1. Exemplary Sexual Health Education in Highline
June 11, 2015
Nichole Calkins, Highline School District
Kari Kesler, Public Health – Seattle & King County

2. Agenda On Your Table of Contents: Teacher Preparation & Information
Safe & Supportive Environments
Lessons
Laws & Policies
Resources
What is ESHE & Teacher Preparation
Key Concepts
Safe & Supportive Environments
Lesson Planning & Content Delivery
Lesson Sneak Peeks
Answering Student Questions
Online Lesson Selection Tool

3. Today’s Objectives
Develop an understanding of how to deliver a comprehensive sexual health education unit that is aligned to standards and is medically and scientifically accurate
Increase your understanding of how to create a safe and supportive environment for all students
Increase your comfort and confidence in teaching gender identity and sexual orientation concepts
Develop an understanding of laws pertaining to minors and sexual health education
Increase your comfort and confidence in answering difficult and/or value-laden questions in the classroom

4. THE GOAL OF SEX EDUCATION:
The goal of sex education is safe and healthy people. These are
individuals who:
Express love and intimacy in appropriate ways.
Avoid exploitative or manipulative relationships.
Recognize their own values and show respect for people with different values.
Take responsibility for and understand the consequences of their own behavior.
Communicate effectively with family, friends and partners.
Talk with a partner about sexual activity before it occurs, including sexual limits (their own and their partner’s), contraceptive and condom use, and meaning in the relationship.

5. Exemplary Sexual Health Education (ESHE):
A systematic, evidence-informed approach to sexual health education that includes the use of grade-specific, evidence-based interventions, but also emphasizes sequential learning across elementary, middle, and high school grade levels. ESHE provides adolescents the essential knowledge and critical skills needed to avoid HIV, other STD, and unintended pregnancy. ESHE is delivered by well-qualified and trained teachers, uses strategies that are relevant and engaging, and consists of elements that are medically accurate, developmentally and culturally appropriate, and consistent with the scientific research on effective sexual health education.

6. Sexual Health Education Outcomes
Independent reviews of the scientific evidence show that well-designed and well-implemented HIV/STD prevention programs are effective in decreasing sexual risk behaviors among youth. Specific outcomes include:
• Delaying first sexual intercourse
• Reducing the number of sex partners
• Decreasing the number of times students have unprotected sex
• Increasing condom use

7. Healthy Youth Survey Data
Sexual behavior questions:
o How old were you when you had sexual intercourse for the first time? (I have never had sexual intercourse; 11 years or younger; 12, 13, 14, 15, 16, 17 years old or older).
o With how many people have you ever had sexual intercourse? (I have never had sexual intercourse; 1 person; 2 people, 3 people, 4 people, 5 people; 6 or more people)
o The last time you had sexual intercourse, did you or your partner use a condom? (I have never had sexual intercourse, No, Yes)

8. Sexual Health Education Outcomes
High quality, comprehensive sexual health education can reduce the likelihood that teens are involved in a pregnancy or acquire an STD or HIV.
It may also be able to reduce sexual violence
These outcomes are achieved by focusing on beliefs, attitudes, and skills at all ages. KK
Outcomes and Key Concepts
Let’s talk briefly about what we’re trying to achieve overall in sexual health education.
We know with confidence that comprehensive sexual health education can reduce the likelihood that teens are involved in a pregnancy or acquire an STD or HIV.
These outcomes are achieved by focusing on specific sexual beliefs, attitudes and skills that research tells us (1) have the most impact, and (2) are the most amenable to change.
If someone asks about middle school:
Very few students are already sexually active in middle school. Some of the information and skills we’re teaching them they aren’t going to immediately put to use. But that’s exactly what we want.
It gives us an opportunity to help these students form attitudes and beliefs , and acquire skills before the stakes are high. It increases the likelihood that they’ll be able to use those skills later, when they really need them.

9. Key Concepts
Key concepts are the main ideas you’re trying to convey in the lesson.
Returning to your key concepts helps you stay focused and achieve the goals of the lesson. KK
In sexual health education, we are trying to achieve learning that is deep and long-lasting.
Of course, sexual health education is by no means the first field to think about how to achieve more lasting learning. There is a sea of academic literature on this topic, and much of it advocates for teaching bigger ideas.
We’re calling these bigger ideas “key concepts.”
By keeping them in the forefront, we stay connected to the skills, behaviors and attitudes that we’re after, and of course, we have a much better chance of achieving the goals of the lesson and the curriculum.
This focus on key concepts is a pedagogical shift that has taken place within sexuality education.
In the past, there has been a tendency to focus on the many medical facts in sexual health, about HIV or STDs, for example. The risk is that we lose track of the larger goals of the lesson – the very reasons we do sexual health education in the first place.
Of course, this happens at some point with all of us, for very good reasons. It may be that this was how we were taught to teach sexuality, or it’s in the lesson plans we’re using. It may be that we worry that students aren’t going to get the information anywhere else so I need to cram it all in right now. Its certainly understandable how we can lose track of our guideposts.
Today, we’ll be using key concepts as a way to stay focused on the bigger pictures in our lessons, and on the broad goals of sexual health education.

10. Key Concept Guide
Key concepts are derived from research on the behavioral goals of sexual health education
Focus on beliefs, attitudes and skills related to sexual behavior.
Less emphasis on knowledge alone.
Based on age, level of development KK
FLASH has a key concept guide to assist you in implementing the curriculum, so you know exactly what key concepts to focus on.
These key concepts align with the student behaviors and attitudes that I spoke about earlier. Again, they are the ones with the greatest impact and that have the greatest amenability to change.
The key concept guide is set up by topic and be age level.
At some of the younger grade levels, you’ll see key concepts for subjects we don’t teach that young, like birth control, for example. The reason is to guide teachers in age-appropriate responses when students bring up these questions on their own. They work as stepping stones for later key concepts.
If anyone asks about alignment: We’ve aligned the HS lessons (not the key concepts) with the national and state health standards. The curriculum also complies with the Healthy Youth Act, the AIDS Omnibus Act, and WA State Guidelines for Sexual Health Information.

11. Instructional Approach
Focus on key concepts
Teach fewer sexual health facts
Use key concepts to frame sexual health information KK
End by 8:35
Here is the instructional approach we’ll be using…
Focus the lesson on our key concepts.
Share a reasonably small number of carefully selected sexual health facts,
And frame them with key concepts.
(Repeat, with emphasis on sharing less facts.)
We know that students will walk away remembering only a few things from the lesson. We don’t want it to be random. We want them to be tied to the key concepts that can really impact their learning.
Teachers tell us that this is extremely helpful to them. It doesn’t just provide guideposts to their lesson, but helps them tie in all the seemingly random stuff that their students bring up too. It also frees you from having to become sexual health experts, which is not what your students need from you.

12. Key Concept Exercise Share your concept with others
Check off the concepts you hear
Check off at least 5 that you hear from others

13. Safe & Supportive Environments and ESHE
The CDC recognizes that in addition to sexual health education, climate and safety in schools impact HIV, STD and pregnancy prevention efforts.
Focus on:
Bullying and sexual harassment
School connectedness
Parent/caregiver engagement
Special focus on Youth at Disproportionate Risk (YDR)

14. Safe & Supportive Environments: Climate Setting
Purpose of Climate Setting
Qualities of effective climate setting
Ways to set climate
Developing a safe, respectful and engaging learning environment
Create space for students who may be invisible
Get buy in
Welcome all students
Introduce positive attitudes

15. Safe & Supportive Environments
The Power of Your Words
“Language may be a teacher's most powerful tool. Every day the words, phrases, tone, and pace you use have the power to help students develop self-control, build their sense of belonging, and gain skills ...”
We may not even be aware of the fact that our words are creating a climate where our students don’t trust us—or that they feel isolated, defeated, or “weird.”

16. Safe & Supportive Environments
Youth at disproportionate risk for poor sexual health outcomes:
LGBT Youth
Youth in foster care
Homeless youth
Teen parents
Survivors of sexual trauma
Other Adverse Childhood Experiences (ACEs)

17. Safe & Supportive Environments
Best practices for serving Youth at Disproportionate Risk:
Inclusive of sexual and gender diversity
Neutral stance on value-laden topics
Avoid scare tactics, shame and judgement
Acknowledge prevalence of trauma
Healthy relationship skill development

18. Delivering Lessons Sexual Orientation and Gender Identity
Vocabulary and concepts
Watch video
Answer advice column

19. Delivering Lessons: Minor’s access to care
Youth of any age can consent for their own care for:
Birth Control
Abortion
Prenatal care
Emergency medical services
STD services at Public Health (14 and older with other providers)
Youth age 13 and over can consent for their own outpatient mental health care and substance abuse treatment

20. Lesson Practice Each Teacher will be assigned one lesson to review
You will then present the first 6 minutes of that lesson to other members of your group
Teach your group as if they were your students

22. Lesson Sneak Peek!

23. Answering Student Questions
Generating student questions
Values Question Protocol
Other student questions

24. Agenda Strategies for generating student questions
Strategies for answering different types of questions
Question exercise KK
11:45 – 11:50 (5 mins)
We’re going to spend the afternoon together today working on the skill of answering value laden student questions . Tomorrow we will discuss answering other types of student question. One reason we’re spending so much time on this is that student questions are the cornerstone of sexual health education and give you an opportunity to build trust in your classroom, and to build your own credibility as a trusted and reliable source of accurate information – amidst a sea of myths and confusion.
Please raise your hand if you’ve ever felt anxiety from a student question?
Raise your hand if you’ve ever wanted to avoid calling on a specific student because you knew what question was coming?
And finally, raise your hand if you’ve ever thrown away (or wanted to throw away) a student anonymous question cause you were not comfortable reading it or answering it in front of the class?
Exactly! The other reason that we’re spending so much time on answering student questions is that teachers tell us over and over that this is the part of teaching that the unpredictability of student questions can make them eel a little anxious about teaching sex ed. We’re all able to follow a lesson plan, but who knows what our students – or particular students -- will bring up and ask!
And as anxious as some of us may feel at times, our students feel it tenfold. They are taking a huge risk by asking questions. Surveys tell us that their questions about sexuality are extremely important to them, and they desperately want trusted adults that they can ask.
Fortunately, there are many effective strategies to responding to students’ questions. Past participants have told us that this part of the training has helped them move forward in answering student questions, whether you are new to this subject area, or you want to refine and advance your skills.
HAND OUT anon Q overview

25. Anonymous Questions Why do them? How to set it up
Explain what you’re doing
Pass out slips of paper, same size and color
No names
Post big list of possible topics
Post sentence stems (e.g. “Is it true that…”)
Everyone writes
KK end by 12
Most questions are asked out loud during class, and that’s great. But many educators also give students an opportunity to ask anonymous questions. Whether or not you’ve done this in your own classroom, why do you think it might be valuable?
Confidential, less embarrassing
Best possible assessment of what students need to know
Gives teacher time to think about their answers ahead of time!
Let’s talk through how to set this up. Has anyone used this strategy before?
Pass out handout and talk through it.
In just a minute, we’ll work with some real anonymous questions!

26. Questions about Value-laden Topics
Student questions may be about values
Student questions may be about topics which people hold strong values about AG
12 – 12:20 (20 mins)
We are going to talk now about students questions. We’re going to start with the ones that can sometimes be the most unnerving for teachers – questions that are about value-laden topics. These questions may be directly about values, or may be about topics which people have strong values about.
For instance, a student may ask directly about a value, such as “Why do people have sex when they are not married?” Or they may ask a question about a value-laden topic, such as “Can girls masturbate?”
The overall goal when answering these types of questions is to give an answer that is honest and helpful, and that is respectful of the broad range of values and beliefs held by your students and their families.
We have some strategies to help you do that. 26

27. The Role of Values Universal Values
Large majority of our society holds these values.
We are obligated to teach these values. AG
First of all, value questions might be about values that are universal, that is values are those that 95% or more of the community agrees on. We are obligated to teach these values.
What would be some examples of universal values? 27

28. Universal Values Forcing someone to have sex with you is wrong.
Knowingly spreading disease is wrong. 
Elementary school age children should not have sex. 
Sex between children and adults is wrong. 
Taking care of your reproductive health is important.  AG
Anyone have any questions, or disagree that these are universal values? 28

29. The Role of Values Non-Universal Values
There is no large consensus on these issues
Examples include… AG
Non-Universal values are everything else - those that 95% or more of the community does not agree on. There is not a consensus in the larger community about these issues. 29

30. Non-Universal Values on Many Topics
Sex outside of marriage 
Same-sex relationships
Birth control 
Masturbation
Cohabitation 
Abortion  
What age/under what circumstances it's ok to start having sex  AG
Great. 30

31. Non-Universal Values in the Classroom
It is not helpful or educational to express our own personal beliefs on non-universal issues at school
Families have the role of teaching values on non-universal issues, not schools.
Schools must teach about these topics in a way that respects family diversity. AG
It’s not helpful or educational to express our own beliefs about non-universal values, and we need to refrain from doing it. It is the role of the family to teach values about these issues.
However, we can, and should, answer our students questions about these topics, and teach about them. We do it with respect for the diversity of opinion within our communities.
For example, you can discuss tampons- what they are and how they’re used, the fact that many women and girls use them, etc., but it is not appropriate to share your opinion about whether or not tampons are a good choice. 
We have developed a protocol to help you answer your students questions about non-universal values. 31

32. Values Question Protocol
Has anyone here ever used this values question protocol before? Great! You can help out the others as they are learning it. Like I alluded to earlier, the VQP is a way to acknowledge and respect the full range of beliefs on an issue, while still answering any factual parts of the question. It’s respectful to students and their families., and it helps the teacher avoid accidentally sharing their own beliefs. Let’s go through it together.
Validate the student: 
"I am glad someone asked this one.“ "That's an interesting question.“ "People ask me this one every year.“ "This one really thoughtful, compassionate, imaginative, respectful.” This will encourage your students to keep asking questions.
Identify it as a belief or value question:  "Most of the questions you've been asking have been "fact questions" where I could look up an answer that all the experts agree upon. This one is a "value question" where every person, every family, every religion has a different belief.”
Answer the factual part, if there is one.
For example, "Can you get birth control without your boyfriend or husband's knowing?” is a factual question about a value-laden topic. Our answer should include, “Yes, in Washington State women can get birth control confidentially.” But the next steps of the protocol would be important to include.
Help the class describe the community's range of beliefs, not their own.
The idea is to make sure a complete a range of beliefs gets expressed, not just “some people believe it’s right” and “some wrong,” even if you have to supplement the few values yourself. It’s important to make sure that all of the beliefs gets expressed with equal respect. I want to clarify that we’re not asking students about their own beliefs, which they should be allowed to keep private. It’s also illegal to ask them in Washington State. But it is very appropriate to generalize: "Tell me some of the things you've heard that people believe about that.“
Refer to family, clergy and other trusted adults. 
"Because people have such different beliefs about this, I really want to encourage you to talk with your families, or with somebody at your community of worship, if you attend a church or mosque or synagogue or temple. Or talk with some other adult you trust and whose opinions matter to you.
Leave the door open. 
Validate the student for asking the question.
Identify the question as a belief or value question.
Answer the factual part of the question.
Describe the range of beliefs.
Refer the student to family, clergy, or other trusted adult.
Leave the door open to other questions. 32

33. Validate the student for asking the question. AG
End at 12:20
Let’s work on this one together… (Go through steps, eliciting suggestions.)
Validate: I’m glad you asked that question. Often when we hear about masturbation, it seems like they’re talking about boys. So it makes sense to wonder if girls can masturbate as well.
About values: This question is asking about a fact, whether girls can masturbate. But masturbation is also a topic that people have different beliefs about.
Factual part: Masturbation is when someone touches their own genitals for pleasure or comfort. Girls and women, as well as boys and men, can masturbate. There is no physical harm caused by masturbation. (Be sure terms are defined for students. Here, I’m assuming the word “genitals” was defined in a recent lesson .)
Give range: However, there area lot of different beliefs or values about masturbation.
If you’re going to put it back on the students. Don’t ask them what the personally believe, but ask what different beliefs are out there. Remember, you’re trying to get the full range of community beliefs.
Some people believe that masturbation is natural and healthy. Other people think it’s wrong and that people shouldn’t do it. Some people think it’s okay for boys but not girls. Some people think it’s only okay for young people. Some people think it’s okay if they’re not in a relationship; others think it’s fine in a relationship.
Refer to family: Because families have different values about masturbation, I encourage you to talk with an adult in your family that you trust about your family’s views on this.
Check and keep door open: I hope this answer was clear. Let me know if there’s still questions.
Validate the student for asking the question.
Identify the question as a belief or value question.
Answer the factual part of the question, if there is one.
Describe the range of beliefs.
Refer the student to family, clergy, or other trusted adult.
Leave the door open. 33

34. Additional Strategies for Answering Questions
Technique questions
Slang questions
Personal questions
Additional Strategies for Answering Questions KK
12:20 – 12:50 (30 mins)
We’ve just discussed the strategy we use when answering questions with value-laden topics.
Questions about value-laden topics are just one of the types of questions we encounter. There are some other broad categories that each have their own challenges and strategies, like questions about sexual techniques, questions that involve slang, and personal questions about the teacher, themselves or someone else.
Of course, questions don’t usually fall neatly into one category. But by discussing strategies for each of these different types of questions, it gives us a lot of useful tools to select from our toolkit.

35. Small Group Question Practice
Break into 3 small groups
Each group will receive a student question and a strategy sheet
In your small group, come up with an answer to the student’s question using some of the strategies on your sheet
In the large group, we’ll hear each groups answer and discuss the strategies you employed
Small Group Question Practice
KK end by 12:50
Technique: How do you French kiss?
Slang: Can a girl cum?
Personal: Were you married when you had sex the first time?
Give each small group their question and several tips for them to utilize in answering their question. Give 10 minutes. Debrief each answer in the large group, focusing on the strategies used.

36. Question Practice Move around the room while the music plays.
When the music stops, FREEZE!
Partner up with the person standing nearest you.
In each pair, pick a “teacher” and an “asker”.
“Teacher” answers the question on the screen.
We’ll discuss as a group.
Then switch roles, “asker” becomes the “teacher”.
AG set up
1:05 – 1:50 (40 mins)
Now we’re going to have a chance to practice answering more questions.
In the past, participants have sometimes been concerned about their eloquence. Everyone is probably much more eloquent in front of their class than their peers.
For today, concentrate on the words, not on smoothness of delivery.
Also, remember that we show our students respect by sticking with it and struggling to get the right words out. It shows we value them and their questions.
(Explain how exercise works.)

37. How big is an averge Dick
Question Practice
How big is an averge Dick
My Guess is ½ inch
What kind of question is this? Slang and factual.
How did you respond, if you knew the answer?
This question is asked every year! It’s about the average length of a penis. Dick is a slang word for penis. Penises have different lengths when they’re soft compared to when they’re erect (that’s when the spongy tissue is filled with blood, making it hard.)
I’ve read that the average length is 3 – 4 inches flaccid (that means, not erect), and 5 – 7 inches erect. But that’s just average. All different sizes are still normal.
There are many possible directions to take this depending on your class and your inclination. Any other possibilities…?
Male and female sexual response systems. (Where are most of the nerve endings in a woman’s vulva and vagina?)
Myths about penis length. Nothing a person can do to make it bigger.
Impact of steroid use on genitals.

38. Can you get pregnant if you have sex in a hot tub?

39. How would you know if someone else has an STD?

40. Is that new birth control (Mirya) Ive been seeing on tv
Question Practice
What type of question is this one? Factual.
What key concept could you reinforce in answering this question? BC is very safe and others.
How did you answer? (some possible points are below)
Check-in on validation. Examples?
Be sure answer is positive, accurate and reinforces key concept.
Is that new birth control (Mirya) Ive been seeing on tv
healthy for women

41. Question Practice
How do I know if I’m a lesbian?

42. Online Lesson Selection Tool
1. Select by “content area”
Increase family communication
Increase knowledge of reproductive and sexual health
Prevent pregnancy
Prevent sexual violence
Prevent STDs including HIV
2. Select number of class periods
3. Select Health Behavior Outcomes (HBOs)

43. Question Wrap-Up
Other possible student questions that you’d like to hear sample answers for…
End by 1:50
We wanted to leave some time to talk about any student questions you still might have questions or concerns about.
Are there any potential questions that you’d like to hear a sample answer for?
We’ll make a quick list of them, and the two of us will throw out some quick sample answers for you. People tend to find this helpful, and it will most likely reassure you that you could come up with these answers to.
(List on newsprint…)

44. Thank You!
Pregnancy is cited as the “leading factor” for over 50% of girls and over 1/3 of boys who drop out of school.
Strategies for working with Youth at Disproportionate Risk improve school retention beyond pregnancy prevention.
Exemplary Sexual Health Education is critically important