Barbara Huberman, RN BSN, MEd

Can you imagine a state cancer society supporting smoking based on the personal beliefs of a few in the community?  Would that society invite tobacco companies to join?  What would discussions be like at the meetings of the state lung association if smokers were at the table making decisions?  Would it affect policies and direction of the organization? 

In every state in the country, when you look at major health issues such as diabetes, heart disease, birth defects, or cancer, each having significant societal implications, you will find strong local and state organizations involved in advocacy, research, education and awareness and /or raising funds to address the problem.  These groups usually have committed community leadership and are not just led by those who are professionals or service providers in the field.  Their boards are usually composed of influencers and the powerful decision makers in the community or state.  They have wealth or access to wealth.  These groups usually have staff and operating funds to run the organization effectively and for the long term. Strategies for the prevention and management of these problems are not left only to local and state departments of health, education or social services.  Almost all are independent nonprofits that use science and research to guide their plans and activities.

With a few exceptions, pregnancy prevention organizations at the local and state level have not operated within this model.  Teen pregnancy councils, task forces, alliances or coalitions have generally been volunteer groups, usually made up of “worker bees” from the field, have little or no funding, and have difficulty taking stands for effective prevention strategies that are research based and meet the real needs of young people.   In an effort to be “inclusive,” the activities and strategies chosen by pregnancy prevention organizations are watered down, low impact, “make everybody feel good” and are “no controversy” programs.  These groups may go in and out of business and usually avoid any advocacy or policy strategies.  Many serve at the pleasure of a governor or political body, have little power and can’t support strategies that might be controversial or politically risky for the political party or elected leader. 

In an assessment of the state organizations which address teen pregnancy and prevention in the US, the chart below (Table I) indicates that there are very few that follow the model of other statewide organizations seeking to affect serious health, social, and community problems. 

 
This chart looks at formal organized bodies responsible for creating, implementing, and/or monitoring and evaluating teen pregnancy prevention efforts in a state.

State organizations regardless of their structure may use any of the following titles:

Campaign               Association              Task Force         Steering Committee
Council                   Organization             Committee          Action Group
Coalition                 Caucus                     Network

*Almost all states have a person or office identified within state government that is defined as the responsible party for adolescent pregnancy prevention in the state.  This may be a designated person or the state adolescent health coordinator may be the designate.

The use of the name “coalition” may be somewhat confusing.  “Coalition” usually means bringing together many diverse groups or constituencies to support a common mission.  Unfortunately, some state and local coalitions have allowed this description to affect their decision-making and operation.  Because groups or organizations make up the coalition, different representatives may be active at different times, their representatives may have no decision making capability, and some decisions made by the coalition may affect the fund raising or operations of the coalition member, so they become very cautious and are reluctant to take controversial positions.
For example, one state coalition decided to host a conference on comprehensive sex education and four major youth organizations members refused to support the conference and in fact tried to have it shut down because they had funders who objected.  In another case, a state coalition made up of many organizations never held any sex education trainings that were proposed because there was so much controversy among the members about curriculum.  Sadly, when differences like this surface, coalition activities sometimes suffer. 

For this article, the term state organization will be used to describe the state group since it connotes independence, democratic decision-making, and advocacy.  No matter what name is given to the state body; coalition, council, campaign, caucus, or alliance, the complexity of a social issue such as the prevention of adolescent pregnancy necessitates multi-faceted, long term, coordinated responses. 
While there is no “one right way” to create and nurture a state wide organization, there is a body of experience over 20 years that offers us a framework for success and the positive outcomes of reducing sexual risk taking.

The major roles of a statewide organization are to:

1. Educate and create awareness of the need for prevention of adolescent pregnancy and services for pregnant and parenting teens.
2. Conduct and synthesize research to promote prevention and disseminate best practice programs and models.
3. Provide resources and supportive materials, trainings and technical assistance.
4. Support the development of strong local councils in communities.
5. Ensure that funds and resources are available for pregnancy prevention programs.
6. Create policy plans and provide leadership and resources for policies and procedures that support and fund effective researched-based strategies. Monitor the implementation of the policies.

These roles are interdependent and equally important.  Many groups only focus on the “safe” role of creating awareness.  Posters, teen help cards, bookmarks, buttons, PSAs all do this, but there is no evidence they affect behavior, policy, or practice.  Education by itself will not be a cure all.  We must also influence systems, create community support, and ensure that youth serving professionals and parents believe in the rights of young people to accurate, uncensored information and access to sexual health services, and they deserve respect and are to be valued by society.  When our prevention programs are built upon these principles, young people can and will act responsibly.  Young people must have information, skills, and the motivation to prevent a pregnancy or STD. 

Political sponsorship of a state organizationl can have advantages: resources, staff, visibility, and legitimacy.  However, political sponsorship can have serious liabilities such as a lack of priority by the political party or  new official who comes into power, and a predetermined philosophy and control of what will be supported by the elected officials. 

When you look at the chart of state organizations several states stand out as clearly meeting all these roles; Illinois,Minnesota,Massachusetts, North Carolina, South Carolina and Georgia being the strongest.  Other states may have had strong programs in one or more of the roles but these  states have been exemplary models of organization and impact. 

Illinois:  Led by Jenny Knauss for over 20 years, the Illinois Caucus recently has been actively involved in support of comprehensive sexuality education (CSE)in a unique way.  They have trained groups of young people themselves to testify, write letters to policy makers and representatives, and take leadership for advocacy of CSE.  Always known for its excellent programs to support teen parents, Illinois has also maintained a balance between prevention and pregnancy and parenting initiatives.
           

In 1993, to broaden its scope to address multiple causes for teen pregnancy, the Caucus changed its name to the Illinois Caucus for Adolescent Health.  Funded by private foundations, state grants, donations, and service fees, the Caucus is a rich source of experience and knowledge for program providers, policy makers, and the media. Their groundbreaking research on the relationship between teen childbearing and sexual abuse supported their development of a prevention curriculum and program and it has been the catalyst for programs across the country.

North Carolina: Begun in 1985, the Adolescent Pregnancy Prevention Coalition of North Carolina (APPCNC) has provided the ideas, the resources, the research, and the organizational model for many other state organizations.  APPCNC first implemented Teen Pregnancy Prevention Month and Let’s Talk Month in the 1980’s, both of which have now been adopted nationally.  The Coalition developed the country’s 1st Hispanic Statewide Teen Pregnancy Prevention Outreach Program and several states have replicated this project.  (N.C. has the highest Hispanic teen pregnancy rate of all the states.)  From its inception in 1985, the coalition has focused on local council development, has staff that serve local councils, conducts regular community trainings, and the Coalition has a manual that is a blueprint for starting and maintaining a local council.  The coalition has had a lobbyist since 1985 and has been instrumental in shaping policies and programs that support local programs in the state.            

Perhaps the greatest strength of the North Carolina Coalition is its board of directors. Not only is it regionally representative, but it follows the tried and true adage of successful boards: 1/3 wealth or access to wealth, 1/3 wisdom and expertise, not necessarily about teen pregnancy, and 1/3 “worker bees.”  They have had critical participation by members of faith communities, media, business, foundations, and policy makers. 

An annual conference has been held every year and numerous trainings have been sponsored to enhance the skills and knowledge of youth serving professionals.  Most unusual also is the grant given to the coalition for 17 years from the state legislature to support its work with no interference or directives.  The United Ways of NC are also key stakeholders and continue to financially support the coalition.  It is a true public-private partnership but is independent, self-sustaining and free to determine it’s own mission, goals, and objectives based on science, not politics.  It has won numerous awards for its publications, programs, and advocacy. 

With the University of North Carolina at Charlotte, the APPCNC created a 3 week summer graduate course, “The Summer Institute in Family Life Education,” to prepare sexuality educators, that has trained over 300 participants from all over the country.

The Coalition recently changed its name to the Adolescent Pregnancy Prevention Campaign of North Carolina.

South Carolina: Influenced and guided in its development by the Adolescent Pregnancy Prevention Coalition of North Carolina, the South Carolina Campaign to Prevent Teen Pregnancy has quickly achieved recognition for its development of ways to access welfare reform (TANFF) dollars for teen pregnancy prevention.  Strong support and technical assistance is given to local councils and communities.

Georgia: Star power does make a difference.  When Jane Fonda decided to organize a statewide group, she sought out ideas about organizational models, listened to experts in the field, and created the Georgia Campaign to Prevent Teen Pregnancy in 1995.  Advocacy is at the top of the list of important functions of this state campaign and it has also been influenced by the North Carolina organizational model.

After 20 years of working with numerous communities and over 25 states, the following are recommendations for those who are interested in forming a statewide teen pregnancy prevention organization.

1. Leaders must be committed, passionate, and skilled at running an organization.  An organization’s leader must have energy and vision, skills to activate all the roles and functions of the organization, and be capable of handling controversy and conflict. 
   
2. Do not have designated seats on the Board of Directors for certain groups or agencies.  The Board should be made up of people who are dedicated to the organization and have assets to bring to the organization.  Individuals, not agencies are elected to serve from the following areas in equal representation.

Chart I:
Board Organizational Model




Effective state and local organizations need to secure leaders from each of these areas. An ideal size of a Board is 15-20 with 2 members from each circle.


 

Table II: Board of Directors

Who	Where to Find
Parents	PTA representatives, community volunteers, people who do not earn a living in the youth field
Neighborhood/Service Groups	Kiwanis, Rotary, Junior League, neighborhood and state leaders
Faith Community	Rotate denominations as board seats become available
Educational Institutions	Schools, public, private, parochial, day care centers, colleges, universities, training schools
Youth/Peers	18-24 –college/working age works best
Media	Radio, TV, Print, Public Relations, advertising firms
Business	Banks, businesses that serve or employ youth (McDonalds, GAP), United Way leaders, Chamber of Commerce
Agencies	Social service/youth serving agencies, scouts, girls club, boys club, YMCA, YWCA, Red Cross
Elected officials	School board, county commissioners health boards, state representatives, senators, governor, and other officers, mayors, judges
Medical providers	School nurses, health departments, hospitals, private practices, nurse health clinics

3. Enforce term limits for Board members.  Boards who do not rotate members become stale, lack creativity, and do not increase presence in the state by bringing to leadership, different constituents and resources.
4. Develop a formal structure, by-laws, assign responsibilities, have a clear definition of roles of staff and board, and follow or adhere to the structure as agreed upon in a consistent manner.
5. Support only research based effective strategies and only undertake new strategies on a “pilot” basis.  Let go of those that are not effective or not based on sound behavior change theory.
6. Operate as a business and use Roberts Rules of Order and democratic principles.  Understand that 100% agreement is not the goal and at some point, a decision making process must be utilized.
   
7. Design a long-term strategic plan (5 – 10 years) and an annual operating plan which supports the long term strategic plan.
8. An organization who has all the above but lacks resources such as staff and long term operating and activity funding, will ultimately collapse and be unable to achieve critical objectives. 
   

Teen pregnancy rates here have decreased over the last 10 years, but the United States still leads the developed world in what are usually unplanned, unwanted pregnancies to teens. While it is time for every state to assess how they are addressing prevention, it is also time for community leaders and policy makers to create state wide plans that don’t sit in drawers, that aren’t scrapped as governor’s change, and reflect best practice research.  It is time for every state to follow the lead of these states and support state organizations or campaigns that have the power and influence to affect policy and practice. Organizations or campaigns that are independent and well supported organizations or campaigns that reflect the value that young people can make healthy, responsible sexual decisions, can be the key to reducing teen pregnancies and STD’s. 

Source: Huberman, B., Advocates for Youth, July 2008