DFCS Online Policies & Procedures

  DFCS Online Policies & Procedures

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Handbook 15: Health Care
15-3 Reproductive Health
Health Care
15-3  Reproductive Health
Reference Points
Overview
Talking to Youth about Reproductive Health
Social Workers' Responsibilities
Caregivers' Responsibilities
Youth's Responsibilities
Role of the Public Health Nurse
Reproductive Health Training
Sex Education in Public Schools
Confidentiality and Documentation
Options for Pregnant Teens
Social Workers' Responsibilities in Providing Services to Pregnant Youth
Considerations in Providing Services to a Pregnant Youth Who Chooses to Parent
Youth Placed Out-of-County
Lesbian, Gay, Transgender, Bi-sexual, and Questioning Issues
HPV and Other Communicable Diseases
Children's Legal Rights
Other References


Reference Points
Effective Date: TBA
Last Updated: 1/20/11
 Legal Basis:
Popup Window Standing Court Order on Reproductive Health
Popup Window Title X - Public Health Service Act
Popup Window

California Minor Consent Laws

Popup Window Standing Order Permitting Health Assessment, Physical Examination, Laboratory Tests, Venereal Disease, Screening and Furnishing of Contraceptives, Immunizations, Routine Medical Care, Mental Health Evaluation and Services, and Dental Assessment and Treatment of Temporarily Detained Minors
 Non CWS/CMS Forms:
MS Word Referral for Public Health Nursing (SCZ1650c)
MS Word Adolescent Family Life Program (AFLP) Referral
 CWS/CMS Forms:
bullet Case Management Section:  Case Plan
bullet Services Management Section: Contacts


Overview  

Providing young people with information on human development, sexuality, and healthy relationships gives them the tools to make responsible decisions and grow into productive members of society.   And, providing access to reproductive health care services is the commonsense solution to keeping young people healthy, as well as to reducing unintended teen pregnancy and sexually transmitted infections (STIs).   A comprehensive sexual health education includes information on healthy sexuality and relationships, pregnancy, family planning, and STIs.  Without such training, communities pay the costs of the educational, health, financial, and social challenges associated with communicable diseases and unintended teen pregnancy. Results from the Santa Clara County California health Kids Survey from 2005-2006 indicated that about one in five middle and high school students reported having had sexual intercourse at least once.  (California Healthy Kids Survey)

Federal and California state laws allow for youth under the age of 18 to receive reproductive health care services and, in many cases, to make decisions about their reproductive health without parental consent. 

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Talking to Youth about Reproductive Health  

Social workers and caregivers are in a position to begin the discussion of reproductive health with youth on their caseloads and in their care.  The thought of having to talk to a youth about reproductive health may cause anxiety in some.  Despite media exploitation, by and large, sexuality remains a taboo subject in the United States.  Religious and cultural beliefs may add to the ambivalence and reluctance to broach the topic with youth.  Nevertheless, it is important that youth learn about reproductive health and healthy sexuality from a caring adult who has good, accurate information designed to help them make the best choices possible. If that learning comes from a neutral source, such as a social worker, it is more likely to be comprehensive, covering all aspects of sexuality, services, and options. Furthermore, speaking to children about reproductive health can build a foundation for a child to approach adults with other problems and difficult questions. 


    1. Teens need accurate information and decision-making skills to help protect them from pressure to have sex, unintended pregnancy, and HIV/AIDS and other sexually transmitted infections.

    2. Put the subject in the context of a "healthy lifestyle" to indicate that sexuality is just one part of the health equation.  

    3. If talking with a youth about sex is difficult for you, admit it. Keep a sense of humor.

    4. Use TV, movies, articles, and real-life situations such as a friend's pregnancy to begin talking about sex.

    5. Don't assume that if the youth asks questions about sex, he or she is necessarily thinking about having sex.

    6. Ask the youth what he or she wants to know about sex. If you don't know an answer, admit it. Find answers with the youth in books or other resources.

    7. Talk with the youth about reasons to wait to have sex. Remind the youth that he or she can choose to wait (abstain) even if he or she has had sex before.

    8. Reassure the youth that not everyone is having sex and that it is okay to be a virgin. The decision to become sexually active is too important to be based on what other people think or do.

    9. Talk with the youth about ways to handle pressure from others to have sex. To feel comfortable talking openly with you, the youth needs to know that you will not punish him or her for being honest.


    10. Talk with the youth about healthy relationships and reproductive health on an ongoing basis. Let him or her know that you are always willing to talk about any question or concern he or she may have about sex.
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Social Workers' Responsibilities  

The Department of Family and Children's Services (DFCS) has a responsibility in addressing the reproductive health needs of court-dependent children and ensuring that all youth receive information and training about reproductive health.  To prepare them for these responsibilities, the Department of Family and Children’s Services schedules periodic trainings that provide information and strategies for working with youth around the issue of reproductive health. Social workers should keep in mind that reproductive health is a subject important to both females and males and the social workers' responsibilities apply to both genders.  The trainings provide an opportunity for social workers to recognize and examine their own biases around issues of reproductive health.  Workers may consult with supervisors, if they find that their own biases are impacting their ability to work with youth regarding reproductive health.

After receiving this training, social workers:

  • At initial placements, review with the caregiver the caregiver’s responsibility for having a youth receive information about reproductive health and health services and for facilitating a youth’s access to reproductive health information, services, and products.

  • Engage the parent or caregiver in dialogue around reproductive health.
    • Inform parents that DFCS provides trainings and information about reproductive health and services to all youth.
    • The same trainings are also available to youth living at home under family maintenance programs.

  • Work with caregivers in ensuring youth receive appropriate training on reproductive health and have access to reproductive health services and products.

  • Discuss with each youth on his or her caseload, or facilitate the youth’s discussion with another person:
    • The importance of receiving accurate information about reproductive health, reproductive health services and products, and healthy relationships.
    • Issues about reproductive health that the youth wants to discuss and strategies for addressing the issues.

  • Encourage the youth, if appropriate, to discuss family planning options with his or her caregivers or parents/legal guardians and attorney.

  • Ensure all youth have access to a full range of reproductive health services and products.
    • It is the responsibility of the social worker to address barriers a youth may encounter in attempting to access reproductive health services and products.

  • Discuss the subject of healthy relationships with the youth or refer the youth to a provider who is knowledgeable on the subject.

  • Ensure each youth is provided an opportunity to attend training and/or to be provided with the information from the training in a neutral manner, when the youth is at a developmentally appropriate level.
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Caregivers' Responsibilities  

Caregivers for children placed in out-of-home care:

  • Attend training on issues related to discussing reproductive health with youth.
  • Recognize their own biases and discuss with the social worker concerns they have related to reproductive health education and services.
  • Notify the social worker of any barriers that are encountered in having a youth receive information about reproductive health or in accessing reproductive health services or products.
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Youth's Responsibilities  

Youth receiving services under DFCS supervision are expected to:

  • Attend training on reproductive health.
  • Use appropriate services and products related to reproductive health.
  • Follow medical guidelines and the advice of health care professionals.

  • Notify the social worker of any barriers that are encountered in receiving information about reproductive health or in accessing reproductive health services or products.
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Role of the Child Health and Disabilities Program (CHDP)  

Public Health Nurses are located on the 4th floor of 373 W. Julian office.  Social workers may request that a PHN:

  • Assists with linking youth to Reproductive Health Services.
  • Provides office consultation with selected youth referred by Social Workers for reproductive health concerns or care coordination.
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Reproductive Health Training  

DFCS efforts to provide youth with information on reproductive health are primarily youth-centered – targeting youth and working to build young peoples' ability to connect with a supportive adult.  When a youth under the supervision of DFCS reaches 12-years-old or when the youth is at a developmentally and emotionally appropriate level, the social worker opens the discussion of reproductive health with the youth and schedules the youth to participate in a comprehensive reproductive health training.  If a youth 12 years or over enters the child welfare system, the social worker schedules the youth to participate in a reproductive health training as soon as possible, after discussing reproductive health with the youth or referring the youth to a health professional for the discussion.

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Sex Education in Public Schools  

Social workers should not assume that youth will be provided comprehensive sex education in school.  Offering sexual health education is optional for schools.

State law, the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act, requires that schools teach HIV/AIDS prevention, but not sexual health education.  Specifically encoded in Educational Code 51934 (a), provides that schools are only required to ensure that all pupils in grades 7 to 12, inclusive, receive HIV/AIDS prevention education from instructors trained in the appropriate courses. The instruction must occur at least once in junior high or middle school and at least once in high school.  Schools are encouraged, not mandated, to offer comprehensive sexual health education to guide students to develop healthy attitudes concerning adolescent growth and development, body image, gender roles, sexual orientation, dating, marriage, and family.  Those schools that do choose to provide reproductive health training, however, must provide a comprehensive curriculum that meets the criteria set forth in Education Code sections 51930-51939.
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Confidentiality and Documentation  


 

  • What Information May Be Shared with Parents and Caregivers
    • Absent consent of the minor, the social worker cannot provide any information regarding reproductive health issues to current or former caregivers without a court order.
    • Social workers may not reveal pregnancy information or other protected reproductive health information about a youth in the absence of the youth’s consent, because to do so violates the youth’s right to privacy. 

    (See Children's Legal Rights section below.)



  • What to Share during a Group Decision Making Meeting
    • If a TDM is held for a pregnant youth, the youth is advised that her pregnancy will not be revealed during the TDM, unless she authorizes the disclosure.
    • If a placement decision must be made for the youth, her prenatal needs must be considered, along with the permanency needs of the teen parent family unit, if the youth chooses to become a teen parent.


  • What Information May Be Shared with Health Care Providers
    • Absent consent of the minor, the social worker cannot provide any information regarding reproductive health issues to health care providers without a court order.
    • Social workers may not reveal pregnancy information or other protected reproductive health information about a youth in the absence of the youth’s consent, because to do so violates the youth’s right to privacy.

      (See Children's Legal Rights section below.)



  • What to Include in CWS/CMS
    • Documenting medical information in the youth’s case file or in CWS/CMS should be inclusive of all conversations with youth and care providers regarding reproductive health, as well as referrals to services and products provided.  

    The social worker documents in CWS/CMS in the:

    • Contact Notebook
      • Ongoing conversations with the youth regarding reproductive health needs, access to services, etc.
      • Conversations with caregivers, parents, health care providers, etc.
      • That referrals were provided to the youth.
      • If a youth is pregnant:
        • That the youth was advised of all options concerning her pregnancy.
        • How and when services are being used by a pregnant youth and the caregiver.
        • Other information regarding reproductive health issues.
    • No information regarding the pregnancy and/or related medical treatment is entered in the Health Contact Notebook on CWS/CMS.
         

Note:  Because the information  is confidential, if information in the case file becomes subject for review, for example, when there is a request for discovery, the information regarding reproductive health issues is redacted prior to turning the case file information over to the requestor.


  • What to Include in the Case Plan
    • For youth 12-years-old and older and at a developmentally and emotionally appropriate level, the social worker adds training on reproductive health as a Case Management service objective for the youth.
      • If the youth is not at a developmentally and emotionally appropriate level at age 12, the social worker continues to assess the youth's developmental and emotional level and encourages the youth to attend training when it is assessed that the youth may benefit from information on reproductive health.
    • If a youth is sexually active and/or has any identified medical needs related to reproductive health, the social worker adds medical services as a Case Management service objective for the youth.

 

  • What to Include in a Court Report

    No reference shall be made in court reports regarding private, protected, reproductive health information without the consent of the youth.  If the social worker believes there is a need for specific court orders for the protection and health of the youth,  placement or other issues, and consent is not granted by the youth to disclose the protected information, then a court order will need to be sought through an confidential application and order.  The social worker may consult with County Counsel with any questions concerning reproductive health information in reports or regarding seeking a confidential court order.

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Options for Pregnant Teens  

Parenting

If a teen becomes pregnant, she has the right to continue her pregnancy, regardless of her age, marital status or financial situation.  If a teen decides to keep the baby, she should be referred for prenatal care, giving the baby the best chance of being born healthy.   Prenatal care includes regular check-ups during pregnancy, special nutrition, adequate rest, regular exercise.  When discussing a youth’s decision to become a parent, the social worker should get responses to the following questions:

  • Who have you talked to /can you talk to about your decision?
  • How do you feel about becoming a parent?
  • How do you feel about being totally responsible for someone else for at least 18 years?
  • How do you feel about giving up much of your freedom?  Your privacy?  The option to go and do as you please?
  • What is your plan for completing your education?
  • If you are not home all day, who will care for your child?
  • Can you afford the costs of food, clothing, housing, childcare and medical care?  Do you know how much it costs to raise a child?
  • How involved can you expect the baby’s father to be?
  • Do you know the physical and mental risks of pregnancy and childbearing?
  • What community agencies can offer help?
  • What might your life be like in five years? In 10 years?

 

 

Voluntary Relinquishment

Voluntary relinquishment is an alternative for a youth who does not feel prepared to raise a child but does not want to have an abortion.  The relinquishment may be made through a private adoption agency or though the Department of Family and Children’s Services (DFCS).  When a parent voluntarily relinquishes a child, the child is placed in an adoptive home.   Once an adoption is finalized by a court, the birth parent looses all legal rights to the child, and the process cannot be reversed.  If a youth wants more information on this alternate, consult the social work supervisor in the Adoption Finalization Unit for further information.  The discussion with the youth should include responses to the questions:

  • Who have you talked to/can you talk to about your decision?
  • What do you know about adoption?
  • How do you feel about going through nine months of pregnancy and delivery and then placing the child in an adoptive home?
  • How do you feel about someone else raising your child?
  • How do you feel about the probability of never seeing your child again?
  • Would it make a difference if the child is a boy or a girl?
  • Do you know the risks of childbearing?
  • What agencies offer adoption services?
  • What are the adoption procedures?
  • What are the terms of the adoption?
  • What might your life by like in five years? In 10 years?
  • How does the other prospective parent answer these questions?

 

 

Pregnancy Termination

The decision to terminate a pregnancy may be made solely by the girl and does not require consultation with the girl's parents, the father of the baby, or any other person.  The abortion procedure is best done as early as possible in the pregnancy.  When a social worker learns that a youth under his/her supervision is pregnant and considering an abortion, the social worker engages the youth in a discussion that answers the questions below. 

  • Who have you talked to/can you talk to about your decision?
  • Are you aware of all of your options?
  • Do you know what type of procedure would be done?
  • Do you know the physical and mental risks of terminating a pregnancy?
  • What agencies offer the abortion services?
  • Do you understand the importance of getting abortion services in a timely way?
  • What might your life by like in five years? In 10 years?
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Social Workers' Responsibilities in Providing Services to Pregnant Youth  

When a social worker learns that a dependent female is pregnant, the social worker:

  • Discusses the youth's feelings about the pregnancy with the youth. 
    • As part of the discussion, ask about her relationship with the father of the baby.
      • The social worker must assess whether a child abuse and neglect or police report may be mandated and must follow though with making the report, if mandated.
      • See Sexual Abuse Reporting Chart.

  • Schedules a staffing to discuss resources and options available to the youth.
    • Contact Leslie Griffith at 975-5496 for scheduling.



  • Advises her of all options available, including:
    • Continuing the pregnancy and keeping the baby.
    • Continuing the pregnancy and relinquishing the baby for adoption.
    • Terminating the pregnancy.
  • Reassures her that her decisions about the pregnancy will be supported by DFCS, no matter what choice is made.
  • Refers her to an appropriate prenatal clinic.

  • Makes a referral to Public Health for home visiting services by the public health nurse, using Referral for Public Health Nursing (SCZ1650c).


  • Ensures that, if referred to a family planning clinic, she is provided with counseling and education for the full range of options, including parenting, adoption, and pregnancy termination.

  • Encourages the youth to have a conversation with caregivers and parents and facilitates the discussion, as appropriate.

  • Assesses her living situation and determines if the home will meet her needs.

  • If appropriate, works with her in engaging the baby’s father in the family planning options and, if applicable, the pregnancy and care of the child.
  • Advises her of the Safely Surrendered Baby law, allowing for the anonymous, voluntary surrender of the physical custody of a newborn with no threat of prosecution or other repercussions.

  • Facilitates a discussion about family planning to prevent subsequent teen pregnancies.
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Considerations in Providing Services to a Pregnant Youth Who Chooses to Parent  

In choosing appropriate referrals and resources for a DFCS supervised youth who is pregnant and choses to parent, the following factors should be considered:

  • What are the teen’s immediate needs, such as health care, housing, financial assistance, schooling, employment, etc?
  • What are the specific physical, social, and emotional problems, if any, associated with the pregnancy/infant?
  • Is the father of the baby involved?  If not, how can this be facilitated or encouraged?
  • Do both parents (if the father is known and involved) have an understanding as to their mutual roles and expectations?
  • What is the level of maturity of the pregnant teen/teen parent?  Has the teen identified realistic goals and objectives?
  • What is the nature of the teen’s relationship with his or her family of origin?
  • If the family of origin is not available for the teen, what are his/her resources in the community?  Is there a support network in place?
  • What is the age of the teen?  Is emancipation a near or long-term goal?
  • What is the teen’s primary language?  Are there cultural issues to consider?
  • Is this the teen’s first pregnancy?  Is the teen parenting at the time of this pregnancy?
  • Is the current placement appropriate? 
    • If not, begin planning for transition.  If yes, work with her caregiver to ensure all necessary supports are in place.
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Youth Placed Out-of-County  

It is the social worker’s responsibility to ensure that youth placed out-of-county receive information on reproductive health and access to reproductive health services and products.  As part of their responsibility, social workers may contact the school the child attends in the county of  placement to find out what training may be offered through the school and to make sure that the training is comprehensive in providing all choices and rights to the child.  Alternately, the social worker may contact Planned Parenthood or agency that offers similar services in the child’s county of placement to arrange for training and consultation for the youth through that agency.

   popup  Find a Planned Parenthood Health Center in California

    popup Find a Clinic in California

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LGBTQ Issues  

Lesbian, Gay, Bisexual, Transgendered and Questioning youth have unique reproductive health needs.   Data from 1990 through 2002 indicates that approximately 5% of American adolescents (ages 13-18) identify as LGBTQ.¹  Sexual orientation is often misinterpreted as synonymous with sexual behavior.  Further, youth who have identified as LGBTQ may continue to question their identification.  This misinterpretation about sexual orientation and seeming ambivalence of some LGBTQ youth has allowed educators, health care providers, and even parents to leave LGBTQ youth misinformed and unaware of important sexual and reproductive health issues. 

Facts:

  • LGBTQ youth are more likely than heterosexual teens to have had sexual intercourse, to have had more partners, and to have experienced sexual intercourse against their will. ²
  • Instances of high-risk behaviors, substance use before sex, and personal safety issues are reported by lesbian, gay and bisexual youth more frequently than heterosexual youth. ³
  • Studies suggest that lesbian and bisexual teens are twice as likely as their heterosexual peers to experience unintended pregnancy.  Additionally, young lesbians may attempt to hide their sexual identity through intentional pregnancy. 4,5  

  • As compared to their heterosexual peers LGBTQ teens are at an increased risk of STIs, including HIV.³
  • Like all teens, LGBTQ youth need accurate, age appropriate, and culturally sensitive information regarding sexual and reproductive health.  However, they may not be receiving this.  In one study, 84% of young lesbians reported feeling that they were at zero risk for HIV and STI and only 21% had ever suggested safer sex practices to a sexual partner. 6
  • Educate yourself.  Learn as much as possible about sexual orientation, gender expression, culture, homophobia, and sexism and be aware of your own attitudes and biases. 7
  • Do not make assumptions.  Realize that a person’s sexual orientation or gender identity cannot be known based on appearances alone and use inclusive, gender-neutral language in order to highlight this. 7
  • Provide safety and support.  Let teens know that they are accepted by DFCS and thus will be guaranteed confidentiality, be free of harassment, and be granted support they may not receive elsewhere. 8

Footnote references

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HPV and Other Communicable Diseases

 

Sexually Transmitted infections (STIs)

STIs are infections that are easily spread through sexual or intimate physical contact. Many people who have an STI don't know it. They may look healthy, but they still could have an STI.  A sexual partner who has an STI may not inform the other partner that he/she has an STI.  Some STIs are curable, others can only be treated.

Human Papillomavirus (HPV) is the most common sexually transmitted virus in the United States.  The highest prevalence of HPV infection is seen in sexually active adolescents and young adults, most of whom initially acquire HPV shortly after they become sexually active.  HPV can cause cervical cancer in women and is also associated with several less common cancers and genital warts.  There is no cure for HPV infection.

HPV vaccine is important because it can prevent most cases of cervical cancer if it is given before a person is exposed to the virus.  Social Workers should discuss the benefits of the HPV vaccine with their youth 11 years and older and encourage them to have further discussions with their physician. It is the policy of DFCS those females 11 years and older should be encouraged to get the vaccine.  Females as young as 9 years old can get the vaccine at the discretion of their physician.  Males ages 9 through 26 may also get the HPV vaccine to prevent genital warts and should be encouraged to talk to their doctor.

For more information about STIs, link to

.
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Children's Legal Rights  

Children’s Legal Rights

 

Law

Confidentiality and/or Informing Obligation of the Health Care Provider

Pregnancy

“A minor may consent to medical care related to the prevention or treatment of pregnancy,” except sterilization. (Cal. Family Code § 6925).

The health care provider is not permitted to inform a parent or legal guardian without minor’s consent. The provider can only share the minor’s medical records with the signed consent of the minor. (Cal. Health & Safety Code §§ 123110(a), 123115(a); Cal. Civ. 56.10, 56.11).

Contraception

A minor may receive birth control without parental consent. (Cal. Family Code § 6925)

The health care provider is not permitted to inform a parent or legal guardian without minor’s consent. The provider can only share the minor’s medical records with the signed consent of the minor. (Cal. Health & Safety Code §§ 123110(a), 123115(a); Cal. Civ. 56.10, 56.11).

Abortion

A minor may consent to an abortion without parental consent and without court permission. (American Academy of Pediatrics v. Lungren, 16 Cal.4th 307 (1997)).

 

The health care provider is not permitted to inform a parent or legal guardian without minor’s consent. The provider can only share the minor’s medical records with the signed consent of the minor. (Cal. Health & Safety Code §§ 123110(a), 123115(a); Cal. Civ. 56.10, 56.11).

Diagnosis and Treatment for Sexually Transmitted Disease

A minor 12 years of age or older who may have come into contact with a sexually transmitted disease may consent to medical care related to the diagnosis or treatment of the disease. (Cal. Family Code § 6926).

The health care provider is not permitted to inform a parent or legal guardian without minor’s consent. The provider can only share the minor’s medical records with the signed consent of the minor. (Cal. Health & Safety Code §§ 123110(a), 123115(a); Cal.

Civ. 56.10, 56.11).

AIDS/HIV Testing and Treatment

A minor 12 and older is competent to give written consent for an HIV test. (Cal. Health and Safety Code § 121020). A minor 12 and older may consent to the diagnosis and treatment of HIV/AIDS. (Cal. Family Code § 6926)

 

The health care provider is not permitted to inform a parent or legal guardian without minor’s consent. The provider can only share the minor’s medical records with the signed consent of the minor. (Cal. Health & Safety Code §§ 123110(a), 123115(a); Cal. Civ. 56.10, 56.11).

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Other References  
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National Campaign to Prevent Teen and Unplanned Pregnancy

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