Texas Healthy Adolescent Initiative
July 2009
Program Background
According to the 2007 results from the Youth Risk Behavior Survey (YRBS)
conducted by the Center for Disease Control and Prevention, Texas youth are at
greater risk than youth across the United States to engage in behaviors that
contribute to the leading causes of death, disability, and social problems. The
following are examples of behaviors youth in Texas are at greater risk of
engaging in compared to other youth in the United States:
 using illicit drugs (i.e. cocaine and methamphetamine);
 being offered, sold or given drugs by someone on school property;
 not using protection during sexual intercourse;
 using cigarettes throughout their lifetime, and
 riding with an intoxicated driver.
Texas needs to strategically address these high-risk behaviors by providing
evidence-based comprehensive youth development programs to: increase
healthy decision-making, increase resiliency in youth, delay sexual debut and
decrease risk taking behaviors. The Texas Healthy Adolescent Initiative uses a
comprehensive evidence-based youth development approach to increasing
healthy behaviors and decision making among Texas adolescents by promoting
the development of confidence, competence, connectedness, character, and
contribution.
Research has demonstrated that comprehensive youth development programs
can increase healthy decision-making, delay sexual debut, increase resiliency
and decrease risk taking behaviors in adolescents (University of California, UC
ANR Latina/o Teen Pregnancy Prevention Workgroup, 2004). Research also
suggests a strong relationship between education and career plans and
protection from adolescent pregnancy (University of California, 2004). Young
people who have skills, goals, social support and opportunities to contribute are
less likely to engage in high-risk behaviors than those who lack these skills and
supports. Adolescent health should include not only physical health, but also
the “multiple process that affect the overall well-being of young people and their
capacity to function effectively in everyday life” (Resnick, 2000). Community
support for programs that focus on pro-social behaviors may increase by
focusing on the strengths of adolescents and demonstrating the contribution
youth can make to their community. This “positive youth development”
approach also benefits youth as it includes trusting relationships, emotional
support from outside of the family, opportunities to develop autonomy, and to
experience achievement. It also promotes a sense of hope and being loveable,
which supports growth and maturation in youth.
Although adolescence is the time when youth are creating their own identity and
developing their own self-image, adolescents tend to start conforming to group
activities and group norms. Even though the influence of a pre-adolescent’s
peers is dominant during this age period, children age 12-14 still seek adult
approval and guidelines. They also seek affection and humor from caring
adults as well as the acceptance by their peer group. Youth at this age need
opportunities to explore their independence and gain more responsibility
without added pressure. Effective programs involving family and other caring
adults focus on building and enhancing family or adult relationships and
communication about parental attitudes and values to reduce the likelihood of
risk-taking behavior.
Through funding from the Texas Healthy Adolescent Initiative, local communities
will provide a positive atmosphere for adolescents that will encourage and
enable the development of healthy lifestyles and positive behaviors and
decrease the risk of negative health behaviors through comprehensive
evidence-based youth development services.
Program Content
The primary objective of the Texas Healthy Adolescent Initiative (Texas HAI)
program is to improve the overall health and well-being of Texas adolescents,
10-18 years, and to prepare them with a strong foundation for adult life. The
Texas HAI program provides funding for local community leadership groups to
conduct a local needs assessment and develop a strategic plan for their
community to address adolescent health through a comprehensive youth
development approach.
Following the needs assessment, successful
respondents will develop and implement services following the principles of
youth development to build upon the strengths of young people within each
community.
DSHS will provide guidance and requirements for service
components and strategies that must be included, but implementation and
structure will be unique to each community. The Department will offer funding in
a five-year cycle using Title V Maternal and Child Health funding. The following
is a description of the requirements for each year of the funding cycle.
Year One
The first year will be dedicated to building the infrastructure of a Local
Community Leadership Group (LCLG). This includes establishing membership,
roles, goals and objectives, and strategic direction for a needs assessment and
service development. Activities that must occur in Year One will include:
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conducting a community needs assessment;
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community mapping of services and issues to establish target
areas and service development;
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conducting focus groups or other forums with youth, parents and
community members;
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developing a strategic plan for adolescent health;
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identifying community partners for sustainable funding; and
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developing program services for implementation in Year 2.
LCLGs will be provided resources to conduct the local needs assessment and
gap analysis, assess cultural competency and evaluate the initiative. A process
evaluation will be conducted in year one by DSHS staff on the development of
the LCLG and services.
DSHS will require each LCLG to have membership representation with
expertise in the following areas:
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Adolescent health
Juvenile justice
Adolescent use of alcohol, tobacco and other drugs
City or County government
Adolescent pregnancy prevention
Business
Education
Faith-based services
School Health Advisory Councils
Community Resource Coordination Groups (CRCGs)
Youth development services
Sports/Recreation arena
Adolescent mental health
Adolescent leaders
Parents of adolescents
Respondents must submit with their application signed letters of participation
from potential or existing members of the LCLG that identifies each area of
expertise that qualifies them for membership.
Developing a plan for comprehensive youth development services in the
community is the primary objective of the LCLG in addition to the above listed
activities. LCLGs must use comprehensive youth development principles of the
holistic development of civic, vocational, physical, social/emotional and
intellectual development of adolescents as the foundation for developing
services. Each contractor will be required to develop a plan for services that
must include evidence-based youth development strategies. These strategies
include:
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Involving families
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Strengthening academic skills and opportunities for the youth and
family members
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Strengthening school-to-work programs (specific partnerships with
local businesses for internship possibilities)
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Mentoring programs or opportunities for adolescent-adult
relationships
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Service-learning/community involvement
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Offering referrals to preventive health services, specifically for
adolescent males.
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Health and mental health care referrals or access to care
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Activities that enhance self-esteem.
DSHS staff must approve the service plans developed by the LCLGs prior to
program implementation.
Year 2
The second year will begin program implementation based on the services and
strategic plan developed in Year One. The goal is for the local healthy
adolescent initiative to become an established and prioritized community effort.
Ongoing evaluation of the community initiatives will begin in Year Two and will
continue through Year Five. This will include the examination of youth
outcomes related to risk behavior reduction, resiliency and skill building using a
standardized measurement tool identified by DSHS. Participant satisfaction
data must be gathered in Year Two for continuous program improvement. If
parents are involved in services, satisfaction data must be gathered from
parents as well.
Each LCLG in Year 2 will also develop a healthy adolescent video that will
serve as a public service announcement (PSA). The purpose of the video is to
provide messaging for adolescents by adolescents in the community. The
video may address issues such as violence, sexual risk taking behaviors,
substance use, preventive health care, and more. LCLGs will be required to
include funding in their Year 2 budget for equipment to make the video. LCLGs
are encouraged to create partnerships in Year 1 with local schools or colleges
to help create the video as well as to help in the recruitment of the adolescents
who will help develop the video.
Years 3-5
Years Three through Five will continue program implementation and coalition
activities, specifically resource development for sustainability and coordination
of services. During Years Three, Four, and Five, evaluation and client
satisfaction data will continue to be gathered for examining changes in youth
resilience, and effectiveness of program implementation and modifications.
Each year, DSHS will host an annual grantee conference to continue building
the capacity of the LCLGs. Trainings will include principles of adolescent
health and youth development, coalition building, creating sustainable efforts,
and more. Each respondent must include funding in their budget for one trip to
Austin, Texas for at least three (3) LCLG members for all five years of the
program.
ii. Program Evaluation
The evaluation for this project will be conducted by the DSHS, the Office of
Program Decision Support. All required evaluation forms and survey
instruments will be provided by the DSHS, Office of Program Decision Support.
In the first year, a process evaluation will be conducted to gather information
about the coalition building and program planning process. In the second year,
when direct services begin, the contractor will be required to implement youth
and parent satisfaction survey forms to assess participant satisfaction with the
program and its processes. Outcomes evaluation conducted through the
collection and analysis of data gathered by a standardized instrument provided
by the Department of State Health Services, Office of Program Decision
Support. The standardized instrument may include, but will not be limited to,
measurement of participant perceptions of future orientation, self –esteem,
social connections, and other risk/protective factors. It will be collected at
pretest and posttest.
iii. Program Performance Measurement
Contractor will be responsible for reporting on process measures and outcome
measures.
The process measures for Year One are:
 Formation of the Local Community Leadership Group (LCLG) with
members representing the 15 identified areas (a member may represent
more than one area);
 Completion of community mapping (needs assessment);
 Development of a program development plan including evidencebased youth development strategies;
 Development of a comprehensive adolescent health strategic plan.
The output measures for Years Two – Five are:
 Dissemination of program development plan to local stakeholders,
including youth;
 Dissemination of comprehensive adolescent health strategic plan to
local stakeholders, including youth;
 Identification of target groups in community;
 Number of unduplicated youth served through services developed by
the local LCLG;
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Number of unduplicated parents served through services developed by
the local LCLG (if applicable).
The outcome measures are:
 Percent of youth satisfied with program activities;
 Percent of parents satisfied with initiative/program activities;
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Statistically significant improvement from pretest to posttest in
constructs measured in the standardized instrument (i.e., better self
esteem, participant feels more socially connected, greater resiliency,
greater future orientation, fewer risk behaviors, etc.);
 Percent of participants under age 18 that do not parent a child following
completion of program participation.