May 1996, Vol. 2, No. 3

Response Center Medical Unit: For Teenagers Only
By Susan Soest, first-year SSA student.

The scene is Skokie, a middle-class neighborhood just north of Chicago, and home of all things suburban: shopping malls, manicured lawns, and easy access to the interstate. It is 7 p.m. and cars file in and out of a strip mall parking lot. Through an inconspicuous door sandwiched between a pizza joint and a bagel place, a young woman named Traci heads up the stairs to the Response Center Medical Unit.

Traci is one of over 100 high school-aged young women who seek contraception, sexually transmitted disease testing, pelvic examinations and counseling through Medical Unit, a program of Response Center. Under the umbrella of the Jewish Federation of Metropolitan Chicago, Response Center has been providing counseling and outreach services to adolescents and their families for over 20 years. Medical Unit was created in the early 1970s to meet the needs of adolescent girls who had limited access to birth control due to cost and confidentiality constraints. Now over 20 years old, Medical Unit is staffed by an interdisciplinary team of a physician assistant, two social workers, and a social work intern. Dr. Gail Floyd, a physician, oversees the medical aspect of the program. The Medical Unit team strives to create a warm, nurturing environment where teenage girls and their partners can feel comfortable taking care of their mental and physical health needs.

Different from other family planning programs, Medical Unit addresses issues of sexual health in a context of empowering teenagers to make responsible choices. "We are not only trying to prevent pregnancy, we are trying to reduce risks for kids. Pregnancy is one risk, and sexually transmitted diseases are another, but so is drinking and driving and using drugs inappropriately," says Joan Schulhoff, P.A. and Medical Unit Primary Care Provider.

The intermingled medical and social work approach taken by the staff at Medical Unit enables teens to look at their choices and actions on several levels. "What is remarkable about Medical Unit is the collaboration between the medical and the social work sides of the program, particularly since the medical issues we are seeing in our kids are behaviorally linked. In addition to my talking to the client about her medical issues, she very often needs to figure out with the social worker why she is engaging in high-risk behavior, how she can set limits on that behavior, and how she can get her needs met in healthy ways," says Schulhoff.

The young women who come to Response Center represent a variety of cultural, racial and socioeconomic backgrounds, as well as a number of north suburban high schools. The program is open to young women of high school age (typically 16 to 19), regardless of sexual orientation or religion.

On a given night, the concerns of Medical Unit clients might range from a possible case of chlamydia to a report of physical abuse in the home. One Tuesday night at Medical Unit, the following clients came in with a full range of medical and mental health issues: Karyn came back for a check on her hormonal disorder, and to discuss a problem with her boyfriend that is causing her to feel suicidal; Sharon was considering going off the birth control pill and was having doubts about her future career; Tina was in for a pill pick-up, but was also interested in discussing the relationship between spirituality and sexuality; Sheila came for her first pelvic exam, wanting to also talk about the ramifications of body piercing; and Traci returned for her three-month pelvic exam to check on her HPV (human papilloma virus). The major concerns of the teenagers at Medical Unit include physical concerns with psychological dimensions: HPV, HIV, chlamydia, yeast infections, pelvic inflammatory disease (PID), and urinary tract infections. In addition, Medical Unit clients often bring up concerns related to self-esteem and assertiveness, fostering healthy relationships, improving body image, working through family problems, and coping with sexual, verbal and/or physical abuse. The Medical Unit social work and medical staff help adolescent girls address these and other issues.

Medical Unit is a program that requires a commitment of at least one year m which the young woman agrees to use a reliable form of birth control, usually condoms and spermicidal foam or the birth control pill. There is a typical schedule that is followed once a young woman decides she wants to join. First, a potential client and her partner make an appointment for the "rap," a discussion covering anatomy, sexually transmitted diseases, the continuum of sexuality, various kinds of birth control on the market, and the basics of a pelvic examination. A section of the rap is also devoted to human papillomavirus since approximately 30% of the girls at Medical Unit are found to have the virus. Associated with genital warts, HPV causes cervical changes in women which, if undetected for long enough, can lead to cervical cancer. After the rap, the new client is scheduled for a medical history and pelvic exam appointment; an appointment for results; and monthly check-ins and pill pick-ups every month for three months. After these initial appointments, the young woman returns to Medical Unit every three months to get pills or condoms, with a pelvic exam scheduled every six months. At each visit, the client meets with both the medical staff and her designated social worker. The total cost of the program is $60 per year which includes all health care and counseling services, as well as pills and condoms.

"Medical Unit is a program and not a clinic; kids need to make a commitment to join the program and agree to certain responsibilities," says Tom Erf, M.S.W., Medical Unit Coordinator. "The benefit to them is that they get their whole person cared for."

An important aspect of serving teenagers is helping them feel comfortable in the physical environment. "I think teenagers have a sense of comfort here that they don't find in other clinics," says Deborah Fisher, M.S.W., of the Medical Unit staff. "I heard a comment today from someone who said she was very nervous coming up the stairs for the first time. She had heard Medical Unit wasn't like other clinics, but still thought it was going to smell like a clinic. She was pleasantly surprised to be able to grab a pillow on the floor and hang out and talk."

Medical Unit also responds to the time needs of teenagers by offering the program on Tuesday and Thursday evenings from 6:00 to 9:00. Though appointments are scheduled, each client is given the time she needs to have her concerns heard and her questions answered. "Unlike a lot of clinics, Medical Unit is not numbers-driven whereby we have to serve a certain number of kids in a certain amount of time. Instead we ask, how can we give the best care?" says Schulhoff. "If a kid is anxious, we can spend an hour talking about the pelvic exam before we actually give the exam, or we can break an exam into two parts. We can be flexible enough so that when kids have crises, medical or psychological, we can fit them in and see them for as long as they need."

Teenagers today appear to have a lot more to cope with than they have in the past, particularly now that sexually transmitted diseases are on the rise and young people are electing to have sex at an earlier age. On the other hand, they have access to much more information about the risks of sexual activity. "What occurs to me most is that nothing has changed," says Schulhoff. "Despite all the media and all of the attention that has been paid to teen pregnancy, the reality is that nothing has changed.

"Kids still get their needs met in ways they have always gotten their needs met. Those needs are so strong and powerful, that the risks are worth it to them and make them feel alive. It is not that they have inadequate knowledge, they actually have more than they have ever had, but they still feel a void of some sort. Especially in the case of young women, they want to be close to someone. This is the same thing we've heard out of young women for 25 years, they just have different clothes and different hairdos now," says Schulhoff.

Susan Soest is a first-year SSA student.
Her field placement is at the Response Center.

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