Stakeholder Education and Community Mobilization Garner Support for Sex Education

Author links open overlay panelKristenPlastinoM.D.aJennieQuinlanM.P.H.aJenniferToddJ.D.aHeather D.TevendalePh.D.b

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https://doi.org/10.1016/j.jadohealth.2016.09.028Get rights and content

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Referred to by
Claire D. Brindis
Advancing the Field of Teenage Pregnancy Prevention Through Community-Wide Pregnancy Prevention Initiatives
Journal of Adolescent Health, Volume 60, Issue 3, Supplement, March 2017, Pages S1-S2
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Wanda D. Barfield, Lee Warner, Evelyn Kappeler
Why We Need Evidence-Based, Community-Wide Approaches for Prevention of Teen Pregnancy
Journal of Adolescent Health, Volume 60, Issue 3, Supplement, March 2017, Pages S3-S6
Download PDF
Heather D. Tevendale, Taleria R. Fuller, L. Duane House, Deborah L. Dee, Emilia H. Koumans
Implementation of Community-Wide Teen Pregnancy Prevention Initiatives: Focus on Partnerships
Journal of Adolescent Health, Volume 60, Issue 3, Supplement, March 2017, Pages S7-S8
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Abstract
Purpose

The University of Texas Health Science Center at San Antonio UT Teen Health (UTTH) implemented a community-wide teen
pregnancy prevention (TPP) initiative in south San Antonio. This article describes how UTTH staff educated community stakeholders
and mobilized community members to support implementation of evidence-based TPP interventions.

Methods

UTTH educated key stakeholders about the need for TPP efforts, strong local support for such efforts, and the value of evidence-based
interventions (EBIs). The process of stakeholder education and partnership development leading to implementation of EBIs was lengthy
with, for example, an average of 11 meetings and 13.5 months between the initial meeting and formal approval of EBI implementation
among school partners. UTTH also mobilized the community by engaging community members on leadership teams that actively
supported the initiative efforts.
 Results

Partnerships to implement EBIs were developed with 16 middle and high schools across five local school districts, two divisions of the
juvenile justice system, and five youth-serving organizations. From 2011 to 2015, more than 12,500 youth (51% female) aged 11 to 19
years received EBIs. Of the total served, 95% were served through partnerships with local schools, 4% by juvenile justice, and 1% by
youth-serving organizations.

Conclusions

Engaging and educating members of the community require notable time and resource investments up front; however, once strong
partnerships are built, there is an ongoing opportunity to reach youth. In south San Antonio, schools provided the opportunity to reach
the largest numbers of youth.

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Keywords
Teen pregnancy prevention
Stakeholder education
Community mobilization
Community-wide initiative
Evidence-based interventions
Schools
Youth
Latino

Implications and Contribution

From 2010 to 2015, efforts to mobilize community members and educate stakeholders in support of evidence-based teen pregnancy
prevention curricula implementation in schools and organizations in one predominantly Latino community in San Antonio, Texas,
resulted in more than 12,500 youth served. Key lessons learned are presented.

San Antonio, with a population of 1.4 million, is the fourth fastest growing city in the U.S.; the population is predominantly
Hispanic/Latino (63.2%) [1]. Although teen birth rates have been declining nationally, rates remain high in south San Antonio. The teen
birth rate of 77.3 births per 1,000 females aged 15–19 years old in 2010 was almost double the national rate of 39.1 [2,3]. In 2010, UT
Teen Health (UTTH) started to address teen pregnancy prevention (TPP) through a community-wide initiative (CWI) intended to reduce
teen birth rates in south San Antonio, Texas.
The UTTH CWI, one of nine projects supported by the Centers for Disease Control and Prevention (CDC) and the Office of Adolescent
Health entitled “Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies through CWIs,” consisted of five
components: (1) implementing evidence-based TPP interventions, (2) linking teens to adolescent reproductive health services, (3)
mobilizing the community in support of TPP, (4) educating key community stakeholders about TPP, and (5) working to meet the needs
of a diverse community [4].
A key objective of the CWI was widespread implementation of evidence-based TPP programs in the five school districts and in
organizations serving high-risk youth in south San Antonio. These evidence-based interventions (EBIs) have been shown through
rigorous evaluation to reduce behaviors associated with teen pregnancy [5]. UTTH engaged each local school district and organization
to select the EBI that best fit the needs of youth served in their respective settings. UTTH provided training and technical assistance
(T&TA) to ensure that each EBI was implemented with fidelity. UTTH partner schools and agencies selected EBIs for implementation
from those indicated to be effective by the Department of Health and Human Service review of TPP programs [6]. The five school
districts UTTH targeted offered non–evidence-based sex education interventions prior to the introduction of the UTTH initiative.
We describe the process of educating key stakeholders about the need for TPP efforts, efforts to mobilize the community so that
community members could actively support TPP efforts in south San Antonio, the use of EBIs as a prevention strategy, and present
results about the extent of partnerships developed and eventual program implementation in south San Antonio. Finally, we discuss
lessons learned and strategies we found useful to build community support for implementation of EBIs.

Methods
Descriptions of the process of educating local stakeholders and seeking to engage community members in TPP are based on records
of events undertaken as part of the project. Partner organizations recruited participants for the focus groups via email, flyers, and word
of mouth and were conducted as part of stakeholder education efforts. The UTTH evaluator led the focus groups, the groups were
recorded, and notes analyzed for common themes.

Educating key stakeholders

In 2007, CDC adapted Getting To Outcomes (GTO), a 10-step framework for planning, implementing, and evaluating programs for use
with TPP programs [7,8], see Figure 1: CDC adapted GTO framework. UTTH used the first five steps of GTO [7] to focus efforts on
educating key stakeholders within the school systems, community leaders, parents, school personnel, and other community members
and then expanded to other youth-serving organizations and agencies to increase support for widespread implementation of evidence-
based TPP programs in south San Antonio.

1. Download high-res image (480KB)

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Figure 1. Getting to Outcomes framework. Ten steps for partners to complete to benefit fully from this process.

Educating school stakeholders

UTTH conducted a community needs assessment (part of GTO step 1) by gathering data on rates of teen pregnancy and conducting
focus groups to learn from parents, teens, and school officials about factors that may influence these rates. Focus groups indicated
strong parent, teen, and school administration support for sexuality education in the schools. UTTH staff presented the project's
objectives and goals and the results of the needs assessment to the superintendent of each school district in the intervention
community, followed by meetings, with each of the principals and other school officials including nurses and social workers. UTTH also
presented to the School Health Advisory Council (SHAC) in each of the districts. SHACs consist of community members, parents,
teachers, and administrators who are responsible for recommending health-related curricula to the districts' school boards.

To carry out the first steps of GTO, each partner developed goals and outcomes and confirmed best practices for EBI implementation.
Each school utilized mail, email, flyers, and advertised on the marquee to request input from parents, school personnel, and youth
regarding an EBI for sexuality education. UTTH then met with these groups to review and finalize which EBIs to implement. To assess
program fit and capacity (e.g., steps 4 and 5), UTTH discussed the strengths and potential concerns of each EBI and solicited
feedback. UTTH compiled the needs assessment data, list of potential EBIs, feedback from parents and school personnel, and
distributed these during meeting with superintendents, principals, and SHACs. Each SHAC reviewed the information gathered through
the GTO planning process and made a recommendation for an EBI to the respective school board. UTTH staff attended monthly SHAC
meetings at each school district after EBI approval to communicate progress and promote continued support.

“Champions” were identified to continue efforts educating stakeholders within the schools and supporting EBI implementation.
Champions were teachers and administrators who demonstrated a commitment to TPP and identified key personnel and parents to
support the initiative and coordinated meetings with UTTH.

The process of engaging and educating key stakeholders involved time, commitment, and continued engagement. For the 11 schools
that implemented an EBI, approximately 11 meetings (range of 7–16) occurred, per school, prior to implementation. As illustrated
in Figure 2 (timeline), based on GTO, the average time between the initial meeting of UTTH staff with the given school district and the
SHAC recommendation for an EBI was 13.5 months. The process from SHAC recommendation to school board approval took, on
average, an additional 2.2 months. After signing formal agreements, UTTH assisted with implementation during the first round of
teaching an EBI in each high school to model implementation. In subsequent rounds, schools and community-based youth-serving
organizations (CBYOs) implemented EBIs on their own.
1. Download high-res image (205KB)
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Figure 2. Timeline from the initial meeting to EBI implementation: This timeline depicts the average length of time in months that it took
for implementation of EBIs to occur from the time of the initial meeting. The entire process from the initial meeting to EBI
implementation took an average of 18 months.

Educating and including community stakeholders and organizations outside of the school systems

In addition to schools, UTTH engaged three CBYOs: a teen-parent support program, an asset-building summer program, and a faith-
based foster care organization. UTTH held up to five meetings with each of the CBYOs; meetings with administrators and organization
staff introduced the CWI, assessed needs of the youth being served by each CBYO, and determined the best curricula fit. The number
of meetings varied to ensure all required approvals was obtained.

As a result of UTTH engaging the local Juvenile Probation Department (JPD) in discussions about TPP, they requested technical
assistance from UTTH in GTO, so that their staff could develop its own short- and long-term strategic plan on TPP. UTTH staff first met
with key JPD stakeholders in November 2011 to introduce the initiative. As part of the needs assessment, UTTH conducted five focus
groups during March and April 2012 with: (1) parents of teens on probation [9]; (2) males residing in a detention facility; (3) females
residing in a detention facility; (4) females on probation attending court mandated classes; and (5) females and males on probation
attending court-mandated classes. UTTH presented focus group results to key JPD stakeholders in May 2012. As a result, a smaller
JPD workgroup was established to review appropriate EBIs. A total of 22 meetings were held over the next 16 months. Meetings were
held to plan and present the needs assessment, select an intervention that was the best fit, and plan for implementation. At the
curricula review meeting, administrators reviewed the pros and cons of each curricula first in small groups and then as part of a large
group discussion. The curriculum was selected by an anonymous vote. Meetings consisted of detailed discussions on developing the
department's strategic plan for reducing teen births, planning for staff education on adolescent reproductive health, and facilitating
youth access to preventative and reproductive health care.
As a result of these efforts, UTTH trained 54 probation and residential treatment officers in the evidence-based curriculum Reducing the
Risk [10], which is provided to teens in detention and/or on probation. UTTH also trained over 300 JPD staff utilizing a training created
by the UTTH staff called “Sex Ed. 101.” This training was designed for individuals who had never implemented an EBI to familiarize
them with the basics of reproductive anatomy, STDs, and contraceptives. Implementation of EBIs began in March 2013.
San Antonio Mayor's Teen Pregnancy Prevention Initiative, whose goal was decreasing the local teen birth rate, was another vital
stakeholder. Meetings between the Mayor's Initiative and UTTH began in 2012. In 2012, community organizations, the Mayor's
initiative, and UTTH formalized as the San Antonio Teen Pregnancy Prevention Collaborative. From the collaborative’s inception until
May 2015, there were 18 meetings. The meetings occurred approximately every 2 months but were more frequent when the
collaborative was developing its logic model in the fall 2013. UTTH provided EBI training to members of the collaborative and technical
assistance in developing a logic model for the collaborative's city-wide TPP strategic plan. Through the collaborative meetings, UTTH
formed new relationships with a local foster care agency that adopted two EBIs (Making Proud Choices! and Teen Outreach Program).

Mobilizing the community

The goal of community mobilization was to increase support for and engage local community members in TPP efforts. Advocates for
Youth a national organization was funded by CDC to design community mobilization strategies and provide T&TA to UTTH. UTTH
brainstormed with the community to identify leaders and individuals with diverse backgrounds to serve as potential “change agents.” A
change agent is an individual who resides in the community, is respected by the community, and has the capacity to initiate changes in
the community [11]. Next, UTTH sought to involve the identified change agents in one of three leadership teams that began meeting in
the first year of the initiative: the Core Partner Leadership Team (CPLT), Community Action Team (CAT), and Youth Leadership Team
(YLT). Community teams were established to promote community involvement, engagement, feedback, and increase the likelihood that
EBIs were implemented.
Implementation partners and stakeholders composed the CPLT, whose goal was to prepare and support team members as
representative members of their community with the capacity to initiate change. On average, this team consisted of 38 community
members who were selected based on positions that would allow them to increase the likelihood of success for EBIs and foster
sustainability (e.g., school superintendents, social workers, health care administrators, and health department leadership). This
leadership team guided the work of the initiative, with an emphasis on community mobilization. In years 2 and 3, this team met 11
times, approximately every 2 months, to discuss topics such as repeat teen births, lack of clinical access for adolescents, EBIs, GTO,
and sustainability. The CPLT suggested UTTH participate in community outreach events, proposed specific community groups for
engagement and educational activities, and identified areas in south San Antonio where implementation of EBIs would reach additional
young people.
Community members who lived and worked in the catchment area including parents and advocates from faith communities, CBYOs,
and UTTH staff composed the CAT. On average, this team consisted of 13 individuals selected for their capacity to be change agents,
who could also provide valuable and diverse grassroots perspectives. Ten meetings were held during the first 2 implementation years
(years 2 and 3 of the project). The CAT advised UTTH on the best strategies for discussing the need for sex education with members of
the community and provided feedback on many aspects of the initiative.

In year 4, the CAT and CPLT merged to become the Core Leadership Team. The Core Leadership Team met three and five times in
years 4 and 5, respectively. The creation of a single combined team was a more sustainable long-term approach.

Youth who attended catchment area schools or CBYOs composed the Youth Leadership Team. The purpose of UTTH's work with this
team was to educate its members as peer educators and plan community mobilization events. As leaders in their schools and
representatives of UTTH, the youth educated peers and informed school facilitators and administrators about UTTH activities in the
community. During years 2 through 5, the YLT met 49 times or approximately once per month. The team averaged 17 members who
attended an average of 9 meetings and 15 Community Mobilization events per year.

The CPLT, CAT, and the YLT provided UTTH valuable feedback on appropriate community strategies regarding sex education,
identifying clinical champions, and effective strategies for implementing EBIs in schools, CBYOs, and clinics. A total of 167 mobilization
events (ranging from 32 to 50 events per year) were held, focusing on media, parents, faith-based community, businesses, and youth.
A key outcome of community mobilization events was to create relationships that led to identification of new organizations to implement
EBIs.

Program implementation

After school district EBI selection and administrative approvals, UTTH worked with each school to identify facilitators. Each school
selected their facilitators based on interest in TPP and subject matter expertise (e.g., health teachers). Meetings with the champion,
principal, and lead teachers at each campus led to an implementation plan and a 2-day facilitator training. Each facilitator received a 2-
day training on the curriculum, T&TA follow-up, and booster sessions of Sex Ed. 101, 40 Developmental Assets, and answering
sensitive questions. UTTH continued to meet with school personnel throughout EBI implementation to provide technical assistance and
ensure that programs were implemented with fidelity. From the initial conversations to implementation in a school district, it took an
average of 18 months. Implementing in CBYOs was a simpler process. Once an EBI was selected, the process only required executive
approval, facilitator training, and parental consent, all of which took approximately 3 months.
Data collection

The numbers and types of partners were tracked. The number of youth reached was based on the number of students who were at the
first intervention session and completed a baseline survey and/or were at the final intervention session and completed a follow-up
survey. The numbers may be a slight undercount given that some may have participated in an EBI but were not present at the first or
the last sessions of the intervention. As part of an effort to reduce burden on program partners, attendance was not taken; thus,
retention rates cannot be calculated.

Results
The number of implementation partners increased over time from eight partners in year 2 to 11 partners in year 3, 16 partners in year 4,
and 23 partners in year 5. By the completion of the initiative, there were 16 middle and high school partners implementing at least one
EBI with all five school districts in the intervention community represented. In addition to school implementation partners, five CBYOs
and two divisions of the local JPD had signed formal partnerships.

The initiative reached a total of over 12,500 youth with TPP EBIs during the course of the initiative. Of the total youth, 95% were served
through partnerships with local schools. By contrast, 4% were served through a partnership with the local JPD, and only 1% were
served by the five CBYO partners. Youth served were predominantly Hispanic (89%) and ranged in age from 11 years old to 19 years
old. The majority of the youth were 15–16 years old (47%), 13–14 years old (32%), and 17–18 years old (13%). There was a nearly
equal ratio of males (49%) and females (51%).

Discussion
UTTH successfully built partnerships with 16 campuses in the five local school districts and eight CBYOs in the community, leading to
over 12,500 youth receiving evidence-based TPP interventions over 5 years. Building these partnerships required substantial time
(average of 18 months) and effort (nearly 11 meetings for each partner) before school partners began implementation; these time
investments may not often be incorporated into planning community-based interventions. However, the benefits of relationship building
are enhanced stakeholder commitment, and large numbers of youth can be reached on an ongoing basis, as occurred in later years of
the project, and the likelihood of sustainability increased.
UTTH found that engaging and developing partnerships with CBYOs were relatively straightforward. However, fewer youth participated
in EBIs through CBYO partnerships compared to school partnerships. Communities with more and larger CBYOs will be able to reach
more youth by partnering with CBYOs with an interest in TPP.

While the relationship with the local probation department resulted in a modest number of youth receiving an EBI, court-involved youth
are at higher risk for teen pregnancy and often are not in school. The partnership with the probation department resulted in more than
508 difficult-to-reach youth receiving services.

Lessons learned

UTTH found that educating the community on all levels was a crucial step in raising awareness of the need for TPP efforts. UTTH
attendance and involvement at key meetings in the community were instrumental to present UTTH's goals and objectives. UTTH found
that presenting data about teen birth rates in the catchment area, particularly when compared to nationwide teen birth rates, made an
impact on community leaders. These leaders then used their influence to forge relationships in the community for EBI implementation,
clinical access, and organizational policy adjustments. The data were useful in motivating community champions, those uncertain about
implementing an EBI, and with different types of organizations (CBYOs, faith based, school based). By educating stakeholders with
objective data, UTTH came to be recognized as a knowledgeable community leader on adolescent reproductive health and a trusted
partner to expand the capacity of other organizations through T&TA.

Demonstrating trustworthiness continues to be the cornerstone of UTTH's partnership with schools. A consistent, transparent, and
flexible approach grew into mutual respect and productive relationships [12]. UTTH responded quickly to emails and phone calls from
partner organizations and consistently completed deliverables in a timely manner to strengthen trust. UTTH promoted transparency
through an in-depth review of potential curricula with partners, highlighting sections that could be a concern (e.g., condom-related
activities implemented in schools). Finally, UTTH exhibited flexibility by supporting adaptations to curricula to make programs a better fit
without compromising the core components.
UTTH understood that each partner has its own schedule and that one of their most valuable resources was time. Approval processes
require consistent contact including status calls, frequent meetings, and follow-up; school district approval can take up to a year or
longer. Turnover of staff may extend this period. A significant amount of time was spent working through each step of the GTO process.
It is important to explain to partners, in the beginning, that the process of selecting and implementing an EBI will take time and they are
investing in the future of their youth.
The complexity of integrating components on a community-wide level should not be underestimated. Using the GTO planning process
offered an evidence-based prevention strategy by building capacity while anchoring practices in evidence and theory. TPP strategies
such as providing EBIs in schools can be a controversial topic. By following the steps of GTO, controversy can be assessed, discussed,
and consensus reached. For example, a needs assessment, including focus groups, makes the opinions of the community part of the
discussion. The focus group data provided the community support needed for EBIs. Additionally, the GTO process ensured the best-fit
programs were selected for the community. This included considering adaptations to curricula to meet community needs, while
maintaining the core components of the EBI.

Engaging the community through leadership teams was crucial to the momentum of implementation efforts. Some implementation
partners adopted programs quickly, and these partners became champions in the community and were active on the leadership teams.
Other implementation partners were slower to adopt programming but remained engaged in the entire process. For example, quickly
adopting high schools served as models for other high schools that adopted later. The interactions among partners on the leadership
teams, particularly the influence of champion organizations, had significant impact on the late adopters and facilitated more rapid
implementation.

By integrating stakeholder education and community mobilization efforts, UTTH successfully garnered support from the community
members, schools, and other organizations for the widespread implementation of EBIs. This approach in south San Antonio, where
teen birth rates are high, led to large numbers of youth served with EBIs. Recent data indicate a 24% decline in the teen birth rate and a
43% decline in the repeat teen birth rate in the catchment area from 2010 to 2013 [13]. An ongoing evaluation seeks to better
understand how the CWI may have contributed to these declines (H.D. Tevendale, unpublished data, 2016).
Acknowledgments
This publication is made possible by Cooperative Agreement Number 5U58DP002919-04 from the Centers for Disease Control and
Prevention (CDC) through a partnership with the U.S. Department of Health and Human Services' (HHS) Office of Adolescent Health.

References

[1]
US Census Bureau, Population division. Top 10 U.S. cities with the largest population increase. Available
at: http://quickfacts.census.gov/qfd/states/48/4865000.html. Accessed June 17, 2014.
[2]
San Antonio Metro Health District, 2011 & 2012 Data. San Antonio Metro Health District, San Antonio,
TX. http://www.sanantonio.gov/Portals/0/Files/health/News/HP2012.pdf?ver=2014-09-16-134728-257. Accessed June 17, 2014.
[3]
S.C. Curtin, J.C. Amba, S.J. VenturaPregnancy rates for U.S. Women continue to drop
NCHS Data Brief, 136 (2013), pp. 1-8
View Record in Scopus
[4]
T. Mueller, H.D. Tevendale, L.D. House, et al.Implementing a community-wide approach to teen pregnancy prevention: Overview and lessons
learned
(2016)
(submitted for publication)
[5]
U.S. Department of Health & Human Services. Office of The Assistant Secretary for Planning and Evaluation. Available
at: http://tppevidencereview.aspe.hhs.gov/. Accessed July 30, 2015.
[6]
U.S. Department of Health & Human Services. Office of The Assistant Secretary for Planning and Evaluation. Available at: ASPE.hhs.gov. Accessed
January 14, 2015.
[7]
A. Wandersman, C. Lesesne, L.D. House, et al.Promoting science-based approaches-getting to outcomes for teen pregnancy prevention (PSBA-
GTO TPP)
Centers for Disease Control and Prevention, Atlanta, GA (2016)
[8]
C.A. Lesesne, K.M. Lewis, C.P. White, et al.Promoting science-based approaches to teen pregnancy prevention: Proactively engaging the three
systems of the interactive systems framework
Am J Community Psychol, 41 (2008), pp. 379-392
CrossRefView Record in Scopus
[9]
J. Quinlan, E. Hull, J. Todd, K. PlastinoHow do guardians of adolescents in juvenile justice system handle adolescent sexual health?
J Juvenile Justice, 4 (2015), pp. 54-99
View Record in Scopus
[10]
D. Kirby, R.P. Barth, N. Leland, J.V. FetroReducing the risk: Impact of a new curriculum on sexual risk-taking
 Fam Plann Perspect, 23 (1991), pp. 253-263
CrossRefView Record in Scopus
[11]
Strategies guided by best practice for community mobilization, Advocates for Youth, Washington, DC (2014)

[12]
The National CampaignCase studies strategies for partnering with schools to implement teen pregnancy prevention programming in Texas
Community Spotlight, Washington, DC (2014)
Available at:
https://thenationalcampaign.org/resource/community-spotlight-case-studies
Accessed September 24, 2014
[13]
San Antonio Metro Health District, 2014 Data. San Antonio Metro Health District, San Antonio,
TX. http://www.sanantonio.gov/Portals/0/Files/health/HealthyLiving/TeenHealth/2014TeenPregnancyReportFINAL.pdf. Accessed August 25, 2016.
Conflicts of Interest: The authors have no conflicts of interest to disclose.
Disclaimer: Publication of this article was supported by the Office of Adolescent Health. The opinions or views expressed in this supplement are those of
the authors and do not necessarily represent the official position of the funder.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC or HHS.

© 2016 Society for Adolescent Health and Medicine.

Part of special issue:

Implementing Community-Wide Teen Pregnancy Prevention Initiatives
Edited by
Claire D. Brindis
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