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 STD/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.
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.
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 STD/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 STD, including HIV. This research-proven approach addresses skills such as risk assessment, communication, decision making, planning, refusal strategies and delay tactics.
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 best, safest 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:
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:
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).
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.
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:
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.
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.
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.
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.
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:
The program logic model can be found here:
Logic Model (pdf)
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.
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.
Reyna, V. F., & Mills, B. A. (2014). Theoretically motivated interventions for reducing sexual risk taking in adolescence: A randomized controlled experiment applying fuzzy-trace theory. Journal Of Experimental Psychology 143(4): 1627-1648.
Cunningham, M. R., van Zyl, M. A., & Borders, K. W. (2016). Evaluation of Love Notes and Reducing the Risk in Louisville, Kentucky. Final Evaluation Report to the University of Louisville Research Foundation, Louisville, KY.
Barbee, A. P., Cunningham, M. R., van Zyl, M. A., Antle, B. F., & Langley, C. N. (2016). Impact of two adolescent pregnancy prevention interventions on risky sexual behavior: A three-arm cluster randomized control trial. American Journal of Public Health, 106, S85-S90.
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.
Core Components (pdf)
For answers to Frequently Asked Questions about program adaptations, please visit our Program Support Help Desk.
Read ETR's Adaptations Policy.
ETR has developed the following PowerPoint to facilitate implementation of the curriculum, particularly in virtual settings:
Click HERE to request access.
ETR also produces other tools to facilitate implementation. Click the link to view.
Fidelity Log (pdf)
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 Answer Key (pdf)
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.
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:
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.
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 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.
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.
(includes additional materials to enhance learning)