1. Angela Dancer, B.A., AFL Project Director Zoe E. Leimgruebler, Ph.D., Evaluation Team Judith A. McDaniel, M.Ed., Evaluation Team Choctaw Nation of Oklahoma Adolescent Family Life (AFL) Care Project Funded By: US Dept. of Health and Human Services, Office of Population Affairs, Office of Adolescent Pregnancy Programs

2. ▶ As an integrated Tribe (i.e., not reservation based), the Nation’s coverage area spans more than 11,000 square miles of beautiful hill country that is extremely remote, rural, and poverty-stricken.  The Choctaw Nation of Oklahoma serves 80,000 Tribal members scattered throughout a 10 1/2 county service area in southeastern Oklahoma. The Tribal coverage area is equal in size to Maryland, Delaware, Rhode Island, and D.C. combined!

3.  The area median annual income is $13,321  The unemployment rate is 10.2%  The pregnancy rate among 15-17 year olds is 63.8 per 1,000 ( compared with 52.7 per 1,000 nationally ).  The majority of pregnant and parenting teens are not married and receive little if any financial support from their babies’ fathers.

4. The Choctaw Nation Tribal Government provides over 80 service programs ▶ social ( e.g., living support, WIC food services), ▶ educational (GED, vocational, higher ed.), ▶ counseling (individual and family), and ▶ health (main hospital and 5 remote clinics) free of charge to Choctaws and members of other federally- recognized Native American Tribes living within the service area.  Traditionally, pregnant and parenting teens have grossly underutilized these free services.  The Nation realized more hands-on outreach had to occur in order to effectively meet these teens’ critical needs. Pregnant and Parenting Teens Need Support

5. Why We Have a Care Project The AFL project was designed to reverse this trend by providing a community-based program to ensure that teens are informed and have available help to access all of the services needed during pregnancy.

6.  To link eligible pregnant teens with critically needed health, education, and counseling services toward the goal of achieving healthy outcomes for the mothers, babies, and their immediate family members. Data from the past three years provides evidence of staff success in serving 111 pregnant teens, their extended families, and the majority of their babies’ fathers in instructional sessions, thus significantly enhancing the potential for every client to achieve her desired positive outcomes.

7.  Community-based Intensive Case Management approach  18 Month program with semi-monthly home visits  Curriculum used – InJoy Series, PIP, and PREP  Evaluation instruments administered – Risk Assessment, Life Plans, OAPP Core Instruments, and AFL Objectives Achievement Survey

8.  Annual AFL Retreat: focuses on educational topics as well as cultural enrichment strengthening activities  Participant incentives  AFL quarterly newsletters  AFL website: www.choctawnation.com  Monthly articles in the Bishinik newspaper  Billboards and banners throughout the region  Visits to 90+ Public Schools Districts  Health Fairs, Community Meetings, and Labor Day Fest

9. Research Design: Quasi-experimental Subjects: AFL Clients and a matched Comparison Group of service-eligible teens Process and Outcome Measures:  Comparisons of subjects’ AFL Survey responses to assess service quality and results  Comparisons of clients’ pre/post test scores to assess learning progress

10.  Goal 1: AFL clients will succeed in avoiding unintended repeat pregnancies throughout their AFL participation.

11. Percent Participating in Training in the Curricula Indicated  Goal 2: AFL clients will demonstrate commitment to achieving their goals regarding their own health, that of their babies, and positive family outcomes.

12.  Goal 3: AFL clients will successfully write and work to achieve their personal goals.

13.  Client Satisfaction Surveys yielded an average score of 9 on a scale of 1 (low) to 10 (high).  Surveys are mailed on a quarterly basis in sealed envelopes. Client anonymity is guaranteed (i.e., completed surveys are for evaluation team members’ eyes only).

14.  Service region is vast (nearly 11,000 square miles)  Varied and frequent communication is critical  Per/client time in service delivery is great  Limits number of clients who can be served  High mobility rate makes follow-up difficult  Recruiting tasks require more time

15.  Gather 5 contact points per client at intake  Call clients more often re: home visits  Mail letters and/or cards to clients as reminders  Publish and distribute articles to clients  Maintain website and updates on activities  Provide participation incentives to clients

16.  Individualizes all services to clients  Keeps lines of staff/client communication open  Client/staff bonding inspires clients’ trust  Ensures greater client & project outcome success  Helps maintain a high client retention rate  Increases accuracy of evaluation data

17.  Use of instructional home visits as the major form of intervention service delivery contributes significantly to success in achieving the desired behavioral changes in teen clients.  Providing two home visits per month (as opposed to one) with additional related telephone contacts improves both the process and resulting outcomes.

18. Funded By: US Dept. of Health and Human Services, Office of Population Affairs, Office of Adolescent Pregnancy Programs