Re:MIX: Genuine Innovation in a Teen Pregnancy Prevention Program
By Mandy Ackerman, LMSW, MPH & Jenifer DeAtley, LMSW | June 14, 2017
Senior Program Coordinator & Director of U.S. Programs, EngenderHealth
Here’s a story that gives us chills—the good kind. A group of our peer educators presented a plenary at a local conference. They shared their personal stories before an audience of about 100 youth-serving professionals from the Central Texas community.
These peer educators are all young mothers. During the presentation, they talked about overcoming hardships in their lives and the labels and stigma society has placed on them. They described their plans for the future and offered practical “insider” guidance about how providers can support young parents.
At the end of their presentation, they received a standing ovation complete with rousing cheers. Audience members rushed up to them—“Can you speak at my conference next month?” “Can you come talk to our youth group?”
They were a total hit.
At the end of the presentation, we asked them, “When you first began with us last August, what if we told you that you’d be doing a closing plenary presentation this May?” They all laughingly exclaimed they would have quit on the spot! But over that 10 months, they developed the skills to be open and vulnerable. They understand that their stories help others and give a voice to the experience of young parents. They now have the confidence to trust their voices before a group of professionals.
Youth: Experts in Their Own Lives
These young women demonstrated one of the core principles of EngenderHealth’s U.S. Country office—that youth are the experts in their own lives.
We believe in self-determination—youth have the right to own their own sexual and reproductive health (SRH). They deserve high quality, factual and age-appropriate information. We are committed to innovation, a necessary component for any organization that wants to keep up with youth culture. We promote respect, and we pay special attention to groups that have faced stigma and discrimination or experienced lack of access to health information and services.
These principles are the root of the work we do, and that’s why the Re:MIX program is a great match for our organization.
Emma, a Re:MIX peer educator, helps youth participants brainstorm how to create equitable gender messages. Photo credit: Gallagher Studios.
Re:MIX is a Tier 2B collaborative agreement with the Office of Adolescent Health Teen Pregnancy Prevention Programs. Our charge is to develop a new, innovative curriculum and rigorously test it. Re:MIX focuses on three central concepts for youth:
- M – Maximize your strength
- I – Imagine your future
- X – EXplore your identities
There are two main components to the program. First, we offer 10 school-based classroom sessions on healthy relationships and sexual health to middle and high school students. Each session is co-facilitated by a peer educator and a professional health educator. The peer educator—a young parent—shares their story, describing their challenges, offering genuine feedback about what it’s like to be a young parent and answering student questions.
Julie, a Re:MIX peer educator, shares with youth participants the story of how she became a young parent. Photo credit: Gallagher Studios.
The second component is the robust professional development we provide to our peer educators. They are hired and paid to work 15 hours a week. As part of their work, they receive curriculum and facilitation training as well as opportunities to increase skills in leadership, communication, accountability and personal motivation. They are connected to community resources and are assigned a community-based mentor/coach to support their own professional development efforts.
Building Buy-In for a School-Based Project
If you have recruited participants for evaluation projects in school-based programs, you know you need to build buy-in from the following stakeholder groups: (1) school personnel (administrators, teachers, health staff); (2) students; and (3) parents. We faced some interesting challenges with each of these groups, and we would like to share some of our solutions with you.
Schools: Cross-Communication and Confusion
When we started our work with schools in spring 2016, we invited too many cooks into the kitchen! Several school staff and representatives were reaching out to our program staff with a range of questions and concerns. Mix-ups and confusion went both ways.
Unintentionally, we also had not been entirely clear with school staff about the nature of the pilot or the evaluation project. We made some assumptions about what the educators understood and were surprised when they did not comprehend some aspects of our randomized control trial approach. We were left with confused school staff, many quizzical faces and the recurring question —“If this is such a great program, why can’t we just give it to all of the students?”
We developed a single liaison at each school who had a single point of contact with the Re:MIX Senior Program Coordinator. This way, no one at the school or within our organization had any questions about who to go to with concerns. We also offered an orientation for school staff where we clarified what the program is, how we would actually do the evaluation, and their role in supporting this initiative.
We emphasized that the schools were participating in a rare and special opportunity to offer a forward-thinking, factual, research-based and comprehensive program that most Texas students were not getting. We assured schools that our goal at the end of the study would be to offer the program to all the students.
In addition to kick-off and end-of-year meetings, we scheduled regular monthly check-ins with school liaisons. This reduced misunderstanding and built more trust and positive relationships with schools.
Parents: Too Many Papers to Read and Sign
The students’ parents/guardians were also confused initially about what they were signing their kids up for. Their first contact was a set of evaluation forms that didn’t fully describe the Re:MIX project. They did not know where to take their questions. And because the opt-out form was included in the packet, it seems that some parents just signed the form without reading it. In our initial semester, our opt-out rate was 15%.
We got some great suggestions for improvement from a Parent Teacher Association (PTA) parent and the school liaisons. We started out the next semester with an open house where parents could come, learn about the program and ask questions. We created parent-friendly materials—well-designed, easy to understand, colorful and positive. We offered these resources in both English and Spanish. We included photos of students participating in the program. The materials emphasized our Re:MIX values (Maximize strengths, Imagine a healthy future, EXplore identities).
We separated the opt-out form from the rest of the packet and highlighted the heading in red at the top that read, “Only sign this form if you do not want your child to participate.” We had a significant drop in opt-outs after this, less than 5%, and a lot more parent engagement and excitement.
Students: Not Really Engaged
In our pilot effort, we focused too heavily on the evaluation part of the project, which is really exciting to us but not so important to students. We needed to build greater interest among students about the program, what it does and why it’s important. We’re now putting more effort into promoting Re:MIX to youth and engaging students from the start.
When we talk to students about the program, we answer their questions within the positive framework of Re:MIX. Example: Question-“Are we going to learn about sex? And condoms?” Answer-“Yes we are! And we’re also going to talk about building your strengths, planning for your future and being healthy in your relationships.” Students became more excited about the program when they realized it would be fun, they would get their questions answered, and the sessions would be co-facilitated by a peer who has experience as a young parent.
Re:MIX youth participants engage in the contraceptive circle activity, where facilitators pass around different birth control examples while providing information on each. Photo credit: Gallagher Studios.
It’s the Relationship
The core of all of these adjustments and improvements is really about the process of building and maintaining relationships. Whether it’s schools, parents or students themselves, the relationship is a huge part of what makes the program effective.
In support of this, we created a Google Drive folder for each participating school. We include the program schedule, any MOU’s, meeting agendas and notes, and links to resources. This is a good way not to overload busy people. Everything they need is in one place and easy to find.
Our openness to feedback from each of these groups has substantially improved the program.
Re:MIX youth participants practice role plays with one another on healthy communication strategies. Photo credit: Gallagher Studios.
Are Parenting Teens Good Role Models?
We are asked all the time whether it’s a good idea to have young parents act as role models for students. Our answer is an enthusiastic yes!
In Re:MIX, we’ve worked diligently to offer effective, appropriate activities and concepts in the curriculum. We’ve put a huge amount of effort into training the peer educators, especially around sharing their stories. They know what they’re doing, they know how to speak to a group of students, and they are co-facilitating with a professional health educator.
Students respond remarkably well to this structure. They are listening—really listening—to their peers. They see both the good and the challenging aspects of young parenting. Yes, these young parents love their children. They also are facing or have faced substantial obstacles and considerable stigma. They are offered fewer opportunities. They must work very hard to care for their children.
This authentic and realistic picture of young parenting does not romanticize the situation. Rather it helps young people make more informed decisions about their own futures and how to reach the goals that they have set for themselves.
We are gathering stories about the ways Re:MIX is having an impact. Here are two that show the strengths and promise of the program.
A Young Parent’s Success
Mariah shares her story about overcoming the challenges she faced as a young parent. Photo credit: Gallagher Studios.
Mariah is one of the peer educators at Re:MIX. By age 21, she had two children, both from unplanned pregnancies. Before she joined Re:MIX, she felt isolated. She did not have the support she needed. She knew of no resources to turn to for help.
As she progressed through her Re:MIX program, she became more familiar with community resources that could support her and others among her family and friends. She has now become the health navigator in her group—everyone comes to her for advice about what to do, who to see and how to arrange support when they’re facing challenges. She has become a role model to young people and other young parents too!
She comes from a family of teen parents—her mother, her aunts, her grandmother. Today, she is helping her younger sister and cousins get access to birth control. Her sister now has access to health resources and options to avoid unplanned pregnancies.
She also has an excellent relationship with her Re:MIX mentor, fellow peer educators and the Re:MIX staff members. She has had the opportunity to experience a range of successes in her work with us. She is now planning to pursue a career as a school psychologist.
A Student’s Success
A peer educator in one of our classes spoke to us recently about one of the students in her session. The student comes from a traditional mind-set that holds a number of stereotypes about gender norms. At the beginning of the Re:MIX program, he would make statements that reflected these values: girls, not boys, should be the ones to take care of birth control; boys are naturally sexual initiators and are expected to engage in sexual activity even if they don’t want to.
Over time, this student’s perspectives began to shift. He listened more and began to express some different ideas. In a role play near the end of the program, he suggested that he and his partner go to a clinic together to learn about birth control. “It’s everyone’s responsibility to make sure they stay healthy,” he told her.
This student’s transformation was one of the highlights of this educator's experience with Re:MIX.
This Is Why
Stories like this are why we do the work we do. The positive impacts we make may come about because of social and system changes. They can also happen at an individual level. We cannot always measure these kind of impacts quantitatively. However, we have the honor of witnessing them every day among the youth who have joined our organization and those who participate in the learning.
You can find more information on Re:MIX and the U.S. Country Office here.
You can hear more stories from the Re:MIX peer educators here.
Mandy Ackerman, LMSW, MPH, is a Senior Program Coordinator at EngenderHealth. She can be reached at firstname.lastname@example.org.
Jenifer DeAtley, LMSW, is the Director of U.S. Programs and Youth Technical Advisor at EngenderHealth. She can be reached at email@example.com.
This publication was made possible by Grant Number TP2AH000033 from the Office of Adolescent Health, U.S. Department of Health and Human Services (DHHS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Adolescent Health or DHHS.