General Articles

Comprehensive Sexuality Education Programs Succeeding in Cleveland

Source: Evaluations of Responsible Sexual Behavior Education in the Cleveland Metropolitan School District. (New York: Philliber Research Associates, December 2008).

The Responsible Sexual Behavior (RSB) Initiative was implemented beginning in the fall of 2006 to provide comprehensive sexuality education programs to all K–12 students in the Cleveland (Ohio) Metropolitan School District (CMSD).  Four comprehensive sexuality education curricula were specifically chosen for this initiative, All About Life (for grades K–3), F.L.A.S.H. (for grades 4–6), Making Proud Choices (grades 7–8), and Safer Choices (for grades 9–12). CMSD adopted a comprehensive health plan based on the Surgeon General’s Healthy People 2010 and the Center for Disease Control and Prevention’s Comprehensive School Health Program. The plan had four key goals for responsible sexual behavior among students: prevention of school-aged parenthood; support for pregnant and parenting school-aged students; prevention of the transmission of STDs, including HIV/AIDS, to students; support for students living with STDs, including HIV/AIDS.

In its first year, the 2006–07 school year, a combination of CMSD employees and educators from six community partner agencies implemented the four curricula.  They reached 36,500 students in grades K-12 of the nearly 50,000 students served by the entire school system.  The same year, a group of 14 physical education (PE) and health teachers underwent intensive training to deliver the curricula to their respective schools.  In the 2007–08 school year, the year in which the evaluation took place, the RSB initiative reached 26,326 students in all grades and was taught by the trained PE and health teachers as well as facilitators from the six community partner agencies.  Teachers and facilitators delivered the curricula over the course of approximately five days. 

In 2007 The AIDS Funding Collaborative hired Philliber Research Associates (PRA) to evaluate the progress and outcomes of the RSB initiative.  The evaluation concentrates on program implementation, student outcomes, parents’ perceptions, and stakeholder perceptions, where stakeholders were defined as CMSD health and PE teachers and external agency facilitators.  In order to evaluate the initiative, PRA conducted a random sample of schools that had not yet received the curricula and collected data from ten of the elementary schools and nine of the high schools.  The students at these schools were given two pre-tests; one a week before the instruction was to start, and the second at the beginning of class on the first day of instruction.  They then received a post-test at the end of the approximately five days of instruction.  The answers submitted between the two pre-tests were compared to the answers submitted between the second pre-test and the post-test in order to compare any post-intervention change to any change that occurred without an intervention. 

The evaluation of the program implementation focused on the number of students reached in each grade, teachers trained, and fidelity to the curriculum.  The original goal of the program was to reach 85 percent of high school students in the district.

To assess student outcomes, the evaluators surveyed 1,430 students, in grades 4–12. Average age and grade level were identical for both groups. The evaluation measured students’ overall changes in knowledge, attitude, skills, and behavioral intent (delaying/refusing sex, condom use, etc). Questions were asked to assess students’ understanding of important concepts covered in the curricula. The evaluation measured students’ attitudes about topics such as responsible sexual behavior, condom use, decision-making skills, saying no to sex, and condom-use negotiation. Finally, students were asked about their satisfaction with the intervention program, whether they would recommend the program to their peers, and how much they felt they learned as a result of the sexual behavior sessions. 

Parents were also asked to determine whether they were aware of the RSB initiative and what their role as parents were in the sexuality education of their children.  Finally, the evaluation included six focus groups and eight individual interviews with health and PE teachers and outside facilitators. The teachers and facilitators were asked about curriculum content and delivery, administrative support and buy-in, progress toward full implementation, and challenges encountered during the program.

Key Findings:

  • 64% of students targeted by the initiative participated in the programs by November 2007. Out of 41,442 CMSD students assigned to receive the comprehensive sexuality education curricula, 26,326 actually participated in the program.
  • 7,280 ninth through twelfth grade students, 6,449 seventh through eighth grade students, 5,424 fourth through sixth grade students, and 7,173 kindergarten through third grade students participated in the program. 
  • Students who participated in F.L.A.S.H, Making Proud Choices, and Safer Choices showed positive changes in student knowledge, attitudes, skills and behavioral intent.
  • 78% of students said they learned a lot as a result of the programs; 20% stated they learned “a little,” while only 2% claimed to have learned nothing.
  • 89% of high school students believed the Safer Choices program to be helpful; 93% would recommend the program to their peers.
  • Following the program, high school students reported they were more likely to talk with a partner about using protection during sex.  
  • In all but one classroom, K–3 students in the All About Life program responded that they learned good touch/bad touch and/or not letting anyone touch their private parts.
  • 94% of parents of children in grades K–6 found it somewhat important or very important for schools to be involved in sexuality education; 97% of parents of middle and high school students found it somewhat important or very important for schools to be involved.
  • In a survey of K–6 parents, only 30% knew that their child was receiving sex education at school. Only 46% of parents with children in grades 7-12 were aware that their child’s school was offering sexuality education.
  • Among parents who knew their children were participating in the RSB initiative, 91% reported engaging in discussions about sexuality with their children.
  • RSB facilitators received high approval marks from classroom teachers and observers regarding the presentation of the materials.
  • Teachers reported being most comfortable discussing how HIV/STDs are transmitted, delaying sex, and puberty. They reported being least comfortable discussing sexual intercourse, sexual orientation, and condom use.

SIECUS Analysis:

The people of Cleveland have taken it upon themselves to implement a district-wide comprehensive sexuality education program in an attempt to improve the health and wellbeing of their young people. As is evident by the study conducted by Philliber Research Associates, students at all grade levels are responding positively to the new Responsible Sexual Behavior Initiative and would even recommend the curricula to their peers. In addition to generating support and funding for the program, Cleveland schools are taking the important step of evaluating the curricula.  The investment Cleveland is making in its youth is amazing, and SIECUS hopes the city can be a model for other parts of the country.  We’re also looking forward to more research on the long-term impact of these programs.   

The study found that parents do support comprehensive sexuality education programs. Parents with children from all age-levels believe their children should receive information presented in the Responsible Sexual Behavior Initiative curricula. What is discouraging, however, is the lack of parental knowledge concerning sex education happening at the schools. More must be done to engage parents in the curricula, whether it is through letters sent home or direct communication. It is particularly important because those parents that are aware of the school’s sexuality education program are discussing the issues with their children.  More than 90 percent of parents who were aware that their child’s school offered sex education reported that they had a discussion with their child about sex or something they learned in the classroom.

The study also highlights the importance of teacher training.  Most trained teachers felt comfortable teaching the necessary material; however it’s important to note that teachers were less comfortable discussing sexual intercourse, condom use, and sexual orientation with their students. These issues need to be addressed in order to create comprehensive curricula inclusive of all youth.

In the fall of 2006, The Cleveland Metropolitan School District took a monumental step forward in implementing the Responsible Sexual Behavior Initiative. The programs are producing positive results and are preparing the youth of Cleveland for real-life challenges concerning their sexual health. While Cleveland continues to work on full implementation of the RSB Initiative, other cities, states, and the federal government should take notice and follow Cleveland’s lead in prioritizing comprehensive sexuality education.