The purpose of this initiative (Ascend) was to determine if one could apply social determinants of health concepts that focus on employment through a primary preventive care clinic to influence the employment and medical outcome of women. Minority low-income post-secondary adolescents and young adult women (AYA) were recruited to participate in an allied health-training program from their medical home, a reproductive health care clinic. Twenty-nine sexually active high school graduate women enrolled in the program. As a result, the majority of the cohort completed the training and were eligible for employment. Participants continued to access care, including contraception in their medical home and there were no subsequent pregnancies among enrollees. This project concludes that social determinant linking access to employment via a medical home has both direct and indirect effect on the health and employment well-being of young women.

Keywords: pregnancy prevention, social determinants, risk reduction, medical employment portals

Emerging evidence-based research suggests that in addition to medical care, nonmedical factors affects health and the economic well-being of youth and young adults.¹ This school of thought, guided by the Social Determinants of Health, considers broad based environmental issues and their impact that includes social and economic opportunities.² According to this approach, non-medical factors explain in part why some young adults are healthier and more successful than other youth. Moreover, social determinants not only include life conditions but financial factors (lack of employment, under employment, childcare and transportation issues) as well, which exert a powerful health influence over groups, among fragile or disadvantaged populations, especially young women. Of the various social determinants, employment has been identified as a powerful dominant of health for a couple of reasons. Several groups including The World Health Organization suggest that employment plays an important role in health establishment and maintenance. Employment also provides economic livelihood and family financial security. Moreover, in the United States employment is the primary vehicle for workforce health insurance. Access to meaningful work is especially important to vulnerable adolescent and young adult women. This commentary’s objective is to explore whether or not access to employment via a young women’s medical home has unique benefits to her health and well-being. Secondarily, it assesses if a link to a variety of services including contraception and work required examinations facilitate participation and program completion. Such a coupling of venues may provide insight on innovative ways to link work to health services for an at risk population which then facilitates employment acquisition.

Subjects: Of the 31 participating young women 24 were Hispanic and 5 were African American and 2 were other. Their ages ranged from 19 to 25 with a mean of 21.84 years. Of this group, eight were already parents. All were single, high school graduates and desired employment in one of four allied health certifications paths: Certified Nurse Aid (CNA), Electrocardiography Technician (EKG), Medical Business Office Professional/Billing and Coding, and Phlebotomist. Personal information including age, education and employment history. Data was also collected on household information, which included members living with the participant, housing (apartment, home, rent or own) transportation, food, childcare and financial responsibilities.. Training classes were located in their medical home clinic providing them a safe environment and easy access to primary care medical services such as immunizations and physical examinations that were pre-requisites to job placement and to family planning services including LARCs. 

Methods

As a four-month program, it included a presentation of an overview of possible health careers, options for job training, and professional development. In addition, Ascend provided assistance in applying to/enrolling for job training through one of the three local county community colleges. The program collaborated with the sponsoring medical school and its Humans Resources department, and provided workshops and events to build job readiness, networking, and life skills. A local foundation provided a need-based stipend to assist with items including the cost of tuition, books and transportation to training. Two case managers using standardized intake forms obtained demographic information as part of the enrollment process. Intake staff also queried participants about their immediate and future long-term employment goals. Contraceptive needs and access to a variety of medical services were provided at no cost to participants. Education and counseling on family planning was available to all young women. The case managers along with a program therapist monitored participants to identify barriers associated with e affected program completion.

The clinic was effective and feasible employment portal for adolescent and young adult women to a multifaceted job-training program in allied health professions. Of this group, 15 are waiting for a class to begin, 11 are in enrolled in a course, 2 completed the program and were eligible to participate in the certification process. In addition, 3 were employment eligible or were already hired. This medical home extension was therefore effective in connecting women to job training and career readiness resources. This project also continued providing education to participants on health, wellness, family planning, financial literacy, and relationship management. Although 26% of participants were already parents, they stayed enrolled in the program and no subsequent pregnancies among enrollees occurred.

The application of this aspect of social determinants of health, employment, is significant for at risk women and young adults in a variety of ways. For our cohort of high school graduate participants, the acquisition of a meaningful job may be one of the most significant factors in supporting their well-being, desired upward mobility and stable employment. The selected health profession training and certificates could also be acquired in a timely fashion as most participants expressed an immediate economic need. Ascend built on this desire by identifying and reduce a variety of job acquisition barriers and used their medical home that offered, medical services, staff mentoring and counseling, pre- employment and employment training and ultimate long-term job placement.

Through this process, subsequent to program enrollment, several barriers became apparent related to life experiences, which potentially could mitigate employment success. In our cohort of young women, these barriers involved social, educational, experiential factors. Even as high school graduates, disorganized families and poverty were still present in their lives and influenced employment opportunities. The chronic lack of childcare and transportation affected employment readiness and sustainability.

A second issue, applied education proficiency was another subtle barrier to technical job acquisition. While all had earned a high school diploma, some lacked basic reading skills that interfered with their ability to pass required licensing examinations once the training was completed. Mathematical skills including basic algebra required for some medical tech jobs also were deficient. Tutoring and study skills workshops were offered to correct these deficiencies.

A third barrier to job acquisition in the allied health fields was their limited exposure to medical professions. This cohort of youth were unaware of opportunities in the allied health fields, even though they lived in a city with a high demand for medically trained employees, they. One explanation is that employment experiences by family and friends and other influencers were traditionally in retail, food or hospitality. To overcome this lack of knowledge barrier staff in some cases had to market allied health opportunities via tours to medical facilities.

Based on our experience, the Social Determinants of Health Theory can influence the health and economic well-being of vulnerable young women. By linking a medical home with a job-training program, young women not only received strategic training and job entry opportunities but obtain primary preventive health care including contraception in a seamless way. As an unintended pregnancy with this age cohort can have significant effect on subsequent employment, we propose that our findings support such an approach. In conclusion, we see Ascend as a significant portal for employment and life skills providing young women with opportunities for managing their lives. This type of education program based in a medical clinic provided important lessons and support for young women that will help their transition to sustainable wages and upward career mobility.

This project was funded in part by JPMorgan Chase Bank, The McGovern Foundation and Baylor College of Medicine. The authors would also like to acknowledge Ms. Jasmine King and Mrs. Reginald Hatter for their assistance in the collection of the data.

The authors have no conflicts of interest.

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2. Braveman, P Gottlieb, L. The social determinants of health: It is time to consider the causes of the causes. Public Health Rep. 2014;129(Suppl 2):19-31.