2006-2007

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Overview of Demonstration Sites

In 2006–2007, NACCHO awarded $16,000 each to two local health departments (LHDs) to pilot an intervention to improve adolescent health—specifically around HIV, sexually transmitted infections (STI), and/or teen pregnancy prevention—and, in collaboration with schools and other community partners, develop a strategic plan to enhance their community's adolescent HIV, STI, and teen pregnancy prevention efforts.

The demonstration sites developed strategic plans that:

Are a collaborative effort, with broad community representation;
Include at least one adolescent representative in the planning process;
Incorporate a positive youth development approach that addresses both risk and protective factors;
Establish long-term goals for sustainability of the collaboration and the implementation of the strategic plan;
Attempt to address individual risk behavior as well as identify and plan for ways to begin to address policies, institutional practices, neighborhood conditions, and environmental factors that have the potential to enhance or threaten adolescent health;
Incorporate a means by which youth at highest risk of HIV, STI, and teen pregnancy will be targeted, both in terms of direct interventions on their behalf and work toward addressing some of the conditions that place them at disproportionate risk;
Involve school, parents, and societal institutions that affect adolescent health either directly or indirectly as targets of planned activity; and
Are submitted for review as a model practice for possible inclusion in NACCHO's Model and Promising Practices database.

Applicants also included in their proposals:

A work plan for the project, including goals and objectives; a timeline of no less than two years; and ideas for using existing community networks and/or partnerships;
Assurance that evidence-based prevention methods are used as a guide for any proposed interventions;
Identification of conditions in the community that constrain options for risk behavior;
A plan for regular and systematic monitoring of partnerships and related progress on the strategic plan; and
Demonstration of how funds will be leveraged to ensure continued collaboration and implementation of the strategic plan after the funding period ends.

Description of Programs

City of Austin Health and Human Services Department

The Austin/Travis County Health and Human Services Department (A/TC HHSD) serves Texas's capital as well as Travis County. The eastern part of Travis County is most disproportionately affected by STIs and teen pregnancies. African American females aged 15–24 in eastern Travis County have rates of chlamydia exceeding 1000/100,000, well over the statewide average of 314/100,000. In 2002, the highest teen pregnancy rates were among Hispanic teens at 53.3 pregnancies per 1,000 females. The teen pregnancy rate among African American teens was significantly lower at 30.3/1,000.Both teen pregnancy rates were significantly higher than the rate among white teens (8.2/1,000). Asset mapping and windshield surveys revealed scarce prevention services that target teen males for teen pregnancy or STI transmission.

Researchers, practitioners, parents, and others who work with youth have increasingly become aware that to prevent teen pregnancy and reduce STI transmission, it is just as important, if not more so, to target teen boys and young men rather than simply focusing on teen girls. In response, A/TC HHSD offered a male-focused program in order to improve male involvement in the prevention of HIV, STI, and unintended pregnancies.

A/TC HHSD worked with schools, churches, community-based organizations, a maternal and child health coalition, and others to develop a three-year strategic plan addressing adolescent HIV, STI, and teen pregnancy prevention within high-risk, adolescent male populations. A/TC HHSD conducted task force meetings along with a hired facilitator to maximize the effort of developing a strategic plan for their male involvement initiative. It also ensured that task force members were representatives of the community.

In addition, A/TC HHSD implemented the Wise Guys Male Responsibility Curriculum®, an evidence-based male involvement program, to target adolescents age 11–17 years who are primarily African American and Hispanic males residing in eastern Travis County. The purpose of this program was to reduce STI, HIV, and teenage pregnancy risk by promoting healthy behaviors through the coordination of the provision of services.

Lessons Learned

The lessons that A/TC HHSD learned from the Wise Guys initiative are:

Plan ahead and allow plenty of time to allow for facilitators to adapt the curriculum to their youth and teach the classes at their own pace.
Facilitators often have varying schedules and can’t always get to teach right away or to stick to a 12-week session. Allow them to compress the curriculum as needed.
Have an incentive for the facilitator and the adolescents. For the facilitators, offer a free training with the curriculum to allow more agencies to participate. For youth, offering incentives that can strengthen participation and enhance the overall learning experience such as pizza parties, T-shirts, and classroom posters/models.
Obtain buy-in from the agency director. Be sure to invite a key agency representative to the training.
Beware of high turnover rates.
Be patient. Many of the facilitators work in schools and have very busy schedules. It may take several calls, e-mails, faxes and drop by visits to keep connected.
Be clear and concise on what you expect to achieve and how it fits in the overall process. Have each of the facilitators sign a memorandum of commitment which states what both parties are responsible for.

The lessons that A/TC HHSD learned from the strategic planning process are:

Don’t assume that all partners understand the concept of the strategic planning effort.
Stay mission focused by utilizing decision making tools that direct all decisions back to the mission and funding criterion/requirements.
Spend the appropriate time to orient stakeholders about “the” undertaking and how it may differ from their previous strategic planning forays.
Be clear and concise on what you expect to achieve and how it fits in the overall process for the funder and your organization. Explain the process in ways that participants will have a clear understanding of expectations.
Schedule sufficient time to complete the task but not so much time that people will lose interest.
Obtain buy-in from the movers and shakers.
Obtain buy-in from those most affected by your planning.
Use the technology (Microsoft live meeting, conference calls, e-mail, etc) to share the message and the thinkwork.

Resources from the Austin/Travis County Health and Human Services Department

Pinellas County Health Department

The Pinellas County Health Department (PinCHD) serves part of the Tampa Bay area in Florida. Within Pinellas County, African American and Hispanic teens aged 15–19 years are the adolescent populations with the highest risk of STI and/or HIV infection. African Americans and Hispanics were also more than twice as likely to have a teenage birth than their white peers. The highest percentage of African American and Hispanic teens live in the county's most socially deprived neighborhoods. Thirteen percent of Pinellas' African American community lives in six St. Petersburg neighborhoods where the unemployment rate is 11 percent, median income is less than $7,000, 45 percent of residents live below poverty level, and less than 50 percent of adults have a high school diploma. Hispanic data is more difficult to gather and analyze. However, the U.S. Census indicates that 20 percent of all Pinellas Hispanics resided in four targeted Clearwater ZIP codes. It is clear that non-white Pinellas teenagers are at highest risk of teen pregnancy, STIs, and HIV.

Historically, few programs addressing teen pregnancy, STIs, or HIV in Pinellas County have been directed to youth. The PinCHD supported youth leadership through a comprehensive approach addressing service gaps currently plaguing Pinellas County programs. This approach centered on (1) establishment and expansion of a peer-to-peer education program focusing on adolescent health, specifically HIV, STI, and unintended pregnancy; (2) partnership with community-based organizations to improve effectiveness of current youth programming; (3) renovation of the fragmented community partnership infrastructure and the reorganization of leadership and membership composition; (4)capacity-building of youth service providers to enhance work with adolescents; and (5) a youth-developed and directed adolescent health Web site.

The lessons that PinCHD learned related to strategic planning are:

The Teen Pregnancy Prevention Partnership Steering Committee initially planned to utilize a professional strategic planning process to develop the strategic plan, however, PinCHD was able to work with a local community planner who had a broad perspective of youth development locally and was familiar with the field of adolescent sexuality. Tapping into this local resource proved to be extremely helpful for the strategic planning process.

The lessons that PinCHD learned related to the development of a teen health promotion Web site are:

Maintaining both perspectives of abstinence-only and comprehensive sexuality education were helpful in developing an objective yet informative Web site. In addition to traditional health issues, the site provides links and information about education and employment, as well as legal issues.

Resources from the Pinellas County Health Department