Peer Education: Building Lasting Change One Leader at a Time

1. Peer Education: Building Lasting Change One Leader at a Time Sunny Holmes, MA Tatiana Falcón-Rodríguez, MA Health Educators Planned Parenthood of New Mexico

2. Overview What is Peer Education? What is Comprehensive Sexuality Education (CSE)? Context Goals of Youth Development Programs Advantages of Peer Education Programs Theoretical Background Research Studies Components of a Successful Peer Education Program Tools, Tips and Resources Adapting your Peer Education Program Challenges of Implementing Peer Education Programs Peer educators’ testimonials

3. What is Peer Education? • Y-PEER (2005). Youth Peer Education Toolkit. • Population Council. Peer Education and HIV/AIDS: Past Experience, Future Directions • Strange et. Al. 2002. Peer-led sex education- characteristics of peer educators and their perceptions of the impact on them of participation in a peer education programme. Health and Education Research 17(3): 327-337 • Peer education is the process whereby well-trained and motivated young people undertake informal or organized educational activities with their peers. • These activities, occurring over an extended period of time, are aimed at developing young people’s knowledge, attitudes, beliefs, and skills and at enabling them to be responsible for and to protect their own health • Peer education may also create change at the group or societal level by modifying norms and stimulating collective action that contributes to changes in policies and programs. • Peer education involves… ‘interaction between individuals with shared characteristics such as behaviour, experience, status or social and cultural backgrounds. Interaction within the group is based on equality’.

4. Context • New Mexico has the #1 teen pregnancy rate in the U.S. • 47.2% of students in Bernalillo County have reported having sexual intercourse • 9.1% had sexual intercourse before age 13 • 16.7% of sexually active adolescents have had 4 or more partners • 25% used drugs or alcohol before sexual intercourse* • 56.8% used a condom* • 14.8% used no protection • 11.7% of youth have been physically abused by boyfriend/girlfriend • 9.8% of youth have been forced to have sex *This number decreased from 9th to 12th grade

5. What is Comprehensive Sexuality Education (CSE)? • Sexuality education is a lifelong process of acquiring information and forming attitudes, beliefs, and values. It encompasses sexual development, sexual and reproductive health, interpersonal relationships, affection, intimacy, body image, and gender roles. • SIECUS • Comprehensive sex education addresses both abstinence and age-appropriate, medically accurate information about contraception. Comprehensive sex education is also developmentally appropriate, introducing information on relationships, decision-making, assertiveness, and skill building to resist social/peer pressure, depending on grade-level. • Advocates for Youth • CSE understands sexuality as a positive, healthy part of life and teaches behavior that is respectful, responsible, non-exploitative and non-violent. CSE recognizes and respects individuality and a wide range of community norms, cultures, cultural beliefs, and language regarding healthy sexuality. CSE is designed to encourage and support youth in developing their identities. CSE recognizes the importance of communities, institutions and individuals working in partnership with families to raise sexually healthy children. • Minnesota Organization on Adolescent Pregnancy, Prevention and Parenting • Sex education… is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy. Sex education is also about developing young people's skills so that they make informed choices about their behaviour, and feel confident and competent about acting on these choices. • Avert

6. Goals of Youth Development Programs Objective is to help youth develop the knowledge, attitudes, beliefs, and skills required to engage in healthy behaviors Individual behavior change Influence on youth social norms Large-scale dissemination of information Community impact Youth learn valuable skills for future educational and professional attainment Promoting well-being, not preventing “ill-health”

7. Advantages of Peer Education • Effective • Similar populations relate well to one another • Young people get a good deal of their information from their peers • Messages can be more relevant • Accepted by their target audiences • Culturally appropriate • Community-based • Can be economical • Can change social and group norms • Networking possibilities • Individual development • Employment and educational opportunities • AIDSCAP (n.d.) How to Create an Effective Peer Education Project.

8. Students more likely to personalize message and change attitude if they believe peer educator (PE) faces similar pressures PEs often seen as more credible PEs more understandable PE can reach hard to access populations Can provide links to other community organizations Interaction of equals Can provide better opportunities for discussion PEs have knowledge of sensitive or culturally taboo issues PEs not “preaching” but “giving advice” PE benefit by: gaining greater understanding of material, clarifying values, having direct voice in the program, training in making decisions, and learning important skills such as facilitation and communication Advantages of Peer Education (contd.)

9. Theoretical Background • Theory of reasoned action: • Young people’s attitudes are highly influenced by their perception of what their peers do and think. • Social learning theory: • People learn indirectly by observing and modeling others with whom the person identifies. • Diffusion of innovations theory: • Opinion leaders in a community act as agents for behavior change by influencing group norms through peer-to-peer contact. • Theory of participatory education • The process of peers talking among themselves and determining a course of action is key to the key to change. • Health belief model • if a person has a desire to avoid illness or get well, and knows a certain action that will prevent illness, then positive action will be taken. A peer educator could reduce perceived barriers through reassurance, correction of misinformation, incentives, and assistance.

10. Research Studies • Both national and international studies of peer educator programs showed that peer-led programs: • Were more effective than adult-led programs at establishing conservative norms • Decreased sexual risk behaviors (example: using condoms) • Increased discussion following curriculum implementation than those counseled by adults • Increased sense of comfort with peer educators because of confidentiality questions and embarrassment issues • Studies also show that the peer-led programs are advantageous to the peer educators as well: • Consistent peer educators have been shown to be less sexually active and more likely to have protected sex. They also achieved greater sexual health knowledge and had fewer risk behaviors • Peer educators also report having greater maturity and independence • Many studies have shown that peer education programs are especially good for in-school programs

11. Components of a Successful Peer Education Program School input Funding Youth involvement Skill development Youth activities Parental engagement Community connectedness Service learning Retention Monitoring and evaluation

12. Designing and Implementing a Program:Tools, Tips, and Resources • Linkage to School or Community-Based Organization • Capacity Building: Provide an on-site worker to ensure sufficient support, ongoing training and sustainability of program • Effective Resource Coordination: Must be well-coordinated within a much larger context of health care services and resources • Referral Access: Can increase referrals for contraceptive services at a fixed site • Networking: Partnerships enable programs to link up with existing services and provide opportunities to recruit peer educators • Look especially at social action research projects, national health schools standards teams, health promotion units, school nursing services, sexual health services, clinics, health action zones, teen pregnancy coordinators

13. Designing and Implementing a Program:Tools, Tips, and Resources (contd.) • Recruitment • Develop clear criteria for peer educators • Peer educators must: have demonstrated interest, be non-judgmental, be acceptable among young people, role model, can deal with information • Use nominations for program • Begin with clearly defined target population • Recruit from a broad base- consider opinion leaders and those strongly committed to program’s goals, search youth out, do not expect them to respond to a notice or flyer. Enlist the help of teachers, and agency staff for recommendations • Do not have any preconceived notions of preferences of programs

14. Designing and Implementing a Program:Tools, Tips, and Resources (contd.) Training Curriculum Select a curriculum to maximize interactive learning, less lecturing, more skill building; should be trained in facilitating as well as giving clear directions. The training should emphasize: Building confidence and skills and instilling clear program objectives Decision-making, making client referrals, and providing commodities or services. Legal reporting, gender and sexuality, communication skills, etc. Classroom management Interactive training important Use drama and counseling techniques in trainings Training should include a component on gender inequalities Training may need to be intensive at first and focus on personal development, then go to more general information Need ongoing training- especially with classroom management and inter-personal skills Exams to test competency

15. Designing and Implementing a Program:Tools, Tips, and Resources (contd.) • Meetings and activity planning • Meetings • Should be regular and at a central site • Should focus on continuing skill development or activity planning • Give sufficient opportunities to practice presentations on key topics • Activities • Set clearly defined goals- time period, # of people reached, target population, etc • Design a manageable scope of work • Give peer educators increased responsibilities and decision making authority as well as opportunities for personal and professional growth • Think about a wide range of activities, not just teaching- like radio shows, theatre, etc. • Progress reports, performance evaluations good ideas • Have peer educators keep a journal with their observations • What the peer educators are allowed to do is a big question (handing out condoms, etc). • Let the peer educators design activities and/or decide which activities to use • Use role play: provide information (people explore problems that they might otherwise feel uncomfortable with), create motivation (engages hearts and minds), build skills, make a linkage to resources

16. Designing and Implementing a Program:Tools, Tips, and Resources (contd.) • Activities and Teaching • Administering games and activities • Tailoring programming to your audience • Empowering v. discouraging • Answering difficult questions • Question & Answer Patrol • How to personalize without getting personal • Addressing different cultural/religious beliefs • LGBT issues • Using social media to your advantage

17. Designing and Implementing a Program:Tools, Tips, and Resources (contd.) • Retention • Expect attrition as youth age, priorities change, or responsibilities change • Promote the program, positive stories from existing educators is especially useful • Have a consistent recruiting plan in place • Offer compensation of some type • Class credit • In-kind • Monetary compensation • Training & activities • Tier system of compensation, where PEs are compensated based on his/her level of responsibility • Close supervision is important • Offer career development opportunities • Make sure that personal values of PE are in line with the program

18. Designing and Implementing a Program:Tools, Tips, and Resources (contd.) • Funding • Peer educator programs can be cost-efficient but still require a good deal of funding • Donor funding is often dependent on an organization’s ability to demonstrate program effectiveness and provide a concrete plan for financial stability • Involve stakeholders in the design of the program • Evaluation can also be important for funders • Think about income generating activities- sale of t-shirts, etc. • School funding for the program

19. Designing and Implementing a Program:Tools, Tips, and Resources (contd.) • Evaluation • Peer & Population • Attitudinal change, peer involvement, teacher feedback, retention, skill building, knowledge, behavioral change, assertiveness • Training staff in basic data analysis • Creating systems for data collection • Analysis

20. Adapting/Modifying your program • Know your audience • Age • Experiential level • Background • Content v. Approach • Least Common Denominator approach • Prevention, Halting and Risk Reduction

21. Challenges of Implementing a Peer Educator Program • Recruitment • Adequate training • Institutionalization • Turnover • Logistics • Competing interests • Scheduling • Commitment • Tension over project development • Peers v. adults • Lack of support or continuity in staff • Securing long-term funding • Organization and management • Focus on outcome, not process

22. Conclusion • Questions? “Never doubt that a small group of thoughtful, committed citizens can change the world. In fact, it is the only thing that ever has”. Margaret Mead • Testimonials from peer educators