Baltimore City Schools teachers at a U Choose Teen Pregnancy Prevention training

Baltimore City Schools educators at an U Choose Teen Pregnancy Prevention curriculum training. 

Over the summer, Baltimore City Health Department (BCHD) officials expected their year three grant award letter for U Choose from the Department of Health and Human Services’ Office of Adolescent Health (OAH). This grant funds the City’s teen pregnancy prevention program. But this year, the award letter contained a surprise: the letter noted that the project period would end in June 2018, two years early.

Baltimore was one of over 80 projects awarded funding through OAH’s Teen Pregnancy Prevention Program in 2015. The grant funded the health department and its U Choose Coalition partners to implement evidence-based teen pregnancy prevention (TPP) interventions in Baltimore City middle schools, high schools, and Title X clinics.

The Johns Hopkins Center for Adolescent Health has been a member of the U Choose Coalition since its inception. CAH acts as the evaluation lead and serves as a member of the core implementation team of the citywide TPP program.

“This is something that our Center has wanted for a very long time--to have systemic sexual health education in the city school system,” said Beth Marshall, CAH’s associate director.

In 2015, Baltimore’s teen birth rate was 36.2 per 1000 women, which represents a 44 percent decrease since 2009. However, this rate is double the state average, according to the Maryland Vital Statistics Annual Report. Teen pregnancy has negative social and economic consequences for teen parents and their children. Teen parents have lower levels of educational attainment compared to young adults who do not have children. The CDC reports that children of adolescent mothers are more likely to dropout of high school, experience more health problems, and become a teen parent themselves.

This is why evidence-based teen pregnancy prevention programs (TPP) are important. Evidence-based TPP programs help prevent teen pregnancy as well as reduce sexually transmitted infections (STIs) and sexual risk behaviors.

Locally, BCHD and its partners are working hard to make sure adolescents continue to receive this programming after the grant’s end. “We have been focused on sustainability in terms of the way we've implemented this program from day one,” Marshall said. To further sustainability, the group chose to train City Schools staff, typically health and physical education teachers, to deliver the school programming instead of contracting health educators through outside agencies.

We wanted to build the infrastructure within City Schools so that they can continue to offer systemic comprehensive sexual health education,” Marshall said. The training has shifted from two days to one day to make it easier for the teachers implementing the TPP programming.

“Having City Schools as a partner helps with sustainability,” said Meghan, CAH’s senior research program coordinator. “We’re training as many people as we can,” she added.

The coalition selected three different TPP programs to implement: It’s Your Game in middle schools, Making Proud Choices in high schools, and Seventeen Days in clinics. The evidence-based programs used in the schools meet the state health education standards for human sexuality and have shown to have positive results. The grant covered the curriculum purchasing costs and training costs.

CAH staff conduct observations in all of the program settings; monitor the young people who participate in the programs; and evaluate and help organize the teacher trainings. The project is required by OAH to reach 10,000 young people and annually report that data online.

Teachers complete logs to note how their lessons went, and the comments are particularly positive. One educator said, “The students seemed engaged and participated in the activities throughout the class. The students understood the lesson and were receptive to the information.” Another teacher mentioned that students “have a million questions.”

As teachers and clinic staff implement the interventions, CAH staff sit in and observe to make sure everything is going smoothly. “We're there to ensure that they get the support they need to be able to offer the curriculum with fidelity,” Marshall said.

The observations put the complex project into perspective. While some people may think young people are not mature enough for the material, Marshall said she sees students having thoughtful discussions about sexual activity and risk.

BCHD and its U Choose Coalition partners are working together to ensure the TPP program continues by identifying its critical components and looking for additional funding sources.

“We as a Center desperately want for all our young people to have access to this information so whatever we can do to further this and ensure that this grant proceeds in a way that has the best chance of success--success being that when these funds are gone this still happens,” Marshall said.

The grant’s early end came as a shock to recipients nationwide. Our Johns Hopkins School of Public Health colleagues at the Center for American Indian Health  were also recipients of TPP funding from OAH. I spoke with Dr. Lauren Tingey about their TPP program designed for native youth, Respecting the Circle of Life. Read more here: https://www.jhsph.edu/research/centers-and-institutes/center-for-adolescent-health/blog/center-for-american-indian-health-seeks-funding-to-continue

By: Lauren Burns