Are you SMART?

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Genevieve Martínez García

The first step for designing an evaluation plan is to get a comprehensive understanding of what the program is trying to achieve and with whom. SMART objectives, as part of the program logic model, can tell us just this information. The program logic model not only lays out a plan or a map to developing a program/intervention, but it also points to the objectives of a program and what should be evaluated and measured.

Most of us are now accustomed to writing SMART objectives, but it’s always helpful to take a step back and revisit the evaluation plan. Are the objectives truly SMART? Can they be SMARTer?

A Review on SMART Objectives…

Specific – What will change and for whom? Be specific.
Measurable – Are your desired outcomes measurable? By how much will things change?
Achievable – Are your desired outcomes achievable and attainable?
Realistic – Are your desired outcomes realistic given our resources?
Time Bound – By when will you expect to see your desired outcomes?

When writing SMART objectives, it may be helpful to use an objective-writing template:

By (TIME BOUND: what date or completion of what activity),(SPECIFIC: describe who) will (SPECIFIC: describe change in knowledge, attitude or behavior) by indicator (MEASURABLE: describe how you will know change has occurred).

Evaluation in Practice: Evaluating the Implementation of Sex Education in Schools

From 2010-2012, Healthy Teen Network partnered with Elev8 and East Baltimore Development, Inc. to implement and evaluate sexuality education programs in several Baltimore City elementary and middle schools. Healthy Teen Network evaluators engaged educators, school staff, and Elev8 administrators in the evaluation process to obtain meaningful process and outcome evaluation data. Data were incorporated into the planning of each implementation cycle to improve program delivery and enhance outcomes.

The evaluation plan included development and administration of pre-and post-test tailored to the selected program and appropriate for young African American students, direct observation of class implementation, fidelity monitoring assessment, and individual and group interviews with key project staff. The mixed-method evaluation plan allowed Healthy Teen Network to assess the quality and fidelity of the implementation; to identify factors at the school, facilitator, and administration levels affecting the delivery of the program; and to assess gains in knowledge among participants.

Healthy Teen Network is able to support you in providing evaluation services, or building your capacity to conduct program evaluation:

  • Conducting a needs and resources assessment using multiple data collection methods and approaches (e.g., secondary analysis, collecting own data)
  • Developing evaluation plans
  • Designing data collection tools (quantitative and qualitative)
  • Planning and implementing data collection methods
  • Designing participant assessment protocols and tools
  • Designing instructor observation protocols and tools
  • Conducting qualitative data analysis using software
  • Developing evaluation reports
  • Interpreting evaluation results
  • Conducting continuous quality improvement (CQI) based on evaluation results

For more information on these capacity-building services, contact Mila Garrido or complete a service request form today.

Genevieve Martínez García, PhD, is a Senior Researcher at Healthy Teen Network.

Teen Pregnancy Rates among LGBTQ Youth Might Be Higher Than You Would Expect

Alia Gehr-Seloover

Alia Gehr-Seloover

In working with LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning) populations over the years, I’ve noticed that is has been widely assumed that these youth don’t require pregnancy prevention education. In fact, this population is two to seven times more likely than heterosexual youth to be involved in a pregnancy. This is a larger issue when looking at the ways in which LGBTQ youth are treated in their communities. It is also indicative of the types of sexual health education taught in this country throughout many different forums.

With an average of 12-17% of LGBTQ teens involved in a pregnancy, compared to an average of 2-5% of heterosexual teens, the question of why these numbers are so drastically different begs to be asked.

Statistically, LGBTQ young people experience elevated rates of discrimination, with eight of 10 LGBTQ teens stating that they have been harassed or abused as a result of their sexual orientation and/or gender identity. Discrimination isn’t just occurring at school–while incidences of family rejection have decreased over the last decade, and more families are accepting of their LGBTQ children, 26% of LGBTQ youth are told to leave home. In fact, according to the 2006 National Gay and Lesbian Task Force Executive Summary, “of the estimated 1.6 million homeless American youth, between 20 and 40 percent identify as lesbian, gay, bisexual or transgender (LGBT).” These types of prejudices lead to higher use of drugs and alcohol, a heightened incidence of depression and suicide, and an increased likelihood of participation in risky sexual behaviors, including survival sex (sex for shelter, food, clothing, etc.).

LGBTQ youth who feel stigmatized may also strive to appear ‘normal’ or ‘heterosexual’, participating in ‘heterosexual sexual activities’ to pass as straight. This becomes an issue when we observe the way sexual health education is presented. In the majority of educational atmospheres, sexual education is focused around heterosexuals, minimizing inclusion of the LGBTQ community, and their need for comprehensive sexual health education. The result is that many LGBTQ identified teens who do participate in ‘heterosexual sexual activities’ may not feel that the sexual health education offered pertains to them, or may not pay attention to the biased education presented.

In my experiences with LGBTQ youth, the one criticism that many voice is that they never received sex education that resonated with them, and in sitting in a classroom they may zone out or stop paying attention. Other youth that I have spent time with have mentioned that while they identify as gay, it isn’t easy to find someone to date–many will go out with people of another sex because they want something to do, or someone to spend time with.

It is important to understand that many LGBTQ adolescents are happy, safe, and feel that they are receiving the education, resources, and access to health materials that they need to thrive. It is also essential that we recognize that for those who don’t feel this way, there are ways that we can work together to change this.

What can we do to help?

  • Educators must work with their schools and districts to include LGBTQ inclusive health education, using terms referring to body parts rather than relationship types and persons involved: penis, vagina, anus, etc., rather than man or woman.
  • Discuss with LGBTQ youth various self-care methods, community resources, and ways in which they can involve themselves with accepting individuals and groups.
  • Parents and teachers need to work together to accept LGBTQ youth. It’s important that they know that they are cared for, and loved no matter what the outside world thinks.
  • It is crucial to educate students in appropriate behaviors; ensuring that efforts to diminish bullying and discrimination are taken seriously and those students who choose to participate in bullying behaviors will face negative repercussions.

What other ways can we ensure that LBGTQ youth are receiving the education, resources, and access to health materials that they need to thrive?

Alia A. Gehr-Seloover is the LGBTQ Health Coordinator, Healthcorps Navigator, at Institute for Family Health.

The Power of Youth: 5 Takeaways

Alia Gehr-Seloover

I was one of several scholarship recipients who attended Healthy Teen Network’s annual conference, The Power of Youth: Joining Forces to Achieve Positive Outcomes, last month in Minneapolis. This was an amazing opportunity for me to network with knowledgeable professionals from around the country who are incredibly invested in the work that they do with young people and health education.

Through the workshops and other conference events I attended, the biggest takeaways for me were:

Humorous approaches to teaching sex education can be very helpful.
Discussing sexuality education with young people can be difficult. Many people feel embarrassed or uncomfortable talking about sexuality and relationships from a health standpoint. By incorporating jokes, fun, and interactive activities and encouraging laughter, teens are more likely to retain the information presented.

We need to always be educating parents and families around discussing sexual health and wellness with young people.
Parents and families are often times a youth’s first contact with health education. It is crucial that parents are getting the comprehensive education that they need to be prepared to comfortably share with the children in their lives.

Advocacy on health policy topics is imperative in ensuring that health education is continually taught in schools and community efforts.
In teaching health education, we need to look at it from a variety of angles. It’s great to plan individual programming for youth, but in order for those programs to be sustained over time, we must look at the bigger picture. Health policy is where it comes together—if we don’t have policy makers on our side, then programming cannot take place.

Sex education and pregnancy prevention needs to be all inclusive.
Teen pregnancy is a systemic issue that stems from more than inadequate sex education. A core issue for sex education and pregnancy prevention is communication. We need to be discussing emotional, psychological, physical, and sexual well-being with ALL teens, including LGBTQ youth who are often times left out of the conversation.

Healthy Teen Network really is a network.
Since The Power of Youth, I have been in contact with many conference speakers and participants, sharing programming ideas and constructive feedback and learning a great deal about the valuable work that we all do to help create healthy teens, and ready parents.

Thank you to everyone who made this experience possible and to Healthy Teen Network for hosting this event!

Alia Gehr-Seloover is an AmeriCorps Volunteer—LGBTQ Health Coordinator at the Institute for Family Health in Kingston, NY

I Love it When You Say the C-word

Vanessa Geffrard

In the midst of reviewing  all the wonderful and inspiring coverage from the recent International AIDS Conference, I stumbled upon an article citing that C-word use is high among teens, 16% higher now than it was in 1991, to be exact!

WOWZERS!

What great news!

Oh, not that C- word….

I mean condoms!  I am beaming with excitement knowing that teens want to protect themselves and want access to resources that enable them to make the safest choices. Reading the article was not only inspiring for the work I am devoted to, but it also made me think about what more needs to be done for our young people when fighting HIV/AIDS and creating this AIDS Free Generation that many leaders are discussing this week.

Currently, 60% of sexually active high schoolers have used condoms the last time they had sex, up from 46% in 1991 (but down a bit from 2003). You might be asking, “Vanessa, why is this so exciting for you?” It’s amazing, awe-inspiring, and the best thing ever because the work that we do whether it be as a volunteer,  a person who likes to give out condoms to their friends, an HIV test coordinator, health teacher, artist, or educator–the work we are doing with young people is working! Something that we are doing and saying is making a difference to our young people. Someone out there is not falling asleep during your condom demos and young people are listening to us when we give them up-to-date, evidence-based resources, education, and frank conversation about their sexual lives– something so natural and something that needs to be protected.

As shown throughout the coverage of the International AIDS Conference , however, is that we have GOT to do better. We’re doing great, but we can do more in light of the CDC reporting that four of every 10 new HIV infections occurs in people younger than 30. This is still too many in our fight to create an AIDS-free generation. I believe that our efforts are working and we have to keep up the good fight. We all know the money is needed to help in the fight, but what else do we need?

I don’t have all the answers, but I offer the following as some possible approaches to add to the mix:

  • Real talk and evidence-based comprehensive education about sex and sexual health in our society. We need to teach our young people how to communicate with partners and what to do in intimate situations when it comes to protecting themselves–even if they are not yet sexually active.
  •  Condoms are not the enemy. What happened to “common” portrayals of people like TLC having condoms in their videos? (Even Snoop Dogg discussed the consequences of STIs if condoms weren’t worn with lady friends!) I may be dating myself, but I feel that the wonderful world of condoms needs to be mainstream. It is FINE for a young man or woman (gasp!) to carry condoms! We carry other paraphernalia to protect ourselves from other elements, but what about pregnancy? STIs? HIV? —Condoms are our friends here, people! And we shouldn’t stigmatize a young person when they become empowered enough to carry them and use them to protect themselves.

I could write  a book on my personal opinions, but I know you also have valuable thoughts on this important subject! What do you think?  What would you add to the mix that would help our young people make responsible sexual decisions  and encourage them to use condoms consistently and correctly?

Vanessa Geffrard is a Training and Technical Assistance Associate at Healthy Teen Network.

Opportunity Knocks: Important Information to Share During a Teachable Moment

Gina Desiderio

This blog post is the third part of a series (Part 1, Part 2) highlighting Healthy Teen Network’s resources on using teachable moments to reach youth, through our Opportunity Knocks resources, including a fact sheet and pre-packaged, fully designed presentation, ready for you to use.  The Opportunity Knocks series is based on Healthy Teen Network’s belief that: With accurate information and adequate support, young people can make healthy and responsible decisions about having sex and using contraception. Adults can be most effective by providing the information and support needed to promote responsible decision-making in youth and help ensure transition to adulthood is safe and healthy.

In order to make the most out of a teachable moment, here is some important information about sex you should know to share with youth

“It’s important to protect yourself.”

  • Many types of protection are available and can be low cost (contraception, condoms, etc.): a clinician can help a teen identify the right type.
  • Remember that all youth need information about protection, even abstinent youth.  You should still first convey the message that abstinence from vaginal, anal, and oral sex is the only 100% way to prevent pregnancy, STIs, and HIV, but it’s important for all youth to have this information.  Youth may currently be abstinent, but it’s important for them to be prepared for when they do engage in sex, which will happen at some point in their lives.  They may be thinking about or preparing to engage in sex.  Also, youth may be defining “abstinent” differently—they may not realize that engaging in oral sex, for example, still puts them at risk.
  • All youth—girls AND boys—need this information.   For example, often, girls are the focus of teen pregnancy, STI, and HIV prevention messages, but it’s obviously important that boys are engaged in the conversation and receive this information too.
  • It’s important to recognize that, for example, a young woman who identifies as a lesbian and lets the trusted adult know this will probably not be interested in hearing about contraception.  If you do provide information on contraception, she may feel as if you are not listening to her.  However, youth who may be questioning their sexual orientation may engage in sexual risk-taking behaviors.  For example, a girl may engage in sexual activity with a boy, but she may not protect herself.  Therefore, it’s important to tailor your approach and information provided to the individual.
  • Plan ahead: it is much easier for teens (or anyone, for that matter!) to think about protection ahead of time, and there are many more options before having sex.
  • Teens need to choose the contraceptive method that is right for them: methods that may not have worked for a friend or relative may work well for another teen.
  • Youth should talk to partners to make it easier to make decisions together.  For example, youth can use these techniques when talking to partners:
    • Say “no” to sexual risk-taking behaviors.
    • Explain why they want to make safer decisions (i.e., prevent pregnancy, STI, HIV).
    • Offer alternatives or strategies to show they still care about their partners and want to have a relationship with them.  Talking through feelings together can help grow a relationship and ease any tension.
  • An integrated message is best: discussion of both pregnancy prevention and reducing sexually transmitted infections is crucial.  Both partners should use protection (such as condoms and/or birth control) to increase protection against pregnancy and STIs.  However, it is not safe to use two condoms at a time.  This is sometimes referred to as double bagging and can actually increase the likelihood of the condom breaking

Emergency contraception (EC) is safe, highly effective, and available.

  • It’s the only existing way to prevent pregnancy after having unprotected sex[1].  EC is now available without a prescription for 17 year olds.  Healthy Teen Network has an Advocacy Resource Guide on Emergency Contraception, available online for free download.

It’s Confidential!

  • Youth can feel comfortable seeking medical advice about protection because confidentiality laws protect their privacy.  Youth have rights; confidentiality laws protect their privacy to access confidential health care services. It’s okay to talk about sex!  Healthy Teen Network has a series of resources on Confidential Access to Contraception, but here are some important points to remember:
  • Many young people indicate that they would not use the services of a family planning clinic if their parents had to be informed, but few say they would stop having sex.[2], [3]
  • A majority of young people share information about sensitive issues such as sexual activity with their parents and other adults in their lives,[4] but sometimes adolescents need or want confidential services.
  • When adolescents are discouraged from seeking health care because their care will not be confidential, the result can lead to adverse health outcomes and significant social and economic costs.[5], [6]
  • At least two recent studies have estimated the potential increase in pregnancies and sexually transmitted infections (STIs)—with the likelihood of significant increases in public financial costs—when adolescents are discouraged from seeking health care.[7]

It can be intimidating for adults to share this important information during a teachable moment.  However, there are some helpful hints and steps you can take to prepare yourself:

  • Know your own limitations and comfort level; it’s okay to refer a young person to another trusted adult if the conversation moves outside of your personal boundaries, but check in with the young person to make sure that someone did indeed answer all of his/her questions.
  • Use humor, when appropriate, as it can go a long way.
  • It is okay to say “I don’t know” and look up answers together; be sure to use a credible source of information.
  • Know other trusted allies and youth friendly professionals for referral.
  • Build a network of trusted adults in your community.
  • Make condoms readily available in your office/home.
  • Be prepared to talk about sex to all youth (e.g., LGBTQ youth, straight youth, abstinent youth, etc.).

What is other important information you always make sure to share during a teachable moment?

What are some other helpful hints or steps you take to prepare for teachable moments?

Gina Desiderio is the Director of Marketing and Communications at Healthy Teen Network.


[1] Emergency Contraception (2009). Office of Population Research, Princeton University. Retrieved online from: http://www.not-2-late.com

[2] Reddy, D.M., Fleming, R., & Swain, C. (2002). Effect of mandatory parental notification on adolescent girls’ use of sexual health care services. The Journal of the American Medical Association, 288(6), 710-714.

[3]Jones, R.K., Singh, S., & Purcell, A. (2005). Parent-child relations among minor females attending U.S. family planning clinics. Perspectives on Sexual and Reproductive Health, 37(4), 192-201.

[4] Jones, R.K., Singh, S., & Purcell, A. (2005). Parent-child relations among minor females attending U.S. family planning clinics. Perspectives on Sexual and Reproductive Health, 37(4), 192-201.

[5] Ford, C.A., & English, A. (2002). Limiting confidentiality of adolescent health services: What are the risks? The Journal of the American Medical Association, 288(6), 752-753.

[6] English A. & Ford, C.A. (2004). The HIPAA privacy rule and adolescents: Legal questions and clinical challenges. Perspectives on Sexual and Reproductive Health, 36(2), 80-86.

[7] Franzini, L., Marks, E., Cromwell, P.F., Risser, J., McGill, L. Markham, C., Selwyn, B., & Shapiro, C. (2004). Projected economic costs due to health consequences of teenagers’ loss of confidentiality in obtaining reproductive health care services in Texas. Archives of Pediatrics and Adolescent Medicine, 158(12), 1140-1146.

The Stakes Remain High

Pat Paluzzi

Alexandra Eisler

The social networks have been a flutter with facts, opinions, and rumors since the release of three additional curricula to the Health and Human Services list of effective programs – Safer Choices, Respeto/Proteger, and Heritage Keepers Abstinence Education. Initially, Healthy Teen Network found research that appeared to call into question the efficacy of Heritage Keepers Abstinence Education. The “Life Skills” component that was referenced in our previous post refers to add-on sessions to the curriculum that were not found to impact the program’s outcomes. We have since located the unpublished manuscript that was used to assess this program, and we will review it to learn more about its findings.

Regardless, Healthy Teen Network remains concerned about any program that promotes abstinence only until marriage. This framework for teaching young people about their sexual health excludes a variety of populations including LGBTQ youth and people who choose not to marry. We believe that youth deserve unbiased information about their sexual health that allows them to think critically about their relationships and community. Healthy Teen Network welcomes the opportunity to examine this curriculum further; however, at this time Heritage Services indicated that they could not share a copy of their curriculum.

We will continue to inquire about the findings associated with this program, and provide updates as we learn more.  We invite you to share any knowledge and/or experience you have had with any of these three newly approved programs.

Pat Paluzzi is the President/CEO and Alex Eisler is the Training and TA Coordinator at Healthy Teen Network.

Through the Years: Exciting Times for Sexual and Reproductive Health!

Alexandra Eisler

I was 13, talking to my mother’s best friend about birth control, when I first realized times have changed, in terms of reproductive rights. She said when she was a teenager, single women couldn’t get birth control. Until that moment, I thought birth control had been around since the Dark Ages, and I was floored. She said it wasn’t until 1972 that unmarried women could purchase contraceptives in Massachusetts.

I grew up in the late ‘80s and early ‘90s when Salt-N-Pepa told us to talk about sex and “push it real good.” It was a time when Magic Johnson showed HIV wasn’t the end of the world, and not only was contraception available, but sex ed was a “thing” that happened in schools—for better or worse. (Sigh.) Things weren’t perfect, but we had a lot more information than my mother’s generation.

Fast forward to 2009. I was working as a public policy consultant at a branding meeting for my employer, and a board member talked about working in HIV prevention in the early 1980s. She said they did their best to fight HIV in an epidemic rife with stigma, myths, and fear. She said that despite their best efforts, few people knew how HIV worked at the time. She said she looks back and is grateful for evidence-based programs—we know lots about preventing the spread of HIV.

I think about the work I am privileged to be a part of and the substantial body of evidence from which we can draw. The teen pregnancy rate is at its lowest since 1972, and the birth rate continues to decline. Whoa! I think about how far the sexual health field has come in what really is a short time, and I feel proud to be part of it.

All of that to say, this is an exciting time for our work! We are standing in a new frontier: I imagine Lewis and Clark setting out to explore the West. Huge gains have been made, but never before have there been so many resources: so much knowledge about what works…so many talented people on the frontlines. Yet there’s a lot of work left to do.

Sometimes it feels like we’re taking shots in the dark trying to find the right answers, to make an impact and satisfy everyone, but it’s happening—we’re making a difference. We can’t continue making these gains without widespread support, both locally and nationally. So we have to keep sharing, supporting, and learning together.

Sometimes the “right answers” seem just out of reach, but the Centers for Disease Control and Prevention call this a winnable battle for a reason. We’re experiencing a massive push to support youth with tools and programming that work; this hasn’t been seen before. Every day we learn more about what helps the communities we live in, and I want to express my appreciation to all the wonderful folks who continue to fight for the futures of young people in this country!

What excites you about where the field is, today, in terms of adolescent sexual and reproductive health?

Alexandra Eisler is the Training and Technical Assistance Coordinator at Healthy Teen Network

The State of the Union in Teen Pregnancy Prevention

Shelby Emmett

Yesterday, President Obama delivered his State of the Union address. The purpose of the address is to inform Congress and the American people about the current state of our nation. The field of teen pregnancy prevention has seen many changes in the last few years. From creations of new departments and new programs to the elimination of successful programs and severe budget cuts, our field has experienced it all in a short period of time. So, what is the current state of teen pregnancy prevention? Read below to see a quick review of the federal landscape.

Obama Administration’s Teen Pregnancy Prevention Programs

The Pregnancy Assistance Fund (PAF) is a 10-year, $250 million competitive grant program created in 2010 designed to help pregnant and parenting teens and women complete their education and gain access to health care, child care, family housing, and other critical support.

The Personal Responsibility Education Program (PREP) was also created in 2010 and is currently funded as mandatory spending under the Affordable Care Act. PREP provides $75 million annually in mandatory funds for FY 2010-2014 for evidence-based programs to educate adolescents on both abstinence and contraception to prevent pregnancy and sexually transmitted infections, and on other adulthood preparation topics such as healthy relationships and communication with parents.

National Sexuality Education Standards Released

In January 2012, national sexuality education standards were published by Advocates for Youth, Answer, and SIECUS to help states and school districts enact and implement sound evidence-based programs proven to reduce teen pregnancy and sexually transmitted infections. These standards address the unique needs of marginalized groups including racial minorities and LBGTQ youth. This is a great step to help collective better data and connect to states and school districts that may need assistance implementing these standards to fit their unique circumstances. The goal of creating these standards was “to create a national dialogue about the future of sex education and to promote the institutionalization of comprehensive sexuality education in public schools.”

The Constitutionality of the Affordable Care Act

The Supreme Court announced in fall 2011 that it would hear arguments regarding the constitutionality of the Affordable Care Act and render its decision before the 2012 election. At issue is the individual mandate which requires every legal U.S citizen to purchase insurance from a private entity. Currently, PREP and PAF are funded under the ACA. If the law is found unconstitutional, funding for these programs automatically cuts off, as the law will be void.

The Federal Deficit

The battle in Congress to cut our nation’s deficit has lead to policymakers on both sides of the aisle eliminating domestic programs even though these programs only make up about 12% of the federal budget. In 2011, Healthy Teen Network fought vigorously to maintain funding for Title X, Title V, Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health (DASH), and multiple other programs designed to support young families. Unfortunately, many of these programs have been reduced, and the Adolescent Family Life program was completely defunded. Abstinence-only programs, though, received an increase in federal funding.

Changes in Young Women’s Behavior in Reproductive Health

A new study published in the American Journal of Public Health revealed fewer U.S. women ages 15 to 24 are receiving reproductive healthcare. Almost 60% of young women received reproductive healthcare within the last year, but use has fallen by eight percent between the two time periods. The declines were seen across all demographic and socioeconomic groups. Overall, however, economically disadvantaged women are the least likely to get care.

 

What do you think about the current state of affairs in teen pregnancy prevention on the national level? Share your thoughts in our comment section!

Shelby Emmett, JD is the Policy and Legal Coordinator at Healthy Teen Network.

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