The purpose of this survey is to learn about adolescent pregnancy prevention efforts in our state and to obtain your views on the need for additional efforts to address this issue.  We are interested in how you, as a state leader, perceive the need for prevention efforts, what programs you would consider, and what concerns you or your organization may have.  This survey should take 15-20 minutes. Your participation is voluntary and you may decline to respond to any question.  All your responses will be completely confidential.

Who should complete the survey/interview?

Your profession is:

Are you aware of any public discussion or expression of concern about adolescent pregnancy in your state?
[ ]     Yes        [ ]     No        If yes, please describe the central issues.

PART I: STATE ANALYSIS/GENERAL

1.   What are the major assets/strengths of your state?

2.   What are the major challenges in your state?

3.   What do you think are the major barriers in your state to addressing adolescent pregnancy prevention?

4.   Who are the major influencer's/power brokers/significant people in your state that have a positive track record in getting involved in trying to solve state-wide problems.
Name/Group                    Affiliation/Role 

SERVICE INTERVIEW FORM (Duplicate as Needed)
Service #____________________    Service:__________________________________________________

Service Exists___________        Service does not exist____________

Who provides:

Who does it serve/client:

How is it funded:

Hours of operation:            Fees:

Location:

Comments:

PART II: SEXUALITY EDUCATION

A. Public School Sex Education Curriculum
_____ System Written
_____ National Curriculum – which one(s):
_____ Is there a community parent advisory committee?
_____ Do you solicit parent permission for students to attend?
        Describe:

K-5 or 6: Elementary
Major curriculum content:



Parental Involvement:



Materials/Resources used:



Who teaches:



Training of teacher:



6-7-8: Middle
Major curriculum content:


Parental Involvement:


Materials/Resources used:


Who teaches:


Training of teacher:

 
9: High School
Major curriculum content:



Parental Involvement:



Materials/Resources used:



Who teaches:



Training of teacher:



B.    Interview major private and parochial schools and ask same questions as public schools.

C.    Interview at least five major religious denominations and review:
_____ Are they doing any sexuality education  _____parent  _____preteen  _____teen

Who is the key contact?


Is it on-going or was it a one time event?

Is there any teacher training?

Contact:
____Methodist        ____Muslim        ____Presbyterian        ____Baptist
____Lutheran        ____Catholic        ____Jewish            ____Other

D. Interview major youth serving organizations (Boy Scouts, Girl Scouts, YWCA, YMCA, etc. and ask some questions about sexuality education curriculum they might use.

 
5.   Who do you think would be non-supportive or oppose realistic prevention efforts?
Name/Group                Affiliation/Role

6.   Has there been any public controversy in your state within the last five years to prevent adolescent pregnancy?
[ ]    Yes        [ ]     No        If yes, please describe this action.

7.   Who provided leadership to this effort?

8.   What organizations or advocacy groups, if any, were active in the effort to address adolescent pregnancy in your state?

9.   Are these efforts still being made?        [ ]  Yes        [ ]  No

10.   List your major media representative/stations/paper.
TV        Radio        Print        Billboards

11.   Have media been involved in positive/constructive support of prevention efforts?  Describe who and how.

12.   Do you have: [ ] State Funded Adolescent Pregnancy Prevention Programs? Contact:          Agency:

13.   Do you have: [ ] State Funded Adolescent Parenting Projects in your DSS?
Contact:         Agency:

14.   What do you believe your state needs to do to prevent or reduce teen pregnancy?

PART III: SERVICE SURVEY

Complete service data sheet below for each service listed: As you begin your process of developing a comprehensive, coordinated state-wide approach to adolescent pregnancy prevention, it is vital that you assess the existing services and resources in your state.  This is a good project for a newly formed state organization because it can involve many people; it creates interest and awareness of the problem, and gives insight and direction for future strategies.  Interviews by phone or in person are suggested.  From this survey, you will be able to define goals and objectives for the first year at least. Gaps and needs should be obvious.

I.    Health Care

1. Adolescent General Health Care: Public
2. Adolescent General Health Care: Private
3. Contraceptive Services/Clinics/Family Planning
4. Pregnancy Testing
5. Prenatal Care: Public
6. Prenatal Care: Private
7. Labor and Delivery
8. Infant care: Illness
9. Infant care: Well Baby
10. School Based Health Care -Comprehensive Primary Care Including Family Planning
11. Male Health Programs
12. STD Testing
13. STD Treatment
14. Male Health Care
15. Other:
    

II.    Education

1. Pregnant Students Programs
• Junior High
• Senior High
• Home-Based Programs
2. Special drop-out prevention programs aimed at pregnant teens and/or teen mothers
3. Alternative School/Program for parenting teens
4. Day Care at Schools
5. Community College/Technical Schools programs for teens & teen parents
6. Drop out Prevention Programs (general)
7. Health Education Coordinator (state funded)
8. Parent Child Development Program
9. Other:
   

III.    Peer Programs

1. Teen Internships
2. Teen Boards
3. Teen Hotline
4. Other:
   

IV.    After School Programs

1. Faith Communities
2. School
3. Youth Agency
4. Neighborhood Centers
5. Other:
   

V.    Mental Health Services

1. Individual Counseling: Public                  
2. Individual Counseling: Private 
3. Support Groups
4. Peer Counseling
5. Other:
   

VI.    Life Planning

1. Career –Counseling
2. Job Bank
3. Teen Employment Agency
4. Other:

PART IV: DEMOGRAPHICS

% of teen pregnancies unmarried__________ married__________

Infant mortality rate to teens__________         year__________

Number of STI’s to teens:     year__________
Syphilis:
Gonorrhea:
HIV-AIDS:
Chlamydia:

Sexual intercourse rate by age (Search Institute Survey or others)

Sample Adolescent Pregnancy Fact Sheet

Background: This year, the Anystate Teen Pregnancy Prevention Coalition conducted an assessment of rate of teen pregnancies in Anystate. A summary of the results is outlined below.

• Last year in Anystate, 21,000 teenagers between the ages of 10 and 19 had babies.
• 70% of the girls who had a child dropped out of school, thus limiting their chances of obtaining a fulfilling job with which they can support a family.  Nationally, only 46% of female teens who drop out of school return to obtain their diploma or go back for their GED.
• In a survey of the local high schools, 60% of students reported being sexually active.
• Of those teens who reported being sexually active, only 35% had used contraception the last time they had intercourse.
• In a survey of parents, residents of the state, and agencies working with adolescents, teen pregnancy was among the top three concerns they had for teenagers.  Drug use and school drop-out were the other two top concerns.
  

In response to these findings, the Anystate Teen Pregnancy Prevention Organization will be working on strategies to support our state’s teenagers. If you would like to work with us in designing and implementing programs, or if you would like to receive a more detailed report, please call us at (telephone).

Summary

The state-wide assessment process chronicles the needs and the unmet needs as well as state assets and resources related to teen pregnancy.  It should provide a profile of the adolescent pregnancy issue and its indicators in the state.
 

Source: Huberman, B., Adolescent Pregnancy Prevention Coalition of North Carolina, 2009.