Best Choices For Curriculum: A Nurse’s Perspective

As a Registered Nurse on a postpartum unit, I have the great privilege of working in an environment where “best practice” that is evidence-based is sought out for the patient. We have always had “clinical expertise”, that is, really excellent nurses who have experience, education and clinical skills, who are working hard to do what is best for our patients.

In the last few years, however, my hospital achieved “Baby Friendly” status. We did that by changing our long established practices to line up with best available external clinical evidence from systematic research. That may sound like an obvious choice, but to be honest, it wasn’t easy. There was a lot of resistance to changing something that everyone was convinced had been the best practice for years. Nurses loudly expressed that the status quo was best. It felt right to us. We were skeptical of the change.

Here is an example of what I mean. On our unit we had the practice of immediately bathing a baby after he or she was born. We would whisk the baby to the warmer to bathe, along with assessing, measuring and administering medications. We would then return the clean little well bundled baby back to the mom so they could enjoy each other.

That long honored practice changed when our leadership reviewed and implemented the Best Research Evidence. What was the result? We now bathe the babies at least after TWELVE hours after birth. Why a dramatic change? The evidence showed that babies need time for their blood sugars and temperature to stabilize. Also the first hour after birth is called the Golden Hour, when bonding hormones are high and the baby is very alert and ready to breast feed. We began putting the baby skin to skin with the mom immediately after birth for the first hour. Our breast feeding rates, which is the best food for the baby, went way up as we began changing our practice to line up with the Best Research Evidence.

This evidence-based practice can be applied to other choices in life. We need leaders to distinguish carefully between what is assumed to be best, what feels best and what is actually the best choice, based on Best Evidence Research.

How does this apply to the sex education debate in San Diego? We have excellent teachers (clinicians) and a dedicated school board that for many years has been going along the path of the “the more knowledge about sex practices and contraceptives, the better” for our students (patients). We have been thinking that more knowledge will lead to fewer pregnancies, more condom use, fewer STD’s. It feels like the right thing to teach. It’s the way that it has been done for many years now.

I would like to take you and myself, the parents of San Diego, down a path of reviewing what the evidence shows and what is really just ideology masquerading as best practice.

Let us start on square one: What sex ed curriculum is the San Diego district using for its large student population? Our curriculum here is called Sexual Health Education Program or SHEP. It was created by Advocates for Youth and is also called 3RRR. SHEP is on the extreme end of a spectrum of programs called CSE or “Comprehensive Sex Education”. It was first approved for use in the summer of 2016 by the board of education.

 

To look more deeply at the research studies behind SHEP, I simply googled their name, 3RRR by Advocates For Youth, and asked for evidence. Up came their Fact Sheet. They had very strong statements about their curriculum being the best. Furthermore, the “Face Sheet” proclaims that the opposition curriculum, Sexual Risk Avoidance (also called Delayed Initiation Of Sex) , is completely unrealistic and ineffective.

For clarity and simplicity, let’s look at the claims of SHEP’s curriculum per their Fact Sheet on their website. (McKeon, 2006, Advocates for Youth).

Claim 1.

San Diego Sexual Health Education Program (SHEP) will successfully get kids to use condoms consistently for sexual intercourse. Condoms are 100% effective at preventing STI’s if used consistently.

 

Reality – PROBABLY NOT. Here is the evidence revealed by research –“The National Campaign to Prevent Teen and Unplanned Pregnancy published a landmark review of 112 peer-reviewed studies covering 20 years of research on sex education (Emerging Answers 2007). To be partially effective in prevent sexually transmitted diseases (30% effective for HPV and 85% effective for HIV), condoms have to be worn 100% of the time for intercourse. If it isn’t worn a single time, it isn’t effective at all. This review identified no school/curriculum-based CSE programs (like SHEP) that had increased the number of teens who used condoms consistently over a one-year period. The same review found no school/curriculum-based CSE programs (like SHEP) that had produced a decrease in teen pregnancy or STI rates for any period of time.” In short, curriculum like SHEP is a total failure.

 

Claim 2.

San Diego Sexual Health Education Program (SHEP) will work to lower teen pregnancy.

 

Reality – PROBABLY NOT. According to research only 3.6% of studies support this claim. A recent study, “What Works 2008: Curriculum-Based Programs that Prevent Teen Pregnancy, published by the National Campaign to Prevent Teen and Unplanned Pregnancy, (2008), revealed 28 programs that have the “strongest evidence of success” in preventing teen pregnancy. Upon closer examination, we see that 20 of those 28 programs did not measure rates of teen pregnancy as an outcome at all, despite their claims of effectiveness. Of the 8 programs that measured teen pregnancy, 2 did not reduce teen pregnancy. Three lasted less than 12 months. One was not a sex education program and did not include discussion of sex. One was ineffective in a second evaluation study (Kirby, et al., 2005). This leaves only one CSE program (like SHEP) that reduced teen pregnancy rates out of 28 supposedly effective programs. One out of 28 is not “strong evidence” for success. (Weed, et. al., 2014)

 

Claim 3.

The competing curriculum, Sexual Risk Avoidance Programs are dangerous, ineffective, and inaccurate.

 

Reality – That claim is FALSE. Dr. McIlhaney called that claim an “outright lie” in his video presentation because of the preponderance of evidence to the contrary – that Sexual Risk Avoidance Programs actually are effective at teaching kids to delay initiation of sex. “A developing pattern of scientific evidence indicates that Delayed Initiation Of Sex programs, if properly designed and implemented, can cut rates of teen sexual activity by as much as half for significant periods of time, without reducing condom use by the sexually active. Furthermore, condom use was measured by two studies of Delayed Initiation Of Sex programs, Jemmott et al. (2006) and Treholm et al. (2007) and no reduction in use by sexually active teens was found, despite claim by dissenters. This body of research suggests that teaching adolescents to avoid sexual activity is a viable primary prevention strategy, one that can fully prevent the harmful and costly consequences of teen sex.” (Weed, et al., 2014). Abstinence-Education-in-Context.pdf

 

Claim 4.

Anyone who is opposed to the SHEP curriculum is a right wing nut and outside of majority opinion.

 

Reality – FALSE. That statement is not only untrue, but an attack against concerned parents. The truth is that “the majority of American parents almost 75% are opposed to premarital sex both in general and for their adolescents.” (McIlhaney, 2015) Even students want a strong message that they should delay intiation of sex. Fully, 93% say that the abstinence message is important. (McIlhaney, 2015).

 

Do you want more evidence that all the claims from SHEP proponents are based on little more than hot air? Even the United Nations Educational, Scientific and Cultural Organization (UNESCO) is admitting that they don’t have studies to back up their claims about the effectiveness of programs like SHEP. “Few of the studies measured impacts on either STI or pregnancy rates, and fewer still measured impacts on STI or pregnancy rates with biological markers.” Concluding that “the evidence reviews commissioned by UNESCO have some limitations that make it difficult to make a general statement.” (UNESCO, 2018). If an organization in the UN can not make a general statement based on the studies, then Advocates For Youth’s cant back up their loud claims on their Fact Sheet either.

 

After a brief presentation of the evidence, I would like to audaciously suggest, that what the San Diego school district has chosen, Sexual Health Education Program, is not the best for our students, based on the best available external clinical evidence from systematic research. Nor is it good for families, schools, or the community we live and work in. I would like to challenge the school board to go back and suspend this curriculum. Make the change. It is incumbent on the board to choose curriculum with better results, that lowers risky behavior, and that will do what it takes to help our children achieve their potential.

 

 

REFERENCES

McKeon, B. (2006) Effective Sex Education. Available at http://www.advocatesforyouth.org/component/content/article/450-effective-sex-education

Kirby, D. B., Rhodes, T., & Camape, S. (2005) The Implementation of multi-component youth programs to prevent teen pregnancy modeled after the Children’s Aid Society—Carrera Program. Scotts Valley, CA:ETR Associates, Unpublished

Kirby, D. (2007). Emerging Answers 2007. Washington DC: National Campaign to Prevent Teen and Unplanned Pregnancy.

McIlhaney, Joe. (2015). Medical Institute Takes On Sex Education in Hawaii. Available at https://www.medinstitute.org/media/medical-institute-takes-on-sex-education-in-hawaii.

Weed, S. E., & Lickona, T. (2014) Abstinence Education In Context: History, Evidence, Premises, and Comparison to Comprehensive Sexuality Education. Available at http://www.acpeds.org/wordpress/wp-content/uploads/Stan-Weed-and-Thomas-Lickona-2014.Abstinence-Education-in-Context.pdf. pg. 31.

UNESCO, (2018) International Technical Guidance On Sexuality Education, An evidence-informed approach. Available at http://unesdoc.unesco.org/images/0026/002607/260770e.pdf. pg. 30-31.

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