By Jessica Ennis
Social worker Cynthia Covell visits with Kenia Perez
and Kenia's daughter Isabella and son Joshua. Photo
by Tia Brayman, Children's Hospital Colorado.
(December 2015) When pregnant young women enter the Colorado Adolescent Maternity Program clinic (CAMP), they don’t have to worry about how their swelling
bellies will be perceived.
“This is a no-judgment zone,” said
CAMP Co-director Stephen Scott, MD, associate professor of obstetrics
and gynecology and pediatrics at the University of Colorado School of
Medicine. “We emphasize a sup-portive environment and an environment
based on trust.”
The 25-year-old program, a partnership between
the School of Medicine and Children’s Hospital Colorado, treats
pregnancy as much more than a medical event for young mothers.
young women want to be good moms but don’t have a lot of
op-portunities, so we provide an obstetric medical home and bring other
services together,” Scott says.
Many of the 250 pregnant young
women—some younger than 13 years old—who come to CAMP each year have
experienced personal traumas in their lives: abusive relationships,
unstable home environ-ments or homelessness. So the CAMP clinic staff
includes certified nurse midwives, an obstetrician, case managers,
social workers, dietitians, psychologists and psychiatrists.
The first contact is always with a case coordinator, who also sees the young women at nearly every visit.
build rapport and trust; we’re not stuffy. I love getting to know them
throughout their prenatal care,” says Lisa Wilcox, a CAMP case
Because of the relationships they foster, case
coordinators along with the social workers often pick up on issues that
need to be addressed but might otherwise go unnoticed.
traditional medical model, there is a hierarchy of positions and medical
providers are expected to recognize problems and refer them out,” Scott
says. “Here we flatten out the pyramid model, giving everyone an equal opportunity to see the patient and bring their expertise.”
Bringing baby into the fold
delivery, the relationship with CAMP doesn’t end; it extends to the
baby. CAMP offers primary care for mothers through age 22 and their
children at their Young Mothers Clinic.
Case coordinators visit
new moms before they are discharged from the hospital and bring diapers
and a gift for the baby. They also schedule the first postpartum
appointment right there in the room.
“We see mom and baby
together allowing for twice the opportunity to interact,” Scott says.
“Teens aren’t proactive about their health but we can improve that
through multiple touch points.”
Kenia Perez was just 16 when she
gave birth to Joshua, now 5, at University of Colorado Hospital. Though
she didn’t know about CAMP before his birth, she was referred to their
Young Mothers Clinic for his primary care. After moving to California,
she returned to Colorado and to CAMP while pregnant with her second
“When I was pregnant with Isabella, I was scared to have
two,” she says. “How was I going to start school? But CAMP helped me
Drawing from years of research
Research is another key component of CAMP and has been since the program’s inception. Jeanelle Sheeder, PhD, MSPH, associate professor of obstetrics and gynecology, is the program’s researcher. She has served in the role since CAMP began collecting data in 1991 and has since published more than 75 papers.
have included weight gain in pregnancy to predict child outcomes,
stress and depression, what types of contraceptives have or haven’t been
used—everything from basic biological studies to psychosocial.
is going to really age me, but we started out with a DOS database,” she
says. “Now we’re in the modern age and have a giant online data set.
Participants now do surveys and assessments online or on iPads so we can
monitor in real time.”
Sheeder says the data has clearly shown CAMP is successful, and now they’re building out other parts of the program.
One example is Pregnancy and Parenting Partners (P3). The biweekly
group care takes 10 young women around the same gestational age from
pregnancy through early infancy.
They participate in group medical visits, go through parenting classes and even learn how to check their baby’s heart rate.
of P3 have gone on to do well. Many continue their personal growth by
coming back to other groups as peer mentors. In addition, the moms find
support in each other.
Sheeder tears up when she talks about how
one group of graduates planned a Halloween party complete with baby
costumes. When one mom could not afford to buy a costume, the others
chipped in to get one.
“It’s these unanticipated values that are
so meaningful. It was so rewarding for these young women to be able to
help,” she says.
There’s also a dedicated effort to ensure these
moms don’t quickly become pregnant again. Through a partnership
between Children’s Colorado and University of Colorado Division
of Family Planning in the Department of Obstetrics and Gynecology, new
moms are offered IUDs or implantable contraceptives before discharge.
It has reduced the rate of second pregnancies within the first year
after delivery dramatically. For those who initiated contraceptive
implants prior to discharge, the rate was 2.6 percent compared to 18.6
percent in those who did not.
On the horizon is improving
education for fathers and creating a program for successful
co-parenting since 80 percent of CAMP participants are single parents.
me, I don’t even see the bad,” Sheeder says. “They all want to be good
moms and we focus on helping them do that. If they need help with
getting back into school, housing, co-parenting, we can help them with
Perez says she’s been inspired by the care and
encouragement she and her children have received at CAMP. She is living
on her own and is seriously considering studying to become a nurse.
want do my own thing. I want to do nursing,” she says. “The [care team]
gave me the info to help me take the first step. They seem to be happy
for me and cheering me on.”