Sexual Health Education in New York City

Sexual Health Education in

New York City

Findings and Recommendations

Sexual Health Education Task Force

7/17/2018

Sexual Health Education in New York City

2018

Dear Mayor de Blasio,

The Sexual Health Education Task Force (Task Force), created by Local Law 90 of 2017, is pleased to

submit its recommendations that promote a comprehensive sexual health education for students in

public schools.

The multi-disciplinary Task Force developed these recommendations between October 2017 and March

2018, and includes students, educators, parents, a principal, a school psychologist, sexual health

education experts, LGBTQ health experts, and New York City Department of Education (NYC DOE) and

New York City Department of Health (DOHMH) representatives.

Comprehensive sexual health education is fundamental to the wellness of students across our City. It

incorporates medically accurate, affirming, age-appropriate, and culturally competent information

about anatomy, physiology, family involvement, personal safety, healthy relationships, sexually

transmitted infections including HIV, contraceptives, sexual orientation, pregnancy, media navigation

and literacy, and more. Holistic approaches to sexual health education also foster equity, rights, respect,

and healthy relationships. These approaches motivate students to take ownership of their own sexual

health which in turn helps to reduce risky behaviors that can cause sexually transmitted infections or

unplanned pregnancies. Ultimately, sexual health education impacts the overall school environment and

can positively affect students’ lives inside and outside of classrooms. Recognizing this significance, the

recommendations in this report prioritize sexual health education and inclusivity in all schools – a

necessary evolution in our approach to sexual health education.

In May 2018, NYC DOE Chancellor Richard Carranza announced the launch of Health Ed Works, a four-

year, $24 million initiative that will increase resources to ensure more students receive comprehensive,

medically-accurate, and age-appropriate health education. Health Ed Works provides additional

professional learning opportunities for teachers, support for school leaders in establishing strong health

education programs, and increased family and community engagement around health. Health Ed Works

will also establish a cohort of schools to implement and model best practices in health instruction and

programs that support student wellbeing.

Meaningful overlaps exist between the Task Force’s recommendations and those adopted in the Health

Ed Works plan. A number of recommendations in the report were adopted via the Health Ed Works

plan. The Task Force is thus pleased that Health Ed Works reflects ongoing conversations between the

NYC Department of Education and the Task Force.

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The Task Force sets forth its recommendations for the consideration of Mayor de Blasio and Chancellor

Carranza, to ensure the City fully embraces comprehensive sexual health education for all New York City

public school students. Nevertheless, the work is far from over. The City must continue to partner with

its agencies, community organizations, schools, and families to identify additional focus areas in which

to wisely invest resources.

As required by Local Law, the Task Force will continue to meet for up to five years. The NYC Commission

on Gender Equity will lead the Task Force, in partnership with the DOE. Task Force members look

forward to collaborating with the City to ensure that all students receive the comprehensive sexual

health education they deserve.

Sincerely,

Jacqueline M. Ebanks

Executive Director, NYC Commission on Gender Equity

Chair, NYC Sexual Health Education Task Force

Pascale Saintonge Austin

Director, Family Planning and Pregnancy Prevention Programs, Children’s Aid

Vice Chair, NYC Sexual Health Education Task Force

Edie Sharp

Chief of Staff to the Chancellor, Department of Education

Vice Chair, NYC Sexual Health Education Task Force

Sexual Health Education in New York City

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I: Origin and Goals of Sexual Health Education Task Force

Comprehensive sexual health education is fundamental to ensuring the health and wellness of students

across New York City. Proactive approaches to sexual health education help foster equality, rights,

respect, and healthy relationships, and motivate students to maintain their sexual health, prevent

disease, and reduce risk behaviors. Ultimately, sexual health education impacts the overall school

environment and positively affects the lives of students inside and outside the classroom.

New York City data reveal troubling statistics regarding young people’s sexual health. The data show

unacceptable rates of HIV and other sexually transmitted infections (STIs), unintended pregnancy, and

intimate partner and sexual violence among young people. Other data reveal that many students do not

receive appropriate and comprehensive health and sexual health education delivered by certified health

education instructors, despite various City and State mandates. Recognizing longstanding challenges

around access to sexual health education,

in 2017, Mayor Bill de Blasio signed Intro 1028B – a bill

establishing a citywide sexual health education task force – into law, making his the first Administration

to launch a comprehensive review of the current state of sexual health education in New York City.

The Mayor appointed 28 members to New York City’s first-ever Sexual Health Education Task Force (the

Task Force), charged with reviewing two domains. First, the Task Force is charged with reviewing the

sexual health education curricula recommended by the New York City Department of Education

(NYCDOE), including whether they align with national standards; are age-appropriate, medically

accurate, and medically affirming; and cover sexual abuse prevention, healthy relationships and

consent, and non-heterosexual relationships. Second, the Task Force is charged with reviewing the

implementation of sexual health education for students from Kindergarten through 12

grade (K-12),

including the number and percentage of students receiving sexual health education, the amount of

instruction time dedicated to sexual health education, who provides the instruction, and whether and to

what extent non-NYCDOE recommended curricula currently in use align with the NYCDOE-

recommended curricula. The Task Force is also charged with recommending ways to improve, expand,

or replace the recommended curricula; to improve and expand implementation and staff training; and

to ensure that sexual health education is fully inclusive of lesbian, gay, bisexual, transgender and gender

nonconforming, and questioning (LGBTQ) students, and the diverse needs of students across New York

City.

Task Force members include students, educators, parents, a principal, and a school psychologist from

NYCDOE schools; sexual health education experts; LGBTQ health experts; and representatives of

NYCDOE and the New York City Department of Health and Mental Hygiene (NYCDOHMH). Jacqueline

Ebanks, Executive Director of the New York City Commission on Gender Equity, is Chair of the Task

Force; and Pascale Saintonge Austin, Director of Family Planning and Pregnancy Prevention Programs at

Children’s Aid, and Edie Sharp, Deputy Chief of Staff at NYCDOE, are Vice-Chairs. The full Task Force

developed the recommendations in this report between October 2017 and March 2018.

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The Task Force worked to develop strategies and recommendations to address existing gaps around

sexual health education in our school system. The Task Force recognizes the magnitude of the task at

hand. NYCDOE schools educate 1.1 million students from a diverse array of gender identities and

expressions, sexual orientations, races and ethnicities, socioeconomic backgrounds, abilities, and

immigration statuses. Across all recommendations, it is also critical to meet the needs of English

language learners and students receiving special education services. Nonetheless, sexual health

education is key to the sexual health and overall well-being of students and young adults, and it is

imperative to take meaningful action on this issue.

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II: Sexual and Reproductive Health of Young People in New York City

According to the Centers for Disease Control and Prevention (CDC), the number of new chlamydia,

gonorrhea, and syphilis cases reached a record high in 2016, with more than two million reported

infections in the United States.

Estimates suggest that 15- to 24-year-olds acquire half of all new STIs in

the United States.

From 2012 to 2016, nationally, reported cases of chlamydia, gonorrhea, and primary

and secondary syphilis among both males and females ages 15 to 19 years and 20 to 24 years

increased.

During the same period, New York City saw decreases in reported cases of chlamydia and

gonorrhea among males and females ages 15 to 24 years

; however, primary and secondary syphilis

cases increased 31.9% among 15- to 19-year-olds and 55.7% among 20- to 24-year-olds.

In 2016, there

were 10,525 reported cases of chlamydia among 15- to 19-year-old females and 13,110 among 20- to

24-year-old females in New York City, both representing increases compared to the previous year.

And

while only 15 cases of primary and secondary syphilis were reported among 15- to 19-year-old females

and 28 among 20-24-year-old females in 2016, these represent 150% and 154.5% increases,

respectively, compared to 2015.

The CDC estimated that, in the United States, 1,122,900 adults and

adolescents were living with HIV at the end of 2015, 162,500 (15%) of whom were undiagnosed.

estimated 44% of 13- to 24-year-olds with HIV were unaware of their status.

While the overall number

of new HIV diagnoses in New York City continues to decline, nearly 39% (882 of 2,279) of new HIV

diagnoses in New York City in 2016 were among 13- to 29-year-olds, the vast majority young gay and

bisexual men and other men who have sex with men (MSM) of color.

In 2016, 882 New Yorkers ages

13 to 29 years were newly diagnosed, including 766 males and 116 females.

CDC Youth Risk Behavior Surveillance (YRBS) and New York City Youth Risk Behavior Survey 2015 data

show that 41.2% of high school students nationwide (27.2% in New York City) had ever had sexual

intercourse.

Among those currently sexually active, only 56.9% (62.6% in New York City) had used a

condom during their last sexual intercourse; 13.8% (15.7% in New York City) reported that neither they

nor their partner had used any method to prevent pregnancy during their last sexual intercourse.

A 2017 NYCDOHMH report found that while overall pregnancy rates dropped 60% among 15- to 19-

year-olds in New York City from 2000 to 2015, rates are highest in the city’s poorest neighborhoods.

Among more than 9,000 pregnancies in this age group in 2015, almost eight in 10 were unintended.

New York City youth also face some of the highest rates of intimate partner violence in the country.

According to a 2016 CDC report, 12% of New York City students report experiencing physical dating

violence in the 12 months before they were surveyed, significantly higher than the national average of

9.6% of students.

Nationally, the CDC estimates that nearly 1.5 million high school students are

affected by dating violence annually

and 16- to 24-year-old females report the highest rate of intimate

partner violence, compared to all other demographics, which can have lasting detrimental effects on

physical and sexual health and on future relationships.

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In 2015, for the first time, the CDC included in the YRBS a question to ascertain sexual identity and sex of

sexual partners; about 14% of New York City students identified as “gay or lesbian,” “bisexual,” or “not

sure.”

The same data show that LGBTQ students in New York City were more likely to be bullied,

experience depressive symptoms, and seriously consider suicide and actually attempt suicide when

compared to their heterosexual, cisgender peers.

For transgender and gender nonconforming (TGNC)

students K-12, school can be even more difficult; nationwide, 78% of transgender individuals reported

being harassed, 35% being physically assaulted, and 12% experiencing sexual violence.

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III: The Value of Sexual Health Education

Sexual health education is imperative to the sexual health and overall well-being of students and young

adults. The Future of Sex Education Initiative (FoSE), a partnership between Advocates for Youth,

Answer, and the Sexuality Information and Education Council of the United States (SIECUS) launched in

2007, and adapted the CDC definition of health education in its own definition of comprehensive sex

education: “A planned, sequential K-12 curriculum that is part of a comprehensive school health

education approach which addresses age-appropriate physical, mental, emotional and social dimensions

of human sexuality. The curriculum should be designed to motivate and assist students to maintain and

improve their sexual health, prevent disease and reduce sexual health-related risk behaviors. It should

allow students to develop and demonstrate developmentally appropriate sexual health-related

knowledge, attitudes, skills, and practices. The comprehensive sexuality education curriculum should

include a variety of topics including anatomy, physiology, families, personal safety, healthy relationships,

pregnancy and birth, sexually transmitted diseases including HIV, contraceptives, sexual orientation,

pregnancy options, media literacy and more. It should be medically accurate and affirming. Qualified,

trained teachers should provide sexuality education.”

Leading public health and medical professional organizations agree. Following a 2009 review of

published literature and sentinel reports on the effectiveness of comprehensive and abstinence-only

sexual education published in the previous decade, the American Medical Association stated:

“Comprehensive-based sexuality education curricula that include accurate information about

contraception and condom use, and that may also encourage abstinence (as the only fully effective way

to prevent pregnancy and the transmission of disease), continue to be the most effective at increasing

adolescents’ knowledge about pregnancy and disease prevention.”

In 2014, the American Public

Health Association issued a Policy Statement asserting that “[w]hile sexual risk reduction for HIV, STIs,

and pregnancy prevention cannot rely on a single strategy given the many contributing factors, rigorous

research and evaluations have consistently demonstrated that comprehensive sexuality education (CSE)

can have a positive impact on young people’s sexual behavior...” and that “[e]xperts in the fields of

adolescent development, health, and education recommend that sexuality education programs, as part

of a comprehensive health education program, provide young people with accurate information

necessary to protect their sexual health; foster equality, rights, and respect; assist youth in developing a

positive view of themselves and their sexuality; and help them acquire skills to communicate effectively,

make informed decisions, and stay safe.”

The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, Society for

Adolescent Health and Medicine, and American Sexual Health Association,

– along with leading

advocacy organizations

– similarly champion comprehensive sexual health education programs as

beneficial to the sexual health and well-being of young people.

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IV: Sexual Health Education in NYCDOE Schools

A. Sexual Health Education Requirements in NYCDOE Schools

In New York State, public schools are not required to teach students sexual health education as part of

the New York State Education Department (NYSED)’s health education mandate. Schools must offer

basic HIV/AIDS education to all students K-12, but the decision to offer sexual health education as

described in the previous section is left to local school districts.

Elementary Schools (Grades K-5)

In New York State, elementary school classroom instruction must include a sequential health education

program for all students. While state regulations do not specify a required number of lessons or amount

of instructional time, they require teachers to provide “planned activities for developing attitudes,

knowledge and behavior that contribute to [students’] own sense of self-worth, respect for their bodies

and ability to make constructive decisions regarding their social and emotional, as well as physical,

health” for the lower grades, and “health instruction through which pupils may become increasingly

self-reliant in solving their own health problems and those of the group” for the upper grades.

State regulations also require appropriate instruction with regard to HIV/AIDS as part of the sequential

health education program for students K-12.

NYCDOE specifies the number of HIV/AIDS lessons

required in each grade. Elementary school students K-5 must receive five HIV/AIDS education lessons

each year. NYCDOE requires that elementary schools use its HIV/AIDS Curriculum,

which provides age

and developmentally appropriate lessons for students K-12, to meet this requirement.

In elementary schools, certified health education teachers or classroom teachers may teach health

education and HIV/AIDS education lessons. NYCDOE offers full-day, in-person trainings to help teachers

implement the HIV/AIDS Curriculum for students K-5, as well as trainings on recommended health

education curricula.

Middle and High Schools (Grades 6-12)

In 2011, NYCDOE made sexual health education a mandatory component of the comprehensive health

education courses required in middle and high schools.

New York State requires one credit (54 hours) of health education for middle school students and the

same for high school students 9-12. Completing a health education credit is not a requirement for

promotion from middle school to high school, but is a requirement for high school graduation. NYCDOE

strongly recommends that middle school students meet their health education requirement in 6

or 7

grade, and high school students in 9

or 10

grade. NYCDOE – but not the state – requires that these

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health classes include sexual health education, but does not specify a number of lessons to be dedicated

to the topic.

In New York State, middle and high school students must receive HIV/AIDS education lessons each year.

NYCDOE specifies the number of lessons required: 6

graders must receive five lessons per year and

students in grades 7-12 must receive six lessons per year. NYCDOE requires that middle and high

schools, like elementary schools, use its HIV/AIDS Curriculum to meet this requirement.

Parents/ guardians have the right to opt their children out of select lessons on pregnancy, STIs, and HIV

prevention by submitting a written request to the school principal, including an assurance that they will

provide these prevention lessons at home.

In middle and high schools, only certified health education teachers may teach health education. New

York State has an incidental teaching provision, which permits teachers to teach one class out of license

if they demonstrate subject matter competency.

NYCDOE teachers not certified in health education

are frequently assigned to teach health education under this provision. NYCDOE offers full-day, in-

person trainings to help teachers implement the HIV/AIDS Curriculum for students 6-12 in their schools;

half-day refresher trainings are available for teachers who have previously participated in the training.

Trainings are also available for teachers on recommended health education curricula.

B. NYCDOE Schools’ Compliance with Sexual Health Education Requirements

In 2015, Mayor de Blasio signed two laws that require NYCDOE to issue annual reports on health

education in schools K-12. Local Law 14 reports provide district- and school-level data on the number of

middle and high school students scheduled for the required semesters of health education; Local Law 15

Condom Availability and Demonstrations in NYCDOE Schools

Another important sexual health resource available in NYCDOE high schools is the Condom Availability

Program (CAP), overseen by NYCDOE Office of School Wellness Programs. High schools are required to

provide Health Resource Rooms, where free male and female condoms, health information, and health

referrals are made available to students by trained staff. Trained staff may also provide condom

demonstrations, upon student request.

The Office of School Wellness Programs ensures CAP staff is appropriately trained, Health Resource Rooms

are sufficiently stocked with condoms and other safer sex materials and information, and technical assistance

is available to CAP staff.

As of 2015, high schools may offer condom demonstrations as a part of the health education curriculum.

Parents/ guardians may opt their student out of participating in condom demonstrations or receiving

condoms through CAP. Parents/guardians may not opt their student out of receiving information about

health services or referrals.

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reports provide district- and school-level data on the number of full- and part-time licensed health

education instructors in NYCDOE schools, and the number receiving professional development from

NYCDOE Office of School Wellness Programs.

Student Enrollment in Health Education: Middle and High Schools

The Local Law 14 report for the 2016-2017 school year found that only 60.2% of 8

graders were

scheduled for at least one semester of health education in middle school

; 99.7% of high school

students who graduated in 2017 had met the one semester of health education required for

graduation.

Data on the content of health education are not collected; therefore, there are no data on

the content or quantity of sexual health education provided during the health education courses.

Teachers: Licensed Health Teachers and Sexual Health Education Professional Development

The Local Law 15 report for the 2016-2017 school year identified a total of 151 licensed health

instructors across all NYCDOE schools, while 17,957 instructors were assigned to teach health

education.

The Local Law 15 report also found that a very small number of instructors had received sexual health

education training from NYCDOE. Only 10.8% of all health education instructors (1,942 instructors out of

17,957 total instructors assigned to teach health education) received training on sexual health education

by NYCDOE in the 2015-2017 school years. Only 2.4% of all health education instructors (427) attended

multiple sessions of sexual health education professional development in that time period.

C. Sexual Health Education Curricula in NYCDOE Schools

As is standard across subject areas, NYCDOE does not mandate a specific health or sexual health

education curriculum. NYCDOE Office of School Wellness Programs does recommend health curricula,

identified through a rigorous curriculum review process, which involves engaging a formal review

committee and utilizing established curriculum evaluation tools. Curricula recommended via the review

process are research-informed and/or evidence-based, and developed by leading national publishers.

Recommended curricula align with the New York State Standards in Health Education,

the CDC’s

National Health Education Standards,

and FoSE’s National Sexuality Education Standards: Core Content

and Skills, K-12.

NYCDOE Office of School Wellness Programs works with educators and health

education experts to identify resources to help fill gaps in the curricula.

After it selects a curriculum to recommend, NYCDOE Office of School Wellness Programs designs

trainings and guidance materials to introduce the curriculum to teachers. Schools may purchase the

curriculum through NYCDOE purchasing systems, but teachers who attend trainings receive the

curriculum free of charge. Information about recommended curricula is posted on the NYCDOE website

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NYCDOE Office of School Wellness Programs

NYCDOE Office of School Wellness Programs (OSWP), part of NYCDOE Division of Operations and Office of School

Health (an office jointly operated by NYCDOE and NYCDOHMH), “partner[s] with schools to create conditions

where health and physical education thrive and engages the school community with programs to support student

wellbeing.” OSWP provides citywide support for K-12 health education and physical education, across all City

schools.

OSWP also offers schools resources for health and sexual health education, including recommended curricula;

free trainings; mentoring; a K-12 health education scope and sequence document (which outlines key health

topics and a logical progression for teaching them), and connection with community-based organizational

partners offering health- and sexual-health education programming. Finally, OSWP oversees the NYC District

Wellness Advisory Council, which brings together stakeholders and experts on a quarterly basis to review health

and physical education materials and advise on effective implementation of programs that support student well-

being.

OSWP oversees the following health education-related programs:

• Condom Availability Program (CAP)/Health Resource Rooms: Program providing free condoms, health

information, and health referrals from trained staff for students in grades 9-12

• School Wellness Councils: Advisory groups of students, parents, and school staff committed to

improving the health and well-being of students and the school community

Other OSWP programs relate to physical education and activity.

and shared through various teacher and principal communication channels. NYCDOE Office of School

Wellness Programs continually monitors teacher feedback, updated NYSED requirements, the standards

mentioned in the previous paragraph, emerging best practices, and local and national data to ensure

curricula are current and responsive to student and teacher needs.

To further support principals and teachers seeking to implement effective health and sexual health

education, NYCDOE Office of School Wellness Programs is developing Health Education Scope and

Sequence documents for grade bands K-5, 6-8, and 9-12, to be rolled out during the 2018-2019 school

year. These documents offer a practical framework for administrators, teachers, and parents that

outline the range of key health concepts and skills students learn across grade levels (scope), and the

logical progression of essential health knowledge, skills, and behaviors at each grade level K-12

(sequence). They will also include guidance on how teachers can use the recommended health

education curricula in alignment with the Scope and Sequence documents.

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D. Task Force Highlights

Mayor de Blasio and the City of New York are committed to improving the state of sexual and

reproductive health for young people in the City. Consequently, the Mayor signed Intro 1098-B which

convened a number of students, educators, direct service providers, city officials, and content experts,

to thoroughly review the state of sexual health education in New York City.

The Task Force closely reviewed and discussed the state of young New Yorkers’ sexual and reproductive

health, City and State educational mandates, and the data in the reports mandated by Local Laws 14 and

15.

Task Force members also drew from their own expertise and experiences to build the recommendations

in this report. Students described their experiences in sexual health education classes and across their

schools; parents emphasized the importance of family and community buy-in; educators shared their

experiences leading health education classes; health and sexual health education experts shared best

practices occurring locally and across the country; City agency representatives shared educational and

health surveillance data and clarified the structure of NYCDOE and NYCDOHMH programs; and school

administrators described the importance of balancing the safety and well-being of their students with

respecting the agency of students’ parents, families, and chosen families.

The diversity of Task Force members and their perspectives underscores the City’s commitment to

working with communities and partners to address sexual health education in NYCDOE schools. By

drawing on this broad array of perspectives, opinions, experiences, and expertise, the Task Force was

able to develop recommendations that meaningfully address the need of different communities and

stakeholders.

Underlying all Task Force conversations was a sense of urgency to address systemic issues and a call for

action for policy changes on sexual health education.

The Task Force worked diligently to develop actionable recommendations that address the urgent need

for policy and practice reform, within the reality of health and sexual health education in NYCDOE

schools, and in the context of increased support for this issue by NYCDOE and other City agencies.

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V: Recommendations

The goal of sexual health education is to provide young people with medically accurate, medically

affirming, age-appropriate, and comprehensive information about bodily development, sex, sexuality,

and relationships, along with skills-building to help them communicate and make informed decisions

about sex and their sexual health.

Student, school, family, and community participation is critical to

implementing meaningful, culturally responsive, inclusive, and sustainable sexual health education. The

Task Force identified four broad strategies to achieve this goal, and developed specific

recommendations within each:

A. Prioritize a Culture of Sexual Wellness and Inclusivity in all Schools. Schools play a fundamental

role in students’ development of the knowledge and skills needed to care for their health, including

their sexual health. NYCDOE must ensure schools have the resources and support necessary to build

a culture of sexual wellness and inclusivity both within and outside the classroom.

B. Ensure All Students Are Served by Well Equipped and Supported Health Education Instructors.

Teachers of comprehensive health education, which includes sexual health education, play a critical

role in helping students develop the knowledge and skills that will support their well-being. Given

that many NYCDOE health education teachers are not certified in health education and/or have not

received training on the subject, NYCDOE must provide for more qualified teachers and professional

development opportunities to ensure effective delivery of health education in schools.

C. Improve the Content, Substance, and Methods of Sexual Health Education. A critical function of

NYCDOE is to assess the content of the health education curricula (including sexual health

education) in use in K-12 schools. Inconsistencies in current health education lesson content and

instruction time demonstrate the necessity of content, methods, and timing standards (including the

amount of instructional time at different grade levels).

D. Strengthen Accountability and Reporting. To ensure equitable access to sexual health education for

all students, NYCDOE must employ more comprehensive tracking and monitoring strategies to hold

principals and instructors accountable for sexual health education implementation.

A. Prioritize a Culture of Comprehensive Sexual Wellness and Inclusivity in All

Schools

Schools must foster a culture of wellness and inclusivity that intentionally incorporates the voices and

experiences of those who are often marginalized due to their gender identity and expression, sexual

orientation, race and ethnicity, income, ability, language of origin, immigration status, and other factors.

Shifting school culture regarding health education and sexual health education will, in turn, increase

school and community accountability toward ensuring student access to health education and sexual

health education.

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RECOMMENDATION 1: Establish a district-wide philosophy and vision of comprehensive health

education, including sexual health education, that is developed by central NYCDOE leadership and

modeled in all schools

NYCDOE schools have a responsibility to ensure equitable access to comprehensive and inclusive health

education and related services and support for all students in all school contexts. Through its leadership

and Office of School Wellness Programs, NYCDOE must clearly communicate that comprehensive health

education equity – including health and sexual health education instruction, supportive programs,

students’ access to necessary services, and overall school culture – is a priority and a core principle. The

Task Force recommends the City:

a. Develop a comprehensive set of City-wide expectations for equitable provision of health

education. These expectations should explicitly address and prioritize sexual health education in

both elementary and secondary schools. They should guide health education policies, the

allocation of resources, and how schools and principals are held accountable. These

expectations should avoid using – and should actively dismantle – cisnormative,

heteronormative, and ethnocentric frameworks. A multidisciplinary team led by NYCDOE Office

of School Wellness Programs and including representatives of NYCDOE Office of Safety and

Youth Development and Office of the Chancellor should develop these expectations. This team

should initiate its work during the 2018-2019 school year, and the Chancellor’s office should

publicly release principles in early 2019. The expectations should be clearly defined, in order to

facilitate measuring progress towards goals.

b. Fund expansion of NYCDOE Office of School Wellness Programs Health Education Focus Schools.

Currently, under a CDC grant ending in 2018, NYCDOE Office of School Wellness Programs works

closely with administrators, health educators, and School Wellness Councils at 26 “Health

Education Focus High Schools” to provide quality sexual health education in health education

classes; establish strong

Condom Availability Programs and linkages with external youth-serving

clinics; and support LGBTQ students through classroom and school-wide initiatives.

NYCDOE

should expand the initiative to additional high schools, and develop similar programs at select

elementary and middle schools to tackle the specific barriers and issues that exist at each grade

level. Funding should be provided to expand to a minimum of 50 schools, across all grade levels,

per borough per year, with priority given to areas with high pregnancy and STI rates where the

majority of students live near the school.

c. Fund district-wide expansion of NYCDOE School Wellness Councils. School Wellness Councils,

school-based groups of parents, students, school staff, and community members, work to

promote healthy school environments, set school wellness goals, promote inclusivity, and make

sure physical education and health education instruction (including sexual health education) are

prioritized schoolwide. School Wellness Councils current operate in approximately 175 schools

under a NYCDOE Office of School Wellness Programs grant program. NYCDOE should

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significantly expand free tools and trainings for other schools to establish School Wellness

Councils.

Schools’ health education instructors should have an active role in the Councils.

d. Engage students in health education equity efforts. Students should have regular opportunities

to participate in discussions of sexual health education and to co-facilitate supplementary health

education programs where age appropriate. NYCDOE Office of School Wellness Programs should

oversee these student involvement initiatives, including partnering with local community-based

organizations and City agencies that have developed successful student- and youth-led

workshops and advisory groups, such as the Human Resource Administration’s

Teen

Relationship Abuse Prevention Program.

RECOMMENDATION 2: Ensure school staff have basic competencies around inclusivity and respect,

and can link students to appropriate sexual health resources outside the school setting

Though a limited number of instructors are directly responsible for teaching health education (see

Section C for related recommendations), every adult in the school environment can help shape a culture

conducive to positive health outcomes. NYCDOE should draw upon the existing and potential expertise

of instructors and other school-based stakeholders. The Task Force recommends the City:

a. Ensure all instructors, administrators, behavioral health professionals, and student peer leaders

understand basic concepts regarding inclusivity and respect; can respond to student concerns

about sexual health in an appropriate, nonjudgmental manner; and are able to refer students to

appropriate health resources within the school as necessary. NYCDOE should partner with

existing initiatives such as NYCDOHMH NYC Teens Connection (an initiative that brings together

youth, parents, community-based organizations, schools, clinics, and City agencies in a

comprehensive effort to reduce unintended teen pregnancy) to draft guiding principles on these

concepts. Once the guiding principles are established, they should be clearly and regularly

communicated and reinforced to the groups listed above. NYCDOE should also explore the

feasibility of adding a preservice certification requirement for all teachers on inclusivity and

consent.

b. Develop a student-facing resource bank of sexual health, gender identity, healthy relationships,

and gender equity information available to all students. Various high-quality resources are

available through City agencies, including NYCDOHMH’s Teens in NYC mobile app and booklet

and the NYC Health Map, an online provider locator; NYC Department of Youth and Community

Development’s Youth Connect, a resource and referral service for youth, families, and

community-based organizations utilizing web-based strategies and confidential hotline; The

LGBTQ Guide of Services and Resources maintained by NYC Office of the Comptroller; NYC

HOPE, a web-based portal from the Mayor’s Office to Combat Domestic Violence, which

connects New Yorkers to resources and information to assist those experiencing intimate

partner violence, including teen dating violence; and

Generation NYC, from the NYC Children’s

Cabinet. NYCDOE should aggregate a list of these and related resources, post them on the

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NYCDOE website, and promote this student-facing resource bank via posters and other signage

in School-Based Health Centers, CAP/ Health Resource Rooms, hallways, and other high-traffic

areas in middle and high schools.

RECOMMENDATION 3: Increase broad community buy-in of sexual health education through public

awareness campaigns and informational sessions

Students’ education is not confined to their experience in school. Efforts to create a culture of sexual

health and wellness for NYCDOE students will be most successful with the participation and support of

students’ parents, families and chosen families, and communities. The Task Force recommends the City:

a. Develop and implement culturally responsive public awareness campaigns to help parents,

families and chosen families, communities, faith leaders, and other stakeholders understand the

meaning and importance of health and sexual health education. These public awareness

campaigns and informational sessions should be offered in multiple languages according to the

needs of the local community; reflect current, medically accurate, and medically affirming

information with regard to sexual health; avoid cisnormative, heteronormative, and

ethnocentric frameworks; and include content on how to discuss this subject matter with young

people. NYCDOE should consider funding community partners to develop these campaigns and

information sessions in collaboration with NYCDOE. For example, the City could expand

NYCDOE’s existing partnership with Planned Parenthood of New York City, which currently trains

school-based parent coordinators to serve as sexual health education resources for families and

chosen families, and partner with the Mayor’s Office to Combat Domestic Violence to expand

the parent workshops offered through the

NYC Healthy Relationship Training Academy. All

public awareness campaigns and informational sessions should launched by 2020.

b. Develop resources for school leaders to use in informational sessions that provide detailed

information on sexual health education for parents, families and chosen families, and

communities. NYCDOE should encourage schools to regularly organize these sessions, and tailor

them to the needs of their school community. In-person and webinar sessions should serve as

opportunities for attendees to discuss content (such as sexual and reproductive health, sexual

orientation, gender identity, and gender expression) as well as the overall goals of

comprehensive sexual health education. This will allow adults in students’ lives to model and

reinforce positive lessons from sexual health education received in schools. NYCDOE Office of

Family and Community Engagement and Office of School Wellness Programs should organize

and lead these sessions.

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B. Ensure All Students Are Served by Well-Equipped and Supported Health

Education Instructors

To be effective, sexual health education curricula must be delivered by skilled, prepared, and culturally

responsive instructors. Evidence shows that trained teachers are more likely than untrained teachers to

follow a designated curriculum for sexual health education, and that teacher training positively affects

program outcomes.

Proper training also builds teachers’ comfort and confidence around teaching

sexual health education, addresses their personal biases, and ensures greater understanding of the

biological, socio-emotional, and legal aspects of sexual health.

As described earlier in this report, only a small number of NYCDOE teachers assigned to teach health

education are licensed in health education or have received professional development offered by

NYCDOE on health or sexual health education. Further, 161 schools reported no instructors assigned to

teach health education in the 2016-2017 school year.

RECOMMENDATION 4: Require schools to provide health education from a certified or otherwise

qualified health instructor, with demonstrable sexual health education teaching competencies

Comprehensive health education instructors must be able to accurately and clearly communicate a large

body of medical, socio-emotional, and interpersonal information; comfortably discuss sensitive topics

with young people; and be respectful of students’ varied experiences and identities. The Task Force

recommends the City:

a. Require that all K-12 schools provide health education taught by a certified or otherwise

qualified health instructor who has received high-quality training in sexual health education. In

addition to health education certification, acceptable qualifications for health education

instructors include completing Health Education Pathway offered by the NYCDOE Office of

School Wellness Programs,

or completing training from high-quality community-based

organization or educational partners approved by NYCDOE. In addition to ensuring sufficient

funding to allow for this staffing, the City should explore incentives or other strategies for

increasing the consistency of health education teachers (i.e., not assigning different teachers to

the role each year). NYCDOE should explore multiple strategies to meet this recommendation.

b. Establish a pool of instructors that provide instruction at two or more schools for schools too

small to require full-time health education instructors. NYCDOE should explore the possibility of

sharing health education instructors across co-located schools.

c. Develop a set of competency standards agreed upon by NYCDOE and the United Federation of

Teachers for certified and non-certified health education instructors teaching sexual health

education.

d. Ensure compliance with standards through ongoing evaluation of health education instructors.

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RECOMMENDATION 5: Invest in policies and programs that increase the number of certified health

education teachers

a. Collaborate with NYSED on strategies to increase the number of certified health education

teachers in NYCDOE schools. NYCDOE should work with NYSED to establish a local health

education certification for NYCDOE instructors that NYSED both recognizes and supports and

more seamless interstate reciprocity policies for applicants with health education certifications

in other states. In addition, NYCDOE should work with NYSED to develop a health certification

extension for instructors with an initial teaching certification, modeled after the Subsidized

Bilingual Extension Program, which allows content-area teachers to become authorized bilingual

educators quickly and at no cost to the teacher.

b. Incentivize NYCDOE teachers who are not currently health instructors to obtain certification in

health education or pursue a health education subject extension (as described above).

c. Establish, fund, and sustain a health education instructor recruitment initiative similar to

existing models. Model programs may include NYC Men Teach, which funds new initiatives and

programs aiming to put an additional 1,000 men of color on course to become NYCDOE

teachers, and

NYC Teaching Fellows, which prepares college graduates and career changers for

careers in teaching high-needs subjects. A critical prerequisite for this recommendation is

creating demand for health education instructors, as in recommendation 4a, above.

RECOMMENDATION 6: Require professional development for instructors assigned to teach health

education, in order to ensure students receive high-quality health education from a prepared and

knowledgeable teacher

As medical information changes and cultural norms around sexuality and gender evolve, health

education instructors must remain current with regard to sexual health education information and

instruction. The Task Force recommends the City:

a. Mandate training and ongoing professional development for instructors assigned to teach

health education that focuses on comprehensive sexual health topics. These topics should

include puberty and anatomy; healthy relationships, consent, self-management, and decision-

making; body image and self-esteem; gender, gender identity, and gender expression; sexual

orientation; the benefits of delaying sexual activity; prevention methods for unintended

pregnancy; HIV and STIs, including prevention, testing, and treatment; access to local

reproductive health care providers; skills-building strategies for preventing and addressing

bullying, sexual violence, and dating violence; and the role of technology and social media in

relationships, including cyber-sexual abuse. NYCDOE should also encourage health education

teachers to participate in implicit bias training. NYCDOE should fund substitute instructor

coverage and other incentives to allow instructors the opportunity to attend trainings and

professional development opportunities. NYCDOE Office of School Wellness Programs should

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continue to – and external training providers should be encouraged to – offer teachers

Continuing Teacher and Leader Education (CTLE) credits for attending trainings as an incentive

to attend trainings outside of school hours. NYCDOE Office of School Wellness Programs should

update mandated health education instructor training materials biannually, to ensure content

remains up-to-date.

b. Provide funding to increase the number of sexual health education training and ongoing

professional development opportunities for all NYCDOE employees. NYCDOE should explore

multiple strategies to increase access to these opportunities, including facilitating a cohort or

professional learning community through which participants have access to trainings, site visits,

and mentoring by experienced health education instructors who can support new or aspiring

instructors; NYCDOE’s existing mentorship program for all new teachers may serve as a model.

Other strategies include expanding the number of trainings NYCDOE Office of School Wellness

Programs offers and partnering with community-based organizations and other City agencies to

enhance and localize existing trainings and/or develop new ones.

C. Improve the Content, Substance, and Methods of Sexual Health

Education

A critical function of NYCDOE is to set expectations, provide resources, and ensure equitable instruction

for all students.

RECOMMENDATION 7: Expand support and resources for rigorous curriculum review, development,

and implementation by NYCDOE Office of School Wellness Programs and NYC District Wellness

Advisory Council

NYCDOE currently offers a set of recommended health education curricula for free to instructors who

participate in relevant trainings. Recommended curricula go through a rigorous review process during

which committees of teachers, parents, health education specialists, public health experts, and

community partners review content and provide recommendations for improvement. In spring 2017,

NYCDOE Office of School Wellness Programs launched the NYC District Wellness Advisory Council, which

meets quarterly to review health and physical education materials and advise on effective

implementation of programs that supports student well-being. The Wellness Advisory Council’s Health

Education Subcommittee provides ongoing review of health education materials and programs. Given its

structure and expertise, the Wellness Advisory Council is best positioned to review recommended sexual

health education curricula on an ongoing basis. The Task Force recommends the City:

a. Support rigorous review and high-quality implementation of health education curricula. NYCDOE

should provide sufficient funding to ensure that NYCDOE Office of School Wellness Programs

staff have the capacity to review and assist instructors in implementing sexual health education

curricula on an ongoing basis.

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b. Fund the Office of School Wellness to support a new initiative to work with teachers to identify

or develop instructional materials and resources specific to New York City (i.e., designed with

NYC’s student population in mind), and establish supplementary and additional materials that

fill gaps identified through ongoing review. NYCDOE should explore developing teaching

materials for subjects other than health, such as social studies or language arts. NYCDOE should

disseminate these materials to NYCDOE schools, principals, and educators, as appropriate.

c. Ensure instructor participation in curriculum reviews, including direct review of curricula,

piloting new curricula, and mentoring other instructors.

d. Ensure that NYC District Wellness Advisory Council reviews address critical topics, skills, and

concepts, as described in Appendix B.

RECOMMENDATION 8: Increase the mandated quantity of sexual health education across all grade

levels

Currently, NYCDOE requires that sexual health education topics be included in the one semester of daily

health education required of middle school students, and in the one semester of health education

required of high school students. The Task Force recommends the City:

a. Require sexual health education to be taught on a regular basis, across all grade levels. The Task

Force recommends the City require NYCDOE schools to offer sexual health education in at least

once within grades K-2 and at least once within grades 3-5. Sexual health education should be

led by classroom teachers as part of the existing health education requirements for elementary

school classrooms. The sexual health component should constitute approximately 20% of the

health education lessons. Sexual health education for elementary school students should cover

healthy relationships and sexuality, consent and bodily autonomy, and should be in alignment

with National Sexuality Education Standards (NSES). Setting the foundation for these concepts in

elementary school is critical to building upon them in successive years, as with every other topic

area. For middle school students, the required health education class should be offered in 6

grade, and the sexual health education component should constitute approximately 20% of

the health education lessons. For high school students, the required health education class

should be offered in 9

or 10

grade, and the sexual health education component should

constitute approximately 20% of the health education lessons. Ensure that schools have

properly trained staff to provide health education at these levels by funding Recommendations

4, 5, and 6 above.

b. Provide students access to some form of sexual health education every year, K-12, in addition to

the sexual health education offered as part of required health education courses. Schools should

have flexibility with regard to these programs so that they meet the needs of their students.

NYCDOE Office of School Wellness Programs should provide a list of recommended activities,

programs, or collaborators for this work –as well as a list of sexual health education topics that

should be addressed – to encourage creative program offerings and collaboration with high-

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quality community-based organizations. These programs provide an opportunity to address

other topics critical to sexual health, including gender equality, gender diversity, and sexual

justice. Principals should be accountable for ensuring that schools offer these programs through

the Annual Principal Performance Review (APPR) and/or School Quality Review. NYCDOE should

consider providing a moderate amount of funding to each school in each year to fund these

programs.

D. Strengthen Accountability and Reporting Practices

Several changes to NYCDOE data collection mechanisms are necessary for adequately monitoring

compliance with existing NYCDOE, NYSED, and other City and State health education and sexual health

education requirements, as well as with the policy changes this report recommends. Following a system-

wide assessment of existing mechanisms, NYCDOE should ensure that its overall system is capable of

capturing comprehensive content, quantity, timing, and instructor data. These data should come from

diverse observers, including students, through quantitative and qualitative means. The nature and

volume of these data should allow for analysis and quality improvement recommendations by external

stakeholders.

RECOMMENDATION 9: Create district- and school-level accountability for sexual health education

The Task Force recommends the City:

a. Convey the importance of health and sexual health education to superintendents through

annual trainings and strong communication from the central NYCDOE office. (See

Recommendation 1 about creating a district-wide set of health education expectations).

b. Encourage superintendents to hold schools and principals accountable to offering high-quality

health and sexual health education. NYCDOE should hold schools accountable through their

periodic School Quality Reviews, which are two-day, onsite evaluations conducted in a sample of

schools each year.

NYCDOE should hold principals accountable through their annual

professional performance review (APPR), via inclusion in the Multidimensional Principal

Performance Rubric.

Specifically, during School Quality Reviews and while completing the

MPPRs, reviewers should indicate whether educators at a school have had the opportunity to

attend at least three professional development opportunities related to sexual health education

within a year, and whether students have had the opportunity to engage in sexual health

education in each school year.

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RECOMMENDATION 10: Develop systems to assess the quantity, implementation and delivery, and

student experience of health education and sexual health education

The Task Force recommends the City:

a. Add the number of hours of health education that students receive to the existing annual Local

Law 14 report, to provide public reporting on the specific quantity of health education provided

in both middle school and high school.

b. Develop mechanisms to capture student feedback on health education and sexual health

education courses and instructors, such as through the annual school survey. Students should

have opportunities to provide feedback on instructor knowledge and sensitivity about sexual

health topics; amount of instruction time within their health education class dedicated to sexual

health; information that was not included in the instruction; and schools’ progress in creating a

school-wide culture of sexual health wellness and inclusivity. These data will provide valuable

school-level information that can help identify student needs and actions school should take to

create and sustain a culture of sexual health wellness and inclusivity. NYCDOE should establish

mechanisms to ensure that schools review and respond to this feedback as appropriate.

c. Fund and implement annual onsite observations to gauge schools’ compliance with NYCDOE and

NYSED health education and sexual health education requirements, instructor delivery of

curricula, and schools’ overall efforts to create and sustain a culture of sexual health wellness

and inclusivity. These observations should serve as opportunities to identify schools’ strengths

and weaknesses and collectively develop action plans to help schools provide students with the

appropriate content, instruction, dosage, and timing of health education and sexual health

education. NYCDOE should conduct observations in a sample of schools each year, including at

least one school from each grade band in each district.

RECOMMENDATION 11: Engage external stakeholders and experts to study sexual health education in

NYC and make quality improvement recommendations

In addition to developing an internal system to track health and sexual health education content,

instruction, quantity, and timing, the Task Force recommends partnering with outside researchers to

review and publish findings regarding implementation of comprehensive health education curricula,

which includes sexual health education. The Task Force recommends the City:

a. Hire an external evaluator to explore the effectiveness of sexual health education

implementation in NYCDOE schools, and provide recommendations for improvement. An

evaluation of the effectiveness of the School Wellness Council model would be particularly

valuable. NYCDOE should explore funding demonstration projects to pilot new sexual health

education instructions and implementation strategies.

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VI: Appendices

Appendix A: Task Force Leadership and Members

Leadership

Jacqueline M. Ebanks, Executive Director, Commission on Gender Equity – Chair

Pascale Saintonge Austin, Director of Family Planning and Pregnancy Prevention Programs, Children’s

Aid – Vice Chair

Edie Sharp, Deputy Chief of Staff, NYCDOE – Vice Chair

Members

Elizabeth Adams, Co-Chair, Sexuality Education Alliance of New York City

Naureen Akhter, Parent

Aretza Arias, Student, George Washington High School

David Bell, Medical Director, Young Men’s Health Center

Maya Brady Ngugi, Student, Bard High School

Smita Deshmukh, Senior Legislative Counsel, NYC City Council

Sherell Farmer, Student, Midwood High School

Rodney Fisher, New Principal Support Coaching Fellow and Founding Principal, Marie Curie High School

for Medicine and Health Professions

Maura Flanagan, Teacher, PS373K Brooklyn Transition Center

Nora Gelperin, Director of Sexuality Education and Training, Advocates for Youth

Ashwini Hardikar, Director of Prevention and Outreach, Callen-Lorde Community Health Center

Lindsey Harr, Executive Director, NYCDOE Office of School Wellness Programs

Jennifer S. Hirsch, Professor of Sociomedical Sciences, Columbia University Mailman School of Public

Health

Deborah L. Kaplan, Assistant Commissioner, Bureau of Maternal, Infant, and Reproductive Health,

NYCDOHMH

Walter Logan, Student, Midwood High School

David Lopez, Director of Prevention Programs, BOOM!Health

Louise Marchena, Senior Director of Youth Program, Planned Parenthood of New York City

Will Mellman, Research Scientist, Columbia University

Hannah Pennington, Assistant Commissioner, Policy and Training, Mayor’s Office to Combat Domestic

Violence

Bryson Rose, Assistant Director of Training at the Center for LGBTQ Youth Advocacy and Capacity

Building, Hetrick-Martin Institute

Elizabeth Schroeder, Educator, Author, Trainer in Sexual Health Education

Anurag Singh, Chapter Leader of School Psychologist and Social Workers, United Federation of Teachers

Larry Tantay, LGBTQI Health Equity Specialist, NYCDOHMH

Yolanda Torres, Executive Superintendent, Division of Family and Community Engagement, NYCDOE

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Patty Yuen, Parent

Coordinators

Stephanie Fernandez, Policy Analyst, Office of the First Deputy Mayor

Shifra Goldenberg, Senior Policy Analyst, Mayor’s Office of Operations

Adrian Guzman, Director of Policy and External Affairs, Bureau of HIV/AIDS Prevention and Control,

NYCDOHMH

Jibreel Jalloh, Urban Fellow, Office of the First Deputy Mayor

Jackie Matos, Policy Advisor, Mayor’s Office of Operations

Angel Parker, Urban Fellow, Commission on Gender Equity

Juan Rosales, Managing Director for Policy Implementation, Office of the Chancellor, NYCDOE

Sara Shoener, Senior Policy Advisor, Office of the First Lady

Appendix B: Questions for Sexual Health Education Curricula Review

The Task Force recommends that the following questions be incorporated into sexual health education

curricula review conducted by the NYC District Wellness Advisory Council

Skills

• Are all skills from the National Health Education Standards, such as accessing reliable

information and self-advocacy, included?

Safety and Healthy Relationships

• Does the curriculum include violence against trans/GNC folks? How do they define violence?

Does it also include institutional and structural violence based on perceived and/or actual

gender identity and expression? Do lessons put onus on or blame victims of sexual violence in

any way?

• Are lessons regarding sexual violence and consent LGB and TGNC inclusive? Are they taught in

elementary, middle, and high school?

• Are lessons regarding healthy relationships and romantic relationships LGB and TGNC inclusive?

• Does the curricula include information for youth on how to protect themselves from sex

trafficking and exploitation, including tools to safely navigate potential exploitation and

information about resources available to youth who are at risk or in an exploitative situation.”

• Are lessons around navigating unsafe situations inclusive of LGB and TGNC students?

• Are K-5 topics such as family diversity, body autonomy/sexual abuse prevention, consent,

friendships, and puberty LGB and TGNC inclusive?

Gender

• Are lessons regarding anatomy and puberty TGNC inclusive in its content and teaching methods

(e.g., do they divide class by gender)?

• Do topics regarding sexual orientation also include information on gender identity and

expression?

• Does information regarding sexual orientation and gender identities and expressions get

introduced early in elementary school?

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Access to Resources

• Is there a lesson in middle/high schools about accessing clinic services and New York State

adolescent reproductive and mental health rights?

• Is information regarding HPV and prevention methods up to date?

• Is information regarding emergency contraception and methods of access up to date?

• Is information regarding PrEP/PEP and methods of access up to date?

• What information is provided about options for students who become pregnant (not just

pregnancy prevention)?

Other

• Do high school lessons regarding sex and sexuality include information on pleasure?

Pedagogical approaches

• Do recommended curricula utilize a skills-based approach (e.g., simulation situations)?

• Do recommended curricula encourage active learning (rather than didactic teaching/passive

learning)?

• Do recommended curricula actively encourage culturally responsive methods?

• Do recommended curricula take advantage of new media and other strategies to maximize

student learning?

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