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.
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.
The outcome findings documented a number of statistically significant changes in knowledge, attitude, intention, and behavior, providing strong evidence of effectiveness.