A Step Ahead looks for long-term fix to unwanted pregnancies

A Step Ahead Chattanooga Executive Director Rachel Schulson
A Step Ahead Chattanooga Executive Director Rachel Schulson

Champions of Health Care

America's complex and technologically driven medical system is as sophisticated, complex and expensive as any in the world. But within that vast system are those who still put the "care" in health care and who we recognize as the winners of this year's Champions of Health Care awards.Edge magazine, in partnership with the Chattanooga-Hamilton County Medical Society and BlueCross BlueShield of Tennessee, received more than 150 nominations from the public about health care providers, administrators and volunteers who have made health care better in Chattanooga. From among those nominations, a panel of judges comprised of top leaders from the medical society and each of Chattanooga's three major hospital systems - Erlanger Health System, CHI Memorial Hospital, Parkridge Health System - picked the winners that we salute in the following pages.The Champions of Health Care award winners recognize those who have tackled major community health problems, starting programs to tackle obesity and smoking, adding physical therapy training in Chattanooga, and bringing needed medical services to those without health insurance. Others are recognized for new approaches, strong leadership and simple acts of kindness during their lifetimes of achievement and service.In our second year of the awards, we have quickly discovered the rich talent and commitment from those who work every day to keep us healthy.

Rachel Schulson, the executive director of A Step Ahead Chattanooga, likes to think of herself as a pragmatist who would rather find common ground to solve a problem than argue over possible solutions.

Years ago, she wrote a book telling young children about guns that won kudos from advocates and opponents of firearms by focusing on information any child should know if they encounter a gun.

"One of the things I like to do is to take a hot issue and try to find the center," Schulson says. "Because I feel like people are going to argue forever about abortion or gun rights... but in the meantime, here are ways you can help."

When she started A Step Ahead Chattanooga three years ago to help women avoid unintended pregnancies, Schulson followed the same path, side-stepping the heated fights over abortion by focusing instead on something much less controversial: long-term reversible birth control.

"If we could keep women from getting pregnant when they don't want to be, that's the root of it all, right?" she says. "Let's take a few steps back, further upstream, and catch them there. I just really have a passion for this because I really think at the root of so many other problems are people having babies they didn't intend to have."

Most people have personal experience with birth control. "Nintey-nine percent of child bearing couples have used birth control at some point," Schulson says. "And yet it's perceived as a controversial topic. I believe the reason that's happened is because when people hear birth control, they think abortion. Part of what we do as a prevention-only organization, is to try to separate those two. When people realize that we are only about prevention, you can see them relax."

A Step Ahead only helps women purchase long-term contraceptives and not condoms, the pill or the "morning after" pill.

In three years, Schulson has corralled major funding from foundations as well as an impressive list of private donors while expanding her organization's services to dozens of area medical clinics and social service agencies. Those successes won A Step Ahead this year's Champions of Health Care award for Community Outreach.

While initially only available in Hamilton County, A Step Ahead is now expanding its network to 11 counties in southeast Tennessee.

So what is the program and how does it work?

Community Outreach Award

Honors a company or organization that reached out of its normal sphere of operation to focus attention on a health care issue or helped to solve a community health problem.Winner: A Step Ahead ChattanoogaAccomplishments: The program helps women avoid unintended pregnancies through long-term reversible birth control and it has already served more than 1,000 women. Rachel Schulson launched the program three years ago and has secured funding from several foundations.

The goal, Schulson explains, is for women to avoid unplanned pregnancies. About half of all pregnancies in the U.S. are unintended, she says.

A Step Ahead focuses on women who want to control when they become pregnant, but either don't know how or don't have the money they need for long-acting contraceptives, which can cost hundreds of dollars. A Step Ahead emphasizes what are called LARCs, or Long-Acting Reversible Contraceptives. LARCs come in two basic varieties, IUDs and implantables. IUDs have been around for decades, but they got a bad reputation in the 1970s when one version with a faulty design, the Dalkon Shield, left thousands of women with serious infections.

Those problems disappeared years ago and now IUDs, which come in various designs, seem to be well accepted. The newer form of LARCs are implantables, small tubes that are inserted under the skin and slowly release a contraceptive chemical.

A Step Ahead has volunteers who operate a telephone appointment line that takes calls from women who are interested in learning more about the program. Woman who have health insurance are generally already covered for LARCs, although many of them aren't aware of that, Schulson says. TennCare, Tennessee's Medicaid program, also covers LARCs.

But if women have no health insurance, A Step Ahead will put them in touch with one of the 13 local medical clinics that provide the contraceptives, cover the cost, and even help with transportation. "We reimburse the clinic so the patient pays nothing," Schulson says. "It can cost us as much as $850 and even up to $1,000. We pay for the whole visit, not just for the insertion and the IUD, we pay for Pap smear, pregnancy tests, all of it."

A Step Ahead recommends LARCs, but explains alternative forms of contraception. If a woman chooses a method other than a LARC, A Step Ahead will pay the cost of the medical visit but not the cost of the contraceptive, Schulson said.

Outreach coordinator Susan Vandergriff spends most of her days meeting with local clinics and social agencies, explaining what A Step Ahead does and signing them up for the program. Once they are on board, they can provide LARCs directly, if they are a medical clinic, or refer them to a clinic, in the case of a social service agency.

A typical social service program might be serving a client who is trying to overcome drug or alcohol addiction such as CADAS, the Council for Drug Abuse Services.

Schulson's path to founding A Step Ahead is a winding one. Born in Queens in New York City, she moved to Kansas when she was in the ninth grade and graduated from the University of Kansas where she majored in journalism and advertising. After college, she worked in San Francisco in advertising, and then moved back to Manhattan, where she met her husband, Henry, who was on the staff of the Museum of Natural History. They moved to Dallas when he took a position as head of the natural history museum there, and then to Chattanooga 20 years ago when he became director of the Creative Discovery Museum.

She worked as a freelance writer and as part-time editor for the newspaper published by the Jewish Federation of Greater Chattanooga. But then she heard about A Step Ahead, a program in Memphis that provided long-term contraceptives.

"I'm more of a person who would rather be practical and do something instead of just sit around and argue," she says. "So this called to me immediately when I heard about it."

Schulson got permission to launch her own version of A Step Ahead here, something which encouraged the Memphis program to expand its efforts to several other areas of the state, she said.

Schulson said she does not see any need to change the services A Step Ahead provides, but she wants to continue expanding the number of people it reaches.

"We want our service numbers to go up, but we're not trying to change our model," she says. "We want to keep it as a very simple organization where what we do is to make sure that women have access to the most reliable birth control, and just keep doing more of it."

While the program now offers its services to women in 11 counties in southeast Tennessee, she is still looking for partners in counties outside of Hamilton.

To help recruit more doctors and medical practices to the program, A Step Ahead is hosting its first symposium, on Sept. 29, focused on LARCs and featuring speakers from the Centers for Disease Control and Prevention.

A Step Ahead celebrated serving its 1,000th client last month and Schulson said she is pleased with the positive reception the program has received.

"It's just amazing how this calls to people," she says. "Because everybody knows somebody who has had an unintended pregnancy or they themselves have. There's nobody that's not touched by this."

"We want to change the conversation. We want people to be able to talk freely about birth control," Schulson says. "With one out of every two pregnancies in Hamilton County being unintended, it's not something we can't afford to talk about. We have to talk about it."

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