A comprehensive model for teaching teens that are in high-risk environments.
- Why a Manual on Sexuality Education for High-Risk Youth?
Streetwise to Sex-Wise provides an easy to use yet comprehensive model for a basic series on human sexuality for high- risk teens. It applies a current “state-of-the-art” methodology of sexuality education to teens in non-traditional settings who often have limited academic skills and are resistant to classroom- based learning. The lessons are simple, concrete and actively involve group members in the learning process. They extend beyond mere factual information and address attitudes, values, and skills, an approach that experts find is more likely to lead to positive behavior change in young people.
In addition, this manual provides background information on teaching sexuality education to high-risk teens, including profiles of the sexual health concerns of four specific high-risk populations. And finally it includes a resource section of books, audio-visuals, and other teaching tools especially appropriate for high-risk youth.
A substantial amount of evaluation has been done on Streetwise to Sex-Wise. Details can be found here.
Young people have always been faced with having to make significant decisions that have long-term impacts on their sexual health and well-being. Today, with digital information at their fingertips, youth can easily research and develop their own conclusions — a dynamic that can be beneficial but can also lead to high-risk, misinformed choices.
Young people’s decisions are often influenced by messages, expectations and cultural ideologies promoted on social media and in the world around them. Even with all these external forces and narratives, health professionals recognize that adults can continue to have influence, meaning and power in adolescents’ lives, shaping their sexual and personal identities.
Unfortunately, most programs and educational materials developed to assist adults and kids alike in this process are out of date, working to isolate youth who feel that these resources do not speak to their current reality. The consequence of this for the adult-youth relationship — particularly when it comes to topics related to sexuality — can be a strained dynamic that potentially inflicts serious damage on youth’s perspective and how they internalize messaging around their sexual identity.
Streetwise to Sexwise is a critical tool for reaching high-risk youth with an approach that captures the latest developments in sexuality education and research, and is specifically centered around student learning. In its first edition, Streetwise introduced the Principles for Sex Education into the lexicon of what is now The Center for Sex Education (CSE). These principles have become the foundation and philosophy of all CSE publications. New principles regarding the need to address sexual consent and sexual trauma were added to this latest edition, making it the most responsive and comprehensive to date.
First published in 1993, and now in its third edition, Streetwise is one of the most widely used sexuality education teaching manuals. It employs the signature style of the CSE: engaging, highly interactive and focused on student-centered learning. Beyond the great lesson plans, this manual has substantial sections helping facilitators to understand the unique sexual health needs of high-risk youth.
What is most impressive about Streetwise is that it addresses all facets of identity — age, race, cultural identity, sexual identity, gender identity and ethnicity — thus redefining inclusivity. To promote an authentic approach to the conversations it encourages, this edition notably includes profiles about teen fathers, transgender and gender nonconforming youth, and youth who have been involved in commercial sex work, in addition to updating the youth profiles from previous editions.
Throughout my career working with both community-based organizations and in academia, much of my work has been focused on supporting and educating those in underserved communities. I commend the ongoing efforts and commitment of the CSE to address these populations in a unique and effective way. Whether you are an educator, parent, nurse, doctor, caregiver or young person, now that you have found this book, please give yourself a break and read it!
Christian Thrasher, MA, CSC, CSE
Senior Vice-President of Behavioral Health
Section 1: Background for Educators
A Healthy Sexuality Mindset for Working with High-Risk Youth
Why a Manual on Sexuality Education for High-Risk Youth?
How to Use Streetwise to Sexwise
A Framework for Understanding Sexuality
Profiles of Select Youth Populations
Lesbian, Gay, Bisexual and Queer (LGBQ) Youth
Pregnant Teens and Teen Parents
Sexually Abusive Youth
Teens Who Have Been Sexually Abused
Transgender and Gender Nonconforming (TGNC) Youth
Youth Involved in Commercial Sexual Exploitation
Principles for Sex Education
Trauma-Informed Sexuality Education
Five Things to Know About Trauma
Creating a Group Atmosphere Conducive to Learning about Sexuality
How to Use Role-Play
Section 2: Staff Training Workshops
1: Healthy Sexuality 101
2: Building Comfort Talking with Teens about Sexuality
3: Having Great Mentoring Moments About Sexuality with Teens
Section 3: Lessons
1: Getting Ready
2: What Do You Call “Down There”?
3: Sex: The Facts, the Acts, and Our Feelings
4: “Yes Means Yes” and “No Means No”
5: Swept Away Is Not OK
6: Conversation is the Key
7: Love Gloves for Love Bugs
8, Part 1: Who You Like and Who You Love
8, Part 2: What It’s Really Like
9: “What If We Get to First Base and…?”
10: Is This Really Love?
11: Sex, a Decision for Two
12: Child Sexual Abuse
14: The Porn Explosion
15: Taking Care of Our Sexual Selves
Sexual Health Concerns for High-Risk Teens
Youth in general — regardless of class, race, ethnicity or risk status — may experience challenges related to their sexual health. Yet youth from high-risk populations (described in the section “A Healthy Sexuality Mindset for Working with High-Risk Youth”) have more complications than other teens. Being aware of these potential issues, and prepared to address them, is a critical part of educating around sexual and reproductive health topics.
The statistics below provide a glimpse into the additional risk factors that high-risk teens may experience. However, when working with these teenagers, it is important to keep in mind that, while they face challenges, the challenges should not define your understanding of the individuals you work with.
Pregnant and Parenting Teens
- Approximately 1 in 4 teen girls in the United States will get pregnant at least once by age 20.
- Teens with more risk factors are more likely to experience multiple adolescent pregnancies than teens with fewer risk factors.
- Teenagers who identify as lesbian, gay or bisexual are more likely to experience a pregnancy than teens who identify as heterosexual.
- As many as 41% of youth in foster care have had sexual intercourse by age 13.
- Studies suggest that pregnancy, childbearing and STI rates among foster youth are higher compared to rates among in-home youth.
- Women in foster care are 30% more likely than a national sample to have been pregnant by age 19 and almost three times more likely to have had a child.
- Among youth offenders, African-American male juvenile offenders reported more sexual partners, were more likely to be sexually active, and did not engage in consistent safe sexual practices (i.e., condom use) compared to other racial and ethnic groups.
- A majority of studies support a correlation between delinquency and sexual activity.
- In a study of teens in a juvenile detention facility, almost 90% reported having intercourse by age 18.
- 68% of gender non-onforming (GNC) high school LGBQ students feel unsafe because of their sexual orientation, and 42% because of their gender expression; 42% of high school students who are not GNC feel unsafe because of their sexual orientation, and 14% because of their gender expression.
- As many as 1 in 5 foster youth identify as LGBTQ.
- LGBTQ youth are up to five times more likely to be a victim of human sex trafficking.
- Teens account for one-quarter of all new HIV infections are among youth ages 13-19 and young men who have sex with men constitute 93% of those diagnoses.
- Transgender people, particularly those who are visibly gender nonconforming, are more likely to experience violence in the home, on the street and in health care settings, as well as dramatically increased rates of HIV and suicide attempts.
Youth of Color
- Twenty-four percent of African-American males have had intercourse by age 13. This compares to 9% for Hispanic males and 4% of Caucasian males.
- Although birth rates have fallen for teens of all races and ethnicities, the rates for African-American, Hispanic and Native American teens are over twice the rates of white and Asian-American youth.
- In 2015, black youth accounted for an estimated 55% (3,888) of all new HIV infections among youth in the United States, followed by Hispanic/Latino (24%; 1,672) and white (16%; 1,159) youth.
- Largely due to the circumstances they face in their lives (poverty, lack of opportunity, racism), youth of color are over-represented in schools and agencies serving high-risk youth.
With regard to sexuality, many high-risk youth:
- begin to have sexual experiences at an early age;
- engage in sexual behaviors to satisfy primarily nonsexual needs (e.g., a teen may fulfill a need for acceptance and attention by having intercourse, or a victim of sexual abuse may overcome feelings of being out of control by sexually controlling others);
- have more experience with sexual behavior than accurate sexual knowledge;
- have negative feelings about sexuality and themselves as sexual people, though this may not be outwardly apparent; are likely to have an underlying attitude that sex is dirty, dangerous, hurtful and not something about which they can talk openly, nor feel positively;
- have rarely discussed sexuality in a positive, open and honest atmosphere with a knowledgeable and supportive adult;
- may not understand the difference between appropriate behavior and abusive behavior in a given situation; and
- rigidly conform to, or just as rigidly defy, sex-role stereotypes.
Finally, it is also important to recognize that many — though by no means all — high-risk teens:
- are hesitant to trust adults;
- find traditional classroom settings unhelpful;
- have limited reading, writing and speaking skills;
- have little experience and comfort working in groups with their peers on a common task;
- have mild to severe learning disabilities; and
- have short attention spans and learn best through concrete tasks.
All these factors need to be considered in designing and presenting sexuality education programs that best fit the needs of this extremely diverse group of young people.
High-Risk Teens Get Little Quality Sexuality Education
Targeted at Their Needs
Although the reality is that high-risk teens have profound challenges related to their sexuality, they rarely receive responsible sexuality education or family planning services. Youth in foster care, for example, receive little sexuality education, formal or informal, because of unstable living conditions, frequent placement outside of mainstream schools, and lack of parent training about sexuality. The National Campaign to Prevent Teen and Unplanned Pregnancy estimates that only 31 states provide any resources for youth in foster care related to pregnancy prevention, and many do so only in a few counties.
Numerous arguments have been made against sexuality education for high-risk teens. Some of the issues raised most frequently include:
- The topic is too controversial and will invite parent or community backlash.
- Sexuality education condones and promotes sexual activities among teenagers. This is especially true with high-risk teens who have been sexually active from a young age.
- Teaching sexuality education in a co-ed program would create an unsafe atmosphere.
- Sexuality education will distract the teens from the primary reason they are in a treatment program: to get clinical treatment.
- Teens, especially those who have been sexually abused, will get triggered and over-activated and will not be able to tolerate sexuality education.
- With all the other issues these teens present, there is just no time.
- Teens receive sexuality education in their “mainstream” schools, so it’s already being taught.
This manual asserts that our choice is not whether teens should receive sexuality education. Teens are constantly learning about sex from the media, from their peers and from personal experimentation. Our choice is whether we leave sexuality education to these unreliable and, at times, exploitative sources, or whether we provide opportunities for teens to learn accurate information and explore their feelings and values. For treatment programs, sexuality education can be viewed as a vital part of a holistic approach.
While it is true that some people oppose sexuality education, it is important to know that parents are overwhelmingly supportive of it. Furthermore, research has repeatedly demonstrated that sexuality education does not lead to increased sexual activity. In fact, some studies report a decrease in sexual intercourse following sexuality education.
Often, concerns have more to do with adults’ ambivalence and discomfort over confronting the sensitive area of teen sexuality than with any realistic risk of sexuality education itself. With quality education by professionals who obtain some training in sexuality education and use state-of-the-art resources like Streetwise, our own experience has shown us that very few of the concerns described above materialize during sexuality education.
Schools and agencies can minimize the risk of parental/community complaints and teen negative reactions by doing some advanced preparation for sexuality education groups. See the section “How to Use Streetwise to Sexwise” and the staff workshops for ideas about preparing your school/agency for sexuality education.
Alford, S. (2008). Science and success: Sex education and other programs that work to prevent teen pregnancy, HIV & sexually transmitted infections, 2nd ed. Washington, DC: Advocates for Youth.
Barr, E. M., Moore, M. J., Johnson, T., Forrest, J., & Jordan, M. (2013). New evidence: data documenting parental support for earlier sexuality education. Journal of School Health, 84(1): 10-17.
Boonstra, H. (2011). Teen pregnancy among young women in foster care: A primer. Guttmacher Policy Review, 12(2): 8-19. Retrieved from http://www.guttmacher.org/pubs/gpr/14/2/gpr140208.pdf
Cavazos-Rehg, P. A., Krauss, M. J., Spitznagel, E. L., Schootman, M., Cottler, L. B., & Bierut, L. J. (2010). Associations between multiple pregnancies and health risk behaviors among U.S. adolescents. Journal of Adolescent Health, 47(6): 600-603.
Centers for Disease Control and Prevention (CDC). (2017). HIV in the United States: At a glance. Retrieved from https://www.cdc.gov/hiv/pdf/statistics/overview/cdc-hiv-us-ataglance.pdf
Centers for Disease Control and Prevention (CDC). (2014). HIV and young men who have sex with men. Retrieved from https://www.cdc.gov/healthyyouth/sexualbehaviors/pdf/hiv_factsheet_ymsm.pdf
Centers for Disease Control and Prevention (CDC). (2014). HIV among youth. Retrieved from http://www.cdc.gov/hiv/risk/age/youth/index.html
Centers for Disease Control and Prevention (CDC). (2013). Youth Risk Behavior Survey: Teen pregnancy prevention. Retrieved from http://nccd.cdc.gov/youthonline/App/
James, S., Montgomery, S., Laurel, L. K., & Zhang, J. (2009). Sexual risk behaviors among youth in the child welfare system. Children and Youth Services Review, 31(9): 990-1000.
Kosciw, J. G., Greytak, E. A., Giga, N. M., Villenas, C., & Danischewski, D. J. (2016). The 2015 National School Climate Survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. New York: GLSEN. Retrieved from https://www.glsen.org/sites/default/files/2015%20National%20GLSEN%202015%20National%20School%20Climate%20Survey%20%28NSCS%29%20-%20Full%20Report_0.pdf
Lindley, L. L. & Walsemann, K. M. (2015). Sexual orientation and risk of pregnancy among New York City high-school students. American Journal of Public Health, 105(7): 1379-1386.
Martin, J., Hamilton, B., Osterman, M., Curtin, S., & Mathews, T. (2013) Births: Final data for 2012. National Vital Statistics Report, 62(9). Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_09.pdf
National Campaign to Prevent Teen Pregnancy. (2014). Teen pregnancy fact sheet. Retrieved from http://thenationalcampaign.org/sites/default/files/resource-primary-download/fast_facts_-_teen_pregnancy_in_the_united_states_aug_2014.pdf
National Campaign to Prevent Teen Pregnancy. (2015). Implementing evidence-based teen pregnancy prevention programs with youth in foster care. Retrieved from https://thenationalcampaign.org/sites/default/files/resource-primary-download/briefly-foster-care-2015.pdf
Negriff, S., Susman, E., & Trickett, P. (2011). The developmental pathway from pubertal timing to delinquency and sexual activity from early to late adolescence. Journal of Youth & Adolescence, 40(10): 1343-1356.
Robertson, A., Stein, J., & Baird-Thomas, C. (2006). Gender differences in the prediction of condom use among incarcerated juvenile offenders: Testing the information-motivation-behavior skills (IMB) model. Journal of Adolescent Health, 38: 18-25.
Robillard, A. G., Conerly, R. C., Braithwaite, R. L., Stephens, T. T., & Woodring, T. M. (2005). An assessment of sexual risk behavior among adolescent detainees. American Journal of Health, 20(2): 106-114.
Rowland, M. (2011). The sexual health and risk factors of youth in foster care. In Gowen, L. K., & Aue, N. (Eds.). Sexual health disparities among disenfranchised youth. Portland, OR: Public Health Division, Oregon Health Authority and Research and Training Center for Pathways to Positive Futures, Portland State University.
The GenIUSS Group. (2014). Best practices for asking questions to identify transgender and other gender minority respondents on population-based surveys. J. L. Herman (Ed.). Los Angeles: The Williams Institute. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/geniuss-report-sep-2014.pdf
U.S. Department of Health and Human Services, Administration for Children, Youth and Families. (2014). Guidance to states and services on addressing human trafficking of children and youth in the United States. Available at http://www.acf.hhs.gov/sites/default/ files/cb/acyf_human_trafficking_guidance.pdf/
Wilson, B., Cooper, K., Kastanis, A., & Nezhad, S. (2014). Sexual and gender minority youth in foster care. Los Angeles: The Williams Institute. Retrieved from http://williamsinstitute.law.ucla.edu/wp-content/uploads/LAFYS_report_final-aug-2014.pdf
Young, M. E. (2010). Promoting the sexual and reproductive health of adolescents in foster care. Oakland, CA: California Adolescent Health Collaborative.
“As a teacher in a juvenile detention center, I have met many adolescents who have participated in high-risk sexual experiences. Some are parents; some struggle with sexual identity or are sexual predators; many have been sexually exploited and abused. I’ve listened to their stories and wondered what I could do to help them make a change with sexual responsibility and respect, communication, and preventing risky sexual behaviors. But I struggled with finding a resource to address the various needs of these high-risk youth.
“Streetwise to Sexwise fills a great need as a comprehensive guide to sexuality education for high-risk youth. This updated edition expands who is included and provides up-to-date statistics and thorough lesson plans. Author Steve Brown and Editor Karen Rayne have created a unique sexuality education resource for high-risk youth and the adults in their lives — easy for educators to utilize and easy for youth to participate in learning. Thank you for this wonderful, comprehensive, and updated edition. Streetwise will be the go-to sexuality education resource in my classroom.”
Shanna M. Dusablon Drone, MSW, MAEd, MAEd, MEd
“In the world of treatment for youth who sexually abuse, Streetwise to Sexwise is THE go-to curriculum for teaching sex ed. From its concept to its layout, it’s the best resource out there, and many others have tried. It’s not just a catchy title, every aspect of this book is streetwise and sexwise.”
— David S. Prescott, LICSW
Clinical services development director, Becket Family of Services; co-editor, Current Perspectives: Working with Sexually Aggressive Youth and Youth with Sexual Behavior Problems; and past president, Association for the Treatment of Sexual Abusers
“Streetwise to Sexwise is the ultimate go-to publication for those working with young people at-risk around particular issues of sexuality and gender. It’s an outstanding resource for all educators looking for comprehensive content and curriculum ideas, enriched learning activities, and effective teaching skills around the most sensitive of topics.”
Deborah Roffman, MS, CSE, CFLE
Teacher and author, Sex and Sensibility
“I am thrilled to see a program that includes such extensive guidance for facilitators helping their groups explore these often-challenging topics. It’s especially helpful to see such specific guidance around how to address topics frequently left out of other programs, like sexual orientation, gender identity, consent to sexual activity, child sexual abuse, and pornography. The lessons themselves are structured around real-world scenarios and examples designed to meet youth where they are and engage them in critical thinking.”
Valerie Sedivy, PhD
Healthy Teen Network
“The first edition of Streetwise to Sexwise was my most valuable resource when I was a young sexuality educator working for a substance abuse recovery organization. Its lessons were always engaging — much more than any other I encountered — and reading its profile sections was like taking an advanced course on the unique sexual health learning needs of my high-risk audiences. The new edition improves substantially on an already excellent resource, and provides alternative schools, group homes, juvenile detention facilities, residential treatment programs, substance abuse programs, and all other organizations serving high-risk youth with everything necessary to prepare their staff and participants for some much-needed sex ed.”
Bill Taverner, MA, CSE
Executive director, The Center for Sex Education
“Hurray for the latest edition of Streetwise to Sexwise! It is truly trauma-informed sexuality education for youth who are, all too often, the least likely to receive sex ed. The manual provides helpful background information, staff training activities, and a nice collection of educational activities for high-risk youth on very relevant topics including healthy relationships, sexual abuse, commercial sexual exploitation and pornography. I’m very impressed with the focus throughout the manual on helping youth understand their feelings and reactions (often resulting from trauma experiences) and work on managing those feelings as they explore difficult topics.”
Pamela M. Wilson, MSW
Co-author, Making Proud Choices! An Adaptation for Youth in Out-of-Home Care