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Objective: To provide a description of Prime Time, an intervention to reduce pregnancy risk behaviors among high-risk adolescent girls. Methods: Prime Time, a clinic-based, multicomponent youth development intervention aims to reduce sexual risk behaviors, violence involvement, and school disconnection. Results: We highlight key considerations in conceptualization, design, and methods for a Prime Time randomized trial. Conclusions: Prime Time comes at a time of great interest in restructuring adolescent health services. This study represents an important effort to expand preventive and youth development services among young people most vulnerable to early pregnancy, for whom services must go beyond traditional problem-oriented approaches. [ABSTRACT FROM AUTHOR]

Objective: To describe aspects of the social context that low-income, urban African American young women articulate as having influenced social messages they received during adolescence about pregnancy timing and childbearing. Methods: Individual interviews were conducted with 20 African American young women ages 18-22. Results: Findings clustered into 5 themes: first sex; getting ready and getting it over with; the path for African American girls; gender expectations: insecurity and independence; living into a future; and living in a context of instability and uncertainty. Conclusions: Findings portray a complex relationship between social context, social messages, and decisions about pregnancy timing and childbearing. [ABSTRACT FROM AUTHOR]

The growing prevalence of chronic conditions in childhood underscores the urgent need to educate pediatric nurse leaders to address the complex issues these children and families face. This article describes a model of graduate education for preparing pediatric nurse leaders who are equipped to manage and advocate for these children and families. Fifty-one master's prepared graduates completed a Strategic Plan Needs Assessment Survey in 2007 and were asked to indicate specific clinical and leadership competencies that they perceived were essential for pediatric nurse leaders in their areas of practice. Results revealed the highest priority for continuing education and outreach regarding pediatric health to be clinical updates and management of children with special healthcare needs (CSHCN), followed by health promotion for CSHCN and care coordination/case management. The highest priority for continuing education and outreach regarding leadership in pediatrics was evidence-based practice, followed by team care/interdisciplinary practice. The challenge for current nurse leaders is to be cognizant of the urgent need to prepare and retain future pediatric nurse leaders who are experts in the care of CSHCN and their families. [ABSTRACT FROM AUTHOR]

A community-based needs assessment was conducted to identify urban American Indian family caregivers' perceptions of the quality of care they received for their children with chronic conditions. Thirty family caregivers in a large midwestern city completed the What Do You Think? Survey. One third of the participants thought their child's providers believed things about their backgrounds that were not true and that they were treated less well because of their ethnic or cultural background. One fourth of the caregivers reported that providers were not sensitive to family needs or adequately informed about their child's condition. To ensure the delivery of family-centered care that is culturally appropriate, we recommend that providers respectfully inquire about the family's particular needs, cultural beliefs, and practices and plan care in partnership with family caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Recent evidence demonstrates increasing rates of involvement with violence among adolescent girls. The objective of this study was to describe the types and sources of violence experienced within social contexts of adolescent girls at high risk for pregnancy., Method: Qualitative data for this analysis are drawn from intervention summary reports of 116 girls participating in Prime Time, a youth development intervention for adolescent girls. Descriptive content analysis techniques were used to identify types and sources of violence experienced by girls within their daily contexts., Results: Types of violence included physical fighting, witnessing violence, physical abuse, gang-related violence, verbal fighting, verbal abuse, and sexual abuse. Sources of violence included family, peers and friends, romantic partners, community violence, and self-perpetrated violence. Many girls in this study experienced violence in multiple contexts., Discussion: It is imperative that efforts to assess and prevent violence among adolescent girls include paying attention to the social contexts in which these adolescents live., (Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.)

Introduction: Evaluating interventions for reducing unintended adolescent pregnancy is necessary to ensure quality and efficacy. The purpose of this study was to examine core case management practices and processes for engaging high-risk girls in Prime Time, an intensive multi-component intervention from the perspectives of intervention program staff., Method: Structured individual interviews were conducted with the entire Prime Time program staff (N = 7) to assess successes and challenges in engaging adolescent girls at high risk for early pregnancy. The girls were recruited from school and community clinics., Results: Program staff described different capacities of adolescents to engage with the program (those who connected easily, those in the middle range of connecting, and those who had difficulty connecting) and provided specific recommendations for working with the different types of connectors., Discussion: Findings from this study support the supposition that persons engaging in preventive interventions with vulnerable groups of adolescents must pay careful attention to strategies for establishing trusting youth-adult relationships. The ability of staff (e.g., case managers and nurses) to engage with adolescents is a crucial step in improving health outcomes. The identified strategies are useful in helping adolescents build skills, motivations, and supports needed for healthy behavior change., (Copyright © 2012 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.)

Objective: To determine the proportion of adolescents with arthritis who receive health care transition services and to compare the rates with those reported for adolescents with other special health care needs and adolescents with diabetes., Methods: We used data from the 2005-2006 National Survey of Children with Special Health Care Needs. A parent/guardian identified youth ages 12-17 years with arthritis (n = 1,052), diabetes (n = 389), and special health care needs (n = 18,189). Four questions examined the extent to which providers discussed health care transition issues, including 1) transfer of care to adult providers, 2) health care needs of adults, 3) acquiring health insurance, and 4) encouraging self-care responsibility. Bivariate comparisons assessed the associations between sociodemographic characteristics and health care transition services, and multivariate regression models compared outcomes between conditions., Results: Many adolescents with arthritis are being encouraged to assume self-care responsibilities (74.8%); fewer discussed how health needs will change in adulthood (52.1%), acquiring insurance (22.5%), or transferring care to a provider who sees adults (19.0%). These results are similar to youth with other special health care needs, but behind youth with diabetes., Conclusion: Among this sample of US adolescents, many report discussions about health care needs and self-management, but few are addressing critical aspects of the transition to adult-oriented health care.

The purpose of this interpretive descriptive study was to describe how eight Black-White couples with school-aged children constructed their interracial family identity through developmental transitions and interpreted race to their children. Within and across-case data analytic strategies were used to identify commonalities and variations in how Black men and White women in couple relationships formed their family identities over time. Coming together was the core theme described by the Black-White couples as they negotiated the process of forming a family identity. Four major tasks in the construction of interracial family identity emerged: (a) understanding and resolving family of origin chaos and turmoil, (b) transcending Black-White racial history, (c) articulating the interracial family's racial standpoint, and (d) explaining race to biracial children across the developmental stages. The findings guide family nurses in promoting family identity formation as a component of family health within the nurse-family partnership with Black-White mixed-race families.

This article describes a preliminary qualitative evaluation of risk and protective factors associated with consistent contraceptive use and healthy sexual decision-making among ten of the first participants in the Prime Time intervention study. Prime Time is an 18-month intervention including one-on-one case management and peer educator training targeting sexually active 13-17-year-old girls who are recruited from health care clinics. Using an approach grounded in findings from previous research, social cognitive theory, and the social development model, Prime Time aims to improve participants' contraceptive use consistency, reduce number of sexual partners, and reduce unwanted sexual activity. Findings from this preliminary evaluation alert health care providers to the complex and dynamic nature of adolescent girls' sexual behaviors and to a broad range of risk and protective factors within individuals and their environments that may influence adolescent girls' sexual behaviors and contraceptive use. Findings suggest that an ongoing, supportive relationship with a case manager who is able to pace and tailor an intervention to the individual young person can have positive effects on adolescent girls' sexual behaviors and contraceptive use.

Community-based research projects are critically needed to reduce health disparities and ensure the delivery of health care that is culturally appropriate and relevant to families and communities. The purpose of this article is to share experiences and lessons learned from utilizing a participatory action approach in a series of five subprojects within the Indian Family Stories Project. Participatory action research (PAR) focuses on identifying community needs and designing action plans in partnership with the community. To effectively implement PAR projects, investigators need to: (a) Build and maintain strong, collaborative working relationships with a broad network of community representatives, (b) Secure funding that addresses community needs and provides mechanisms for giving back to the community, (c) Ensure that the project fits the particular cultural and community context, (d) Evaluate and adapt the project as needed, (e) Keep the community informed, (f) Develop sustainable community resources, and (g) Advocate on behalf of the community.