Risky Behaviors

& Sexual Health

MTSS GROUP PROJECT
Julia, Karla, and Morgan
Overview: Risky Behaviors in Adolescence
● Unprotected sexual activity, multiple sexual partners
● Alcohol and drug use
● Truancy
● Vandalism

These behaviors are associated with poorer academic performance in school, less
school-connectedness, and poorer physical health (Rew and Horner, 2003).
Overview of facts about STIs
● A sexually transmitted infection is an infection contracted through sexual contact; this is different
than an STD, or sexually transmitted disease, which is less common. An STD may follow an STI.

● Those aged 15-24 make up just 24% of the entire United States populace, and yet they account
for over 50% of the 20 million new STI cases each year (CDC, 2019).

● According to the Center for Disease Control and Prevention (2018) black males were 6.6 times
more likely to report chlamydia than white males, and black females were 5.0 times more likely
to report it than white women. Similarly, black and Hispanic people reported higher rates of
gonorrhea than their white peers (CDC, 2018).
Overview: Why does this issue matter to SCs?
The Center for Disease Control and Prevention (2019) has repeatedly found links between overall
physical health and good grades.

A health complication like a sexually transmitted disease is often accompanied by feelings of shame.
Sadly, feelings of shame lead to a lack of motivation to learn, loss of school connectedness, and chronic
absenteeism (CDC, 2019).
Overview: Sex-Ed in America
A study found high-school students in America to have much higher rates of STIs than their peers in the
Netherlands, France, and Australia, namely countries with sex-positive attitudes (Weaver, Smith, and
Kippax, 2005).

It is important to note, comprehensive sex-ed does not increase sexual activity for young people.
Tier One Interventions: 80-90% population
Already in Place

● California Healthy Youth Act - classroom sex-ed lessons beginning in 7th grade, written
request to remove student required, abstinence-only prohibited (CDE, 2016)

Evidence

● Research from the National Survey of Family Growth assessed the impact of sexuality
education on sexual risk-taking for people ages 15-19 and found that teens who received
comprehensive sex education were 50% less likely to experience pregnancy than those who
received abstinence-only-until-marriage programs (Kohler, Manhart, Lafferty, 2007)
Tier One Interventions: 80-90% population
Proposed Additions

● Majority of states still follow abstinence-only curriculum which is correlated with higher
rates of STIs (Weaver, Smith, and Kippax, 2005)
● Expansion of scope: Relationship skills, Intimate Partner Violence red flags, and sexual
identity included in classroom lessons
● Inclusive sex-ed should provide information on non-heterosexual relationships
● Online class option should be eliminated as they have proven less engaging and effective
than face-to-face instruction (Bergstrand and Savage, 2013)
● Optional lunch-time discussions that allow for Q & A sessions with diverse, well-informed
staff members
Progress Monitoring: Tier One
● Pre/Post Test surveys are the easiest way to monitor changes in students’
understanding and behavior
● A pre-test survey also informs counselors of the areas that need focus during
classroom sex-ed lessons
● Surveys generally taken anonymously, so cannot be used to identify students
at-risk; must self-disclose

Example of pre/post test survey: NY State (True/False/Unsure)

1. A person with an STD who looks and feels healthy cannot give the infection to others.

8. A condom should be completely unrolled before it is placed on the penis

 Tier One Reaches All
Each day 54.7 million young people attend nearly 119,000 schools across the USA, making school

based sex-education the best way to prevent STIs (Gaydos, et al. 2008).
Tier Two: 10-20% of population, higher risk

Tier Two Intervention
Higher Risk: Small Group
Secondary-tier interventions play a
key role in supporting students at risk
of academic and social problems and
may prevent the need for more
intensive interventions
(Hawken, Adolphson, Macleod, & Schumann, 2009)
Students:
● In a relationship
●
●
Expressing high interest in dating
Caught drinking or doing drugs
● Who are constantly being dress-coded
● Inappropriate website searches
● Removed from the home (i.e. homeless,
foster care, etc)
● Poor peer relations
● Low academic achievement
● Chaotic home life
 Research shows that students who repeatedly demonstrate risky
behaviors at school & home are more likely to make risky sexual
decisions in regards to their own sexual health.

Let's teach students how to effectively take care of their bodies

and what that means.

(Commendador, 2010)
 What is ALREADY being done?
➔ Positive adolescent life skills

◆ Small groups for adolescents & teens who are higher risk

◆ Ex: Teen Club

➔ School Based Health Centers (SBHCs)

◆ More than just the nurses office where students can go for more direct information
and resources

◆ Experienced or trained professionals

(Tuttle et al, 2005; Kisker & Brown, 2008)

 What CAN we do?
Tier Two Interventions
➔ Restorative Circles
➔ Opportunities for Campus Responsibility
◆ Peer Educators
➔ After School Programs
◆ Find out why they may be engaging in risky behaviors
➔ Training to Enhance Motivation
◆ Develop fun & engaging curriculum
◆ Use technology and make it relevant to students
➔ Behavior Interventions Groups
◆ Lesson plan to teach, practice, & reinforce skills

(Botvin & Griffin, 2007)

 What Small Groups May Look Like...
● Restorative Circles...Why?
○ Topics:
■ What do you think risky sexual behavior means?
■ What do you think the consequences of those behaviors are? If any?
■ What do you think of when you hear healthy sexuality?
■ What does a healthy relationship look like?
■ What do you think contributes to making riskier sexual decisions?
● Provide Opportunities for Campus Responsibilities
○ Campus Peer Educators
■ Research show that substance use decreases in adolescents once they begin to take
on more adult responsibilities
● Why not create those on campus?
 ➔ Pre/Post Assessments
◆ Behaviors demonstrated at school.
Overall less dress-codes, disciplinary
actions, etc
Progress ➔ School Wide Information System
Monitoring: Tier Two (SWIS)
◆ Grades
◆ Disciplinary actions & attendance

➔ Monitor Behavior Intervention Plan

(BIP)
◆ Replace problem behaviors with more
positive ones

➔ Functional Behavior Assessment

(FBA)

➔ Interval Data Sheet

This is a great way to monitor your students progress with specific behaviors and further access
if you need to implement a Behavior Intervention Plan (BIP) . You are also able to see what
previous interventions have been ineffective.
Tier Two & Three Automated Tracking
Tool
 Tier 3:
“At high risk”

● Tier 3 students account for about 1- 5% of the

Who are the “At-high-risk” in
student population this scenario?

● Students who Tier 1 and Tier 2 supports are not Pregnant Teens and
Adolescent Parents
sufficient
● More intensive and individualized→ referral to
outside agencies like Adolescent Family Life
Program(AFLP) and Cal-Learn Program
http://www.ochealthinfo.com/civicax/filebank/blobdload.aspx?BlobID=78477
 ● Not receiving a highschool diploma before the
High Risks for pregnant age of 22 or not at all

teens & teen parents ○ Women who gave birth before the age of 18 were

are:
even less likely to obtain a HS diploma.
● Low socioeconomic status and social difficulties
and possible depressive symptoms (Gossens,
Kadji, & Delvenne, 2015)
● Children of teen moms are more likely to
○ Have low academic performance to the extent that
they can drop out of highschool
○ Be incarcerated
○ Be teen parents themselves
○ Unemployment
 Already in Place
Title IX of the Education Amendments Act of 1972: Federal law that prohibits
discrimination based on sex in the education system.

● This laws also protects individuals who may, are, or have been pregnant and
allows them to have equal access to school programs.
● Other protections include
○ Excused absences due to pregnancy/childbirth.
○ Offer separate programs for them and they have to be voluntary and it has
to provide same to opportunities.

(Title IX, 2018)

 Possible Additions
Schools should try the following:

● Develop programs and policies that support pregnant students and

adolescent parents that...
○ give them excused absences when needed
○ provide them with opportunities to make up work
○ have extra assistance with school homework
○ provide on-site child-care or resources for Head-Start, free services
● Have a Title IX coordinator to be a liason for that population, that way
they get the services necessary to succeed.

(nwlc.org, 2012)
Progress
Monitoring in Tier 3
● Individual Diagnostic Assessment
○ Surveys that help detect depression
● Collaborating with students
physician
● Wraparound Support
● Functional Behavior Assessment
○ Positive Strategies Setting Events
Checklist
● Mentoring→ checking with a mentor
Role of the School Counselor
● Advocate for comprehensive, inclusive sex-education at the Tier One, Two and Three Levels

● Make oneself a visible figure on campus for students to come to with questions/concerns regarding

risky behaviors, relationships, and their identities

● Educate teachers and staff members about risky behaviors, the warning signs, and consequences
Role of the School Counselor: Tier One
● Tier One education involves teachers, staff members, and community partners.
○ Classroom lessons may be provided by teachers, with the counselor’s assistance
○ Staff may create posters to hang around campus, with direction from the counselor
○ Community partners may provide school-wide assemblies, as organized by the
counselor
Role of the School Counselor: Tier Two
● Be the head of the team
○ Collaborate with teachers, administration, parents, BUT also collaborate with outside agencies
● Safe Space
○ Yes we want to ensure these students are receiving the help & resources, but nothing is going to stick or be
different if they do not feel COMFORTABLE with you and the environment.
○ Spend adequate time ensuring students feel safe and comfortable with you and their peers
● Conduct Assessments
○ Determine who would be a good fit for your small group
○ Are they truly at a higher risk?
○ Will they work well with others you have in mind for the group?
○ Are they willing or able to be apart of small groups?
● Reach Out
○ As school counselors we should dabble in almost everything. That does not mean we need to be experts,
reach out to outside agencies to come in and lead a small group session, or to provide more information on a
topic where you may not be as familiar.
Role of the School Counselor: Tier Three
Similar to Tier Two:

● Reach out to pregnant and parenting teens; offer individual counseling & provide resources for
affordable child-care, medical care, and school assistance
● Increase teen parents, especially the moms, connectedness and confidence
● Educate teachers/staff about needs and accommodations of this population
● Advocate for inclusivity on campus of these teens
 Having teen parents educate kids

https://www.youtube.com/watch?v=hAPqYCRSkaA
Appendix A: NY State Sex-Ed pre/post test
True/False/Unsure Format

1. A person with an STD who looks and feels healthy cannot give the infection to others.

3. All STDs can be cured by taking medicine.

2. A sign of having an STD is pain or burning when urinating (peeing)

4. Persons infected with STDs often do not have any signs of infection.

5. It is safe to start sex without a condom as long as the condom is put on before the man ejaculates.

6. Condoms exposed to heat and sunlight may break more easily.

7. The best way to use a condom is to leave some space at the tip for the sperm

8. A condom should be completely unrolled before it is placed on the penis

Appendix A: NY State Sex-Ed pre/post test
9. It is safe to use oil with latex condoms

10. Most health clinics must have the permission of parents to test and treat people under 18 years old for STDs.

11. Can the following behaviors put you at risk for getting HIV? a. Sharing needles for tattooing or piercing b. Having sex
without a condom c. Donating blood d. Using the same condom twice e. Hugging

12. Which of the following methods are effective if used correctly to protect people from STD (including HIV) and
pregnancy? a. Choosing not to have sex (abstinence) b. Using latex condoms c. Using hormone based birth control (e.g., the
pill, Depo-Provera shot, patch, vaginal ring)
CEO d. Using withdrawal e. Douching
CFO (washing out the vagina) Sales Director
Wendy Writer
 References
Botvin, G. J., & Griffin, K. W. (2007). School-based programmes to prevent alcohol, tobacco and other drug use. International Review of Psychiatry, 19(6), 607–615.
doi: 10.1080/09540260701797753
California Department of Education. (2016). Comprehensive Sexual Health and HIV/AIDS Instruction. Retrieved from:
https://www.cde.ca.gov/ls/he/se/

Center for Disease Control and Prevention. (2019). Sexually transmitted infections among young Americans. Retrieved from:
https://www.cdc.gov/std/products/youth-sti-infographic.pdf

Condoms. (n.d.). Retrieved November 15, 2019, from https://www.healthdirect.gov.au/condoms.

Bergstrand, K., & Savage, S. V. (2013). The Chalkboard Versus the Avatar: Comparing the Effectiveness of Online and In-class Courses. Teaching Sociology, 41(3),
294–306. https://doi.org/10.1177/0092055X13479949

Education Amendments Act of 1972, 20 U.S.C. §§1681 - 1688 (2018)

Egan, J., & Kaufmann, L. S. (2012). EXECUTIVE SUMMARY A PREGNANCY TEST FOR SCHOOLS: The Impact of Education Laws on Pregnant and Parenting
Student. Retrieved from https://nwlc.org/sites/default/files/final_nwlc_pregparexecutivesummary.pdf.

ETR Associates. All4You2! Student Knowledge Survey Key. Scotts Valley, CA: ETR Associates. © 2015 ETR Associates

Gaydos, C. A., Hsieh, Y. H., Galbraith, J. S., Barnes, M., Waterfield, G., & Stanton, B. (2008). Focus-on-Teens, sexual risk-reduction intervention for
high-school adolescents: impact on knowledge, change of risk-behaviours, and prevalence of sexually transmitted diseases. International journal of STD & AIDS,
19(10), 704–710. doi:10.1258/ijsa.2008.007291
 References
Goossens, G., Kadji, C., & Delvenne, V. (2015). Teenage pregnancy: a psychopathological risk for mothers and babies. Psychiatria Danubina, 27(1), 499-503.

Hawken L.S., Adolphson S.L., Macleod K.S., Schumann J. (2009) Secondary-Tier Interventions and Supports. In: Sailor W.,
Dunlap G., Sugai G., Horner R. (eds) Handbook of Positive Behavior Support. Issues in Clinical Child Psychology. Springer, Boston, MA

Hoffman, S. D., & Maynard, R. A. (2008). Kids having kids: economic costs & social consequences of teen pregnancy. Washington, D.C.: The Urban Institute Press.

Kohler P.K, Manhart L.E, Lafferty W.E. (2007). Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy.
Journal of Adolescent Health. 42(4): 344-351.

Perper, K., Peterson, K., & Manlove, J. (2010). Diploma Attainment among Teen Mothers. Fact Sheet. Publication# 2010-01. Child Trends.

Rew, L., Horner, S.D., (2003). Youth resilience framework for reducing health-risk behaviors in adolescents, Journal of Pediatric Nursing, 18(6), Pp. 379-388, ISSN
0882-5963, https://doi.org/10.1016/S0882-5963(03)00162-3.

Tuttle, J., & Campbell-Heider, N. (2005). Positive adolescent life skills for high risk teens: Findings from a group intervention study. Journal of Adolescent Health,
36(2), 118–119. doi: 10.1016/j.jadohealth.2004.11.051

Weaver, H., Smith, G. and Kippax, S. (2005). School‐based sex education policies and indicators of sexual health
among young people: a comparison of the Netherlands, France, Australia and the United States, Sex Education, 5(2), 171-188,
DOI:10.1080/14681810500038889

Weiss, J. A. (2007). Let us talk about it: Safe adolescent sexual decision making. Journal of the American Academy of Nurse Practitioners, 19(9),
450–458. doi: 10.1111/j.1745-7599.2007.00252.x