plain talk / hablando claro what works to reduce pregnancy, stds and hiv/aids for african american...
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Plain Talk / Hablando ClaroWhat Works to Reduce Pregnancy, STDs and
HIV/AIDs for African American and Latino Youth
APHA San Francisco, Ca.
Marcia Bayne Smith and Debra Delgadowww.aecf.org
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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
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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
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Addressing Culture, Families and ARH
NeighborhoodSchool
FP Services/Programs
Social/PoliticalParents/Family
Parents/FamilyYouth
Culture
Culture
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Parent/Family Engagement Planning Wheel
2
Pick Target Audience
3Select
Program Activities
1Focus
Investment and Intentions
4Implement Engagement
Program
5Assess
Engagement
Program
6Use Feedbackto Improve
PLANNING FOR POSITIVE
PARENT/FAMILY ENGAGMENT
(Model/approachesImplementation
strategy)
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Hablando Claro SobrePlain Talk
• It’s about Messages.• It’s about the Messengers.• It’s about the skills, knowledge
and comfort Messengers need to become effective.
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Tasks Activities Strategies Objectives Goal
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 HealthParties
Walkers&
Talkers
Reduce AdolescentPregnancy, STDs And HIV/AIDS
Tactical UseOf
Data
•Resident Networks•Adult Education & Training•Reinforcing Key Messages•Sustaining Resident Involvement
1. Create Parent / Adult consensus
2. Influence skills
3. Increase Access
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Data Shaped Plain Talk’sCore 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.
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Theory of Change
Effective Communicati
on
Use of Contraception and STD protection
Pregnancy and STD rate
Create Consensus
Educate Community
Adults
Adolescent Knowledge
and Attitudes
Reproductive Health Services
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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.
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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.
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Evaluation HighlightsIncreased 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
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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.
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Evaluation HighlightsImportance 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.
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The Evaluation Results Informed the Replication
Assessment
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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:
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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:
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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”.
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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:
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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.
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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
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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).
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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)
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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.
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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.
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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.
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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.
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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
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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)
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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
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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.
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Program Role...
• Demonstrate authentic commitment, compassion and respect for community partners;
• Recruit committed, credible and outgoing residents; and
• Provide strong supports and training.
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The Plain Talk / Hablando Claro Story Continues…
• 1st 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
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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.
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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
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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/[email protected]