MetroDoctors Guest Post: Michelle Van Vranken, MD
50 Years of Teen Clinics
Michele Van Vranken, MD has been a family physician in the Twin Cities for over 25 years. She trained with the Ramsey Family and Community Medicine Program in the late 1990s. After residency and a year-long fellowship focused on community and adolescent care, she spent almost 10 years focused on adolescent healthcare providing services at three Twin Cities teen clinics. While she has moved back into primary care and community medicine, she continues to spend a small but joyful portion of her work week in the adolescent healthcare setting.
The last 50 years encompass four generational groups of adolescents: the Baby Boomers (1946-1964), Generation X (1965-1979), Millennials (1980-1994) and Generation Z (1995-2012). Each of these groups would likely describe very different experiences in what it meant to access confidential, reliable and comprehensive care, especially in regard to their reproductive health. It was the Baby Boomer generation that was the first to have access to confidential reproductive, chemical dependency, and mental health services. In 1971, Minnesota passed legislation allowing minors to consent to and receive these services confidentiality. This law was unsuccessfully challenged in both 2003 and 2005, and the statute remains in place today. On a national level, the Title X program (a federal family planning program created in 1970) clarified through a 1978 amendment that recipients of funding through this program must also provide these services to adolescents.
Recognizing the need to address rising rates of sexually transmitted infections and unplanned pregnancies during the adolescent years, the new legislation provided an opportunity for community members and volunteers to create spaces and programs focused on adolescents and their health to address these concerns. It was this era that led to the creation of multiple clinics that focused specifically on adolescents. TeenAge Medical Services (as part of Childrens’ Hospital in Minneapolis) opened their doors around 1970, The Annex Teen Clinic in Robbinsdale in 1971, West Suburban Teen Clinic (now MyHealth) in Excelsior in 1972, and the country’s first school-based clinic in Saint Paul in 1973. Most of these and other youth focused clinics continue to serve adolescents today, continuously improving how the medical community cares for young people and expanding the services provided to meet the growing and changing needs of youth across generations.
As the decades moved forward, access to a greater variety of family planning options allowed for increased reproductive choices around if and when to bear children for patients of all ages. While the first birth control pill was developed in 1960, it wasn’t until a Supreme Court decision in 1972 that this option regularly became available to unmarried women. This was followed by:
Lower dose pills
Copper IUD (Paragard) in the 1980s
Medroxyprogesterone acetate (Depo-Provera),
Norplant (the first long-acting reversible implant)
Female condom
Emergency contraception in the 1990s
Mirena IUD
Contraceptive patch (Evra)
Vaginal ring (Nuvaring)
Implanon, a single rod long-acting implant in the 2000s
Additional IUD and emergency contraception options in the 2010s (including over the counter access of emergency contraception for adult women in 2006 and for minors in 2013).
As options and access increased for all women, teen clinics were able to specifically provide access to these same options to the youth in their communities. These options are presumed to be one of the significant factors that has allowed us as a state and country to witness a decline in unplanned pregnancies in adolescents since about 1990 in all demographics, though disparities among different ethnic and cultural groups persist to this day. However, despite the decline, in 2021 the birth rates among Black, Hispanic, and American Indian/Alaskan Native teens was more than twice that of their white counterparts. Several factors may play a role including poverty and access to the education and medical services needed to support decision making around planning and spacing pregnancies.
Teen clinics have also historically been a safe space for youth to confidentially, and in a nonjudgmental way, get information about and get tested and treated for sexually transmitted infections. This component has not changed over the past 50 years. Like the rest of the country during the 1980s and 1990s, teen clinics were also impacted by the early unknowns of the HIV/AIDS epidemic. While the disease was having a greater impact on adults beyond their teen years, the epidemic also became a component of the cultural and social changes in how the LGBT community was treated and cared for by the medical establishment. Adolescent clinics provided a safe space for information and care surrounding HIV and sexual health during the coming out period often experienced during the adolescent years. Teen clinics continue to provide a safe and confidential space for the early diagnosis and treatment of HIV as a chronic condition. While the disease has typically more greatly impacted older adults, about 1 in 4 new cases of HIV are currently found in a young person between the ages of 13-24 in Minnesota.
What started out primarily as smaller volunteer-driven clinics hoping to meet the unique health needs of adolescents in the community has continued to evolve and expand over the past five decades. While reproductive health continues to be a mainstay of the confidential care provided, some clinics now provide an expanded array of primary care services. The health education model has expanded from focusing on providing education on a variety of health education topics to one focused on youth development and youth empowerment in decision making about their healthcare needs now and moving into adulthood. There is greater acknowledgment of the different cultural identities youth bring to the table when making their healthcare decisions and there is a greater effort to address the racial and ethnic disparities across the state.
So, where do we go from here? There is a continued need to research and explore approaches that might give us the same success rate in treating sexually transmitted infections as we have had in the prevention of unplanned pregnancies. While there are some adolescent clinics, like Aqui Para Ti in Minneapolis, that create spaces for teens that specifically address the cultural needs of the community while providing care, there is an opportunity to expand similar models into additional communities throughout the state that are disproportionately affected by disparities in health outcomes. And while culturally there has been a shift in the discussion of sexual and gender differences, the ability to provide gender-affirming care to youth confidentially is currently not protected and is even targeted in parts of the state and country. The challenge is to both honor the history of Minnesota’s adolescent clinics and the work that has been done, while continuing to push the needle forward in supporting the health and well-being of all adolescents within our state.