Designing a Sex Ed Program for Students with Developmental Disabilities
How Denver Public Schools used Human Centered Design to Reinvent Sex Ed
THE PROBLEM
Studies around sex education are clear: students who receive comprehensive sex education are less likely to experience unintended pregnancies and sexually transmitted infections; and students who receive education on healthy relationships and consent experience less sexual violence and teen dating violence.
Studies also show that students with disabilities benefit from sex ed just as much as their peers. These are students who are growing up, going through puberty, and experiencing sexual feelings like all young adults. Yet they are often being told that they are not sexual beings or that if they act on these feelings something bad will happen. Often they are being disregarded completely around sexuality.
Studies also show that students with disabilities benefit from sex ed just as much as their peers. These are students who are growing up, going through puberty, and experiencing sexual feelings like all young adults. Yet they are often being told that they are not sexual beings or that if they act on these feelings something bad will happen. Often they are being disregarded completely around sexuality.
So why is sex education not more of a priority for this group of students?
“My students have a range of disabilities, including intellectual and speech language disabilities. Teaching adapted sex ed and social skills/relationship skills is incredibly important for my students. The biggest needs for our students include teaching boundaries and consent.”
Molly Mason, Special Education teacher in the Denver Public School system
Taking Up the Challenge
When sex education specialist Rose Barcklow joined Denver Public Schools in 2017, she knew she was taking on a big job. Denver Public Schools (DPS) is the largest school district in Colorado with over 200 schools, 90,000 students, and 4,700 classroom teachers.
Rose recognized that a Human Centered Design (HCD) approach was an ideal methodology to create a sustainable, comprehensive system for sex education in DPS. Sex education is a sensitive topic: she needed to approach the design by centering students and teachers rather than basing the program on external curriculum mandates. Early on in her tenure Rose completed a round of ethnographic research by interviewing teachers, students, and parents. Rose learned that teachers’ comfort with teaching sex education is often the barrier to providing comprehensive sex education to students. This provided her with a launching point to begin to redesign a comprehensive sex education program for DPS.
Her research, however, also revealed a surprising insight related to sex education for students with disabilities. While most teachers showed some interest in finding ways to fit sex education into their full schedules, teachers of students with disabilities were extremely interested. They shared that sex education was one of the biggest pain points and needs in their special education classrooms. These teachers face many challenges, such as students masturbating in class, not familiar with menstruation, unaware what is happening to their changing bodies, and aggressively pursuing relationships with other students without an understanding of boundaries and consent. Rose also learned that any previous approaches to teaching sex education to students with disabilities was entirely around risk prevention, and that special education teachers are hungry for broader content.
Rose also heard from students with disabilities that they were interested in learning about adolescence and puberty. Understanding the changes occurring within their bodies, how to develop romantic relationships and friendships, and understanding how to say no to unwanted advances. She learned that students wanted to learn about where they could go for sexual health services like birth control, condoms, and menstruation management.
It was clear there was a need for more inclusive sex education.
Rose recognized that a Human Centered Design (HCD) approach was an ideal methodology to create a sustainable, comprehensive system for sex education in DPS. Sex education is a sensitive topic: she needed to approach the design by centering students and teachers rather than basing the program on external curriculum mandates. Early on in her tenure Rose completed a round of ethnographic research by interviewing teachers, students, and parents. Rose learned that teachers’ comfort with teaching sex education is often the barrier to providing comprehensive sex education to students. This provided her with a launching point to begin to redesign a comprehensive sex education program for DPS.
Her research, however, also revealed a surprising insight related to sex education for students with disabilities. While most teachers showed some interest in finding ways to fit sex education into their full schedules, teachers of students with disabilities were extremely interested. They shared that sex education was one of the biggest pain points and needs in their special education classrooms. These teachers face many challenges, such as students masturbating in class, not familiar with menstruation, unaware what is happening to their changing bodies, and aggressively pursuing relationships with other students without an understanding of boundaries and consent. Rose also learned that any previous approaches to teaching sex education to students with disabilities was entirely around risk prevention, and that special education teachers are hungry for broader content.
Rose also heard from students with disabilities that they were interested in learning about adolescence and puberty. Understanding the changes occurring within their bodies, how to develop romantic relationships and friendships, and understanding how to say no to unwanted advances. She learned that students wanted to learn about where they could go for sexual health services like birth control, condoms, and menstruation management.
It was clear there was a need for more inclusive sex education.
Rose’s HCD Capacity and Her Team
BUILDING CAPACITY
In December 2019, Rose attended the Stanford d.school’s Designing for Social Systems workshop. The workshop provided frameworks and methods for how to integrate Human Centered Design, Systems Thinking, and Strategic Planning approaches with her unique work. It also brought clarity to the benefits of completing full cycles of design where research leads to insights, idea generation, experimentation, and implementation–a path to create a sustainable program.
Following the workshop, Rose prioritized using the HCD process specifically for comprehensive sex education for students with disabilities because of the high need, high interest, and unique opportunity to work alongside students with disabilities to create a program for and with them.
The d.school program helped Rose figure out how to move past some of the barriers she was facing in applying an HCD approach within a large organization. She realized a number of organizational factors were preventing successful design work: such as making decisions without substantial input from teachers and students, a lengthy approval process to move forward with prototyping, and competing priorities that often demanded immediate attention and took time away from the HCD process.
Rose wrote several grants to expand the team to three individuals so that they could engage deeply in a design process and provide adequate staffing for comprehensive sex education for students with disabilities. Rose hired Rebekkah Abeyta who would specifically focus on creating Adapted Sex Education for students with disabilities. Also recognizing the difficulties to complete robust design work in a large system, Rose included a consultancy budget in the grant to bring someone on to prioritize completing the process. With her team in place, Rose was able to move forward with the capacity to take on the challenge.
The d.school program helped Rose figure out how to move past some of the barriers she was facing in applying an HCD approach within a large organization. She realized a number of organizational factors were preventing successful design work: such as making decisions without substantial input from teachers and students, a lengthy approval process to move forward with prototyping, and competing priorities that often demanded immediate attention and took time away from the HCD process.
Rose wrote several grants to expand the team to three individuals so that they could engage deeply in a design process and provide adequate staffing for comprehensive sex education for students with disabilities. Rose hired Rebekkah Abeyta who would specifically focus on creating Adapted Sex Education for students with disabilities. Also recognizing the difficulties to complete robust design work in a large system, Rose included a consultancy budget in the grant to bring someone on to prioritize completing the process. With her team in place, Rose was able to move forward with the capacity to take on the challenge.
Designing for Student With Disabilities
DESIGN PROCESS
Starting with an Ethnography Phase, the team interviewed a total of 31 individuals: 9 students with disabilities and 22 adults with roles such as paraprofessionals, teachers, social workers, health educators, parents, and a speech and language pathologist.
As interviews were completed, Rose and Rebekkah did deep synthesis work to make sense of all the information. They listened to the full recordings of the interviews and wrote a summary of key insights; applied a rapid analysis process to capture key data points in a spreadsheet; and created brief analytic memos as a way to identify themes and patterns within the coded ethnographic research.
One fundamental insight became clear: Students with disabilities are often left behind or left out of sex education because it is assumed that they won’t have opportunities to form healthy, romantic relationships.
Students shared that they are in school with other kids, and seeing those kids in relationships, and they are wondering why they can’t have those feelings. Additionally, they are seeing people their age on TV and in the media have sexualities but unsure why they are treated like it does not relate to their own lives.
One fundamental insight became clear: Students with disabilities are often left behind or left out of sex education because it is assumed that they won’t have opportunities to form healthy, romantic relationships.
Students shared that they are in school with other kids, and seeing those kids in relationships, and they are wondering why they can’t have those feelings. Additionally, they are seeing people their age on TV and in the media have sexualities but unsure why they are treated like it does not relate to their own lives.
“Students with disabilities are often left behind or left out of sex education because it is assumed that they won’t have opportunities to form healthy, romantic relationships”
Synthesis led to the development of three major opportunities, articulated as How Might We (HMW) questions:
How might we raise awareness for all adults in the school about why sex education is essential for supporting young people with developmental disabilities to transition from adolescence to adulthood?
How might we make the most of the strong relationships that paraprofessionals have with students to maximize student learning and support student learning outcomes?
How might we create a system where paraprofessionals feel supported and equipped to support sex education for students with disabilities?
To kick off an Ideation Phase, the team invited key adults–included those who had also participated in interviews–to participate in two, two-hour working sessions via Zoom.
In these sessions, the group considered each of the three HMW questions, brainstormed possible solutions, mapped ideas according to their feasibility, and ranked and prioritized the ideas they collectively decided would be easy to implement and have the most impact on student learning.
The team concluded with several key ideas to prototype:
Creating engagement activities so that all school staff get to know the students with disabilities and can reinforce the sex ed lessons outside of the classroom: in hallways, cafeterias, and on the bus.
Prioritizing lessons about consent, boundaries, and private and public behavior. Identifying differentiation techniques for teaching the curriculum for different student ability levels.
Engaging paraprofessionals by including them in training and lesson preparation.
The DPS team was ready to test these ideas and pilot an Adapted Sex Ed program.
In Fall 2020, 7 months after starting the design research, Rose and her team piloted an Adapted Sex Ed Program. The program was piloted in five middle and high school classrooms serving fifty-one students.
Over the course of the next year, Rose and her team continued to iterate and improve the programming, so much so that there is now a waitlist for schools interested in offering this program to their students.
Unique Program Principles, Shaped by Human Centered Design Insights
NEW PRINCIPLES
The ethnographic research, collaborative ideation sessions, and the running of the pilot itself has led to five key principles that have shaped the program. By piloting the program with an active experimentation mindset, the team was better able to identify the principles that then helped to shape the nuances of the program; the team viewed the pilot not as the deliverable but another learning opportunity. The team continued to evolve the program as the pilot progressed, responding to students' and teachers' needs and feedback.
01
HELP STUDENTS WITH DISABILITIES EXPLORE VARIOUS RELATIONSHIPS AND ACCOMPANYING BOUNDARIES
One lesson they developed in the Adapted Sex Ed program is Different Types of Relationships. In this lesson students explore all the various relationships someone could have in their life, what feelings they get in those different relationships, and what types of touch/behaviors are okay. The lesson normalized the different range of feelings students can have about certain people and what they can do with those feelings. This is all further explored and discussed when the class gets to a later lessons on puberty, anatomy, healthy relationships and the steps to dating.
This principle included other supportive measures, like involving parents and guardians, through Parent Sessions to learn about the Adapted Sex Ed Program, and receive resources on how to talk to their kids about sex ed.
There is evidence of positive change: In a post-program focus group, students demonstrated through storytelling and pictures they are learning the skills they need to advocate for themselves and make the best decisions about their own bodies and relationships.
This principle included other supportive measures, like involving parents and guardians, through Parent Sessions to learn about the Adapted Sex Ed Program, and receive resources on how to talk to their kids about sex ed.
There is evidence of positive change: In a post-program focus group, students demonstrated through storytelling and pictures they are learning the skills they need to advocate for themselves and make the best decisions about their own bodies and relationships.
02
HELP TEACHERS BUILD THEIR CONFIDENCE IN TEACHING SEX EDUCATION
With this program, professional development/training throughout is crucial for the teachers and school staff. With this in mind, Rose and her team designed a sustainability model for Teacher Professional Development that takes a three-step process:
Teach: Sex Educator teaches Sex Ed Classes with the classroom teacher and paraprofessionals observing.
Co-Teach: Sex Educator teaches Sex Ed Classes with the classroom teacher and paraprofessionals.
Train: Classroom teacher and paraprofessional teach Sex Ed Classes with coaching, observation, and further professional development from a Sex Educator.
This effort was driven by the insight that teachers feel ill-equipped and unsure of how to teach children about their changing bodies and healthy behaviors like maintaining good boundaries and establishing consent.
Teach: Sex Educator teaches Sex Ed Classes with the classroom teacher and paraprofessionals observing.
Co-Teach: Sex Educator teaches Sex Ed Classes with the classroom teacher and paraprofessionals.
Train: Classroom teacher and paraprofessional teach Sex Ed Classes with coaching, observation, and further professional development from a Sex Educator.
This effort was driven by the insight that teachers feel ill-equipped and unsure of how to teach children about their changing bodies and healthy behaviors like maintaining good boundaries and establishing consent.
03
EMPOWER PARA- PROFESSIONALS TO SUPPORT SEX ED PROGRAMMING
Since the relationships between paraprofessionals (paras) and students are important, some aspects of sex ed can be taught by paras during informal moments in between and after classes. Rose and her team worked closely with paras from the start of the program in various way and through the different stages of design thinking.
This was based on the insight that paraprofessionals often develop strong, long-term relationships with their students and can be helpful in promoting and enhancing sex ed programs. Sometimes paraprofessionals are following students for seven to ten years. Paraprofessionals are a key support system in DPS schools, working with students throughout the day in the classroom, social settings, and as a liaison with families.
One paraprofessional shared the role she sees herself playing in a student’s life “... If a student knows that you’re really sincere, and that you really care, and that you’re listening–that’s the main thing, to listen ... The world is so busy. You know, a lot of students just don’t have that person that will listen to them and not judge them.”
This was based on the insight that paraprofessionals often develop strong, long-term relationships with their students and can be helpful in promoting and enhancing sex ed programs. Sometimes paraprofessionals are following students for seven to ten years. Paraprofessionals are a key support system in DPS schools, working with students throughout the day in the classroom, social settings, and as a liaison with families.
One paraprofessional shared the role she sees herself playing in a student’s life “... If a student knows that you’re really sincere, and that you really care, and that you’re listening–that’s the main thing, to listen ... The world is so busy. You know, a lot of students just don’t have that person that will listen to them and not judge them.”
04
SIMPLIFY THE CURRICULUM
Rose and the team adapted the 24-lesson Elevatus curriculum, an existing sex education curriculum for students with developmental disabilities, to prioritize five lessons that address the most important needs that were elevated during the ethnography interviews. Once these main lessons are covered, teachers can then pick one to five additional lessons if they have time and space.
This is based on the insight that teachers do not have the time to teach all twenty-four Elevatus lessons, which is the only curriculum available for students with developmental disabilities.
The five recommended to start with are:
Introduction to Sex Ed & Creating a Safe Space; Different Types of Relationships; Public & Private; Consent & Boundaries; Puberty and/or Anatomy.
The crucial topics that are included in these lessons are: boundaries, consent, puberty, healthy relationships, masturbation, public and private places and behaviors, sexuality and gender identity.
This is based on the insight that teachers do not have the time to teach all twenty-four Elevatus lessons, which is the only curriculum available for students with developmental disabilities.
The five recommended to start with are:
Introduction to Sex Ed & Creating a Safe Space; Different Types of Relationships; Public & Private; Consent & Boundaries; Puberty and/or Anatomy.
The crucial topics that are included in these lessons are: boundaries, consent, puberty, healthy relationships, masturbation, public and private places and behaviors, sexuality and gender identity.
05
DESIGN AN ADAPTIVE CURRICULUM FOR DIVERSE NEEDS
Rose and her team learned very quickly that the range of adaptations needed for the curriculum are endless. Students with disabilities are a diverse group with quite varied needs and abilities. They had the insight to not attempt to create a single static curriculum, but instead make it adaptable.
DPS has five different center-based classrooms: Multi-Intensive Rooms, Multi-Intensive Autism Rooms, Multi-Intensive Severe Rooms, Pragmatic Language Executive Functioning Rooms, and Affective Needs Rooms. There are so many different needs not only depending on the type of classroom but the students that are in that room.
The team designed the Adapted Sex Ed program to be versatile and it has worked well in all five different types of center-based rooms.
DPS has five different center-based classrooms: Multi-Intensive Rooms, Multi-Intensive Autism Rooms, Multi-Intensive Severe Rooms, Pragmatic Language Executive Functioning Rooms, and Affective Needs Rooms. There are so many different needs not only depending on the type of classroom but the students that are in that room.
The team designed the Adapted Sex Ed program to be versatile and it has worked well in all five different types of center-based rooms.
20
As of Spring 2022 center-based classrooms have begun implementing and teaching the program
9
classrooms are on a waitlist, wanting programming to start as soon as possible, which will most likely take place next fall.
As the program continues to evolve, Rose and her team continue to improve their offerings.
Imagining New Possibilites
The Adapted Sex Ed program has improved many lives. For the first time in Denver Public School's history, students with disabilities are receiving sexual health education and access to quality sexual healthcare through a program that elevated and continues to elevate their voice in the design and implementation.
The success of the program can be traced back to Rose’s belief that a design approach was beneficial and worth investing in to do the work. The challenge demanded that Rose and her team understand the experience and needs of different people, imagine new possibilities, and take a very iterative approach to shaping the program. The rigorous design work that Rose and her team engaged in paid off with a program that so much better serves students, teachers, paraprofessionals, and parents.
The success of the program can be traced back to Rose’s belief that a design approach was beneficial and worth investing in to do the work. The challenge demanded that Rose and her team understand the experience and needs of different people, imagine new possibilities, and take a very iterative approach to shaping the program. The rigorous design work that Rose and her team engaged in paid off with a program that so much better serves students, teachers, paraprofessionals, and parents.
