Presenters: Amanda Perez, M.P.H. Meghan Weidl, M.P.H. Gabriela Betancourt, M.A., M.P.H .

1. Building SRH-Ready Afterschool ProgramsLessons Learned from “Afterschool Health & Sexuality Education Project (AHSEP)” Presenters: Amanda Perez, M.P.H. Meghan Weidl, M.P.H. Gabriela Betancourt, M.A., M.P.H.

2. What is the Afterschool Health & Sexuality Education Project? • AHSEP is a capacity building assistance program launched in 2008 by The Partnership for After School Education (PASE) and Planned Parenthood of New York City (PPNYC). • AHSEP provided site-based capacity building services to six afterschool programs serving middle and/or high school youth from low-income and marginalized communities in New York City.

3. Why SRH-Ready Afterschool Programming? • Lack of comprehensive sex education in schools • Poor SRH Youth Outcomes & Racial and Ethnic Disparities • 1 of every 4 girls in the US between the ages of 15-19 has had a sexually transmitted infection, and 50 percent of black girls in that age group. • In NYC, teenagers account for 1 in 4 of all sexually transmitted infections. • While HIV infections are down in NYC, they are going up among young men who have sex with men, especially blacks and Latinos. • 82% of teen pregnancies are unintended, and black and Latina teens have the highest rates of unintended teen pregnancy. • Afterschool program staff are in an opportune position to deliver SRH education and referrals and voiced their need for training and support.

4. Common Concerns What are reasons why afterschool and other youth-serving providers express concern over addressing the SRH needs of young people?

5. What is SRH-Ready? An SRH-Ready organization is one where youth providers: 1. Regard sexual and reproductive health as central to their clients’ lives and well-being. SRH education and referrals are an integral component of their everyday work with young people. 2. Are equipped to discuss SRH due to: • Managerial involvement and support • Policies that encourage SRH education and referrals, such as Sexuality Guiding Principles* • Professional development opportunities to expand their SRH knowledge and skills • The availability of teaching tools and resources to facilitate SRH education and referrals *Sexuality Guiding Principles (SGPs) is a policy document that serves as a framework for providing sexual and reproductive health education and referrals. SGPs help professionals to send clear and consistent messages to clients about sexuality.

6. Program Intervention / Capacity-Building Components • Regular meetings with administrators and key leadership. • Five-part initial SRH training series for staff and managers, plus a booster session six months later. • Materials distribution (SRH-Ready Toolkit).

7. Theoretical Framework* AHSEP Program Components Community: PASE I. Managerial Involvement & Support Community: Afterschool organization Family: Parents and caregivers II. Training Individual: Youth III. Materials *Based on: 1.Bronfenbrenner’s Ecological Systems Theory, and 2.Tseng & Seidman’s Social Setting Systems Theory

8. Evaluation Methodology • An observational scan, or walk-through assessment, of the availability of SRH educational materials, condoms, referral lists, and organizational polices. • Pre, post, and follow-up surveys of administrators and staff to assess their perceptions of the organizational setting, knowledge of SRH, and use of SRH information with youth. 103 staff were surveyed at baseline, 78 at post, and 80 at follow-up. • Pre, post and follow-up surveys of youth asking about availability of SRH materials and resources at the organization, obstacles to receiving SRH education, and referrals to outside services for SRH care. 174 youth were surveyed at baseline, 164 at post, and 188 at follow-up.

9. Results: Percentage of SRH Items in Organization’s Physical Setting

10. Results: Staff & Manager Reports of Org. Support Rate level of organizational support for: • Encouragement to discuss SRH with youth • Sufficient time for discussions • Provision of materials & resources • Definition of staff roles & responsibilities • System for referrals • Staff development opportunities 1=Not at all supportive, 5=Very Supportive

11. Results: Staff & Manager Knowledge of SRH % Correct • Asked a series of 21 questions • Answered True/False • Scored in 3 different knowledge categories

12. Results: Manager & Staff Efficacy • Staff & managers asked about how confident and prepared they felt to: • Provide SRH referrals, information, condoms/dental dams to youth • Discuss SRH topics with youth • 1=Not at all prepared, 5=Very prepared

13. Manager & Staff Efficacy: Discussion Topics 1=Not at all prepared, 5=Very prepared

14. Evaluation Results • Organizational policies: All 6 organizations developed a Sexuality Guiding Principles document posted throughout their organizations. • Knowledge: Administrator and staff SRH knowledge went up at post and knowledge regarding teen access/rights increased at follow-up. • Self-efficacy: Staff reports increased for all areas such as feeling prepared to discuss birth control and STIs and to make referrals. • Resource availability: Positive changes in the physical setting included 6 newly revised condom distribution systems.

15. Program Component #1. Meetings with Administrators and Key Leadership • Develop Sexuality Guiding Principles • Monitor Overall Program Progress • Project timeline • Training series • Emerging staff and organizational needs • Action Plan Execution

16. Sexuality Guiding Principles Small Group Activity to understand the importance of utilizing organizational (non-personal) values and guidelines when discussing SRH with youth participants.

17. Program Component #2. Six-part SRH Training Series 1. Fostering an SRH-Ready Afterschool Program 2. Child Sexual Development: What to Expect at Each Stage of Sexual Development and How to Deliver Age-Appropriate Sex Education 3. Gender and Sexual Orientation: What Afterschool Providers Need to Know 4. Birth Control Options 5. Action Plans: How to Sustain SRH-Ready Afterschool Settings 6. Booster Training Session (tailored to each org. after admin. meeting)

18. SRH Training Series Small Group Activity to highlight and discuss lessons learned and strategies for engaging and training afterschool staff and managers in SRH.

19. Program Component #3. SRH-Ready Toolkit • Anatomy models • Contraceptive methods demonstration kit • Instructional flip charts • Condoms and dental dams • Books • Videos • Posters • Youth-focused referral lists

20. SRH-Ready Toolkit: Case Study #1 “The Vault” One Brooklyn organization created a room called, “The Vault.” This was the area designated for private SRH conversations between youth and providers. The room also contained the bulk of the organization’s educational materials including anatomy models, instructional flip charts, a contraceptive methods demonstration kit, and various books. When private conversations were not taking place, The Vault was left open for young people to occupy. They were permitted to explore the educational materials at their leisure.

21. SRH-Ready Toolkit: Case Study #2 The Anonymous Question Box A Bronx organization placed a decorated shoebox in a high-trafficked youth area along with index cards and pencils. Youth were encouraged to write down SRH questions and place them in the box at any time. Staff scheduled a monthly session with youth to read all questions aloud and answer them in front of the entire group. The staff also posted the questions and answers on a bulletin board just outside of the teen area.

22. SRH-Ready Toolkit Small Group Activity to identify at least three ways to enhance the physical afterschool environment via the provision of SRH education materials and resources.

23. Acknowledgements Thank You to. . . • PASE (Partnership for After School Education) • Private family foundation • Six participating afterschool organizations • Healthy Teen Network The opinions expressed in this article do not necessarily reflect those of Planned Parenthood Federation of America, Inc.

24. Wrap-up and Closing • Questions and final thoughts • Complete evaluation forms • Stay in touch - best practices manual coming in December! Amanda Perez, Director of Adult Education and Professional Development Programs 212.274.7336 amanda.perez@ppnyc.org Meghan Weidl, Associate Director of Adult Education and Professional Development Programs 212.274.7334 meghan.weidl@ppnyc.org Gabriela Betancourt, Research Associate 212.274.7269 gabriela.betancourt@ppnyc.org