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Teenage Pregnancy Prevention and the Replication of Evidence-based Programs: the Research and Demonstration Programs and Personal Responsibility Education Program are Two RFPs that Provide a “Madeleine Moment” for a Grizzled Grant Writer

Everyone has a Madeleine Moment from time to time, when a breakfast pastry or, for an old grant writer, an RFP, sends one into a reverie. I experienced a Madeleine Moment recently when the Office of Adolescent Health (OAH) issued two RFPs, one for Teenage Pregnancy Prevention: Replication of Evidence-based Programs and one for Replication of Evidence-based Programs and Teenage Pregnancy Prevention: Research and Demonstration Programs and Personal Responsibility Education Program.

There’s nothing like $100 million for the same old teen pregnancy prevention ideas that I used to write proposals about during the latter days of the Nixon administration to get the juices flowing. When we started Seliger + Associates 17 years ago, there was still lots of money for teen pregnancy prevention programs that provided “medically accurate” information, like the requirements of the two new RFPs. “Medically accurate” is a euphemism for teaching about family planning, which is also a euphemism for teaching about contraception, condoms, and birth control pills. In the old days, referral for what was termed “clinical services” (e.g., family planning services, which meant birth control pills) was typically mandatory.

About ten years ago, the pendulum shifted and suddenly there was no more money for the medically accurate/clinical referral approach to teen pregnancy prevention project concepts. We started writing endless “abstinence” education proposals instead, in which birth control could never be mentioned and clinical referrals could never be made.

The new RFPs, compared to old version of medically accurate RFPs, do not want information on clinical referrals for the teens. So the proposal can discuss how the young folk will be told about birth control and family planning but not actually mention how they might actually receive birth control services. To be charitable to the GS 11s who wrote these RFPs, both include the following coded statement:

As appropriate and allowable under Federal law, applicants may provide teenage pregnancy prevention related health care services and/or make use of referral arrangements with other providers of health care services(e.g., substance abuse, alcohol abuse, tobacco cessation, family planning, mental health issues, intimate partner violence), local public health and social service agencies, hospitals, voluntary agencies, and health or social services supported by other federal programs (e.g., Medicaid, SCHIP, TANF) or state/local programs.

Note that “family planning” is stuck randomly between “tobacco cessation” and “mental health issues”. Reminds me of the scene in American Graffiti in which Toad is trying to buy booze for the blond bombshell he just met and says to the suspicious store clerk, “Let me have a Three Musketeers, and a ball point pen, and one of those combs there, a pint of Old Harper, a couple of flash light batteries and some beef jerky.” Why is referral for family planning, arguably the most important aspect of teen pregnancy prevention, not required and only mentioned once in a laundry list of referral services in the RFPs? Because the unstated but obvious implication is that family planning (clinical) referrals mean not only birth control pills for the young ladies, but possibly referrals for “you know what” if the birth control fails.

Writing one of these proposals is a bit of a Kabuki exercise. For staff who actually run supportive services programs for teens, this obfuscation about family planning and Title X is nonsense, since they know the feds actually spend about $300 million dollars annually funding “family planning” services under Title X of the Public Health Service Act. And they have since 1980. Over 4,500 family planning clinics, many run by Planned Parenthood, receive federal funding for birth control and related services, but you’d never know it from these two new OAH RFPs, which pretend Title X doesn’t exist.

We’re writing a few of these new-fangled (or new-old-fangled) teen pregnancy prevention proposals, which for us just means taking a short stroll down memory lane to The Thrilling Days of Yesteryear!.* I don’t have a dog in the “medically accurate” versus “abstinence” versus “clinical referral” fight and don’t wish to raise the ire of advocates with this post. I’m just a grizzled grant writer who wants to help you young whippersnappers out there understand that grant writing moves in waves, as Jake describes at the link. What was old is new again and whatever you’re writing today, you’ll write again someday, when the pendulum inevitably swings back.

*As far as I am concerned, Clayton Moore will always be the one and true Lone Ranger. Hi Yo Silver, Away!