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 Basic Set 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.

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 of 5 and 30 are available. Contact ETR regarding custom site license pricing to reprint student workbooks.

Program sets with supplemental materials to enhance student learning, including DVDs, pamphlets and posters, are also available. The enhanced set includes the LGBTQ Supplement.

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 STD and HIV risk, prevention, transmission, treatment and consequences.
• Perception of individual risk for pregnancy, STD and HIV 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 STD.
• 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).

References

Kirby, D., R. Barth, N. Leland, J. V. Fetro. 1991. Reducing the Risk: Impact of a new curriculum on sexual risk-taking. Family Planning Perspectives 23 (6): 253-263.

Hubard, B. M., M. L. Giese, J. Rainey. 1998. A replication of Reducing the Risk, a theory-based sexuality curriculum for adolescents. Journal of School Health 68 (6): 243-247.

Zimmerman, R. S., P. K. Cupp, L. Donohew, C. Sionean, S. Feist-Price, D. Helme. 2008. Effects of a school-based, theory-driven HIV and pregnancy prevention curriculum. Perspectives on Sexual and Reproductive Health 40 (1): 42-51./p>

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.

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 >>

Training & TA

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.

Training of Educators

Educators interested in implementing RTR should be skilled in using interactive teaching methods and guiding group discussions. It is highly recommended that educators who plan to teach RTR receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.
Training on RTR is available through ETR's Professional Learning Services. Training options include:

• Three-day Training of Educators (TOE)—ETR’s TOE is a professional learning process that builds the knowledge and skills required of adult learners to implement RTR with fidelity and, when applicable, germane adaptations. The learning process includes pre-work, skill-based instruction and post-training follow-up support. The TOE is designed intentionally to be outcome based by boosting skills that lead to quality implementation.
• Four-day Training of Trainers (TOT)—available for qualified, seasoned trainers who have experience in delivering RTR. The TOT prepares select trainer candidates to effectively prepare adult learners to implement the intervention with fidelity. Completion entitles participants to use ETR's research-based training design to conduct TOEs for their organization or designated affiliate group. TOT attendees who have completed the four-day TOT are eligible to attend a condensed TOT course on additional EBPs.
• RTRWorks!, a self-paced, highly interactive, evidence-based online training designed to prepare and support educators to effectively lead RTR. The training can be completed in just 2 to 5 hours, at the convenience of the educator.

Technical assistance (TA), coaching and ongoing support

ETR provides in-person and web- and phone-based TA before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation.

Enrichment Training

To support a holistic approach to teen pregnancy and HIV prevention programs, ETR offers a number of additional training and technical assistance opportunities, including content-specific workshops, skill-based trainings, organizational development consultation and much more. To learn more about these opportunities, visit our Training & TA pages >>

Adaptation

Adaptation support materials, training and TA are available to assist educators in meeting the needs of individual communities by implementing EBPs effectively and consistently with core components. All adaptation support is based on ETR's groundbreaking, widely disseminated adaptation guidelines and kits for effective adaptations.

Evaluation

ETR also provides evaluation support for EBP implementation. ETR uses well-established tools for measuring fidelity and outcomes. ETR's evaluation support blends participatory approaches with cutting-edge evaluation science. Services address process and outcome evaluation and include assistance with evaluation planning, instrument design and development, implementation fidelity, data management and analysis, performance measurement, continuous quality improvement (CQI) protocols, and effective tools and strategies for reporting results.

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