
"I feel that having the physician involved plants the seed for the youth not to be intimidated by doctors or clinics," he notes. "It is hoped that they will be willing to access us in the future without fear."
Anecdotal success
Is the AMIP project working? Program officials plan to implement outcomes evaluation into the program to measure the impact of risk reduction education. But if comments from past participants can be used as an indicator, the program is headed in the right direction.
"I have been using condoms more regularly," said one teen. Another commented, "I have been going out a girl for two months, and I haven’t had sex with her yet."
(Contraceptive Technology Update will report formal outcomes evaluation when the component is added to the AMIP program.)
Reference
1. Alan Guttmacher Institute. Sex and America’s Teen-agers. New York; 1994.
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