Baylor Teen Health Clinic

Philosophy

History

The Program

Teens in a clinic waiting room are somewhat a captive audience, and the Baylor Teen Health Clinic uses this to its advantage. While waiting rooms in most clinics are filled with bored clients anxiously checking the time and listlessly looking through magazines, the Baylor Teen Health Clinic waiting room is busy with interactive educational activities. These interactive sessions, facilitated by health educators, are usually in the form of games, such as "The Wheel of Misfortune" and "Condom Bingo." There is also a condom club in which participants receive prizes, such as earrings, beauty and health aids, and school supplies, each time they return without having contracted a STD or without getting pregnant. Baylor Teen Health Clinic acquires these incentive gifts by participating in the United Way, "gifts in kind" program, through which companies donate products to the United Way, and programs are then able to purchase items at a reduced cost.

Clinic services at the seven sites include prenatal care, postpartum care, family planning, STD testing and treatment, HIV testing and counseling, school physicals, work physicals, sports physicals, and immunizations. Additional services for males include screening for testicular cancer and instruction for testicular self-exam. Sport and work physicals have been an especially great draw for male clients since initiated in 1977. Intensive case management, social work services, and counseling are also offered.

Community Outreach and Education

Specifically for males, the Baylor Teen Health Clinic sponsors "For Males Only," a series of conferences targeting young men in the community. These conferences are held on Saturdays with workshops in the morning and a basketball tournament in the afternoon. Each conference has an overarching theme that conference workshops expand upon, such as teenage pregnancy, life skills, drugs and alcohol, and sexuality. Approximately 40 individual at-risk males are recruited to attend each conference; the first two conferences drew about 75 percent of the targeted population. Participants are recruited by male outreach workers primarily from housing projects, juvenile probation centers, and schools. Speakers from various community organizations and from the broader community are invited to present workshops at the "For Males Only" conferences.

The goals of the "For Males Only" program are to prevent unplanned pregnancies, reduce drop-out rates, improve academic performance, expand knowledge of community services and resources, and improve employment skills. Funding for the conferences and transportation for the participants are contributed by local companies.

Baylor Teen Health Clinic educators also provide group education to adolescents at schools, churches, and community centers. Two of the male health educators work primarily with young African American males in the community. Each of these educators provides weekly or biweekly visits to approximately 10 to 12 schools each year, with presentation topics depending on the students' needs. Topics are generally related to such issues as gang violence, STDs and HIV, sexuality, birth control, establishing paternity, and dating. In all of their community and school-based work, the health educators inform the teenagers about available clinic locations and services and encourage males to access these services.

Participants

Female clients have always been encouraged to bring their partners in for services. Initially, the clinic provided services to partners only if they were less than 20 years old. This precluded many males from receiving services because some of the adolescent female clients had partners who were not teenagers themselves. Beginning in the late 1980s, Baylor Teen Health Clinic began to see male partners regardless of their age. As a result, the clinics have seen an increase in the number of males served and have also noted a lower chlamydia reinfection rate in their female clients.

The majority of the males seen tend to be very low-income, without health insurance and dependent on the teen health clinic for all of their health care needs. Currently, about 65 percent of clients are African-American, 20 percent are Latino, and the remainder are white. Aside from partner treatments, word of mouth through partners or friends remains the most effective way of bringing adolescent males in for clinic services. The male health educators who facilitate the "For Males Only" conferences have been instrumental in making young men aware of clinic services and locations by fostering a sense of trust between the males and clinic staff.

The Baylor Teen Health Clinic has built up an extensive referral network over the last 25 years that has been helpful in recruiting males for family planning services. Other local providers often refer teens, both male and female, to the Baylor Teen Health Clinic for reproductive health services. At the same time, this referral network serves as a resource for clients whose needs cannot be met at the Teen Clinic.

Funding

Staff

Barriers

The process of just getting to the clinic is a barrier for many clients. Although the clinic will give out bus tokens to those who request them, clients may have to take two or three buses to get to a clinic location. Many clients are discouraged by the long bus rides, and the effort involved in negotiating the Houston public transportation system.

Finally, the clinic staff believe that males are not as familiar with the health care system as are females. They are not accustomed to seeking out preventive services, only going to a doctor's office when they are sick or injured. Therefore, extra effort must be put into motivating males to come in for reproductive health care and encouraging female clients to bring their partners in for services.

Brothers to Brother

Philosophy

History

The Program

Although not all of the sessions deal with issues of pregnancy prevention directly, Jefferson states that the concepts introduced in the lessons build upon each other, helping the young men to make wiser decisions in all areas of their lives. For example, the presentation on cultural esteem does not directly discuss pregnancy prevention; however, cultural esteem is tied into a positive self-image that, in turn, leads to more responsible decision-making behaviors, including those regarding sexuality. Throughout the first four sessions, participants focus on goals and values and work to develop a stronger sense of personal identity and pride. With this foundation, they can begin to see options outside of sexual involvement, substance abuse, and violence. The group then tackles these behavioral issues more directly. The young men often take field trips that relate to the different lessons, such as a visit to a cultural museum, an African-American-owned business, or the Health Department facilities. In addition, participants are rewarded for their involvement with cultural incentives such as Kente pens, folders, T-shirts, and notebooks or dog tags that picture the Brothers to Brother logo.

Although the curriculum is only five weeks long, Jefferson stresses the importance of not abandoning the young men after these initial five weeks. In order to foster the skills that the participants have learned throughout the curriculum sessions, the mentors continue to meet with the young men once every two weeks over the next six months. Through these meetings, the mentors provide the young men with new information, take them on field trips, and monitor their progress. At the end of this six months, peer mentors continue to follow up with the males every three months. Jefferson says, however, that these more periodic follow-ups last for only about seven or eight months because many of the participants relocate and become difficult to find.

The Brothers to Brother program makes concerted efforts to involve the participants' parents in the program. During the fifth and eighth weeks of the family life education sessions, the project holds a Parents' Day during which participants and parents gather to share information that the young men have learned in Brothers to Brother. To convey their new knowledge, participants often prepare verbal presentations or posters. The program also holds a graduation ceremony. In addition, Brothers to Brother sponsors an annual health fair in which participants, past participants and parents come together to enjoy cultural entertainment, educational exhibits set up by local agencies, and food donated by local businesses and restaurants. Medical and dental screenings are offered to participants as well as health information. The "Mr. Teenage Ebony Male Scholarship Showcase" is a major fair event. Participants are given the opportunity to display a selected talent with the first-place winner receiving $500 in scholarship money. The young men typically display such talents as singing, art work, poetry recital, dancing, or academic works.

Brothers to Brother participants are granted free access to the County Health Department services, including STD screening and treatment and free condoms.

Evaluation Findings

A formal evaluation of Brothers to Brother was completed by AFCOM Consultants in 1994-95. The evaluation revealed that participants showed aggregate increases in positive attitudes toward "male and female sexual expectations," such as a belief that abstinence is a good choice and contraception is both a male and female responsibility. Participants also showed an increase in positive views toward their community.

Participants

Jefferson states that in the early days of Brothers to Brother, staff members went door to door to let community members know about the program. The program is now well established, serving more than 100 participants per year, and no longer uses specific outreach efforts. When asked what attracts young men to the program, Jefferson states that participants value the constancy of the staff. Under all circumstances, peer mentors show up to give the presentations. This dedication offers the young men a sense of stability on which they grow to depend.

African-Americans make up 96 percent of the Brothers to Brother participants. Because one of the primary goals of the program is to build cultural esteem among African-American youth, many of the concepts and activities are based in African tradition and beliefs. The program serves boys between the ages of 9 and 14, all of whom are from urban, low-income families. Fully 96 percent of these boys come from single-parent homes, and 95 percent have more than four people living in their households. According to Jefferson, about 5 percent of the boys are sexually active but none have fathered a child.

Funding

Staff

When a participant graduates from the program at age 15, he becomes eligible to be a peer mentor; however, former participation in Brothers to Brother is not required. The mentors are trained in the curriculum by the Health Department educators. Currently, the project has four student mentors, with each facilitating a presentation at two sites per week and receiving a stipend of $5.93 per hour. Each mentor is paid for a total of 10 hours of work each week, which includes group facilitation and peer mentor meetings.

Barriers

Compass

Philosophy

History

The Program

Compass is primarily delivered in the form of small, one-hour group sessions held once per week. Rodriguez, the program's coordinator and outreach worker, dedicates the first several group meetings to discussions on "nonsexuality" issues in order to build a sense of comfort and rapport with the young men. Introductory topics may include peer pressure, self-esteem, school drop-out, drug and alcohol abuse, and gangs. Once members of the group have become more familiar with each other, the facilitator moves into discussions of sexuality, addressing such topics as relationships and decision-making, contraception, STDs/HIV, male responsibility, and gender roles. Compass places great emphasis on how to make decisions about whether or not to be sexually active. The curriculum stresses the fact that abstaining from sexual activity is an option that is both viable and respectable. Rodriguez says that although most young men will resist the idea of abstinence, he continues to plant it as an "alternative" seed in their minds and to enforce the notion that they do have choices.

In addition to group work, Rodriguez has some time for one-on-one interaction with the males during regular sessions. He will also make arrangements to meet individually with students outside of regular class time if they desire.

Compass's messages are based on the theme that premature fatherhood will most likely present negative consequences for a young man throughout his life. Rodriguez leads the participants to consider the possible outcomes of early fatherhood, such as financial obligation to a child, difficulties in pursuing an education, and changing relationships with friends and family. He then asks the young men to envision their lives at different stages, first as a teen father and then as a young man without a child involved in a healthy relationship. The young men decide which scenario appeals more to them and what steps they will have to take in order to achieve the future lifestyle that they most desire.

In addition to small group discussions, Rodriguez uses active participation and video presentations to reinforce the Compass messages. Among the activities, Rodriguez believes that the "empathy belly," an artificial belly that can be worn to simulate pregnancy, is especially fun in helping males to understand the physical discomforts that pregnancy can present.

Participants

Compass targets young, low-income males in grades five through twelve in the Fort Worth Independent School District. About 90 percent of the participants are Mexican-American and the other 10 percent are either African-American or white. Almost all of the participants are native English speakers. Before starting the program, students are asked to complete anonymous pre-program surveys that cover the extent of their sexual involvement and measure their knowledge of sexuality information. Of those participants in middle school and beyond, Rodriguez says that about one-half report being sexually active; however, last year only one young man reported being a father.

The young men whom Rodriguez sees are greatly influenced by their neighborhood conditions. Rodriguez says that "some of these guys (in the community) have lived by age 18 more than most people have lived their whole lives." Their environment can play a large role in their decisions to drop out of school, have unprotected sex, or take drugs. Many young males in Tarrant County feel that there are no life course alternatives and that they must settle for the situations into which they were born. Compass attempts to give them enough empowerment to make positive choices and take control of their futures.

Funding

Staff

Barriers

Dads Make a Difference

Philosophy

History

Around the same time, the State of Minnesota also began emphasizing the importance of father involvement. In 1993, voluntary establishment of paternity in hospitals at birth was established by law. In addition, legislation was also passed in 1993 to promote and fund male responsibility and responsible fathering programs that would focus on the connection between sexual behavior, adolescent pregnancy, and the responsibilities of parents, particularly those of fathers.

Program Development

The collaborative team conducted eight single-sex focus groups with 55 male and female middle school adolescents to learn what youth knew about parenting issues, to assess their attitudes about their fathers, and to understand the best way to reach them with fatherhood prevention messages. Based on feedback from the focus groups, the DMAD collaborators created the curriculum's messages, produced a video that would be entertaining to teens, and developed a peer-education strategy.

DMAD is now gaining a strong national reputation and is regarded by other states as a model male responsibility and child support program. In 1995, DMAD was funded by the U.S. Attorney General's office to be developed into a statewide program. Under this grant, the program has begun training for youth from 92 schools statewide. DMAD is currently working on replication within the State of Massachusetts. In addition, requests have come from other states that are interested in passing similar state male responsibility legislation and implementing statewide programs.

The Program

The focus groups that were conducted with middle school students in 1993 demonstrated that among youth, sexual activity is conceptually disconnected from parenthood. The program seeks to reconnect these themes in the minds of young people by relating the potential consequences of early sexuality to the legal, financial, and emotional responsibilities of parenthood in general, and of fatherhood in particular. The program coordinator refers to this approach as "above the waist" pregnancy prevention, a term coined by Michael Carrera of the Children's Aid Society in New York City. DMAD provides messages about abstinence and protection, but offers no explicit instruction on the use or availability of contraception. Whether or not this information becomes integrated with the DMAD curriculum is left up to local school districts responsible for the implementation of the program. However, DMAD Coordinator Gary Greenfield believes that the impact of the program improves when the curriculum is complemented by information about contraception, providing sexually active youth with the tools to prevent pregnancy and disease.

DMAD uses a peer-led approach and trains male-female pairs from high schools all around the state to be "teen teachers" for their area's middle schools. The peer-led approach arose from suggestions made by focus group participants. One participant had said, "If a young father came in and talked about what happened to himself, I would sit up and listen."

Training

Teen teacher training sessions last for two days and consist of learning the curriculum's content as well as techniques for presenting the curriculum to middle school students. Trainees practice teaching the curriculum and are confronted with "tough," sensitive questions that they might be asked in an actual classroom setting. The basic concepts in teen teacher training are:

The training team consists of one adult male trainer, one adult female trainer, a child support specialist, and acting teen teachers who have previously been trained and demonstrate leadership. The training site may be a forest reserve, a large motel, or even a convention center, depending on the size of the group and the preferences of the local sponsors. Usually training sessions are overnight retreats, but can also be conducted as day sessions only. Training groups vary in size but may include as many as 100 students— 25 teens in each of four groups.

Teaching

After being trained, high school students return to their respective schools, where they will teach the four-part curriculum to middle school students. Schools send a male-female pair of students, accompanied by an adult supervisor from the school, to balance the content and meaning of messages and to maximize the program's impact. At this point, the implementation and outcome of DMAD is up to the local school boards. The program is designed to be completed in four 50-minute lessons, though this may vary depending on the schedule allowed by the school and the availability of the teen teachers.

The DMAD curriculum consists of four modules:

Lesson 1: Risky Business

Defining risk.
Recognizing risky behavior.
Dads Make a Difference video: An 18-minute video featuring teen parents.

Lesson 2: Being a Legal Father

What it means to be a dad, legally and biologically.
Why paternity benefits the father, the mother, and the child.
How paternity can be established in Minnesota.

How families can differ from one another.
Ways in which fathers and mothers provide support for their children.
How child support works in Minnesota.

Lesson 4: Decisions Are for the Making

How risks can alter one's future.
How people are responsible for their choices.
Creating a vision for the future.

Lessons include information about abstinence or delaying sex, communication skills, decision-making skills, consequences of early parenthood, child support, and fathering skills.

A formal evaluation was conducted by the Wilder Research Center (St. Paul, MN) in the fall of 1995 in order to assess, first, the impact of training on teen teachers' knowledge and attitudes, and second, the impact of the curriculum on middle school students to whom it is presented. As a result of the training, teen teachers were shown to have improved their ability to define paternity and to identify the benefits of legal fatherhood. Middle school students were also shown to have improved their knowledge of paternity issues.

DMAD is currently making an effort to adapt the training sessions and curriculum to different cultural backgrounds. Greenfield recognizes that progress in reaching the Southeast Asian community has been slow, that the needs of Native American groups must be further explored, and that the curriculum needs to be translated into Spanish. However, as DMAD prepares to devote more resources to serving inner city youth, the program has received funding to investigate the cultural barriers that are inherent in the DMAD curriculum. Two Southeast Asian groups have brought teens to training and have begun to implement the program.

Other Activities

DMAD has developed a 60-page training manual so that others can replicate Minnesota's program. Included in the manual are suggestions for how to select appropriate students and supervisors and how to implement the program. DMAD is pilot testing a booster curriculum to reinforce and expand lessons for older high school students. Finally, DMAD has hired a contractor to develop materials for parents of middle school children.

Participants

Funding

Staff

DMAD recently hired a full-time urban community program specialist to coordinate and supervise paternity education in the Minneapolis/St. Paul school system.

DMAD contracts with sexuality educators, schoolteachers, and experienced teen teachers to help facilitate the new teen teacher training sessions. Both adults and teen trainers are paid a stipend to conduct the two-day training.

Barriers

Getting males to become involved and stay involved has been another barrier faced by DMAD. Recruiting males to attend teen teacher training sessions can be difficult, and males tend to drop out more often than females. The program needs to be perceived as fun and not a female-centered initiative. Employing male adult trainers and supervisors can have an influence on male participation. Moreover, the adults need to be able to address sensitive subjects and speak in language to which youths relate.

Greenfield thinks that evaluating the impact of an educational program such as DMAD on pregnancy prevention is difficult, given that the outcomes are often long-term, behavioral, and subject to many internal and external sources. Still, there is pressure from funders to demonstrate impact on youth sexual behavior resulting from a one-year program. The program seeks to conduct longitudinal evaluation and analysis to be better able to prove the impact of DMAD.

Finally, the program has only limited staff to assist various replication sites in working out any challenges that they might face. If DMAD had extra money, it would expand local staff by placing coordinators at the county level around the state. Staff expansion would also free up Greenfield's time to increase collaboration, to promote replication elsewhere, and to develop a systematic way to keep track of the implementation of DMAD around the state.

Fifth Ward Enrichment Program, Inc.

Philosophy

History

The Program

FWEP incorporates a variety of activities to allow participants the opportunity for personal growth in several areas. Young men are active in field trips, community service, drama, chess, arts, camping, and competitive sports. To foster empowerment, FWEP facilitates four leadership skills retreats per year through which males build skills to become peaceful leaders in their schools and communities. McMillan stresses the importance of taking the young men out of their neighborhood environment to help them gain a different perspective. He likes to take the young men to a nearby campground, such as the Prairie View University campground or the YMCA camp. At these retreats, young men do group exercises that involve team work, such as ropes courses, and they are given an opportunity to work and communicate with young men with whom they would not normally associate.

Academic achievement is a strong focus of FWEP. FWEP awards good school attendance and academic improvement with points that can be redeemed for merchandise at the H.P. Carter Middle School store, which operates once per month. The store sells a variety of items including pencils, T-shirts, and radios. The program hopes that the buying power of the points will teach young men the benefits of delayed gratification. Rather than redeeming their points immediately, participants can save them up to buy something of greater value. In addition, FWEP sponsors academic clubs that incorporate competition through culturally relevant spelling bees and creative writing projects that involve Latino and African-American themes. Teens can also participate in non-academic clubs. For example, participants in the Teen Enterprise Group engage in after-school work such as computer repair and community gardening.

In addition to its close work with the school system, FWEP collaborates with local law enforcement, health providers, and church organizations. Recognizing the multiple needs of young men, the program often refers participants to neighborhood resources, such as community teen clinics and outpatient drug and alcohol support groups.

Summer Activities

FWEP offers summer activities to keep its participants off the streets and involved in enriching experiences while they are not in school. The summer program includes paid employment in the community; participants receive a stipend of $10 per day for doing such work as mowing lawns, setting up burglar bars, and moving furniture at schools. Older boys, ages 15 to 17, are engaged in teen enterprise projects that operate businesses such as bike repair, computer repair, silk-screen printing, filmmaking, and urban gardening. Life skills classes similar to those offered during the school year are also incorporated. The summer program welcomes males from communities surrounding the Fifth Ward; 20 percent of summer program participants come from outside communities. McMillan believes that summer programming helps keep the young men on the right track.

Participants

FWEP participants are mostly referred to the program by teachers and school administrators. The program staff establishes ongoing communication with the participants' teachers in order to work together in assessing the students' progress. In addition to those referred by the school, 10 percent of participants are court mandated to attend the program.

FWEP works with young men from four target schools who are ages 10 to 17. McMillan tries to involve males who are engaged in negative activities such as drugs and risky sexual acts, or who have dropped out of school. On the other hand, McMillan also seeks to involve young men who have distinguished reputations in the neighborhood as peacemakers. In all cases, the program tries to set males on the right track by showing them positive pathways for development.

Participants are typically involved with FWEP for three years. Many, however, choose to stay in the program from the fourth grade until high school. The program participants need to attend the program at least three times per week. Participants have the option of attending recreational activities after attending a minimum single counseling session each week.

Parental Involvement

McMillan believes that FWEP could not be successful without parent involvement. To this end, FWEP makes a great effort to inform parents of current activities. Periodically, the program sends out a newsletter to update parents on recent program plans and events. Parent workshops and support groups are also sponsored in order to facilitate communication between parents and the program. Finally, FWEP hosts parent/child social activities such as holiday parties.

With an eye for prevention and mediation, FWEP staff provides home visits to help address domestic problems or to resolve specific incidents. Through these visits, staff offer individual counseling and parent conferences to open the lines of communication between family members. Parents have an opportunity to learn of their son's progress in school and in FWEP. In turn, if the home visitor discovers significant problems in the home, the schools are made aware of the situation. If staff detect more serious conflicts, the family is referred to a clinical psychologist who works on contract with FWEP.

Funding

Staff

Barriers

Hablando Claro con Cariņo y Respecto

Philosophy

Hablando Claro is a community-based strategy that involves many segments of the community in a collaborative process. The creation and maintenance of consensus across a wide constituency, especially around sexuality, is a challenge that Logan Heights Family Health Center has undertaken through the experience with Hablando Claro/Plain Talk.

History

In the planning year, a program director was hired, and a Community Core Group was organized, composed of fourteen adolescent and adult Barrio Logan residents who could convey the concerns and needs of the larger community. In order to further assess the community's needs, organizers designed and administered two neighborhood surveys to collect information about Barrio Logan's population characteristics, the area's family planning services, accessibility of services for adults and adolescents, and residents' knowledge, attitudes, and beliefs regarding contraception and sexual practices.

In meeting the program's goals, the program staff has made deliberate efforts to include males in the design and implementation of the Hablando Claro classes, training sessions, and community events. In the initial community survey process, the adult and adolescent males in the neighborhood were given the opportunity to describe their specific sexual health needs to help shape the program services offered by Hablando Claro. Through these surveys, LHFHC staff learned that teen males felt that their needs were not being addressed in the clinic and that they were being excluded from discussions and information about reproductive health. Staff also learned that many teens found it difficult to reach the teen clinic in order to make appointments. In response to these concerns, LHFHC has conducted teen in-service training sessions for its clinic staff to heighten awareness of teen issues and sensitivity to male inclusion. The phone system has also been changed to provide an extension that offers direct access to the teen clinic. In response to males' needs specifically, LHFHC hired a male outreach worker and has incorporated male peer educators to work in the clinic. Flores believes that the strategies involved in this careful implementation process have both been critical in retaining community and especially male interest in the Hablando Claro program.

The Program

In-home communication forums made up of six to eight adults and adolescents are held in a community member's home. These forums are guided by the Vecino-a-Vecino (Neighbor-to-Neighbor) curriculum, a four-part sexuality education curriculum developed in Spanish by the Hablando Claro staff. The curriculum is delivered by core group members, "Promotoras," who are trained and supervised by outreach workers. The four-week course includes five modules: an overview of the Hablando Claro program; Puberty and Sexual Development; Anatomy and Physiology; Reproductive Health and Contraception; and Self-Esteem and Effective Communication. Through role playing, adolescents and adults are able to increase their levels of communication and enhance their knowledge about human sexuality. In an effort to make the materials more accessible, the curriculum can also be found at the local public library.

Because Hablando Claro is a community-based initiative, collaboration with other community organizations is fundamental to the program's goals. Health care referrals for both teens and adults are made to LHFHC or Comprehensive Health Centers, while referrals for social services are made to Barrio Station, a social service agency for youth in the Barrio Logan neighborhood. Community education and community core group meetings are held at the three local schools while training sessions are held at the Boys and Girls Clubs and at the Memorial Recreation Center. These collaborative efforts are designed to increase familiarity between program participants and various service providers in the neighborhood.

Participants

Adolescents in Barrio Logan tend to initiate sexual activity at an early age. Based on data collected in the neighborhood survey, by age 11, 70 percent of adolescents have engaged in some form of sexual activity. By age 16, more than half of the adolescents in the community have had sexual intercourse. Despite the high levels of sexual activity, Barrio Logan teens infrequently use neighborhood contraceptive services or talk with their parents about sexuality issues. Only 34 percent of adolescents reported that they would discuss a sexual problem or concern with their parents, while 75 percent of parents reported feeling at least some uneasiness in discussing sexual issues with their children. Barrio Logan adolescents also very rarely seek advice about sexual concerns from adults in community institutions outside of the family, such as schools and churches. Concurrent with these findings, by age 18, at least 40 percent of Barrio Logan female adolescents report having been pregnant, and rates of sexually transmitted diseases are high.

Hablando Claro sees male involvement as critical in protecting adolescent health and actively seeks to include males in all programming. Last year, Hablando Claro reached approximately 1,000 Latino males from Logan Heights through outreach, educational sessions, and community events. An Hablando Claro male outreach worker actively recruits men to participate in the community events. He targets locations where males in the community tend to congregate (e.g., basketball courts, recreation centers, mechanic and auto body shops) and invites the males to take part in Hablando Claro events. Hablando Claro also attracts participants through word of mouth in the community, door-to-door canvassing, and asking female participants to involve "their men" (brothers, boyfriends, sons) in Hablando Claro events. The program director believes that the word-of-mouth approach is by far the most successful method of recruitment. In addition, the distribution of small gifts at community events helps to generate enthusiasm and participation in program events.

Funding

Staff

Barriers

Although males may initially attend the Hablando Claro educational sessions, their interest often begins to wane. Whereas women in Barrio Logan are motivated to learn about pregnancy prevention, men in the community often do not personally identify with the risk of unintended pregnancy. To combat this lack of interest, program staff have focused their all-male educational sessions toward HIV and other STDs, which may be of greater personal concern to men and offer more incentive for preventative behaviors.

HiTOPS

Philosophy

The second fundamental HiTOPS principle is that sexual health and healthy relationships are built on a foundation of respect. Outcomes ranging from pregnancy and harassment to violence and rape are seen to result when respect is lacking in a relationship. Taking a prevention strategy, HiTOPS targets younger adolescents so that they can learn the importance of respect in relationships early on.

History

The Program

HiTOPS supports teen peer sexuality education throughout three counties in Central New Jersey and provides medical services and counseling to teens in the Princeton area. The central feature of HiTOPS is the Teen Council, a group of high school seniors, half males and half females, that facilitate presentations in schools and organizations, serve as role models to other youth, and refer youth to HiTOPS services. Princeton area high school juniors are invited to apply to the Teen Council every year. The 12 males and females selected for the Teen Council are led through a three-day orientation and team-building retreat followed by five half-days of training prior to their senior year. During the school year, peer leaders are expected to attend a 3-hour weekly meeting as well as any scheduled presentations.

HiTOPS has developed its own curriculum for use in training peer leaders. Training covers a wide range of topics including puberty, HIV/AIDS, gender roles, contraception, homophobia, and sexual violence. Speakers' panels are used to give trainees a first-hand look at issues from a personal perspective. For example, peer leaders interact with a panel of persons living with HIV/AIDS and a panel of gay, lesbian, and bisexual college students.

Parker describes student-led presentations as non-threatening, noisy, interactive, and activity-based. Although facilitated by the teens, presentations are always attended and supervised by HiTOPS staff. The teen leaders incorporate skits, improvisation, and other interactive learning techniques to present topics ranging from HIV and pregnancy prevention to sexual harassment and acquaintance rape. The students are then broken down into smaller groups to participate in activities and discuss sensitive issues. Students in local schools are exposed about three times a year to these presentations over the course of several years. For example, the current older high school students have participated in HiTOPS annually since they were in middle school.

While HiTOPS does not offer a separate male-only component, recently it has placed special emphasis on male involvement in peer education and in the development of male-oriented clinical services. Occasionally, HiTOPS supports peer-led, all-male presentations either in public schools or in organizations and private schools that only serve male adolescents. In male-only groups specifically, Parker observes that boys feel freer to ask questions that they would otherwise be embarrassed to ask in mixed gender groups out of fear of sounding sexually inexperienced or ignorant. In addition, she finds that older adolescent males do not like to raise issues about communication, safety, and values; such topics tend to be more comfortably discussed at older ages if introduced when the males are younger.

Clinic Services

Medical services are offered to females at the HiTOPS adolescent health center, including contraception and free condoms. Individual, couple, and parent/child counseling are also offered on site to address issues pertaining to pregnancy, pregnancy options, and HIV/AIDS. Referrals are made for services not offered at HiTOPS, for example, to the Princeton teen substance abuse clinic for drug-related counseling and clinical services.

Except for condom distribution and presumptive partner treatments, HiTOPS does not currently have the capacity to provide health services to males. To meet males' needs, the program refers them to a local teen clinic or to an area urologist. HiTOPS has not found either service satisfactory for adolescent males, however, because neither offers counseling services to complement the medical care. The program continues to look for a medical practitioner who would provide appropriate on-site male health services.

Outreach Efforts

HiTOPS' outreach efforts are devoted to promoting the development of Teen Councils in established youth organizations, primarily those in neighboring urban communities most affected by high rates of teen pregnancy and HIV infection. HiTOPS offers technical support and staff training to both developing and existing programs on how to establish and run peer-led education programs. Presently, Teen Councils are active in six urban areas surrounding the Princeton community with plans for another that will serve juvenile offenders in the Trenton community, the majority of whom are male.

Participants

Because the educational sessions take place during school hours, participation in school-based activities is usually mandatory. Parker feels that teens really want to be part of HiTOPS, however, because it offers them "responsibility," "structure," and "fun." HiTOPS' good reputation is evident, as many of the clinic clients and peer leaders hear about the program by word of mouth. Parker says that "when you have a good track record, kids will talk about you." She also feels that adolescents are naturally curious about sex and sexuality; the fact that it is "always on their minds" makes recruitment that much easier.

Funding

Staff

Barriers

A major barrier to getting HiTOPS up and running in the initial year was opposition from religious groups who were opposed to the program's activities on moral grounds. HiTOPS was able to overcome this opposition by getting its curriculum approved through formal school board channels and keeping a low profile.

Involving Males

Drawing males into the peer leadership program and into clinical services has proved to be difficult. In response to community interests to increase male involvement, HiTOPS has placed special emphasis on increasing male participation as well as male services. Until only recently, HiTOPS had few male candidates to serve as peer leaders. After five years of building a strong reputation, however, the program has had success in attracting many more male candidates to volunteer for this position. Parker says that being involved in the program has become "cool" for both boys and girls. In addition, HiTOPS currently has a male adviser on staff working with the Teen Council, which makes the program seem friendlier to males.

Providing health services for males remains a challenge. The fact that adolescent males tend to use clinic services irregularly makes supporting a doctor on-site financially difficult. Males are currently referred to a private urologist, but payment of these private services usually requires use of parental insurance, a problem for young men who want to maintain confidentiality. HiTOPS is looking for a practitioner who can serve males' health needs so that HiTOPS can ensure that appropriate counseling for males will be provided with medical services.

Evaluation

HiTOPS has been unable to successfully conduct an outcome evaluation of its program. Despite having received a grant for evaluation purposes, the project was thwarted when the school board would not allow students to be asked questions concerning sexual behavior. HiTOPS was included, however, in a 1992 World Health Organization/International Youth Foundation report on replicable approaches to adolescent health and development. In this exploration of programs worldwide, HiTOPS was considered one of the most successful and replicable because of its structure and its approach.

Hombres Jóvenes con Palabra
(Young Men with Word)

Philosophy

History

Today, Tello both delivers his curriculum to urban youth in Los Angeles County and provides training to other program providers across the country who wish to deliver HJCP in a variety of capacities and settings. Currently, HJCP is implemented both as a stand-alone program and within the context of the larger Rites of Passages program, a comprehensive 32-session life skills curriculum. In providing training and consultation for HJCP, Tello first does an assessment of the agency that would like to deliver the program, looking at the agency's goals, staff, strengths, and weaknesses, and its relationship with its community. He tailors each training so that an individual agency may deliver HJCP in a way that will be most effective for its particular situation and community.

The Program

Session 1: This session addresses the question of what it means to be a man with "word." In this session, the young men explore whom they "represent," such as family members, friends, or girlfriends, in order to appreciate that they are part of a larger network in which their actions can affect others. The group begins to explore issues of sexuality and sexual responsibility through the use of "consequence cards" that present different outcomes to risk-taking choices. Tello likes to present various situations in which the young men are forced to choose an action; this generates discussion of what the consequences might be. For example, he may present a scenario in which a young man's girlfriend would like to have sex but does not want to use a condom and ask the group, "What should you do?" Participants who choose to have sex without the condom must take a consequence card that will state an outcome such as "You are HIV positive," "You got your girlfriend pregnant," or "You were smart and decided to wait." The consequence cards are used throughout the entire curriculum to continue to enforce the notion of serious outcomes for one's actions.

Session 2: Session 2 focuses on the differences between "manhood" and "maleness." More specifically, "maleness" refers to male physiology and puberty, including sexual urges and expectations. "Manhood" refers to taking sexual responsibility by either abstaining from sexual activity or using contraception to prevent pregnancy.

Session 3: Session 3 is called "El Coyote" or "life's trickster." This session focuses on unwanted pregnancy as a symptom of deeper life pains, dilemmas, or challenges. These life challenges may lead to behavior that places the young men and their partners at risk. According to Tello, this session touches on the very foundation of behavior change needed to prevent unwanted pregnancies. He approaches this issue with a story of a coyote that does not want to be a coyote. Rather he wants to be high like the eagle, isolated like the bear, or aggressive like the lion. Through this story, the young men address the issue of having an identity and wanting to be something different. They discuss reasons why someone might not like who he is, such as negative racial stereotypes, family problems, and societal expectations. Tello says that many of the stereotypes and falsehoods around manhood—such as the "macho Latin lover"—have been taken to heart by these young men. This session focuses on redefining oneself based on being un Hombre Noble (a Noble Man) and exploring deeper pains that might lead to repeating cycles, particularly for those who grew up in homes with absent fathers. In this session, sexually transmitted infections and particularly symptoms and indications of an infection are also addressed.

Session 4: This session incorporates role plays that allow participants to apply the concepts they have learned to being a noble man. The facilitator presents situations depicting sexuality or violence that would tempt the young men to stray from the principles they have learned. The group then explores ways to keep their word such as hanging out with other young men who have "word," focusing on principles, and being honest with oneself. Being honest with oneself includes carrying contraception if you are sexually active. In this final session participants are given a "Palabra" card that includes community resources.

The Participants

HJCP as Delivered by Bienvenidos Children's Center, Inc.

Bienvenidos Children's Center, Inc., is only one of several programs that has adopted the HJCP curriculum in providing services to young men. Their specific program, however, offers a closer look at the way in which HJCP can be used to bring the males in a community together.

The Program

Kappos states that the concept of "palabra" is absolutely fundamental to the program, and Bienvenidos focuses on this concept in its promotion of HJCP. The agency hands out T-shirts and puts up billboards within the community featuring the word "palabra," which young men identify as meaning a "man of dignity," one who is true to his word.

Funding

Staff

Currently, HJCP is run by a coordinator working at 75 percent time, as well as an outreach worker, a presenter, and a "Compadres Network" organizer, all working at 25 percent time. Five young fathers also work part time as outreach workers and presenters.

It Takes Two

Philosophy

Because IT2's message lies in the notion of "shared responsibility," the program is very flexible and can be adapted to a wide variety of environments, topics, and community values and needs. For example, the curriculum may easily function as an abstinence-only program, or it may incorporate information about contraception for sexually active teens.

History

The Program

Classroom/Group Presentations

IT2 is most commonly implemented in the form of classroom-based group presentations. The program is very flexible and can encompass 3 to 15 sessions. Klaus, however, believes in a strategy of "the longer the better." He thinks the program should be delivered longitudinally in three sessions per year over the course of three to five years. His position is supported by evaluation findings that have shown that IT2's impact on student behavior remains the same regardless of the number of sessions to which they are exposed in a single year. Therefore, Klaus feels that rather than hitting the teens over the head with the material all at once, the program is more useful when the messages are delivered consistently over the course of several years. Regardless of the format, IT2 is always delivered by a male/female presenter team in an effort to model a positive relationship between the two sexes.

Throughout each year, the themes of the presentations and the basic philosophy of the curriculum remain the same. However, the activities used to convey these messages change with each consecutive year to become appropriate for each age group. In a typical delivery setting, three topics will be covered within three days of presentations: "Parenting as a Major Life Decision," "Relationships: The Search for Love," and "Sexual Decision-Making."

Klaus believes that the second session, "Relationships: The Search for Love," is the most critical of the program. Essentially, this session explores with students the way in which the quality of relationships may make us more or less likely to take risks. Relationships are presented as a triangle, with one side being "respect," one side being "trust," and the base being "honesty." IT2's basic message is that if two people are honest in a relationship, then trust and respect will follow, creating a healthy relationship. The curriculum takes the stance that when teens establish quality relationships, they can feel comfortable with their desires not to have sex and these wishes will be respected by their partners. However, if a couple does decide to become sexually active within a healthy relationship, they will have the tools and the foundation to discuss such issues as birth control and sexual history.

In discussing relationships, IT2 makes the point that both females and males need to be committed to relationships that are characterized by honesty, respect, and trust. Klaus thinks that the male attitude can have an especially great impact on a couple's willingness to take risks. He sees many young women who do have the knowledge and resources to protect themselves in a sexual relationship, all too often compromise in an effort to preserve the relationship and please the male partner. For these reasons, IT2 specifically focuses on both male and female stereotypes in order to call into question the attitudes and expectations of both sexes. For males specifically, media, cultural, and peer influences to become sexually active are discussed, as are the dangers for young men to act upon these influences in unhealthy ways. Activities such as "G.I. Joe and Barbie Go on a Date" are used to illustrate the ways in which gender roles are played out in male/female communication.

Each component of the curriculum incorporates a worksheet assignment that students must complete with their parents. The students bring a coupon back to class the next day, signed by their parents, that records how much time the pair spent completing the assignment. This parent involvement component has been shown to facilitate parent/child communication for an average of 25 to 30 minutes per night.

Independent Learning Program and Teen Parenting Program

The Independent Learning version of IT2 is designed for teens to work through the material at their own pace. This curriculum has been implemented largely in group homes, juvenile detention centers, and schools for "high-risk" youth. The program makes use of learning tools such as videos and software and can be implemented on an individual basis or in small groups. Although this curriculum does address the importance of postponing sexual involvement, the focus is placed more heavily on issues such as contraception and sexually transmitted diseases. In addition, a Teen Parent Program has been developed with the goal of preventing additional pregnancies among already-parenting teens.

Replication Trainings

In addition to its work in Polk County, the IT2 program is being replicated in other counties within Iowa and in eight other states. The replication training includes on-site training, technical support, evaluation services, a program license, and presenter's manuals. The IT2 curriculum may not be purchased without the provision of a license through formal training. Several training packages are offered including training in Des Moines for $600 per team or in the host agency community for $3,900 plus travel expenses. A Full Replication package starts at $9,100 and includes monthly follow-up, evaluation, and "training of presenters" sessions.

Participants

IT2 garnered great popularity within the school districts. Currently within Des Moines, the curriculum is implemented in seven out of ten middle schools and in all of the high schools. The program has built a well-established reputation and presenters are invited into the schools—current demand far exceeds the program's original goals. Last year, the program set out to reach 1,700 teens; however, it ultimately served 3,000. When asked what drives the popularity of the program, Klaus responds that "kids love it." The presentation style creates a fun environment in which kids can be rowdy and laugh. There is an opportunity for teens to ask anonymous questions that are always answered in a straightforward and honest way.

IT2 has also been successfully implemented in communities across the United States that contain diverse populations. Examples are Aurora, Colorado; El Paso, Texas; and Lennox, California.

Funding

Staff

Barriers

Male Involvement Program

Philosophy

History

The Program

Within the clinic setting, MIP offers males a full range of reproductive health care services as well as general and sports physicals. Prior to seeing a practitioner, each new client participates in a group or individual education session conducted by the male involvement coordinator. This session offers the young men the opportunity to gain more comprehensive education on issues such as STDs, contraception, communication, and violence against female partners. Each male is asked to take the initiative in choosing a form of birth control that is right for him, and the male involvement coordinator goes over that method with him one on one in detail. The educator presents information about the full range of contraceptive options, all of which HTC offers except for the IUD and Norplant.

Classroom

Bryant currently provides classroom presentations within 10 middle schools and high schools within Prince George's County. In delivering health education, he uses MIP's own seven-part curriculum, which covers a range of topics, including contraception, STDs/HIV, acquaintance rape, decision-making and peer pressure, relationships, and male and female anatomy and physiology. Bryant usually visits a class for one or two days and delivers the material over the course of a 45- to 50-minute class period.

Sports

MIP relies most heavily on its provision of sports physicals to attract males to the program. HTC staffs a sports medicine physician who conducts sports physicals for middle school and high school students throughout the county. HTC staff take advantage of the young men's presence in the clinic for sports physicals to offer information and discussion on reproductive health. Bryant also actively promotes physical fitness and good health in the community through posters and street outreach touting the importance of a healthy lifestyle. In addition to reproductive health, he addressed such issues as diabetes and high blood pressure.

While the sports component revolves around physicals and healthy lifestyle promotion, MIP also uses this format to discuss the sexual behaviors of popular sports figures who many of these young men see as role models. If a sports figure has been highlighted in the media for negative acts pertaining to relationships and sexual risk taking (i.e., date rape, domestic violence, out-of-wedlock pregnancy), the facilitator will use the sports star as a topic for discussion. The participants learn that even though sports figures are celebrities, their behaviors should not necessarily be models for others to follow. Through sports and nutrition, Bryant hopes to teach young males to have "discipline over their own bodies," one step toward sexual responsibility.

Ministry

MIP regards spirituality as an important key to making good decisions regarding sexual behavior. Currently, a coalition of local ministers is working to establish ministry meetings that will be held one day per week at the Healthy Teens Center. These group counseling sessions will be geared toward fostering a spiritual foundation in the young men that will help to shape their attitudes and behaviors around sexual practices, risk taking, and violence. Peer ministers will help to facilitate the sessions, sharing their personal experiences and giving personal accounts of how they reformed their own lives. The coordinating ministers hope that the youth ministers will serve as positive role models and inspire the participants to rethink their approach to sexuality.

Parenthood

To offer support to young fathers, MIP refers interested clients to the Northwestern High School Young Fathers Program. These parenting classes are designed for young men who are fathers but do not have contact with their children. The goal is to prevent future unwanted pregnancies and to help young men reestablish relationships with their children. This fathering program teaches the young men about custody rights and child support as well as how to provide for their children both financially and emotionally by setting goals and planning for their careers.

Participants

Bryant uses extensive recruitment efforts to lure males to HTC. He ventures to community sites that are characteristically male, such as basketball courts and recreation centers, to get the word out about male services at the teen clinic. Bryant explains that he targets "all types, anybody. If he looks like a man, I got him." He also recruits males with fliers, pamphlets, at project fairs, and through word of mouth.

Funding

Staff

Barriers

Male Involvement Program

Philosophy

History

Programs

Whatever the topic covered, Buscemi delivers that material in a way that will engage the participants. Many workshops involve "forced-choice" activities in which participants confront difficult situations, such as "if a girl you really like wants to have sex, what should you do?" Participants are asked to make a decision and defend their positions. Presenting this situation encourages discussion among the group about what decisions could be made and what the consequences of each decision might be. Buscemi states that young men are able to absorb much more information on sexuality-related issues in all-male groups because they "don't have to put on an act in front of the girls," and they feel more free to ask questions. He also allows the young men to use comfortable terms and language in discussions, as long as everyone in the group has a clear understanding of what is being talked about.

One of the strengths of the Male Involvement Program is its connection to the PPNC health center. Young men are referred to the health center if they need further information, contraception, STD information and treatment, and HIV testing and counseling.

Participants

Funding

Staff

In relating to the males, Buscemi believes it is very important for a facilitator to have a background similar to that of the program participants so he can understand their perspectives. He also believes that his job requires a working knowledge of popular culture and current media trends.

Barriers

Male Outreach Program

Philosophy

The Male Outreach Program (MOP) was developed by Valley Community Clinic (VCC) to confront this male ignorance and to motivate young men to be responsible actors in pregnancy prevention. Through classroom and one-on-one education, MOP hopes to give males a place to go with their questions about reproductive health. Ultimately, the program aims to give young men options that they did not know they had by providing information about contraception and encouraging abstinence. Kruzan explains, "If you give teenagers options they will be responsible. They want to be responsible. It's hard to be responsible if you don't have the tools." Kruzan believes MOP gives young men the tools to be responsible partners.

History

The Program

Classroom Presentations

VCC health educators make arrangements through individual teachers to be invited into high schools to provide classroom presentations, usually as part of health or nutrition classes. Classroom presentations are delivered to both male and female students, but students are sometimes divided into single-sex groups, particularly to do values and choices activities. Kruzan believes that single-sex groups allow the students to talk more freely and express their true opinions. The males and females always come back together as a group, however, to share what they have learned. One example of this is an activity used to examine gender roles called "Because I Am and If I Were. . . ." After splitting the class by gender and assigning a same-sex health educator to each group, the students complete the sentence "Because I am a (man/woman) I have to. . .," identifying obligations they associate with being their gender. They then switch roles and answer "If I were (the opposite gender) I would. . . ". This exercise stimulates discussion and shares information between males and females about traditional roles and stereotypes.

Individual Outreach

The key element of MOP is the availability of a male educator to provide one-on-one health education and counseling for male students. After conducting classroom presentations, the educator returns to the school on a biweekly basis and establishes himself as a recognizable element of the school landscape. Usually, the teacher who initially invited the educator in to provide the classroom presentations will advocate for the educator's extended presence on campus. Spreading pamphlets and pictures on a lunchroom table or outdoors, the health educator makes himself available for conversation and questions. Pictures of STDs are said to have an especially big impact on males. Kruzan believes that these are used "not as a scare tactic, but an educational tool" to stimulate conversation. The educator also displays the different contraceptive methods themselves, so that students can see and touch them. When allowed by the school, the educator hands out condoms, and in some schools, vaginal film. Sometimes, condom key chains are given out to initiate contact and to break the ice.

At first, individual contact is usually made with only a few of the more outgoing students. As other students see the health educators "hanging out," however, they start to come out of their shells as well. The educator provides individual attention to males, offers his time in answering questions, and talks with them privately about issues of personal concern. Comparing the classroom and one-on-one components of the program, the Director concludes that "it is better to deal with the individual than to deal on a broad scale in the classroom." Kruzan says that "the response [to MOP] has been really overwhelming. . . [these males] do care, but no one has ever approached them with this information before."

When appropriate, students are referred to the Teen Clinic at VCC. Kruzan feels that VCC's ability to offer referrals and free services to the male students is instrumental in making the education "very concrete." Those males who seek services at the clinic tend to come in for STD screening or treatment, or come with their female partners. VCC also runs a teen phone line, where teens can call and talk to peers about questions they have regarding reproductive health care. Kruzan regrets that the clinic does not currently have the funds to expand one-on-one services to females. In fact, the male educators will not deal individually with female students, as Kruzan does not "want male health educators to be put in a precarious position."

The Participants

In the course of a school year, MOP reaches approximately 500 males. Health educators work at five to six public schools. In addition, MOP provides classroom-based education at the San Fernando Valley Juvenile Hall as well as in group home settings. Presentations are also made to more than 15,000 teens a year.

Funding

Staff

Barriers

Serving a population that is 40 percent Hispanic can place language demands on the program. While most students are bilingual, bilingual health educators add the flexibility of providing counseling and classroom presentations in either Spanish or English as needed.

Educators also feel that gang involvement can influence teens' attitudes toward pregnancy as well. Kruzan explains that gang members may feel that they "want to procreate before [they] die, which might be tomorrow." In addressing this attitude, Kruzan thinks that the educators should stick to a practical approach, emphasizing the real financial and emotional responsibilities of having a child. Because many of the students that VCC sees have been raised in single parent households, they ask them to consider how they felt growing up without a two parent family and whether they would want that for their own children.

Male Youth Enhancement Project

Philosophy

The Rev. Barry Hargrove, director of MYEP, feels that the program has had great success in meeting its general goals. He asserts that the participants in MYEP's mentoring program specifically have largely avoided the criminal justice system and that only one out of 60 participants has fathered a child. Without MYEP, Hargrove believes that these statistics would be much worse. In addition, MYEP's participants have shown good academic progress, and none have been held back in school.

History

The Program

The "life-skills" portion of MYEP takes place through both workshops and "rap sessions." The workshops are guided by MYEP's own curriculum, with content varying according to the age of the participants. MYEP breaks down participants into three different age groups: 8 to 10, 11 to 13, and 14 to 18. The boys ages 8 to 10 address such issues as growing up in their community, doing well and behaving in school, and growing up without a father in their homes. Hargrove thinks that often the young men feel pressure from a young age to be "the man in the house." The program tries to "create a buffer zone" and impress upon the young boys that they are still children and do not need to take on the responsibilities of a grown man.

While still addressing problems of growing up, the boys ages 11 to 13 begin to deal with issues of sexuality as well. The program stresses abstinence as the best option until one is prepared for the responsibility of fatherhood. However, topics such as birth control, sexually transmitted diseases, and communication and decision-making skills are also discussed. In addition to its own curriculum, MYEP invites teen peer teachers to provide two interactive workshops a year addressing issues of sexuality.

Young men ages 14 to 18 are put through a 16-part "manhood training" called the "Rites of Passage." The Rites of Passage incorporates the sexuality and communication components delivered to the younger boys; however, it also includes components on job skills training, financial management, community service, and African-American history. A certificate of completion is given to those who attend the entire training.

Hargrove sees the mentoring program as MYEP's greatest strength. On Saturdays, men from the church and the community volunteer to spend a few hours one on one with the program participants. The young men are set up with a mentor through their parents' request. As the relationship strengthens, mentors and participants spend more time together in activities that the two enjoy.

Parents are included as much as possible in MYEP. MYEP facilitates a support group through which parents meet to discuss the progress of their children, share personal experiences, and help each other with parenting problems. In addition, the group concentrates on program-specific issues such as fund raising efforts and content of the curriculum and activities. The group meets once per month for ten months during the school year.

Finally, physicians who are members of the Shiloh Baptist Church donate their time once per year to offer the young men physicals on site at the Family Life Center.

Participants

All participants enroll in the program in September at the beginning of the school year. MYEP drops off a few fliers at schools and apartment buildings to spread the word about its services, but most participants hear about the program by word of mouth. In the four years that Hargrove has been director, the program has not had a problem filling its capacity of 60 participants. Some young men are attracted to the program because they can gain access to the church's basketball court. Still others recognize that the staff will act as their advocates within school if needed. Participants' parents often seek to enroll their sons in MYEP. Hargrove says that most of his program participants come from single-parent, female-headed households. Mothers may feel that their sons will benefit from the male role-modeling and influence that MYEP can provide. In all cases, parents must sign their children up for the program and each participant must be enrolled in school. Participants are involved in the program for at least one year; however, the average length of involvement is five years.

Funding

Staff

Barriers

Male Youth Enhancement Project

Philosophy

Fostering a sense of empowerment in these men is not an easy task—many have a long way to go. Most often, they have never had an arena to develop their skills in parenting and relationships. Completely accepting men exactly as they are when they come through the door is a fundamental attitude adopted by the program. The primary goal is to help these men move into the next level of personal development, whatever that level may be. While the program strives to promote a healthy relationship between male and female partners, the focus remains on the importance of the father's involvement with the child, regardless of the nature of his relationship with the child's mother. Jones realizes that many of his participants have fragile relationships with the mothers of their children. Therefore, the primary goal of the program is not to salvage the romantic relationship between the parents, but rather to help them to cooperate as the care-givers of the child so that the child may have a relationship with both parents.

The Men's Services Program takes a holistic approach to the process of personal development. Participants work with program staff in learning fathering skills, utilizing job skills, accessing employment opportunities and educational assistance, and becoming involved in the development of their children. Healthy Start takes the stance that active parenting begins at conception. Therefore, participants follow a standard "care plan" that includes attendance at prenatal and pediatric appointments in addition to attendance at weekly life skills education and group therapy sessions.

History

The Program

Both the males and females in Healthy Start go through a "life planning" session in which they meet with case managers to establish care plans to be followed during the program. Life planning counselors discuss such issues as education assistance, employment assistance, and information around contraception and child spacing. Life planning is provided to the male/female parent couple together and then to each individually. In situations in which the male and female are not a couple, the session is done on an individual basis only.

The Men's Services Program client care plans require male participants to attend prenatal and pediatric visits, as well as weekly life skills education and group therapy sessions. The educational sessions revolve around a 15-part curriculum, The Healthy Start Father's Journal, developed specifically for the Men's Services Program. Although the curriculum contains a total of 15 modules, each module requires more than one session to complete. While flexible, Jones says that the pilot project took 33 weeks to complete; however, he is modifying this time frame. The curriculum begins with a discussion of what it means to be an African-American male within the community. Many of these men have been "nurtured on the street" and may feel that manhood is characterized by the ability to pull a trigger or to father many children. The group confronts these old concepts of manhood and explores new, positive definitions.

Male sexuality is a central topic during which the group talks about the sexual pressures that men face and how to manage those pressures. Contraceptive methods and the male responsibility in preventing "serial pregnancies" is also discussed. Effective male/female and male/male communication is stressed.

Group activities are used to help the men learn about the importance of childhood development and health. In discussing fetal development, the men are broken up into three small groups. Each group is responsible for learning about fetal development during one trimester of pregnancy and reporting the facts to the rest of the group. In this way, the men grow to truly understand why certain behaviors are harmful to the fetus. Breastfeeding is also greatly encouraged. The men participate in role plays around breastfeeding in which one plays the female partner and the other plays the male partner. In this scenario, the female partner is reluctant to breastfeed and the male partner must stress the benefits and encourage the behavior. Behind these activities lies the belief that if men are provided with proper information, they can play a primary role in encouraging their female partners to practice good health behaviors.

Employment is a primary concern to many Men's Services Program participants; the program is able to provide some assistance in this capacity through grant funding and collaboration. Through a $12 million grant from the U.S. Department of Housing and Urban Development, the Men's Services Program is able to hire contract workers to do lead abatement in Baltimore's inner-city housing on the condition that the contractors, in turn, employ a proportion of fathers from the Men's Services Program. Currently 25 participants are employed in the lead abatement program; the Men's Services Program has plans to increase the number of participants to 50 over the next year. In addition, the Men's Services Program collaborates with the Kaiser Permanente Bridge Program to provide health insurance for the men employed in the lead abatement program. The Men's Services Program also has an agreement with the Johns Hopkins Hospital and the Baltimore Hyatt Regency Hotel in which a concerted effort is made to hire men from the program for available positions.

Participants

The participants in the Men's Services Program are between the ages of 16 and 40, with the average age being 24. All of the men are African-American and come from low-income households. Eighty percent are unemployed at the time they enroll in the program. Participation in the program is completely voluntary. Jones feels that the men are attracted to the program by a sincere desire to get something better out of life; the Men's Services Program offers them an alternative.

Funding

Staff

Qualifications for each employment level range from a good comprehension of the English language for entry level advocates to at least one year of college for the case coordinator positions. In some cases, Jones is able to hire men who are "graduates" of the Men's Services Program. For senior level advocate positions, Jones recruits at the local community college and looks for men with at least one year of experience in community work and a high school diploma or GED.

Barriers

Project Alpha

Philosophy

History

The Program

Knowledge

The knowledge-building component is meant to arm young men with factual information. Wilbur Jackson, Project Alpha's Regional Coordinator in San Jose, feels that ideally, these informational presentations should be delivered by experts in each field who are skilled at working with young people. For example, he recommends that the human sexuality components (physiology, STDs, and contraception) be delivered by a urologist. Jackson feels that a specialist is particularly important when it comes to question-and-answer sessions, as he or she has the tools to answer unpredictable questions and dispel myths and fears that the young men might have. Jackson sees that young men often have the "Sesame Street answer" to questions about sexuality. They know the most basic facts but do not truly understand them, and they have trouble translating the facts they do know into actual behavior.

The knowledge-building component can be modified to be appropriate for each specific group. Topics typically include comprehensive sexuality, social development, societal impacts and consequences of teen parenting, and legal implications of parenting. In addressing the social and legal issues, Jackson recommends bringing in a lawyer or a social worker to discuss teen pregnancy's impact on families and the community. Some chapters have added additional components to the curriculum as well, such as tobacco use and substance abuse.

Attitudes

The motivation component gives the young men the tools to incorporate their new-found knowledge into their lives as well as into their larger communities. Before they can do this successfully, the young men first need to explore their own values and determine how they can use the information in a way that feels most comfortable for them. For example, if a young man strongly believes in abstinence, he might wish to carry the information back to his community in a way that supports sexual postponement. A young man who believes that sexual activity is acceptable, however, might choose to stress contraceptive use. The position that the actual program takes can be determined by the sponsoring organization, although Project Alpha's most basic message is that abstinence is the only 100 percent "bulletproof" way to avoid pregnancies.

Skills

For the final piece of Project Alpha, the participants deliver the information that they have learned to the larger community. Jackson thinks that this component is the most difficult to implement because of the time and resources required. Some relatively simple options are for participants to arrange for assembly speakers at their schools or to address the parent-teacher association. When possible, helping the teens get on a local radio or TV talk show is not only the most effective way to reach a broad audience, but it is also really fun for the teens.

Program Delivery Options

Project Alpha can be delivered in a variety of formats. Although Jackson is willing to do even a one-hour presentation just to provide the most basic information to young men, he strongly feels that multiple-day sessions are the most effective. While one-day conferences have the advantage of costing less and reaching a larger number of youth, Jackson prefers to do two-day weekend retreats with the young men. Longer programming gives participants the opportunity to feel more comfortable, let down their guard, and become interested enough to learn. A weekend also allows facilitators to go into greater depth with the subject matter and leaves the young men more time to think about what they have learned and ask questions. Finally, the recreational downtime between sessions gives teens the opportunity to ask questions one on one that they may have been uncomfortable asking in a group setting.

For a typical retreat, the young men and facilitators usually go to a campground outside of their community. The day is spent in educational workshops, group discussions, and recreational activities. In the evening, the participants do a creative presentation of the information they have learned, for example, through rapping or putting on a skit. A retreat usually includes about 50 young men with each adult leader responsible for a certain number of young people.

Participants

Funding

Jackson estimates the total cost of a Project Alpha conference to be about $5,000 for a weekend retreat and about $2,000 for a one-day workshop. Most of these costs can be easily covered by securing in-kind donations. Because the program is not "institutionalized," meaning not implemented within schools or other more structured settings, paid staff are not a consideration and the cost is greatly diminished.

Staff

Barriers

Project MISTER

Philosophy

History

The Program

In addition to classroom workshops, each male participant meets one on one with his case manager an average of five to six hours per month to develop a case plan, set personal goals, and address specific needs. A nurse from the Public Health Department is also available at each site for 10 to 20 hours per week. Williams says that much of the pregnancy prevention education that occurs one on one with the nurses results from "pregnancy scares" when couples believe that the female is pregnant and seek out help. The nurses also provide educational sessions two times per year within the Project MISTER classroom on prevention, contraception, and partner negotiation.

There is also a Project MISTER Fatherhood program that assists teen fathers in accepting and meeting the challenges of responsible parenting. Community discussions are held to highlight teen fathers' need for education and other system supports. The Project MISTER program incorporates field trips that are meant to reinforce the messages that the young men learn in class. For example, the group may go to a state prison and talk with the inmates, to a neonatal intensive care unit to see infants born to parents who used drugs, or to a college campus to meet some of the male college students. To promote leadership skills, Project MISTER also encourages the participants to sponsor events, such as dances or larger educational workshops, in order to learn how to conceptualize a plan and work together to see it to completion.

In order to empower young men through positive male role modeling, Project MISTER and "The Breakfast Group" collaborate to provide a mentoring component. "The Breakfast Group" is a group of African-American professional and business men who organize and participate in events with the young men; for example, every year the Breakfast Group has a Super Bowl party for the participants in which the young men and the mentors get together and watch the game on a big screen TV. The Breakfast Group mentors are also involved in the end-of-the-year Project MISTER graduation reception called "Tie One On." This reception honors participants who are either graduating from high school or have completed a year of Project MISTER. During this ceremony, the participants are given neckties by the Breakfast Group. An added bonus to the program is a necktie design contest in which participants can win prizes and scholarships and have their ties provided for the Tie One On event. The neckties are now sold as a program fund raiser and participants have an opportunity to learn marketing and business skills.

Participants

The Project MISTER participants are between the ages of 13 and 21, with the average age being 17. About 60 percent of participants are from low-income backgrounds. Williams estimates that 75 percent of the participants are sexually active and that 15 percent are already fathers.

Most participants enroll voluntarily; however, 10 percent are court ordered to participate in the program. Project MISTER has had the most success in recruiting participants by networking with other agencies, such as the Breakfast Group, the Public Health Department, the Urban League, the juvenile courts, and the Seattle African American Mentorship Consortium. In addition, word of mouth among young people about the program is very positive. Many young men see their friends having great success within the program and want to become involved. Last year, the program placed 24 percent of its participants in employment; one-third of the participants graduated from high school or received a GED; and 98 percent did not become fathers.

Funding

Staff

The community resource development coordinator is responsible for providing employment readiness training to the participants covering such topics as résumé development, interview skills, and appropriate dress and hygiene. He also recruits and coordinates the program's mentors, tutors, and professional legal speakers, who occasionally address the group about legal rights/responsibilities.

In addition to the core staff, nurses from the Public Health Department are available on campus to answer questions or give referrals for needed services.

Barriers

The Responsive Fathers Program

Philosophy

The goal of RFP is to prevent pregnancy and violence by building a sense of respect for oneself and others. Patton says that the assemblies target the common "it won't happen to me" attitude among students by discussing the realities of early parenthood in a way that young males can understand. RFP focuses on short-term goals such as "what do you want to be when you are 16?" rather than looking at the distant future—something that may not be tangible to middle school students. The program stresses to young men that they do not have to struggle to survive with a child—they can prevent births and open the door to choices in their lives. A child can always come later, when they are prepared to accept the emotional and financial responsibility. Patton feels that these young men need to be told that, even in the face of social and peer pressure to do otherwise, it is okay to succeed.

History

The Program

The program is delivered over the course of three 90-minute assemblies. Each assembly, run by an adult male panel and student assistant facilitators, includes presentations, group activities, and discussion. Patton, who is active on the adult male panel, also recruits a different student volunteer to help facilitate each day's discussion. He says that the young men who volunteer for this role are usually motivated by a desire to rap in front of the group. After the assembly, the facilitators make themselves available to the young men for an additional 90 minutes to answer questions and provide one-on-one discussion.

The first day's meeting is an introduction and involves a general discussion about "male issues," specifically pregnancy prevention, violence prevention, and respect for oneself and others. This discussion is continued into the second meeting. Many of the young men will have gone away the day before and talked with older brothers, friends, or cousins about what they learned in the first day. For example, they may discuss fathering a child as a great financial responsibility. Often they will return the next day with a list of possible tactics to get out of fathering responsibilities, such as paying child support. The facilitators use this opportunity to combat the incorrect information the participants may have received from other young men and to reinforce the fact that if they father a child, they are responsible. The third day's discussion revolves around the demands of parenting and the benefits of not having children as a young man. Facilitators encourage the boys to stay focused on their life plans and not to be sucked into a "macho" image that can influence their decisions about sex.

RFP always tries to connect its messages with real examples the young men can understand. When addressing interpersonal skills, the group talks about "name-calling" and lack of respect. To illustrate, the group constructs two lists of both positive and negative things that they might call a young woman. In response to the negative, Patton asks them, "Is your sister, mother, or grandmother one of these names? Why would you call someone else's sister, mother, or grandmother that?" He wants young men to take responsibility for what they say and to realize that if they want respect, they have to give it.

Ultimately, RFP's goal is to encourage male responsibility and condom use to prevent pregnancy—the program strives to accomplish this, however, by focusing more heavily on the risks of STDs and HIV. Patton believes the risk of infection is more immediate and personal to young men and offers a greater incentive to use condoms. He says that young men do not feel much responsibility for birth control and do not see a pregnancy as having anything to do with them. Many of them feel that even if they fathered a child, they would not play any role in the baby's daily upbringing. Patton continually tries to get the message through that taking responsibility for a child is not optional.

Learning from others' real-life, personal experiences is a fundamental approach of RFP. Patton himself was raised in the inner-city and became a teen father. He uses his own experiences to share firsthand with the students the difficulties that he had to face in fathering a child at a young age. Other adult males on the panel also share their experiences, telling of decisions they have made in their lives and the outcomes of these decisions. They tell the students about their own childhoods and what their fathers were like, in addition to telling the students about their relationships with their own children. Whenever possible, Patton encourages the young men to share examples of real experiences that have happened to their "cousins" or "friends." He hopes to get the message across that when people make choices in their lives, they are faced with the consequences—and these may sometimes be painful.

Participants

Funding

Staff

Barriers

Patton believes that much social support exists for young people to grab on to short-term solutions in dealing with the urban problems that they face. Doing the "right thing" does not appear to pay off in the immediate future. In addition, Patton points out that the media paint a very negative picture of African-American males that is then embraced by the young men. He says that the students he deals with can easily point out who in their neighborhood was recently shot, killed, or paralyzed, yet they have no idea who on their block holds a college degree. Patton tries to emphasize that there are males in the neighborhood who hold regular jobs and contribute to their community and their families—an idea that he attempts to reinforce with the adult male panel.

Teen Parenting Skills Project

Philosophy

The Teen Parenting Skills Project places great emphasis on building a family relationship between the detention center residents and the partners with whom they have had children. Robert Pacheco, Program Manager, believes that in order to prevent further pregnancies, a young man not only needs to use contraception, but he needs to take responsibility for the family that he has already started. Pacheco sees that many of these young men leave the mothers of their children only to get other females pregnant. When these young men become invested in their current partners and children, they learn to take responsibility and work through challenges with their new families. Therefore, while the program teaches the young men to be more active parents, it also teaches them to become better partners and "family men" by exposing them to a broad range of skills and community resources that will help them keep their families together.

History

The Program

Although the workshops are voluntary, in order to have Sunday visiting privileges with partners and children, teen parents are required to attend the life skills classes consistently. Actual Sunday visits last for only one hour; however, they do offer some opportunity for the fathers to have contact with their children and practice their parenting skills. Pacheco impresses upon the teen parents the importance of bonding as much as possible during that hour. He tells the fathers, "If the diaper needs changing, if the baby needs to be fed, you need to do it." The visits also give Pacheco an opportunity to observe the family dynamics and the relationship between partners in order to identify any services that may be needed when the residents are released, such as family counseling.

Participants

Funding

Staff

Barriers

Teens on Track

Philosophy

History

The Program

The TNT recreation and education components operate in tandem, with each recreational activity preceded by a one-hour education session focusing on male responsibility and related topics. A contract with the Camden YMCA allows the program to use YMCA facilities to provide recreation and education sessions. Since the program's inception in 1990, the coordinator has tried several types of recreational activities to attract young males to the TNT program. Activities have included teen night, cultural events, parties, dances, and basketball, softball, and swimming leagues. Teen night, cultural events, and the basketball and swimming leagues have been the most successful at attracting and retaining participants.

Teen Nite

"Teen Nite" takes place eight Saturday nights per year at the YMCA. Upon arriving, the teens register with a peer counselor in order to keep the TNT mailing list up to date. The first activity of the evening is an hour of education related to male reproductive health and sexuality. This hour may entail informal rap sessions, outside speakers, and workshops on such topics as male responsibility, self-esteem, and communication. After a one-hour educational program, the participants choose between playing basketball or swimming.

Attendance at Teen Nite has far exceeded the staff's expectations. The first teen night was planned to serve about 30 participants. Instead, 106 males between the ages of 10 and 18 arrived at the YMCA on the first night. Thinking that maybe 106 was a fluke, the second Teen Nite was planned for 75 participants, but 130 males attended. The mailing list is currently up to 600 names.

Sports Leagues

Two basketball and two swimming leagues are organized each year, meeting once or twice a week and lasting six to eight weeks. To accommodate the increasing number of participants, the TNT teams are entered into the YMCA basketball and swimming leagues. The first 30 to 45 minutes of each meeting is spent covering a topic related to male sexuality and reproductive health. At the end of the season, an awards party is held for all participants.

In an effort to reach teens from parts of North and South Camden who were not participating in the activities at the YMCA, the TNT coordinator goes to neighborhood community centers once a week during the school year and organizes after-school activities. The first hour is spent in discussions of male responsibility, reproductive anatomy and physiology, birth control, and decisionmaking. During the second hour, the teens are free to use the community center's recreational facilities.

Approximately two years ago, TNT staff began to plan group outings in order to expand participants' interests beyond sports and recreation. Most of these have centered on science education and include an educational session provided by the host organization. Recent outings have included a trip to the Academy of Natural Science, the Franklin Institute, and a paper mill. The most recent activity added has been a weekend group retreat in which the teens work on developing trust and team building skills. Both the group outings and retreats are attended by 12 to 15 teens; they have been very well attended and are in great demand. Therefore, the TNT coordinator hand-picks the participants for these events as an informal award for consistently participating in other TNT-sponsored events.

In addition to the TNT activities, the male program coordinator also provides sexuality education in the local public schools, reaching elementary school to high school students.

Clinic Services

A basic array of health services is available to teen males during the clinic sessions, including condom distribution, reproductive health services, sports and work physicals, STD testing, and HIV testing and counseling. The males are greeted and prepared for their visit by the TNT coordinator and/or the Latino health educator. A pediatric physician from a nearby hospital examines the teens who come in for services. Clients are referred to a nearby hospital for any complications or for services not offered by PPSNJ.

The Participants

Almost all of the males who participate in the recreational programs or who come into the clinic for services belong to families below the official poverty level. Approximately 70 percent of the program participants are African-American and 30 percent are Latino. All of the males are between 10 and 20 years old.

Funding

Staff

Barriers

Transportation is another problem cited by TNT staff, especially for clinic access. Males must come into the main clinic specifically for services and cannot be seen at satellite clinics. While the clinic is very accessible by public transportation, many teens either do not have the money for bus fare or are unwilling to spend their money on a bus ride. The TNT coordinator often goes out in his car to pick up males who need a ride to the clinic.

When the program began, the misconception that Planned Parenthood serves only females inhibited males from coming to the clinic. However, the TNT staff feel they have been able to work past this barrier. In the early days of the male clinic, staff made efforts to make the clinic and waiting room more "masculine." They changed the pictures on the walls, they put away all the female magazines and replaced them with Sports Illustrated, and they hired all male staff (including a doctor and a nurse). However, as time went on, it became apparent that some of these precautions were unnecessary. Staff still put out the Sports Illustrated, but they no longer modify the decor. In addition, when the male nurse left for another job, staff realized that the males were perfectly comfortable with a female nurse.

Wise Guys

Philosophy

History

The Program

Using data gathered between 1990 and 1994, Philliber Research Associates conducted a formal evaluation of Wise Guys that showed several positive results. Researchers compared 335 males who participated in the Wise Guys program to a similar comparison group of 145 males who did not receive the program between the time of program entry and a six-month follow-up. The evaluation found increases in knowledge of sexuality and birth control, improved communication with parents, and more positive attitudes toward gender roles among the program participants. Second, males who were sexually active at the time of program entry showed a 28 percent increase in contraceptive use while the comparison group showed a decrease in contraceptive use. Finally, the percentage of males who reported always using birth control increased from program entry to program exit and again, from exit to six-month follow-up. Conversely, the comparison group showed an increase in the percentage of males who never used contraception.

Participants

Funding

Staff

Barriers

The program has also faced problems having adequate time to deliver the curriculum. Sometimes schools only allow the educators 30 to 35 minutes to deliver a session. As a result, some components have to be eliminated from the series due to time constraints. The decision-making, values, and goal-setting components are usually the first to go. In order to address problems of time, the Family Life Council uses a formalized agreement with schools to ensure that their educators are given sufficient time, in both hours and weeks, to deliver all the curriculum material.

Young Dads Program

Philosophy

History

James began recruiting participants by going to the basketball courts, the malls, and anywhere else young fathers might be hanging out. He passed out business cards and told the young men about the program. Not having any support staff, James ran the entire program single-handedly for two years, doing the recruitment, providing the case-management, facilitating the group workshops, and arranging for guest speakers. As the program has grown, James has been able to hire additional staff, enabling participants to receive more individual attention.

The Program

The program offers most services on site at EAC. Employment services include job readiness training, interview preparation, résumé development, and instruction on job retention. The vocational counselors work to help participants identify career options suitable for them. The program also offers an on-site GED classroom. Participants who need assistance for drug and alcohol abuse, housing, mental health services, and legal help are referred to other local agencies.

In addition to employment and education services, male parenting support groups are held two times per week. In order to participate in the employment and education services that the Young Dads Program provides, each participant is required to attend six parenting support group sessions. Among other topics, these sessions explore issues such as pregnancy prevention, child support, and gender roles. James himself will usually do a presentation for the group discussing the range of contraceptive methods. Condoms are provided and the group learns how to use and put on a condom. James may also invite a guest speaker from Planned Parenthood, the Public Health Department, or an HIV awareness organization to come in and discuss contraception, HIV, and/or STDs. In teaching the fathering component portion of the workshops, the program uses the Fragile Families Curriculum to discuss basic parenting skills. James states, however, that many of his participants have exceptional barriers to parenting that revolve around homelessness or lack of custody. Many of these men not only need to know how to feed or discipline a child, but also how to maintain their role as a parent under very challenging circumstances.

Outside of EAC, James facilitates male education groups within the juvenile detention center. He hopes to let these young men know what YDP has to offer so that, when they are released, they will have a place to go to make necessary lifestyle changes.

Participants

Funding

Staff

Barriers

In the interest of having more positive program outcomes, James has somewhat modified his participant recruitment strategies. His current approach is not to serve a large number of men, but rather to focus on fewer enrollees with increased attention given to meeting individual goals.

Young Men's Clinic

Philosophy

YMC seeks to enhance the general health of young men and reach them before they experience a negative reproductive outcome, such as an unwanted pregnancy or an STD. Thus, YMC staff regard "every moment the men are at the clinic [as] a teachable moment." Staff inform every patient about pregnancy prevention and sexually transmitted diseases, regardless of the nature of his visit.

History

Between 1967 and 1983, eight hospitals near the Washington Heights neighborhood have closed, leaving Columbia Presbyterian Hospital as the only major health care provider in the community. Many Washington Heights residents do not have medical insurance, and there are no public health STD clinics in the neighborhood. As the only provider of free reproductive care specifically designed for men, YMC has become an integral part of maintaining the reproductive health among young males in the community.

The Program

After the slide presentation, "life space interviewing" takes place either as individual or small group counseling sessions. The counseling sessions are intended to expand upon the issues presented in the slide shows. For example, if the slide presentation focuses on sexually transmitted diseases and symptoms, the facilitators may engage the young men in subsequent discussions about STDs and HIV using sketches and graphs to describe the infections. Other counseling topics may include responsible decision-making, relationships, and contraception. Male and female contraceptive methods are covered so that males can be supportive of their partner's choice and use of a birth control method. Individual counseling is provided by first-year medical students.

YMC does a comprehensive assessment of its participants using the "biheads formula," which stands for body image, employment, activities, drugs, and sexuality. The medical students use this approach to record the patients' psychosocial and reproductive health histories. When necessary, referrals are made to the clinic social worker. This person with an MSW has responsibility for making further assessments of need and provides short-term case management services for patients referred for mental health, education, employment and other services.

YMC serves as the primary care provider for many young men in the community, providing comprehensive physical exams, condoms, HIV testing and counseling, and a full array of reproductive health services.

Participants

The services of YAC and YMC are complimentary and tightly linked. Group counseling sessions at the YAC encourage young women to talk with their partners about getting health screenings at YMC. In addition, many YMC clients are referred to services by nurse practitioners at the YAC.

Funding

Although the YMC is the only reproductive health clinic of its kind in New York City, funding over the next two years remains uncertain. Armstrong is seeking additional funding from private foundations and individual donors. Until now, YMC has not charged a fee for services to its patients. However, the clinic is considering charging a fee for services.

Staff

Barriers

Youth Education and Development Program

Philosophy

History

The Program

Many of these themes are explored through field trips, workshops, and presentations by speakers from outside agencies. Taylor likes to involve parents as much as possible, inviting them to come in and speak about such issues as what it is like to be a single parent, what it is like to be an AFDC recipient in the face of welfare reform, and what it is like to be a working parent. Taylor would eventually like to have teen fathers come in and present their personal challenges and perspectives on fatherhood to the young men; however, finding teen fathers who are willing to do these presentations has proved to be difficult.

The health component of YEDP takes a holistic approach covering such issues as mental health, nutrition, substance abuse, sexuality, HIV/STDs, and male sexual responsibility. The program stresses abstinence as an appropriate choice but also presents contraceptive methods and how to put on and use a condom. The program stresses that "when people have sex, there are two partners there," and although males are often left out of conversations about sexuality, males play a major role in the "game of sex." The program also addresses the role of the male if he does get a girl pregnant. Taylor says that the program conveys to participants, "If you get a girl pregnant, here is what we would like you to do: be a present dad, go to parenting classes, and be there for prenatal care." Through these discussions, the young men explore the difference between being a "father" and being a "dad." Taylor says that most of YEDP's participants come from homes in which the father is not present; therefore, they benefit from a clear discussion about responsible male behavior. To address topics of contraception, YEDP will usually bring in guest speakers who cover all of the available contraceptive methods. Although only about 15 percent of the program directly addresses pregnancy prevention, the overarching themes of decision-making and choices help to guide the young men in all areas of their lives, including areas of sexuality.

Participants

In addition to those nominated, 30 to 40 percent of the participants are volunteers. These young men hear about the program through word of mouth. They hear about the activities and group workshops from their friends, and they want to be included.

Taylor points out that YEDP's participants are often the youngest siblings in families with three or more children. He sees this as important because when these young men come into the program, they have already learned both good and bad behaviors from their older siblings. Sometimes these influences can be difficult to work with, and ultimately the program would like to have both the parents and the siblings of the participants involved as well. YEDP does not strive to combat influences in the home, but rather to "supplement" the home and "construct a partnership" with the family.

Funding

Staff

Taylor feels that it is important for staff to have a similar background to that of participants. The program is largely based in personal sharing and experience. Taylor says that he can only speak to the group about "me" as a black male. As a black male, he can focus on issues that these young men will face but also impress upon them that the "male needs to help and be a part of our society." In Taylor's eyes, "now it is the males' turn to stand up and be proud and be counted."

Barriers

CHAPTER 4
Practical Advice and
Program Philosophy

Practical Advice
from the Programs

1. Be knowledgeable about the needs of the community and the population to be served before implementing your program. Find out what participants know and what they are interested in learning.

Many programs gain participant feedback by giving young people the opportunity to evaluate the program. Information about what the participants learned and liked can be used to modify the program to better suit participants' needs.

2. Collaborate with other agencies to provide services and to get referrals.

Collaboration with other agencies also helps to identify and bring in males who might benefit from a pregnancy prevention program. Males often fall through the cracks within social services. Collaboration means that other agencies can refer participants to your program—many of the programs get their participants through outside agency referrals. Collaboration also makes it easier for males to get hooked up with the variety of services that they need (Hablando Claro/Plain Talk, Compass, Project Alpha, Wise Guys, Baylor Teen Clinic).

3. Male staff is essential.

Importance of male staff revolves around two primary issues. Many of the young men in these programs were raised in single-parent, female-headed households. Young men are thought to need a positive male influence in their lives that can be provided through male program staff. The second benefit is that male staff allow young men to feel more comfortable about opening up and asking questions. In a clinic setting, for example, having at least a male health educator or outreach worker present to meet with the males prior to their exam is thought to be helpful in breaking down the misconception that reproductive health services are only for women (Male Involvement Program of Planned Parenthood of Nassau County, NY, Young Men's Clinic, Male Involvement Program in Landover, MD). Having staff with a similar socioeconomic or ethnic background to the participants is often seen as an additional strength. However, virtually all program providers interviewed stated that having same-sex staff was more important than employing staff with a similar background to the participants.

Although a male facilitator is viewed as essential, having a female speaker or a coed discussion group is also seen as beneficial (Teen Parenting Skills Project, HiTOPS, It Takes Two, Dads Make a Difference, Project MISTER). Program staff feel that many young men do not have any idea of how to relate to women on a non-sexual level or how to discuss sexuality-related topics with women. Having a forum that allows them to practice communication is thought to be important, but is rarely included in these programs.

4. Increase your success in recruiting males by offering employment, training, or recreation services and then provide reproductive counseling and education.

Other programs, such as Teens on Track and Always on Saturday, bring young men in by offering recreational activities but offer a strong educational component as well. The Male Youth Enhancement Program of Shiloh Baptist Church attracts young men with a great basketball court.

Reaching young men through their female partners has also proved to be successful because the female partner may be initially attracted to the program and encourage her partner to become involved as well (Hablando Claro/Plain Talk, Men's Services Program of Baltimore City Healthy Start, Inc.).

5. Be flexible and willing to test new approaches.

Program evaluation is rare in male involvement programs. Systematic self-assessments as well as more formal and rigorous program evaluations are needed to measure the successful elements of a program.

6. Approach the subject of pregnancy prevention with males in a playful, entertaining, and nonthreatening way. The information has to be real and accessible.

The majority of program providers interviewed expressed concern that male involvement in pregnancy prevention has either not been addressed at all or, when addressed, has been cast as negative—in terms of blame and irresponsibility. Many males may feel ambivalent or defensive about reproductive responsibility, and this perspective can be a barrier to their program participation. Many program providers recommend being careful to approach the subject in a way that empowers young men to be involved in the prevention process. Klaus of It Takes Two, for example, works from an ideal of male "investment" rather than responsibility or involvement. He feels that "involvement" is too ambiguous and "responsibility" has burdensome connotations.

Lecturing is not a widely used strategy; most of these programs incorporate group activities, group discussion, and/or peer facilitation. Program messages are better received if they are conveyed through engaging and fun activities that allow group interaction and discussion. Appendix 4 includes the curricula, films/videos, and activities that the programs have found useful.

7. Take care to develop a good relationship with the community in which you are developing programs.

Some programs, such as Fifth Ward Enrichment Program, establish themselves in the community by enlisting the support and interest of influential community leaders. Hablando Claro/Plain Talk in San Diego maintains its relationship with the neighborhood primarily using a community group created specifically to communicate the needs and concerns of the larger community to the program providers. This group, made up of both adolescents and adults, meets on a regular basis to discuss goals and strategies for the program. Programs in housing authority projects (Brothers to Brother, Male Youth Enhancement Project, and Fifth Ward Enrichment Program) can establish positive community relationships by going door to door to provide information about their services and by showing their presence in the housing projects. In all cases, respecting the values and wishes of the larger community is essential to gaining trust in the program. In some cases a program "out of the box" can be tailored to appeal to the community's values. It Takes Two uses this approach. As trust increases, often the community is willing to consider expanding its notion of what the program can appropriately cover.

8. Choose lengthier rather than briefer contact with program participants.

Programs that enroll males for the course of an academic year, or in some cases for several years, find that participants come to rely on the dependability of the program and its facilitators. Consistency in relationships, especially with adult males, may be missing from many of these young men's lives and the programs may help to fill this void. Many program providers stressed the importance of this consistency and reliability in providing an example of following through with one's commitments to others.

9. Use different messages for different developmental stages.

Program providers say that older teens, usually those who have already entered high school, are not interested in practicing communication and decision-making skills. They want to know about the nuts and bolts of preventing pregnancy and STDs (HiTOPS, Male Involvement Program of Planned Parenthood of Nassau County).

Emphasizing STD prevention may have greater impact on young men's reproductive behaviors than concentrating solely on pregnancy prevention. STDs are often seen by males as a more immediate and "real" risk to themselves than pregnancy. Some programs say that the message of "protecting oneself from STDs" works better with males than the message of "protecting one's partner from pregnancy."

10. Remember that satisfied participants and collaborators are the best source of positive program publicity.

11. Recognize that active parental involvement is difficult to achieve.

12. Be prepared to be resourceful in keeping your program funded.

Advice about
Program Philosophy

1. Be careful to avoid negative stereotypes.

This program philosophy—whatever form it takes—needs to permeate the entire program and, potentially, its host agency. Just tacking a pregnancy prevention component for males onto an existing program may not work if philosophical assumptions and staff attitudes convey negative messages to young men.

2. Make the program the mentor.

Many of these programs adopt a mentor/nurturer psychology. They identify the need to change current attitudes and behaviors, but they want to avoid stigmatizing the young men as irresponsible and callous about pregnancy prevention. The providers of these programs believe that males fundamentally want to take more responsibility in their lives. They focus heavily on nurturance, role-modeling, and consistency/dependability to rebuild a young man's vision of himself and his future as positive (Men's Services Program of Baltimore City Healthy Start, Fifth Ward Enrichment, Brothers to Brother, Project MISTER). Accepting males as they are and then working with them to bring about positive changes is central to the programs' approaches. Theoretically, greater self-respect translates into more responsible behavior and "smarter" decision-making.

3. Use males to guide males into new definitions of "masculinity."

How do programs get males to redefine "manliness?" Most do it through the communication and support of other men. Program administrators believe that the redefinition process can only be successfully achieved through a male facilitator. Bonding with a male facilitator can create a situation in which young men feel safe to examine their views of masculinity and initiate activities that are traditionally thought to be "unmale"—such as talking about feelings, goals, and values in a straightforward and honest way (Responsive Fathers Program, Men's Servces Program of Baltimore City Healthy Start). The facilitator cannot be any man; he must have unique characteristics. He should be perceived as "manly" to gain the respect and confidence of the young program participants. But he must also be a highly skilled communicator and human relations expert to be able to create an environment in which males can open up and talk about their feelings (Male Involvement Program of Planned Parenthood of Nassau County, It Takes Two). Contact with this type of male is rare for these young men, and is thought to motivate them to participate in prevention programs (Youth Education and Development Program). Providers typically believe that males want to have this male-to-male contact even though this motivation is not what initially brings them into the program.

4. Define male responsibility as starting with respect for oneself.

Next Steps

1. Create a clearing house.

2. Evaluate promising programs.

3. Innovate.

APPENDIX 1
Methodology

Letters were sent to more than 100 experts asking them to identify promising programs. In this guide we only include programs nominated by respected professionals in various fields. This limitation may mean that we have missed some excellent programs, but it provides some quality control for the program selection process. Through this nomination process, about 80 potential programs were identified.

Our next step was to send a letter to each of these programs requesting any descriptive materials that they could send us about their programs. Since we were identifying programs that might be replicated, we used this approach to identify those who would respond to requests for information. Almost 60 programs responded to our letters.

We read through all the program materials that were sent to us to identify programs that clearly fit our criteria, those that did not, and those for which more information was needed to make a determination. At this stage, 29 programs were screened out. The remaining programs were then interviewed by telephone.

The first part of the interview determined program eligibility. The program contact person was asked questions about the program's goals, participants, and the length of operation to determine whether it fit our criteria for inclusion. If it did, a lengthy semi-structured interview was conducted to obtain the information that is now included in the program description that follows. Program descriptions were drafted and in many cases follow-up information was solicited and received from the programs.

We are extremely grateful to the nominating experts and all the nominated programs that responded to our requests for information. Appendix 3 contains a list of all the male involvement programs that we identified, listed by state. Many of these were too small or too new at the time to be included. One year later they will have had more experience. Moreover they could be useful sources of information and advice to program developers operating in communities near theirs.

How the National Survey of
Adolescent Males Was Conducted

In 1995 the survey was conducted by Research Triangle Institute. The sample was drawn to be representative of males ages 15-19 living in the conterminous United States. The sample also was stratified to oversample for black and Hispanic youth. The response rate was 74.65 percent. In 1995 the sample was not limited to never-married eligible youth. As a result, 1,710 never-married males were interviewed and an additional 19 ever-married males were also included.

In both surveys written parental permission was required for teenagers under the age of 18. In 1988 only 6.1 percent of households with eligible respondents did not participate because a parent withheld consent for his/her minor child; in 1995 this proportion was 5.6 percent.

In 1988 and 1995 face-to-face personal interviews were conducted by trained interviewers in the respondents' homes or other confidential locations. The survey consisted of an interview lasting about one hour and a self-administered questionnaire lasting 10-15 minutes that covered many of the most sensitive questions. In 1988 the self-administered questionnaire was a paper and pencil instrument (PAPI); in 1995 most of the respondents completed these questions using audio computer assisted self interview (ACASI) technology, although some respondents were experimentally assigned to PAPI. The results of this experiment will be presented elsewhere. The data presented in this guide come from interviewer-administered items. Core topics include demographic characteristics, family background, educational history and aspirations, and a detailed history of sexual, contraceptive, and HIV-related behaviors, including detailed histories of first and last intercourse and information about recent partners, use of alcohol and drugs, attitudes about condom use, gender role attitudes, and knowledge about sex, AIDS, and contraception.

Distributional data presented in this guide are weighted. Weights were developed to compensate for probability of selection and non-response and were post-stratified to correspond with the March 1987 Current Population Survey and the May 1995 Bureau of Census Preliminary Projections of the Civilian Noninstitutionalized Population by Age, Sex, Race and Hispanic Origin.

NSAM: Question Wording

Sexual Experience

YES	01
NO	02

______	YEARS OLD

NUMBER	______

NUMBER	______

______	YEARS OLD

YES	01
NO	02

YES	01
NO	02

Contraception

YES	01
NO	02

CONDOM	01
WITHDRAWAL, PULLING OUT	14
COMBINATION OF METHODS	
	(SPECIFY):___________________	15
OTHER (SPECIFY):_____________	77

YES	01
NO	02
DON'T KNOW	08

DEPO-PROVERA
DIAPHRAGM OR CERVICAL CAP	
DOUCHING (WASHING OUT) AFTER INTERCOURSE	
FEMALE CONDOM	
SPERMICIDAL FOAM/JELLY/CREAM OR SUPPOSITORY	
IUD, COIL, LOOP	
NORPLANT	
PILL	
RHYTHM, OR SAFE PERIOD	
STERILIZATION	
TODAY SPONGE	
VAGINAL CONTRACEPTIVE FILM OR INSERT	
COMBINATION OF METHODS (SPECIFY):	
SOMETHING ELSE (SPECIFY):

____%

____%

____ %

Attitudes Toward Male Responsibility for Contraception

Reaction to Pregnancy

Very upset,	01
A little upset,	02
A little pleased, or	03
Very pleased?		04
They wouldn't care	05

Very upset,	01
A little upset,	02
A little pleased, or	03
Very pleased?	04
They wouldn't care	05

Very upset,	01
A little upset,	02
A little pleased, or	03
Very pleased?	04
No different	05

A lot,	01
Somewhat,	02
A little, or	03
Not at all?	04

Expectations Regarding Condoms

Sources of Information about Contraception

O17. In the last 12 months, has any doctor or nurse discussed any of these topics with you? (CIRCLE ONE NUMBER FOR EACH)

O18. In the last 12 months, have you seen any TV programs or TV ads about these topics? (CIRCLE ONE NUMBER FOR EACH)

C2. Did you ever have any formal instruction in school or in an organized program on the following topics?

C3. What grade were you in when you first received this instruction?

Activities That Teenage Males Engage In

A12. Have you attended school, college, or a training program in the last 12 months; since this time last year? (CIRCLE ONE NUMBER)

YES	01
NO	02

YES	01
NO	02

Health Care

YES	01
NO	02

SCHOOL CLINIC	01
CLINIC AT WORK	02
OTHER CLINIC	03
HOSPITAL	04
PRIVATE DOCTOR'S OFFICE	05
HEALTH MAINTENANCE ORGANIZATION	06
OTHER, (SPECIFY)	77

Within the last month,	01
2-6 months ago,	02
7-12 months ago,	03
1-2 years ago, or	04
More than 2 years ago?	05
DON'T KNOW	08

Problem Behaviors

01	Never
02	A few times
03	Monthly
04	Weekly
05	Daily

01	Never
02	A few times
03	Monthly
04	Weekly
05	Daily

01	Never
02	A few times
03	Monthly
04	Weekly
05	Daily

01	Yes
02	No

01	Yes
02	No

01	Yes
02	No

(Note: Behind in school is computed by comparing grade to age. Males who are two years behind in grade are designated behind in school.)

* Self-administered questions

APPENDIX 2
Contact Information for Exemplary Programs

	WILL ACCEPT	WILL ACCEPT	PROVIDE	PROVIDE	CURRICULUM	REPLICATION	CONTACT
PROGRAMS	PHONE CALLS	VISITORS	CONSULTATION	TRAINING	AVAILABLE	NOTES	INFORMATION
Always on Saturday						Program currently	Flora Parisky, Chief Operating
Hartford Action Plan						testing expanded	Officer, Hartford Action Plan
						Always on Saturday	30 Arbor St.
						curriculum.	Hartford, CT 06106
							(860) 232-0641
Baylor Teen Clinic						Willing to provide	Peggy B. Smith, Clinic Coordi-
Baylor Medical College						phone consultation	nator, Baylor Teen Health Clinic
						but not technical	8111 Lawn, Box 2
						assistance.	Houston, TX 77088
							(713) 793-3601
Brothers to Brother						Brothers to Brother	Delmonte Jefferson, Project
Wake County Health Dept.						Activity and Resource	Coordinator, Brothers to
						Guide curriculum in	Brother, Wake County Health
						publication. To be	Department, P.O. Box 14049
						available February	Raleigh, NC 27620
						1997	(919) 250-3990
Compass						Expects to provide	Jeff Rodriguez, Male Outreach
Adolescent Pregnancy						training in the near	Coordinator, Adolescent
Prevention, Inc.						future.	Pregnancy Prevention, Inc.
							1300 W. Lancaster St.
							Fort Worth, TX 76102
							(817) 338-4559
Dads Make a Difference						Willing to work with	Gary Greenfield, Project
University of Minnesota						the individual needs	Coordinator, Dads Make a
Extension Service						and restrictions of	Difference, University of
						different states.	Minnesota Extension
							Service
							2020 White Bear Ave.
							St. Paul, MN 55109
							(612) 704-2060
Fifth Ward Enrichment						In the process of	Ernest McMillan, Fifth Ward
Program						developing a training	Enrichment Program
						program to be	4014 Market St., Houston, TX
						completed March	77020
						1997	(713) 229-8353
Hablando Claro/Plain Talk						Curriculum develop-	Marta Flores, Director, Logan
Logan Heights Family						ment in progress. To be	Heights Family Health Center
Health Center						ready in 1997.	1643 Logan Avenue
							San Diego, CA 92113
							(619) 239-0268, ext. 210
HiTOPS, Inc.						Curriculum available	Bonnie Parker, Director
						only with training.	HiTOPS, Inc.
							21 Wiggins St.
							Princeton, NJ 08540
							(609) 683-5155
Hombres Jóvenes						Fee required for training	Jerry Tello, Director
con Palabra						and curriculum.	15865-B Gale Ave.,
							Suite 1004,
							Hacienda Heights, CA 91745
							(818) 333-5033
It Takes Two						Training required	Tom Klaus, Program Director
Young Women's						to implement program.	It Takes Two
Resource Center							1909 Ingersoll Ave.
							Des Moines, IA 50309-3320
							(515) 244-4901
Male Involvement							Darryl Bryant, Male Involvement
Program							Coordinator, Healthy Teens
Healthy Teen Center							Center, 7824 Central Ave.
							Landover, MD 20785
							(301) 324-5141
Male Involvement						Program uses parts of	Matthew Buscemi,
Program						PPNC's Peer Education	Male Involvement Program
Planned Parenthood of						Program Training	Coordinator, Planned
Nassau County						Curriculum.	Parenthood of Nassau County
							540 Fulton Ave.
							Hempstead, NY 11550
							(516) 483-3193, ext. 3018
Male Outreach Program						The curriculum consists	Connie Kruzan, Director
Valley Community Clinic						of outlines. Not a	Valley Community Clinic
						detailed, published	5648 Vineland Ave.
						curriculum. Fee required	N. Hollywood, CA 91601
						for training and	(818) 763-1718, ext. 210
						consultation.
Male Youth Enhancement						Training and curriculum	Rev. Barry Hargrove, Director
Program						available early 1997.	Shiloh Baptist Church Family
Shiloh Baptist Church							Life Center
							1510 9th St., NW
							Washington, DC 20001
							(202) 332-0213
Men's Services Program						Curriculum available	Joseph Jones, Director of Men's
Baltimore City Healthy						at cost with facilitator	Services, Baltimore Healthy
Start, Inc.						guide. Technical	Start, Inc., 600 N. Carey St.
						assistance available	Baltimore, MD 21217
						on limited basis.	(410) 728-7470
Project Alpha							Wilbur Jackson, Regional
Alpha Phi Alpha Fraternity							Coordinator,
							6716 Indian Spring Court
							San Jose, CA 95120
							(408) 268-6171
Project MISTER						Training manual	Cynthia Williams, Project
Medina Children's						available for purchase.	Director, Medina Children's
Services							Services, 123 16th Ave.
							Seattle, WA 98122
							(206) 461-4520
Responsive Fathers							Gregory Patton, Family Support
Program							Coordinator, Family Resource
Philadelphia Public							Network, Philadelphia Public
School District							School District Administration
							Bldg., Rm. 509, 21st St.
							So. of the Parkway
							Philadelphia, PA 19103
							(215) 299-7327
Teen Parenting Skills							Robert Pacheco, Program
Project							Manager, Juvenile Detention
Bernalillo County							Center, 5100 Second St., NW
Juvenile Detention							Albuquerque, NM 87107
Center							(505) 761-6606
Teens on Track						Training manual	Joyce Kurzweil, Executive VP
Planned Parenthood						to be available	Planned Parenthood
So. NJ						in 1998.	of Southern New Jersey
							317 Broadway
							Camden, NJ 08103
							(609) 365-3519, ext. 219
Wise Guys						On-site training	Jeff Wilt, Male Responsibility
Family Life Council of						available. Evaluation	Educator, Family Life Council of
Greater Greensboro						model available.	Greater Greensboro
							301 East Washington St.,
							Suite 204
							Greensboro, NC 27401
							(910) 333-6890
Young Dads Program							Clarence Jones, Program
Employment Action							Director, Employment Action
Center							Center, 2104 Park Ave, So.
							Minneapolis, MN 55404
							(612) 871-6002
Young Men's Clinic							Bruce Armstrong, Clinic
Columbia University							Coordinator, Columbia
							University School of Public
							Health, Center for Population
							and Family Health
							60 Haven Ave., B-3
							New York, NY 10032
							(212) 304-5247,
							E-mail: [email protected].
Youth Education and							E. Franklin Miller, Program
Development Program							Director, Urban League of
Urban League of							Eastern MA, 88 Warren St.
Eastern MA							Roxbury, MA 02119
							(617) 442-4519

APPENDIX 3
List of Other Male Involvement Programs by State

Arizona

California

Colorado

Connecticut

District of Columbia

Maryland

Massachusetts

Minnesota

Missouri

New Jersey

New York

Tennessee

Texas

Vermont

Washington

Wisconsin

APPENDIX 4
Examples of Materials Used by Male Involvement Programs

APPENDIX 5
References

About the Authors

Freya L. Sonenstein is director of the Population Studies Center at the Urban Institute. Since the early 1980s she has conducted applied and behavioral research related to teenage fertility. She directs the National Survey of Adolescent Males. Dr. Sonenstein has published widely about sexual behavior and contraception among teenage males, as well as about the policies and programs which address these behaviors. Dr. Sonenstein, who is trained as a sociologist, has also served on the faculty at the Heller School, Brandeis University.

Kellie Stewart was a research associate in the Population Studies Center of the Urban Institute during the writing of this book. She has a masters of public health from Johns Hopkins University, with a specialization in population dynamics. Ms. Stewart, a native Californian, worked for a number of years as a patient educator with Planned Parenthood. She is currently serving as a Peace Corps volunteer in Guatemala.

Laura Duberstein Lindberg is a research associate at the Urban Institute. She holds a Ph.D. in sociology and demography. Dr. Lindberg specializes in the demography of health and fertility behaviors. Her current research focuses on the male role in teenage pregnancy and the spread of sexually transmitted diseases. Dr. Lindberg was a research fellow at the University of Chicago prior to joining the Urban Institute.

Marta Pernas is currently pursuing her Ph.D. in social welfare at the University of California, Berkeley. Prior to entering graduate school, Ms. Pernas was a research assistant at the Urban Institute, studying issues related to sexual behavior and reproductive health services in the U.S. Ms. Pernas has also performed research on welfare reform in Texas and Florida.

Sean Williams, a graduate of Haverford College, is a research assistant at the Urban Institute. He is the data manager for the National Survey of Adolescent Males, and has worked on several projects examining reproductive health among at-risk populations in the U.S. Currently, he is estimating rates of sexually transmitted disease infection among adolescent males.

Acknowledgments