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HIPTeens

HIPTeens

A school-based program for high school girls aimed at reducing pregnancy and sexually transmitted diseases.

Fact Sheet

Program Outcomes

  • Sexual Risk Behaviors
  • Teen Pregnancy

Program Type

  • Skills Training

Program Setting

  • Community
  • School

Continuum of Intervention

  • Selective Prevention

Age

  • Late Adolescence (15-18) - High School

Gender

  • Female

Race/Ethnicity

  • All
  • African American

Endorsements

Blueprints: Promising

Program Information Contact

Dianne Morrison-Beedy
Phone: (813) 230-3335
Email: hip4change@gmail.com
Web: www.hip4change.com

Program Developer/Owner

Dianne Morrison-Beedy
The Ohio State University


Brief Description of the Program

HIPTeens is a sexual-risk reduction program that targets nonpregnant, sexually active teenage girls. The program includes four weekly, 120-minute sessions. At 3 and 6 months after the initial intervention, two 90-minute booster sessions are offered. The intervention is delivered in small groups (6-10 girls) by trained program facilitators. The intervention (a) provides HIV and sexual health information, (b) strives to increase motivation to reduce sexual risk behaviors and (c) allows time to practice interpersonal and self-management skills that facilitate sexual risk reduction. The intervention uses developmentally appropriate strategies such as games, group activities and role plays to deliver program content.

Outcomes

Compared to the control group, intervention participants experienced:

  • reduced frequency of vaginal sex and unprotected vaginal sex
  • reduced number of sexual partners and amount of unprotected sex with a steady partner
  • greater abstinence from vaginal sex at 6 months
  • fewer pregnancies

Brief Evaluation Methodology

The evaluation used a randomized controlled trial in which sexually active teenage girls (n = 639) were randomized to the sexual-risk reduction program or a health promotion control group. All subjects were between the ages of 15 and 19 years, and were recruited from youth development and adolescent health centers in upstate New York. Block randomization was used to assign participants to the intervention (n = 329) or control (n = 310) condition. Data were collected at baseline, and at 3-, 6-, and 12-months post-intervention. Outcome measures included frequency and type of sex, use of protection, and number of sexual partners.

Study 1

Morrison-Beedy, D., Jones, S., Xia, Y., Tu, X., Crean, H., & Carey, M. (2013). Reducing sexual risk behavior in adolescent girls: Results from a randomized controlled trial. Journal of Adolescent Health, 52(3), 314-321.


Protective Factors

Individual: Refusal skills

See also: HIPTeens Logic Model (PDF)

The program targets non-pregnant, sexually active teenage girls, ages 15-19. The sample for the evaluated study came from a low-income, urban area.

Race/Ethnicity/Gender Details

The sample was predominantly African American (69%).

The training of facilitators consists of two full days on site or at an alternate location and covers:

  • Curriculum introduction
  • Module-by-module review with materials and slides
  • Logic model
  • Discussion and provision of tools for fidelity monitoring and evaluation
  • Trauma-informed care training
  • Positive youth development
  • Learning disabilities - Universal Design for Language

Before the initial training, the developer asks that new providers complete an interactive online module which covers the foundation of HIPTeens including theoretical framework, working with teens, and motivational intervention techniques. Trainees receive their manual prior to training for their review. Sites are assigned to complete this online module prior to the initial face-to-face training at their site.

Program Costs

Start-Up Costs

Initial Training and Technical Assistance

An initial on-site, 2-day training is provided at $995 per trainee + $1,250 per diem for the trainer. Included in the cost is up to 3 hours of additional booster training to support implementation of the model.

Training requires a space that has projection and audio capabilities, and a laptop connected to projection.

Curriculum and Materials

Participant Workbooks:
50 @ $495
250 @ $2,250
1,000 @ $8,950

Implementation Kit cost is built into the training expense.

Licensing

No ongoing licensing costs currently.

Other Start-Up Costs

Space for program delivery must be able to accommodate groups of 6-10 students and one to two facilitators. Also necessary, are a computer capable of projecting PowerPoint slides and short video clips, flip charts, and other writing surfaces to effectively deliver the HIPTeens program to a group of students.

Intervention Implementation Costs

Ongoing Curriculum and Materials

No information is available

Staffing

Qualifications: No educational requirement or specific criteria – we only tell organizations that facilitators must have enthusiasm for helping adolescent girls.

Ratios: One facilitator can deliver the intervention to groups of 6-10 girls. In the Blueprints certified evaluation, two facilitators were used.

Time to Deliver Intervention: The program includes 4 weekly 2-hour modules and 2 90-minute booster sessions offered at 3 and 6 months after the initial intervention.

Other Implementation Costs

No information is available

Implementation Support and Fidelity Monitoring Costs

Ongoing Training and Technical Assistance

There are no ongoing training costs.

The developer provides customized evaluation plans and consultation to each site as needed/requested. Sites have generally only needed 1 hour extra per site which is included in the initial training costs. If sites need more hours of technical assistance, then building in a buffer for this would be an additional cost. This could be anticipated and planned for during initial start-up and discussed with the developer depending on provider readiness/capacity.

Fidelity Monitoring and Evaluation

Included in initial training costs.

New providers of HIPTeens are provided with an Evaluation Guide which details the program objectives, the fidelity tools, programmatic evaluation, data collection tools and procedures for managing and monitoring the evaluation. Options for evaluation data collection include the facilitators, participants, and supervisor fidelity assessors. Options for end of session feedback include forms for facilitators, observers, and participants. The feedback that is collected from participants is done anonymously and kept confidential. Developer works with each site to determine the site’s data collection need based on what data they must provide to satisfy state or federal funding requirements. Additionally, multiple quantitative data collection measures, including HIV-Q (Brief), can be completed. Guidance is provided by the developer on how to support assessors and facilitators.

Ongoing License Fees

No information is available

Other Implementation Support and Fidelity Monitoring Costs

No information is available

Other Cost Considerations

No information is available

Year One Cost Example

For a youth program to train 4 existing staff members as program facilitators who reach a total of 250 girls in a year, the following costs could be expected.

Participant workbooks $2,250
Trainer per diem $1,250
Initial training: $995 x 4 facilitators $3,980
Total Year One Cost $7,480

With a total Year 1 cost of $7,480, the per participant expense would be $29.92.

Funding Strategies

Funding Overview

HIPTeens, as a health education program aimed at preventing HIV and other STIs and unwanted pregnancy, can be funded with prevention and health promotion dollars focused on high-risk adolescents.

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 locality can consider re-directing funds targeted for health education and pregnancy prevention into HIPTeens to get better outcomes.

Allocating State or Local General Funds

State and local health departments as well as city youth development and recreation offices may offer grants supporting pregnancy prevention and the reduction of sexually-transmitted disease. The developers will provide tailored assistance to ensure that providers can meet data reporting needs of system/stakeholder.

Maximizing Federal Funds

Entitlement Funds:

  • Medicaid can be successfully accessed to cover the cost of the program for qualifying participants; individual sessions are documented for payment by Medicaid.
Formula Funds:
  • The Personal Responsibility Education Program (PREP), administered by the Administration on Children, Youth, and Families (ACYF), provides $55 million annually 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: Discretionary grants opportunities may be found under the CDC Office of Adolescent Health (OAH) grants, as well as the Administration for Children and Families, Family Youth Services Bureau (FYSB). OAH administers the Teen Pregnancy Prevention Program which supports replication of evidence-based TTP programs, of which HIPTeens is one. The Prevention and Public Health Fund, created by the Affordable Care Act and administered by the Department of Health and Human Services (HHS) is also funding some community-based prevention programs. The Fund was originally funded with $15 billion over 10 years, but has undergone $5 billion in cuts since it was passed. HHS is continuing to administer remaining dollars in the fund to a wide variety of public health and prevention purposes.

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

Evaluation Abstract

Program Developer/Owner

Dianne Morrison-Beedy The Ohio State University College of Nursing 1585 Neil Ave. Columbus, OH 43210 813-230-3335 morrisonbeedy@gmail.com hip4change.com

Program Outcomes

  • Sexual Risk Behaviors
  • Teen Pregnancy

Program Specifics

Program Type

  • Skills Training

Program Setting

  • Community
  • School

Continuum of Intervention

  • Selective Prevention

Program Goals

A school-based program for high school girls aimed at reducing pregnancy and sexually transmitted diseases.

Population Demographics

The program targets non-pregnant, sexually active teenage girls, ages 15-19. The sample for the evaluated study came from a low-income, urban area.

Target Population

Age

  • Late Adolescence (15-18) - High School

Gender

  • Female

Race/Ethnicity

  • All
  • African American

Race/Ethnicity/Gender Details

The sample was predominantly African American (69%).

Risk/Protective Factor Domain

  • Individual

Risk/Protective Factors

Risk Factors

Protective Factors

Individual: Refusal skills

See also: HIPTeens Logic Model (PDF)

Brief Description of the Program

HIPTeens is a sexual-risk reduction program that targets nonpregnant, sexually active teenage girls. The program includes four weekly, 120-minute sessions. At 3 and 6 months after the initial intervention, two 90-minute booster sessions are offered. The intervention is delivered in small groups (6-10 girls) by trained program facilitators. The intervention (a) provides HIV and sexual health information, (b) strives to increase motivation to reduce sexual risk behaviors and (c) allows time to practice interpersonal and self-management skills that facilitate sexual risk reduction. The intervention uses developmentally appropriate strategies such as games, group activities and role plays to deliver program content.

Description of the Program

HIPTeens is a sexual-risk reduction program that targets nonpregnant, sexually active teenage girls. It is delivered to small groups of 6-10 girls by trained program facilitators. The program includes four weekly, 120-minute sessions. Two 90-minute booster sessions are offered at 3 and 6 months after the initial intervention. The intervention (a) provides HIV and sexual health information, (b) strives to increase motivation to reduce sexual risk behaviors, and (c) allows time to practice interpersonal and self-management skills that facilitate sexual risk reduction. Facilitators use developmentally appropriate strategies such as games, group activities and role plays to deliver program content.

Session content includes:

  • Session 1: Value setting and future goals, sexual health knowledge, and empowerment to practice safer sexual behaviors
  • Session 2: Triggers to risk situations, safer behaviors, and identifying strategies to reduce risk
  • Session 3: Condom use and negotiation skills, role of future goals in changing risky behavioral choices
  • Session 4: Self-empowerment, communication, negotiation skills, developing an individualized menu of risk reduction strategies, and personal motivation for achieving healthy behaviors

Theoretical Rationale

The program is guided by the Information, Motivation, Behavioral (IMB) Skills model, which uses information and motivational strategies to change specific behaviors.

Brief Evaluation Methodology

The evaluation used a randomized controlled trial in which sexually active teenage girls (n = 639) were randomized to the sexual-risk reduction program or a health promotion control group. All subjects were between the ages of 15 and 19 years, and were recruited from youth development and adolescent health centers in upstate New York. Block randomization was used to assign participants to the intervention (n = 329) or control (n = 310) condition. Data were collected at baseline, and at 3-, 6-, and 12-months post-intervention. Outcome measures included frequency and type of sex, use of protection, and number of sexual partners.

Outcomes (Brief, over all studies)

There were several intervention effects that favored the experimental condition. Intervention participants had significantly reduced frequency (total episodes) of vaginal sex at 3, 6, and 12 months post-intervention, when compared to the control condition. There was also a significant decrease in the number of unprotected vaginal sex acts at 3 and 12 months.

The intervention group had a significant reduction in the total number of sexual partners at 6 months (but not at 3 and 12 months), and a reduced amount of unprotected sex with a steady partner at 3 months (but not at 6 and 12 months), compared to the control condition. There were no significant differences in frequency of unprotected sex with nonsteady partners. The intervention group had greater abstinence from vaginal sex (total, unprotected, with steady partner, without steady partner) than the control group at 6 months.

The results using medical records presented raw percentages without formal models. They showed significantly fewer pregnancies in the intervention group than the control group.

Outcomes

Compared to the control group, intervention participants experienced:

  • reduced frequency of vaginal sex and unprotected vaginal sex
  • reduced number of sexual partners and amount of unprotected sex with a steady partner
  • greater abstinence from vaginal sex at 6 months
  • fewer pregnancies

Mediating Effects

There was no analysis of mediating effects.

Effect Size

Most tables did not include effect sizes, but odds ratios for number of sex partners ranged from .368 to .536 (small-medium to medium effects).

Generalizability

Given that the program targets nonpregnant, sexually active teen girls and the evaluated sample came from an urban, low-income area, program effects may only be generalizable to similar populations.

Limitations

  • Significant baseline differences existed for two outcomes (Table 2); however, these indicated the treatment group was more at risk
  • Although similar across conditions, attrition differed by age

Endorsements

Blueprints: Promising

Program Information Contact

Dianne Morrison-Beedy
Phone: (813) 230-3335
Email: hip4change@gmail.com
Web: www.hip4change.com

References

Study 1

Certified Morrison-Beedy, D., Jones, S., Xia, Y., Tu, X., Crean, H., & Carey, M. (2013). Reducing sexual risk behavior in adolescent girls: Results from a randomized controlled trial. Journal of Adolescent Health, 52(3), 314-321.

Morrison-Beedy, D., Jones, S., Xia, Y., Tu, X., Crean, H., & Carey, M. (2013). Reducing sexual risk behavior in adolescent girls: Results from a randomized controlled trial. Journal of Adolescent Health, 52(3), 314-321.

Study 1

Evaluation Methodology

Design: The evaluation used a randomized controlled trial in which sexually active teenage girls (n = 639) were randomized to the sexual-risk reduction program or a health promotion control group. All subjects were between the ages of 15 and 19 years, and were recruited from youth development and adolescent health centers in upstate New York. Block randomization was used to assign participants to the intervention (n = 329) or control (n = 310) condition. Data were collected at baseline, and at 3-, 6-, and 12-months post-intervention, but relative to the 6-month program of group meetings and booster sessions, the assessments occurred at baseline, mid-program, posttest and 6-month follow-up.

Eligibility requirements included: English-speaking, unmarried, not currently pregnant, not given birth within the past 3 months, and sexually active within the past 3 months. The control condition included information on general health topics (i.e., nutrition, breast health and anger management). The control condition was designed to be structurally equivalent to the intervention, and had the same number of sessions and same program facilitators as the intervention.

Attrition: Of the 1,778 girls who were screened, 765 (43%) did not meet eligibility criteria. Among eligible participants, 738 consented, and 639 ultimately participated. Across both groups, completion was 85% at 3 months, 84% at 6 months and 76% at 12 months.

Sample: Participants were predominantly African American (69%), but also included Caucasian (9%), multiracial (11%) and other (11%). The sample was mostly low-income (69%, as measured by 'free lunch' status). All subjects were girls, with a mean age of 16.5 years.

Measures: Measures were collected using an audio computer-assisted self-interview at all intervals. In the self-interview, participants reported demographic and health behaviors. These items included age at first vaginal, oral and anal sex; age of sexual partner; number of concurrent male sexual partners; and episodes of protected and unprotected vaginal and anal sex with steady and nonsteady partners (past 3 months). Participants also provided urine samples at baseline, 6 and 12 months that were tested for Chlamydia and Gonorrhea.

Additionally, data from some participants' medical charts (n = 322) were abstracted from participating health clinics. Researchers used the data to identify additional infections and positive pregnancy tests outside of those documented by the testing protocol.

Analysis: Analyses followed the intent-to-treat principal and included all girls randomized to groups. Analyses controlled for race, age, and poverty, as well as baseline status of the dependent measure. The models did not adjust for clustering within the intervention groups.

Zero-inflated Poisson (ZIP) regression analyses were used for count behavior (frequency of sexual behavior) with substantial numbers of zeros. For the ZIP models, two regression equations were estimated simultaneously: (a) a logistic regression model to predict whether specific types of sexual behavior occurred (e.g., reported protected vaginal sex), and (b) a Poisson regression model to predict the values of the episodes of sexual activity. The ZIP models allowed for the possibility that different variables may predict whether a subject had participated in a sexual behavior, as well as the frequency.

The impact of the intervention was also analyzed on the number of sex partners. Number of partners was classified into three categories (zero partners, one partner, and two or more partners). These categorical data were then modeled using generalized logit regression, assessing the differences between those subjects with (a) zero partners and one partner, (b) zero partners and two or more partners. Cases with missing data were evaluated to assess potential biases on the outcomes. The ZIP model was evaluated with 3, 6, and 12-month post-intervention data for each outcome, controlling for the baseline value of the variable and six covariates: age, white race, multiracial, other ethnicity, Hispanic, free lunch, and treatment condition. Each follow-up visit was modeled separately.

Outcomes:

Implementation fidelity: Program sessions were audiotaped and randomly selected for review. Independent raters scored facilitators at 97% fidelity to content and process. There was no information on program attendance.

Baseline equivalence: There were no differences between intervention and control groups in race, ethnicity or poverty (as measured by 'free lunch' status). However, Table 2 showed some significant baseline differences on the number of times having had vaginal sex and unprotected vaginal sex, indicating greater risk for the treatment group.

Differential attrition: Group assignment was not associated with attrition, but older girls were significantly more likely to be lost to follow-up. Figure 1 shows that 24 control subjects (7.7%) and 0 intervention subjects were "lost to follow-up" rather than to attrition, but the study made no note of the different form of drop out or the possible influence on results.

Posttest:

There were several intervention effects that favored the experimental condition. Intervention participants had significantly reduced frequency of vaginal sex at 3, 6, and 12 months post-intervention, when compared to the control condition. There was also a significant decrease in the number of unprotected vaginal sex acts at 3 and 12 months.

The intervention group had a significant reduction in the total number of sexual partners at 6 months (but not at 3 and 12 months), and a reduced amount of unprotected sex with a steady partner at 3 months (but not at 6 and 12 months), compared to the control condition. There were no significant differences between conditions in frequency of unprotected sex with nonsteady partners. The intervention group had greater abstinence from vaginal sex (total, unprotected, with steady partner, without steady partner) than the control group at 6 months.

The results using medical records and urine tests presented raw percentages without formal models. They showed significantly fewer pregnancies in the intervention group than the control group but no significant differences in sexually transmitted infections.

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.