Keeping It Real Together: A Model for Scaling up Evidence-Based Teen Pregnancy Prevention in High-Need Schools in Los Angeles County

Introduction: The literature has identified numerous factors that facilitate the scale-up of evidence-based prevention interventions (EBIs) in community settings, including incorporating EBIs within existing systems, building organizational infrastructure and capacity for EBIs through training and technical assistance, establishing practitioner-scientist partnerships, and utilizing data systems to assess needs and evaluate impacts. Since 2010, the Teen Pregnancy Prevention Program, funded by the U.S. Department of Health and Human Services, has sponsored efforts to scale up and evaluate EBIs that target sexual risk behaviors among youth. We describe a model for the scale-up of the HIV/AIDS and pregnancy prevention program, It’s Your Game…Keep it Real (IYG), implemented in schools located in high-need areas of Los Angeles County as part of the multi-component Keeping it Real Together intervention.

Methods: Over a 7-year period, we recruited 42 middle schools and 325 teachers to implement the IYG program. Teachers reported data on student attendance, fidelity and adaptations, and program dosage. Each year, teachers completed a survey that assessed satisfaction with the program, implementation barriers and facilitators, usefulness of technical assistance, and effectiveness of the lead teacher approach. Teachers received an incentive (gift cards) following completion of implementation. School-based program implementation occurred in the context of a community-wide intervention that also included parent education, community mobilization, and disseminating information about youth-friendly clinics.

Results: Strategies that facilitated implementation were obtaining a written commitment from administrators; providing teacher training, booster sessions, and regular technical assistance visits from project staff; identifying and supporting a lead teacher at each school; creating an online toolkit for resources and process evaluation data reporting; development and regular meetings of a Teacher Advisory Board; and establishing a system for collecting outcome data.

Overall, the program reached more than 46,000 students. On average, students received 90% of the program lessons. Teachers reported high levels of satisfaction with the program and perceived success of the lead teacher model. Barriers to implementation included obtaining access to technology for the computer-based lessons in poorly-resourced schools, finding time to complete the lessons, large class sizes, management of students’ behaviors during lessons, and limited support by administrators.

Conclusions: These findings have important implications for large-scale implementation of school-based prevention programs in high-need areas. Scaling up not only requires resources (both internal and external), but also a plan for building capacity, supporting implementation, collecting evaluation data, and sustaining implementation that is co-developed and endorsed by key community stakeholders.