Families in Our Community United for Success: Community-Building to Support Prevention Program Recruitment and Retention
Susan Bekenstein, MSW, Lake County Health Department/Community Health Center (LCHD/CHC), Waukegan IL
Introduction
Families in Our Community United for Success (FOCUS) is in the process of demonstrating that participants are more likely to abstain from the early onset of sexual behavior and other negative risk behaviors as a result of a wide range of innovative interventions including: 1) in school and after school teen abstinence education; 2) educational sessions and support for parents to become the primary sexual health educators of their children; 3) training, activities, and coaching for parents to increase the quality of the connectedness they experience with their children; 4) youth development experiences and activities; 5) educational and career guidance designed to enhance a positive future orientation; and 6) building a network of participants, and their families, friends, school personnel, and community members who are supportive of healthy teen choices, including abstinence. Interwoven into all interventions is exploration of the role that cultural heritage and values play in personal choices. Interventions are supported by cultural enrichment field trips and service travel designed to broaden participants’ view of the world and their place in it. The FOCUS evaluation seeks to test the extent to which this mix of intervention strategies positively affects: 1) teen participants’ development of knowledge, attitudes and behaviors that support abstinence from sexual activity and other negative risk behaviors, particularly alcohol and drug use; 2) perception of support from family and friends for abstinence; 3) parents becoming the primary sexual health educators for their children; 4) the connection between parents’ involvement in their children’s lives so that bonds and shared values between them are strengthened; and 5) the ability of teens, with support from their families, to set and move to achieve educational, career, personal and family short- and long-term goals.
Methods
Using a quasi-experimental, two-group repeated measures design, FOCUS seeks to provide an objective, well constructed evaluation that will contribute to knowledge about promoting adolescent sexual abstinence and offer information useful for program development and replication. FOCUS is being implemented in North Chicago, population 33,000. It is a low-income Lake County community with the highest rate of births to teens (18.0%)1 compared to 7.0% county-wide. It also accounts for a large concentration of STI diagnoses. Ninety-six percent (96%) of children in the public schools are either African-American or Latino with a rapidly growing immigrant community. North Chicago is the home of a large military installation, which significantly impacts both the tax base and stability of the community as a whole. For example, the public school district has had 19 superintendents in the past 18 years.
A cohort of 180 6th and 7th grade participants and their families will agree to participate in FOCUS services throughout the life of the grant enabling teens and parents to benefit from over four years of consistent services. A comparison group of 250 from a well-matched, local community is being recruited this fall. FOCUS teen participants will respond on an annual basis to several survey instruments that are designed to provide the depth and breadth of measures needed to assess the impact of the multi-faceted interventions. As soon as consents for participation in the evaluation are completed, teen participants are administered the Core Baseline Questionnaire and a supplemental survey on perceived knowledge and attitudes not covered by the Core (tested over 10 years with previous AFL prevention grants). The Core Follow-up Questionnaire will be administered in April-May in subsequent years. In addition to these two surveys, FOCUS participants will also be assessed using the Search Institute’s Developmental Assets Profile (DAP) that will be administered in October-November of each year. When the cohort of FOCUS teen participants move into high school a behavior survey will be administered in the spring of each year. School performance data (grades, attendance, disciplinary actions) will be collected at the close of each semester. Birth records will be reviewed and compared to the roster of FOCUS participants. Surveys designed to measure changes in perceived knowledge and attitude of parents participating in sexuality education or Parent-Child Connectedness training will be developed, tested and implemented, as will follow-up surveys designed to assess changes in long term behavior.
Qualitative information will be collected annually using the “Report Card” format in which both teens and their parents will be asked to provide feedback on satisfaction and perceived value of program participation. Focus groups are planned for Year 05 to glean more in-depth qualitative information about the impact of FOCUS. The FOCUS evaluation team has set an ambitious goal of assessing the impact of the program on the community. Given the size of the community and the multi-faceted approach of FOCUS, being cognizant of the potential for broader community impact at the outset will guide questions posed as the evaluation unfolds.
Results
Recognizing the challenges of recruiting and engaging teens and their families living in North Chicago, staff approached the initial phases of program implementation from a “community building” perspective. FOCUS staff used the early months of the program to reconnect individually with the wide array of organizations and individuals who signed memoranda of agreement or letters of support during grant development. Press releases announced the grant award and staff presented the program to the school board and other organizations within the community. A community kick-off breakfast was held in April 2008.
In an effort to engage potential participants and their families in FOCUS, staff decided to hold a poster contest for 5th and 6th grade students. These students represented the recruitment pool for students who will enter 6th and 7th grade in fall 2008 when school-based services commence. The poster contest also served as a vehicle to inform classroom teachers and other school personnel about FOCUS and involved them in promoting the contest. The theme of the posters was Families in Our Community United for Success and over 150 entries were received. The presentation of the winning posters and their creators and families was made at the kick-off breakfast by the North Chicago Mayor. The FOCUS Kick-off Breakfast was a phenomenal success with over 150 North Chicago stakeholders and residents attending. The poster contest supported the success by bringing poster contest winners and their families to the same table as community stakeholders. Further, sets of the winning poster were framed and placed at City Hall, the
LCHD/CHC North Chicago Clinic, the local library and the school buildings from which participants would be recruited.
Because of all of these “community building” efforts, over 100 families have committed to FOCUS participation to date and all but two have signed consents to be part of the evaluation study. FOCUS staff expects to complete recruitment of the full cohort of 180 6th and 7th grade participants by the end of December 2008. Baseline demographic and survey response will be presented in the poster session. In addition to successful recruitment efforts, 79 teen participants had more than 300 contacts with FOCUS staff through 11 events held over the summer months. Further, two 4-session Parent-Child Connectedness series, presented to 38 parents, were extremely well received. Additionally, 14 parents attended two “Ready or Not” training sessions designed to help them become the primary sexual health educators for their children.
Discussion
North Chicago, for the reasons described above, consistently has been a difficult community in which to provide sustained prevention programming that engages both teens and parents. It is a community in which even the most dedicated advocates express skepticism about the willingness of families to engage in services. On the other hand, the LCHD/CHC has had a continuous presence in the community through a locally-based primary care clinic and limited school-based services addressing pregnancy prevention/abstinence education, as well as services to pregnant and parenting teens. The overwhelmingly positive response to the FOCUS program at all levels of the community suggests a readiness among many residents to look for solutions to the longstanding problems of teen births and other negative outcomes for North Chicago’s youth. It also suggests that the LCHD/CHC has built trust in North Chicago that has opened doors that have been closed to other services providers.
Implications
It is too early in the implementation of FOCUS to draw any serious conclusions about outcomes of the program on individuals or the community as a whole. However, the results to date support the “community building” approach that the FOCUS staff chose to emphasize early in implementation, leading to strengthened relationships with stakeholders and residents throughout North Chicago. It also supports the early broadly-based engagement strategy (the poster contest) to inform and involve potential participants, their families, teachers, other community members and the media about FOCUS. Finally, the early, very positive reception of the Parent-Child Connectedness curriculum shows great promise as a means to equip parents living in a challenging child-raising environment with practical, usable tools to develop/enhance positive and deep bonds with their children.
Contact Information:
Susan Bekenstein, MSW
Program Coordinator, Community Health Services
Lake County Health Department/Community Health Center
3010 Grand Aveue, Waukegan, Illinois 60085
847-377-8188
sbekenstein@co.lake.il.us1 Illinois Department of Public Health, Vital Statistics, 2006 (the most recent year available).
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