Positive Choices, Positive Futures

State: NV Type: Model Practice Year: 2007

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Positive Choices, Positive Futures (PCPF) targets parents of adolescents in the age range of 9-14 to address the issue of adolescent sexual risk taking, including adolescent STI/HIV and teen pregnancy (TP) rates. The program has three goals and multiple objectives.

Goal 1: To improve parent-child communication about sexual risk-taking and protection from STIs and HIV.

  • Objective 1.1: By month two, the WCDHD and four Youth Service Organizations (YSOs) will be trained to provide the PCPF program. 
  • Objective 1.2: By month nine, the PCPF program will be implemented eight times to parents in Washoe County; four sessions will be conducted in English and four in Spanish. 
  • Objective 1.3: By month nine, 80 parents/guardians will participate in PCPF; of these, two-thirds will be Spanish-speaking. 
  • Objective 1.4: By month nine, 40% of parents/guardians who evaluate PCPF will report an increase in parent-child communication about sexual risk-taking and protection from STIs/HIV.
  • Objective 1.5: By month nine, 40% of parents/guardians who evaluate PCPF will report an increase in parent-child connectedness.


Goal 2: To decrease STI and HIV rates among high-risk adolescents in Washoe County.

  • Objective 2.1: By month nine, 30% of youth whose parent/guardian participated in PCPF will report an increase in the use of condoms and/or abstinence from sexual intercourse.
  • Objective 2.2: By month nine, 40% of youth whose parent/guardian participated in PCPF will report an increase in parent-child communication.
  • Objective 2.3: By month nine, 40% of youth whose parent/guardian participated in PCPF will report an increase in parent-child connectedness.

Goal 3: To increase the capacity of four YSOs in Washoe County.

  • Objective 3.1: By month eight, the collaborating YSOs will report an increased capacity to provide STI/HIV prevention education to youth in Washoe County.

Outcomes of practice include: Five community agencies were trained on the PCPF curriculum and offered the program to the community. The PCPF program was implemented fourteen times within the project year. Seven sessions were conducted in English; six sessions were conducted in Spanish; and the remaining session was conducted in both English and Spanish. Ninety-four parents/guardians participated in the PCPF program. Of the original 80 parents/guardians targeted to participate in this program, 45 (56%) were Spanish-speaking.

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Washoe County District Health Department
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Positive Choices, Positive Futures
Positive Choices, Positive Futures (PCPF) targets parents of adolescents in the age range of 9-14 to address the issue of adolescent sexual risk taking, including adolescent STI/HIV and teen pregnancy (TP) rates. The program has three goals and multiple objectives. Goal 1: To improve parent-child communication about sexual risk-taking and protection from STIs and HIV. Objective 1.1: By month two, the WCDHD and four Youth Service Organizations (YSOs) will be trained to provide the PCPF program.  Objective 1.2: By month nine, the PCPF program will be implemented eight times to parents in Washoe County; four sessions will be conducted in English and four in Spanish.  Objective 1.3: By month nine, 80 parents/guardians will participate in PCPF; of these, two-thirds will be Spanish-speaking.  Objective 1.4: By month nine, 40% of parents/guardians who evaluate PCPF will report an increase in parent-child communication about sexual risk-taking and protection from STIs/HIV. Objective 1.5: By month nine, 40% of parents/guardians who evaluate PCPF will report an increase in parent-child connectedness. Goal 2: To decrease STI and HIV rates among high-risk adolescents in Washoe County. Objective 2.1: By month nine, 30% of youth whose parent/guardian participated in PCPF will report an increase in the use of condoms and/or abstinence from sexual intercourse. Objective 2.2: By month nine, 40% of youth whose parent/guardian participated in PCPF will report an increase in parent-child communication. Objective 2.3: By month nine, 40% of youth whose parent/guardian participated in PCPF will report an increase in parent-child connectedness. Goal 3: To increase the capacity of four YSOs in Washoe County. Objective 3.1: By month eight, the collaborating YSOs will report an increased capacity to provide STI/HIV prevention education to youth in Washoe County. Outcomes of practice include: Five community agencies were trained on the PCPF curriculum and offered the program to the community. The PCPF program was implemented fourteen times within the project year. Seven sessions were conducted in English; six sessions were conducted in Spanish; and the remaining session was conducted in both English and Spanish. Ninety-four parents/guardians participated in the PCPF program. Of the original 80 parents/guardians targeted to participate in this program, 45 (56%) were Spanish-speaking.
Sexual activity and sexual risk taking in the adolescent population are the issues addressed by the PCPF program. In 2005, 48% of Washoe County adolescents reported being sexually active, which is almost double the Healthy People 2010 target of 25% (YRBS, 2005). The number of STIs reported in Washoe County has been rapidly increasing, and adolescents (ages 15 - 24) have been one of populations hardest hit. Washoe County has one of the highest teen pregnancy rates in Nevada and the teen pregnancy rate among Hispanic teens is even higher. Hispanics in Washoe County are also over-represented in the STI burden; in 2002, Hispanics accounted for 33% of total chlamydia cases, yet are only 18% of the population (WCDHD, 2003). A review of Washoe County’s data related to STIs, HIV and teen pregnancy showed a need to put more of an emphasis on adolescent sexual health. And informal needs assessment of the programs available in the community showed a fair number of programs and services available to adolescents, but few programs and services available to assist parents of adolescents. Data shows parents have a major influence on adolescents’ sexual health choices, and the PCPF program was determined to be a positive approach to addressing adolescent sexual health in Washoe County. The PCPF program addresses the issue of adolescent sexual health by educating parents of early adolescents (ages 9-14) on adolescent development and improving parent-child connectedness and communication. The program informs parents of the importance of talking to their children about sex and sexuality and offers them suggestions on how to begin and continue conversations. The adaptation of the PCPF program was innovative in several ways. The WCDHD did not offer the class itself, but contracted with agencies that were well established in the area and had relationships with parents and families in their communities. By partnering with agencies it was found that the groundwork for establishing trust and relationships was already laid. WCDHD was able to partner with agencies based on the communities with which those agencies worked. For example, a concentrated effort was made to partner with agencies that could offer classes to the Hispanic community. The WCDHD, participating in a demonstration project, allowed for and encouraged variances in the program outreach and implementation efforts, which helped in determining which efforts were best suited to the program and the community. Implementation of this program was unique in two ways: target population and outreach. The overall goal of the program was to decrease adolescent sexual risk taking. While traditionally the approach to changing adolescent behavior is to target adolescents, the PCPF program targets parents of adolescents and gives parents tools to prevent risky behaviors in their adolescents. The outreach efforts were unique because the primary method utilized was the “Tupperware Approach”. This approach utilizes a few gatekeeper parents that are recruited to host the educational seminar in their home and invite family and friends who have children in the target age range. At the end of the program, attending parents in the group are asked to host a seminar in their home and invite people in their social circles.
Agency Community RolesThe Washoe County District Health Department’s role was implementing the PCPF program in the community. The WCDHD obtained funding, coordinated trainings on the PCPF curriculum, offered technical assistance, revised and updated curriculum, provided programmatic materials, and worked with YSOs to have the program implemented to parents in the community. These activities were a collaborative effort among the HIV, STI and Teen Pregnancy prevention programs of the WCDHD. The cross-programmatic integration has increased cooperation, and the efficiency of combining resources resulted in a more successful implementation of the program. Community partners implemented the program for groups of parents. This process consisted of coordinating with the WCDHD to have staff trained, outreach in the communities they worked with, recruiting parents and providing PCPF classes. Community partners also participated in the evaluation process.  Costs and ExpendituresNACCHO Demonstration Site Funding was used for program start-up, implementation and evaluation costs: $12,000 (this does not include in-kind contribution of staff time by WCDHD).  ImplementationGoal 1: To improve parent-child communication about sexual risk-taking and protection from STIs/HIV. Month two: Train CBOs to implement PCPF program (Program coordinators).  Month one through seven: Recruit program participants (WCDHD and YSO staff).  Month three through eight: Implement PCPF program (WCDHD and YSO staff).  Month nine: Conduct follow-up eval of participants (Evaluator).  Month nine: Analyze evaluation data (Evaluator). Goal 2: To decrease STI and HIV rates among high-risk adolescents in Washoe County. Month nine: Conduct follow-up evaluation of youth (Evaluator). Month nine: Analyze evaluation data (Evaluator). Goal 3: To increase the capacity of four YSOs in Washoe County. Month one: Conduct YSO technical assistance/capacity building needs assessment (Evaluator). Month two: Provide training based on results of need assessment (Program Coordinator).  Month nine: Solicit feedback for YSOs (Evaluator).
Objective 1.1: By month two the WCDHD and four YSOs will be trained to provide the PCPF program.  Performance Measures: By month two, four partner YSOs had been trained, as well as other agencies in the community. Additional training sessions were provided as needed.  Feedback: Program materials were not available at training. To maintain momentum and interest, materials need to be ordered previous to training. Objective 1.2: By month nine the PCPF program will be implemented eight times, four classes in English and four in Spanish.  Performance Measures: By month 12 (with extension) program was implemented 14 times, seven in English, six in Spanish and once to a mixed group Sp/Eng speaking.  Feedback: YSOs that had parents involved in other classes were more successful in having well-attended classes. Objective 1.3: By month nine 80 parents will have participated in PCPF, of these 2/3 will be Spanish-speaking.  Performance Measures: By month 12, 94 parents had participated in PCPF. Of the original 80 parents/guardians targeted to participate in this program, 56% were Spanish-speaking.  Feedback: YSOs working with the Hispanic parents found incentives were important. Additional incentives were purchased and YSOs were encouraged to use incentives.
SustainabilityThe WCDHD is committed to continue to market and provide the PCPF training, offer technical assistance, and offer program materials to community agencies that implement the PCPF program in Washoe County. A small amount of funding has been secured by the WCDHD to continue to promote implementation of the program. Plans are to use the money as a stipend to help offset programmatic costs to community partners. In the evaluation of the PCPF program, two agencies stated they would continue to implement the PCPF program with agency resources. While personnel costs were expected to be covered through the agency, funds for parent materials, snacks and incentives were not included in the budget. With regard to leveraging resources, the NACCHO grant allowed for program integration within the Health Department. It is more efficient for the HIV, STI and Teen Pregnancy Prevention Programs to work together than separately on similar or the same projects. It is the hope that this project will allow for future collaborations among these three programs and other sexual health programs within the Health Department. Furthermore, the Health Department was able to provide the community with another valuable resource and now has greater access to people within the community via collaborating agencies. Finally, the Health Department diversified its funding streams by working with NACCHO. With regard to leveraging resources among partner agencies, collaborations were formed with the Health Department and networking opportunities among the sub granted agencies occurred. In addition, parent participants received information and referrals to other agency programs for themselves and their children. Lessons LearnedPrevious to implementing this program, the WCDHD offered training on the PCPF program that was well attended by Community Based Organizations (CBOs). After attending the training none of the CBOs offered the class in the community. With the recent implementation the WCDHD offered not only training on the program, but small stipends to community partners who contracted with the WCDHD to offer two classes each to parents in the community. In addition to the stipend, WCDHD provided partners with presentation materials and parent information packets that could be provided to the parents attending the class. Technical assistance was offered, including additional training, templates of recruiting materials/flyers, assistance teaching the class, and grant-writing assistance. Relationships with the community partners were positive and contributed to successful implementation of the program.
 
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