Factors For Success in Conducting Effective Sexual

Health and Relationships Education with Young

People in Schools: a Literature Review
2003

Sue Dyson, Anne Mitchell, Derek Dalton & Lynne Hillier

Australian Research Centre in Sex, Health & Society
La Trobe University
1st Floor, 215 Franklin St
MELBOURNE VIC 3000
Australia

This literature review was commissioned by SHine SA as part of the Sexual Health And Relationship
Education (SHARE) project. SHARE is a collaboration between SHine SA, South Australian
Department of Education and Children’s Services and the Department of Health. SHARE is funded
by Department of Health.
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Conducting Effective Sexual Health and Relationships Education with

Young People in Schools - Factors for Success
A Literature Review

In recent years one of the major challenges facing educators has been providing
education programs to assist young people to gain the knowledge, skills and
understanding they need to optimise their sexual health. For many years ‘sex
education’ focused on the human reproductive system and urged sexual abstinence
on young people. In recent years the concepts of sexual health and sexual health
promotion has started to replace this kind of program, and in Australia and many
other western countries, schools have become the primary site for programs to
promote sexual health for young people.

Sexual health is defined by the World Health Organization as

"the integration of the physical, emotional, intellectual, and social aspects of
sexual being, in ways that are positively enriching and that enhance
personality, communication, and love . . . every person has a right to receive
sexual information and to consider accepting sexual relationships for pleasure
as well as for procreation" (World Health Organisation 1975).

The Olin Health Centre at the University of Michigan takes this definition further
and suggests that:
The development of sexual health is a lifelong process of acquiring
information and forming values, beliefs and attitudes about identity,
relationships, and intimacy. It encompasses sexual development, reproductive
health, interpersonal relationships, affection, intimacy, body image and gender
roles. Sexual health encompasses the biological, sociocultural, psychological,
and spiritual dimensions of sexuality from the cognitive domain, the affective
domain, and the behavioural domain, including the skills to communicate
effectively and make responsible decisions (Olin Health Centre 2001).

The aim of the SHine Sexual Health and Relationships (SHARE) project is to
“improve the sexual health, safety and well-being of young South Australians by
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running sexual health and relationships education programs over a three year period
with young people in years 8, 9 and 10 in selected secondary schools”. To inform the
SHARE program, this literature review will focus on two questions:
1. What are the critical factors for success that have been identified for
effective sexual health and relationships education with young people in
schools?
2. Is there any evidence that a whole schools approach to relationships and
sexual health has a positive impact on issues such as teenage pregnancy, STIs,
homophobic harassment and sexual coercion/assault?

CRITICAL FACTORS FOR SUCCESS

A number of authors have attempted to identify the factors that are critical to success
in sex education programs. A 1996 project to develop a strategic plan for HIV,
sexually transmitted infections (STI) and blood borne virus (BBV) prevention
education in secondary schools in Australia included an extensive review of
literature, as well as a nation-wide consultation with experts in the field. Ollis (1996)
suggests a framework for the development of a comprehensive program in STI
prevention education with five key elements:
• Taking a whole school approach and developing partnerships;
• Acknowledging that young people are sexual beings;
• Acknowledging and catering for the diversity of all students;
• Providing an appropriate and comprehensive curriculum context;
• Acknowledging the professional development and training needs of the
school community (Ollis 1996).

Ollis’ five elements are supported by Gourlay (1996), who sought to identify and
document the critical factors for successful sex-education programs and suggests ten
interconnected features for planned and effective outcomes:
• Showing an acceptance of adolescent sexuality.
• Adopting a multi-dimensional approach to sexuality and sexuality education.
• Avoiding making generalisations about adolescents.
• Adopting a developmental-based approach to curricula.
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• Ensuring programs are gender inclusive.

• Incorporating peer education strategies.
• Introducing sexuality education early.
• Involving parents and the community.
• Providing sexuality educators with adequate training and support.
• Working at a systems level as well as an individual level (Gourlay 1996).

This review will focus on the elements for success in teaching sexual health
identified by Ollis and Gourlay, and explore relevant Australian and international
literature that addresses the critical factors for success in teaching sexual health,
including curriculum content, personnel and the efficacy of the whole school
approach to sexual health education.

Young people are sexual beings

Gourlay (1994) argued that it is essential for educators to realistically acknowledge

that young people are sexual beings, and that their sexuality will inevitably find
expression, not only in how they act, but also in how they think and feel. Ample
evidence exists to demonstrate that young people are sexual beings from a very early
age, and that increasingly they are becoming sexually active from early in their
adolescence. In a national survey of Australian secondary school students, by year
10, the majority were found to be sexually active in some way. Eighty percent
participated in deep kissing, 67% had genital contact, 45.5% gave or received oral
sex and 25% had experienced vaginal intercourse. By year 12, just over half had
experienced vaginal intercourse (Smith, Agius et al., 2003). In the United Kingdom a
population based survey found that 30% of young men and 26% of young women
aged 16 to 19 reported their first heterosexual intercourse occurring before age 16
(Starkman 2002).

A 2001 study in New Zealand explored the gap between what young people aged 17
– 19 learned in sexuality education and what they do in practice. This study reported
that the participants gained information about sexuality in two ways, from sexuality
education, and from personal sexual experience. The types of sexual knowledge
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young people were most interested in, and which they identified as lacking in
sexuality education, centred on a 'discourse of erotics' (Allen 2001). Thus a critical
factor for the success of any program promoting sexual health is to acknowledge that
young people are sexual beings, and that the majority of them will be sexually active
in some way; to ensure that the content of any program is appropriate to the needs
and interests of the entire group, including those who are, and those who are not
sexually active. Ollis (1996) and Gourlay (1996) both identify the importance of any
program taking a positive and accepting approach to the sexuality of young people.

Teaching Sexual Health

The Learning Environment

While the content of school-based sexual health education is vitally important, the
context in which such education is delivered is equally important. Sexual health
curriculum content is vastly different from other school subjects and both the
environment and the approach of those teaching sexual health programs need special
preparation and attention. Buston, Wight et al. (2002) suggest that teachers need to
be approachable, that students should be able to ask explicit questions, including
those about the physical aspects of sex. Furthermore, students should be able to
make comments that are not dismissed by the teacher. Wight (1993) identified four
interrelated processes that work to reduce students’ discomfort in the classroom
setting. These include the teacher as protector and friend, that there should be a
climate of trust fostered between students and that the program should be seen as
fun.

Wight (1993) argues that students should receive sex education in familiar class
groupings, that the teacher should, ideally, attempt to minimise disruptions, and that
they should work towards eliminating hurtful humour while maintaining an
approachable manner.
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Personal qualities and staff selection

Those involved in teaching sexual health programs need to have a number of
personal qualities if they are able to work effectively in this area. (Bowden 2003)
argue that the most important element in a successful human sexuality program may
not be the material, but the classroom teacher. Teachers' attitudes are identified as
influential in the success of any program they present, however these authors argue
that evaluations of specific curricula tend to concentrate not on teacher qualities but
on the program components, reliability, validity and outcomes. They assert that
teacher characteristics, attitudes, conceptions of self, and intellectual and
interpersonal dispositions can influence both the explicit and the hidden curriculum
in the classroom.

According to (Hillier 1996)) young people lack positive, realistic and candid models
that they are able to draw from as they begin to develop their own sexual identities.
Wight (1993) argues that when schools decide who should deliver sex education it is
more important to select teachers who feel comfortable with sex education, and have
the requisite skills to deliver it, than selecting who will teach in the subject based on
‘timetable’ provisions or other constraints; teachers who are uncomfortable with
discussing sexuality with students convey this attitude to their students. Given
Hillier’s assertion that young people need role models who are positive, realistic and
candid, teaching about an area that creates personal discomfort is clearly
inappropriate.

Peer education and peer support

Benefit has been demonstrated in sexuality education programs that involve
adolescent ‘peer leaders’. The authors of a study that investigated the efficacy of
peer leaders suggest that they should be drawn from the school community and
exercise an ability to influence the behaviour of others ‘irrespective of adult wishes
or norms’. Providing that the peer leaders chosen are those approved of by teachers
and school administrators, this study indicates that they can play an important role in
influencing how other students respond to health-related curricula (Carter 1999).
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In the United Kingdom researchers found that if education programs are to do more
than merely inform they must be resourced to include peer led interventions and
skills training (Bellingham and Gillies 1993). (Mellanby, Phelps et al. 1995) also
advocate peer led interventions as part of an effective HIV/AIDS education program.
Their study examined an intervention that included medical and peer led training in
various Devon (UK) secondary schools. They concluded that school sex education
that includes specific targeted methods with the direct use of peers can produce
behavioural changes that lead to health benefits.

Curriculum
(McGrane 1993) argues that in order to empower young people to be responsible for
their own sexual health, sexuality and relationship education programs are needed.
This author recommends that such programs focus on providing a forum for
discussion of ideas about sexuality, promote respect for differences and the views
and values of others, as well as promote a positive view of one's own body and
sexuality. This view of sex education as a forum where respect and positive views
are promoted is at variance with the traditional sex education class, which has
mainly focused on providing information about reproduction and disease
transmission and a number of authors posit that information alone is not sufficient to
ensure safe and responsible sexual behaviour. (Smith, Kippax et al. 2000) argue that
that school-based programs and activities need to go beyond infection transmission
and knowledge about reproduction to focus on sexual health in its social context.
They suggest that this may include such areas as assertiveness development, values
clarification and negotiation skills. Furthermore, programs must be appropriate and
comprehensive and cater to the diversity of students. This suggests that teachers
should be aware that not all students will be heterosexual, that some will already be
sexually active and others will have decided to delay becoming sexually active, that
a range of cultural backgrounds will be represented and that sexuality is constructed
differently for young women and young men.

Inclusive Curricula
Sexual health programs must be delivered in a manner that is culturally and socially
relevant to the lives of all the young people for whom it is intended. This means that
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program content must be planned with an awareness of diversity. Accordingly all

plans and language should be inclusive of gender, cultural and racial diversity and
disability, regardless of the make up of the group, as some groups may be invisible,
or prefer not to disclose their presence because of fear of prejudice or discrimination
(Flick, 2002).

Gender
Young people’s knowledge, attitudes and behaviour about sexuality is strongly
gendered, with different understandings, beliefs and behaviours being ascribed as
‘appropriate’ for young women and young men. The report Secondary Students and
Sexual Health 2002 highlights this and calls for some sexual health education to be
gender specific to ensure that young women and men have the knowledge and
understanding necessary to ensure that they can make sound decisions and minimise
risk (Smith et al. 2003). Because of this gendering, relations between young men and
young women can present challenges in the classroom context when teaching about
sexual health. Many young people experience discomfort when asked to discuss
sexual matters, and this may be particularly so in a mixed gender environment,
where they may be reluctant to ask questions or participate actively in lessons
(Wight 1993). Buston, Wight et al. (2002) suggest that teachers should try to
minimise factors such as gender dynamics which lead to student discomfort and
inhibit open discussion.

Teachers and others involved in sexual health education with young people must
have a sound understanding about gender issues, and be comfortable about
approaching these issues in the classroom context. This understanding will provide
the best possible ground work for ensuring that gender issues are addressed in both
mixed and single gender groups.

Any sexual health program which ignores the gendered sexual positioning of men
and women puts both young men and young women at a disadvantage. Hillier et al.
(1999) has stressed the importance of challenging the notion that female sexuality is
passive and male sexuality active (for example men penetrate, women are
penetrated) in sex education. She argues that such gendered constructions are deeply
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embedded in culture and delimit the sexual choices that many women feel are open
to them, and if young women are to control and enjoy their own sexuality, they need
to be presented with active representations of female sexuality. This representation
of female sexuality as passive has resulted in a silence surrounding the female body,
and according to Hillier, many young women (particularly those from rural areas)
lack a sense of embodied sexuality. This silence has ramifications for sexual health,
because in order to practise autonomy and agency in sexual encounters, women need
to feel connected to their own bodies and have access to language to express their
needs. More generally, she argues that young women need to be given permission to
use language to describe their sexuality and pleasure. This will start to redress the
dominance of male descriptions of embodied sexual pleasure that proliferate in
discourse and culture (Hillier 1999). Other authors have argued that sex education
programs should counter the prevailing norm of passive female sexuality, which may
prevent women from being “trained into positions of victimization” (Wight 1993).
Mitchell, Peart et al. (1996) examined the gendered assumptions behind programs
aimed at helping young women to say “no” to sex and suggested that including a
positive discourse of desire for young women will help to counterbalance discourses
which construct women as victims and focus on how girls can please men.

Research has demonstrated that ‘trust’ or ‘faith’ in sexual partners may have become
equated with offering a precaution against STIs or pregnancy for young women,
which conflicts with the safe sex messages in education programs. It is therefore
critical that the discourse of trust, love and romance is included in sex education
programs to help students appreciate that students that these concepts are not
protective (Hillier 1998).

While a great deal of stress has been placed on young women in the literature, it is
becoming increasingly evident that young men are also disadvantaged by the
gendered nature of sexuality. Smith et al. (2003) reported that young men in year 10
were more likely than young women to have multiple sexual partners, to participate
in casual sex and be drunk or high at their last sexual experience (although this gap
appears to be closing). McGrane (1993) posited that young men need to be given
permission to experience and express their normal human need for intimacy and
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emotional expression without fear of being seen as weak or lacking in masculinity.

There is increasing recognition that the social construction of sexuality has harmful
outcomes for both young women and young men. In a comparative study in the UK
and New Zealand, young people in year 12 were found to invoke a discourse of
gender differences to explain male and female sexuality. Young women were found
to take the role of gate keepers of heterosexual relations, and to have to negotiate
complex and contradictory discourses that cast them as either ‘sluts’ or 'angels'.
Their desire is defined by its absence. Young men saw themselves as unlikely to use
protection against pregnancy or STIs because in sexual encounters, their 'hormones'
and 'emotions' take over. Young men in both countries were found to believe that
they must be vigilant in establishing and maintaining their distinction from
homosexuals, mainly accomplished by the pursuit of women. (Hird 2001)

Culture
A number of researchers have explored the relevance of sexual and social cultures to
the provision of education. Rosenthal and Moore (1991:25) conducted research into
the relationship between knowledge, intentions and behaviours in regard to HIV and
adolescents. They concluded that education needs to take place within a framework
to which young people feel culturally connected. They suggest that young people
may have multiple cultural identities (e.g. the ‘student’, the ‘middle-class
conservative adolescent’, the ‘homeless teenager’, the ‘disco/club attendee’ and the
‘church minded youth’), and that all of these groups have an unspoken but
persuasive climate of beliefs, attitudes and values which direct their sexual
behaviour. They argue that it is the task of the educator to understand these cultures
and develop HIV/AIDS education programs which are targeted appropriately.
Buzwell, Rosenthal et al. (1992) similarly argue that to provide effective HIV/AIDS
education, it is important to first understand that adolescent sexuality is constructed
by a range of social factors. For example, constructions and understandings of
young people’s understanding of such notions as ‘virginity’, ‘fidelity’, ‘infidelity’
and ‘faithfulness’ need to be unpacked in order to understand what these terms mean
and how they affect the ways in which adolescents behave and interact on a sexual
level. For example, one area where youth culture and commonly accepted
understandings about terminology differ is illustrated by Smith et al. (2002) who
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report that while 45.5% of young people surveyed in 2002 engaged in giving or
receiving oral sex, they do not consider it to be ‘sex’.

Smith (2000) argued that educators must recognise the importance of cultural
differences as determined by regions or localities (for example rural and urban
students may require differently constructed health messages). These views are
summarised by Hillier (1998:28) who conclude that safe-sex education must address
the range of young people’s sexual concerns, while at the same time providing them
with more ways of being safe.

Awareness in of young people from culturally and linguistically diverse backgrounds

has also been recognised as significant, although has been the subject of remarkably
little research. Rosenthal, Moore et al. (1990) studied adolescents from Anglo-Celtic,
Greek, Italian and Chinese backgrounds and emphasize the need for educators to
take ethnic and cultural differences into account when planning HIV/AIDS
prevention programs. These differences are seen as important so that such young
people do not feel that the lessons and messages they receive are not applicable to
their culture and, therefore, their lives.

Sexual orientation
Sexuality education curricula must make room for the discussion of sexualities other
heterosexuality, because in discourse about sex homosexuality is frequently vilified,
demonised or missing, which leaves nowhere for lesbian, gay or bisexual youth to
situate themselves other than as absent or abhorrent. This represents a serious
concern for sex educators, as such silences and omissions contribute to problems of
low self esteem, self loathing and vulnerability to self harming behaviours. Hillier et
al. (1999) argued that by ensuring that human sexuality is presented as fluid and
multiple, same-sex attraction is kept ‘visible’ and relevant in the educational
program, and lesbian and gay youth will be less likely to disengage from lessons. In
a study with rural young people, the authors noted that young people tended to
assume heterosexuality as the norm, and penis-vagina sexual intercourse as the
pivotal activity in sex. Effective sex education can disrupt these assumptions and
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expose students to the diversity of human sexual practices and their concomitant
risks in relation to HIV and STIs.

When to introduce sexual health promotion programs

The age at which sexual health education should be delivered to young people
remains a controversial matter. Ollis (1996) asserts that sexuality and health
promotion programs should be introduced early, prior to students becoming sexually
active, ideally in late primary or at the beginning of secondary school and be
designed at an age appropriate level for the students. The content of such programs
should focus not only on the physiology of sex, but on such notions as intimacy and
desire as well.

In Victoria, sex education was mandated for primary school students in 1998. The
curriculum for upper primary (9 – 12 year old) students focuses on the biological
aspects of reproduction, when it is generally accepted that they may be able to grasp
the material at a cognitive level. However, in a study with primary school aged
children who were recipients of the Victorian curriculum, (Hay 2001) found that not
all students who received this program did grasp the information adequately.
According to Hay, this is not a problem with the timing of the introduction of a
sexual health curriculum, but a matter that could easily be rectified by changes in
pedagogical practices. She argues that unless programs provide a means by which
children can conceptualise the dynamic and integrated nature of reproductive
biology, they will fail the students.

Given that many students will not receive any sexual health teaching until middle
secondary school, that a significant number do not clearly understand the program
delivered in primary school and that a considerable proportion of students are
sexually active by middle secondary school (Smith et al. 2003), leaving young
people inadequately informed between the ages of 12 and 15 may for some have
grievous results, and do a serious disservice to others at a time when they most need
not only information but a venue in which to explore values and learn skills in
communication, assertiveness and negotiation.
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A Multi-dimensional approach
It is critical to the success of sexual health programs that the curriculum is multi-
dimensional, focusing the domains of knowledge, attitudes and behaviour (Gourlay,
1996; Hillier et al., 1998). This review will examine the literature on each of these
domains and argue that sexual health programs that do not address all three are
incomplete.

Information/ Knowledge
Gourlay (1996) stresses that ‘knowledge alone does not change behaviour’(p. 42)
and that behaviour will not be changed by the mere acquisition of knowledge.
Hillier et al (1998) argued that beyond the provision of information, consideration
needs to be given to the social and gendered meanings that young people attribute to
sexuality and sexual behaviour, and how these factors impact upon the rational
choices they make. She further suggests that successful sexual health promotion
strategies must address the social context in which young people live their lives,
including the broad spectrum of concerns facing young people when they become
sexually active. Smith (2000) further argued that if HIV/AIDS education is confined
within a subject such as science or biology, that the links between HIV/AIDS and
broader social concerns are likely to be left unexplored. Indeed where HIV/AIDS is
positioned as a ‘question’ for science, any useful discussion of interpersonal sexual
relations may be systematically downplayed. Hillier et al. (1998) suggested that
programs which focus exclusively on HIV prevention run the risk of being perceived
as irrelevant if they do not acknowledge other perhaps more immediate concerns in
the lives of young people.

Sexuality education remains a controversial topic with vigorous debate about

whether or not it is appropriate for young people by both its many detractors and
supporters. Those opposing sexuality education have accused it of undermining
family values, and promoting inappropriate sexual behaviour, and argue that young
people should be taught that celibacy is preferable until after marriage (noted in
Gourlay, 1995), as a result some programs have promoted abstinence. While
abstinence is a certain way of preventing pregnancy and the transmission of
infections, it has not been demonstrated to be an effective strategy for many young
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people. DiClemete (1998) reported from a US study that after a 17 month follow up,
that young people who received an abstinence curriculum were as likely as the
control group, who received safer sex education, to become sexually active, and
report similar rates of pregnancy and STIs. The young people in this study who
received the safer sex program reported less frequent sexual intercourse, which
contradicts the belief that sex education increases sexual activity. Christopher (1990)
evaluated another teenage pregnancy prevention program, based on abstinence,
called ‘Just Say No’ and discovered that after being exposed to six program sessions
espousing abstinence and the need to confine sex to marriage, the only change
shown by the 191 participants was an increase in precoital sexual activity. Smith,
Kippax and Aggleton (2000) argued against the promotion of abstinence as a valid
option to avoid contracting diseases. They pointed out that, morality issues aside, no
credible evidence suggests that such an approach works. The casualties of such an
approach are the young people who are denied information about how to prevent
HIV and STIs in the likely event that a number of them become sexually active.

Attitudes
Attitudes and values are identified by a number of authors as critical to the success
of any sexual health program, both in terms of content and the approach of those
involved in running programs. This applies equally to the personal attitudes of those
teaching the program, their understanding of the values clarification process and
their skills as they work with young people to assist them to clarify their own values
in relation to sexuality. Ollis (1996) argues that programs should involve values
clarification and be taught by skilled, confident teachers with assistance from local
health professionals who understand and can complement this conceptual
framework.

Harrison et al. (1996) posited that attempts by teachers to adopt a value-neutral

stance are doomed to failure. They argued that that teacher values and attitudes are
invariably imparted to students through spoken languages as well as through
silences, body language, and role modelling (p. 69). According to Harrison et al.
values transmitted through the curriculum hinge as much on what is written and said,
as what is not written and not said. The authors propose that teachers should ‘work
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to create a safe environment for their students and themselves …. one in which they
can talk about not only what is safe, but what is pleasurable/desirable for all their
students’ (p. 81). Fine (1988) argues that to promote the development of sexual
responsibility among young people, anti-sex rhetoric should be avoided. She
suggests that young people are entitled to a discussion of desire rather than being
exposed to anti-sex rhetoric, which may be remote from their own feelings and may
alienate them from what is being taught. Hillier, Harrison et al. (1998) also take this
position, arguing that in the curriculum, sex for pleasure should to sit alongside sex
for reproduction as a valid reason for engaging in sex.

Behaviour
Perhaps the most controversial area of sex health education is that of behaviour. A
persistent fear that is voiced about sexual health promotion suggests that providing
young people with knowledge about sexuality will lead to increased sexual
behaviour, unplanned pregnancy and exposure to disease. An evaluation of a sexual
health and relationships education program in Scotland found that while there were
no differences in sexual activity or sexual risk taking between the intervention group
and the control group by the age of 16, those in the intervention group reported less
regret at first and most recent intercourse. Students evaluated the intervention
program more positively and their knowledge of sexual health improved (Wight
2002). Another study that investigated sex education programs that included
promotion and distribution of condoms as a major component of the curriculum,
found that this did not lead to an increase in sexual activity among adolescents
(Sellers, McGraw et al. 1994).

One of the major concerns expressed about discussing sexual behaviour and
acknowledging that some students are sexually active, is that of increased risk. Many
adolescents perceive themselves as invulnerable to the threat of HIV/AIDS and
continue to engage in unsafe sexual practices Moore and Rosenthal (1991a). These
authors suggest that it is critical for educational programs to discuss issues related to
risk taking behaviour and perceptions of safety. For example, students should be
made aware that risk taking behaviours expose people to the possibility of HIV
infection, not sexual identity. Misconceptions and myths about HIV/ AIDS only
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affecting people they view as different to them must be challenged (1991a: 178). In
a follow up study, (Moore and Rosenthal 1991b) stress that education programs and
interventions often under-estimate young people’s ability to make realistic
judgements about risk, and consequently overstate the dangers of behaviours
considered undesirable. The danger is that such tactics can lead to young people
rejecting the total content of the message, instead of engaging in the rational decision
making process of deciding which parts of the message have greatest personal
relevance.

Sex education programs are more likely to influence behaviour if they are narrowly
focused on behaviours, have a clear behavioural message and develop student’s
negotiation skills (Wight, Raab et al. 2002). Kirby and Alter (1980) concluded that
sex-education programs are different from other high-school courses because, in
addition to imparting knowledge, they seek to change behaviours. They argue that it
is: ‘vital to the effectiveness of school-based education that teachers adopt strategies
which allow knowledge and skills to be generalized to appropriate human relations’
situations’.

Sexuality education programs must also address interpersonal and communication

skills. This will empower students to negotiate sexual intimacy more effectively and
Wight (1993) argues that this will help young women avoid and resist unwanted
sexual experiences. Sikkema, Winett et al. (1995) also emphasise the importance of
imparting assertiveness skills to young women. They devised an AIDS education
and prevention education strategy that focused on sexual assertiveness skills and the
reduction of risk related behaviours, which was designed and evaluated in
comparison with an ‘education-only’ program. They found that skills training
participants compared to education-only participants, scored higher on sexual
assertiveness skills.

A WHOLE SCHOOL APPROACH

A whole school approach has been advocated for wide variety of educational
applications, and practiced in a wide variety of education programs to address social
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issues, including anti-bullying and anti-violence programs, health promotion and

mental health promotion strategies in schools. In spite of this there appear to be
surprisingly few references that refer to the whole school approach for sexual health
programs. When referring to the whole school approach definitions are either absent
or unclear, and each reference appears to define the concept differently, although
many share the same principles. A web search for programs using a whole school
approach revealed the following definitions

The whole school approach is … the involvement of all teachers with the
potential to deliver sexual health education (Health Education Board of
Scotland 2002).

Whole-school approaches seek to engage all key learning areas, all year levels
and the wider community. They include many aspects of school life, such as
curriculum, culture, teaching practices, policies and procedures (Queensland
Government 2003).

A search of the AUSTROM (Education) data base showed 137 records relating to a
whole school approach, however only one related to sexuality education. It is
apparent from both the data base and web search that in general, the term whole
school approach refers to cross curricula integration of a subject within a school.
Some of the layers which can be identified in a whole school approach include the
policy domain; curriculum and pedagogical practices; professional development;
staff-student relationships; student-student relationships; parent-staff and school
community relationships’ (Magill 2000). Carter (1999) also argued that for sexual
health strategies to be effective, the wider school community needs to be involved,
particularly the school parent body; community based strategies optimise the
likelihood of successful health education outcomes.

The work of Mitchell, Ollis et al. (2000) in developing a national framework for
sexual health promotion in secondary schools in Australia builds on and extends
these concepts and defines a whole school approach as being more than the
implementation of a formal curriculum. It calls for policy and guidelines to be
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developed, implemented and reviewed; consultation and working in partnership with

parents, elders and the school community; accessing community resources and
involving students. They argue that this is insufficient if policy and guidelines do not
support practice. For example anti-discrimination policies should not only be taught,
but put into practice throughout the school; programs should be integrated within a
formal student welfare support structure so that linking students to community
agencies complements education programs.

In attempting to examine the efficacy of the whole school approach to specific social
issues such as teenage pregnancy, STIs, homophobic harassment and sexual coercion
it is possible to learn both from the experience of using this approach in other related
areas such as health promotion and behaviour change programs, as well as from the
(limited) literature pertaining to the issues specifically identified. The concept of
health promoting schools is relevant to any discussion of a whole school approach,
particularly in the context of sexual health promotion.

‘Health promoting schools’ is defined by the World Health Organisation, as

displaying in everything that is said and done in schools providing support for and
commitment to enhancing the emotional, social, physical and moral well-being of all
members of their school community. In Australia the health promoting schools
approach has been widely adopted at a policy level by Governments, and in practice
in many school communities. The Health Promoting School framework has been
depicted as having overlapping and interconnected domains,
• Curriculum, teaching and learning. This domain includes content, pedagogy,
resources and outcomes;
• School organisation, ethos and environment. This domain focuses on school
culture, attitudes and values, policies and practices, extracurricular activities
and the social and physical environment; and
• Partnerships and services. This domain is concerned with the relationships
between school, home and the community.
• The Curriculum Framework recognises the value of this holistic approach to
education (Magill 2000)
18

Marshall, Sheeman et al. (2000) have written extensively about the ‘health
promoting schools’ (HPS) movement and explain its connection to a whole school
approach. They stress that any HPS project must develop a whole school approach if
it is to be successful. Simply providing curriculum ‘that might or might not be
supported by broader policies and practices within the school’ will not guarantee
success (p. 252). However they warn that multiple interpretations of HPS are
problematic because broad and flexible approaches could lead to justification of any
health-related activity as being health promoting even if ‘it failed to adopt a holistic,
whole school approach’ (p. 252). In concluding their findings, they argued that there
is a need to provide training for teachers around the concepts of the HPS, that
curriculum documents and topic-specific projects need to be embedded in a whole-
school approach, and that greater cooperation is necessary between the health and
education sectors, at a national, state and local community level.

In an extensive evaluation of the impact of a co-ordinated whole school approach to

health education in 16 pilot and 32 reference schools in Europe, Healy (1998)
concluded that such an approach can make ‘a positive and tangible contribution’ to
young people’s health. He particularly emphasised that the contribution of welfare
staff may greatly enhance the health promotion message, with ‘corresponding
benefits for the whole school community’ (p. 23). The schools in question used the
whole school approach to address issues relating to healthy eating, substance misuse,
bereavement and grief, and various sex education provisions, although the article
does not elaborate on the details of these programs.

Using a whole school approach to combating prejudice and discrimination

Pallotta-Chiaroli (2000) has identified that many students: ‘wish to see schools
supporting student initiatives in policy, curriculum and school culture that challenge
homophobia and heterosexism in ways that are meaningful for students’ (p. 38). A
three tiered approach encompassing policy, curriculum and school culture clearly
adheres to the philosophy of ‘whole school’ model. Pallotta-Chiarolli argues that a
common mistake that schools often make is that they deal with the issue of
homophobia, ‘an issue about students’, without actually involving the students
themselves (p. 38). Her research reveals that it is critical to involve students by
19

soliciting their opinions, given that they are the people affected by homophobic
discrimination within the school and wider schools environment. She asserts that
many students want to be effective leaders and take on challenges in regard to
homophobia and that it is therefore imperative that students be consulted to gauge
what their role should be in a whole school approach to homophobia and hetero-
normativity. Owens (1999) concurs with this idea, arguing that schools need to
encourage and support ‘grassroots student tactics’.

The whole-school approach is suggested as a model for addressing discrimination,

harassment and vilification in NSW schools. This model involves using a unified
approach; the provision of policies and mechanisms to address complaints; including
the necessity of dealing with homophobia sensitively; the need to implement
programs which assist gay and lesbian students to feel comfortable within the school
community; and the need to provide professional development resources to ensure
staff fully understand the consequences of homophobic harassment (Gardner 1996).

Whilst Nickson (1996) does not specifically use the term ‘whole-school approach’ in
her article which proposes strategies to combat homophobia, it is clear that such an
approach underpins the strategies that she details. She asserts that a holistic and
proactive approach is the only effective way for school communities to tackle
homophobia, and that as a microcosm of society, schools must stop reinforcing a
dominant heterosexist norm and begin to both teach and practice acceptance of
sexual and cultural difference. Nickson advocates that change needs to be addressed
at an institutional, classroom and curriculum level. She provides detailed and
comprehensive suggestions for each of these three ‘streams’. The emphasis is that of
confronting the existence of homophobia and providing all school members not only
with strategies to challenge it, but permission to do so, acknowledging that it is the
insidious culture of denying, silencing and ignoring the existence of homophobia
that allows it to flourish. Many of the interventions proposed are aligned with
simple concepts such as the imperative not to assume heterosexuality and the need to
affirm sexual diversity.
20

Other sources support the benefits of utilising a whole school approach to racist,
cultural and homophobic bullying. For example, the Manchester City Council News
(2002) reported that an anti-bullying conference held in the city would provide the
backdrop for the launch of a new information pack for teachers which provided
guidelines for developing anti bullying policies and practices in schools based on a
whole school approach.

Hinson (1996) proposes that if schools are to successfully address the problem of
physical, verbal, visual or sexual forms of homophobic violence directed against
individuals or groups, on the basis of their perceived sexual orientation, then a
concerted approach is required across the entire school to effect a cultural change.
Hinson stresses that the key to addressing heterosexist harassment is to seek to
change specific local, contextual, violence-maintaining practices with the school
environment. These include certain kinds of blame attribution, silencing and
oppressive constructions of gender and sexuality. These factors typically include the
things that people ‘do, say and think’ which maintain and sanction heterosexist
violence. These actions, statements and thoughts which contribute to victim
blaming, offender defending and silencing need to be addressed across the school, to
disrupt those embedded practices which reflect and reinforce dominant power-
relations in class rooms, schools and departments. Hinson also advocates that
violence-maintaining practices need to become a central consideration when
reforming related policy, guidelines, procedures, behaviour management, curricula,
professional development.

Using a whole school approach to prevent bullying and harassment

‘The whole school approach emerges strongly through the literature as primary good
practice, addressing multiple layers of intervention’ (Magill 2000). Magill stresses
that it is evident that the success of the whole school approach is based on
collaborative contributions from a range of individuals. Furthermore, he argues that
to effectively challenge violent cultures, attention must be paid to the whole school
climate, and suggests that ‘it is very clear in this arena that ‘the medium is the
message’ (p. 140). The whole school approach should be focused on reducing the
21

inequality gaps in outcomes for students because it addresses the fact that the
production of inequality in schools functions a system of violence in its own right.

A whole school based preventative strategy to bullying and harassment was

effectively implemented in a Canberra school for students with mild intellectual
disabilities. This involved formulating anti-harassment policy initiatives, soliciting
parent support, and involving the entire school community in what was termed ‘anti-
harassment lessons’. Furthermore, the entire school community adopted and
enforced school rules designed to create a safe school environment. The perpetrators
of harassment and bullying were offered support and counselling rather than be
subjected to punishment. Parents were called upon to assist in changing anti-social
behaviours (Driscoll 1998). Whilst this paper did not use ‘rigorous measures of
research’, it asserts that: ‘anecdotal results of the program suggest that a whole
school preventative approach with all students involved in learning about harassment
was most worthwhile’. It was also notes that harassment incidents declined after the
program was implemented. The authors note that ‘commitment to a whole school
approach of anti-harassment based on a protective behaviours program is a
significant step forward in teaching students about safety and respect for themselves
and community members’ (p. 10).

The text ‘Bullying: A Whole-School Approach’ has a practical approach to this

issue. The authors set out a clearly defined approach to developing a whole-school
approach, providing practical intervention and prevention studies. They provide
guidelines for formalising grievance procedures; and developing and implementing
an anti-bully policy and suggest ways of putting these approaches into practice.
Fifteen lessons that teachers can adapt to their particular school environment are
provided (Suckling and Temple 2001).

Using a whole school approach to combat gender-based violence

Based on extensive reviews of the research, and consultation in Australia a
comprehensive ‘whole of school’ approach to the problem of gender-based violence
against girls was developed by Ollis and Tomaszewski (1993). These authors
advocate that schools need to develop management practices and organisational
22

structures to promote a culture where any form of violence against women is

unacceptable. They detail strategies that intervene at the level of the school, the
individual student and teachers. Whilst no empirical data is supplied to substantiate
the relative success of such interventions, it is argued that the adoption of whole
school approach is imperative if the culture of violence is to be interrupted and
diminished. In regard to specific educational approaches, at a whole school level
they advocate educating staff and students about the criminal nature of violence and
drawing out links between sex-based harassment and violence against girls and
women.

A gender and violence project advocated by the Australian Council of State School
Organisations (ACSSO) argues that a whole school approach is required to deal with
the problem of gender-based violence within schools. The ‘No Fear’ kit for use by
students (in conjunction with a ‘parent pack’), is designed to help create a non-
violent school community. The benefits of a whole school approach are promoted in
his kit, which suggests that ‘productive partnerships are an important ingredient in
the whole school approach and in groups working together on sensitive and
controversial issues’ (Beckett, Bode et al. 1995). Partnership strategies include
inviting key parent representatives to work on a school ‘anti violence’ team. This
ensures that parents are able to contribute their knowledge, life experiences and
insights into violence. The authors stress that such input is ‘relevant to the task of
teaching and learning’ and should not be omitted in attending to a whole school
approach to the problem of violence (p. 150).

An analysis of sexual harassment in schools provides some understanding of the

levels of resistance to gender reform in schools. In order to bring about gender
reform in schools, it is important to think strategically about how to introduce
policies in ways which address the investment that both boys and girls have in
existing constructions of masculinity and femininity. Unless these power relations
are addressed in ways which do not merely redress individual grievances (as sexual
harassment policies tend to do), there is little chance to make cultural shifts or
provide new subject positions and discourses of masculinity and femininity which
will produce significant change. This research suggests that programs which merely
23

react to specific harassment grievances will not adequately remedy the underlying
systemic culture that sees acts of harassment go unchallenged in the school
environment on a daily basis (Blackmore, Kenway et al. 1996).

In a US study a whole school approach is advocated by investigators who researched

strategies prevent sexual harassment in the classroom and the wider school
environment. Several elements are proposed First, plans must be made for ‘teachable
moments’ through the curriculum. Lessons messages ‘must travel into the
mainstream discourse and into the public arena of the classroom’. Secondly, the
entire school community (teachers, administrators, cafeteria workers etc) need staff
development to ensure that includes case studies detailing what constitutes
harassment and how best to respond to it. Thirdly not punitive, but compassionate
responses must be offered to students involved in harassing or abusive interpersonal
relationships (Stein 1996).

Using a whole school approach to educate students about STIs.

In a Netherlands study into HIV/STD education, with ninth and tenth grade students
at vocational secondary schools, a program based on ‘co-operation with students,
teachers and gatekeepers within the school’ was found to be likely to improve the
implementation of the program. The findings from this study suggest that involving
the whole-school community in the process of developing curriculum is a desirable
objective (Schaalma, Kok et al. 1994). Another study that assessed HIV/AIDS health
education programs in Scotland, advocated that schools need to develop policies to
achieve good school-parent links in relation to sex education by adhering to a
‘whole-school approach’ model (Wight 1993). In a later study Wight, Raab et al.
(2002) indicated that recent finding from the USA suggest that ‘school wide events’
and parent education can reduce sexual risk taking.

Using a whole school approach to prevent teenage pregnancy

Reducing the rate of teenage pregnancy has been the target of many sexual health
programs around the world. An evaluation of programs that provided sexual health
education for young people was carried out by UNAIDS in 1997. Of the 53 studies
that evaluated specific interventions, 27 reported that HIV/ AIDS and sexual health
24

education neither increased or decreased sexual activity, 22 reported a delay in the

onset of sexual activity and only 3 found an increase in sexual behaviour associated
with sexual health education (Grunseit 1997) In the USA, which has extremely high
teenage pregnancy rates, with four in ten teenage girls becoming pregnant while in
their teens, there has been a consistent decline in these rates over the past decade.
While the reasons for this decline is not entirely understood, a number of sexuality
education (and other) programs aimed at reducing these rates were evaluated in
1997, with a follow up in 2001. The author of the study examined the various
approaches to reducing teenage pregnancy and concluded that while these programs
cannot solve the problem of teenage pregnancy, they are an important part of the
answer. In the USA, almost every teenager in the country receives some form of sex
education, which can be divided into two broad categories, abstinence only and sex
or HIV education. A large body of evaluation research demonstrates clearly that sex
education and HIV programs delay sexual activity for some students, and increase
responsible sexual behaviour among those who do become sexually active (Kirby
2001).

In his evaluation of sex education programs, Kirby identified that short term
curricula do not have a measurable impact on the behaviour of young people, and
suggests that effective sexual health education programs share the following
characteristics. They:

1. Focus on the behaviours that lead to unintended pregnancy or HIV/ STI

infection;
2. Are based on theoretical approaches that have been demonstrated to
influence other health related behaviour and identify specific important
sexual antecedents to be targeted;
3. Deliver and consistently reinforce a clear message about abstaining from
sexual activity/ and or using condoms or other forms of contraception. This
appears to be one of the most important characteristics that distinguishes
effective from ineffective programs;
25

4. Provide basic, accurate information about the risks of teen sexual activity and
about ways to avoid intercourse or use methods of protection against
pregnancy and STIs;
5. Include activities that address social pressures that influence social
behaviour;
6. Provide examples of and practice with communication, negotiation and
refusal skills;
7. Employ teaching methods designed to involve participants and have them
personalise the information;
8. Incorporate behaviour goals, teaching methods and materials that are
appropriate to age, sexual experience and culture of the students;
9. Last sufficient length of time (i.e. More than a few hours);
10. Select teachers or peer leaders who believe in the program and then provide
them with adequate training.

Kirby’s evaluation focuses on more than curricula approaches to sex education,

including programs for parents and families, clinic based programs to provide
reproductive health care, community wide initiatives that address the social factors
that lead to teenage pregnancy including early childhood and youth development
programs. However there is no mention of a whole school approach that includes
involving students, teachers, parents and the wider community in the planning,
delivery and support of sexual health programs.

Indeed, there appears to be a paucity of literature that evaluates a whole school

approach for sexual health programs. Web searches identified specific school
districts that stated that they utilised ‘a whole school approach’ to teenage
pregnancy. Such programs appear to have been adopted in California (USA),
Alberta (Canada), Middlesbrough (UK), Essex (UK), and Aberdeen (Scotland). All
of these sources merely noted that a ‘whole school approach’ was being
implemented. There was no evidence of any evaluation of these programs or of their
specific content. Nevertheless, given that these programs are reported as having
been implemented in the years 2000 to 2001, it would appear that a whole school
approach to teenage pregnancy is being widely used across national boundaries.
26

In spite of the many applications of the whole school approach to a wide variety of
education programs there appear to have been few evaluations of the approach.
Curtin University evaluated a schools drug education project in Western Australia
that used three levels of teacher training in schools implementing the program. Some
schools elected to participate in a whole school approach, some in a train the trainer
program and others in a regional school drug education network. When this
evaluation compared each of the interventions, it found that while schools that
received the train the trainer intervention did well on all measures, the schools which
received the whole school intervention were more likely to be actively involved in
regional drug networks, teachers were significantly more likely to be aware of harm
reduction and have higher drug related knowledge than the other groups. In addition
the whole school approach schools were more likely to have implemented a school
drug related policy and see it as a priority, and to be more successful in involving
parents and community in planning and other awareness raising, as well as teaching
and learning activities (Cross 2000). However, on outcome measures evaluation of a
whole school approach appears to be less successful. Schonfeld (1995) evaluated a
whole school anti-smoking strategy and found that program failed to improve
smoking behaviour over 2 years. The program was successful in improving smoking
knowledge, but not attitudes. Gourlay (1995) argues that it is a mistake to evaluate
only the measurable outcomes of sexuality education, and that education can have
effects and intrinsic worth beyond its measurable outcomes. He suggests that when
young people report positive effects from sexuality education they refer to more
diverse outcomes than the obviously measurable behavioural changes. For example
self esteem, body awareness, confidence, hope and understanding.

While there is insufficient formal evidence to be able to definitively answer the

question seeking evidence that a whole school approach to relationships and sexual
health has a positive impact on issues such as teenage pregnancy, STIs, homophobic
harassment and sexual coercion/assault, it is clear from anecdotal information and
the limited evaluation data that such an approach has a great deal to offer. Clearly
there is a need for more programs to be evaluated, particularly programs that aim to
promote improved sexual health and behaviour change. It is also apparent that it is
27

not enough to use rhetoric about a whole school approach without providing
understandable definitions to all those who will be involved and training and
ongoing support to the staff who will have primary responsibility for the program.
 28

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