Challenges in Implementing Evidence-Based Programs for Teenage Pregnancy Prevention

A major priority for the Department of Health and Human Services is finding ways to reduce teen and unwanted pregnancy. A key strategy to achieve this goal is through investing in evidence-based pregnancy reduction strategies and targeting populations at highest risk for teen pregnancy. The federal Teen Pregnancy Prevention Program, which began in 2010, includes funding for programs that are intended to address high rates of teenage pregnancy by (1) replicating evidence-based models, and (2) testing innovative strategies. Funding is structured to maximize investments in programs that have been shown to be effective, but at the same time provide support for research and demonstration grants that provide an opportunity to add to the existing knowledge base. This tiered approach to funding underscores the cross-cutting nature of the problem and the strategies to address it.

This presentation will draw on lessons from an ongoing evaluation of a set of programs funded through the Teen Pregnancy Prevention program. The evaluation includes a rigorous impact study as well as a comprehensive implementation study that offers an opportunity to move beyond the question of the impact of a single replication of a program to look at variation in impacts for program models implemented in different settings and/or with different populations. The implementation study will allow us to examine the relationships between variation in impacts and program implementation, and will provide critical information about the contexts in which evidence-based programs are put in place, the challenges encountered, and the aspects of program implementation that are associated with program impacts.

While the lessons learned from this aspect of the study will provide important guidance for future replication efforts, the grantees that are participating in the study have developed solutions and strategies that can be shared much earlier, to benefit colleagues who may be wrestling with some of the same issues.  Each of the three program models selected for the Replication Study presents a unique set of implementation challenges. For Safer Sex, a clinic-based intervention for sexually-active female youth, which requires three follow-up sessions after the initial session, a major challenge is to retain participants over a six-month period. For ¡Cuídate!, a small-group intervention that focuses on Latino culture and values, a major issue is how to introduce and implement such a program in schools with diverse populations. Reducing the Risk, a widely-used classroom-based curriculum, presents a number of implementation challenges, including where, in schools under intense academic pressure, it can be delivered without affecting core classes, and how facilitators deal with material, such as role-plays and scripts that use dated vocabulary and expressions.

This session will first present the framework for the implementation study and describe how the different elements interact to produce a) effective implementation and b) desired outcomes. The presenters will then move to examine some of the major issues that arose as each of the three program models was rolled out, and describe the strategies developed by grantees to resolve them.