Collaboration for STD, HIV, and Teen Pregnancy Prevention: Perspectives on Process, Achievements, Challenges, and Lessons Learned in California 2008 National STD Prevention Conference Confronting Challenges, Applying Solutions Chicago, Illinois, March 10-13, 2008 Dana Cropper-Williams, Danielle Sollers, Karen Ramstrom, Gail Sanabria, Sharla Smith, Paul Gibson, MJ Puffer, Cheri Pies

Strengthening State Health & Education Agency Partnerships in Order to Improve HIV, STD, & Unintended Pregnancy Prevention among School-aged Youth 2008 National STD Prevention Conference March 11, 2008 Funding Partner CDC-Division of Adolescent School Health

Goal Strengthen communication and collaboration between SEA and SHA to support and improve HIV, STD, and unintended and teen pregnancy prevention for school-aged youth Objectives Articulate a shared vision Identify challenges to achieving the vision Name collaborative strategies for overcoming challenges Create a state-specific action plan for enhancing collaboration Describe the role of the national partners Plan to identify health and education disparities (2007 NSM) What is a National Stakeholder Meeting (NSM)?

NSM Participants As of January 2008 AL AR GA ID IL IN KY MO MT NV NH OH SC SD TX VA WY OK ME MD NJ NY OR AK CO LA UT CA KS MS FL HI NM AZ ND MN IA WI MI NE WA PA NC TN WV VT MA RI DE CT DC

Who attended all of these NSMs? State Department of Health  Adolescent Health Coordinator  STD Director  AIDS/HIV Director State Department of Education  HIV Director in Education Agency and/or Health education director

Why Integrate HIV, STD and Unintended Teen Pregnancy Prevention? Promotes sharing of knowledge among health and education agencies Provides consistent messages to young people Reduces programmatic gaps Improves efficiency of approach Uses resources effectively Increases potential effectiveness Elevates importance of the issue

* Male and female condoms ** Alcohol and other drugs HIV STD Risk and Protective Behaviors for HIV and STD, and Unintended Pregnancy Risk Behaviors Unprotected vaginal sex Protective Behaviors Sexual abstinence Consistent and correct condom* use Abstinence from AOD** Unintended Pregnancy

Follow Up Support Phase I: 6-8 weeks  Individual State Team Conference Calls Follow Up Support Phase II: 4-5 months

Follow Up Support Phase III: 6-12 months  Cross-State Sharing Calls Dialogue around Common Challenges and Solutions Share Successes Technical Assistance Needs

Follow Up Support Phase IV: 6-12 months  Support Visits  Mini-grants Follow Up Support Phase V: 9 months Online Evaluation

Participant Quote “Real collaboration requires a willingness to give things up and address that territorial stuff. It’s a willingness to share resources, power, and control and that’s really hard to do. But it is amazing what you can get done if you can.” (NSM participant)

The California Adolescent Sexual Health Work Group (ASHWG): Background and Formation Paul Gibson, M.S., MPH STD Control Branch California Department of Public Health California Adolescent Sexual Health Work Group 2008 National STD Prevention Conference Confronting Challenges, Applying Solutions Chicago, Illinois, March 10-13, 2008

California Adolescent Sexual Health Work Group (ASHWG) REGIONAL STAKEHOLDERS MEETINGS An Ongoing National Effort for Strengthening Partnerships to Improve HIV, STD, and Pregnancy Prevention Among School-Age Youth Las Vegas 2003 San Antonio 2005* Portland 2005 Washington D.C. 2005* San Francisco 2005*

ASHWG : Key Events in Formation On-going meetings/conference calls with CDC-DASH and National Partners 1 st Report-back to Leadership Group ( Chiefs from OA, MCAH, OFP, CDE) 6 development meetings with mid-level program managers 2 nd Report-back to Leadership Group = endorsement of ASHWG Formation of Data Integration & Core Competencies subcommittees and Steering Committee Addition of key NGO members

California Adolescent Sexual Health Work Group (ASHWG) A standing work group of program managers from the California Department of Public Health, California Department of Education, and key non-governmental organizations committed to working more effectively to address the sexual and reproductive health of California adolescents. Vision: Create a coordinated, collaborative, and integrated system among government and non- government organizations to promote and protect the sexual and reproductive health of youth in California.

ASHWG Goals 1)To increase awareness of ways to foster an integrative approach to HIV, STD, and teen pregnancy prevention 2)To strengthen communication and collaboration among HIV, STD, and teen pregnancy prevention programs.

ASHWG High Priority Objectives 1) Improve/expand sharing and use of HIV, STD, and Teen Birth Data: Data Integration Subcommittee - improve access, comparability, and presentation of collective data 2) Ensure that educators, counselors, case managers deliver effective behavioral interventions. : Core Competencies Subcommittee - benchmarks for core knowledge & skill sets for providers of ASRH programs/services

ASHWG High Priority Objectives 3) Identify/develop and promote the use of culturally-appropriate, youth-focused sexual health curricula… 4)Improve adolescent access to sexual and reproductive health services – and expand awareness of adolescent legal rights. 5)Identify funding, policy recommendations, and other resources to support # 1-4 above.

ASHWG Membership Governmental CA Dept. of Public Health MCAH OFP Office of AIDS STD Control Branch CA Department of Education CA School Boards Association CA Department of Alcohol & Drug Programs Non-Governmental CA Family Health Council MCH Action CA Adolescent Health Collaborative Center for Health Training ETR Associates Gay/Straight Alliance Network Health Initiatives for Youth Internet Sexuality Information Services (ISIS)

California Adolescent Sexual Health Work Group (ASHWG) Meets twice per year* Provides a forum for government and non- government agency staff to: - share information & network - provide input on current issues - identify collaborative opportunities - create new affiliations for mutual benefit and programmatic synergy

How do ASHWG Members Benefit? Forum to develop a shared vision for addressing HIV, STDs, and unintended pregnancy with overlapping priority populations Connections with partners we would not meet otherwise Time and space to collaborate with CDPH, CDE, and NGO programs and partners

How do ASHWG Members Benefit? Information conduit for statewide adolescent health activities, training, research, policy, and technology Continuity of knowledge and expertise across our respective programs Helps members tackle the challenge of California’s immense size and considerable diversity

ASHWG Collaboration: Perspective of the Maternal, Child, and Adolescent Health Branch & Progress with Data Integration Karen Ramstrom, DO, MSPH Maternal, Child, and Adolescent Health Program Center for Family Health California Department of Public Health California Adolescent Sexual Health Work Group 2008 National STD Prevention Conference Confronting Challenges, Applying Solutions Chicago, Illinois, March 10-13, 2008

California Maternal Child & Adolescent Health Program (MCAH) How MCAH benefits from ASHWG: Provides opportunity for us to develop tools for our local MCAH jurisdictions (e.g., data integration) Provides specific and genuine local examples which brings credibility to various MCAH reports An avenue to work on one of our Title V Priorities: Promote responsible sexual behavior in order to decrease the rate of teen pregnancy and STD

California Maternal Child & Adolescent Health Program (MCAH) How ASHWG benefits from MCAH: Broader public health perspective Connection to 61 local health jurisdictions through health department MCAH Directors: MCAH Director role is assessment, policy development, assurance and evaluation to improve the health of the MCAH population; Bidirectional avenue for information sharing; Understanding of local priorities/politics and insights into best approaches for promoting adolescent sexual health

California Maternal Child & Adolescent Health Program (MCAH) How ASHWG benefits from MCAH: Bring ideas about integration into existing programs, particularly for those LHJs without an active adolescent health initiative As do other state partners, brings credibility to the partnership Epidemiology expertise for data integration Resources for ASHWG support through the Adolescent Health Collaborative

ASHWG Collaboration: Perspective of the Office of HIV/AIDS Programs & Unanticipated Benefits Gail Sanabria Office of AIDS California Department of Public Health California Adolescent Sexual Health Work Group 2008 National STD Prevention Conference Confronting Challenges, Applying Solutions Chicago, Illinois, March 10-13, 2008

Advantages to Office of AIDS Provides opportunity for collaborating on mutually beneficial projects OA to fund WRITCHE, then CDE Enables sharing of data and program information Provides opportunity to ensure non-duplication of efforts at the state level Sharing with local communities the benefits of collaboration among ASHWG participants and providing examples of successful endeavors

Challenges for OA Working within the “silo” funding streams – helps to have NGO partners Dealing with different reporting requirements and timeframes Finding agreeable times to meet within everyone’s very busy schedules Steering Committee Sub-Committees

Unanticipated Benefits for OA Becoming aware of the shared objectives and barriers Learning of different approaches and successes Obtaining opportunities to collaborate on projects

ASHWG Collaboration: Perspective of the California Department of Education & Lessons Learned Sharla Smith, MPH School Health Connections Office California Department of Education California Adolescent Sexual Health Work Group 2008 National STD Prevention Conference Confronting Challenges, Applying Solutions Chicago, Illinois, March 10-13, 2008

California Department of Education How CDE benefits from ASHWG: California Department of Education now uses the STD and teen birth rate data sets to prioritize schools for enhanced interventions and compliance reviews – Categorical Program Monitoring – Closing the achievement gap – Geographic focus for HIV/STD prevention

California Department of Education How ASHWG benefits from CDE: Programmatic synergy results from a strong track record of collaboration and networking – Synergy must be nurtured – Unified programmatic goals for overlapping priority populations – Programmatic, Department, Staff New Partnerships and Opportunities for Teacher Training – W.R.I.T.C.H.E. & STD Overview for Educators – Communication Conduit for Government and NGOs – Joint Objectives for the Centers for Disease Control

California Department of Education Challenges for ASHWG Collaboration: Silo funding segregates programs HIV/AIDS prevention education is required (Comprehensive Sex Education is permissible) but, HIV prevalence is so low, how to expand instruction to include sexual risk taking Getting school staff to understand the Core Competencies Sheer size of our state impacts meetings and collaboration opportunities

ASHWG Collaboration: Perspective of STD Control Branch & Development of Core Competencies Paul Gibson, M.S., MPH STD Control Branch California Department of Public Health California Adolescent Sexual Health Work Group 2008 National STD Prevention Conference Confronting Challenges, Applying Solutions Chicago, Illinois, March 10-13, 2008

Benefits of Collaboration for STD Branch Multilateral approaches to challenging issues that cross programmatic silos yield:  access to overlapping youth populations (e.g., young MSM in school; C.C.G.s with CBOs, etc.) More comprehensive approach to racial/ethnic disparities Better understanding of shared risk/protective factors for HIV, STI, unintended pregnancy Unified support for Comprehensive Sexuality Education (includes STIs )

Benefits of Collaboration for STD Branch Expanded partnerships with CDPH, CDE and NGOs create new opportunities for STD awareness and prevention: STD/HIV Update for Educators STD Updates for Family Planning Staff Data Integration links awareness of STDs to HIV and unplanned pregnancy Core Competencies support CDC-NCHHSTP Initiative on Program Collaboration and Service Integration

How ASHWG benefits from STD Branch Involvement Enhanced understanding of STIs STIs added to “common agenda” for SRH STD staff serving on committees Local perspective & reality-checks

Challenges of Collaboration for the STD Branch Paltry funding = fewer staff and resources Time consuming to establish trust & credibility Silo funding restricts activities, encourages duplication, undermines efficiency Historical focus on disease control rather than health promotion

Core Competencies for Providers of Adolescent Sexual & Reproductive Health May Subcommittee formed Three Phases of Review/Revision Expert review and feedback Web-based survey and feedback National Expert review and feedback * “Living document” - annual updates

Core Competencies for Providers of Adolescent Sexual & Reproductive Health Competency = a benchmark for the knowledge, ability, or skill that a provider should possess in order to deliver effective and appropriate SRH services and programs to adolescents. Core = mutually-inclusive across each competency domain and across all provider job types/roles (DIS, health educator, clinician, counselor, teacher, etc.).

Core Competencies for Providers of Adolescent Sexual & Reproductive Health 52 Competencies in 5 Domains: A. Professional and Legal Role B. Adolescent Development C. Youth Centered Approach & Youth Culture D. Sexual and Reproductive Health E. Pregnancy, STIs, and HIV 2 Sub-Domains: Cognitive: What a provider knows Operative: What a provider does

Benefits of Core Competencies for the STD Branch Facilitate adoption of shared perspective, language, knowledge, and skills that: bridge HIV, STD, and family planning enhance staff capability support integrated services Foundation for competency-based trainings Cross-trained providers better prepared to provide “seamless” system of services that will improve outcomes and referrals

Contact Information Paul Gibson, MS, MPH (408) Sharla Smith, MPH (916) Karen Ramstrom, DO, MSPH (916) Dana Cropper-Williams, MPA, MHR (202) Gail Sanabria (916)

ASHWG Accomplishments: Core Competencies Subcommittee Activities – 2008 Draft Core Competencies – MCAH Title V Objectives Data Integration Subcommittee Activities – Statewide integrated data sets Expanded NGO membership and involvement: ETR Associates, Center for Health Training, California Family Health Council, Gay/Straight Alliance Network, Health Initiatives for Youth, ISIS, etc.

ASHWG Accomplishments: Partnered with the Sexuality Information and Education Council of the United States (SIECUS) to plan and conduct two trainings (Focusing on Youth in HIV and Sexuality Education: Cultural Competence and Youth Development) for 65 STD, HIV, and teen pregnancy prevention providers in June Partnered with Center for Research on Adolescent Health and Development (Public Health Institute - Oakland) to study issues of relevance to adolescent sexual health policy

ASHWG Accomplishments: PHI Policy Papers: Acceptance of Human Papillomaviruses Vaccination among California Parents: A Representative Statewide Analysis. N. A. Constantine and P. Jerman. Journal of Adolescent Health. February California Parents’ Preferences and Beliefs Regarding School-Based Sex Education Policy. N.A. Constantine, P Jerman, A.X. Huang. Perspectives on Sexual and Reproductive Health, 2007, 39(3): Sexually Transmitted Infections among California Youth: Estimated Incidence and Direct Medical Cost, P. Jerman, NA Constantine, CR Nevarez. California Journal of Health Promotion 2007, Volume 5, Issue 3,

ASHWG Wish List Comprehensive Sexuality Education (CSE) Curriculum for California: including STD education meeting CA Education Code Competency-based training for teachers and educators using the CSE curriculum Job-specific competencies More fully integrated HIV, STD, and family planning services & prevention efforts