Program Success Center
for Sexual & Reproductive Health
Reducing the Risk
Reducing the Risk (RTR) is a 16-session curriculum designed to help high school students delay the initiation of sex or increase the use of protection against pregnancy and STI/HIV if they choose to have sex. This research-proven approach addresses skills such as risk assessment, communication, decision making, planning, refusal strategies and delay tactics. The program is available in both print and digital formats.
| Category | Program Features |
|---|---|
| Format |
Print or Digital |
| Setting |
School based |
|
Program Length |
16 hours/year | 1 year 16 sessions total |
| Age Group | Ages 14–18 |
| Look Inside |
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National Recognition
Proven effective in 3 studies, RTR has been chosen as an effective evidence-based program by the Centers for Disease Control and Prevention (CDC), the Office of Adolescent Health and other national organizations recognized as authorities on teen pregnancy prevention, including Emerging Answers 2007 and What Works 2010: Curriculum-Based Programs That Help Prevent Teen Pregnancy, The National Campaign to Prevent Teen and Unplanned Pregnancy; Programs That Work, 2010, Promising Practices Network; and Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections, Advocates for Youth.
Overview | Description | Population | Author | Who's Using
Overview
Reducing the Risk (RTR) is a 16-session curriculum designed to help high school students delay the initiation of sex or increase the use of protection against pregnancy and STI/HIV if they choose to have sex. The major focus is the development of attitudes and skills that will help teens prevent pregnancy and the transmission of STIs, including HIV. This research-proven approach addresses skills such as risk assessment, communication, decision making, planning, refusal strategies and delay tactics.
Description
The greatest emphasis of Reducing the Risk is on teaching students the interpersonal or social skills they can use to abstain or protect themselves. Abstinence is presented as the safest, most effective and most common choice for high school students, but Reducing the Risk also recognizes that some students are sexually active. For this reason, students are given clear guidelines and rationales for using protection during sex. Young people do not find these messages contradictory, and lessons reviewing protection do not increase the likelihood that students will become sexually active. Students learn they must consult with their parents and think through their own values to decide what to do.
Two key skills are taught:
- Refusal skills – Responses that clearly say no in a manner that doesn't jeopardize a good relationship, but which leave no ambiguity about the decision not to have sex or to refuse unprotected sex.
- Delay tactics and alternative actions – Ways students can avoid a situation or delay taking action until they have time to decide what to do or say, or until they are more prepared to make a decision.
Reducing the Risk is delivered through roleplays, skill practice, brainstorming, mini-lecture and worksheet activities. Roleplays are an essential and powerful part of the program. At first, students may be hesitant about their performances, but they soon begin to enjoy these opportunities and use them to great advantage. Teachers help students by encouraging them to practice their interpersonal skills in the roleplays. The more students practice effectively saying no to sex (or to unprotected sex), the more likely they'll be to use these skills in real life.
As a result of participating in RTR, students will be able to:
- Evaluate the risks and lasting consequences of becoming an adolescent parent or becoming infected with HIV or another STI.
- Recognize that abstaining from sexual activity or using contraception are the only ways to avoid pregnancy, HIV and other STIs.
- Conclude that factual information about conception and protection is essential for avoiding teen pregnancy, HIV and other STIs.
- Demonstrate effective communication skills for remaining abstinent and for avoiding unprotected sexual intercourse.
Population Served & Setting
RTR can be implemented with high school students in both rural and urban areas. It has been used successfully with students from a range of racial/ethnic backgrounds. While designed primarily for ninth grade students, it can be used with students in other appropriate grades (e.g., 8–12) or the appropriate age (e.g., 13–18).
About the Author
Richard P. Barth, MSW, PhD, is Dean, School of Social Work, University of Maryland. His AB, MSW and PhD are from Brown and UC Berkeley, respectively. He has served as a chaired professor at UC Berkeley and the University of North Carolina.
He was the 1986 winner of the Frank Breul Prize for Excellence in Child Welfare Scholarship from the University of Chicago, a Fulbright Scholar in 1990 and 2006, the 1998 recipient of the Presidential Award for Excellence in Research from the National Association of Social Workers, the 2005 winner of the Flynn Prize for Research, and the 2007 winner of the Peter Forsythe Award from the American Public Human Services Association.
He is the author, co-author, or editor of ten books and three curricula, including Reducing the Risk, Safer Choices and Power through Choices, all designed to reduce the likelihood and risks of youth becoming sexually active. He was also the Principal Investigator (PI) of the ENABL evaluation in California, and served as PI of the evaluation of the Hewlett Foundation’s Responsible Fatherhood and Male Involvement Initiative in the San Francisco Bay Area and the Teenage Pregnancy Prevention Initiative (TPPI) in North Carolina. He has published more than 120 articles in a variety of health and social work journals and is on the editorial board or a consulting editor of Social Work, Social Service Review, the Journal of Adolescent Research, Children and Youth Services Review and Adoption Quarterly. He has also served on the boards of numerous child-serving agencies and is now a Commissioner on the Advisory Board of the Baltimore City Social Services Department.
He has led research studies and service evaluations for numerous federal and state agencies and foundations in the area of children’s services. For 8 years he served as Co-PI on the National Survey of Child and Adolescent Well-Being, the first national probability study of child welfare services. He is currently PI of a Maryland DHR funded effort to examine reproductive health services and teenage births in foster care.
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.
Some of the sites that have purchased Reducing the Risk include:
- Montana Department of Health & Human Services
- Duval County Public Schools, Florida
- Maricopa County Department of Public Health, Arizona
- San Diego Youth Services, California
- Wyoming Alliance of Boys & Girls Clubs
- Buffalo Public Schools, New York
- San Antonio Metropolitan Health District, Texas
- Belmont County Health Department, Ohio
- Communities in Schools of the Charleston Area, Inc, North Carolina
- Planned Parenthood of Greater Ohio
- Sedgwick County Health Department, Kansas
- West Virginia Department of Health & Human Resources
Length | Elements | Staffing | Notification
Length of Program
The program consists of 16 classes, conducted 2-3 times per week. The classes must be taught in sequence. The ideal class size is between 10 and 30 youth. The classes are designed for 45-60 minute periods. Most can be expanded to fill more time, or 2 full periods, by increasing time to practice the skills and discuss the activities.
Program Elements
The Reducing the Risk program includes a teacher’s guide, activity kit, and student workbooks, plus STD Facts for Teens, HIV Facts for Teens and Birth Control Facts for Teens pamphlets—everything required for one classroom of 30 students. Student workbooks are available in English and Spanish. The program is also available in a digital format, with an online flipbook version of the teacher’s guide and fillable PDFs of the Student Workbook pages.
An optional LGBTQ Supplementhelps teachers build a supportive environment for LBGTQ students. It includes a lesson that can be taught before implementing the intervention as well as suggestions for acceptable adaptations to make the RTR program more inclusive of LGBTQ youth.
Student workbooks are required for every student. Additional classroom workbook sets or digital licenses of 5 and 30 are available. Contact ETR regarding custom site license pricing to reprint student workbooks.
ETR also provides free downloads of pre- and post-tests and Adaptation Tools.
Staffing Requirements
This curriculum is designed to be taught by classroom teachers or family life educators. Educators interested in implementing this program should be skilled in using interactive teaching methods and guiding group discussions, and should be comfortable with the program content.
Parent/Guardian Notification
It is essential to inform parents and guardians regarding the nature and scheduling of this or any sexual health education program. Prior to implementation of the curriculum, families should receive written notice describing the goals of Reducing the Risk and the nature of the content to be covered. Parents also should be given an opportunity to view the curriculum and related materials if they wish. The vast majority of parents want their children to receive appropriate instruction and be given the information and skills they need to protect their sexual health, but parents/guardians also must be allowed the chance to opt out or exclude their children from participating in the program, if they wish.
Theory | Core Content | Logic Model | Evidence Summary | References
Theory
Reducing the Risk is based upon several interrelated theoretical models: Social Learning Theory, Social Inoculation Theory and Cognitive Behavior Theory. As applied to pregnancy prevention, Social Learning Theory suggests that the likelihood of an action such as using birth control is influenced by an understanding of what must be done to avoid pregnancy, a belief that the method will successfully prevent pregnancy and the anticipated benefit of the action. Social Inoculation Theory suggests that people develop resistance to social pressure when they can recognize the forms of pressure, are motivated to resist them, and are capable of doing so. Cognitive Behavior Theory suggests that young people need specific cognitive and behavioral skills to resist pressures and successfully manage interpersonal encounters. The model has 3 components: activities to personalize information about sexuality, reproduction and contraception; training in decision-making and assertive communication skills; and practice in applying these skills in personally difficult situations.
Key content covered by the program consists of:
- Knowledge of pregnancy risk and prevention.
- Knowledge about STI and HIV risk, prevention, transmission, treatment and consequences.
- Perception of individual risk for pregnancy, HIV and other STIs and their consequences if teenagers engage in unprotected sex.
- Knowledge of how to be abstinent or use birth control methods effectively and how to access health care information and contraception (including condoms).
- Effective and ineffective refusal skills.
- Social and peer norms, as well as personal attitudes about abstinence, sex, unprotected sex, condoms and contraception.
- Refusal and communication skills in pressure situations in order to avoid pregnancy and STIs.
- Skills to obtain health care information and contraception from a clinic and use it.
- Skills to communicate with parents or other adults about teen sexual activity and birth control.
Logic Model
The program logic model can be found here:
Logic Model (pdf)
Evidence Summary
Reducing the Risk is one of the first rigorously evaluated sexuality education curricula to have a measurable impact on behavior, and the first curriculum that has been independently implemented and evaluated in three different states and been found to significantly improve one or more sexual behaviors in each.
In a California study:
- Reducing the Risk delayed the onset of intercourse at 18 months among sexually inexperienced students by as much as 24% and reduced the rate of unprotected intercourse by 40% (Kirby, et al., 1991).
- The program significantly increased teens' knowledge and communication with parents regarding abstinence and contraception.
In an Arkansas study:
- Reducing the Risk both delayed the initiation of sex among youth who had not had sex at pretest and increased condom use among those youth who did initiate sex (Hubbard, Giese and Raney, 1998).
In a Kentucky study:
- Reducing the Risk significantly delayed the initiation of sex (Zimmerman et al., 2008).
In additional studies:
- Later replication studies have also shown evidence of effectiveness. One replicated the favorable impact on sexual initiation found in earlier studies (Reyna and Mills, 2014). In the other, Reducing the Risk delayed sexual initiation and also had a positive impact on the incidence of pregnancy and the number of participants who reported having had sex without an effective birth control method (Cunningham et al., 2016; Barbee et al., 2016).
References
Adaptation Guidelines | Other Tools | Pre/Post Tests | FAQ | Policy
Adaptation Guidelines
ETR is a leader in developing adaptation guidelines to enable professionals to adapt evidence-based intervention programs for implementation in underserved communities, while maintaining fidelity to the intervention's core components. To produce the best adaptation tools, ETR works directly with the developer of each intervention to ensure that these tools are of the highest quality and meet the different needs of the field and end users, e.g., teachers, trainers, program mangers/staff, research teams, and funders.
Click the links below to view Adaptation Guidelines for Reducing the Risk.
Adaptation Green/Yellow/Red Guidelines (pdf)
Core Components (pdf)
For answers to Frequently Asked Questions about program adaptations, please visit our Program Support Help Desk.
Read ETR's Adaptations Policy.
Tools for Online Implementation
ETR has developed the following PowerPoint to facilitate implementation of the curriculum, particularly in virtual settings:
- Reducing the Risk PowerPoint Slides
Click HERE to request access.
Other Implementation Tools
ETR also produces other tools to facilitate implementation. Click the link to view.
Fidelity Log (pdf)
Pre/Post Tests
Classroom teachers can use pre/post tests to examine whether short-term knowledge learning objectives have been met. A simple pretest-posttest assessment design can be used to measure pre-instruction levels and post-instruction changes in student learning.
Your ability to detect student change using this survey may vary and can be affected by numerous factors (e.g., number and content of lessons students receive, student scores at pretest, student motivation and interest in topic and survey, etc.) Improvement on the Reducing the Risk Student Knowledge Survey between pretest and posttest can be viewed as supportive, but not definitive, evidence of the curriculum's impact on short-term knowledge learning objectives. A well designed evaluation study (e.g., using a strong experimental design with a well matched comparison group and adequate sample size) with more extensive measurement would be needed to provide stronger evidence of curriculum impact.
Survey (English) (pdf) Survey (Spanish) (pdf)
Survey Answer Key (pdf)
Learn more about how ETR can help with your evaluation needs >>
NOTE: Due to Covid-19, ETR is offering our Trainings in a virtual format only at this time. The virutal training addresses both in-person and online implementation of the program and our trainers will model the virtual delivery of activities.
Training of Educators (TOE)
For over 30 years, ETR has been building the capacity of community-based organizations, schools, school districts, and state, county and local agencies in all 50 states and 7 U.S. territories to implement and replicate evidenced-based programs (EBPs) to prevent teen pregnancy, STD/STI and HIV. Our nationally recognized training and research teams work in partnership with clients to customize training and technical assistance (TA) to address the needs of their agencies and funding requirements.
ETR’s Virtual Training of Educators (TOE) for Reducing the Risk equips sexual health facilitators with the knowledge and skills necessary to implement the program with youth.
All trainings align with ETR’s distributive learning process, an interactive experience that takes place over time. Core to this research-based approach is the acquisition of knowledge and development of skills, followed by the implementation of the program and educator self-reflection. During this process, ETR trainers engage learners through teaching strategies, interactive activities, modeling and follow-up support.
Training Components
The virtual TOE for Reducing the Risk has the following components:
- Priming Activities prior to Live Session 1 help participants ground themselves in the theory that informed the development of the program as well as the research detailing the program’s impact on the sexual health behaviors of youth.
- Live Sessions take place in three 2.5-hour sessions over a 3-week period. Using engaging interactive activities along with a variety of virtual tools and strategies, the trainer models best practices for providing sexual health education and demonstrates effective teaching strategies for both in-person and virtual implementation.
- Intersession Activities are completed between live sessions and take around 30 minutes. They enable participants to continue the learning process by completing various tasks such as reviewing program content and completing an Action Planning document.
- Practice Session follows the completion of the third live session and is a core part of ETR’s distributive learning approach. After completing the practice session, participants submit a Practice Session Reflection document to the trainer and receive their Certificate of Completion.
- Follow-up Support is part of every ETR training and is provided for 3 months after the last live session. During this time, the trainer provides additional resources via email and is available to answer questions, address challenges and brainstorm solutions tailored to each participant’s needs.
Participants in all trainings are required to commit to each component as it is a necessary to ensure that they feel confident and prepared to implement the program with youth.
Training Goal
Educators will have the knowledge, skills and confidence to effectively implement the program with youth.
Training Objectives
- Share accurate information related to:
- Key findings from student outcomes of the EBP evaluation
- Facts about STI and HIV prevention methods
- Facts about pregnancy prevention methods
- Increase youth proficiency to:
- Set and evaluate goals
- Utilize refusal skills
- Utilize negotiation skills
- Utilize problem-solving skills
- Assess and avoid risky situations
- Avoid sex or say no to unprotected sex
- Obtain and use condoms correctly
- Effectively use teaching strategies:
- Brainstorming
- Roleplay
- Small-group work
- Large-group discussion
- Video processing
- Answer student questions accurately and sensitively.
- Identify activity objectives and core program content to inform adaptations to lessons and specific activities.
- Identify the impact of personal values on teaching.
- Create an action plan to implement the program.