Sustainability Case Study No. 2 February 2018 Making a little go a long way: The experience of Sasha Bruce Youthwork Introduction Organizations implementing teen pregnancy prevention programs with federal support are interested in understand- ing how to sustain their programs beyond the grant period. Federal funding can help identify and bolster evidence-based approaches, but these resources are limited and competitive. Therefore, grantees must begin planning early in the grant period, develop strategies to institutionalize services, and be able to adjust quickly to continue serving their communities when their funding environment changes. In 2015, the Office of Adolescent Health (OAH) launched a three-year effort to explore the key factors that affect program sustain- ability strategies that former OAH grantees have success- fully employed to sustain their programs (see About OAH’s Sustainability Study). In 2010, Sasha Bruce Youthwork (SBY), a nonprofit organization located in Washington, D.C., received an OAH grant to implement an evidence-based intervention in four schools in the city. After their grant ended in early 2016, SBY secured funding from the DC Department of Health that enabled them to sustain by scaling back implementation of the program. This case study highlights the experiences of SBY and details the factors and strategies that made it possible for them to sustain their program despite funding constraints. OFFICE OF ADOLESCENT HEALTH Authored by Rebekah Selekman, Subuhi Asheer, and Jean Knab for the Office of Adolescent Health, under contract number HHSP233201300416G Engaging youth and starting small to gain buy-in from school staff early on. Early in the helped build program support OAH grant period, SBY began developing support for the program by making presentations to school staff and SBY has a long-standing history of working with Ballou leadership. Facilitators also conducted a 10- to 15-minute High School in Washington, D.C., to address high rates condensed sample session so school staff could better of teen pregnancy. As part of its OAH TPP program understand the program. This strategy was particularly grant, SBY leadership selected an evidence-based program helpful because, according to the grantee, “it’s one thing model with life skills and community service components to read a paper or show a slide show, but to actually see which they felt would align well with school requirements what the program looked like is good.” Similarly, teachers and the needs of the target population at Ballou High. who stayed in the classrooms during sessions became To graduate high school, DC students are required to champions for the program. According to SBY staff, “they complete 100 hours of community service so 20 hours [teachers] really come through and advocate for us.” of community service was built into the program to help students meet that requirement. As the program rolled out in Ballou High School early in the grant period and started to receive positive feedback, To build rapport and engage youth, SBY also added or word spread to other schools, who then expressed interest adapted some of the program’s components. For example, in participating. As a result of their outreach and positive they conducted a community service retreat in which engagement, SBY entered into agreements for program facilitators worked with students over a weekend on delivery in two middle schools and another high school. building civic engagement, connecting what they learned As they expanded, SBY implemented the recommended in class to the real world; and team-building activities like number of sessions at each of the four schools within a rock climbing and zip lining. SBY also planned field trips nine-month time frame. Students enrolled in the pro- to local amusement parks when students attained their gram in three ways. They could (1) receive the program community service goals. as part of their regular class, (2) be selected to participate based on an assessment conducted by community coor- The evidence-based program model SBY selected is long dinators on whether the student would benefit, or (3) and requires school commitment, such as space for facil- volunteer to participate. itators when they are in the building, so it was important Figure 1: Program Implemented Under OAH Grant Targeted outcomes: Development of healthy behaviors, reduction in teen pregnancy, and development of life skills Program length: 25 sessions, each 45-50 minutes long over 9 months, and 20 hours of community service projects Facilitators: Grantee staff Implementation setting: 2 high schools and 2 middle schools Population served: 500 7th to 12th grade students Source: SBY grant application, final report, and discussions with grantee staff. 2 Even the best-laid plans require backup Near the end of the no-cost extension period, the DC plans Department of Health (DOH) circulated a request for proposal to fund community programming for youth. SBY To sustain the program at the same scale in all four schools applied for and was awarded a limited amount of funding after the OAH grant ended, SBY was hoping to receive new to support the program at a reduced scale through the end funding through an agreement with the program’s developer. of the school year in all four schools. At the end of 2015, the developer was working on a contract with the DC State Superintendent of Education through Sustaining the program required diffi- which several implementation partners, including SBY, cult compromises and creative thinking would deliver the program in DC public and charter schools. As part of this agreement, SBY expected that they could To adjust for a lower level of funding, SBY scaled back sustain the program at the same scale as they had during their program in two ways: they had to (1) reduce staff the OAH funding period. Because they were anticipating and the extent of staff training and (2) adjust some service that the developer and the DC State Superintendent of components (Table 1). Education would successfully execute the agreement, SBY did not actively search for other funding opportunities in the Under OAH funding, SBY had 4–5 facilitators leading last year of the project. However, the agreement fell through, approximately 28 program clubs and serving 500 youth. With and SBY found themselves in need of new funding to the DOH funding, SBY was able to hire two facilitators and continue providing the program after the OAH grant ended. then used their community service coordinator as an extra facilitator to supplement staffing. Using this structure, SBY “When the program first started there were could facilitate 20 program clubs across the four schools, a lot of presentations and meetings, a lot of serving approximately 300 youth. The OAH grant had also presenting to staff and administrators on what supported travel for facilitator training with the developer in the program actually is. As we got more St. Louis. However, under the DOH grant, experienced SBY experience with the program and the staff trained the new facilitators, rather than the developer. As a result, SBY staff felt that the new facilitators needed extra leadership was able to see this was a really reinforcement to understand the program’s approach. good program, we no longer had to do that.” —SBY staff About Sasha Bruce Youthwork SBY received a six-month, no-cost extension from OAH, SBY serves runaway, homeless, abused and neglected, and during which SBY was only able to serve Ballou High at-risk youth and their families in the D.C. area. Founded in School, where they had permanent office space. The official 1974, SBY runs 19 programs that aim to reduce high-risk program meetings ended and were replaced by informal behaviors and stabilize living situations. To that end, SBY lunchtime groups and some monthly workshops. At the provides services including counseling and life skills train- ing, positive youth development programming, and shelter. lunch group meetings, facilitators would bring up topics to As of March 2017, SBY employed roughly 140 people discuss with youth, such as relationships, social media, and including full-time, part-time, and “occasional” workers. world events or lead activities such as résumé writing. “It SBY receives a mix of federal and district funding, as well as some private funding and donations. was structured as an informal conversation where we would say, ‘we want to talk about this with you all, we want to see SBY has delivered pregnancy prevention services for over ten years through multiple funding streams. Since 2006, how you feel about this.’ It was also a way to check in and SBY has contracted with the D.C. Department of Human stay connected with the young people.” During this time Services to provide pregnancy prevention services to SBY maintained some community service activities for the youth and their family members, including delivery of the students, such as making care packages for homeless families. Reducing the Risk curriculum and providing education on risky sexual activities and drug use. Through the D.C.- based Summit Fund, SBY offers individual and group-level “I think that’s one thing that hurt us, we kind pregnancy prevention counseling services to teens in SBY of put all of our eggs in one basket because programs who are at highest risk for initial and subsequent pregnancy. SBY also integrates HIV prevention education everything was going so right.” into their pregnancy prevention programming. —SBY staff 3 Despite the decrease in staff training support, SBY was able paraphernalia, including sweatshirts, T-shirts, and water to use the new DOH funding to sustain their partnership bottles—which could be earned based on a point system. with the developer, which included eight hours of technical assistance per year and a dedicated representative, who “The old staff had a connection with the pro- provided support around programming and community gram's developer. It enhanced the program. service. The representative offered suggestions and best There are still some pieces [new staff] are practices for scaling down the program, including how to missing that they would get if they went to the reengage schools and ideas for smaller-scale community training with the developer. service events. So, instead of large-scale or longer activities —SBY staff (for example, chartering several buses to go to a soup kitchen after school hours or on the weekend), SBY •Scaled-back community service events. With OAH realized it may be more feasible to conduct similar activities funding, facilitators could identify large-scale on a smaller scale (for example, making care packages community service projects to help youth meet their 20 during school hours with fewer youth). hours of required community service activities. These events often included busing youth and providing food. In addition to making changes to the staff and training However, with the lower funding level, SBY facilitators structure, SBY made adjustments to the program’s coordinated smaller community service activities that scope. Although they were able to continue covering the could be done in the school or were accessible by public curriculum as originally designed, SBY reduced incentives transportation. Other community service activities were and scaled back community service projects. also scaled back. For example, with OAH funding, •Reduced incentives. Under OAH funding, SBY program participants could organize “service parties,” advertised the end-of-year trips and community service a large-scale event where staff reserved the school’s retreat as a way of motivating students to enroll in the cafeteria and organized multiple service-oriented program. As the DOH funding level did not support such “stations,” such as creating care packages for homeless trips, SBY advertised different incentives for enrollment— families. However, with DOH funding, the parties were such as gift cards to restaurants, movie tickets, and program smaller, shorter, and organized with fewer resources. Table 1: Program implementation under OAH and DOH grants (Teen Outreach Program or TOP) OAH grant program model DOH grant program model Staff/staff training • Four to five facilitators. • Two to three facilitators. • Facilitators attended training with the developer. • Facilitators trained by SBY staff who attended developer training. Recruitment strategy • Advertised availability of end-of-year trips, commu- • Advertised promotional items and gift cards that nity service retreats, and overnight college tours. could be earned through a point system. Program components • All program lessons delivered in 25 sessions over • All program lessons delivered in 25 sessions over nine months.* nine months. Community service events • Two to three large-scale events that required trans- • More-frequent, smaller-scale activities that could portation and meals. be completed during club sessions. Participation incentives • Completion of 20 hours of community service • Completion of 20 hours of community service rewarded by trip to local amusement park. rewarded by pizza party or ice cream social during • Participation in other enrichment trips such as program session. overnight college tours and a community service • Earn points for on-time arrival to program session, retreat. improvements in grades, good behavior in class, etc. With enough points, participants could earn materials such as sweatshirts, T-shirts, and water bottles as well as gift cards to restaurants and movie tickets. Source: SBY grant application, final report, and discussions with grantee staff OAH = Office of Adolescent Health; DOH = DC Department of Health; SBY = Sasha Bruce Youthwork. *Immediately following the end of the OAH grant, structured sessions were replaced with informal lunchtime groups. 4 Changing incentives may have affected “[Having less funding] challenged us to be some youth’s participation more creative and intentional in how we engage young people to really make sure that The grantee reported that scaling back program components had mixed effects on program engagement and participation. when we are engaging them, we are having Most youth served under the DOH funding were new to positive interactions at all times…if we still have the program and had not experienced the previous version. the same rapport, the same positive attitude, Their participation likely was not affected by the changes in the young people will still want to come to incentives and trips. However, staff indicated that youth who the program.” had been enrolled in the program prior to the funding shift —SBY staff noticed the differences in incentives and their participation decreased. SBY continued to celebrate end-of-year successes through pizza parties and ice cream socials. Engagement in community service activities seemed unaffected by the reduced scale of activities, though this may be a result of the D.C. graduation requirements. Even with the scaled-back community service events, participants were still able to meet their 20-hour community service target. Rather than participating in a few large events, youth completed these hours through more-frequent, smaller events. Overall, the grantee reported that youth interest and enthusiasm for community service activities were unchanged. Nonetheless, SBY plans to apply for additional funding from DOH for the next grant year so that they can reinstate the enrichment activities and larger community service projects. 5 Key lessons learned SBY had to quickly adapt to implement an evidence-based program under new funding constraints while maintaining fidelity and participant engagement. Based on their experience, SBY highlighted the following strategies to successfully sustain programs after federal funding ends:  Choose a model that can adjust and adapt if funding decreases or implementation needs change. The grantee emphasized that it is important to select a program that meets community needs but that can be scaled up or down as needed. It also helped that the grantee collaborated with the developer and found creative ways to adjust the program.  Start slow and build support. For SBY, it was important to develop strong relationships with facilitators and schools from the beginning. When teachers and staff championed the program, it was more likely to get integrated into the school and be sustained in the long term.  Stay engaged with youth. Despite scaling back activities, the support and interest from youth was critical in sustaining the program. Even with scaled down participation incentives, it was possible to continue delivering the core content to the target population. About OAH’s Sustainability Study Since its inception in 2010, the Office of Adolescent Health has funded organizations across the country to deliver programs to prevent teen pregnancy. OAH’s Teen Pregnancy Prevention program provides funding for the implementation, development, and evaluation of evidence-based, as well as new and innovative approaches to prevent teen pregnancy. In 2010, OAH funded 94 grantees to either replicate evidence-based programs with new populations or in new settings, or evaluate new and innovative programs. Grantees were expected not only to implement their programming but also to sustain their program over time. Over 60 percent of 2010 grantees did not receive renewed funding. In September 2015, OAH launched a three-year study to help understand whether and how programs were sustained after federal funding ended. Interviews were conducted with 37 of the 64 former grantees who did not receive renewed funding. Twenty-eight of these former grantees sustained their programs in some form once OAH grants ended, whereas 10 programs are no longer operating. OFFICE OF ADOLESCENT HEALTH Office of Adolescent Health | Website: http://www.hhs.gov/ash/oah/ Email: oah.gov@hhs.gov Phone: (240) 453-2846