Texas Healthy Adolescent Initiative

Texas Healthy Adolescent Initiative

July 2009

Program Background

According to the 2007 results from the Youth Risk Behavior Survey (YRBS) conducted by the Center for Disease Control and Prevention, Texas youth are at greater risk than youth across the United States to engage in behaviors that contribute to the leading causes of death, disability, and social problems. The following are examples of behaviors youth in Texas are at greater risk of engaging in compared to other youth in the United States:

·  using illicit drugs (i.e. cocaine and methamphetamine);

·  being offered, sold or given drugs by someone on school property;

·  not using protection during sexual intercourse;

·  using cigarettes throughout their lifetime, and

·  riding with an intoxicated driver.

Texas needs to strategically address these high-risk behaviors by providing evidence-based comprehensive youth development programs to: increase healthy decision-making, increase resiliency in youth, delay sexual debut and decrease risk taking behaviors. The Texas Healthy Adolescent Initiative uses a comprehensive evidence-based youth development approach to increasing healthy behaviors and decision making among Texas adolescents by promoting the development of confidence, competence, connectedness, character, and contribution.

Research has demonstrated that comprehensive youth development programs can increase healthy decision-making, delay sexual debut, increase resiliency and decrease risk taking behaviors in adolescents (University of California, UC ANR Latina/o Teen Pregnancy Prevention Workgroup, 2004). Research also suggests a strong relationship between education and career plans and protection from adolescent pregnancy (University of California, 2004). Young people who have skills, goals, social support and opportunities to contribute are less likely to engage in high-risk behaviors than those who lack these skills and supports. Adolescent health should include not only physical health, but also the “multiple process that affect the overall well-being of young people and their capacity to function effectively in everyday life” (Resnick, 2000). Community support for programs that focus on pro-social behaviors may increase by focusing on the strengths of adolescents and demonstrating the contribution youth can make to their community. This “positive youth development” approach also benefits youth as it includes trusting relationships, emotional support from outside of the family, opportunities to develop autonomy, and to experience achievement. It also promotes a sense of hope and being loveable, which supports growth and maturation in youth.

Although adolescence is the time when youth are creating their own identity and developing their own self-image, adolescents tend to start conforming to group activities and group norms. Even though the influence of a pre-adolescent’s peers is dominant during this age period, children age 12-14 still seek adult approval and guidelines. They also seek affection and humor from caring adults as well as the acceptance by their peer group. Youth at this age need opportunities to explore their independence and gain more responsibility without added pressure. Effective programs involving family and other caring adults focus on building and enhancing family or adult relationships and communication about parental attitudes and values to reduce the likelihood of risk-taking behavior.

Through funding from the Texas Healthy Adolescent Initiative, local communities will provide a positive atmosphere for adolescents that will encourage and enable the development of healthy lifestyles and positive behaviors and decrease the risk of negative health behaviors through comprehensive evidence-based youth development services.

Program Content

The primary objective of the Texas Healthy Adolescent Initiative (Texas HAI) program is to improve the overall health and well-being of Texas adolescents, 10-18 years, and to prepare them with a strong foundation for adult life. The Texas HAI program provides funding for local community leadership groups to conduct a local needs assessment and develop a strategic plan for their community to address adolescent health through a comprehensive youth development approach. Following the needs assessment, successful respondents will develop and implement services following the principles of youth development to build upon the strengths of young people within each community. DSHS will provide guidance and requirements for service components and strategies that must be included, but implementation and structure will be unique to each community. The Department will offer funding in a five-year cycle using Title V Maternal and Child Health funding. The following is a description of the requirements for each year of the funding cycle.

Year One

The first year will be dedicated to building the infrastructure of a Local Community Leadership Group (LCLG). This includes establishing membership, roles, goals and objectives, and strategic direction for a needs assessment and service development. Activities that must occur in Year One will include:

·  conducting a community needs assessment;

·  community mapping of services and issues to establish target areas and service development;

·  conducting focus groups or other forums with youth, parents and community members;

·  developing a strategic plan for adolescent health;

·  identifying community partners for sustainable funding; and

·  developing program services for implementation in Year 2.

LCLGs will be provided resources to conduct the local needs assessment and gap analysis, assess cultural competency and evaluate the initiative. A process evaluation will be conducted in year one by DSHS staff on the development of the LCLG and services.

DSHS will require each LCLG to have membership representation with expertise in the following areas:

·  Adolescent health

·  Juvenile justice

·  Adolescent use of alcohol, tobacco and other drugs

·  City or County government

·  Adolescent pregnancy prevention

·  Business

·  Education

·  Faith-based services

·  School Health Advisory Councils

·  Community Resource Coordination Groups (CRCGs)

·  Youth development services

·  Sports/Recreation arena

·  Adolescent mental health

·  Adolescent leaders

·  Parents of adolescents

Respondents must submit with their application signed letters of participation from potential or existing members of the LCLG that identifies each area of expertise that qualifies them for membership.

Developing a plan for comprehensive youth development services in the community is the primary objective of the LCLG in addition to the above listed activities. LCLGs must use comprehensive youth development principles of the holistic development of civic, vocational, physical, social/emotional and intellectual development of adolescents as the foundation for developing services. Each contractor will be required to develop a plan for services that must include evidence-based youth development strategies. These strategies include:

·  Involving families

·  Strengthening academic skills and opportunities for the youth and family members

·  Strengthening school-to-work programs (specific partnerships with local businesses for internship possibilities)

·  Mentoring programs or opportunities for adolescent-adult relationships

·  Service-learning/community involvement

·  Offering referrals to preventive health services, specifically for adolescent males.

·  Health and mental health care referrals or access to care

·  Activities that enhance self-esteem.

DSHS staff must approve the service plans developed by the LCLGs prior to program implementation.

Year 2

The second year will begin program implementation based on the services and strategic plan developed in Year One. The goal is for the local healthy adolescent initiative to become an established and prioritized community effort. Ongoing evaluation of the community initiatives will begin in Year Two and will continue through Year Five. This will include the examination of youth outcomes related to risk behavior reduction, resiliency and skill building using a standardized measurement tool identified by DSHS. Participant satisfaction data must be gathered in Year Two for continuous program improvement. If parents are involved in services, satisfaction data must be gathered from parents as well.

Each LCLG in Year 2 will also develop a healthy adolescent video that will serve as a public service announcement (PSA). The purpose of the video is to provide messaging for adolescents by adolescents in the community. The video may address issues such as violence, sexual risk taking behaviors, substance use, preventive health care, and more. LCLGs will be required to include funding in their Year 2 budget for equipment to make the video. LCLGs are encouraged to create partnerships in Year 1 with local schools or colleges to help create the video as well as to help in the recruitment of the adolescents who will help develop the video.

Years 3-5

Years Three through Five will continue program implementation and coalition activities, specifically resource development for sustainability and coordination of services. During Years Three, Four, and Five, evaluation and client satisfaction data will continue to be gathered for examining changes in youth resilience, and effectiveness of program implementation and modifications.

Each year, DSHS will host an annual grantee conference to continue building the capacity of the LCLGs. Trainings will include principles of adolescent health and youth development, coalition building, creating sustainable efforts, and more. Each respondent must include funding in their budget for one trip to Austin, Texas for at least three (3) LCLG members for all five years of the program.

ii. Program Evaluation

The evaluation for this project will be conducted by the DSHS, the Office of Program Decision Support. All required evaluation forms and survey instruments will be provided by the DSHS, Office of Program Decision Support. In the first year, a process evaluation will be conducted to gather information about the coalition building and program planning process. In the second year, when direct services begin, the contractor will be required to implement youth and parent satisfaction survey forms to assess participant satisfaction with the program and its processes. Outcomes evaluation conducted through the collection and analysis of data gathered by a standardized instrument provided by the Department of State Health Services, Office of Program Decision Support. The standardized instrument may include, but will not be limited to, measurement of participant perceptions of future orientation, self –esteem, social connections, and other risk/protective factors. It will be collected at pretest and posttest.

iii. Program Performance Measurement

Contractor will be responsible for reporting on process measures and outcome measures.

The process measures for Year One are:

·  Formation of the Local Community Leadership Group (LCLG) with members representing the 15 identified areas (a member may represent more than one area);

·  Completion of community mapping (needs assessment);

·  Development of a program development plan including evidence-based youth development strategies;

·  Development of a comprehensive adolescent health strategic plan.

The output measures for Years Two – Five are:

·  Dissemination of program development plan to local stakeholders, including youth;

·  Dissemination of comprehensive adolescent health strategic plan to local stakeholders, including youth;

·  Identification of target groups in community;

·  Number of unduplicated youth served through services developed by the local LCLG;

·  Number of unduplicated parents served through services developed by the local LCLG (if applicable).

The outcome measures are:

·  Percent of youth satisfied with program activities;

·  Percent of parents satisfied with initiative/program activities;

·  Statistically significant improvement from pretest to posttest in constructs measured in the standardized instrument (i.e., better self esteem, participant feels more socially connected, greater resiliency, greater future orientation, fewer risk behaviors, etc.);

·  Percent of participants under age 18 that do not parent a child following completion of program participation.