NTARUP Better Together Report_V1````

opportunity. uninterrupted.

TEEN PREGNANCY IN DALLAS, TEXAS

A COMMUNITY-WIDE ACTION PLAN TO REDUCE TEEN PREGNANCY IN DALLAS BY 50% BY 2023 POWERED BY

FUNDED BY

TABLE OF CONTENTS Letter from Our Chief Executive Officer.............. 03 Preventing Teen Pregnancy: National, State and Local Landscape................... 04 Individual Teens..................................................... 11 Parents and Other Caregivers.............................. 16 Faith Communities................................................ 19 Health Care Providers and Organizations............ 22 Society: Equity in Teen Pregnancy Prevention: Social Determinants of Health.............................. 26 Conclusion.............................................................. 31 Collaboration..................................................... 31 Collaboration Needed....................................... 32 Organizational Excellence– Merging to Enhance Capabilities...................... 33

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Dear Better Together, If nothing else, 2020 has brought into clear focus the societal disparities that endanger the health and economic security of the most vulnerable people in our communities. They are the same disparities directly associated with teen pregnancy, a well-publicized driver of generational poverty.

While the nation’s birthrate has declined over the past decade, Dallas has the highest teen birthrate of the 20 largest metropolitan counties in the U.S. In Dallas, 1 in 3 children grow up poor, and face a multitude of inequities at the very start. As you can image, Covid19’s disruption has only further magnified these inequities.

A champion of teen pregnancy prevention, former Mayor Mike Rawlings did not shy away from addressing these inequities, “In zip code 75215 in the Fair Park area, the average income is about $25,000. When you think that 1 in 10 teen girls in this area are having babies, we’ve got poor, young women that growing up in poverty, having babies, and the chance of them pulling out of that income spiral is slim.”

It is a sobering issue as we contemplate the future of Dallas. We aspire for better for our children and see the evidence that reducing teen pregnancy can WITH A COMMITMENT TO be an integral part of a greater strategy EQUITY AS THE CENTER OF to eliminate poverty. We have got to go EVERYTHING WE DO, OUR deeper, wider, and open up people’s hearts COMMUNITY OF PARTNERS and minds to the possibilities of a city where WILL REDUCE THE TEEN all children have the tools to succeed.

BIRTH RATE IN THE TOP 12 By paying greater attention to the role of ZIP CODES BY 50% BY 2023. the community in this effort for change, we will support a movement that leverages the community’s aspirations, and engages all aspects of education, healthcare, and policy. We seek to transform Dallas and eliminate the high teen birth statistics.

We owe our children real, accurate, and reliable information. Working together, we will ensure teens have access to quality reproductive health education and services and the adults and parents who guide them will receive similar information and support.

Over the last few years, Dallas has demonstrated that it is ready to tackle this tough issue. With the strong advocacy of Ntarupt, Dallas ISD adopted quality sex education curricula in 2019, and the City of Dallas has supported teen pregnancy prevention efforts, including Ntarupt’s public awareness campaign, Talk About It Dallas.

With a commitment to equity as the center of everything we do, our community of partners will reduce the teen birth rate in the top 12 zip codes by 50% by 2023.

Through this report, we highlight the partners who have made a difference and will continue this movement to put our children in the best position to make healthy, informed decisions, avail themselves of resources, and lead the lives they envision for themselves.

Dallas has many more capable partners who can all offer pieces of the solution. We have a real opportunity to continue our momentum and look forward to the possibility of working with Better Together to build on past work for inclusive community involvement to reduce teen pregnancy.

Terry Goltz Greenberg, CEO

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PREVENTING TEEN PREGNANCY: NATIONAL, STATE AND LOCAL LANDSCAPE WHERE WE ARE

In most places around the country, teen pregnancy is down. After peaking in 1991, the national teen birth rate went down 64% by 2015.1 Preventing at least 428,000 births to teen parents saved $4.4 billion in public spending in 2015 alone. By delaying pregnancy and parenting just one to three years, young people are more likely to access economic resources, including finishing school, ensuring a brighter future for themselves and the children they may have someday. For all teens, systemic changes that increase access to resources defined in the social determinants of health can dramatically improve life options for them and for their children.

Texas—and particularly Dallas-- are the lowest achievers of the national downward trend in teen pregnancy, unfortunately.

Of the twenty largest counties in America in 2017, Dallas County had the very highest teen birth rate. When ranking these largest counties by teen birth rate, of the top 5, 4 were counties in Texas. As high as the Dallas County rate was, several zip codes within the county have rates two to three times higher.

A study of the 2017 STD Surveillance Report by the Centers for Disease Control and Prevention (CDC) found that Dallas County saw the highest percentage increase in the nation for cases of chlamydia and gonorrhea between 2016 and 2017.

BECAUSE EVEN THOUGH I SEE PEOPLE TALKING ABOUT IT TO A CERTAIN EXTENT, IT’S AMONG THEMSELVES AND THEIR FAMILIES. IT’S NOT ON A GRAND SCALE TO THE COMMUNITY AND THE LEADERS RUNNING IT. IT’S STILL SEEN AS A VERY TABOO TOPIC AND I DON’T SEE WHY.” --DALLAS HIGH SCHOOL SENIOR, AGE 18

US TEEN BIRTH RATES (YEAR 2017) 20 Largest Counties Based on Age 15-19 Female Population Listed by Age 15-19 Birth Rate 35 31.8 30

27.4

27.1

25

23.5

23.3 21.5

Births to Teens

20

21.3

21

19.3 15.9

15

10

14.7

14.4

13.3

12.9

12.9

11.7

10.6 7.5

7.3 4

5

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ou nt Ha y rri sC ou nt Be y xa rC ou W nt ay y ne Co un Ta ty rra nt Co un ty Cl Sa ar n k Co Be un rn ad ty in o Co M un ar ico ty pa Co un ty Co ok C Ri ou ve nt rs y id eC Lo sA ou ng nt y el es M Co iam u i-D nt y ad eC ou nt Ki y ng sC ou Br ow nt y ar dC Sa ou n nt Di y eg oC o un Qu ty ee ns Co un Or ty an ge Co un ty Ki ng Sa Co nt un a ty Cla ra Co M idd un ty le se xC ou nt y

0

Source:CDC Wonder US State and County Birth data

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TEEN BIRTH RATE: BIRTHS PER 1000 FEMAILS OF THE AGE 15-19 AGE GROUP IN THE COUNTY

10 HIGHEST ZIP CODES IN DALLAS (Teen Birth Rate, Dallas, 2016) American Community Survey Data

I THINK (PREVENTING TEEN PREGNANCY) IS IMPORTANT TO SOME OF THEM BECAUSE IT’S A PART OF ENDING A CYCLE OF POVERTY. I MEAN YOU THINK ABOUT IT. MANY HIGH SCHOOL STUDENTS DON’T EVEN HAVE A JOB, SO IF THEY ARE ALL GOING TO ALL HAVE BABIES AT A YOUNG AGE, IT’S GOING TO AFFECT THEIR FUTURE.”

--DALLAS HIGH SCHOOL FRESHMAN, AGE 14

DALLAS COUNTY BIRTHS TO TEENS, 20182

Even when compared with other large counties with significant teen birth rates, Dallas County is high.4 Figure 4 on page 6 is the percentage of three counties when compared with the state average.

3

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The personal and community impacts of teen pregnancies in Dallas County are staggering. Teens’ lives are always made more challenging when they become parents. The tremendous responsibility of raising a child is one for which few teens are prepared. The following statistics demonstrate the limitations imposed by teen parenthood:

2%

JUST 2% OF TEEN MOTHERS COMPLETE A COLLEGE DEGREE

BY AGE 30.5

IN TEXAS FOSTER CARE, ONE OF EVERY 20 GIRLS AGES 13 TO 17 WILL BECOME PREGNANT. 6

FIGURE 4: TEEN BIRTH RATE: ABOVE OR BELOW STATE AVERAGE

25.7%

FOR MOMS UNDER AGE 15, 25.7% RECEIVED LATE OR NO PRENATAL CARE, WHILE FOR MOMS 15-19, THE RATE WAS 11%.7

TEEN FATHERS HAVE UP TO A 30% LOWER PROBABILITY OF GRADUATING FROM HIGH SCHOOL THAN THEIR NON-PARENT PEERS.8,9

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20%

30%

BY AGE 22, JUST 50% OF TEEN MOTHERS OBTAIN A HIGH SCHOOL DIPLOMA, WITH 30% RECEIVING THEIR GEDS. THE NATIONWIDE AVERAGE GRADUATION RATE IS 90% FOR TEENS WHO DID NOT GIVE BIRTH DURING HIGH SCHOOL.10

WHAT WE KNOW WORKS We know what works. Significant investment in better access to comprehensive reproductive health care and medically accurate sexuality education in schools or in the community has fueled the national downward trend. Research shows us that for every $1 of public money spent to provide family planning services, the public receives more than $7 in benefits.11,12 These benefits are wide-ranging and include preventing teen childbirths, reducing abortions, cervical cancers, HIV, sexually transmitted infections (STI), low birthweight babies, preterm births, and many others.

THE SOCIOECOLOGICAL MODEL Successful campaigns in Milwaukee, Wisconsin and Tulsa, Oklahoma included the entire community in their plans to address teen pregnancy. Ntarupt and its partners know that teen pregnancy is a community issue that requires a community solution. When addressing complicated societal issues, the Socioecological Model is often the framework that best describes the role the community plays in offering solutions.

The Socioecological Model provides a framework for understanding and modifying the social and environmental factors that influence teen behavior and helps address broader systemic issues that may affect this work. The individual is at the center of a range of influences in the broader environment, and each level of the model is critical when we plan strategies that focus on teens.

This model showcases the synergy needed to create large-scale social change, enabling us to co-create an environment that supports individual change. Teens are still able to influence the community that surrounds them in this model.

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SUCCESS IN ACTION IN MILWAUKEE, WISCONSIN & TULSA, OKLAHOMA In 2006, the City of Milwaukee confronted an ugly truth: one out of every 20 girls gave birth to a child. Health department epidemiologists, academics, and United Way of Greater Milwaukee and Waukesha County staff came together to set a goal to reduce teen pregnancy. The initial, highly ambitious goal was to reduce teen birth rates by 46% by 2015. In 2013, the United Way’s Teen Pregnancy Prevention Initiative announced that it had met its initial goal two years early.

It then established a new goal, to reduce to 11.4 births per 1,000 teens ages 15-19 by 2023.

The program used a several of unique strategies to draw in and retain community attention and effectively leveraged in-kind and monetary support to decrease teen pregnancy. This approach included: » Bringing together business, government, education, the medical field, the faith community, law enforcement and other groups to collaborate on this community issue. » Encouraging parents/caregivers to talk to the youth in their lives by distributing the Family Communication Toolkit, available free of charge in English and Spanish. » Investing in the Healthy Youth Initiative program to fund youth-focused efforts designed to educate youth about the consequences of teen pregnancy. » Maintaining the BabyCanWait.com web site with medically accurate, age-appropriate information on preventing pregnancy and promoting healthy relationships for youth. » A public awareness campaign targeting teens with messaging. The campaign kicked off in 2006 and culminated with a thank you campaign in 2017, thanking teens for making better choices. » Funding of reproductive health education throughout the City In Tulsa, these same focus areas where employed by the Community Service Council who developed the Tulsa Campaign to Prevent Teen Pregnancy (now “Amplify”) to address the critical issue of our high teen birth rate in Tulsa County. Launched in 2013, Tulsa Campaign focused on four main areas: » Education: Expanding sex education within Tulsa Public Schools, » Public Awareness: increasing awareness on issues affecting youth health » Developing and evaluating teen-friendly clinics, and » Using public perception polling and national and state data to influence the direction of teen pregnancy prevention in Tulsa.

Across these four program areas outcomes were: » 4,986 Tulsa Public Schools student received sex education in the 2018-2019 school year » 57.7% decrease in Tulsa County’s teen birth rate from 2009-2018 » 209 certifications were earned from participants in 2019 trainings » 88% of Tulsans support sex education implementation in Tulsa Public Schools

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WHERE WE ARE GOING – DALLAS READY TO ACT COMMUNITY READINESS ASSESSMENT

In 2018 and 2019, Ntarupt enlisted the help of several people with experience on Milwaukee’s successful campaign to reduce teen pregnancy to do a Community Readiness Assessment (CRA) with support from Better Together Fund. Using a model created by the Tri-Ethnic Center at Colorado State University, 45 interviews were conducted with elected officials, parents, faith community leaders, educators, teens, health care providers, and others.

More than 80 hours of interviews were analyzed and scored to determine the “readiness level” of the entire Dallas community to address reducing teen pregnancy. Through the approach of a Readiness Assessment, a readiness score measures the amount of information known by the community on the issue, leadership’s readiness level to address the issues, the community climate, and what resources are available to address the issue.

“I think a lot of people see what is going on and it’s affecting more and more people each day. They just need to take action.”

--Youth Interviewee

“I think our community leaders are just looking for someone with a plan, and if it’s a plan that everyone can agree on, I think it would be very well received.”

–Faith Community Interviewee

While the education sector interviewees were at higher readiness levels than others, the overall readiness score for the Dallas Community was a Level Three: Vague Awareness.

The Vague Awareness level can best be summarized by: “Something should probably be done, but what? Maybe someone else will work on this.” Moving a community beyond that level into higher rates of readiness means working hard to raise awareness of the issue so that more people in Dallas understand the full depth and breadth. Raising awareness means public events, communicating using multimedia strategies, and working closely with parents, educators, the faith community, policymakers, and others with a vested interest.

SUCCESS IN DALLAS ISD

In Dallas, educators, as a group, were at a Level 4, the Pre-Planning stage. Ntarupt’s success in advocating for significant reproductive health curriculum change in 2019 in Dallas Independent School District (DISD) proved that Dallas is more ready than we think to do what is right for our children. The DISD school board adopted a set of curricula for grade levels 6-12 that were more consistent with what Dallas students, parents, and educators saw as the primary needs for a curriculum. The set of curricula adopted were age-appropriate, and evidence-based (an approach backed by science).

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PUBLIC AWARENESS

In 2018, as a result of Ntarupt’s advocacy and participation on the Dallas Taskforce on Poverty, the City recognized teen pregnancy as a significant driver of poverty. Three years in a row, the City has earmarked funds for teen pregnancy prevention programs that included a comprehensive public awareness campaign, parent seminars, and other proven strategies and has awarded Ntarupt with three consecutive contracts to do this work. Under the first contract, Ntarupt launched a citywide public awareness campaign addressing teen pregnancy in 2019, “Talk About It Dallas.” Ntarupt set an initial goal to reduce the teen birthrate in the most affected zip codes by 50% by 2023.

THE PLAN

Leveraging lessons learned from successful programs in other cities, Dallas’ leaders in reducing teen pregnancy envision a strategy that intervenes at all levels of the model. Ntarupt has drawn on these successful efforts to identify five key areas on which to focus efforts:

• Individuals

» Reproductive Health Education, » Public Awareness and Messaging and » Access to information and resources, and digital information

• Parents & Other Caregivers – Giving caregivers information and skills to be a resource for their children, including: » Education, » Awareness messaging and » Digital information

• Faith Community – Ntarupt has made it a priority to include essential the faith community and encourage

families and ecumenical organizations to have difficult and necessary conversations about sex, using their own language.

• Community

» Ntarupt – Ntarupt’s alliance must continue to advocate for reproductive health education, equitable reproductive healthcare, and support for teens and their caregivers » Health Care Providers & Organizations – Facilitating teen friendly clinics and availability of all contraception methods » The Business Community – Provide access to opportunity for teens, and more importantly, assist in the public awareness campaign to promote access to information in order to delay childbearing and more easily access opportunity.

• Society

» Public Policy- Advocating for and creating a more equitable Dallas, creating access to overall opportunity with emphasis on in health care access and quality reproductive health education to support teens and families.

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INDIVIDUAL TEENS WHAT WE KNOW WORKS

Education. Evidence-based, comprehensive, medically accurate reproductive health curricula have been demonstrated through years of research to have an impact on changing behavior, thereby reducing teen pregnancy rates. Limiting availability to such programs—or offering abstinence-only programs—effectively limits a teen’s ability to make informed decisions for themselves.

Historically, Texas school districts have supported abstinence-only education or given none. More than 80 percent of Texas school districts in the 2015-16 school year taught abstinence-only or nothing at all when it came to sex education: • Abstinence-only: 58.3% • No sex education: 25.1% • Abstinence-plus: 16.6%.13 The fact that Texas Counties are 4 out of the top 5 Largest Counties in the US ranked by teen birth rate demonstrates this.

THERE ARE NOT A LOT OF PROGRAMS TO PREVENT TEEN PREGNANCIES. THE PROGRAM I PUT MY KIDS IN IS ONLY FOR AGES 6-14 YEARS OLD. THERE NEEDS TO BE A PROGRAM FOR OLDER TEENS, TOO. MAYBE I HAVEN’T LOOKED ENOUGH.” –PARENT INTERVIEWEE

In an information vacuum, teens are more prone to rely on misinformed friends, believe myths about preventing pregnancy, or engage in “magical thinking” that allows them to believe an unplanned pregnancy cannot happen to them. By investing in comprehensive, medically accurate sexual and reproductive health education programs that are age-appropriate at the elementary, middle school and high school levels, entire communities will experience benefits ranging from higher self-efficacy and graduation rates to increased averaged earnings.

Dallas educators surveyed by Texas Woman’s University reported the following issues or concerns related to teen pregnancy prevention: » 46% of Dallas teachers, administrators, counselors, and case managers surveyed said that teen pregnancy was an issue on their campuses » 23% of this group said they had “often” been approached by a student needing sexual health advice » Only 15% felt that their school’s sex education was “enough to meet the needs of youth” » 69% cited lack of education about contraceptive use as the greatest risk for unintended pregnancy » Lack of access to contraception and lack of career/education goals were cited by 46% as the greatest risk for unintended pregnancy The Sexuality Information and Education Council of the United States (SIECUS) has extensively researched different approaches to sexuality education, and identified certain elements that are effective at reducing risky behavior and teen pregnancy, which include: » Helping teens become effective decision-makers; » Information on the benefits of abstinence, along with information on how to effectively prevent pregnancy if teens do choose to have sex; » Medically accurate information on anatomy, pregnancy, contraception, and sexually transmitted infections (STIs); » An emphasis on family (including parent/caregiver-child) communication; and » Information on the characteristics of healthy and unhealthy relationships.

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Public Awareness: Communities who have made significant inroads on teen pregnancy prevention like Milwaukee and Tulsa, included public messaging to motivate teens to consider the impact of their decisions, and to drive them to reliable resources. The resources need to be accessible and responsive to the questions they are asking.

WHERE WE ARE

Education: In alignment with the Socialecologic Model, Ntarupt

I HAVE A DAUGHTER SO I’M WORRIED. THEY DON’T KNOW THE CONSEQUENCES THAT COME AFTER HAVING A BABY.”

took a community level impact approach by advocating for educational changes in local ISDs related to the adoption of evidence-based sexual health education. Dallas Independent School District (DISD) adopted a set of evidence-based sexual and reproductive health programs for multiple grade levels in -PARENT INTERVIEWEE February, 2019. Ntarupt was a major influencer in this change.

Ntarupt mobilized its Alliance member organizations, board, and community partners like the First Unitarian Church of Dallas to support the Dallas ISD school board in this important change and decision to provide evidence informed, medically accurate curricula to its students – eventually all 155,000 students will have had the benefit of real information. The first cohort of students should have received this instruction late in the 2019-2020 school year, though COVID-19 surely altered plans. Until this implementation, DISD, one of the largest school districts in the country, had taught little or no sex education, contributing to Dallas’ high teen birth rates.

“I have a daughter who is in high school. There was a young lady in her school that had no clue whether she was pregnant or not.” --Parent Interviewee “…A lot of the times what the school districts are teaching aren’t comprehensive. And parents would like to have more knowledge sometimes.” --Health Organization Interviewee To assist DISD, Ntarupt trained 22 teachers in DISD on one of the new curricula, sadly only a fraction of the number of teachers who are needed for full implementation. As always, teachers who deliver sexual health information should be trained by a certified trainer, be comfortable with the subject matter, and be trained in inclusivity and trauma informed approaches. Ntarupt will do whatever is necessary to assist in this implementation as 8,000-12,000 students per grade level now have the opportunity to receive accurate sexual health information.

Other school districts and charter school networks in the area have yet to implement this type of curriculum. Ntarupt has inventoried local school districts, to the extent they would cooperate and identified other key school districts who must be part of the student level support and education needed.

Those surrounding large school districts which are in Dallas County (at least partially) include Garland, Mesquite, Irving, De Soto, Grand Prairie, Carrollton-Farmers Branch and Richardson.

Tarrant County, having adopted and implemented evidence- based curriculum, has a lower teen birth rate than Dallas County.

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On a Dallas community level, Ntarupt and its 2015 Teen Pregnancy Prevention federal grant subcontractors (UT Southwestern, Planned Parenthood, The Concilio and Girls Inc.) delivered evidencebased, medically accurate teen pregnancy prevention programs to teens and caregivers/parents over the past 5 years. The delivery of education included over 50 community-based organizations and charter schools. Additionally, Ntarupt provided hundreds of hours of evidence-informed education to groups who do not have time for full interventions. Over this time, we have reached well over 5,000 people.

To further support students, we delivered training to youth serving professionals – Askable Adults-and have trained reproductive health education professionals. As the leader of sexual health education in North Texas, in response to COVID-19, Ntarupt rapidly pivoted to deliver virtual education, and has reached students, parents and youth serving professionals on Zoom, Google Hangouts, on the phone and even socially distancing in driveways.

In July of 2020 Ntarupt received another federal award from HHS’s Office of Population Affairs – Optimally Changing the Map for Teen Pregnancy Prevention. Using a systems approach, Ntarupt will work within two significant local charter systems Uplift Education and Can Academies to provide evidence-based education, create and run a Youth Advisory Board, an adult Community Advisory Group and refer teens to reproductive healthcare. Ntarupt is subcontracting on another OPA grant to serve foster youth and parents. This collaboration will be one with multiple organizations

including the Texas Campaign to Prevent Teen Pregnancy and Health Futures of Texas.

To engage in a State level approach, based on the Socioecological Model, Ntarupt is currently engaged in a multi-city coalition to create policy change related to sex education -Texas is Ready.

This year, the Texas State Board of Education (SBOE) will review and hopefully expand the state’s sexual health education curriculum minimum standards, which have not been revised in 22 years. Ntarupt, Healthy Futures of Texas, and the Texas Campaign to Prevent Teen Pregnancy, together, launched a statewide campaign as part of a grassroots advocacy effort to improve sex education curriculum standards.

The campaign, Texas is Ready, has used the expertise of its combined staffs to offer review and guidance of the standards and an online advocacy resource page at www.texasisready.org.

The three organizations (one Statewide and two local) were able to leverage the advocacy expertise of the Texas Campaign, along with the combined with curriculum knowledge provided by the educators from Ntarupt and Healthy Futures, data from the Texas Campaign, and marketing coordination from Ntarupt. As the effort stands currently, a significant change to require contraception education in middle school was added so that even students who don’t take health in high school, will get this vital information needed for a lifetime of health.

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Creating Awareness: In the first month, the campaign earned over $300k in earned media via PR efforts Ntarupt and Talk About It Dallas.com have been featured in the city’s most highly viewed media: WFAA Chanel 8, Fox 4 Texas, Al Dia, Dallas Morning News, D Magazine and more. In its first year, Ntarupt produced a short feature film, The Pull Out Game, highlighting the consequences of risky behavior. Ntarupt’s paid and organic digital social media efforts for TalkAboutItDallas have registered almost 9,000,000 impressions in the top teen birthrate zip codes. We are getting the message out where it matters. Ntarupt’s messages are not just for teens, its highest performing ads and messaging are targeted to parents, urging them to get talking and to start the conversation. This is an important conversation for parents and for our city. The high click-through rates on this media show our messaging is right, is resonating and that people want… to talk about it.

Reaching teens: in 2020, as COVID has driven teens away from in-person learning, and Ntarupt intensified efforts to reach them where they are on social media. With our media partner, 97.9 The Beat, Ntarupt launched #quaranteentalks campaign. Ntarupt is targeting teens and driving them to the talkaboutitdallas.com website to access information and resources. In the first half of 2020, the campaign launched a digital campaign targeting Dallas teens, which included Paid Search, and the top social media platforms - YouTube and Instagram. The results were: 5,561 clicks for paid search, and 1,177,652 impressions between YouTube and IG. During the six weeks that the campaign was active, 7,472 sessions of the Talk About it Dallas website were achieved.

Finally, we reached hundreds of parents with our Facebook live event about talking to your kids with influencer, MamaChallenge.

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First campaign 2020 metric: Ntarupt has engaged an evaluator for all of its public awareness activity and is preparing to launch its first set of surveys following these efforts. We know it will be a long haul, and are continuously working to improve.

WHERE WE ARE GOING & NECESSARY PARTNERS

PARTNERS Ntarupt

School Districts

State Advocacy partners- The Texas Campaign to prevent Teen Pregnancy and Health Futures of Texas

Community Organizations

ROLE » Conduct advocacy to change and enhance local district policy » Provide Training of reproductive health educators and direct education to youth and caregivers. » Education, adoption and implementation of quality evidencebased reproductive health education » Advocacy for positive changes in the State Education Code – TEKS (Texas Essential Knowledge and Skills) that up for review in 2020 and other supportive educational and health care policies » Share data and research » Launch new research » Partner to train educators » Partner to deliver education on a larger scale » Share public awareness campaign messages (Talk About It Dallas) » Education Delivery sites, Alliance partners and advocates. Provide locations and include reproductive education in other youth development activities and parent/caregiver programs. » Share public awareness campaign messages from Talkaboutidallas. com.

Planned Parenthood and other reproductive health education providers

» Advocacy partner for improved Reproductive Health Education in ISDs and on the State level » Community education in sexual and reproductive health

Talk About It Dallas (a campaign of Ntarupt)

» Continue Public Awareness campaign getting information to teens

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PARENTS & OTHER CAREGIVERS Parents and other caregivers are the primary sexuality educators of their children. They set the tone for what children think and believe to be permissible and acceptable within their family’s value structure, and what healthy relationships look like or should look like. They create environments where talking about body parts and functions are healthy, and where questions can be asked openly.

But children need these expectations set early on, and they need frequent reminders as well as opportunities to ask lots of questions. Parents and caregivers set expectations of completing high school, furthering education, and of sexual responsibility and delaying sex until both parties are able to make informed decisions that are consistent with their ability to be pregnant or parenting.

Research shows that teens who report strong family connectedness, parental monitoring, and good adolescent-parent relationships have lower rates of teen pregnancy. Effective parent-child communication about sexual activity and contraceptive use has also been shown to reduce the chance of teens becoming parents.

WHAT WE KNOW WORKS

The Power to Decide (formerly the National Campaign to Prevent Teen and Unplanned Pregnancy) identified ten tips for parents or other caregivers to follow when they want to prevent their teen from becoming pregnant or becoming a parent before they are ready.

1. Be clear about your own sexual values and attitudes.

2. Talk with your children early and often about sex, and be specific.

3. In addition to being an askable parent, be a parent with a point of view. Tell your children what you think.

4. Know your children’s friends and their families.

5. Discourage early, frequent and steady dating.

6. Take a strong stand against your daughter dating a boy significantly older than she is.

7. Help your teenagers to have options for the future that are more attractive than early pregnancy and parenthood. (Equitable access to resources and opportunity has a huge impact on this piece) 8. Let children know that you value education highly.

9. Know what your children are watching, reading and listening to.

10. These first nine tips for helping your children avoid teen pregnancy work best when they occur as part of strong, close relationships with your children that are built from early age.

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WHERE WE ARE

Ntarupt recognizes that caregivers are key pieces of a youth’s support network. Ntarupt and its former federal grant partners have been delivering parent education – Families Talking Together--since 2015 as part of implementation of a grant from the U.S. Department of Health and Human Services under the Teen Pregnancy Prevention Program. This course teaches parents and caregivers that their communication with the teens in their lives is crucial. It also gives them tools to have effective, interactive conversations – to talk so that kids will also talk and listen.

The program has shown to increase caregiver/ child communication and discussions about sex.

This work is essential to making progress and cannot be done by one agency. Ntarupt has also increased capacity in other organizations to deliver this education, training facilitators who work for both former grant partners (Planned Parenthood, UT Southwestern, and The Concilio) and community partners. Ntarupt has delivered this education through many essential community partners such as Lumin, the former Trinity River Mission, Dallas ISD, Vickery Meadow Youth Development Foundation, the Stewpot and more as well as directly out in the

community to parents at Zumba classes and in laundromats. Since COVID-19, we have been delivering on Zoom, the telephone and socially distanced front yards.

With new federal funding awarded, Ntarupt will continue to support caregivers, including those in the foster system as well as those of children attending Can and Uplift. Always seeking more effective interventions, we will be adding Brave Conversations to our toolkit.

Online resources are also key: the Talkaboutitdallas.com website in English and Spanish offers real-time, useful information to caregivers. Parents can answer their own and their teens questions about sex. The site contains a guide on how to have those difficult and necessary conversations with teens on sex, birth control, abstinence and more. The site contains accurate information on birth control, STI’s, abstinence, sexuality, what to expect at a visit to a doctor as well as a clinic finder. Parents armed with information can be better and more confident resources to children with questions.

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WHERE WE ARE GOING & NECESSARY PARTNERS

In order to approach this work holistically, Ntarupt and partners recommend:

PARTNERS Ntarupt

ROLES » » » » »

»

Conduct parent education sessions throughout the community Create online and printed resources for parents/caregivers to support their conversations with their children.

Develop mini e-books for parents in English and Spanish with community professionals Develop a series of presentations for parents of children, designed for each developmental stage about age-appropriate communication Allocate funding to allow partner organizations to join in this work with their clients.

»

Support positive parent-child communication about sexual health, values around sexual activity,and contraceptives by becoming delivery sites and advocacy partners in strengthening caregiver/teen relationships.

Work to improve the home lives of teens by supporting policies that reduce poverty, reduce the number of teens who experience an unstable home life Provide mental health care, counseling and family support Provide education and resources for parents on healthy relationships and parenting Provide after-school and summer programs that enrich, provide mentoring and internship programs and academically support children Support and promote positive messaging to caregivers about reproductive health Share Talk About It Dallas messages directed toward parents

Talk About It Dallas

» »

Produce parent directed messaging Maintain accurate information in English and in Spanish

Faith Organizations

» »

Partner to offer and create parent education programs, and materials Host events or listening sessions for families where teen pregnancy remains a significant concern

Planned Parenthood and other reproductive health education providers

» »

Continue to provide parent education to the community Be an advocacy partner in the community

The Texas Campaign to Prevent Teen Pregnancy, Healthy Futures of Texas

» » »

Work together to aggregate data Work together to cross-train educators and create materials Work together on federal grant to address education of foster parents, caregivers and case-workers

City of Dallas

»

Fund and publicize activities to educate and inform caregivers

Funders

»

To fund parent education and development of accessible parent information materials

Community Organizations

» » » » »

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FAITH COMMUNITIES “Teens, even adult parents of teenagers, don’t know where to necessarily find these programs and resources. It’s not to say that they’re not out there. It’s just people aren’t aware.”

--Faith Community Interviewee for Community Readiness Assessment

WHAT WE KNOW WORKS

Dallas residents have strong ties to their faith communities and are more likely than many other urban communities around the country to identify a strong faith affiliation. Leaders in these faith traditions—particularly Evangelical Protestant, Mainline Protestant, and Catholic denominations— have the potential to reach significant proportions of their congregations in teen pregnancy prevention. Each church or other faith community must decide for itself whether or how to become involved, but the potential is there for greater pastoral and lay leadership in the prevention of teen pregnancy. This can occur when supporting caregivers and parents to address difficult issues, and by training their own youth leaders and staff to address issues surrounding sex.

WHERE WE ARE

Faith community leaders have been surveyed twice by Ntarupt, first for a Texas Woman’s University study completed in 2017 and then interviewed for a Community Readiness Assessment completed

by Ntarupt in 2019. It is an understatement to say that Religious leadership has a big influence in the community. This is seen by some to hinder teen pregnancy prevention efforts, while Ntarupt sees the potential for them to step up and become leaders on this issue. They are recognized as powerful institutions that can make or break initiatives like teen pregnancy prevention efforts.

The needs assessment completed by Texas Woman’s University for Ntarupt in 2016 gathered data from interviews with Dallas’s faith community leaders. These leaders felt that churches or other religious organizations play an important but limited role in teen pregnancy prevention. The Community Readiness Assessment, likewise, identified faith community participation as a pivotal part of addressing teen pregnancy. » 96% of religious leaders “strongly agreed” that their community needed more efforts to prevent teen pregnancy » 82% of religious leaders said that they/religious groups should be doing more to help prevent teen pregnancy » Leaders cited a lack of educational materials and the education needed to use them as obstacles to conducting sexual education in a church setting » Religious leaders were most likely to cite a “lack of career and educational goals” as the biggest risk for unintended pregnancy » A full 73% of religious leaders said they were “very comfortable” discussing healthy relationships with teens

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WHERE WE ARE GOING & NECESSARY PARTNERS

Many faith communities have health fairs or other community events to which Ntarupt, partners, or parent ambassadors could be invited. Faith community leaders who become part of the leadership team can help identify ways for information about teen pregnancy prevention to be presented at its events, be it through information tables or more formal presentations. Materials for parents can also be distributed through family ministries or outreach efforts, particularly in communities where there is already a high level of teen pregnancy. Working with the faith community is slow and requires particular development of trust. Ntarupt has worked to get churches in the high teen birth rate areas of Dallas on board to talk about the issue or to attend meetings about it. Those areas are the same areas that suffer a variety of economic, educational and health care inequities, all of which impact teen pregnancy. Below are the steps we have taken toward this work and the creation of a Faith Coalition to advance this work from a faith perspective.

History of Ntarupt efforts:

» Nov. ’18 had meeting with faith leaders and United the Church/focus group » Individual meetings with pastors over five years » Jan ’19 held follow up meeting with Unite the Church » March ‘19, Ntarupt conducted a faith leaders meeting at First United Methodist Church, over 20 ecumenical organizations in attendance » May ’19 Ntarupt co-sponsored a Prayer Rally in Pleasant Grove with the Pleasant Grove Ministerial Alliance » May ’19 Ntarupt CEO was guest on Podcast conducted by Rev. George Mason, founder of Faith Commons – Good God » Oct. ’19 conducted faith meeting at Cliff Temple » Feb. ’20 individual outreach planning meeting with 6 clergy in attendance

We have learned that this type of effort and leadership takes sustained and dedicated effort.

This last meeting, the faith leaders convened by Ntarupt decided to do embark on individual outreach to churches, and will soon approach several churches where inroads may be made.

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Faith Coalition goals: » » » » » »

Create a page on the Ntarupt website (or a separate website) for faith-created and centered resources Create resources requested by the faith community Ntarupt will develop and share sexual health information produced in response for distribution Offer parent education support Offer faith-directed reproductive health education for teens Have faith groups share resources they have already created

To continue this work with maximum impact, Ntarupt will need personnel dedicated to moving the work along. Building relationships in the community is important, impactful, and takes time.

Partner

Primary Role

Individual » Participate to help direct creation of reproductive health resources Ecumenical »

Partner with Ntarupt to deliver parent Institutions

education » Partner with Ntarupt to train ecumenical staff members working with parents and teens on reproductive health issues » Partner with Ntarupt to create education for youth

First Unitarian Church » of Dallas and First United Methodist Church »

Provide faith-based curriculum Our Whole Lives, and Created by God to interested ecumenical organizations and community members Advocate for comprehensive sex education throughout City and State

Faith Commons » Assist in outreach Faith Forward » Assist in production of faith informed materials Unite the Church

Secondary Role » Acknowledge teen pregnancy prevention as a key community issue

» Assist in outreach to other faith institutions

» Identify individual communities for partnerships and collaborations

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HEALTH CARE PROVIDERS & ORGANIZATIONS Health care providers are in a unique position to impact teen pregnancy prevention, from providing and advocating for greater access to preventive health care services to changing policies to promote access to medically-accurate information in school settings.

WHAT WE KNOW WORKS

The American Academy of Pediatrics recommends reducing health disparities across a number of health indicators by expanding access to Medicaid or other health insurance for children and families. Texas is one of just 12 states that has not accepted Medicaid Expansion dollars. Additional measures that can be taken by health care education and clinical provider organizations include: Deliberately creating teen-friendly clinic environments » Expanding access to clinics by adjusting hours, increasing locations and access by available transportation » Training providers that provide education to youth and work with caregivers of children and teens to maximize care » Supporting parents and caregivers as the primary sexuality educators of their children, assisting them as they learn to communicate their family’s values to their teen(s) » Training health care professionals to become active listeners when teens have questions, and know how to refer them to local resources for education, and mental health care » Understanding racial history with reproductive health care » Learning to provide anti-racist health care » Being culturally and historically responsive

WHERE WE ARE

Health care providers are on the front lines of the teen pregnancy crisis in Dallas.

When surveyed for Ntarupt’s needs assessment completed by the Texas Woman’s University, health care providers acknowledged the role of other community resources and wanted to see better education, better healthy relationship information and support, better parental support, and better sex education for youth.

Addressing clinical resources, 78% cited a lack of contraceptive use as the greatest risk for unintended pregnancy, while 88% cited a lack of education about contraceptive use as the greatest risk for unintended pregnancy. Many (60%) felt that a lack of career/education goals put teens at greatest risk for unintended pregnancy. A lack of parents and other caregiver support was cited for keeping health care service and education providers from reaching youth. Providers also frequently cited the lack of public transportation options in Dallas as a barrier to accessing health care services.

“Transportation is always a barrier, when the resources are available. So, for example, you know you have kids who unfortunately are also working adults to a degree or have activities that they’re doing and that sort of thing.

So, when (transportation is not) available to them can be a barrier.”

–Health Care Provider, Ntarupt Community Readiness Assessment, 2019

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While there are Title X clinics and HHSC clinics near some of the most economically affected areas, the community needs more information. In Ntarupt’s 2019 clinic mapping project, we mapped access to reproductive health care throughout the City. We analyzed 1) Clinics with hours after 5pm; 2) Clinics with weekend hours; 3) Clinics that provide all forms of contraception; 4) Zip codes shaded by density of poverty among women aged 15-19 - a proxy for demand; 5) Travel time to HHSC clinics by zip code; 6) Travel time to Title X clinics by zip code. Here are the findings with respect to clinics in the four of the zip codes we are targeting:

CLINIC MAPPING DATA, ANALYZED Zip Code 75203 75208 75210 75215

Teens in poverty per square mile 40 34 62 21

Travel Time to nearest Clinic Title X Clinic 12.5 min 8.1 min 5.2 min 5.2 min

HHSC Clinic 12.4 min 8.2 min 5.2 min 8.8 min

Evening and Weekend Hours After 5 PM 0 0 0 2 hrs/week

Weekends 0 0 0 0

Clinics having all forms of contraception?

No No adjacent to 75215 Yes

Given the findings above, the need for clinics with late or weekend hours and to be able to offer all forms of contraception stand out as the most obvious needs.

Additionally, given that race is a social determinant of health, it is critically important that medical caregivers be at a minimum culturally competent, and understand how the history of medical experimentation and bias has impacted Black and LatinX people in Dallas. Data shows strong evidence that implicit bias plays a role in disproportionately high maternal and infant mortality, and likely affects many other poor health outcomes. Black and LatinX women are too often not being heard by providers, which can lead to them not receiving necessary medical treatment. Providers must work to address any biases they have and work to address persistent issues of mistrust in the Black and LatinX communities.

The World Health Organization worked to pioneer the concept of youth-friendly clinics nearly a decade ago, identifying that five key dimensions were necessary. These clinics needed to offer services that were: equitable, accessible, acceptable, appropriate and effective.14 Over time, these have become the building blocks of a Youth-Friendly Clinic Initiative that has been widely adopted around the country. Youth who receive health care services delivered in a way that meets the unique needs of adolescents ultimately develop into healthier adults who also have a higher likelihood of having healthier children should they become parents one day. The thirteen items outlined in the table that follows allow organizations to determine how youth-friendly they are.

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FIGURE 9: YOUTH-FRIENDLY HEALTH CLINIC CHARACTERISTICS, MICHIGAN ADOLESCENT HEALTH INITIATIVE

WHERE WE ARE GOING & NECESSARY PARTNERS

Since COVID-19, healthcare providers’s attention has been diverted. Ntarupt will keep the following goals on the very necessary to-do list as they become feasible for the medical community. Like other projects, moving this forward will take concentrated personnel who can work individually with clinics and collaborate with the important partners listed on below

Partner

Role

Dallas ISD » Work to establish clear DISD/Parkland School Health Clinics policies to ensure reproductive health care is available to teens at school based clinics, and that the community is aware of the resource » Expand hours and reproductive health care (including all contraceptive methods) to at least one schoolbased clinic in the Southern Sector » Work to establish clear DISD polices that allow, train and encourage all school nurses to address questions about reproductive health and contraception and provide condoms

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Secondary » Encourage stronger messaging to DallasISD families about the availability of its School Health Clinics

Parkland Women’s Clinics » Continue to receive and track

youth referrals from Ntarupt » Provide information/data on contraceptive youth with teens » Participate in Youth Friendly Clinic initiative (training and make necessary changes » Participate/conduct training for providers on historical and cultural factors affecting health care in Black and LatinX patients

» Continue to provide outreach staff to talk to Ntarupt teen classes » Share teen birth data with Ntarupt

Dallas County Health Services » Continued access to STI testing

» Provide site for contraceptive counseling as safety allows

Child Poverty Action Lab » Expand access to contraception (CPAL) at local clinics

» Support messaging about contraceptive options and use » Launching “Trust Her” to share best practices with clinicians, partners and medical providers

» Partner for contraception education delivery (MOU in place) » Share messaging for Talk About It Dallas campaign

» Assist and expand locations that offer all types of contraception » Provide funding for long acting reversible contraception to clinics » Work with Parkland on pilot to provide immediate post-partum patients with same day access to long acting reversible contraception

Children’s Health Adolescent » Continue providing teen friendly adolescent Clinic and Planned reproductive health care Parenthood Clinics » Participate in Youth Friendly training

»

Participate in collaborative researchReceive/ conduct training on historical and cultural factors affecting health care in Black and LatinX patients

Other local clinics (Foremost, » Ensure access to reproductive Agape, Los Barrios Unidos) health care and ability to provide all contraceptive choices for teens » Implement youth friendly care » Implement culturally competent care »

The Texas Campaign to » Conduct the Youth Friendly Initiative Prevent Teen Pregnancy training and evaluation

» Coordinate with the Michigan Adolescent Health Initiative

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SOCIETY - REDUCING HEALTH INEQUITIES & RACIAL DISPARITIES IN TEEN PREGNANCY WHERE WE ARE

The social determinants of health (SDOH) are life-enhancing resources, such as food supply, housing, economic opportunity, family and social relationships, transportation, education, and health care, whose distribution across populations effectively determines length and quality of life.

Recently, the American Academy of Pediatrics specifically added racism to the factors affecting the health of adolescents. Several SDOH have been identified as particularly relevant to teen pregnancy and adolescent sexual health behaviors, among them: education and employment opportunities, neighborhood characteristics, community-level economic structures, and access to quality health care. The absence of positive resources has a negative effect on teen pregnancy.

Dallas County’s public health hospital, Parkland Hospital, released its Community Health Needs Assessment in 2019, highlighting strong evidence of health disparities that are significant in Dallas County:

1) Dallas County has one of the highest uninsured rates among all urban counties in the nation. This can drive up hospital costs for insured and uninsured alike.

2) Dallas residents have persistently low rates of health literacy, presenting

challenges for people trying to enroll in and use health insurance coverage, adhere to treatment plans and provider instructions, and navigate the health care system. These issues are particularly acute for racial and ethnic minorities, who sometimes find that services are not culturally or linguistically accessible.

3) The most significant health disparities are by race, ethnicity and geographic location

in Dallas County, with African American and people living in ZIP codes in Southeast Dallas experiencing the highest burdens of disease and mortality.

The SocioNeeds Index Map below, taken from the Parkland Community Health Assessment in 2019, shows that the zip codes that Ntarupt seeks to work with most closely have been most impacted by historical segregation and inequalities that have become systemic. This impact is seen through the measures of poverty, income, unemployment, occupation, education and language. The darker the coloration on the map, the greater the impact across the six areas.

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SOCIONEEDS INDEX MAP PARKLAND COMMUNITY HEALTH ASSESSMENT 2019

DO YOU HAVE A HIGHER RES VERSION?

In addition to these hurdles, the spread of COVID-19 virus in our world, nation and local community has had an immense, immediate and injurious impact on our most vulnerable communities: communities of color. As a result of the COVID-19 pandemic, Dallas’ families are losing jobs and have and unprecedented need for rent and food assistance. Teens separated from physical school often lack computers and reliable internet, making it hard for them to access digital learning. And as always, unsupervised teens with time on their hands tend to be more sexually active. Now, more than ever, teens need access to information and resources so that they can make the best choices for themselves.

The impact of COVID-19 on reproductive health services became apparent as early as mid-June of 2020, 5-6 months into the pandemic. The table that follows shows the impact that even a small decline in health care service usage can have on individuals, families, and communities.

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TABLE 1. Potential annual impacts of a 10% proportional decline in use of sexual and reproductive health care services resulting from COVID-19– related disruptions in 132 low- and middle-income countries15 Disruption in essential sexual and reproductive health care 10% decline in use of short- and long-acting reversible contraceptives

Impact 48,558,000 additional women with an unmet need for modern contraceptives 15,401,000 additional unintended pregnancies

10% decline in service coverage of essential pregnancy-related and newborn care

1,745,000 additional women experiencing major obstetric complications without care 28,000 additional maternal deaths 2,591,000 additional newborns experiencing major complications without care 168,000 additional newborn deaths

The diagram that follows, provided by Social Impact Architects, is one way of looking at the impact of social determinants of health “downstream” and “upstream” when working to reduce health inequities within the SDOH framework.

FIGURE 5: FRAMEWORK FOR REDUCING HEALTH INEQUALITIES

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WHAT WE KNOW WORKS

A number of strategies help to build health equity and reduce the disparate impact of teen pregnancy.

» Expansion of access to child health insurance, and access for all to reproductive healthcare » Ensuring all teens get medically accurate reliable reproductive health information » Narrowing the disparities between white parents’ employment rates and the rates experienced by Black, LatinX, and American Indian parents » Reducing preterm birth rates, which are associated with perceived racial discrimination and maternal stress and are disproportionately experienced by Black mothers » Ensure that pediatricians, obstetricians, and gynecologists working with teens and young adults deepen their understanding of and improve their ability to screen for the effects of racism on their patients of color- resulting inculturally competent, anti-racist healthcare » Advocate for policies that diversify the pediatric and educational workforces » Livable wage job availability,

WHERE WE ARE

“[T]eenage motherhood is not a single issue, but a phenomenon that in America is deeply entangled with contemporary and historical issues of race, poverty, and marital status. The intersectional approach embraced by the reproductive justice perspective demands that teenage mothers be viewed with respect to their multiple marginalized social identities and understood through the social, political, and historical contexts in which they live and raise their children.”16 --Hans, S. L., & White, B. A. (researchers) As an organization, Ntarupt embraces Reproductive Justice.

SisterSong defines Reproductive Justice as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”

While Ntarupt focuses its core work in creating access to information about reproductive health and supporting teens to make the best choices for themselves, supporting safe and sustainable communities leads Ntarupt to support ongoing efforts to create an equitable Dallas.

The good news is that Dallas County’s public health provider, Parkland Health and Hospital System, has identified and is working on some of the factors that create health disparities – Dallas is poised for change.

I WOULD SAY THAT IT IS OF LESS INTEREST TO MOST COMMUNITY CITIZENS BECAUSE… IF THEY ARE NOT TOUCHED BY IT AND IF THEY DON’T HAVE TO SEE IT, IT CAN BE OUT OF SIGHT, OUT OF MIND...”

–BUSINESS COMMUNITY INTERVIEWEE

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WHERE WE ARE GOING & NECESSARY PARTNERS

Ntarupt must be responsive to community needs and community voices in the work it does. This means supporting initiatives that would create equitable access to the social determinants of health in the neighborhoods most affected by racism and poverty.

Starting in late 2019, Ntarupt became part of Dallas Truth Racial Healing & Transformation – Racial Equity NOW Cohort. Ntarupt has worked to set its own racial equity outcome: To eliminate racial disparities in unintended teen birth rates for Black and LatinX young women ages 15-19 in Dallas County by 2030. This ten-year goal will involve:

1) Changing the way Dallas understands how racism impacts economic and health outcomes having a direct impact on teen pregnancy.

2) Providing transformative reproductive

health education to all students.

3) Ensuring that young women of color

BECAUSE WE LIVE IN DALLAS COUNTY, WE LIVE IN A SPACE WHERE THERE ARE AN INSURMOUNTABLE AMOUNT OF ISSUES AND PROBLEMS THAT ARE AFFECTING OUR YOUNG PEOPLE. TEEN PREGNANCY… GETS THROWN IN THE MIX. AND THERE’S A LEVEL OF RESILIENCY, ON THE POSITIVE SIDE, OR ALMOST COMPLACENCY… FEELING LIKE IT’S JUST A PART OF THE REALITY THAT WE LIVE IN. SO, OFTEN TIMES COMMUNITY MEMBERS WITH A LOT OF THESE SOCIAL PROBLEMS, THEY THROW THEM ALL IN A BUNCH AND THEY SAY IT’S JUST A PART OF THE ENVIRONMENT. IT’S JUST SOMETHING THAT HAPPENS OR SOMETHING THAT WE’RE USED TO.”

--EDUCATIONAL PROFESSIONAL INTERVIEWEE have equitable access to trustworthy reproductive health care. Ntarupt will work with local providers to increase accessibility to anti-racist and culturally competent care in geography, convenient hours, and affordability.

Ntarupt has studied Young Women United (YWU), an organization that leads reproductive justice organizing and policy initiatives by and for self-identified young women and people of color in New Mexico, and affirms that “Young people, including young parents, need accurate information and basic respect — so that they may have what they need to be who they are, and to thrive. It’s crucial that justice minded allies, advocates and policy makers invest in the resources, education, and information young people need to make decisions about their own bodies and lives, while moving away from problematic and harmful teen pregnancy prevention approaches. We must stop blaming young people in general—and young parents in particular—for systemic inequities.”

Systems and services that are geared toward teens need to equip them with what they need, either in preventing teen parenting or best situating them when and if they do become parents, but these are not systems that teens control. Parents and health care providers recognize that teens are not getting the information they need to delay pregnancy and parenting.

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CONCLUSION - DRIVING CHANGE BUILT ON COLLABORATION:

Cities that have reduced teen pregnancy rates have established strong multi-sector coalitions, dedicated significant monetary and in-kind resources, and committed to address the issue for a period of five or more years. These cities’ efforts provide examples of the way forward for the Dallas community. By coming together toward a common purpose, this community-wide issue can be addressed in a holistic, successful way so that it benefits everyone.

Recognizing this, Ntarupt’s genesis was as an alliance of 40+ community organizations and individuals who first came together at the end of 2013 with the goal of reducing teen pregnancy because each organization recognized that it affected their clients ability to thrive. Collective action and collaboration is embedded in our work, and we have worked along side many elected officials and funded numerous organizations to move the work ahead.

In 2015, with a grant from the U.S. Department of Health and Human Services, we funded the Concilio, Girls Inc., Planned Parenthood, UT Southwestern, and Texas Woman’s University to work with us in high needs areas to replicate evidence-based teen pregnancy programs for teens and parents and refer teens to reproductive healthcare. Over those years, we educated over 5,000 teens and parents, and hosted numerous youth, parent and city seminars and summits.

In 2018, with a grant from the Better Together Fund, we continued our work with the City, were able to hire a consultant to conduct the Community Readiness Assessment and hire Social Impact Architects to assist with this plan for addressing teen pregnancy in Dallas, and fund Unite the Church to help with our faith outreach And now, in 2020, with funding again from the U.S. Department of Health and Human Services, Ntarupt will be able to use a systems approach in two charter school networks, Uplift Education and Can Academy to work on teen pregnancy. Additionally, as a subcontractor to the University of Texas, Ntarupt will help develop programs to address the issues of foster youth, reproductive health and teen pregnancy.

Finally, we have collaborated with the Texas Campaign to Prevent Teen Pregnancy and Healthy Futures of Texas on two different projects. The first project was in recognition that the goals of messaging to teens, parents and the public through social media and other outlets is completely shared. We also collaborated to create messaging for Sex Ed for All month in May. Most recently, the same three organizations formed Texas Is Ready, a collaboration that harnessed various areas of expertise in advocacy, effective reproductive health programs, and messaging to impact the revisions of the Texas Standards for Knowledge and Skills (TEKS) on sex education. This collaboration has been successful, and the work continues.

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NEW COLLABORATION NEEDED:

Working to better understand, respond to and incorporate the diverse voices of the community in which we operate is key to the success of this plan and will ensure the community has the power to address and solve this problem. Initiatives that deserve and require dedicated professionals are:

1. Individual Teens: ensure that teens are trained in decision-making, the development of life

planning skills, and that no matter where they turn for information it is medically accurate and age-appropriate. Continuation of district by district advocacy to ensure selection of medicallyaccurate, evidence-based or informed, trauma informed and inclusive programs is a significant undertaking. Marrying the expertise of both Ntarupt and The Texas Campaign in the creation of a regional approach to be used on a local level would help generate more successes such as the one in Dallas ISD

2. Parents and Other Caregivers: While all parents need access to the education and

information to support their children delaying pregnancy and parenting, the Dallas community is diverse. Because ultimately, parents are the key health educators of their children and vital partners in effective prevention, Ntarupt proposes funding of community outreach specific to the Black and LatinX communities to understand what information they need, and how they would like this information so that they can be a driving part of the change.

3. Faith Communities: become full partners in this work, acknowledging their role with families

and equipping them in a way that works well within their denominations or across ecumenical organizations. Ntarupt proposes funding of an individual to support the faith community effort and response to teen pregnancy, which will include gathering, consensus building and vetting and organizing and designing resources requested by the collaboration.

4. Health Care Providers & Organizations: push for additional teen-friendly health care access

points, ensuring that these sites are teen-friendly within many criteria, culturally competent and present all health care and education options to teens. This can be done by in-house dedicated professional as they did in Tulsa, or through local clinic participation in the two year, evidence-based Youth-Friendly Initiative – now successfully coordinated in three cohorts throughout Texas by the Texas Campaign to Prevent Teen Pregnancy.

5. Community Organizations and Businesses: these have key roles in successful public

awareness campaigns. Leadership in non-profit or business organizations can help publicize events, inform the public about the importance of finishing school or vocational training before becoming a parent, or play other unique roles. Ntarupt requires more internal personnel dedicated to meeting with City business leaders and organizations to tailor messaging that is effective.

6. Funders: a long-term commitment to this as a need to prioritize this as a key part of broader

community improvement and economic development platform. Teen pregnancy prevention is more important than ever during the time of COVID-19, as inequities are enhanced during national economic and health care stresses. Ntarupt looks forward to working with established and potential partners in Dallas to support families and organizations dedicated to creating a healthier, more prosperous community for us

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ORGANIZATIONAL EXCELLENCE – MERGING TO ENHANCE CAPABILTIES: Recent collaborative efforts with both The Texas Campaign to Prevent Teen Pregnancy and Healthy Futures of Texas have been incredibly successful and rewarding. We have worked together so far to:

1. Advocate on a Statewide level 2. Create and share messaging 3. Share research 4. The CEOs of the three organizations have had semi-monthly calls to share organizational practices, goals, and needs

The Ntarupt Board of Directors and the Board of Directors of The Texas Campaign to Prevent Teen Pregnancy are interested in strategizing how a partnership would enhance our work in Dallas.

Identified topics motivating these discussions, in addition to those listed above are:

OPPORTUNITIES AHEAD:

1) Rebranding:

With or without a merger, both organizations have board directives to rebrand.

“Preventing teen pregnancy” is now seen as stigmatizing to teen parents, but also fails to recognize that it is the adults in the community who owe youth and parents information and resources to make the best decisions for themselves. This is more of an empowering approach. Additionally, we need to incorporate not only sex education, but mental health care, LGBTQ support, gender discussions, women’s issues and more. It is no longer just about teen pregnancy 2) Focus on Mobilization projects: Help mobilizing the faith, community and healthcare sectors is a big lift, and a larger staff that can focus on specific projects would be useful.

3) Capacity to perform research; Ntarupt works collaboratively with students from UT Southwestern and some physicians there, but this also takes dedicated time and expertise.

The Texas Campaign has a data specialist who generously shares, but being able to collaborate on data and research would be powerful.

4) Collaborative messaging: As stated above, the messaging we create should be shared as the purpose and voice will be similar.

5) Sharing HR and Administrative oversight: Both CEOs need a COO to liberate their time to do more mission centric work.

6) Cross training for programs among organizations: Each of our organizations has expertise on different sets of evidence base programs. A merger would enable cross-training and sharing expertise easier.

7) Fundraising: Finally, fundraising professionals who understand the issue for one of us, understand it for all of us. Though differences exist in each City, combined efforts would enhance efficacy and allow us to pursue funding on a larger scale.

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We hope you will consider supporting exploration of merged capacity between these organizations To be effective driving change on each of these levels – individual, parent/ caregiver, healthcare, faith coalition, business and driving equitable change in Dallas, requires heightened dedication to both collaborative mobilization and advocacy, enhanced expertise and funding.

“…I don’t think (local leaders) are too concerned. I think they are concerned with other issues and when they are not focused on the need to bring in more money to develop a program to be able to help the teenagers, especially the Latinas.” ~community interviewee

624 N. Good-Latimer Expy, Suite 100 | Dallas, Texas 75204

ntarupt.org

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References (Endnotes) 1 Santelli, J, Lindberg, L, Finer, L, Singh, S. Explaining recent declines in

adolescent pregnancy in the United States: the contribution of abstinence and improved contraceptive use. Am J Public Health. 2007;97(1):150-6.

2 The Texas Campaign to Prevent Teen Pregnancy, retrieved on 9-320 from: https://txcampaign.org/county-rate-comparison/ 3 Texas Campaign to Prevent Teen Pregnancy data, retrieved on 8-2920, from: https://txcampaign.org/county-rate-comparison/ 4 Ibid.

5 Ibid.

6 Texans Care for Children & The Simmons Foundation (2018). Fostering Healthy Lives: Strategies to prevent teen pregnancy in foster care and support teen parents in foster care. https://static1.squarespace.com/static/5728d34462cd94b84dc567ed/t/5ad4aa00 1ae6cfce64d7316f/1523886600659 fostering-healthy-texas-lives.pdf 7 Osterman, MJK, Martin, JA. Timing and adequacy of prenatal care in the United States, 2016. National Vital Statistics Reports, vol 67 no 3.

Hyattsville, MD: National Center for Health Statistics. 2018.

8 Covington, R, Peters, HE, Sabia, JJ, & Price, JP (2011). Teenage fatherhood and educational attainment: Evidence from three cohorts of youth. Retrieved from http:// resiliencelaw.org/wordpress2011/wp- content/uploads/2012/04/ Teen-Fatherhood-and-Educational- Attainment.pdf 9 Fletcher, JM, & Wolfe, BL (2012). The effects of teenage fatherhood on young adult outcomes. Journal of Population Economics, 25, 201-218.

10 Centers for Disease Control and Prevention (CDC), 2011; Hoffman & Maynard, 2008 11 Frost, JJ, Sonfield, A, Zolna, MR, & Finer, LB (2014). Return on Investment: A Fuller Assessment of the Benefits and Cost Savings of the US Publicly Funded Family Planning Program. The Milbank Quarterly, 92(4), 667–720.

12 Lindberg LD, Santelli JS, Desai, S. Understanding the Decline in Adolescent Fertility in the United States, 2007–2012. J Adolesc. Health. 2016: 1-7.

13 https://tfn.org/sex-ed/Factsheet_ByTheNumbers_LH_2019.pdf 14 https://apps.who.int/iris/bitstream/handle/10665/44240/9789241598859_eng.pdf?sequence=1 15 https://www.guttmacher.org/journals/ipsrh/2020/04/estimates-potentialimpact-covid-19-pandemic-sexual-and-reproductive-health 16 Hans, SL, & White, BA (2019). Teenage Childbearing, Reproductive Justice, and Infant Mental Health. Infant mental health journal, 40(5), 690–709

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