Plain Talk / Hablando Claro
What 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
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
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
Addressing Culture, Families and ARH
Culture
Social/Political
Parents/Family
Youth
Neighborhood
School
FP Services/Programs
Parents/Family
Culture
Parent/Family Engagement
Planning Wheel
1
Focus Investment
and Intentions
6
Use Feedback
to Improve
5
Assess
Engagement
Program
2
Pick Target Audience
PLANNING FOR
POSITIVE
PARENT/FAMILY
ENGAGMENT
4
Implement
Engagement Program
3
Select Program
Activities
(Model/approaches
Implementation
strategy)
Hablando Claro Sobre
Plain Talk
• It’s about Messages.
• It’s about the Messengers.
• It’s about the skills, knowledge and
comfort Messengers need to become
effective.
The Plain Talk Model:
A Process for Reducing Adolescent Pregnancy, STDs and HIV/AIDS
Tasks
Phase I:
Initial Start-Up
-Select Lead Agency
-Form Planning Grp
-Community Mapping
-Consensus Building
-Disseminate info
-Plan use of findings
Phase II:
Implementation
-Education
-Skills Building
Phase III:
Institutionalization
-Maintenance
-Sustainability
Activities
Community
Mapping
Strategies
Tactical Use
Of
Data
Objectives
1. Create
Parent / Adult
consensus
2. Influence
skills
Home
Health
Parties
Walkers
&
Talkers
•Resident
Networks
•Adult Education
& Training
•Reinforcing
Key Messages
•Sustaining
Resident
Involvement
Goal
3. Increase
Access
Reduce
Adolescent
Pregnancy,
STDs And
HIV/AIDS
Data Shaped Plain Talk’s
Core 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.
Theory of Change
Create
Consensus
Educate
Community
Adults
Reproductive
Health
Services
Effective
Communication
Adolescent
Knowledge and
Attitudes
Pregnancy and
STD rate
Use of
Contraception
and STD
protection
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.
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.
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
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.
Evaluation Highlights
Importance of local community context
• Resident involvement in implementation:
community mapping, planning, curriculum
development/implementation, 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.
The Evaluation Results
Informed the Replication
Assessment
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.
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.
Blueprint for Success
• Community Mapping: Survey of neighborhoodbased 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”.
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.
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.
Walkers & Talkers/Promotoras Were
Pivotal to Plain Talk’s 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
Lessons Learned from the Evaluation
and Replication Assessment
• W&T/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).
The Role of Staff
Create a Safe Space to
help W&T/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)
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.
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.
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.
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.
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
Let’s 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)
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
Summary Comments:
Walkers & Talkers and Promotoras
• W&T/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.
Program Role...
• Demonstrate authentic commitment,
compassion and respect for community
partners;
• Recruit committed, credible and outgoing
residents; and
• Provide strong supports
and training.
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 semirural area
– Children’s Aid Society:
Integrated Walkers &
Talkers into its
flagship teen
pregnancy program
Replication is More Than Program
Duplication….
Plain Talk is the cornerstone for AECF’s 4pronged 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.
Field-Building Investments
• Examples:
– Practice: CARTA, P/PV, Children’s 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
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@aecf.org