"The List" and Its Impact

By Andie Lyons, Community Programs Director and Maximizing Success Project Director
May 4, 2016

Last week, Mathematica Policy Research, in collaboration with the Office of Adolescent Health, the Office of the Assistant Secretary for Planning and Evaluation and the Family and Youth Services Bureau, released the most recent findings on effectiveness of Teen Pregnancy Prevention programs. In other words – “The List” has officially been updated!

Since 2010, when President Obama’s newly minted Teen Pregnancy Prevention initiative began requiring teen pregnancy prevention programs to be “proven effective through rigorous evaluation” – ending a 10 year focus on ineffective “Abstinence Only Until Marriage” funding – “The List” has provided guidance to federally funded teen pregnancy prevention programs on which curricula they may implement with those federal dollars. The list has also deeply impacted the broader field of adolescent sexual health education. This update both expands the list – adding 7 programs to the 37 previously reviewed – and, perhaps even more importantly, adds additional research to a number of existing programs. Since the inception of the Evidence Review list, programs have been required to have only a single study showing evidence of impact on one of four sexual risk behaviors. This gave us some information of a program’s impact, but was generally limited to a single population or context. With the addition of new research, we gain additional details about what aspect of a program is impacting behavior, and for whom this program might work best. 

This update is good news! In the most practical sense, it provides many – including Colorado Youth Matter’s Maximizing Success partners – with some new and exciting options to choose from when implementing federally funded curricula. But the update has done more than just add new options, it has also started to add nuance and complexity to a tool that has, historically, been more heavy handed than responsive – giving guidelines without providing much flexibility for individual schools, clinics or organizations. The evidence review report deepens the conversation about how, why and with whom certain programs work. For example, a study of It’s Your Game – Keep it Real, an evidence based program added to the review three years ago, confirmed its effectiveness at impacting sexual risk behaviors but also found that teachers must be both highly qualified and given specialized training and support. While best practice has assumed elements like this are important, additions to the evidence review have provided scientific support for many of our beliefs about what works – and what doesn’t.

The Teen Pregnancy Prevention Evidence Review is an important component in ensuring that sexual health education is rooted in science and effectiveness, shifting the conversation from bias to science. Having a clearly defined list of programs that have been proven to prevent teen pregnancy and reduce rates of sexually transmitted diseases allows schools, clinics and community based organizations to quickly and easily select a program that meets their needs. Setting standards around effectiveness ensures that we rigorously evaluate and continuously improve our efforts.

But the Evidence Review is only one element of robust, responsive youth sexual health education and services, and it comes with limitations. Important bodies of evidence – for example, those about lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth, or economic inequalities and health – are missing from the evidence base. Occasionally, programs that continue to have problematic elements are added to the list as a result of questionable study methodologies. There continues to be a singular focus on pregnancy and disease prevention and individual level change, at the cost of examining the broader spectrum of youth sexual health and the impacts of systematic, structural level impact. And perhaps most tangibly, there are still a limited number of programs to choose from, and sometimes, none of them are an adequate fit for a school, clinic or organization. Colorado Youth Matter supports schools, clinics and community based organizations – including our partners on the Maximizing Success project – to address these deficits through the use of supplemental programs, intensive training, and ongoing capacity building assistance.

This newest update to the Evidence Review includes some really exciting programs – including Positive Prevention Plus and Love Notes – and affirms what we knew about some of the existing curricula, like Teen Outreach Program and Reducing the Risk. Both Positive Prevention Plus and Love Notes have more inclusive lessons and are more closely aligned with Colorado state law and standards. We are most excited, however, about the Office of Adolescent Health’s willingness to work with its partners like Colorado Youth Matter to dig deeper into the complicated and messy business of uncovering what works when it comes to comprehensive sexual health education.