Implementing Sexual Health Education in Schools

State: MN Type: Promising Practice Year: 2014

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The practice we are highlighting is the effort of the Minneapolis Urban Initiative for Reproductive Health, a group convened by MHD, to utilize committed stakeholders and experts to promote and guide the process of creating policy to support implementation of sexual education in a local school district. The goals and objectives of this practice were to create a district policy to implement science-based sex education in the middle school grades, and guide the curriculum selection process, provide training and ongoing technical assistance for teachers implementing curriculum, and utilize local expertise to ensure consistent, sustainable implementation. In 2008, a youth violence prevention workgroup convened by the City of Minneapolis identified teen pregnancy and related social issues, including school completion and teen parenting, as critical factors in preventing youth violence. During this same time, MHD was working with Minneapolis Public Schools (MPS), a local public school district serving 35,000 K-12 youth, to update and standardize the district health curriculum. Representatives from both MHD and MPS attending the National Institute for Reproductive Health National Summit, where they learned how to better collaborate by identifying and addressing gaps in reproductive health services to youth.

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Minneapolis Health Department
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Implementing Sexual Health Education in Schools
The Minneapolis Health Department serves the City of Minneapolis, Minnesota, with a diverse population of approximately 393,000 people. The Minneapolis Health Department's mission is to achieve health, equity, and wellbeing for all people in their communities, and have focused efforts specific to adolescent sexual health. One of our primary goals is to prevent teen pregnancy, which is defined by NACCHO as one of their winnable battles. Teen pregnancy and birth rates in the United States have been declining since the 1990s, however there is still work to be done to assist youth in preventing teen pregnancy. In 2008 alone, teen childbearing was estimated to cost Minnesota taxpayers $173 million, including costs for public health care, child welfare, and lost tax revenue. The social and economic costs are often high, and there are immediate and long-term negative outcomes, including higher drop-out rates, and lowered ability for economic self-sufficiency. Within the City of Minneapolis, there are also racial/ethnic disparities between the white population and American Indian, Hispanic, and African American populations. The Minneapolis Health Department (MHD) has taken a comprehensive approach to improving adolescent sexual health and decreasing teen pregnancy through the following four goals: All students are exposed to comprehensive sex education before the end of 8th grade Teens have access to confidential, teen-friendly reproductive health care Teens have access to contraceptives Develop and promote culturally specific, evidence-based interventions and programs. The practice we are highlighting is the effort of the Minneapolis Urban Initiative for Reproductive Health, a group convened by MHD, to utilize committed stakeholders and experts to promote and guide the process of creating policy to support implementation of sexual education in a local school district. The goals and objectives of this practice were to create a district policy to implement science-based sex education in the middle school grades, and guide the curriculum selection process, provide training and ongoing technical assistance for teachers implementing curriculum, and utilize local expertise to ensure consistent, sustainable implementation. In 2008, a youth violence prevention workgroup convened by the City of Minneapolis identified teen pregnancy and related social issues, including school completion and teen parenting, as critical factors in preventing youth violence. During this same time, MHD was working with Minneapolis Public Schools (MPS), a local public school district serving 35,000 K-12 youth, to update and standardize the district health curriculum. Representatives from both MHD and MPS attending the National Institute for Reproductive Health National Summit, where they learned how to better collaborate by identifying and addressing gaps in reproductive health services to youth. The result of this meeting was the creation of the Minneapolis Urban Initiative for Reproductive Health, a group convened by MHD and including numerous school, city, and community partners, which adopted a resolution to work with MPS to implement science-based sexual education in all middle schools. Prior to this process, implementation of sexual education was decided by individuals schools and not the district administration, and was not present in all schools. Middle school, grades 6-8, were chosen as the ideal time to address adolescent sexual health by providing accurate information, promoting healthy sexual behaviors, including sexual initiation delay and condom/contraception use for sexually active youth. The process/practice included the following steps: invite stakeholders and convene coalition; determine need; clearly articulate the coalition's ultimate goal; secure funding; prepare for controversy, but don't invite it; find individual educators, parents and students who would like to be "champions" for the cause among their peers; and create a detailed sustainability plan. As a result of the work of the last five years, there were many successes, including the adoption of new MPS health standards, initiation of science-based sex education curricula in middle schools and high schools, the adoption of Making Proud Choices as the official MPS curriculum for grades 6-8, increased ownership by MPS district administrators to internalize processes to support/sustain sexual education, development of Policy 6411 to adhere to science-based materials for sex education, and in 2013, full implementation of Making Proud Choices in 23 middle schools in Minneapolis Public Schools, reaching an average of 2400 middle school youth a year. MUI has completed a charter/alternative middle school assessment, and will be partnering with these schools to go through the same process. This process would not have been possible without the deep commitment of MUI partners to support and sustain the process from conception to implementation. The public health impact of this practice is shown in decreasing pregnancy rates, including an 18.6% decrease in teen births from 2010 to 2011.
The Minneapolis Health Department is located in the City of Minneapolis, Minnesota. The City of Minneapolis has approximately 393,000 people, with about 65% of the population white, 19% black, and the rest comprised of various other ethnicities. Minneapolis also has a large American Indian population, as well as Somali and Hmong immigrant communities. The Minneapolis Health Department (MHD) promotes health equity and meets the unique needs of the urban community by providing leadership and fostering partnerships to support the following goals: strong urban public health infrastructure, healthy weight through active living and healthy eating, healthy sexuality and relationships, thriving and violence-free youth, and a healthy start to life and learning. The public health issue we are targeting with this practice is teen pregnancy prevention. Teen pregnancy and birth rates in the United States have been declining since the 1990s, however there is still work to be done to assist youth in preventing teen pregnancy. In 2008 alone, teen childbearing was estimated to cost Minnesota taxpayers $173 million, including costs for public health care, child welfare, and lost tax revenue. The social and economic costs are often high, and there are immediate and long-term negative outcomes, including higher drop-out rates, and lowered ability for economic self-sufficiency. Within the City of Minneapolis, there are also racial/ethnic disparities between the white population and American Indian, Hispanic, and African American populations. The Minneapolis Health Department (MHD) has taken a comprehensive approach to improving adolescent sexual health and decreasing teen pregnancy through the following four goals: All students are exposed to comprehensive sex education before the end of 8th grade; teens have access to confidential, teen-friendly reproductive health care; teens have access to contraceptives; and develop and promote culturally specific, evidence-based interventions and programs. Young people in Minneapolis between the ages of 10-19 represent about 12% of the population, however our target population for this practice was middle school age youth attending Minneapolis Public Schools, which averages around 7,500 youth per year. Every year, since implementation of the sex education curricula, we have reached an average of 2500 youth, or about 33% of all middle school youth in a given year. Over the course of the next few years, with continued implementation, we should reach a majority of middle school youth. Prior to the implementation of the Minneapolis Urban Initiative for Reproductive Health practice to advocate for policy change, and utilization of local content experts to assist with the selection, training, and implementation of science-based sex education, MPS did not have an overarching policy regarding sex education curricula. The results of the MUI process has had a positive impact, and has been identified by the City of Minneapolis as a key factor in reducing significant disparities in rates of teen pregnancy across race/ethnicity and in reaching the 2014 teen pregnancy target of 37.8 pregnancies per 1000. This practice was innovative in utilizing various partners across the city to assist with the process, with a focus on the social and environmental context that influences teen pregnancy, from parents to healthy youth development experts. Through lessons learned from this process, and efforts from various partners, we were able to compile a guide to assist advocates and administrators in other school districts in making sexual health education a reality in their schools. The use of this practice led to the implementation of Making Proud Choices, an evidence-based sex education curricula which is appropriate for urban youth. When implemented with fidelity, Making Proud Choices has been found to: Delay initiation of sexual intercourse Reduce frequency of sex Reduce incidence of unprotected sex Increase condom use. While using community leverage and partnerships is not new to the field of public health, and many national organizations have provided materials which assist with creating access to sexual health education for youth, it is our hope that our guide can be used as a model for other school districts to prioritize and systematize implementation of sexual health education as an integral part of education for all youth.
Teen Pregnancy
Goal of practice: Implement MPS school board policy requirement to choose and teach science-based sex education curricula in all middle schools. Steps taken to implement program: 1. Invite stakeholders and convene coalition (MUI) 2. Determine need using relevant Minneapolis statistics around teen pregnancy/adolescent sexual health, current gaps in health education and access for Minneapolis youth 3. Clearly articulate the coalition's ultimate goal, with flexibility towards what is actually possible within district 4. Secure funding through National Institute for Reproductive Health, and additional TANF and Minnesota Department of Education funds 5. Prepare for controversy, utilize communications plan with talking points and community and parent engagement 6. Find champions of the cause, including youth, parents, and school staff 7. Create detailed sustainability plan for funding, staffing, and training, and institutionalize process and agenda.The Minneapolis School district is the largest school district within the city of Minneapolis, and was the best partner to reach the highest numbers of youth. The timeline is ongoing, but we have reached a point where we can now to outreach to charter/alternative schools to institutionalize a process and provide training and technical assistance to implement appropriate sex education curricula for their unique populations. After five years, 23 middle schools have now fully implemented sex education, and high schools are implemented an age appropriate curricula. There were a large number of partners involved in the initiative, including: Teenwise Minnesota (previously named MOAPPP), Greater Twin Cities United Way, Hennepin County Research, Planning, and Development, Minneapolis Health Department, Minneapolis Mayor's Office, Minneapolis Public Schools, Minnesota Religious Coalition for Reproductive Choice, Minnesota Department of Education, Minnesota Department of Health, NARAL Pro-Choice Minnesota, Planned Parenthood of Minnesota, North Dakota, South Dakota, Pro-Choice Resources, University of Minnesota Healthy Youth Development-Prevention Research Center, and Minneapolis Youth Coordinating Board. National expertise was utilized through the following organizations: Advocates for Youth, Guttmacher Institute, It's That Easy, National Institute for Reproductive Health, and SIECUS. Local stakeholders provided the expertise and commuity engagement necessary to move the work forward within the local school district. MHD convened and led all meetings, including subgroups/workgroups. MHD fosters collaboration with community stakeholders using the following processes: We build on our urban community’s cultural diversity, wisdom, strengths, and resilience. We support individual health within the context of families and communities across the lifespan. To achieve health equity, we invest in the social and physical environments of our residents. We bring people and resources together to achieve our common health goals. Sound research and promising strategies inform our activities and decisions. We promote health as the interconnection of physical, mental, social, and spiritual well-being. This process would not have been possible without all of the partners who brought subject matter expertise and resources throughout the curriculum review and implementation process, and continue to lead progressive work to support adolescent sexual health in Minneapolis. Estimates for overall budget: 2009 Grant from National Institute for Reproductive Health: 27,000 Ongoing: Minneapolis Heath Department TANF Funds: 25,000 Minnesota Department of Education: 25,000 This budget covered training expenses, sub-pay for teachers, staff time for MOAPP and MPS Health Lead, and additional costs such as curriculum and supplies
Through this work we were able to: Assist MPS in the adoption of new health standards Select science-based sexual education curricula for middle school and high school students Create cultural change and increased ownership and commitment by MPS district administrators to internalize processes to implement chosen curricula Provide training and ongoing technical assistance to MPS staff to implement curricula Utilize local sexual health experts to inform all processes Receive bi-annual reports from the MPS Health Curriculum Lead Specialist to update status of curriculum implementation, teacher training, and successes and challenges through implementation. The practice is process oriented and so we can report out on successful relationships and policy, and also track the number of teachers trained, number of schools implementing curricula, number of youth receiving instruction and demographics of youth, and additional initiatives to support sexual health programming in Minneapolis Public Schools, including assessments to ensure equity of instruction and use of a common assessment throughout the district, and any additional needs the coalition can address.
Lessons Learned: Systems changed is a long, arduous process, however the gains through sustained community partnerships are measurable and significant. Record keeping of successes and challenges are instrumental in improving capabilities of sustaining the work. Providing ample support to teachers is essential to ensuring the longevity of the sexual health education program within the school district. Having a plan for fidelity is crucial before teaching begins and determining how fidelity will be assessed and tracked. Always consider the future for funding, staffing and training, and teacher support. For partner collaboration, determine collective agenda, create a communications plan, and use clear language to determine roles. We do believe this process contributed to a clearer understanding of the importance of sexual health education to district administrators and staff, and they have been incredible partners in ensuring the work was and is being carried out effectively. There is continued efforts within the Minneapolis Urban Initiative for Reproductive Health to continue the work with MPS and additional schools. The Minnesota Department of Education will also be instrumental in ensuring the delivery of exemplary sexual health education, improving adolescent access to key sexual health services, and establishing safe and supportive environments for all students in schools.
 
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