An adolescent comes home from school at 3 p.m. No adults are at home, but perhaps the familiar electronic caretakers are available: a television, a VCR, a computer with Internet access, and a telephone. Or worse, perhaps there is a cabinet filled with liquor, a gun stored in the closet, or a pack of cigarettes in the top drawer. The phone rings, or there is a knock on the door. The adolescent's friend wants to get together.
Unsupervised out-of-school time: Anything can go, and nobody will know.
High-Risk Behaviors
All research data, including the Centers for Disease Control's Youth Risk Behavior Surveillance System, illustrate that youth engage in high-risk behaviors in alarming numbers. Nine out of 10 U.S. adolescents experiment with sexual behaviors, with one million becoming pregnant annually (86 percent unintentionally), 500,000 giving birth, and three million contracting a sexually transmitted disease (STD) (Haffner, 1995). Thousands of teens smoke cigarettes and use alcohol and drugs for the first time after school. Further, a recent study from the Office of Juvenile Justice and Delinquency Prevention (U.S. Department of Justice, 1999) reveals that one out of every 10 known violent crimes committed against juveniles on school days occurs between 3 and 4 p.m.
When most of us think of out-of-schooltime programs, we think of care for young children. But young children are not the only age group to benefit from adult supervision after school. Adolescents—especially those in middle school and junior high—can feel safe, improve their learning, and strengthen their life skills through programs that operate from the time school is over until a guardian comes home from work. We might suppose that a young person would scoff at the idea of attending an out-of-school program, but students who are involved not only are positive about their afternoons, but also are willing to continue these programs, even during summer vacation.
Although out-of-schooltime programs for adolescents offer many activities—from cooking classes to computer technology, homework assistance, and sports—they also offer an effective environment for health education and wellness instruction, especially pregnancy prevention, which many school districts tend to ignore. In fact, only 5 percent of U.S. students receive comprehensive sexuality education in school, despite broad-based support for such education from most sectors (National Guidelines Task Force, 1996). The reason for such a large discrepancy between the need for and the implementation of sexuality programs in regular classrooms is predominantly political, although administrators also indicate financial and time constraints. Where regular classroom instruction cannot be implemented or must be enhanced, out-of-schooltime programs provide an alternative avenue for preventative health education.
Supervised out-of-school time: A place to go for health information and skills that all youth should know.
Health and Wellness Instruction After School
The Palm Beach County, Florida, school district, the 15th largest in the country, serves students who live in communities that vary in geographic size, ethnicity, and socioeconomic situations. Many families are made up of working adults and school-age children. Twenty-eight percent of the households are single-parent homes. The district is unique in offering after-school programs at all 26 of its middle schools, a trend that is beginning to appear in innovative school districts across the United States. Those participants who receive free or reduced lunch, or who would otherwise be unsupervised after school, may attend the programs free of charge. Students who do not qualify for free admission but wish to take advantage of the program pay an hourly fee.
In 1997, a survey revealed that approximately 25 percent of those 7th and 8th grade students queried in the county were sexually active and participated in other unhealthful behaviors. In response to this finding, we were given permission to implement a growth and development and mental and emotional health project in six middle school after-school sites across the county during the 1998 school year and in one out-of-schooltime program managed by the Department of Health beginning early that summer. With funding from the Children's Services Council of Palm Beach County, the Working on Wellness (WOW) program was implemented.
After approval from the District Health Resource Committee, five certified teachers received training and materials. The teacher's manual contained eighteen 45-minute lessons designed to impart knowledge and to develop higher-order critical-thinking skills through class, group, and individual activities. Teachers also received worksheets for the students. We gave students a colorful eight-page newsletter, Hang on for the Ride!, which served as the text, and a folder to store the newsletter and worksheets. The teachers collected the folders after each session. About 200 middle school students participated in this part of the project.
The goals of the project were to teach students, through informal discussions and role-play, the knowledge and skills necessary to develop positive attitudes about their own health and the health of others and to understand how to make skillful and age-appropriate decisions regarding their behaviors, with a special focus on sexual activity and disease prevention. The project was marketed as health education and wellness "chat" sessions, emphasizing that this was not an academic offering, but a less structured way of helping adolescents gain information and skills in a more relaxed atmosphere than a regular classroom. Students signed up for the program voluntarily with parental permission. Student interest was significant; the program was oversubscribed because we had a limited number of available teachers.
All five sessions combined males and females of several grade levels. At five sites, students were in grades 6, 7, and 8; one site combined junior and senior high students. Most students were deemed at-risk because of socioeconomic standing or academic failure. The majority were African American and Haitian. Students learned through discussion and role-play, often accompanied by graphic organizers that reflected the contributions of the class. Thinking skills focused on compare-and-contrast activities, decision making, predictions, and analysis. Life skills focused on goal setting, refusal skills, and asking for help. Social skills included communicating, making friends, and showing empathy.
The experience was positive for two reasons. First, the informal, nongraded health education and wellness sessions allowed adolescents to discuss subjects that they ordinarily might not discuss in health class. And second, because of the relaxed atmosphere, participants felt more comfortable asking questions and sharing experiences that they otherwise might have kept to themselves. Peers communicated with one another and talked about common concerns, from sexual pressures to feelings of inadequacy. Discussions revolved around the specific functions of the reproductive system and development, abuse, STDs, abstinence, and laws affecting child support. Participants set short- and long-term goals, discovered how to get help for problems that they could not handle on their own, and practiced refusal skills to use when they felt pressured to become sexually active.
The Out-of-Schooltime Program
About 40 miles west of Palm Beach lie the western communities of Belle Glade, Pahokee, and South Bay, an area mainly supported by the sugar cane industry and local agriculture. There is much poverty, minimal economic opportunity, and little to occupy youth once school is out of session. The population has deeply felt the ravages of AIDS and is no stranger to adolescent pregnancies. Yet amid all these difficulties, the western communities have adults who are willing to give their time and expertise to create out-of-school-time programs that make a difference in young lives.
One such program is called HEART, managed by Henrietta Johnson of the Palm Beach County Health Department. HEART consists of a team of 90 adolescents, ages 10 to 18, who join together to reach out to their communities as peer educators. The HEART team's original purpose was to work toward the prevention of AIDS among African American, Haitian, and Latino youth through peer education and outreach. More recently, it has expanded its focus to include pregnancy prevention and other areas of health education. Twenty-two of the 90 members participated in the WOW project.
Unlike the discussion strategies that we used for sexuality education in the middle school after-school programs, this out-of-schooltime program implemented the community outreach project that accompanies the WOW growth-and-development module. Stay Cool: Don't Be a Fool is a youth-designed theatrical and musical performance that focuses on the common emotions that peers face and some "cool" ways to deal with these emotions. The HEART team analyzed how these emotions affect and are affected by sexual activity.
Participants worked on peer-leadership skills, discussed growth and development and mental and emotional health issues, and practiced life skills. Initial discussions about emotions revealed much about the participants and their peers: the ways in which they think, perceive, and react in various situations; their struggles; their strengths and weaknesses; and the skills that they need to cope with their emotions. Participants used the information to design the performance. They invited professionals to help develop the production, including a child and family therapist who advised on coping strategies and a music instructor who helped write the rap music. The participants have performed at numerous local public gatherings and are creating a music video from the original work, which they expect will air on cable stations.
Making a Difference
Although health and wellness education in after-school and out-of-schooltime community programs do make a difference, traditional evaluations of such projects are difficult, if not impossible. A major reason is that attendance in these programs is optional and those who might come to the first session may not attend regularly, thereby creating problems with pre- and post-testing. Also, because we combine most grade levels and learning abilities, comprehension occurs at all different levels. Finally, not all participants are proficient in English, and comprehension of materials and testing therefore vary.
Anecdotal assessments—through interviews and discussions with instructors and participants—are perhaps a more realistic and valid approach to assessing the success of a project. The words of the WOW project participants speak to its success. "I would not change these sessions because they can help others as they come along," one participant stated. Another commented, "The sessions have helped because before [attending] them, I never knew I could get a baby when my period's not on." Still another said that the sessions helped her understand why she should "not have sex at an early age." And another expressed that the sessions "helped me see what I can be in life, and what I can hope for."
As for the participants in the community outreach project, the messages that peers received through the music and the play indicate that these adolescents have become messengers of prevention, healing, and caring. They now can increase their own resiliency as well as help others resist unhealthy behaviors.
Taking an Active Role in Health
The research provides us with clear directions to take with youth. We must let students be part of the learning process. Youth no longer have to be passive recipients of health and wellness education. They can be involved and active assistants in their own learning and can, in turn, teach their peers (Berkin, 1993).
The experience in Palm Beach County, Florida, reconfirmed our belief that teaching adolescents to be advocates for health and safety is essential to make an impact on their attitudes and behaviors. These projects demonstrated that additional avenues and alternative approaches to learning about health and wellness can make a difference—especially when youth take an active role and are empowered to take an interest in their own health and the lifestyles of their peers.
