• By Dartington SRU
  • Posted on Thursday 27th May, 2010

28 things on the menu; only 2 worth having

The news that the US Department for Health and Human Services (HHS) is putting $110-million into the prevention of teen pregnancy is a crowd pleaser, but the devil is in the details. The money is being spread across 28 different interventions. But The Coalition for Evidence-Based Policy, a leading not-for-profit in Washington, cautions that only two may be worth the investment. Let’s be clear. The Coalition supports the new initiative, which it calls an ‘an excellent first step.’ In time, the initiative may assist the government in understanding what really works in teen pregnancy prevention. The Coalition’s concern is that ‘much of [the government’s] funding will still likely support activities that do not have a meaningful impact.’ To understand why requires a look at how the menu of interventions was constructed in the first place. The 28 interventions were selected through an independent review, conducted by Mathematic Policy Research. The review looked at 199 studies of various interventions related to teen pregnancy. The review rated the quality of the studies as high, moderate or low. The approved menu of programs announced by HHS include interventions that are supported by at least one high or moderately rated study and demonstrated evidence of having an impact on teen pregnancy. So, why are only two of the interventions considered effective? The distinction lies in the definition of ‘evidence.’By the Coalition’s standards, only two of the interventions—the Carrera program, and Project TALC—are backed by studies where there is sufficiently strong research design coupled with evidence of sustained impact. The Carrera program demonstrated up to 50% reductions in the rate of teen pregnancy three years after receiving the intervention [See: Young teens wait on more Obama Care]. Project TALC, an intervention directed at children whose parents have HIV, showed a 29% reduction four years after the intervention. By contrast, the remaining 26 model interventions selected by HHS are only backed by what the Coalition termed ‘preliminary evidence’. That means the studies only looked at immediate or short-term effects on pregnancy rates (less than a year after the intervention) or they were only indirectly related to teen pregnancy. Some studies, for instance, just measured condom use or the number of sexual partners. Simply put, the jury is still out on whether these 26 interventions will have any long-term effect on teen pregnancy. The menu of interventions offered by HHS, however, makes no distinction between the programs backed by strong evidence and those where the evidence is less robust. All 28 interventions, it seems, are equally fundable. A different approach may be a comprehensive framework akin to that used by the Greater London Authority, which oversees the 32 local authorities across London. The Authority’s framework allows programs to be rated and compared. HHS has made recommendations about how to use these evaluations to refine the approved list of interventions over time. The hope is that more effective programs will take the place of weaker one as the evidence comes in. So, while there may be disagreement about the current menu choice, the proof, it seems, will be in the pudding. Applications to HHS for the competitive delivery tender are due 1st June 2010. Follow this link for more information.ReferencesThe Coalition for Evidence-Based Policy, HHS’s evidence-based teen pregnancy prevention program: excellent first step, but only 2 out of 28 approved models have strong evidence of effectiveness. Press release 5th May 2010. Office of Adolescent Health, Office of Public Health and Science, U.S. Department of Health and Human Services (2010) Teenage Pregnancy Prevention: Replication of Evidence-based Programs. Funding Opportunity Announcement and Application Instructions.

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