Problem Addressed

• High rates of teenage pregnancy and births: In 2006, 750,000 girls in the United States between the ages of 15 and 19 years became pregnant (equivalent to 71.5 pregnancies per 1,000 girls in that age range),² with the majority of those teenagers giving birth. (The nationwide birth rate for girls ages 15 to 19 years was 41.9 births per 1,000 in 2006.) In New York State in 2004, teenage girls gave birth to 17,323 babies, a rate of 26.9 births per 1,000 teenage girls.³
• Leading to high economic and social costs: Across the United States, the annual cost associated with a child born to a teenage mother averages $1,430; in New York State, these costs are almost six times higher (averaging $6,094 per child).³ Society often ends up bearing these expenses (e.g., for medical care, housing, food, etc.); for example, in 2004, teenage childbearing cost taxpayers just over $9 billion.³ Teenage pregnancy and childbirth also create significant social costs, as teen mothers are more likely to drop out of school, remain unmarried, and live in poverty than females who delay childbearing until after age 20 years.³

Description of the Innovative Activity

• Afterschool or integrated school model: The program serves young people from low-income communities beginning in middle school and continuing through high school graduation and beyond. Services are available between 1 and 4 hours a day, 6 days a week (including Saturdays), 50 weeks per year. In the integrated school model, class time for the program components is provided through advisory and guidance periods, resource time, and other available and/or extended school day hours.
• Education: Educational professionals guide students toward academic success by reviewing past and current test scores with teachers and then creating an individualized academic plan with each student. Students receive daily one-on-one or small group tutoring. This includes homework help, remediation, enrichment with trained teachers, PSAT and SAT preparation, and field trips to colleges. For the in-school model, student's grades and standardized test scores are entered into a program-wide computer system; this database helps to track progress and guide planning and counseling efforts. 
• Employment assistance, with built-in incentives: A weekly "job club" helps students learn about the world of employment and money, including how to complete job applications, interview for a position, explore career options, and open a bank account. Employment staff with bachelor or masters-level degrees and business experience run the job club. Students receive a monthly stipend of $3 for every hour they participate (typically 4 to 5 hours per month) in the job club. The money earned is deposited in accounts set up at "kid-friendly" banks that have relationships with the program. As part of this effort, many teens secure summer or part-time jobs. 
• Family life and sexuality education classes: Masters-level mental health professionals (often with national sexuality association certifications) teach age-appropriate, weekly, holistic sexuality education classes. The classes focus on abstinence, increasing sexual literacy, and how to build healthy relationships. Parents are invited to attend a separate set of classes where they learn to communicate effectively with their children about sexuality issues.
• Self-expression: Teens discover talents and build self-confidence by taking part in weekly self-expression activities, such as music, dance, writing, and drama taught by theater and arts professionals.
• Lifetime sports and physical activities: Students learn self-discipline and impulse control by participating in an individualized sports component in which a fitness professional teaches sports such as golf, squash, swimming, and bowling on a weekly basis at nearby community centers.
• Medical and dental services: Through partnerships with local providers, program participants have access to comprehensive medical/reproductive health and dental services with the parents' consent. This includes free contraception and testing for sexually transmitted infections. Program staff can schedule and accompany teens to their medical appointments. 
• Mental health services: Certified social workers employed by the program lead weekly socialization groups (called "power groups") and provide individual counseling, case-management, and crisis-intervention services as needed.

References/Related Articles

Contact the Innovator

Innovator Disclosures

Results

• Results from afterschool model:
  • Greater knowledge of sexuality: Program participants exhibited greater gains in knowledge about sexuality than did a control group of nonparticipants.
  • Less risky sexual behaviors: Participants were less likely to have sexual intercourse and more likely to use birth control. Among program participants, 15 percent (40 out of 268) reported having vaginal intercourse in the 3 years they participated, compared to 18 percent (45 out of 251) in the control group. Program participants were also more than twice as likely than members of the control group (22 vs. 9 percent) to use birth control (Depo-Provera) during their most recent intercourse.⁴
  • Significantly fewer pregnancies and births: Only 15 percent of program participants (40 out of 268) have ever been pregnant, compared to 25 percent of the control group (63 out of 250). Program participants were only half as likely to have ever given birth (50 percent reduction in births), with 5 percent of participants having done so versus 10 percent of the control group.⁴
  • More primary care, less ED use: During their 3 years in the program, roughly 90 percent of participants received health care services outside of the ED, slightly above the 82 percent in the control group who had done so. Program participants were more likely to use a private physician for medical care to have had a hepatitis B vaccine (83 vs. 77 percent) and to have had a reproductive health appointment (86 vs. 78 percent).⁴ 
  • More academic success: At a 7-year followup with participants from six New York City locations, participants were 30 percent more likely than members of the control group to have graduated high school or obtained a general education diploma or GED (86 vs. 66 percent) and 37 percent more likely to be enrolled in college (63 vs. 46 percent). Participants also had higher PSAT scores and were more likely to have made a college visit (64 vs. 49 percent).⁴
  • Enhanced work readiness: Also at the 7-year followup, roughly 9 in 10 participants (89 percent) had work experience, compared with 77 percent of those in the control group. Participants were also more likely to have bank accounts (59 vs. 32 percent) and use the Internet (81 vs. 75 percent) and e-mail (58 vs. 49 percent).⁴
• Positive feedback from integrated school model: Interviews with principals from four New York City schools suggest that the Integrated School program has led to calmer classrooms, better student behavior, a shift in school culture to focus more on youth development, earlier identification of student needs, faster interventions in crisis situations, better communication with parents, a stronger sense of belonging and school spirit, and increased teaching time.^5,6

Evidence Rating (What is this?)

Context of the Innovation

Planning and Development Process

• Soliciting input from students: The program developer asked teens about their interests, concerns, and life issues to get a better sense of how to effectively help them to prevent pregnancy and to fulfill their goals for a positive and productive future.
• Developing program curriculum: The program developer created a comprehensive curriculum that covers seven components that touch on all aspects of teen's lives, as described earlier. Along with this curriculum, leaders implemented a program philosophy that emphasizes the creation of a gentle, generous, and forgiving environment.
• Raising funds: The program developer raised funds from local and national foundations and corporations and used public funds if available. Partnership sites are responsible for their own fundraising to support ongoing program implementation.
• Hiring and training staff: Program leaders developed a staffing strategy that included hiring credentialed professional staff from diverse backgrounds (e.g., social work, employment, teaching, sports) and training them in how to deliver the seven program components.
• Developing partnerships in the afterschool and in-school environment: The program developed partnerships with schools and community-based organizations in low-income New York City neighborhoods and across the United States. The Children's Aid Society - Carrera has partnered with public and charter schools to implement the Integrated School Model.
• Replicating and evaluating program: To ensure fidelity to the program model, developers designed and implemented a blueprint for the successful launch and maintenance of program replication. Trained staff were sent to help community-based organizations in New York City and across the country to replicate the program. By 2001, the afterschool legacy program had been implemented and evaluated in 12 sites.

Resources Used and Skills Needed

• Staffing: The Children's Aid Society - Carrera employs more than 100 (95 full-time and 20 part-time) staff to deliver the program components at locations in New York City as well as to provide support to partnership sites throughout the United States. Staff include licensed social workers, certified teachers, master's-level family life and sexuality professionals (some certified by national sexuality organizations), business professionals, art and sports professionals, and 10 medical/dental advocates (with a bachelor or master's degree). At the individual site level, program staff are typically hired in May or June and then spend 2 months in training so they can start work in September. Each implementing site also needs a full-time coordinator and community organizer to oversee day-to-day program activities.
• Costs: The legacy afterschool version of the program costs approximately $4,000 per child per year for the first year and an average of $2,500 per year over the course of the entire program (can vary based on a number of factors). The in-school version benefits from economies of scale generated by taking on additional classes of students each year; typical costs for a group of 100 students average between $3,500 and $3,700 for the first year with costs reducing to $2,300 to $2,500 by year 3 and significant declines thereafter.

Funding Sources

Tools and Other Resources

Getting Started with This Innovation

• Identify target community or school with progressive leader: Find a school or community-based organization in a low-income neighborhood where gaps exist between what children have and what they need to thrive. Communities with high teen pregnancy rates and other social challenges will be most likely to benefit. Sponsoring organizations or schools interested in replicating a Children's Aid Society - Carrera program should have leadership that is aligned with the program's philosophy of viewing young people as "at promise" and who recognize that all children thrive in gentle, generous, and forgiving environments. A willingness to adjust hours for program activities is also necessary. If the adopting organization does not have its own source of sustainable funding, consider contacting a local "sponsoring" agency (e.g., as a community center) and help that agency apply for grants to fund the program.
• Launching a Carrera Replication: Those interested in adopting the program should contact the national training center which provides ongoing technical assistance, training, and support needed to launch and maintain the program. Program leaders in the adopting organization spend 6 to 8 months working with the leadership and management team from the national training center to establish a program workplan and timeline that covers the following areas:
  • Hiring and training staff: The sponsoring agency hires its own staff to run the program. National training center personnel travel to the site location to screen potential hires and assist with program launch and implementation. Staff complete 2 months of training led by national training center personnel on the program philosophy and curriculum. The national training center staff continue to provide ongoing fidelity management to all sites.
  • Arranging for medical and dental services and coverage: Work with the national training center to identify and approach local medical providers and/or other community-based organizations to secure access to no cost comprehensive medical and dental services. To the extent possible, raise funds to cover specialty services not covered under typical insurance policies, such as glasses, braces, and skin care.
  • Other preparations: Work with the national training center to develop a plan for recruiting participants, preparing the program site, planning program activities, and evaluating the program's performance over time.
  • Fidelity management/quality control: To ensure fidelity to the program model locally and nationally, Children's Aid Society - Carrera works with partner agencies to deliver ongoing technical assistance, support, and general program oversight from the national training center in New York and/or locally staffed Regional Implementation Centers. This support includes the provision of preservice and ongoing professional development for local program staff. To ensure a seamless professional development process, staff also participate in monthly "maintenance" training and receive supervision and technical assistance from regional implementation managers on an as-needed basis (typically several times a week initially).

Sustaining This Innovation

• For long-term sustainability, consider implementing the program in public domain: Implementing the program in a public or charter school puts the program in the "public domain," thus making it easier to form public-private partnerships and to apply for public subsidies.
• Develop a fundraising and sustainability strategy: To ensure long-term survival of the program, develop a strategy for raising funds and maintaining the program over time.
• Consider benefits of economies of scale: The in-school model may lead to lower per-student costs, because this approach "guarantees" high participation rates, as children take part in the program from 6th grade through high school graduation. 
• Be patient: There are no "quick fixes" to preventing teen pregnancies. Rather, programs must address all major aspects of the teen's lives over a long period of time. Young people need to hear repeated messages—over the course of days, months, and years—about core values, how to take care of themselves, and how to prepare for the future.
• Track and share data on program impact: Monitor outcomes and share evidence documenting the program's positive benefits to potential donors, policy makers, government officials, and other interested stakeholders. Would-be funders will use this information to make funding decisions.

Additional Considerations and Lessons

• As the only initiative in the United States targeting teenage pregnancy that has been fully evaluated and shown to lead to statistically significant improvements, this program has earned "top-tier" designation by the Coalition for Evidence-Based Policy. An evidence summary of the program from the Coalition for Evidence-Based Policy is available at http://toptierevidence.org/wordpress/?page_id=172.

Use By Other Organizations

• The in-school model is currently being used in the following New York City locations: Bronx, Central Harlem, Brooklyn, and Washington Heights. This program is also being replicated in Washington, DC; Flint, MI; Tulsa, OK; and Milwaukee, WI.
• The afterschool program is being used in the following New York City locations: Central Harlem, Queens, Lower East Side, and Bronx. This model is also being replicated in Connecticut; Flint, MI; and Newark, NJ. New Jersey, Delaware, Florida, Georgia, Illinois, Michigan, New Jersey, New York, West Virginia, New Mexico, and Ohio.
• More information on these programs is available at http://stopteenpregnancy.childrensaidsociety.org/about-us.