Model programs for adolescent sexual health evidence based HIV STI and pregnancy

New York

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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

Printed in Canada by Transcontinental.

Dedi cati on

For Dr. Susan Newcomer of the National Institute of Child Health and Human Development, staunch supporter of developing and disseminating model programs for adolescent

sexual health

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Contents

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

PART 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 Reproductive Health Counseling for Young Men: A High School Pregnancy and STI/HIV/AIDS Prevention Program . . . . . . . . . . . . . . . . . . . . . . . . . 71 Ross Danielson, Starr Niego, and Janette Mince

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

PART II 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

PART III 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 Tabitha A. Benner Aban Aya Youth Project: Preventing High-Risk Behaviors Among African American Youths in Grades 5–8 . . . . . . . . . . . . . . . . . . . . . . . 157 Tabitha A. Benner

Contents

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 J. Barry Gurdin, Starr Niego, M. Jane Park, and Janette Mince Rikers Health Advocacy Program (RHAP): An STI/HIV/AIDS Prevention Program for Young Men . . . . . . . . . . . . . . . . . . . . . . . . . . 263 J. Barry Gurdin, Starr Niego, M. Jane Park, and Janette Mince

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

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383

Acknowl edgments

The development of this compilation of model programs for adolescent sexual health was funded by the National Institute of Child Health and Human Develop- ment under a series of grants and contracts to Sociometrics Corporation (Dr. Josefi na J. Card, Principal Investigator).

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Intr oducti on

Funders and lawmakers are increasingly requiring that adolescent pregnancy and STI/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 adolescent 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 Evaluation 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.

This book describes the model programs comprising PASHA. Bridging research and practice, the model programs in the book pull together scientifi c research fi nd- ings on the effectiveness of existing adolescent pregnancy prevention and STI/HIV prevention programs, highlighting the most promising of the lot for national atten- tion and scrutiny. Readers interested in replicating or adapting any of the model programs in this book can acquire the program and evaluation materials from www. socio.com/pasha.htm.

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PART I

Primary Pregnancy Prevention Programs

Pr ogr ams Desi gned for Youths i n Mi ddl e School or Juni or Hi gh School

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

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

Reach for Health was supported by grants from the National Institute of Child Health and Human De- velopment (Grants HD30101 and 1RO1HD35378) and the National Institute for Nursing Research (Grant NR03633).

4 Model Programs for Adolescent Sexual Health

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;

Chapter 1 Reach for Health

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%).

Program Components

5 Adult involvement

… Case management

5 Group discussion

5 Lectures

… Peer counseling/instruction

… Public service announcements

5 Role play

6 Model Programs for Adolescent Sexual Health

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.

Chapter 1 Reach for Health

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

8 Model Programs for Adolescent Sexual Health

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 communities in ways that were rewarding for both stu- dents and the agencies they served. At the beginning of each school term, students 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). During 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.

Chapter 1 Reach for Health

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 less-

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 helping 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.

While the original intervention included lessons on violence and substance abuse prevention, the adolescent growth, development and sexuality lessons are the only ones included in this replication kit, given the intervention’s predominant focus on reducing sexual risk taking. Should you opt to enhance the sexuality curriculum with lessons on substance use and/or violence prevention, there are many effective programs from which to choose—some of which are described in this book.

10 Model Programs for Adolescent Sexual Health

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 community 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 supervising 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 mentors, 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.

Chapter 1 Reach for Health

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 describing and discussing the rationale of service learning 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 training 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

12 Model Programs for Adolescent Sexual Health

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

Chapter 1 Reach for Health

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 Any Town, USA 00001

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 students’ 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;

14 Model Programs for Adolescent Sexual Health

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.

After identifying agencies whose missions and operating procedures match the goals and objectives of the service-learning program, it is necessary to establish lines of communication so that any potentially harmful issues can be discussed when and if they arise. Strong relationships with community agencies help make students’ experiences more meaningful.

15 In-Class Refl ection

Chapter 1 Reach for Health