Power Through Choices was first sexuality education curriculum developed for youth who are involved in a child welfare or juvenile justice system to help them prevent pregnancy, HIV, and other sexually transmitted infections (STIs).
Read more about the curriculum below (also available in a printable curriculum overview pamphlet).
Power Through Choices has two main themes: self-empowerment and the impact of choices on an individual’s future.
Goals and Objectives
The curriculum’s goal is to provide youth in systems of care with specific information and skills to help them avoid risk-taking sexual behavior and reduce the incidence of adolescent pregnancy, HIV, and other STIs.
Curriculum objectives are to enable the youth participants to:
- Make healthy, positive choices related to sexual behavior
- Develop and practice effective communication skills
- Identify and access available resources
- Use effective pregnancy, STI, and HIV protection
The Power Through Choices curriculum is divided into 10, 90-minute sessions.
- Making Choices Clear
- Adolescent Reproductive Health Basics
- Increasing Contraceptive Knowledge
- Understanding STIs and HIV and How to Reduce Your Risks
- Practice Makes Perfect
- Using Resources to Support Your Choices
- Making Choices that Fit Your Life
- Creating the Future You Want
- Plan + Prepare = Power
Power Through Choices is anchored on four theories:
Health Belief Model
Readiness for action stems from an individual’s perception of the threat of an undesired outcome and the likelihood of being able, through personal interaction, to reduce that threat. In this case, the undesired outcome is pregnancy, or the contraction of HIV or another STI. The curriculum’s skill-building approach and its focus on self-empowerment seek to increase the perceptions of participants of their own abilities to reduce these situations.
(Carver, 1981; Mithaug, 1993)
Individuals are viewed as feedback systems attempting to bring their current states closer to their goal states. Power Through Choices focuses on setting short- and long-term goals, as well as the importance of planning ahead and protecting oneself if they are going to have sex.
Theory of Reasoned Action/Rational Model
(Mullen, Hersey, Iverson, 1987; Terry, Gallois, & McCarnish, 1993)
Behavioral intention is a strong predictor of behavior. This theory focuses on the individual evaluating the consequences of their behavior and their attitudes, as well as the attitudes of others. The curriculum’s emphasis on making choices and the impact of choices on an individual’s future relates directly to this theory.
Social and Cognitive Learning Theory
(Bandura, 1977; Bandura, 1986; Rosenstock, Strecher, & Becker, 1988)
Actions are often learned by watching others model the action and then practicing the behavior. Power Through Choices provides many opportunities for observation and practice through activities which engage the youth.
- Becker, M. (1974). The health belief model and personal health behavior. Thorofare, NJ: C. B. Slack.
- Carver, C. (1981). Attention and self-regulation: A control-theory approach to human behavior. New York: Springer-Verlag.
- Mithaug, D. (1993). Self-regulation theory: How optimal adjustment maximizes gain. Westport, CT: Praeger.
- Mullen, P., Hersey, J., & Iverson, D. (1987). Health behavior models compared. Social Science and Medicine, 24(11), 973-981.
- Terry, D., Gallois, C., & McCamish, M. (1993). The theory of reasoned action: Its application to AIDS-preventive behavior. New York: Pergamon Press.
- Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice-Hall.
- Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.
- Rosenstock, I., Strecher, V., & Becker, M. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15(2), 175-183.
This curriculum can be delivered in a wide range of settings. The setting should be spacious enough for participants to divide into small work groups, move around, participate in role-plays, and use writing tools for activities. Settings should be comfortable, put the young people at ease, and make them feel safe and positive about participating in the activities.
Group Age, Size, and Gender
Due to the interactive nature of the curriculum and the needs of the participants, it is best suited for small groups of 8–20. The curriculum is designed for adolescents between the ages of 13–18 and can be implemented with any gender and in groups of all genders.
To maximize consistent attendance, the curriculum should be implemented within a timeframe of three-to-five (3–5) weeks whenever possible, offering multiple sessions per week. During the piloting of Power Through Choices, youth were found to retain the material more effectively when the sessions were held closer together, and participants were able to attend all of the sessions.
Facilitators are encouraged to allow time for participants to process what they learned during the activities. Participants may miss or confuse essential messages and information if they are rushed and do not have time to process the meaning of the activities.
Power Through Choices was designed to assist youth in developing the decision-making skills and self-efficacy to prevent pregnancy, HIV, and STIs, regardless of their gender, sexual identity, or sexual orientation. To be inclusive of the diversity found in the systems of care community, the curriculum includes gender-inclusive language, such as the pronouns “they/them/theirs” rather than “she/her/hers” or “he/him/his,” characters with same-gender sexual experience, and language that does not gender bodies and body parts.
Also, the authors heard from current and former foster youth who said the curriculum should include role-plays that reflect the spectrum of sexual decision-making circumstances and from professionals who work with youth about the need to demonstrate to all youth, including youth who identify as LGBTQ+, that this information also pertains to them and the sexual choices they may encounter. Based on that input from youth and professionals, some role-plays have been included which present same-gender couples and discuss the use of sexual aids (commonly called “sex toys” by the youth).
Throughout the program, facilitators should emphasize that all sexually active individuals are at risk for contracting HIV and other STIs—even when there may not be any risk of pregnancy. The health information and skills presented in this program are important for all individuals, regardless of sexual identity and orientation.
Fidelity, Adaptation, and Medical Accuracy
A Power Through Choices Facilitator Feedback Form was created for use by the facilitators immediately after each session to monitor program fidelity by recording the extent to which the session was presented as planned (e.g., content, activities, timeframe, other). This tool provides the basis for a process evaluation, allowing the facilitator to note what worked well, any adaptations (i.e., changes) that were made, along with issues that need to be addressed in future presentations to improve particular activities or sessions.
Approved adaptations appear within the Power Through Choices curriculum and are available from Healthy Teen Network. Two examples of approved adaptations are:
- Taking a short break for snacks in the middle of the session
- Encouraging youth to have fun with the role-plays and adapt the language in the scripted portion to whatever sounds natural for them
This curriculum has been reviewed by reproductive health experts to ensure that all information related to STIs, HIV, and contraception is current, accurate, and appropriate. However, facilitators should update content as new reproductive health information and technology become available.
Our research experience strongly suggested that the curriculum be presented by a team of two experienced, effective facilitators who have an aptitude for working with youth and an understanding of this particular population, as well as training in adolescent sexual and reproductive health. Having two facilitators provides a high level of personal attention for the participants and ensures continuity if one facilitator has to be absent for a session.
Youth from a wide range of cultural backgrounds will participate in Power Through Choices. As educators in a diverse society, it is important to recognize that the acceptability of many behaviors varies between cultures and to strengthen our teaching by understanding cultural differences and increasing our skills in presenting information effectively to young people from various backgrounds, cultures, and traditions.
From the very beginning of implementation, facilitators need to set a tone that is welcoming and reflects respect, safety, trust, and genuineness.
To engage the youth throughout the Power Through Choices program, facilitators should provide positive and encouraging messages to the young people, and listen and respond to their concerns and suggestions. It is especially crucial that facilitators understand, and are sensitive to, the issues of sexual abuse and other trauma which may be part of the life story of the participants.
It is important to recognize that adolescent sexuality can be a highly-charged and emotional issue for many adults as well as adolescents. However, developing a healthy sexual identity is an essential part of adolescence. Sexual feelings can be expressed through various behaviors which can occur alone or with a partner(s) of any gender. It is important for facilitators discussing sexual identity with young people to be aware and accepting of the range of relationships, sexual expressions, and healthy and safe sexual behaviors.
One of the first activities will be assisting the group in establishing group agreements to create a positive learning atmosphere where topics can be discussed honestly, and all participants are treated respectfully. The facilitators should review the group agreements at the start of each session.
Working with Systems, Custodial Adults, and System Staff
Before implementing the curriculum in any setting, facilitators should understand agency and state regulations and mandates regarding the teaching of sexuality education and topics that may be deemed sensitive. Facilitators should obtain appropriate approval and consents, as necessary, prior to initiating the curriculum. We recommend using a memorandum of agreement (MOA).
It is important that the custodial adults (i.e., parents, guardians, or foster parents) and/or key system staff (i.e., caseworkers, residential care staff, or probation officers) understand and support the curriculum’s goal, objectives, and activities. It is also important that there are clear expectations related to Power Through Choices implementation, agreement on the roles and responsibilities of all parties, and an understanding regarding the youth participants’ right to privacy and confidentiality. Include these items in the MOA.
Custodial adults and system staff are not to be present in the room with the youth participants during the program, unless they have a line-of-sight supervision requirement. However, they need to be available nearby to handle any issues or situations that arise.
It can be helpful to provide custodial adults and/or system staff resources related to the topics discussed in the curriculum. They should be encouraged to contact facilitators with their questions or concerns, as well as share feedback they receive from the youth participants. After the Power Through Choices session, it is important that facilitators provide feedback to the appropriate adults and flag any issues or topics that were discussed that might arise later in discussions, while keeping in mind issues of privacy and confidentiality.
Sexual Abuse and Consent
Sexual abuse and consent are extremely sensitive subjects and Power Through Choices includes content about both. It is important to alert custodial adults and/or system staff that these issues may arise in order for them to be prepared to refer any participants to counseling or additional support services, as needed. These topics are included to acknowledge that sexual abuse is a situation that exists, but not to explore the issue in depth or address individual experiences in a therapeutic manner.
Also, people who have experienced sexual abuse may need additional support and guidance to master the skills for making positive, effective
choices and gaining a sense of self-empowerment, two concepts at the core of Power Through Choices.
Please note, however, that Power Through Choices does not include specific content about commercial sex trafficking, although, according to one report (Walker, 2013) a majority of survivors “are or were formerly involved in child welfare.” Additional external resources include Polaris, the National Human Trafficking Hotline (888-373-7888), and the BeFree textline.
State laws mandate the reporting of child sexual abuse. Facilitators should review the state laws and agency regulations to make sure they have accurate information, contacts and resources, should further information be needed. See Child Welfare Information Gateway in the Resources section for information on your state’s statutes.
Research and Evaluation
The Power Through Choices Demonstration and Evaluation Project conducted a multi-year, multi-state evaluation of the new Power Through Choices curriculum. The rigorous study, which included over 1,000 youth, was funded by a Personal Responsibility Education Innovative Strategies (PREIS) grant from the U.S. Department of Health and Human Services Administration on Children & Families (HHS/ACF), with additional support from The Annie E. Casey Foundation. In addition to the independent evaluation conducted by the University of Oklahoma Health Sciences Center, the project was included in the large federal evaluation directed by Mathematica Policy Research. Read more on our research…