The BFH provides services to the adolescent health population domain through a combination of Title V funding and other federal funding, as described below. Within the BFH, most adolescent health programs are situated in the Division of Child and Adult Health Services. By administering all adolescent federal grants in the same division, expertise about emerging needs and best practices for the population are easily shared among Title V and other federally funded programs. Based on overall population needs and the existing capacity and accomplishments of other programs, the BFH has developed strategies for the MCH Action Plan that do not duplicate other funding sources and fill gaps that are not addressed by the existing system of care.

 

In 2017, the sex and race/ethnicity of Pennsylvania’s adolescent population (n=1,571,488) were distributed as shown in the table below.

 

2017 Pennsylvania Adolescents (ages 10-19)
Sex
51%	Male
49%	Female
Race/Ethnicity
77%	White
14%	Black
4%	Asian/Pacific Islander
4%	Multi-race
11%	Hispanic

 

According to 2017 Youth Risk Behavior Surveillance System (YRBSS) data, 37.6 percent of ninth through 12th grade students in Pennsylvania responded affirmatively that they, “ever had sexual intercourse.” In 2017, 27.1 percent of ninth to 12th grade students reported that they had sexual intercourse with at least one person during the three months before taking the survey. Additionally, 11.8 percent of ninth to 12th grade students who were currently sexually active reported that they “did not use any method to prevent pregnancy” during their last sexual intercourse encounter. This combined data demonstrates the need for programming on the prevention of pregnancies and sexually transmitted infections, including HIV/AIDS in Pennsylvania.

 

In Pennsylvania, there is a downward trend of teen pregnancy rates and teen birth rates. Despite this trend, there remains a disparity in teen pregnancy rates in Pennsylvania, particularly by race and ethnicity, as shown in the table below.

 

2017 Pennsylvania Teen Pregnancy Rates, per 1,000 youth (ages 15-17)
Race/Ethnicity
5.2	White
23.8	Black
1.8	Asian/ Pacific Islander
19.4	Multi-Race
21.2	Hispanic

 

The BFH addresses this disparity through several initiatives aimed at reducing teen pregnancy rates among high-risk, high-need youth, and at providing parenting supports for youth with the greatest need. The Personal Responsibility Education Program (PREP), funded by the Administration for Children and Families, educates youth on abstinence, contraception, and adulthood preparation subjects. Evidence-based curricula are implemented in settings serving at-risk, high-need youth including drug and alcohol facilities, residential treatment facilities, and community-based health or human service agencies.

 

The BFH also utilizes Support for Expecting and Parenting Teens, Women, Fathers and their Families funding from the Office of Adolescent Health. Funding is used for the Support. Empower. Learn. Parenting Health Initiative (SELPHI) program which helps expectant and parenting adolescents and their families navigate key social and health services in Philadelphia. Philadelphia has the highest teen birth rate of any county in Pennsylvania and ties for the third-highest teen birth rate among the 11 largest counties in the United States. 

 

Adverse Childhood Experiences (ACEs) can have lasting effects on one’s health and behaviors. ACEs are common, as shown in the 2016 Pennsylvania Behavioral Risk Factor Surveillance System (BRFSS) survey data. For example, 35 percent of BRFSS participants reported that as a child, their parents or adults swore at, insulted or put them down one or more times in their home. Twenty-three percent of participants reported that during childhood, they lived with someone who had a drinking problem or suffered from alcoholism.

 

While ACEs and risk factors are associated with negative health outcomes, protective factors are those characteristics in relationships, communities, and society that lower the likelihood of negative outcomes, or even counter the effects of the risk factors. The BFH aims to increase protective factors among adolescents through evidence-based and evidence-informed mentoring programs. The Teen Outreach Program, funded by the Title V Sexual Risk Avoidance Education Grant, promotes abstinence from sexual activity among youth through an evidence-based approach that aims to affect positive youth behavior change and improve outcomes for youth. The program implements strategies to build protective factors for participants and promote the optimal transition of youth living in high-risk communities from middle childhood to adolescence. 

 

Lesbian, Gay, Bisexual, Transgender and Questioning/Queer (LGBTQ) youth face unique challenges, including higher rates of bullying and harassment than their non-LGBTQ peers. The 2017 Gay, Lesbian, and Straight Education Network (GLSEN) National School Climate Survey reports a majority of Pennsylvania’s LGBTQ youth regularly heard anti-LGBTQ remarks at school and had been victimized at school. Many LGBTQ youth did not have access to in-school resources and supports. Only 13 percent of students attended a school with a comprehensive anti-bullying/harassment policy that included specific protections based on sexual orientation and gender identity/expression. Due to the lack of support for these youth, 54 percent of LGBTQ students who were bullied never reported it to school staff. Among those students who did report bullying to staff, only 35 percent said reporting resulted in effective intervention by staff. While these statistics are specific to youth attending school, youth in out-of-home placement experience bullying and harassment at even higher rates. A study found 78 percent of LGBTQ youth were removed or ran away from their out-of-home placements because of hostility based on their sexual orientation or gender identity. Other research has found that approximately 56 percent of LGBT youth in out-of-home care have spent some time without stable housing because they felt safer on the streets than in group or foster homes.

 

According to the 2017 YRBSS, 38.5 percent of LGB high school students in Pennsylvania seriously considered suicide (transgender teens were not included in the survey). Compared with the percentages for heterosexual peers, these numbers are exceptionally high. The survey results showed that 12.1 percent of straight teens had seriously considered suicide. Rates are even higher among LGBTQ youth who come from highly rejecting families: families whose behaviors rejected their child’s LGBTQ identity, such as preventing a gay youth from attending family events or physically hurting a child because of their LGBTQ identity.

 

Priority: Protective factors are established for adolescents and young adults prior to and during critical life stages

 

NPM 9: Percent of adolescents, ages 12 – 17, who are bullied or who bully others.

 

Objective 1: For the duration of the grant cycle, BFH will annually increase the number of adolescent health vendors receiving training to improve rates of intervention when bullying/harassment is witnessed and increase the number of supportive staff available to LGBTQ youth.

 

ESM: Percent of adolescent health vendors receiving LGBTQ cultural competency training.

 

Personal Responsibility Education Program (PREP) grantees are required to attend LGBTQ cultural competency training. In addition, PREP grantees must attend additional LGBTQ-focused trainings: both a “101” that serves as an introduction to LGBTQ issues that may arise during PREP implementation, and an Advanced Topics training, on topics ranging from bullying, to transgender youth, to health disparities. In 2018, 71 percent of currently active adolescent health vendors received LGBTQ cultural competency training, a decrease of fourteen percent. This was due to several Title V Abstinence Education Programs ending and mentoring programs beginning halfway through the year. New adolescent health programs began October 2018, and the BFH will aim to exceed their ESM 9.1 annual goal (the percent of adolescent health vendors receiving LGBTQ cultural competency training), and have new vendors trained within the first year of the grant agreements.

 

Objective 2: For the duration of the grant cycle, BFH will annually increase the number of adolescent health vendors that adopt and implement comprehensive anti-bullying/harassment policies that specifically enumerate sexual orientation, gender identity, and gender expression as protected categories with clear and effective systems for reporting and addressing incidents that youth experience.

 

ESM: Percent of adolescent serving vendors with a comprehensive anti-bullying/harassment policy.

 

The BFH experienced procurement and contractual barriers when attempting to mandate adolescent health vendors develop anti-bullying policies and when adding this language to work statements. The BFH also found that most adolescent health vendors already had anti-bullying policies established. Pennsylvania is removing this objective for future years. The BFH will revisit the intended outcomes of this mandate and explore more meaningful ways of accomplishing those outcomes.

 

Objective 3: Increase the number of adolescents participating in a bullying awareness and prevention program.

 

ESM: Number of trainers trained in the Olweus Bullying Prevention Program.

 

The Olweus Bullying Prevention Program (Olweus) is the most commonly used bullying prevention program in Pennsylvania. In addition, Pennsylvania has the largest cadre of Olweus trainers in the nation. Clemson University’s Institute on Family and Neighborhood Life is the hub for Olweus training and consultation for North America; therefore, BFH staff met with Clemson University and the Pennsylvania Department of Education staff in early 2017 to determine how the BFH can best support implementation of Olweus and its trainers and address Objective 3: increase the number of adolescents participating in a bullying awareness and prevention program.

 

Based on these discussions, the BFH and Clemson University have partnered to develop a program to train and certify community youth organizations to implement Olweus. Clemson University began their work developing the program July 1, 2018 and is currently reaching out to prospective community youth organizations. The BFH has issued a Request for Applications (RFA) to select community youth organizations to become trained and implement the program beginning January 1, 2020.

 

Priority: Protective factors are established for adolescents and young adults prior to and during critical life stages

 

Objective 1: For the duration of the grant cycle, BFH will annually increase the number of LGBTQ sensitive organizations which provide services to youth.

 

ESM: Number of organizations certified as a safe space provider.

 

The BFH continues to support Persad Center (Persad) and Mazzoni Center (Mazzoni) with Title V funds to provide services to LGBTQ youth. Persad implements the Safe Spaces Project, which provides suicide prevention training to youth, and engages in coalition building activities with known ally organizations and new partners to help the organizations become Safe Space certified. To address ESM 9.6 (the number of organizations certified as a safe space provider) in calendar year 2018, Persad provided three organizations (or 204 individuals) with training to become Safe Space certified. There were 640 youth who took advantage of the Safe Spaces provided by Persad in 2018, 284 more youth than were reached last year. This increase in numbers may reflect the technical assistance provided to Persad by BFH, and the resulting improved data collection methods.

 

Mazzoni provides training on health disparities related to sexual orientation, gender identity and appropriate standards of care for LGBTQ individuals and LGBTQ cultural competency training to medical, behavioral health and social service providers. During calendar year 2018, Mazzoni trained 917 participants in cultural competency and health disparities. While the number of trained participants has declined from the previous year, in 2017 Mazzoni trained two school districts and reached an extraordinary number of staff, far exceeding the annual goal for that year. Mazzoni trainings and trainers continue to be in high demand with organizations and they are scheduling trainings six months in advance. Mazzoni has transitioned to electronic training evaluation forms and has begun completing training needs assessments before providing trainings to tailor them to the audiences Mazzoni is serving.

 

Objective 2: For the duration of the grant cycle, BFH will annually increase the number of LGBTQ youth who have access to suicide prevention interventions.

 

ESM: Number of LGBTQ youth receiving evidence-informed suicide prevention programming.

 

The BFH provided Title V funding to Persad to implement the Yellow Ribbon Suicide Prevention Program five times, which reached 313 youth in the calendar year 2018. This is 44 less youth that were reached in 2017. Persad implements the Yellow Ribbon Suicide Prevention Program within their Signs of Suicide program, an evidence-informed intervention that is modified to be LGBTQ inclusive. The Signs of Suicide program includes screening and education and aims to prevent suicide attempts, increase knowledge about suicide and depression, develop desirable attitudes towards suicide and depression, and increase help-seeking behavior among youth. Persad utilizes this program in schools and community centers throughout Allegheny and Washington counties. The program is also used to raise awareness of suicide prevention in the community. Signs of Suicide has been shown to significantly lower rates of suicide attempts and increase youths’ knowledge of depression and suicide. The program demonstrates significant reductions in self-reported suicide attempts.

 

Persad also implemented Question, Persuade, Refer Gatekeeping Training for Suicide Prevention (QPR). Eleven youth received this training during calendar year 2018. This training was offered as an alternative to the Yellow Ribbon Campaign. It will continue to be offered, however, it is not requested as often as Persad expected.

 

Priority: Protective factors are established for adolescents and young adults prior to and during critical life stages

 

SPM: Percent of youth ages 8-18 participating in evidence-based or evidence-informed programs who increased or maintained protective factors or decreased risk factors.

 

This SPM was revised due to challenges with mentoring data collection. Current mentoring grantees are unable to accurately collect and report the percent change in protective factors or risk factors influencing positive youth development and health outcomes. Each mentoring grantee is implementing an evidence-based or evidence-informed model unique to their agency, and uniform data collection is not feasible. The revised SPM includes only data that mentoring grantees can accurately collect and report. 

 

Objective 1: Annually increase the number of youth participating in evidence-based or evidence-informed mentoring, counseling and adult supervision programs.

 

ESM: Number of youth participating in evidence-based or evidence informed mentoring, counseling or adult supervision programs.

 

Objective 2: For the duration of the grant cycle, the BFH will annually increase the number of evidence-based or evidence-informed mentoring, counseling, and adult supervision programs available to youth ages 8-18.

 

ESM: Number of evidence-based programs implemented in high risk areas of Pennsylvania.

 

The benefits of youth forming supportive, healthy relationships between mentors and mentees are both immediate and long-term. Increased high school graduation rates and a better attitude about school; overall healthier relationships and lifestyle choices; higher college enrollment rates and higher educational aspirations; higher self-esteem and self-confidence; improved behavior, both at home and at school; stronger relationships in part due to improved interpersonal skills; and decreased likelihood of initiating drug and alcohol use are all outcomes that can be obtained through effective mentoring programs for youth.

 

The BFH awarded three grants to implement youth mentoring programming that align with this SPM. Three organizations, Big Brothers Big Sisters Independence Region, City Year Philadelphia, and Students Run Philly Style began program implementation in January 2018 and were selected based on their ability to increase protective factors in the target population and their capacity to reach youth. In the first six months of implementation, a total of 15,418 youth mentees received evidence-based mentoring from 730 mentors. This exceeded the goal of 15,270 youth outlined in the mentoring grantees’ work statements.

 

The BFH also identified a high-risk, high-need population of youth in Allentown, Pennsylvania. A comprehensive LGBT health needs assessment conducted by Bradbury-Sullivan LGBT Community Center revealed that the LGBT community in the Lehigh Valley has the highest obesity rate in Pennsylvania. Additionally, two-thirds of youth served by Bradbury-Sullivan are LGBT youth of color who are at increased risk for obesity and Type II Diabetes. To address this disparity, the BFH partnered with Bradbury-Sullivan to implement the Healthy Eating and Active Living (HEAL) Program with the goals of increasing knowledge about healthy eating and active living and improving the overall health and wellness for participants. Beginning on April 1, 2018, the HEAL program provides youth participants with healthy eating and active living activities on a weekly basis that are guided by adults. Adults also supervise and lead a weekly healthy living discussion group designed to facilitate and promote healthy habits. The HEAL program served 148 youth from April 1 to December 31, 2018.  

 

To increase protective factors among LGBTQ youth transiting to adulthood, the BFH partnered with Persad Center to implement the Youth Age Opportunity Program (YAOP), funded by Title V. YAOP serves LGBTQ youth ages 17 to 24 years old who experience skill and opportunity barriers to launch successfully into adulthood. Youth are offered screenings and assessments during Persad Center’s drop-in hours. In 2018, 261 youth were provided services. Services ranged from job preparation, financial literacy classes, practicing interview skills, social outings with a mentor, and leadership development.

 

Montgomery County Health Department implemented two rounds of Project Adult Identity Mentoring (AIM), an evidence-based, group-level youth intervention program. A total of 33 sixth and seventh grade girls at a Norristown, Pennsylvania school were reached during calendar year 2018.

 

Healthy Youth PA, which is funded through the Title V State Abstinence Education Grant Program (AEGP), continued to support programming with five agencies to implement evidence-based or evidence informed mentoring, counseling, and adult supervision programs to youth ages nine to fourteen. The areas in which the agencies implement programming represent areas of Pennsylvania in which youth are most likely to engage in risky behaviors such as unsafe sexual activity. These areas include Philadelphia, Dauphin, Allegheny, and Lawrence Counties. Federal funding ended for this program September 30, 2018, thereby, concluding programming at this date. 

 

Healthy Youth PA programming saw a decrease in the amount of youth served, the total number of program hours provided to youth, and the number of parents/caregivers served in calendar year 2018 compared to calendar year 2017. There were 748 youth ages 9-14 served in calendar year 2018, compared to 784 in calendar year 2017. The overall goal of the program is to serve, at a minimum, 407 youth per year. It is important to clarify this goal is not a goal of the block grant, but rather an overall program goal Pennsylvania has established for the AEGP. The youth served participated in 6,015 program hours, compared to over 12,000 programming hours from calendar year 2017. And, lastly, there were 142 parents/caregivers of those youth being served who participated in activities, compared to 373 in calendar year 2017.

 

In 2018, BFH developed a program in partnership with the Pennsylvania Coalition Against Domestic Violence (PCADV) to address healthy relationships and intimate partner violence. Funded with Title V funds, the program titled Healthy Adolescents Promoted by Partnerships for Youth (HAPPY) is operational in Delaware and Lawrence Counties. Services began in the summer of 2018. HAPPY engages community-based adolescent health providers and reproductive health providers to accomplish three goals: 1.) Decrease the incidence of adolescent relationship abuse in Pennsylvania through improved case identification and clinic based direct assessment/interventions; 2.) Increase adolescent health and safety by promoting healthy relationships; and 3.) Improve core and other community partners’ capacity to prevent adolescent relationship abuse. Community teams, located in the individual counties, continue to meet with youth to assess for incidents of adolescent relationship abuse using evidence-based practices and educational materials. The primary point of contact for youth is through school personnel, who is usually the school nurse. Appropriate referrals are made to medical professionals and domestic violence agencies when necessary. The community teams also provide outreach services in the schools and communities to inform youth and adults about available services. 

 

The BFH will continue implementation of the Male Involvement Initiative program, starting in 2019, to address intimate partner violence. The program will utilize the Coaching Boys into Men curriculum to promote violence prevention, greater gender equity and respectful and non-violent relationships with dating partners. The BFH will be collecting data and monitoring the progress of the program. 

 

When combining numbers reached for all programs within the ESM: number of youth participating in evidence-based or evidence-informed mentoring, counseling and adult supervision programs, a total of 16,608 youth were served in reporting year 2018. The 2018 goal is 750 youth served. The goal for ESM 9.5: number of evidence-based mentoring, counseling or adult supervision programs implemented in high risk areas of PA, is seven. In 2018, youth were attending programming in eight counties, all selected for their high-risk, high-need youth populations.

 

Priority: MCH populations reside in safe and healthy living environments.

 

SPM: Percent of Title V programming with interpersonal violence reduction components.

 

Objective: As a result of Child Safety CoIIN, implement at least one strategy to address interpersonal violence in PA by 2020.

 

BFH chose to join the Child Safety CoIIN as part of its commitment to serving maternal and child health populations. Participating in cohort one and two of the Child Safety CoIIN provided BFH the opportunity to learn about and apply quality improvement methodologies to child safety programming as well as to further integrate evidence-based practices and strategies into the Title V State Action Plan. Activities focused on interpersonal violence. The Child Safety CoIIN ended in early 2018 and soon after the Child Safety Learning Collaborative (CSLC) was announced. BFH applied for and was accepted to participate in the new project. As part of the CSLC, BFH will implement new quality improvement processes to better shape Safe Sleep programs to meet Title V State Action Plan goals and lower SUID related deaths. In future years, the program will be reported under the Perinatal/Infant Health domain.

 

Priority: Adolescents and women of child-bearing age have access to and participate in preconception and interconception health care and support.

 

NPM 10: Percent of adolescents, ages 12-17, with a preventative medical visit in the past year.

 

Objective 1: In the first year of the grant cycle, BFH will annually increase the number of counties with a HRC available to youth ages 12-17 either in a school or community based setting.

 

ESM: Number of counties with an HRC available to youth ages 12-17.

 

Objective 2: Beginning in the second year of the grant cycle, the BFH will annually increase the number of youth ages 12-17 utilizing HRC services.

 

ESM: Number of youth receiving services at an HRC.

 

ESM: In schools with an HRC, the percent of youth within that school utilizing the HRC services.

 

In response to NPM 10 (percent of adolescents, ages 12 through 17, with a preventive medical visit in the past year), the BFH supports teen pregnancy prevention services through AccessMatters, who uses Title V funds to provide a variety of services to high school students through the Health Resource Center (HRC) program. The HRC program provides: sexual and reproductive health education; confidential, individual level counseling; screening for chlamydia, gonorrhea, and pregnancy testing; referrals and direct linkages to core family planning services; and distribution of safer sex materials (male and female condoms and dental dams). HRCs are located in high schools or clinics near a school and are open during hours that are convenient to youth. AccessMatters operates HRCs in thirteen Philadelphia area schools, as well as twenty-five additional sites in ten counties across the Commonwealth. The twenty-five additional HRCs, considered expansion sites from the original HRCs, operate in areas with high rates of teen pregnancies, STIs and youth leaving school before graduation.

 

Currently, there are HRCs operating in eleven counties. The counties are Philadelphia, Delaware, Berks, Lackawanna, Lycoming, Dauphin, Allegheny, Fayette, Beaver, Lehigh, and Venango Counties. The goal for ESM 10.1: the number of counties with an HRC available to youth ages 12-17 for 2018, is ten counties.

 

In state fiscal year 2017 (July 2017-June 2018), the HRCs provided services to 3,425 youth. This represents a decrease from the prior state fiscal year when 3,780 youth received services. The goal for ESM 10.2: the number of youth receiving services at a HRC during this time period, is 3,500 youth. The decrease in the number of youth receiving services is concerning, especially considering there were seven more HRC sites in state fiscal year 2017 compared to state fiscal year 2016. The decrease had been recognized and BFH has been working with AccessMatters to increase the number of youth served. An emphasis has been made to increase outreach activities, which are critical to promoting HRCs and encouraging youth to visit the HRCs. Also, direct accountability of each HRC has been increased to ensure individual benchmarks of each HRC are met. Specific technical assistance is being developed for HRCs who are falling behind in meeting benchmarks based on their individual needs.

 

The goal for ESM 10.3: In schools with a HRC, the percent of youth within that school utilizing the HRC services, is 18 percent. In state fiscal year 2017, the percent of youth, of all school-based HRCs, who utilized HRC services was 15 percent.

 

To increase visibility and youth-friendliness of the HRCs, the expansion sites were given additional funding to form Youth Advisory Boards. The Boards promote the services of the HRCs, design health awareness campaigns, inform HRC services, and ensure HRC services are teen-friendly. AccessMatters continues to provide training and technical assistance to sites for developing and maintaining Youth Advisory Boards.

 

Objective 3: For the duration of the grant cycle, the BFH will annually increase the number of LGBTQ youth with a medical visit in the past year.

 

ESM: Number of youth receiving services at a drop-in site funded by the BFH.

 

Mazzoni Center provides, with Title V funds, a drop-in health center for youth to obtain a variety of health care and social services. Mazzoni Center provided 3,848 youth with medical services at their drop-in health center in calendar year 2018. This was 328 more youth than last year. Mazzoni Center nearly reached their 2018 goal of 4,000 youth served at a drop-in site. Moreover, 3,303 youth received case management visits (22 more youth than calendar year 2017), and 3,479 unduplicated youth received one service.

 

Objective 4: Starting with reporting year 2015, BFH will increase the number of youth receiving health education and counseling services during a reproductive health visit.

 

ESM: Number of youth receiving health education and counseling services from a reproductive health provider.

 

In state fiscal year 2017/2018, the BFH increased the Title V grant funding amounts to the family planning councils to provide more adolescent clients with reproductive health counseling services. To address inconsistent reporting procedures, data reporting forms were revised to ensure uniform data collection and reporting, and the BFH provided technical assistance as needed. In calendar year 2018, BFH provided 10,692 adolescents with services and did not meet the goal of 15,275 youth served; however, 93 more clients were reached this year than last. With the increase in funding, the goal number of youth served per year increased as well. The BFH periodically reassess the scope of services that are billable to Title V. In 2018, the family planning councils reported that more youth are obtaining services under their parents’ insurance plans or are otherwise able to pay for services. However, for youth who are unable to pay, there is a wider range of services needed than were previously allowable. As such, the list of allowable billing codes grew. With more expensive services being billed to Title V, the goal for number of clients reached per year may need to be reconsidered.  

 

Maternal and Family Health Services, a family planning provider, continued their promotion of the SafeTeens Answers! text line. Staffed by Planned Parenthood of the Rocky Mountains, youth can text their sexual health and healthy relationship questions to the text line and receive a complete, age-appropriate, and medically accurate response within a few hours. Referrals to the appropriate hotlines are also provided, if a texter identifies a need for prenatal care, LGBTQ support, suicide intervention, or information on rape, abuse, or neglect. During calendar year 2018, 2,423 texts were received and 257 teens were referred to services. The most common question topics were pregnancy related, including how to know if one is pregnant.  

 

The BFH provides programming on abstinence and contraception to prevent pregnancy and sexually transmitted infections, and three adulthood preparation subjects (healthy relationships, adolescent development, and healthy life skills) through Personal Responsibility Education Program (PREP) funding. PREP is authorized and funded by Section 513 of the Social Security Act and is administered by the Family and Youth Services Bureau. During the calendar year 2018, 1,482 at-risk youth completed an evidence-based program at a PREP facility. For this reporting period, the following curricula were used:  Sisters Informing, Healing, Living, and Empowering (SiHLE), Rikers Health Advocacy Program, Making Proud Choices, Making Proud Choices School Edition, Becoming a Responsible Teen, Sexual Health and Adolescent Risk Prevention (SHARP), Promoting Health Among Teens (PHAT), HORIZONS, Be Proud! Be Responsible! and Be Proud! Be Responsible! Be Protective!. Compared to the previous year, 18 percent more youth completed 75 percent of the curriculum. In 2018, nine sub-grantees were awarded PREP grants through the RFA process. All but one of the nine sub-grantees are previous PREP implementation sites. Despite the lack of new sub-grantees in 2018, the number of youth being reached continues to increase.