Reach out to young men: Add strength in services

Will adding male programs to existing family planning services subtract from existing care? Not according to the experience of one California center, which nearly tripled its number of adolescent male patients, more than doubled its number of adult male patients, and increased its female patient load by 10% within the first year of adding a male clinic.

Addition of male services at New Generation Health Center, a publicly funded affiliate clinic of the University of California, San Francisco (UCSF), did not impact use of the center by women: Female patients who came to the center completed questionnaires to assess their satisfaction with services and attitudes toward men being served by the center. Most of the women surveyed, both before and after the male clinic opened, expressed satisfaction with their care.1

The opportunity to serve men, particularly adolescents, is wide open to family planning clinics: While 69% of the more than 7,000 publicly funded U.S. family planning clinics have at least one program devoted to outreach, education, or services for teens, just 39% routinely serve young men.2 See if one of the following approaches used by two family planning agencies can help move your agency toward increased services for young men.1,3

Reasons to seek men

Why did the New Generation Health Center decide to expand its services to include young men?

"In an effort to fulfill our mission to help adolescents and young adults avoid unintended pregnancies and sexually transmitted infections, we believe we need to address the male component of the equation, i.e., women do not become pregnant or get sexually transmitted infections in a vacuum," says Tina Raine, MD, an associate clinical professor at UCSF’s Department of Obstetrics/ Gynecology and Reproductive Health Sciences. "There are relatively fewer providers of reproductive health services for men, and we felt we were aptly prepared to address the reproductive health needs of men."

To prepare for the clinic’s opening in July 2001, staff members performed several tasks. First, they completed a staff survey asking about whether they thought males should be served in the center, their concerns or reservations, their experiences serving male clients, and their suggestions for ways of preparing the clinic and its staff. In addition, clinic staff participated in a half-day workshop on providing services to young men led by Arik Marcell, MD, MPH, an assistant professor of pediatrics and medical director of the Adolescent & Young Adult Center at the Baltimore-based University of Maryland School of Medicine. It included presentations from providers from the community with more experience dealing with males and covered areas including sports physicals.

Male peer educators evaluated the clinic for its "malefriendliness" prior to the opening, says Raine.

"In addition to providing staff orientation and training on serving male clients, we went to special effort to place male gender-specific art in the public areas and rest rooms, and we expanded our patient literature to include male-specific educational materials," she states.

Before opening the clinic, male involvement program staff took inventory of other primary care resources available to young men, contacted other primary care doctors and clinics serving males in the area to inform them about the new clinic, and developed a list of primary care providers for referrals for the staff’s clinicians and male patients.

Male clinic sessions are held one-half day each week and are staffed by four rotating adolescent medicine fellows (two male, two female) and a female family nurse practitioner. A clinic assistant assembles client charts, shows patients to examination rooms, measures vital signs, and obtains blood samples. Male and female health educators are available to conduct risk assessments and individualized counseling.

Services provided during the male clinic sessions include STD screening, counseling and treatment; diagnosis of and treatment for genitourinary conditions; HIV counseling and testing; and sports physicals. In addition, female partners of male patients can obtain family planning services.

There are challenges in providing male services, Raine acknowledges. Finding ways to appeal to male clients is one hurdle, she says. Having clinicians who are trained and experienced in dealing with male reproductive health and primary care concerns also presents a challenge, Raine states.

For the Philadelphia-based Family Planning Council (FPC), working with other community organizations has been the key to addressing the sexual and reproductive health needs of area at-risk young men.

The organization, the Title X grantee for southeastern Pennsylvania, is working with three Philadelphia organizations — the Drexel University School of Public Health, St. Christopher’s Hospital for Children, and NorthEast Treatment Centers (NET), a local agency providing mental health, substance abuse treatment and social services — in offering Man2Man. The program targets young men in an economically disadvantaged section of Philadelphia with high teen pregnancy and STD rates. Funding for the project has been provided through demonstration and research grants from the Atlanta-based Centers for Disease Control and Prevention and the Washington, DC-based Department of Health and Human Services (HHS), Office of Population Affairs, through a HHS Region III special initiative grant.

Man2Man uses adult male role models to provide young men with information and support regarding sexual health, disease prevention, child development, relationships with women, and fathering skills. The program has adapted an existing curriculum, "Fatherhood Development: A Curriculum for Young Fathers," developed by Public Private Ventures and distributed by the National Center for Strategic Non-Profit Planning and Community Leadership (now the National Partnership for Community Leadership), to use as the foundation for the Man2Man program.

The Man2Man program consists of 15 weekly, two-hour sessions delivered to groups of 10-12 adolescents by a adult male facilitator. Sessions work toward developing personal definitions of manhood, discussing myths and misperceptions about male sexuality, and exploring differences in men’s and women’s health. Two high schools serve as sites for the program, as well as NET, which serves adjudicated young men through one of its behavioral health programs.

Traditional recruitment strategies, such as announcements over the public address systems and fliers displayed on school bulletin boards, have been used at the high school sites to recruit young men, says Genevieve Sherrow, FPC research associate. At the community-based center, adult male facilitators have distributed informational materials and given formal presentations to probation officers and judges to increase their awareness of the program. Once informed of the program, judges and probation officers can refer young men to Man2Man.

The Man2Man program has just completed its fourth year. Its next goal is to not only enhance its services, but expand its boundaries to other disadvantaged neighborhoods in Philadelphia and other surrounding communities, says Sherrow.

References

1. Raine T, Marcell AV, Rocca CH, et al. The other half of the equation: Serving young men in a young women’s reproductive health clinic. Perspect Sex Reprod Health 2003; 35:208-214.

2. Frost J, Bolzan M. The provision of public-sector services by family planning agencies in 1995. Fam Plann Perspect 1997; 29:6-14.

3. Sherrow G, Ruby T, Braverman PK, et al. Man2Man: A promising approach to addressing the sexual and reproductive health needs of young men. Perspect Sex Reprod Health 2003; 35:215-219.

Sources/Resources

More information on the training material used in preparation of the New Generation Health Center is available by contacting:

  • Arik Marcell, MD, MPH, University of Maryland School of Medicine, 120 Penn St., Baltimore, MD 21201. E-mail: amarcell@peds.umaryland.edu.
  • Erica Monasterio, RN, MN, NP, Associate Clinical Professor of Pediatrics and Nursing, University of California, San Francisco, 400 Parnassus, ACC Second Floor, San Francisco, CA 94143. E-mail: ericam@itsa.ucsf.edu.
  • Barbara Long, MD, Assistant Clinical Professor of Pediatrics, University of California, San Francisco, 3333 California Ave., Suite 245, San Francisco, CA 94118. E-mail: blong@itsa.ucsf.edu.

Marcell’s workshop used materials developed by The Center for Health Training. The center offers a free download of its program, "Blueprint for Male Involvement." Click on "Materials and Resources" at the home page, then the program title. The material is available in Adobe Portable Document Format. For more information, contact:

The charge for the three-day Fatherhood Development training workshop (including all materials) is $600. Check the web site below for 2004 scheduled workshops, with dates to be posted soon. Cost for an on-site workshop is $15,000. Up to 25 people may attend. For more information, contact:

National Partnership for Community Leader-ship, 2000 L St. N.W., Suite 815, Washington, DC 20036. Telephone: (202) 822-6725. Fax: (202) 822-569. E-mail: info@npcl.org. Web: www.npcl.org.