ESHE Performance Measure 1: % of priority districts
that have a written MS/HS curriculum framework that reflects ESHE
programs
|
Currently,
does [PRIORITY DISTRICT
NAME] have a written
curriculum framework for sexual health education?
Yes
⃝ No ⃝ Don’t Know ⃝
Does
[PRIORITY DISTRICT NAME]
require a course including HIV, STD, or pregnancy prevention
topics in each of the following grades or range of grades?
(Mark yes or no for
each.)
-
Grades
|
|
6
|
Yes
⃝ No ⃝
|
7
|
Yes
⃝ No ⃝
|
8
|
Yes
⃝ No ⃝
|
9
|
Yes
⃝ No ⃝
|
10
|
Yes
⃝ No ⃝
|
11
|
Yes
⃝ No ⃝
|
12
|
Yes
⃝ No ⃝
|
Middle
school (No specific grade)
|
Yes
⃝ No ⃝
|
High
school (No specific grade)
|
Yes
⃝ No ⃝
|
Currently,
does [PRIORITY DISTRICT
NAME] include each of the
following topics in sexual health education for grades 6-8?
(Mark yes or no for each
topic.)
How
to create and sustain healthy and respectful relationships.
|
Yes ⃝ No
⃝
|
Communication
and negotiation skills related to eliminating or reducing
risk for HIV, other STD, and pregnancy.
|
Yes ⃝ No ⃝
|
Goal-setting
and decision-making skills related to eliminating or
reducing risk for HIV, other STD, and pregnancy.
|
Yes ⃝ No ⃝
|
The
benefits of being sexually abstinent.
|
Yes ⃝ No
⃝
|
The
importance of limiting the number of sexual partners.
|
Yes ⃝ No
⃝
|
The
importance of using condoms consistently and correctly.
|
Yes ⃝ No
⃝
|
The
importance of using a condom at the same time as another
form of contraception to prevent both sexually transmitted
diseases (STD) and pregnancy.
|
Yes ⃝ No ⃝
|
How
to access valid and reliable health information, products,
and services related to HIV, other STD, and pregnancy.
|
Yes ⃝ No ⃝
|
Preventive
care such as screenings and immunizations that is necessary
to maintain reproductive and sexual health.
|
Yes ⃝ No ⃝
|
Influences
of family, peers, culture, media, technology, and other
factors on sexual risk behaviors.
|
Yes ⃝ No
⃝
|
Influencing
and supporting others to avoid or reduce sexual risk
behavior.
|
Yes ⃝ No ⃝
|
Currently,
does [PRIORITY DISTRICT
NAME] include each of the
following topics in sexual health education for grades 9-12?
(Mark yes or no for each
topic.)
How
to create and sustain healthy and respectful relationships.
|
Yes ⃝ No
⃝
|
Communication
and negotiation skills related to eliminating or reducing
risk for HIV, other STD, and pregnancy.
|
Yes ⃝ No ⃝
|
Goal-setting
and decision-making skills related to eliminating or
reducing risk for HIV, other STD, and pregnancy.
|
Yes ⃝ No ⃝
|
The
benefits of being sexually abstinent.
|
Yes ⃝ No
⃝
|
The
importance of limiting the number of sexual partners.
|
Yes ⃝ No
⃝
|
The
importance of using condoms consistently and correctly.
|
Yes ⃝ No
⃝
|
The
importance of using a condom at the same time as another
form of contraception to prevent both sexually transmitted
diseases (STD) and pregnancy.
|
Yes ⃝ No ⃝
|
How
to access valid and reliable health information, products,
and services related to HIV, other STD, and pregnancy.
|
Yes ⃝ No ⃝
|
Preventive
care such as screenings and immunizations that is necessary
to maintain reproductive and sexual health.
|
Yes ⃝ No ⃝
|
Influences
of family, peers, culture, media, technology, and other
factors on sexual risk behaviors.
|
Yes ⃝ No ⃝
|
Influencing
and supporting others to avoid or reduce sexual risk
behaviors.
|
Yes ⃝ No
⃝
|
Currently,
does [PRIORITY DISTRICT
NAME] recommend or require
schools to assess the ability of students to do each of the
following in grades 6-8? (Mark
yes or no for each topic.)
Comprehend
concepts important to prevent HIV, other STD, and pregnancy.
|
Yes ⃝ No
⃝
|
Analyze
the influence of family, peers, culture, media, technology,
and other factors on sexual risk behaviors.
|
Yes ⃝ No ⃝
|
Access
valid information, products, and services to prevent HIV,
other STD, and pregnancy.
|
Yes ⃝ No
⃝
|
Use
interpersonal communication skills to avoid or reduce sexual
risk behaviors.
|
Yes ⃝ No
⃝
|
Use
decision-making skills to prevent HIV, other STD, and
pregnancy.
|
Yes ⃝ No
⃝
|
Set
personal goals that enhance health, take steps to achieve
these goals, and monitor progress in achieving them.
|
Yes ⃝ No ⃝
|
Influence
and support others to avoid or reduce sexual risk
behaviors.
|
Yes ⃝ No ⃝
|
Currently,
does [PRIORITY DISTRICT
NAME] recommend or require
schools to assess the ability of students to do each of the
following in grades 9-12? (Mark
yes or no for each topic)
Comprehend
concepts important to prevent HIV, other STD, and pregnancy.
|
Yes ⃝ No
⃝
|
Analyze
the influence of family, peers, culture, media, technology,
and other factors on sexual risk behaviors.
|
Yes ⃝ No ⃝
|
Access
valid information, products, and services to prevent HIV,
other STD, and pregnancy.
|
Yes ⃝ No
⃝
|
Use
interpersonal communication skills to avoid or reduce sexual
risk behaviors.
|
Yes ⃝ No
⃝
|
Use
decision-making skills to prevent HIV, other STD, and
pregnancy.
|
Yes ⃝ No
⃝
|
Set
personal goals that enhance health, take steps to achieve
these goals, and monitor progress in achieving them.
|
Yes ⃝ No ⃝
|
Influence
and support others to avoid or reduce sexual risk
behaviors.
|
Yes ⃝ No ⃝
|
Currently,
does the SEA have the following materials:
Materials
|
Yes ⃝ No
⃝
|
A curriculum framework or model curriculum
framework that includes sexual health education
|
Yes ⃝ No
⃝
|
A list of recommended sexual
health curricula for grades 6-8
|
Yes ⃝ No
⃝
|
A list of recommended sexual
health curricula for grades 9-12
|
Yes ⃝ No
⃝
|
Guidance on selecting sexual
health curricula
|
Yes ⃝ No
⃝
|
Guidance on adapting sexual
health curricula
|
Yes ⃝ No
⃝
|
Currently,
does [PRIORITY DISTRICT
NAME] provide each of the
following materials to those who teach sexual health education
in grades 6-8? (Mark yes
or no for each material)
Materials
|
|
Goals,
objectives, and expected outcomes for sexual health
education.
|
Yes ⃝ No
⃝
|
A
written health education curriculum that includes objectives
and content addressing sexual health education.
|
Yes ⃝ No
⃝
|
Strategies
that are age-appropriate, relevant, and actively engage
students in learning.
|
Yes ⃝ No
⃝
|
A
chart describing the annual scope and sequence of instruction
for sexual health.
|
Yes ⃝ No
⃝
|
Methods
to assess student knowledge and skills related to sexual
health education.
|
Yes ⃝ No
⃝
|
Currently,
does [PRIORITY DISTRICT
NAME] provide each of the
following materials to those who teach sexual health education
in grades 9-12? (Mark yes
or no for each material.)
Materials
|
|
Goals,
objectives, and expected outcomes for sexual health
education.
|
Yes ⃝ No
⃝
|
A
written health education curriculum that includes objectives
and content addressing sexual health education.
|
Yes ⃝ No
⃝
|
Strategies
that are age-appropriate, relevant, and actively engage
students in learning.
|
Yes ⃝ No
⃝
|
A
chart describing the annual scope and sequence of instruction
for sexual health.
|
Yes ⃝ No
⃝
|
Methods
to assess student knowledge and skills related to sexual
health education.
|
Yes ⃝ No
⃝
|
|
ESHE Performance Measure 3: % of priority
districts that have adopted sexual health curricula (including
EBI if applicable)
|
Currently,
has [PRIORITY DISTRICT NAME] adopted sexual health
curricula for use in grades 6-8?
Yes ⃝ No ⃝
If
yes, what sexual health curricula were adopted in [PRIORITY
DISTRICT NAME] for use in grades 6-8? (Mark all that
apply and specify name or description of any “other”
sexual health curricula.)
⃝ Aban Aya
Youth Project
⃝ Adult
Identity Mentoring (Project AIM)
⃝ All4You!
⃝ Be
Proud! Be Responsible!
⃝ Becoming
a Responsible Team (BART)
⃝
¡Cuídate!
⃝ Draw the
Line/Respect the Line
⃝ FOCUS
⃝ Focus on
Youth + ImPACT
⃝ Heritage
Keepers Abstinence Education
⃝ Horizons
⃝ It's
Your Game: Keep it Real
⃝ Making a
Difference!
⃝ Making
Proud Choices!
⃝ Project
AIM
⃝
Promoting Health Among Teens! Abstinence-Only Intervention
(formerly known as 'Promoting Health Among Teens!')
⃝
Promoting Health Among Teens! Comprehensive Abstinence and Safer
Sex Intervention (formerly known as 'Comprehensive Abstinence and
Safer Sex Intervention!')
⃝ Raising
Healthy Children (formerly known as the Seattle Social
Development Project)
⃝ Reducing
the Risk
⃝ RESPECT
⃝ Safe in
the City
⃝ Safer
Choices
⃝ Safer
Sex
⃝ SIHLE
⃝ Sisters
Saving Sisters
⃝ Street
Smart
⃝ Teen
Health Project
⃝ Teen
Outreach Program
⃝ What
Could You Do?
⃝ WILLOW
⃝ Other
curriculum
Provide name or
description of other
curricula:_______________________________________________
Currently,
has [PRIORITY DISTRICT NAME] adopted sexual health
curricula for use in grades 9-12?
Yes ⃝ No
⃝
If
yes, what sexual health curricula were adopted in [PRIORITY
DISTRICT NAME] for use in grades 9-12? (Mark all that apply
and specify name or description of any “other”
sexual health curricula.)
⃝ Aban Aya
Youth Project
⃝ Adult
Identity Mentoring (Project AIM)
⃝ All4You!
⃝ Be
Proud! Be Responsible!
⃝ Becoming
a Responsible Team (BART)
⃝
¡Cuídate!
⃝ Draw the
Line/Respect the Line
⃝ FOCUS
⃝ Focus on
Youth + ImPACT
⃝ Heritage
Keepers Abstinence Education
⃝ Horizons
⃝ It's
Your Game: Keep it Real
⃝ Making a
Difference!
⃝ Making
Proud Choices!
⃝ Project
AIM
⃝
Promoting Health Among Teens! Abstinence-Only Intervention
(formerly known as 'Promoting Health Among Teens!')
⃝
Promoting Health Among Teens! Comprehensive Abstinence and Safer
Sex Intervention (formerly known as 'Comprehensive Abstinence and
Safer Sex Intervention!')
⃝ Raising
Healthy Children (formerly known as the Seattle Social
Development Project)
⃝ Reducing
the Risk
⃝ RESPECT
⃝ Safe in
the City
⃝ Safer
Choices
⃝ Safer
Sex
⃝ SIHLE
⃝ Sisters
Saving Sisters
⃝ Street
Smart
⃝ Teen
Health Project
⃝ Teen
Outreach Program
⃝ What
Could You Do?
⃝ WILLOW
⃝ Other
curriculum
Provide name or
description of other
curricula:_______________________________________________
|
ESHE Process Measure 1:
Funded SEA has
assessed its sexual health education and/or HIV education
policies
|
In the past six months, did you complete each of the following
actions regarding the assessment of state-level sexual health
and/or HIV education policies (including laws, codes, or
regulations)? (Mark yes or no for each item.)
Identified
policies that guide sexual health and/or HIV education work.
|
Yes ⃝ No
⃝
|
Documented
any gaps in sexual health and/or HIV education policies as
compared with the ESHE Performance Measures.
|
Yes ⃝ No
⃝
|
Collaborated
with SEA leadership and staff to prioritize actions for
addressing any identified gaps in sexual health and/or HIV
education policies.
|
Yes ⃝ No
⃝
|
|
|
|
|
|
ESHE Process Measure 2:
% of priority
districts that have assessed their sexual health and/or HIV
education policies
|
In the past six months, did [PRIORITY DISTRICT NAME]
complete each of the following actions regarding sexual
health and/or HIV education policies (including laws, codes, or
regulations)? (Mark yes or no for each item.)
Identified
policies that guide sexual health and/or HIV education work.
|
Yes ⃝ No
⃝
|
Determined
whether sexual health and/or HIV
education policies are aligned with state policies,
codes, laws, and regulations.
|
Yes ⃝ No
⃝
|
Documented
gaps in sexual health and/or HIV education policies as
compared with the ESHE Performance Measures.
|
Yes ⃝ No
⃝
|
Collaborated
with district leadership and staff to prioritize actions for
addressing identified gaps in sexual health and/or HIV
education policies.
|
Yes ⃝ No
⃝
|
|
ESHE Process Measure 3: Funded SEA has monitored
the implementation of sexual health and/or HIV education policies
|
In the past six months, did you complete each of the following
actions regarding the monitoring of priority district
implementation of state-level sexual health and/or HIV education
policies (including laws, codes, or regulations)? (Mark yes
or no for each item.)
Developed
or maintained a list of priority districts’ current
sexual health and/or HIV education policies.
|
Yes ⃝ No
⃝
|
Reviewed
priority districts’ sexual health and/or HIV education
policy guidance to ensure alignment with state law, state
education agency policy, and district policy.
|
Yes ⃝ No
⃝
|
Tracked
priority districts’ implementation of sexual health
and/or HIV education policies
|
Yes ⃝ No
⃝
|
|
ESHE Process Measure 4:
% of priority
districts that monitored school implementation of sexual health
and/or HIV education policies
|
In the past six months, did [PRIORITY DISTRICT NAME]
complete each of the following actions regarding the
monitoring of schools’ implementation of sexual health
and/or HIV education policies (including laws, codes, or
regulations)? (Mark yes or no for each item.)
Maintained
or developed a list of schools’ current sexual health
and/or HIV education policy guidance.
|
Yes ⃝ No
⃝
|
Reviewed
school-level sexual health and/or HIV education policy
guidance to ensure alignment with state law, state education
agency policy, and district policy.
|
Yes ⃝ No
⃝
|
Tracked
school-level implementation of sexual health and/or HIV
education policy guidance.
|
Yes ⃝ No
⃝
|
Prepared
informational materials about sexual health and/or HIV
education policies or policy options for stakeholders.
Maintained
a tracking system of schools that have used CDC’s
School Health Index to evaluate sexual health and/or HIV
education policy implementation.
|
Yes ⃝ No ⃝
Yes ⃝ No ⃝
|
|
ESHE Process Measure 5:
% of priority
districts that received assistance on ESHE
|
In
the past six months, how often did you interact with [PRIORITY
DISTRICT NAME] to provide assistance (e.g., professional
development events, technical assistance, guidance or resource
materials, and referrals to other agencies or organizations) on
ESHE?
______ Never
_____ 1 time
_____ 2 times
_____ 3 - 5
times
_____ 6 - 10
times
_____ 11 - 15
times
_____ 16 - 20
times
_____ 21 or
more times
On
what ESHE topics did you provide assistance to [PRIORITY
DISTRICT NAME]? (check all that apply)
Assess
curricula with the Health
Education Curriculum Analysis Tool (HECAT)
Select
an appropriate curriculum
(including evidence-based interventions, if appropriate)
Implement
a specific
curriculum with
appropriate fidelity (including evidence-based interventions, if
appropriate)
Make
appropriate adaptations
to curricula (including evidence-based interventions, if
appropriate)
Implement
a viable scope-and-sequence
for sexual health education
Assess
sexual health and/or HIV
education policies
Monitor
the implementation of sexual health and/or HIV education
policies
Manage
controversy around sexual
health education
Build
instructional competencies
and techniques for sexual health education
Assess
school policies with School
Health Index
Establish
and maintain a state- or district-level school health
advisory council (SHAC)
|
ESHE Process Measure 6:
Frequency with
which funded SEA received assistance from NGO on ESHE
|
In the past six months, how often did you interact with
Advocates for Youth to receive assistance (e.g., professional
development events, technical assistance, guidance or resource
materials, and referrals to other agencies or organizations) on
ESHE?
_____ Never
_____ 1 time
_____ 2 times
_____ 3 - 5
times
_____ 6 - 10
times
_____ 11 - 15
times
_____ 16 - 20
times
_____ 21 or
more times
|