Grantee Spotlight: Shifting the Paradigm from Teen Pregnancy Prevention to Youth Sexual Health

With funding from the Family and Youth Services Bureau’s State Personal Responsibility Education Program, the Oregon Public Health Division’s programs take a holistic view of teen pregnancy prevention. They are focusing on all aspects of youth sexual health and involving as many community partners as they can.

In the past, “Everyone was working to improve outcomes for youth one way or another,” says Jessica Duke, manager for adolescent and school health programs at the Oregon Public Health Division, one of Oregon’s state youth-serving agencies and community partners. “But not everyone was thinking about teen pregnancy prevention.”

To get everyone on the same page, five years ago the state used Title V Maternal and Child Health Block Grant funding to put together the Oregon Youth Sexual Health Plan (PDF, 919KB), complete with a list of outcomes and a logic model. The plan seeks to eliminate sexual health inequities, prevent teen pregnancy and sexually transmitted infections, and empower youth to make thoughtful choices that lead to healthier relationships, better sexual health and less dating violence.

‘An Inclusive Umbrella’

The plan brought a sense of unity to agencies that were getting stuck in debate about whether sex education should only focus on abstinence or be comprehensive, Duke says. “Talking about youth sexual health opened a lot of avenues and made it easier for all the partners to see how they fit into youth sexual health as an inclusive umbrella.”

All agencies receiving federal teen pregnancy prevention funding participate in the Oregon Youth Sexual Health Partnership, the group of partners that collaborated together on the plan. Monthly meetings allow Abstinence Education Grant Program, PREP, and Office of Adolescent Health Teen Pregnancy Prevention grantees, agencies working in sexual violence prevention and community nonprofits interested in school health to stay in sync and identify opportunities for continued collaboration.

“When different [funding] opportunities came out there was a big change from thinking competitively to thinking collaboratively, Duke says. “We had conversations about what we wanted to apply for, what programs, what areas, to maximize benefits for whole state. Writing the plan set the stage to do that more effectively.”

Sexual Health Equity

Vital statistics data covering a decade showed that around one-third of Oregon’s teen pregnancies were among Hispanic girls. So PREP program administrators are using ¡Cuídate!, an evidence-based program designed to reduce HIV and sexual risk among Hispanic youth. In order to incorporate more elements of youth sexual health, they added a session on contraceptives. PREP is implemented in six counties representing rural, urban and suburban areas. Each has high sexually transmitted infection rates, high teen pregnancy rates overall or high birth or pregnancy rates among minority groups, such as Hispanic youth.

Involving Youth

The partnership involved youth in the formative research that went into creating the Oregon Youth Sexual Health Plan. Through three youth action research projects, it become evident that youth wanted to know more than just the mechanics of how to prevent pregnancy.

So, members of the Oregon Youth Sexual Health Partnership collaborated, and continue to collaborate, on how to incorporate youth input into their efforts.  An example is Oregon’s AEGP-funded program “My Future-My Choice”, which emphasizes postponing sexual involvement. The program has a Teen Advisory Board that regularly provides input on keeping My Future-My Choice content relevant to youth.

“As they become adults it is developmentally appropriate for young people to start thinking about their sexuality, but just talking about teen pregnancy prevention is not necessarily youth’s focus. If they are not engaging in sexual activity, they won’t relate. Framing programs around sexual health, rather than pregnancy prevention, makes programs more meaningful to youth,” Duke says.

Visit FYSB's Teen Pregnancy Prevention Month website for more information about the bureau's holistic approach to preventing teen pregnancy and childbearing.

Q&A: Putting Teens on Better Life Paths May Keep Them From Having Children Too Soon

In March, economists Phillip Levine of Wellesley College and Melissa Kearney of the University of Maryland released a compelling brief exploring the reasons the U.S. teen birth rate has been falling (PDF, 451KB) for two decades. They largely attribute the decline to worldwide trends, such as improvements in women’s access to education and better contraception. National trends such as high unemployment and a popular MTV reality show, “16 and Pregnant,” also played a role, they say.

We talked to Levine about the brief (released by The Brookings Institution) and what it will take to reduce U.S. teen birth rates even further.

NCFY: Teen birth rates have been falling for years. That’s obviously good news. Why is it important to figure out why rates have fallen?

Levine: One of the most dramatic facts about teen pregnancy and teen child bearing is how high those rates are even after the decline. We’re at rates of teen childbearing that are considerably higher than any other developed country. So it certainly makes sense to use whatever tools we have in our arsenal to try to figure out what’s going on so that we might be able to promote further reductions. And one of those things we have is our historical experience. What can we learn from what’s been happening over the past 20 years or so that’s led to what has been a remarkable decline, so that we can use it to keep the ball rolling?

NCFY: Some researchers are studying individual teens and what affects their behavior and in turn affects their likelihood or unlikelihood of having a teen birth. But you’re looking, as you said, at historical trends. How can both kinds of research inform each other?

Levine: For the most part they’re saying similar sorts of things about the underlying causes of the high rates of teen childbearing in the United States. From the ethnographic studies, you get a real sense of desperation and hopelessness, where it seems like there’s a large component of population that just think it doesn’t really matter whether they get pregnant or not. They’re not looking forward to great outcomes anyways.

From our perspective, that’s completely consistent with the fact that public policy has a difficult time altering teen birth. If women are in a situation that they’re going to do what they’re going to do because their aspirations have been sufficiently diminished, it’s going to be really hard to move them off of that by providing different forms of sex education, better access to contraceptives, or things like that. Those policies may have some effect but they can be pretty limited.

It’s difficult to find any evidence of teen child bearing and its effect on subsequent outcomes for women. So it’s not the act of teen childbearing itself that leads to greater high-school dropout rates or a range of things like that. We do observe those things in women who give birth at a young age, but they were on a trajectory towards those outcomes anyway, and having a baby at a young age was just one of the steps on that path.

NCFY: In “Teen Births Are Falling: What’s Going On?” (PDF, 451KB) you recommend a holistic approach to teen pregnancy, viewing it as just one part of a bigger issue of poverty and, maybe, disaffection.

Levine: That’s exactly right, that’s exactly what we think. I think a lot of times when we think about teen child bearing we think about what can we do at the moment that a teen is about to make a decision that would lead to birth at a young age or having sex without protection. I would argue that there may be some value to that kind of approach, but I think that it probably is of limited value. It’s what leads you to the position where you make that sort of decision in the first place. Those are the things that need to change.

If you’re going down a life path where you have high expectations and high aspirations for the sorts of things you’re going to achieve down the road, you’re going to make those kinds of decisions anyway—to use contraception or not to engage in sexual activity.

But if you’re in a position where you think to yourself, “What difference does it make?”—it’s going to be very hard to move that person off of that kind of behavior.

So in terms of public policy, the kinds of things that we need to think about are not what’s going to happen at that particular moment and stopping that thing from happening, but finding ways to put people on better life paths so that when they get to that point they make better decisions on their own.

Read our look at Levine and Kearney’s research on the MTV show “16 and Pregnant.”

Check out FYSB’s Teen Pregnancy Prevention Month website, which includes information about the bureau’s holistic approach to preventing teen pregnancy and childbearing.

Share FYSB’s infographic, “Keeping Up the Momentum: Together We Can Keep Teen Birth Rates Falling” (PDF, 365KB).

Research Roundup: Developing Culturally-based Teen Pregnancy Prevention Programs for Minority Youth

When it comes to choosing evidence-based, culturally-relevant teen pregnancy prevention programs, organizations often don’t have a large selection, but this is changing. Taken together, three recent studies provide a blueprint of how strong, culturally-based teen pregnancy prevention programs can be developed.

Read on for a summary of each of the studies, followed by some tips based on our reading of them.

Multimedia Circle of Life: Carol Kaufman and her colleagues, from the Centers for American Indian and Alaska Native Health and the Center for Public Health Practice at the University of Colorado-Anschutz Medical Campus received a grant to take Circle of Life--a curriculum for older youth that combines Native American philosophy, such as the Medicine Wheel, with Western behavior change theories--and modify it for 10- to 12-year-olds. Preteens are considered by some the most appropriate target group for a prevention program, because most of them have not yet had sex.

The curriculum the researchers came up with, Multimedia Circle of Life, or mCOL, uses an online format to address not only teen pregnancy prevention, but also prevention of Hepatitis B and C, two sexually transmitted infections that are prevalent in Native American communities of rural North and South Dakota.

Pono Choices: The research team of Holly Manaseri, Denise Uehara and Kelly Roberts, from the University of Hawai’i at Manoa-Center on Disability Studies, created the Pono Choices curriculum and program, based on Native Hawaiian cultural beliefs and values. Pono Choices aims to prevent teen pregnancy and sexually transmitted infections among Hawaiian middle school students.

The program teaches ‘pono,’ or right, choices that lead to a balanced life, and it includes ‘ohana' (family) activities. As with mCOL, feedback from community members was an integral part of the curriculum development process.

Family Festival Prevention Model: Previously featured in May 2013’s Research Roundup about programs tailored to the Latino community, the Family Festival Prevention Model, or FFPM was developed after an adolescent pregnancy prevention program in a rural, Latino community had difficulty recruiting participants. Yvette Murphy-Erby, Kimberly Stauss and Edwar Estupinian, from the School of Social Work at the University of Arkansas in Fayetteville, held focus groups with community members to see how they could better attract youth and families.

The feedback they collected informed FFPM. The model incorporates the cultural beliefs and values central to rural Latino families, and takes into account everyday realities, such as fathers’ work schedules and their limited time availability.

What are the takeaways for youth and family service professionals?

All three programs demonstrate that culturally-based teen pregnancy prevention programs can be designed in unique communities, with community buy-in, community involvement and cultural humility on the part of researchers and program planners. Here's what we gleaned about how you can use the lessons learned by these projects to design culturally relevant teen pregnancy prevention in your community:

  • Community involvement is the key to program success. Including community members in the design and development of a program is essential for making a program culturally-relevant and for establishing community buy-in. For the Native American communities that participated in the mCOL program, it was important that all residents, not just parents, had a say in every concept covered in the curriculum. For example, many elders could not agree on the right age for a person to have their first child. This range of cultural viewpoints required extensive discussion between the researchers and community members before the curriculum could be finalized.
  • Allow time for program planning and learning about the population. The more time invested in planning, the better a program will be. Manaseri, Uehara and Roberts recommend using planning time to learn about the sociocultural norms and unique programmatic needs of the target community. The planning stage is also the time to design an evaluation plan, they write. In the Pono Choices curriculum, program planners made sure to build time into their program for data collection (surveys, in this case) and data evaluation.
  • Flexibility and adaptability make programs resilient. Programs are often implemented in the context of an ever-changing community. Expect that there will be ups and downs, as well as unexpected events, Manaseri and her colleagues write. During the implementation of the mCOL curriculum, community crises interrupted planned program activities, but the well-trained staff members were skilled improvisers who restructured activities around the community’s need for grieving and healing. In the Pono Choices curriculum, it helped to create flexible lesson plans that could be adjusted to varying class schedules, as is common in Hawaiian middle schools.
  • Respect participants’ needs for privacy. Involve community members in discussions about how privacy and confidentiality can be protected in the program, especially in rural, close-knit communities. Yvette Murphy-Erbya, Kimberly Staussa and Edwar F. Estupinian found that Latino families in Mena, AR, were worried about being identified with a sexual health education program, especially since the community was highly involved with the local Catholic Church. Having agreed-upon confidentiality standards alleviated these concerns and fostered trust.

Read the Articles

 “Planning For a Group-Randomized Trial with American Indian Youth.” Kaufman, C. E., Black, K., Keane, E. M., Big Crow, C. K., Shangreau, C., Arthur-Asmah, R., Tuitt, N. Journal of Adolescent Health, Vol. 54, No. 3 (2014).

 “Making Pono Choices: A Collaborative Approach to Developing a Culturally Responsive Teen Pregnancy and Sexually Transmitted Infections Prevention Curriculum in Hawai’i.” Manaseri, H., Uehara, D. & Roberts, K. Maternal and Child Health Journal, Electronically published ahead of print (December 2013).

A Participant-Informed Model for Preventing Teen Pregnancy in a Rural Latino Community.” Murphy-Erby, Y., Stauss, K. & Estupinian, E. F.  Journal of Family Social Work, Vol. 16, No. 1 (2013).

(Publications discussed here do not necessarily reflect the views of NCFY, FYSB or the Administration for Children and Families. Go to the NCFY literature database for abstracts of this and other publications.)

Resource Roundup: Community Violence

In many communities, young people experience and witness violence every day. They may fear walking outside and going to school and feel that they are constantly in danger. These resources can help you give young people tools to stay safe.

Two short publications for youth from the National Child Traumatic Stress Network tackle the topic of community violence head on. Youth can use the 1-page checklist "Violent Places, Dangerous Times: Does Community Violence Control Your Life?" (PDF, 483KB) to determine if they’ve been affected by violence outside the home. If the answer is yes, young people can go to the fact sheet "Community Violence: Reactions and Actions in Dangerous Times" (PDF, 2MB) for advice and encouragement. The handout lets youth know they are not alone, advising them to talk to a trusted adult about their fears and concerns. A list of hotlines is helpful for young people if they don’t have someone nearby to reach out to.

The National Forum on Youth Violence Prevention is a network of communities and federal agencies that work together, share information and build local capacity to prevent and reduce youth violence. Established in 2010, the forum developed the "Strategic Planning Toolkit for Communities" (PDF, 382KB). It’s a useful tool if your city or community wants to launch or revisit a comprehensive action plan to prevent violence by and against young people. The toolkit lays out a four-step process:

Step 1: Build Partnerships and Raise Awareness

1.1: Initiate a call to action.

1.2: Agree on a common vision of success

1.3: Organize a structure for developing the plan.

Step 2: Gather and Use Data to Inform Strategies

2.1: Review current youth violence research and evidence.

2.2: Collect and share local data on youth violence.

2.3: Use the data to inform strategy selection.

2.4: Identify resources and assets.

Step 3: Write the Plan

3.1: Develop strategies and goals.

3.2: Match resources to strategies and goals.

3.3: Develop measurable objectives and activities.

Step 4: Implement the Plan

4.1: Work the plan.

4.2: Revisit and update the plan.

The Centers for Disease Control and Prevention is also tackling the issue of youth violence. Its national initiative Striving To Reduce Youth Violence Everywhere, or STRYVE, helps communities take a public health approach to preventing youth violence—stopping it before it even starts.  If you want to learn about the approach, take the STRYVE online training designed to familiarize you with the key concepts and strategies of youth violence prevention.

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

Positive Parenting Resources for Parents of Teens

How can parents be a part of teen pregnancy prevention month? There's some evidence that having a positive relationship and good communication with parents can protect teens from becoming parents too soon. Here are some resources for parents of teens:

The Centers for Disease Control and Prevention offers resources for parent of teens on positive parenting practices such as understanding the importance of monitoring your teens' activities and the importance of fathers in curbing risky sexual behavior.

The Child Welfare League of America offers advice on positive parenting practices for every type of parent, including single or divorced parents and parents of boys.

The Office of Adolescent Health's "Talking with Teens" section has helpful tips for parents and caregivers about the best ways to approach the topic of pregnancy with their teens. Parents will also find guidance on discussing other tough-to-talk-about issues that can cause pregnancy, like substance abuse and dating violence.

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

Research Roundup: Reality Shows Contributed to Decline in Teen Childbearing—but Other Factors Also Played a Role

The media often gets a bad rap when it comes to teen programming, but recent research suggests television shows can lead to positive outcomes under the right circumstances. Since “16 and Pregnant” debuted in 2009, followed by its spin-offs, “Teen Mom” and “Teen Mom 2,” there has been debate over whether the shows accurately portray early motherhood and its challenges or glamorize it. Two recent studies try to inject some data into the conversation, looking at the shows’ impact on teens' attitudes and behaviors.

One of the studies, published in January by researchers from the University of Maryland and Wellesley College, attempts to draw a line from the amount of buzz the shows generated in each state to teen birth rates after the first show debuted. Authors Melissa S. Kearney and Phillip B. Levine compared Google search activity and postings on Twitter about the shows and about contraceptive use and abortion, along with Nielsen’s TV ratings of the shows, following the release of new episodes. Then, they looked at CDC Vital Statistics birth data to determine how many 12- to 24-year-olds in each state ultimately became teen mothers.

Kearney and Levine observed spikes in search activity and tweets containing the terms “birth control” and “abortion” when new episodes of the shows came out. In addition, they observed a more rapid decline in the teen birth rate in geographic areas where the shows were more widely viewed. Still, they say, it is possible that this finding is not random but rather that the show is more popular in locations with higher rates of teen childbearing.

Kearney and Levine write that based on their analyses, these shows “led to a 5.7 percent reduction in teen births that would have been conceived between June 2009, when the show began, and the end of 2010”—roughly one-third of the decline over that period. As with any causal research, it is important to look at other factors. Kearney and Levine point to previous research finding that during times when there is a weak labor market, as when the shows debuted, birthrates across the board tend to decline.

The impact of parent communication

So what about those teens who watched the show and still became young moms? A study from Indiana University and the University of Arizona, Tucson, published last year, informs the debate by taking a look at the influence of parents and popular culture side by side.  Previous research has found that U.S. teens cite their parents as perhaps the most important influence on their sexual behavior.

Authors Paul J. Wright, Ashley K. Randall and Analisa Arroyo wanted to see whether talking openly with their parents about sex changed the degree to which young women were influenced by the shows.

The researchers asked 313 unmarried 18- to 23-year-old women who were sexually attracted to men how often they viewed “16 and Pregnant” and “Teen Mom.” The young women also answered questions about whether they had had sex in the past year and how often their mothers and fathers had communicated with them about sex during their childhoods.

Overall, women who had viewed either show were more likely to have recently had sex. This was true even after the researchers controlled for relationship status and ethnicity.

However, when Wright, Randall and Arroyo included parent communication in the analysis, they found a different story. Watchers of the TV shows whose fathers did not talk to them about sex while they were growing up were more likely to have recently had sex. But the opposite was true for women whose fathers had often talked to them about sex. The more those women watched the two shows, the less likely they were to have recently had sex.

Having talked to their moms about sex did not have a significant effect on women’s behavior.

Previous research suggests that “mothers are less prone to strongly and unambiguously discourage pregnancy-risk behavior than fathers,” Wright, Randall and Arroyo write. Fathers, they say, are more likely to point out the negatives of premarital sex, the possibility of young men putting sexual pressure on young women, and the negative consequences of other people’s risky sexual behavior.

In this study, young women who received strong messages about sexual risks were more attuned to the challenges presented in the shows. Those who did not get those messages were more likely to emphasize the positive traits of the teen moms, appreciate how they overcame challenges, and develop an optimistic view of teen motherhood.

These studies demonstrate that many factors influence teens’ behavior and whether they have unintended pregnancies and births. More research will help us get closer to understanding how healthy sexuality and the decline in teen births actually come about.

Read the articles

 “Media Influences on Social Outcomes: The Impact of MTV’s 16 and Pregnant on Teen Childbearing” (PDF, 366KB). Melissa S. Kearney and Phillip B. Levine. (January 2014).

Father-Daughter Communication About Sex Moderates the Association Between Exposure to MTV’s ‘16 and Pregnant’/’Teen Mom’ and Female Students’ Pregnancy-Risk Behavior” (abstract). Paul J. Wright, Ashley K. Randall, and Analisa Arroyo. Sexuality & Culture, Vol. 17, No. 1 (March 2013).

Look for more articles about media and teen pregnancy in NCFY’s research library.

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

Bright Idea: Development Councils Help Youth Build Leadership Skills, Strengthen their Communities

The group of teens strolling through Los Angeles’ Wabash Recreation Center weren’t there to use the new basketball hoops or sit on a freshly painted park bench. Their visit had a more professional purpose—to review the repairs and renovations they had funded as members of a local community development council.

Martha Burzycki has been helping young people award grants that address community needs since 2002. That year, changes to the federal Workforce Investment Act compelled her to create the Cape & Islands Youth Community Development Council to build leadership skills among at-risk youth.

Burzycki, who works at the Hyannis, MA-based Job Training and Employment Corporation, now divides her time between Massachusetts and California–-where she launched a sister council in 2008. Youth participants have awarded nonprofits more than $120,000 to-date. In the process, they’ve shown adults on both coasts just how much they know and care about their communities.

“These young people think about the future more than we think they do,” Burzycki says. “They want to know how they can interact with the world around them and what they can do to make society better.”  

Money Matters

Burzycki runs each council similar to a board of directors, recruiting roughly 12 to 14 participants per cohort. Groups meet about once per month, on average, with some councils consolidating multiple meetings into a weekend retreat.

Participants create a group mission statement and discuss gaps in available services to pick areas they’d like to fund, such as teen suicide prevention and the environment. They then develop a four-page Request for Proposals that Burzycki posts online and distributes by press release, legal notice and direct mail.

Young people review incoming applications and decide which nonprofits should receive funding, which is generally donated by local banks and foundations. Two adults attend each meeting to provide support and facilitate conversations, but they ultimately have no decision-making power.

Says Burzycki: “It’s very empowering for these kids [to make decisions themselves] because nobody’s ever said to them, ‘What do you think?’ or ‘How do you want to spend this large chunk of money?’”

Starting a Youth Community Development Council

We talked to Burzycki about ways that youth-serving agencies can start similar programs in their own communities.       

  • Recruit youth not traditionally asked to serve: Teens facing problems at home and school often know the most about services available—or not available—to them and their peers, Burzycki says. Your agency can meet with local social service providers to help identify potential participants and to help distribute promotional fliers. Incentives may also help, like the $50 Burzycki offers young people if they attend 90 percent of meetings.
  • Ensure young people are learning, not just doing: Consider using a facilitators’ guide, like the toolkit Burzycki created to explain topics like grant reviews and proposal writing. Related readings can help teens understand a concept better, she says, but you should also include activities like journaling, group discussions and personal reflection to support a wide range of learning styles.
  • Seek funds from local partners: Approach local banks, foundations and corporations to solicit funds and explain how youth councils benefit young people and the broader community. Don’t forget to expand your view of potential advocates, Burzycki adds, to include board members and even national service organizations like the Corporation for National & Community Service.

Spotlight on Trauma-Focused Cognitive Behavioral Therapy: A Road to Healing

JR (not his real name) was very bitter when he came to the emergency shelter at Family Connection, Inc., in Birmingham, AL. He’d clashed with his mom and her boyfriend and experienced physical abuse. He didn’t want a relationship with his mom anymore and suffered from low self-esteem. He thought his mom had chosen the boyfriend over him, and he felt no one would ever choose him.

To help JR come to terms with the things he’d gone through, clinical staff at Family Connection used a popular evidence-based practice called Trauma-Focused Cognitive Behavioral Therapy. TF-CBT, as it’s called, helps youth see how post-traumatic stress manifests itself in their thoughts, emotions and behaviors. The therapy’s goal is to provide an outlet for youth to find what works for them—what soothes them and lets them heal emotionally.

In JR’s case, “We worked through all those feelings, and got Mom involved in counseling too,” says Residential Program Director Brandi Horton. “She ultimately ended up breaking up with the boyfriend and making changes for herself too once she saw how her behaviors were affecting her son.”

In the end, TF-CBT enabled JR to return home. His relationship with his mom blossomed, and he became more involved in school, Horton says.

A Roadmap to Change

TF-CBT is typically delivered in 12 to 16 therapy sessions. Therapist and youth can work one-on-one, in joint sessions with a parent or caregiver, or in a group setting. The therapy includes the following steps:

Assess trauma. The therapist looks into the youth’s history of traumatic exposure, post-traumatic stress disorder symptoms, and behavior.

“It’s so important in the first day or two to meet with youth as often as possible, gather information about what issues are present, and how their behaviors and beliefs are related to the traumatic experience,” Horton says.

Define goals. The therapist and youth make a plan for how they will measure progress over time and how they will know the young person is better.

“People”--both youth and therapists—“need to have a sense of success,” says Rosemary Creeden, associate director of trauma services at FrontLine Service, a community-based organization offering services to help people overcome trauma and end homelessness in Cleveland, OH.

‘Normalize’ symptoms to reduce self-blame. The therapist enables the young person to draw a dotted line between past experiences and the actions they take every day, so they won’t just think they are “bad” people.

“A lot of kids are not seeing the connections—that they are acting out in school because they were abused by their uncle, for example,” says Jennifer Mettrick, director of implementation services who has trained youth- and family-serving professionals on TF-CBT through the University of Maryland Institute for Innovation & Implementation. “We help them see that the root is something that happened to them, not that there’s something defective about them.”

Involve caregivers, if possible. Parents and caregivers often naturally block out family trauma and minimize it because they don’t want to think about it, as JR’s mom had likely done. But it's critical to train adults invested in young people’s recovery on how to react when young people show symptoms of trauma, says Creeden. And involving them in the process allows them to see what it means for young people to get better. That can help the adults heal, too.

Teach coping methods. The therapist introduces young people to practices they can use every day, such as relaxation and mindfulness techniques. In this stage, young people learn to think about their trauma differently and tell a different story about what it means in the context of their lives. Young people also learn that they don’t need to disclose what happened to everyone they meet. Therapists can also help youth find creative outlets that work for them—such as dance, art and music—to stop intrusive thoughts from overpowering them, says Creeden.

Getting Certified

Allegheny Health Network and the Rowan University School of Medicine Child Abuse Research Education Service Institute are the purveyors of TF-CBT training. Certification is open to professionals who hold a master’s degree and licensure for psychology or social work in their state. Getting certified takes three steps:

  1. Training. Staff complete a free online course to familiarize themselves with the language and content of the treatment, and then they attend a two-day training.
  2. Practice. For 6 to 12 months, trainees take on at least three cases where it is appropriate to use TF-CBT, two of which must involve the caregiver as well, and trainees participate in regular consultation calls with a certified TF-CBT train-the-trainer graduate as well as his or her supervisor.
  3. Testing. Lastly, trainees register to take a two-hour online exam.

The two-day training can cost from $100 to $300 per person if done at regional and national conferences, or around $3,000 to have a TF-CBT trainer come to an agency and provide training. The exam costs $125 per person. To lower costs, FrontLine shared the expense of onsite training with several other agencies.

If your agency can afford it, you might want to consider training non-clinical staff as well as clinicians, so that your organization can consistently apply the underlying philosophy of TF-CBT to all interactions with youth, Horton says.  

“A youth might be really aggravated one day and have a lot of behavior issues,” Horton says. “Having the TF-CBT training allows both certified and non-certified staff to look past that, consider the reasons, and find the patience to teach them and try to help them,” Horton says.

Learn more

Read about strategies for incorporating art and other creative activities as an alternative to talk therapy in helping youth overcome traumatic stress.

Download this TF-CBT Practice Checklist (PDF, 36.6KB) for a list of strategies for identifying appropriate TF-CBT cases and using the practice.

Read the National Child Traumatic Stress Network's detailed TF-CBT implementation guide (PDF, 426KB) for more detail.

Webinar on Proposed Regulations for the Runaway and Homeless Youth Program Available Now

The Family and Youth Services Bureau is pleased to offer a prerecorded webinar that reviews the proposed regulations for the Runaway and Homeless Youth Program. The webinar describes the Federal rulemaking process, reviews the major changes proposed in the rule, and provides information on how to submit public comments.

The proposed regulations would establish new program performance standards for Runaway and Homeless Youth grantees providing services to eligible youth and their families. Also proposed are revisions to existing performance standards to reflect recent statutory changes and to update procedures for soliciting and awarding grants.

View the free webinar (you'll be prompted to submit your name and email address before viewing the slides)

Review the proposed regulations in the Federal Register

Provide your comments on

A New Guide Can Help You Get Youth and Families to Volunteer

Want to get more youth and their families to volunteer at your organization? GenerationOn's new "Ready-Set-Go! Resource Guide" aims to help nonprofits "increase their capacity to engage youth and family volunteers."

The strategies and best practices found in the guide come from a five-city pilot project that began in 2012 to bring together the expertise of more than 20 volunteer managers. You'll learn how to reach out to and recruit young volunteers, prepare staff to work with youth, plan appropriate community service projects with young people, and guide them in their efforts.

Chapters include:

GenerationOn, which is a project of Points of Light, a national organization that promotes community service, also has a whole resource section for teens.

Read "Ready-Set-Go! Resource Guide."

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


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