Q&A: Building the Evidence Base for Pregnancy Prevention Among System-Involved Youth

Young couple in the city texting

Earlier this year, we highlighted three Family and Youth Services Bureau (FYSB) grantees partnering with researchers to see if their programs have what it takes to make the list of evidence-based interventions. One of those grantees, the Oklahoma Institute for Child Advocacy, was the first to have a report of researchers’ short-term findings (PDF, 1MB) released by Mathematica Policy Research. The report focused on the agency’s POWER Through Choices program, a 10-session intervention addressing reproductive health, sexuality, and healthy relationships among youth in foster care or other out-of-home placements.

POWER Through Choices presents youth with scenarios that help them think critically about situations they might encounter in life and the choices they can make to minimize their risk for sexually transmitted infections (STIs). Youth participating in Mathematica’s short-term findings report demonstrated increased knowledge and awareness of sexual health, contraceptive methods, and where to find resources in the community. They also reported increased use of contraception and fewer risky behaviors at the end of the intervention.

We contacted Project Director Janene Fluhr to get her thoughts on the report and how it might influence the services offered by the institute or other youth-serving organizations.  

NCFY: Were any of the impact report findings surprising? If so, what?

Fluhr: The most surprising data showed that [system-involved youth’s] risk levels are higher than we anticipated prior to collecting data. What we know from the [Youth Risk Behavior Survey] is that the rate of adolescents in the U.S. who have ever had sex in high school is at or near 50%. When we wrote the proposal, our statisticians guessed the rate [among system-involved youth] would be maybe 15% to 20% higher, and it surpassed that. Our data found 85% to 90% reporting they ever had sex between ages 13 and 18.

NCFY: What are some ways you plan to update the program based on the findings?

Fluhr: Whether or not it changes the curriculum is dependent on final outcomes. The data so far have shown us that this type of programming is desperately needed for these special populations of youth. It gave us reassurance that we are right to focus on [system-involved youth]. Anecdotally, if anything, what [the report] tells us is [youth] need more information, and they need more opportunities to engage with this information. As they get older and their cognitive and behavioral development changes, that information needs to be aligned with that.

NCFY: A past literature review found that some homeless youth intentionally seek out pregnancy and parenting as possible solutions to their problems. How does POWER Through Choices address a similar approach among youth in foster care, if it exists?

Fluhr: To get at these intentions, we asked things like, “What do you want out of life?” and “How might an unplanned pregnancy or STI change that trajectory?” This provides [youth] with some incentive for why they might be interested in taking action to make sure an unplanned pregnancy or STI does not negatively impact their ability to make plans for themselves.

[Sexuality education programs] often don’t make a lot of sense to lower-income kids and those with lower school success. But it may [make sense to them] if you put it in context of their life, allowing them to consider the choices they have and how one choice might play out versus another. Having looked at choices in a safe environment, one might have more motivation to say, “This is the option I want; this is what I need to do to make this work for me.”

NCFY: What advice would you give to other programs about using evaluation research to make their programs more effective?

Fluhr: Programs offer similar concepts, but to allow [youth] to experience them in a safe environment where they can question all of the concepts … meets them where they are without judgment. Trust that if we provide [youth] with adequate information, it will allow them the opportunity to engage with it because they are the ones that are going to be out there making decisions. It’s about more than just delivering information. It’s about giving [youth] a safe place where they can experiment and be curious with the options available to them, where they feel accepted and not judged. They can develop a sense of confidence knowing what they want and what’s good for them.

Mathematica will publish a second report looking at longer-term outcomes of POWER Through Choices later this year. In the meantime, you can read about two other FYSB-funded teen pregnancy prevention programs deemed effective during an evidence review by the U.S. Department of Health and Human Services.

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