El Rio Health

Unplanned pregnancy rates are highest among teens and those just entering adulthood. Compared to other developed countries, the United States has one of the highest adolescent pregnancy rates.1

Because teens receive limited sex education in the classroom, it’s up to parents to educate their children about contraception, sexually transmitted infections (STIs) and abstinence. But what happens when kids don’t have a positive adult role model in the household?

This is where Joy Baynes enters the picture to help save the day. She’s a Nurse Practitioner at El Rio Community Health Center. She started working with El Rio in October 2016, and runs the Advocates for Youth Program. This program is a Washington, D.C.-based reproductive health initiative that decreases barriers so teens can access contraception.

Joy wrote a grant to work at El Rio, and received funding for three years. Her mission is to increase access to all types of contraceptives for teens and young adults, including IUDs and implants, birth control pills, patches, rings, and shots like Depo-Provera.

In addition to helping teens get access to the preventive measures they need, Joy’s overarching goal is to create a system that would increase access to these methods and replicate that model for other Federally Qualified Health Centers. Ultimately, at the end of the three-year grant, she’ll have a working manual and model to train other Health Centers.

Joy has her work cut out for her because she’s not dealing with your everyday teenagers. Instead, she’s reaching out to young people who are homeless, in foster care, are not enrolled in mainstream education programs, have been previously incarcerated, are current substance abusers and are victims of the sex trafficking trade.

These kids, with varying but equally challenging backgrounds, are working directly with Joy as part of a youth leadership team. Joy explains, “We view the young people as partners, not just recipients of the services. They are the best voice to help make these decisions and increase access to teen services. They help audit and improve the experience.”

And the teens have indeed been instrumental in improving that experience. When Joy began working at El Rio, they did focus group testing all over Tucson. It started with Pizza Protection Parties in the community twice a month. These get-togethers included basic education on birth control, information about teens’ rights to access services, and an overview of the services that El Rio provides to young people.

Most teens didn’t know that they have a right to confidential and free services, for example. Being armed with that information alone can make a huge difference in the lives of teenagers who might not seek help due to inadequate finances or risk of being found out.

The parties also included games and educational programs that aimed to dispel common myths about pregnancy, along with a survey to gather information from the teens. Initially, the parties didn’t go as well as planned, and Joy began working with the Youth Leadership Team to make improvements.

“The biggest challenge is that some of the teens can’t read, and many didn’t understand the survey we gave them. We simplified the survey from four pages down to one page based on the feedback and guidance we received from the Youth Leadership Team,” Joy reports.

The funding from this grant is making an important difference for the future of teens in Tucson and the surrounding areas. The teens, who have their own daily struggles, receive payment, transportation and food in exchange for participating. They are active participants in the development of this program and their ideas and suggestions are taken seriously.

Under Joy’s guidance, they are building a social media presence that will officially launch in January 2018. In addition to social media, they’ve also begun creating videos and commercials targeting their audience. Joy says, “They have really taken ownership of this.”

Another recently launched initiative is Telehealth, a texting project. The text messaging allows teens to reach out and communicate using their most preferred media platform. They can Facetime or have text-only conversations with providers who are specifically trained to work with teens. These providers perform the general intake process, so when the teens appear for their appointment, the information is already available in El Rio’s system.

Joy’s team has also implemented a secret shopper program where teens audit the entire process, from making an appointment to receiving contraception. The goal is to find out which parts of the process are positive and negative, and then fix and enhance problem areas.

Joy admits that without buy-in from upper management, they wouldn’t be able to change or improve anything. Fortunately, Joy has received tremendous support from Douglas Spegman, El Rio’s Chief Clinical Officer.  He regularly sits in on meetings and actively helps with challenges.

Joy says that overwhelmingly, the collaboration across the entire El Rio organization has been incredible. She says, “the youth leadership team respects each other, they enjoy spending time together, and they feel like their time is valued.”

Despite their diverse backgrounds, they work cohesively as a team, and because of that, they get rewarded with fun activities like visiting pumpkin patches.

Joy is one year into her three-year project. After the three years, her goal is to integrate these processes into normal care at El Rio. She hopes to drive the continuation of the project, with or without funding.


  1. http://www.arhp.org/publications-and-resources/studies-and-surveys/providers-prospectives-perceived-barriers-to-contraceptive-use-in-youth-and-young-adults

About El Rio Community Health Center

Our Mission is to improve the health of our community through comprehensive, accessible, affordable, quality and compassionate care. Our Vision is to be a national model of excellent healthcare.
We are dedicated to serving all people. Since El Rio began in 1970, we have grown to be one of the largest, non-profit community health centers in the United States. We focus on positive health outcomes, treating the whole person and prevention. Our health care is delivered by compassionate, professionally trained integrated health teams who give from their hearts to provide you with caring, high quality, world class care.

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