California Foster Youth Pregnancy Prevention Institute

1. California Foster Youth Pregnancy Prevention Institute with support from the Conrad N. Hilton Foundation Webinar | September 3, 2014

2. AGENDA • Introduction of Institute Partners • Overview of the Issue • Understanding SB 528 • California Foster Youth Pregnancy Prevention Institute • Past Successes with the Teen Pregnancy Prevention Integration • Institute Participant Activities and Institute Timeline • Application Information • Questions and Closing

3. Institute Partners and Presenters: • Amy Lemley, John Burton Foundation • Phil Basso, American Public Human Services Association • Rebecca Griesse, The National Campaign to Prevent Teen and Unplanned Pregnancy • Mary Doyle, Representative from the Minnesota TPP Integration Team • Cecilia Tran, John Burton Foundation

4. Compared to their non-foster peers: Foster youth are more likely to: • Begin having sexual intercourse at an earlier age • Have more sexual partners • Use contraceptives more inconsistently • Experience intimate partner violence that includes forced sex Foster youth are more likely to: • Experience teen pregnancy and child bearing • Contract sexually transmitted infections (STI)

5. Cumulative Percentage of Girls in a Los Angeles County Foster Care Placement at Age 17 Who Had a First Birth as a Teen, 2003-2007

6. 21 year old men who impregnated a partner or fathered a child:

7. The number of older youth in foster care has increased considerably

8. Key Findings from a Study of Foster Youth in LA County: • By age 5, children born to teen mothers who had been in out-of-home care were abused and neglected at twice the rate of other children • 1 in 3 girls in foster care who gave birth before they turned 18 will have at least one more teen birth • Even with controls for other health factors, maternal history of being in neglected or abused was a predictor of infant low birth weight.

9. SB 528: Pregnant and Parenting Youth in Foster Care Key Components: • Establishes foster youth’s right to access sexual development and reproductive health information and services • Requires counties to collect data on parenting foster youth and DSS to make it publicly available • Authorizes child welfare agencies to have specialized planning conferences to update case plans when a foster youth is pregnant

10. SB 528: Pregnant and Parenting Youth in Foster Care • Chaptered in September 2013 • A core component of the bill establishes that foster youth ages 12 and older have the right to receive health services and age-appropriate, medically-accurate information relating to: • The prevention of unplanned pregnancy • The prevention and treatment of sexually transmitted infections (STI) • Authorizes social workers to inform foster youth about these rights and assist with accessing these health services.

11. Foster youth are not accessing pregnancy prevention information: • Between fiscal year 2007-2008 and 2012-2011, the state cut funding for teen pregnancy prevention programs by $33.5 million • While some new federal funds have been accessed by the state, the $5 million was to be distributed among 21 agencies in 2012-13. • 72% decrease in TPP funding • 94% reduction in participants served by TPP programs

12. How can the California Foster Youth Pregnancy Prevention Institute make a difference?

13. The California Foster Youth Pregnancy Prevention Institute Institute Goal: The Institute will partner with six county teams consisting of 3-5 individuals from each county’s child welfare agency to incorporate pregnancy prevention strategies into services for foster youth

14. Institute Approach: The Institute will provide the tools and technical assistance to help counties develop county policies that are compatible with the needs of that region, taking into consideration local resources and existing pregnancy prevention efforts.

16. Organizational Effectiveness is a systemic and systematic approach to continuously improving an organization’s performance, performance capacity and client outcomes. Why Use OE?The sustainability and impact of practice innovations and policy reforms are enabled by well-aligned organizational capacity, sound organizational functioning, and a culture of continuous improvement. Since 2004, APHSA’s OE practice has been developed and used in over 30 states through more than 75 projects. APHSA OE has recently been evaluated, with strong connections found between using OE tools, implementing desired changes, improving organizational functioning, improving agency partnerships, and improving the impact on those served.

17. Why Use OE for this Institute? • To move the actual work forward during and between sessions! • An up-front readiness review: “How fast, how much, and with what support?” • Up front work on an effective change management structure • Access to curriculum options and how best to embed them in practice • Access to OE tools based on your actual challenges and obstacles • Help in selecting a set of solutions that address the reasons for current gaps • Reinforcement of essential resource management and monitoring activities • Ongoing peer to peer learning, support and exchange • Dedicated team time away from your day jobs • National visibility of the great work you’re doing

18. Examples of OE Tools: Sponsor group charters for improvement & implementation teams The “DAPIM” Flywheel Communication planning Continuous improvement planning Assessing current readiness for change Topic-specific improvement tools including those for trust, retention, staff buy-in, and partnerships Managing meetings and facilitating teams Using data to monitor progress, impact, lessons, and adjustments to make

19. Define Work products – baseline surveys and measures, alignment notes, initial feelings, ground rules, defined areas for improvement Monitor Assess Work products – monitoring quick wins, and other changes, evaluations and measures of progress and impact Work products – findings: strengths and gaps, root causes and general remedies Performance & Capacity Implement Plan Work products – team activities, action plans, charters for working teams, communication efforts Work products – quick wins, mid- and long- term improvement plans, communication and capacity plans Sneak Peek at the “DAPIM” Flywheel and Work Products

20. Two Examples of OE Helping Agencies: • Charlottesville, VA (through an Institute) • Hampton, VA

21. Has this approach been tried before?

22. Integration of Teen Pregnancy Prevention into State and Local Child Welfare Systems Project: • The TPP Integration project adapted an evidence-based curriculum Making Proud Choices: An Adaptation for Youth in Out-of-Home Care (MPC+). • Worked with 5 state and local teams with different levels of needs and resources to implement the MPC+ curriculum: • Alameda County, California • Hawaii • Minnesota • North Carolina • Rhode Island Most counties experienced budget constraints and overcame these barriers by building curriculum into existing systems.

23. Implementation: What did we learn from the Institute? • Institute framework and written plans were helpful • Dedicated time to work as teams away from normal, busy schedules was important • Idea exchange, collaboration & networking aspect across states were also very helpful • Varied representation/diversity across sites Teams increased cross-collaboration, particularly between child welfare and public health

24. TPP Integration Successes • Trained 333 foster youth participants with the MPC+ curriculum: • 88% of participants said they learned more about pregnancy prevention • 89% of participants said they learned more about STI prevention • 86% of participants said they enjoyed the class • Developed strong networks with individuals from private and public agencies from child welfare and public health sectors • Identified and filled gaps of service in existing systems • Sustainability plans were set in place to ensure that the work continued after the TPP Integration project ended

25. State Successes: • Hawaii: Implemented MPC+ in 3 out of 4 ILPs statewide. • Alameda, CA: Presented MPC+ curriculum overview to 1100+ child welfare staff and caregivers • Rhode Island: Integrated MPC+ into state-wide Life Skills program

26. Minnesota’s Experience with TPP Integration: Reasons for Participation: • MN Dept of Health and Dept. of Human Services: Birth rate of youth who had been in care for more than 30 days was 2.5 times the rate of the general population of girls ages 15 to 19. • Implications for long term education and employment outcomes. Method: • Collaborated with state-funded Independent Living Programs, a correctional site, and a mental health site for youth to implement the Making Proud Choices for foster youth. • Program promotions and additional services provided • Trained social workers on MPC curriculum and on sexual health and development basics with help from public health partners.

27. Minnesota Experience: Outcomes: • Increased awareness and coordination between public health and child welfare systems • Social workers: Knowledge of the population/trauma-informed care • Public health workers: Sexual development and sexual health knowledge • Sustainable training model: Youth workers are spreading the trainings to other foster youth service providers after they learn it • Broad and continued interest in utilizing the curriculum and training TPP Integration

28. Institute Timeline: Dec. 8-9, 2014 Feb. 26-27, 2015 April 20-21, 2015* Oct. 15, 2014 Sept. 23, 2014 Oct. 29, 2014 May to Oct. 2015 *All Institute sessions will take place in Los Angeles

29. Institute Costs:

30. Participant Activities: • Attend three, 2-full day in-person sessions that will take place in Los Angeles to learn about pregnancy prevention strategies and organizational effectiveness tools to support their implementation and impact • Engage in intersession workin which models, tools, and strategies from Institute sessions are adapted and applied for use at the county level • Provide baseline data, process data, and ending datato the evaluation team for project planning and implementation assessment • Assist in developing case studiesformulated by the institute team on each participating county

31. Intersession Work: The Sponsor Group consists of senior agency leaders and others with the authority to secure resources and provide direction for pregnancy prevention efforts. • Forming and briefing a Sponsor Group • Forming and leading a Continuous Improvement Groupwith support from an Institute staff liaison • Creating a series of change management work products • Implementing change plans and launching related work teams The CI Group consists of public and private partners, staff at different departments or levels of the agency, and foster youth or foster parents who develop and help implement specific strategies for reaching related goals.

32. Interested in Participating in the Institute? • Applications can be found here • Application Due Date: October 15, 2014 by 5 pm. • Completed applications should be sent to: Attn: Cecilia Tran John Burton Foundation 235 Montgomery St. Suite 1142 San Francisco, CA 94104 Please feel free to contact Cecilia Tran at cecilia@johnburtonfoundation.org with or at (415) 693-1323 with any questions.

33. Any Questions?

34. Thank you for your participation!

35. Sources American Public Human Services Association (2010).  Positioning Public Child Welfare Guidance, Section on Change Management.  To be found at ppcwg.org  Basso, P., Cahalane, H., Rubin, J., & Jones-Kelly, K. (2013). Organizational Effectiveness Strategies for Child Welfare. In H. Cahalane (ED.), Contemporary Issues in Child Welfare Practice (pp. 257–287). New York; Springer Midwest Evaluation of the Adult Functioning of Former Foster Youth: At Age 19 Midwest Evaluation of the Adult Functioning of Former Foster Youth: At Age 21 Malvin, J; J. Yarger & C. Brindis (2013). Teen Pregnancy Prevention in California after State Budget Cuts. Bixby Center for Global Reproductive Health, Philipp R. Lee Institute for Health Policy, University of California, San Francisco. Manlove, J; K. Welti, M. McCoy-Roth, A Berger & K. Malm. (2011). Teen Parents in Foster Care: Risk Factors and Outcomes for Teens and their Children. Washington, D.C. Child Trends. Ng, A. S., & Kaye, K. (2013). Why It Matters: Teen Childbearing and Child Welfare. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy. Putnam-Hornstein, E.; J. Cedarbaum, B. King, & B Needell. (2013). California’s Most Vulnerable Parents: When Maltreated Children Have Children. Los Angeles, CA. Conrad N. Hilton Foundation.