Sexuality Education: Findings and Recommendations from an Environmental Scan of US Programs

1. Sexuality Education: Findings and Recommendations from an Environmental Scan of US Programs Leslie Kantor, MPH National Director of Education Initiatives, PPFA Assistant Professor of Clinical Population & Family Health, Mailman School of Public Health Nicole Cushman, MPH Manager of Education, PPFA Graduate Research Assistant, Mailman School of Public Health

2. In fiscal year (FY) 2010 appropriations, Congress funded the President’s proposed new community Teen Pregnancy Prevention Initiative PREP: 48 grantees in 45 States, Puerto Rico, the Federated States of Micronesia, and D.C. Received over $45 million in PREP (Personal Responsibility Education Program) funding. PREP funds are block grants to the state, which may be re-granted to CBOs. Tier 1: 75 grantees in 32 States and D.C. received over $79 million in Tier 1 funding for the replication of evidence based-programs. These are 5-year grants. Tier 2: 38 grantees19 States and D.C received $34.7 million in Tier 2 funding for demonstration programs to develop and test additional models and innovative strategies. These are 5-year grants.

3. 28 Programs for Replication • AbanAya Youth Project • Adult Identity Mentoring (Project AIM) • All4You! • Assisting in Rehabilitating Kids (ARK)) • Be Proud! Be Responsible! • Be Proud! Be Responsible! Be Protective! • Becoming a Responsible Teen (BART) • Children’s Aid Society (CAS)—Carrera Program • ¡Cuídate! • Draw the Line/Respect the Line • FOCUS • HIV Risk Reduction Among Detained Adolescents • Horizons • It’s Your Game: Keep it Real • Making a Difference! • Making Proud Choices! • Project TALC • Promoting Health Among Teens! Abstinence-Only Intervention • Promoting Health Among Teens! Comprehensive Abstinence and Safer Sex Intervention • Raising Healthy Children • Reducing the Risk • Rikers Health Advocacy Program (RHAP) • Safer Sex • SiHLE • Sisters Saving Sisters • Teen Health Project • Teen Outreach Program • What Could You Do?

4. States with PREP Funding • All but 5 states initially applied (North Dakota, Texas, Minnesota, Indiana, Hawaii)

5. Environmental Scan: Program Selection • Identified 10 programs • Reflected broad geographical diversity • Incorporated established characteristics of effective programs • Had some internal evaluation results • Were not profiled in existing literature

6. Environmental Scan: Program Locations

7. Environmental Scan: Study Procedures • In-depth interviews • 1-1.5 hour phone interviews with program developers and administrators • Detailed questions about planning, implementation, and evaluation • Descriptive case studies developed • Cross-case analysis compared findings across programs

8. Findings: Needs Assessment • Consulted local data sources • YRBS, county health departments • Frequently relied on anecdotal accounts by teachers and agency staff • Georgia: teachers observed need from student questions, feared political backlash • Few used rigorous methods • Massachusetts: focus groups, interviews, surveys with variety of stakeholders

9. Findings: Goals and Outcomes • Selected goals based on data demonstrating need • Some consulted SIECUS guidelines, state standards • Ohio: aligned with goals of Healthy People 2010 • Most created logic models during planning or for funders • Many used committees or partnerships • Colorado: 6 organizations, led by government office with research expertise

10. Findings: Curriculum Selection • Developed in-house curricula • Committees with a range of expertise • Pulled from existing curricula • Selected evidence-based or promising programs • Based on content, target population, cultural competency, perceived community acceptability

11. Findings: Curriculum Modification • Updated for medical accuracy, recent statistics • Altered time and frequency of sessions • Concerns over detracting from core academic curriculum, focus on increasing student test scores • Adapted to increase cultural competency • Hawaii: re-made HIV prevention video to be relevant to Asian and Pacific Islander population

12. Findings: Planning & Implementation • Use of committees or partnerships • Georgia: community mobilization process • Resistance from administrators • New Jersey: planning year to get buy-in, build infrastructure to support programs • Lack of time for implementation, teacher training • California: teacher implementation plans • Massachusetts: web-based tools for training & support

13. Findings: Program Evaluation • Widespread use of external evaluators • Process evaluation utilizing program records, classroom observation, qualitative methods • Fidelity still difficult to monitor and achieve • Outcome evaluation using pre and post-tests • Demonstrated increases in knowledge, improved attitudes, some behavior change

14. Findings: Program Evaluation • Few experimental or quasi-experimental designs • Lack of comparison groups • Inability to measure behavior or intentions • Short duration of program • A few randomized controlled trials • Federal funding increased opportunities for rigorous evaluation (New Jersey, Hawaii, Minnesota)

15. Findings: Sustainability • Funding seen as greatest threat to sustainability • Need to institutionalize programs at school and community level • Build support among teachers, administrators, parents, students, policymakers

16. Group Work: Case Study Analysis

17. What challenges did you identify? • ? • ? • ? • ?

18. What strategies were used to address these challenges in your case study? What strategies have you used in your own work? • ? • ? • ? • ?

19. Recommendations • Technical assistance for research and evaluation • Increase focus on needs assessment, fidelity monitoring, rigorous outcome evaluation • Dedicated funding streams for capacity building • Move programs toward institutionalization and sustainability • Others?