Evidence-Based Interventions - PowerPoint Presentation

Slide1

Evidence-Based Interventions

Cybele Boehm

HIV/AIDS Program Coordinator

Office of Healthy SchoolsSlide2

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 Slide3

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 infectionsSlide4

EBIs

Why are they important?

Proven to be effective:

Strong outcome data

Tested in various communities

Focus on behaviors more amenable to changeSlide5

EBI ResourceSlide6

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 achievementSlide7

Benefits of Using EBIs in Schools

Maximum return on investment

Packaged curriculum

Efficient use of available and/or limited resources

Funders requesting use of EBIsSlide8

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 modelsSlide9

Challenges Using EBIs in Schools

Competing priorities for core subjects

Community support/buy-in

Too narrow in focus – not comprehensive

Funding

Teacher discomfort with topicsSlide10

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 & trainingSlide11

What is the “secret”?Slide12

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 levelsSlide13

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”.Slide14

Questions?

Cybele Boehm

Office of Healthy Schools

HIV/AIDS Program Coordinator

304-558-8830

cboehm@access.k12.wv.usSlide15

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

1-800-642-8522

wvdhhr.org/

ahi

Patty McGrew, Director

Patty.F.McGrew@wv.gov

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 HealthSlide16

Promotes positive health outcomes for adolescentsPhysicalEmotionalCognitive

Utilizes a positive, “whole child” approach to risk behavior reduction

Increasing protective factors

Increasing parental involvement and communication

Increasing community involvement

Adolescent Health InitiativeSlide17

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 InitiativeSlide18

Adolescent Health CoordinatorsCommunity-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”

Adolescent Health InitiativeSlide19

Abstinence-OnlyAbstinence-Until-Marriage

Abstinence-Only-Until-Marriage

Abstinence-Based

Abstinence-Centered

What is abstinence education?Slide20

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!

What is Title V Abstinence?Slide21

“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 guidance:Slide22

“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 guidance:Slide23

“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.”

Funding guidance:Slide24

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 TeensSlide25

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 TeensSlide26

Getting to Know You and Steps to Making Your Dreams Come TruePuberty and Adolescent SexualityMaking 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

Promoting Health Among TeensSlide27

Draw The Line, Respect the LineEvidence basedMiddle school

More information available

www.etr.org

Reducing the Risk

Evidence based

High school

Other curriculums:Slide28

The Adolescent Health Educators (AHEs) provide medically accurate sexual educational classes and parent seminarsHave 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 EducatorsSlide29

BARBOUR

BERKELEY

BOONE

BRAXTON

BROOKE

CABELL

CLAY

FAYETTE

GILMER

GRANT

GREENBRIER

HAMPSHIRE

HANCOCK

HARDY

HARRISON

JACKSON

KANAWHA

LEWIS

LINCOLN

LOGAN

MCDOWELLL

MARION

MASON

MERCER

MINERAL

MINGO

MONONGALIA

MONROE

MORGAN

NICHOLAS

OHIO

PENDLETON

POCAHONTAS

PRESTON

PUTNAM

RALEIGH

RANDOLPH

RITCHIE

ROANE

SUMMERS

TAYLOR

TUCKER

TYLER

UPSHUR

WAYNE

WEBSTER

WIRT

WOOD

WYOMING

JEFF-

ERSON

ANTS

PLEAS-

RIDGE

DODD-

HOUN

CAL-

MARSHALL

AHI State Office

Rainelle Medical Center

Community Action of SE WV

Regeneration, Inc.

WETZEL

Wetzel County Commission

Adolescent Health Educators

Valley Health

*PHAT

*PHAT

*PHAT

*Draw the Line

*PHAT

*Draw the Line

*Reducing the Risk

*PHAT

*Draw the Line

*Reducing the RiskSlide30

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

 Slide31

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

Adolescent Health CoordinatorsSlide32

Wood

Adolescent Health Coordinators

Region 1

Region 2

Region 4

Region 5

Region 6

Region 7

Region 8

Denotes lead agency location

Region 3

Barbour

Boone

Braxton

Brooke

Cabell

Clay

Fayette

Gilmer

Grant

Greenbrier

Hampshire

Hancock

Hardy

Harrison

Jackson

Kanawha

Lewis

Lincoln

Logan

McDowell

Marion

Mason

Mercer

Mineral

Mingo

Monongalia

Monroe

Morgan

Nicholas

Ohio

Pendleton

Pocahontas

Preston

Putnam

Raleigh

Randolph

Ritchie

Roane

Taylor

Tucker

Tyler

Upshur

Wayne

Webster

Wetzel

Wirt

Wyoming

Marshall

Cal

-

houn

Dodd

-

ridge

Jeff

-

erson

Pleas

-

ants

Sum

-

mers

Vacant

RESA I

Cathy Davis

Valley Health

Systems, Inc.

Nonie Roberts

New River Health Association

Stella Moon

RESA V

Dara Pond

Marshall County

Family Resource Network

Idress

Gooden

RESA VII

Christine Merritt

Pendleton Community

Care

Margo Friend

United Way of

Central WV

Berkeley

I70

50

33

35

19

119

I68

I81

I77

I77

I77

I64

I64

I79

I79

I79Slide33

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 30

th

)

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

304-356-4421Slide35

Questions?Slide36

Adolescent pregnancy prevention initiative

Helmet required!Slide37

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. Slide38

It isn’t comfortable to talk about sex with a teenager…

but it is necessary!

Knowledge is Power!

When it comes to sex…

Teens are naturally curious.

Parents are naturally terrified

.

I want to talk to her but I’m afraid I’ll say the wrong thing.

I wish I could ask my mom.Slide39

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!Slide40

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.Slide42

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.Slide43

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. Slide44

Talk!Slide45

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

West Virginia Department of Health and Human Resources

Bureau For Public Health

Office of Maternal, Child and Family Health

Family Planning ProgramSlide46

Evidence-Based Interventions and Approaches for addressing teen pregnancy in west virginiaSlide47

WHY??????

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 frameSlide48

WHY???????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)Slide49

WHY??????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 intercourseSlide50

WHY?????????

Pregnancy rate

for teens

not using any contraception

:

Pregnancy rates for

condom use:

87%

18%Slide51
Slide52

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)

Depo

provera

--every 3 months

6% pregnancy rate with “typical” useSlide53

FAMILY PLANNING IN A SBHC“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 teensSlide54

FAMILY PLANNING IN A SBHCSTI

Prevention (= abstinence or condom use)

Screening

Adding HIV in-house screening

LOTS OF COUNSELING/EDUCATION!!!!!Slide55

FAMILY PLANNING IN A SBHCWHO???????

“EVERY PATIENT”

Encourage “coached” autonomy

Encourage healthy relationship-building with peers and parents/guardians

Encourage connectedness between adolescents and caregiversSlide56

HOW??????Slide57

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”Slide58

An example of effective collaboration

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

entire

student body (county approved)

Introduce Reducing the Risk to all 9

th

graders starting next year (

Board approved)Slide59

An example of effective collaborationLimited 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)Slide60

An example of effective collaboration

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, 2012Slide61

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