Sexual Risk Avoidance Education 2020 Toolkit

The Administration on Children, Youth and Families – Family and Youth Services Bureau has released the following grant: Sexual Risk Avoidance Education Program. The submission deadline is May 26, 2020.

The Dibble Institute is dedicated to your success as an applicant!

Love Notes Sexual Risk Avoidance Adaptation (SRA) Evidence Based Program (EBP) is the version of Love Notes that meets all the criteria of this funding announcement because it complies with SRA criteria and is evidence based.

Love Notes is the only evidence based program that HHS has placed on their Evidence-Based Teen Pregnancy Prevention Program list that both reduces adolescents’ risk for experiencing a pregnancy by 46%, delays initiation of sexual activity, and helps youth who are already sexually active return to a lifestyle without sex.

Love Notes SRA EBP is medically accurate, age appropriate for ages 12-19*, culturally and linguistically appropriate, and trauma-informed. The program does not normalize teen sex.

* The Love Notes SRA EBP program now contains approved guidance for adapting the content to youth in grades 6-8.

Love Notes SRA

Download the PDF of Love Notes correlations to Sexual Risk Avoidance Education

SRAE Love Notes Correlations

Overview of Love Notes SRA (pdf)

Love Notes builds skills and knowledge for healthy and successful relationships with partners, family, friends, and co-workers. It is designed to help young people (12-19 years of age) make wise relationship and sexual choices. Wise choices will assist them in achieving their education, employment, relationship, and family goals, while poor relationship and sexual choices may create barriers to these goals. It was developed especially for teens and young adults at risk for unstable and poor quality relationships, unplanned pregnancies, and for those who are pregnant or already parenting. That said, much of the content of Love Notes is relevant to any young person.The communication skills and self-awareness components of Love Notes are key to all kinds of relationships in life. For example, these soft skills increase successful and cooperative interactions in the workplace. Employers report that soft skills are vital for the success of young people entering the workforce.

Love Notes also represents an innovative approach to both pregnancy/STIs and intimate partner violence prevention within the context of a positive youth development approach. These goals, typically addressed in separate programs, are integrated and embedded into one comprehensive healthy relationship skills program. This comprehensive approach was selected by the US Department of Health and Human Services (HHS) for a 5-year evaluation. Researchers found that teaching Love Notes to teens resulted in a 46% reduction in the teen pregnancy rates compared to the control group. This was the highest pregnancy reduction rate achieved for males and females on the HHS Office of Adolescent Health’s (OAH) list of Evidence-Based Teen Pregnancy Prevention Programs. In addition, the group of teens that were taught Love Notes also had the most positive outcomes compared to the control group on the OAH list, including less recent sexual activity, less frequency of sexual activity, and, for the teens that decided to remain sexually active, those from the Love Notes group were more likely to use a condom; and for the teens that chose to remain abstinent, a higher percentage of those in the Love Notes group remained abstinent.1

Love Notes builds assets and strengthens protective factors. It appeals to young people’s aspirations, rather than merely emphasizing what they must avoid. Love Notes engages young people in learning more about themselves and supports them in cultivating a vision for their future. Love Notes empowers youth with the skills needed to further their own personal development, to form and maintain healthy relationships, to make wise sexual decisions, and to work towards success with education and employment.

All youth, regardless of sexual orientation, have attractions, emotions, and desires for healthy relationships. All youth need skills and knowledge to navigate their relationships and make wise sexual choices. This is a LGBTQ-inclusive curriculum.

Building Models and Confidence for Healthy Relationships

Many young people today lack models of healthy relationships. A recent Child Trends survey of disadvantaged youth reported that while respondents could list general qualities for healthy relationships, when asked if they saw many around them, they said, “No.” More sadly, they said they had little confidence they would be able to achieve a healthy relationship despite their aspirations to develop one.2

Love Notes offers young people—including young parents—knowledge of what a healthy relationship is and isn’t, as well as skills for handling the early chemistry of attraction and choosing partners wisely. Young people learn the building blocks of healthy relationships and are encouraged to identify relationship qualities they find personally important. They are provided several frameworks to help them assess relationships (past or present) and to make important relationship decisions. They learn the red flags of unhealthy and dangerous relationships and ways to exit those relationships safely. They identify what needs to change or improve for a relationship to continue. They learn how to handle break-ups and then move forward.

Improving Communication Skills

This program includes a powerful set of evidence-based skills to improve communication, negotiation, and the handling of conflict. These skills are adapted from PREP, the Prevention and Relationship Enhancement Program. Youth practice new ways to handle anger and regulate strong emotions. They learn a technique for how to talk through difficult or sensitive issues. They learn how to more effectively raise issues and complaints, recognize hidden issues, and solve problems within their relationships.

The communication skills components are also essential in increasing successful and cooperative interactions in the workplace.

Strengthening Intimate Partner Violence Prevention

Building robust knowledge and skills for healthy relationships provides a positive and proactive way to prevent intimate partner violence (IPV). It is difficult to steer clear of or exit a destructive relationship if young people have only experienced and seen unhealthy relationships, and they have no clue how to build a healthy relationship. This problem is compounded if they have little insight into themselves and their unaddressed issues. The vision building, skills, guides, and frameworks in Love Notes help raise young people’s confidence that they can develop healthy selves and healthy relationships. Love Notes contains activities to identify early warning signs of abuse along with how to set boundaries and apply them at the first sign of disrespect. It also raises awareness of how children are harmed by turbulent and destructive parental and partner relationships.

Sex—It’s More than Bodies, Risks and Protection

Love Notes contains an important missing piece in sexual decision-making and STI/ pregnancy prevention by addressing relationship issues. After all, sex is a relationship issue. For example, can young people make wise sexual choices if they:

  • Have never clarified what’s important to them in a partner or relationship?
  • Know little about how to distinguish between healthy and unhealthy and/or abusive relationships?
  • Lack communication and negotiation skills?
  • Have never defined a context for sex that is personally meaningful?

Youth are rarely asked to think about sex beyond the usual health paradigm of bio-reproduction, disease, and risk avoidance. If young people have never considered what deepening levels of physical intimacy mean to them (and how to discern if their partner is on the same page) then how are they to make wise sexual decisions and stick to their choices? Sex is not just about bodies, risks, and protection. It’s about power dynamics, knowing one’s self and one’s values, and possessing the skills to navigate this terrain. It is ultimately also about the heart and aspirations.

Love Notes takes a health- and heart-based approach to sexuality and provides unique ways to tap motivation. Sexual decision-making is embedded within a rich exploration of intimacy and the development of healthy relationships. Activities guide youth in cultivating their own North Star for sexuality. They are asked to develop goals, boundaries, and a context and pace for sexual intimacy that is responsible, protective of their own aspirations in life, and personally meaningful. Films, music, poetry, and stories are used to inspire and help young people identify their values. They also develop a personal plan for their sexual choices. Medically accurate information on pregnancy, STIs, contraception, and condoms is included. This information is reinforced through films from Scenarios USA, (written by youth and produced by award-winning filmmakers) as well as other visual media, and role-plays on negotiation and refusal skills.

It takes a lot of motivation not to slide into sex and to keep the boundaries and pacing of physical intimacy that one intends. It also takes a lot of motivation to use condoms and contraception correctly and consistently to prevent STIs and pregnancy if sexually active. The unique heart- and health-based approach of Love Notes offers some new ways to motivate.

A New Message on Pregnancy Prevention

Many of our pregnancy prevention messages focus on a young person’s self-interest in how a pregnancy would negatively affect him or her. Love Notes takes a different track. It encourages young people to step outside themselves and look more deeply at the consequences of unplanned pregnancy on children. By placing the child at center stage in the activities, participants see through the eyes of the child the consequences of sliding into an unplanned, first or subsequent pregnancy, and the relationship turbulence that often accompanies it. Examining how an unplanned pregnancy can disadvantage or hurt a child may tap a more powerful and positive source of motivation to more consciously plan to prevent a first or subsequent pregnancy. It helps bring home to young people why it really matters to avoid pregnancy and to wait to have a child (or a second child). Youth learn that doing some of life’s big things in a particular sequence really does matter.

In terms of positive youth development, one’s love life is never neutral; it’s one of the central developmental tasks on the path to adulthood. A troubled love life, especially

linked with unplanned pregnancies, can derail everything. Helping young men and women assess their relationships, choose partners wisely, and acquire the skills and insights for forming and/or maintaining healthy relationships (and later healthy marriages if they choose to marry) can help them be successful. Encouraging deliberate planning for their own sexual decisions can reduce some formidable barriers in their personal lives as young people work toward their goals in education, employment, intimate unions, families, and parenting.

Love Notes is dedicated to the success of young people as much as it is to the success and well-being of their children. Clearly, children are affected for better or worse by the parental, partner, and other adult relationships in their families.

Young Parents and Co-Parenting Challenges

The approach embedded in Love Notes is especially important for young parents. We should not assume these relationships are all viable, nor all doomed. Some are workable, but these couples need support and skills to make their intentions of staying together a reality and not just wishful thinking. Young parents need guidance for taking a realistic look at their relationship and determining if it’s viable or not. If viable and safe, they need to be able to identify what they both need to work on. If not, they need support in leaving safely. This kind of assessment, for which Love Notes provides the tools, is important for them as well as for their child’s well-being.

Young parents need evidence-based communication and conflict management skills (included in Love Notes) to have a chance at a future together. How a couple communicates and handles conflict is perhaps one of the best predictors of how a couple will do over time. But they also need these skills to co-parent, whether they stay together or not.

Young parents need a heavy dose of healthy relationship education. Research tells us that relationship instability and multiple partner fertility is highly likely among these young unmarried parents.3 Young parents will do better if they can either take a break from relationships on the one hand or work to strengthen their relationship on the other hand, and if they avoid having a second child too soon. Focusing on their child and parenting and pursuing their school and employment goals will benefit themselves and their child. But also critically important is learning to choose a partner more wisely and cautiously with their next relationship, since most will have subsequent relationships. The skills embedded in Love Notes can help young parents slow down the relationship-go-round that is so common as much as it can help those young parents who wish to improve and stabilize their relationship. Their future success and their child’s future success will be strongly linked to their ability to form and maintain a healthy intimate relationship, or to at least stay single and away from unstable or destructive relationships as they focus on their own development.

An Activity and Media-Based Approach

Love Notes is packed with lively activities that use real-life relationship, work, and parenting scenarios, written by diverse teens and young adults, that are LGBTQ inclusive. It incorporates popular music, music videos, film, stories, drawing, and sculpting. It appeals to males as much as females. It includes an engaging, interactive workbook where they can apply all the concepts to their own lives. Finally, there is a Trusted Adult Connection activity for each lesson to build a bond by communicating with a caring adult or mentor on these very important issues.

Love Notes is an adaptation from one other curricula authored by this author. It is Love U2®: Relationships Smarts PLUS, a teen relationship curriculum. Relationship Smarts PLUS has completed a five-year evaluation involving 8,000 diverse teenagers in the state of Alabama. Researchers from Auburn University conducting the study report sustained gains over time. Findings include increases in students’ realistic understanding of relationships and decreases in faulty relationship beliefs, broadened understandings of relationship aggression, and declines in aggression in relationships as compared to those in control groups.4

Within My Reach, co-authored with Scott Stanley and Galena Kline-Rhoades, is a decision-making and relationship skill program for adults who struggle with disadvantages and who are at risk for poor quality relationships and relationship instability. Within My Reach contains the research-based communication and conflict management skills of the nationally acclaimed Prevention and Relationship Enhancement Program (PREP) that have been shown to reduce divorce and incidences of physical aggression, while increasing relationship satisfaction and communication. Love Notes, as an adaptation of Relationship Smarts PLUS, is listed in the National Registry of Evidence-based Programs and Practices (NREPP), a service of the Substance Abuse and Mental Health Services Administration (SAMHSA). Within My Reach, as an adaptation of PREP, is similarly listed.

1 Barbee, A. P., Cunningham, M. R., van Zyl, M. A., Antle, B. F., & Langley, C. N. (2016). Impact of Two Adolescent Pregnancy Prevention Interventions on Risky Sexual Behavior: A Three-Arm Cluster Randomized Control Trial. American Journal of Public Health, 106(Suppl 1), S85–S90. http://doi.org/10.2105/AJPH.2016.303429. For the OAH evidence-based list, see https://www.hhs.gov/ash/oah/sites/default/files/ebp-chart1.pdf

2 Child Trends Research Brief (October 2009) Telling It Like It Is: Teen Perspectives on Romantic Relationships. childtrends.org

3 McLanahan, S. “Family Instability and Complexity after a Non-Marital Birth” in Carlson, M. & England, P. editors. Social Class and Changing Families in an Unequal America (Stanford University Press, 2011; for a compilation of research articles on various aspects of fragile families see “Fragile Families” in The Future of Children (Princeton-Brookings) Vol. 20, Number 2, Fall 2010.

4 For more information on the Relationship Smarts Plus study (principal investigator Dr. Jennifer Kerpelman, Auburn University) see DibbleInstitute.org/?page_id=2942

LN SRA Citation and Abstract of Supporting Research Study (pdf)

Citation:

Barbee, A. P., Cunningham, M. R., van Zyl, M. A., Antle, B. F., & Langley, C. N. (2016). Impact of Two Adolescent Pregnancy Prevention Interventions on Risky Sexual Behavior: A Three-Arm Cluster Randomized Control TrialAmerican journal of public health106(S1), S85-S90.

Abstract:

Objectives. To test the efficacy of Reducing the Risk (RTR) and Love Notes (LN) on reducing risky sexual behavior among youths yet to experience or cause a pregnancy.

Methods. The four dependent variables were ever had sex, condom use, birth control use, and number of sexual partners at 3- and 6-month follow-up in a 3-arm cluster randomized controlled trial of 1448 impoverished youths, aged 14 to 19 years, in 23 community-based organizations in Louisville, Kentucky, from September 2011 through March 2014.

Results. At 3 and 6 months, compared with the control condition, youths in RTR reported fewer sexual partners and greater use of birth control. At 6 months, LN participants reported greater use of birth control and condoms, fewer sexual partners, and were less likely to have ever had sex compared with the control condition.

Conclusions. We provided additional evidence for the continued efficacy of RTR and the first rigorous study of LN, which embeds sex education into a larger curriculum on healthy relationships and violence prevention.

As of January 2009, Kentucky ranked eighth highest in the United States in adolescent births, with an overall adolescent birth rate of 51.3 per 1000 females aged 15 to 19 years, and a non-Hispanic Black female birth rate of 57 per 1000, which were both significantly higher than the national rate, which was 39.1 per 1000 females.1 Major contributing factors to high adolescent pregnancy and birthrates are engagement in high-risk sexual behaviors, such as having multiple partners and lack of consistent use of condoms and other forms of birth control. In Kentucky, more than 24% of high school students reported having had 4 or more partners by graduation, and more than 50% of sexually active students had not used a condom during their last sexual intercourse.2 One recent review found that comprehensive sex education programs are effective in reducing high-risk sexual behavior.3 The Teen Pregnancy Prevention Evidence Review by the US Department of Health and Human Services (HHS) confirmed that 1 program, Reducing the Risk (RTR), showed evidence of effectiveness with increased birth control and condom use4–7 and was tested in the present study. We chose to test the fifth edition of RTR with adaptations.8,9

We also tested a new approach to adolescent pregnancy prevention. Love Notes (LN) embeds pregnancy and disease prevention messages in a curriculum that emphasizes the importance of forming healthy relationships and avoiding intimate partner control or violence for individuals to reach their life goals. LN uses sound pedagogy and includes the use of brief lectures, video, music, discussion, workbook exercises involving self-reflection and goal setting, role plays or scenarios, games, and group activities, many of which involve the use of artistic expression. Studies have found that intimate partner violence is related to sexual risk taking, inconsistent condom use, partner nonmonogamy, and unplanned pregnancy.10 A focus on this destructive dynamic is not emphasized in most adolescent pregnancy prevention interventions. Research on an early version of LN (Love U2: Relationship Smarts) with high-risk youths and delivered through the public school system found an impact on awareness of healthy versus unhealthy relationship patterns and reduction of verbal aggression.11 A subsequent study with high-risk youths using LN in a community-based organization found that students significantly increased their knowledge about relationships, showed a significantly lower acceptance of violence in dating relationships, and significantly increased communication and conflict management skills.12 However, the efficacy of LN as an adolescent pregnancy prevention intervention has not been tested.

Our purpose in this study was 2-fold. First, we set out to test the efficacy of an adapted version of RTR, compared with a control condition, The Power of We (POW), as well as with LN. Second, we tested the efficacy for the first time of a new adolescent pregnancy prevention intervention, LN, compared with the same control condition. We examined 3 high-risk sexual behavioral outcomes for the previous 3-month period at 3- and 6-month follow-ups, plus whether the participants engaged in sexual intercourse.

Compared with participants in the POW control condition, 3 and 6 months after the conclusion of the program, we asked if participants (1) in the RTR intervention group and (2) the LN intervention group use condoms and other forms of birth control more often and did they have fewer sexual partners? As secondary research questions, we asked whether (3) LN and RTR differed in their impact on the primary outcomes, and (4) whether LN and RTR affected the onset of engagement in sexual intercourse.

Download the Love Notes SRA correlations to Positive Youth Development Below

PYD: Love Notes Sexual Risk Avoidance Correlations

Download the FULL Medical Accuracy Review

“In 2018 the Family and Youth Services Bureau (FSBY) reviewed Love Notes SRA EBP for medical accuracy.

The reviewer indicated that LN “meets the definition of medical accuracy with modifications.”

They detailed the requested modifications in a medical accuracy review report dated November 8, 2018. Dibble received this report from a FSBY grantee on June 11, 2019.

Requested modifications included:

  • Citing the most current Youth Risk Behavior Survey and Department of Health and Human Services statistics
  • Assuring that all statements in the program had a confirming citation
  • Changing language, statistics, guidance, and recommendations to reflect those of the Centers for Disease Control (CDC)
  • Omitting contraceptive brand names

All requests for modifications to the content were made to comply with the medical accuracy report by July 15, 2019. Based on the modifications made to Love Notes, The Dibble Institute attests that it is medically accurate.”

All requests for modifications to the content were made to comply with the medical accuracy report by July 15, 2019. Based on the modifications made to Love Notes, The Dibble Institute attests that it is medically accurate.

The following fidelity aids and checklists are included when you purchase the Love Notes SRA EBP Manual:

  • Annotated slide deck to focus the instructor on key content.
  • Observational fidelity tools for coaches and evaluators
  • Love Notes knowledge test
  • Inventory of related scales that can assess attitudinal and behavioral outcomes regarding sex, relationship quality, communication, conflict, control, violence as well as mediators.

Note: To maintain fidelity, your Love Notes instructors must be professionally trained by a Dibble Master or Certified Trainer.

Love Notes is being successfully implemented with diverse types of youth in a wide variety of settings. Here is a partial list of populations and settings where Love Notes is being used.

Populations
  • Populations Risk-immersed youth Expecting and parenting teens (both fathers and mothers)
  • LGBTQ youth in correctional settings
  • Tribal youth
  • Runaway and homeless youth
  • Community college students
  • Foster youth (both within the system and aging out)
  • Abused young people
Settings
  • Workforce Development (YouthBuild/Job Corps)
  • Group homes (Foster)
  • Residential settings (Mental health)
  • Detention centers
  • Challenge academies Schools
  • Alternative schools
  • Faith-based settings
  • Community agencies
  • Community colleges
  • In-home visitation
  • Domestic violence shelters

Power to Decide, previously the National Campaign to Avoid Teen and Unplanned Pregnancy, offers a free

TEEN PREGNANCY PREVENTION POTENTIAL SAVINGS CALCULATOR.

This tool allows you to determine the potential cost savings of your project based on your county or the number of teen births in your area. The Hamilton Project created the Vitality Index, which measures the economic and social well-being of a place.

INTERACTIVE EXPLORATION OF THE GEOGRAPHY OF PROSPERITY.

The index combines all measures of median household income, poverty rate, unemployment rate, prime-age employment-to-population ratio, housing vacancy rate, and life expectancy.

Budget

Third Party Agreement/Memorandum of Understanding

The Dibble Institute is  pleased to sign an MOU with you as part of your grant application. To help us understand your plans, please send an email to Aaron Larson at Aaron@ DibbleInstitute.org with the following information:

  • What program(s) you plan to use (If you are not planning to use Love Notes SRA EBP, please  explain to help us understand your thinking.)
  • A brief overview of your project – setting, youth targeted, proposed timing of instruction (how many hours/days/weeks), number of youth reached, and instructional hours
  • Recruitment/retention plans
  • Evaluation approach and research question(s), if including
  • How you plan to implement with fidelity and what adaptations, if any, you propose.

Please complete this form as part of your planning and budgeting process. We will need to see it prior to signing an MOU with your organization.

Download the SRA 2020 Materials and Training Agreement

The Dibble Institute is pleased to consult with you as you write your grant and after it has been awarded strategies to sustain your activities over time. We have demonstrated over nine years of a federal grant, how to bring relationship education cost-effectively to large numbers of youth by using existing community systems.

We can also help you develop your sustainability plans by identifying alternative funding streams that support relationship education beyond your grant. For instance, Love Notes has been implemented using Rape Prevention Education funding. And, in some jurisdictions Love Notes is funded for mental health prevention and early intervention.

Please email Kay Reed, Executive Director, at kayreed @ DibbleInstitute.org to set up a time to consult.