Program Success Center

for Sexual & Reproductive Health

IN·clued

In-clued coverIN·clued: Inclusive Healthcare – Youth & Providers Empowered is an LGBTQ-centered and evidence-based program that addresses the sexual health disparities affecting LGBTQ youth across the United States. This dual approach program combines LGBTQ youth-friendly health services with direct relevant and inclusive sex education. It consists of a 3-hour interactive youth workshop and a 3-hour interactive workshop for health center staff and providers.

Category Program Features
Setting Community based
Program Length 3 hours per session
2 sessions total
Age Group Ages 14–19
Look Inside

Program Summary
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Overview | Description | Population | Authors | Who's Using

Overview

IN·clued is an exciting new educational program from Planned Parenthood of the Great Northwest and the Hawaiian Islands that addresses the sexual health disparities affecting lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ) youth across the United States. Currently, IN·clued is one of the only evidence-based sexual health education programs designed specifically to meet the needs of LGBTQ youth.

 

Description

IN·clued is a program that aims to lower teen pregnancy rates and STD rates among LGBTQ youth ages 14-19. The IN·clued Program takes a dual approach to address the unjust sexual health outcomes for LGBTQ young people: (1) a three-hour workshop for LGBTQ youth on sexual health and accessing healthcare, and (2) two 90-minute, youth-led workshops for healthcare providers and clinic staff on best practices for providing care to LGBTQ young people. This combination has the outcome of youth seeking and receiving sexual health services on a more consistent basis.

The program is grounded in the Health Belief Model theory of change and several evidence-based best practices in adolescent sexual health prevention education. It uses an established theoretical foundation, sound educational pedagogy, and the use of peer educators for program delivery.

 

Populations Served & Setting

IN·clued is a program designed specifically for LGBTQ young people. Unlike sex education programs that are simply “inclusive of” LGBTQ learners, this program speaks directly to them and centers their experiences and needs.

IN·clued is made up of two workshops that serve two different populations: The youth workshop is for youth ages 14-19 who identify as LGBTQ in some way. The Health Center workshop is for all Health Center staff and providers.

The Youth Workshop works when facilitated with groups of youth who are already members of an established group, (e.g. a Queer-Straight Alliance, an LGBTQ community youth activism group, etc.), as well as with groups of youth recruited just for the purpose of this program.

The ideal group size for the IN·clued Youth Workshop is 12–15 participants per workshop. However, the workshop has been successfully facilitated with up to 35 participants in the space, and with as few as four participants. For especially large or small group sizes, adaptations will need to be made to the activities, and space, accommodations, and facilitators will need to be prepared to make these adaptations.

A Note on Trauma: Because the workshop covers sexual health content and includes discussions of sexual behaviors, safer sex practices, and sexual health services, young people who’ve experienced sexual trauma or trauma at the hands of healthcare systems may experience undue discomfort or a lack of safety in the workshop. It is up to the discretion of the facilitators to review the curriculum and decide on the appropriateness of the content for their participant group. Similarly, facilitators who have trauma related to the content of this workshop may experience discomfort or lack of safety themselves. Again, it is up to the discretion of the facilitators, their supports (supervisors, etc.) to decide who is the best fit to facilitate this program.

 

About the Authors

Planned Parenthood of the Great Northwest and the Hawaiian Islands (PPGNHI), is a leader in reproductive health care, rights, and education, and has been working with and serving youth in the sexual health field for over 30 years. PPGNHI provides medically accurate, age appropriate, comprehensive sex education that furthers understanding of human sexuality and promotes healthy behavior.

Annika Shore, MPH, serves as Director of Education at Planned Parenthood of the Great Northwest and the Hawaiian Islands. In this role she oversees educational programs ranging from LGBTQ+ specific sex education, to Family Programs, to Capacity Building efforts. She led curriculum and program development on IN·clued: Youth and Providers Empowered, a sex education program intended to reduce unintended pregnancies and STDs among LGBTQ+ adolescents across the United States. She received her MPH from Columbia University, with a certificate in sexuality, sexual and reproductive health. She comes to the adolescent sexual health education field with over 12 years of experience working with young people and adults, providing relevant and innovative sexual health education; HIV, STD and pregnancy prevention education; youth development programming; and capacity building for youth-serving professionals. The bulk of her work has centered on engaging underserved communities of youth through peer education and youth-adult partnership programs, with a focus on LGBTQ+ adolescent health and activism, as well as providing education and training to adults who serve youth.

There are many individuals and entities whose hard work and partnership went into the development of the IN·clued Program. The input and contributions of LGBTQ+ young people to this project, through our community assessment, feedback during pilot programs, ideas, skills, and expertise all went into the development of this program. Additionally, we acknowledge all of the adults whose skills, expertise, and passion went into this project and made it better. They served as curriculum reviewers, implementation partners, facilitators, and thought partners.

 

Who’s Using?

ETR's effective, award-winning, evidence-based resources are used by schools, departments of education, youth groups, government agencies and clinics nationwide.

Length | Elements | Staffing

Length of Program

Youth Workshop: The program is a 3-hour interactive workshop for LGBTQ youth on sexual health and accessing healthcare.

Health Center Workshop: The program is a 3-hour workshop that can be delivered in two 90-minute, youth-led sessions for healthcare providers and clinic staff on best practices for providing care to LGBTQ young people. The two sessions can be implemented one after the other, or they can take place on different days.

 

Program Elements

The Youth Workshop comes with materials and resources needed for effective implementation. The program package, (purchased individually or as a bundle with the Health Center Workshop), includes a Youth Program Manual, Facilitator Curriculum, Peer Educator Training materials, and Workshop materials and resources, (including the IN·clued zine, mp4 workshop video, Q-cards ©, adaptations guidance, and more).

The Health Center Workshop comes with materials and resources needed for effective implementation. The program package, (purchased individually or as a bundle with the Youth Workshop), includes a Facilitator Curriculum, Peer Educator Training materials, and Workshop materials and resources, (including Q-cards ©, "We're Clued In" stickers, Adaptations Guidance, and more).

All IN·clued Facilitators are highly encouraged to participate in the IN·clued Training of Facilitators (TOF). Virtual or in-person trainings are available. For more information on IN·clued trainings see the Training & TA tab.

 

Staffing Requirements

The Youth Workshop should be implemented by community-based educators or those who have sexual health education experience and sufficient sexual health knowledge and facilitation skills to answer questions and lead activities smoothly. Additionally, the young people who took part in the IN·clued community assessment voiced a strong desire to have LGBTQ facilitators, so we encourage those facilitating to have demonstrated connection to and experience with the LGBTQ community in which they’ll be facilitating the workshop. If peer educators are engaged as co-facilitators, they should be trained to facilitate activities within the curriculum, be clear on their roles, and have had the chance to practice more than once.

The Health Center Workshop is co-facilitated by adult facilitators and peer educators. We suggest adult facilitators be community-based educators working with a preexisting peer education program. Peer educator involvement is required for the Health Center Workshop with adult clinicians and health center staff. The eer educators delivering the health center curriculum should receive up to 20 hours of training by professional adult mentors on facilitating activities within the curriculum. They should be clear on their roles, and have had the chance to practice more than once.

Individuals implementing IN·clued should be knowledgeable about the content, be comfortable discussing the material and answering sensitive questions about sexual behaviors and/or LGBTQ sexual health care, and have experience using interactive teaching strategies such as roleplaying. Ideally, all educators implementing the program should be trained on its contents and teaching strategies. All facilitators are highly encouraged to participate in training through the IN·clued Training of Facilitators (TOF) process specifically for the workshop they will be facilitating. The process for each workshop (Youth and Health Center) consists of a 4-hour virtual or a 1-day, in-person training.

 

Evidence Summary |Logic Model | Theory

Evidence Summary

Findings

Youth Workshop:

The results of this Randomized Control Trial found that participants in the IN·clued Youth Workshop were significantly more likely to have the following positive outcomes than their peers who did not participate in the workshop 12 months after the baseline survey:

  • Lower likelihood of having recent vaginal sex without condoms (and fewer times doing so)
  • Greater knowledge of sexual health
  • Greater self-efficacy to advocate for their own sexual health needs
  • Greater likelihood of having been to a doctor or clinic for (and received) contraception or birth control

Outcomes varied by demographic characteristics and were positive among groups not often served by adolescent sexual health programs.

The IN·clued program had a significant and positive impact on sexual health care outcomes among those who identified as transgender, nonbinary, genderqueer, genderfluid, gender non-conforming or additional non-cisgender identities. In this subgroup, after one year, a significantly greater proportion of IN·clued participants than control participants reported having been to a doctor or clinic for contraception or birth control, receiving contraception or birth control, having had any sexual or STD health care, and having confidence talking to providers about sexual health issues.

The IN·clued program had significant and positive impacts for People of Color including significant and positive sexual behavioral changes. One year after the workshop, compared to control group youth, IN·clued participants had significantly smaller proportions reporting having had vaginal or anal sex without condoms in the past three months. Compared to the control group, IN·clued youth also reported higher self-efficacy scores and a greater proportion reported comfort asking their doctors to do something differently.

Health Center Workshop:

The results of this Randomized Control Trial found that participants in the IN·clued Health Center Workshop were significantly more likely to have the following positive outcomes than their peers who did not participate in the workshop.

  • The short-term clinic outcomes show statistically significant positive changes in overall knowledge scores, overall comfort scores, and overall desires for their work environments.
  • Provider comfort levels regarding serving LGBTQ youth, and asking patients about their gender, sexual orientation, and/or birth-assigned sex all increased significantly.
  • After the program, clinic staff were also significantly more likely to believe their clinics should use Q cards.

The long-term clinic outcomes one year later show statistically significant positive differences between the program and survey-only group for using inclusive or open-ended questions about sexual relationships.

Research Design

The IN·clued Program was rigorously evaluated using a Randomized Control Trial (RCT) evaluation design. By conducting an RCT we are able to demonstrate that the outcomes for young people were directly caused by participation in the program, rather than by random chance. This evaluation was funded through the federal Office of Adolescent Health Teen Pregnancy Prevention Initiative.

Due to this evaluation process, each IN·clued workshop was subject to the following requirements:

  • The IN·clued curriculum was approved by the Office of Adolescent Health as being medically accurate, age and developmentally appropriate for the intended audience, inclusive, and trauma-informed.
  • Each IN·clued workshop was implemented with fidelity to the entire program curriculum. No site-specific adaptations to the program activities were made during the course of the evaluation.
  • Youth were randomly assigned to one of two groups. One group received the IN·clued Youth Workshop; the other group received a set of activities that were LGBTQ-centered but made no mention of sexual health information, skills, or content.
  • Clinics were randomly assigned to one of two groups. One clinic to the program group, which received the IN·clued youth-led workshop, and one to control, or survey-only group, which did not receive any specialized training.

The Youth Workshop evaluation was conducted from 2015 through 2020, and enrolled 1,401 LGBTQ young people between the ages of 14 and 19 from 16 states across the United States: Alaska, Washington State, Oregon, California, Montana, Utah, Texas, Nebraska, Iowa, Wisconsin, Minnesota, Michigan, Massachusetts, Rhode Island, Connecticut, and North Carolina.

The Health Center Workshop evaluation was conducted from 2015 through 2019, and enrolled a total of 22 clinics and 471 clinic staff from seven states across the United States: Alaska, Massachusetts, Minnesota, Montana, Oregon, Utah, and Washington.

Data Gathering

Youth Workshop: Youth who attended the IN·clued Youth Workshops were asked to complete a baseline survey, a 3-month (after the workshop), and a 12-month follow-up survey, to gauge any short and long-term changes in knowledge, self-efficacy, healthcare acquisition, and sexual behavior. Those assigned to the IN·clued program group also took a satisfaction survey immediately after the workshop.

Health Center Workshop: Clinic staff assigned to both groups were asked to complete a baseline survey and a survey one year after the program to gauge any long-term changes in knowledge, comfort, or desires for their work environments. Those assigned to the IN·clued program group also took a post-program survey immediately after the workshop to gauge any immediate changes.

 

Logic Model

The program logic model can be found here:

Logic Model (pdf)

 

Theory

The IN·clued program is built on several evidence-based best practices in adolescent sexual health prevention education. It uses an established theoretical foundation, sound educational pedagogy, and the use of peer educators for program delivery.

The IN·clued Youth Workshop is built on the Health Belief Model, which posits that six cognitive constructs impact health behavior change:

  1. Perceived susceptibility—a person’s belief that they are at risk for an adverse health outcome.
  2. Perceived severity—a person’s belief that the risks have serious consequences.
  3. Perceived benefits—a person’s belief that changing their behavior carries benefits.
  4. Perceived barriers—a person’s belief that the costs of taking action are outweighed by the benefits.
  5. Cues to action—a person’s exposure to factors that prompt behavior change.
  6. Self-efficacy—a person’s confidence in their ability to successfully perform an action (e.g. change their behavior).

Each of the activities in the Youth Workshop map directly to one or more of the Health Belief Model constructs, solidifying the program’s likelihood to impact participant behaviors.

Peer Education (optional)

The IN·clued Program is facilitated by trained sexual health educators, who may be accompanied by teen peer sexual health educators. The peer educators delivering the curriculum should receive up to 20 hours of training by professional adult mentors. Their involvement is optional but encouraged in the Youth Workshop, as it enhances the workshop’s relevance and proven impacts for LGBTQ youth participants, especially if the peer educators identify as LGBTQ themselves. Peer educator involvement is required for the Health Center Workshop with adult clinicians and health center staff. The peer education model is used with great success in both national and international public health educational programming.

 

Adaptation Guidelines | Communication Tools | FAQs | Policy

Adaptation Guidelines

Click the links below to view Adaptation Guidelines for IN·clued.

Youth Workshop Adaptation Green/Yellow/Red Guidance (pdf)

Health Center Workshop Adaptation Green/Yellow/Red Guidance (pdf)

 

Communication Tools

IN·clued Program Summary (for youth and health center workshops)

IN·clued Program Summary (for youth workshop only)

 

For answers to Frequently Asked Questions about program adaptations, please visit our Program Support Help Desk.

Read ETR's Adaptations Policy.

Training of Facilitators

Training

Educators planning to implement IN·clued are highly encouraged to attend an IN·clued Training of Facilitators (TOF). IN·clued developers believe in the importance of preparing and fully training educators who teach IN·clued to youth and health center staff, thereby increasing the efficacy of the program to impact youth behavior.

Those attending will engage in an interactive learning process in a fun and supportive environment. Educators will be trained to implement the curriculum using an LGBTQ-centered approach to sex education. Upon completion, participants will have a solid foundation to work from to successfully teach IN·clued with a high degree of comfort and fidelity.

The IN·clued TOF includes:

  • Online course—a 4-hour virtual TOF with IN·clued Trainers for each IN·clued workshop that builds a foundation of knowledge and skills for facilitating IN·clued

OR

  • In-person training—an all-day, in-depth TOF with IN·clued Trainers for each IN·clued workshop that delves deeper into the program and builds the knowledge and skills for facilitating IN·clued.

Learn more about these and other training opportunities, see the schedule of upcoming trainings, and register HERE.

 

Technical assistance (TA), coaching and ongoing support

Technical Assistance is provided by IN·clued trained staff. It is available for IN·clued facilitators who have gone through the IN·clued TOF. Please contact INclued@ppgnhi.org for more information and pricing.

IN·clued Pricing

Youth Curriculum—1-Year Subscription – $399.99
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(contains everything needed to teach with fidelity)

  • IN·clued Youth curriculum and scripts (digital)
  • Youth curriculum workshop materials:
    • Q Cards (50)
    • Zines (50)
    • Pronoun Pins (25 each)
    • PowerPoint
    • printable versions of paper materials
    • mp4 of IN·clued Alexa Talks video and access to online version with closed captions
  • Adaptations Guidance
  • Recruitment Encyclopedia
  • Guidance Manual (digital)
  • Peer Educator Training Manual, materials and PowerPoint

Health Center Curriculum—1-Year Subscription – $399.99
BUY NOW

(contains everything needed to teach with fidelity)

  • IN·clued Health Center curriculum and scripts (digital)
  • Health Center workshop materials:
    • Q Cards (100)
    • "We're Clued In" stickers (50)
    • Pronoun Pins (25 each)
    • printable versions of paper materials
  • Adaptations Guidance
  • Peer Educator Training Manual, materials and PowerPoint

 

Curricula Bundle—1-Year Subscription – $599.99
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  • Includes all materials for both workshops listed above.

Additional IN·clued Materials

  • IN·clued T-shirts
  • IN·clued Mugs
  • IN·clued Pens
  • IN·clued Journal
  • IN·clued Stickers

IN·clued Training of Facilitators

Learn more about virtual and in-person training opportunities and pricing, or register for a training HERE.