All in a Day’s Work

ADOLESCENT HEALTH CARE ADVOCATE: “It’s dynamic and inspiring,” says HiTOPS Director of Health Services Sandra Zordan-Friedman, CNM, MSN, pictured (left) counseling a client. “I learn every day from young people. It’s really all about empowering them to be advocates for their own health.”

Borough resident Sandra Zordan-Friedman is the Director of the J. Seward Johnson Sr. Center for Adolescent Health at HiTOPS, the Princeton-based non-profit organization that seeks to combine affordable reproductive health services with sexuality education in order to help teenagers make responsible choices and act responsibly and safely in their relationships. HiTOPS provides male and female health services; HIV testing and counseling; and information on contraceptive methods and sexually transmitted diseases.

Ellen Gilbert

There’s so much that I do. We focus on prevention and education. Physician care is different; it’s not better, it’s not worse, but when you combine approaches it’s really better, especially for adolescents.

The initials “CNM” and “MSN” are really important to what I do. The CNM is for Certified Nurse Midwife, and MSN is my Masters of Science in Maternal and Child Health Nursing, which I received from Yale University. The interdisciplinary, nurse-practitioner model we learned at Yale is absolutely key. At Yale, nurse-midwives taught residents about normal ob-gyn practices, and they taught us about high risk practices. Right now, we teach pediatric residents doing the Adolescent Medicine rotation at St. Peter’s Hospital about prevention; physicians often don’t get into that.

When I came to HiTOPS five years ago the Health Clinic consisted of one room, with one office. I was hired to move the clinic into the free-standing building it currently occupies. With support from the Board and our wonderful staff, the clinic is growing by leaps and bounds. We moved in here and began seeing more and more patients in this private setting. The Borough location (21 Wiggins Street) is really accessible.

I was recently reading a publication from The National Campaign To Prevent Teen and Unplanned Pregnancy. It identified the characteristics of successful teen clinics. I had tears in my eyes when I finished: we have it all, including confidentiality (though we do welcome parents); low cost, sliding-scale fees (we never turn anyone away, even if they can’t pay); and the ability to make community-based referrals when it’s appropriate.

Kids know that this is a safe spot. Confidentiality is an emerging issue for adolescents; it should be kept as a right, a law. Problems arise with insurance policies that are owned by parents, where the “explanation of benefits” must show what the child is being treated for.

Preventing teen pregnancy is one of the most important things that we do. The rates in the U.S. are still the highest among fully industrialized nations, and after 15 years of continuous decline, the U.S. teen birth rate is now on the rise: about three in ten teens get pregnant by age 20. This has to do with minors’ limited access to health care, the high cost of birth control, confidentiality issues, and a lack of education.

We also enjoy a growing relationship with Princeton University, where HiTOPS was chosen as a non-profit affiliate of the Community Based Learning Initiative. I’ve worked with a professor and group of students every year for the last four years. Most recently, I collaborated with Mitchell Duneier on his class “Sociology on E Street.” It focused on Bruce Springfield’s work and its influence on our culture. The project that we oversaw had four University students conduct anonymous interviews with four HiTOPS clients. These “life stories” are being used to help us further identify what’s important in an adolescent health care center. Different themes that came to light were knowledge, confidentiality, empowerment, and “going the extra mile,” which means staying late, being open on Saturdays, and being flexible when people call to change their appointments. That’s natural: they’re teen-agers. A holistic approach was also important, as was the notion of “a needed service worth sharing.”

Right now we have three clinicians and a front desk person. It’s a bare-bones operation; volunteers help. We see eight to ten people a day. Visits can last from 35 to 50 minutes, because we spend time educating our clients, who are males and females, ages 13 through 26. We also spend a lot of time on the telephone answering questions and making referrals.

I can’t emphasize enough the importance of adolescents having a voice in their health care. It’s difficult to achieve that in a traditional doctor’s office with your parents sitting there. We do many “prevention talks” with 13-year-olds. They arrive with their parents, who usually leave the room once they realize they can trust us. We can help parents too; they often fear their adolescents and need models for how to handle certain topics.

We do not terminate pregnancies, but I do offer “options counseling” for explaining the three possibilities — termination, keeping the baby, or putting the baby up for adoption — with a neutral point of view. This is very dear to my heart; it’s rare to find opportunities to talk about these things. They’re not easy decisions, and people need a chance to work it through.

A new grant from the Horizon Foundation enables us to screen every client who comes in for eating disorders and depression. There is 7.9 percent incidence of clients needing referrals for depression. Mental health is a huge issue; we’d like to be able to teach kids how to cope with stress. Kids know, by the way, that I will break the confidentiality rule and call their parents if they are at risk. It’s important for parents to know it too. There’s nothing secretive about what’s going on here: kids just need a safe space.

For more information on HiTOPS see www.hitops.org. The Health Clinic is open Monday and Wednesday from 10 a.m. to 6 p.m.; Thursday from 10 a.m. to 6:30 p.m.; and Tuesday and Friday from 9 a.m. to 5 p.m. Appointments can be made in person or by calling (609) 683-5155, ext. 211.

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