Q&A: Sheana Bull On Enhancing Teen Pregnancy Prevention With Text Messaging

Can text messaging help prevent teen pregnancy? For the past few years, Sheana Bull of the Colorado School of Public Health in Aurora, CO, has been working with colleagues to answer that quetion. The team has been studying the effects of adding a text messaging component to Teen Outreach Program, or TOP, an evidence-based adolescent pregnancy prevention program. Text messages sent to youth in the program included fun facts and tips, polls, and quotes from popular artists.

The study so far, detailed in “Enhancing a Teen Pregnancy Prevention Program With Text Messaging: Engaging Minority Youth to Develop TOP Plus Text,” has found that the text component may make young people more likely to get and to stay involved with programs. But because not all teens have access to text-capable phones or phone plans, Bull and her colleagues say programs need to offer youth more than one way of receiving information.

We talked to Bull about the scope of her research, young people's input into the project, and how texts can fit into adolescent pregnancy prevention programs.

NCFY: What did you find most interesting about the study?

Bull: It’s still ongoing, so we have another year to go. I think for me it is the opportunity to answer the question about how to integrate technology into an effective program: Can technology be used not only as a standalone tool for health promotion but also to make programs better? Will it help sustain programs, and make information more available?

NCFY: How specifically were youth involved in text creation?

Bull: We had a few rounds of youth involvement before we really even began. We sat down with youth and asked them for ideas, and to give them the opportunity to tell us what message would resonate best. They helped us with things like branding, establishing the ideal number of texts per week and length of messages. Then they helped us with choosing fun facts, creating polls asking [youth] whether they were still interested and what would get them engaged. We could guarantee that [the texts] were delivered but we couldn’t guarantee that they were read.

Before the research began, we did a month-long pilot test to see whether the system functioned.

Each year for the past two years we’ve had [youth] tell us what they liked and disliked about including the text messages. We were able to improve messages and make cosmetic changes. Youth told us they liked inspirational quotes from role models, so we have quotes from artists and leaders. We want to keep those but we also want to update them. An artist who was popular three years ago might not be so relevant this year.

NCFY: Do you think the texts help reduce teen pregnancy? Why?

Bull: We’re in the third year of four years of data collection, and we’ve designed it in such a way that there are eight separate boys’ and girls’ programs that are participating in the TOP program. Four of these programs are enhanced with text messaging, and four are not, so we’re going to be able to compare the people who had TOP alone with the people who had the enhanced program.

We can compare pregnancy outcomes and performance outcomes. We likely will not have enough information on pregnancy to tell whether it made a difference in that area, but we will have information on use of contraception.

NCFY: How can other adolescent pregnancy prevention programs put this to use?

Bull: The program as we’ve developed it is really specifically tailored to the TOP program, so I don’t believe it can be taken as-is and utilized as a standalone or with a different teen pregnancy prevention program. We had a very clear protocol for how we developed the messages. But I’m confident we can adopt a text messaging protocol for other programs.

NCFY: Is there a list of texts available that other APP programs can use?

Bull: What we’re going to do is talk with Wyman, the TOP developer, and once we have our efficacy data from the trial we’re going to see whether they want to use it as part of the TOP program. We can work with any group that wants to use texts as part of their protocols.

Primary Sources: Do Fathers Play a Role in Youth Sexual Health?

Paternal Influences on Adolescent Sexual Risk Behaviors: A Structured Literature Review” (abstract). Vincent Guilamo-Ramos, Alida Bouris, Jane Lee, Katharine McCarthy, Shannon L. Michael, Seraphine Pitt-Barnes, Patricia Dittus. Pediatrics, Vol. 130, No. 5 (November 2012).

What it’s about: The authors wanted to investigate the influence that fathers have on their adolescents’ sexual behavior. After going through 30 years’ worth of archives in six different databases, the researchers found and reviewed thirteen relevant studies, some of which were devoted to both maternal and paternal influence.

Why read it: In surveys about adolescent sexual health and pregnancy, teens report that parents have a deep impact on their knowledge, values and choices when it comes to sex. But while the field of adolescent-health research has long paid attention to the role of mothers and families in youth sexual behavior, there is a much smaller body of knowledge related to the role of fathers in this aspect of teenagers’ lives. Understanding the effect fathers have can help sexual health educators find positive ways to involve fathers in teen pregnancy prevention programs.

Biggest takeaways for family and youth workers: On the whole, closer relationships with fathers led to adolescents taking fewer sexual risks. Several of the studies reviewed found that a healthy father-child emotional connection correlated to the young person’s delaying sexual behavior. Others found that positive relationships with fathers led to less sexual activity among younger teens but increased sexual activity among older teens.

The authors say that “the most consistent finding across reviewed studies … was the significant association between father-adolescent communication and adolescent sexual behaviors such as increased condom use and abstinence from sex.” More plainly, better communication with dad equals safer sexual behavior.

Other potential correlations were less clear. For example, there was no identifiable connection between fathers’ strictness about sex and their children’s chance of becoming pregnant.

The chief message of this study is the difference between mothers and fathers in terms of their parenting and effect on children’s lives. While the findings have been so far mostly tentative, the authors claim that there is reason to believe that fathers have their own significant role to play in their teens’ lives, independent from mothers. Supportive relationships with fathers had a greater effect on girls’ sexual behavior than equivalent relationships with mothers, for example.

At the very least, this study points out that fathers have their own independent role to play in children’s lives, and that service providers should seek out opportunities to increase or otherwise improve that role.  The authors call for greater research to identify new ways of including fathers in youth and family work, specifically the creation of new interventions based specifically around dads. 

Additional references: Find abstracts of other literature on fathers and father involvement in our digital library

Previous studies have looked at ways to break the generational cycle of teen fatherhood and the effect of paternal behaviors on African-American teens. The National Responsible Fatherhood Clearinghouse is a federal resource for programming, advice and research about fatherhood.

Publications discussed here do not necessarily reflect the views of NCFY, FYSB or the Administration for Children & Families.

#NCFYchat Continues Conversation on Teen Pregnancy and Sexual Health

On May 28, sexual health educators and teen pregnancy prevention advocates convened on Twitter for our latest #NCFYchat--"PREP Teens for the Future: A Conversation About Teen Pregnancy and Sexual Health." The chat, part of the Family and Youth Services Bureau's observation of National Teen Pregnancy Prevention Month, helped raise awareness of the issue and introduced the work of three grantees of the Adolescent Pregnancy Prevention Program.

Grantee panelists--namely, Cherokee Nation, Georgia Campaign for Adolescent Power & Potential in Atlanta, and Child & Family Resources in Tucson--kicked off the chat by explaining how their programs incorporate skills like communication and goal-setting to help teens develop healthy relationships and to make more informed choices about their bodies. They also discussed common challenges to their work and offered advice to other advocates before fielding questions from the Twitter audience.

The panel then shifted to a general discussion, with attendees weighing in on the importance of youth sexual health and sharing resources useful to their own work.

For those of you who couldn't make it on May 28, we're sharing a small sample from the conversation below. You can also read the full text of the chat by logging into Twitter and searching for #NCFYchat.

On the importance of parents/caregivers talking to teens about sex:

On advice for FYSB grantees, potential grantees, and teen pregnancy prevention advocates:

On participants' own challenges and accomplishments:

Help Youth Connect to Internships!

As the summer approaches, many of the youth you work with may be looking for summer employment and internships. Internships can help youth explore career paths, learn appropriate workplace behavior, and understand how to fit into workplace culture. 

Youth Engaged 4 Change, a project of the federal Interagency Working Group on Youth Programs, has launched a series of Web pages about internships. Youth will find internship advice, a list of federal internships they can apply for, and information on how to expand their skills.

We think the direct links to open internship opportunities will be very useful for young people seeking a meaningful summer job.

Read More About Internships for Youth

Go back to the NCFY archives for stories about a formerly homeless youth doing a summer internship at the nonprofit that helped him and an internship program where formerly homeless youth work with farm animals and wildlife.

Publications discussed here do not necessarily reflect the views of NCFY, FYSB or the Administration for Children & Families.

This Father's Day, Encourage a Terrific Father to Spread His Knowledge

The daily lessons of parenting are many. The National Fatherhood Initiative's Double Duty Dad program encourages experienced fathers to share their knowledge with other dads, or use their knowledge to mentor young people growing up without their fathers. 

Dad's sign a "Double Duty Dad Pledge," committing to model "involved, responsible and committed fatherhood." You can find the pledge form in the "The Double Duty Dad Guide" (PDF, 10MB), which also includes step-by-step advice on how to find and mentor children and dads in need of assistance.

The free guide (PDF, 10MB) is a perfect father's day gift for the terrific dads you know. The authors estimate that being a Double Duty Dad takes just 12 hours a year.

You may also want to read our article about African American teen dads perspectives on fatherhood, or view our slideshow about a program in New Mexico that helps dads and kids bond over poetry and movies.

Publications discussed here do not necessarily reflect the views of NCFY, FYSB or the Administration for Children & Families.

For Foster and Refugee Youth, a Teen Pregnancy Prevention Program That Acknowledges Trauma

At Bethany Christian Services in Grand Rapids, MI, a teen pregnancy prevention session can feel like a United Nations meeting.

Funded by a Competitive Abstinence Education Grant from the Family and Youth Services Bureau’s Adolescent Pregnancy Prevention Program, Bethany’s program for youth in Michigan’s child welfare system serves many refugees from Central America, Africa and other parts of the globe.

“There are so many youth from so many different countries and so many interpreters,” says Tiffany Clarke, who supervises the program. “There’s this energy and youth are raising their hands and trying to get their interpreters to work faster so they can participate.”

Held in child welfare facilities and afterschool sites in Kalamazoo, Holland, Grand Rapids and Detroit, the 16-week program offers refugee and U.S.-citizen youth a carefully calibrated set of programming and services. Youth participate in an evidence-based teen pregnancy prevention curriculum called Teen Outreach Program, or TOP, plus a trauma-informed curriculum created by Bethany staff. The mostly 14- to 18-year-olds (and a few older youth) also benefit from a host of social services and referrals offered by Bethany.

‘Like Tumbleweeds’

About 380 young people, about one-third of them refugees, have gone through the program since it launched in January 2013, Clarke says. The weekly sessions are a small slice of stability in the lives of the young people, for many of whom change and trauma are the only constants.

“They’re like tumbleweeds,” moving from placement to placement, Clarke says.

The repeated upheaval foster youth experience makes a program like Bethany’s important, says Youth Development Specialist Linette Dyer.

“Because they don’t have control, they take control anywhere they can in their lives--sexual relationships, acting out in school, knowing healthy boundaries but choosing to go against them because that’s in their power,” Dyer says. “Our program teaches them they do have control.”

Positive Factors

Clarke says the program works because it offers “positive protective factors to decrease risk factors—relationships with facilitators, self-esteem skills, and community-service learning projects. Our approach to pregnancy prevention is giving youth something else to hold on to so they have a sense of worth.”

That “something else to hold on to” comes in part from TOP’s youth empowerment approach, which puts young people in control.

TOP is designed to give youth healthy behaviors, life skills, and a sense of purpose. Studies of the program, which was developed by the Wyman Center in St. Louis, found that graduates have lowered risk of school suspension, pregnancy and course failure.

Since those are issues youth in foster care face at a higher rate than their peers, Clarke said, TOP seemed a good match for the youth Bethany aimed to serve.

Acknowledging the Past

To ensure the program fits the needs of teens nearing their transition out of the child welfare system, Bethany worked with the Wyman Center to condense the curriculum from nine months to about four. They also added their own trauma component, to address the experiences of young people separated from their families and, in many cases, their cultural group.

 “We’re not just focused on the future,” Dyer says. “We acknowledge a lot of the hurt and pain and great things that have happened to youth in the past. When you’re hurt you can’t move on until it’s acknowledged.”

Youth in the teen pregnancy prevention program also benefit from Bethany’s education, employment, mental health and other services. By wrapping everything together, Bethany’s staff aims to help vulnerable youth deal with all of the issues they face as they approach adulthood, rather than focusing solely on sexual choices and abstinence.

“It’s hard to tell someone to value something that has never been a value to them before, to make it meaningful for them,” Dyer says. “By starting with what’s valuable to the youth and working your way through the questions they have themselves and then sharing they do have options when it comes to having sex and remaining abstinent—it’s getting that buy-in and having that trust.”

This story is cross-posted from the Family and Youth Services Bureau website for Teen Pregnancy Prevention Month.

Nominate A Dad or Male Role Model for Our Thank You Campaign

We’re spending June talking about positive fatherhood and the role it can play in ending teen pregnancy, family violence and youth homelessness. As part of the fatherhood theme, we’d like to show our gratitude to amazing fathers and male role models who promote the missions of youth- and family-serving organizations.

We call it the Thank-a-Dad campaign.

Here’s how it will work: You nominate someone. We’ll feature outstanding stories on our website and in our social media channels. The nominees will feel thanked and appreciated.

You can nominate up to three men, ages 18 and up, who have been associated with your organization in the past year. Your nominee(s) might be

  • The dad of one of the youth in your program
  • A foster father
  • A teen dad
  • A guy who volunteers or works in your program and is considered a “dad” by many youth

Send us a short description of how amazing they are, their first name or a pseudonym, and what they have done to support your organization’s mission by June 20. Send the description in one of these ways:

  1. By email to ncfy@acf.hhs.gov
  2. By following us on Twitter and tweeting a message to @ncfy
  3. By liking us on Facebook and commenting on a post about our Thank-a-Dad campaign.
  4. By clicking the live chat button at the top of this page.

We’d especially love to hear from organizations that receive funding from the Family & Youth Services Bureau, but any family and youth services organization can nominate someone.

We look forward to hearing from you!

In April we ran a Thank-a-Volunteer campaign. Read about the nominees.

When a Local Partner Closes, a Response Plan Keeps Youth Services Constant

No youth and family services organization works alone, so the Tucson-area youth-serving community reacted with concern in March upon hearing that Open Inn, a local runaway and homeless youth program, was closing its doors.

“The closing of Open Inn is definitely going to affect southern Arizona,” says Teresa Liverzani-Baker, executive director of Youth on Their Own, which helps at-risk youth stay in school.

Like many of the agencies in Tucson’s close-knit nonprofit community, Youth on Their Own has shared donors, volunteers, and funding streams with Open Inn and has helped many of the same clients. Now those youth will have one less resource, but local partners are doing what they can to pick up the slack.

Liverzani-Baker and Patti Caldwell, executive director of Tuscon's Our Family Services, shared some insights about how social services organizations can ensure that services to young people continue to be delivered seamlesslessly when a longtime source of support is no longer available.

Try prevention when possible.

No program closes instantaneously, especially not an established one like Open Inn. Patti Caldwell says that Our Family Services was aware of Open Inn’s financial struggles. “We and two other organizations have been actively involved in conversations about possible mergers or another kind of alliance,” she says.

While those talks didn’t lead to that kind of arrangement, Caldwell still thinks that honesty among partners is still the best way to prevent a sudden shakeup to the community. When Open Inn made their announcement, Our Family Services already had a response plan in mind.

Pick up the pieces.

The most important part of that plan was making sure the lives of Open Inn’s clients weren’t disrupted.

“We immediately began having conversations about how many clients they had in their various programs,” says Caldwell. “Open Inn ran a program for kids getting ready to age out of foster care, for example, and another organization in town is looking to take that on.” Our Family Services also looked into whether they could purchase some of Open Inn’s residential properties in and around Tucson.

But Teresa Liverzani-Baker warns against being too pushy or aggressive in the quest to preserve programming or funding. “Whenever an organization closes, the timetable is very individual,” she says. “You never really know what point they’re at in the process. And donor information is very proprietary. Asking something like, ‘What about your donor base?’ would be inappropriate.”

Look out for your own program.

For people outside those early discussions, Open Inn’s closing seemed more sudden than it really was, which leads to widespread concern over the fate of other ostensibly healthy programs.

“There have been news stories, and we’re part of the group that gets interviewed,” says Caldwell. She and her colleagues called meetings and sent out emails to get their board and staff on the same page in the event they were asked to comment, publicly or privately. “We try and make sure we always say we’re working to help the youth in our community. We want them to have an agreed-upon statement that hammers that home. Our whole staff needs to be prepared to answer those questions: what happened, and how are we responding?”

But once again, tact is key, especially when reputations are on the line. “We’re trying to be respectful of Open Inn and let them take the lead for explaining what’s going on,” says Caldwell. “We greatly respect who they are and what they’ve done over the last 40 years, and we don’t want to add any fuel to rumors or gossip. We all know the challenges facing nonprofits and we’re working with our board to ensure that what happened with Open Inn is a learning experience.”

From the National Alliance to End Homelessness, a Comprehensive Assessment Tool

If your community has put in place a system for coordinating services for people experiencing homelessness, a new tool from the National Alliance to End Homelessness can help you share information across agencies and quickly get people the assistance they need.

The alliance's "Comprehensive Assessment Tool" was derived from the Prince George’s County, MD, Assessment Tool (PDF, 1.6MB) developed as part of the county's 10-year plan to prevent and end homelessness. The new tool covers:

Intake and Assessment: The tool integrates information so that referral agencies and the Department of Housing and Urban Devlepment's Homeless Management Information System will be able to communicate client information effectively. Another goal is for clients not to have to answer the same questions repeatedly if they deal with more than one service provider.

Prevention and Prioritization: The tool asks clients about other housing options to help divert those who do not need to necessarily enter the system. The tool also includes questions to help identify housing barriers and clients who may be considered "hardest to serve," as well as to determine the best intervention and level of priority to be placed on a specific client or circumstance. The tool encourages a housing first or rapid re-housing approach.

Referral and Placement: This section allows youth-serving professionals to implement a Positive Youth Development approach, working with clients to find out what interventions they feel most comfortable with and are willing to participate in. The tool also helps to determine how high a priority a client should be for receiving permanent supportive housing, using a component called "the dynamic waiting list process." The length of the waiting list for each intervention (transitional housing, rapid re-housing, or permanent supportive housing) will determine how many more people can be added. For example, if the list for permanent supportive housing is long, communities would add only the highest priority households to the list. If the list is short, communities would add lower priority households. This process ensures that waiting lists stay short, so that people who most need assistance can get it quickly and there aren't a lot of people waiting in shelters for long periods of time until their names come up.

Publications discussed here do not necessarily reflect the views of NCFY, FYSB or the Administration for Children & Families.

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