On April 8, 2003, Lynda Bell from Cornerstone Consulting and Mary Martha Wilson from NOAPP joined moderator Lori Rolleri from ETR for ReCAPP's forum on service learning as an approach to teen pregnancy prevention. One hundred and forty two participants from across the United States, Canada and as far away as Uganda joined the forum and shared information, resources and common concerns and questions regarding service learning as it relates to the Teen Outreach Program (TOP).

Co-moderator Mary Martha Wilson, Acting Co-Director at NOAPP in Washington DC, opened the forum by noting how pleased NOAPP is to be partnering with ETR and the CDC on developing resources that promote science-based interventions to prevent pregnancies, STIs and HIV among adolescents.

Co-moderator Lynda Bell, with Cornerstone Consulting, introduced herself as the national coordinator of the Teen Outreach Program (TOP) National Replication and Dissemination Project which was featured in the forum.

The forum covered service learning in general and the TOP program in particular. It also explored general issues about evaluation, resources and implementation problems, concerns and recommendations. The three moderators fielded questions and offered advice on the following topics:

• What is service learning?
• The link between service learning and the reduction of sexual risk taking
• The importance of reflection in Service Learning
• Evaluation
  
  
• What is the Teen Outreach Program (TOP)?
• Is TOP an abstinence-plus program?



• Implementing TOP
• Cost
• Transport
• Staffing
• Community support
• Potential problems
• Second pregnancies
• Hispanic youth
• Examples of other peer education projects, and
• Successful community service projects



• Resources & community support

In response to several questions regarding service learning and its value as an approach to teen pregnancy prevention, co-moderator Lynda Bell quoted Cornerstone Consulting's Community Service Learning Guide:

"Service Learning is a method of teaching and learning that connects meaningful community service with academic learning, personal growth and civic responsibility. Although the origin of the term is unknown, it is predicated on the belief 'that there is something uniquely powerful about the combination of service and learning, that there is something fundamentally more dynamic in the integration of the two than in either alone."
(Kendall, Jane C. and Associates, Combining Service and Learning: A Resource Book for Community and Public Service, Raleigh, North Carolina, National Society and Internships and Experiential Education, 1990.)

Co-moderator Lori Rolleri asked Ms. Bell to distinguish between service learning and community service. Ms. Bell said that the distinction is one of the reasons Cornerstone Consulting has always made a point of emphasizing that TOP has three, not two, components as many people have wanted to describe it. They do so because too often they see programs where young people are doing service work, but there is no "learning" component — no follow through via a reflective piece to help youth authentically assess their own learning.

On the other hand, they've seen programs where youth learn about a specific topic, i.e., child care, elder care, but never perform one hour of service. In TOP, youth must engage in active service — be it of a direct, indirect or civic action nature. Through service learning, they have to prepare for and reflect upon that experience.

Ms. Rolleri shared some points about "lessons learned" from a service learning project ETR implemented in California:

1. Students should be involved in the selection of the project.
2. The service learning project should provide youth with an opportunity to make a real contribution to the community.
3. Service learning projects should have a buy-in from adults (parents, teachers, community leaders, service recipients, etc.).
4. A successful service learning project must include structured time for reflection on the experience, constitutions made, and skills gained.
5. The service should run at least 20 hours.

Ms. Bell noted that TOP sees service learning as the overarching teaching and learning tool that encompasses "community service" in its action phase. She described TOP's service learning process as Planning, Action, Reflection and Celebration (PARC).

Ms. Rolleri noted, at the conclusion of the forum, that service learning is an innovative approach that she thinks more practitioners in the field of adolescent pregnancy prevention should consider. The opportunity for connection, confidence and skill building, and motivation to make positive future plans are valuable protective factors that are strengthened through the approach.

A participant who has worked in the field of teen pregnancy prevention for years asked the moderators for the theory linking service learning with reduced sexual risk-taking among youth. Co-moderator Lori Rolleri provided some possible reasons that have surfaced in the literature about why service learning works to reduce teen pregnancy:

• A service learning project provides youth with hours of supervised alternative activities. TOP participants spend an average of 46 hours doing service, which equates to time not spent on possible risk-taking opportunities.



• Service learning projects allow for an on-going relationship with caring facilitators who may also serve as mentors, role models, and advisors. There is clear evidence that connection to positive adult role models is a strong protective factor in the prevention of a variety of adolescent health outcomes.



• Service learning projects give youth an opportunity to make a difference in the lives of others as well as foster a sense of competence and self-efficacy in youth. This may also serve as a protective factor.



• Service leaning activities give youth an opportunity to think about their futures and motivate youth to delay parenthood.



• Service learning projects often require the development and practice of life skills that are also helpful in negotiating personal relationships.

The combination of service and learning seems to help youth feel valued and increases their life options. Because school success is a basic indicator that youth are avoiding risky behavior, service learning is viewed as an intervention for teen pregnancy and other negative behaviors.

Co-moderator Lynda Bell noted that reflection is and should be happening in all phases of service learning. As one says in the field, "Reflection is the Key to Service Learning." The beauty of reflection is that it can and should occur both naturally as well as part of a planned session or seminar. Informal reflection is part of a "teachable moment." A young person raises a question about some aspect of the project and the inquiry is taken seriously and addressed as well as one can at the moment. But there needs to be a designated time when youth and their adult leaders can "check in" on the process of learning that is being facilitated by the service experience.

In planning, we want to know why we're doing the project, what exactly will happen, who will do what, what training or additional support might be needed to help youth do the best job possible.

In the action phase, youth need to be able to talk about and address issues and challenges that arise, hone developing skills, or rework their plan. As the project comes to an end, they want to explore what they might have done differently, what they learned and what else (or more) they might want to do.

There is a basic format to a reflection seminar and key strategies that can be used to facilitate this process, aside from the activities themselves. The format of a seminar is: Restating the project goal, setting a seminar objective, allowing for various forms of reflection (role playing, journal writing, presentations), using guiding questions to keep youth on task, and using techniques to connect school and service learning.

The strategies used in activities designed to help youth reflect should be learner-centered. Using open-ended questions to have youth share their thoughts in journals or open discussion, giving them options of creating visual, oral and artistic presentations and having them use cognitive organizers to demonstrate what and how they used the skills they learn in school (reading, math, writing) during the service project.

A participant who is interested in encouraging participating schools and agencies in his district to move toward service-learning asked for assistance in formulating broad, general questions to use as part of the reflection piece after the service that would allow them to move their activities in a service-learning direction. Ms. Bell provided the following examples of open-ended questions used in reflection:

1. If I had to choose whether to do this project again, I would choose ________________ because _____________________.



2. If I were planning this project again, one thing I would do differently is___________________.



3. What I learned most from doing this project was ____________________.



4. For me personally, the hardest part of doing this project was _______________________.



5. For me personally, the most rewarding thing about doing this project was ___________________.



6. One new thing I've learned in this program is ________________________.



7. Something I can do now that I couldn't do before _______________________.

Several participants asked about evaluating service learning and how best to measure success in maintaining behaviors learned or committed to during the service learning. Katrina Hammer from Free-to-Be based out of Santa Rosa, California responded that her program uses an evaluator based in Sonoma County, California called "The Christopher Group." They have the teens in their program fill out a survey both before and after their presentations (pre- and post-test).

Co-moderator Lynda Bell also directed participants hoping to evaluate their programs to the potential outcomes that her fellow moderator Lori Rolleri identified in an earlier response: increased hours of adult supervision and increased number of positive relationships with adults in the community.

Ms. Bell described the formal evaluation that was done by Philliber Research Associates of TOP sites in 1981. Using control and comparison groups, outcomes were consistently positive for TOP youth in the areas of academic success (school suspension, failures and dropout) and pregnancy prevention over the next several years.

In 1996, Drs. Joseph Allen, Univ. of VA and Susan Philliber undertook a study on TOP using random assignment to determine the correlation between the program and participant outcomes. That study, "Preventing Teen Pregnancy and Academic Failure: Experimental Evaluation of a Developmentally-based Approach" (see Cornerstone web site to view it in its entirety) has been cited in several national publications as the definitive piece on the program's success in preventing teen pregnancy.

In response to a request from co-moderator Lori Rolleri for more information about the evaluation, Ms. Bell explained that the TOP evaluation was mandatory for all participating sponsors from 1981 to 1985. The evaluation model used control and comparison groups. Control groups got TOP, comparison groups did not. All groups completed an entry and exit survey designed to measure changes in behavior around school success (failure, suspension, dropout) and pregnancy prevention.

The evaluation covered the one-year period of participation, with the survey at entry capturing behavior in the aforementioned areas for the year prior to TOP and at exit for the year of enrollment in TOP. During this period, site level data from 66 programs around the country was collected on more than 2,000 participants. Ms. Bell pointed out that the Association of Junior Leagues International managed the program during this period and replication was basically within the network's affiliate communities.

Cornerstone has been managing TOP since 1995 and the program has grown to over 12,000 participants. Although Cornerstone does not implement the national evaluation requirement, they do require official TOP sponsors to have an evaluation component in place — their own or PRA's which is created specifically for program level assessment.

As noted earlier, the most current evaluation was conducted by Drs. Joseph Allen (Univ. of VA) and Susan Philliber (PRA) in 1996. This evaluation of a select number of sites used random assignment. For results of the 12-year evaluation outcomes and the more recent work, participants were encouraged to visit Cornerstone's web site at www.cornerstone.to.

In response to queries from several participants regarding TOP's success as a teen pregnancy prevention strategy, co-moderator Lynda Bell explained that TOP has three main components:

1. Classroom/Group Discussion — guided by the Changing Scenes curriculum, young people ages 12-17 are engaged in an open discussion format on topics of interest to them. A trained adult facilitator leads these discussions in which young people have a chance to connect what they already know with new learning around values, relationships, sexuality and life skills.



2. Community Service — young people are required to perform 20 hrs of service in the "community" of their choice on projects they have selected and planned.



3. Service Learning — through informal and formal reflection, youth get to make connections across "school learning," learning acquired through the community experience, and their own personal growth and development facilitated via the TOP "classroom" discussion.

Ms. Bell noted that TOP's principles and their key elements, which are embedded in the program components, are a recipe for success. TOP's "pillars" are:

• Youth Development — focusing on youth as assets and resources, giving them opportunities to discover their own interests, skills and talents



• Community Involvement — helping youth reconnect with their communities through service while simultaneously enlisting diverse stakeholders across the community in the implementation processes of the program



• Learner Centered Education — understanding the developmental needs of young people at various stages of their development, and



• Academic Extensions — using the power of service learning to make school meaningful and applicable to the "here and now" lives of young people.

One participant, after noting that he considers TOP to be the most cost-effective primary prevention program available in the United States, asked if TOP is considered an abstinence-plus program. He also asked if TOP has been adapted for schools/groups/communities that will only consider or implement abstinence-only programs and if the favorable evaluations of TOP have been of the abstinence-plus version.

Co-moderator Lynda Bell responded that TOP is an abstinence plus program, but it has been used in several communities where the "social climate" requires abstinence only programs. The 1996 study revealed that at least one-third of the sites evaluated elected not to use the four to five sexuality lessons found in each level of the curriculum. Participants in these programs did equally as well as those in programs that did use these lessons. These results have helped Cornerstone to always frame the program as a youth development approach that has had proven success in increasing school success and preventing teen pregnancy.

The evidence seems to suggest that service is the intervention in TOP. As such, Ms. Bell explained, TOP sells in a lot more places and in the end, that's the point — to get more youth exposed to something that works.

Co-moderator Lori Rolleri asked fellow moderator Lynda Bell to distinguish between TOP's service learning and community service component. Ms. Bell responded by saying that service learning is the overarching teaching and learning tool that encompasses "community service" in its action phase.

Ms. Rolleri also asked if there are any program models where service learning and peer education are combined to which Ms. Bell responded that peer learning in TOP is most popular among older high school youth (10th-12th graders). Youth have created service directories focused on the needs of older adolescents, sponsored health and job fairs, and started their own radio talk shows featuring topics of interest to their peers. Coming from a youth development approach, these peer-to-peer learning opportunities address the diverse and varied needs of this age group.

Those participants who have not yet implemented TOP in their communities asked about the cost of doing so. Co-moderator Lynda Bell replied that Cornerstone Consulting's research estimates the cost at between $100-$600 per participant, per program year. The range is reflective of how program sponsors chose to design and implement their local models — TOP as a stand alone vs. TOP as an enhancement and/or part of something larger.

Ms. Bell went on to explain that the latter is at the high end of the spectrum and includes budgetary concerns of staffing, facilities, transportation and service project-related costs, while the former is at the lower end with the above costs partially or fully covered as part of existing budgets and in-kind resources.

Follow-up questions were asked about the cost of a TOP training and whether there are any restrictions placed on where, when or with whom the person who is trained can conduct training on TOP. Ms. Bell replied that one has to talk about training and technical assistance together. There are several options, depending on the needs, resources and capacity of local sponsors. Cornerstone Consulting can do a full package of training and TA that take a community from startup to follow-through. This includes everything from helping a community identify stakeholders and partners in the early stages and conducting workshops to get everybody on board.

The next step would be an implementation training that prepares direct service staff to deliver the program components. The final stage could and often does involve additional mini seminars to address site-specific issues and make "house calls" to work one-on-one with providers. This package is priced on a site-by-site basis.

For communities using TOP as part of something larger, implementation training is usually what is needed. The base cost of this training is $8,000 for a group of 10 (minimum) to 20 (maximum) participants. Program resources are ordered separately, allowing sponsors to pick and choose from Cornerstone's menu (curriculum package, operations manual, service handbook) based on their local design. A technical assistance (TA) contract can be added to either the startup or follow-through phase for an additional contractual fee.

The Training of Trainers is an invitation only event for sponsors with at least one year's experience doing TOP. Facilitators are transformed into certified trainers capable of training others in the TOP approach. These trainers may use their certification to train within their respective state only. The cost of this bi-annual event is $695 per person, which includes needed resources to conduct the training.

A participant asked others to comment on the cost of transportation for non-school activities and asked whether other programs have included transportation costs in their budgets and if they have any other creative solutions to this barrier.

Co-moderator Lynda Bell replied that many sites have been able to make transportation a "non issue" by helping youth identify service projects within close proximity to the school. For example, in school cluster communities, middle school youth can walk to the elementary school to serve as "buddies" for younger children needing help and support. The same holds true for high school students as "helpers" of middle schoolers. She noted, however, that where resources are sufficient, either monetary or in-kind, sponsors build transportation cost into their budgets to allow for the 20 minimum hours of service required.

Katrina Hammer, the Peer Program Supervisor at Free-to-Be, responded that her program handles transportation by requiring the participating children's parents to sign permission forms allowing Free-to-Be to drive them around. Free-to-Be staff logs the number of miles they drive and is reimbursed .32 per mile.

A participant from South Carolina who is planning to implement TOP in collaboration with the local school district and the local hospital system asked how many groups/classes (or number of students) they can realistically expect to reach at each site. Co-moderator Lori Rolleri replied that the interactive nature inherent in TOP components makes the "ideal" group size 5-17 youth. This makes (again) the "ideal" ratio of the two direct service positions, i.e., classroom/group facilitator and community service coordinator to youth 1:15, or 1:17.

Ms. Hammer, Peer Program Supervisor at Free-to-Be, replied that her program teaches and trains children to talk about their decision of sexual abstinence, and they have published curriculum that is presented by their trained staff in local high schools and junior high schools. She noted that 10 children per youth leader works the most efficiently, but that partly depends on whether the children are all well-mannered or not.

A participant from Canada solicited suggestions on garnering community support for the teen pregnancy prevention coalition they recently implemented. Co-moderator Mary Martha Wilson responded that NOAPPP organizes an annual Coalition Directory, listing local, regional and state groups focused on building community support for teen pregnancy prevention and parenting issues. Each coalition has faced their share of "what can we do?" questions that can help galvanize interest from diverse groups in these issues.

Ms. Wilson suggested contacting Leslie Thompson at NOAPPP (lthompson@noappp.org) for the directory, which will, in turn, provide links to coalitions all over the United States. She also suggested checking with local health departments and teen health clinics for Canadian resources.

Lisa Fletcher-Udel, a Coalition Coordinator for an area that includes 32 cities and towns, stated that it is no easy task to convene folks and get them involved and interested in taking action. She noted that her organization, Berkshire Coalition to Prevent Teen Pregnancy, has had success at open forum coalition meetings that have a topic and presenter and offer an opportunity for attendees to participate in the discussion.

It also helps to frame the discussion around "best practices" in teen pregnancy prevention. Otherwise, community-based attendees will offer "solutions" that we know from the research do not work. Ms. Wilson agreed with that advice, noting that there are so many coalition models out there, with a HUGE variety of activities, and there can also be steep cycles of interest, apathy, etc. Connecting with other coalition leaders can be a real life-saver and a source of wonderful ideas and resources.

Co-moderator Lori Rolleri, following up on the suggestion of utilizing "best practices," recommended two sources for information about science-based pregnancy prevention programs in the US. (These are listed below under Resources). Co-moderator Lynda Bell added that use of such resources is helpful not only from the community engagement perspective but also as a means of enlightening the youth services field about how to attract needed resources for their programs. The new deal is that people go with what's been proven to work.

In response to a participant's query about potential problems implementing TOP, co-moderator Lynda Bell said that she doesn't foresee barriers as much as the challenge of keeping middle schoolers engaged in such a project over time.

This does not mean that there is not work to be done. Sites will need to help older students prepare to work with younger children in the planning phase of the project by engaging them in activities and providing them with information that helps them understand the needs and characteristics of younger children, examine their own view and perceptions and reflect on what they were like as younger children.

Once the project progresses, Ms. Bell suggests seeing where the students want to take the project beyond just tutoring. She also recommended that adults have a "canned" project to get younger adolescents started in the service experience, but that they ultimately need to be part of the decision making process that identifies and shapes the service experience.

Several participants asked about TOP's and other programs' success in preventing second pregnancies in teens. In response, co-moderator Lynda Bell noted that a recent study by Dr. Allen (Univ. VA), "Who Benefits Most From a Broadly Targeted Prevention Program?: Differential Efficacy Across Population in the Teen Outreach Program," shares results around Dr. Allen's hypothesis that "the developmental focus of a broadly-targeted intervention would lead it to have greater program efficacy among those young people who began the program at greatest risk." The study suggests that TOP is most effective with teen parents in delaying an unwanted second pregnancy. A copy of this study can be obtained by contacting Gayle Waden in Cornerstone's Houston office at gwaden@cornerstone.to.

Co-moderator Lori Rolleri added that the National Campaign to Prevent Teen Pregnancy is currently working on a report on this issue. The author of the report is Lorraine Klerman, and more information is available by calling the Campaign's Publishing Department at 202-478-8566 or visiting the Campaign's web site at www.teenpregnancy.org

Carol Sullivan from GRADS in New Mexico, a program for pregnant and parenting teens, stated that their repeat pregnancy rate stays at 4-6% which is significantly lower than most programs like it, as confirmed by Philliber and Associates over a three-year study period. Case management of these youth and involving them in peer leadership and service learning experiences play a big role in this success.

Ms. Bell added that there are several sponsors that use TOP across mixed audiences (they have one program in-school/after school, one community-based program, one for specially targeted populations, i.e., youth involved with juvenile justice system, youth in group homes) and that she knows of one sponsor in the LA area that was using TOP with teen moms.

A lot of interest was expressed in learning how TOP has been implemented with Hispanic youth, specifically whether the program is simply translated into Spanish or whether there are any changes made to meet the cultural differences of Hispanic youth.

Co-moderator Lynda Bell replied that TOP en Español (TOP-E), the California and Mexico-tested project, was a full cultural and linguistic translation endeavor. Areas that required changes are standard areas of variation in cultural competence. Health beliefs, family relationships, sexuality, gender roles and religion were closely examined in taking the curriculum from its English (Western culture) to its Spanish (primarily Mexican) version. The underlying issues regarding level of acculturation and immigration status were also considered.

Cornerstone found that the less acculturated both adults and youth were to Western culture, the better the program. TOP-E was noticeably more successful in Mexico than in urban Los Angeles.

Co-moderator Lori Rolleri and several participants asked a series of follow-up questions focused on adapting the curriculum to cultural differences rather than simply translating the materials into Spanish. In response, Ms. Bell noted that the issues she recalls requiring the most cultural sensitivity were sexuality and communications.

While trying to help youth "find their voice" through TOP's assertiveness activity, it was a challenge to measure the right words to convey the "rights" of young people to ask for what they need and want and to refuse a request that is not in their best interest against the cultural norm of not speaking in a disrespectful way to adults. Cornerstone found themselves walking a very tight line in trying to give youth strategies for being more assertive within constrained restrictions about what was and was not respectful.

Similarly, the sexuality piece got tied into religious and health beliefs. Information about contraception, gynecological exams and even STIs had to be constantly framed and reframed in the context of family values. Ms. Bell offered to put anyone interested in further information in direct contact with the curriculum developers, both of whom were invaluable in understanding how even "pop culture" phrases would not translate into the Spanish-speaking version.

Carol Sullivan, a participant from the New Mexico GRADS, noted that they have partnered with NM March of Dimes to develop a program to teach peer education and presentation skills to students across the state. These trained youth teach the ramifications of poor pre-conception health (folic acid and nutrition), risk-taking behaviors like alcohol, tobacco and other substance abuse and violence. They learn to present information effectively and then present programs as a service to the community, at civic clubs, community health forums, and middle school classes.

Ms. Sullivan stated that a neat twist has been teaming the GRADS teen parents up with the local abstinence peer leadership teens. Together these groups have greatly influenced children in the 5th through 8th grades while developing a greater appreciation for peers who have made different choices than they have made. NM GRADS hopes to expand this program.

Co-moderator Lynda Bell, after complimenting Ms. Sullivan on her program's creative matching of teen parents with the abstinence education peer educators in a service learning context, asked how the stage was set for these two groups of young people to work together and whether NM GRADS has been able to evaluate any change in attitudes (positive or otherwise) towards teen parents because of the program.

Ms. Sullivan responded by saying that using both teen parents and the abstinence youth was the result of the leaders of both groups just getting together and presenting the concept to the teens. No scientific study was planned or done, but NM GRADS hopes to set up a more scientific study of the effects of this strategy soon. The youth were polled following the presentations, however, and the results suggested that the peer educators gained new respect and tolerance for each other, and the audiences to whom they made the presentations were greatly influenced to avoid risk-taking behaviors.

Edward Bwengye, who works with UNICEF Kampala in Uganda as part of an HIV/AIDS program, discussed his program's strategies for providing peer-to-peer education to hard-to-reach adolescents in remote areas of the country. Some of UNICEF's more unusual tactics include providing peer educators with bicycles so that they can reach remote areas and having them perform music and drama shows that draw huge crowds from neighboring communities. Co-moderator Lori Rolleri complimented Mr. Bwengye on Uganda's effective social marketing campaigns on fidelity and abstinence.

In response to a request for examples of community service projects that have been more successful than others, co-moderator Lynda Bell provided the following suggestions (noting that she could not vouch for their success but rather their popularity):

• tutoring projects through which middle schoolers become buddies to elementary children who are having behavioral problems or need additional support with classroom studies



• mentoring and tutoring projects through which high schoolers helped middle school youth prepare for their transition to high school



• generational projects in which youth and seniors "adopt" one another in caring and learning relationships



• youth-focused projects in which young people help their peers learn more about and find ways to address issues directly impacting their age groups, i.e., homework help and suicide hotlines, radio talk shows created and run by youth, newsletters and service directories (youth yellow pages) listing programs, services and resources to address identified needs.

Ms. Bell added that some of the more unique projects have included a fruit and produce giveaway project where youth in a rural community grew, harvested and gave away food items to elderly residents, and the "Rock the Vote" project where young people enlisted the help of a local TV station and telephone company in a campaign to increase the voting percentage in their community by 20% in an upcoming election.

• Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy by Doug Kirby, PhD. Published by the National Campaign to Prevent Teen Pregnancy. You can order to full version for $15 or download a free summary at www.teenpregnancy.org/store/item.asp?productId=151



• ReCAPP's section on Programs That Work for information on pregnancy prevention programs that have been rigorously evaluated with evidence for behavior change



• ReCAPP's information about Service Learning and the Teen Outreach Program in "Theories and Approaches" or the Cornerstone Consulting web site at www.cornerstone.to/



• Ten Characteristics of Effective Programs also available on ReCAPP

• National Service-Learning Clearinghouse
  www.servicelearning.org/
  This web site has a lot of good information
  
  
• National Service Resource Center
  nsrc.etr.org
  
  
• National Youth Leadership Council
  www.nylc.org/
  
  
• Youth Service America
  www.ysa.org
  
  
• Learn and Serve America
  www.learnandserve.org