and practice experience of medics at Sverdlovosk Oblast family planning Centre June
1999- November 2000
Juliana Slobodian

Seconda parte


A policy provides an outline of the structure and organisation of sex education programs in an establishment. Generally, one lead person takes responsibility for creating a small working party of colleagues and parents who develop and write it. It is then disseminated to a wider audience for further consultation and input to produce the final document. It is extremely useful because
• Staff and parents know this is a well thought out planned area of work
• It provides a focus that prevents ‘anything’ from being taught
• Staff, community and parent representatives work together for the benefit of young people
• It supports the establishment should it be questioned about its activities by people external to the organisation.

‘Model Framework for a Written Policy Document in Organisations
Working with Children and Young People’
Name and type of Organisation Date of policy Review date
1. Description of organisation; (social, environmental details etc)
2. Policy Development and Consultation Process.
People involved; staff, community leaders, parents
Statement about the rationale for sex education with children and young people.
3.Aims and objectives.
Overall aim of sex education for children and young people
What areas are to be taught?
What children and young people will learn?
4.Morals and Values Framework.
What messages the organisation will encourage it’s children and young people to value, promote and respect in each other, society and the organisation community.
5.Organisation of Sex Education.
Name of Co-ordinator responsible for planning and delivery.Who will teach it?Where and when it will take place.Specific arrangements; room, single sex or mixed groupsTraining for staff; meetings or workshopsMethodology and approaches; HOW it will be taught; activities, discussion, lectures, outside speakersStrategies and safeguards; ground rules, confidentiality
6. Content Headings for the Program.
     Include a statement about imparting information, developing skills.
7.Working with Parents.
A statement on how the organisation will work with and consult with parents; meetings, workshops or individually
8.Dissemination of the Policy.
Who will receive it?
How will it be made available?
9.Monitoring and reviewing the program.
What procedures the organisation will use for determing its effectiveness;
questionnaires etc

Rationale for undertaking sex education work:‘Why am I doing this?’
From time to time the medic will be asked about the purpose of sex education programs and why she or he is personally involved. This question may be the result of genuine interest on behalf of the inquirer or it may be in the form of criticism. It is extremely useful for the medic to consider their rationale for doing this work prior to such a situation. Inquirers may come from representatives of religious groups, parents, youth and teaching institutions, colleagues, and friends who are often reflecting on information received through the mass media. Consider information that can be given as responses to questions
Gather statistics that support there is a problem requiring a structured well planned educational response.

  • Use points from the sections ‘policy’, ‘what is sex education?’ and ‘why do it?’
  • Collect information from regional and local strategy to indicate a context for the work.
  • Refuse to enter into a personal debate and maintain a calm, professional, work focus.
  • Refer persistent enquirers to a manager or appropriate person in authority.

Meetings and workshops with staff
Many staff working with young people feel unskilled and inexperienced when giving advice on personal relationships. Family Planning Centres respond to this by offering core training courses. There is an increasing need to provide basic training to non•medical professionals working in youth clubs schools. In some countries, the main responsibility for delivering sex education work in schools is with trained teachers in partnership with nurses. An initial meeting with a staff member in the establishment provides valuable information about the needs of teachers and youth workers in supporting sex education work. What staff want to know about sex education can be determined via a questionnaire. It is best distributed and completed prior to the training as medics can pre-plan accordingly. A small response will give a good indication of the needs of the whole group.

Staff workshop questionnaire
Establishment date
Please complete the following questions regarding teaching sex education sessions. It will help medics to plan a workshop according to the areas of need in developing or updating the work with young people in your establishment. Please indicate which of the following is taught in your institution
1. Information and facts 
• Anatomy and physiology
• Sexual activity 
• STIs and HIV
• Puberty 
• Pregnancy 
• Contraceptive methods 
2. Relationships  
• Different types
• Special relationships and dating 
• Marriage and parenthood 
• Communication skills 
• Assertiveness and dealing with pressure 
• Delaying sex 
3. Attitudes 
• Changes in society and impact on young people’s lifestyle
• Images of relationships and gender roles via media, family, friends
• Personal and society attitudes towards unplanned pregnancy, abortion, STIs and HIV, different types of family, monogamy and multiple partners, teenagers use of contraception.
4.  Which age groups are taught the above?
5.  Who teaches it? How many sessions?
6.  How is it taught-organisation and methods? (individual, mixed or single sex groups, lectures, active learning techniques etc)
7. What areas do you want discussed in the workshop?
• Information and facts. 
• Skills (how to apply  Attitudes (pressures learned facts to risky  placed on individuals 
situations).  by media, society etc 
8. Is there anything else you would like covered? 

The benefits of staff having a workshop or meeting are
• To clarify what sex education is, and is not, and why there is a need for programs with young people.
• To dispel myths and misinformation, and provide information on curriculum areas that is at an appropriate level for non-medical staff.
• To encourage staff to consider their attitudes and experience in the context of changing society and young people’s lifestyles.
• To gain support for the programs and provide referral information to medical services.
• To provide a forum for discussion and an opportunity to develop staff confidence.
• To encourage staff to undertake any initial preparation or follow-up work with young people prior to or after sessions with the medic.
The above objectives would be met within a one-day workshop or prioritised for two
sessions lasting two hours each. A discussion meeting may be more appropriate if there
are time constraints or medics lack experience and skills in training.
The following agenda outlines a meeting with staff. Amendments may be required for certain situations.

Sample agenda for a staff meeting
1. Introduction of personnel (medic, staff member responsible for linking with medic, school director etc)
2. Why have a staff meeting/workshop:  Points from the above section, ‘rationale for sex education’ and ‘agenda for parent’s  meeting.’
3. Description of the program (If a needs assessment workshop, the following to be determined during the session)
• The aims and objectives.
• The main topics
• The activities
• Materials used
• Total number of sessions and hours.
4.  Questions
5.Where next?

 What is going to happen as a result of this meeting ( for example designing the
program or another meeting after the program delivery for feedback) If funding allows, providing refreshments helps to reduce tension and create a more relaxed atmosphere.
This questionnaire can be used for discussion on defining what is sex education.



I think sex education is ( Yes  No ) 
Teaching details of the human body 
Teaching young people to enjoy their sexuality 
Preparing young people to have personal relationships 
Reducing the risk of possible exploitation 
Helping young people to gain confidence in communicating with the opposite sex 
Giving young people knowledge of the physical and emotional aspects of relationships 
Teaching young people about responsible sexual behaviour 
Helping young people to build personal relationships in accordance with family values 
Giving knowledge on human reproduction 
Giving fundamentals of healthy family relationships 
Unplanned pregnancy and STIs prevention 
Helping young people to consider ways of expressing their sexuality 
Teaching about HIV and safer sex practices 
Add one more item 

Staff may be resistant to attending training due to the subject raising discomfort or because they believe it is not their job. Occasionally, it is a minor crisis that encourages staff to seek training from medics (for example, a series of unplanned pregnancies among the young women). As with young people and parents, the medic will have to deal with staff defences. The following may help:
•Prior to the session provide basic information about its content. This could be a letter to be read aloud at a staff meeting or a course leaflet. Keep it ‘low key’. This reduces people’s fantasies about what is going to happen.
•In the workshop title use words concerned with relationship and lifestyle issues and avoid direct words associated with sex. Make the wording and title relevant to their profession and client group.
•Provide some indication of what the staff will gain as a result of the workshop.
•Indicate that participants will be discussing professional and not personal issues.


Example of staff leaflet
You are invited to a professional development workshop delivered by (medic’s name) of the (medic’s clinic).
Are you concerned that young people make healthy choices about relationships?
Do you want to support young people to engage in less risky behaviour?
Relationships and lifestyle issues for young people
Attend this meeting to Update your information on the aspects and consequences of personal relationships among young people. Discuss what can be done to improve the situation and how this establishment may contribute.
Venue: Date: Time:
Please contact (staff name) for additional details.
This is a professional workshop – staff will not be asked to discuss personal issues.

A Safe Environment
A safe environment is a meeting, workshop or session where leaders enable the participants to feel comfortable about expressing thoughts or admitting to vulnerabilities. This applies not only with staff groups but also with parents and the young people themselves. Certain things can be done to create a safe environment;
•Avoid the need for personal exposure by using the third person and other distancing techniques.

•Use a development approach to increase the safety of sessions; discuss sensitive topics after group introductions and after a few less controversial points have been explored.
•Don’t impose your personal agenda – by, for instance, making participants feedback the results of small-group discussions to the whole group if they don’t wish to
•Recognise that not everything can be dealt with in these sessions. Provide links to other services or sources of support.
• Create a list of agreements for working together or ‘ground rules’. If two or more sessions are planned, discuss the pros and cons of whether the group will be  ‘Closed’- a safer group, with a fixed number of known participants regardless of sessional attendance figures. Or  ‘Open’- a less safe group, with a fluctuating number and mixture of new and old members each session.
Principles of working together
Ground rules establish a way of group members working together. Sex education arouses strong feelings in people and hence, influences certain behaviours and consequences. The medic at the beginning of the program/session can provide a short list of agreements and ask the group to sanction and add to them, or can do a short brainstorming activity to create a personalised list for each group. It is useful to pose the following:
 “If I want to say something in this group, I need to know that members will accept my contribution and behave in a particular manner.” It is then useful to offer an example such as; “ Listen to me and not speak as I talk.” This can then be transferred into a general rule about speaking and listening. It is vital that the group understands what each means and it is essential that the following rules are included
• Confidentiality (1) – group members do not divulge personal information about
identified other people during the session. This includes clients, other group
members, neighbours etc.
• Confidentiality (2) – the personal opinions discussed in the session remains the business of the group members only. Information and learning may be used and applied outside the group.
• Disclosure – personal experience of a sexual nature is not required for learning in the work. It is also unnecessary to enquire about the personal experience of other group members including that of the medic.
The above are essential for focusing the sessions on educational principles and avoiding sensational and sexual overtones in practise. Should a group member start to personalise matters in the sessions it is essential to remind him/her of these agreements.The whole list must be manageable and contain a priority of agreements; no more than 6 in total. They can always be reviewed should situations demand something else be added. Avoid making too many ‘don’ts’ and try to couch agreements in a positive way. Language, age and developmental levels must be taken into account when devising agreements with different groups (including staff and parent groups).
The role of staff in the session
The medic may deliver the program alone or with a colleague. However, it is worthwhile considering whether to include a key member of staff from the organisation. This person’s role could be as a partner if they have particular experience such as biology teaching or psychology training. They may have a learning observational role if they lack experience or specific knowledge.
Partner  Multi-disciplinary working.
Sharing of different perspective, skills and experience. Ensures a key staff member has relevant training skills and knowledge from medics. Young people have an immediate source of future information in the organisation. Key staff member likely to refer young people to medical services for individual consultation.  Time required pre-planning and preparing sessions. Needs negotiation of who leads which activities. Requires discussion about individual responsibility with the group – who disciplines, which contributes which resources. Demands mutual respect for specific skills and experience. 
Observational  Key staff member learns about the subject area and referral possibilities for young people. May learn new information about the lifestyle, behaviour, and attitudes of the client group. May provide useful feedback to medics about the activities and style of the session.  Staff member may be unable to observe without participating and affecting the session. Young people may feel uncomfortable with staff in the room and not contribute. Medics may feel uncomfortable when sensitive issues are discussed. 


Communication between adults and teenagers
Teenage years is a time of life when young people are going through a process of huge physical change which impacts on the individual emotionally and psychologically. As a result, family members are involved in the consequences of such shifts in growth and trauma. This is often experienced as a difficult time for all concerned. The major emphasis for young people is one of leaving childhood behind and struggling to enter the world of adults. It involves risk taking, experimentation, peer group identification, and learning from mistakes. This process is worrying for parents who wish to provide support and protection but experience rejection from their child. Most adults including teachers and medics encounter a struggle with control as young people demand more power for themselves in their relations with them. Anyone who is not part of the peer group and youth culture may also experience this. Consequently, changes are required in the way adults relate to young people if channels of communication are to remain open.
Participation of Parents and Family Members
The involvement of parents and other family members in programs relating to sexuality benefits both children and parents. If the program is to make a difference, it needs to receive support from the home. Parents who are involved provide valuable support and motivation for the program and serve as valuable resources for reinforcement of healthy attitudes and behaviours.
A program that involves parents and families:
- Offsets possible resistance in the local area
- Increases knowledge of parents, relatives, and other children in the family.
- Ensures greater acceptance of the program in the community.
- Acknowledged the role of parents and relatives in their child’s education and in the development of his or her values.
- Facilitates communication between adults and children in the family.
Although many medics fear opposition by parents, most of them are favourable to sex education programs once they realise the benefits for their children. Many medics are parents themselves and it is useful to consider the issue from this parental experience as well as from the medical perspective. The need for preventive education needs to be explained to them; they need reassurance that sex education does not promote sexual experimentation, but rather protects them from exploitation and makes them aware of the risks involved.
Family units
Delivery of sex education should be in context of family values and positive relationships. Within Russian society, there are different types of family units: single parent families, second or third marriages that brings together children from previous marriages, and unregistered partnerships. Consequently it is vital when working with parent groups and young people to be sensitive to these situations. A percentage of the participants are likely to be living differently from the ‘ideal’ family unit. Discussing family values without acknowledging these variants in a positive manner may cause offence. In working with this issue, consider the following;
• Use positive phrases such as ‘Most people stay married to the same person all their lives and others chose to do differently’.
• Discuss social and personal attitudes to various family units in a non-biased and sensitive manner.
• Without judgement, consider the advantages and disadvantages of different relationships.


How to involve parents and other family members
Parents concerns about sex education programs can be alleviated with good communication between themselves and the medic delivering the work. Success can be enhanced through considering the following:
 • Parents are worried about the welfare of their children. Understand their viewpoint
and invite them to discuss issues of protection and reducing risks for their children. • Be sensitive, use language that will not offend or prohibit them attending a meeting or supporting the work
• Avoid sexual words or direct reference to sexual activity in written materials.
• Consider alternative titles for the program such as ‘relationships’ or ’personal lives of
teenagers’ or ‘becoming adults’.
• Respect them as supportive and contributing partners in this program with their children. • Accept they may wish the medic to take more responsibility in this ‘specialist’ area.
How can parents be involved?
Contacting parents may require collaboration with other professionals who have already developed good links with them. Consequently the medic may delegate this task to a teacher or youth worker and discuss which of the following may be the best approach
• Parents attend a meeting to discuss the program, look at any materials, and ask questions.
• The medic attends other parent gatherings such as meetings at school and asks for time to talk to them about the program and protection.
• During or following the sessions, parents could be invited to attend a presentation on the work or a short play by young people.
• Parents’ leaflet can be prepared and distributed with information on the issues for young people and advice on how they can best help their children.
• Parents are informed by letter or in a meeting about the program.
Parents and some young people may find it difficult to talk with each other on sexual matters. It is important that they are informed this is a common situation and not made to feel bad about this. Referral services and places of advice and support for young people should be given to parents to suggest to their children.

Sample letter to parents

Dear parent/guardian
We are starting a new educational program on relationships. Your child will learn about aspects of adult relationships and acquire facts and information that will protect him or herself from unwanted behaviours and to keep healthy.
STIs and unplanned pregnancy are a problem in our country, and young people are at risk of these situations. They need information and skills in order to avoid them. Education about these issues does not encourage young people to have intimate relations, rather it makes them realise the risks involved and enables them to make responsible decisions about delaying such behaviour and to protect themselves. Research shows that this kind of education is most effective if given before young people become involved in intimate relationships.
Your interest and support in these activities will be most valuable. If you have any questions about the program do not hesitate to contact me.
Yours sincerely,
(Name of medic and supporting signature of organistion director)


The following agenda outlines a meeting with parents. Amendments may be required for certain situations.

Sample agenda for a parents meeting
1.  Introduction of personnel (medic, host of youth organisation, school director etc)
2.  The need for a program: ‘sex education’, ‘relationships’ or ‘becoming an adult’. Examples of points to use:
•  Statistics and sexual health problems amongst young people in the region
•  Risks for young people about STIs/HIV, pregnancy.
• Young people have sexual relations despite the recommendations of adults to the    contrary.
• Young people need information and skills to avoid infection and unplanned pregnancy.
• Education about sex does not encourage sexual activity rather it makes them realise the risks involved.
• Parents should talk about sex with their children, and the program may make this easier.
• Society has changed and children are exposed early to information whether parents like it or not. It is better they have correct information.
• Sex education for delaying sex and protecting oneself is more effective if given before young people become sexually active.
3. Description of the program
• The aims and objectives.
• The main topics
• The activities
• Materials used
• Total number of sessions and hours.
4.  Questions
5. If appropriate, try one young person’s activity with the parents
6. Make suggestions how they may interact with their children. If appropriate, do an activity together.
7.  Final questions, contact numbers of services and farewells.
The session should be about one and half-hours. It will be necessary to negotiate a break with participants if they request longer. If funding allows, providing refreshments helps to reduce tension and create a more relaxed atmosphere.

Assessment and evaluation of parent meetings
Parent meetings tend to be one session. On-going work may occur where there is a special need and the situation provides the ideal environment; for example, mothers spending time with children in hospital. Most parents cannot dedicate regular time to parents programs on sex education due to other demands and pressures. Consequently  parents needs assessment may have to take place as part of the evaluation process from a previous meeting with another group.A short questionnaire may be given to early-arrivals at a meeting whilst waiting for others or it could be part of a question and answer section at the end of a meeting.

Examples of assessment-type questions

1. What are parents main concerns about the relationships of teenagers?
2. How can parents, teachers and medics prepare young people for adult relationships?
3. What kind of information and education do young people need?
4. What kind of information do parents need?

Examples of evaluation-type questions

1. What did you find most interesting in the meeting?
2. What will be most useful in your communication with your son/daughter?
3. What would you have liked to know more about?
4. Was there something not particularly useful?
5. Any other comments?


Methods of working with adults
It is feasible to work with parents in the same ways as those with young people and staff groups (see methodologies section). However, consider the following
• Creating an open dialogue and discussion is the main focus.
• The medic is likely to be placed in the expert role and responsibility deferred to her/him.
• Parents may prefer to be passive due to the sensitivity of the subject area. Seminar format is what most will be used to from their school days and institutes.
• Participatory methods may be threatening to them and non-familiar.
• Small group work can reduce embarrassment and be an excellent arena for good ideas and consultation. Splitting the group according to genders or to age may produce good results. Ask first!
Using techniques to create dialogue will more likely result in a two-way discussion. However, all groups respond differently: some will not ask questions whilst others will be keen to participate and demand more than was expected.

Example of a parents’ questionnaire

-Talking with children about sex
- Yes  Sometimes 
-I am always frank and honest in answering my children’s questions about sex. 
-If I feel that my children need information concerning sex or relationships I can always start the conversation with them. 
-I always had the opportunity of talking about sex with my own parents. 
-I can always think of suitable words for discussing sex with my children. 
-Being a parent, I can always discuss and answer my children’s questions concerning Menstruation, 
Contraception , Abortion , Sexual activity ,Relationships , Love , Sexuality, HIV , Rape , STIs , Masturbation, Gay and lesbian relationships, Anal sex 
-At the end of my school life I had enough knowledge about my body.
-I think young people need to know more about sex than I did at their age.

The following text may be used to create a leaflet for parents.
 It is very difficult for parents and carers to talk to children about the way their bodies work if they’re uncomfortable with the subject and vocabulary. It’s easy to teach children to wash their hands and face because it’s so easy to talk about hands and faces, but not so easy to talk about how babies are made if you can’t talk about private parts of the body. The more you talk about these things, the easier it will get. There are several reasons why we don’t talk about these issues with our children:
• We want to preserve their innocence by keeping them ignorant
• We do not recognise them as sexual beings
• We have to deal with our own issues about sex
• We lack knowledge
• We are embarrassed


You may find that some of what follows is not very easy at first. Don’t worry. It gets easier as you go along.
• Try and overcome your own embarrassment about sex.• Offer opportunities for informal chats – and be supportive
.• Compromise – give and take on both sides makes things much easier
.• Negotiate family ground rules together e.g. coming home at a certain time.
• Ensure your children know about contraception and preventing sexually transmitted
• Give your child the option of someone else to talk to if they do find it difficult to talk to you.
• Be sensitive to unspoken concerns – e.g. the daughter who thinks her breasts are too small or too large.
 DON’T ...
• Tease or be sarcastic
• Be heavy handed – it only causes confrontation and makes it much harder to step down.
• Embarrass or upset your child by putting them down in front of other people.
• Hold other young people up as models of perfection.
• Be put off by an initial refusal to discuss things – don’t stop offering
.• Be put off if cuddles become less frequent or unwanted – Don’t stop offering.
As sex educators, we aim to help children to recognise their sexuality, enjoy their relationships as sexual beings, prevent harm from infection and unwanted pregnancy, and provide a positive role model of good parenting.   

                                                                                                                  to be continued