Plain Talk Hablando Claro What Works to Reduce Pregnancy, STDs and HIVAIDs for African American and

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Plain Talk / Hablando ClaroWhat Works to Reduce
Pregnancy, STDs and HIV/AIDs for African American
and Latino Youth

• APHA
• San Francisco, Ca.
• Marcia Bayne Smith and Debra Delgado
• www.aecf.org

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Presentation Objectives

• Provide an overview of the Plain Talk/Hablando
  Claro Initiative
• Discuss evaluation highlights and their
  implications for evidence-based practice.
• Describe replication and dissemination strategies

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What is the Plain Talk/Hablando Claro Initiative?

• 5 million, 4-year Program Demonstration to
  reduce teen pregnancy, STDs and HIV/AIDs
  conducted 1993-1998
• Atlanta, Hartford, New Orleans, San Diego and
  Seattle

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Addressing Culture, Families and ARH
Culture
Parents/Family
Social/Political
Parents/Family
Youth
Neighborhood School FP Services/Programs
Culture
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Parent/Family Engagement Planning Wheel

1 Focus Investment and Intentions
2 Pick Target Audience
6 Use Feedback to Improve
PLANNING FOR POSITIVE PARENT/FAMILY ENGAGMENT
3 Select Program Activities
5 Assess Engagement Program
(Model/approaches Implementation strategy)
4 Implement Engagement Program
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Hablando Claro SobrePlain Talk

• Its about Messages.
• Its about the Messengers.
• Its about the skills, knowledge and comfort
  Messengers need to become effective.

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Data Shaped Plain TalksCore Assumptions

• Large numbers of teens - both boys and girls -
  have sexual intercourse
• Sexually active youth do not view themselves at
  risk for pregnancy, STDs and HIV/AIDs
• Many parents and other adults want to do
  something but lack the confidence, comfort and
  skills to communicate with teens and
• Sexually active youth need access to clinical
  services and comprehensive sexuality education.

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Theory of Change
Create Consensus
Pregnancy and STD rate
Educate Community Adults
Reproductive Health Services
Use of Contraception and STD protection
Effective Communication
Adolescent Knowledge and Attitudes
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We Know Plain Talk Works

• Cross-site evaluation conducted by Public/Private
  Ventures
• Quantitative date collection, including pre and
  post household surveys, site visits, etc.
• Qualitative data collection via ethnographic
  studies and
• Extensive consultation with the sites.

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Evaluation Highlights

• Sexually active youth who spoke with adults
  about topics related to sexuality were half as
  likely to
• have an STD,
• have had or created a pregnancy
• have a child

compared to youth who did not talk with adults.
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Evaluation Highlights

• Increased communication
• Increased levels of talk between adults and
  sexually active youth
• 61 in 1994
• 70 in 1998
• Talkers showed increased knowledge about
  sexuality and birth control
• 2.1 times more likely to know where to get birth
  control in 1998

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Evaluation Highlights

• Increased Access to Reproductive Health Services
  for Teens
• Large numbers of community adults went to
  community education classes.
• Clinic hours increased or improved.
• Two sites opened clinics in the community.
• Increased numbers of young people seen by local
  clinics each week.

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Evaluation Highlights

• Importance of local community context
• Resident involvement in implementation community
  mapping, planning, curriculum development/implemen
  tation, peer education and use of social
  networks.
• Parents and non-related adults can offer
  complementary messages to young people
• What community residents need Skill
  development, clarity about their role.

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The Evaluation Results Informed the
ReplicationAssessment
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Replication Assessment
A program is worthy of replication when it meets
four conditions

• 1. It addresses an important public problem or
  need.
• 2. It achieves positive, measurable results.
• 3. It achieves these results in a timely fashion.
• 4. It can make a convincing case that the
  program, not other factors, caused the results.
• Plain Talk hit the mark on all four conditions.

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Replication Assessment
The assessment focused on RESULTS. The process
identified core elements that

• Were directly connected to the positive
  evaluation results
• Had been implemented in two or more sites and
• Had been successfully implemented in at least two
  sites.

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Blueprint for Success

• Community Mapping Survey of neighborhood-based
  knowledge, attitudes and beliefs of adults and
  adolescents about teens sexual behaviors and
  their access to services and supports
• Walkers and Talkers/Promotoras Adult peer
  educators who can make a difference one person at
  a time and
• Home Health Parties/Vecino-a-Vecino Small group
  learning circles to help adults become askable
  adults.

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What Are Promotoras and Walkers Talkers?
Adult Peer Educators who

• Build awareness of local attitudes, thoughts and
  beliefs about teens sexual behaviors
• Point out the differences between what adults
  want and what young people are doing
• Inform residents about services and supports for
  young people and
• Inform the community about Plain Talk and related
  strategies.

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Characteristics

• Outgoing and friendly
• Known and respected in the community
• Able to motivate others
• Able to read and write
• Able to communicate in a manner that is easily
  understood and
• Able to think fast and grasp new information
  quickly.

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Walkers Talkers/Promotoras Were Pivotal to
Plain Talks Success

• Quantity Sites had a higher degree of success in
  providing adult peer education
• Quality Sites with home health parties were able
  to have more candid, effective conversations

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Lessons Learned from the Evaluation and
Replication Assessment

• WT/P were residents themselves, thus viewed with
  less suspicion
• They had access to more people in the
  neighborhoods
• They led more direct and focused discussions than
  professional health educators and
• They felt they had the responsibility and right
  to challenge other residents with the PT/HC
  messages (moral authority).

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The Role of Staff

• Create a Safe Space to
• help WT/Ps
• Identify their characteristics, values, attitudes
  and traits that will help them to be effective
• Identify relevant personal and professional
  experiences
• Determine gaps in information and learning needs
  and
• Establish a conceptual link between this work and
  their desire to make a difference in their
  community.
• (reference Self-Evaluation Matrix)

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Core Learning Components

• Exploration of attitudes and values about teen
  sexual activity
• Exploration of their family communication
  traditions
• Adult/adolescent communication including
  information about listening skills and
• Adolescent growth and development.

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Core Learning Needs(continued)

• Pregnancy Prevention
• How pregnancy occurs.
• Types of methods available to young people.
• Relative risks associated with the methods.
• Correct use of methods/protection.
• Where and how to obtain contraceptives locally.

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Core Learning Needs(continued)

• Sexually Transmitted Diseases and HIV/AIDs
• What an STD is.
• How HIV and STDs are transmitted.
• How HIV and STDs are prevented.
• Where to go for services.

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Vecino-a-Vecino/Home Health Parties

• Purpose
• To create a safe space and learning environment
  for neighborhood adults
• To increase the number of Askable Adults in
  neighborhoods which consequently leads to
• An increase in the accuracy and frequency of
  adult/adolescent communication about sex,
  protection and contraception.

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Preliminary Activities

• A resident volunteers to host the event
• The WT/P meets w/the host to plan logistics
• Small stipend provided to cover refreshments
• Review paperwork, e.g. sign-in sheets, ground
  rules, etc
• Address emergent questions
• Host recruits 6 to 10 participants

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Lets Party!

• WT/P arrives 30 minutes early to help Host
  prepare.
• When guests arrive, host WT/P introduce
  themselves. Participants also provide
  introductions. (10 minutes)
• Sign-in sheet is distributed (get contact
  information to assist with future outreach).
• Confidentiality sheet is discussed and
  distributed. (10 minutes)

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La Fiesta Continua.

• Icebreaker - should be quick, simple and FUN! -
  10 minutes
• Pre-test question sheet - 5 minutes
• Presentation of community mapping data (flip
  charts and handouts) 30 minutes
• Mini-lecture on selected topic (adult/adolescent
  communication, birth control, STD prevention)
  40 minutes
• Q and A period - 10 minutes
• Post-test question sheet - 10 minutes
• Raffle
• Refreshments
• Total time approximately 2 hours

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Summary CommentsWalkers Talkers and
Promotoras

• WT/Ps have proven to be effective
• They have deeper and more consistent reach into
  the neighborhoods
• They increase service providers capacity to
  conduct outreach and
• They have moral authority.
• They play a dual role
• Ongoing outreach and information sharing
• Front-line support for Home Health/Vecino-a-Vecino
  sessions.

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Program Role...

• Demonstrate authentic commitment, compassion and
  respect for community partners
• Recruit committed, credible and outgoing
  residents and

• Provide strong supports and training.

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The Plain Talk / Hablando Claro Story Continues

• 1st Cohort
• New Orleans State and local funds to adapt model
  for Medicaid enrollment
• San Diego Private foundations supporting
  replication in two new sites
• Atlanta Contracted by DOH to expand Askeable
  Parents

• Sample Replication Activities
• Minneapolis state s to launch community
  mapping
• Wayne County TANF s used to replicate Plain
  Talk in semi-rural area
• Childrens Aid Society Integrated Walkers
  Talkers into its flagship teen pregnancy program

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Replication is More Than Program Duplication.

• Plain Talk is the cornerstone for AECFs
  4-pronged field building strategy
• Improve practice
• Increase knowledge about reproductive health
  behaviors of African American and Latino Youth
• Build Public Will
• Influence policy and shift public resources to
  increase teens access/utilization of
  reproductive health services and comprehensive
  sexuality education.

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Field-Building Investments

• Examples
• Practice CARTA, P/PV, Childrens Aid Society,
  ETR, NOAPPP, PPNYC, National Campaign to Prevent
  Teen Pregnancy, SIECUS
• Knowledge Development Joint Center for
  Political and Economic Studies, UCSF, Girls Inc.
• Build Public Will AGI, Advocates for Youth
• Shift Public and Private Resources Association
  of Maternal and Child Health, Ms Foundation

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Plain Talk / Hablando Claro Resource Materials

• Plain Talk The Story of a Community-Based
  Strategy to Reduce Teen Pregnancy, 1999
• Adult Communication and Teen Sex Changing a
  Community, P/PV, 2001
• The Plain Talk Planning Year Mobilizing
  Communities to Change, P/PV, 1995
• The Plain Talk Implementation Guide, P/PV 2002
• Walking the Plain Talk A Guide for Trainers,
  P/PV, 2003
• www.aecf.org/publications
• ddelgado_at_aecf.org