Frequent Questions About the Postponing Sexual Involvement Program
The Postponing Sexual Involvement Program staff at Cincinnati Children's Hospital Medical Center have prepared responses to questions frequently asked by professionals.
PSI Frequently Asked Questions, February 2008
Q. What is PSI?
The Postponing Sexual Involvement Educational Series (PSI) was created by Marion Howard, PhD, and Marie Mitchell, RN, at Emory University / Grady Memorial Hospital in 1983. It is an educational curriculum designed to help young teenagers and pre-teens learn to resist social pressures and peer pressures to become sexually active at inappropriately early ages. The mission of Cincinnati PSI is to create among young teens positive peer pressure and social pressure for abstaining from sexual activity.
Q. Where can I order the PSI curricula?
Contact: Jane Fonda Center at Emory University, 404-712-4710
Q. Who runs Cincinnati PSI?
In Cincinnati, PSI is run as a partnership between Cincinnati Children's Hospital Medical Center and the Cincinnati Public Schools (CPS). PSI is one of several community health education programs of Cincinnati Children's Division of Adolescent Medicine, and affiliated with the Adolescent Health Center of Greater Cincinnati, Inc. The program is overseen by Christopher Kraus, JD, MTS, Adolescent Advocacy Manager, and Paula Braverman, MD, Director of Community Programs. Five professional staff members deliver the program, along with student interns and Americorps community service fellows.
Cincinnati PSI also operates PSI PAYOFFSM, a community outreach, training and consultation service for school districts and community groups outside of CPS. PSI PAYOFFSM has helped establish PSI teen leadership programs in the tri-state area, and around the country, including:
- Washington, DC
- Harlem, New York
- Rochester, New York
- Corpus Christi, Texas
- Richmond, Virgina
- Williston, North Dakota
- Ft. Smith, Arkansas
- Columbus, Ohio
- Milford, Ohio
- Highland County, Ohio
- New Miami Schools in Hamilton, Ohio
- St. Bernard-Elmwood Place Schools
- Ohio and Kentucky Department of Health
Q. How is PSI places in the school curriculum?
This depends on whether the school building has a discrete health class, or an integrative approach where health topics are introduced into the science or language arts curriculum. Both scenarios apply in the 28 school buildings that hosted PSI in 2006 and 2007. The most popular grades for PSI are 6th and 7th.
However, a significant number of 5th and 8th grade teachers host PSI. In each class, the teacher is responsible for teaching basic sexuality information about human anatomy, reproduction, family planning, pregnancy and sexually transmitted infections. A pair of PSI Teen Leaders and a PSI Adult Leader teach PSI once a week over a six-week period. Teacher training is provided through workshops, orientation sessions, and follow-up support from Cincinnati Children's.
Q. Does PSI teach abstinence?
Yes. Don't get caught up in the politics of sex education. Public rhetoric about sex education describes a subtle distinction between "Abstinence Only" and "Abstinence-Based" curricula. Sometimes a distinction is made between "Abstinence Until Marriage" curricula and "Comprehensive Sex Education." The political jargon describes the moral philosophies of program sponsors, as well as the extent to which written curricula and human instructors emphasize abstinence and de-emphasize protection. Certain government grants require adherence to the federal definition of "abstinence only" education. Cincinnati PSI reflects the policies of its sponsors and funders:
- Cincinnati Children's
- Cincinnati Public School District
- United Way of Greater Cincinnati
- The Rudi Johnson Foundation
PSI takes a medical, social and emotional perspective that emphasizes to young teens that they should postpone sex until they are mature enough to handle the consequences. PSI curricula and instructors discuss marriage as a societal ideal that sometimes does not comport with participants' reality. PSI discusses protection as a way to reduce but not eliminate the risks of sex.
Q. How is PSI financed in Cincinnati?
PSI has been funded by a variety of private and public foundations. In fiscal year 2007 revenue supported a program that reached 1,800 students, and a consultation service that assisted five other school districts and community groups in implementing a PSI peer-led program. In fiscal year 2007 funding included the local United Way (46% of PSI revenue), 25 Cincinnati Public School buildings primarily through federal Safe and Drug Free Schools grants, University of Cincinnati's federally funded GEAR UP Success Partnership program, The Rudi Johnson Foundation and individual donors. There are significant in-kind contributions from Cincinnati Children's Hospital, The Adolescent Health Center of Greater Cincinnati and Cincinnati Public Schools. Contributors in fiscal year 2008 include the The City of Cincinnati, United Way, ReZoom.com and Cincinnati Public School buildings that have directed some of their general funds or federal Safe and Drug-Free Schools funds towards PSI.
Historically, over 90 foundations have supported PSI during its eighteen years, including the Adolescent Health Center of Greater Cincinnati, the Cincinnati Public Schools, Health Foundation of Greater Cincinnati, Ohio Wellness Block Grants, Greater Cincinnati Foundation and many more private foundations committed to short-term start-up objectives.
In Cincinnati, PSI costs about $200 per pupil. Cincinnati PSI charges a $25 per-pupil service fee to CPS buildings hosting PSI in 2007-08. In a small school district that targets 400 students per year, PSI can cost as low as $8 per pupil. PSI PAYOFFsm charges groups outside of CPS a training fee of $800 per 8-hour day ($100/hour), plus travel, meals and lodging. This does not include the cost of PSI books, which must be purchased from Atlanta PSI.
Q. How do we recruit and screen teen leaders?
In 2007, 140 high school students applied for 55 PSI Teen Leader positions. Cincinnati Public School students can pick up applications from their principal, guidance counselor, or online and return completed PSI applications to the PSI Office at Hughes Center, by May 15. Grades, personal references, and an essay make up part of the selection criteria. All qualified applicants entering grades 10, 11, or 12 are interviewed in person by a PSI Adult Leader. Final selections are based on the applicant's belief in the philosophy of PSI, ability to speak persuasively in front of peers, and social/academic responsibility. PSI seeks qualified male and female candidates from a variety of schools, neighborhoods, and cultures.
The sexual behavior of Teen Leaders is a private matter, and thus not an explicit selection criterion. PSI Teen Leaders must agree to abstain from sex. Students involved in a teen pregnancy or teen parenthood are not permitted to be a PSI Teen Leader. Qualified teen parents are selected as guest speakers who speak on the realities of teen parenthood.
Q. What do the teen leaders do in PSI?
First, PSI Teen Leaders are role models for responsible sexual behavior, ambitious career aspirations, and community service. Once a week, Teen Leaders travel in pairs to an elementary or middle school class, where they teach six 45-minute lessons from one of the PSI Leaders' guides Postponing Sexual Involvement, or Managing Pressures Before Marriage. Teen Leaders actually run the class, conducting activities, leading discussions and role plays, showing video segments, assigning homework and interactive activities with students' guardians and developing a positive rapport with the students. Teen Leaders are also involved in some behavior management of their students.
Q. How is adult supervision provided?
The PSI Adult Leaders provide training for the Teen Leaders. There are 19 hours of training in August, and two hours each month throughout the year. The Adult Leaders drive the Teen Leaders from their own senior high schools to the junior high, middle, or elementary school buildings, and assist the Teen Leaders in getting ready for the class, and managing students' performance. The Adult Leaders stay with the class and then take the Teen Leaders back to their own school. Adult Leaders complete written performance evaluations for each Teen Leader.
Q. Is this a high school program? A middle school program? An elementary school program?
In Cincinnati, it is a program that is serving all three levels of the school system.
Q. How is PSI being evaluated in Cincinnati?
In several ways. PSI has been well received by students, parents, teachers and the general community. Less than 1% of parents of students have opted for their son or daughter to not participate in PSI. Parent surveys conducted by volunteers indicate a high percentage of satisfaction with the program. It has received numerous favorable feature and editorial comments in the Cincinnati and national press, radio, and television.
Secondly, individually matched pre- and post-tests from 1,002 student participants in 2006-07 show that PSI had a statistically significant impact on young teens and pre-teens.
- 45% of students significantly improved their knowledge of assertiveness techniques after taking PSI (p <.01)
- 80% of students maintained or strengthened their intentions to abstain from sex after taking PSI (p <.01)
- 40% significantly strengthened their intention to talk with their parent/guardian in the next three months about the right time to become sexually active (p < .01)
- 31% significantly increased their comfort level in starting a conversation with their parent/guardian about the right time to become sexually active (p<.05)
Thirdly, PSI tracks the number of live births by year as well as by age (16 years and younger) for girls in the City of Cincinnati. This information gives some trends, but does not specifically address the effect of the program on an individual student. From 1993 to 2004, the number of births to young female teens in Cincinnati has declined by 47%.
The references below cite research studies in Atlanta, Washington DC, and Exeter, England where PSI had a statistically significant impact on delaying student participants' sexual behavior, compared to similar groups that did participate in PSI.
Q. What advice do you have for smaller and/or suburban school districts who want to start PSI?
First, identify Coordinators, people who have time, are motivated and comfortable with the philosophy and content of PSI. Approval of the material should begin with the Board of Education. Finally, establish a partnership with a regional hospital to pool resources, and finance the program.
Q. Are Cincinnati PSI staff available for consultation?
Yes. Contact Mr. Kraus (christopher.kraus@cchmc.org) at 513-363-7795; fax: 513-363-7765, or e-mail.
Q. Why can't the health teachers teach PSI?
They can. There is some evidence (see references) that PSI is effective for young teens when taught by Teen Leaders, or others who are enthusiastic about the lessons. However, peer education in PSI attracts schools and local funding sources that prioritize youth leadership development and community service.
References
Aarons, S. J., Jenkins, R.R., Raine, T.R., El-Khorazaty, M.N., Woodward, K.M., Williams, R.L., Clark, M.C., and Wingrove, B.K. (2000). Postponing Sexual Intercourse Among Urban Junior High School Students—a Randomized Controlled Evaluation. Journal of Adolescent Health. 27(4):236-247.
Howard, M. (1985). Postponing Sexual Involvement Among Adolescents. Journal of Adolescent Health Care. 6:271-277.
Howard, M. J. McCabe. (1990) Helping Teenagers Postpone Sexual Involvement. Family Planning Perspective. 22(1): 21-26.
Howard, M. Delaying the Start of Intercourse Among Adolescents. (1992). Adolescent Medicine State of the Art Reviews. Philadelphia: Hanley & Belfus, Inc. 3(2): 181-192
Kirby, D. (1997). No Easy Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: The National Campaign to Prevent Teen Pregnancy.
Kirby, D. (2001). Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: The National Campaign to Prevent Teen Pregnancy.
Manlove, J., Franzetta, K., McKinney, K., Romano-Papillo, A., and Terry-Humen, E. (2004). No time to waste: Programs to reduce teen pregnancy among middle school-aged youth. Washington, DC: National Campaign to Prevent Teen Pregnancy.
Mellanby, A, and Tripp, J. (1996). Delay in First Sex is Seen Among British Teenagers in Sex Education Program. Family Planning Perspectives. 28:83-84.
14 and Younger: The Sexual Behavior of Young Adolescents. (2003). Bill Albert, et al., Editors, Washington, DC: National Campaign to Prevent Teen Pregnancy.
Sulak, PJ, Herbelin, SJ, Fix, DDA, et al. (2006). Impact of an adolescent sex education program that was implemented by an academic medical center. American Journal of Obstetrics and Gynecology, 195(1): 78-84.
Terry-Human, E, Manlove, J and Moore, K. (2005, January). Playing Catch-Up: How Children Born to Teen Mothers Fare. Washington, DC: National Campaign to Prevent Teen Pregnancy.
Sieving, R.E., Eisenberg, M.E., Pettingell, S. and Skay, C. (2006, March). Friends' influence on adolescents' first sexual intercourse. Perspectives on Sexual and Reproductive Health, 38(1), 13-19.
Fasula, A.M., Miller, K.S. (2006). African-American and Hispanic adolescents' intentions to delay first intercourse: parental communication as a buffer for sexually active peers. Journal of Adolescent Health, 38, 193-200.
Glynn, L.G., MacFarlane, A, Kelly, M, Cantillon, P., and Murphy, A.W. (2006, March). Helping each other to learn – a process evaluation of peer assisted learning. BMC Medical Education, 6:18.
To see a change... Be the change...
Get more involved in PSI!
- Attend teen leader training on topics like Preparing for college, and How to get along with your Parent
- Recruit qualified Teen Leader applicants by putting an application in their hand
- Join the Adolescent Medicine Community Health Education Advisory Committee
- Call the PSI Office with your ideas, 513-363-7795
