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 mission 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” (see www.letsgetreal.org). 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.