Teen Options to Prevent Pregnancy (TOPP)

Young women between the ages of 10 and 19 who are pregnant (at least 28 weeks into their pregnancy) or have given birth (up to 8 weeks postpartum) and who are on Medicaid or eligible for it.

The Teen Options to Prevent Pregnancy (TOPP) program uses motivational interviewing techniques to help prevent rapid repeat pregnancy and promote healthy birth spacing among adolescents. TOPP’s goal is to reduce rapid repeat teen pregnancies and promote healthy birth spacing through telephone and home-based care coordination that encompasses motivational interviewing and access to family planning and other services. The services are delivered by nurse educators and a program social worker over an 18-month period. The core component of TOPP —motivational interviewing—is delivered by trained nurse educators. Motivational interviewing is an individualized, client-driven, collaborative and non-confrontational form of communication aimed at promoting individual change. In the case of TOPP, the individual change refers to the process of teen mothers learning about birth control options, selecting their own method of birth control, and making contraceptive decisions that promote healthy birth spacing and prevent unintended pregnancies.

In addition to motivational interviewing, TOPP provides personalized access to contraception (via transportation to clinics or hospitals, home and community visits, or a TOPP clinic) and referrals by a social worker to additional services as needed.

Robyn Lutz

• Agency/Affiliation: OhioHealth
• Website: https://www.etr.org/ebi/programs/teen-options-to-prevent-pregnancy/
• Email: Robyn.Lutz@ohiohealth.com

The goals of Teen Options to Prevent Pregnancy (TOPP) are:

• Reduce rapid repeat pregnancy
• Learn about healthy birth spacing and strategies to achieve it.

The essential components of Teen Options to Prevent Pregnancy (TOPP) include:

• Telephone-based, one-on-one motivational interviewing sessions with a trained nurse educator.
  • Commonly covered topics include:
    • Importance of birth spacing and preventing rapid repeat pregnancy
    • Birth control methods (ranging from abstinence to long-acting reversible methods)
    • Misconceptions that inhibit contraceptive use
    • Future planning for achieving birth control
    • Birth spacing goals.
• Access to contraception via:
  • Transportation to clinics/hospitals
  • in-person visits from a TOPP nurse educator
  • Services at a TOPP clinic.
• Access to a TOPP social worker to:
  • Screen for risk factors (e.g., domestic violence or depression)
  • Provide service and resource referrals as needed
• Recruitment of participants:
  • At the time of their prenatal appointments
  • Shortly after the birth of the baby while still at hospital
  • During postpartum visits

Child/Adolescent Services

Teen Options to Prevent Pregnancy (TOPP) directly provides services to children and addresses the following:

• Young women between the ages of 10 and 19 who are pregnant (at least 28 weeks into their pregnancy) or have given birth (up to 8 weeks postpartum) and who are at high risk for welfare or child welfare involvement

Recommended Intensity

Weekly one-hour child-led session

Recommended Duration

Approximately 18 months

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Community Daily Living Setting
• Hospital
• Outpatient Clinic
• Virtual (Online, Smartphone, Zoom, Telephone, Video, etc.)

Homework

This program does not include a homework component.

Resources Needed to Run Program

The typical resources for implementing the program are:

Chart – can be paper if computers unavailable

Prerequisite/Minimum Provider Qualifications

Women’s Health Nurses-RNs trained in Motivational Interviewing

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

The Teen Options to Prevent Pregnancy (TOPP) Clinician Manual is available as part of the curriculum at https://www.etr.org/store/product/teen-options-to-prevent-pregnancy-topp-curriculum/

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

ETR can provide training on the curriculum by request. The curriculum involves Motivational Interviewing (MI) and training in it to competence is recommended. MI trainers can be found at https://motivationalinterviewing.org/

Number of days/hours:

Varies by provider

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Teen Options to Prevent Pregnancy.

Formal Support for Implementation

There is formal support available for implementation of Teen Options to Prevent Pregnancy as listed below:

Provided by ETR on request.

Fidelity Measures

There are fidelity measures for Teen Options to Prevent Pregnancy as listed below:

Fidelity measures are included in the manual.

Fidelity Measures Required

Fidelity measures are required in the implementation of this program.

Implementation Guides or Manuals

There are implementation guides or manuals for Teen Options to Prevent Pregnancy as listed below:

Implementation information is included in the program manual.

Implementation Cost

There are no studies of the costs of Teen Options to Prevent Pregnancy.

Research on How to Implement the Program

Research has not been conducted on how to implement Teen Options to Prevent Pregnancy.

Child Welfare Outcome: Child/Family Well-Being

• Stevens, J., Lutz, R., Osuagwu, N., Rotz, D., & Goesling, B. (2017). Full Title: A randomized trial of motivational interviewing and facilitated contraceptive access to prevent rapid repeat pregnancy among adolescent mothers. American Journal of Obstetrics and Gynecology, 217(4), 423.e1–423.e9. https://doi.org/10.1016/j.ajog.2017.06.010

  Type of Study: Randomized controlled trial

  Participants: 598

  Sample / Population:

  • Age — TOPP: (22) - 15 years and younger, (26) - 16 years, (35) - 17 years, and (214) - 18 years and older; UC: (16) - 15 years and younger, (30) - 16 years, (36) 17 years, and (219) - 18 years and older
  • Race/Ethnicity — TOPP: 137 White/Non-Hispanic, 107 Black/Non-Hispanic, 30 Multiracial/Other, and 17 Hispanic; UC: 143 White/Non-Hispanic, 105 Black/Non-Hispanic, 26 Multiracial/Other, and 21 Hispanic
  • Gender — 100% Female
  • Status —

    Participants were adolescent females enrolled in 7 obstetrics-gynecology clinics and 5 postpartum units of a large hospital system.

  Location/Institution: A large Midwestern city

  Summary:

  The purpose of the study was to evaluate the impact of the Teen Options to Prevent Pregnancy (TOPP) program on rapid repeat pregnancies at 18 months after enrollment. Participants were randomized to either the TOPP intervention or a usual-care (UC) control condition. Measures utilized include study-developed measures assessing demographic characteristics, contraceptive use, pregnancy status, and future pregnancy intentions, and administrative data from state vital statistics files for a subset of study participants aged 18 or older at baseline. Results indicate that there was an 18.1% absolute reduction in self-reported repeat pregnancy in the TOPP intervention group relative to UC. There was a 13.7% absolute increase in self-reported long-acting reversible contraception use in the TOPP intervention group relative to UC. There was no evidence of harmful effects of the TOPP intervention on sexual risk behaviors, such as having sexual intercourse without a condom or a greater number of partners. Limitations include that the 2-group design did not permit identification of the part(s) of the multifaceted intervention that led to the reduced pregnancy rates; the lack of an attention placebo control group allowed for the possibility that outcomes were solely due to nonspecific factors like extra social attention from the TOPP clinicians; the sample was restricted to pregnant and parenting adolescents with Medicaid coverage from a Midwestern state; the TOPP program featured resource-intensive components that some communities may not financially support; a secondary data source, birth certificate files, was utilized for only three quarters of the total sample (i.e., those adolescents who were 18 or 19 years old at baseline) because of limited study resources; and cost analyses were not conducted.

  Length of controlled postintervention follow-up: None.

• Luca, D. L., Stevens, J., Rotz, D., Goesling, B., & Lutz, R. (2021). Evaluating teen options for preventing pregnancy: Impacts and mechanisms. Journal of Health Economics, 77, Article 102459. https://doi.org/10.1016/j.jhealeco.2021.102459

  Type of Study: Randomized controlled trial

  Participants: 598

  Sample / Population:

  • Age — TOPP: Mean=18.43 years; Control Group: Mean=18.36 years
  • Race/Ethnicity — TOPP: 48% White/Non-Hispanic, 35% Black/Non-Hispanic, 11% Other Race/Ethnicity or Multiracial, and 7% Hispanic; Control Group: 47% White/ Non-Hispanic, 37% Black/Non-Hispanic, 9% Other Race/Ethnicity or Multiracial, and 8% Hispanic
  • Gender — 100% Female
  • Status —

    Participants were recruited from seven OhioHealth women’s clinics and the postpartum units of five OhioHealth hospitals.

  Location/Institution: Ohio

  Summary:

  The study used the same sample as Stevens et al. (2017). The purpose of the study was to present findings from an experimental evaluation of the Teen Options to Prevent Pregnancy (TOPP) program, an 18-month intervention that consists of a unique combination of personalized contraceptive counseling, facilitated access to contraceptive services, and referrals to social services. Participants were randomized to either the TOPP intervention with access to optional services or to a standard-of-care services control group. Measures utilized include administrative data from OhioHealth’s electronic medical record system and study-developed measures that assessed demographic characteristics, contraceptive use, pregnancy status, and future pregnancy intentions. Results indicate that TOPP led to large and statistically significant increases in the use of long-acting reversible contraceptives (LARCs), accompanied by substantial reductions in repeat and unintended pregnancy among adolescent mothers. However, no significant impacts on other policy-relevant outcomes, such as educational attainment or benefit receipt were observed. Limitations include that the findings may not generalize to populations or settings outside the study sample; the voluntary nature of service use makes it difficult to disentangle which component(s) of the TOPP program were driving the observed results; the results are based on survey data captured at 18-months post-enrollment; and the large number of exploratory analyses may have resulted in some chance findings.

  Length of controlled postintervention follow-up: None.

There are currently no references available for Teen Options to Prevent Pregnancy.