California Adolescent Sexual Health Workgroup (ASHWG): Collaboration brings unanticipated benefits Karen Ramstrom, DO, MSPH, California MCAH Program Sharla Smith, MPH, California Department of Education Maryjane Puffer, BSN, MPA, California Family Health Council John Elfers, MA, MFT, San Luis Obispo County Office of Education

REGIONAL STAKEHOLDERS MEETINGS An Ongoing National Effort for Strengthening Partnerships to Improve HIV, STD, and Teen Pregnancy Prevention Las Vegas 2003 Scottsdale 2003 San Antonio 2005 Portland 2005 Washington D.C San Francisco 2005

* 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

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 Membership Governmental California Department of Public Health MCAH OFP Office of AIDS STD Control Branch California Department of Education California 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)

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 Priorities 1. Improve and expand sharing and use of HIV, STD, and Teen Birth Data (improve comparability, access, and presentation of integrated data); 2. Ensure that educators, counselors, case managers deliver effective behavioral interventions to protect the sexual and reproductive health of youth in CA (core competencies, Adolescent Sexual Health “101”); 3. Identify/develop and promote the use of culturally-appropriate, youth-focused Sexual health curricula…for use by trained educators in school & community settings; 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 all of the above

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: –To implement the Across the Map survey of parent opinions about comprehensive sexuality education in California Public Schools; –Successfully add three questions on HPV vaccine acceptability to the Across the Map survey Data Integration subcommittee activities Core Competencies subcommittee activities

Data Integration Subcommittee Goals 1)Create statewide data sets for HIV, STD, Teen Births: –standardized measures for age, race, and time frame –updated annually –readily accessible online –linked to respective web pages for CDPH and others 2) Create a similar data set for high-priority local health jurisdictions (LHJs) in CA with same criteria 3) Collect core sexual risk behavioral surveillance data for adolescents in CA high-priority LHJs

Overarching Benefits for ASHWG Members Keeps member organizations informed regarding statewide adolescent health activities, training opportunities, research, technology to reach youth Connects us to partners we would not meet otherwise Time to collaborate with other state Departments (and programs within CDPH!) An established vehicle which assures continuity of knowledge and expertise regarding adolescent health needs and statewide efforts Helps members to tackle the challenge of California’s size and diversity

California Maternal Child & Adolescent Health Program (MCAH) How MCAH benefits 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 involvement? 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 approach to promote adolescent sexual health

California Maternal Child & Adolescent Health Program (MCAH) How ASHWG benefits from MCAH involvement? 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

California Department of Education (CDE) Challen ges 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

California Department of Education (CDE) How ASHWG benefits CDE? Programmatic synergy results from a strong track record of collaboration and networking –Synergy must be nurtured –Unified programmatic goals-overlapping priority populations –Programmatic, Department, Staff New Partnerships and Opportunities for Teacher Training – WRITCHE & STD Overview for Educators Joint Objectives for the Centers for Disease Control

California Department of Education (CDE) 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 Family Health Council (CFHC) A statewide not for profit agency and Title X grantee for California (the largest in the nation) Over 300 delegate agencies and clinical sites are subcontracted for family planning programs throughout the state

Title X in California Over 800,000 people are served by the Title X funds in California Of these, 492,000 or over half are ages 24 years and younger.

Title X Agencies in California Regions 3 Brookside Community Health Center City and County of San Francisco Dept of Public Health City of Berkeley Dept of Health and Humans Services East Valley Community Clinic, Inc. La Clinica de la Raza Marin County Dept of Health and Human Services Planned Parenthood Golden Gate Planned Parenthood Mar Monte Planned Parenthood Shasta-Diablo Regents of UCSF - New Generations Health Center Tri-City Health Center Region 4 Butte County Department of Public Health Mendocino Co. HHSA, Public Health Planned Parenthood Golden Gate Planned Parenthood Shasta-Diablo Six Rivers Planned Parenthood Southwest Community Health Center Women’s Health Specialists Region 5 CommuniCare Health Centers Delta Health Care Nevada County Health Department Placer County Health and Human Services Planned Parenthood Mar Monte Planned Parenthood Shasta-Diablo Region 6 Central Valley General Hospital Community Action Partnership of Kern Family HealthCare Network Fresno County EOC Golden Valley Health Centers Kings County Health Department Planned Parenthood Mar Monte Stanislaus County Health Services Agency Region 1 Clinicas de Salud Del Pueblo Community Health Agency - County of Riverside Family Health Centers of San Diego Imperial Beach Community Clinic, Inc. Neighborhood Healthcare North County Health Services PP of San Diego & Riverside Counties Planned Parenthood of Orange & San Bernardino Counties San Bernardino County Dept of Public Health San Diego Family Care Vista Community Clinic Region 2 AltaMed Health Services Corporation Asian Pacific Health Care Venture Chinatown Service Center East Valley Community Health Center, Inc. Eisner Pediatric & Family Medical Center EOC of San Luis Obispo County, Inc Hollywood Sunset Free Clinic JWCH Institute, Inc. L.A. County Department of Health Services Los Angeles Free Clinic Northeast Valley Health Corporation Our Savior Center/Cleaver Family Wellness Clinic Planned Parenthood of Los Angeles Planned Parenthood of Pasadena Planned Parenthood of Santa Barbara, Ventura & San Luis Obispo Counties, Inc. Regents of UCLA Reproductive Health Service Samuel Dixon Family Health Center, Inc. Regions 2 (continued) South Bay Family Healthcare Center South Central Family Health Center St. John’s Well Child and Family Center T.H.E. Clinic, Inc. Valley Community Clinic Venice Family Clinic Westside Family Health Center Women’s Clinic.

California Family Health Council (CFHC) and ASHWG CFHC was the first not for profit partner serving on the ASHWG committee Statewide and youth serving, it made sense for CFHC to collaborate

California Family Health Council (CFHC) How ASHWG benefits from CFHC involvement? CFHC brought additional new partners to the table CFHC has staff focused on youth issues who can contribute to projects, e.g., Core Competencies review, development of surveys CFHC has relationships with private funders to support ASHWG activities CFHC has lobbyists who can help support policy recommendations

California Family Health Council (CFHC) How CFHC benefits from ASHWG? Because of the newly established relationships and friendships, CFHC is better able to move other statewide impact projects forward

California Family Health Council (CFHC) Challenges Ability to attend meetings in Sacramento Coordinating efforts with all CFHC partners

Core Competencies for Providers of Adolescent Sexual and Reproductive Health Programs and Services

Core Competencies Subcommittee Goals 1)Develop a set of benchmarks for core knowledge and skills that providers of adolescent sexual and reproductive health programs need to provide effective and appropriate services: –mutually inclusive –apply equally to STD, HIV, and Family Planning staff that work directly with adolescents 2)Obtain endorsement of Core Competencies from STD, HIV, Family Planning, Education agencies 3)Facilitate adoption of Core Competencies across programs of sexual and reproductive health in CA

Practice Rating Scale 1 = Beginner 3 = Competent 5 = Expert

NEED for Core Competencies A variety of reproductive health programs with different standards, training, strategies, and messages targeting the same youth.

PURPOSE of the Core Competencies Guide hiring, training, & evaluation Collaboration & cross training Support consistent health outcomes Shared body of knowledge & skills

DEVELOPMENT of the Core Competencies May 2006: Subcommittee development Expert Review, Input and Revision Web-based Survey National Experts Final Revisions

NEXT STEPS for the Core Competencies Complete the document In-service agencies on use of the CC Design training and curriculum based on the competencies

…and we are making a difference.

Questions?