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The Teen Pregnancy Prevention (TPP) Program administered through the Department of Health and Human Services, Office of Adolescence was established in 2010 to identify and support diverse organizations working to prevent teen pregnancy across the United States. Its purpose was to develop and identify evidence-based programs aimed at promoting healthy choices and well-being in youth. The program also sought to inform future practice through ongoing program evaluations. 

Organizations receiving TPP program funds serve youth in communities, juvenile detention facilities, foster care and schools through government agencies, tribal organizations, non-profits and religious organizations. TPP Program grantees provide participating youth with comprehensive reproductive health education and focus on strategies to resist peer pressure and mitigate intimate-partner violence in addition to building healthy relationships with parents and providing career planning services.

From 2010 to 2014, 102 organizations were awarded five year TPP grants, serving over 500,000 youth nationally. Over the course of these five years, 41 independent evaluations were conducted that provided significant insight for the youth services field on the most effective programs. Through independent evaluations, the work of these organizations increased programmatic knowledge of effective prevention programming for youth that has helped move the field forward. Using the knowledge generated from these evaluations and the experiences of these agencies, the second round of TPP awards were made to build on the work from the first cohort and support replication of evidence-based programs. Grants were awarded to organizations that implemented evidence-based teen pregnancy prevention programs, built the capacity of youth-serving organizations and developed technology-based and other innovative youth-informed programs. 

In order to ensure positive outcomes for youth, including avoiding unsafe sexual behaviors, it is important that policies focus on – and funding be invested in – programs with a proven track record in increasing access to high-quality, comprehensive services that meet the needs of youth. The TPP Program does just that, however in late June 2017, the current Administration – which favors abstinence-only policies – quietly cut the program, eliminating $213.6 million in funding for organizations combating teen pregnancy.

Teen pregnancy has been declining since 2007. Between 2010 and 2014 (during the first cohort of TPP grantees), we saw the national teen pregnancy rate drop by 29 percent. While this is important progress, teen pregnancy still remains relatively high – particularly for young people facing additional risk-factors. Adolescents who live in poverty, grow up in a single parent household or are in foster care are at an increased risk of having an unplanned pregnancy. Further, Hispanic and Black adolescents, who experience these risk factors at disproportionate rates, are twice as likely as their white peers to experience pregnancy by the age of 19. TPP grantees have worked to reduce these disparities by targeting their efforts to these most at-risk youth and by tailoring their programming to address specific community needs.   

This funding cut and other similar efforts ignore the positive impacts that these public and community based programs provide to the health and well-being of youth. We know that the promotion of healthy development, strong social connections and concrete supports increases positive outcomes for youth and their families. The elimination of the TTP Program showcases the Administration’s disregard for programming proven to reduce teen pregnancy and for investing in the health and well-being of our country’s children, youth and families. CSSP recognizes that healthy development and well-being in youth depend on their ability to postpone starting a family of their own until they are emotionally and financially prepared for the responsibilities that come with parenting. Eliminating support for programs that seek to give youth the information and resources they need to make informed decisions about their life runs counter to best practice, existing research and common sense. We call on advocates, communities and states to continue to invest in programs that we know work, promote healthy development in youth and support youth to thrive.


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Alexis Grinstead is a policy analyst at CSSP.

Healthy relationships are important for the positive development of children and youth, and are especially important for lesbian, gay, bisexual, transgender or queer (LGBTQ) youth of color in child welfare. LGBTQ youth are disproportionately represented in the child welfare system and within that demographic, youth of color are particularly disproportionately represented. According to the National Survey of Child and Adolescent Well-Being – II, 61.8 percent of LGB children in child welfare are youth of color. Not only do LGBTQ youth of color experience disproportionate representation in the child welfare system, when systems fail to meet their needs they are also at a “heightened risk of exploitation due to experiences including rejection and desperate need of shelter, food and other necessities”.

The importance of healthy relationships for youth was apparent in CSSP-led focus groups, where youth spoke of experiences with healthy and unhealthy relationships, including sexual exploitation, and the response (or lack thereof) by child welfare systems. One barrier youth identified was the inaccessible language used by systems to identify and document these experiences, including the use of terms like sex trafficking or commercial sexual activity in assessments and intake forms. In order for child welfare systems to be able to identify and serve youth who have experienced sexual exploitation, it is important to use language that resonates with and matches the lived experiences of youth and to work with young people to identify healthy relationship patterns.

Often, young people involved in sexual exploitation are unaware of the exploitative nature of their relationships. For example, a young person might perceive the exchange or expectation of sex in return for basic needs such as food or shelter as a normal part of an intimate relationship. Youth also cite fear of punishment and resulting stigma as to why they are hesitant to identify their experiences as sexual exploitation to adults and systems professionals. In addition, implicit bias on behalf of workers and perceptions of promiscuity or perceptions that youth of color are older and less innocent than their white peers may affect how assessment tools are applied for LGBTQ youth of color. Consequently, when the language systems use around sex trafficking and exploitation at intake and in assessments does not match the experiences of LGBTQ youth of color in the child welfare system, both systems and young people themselves may be prevented from accurately identifying those who have experienced sexual exploitation. This lapse between language and lived experience in turn also prevents the system from connecting these youth with appropriate supports and services.

In 2014, President Obama signed the Preventing Sex Trafficking and Strengthening Families Act (H.R. 4980) into law which requires child welfare agencies to identify, report and support youth who are either at risk or have been victims of sex trafficking. Our focus groups and interviews concluded that in order to fully meet this requirement, the language utilized by the child welfare system must enable and support youth and fully engage LGBTQ youth of color.

Our recent brief, Bridging the Language Gap in Child Welfare: Identifying and Supporting LGBTQ Youth who have Experienced Sexual Exploitation, recommends ways for systems to support the identification of LGBTQ youth of color who have experienced sexual exploitation. States should:

  • Ensure youth engagement in the design and implementation of improved screening tools to increase capacity for child welfare systems to identify youth involved with sexual exploitation and trafficking;
  • Utilize multidisciplinary teams to ensure consistent language and definitions across systems;
  • Eliminate barriers to accessing child welfare services by updating and clarifying key definitions and terminology; and
  • Raise the minimum age from 18 to 21 years old for instances of sex trafficking that must demonstrate force, fraud or coercion.

These four recommendations aim to remove barriers to identifying LGBTQ youth who have experienced sexual exploitation. Identifying youth is the first step to connecting them with the appropriate and necessary supports and services. If child welfare systems are not able to identify youth, then they will not be able to provide supports and services that address unhealthy relationships and strengthen healthy relationships for LGBTQ youth of color.

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Justine Kim is a communications intern at CSSP. She is currently an undergraduate at Northwestern University, majoring in social policy and Asian American studies. 

The Texas “Freedom to Serve Children Act”, passed by the Texas Senate on May 22 and sent to Governor Abbot for approval, allows publicly-funded foster care and adoption agencies to refuse to place children with non-Christian, unmarried or gay prospective parents due to religious objections. This legislation, along with a similar bill passed in South Dakota in March, rather than protecting children in foster care puts first the needs and wants of a specific group of adults and undermines the safety and well-being of all children involved in the child welfare system. This legislation specifically targets lesbian, gay, bisexual, transgender, queer (LGBTQ) and gender expansive communities as well as prospective foster and adoptive parents who are single parents, non-Christian couples such as Jews, Muslims and interfaith couples.

When children and youth enter the child welfare system, the state child welfare agency has a responsibility to ensure that they are safe, placed in the least-restrictive, most family-like settings possible and supported in their development and well-being. When children and youth cannot reunify with their parent(s), all efforts are to be made to find and support a positive permanent relationship with another parent or caregiver. Already, child welfare systems across the country struggle to identify and maintain enough loving and supportive foster and adoptive homes and each year more than 20,000 young people “age-out” of foster care without ever being placed in a family or permanent home. Allowing publicly-funded agencies to prevent safe, loving and caring individuals and families from becoming foster and adoptive parents directly contradicts the mandates of the child welfare system and will have very real and harmful effects on all children in the child welfare system.

Further, we know that LGBTQ and gender expansive youth are overrepresented in the child welfare system and are disproportionally youth of color.  Many of these youth have entered foster care because they were rejected by their families due to their sexual orientation or gender identity. This legislation sends a clear and powerful message that the public agencies charged with protecting youth who have been rejected by their families will further repeat that trauma and validate such rejection by not supporting or affirming their identities. This rejection and additional traumatization directly contradicts all that we know is considered good parenting, including the results of scientific studies showing that children raised by same sex couples experience healthy outcomes. It also discounts the fact that foster and adoptive parents of all religions have demonstrated the ability and commitment to provide loving and affirming homes to all children regardless of their religious affiliation.

Research shows that young people who identify as LGBTQ or who are gender expansive are more likely than their heterosexual, cisgender peers to experience multiple foster placements, be moved from their first placement at the request of the caregiver or foster family and be placed in congregate care settings. As many as one out of every four LGBTQ youth in a congregate care setting will exit care without achieving permanency. Young people who age out of care without achieving positive permanency are more likely to experience housing instability and homelessness, face poor educational outcomes and become involved with the criminal justice system. The cost to our families, communities and our country continue to mount with this kind of discriminatory legislation.

These outcomes are far from inevitable and many states and communities are moving forward to explicitly affirm and support LGBTQ and gender expansive families, youth and communities. To thrive, we know that all young people involved in child welfare need:

  1. safe and affirming placements in the most family-like settings possible
  2. safe schools and communities
  3.  appropriate medical and behavioral health care
  4. connections to family and supportive social networks;
  5.  external connections and support transitioning from care; and
  6.  connections to aftercare services.

Across the country, many communities, schools and allies, including those with deeply held religious beliefs are putting in place policies and practices that affirm and support LGBTQ and gender expansive children, youth and families. In addition to the 19 states and many local jurisdictions that have non-discrimination policies that include and protect LGBTQ and gender expansive youth, we have seen many recent positive pieces of state legislation:

  • Connecticut House Bill 6695, signed into law in May, 2017, bans conversion therapy
  • Illinois enacted enhanced Department of Children and Family Services procedures in May, 2017 that increase mandatory training for anyone working with LGBTQ youth and clarifies protections for transgender and gender expansive children in care
  • Nevada AB99, which was signed into law in April 2017, mandates training for working with LGBTQ youth, respecting a young person’s gender identity and placing LGBTQ and gender expansive young people in accepting homes

Policy makers, child welfare system leaders and practitioners must remain committed to their mission and mandate to achieve permanence, safety and well-being for all system-involved children and continue to advocate against discriminatory legislative proposals. Promoting safety and affirmation is critical to ensuring healthy identity development and positive outcomes for LGBTQ and gender expansive young people. We must ensure that all young people involved in child welfare are recognized, engaged, affirmed and loved to achieve well-being. This is best achieved through their in permanent loving, affirming families that we know exist across all faiths, sexual orientations, gender identities and family configurations.

This legislation and other similar efforts, such as the rescindment of federal guidance supporting transgender youth’s safety and well-being in school settings, undermine the safety and well-being of LGBTQ and gender expansive communities. CSSP promotes promising policies and practices that support the well-being of all children, youth and families. This legislation and similar proposals affirmatively hurts children, youth and families and runs counter to evidence and best practice in the field.  We call upon advocates and policymakers across the country to proactively work to protect all children and youth in foster care and reject such legislation and any other similar efforts.

For more information about policies that support LGBTQ and gender expansive youth in child welfare, please see our recent report, “Out of the Shadows: Supporting LGBTQ Youth in Child Welfare through Cross-System Collaboration.”

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Rosalynd Erney is a policy analyst at CSSP.

In 2011, in response to the troubling outcomes of young people in and exiting foster care, the Center for the Study of Social Policy (CSSP) assembled recent research on resilience, positive youth development, neuroscience and trauma to examine how all youth, and specifically youth involved in public systems such as child welfare and juvenile justice, can be supported in ways that advance healthy development and build upon young people’s strengths. The result is a framework called Youth Thrive™, which identifies five protective and promotive factors that help mitigate risk and build youth well-being. The Youth Thrive™ framework is currently implemented in seven states and jurisdictions across the country. These child welfare and juvenile justice public agencies have adopted the Youth Thrive™ Framework and are using it as a lens to revise their policies and programming. For more information on the Youth Thrive™ protective and promotive factors, please visit: http://www.cssp.org/reform/child-welfare/youththrive

Recently, CSSP received requests from judges and other court partners to develop a guide on how to use the framework in the context of family court proceedings. The Youth Thrive™ Tip Sheet for Family Court Partners is designed to guide conversations about the five protective and promotive factors among partners in preparation for and during family court proceedings. It provides an introductory summary to the Youth Thrive™ framework for judges, guardians ad litem, lawyers, parents, CASA workers, agency workers and youth. The purpose of the tip sheets, which are divided by role, is to actively promote the building of the Youth Thrive™ protective and promotive factors by providing sample questions that can be posed to youth, parents, professionals and other colleagues to ensure that young people receive the services and opportunities they need to thrive.

Read and download the tip sheet here.

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Martha Raimon is a senior associate at CSSP.

In the Footsteps of Giants

  ·   By Robert Sege, MD, PhD, FAAP

Each of us is the product of our own experiences, and those who molded our personal and professional lives. This Memorial Day weekend, I found myself in the midst of encounters with my own role models in pediatrics. On Sunday, I saw T. Berry Brazelton, the kind and brilliant pediatrician whose books captured the imagination of parents in the late 20th century. Although he is now 99 years old, Berry walked in with a huge smile on his face, and promptly engaged in conversation with an eleven-year-old girl who wants to become a pediatrician.

Later this week, I will head up to Vermont for a celebration of the life of Paula Duncan, the guiding force (and I do mean force) behind the movement in pediatrics to move beyond screening for risk to assessing the positive in children and families, and partnering with parents to grow these assets.

These two leading lights amplify the themes that children need more than protection from adversity, they also need safe places to live, learn and play and to experience connection and support from the adults and peers who shape their worlds.

With the support of Casey Family Programs, I led a group of early childhood experts to produce a new report, Balancing Adverse Childhood Experiences with HOPE (Health Outcomes of Positive Experiences). This report pulls together results from four separate population surveys. We learned that adults who recalled warm, nurturing relationships with their families and communities became healthier adults, even if they had multiple adversities in childhood.

While policymakers struggle to improve screening for risk and adversity, US parents and other adults already get it: children’s brains grow and develop in response to all their experiences, both adverse and positive. According to a 2016 population survey conducted by yougov.com and reported for the first time in the HOPE report, there is wide consensus among American adults of all ethnicities about the importance of positive parenting practices, and the political will to move forward in supporting families.

HOPE complements other new approaches to supporting child development and preventing abuse and neglect. Looked at through the lens of the social-ecological model, they all fit: The CDC advocates policies that support families through its Essentials for Childhood initiative. CSSP’s Strengthening Families approach emphasizes the centrality of the family in the lives of children, and articulates a set of protective factors that families need to thrive. HOPE completes this triad by demonstrating that protective factors operate through affecting children’s experiences.

The HOPE report provides more data and background for an approach that balances concerns about trauma and adversity with one that promotes the development of healthy resilient children who have had the positive experiences we all need. Although the report and the information within it is new, my own relationships with my mentors – Paula Duncan and T. Berry Brazelton – remind me that we are in fact only adding to a solid foundation of understanding.

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Dr. Robert Sege, MD, PhD, FAAP, is a practicing pediatrician, the Chief Medical Officer at Health Resources in Action, and a Senior Fellow at CSSP. 

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