The Title V Competitive SRAE program supports educational services for youth that normalizes the optimal health behavior of avoiding non-marital sexual activity. The program is designed to teach youth personal responsibility, self-regulation, goal setting, healthy decision-making, a focus on future goals, and the prevention of risk behaviors such as drug and alcohol usage without normalizing teen sexual activity.
According to the Centers for Disease Control and Prevention (CDC), the proportion of high school students who had ever had sexual intercourse decreased significantly overall and among ninth and tenth grade students, non-Hispanic black students in all grades and Hispanic students in ninth, tenth, and eleventh grades. During 2005–2015, the overall decrease in the prevalence of ever having had sexual intercourse is a positive change in the level of sexual risk among adolescents in the United States.  This trend supports the expansion of sexual risk avoidance education and demonstrates the broad appeal for the Sexual Risk Avoidance (SRA) message.
In spite of these encouraging statistics, more work remains. The 2015 Youth Risk Behavior Surveillance report notes that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. Examples of the health-risk behaviors associated with the leading causes of death are sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection, alcohol, drug use, and tobacco use. Specifically, many high school students are engaged in sexual risk behaviors related to unintended pregnancies and sexually transmitted infections (STIs), including HIV infection. Despite the nationwide decrease in the number of teens that have not had sex, 41.2 percent of students never had sexual intercourse, 30.1 percent had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 11.5 percent had sexual intercourse with four or more persons during their life.
Among currently sexually active students, 56.9 percent used a condom during their last sexual intercourse. During the 30 days before the survey, 10.8 percent of high school students had smoked cigarettes and 7.3 percent used smokeless tobacco.  While trend data reports that fewer teens are currently engaged in risky behaviors, there is a need for intentional efforts to teach sexual delay as normative behavior. In 2016, the birth rate for youth ages 15-19 reached a historic low of 20.3 births per 1,000 women. Additionally, the birth rate for teenagers declined for both younger (aged 15–17) and older (aged 18–19) teenagers to 8.8 and 37.5 births per 1,000 women, respectively.  Although there has been a significant decline in the teen birth rate for all groups, disparities still exist. African American youth, Hispanic/Latino youth, American Indian/Alaska Native-youth, and socioeconomically disadvantaged youth of any race or ethnicity experience the highest rates of teen pregnancy and childbirth.  Additionally, the latest CDC data indicate that young people ages 15 to 24 account for half of new sexually transmitted diseases reported annually.  Adolescents who are at greatest risk of STIs and unintended pregnancies are a complex and dynamic group. Thus, a targeted and holistic approach is essential to preventing teen pregnancy and other risk behaviors.
SRAE PROGRAM OVERVIEW
Title V Competitive SRAE Goal and Objectives
The goal of the Title V Competitive SRAE program is to provide messages to youth that normalizes the optimal health behavior of avoiding non-marital sexual activity. The objectives of the Title V Competitive SRAE program are to:
- Implement curricula that includes medically accurate information referenced in peer- reviewed publications by educational, scientific, governmental, or health organizations.
- Select sexual risk avoidance curricula and/or strategies with an evidence-based approach to integrate research findings with practical implementation that aligns with the needs and desired outcomes of the targeted audience of youth.
- Teach risk avoidance skills through methods that do not normalize teen sexual activity.
- Target youth ages 10 to 19.
SRAE Program Requirements and Design
Under the Title V Competitive SRAE Program, the following items are requirements of the program:
- Medically Accurate Materials and Culturally and Age Appropriate Approach
- Evidence Based Interventions or Strategies
- Positive Youth Development Framework
- Target Population to be Served
- Referrals to Healthcare and Other Services
- Research and Evaluation
- National Evaluation
- Performance Measures
Medically Accurate Materials and Culturally and Age Appropriate Approach
Title V Competitive SRAE projects must provide information that is medically accurate and complete. Medical information must be verified or supported by the weight of research. The research must be conducted in compliance with accepted scientific methods and published in peer- reviewed journals where applicable, or comprise information that leading professional organizations and agencies with relevant expertise in the field recognize as accurate, objective, and complete. Program materials, such as texts, supplements, workbooks, videos, flyers, handouts, posters, and flash cards should be reviewed in comparison to current medical statements of fact in accordance with the most up to date scientifically supported information.
Title V Competitive SRAE projects must provide age-appropriate information and activities. The topics, messages, and teaching methods implemented by the project must be consistent with the developmental and social maturity of the program participants.
Grantees will be required to take appropriate action to correct any inaccurate or age-inappropriate information discovered by ACF during the grant project period.
For applicants that provide information on contraception, the information must be medically accurate and complete and ensure that students understand that contraception offers physical risk reduction, but not risk elimination; and the education cannot include demonstrations, simulations, or distribution of contraceptive devices.
Evidence-based Interventions or Strategies
The U.S. Department of Health and Human Services (HHS) is committed to giving youth information and skills that are solidly based in scientific literature. Decades of social science research indicate that applied research is difficult. Identifying specific curricula that can be successfully, reliably and broadly applied across many applications and among diverse audiences and locations is extremely challenging.
However, social science and educational research is rich in identifying program elements that are key in attaining positive behavior change. Many of these elements have been identified in research summary documents such as the Systematic Method for Assessing Risk Avoidance Tool (SMARTool) and the CDC Health Education Curriculum Assessment Tool (HECAT). These tools provide critical elements to success in implementing programs to positively change youth behavior. More information on SMARTool can be found at: https://www.myrelationshipc enter.org/getmedia/dbed93af-9424-4009-8f1f-8495b4aba8b4/SMARTool-Curricula.pdf.aspx. Information on (HECAT) is located at https://www.cdc.gov/healthyyouth/HECAT/index.htm
ACF requires applicants to review effective programs to determine whether the interventions can be adapted subject to copyright restrictions, implemented with fidelity, and adhere to the core curriculum components to meet the requirements of programs designed for this grant.
The selected interventions must be promising practices or have evidence of effectiveness with the target populations. Interventions and strategies on sexual risk avoidance, per Title V Competitive SRAE legislation, must address the following topics:
A. The holistic individual and societal benefits associated with personal responsibility, self-regulation, goal setting, healthy decision-making, and a focus on the future.
B. The advantage of refraining from non-marital sexual activity in order to improve the future prospects, and physical and emotional health of youth.
C. The increased likelihood of avoiding poverty when youth attain self-sufficiency and emotional maturity before engaging in sexual activity.
D. The foundational components of healthy relationships and their impact on the formation of healthy marriages and safe and stable families.
E. How other youth risk behaviors, such as drug and alcohol usage, increase the risk for teen sex.
F. How to resist and avoid, and receive help regarding sexual coercion and dating violence, recognizing that even with consent teen sex remains a youth risk behavior.
The applicant should provide a plan for ensuring that training on the selected intervention is delivered by professionals that can provide follow-up technical assistance to the facilitators.
Positive Youth Development Approach Framework
Title V Competitive SRAE programs should include Positive Youth Development (PYD) as part of any risk avoidance strategies to help participants build healthy life skills and protective factors that mitigate the impact of past and future negative factors, empower participants to make healthy decisions, provide tools and resources to prevent pregnancy and STIs, and prevent youth engagement in other risky behaviors. The program approach should include service linkages to local community partners that support the safety and well-being of the target population. For more information on PYD, please see: https://aspe.hhs.gov/execsum/positive- youth-development-united-states-research-findings-evaluations-positive-youth-development- programs.
Target Populations to be Served
Title V Competitive SRAE programs must provide services to youth populations between the ages of 10 and 19. Title V Competitive SRAE programs may target services to vulnerable youth populations to include, but not limited to, youth living in under resourced regions and areas with high rates of teen births and STIs, culturally underrepresented youth populations, especially Hispanic, African American, or Native American teenagers, youth in or aging out of foster care or adjudication systems, youth who are victims of trafficking, runaway and homeless youth, and other vulnerable youth populations. Program services must align with the needs and desired outcomes for the intended audience.
Referrals to Healthcare and Other Services
Title V Competitive SRAE programs may be used only to provide education to youth on sexual risk avoidance. Funds may not be used to provide separate services, such as health care, educational, career development, or counseling services (e.g., substance abuse, including alcohol, tobacco cessation, mental health issues, and intimate partner violence). As needs are identified, grantees should provide referrals for necessary services, but may not pay for the services themselves. Programs should encourage eligible youth or their parents to enroll in health assistance programs such as Medicaid and Children's Health Insurance Program (CHIP), or any other federal or state assistance program for which they may be eligible.
Research and Evaluation
Applicants that choose to propose a plan to conduct a local evaluation must describe the amount of funding that will be allocated towards conducting research and evaluation, within the allowable amount of no more than 20% of total grant budget.
Applicants have the option to conduct local research or local evaluations of their Title V Competitive SRAE projects. Applicants that choose to conduct local evaluations must provide a description of the plan to conduct grantee-specific evaluations, called “local evaluations.” The purpose of the local evaluations is to contribute to the evidence base for sexual risk avoidance programming, and provide an opportunity for grantees to learn whether desired outcomes are being achieved and/or if the program(s) being implemented is effective. Evaluations must answer one or more specific research questions related to programming implemented and funded by the state grant.
Local evaluations must consider the short project period for grants. Local evaluations must be well designed especially with regard to quality of data collection and analysis. ACF will work in collaboration with grantees to disseminate information about the evaluation findings. In accordance with legislation, any Title V Competitive SRAE research and evaluation conducted or supported must be:
- Evidence-based; and
- Designed and conducted by independent researchers who have experience in conducting and publishing research or evaluation studies in peer-reviewed outlets.
(See Glossary of Terms for definitions.)
Evaluation plans may only propose one local evaluation. The research question(s) must drive the local evaluation, including its design, methods, data collection, and analyses. Evaluations must be rigorous, which means that they utilize Section 510 of the Social Security Act (42 U.S.C. § 710, as amended by Section 50502 of the Bipartisan Budget Act of 2018 (Pub. L. No. 115-123).
- Established scientific methods for measuring the impact of an intervention or program model in changing behavior (specifically sexual activity or other sexual risk behaviors, or reducing pregnancy among youth); or
- Other evidence-based methodologies established by the Secretary.
Given the short project period, grantees must employ methodologies that produce high quality findings in the short term, e.g.:
- Comprehensive needs assessments: scientific/systematic investigations that identify needs and challenges around a given issue, determines root causes, identifies current barriers to addressing the need, and sets priorities for future actions; and
- Descriptive studies: studies that document program implementation (i.e., activities/components/program delivery) and/or participant outcomes.
Well-conducted evaluations require time for planning, implementation, analysis, and reporting and dissemination activities. Applicants are advised that evaluation timelines must be sufficient for conducting the proposed studies.
Local evaluations must be designed and conducted by independent researchers, called “local evaluators,” who have experience in conducting evaluations of youth-focused programs in the community and publishing research in peer-reviewed outlets. The expertise of the evaluator should match the type of methodology for the proposed local evaluation. Applicants must select evaluators that have prior experience conducting randomized controlled trials or quasi- experimental studies. Examples of independent researchers may be universities, research organizations, evaluation consultants, or other institutions with experience in conducting high- quality evaluations of community programs.
ACF will provide technical assistance and/or training to grantees conducting local evaluations, and to their local evaluators, on evaluation planning, implementation, analysis, reporting, and dissemination, in order to maximize learning from these projects. As part of the technical assistance, grantees may also be required to complete standardized forms and templates to describe their evaluation plans and submit evaluation updates. These forms and templates are subject to Office of Management and Budget (OMB) approval under the Paperwork Reduction Act (PRA). ACF will obtain OMB approval prior to requiring grantees to complete the forms and/or templates. ACF will review and provide suggestions to grantees to improve plans prior to the initiation of local evaluation activities. Improvements may include reconsiderations of research design and funding.
Upon completion of local evaluations, grantees will be required to submit a final report to ACF. The final report template is subject to OMB approval under the PRA. ACF will obtain OMB approval prior to use. Although ACF will provide technical support to grantees that propose local evaluations, the grantees will ultimately have oversight of the entity that conducts the evaluation as well as any sub-awardee(s) that they select to participate in the evaluation.
ACF will select a subset of projects funded under this announcement to participate in one or more rigorous Federal evaluations. All applicants and applicable sub-awardees will be required to participate, if selected, and must give their assurance that they will participate.
ACF plans to use performance measure data to monitor the extent to which the programs are being implemented according to the Title V Competitive SRAE objectives, to monitor progress towards expected outcomes, to improve programs by strategically directing training and technical assistance efforts, and to report on the status and progress of the program to key stakeholders. ACF will be seeking approval from OMB for information collection under the PRA for post-award reporting. ACF does not intend to use performance measures to measure program effectiveness or impact. Upon approval from OMB, all grantees and sub-contractors will be required to monitor and report on program implementation and outcomes through performance measures. ACF will provide training on how to submit performance measure data. Grantees will be a required to report on performance measures approximately two times each year. Performance measures are intended for monitoring purposes and to provide feedback about whether grantees are implementing programs as intended and demonstrating progress towards expected objectives.
Generally, there are five broad categories of performance measures that FYSB anticipates all grantees will be required to track: (1) output measures (e.g., number of youth served, hours of service delivery); (2) fidelity/adaptation; (3) implementation (e.g., community partnerships, competence in working with the identified population); (4) outcome measures (e.g., behavioral, knowledge, and intentions); and (5) community data (e.g., STI rates, teen birth rates, substance use rates, and other rates of risky behaviors). Based upon ACF receiving OMB approval under PRA, applicants must indicate their agreement to collect information related to the performance measures and report the data to ACF. Grantees are encouraged to develop additional indicators of program performance.
Post Award Requirements
The acceptance of federal funds under this FOA will signify agreement by the grantee that it must comply with the following requirements:
- Have the project fully functioning within 90 days following the Notice of Award for the grant;
- Have facilitators/educators formally trained in the selected program components and strategies by professionals who can provide follow-up technical assistance to facilitators;
- Send at least three key staff persons to the 3-day Adolescent Pregnancy Prevention (APP) Program Grantee Conference held in the Washington, DC area and two staff persons to a minimum of one of three topical training sessions offered each year of the project in areas such as Washington, District of Columbia, Portland, Oregon, and Boston, Massachusetts;
- Participate in a grantee orientation webinar. The webinar is expected to be held shortly after the official award date;
- Collect and report on OMB-approved federal SRAE performance measures (grantee, partners, and sub-awardees); and
- For those conducting local evaluations, participate in training and technical assistance provided by the government and follow related guidance provided by FYSB.
Glossary of Terms
The terms, Age-Appropriate, Rigorous, and Youth are defined according to the legislation. All other terms are defined by applicable research for the purposes of this FOA.
Activities – All the actions needed to prepare for and carry out the program. This includes program and financial management, intervention activities, training activities, and staff debriefings.
Age-appropriate – Information that is suitable (in terms of topics, messages, and teaching methods) to the developmental and social maturity of the particular age or age group of children or adolescents, based on developing cognitive, emotional, and behavioral capacity typical for the age or age group (Section 510 of the Social Security Act 42 U.S.C. § 710)
Comprehensive needs assessment – Scientific/systematic investigations that identify needs and challenges in an area, determine root causes, identifies current barriers to addressing the need, and sets priorities for future actions.
Dating Violence – Physical, sexual, emotional, or verbal abuse from a romantic or sexual partner
Effectiveness – The impact of a program under conditions that are likely to occur in a real world implementation.
Evidence-Based – Interventions, strategies, approaches, and/or program models that have been evaluated using rigorous evaluation design such as randomized controlled or high-quality quasi- experimental trials and that have demonstrated positive impacts for youth, families, and communities.
Evidence-informed- Interventions, strategies, approaches, and/or program models that bring together the best available research, professional expertise, and input from youth and families to identify and deliver services that have promise to achieve positive outcomes for youth, families, and communities.
Goal Setting – The process of deciding what to accomplish and devising a plan to achieve the desired result(s).
Healthy Relationships – Peer, romantic, marriage, family, and other interactions that are based on trust, honesty, and respect and allows adolescents to feel supported, connected, and independent. In healthy relationships, key elements are communication, appropriate boundaries, empathy, effective conflict resolution, and resistance of peer pressure.
Impact evaluation – Efficacy/effectiveness study; has a control/comparison group receives no services or distinct services from the intervention group.
Implementation – The process of introducing and using interventions in real-world service settings, including how interventions or program are adopted, sustained, and taken to scale.
Objectives – The specific and measurable actions that support the expected result of the program.
Organizational Capacity – The resources (e.g., staff, skills, facilities, finances, technology, partnerships capabilities, and other resources) an organization has to implement a program.
Outcomes - The intended effects of the implemented program or program elements such as increase in knowledge, development of skills, and behavior changes.
Performance Measures – Indicators that are designed to collect data for program monitoring, improvement, and reporting purposes.
Rigorous - Established scientific methods for measuring the impact of an intervention or program model in changing behavior (specifically sexual activity or other sexual risk behaviors), or reducing pregnancy among youth; or other evidence-based methodologies established by the Secretary. (Section 510 of the Social Security Act 42 U.S.C. § 710)
Self-Regulation – The act of managing thoughts and feelings to enable goal directed actions, including a variety of actions necessary for success in school, relationships, and the workplace.
Youth - One or more individuals who have attained age 10 but not age 20. (Section 510 of the Social Security Act 42 U.S.C. § 710)
 Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report: Sexual Intercourse among High School Students — 29 States and United States Overall, 2005– 2015 (2018) https://www.cdc.gov/mmwr/volumes/66/wr/mm665152a1.htm?s_cid=mm665%20152a1_w.
 Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report: Youth Risk Behavior Surveillance, (2015) https://www.cdc.gov/HealthyYouth/sexualbehaviors/
 Hamilton, B.E., Martin, J.A., & Osterman, M.J.K., et al. (2017). Births: Provisional Data for 2016. National vital statistics report; no 2. Hyattsville, MD: National Center for Health Statistics. https://www.cdc.gov/nchs/data/vsrr/%20report002.pdf
 Centers for Disease Control and Prevention (2017). Sexually Transmitted Disease Surveillance 2016. Atlanta: U.S. Department of Health and Human Services