Addressing the Needs of a Priority Population
Some of the most vulnerable youth in the United States are those living apart from their families in residential care administered by the foster care or juvenile justice systems. Many of these youth have experienced abuse and neglect, face mental health and substance abuse challenges and struggle with serious behavioral problems — all factors found to increase sexual risk-taking behavior (James et al. 2009; McGuinness et al. 2002). Although these youth commonly face many challenges and risk factors, they often do not receive much sexual health education (Hudson 2012; Becker and Barth 2000).
Youth in foster care, juvenile justice and other out-of-home care settings are a priority population for efforts to prevent teen and unplanned pregnancy. These youth report having first sexual intercourse at earlier ages and more sexual partners compared with other youth (Belenko et al. 2009; James et al. 2009; Kelly et al. 2003; McGuinness et al. 2002; Carpenter et al. 2001). Moreover, teen girls in foster care are 2.5 times more likely to become pregnant by the age of 19 and 1.5 times more likely to have a subsequent teen pregnancy than their peers outside the foster care system (Dworsky and Courtney 2010; Bilaver and Courtney 2006). Among boys in foster care, about 50 percent reported impregnating someone by age 21 compared with 19 percent of their peers not in foster care (Courtney et al. 2011).
Youth living in out-of-home care typically have limited access to sexual health education about contraception and pregnancy prevention. Overall, research has found that teens living in foster care have relatively low levels of knowledge about contraception and reproductive health (Hudson 2012). These youth commonly experience disruptions in schooling and may even be removed from public school completely, so they often do not have access to the sexuality education provided in public schools (Becker and Barth 2000). Moreover, youth living in group homes have reported difficulty accessing reproductive health information and services, and some studies have indicated a lack of sexual health education provided within group home settings (Freundlich 2003; Crottogini et al. 2008). This lack of access to sexuality education puts youth in out-of-home care at risk of higher rates of sexual risk-taking behavior and teen pregnancy.
Impact Results: Strong Evidence of Effectiveness
PTC was evaluated as part of the federal Evaluation of Adolescent Pregnancy Prevention Approaches (PPA) in collaboration with the Oklahoma Institute for Child Advocacy, and its independent evaluators at the University of Oklahoma Health Sciences Center and University of Nevada, Reno. PPA was a national evaluation funded by the Office of Adolescent Health within the U.S. Department of Health and Human Services to study the effectiveness of seven teen pregnancy prevention approaches. The PPA evaluation conducted random-assignment studies to provide rigorous evidence about program impacts, document implementation of the program and generate insights about the successes and challenges of delivering innovative teen pregnancy prevention programs.
Data collection and analysis was completed in the summer of 2015. The final Impact Evaluation Report was released in September 2016. The outcome findings documented a number of statistically significant changes in knowledge, attitude, intention and behavior, providing strong evidence of effectiveness.
Key outcome findings at a 12-month follow-up survey among youth receiving PTC included:
- Increased knowledge about reproductive health issues and resources
- Lower sexual activity rates
- Less likely to have sex without protection
- Less likely to be involved in a pregnancy
Implementation Results: Quality Matters
PTC is the only program studied through the PPA evaluation that focused on reducing pregnancy and associated sexual risk behaviors among youth living in out-of-home care. The evaluation was the first rigorous test of PTC’s effectiveness in improving behavioral outcomes. An initial project implementation report prepared by Mathematica Policy Research, Inc. described the first phase of the Power Through Choices Demonstration and Evaluation Project, including the structure, staffing, training, program delivery and fidelity monitoring, along with feedback from the project staff, group home staff and youth participants. (Meckstroth, Alicia, Megan Barry, Betsy Keating, Ellen Kisker and Kristine Andrews. “Addressing Teen Pregnancy Risks for Youth Living in Out-of-Home Care: Implementing Power Through Choices 2010.” Princeton, NJ: Mathematica Policy Research, November 2014.)
Key findings from the implementation report that assessed the PTC program implementation with over 1,000 youth in 44 group home settings in three states, included:
- Over 90% of youth felt PTC was “very valuable” or “extremely valuable” to them.
- The PTC curriculum was relevant to the lives of the high-risk youth.
- The interactive format more fully engaged the youth in the learning process.
- The high quality of facilitation was critical to the success of the program.