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Teen Options to Prevent Pregnancy (T.O.P.P.)
Developers
OhioHealth Community Health and Wellness
Program Summary
The Teen Options to Prevent Rapid Repeat Pregnancy (T.O.P.P.) program provides motivational interviewing, contraceptive access, and social service support over an 18-month period to help at-risk teen mothers develop and adhere to a birth control plan and to prevent rapid repeat pregnancies. The program is delivered by trained nurse educators through home and telephone-based care coordination.
Intended Population
The program is designed for and was evaluated with females ages 10 to 19 who are pregnant (at least 28 weeks into their pregnancy) or have just given birth (up to nine weeks postpartum).
Program Setting
The program was designed for and evaluated through home- and telephone-based care coordination delivered by trained nurses in Ohio.
Contact and Availability Information
For curriculum, materials, and pricing information, please contact:
Robyn Lutz
Project director
Phone: 614-566-9085
Email: Robyn.Lutz@ohiohealth.com
Robyn Lutz
Project director
Phone: 614-566-9085
Email: Robyn.Lutz@ohiohealth.com
For training and support, please contact:
Robyn Lutz
Project director
Ph: 614-566-9085
Email: Robyn.Lutz@ohiohealth.com
Robyn Lutz
Project director
Ph: 614-566-9085
Email: Robyn.Lutz@ohiohealth.com
Sample of curriculum available for review prior to purchase
Yes
Adaptation guidelines or kit available
Yes
Languages available
English
Program Core Components
Program Objectives
T.O.P.P.’s goal is to reduce rapid repeat teen pregnancies and promote healthy birth spacing through home and telephone-based care coordination that encompasses motivational interviewing and access to family planning and other supportive services.
Program Content
The core component of the T.O.P.P. model is motivational interviewing, which is based on the Behavioral Model of Health Services Use (Andersen 1995). The premise of this model is that contraceptive behavior can be changed by empowering a young woman to make her own informed choices about birth control and pregnancy, and providing her easy access to birth control. Motivational interviewing is an individualized, client-driven, collaborative form of communication designed to promote individual change.
The model encompasses the following:
Motivational interviewing: 18 monthly one-on-one home and telephone motivational interviewing sessions with a nurse educator focusing on birth spacing and preventing repeat pregnancy, birth control methods and misconceptions about the methods, and future planning for achieving birth control and spacing goals.
Access to contraception: T.O.P.P. improves access to
contraception by offering access to a T.O.P.P. clinic, transportation services, and/or in-person discussion about and distribution of contraceptives.
Assessment and referrals by a social worker: T.O.P.P. provides participants access to a social worker who, based on initial psychosocial assessments and case management, can refer participants to services. The theory behind these service referrals is that addressing other barriers that teen mothers face, such as poverty, trauma, and homelessness, will ultimately help them adhere to a birth control regimen.
These components are designed to increase participants’ consistent use of contraception which, in turn, will lead to the program’s desired goals of promoting healthy birth spacing and reducing rapid repeat teen births.
Program Methods
T.O.P.P. provides monthly home and telephone-based coordinated care supplemented with access to contraceptive services during individual, in-person visits with the teen mothers.
During the nurse educators’ contacts with participants, they use motivational interviewing, to educate clients about family planning and the value of preventing rapid repeat pregnancies. Educators strive to gently guide the conversation in a manner that educates participants about the health benefits of delaying subsequent pregnancy, provides medically-accurate information on various birth control methods (including abstinence), addresses any misconceptions inhibiting contraceptive use, and helps the teens develop a birth control plan.
Follow-up telephone calls provide an opportunity to provide further information on contraceptives, help participants identify and schedule appointments with their OB/GYN or other
medical provider, debrief about the participants’ appointments, and problem-solve barriers to consistent and continued birth control use.
The calls also provide a forum for the educators to address supportive service needs participants may face, and refer them to the T.O.P.P. social worker for additional support, as needed.
Participants may also access birth control through the T.O.P.P. Clinic if they cannot get into their clinic or medical home. Nurses also provide in home Depo Provera shots.
During the nurse educators’ contacts with participants, they use motivational interviewing, to educate clients about family planning and the value of preventing rapid repeat pregnancies. Educators strive to gently guide the conversation in a manner that educates participants about the health benefits of delaying subsequent pregnancy, provides medically-accurate information on various birth control methods (including abstinence), addresses any misconceptions inhibiting contraceptive use, and helps the teens develop a birth control plan.
Follow-up telephone calls provide an opportunity to provide further information on contraceptives, help participants identify and schedule appointments with their OB/GYN or other
medical provider, debrief about the participants’ appointments, and problem-solve barriers to consistent and continued birth control use.
The calls also provide a forum for the educators to address supportive service needs participants may face, and refer them to the T.O.P.P. social worker for additional support, as needed.
Participants may also access birth control through the T.O.P.P. Clinic if they cannot get into their clinic or medical home. Nurses also provide in home Depo Provera shots.
Program Structure and Timeline
T.O.P.P. expects that nurse educators will conduct monthly telephone calls with participants over a period of 18 months. Frequency of calls may be greater during the initial program period or when the participant is changing their birth control method. There is no minimum or maximum length for each call.
To facilitate initial and continued contraceptive use, the nurse educators make follow-up telephone calls and are also encouraged to conduct home or other in-person visits, if possible, at least one per participant during their time in the program. Ideally, such a visit would be conducted within the first few months after a client’s enrollment in T.O.P.P.
Staffing
T.O.P.P. should be delivered by nurse educators with training in motivational interviewing, obstetrics, gynecology, or maternal and child health. Staff are expected to also be trained in educating clients on the characteristics of different contraceptive options.
Program Materials and Resources
The developer has a program tool kit available for purchase. The tool kit includes a program overview, the T.O.P.P. logic model, a chapter on the pedagogy and enabling factors, information on curriculum and program components (including worksheets and patient screening tools), and fidelity guidelines.
Additional Needs for Implementation
Additional in-person training may be needed.
Fidelity
The T.O.P.P. program relies on ongoing staff training, expert telephone call reviews, and the use of monitoring tools to maximize fidelity to motivational interviewing methods. The T.O.P.P. logic model may be obtained by contacting the developer. Fidelity benchmarks and monitoring tools are in the program tool kit available for purchase.
Staff Training
Staff delivering T.O.P.P. are required to attend an initial two-day training retreat focused on motivational interviewing techniques, led by a motivational interviewing expert consultant. Staff also need training regarding the provision of Efficacy-based Contraceptive Counseling.
Technical Assistance and Ongoing Support
After the initial training, staff should meet weekly with the training expert during the first program year and continue to do so every other week. The ongoing technical assistance sessions offer ongoing training, review recent motivational interviewing interactions, and discuss the quality of those interactions. The sessions also provide an opportunity to discuss ways to handle the challenges staff face in conducting motivational interviewing.
Allowable Adaptations
The program's toolkit (available for purchase) lists specific activities that are required for fidelity to the T.O.P.P. model, and those that are optional.
Reviewed Studies
| Citation | High-Quality Randomized Trial | Moderate-Quality Randomized Trial | Moderate-Quality Quasi-experiment | Low Study Rating | Did Not Meet Eligibility Criteria |
|---|---|---|---|---|---|
| Smith et al. 2015a Rotz et al. 2016a Stevens et al., 2017 |
✓ |
Study Characteristics
| Citation | Setting | Majority Age Group | Majority Racial/Ethnic Group | Gender | Sample Size |
|---|---|---|---|---|---|
Smith et al. 2015a Rotz et al. 2016a Stevens et al., 2017 |
Multiple settings | 18 or 19 | White | Young women | 493 |
Study Findings
Evidence by Outcome Domain and Study
| Citation | Sexual Activity | Number of Sexual Partners | Contraceptive Use | STIs or HIV | Pregnancy |
|---|---|---|---|---|---|
Smith et al. 2015a Rotz et al. 2016a Stevens et al., 2017 |
|
|
|
n.a. |
|
Detailed Findings
| Citation | Details |
|---|---|
Smith et al. 2015a Rotz et al. 2016a Stevens et al., 2017 |
The program was evaluated using a randomized controlled trial involving pregnant or recently pregnant young women recruited from seven obstetrics-gynecology clinics and five postpartum units of a large hospital system in a Midwestern city. Participants were randomly assigned to either a treatment group that received the 18-month T.O.P.P. program or a control group that received usual care. Surveys were administered at baseline, mid-intervention (6 months after enrollment), and immediately after the end of the intervention (18 months after enrollment). The study found that adolescents participating in the intervention were significantly less likely to report having had unprotected vaginal intercourse in the past three months at six months after enrollment (effect size = .02) and at 18 months after enrollment (effect size = 0.01). The study also found that 18 months after enrollment, adolescents participating in T.O.P.P. were significantly less likely to report having had a repeat pregnancy (effect size = 0.01), unintended repeat pregnancy (effect size = 0.02), or live birth (effect size = 0.03) since enrollment. At both six and 18 months after study enrollment, the study found no statistically significant program impacts on whether the participant had vaginal sex, whether the participant had vaginal intercourse without a condom, or the number of sexual partners in the past three months. The study also examined program impacts on measures of use of long-acting reversible contraception, use of effective birth control, trying to avoid pregnancy in the next year, school enrollment, and completion of high school or GED. Findings for these outcomes were not considered for the review because they fell outside the scope of the review. |