1. Plain Talk / Hablando Claro What Works to Reduce Pregnancy, STDs and HIV/AIDs for African American and Latino Youth APHA San Francisco, Ca. Marcia Bayne Smith and Debra Delgado www.aecf.org

2. Presentation Objectives Provide an overview of the Plain Talk/Hablando Claro Initiative Discuss evaluation highlights and their implications for evidence-based practice. Describe replication and dissemination strategies

3. What is the Plain Talk/ Hablando Claro Initiative? $5 million, 4-year Program Demonstration to reduce teen pregnancy, STDs and HIV/AIDs conducted 1993-1998 Atlanta, Hartford, New Orleans, San Diego and Seattle

4. Addressing Culture, Families and ARH Neighborhood School FP Services/Programs Social/Political Parents/Family Youth Culture

5. Parent/Family Engagement Planning Wheel 2 Pick Target Audience 3 Select Program Activities 1 Focus Investment and Intentions 4 Implement Engagement Program 5 Assess Engagement Program 6 Use Feedback to Improve PLANNING FOR POSITIVE PARENT/FAMILY ENGAGMENT (Model/approaches Implementation strategy)

6. Hablando Claro Sobre Plain Talk It’s about Messages. It’s about the Messengers. It’s about the skills, knowledge and comfort Messengers need to become effective.

7. TasksActivitiesStrategiesObjectivesGoal The Plain Talk Model: A Process for Reducing Adolescent Pregnancy, STDs and HIV/AIDS Phase I: Initial Start-Up -Select Lead Agency -Form Planning Grp -Community Mapping -Consensus Building -Disseminate info -Plan use of findings Phase II: Implementation -Education -Skills Building Phase III: Institutionalization -Maintenance -Sustainability Community Mapping Home Health Parties Walkers & Talkers Reduce Adolescent Pregnancy, STDs And HIV/AIDS Tactical Use Of Data Resident Networks Adult Education & Training Reinforcing Key Messages Sustaining Resident Involvement 1. Create Parent / Adult consensus 2. Influence skills 3. Increase Access

8. Data Shaped Plain Talk’s Core Assumptions Large numbers of teens - both boys and girls - have sexual intercourse; Sexually active youth do not view themselves at risk for pregnancy, STDs and HIV/AIDs; Many parents and other adults want to do something but lack the confidence, comfort and skills to communicate with teens; and Sexually active youth need access to clinical services and comprehensive sexuality education.

9. Theory of Change Effective Communication Use of Contraception and STD protection Pregnancy and STD rate Create Consensus Educate Community Adults Adolescent Knowledge and Attitudes Reproductive Health Services

10. We Know Plain Talk Works Cross-site evaluation conducted by Public/Private Ventures: –Quantitative date collection, including pre and post household surveys, site visits, etc. –Qualitative data collection via ethnographic studies; and –Extensive consultation with the sites.

11. Evaluation Highlights Sexually active youth who spoke with adults about topics related to sexuality were half as likely to: –have an STD, –have had or created a pregnancy –have a child …compared to youth who did not talk with adults.

12. Evaluation Highlights Increased communication Increased levels of talk between adults and sexually active youth –61% in 1994 –70% in 1998 “Talkers” showed increased knowledge about sexuality and birth control –2.1 times more likely to know where to get birth control in 1998

13. Evaluation Highlights Increased Access to Reproductive Health Services for Teens Large numbers of community adults went to community education classes. Clinic hours increased or improved. Two sites opened clinics in the community. Increased numbers of young people seen by local clinics each week.

14. Evaluation Highlights Importance of local community context Resident involvement in implementation: community mapping, planning, curriculum development/implementation, peer education and use of social networks. Parents and non-related adults: can offer complementary messages to young people What community residents need: Skill development, clarity about their role.

15. The Evaluation Results Informed the Replication Assessment

16. Replication Assessment 1.It addresses an important public problem or need. 2.It achieves positive, measurable results. 3.It achieves these results in a timely fashion. 4.It can make a convincing case that the program, not other factors, caused the results. Plain Talk hit the mark on all four conditions. A program is worthy of replication when it meets four conditions:

17. Replication Assessment Were directly connected to the positive evaluation results; Had been implemented in two or more sites; and Had been successfully implemented in at least two sites. The assessment focused on RESULTS. The process identified core elements that:

18. Blueprint for Success Community Mapping: Survey of neighborhood- based knowledge, attitudes and beliefs of adults and adolescents about teens’ sexual behaviors and their access to services and supports; Walkers and Talkers/Promotoras: Adult peer educators who can make a difference one person at a time; and Home Health Parties/Vecino-a-Vecino: Small group learning circles to help adults become “askable adults”.

19. What Are Promotoras and Walkers & Talkers? Build awareness of local attitudes, thoughts and beliefs about teens’ sexual behaviors; Point out the differences between what adults want and what young people are doing; Inform residents about services and supports for young people; and Inform the community about Plain Talk and related strategies. Adult Peer Educators who:

20. Characteristics Outgoing and friendly Known and respected in the community Able to motivate others; Able to read and write; Able to communicate in a manner that is easily understood; and Able to think fast and grasp new information quickly.

21. Walkers & Talkers/Promotoras Were Pivotal to Plain Talk’s Success Quantity: Sites had a higher degree of success in providing adult peer education; Quality: Sites with home health parties were able to have more candid, effective conversations

22. Lessons Learned from the Evaluation and Replication Assessment W&T/P were residents themselves, thus viewed with less suspicion; They had access to more people in the neighborhoods; They led more direct and focused discussions than professional health educators; and They felt they had the responsibility and right to challenge other residents with the PT/HC messages (moral authority).

23. The Role of Staff Create a Safe Space to help W&T/Ps: –Identify their characteristics, values, attitudes and traits that will help them to be effective; –Identify relevant personal and professional experiences; –Determine gaps in information and learning needs; and –Establish a conceptual link between this work and their desire to make a difference in their community. (reference: Self-Evaluation Matrix)

24. Core Learning Components Exploration of attitudes and values about teen sexual activity; Exploration of their family communication traditions; Adult/adolescent communication; including information about listening skills; and Adolescent growth and development.

25. Core Learning Needs (continued) Pregnancy Prevention How pregnancy occurs. Types of methods available to young people. Relative “risks” associated with the methods. Correct use of methods/protection. Where and how to obtain contraceptives locally.

26. Core Learning Needs (continued) Sexually Transmitted Diseases and HIV/AIDs What an STD is. How HIV and STDs are transmitted. How HIV and STDs are prevented. Where to go for services.

27. Vecino-a-Vecino/Home Health Parties Purpose: –To create a safe space and learning environment for neighborhood adults; –To increase the number of “Askable Adults” in neighborhoods; which consequently leads to… –An increase in the accuracy and frequency of adult/adolescent communication about sex, protection and contraception.

28. Preliminary Activities A resident volunteers to “host” the event; The WT/P meets w/the host to plan logistics –Small stipend provided to cover refreshments –Review paperwork, e.g. sign-in sheets, ground rules, etc –Address emergent questions Host recruits 6 to 10 participants

29. Let’s Party! WT/P arrives 30 minutes early to help Host prepare. When guests arrive, host & WT/P introduce themselves. Participants also provide introductions. (10 minutes) Sign-in sheet is distributed (get contact information to assist with future outreach). Confidentiality sheet is discussed and distributed. (10 minutes)

30. La Fiesta Continua…. Icebreaker - should be quick, simple and FUN! - 10 minutes Pre-test question sheet - 5 minutes Presentation of community mapping data (flip charts and handouts) – 30 minutes Mini-lecture on selected topic (adult/adolescent communication, birth control, STD prevention) – 40 minutes Q and A period - 10 minutes Post-test question sheet - 10 minutes Raffle Refreshments Total time: approximately 2 hours

31. Summary Comments: Walkers & Talkers and Promotoras W&T/Ps have proven to be effective: –They have deeper and more consistent reach into the neighborhoods; –They increase service providers’ capacity to conduct outreach; and –They have moral authority. They play a dual role: –Ongoing outreach and information sharing; –Front-line support for Home Health/Vecino-a-Vecino sessions.

32. Program Role... Demonstrate authentic commitment, compassion and respect for community partners; Recruit committed, credible and outgoing residents; and Provide strong supports and training.

33. The Plain Talk / Hablando Claro Story Continues … 1 st Cohort –New Orleans: State and local funds to adapt model for Medicaid enrollment; –San Diego: Private foundations supporting replication in two new sites; –Atlanta: Contracted by DOH to expand “Askeable Parents” Sample Replication Activities –Minneapolis: state $$$s to launch community mapping –Wayne County –TANF $$$s used to replicate Plain Talk in semi- rural area –Children’s Aid Society: Integrated Walkers & Talkers into its flagship teen pregnancy program

34. Replication is More Than Program Duplication …. Plain Talk is the cornerstone for AECF’s 4- pronged field building strategy : Improve practice Increase knowledge about reproductive health behaviors of African American and Latino Youth Build Public Will Influence policy and shift public resources to increase teens’ access/utilization of reproductive health services and comprehensive sexuality education.

35. Field-Building Investments Examples : –Practice: CARTA, P/PV, Children’s Aid Society, ETR, NOAPPP, PPNYC, National Campaign to Prevent Teen Pregnancy, SIECUS –Knowledge Development: Joint Center for Political and Economic Studies, UCSF, Girls Inc. –Build Public Will: AGI, Advocates for Youth –Shift Public and Private Resources: Association of Maternal and Child Health, Ms Foundation

36. Plain Talk / Hablando Claro Resource Materials Plain Talk: The Story of a Community-Based Strategy to Reduce Teen Pregnancy, 1999 Adult Communication and Teen Sex: Changing a Community, P/PV, 2001 The Plain Talk Planning Year: Mobilizing Communities to Change, P/PV, 1995 The Plain Talk Implementation Guide, P/PV 2002 Walking the Plain Talk – A Guide for Trainers, P/PV, 2003 www.aecf.org/publications ddelgado@aecf.org