Evidence-Based Interventions

1. Evidence-Based Interventions Cybele Boehm HIV/AIDS Program Coordinator Office of Healthy Schools

2. Objectives • Define Evidence-Based Interventions • Discuss the benefits of implementing Evidence-Based Interventions in school settings • Identify the “secret” behind effective school-based prevention programs

3. Evidence-Based Interventions (EBIs)What are they? • Based on rigorous evaluation • Shown to be effective in changing at least one of the behaviors that contribute to early pregnancy, STI and HIV infections

4. EBIsWhy are they important? • Proven to be effective: • Strong outcome data • Tested in various communities • Focus on behaviors more amenable to change

5. EBI Resource

6. EBIs in Schools Matter! • High teen pregnancy and STD rates among school-age young people • Most children and adolescents enrolled in school • Schools can reach youth before sexual activity begins • Impacts academic achievement

7. Benefits of Using EBIs in Schools • Maximum return on investment • Packaged curriculum • Efficient use of available and/or limited resources • Funders requesting use of EBIs

8. Benefits of Using EBIs in Schools • Increase program success • Can be aligned with district policy requirements & health standards • Can be used by facilitators with different skill levels • Consistency and awareness of what teachers are teaching • Already familiar with using evidence-based models

9. Challenges Using EBIs in Schools • Competing priorities for core subjects • Community support/buy-in • Too narrow in focus – not comprehensive • Funding • Teacher discomfort with topics

10. Overcoming challenges • Assess priority population • Identify programs that fit with target population, community and organizational capacities • Align with policies/standards • Use language that schools already understand • Identify champions • Include school/community stakeholders • Build skills – through TA & training

11. What is the “secret”?

12. Are you ready?Prior to program planning and implementation with schools: • Assess • Readiness • Willingness • Capacity • Create a plan for next steps • Based on level of readiness • For building capacity (TA, training, community mobilization) • To engage stakeholders at all levels

13. What our state superintendent says… “Teen pregnancy can have serious effects on our schools and communities. School dropout rates are higher among girls who give birth during high school. In addition, children born to teen parents are at greater risk for poor health and education outcomes due to increased chances of growing up in poverty and unstable homes. They are also more likely to start kindergarten at a disadvantage than children born to older parents. It is in this context that we need to increase our efforts in public schools by working collaboratively with community partners to address this issue. Preventing teen pregnancy is a challenge that teens, parents, school administrators, policy makers, and society at large must take on”.

14. Questions? Cybele Boehm Office of Healthy Schools HIV/AIDS Program Coordinator 304-558-8830 cboehm@access.k12.wv.us

15. West Virginia Department of Health and Human Resources Bureau For Public Health Office of Maternal, Child and Family Health Division of Infant, Child and Adolescent Health Adolescent Health Initiative 1-800-642-8522 wvdhhr.org/ahi Patty McGrew, Director Patty.F.McGrew@wv.gov The underlying philosophy of the Adolescent Health Initiative is holistic, preventive, and positive focusing on the development of assets and competencies in youth as the best means for fostering health and well-being and for avoiding negative choices and outcomes.

16. Adolescent Health Initiative • Promotes positive health outcomes for adolescents • Physical • Emotional • Cognitive • Utilizes a positive, “whole child” approach to risk behavior reduction • Increasing protective factors • Increasing parental involvement and communication • Increasing community involvement

17. Adolescent Health Initiative • Focus Areas: • Adolescent Violence (bullying) • Alcohol, tobacco and illegal drug use • Obesity, physical fitness and nutrition • Adolescent depression and suicide • Injury prevention (seatbelt use, helmet use, impaired driving, etc.) • Teen pregnancy prevention

18. Adolescent Health Initiative • Adolescent Health Coordinators • Community-Based • Funded by the Title V Block Grant • Primary focus is positive youth development • Utilizes environmental strategies • Centered on Search Institute’s 40 Developmental Assets • Adolescent Health Educators • School-Based • Funded by Title V State Abstinence Education Grant Program • Primary focus is teen pregnancy prevention • Utilizes evidence based curriculums, i.e. “Promoting Health Among Teens”

19. What is abstinence education? • Abstinence-Only • Abstinence-Until-Marriage • Abstinence-Only-Until-Marriage • Abstinence-Based • Abstinence-Centered

20. What is Title V Abstinence? • Often “labeled” or “stereotyped” • Incorrect assumptions: • Does not provide services to sexually active students • Discriminates against LGBTQ youth • Is a “virginity” program • Does not discuss contraception • Is not “comprehensive” It’s not about titles—it’s about content!

21. Funding guidance: “States are encouraged to develop flexible, medically accurate and effective abstinence-based plans responsive to their specific needs. These plans must provide abstinence education, and at the option of the State, where appropriate, mentoring, counseling, and adult supervision to promote abstinence from sexual activity, with a focus on those groups which are most likely to bear children out-of-wedlock.”

22. Funding guidance: “The Administration for Children and Families encourages States to consider the following approaches as they seek to design effective programs: • The research on effective abstinence programs suggest that they are based on sound theoretical frameworks (e.g., social cognitive theory, theory of reasoned action, or theory of planned behavior, etc); • The use of intense, high dosage (at least 14 hours) programs implemented over a long period of time [Kirby, 2001]; • The use of programs that encourage and foster peer support of decisions to delay sexual activity [Trenholm 2007]; • The use of programs that select educators with desired characteristics (whenever possible), train them, and provide monitoring, supervision, and support [Kirby 2007]; and, • The use of programs that involved multiple people with expertise in theory, research, and sex and STD/HIV education to develop the curriculum [Kirby 2007].”

23. Funding guidance: “As States design their programs, ACF also encourages them to consider the needs of lesbian, gay, bisexual, transgender, and questioning youth and how their programs will be inclusive of and nonstigmatizing toward such participants.”

24. Promoting Health Among Teens • Evidence based recognition by the HHS/Office of Adolescent Health, National Campaign to Prevent Teen and Unplanned Pregnancy, etc. • Differs from stereo-typical “abstinence-only” curricula: • The message isn’t “abstinence until marriage” • Based on behavior change theory, not moralistic views or political language • Does not disparage the use of condoms or any form of contraception and encourages discussion

25. Promoting Health Among Teens • Curriculum is labeled as abstinence-only “….because it focuses entirely on knowledge, attitudes, and skills that encourage and assist young people in implementing abstinence in their relationships.” • “Only the use of latex or polyurethane condoms are approved of in this text. Students should be constantly reminded that only condoms consisting of one of these materials can help stop the acquisition of STDs.”

26. Promoting Health Among Teens • Getting to Know You and Steps to Making Your Dreams Come True • Puberty and Adolescent Sexuality • Making Abstinence Work for Me • Consequences of Sex: HIV/AIDS • Consequences of Sex: Sexually Transmitted Diseases • Consequences of Sex: Pregnancy • Improving Sexual Choices and Negotiation • Role Plays: Refusal and Negotiation Skills

27. Other curriculums: • Draw The Line, Respect the Line • Evidence based • Middle school • More information available www.etr.org • Reducing the Risk • Evidence based • High school

28. Adolescent Health Educators • The Adolescent Health Educators (AHEs) provide medically accurate sexual educational classes and parent seminars • Have been fully trained in evidence-based interventions • Extensively trained in medical accuracy • Extensively trained in fidelity implementation and programs are monitored for compliance • The AHEs work with local groups to design programs which respect the values and concerns of the community. • Free resource materials • Make referrals for contraceptive services and/or STI testing

29. HANCOCK BROOKE OHIO Regeneration, Inc. MARSHALL MONONGALIA WETZEL MORGAN PRESTON MARION TYLER BERKELEY HAMPSHIRE JEFF- PLEAS- ANTS MINERAL TAYLOR ERSON DODD- HARRISON RIDGE WOOD RITCHIE GRANT BARBOUR TUCKER HARDY LEWIS WIRT GILMER JACKSON UPSHUR CAL- RANDOLPH MASON HOUN BRAXTON ROANE PENDLETON Rainelle Medical Center CLAY WEBSTER CABELL PUTNAM KANAWHA NICHOLAS POCAHONTAS LINCOLN FAYETTE BOONE GREENBRIER WAYNE MINGO LOGAN RALEIGH WYOMING SUMMERS MERCER MONROE MCDOWELLL Community Action of SE WV AHI State Office Adolescent Health Educators Wetzel County Commission *PHAT *PHAT *Draw the Line Valley Health *PHAT *PHAT *Draw the Line *Reducing the Risk *PHAT *Draw the Line *Reducing the Risk

30. AHE Contact Information • Darla Thomas • Rainelle Medical Center • 304-438-6188, Ext 1082 • dthomas@rmchealth.org • Brad Riser • Regeneration, Inc. • 304-643-4187 • ritprojectchat@yahoo.com • Theresa Hoskins • Wetzel County Commission • 304-771-8533 • wcfrn@yahoo.com • Jim Pettus • CASE WV • 304-888-6370 • jpettus@casewv.org • Cathy Davis • Valley Health • 304-617-880 • cdavis@valleyhealth.org

31. Adolescent Health Coordinators • The Adolescent Health Coordinators (AHCs) work to implement environmental strategies to produce positive health outcomes and reduce risk behaviors in youth • Utilize a positive youth develop approach to programming based on Search Institute’s 40 Developmental Assets • AHCs actively collaborate with local partners to link adolescents in need of preventive health care • AHCs work with local groups to design programs which respect the values and concerns of the community. • Free resource materials

32. Region 6 Hancock Adolescent Health Coordinators Dara Pond Brooke Marshall County Family Resource Network Ohio I70 Region 7 Region 5 Marshall Idress Gooden Stella Moon I81 Monongalia RESA VII Wetzel Morgan I68 RESA V Pleas - Marion Berkeley Tyler Preston ants I79 Mineral Jeff - Taylor Dodd - Harrison Hampshire erson 50 ridge Wood Grant Ritchie Barbour Tucker Wirt Hardy Region 3 Lewis 33 Cal - Gilmer Region 8 houn Jackson I79 Upshur Randolph Margo Friend Mason I77 Roane Braxton Pendleton United Way of Central WV Christine Merritt 35 Pendleton Community Cabell Putnam Webster I79 Clay Care I64 Nicholas Kanawha Pocahontas Region 4 19 Wayne Lincoln I77 Boone Fayette Nonie Roberts Greenbrier 119 New River Health Association Mingo Logan Raleigh I64 Region 2 Wyoming Sum - Monroe mers Region 1 Cathy Davis Mercer Denotes lead agency location McDowell Valley Health Vacant Systems, Inc. RESA I I77

33. AHC Contact Information • Vacant • RESA I • 304-256-4712, Ext 1120 • Cathy Davis • Valley Health • 304-617-880 • cdavis@valleyhealth.org • Margo Friend • United Way • 304-340-3622 • ahiuwcwv@yahoo.com • Nonie Roberts • New River • 304-877-6342 • nonieroberts@suddenlink.net • Stella Moon • RESA V • 304-485-6513, Ext 120 • smoon@access.k12.wv.us • Dara Pond • Marshall FRN • 304-845-3300 • ahicoordinator@comcast.net • Idress Gooden • RESA VII • 304-624-6554, Ext. 245 • igooden@access.k12.wv.us • Christine Merritt (Ret. June 30th) • Pendleton Community Care • 304-358-2531 • cmerritt@pcc-nfc.org

34. Adolescent Health Initiative State Office 1-800-642-8522 wvdhhr.org/ahi Patty McGrew, Director Patty.F.McGrew@wv.gov 304-356-4360 Trina Walker, Assistant Trina.K.Walker@wv.gov 304-356-4421

35. Questions?

36. Helmet required! Adolescent pregnancy prevention initiative

37. Why it matters…Teen pregnancy is preventable! Compared with their peers who delay childbearing, teen girls who have babies are: • Less likely to finish high school; • More likely to be poor as adults; • More likely to rely on public assistance; and • More likely to have children who have poorer educational, behavioral, and health outcomes over the course of their lives than kids born to older parents. For these and many other reasons, a key priority is to reduce teen pregnancies.

38. It isn’t comfortable to talk about sex with a teenager…but it is necessary! I want to talk to her but I’m afraid I’ll say the wrong thing. Knowledge is Power! When it comes to sex… • Teens are naturally curious. • Parents are naturally terrified. I wish I could ask my mom.

39. Starting the conversation • Be prepared! • You wouldn’t let them ride a bike without a helmet or drive a car without learning the rules of the road. • Share your expectations! • Model Healthy Relationships. APPI Specialists can help get the conversation started!

40. Evidence Based Programming APPI staff is fidelity-trained by the publisher in the following Center for Disease Control and Prevention (CDC) identified evidence-based curricula (EBC): • Reducing the Risk • RTR emphasizes teaching refusal skills, delaying tactics and alternative actions. Students can use these skills in a multitude of settings to abstain from risky behaviors and make healthier decisions. • Making Proud Choices • Making Proud Choices provides youth with knowledge, confidence and the skills necessary to change their behaviors • Wise Guys • Wise Guys curriculum is rated as “promising”, it focuses on comprehensive sexuality education from a male perspective and for a male audience.

41. APPI 2007-2011 • During the past five years, APPI Specialists have conducted more than 2,000 presentations reaching nearly 70,000 West Virginia students with State mandated, medically accurate, comprehensive sexuality education. • APPI has distributed 350,000 pieces of literature to further help educate the public about sexual health and reproductive options.

42. Purpose  APPI is a focus area of the Family Planning Program. Presentations are abstinence based, but also do include information about contraceptive methods, introduction to reproductive life planning and information about sexually transmitted infections. • APPI is used as a resource by teachers, school nurses, community service organizations and the juvenile justice system throughout the state.

43. Family Planning • The West Virginia Department of Health Human Resources Family Planning Program has at least one provider in every county. • Services are available confidentially at low or no cost to teens. No one is denied services because of inability to pay. • Family planning clinics help teens by providing counseling and guidance about birth control methods. • They help women plan and space their pregnancies and avoid mistimed, unwanted or unintended pregnancies, reduce the number of abortions, lower rates of sexually transmitted diseases, and significantly improve the health of women, children and families.

44. Talk!

45. West Virginia Department of Health and Human Resources Bureau For Public Health Office of Maternal, Child and Family Health Family Planning Program West Virginia’s Adolescent Pregnancy Prevention Initiative APPI influences and supports teens as they explore and determine responsible sexual and reproductive options for their further. Adolescent Pregnancy Prevention Initiative

46. Evidence-Based Interventions and Approaches for addressing teen pregnancy in west virginia

47. Between 2007-2009, WV was the only state in the country to have an INCREASE in teen births (teens aged 15-17). Teen birth rate in WV increased 17% during this time frame WHY??????

48. 2011 CDC Youth Risk Behavior Survey data: • 50.9% of WV high school students are sexually active. • 60.3% of those sexually active teens report not using condoms the last sexual encounter • 74.1% of active teens report not using birth control pills or depo-provera injection at the time of their last sexual encounter (2009 data) (?this may be skewed) WHY???????

49. 39.4% report having intercourse within the 3 months prior to taking the survey 12.4% admit to at least 4 or more lifetime partners 19.8% of sexually active teens acknowledge drug/alcohol use before last intercourse WHY??????

50. Pregnancy rate for teens not using any contraception: • Pregnancy rates for condom use: WHY????????? 87% 18%