The School/Community Sexual Risk Reduction Replication program is a comprehensive community-wide strategy for preventing adolescent pregnancy first developed in South Carolina in 1982. The Kansas replication, funded by the Kansas Health Foundation, began in 1993 with four-year grants to three sites: Geary County-with the Fort Riley military base, Franklin County-primarily a rural community, and Wichita-an urban area. The Foundation is currently establishing phase 2 of this initiative with four years of funding to three new sites in the state.
Developed and initially implemented in Bamberg County, South Carolina, the School/Community Sexual Risk Reduction Model (the Model) is based on the hypothesis that the greater the number of important changes in school and community contexts related to reducing adolescent pregnancies, the greater the likelihood of achieving this outcome. The ultimate mission of the initiative is "to improve social and health status in the community through long-term change in environmental factors and personal behavior related to health."
- Reduction of unintended pregnancy among never-married teens and preteens,
- Promotion of abstinence and postponement of the age of first intercourse, and
- Promotion of effective contraceptive use among teens who choose to be sexually active.
The program included components designed to: 1) enhance sexuality education; 2) implement age-appropriate comprehensive K-12 sexuality education; 3) increase access to health services and contraceptives; 4) collaborate with school administrators; 5) use the mass media to increase awareness and involvement; 6) provide peer support and education; 7) provide alternative activities for youth; 8) establish community linkages; and 9) establish programs in religious organizations. It is the combination of these multiple components that is hypothesized to change the environment and impact teen pregnancy.
The Kansas sites replicated the Model, including the program time frame and key components. However, each community defined specific project objectives for reducing pregnancies, increasing abstinence, and increasing contraceptive use by 1996. Evaluation was key to the replication and included both process and impact measures, measuring integrity of the replication and changes in estimated pregnancy rates. Teen pregnancy rates were successfully reduced in both counties and in one zip code in Wichita.
The program director feels that several lessons learned in these sites will be of value in phase 2. Essential to all was the development and support of alliances among community members across a broad spectrum of sectors. A key first step in this process was involving these sectors as partners in the agenda-setting process. In support of this, the leadership of the project on both the lead agency level and the community level was critical. Lead agency staff had to be ready to be vocal and strategic in their agency alliances and in the allocation of resources to support the goals of the project. In addition, both levels had to be ready to make hard decisions in the community and at meetings about strategies, interventions, resources, and the direction of the project.
Each site had an advisory board or steering committee that guided the development of the action plan. The composition of each board was to be as reflective of the community as possible and to include sectors of the community that could be instrumental in meeting the goals and implementing the strategies laid out by the foundation. It was suggested that sites seek out and recruit those in the community who opposed the project. This was particularly important because there was organized opposition to the project in all three communities, primarily in the faith communities and around the issue of access to contraceptives. Questions remain open: who should be involved and how and what expectations for their involvement in the project might be reasonable. Given the importance of its work, the board/steering committee needs orientation and capacity building assistance on expectations, tasks, and the process of implementation.
With regard to community commitment, there is a need for increased evidence of a broad range of sectors involved in the planning and the implementation of the action plan. Often partners who were included in the initial proposal were not at the table when implementation began. In phase 2, Letters of Intent submitted as part of the application process by the partners will help to formally bind all to the project and its implementation. In addition, the action plan, which in the original replication was part of the application, will now be a product of the first quarter of funding and must reflect the inclusion of the broad sectors who committed in the application process.
Evaluation will continue to be a key component of Phase 2. Summative and formative evaluation processes allowed the sites and oversight staff to analyze the effectiveness of the partnership in addressing the needs of its members and in meeting project goals. Satisfaction surveys distributed semi-annually monitored the community collaboration process. These were also helpful in identifying technical assistance and training needs for the sites. The evaluators are in the process of analyzing the data, including behavioral changes associated with sexual activity and contraceptive use and estimated pregnancy rates. They hope to publish their findings in the coming year.
More than 100 documented changes occurred in these communities, creating an environment that is more conducive to addressing teen pregnancy. Curriculum changes and increased access to condoms have become part of the system in some of the communities. All three communities continue the teen pregnancy prevention efforts begun during the replication project, to a greater or lesser extent, depending largely on their success in fundraising. All of the sites are currently in transition, since the replication project ended in the summer of 1997. The extensive evaluation component ended with the replication.
In Geary County, the program is receiving unspent funds from the original Kansas Health Foundation grant and, as a condition of funding, maintains its commitment to the original mandates of the grant. The County Health Department has assumed leadership of the program, with the school district remaining as fiscal agent responsible for management and supervision of the grant. The program has retained the previous staff, including a director, on-site coordinator, administrative assistant, and three interns from Kansas State University. For the most part, programs from the replication project remain intact. They are currently looking for additional funding and considering broadening their scope to youth development.
In Franklin County, teen pregnancy prevention efforts continue among agencies and community-based organizations that were partners in the initial project, which is still known as the Phase Program. Parent education classes, youth groups in the schools, and limited teacher education opportunities are on-going. In addition, Phase Program staff still provide community presentations to promote awareness of teen pregnancy and provide sexuality education information. After-school mentoring, recreation, and employment programs were developed during the demonstration project by Phase staff and other youth serving agencies working collaboratively. These agencies have now taken the lead in supporting and staffing these programs, which continue much as they did before. The Phase staff is working on increasing access to health services provided by the County health clinic. They hope to develop links between the school district and the clinic eventually. Staff are working to increase youth development efforts and to seek out other partners and funding opportunities. They are also considering focusing their efforts on a more targeted population of teens at high risk for pregnancy.
The Wichita City program continues with support from various state and local funding sources, providing youth workshops, teacher education opportunities, health education classes, and after-school programming. The community advisory board, which was an essential element of the initial project, is in the midst of transition, moving toward a membership that can support the teen pregnancy prevention effort with human and material resources. The need for funds has assumed primary importance for this community.