Hennepin County's nationally recognized teenage pregnancy prevention program has won a significant victory in court against the Trump administration, which seeks to defund it as part of its public health focus on abstinence.
On Friday, a district court judge in Washington, D.C., ruled that the U.S. Department of Health and Human Services (HHS) must process the county's grant application for more than $3 million in funding. The money is critical to keeping the program afloat, and a loss in court would have meant the potential loss of 20 health educator jobs and the closing of a clinic.
Judge Ketanji Brown Jackson agreed to put Hennepin County and nearly 80 other grantees throughout the country in a class-action suit filed by a group in Texas, and she granted summary judgment in their favor. She ruled that the government's termination of the more than $214 million in program funding violated administrative policy and was arbitrary and capricious.
"We are pleased with the outcome," said Hennepin County Commissioner Mike Opat. "The federal government made a deal with the county, and the Trump administration tried to break it. We feel like we are doing the right thing and now can continue to keep doing it."
If the suit had failed, Opat said the board could have only partly replaced the funding.
HHS has 60 days to appeal. The department could deny the county's application, but it's a noncompetitive grant and the county has received favorable reviews in the past, said Dan Rogan, civil division manager for the County Attorney's Office.
"We believe they have no legal basis for our application to be denied," he said.
HHS argued that lawsuits weren't filed in a timely manner and that it would be unfair to be forced to accept the current grantees because the agency has spent millions of dollars on new program requirements.
The federal Teen Pregnancy Prevention Program was created under former President Barack Obama in 2010 and has funded organizations working to prevent teen pregnancy through a variety of programs, including some that were abstinence-focused.
Hennepin County received its first grant in 2010 and started the Better Together Hennepin initiative with it. The county cultivated relationships with health care providers and school districts to position it for the second phase of the program, which focused on geographical areas with the highest birthrates.
From 2007 to 2016, teen pregnancies in Hennepin County fell by 64 percent, from 1,152 to 418. In 2016, the county's teen birthrate was lower than state and U.S. averages. More than 13,500 students in 33 schools have received the program's curriculum since 2015, and the county expects that total to double in the next two years.
The string of lawsuits started after the government terminated funding in May 2017. Five-year grants that initially had been approved through June 2020 would have ended this month. In addition, if counties want to reapply for new funding, they must shift the focus of their prevention programs to abstinence education.
Under new Trump administration requirements for the federal program, applicants now must choose between two program tools: a sexual risk avoidance model, which encourages teens to avoid sex, or a sexual risk reduction model, designed to reduce sexual behaviors in teens who may already be sexually active. The guidelines don't say that groups can't teach about contraception and safe sex, but those topics can no longer be the focus.
Before the requirement changes, HHS's Office of Adolescent Health, which provided the teen pregnancy prevention grants, compiled a list of the best education curricula based on evidence-based programs. Those are programs that have been rigorously evaluated and found to have significant outcomes on intended behaviors. Abstinence programs were also on the list, but the county decided that wasn't the most effective approach.
One of the most successful programs in Better Together Hennepin is run at the Annex Teen Clinic in Robbinsdale. Opened in 1971, it's a sexual health clinic for young people up through age 26. The clinic receives $430,000 annually.
The Annex Teen Clinic developed a curriculum that is presented to middle and high school students in the Robbinsdale and Brooklyn Center school districts, because it was determined that teens in those communities had birthrates higher than the national average.
Teachers are trained to present the program with a facilitator, giving age-appropriate medical information and discussing decisionmaking, values and healthy relationships, said Ellen Saliares, the clinic's director of sexuality education.
"We also encourage the students to talk to their parents or a trusted adult," she said. "But many students come up to the facilitators after a presentation."
Another important element of the program is its Youth Leadership Councils. Students lead community-mobilizing efforts to create safer schools, more adolescent-friendly clinics and to get their peers talking about what it takes to be healthy, Saliares said. Last year, 48 students participated.
Beyond the statistics for teen pregnancies, Better Together Hennepin's success is measured by student surveys, observation of educators and self-evaluation by the educators. And there are the dozens of stories she hears from the students.
"There is just a lack of resources to fund evidence-based programs, so keeping our funding was critical," she said.