Instrument #1: Discussion Guide for Use with Researchers, Policy Experts, and Macro-Level Coordinators (e.g. State-Level Coordinators)

APPENDIX A

Discussion Guide for Use with Researchers, Policy Experts, and Macro-Level Coordinators (e.g. State-Level Coordinators)

Evaluation of Pregnancy Prevention Approaches (PPA)

Discussion Guide for Use with Researchers, Policy Experts, and Macro-Level Coordinators (e.g. State-Level Coordinators)

[Introduction.] The PPA Evaluation is a new demonstration initiative to rigorously test adolescent pregnancy prevention approaches, including innovative approaches. We are interested in testing a range of strategies, including abstinence-until-marriage education programs, abstinence-based education programs, sex education programs (often called comprehensive sex education programs), HIV/STD education and prevention programs, and others. We will experimentally test a select number of these strategies using random assignment methods; random assignment may be at the individual, classroom, school or other level.

We are beginning an exploratory phase to obtain feedback from program administrators and staff, researchers, policy experts, and school administrators about strategies you believe should be studied, in terms of impact on outcomes related to teen pregnancy (e.g. sexual debut, sexual risk behavior, pregnancy, STD, etc.). The purpose of this discussion is to get your opinion on the most important types of strategies that should be tested around the country as we want this demonstration to test strategies that are of high interest to the field and can effectively prevent teen pregnancy. In addition to any strategies or promising approaches you may know of, please be sure to let us know of existing programs that might be appropriate demonstration sites.

Lastly, please note that your responses will be discussed internally among the research team and the funding agency (the Administration for Children and Families) but that, to the extent allowable by law, individual identifying information will not be disseminated publicly.

Individual(s) Interviewed: (names and titles)

Sponsoring Organization:

Date of Communication:

Module A: General Issues and Priorities

A1. [General Framework] Please provide the general framework by which you view the problem of pregnancy prevention.

Probes: If you were to put the problem of sexual risk behavior and pregnancy among adolescents into a framework, what would that framework look like? What are the primary causes and effects? How do you think of the problem of sexual risk behavior and pregnancy among youth? How do you conceptualize the problem?

A2. [Intervention Points/Approaches] Please indicate the primary points of intervention (i.e. approaches) for preventing pregnancy.

Probes: What are the primary points of intervention, from your perspective? Which are the most critical points of intervention, from your perspective? How would you rank these intervention points, from most to least critical?

A3. [Programs/Strategies] Please describe the programs (or strategies) for targeting these points of intervention.

Probes: Considering your list of critical points of intervention …

1. What strategies do you know of for targeting these intervention points? Please include any strategies you have heard of, especially including those which may be new, innovative, or heretofore untested.

2. Of these strategies, which do you think hold the most promise for reducing sexual risk behavior and pregnancy among adolescents?

A4. [Population Groups] Please describe how these programs may differ for different groups of people.

Probes: (Going back to the framework you first suggested,) do you think the problem of adolescent sexual risk behavior and pregnancy is different for different population groups? If so …

1. Which groups, do you think, are at greater risk? Are there groups that have different risk factors associated (and not necessarily greater or lesser risk)?

2. Why do you think these groups are at greater risk?

3. Are there interventions that would work better for some of these groups than others? Which ones?

A5. [Future Problems and Trends] Please describe any future problems or trends you see in the field of teen pregnancy prevention.

Probes: We are interested in identifying pregnancy prevention strategies that are both important today and will make a sustained contribution for years to come. What trends and issues do you think may impact efforts to improve sexual risk behavior and pregnancy prevention in future years? Are there any emerging issues, trends, or problems you see in the near future? How do you think these trends will impact efforts to combat sexual risk behavior and pregnancy prevention among adolescents?

A6. [Research Needs] Please describe current research needs.

Probes: Given the challenges, intervention points, and strategies we’ve discussed, where do you see the greatest needs for improved information? Which gaps can experimental research best “fill in?” You may have ideas to research what works, as well as what doesn’t work.

A7. [Additional Issues and Priorities] Please tell me about any other issues and priorities that should be noted in the field of teen pregnancy prevention.

Module B: Promising Initiatives

[Introduction.] PPA is assessing a wide range of program strategies as possible bases for this next-generation demonstration. One key requirement is that these strategies hold promise for effectively preventing teen pregnancy. The range of strategies we are considering includes, but is not limited to [Hand list to respondent/send in advance]:

• Abstinence-Until-Marriage Education. These programs educate young people and create an environment within communities that supports teen decisions to postpone sexual activity until marriage. Their exclusive purpose is to teach the social, psychological, and health gains to be realized by abstaining from sexual activity. They do not promote the use of contraceptives. Abstinence education programs typically cover a variety of topics including physical development, reproduction, risk awareness, and relationship skills.

• Abstinence-based Education. These programs place a primary emphasis on abstinence, but do not necessarily emphasize abstinence until marriage. When these programs target older youth, information about contraceptive methods is often provided along with abstinence, as an option to prevent infection and unintended pregnancies.

• Sex Education. The primary goal of these programs, often referred to as comprehensive sex education, is to ensure that youth have the information and skills needed to make decisions about when to initiate sex and protect themselves and their partners from unplanned pregnancies and STDs. These programs often include information on sexuality, personal behavior and decision-making. Information about contraceptives and their use is provided and use of contraceptives to prevent infection and unintended pregnancies is supported. Sexually-active youth may be referred to a school or community clinic for contraceptive or other services.

• STD/HIV Education and Prevention. The primary focus of these programs is the awareness and prevention of STDs and HIV/AIDS infections. Some programs address a broad range of STDs, while others are more narrowly focused on HIV/AIDS. These programs provide information about how the diseases can be transmitted. Depending on the operational environment, programs may stress abstinence as the only sure protection against infection, or may provide a positive message about the role of contraceptives in disease prevention.

B1. [Expanding/Focusing List] Please describe how you would expand or focus this list.

Probes: Considering the list of the types of strategies …

1. Are there any general categories that you think are missing from this list?

2. Are there any general categories that should absolutely be pursued? Any that should not be pursued?

B2. [Identifying Promising Programs/Strategies] Please describe any promising programs/strategies you know of.

Probes: Looking at these strategy types …

1. What approaches or programs are you hearing about or involved with that you see as especially worthwhile considering/implementing? Are there any interventions (within the larger strategies – e.g. program curricula) that seem particularly promising?

2. What kinds of interventions (within the larger strategies – e.g. program curricula) or policies seem to be “hot topics” now—for you and for others concerned about pregnancy prevention (e.g. practitioners, advocates, policymakers, researchers, general public)?

3. How does funding, and funding decisions, affect these programs?

4. When you look around, there are a lot of different possible directions for policies and programs to prevent pregnancy. Please think about some of the policies, programs, or service delivery strategies that you have heard may be promising, but haven’t yet been implemented. What are some of the reasons that they have not yet been implemented? Do you think that they can be surmounted? Is there any information that would be helpful?

B3. [Identifying Outcomes, Research Questions, and Published Research] Please describe the outcomes of these promising practices, and the research questions that could be answered by evaluations of them (or the existing research that already answers these questions).

Probes: Considering promising practices …

1. What do you consider a successful outcome to be? How successful do you think these programs or types of strategies are or might be? Why do you think that? Are there any negative outcomes that are associated with any of these programs, i.e. could any of these programs actually be harmful?

2. What might you like to know that you don’t know now—such as long-term outcomes, or what would have happened without the services, or how to mix services? Are there any particular programs or strategies that you think are interesting, but for which there is currently insufficient information about whether they work well to support a decision to implement them?

3. Are you aware of reports or papers about these programs/strategies? How can I obtain reports or studies of these programs?

B4. [Specifying Programs] Please recommend specific programs we should consider.

Probes: Can you recommend any people we should talk to or programs that we should see that would provide additional information about pregnancy prevention approaches that may be of interest to program administrators and policy makers?

1. Please describe the intervention.

2. What strikes you as the major strengths of this program? Weaknesses or shortcomings?

3. Are you aware of any plans for substantial changes to this program, either in design or scope?

4. Is this program or approach the only one of its kind being used in the area, or are other services or program approaches also operating within the area that have generally similar goals and approaches?

5. Are you aware of localities beyond this one that are operating, or planning to operate, this intervention or a similar intervention?

6. Whom should I contact for additional information about this program or program approach?

B5. [Additional Information about Initiatives] Please provide any additional information pertinent to the area of promising teen pregnancy prevention initiatives.