Teen Pregnancy Prevention Initiative
The Department of Health and Human Services (HHS) launched a Teen Pregnancy Prevention Initiative in 2010 that is comprised of programs targeting groups with high teen pregnancy rates. Through this Initiative, HHS is investing in program models that have been identified under the Teen Pregnancy Prevention Evidence Review as shown to impact sexual risk behaviors (e.g., contraceptive use, sexual activity, etc.), teen pregnancies or births, or sexually transmitted infections. In addition, funding is allocated to test innovative or untested approaches.
Teen Pregnancy Prevention Program
Under the Teen Pregnancy Prevention (TPP) Program, HHS’s Office of Adolescent Health competitively funded $100 million in grants to states, non-profit organizations, school districts, universities, and others for a five-year project period. Seventy-five million is dedicated to the replication of program models that have been rigorously evaluated and shown to be effective at reducing teen pregnancies, sexually transmitted infections, or other associated sexual risk behaviors. The 75 grantees funded to replicate models receive awards ranging from $400,000 to $4 million per year. Twenty-five million supports 19 research and demonstration projects to develop and test additional models and innovative strategies to prevent teen pregnancy, so that the evidence base continues to be expanded and refined. Grantees funded for the research and demonstration projects receive between $400,000 and $1 million per year.
Evidence Standards and Evaluation:
Grantees replicating program models are expected to select one of the evidence-based models identified by HHS through its Teen Pregnancy Prevention Evidence Review. HHS initiated a systematic, comprehensive review of rigorously evaluated program models in order to identify program models that have proven effective. The review identifies program models that are supported by a high or moderate quality study that shows a positive, statistically significant impact on one of the sexual behavior or reproductive health outcomes of interest for either the full analytic sample or a subgroup defined by (1) gender or (2) sexual experience measured at baseline. High and moderate quality studies are defined in the Protocol for the Teen Pregnancy Prevention Evidence Review. The program models identified include a range of approaches to serve youth, including youth development, comprehensive sex education, abstinence education and clinic-based models.
HHS has created a Federal Teen Pregnancy Prevention Coordination Workgroup to develop and manage a coordinated strategy for research and evaluation efforts that will enable the Department to answer a range of questions that are complementary. HHS's goals were to (a) understanding how to effectively replicate and implement evidence-based program models and evaluated them to assess impacts found in the original evaluation, and (b) adding to the evidence base by evaluating new and untested approaches. HHS’s evaluation strategy includes a combination of fed-led and grantee-led evaluations.
Of the TPP grantees receiving funding to replicate models, those grantees funded between $1 million and $4 million are expected to conduct a rigorous local evaluation that uses a random assignment or quasi-experimental design with comparison groups. All funded research and demonstration grantees are required to conduct a rigorous grantee-led evaluation so others can benefit from these strategies and innovative approaches. Through a contractor, the Office of Adolescent Health (OAH) reviews all the evaluation designs and provides ongoing technical assistance to grantees to ensure these evaluations are rigorous and feasible. In addition, there are two federally managed evaluation studies that address unique questions about the implementation and effectiveness of a subset of projects. One study is examining the implementation and impacts of three TPP replications of three different evidence-based program models. The other is assessing the implementation and impacts of innovative strategies and untested approaches for preventing teen pregnancy in seven sites.
Community-Wide Teen Pregnancy Projects
HHS’s Office of Adolescent Health, and Centers for Disease Control and Prevention (CDC) partnered to award almost $10 million to support eight community-wide projects that demonstrate the effectiveness of innovative, multi-component models of reducing teen pregnancy and births in communities with the highest rates, with a focus on reaching African American and Latino/Hispanic youth ages 15 – 19. The program has four overarching goals:
- Reduce the rates of pregnancies and births to youth in the target areas.
- Increase youth access to evidence-based and evidence-informed programs to prevent teen pregnancy.
- Increase linkages between teen pregnancy prevention programs and community-based clinical services.
- Educate stakeholders about relevant evidence-based and evidence-informed strategies to reduce teen pregnancy and data on needs and resources in target communities.
A community-wide model has been defined as an intervention implemented in defined communities (a specified geographic area) applying a common approach with different strategies. Community-wide approaches will be tailored to the specified community, and will include broad-based strategies that reach a majority of youth in the community (e.g., through communication strategies and media campaigns); and intensive strategies reaching youth most in need of prevention services (e.g., through implementation of evidence-based programs and improved links to services). A quasi-experimental evaluation study is underway to examine the effects of integrating services, programs and strategies.
Personal Responsibility Education Program
The Family and Youth Services Bureau in the Administration for Children and Families (ACF), oversees the Personal Responsibility Education Program (PREP). Part of the Affordable Care Act, PREP is funded at $75 million and aims to educate adolescents on abstinence and contraception, and at least three of the following adulthood preparation subject areas:
- Healthy relationships, including development of positive self-esteem and relationship dynamics, friendships, dating, romantic involvement, marriage and family interactions;
- Positive adolescent development, to include promotion of healthy attitudes and values about adolescent growth and development, body image, racial and ethnic diversity, and other related subjects;
- Financial literacy, to support the development of self-sufficiency and independent living skills;
- Parent-child communication skills;
- Education and employment preparation skills; and
- Healthy life skills, such as goal setting, decision making, negotiation, communication and interpersonal skills, and stress management.
The PREP program includes three distinct components:
- Awards to states: $55 million in formula grants was allotted to states to either replicate evidence-based effective programs or to substantially incorporate elements of effective prevention programs while including three of six adult preparation subjects mandated by Congress.
- Competitive awards to an array of public and private entities: $10 million in PREP Innovative Strategies cooperative agreements were awarded to test innovative approaches and were issued in conjunction with the OAH research and demonstration grants. These grants focus on youth ages 10-19 who are homeless, in foster care, live in rural areas or in geographic areas with high teen birth rates, or come from racial or ethnic minority groups. The program also supports pregnant youth and mothers under the age of 21.
- Tribal Grants: $3.25 million was competitively awarded to Indian tribes and tribal organizations to support culturally appropriate methods of reducing adolescent pregnancy within tribes.
Evidence Standards and Evaluation:
PREP programs must either replicate or substantially incorporate elements of effective programs that have been proven on the basis of rigorous scientific research to change behavior (as determined by HHS through the Teen Pregnancy Prevention Evidence Review. HHS will also oversee a large-scale evaluation effort focused on measuring the effectiveness of each PREP project, based on identified performance measures). HHS is overseeing a large-scale evaluation of the PREP program, which will include (1) a descriptive study of how all PREP state grant programs were designed and implemented, (2) the collection and analysis of performance measure data from all PREP state grantees, and (3) random assignment impact evaluations and in-depth implementation evaluations of 4-5 selected PREP-funded sites.