Also available in [PDF] format and in Spanish [HTML ] [PDF]. 
Watch the Video.

I wasn’t expecting to get pregnant. I was in 10th grade.

My friends were surprised because I was always the “school girl.” When I had her, it was hard. I had to get used to not sleeping that much. It was hard when she got sick and I had homework. I think it's important for young people to know about birth control and STDs. My parents didn't talk about it until after they knew I was having sex. Now that I'm a mom, when I think about it, I think it's going to be hard to start that conversation. It's uncomfortable, but it has to be taught.
- Carla Nieto, age 17

Children and teens in New Mexico are more at risk for poverty, adolescent births, dropping out of school, substance use, and violence than are their peers in many other states across the nation.

Residents of Albuquerque’s South Valley community confront these challenges each and every day. And they are working for change.

Our cousins are pregnant, our friends are pregnant... health class is optional. - Martin Martinez

The South Valley

For hundreds of years, the waters of the Rio Grande have run through the town of Barelas, New Mexico. Since Spanish colonial times, residents have lived off the land just south of the much larger city of Albuquerque.

In the past few decades, Albuquerque has grown rapidly and has come to envelop this small agricultural community. With 54,000 residents, the area is now known simply as “the South Valley.”

Though there are no strict boundaries between the South Valley and the rest of Albuquerque, as historic Route 66 winds southward through the city, the surroundings start to change.

Every once in a while, a bright white suburban house stands among rows of homes built in the traditional New Mexican style. Children play in a gravel driveway, oblivious to the abandoned car on the lawn across the street.

The South Valley experiences some of the highest rates of teen pregnancy and poverty in New Mexico. Social services and other resources are scarce, leading to increasing friction between native Hispanics whose families have lived in New Mexico for several hundred years and recent immigrants from Mexico, Cuba, and Central and South America.

Though drug use and gang violence are also present, the community is not without assets. In fact, the community itself has earned a strong reputation for investing in and caring for its children and families. Community members, government and nonprofit agencies, and small businesses have joined together and are working hard to make the South Valley a better place to live.

Plain Talk / Hablando Claro

Plain Talk, known as Hablando Claro in Spanish, is a community-based health initiative that encourages parents and other adults to have open, honest, and accurate discussions with young people about sex.

The success of Plain Talk lies in its simplicity. By increasing adult-teen communication about sex and increasing teens’ access to contraception, the program works to decrease unwanted pregnancies, STDs, and HIV/AIDS.

Since the early 1990s, the Annie E. Casey Foundation has supported Plain Talk. Through its continuing support, the program is currently active in nearly 30 communities throughout the country.

A prospective Plain Talk community must meet certain criteria:

• The community is low income
• The community has a high teen pregnancy rate and/or high STI rates
• The community shows a readiness to confront the sexual health issues facing its youth

Beyond these set criteria, sites can vary significantly. For example, some sites are ethnically diverse while others are not. Some communities have supportive infrastructures – including small businesses and formal and informal networks among residents – while others lack these assets. Most residents in some sites speak English as their first language; in other sites, most residents are primarily Spanish-speaking.

In each case, Plain Talk works to create community consensus around the needs of adolescents by focusing on adults – both as recipients of accurate information and as sharers of that information with other adults and with the community’s youth.

The goals of Plain Talk/Hablando Claro are to:

• Create consensus among the community’s adults about the need to encourage sexually active youth to use contraception consistently
• Give parents and other adults the information and skills they need to talk more effectively with young people about responsible sexual behavior
• Improve adolescents’ access to high quality, age appropriate, readily available reproductive health care, including contraception

In 2004…

As the birth rate in New Mexico remained among the highest in the nation, the New Mexico Teen Pregnancy Coalition was looking for proven programs to address the problem.

Plain Talk/Hablando Claro seemed like an ideal fit. It was not only a grassroots program with an evaluated record of success, but it was well-suited to take advantage of certain assets:?strong cultural values around family and child-rearing, existing community support networks, and a dedication to positive change.

Moreover, the implementation of Hablando Claro is designed to adapt to the specific cultural environment of low-income communities of color.

Using data collected in statewide surveys, the coalition was able to identify communities in which the teen birth rate was considerably higher even than the statewide average.

Albuquerque’s South Valley was one such community and seemed a perfect home for the first Hablando Claro site in New Mexico.

To begin to redress some of the issues plaguing the South Valley’s youth, the New Mexico Teen Pregnancy Coalition decided to apply to Public/Private Ventures (P/PV) to replicate Plain Talk/Hablando Claro.

First, however, the coalition needed to raise at least $80,000 for each of three years to support the project.

Conversations with the state’s department of health and the governor’s office gave the coalition encouragement, and staff began drafting proposals to raise the necessary three-year commitments.

Funding was eventually secured from a variety of sources: New Mexico Department of Health, Family Planning Program; Office of Adolescent and School Health Promotion; and New Mexico Human Services Department, Medical Assistance Division.

With these commitments in hand, the coalition submitted an application to P/PV. In December 2005, the New Mexico Teen Pregnancy Coalition was selected as the lead organization for replicating Hablando Claro in the South Valley, officially beginning a three-year partnership between the coalition, P/PV, and the Annie E. Casey Foundation.

Plain Talk Evaluation

In the early 1990s, the Annie E. Casey Foundation launched pilot projects of Plain Talk in five sites.

An independent evaluation in 1998 found that Plain Talk was effective in:

• - Both Latino/Hispanic and African American/black communities
• Changing the ways in which adults communicate with teens regarding sexuality

In particular, the evaluation found:

• Increased levels of communication between adults and sexually active youth
• Increased levels of awareness among youth about where to get contraception

The evaluation also found that, compared to youth who did not talk about sexuality with trusted adults, youth who had such conversations with adults:

• Knew more about and were more comfortable with contraception
• Used contraception more consistently
• Used reproductive health services more often
• Were less likely to have been involved in a pregnancy or diagnosed with an STI

P/PV worked with the New Mexico Teen Pregnancy Coalition to plan and implement the three components essential to replicating the program.

The three components of Plain Talk / Hablando Claro include:

• Community Mapping, which gives the community an opportunity to identify residents’ own attitudes, knowledge, and beliefs with regard to adolescent sexuality and encourages residents to develop community-specific messages that will help adolescents reduce sexual risk-taking
• Walkers and Talkers / Promotoras, who are community residents and trained as peer educators, reach out to other adults to: (1) share accurate sexual health information with them so they, in turn, can have informed discussions with youth; and (2) teach them communication skills so discussions with youth are productive and positive
• Home Health Parties, which create regular opportunities for the Walkers and Talkers to provide parents and other adults with accurate sexual health information and teach effective communications skills in a safe and relaxed environment where participants can learn about and discuss sensitive sexual health topics

Community Mapping

By conducting hundreds of mapping surveys, it is possible to understand the community’s knowledge, attitudes, and behaviors related to issues regarding teen sexual health and adult-youth communication. In early 2006, P/PV staff traveled to Albuquerque to train coalition staff and 17 community members in the Plain Talk community mapping process. The surveyors attended P/PV’s two-day course on community mapping that covers survey content, getting informed consent, and improving interviewing skills.

The mapping plan required 500 completed surveys for analysis. To reach that number, surveyors contacted a random sample of 600 of the 2,639 available housing units in the South Valley. They also conducted surveys at the popular weekly farmer’s market in town.

“For participating, respondents received a $10 voucher for food at the local farmer’s market,” explained Sylvia Ruiz, Executive Director of the New Mexico Teen Pregnancy Coalition. “I anticipated a little bit of a problem, but it went just like a snap. The $10 made a difference to this poor community.”

At the end of the process, the team of surveyors successfully collected 496 surveys for analysis.

Walkers and Talkers / Promotoras

As P/PV’s staff analyzed the data back in their Philadelphia office, the New Mexico Teen Pregnancy Coalition turned its attention to issues of staffing the program. Using funds from the New Mexico Department of Health, the coalition recruited Kelly Garridas, an outreach worker with another local reproductive health organization, to be Hablando Claro’s program coordinator.

The coalition also recruited Hablando Claro Promotoras from the South Valley’s existing network of informal leaders, including health workers and resident curanderas.

In the South Valley, Promotoras are part-time employees of the Hablando Claro project and receive $10 an hour for their work.

Promotoras have four responsibilities:

• Disseminating community mapping results
• Building awareness of and acting as a messenger for Hablando Claro
• Informing residents about adolescent reproductive health issues and services
• Facilitating home health parties

Individuals recruited as Promotoras need to be outgoing and friendly, known and respected in the community, able to motivate others, able to read and write, able to communicate easily and clearly, and able to think fast and understand quickly.

Each Promotora participates in over 60 hours of training that increases her knowledge of reproductive and sexual health, provides her with the results of the mapping process in her community, and hones her communication and teaching skills.

Specifically, Promotoras learn about sexual health, human physiology, reproduction, contraceptive methods, myths and facts about sexuality, and information about where to go for additional support.

They also receive training in how to teach parents and other adults about effective communication as well as techniques and skills which promote open and honest communication with teens throughout the community.

Community Mapping Survey Results

80% of teens in the South Valley reported that they could talk to their parents about sex. But only 40% had actually done so.

With this in mind, Hablando Claro works to bridge the communication gap between adults and teens.

On October 17, 2006, P/PV staff presented the results of the community mapping surveys to an open meeting of coalition staff, community leaders, Promotoras, and community residents. More than 50 individuals attended this presentation.

Overall, the community mapping process showed that youth and adults in the South Valley were willing to talk about sexual health issues. Adults generally supported contraceptive access for sexually active youth. At the same time, many sexually active young people felt anxious about their parents learning that they were having sex.

Some important highlights emerged:

• Nearly half of all adult respondents said they had been involved in a pregnancy while they were teens.
• Most respondents (teens and adults) thought that half of all teenage girls would experience pregnancy prior to age 20.
• Parents were more willing to help sons than daughters to avoid pregnancy.
• While the large majority of sexually active teens knew that using birth control is very important, a much smaller majority said they use protection at every act of sex.
• Over half of teens surveyed felt their parents would NOT approve of their using birth control.
• When asked whether someone should take “no” for an answer when he/she wanted to have sex, nearly one-third of teens surveyed were unsure or believed that people should “never take no” for an answer.

Home Health Parties

Home health parties are the centerpiece of the Plain Talk program. The parties are designed to bring together small groups of community members in the comfort of someone’s home in order for everyone to learn more about sexual health issues. Skills-building exercises help adults gain knowledge and ease in speaking with young people about sexual health, including contraception.

The home health parties in the South Valley have been occurring since February 2006. The four Promotoras lead up to 10 home health parties each week. While all parties cover the information central to the program, attendees often request extra emphasis on certain information.

The Promotoras seek people to host a party through personal contacts, previous participants, and the Saturday farmer’s market. Each host invites family members and close friends to come to her/his home health party.

“Many of the people who participated did not necessarily have kids of their own, explained Kelly Garridas. “They have a niece or a grandchild to whom they can take the message that we are spreading.”

The Promotoras report that the mothers who come to the home health parties often bring their teens. This is a new direction for Plain Talk because, in other locations, home health parties usually draw mostly or only adults. Yet in the South Valley, intergenerational parties are the norm. Other aspects, like community change, sharing information, and finding answers to people’s questions, are central to home health parties in every Plain Talk site.

According to the Promotoras, many questions come up at the home health parties, offering excellent opportunities to replace misinformation and myth with fact. Sometimes questions are about pregnancy, such as, “Can I get pregnant during my period?” However, the Promotoras agree that most questions have to do with STIs, including HIV, such as, “Can I get HIV if I touch someone?” and “Can I get an STI from a toilet seat?”

Every home health party includes skills building exercises and information on a variety of sexual health topics. However, participants may request added emphasis on a certain topic or topics.

Specially requested topics include (% of home health parties where topic was requested):

• 58% reproductive anatomy & physiology
• 58% parent-teen communication
• 11% community mapping results
• 7% birth control methods
• 7% STIs and HIV/AIDS

Going Above and Beyond

The Promotoras in the South Valley have taken on additional roles to strengthen their community – some apparently unique to this Hablando Claro site and some more recognizable across Plain Talk sites.

Medicaid Enrollment

An extremely valuable facet of Hablando Claro in the South Valley is a partnership with the New Mexico Department of Health through which the Promotoras enroll eligible people in Medicaid. In the South Valley – where lack of transportation is a huge barrier to enrollment and to using services – this partnership works well. The coalition applied to and receives funding from Medicaid to train and certify the Promotoras for the enrollment process.

Available data showed that as age increases among New Mexico children, Medicaid enrollment decreases. But because they are already trusted community members, the Promotoras can often more easily identify and reach those families that qualify for different Medicaid programs than can department of health employees.

This is yet another way of connecting adolescents with necessary health care services and access to prevention methods.

Informal Case Managers

The Promotoras have also become informal case managers, working with families to direct them to a variety of needed health and social services. As such, all the Promotoras require and receive ongoing training in topics such as resource referral, vaccinations, and child services.

For example, the New Mexico Children, Youth and Families Department (CYFD) recently conducted an all-day training for the Promotoras regarding child neglect and child abuse. The training also covered Promotoras’ responsibility to report child neglect and abuse when they observe it. At the same time, the Promotoras were assured of the confidentiality in reporting suspected child abuse or neglect. Just as reassuring, the Promotoras learned that CYFD seldom removes children from their home. Much more often, CYFD provides parenting training and also ensures that parents and children get the mental health care, speech therapy, or other services they need in order to ensure the safety and well-being of the children while keeping the family together.

Future Directions

The New Mexico Teen Pregnancy Coalition has identified several lessons learned as lead organization during the first two years of the South Valley program’s existence:

1. Be clear with partners on the different roles from the beginning. Use memoranda of understanding.
2. Make sure that roles are not “personnel dependent,” that the role will continue when one person leaves and another arrives. For each role, ask, “What does this person do and how and what is expected and by when?”
3. Cross-training is essential. Make sure staff are familiar with one another’s jobs so that if anyone leaves, someone else can pick up that role and run with it. The program must not fail because this person or that person has left.
4. Match the Promotora leading the home health party to the culture of the people in the home. Hispanics do not have just one culture. Recognize that culture matters and that slang and cultural assumptions vary, especially on sensitive topics like sexual health. For example, native Hispanics differ greatly from Cuban immigrants who differ greatly from Mexican immigrants, and so on.
5. Hire people who can devote time and energy to the work. Don’t hire Promotoras who already have a full-time job. Being a Promotora is intensive, exhausting work. Preparing and leading presentations is draining because it means being in other people’s homes and complying with complex rules of hospitality while presenting accurate information in such a way as to encourage questions and full participation.
6. Anticipate providing training and support for Promotoras who are immigrants to this country. If Promotoras are immigrants, expect that they will need training and support around many facets of American life – facets such as acquiring a driver’s license, opening a bank account and writing checks, paying taxes, complying with scheduled well-baby and other health promotion check-ups, and so forth.

Long after we’re gone, if we’ve helped these kids, the change will remain…

The New Mexico Teen Pregnancy Coalition and other stakeholders agree that sustainability is the most important issue facing Hablando Claro in the South Valley. As such, these committed people are working hard to ensure that the program will continue when the three-year funding and support from the Annie E. Casey Foundation and Public/Private Ventures ends in December 2008.

Sustainability should be possible because there’s so much community support, especially for Plain Talk, with its heavy community involvement. Several New Mexico foundations are being supportive and are working together with the state on teen pregnancy prevention in Doña Ana and Taos counties. They also help fund Plain Talk in Doña Ana.
- Susan Lovett, Family Planning Bureau

Hablando Claro has been operating in the South Valley for roughly two years. As such, it is much too early to assess its long-term impact on the community. Nevertheless, the stories of the Promotoras and the views of those who oversee the program provide lively indications that Hablando Claro is indeed making a difference among the South Valley’s adults and teens.

Hablando Claro promises to bring huge benefits to the adults and youth who are learning to talk together about sexual health and so much more. The executive director of the New Mexico Teen Pregnancy Coalition probably best summed up the program and its impact:

The key to the success of Hablando Claro and other community-driven programs is choosing effective strategies and tailoring them to be culturally appropriate.

Adolescent reproductive health is a complex issue. Teen pregnancy affects teens, their children, and their future. Teen pregnancy and teen parenthood also affect the education and health systems, extended families, and communities. Teen pregnancy contributes to higher costs in emergency room visits, prenatal and obstetrical care for young mothers, and care for their infants… Through Hablando Claro, lives are turned around. Long after we’re gone, if we’ve helped these kids, the change will remain.
- Sylvia Ruiz, New Mexico Teen Pregnancy Coalition

For more information on Plain Talk replication

In 2000, the Annie E. Casey Foundation contracted with Public/Private Ventures to operate the Plain Talk National Replication Center. P/PV reviews applications from communities that want to replicate the program and provides training and technical assistance to those chosen to become Plain Talk sites. The sites are varied and currently include a range of community-based organizations as well as health departments in 17 states. The communities all have three things in common: concern about high rates of teen pregnancy and STIs, a desire to intervene, and a commitment of support from one or more funding sources.

Through the Annie E. Casey Foundation, P/PV provides each site with $40,000 in implementation support. In turn, each site must secure up to $100,000 per year for three years in order to fully implement the program, hire staff and conduct community activities. P/PV can assist interested communities with the funding process. For more information, visit http://www.plaintalk.org.

To learn more about replicating Plain Talk / Hablando Claro, please contact Tammi Fleming at Public/Private Ventures ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

This case study was produced by Advocates for Youth with funding from the Annie E. Casey Foundation. Advocates would like to thank the Casey Foundation for its support but acknowledges that the findings and conclusions presented in this report are the authors’ alone, and do not necessarily reflect the opinions of the Foundation.

Written by Sue Alford, MLS, and William Neville
Advocates for Youth © 2008