Addressing the Pregnancy, STI and HIV Prevention Needs of At-risk Populations in San Diego County

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1 Addressing the Pregnancy, STI and HIV Prevention Needs of At-risk Populations in San Diego County REDUCING THE RISK AND THE TEEN HEALTH EMPOWERMENT STUDY THURSDAY, FEBRUARY 13 TH 2014 SAN DIEGO YOUTH SERVICES AND SANDAG (San Diego Association Of Governments)

2 Workshop Objectives 1) Describe participation in a large-scale, national replication study of an evidence-based pregnancy prevention curriculum 2) Discuss challenges and successes of participating in a rigorous evaluation 3) Share best practices related to delivery of an evidence-based curriculum 4) Describe the initial, first-year descriptive information about the sexual risk-taking and level of sexual activity of at-risk youth 2

3 Grant Background OAH is administering a five-year federally funded study to support evidence-based teen pregnancy prevention approaches The project described was supported by Grant Number TP1AH from the HHS Office of Adolescent Health Contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services or the Office of Adolescent Health TPP addresses rising teen pregnancy rates SDYS is implementing and evaluating Reducing the Risk (RtR) 3

4 Grant Background Teen Pregnancy Prevention Program Funding through the Office of Adolescent Health (within the U.S. Department of Health and Human Services) Emphasis on evidence-based and innovative programming Rigorous evaluation requirements SDYS is one of 75 Tier 1 grantees providing evidence-based programming Federal evaluation of evidence-based programs Rigorous experimental evaluation of a select number of evidence-based program models Focus on replication SDYS is one of 10 selected grantees for the Federal Replication Study Updated information about program effectiveness Existing evidence base is limited 4

5 SDYS TPP/CAT+ Collaborative Two separate studies conducted at the same time Community-based study Conducted in partnership with agencies CAT programs (Community Assessment Teams) Smaller groups, 6-12 youth School-based study Conducted in partnership with local schools PE curriculum Science curriculum Larger groups, youth 5

6 SDYS TPP/CAT+ Collaborative Implemented across San Diego County Five partner agencies (San Diego Youth Services, South Bay Community Services, SAY San Diego, North County Lifeline, Mental Health Systems) Conduct a replication study of the RTR curriculum Previous research on RtR conducted in 1991 and

7 SDYS TPP/CAT+ Collaborative Program Goals To reduce incidents of teen pregnancy and STI s among high risk youth populations throughout the county RtR is implemented in known teen pregnancy hot spots throughout the county To deliver, with fidelity, RtR to youth ages who are enrolled in SD schools or CAT/Diversion programs To conduct a replication study of RtR to further the knowledge about the effectiveness of RtR with high risk populations 7

8 SDYS TPP/CAT+ Collaborative Successes Maximize agency relationships in each community Serve larger number of youth Shared resources Trainings Ability to learn from partner agencies Access to federal resources Trainings, newsletters, webinars, consultation Challenges Transition from service provider to researcher Treatment vs. Control Increased workload for staff Informed consents School districts and community barriers Hesitant to allow a sexual health curriculum in schools/communities Recruitment from CAT/Diversion often a challenge 8

9 SDYS TPP/CAT+ Collaborative Best Practices Ongoing staff training on RTR New staff training and Booster staff training Additional trainings Trauma-informed Care; Teaching Sexual Health to Adolescent Males; Teens and Technology Fidelity Monitoring Measured by facilitators and outside observers Culturally competent and Trauma-informed staff Support from community stake-holders (schools, parents, agency staff) 9

10 Reducing the Risk The goal of RtR is to provide an educational intervention that will reduce the rate of teen pregnancy prevention, STI and HIV infection by decreasing sexual risk-taking behaviors and increasing abstinence or the use of protection. 10

11 Reducing the Risk RtR is based on 3 health behavior theories Social Learning Theory Social Influence Theory Cognitive-Behavioral Theory These theories hypothesize that in order to reduce risktaking behavior, people need to: Learn and personalize relevant information Recognize social pressures and anticipate risky situations Establish norms for positive behaviors Learn and practice skills to act on the information and cope with social pressures 11

12 Reducing the Risk The three health behavioral theories address the following risk factors associated with teen pregnancy and STI/HIV: Knowledge alone does not result in change Negative social pressure Lack of skill 12

13 Knowledge alone does NOT result in change Barrier: Invincibility mindset of teens This won t happen to me RtR solution: Present facts and personalize the information for the youth so that they find it relevant to their own lives Example: A Lunchtime Chat (pg 147) 13

14 Negative Social Pressure Barrier: Negative social pressures influence teens to engage in risk-taking behavior RtR solution: Examine common social pressures Explore norms of abstinence and protected sex Share stats about abstinence among teens Teach teens to anticipate and prepare for risky situations Example: At a Party (page 81), Refusal or Delay Quiz (Page 95) 14

15 Lack of Skill Barrier: Teens unable to USE what they ve learned RtR solution: Teach and practice skills: Communication skills Refusal skills and delay tactics How to talk to responsible adults about sex Personalize skills and make relevant to THEM MadTV Can I get your number? skit Example: Time for a Condom Roleplay, pg

16 Research Purpose Identify best practices in the teen pregnancy prevention field through rigorous research Nation s eyes are on San Diego One of 10 sites chosen to be a part of the national evaluation Only site offering services in the community Local and National research 16

17 Overview: Evaluation Design Experimental design with random assignment Random assignment to either RtR or treatment as usual Creates similar groups like characteristics Allows any treatment effect to be attributed to the intervention rather than possible differences between the two groups Four-year study period (2011 to 2016) 950 sample size (95 youth per year for two years, per agency) 2 to 1 random assignment (633 RtR & 317 treatment as usual) Three data collection points Intake, 12 & 24 months post-intake 17

18 What San Diego has Accomplished 2,624 youth have received RtR programming On average, youth attended 84% their assigned lessons (13 lessons on average) 184 RtR groups occurred during the first half of the project Completion of all randomized youth Completion of a 90% follow-up rate for year one cohort 18

19 Youth Characteristics More females (53%) than males (47%) Two-thirds were either 14 or 15 years old The majority of youth were Hispanic (63%) Over one-quarter (28%) reported having had sex prior to starting RtR Percent having had sex prior to starting RtR 100% 80% 60% 40% 20% 0% 16% 41% 25% 10% 7% 1% >= 18 Age 19

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25 Realities of Research and Program Delivery Provides valuable information on what is working and what does not Will inform policy and program development Difficult transition for social service staff Limits flexibility and spontaneity Additional paperwork for youth and staff 25

26 RTR Research Findings Initial research from first round of evaluation: Increased knowledge about contraceptives, pregnancy risk and STI/HIV infection Increased communication with parents about abstinence and birth control Delayed initiation of intercourse among adolescents who had not initiated sexual intercourse at pretest Reduced likelihood that students who had not initiated sexual intercourse at pretest would have unprotected intercourse during the next 18 months 26

27 Lessons Learned RtR seems to be most effective when delivered early years old RtR seems to be more effective when delivered in school Higher attendance rates Special populations need a more targeted approach/program Juvenile detention centers, pregnant or parenting teens 27

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