Components of Sexual Health Education
In this section:
- Defining Sexual Health Education
- Characteristics of Effective Programs
- Developmentally Appropriate
- Fundamental Principles of Sexual Health Education:
- Evidenced-based programs/curricula
- Program Evaluation
- Policy Recommendations
Defining Sexual Health Education
Sexual health education is “a lifelong process of acquiring information and forming attitudes, beliefs, and values about such important topics as identity, relationships, and intimacy” (SIECUS, Guidelines, 2004, p.13). Sexual health education programs start in prekindergarten and continue through Grade 12. These programs include age- and developmentally appropriate, medically accurate information on a broad set of topics related to sexuality, including abstinence, contraception and disease prevention. SIECUS further delineates inclusion of “sexual development, reproductive health, interpersonal relationships, emotions, intimacy, body image and gender role topics. Sexual health education addresses the biological, socio-cultural, psychological, and spiritual dimensions of sexuality from the cognitive domain (information); the affective domain (feelings, values and attitudes); and the behavioral domain (communication, decision-making, and other relevant personal skills)” (SIECUS, On the Right Track, 2004 p. 4). The overall goal of sexual health education is to provide young people with the knowledge and skills to promote their health and well-being as they mature into sexually healthy adults (SIECUS, Guidelines, 2004).
According to SIECUS Guidelines for Comprehensive Sexuality Education (2004), sexual health education has four main goals:
- to provide accurate information about human sexuality;
- to provide an opportunity for young people to develop and understand their values, attitudes, and insights about sexuality;
- to help young people develop relationships and interpersonal skills; and
- to help young people exercise responsibility regarding sexual relationships, including addressing abstinence, pressures to become prematurely involved in sexual intercourse, and a use of contraception and other sexual health measures.
Characteristics of Effective Programs
The characteristics of effective comprehensive school health education identified by the Centers for Disease Control and Prevention (CDC)/Division of Adolescent and School Health (DASH) are also applicable to sexual health education. These elements, taken together, inform the effectiveness of school policy, practice and programs. These characteristics are listed below.
Characteristics of an Effective Health Education Curriculum (CDC, 2008):
- focuses on clear health goals and related behavioral outcomes;
- is research-based and theory-driven;
- addresses individual values and group norms that support health-enhancing behaviors;
- focuses on increasing personal perceptions of risk and harmfulness of engaging in specific health-risk behaviors and reinforcing protective factors such as connectedness to school;
- addresses social pressures and influences;
- provides functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors;
- uses strategies designed to personalize information and engage students;
- provides age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials;
- incorporates learning strategies, teaching methods, and materials that are culturally inclusive;
- provides adequate time for instruction and learning;
- provides opportunities to reinforce skills and positive health behaviors;
- provides opportunities to make positive connections with influential others; and
- includes teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning.
In addition, Kirby identifies 17 characteristics that fall into three general categories of effective human immunodeficiency virus (HIV) and teen pregnancy prevention programs at the middle and high school level that can improve the likelihood of changing student behavior (Kirby et al., 2006).
These three categories are identified below:
- Curricula development—involvement of multiple and varied experts, administering a needs assessment to target group, design consistent with community values and resources, use of a logic model approach and adoption of a pilot-testing phase.
- Curricula content—based on solid theory, focuses on specific behavioral goals of preventing HIV/sexually transmitted diseases (STD)/pregnancy, gives clear messages about responsible behavior, addresses psychosocial risk and protective factors, creates a safe learning environment, uses instructionally sound, culturally relevant and developmentally appropriate learning activities that engage students.
- Implementation of curricula—administrative support of programs, professional development and ongoing support provided for teachers, recruitment of youth, and implementation of curricula with reasonable fidelity.
Kirby found that the programs with longer-term impacts tended to be schools that implemented 12 sessions or more in a sequential fashion over multiple years. Such programs exposed youth to the curriculum over a longer period of time and had the ability to reinforce key knowledge, attitudes, and skills year after year (Kirby et al., 2006, p. 43-44).
Coupled with the CDC/DASH key elements above, Kirby's 17 characteristics provide important keys to developing a strong, well-designed program that is more likely to produce the intended results or outcomes. These characteristics are seen as a set of best practices for teen-pregnancy, HIV- and STD-prevention program development.
In addition, CDC’s Health Education Curriculum Analysis Tool (HECAT), “provides processes and tools to improve curriculum selection and development” (CDC, 2007, p.1). The sexual health curriculum module “contains the tools to analyze and score curricula that are intended to promote sexual health and prevent risk-related health problems, including teen pregnancy, human immunodeficiency virus infection, and other sexually transmitted diseases” (CDC, 2007 p. SH-1). This module also includes examples of concepts, skills and learning experiences that assist students in prekindergarten–Grade 12 to adopt and maintain behaviors that promote sexual health (CDC, 2007).
An inherent principle of sexual health education is that it must be designed and implemented in a developmentally appropriate fashion. Like any important program, sexual health education must be thoughtfully planned, implemented and evaluated to ensure program effectiveness and reflect the needs of the local school community. For each grade cluster, (PK–K, 1–4, 5–8, 9–12) the curriculum should reflect the developmental issues of the relevant age group and also prepare children for the upcoming stage of development.
Research by Crooks and Baur, 2008; Pierno, 2007; K, Kelly, 2003; and Society of Obstetricians and Gynecologists of Canada, 2006, indicates that children grow and develop in many different ways to become healthy and well-functioning adults, including:
- Physically. Their bodies grow in height and weight, and during puberty their bodies mature from that of a child to that of an adult who is capable of reproducing.
- Cognitively.As their brains continue to develop from birth through adolescence, young people’s ability to think, organize, solve problems and predict consequences matures.
- Psychological, Social and Emotional.They learn how to be in relationships (family, friendships, work, and romantic) with other people; how to recognize, understand, and manage emotions; who they are and establish an identity; and that self-concept evolves over time.
- Morally.In response to parental, peer, community, and societal norms, children learn to distinguish right from wrong, and over time, to formulate their own system of moral values.
- Sexually.They learn how to become sexually healthy people, for example, they discover and/or learn how their bodies work, how they feel about their bodies, how to care for their bodies, how they perceive their gender identity, how to express their sense of their gender, who they find themselves attracted to romantically and sexually; how to be in intimate relationships; how to respect their own and others’ boundaries; and how to make healthy sexual decisions (Crooks & Baur, 2008; Pierno, 2007; K, Kelly, 2003; Society of Obstetricians and Gynecologists of Canada, 2006).
(For an example of a developmentally appropriate approach to sexual health education, refer to Appendix B: Developmentally Appropriate Approach to Sexual Health Education Example.)
Social worker Angela Oswalt (2009) explains how developmental theorists such as Eric Erikson, Jean Piaget, and Lawrence Kohlberg have contributed to our understanding of child and adolescent development. Erickson’s research explored the importance of children’s psychological, mental and social development; Piaget studied cognitive development; and Kohlberg studied moral development. All these theories on different aspects of child development contribute to a more holistic understanding of what to expect from children at different stages (Oswalt, 2009).
A report outlining the implementation of a K-12 sexual health education program supports the case for starting sexual health education early. Sorace and Goldfarb (n.d.) observed that elementary school programs can promote children’s development by helping them:
- understand, appreciate, and care for their bodies;
- develop and maintain healthy friendships and relationships;
- avoid unhealthy or exploitative experiences and relationships;
- recognize and deal with peer pressure;
- make responsible decisions; and
- understand how their behavior is linked to their beliefs about what is right and wrong.
In an age-appropriate sequence, these concepts can be built upon in middle and high school so that young people gain the knowledge and skills they need to develop a healthy sense of sexuality, which includes the ability to avoid unintended pregnancy and sexually transmitted infections throughout their lives.
In 1991, SIECUS sponsored the publication, Guidelines for Comprehensive Sexuality Education: Kindergarten-12th Grade, which represents the first national consensus about appropriate topics to teach at each developmental level in a sexual health education program (National Guidelines Task Force, 1992). Revised in 2004, the SIECUS Guidelines outline six key concept areas that represent the most general knowledge about human sexuality and family living:
- human development;
- personal skills;
- sexual behavior;
- sexual health; and
- society and culture.
These concept areas were further divided into 36 subtopics with corresponding developmental messages for four different age groups or grade clusters. The SIECUS Guidelines are not a curriculum but rather “a starting point for teacher and curriculum designers and can be used by local communities to plan new programs, evaluate existing curricula, train teachers, educate parents, conduct research, and write new materials” (SIECUS Guidelines, 2004, p. 21).
The SIECUS Guidelines, the National Sexuality Education Standards(2011) and the Sexual Health Componentof HECAT(CDC, 2007) provide evidence of best practice in sexual health education. The Healthy & Balanced Living Curriculum Framework,along with these CT Guidelines provide comprehensive, developmentally appropriate guidance to local districts when developing sexual health education curriculum for Connecticut students.
Fundamental Principles of Sexual Health Education
The following fundamental principles have been adapted for Connecticut and are based on SIECUS Guidelines. The SIECUS Guidelines (2004, p. 19) identify the following principles as fundamental to the development of sexual health education programs:
- parent and community involvement;
- being part of a comprehensive health education program;
- well-trained teachers;
- a focus on all youth; and
- a variety of teaching methods.
The following guidance is provided to further expand upon the definition of these fundamental principles.
1. Parent and Community Involvement
Schools alone cannot be responsible for addressing the nation’s most serious health and social problems. Schools, families and communities must work collaboratively to help children become healthy productive citizens (CSDE, CSH Guidelines, 2007, p.5). Parents and guardians are their child’s primary sexual health educators and have the responsibility of ensuring that their child receives developmentally appropriate information about sexual health. It is the school district's responsibility to provide a planned, ongoing and systematic health education program that addresses the needs of all students. This program should be inclusive of developmentally appropriate sexual health education. Parents and guardians have the right to opt their child out of lessons pertaining to family life and HIV/AIDS education. Each school district is responsible for having a policy in place regarding opt-out procedures. In addition, it is recommended that parents and guardians have the opportunity to learn about the sexual health education curriculum and review materials. These opportunities can be offered during school orientations, parent education night, posted on school Web sites, or shared informally throughout the school year.
School sexual health education programs must respect the diversity of values and beliefs represented in the community and meet the educational needs of all students. In order to accomplish this, one strategy may be for a district to convene an advisory committee to allow for dialogue around the sexual health education program. This committee could be a component of the school health team and may include such members as parents, family members, school nurses, teachers, administrators, students, community and faith-based leaders and representatives from HIV/AIDS organizations, teen-pregnancy prevention coalitions, family planning clinics, local health departments, and/or youth-serving organizations. The level of involvement of the advisory committee is the local school district’s decision. Because there can be debate about the best way to approach sexual health education, it is particularly important to get community and parental input on this component of school health (see Appendix C, Building Community Support).
The CSH Guidelines (2007) outline strategies for organizing school health teams at the district level to bring together a broad range of school and community stakeholders. The goal of these teams or councils is to provide a systematic approach to developing policy, as well as implementing and monitoring the various school health activities, including sexual health education. This coordinated approach:
- makes possible the communication of a variety of perspectives, interests, and concerns;
- contributes to districtwide ownership of outcomes; and
- is incorporated into district and school improvement plans as an essential element of the district’s educational mission (CSDE, CSH Guidelines, 2007, p. 13).
Community involvement and input can provide the school sexual health education program with:
- an atmosphere of inclusion rather than exclusion;
- diverse perspectives;
- a base of parent and community support for the program; and
- additional expertise, support, and resources.
2. Comprehensive School Health Education Program
The CSDE Guidelines for a Coordinated Approach to School Health defines comprehensive school health education as a sequence of learning experiences that enable children and youth to become healthy, effective and productive citizens. A planned, sequential, PK-12 curriculum addresses the physical, mental, emotional, and social dimensions of health. The curriculum is designed to motivate and assist children and youth to maintain and improve their health, prevent disease, and reduce health-related risk behaviors, helping them to develop and demonstrate increasingly sophisticated health-related knowledge, attitudes, skills and practices (CSDE, CSH Guidelines, 2007).
Comprehensive school health education includes an array of topics such as (CDC, 2006):
- personal, family, community, consumer and environmental health;
- sexual health education;
- mental and emotional health;
- injury prevention and safety;
- prevention and control of disease; and
- alcohol, tobacco and other drugs.
Comprehensive school health education targets the six youth-health-risk behaviors identified by the CDC’s DASH, as well as protective factors and youth development initiatives. These behaviors, which are the leading causes of morbidity and mortality among youth, are tobacco use; alcohol and other drug use; intentional and unintentional injuries; lack of physical activity; unhealthy eating patterns and sexual behaviors that can lead to HIV infection; infection with other sexually transmitted diseases; and unwanted pregnancies (CDC, 2006). “These behaviors which are interrelated and preventable, are often established during childhood and adolescence and can extend into adulthood” (CSDE, CSH Guidelines , 2007).
Sexual health education is a component of comprehensive school health education programs and should be medically accurate and based on current research. It should be standards-based using national or state developed standards such as the National Health Education Standards, National Sexuality EducationStandards, and the CSDE’s Healthy and Balanced Living Curriculum Frameworkand should be offered as part of a planned, ongoing and systematic program taught by certified, highly qualified and effective teachers.
3. Well-Trained Teachers
Best practices in sexual health education focus on the importance of the role of teachers and ensuring that they are well trained. One of the most critical factors that influence the effectiveness of sexual health education programs is the comfort and skill level of the teacher. Teachers need to be well prepared to educate students about sexuality. This preparation includes a strong and comprehensive teacher pre-service program, coupled with ongoing professional development that increases knowledge, skills, and comfort level in the following areas:
- scientific and medically accurate information about human sexuality topics;
- comfort with the topic;
- cultural competence and the ability to communicate in an inclusive fashion;
- effective facilitation skills;
- creating a comfortable and safe learning environment for all students;
- using a variety of engaging teaching methods; and
- modeling universal and specific program values while not imposing their personal values related to sexuality issues (SIECUS, Guidelines, 2004).
In addition, Connecticut’s Common Core of Teaching: Foundational Skills and the Health Education content-specific standards articulates the knowledge, skills, and qualities that Connecticut teachers need in order to prepare students to meet the challenges of the 21st century.
Certification to teach health education at the primary or secondary level requires a PK-12 health education teaching certificate endorsement (043) or school nurse/teacher certificate endorsement (072). At the primary level (Grades K-6), an elementary teacher may deliver health education, but cannot be the sole provider per Section 10-145d-435(a) of the certification regulations. Elementary classroom teachers may provide a part of health education instruction, but a certified teacher in health education must also provide a portion including ongoing:
- direct instruction;
- collaboration with classroom teachers; and
- curriculum development.
At the middle and secondary level (Grades 7-12), teachers must be certified in health education or hold a school nurse/teacher certificate to teach health education.
Besides certified teachers, school health and mental health providers such as school nurses, school psychologists, school social workers and school counselors can serve as 1) in-school resource persons for health and safety education; 2) providers of counseling for at-risk students; and 3) professionals to assist classroom teachers in developing and implementing developmentally appropriate lessons (CSDE, CSH Guidelines, 2007, p. 31).
According to the 2010 Connecticut School Health Profiles, approximately 70 percent of middle and high school health teachers desire to receive professional development on a wide range of topics related to HIV, human sexuality, pregnancy prevention and STDs. While certification is a required prerequisite, it does not guarantee that teachers will have the specific knowledge, comfort, and skills necessary to educate students about a range of specific sexual health education topics. The CSDE recommends that health educators receive specific training in teaching sexual health education that provides opportunities for increased knowledge, comfort, and skills to deliver instruction to students at specific grade levels. This foundation of training consists of college courses, institutes, and ongoing professional development.
4. A Focus on All Youth
Schools must create healthy learning communities that are physically, emotionally, and intellectually safe and secure for all school community members (CSBE, 2010). To educate, engage and meet the needs of diverse students, local school districts must incorporate beliefs and implement practices that foster understanding and respect for diverse cultures. According to Messina (1994), in providing all youth with relevant sexual health education, school districts must focus on many different dimensions of diversity: 1) racial and ethnic; 2) socioeconomic; 3) sexual orientation and gender identity; and 4) special education needs. These dimensions affect students’ attitudes, beliefs, and values about sexuality-related issues such as family relationships, gender roles, health practices, and sexual norms and behavior. To educate and engage diverse students in a competent manner, teachers must continually strive to be culturally competent. They must continually assess their own attitudes and potential biases, gain knowledge about their students’ experiences, beliefs, and perceptions, interact and communicate in a caring respectful manner, and use culturally and linguistically relevant curriculum materials (Messina, 1994).
Racial and Ethnic Diversity
According to Augustine (2004),
“youth-serving organizations are most successful when their programs and services are respectful of the cultural beliefs and practices of the youth they serve. A culturally competent program values diversity, conducts self-assessment, addresses issues that arise when different cultures interact, acquires and institutionalizes cultural knowledge, and adapts to the cultures of the individuals and communities served. This may mean providing an environment in which youth from diverse cultural and ethnic backgrounds feel comfortable discussing culturally derived health beliefs and sharing their cultural practices.”
Students’ race and ethnicity is an important component of their personhood. Race and ethnicity affects students’ language and communication style; health beliefs; family relationships; beliefs about sexuality; gender-role expectations; religious beliefs and practices; and many other aspects of their understanding of themselves as sexual people (Advocates for Youth, 2008).
Socioeconomic background also has a profound impact on young people’s health and sexuality. Socioeconomic inequities affect everything from students’ basic beliefs about health to significant differences in their access to relevant health information and health care. In fact, after determining the extent of the problem in urban, suburban, and rural areas of the state, the Connecticut Health Foundation selected eliminating racial and ethnic health disparities as one of its three program priorities (CT Health Foundation, 2005).
Sexual Orientation and Gender Identity
School sexual health educators must teach with full recognition that there are young people of every sexual orientation and gender identity in their classrooms. Education about relationships, decision-making, dating violence, HIV/STD prevention, pregnancy prevention and many other topics must be relevant to all students. Therefore, it is important for sexual health educators to create an atmosphere in the classroom that demands respect for all students, has zero tolerance for put downs or hate speech directed to any youth, and creates safe school environments for all youth to participate fully in program activities and be integrated with required school-climate improvement plans.
“Omitting the topic of sexual orientation, or teaching about it inaccurately or insensitively, is therefore likely to result in misinformation, in alienating the non-heterosexual population of a given class (Macgillivray, 2000), and in an incomplete sexuality education course (Hedgepeth and Helmich, 1996, p.18, as cited in Schroeder 2007). Teaching about sexual orientation — including heterosexuality as well as homosexuality and bisexuality — can only serve to benefit students of all orientations by debunking myths, by breaking gender-role stereotypes that are often behind homophobic beliefs, and by providing factual information alongside every other sexuality-related topic that is addressed in a sexuality education program (Macgillivray, 2000). Sexual orientation and gender identity and expression should be a component of sexual health education and be included in a developmentally appropriate fashion as specified in Section 3 of these CT Guidelines.
Sexual Orientation and Gender Identity Common Terminology and Definitions
- sexual orientation: Romantic and sexual attraction to people of one’s same and/or other genders. Current terms for sexual orientation include gay, lesbian, bisexual, heterosexual and others.
- bisexual: A term used to describe a person who attraction to other people is not necessarily determined by gender.
- heterosexual: A term used to describe people who are romantically and sexually attracted to people of a different gender from their own.
- homosexual: A term used to describe people who are romantically and sexually attracted to people of their own gender. Most often referred to as “gay” or “lesbian.”
- gender: The emotional, behavioral and cultural characteristics attached to a person’s assigned biological sex. Gender can be understood to have several components, including gender identity, gender expression and gender role.
- gender identity: People’s inner sense of their gender. Most people develop a gender identity that corresponds to their biological sex, but some do not.
- transgender: A gender identity in which a person’s inner sense of their gender does not correspond to their assigned biological sex.
(National Sexuality Education Standards, 2011)
Students with Disabilities or Other Special Needs
All children, including children with emotional/behavioral, physical, cognitive, communication, or learning disabilities, need accurate, developmentally appropriate information to learn about their developing sexuality (Wisconsin, 2005, p. 12). In Connecticut, the term special education refers to conditions including autism, visual and hearing impairments, physical and orthopedic disabilities, intellectual and specific learning disabilities, emotional disturbances, speech or language impairments, traumatic brain injuries, and many other health impairments (CSDE, Bureau of Special Education, 2007, p.1). This diverse group of students has very specific learning needs that must be considered when delivering any curriculum or program content, including sexual health education.
The American School Health Association (ASHA) has adopted a resolution that supports the implementation of sexual health education for students with disabilities or other special needs. This resolution, Quality Sexuality Education for Students with Disabilities or Other Special Needs, also highlights vital components that ensure sexual health education is effectively delivered to those with disabilities or other special needs (ASHA, 2009).
Additionally, according to Maurer (2007), providing quality, sexual health education has many benefits for all people, and is particularly beneficial for children and youth who have developmental disabilities. The positive effects go beyond basic understanding of sexuality topics themselves and are included in the table below.
Benefits of Sexual Health Education for Students
with Developmental Disabilities (Maurer 2007)
- Self Esteem and Empowerment—Physical development and the accompanying feelings provide the sense of being a part of a larger group that shares the same issues. The realization of this fact can be very empowering for youth who are constantly viewed as different. In fact, the tangible physical changes and feelings that children and youth observe and experience may be one of the few instances in which they feel truly equal to nondisabled classmates.
- 2. Skill Building—Sexuality education provides information and opportunity to practice skills that assist youth in recognizing and responding to social and sexual situations appropriately.
- 3. Improved Communication—Youth learn to communicate without guilt or embarrassment when sexuality education provides the foundation of anatomically accurate vocabulary. When equipped with the proper terminology, youth can also describe questions, symptoms, and concerns more accurately to caregivers or healthcare providers.
- 4. Setting the Stage—Accurate, age-appropriate (and developmentally appropriate) sexuality education sets the stage for future topics and discussions. A framework of basic information makes topics that are more advanced easier to understand.
- 5. Articulating Goals—Discussions about sexuality and social skills assist youth in envisioning their future. Young people may underestimate their capabilities without these discussions. Making concrete plans toward realistic goals is easier when youth have had many opportunities for these discussions.
- 6. Preventing Negative Outcomes—Sexuality education provides youth with information and skills to recognize and prevent sexual abuse. It also provides a framework to understand and avoid behaviors that are socially inappropriate or illegal.
5. Teaching Methods
Sexual health education should be delivered through a variety of engaging and active teaching methodologies, including, but not limited to, small group discussions, brainstorming, role-playing for skill practice, and use of drama and literature. Because there are many individual, family, and cultural attitudes and beliefs related to human sexuality, students benefit from opportunities to reflect on what they are learning individually in journals, in small and large group discussions, and with their parents or guardians through homework assignments. Students need opportunities to personalize what they are learning in class and consider how it applies to them in their own lives.
At the classroom level, teachers must:
- create a healthy and safe learning environment by involving students in establishing group norms, modeling and enforcing those norms, demonstrating comfort with the topic, showing care, concern and being nonjudgmental;
- address the needs of all students by being open and attuned to questions, providing opportunities for students to ask questions anonymously, answering questions factually, with medical accuracy and in a developmentally appropriate fashion, referring students to health or guidance services as appropriate, and following state law and district policies regarding disclosures of sexual abuse or intimate partner violence. Adolescent Health Care: Legal Rights of Teensprovides information on Connecticut and federal laws in areas such as mandated reporting, privacy rights, reproductive health care, medical conditions and treatments and privileged communications (Center for Children’s Advocacy);
- facilitate discussion by understanding and managing group dynamics, using inclusive language, listening carefully to students, asking thoughtful open-ended questions, encouraging the sharing of ideas and perspectives by all students, discussing the range of sexual values held in society, and encouraging students to communicate with their parents or guardians and effectively use a wide variety of active learning strategies; and
- accomplish the program goals and objectives through clearly articulated lessons that present medically and scientifically accurate information, provide opportunities for students to explain their attitudes and beliefs, promote positive health beliefs, build knowledge and healthy behaviors and model skills such as refusal and responsible decision making by providing opportunities for students to practice these skills and get feedback and assess what students are learning.
The CSDE’s Connecticut Accountability for Learning Initiative (CALI) has partnered with the Leadership and Learning Center to provide professional development in effective teaching strategies. These strategies, listed below, were developed by Marzano, et al., (2001), and are applicable to all content areas, including sexual health education. Effective Teaching Strategies include:
- identifying similarities and differences;
- summarizing and note taking;
- reinforcing effort and providing recognition;
- nonlinguistic representations;
- cooperative learning;
- setting objectives and providing feedback;
- generating and testing hypotheses; and
- cues, questions, and advance organizers.
An overview of the research supporting these strategies and practical applications for the classroom can be accessed at the CSDE CALI Information and Resources Web site.
Research shows that programs that focus on reducing sexual risk-taking behaviors and preventing HIV can be effective in delaying young people engaging in sexual intercourse (Kirby 2007). When choosing a program, school districts should ensure that the program selection is based on identified community needs and implemented with fidelity to achieve the desired outcome.
Fidelity is the extent to which a curriculum or program is delivered in accordance with the intended design.
Guidance on evidenced-based programs is offered through:
- The National Campaign to Prevent Teen and Unplanned Pregnancy: What Works 2010 Curriculum-Based Programs That Help Prevent Teen Pregnancy; and
- United States Department of Health and Human Services: Office of Adolescent Health.
“Evaluation is a valuable means for measuring program effectiveness and determining if newly developed and existing sexuality education programs are accomplishing their goals and objectives” (Fetro, 1994, p.15).
Evaluation of any program includes three types of activities: 1) identifying what needs to happen (formative evaluation); 2) examining whether and how well educational activities are being carried out (process evaluation); and 3) demonstrating effectiveness (summative or outcome evaluation) (CSDE, CSH Guidelines, 2007, p. 19).
As a component of comprehensive school health education, Fetro (1994) states that sexual health education should be evaluated systematically to determine:
- how to design and/or revise the program to meet the needs of students and the community;
- how much sexual health education is actually being taught (i.e., how much time is allocated during each grade level);
- whether the program is being implemented effectively and as planned; and
- how effectively the proscribed learning objectives are being accomplished (i.e., outcomes).
The Connecticut Guidelines for a Coordinated Approach to School Health (2007, p. 39) lists evaluation strategies, which have been refined and adapted for evaluation of sexual health education programs:
- Assess educational needs by: 1) collecting baseline information about students (e.g., knowledge, behaviors and attitudes); 2) determining student interests and concerns; and 3) determining school and community needs (Fetro, 1994).
- Schedule ongoing, systematic curriculum review process, preferably every three to five years, to update medical and scientific accuracy and program effectiveness.
- Determine whether new curriculum goals have emerged; for example, the role of the Internet and other technology and their impact on young people’s communication, relationships, and risk-taking behaviors.
- Conduct ongoing grade-level formative assessments.
- Ask questions such as:
- What are the program goals/objectives?
- What resources already exist to meet these goals/objectives – both within the school and community?
- What is required by the State Department of Education or local school board?
- What specific sexual health education curriculum has been chosen for the program? If an evidence-based curriculum was chosen, is it being implemented with fidelity?
- If curriculum materials are being developed or adopted, do they incorporate Kirby’s key characteristics of evidence-based curricula (2007), as appropriate?
- Monitor the program to determine implementation and program delivery.
- Analyze course enrollment (e.g., determine number of classes offered and number of students enrolled).
- Use surveys of students’ knowledge, attitudes, skills and behaviors, focus group interviews with students, teachers, parents, and administrators, classroom observations, and meetings to gather data on perceptions of program strengths, weaknesses and needs; preferences regarding classroom resources; and the relevance of topics or objectives.
- Assess teacher competency.
Ask the following questions:
- Is sexual health education consistently offered across the grade levels and the district? What are the gaps or overlaps? What topics are being covered in each grade level?
- Is there adequate time and are there adequate materials and supplies provided for the delivery of sexual health education?
- Are information and materials up-to-date, developmentally appropriate, and medically and scientifically accurate?
- What recommendations do health education teachers and classroom teachers have for improvement in curriculum, classroom instruction and student assessment?
- What recommendations do students have for program improvement?
- What is the comfort level of the health education teachers and classroom teachers delivering the curricula?
- Are the health education teachers and classroom teachers effective and highly qualified?
- Is sufficient professional development in sexual health education offered to teachers, administrators, and health and mental health professionals?
- In addition to professional development training, what support is provided for health education teachers and classroom teachers?
- How can implementation of sexual health education programs be improved?
- Conduct ongoing, developmentally appropriate grade-level summative (or outcome) assessments.
- Administer pre- and post-surveys to determine changes in students’ knowledge, attitudes, skills, and behavioral intentions.
- Conduct in-depth interviews with school staff and focus groups with students and teachers to identify their perceptions of the impact of the program.
- Examine multiple sources of data to inform curriculum content, skill focus and program delivery (e.g., Connecticut School Health Survey and other appropriate state and local health data).
Ask the following questions:
- Is the sexual health education program meeting its objectives?
- How effective is the program at each grade level?
- What are the specific effects or outcomes of the program?
- How do teachers and other school personnel think the program has affected students?
- How do students think the program has affected them?
For schools, evaluating behavior change (outcome evaluation) is the most challenging. According to the CSH Guidelines, “each district may have different outcome questions based on their specific priorities. These questions cannot be answered without baseline data such as the informational data obtained in a needs assessment. Conducting outcome evaluations can require special skills, primarily because it is difficult to determine whether improved outcomes can be attributed to the program or other factors in the community, such as a media campaign. A local health department or university may be able to assist districts in identifying and conducting appropriate outcome evaluations” (CSDE, CSH Guidelines , 2007, p. 19).
Many school districts rely on the biannual administration of the Centers for Disease Control and Prevention’s Youth
Risk Behavior Survey (YRBS) as one data source to assess progress in student health behaviors. The YRBS asks students
a number of questions about sexual behavior and allows state departments of education and local education agencies (typically
larger cities) to compare the status of adolescent health nationally. In Connecticut, the YRBS is called the Connecticut
School Health Survey, and is co-administered by the State Departments of Education and Public Health. Results from this
survey can be accessed at the
Connecticut Department of Public Health Web site.
The Connecticut School Health Survey is one source of data, and it is recommended that local districts examine multiple sources of data to determine health-risk behavioral trends in youth and adolescents that will inform their school health policies and programs (teen birth rates, STD rates, school dropout, access to reproductive health care).
In summary, the CSDE has outlined eight key policy recommendations to support implementation of comprehensive school health education. Similar policies that support the fundamental principles stated above should be established for a sexual health education program.
Adapted from the CSH Guidelines , 2007, these policy recommendations include:
- Certified teachers. Sexual health education should be taught by certified, highly qualified, effective teachers. Connecticut’s Common Core of Teaching: Foundational Skills and the Health Education content specific standards articulates the knowledge, skills and qualities that Connecticut teachers need in order to prepare students to meet the challenges of the 21st century.
Curriculum guidelines. The district should have guidelines for the development, review and adoption of curriculum.
Healthy and Balanced Living Curriculum Frameworkis a best practice document, based on the
National Health Education Standards and created to guide school districts’ development of school health
education, including sexual health education curriculum.
Standards-based program. Sexual health education should be offered as part of a planned, ongoing, systematic,
sequential, and standards-based school health education program. Standards represent an articulation of what a student
should know and be able to do (CSDE, 2006). The
Healthy & Balanced Living Curriculum Framework, the
Guidelines for the Sexual Health Education Component of Comprehensive Health Education, and the
National Sexuality Education Standards provide information-based and skills-based content standards and performance
indicators that promote behavior change and health literacy for students in prekindergarten–Grade 12.
- Sufficient time and resources. The district should allocate sufficient time and resources for effective instruction. Based on research and best practice, the CSDE highly recommends that at a minimum, students in prekindergarten–Grade 4 receive a minimum of 50 classroom hours in health education per academic year and students in Grades 5-12 receive a minimum of 80 hours in health education per academic year (CSDE, CSH Guidelines, 2007). Within those allotted times it is recommended that 12 or more class sessions be dedicated to sexual health education in order to achieve longer-term impacts (Kirby et al., 2006).
- Attention to diverse learning needs. Sexual health education should offer multidisciplinary, multicultural perspectives and provide learning opportunities for multiple learning styles, including instruction and classroom materials that address the needs of all children and youth.
- Ongoing professional development. The district should provide ongoing, timely professional development related to sexual health education for teachers, program administrators, and school health and mental health providers. School districts should assess and address teachers’ knowledge, skill and comfort level to ensure effective delivery of this instruction.
- Alignment of curriculum, instruction and assessment. Sexual health education curriculum, instruction and assessment should be aligned. The alignment of curriculum, instruction and assessment ensures that classroom implementation and student assessment are consistent and that student assessment strategies measure whether students have attained curriculum objectives.
- Program review. The health education program should be reviewed on a regular basis, at a minimum of every three to five years, to determine if content and materials need to be updated or revised. This includes reviewing educational materials that are used in the program.
- Program evaluation. The district should conduct regular evaluation of the health education program at a minimum of every three to five years. Sexual health education programs should be evaluated systematically to determine how much of the curriculum is being delivered and whether instruction is consistent with the planned curriculum.
(Adapted from CSDE, CSH Guidelines, 2007, p. 30)
- 2009 Guidelines for Identifying Children with Learning Disabilities Executive Summary. (June 2009). Connecticut State Department of Education.
- Adolescent Sexuality. Retrieved on March 31, 2010.
- Advocates for Youth and the Parinsky Group. (2004). Speaking out! Connecticut's parents and other adults want comprehensive sex education in schools .
- Advocates for Youth. Chapter One: Cultural Components. A Youth Leader's Guide to Building Cultural Competence. Advocates for Youth, 2008. Retrieved on March 29, 2010.
- American School Health Association (ASHA). (2009). Quality Sexuality Education for Students with Disabilities or Other Special Needs . Kent, OH. Retrieved on April 9, 2010.
- APA Module – LGBQ.
- Augustine, Jennifer. (2004) Creating Culturally Competent Programs. Transitions: Serving Youth of Color; Volume 15, No. 3, January 2004. By Jennifer Augustine, MPH, CHES, Program Manager, HIV/STI Prevention Programs, Advocates for Youth. Retrieved on April 9, 2010.
- Burrill, M. (2009). All God’s children: Teaching Children About Sexual Orientation and Gender Diversity. Fort Wayne, IN: LifeQuest, Inc.
- Center for Children’s Advocacy: Medical Legal Partnership Project. Adolescent Health Care: Legal Rights of Teens. (2008). Hartford, Connecticut. www.kidscounsel.org
- Centers for Disease Control and Prevention (CDC). Health Education Curriculum Analysis Tool (HECAT) . (2007). Atlanta, GA. Retrieved on April 16, 2010.
- Centers for Disease Control and Prevention (CDC) Characteristics of an Effective Health Education Curriculum. (2008). Retrieved on April 16, 2010.
- Chrisman, K. & Couchenour, D. (2002). Healthy Sexuality Development: A guide for Early Childhood Educators and Families.Washington, DC: National Association for the Education of Young Children.
- Compendium of HIV Prevention Interventions with Evidence of Effectiveness. CDC’s HIV/AIDS Prevention Research Synthesis Project. (November 1999). (Revised on August 31, 2001).
- Compendia of Science-Based Programs
- Connecticut Health Foundation. (2005). Pathways to equal health: Eliminating racial and ethnic health disparities in Connecticut. Recommendations of the Connecticut health foundation’s policy panel on racial and ethnic disparities . Retrieved on March 13, 2009.
- Connecticut School Health Survey (2007). Retrieved on March 13, 2009.
- Connecticut State Board of Education Position Statement on a Coordinated Approach to School Health. (September 2, 2009).
- Connecticut State Department of Education: Special Education Resources Web site.
- Connecticut State Department of Education, Bureau of Health/Nutrition, Family Services, and Adult Education. (2007). Guidelines for a coordinated approach to school health: Addressing the physical, social, and emotional health needs of the school community . Retrieved on March 13, 2009.
- Connecticut State Department of Education. CALI - Information and Resources . Retrieved on March 13, 2009.
- Connecticut State Department of Education, Bureau of Special Education. (2007). A Parent’s Guide to Special Education in Connecticut . Retrieved on March 13, 2009.
- Connecticut State Department of Education, Division of Teaching and Learning Programs and Services. (2006). Healthy and Balanced Living Curriculum Framework: Comprehensive School Health Education, Comprehensive Physical Education . Retrieved on March 13, 2009.
- Crooks, R. & Baur, K. (2008). Our Sexuality, Tenth edition, Belmont, CA: Thomson Learning Inc.
- Dailard, C. (2001). Sex education: Politicians, Parents, Teachers and Teens, Guttmacher Report on Public Policy, Volume 4, No. 1, February 2001. Retrieved on June 10, 2010.
- Darroch JE et al. (2000). Changing emphases in sexuality education in U.S. public secondary schools, 1988–1999, Family Planning Perspectives, 32(5):204–211 & 265.
- Emerging Answers 2007
- Fetro, J.V., (1994). Evaluating sexuality education programs. In J.C. Drolet & K. Clark (Eds.), The sexuality education challenge: Promoting healthy sexuality in young people. (pp. 555-581). Santa Cruz, CA: ETR Associates.
- Future of Sex Education Initiative. National Sexuality Education Standards: Core Content and Skills, K-12. Future of Sex Education Initiative, 2011.
- GLSEN. (2008). The 2007 national school climate survey: The experiences of lesbian, gay, bisexual, and transgender youth in our nation’s schools . New York: Gay, Lesbian and Straight Network.
- Goode T, Jones W, Mason J. (2002). A Guide to Planning and Implementing Cultural Competence: Organizational Self-Assessment. Washington, DC: National Center for Cultural Competence, Georgetown University, Child Development Center.
- Hedgepeth, E. & Helmich, J. (1996). Teaching About Sexuality and HIV: Principles and Methods for Effective Education.New York: New York University Press.
- Kaiser Family Foundation. (2002). Sex Education in the US: Policy and Politics . Retrieved on June 10, 2010.
- Kelly, G.E. (2003). Sexuality Today: The Human Perspective Updated Seventh Edition.New York: McGraw Hill Higher Education.
- Kirby D. (2007). Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases . Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved on March 13, 2009.
- Kirby, D., Laris, B.A, & Rolleri, L. (2006). Sex and HIV Education Programs for Youth: Their impact and Important Characteristics. Santa Cruz, CA: ETR Associates. Retrieved on September 8, 2010
- Kirby, D., Rolleri, L. &Wilson, MM. (2007). Tool to Assess the Characteristics of Effective Sex and STD/HIV Education Programs . Washington, DC: Healthy Teen Network.
- Klopp, R. & S. Miguel. (2003). Teens Campaign for Better Sex Education. SIECUS Report, 31(4), pp. 34-35.
- Marzano, R. (2007). The Art and Science of Teaching. Alexandria, VA: Association for Supervision and Curriculum Development.
- Marzano, R. Pickering, D. & Pollock, J. (2001). Classroom instruction that works: Research based strategies for increasing student achievement.Alexandria, VA: Association for Supervision and Curriculum Development.
- Maurer, L. (2007). Teaching Sexuality to Developmentally Disabled Youth. What Do I Say? How Do I Say It? ETR Associates, 2007-2009. Retrieved on March 29, 2010.
- Messina, S. (1994). A youth leader’s guide to building cultural competence. Report. Washington, DC: Advocates for Youth. Retrieved on March 13, 2009.
- Michigan LGBQ resource: Safe Schools.
- Neutens, J.J., Drolet, J.C., Dushaw, M., Jubb, W., eds. Sexuality Education Within Comprehensive School Health Education. 2nd ed. Kent, OH: American School Health Association. (2003). (Greenberg, J.S. Controversy Regarding Sexuality Education).
- NPR/Kaiser Family Foundation/Kennedy School of Government. (2004). Sex Education in America .Retrieved on March 13, 2009.
- Oswalt, A. (2009). Child and Adolescent Development Overview: An Overview of Child Development Theories . Retrieved on March 17, 2009, from Austin Travis County Mental Health Mental Retardation Center Web site.
- Parello et al. (2000). The Roadmap: A Teen guide to Changing Your School’s Sex Ed.Piscataway, NJ: Network for Family Life Education (Answer at Rutgers University). Retrieved in March 2009.
- Pierno, K. (2007). Theories and approaches: Adolescent development. Retrieved on March 17, 2009, from http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.TheoriesDetail&PageID=373.
- Schroeder, Elizabeth, MSW, Ed.D., Addressing Sexual Orientation in New Jersey High Schools: An Exploratory Study. (2007).
- Science Based Approaches and Research
- Sexuality Information and Education Council of the US (SIECUS). Adolescent Sexuality . Retrieved April 12, 2010.
- Sexuality Information and Education Council of the US (SIECUS). (2007). State Profiles: A portrait of Sexuality Education and Abstinence-only-until-marriage Programs in the States (Fiscal Year 2007 Edition) New York: SIECUS. Retrieved on March 16, 2009.
- Sexuality Information and Education Council of the US (SIECUS). (2004). Guidelines for Comprehensive Sexuality Education: Kindergarten - 12th Grade, Third Edition. Retrieved on March 16, 2009.
- Sexuality Information and Education Council of the US (SIECUS). (2004). On the Right Track. Retrieved on March 16, 2009.
- Sexuality Information and Education Council of the US (SIECUS). Sexuality Education Q & A . Retrieved on March 2, 2009.
- Society of Obstetricians and Gynecologists of Canada. (2006). Sexuality and Child Development . Retrieved on March 17, 2009.
- Sorace, D. & Goldfarb, E. (n.d.) A Community Response to Improving Sex Education. (An internal report). NJ: Answer at Rutgers University.
- Sowers, J. G. (1994) Guidelines for Dealing with Resistance to Comprehensive Health Education. Sowers Associates, Hampton, NH.
- State Advisory Council on Special Education.
- The National Campaign to Prevent Teen and Unplanned Pregnancy: What Works 2010 Curriculum-Based Programs That Help Prevent Teen Pregnancy.Retrieved on April 16, 2009.
- The National Campaign to Prevent Teen and Unplanned Pregnancy. (n.d.). Why It Matters: Teen Pregnancy and Education. Retrieved on March 15, 2009.
- Trenholm, C., Devaney, B., Fortson, K., Quay, L., Wheeler, J., & Clark, M. (2007). Impacts of Four Title V, Section 510 Abstinence Education Programs: Final Report. Washington, DC: Mathematica Policy Research, Inc.
- Wisconsin Department of Public Instruction, Human Growth and Development: A Resource Packet (4th Edition). (2005).
- Yarber, W.L., (1994). Past, present and future perspectives on sexuality education. In J.C. Drolet & K. Clark (Eds.), The Sexuality Education Challenge: Promoting Healthy Sexuality in Young People. (pp. 3-28). Santa Cruz, CA: ETR Associates.