Relationships and Sex Education: exploring the process of quality assuring content, delivery and training

Transcription

1 Relationships and Sex Education: exploring the process of quality assuring content, delivery and training Report September 2011 Developed by Brook Bristol On behalf of the RSE Hub South West Steering Group, supported by the South West Office for Sexual Health and NHS South of England. Written by Nicole da Costa, BSc, BScN Brook Bristol Sexual Health Outreach Worker Strengthening Relationships and Sex Education

2 Contents Foreword... 5 Executive summary... 6 Background and introduction... 7 What is Sex and Relationships Education?... 7 Why is RSE important? Does it work?... 8 Brief overview of RSE delivery in the UK... 8 Context... 8 Quantity and quality... 9 Aim of the report Methods Limits Guidance from recognised international bodies UNESCO WHO Europe and Federal Centre for Health International Planned Parenthood Federation (IPPF) Statutory and voluntary RSE guidance in the UK... 1 Statutory and voluntary RSE guidance in the UK National Curriculum and educational legislation Department for Education Ofsted Department for Health NICE guidelines School RSE policy Sex Education Forum (SEF) Education for Choice Viability of quality assurance and quality standards Perspective of organisations Perspective of schools Perspective of independent consultants Quality assurance around the world: a snapshot The Netherlands Long Live Love Canada Options for Sexual Health, British Columbia Australia SHine SA (Sexual health information, networking, and education South Australia) Quality assurance in the UK: a snapshot Training of RSE facilitators PSHE CPD programme Sheffield Centre for HIV & Sexual Health FPA Brook The Christopher Winter Project Setting standards Sex and Relationships Education 2 Sept 2011

3 Healthy schools kite-marking Kent Sex and Relationships Education Quality Mark Brook Agencies Supporting Southwark Programme (ASSP) PQASSO Quality Mark ASDAN Summary Defining quality Perspective of key stakeholders Approaches to quality assurance Recommendations References Bibliography Sex and Relationships Education 3 Sept 2011

4 Foreword Nicole Da Costa from Brook Bristol was commissioned to research this piece of work by the RSE Hub South West Steering group. Having read the report and heard Nicole present the rationale and content of the research I was impressed by the breadth and depth of the work and its tangible uses. The research was undertaken due to concerns about the quality and consistency of RSE. This was considered both in terms of content: what is being taught and delivery: how (and by whom) it is being taught. The need for quality assurance has been voiced across the South West by members of the steering group, by Ofsted (Time for change? Personal, social and health education, April 2007) and Young People (SRE: Are you getting it? A report by the UK Youth Parliament, June 2007) PSHE, including RSE unfortunately remains non- statutory, it is still, however a subject that needs to be accountable, measured and considered at the same level as all subjects. In the Department for Educations The Importance of Teaching - The Schools White Paper 2010 the Department has acknowledged that Children need high-quality sex and relationships education so they can make wise and informed choices and recognises that Children can benefit enormously from high-quality Personal Social Health and Economic (PSHE) education (DFE reference 4.29 & 4.30 page 45) please do as a footer PSHE (including RSE) is expected to meet the same high standards required by Ofsted of all subjects and teaching. Teachers must have consistently high expectations of all pupils, draw on excellent knowledge, plan astutely, set challenging tasks based upon accurate assessment of pupils prior skills, knowledge and understanding and use well judged teaching strategies (PSHE education and the new Ofsted Inspection Framework January 2012, PSHE Association briefing) The comprehensive and robust research pulls together regional, national and international approaches and has some thought provoking options for assuring quality RSE. We hope the outcomes will prove interesting and provide some evidence based methodology and ideology to inform practice locally and regionally, enabling the development of tools, to ensure children and young people receive high quality, coherent RSE, taught by well trained teachers and practitioners. Zoe Baxter, SRE Advisor, and RSE Hub South West steering group member for Cornwall and Isles of Scilly. Sex and Relationships Education 4 Sept 2011

5 Executive summary Introduction Despite a growing body of evidence demonstrating that the delivery of comprehensive, high quality relationships and sex education (RSE) has a positive impact on the sexual health and well-being of young people (Kirby 2007), RSE delivery in the UK is often fragmented, described as poor or very poor by young people, and inconsistent. This report aims to explore the process of quality assuring RSE, both internationally and in the UK, and to identify approaches that might be appropriate for use in the South West, and potentially nationally. What is quality RSE? This report found that international bodies echo local guidance on what constitutes quality RSE and competent RSE educators. Quality RSE can be identified as: comprehensive and representative of the needs of young people; free from judgment, prejudice, agenda and based on human rights; positive and holistic; established through partnerships; focused on knowledge, attitudes, values, beliefs and skills with the aim of empowering young people; based on effective learning principles (engaging, interactive, and participatory learning in a graduated and regularly taught programme) and evaluated frequently. Competent RSE educators can be identified as: motivated and interested in the delivery of RSE within an agreed values framework; comfortable discussing sexuality; skilled in managing sex and relationships discussions and possessing a strong subject knowledge; having received comprehensive training that explored personal values and was taught by experienced trainers; having access to ongoing support and supervision. Sex and Relationships Education 5 Sept 2011

6 Perspectives of key stakeholders on quality assurance of RSE This report found that key stakeholders: support a quality assurance process that focuses on young people, includes partnerships, acknowledges levels of expertise, clearly identifies quality RSE, includes ongoing assessment of competency and is recognised nationally; identify time, funding, and capacity as barriers to implementation. Recommendations A range of approaches exist internationally and locally that aim to set standards for RSE delivery. Ideally, a quality assurance process would exist nationally. However, several international and local approaches are worth considering in the context of the South West and the achievement of quality RSE. This report recommends three progressive actions to assure quality RSE in the South West, and potentially nationally: Identifying quality: checklists, informed by international and local guidance, can provide a clear definition of quality RSE and a matrix for developing practice and endorsing specific award systems, such as ASDAN, and educator training programmes such as those delivered by the FPA and Sheffield Centre for HIV and Sexual Health. Recognising quality: quality assurance checklists can provide the basis for quality or kite-marks such as the Richmond kite-mark or the Kent quality mark. Building capacity: educator confidence and competence could be improved by reinvesting in programmes locally, such as the CPD in PSHE, and expanding them to include a means of renewal or recertification, similar to the SHEC programme in Canada. A quality mark, similar to the SHine South Australia Focus Schools Programme, could enhance uptake by schools by pairing participation with teacher training. The Christopher Winter Project and Brook Bristol s teacher training pilot are examples of RSE delivery being paired with educator development in the UK. Sex and Relationships Education 6 Sept 2011

7 Background and introduction What is Relationships and Sex Education? In the UK, RSE is described by the Sex Education Forum (SEF 2005 p.1) as learning about sex, sexuality, emotions, relationships, sexual health and ourselves. Elsewhere in the world, terms such as sexual health education or sexuality education are used in a similar context. For example: Sexuality education is defined by UNESCO (2009a) as being an ageappropriate, culturally sensitive and comprehensive approach to sexuality education that includes programmes providing scientifically accurate, realistic, non-judgemental information. Comprehensive sexuality education provides opportunities to explore one s own values and attitudes and to build decision-making, communication and risk reduction skills about all aspects of sexuality. Comprehensive sexuality education promotes critical thinking, self-actualisation, and behavioural change through gaining knowledge about the body; healthy sexuality; relationships; sex abuse, pregnancy, HIV and sexually transmitted infection prevention; and many other topics regarding human sexuality, and sexual and reproductive health and rights. A comprehensive sexuality programme will respect the diversity of values and beliefs represented in the community and will complement and augment the sexuality education children receive from their families, religious and community groups, and health care professionals. Sexual health is defined by the WHO (2011) as being a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For the purpose of this report both the terms Relationships and Sex Education or RSE and Sex and Relationships Education or SRE will be used synonymously. This reflects the move to RSE in many local areas to promote the relationships aspect whilst recognising national and international guidance, and academic reference to SRE. The general aim of RSE is to equip young children and young people with the information, skills and values they need to have safe, fulfilling and enjoyable relationships and to take responsibility for their sexual health and well-being (SEF 2005 p.1) and possess the knowledge, skills and values to make responsible choices about their sexual and social relationships (UNESCO 2009b p.2). Sex and Relationships Education 7 Sept 2011

8 Why is RSE important? Does it work? RSE is a priority for the following reasons: sexuality is part of being human; people have a right to be informed; informal sexuality education is inadequate for modern society; young people are exposed to many new sources of information; there is a need for sexual health promotion (WHO Europe and BZgA 2010). Not only does RSE provide young people with the opportunity to acquire information, explore attitudes, values and practise the skills needed to make informed decisions, it is also a critical part of preventative measures, such as stopping the spread of HIV (UNESCO 2009b). A growing quantity of good quality evidence demonstrates that the delivery of comprehensive RSE brings forth positive behaviour change (Kirby 2007). The Sex Education Forum (2010a) reports the following: national and international research shows that young people who have had good RSE are more likely to have sex for the first time later and there is no evidence indicating that RSE hastens the first experience of sex or increases the frequency of sex; research shows that young people who have taken part in a good quality RSE programme are more likely to use condoms and contraception if they do have sex; research carried out in England has found that areas of the country which have achieved the greatest reductions in teenage conception rates in recent years have provided both good quality school RSE as well as accessible sexual health services for young people. Brief overview of RSE delivery in the UK Context The UK has one of the highest rates of teenage pregnancy in Western Europe (cited in SEF n.d.), although this rate is decreasing (Office for National Statistics 2011). Despite the knowledge that strong delivery of RSE is key to reducing conceptions and STI transmission (SEF 2010b) and the general agreement between education professionals and parents that young people need to be informed about safer sex (NCTA et al 2010), clauses that made RSE statutory were removed from the Children, Schools, and Families Bill prior to its Royal Assent in April Therefore, RSE in England continues to be guided by: Sex and Relationships Education 8 Sept 2011

9 the National Curriculum which includes some statutory SRE content within science teaching; the Department of Education s Sex and Relationship Education Guidance (2000) which considers the delivery of SRE within nonstatutory Personal, Social, Health and Economic education. Additionally, schools have a legal obligation to ensure the well-being of their pupils and RSE can contribute to this duty (SEF 2011a). RSE in England is mainly delivered by school teachers who may or may not receive support from Personal Social Health and Economic education (PSHE) co-ordinators, school nurses, outside visitors or not-for-profit groups (IPPF European Network 2006). Yet 80% of school leaders do not feel that they have been trained to talk confidently about RSE (NCTA et al 2010) and only 3% of teachers report that RSE is covered adequately in Initial Teacher Training (ITT) (SEF 2008a). Teachers report that insufficient time, confusion over what should be taught, too few teachers willing to teach the subject, and individual school RSE policies are barriers to RSE delivery in the UK (SEF 2008a). Quantity and quality There is significant variation in the quality and quantity of RSE provision across England (IPPF European Network 2006). The Office for Standards in Education (Ofsted) and numerous youth surveys give accounts of this variation and reveal significant gaps in learning. Ofsted (2010), who assess the effectiveness of school policy and programmes, reviewed SRE delivery between 2006 and 2009 and found that: in just under a third of schools, SRE was fragmented and lacked specialist teaching, resulting in weak skill development and superficial knowledge and understanding; out of 73 schools assessed, SRE delivery was no better than satisfactory in 25 and inadequate in three; the standard of teaching by form tutors was inconsistent a number of schools were delivering SRE through drop-down days (rather than through a timetabled programme) which does not allow for progression in learning. Youth surveys conducted in the UK provide a similar picture of school-based RSE: 40% of young people between the ages of 11 and 18 rated their RSE as poor or very poor, whilst a further 33% thought it was average (UK Youth Parliament 2007); more than half of the young people had not been informed of where their local sexual health service was (UK Youth Parliament 2007); Sex and Relationships Education 9 Sept 2011

10 57% of year old females had not been taught how to use a condom (UK Youth Parliament 2007); 43% of young people reported that they had received no teaching on personal relationships (UK Youth Parliament 2007). a quarter of young people had learnt nothing about HIV and AIDS (SEF 2011b); of the RSE that is received, young people said that the information they receive is too little too late and too biological (SEF 2008b). Aim of the report RSE becoming a statutory part of the curriculum is a significant step towards achieving effective delivery; however, this does not automatically lead to good quality education (WHO Europe and BZgA 2010). Good quality RSE is dependent on a range of factors including bottom-up support, such as teacher training (WHO Europe and BZgA 2010), as well as top-down leadership, such as a cultural, moral and political context that supports its delivery (Schaalma et al 2004). Therefore, mandated or not, there is significant value in considering the implementation of methods and frameworks to ensure the highest quality RSE is being delivered to young people. Questions around setting standards for the delivery of RSE may include: what is covered, at what age and how is the content delivered? who delivers it, how are they trained, and what qualifications do they have? By exploring the process of quality assuring RSE content, delivery and training this report aims to answer the following questions: Methods what guidance and approaches exist internationally and in the UK that provide a framework for the quality assurance of RSE? what recommendations can be made on the viability of quality assuring the content, delivery and training of RSE? which of these measures and approaches might be appropriate for use in the South West, and potentially nationally? The following was conducted in the preparation of this report: a literature search was completed using the Ebsco database, CINHAL database and worldwide web. Published articles and a variety of government documents were reviewed; Sex and Relationships Education 10 Sept 2011

11 Limits international frameworks and methods were included after a review of information available on the worldwide web, with a focus on International Planned Parenthood Federation (IPPF) affiliates of selected countries; key stakeholders in England delivering RSE education, to both young people and professionals, were interviewed to gather information on the programmes and training they deliver; key stakeholders in England were interviewed to gather information on their perspective on the viability of a quality assurance process. The time allotted for this report was 18 days, which included: completing a search of the literature; reviewing pertinent journals and government documents; arranging and completing interviews; reviewing, compiling and editing gathered information; attending meetings with the commissioner and the South West Relationships and Sex Education Steering Committee. Due to the time frame, the information contained in this report provides preliminary answers to the questions posed and further work is required to investigate the issue of quality assurance in greater depth. In particular, additional time would be required to establish a more complete picture of the methods and frameworks used internationally as it is expected that, as in the UK, many innovative initiatives take place on a local level and may not have been identified in broader, nationwide searches. Guidance from recognised international bodies UNESCO, WHO Europe and the IPPF have been profiled for their contributions to the promotion of high quality RSE. As it relates to quality assurance, each organisation profile includes: UNESCO a list of significant resources produced; a position on values; recommendations on educator 1 training and characteristics. The United Nations Educational, Scientific and Cultural Organisation (UNESCO) is a specialised United Nations agency whose focus includes the attainment of quality education for all (UNESCO 2011). 1 Includes the various professional groups involved in the delivery of sex and relationships education (teachers, nurses, youth workers, and others) Sex and Relationships Education 11 Sept 2011

12 Educator training UNESCO (2009b) states that RSE educators should have an interest in teaching the curriculum, personal comfort discussing sexuality, an ability to communicate with students, and be skilled in the use of participatory learning methodologies. The training teachers receive should: have clear goals and objectives; teach and provide practise in participatory learning methods; provide a good balance between learning content and skills; be based on the curriculum that is to be implemented and provide opportunities to rehearse key lessons in the curriculum; help educators distinguish between their personal values and the health needs of learners; encourage educators to teach the curriculum in full, not selectively; address challenges that will occur in some communities; last long enough to cover the most important knowledge, content and skills and to allow participants time to personalise the training and raise questions and issues; be taught by experienced and knowledgeable trainers solicit participant feedback. Resources In relation to quality assurance of RSE, UNESCO provides: Values a summary of 18 characteristics of effective sexuality education programmes (see Appendix 1) (UNESCO 2009b); five recommendations based on identified good practice (see Appendix 2) (UNSESCO 2009b); a basic minimum package of topics and learning objectives for a sexuality education programme for children and young people aged five to 18+ years of age (see overview Appendix 3) (UNESCO 2009c). Although it is not possible to remove values from the discussion of sexuality, UNESCO (2009b) supports a rights-based approach to sexuality education that links values such as respect, acceptance, tolerance, equality, empathy and reciprocity to universally accepted human rights. Sex and Relationships Education 12 Sept 2011

13 WHO Europe and Federal Centre for Health Launched by the WHO Regional Office for Europe in 2008 and developed by the Federal Centre for Health Education (BZgA), the Standards for Sexuality Education in Europe provide standards for RSE that can be used to develop or upgrade curriculums. Unlike the UNESCO guidelines, this document is regionally specific to Europe. Resources In relation to quality assurance, WHO Europe and BZgA (2008) provide: Values a set of principles and outcomes of RSE (Appendix 4); seven characteristics of RSE (Appendix 5); a matrix of topics to included in SRE by age group that calls for RSE to start at birth. WHO Europe and BZgA (2008) endorse holistic SRE ; defined by the following: gives children and young people unbiased, scientifically correct information on all aspects of sexuality; helps them develop the skills to act on the acquired information; contributes to the development of respectful, open-minded attitudes and helps build equitable societies; supports young people in becoming more empowered in order to live out their sexuality and their partnerships in an enjoyable, fulfilling and responsible manner; views sexuality as a positive human potential and a source of satisfaction and pleasure; based on internationally accepted human rights, in particular the right to know, which precedes prevention of ill health. Educator training WHO Europe and BZgA list the following criteria for competent educators: training in RSE; openness to the subject and a high motivation for teaching it; firm belief in the principles of RSE; support and access to supervision; consistent use of neutral language; founding of RSE on human rights and the acceptance of diversity. Sex and Relationships Education 13 Sept 2011

14 International Planned Parenthood Federation (IPPF) The IPPF is one of the largest non-governmental organisations working in the field of sexual health (Parker et al 2009). Resources In relation to quality assurance, the IPPF (2010) provides: Values a set of seven essential components of comprehensive RSE (Appendix 6); a set of principles of good practice in relation to planning, delivery, assessment and evaluation (Appendix 7). The IPPF approach to RSE links safer sex with positive development, empowerment and choice, including sexual expression and fulfilment, representing a shift away from the traditional approach that focuses exclusively on the reproductive aspects of adolescent sexuality and that associates sex with risk-taking and the prevention of pregnancy and infections (Parker et al 2009 p.227). They endorse a rights-based approach to RSE and strongly discourage education focusing solely on abstinence as young people s right to informed decision making is embodied by comprehensive education (IPPF 2010). Educator training The IPPF believes that, ideally, all professionals that support RSE delivery should (2010): have appropriate information, training, tools, skills and qualities; have an understanding of young people and their agenda; have the intention of enlightening, transforming and preparing others; be someone who young people trust and feel comfortable with and who creates an enabling environment; be someone who imparts knowledge and facilitates the development of skills; be accessible and non-judgmental, with no personal agenda that they want to impose; have access to ongoing support, supervision, materials and resources. Sex and Relationships Education 14 Sept 2011

15 Statutory and voluntary RSE guidance in the UK In the UK, the delivery of RSE is directed by both statutory and voluntary sector guidance. Governmental bodies and other organisations that produce such guidance and are thus significant to a quality assurance process are profiled below. National Curriculum and educational legislation Current legislation relating to SRE requires that: all maintained schools teach the statutory parts of the National Curriculum science, which includes the biological aspects of puberty, human reproduction and the spread of viruses, with a separate requirement for secondary schools to teach about HIV and AIDS (SEF 2011a); academies have varying academic requirements and do not have to follow the National Curriculum (SEF 2011a); additional SRE is contained within the non-statutory PSHE curriculum the Department of Education s SRE Guidance (2000) strongly recommends the delivery of SRE and it is expected by law that school governors, of both maintained schools and academies, give due regard to such government guidance (SEF 2011a); the Education Act Section 405 (1996) gives parents the right to excuse their children from receiving SRE at school, with the exception of the education comprised in the National Curriculum. In January 2011, The Department for Education (DfE) launched a review of the primary and secondary National Curriculum. Although components of SRE are included in the National Curriculum science, SRE is not included in the remit of the review. Instead, a separate internal review into PSHE was launched in July At present, both reviews are ongoing and the current curriculum is to be followed until a new curriculum is in place. Department for Education In 2000, the DfE published Sex and Relationships Education Guidance. This document directs SRE by identifying the legal responsibilities of schools (including the development of SRE policy) and providing guidance on the delivery of SRE within PSHE. Sex and Relationships Education 15 Sept 2011

16 The DfE (2000) states the following: meeting the objectives of SRE requires a graduated, age- appropriate programme; teachers, and those contributing to SRE, are expected to work within an agreed values framework described in the school s policy, which must be in line with current legislation. Ofsted Ofsted reviewed SRE delivery in maintained English schools between 2006 and 2009, and published a report on the status of PSHE in July The findings are significant as they demonstrate factors that have contributed to high quality SRE specific to the UK. In relation to quality assurance of SRE, Ofsted (2010) reports: discrete, regularly taught PSHE lessons, supplemented with crosscurricular activities, is the most effective curriculum model; the best schools matched the content of their PSHE curriculum closely with the assessed needs and levels of maturity of their students; the use of methods such as open-ended questions, drama techniques, games and debate were seen in good PSHE; good PSHE was seen when feedback was used to revise content and approach before the material was used with the next group; the most effective schools took advantage of opportunities to formally accredit PSHE work (e.g. Trident Gold Award, GCSE-equivalent courses); in good and outstanding teaching, discussion and debate about sensitive and controversial issues was skilfully managed and teacher s approach to students responses was non-judgmental; in good and outstanding teaching, teachers subject knowledge was good, often because they were part of a specialist team and had access to training such as the national PSHE CPD programme. Although the quality of teaching from form tutors was inconsistent, tutors who were given effective training and support often taught PSHE effectively; use of external presenters was most effective when they were wellbriefed, students were actively engaged and teachers kept responsibility for the educational goals. Sex and Relationships Education 16 Sept 2011

17 To achieve high quality PSHE across all schools Ofsted (2010) recommends: the DfE, with its delivery partners, should: o develop routes for initial teacher training education in PSHE education; o promote the take-up of continuing professional development in PSHE education; o support the development of good practice in assessing PSHE education. local authorities should provide access to high-quality continuing professional development and facilitate networking between teachers delivering PSHE; schools should ensure that teaching meets pupil needs, is engaging, and that systems are in place for assessing delivery. Department for Health In 2005, the Department for Health published recommended standards for the sexual health training of professionals and volunteers in clinical and non-clinical settings. They provide: best practice standards; recommended values and principles that underpin good quality sexual health training; standards for the preparation and delivery of sexual health training. (See Appendix 8). NICE guidelines The National Institute for Health and Clinical Excellence (NICE) guidance for PSHE, focusing on SRE and alcohol education, was drafted and put out for consultation. The draft guidance is available but currently there is no proposal to respond to the consultation or formally publish this guidance. For further information please visit: School RSE policy It is mandatory that all schools have an up-to-date RSE policy (DfE 2000) that: defines RSE; describe how RSE is provided and who is responsible for providing it (including materials used and clear parameters on what will be taught); indicates how RSE is monitored and evaluated; includes information about parent s right to withdraw. Sex and Relationships Education 17 Sept 2011

18 Sex Education Forum (SEF) The SEF is a collaboration of diverse member organisations and practitioner networks and the leader in the UK for the achievement of quality SRE. In relation to quality assurance of SRE, the SEF has published several excellent resources including: a set of principles and values that should underpin quality SRE (SEF 2011c) (Appendix 9); a set of principles of good practice (SEF 2005) (Appendix 10); a set of key elements of curriculum content (SEF 2005) (Appendix 11); a set of guidelines on what to include in an SRE curriculum by age (SEF 2011d) (Appendix 12); a checklist for the use of resources (SEF 2011d) (Appendix 13); guidance in the use of external visitors (SEF 2010c). Education for Choice Education for Choice is a member of the SEF and the only UK charity that specifically focuses on supporting young people in making informed choices about pregnancy and abortion (Education for Choice 2005). In relation to quality assurance, Education for Choice (2005) has produced several significant publications including: eight aims and principles of best practice in abortion education which includes a checklist for assessing outside speakers (Appendix 14); a checklist for those delivering abortion education that considers resources and lesson planning (Appendix 15). Viability of quality assurance and quality standards In exploring the process of quality assuring RSE, is it imperative to elicit the perspectives of potential key stakeholders. As part of this report, several organisations, school leaders and independent RSE educators were consulted. Their perspectives of the benefits and challenges of a quality assurance process are highlighted. Sex and Relationships Education 18 Sept 2011

19 Although the process should not be too complicated, interview data indicated that ideally the following components would be included: Methods a mechanism for ongoing evaluation of practice and maintained competencies (which involves young people); a level of flexibility in RSE delivery that ensures the needs of young people are always given highest priority (both in delivery and content); a clear understanding of the outcomes expected with an acknowledgement that evaluating youth work is very difficult; a framework outlining how those delivering RSE can work together in a complementary way based on level of skills, training and expertise (for example on in a levels-based approach, where basic training can be identified as appropriate for some situations while higher level of competencies are required for more challenging work); a framework which would be transportable and recognised across the UK. Four representatives from national and local organisations involved in RSE delivery, two school staff and three independent consultants participated in individual phone interviews which were structured around a set of interview questions. As this report does not include a structured analysis of the collected data, a brief summary of what appear to be common themes and key points is provided below. Perspective of organisations Organisations currently involved in the delivery of RSE appear to be supportive of a quality assurance process for RSE. Those interviewed stressed the importance of partnerships and identified key components of the process. However, they reported the absence of funding and capacity as significant barriers. Across all four interviews, partnerships were identified as a key component to any quality assurance process. This included partnerships with organisations and agencies delivering RSE, schools, parents and, most importantly, young people. Partnerships with regional and national organisations in developing the process would ensure that organisational needs are met and are reflected in the standards. Involving young people would keep the process aligned with the needs of those receiving RSE. Parental support was seen as key to the success of the process. Sex and Relationships Education 19 Sept 2011

20 Ideally, the quality assurance process would: assess for consistent emphasis on both relationships and sex; look beyond RSE delivery and include an assessment of the wider PSHE curriculum and ethos of the school; involve young people in the process (for example eliciting their feedback); remain focused on the needs of young people; include a mechanism for ongoing evaluation of practice (for example ongoing observation of session delivery by either an RSE specialist or by a peer using a set of guidelines); consist of various levels to identify differing levels of training and expertise; be a supportive process that focuses on strengths and building capacity. All four representatives interviewed agreed that funding and capacity are significant factors in the viability of a quality assurance process. Having an education lead or coordinator was seen as important to viability though it was felt that this capacity does not currently exist at the local level. Additionally, the involvement of young people as well as a means of ensuring ongoing competencies would also require significant ongoing investment. Perspective of Schools School staff appear to consider quality assurance as important to RSE. From the perspective of a head teacher, such a method would provide schools who want to deliver high quality RSE with a means to evaluate and develop their practice. From the perspective of a PSHE Coordinator, it would facilitate the evaluation of work being done, provide a means to demonstrate quality and be a tool with which to petition for continued RSE delivery. Both interviewees agreed that RSE must be acknowledged as a priority by key stakeholders to move forward. For example, senior school management must support teacher training and development and parents must be supportive of progressive, age-appropriate RSE. From the perspective of the head teacher, school reputation and student well-being are considered when parents choose the schools their children attend. A quality assurance process could demonstrate school commitment to well-being to the community while also improving RSE. The PSHE Coordinator noted that this commitment to student well-being has, in fact, been behind her school s continued support of RSE, and her school administrators acknowledge that the skills young people develop through RSE contribute to student well-being. Sex and Relationships Education 20 Sept 2011

21 Perspective of independent consultants Ideally, the quality assurance process would: be recognised nationally; take previous work and experience into consideration when assessing educator competencies; provide an agreed set of guidelines and definitions that inform RSE delivery; include a multi-level system to identify the range of knowledge and expertise among those delivering RSE education and training; require RSE educators to demonstrate assessment and reflection of personal values relating to RSE and to commit to an agreed values framework for RSE delivery; include a framework for quality assuring resources in RSE delivery. Independent consultants appear to be very supportive of quality assuring RSE and would welcome a means of setting standards for its delivery. Those interviewed identified personal benefits to quality assurance (for example, recognition of the quality of RSE delivered would make them more competitive with commissioners) as well as the benefit to young people who would receive better RSE. It would also provide a means of regulating terms such as trained RSE educator and specialist RSE teacher, address the current gap in required qualifications and give a clear framework of what constitutes high quality RSE. Those interviewed consistently identified time and funds as potential barriers to participation in a quality assurance process. The process would be best received if it was thorough but not complex. Most importantly, those commissioning or purchasing services would need to see value in the process in order to justify consultant participation. Sex and Relationships Education 21 Sept 2011

22 Quality assurance around the world: a snapshot The Netherlands, Canada and Australia have been profiled to provide an international snapshot of quality assurance of RSE. These countries have been included for their individual contribution to quality assurance. A national curriculum is highlighted in the Netherlands, a set of national guidelines and a certification programme for RSE educators is highlighted in Canada, and a kitemarking scheme for RSE is highlighted in Australia. The Netherlands The Netherlands provides an important reference with regard to adolescent sexual health and related educational provisions (Ferguson et al 2008). Despite there being very little difference in the reported sexual experience (vaginal intercourse, oral sex and anal sex) of young people in the Netherlands compared to those in the United States, for example, the Netherlands continue to report low rates of teenage pregnancy and high rates of contraceptive use (Ferguson et al 2008). Comprehensive RSE has been identified as a key contributing component to such positive health outcomes (Ferguson et al 2008). Nonetheless, it is valuable to consider RSE in the Netherlands within its wider context. The national curriculum in the Netherlands provides schools with information on the subjects they are to teach and an indication of what students must learn. The information, however, is general and vague, with schools free to decide how each target is met and how much time should be spent on the various subjects (NFER and INCA 2009). Within the national curriculum, it is only mandatory for Dutch schools to cover the biological aspects of RSE (IPPF European Network 2006). Parents and schools themselves decide if further RSE is needed and how the school participates in its delivery (NFER and INCA 2009). Despite this, 97% of secondary schools and half of primary schools include sexuality information in their curriculum (Weaver et al 2005). Key messages include responsibility and individual decision-making (Ferguson et al 2008). There is also an understanding that RSE includes not only transmission of knowledge but also of communication skills and attitudes (IPPF European Network 2006 p.65). National guidelines around RSE may be vague, but socio-cultural factors set the stage for positive sexual health outcomes. For example, principles of nondiscrimination and tolerance of different beliefs are enshrined in Dutch constitution and society (NFER and INCA 2009). Additionally, the Netherlands has, for many decades, had a pragmatic approach to all aspects of sexuality, including a generally liberal attitude towards young people s sexuality (NFER and INCA 2009; Weaver et al 2005). All of the above is reflected in the positive approach taken towards RSE, which often includes topics such as sexual orientation and masturbation (Ferguson et al 2008). Sex and Relationships Education 22 Sept 2011

23 The media further reflects this prevailing attitude and actively contributes to these matters by disseminating information in relation to sexual health (NFER and INCA 2009). Overall, this socio-cultural context has a strong influence on the types and content of health promotion activities (Ferguson et al 2008 p.104). The delivery of RSE in the Netherlands is well supported. Firstly, unlike the UK and the other countries featured in this report, teachers in the Netherlands are trained in the delivery of RSE during their initial teacher training (Weaver et al 2005). Secondly, RSE is enhanced by the Rutgers Nisso Groep (the Dutch Expert Centre on Sexuality and the International Planned Parenthood member in the Netherlands), which provides a range of clinical and educational services (IPPF European Network 2006; Rutgers Nisso Groep 2011). Thirdly, the Netherlands has maintained a level of financial commitment to a national RSE programme called Long Live Love which is accessed by teachers and strongly supported by the Department of Health. Long Live Love Long Live Love is a national government-funded programme developed in the early 1990s through extensive collaboration with key stakeholders (Ferguson et al 2008). Although it has undergone significant evaluation and revision since its inception, the theoretical foundation is largely unchanged (Wiefferink et al 2005). The programme is aimed at students aged years old with safe sex as the central theme; the goal is to increase young people s ability to engage in safe, mutual and pleasurable sexual experiences by developing communication and negotiation skills (Ferguson et al 2008). The programme consists of 30 learning activities divided over six lessons, with nineteen activities indicated as core curriculum and the others providing teachers with alternatives that may better meet student needs (Wiefferink et al 2005). Teachers are provided with a manual, student magazine and film and are trained to deliver the programme by Department of Health educators, who also encourage and support schools to deliver it (Ferguson et al 2008). Canada From 1996 to 2006, teenage pregnancy 2 rates declined by 36.9% in Canada and by only 4.75% in England and Wales (McKay and Barrett 2010). In comparison to Sweden, England and Wales and the USA (countries similar to Canada with respect to economic development and political structure), Canada had the lowest teenage pregnancy rates in 2006 (McKay and Barrett 2010). McKay and Barrett (2010) suggest that this decline likely reflects increasing levels of effective contraceptive use, greater access to reproductive health services, exposure to higher quality sexual health education, and/or shifting of social norms in a direction that provides greater support for young women s capacity to exercise reproductive choice (p.43). 2 Teenage pregnancy is defined here as teenage births and abortions Sex and Relationships Education 23 Sept 2011

24 Although RSE may be contributing to the decline of teenage pregnancy rates, it is important to note that there is no nationally mandated RSE curriculum in Canada. Instead, the Constitution Act gives each Canadian province the authority to regulate education (NFER and INCA 2009). As such, variation exists across the country, evidenced by comparing provincial curricula (British Columbia Ministry of Education 2005, 2006; Ontario Ministry of Education 1999, 2010). However, national guidelines for RSE delivery do exist. In 2008, the Public Health Agency of Canada published the 3 rd edition of the Canadian Guidelines for Sexual Health Education, a document which provides a framework to develop and evaluate RSE. The guidelines include the following: key definitions, including the working definition of sexual health presented by the World Health Organisation; a set of elements of effective RSE; a set of guiding principles; a set of easy to use checklists (see Appendix 16); endorsement of the Information, Motivation and Behavioural Skill Model with detailed guidance on how to integrate the model into assessment, planning, delivery and evaluation (see Appendix 17). The Sex Information and Education Council of Canada (SIECCAN) is a registered charitable organisation which supports the delivery of high quality RSE through research, guidance, and up-to-date online resources (SIECCAN 2010a). For example, in 2010 SIECCAN published Sexual health education in schools: Questions & Answers, 3 rd Edition (2010b), a publication which specifically aims to support RSE. The publication highlights how the Canadian Guidelines for Sexual Health Education can contribute to the initiation and maintenance of high quality sexual health education programming in schools through the use of the clear, easy-to-apply, evidence-based guides (p. 16). Literature from across Canada indicates strong support for school-based RSE from the majority of students, parents, and teachers (Lokanc-Diluzio et al 2007). Despite this support, many young people are dissatisfied with the quality of RSE, the lack of information on topics they consider important, and the lack of comfort and knowledge of those delivering the curriculum (Lokanc-Diluzio et al 2007). More often than not, teachers are required to prepare themselves through a combination of workshops, conferences, seminars or self-education; this reflects the limited number of initial teacher training programmes that include any training in RSE (McKay and Barrett 1999). Similarly to the UK, various education and training programmes exist across Canada that aim to improve the quality of RSE. For the purpose of this report, education and training provided by affiliates of the Canadian Federation for Sexual Health (the Canadian member of the IPPF) were reviewed. Sex and Relationships Education 24 Sept 2011

25 Most affiliates provide training, ranging from short topic specific workshops to more comprehensive training, often with an opportunity or requirement to do in-depth values clarification work based on the Sexual Attitudes Reassessment (SAR) model. Options for Sexual Health (OPT), a Canadian Federation for Sexual Health member in British Columbia, is unique in offering the only certification programme for RSE educators in Canada. Detailed information about the organisation, its work, and specifically its certification programme, is provided below. What is SAR? SAR is a multi-day workshop that provides an opportunity for those working in the sexual health field to explore their values, beliefs and attitudes across the spectrum of sexuality. The aim is to increase individual comfort with the wide variation of existing sexual attitudes, behaviours, practices and subcultures (ASPSH 2011). Some SAR programmes are accredited by the American Association of Sexuality Educators, Counsellors and Therapists (AASECT), who certify sexual health professionals, including sexuality educators, through an in-depth and comprehensive review of education and experience (AASECT 2004). Due to its complex nature, the AASECT certification has not been included in detail in this report as the feasibility of implementing such a programme in the UK is limited at this time. It has however been included for the purpose of completeness and future work. Options for Sexual Health, British Columbia OPT is the largest non-profit provider of sexual health services in Canada, including clinics, advocacy, education programmes, and an information and referral line. The organisation s mission is to provide comprehensive education, accurate information, support for sexual expression and reproductive choice, and confidential clinical services that help [residents] enjoy healthy sexuality throughout life (OPT 2011a). The Executive Director of OPT reports that the organisation is funded through government contracts for delivered services (40%), earned revenue (such as contraceptive sales and education fees) (47%), and project-specific grants and individual donations (13%). In addition to providing education to young people, parents, and professionals, OPT runs the Sexual Health Educator Certification (SHEC) programme, which is a competency, knowledge and performance-based training programme designed to prepare educators to deliver comprehensive RSE (OPT 2011b). It is aimed at, but not limited to, teachers and health professionals who deliver school or community based RSE. Although not formally accredited, OPT acknowledges that SHEC graduates may later consider applying for certification through ASSECT. Initial certification and certification renewal (required two years after completion and then every five years) is awarded by the SHEC Advisory Committee. Sex and Relationships Education 25 Sept 2011