Slide1 :
Musical Introduction Provided by Milwaukee’s youth leaders She had it all in the bag so she
should have been glad
But she was mad and sad and feelin' bad
Thinkin' about the things that she never had
No love, just sex, followed next
with a check and a note
That ‘last night was dope.’
“Let’s Talk About Sex” – Salt-N-Pepa Now Brenda’s belly is getting’ bigger But no one seems ta notice any change in her figure She's 12 years old and she's having a baby In love with tha molester, who’s sexin’ her crazy And yet she thinks that he'll be with her forever And dreams of a world with tha two of them are together,
Whatever
“Brenda’s Got a Baby” – Tupac Shakur
Connections & Disconnections in Adolescent Reproductive Health : Connections & Disconnections in Adolescent Reproductive Health A “Shared-time”
Keynote Address
Steve Bean
Senior Program Manager
ETR Associates
Youth in Charge “It’s Not Over Until We Win”
Wisconsin Teen Pregnancy Prevention Conference
April 12, 2006
Milwaukee Teen Pregnancy Prevention : Milwaukee Teen Pregnancy Prevention
I don’t watch much TV, but I’ve been watching this
one program.
I think it’s an historical look at teen relationships and families in the Milwaulkee area…
Now Playing… : Now Playing… A focus on
interpersonal connections
often within their
societal contexts
is one new direction
in the field of
teen pregnancy
prevention.
The Connection Direction : The Connection Direction Four examples:
Parent-Child Connectedness
Community-driven/Community- level Change (e.g. Plain Talk)
Youth Media Projects
Addressing Structural Racism as a Cause of Health Disparities
My Goal: : My Goal: Inspire you
to investigate these
“new frontiers” in adolescent reproductive health and teen pregnancy prevention.
See if they’re a fit for your work!
Slides available after 4/21:
www.etr.org/recapp
Parent-Child Connectedness (PCC) : Parent-Child Connectedness (PCC)
Parent-Child Connectedness:
A risk & protective factor
that’s not well understood
Over 3 years, the PCC BRIDGE project has:
- Synthesized PCC research literature
- Summarized it for practitioners
- Conducted original research with economically challenged African-American & Latino parents and teens.
- Created two models of PCC
- Developed 5 original PCC intervention activities
The Importance of PCC : The Importance of PCC Unwanted pregnancy, HIV/STDs & sexual risk-taking
(ETR Associates, Social Development Research Group, University of Miami School of Medicine, & the National Longitudinal Study on Adolescent Health)
Alcohol, tobacco & drug use (SAMHSA Model programs)
Delinquency & truancy
(OJJDP Model Programs and the Social Development Research Group)
Gang involvement (OJJDP Model programs)
We call PCC the
“super protector.”
It’s a protective factor
for many outcomes:
PCC Exercise : PCC Exercise Please turn to
someone next
to you and take turns
sharing an answer to the following question(s):
Describe a time
when you were a teen and you
felt a strong connection to a parent or other adult.
What was 1 important thing contributed to creating that connection.
Or, describe a time when you were a teen and an adult did something that damaged their connection with you.
What did they do to damage the connection?
Take three minutes to discuss, then I’ll ask a few
volunteers to share using the audience microphones.
What is Parent-Child Connectedness? : What is Parent-Child Connectedness?
ETR’s Basic Definition:
Parent-Child Connectedness (PCC) is a condition that is characterized by the quality of the emotional bond between parent and child and the degree to which this bond is both mutual and sustained over time.
Operationalizing PCC : Operationalizing PCC How would I know if I were seeing PCC when observing a family?
How does PCC develop in the first place?
What kinds of family interactions establish, maintain or detract from PCC?
Does PCC and the processes that produce it look the same in every family, regardless of race, ethnicity, religion, SES, etc?
Analytical Models of Factors that Determine PCC : Analytical Models of Factors that Determine PCC
Q: How can we systematically analyze a condition like PCC to understand what factors create and influence it?
(The analysis should help us design interventions that will positively impacting these factors.)
A: LOGIC MODELS!
PCC Parent BDI Logic Model : PCC Parent BDI Logic Model
PCC Behaviors Determinants Provide Basic
Physiological Needs 7 potential determinants Build and
Maintain Trust 8 potential determinants Demonstrate Love,
Care & Affection 16 potential determinants Share Activity 15 potential determinants Prevent, Negotiate & Re-
solve Family Conflicts 15 potential determinants Effective Verbal
Communication 29 potential determinants Establish &
Maintain Structure 46 potential determinants (Health) Goal
Operationalizing PCC (continued) : Operationalizing PCC (continued) Connectedness Modeling Communication
(Oral or verbal)
The Bean-Rolleri “Sticky Hypothesis” : Says:
There is a relationship between the condition of connectedness and modeling & messages:
Modeling and messages by parents are more likely to “stick” if there is connectedness. The Bean-Rolleri “Sticky Hypothesis”
Modeling and Messages : Modeling and Messages What is mom modeling and what message is she sending?
Intervention Activity Design : Intervention Activity Design 1) Determinants (risk & protective factors) chosen for their Degree of Influence on PCC, Amenability to Change & Uniqueness to PCC.
2) Respectful of parents’ time: brief – 45 minutes.
3) Stand alone – Parents can miss sessions and activities can be custom “mixed and matched.”
4) Can be used in a wide variety of programs and settings (Some are even self-guided.)
Coming soon?: A PCC Teen BDI Logic Model and more intervention activities. Principles of Design:
PCC Intervention Activities : PCC Intervention Activities 1. Parenting Style & Parent-Child Connectedness – Parts 1 & 2 (45 min. each)
2. Understanding Adolescent Development (45 min.)
3. Responding to Your Teen (45 min.)
4. Connectedness & the “Emotional Bank Account” (45 min.)
5. Positive Reinforcement (45 min.)
6. Active Listening for Emotional
Connection (90 min.)
Community-led, Community-level Change : Community-led, Community-level Change Changing individual
behavior is good.
Changing the
whole context,
or “ecology”
in which behavior
occurs is better.
People can be agents of change within their own social contexts or “ecologies.”
Examples of Ecological Change Efforts : Examples of Ecological Change Efforts Plain Talk
An initiative of the Annie E. Casey Foundation
Replication by Public/Private
Ventures Raising
Healthy
Children
University of Miami School of Medicine Seattle Social Development Project
Social Development Research Group These projects work with family-, school-, neighborhood-
and community contexts, relationships and institutions to create change.
Plain Talk : Plain Talk It is aimed at helping adults, parents and community leaders
communicate effectively with youth
Plain Talk is a neighborhood-based initiative.
This communication is focused on
reducing adolescent sexual risk-taking.
A Little History… : A Little History… Starting in 1993,
Plain Talk was implemented in 5 urban neighborhoods: Mechanicsville in Atlanta, Georgia;
Logan Heights in San Diego, California;
White Center in Seattle, Washington;
St. Thomas in New Orleans, Louisiana &
Stowe Village in Hartford, Connecticut. Today, Plain Talk programs are active in Georgia, Louisiana, California, North Carolina & Minnesota, among other states.
Plain Talk in a Nutshell : Plain Talk in a Nutshell
Plain Talk Results : Plain Talk Results Plain Talk has been found to:
Increase neighborhood awareness about the risks of teen pregnancy, STDs and HIV/AIDS
Improve adult/adolescent communication about responsible decision-making
Increase access to ARH services
Expand neighborhood organizations' capacity to conduct outreach and provide peer adult education
Develops resident leadership and advocacy skills
Plain Talk Results : Plain Talk Results Increasing the # of
“Askable Adults:”
“In the communities where Plain Talk has been implemented the level of talk between adults and sexually active teens increased from 61% to 70% over a four year period.”
-- Plain Talk evaluation finding
Public/Private Ventures
Bringing Plain Talk to Milwaukee : Bringing Plain Talk to Milwaukee Capri-Mara Fillmore, MD, MPH, MSc
Associate Medical Director,
City of Milwaukee Health Department Please welcome
to the podium:
Milwaukee Plain Talk : Milwaukee Plain Talk Midtown
(CDBG 12)
and
Walnut Hill
(neighborhood 125) Target Area
Milwaukee Plain Talk : Milwaukee Plain Talk Involves Multiple Community Partners—
New Concept Self Development is a key partner for mobilizing the community, with the assistance from the many of the community-based organizations of Brighter Future’s Milwaukee Youth and Family Alliance.
Involves Multiple Funders–
Funding received thus far from MHD, DHFS, New Concept,
Milwaukee Public Schools Wellness and Prevention & Brighter Future’s Milwaukee Youth and Family Alliance. We have a proposal for recruiting some of the Mayor’s summer intern high school students. And we will be looking for more funds…
Different from other sites across the nation…
Milwaukee Plain Talk : Milwaukee Plain Talk A grassroots model…
…to help adults develop the skills and tools to communicate effectively with young people about reducing sexual risk-taking.
The City of Milwaukee Health Department (MHD) will lead this initiative in collaboration with the Wisconsin Department of Health and Family Services and several community agencies located within our target area. For information, contact Capri Fillmore,MD at cfillm@milwaukee.gov or David Garcia, MPH at dgarci@milwaukee.gov or Vanessa Key at vanessakey@ncsdc-inc.org
A Milwaukee Plain Talk Steering Committee has been instrumental in bringing this project to fruition since September 2005. For information on this committee and this Initiative, contact Claude Gilmore at gilmoca@dhfs.state.wi.us
Youth Media Projects : Youth Media Projects …to share their
experiences with,
and their answers to,
social problems
…and using social documentation
to become
agents of change. Connecting with
audiences world-wide…
The Big Picture Alliance www.bigpicturealliance.org : The Big Picture Alliance www.bigpicturealliance.org
Teen Aware Youth Media Project on Abstinence www.k12.wa.us/TeenAware/default.aspx : Teen Aware Youth Media Project on Abstinence www.k12.wa.us/TeenAware/default.aspx
KQED Youth Media Corps Teen Pregnancy Campaign www.kqed.org/w/ymc/pregnancy/index.html# : KQED Youth Media Corps Teen Pregnancy Campaign www.kqed.org/w/ymc/pregnancy/index.html#
ScenariosUSA http://scenariosusa.org : ScenariosUSA http://scenariosusa.org
Global Action Project “Youth Making Media” www.global-action.org/main.html : Global Action Project “Youth Making Media” www.global-action.org/main.html
Three Girls In the Heights (2003) : Three Girls In the Heights (2003) Global Action Project “Youth Making Media” www.global-action.org/main.html Running Time: 6 minutes To me this film says that for youth, “connectedness” with friends is
the key to overcoming adversity.
Structural Racism & Health Disparities : The Center for Applied
Research & Technical Assistance
is led by Dr. Barbara Sugland.
CARTA has been looking at
structural racism and its role
in accounting for health disparities.
Much of the work focuses on
adolescent reproductive health disparities. Structural Racism & Health Disparities
www.cartainc.org
Ratio of Teen Birth Rates Non-Whites to Whites: 1990 - 2004 : Ratio of Teen Birth Rates Non-Whites to Whites: 1990 - 2004
Ratio of Teen Chlamydia Rates: Non-Whites to Whites, 1996 – 2004 : Ratio of Teen Chlamydia Rates: Non-Whites to Whites, 1996 – 2004
Slide40 : What Might Account for Disparities? Individual factors
- Knowledge, attitudes, skills
Family factors
- Connectedness, parenting style & monitoring
Parent and family context, e.g.
single parent
non-traditional family structure
- Parent education
Socio-Economic factors
- Poverty
- Access to services
What About Structural Forces? : What About Structural Forces? “Racial differences in individual factors
do not fully account
for greater sexual risk-taking among teens.”*
Research-to-Action Brief:
Structural Racism and Disparities in Adolescent Reproductive Health & Sexual Health *Citations:
Santelli, J.S., Kaiser, J., Hirsch, L., Radosh, A., Simkin, L. & Middlestadt, S. (2004)
Raine, T., Harper, C., Paukku, M., & Darney, P. (2002)
Sugland, B.W., Wilder, K.J., & Chandra, A. (1997)
What About Structural Forces? : What About Structural Forces? “Even when these
[individual, social and economic] factors are considered
(separately and in combination), race/ethnicity often continues to demonstrate an independent effect on teen sexual behavior.”
Research-to-Action Brief:
Structural Racism and Disparities in Adolescent Reproductive Health & Sexual Health
What is “Structural Racism?” : What is “Structural Racism?” Conclusion:
Since there is
no scientific evidence
to support racial distinctions from a biological perspective,*
differential treatment and experience across “race” must be a result of the how our society treats “race” as a
social construct. *Citations:
Marshall, E. (1998)
Kreiger, N., Rowley, D., Herman, A.A., Avery, B., & Phillips, M.T. (1993)
Lillie-Blanton, M. op.cit.
Sugland, B.W., Innocent, M.A., Ross, K.Y., et. al. (unpublished paper)
What is “Structural Racism?” : What is “Structural Racism?” Racial inequality and bias built into the
economic and social structure of a society.
One race/ethnic group afforded a superior position and receives greater political, economic and social rewards than others. (CARTA, 2004)
Mediated - Between individuals
Internalized - Beliefs about self
Institutional - Systemic/Policy embedded
Definition:
Slide45 : Examples of Structural Racism Residential Segregation School
Segregation Racial stigma Job segregation Impacts on community power and assets Impacts on educational achievement Exposure to crime, arrest,
networks & resources Transportation limitations
and inequity public services Adapted from figure by Barbara Reskin at: http://faculty.washington.edu/reskin/ Housing Policies
Lending Policies & Practices Institutional Example
Slide46 : Structural Racism and Teen Sexual Health Intimacy
& Trust
Teen
Sexual Behavior
Critical Elements of
Adolescent Development
- Residential Segregation
- School Segregation
- Occupational Segregation
- Interpersonal Bias
- Negative Media Messages
- Institutional Bias
Structural Racism Identity Industry Sexual Health Protects Impedes
Sexual Health
Outcomes
Heroes wanted: now, as much as ever… : Heroes wanted: now, as much as ever…
Slide48 : Where Do We Begin? Addressing Structural Racism At the individual/organizational level, our ability to change institutional racism is limited
Start by understanding how structural racism affects the youth we serve
Address it as part of our work with youth
Structural racism constitutes a different type of risk factor than the knowledge, attitudes and behaviors we typically deal with professionally
Slide49 : Addressing Structural Racism
Connections and Challenges… : Connections and Challenges… Take home messages:
Congratulate yourselves on a cutting-edge conference that embodies connectedness
There are four new directions for your ARH work that can involve connectedness.
Disconnections in our society pose continuing challenges to our health and well-being
This Power Point presentation will be available at www.etr.org/recapp