Seven “client-centered” pregnancy prevention programs were
set up in Washington
state in the late ’90s. An evaluation of these programs’ effectiveness randomly assigned high-risk
9-17 year-olds to a treatment group or a control group. Treatment
students received a client-centered intervention that combined sex education
and skills-building with individualized services.
Among pre-teens, one program site had an impact on intent to
have sex and a different program site had an impact on intent to use
substances, but no significant differences were found between treatment and
control pre-teens overall.
Among teens, significant overall differences were found
between treatment and control groups on measures of sexual behaviors and
intentions. Five to nine months into the intervention, teenagers assigned
to the treatment group were significantly less likely
to have had intercourse during the past month than were students assigned to
the control group. They were also significantly less likely to intend to
One teenage program site had an impact on contraceptive use
and another had an impact on intent to use contraceptives, but the programs had
no overall impact on these outcomes. The programs had no overall impact
on educational aspirations, substance use, or sexual values either.
DESCRIPTION OF PROGRAM
Target population: High-risk 9-17 year-olds
“Client-centered” pregnancy prevention interventions combine
sex education and skills-building with a broad array of individualized
services, including counseling, mentoring, and advocacy. These programs
also provide links to clinical family planning services and opportunities for
clients to participate in social and recreational activities.
These programs aim to be comprehensive. They address
not only sex and STDs, but also drugs and alcohol, values and attitudes,
life-planning, goal-setting, and coping skills. Many client-centered
programs use a sex education curriculum, but modify its messages according to
the needs of individual clients.
The motivation for these programs comes from the
practitioner wisdom that helping students avoid risky behaviors involves not
only informing them about sexual activity and its consequences, but also
providing them with consistent emotional support and positive guidance.
Students in client-centered programs have an adult they can trust and confide
in – someone they can go to for “real” information about sex.
EVALUATION(S) OF PROGRAM
McBride, D. & Gienapp,
Designs to Evaluate Client-Centered Programs to Prevent Pregnancy. Family
Planning Perspectives, 32(5), 227-235.
Evaluated population:Seven different client-centered
programs located in seven different communities in Washington state
were evaluated in this study. Four programs served pre-teens (aged 9-13)
and three programs served teenagers (aged 14-17). High-risk 9-17
year-olds were referred to the programs by school counselors, family planning
clinics, and other social service agencies. 1,042 students consented to
participate in pre-teen programs and 690 students consented to participate in
teenage programs. These students were predominantly white (63%) and
Approach: At each program site, students were
randomly assigned to the treatment group or the control group. Students
assigned to the treatment group received their site’s
client-centered services; students assigned to the control group did not.
Sites differed in what specific services they offered, but all had educational
components and individualized services. Three of the pre-teen sites
provided education and skills-training to both treatment and control students,
but did not offer individualized services to control students. All other
sites reserved all aspects of their program for treatment students.
Active parental consent was required for clients under the age of 14.
Site staff included trained sexuality educators, social workers, and
counselors. Each site received $40,000-$50,000 for the year.
The amount of time treatment students spent receiving
services varied significantly. Though education and skills-building were
generally provided for a fixed number of hours, the amount of time any given
student spent receiving individualized services depended on his/her individual
needs. At pre-teen sites, treatment students received an average of 14
hours of services, while control students received an average of 5 hours of
services. At teenage sites, treatment students received an average of 27
hours of services, while control students received an average of 2 hours of
services. Treatment clients at Site F received 31 hours of services, on
All students were surveyed before the intervention began and
again 5-9 months later. These surveys assessed students’ aspirations,
values, intentions, and behaviors. Teenage students were surveyed on
their sexual behaviors and contraceptive use, but pre-teens were not. 75%
of students completed follow-up surveys.
Results: Assignment to the treatment group appeared
to have no impact on pre-teens overall. Pre-teens assigned to the
client-centered program did not differ significantly from pre-teens assigned to
the control group on measures of sexual values, communication with parents,
educational aspirations, and substance use. At one pre-teen site
(identified as Site C), treatment students reported significantly less intent
to have sex than did control students, but this significant difference was not
present at any other pre-teen site, nor among pre-teens overall. At a
different site (identified as Site B), treatment students reported
significantly less intent to use substances than did control students, but,
once again, this difference was not present at any other pre-teen site, nor
among pre-teens overall.
One teenage site (identified as Site F) was particularly
successful at impacting the sexual practices of treatment students.
Treatment students at Site F were significantly less likely than control
student to report having had intercourse during the past month. This
difference was insignificant at the other two teenage sites, but was
significant when all teenage students were analyzed together. Treatment
students at Site F were also significantly more likely than control students to
report having used contraception the last time they had sex and to report
always using contraception. These impacts were not present at the other
two teenage sites. No overall significant difference emerged between
treatment students and control students on either of these measures.
A different teenage site (identified as Site E) was
successful at impacting the sexual intentions of treatment students.
Treatment students at Site E were significantly more likely than control
students to report an intent to abstain from sex and
to report an intent to use contraception when engaging in sex. These
intentions did not translate into significantly higher rates of abstinence or
contraceptive use, however. Intent to engage in sex was not measured at
Site F and, at the remaining teenage site (Site G), treatment students reported
slightly greater intent to engage in sex. When analyzed all together,
treatment students had significantly lower intent to engage in sex than control
students. Differences between treatment and control groups at Sites F and
G on intent to use contraceptives were insignificant, as were differences
Site E was also successful at positively reducing the hard
drug use of treatment students. Treatment students at Site E were significantly
less likely than control students to use hard drugs; however, at Sites F and G,
treatment groups were significantly more likely than control groups to use hard
drugs. Consequently, there was no overall impact of the program on hard
No significant differences were found between the treatment
and control group, overall or at individual programs, on measures of
educational aspirations, sexual values, or use of tobacco, marijuana, and
The authors suggest that higher doses of services are needed
by high-risk adolescents.
SOURCES FOR MORE INFORMATION
Program materials are not available for purchase.
McBride, D. & Gienapp,
A. (2000).Using Randomized Designs
to Evaluate Client-Centered Programs to Prevent Pregnancy. Family
Planning Perspectives, 32(5), 227-235.
Program categorized in this guide according to the
Evaluated participant ages: 9-17
Program age ranges in the guide: Middle Childhood,
Program components: Mentoring/tutoring, Counseling/therapy,
School-based, Clinic/provider-based, Service/vocational learning
Measured outcomes: Reproductive Health, Behavioral Problems
(specifically, substance abuse)
KEYWORDS: Middle Childhood (6-11), Adolescence (12-17),
Youth (16-24), Children, Mentoring, High-Risk, Caucasian or White,
African-American or Black, Hispanic or Latino, Middle School, High School,
Community-Based, School-Based, Clinic-Based, Provider-Based, Tutoring,
Education, Counseling, Therapy, Life Skills Training, Substance Use, Alcohol
Use, Tobacco Use, Illicit Drugs, Education, Academic Achievement, Educational
Expectations, Reproductive Health, Sexual Initiation, STD/HIV/AIDS, Risky Sex.
Program information last updated on