1. Texas Freedom Network Webinar January 27, 2011 Christine Markham, PhD and Melissa Peskin, PhD University of Texas Prevention Research Center Adopting and Implementing Evidence- Based Sexual Health Education Programs

2. WHAT WE KNOW…

3. Source: Shanklin, S.L., Brener, N., McManus, T., Kinchen, S., Kann, L. (2007). 2005 Middle School Youth Risk Behavior Survey. Atlanta, G.A.: Centers for Disease Control and Prevention. About 1 in 10 6th grade students have had sex Students begin having sex at early ages Sexual Behavior

4. Sexual Behavior by 12 th grade… 7 in 10 students have had sex Source: Centers for Disease Control and Prevention. (2007). YRBSS: Youth Online Comprehensive Results. Retrieved August 13,2008 from http://apps.nccd.cdc.gov/yrbss/

5. Outcomes – Teen Birth Source: Matthews, TJ, Sutton, PD, Hamilton, BE, Ventura, SJ. (2010). State Disparities in Teenage Birth Rates in the United States. NCHS Data Brief, (46). Available at: http://www.cdc.gov/nchs/data/databriefs/db46.pd Birth Rates by Selected States, Teens 15-19 years (per 1,000 teen girls)

6. Source: Martin, J.A., Hamilton, B.E., Sutton, P.D., Ventura, S.J., Matthews, T.J., Kirmeyer, S. & Osterman, M.J.K.. (2010). Births: Final data for 2007. National Vital Statistics Reports,58 (24)

7. Cycle of Teen Pregnancy

8. Never taught in school about AIDS or HIV Source: Centers for Disease Control and Prevention. (2009). YRBSS: Youth Online Comprehensive Results. Retrieved August 13,2008 from http://apps.nccd.cdc.gov/yrbss/

9. Four Steps #1) Know State Law & School District Policy #2) Work with your School Health Advisory Council (SHAC) to identify an Evidence-Based Program #3) Advocate effectively to your School Board for program adoption #4) Implement the program with fidelity

10. STEP 1: KNOW STATE LAW & DISTRICT POLICY

11. TX Education Code: Human Sexuality Instruction Abstinence from sexual activity as the preferred choice of behavior; abstinence the only method that is 100 percent effective Teach contraception and condom use in terms of human use reality rates A school district may not distribute condoms in connection with instruction relating to human sexuality. Before each school year, a school district shall provide written notice to parents and the right to review curriculum materials, remove the student if needed School districts shall make all curriculum materials available for reasonable public inspection Texas Education Code Chapter 28: http://www.statutes.legis.state.tx.us/Docs/ED/htm/ED.28.htm

12. District Policy Talk with school district officials to determine if policy exists – Schools may or may not have one – Some may use TX policy Can work with School Health Advisory Council (SHAC) to develop policy if one does not exist

13. STEP 2: WORK WITH YOUR SHAC TO IDENTIFY AN EVIDENCE-BASED PROGRAM

14. School Health Advisory Council (SHAC) Required by state law (§ TEC 28.004, S.B. No. 283) Ensures local values are reflected Representation – Parents: majority of members – School personnel – Community professionals – Students Makes recommendations to the school board on sexual health instruction

15. What is an Evidence-Based Program? An evidence-based program has been: Implemented with a group Rigorously evaluated Published in peer-reviewed journal Found to be effective in changing behavior

16. What Is Evidence? Surveillance data Systematic reviews of multiple intervention studies An intervention research study Program evaluation Word of mouth Personal experience Objective Subjective

17. Why the Fuss? More federal funders are requiring program planners to use evidence-based programs. – Funders look to support programs that have a maximum return on their dollars Using evidence-based programs is a more efficient use of limited resources.

18. Advantages to Evidence-Based Programs Effective in changing behavior in the study populations Cost effective Shorten the time it takes to develop a program Reduce the time it takes to research a community Help narrow the evaluation

19. Evidence-Based Program Barriers I don’t know what evidence-based programs are or where to find them. Using evidence-based programs limits my creativity. Evidence-based programs take too much time and/or money. Evidence-based programs are too scientific. My community is unique. An evidence-based program will not be as appropriate as if I developed the program myself.

20. Where Can I Find Evidence-Based Programs? National Campaign to Prevent Teen and Unplanned Pregnancy: http://www.thenationalcampaign.org/resources/effectiveprogra ms.aspx http://www.thenationalcampaign.org/resources/effectiveprogra ms.aspx Child Trends, Guide to Effective Programs for Children and Youth: http://www.childtrends.org/Lifecourse/programs_ages.htm http://www.childtrends.org/Lifecourse/programs_ages.htm National Registry of Evidence-Based Programs and Practices: http://www.nrepp.samhsa.gov/ http://www.nrepp.samhsa.gov/ Resource Center for Adolescent Pregnancy Prevention (ReCAPP): http://www.etr.org/recapp/index.cfm?fuseaction=pages.ebpho me http://www.etr.org/recapp/index.cfm?fuseaction=pages.ebpho me Diffusion of Effective Behavioral Interventions: http://www.effectiveinterventions.org/ http://www.effectiveinterventions.org/ The Program Archive on Sexuality Health, & Adolescence (PASHA): http://www.socio.com/pasha.phphttp://www.socio.com/pasha.php

21. National Campaign to Prevent Teen and Unplanned Pregnancy http://www.thenationalcampaign.org/resources/pdf/pubs/WhatWorks.pdf http://www.thenationalcampaign.org/resources/pdf/pubs/WhatWorks.pdf

23. Criteria for Selecting An Evidence-Based Program  Is the program appropriate for the age & sexual experience of your audience?  Was the program conducted with people who had similar: Priorities Race/ethnicity Community structure and values  What time and resources do you have for a program?

24. Characteristics of Effective Sex Education & HIV Prevention Programs Based on theoretical approaches Deliver and reinforce clear message(s) Provide accurate information on sexual risk, ways to avoid sex, using protection Include activities that address social pressures Provide examples & practice of communication/refusal skills Interactive teaching methods, personalize information Behavioral goals & teaching methods appropriate for age, sexual experience, culture Last sufficient length of time Select teachers/peer leaders who believe in program, give adequate training Source: Kriby, D. 2001. Emerging Answers. National Campaign for Teen Pregnancy Prevention

25. Program Example www.itsyourgame.org (Code: C21) www.itsyourgame.org

26. IYG Outcomes Delays sexual initiation Reduces risk for sexually experienced youth (e.g., reduces frequency of sex, increases condom use)

27. Scope & Sequence LessonLesson TopicDelivery 1Pre-Game ShowClassroom 2 & 3Healthy FriendshipsClassroom Computer 4 & 5Setting Personal Limits & Detecting Risky Situations (general) Classroom Computer 6 & 7Refusal Skills (general)Classroom 8Know your BodyComputer 9Setting Personal Limits (related to sex) Classroom 10 & 11Refusal Skills (related to sex) Classroom Computer 12Post Game ShowClassroom LessonLesson TopicDelivery 1Pre-Game ShowClassroom 2Consequences of PregnancyClassroom 3 & 4Consequences of STI/HIV Pregnancy Computer Classroom 5Risk Reduction StrategiesComputer 6 & 7Setting Personal Limits & Detecting Risky Situations (related to sex) Classroom Computer 8 & 9Healthy RelationshipsComputer 10Refusal Skills (related to sex)Classroom 11Computer Free TimeComputer 12Post Game ShowClassroom Level 1Level 2

28. Types of Activities Information transfer Skills / practice Peer modelingReal-life serial - modeling Skills / practice Information transfer

29. STEP 3: ADVOCATE EFFECTIVELY TO YOUR SCHOOL BOARD FOR PROGRAM ADOPTION

30. Framing the Issue It is NOT about adolescent sexual health It IS about: – Academic achievement – Drop-out prevention – Cost savings

31. Advocacy Tools that Changed Perspectives In 2010, 13 school districts in Harris County, TX, adopted an evidence-based program – PowerPoint Presentation – Teen Birth Rate Maps – Fact Sheets

32. PowerPoint Presentation Purpose Start the dialogue of prevention within the community Increase awareness about the problem Present data in clear and simple terms Personalize the problem Present solutions Be a tool that community members could use

33. We Can Do More Meeting the Challenges of Adolescent Sexual Health in Texas

34. 7 th Grade Sexual Behavior – Results from Two Independent Studies Number of Students: 2004: N = 1,302 2006: N = 1,742

35. Students engage in different types of sex Source: Markham, C.M., Peskin, M.F., Addy, R.C., Baumler, E.R., Tortolero, S. Patterns of vaginal, oral, and anal sexual intercourse in an urban seventh grade population. Journal of School Health. 79:193-200, 2009. Sexual Behavior among 7 th Grade Students 2004 2006 15.9% Any 15.9% Any 13.0% Vaginal 13.0% Vaginal 8.7% Oral 8.7% Oral 6.8% Anal 6.8% Anal

36. In the U.S. at least 1 in 4 teenage girls has a sexually transmitted infection Outcomes -Sexually Transmitted Infections

37. Outcomes – Teen Births Nationally, 68% of teen mothers do not graduate high school

38. Cost of Teen Childbearing in Texas Outcomes – Teen Births National Campaign to Prevent Teen and Unplanned Pregnancy Source: Hoffman SD. By the Numbers: The Public Costs of Teen Childbearing. Washington, D.C.: National Campaign to Prevent Teen and Unplanned Pregnancy; 2006

39. Birth rate change per 1000 teens for Texas and California Ca. Source: Spitz, AM, Ventura, SJ, Koonin, et al. (1993). Surveillance for Pregnancy and Birth Rates Among Teenagers, by State – United States, 1980 and 1990. MMWR Surveillance Summaries, 42(SS-6):1-27.; Matthews, TJ, Sutton, PD, Hamilton, BE, Ventura, SJ. (2010). State Disparities in Teenage Birth Rates in the United States. NCHS Data Brief, (46). Available at: http://www.cdc.gov/nchs/data/databriefs/db46.pd

40. Teen Birth Rate Maps Purpose Increase awareness of teen pregnancy in the community Illustrate the magnitude of the problem Personalize the problem Be a tool that community members could use

44. Factsheets Purpose A resource that could easily be distributed Present data in clear and simple terms Personalize the problem Provide solutions to the problem

47. www.sph.uth.tmc.edu/tprc

50. STEP 4: IMPLEMENT THE PROGRAM WITH FIDELITY

51. What is Fidelity? Implementing a program exactly as it was developed – Teaching ALL lessons in specified sequence – Do NOT omit any activities – Do NOT add any new activities

52. Implementation: Keys to Success Select and train appropriate teachers Plan early with teachers and administration – Scheduling – Space needs – Notifying parents about the program Keep staff informed of progress (administration, teachers, nurses and counselors)

53. Characteristics of Effective Teachers Relates well with young people Is willing and enthusiastic about teaching the subject Is open-minded and non-judgmental with respect to values, attitudes, beliefs and behaviors which may differ from his/her own Has adequate and current knowledge of the factual material included in the program RECEIVES ADEQUATE TRAINING AND ONGOING SUPPORT!!

54. LESSONS LEARNED

55. Lessons Learned Change takes time It requires commitment and planning It requires a program champion It is achievable

56. Any Questions? For more information please contact: Melissa Peskin melissa.f.peskin@uth.tmc.edu Christine Markham christine.markham@uth.tmc.edu