The study was an evaluation of the IHS Albuquerque Area teen centers. The teen centers were first developed in the Albuquerque Area in 1983, and have been in operation since that date. The teen centers reflect both concern about the deteriorating health of adolescents among the IHS clients and the increasing emphasis on health promotion and disease prevention by the IHS. This was the first formal evaluation of the teen centers. The objectives of the study were to 1) conduct an evaluation of the efficiency and effectiveness of the Albuquerque Area Teen Centers and 2) develop a programming model to serve as a guide for policy regarding establishing additional teen centers and to establish a planned approach for promoting adolescent health and preventing behaviors that put Indian youth ""at risk""The study was a qualitative evaluation. The approach employed was similar to a case study utilizing repeated unstructured, in-depth interviews with the teen center and IHS staff and reviews of available data including monthly, quarterly, annual, and special reports. All study data were reviewed with the objective of addressing, to the degree possible, the 15 questions in the statement of work for the evaluation. Unstructured personal interviews were conducted, both on site and by telephone with IHS and contractor staff who were working or had worked with teen center programs.There is a clear need for the services provided by the teen centers, the existing programs are viable, and the services are being used. The average cost of operation of a teen center is $48,196 per year or $38,141 per year depending upon the contractor. A teen center probably costs less to operate for one year that the costs associated with the treatment of one teenager who contracts AIDS. Any new demonstration teen centers funded by IHS should incorporate sound evaluation methods and should utilize the model developed in this evaluation so that the impact and cost-efficiency of the teen center can be better established. The following activities and approaches should be replicated in new teen centers. Teen centers benefit from support from high levels of the IHS Area Office. Without the commitment and leadership provided by IHS administrators, the teen centers would not have developed. Critical commitments and decisions made by Area Office administrators include 1) insuring that the teen center procurement process was successful, from development of the request for proposal to actual contract award, 2) allocating scarce funding and other resources for a new unbudgeted program, and 3) assigning scarce health care professional as Project Officers to monitor the performance of the teen center contractors. Teen centers are contracted out to tribes and community-based organizations to facilitate community ""ownership"" of and involvement in the programs This process is consistent with the IHS goal of Indian self-determination. In some situations states, counties, cities, and other funding sources can help defray teen center costs. Matching state funding was obtained for the Bernalillo Teen Center. Similar matching funds should be solicited wherever possible. A teen center developer handbook should be created and provided to new teen centers. The handbook should be based on the model developed from the experiences of this evaluation. Three-year contracts will help teen centers recruit and retain quality staff and facilitate planning. Year-to-year funding has frustrated efficient planning and management of the two centers. Contracts should be offered to only contractors who submit technically acceptable proposals and who provide evidence of successful operations. IHS should develop standard reporting forms and use the same definitions and reporting procedures to facilitate evaluation of contractor operations. A standard evaluation form and procedures should guide Project Officer\'s review of teen center operations. IHS should provide technical assistance for the evaluation of teen center impact to contractors. The evaluation should determine the return on the investment in terms of the number of pregnancies prevented, STD\'s prevented, decrease in substance abuse, etc. Teen centers deal with controversial and emotionally charged issues such as teen sexual behavior and pregnancy. IHS needs a ""disaster recovery"" plan that deals with negative publicity and opposition before it happens. Teen center funding has been variable, uncertain, and unequal. Planning and stable operations require a predictable and stable budget. Teen centers have been cost efficient: however, they perform at different levels of efficiency. IHS should fund teen centers in other IHS Areas on an experimental basis as demonstration projects. The model developed in this evaluation should be used to plan and evaluate the operation of new teen centers.
Indian Health Service, Staff Office of Planning, Evaluation, and Support, Rockville, MD 20857 (E-112).
Support Services, Inc. Evaluation of the Albuquerque Area teen centers. Indian Health Service, Staff Office of Planning, Evaluation, and Support, Rockville, MD 20857 (E-112). 1991