Guest Blog Post by Sharon Rodine & Janene Fluhr

Research shows youth in foster care and juvenile justice systems are far more likely to become pregnant or get someone pregnant, compared to youth in the general population. System-involved youth have experienced chronic trauma, abuse/neglect, and family dysfunction; may face mental health and substance abuse challenges; and struggle with serious behavioral problems and school failure—all factors found to increase adolescent sexual risk-taking behavior and unintended pregnancy.

To address the sexual health needs of these vulnerable, high risk and underserved youth, Dr. Richard Barth, Marla Becker, and colleagues developed the Power Through Choices curriculum in 1995. The original curriculum was designed with and for youth in foster care out-of-home placements. Participant feedback was positive, but no rigorous evaluation was conducted to document Power Through Choices’ effectiveness.

Rediscovered and Revised

A decade later, the original Power Through Choices curriculum was rediscovered and revised by Janene Fluhr, Shante Fenner, LaDonna Marshall, and Sharon Rodine as part of a CDC-funded teen pregnancy prevention initiative in Oklahoma, called Healthy Teens OK! The revised 2^nd edition of Power Through Choices expanded reproductive health content, updated activities, confirmed medical accuracy, strengthened a trauma-informed and culturally responsive focus, and included supplemental materials for facilitators and front-line agency staff.

Actively engaging young people themselves in shaping the content remained a priority during the revision. Intentionally including the voices of system-involved youth ensured Power Through Choices would be relevant in meeting their specific needs, while also aligning with the realities of today’s child welfare and juvenile justice systems.

In 2010, the Power Through Choices Demonstration and Evaluation Project was selected by the U.S. Health and Human Services (HHS) Administration on Children and Families (ACF) for a Personal Responsibility Education Innovative Strategies (PREIS) grant. Additional project funding was provided by the Evidence-Based Practices Group of the Annie E. Casey Foundation. The overarching goal of the study was to test the efficacy of the newly-revised curriculum in reducing pregnancy among youth, ages 13 to 18, living in both foster care and juvenile justice out-of-home placements.

Rigorous Evaluation

The study was conducted with over 1,000 youth in 44 foster care or juvenile justice intervention sites in California, Maryland, and Oklahoma. All youth participants (both living in the intervention group homes and the control group homes) participated in four surveys at different intervals. The group homes were randomized and received the intervention in ten (90-minute) sessions delivered twice per week over a 5-week period by a team of health educators in settings comfortable for the youth.

Power Through Choices was selected to be part of the Evaluation of Adolescent Pregnancy Prevention Approaches (PPA), a national evaluation funded by the HHS Office of Adolescent Health to study the effectiveness of seven teen pregnancy prevention approaches. The PPA evaluation, led by Mathematica Policy Research, conducted random-assignment studies to provide rigorous evidence about program impacts, document implementation of the program, and generate insights about the successes and challenges of delivering innovative teen pregnancy prevention programs. Dr. Roy Oman and research teams from the University of Oklahoma Health Sciences Center and University of Nevada, Reno, partnered on the evaluation and have published numerous journal articles about Power Through Choices findings.

Documented Evidence of Effectiveness

The Impact Evaluation Report was released in September 2016, with outcome findings documenting strong evidence of effectiveness. Key outcome findings at a 12-month follow-up survey among youth receiving Power Through Choices included:

1. Increased knowledge about reproductive health issues and resources
2. Lower sexual activity rates
3. Less likely to have sex without protection
4. Less likely to be involved in a pregnancy

Two of the most recent academic articles published from Power Through Choices findings are featured in the special Adolescent Pregnancy Prevention Supplement of the American Journal of Public Health (February 2018).

Innovation and Impact Continue

Following the study, the Power Through Choices model was piloted with youth involved with a county Juvenile Bureau, offering a more relevant alternative to the mandated probation program options currently available. Eboni Rhodes, Power Through Choices Project Coordinator, presented a workshop on this new local juvenile bureau model at the HHS teen pregnancy prevention grantee meeting in June 2017.

Janene Fluhr, Power Through Choices Project Director, reflected, “During the research study, we were privileged to witness the impact Power Through Choices had in helping system-involved youth feel empowered and supported to make decisions that strengthened their relationships, improved their reproductive health and assisted them in achieving their goals. Many participants told us stories about how the program had made a significant difference for them. They now believed they had power and choices.”

Following the conclusion of the research project, Power Through Choices was transferred to the Healthy Teen Network to provide training and support for the program as part of their Center for Evidence and Innovation.

To learn about upcoming Power Through Choices trainings, contact Healthy Teen Network.