Translating Theory into Practice: Lessons Learned from Developing a Program Model to Foster Resiliency in Expectant and Parenting Youth.

PURPOSE: This paper describes the approach used to develop the Adolescent Family Life Program (AFLP) Positive Youth Development (PYD) Model within the structure of an existing state government-run program. DESCRIPTION: The California Department of Public Health, Maternal, Child and Adolescent Health (CDPH/MCAH) Division undertook an innovative approach to develop a program model to help expectant and parenting youth build resilience. CDPH/MCAH started by assessing existing program efforts and theory to develop and test new strategies in the field, structure a program model, and build toward broader expansion and sustainability. CDPH/MCAH engaged local organizations from across the state, their staff and enrolled youth, experts, and evaluators in an iterative program development process to standardize an effective model that could be replicated and evaluated. ASSESSMENT: Key lessons for program developers and administrators are to ensure adequate staffing with diverse expertise related to the topic and content to support the multiple components of program development and implementation, evaluation, and training; identify the guiding theory and framework early and link them with clearly articulated core components to ensure the final model reflects the intended purpose and is structured to support implementation; engage implementation staff on the ground and focus early and often on processes for supporting people through change. CONCLUSION: The lessons learned can guide others working with existing programs to develop standardized program models or translate new science and theory into practice.

Trends in Adolescent Birth Rates in California: Examining the Influence of Community Characteristics Through Geographic and Temporal Analysis.

PURPOSE: The aim of the article was to understand community-level factors associated with the decline in the adolescent birth rate (ABR) in California from 2000 to 2014. METHODS: We consolidated multiple data sources at the level of the Medical Service Study Area (MSSA), a federally recognized subcounty geographic unit (N = 497). We used ordinary least squares regression to examine predictors of change in the ABR at the MSSA level over three periods of notable change in California's ABR: 2000-2002, 2006-2008, and 2012-2014. Variables assessed include geographic density, change in sociodemographic and economic characteristics, and change in the availability of publicly funded sexual health services. RESULTS: The ABR declined more in urban than rural MSSAs. In the earlier period, growth in the black, Hispanic, and foreign-born populations, unemployment, and receipt of public assistance were associated with smaller declines in the ABR. Growth in the share of married households and high school completion were associated with larger declines in the ABR. In the later period, growth in public assistance receipt was associated with smaller declines in the ABR, whereas growth in high school completion and college attendance were associated with larger declines. Decline in the ABR was steeper in areas that began offering publicly funded long-acting contraception to adolescents. Rural-urban differences were no longer significant after controlling for change in the provision of long-acting contraception. CONCLUSIONS: Identifying the independent contributions of changes in sociodemographic, economic, and service characteristics to changes in the ABR supports the development of programs and policies that are more responsive to the communities they serve.

Reaching High-Need Youth Populations With Evidence-Based Sexual Health Education in California.

OBJECTIVES: To explore the programmatic reach and experience of high-need adolescents who received sexual health education in 3 distinct implementation settings (targeted-prevention settings, traditional schools, and alternative schools) through a statewide sexual health education program. METHODS: Data are from youth surveys collected between September 2013 and December 2014 in the California Personal Responsibility Education Program. A sample of high-need participants (n = 747) provided data to examine the impact of implementation setting on reach and program experience. RESULTS: Implementation in targeted-prevention settings was equal to or more effective at providing a positive program experience for high-need participants. More than 5 times as many high-need participants were served in targeted-prevention settings compared with traditional schools. Reaching the same number of high-need participants served in targeted-prevention settings over 15 months would take nearly 7 years of programming in traditional schools. CONCLUSIONS: To maximize the reach and experience of high-need youth populations receiving sexual health education, state and local agencies should consider the importance of implementation setting. Targeted resources and efforts should be directed toward high-need young people by expanding beyond traditional school settings.

Rural-Urban Differences in Awareness and Use of Family Planning Services Among Adolescent Women in California.

PURPOSE: The purpose of this study was to compare awareness and use of family planning services by rural and urban program site among a sample of adolescent women before participation in the federal Personal Responsibility Education Program in California. METHODS: We conducted a secondary analysis of survey data collected from youth before participation in California's Personal Responsibility Education Program. Bivariate and multivariate analyses were conducted for a sample of 4,614 females ages 14-18 years to compare awareness and use of family planning services between participants at rural and urban program sites, controlling for the program setting and participant demographic, sexual, and reproductive characteristics. RESULTS: Overall, 61% of participants had heard of a family planning provider in their community, and 24% had visited a family planning provider. Awareness and use of family planning services were lower among rural participants than urban participants. After adjusting for the program setting and participant characteristics, rural participants were less likely to know about a family planning provider in their community (odds ratio, .64; 95% confidence interval, .50-.81) or receive family planning services (odds ratio, .76; 95% confidence interval, .58-.99) than urban participants. CONCLUSIONS: Findings suggest that adolescents in rural areas face greater barriers to accessing family planning services than adolescents in urban areas. Targeted efforts to increase awareness and use of family planning services among adolescents in rural areas and among other underserved populations are needed.

The Prevention of Child Maltreatment Through the Nurse Family Partnership Program: Mediating Effects in a Long-Term Follow-Up Study.

We examine maternal life-course mediators of the impact of a nurse home visitation program on reducing child maltreatment among participants in the Elmira trial of the Nurse Family Partnership program from the first child's birth through age 15. For women having experienced low to moderate levels of domestic violence, program effects on the number of confirmed maltreatment reports were mediated by reductions in numbers of subsequent children born to mothers and their reported use of public assistance. Together, the two mediators explained nearly one half of the total effect of nurse home visiting on child maltreatment. The long-term success of this program on reducing child maltreatment can be explained, at least in part, by its positive effect on pregnancy planning and economic self-sufficiency.

Long-term effects of prenatal and infancy nurse home visitation on the life course of youths: 19-year follow-up of a randomized trial.

OBJECTIVE: To examine the effect of prenatal and infancy nurse home visitation on the life course development of 19-year-old youths whose mothers participated in the program. DESIGN: Randomized trial. SETTING: Semirural community in New York. PARTICIPANTS: Three hundred ten youths from the 400 families enrolled in the Elmira Nurse-Family Partnership program. Intervention Families received a mean of 9 home visits (range, 0-16) during pregnancy and 23 (range, 0-59) from birth through the child's second birthday. MAIN OUTCOME MEASURES: Youth self-reports of educational achievement, reproductive behaviors, welfare use, and criminal involvement. RESULTS: Relative to the comparison group, girls in the pregnancy and infancy nurse-visited group were less likely to have been arrested (10% vs 30%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.13-0.82) and convicted (4% vs 20%; 0.20; 0.05-0.85) and had fewer lifetime arrests (mean: 0.10 vs 0.54; incidence RR [IRR], 0.18; 95% CI, 0.06-0.54) and convictions (0.04 vs 0.37; 0.11; 0.02-0.51). Nurse-visited girls born to unmarried and low-income mothers had fewer children (11% vs 30%; RR, 0.35; 95% CI, 0.12-1.02) and less Medicaid use (18% vs 45%; 0.40; 0.18-0.87) than their comparison group counterparts. CONCLUSIONS: Prenatal and infancy home visitation reduced the proportion of girls entering the criminal justice system. For girls born to high-risk mothers, there were additional positive program effects consistent with results from earlier phases of this trial. There were few program effects for boys.