Evaluation Report: Young Women's CHOICES Program

RESEARCH SUMMARY

Evaluation Report: Young Women's CHOICES Program
July 2001 - December 2002

Date: July 2003
Authors: Elaine Wolf and Susan Adair

Summary

Young Women's CHOICES is designed to serve HIV-negative adolescent girls between the ages of 14 and 17 who are involved in the juvenile justice system and therefore highly at risk of acquiring HIV. The evaluation, covering the period July 2001 through December 2002, was designed to provide formative evaluation services to program managers and staff and to inform stakeholders as to client outcomes. A safe supportive environment for learning is a key component of the program along with the training and utilization of peer educators in educating this challenging population. Client engagement shows positive outcomes and client satisfaction with the program is high. Because the program is small, findings can only imply trends that might occur as the program enlarges and matures. Success in reaching and altering risky behaviors in this population have potentially far-reaching and positive public health effects.

HIV Prevention and Policies Related to Health and Criminal Justice

The attention devoted to educating and supporting juvenile justice system-involved youth in the area of HIV prevention can have a considerable public health payoff. The evaluation's finding regarding peer educators' increasing openness to discussing safer sex and HIV-related issues with family, peers, and partners suggests that there can be a snowball effect of training peer educators that goes far beyond their own knowledge and changes in behaviors. The small size of this program should not obscure the long-term implications of the evaluation findings as programs like these mature and take root in the communities they serve. The curriculum has a solid foundation in up-to-date information and teaching materials. The program is well served by evaluators from the City of New York Department of Health who actively encourage the program's utilization of its technical assistance services and staff reflection on practices. The support of the program's various stakeholders enhances its ability to work with a challenging population, thereby increasing the likelihood of achieving its public health goals. Further, its focus on strengthening the interpersonal and refusal skills that can lead to safer sex practices can be expected to enhance program participants' ability to avoid future involvement in the juvenile and criminal justice systems.

Background

The Young Women's CHOICES program is located within the Youth Services (YS) unit at the Brooklyn, NY office of the Center for Community Alternatives (CCA), a private, not-for-profit agency providing direct services to professionals and clients in the criminal and juvenile justice and related human services systems. The Brooklyn YS unit serves court-mandated youth as an alternative to incarceration.

Young Women's CHOICES is designed to serve HIV-negative adolescent girls between the ages of 14 and 17 who are involved in the juvenile justice system and highly at risk of acquiring HIV. The goal of the program is to reduce the likelihood of the acquisition of HIV which is to be achieved by reducing risky sexual behaviors through increasing participants' knowledge about HIV/AIDS and risk behavior, encouraging favorable attitudes about condom use and other safer sexual practices, and strengthening interpersonal and refusal skills necessary to reduce risky behaviors. These objectives are designed to be achieved primarily through a group-level educational and support intervention and secondarily through outreach and peer education.

The requirements for a mandated client in CCA's Youth Services unit consist of a minimum participation period of six months, frequent urinalysis, curfew checks, participation in the gender-specific groups, remaining without any arrests for a serious charge, and avoiding being remanded. Because the courts mandated very few young women to CCA during the reporting period, the program, beginning in August 2002, relaxed its eligibility criteria for enrollment to include young women who are judged by clients or staff to be at risk of HIV infection but are not currently involved in the juvenile justice system.

Most clients were residents of Brooklyn; had no prior drug treatment or counseling; were not in counseling at the time of intake; were in school prior to their arrest but were less likely to be in school at the time of enrollment in the program; and reported no experience with drugs at the time of intake. Of those who report having used drugs, most indicated marijuana as their drug of choice. The average age of clients at the time of intake was 15.4 years, representing a range from 13 to 20.

The program is funded by the Medical & Health Research Association (MHRA) of New York City / HIV CARE (Comprehensive AIDS Resources Emergency) Services, with technical assistance provided by the AIDS Research/HIV Serosurvey Program/Program Evaluation Unit of the City of New York Department of Health.

Main Findings

The extent to which mandated clients were exposed to the program's educational and support components largely depended upon their successful completion of CCA's YS requirements. Program participants reported that they were generally satisfied with the provocative and informative nature of the curriculum as well as the opportunities it offered for self-reflection. They were universal in their assessing the group as something they would recommend to others.

Peer educators who participated in a focus group with evaluation staff indicated that they learned facts about HIV and AIDS that they hadn't known before; learned about public speaking, including overcoming their fears of speaking to strangers in public; and learned how to get along with each other and support each other as peer educators and friends. A pre-post survey administered to peer educators indicated that following their training they had overcome their fears of HIV testing, were more likely to seek testing, and felt more capable of talking openly and comfortably with family, peers, and partners about safer sex and HIV-related issues.

The evaluation's reporting on the program's implementation noted that CCA establishes a strong supportive atmosphere for young people that is appreciated by clients, peers, and staff. CCA is seen as a safe place that provides an alternative to being on the streets and has a friendly, supportive, and caring staff who listen well and treat clients with respect.

Recommendations for program strengthening included the continued collection of detailed baseline and programmatic data (both qualitative and quantitative) on an expanded client base. These measures would enhance the program's ability to identify issues that could, if addressed, increase the likelihood of client retention and program success.

The Study

Justice Strategies, the research, training, and policy initiative of the Center for Community Alternatives, conducted the evaluation of the Young Women's CHOICES program. The evaluation, covering the period from July 2001 through December 2002, called for an assessment of the program's implementation and success in achieving its goals. Because of a small numbers of clients, findings from this study should be considered suggestive, at best, of patterns that may emerge when the program has gained more maturity. This is a small program whose measurement of outcome indicators has yet to be fully implemented.

Questions Addressed

The data analysis focused on answering questions regarding client retention and satisfaction as well as peer educators pre-post changes in knowledge, behavior, and self-efficacy.

Approach

The evaluation utilized three sources of outcome data: program monitoring data; the results of a satisfaction survey; and data from pre-post surveys of peer-educators' knowledge, attitudes, and behavior related to HIV risk avoidance. Process data consisted of fieldnotes from site visits by evaluation staff. During site visits they met with program staff to discuss the program's implementation and to arrange for the transfer of program data. They also observed an outreach activity and a peer educator presentation and graduation event. In addition, evaluation staff facilitated two focus groups at the Brooklyn office: one with peer educators and another with clients. Their purpose was to identify ways in which clients are satisfied with the program, aspects of the program that they don't like, and strategies for improving the program. The research protocol was approved by the Institutional Review Board for Human Subjects at Syracuse University.