M
odel
P
rograms
for
A
dolescent
Josefi na J. Card, PhD,
is Founder and President of Sociometrics Corporation. Card is a nationally recognized social scientist and an expert in the establishment and operation of research-based social science resources, products, and services for population researchers and health practitioners. She has served as Principal Inves-tigator of over 70 grants and contracts funded by the National Institutes of Health and the National Science Foundation, including the AIDS/STI Data Archive and the HIV/AIDS Prevention Program Archive.Card has established a solid track record as a health and population scientist. She has authored over 80 books, monographs, and journal articles. Her work is noted for its integration of behavioral, psychological, and demographic perspectives.
Card has served as a member of many federal advisory committees, including the NIH (National Institutes of Health) Study Section for Social Sciences and Popu-lation, the NICHD (National Institute on Child Health and Human Development) Population Research Committee, and the NICHD Advisory Council.
Tabitha A. Benner, MPA,
is a Research Associate at Sociometrics Corporation and currently the project director of two projects related to STI/HIV/AIDS pre-vention for at-risk youth and/or adults: Program Archive on Sexuality, Health, and Adolescence (PASHA); and Computer-Based HIV Prevention Interventions for African American Women (SAHARA).As program director of PASHA, she oversees researching new and innovative effective interventions in the areas of primary/secondary pregnancy prevention and STI/HIV/AIDS prevention for youth and works with the original program devel-opers to create user-friendly replication kits. As project director for the SAHARA program, she developed the storyboards and scripts for two interactive, new media interventions—one for African American women, and the second for Hispanic women.
Prior to joining Sociometrics, Benner completed a masters of public adminis-tration at the American University in Washington, DC, with an emphasis on the impact of state and local regulations on minors’ access to family planning and reproductive health services without parental consent. She is also a full-time Yoga instructor and hypnotherapist.
Evidence-Based HIV, STI, and Pregnancy
Prevention Interventions
EDITORS
Josefi na J. Card,
PhD
Tabitha A. Benner,
MPA
New York
M
odel
P
rograms
for
A
dolescent
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC.
Springer Publishing Company, LLC 11 West 42nd Street
New York, NY 10036 www.springerpub.com
Acquisitions Editor: Jennifer Perillo Production Editor: Julia Rosen Cover design: Mimi Flow
Composition: Apex Publishing, LLC.
08 09 10 11/ 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Model programs for adolescent sexual health : evidence-based HIV, STI, and pregnancy prevention interventions/Josefi na J. Card, Tabitha A. Benner, editors.
p. ; cm.
Includes bibliographical references and index. ISBN 978-0-8261-3824-8 (alk. paper)
1. Sex instruction for teenagers. 2. Sexually transmitted diseases—Prevention. 3. Preventive health services for teenagers. I. Card, Josefi na J. II. Benner, Tabitha. [DNLM: 1. Adolescent Health Services. 2. School Health Services. 3. Adolescent Behavior. 4. Adolescent. 5. Pregnancy in Adolescence—prevention & control. 6. Sexually Transmitted Diseases—prevention & control. WA 330 M689 2008]
HQ35.M595 2008
373.17’14—dc22 2007051941
v
For Dr. Susan Newcomer of the National Institute of ChildHealth and Human Development, staunch supporter of developing and disseminating model programs for adolescent
P A R T I
PRIMARY PREGNANCY PREVENTION PROGRAMS
Section A
Programs Designed for Youths in Middle
School or Junior High School . . . .
2
Chapter 1
Reach for Health:
A School-Sponsored Community
Youth Service Intervention for Middle School Students . . . . 3
Diana Dull Akers, Tabitha A. Benner, and the Education Development Center Staff
Chapter 2
Human Sexuality—Values & Choices:
A Values-Based
Curriculum for 7th and 8th Grades . . . 21
Starr Niego, Alisa Mallari, M. Jane Park, and Janette Mince
Chapter 3
Project Taking Charge:
A Pregnancy Prevention Program
for Junior High School Youth . . . 33
J. Barry Gurdin, Starr Niego, M. Jane Park, and Janette Mince
Section B
Programs Designed for Youths in High School. . . .
44
Chapter 4
School-Linked Reproductive Health Services
(the
Self Center
):
A High School Pregnancy Prevention Program . . . 45
Kathryn L. Muller, Starr Niego, M. Jane Park, and Janette Mince
Chapter 5
Reducing the Risk:
A High School Pregnancy and
STI/HIV/AIDS Prevention Program. . . 61
Kathryn L. Muller, Starr Niego, Margaret S. Kelley, and Janette Mince
Chapter 6
Reproductive Health Counseling for Young Men:
A High School Pregnancy
and STI/HIV/AIDS Prevention Program . . . 71
Ross Danielson, Starr Niego, and Janette Mince
Acknowledgments . . . .xi Introduction . . . xiii
Section C
Programs Designed for Youth/Community Collaboration . . . .
79
Chapter 7
School/Community Program for Sexual Risk Reduction Among Teens:
An Adolescent Pregnancy Prevention Program . . . 81
Starr Niego, William S. Farrell, M. Jane Park, and Janette Mince
Chapter 8
Teen Talk:
An Adolescent Pregnancy Prevention Program . . . 95
Danette M. Schott, Starr Niego, Alisa Mallari, M. Jane Park, and Janette Mince
Section D
Programs Designed for Youths of All Ages. . . .
105
Chapter 9
Tailoring Family Planning Services to the Special Needs of Adolescents:
New Adolescent Approach Protocols . . . 107
Kathryn L. Muller, Starr Niego, and Janette Mince
P A R T I I
SECONDARY PREGNANCY PREVENTION
Chapter 10
A Health Care Program for First-Time Adolescent Mothers and
Their Infants:
A Second Pregnancy Prevention Program for Teen Mothers . . . 121
J. Barry Gurdin, Starr Niego, and Janette Mince
Chapter 11
Queens Hospital Center’s Teenage Program:
A Second Pregnancy
Prevention Program for Young Men and Women . . . 131
J. Barry Gurdin, Alisa Mallari, M. Jane Park, and Janette Mince
Chapter 12
Family Growth Center:
A Community-Based Social Support Program for
Teen Mothers and Their Families . . . 143
Diana Dull Akers and Janette Mince
P A R T I I I
STI/HIV/AIDS PREVENTION
Section A
Programs Designed for Youths in Middle School or
Junior High School . . . .
156
Chapter 13
Aban Aya Youth Project:
Preventing High-Risk Behaviors Among
African American Youths in Grades 5–8 . . . 157
Chapter 14
Youth AIDS Prevention Project (YAPP):
An Adolescent STI/HIV/AIDS Prevention
Program for Junior High School Youths . . . 165
J. Barry Gurdin, Starr Niego, and Janette Mince
Chapter 15
Draw the Line/Respect the Line:
A Middle School Intervention to
Reduce Sexual Risk Behavior. . . 177
Tabitha A. Benner
Section B
Programs Designed for Youths in High School. . . .
185
Chapter 16
AIDS Prevention for Adolescents in School:
A High School-Based
STI/HIV/AIDS Prevention Program. . . 187
Anne Belden, M. Jane Park, and Janette Mince
Chapter 17
Get Real About AIDS
®:
A High School-Based STI/HIV/AIDS
Prevention Program . . . 197
Nicole Vicinanza, Starr Niego, M. Jane Park, and Janette Mince
Chapter 18
IMB: Information–Motivation–Behavioral Skills HIV Prevention Program
. . . 207
Diana Dull Akers
Section C
Programs Designed for Young Women . . . .
215
Chapter 19
FOCUS:
Preventing Sexually Transmitted Infections and Unwanted
Pregnancies Among Young Women . . . 217
Tabitha A. Benner
Chapter 20
What Could You Do?
Interactive Video Intervention to Reduce
Adolescent Females’ STI Risk . . . 227
Tabitha A. Benner
Chapter 21
AIDS Prevention and Health Promotion Among Women:
An HIV/AIDS
Prevention Program for Young Women . . . 235
Nicole Vicinanza, Starr Niego, and Janette Mince
Chapter 22
A Clinic-Based AIDS Education Program for Female Adolescents:
An HIV/AIDS Prevention Program for Young Women . . . 245
J. Barry Gurdin, Starr Niego, Margaret S. Kelley, and Janette Mince
Chapter 23
SiHLE:
Health Workshops for Young Black Women . . . 253
Tabitha A. Benner
Section D
Programs Designed for Young Men . . . .
261
Chapter 24
Rikers Health Advocacy Program (RHAP):
An STI/HIV/AIDS
Prevention Program for Young Men . . . 263
Section E
Programs Designed for College Students. . . .
272
Chapter 25
Safer Sex Effi cacy Workshop:
An Adolescent STI/HIV/AIDS Prevention Program for
College Students . . . 273
J. Barry Gurdin, Starr Niego, M. Jane Park, and Janette Mince
Chapter 26
AIDS Risk Reduction for College Students:
An STI/HIV/AIDS
Prevention Program . . . 281
William S. Farrell, Kathryn L. Muller, and Janette Mince
Chapter 27
ARREST:
AIDS Risk Reduction Education and Skills Training Program . . . 291
Anne Belden, Starr Niego, and Janette Mince
Section F
Programs Designed for Youth/Community Collaboration . . . .
299
Chapter 28
Focus on Kids:
An Adolescent HIV Risk Prevention Program . . . 301
Diana Dull Akers and Janette Mince
Chapter 29
Poder Latino:
A Community AIDS Prevention Program for
Inner-City Latino Youths . . . 311
Anne Belden, Starr Niego, and Janette Mince
Chapter 30
Safer Choices:
A High School-Based Program to Prevent STIs,
HIV, and Pregnancy . . . 323
Tabitha A. Benner
Section G
Programs Designed for Gay/Lesbian/Bisexual/
Transgender Youths. . . .
334
Chapter 31
Adolescents Living Safely:
AIDS Awareness, Attitudes, and
Actions for Gay, Lesbian, and Bisexual Teens . . . 335
Anne Belden, M. Jane Park, and Janette Mince
Chapter 32
Youth and AIDS Project’s HIV Prevention Program:
An STI/HIV/AIDS
Prevention Program for Young Gay Men . . . 349
J. Barry Gurdin, Starr Niego, and Janette Mince
Section H
Programs Designed for Runaway Youths . . . .
359
Chapter 33
Adolescents Living Safely:
AIDS Awareness, Attitudes, and Actions . . . 361
Anne Belden, William S. Ferrell, Starr Niego, and Janette Mince
Section I
Programs Designed for Use by Primary Caregivers. . . .
373
Chapter 34
ASSESS:
For Adolescent Risk Reduction . . . 375
Diana Dull Akers
xi
The development of this compilation of model programs for adolescent sexualxiii
Funders and lawmakers are increasingly requiring that adolescent pregnancy andSTI/HIV prevention programs be based on effective prevention strategies to be con-sidered for funding. Moreover, for funding to continue, programs are now generally expected to document their own effectiveness in preventing adolescent pregnancy or STI/HIV or in changing the risky sexual behaviors antecedent to these problems. Behavioral change, as opposed to knowledge or attitudinal change alone, is the standard criterion of effectiveness. Included in the list of behaviors to be changed are those known to lead to adolescent pregnancy and sexually transmitted infec-tions, such as early age at fi rst intercourse, numerous sex partners, frequent inter-course, failure to use contraception and/or an STI-prophylactic (e.g., a condom) at fi rst intercourse, and inconsistent use of effective contraception and/or a condom at every intercourse.
Originally established in the early 1990s and continuing to grow through the present day, the Program Archive on Sexuality, Health & Adolescence (PASHA) is a resource aimed at assisting teachers and health educators around the country in meeting the fi eld’s demands by: (1) facilitating access to proven effective adoles-cent pregnancy and adolesadoles-cent STI/HIV prevention programs, and (2) encouraging rigorous re-evaluation of these programs at sites different from the ones in which they were developed. The PASHA collection includes program and evaluation ma-terials from intervention programs judged by a Scientist Expert Panel to have dem-onstrated salutary impact on one or more of the fertility- or STI-related behaviors listed previously, in at least one subgroup of adolescents and/or young adults ages 10–19 (10–21 for STI/HIV prevention programs) in at least one site in the United States.
For each program in the PASHA collection, we prepare a box (henceforth called the PASHA program package or replication kit) containing all the materials required to replicate the promising intervention. We encourage rigorous re-evaluation of the program by including in each box two evaluation instruments: the original instru-ment used to demonstrate the program’s effectiveness, as well as a generic Preven-tion Minimum EvaluaPreven-tion Data Set. Finally, a PASHA staff-prepared user’s guide gives the program’s history, rationale, the evidence for the program’s effectiveness, and program implementation tips. Each PASHA program package can be used as a stand-alone intervention. Two or more program packages can also be creatively combined, or used in tandem, by communities engaged in coordinated, commu-nity-wide adolescent pregnancy or STI/HIV prevention initiatives.
Primary Pregnancy
A
3
Original Program Developers and Evaluators
Lydia O’Donnell, EdD Alexi San Doval, MPH Richard Duran, MSW Deborah Haber, MEd Rebecca Atnafou, MPH
Renée F. Wilson-Simmons, DrPH Education Development Center Newton, MA
Ann Stueve, PhD
Division of Epidemiology
Columbia University School of Public Health New York, NY
1
Reach for Heal th:
A School -Sponsor ed
Communi t y Youth Ser vi ce
Inter venti on for Mi ddl e
School Students
Diana Dull Akers, Tabitha A.
Benner, and the Education
Development Center Staff
Norma Johnson, MS, RN Uda Grant, MS, RN Helen Murray, MS, RN Department of Nursing Medgar Evers College City University of New York New York, NY
PROGRAM ABSTRACT
Summary
Originally implemented in two middle schools in Brooklyn, New York, in the mid-1990s, Reach for Health (RFH-CYS) is a service-learning intervention that com-bines community fi eld placements with classroom health instruction to help middle school students develop the knowledge, attitudes, and skills that will keep them safe and healthy. Through fi eld placements in various health and social service set-tings, students have the opportunity to experience the sense of empowerment and accomplishment that comes from being asked to do something meaningful, and doing it well. Back in the classroom, they are provided with the information, skills, and support they need to reinforce their community service experiences through health instruction that focuses on reducing risks related to early and unprotected sex as well as other health-compromising behaviors.
Several key features of RFH-CYS increase the likelihood of success and enhance ease of implementation:
RFH-CYS is based on a theoretical model of behavior change. The program is grounded in the theories of social development and social learning, which help explain why young adolescents behave as they do. RFH-CYS also high-lights four positive themes in young people’s lives: protection, responsibility, interdependence, and affi rmation of positive behaviors.
RFH-CYS is designed for diverse student audiences. The program is based on research exploring the culture-, gender-, and developmental-based rea-sons why people engage in unhealthy behaviors. Community placements are tailored to the needs, interests, and developmental levels of students or groups of students. Lessons are active and geared toward diverse learning styles. Materials offer opportunities for creative thinking as well as for criti-cal analysis.
RFH-CYS is easily integrated into school health programs. Both the service learning and the curriculum are designed to supplement rather than replace existing health education programs offered in middle schools. RFH-CYS can be easily adapted to any health curriculum and will support these programs by providing clear, consistent prevention messages as well as the opportu-nity to practice important health-promoting skills.
Further, evaluation of RFH-CYS demonstrates that the program has a positive impact on reducing risky behaviors. Compared with students in control groups, students participating in the RFH-CYS program were
signifi cantly less likely to report recent intercourse at 6-month and 2-year follow-up;
■
■
■
signifi cantly less likely to report sexual initiation at 6-month and 2-year follow-up;
less likely to report recent sex without a condom or other birth control at 6-month and 2-year follow-up;
less likely to report violent behaviors at 6-month follow-up.
The National Campaign to Prevent Teen Pregnancy has recognized RFH-CYS as a model sexually transmitted infection (STI)/HIV/AIDS prevention and teen preg-nancy prevention program (Kirby, 2001).
Focus
5 Primary pregnancy 5 Secondary pregnancy 5 STI/HIV/AIDS
prevention prevention prevention
Original Site
5 School based 5 Community based Clinic based
Suitable for Use In
RFH-CYS was designed to be implemented in middle schools and surrounding com-munity health care and social service settings such as day-care centers (in the 7th grade), or nursing homes, health clinics, or senior centers (in the 8th grade).
Approach
5 Abstinence
5 Behavioral skills development
5 Community outreach
Contraceptive access
5 Contraceptive education
5 Life option enhancement
5 Self-effi cacy/Self-esteem
5 Sexuality/HIV/AIDS/STI education
Original Intervention Sample
In the fall of 1994, 1,157 students completed the baseline survey. Of these, 1,061 completed the spring follow-up in 1995. At baseline, the average ages of 7th and 8th graders were 12.2 and 13.3, respectively. About half of all participants completing both surveys were 8th graders (48.4%), and slightly more than half of the sample was female (52.8%). Almost all students identifi ed themselves as non-Hispanic African American (79.2%) or Latino (15.9%).
During spring 1998, 195 students completed a 10th-grade survey. Almost all students identifi ed themselves as non-Hispanic African American (71%) or Latino (26%).
Peer counseling/instruction
5 Video
5 Other: Service learning
Program Length
RFH-CYS is an intensive intervention, taught over the course of a full school year in 7th and 8th grades. During the year, students spend approximately 3 hours per week in a supervised community placement. In addition to that off-site work, stu-dents receive weekly health lessons—35 lessons in the 7th grade and 30 in the 8th grade—that supplement the traditional health class curriculum.
Staffi ng Requirements/Training
Implementation of RFH-CYS requires collaboration between middle schools and community service sites. In the original implementation of RFH-CYS, a full-time, on-site coordinator was hired to manage activities between school and community sites as well as communication among various agents and players, including stu-dents, parents, school administrators, teachers, fi eld-site mentors, and other com-munity site staff.
At the middle school, health teachers delivered the classroom component of
RFH-CYS. Teachers participated in four training sessions designed to prepare them to deliver RFH lessons led by experienced health education trainers.
At the community sites, nursing students and other agency staff mentored stu-dents and crafted and supervised community experiences. Staff participated in pro-gram orientation.
BIBLIOGRAPHY
Kirby, D. (2001). Emerging answers: Research fi ndings on programs to reduce teen pregnancy . Washington, DC: National Campaign to Prevent Teen Pregnancy.
O’Donnell, L., Duran, R., San Doval, A., Breslin, M., Juhn, G., & Stueve, A. (1997). Obtaining writ-ten parent permission for school-based health surveys of urban young adolescents. Journal of Adolescent Health, 21 (6), 376–383.
O’Donnell, L., Myint-U, A., O’Donnell, C., & Stueve, A. (2003). Long-term infl uence of sexual norms and attitudes on timing of sexual initiation among urban minority youth: Implications for prevention programs . Journal of School Health, 73 (2), 68–75.
O’Donnell, L., O’Donnell, C., & Stueve, A. (2001). Early sexual initiation and subsequent sex-related risks among urban minority youth: The Reach for Health study. Family Planning Perspectives, 33 (6), 268–275.
O’Donnell, L., Stueve, A., O’Donnell, C., Duran, R., San Doval, A., Wilson, R. F., et al. (2002). Long-term reductions in sexual initiation and sexual activity among urban middle schoolers in the Reach for Health service learning program. Journal of Adolescent Health, 31 (1), 93–100. O’Donnell, L., Stueve, A., San Doval, A., Duran, R., Atnafou, R., Haber, D., et al. (1999). Violence
prevention and young adolescents’ participation in community youth service. Journal of Ado-lescent Health, 24 (1), 28–37.
O’Donnell, L., Stueve, A., San Doval, A., Duran, R., Haber, D., Atnafou, R., et al. (1999). The ef-fectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students. American Journal of Public Health, 89 (2), 176–181.
Related References by the Developers of
Reach for Health
O’Donnell, L., Stueve, A., Wardlaw, D. M., & O’Donnell, C. (2003). Adolescent suicidability and adult support: The Reach for Health Study of urban youth. American Journal of Health Be-havior, 27 (6), 633–644.
O’Donnell, L., Stueve, A., & Wilson-Simmons, R. (2005). Aggressive behaviors in early adoles-cence and subsequent suicidality among urban youth. Journal of Adolescent Health, 517, 15–517, e.25.
O’Donnell, L., Stueve, A., Wilson-Simmons, R., Dash, K., Agronick, A., & JeanBaptiste, V. (2006). Heterosexual risk behaviors among urban young adolescents. Journal of Early Adolescence, 26, 87–109.
THE PROGRAM
Program Rationale and History
RFH-CYS was originally implemented and evaluated in two middle schools in Brooklyn, New York, during the mid-1990s. 1 The program combined service
learn-ing with health instruction in order to provide low-income, inner-city students with the information, skills, and support they needed to stay healthy. Working with youths at a critical developmental stage in their lives, the RFH-CYS program sought to promote health and reduce sexual risk taking and other health-compromising behaviors.
RFH-CYS built upon a preexisting community services program in Brooklyn’s School District 13. The existing program was a collaborative effort between the school district, Medgar Evers College Department of Nursing, and several com-munity service organizations in the area. Program expansion involved increasing the number of participating organizations to accommodate a larger number of stu-dents, and incorporating a classroom component on health education—the com-panion RFH curriculum.
The original curriculum consisted of 40 lessons in 7th grade and 34 lessons in 8th grade and was designed to supplement rather than replace the existing New York City health education program. Lessons were designed to be culturally relevant to the needs of urban youths and focus on risks related to early and unprotected sex, violence, and substance use. Teachers, parents, and students contributed ex-tensively to development of the curriculum content in a series of advisory meetings and focus groups.
Theoretical Framework
Theories of social development and social learning, which seek to explain why young people behave the way they do, guided intervention development. Social development theories provide a model for understanding how a young person’s life course is infl uenced by the availability of prosocial and antisocial opportunities, the rewards reaped from involvement in such opportunities, and the bonding to those groups that provide the opportunities. In other words, to reduce the likeli-hood of risky or antisocial behavior, youths must have opportunities for prosocial involvement (in the family, in school, or in the neighborhood). They then have to get involved in these opportunities. (To some extent this involvement depends on the youth’s academic and social skills.) If involvement is meaningful and reward-ing, youths may form bonds to the prosocial groups that offer the opportunities and share their beliefs.
Social learning theories—including such theories as social infl uence, planned behavior, and social inoculation—complement social development theories and suggest that behavior is learned, infl uenced, or mediated by the following:
How young people perceive social norms (at the neighborhood, school, fam-ily, and peer levels)
How young people assess information (regarding the benefi ts and costs of different actions, the expectations of signifi cant others to behave a certain way, and their ability to do the right thing)
How much youths rehearse or practice prosocial ways of thinking about or responding to pressures and infl uences
■ ■
Thus, to reduce the likelihood of early sexual involvement and other health-compromising behaviors, youths must learn to
challenge or demystify social norms that promote risky behaviors while also recognizing and embracing those community standards that encourage health-promoting behaviors;
think critically about behaviors that put them at risk, seek alternative so-lutions to risky behavior, and act in ways that promote their health and well-being;
rehearse or practice ways to resist future peer pressure to engage in risky behaviors.
The following principles, which bind together the two main elements of the program—community service and school health education—also guided interven-tion development:
Protection: We must take action, individually and as a society, to protect our health and well-being as well as to protect the health and well-being of oth-ers in our community.
Responsibility: We each must act responsibly, respecting ourselves and others, and identifying the things we can change in ourselves and our surroundings.
Interdependence: We are all connected; therefore, our actions, the actions of our peers, and the actions of the greater community matter to all of us.
Affi rmation of positive behaviors: Our efforts to promote health in ourselves and our community are supported by members of our community, and we can take pride in staying healthy.
Drawing on these perspectives, RFH-CYS developers worked with urban com-munities to design, implement, and evaluate an intervention that affi rmed health-promoting patterns of thinking and acting among youths.
Program Elements
RFH-CYS included two core elements: community fi eld placements and the RFH sexuality curriculum. These two elements combined a youth development approach with skills-based learning that specifi cally focused on reducing sexual risk taking. Of the two elements, the service-learning component was crucial.
Community Field Placements
Well-selected community fi eld placements provided young people with opportuni-ties to contribute to their communiopportuni-ties in ways that were rewarding for both stu-dents and the agencies they served. At the beginning of each school term, stustu-dents participated in an orientation that defi ned the goals of service learning, provided codes of conduct for being in community settings, and prepared them for specifi c responsibilities and situations (such as what they would be likely to see in a nurs-ing home and how to be respectful of elders). Durnurs-ing this time, they
learned more about the organization where they might be assigned; set personal goals for what they wanted to achieve in the fi eld;
recognized the importance of their role in the site where they would be working;
made predictions about what to expect on-site;
considered and, as necessary, challenged their attitudes about the popula-tion with whom they would be working.
At the completion of the orientation lessons, students received an RFH-CYS jacket and an identifi cation badge to wear to their fi eld placements.
After orientation, 7th and 8th graders were assigned to two different fi eld place-ments per academic year (to broaden exposure and maintain interest), for a total of approximately 90 hours (3 hours per week/30 sessions). This included both travel time to the sites and debriefi ng sessions back in the classroom. Unlike organized volunteer work in the community, RFH-CYS was a group experience. In most settings, classrooms were divided into two or three groups of students and then assigned to placements by group. Students then went to their fi eld placements with their peers and accompanying teachers. Transportation was provided.
Within a fi eld placement, students were assigned to a specifi c area where they could perform a variety of tasks under the direction of fi eld-site staff who served as mentors. They also had the opportunity at the end of their visit for on-site informal interactions with adults. In the fi eld, students provided service in health settings, such as nursing homes, senior centers, full-service clinics, and child day-care centers. In these settings, students performed a variety of tasks tailored to the needs and in-terests of individual students or groups of students and to students’ maturity and developmental levels. Examples of tasks included reading to elders; assisting and observing doctors and dentists during medical examinations; clerical tasks; assist-ing with meals; and helpassist-ing with exercise, recreation, and arts and crafts groups. Back in their classroom, students shared their experiences in debriefi ng sessions used to reinforce skills in decision making, communication, information seeking, health advocacy, and other areas.
Sexuality Curriculum
The RFH curriculum contains ten 7th-grade and ten 8th-grade lessons on healthy development and sexuality and was designed to supplement rather than supplant existing health curricula. The curriculum focused on sexual behaviors that could result in pregnancy, HIV infection, and other STIs. Using developmentally appropri-ate and culturally relevant situations and student-centered, hands-on, interactive classroom activities aimed at reaching all learners, the curriculum aimed to help students choose healthy options, communicate their needs effectively, and avoid risky behaviors.
The curriculum also offered opportunities for students to learn and practice health-enhancing skills, including self-assessment, risk assessment, communica-tion, decision making, goal setting, healthy self-management, and resistance or refusal skills.
The RFH sexuality curriculum drew from the Teenage Health Teaching Mod-ules (THTM), a nationally recognized and independently evaluated comprehensive school health curriculum. It also drew from the Michigan Model and other research-based curricula, including Reducing the Risk, Postponing Sexual Involvement, and
Being Healthy.
The curriculum gave clear messages about the importance of risk reduction and the consequences of early and unprotected sex. The behavior goals, teach-ing methods, and materials were appropriate to the age, sexual experience, and culture of the students. For example, greater attention was paid to refusal skills and reasons not to have sex than to the use of protection, although this also was addressed.
Program Implementation
Implementation of RFH requires advanced planning. While the objectives you set for your milieu (for example, the number of students, community sites, and how to integrate RFH into existing health education efforts) will infl uence the way your school implements RFH-CYS, there are some factors critical to its successful deliv-ery. These factors include a team of well-prepared staff in the school and at commu-nity placement sites, parent involvement, well-vetted and well-selected commucommu-nity placement sites, and in-class time for refl ection. Each of these factors is described in greater detail below.
Staff Involvement
At minimum, the RFH-CYS team consists of the following individuals at the school:
An administrator (e.g., superintendent, principal, assistant principal) with the power to allocate human and material resources to the program.
Health education teachers responsible for conducting the RFH curriculum lessons, selecting and working with community placement sites, and inte-grating service into the curriculum.
And at the community placement site, the team consists of these individuals:
A manager with the power to allocate human and material resources to the program, oversee mentoring and supervision of students, and answer ques-tions or problems as they arise;
Community agency staff responsible for mentoring students as well as craft-ing and superviscraft-ing community service experiences. 2
Further, of critical importance to achieving buy-in at the community level as well as responding to local norms and concerns will be the establishment of an
advisory board . These boards should be established early in the preparation pro-cess. The board should include several youth representatives, given that service learning is a youth development model. School administrators who sanction the program and teachers responsible for its day-to-day delivery should also sit on the advisory board, as should representatives from the fi eld placement sites and
parents.
Schools might also consider hiring or assigning a hands-on leader or coor-dinator to introduce the program and usher it through implementation. One of the biggest challenges to implementing the original RFH-CYS program was the coordination of activities across institutions. To deal with the challenges of creat-ing fi eld-visit schedules, fi eld-site supervision, and transportation for students,
RFH-CYS hired a full-time, on-site project coordinator. This person coordinated activities between school and community sites as well as communication among the various agents and players, including students, parents, school administra-tors, teachers, fi eld-site menadministra-tors, and other community site staff. Specifi cally, this coordinator
developed a protocol for student travel to and from fi eld sites; reviewed teacher performance and provided feedback; recruited new fi eld sites;
conducted focus groups with students; and visited fi eld sites to monitor activities.
Staff preparation was vital to the successful implementation of RFH-CYS. The training, delivered by the original developers, provided an overview and rationale for the program, as well as opportunities for participants to observe lessons, prac-tice teaching, and receive feedback from their peers. Training was conducted in a workshop format, using interactive teaching techniques such as role-playing and small-group work to emphasize key points. Those attending the training included health and physical education teachers as well as teachers drawn from other sub-ject areas and assigned to teach RFH-CYS. Thus, teachers had varying levels of expertise and experience with the health curriculum. The trainers also worked with small groups of teachers throughout the school year, as the different RFH curricu-lum units were delivered.
In addition to the primary focus on delivering the health curriculum, the train-ing devoted time to describtrain-ing and discusstrain-ing the rationale of service learntrain-ing and the teacher’s role as facilitator of students’ community placement experiences. Teachers practiced generating open-ended questions to promote student refl ection. They generated ideas for leading students in debriefi ng and refl ection activities as well as strategies for incorporating student self-assessment of their learning in the community.
Members of the community involved in the service-learning placements, includ-ing students and faculty from local community colleges, also attended the traininclud-ing sessions. Such support contributed to the strength of the school–community col-laboration that was required to maintain a service-learning program.
Parent Involvement
If encouraged to participate, parents assist with a variety of tasks such as providing transportation to service sites and helping with fund-raising and public relations events. They play an important role in program planning. One way strong school– family partnerships can be forged is via a pledge or compact — a written agreement among the school, RFH-CYS students, and their parents to work together to enhance student learning and create effective school–family partnerships. School offi cials and parents collaborate to determine the feasibility and nature of such a pledge.
Although there are many benefi ts to strong school–family partnerships, there are also many challenges that must be addressed. These challenges may include
confl icting values and beliefs, based in large part on social class and/or racial and ethnic differences;
school concerns related to loss of control;
family fears related to insuffi cient experience dealing with schools;
the limited time available to working families for involvement in school activities;
the diffi culties of balancing school and program requirements with parental interests.
Parents are more likely to welcome service-learning programs in schools that open their doors to families and the larger community for after-hours recreational activities and parent education classes, and in schools where parents are viewed as true partners in their child’s educational process. However, if only a small group of parents is currently involved in school activities, they can be called on to help develop parent support for community youth service. For example, parents can as-sist staff in forming an RFH-CYS parent advisory committee or identifying possible representatives to serve on the advisory board.
Whether serving as members of an advisory committee or planning team, parents are able to make signifi cant contributions to the development, effective
operation, and continued existence of RFH-CYS. Among other things, they can help identify student needs and assess community defi cits and resources, explain potential parental concerns and expectations (as well as help address them), and assist in mapping out a role for parents and clarifying the roles of other partici-pants. As with any program that addresses health-risk behaviors and, specifi cally, topics related to sexuality and HIV transmission, parental and community support for implementation is one of the best ways to ensure that the program will not meet with opposition once implemented.
Exhibits 1.1 and 1.2 offer samples of a parent information letter and parent permission form.
E X H I B I T 1 . 1 S A M P L E PA R E N T I N F O R M AT I O N L E T T E R
Dear Parents:
Our school needs you! NAME OF SCHOOL is part of a special new program called Reach for Health. This program provides opportunities for your child to participate in community service activities at local day-care and senior centers as well as to receive a new health curriculum. The purpose of the program is to help make better school health programs for boys and girls who live in NAME OF COMMUNITY.
Through Reach for Health, NAME OF SCHOOL is committed to helping stu-dents learn to stay healthy by teaching them how to do the following:
Choose healthy options Realize their potential Avoid risky behaviors
Cope effectively in their school and community
As part of this special program, we are asking for your permission for your child to participate in the community service activities. If you grant permission, your child will spend about 3 hours a week at a community site such as a day-care center or senior citizen home. Some activities that students may participate in include reading to the elderly or to children, assisting with meals, and helping with arts and crafts. The school will provide transportation to and from the site, and students will have adult supervision at all times. In addition, all students will receive an orientation before they start their community service. This orientation will prepare your child for what to expect when he or she arrives at the community site for the fi rst time. Finally, students will have a chance to talk about their ex-periences and ask questions or voice concerns when they are back in their health classes.
Whether or not you give permission for your child to participate in the commu-nity service activities, we need you to sign and return the enclosed consent form in the self-addressed, stamped envelope. If you have any questions or would like more information, please call the project coordinator at TELEPHONE NUMBER.
Sincerely,
NAME
Principal
Community Site Selection
Simply putting students in a community agency several times a week will not en-sure that they have a meaningful experience. Assignments and placements need to be tailored to the needs and interests of individual students or groups of stu-dents and to stustu-dents’ maturity and developmental levels. When researching com-munity placements and service-learning experiences, keep in mind that young adolescents
can be involved in planning but need to be pushed to follow through; will discuss current events, so political and societal issues should be incor-porated into refl ection activities;
■ ■
E X H I B I T 1 . 2 S A M P L E PA R E N T P E R M I S S I O N F O R M
REACH FOR HEALTH
Community Service Activities PARENT PERMISSION FORM
Your Child’s Name: ________________________________ Your Child’s Date of Birth: __________________________
Please circle YES or NO below.
YES, I give permission for my son/daughter to participate in the community service activities that are part of the Reach for Health program.
NO, I do not give permission for my son/daughter to participate in the community service activities that are part of the Reach for Health program.
Signature of Parent or Guardian Date
Name of Parent or Guardian Phone Number
(Please Print)
WHETHER OR NOT YOU GRANT PERMISSION FOR YOUR CHILD TO PARTICIPATE IN THE COMMUNITY SERVICE ACTIVITIES, PLEASE SIGN THIS FORM AND RETURN IT IMMEDIATELY IN THE SELF-ADDRESSED, STAMPED ENVELOPE TO
Reach for Health Project Coordinator Smith Junior High
55 Main Street
are still forming their identities and developing relationships with peers, members of the opposite sex, family, siblings, and friends, so be fl exible and give them the opportunity to interact with others of all ages and sexes; may evade diffi cult tasks and make unrealistic choices, so give them a lot of support and guidance around realistic choices, and push them to try new tasks.
The fi rst step in selecting agencies that can cater to the developmental needs of middle school students is to learn as much as possible about them. Interested agencies are identifi ed by working through the school and other community con-tacts, and then visited by school/program staff. During the initial information-seeking stage, school and community leaders can share the goals of the program; determine together whether the setting is appropriate for young adolescents; and decide whether the agency’s mission, values, and goals are consistent with those of the school and the RFH-CYS program. This is the time to discuss the following questions:
Will students be safe? Can the organization provide suffi cient supervision and safety assurances? Is the agency in a safe location?
What staff members are available to help implement the program? Is there a designated agency staff person present to assist the teacher with supervision as well as to answer questions and deal with any problems or issues that may arise? Are there staff members available to provide individual supervi-sion and mentoring to students? Is there a sponsor willing to take on the responsibility of overseeing student placements?
Is the site easily accessible? How close is the site? Can students get there by public transportation? Could they walk there?
Is there meaningful work to perform? Would students be meeting an actual organizational need or just marking time? What knowledge and skills would the students be building? Is there an opportunity for students to see a tan-gible outcome as the result of their work? Is there some follow-through from the beginning of the assignment to the end?
Is that work compatible with the goals of RFH-CYS ? Does the agency’s mis-sion fi t with the goals of the service-learning project?
Thus, selection of community agencies with both the commitment to youths and the capacity to oversee such an effort is important. There is no doubt that youths can provide valuable service to a variety of agencies, but it is also clear that the agencies are providing a service to youths. The matching of mutual needs is key to a successful community placement.
Once a site is selected for fi eld placements, meetings between school and agency staff must be held to clarify roles and responsibilities. Agency staff members should be invited to attend some teacher-training events, as well as an orientation session at the school. During this session, agency staff can ask questions about the program as well as about important practical issues. School and agency staff can then review rules of conduct for student behavior and discuss what is reasonable to expect from youths of this age, including the types of guidance and support students might need in order to complete tasks successfully.
In-Class Refl ection
Refl ection is one of the most critical elements of a service-learning program. Indeed, it is what puts the “learning” in service learning and distinguishes it from commu-nity service. Service learning is guided by the principle that students do not learn solely by doing but rather from thinking about and refl ecting upon what they are doing. Without refl ection, students can still have a valuable experience, but may learn the wrong lessons or fail to build new skills. Providing in-class time to make observations, pose questions, and analyze their experiences provides students with a way to put their service experience into a context. The process gives students an opportunity to take an unstructured service activity and turn it into a constructive and productive learning experience.
RFH-CYS students went through a process of refl ection before, during, and after service. Before service, students mentally and practically prepared for their fi eld visits by learning more about the organization where they would be placed. In ad-dition, with the help of teachers and nursing students, they set goals, thought about their role in the service environment, made predictions about what to expect, and looked at their current views of the population they would be helping. During the service experience, students highlighted problems they encountered, thought about solutions, posed questions, and shared feedback. All of these exercises were impor-tant for making the experience more real in a larger societal context. Finally, after the service experience was complete, students had the opportunity to step back and analyze what they learned. Having some distance from the project gave students time to think about how they made a difference, what they learned, and how to use their newly found knowledge and skills.
While some form of refl ection was necessary at several stages during the ser-vice experience, the form it took varied from student to student. Each student experienced service in a different way and, therefore, needed to have a variety of options for expressing those lessons learned. Students refl ected on their experi-ences, interactions, effectiveness of service provided, and the social problems lead-ing to service by dolead-ing the followlead-ing:
Writing poems, letters, stories, and in journals
Creating songs, dance, drawings, cartoons, and photographs Making scrapbooks that combined both writing and art Meeting face-to-face with teachers
Getting together and talking with small groups of students
Keep in mind that students must choose refl ection activities that are relevant and appropriate for their developmental stage and personality.
Although refl ection activities should be led by students, this does not mean they should be disorganized or lack structure. Teachers must provide guidance and help students think about and understand the implications of their service experience. They are facilitators, asking questions and guiding discussion without injecting their own opinions or dominating the conversation. RFH-CYS teachers were trained in the curriculum and theoretical underpinnings of service learning, so they were aware of their role as facilitators. Teachers were encouraged to ask open-ended but pointed questions such as the following:
What did you enjoy doing? What did you avoid doing?
What did you learn about yourself or others? How did you feel about yourself and what you did?
These questions were designed to teach students how to think critically and creatively, make effective observations, analyze new experiences, and pose solu-tions to key problems. Students working in places like elder-care homes, day-care centers, and health clinics encountered illness, poverty, disabilities, and aging—all issues that raise key questions for young people. Finding unique and creative ways to tap into each student’s thoughts on these issues and the service experience is the key to effective refl ection activities.
PROGRAM EVALUATION
The Original Evaluation
Objective
RFH-CYS was originally conceived as a school-based, service-learning intervention designed to reduce sexual risk taking as well as other health-compromising be-haviors among African American and Latino youths in urban areas. Key outcome indicators included reports of sexual initiation, recent sexual intercourse, and con-traceptive use with recent sexual intercourse.
Intervention
Students participated in mentored community service activities in health care set-tings and then refl ected upon and evaluated these experiences back in the class-room. Community fi eld placements were also linked to comprehensive health instruction that focused on reducing risks related to early and unprotected sex, violence, and substance use.
Design
In 1994, two large middle schools in Brooklyn, New York, were recruited to partici-pate in a service-learning intervention designed to reduce sexual risk taking as well as violence and substance abuse. One school was designated as the intervention school, the other as the control. A total of 68 classrooms participated in the initial implementation. In the control school, 33 classrooms (584 students) received the standard New York City health education program, which includes some mandated lessons on drugs and AIDS. Within the intervention school, 22 classrooms (222 students) were randomly assigned to receive the core RFH curriculum (classroom component only). The remaining 13 intervention classrooms (255 students) re-ceived the service learning and the RFH curriculum (community fi eld placements and classroom component combined).
The sites were closely matched in terms of student-body size and ethnicity (more than 700 students in each school, 99% combined African American and Hispanic), a high-risk health profi le (rates of violence-related injuries, HIV, STIs, teen pregnancy, etc.), a high-risk academic profi le (below-grade standardized test scores, low attendance, low high school graduation rates), and limited access to resources (including a Title I poverty index above the New York City average, and limited school-based health programs). The majority of the students at the two sites scored substantially below the New York City average on standardized tests; fewer than a third scored above the 50th percentile in math, and fewer than 40% scored above the 50th percentile in reading.
Data Collection Procedures
both students and parents. About 6 weeks before survey administration, parent consent letters (in both English and Spanish) were distributed to all students. The letters described the purpose and content of the survey, which
was designed to help identify types of health programs that would work best for New York City students;
asked questions about behaviors (e.g., fi ghting, taking drugs, and early sex-ual relationships) that place students’ health at risk;
included questions about behaviors (e.g., doing well in school and playing sports) that protect students’ health.
Letters assured parents that survey responses would be confi dential, and that students would be able to skip any question they chose not to answer or not take the survey at all. Consent packages also informed parents that neither they nor anyone else at the school would have access to the responses.
Research staff made multiple attempts to enlist student and teacher support in returning completed forms. They offered substantial incentives to encourage the return of signed forms, whether or not participation consent was granted. Schools received gift certifi cates ($250) when 90% of the forms were returned. Teachers re-ceived smaller gift certifi cates when their classes returned 90% of the signed forms. Students who returned their signed forms received an RFH T-shirt (each school held a design contest) with the winning design.
Approximately 20% of parents either did not give consent or did not return the survey. Although the surveys were available at school offi ces for parental re-view prior to making a decision, schools reported that no parents requested this option.
Research staff administered both baseline and follow-up surveys in group/ classroom settings using pencil and paper format. Each survey contained approxi-mately 250 items. Gender and school grade questions were asked directly. Ethnic-ity was assessed via separate questions. Other questions addressed the following topics:
Lifetime experience with intercourse Recent intercourse
Use of protection (condoms with or without other birth control) with recent intercourse
Fighting
Threatening to beat up, cut, stab, or shoot others Weapon carrying and use
Social desirability issues
Final Sample Composition
In the fall of 1994, 1,157 students completed the baseline survey (74.7% of eligible students). Researchers conducted multiple survey sessions to ensure that all stu-dents who had parental consent were included in the survey. Of these, 94% were surveyed. In the spring of 1995, 1,061 students completed the follow-up survey (91.7% retention). Nearly all students who did not complete the spring survey were no longer students in the study sites.
At baseline, the average ages of 7th and 8th graders were 12.2 and 13.3, re-spectively; 48.4% were 8th graders, and 47.2% were male. Students self-identifi ed as Hispanic (15.9%), non-Hispanic African American (79.2%), or other (4.9%, in-cluding missing data). Of the 1,061 students who completed both the fall and spring surveys, 255 participated in the RFH-CYS intervention, and 222 participated in the curriculum-only RFH; the remaining 584 served as controls.
Evaluation Results
Results of the evaluation demonstrated that the RFH-CYS program had a positive impact on reducing sexual behaviors of middle school students at risk for HIV, STIs, and unintended pregnancy. Those students who received the strongest intervention (curriculum plus service learning) showed the greatest gains. The evaluation also demonstrated that RFH-CYS had a positive impact on reducing violent behaviors, particularly among 8th-grade students.
Sexual Initiation and Recent Sex
Signifi cant differences in sexual initiation rates were observed between baseline and up among students reporting no sexual activity at baseline. At follow-up, 13.0% of the RFH-CYS group reported having had sex, compared with 17.3% of curriculum-only RFH participants and 21.2% of control group students. RFH-CYS students who were not virgins at baseline were less likely to report recent sex (within the last 3 months) (51.5%) at follow-up as compared to RFH students (60.9%) and their control group counterparts (59.4%).
A logistical regression analysis (controlling for recent sex at baseline, gender, and grade) revealed that students participating in the RFH-CYS program were sig-nifi cantly less likely ( p < .05) to report recent intercourse at follow-up than were the students in either the control group or the RFH curriculum-only group. There was a positive trend ( p < .08) for students in the curriculum-only condition versus their peers in the control condition.
The research team also found that the effect of participating in RFH-CYS was stronger among 8th graders than among 7th graders. It is worth noting that the 8th-grade RFH-CYS program was more intensive than the 7th-grade program. Eighth grade students had two separate fi eld assignments during the year with higher levels of responsibility than their 7th-grade counterparts. They also had additional orientation sessions, which prepared them for their fi eld assignments.
Recent Sex Without a Condom and Without Birth Control
When asked in the baseline survey about condom use during recent sex, 34.7% of the control group who had had recent sex reported doing so without a condom. By comparison, 48.3% of RFH curriculum-only students and 42.6% of RFH-CYS students reported recent sex without a condom. At follow-up, those numbers had changed to 37.7% control (an increase from 34.7%), 35.6% RFH curriculum-only (a decrease from 48.3%), and 26.7% RFH-CYS (a decrease from 42.6%).
At baseline, 38.1% of the sexually active control group members reported hav-ing had recent sex without a condom or other form of birth control. Among RFH curriculum-only students and RFH-CYS group members, the fi gures were 58.6% and 48.9%, respectively. At follow-up, the control group percentage had increased to 46.1%, while the RFH curriculum-only students and RFH-CYS group percent-ages decreased to 53.6% and 40.5%, respectively. These fi gures are summarized in Table 1.1.
Special Education Students
Among special education students, it appeared that the curriculum-only RFH was most effective in positively impacting sexual risk behaviors, as shown in Table 1.2.
Summary
1.1
Baseline and Follow-Up Risk Behavior Percentages Among I ntervention and Control Groups (All Participants)BASELINE PERCENTAGE
FOLLOW-UP
PERCENTAGE DELTA
Ever had sex
Control 32.5 40.7 +8.2
RFH 34.3 37.7 +3.4
RFH-CYS 27.8 32.2 +4.4
Recent sex
Control 22.9 28.2 +5.3
RFH 25.7 29.1 +3.4
RFH-CYS 21.0 20.6 −0.4
Recent sex without condom
Control 34.7 37.7 +3.0
RFH 48.3 35.6 −12.7
RFH-CYS 42.6 26.7 −15.9
Recent sex without birth control
Control 38.1 46.1 +9.0
RFH 58.6 53.6 −5.0
RFH-CYS 48.9 40.5 −8.4
1.2
Baseline and Follow-Up Risk Behavior Percentages Among Intervention and Control Groups (Special Education Students Only)BASELINE PERCENTAGE
FOLLOW-UP
PERCENTAGE DELTA
Ever had sex
Control 34.4 60.5 +26.1
RFH 45.2 32.4 –12.8
RFH-CYS 26.9 31.3 +4.4
Recent sex
Control 24.2 55.3 +31.1
RFH 38.1 27.0 –11.1
RFH-CYS 15.4 18.8 +3.4
Recent sex without condom
Control 42.9 35.3 –7.6
RFH 57.1 30.0 –27.1
RFH-CYS 100.0 0.0 –100.0
Recent sex without birth control
Control 33.3 55.6 +22.3
RFH 53.3 33.3 –22.0
a positive effect on reducing sexual risk behaviors among middle school students. Such programs can also be effective in reducing violent behaviors among 8th graders.
The study also demonstrated that curriculum-only programs can be effective in reducing sexual risk behaviors among students in special education classes.
Parallel Study
Additional funding enabled the research team to follow a group of students from their baseline survey in fall 1994 (7th grade only, n = 1,287) through a follow-up survey at the completion of their 10th-grade year in spring 1998 (n = 970). These students were from three middle schools in Brooklyn, New York. They were tested at four data points: 7th grade, fall and spring; 8th grade, spring; and 10th grade, spring. The average age at baseline was 12.2, and 16.1 at fi nal follow-up.
The core survey questions remained the same throughout the study, but some questions were added/modifi ed to account for maturation and to prevent boredom. The study revealed that minority adolescents who initiate sexual activity early tend to engage in behaviors that place them at high risk for negative health outcomes. Early sexual initiators had an increased likelihood of having multiple partners, forc-ing a partner to have sex, havforc-ing frequent intercourse, and havforc-ing sex while drunk or high.
Long-Term Follow-Up Study
To evaluate the sustained effectiveness of RFH-CYS on reducing sexual initiation and recent sex, researchers at EDC conducted a follow-up survey in the spring of 1998, as they were completing their 10th-grade year (whether or not they continued to attend school regularly). This evaluation point was nearly 4 years after initial enrollment (fall 1994, 7th grade) and 2 years after completion of the middle school program. Self-reported sexual behaviors of youths who participated in RFH-CYS (combined service learning and health curriculum) were compared with those of controls receiving the RFH classroom curriculum alone.
Findings indicate that RFH-CYS participants were signifi cantly less likely than controls to report sexual initiation. Those receiving 2 years of the intervention re-ported slightly better odds of delaying sexual initiation than those receiving 1 year of RFH-CYS. Among those who were virgins at 7th grade, 80% of males in the RFH curriculum-only condition had initiated sex, compared with 61.5% who received 1 year of RFH-CYS , and 50% who received 2 years. Among females, the fi gures were 65.2%, 48.3%, and 39.6%, respectively.
NOTES
1. A full set of program materials, including sample curricula, teacher’s guide, videotape, evaluation materials, and more, is available for purchase from Sociometrics at http://www.socio.com/pasha. htm.
21
Original Program Developer and EvaluatorMichael Donahue, PhD The Search Institute Minneapolis, MN HealthStart Inc. St. Paul, MN
PROGRAM ABSTRACT
Summary
Developed for use in 7th- and 8th-grade classrooms, Human Sexuality — Values & Choices (hereafter referred to as Values & Choices ) aims to reduce teenage preg-nancy by promoting seven core values that support sexual abstinence and healthy social relationships. The curriculum—including 15 student lessons and 3 adult-only sessions—is distinguished by: (a) an emphasis on parent–child communica-tion; and (b) the use of a standardized, video-assisted format. Participants gain
2
Human Sexual i t y—
Val ues & Choi ces:
A Val ues-Based Cur r i cul um
for 7th and 8th Gr ades
Starr Niego, Alisa Mallari,
M. Jane Park, and
Janette Mince
mastery through role plays, group discussions, and behavioral skills exercises. Following a fi eld test in nine schools, program participants showed a greater un-derstanding of the risks associated with early sexual involvement and expressed increased support for postponing sexual activity, as compared to a control group of their peers.
Focus
5 Primary pregnancy Secondary pregnancy STI/HIV/AIDS
prevention prevention prevention
Original Site
5 School based Community based Clinic based
Suitable for Use In
This program is suitable for use in schools and any other community organization that provides education or services to 7th and 8th graders.
Approach
5 Abstinence
Behavioral skills development
Community outreach
Contraceptive access
Contraceptive education
5 Life option enhancement
Self-effi cacy/self-esteem
5 Sexuality/HIV/STI education
Original Intervention Sample
Age 56% age 12, 33% age 13, 7% age 14.
Gender 48% male .
Race/ethnicity 62% White, 19% African American, 10% Hispanic, 9% Other (includes Asian and Native American).
Program Components
Peer counseling/instruction
Public service announcements
The 15 student lessons are designed to run 45–50 minutes each. The 3 parent ses-sions each last about 2 hours. The sequencing of the sesses-sions is fl exible.
