PPA Evaluation of Adolescent Pregnancy Prevention Approaches EXECUTIVE SUMMARY May 2014 Taking a Teen Pregnancy Prevention Program to the Home: The AIM 4 Teen Moms Experience I n 2009, staff at Children’s Hospital Los Angeles (CHLA) saw a need for new reproductive health and pregnancy prevention programming for pregnant and parenting teens. To meet the need in About this Summary This executive summary provides a brief overview of Los Angeles County for additional services to prevent rapid repeat the implementation study findings from the evaluation pregnancies among teen mothers, CHLA sought an evidence-based of AIM 4 Teen Moms in Los Angeles County, Cali- program well suited to the needs of the teen mothers and com- fornia. The full report on program implementation munities the hospital serves. The search led to Project AIM, which discusses these findings in more detail. CHLA adapted for use with teen mothers. The resulting program, AIM 4 Teen Moms, consists of a structured curriculum delivered to brochures in target neighborhoods inviting potential participants teen mothers in home visits and two group sessions. to call the hotline or text designated staff. Staff also presented AIM 4 Teen Moms seeks to affect sexual risk outcomes by information at health fairs and public events to recruit for the helping teens define specific life aspirations and make appro- program. Through their professional networks, CHLA staff also priate choices to achieve them. The program consists of seven reached out to other case management agencies and schools to individual sessions, one group session in the middle of the encourage them to refer eligible teens to AIM 4 Teen Moms. program, and another group session at the end of the program. CHLA’s recruitment efforts attracted teen mothers with multiple The AIM 4 Teen Moms program was selected along with six other risks and service needs. Teen pregnancy was not unusual in par- programs to participate in the Evaluation of Adolescent Pregnancy ticipants’ families. At enrollment, slightly fewer than half of teen Prevention Approaches (PPA), a national evaluation funded by the mothers reported having been sexually active in the preceding four Office of Adolescent Health in the U.S. Department of Health and weeks. On average, participating teen mothers reported that they Human Services. The PPA evaluation studies the effectiveness of had begun having sex at age 15 and had had three sexual partners. promising new or innovative teen pregnancy approaches (Figure 1). It will test whether AIM 4 Teen Moms increases long-term Developing Staff Capacity and Skills to contraceptive use and reduces or delays repeat pregnancy. This Implement AIM 4 Teen Moms summary presents findings from the study of program implemen- tation in the first 18 months of the evaluation. CHLA managers had to hire and train advisors with the skills needed to deliver AIM 4 Teen Moms in homes and group ses- Meeting Recruiting Challenges for AIM 4 sions as intended. Advisors had to be able to engage teen moth- ers in the curriculum activities in varying and sometimes chaotic Teen Moms environments. To find the right mix of skills and experience, CHLA initially established referral relationships with two CHLA and its partner, El Nido, recruited applicants with case programs that already served teen mothers and could refer management backgrounds who had previously worked with teen eligible clients to AIM 4 Teen Moms. However, state funding parents and their families in the target communities. CHLA hired cuts reduced referrals and forced CHLA to expand its outreach staff who already had some of the required skills and experience activities. CHLA established a hotline and distributed flyers and and provided pre-service and ongoing refresher training. 1 Advisors participated in a three-day training in summer 2011 especially appreciated the confidence-building activities and before the start of program delivery. The developer, along interviewing and negotiation skill development, which made with the AIM 4 Teen Moms program director and supervisors, them feel empowered. According to advisors, teen mothers felt conducted live demonstrations by role-playing each of the these skills would enable them to advocate for themselves and program’s nine sessions to familiarize the advisors with the achieve their objectives despite societal pressures. Through content. The training emphasized fidelity to the program model. AIM 4 Teen Moms, participating teen mothers were able to As a supplement to CHLA’s training, each advisor was trained share their lives and feelings with someone who visited them in in developing reproductive life plans and certified as a fam- their homes and listened, taught, and advised them on a regular ily planning health counselor by the California Reproductive basis. When the program ended, so did the relationships the Health Council. Regular monitoring revealed areas in which teens had developed with their advisors. Participants wanted advisors needed additional training and supervision. Refresher the program and their relationship with their advisors to con- training, practice, and ongoing technical assistance helped tinue beyond the 12-week period. improve delivery and increase comfort level. Looking Forward: Lessons to Inform Engaging and Retaining Participants in Future Replication Efforts AIM 4 Teen Moms Lessons from CHLA’s implementation of the AIM 4 Teen Moms Ultimately, the biggest challenge for AIM 4 Teen Moms staff program could support stronger implementation of AIM 4 Teen was engaging and retaining participants in the program. Missed Moms in the future. appointments were common. For those who missed sessions, CHLA leaders learned that filling program spaces required advisors were instructed to reschedule appointments as soon as multiple strategies for finding and enrolling teen mothers, and possible and make up the session. However, time and schedul- advisors needed training along with regular communication ing constraints often prevented make-up sessions. Anticipating about their experiences to master the curriculum materials, use that teen mothers would miss sessions, the developer had also them as intended, and address the challenges they encountered. incorporated redundancy in the curriculum to reinforce mes- sages and help ensure that participants received all of the key CHLA’s experiences also suggest that further adjustments to content, even if they missed some sessions. the program format might improve attendance, and identifying and linking participants to services that can continue reinforc- Few participants attended all nine sessions, but most received ing the messages of Aim 4 Teen Moms after the program ends the minimum specified dosage. Based on the developer’s might help sustain the program’s effects. criteria, most teens (81 percent) completed the minimum five or more sessions required by the program. On average, teens attended six of the nine sessions. Attendance was relatively high in sessions with most of the sexual risk and pregnancy prevention content, ranging from 74 to more than 80 percent. Group attendance was lower than attendance at individual sessions. Staff and participants cited lack of access to viable transportation as a major barrier to group attendance. Participants reported that they liked the aspirational content and personal focus of the program. Advisors noted that participants 2 F i g u r e 1 . A I M 4 Te e n M o m s E v a l u a t i o n — A S n a p s h o t Part of the national multiyear Evaluation of Adolescent Pregnancy Prevention Approaches • Funded by the Office of Adolescent Health, U.S. Department of Health and Human Services • Conducted by Mathematica Policy Research, with Child Trends and Twin Peaks Partners, LLC • Assessing effectiveness of seven programs Approximately 950 teen mothers ages 15 to 19 years old with one child younger than 7 months old in the Los Angeles, California, area were recruited and randomly assigned—half to a program group and half to a group that did not receive Aim 4 Teen Moms • Program delivered to eight cohorts of teen mothers in 12-week cycles, November 2011 to March 2014 • Rolling sample intake through December 2013 • Staff recruited participants through (1) referrals from El Nido Family Centers, Project NATEEN, and AltaMed (programs already serving teen mothers); (2) local outreach at schools and health fairs; (3) referrals from pregnant and parenting teen schools and local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offices; and (4) free hotline and text messages • Program implemented in three locations: metro Los Angeles, South Los Angeles/Compton, and San Fernando Valley Program components: • Seven individual one-hour sessions with a trained facilitator (advisor) in participant’s home • Two approximately 90-minute group sessions, in the middle and at the end of the program, conducted by one or two trained facilitators Adaptation of Project AIM, a curriculum originally used in 7th-grade classrooms in Birmingham, Alabama Topics include positive thinking, future planning, birth control, birth spacing, reproductive planning, and motherhood as an identity strength Impacts on long-term contraceptive use and rapid repeat pregnancy measured by follow-up surveys 12 and 24 months from baseline 3