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Effective Sexual Education To Patients

Effective Sexual Education To Patients

“A lifelong process of acquiring information and forming attitudes, beliefs, and values about such important topics as identity, relationships, and intimacy” is what sexual health education is (SIECUS, Guidelines, 2004, p.13). Programs for sexual health education begin in prekindergarten and continue through Grade 12. These programs provide age- and developmentally-appropriate, medically accurate information on a wide range of sexuality-related topics, such as abstinence, contraception, and disease prevention. SIECUS says that “sexual development, reproductive health, interpersonal relationships, emotions, intimacy, body image, and gender role topics” are all included. “From the cognitive domain (information); the affective domain (feelings, values, and attitudes); and the behavioral domain (communication, decision-making, and other relevant personal skills), sexual health education addresses the biological, socio-cultural, psychological, and spiritual dimensions of sexuality.” (SIECUS, On the Right Track, p. 4; 2004). The overall goal of sexual health education is to equip young people with the knowledge and skills they need to promote their health and well-being as they grow into sexually healthy adults (SIECUS, Guidelines, 2004).
Sexual health education has four main goals, according to the SIECUS Guidelines for Comprehensive Sexuality Education (2004):

To provide accurate information about human sexuality; to provide an opportunity for young people to develop and understand their sexual values, attitudes, and insights; to assist young people in developing relationships and interpersonal skills; and to help young people in exercising responsibility for sexual relationships, including addressing abstinence, pressures to become prematurely involved in sexual intercourse, and the use of contraception and other sexual health measures.
Effective Program Characteristics
The Centers for Disease Control and Prevention (CDC)/Division of Adolescent and School Health (DASH) identified effective, comprehensive health education characteristics that apply to sexual health education. These factors, when considered together, influence the effectiveness of school policy, practice, and programs. These qualities are listed below.

Characteristics of an Effective Health Education Curriculum (CDC, 2008): focus 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 irrationality; addresses social pressures and irrationality; addresses social forces and ir
Furthermore, Kirby identifies 17 characteristics of the effective human immunodeficiency virus (HIV) and teen pregnancy prevention programs at the middle and high school levels that can increase the likelihood of changing student behavior (Kirby et al., 2006).

These three categories are as follows:

Curriculum development involves involving a wide range of experts, administering a needs assessment to a target group, designing according to community values and resources, employing a logic model approach, and implementing a pilot-testing phase.
Curricular content is based on solid theory, focuses on specific behavioral goals of preventing HIV/STDs/pregnancy, sends clear messages about responsible behavior, addresses psychosocial risk and protective factors, creates a safe learning environment, and engages students through instructional sound, culturally relevant, and developmentally appropriate learning activities.
Curriculum implementation—administrative support for programs, professional development and ongoing support for teachers, youth recruitment, and curricula implementation with reasonable fidelity.
Kirby discovered that schools that implemented 12 or more sessions sequentially over multiple years tended to have longer-term impacts. These programs exposed youth to the curriculum over time and could reinforce key knowledge, attitudes, and skills year after year (Kirby et al., 2006, pp. 43-44).
Effective Sexual Education To Patients
Kirby’s 17 characteristics, combined with the CDC/DASH key elements listed above, provide important keys to developing a strong, well-designed program that is more likely to produce the desired results or outcomes. These characteristics are regarded as best practices for developing teen pregnancy, HIV, and STD prevention programs.

Furthermore, the Centers for Disease Control and Prevention’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 tools for analyzing and scoring curricula that are intended to promote sexual health and prevent risk-related health problems, such as teen pregnancy, HIV infection, and other sexually transmitted diseases” (CDC, 2007, p. SH-1). This module also includes examples of concepts, skills, and learning experiences that can help prekindergarten through grade 12 adopt and maintain sexual health-promoting behaviors (CDC, 2007).

Appropriate for Development
Sexual health education must be designed and implemented in a developmentally appropriate manner, according to an inherent principle. Sexual health education, like any other important program, must be carefully planned, implemented, and evaluated to ensure program effectiveness and to reflect the needs of the local school community. The curriculum for each grade cluster (PK-K, 1-4, 5-8, 9-12) should reflect developmental issues of the relevant age group while also preparing children for the next stage of development.

Crooks and Baur (2008), Pierno (2007), Kelly (2003), and the Society of Obstetricians and Gynecologists of Canada (2006) found that children grow and develop in a variety of ways to become healthy and well-functioning adults, including:

Physically. Their bodies grow in height and weight, and they mature from that of a child to that of an adult capable of reproducing during puberty.
Young people’s ability to think, organize, solve problems, and predict consequences mature as their brains develop from birth to adolescence.
Emotional, social, and psychological.
They learn how to be in relationships with other people (family, friendships, work, and romantic); how to recognize, understand, and manage emotions; who they are and how to establish an identity; and how their self-concept evolves.
Children learn to distinguish right from wrong by responding to parental, peer, community, and societal norms, and they eventually develop their own set of moral values.
They discover and 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 gender, which they find themselves romantically and sexually attracted to, 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).
(See Appendix B: Developmentally Appropriate Approach to Sexual Health Education Example for an example of a developmentally appropriate approach to sexual health education.)

Two students are smiling while lying on the grass.

Angela Oswalt, a social worker, explains how developmental theorists like Eric Erikson, Jean Piaget, and Lawrence Kohlberg have aided our understanding of child and adolescent development. Erickson’s research looked into the importance of children’s psychological, mental, and social development; Piaget looked into cognitive development; and Kohlberg looked into moral development. These theories on various aspects of child development contribute to a more comprehensive understanding of what to expect from children at various stages (Oswalt, 2009).

A report outlining implementing a K-12 sexual health education program bolsters the case for beginning sexual health education at a young age. Sorace and Goldfarb (n.d.) discovered that elementary school programs could help children develop by:

Understand, appreciate, and care for their bodies; form and maintain healthy friendships and relationships; avoid unhealthy or exploitative experiences and relationships; recognize and deal with peer pressure; make responsible decisions; and comprehend how their behavior is related to their beliefs what is right and wrong.
These concepts can be built on in middle and high school in an age-appropriate sequence to provide young people with 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.

SIECUS sponsored the publication Guidelines for Comprehensive Sexuality Education: Kindergarten-12th Grade in 1991, representing the first national consensus on appropriate topics to teach in a sexual health education program at each developmental level (National Guidelines Task Force, 1992). The SIECUS Guidelines, revised in 2004, outline six key concept areas that represent the most general knowledge about human sexuality and family living:

Human development, relationships, personal skills, sexual behavior, sexual health, and society and culture are all topics covered.
These concept areas were further subdivided into 36 subtopics, each with its developmental message for one of four age groups or grade clusters. The SIECUS Guidelines are not a curriculum; rather, they are “a starting point for teachers 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 Component of HECAT (CDC, 2007) demonstrate best practices in sexual health education. When developing sexual health education curriculum for Connecticut students, the Healthy & Balanced Living Curriculum Framework, in conjunction with these CT Guidelines, provides comprehensive, developmentally appropriate guidance to local districts.

The Fundamentals of Sexual Health Education
The fundamental principles outlined below have been adapted for Connecticut and are based on SIECUS Guidelines. According to the SIECUS Guidelines (2004, p. 19), the following principles are critical to the development of sexual health education programs:

Parental and community involvement; participation in a comprehensive health education program; well-trained teachers; a focus on all youth; and various teaching methods are all important.
The following guidelines are provided to supplement the definition of these fundamental principles.

1. Involvement of Parents and the Community
Schools cannot solve the nation’s most serious health and social problems alone. Schools, families, and communities must work together to help children grow into healthy, productive citizens (CSDE, CSH Guidelines, 2007, p.5). Parents and guardians are their child’s primary sexual health educators, and their responsibility is to ensure that their child receives developmentally appropriate sexual health information. It is the school district’s responsibility to provide a planned, ongoing, and systematic health education program that meets the needs of all students. This program should include sexual health education that is developmentally appropriate. Parents and guardians can opt their children out of family life and HIV/AIDS education lessons. Each school district is responsible for establishing an opt-out procedure policy.
Furthermore, it is recommended that parents and guardians learn about the sexual health education curriculum and review materials. These opportunities can be shared informally throughout the school year, during orientation, and during parent education nights. They can also be posted on school websites.

School sexual health education programs must respect the community’s diversity of values and beliefs while meeting all students’ educational needs. One strategy might be for a district to form an advisory committee to facilitate dialogue about the sexual health education program. This committee, which may include 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 youth-serving organizations, could be a component of the school health team. The local school district determines the advisory committee’s level of involvement. Because there may be disagreements about the best approach to sexual health education, it is especially important to solicit community and parental input on this aspect of school health (see Appendix C, Building Community Support).

The CSH Guidelines (2007) outline strategies for organizing district-level school health teams to bring together a diverse range of school and community stakeholders. These teams or councils aim to provide a systematic approach to policy development and implement and monitor various school health activities, such as sexual health education. This coordinated strategy:

Allows for the exchange of diverse perspectives, interests, and concerns; contributes to districtwide ownership of outcomes; and is incorporated into a district and school improvement plans as an essential component of the district’s educational mission (CSDE, CSH Guidelines, 2007, p. 13).
Community involvement and input can provide the following benefits to the school sexual health education program:

A climate of inclusion rather than exclusion; diverse perspectives; a foundation of parent and community support for the program; and additional expertise, support, and resources.
2. Comprehensive Health Education Programs in Schools
The CSDE Guidelines for a Coordinated Approach to School Health defines comprehensive school health education as a series of learning experiences that enable children and youth to become healthy, effective, and productive citizens. A PK-12 curriculum that is planned and sequential addresses the physical, mental, emotional, and social dimensions of health. The curriculum is intended to motivate and assist children and adolescents in maintaining and improving their health, preventing disease, and reducing health-related risk behaviors, by assisting them in developing and demonstrating increasingly sophisticated health-related knowledge, attitudes, skills, and practices (CSDE, CSH Guidelines, 2007).

Comprehensive school health education covers a wide range of topics, including (CDC, 2006):

Sexual health education; mental and emotional health; injury prevention and safety; nutrition; disease prevention and control; and alcohol, tobacco, and other drugs are all examples of personal, family, community, consumer, and environmental health.
Comprehensive school health education focuses on the six DASH-identified youth health-risk behaviors, protective factors, and youth development initiatives. 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 are among the leading causes of morbidity and mortality among youth (CDC, 2006). “These interconnected and preventable behaviors are frequently established during childhood and adolescence and can extend into adulthood” (CSDE, CSH Guidelines, 2007).

Sexual health education should be medically accurate and based on current research as part of comprehensive school health education programs. It should be standards-based, based on national or state-developed standards such as the National Health Education Standards, National Sexuality Education Standards, and the California State Department of Education’s Healthy and Balanced Living Curriculum Framework, and it should be offered as part of a planned, ongoing, and systematic program taught by certified, highly qualified, and effective teachers.

3. Well-Educated Teachers
Best practices in sexual health education emphasize the importance of teachers’ roles and the importance of teacher training. The teacher’s comfort level and skill are among the most important factors influencing the effectiveness of sexual health education programs. To educate students about sexuality, teachers must be well prepared. This preparation includes a comprehensive teacher pre-service program as well as ongoing professional development that increases knowledge, skills, and comfort in the following areas:

Scientific and medically accurate information about human sexuality topics; comfort with the topic; cultural competence and the ability to communicate inclusively; 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 sexuality values (SIECUS, Guidelines, 2004).
Furthermore, Connecticut’s Common Core of Teaching: Foundational Skills and Health Education content-specific standards articulate the knowledge, skills, and qualities that Connecticut teachers require to prepare students for the challenges of the twenty-first century.


A PK-12 health education teaching certificate endorsement (043) or a school nurse/teacher certificate endorsement is required for certification to teach health education at the primary or secondary levels (072). An elementary teacher may deliver health education at the primary level (Grades K-6) but cannot be the sole provider, according to Section 10-145d-435(a) of the certification regulations. Elementary school teachers may provide some health education instruction, but a certified health education teacher must also provide some, including ongoing:

Direct instruction, collaboration with classroom teachers, and curriculum development are all examples of direct instruction.
Teachers must be certified in health education or hold a school nurse/teacher certificate to teach health education at the middle and secondary levels (Grades 7-12).

School nurses, school psychologists, school social workers, and school counselors, in addition to certified teachers, 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, roughly 70% of middle and high school health teachers want to receive professional development on various topics, including HIV, human sexuality, pregnancy prevention, and STDs. While certification is required, it does not guarantee that teachers will have the specific knowledge, comfort, and skills needed to educate students about various sexual health education topics. The CSDE recommends that health educators receive specialized training in teaching sexual health education, which provides opportunities for increased knowledge, comfort, and skills in delivering instruction to students at various grade levels. This training foundation includes college courses, institutes, and ongoing professional development.

4. Emphasis on All Youth Schools must foster healthy learning environments that are physically, emotionally, and intellectually safe and secure for all members of the school community (CSBE, 2010). Local school districts must incorporate beliefs and practices that foster understanding and respect for diverse cultures to educate, engage, and meet the needs of diverse students. School districts, according to Messina (1994), must focus on many different dimensions of diversity in order to provide relevant sexual health education to all youth: 1) racial and ethnic background; 2) socioeconomic background; 3) sexual orientation and gender identity; and 4) special education needs. These dimensions influence students’ attitudes, beliefs, and values regarding sexual issues such as family relationships, gender roles, health practices, and sexual norms and behavior. Teachers must constantly strive to be culturally competent to educate and engage diverse students competently. They must constantly evaluate their attitudes and potential biases, learn about their students’ experiences, beliefs, and perceptions, interact and communicate in a caring and respectful manner, and use culturally and linguistically appropriate curriculum materials (Messina, 1994).

Diversity of Race and Ethnicity

Augustine believes (2004),

“Youth-serving organizations are most successful when their programs and services respect the cultural beliefs and practices of the youth they serve. A culturally competent program values diversity, assesses itself, addresses issues that arise when different cultures interact, acquires and institutionalizes cultural knowledge, and adapts to the cultures of the people and communities served. This could imply creating an environment in which young people from various cultural and ethnic backgrounds feel comfortable discussing culturally derived health beliefs and sharing their cultural practices.”

The race and ethnicity of students are important aspects of their identity. Students’ language and communication styles, health beliefs, family relationships, sexuality beliefs, gender-role expectations, religious beliefs and practices, and many other aspects of their understanding of themselves as sexual people are all influenced by race and ethnicity (Advocates for Youth, 2008).

Diversity in Socioeconomic Status

The socioeconomic background of young people has a significant impact on their health and sexuality. Socioeconomic disparities influence everything from students’ basic health beliefs to significant disparities in access to relevant health information and health care. Indeed, after assessing the scope of the problem in the state’s urban, suburban, and rural areas, the Connecticut Health Foundation identified eliminating racial and ethnic health disparities as one of its three program priorities (CT Health Foundation, 2005).

Gender Identity and Sexual Orientation

Two students are studying a textbook, and the boy points to a book section.

School sexual health educators must teach with full recognition that their classrooms contain students of all sexual orientations and gender identities. Relationship education, decision-making, dating violence prevention, HIV/STD prevention, pregnancy prevention, and a variety of other topics must be available to all students. As a result, it is critical for sexual health educators to create a classroom environment that demands respect for all students, has zero tolerance for put-downs or hate speech directed at any youth, and creates safe school environments for all youth to participate in program activities fully and be integrated with required school-climate improvement plans.

“Omitting the topic of sexual orientation, or teaching about it incorrectly or insensitively, is therefore likely to result in misinformation, alienation of a given class’s non-heterosexual population, and an incomplete sexuality education course” (Macgillivray, 2000). (Hedgepeth and Helmich, 1996, p.18, as cited in Schroeder 2007). Teaching about sexual orientation — including heterosexuality, homosexuality, and bisexuality — can only benefit students of all orientations by debunking myths, breaking down gender-role stereotypes that are often at the root of homophobic beliefs, and providing factual information alongside every other sexuality-related topic covered in a sexuality education program (Macgillivray, 2000). Sexual orientation and gender identity and expression should be included in developmentally appropriate ways in sexual health education, as specified in Section 3 of these CT Guidelines.

Common Terminology and Definitions for Sexual Orientation and Gender Identity

Romantic and sexual attraction to people of one’s own and different genders. Gay, lesbian, bisexual, heterosexual, and other terms for sexual orientation are currently in use.
Bisexual: A person’s attraction to other people is not necessarily determined by gender.
A heterosexual person is romantically and sexually attracted to someone of a different gender than themselves.
Homosexuals: People who are romantically and sexually attracted to people of their gender. Most commonly known as “gay” or “lesbian.”
Gender: The emotional, behavioral, and cultural traits associated with a person’s biological sex. Gender has several components, including gender identity, gender expression, and gender role.
Gender identity is a person’s internal sense of their gender. Some people do not develop a gender identity corresponding to their biological sex.
Transgender: A gender identity in which a person’s inner sense of gender differs from their biological sex.
2011 National Sexuality Education Standards

Disabled or Other Special Needs Students

To learn about their developing sexuality, all children, including those with emotional/behavioral, physical, cognitive, communication, or learning disabilities, require accurate, developmentally appropriate information (Wisconsin, 2005, p. 12). Autism, visual and hearing impairments, physical and orthopedic disabilities, intellectual and specific learning disabilities, emotional disturbances, speech or language impairments, traumatic brain injuries, and a variety of other health impairments are all considered special education in Connecticut (CSDE, Bureau of Special Education, 2007, p.1). When delivering any curriculum or program content, including sexual health education, this diverse group of students has very specific learning needs that must be considered.

The American School Health Association (ASHA) has passed a resolution in support 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 emphasizes critical components that ensure sexual health education is delivered effectively to those with disabilities or other special needs (ASHA, 2009).

Furthermore, according to Maurer (2007), providing high-quality sexual health education benefits everyone, but it is especially beneficial for children and youth with developmental disabilities. The positive effects extend beyond the basic understanding of sexuality topics, as shown in the table below.

Sexual Health Education Benefits for Students with Developmental Disabilities (Maurer, 2007)

Self-Esteem and Empowerment—Physical development and the feelings accompanying it provides a sense of belonging to a larger group dealing with similar issues. Realizing this fact can be very empowering for young people who are constantly labeled as different. Indeed, the visible physical changes and feelings that children and youth experience may be one of the few times they feel equal to their nondisabled classmates.
2. Skill Development—Sexuality education provides information and opportunities for youth to practice skills that help them recognize and respond appropriately to social and sexual situations.
3. Improved Communication—When sex education provides the foundation of anatomically accurate vocabulary, youth learn to communicate without guilt or embarrassment. When equipped with the appropriate terminology, youth can more accurately describe questions, symptoms, and concerns to caregivers or healthcare providers.
4. Setting the Stage—Sexuality education that is accurate, age-appropriate (and developmentally appropriate) sets the stage for future topics and discussions. A basic information framework makes more advanced topics easier to understand.
5. Goals Articulation—Discussions about sexuality and social skills help youth envision their future. Without these discussions, young people may underestimate their abilities. When youth have had numerous opportunities for these discussions, making concrete plans toward realistic goals is easier.
6. Preventing Negative Outcomes—Sexuality education teaches youth how to recognize and prevent sexual abuse. It also provides a framework for understanding and avoiding socially inappropriate or illegal behaviors.
5. Methods of Instruction
Sexual health education should be delivered using various engaging and active teaching methods, such as small group discussions, brainstorming, role-playing for skill practice, and drama and literature. Because there are numerous individual, family, and cultural attitudes and beliefs about human sexuality, students benefit from opportunities to reflect on what they are learning in journals, in small and large group discussions, and with their parents or guardians through homework assignments. Students require opportunities to personalize what they learn in class and consider how it applies to them in their everyday lives.

Teachers must do the following in the classroom:

Create a healthy and safe learning environment by involving students in the establishment of 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 appropriate resources, Adolescent Health Care: Teens’ Legal Rights (Center for Children’s Advocacy) provides information on Connecticut and federal laws in areas such as mandated reporting, privacy rights, reproductive health care, medical conditions and treatments, and privileged communications; 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, and discussing
The Connecticut Accountability for Learning Initiative (CALI) of the Connecticut State Department of Education (CSDE) has partnered with the Leadership and Learning Center to provide professional development in effective teaching strategies. Marzano et al. (2001) developed these strategies applicable to all content areas, including sexual health education. Effective teaching strategies include the following:

Recognizing similarities and differences; summarizing and taking notes; reinforcing effort and providing recognition; homework; nonlinguistic representations; cooperative learning; setting objectives and providing feedback; generating and testing hypotheses; and cues, questions, and advance organizers.
The CSDE CALI Information and Resources Web site provides an overview of the research supporting these strategies and practical applications for the classroom.

Evidence-based programs and curriculum
According to research, programs aimed at reducing sexual risk-taking behaviors and preventing HIV can effectively delay young people from engaging in sexual intercourse (Kirby, 2007). When selecting a program, school districts should ensure that it is based on identified community needs and implemented with fidelity to achieve the desired outcome.

The degree to which a curriculum or program is delivered following the intended design is fidelity.

Guidance on evidence-based programs is available from:

What Works 2010 Curriculum-Based Programs That Help Prevent Teen Pregnancy; and United States Department of Health and Human Services: Office of Adolescent Health.
two students staring at a computer monitor
“Evaluation is an important tool for determining program effectiveness and determining whether newly developed and existing sexuality education programs are meeting their goals and objectives” (Fetro, 1994, p.15).

Program Evaluation Any program’s evaluation includes three types of activities: 1) determining what needs to be done (formative evaluation); 2) investigating whether and how well educational activities are carried out (process evaluation); and 3) demonstrating effectiveness (summative or outcome evaluation) (CSDE, CSH Guidelines, 2007, p. 19).

According to Fetro (1994), sexual health education should be evaluated systematically as part of comprehensive school health education to determine the following:

How to design and revise the program to meet the needs of students and the community; how much sexual health education is taught (i.e., how much time is allocated during each grade level); whether the program is implemented effectively and as planned; and how well the prescribed learning objectives are met (i.e., outcomes).
The Connecticut Guidelines for a Coordinated Approach to School Health (2007, p. 39) include the following evaluation strategies for evaluating sexual health education programs:

Formative Assessment

Assess educational needs by 1) gathering baseline student information (e.g., knowledge, behaviors, and attitudes); 2) determining student interests and concerns; and 3) determining school and community needs (Fetro, 1994).
Schedule a systematic curriculum review process on an ongoing basis, preferably every three to five years, to update medical and scientific accuracy and program effectiveness.
Determine whether new curriculum goals have emerged, such as the Internet’s and other technology’s role in young people’s communication, relationships, and risk-taking behaviors.
Conduct ongoing formative assessments at the grade level.
Inquire about the program’s goals and objectives.
What resources are already available in the school and community to meet these goals/objectives?
What does the State Department of Education or the local school board require?
What curriculum for sexual health education has been chosen for the program? Is an evidence-based curriculum being implemented with consistency?
Do curriculum materials that are being developed or adopted incorporate, as appropriate, Kirby’s key characteristics of evidence-based curricula (2007)?
Process Assessment

Keep track of the program’s implementation and delivery.
Examine course enrollment (e.g., determine the number of classes offered and several students enrolled).
Surveys of students’ knowledge, attitudes, skills, and behaviors, focus group interviews with students, teachers, parents, and administrators, classroom observations, and meetings can all be used to collect information about program strengths, weaknesses, and needs, as well as preferences for classroom resources and the relevance of topics or objectives.
Evaluate the competency of the teacher.
Inquire about the following:

Is sexual health education provided consistently across grade levels and the district? What are the gaps and overlapping areas? What subjects are covered in each grade level?
Is there enough time, materials, and supplies available to deliver sexual health education?
Are current, developmental, and medically and scientifically accurate information and materials?
What suggestions do health education and classroom teachers have for curriculum, classroom instruction, and student assessment?
What suggestions do students have for program enhancement?
What is the comfort level of the health education teachers and classroom teachers who will deliver the curriculum?
Are health education and classroom teachers effective and well-qualified?
Is there enough professional development in sexual health education for teachers, administrators, and health and mental health professionals?
What resources are available to health education and classroom teachers in addition to professional development?
How can sexual health education program implementation be improved?
Evaluation of outcomes

Conduct ongoing summative (or outcome) assessments at the grade level that are developmentally appropriate.
Pre- and post-surveys should be administered to determine changes in students’ knowledge, attitudes, skills, and behavioral intentions.
Conduct in-depth interviews with school personnel and focus groups with students and teachers to determine their perceptions of the program’s impact.
Examine various data sources to inform curriculum content, skill focus, and program delivery (e.g., Connecticut School Health Survey and other appropriate state and local health data).
Inquire about the following:

Is the sexual health education program achieving its goals?
What is the program’s effectiveness at each grade level?
What are the program’s specific effects or outcomes?
What effect do teachers and other school personnel believe the program has had on students?
What impact do students believe the program has had on them?
In class, a boy is laughing.

The most difficult task for schools is evaluating behavior change (outcome evaluation). “Each district may have different outcome questions based on their specific priorities,” according to the CSH Guidelines. These questions cannot be answered without baseline data, such as information gathered during a needs assessment. Conducting outcome evaluations can be difficult because it is difficult to determine whether improved outcomes can be attributed to the program or other community factors, such as a media campaign. A local health department or university may be able to help districts identify and carry out appropriate outcome evaluations” (CSDE, CSH Guidelines, 2007, p. 19).

Many school districts use the Youth Risk Behavior Survey (YRBS) administered biannually by the Centers for Disease Control and Prevention as one data source to assess student health behavior progress. The YRBS asks students a series of sexual behavior questions and allows state departments of education and local education agencies (typically in larger cities) to compare adolescent health status across the country. The YRBS is known as the Connecticut School Health Survey in Connecticut, and it is co-administered by the State Departments of Education and Public Health. The survey results can be found on the Connecticut Department of Public Health’s website.
The Connecticut School Health Survey is one source of data; however, it is recommended that local districts examine multiple sources of data to identify 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).
As providers, how can we provide substantial and effective sexual education to our patients?

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