Power Through Choices

Developers
Janene Fluhr, M.S.; Shante Fenner, B.A.; Richard P. Barth, MSW, Ph.D.; and Marla Becker, M.P.H.
Program Summary
Power Through Choices (PTC) is a teen pregnancy, HIV, and STI prevention program designed for youth in out-of-home care settings, such as foster care and juvenile justice facilities. This comprehensive program consists of 10 sessions that aim to address the unique barriers of youth in foster care and juvenile justice settings by focusing on self-empowerment and the impact of their choices. PTC promotes informed decision-making regarding sexual risk behaviors, inspires youth to imagine a positive future for themselves, and encourages youth to recognize the potential consequences their decisions may have on future success.
Intended Population
The curriculum is designed for male and female youth ages 13-18 living in foster care, the juvenile justice system, and other out-of-home care settings. The program was evaluated among youth in the child welfare and juvenile justice systems who were living in residential group homes. Study participants ranged in age from 13 to 18 years.
Program Setting

The program was developed for use with youth in various out-of-home care settings, such as family foster homes, kinship foster care, residential group homes, transitional living centers, and juvenile justice facilities. The program was evaluated with youth living in residential group homes across Oklahoma, California, and Maryland.

Contact and Availability Information
Janet Max
Healthy Teen Network
1501 Saint Paul Street, Suite 124
Baltimore, MD 21202
Email: capacitybuilding@healthyteennetwork.org
Phone: 443-216-1355
Sample of Curriculum Available for Review Prior to Purchase
Yes
Languages Available
English
Monitoring and Evaluation Tools
Monitoring and evaluation tools available
Yes
Monitoring and evaluation tool usage required
No
Information about available monitoring and evaluation tools (if applicable)

Power Through Choices provides a fidelity monitoring checklist and a post-session facilitator feedback form.

Program Core Components

Last updated in 2023

The data presented on this page reflects responses from the program’s developer or distributor to a program component checklist that asked them to report on the individual components within their TPP program. The same program component checklist was sent to the developer or distributor of every active TPP program with evidence of effectiveness. The program component table provides data on seven types of program components including content, delivery mechanism, dosage, staffing, format, environment, and intended population characteristics; whether the component was present or optional in the program; whether the component is considered to be core to the program; and the lesson number or activity where the component can be found in the program. For more details, refer to the FAQ.

Category Component Core Component Component present Notes Lesson number(s) / activities where present
Content Substance use - Abstinence No
Content Other
Content Volunteering/civic engagement No
Content Spirituality No
Content Morals/values No
Content Identity development No
Content Social support/capital Yes Yes (both versions) Lesson 2,6,7,8,9
Content Social influence/actual vs. perceived social norms No
Content Social competence Yes Yes (both versions) Lesson 2
Content Parenting skills No
Content Normative beliefs Yes Yes (both versions) Lessons 1,2,7,8,9,10
Content Leadership No
Content Gender roles No
Content Gender identity Yes Yes (current version) Lesson 3
Content Cultural values No
Content Connections with trusted adults Yes Yes (both versions) Lessons 2,6,7
Content Conflict resolution/social problem solving No
Content Communication skills Yes Yes (both versions) Lesson 2
Content Child development No
Content Boundary setting/refusal skills Yes Yes (both versions) Lesson 2
Content Vocational/skills training No
Content Supplemental academic services No
Content School engagement No
Content Graduating from high school No
Content College preparation No
Content Alternative schooling No
Content Self-regulation Yes Yes (both versions) Lesson 2,6,8,9,10
Content Self-esteem No
Content Self-efficacy/empowerment Yes Yes (both versions) Lessons 1,2,6,7,8,9,10
Content Resilience No
Content Personal vulnerability Embedded in communication practice but not covered explicitly Lesson 2,8,9
Content Motivational interviewing No
Content Mindfulness No
Content Meditation No
Content Goal setting Yes Yes (both versions) Lesson 9,10
Content Empathy Embedded in scenarios but not covered explicitly Lesson 2,8,9
Content Cognitive behavioral therapy (CBT) No
Content Brain development and emotions No
Content Values and sexuality Yes Yes (both versions) Lesson 1,2,8,9
Content Social media, texting and online interactions No
Content Substance use - Other drugs No
Content Maternal health No
Content Contraception - Pills, patches, rings, and shots Yes Yes (both versions) Lesson 4
Content Contraception - Other Yes Yes (both versions) Lesson 4
Content Contraception - Long-acting reversible contraceptives Yes Yes (both versions) Lesson 4
Content Contraception - Condoms Yes Yes (both versions) Lessons 4,5,6
Content Anatomy/physiology Yes Yes (both versions) Lesson 3
Content Substance use cessation No
Content Reproduction Yes Yes (both versions) Lesson 3
Content Risk of STIs and Pregnancy Yes Yes (both versions) Lesson 5
Program Objectives
The PTC program seeks to provide targeted youth with the information and skills necessary to avoid risky sexual behaviors and reduce the occurrence of STIs, HIV, and adolescent pregnancy. The curriculum objectives focus on preparing youth to:
  1. Make healthy, positive choices related to sexual behavior.
  2. Build condom and contraceptive knowledge and skills.
  3. Develop and practice effective communication skills.
  4. Learn how to access available resources.
Program Content
The PTC program comprises ten 90-minute sessions that are carried out by trained facilitators. The sessions are interactive in nature and include role-playing scenarios, demonstrations and group discussions. The ten sessions are:
  1. Introduction to PTC: Introduce curriculum, assess participants’ knowledge regarding pregnancy prevention and sex education, and demonstrate role playing.
  2. Making Choices Clear: Help participants to build assertiveness and communication skills related to sexual activity.
  3. Adolescent Reproductive Health Basics: Increase knowledge of male and female reproductive anatomy, the process of fertilization and conception, and the menstrual cycle.
  4. Increasing Contraceptive Knowledge: Increase knowledge about contraceptive methods.
  5. Understanding STIs and HIV and How to Reduce Your Risk: Increase knowledge and understanding of STI/HIV transmission and prevention.
  6. Practice Makes Perfect: Discuss the level of risk associated with various sexual behaviors, use role playing to demonstrate the importance of dual methods, and learn condom use skills.
  7. Using Resources to Support Your Choices: Discuss ways to improve communication about contraception with foster parents, guardians, and group home staff members; learn how to access local sexual and reproductive health resources.
  8. Making Choices that Fit Your Lifestyle: Develop a plan for avoiding unwanted pregnancies and STIs, set short- and long-term goals, and identify choices needed to attain goals.
  9. Creating the Future You Want: Identify planning involved in practicing positive sexual behaviors, outline individual choices involved in sexual decision making, and discuss abstinence as a viable choice.
  10. Plan + Prepare + Practice = POWER: Reinforce themes and messages of the curriculum.
Program Methods
PTC adopts a trauma-informed approach and is specifically designed for and with youth in out-of-home placements. The developer recognized that the program is for youth who have experienced “an array of adverse childhood experiences.”
Program Structure and Timeline
The comprehensive PTC program consists of ten 90–minute interactive sessions that can be delivered by trained facilitators once or twice a week for 5 to 10 weeks. However, the developer recommends completing all ten sessions over a period of five weeks rather than ten, so youth are more likely to complete all ten sessions.  PTC is designed to be implemented in groups of 8 to 20 youth.
Staffing
The PTC program is designed to be carried out by two trained facilitators who have experience and are capable of building relationships with youth in out-of-home care. The developer recommends that facilitator teams represent ethnic and racial diversity and include at least one male and one female. The developer indicates that two facilitators are necessary because:
  • When working with young people who may have been victims of sexual abuse or rape, as well as youth who struggle to define appropriate boundaries, it is important for the safety of the youth and of your staff that no adult be left alone with a youth at any time.
  • Utilizing a team of two facilitators allows the team to better reflect the potential diversity of the youth being served. 
Staff Training
PTC trainings are held intermittently at the PTC offices in Oklahoma City, Oklahoma. Contact the developer for further information. Organizations can also request on-site training in other locations.
Additional Needs for Implementation
A program manual is required to implement the program model. A laptop and projector are needed for some sessions and internet access is helpful for one session activity.
 
Program providers should have previous experience implementing adolescent reproductive health and teen pregnancy programs. Prior experience working with groups of youth in child welfare, juvenile justice, and other high-risk youth populations is also recommended.
Fidelity
The program manual includes facilitator tips throughout the sessions to assist with implementation and fidelity. 
 
The program has a fidelity monitoring checklist for each program session. Post-session facilitator feedback forms for each lesson allow facilitators to record information and denote the completion of key activities. In addition, facilitators can identify successes and challenges for each lesson and make recommendations for additional training and assistance that would be useful for continuous quality improvement.
Technical Assistance and Ongoing Support
Individual phone and/or email-based technical support and assistance are available from the developer. Technical support and assistance is available as part of a training package.
Allowable Adaptations
A list of ‘green light’ or acceptable adaptations is provided to individuals attending the training of facilitators.
Adaptation Guidelines or Kit
Yes
Study Findings

Evidence by Outcome Domain and Study

Citation Sexual Activity Number of Sexual Partners Contraceptive Use STIs or HIV Pregnancy

Oman, R. F., Vesely, S. K., Green, J., Fluhr, J., Williams, J. (2016). Short-term impact of a teen pregnancy-prevention intervention implemented in group homes. Journal of Adolescent Health, 59(5), 584-591.

 		n.a. n.a. n.a. n.a. n.a.

Covington, R.D., Goesling, B., Clark Tuttle, C., Crofton, M., Manlove, J., Oman, R.F., Vesely, S. (2016). Final impacts of the POWER Through Choices program. Mathematica Policy Research.

Oman, R. F., Vesely, S. K., Green, J., Clements-Nolle, K., Lu, M. (2018). Adolescent pregnancy prevention among youths living in group care homes: A cluster randomized controlled trial. American Journal of Public Health, 108(S1), pp. S38-S44.

Oman, R.F., Vesely, S.K., Green, J., Fluhr, J., Williams, J. (2016). Short-term impact of a teen pregnancy-prevention intervention implemented in group homes. Journal of Adolescent Health, 59, 584–591.

 		Indeterminate evidence Indeterminate evidence Potentially favorable evidence Indeterminate evidence Favorable evidence
KEY
Evidence Indication
Favorable findings
Two or more favorable impacts and no unfavorable impacts, regardless of null findings
Potentially favorable findings
At least one favorable impact and no unfavorable impacts, regardless of null findings
Indeterminate findings
Uniformly null findings
Conflicting findings
At least one favorable and at least one unfavorable impact, regardless of null findings
Potentially unfavorable findings
At least one unfavorable impact and no favorable impacts, regardless of null findings
Unfavorable findings
Two or more unfavorable impacts and no favorable impacts, regardless of null findings
Note: n.a. indicates the study did not examine any outcome measures within that particular outcome domain, or the study examined outcome measures within that domain but the findings did not meet the review evidence standards.
Detailed Findings
Citation Details

Oman, R. F., Vesely, S. K., Green, J., Fluhr, J., Williams, J. (2016). Short-term impact of a teen pregnancy-prevention intervention implemented in group homes. Journal of Adolescent Health, 59(5), 584-591.

This study did not meet the review's screening criteria

Covington, R.D., Goesling, B., Clark Tuttle, C., Crofton, M., Manlove, J., Oman, R.F., Vesely, S. (2016). Final impacts of the POWER Through Choices program. Mathematica Policy Research.

Oman, R. F., Vesely, S. K., Green, J., Clements-Nolle, K., Lu, M. (2018). Adolescent pregnancy prevention among youths living in group care homes: A cluster randomized controlled trial. American Journal of Public Health, 108(S1), pp. S38-S44.

Oman, R.F., Vesely, S.K., Green, J., Fluhr, J., Williams, J. (2016). Short-term impact of a teen pregnancy-prevention intervention implemented in group homes. Journal of Adolescent Health, 59, 584–591.

The program was evaluated in a cluster randomized controlled trial involving 885 youth recruited from 44 residential group homes in California, Maryland, and Oklahoma. The study randomly assigned clusters of youth to a treatment group receiving the 10 sessions of the POWER Through Choices program or to a control group that did not receive the program but had access to other community and group home services. Data for the study were collected before the program (baseline), immediately after the program, and six and 12 months after the end of the program. This study focused on data collected at the six- and 12-month follow-ups.

Six months after the program ended, youth who participated in the program were significantly less likely than youth in the control group to report having had sex without using birth control in the past three months (odds ratio = 0.72, confidence interval = 0.52 to 0.98). The study found that at the six-month follow-up, there were no statistically significant impacts on whether youth had ever been pregnant or gotten someone pregnant.

Twelve months after the program ended, youth who participated in the program were significantly less likely to report ever having been pregnant or gotten someone pregnant than youth in the control group were (odds ratio = 0.81, confidence interval = 0.75 to 0.88). In addition, the study found that 12 months after the end of the program, the subgroup of female youth who participated in the program were significantly less likely to report ever being pregnant than their counterparts in the control group (odds ratio = 0.66, confidence interval = 0.56 to 0.77). At the 12-month follow-up, there were no statistically significant impacts on measures of recent (in the last three months) sexual activity, number of sexual partners, condom and birth control use during recent sexual activity, and being tested and diagnosed with a sexually transmitted infection (STI) in the past 12 months.

The study also examined program impacts on measures of knowledge about reproductive anatomy and fertility, HIV and STIs, and methods of protection; attitudes toward safe sex and the use of protection; perceived self-efficacy to avoid unprotected sex; perceived ability to find methods of protection; perceived access to condoms and birth control; and intention to have sex, use a condom, and use birth control in the next year. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample. A blank cell indicates the study did not examine any outcome measures within the particular outcome domain or the findings for the outcome measures within that domain did not meet the review evidence standards.

Information on evidence of effectiveness is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.