Aim: The aim of this program is to reduce teen pregnancy through a range of strategies including prevention education, clinical linkage, community awareness, male involvement, mentoring, peer provided services, and youth leadership development. Some of the thirteen (13) core-themes that are taught to young Native Americans are explicated below:
A – H Abstinence Themes
- Has as its exclusive purpose, teaching the social, psychological, and health gains to be realized by abstaining from sexual activity;
- Teaches abstinence from sexual activity outside marriage as the expected standard for all school age children;
- Teaches that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems;
- Teaches that a mutually faithful monogamous relationship in the context of marriage is the expected standard of human sexual activity;
- Teaches that sexual activity outside of the context of marriage is likely to have harmful psychological and physical effects;
- Teaches that bearing children out of wedlock is likely to have harmful consequences for the child, the child’s parents, and society;
- Teaches young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances; and
- Teaches the importance of attaining self-sufficiency before engaging in sexual activity.
Native Challenge program employs a variety of strategies to reach out to the youth and the community at large.The programs that are implemented on the reservations and schools are:
Baby Think It Over
Baby Think It Over is a great way for teens to experience the emotional, financial and social responsibilities associated with parenting. For 72 hours, each teen is given a simulated (computerized) doll to care for as if it were a real baby. During these 72 hours the teen will feed the baby, change diapers, do burping, and rocking all hours of the night and day, typical situation if they were to have a baby. The computer that is programmed in the baby records how the teen is caring for the baby for example it will record if the baby cried at night and the teen did not respond to it or if it was not bathed and fed. A printed report is downloaded on the computer in terms of how successful the teen was in being a parent. The program helps teens understand that infants require a great deal of time and attention, hence help them be aware that they are not yet ready to be parents or to get pregnant. Each teen is given an incentive based on satisfactory completion of the program. The program requires parental consent, and the age limit is 12 years old.
Family Fun Night
Parent and child communication is very important when trying to avoid teen pregnancy, drug abuse, alcohol abuse, and high school drop out rates. Family Fun Night is a prevention activity combined with a recreational activity for the whole family in which the family come together and have a fun activity while bonding and learning effective ways of communicating with each other. Each event includes prevention education, which may be presented by a guest speaker or showing a video. To attract a larger audience, we have had celebrities come to these events like former Lakers Player A.C Green, Actress Masie “Happy” Frijo, Rapper Henry “Redcloud” Andrade, Comedy Central Native Comedians like JR Redwater and Mark Yaffee.
The Big Talk
Many times parents are not aware of the risks their teens are taking by being sexually involved with another person. This program focuses on educating parents on the negative consequences and emotional stress that comes with having premarital sex. Often, parents are unaware of the right time or how to speak to their teens about sex. This presentation includes an informational PowerPoint presentation, which helps parents, be more approachable to their teens when it comes to talking about sex. After these sessions each parent is given a copy of the book called “The Big Talk “ which details steps on how to help your child to remain abstinent until marriage. The Big Talk is facilitated from the “Choosing the Best Curriculum” Parent Training Program. The target population for this intervention is all parents with or without teens in their homes or young couples.
Peer Education
“Peer Educating Peers” is an abstinence based peer education curriculum where teens come together and learn about abstinence and sex. This curriculum is used to train teen peer educators in a 6-week, 2-hour program. After completion of the training each teen receives a certificate. As a group these teens will plan an activity to give back to the peers in their community. Each teen receives an incentive in the form of a gift card at the completion of the program. The teens are then expected to give back to their communities by teaching their peers about the dangers of pre-marital sex and participating in community development events.
Research suggests that people are more likely to hear and personalize messages, and thus to change their attitudes and behaviors, if they believe the messenger is similar to them and faces the same concerns and pressures. Numerous studies have demonstrated that their peers influence youth's health behaviors—not only in regard to sexuality but also in regard to violence and substance use. Peer education draws on the credibility that young people have with their peers, leverages the power of role modeling, and provides flexibility in meeting the diverse needs of today's youth. Peer education can support young people in developing positive group norms and in making healthy decisions about sex.
Teen Outreach Program
This program is a school-based program, that uses the “Choosing the Best” Curriculum and the “Game Plan” curriculum. This program is conducted weekly, bi-weekly, or monthly depending on the times allocated by each school. Each student is given a workbook that they use as a resource and to follow as the health educator makes presentations. Teens in schools are given different questions to share with their parents as a way of encouraging communication with their parents on such matters. This program has eight sessions. The program is currently being implemented at the following schools: Noli Indian School, Sherman Indian High School, Banning High School, Barstow Junior High, Barstow High School, Nicolet Middle School, Perris High School, Poloma High School, Ave Macav Indian School, and Hamilton High School.
Program Evaluation
RSBCIHI has experience and capacity to collect and report data. It has over five years of experience and continues to currently participate in Indian Health Service’s Outcome Measurements in compliance with the Government Performance Results Act (GPRA).
Qualitative and quantitative indicators are established for continuous program monitoring and evaluation. Data is routinely collected and analyzed utilizing the RPMS computer network system between all clinics and specialized programs. SPSS is used to analyze data thereby coming up with frequencies, mean, mode, cross-tabulations, multivariate analysis or use Chi-Squares. This enables project implementers to analyze the efficiency and effectiveness of the program on a continuous basis.
Work-plan outcomes are measured by utilizing standardized pre-simulation exposure and post-simulation exposure survey along with other related surveys that are given as a matched pair of questionnaires. These enable the evaluator to measure the occurrence of improvement in knowledge and changes in behaviors and attitudes.
Data is confidentially managed for program use. It is stored in databases that are accessible to authorized personnel who have a password to access it. RSBCIHI has a Management Information Systems department that has experience in data storage, management and confidentiality that also helps in this regard.
Process evaluation occurs regularly throughout the life of the project and answers questions like, “Under what conditions are the prevention efforts conducted?” and “Were the prevention efforts implemented as planned?” This assessment also looks at what happened, how it happened, how much, where, and to whom. Reach, frequency, awareness, and reactions of the target population in the project area. The purpose of process evaluation is to describe how the program is being implemented--who is involved and what problems are being experienced. A process evaluation is always useful for monitoring program implementation; identifying changes to make the program operate as planned with no deviations; and, generally, for program improvement.
Outcome evaluation (sometimes referred to as summative evaluation) assesses whether the outcomes or results of the project are consistent with the desired outcomes. Outcome evaluation asks questions about whether the program worked, and if so, how well and for whom it worked. Interpreting and using the results of an outcome evaluation depends on an understanding of what outcomes the program is or was designed to produce, how the program intended to produce those outcomes (the program logic model), and how well the program was implemented.
Before conducting an outcome evaluation, an evaluability assessment is conducted to determine whether it makes sense, based on the program’s conceptualization and stage of implementation, to evaluate it for results. As part of this assessment the evaluator/evaluation team establishes how the intended users of the evaluation information define success and how this information will affect decisions and policies about the program.
However, where there is a high degree of uncertainty or the decision stakes are particularly high, evaluation users will require proof that the program, over and above other factors, caused the observed outcomes. Impact evaluation is a form of outcome evaluation that uses more rigorous experimental or quasi-experimental designs to assess this cause-effect link, and to estimate the net outcomes attributable to the program intervention. In selecting outcome measures, we ensure that they are indicative of program outcomes as opposed to service delivery outputs, and that they are reliable and valid measures of the outcomes they purport to measure. Examples of program outcomes that we measure include changes to the participants’ beliefs, attitudes, feelings, behaviors, and /or functioning.
Work-plan outcomes are measured by utilizing standardized pre-simulation exposure and post-simulation exposure survey along with other related surveys that are given as a matched pair of questionnaires. These enable the evaluator to measure the occurrence of improvement in knowledge. A cross-sectional quasi-experimental design is used to survey youth who have been exposed to varying extent to the teachings about abstinence until marriage. Both process and outcome evaluation are used to ensure fidelity to the prevention intervention strategies.
Validity and Reliability: The proposed evaluation methods and instruments relative to the target population, in terms of gender, age or culture are supposed to be both valid and reliable. For example, age appropriate surveys are administered in schools and the surveys have already been pre-tested for age appropriateness and understandability. When surveys are consistently used from year to year, they will produce reliable information.