Table 1.
Applying the three domains: Teenage pregnancy as a case study
| Issue | Action |
|---|---|
| Health improvement | |
| Avoiding unwanted teenage pregnancy through appropriate sex education, including peer education, and counselling services available to young people attending schools and youth clubs | Needs links at policy level with education, schools, youth service, connexions. Roles for school nurses, counsellors, teachers and others in primary care |
| Messages re-inforced through media | Links made at local and/or national level with journalists |
| Support to young parents within communities, for example, through faith-based groups and providing housing opportunities | Community-based initiatives supported through joint working in local strategic partnerships. Members of public health team will be engaged through local links. Support for housing through housing associations |
| Health protection | |
| Young people who are having unprotected sex are at risk of sexually transmitted diseases such as chlamydia/HIV | Local health protection teams have a role in surveillance based on robust system linked to labs. Needs to communicate with primary care trust team. Advice also needs to be available from GUM clinic/PCT/school-based scheme |
| Once pregnant, screening for disease including HIV/hepatitis B/syphilis | HPA advises on screening working with local providers |
| Local PCT needs to know rates of STIs and whether targets are being met | Role for observatories, best linked with HPA. Diversification of provision needs information overview to enable DPH to monitor their population |
| Health service quality | |
| Unprotected sex: needs emergency contraception | Could be available from local pharmacy, practice, family planning clinic |
| For those who become pregnant and choose to terminate the pregnancy, services providing not only abortion but counselling and advice are needed | Service planning need to be aware that access is likely to be primary care: voluntary agency. Role for primary care staff caring for pregnant mother with understanding of risks, needs for information and social context |
| For those continuing with the pregnancy, sensitive antenatal care, delivery and postpartum care followed-up into the community are needed with paediatric follow-up | Commissioning role of public health specialist important to ensure quality of services, with community links |
| Primary care is essential as the setting for much of this care but needs to link effectively with hospital sector | DPH/specialist links within PCT with clinicians as well as with board are important, articulating needs, effective interventions, priorities and service plans, monitoring outcomes. Health visitor engagement |
| Once the baby is born, schemes such as Surestart16 need to be available | To help young mothers to get back into education and employment as well as providing parenting skills, childcare advice and provision |
HIV, human immunodeficiency virus; GUM, genito-urinary medicine; PCT, primary care trust; HPA, Health Protection Agency; STIs, sexually transmitted diseases; DPH, director of public health.