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The California Wellness Foundation’s Teenage Pregnancy Prevention Initiative:

Accomplishments, Challenges and Lessons Learned
By Tom David
October 2007

This paper highlights the accomplishments, challenges and lessons learned from TCWF’s Teenage Pregnancy Prevention Initiative.

Table of Contents

  1. Recalling the Time
  2. Methods
  3. Framework
  4. Reducing injury and death due to firearms
  5. Increasing the level of youth resources
  6. Applying the Framework
  7. Barriers to Cooperation
  8. Legacy of PPEP and the VPI
  9. Conclusions and Lessons Learner
  10. References

Over a 10-year period beginning in 1995, The California Wellness Foundation (TCWF) made nearly $60 million in grants for its Teenage Pregnancy Prevention Initiative (TPPI). An impressive array of individuals and organizations contributed their talents to this undertaking, with some significant results. Participants in the TPPI were credited with transforming practice at the community level, contributing to landmark public policy victories, and perhaps most important, helping change how decision makers, youth-serving professionals and others view the issue of teen pregnancy. The final report of the comprehensive formal evaluation of the Initiative details those outcomes and other aspects of this complex grantmaking program.1

The purpose of this document is to complement that evaluation with some of the lessons learned by the Foundation. With the benefit of 20/20 hindsight, how did strategic decisions made by the Foundation affect the implementation of the Initiative? What seemed to work well? What challenges emerged and how were they addressed? What insights might we offer other funders engaged in social change work?

Initial Context

The issue of teenage pregnancy prevention was prominent in some of the earliest Board discussions at The California Wellness Foundation. When the Foundation was established in 1992, California led the nation with more than 60,000 births to teens. The pregnancy rate among 15-to-19-year-olds in the United States was 111 per 1,000. In California, the rate was the highest in the country at 157 per 1,000, or 41 percent higher than the national average.2 Of particular concern, teen pregnancy was also associated with significant health complications (e.g., low birthweight deliveries) and with a variety of social concerns (e.g., school dropout and a higher likelihood of living in poverty).

It was within this challenging context that TCWF’s Board approved a 10-year, $60 million funding initiative in 1995. Several on the staff and Board had extensive prior experience in teen pregnancy prevention work, and TCWF assembled an advisory committee composed of seasoned veterans of efforts to prevent teen pregnancy around the country. As a group, they had been frustrated by past program failures and were tired of the typical constraints that government and other funders had imposed on those efforts. They were also very concerned about the new wave of politically motivated attempts to replace more balanced approaches to sex education with simplistic “abstinence only” curricula.

Battle weary as they may have been from years of this difficult work, the TPPI’s advisory committee, the Foundation’s staff and Board, nonetheless drew on a shared wellspring of optimism. They had learned a lot from their previous experience with programs such as the Annie E. Casey Foundation’s Plain Talk Initiative, the Junior League’s Teen Outreach Program, and the State of California’s Adolescent Family Life Program. With the Foundation’s significant, long-term commitment as a platform, they saw this as an opportunity to “put all the pieces together” and “to really do this right.”

Constructing the Initiative

At the time of the TPPI’s approval, the bulk of TCWF’s grantmaking was devoted to multiyear strategic initiatives. The Foundation had selected this strategy because it offered the opportunity to simultaneously fund multiple complementary approaches to complex problems. It also helped to ramp up the public visibility of important issues and potential solutions. Competitive Request for Proposal (RFP) processes served to engage the field in a widespread conversation about the TPPI’s principles. Rather than a sequential, grant-by-grant approach, an initiative also presented unique opportunities for synergy and cross-learning among the various funded components. As a statewide foundation, initiatives also promoted a statewide perspective rather than merely a collection of local views on public health issues with large-scale implications.

A number of other foundations around the country were also supporting what came to be known as comprehensive community initiatives in low-income neighborhoods. What distinguished TCWF’s approach was a strong Board interest in not only direct service strategies but also in research, advocacy and strategic communications as integral to the work. They had seen the benefits of media campaigns in moving policy and public opinion on other public health and safety issues such as smoking and auto seat belts. They were a group that was willing to have the Foundation publicly take a stand on potentially controversial issues consonant with its and were not shy about using paid media to do so.

The framing of the Initiative built on the programmatic knowledge that had come before, but also signaled that the Foundation was prepared to break new ground in the public dialogue over approaches to teen pregnancy prevention. The stated goal of the TPPI was to decrease the incidence of teenage pregnancy by :

• defining teen pregnancy as not only an individual and family problem, but also as an adult and societal problem;

• reinforcing community norms that value healthy adolescent sexuality instead of rewarding pregnancies and high-risk sexual behaviors; and

• increasing the proportion of teens that delay the initiation of sexual activity and/or effectively use contraception.

Just this simple formulation signaled to the field that TCWF was prepared to utilize research evidence and the cumulative experience of frontline health care professionals in developing the TPPI. It also outlined a multilevel strategy that would work not only at the individual and family level, but also at the community level—and address the broader context of public opinion and public policy.

TCWF’s 2003 Annual Report provides a much more detailed description of the TPPI’s many moving parts. For the purposes of this paper, the Initiative consisted of four components:

• The Research component provided grants for more than a dozen research projects to help inform the TPPI’s grantmaking activities and to contribute to the body of knowledge in the fields of healthy adolescent sexuality and teen pregnancy. Some researchers gathered new data while others conducted analyses of existing information, including syntheses of characteristics of effective programs.

• The Public Education and Policy Advocacy component focused on influencing social and community norms and creating a political environment supportive of programs and policies that prevent teen pregnancy. In 1995, the Public Media Center received a grant for the first phase of a public education effort to frame teen pregnancy as an adult/societal problem as well as an individual/family problem. Later, Ogilvy Public Relations Worldwide received several grants to develop and implement a public education campaign titled “Get Real About Teen Pregnancy.” Grants were also made to a number of advocacy organizations across the state to mobilize their constituents and to inform policymakers about effective policies to promote healthy adolescent sexuality and prevent teen pregnancy.

• The Professional Development and Leadership Recognition component focused on increasing knowledge and skills among youth-serving professionals to help reduce teen pregnancy and on recognizing those who were working toward that goal. The California Family Health Council received grants to develop and implement an interactive training program that encouraged participants to remember their own teenage experiences while learning how to communicate more effectively with youth about teen pregnancy, contraception and sexually transmitted diseases (STDs). The Youth for Adolescent Pregnancy Prevention scholarship program was developed through a grant to the Health Professions Education Foundation to recognize and reward young leaders for their contributions to teen pregnancy prevention. A total of 24 young people each received a $25,000 scholarship through the program to pursue careers in the health professions.

• The Community Grants component supported three programs designed to demonstrate that teen pregnancies and sexually transmitted diseases can be prevented through community-based efforts to promote healthy adolescent sexuality and effective contraceptive use. The Community Action Program provided substantial eight-year funding for seven communitywide interventions in both urban and rural neighborhoods with high rates of teen pregnancy. The Community Support Program provided more modest, three-year funding to build the capacity of youth-serving agencies in nine additional communities with high rates of teen pregnancy. Finally, the Community Access Program supported teen-oriented clinics implementing the Peer Provider Program in eight communities.

In sum, the TPPI employed a multifaceted, multilayered statewide approach to teen pregnancy prevention, unified by its three organizing themes. It provided substantial support for direct services at the community level, but also invested significant resources in public education and policy/advocacy activities. Support for infrastructure also underpinned all the components of the Initiative; training, skill development, planning and capacity building were essential aspects of the design. A comprehensive evaluation was also integral to the Initiative from its early stages, and it played an important role in providing periodic feedback to all participants and in suggesting areas for program improvement. All those involved endeavored to promote a culture of mutual learning and support across the components of the Initiative.

A Culture of Learning and Mutual Support

The structure and style of the TPPI benefited from close collaboration with other program staff members of the Foundation, who were generous in sharing what they had learned and in providing ongoing informal peer consultation. That kind of internal culture of learning and mutual support is an invaluable asset in any kind of grantmaking, but it is particularly critical for a complex initiative like the TPPI.

Primary responsibility for design, management and monitoring of the Initiative was delegated to a four-person team consisting of a senior program officer, program officer and their two program assistants. However, from the beginning, they reached out to other funders who had been working in the area of teen pregnancy prevention, as well as those involved in the National Campaign to Prevent Teen Pregnancy, in order to connect the work and learning of the TPPI with larger developments in the field. They also consulted regularly with a variety of national and local experts.

That openness to learning from the experience of peers and from others outside the Foundation set the tone for a relatively “ego-free zone” that facilitated the kinds of productive cross-institutional conversations and collaborations that characterized the TPPI throughout its lifespan. That elusive synergy is always an intention of large-scale initiatives, but seems to be more a matter of good chemistry than precise engineering. The Foundation staff has an important role to play in modeling effective collaborative practice and providing access to resources, including expert advisors. A significant, but often unappreciated part of that role is to create the space and allow the time for relationships to develop. It’s a process that can’t be rushed, no matter how much we might like it to conform to a carefully constructed project timeline.

The evaluation team also played an essential role in building a culture of learning within the Initiative. First of all, three different evaluation groups partnered together on this project: Philliber Research Associates; University of California, San Francisco; and SRI International. Each contributed complementary skills and experience, and all were considered valued learning partners by the Foundation staff and the other participants in the Initiative. From the beginning, their approach was to help build the capacity of all those who were part of the TPPI to participate directly in the assessment of their own work. While there were some inevitable bumps in the road, the ongoing, informal input and regular formal reports of the evaluation team were seen by all as helpful assets in helping the TPPI realize its potential.

Reframing the Issue

One of the most unusual—and ultimately most effective—aspects of the TPPI was the level of resources devoted to strategic communications. More than $16 million went to the Public Media Center and Ogilvy Public Relations Worldwide for a multiphase media campaign throughout the lifespan of the TPPI. While that may sound like a lot of money, it’s a pittance when compared with the sums spent on political advertising or the typical commercial advertising budget. In essence, it provided the resources for a public affairs campaign targeted at decision makers rather than a broader social marketing effort aimed at teens.

Ogilvy was the primary Grantee for the public education work, and its “Get Real About Teen Pregnancy” campaign focused on three core messages. The campaign sought to increase the prevalence of comprehensive sex education, to promote teen access to contraception, and to focus policies and program resources on promoting healthy adolescent sexuality. It was an action-oriented campaign. In each case, it aimed to communicate not only what the audience should know about the issue, but also what they could do.

One of the keys to the campaign’s success was an investment in research. It utilized data from market research, surveys, focus groups and community roundtables. Although each data collection effort was time-consuming, taking as much as six months to complete, having fresh research as the “hook” was very effective in attracting widespread media coverage. Data collected for the Initiative on those regions of the state where teen pregnancy rates were the highest (dubbed the “hot spots”) also helped the campaign to dedicate its limited resources to specific media markets.

Another important success factor was Ogilvy’s conscious effort to bring a multicultural perspective to bear on all aspects of the campaign. At the outset, it had assembled a team of collaborators with expertise in specific ethnic media, something quite unusual for the time. All were clear from the beginning that a successful campaign on teen pregnancy would have to speak to multiple cultural audiences and that simple translation of the message into multiple languages would not be effective. Given the sensitive nature of many of the messages, the public education team made a special effort to ensure that it was capturing the appropriate cultural nuances for each audience. To do so, it turned to the other Grantees for help, specifically the Community Action Programs. In turn, Ogilvy also provided technical assistance to the local programs on their media outreach and communications efforts.

Ogilvy’s surveys and focus groups validated the importance of engaging adults and community involvement in building an environment supportive of access to contraception and promotion of healthy adolescent sexuality. The information collected through polling, focus groups, etc., provided a very effective counter to highly vocal opponents, who were revealed to represent a minority viewpoint in the most affected communities. They were not speaking for the majority of kids, parents or the public.

The state of California was also sponsoring a media campaign on teen pregnancy in the early years of the TPPI, with a much larger budget, but it was quite limited in the messages it could convey. The “Get Real” campaign was credited by observers (including state officials) with having the freedom and courage to simultaneously tackle tougher messages. There was a good deal of backstage conversation between the two campaigns, and the “Get Real” campaign was able to say things that the state wasn’t able to say in a complementary fashion that helped increase the impact of both campaigns. Later, when the state’s funding ended, the “Get Real” campaign was able to continue to keep the issue of teen pregnancy prevention before decision makers.

The media campaign also had a galvanizing effect on others directly involved in the TPPI. They were heartened by the fact that the campaign was putting out messages about teen pregnancy that no one else was using. Identification with the campaign gained them a lot of credibility in their communities, since it conveyed to parents that they were genuinely concerned about their kids’ well-being.

Something unanticipated at the beginning of the Initiative was the degree to which an online presence would be an important tool for the “Get Real” campaign. Originally, not much thought was given to a website, for example, but it definitely evolved into an essential element of the campaign. It was one of the first of its kind, and it had a password-protected section for TPPI participants and also provided open access to downloadable copies of all of the materials produced for the campaign. The site continues to be used as a resource by organizations working on teen pregnancy prevention in California and around the country.

Targeting Resources

How to distribute grant dollars for maximum impact is a key concern for any philanthropic venture. The Foundation devoted a great deal of effort to ensure that good data helped to drive grantmaking decisions. The Center for Health Training at the UC Berkeley School of Public Health and the State Office of Family Planning were commissioned to conduct an analysis of birthrates among 15-to-17-year-

olds between 1992 and 1994 for all California zip codes.3 The 82 areas that were in the upper quartile were identified as hot spot communities and they became the focus of the TPPI. Parenthetically, this approach has continued to be used by the state of California to target its funding for other programs.

In addition to the hot spot analysis, TCWF commissioned other background research on criteria for site selection, best practices from effective and promising programs, and the public policy context for teen pregnancy prevention work.4 These data sources provided the underlying structure of the competitive RFP process to select the Community Action Programs. When the readiness criteria were applied to the top-rated proposals, only seven met most of them. That’s when the decision was made to extend a second tier of funding to include hot spot communities that did not quite demonstrate the capacity to take on the challenge of communitywide mobilization. Those sites, selected partly for geographic diversity, became the Grantees of the Community Support Program.

Another criterion in site selection was to complement existing state government funding rather than duplicating resources. Foundation and state staff were in regular communication to help foster appropriate synergies and to create an environment where each entity could track the other’s work. The state staff invited TCWF program staff to their meetings, and Foundation staff also included state staffers in their planning conversations on several occasions. That kind of public/private coordination of effort takes place too rarely—and both sides saw it as beneficial.

Despite the rigorous, data-driven nature of the site selection process, real-life constraints inevitably manifested themselves. It was very difficult to identify organizations in the hot spot regions that possessed the capacity and other connections that background research indicated were important for high-quality programming and effective community engagement. Vigorous debate ensued within the Foundation and with key TPPI support Grantees on how best to proceed. Even though the TPPI had developed very explicit criteria for the kinds of interventions it expected to be most successful, it was clear that a “one size fits all” approach was not going to work and that the sites were going to require substantial individualized technical assistance (see next section on Building Capacity).

Another question that was debated was the appropriate grant size, or dosage, per site. It was decided that each Community Action Program would receive substantial funding ($300,000 per year over six and a half years of full implementation) in addition to significant resources for planning and technical assistance. In the name of equity, each site received the same amount.

With the wisdom of 20/20 hindsight, some observers have suggested that some sites could have profitably used greater funding, while others could have made do with significantly less. The effectiveness of annually distributing the same amount throughout the life of the project is another open question. While it made for maximum predictability for staffing and program planning, it’s also possible that all might have benefited from a somewhat more sophisticated disbursement procedure, perhaps based on achievement of benchmarks. That would have acknowledged the reality of disparities in capacity among the sites and also rewarded those who were proceeding more quickly to achieve their goals. Whether that would have been politically feasible and palatable to everyone involved is another question. But future multiyear initiatives might benefit from considering alternative methods for targeting resources on an annual basis.

No matter how well-informed and thorough the site selection process, another lesson is that the longer the lifespan of the Initiative, the higher the likelihood that the important elements will change. This is a dilemma familiar to any foundation that has supported place-based initiatives. It is impossible to draw a cordon around a neighborhood over a multiyear period to try to ensure that one’s funding has the desired cumulative effect.

Low-income communities, particularly neighborhoods like the TPPI’s hot spots, are constantly in flux. There is a high level of transience, and it’s not uncommon for 40 percent to 50 percent of the local school population to turn over in the course of a year. Likewise, key staff at Grantee agencies will inevitably move on during the course of the grant, taking their newly acquired knowledge and networks, and program materials, with them. Keeping the attention of the leaders of Grantee organizations over a multiyear period is also a challenge. As grateful as they might be for Initiative support, it’s only one of many funding sources for their agencies—and their energies are frequently spread quite thin.

By most standards of the field, TCWF approached the targeting of resources the “right” way. It collected appropriate background data and devoted substantial intellectual resources to select sites and calibrate grant amounts for maximum effect. Nevertheless, significant challenges emerged. Of the seven sites so carefully selected as Community Action Programs, two dropped out of contention during the planning process and a third lost momentum midstream in implementation when the two project coordinators left after a dispute with their sponsoring agency. Despite the Foundation’s best laid plans, the nature of these complex, multiyear grantmaking programs is that they are never a “done deal.” Rather, they are a continuously unfolding work in progress. A flexible and adaptable mindset is required of all participants, as well as ongoing attention to capacity building.

Despite all these challenges, it is important to note some significant outcomes of the Community Grants component. Thousands of teens received reproductive health education and contraceptive services. Perhaps more importantly, sexually active teen girls living in the Community Action Program (CAP) areas increased their use of family planning services more than did teens at similar communities in California, and births to teens in the CAP neighborhoods decreased more than in other hot spots in the state.

Building Capacity

Any foundation embarking on a complex venture like the TPPI faces a similar challenge. How do you incentivize and sustain innovation and change at the community level—when the instruments of change (i.e., Grantees) are likely to be chronically under- resourced organizations who are typically forced to chase project dollars to meet their payroll? Moreover, even though the focus of your initiative may be consonant with the Grantees’ mission, it is most likely not the only thing they do. Add to that a lack of capacity for dealing with data—and a steep, winding hill has been added into your roadmap for change.

Significant resources for the capacity building challenge were built into the TPPI’s structure from the beginning. Cornerstone Consulting Group, an organization with extensive experience with other foundation initiatives related to teen pregnancy prevention and child welfare, received a grant to provide technical support to the Community Action Programs. As noted previously, the evaluation team also provided technical assistance to the sites on data collection, analysis and reporting. Funding was provided for an 18-month planning period to help the sites lay the groundwork for community engagement, partnership development and capacity building around best practices for teen pregnancy prevention.

It’s fair to say that there was conflict between Cornerstone and some of the sites during those early stages of the Initiative. Cornerstone understood its job as helping prepare the sites to meet the Foundation’s criteria for full implementation funding. In essence, it was functioning as an intermediary, yet it was not really given the license to act on the Foundation’s behalf. Meanwhile, some Grantees felt that the technical support was heavy-handed and interfered with their autonomy. They also felt inundated on occasion, trying to balance visits and requests from the technical support team, the evaluators, the public education Grantee and the Foundation.

As time passed and the sites matured, Cornerstone’s approach to capacity building evolved to help link sites to individualized resources to help them implement their action plans. Cornerstone also supported peer exchanges via a learning-circle approach that allowed Community Action Program staff to build their own skills as they were teaching one another across sites. The site coordinators were encouraged to form their own work groups to meet separately to discuss their common issues and build on their experiences, and an effective learning community emerged.

Cornerstone developed a productive, nuanced working partnership with the Community Action Program sites. As with the most effective technical assistance (or any adult learning), the sites needed space to learn to implement the principles in their own way, being free to make mistakes without being penalized. That kind of learning is not necessarily sequential or linear, despite our well-planned logic models or theories of change. One can’t underestimate the importance of allowing time for thorough planning and alliance building and for trial-and-error implementation.

Something else that took more time than anticipated was the research projects. The original plan was to commission research to fill information gaps that would be directly useful for the community sites. While a significant amount of research was generated and published that made a valuable contribution to the field, many research projects were not completed according to the timeline desired for maximum utility for other TPPI Grantees.

There were distinct payoffs from the Foundation’s substantial investment in capacity building. Despite significant staff turnover, the participating institutions built new skills and practices that have had a long-term impact on the way they do business. For example, the experiential training that the California Family Health Council developed for clinic and youth workers has been credited by many for transforming the way they work with teens.

Another example is the continued spread of the Peer Provider model of staffing clinics by teens for teens.5 The California Family Health Council took the model that originated at the Valley Community Clinic and codified its key elements as part of its three years of funding from the TPPI to build agency capacity and implement it in five communities. They not only managed to cut the implementation time to six months in some cases, but clinics across the state have fundamentally changed the way they work with teens. The California Family Health Council has since spread the model to 28 sites and four learning labs—with the help of Family PACT and Title X funding along with a Hot Spot program that has engaged an additional 14 agencies in comprehensive sex education.

Managing Complexity

Inherent in everything discussed up to this point is the formidable overarching challenge of how to appropriately and effectively manage all of the moving parts of a complex initiative like the TPPI in order to maximize the potential synergies and collective impact. TCWF has a longstanding, much-appreciated institutional policy of minimal intervention in the work of its Grantees once a grant has been awarded. A complicated, multiyear venture like the TPPI puts that way of working to the test.

The Foundation may have missed opportunities to increase the Initiative’s impact by not playing a more active role in orchestrating and connecting the work of its various components. The counter view is that it’s then too tempting (and perhaps inevitable) for Foundation staff to inappropriately micromanage their Grantees—to no one’s benefit. Also, it’s difficult—if not impossible—for a program officer to serve as a fair and impartial monitor of Grantee activities that he or she has had a direct hand in shaping on a daily basis. So, given the ambitious goals of a TPPI, what’s the appropriate balance between foundation prescriptiveness and Grantee autonomy?

In the case of the TPPI, the program staff developed a structure of quarterly meetings with the key support Grantees. Although the Foundation set the agenda, ample time was set aside for updates and cross-component learning. There were also routine conversations with individual Grantees, as needed, between meetings.

Others argue that the sheer complexity of the task of managing an initiative like the TPPI is not a job that plays to the strengths of a typical program officer. They suggest that to really maximize the opportunity to align the activities of the multiple Grantees, a separate structure is required, which the Foundation did not put in place. Other foundations, for example, have contracted with intermediary organizations to manage initiatives for them. Of course, those arrangements are not without complications. To what degree can an external partner ever really act on a foundation’s behalf in just the way that the foundation itself might? Does the foundation then relinquish total control over implementation?

It all comes back to a foundation’s core philosophy of grantmaking. Does it see its Grantees as agents of the foundation’s strategy or as organizations worthy of support because they have the potential to advance their respective fields? An Initiative straddles those two approaches to grantmaking. Multiple Grantees are funded simultaneously with the intent that, collectively, they are likely to have more impact than an incremental grant-by-grant approach. How far should that collectivity be pushed by the foundation?

TCWF’s approach has been to provide cross-cutting resources such as technical support, evaluation and strategic communications but to stop short of trying to engineer precise coordination among all the moving parts. The Foundation’s grantmaking experience indicates that synergy cannot be engineered. You can create an environment that fosters collaboration, but you can’t force marriages among Grantees, even when they might potentially have much to gain from the connection. Whether in the context of an initiative like the TPPI the Foundation erred too much on the side of Grantee autonomy is a question that can be debated but one that is ultimately unanswerable. Looking across other foundation-driven initiatives, it is difficult to point out examples where more direct foundation intervention in the work of the Grantees produced demonstrably better results.

It’s also important to examine this question from the Grantee perspective. By accepting a grant to participate in an initiative, an organization realizes that it is signing on for something more demanding than a typical foundation grant. But no matter how generous, the funding from the initiative is only one of many sources of revenue for the organization. An initiative may be the foundation’s top priority, but it is rarely so for most Grantees. Sometimes foundations tend to forget that. That begs the question of how much initiative management is warranted—and ultimately productive.

Turnover is another manifestation of complexity in these multiyear grantmaking programs. Short tenure of line staff is a fact of life for most nonprofit organizations. Despite the incentive of multiyear funding, turnover of key staff in Grantee organizations was a challenge for the TPPI as it was for all of TCWF’s initiatives. Much of that turnover is predictable and unavoidable. Young people get married, have babies, go to graduate school, and/or leave for higher paying jobs. But it certainly affects the continuity of operations in an initiative, which assumes that cumulative experience will lead to greater impact. In the case of the TPPI, there was also substantial turnover among the Foundation staff assigned to the Initiative, which caused additional complications. But, ultimately, turnover is to be expected and the likelihood increases with the length of an initiative. Consequently, it needs to be factored into a foundation’s expectations when embarking on such a venture.

A particular strength of the TPPI was that it managed to keep the same intact core of support Grantees throughout the life of the Initiative. Key senior staff from the evaluation team, Cornerstone Consulting Group, Ogilvy, the California Family Health Council, and the Public Health Institute remained involved with the Initiative throughout its lifespan. The strong working relationships they created with the Foundation’s help provided an excellent platform on which the other Initiative activities could be built.

An important way in which foundations can set the stage for synergy is to convene Grantees across an initiative. Annual meetings of the Grantees of TCWF’s Violence Prevention Initiative became a vital ritual for connecting and sharing experiences across the disparate components of the program. In the case of the TPPI, it was decided to not convene all the Grantees each year. Instead, a total of five cross-initiative conferences took place over the 10 years. It is an expensive and labor-intensive undertaking to bring everyone together, and it is also yet another demand on the time of Grantees. But participants point out that the conferences had genuine value. In the later years of the TPPI, when scholarships were awarded at the Grantee meetings to young people who had been involved in teen pregnancy prevention, it was particularly powerful and revitalizing for all.

Another management challenge was the timing of the rollout of the various components of the Initiative. The Foundation’s plan for the TPPI was to phase in the components over time instead of launching everything at once. Therefore, the TPPI was not fully implemented until several years into its 10-year lifespan. Some might suggest that also represented a missed opportunity for greater impact. But the practical realities of launching multiple statewide competitive RFPs are formidable. The time required to get from the initial announcement to reading and scoring proposals to multiple face-to-face site visits to actual awarding of the grants can easily be six months. Again, it is possible to imagine using an outside organization to manage that process, but giving up the selection of Grantees would be difficult for most foundations to do. That said, it is clear that the phased in approach TCWF used for the TPPI resulted in missed opportunities, especially around the public policy work—the last component funded.

Some Lessons for the Field

Even though most foundations may not have the resources to support an initiative of the scale and ambition of the TPPI, there are a number of lessons for the field that can be drawn from this experience. Among them:

The Significance of Dosage. Too often, foundations are naïve about the level of resources and amount of time required to really effect change. While an initiative like the TPPI is not the only structure that can support such work, it demonstrates the importance of substantial funding for a multilevel intervention (individual/family; community; public policy) over a sustained period of time in order to make significant progress on a complex problem like teen pregnancy.

On Building Capacity. Investing in capacity building has become common practice in philanthropy, but the TPPI illustrates the critical importance of providing adequate time and resources for planning as well as ongoing substantial funding for technical support, training and Grantee conferences. One of the TPPI’s signal achievements was the way in which it helped to underwrite and encourage the use of data for decision making. The initial hot spot data set the tone for the enterprise, and the evaluation emphasized building local capacity for data collection and analysis from the beginning.

Expect Change. No matter how brilliant one’s theory of change or comprehensive one’s logic model, real-world implementation requires flexibility and adaptability. It takes more time than expected to roll out multiple components of an initiative. Commissioned research may not be completed until well after the time frame in which it might have helped to inform key decisions. Principal actors within the foundation and Grantee organizations are likely to leave; moreover, low-income families and children may not stay in one place for the life of a program. Expectations for cumulative impact should be calibrated accordingly.

The Contribution of Strategic Media. Almost a quarter of the TPPI’s grant dollars supported a multiyear media campaign targeted at decision makers—with real impact. The Foundation’s independence was a key factor in putting out messages that were considered controversial in some circles but were backed by research and practice. The Ogilvy team worked assiduously to craft materials that were appropriately resonant with different cultural audiences and also partnered with frontline service providers to incorporate their perspective. The resulting campaign gave voice to community perspectives and helped to inspire and reinforce the work of other initiative components.

The Power of Peers. The Community Action Programs focused on young people playing key roles in influencing their peers. The Peer Provider clinic model has spread throughout the state, helping experienced health care providers to appreciate the many contributions young people can bring to a clinical setting. Finally, the awarding of scholarships to recognize the leadership of young people in teen pregnancy prevention became the personification of the TPPI for many of its participants.

Focus on Learning. The evaluation played an important role throughout the life of the Initiative in encouraging all participants to make continuous learning a priority. The TPPI particularly benefited from the continuity of a core group of senior support Grantees. With the facilitation of Foundation staff, they built a learning community at the center of the initiative characterized by openness and mutual support. That kind of candid exchange happens all too rarely in foundation-sponsored programs; it was instrumental to the Initiative’s ultimate success.


California’s teen birthrate declined to 37 per 1,000 at the conclusion of the Initiative, down from 75 per 1,000 when it began. That decrease was part of a national trend, but although teen births were down 30 percent across the country over the same time period, in California they were down 44 percent. Of course, those positive outcomes cannot be attributed to the Initiative’s efforts alone. The TPPI was part of a larger effort to achieve that result, including significant funding from the state of California during the same time period. But it’s fair to say that TCWF Grantees and associated activities were a contributing factor.

Complex multiyear grantmaking programs like the TPPI are difficult undertakings at best. They are resource and labor intensive, and demand a lot from their participants. They are not the only mechanism for foundations to strategically advance their goals; indeed, it could be argued that their very complexity can sometimes get in the way of the work. The more moving parts there are, the more challenging it becomes to “hold the whole.”

But when the right people are brought together at a propitious time along with significant resources, the resulting “whole” can exceed the sum of its parts. That was certainly the case with the TPPI.

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