Abstinence Report_Kerry

Promising Practices for Providing Abstinence
Education to High-risk Populations
Project Results and Findings

Promising Practices for providing abstinence education to high-risk populations
Introduction:
The project team identified common themes from among the seven site
visits (see Table 1 for a summary of the sites visited and the particular
high-risk populations they served), which we term promising practices for
abstinence education to high-risk populations.
Table 1: High Risk Abstinence Education Site Visits
Program, Organization, Location
of site visit
Description of Program and high-risk Youth Population(s) Served and High-Risk Youth
Population(s) served
Resolve,
Jewish Child Care Agency (JCCA),
Bronx and Pleasantville,
New York (JCCA), Bronx and
Pleasantville, New York
JCCA, founded in the early 1800’s, is a full-service foster care placement agency serving foster children and
abused youth in the New York metropolitan area. JCCA’s mission is based on the universal mandate within Jewish
tradition of tikkun olam – repair the world. Their facilities include 300 beds encompassing therapeutic boarding
houses, group homes, and residential facilities. JCCA also has mental health programs in Brooklyn and Queens,
and serves over 12,000 children with a staff of 500.uaff of 500.
Aiming for Abstinence,
Booneville School District,
Bonneville, Mississippi
The Booneville School District’s Aiming for Abstinence program serves a 5-county area in Northern Mississippi
that includes rural poor with 70% of the teens who give birth being unmarried. The vision of the program is to
give youth and their family the tools necessary to combat the myriad of problems associated with teen pregnancy,
STDs, drugs and alcohol, violence and other high-risk behaviors through the dissemination of information and
training to promote abstinence from all these high-risk behaviors. The Aiming for Abstinence program works with
parents, students, and communities, and has over sixty-four collaborating partners
Native Challenge Abstinence
Project (NCAP),
Riverside-San Bernardino County
Indian Health, San Bernardino,
California, CA
NCAP operates abstinence education in 13 schools targeting Native American youth from among ten different
tribes located in the Riverside/San Bernardino counties. The program served approximately 2,200 youth with
their in-school abstinence programming, and has had over 6,000 youth, community members and tribal elders in
signed attendance at either the monthly family fun nights or the annual Youth Leadership Conference.
It’s a Better Life,
Pennsylvania Association of
Latino Organizations (PALO),
Harrisburg, Reading, and
Bethlehem, Pennsylvania
PALO was incorporated in 1998 to serve as a statewide Latino intermediary dedicated to the strengthening of
Latino Community-Based Organizations (LCBOs) through economic development, capacity-building, education,
and creation of effective bilingual/bicultural community services across Pennsylvania. For the abstinence project,
the mission is to teach the abstinence message to Hispanic/Latino youth through 10 affiliated LCBOs across the
state implementing abstinence education programs, and for each project site to actively collaborate with the youth
to create additional curricula.
Choices,
Christ Community Health
Services (CCHS),
Memphis, Tennessee
Christ Community Health Services (CCHS) has four health-care settings in Shelby County, Tennessee. CCHS is the
fiscal agent for “Choices” abstinence program, which has been providing abstinence education to primarily African-
American, urban youth in Memphis. Initially, the grant proposal allocated funds to serve 145 youth; however, the
program has steadily increased and now serves a total population of 421 students –mainly through in-school,
classroom presentations.
Authentic Answers Abstinence
Alliance (4-A),
Celebrate Kids, Inc.,
Killeen, Texas
The children of Army personnel attend school in the local Killeen Independent School District with the children
of the civilians that live in Killeen. This leads to a very culturally and racially diverse community inside the school
buildings. Celebrate Kids, has served high-risk youth for over 15 years and is based in Fort Worth Texas. They
incorporated their abstinence education program within their broader youth education framework. The program’s
mission is to help teens avoid high-risk behaviors by identifying and meeting their core needs in healthy ways.
Positive Choices,
St. Vincent Mercy Medical Center,
Toledo, Ohio Choices,
St. Vincent Mercy Medical Center,
Toledo, Ohio
The Positive Choices program, founded in 1986 by a pediatrician, provides abstinence education services to
a wide variety of high-risk populations, primarily African-American, including: homeless and foster care youth
in households with substance abuse and domestic violence. All of the programs (including a privately funded
program for parochial schools) offer 8 sessions built around the Choosing the Best and Game Plan curricula
in schools. In addition to the classroom education, the program offers approximately twenty different outreach
opportunities.

Thirteen promising practices are presented here, as
they are in the accompanying publication (Promising
Practices for Providing Abstinence Education to High-
Risk Youth—Perspectives from the Field), in a semi-
chronological order, based roughly on the sequence
these practices would follow in implementing
an effective abstinence education program for
high-risk youth. Taken together, however, these
practices represent more of a cycle than a linear
progression of activities and strategies, whereby
abstinence educators inculcate a continuous quality
improvement process.
For example, practice #13: Incorporate efforts at the
beginning of the grant to ensure continuity of services
beyond the end of the grant links back to practice #1:
Engage community leaders, parents or guardians, and
school staff and administrators to support your program.
The engagement of community leaders is part of
the launching of the program, but also represents
the same people you need to continue to work with
for continued support, both programmatic and
financial, of your abstinence education program to
ensure sustainability of your program.
Note: This study was not conducted as a
comparative analysis of programs serving high-risk
populations and those serving other (i.e., low-risk)
populations. All of the sites visited served high-risk
populations. In most cases these practices are not
necessarily specific to high-risk populations and
are applicable to abstinence education in general.
However, throughout this publication, each practice
is discussed in light of the particular high-risk
category(ies) where the practice was observed, thus
providing the proper context. For some of the
promising practices, reference will be provided as to
why it is of particular significance for serving high-
risk youth.
The purpose of this study report is to provide
additional analyses and content related to each
practice beyond what is furnished in the promising
practices publication. This report is a companion
piece to the publication, providing additional
insight, examples, and other information related to
each practice, such as the prevalence of each practice
among the seven sites. Each practice also has its
own appendix with yet more examples, quotes, and
associated materials.
As with the publication itself, the overall purpose
is not to prescribe specific practices for replication,
but rather to describe how particular practices were
represented and implemented among these seven
programs. Local circumstances, the particular
high-risk population(s) targeted, and the unique
skills, perspective, and creativity of each abstinence
education program are all determining factors for
whether and how a particular promising practice is
used by another program.

The adage that “it takes a village to raise a child” is
particularly true for high-risk youth, many of whom
come from broken families. Abstinence educators
serving these populations need to identify and connect
with other organizations serving these youth, the most
important being the school system, to gain the access
needed to communicate the abstinence message. The
examples below reflect different approaches taken by
some of the programs visited.
We may like to think that programs operate in a
vacuum, but they do not. Support from all parts
of the community is critical for the success of
abstinence education programs. This takes time and
often you will not see an immediate payoff, but it
does work in the long run. Community engagement
is also critical for sustaining your program beyond
your funding period.
This practice, which was represented in all seven
programs, highlights the process of engaging
and enlisting the support of various stakeholder
audiences, particularly during the introduction
of the program. The key to this practice is to set
a precedent with these stakeholders to share the
ownership of the abstinence education task among
the parents and youth-serving organizations that
support this message. As Brighton Ncube, project
director for the Native Challenge Abstinence
Program (NCAP), explained:
In terms of community leaders and parents,
when we start a program we say what is
needed in the community and then get
their buy-in to the need. Then it’s all about
implementing the message, and having them
come along with us and own the message as
much as we do.
There are three overriding themes to this
practice, each described below with examples and
commentary from among the seven sites we visited
and studied.
i) Identify people and organizations in your
community that may be interested in
promoting the abstinence message.
Aside from parents (addressed in ii below), we
identified three main stakeholder groups critical to
the successful implementation and sustainability of
these high-risk abstinence education programs.
a) Contact community leaders and
“gatekeepers” to discuss your program
and ask for their support and/or access
to youth (i.e., via class/program time).
It is essential to study your community to
identify leaders and organizations supportive of
the abstinence message for their high-risk youth.
For example, Mr. Ncube, who is himself a native
of South Africa, used both his knowledge of
tribal governance and leadership, along with his
community planning expertise from operating
HIV/AIDS prevention programs internationally,
to identify the key opinion leaders within each
tribal community their program served. Ncube
and NCAP leveraged the conservative views of
these tribal leaders, who were more supportive of
abstinence-based programming for their youth than
of condom-based comprehensive sex education
programs.
The Aiming for Abstinence program, operated
by the Booneville School District in Mississippi,
established connections with 64 partner groups
in their community. Presentations and program
activities are offered at a variety of venues, such
as classrooms, mentoring programs, The Boys
1Engage community leaders, parents or guardians, and school staff and
administrators to support your program.

Girls Clubs, church youth groups, Alternative High
Schools, juvenile detention center, public housing
authority, and summer retreats for foster children
and kids who live below the poverty line. Many in
the community know the project director and are
familiar with the program. Partner programs are
often looking for activities for their participants and
will invite the RISE team to administer a program
or presentation.
Others, such as the Authentic Answers Abstinence
Alliance program operated by Celebrate Kids in
Killeen, Texas, had to make a concerted effort to
gain acceptance from the community. When the
Celebrate Kids personnel began the grant writing
and grant implementation process, there was
some initial hesitation among the local Killeen
community. The Celebrate Kids program, which
was actually based in Fort Worth, was viewed as an
outside group coming in, and many people feared
that they were only receiving the grant to get the
money.
To gain community acceptance of the program, the
program staff first met with the local community to
see who was interested, hosting lunch presentations
to introduce themselves. The second step was to visit
the schools to let the teachers and administrators
know about themselves as individuals and as a
Celebrate Kids program. Once trust was built, they
were allowed in to present.
The program also had to make tough choices. The
Mayor’s Task Force for Abstinence was a community
group that met to set a policy for the city. Although
the name included “for Abstinence,” the group
decided on a policy that stressed so called “safe
sex” above abstinence. Celebrate Kids refused to
be associated with the group. It may have hurt
them with the people and groups in that circle, but
overall more doors opened because of their strong
commitment for abstinence-until-marriage, and
nothing else.
b) Identify and nurture a school staff
person that can champion your
program from the inside.
For youth living in the inner-city, it is especially
important to engage the school system, because of
the transportation challenges in involving them in
after-school programs. The sites we visited generally
used a two-pronged approach, with both a formal
engagement of the leadership of the school system,
as well as a more informal process of networking
and relationship-building with key “line” staff to
serve as internal advocates and supporters of their
program.
A prime example of the formal engagement of the
school system leadership was the Choices program
operated by Christ Community Health Services in
Memphis, Tennessee. They were told the schools
would not welcome the program. Therefore, shortly
after receiving funding, Choices hosted a luncheon
for school principals at an exclusive country club
(the space was donated by a board member). During
this time, the Choices team presented their program
and objectives to the principals in hopes of being
offered class time to present the program in the
schools. The event was very successful in providing
Choices with access to the schools, to the point that
now there are seven schools on the waiting list to
have them come to their school.
Another one of the key components of the success
of the program was presenting to the Memphis City
School Board and becoming certified by the board.
This afforded the program a “stamp of approval”
by the schools and lent credibility to the program,
providing more accessibility and acceptance by the
school principals and parents of students. It has
also been certified through Memphis City School
Adolescent Family Life, which makes Choices
the first name given if someone calls requesting
abstinence education.
On the informal side of engaging the schools, the
It’s a Better Life program, operated through the
Pennsylvania Association of Latino Organizations
(PALO), offered an excellent example of the effect

of networking with school staff on a one-to-one
basis. They were successful by investing a lot of
“face time” and eventually won over one teacher
who became their champion in the school. The
identification of a school champion has been their
way of gaining access to the four middle schools and
one high school where they operate.
For example, PALO networked with a guidance
counselor at one of the middle schools. This person
met with the principal on behalf of PALO to get the
program into the school. The guidance counselor
also helped to get the classes scheduled and get
the permission slips signed for a youth conference
sponsored by PALO. Once inside the school, the
program marketed itself. The teachers have nothing
but positive things to say. The program is well
accepted among teachers and students. The students
like the program and are anxious for the presenter
to arrive for presentations. They look forward to the
sessions and seem to have a good relationship with
the abstinence program coordinator, Artemus Kahl.
If there is a cancellation, kids ask when Ms. Kahl is
coming back. They do not show this same kind of
interest for other classes.
c) Look to other institutional stakeholders
outside of the school system.
The Positive Choices program, operated by the
St. Vincent’s Mercy Medical Center, leveraged its
connections with the healthcare community to
expand its abstinence message. The Mercy School
of Medicine and the local medical school have close
ties with the St. Vincent’s Mercy Medical Center.
This has allowed the program to reach out to the
colleges and offer training. The medical college also
has a summer internship program, and the medical
students routinely choose Positive Choices for their
placement. This college outreach is changing the
culture and understanding of abstinence education
within the colleges.
Dr. Alean Zeiler, who founded the Positive Choices
in 1986, is a full-time pediatrician with the Mercy
Medical Group. When she began the program,
the medical professionals with whom she worked
believed that teens had to be given “protection”
from sexually transmitted diseases (STDs) and
pregnancy. Now they refer adolescent patients to the
Positive Choices program and talk about the other,
non-medical consequences of sexual activity.
ii) Involve parents and guardians both as key
promoters as well as participants of your
program.
Parents and guardians represent the most important
stakeholders when it comes to reinforcing the
abstinence message at home. This is especially
important for high-risk youth, whose parents/
guardians are often overwhelmed with the
challenge of providing for their family, and/or
battling challenges themselves in terms of high-risk
behaviors.
The Positive Choices program stood out among
the seven sites in terms of their formal deliberate
engagement of parents/guardians with their program
efforts. Before any child attends a Positive Choice
after-school program, the staff member in whose
group the child will attend visits the child’s home to
meet with the parent or primary caregiver. During
the home visit, the staff member introduces him/
herself and the program to the parent. The staff and
the parent begin a relationship where the educator is
given the opportunity to reinforce and expand upon the
abstinence message hopefully being delivered at home,
and the parent learns more about promoting abstinence
until marriage outside of the home. During the home
visit, the staff member also has the permission slips
signed and discusses the opportunity to receive free
transportation to all the program events.
While the home visits are time-consuming, they
are effective at obtaining parental consent and
parental buy-in into the program. The home visits
are considered culturally relevant because many of
the parents/caregivers lack the transportation and/or
child care needed to attend an office visit or parent
seminar.

Despite their significant potential effect, parents/
guardians are not always the initiator of the
abstinence message, which is often to the result of a
number of cultural and social factors. For example,
the abstinence education program conducted
by PALO to predominately Hispanic/Latino
populations has been well received by both the staff
of the Latino Community-Based Organizations
(LCBOs) and the community. Because sexual
education is a taboo in the Latino community, the
program has helped parents to communicate with
their children. The PALO staff view abstinence
education and teen pregnancy as an economic
development issue for the Latino population served
by their affiliates. Teen pregnancy tends to result
in youth not completing high school or college,
placing them and their children at a disadvantage
economically.
The Resolve program, operated by the Jewish Child
Care Association (JCCA) at residential foster care
programs in the Bronx, Brooklyn, and Pleasantville
New York, also recognizes and engages parents
and guardians as key stakeholders. The abstinence
program conducts an annual working retreat
for youth and families, and the youth run the
program. They also constituted a community board
comprised of other adolescent community service
providers, youth in the program, foster parents, and
staff. One outcome is that they offer peer conflict
resolution, and this is provided by one of the
community board members.
Parents and governmental agencies are major
stakeholders. One parent is a big marketer of their
program. Parents often see foster care and the
system as the enemy. JCCA establishes safe spaces
for parents and they work to minimize the barriers
for parents. The Administration for Children’s
Services (the local Department of Social Services)
is a strong supporter of the program, and wrote a
letter of support for the grant renewal. Community
board members are strongly committed to the
program.
iii) Keep community leaders and other partners/
stakeholders informed and engaged with your
program activities.
The maintenance of the relationships with
these aforementioned stakeholders is of equal
importance as the initial engagement. The Native
Challenge Abstinence Project (NCAP) maintains
its stakeholder relationships by engaging them in
the planning of events. In fact, most of the extra-
agency involvement from NCAP is tied to the
planning of events such as the family fun nights
and youth leadership conferences. At times, NCAP
staff will be invited to participate in other events
(e.g., Pow Wows). One of the benefits of NCAP is
that some of the health educators are themselves
Native American and living in the communities
they serve, which helps to reinforce the notion that
the project is of the community and not just for the
community. Parents and volunteers are also engaged
by helping to prepare for the events, helping with
the set-up, and helping to get the word out about
the event to others in the community.
Other examples of how programs maintain their
stakeholder relationships are:
• Ask for concrete help. Request help for
specific chores, such as asking permission to
teach abstinence education to members of their
organization, arranging meetings with key
gatekeepers, promoting the program to other
organizations, coordinating press coverage, and
sponsoring an activity.
• Once the relationship has been established,
nurture the relationship with regular contact.
Invite community leaders and organizations to
special events, such as the launching of a new
program in the area. Share good news about the
program, such as new funding, recognitions,
and awards. Call them when things are going
right, not just when you need their help.

• Take every opportunity to publicly recognize
their support. Be sure to mention who you
are working with on the materials developed
for your program, such as fliers, posters, and
curricula. Mention the organization’s name at
meetings and local events.
• Show your curriculum to people in the
community and ask if it will work in their
community before introducing it.
Please see Appendix A-1 for more examples
pertaining to this practice.

11Promising Practices for providing abstinence education to high-risk populations
High-risk youth are often served by more than
one organization, each addressing other high-risk
behaviors (e.g., violence, substance abuse) that
stem from the same causes as risky sexual behavior.
These organizations often invite guest speakers and
presenters as part of their programs. Be creative in
finding these audiences to gain new and different
platforms for communicating the abstinence
message, while also remembering that the youth
themselves are your most powerful tool for growing
your program.
This practice is a direct follow-on to the stakeholder
engagement described under the aforementioned
promising practice #1. The most obvious and
immediate purpose for engaging particular
stakeholders (e.g., schools, community groups) is to
gain access to and an audience with targeted high-
risk youth. Because high-risk youth are generally
served by more than one organization outside of
school, it is important to identify where to find
and engage these youth, which also minimizes
the logistical (e.g., transportation) challenges
of bringing them together specifically for your
program. The themes addressed under this practice
relate to how to maximize these opportunities
to communicate your abstinence message and
programming.
i) Be flexible with your curricula to fit within
whatever time frame you are given.
This is especially true when working within the
structured class time available through the school
system. PALO has adjusted its staffing model
for the It’s A Better Life program to adapt to the
time provided by schools through one of their
project sites in Bethlehem, Pennsylvania. School
site implementation is strictly time-limited, some
sites work with students in 30-minute increments
and others work in 40-minute increments. Team
teaching in these tight time-restricted settings seems
to have the best outcome regarding achieving the
stated learning objectives. Team teaching consists
of one of the instructors completing all paperwork
requirements, while the second instructor works
constantly with the students delivering the lesson.
Similarly, the Aiming for Abstinence program,
operated through the Booneville School District,
also kept its curriculum flexible to adapt to the time
provided them by their community partners to
communicate the abstinence message. Many times,
these groups such as the Boys and Girls Club have
weekly meeting times and have time slots to fill
with various activities. RISE helps these programs
by taking charge of that time slot and providing
the kids with engaging lessons and activities that
teach abstinence and character building. Because the
program is so flexible and dependable, many groups
invite RISE to visit their program knowing that
RISE will be educational and entertaining.
ii) Be open to opportunities to present the
abstinence message through other youth-
serving organizations
The Authentic Answers Abstinence Alliance
program (operated by Celebrate Kids), is
periodically asked to do a “1 Shot” to an outside
group such as a church youth group or other after
school program. Before doing these 1 Shots, they
ask the organization what is the most important
need to address. They assist the group leader in
getting to the bottom of the problem because,
“Symptoms are not always the problem.” These 1
Shots vary in length from 30 minutes to 2 hours
but can be an important booster to the abstinence
education lessons the students already receive in
the schools. An example of this is one of the girls
in the Haynes School High alternative class, which
was observed, approached the instructor after the
2Promote your program to schools and other youth-serving organizations for
integration of abstinence education into existing classes and activities.

Project Results and Findings12
abstinence education lesson and reminded the
instructor that she had also spoken to the girls’
church youth group. The girl said that hearing
the information a second time really helped her
understand the presentation.
Celebrate Kids had the opportunity to present
to the participants of Camp Coca-Cola (a youth
leadership camp held for 2 weeks over the summer)
for the past 3 years. They are the only outside
group invited to address abstinence until marriage
during camp. Overall, Celebrate Kids has 5 hours
broken into two presentations in which they provide
the whole 10 lessons of the authentic answers
curriculum. The leaders of the camp invite Celebrate
Kids back each year because of the core needs and
the fact that Celebrate Kids relates abstinence and
life decisions to their future leadership roles. That is,
if you are a leader, you have to help people you are
leading be good leaders.
iii) Be attuned to where and how your abstinence
program supports key themes that the school
or other youth-serving partner organization is
trying to communicate.
Mr. James, director of the Haynes alternative high
school in Killeen Texas, a public school for students
with failing grades, believes that the Celebrate
Kids philosophy of “Caring about all children as
individuals at the foundational level and wanting to
help them to make positive choices to have a better
life” fit perfectly within the Haynes curriculum.
This is why Mr. James chose the Celebrate Kids
organization rather than the others that proposed
coming into the school.
Another key to the success of the programs we
observed was how they understood where the
abstinence message fit into the broader context of
other high-risk youth behaviors. For example, the
Life Skills Program (provided by St. Vincent’s Mercy
Medical Center in Toledo, Ohio) is not abstinence
education, and is not funded by the abstinence
education grants, but is an excellent opportunity
for abstinence education outreach. The program
is taught by Positive Choices staff to students in
charter schools and alternative school settings.
These schools serve people up to age 23 who have
had their education interrupted. Often times, the
students in this program are adults living adult lives,
finishing high school to make a better life for their
families. Most of the students are already sexually
active and often have young children.
The Positive Choices program focuses on
decisionmaking, especially re-evaluating past
decisions so that bad ones are not repeated. Even
though these students have children, the Positive
Choices program does not shy away from discussing
abstinence until marriage and building healthy
relationships. The school reports that the students
enjoy the program and have received benefits from
it. In fact, the attendance for the high school goes
up (there are fewer absences) on the days that
Positive Choices is being taught compared with
other days of the week.
Similarly, the director of PALO’s Reading site in
Pennsylvania has been able to piggy back abstinence
education activities onto similar programs such as
their tobacco prevention program and their program
to enhance access to higher education. They were
able to incorporate other messages to the abstinence
program such as rape, STDs, HIV, and culture.

iv) Focus on providing a quality product
Although networking through schools and youth-
serving organizations is essential for gaining initial
access to the targeted high-risk youth, it is the
quality of the “product” (i.e., the programmatic
delivery of the abstinence message) that ultimately
determines whether the program is able to reach
more youth. As Mr. Ncube, project director of the
NCAP, explained:
The best marketing we have is the word-of-
mouth between the kids that have taken the
class telling their friends to sign up for the
class. We work hard to make the classes as
participatory, hands-on, and interactive as
possible, and the kids are really responding to
the message.
The buzz that these programs get from the youth,
which then affects the teachers, is the primary
means by which these projects were able to
expand the number of classes and other venues for
communicating the abstinence message. One school
administrator served through PALO’s Reading site
mentioned that the head of the English Language
Acquisition program loves the abstinence classes.
The teachers have nothing but positive things to
say. The program is well accepted among teachers
and students. The students like the program and are
anxious for the presenter to arrive for presentations.
One way the teachers know the students enjoy the
abstinence education program is because they hear
the students talking about what they have learned in
the program and ask when the abstinence educators
are coming back to the classroom.

High-risk youth are seeking positive role models,
which makes the selection of abstinence educators
that much more important. Sometime this
means hiring staff that were themselves un-wed
teen parents, while other times it simply means
someone the kids consider “cool.” For certain
cultural groups, staff that share the same race/
ethnicity or gender are important. In any event,
these educators need to be empowered to do
what they need to in order to connect and relate
with these youth, while also receiving the needed
professional develop support and training.
The dedication and commitment of the abstinence
educators responsible for teaching youth the
abstinence message was critical for the success of the
programs we visited. For some, the importance of
this practice was revealed through trial and error, as
Mr. Ncube explained:
I soon discovered that the people I originally
hired had higher salary expectations, and
perceived their role more formally as teachers.
After this first round of hires left, I approached
the hiring process in a less conventional
way, looking for people who had certain
intangibles, like passion and commitment,
and seemed as though they could make
a stronger connection to the youth. The
trade-off in going in this direction was that I
would have to re-direct some of my project
management time to do some professional
mentoring and teach them the skills they did
not have.
His second recruiting efforts produced a staff
with a wide range of skills, such as an events planner
(e.g., for birthday parties, anniversaries), a person
with private sector experience in customer service,
a substitute teacher, and a receptionist at the
Riverside-San Bernardino County Indian Health
Institute (from which NCAP operates) that wanted
to be involved in working with kids. These staff,
all of whom have remained with the project for
the past 2 years, became the primary drivers of the
success of the program. Mr. Ncube explained:
What I learned from the hiring process
was that there is no substitute for being
passionate and motivated about the work you
do. These are all self-starters, collaborators,
and dedicated to the project. What I do is
simply help to steer and direct them, and help
them with resources and ideas, because they
already know where they want to take the
project.
The realities of family life for many high-risk youth,
or the lack thereof, is another reason why the
commitment of the instructors is so crucial to the
success of the program. Margaret Barajas, project
director for PALO’s It’s A Better Life program,
described two of their program’s health educators:
Rosa and Edith give to kids from the heart.
Our kids, as low-income kids, don’t have
much. But what you give they receive and
then they give back. You can’t quantify this.
We are to a degree surrogate parents to kids
and also to the parents. We help the parents
to fill gaps that are missing to them. We offer
love, understanding, and a non-judgmental
relationship. It’s the love that makes the
difference. Without the love, then it probably
won’t work. We get to bond with the kids.
They really know that we care about them.
We always tell them to come to us with any
questions or problems outside of class. We
open that door to them. They are allowed to
keep that relationship with us.
3Recruit and support staff that are passionate about working with young people
and can relate to the issues and challenges faced by the youth they are serving.

i) Choose instructors that serve as role models
for the youth they are working with.
Elizabeth Schnur, a senior vice president of
JCCA, noted that one of the “secret weapons” of
their Resolve program was the women who run
the program, who are “phenomenal.” They have
a particularly excellent ability to engage youth.
Because they promote abstinence and healthy
choices, and the youth view them as “cool,” the
youth perceive their participation in the program as
cool. They also know they will have staff support.
Although the “cool” factor may engage them,
what keeps them in the program is the depth of
programming. Resolve is one of the few programs
where all relationships can be discussed. The
Resolve program is the only place youth hear the
abstinence message.
Part of the role-modeling involves being visible and
present to the youth outside of the classroom. As
one abstinence educator from Booneville’s Aiming
for Abstinence program explained:
I’m in their face everywhere they go. I even
have extra clothing and accessories like
belts, t-shirts, safety pins, in my car to give
to students if they’re wearing something
inappropriate.
The abstinence educators from the Choices program
in Memphis, Tennessee also have a very close
relationship with the students. The students and
educators use cell phones and text messaging to
keep in contact and they are on the phones often
with kids checking in on them or helping them with
their personal lives and choices. About 55 percent of
the time is spent with the students in the classroom,
25 percent outside of class, and 20 percent at staff
meetings, parent events, and weekend activities.
ii) Use instructors that are culturally/socially
matched with the youth
For PALO, the fact that the abstinence educators
were Latinos was positively highlighted by the
school teachers, as the students see them as people
from the community. One of the teachers describes
the abstinence educators as very charismatic with
great rapport with the students and an ability to
teach the content as well. Another positive aspect
of the program is that classes are interactive; the
students need to take notes, ask questions, and are
involved in a series of activities that makes them
participate actively on the program.
iii) Employ male instructors to talk with male
youth.
For example, the Boot Camp for Dads is a program
funded by the OB/GYN department at St. Vincent’s
Mercy Medical Center, who also run the Positive
Choices abstinence education program. It is a
seminar for new dads to help them learn about
baby care. The OB/GYN staff is all female, and the
men did not respond well to the female instructors.
The male instructors from the Positive Choices
program volunteered to teach the class. The young
dads were more at ease with the male instructors
and the mentor dads. They were more easily able to
discuss the concerns that men have about being new
fathers. The curriculum covers anti-child-abuse and
anti-shaken-baby syndrome. Many of the lessons
lead back into healthy relationships.
Likewise, the Choices project uses male educators to
teach boys, many of whom do not have a male role
model in their lives. The entire staff is attractive and
young, with character to which the kids can relate.
iv) Empower staff as your program ambassadors,
and support them with training.
The abstinence educators/instructors are not only
key for making the connection with the kids, they
are also perceived by the projects we visited as
central to the overall success of the program. To
support them, staffs were given:
Autonomy and flexibility: For example, the staff
members of the Positive Choices program are very
committed to this program. They genuinely care

about the students they reach. This is especially
true of those students that are in the after school
programs. The staff members are given flexible
schedules, where they can work as they need to get
the job done.
This system works well because the staff must make
the home visits, present in the classrooms, and work
in the evenings for the after school programs. Each
educator is responsible for recruiting and booking
their own classroom presentations and filling
their after school groups. This system has created
motivated educators who constantly promote the
program in the community among the parents,
grandparents, and caregivers of their students.
This matter of providing abstinence educator staff
autonomy and flexibility is also about the leadership
style these organizations adopt to make their
programs effective. For example, Celebrate Kids
had 17 employees in 2 offices, 2 hours apart. When
the abstinence grant was received, the program
very quickly grew from 4 staff members to 10
and then to 17. This was a challenge for the staff,
especially for Dr. Kathy Koch. Dr. Koch had to
make a decision about the direction of the program.
She could hold on tight and it would be strangled
and die, or she could empower her employees to
understand her vision and her model, and allow
them to use it. “It’s not easy,” said Dr. Koch, “There
is a high level of trust, but it will never grow if it
is not given freely” She tries very hard to put other
voices forward so it is bigger than just “Dr. Kathy
Koch, Inc.”
Peer learning opportunities: For the Aiming for
Abstinence program, the staff meets once per month
to share experiences and discuss how to better
connect with the kids. They talk about such subjects
as what worked well, what did not, and share
success stories. Staff also attend trainings as much
as possible (e.g., conferences, technical assistance
workshops) so they can keep abreast of the latest
issues and medical accuracy as well as learn new
approaches.
Likewise, PALO’s facilitators and coordinators from
12 inner-city LCBOs gather together with PALO
staff and the evaluation team four times a year to
share their observations of changes in youth culture
and the lesson plans they have developed based on
the 16 curriculum lessons that respond to realities
facilitators encounter in changing youth culture.
Findings from the process evaluation are
communicated to all facilitators on a quarterly basis
to continually develop and improve the PALO
Community-Based Abstinence Education (CBAE)
program, the lesson plans available for each learning
objective, and use of suitable supplementary
resources. All curricula, lesson plans, and
supplementary resources are reviewed by consultant
Julie Erickson, PhD, RN, and she ensures that all
materials used are medically accurate. The PALO
CBAE Coordinator also reviews all materials
for compliance with legislative guidelines and
requirements.
Training and other educational resources: The
staff of Celebrate Kids learns about abstinence
education from a variety of sources. From the e-mail
update service offered from a national abstinence
organization to Google News searches and
magazines such as “People” and “Family Circle,” and
journals such as “Educational Leadership,” the staff
is well-read. More evidence of their commitment to
reading is that the program budgets $1,000 annually
for books and publications. The staff also attends
professional development conferences sponsored
by the government and local Texas sex education
and clinic associations. The staff also goes to the
Military Child Education Coalition Meetings.
The staff learns about effective teaching principles,
primarily from Celebrate Kids’ president Dr. Koch,
relying on her experiences and advanced degree in
educational psychology and reading. She teaches the
staff about such subjects as learning styles, multiple
intelligences, and thinking skills.

As explained by Kathy Okuley, project director
for the Positive Choices program at St. Vincent’s
Mercy Medical Center, “Studies of the culture of
poverty point to the number one most important
element of successful programs/interventions as
relationships. The value of a relationship is equal
to the working class of currency or acquisition. It
takes time and many interactions to build trust
and develop relationships.”
Whereas practice #3 addresses who provides the
abstinence message (i.e., the qualities and attributes
of the abstinence educator), practice #4 focuses
on how to effectively communicate this message.
Because of the highly personal and sensitive nature
of sex and sexuality, especially considering the
broken and dysfunctional households in which
high-risk youth are raised, with some being victims
of sexual abuse, it is essential to “disarm” the
youth and prepare them for the serious matter
of communicating the importance of sexual
abstinence.
i) Create an open atmosphere where students feel
comfortable.
One student participating in the Aiming for
Abstinence program explained their relationship
with their abstinence educator and the class:
Our teacher is like a friend to me. I feel I
can tell them my problems both inside and
outside of the class. Most of my friends are
in the same programs, so we can discuss
the information with each other. I would
recommend the class to other kids. I think it’s
a fun thing to learn and you should always
wait to have sex until you’re married.
The abstinence educators for the Choices start
teaching the kids from where they are. They find
out what issues are of concern to the students and
address major concerns first. They do not walk in
and begin teaching abstinence right away. They
work to gain trust first. One of the youth from one
class once asked of the abstinence educators about
how she was able to deal with temptation. She
shared that she would not put herself in situations
where things would happen that she did not feel
comfortable with. They asked her if they could call
her on her cell phone if things “got tough.” She
agreed.
Another abstinence educator from CCHS noticed
that, once they have your trust, the kids really open
up and discus personal issues, noting that “This is
an abstinence program, but it’s also a brotherhood.”
He stated that it is positive for kids to talk to
someone who has been in their shoes and knows
where they are coming from.
The Positive Choices program created an activity
called The Dialogue Night for the specific purpose
of creating trust and opening up communication,
particularly between the boys and girls. It has since
been expanded to include teens and parents and
teens and kinship care givers.
Boys sit in a line on one side of the room. Girls
stand in a line on the other. Girls take turns airing
their grievances against boys/males in general
such as, “I don’t like it when you make a baby and
abandon it” or “I don’t like it when you hit my
mother.” Boys stand and repeat the girl’s statements,
“I heard that you don’t like it when….” Boys then
air their grievances and the girls repeat. In the
final steps, communication is opened up because
both the boys and girls (parents and teens) have a
better understanding of what the problems are and
solutions can be found.
For PALO’s It’s A Better Life program, abstinence
educators get the youth comfortable and in the
proper frame of mind by giving the youth more
4Establish trust before teaching abstinence, and continue to cultivate
relationships with the youth you are serving.

control over the learning process itself. As one
abstinence educator explained:
It is most enjoyable and effective if students
drive the activities and, with careful guidance
from their facilitators, reach these conclusions
through their own processes of thought and
feeling.
Some of the comments from the middle school
youth participating in the school-base program
include the following:
It helps us a lot. It teaches about our body
and how we can get diseases and that you
can get pregnant in one night. The program
is a lot of fun. They are exciting people. We
learn not just about sex but how our body
matures.
It teaches new things none of us knew about
puberty, like how men’s voice changes and
about sex.
It tells about your body and the opposite sex
and about STDs. They make it interesting;
you won’t get bored. It’s well given so you
won’t get shy about it.
It gives advice on how to avoid diseases and
what it is like to have a baby.
JCCA’s Resolve staff members were also queried
about what they enjoy about the program. One
educator noted that she enjoys working with the
teens and seeing them have success. Another
thought the most exciting activity was the camping
trips, which helped to break down barriers between
staff and youth. They noted that they often get
better outcomes from one camping trip than from
multiple therapy sessions with the youth. Their
language improves, becoming more respectful and
less like street talk, when on the camping trips.
ii) Effective abstinence educators make
themselves available to youth outside of the
classroom.
For example, the Choices program staff does not
feel this is just a job for them; it iss a lifestyle and
they work various hours of the day, communicating
with the kids and following up on their activities.
The staff is well-versed and knows how to connect
with kids and show them the values they may not
be seeing at home. The administrative team was very
careful to hire only people who are passionate and
who can connect with the kids. The educators also
know how to be diverse and flexible—that is, how
to come up with a teaching technique that will fit
the various situations presented by different kids at
different places in their lives. Four out of the five
educators are involved with the youth programs in
their churches.
The PALO project staff we met all stressed the
caring relationship they have with the kids:
We run into these kids all over town. If we
catch them acting out, we “pull their ears.”
I like helping the children to do things that I
couldn’t do myself at that age.
PALO project director Margaret Barajas explained
about a couple of their abstinence educators:
Rosa and Edith give to kids from the heart.
Our kids, as low-income kids, don’t have
much. But what you give they receive and
then they give back. You can’t quantify this.
We are, to a degree, surrogate parents to
kids and also to the parents. We help the
parents to fill gaps that are missing to them.
We offer love, understanding, and a non-
judgmental relationship. It’s the love that
makes the difference. Without the love, then
it probably won’t work. We get to bond with
the kids. They really know that we care about
them. We always tell them to come to us with
any questions or problems outside of class.
We open that door to them. They are allowed
to keep that relation with us.

Some of the other pointers and practices we learned
from these site visits are as follows:
• Identify the activities you want to do and
present to the students. (If possible, select
several good activities to cover a specific learning
objective and then allow the students to choose
which activity they would like to do.)
• Identify areas where students can help
• Ask for committed students to volunteer their
time to help develop the activities
• Guide the students and mentor them through
the completion of the event
• Be open to new ideas the students might bring
• Recognize students’ contributions to the event
• Set an example of mutual respect and promote
respect among students
• Be conscious of the verbal and nonverbal cues
you are using
• Be careful not to make young people feel that
you or others are judging them for what they say
or do
• Use humor appropriately to ease tensions and to
make people feel comfortable.

In multicultural, urban settings, youth culture
changes rapidly. A curriculum that is developed
one year may appear outdated the next, which
only serves to confirm that adults are “out-of-
touch.” If high-risk youth who are already highly
distrustful believe the adult abstinence educators
don’t understand them, they will be deaf to
whatever message is being delivered.
This practice points to the importance of cultural
competency for effective communication of the
abstinence message to high-risk youth. The concept
of culture here needs to be understood on multiple
levels, in terms of youth culture in general, youth
culture among particular ethnic groups (e.g.,
Latinos, African-Americans, Native Americans);
and/or other socio-demographic factors (e.g., foster
care, homeless).
However, this practice also embodies programs
and staff that understand shared, human needs
that all people (e.g., young and old, high-risk and
otherwise) have, which influence their behaviors
and decisionmaking. This practice speaks to the
process by which the abstinence message was placed
in a context that was both accessible and beneficial
to the high-risk youth served through the programs
we studied.
i) Ensure that the curriculum materials that you
are using are both current and relevant.
Youth culture is constantly evolving, especially in
multi-cultural urban settings, where youth culture
changes rapidly. Curriculum developed one year
may appear outdated the next, which serves to
confirm youths’ tendency to believe that adults are
“out-of-touch” If youth believe the adult CBAE
facilitators do not understand them, they will be
deaf to whatever message is being delivered. To
establish the level of trust necessary to make an
abstinence education program successful, students
must believe that their adult facilitators understand
the complexities inherent in their bicultural lives.
For PALO, a significant percentage of the Latino
populations across Pennsylvania have limited
proficiency in English, which would present a
barrier to mainstream organizations seeking to
reach them. These barriers were anticipated and
addressed in the initial design efforts for the It’s A
Better Life program. All PALO CBAE facilitators
are bilingual and bicultural. All materials used
are available in both English and Spanish. All
evaluation instruments are bilingual and have
undergone extensive revision to ensure accuracy
of translation. The evaluation team is bicultural
and bilingual as are all PALO staff assigned to the
CBAE project. PALO staff and external evaluators
come from several Latino national origin groups,
which is important to ensure that translations of
materials and measurement instruments are widely
understandable.
The expertise PALO in translation and cultural
competence is recognized by the Commonwealth
of Pennsylvania, which contracts with PALO for
translation and interpreter services. Pennsylvania
social service agencies, nonprofits, and institutions
of higher education similarly recognize PALO, and
call upon them to provide cultural competency
training.
ii) Provide your staff and students with a broader
framework within which to deliver the
abstinence message and to ensure consistency
in program delivery.
Youth that are at-risk for early sexual activity are
often vulnerable to substance abuse and other
high-risk behaviors as well. The Authentic Answers
Abstinence Alliance program relies heavily on an
5Adjust and frame the lessons and activities of your curriculum to make them
appropriate to the situation, culture, and language of your students.

education model developed by Celebrate Kids
founder Dr. Koch more than 20 years ago. The
model is designed to help the audience identify
their core needs and change their lives so the needs
are met in healthy ways. As explained on materials
given to the youth, the components of the model
are as follows:
• Security: Who can I trust? I need to trust people
who have earned my trust—they tell me the
truth and don’t want to hurt me. Also, I need
to make wise choices so I can respect and trust
myself.
• Identity: Who am I? I need to know my
strengths to use them, and my weaknesses to
improve them. Change is possible! When I
respect myself, I’ll work to develop more of my
talents and I won’t believe lies about me.
• Belonging: Who wants me? I should meet this
need with people who are good for me. When
I respect myself and others, I’ll work to become
someone others want to be with for the right
reasons.
• Purpose: Why am I alive? I need to positively
influence other people. The good things I can
do, I should do! When I respect myself, I’ll
believe I can help others and I will!
• Competence: What do I do well? I can do many
things well. When I respect myself and others,
I won’t base my feelings of competence on how
others do.
All lessons provided by Celebrate Kids revolve
around these five core needs. The lessons build upon
one another so that each of the five core needs is
addressed during a 10-session curriculum.
The staff considers the program to be both
preventative and restorative. If a student is already
engaged in a behavior, such as sexual activity, the
curriculum explains why the behavior is destructive
and helps the child restore his/her identity. Identity
dictates behavior. If a student is currently abstinent,
the program reinforces the knowledge base and
beliefs of the student and strengthens the student’s
identity as an abstinent individual. The components
of the A-H criteria
are worked into each lesson. For
example, security (i.e., Who can I trust?) covers STD
statistics, and identity (i.e., Who am I?) touches on
how different STDs such as herpes and HIV affect
a person’s identity. Relationship skills are taught
during the belonging (i.e., Who wants me?) lesson.
iii) Institute continuous quality improvement
processes in your evaluation to adjust
curriculum content as needed.
JCCA’s Resolve program, for example, involved
their youth leaders as partners in the curriculum
development process. Even so, the staff noted that
often they had to “make the curriculum up” as
they went along. They admitted to the youth that
at times their efforts were trial and error. They
debriefed after each group to ascertain what worked
and what did not.
Celebrate Kids hosted a focus group to help the
kids have a better understanding of abstinence
education and also to help the program have a
better understanding of teen culture. As many as 50
youth have attended a focus group program. The
students are given a dinner and allowed to discuss
their lives and their needs in an open setting. The
teens contribute to the program by serving as an
actual focus group for Celebrate Kids projects such
as their print jobs, the levels of friendship model,
and Family Fun Nights.
1. This refers to the to the eight mandated criteria for abstinence-until-marriage contained in Title V,
Section 510(b)(2) of the Social Security Act (“A-H”).

For PALO, which implements its abstinence education
program through partnerships with 12 LCBOs across
the state, each site had the latitude to adopt any
supplemental curricula and activities that make the
program relevant to the particular Latino youth sub-
culture (e.g., Puerto Rican, Mexican) they are trying
to reach. The success of the project was in using its
core curriculum (i.e., It’s a Better Life) as a jumping
off point relevant to each project’s community.
To manage the program, PALO instituted process
evaluations to ensure program fidelity to the
following standards: (1) all students that complete
the program have attended lessons based on
at least 80 percent of the curriculum learning
objectives; (2) all CBAE facilitators (i.e., abstinence
educators) have sufficient rapport with students
so as to provide the influence of a “caring adult”
for their CBAE students; (3) all facilitators exhibit
flexibility, creativity, and ability in working within
a consumer-determined pedagogical model that
requires facilitators to respond quickly to changes in
youth culture to deliver the 16 learning objectives
effectively.
Findings from the process evaluation are
communicated to all facilitators on a quarterly basis
to continually develop and improve the abstinence
education program, the lesson plans available for
each learning objective, and the use of suitable
supplementary resources. All curricula, lesson plans,
and supplementary resources are reviewed by a
consultant, and she ensures that all materials used
are medically accurate. All materials are reviewed
for compliance with legislative guidelines and
requirements.
Other overall suggestions from the sites we studied
relative to this practice are as follows:
a) Review the lessons and activities and
decide which might not be appropriate
for your students.
• Make appropriate changes to customize
the lessons and activities you will be
presenting during the program, taking into
consideration the culture and economic and
social status of your students.
• If your students are Hispanic, they may
or may not prefer to receive the lesson in
English. You need to assess what language
they are more familiar with. In some cases,
Hispanic students may want to speak
“Spanglish,” using words in Spanish and
English.
b) Rewrite the lessons and activities with
appropriate scenarios for your students.
If necessary, discuss with some
students.
• Ask the students to list their favorite
activities, TV shows, and music. Knowing
what your students like will help you present
examples students can relate to.
• If your students are young African American
males they may like a type of music that
may not be the favorite music of young
female Caucasian students.
c) Share the new lesson and activities with
other colleagues and alumni and ask
for their feedback.
• Once you have developed the new lesson,
share it with other colleagues and ask for
their feedback. If you keep in touch with
former students of your program, ask for
their input on the activities you are planning
to develop.
d) Once you carry out the lesson or
activity with your students, and before
ending the session, get the students’
feedback on how to improve the lesson
and what might make it more relevant.

High-risk youth are particularly in need of
innovative educational approaches that: (1)
attract and keep their attention; and (2) help
them view their risky behaviors in a new context,
so they can apply alternative models for behavior
and decisionmaking. Below are some examples of
hands-on activities from the programs we studied.
Abstinence education may seem to be a “dry”
or “preachy” subject for students. Abstinence
educators, through activities, exercises, and
discourse, bring students, little-by-little to the
realization of how important it is to remain
abstinent. Abstinence education is most enjoyable
and effective if students drive the activities and, with
careful guidance from their facilitators, reach these
conclusions through their own processes of thought
and feeling.
The Celebrate Kids’ staff believes strongly that the
lessons must be hands-on. By keeping the students
actively involved in the lesson, the Authentic
Answers Abstinence Alliance classes are separate
from the normal day-to-day classroom lessons,
and they are responsive to the students whose
multiple intelligence levels lean toward those that
need activity, touch, or interaction for the best
learning. The hands-on activities also give students
an opportunity to reveal the areas in which they
are struggling. The educators stay interactive and
involved with the students as they complete the
hands-on activities, and learn from the students.
The lesson plans are then adjusted to the needs of
the students.
The staff from JCCA’s Resolve program brings
in the lyrics to hip-hop songs (both positive and
negative) and dissects the message they contain.
This is informative both to the teens and the staff.
They use an STD game and that has worked well.
They created a life game the teens enjoy playing.
In this game of life, they face various struggles and
need to overcome them. Occasionally staff will
surprise youth with a movie day. They held a Tae-Bo
night and served culturally different meals. The big
reward is a camping trip. The staff receives technical
assistance from New York City as well as from
attending conferences (e.g., the CBAE conference).
i) Involve youth in such activities as creating
retreats, conferences, and community services.
The kids in the Celebrate Kids program also do
service, such as helping at the teacher appreciation
dinner and performing a self-written and self-
directed skit for the people in attendance. In the
future, they are looking to have a drama and dance
troop and are building a program called Safe Risk.
The Choices program supports two main
community service events. This year they worked
with the American Cancer Society and the March
of Dimes. The program provided opportunities for
the students to get involved and volunteer for these
organizations.
JCCA’s program conducts an annual working retreat
for youth and staff, and the youth run the program.
They also constituted a community board composed
of other adolescent community service providers,
youth in the program, foster parents, and staff. One
outcome is that they offer peer conflict resolution.
The primary strategy that NCAP uses for engaging
the parents of the youth is through what they call
a family fun night. NCAP rotates the family fun
night among the 10 tribes they serve, holding the
events in such places as tribal halls, school halls, and
local recreation centers. The primary purpose of the
fun nights is to provide a forum where parents can
come together with their kids to hear the abstinence
message delivered through guest speakers, activities,
and information booths.
6Use participatory and dynamic learning activities

The family fun nights are also a vehicle for engaging
the youth through the planning of the event,
working with youth from the host site to play an
active role in organizing the event. NCAP also
benefits from the events planning skills of one of
its abstinence educators. NCAP uses the events as
a means of collaborating with tribal leaders and
other partners to advertise the events, again using
the power of word-of-mouth to get the community
to show up. NCAP has seen the attendance at these
events increase from only 20 to50 participants in
the first year, to an average of 150 in the second
year. One recent family fun night held by the
Soboba tribe had 500 youth and their families in
attendance.
ii) Whenever possible, use hands-on methods that
require students to engage actively in the class.
Table 2 provides a compendium of the interactive
activities that were either directly observed in
our visit to the programs, or were described by
staff during the interview process. These activities
are organized according to the relevant A-H
criteria(on), as established in 2001 through Title
V, Section 510(b)(2) of the Social Security Act
governing Federal funding of abstinence education.

Table 2: Compendium of Interactive Abtinence Education Activities
Who What How Justification Relevant A-H criteria
Authentic Answers
Abstinence Alliance
(Celebrate Kids)
Filter Fill a couple of transparent cups with
water. Explain to the class that a decision
is a simple cup of water. It may contain
impurities such as chlorine and minerals.
These may not hurt you, but they are not
necessary to your survival. Add dirt to the
other cup. This cup of water represents a
bad decision.
Explain to the students that to get the
water clean and drinkable again, it must
go to the water treatment plant—just
as you might have to if you get involved
in drugs and alcohol, or if you have an
STD that must be treated. Add herbs to
the water. These are choices that are not
harmful and add spice to life, but they
might have unintended consequences.
For example, if salt or sugar is added, it
can be used for cooking, but probably
not for drinking.
Helps students realize the
importance of making
good decisions.
A – Curriculum that has, as its exclusive
purpose, the teaching of social,
psychological, and health gains to
be realized by abstaining from sexual
activity.
Positive Choices
(St. Vincent’s Mercy
Medical Center)
What do you
value?
Have the students make a list on the
board of the things and ideals they value
(e.g., love, education, money). Then have
the students identify which values would
be improved by having sex outside of
marriage.
Helps students rethink the
things they value and how
they are not improved by
unmarried sex.
A – Curriculum that has, as its exclusive
purpose, the teaching of social,
psychological, and health gains to
be realized by abstaining from sexual
activity.
Authentic Answers
Abstinence Alliance
(Celebrate Kids)
Circle of Friends Have all the students stand and form a
circle around one person in the center.
Have different students standing at
different distances from the student in the
center. Compare the circle to the different
levels of comfort and trust in the levels of
friendship.
The educator asks person in the center
who (how many people) he or she can
see. Most likely the person will respond
that he or she can only see about half
of the people in the circle. The educator
asks the rest of the group who can see
the people behind them. The students
reply that the person in the center is
looking at half of the circle, but they
could see the students in the other half
of the circle.
Explain that students
could not observe all of
their friends all the time,
but if one or more friends
warns them about one of
their other friends, they
should probably listen,
especially if the students
that are warning them
have earned their trust.
Educator helps students
realize that they must use
friends as resources to
help them grow and that
choosing good friends is
very important.
B – Curriculum that teaches abstinence
from sexual activity outside of marriage
as the expected standard for school-
age children.

Aiming for
Abstinence
(Booneville School
District)
Pottery Wheel The educator takes a lump of clay and
begins making a bowl with it. She or he
makes a mistake with the clay and has to
start over. At the end the educator show
the students a beautiful bowl.
Helps students realize that
even though a mistake
was made and it had to
be re-worked, she or he
can still start over. The
message of “secondary
virginity” can be
introduced to the class.
C – Curriculum that teaches that
abstinence from sexual activity is
the only certain way to avoid out-
of-wedlock pregnancy, sexually
transmitted diseases, and other
associated health problems.
Aiming for
Abstinence
(Booneville School
District)
Flash Paper The educator ignites a piece of flash
paper to demonstrate the idea that
“passion” is flashy and fun but is fleeting
and does not necessarily leave anything
good behind.
Helps students learn that
when passion leads to
sexual activity outside
of the committed love
relationship of marriage,
not only may it leave
someone without anything
good, but it can also
leave someone pregnant,
ill, broken-hearted, or all
three.
C – Curriculum that teaches that
abstinence from sexual activity is
the only certain way to avoid out-
of-wedlock pregnancy, sexually
transmitted diseases, and other
associated health problems.
D – Curriculum that teaches that
a mutually faithful monogamous
relationship in the context of marriage
is the expected standard of human
sexual activity.
Positive Choices
Medical Center)
Gift Bags Have a series of beautiful gift bags
and a series of ugly gift bags. Inside
the beautiful bags, place items such as
a Baby Ruth, a Laffy Taffy, and other
candies that can be explained to have
negative connotations (e.g., you’re
having a baby, everybody is laughing at
you). Fill the ugly bags with ring pops,
Hundred Grand bars, and other candies
with positive connotations (e.g., marriage,
successful job). Have the students select
their favorite bag and remove the candy.
Helps students realize
how Hollywood movies
and other media
messages tell that sex
before marriage is good,
but inside there are
negative consequences.
Hollywood movies often
make marriage and
abstinence look bad, but
good results come from
these decisions.
sexual activity.
Positive Choices
Medical Center)
Plan a Wedding Have the girls plan their wedding
- menus
- invitations
- gowns
- number of bridesmaids
- music
- etc.
Many of these girls have
never attended a wedding
and may not have
seen a marriage. This
is an activity that helps
normalize the process of
formalizing the marriage.
sexual activity.
Positive Choices
Medical Center)
Love Box Have a box with papers inside. Each
paper has a short phrase or word such
as a walk in the park, a swing, and
frustrating. Have each person draw a
paper and explain how it relates to love.
Helps open groups with a
history of sexual abuse to
past pain to allow healing
to begin, without forcing
anyone to share their
deep dark secrets.
E – Curriculum that teaches that sexual
activity outside the context of marriage
is likely to have harmful psychological
and physical effects.

Choices
(Christ Community
Health Services)
Is Your Bed
rowded?
The educator places a bed sheet and
pillow on the floor in front. Write on the
board behind it the phrase “Is your bed
crowded?” Then hand out index cards
with names on them to almost every
person in the room and then proceed to
read a story about an engaged couple
who was thinking about the people
they had had sex with in the past. While
reading the story, some of the names
on the index cards were read. Students
with those cards come sit on the “bed”
in front of the room when they hear their
name used.
As the story goes, each
person links to another
and another, showing how
having sex with a few
people links you to all the
others with whom those
people have had sex.
Students may be shocked
at how crowded the bed
becomes. Ask students
what they should know
about their partner (even
a fiancé) before having
sex.
E – Curriculum that teaches that sexual
activity outside the context of marriage
is likely to have harmful psychological
and physical effects.
Aiming for
Abstinence
(Booneville School
District)
Budget Activity Have the students ask their parents or
guardians for past house bills such as
rent, phone, utilities, and car payments.
Have students research the price of
diapers, baby food, daycare, and other
baby needs. Help the students develop
a budget for a month based on a couple
earning the minimum wage.
Helps the students realize
that if they do not finish
school, most likely they
will end up working a job
that pays minimum wage.
Also, this activity helps
students realize how
much it costs to maintain
a family.
F – Curriculum that teaches that
bearing children out of wedlock is likely
to have harmful consequences for the
child, the child’s parents, and society.
It’s A Better Life
(PALO)
Baby Monchito “Baby Monchito” is a computerized
baby doll that cries at certain times and
the students need to change, feed, and
entertain.
Gives an idea of how life
is for parents and how
the parents need to figure
out what is happening to
the baby (when the baby
cries).
F – Curriculum that teaches that
bearing children out -of wedlock is
likely to have harmful consequences
for the child, the child’s parents, and
society.
Positive Choices
Medical Center)
M M Game Place a few MMs in bags and give one
bag to each student. Play music and
have students “party” by exchanging a
single MM with each interaction. Each
color represents something that could
happen at a party (e.g., drinking, passing
out, being raped, having sex while
intoxicated).
Helps students think
about he effects of being
intoxicated by drugs and/
or alcohol while making
decisions.
G – Curriculum that teaches young
people how to reject sexual advances
and how alcohol and drug use
increases vulnerability to sexual
advances.

Choices
(Christ Community
Health Services)
Preparing for
Summer
Put up a poster on the seasons of
manhood (boy, brother, husband, father)
and post a blank piece of flipchart paper
on the board in the front of the class with
the heading “Summer Memories.” The
educator makes the point that summer is
coming and that the students need to get
their minds on preparing for summer. The
educator invites students to come up and
write down some of their best summer
memories. Stress the importance of
having a plan for the summer by setting
positive goals for the summer as well as
for preparing for ways to deal with the
temptations to engage in risky behaviors.
While summer is a
fun time, there are
also risks that the kids
will face. The lack of
school responsibilities
and structure may be
a source of boredom
and this boredom may
push the boys into doing
things they might not
do otherwise, just for a
change of pace. Sexual
temptations increase with
the summer as people
wear fewer clothes and
parents may not be
around during the day
to supervise kids. Helps
students set goals and
make plans for using their
free time.
advances.
Resolve
(JCCA)
Delayed
Gratification
Throughout a lecture, the educator has
boxes of Pop-Tarts strategically placed
so every student can see them. Ask the
class if they are hungry. Eventually, put
one box of Pop Tarts on each desk and
tell students they cannot open it. Open
your box an eat it. The educator opened
his and ate it.
The message is sex is
just another appetite
and we need to control
it. Sign each package
and tell students to keep
them for a week, do
not eat them, and they
could not give them to
their educator or dorm
monitor as the boxes are
their responsibility. Tell
students that for those
that succeed there would
be a bigger prize the next
class. Helps students
understand that this
activity is a metaphor for
life and the choices they
would make.
advances.
Positive Choices
Medical Center)
Collage Have students cut out pictures from
magazines to describe their future (e.g.,
wedding, career).
Helps students visualize
and realize their dreams.
H – Curriculum that teaches the
importance of attaining self-sufficiency
before engaging in sexual activity.

Authentic Answers
Abstinence Alliance
(Celebrate Kids)
Life Building
Blocks
Using toddler wooden building blocks in
different sizes, shapes, and bold, bright
colors, the educator tells his/her story of
life decisions from middle school through
marriage. Include graduating from high
school, going to college, graduating from
college, getting a job, traveling, getting
married, having children, etc. Place one
block for each experience and start
creating a building out of the blocks.
Explain to the students that each block
represents a different life choice. Once
you have finished telling the story, gently
shake the desk, and have the students
see how the building is stable.
The educator helps
students realize that
if they make good
decisions they can build a
stable future.
H – Curriculum that teaches the
importance of attaining self-sufficiency
before engaging in sexual activity.
Authentic Answers
Abstinence Alliance
(Celebrate Kids)
Change
Process
Have two shirts, one with the word
“FLIRT” and another with the word
“FRIEND.” Have a student put the
shirt that reads “FLIRT” over his or her
clothing. On paper or on the board
have the students identify the words
associated with the word “flirt.” Ask the
student wearing the shirt how she feels
being identified as a flirt (only for this
demonstration, not in real life). Have
the students write the words associated
with the word, “friend.” Then have the
students identify steps that a flirt can
take to stop being a flirt and start being
a friend. Have the student switch the
“Flirt shirt” for the “Friend shirt.” Ask the
student wearing the “friend shirt” if she
or he felt differently wearing the “Friend
shirt” and seeing the positive things
written about friends.
Helps students learn that
identity drives behavior
and that changing a
behavior is a process
that takes time but it is
possible.
Not directly tied to any particular
criteria.
Positive Choices
Medical Center)
Dialogue Night Boys sit in a line on one side of the
room. Girls stand in a line on the other.
Girls take turns airing their grievances
against boys/males in general, “I don’t
like it when you make a baby and
abandon it” or “I don’t like it when you
hit my mother.” Boys stand and repeat
the girl’s statements, “I heard that you
don’t like it when….” Next, boys air their
grievances and the girls repeat. In the
final steps, communication is opened up
because both the boys and girls (parents
and teens) have a better understanding
of what the problems are and solutions
can be found.
The Dialogue Night was
designed to help build an
understanding between
teen boys and girls, but
has been expanded to
include teens and parents
and teens and kinship
care givers.
Not directly tied to any particular
criteria.

High-risk youth, many from broken homes, are
especially vulnerable to the influence of media
messages, because there is often no one at home
to act as a role model or otherwise contradict
messages promoting sexual activity.
The first requirement for applying this practice is to
help the youth you are serving to see and appreciate
the way media and advertising influence us and our
behaviors and decisionmaking in general.
The Resolve program, for example, showed students
a list of popular media slogans and logos (e.g., Nike,
Mercedes Benz, Mountain Dew). They then asked
the students to identify the company and products
as quickly as possible. This served to illustrate how
much information we get from television and how
we retain it. This exercise helps students understand
how media can affect our minds with messages we
remember—even if we are not trying to retain them.
i) Make students aware of the effect of
advertising and “sexualized” media messages.
Once students are sensitized to the media influence
in general terms, the next step in the process is to
focus their attention on media messages that use
sexual content to sell a product or service (i.e., as
an advertisement tool). Students at one of PALO’s
programs made a collage of images from magazines
and newspapers to help them look critically at the
use of sexualized images in advertisements targeting
young people. They asked the kids to write about
the use of sexuality in the TV shows that they
watch.
Some of the other activities that PALO’s abstinence
educators thought the students enjoyed include the
construction of poster boards with media messages,
of which students were asked to create a poster with
positive messages on one side and another side with
messages that had sexual connotations. The students
needed to think about TV, radio, and print messages
and also about popular songs and include them in
the poster.
Likewise, for the Resolve program, the focus of
one particular lesson was the effect of mass media
through the use of sexual innuendo. The educator
quickly showed them the cover of a magazine with a
scantily clad girl on the cover. He then asked them
if they remembered the name of the magazine. Most
agreed their eyes were on the girl and not the name
of the magazine. He repeated this with two other
ads.
Another aspect of the influence of the media on
which these programs focused was movies and TV,
and the values and messages they convey. One of
JCCA’s abstinence educators asked the students if
they knew how movies have changed. He indicated
that since 1980, there was more violence and sex in
movies. Movies rated R now were X-rated 20 years
ago. Seventy-five percent of all movies now have
violence or sexual innuendo. The message he relayed
is that seeing more sex and violence at a younger age
will generally result in the person having more sex
and violence in their lives.
The Positive Choices project used a series of
beautiful gift bags and a series of ugly gift bags to
make a point about media messages. Inside the
beautiful bags, they placed items such as a Baby
Ruth, a Laffy Taffy, and other candies that can be
associated with negative connotations (e.g., you’re
having a baby, everybody is laughing at you). They
then filled the ugly bags with ring pops, Hundred
Grand Bars, and other items associated with positive
connotations (e.g., marriage, successful jobs). They
asked the students to select their favorite bag and
remove the candy. A discussion followed on how
Hollywood tells us that sex before marriage is good,
but inside this message are negative consequences.
The conclusion was that Hollywood often makes
7Make youth aware of media messages that misrepresent and distort sexual
activity.

marriage and abstinence look bad, but good results
come from these decisions.
ii) Develop a social marketing campaign to
counteract media influences and reinforce the
abstinence message.
A couple of programs we studied adopted a
proactive approach, using media as a tool for
extending and reinforcing the abstinence message
taught in the classroom.
Authentic Answers Abstinence Alliance conducted
a social marketing campaign using a branded look
that flows through all aspects of the program. The
colors of the program are bold, primary colors: red,
blue, purple, green, and yellow/orange. These colors
and the look of the campaign were proposed, along
with others, to the teens of the focus group, which
chose their favorites. Colors and messages were
coordinated with all the billboards, movie theater
ads, t-shirts, and student folders and posters, which
developed a form of “branding” students, parents,
and professionals could quickly identify. The staff
spoke of how important they felt branding was
to the success of the program, arguing that when
people see the advertisements, flyers, posters, and
notices, they immediately associate them with the
program, which reminds everyone of the lessons
they received in the program and reinforces the
messages.
St. Vincent’s “Join the Abstinence Movement”
is a pilot project and media campaign focused
on changing the message of abstinence from
a deficient (“just say no”) message to an active
(“join us”) message. It is presented as a simple and
clear message, in black and white. The black and
white motif represents the black/white or yes/no
clarity of remaining abstinent until marriage. It
also represents a musical happening—a party. An
abstinent lifestyle does not mean a boring lifestyle.

Because of the lack of “moral” role models and/or
examples of abstinence-until-marriage within
their homes and communities, high-risk youth
especially need to see and understand, among
other things, the health consequences of their risky
behaviors as part of the effort to change their
decisionmaking processes.
i) Get the latest facts about STD rates in your
area and the types of treatments available.
Students from a number of the programs we visited
were usually surprised by the STD statistics and
typically remembered, at a minimum, the public
health aspect of the abstinence message. One
student realized he could easily be a part of those
statistics if he did not choose abstinence.
Up-to-date information on public health statistics
for your county or city is available via the Internet.
Sample sources: www.cdc.gov, www.naphsis.org,
http://phpartners.org/health_stats.html, or your
State Department of Health website.
ii) Present the information in clear and creative
ways that the youth can understand.
Students interviewed at one of the It’s A Better Life
program sites indicated that using large numbers to
illustrate the prevalence of STDs is not effective. For
example, telling students that 40,000 people in the
United States become infected with HIV each year
does not register with students because they may not
have a point of reference for that number. They may
not know the current population of the country and
how the infection rate poses an actual risk to them.
Rather, students understand illustrations, such as
“one in five people are currently infected, or will be
infected in their lifetime, with the Herpes A virus.”
In another example, abstinence educators from
the Resolve program played a popular hip-hop
song while showing a slide show of STD facts and
statistics. The song is glamorizing sexual activity,
while the slides are showing the risky results of that
type of behavior.
iii) Use creative, interactive activities to convey
how STDs can spread.
Students learn and remember most through the use
of hands-on activities. Keep the lessons short and
interesting, with visuals and examples that will stand
out.
As part of the Choices program, the abstinence
educator put a bedspread on the floor in front of
the classroom and then handed a card with a first
name written on it to each student as they enter
the classroom. The educator then told a story about
a couple who is considering getting married. The
night before their wedding, they are each reflecting
on their past sexual partners. As the educator
named each partner (and the partner’s partners),
the students with the said name on their card came
up and sat on the blanket. The object is to illustrate
that when you have sex with a person, you are
exposed to everything their past partners (and their
partners) might have been exposed to. The blanket
rapidly gets crowded and the students clearly see
how quickly “a few partners” can expose you to
hundreds of STDs.
Another practice we observed was to bring
examples of people whose lives have been affected
by STDs. Both program staff and students have
conveyed the importance of being able to relate to a
speaker in general. A number of students recounted
real-life stories from people who had been affected
by STDs.
8Present information and statistics on STDs in a way that youth can understand
and communicate.

iv) Work with other stakeholders who influence
youth, especially in the healthcare community
(e.g., pediatricians), to reinforce the fact that
abstinence is the surest way to avoid STDs.
The Positive Choices program was founded in
1986 by a pediatrician. Dr. Alean Zeiler. When she
began the program, the medical professionals with
whom she worked believed that teens had to be
given “protection” from STDs and pregnancy. This
doctor likened this “safer” sex message to telling a
teen that it is okay to drink and smoke because we
have medical treatments for lung disease and liver
cancer. It is not okay to have sex just because we
can cure or treat STDs. This is the message that she
and other physicians share with their patients and
their patients’ parents during the checkups. They
refer adolescent patients to the abstinence program
and talk to them about the other, non-medical
consequences of sexual activity.
Through the years, the staff has noticed some
changes linked to the program. In the beginning,
the students had STDs and teen pregnancies. Now,
there are fewer students testing positive and facing
life-long consequences. Before, the students would
not admit to being a virgin. Now, students openly
talk about their virgin status with pride. Before, the
medical professionals believed that teens had to be
given “protection” from STDs and pregnancy. Now
they refer adolescent patients to the Positive Choices
program and talk about the other, non-medical
consequences of sexual activity.

“Many of the students may not have been exposed
to good examples of married couples in their
community. The message that seems to reach the
students most effectively is to help them explore
the economic consequences of becoming a parent
while still a teenager.” [Margaret Barajas, director for
the It’s A Better Life project, PALO]
Statistics abound on the difference in
lifetime earnings for individuals completing high
school, as well as those with some college education,
versus those who drop out. Not all students are
aware of this. One of the key messages from this
practice is that not completing high school because
of becoming a “premature” parent places youths and
their children at a severe economic disadvantage.
Many high-risk youths are caught up in the cycle of
welfare and have conceded to stay there. The goal
of efforts around this practice is to empower youths
and ask them, “Is that enough for you?”
i) Frame the abstinence message as an economic
development issue.
The program staff for PALO views abstinence
education and teen pregnancy as an economic
development issue for the Latino population
served by their affiliates. Teen pregnancy tends to
result in youths not completing high school or
college, thereby placing them and their children
at a disadvantage economically. The message that
seems to reach the students most effectively is to
help them explore the economic consequences
of becoming a parent while still a teenager. The
message to abstain from sex until you finish college
and are economically and emotionally ready to
marry and start a family resonates very deeply with
the students.
ii) Present activities where students can realize
how expensive having a child is.
Abstinence educators from the It’s A Better Life
program have found that the message to abstain
until marriage, by itself, does not resonate well
with the students, as most come from a single-
parent household or the student is being raised by
a relative (e.g., grandmother or aunt). Many of the
students also may not know of a good example of a
married couple. The message that seems to reach the
students most effectively is to help them explore the
economic consequences of becoming a parent while
still a teenager.
At one of PALO’s sites, we observed students
engaged in activities that educated them on the
economic costs of parenthood. For instance, “No
Time, No Money for a Baby” is an activity in which
they make a family budget. During another activity,
called “The Price is Right,” students compete to
correctly guess the costs of items such as groceries,
electric bills, and rent.
In the Aiming for Abstinence program, abstinence
educators had students ask their parents or
guardians for past house bills such as rent, phone,
utilities, or a car payment. The students were also
asked to research the prices of diapers, baby food,
daycare, and other baby needs. The abstinence
educators then helped the students develop a
budget for a month, based on a couple earning the
minimum wage. When students from this program
were asked during a group interview which activities
affected them the most, these students all agreed
that developing a family budget was an eye-opener.
“You would not think it was that much,” said one
of the students, “You cannot afford having a baby
making (earning) the minimum (wage).”
9Emphasize the economic and social impact of having a child.

iii) Develop activities that help students recognize
how their lives would change when a child
arrives.
For the Booneville program, the abstinence educator
played a tape of a baby crying during class time and
asked the students to continue to concentrate on
their work. The noise gave the students a glimpse
of the frustration that can accompany caring for a
crying baby.
As part of the Positive Choices program, students
were asked to make a list of the things and ideals
they value (e.g., love, education, money). They
then asked them to identify which values would be
improved by having sex outside of marriage. This
activity helped them to see that none of the things
they value are improved by unmarried sex, when the
consequences are genuinely considered.
Much of the purpose of this practice within the
context of abstinence education is to present a
proper framework for youth to make choices
and understand the consequences, not simply to
communicate what they should not do. Mr. Ncube,
project director for the Native Challenge Abstinence
Program, explained:
Kids are impressionable and focus primarily
on “what’s in it for me?” In all our programs,
prevention education is taught. This means
that the kids are seeing and understanding
that if they don’t do this, this is what they can
become. Instead of giving threats, we give
them benefits and get a positive message
across. It is essential to balance the benefits
with the consequences.
There are no additional examples provided in the
Appendix.

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