Guide to Effective Programs
for Children and Youth

Reach for Health Service Learning Program

OVERVIEW

The Reach for Health community service (RFH CYS) program is an intervention designed help youth develop the skills and knowledge they need to make positive health choices and avoid high-risk behaviors, such as early sexual initiation. The program consists of classroom health lessons and service learning, where students perform weekly community service and reflect on the experience in the classroom as a group. A study of RFH CYS participants surveyed in 7th grade and again in 10^th grade found that students who participated in the intervention were less likely than their peers in the curriculum-only group to have initiated sex by 10^th grade.

DESCRIPTION OF PROGRAM

Target population: Urban African-American and Latino middle school students.

The Reach for Health community service (RFH CYS) aims to help children and adolescents develop the attitudes, skills, and knowledge necessary to make healthy choices and avoid risky health behaviors. The program has two core elements: a classroom health curriculum and a service learning component. At the beginning of the school year, students participate in an orientation where they learn about their community service placements and set personal goals for their service. Students work at their placements three hours a week which results in approximately 90 hours of community service in a year. Each student participates in one or two different placements which include, for example, nursing homes, child day care centers and full-service clinics. Students receive instruction and guidance from field staff and their classroom teachers. Once per week students meet to discuss and reflect on their experiences, problem-solve, and share knowledge gained from their service.

The second component of RFH CYS involves a classroom health curriculum. The purpose of the school-based curriculum is to help students choose healthy behaviors while avoiding risks and to communicate their needs. The curriculum is developmentally-appropriate for middle school students and emphasizes interactive classroom activities. The 7^th grade curriculum consists of 40 lessons while the 8^th grade curriculum has thirty-four. Lesson content is determined, in part, by focus groups that consist of teachers, parents and students. Topics are culturally relevant to the population and include sexual activity, violence, and substance use, as well as general healthy development and sexuality.

Classroom teachers receive training in the health curriculum as well as training to help guide reflection on the community service placements. Field placement staff receive a training in the more technical aspects of each students’ placement and site, and there is ongoing collaboration between these staff members and the teachers. Finally, field staff researchers conduct monthly site visits and observations to monitor program implementation and answer questions.

EVALUATION(S) OF PROGRAM

Evaluated population: Seventh-grade students from a New York City public middle school serving economically disadvantaged adolescents were randomly assigned by classroom (n=18) to participate in the RFH CYS program (intervention group) or to a control group. Although only RFH CYS students participated in the community service component, students in both groups received the classroom health curriculum. Both the classroom health instruction and community service assignments were implemented for 2 years while the students were in 7^th and 8^th grade. Seventy-one percent of the students identified themselves as African-American and 26 percent as Latino.

Approach: During the spring of 1998, when the participants were in 10^th grade, follow-up surveys were administered to students who completed a 7^th grade baseline survey, attended 8^th grade at the school, and continued to live in the New York Metropolitan area. Seventy-seven percent of eligible students completed a 10^th grade survey (195/255). Although the majority of students remained in their assigned condition over the course of the study, fifty-two students did move between treatment and control groups due to additional resources and scheduling conflicts. Students who transferred between conditions are assessed according to their original assignment unless otherwise stated.

Self-report questionnaires were administered at baseline (7^th grade) and follow-up (10^th grade). The questionnaire items assessed lifetime and recent sexual behaviors, teen pregnancy and sexual behavior change scores, i.e., teen became sexually active.

Results: At baseline, 62 percent of boys and 90.5 percent of girls reported never having had sex. At the 10^th grade follow-up, 69.2 percent of boys and 50 percent of girls had become sexually active. Although differences by gender were significant, results did not vary by ethnicity.

Data reveal that among virgins at baseline, 27 percent of boys and 47 percent of girls in the curriculum-only control group remained virgins at follow-up. These numbers contrast with data from the RFH CYS treatment group, which reveal that as many as 43.5 percent of boys and 57.1 percent of girls had not initiated sex during the same time period. Furthermore, 69 percent of boys and 47.2 percent of girls in the control group reported recent sex at follow up. The treatment group reported that 44.8 percent and 38.1 percent, respectively, had engaged in recent sex.

Overall, the study found that RFH CYS students were less likely than control students to have initiated sex or to have engaged in recent sex by the 10^th grade follow-up. (Although these findings were significant at the p < .1 level, when students who had switched conditions were removed from analyses, these findings became significant at the p < .01 level.)

Further analyses assessed differences among the full 2-year RFH CYS students, the 1-year RFH CYS crossover students, and the curriculum-only control students. No differences were found among the three groups at baseline. By the 10^th grade follow-up, 18.5 percent of control females reported having been pregnant, in comparison to 10.3 percent of 1-year crossovers, and 6.8 percent of 2-year RFH CYS female students. However, the authors caution that sample sizes are too small to warrant firm conclusions.

With regard to initiation of sex, 80 percent of boys and 65.2 percent of girls in the control group had initiated sex by the 10^th grade follow-up. The results for boys and girls in the 1-year and 2-year RFH CYS condition groups are 61.5/48.3 percent and 50/39.6 percent, respectively. Overall, students in the curriculum-only control group were more likely to initiate sex and report recent sex by the 10^th grade follow-up than either the 1- or 2- year RFH CYS groups. Gender remained a significant predictor, with boys more likely than girls to engage in the sexual behaviors reported.

SOURCES FOR MORE INFORMATION

References

O’Donnell, L., Stueve, A., O’Donnell, C., Duran, R., San Doval, A., Wilson, R.F., Haber, D., Perry, E., and Pleck, J.H. (2002). Long-Term Reductions in Sexual Initiation and Sexual Activity Among Urban Middle Schoolers in Reach for Health Service Learning Program. Journal of Adolescent Health, 31, 93-100.

Program categorized in this guide according to the following:

Evaluated participant ages: 7^th, 8^th and 10^th grade students

Program age ranges in the Guide: 12-14, 15-21

Program components: school-based; service or vocational learning

Measured outcomes: social and emotional health and development; teen pregnancy and reproductive health; positive citizenship

Program information last updated 9/22/2006.