ST. LOUIS • Taylor Johnson entered foster care like so many teenagers - worn out from years in a neglectful home and scared about moving in with a foster parent she didn't know.

But Johnson carried another burden. Not only did she have to fit into the new foster home, so did her toddler.

Before long, the 15-year-old mother and her foster mom clashed over the rules. The placement failed, and Johnson ended up raising her daughter, Justice, in a group home for young mothers who had no place else to go.

Even that experience didn't prevent her from getting pregnant again. She was 18 and still in foster care when she gave birth to her son, Bryan. For most of the past three years, she raised her children in state care while working odd hours at fast food jobs and shuttling the children to child care on buses.

"I was looking for love in all the wrong places," said Johnson, now 21, while gently brushing her 7-year-old daughter's hair. "I want to tell others, ‘Don't do it.' "

Johnson's story is not unique. Social workers nationwide have long fretted about rampant pregnancies among teens in foster care or those who have recently aged out of the system.

Eight years ago, Curtis McMillen, then a professor of social work at Washington University, set out to find just how bad the problem was in the state.

By 2005, he completed the study, in which researchers interviewed 400 Missouri female foster youths, ages 17 to 19, every three months. The teens lived in eight counties, six of them in the St. Louis region.

At 17, more than a fifth reported having a baby or at one time being pregnant. By 19, the figures more than doubled. About 53 percent had been pregnant or had a baby while in or just aged out of foster care.

"It's sort of known about but rarely talked about in a public forum in Missouri," McMillen said.

In the past year, there's been quiet movement by the Children's Division, a branch of the Missouri Department of Social Services, to take a more active role, triggered in part by doctors and staff at Washington University School of Medicine's teen outreach medical clinic, The SPOT.

The clinic has landed a $2 million federal grant through the Department of Health and Human Services to conduct a five-year pregnancy prevention program aimed at the high number of teens in the St. Louis area who are having babies while in or just after aging out of foster care.

Key to the program is a planned partnership with the St. Louis city and county branches of the state's Children's Division. Both have supported the implementation of the grant among the majority of their foster teens, ages 13 to 18, with the goal of getting the youths to The SPOT for a first visit within 30 days of entering state care.

McMillen said the state had been reluctant to talk about the broader issue publicly because proposing birth control for any teen population is fraught with politics and opposition.

Officials within the Children's Division declined to be interviewed about the program. Instead they provided a letter of support written in May by former Director Paula Neese, who retired in September.

In the letter Neese wrote, "I believe outcomes will improve when information is clear, consistent, coordinated and supported by medical professionals who remain in touch with the youth over time."

A COMPLEX PROBLEM

Child advocates say the high rate of pregnancy among foster youths isn't surprising given their circumstances.

McMillen said the rate in Missouri compares with most U.S. cities, where typically half of youths who have spent time in foster care have one and sometimes more babies before reaching 20. Nevertheless the rate is huge, surpassing St. Louis city's 17.6 percent overall teen pregnancy rate in 2009 - which is already more than 5 percentage points above the teen pregnancy rate in the nation's 50 largest cities.

Female foster teens commonly experience every risk factor for early pregnancy, including broken homes, sexual abuse, substance abuse, family behavioral problems and running away, McMillen said.

McMillen said prevention efforts varied from social worker to social worker. One teen may be getting intensive supervision on birth control, while another may not.

The problem is compounded by the high level of trauma these children endure.

A national Child Trends study indicated that youths who had lived in foster care were far more likely to have experienced forced sex. And McMillen said research by a Washington University colleague suggests that female teens in foster care who had been sexually abused were unresponsive to traditional attempts to discourage risky sexual behaviors.

And there is another psychological issue at play, said Julie Reed of Epworth Children and Family Services, based in Webster Groves. Foster teens yearn for the family experience they never had. Despite warnings, they think having a baby will give them something they deeply need.

"They think having a baby will bring them love," she said.

THE SPOT MODEL

Katie Plax, a physician and medical director of The SPOT, said the federally funded program would go beyond traditional pregnancy prevention by stressing overall healing in a reliable medical setting for a population that's been through traumatic, often abusive events.

"It's that combination that makes the program unique," she said.

The program is based on a proven model endorsed by the federal government for poor urban youths. Kimberly Donica, a program director at The SPOT, said it would provide something the majority of these teens have never had: a familiar doctor and staff.

"We work really hard to build that continuity," she said. "We want them to know that we want them to come and we won't go away."

For youths who may have no other permanent adults in their lives, organizers expect regular contact will keep them focused on their physical and mental health and reduce risky sexual behaviors.

The full program is expected to start in the fall. Teens in state foster care will first get a health screening at The SPOT's drop-in clinic in the Central West End.

Those deemed at risk or sexually active - about 80 percent over the five-year period of the grant - will then be enrolled in the long-term program. They will have follow-up visits at 30 and 90 days with special counseling pertaining to pregnancy prevention as well as access to regular medical and psychiatric care.

The teens will have the final say on whether they participate, but Plax is optimistic they will.

It is far different from what most teens in foster care get now. A national study by the Annie E. Casey Foundation found that a little less than half of the 17- and 18-year-olds surveyed in foster care had ever received information about birth control.

Plax said the solution lay within the program's focus on "healing."

"We see a lot of people who have been really profoundly hurt," she said.

HIGH STAKES

There are about 270 girls, ages 13 to 17, currently in foster care in St. Louis city and county, according to the Missouri Department of Social Services. If the pregnancy rate among that group remains the same, more than half have already had or will have pregnancies in five years.

The SPOT program aims to reduce the rate among foster teens by 10 percent. Plax said that goal was optimistic.

That impact may seem small, but any reduction in those rates will yield taxpayers a huge return, said Greg Echele, director of Family Resource Center, a St. Louis agency that runs a program for teen mothers to improve their parenting and deter additional pregnancies.

Echele said a high percentage of children born to foster children ultimately end up in foster care, costing taxpayers more than $23,000 a year per child. He said those costs didn't include family court expenses or neonatal intensive care costs for premature babies born to teens with no prenatal care. There are also future social costs associated with a population that typically fails to complete high school, has high unemployment and is often involved in juvenile and adult courts.

Johnson is trying her hardest to break the cycle of foster care that has plagued her family. Her mother was adopted out of foster care, but later lost custody of Johnson and her five siblings because of neglect. Some of Johnson's siblings were adopted, but others remain in foster care.

Johnson's children live with her and are doing well in school and child care. She just landed a job with Youth In Need to do street outreach with homeless teenagers. She's a member of a state advisory board on foster care and is active in a support group for former foster youths. She's also engaged to be married.

But she doesn't want her peers to think it's OK to go through what she did - becoming a parent before she had grown up.

"I've lived my whole life in reverse," she said.