Internship Proposal: Planned Parenthood

Jennifer N. McLean
HEA 648
University of North Carolina at Greensboro

Part 1: Problem definition and description

Description of the health problem.

HIV is spread most often through different sexual acts where protective

barriers are omitted, secondly they it is spread through intravenous drug us,

and lastly it is spread at birth from mother to child in various ways

(HIV/AIDS, n.d.). Globally, in 2015, there were 2.1 million new cases of HIV,

and overall, there are about 36.7 million people in the world living with HIV

(Basic Statistics | HIV Basics | HIV/AIDS | CDC, n.d.). Those who are most

affected by HIV on global scale are those who are in Sub-Saharan Africa,

accounting for about 65% of all cases in the world (Basic Statistics | HIV

Basics | HIV/AIDS | CDC, n.d.). By the end of 2012, it was estimated by the

CDC that there were about 1.2 million people in the United States who were

living with HIV (Basic Statistics | HIV Basics | HIV/AIDS | CDC, n.d.). It has

also been found that every year, youth between the ages of fifteen and

twenty-four years old make up half of the new cases of HIV infections in the

United States. Another risk factor for adolescents is that many teenage girls

have serious boyfriends who are older than them and are often pressured or

forced to have sex which increases their risk of contracting HIV (Oxley,

2001).

Southern states have a higher prevalence of HIV and in a study

conducted where North Carolina was defined as a southern state, it was

found that Black women were disproportionately affected by HIV, contracting

it through heterosexual contact (Fleming, Lansky, Lee, & Nakashima, 2006).

The state of North Carolina has the fifth highest number of people living with

HIV (North Carolinas Youth: Focus on Sexual and Reproductive Health,

n.d.). According to the Forsyth County Public Health Department HIV

surveillance report, almost 10 percent of the newly diagnosed HIV cases

happened among youth at the age of nineteen and under (Department of

Public Health, North Carolina, n.d.).

Planned Parenthood has chosen to market their program Making Proud

Choices (MPC) which is a co-ed HIV intervention and Health Improvement

Project (HIP) to teenage girls in different areas of Winston Salem, NC. Both

MPC and HIP are programs that use evidence-based sexual health education

to help increase self-efficacy pertaining to sexual health as well as to help

increase knowledge about sexual health topics that ultimately contributes to

HIV.

Description of the Non-health problem

The non-health problem that Planned Parenthood will be addressing is

the lack of a standardized comprehensive sexual health education that

happens in school in Winston Salem, NC among youth. North Carolina has

passed laws saying that schools do not solely have to teach abstinence

based sexual health education in school anymore, but there is no law put in

place that they now are required to provide comprehensive sexual health

education. Providing sexual health education now is up to the individual

schools and what they want to teach.

At the beginning of this year through May of 2016, there were focus

groups conducted by Planned Parenthood to do a sexual health education

inventory. It was found that many of the youth that participated in these

groups thought that they were not properly educated about sex and their
sexuality in school. While school is technically the ideal setting to do HIV

prevention because of the direct access to a large group of youth at once,

community based programming outside of school has been found to be more

successful among Black and Latino youth (Rotheram-Borus, OKeefe, &

Kracker, 2000). School based interventions have been found to be less

effective because the quality of teaching differs and overall the quality is

low, although all teachers are trained the same; the curriculum focuses on

basic sex and drug education and not specific HIV/AIDS prevention methods;

and there is too little time to discuss other factors that contribute to the

spread of HIV like peer pressure to have sex and knowing how to refuse sex if

they do not want to engage (Rotheram-Borus et al., 2000). Delivering

educational interventions outside of the school in the community showed to

be successful when they are held in a group setting; when there are multiple

sessions reinforcing positive behaviors; and when behaviors were addressed

in addition to knowledge, beliefs and attitudes (Rotheram-Borus et al., 2000).

Part of the mission at Planned Parenthood is to inform and educate the

community (Who We Are, n.d.). Planned Parenthood is considered as a

respected leader for educating the general public about reproductive and

sexual health and because it was found that there is a lack of education for

sexual health among youth, this is how the problem is relevant to Planned

Parenthood (Who We Are, n.d.). Planned Parenthood as a whole provides

educational programs and outreach to over 1.5 million youth and adults

every single year (Who We Are, n.d.).

 There are several ethical issues that could come up when working with

youth. There may be subjects that come up when talking about sexual health

that could trigger a bad memory or experience for the child. This could cause

a child to feel uncomfortable and drop out of the program. This could also

cause the child to disclose certain personal information to the moderators of

the sessions that might put the moderators in a bind if it is something that

needs to be disclosed to a third party.

SWOT Analysis of Making Proud Choices Program and Planned Parenthood

as an agency

The strengths of MPC HIV intervention include the uses of evidence

based sexual education curriculum. When using evidence based materials, if

facilitated the correct way, there are proven changes that can take place

amongst your group. Planned Parenthood also has the resources to give

every girl who completes and graduate the program a $100 Visa gift card. It

is common knowledge that having an attractive incentive is important to

encourage participants to complete the program you are offering. The last

strength would be the location of where the intervention programs are held.

It is walking distance for many of the teens we are serving, which eliminates

a barrier of needing transportation. I have not been there long enough to

notice any weaknesses of the intervention as of yet.

The main opportunity that presents MPC and Planned Parenthood is

that HIV is still very relevant among sexually active minority adolescents.

This allows for the programming and intervening to be appropriate and still

very needed. The threats to MPC and Planned Parenthood are that they may
possibly not gain enough participants to have a true effect on the community

like they are planning. Yes, they may be able to impact a small group of

friends or small group, and one less HIV person is always a great thing, but

they want to make a great impact. Another threat to the program and the

organization is that there is a push back for comprehensive sexual health

education and so marketing in schools and some parents not allowing their

teens to take part is something that is a threat and is out of the hands of the

organization.

Part 2: Problem Analysis

When analyzing the non-health problem, the social ecological model of

health promotion (SEMHP) was a useful tool to target the appropriate

intervention. This first step when implementing either HIP or MPC is to target

the individual level of the SEMHP by educating students and training them to

become peer health educators. Below, a conceptual model (Figure 1)

displays the important factors that are associated with the health problem.

The factors on the conceptual model display many ways that the health

problem is affected. The factors also show how effective targeting the non-

health problem can be in order to decrease the risk of HIV among teens.

Figure 1: Decreased Risk of HIV Among Youth Conceptual Model

 Figure 1 shows the factors that contribute to a decrease in HIV

infections and can be read from left to right. While the MPC and HIP sexual

health curriculums will not address every single factor displayed, addressing

the non-health problem of a lack of standardized comprehensive sexual

health education in schools will contribute to the decreasing of risks in this

youth population

Once the teens become peer health educators it will affect other levels

of the SEMHP because after the students become certified they can facilitate

sexual health education sessions in their communities and make others

aware of resources they know of. While it is known that focusing on the

individual level of the SEMHP is not the most effective way to get the

greatest deal of change, Planned Parenthood has chosen to do small groups

of evidence based peer education sessions to train individual teens to be

peer health educators as a domino effect of how sexual health will be

impacted at other levels once this level is targeted. Literature shows that

often times that when children look for any information that their first point

of contact is their friends (Harrin, 1997). Planned Parenthood has chosen to

educate teens as peer educators when teens do go to their friends they will

be able to give their friends clear and accurate information (Harrin, 1997).

There is strong evidence in the literature to suggest that

comprehensive sexual health education is more effective than abstinence

based sexual health education (Hollander, 2008). Data from the 2002

National Survey of Family Growth suggests that teens who had

comprehensive sexual health education were less likely to be sexually

experienced and had less incidence of being pregnant or impregnating a

partner (Hollander, 2008). Using the evidence based model of MPC to deliver

comprehensive sexual health education is the main focus of the internship.

In the conceptual model, policy and resources affect the ability to

deliver comprehensive sexual health in the school system in North Carolina.

It is shown that in the United States, abstinence based only education has

proven to be ineffective to keep children abstinent and to detour them from

risky sexual behaviors (Underhill, Montgomery, & Operario, 2007). The goal

is for Planned Parenthood and MPC to help supplement the lack of

comprehensive sex education in the school system, and to educate the teens

about all aspects of sexual health. Comprehensive sexual health education

can have a great effect on a teens sex knowledge; attitudes about sex;

beliefs about sexual norms; beliefs about sexual expectancies; and they
learn how develop their sex negotiation skills (Yee, 2010) (Onyehalu AS,

1983).

Once these things are addressed, students will be knowledgeable

about the importance of getting STI/HIV testing frequently when sexually

active, they will know where to buy condoms or get them for free. Increased

knowledge about such topics leads to less risky sex because the students

know how to decrease their sexual risk when engaging in sex (Starkman, N.

& Rajani N, 2002). Decreasing their sexual risk also includes abstaining from

sex until they consider themselves ready or older.

MPC and HIP also encourages the teens to develop better

communication with their parents about sexual health. Speaking openly

about sex with a parent can increase the childs relationship with the parent

(Jaccard, Dodge, & Dittus, 2002). In turn, this increases their knowledge

about sex but also makes the teen more comfortable with speaking to their

parent about sex that leads to less risky sex (Jaccard et al., 2002). This in

turn can attribute to ones decreased risk for HIV (Jaccard et al., 2002).

Internship Objectives:

Provide knowledge about HIV, how it is spread, and how the teens can

prevent it

Provide knowledge about local sexual health resources

Provide knowledge about sexual consent and condom self-efficacy

Train teens to become peer educators

Advocate for the teens to speak in their communities about sexual

health to their peers

 Connect with community members to recruit teens to train

Part 3: Internship Activities Plan/Methods

During the course of the internship, a variety of inputs and activities

will be completed to reach the goals of the internship. The projected plans

for the internship are outlined in a logic model that is presented on Table 1

below. A logic model is used as an organization tool to communicate a

strategically structured plan (Sellick, 2012). The logic model for the Planned

Parenthood internship shows the sequence of how the inputs and activities

are supposed to produce the desired outputs and outcomes. Following the

logic model, each of the activities will be outlined in further detail. A Gantt

chart will then be outlined as a guide for a timeline of these activities.

Table 1: Planned Parenthood Internship

Logic Model
Inputs: Activities: Outputs: The Outcomes: Results anticipated
Resources Methods of measurable as consequences of the outputs
dedicated to fulfilling the products of
or consumed internship internship
by the objectives using activities
internship inputs Short Long
Community
engagement:
calling and
meeting with
previously
Planned established Increased
30 newly Decrease rates
Parenthood contacts to knowledge for
trained peer of HIV in this
Health reserve space teens about
educators county
Educator and recruit sexual health
youth

Marketing to
recruit youth
participants
Intern Deliver and Reinforced Improved Increased
analyze pre/post information to communication condom use
test previously between parent
trained peer and child about
 educators sex and self-
esteem

Parents of
Peer educator children have
training: HIP or resources to Increased self-
Funding
MPC lesson better esteem
facilitations communicate
with children
Follow up
sessions with
Training
previously
manuals
trained peer
educators
Parental training
Materials for
about sexual
health
health,
education
parent/child
sessions
communication

Community Engagement

In order to gather the groups for peer educator training or parental

training, the intern must use previously established contacts to plan and

market for the groups. There are some locations and timeframes that have

already been established by the health educator from Planned Parenthood

and different contacts but the intern will narrow down those details to

specific dates and times. The marketing will then happen after that is

established to acquire participants for the peer educator training or the

parental workshops.

Pre/Post Test

The pre-test and the post-test will serve as a data collection method

for the HIP and MPC peer educator training. The pre-test is a tool used to
gain information about what the teens know before they enter the training.

The post-test will reflect if they have any increase in their knowledge after

the five-week training is complete. The test will be scored and they are

matched by a code for each teen in order to hid the identity of the teens

while still making sure that their pre-test and post-test are scored properly.

The intern will do the scoring of the pre- and post-test as a part of the

internship for those sessions that are facilitated. The pre- and post-test are

implemented to gauge a change in knowledge for the participants to analyze

whether their knowledge of sexual health was increased.

Peer Educator Training

The peer educator trainings are evidence based sessions of the

curriculum HIP Teens or MPC. Each of the groups will have five sessions each,

which are two hours long. HIP Teens is an all-girl curriculum and MPC is a

curriculum for both boys and girls. This training will result in the teens who

attend all sessions to be certified as peer educators.

Follow Up Sessions

Follow up sessions will be done with teens who have already went

through the sessions and were named as certified peer educators. These

follow up sessions are done to increase the dosage of the information that

was originally given in their trainings. It is important to reinforce information

to the teens in order to build upon their confidence of knowing the

information they learned as well as to increase their confidence.

Parental Workshops
 Parental training workshops are important because parents of the

teens that are going through the program should know how to communicate

to their teens about sex. One of the goals to ultimately decreasing HIV is to

increase parent/child communication. Having a positive and open

relationship with ones parents has shown to help decrease sexual risk and

this one of the reasons that parents are incorporated in this learning

(Hutchinson MK, 1999).

Internship Timeline

The internship timeline has already been established by the internship

preceptor. A Gantt chart is a project management tool used to display tasks

that correspond with a timeframe that the tasks needs to be completed

(What is a Gantt Chart? Gantt Chart Information, history and Software,

n.d.). The internship timeline with the activities listed and the corresponding

months that the activity would happen is displayed in Table 2 below.

Table 2: Gantt Chart for Internship

Activities
Fall
Activity 2016 Jan-17 Feb-17 Mar-17 Apr-17 May-17
Shadowing preceptor -
X X
facilitation of trainings
Training to facilitate peer
X
educator sessions

Community engagement X X X X
Planning for sessions X X X X

Peer educator trainings X X X

Follow-up sessions X X X

Parent workshops X

Pre/post data collection X X X

 References

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