UpNXT!: Turning Learning into Healthy Choices - ETR, in partnership with independent evaluator RTI International (RTI), proposes to refine, pilot, and rigorously evaluate UpNXT!, a self-paced, scenario-based digital program designed to strengthen higher-order thinking, problem-solving, and real-world application to promote self-advocacy and reduce sexual risk among young people with experience in California's foster care system. According to the federal Administration for Children and Families' Home for Every Child Initiative, adolescent girls in foster care are more than twice as likely to become pregnant by age 19 as their peers outside the system. Despite this need, few evidence-based pregnancy prevention programs are designed specifically for youth in foster care, and lengthy, multi-session formats may not be suited to a population for whom housing and placement instability are associated with increased pregnancy risk. Programs are also rarely developed in direct collaboration with the young people they are intended to serve, missing an opportunity to build on these young people's resilience in navigating complex systems. UpNXT! addresses these gaps by building on lessons from a recently completed study and its existing delivery platform, while introducing an innovative intervention that has not yet been rigorously evaluated. UpNXT! will be refined through ETR's Trauma-Informed Youth-Centered Health Design (TIYCHD) process, which directly engages youth with foster care experience in shaping program content and delivery. Informed by this co-design process, end-user feedback, and findings on how much program exposure drives outcomes in a prior trial, UpNXT! combines a self-paced, scenario-based approach to building self-advocacy with universal, disclosure-independent human trafficking education and instructional strategies grounded in experiential learning and adolescent development science. The Healthy Life Skills content further supports self-sufficiency by strengthening financial literacy, health care navigation, and self-advocacy skills during the transition from foster care, a period when unintended pregnancy can disrupt progress toward education, stable housing, and employment. The project draws on proven recruitment relationships that supported enrollment of 492 foster youth across 24 California counties, and will serve young people ages 16 to 19 who are in or transitioning out of foster care. The evaluation will assess whether, at three and nine months post-intervention, UpNXT! increases abstinence and contraception and/or condom use and reduces vaginal intercourse without contraception and/or condoms, relative to a business-as-usual control condition. Across the project, we will: 1) refine and pilot test UpNXT! using TIYCHD; 2) build the capacity of recruitment partners across California; 3) recruit, assent or consent, and serve approximately 702 unique youth, including 667 enrolled in a randomized controlled trial; 4) collect and report performance measure and impact data through a rigorous evaluation led by RTI; 5) package UpNXT! and its implementation materials for dissemination and replication; and 6) share lessons learned and results widely. If funded, the study would be among the first to rigorously test a scenario-based, self-advocacy-focused sexual health program developed directly with and for youth in foster care.
