A sexual health curriculum that aims to improve knowledge and psychosocial outcomes regarding HIV and STIs and thereby reduce rates of sexual activity, STIs, and pregnancy among youth residing in group homes.
Blueprints: Promising
Healthy Teen Network
P.O. Box 741
Churchville, MD 21028
https://www.healthyteennetwork.org/project/power-through-choices/
Samantha Akers, MSW
Program Manager
(515) 657-2811
sam@healthyteennetwork.org
Healthy Teen Network
Power Through Choices (PTC) is a sexual health curriculum for youth in residential group homes and other out-of-home settings but may also serve broader populations. Over the course of 5 to 10 weeks, participating youth attend ten 90-minute sessions delivered by trained facilitators in groups of 8 to 20. Sessions cover topics such as reproductive health, understanding HIV and STIs, building communication skills around sexual health, and making choices that are in line with long-term goals.
Power Through Choices (PTC) is a sexual health curriculum for youth in residential group homes and other out-of-home settings but may also serve broader populations. Over the course of 5 to 10 weeks, participating youth attend ten 90-minute sessions delivered by trained facilitators in groups of 8 to 20. Sessions cover topics such as reproductive health, understanding HIV and STIs, building communication skills around sexual health, and making choices that are in line with long-term goals. Interactive activities focus on developing and practicing skills that target decision-making, making choices that fit with personal goals, accessing relevant resources, and learning to use appropriate prevention. The specific sessions include:
1 Introduction: Introduce curriculum, assess participants' knowledge regarding pregnancy prevention and sex education, and demonstrate role playing
2 Making Clear Choices: Help participants to build assertiveness and communication skills related to sexual activity
3 Reproductive Health Basics: Increase knowledge of human reproductive anatomy, the process of fertilization and conception, and the menstrual cycle
4 Increasing Contraceptive Knowledge: Increase knowledge about contraceptive methods
5 Understanding STIs and HIV and How to Reduce Your Risk: Increase knowledge and understanding of STI/HIV transmission and prevention
6 Practice Makes Perfect: Discuss the level of risk associated with various sexual behaviors, use role playing to demonstrate the importance of dual methods, and learn condom use skills
7 Using Resources to Support Your Choices: Discuss ways to improve communication about contraception with foster parents, guardians, and group home staff members; learn how to access local sexual and reproductive health resources
8 Making Choices That Fit Your Life: Develop a plan for avoiding unwanted pregnancies and STIs, set short- and long-term goals, identify choices that must be made in order to attain a goal
9 Creating the Future You Want: Identify planning involved in practicing positive sexual behavior, outline some of individual choices in the sexual decision-making process, recognize abstinence as a viable option and choice
10 Plan + Prepare + Practice = POWER: Reinforce themes and messages of the curriculum
Primary Evidence Base for Certification
Study 1
At 12 months post-intervention (Covington et al., 2016; Oman et al., 2018), program participants were significantly less likely to have ever:
Older participants aged 17 and up were significantly less likely to have:
Risk and Protective Factors
Oman et al. (2016), Covington et al. (2016) and Green (2017) found that, compared to the control group at posttest and 12 months post-intervention, youth in the intervention group reported significantly improved
Primary Evidence Base for Certification
The one study Blueprints has reviewed (Study 1) meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The study was done by the developer.
Study 1
Covington et al. (2016) randomly assigned 80 clusters drawn from 44 residential homes in three states to treatment and control conditions. Of the total sample of participating youth who lived in the homes (N = 1,036), 517 were assigned to the treatment group and 519 were assigned to the control group. The treatment group received the PTC intervention while the control group received usual care. Data were collected on sexual knowledge, attitudes, and behaviors at baseline, the end of the intervention, and 6 and 12 months after the intervention end.
Study 1
Covington, R. D., Goesling, B., Tuttle, C. C., Crofton, M., Manlove, J., Oman, R. F., & Vesely, S. (2016). Final Impacts of the POWER Through Choices Program (No. 7f82705427314bb9a7a0e9ceb3c0a7ce). Mathematica Policy Research.
Oman, R. F., Vesely, S. K., Green, J., Clements-Nolle, K., & Lu, M. (2018). Adolescent pregnancy prevention among youths living in group care homes: A cluster randomized controlled trial. American Journal of Public Health, 108(S1), S38-S44.
Individual: Refusal skills
*
Risk/Protective Factor was significantly impacted by the program
See also: Power Through Choices Logic Model (PDF)
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific racial, ethnic, or gender group:
Study 1 (Covington et al., 2016; Green, 2017; Oman et al., 2018) found subgroup effects by using a homogenous sample with 75% or more of males. In addition, Green, 2017; Oman et al., 2018) tested for subgroup effects by race and gender and found equal benefits across groups. Covington et al., 2016) tested for subgroup effects with subsample analyses and found benefits for females but not in comparison to other groups.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
The Study 1 sample was 78.7% male. The participants were 36.6% Hispanic, 23.6% White, 19.5% Black, 13.8% American Indian or Alaska Native, 5.3% Asian or Pacific Islander, and 1.3% unknown.
The Training of Facilitators takes place over 4 days, 3.5 hours per day. Typically, training is delivered virtually, but it may be delivered in-person on a case-by-case basis. [Note that in the evaluation certified by Blueprints, training for facilitators occurred in-person.] Training covers the curriculum; each participant practices delivering a portion of the curriculum and receives feedback on their teaching style as wells as tips for using the content. Training of Facilitators occurs typically twice per year but can also be scheduled upon request.
Key Training Components
Training of Trainers models are determined on a case-by-case basis.
Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.
The Training of Facilitators, typically held virtually, takes place over 4 days with 3.5 hours per day. The cost of virtual training is included with purchase of the curriculum ($1,300). An in-person training may be requested for groups of 12 or more facilitators and would incur additional costs for trainer travel. [Note that in the evaluation certified by Blueprints, training for facilitators occurred in-person.]
Curriculum cost is $1,300.
Included in curriculum purchase.
The recommended group size is 8-20 participants, aged 13-18. Space that holds up to 20 young people must be considered.
One-time purchase of the curriculum manual; additional materials may be printed at any time from the Power Through Choices Hub.
Preface page vi. of the curriculum manual states, "Facilitators should understand agency and state regulations and mandates regarding the teaching of sexuality education and topics that may be deemed sensitive." Power Through Choices recommends that custodial adults and/or key system staff understand and support the curriculum. Building this buy-in is an important administrative consideration.
No information is available
One time training comes with the purchase of the curriculum, eligible for one year. Healthy Teen Network staff can provide technical assistance and support, as needed.
Preface page v. of the curriculum manual covers fidelity guidance and the Power Through Choices Hub offers additional resources to monitor fidelity (included with curriculum purchase).
Not applicable.
No information is available
No information is available
Power Through Choices, as a health education program aimed at preventing HIV and other STIs and unwanted pregnancy, can be funded with prevention and health promotion dollars focused on high-risk adolescents.
To the extent that existing health education and pregnancy prevention programs are not evidence-based, a locality can consider re-directing funds targeted for health education and pregnancy prevention into Power Through Choices to get better outcomes.
State and local health departments as well as city youth development and recreation offices may offer grants supporting pregnancy prevention and the reduction of sexually-transmitted disease.
Entitlement Funds:
Formula Funds:
Discretionary Grants: Discretionary grants opportunities may be found under the CDC Office of Adolescent Health (OAH) grants, as well as the Administration for Children and Families, Family Youth Services Bureau (FYSB). OAH administers the Teen Pregnancy Prevention Program which supports replication of evidence-based TTP programs, of which Power Through Choices is one. The Prevention and Public Health Fund, created by the Affordable Care Act and administered by the Department of Health and Human Services (HHS) is also funding a wide variety of public health and prevention programs.
Foundations, particularly those interested in adolescent health and pregnancy prevention and evidence-based practices, can be considered for training and curriculum purchase dollars.
Healthy Teen NetworkP.O. Box 741Churchville, MD 21028 https://www.healthyteennetwork.org/project/power-through-choices/
A sexual health curriculum that aims to improve knowledge and psychosocial outcomes regarding HIV and STIs and thereby reduce rates of sexual activity, STIs, and pregnancy among youth residing in group homes.
Youth aged 13 to 18 who are involved in either juvenile justice or child welfare and residing in group homes. However, the program is designed to also serve broader populations.
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific racial, ethnic, or gender group:
Study 1 (Covington et al., 2016; Green, 2017; Oman et al., 2018) found subgroup effects by using a homogenous sample with 75% or more of males. In addition, Green, 2017; Oman et al., 2018) tested for subgroup effects by race and gender and found equal benefits across groups. Covington et al., 2016) tested for subgroup effects with subsample analyses and found benefits for females but not in comparison to other groups.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
The Study 1 sample was 78.7% male. The participants were 36.6% Hispanic, 23.6% White, 19.5% Black, 13.8% American Indian or Alaska Native, 5.3% Asian or Pacific Islander, and 1.3% unknown.
Attitudes toward delaying sex, intentions to use protection, sex refusal skills, personal knowledge and self-efficacy, STI and reproductive health knowledge, support for birth control measures
Individual: Refusal skills
*Risk/Protective Factor was significantly impacted by the program
Power Through Choices (PTC) is a sexual health curriculum for youth in residential group homes and other out-of-home settings but may also serve broader populations. Over the course of 5 to 10 weeks, participating youth attend ten 90-minute sessions delivered by trained facilitators in groups of 8 to 20. Sessions cover topics such as reproductive health, understanding HIV and STIs, building communication skills around sexual health, and making choices that are in line with long-term goals.
Power Through Choices (PTC) is a sexual health curriculum for youth in residential group homes and other out-of-home settings but may also serve broader populations. Over the course of 5 to 10 weeks, participating youth attend ten 90-minute sessions delivered by trained facilitators in groups of 8 to 20. Sessions cover topics such as reproductive health, understanding HIV and STIs, building communication skills around sexual health, and making choices that are in line with long-term goals. Interactive activities focus on developing and practicing skills that target decision-making, making choices that fit with personal goals, accessing relevant resources, and learning to use appropriate prevention. The specific sessions include:
1 Introduction: Introduce curriculum, assess participants' knowledge regarding pregnancy prevention and sex education, and demonstrate role playing
2 Making Clear Choices: Help participants to build assertiveness and communication skills related to sexual activity
3 Reproductive Health Basics: Increase knowledge of human reproductive anatomy, the process of fertilization and conception, and the menstrual cycle
4 Increasing Contraceptive Knowledge: Increase knowledge about contraceptive methods
5 Understanding STIs and HIV and How to Reduce Your Risk: Increase knowledge and understanding of STI/HIV transmission and prevention
6 Practice Makes Perfect: Discuss the level of risk associated with various sexual behaviors, use role playing to demonstrate the importance of dual methods, and learn condom use skills
7 Using Resources to Support Your Choices: Discuss ways to improve communication about contraception with foster parents, guardians, and group home staff members; learn how to access local sexual and reproductive health resources
8 Making Choices That Fit Your Life: Develop a plan for avoiding unwanted pregnancies and STIs, set short- and long-term goals, identify choices that must be made in order to attain a goal
9 Creating the Future You Want: Identify planning involved in practicing positive sexual behavior, outline some of individual choices in the sexual decision-making process, recognize abstinence as a viable option and choice
10 Plan + Prepare + Practice = POWER: Reinforce themes and messages of the curriculum
A skills-based intervention focusing on self-empowerment and the impact of personal choices is anticipated to reduce rates of sexual activity and pregnancy among a youth population living in a group home setting.
Primary Evidence Base for Certification
The one study Blueprints has reviewed (Study 1) meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The study was done by the developer.
Study 1
Covington et al. (2016) randomly assigned 80 clusters drawn from 44 residential homes in three states to treatment and control conditions. Of the total sample of participating youth who lived in the homes (N = 1,036), 517 were assigned to the treatment group and 519 were assigned to the control group. The treatment group received the PTC intervention while the control group received usual care. Data were collected on sexual knowledge, attitudes, and behaviors at baseline, the end of the intervention, and 6 and 12 months after the intervention end.
Primary Evidence Base for Certification
Study 1
At posttest and 6-month follow-up, Oman et al. (2016) and Green et al. (2017) found that adolescents in the intervention group reported significantly improved knowledge, attitudes, self-efficacy, and behavioral intentions compared to the control group. Oman et al. (2018) reported a significant decline in sex at three months without birth control.
At 12 months post-intervention and as compared to a control group, Covington et al. (2016) and Oman et al. (2018) found that intervention participants were significantly less likely to have ever been pregnant or gotten someone pregnant. In Covington et al. (2016), older participants aged 17 and above were also significantly less likely to have had sex, had sex without protection over the preceding three months, and been pregnant or gotten someone pregnant over the preceding three months. Also at 12 months, Green et al. (2017) found significantly improved knowledge, ability to locate means of protection, support for methods of protection, and self-efficacy regarding sexual health.
Primary Evidence Base for Certification
Study 1
At 12 months post-intervention (Covington et al., 2016; Oman et al., 2018), program participants were significantly less likely to have ever:
Older participants aged 17 and up were significantly less likely to have:
Risk and Protective Factors
Oman et al. (2016), Covington et al. (2016) and Green (2017) found that, compared to the control group at posttest and 12 months post-intervention, youth in the intervention group reported significantly improved
Study 1 (Oman et al., 2018) reported two significant odds ratios of .72 and .67 for behavioral outcomes, both small in size.
One study meets Blueprints standards for high-quality methods with strong evidence of program impact (i.e., "certified" by Blueprints): Study 1 (Oman et al., 2016, 2018; Covington et al., 2016; Green, 2017). The sample for the study included teenagers aged 13-18 years who had been involved in child welfare or juvenile justice systems and were living in group homes.
Study 1 took place in three states (California, Oklahoma, and Maryland) and compared the treatment group to a services-as-usual control group.
Blueprints: Promising
Healthy Teen Network
P.O. Box 741
Churchville, MD 21028
https://www.healthyteennetwork.org/project/power-through-choices/
Samantha Akers, MSW
Program Manager
(515) 657-2811
sam@healthyteennetwork.org
Certified Covington, R. D., Goesling, B., Tuttle, C. C., Crofton, M., Manlove, J., Oman, R. F., & Vesely, S. (2016). Final Impacts of the POWER Through Choices Program (No. 7f82705427314bb9a7a0e9ceb3c0a7ce). Mathematica Policy Research.
Green, J., Oman, R. F., Lu, M., & Clements-Nolle, K. D. (2017). Long-term improvements in knowledge and psychosocial factors of a teen pregnancy prevention intervention implemented in group homes. Journal of Adolescent Health, 60, 698-705.
Certified
Oman, R. F., Vesely, S. K., Green, J., Clements-Nolle, K., & Lu, M. (2018). Adolescent pregnancy prevention among youths living in group care homes: A cluster randomized controlled trial. American Journal of Public Health, 108(S1), S38-S44.
Oman, R. F., Vesely, S. K., Green, J., Fluhr, J., & Williams, J. (2016). Short-term impact of a teen pregnancy-prevention intervention implemented in group homes. Journal of Adolescent Health, 59(5), 584-591.
Summary
Covington et al. (2016) randomly assigned 80 clusters drawn from 44 residential homes in three states to treatment and control conditions. Of the total sample of participating youth who lived in the homes (N = 1,036), 517 were assigned to the treatment group and 519 were assigned to the control group. The treatment group received the PTC intervention while the control group received usual care. Data were collected on sexual knowledge, attitudes, and behaviors at baseline, the end of the intervention, and 6 and 12 months after the intervention end.
At 12 months post-intervention (Covington et al., 2016; Oman et al., 2018), program participants were significantly less likely to have ever:
Older participants aged 17 and up were significantly less likely to have:
Risk and Protective Factors
Oman et al. (2016), Covington et al. (2016) and Green (2017) found that, compared to the control group at posttest and 12 months post-intervention, youth in the intervention group reported significantly improved
Behavioral intentions about using condoms and/or other methods of birth control (posttest only).
Evaluation Methodology
Design:
Recruitment: The sample was recruited between 2012 and 2014 from teenagers aged 13-18 years and living in eligible group homes serving youths from the child welfare or juvenile justice systems. A total of 1,036 or 1,037 youths from 44 residential homes in California (N = 19), Maryland (N = 10), and Oklahoma (N = 15) were eligible and consented to participate. Homes were included where 80% of youth or a minimum of six youth consented to the study and "if they had the capacity and commitment to support the study."
Assignment: Group homes were the unit of randomization. Homes were re-randomized up to four times if the population of residents turned over completely between implementations. A total of 44 group homes were randomized a total of 80 times and clustered according to location, recruitment date, number of youth served, and gender of youth served. Equal numbers of homes were assigned to the intervention (N = 40) and control groups (N = 40), and the groups contained approximately equal numbers of youth (intervention N = 517, control N = 519). Group homes in the control condition received "usual care," which was not related to reproductive health but could include some educational programs on topics such as healthy eating, for example.
Assessments/Attrition: Assessments occurred at pre-intervention, post-intervention, 6-month, and 12-month follow-ups. A total of 952 (92%) completed the post-intervention survey, 853 (82%) the 6-month follow-up, and 885 (85%) the 12-month follow-up. No clusters were lost.
Sample:
Of the 1,036 participants, about 78.7% were male and the mean age was 16.1. The participants were 36.6% Hispanic, 23.6% White, 19.5% Black, 13.8% American Indian or Alaska Native, 5.3% Asian or Pacific Islander, and 1.3% unknown. The majority (61.3%) of the group homes served both child welfare and juvenile justice youth, 20.5% were contracted to serve juvenile justice youth, and 18.2% were contracted to serve child welfare youth.
Measures:
Measures of behavioral outcomes came from youth self-reports. Covington et al. (2016) measured history of unprotected sex with binary variables for whether participants had ever had sex without effective protection (also in Oman et al., 2018) and whether they had ever had sex without a condom. For sexual activity, a binary variable was included for whether participants reported having sex within the previous three months.
Pregnancy risk was assessed with binary variables for whether the participant had ever been pregnant or gotten someone pregnant (also in Oman et al., 2018) and whether they had been pregnant or gotten someone pregnant within the prior three months.
To determine STI risk, binary variables measured 1) whether the participant reported multiple sex partners in the prior three months, 2) whether they had been tested for STIs over the preceding 12 months, and 3) whether they had been diagnosed with an STI over the preceding 12 months.
Measures of risk and protective factors were used in both Oman et al. (2016) and Green et al. (2017). The measures came from subject self-reports. Constructs in the areas of knowledge, attitudes, self-efficacy, and behavioral intentions regarding sexual activity were created using exploratory factor analysis on a polychoric matrix (using principal component analysis and varimax rotation). Reliabilities for the scales were generally high.
Knowledge was assessed in the areas of Reproductive Anatomy (summed from 4 items), HIV and other STIs (7 items), and Methods of Protection (10 items); attitudes were measured using two constructs, Support for Methods of Protection (created from 6 items) and Barriers to Methods of Protection (5 items); self-efficacy was examined through two constructs, Ability to Communicate with Partner (from 3 items), Plan for Protected Sex and Avoiding Unprotected Sex (3 items), as well as one additional item measuring the ability to find a place in the community to obtain birth control of some kind; finally, three behavioral intentions toward sexual activity were measured, the intention to have sex in the next year, the intention to use a condom in the next year, and the intention to use other forms of birth control in the next year.
Analysis: In Oman et al. (2016), the posttest data were analyzed with generalized linear mixed models to look at the effects of the intervention on both the continuous and dichotomous outcome variables, with time (pre vs. post-intervention) and condition (intervention vs. control) as the within- and between-cluster factors, respectively, and age, race, and gender included as covariates in all models. Time-by-condition terms tested for differences in change across conditions. Random intercepts adjusted for clustering within the units of assignment.
Green et al. (2017) compared treatment and control groups using random intercept logistic regression to adjust for assignment of the 80 clusters. Covariates included age, race, gender, living in the group home at 12 months, and baseline outcome measures.
Covington et al. (2016) used OLS regression with clustered standard errors to adjust for assignment of the 80 clusters. Results were compared against alternative model specifications including logistic regression for binary outcomes, multilevel models to address the nested data structure, and cluster-level analysis. Covariates included age, race, gender, and baseline outcome measures. P-values were adjusted to account for multiple tests.
Oman et al. (2018) used logistic regression with random intercepts. They controlled for the baseline outcome and whether the subject was still living at the group home at the end of the follow-up period.
Intent-to-Treat: In Oman et al. (2016), there was little information given on intent-to-treat, but authors noted that "all available data were used in the analyses." In Green et al. (2017), the authors stated that, by including all randomized group homes in the analysis, they used an intent-to-treat approach. In a CONSORT diagram, Covington et al. (2016) noted that only those not completing the 12-month survey were excluded. Oman et al. (2018) used all randomized subjects in the analysis.
Outcomes
Implementation Fidelity:
To evaluate program fidelity, data collectors observed one randomly selected intervention session per program implementation and completed checklists and attendance records. The implementation rate was 100%, and attendance was marked as 87% overall.
Baseline Equivalence:
Using the analysis sample, Oman et al. (2016) reported no significant group differences at baseline among the demographic or outcome variables. Also using the analysis sample, Covington et al. (2016) reported no significant differences between the treatment and control conditions on six socio-demographic measures and 10 sexual behaviors.
Using the randomized sample, Green et al. (2017) reported no significant differences between the treatment and control conditions on five socio-demographic measures and two sexual behaviors. Also using the randomized sample, Oman et al. (2018) reported no significant differences between treatment and control conditions on three socio-demographic measures and five sexual behaviors.
Differential Attrition:
In Oman et al. (2016), tests for baseline equivalence using the analysis sample gave no evidence of a problem. The same was true of Covington et al. (2016) (see Tables II.2-II.3, pp. 15-16). Further, Oman et al. (2018) stated that there were no significant differences in baseline characteristics between those who completed all assessments and those who did not, though no significance tests were reported.
Covington et al. (2016) in Appendix A showed that non-respondents were significantly more likely than respondents to have ever had sex, have first intercourse at a younger age, and have more lifetime partners, but these differences did not translate into condition differences in the tests for baseline equivalence.
Posttest:
There was a significant positive effect of the intervention on all three knowledge areas, one of the two attitude constructs, all three self-efficacy measures, and two of three behavioral intentions (Oman et al., 2016). Six months after the intervention, knowledge, attitudes, self-efficacy and intention to use birth control had increased significantly more among the intervention than the control group (Green et al., 2017).
Oman et al. (2018) tested for two behavioral outcomes at 6 months. The program significantly reduced having had sex without birth control but did not significantly affect having ever been pregnant.
Long-Term:
At 12 months post intervention and as compared to a control group, Covington et al. (2016) found that intervention participants were significantly less likely to have ever been pregnant or gotten someone pregnant. None of the other seven sexual behavior measures differed significantly between conditions. Oman et al. (2018) tested for two behavioral outcomes at 12 months and found the opposite of the 6-month results: The program significantly reduced having ever been pregnant but did not significantly affect having had sex without birth control.
Subgroup analyses by age lacked direct tests of significance for group differences. However, older participants aged 17 and above were significantly less likely to have had sex, to have had sex without protection over the preceding three months, to have been pregnant or gotten someone pregnant over the preceding three months, and to have ever been pregnant or gotten someone pregnant. There were no effects for younger participants. For two of the outcomes, Oman et al. (2018) noted that there were no significant interactions.
Across all participants and also at 12 months, Green et al. (2017) and Covington et al. (2016) reported positive effects on several risk and protective factors: knowledge of reproductive anatomy and fertility, knowledge of HIV and STIs, ability to locate means of protection, support for methods of protection, and self-efficacy regarding sexual health.