Advancing the Field of Teenage Pregnancy Prevention Through Community-Wide Pregnancy Prevention Initiatives.

Journal of Adolescent Health 60 (2017) S1eS2 www.jahonline.org Editorial Advancing the Field of Teenage Pregnancy Prevention Through Community-Wide Pregnancy Prevention Initiatives As a nation, we are at a crucial cross-road in our efforts to further reduce the incidence of teen pregnancy, once considered an intractable problem, but now recognized by the Centers for Disease Control and Prevention (CDC) as a “winnable battle” [1]. Over the past four decades, traditional strategies for teen preg- nancy prevention have evolved from implementing relatively one-dimensional efforts, for example, those focused on changing the behavior of individuals through educational interventions or those increasing accessibility to adolescent-friendly reproductive health services. Today, there is a growing recognition of the importance of a multidimensional array of concurrent and syn- ergistic approaches to teen pregnancy prevention that also engage stakeholders across communities [2]. With the opportu- nity afforded through the special partnership between the Ofﬁce of Adolescent Health and CDC for the national demonstration project: integrating services, programs, and strategies through community-wide initiatives (CWI), we have a unique platform to learn from a wide variety of states’ and community-based orga- nizations’ experiences in implementing community-wide, comprehensive approaches to reduce teenage pregnancy [3]. The CWI built upon several critical elements that enabled testing of more comprehensive approaches. First, CWI commu- nities beneﬁtted from the availability of a growing body of evidence-based educational interventions (EBIs) for teen preg- nancy prevention, as well as the identiﬁcation of evidence-based practices (EBPs) in adolescent reproductive health care. Second, the emergence of the ﬁeld of implementation science provided tools to test whether interventions were in fact carefully repli- cated with ﬁdelity, while also providing opportunities for local enhancements, slight adaptations, and continuous quality improvement. Third, there is a growing recognition of the importance of building informal and formal community and professional partnerships and leadership capacity as part of the necessary infrastructure that supports not only changing norms and culture, but the implementation of curriculum and clinical interventions. This type of “scaffolding” allows for the Conﬂicts of Interest: The author declares no conﬂicts of interest. Disclaimer: Publication of this article was supported by the Ofﬁce of Adolescent Health. The opinions or views expressed in this supplement are those of the authors and do not necessarily represent the ofﬁcial position of the funder. The ﬁndings and conclusions in this report are those of the authors and do not necessarily represent the ofﬁcial position of the Centers for Disease Control and Prevention or the Ofﬁce of Adolescent Health, U.S. Department of Health and Human Services. development of key community leadership to build and sustain a combination of high-quality educational and clinical services. In this special issue of the Journal of Adolescent Health, a broad range of review papers provides insight into important themes and issues regarding the complexity of operationalizing CWI’s overall vision. Presented together from different vantage points, these papers capture the challenges and opportunities at the local community level to approach teen pregnancy prevention from a comprehensive perspective that includes education, health ser- vices, and community engagement. Several cross-cutting themes provide insights that can help the next generation of programs. Cross-Cutting Themes Implementation roadmaps provide valuable milestones CDC provided guidelines for a sequential, staged set of mile- stones and timelines to conduct the planning, assessment, and preparation necessary to select EBI curricula and clinical EBPs [4]. It also provided guidance for assessing community readiness and engaging different community sectors and stakeholders. Across all sites, time-intensive attention to the overall direction of the local initiative, dedicated personnel, leveraging other resources, and solidifying commitment was essential for implementation. This combination of activities was important to shift from an unidimensional focus, such as classroom teaching, to one involving multiple, synergistic, and concurrent community-wide strategies. Key among these features was the importance of building trusting relationships with the community to maximize the likelihood of success, not only during the funding phrase, but continuing through to planned sustainability. To be incorporated into the fabric of the community required dedicated staff, will- ingness to engage and be responsive to relevant sectors, including families, providers, and other stakeholders; and a recognition that attempting to truncate the planning process could potentially create far greater challenges to successful implementation than taking the necessary time to fully engage communities [5]. Formal and informal leadership, champions, and change agents are requisite for success Developing engaged leaders, champions, and change agents was instrumental in the success of the CWI. This was evident from the federal partners who collaborated and combined funding streams to design and implement the CWI and who 1054-139X/O 2016 Society for Adolescent Health and Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/). http://dx.doi.org/10.1016/j.jadohealth.2016.11.027