In response to the U.S. Department of Health and Human Services, Office of Population Affairs' Optimally Changing the Map for Teen Pregnancy Prevention, and in response to the higher than national, state, and city rates of teen pregnancy and birth, STIs, poverty, and foster care placements in NYC’s Bronx, Manhattan, and Staten Island communities, Children’s Aid (CA) proposes to implement Power Through Choices (PTC), an evidence-based comprehensive pregnancy prevention strategy for youth in seven foster care settings in the Bronx, Staten Island, and Manhattan. Understanding the varying circumstances of adolescents in this population, the PTC approach leverages existing support systems for youth, including foster care agencies and residential settings (foster families, group homes, and/or larger facilities) with the goal of achieving long-term positive outcomes and involvement of hard-to-reach foster care youth, arguably the most under-served youth population. CA’s Teen Pregnancy Prevention (TPP) initiative will serve approximately 350 youth in foster care annually, with expected outcomes to include: increased knowledge about reproductive health issues and resources; lower sexual activity rates; higher use of contraception; lower rates of unprotected sex; and lower teen pregnancy rates.
The precise rates of teen pregnancy or births for foster care youth are not known, but research indicates that it is well understood that the rate of sexual activity among adolescents in foster care is higher than their peers; sexual risk behaviors further correlate to high rates of teen pregnancies, STIs, and HIV in this population. A 2018 study published by the Journal of the American Academy of Pediatrics found that half of children born to mothers in foster care will also enter into the child welfare system by their second birthday, setting up a cycle of child welfare involvement.
In order to implement a systems-level program, this intervention is specifically tailored to support foster care agency staff members, foster parents, and biological parents through education, sustainable interventions, and leveraging community resources to best support young people. Addressing the five essentials of adolescent health (positive connections, safe and secure places, high-quality health care, opportunities to engage, and adolescent and family centered services), PTC will be implemented at foster care agency drop-in centers, group homes, and other spaces through our partner agencies, including health centers that are known to provide excellent adolescent primary and reproductive health care. Trainings will be conducted for foster care agency staff at all levels, and will include: curriculum implementation; integrating meaningful policies to address the needs of youth in foster care to prevent pregnancy and high risk sexual and reproductive health behaviors; and training both foster and biological parents with respect to LGBTQIA sensitivities, identifying human trafficking, reproductive health, trauma-informed care and behavior management, and adolescent health rights in NYC.
CA’s TPP Stakeholder Committee will drive this work; members of this committee include parents, providers, and youth who work together to inform project leaders and the broader community about TPP activities and outcomes. TPP youth participants may apply to become a Just Ask Me (JAM) Peer Health Educator – these youth provide reproductive health education for their peers, help youth strengthen their job readiness, and connect them with other youth with similar life experiences along with trusted adults. CA has engaged Philliber Research and Evaluation to conduct an external implementation evaluation of our TPP Program. Our work with foster care youth, staff, parents, and community stakeholders during a three-year project is estimated to reach 3,000 participants.