Addressing the Needs of a Priority Population
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.
Strong Evidence of Effectiveness
Power Through Choices 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 Power Through Choices 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
A two-page summary of the impact evaluation results.
Healthy Teen Network. (2019). Impact evaluation report summary. Power Through Choices: Evidence-based prevention program for youth in systems of care. Baltimore: Author.
OAH Evaluation Report
The full impact evaluation results from the Office of Adolescent Health (OAH) evaluation of Adolescent Pregnancy Prevention Approaches.
U.S. Department of Health and Human Services, Office of Adolescent Health. (2016). Final impacts of the POWER Through Choices Program. Washington, DC: Author.
An infographic summary of the impact and implementation reports.
Sufrinko, N., Garrido, M., & Chilcoat, D. (2018). Equipping youth to succeed. Power Through Choices. Baltimore: Healthy Teen Network.
Power Through Choices is the only program studied through the federal Evaluation of Adolescent Pregnancy Prevention Approaches (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 Power Through Choices’ effectiveness in improving behavioral outcomes.
An initial project implementation report (below), 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.
Key findings from the report that assessed the Power Through Choices program implementation with over 1,000 youth in 44 group home settings in three states, included:
- Over 90% of youth felt Power Through Choices was “very valuable” or “extremely valuable” to them.
- The Power Through Choices 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.
This executive summary provides a brief overview of the implementation study findings from the evaluation of Power Through Choices 2010 in Oklahoma, California, and Maryland. The full report (below) on program implementation discusses these findings in more detail.
Meckstroth, A., Barry, M., Keating, B., Kisker, E., & Andrews, K. (2014). Addressing teen pregnancy risks for youth living in out-of-home-care: Implementing POWER Through Choices 2010. Executive summary. Princeton, NJ: Mathematica Policy Research Group.
The project implementation report, prepared by Mathematica Policy Research, Inc., describes 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, A., Barry, M., Keating, B., Kisker, E., & Andrews, K. (2014). Addressing teen pregnancy risks for youth living in out-of-home-care: Implementing POWER Through Choices 2010. Princeton, NJ: Mathematica Policy Research Group.
The positive outcome findings from Power Through Choices have been featured in academic journals:
Adolescent Pregnancy Prevention Among Youths Living in Group Care Homes: A Cluster Randomized Controlled Trial
Roy F. Oman, PhD; Sara K. Vesely, PhD; Jennifer Green, PhD; Kristen Clements-Nolle, PhD; and Minggen, Lu PhD
American Journal of Public Health
Objective: To determine if the Power Through Choices (PTC) intervention can increase the use of birth control and reduce pregnancy among system-involved youths living in group care homes.
Conclusions: The results suggest that PTC is an effective sexual health education intervention that can be implemented with system-involved youths who represent a sexually experienced multiracial youth population.
DOI: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2017.304126 (Open Access to Full Article)
Sexual Knowledge, Attitudes, and Behaviors of Youth Living in Group Homes
Roy F. Oman, PhD, FAAHB; Sara K. Vesely, PhD; Jennifer Green, PhD; Janene Fluhr, MS; Jean Williams, MPH
Health Behavior and Policy Review
Objective: The purpose of this study was to report sexual knowledge, attitudes, and behaviors of system-involved youth living in group homes, and when appropriate, contrast these data with equivalent national data. Methods: Data were collected from a sample of racially/ethnically diverse youth (N= 1036, 79% male, Mean age=16.1 years).
Conclusions: Youth living in out-of-home care can benefit from programs that provide skills enabling them to reduce sexual risk-taking and prevent pregnancy.
Long-Term Improvements in Knowledge and Psychosocial Factors of a Teen Pregnancy Prevention Intervention Implemented in Group Homes
Jennifer Green, MPH, PhD; Roy F. Oman, PhD ; Minggen Lu, PhD; and Kristen D. Clements-Nolle, PhD
Journal of Adolescent Health
Purpose: Youth in out-of-home care have higher rates of sexual risk behaviors and pregnancy than youth nationally. This study aimed to determine if Power Through Choices (PTC), a teen pregnancy prevention program developed for youth in out-of-home care, significantly improves knowledge and psychosocial outcomes regarding HIV and sexually transmitted infections (STIs), sexual activity and contraception methods, long term.
Conclusion: Findings suggest that the PTC intervention can have positive long-term knowledge and psychosocial effects regarding contraception methods on youth in out-of-home care.