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Positive Prevention PLUS

A comprehensive school-based sexual health education and teen pregnancy prevention curriculum to improve high school students' communication and negotiation skills that will help them communicate assertively, abstain from sexual intercourse, and use birth control effectively.

Program Outcomes

  • Sexual Risk Behaviors
  • Teen Pregnancy

Program Type

  • School - Individual Strategies

Program Setting

  • School

Continuum of Intervention

  • Universal Prevention

Age

  • Late Adolescence (15-18) - High School

Gender

  • Both

Race/Ethnicity

  • All

Endorsements

Blueprints: Promising

Program Information Contact

For information about curriculum, content, or training:
www.positivepreventionplus.com/contact/

Program Developer/Owner

Dr. Kim Clark and Christine Ridley, RN, MEd
California State University


Brief Description of the Program

Positive Prevention PLUS is a school-based adolescent pregnancy prevention program that consists of eleven 45-minute lessons aimed at students in grades 9 through 12. It is delivered by trained classroom teachers during the normal school day in science, health, or physical education courses. The 11-unit curriculum includes lessons on the benefits of abstinence, assertive communication, refusal skills, accessing reproductive health services, condom negotiation, and condom use. Students practice communication about abstinence and risk reduction skills through scripted role play and other interactive activities.

Outcomes

Relative to the control group, students in the treatment group were less likely to report having had:

  • sexual intercourse
  • sexual intercourse without using birth control in the past 3 months.

Brief Evaluation Methodology

LaChausse (2016) conducted a cluster randomized control trial in which 21 schools (with 4,267 students) were randomly assigned to a treatment group that received the Positive Prevention Plus program (n = 11 schools) or a control group that received no sexuality-related classroom instruction or school-wide activities (n = 10). Student self-report data were collected at baseline and 6-months following program completion. Outcome measures included three behavioral measures related to sexual activity: (1) ever had sexual intercourse; (2) ever been pregnant or gotten someone pregnant; and (3) ever had sexual intercourse without using birth control in the past 3 months.

Study 1

LaChausse, R. G. (2016). A clustered randomized controlled trial of the Positive Prevention PLUS adolescent pregnancy prevention program. American Journal of Public Health, 106(S1); S91-S96.


Race/Ethnicity/Gender Details

The study did not provide differential analyses by gender or race/ethnicity; however, the sample contained students from high schools with large minority populations.

Two-Day trainings are highly recommended for school teachers, school nurses, and community agency staff intending to present the Positive Prevention PLUS to adolescents and young adults in a classroom or community setting. Training is conducted by Cardea Services Inc. of Oakland, CA. Trainings include familiarization with the curriculum, laws, trauma-informed instruction, gender-related issues, plus actual participant teach-backs.

Contact: positive.prevention@cardeaservices.org

Training Agenda Overview

Day 1

  • California Education Code/California Healthy Youth Act and how it impacts instruction
  • Understanding values and diversity
  • Answering difficult questions
  • Curriculum introduction

Day 2

  • Curriculum overview
  • Modeling and practicing key activities
  • Curriculum-specific "teach backs"
  • Talking with parents about sexual health education
  • Next steps and resources

Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.

Start-Up Costs

Initial Training and Technical Assistance

$3000 for a two-day training of up to 30 people (plus trainer travel expense), provided by Cardea Services.

Contact: positive.prevention@cardeaservices.org.

Curriculum and Materials

Curriculum package: $279 each (+ tax and shipping), ordered online from www.positiveprevention.com

Student workbooks can be purchased in Spanish or English: $6 each (optional).

Each edition features engaging and easy-to-follow semi-scripted lessons and support materials. The curriculum will arrive shrink-wrapped and three-hole punched including lesson dividers and sample Student Workbook, ready to be placed into a three-ring binder.

ALL EDITIONS INCLUDE:

  • Pre-Post Test
  • Lesson Previews
  • Lesson Wrap Ups
  • Marginal notes to teachers
  • Blackline masters for overhead transparencies and student activity cards
  • Parent materials in Spanish and English
  • Assignments to be completed with a parent or trusted adult
  • Instructional strategies aligned with Common Core and Next Generation Science Standards
  • Downloadable support materials with teacher's lesson slides, parent materials and Safe Surrender video clips
  • Student workbooks in Spanish and English (can be purchased separately)

Licensing

No additional licensing fees.

Other Start-Up Costs

For school teachers, also add in the cost of a substitute teacher for two days per teacher attendee (approx. $80-120 per day).

If Student Workbooks are not purchased, also add approx. 26 worksheets minimum per student.

Cardea Services typically arranges space with the school district for a district-only training or for an "open training" (to which others may be invited) at their site; procedures are similar for an agency-based training for its health educators.

Some clerical time is required to arrange training space, order materials, register attendees if the school district or community agency is hosting the training.

School or agency must provide the teacher/health educator with a computer and projector for the lesson slides.

It is recommended that the Activity Cards (masters provided) be run on cardstock (approx. 100 8-1/2" x 11" sheets of cardstock).

Intervention Implementation Costs

Ongoing Curriculum and Materials

Parent notification letters are typically duplicated and mailed/distributed by school districts.

Recurring cost of $6 per Student workbook, unless school/agency chooses to duplicate student worksheets themselves.

In California, the law requires retraining of teachers with updated curriculum materials approx. every three years.

One lesson requires NaOH and phenolphthalein for a demonstration; additional materials recommended include sample birth control methods, latex gloves, masking tape or pins.

Staffing

Schools typically train and equip a number of designated (science or health) teachers to implement the curriculum; community-based agencies will train and equip a smaller cadre of health educators to service school- or community-based teen populations.

Other Implementation Costs

No information is available

Implementation Support and Fidelity Monitoring Costs

Ongoing Training and Technical Assistance

In California, the law requires retraining of teachers with updated curriculum materials approximately every three years.

Fidelity Monitoring and Evaluation

Recommend conducting both process and impact evaluations. Fidelity monitoring instrumentation is provided free by contacting the publisher. Staff or clerical time is required to assemble data.

Ongoing License Fees

None.

Other Implementation Support and Fidelity Monitoring Costs

No information is available

Other Cost Considerations

Some districts and agencies may request participation in a Training of Trainers (TOT) to build capacity within their own organization to (re)train teachers and health educators. This may be negotiated with Cardea Services on a case-by-case basis.

Year One Cost Example

In this example, a high school implements the Positive Prevention PLUS program in ninth grade required courses, either health or science. Four teachers deliver the program to 250 students. The expenses listed below do not include taxes and shipping of materials.

Initial two-day training $3,000.00
Trainer travel $1,500.00
Substitute teachers for 2 training days @ $200/teacher $800.00
Curriculum package @ $279/teacher $1,116.00
Student workbooks @ $6/student $1,500.00
Total One Year Cost $7,916.00

With 250 students served by Positive Prevention PLUS, the Year 1 cost per student is $31.66.

Funding Overview

Positive Prevention PLUS, as a sexual health education and teen pregnancy prevention program designed to be delivered in schools, can be funded with prevention and health promotion dollars focused on high-risk adolescents, as well as education funds.

Funding Strategies

Improving the Use of Existing Public Funds

To the extent that existing health education and pregnancy prevention programs are not evidence-based, a local school district or community agency can consider re-directing teaching time and funds into Positive Prevention PLUS to get better outcomes.

Allocating State or Local General Funds

Local school districts may support Positive Prevention PLUS with school district funding. In addition, state and local health departments as well as city youth development offices may offer grants supporting sex education and pregnancy prevention.

Maximizing Federal Funds

Formula Funds:

  • Title IV, of the Every Student Succeeds Act (ESSA), a new block grant funded at $400 million in FY 2017, provides funds to states by formula for services that keep students safe and healthy and well-rounded. ESSA specifies that activities that help to prevent dating violence and sexual abuse can be funded with Title IV funds.
  • The Personal Responsibility Education Program (PREP), administered by the Administration on Children, Youth, and Families (ACYF), Family and Youth Service Bureau (FYSB) was funded at $75 million in FY 16, and is administered by formula to states and territories for evidence-based programs that educate adolescents on both abstinence and contraception to prevent pregnancy and sexually transmitted infections.
  • Temporary Assistance to Needy Families (TANF) is a formula grant that states use to provide cash assistance and work supports to needy families. One of the four stated purposes of TANF funding is to prevent and reduce out-of-wedlock pregnancies and many states have used TANF to support pregnancy prevention programs.
  • The Social Services Block Grant Program (SSBG) provides states very flexible dollars to fund a variety of social service programs. State social service agencies may allocate some portion of these funds toward pregnancy programs.
  • The Community Development Block Grant (CDBG) program is administered from the federal Department of Housing and Urban Development to localities to support community economic development. Fifteen percent of these funds can be used to support a wide range of public services. Cities may choose to direct some portion of these funds to pregnancy prevention programs.

Discretionary Grants:

  • HHS Office of Adolescent Health Teen Pregnancy Prevention Program (TPPP) grants, funded at $101 million in FY 17 are administered competitively by OAH and support evidence-based teen pregnancy prevention programs.
  • CDC Division of Adolescent and School Health (DASH) office administers funding to support HIV, STD, and unintended pregnancy prevention.
  • The Administration for Children and Families, Family Youth Services Bureau (FYSB) also occasionally releases competitive funding requests focused on pregnancy prevention for at-risk teens.

Foundation Grants and Public-Private Partnerships

Foundations, particularly those interested in adolescent health and pregnancy prevention and evidence-based practices, can be considered for training and curriculum purchase dollars.

Debt Financing

No information is available

Generating New Revenue

No information is available

Data Sources

No information is available

Program Developer/Owner

Dr. Kim Clark and Christine Ridley, RN, MEdCalifornia State UniversityDepartment of Health Sciences positiveprevention.com

Program Outcomes

  • Sexual Risk Behaviors
  • Teen Pregnancy

Program Specifics

Program Type

  • School - Individual Strategies

Program Setting

  • School

Continuum of Intervention

  • Universal Prevention

Program Goals

A comprehensive school-based sexual health education and teen pregnancy prevention curriculum to improve high school students' communication and negotiation skills that will help them communicate assertively, abstain from sexual intercourse, and use birth control effectively.

Population Demographics

This program targets high school aged students in grades 9 - 12.

Target Population

Age

  • Late Adolescence (15-18) - High School

Gender

  • Both

Race/Ethnicity

  • All

Race/Ethnicity/Gender Details

The study did not provide differential analyses by gender or race/ethnicity; however, the sample contained students from high schools with large minority populations.

Other Risk and Protective Factors

School-based prevention programs that use experiential, interactive activities to emphasize abstinence and risk reduction techniques are more likely to reduce sexual risk-taking behaviors than those that merely increase student knowledge regarding reproductive anatomy or facts about the consequences of teen pregnancy.

Risk/Protective Factor Domain

  • Individual

Risk/Protective Factors

Risk Factors

Protective Factors


*Risk/Protective Factor was significantly impacted by the program

Brief Description of the Program

Positive Prevention PLUS is a school-based adolescent pregnancy prevention program that consists of eleven 45-minute lessons aimed at students in grades 9 through 12. It is delivered by trained classroom teachers during the normal school day in science, health, or physical education courses. The 11-unit curriculum includes lessons on the benefits of abstinence, assertive communication, refusal skills, accessing reproductive health services, condom negotiation, and condom use. Students practice communication about abstinence and risk reduction skills through scripted role play and other interactive activities.

Description of the Program

Positive Prevention PLUS is a school-based adolescent pregnancy prevention program that consists of eleven 45-minute lessons aimed at students in grades 9 through 12. It is delivered by trained classroom teachers during the normal school day in science, health, or physical education courses. The 11-unit curriculum includes lessons on the benefits of abstinence, assertive communication, refusal skills, accessing reproductive health services, condom negotiation, and condom use. Students practice communication about abstinence and risk reduction skills through scripted role play and other interactive activities.

In LaChausse (2016), the treatment was completed over a 3-week period where educators were expected to complete 11 lessons consecutively. Teachers completed a rigorous training schedule with program developers to ensure fidelity of implementation. First, teachers completed a 2-day training that consisted of an overview of the project and opportunities to practice teaching a lesson. Next, teachers completed an online training program to review key components and to observe each lesson being taught by a veteran teacher. About 1 week before implementation, teachers were also given a 1-day refresher to emphasize key lessons and address any concerns about program implementation.

The current version of the curriculum includes 13 sessions. The two additional lessons cover: STDs and Safe Surrender per California requirements.

Theoretical Rationale

The program draws on social cognitive theory, which posits that behavior change occurs through several constructs, including observational learning, behavioral capability, outcome expectations, and self-efficacy.

Theoretical Orientation

  • Skill Oriented
  • Behavioral

Brief Evaluation Methodology

LaChausse (2016) conducted a cluster randomized control trial in which 21 schools (with 4,267 students) were randomly assigned to a treatment group that received the Positive Prevention Plus program (n = 11 schools) or a control group that received no sexuality-related classroom instruction or school-wide activities (n = 10). Student self-report data were collected at baseline and 6-months following program completion. Outcome measures included three behavioral measures related to sexual activity: (1) ever had sexual intercourse; (2) ever been pregnant or gotten someone pregnant; and (3) ever had sexual intercourse without using birth control in the past 3 months.

Outcomes (Brief, over all studies)

At the 6-month follow-up posttest, students in the treatment group were less likely than students in the control group to report ever having had sex. In addition, students in the treatment group (compared to control students) were less likely to report having had sex without birth control in the past 3 months.

Outcomes

Relative to the control group, students in the treatment group were less likely to report having had:

  • sexual intercourse
  • sexual intercourse without using birth control in the past 3 months.

Mediating Effects

Not conducted.

Effect Size

Not reported.

Generalizability

Ethnically diverse sample of 9th grade students in six school districts in Southern California.

Potential Limitations

LaChausse (2016)

  • Tests for baseline equivalence were done on the analysis sample rather than the randomized sample.
  • It is not clear whether baseline outcomes were included as covariates.
  • While the author states the program was implemented with high quality, it is not clear how program quality was measured.

Endorsements

Blueprints: Promising

Program Information Contact

For information about curriculum, content, or training:
www.positivepreventionplus.com/contact/

References

Study 1

Certified LaChausse, R. G. (2016). A clustered randomized controlled trial of the Positive Prevention PLUS adolescent pregnancy prevention program. American Journal of Public Health, 106(S1); S91-S96.

Study 1

Evaluation Methodology

Design:
Recruitment: High schools across six districts in Southern California with data indicating high adolescent birth rates and a lack of comprehensive sexuality education or adolescent pregnancy prevention programming were approached to participate. Criteria for selection into the study included whether schools were able to implement an adolescent pregnancy prevention program, maintain the treatment and control contrast, and provide access to eligible students. Twenty-two schools were assessed for eligibility and one school was dropped for not meeting inclusion criteria. A total of 7,042 students were assessed for eligibility and provided the opportunity to consent to participate. After excluding one school that was not eligible for participation, 4,267 parental consents were obtained and randomization into treatment and control occurred.

Assignment: A total of 21 schools (with 4,267 students) were randomly assigned to condition, with 11 schools (n= 2,483 students) in the treatment group and 10 (n = 1,784) in the control group. Students in the control group classrooms received the standard health, science or physical education curriculum. Schools and teachers in the control group were asked to refrain from providing any sexuality-related classroom instruction or school-wide adolescent pregnancy or STD prevention-focused activities, though they were allowed to discuss human reproduction if relevant to their curriculum (for example, in a biology course).

Attrition: No attrition occurred at the school-level. There were 3,554 participants that completed the baseline survey for an overall baseline attrition rate of 17%. At 6-months follow-up, 3,490 students completed a survey (for an overall attrition rate of 18%).

Sample:
The overall population of the sample was not reported, though demographics were reported by condition. Of the students in the treatment group, 34% were white, 18% were black, 8% were Asian, and 74% reported Hispanic ethnicity. Meanwhile, 38% of students in the control group were white, 18% were black, 9% were Asian, and 73% reported Hispanic ethnicity. More than half the overall sample was female, while 52% of students in the treatment group and 56% in the control group were female.

Measures:
Outcomes were assessed using a student, self-report yes/no question to the following items:

  • Ever had sexual intercourse
  • Ever been pregnant or gotten someone pregnant
  • Ever had sexual intercourse without using birth control in the past 3 months.

Analysis:
The analysis used multi-levels models with robust standard errors, random effects at the school level, and baseline covariates for gender and Hispanic or not. While outcomes were assessed at baseline (see Table 1), it is not clear whether these baseline outcomes were included as covariates. The Benjamini-Hochberg adjustment was made for the three outcomes assessed.

Intent-to-Treat: All available data of students were analyzed based on the condition to which they were initially assigned which is in line with intent-to-treat protocol. Additional analyses used multiple imputation to include all data.

Outcomes

Implementation Fidelity: Teachers completed 95% of the lesson activities scheduled to be delivered. Ninety-one percent of the students attended all of the offered lessons. Seventy-three percent of the lessons received a high-quality rating, however no explanation or quantitative data was provided for how this rating was assessed. In terms of diffusion, only 14% of the participants in the control group reported learning about adolescent pregnancy prevention-related topics, whereas treatment group students reported learning 60% of the adolescent pregnancy prevention-related health topics.

Baseline Equivalence: Tests used the analytic sample, but not the randomized sample. After adjustment for clustering, the tests showed no significant differences on any of the nine baseline measures (Table 1).

Differential Attrition: The attrition rate differed across conditions by approximately 8% at baseline and 8% at the 6-month follow-up, with a higher attrition rate in the control group. Tests found no significant differences between the intervention and control groups in the proportion of dropouts who were female, were Hispanic, ever had sex, ever had been pregnant, and had not used birth control. In addition, per Table 1, equivalence for the analytic sample was established with no statistically significant differences in demographics or outcomes detected between the control and treatment groups at baseline.

Posttest: At posttest, the study found significant impacts on the participants' likelihood to engage in sexual intercourse and to engage in sexual intercourse without birth control. Relative to the control group, participants in the treatment group were approximately 4 percentage points less likely to have had sex at 6-month follow-up. In addition, participants in the treatment group were approximately 2 percentage points less likely than students in the control group to have had sex without birth control at 6-month follow-up. There were no significant differences between groups in getting pregnant/having gotten someone pregnant at 6-month follow-up.

However, sensitivity tests found that use of multiple imputation reduced all the program effects to non-significance and use of logical imputation (i.e., using answers to some questions to impute answer to others) reduced the program effect on use of birth control to non-significance.

Long-Term: , Not conducted.

Registry

The clinical trial registry for the study can be found at Clinical.Trials.gov (see https://clinicaltrials.gov/ct2/show/NCT02540278?term=LaChausse&rank=1). As the primary outcomes, the registry lists had sex (ever and last 6 months), been pregnant or gotten someone pregnant (ever and last 6 months), and sex without birth control (last 3 months). These outcomes and the other registry details correspond to those used in the study.

Contact

Blueprints for Healthy Youth Development
University of Colorado Boulder
Institute of Behavioral Science
UCB 483, Boulder, CO 80309

Email: blueprints@colorado.edu

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Blueprints for Healthy Youth Development is
currently funded by Arnold Ventures (formerly the Laura and John Arnold Foundation) and historically has received funding from the Annie E. Casey Foundation and the Office of Juvenile Justice and Delinquency Prevention.