A comprehensive model for teaching teens that are in high-risk environments.

Streetwise to Sexwise 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.

Section 1: Background for Educators



Being aware of the potential issues high-risk youth face and being prepared to address them is a critical part of educating around sexual and reproductive health topics. This lesson includes statistics to provide a glimpse into the additional risk factors that high-risk teens may experience.

HOW TO USE Streetwise to Sexwise
This lesson gives an overview of the manual, the preparation needed from the administration and educators, and ways to select and adapt lessons.

Sex and sexuality are often equated with sexual behavior, usually sexual intercourse. Yet sexuality encompasses so much more than sexual behavior. This lesson discusses the various aspects of the Circles of Sexuality Model.

These profiles are intended to give you a sketch of the sexual health concerns of certain populations of high-risk teens that you will have in your groups.

  • 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

This discussion serves as a resource for educators using this edition to become familiar with the principles.

This resource provides an overview of what trauma-informed sex education looks like.

This resource, written by Joann Schladale, MS, LMFT, addresses the basics of trauma and trauma-informed care.

This resource provides educators with some tools for how to create a safe and supportive group atmosphere in the classroom.

This resources helps educators learn how to implement role play in the classroom.

Section 2: Staff Training Workshops

This workshop helps participants think more expansively about sexuality and understand that it relates to every part of who we are as humans. This lesson frames sexuality education as promoting sexual health, not only preventing negative consequences, and helps adults think about what they can do concretely to foster healthy qualities in youth.

This lesson helps adults feel more comfortable talking about sexuality in general, and helps them to practice conversations with youth on the subject.

This workshop helps adults begin to be aware of and define their values about teen sexuality and how these values may get in the way, or be helpful, when talking with teens about sex.

Section 3: LESSONS

It is important for young people to think about individual triggers for those strong feelings and how they will manage those feelings. This lesson provides the opportunity to do that, as well as practice a simple relaxation technique.

This lesson allows participants to learn in a fun and nonthreatening way about sexual anatomy and how it functions.

This lesson uses the Circles of Sexuality framework to demonstrate the different domains of sexuality and how much more complicated sexuality is than sexual behavior. This lesson also acknowledges both the pleasures and dangers of sex for teens and sets forth the goal of keeping the pleasure but avoiding the dangers.

This lesson helps participants explore the definition and concept of consent, first in a nonsexual situation, and then in sexual situations. It includes practicing skills such as asking for consent, responding enthusiastically when asked, declining when asked, and dealing with rejection when someone does not consent.

In this lesson, participants identify sexual behaviors that put a person at high, low and no risk for pregnancy, and assess their own risk. Participants learn about the methods of birth control in a hands-on activity. Finally, the lesson introduces assertiveness skills in reference to sexual decision-making.

This lesson helps participants recognize their risk for HIV infection. It will address the information, attitudes and skills necessary for risk reduction. The activities enable teens to talk with their peers about sex, as they must do to practice safer sex.

This lesson dramatizes the rapid geometric progression possible in the spread of an STI. It provides the opportunity for participants to touch and learn how to use condoms in a fun and concrete way. Finally, participants practice talking about safer sex and condoms with a partner.

This lesson provides young people with information, support and space to consider and evolve their own internal belief structures in order to be more accepting.

This lesson confronts young people’s fears and gives them the chance to hear the personal stories of people who identify as LGBTQ and ask them questions. It also presents a healthy and positive image for teens who are questioning their own sexual orientation.

This lesson offers the opportunity for participants to discuss all kinds of feelings — being attracted to someone, feeling nervous about hanging out or on a date, figuring out what to say, recognizing and affirming sexual feelings, and deciding how to deal with those feelings.

This lesson facilitates discussion about relationships and love and helps participants define the characteristics of a healthy relationship.

In this lesson, participants can discuss and challenge the commonly held assumption that “no” means “maybe” or “yes.”

This lesson defines sexual abuse, describes how to recognize a sexually abusive situation, and examines one’s options when deciding whether to tell. It includes stories of teen sexual abuse survivors that illustrate the wide range of feelings young people have about sexual abuse.

In this lesson, participants get to try out both digital and direct modes of interaction, and evaluate the experience in terms of comfort level, sense of connection to others and preferences.

This lesson helps young people consider what in porn is useful and accurate and what is unrealistic and potentially harmful. It also helps young people break down real-life situations involving porn in order to consider how they would advise their friends about the impacts of watching pornography.

This lesson helps young people identify when professional sexual health services would be appropriate, differentiate between reliable and unreliable web resources, and demonstrate how to find a credible resource.

Foreword to Streetwise to Sexwise

By Christian Thrasher, MA, CSC, CSE*

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 is the Senior Vice-President of Behavioral Health at ShareCare (sharecare.com)

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.

Foster Youth

  • 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.

Juvenile Detainees

  • 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.

Read about the evaluations on Streetwise to Sexwise here.

“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.”
Shanna M. Dusablon Drone, MSW, MAEd, MAEd, MEd

“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.”

“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
Co-editor, Current Perspectives: Working with Sexually Aggressive Youth and Youth with Sexual Behavior Problems

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

Streetwise to Sex-wise

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