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Evidence-Based Interventions. Cybele Boehm HIV/AIDS Program Coordinator Office of Healthy Schools. Objectives. Define Evidence-Based Interventions Discuss the benefits of implementing Evidence-Based Interventions in school settings

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evidence based interventions

Evidence-Based Interventions

Cybele Boehm

HIV/AIDS Program Coordinator

Office of Healthy Schools

objectives
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
evidence based interventions ebis what are they
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
ebis why are they important
EBIsWhy are they important?
  • Proven to be effective:
    • Strong outcome data
    • Tested in various communities
    • Focus on behaviors more amenable to change
ebis in schools matter
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
benefits of using ebis in schools
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
benefits of using ebis in schools1
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
challenges using ebis in schools
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
overcoming challenges
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
are you ready prior to program planning and implementation with schools
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
what our state superintendent says
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”.

questions
Questions?

Cybele Boehm

Office of Healthy Schools

HIV/AIDS Program Coordinator

304-558-8830

cboehm@access.k12.wv.us

slide15

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.

adolescent health initiative
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
adolescent health initiative1
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
adolescent health initiative2
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”
what is abstinence education
What is abstinence education?
  • Abstinence-Only
  • Abstinence-Until-Marriage
  • Abstinence-Only-Until-Marriage
  • Abstinence-Based
  • Abstinence-Centered
what is title v abstinence
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!

funding guidance
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.”

funding guidance1
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].”
funding guidance2
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.”

promoting health among teens
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
promoting health among teens1
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.”
promoting health among teens2
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
other curriculums
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
adolescent health educators
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
adolescent health educators1

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

slide30

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
adolescent health coordinators
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
slide32

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

slide33

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
slide34

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

why it matters teen pregnancy is preventable
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.

it isn t comfortable to talk about sex with a teenager but it is necessary
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.

starting the conversation
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!

evidence based programming
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.
slide41
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.
purpose
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.
family planning
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.
slide45

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

slide47

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??????
slide48

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???????
slide49

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??????
family planning in a sbhc

WHAT??? Lots of counseling/education!!!

  • CONDOMS (everyone, always—my “rule”)
  • Oral contraceptive pills (compliance)
  • Contraceptive patches
  • Nuvaring
  • (~9% pregnancy rate with “typical” use)
  • Depoprovera --every 3 months
    • 6% pregnancy rate with “typical” use
FAMILY PLANNING IN A SBHC
family planning in a sbhc1

“LARCs”—long acting reversible contraceptives:

    • Paragard IUC (10 years)
    • Mirena IUC (5years)
    • Implanon/Nexplanon (3years)
    • (0.8/0.2/0.05% pregnancy rate with “typical” use—latter 2 offer lower pregnancy rates than permanent sterilization)
    • CAN be used in teens
FAMILY PLANNING IN A SBHC
family planning in a sbhc2

STI

    • Prevention (= abstinence or condom use)
    • Screening
    • Adding HIV in-house screening

LOTS OF COUNSELING/EDUCATION!!!!!

FAMILY PLANNING IN A SBHC
family planning in a sbhc3

WHO???????

    • “EVERY PATIENT”
      • Encourage “coached” autonomy
      • Encourage healthy relationship-building with peers and parents/guardians
      • Encourage connectedness between adolescents and caregivers
FAMILY PLANNING IN A SBHC
an example of effective collaboration

“There once was a high school in Sissonville…”

Fall, 2011 Advisory committee: Risk Assessment data (hesitation)

Reality hits:

10 confirmed pregnancies by 12/01/2011

“CRISIS MODE”

An example of effective collaboration:

an example of effective collaboration1

Meetings involving SBHC staff, school counselors and school principal, school nurse, APPI, RSWS, lead county nurse and county superintendent

  • Review of resources
  • Plan:
    • APPI Pregnancy prevention presentation to entirestudent body (county approved)
    • Introduce Reducing the Risk to all 9th graders starting next year (Board approved)
An example of effective collaboration
an example of effective collaboration2

Limited Family Planning program at the SBHC

“all but product” (receive at CHC)

School staff education (same presentation as the students)

School staff involvement (resource for students)

An example of effective collaboration
an example of effective collaboration3

Results:

NO known conceptions

occurred between time of APPI presentation/start of Family Planning at SBHC (2/24/12) and the last day of school!!!!!

RTR to be introduced into curriculum Fall, 2012

An example of effective collaboration
slide61

To Be Continued…

      • Have APPI return biannually
      • Work with new school administration and Advisory Committee to introduce some Family Planning product/expand Family Planning services in SBHC
      • Add HIV in-house screening in the fall