At Grassroots Health, we are often asked, “How do you use sports to teach health education, exactly?”, “Do you factor community input into your curriculum?”, and “Is your program evidence-based?.” We are taking the opportunity to use this blog post to sum up the answers to these questions.
Origins of the Curriculum
Grassroots Health’s original program (way back in 2009!) was an adaptation of GrassrootSoccer’s evidence-based (and soccer based!) HIV prevention curriculum. Tyler Spencer, Grassroots Health’s founder, had spent several years implementing the program in South Africa. After learning that HIV incidence in our nation’s capital had doubled among teens over a five-year period and that there was a need to open up dialogues around HIV in schools, Tyler adapted the GrassrootSoccer program by de
Grassroots Health featured by the Washington Post
livering it as a pilot program at a teen drop-in center in Southeast DC. Each week, teens and staff from the organization (MetroTeen
AIDS) drove the adaptation process by offering feedback on how to make the curriculum sports and games based (as opposed to soccer based) and to make it relevant to DC teens. Grassroots Health (then “The Grassroot Project”) delivered thi
s adapted curriculum in more than 50 schools and community centers for thousands of youth, and it trained hundreds of local athletes from across DC to become health educators. You can read about the original program in this Washington Post article here.
Engaging Families and Linking Students to Care Providers
In 2017, we considered replicating our HIV prevention curriculum in other cities, weighing this future plan with another possibility – staying in DC and focusing more comprehensively on improving adolescent health. We decided to stay in DC in order to build a more holistic model for youth, and we planned to revisit expansion outside of DC in later years.
We recognized that one way to deepen our impact was to build new elements of our model that honored two simple facts —
- Health-related communication between youth and their parents and caregivers is one of the most solid “protective factors” for promoting healthy youth development. Yet we’d heard from so many parents and caregivers that talking about awkward health topics was uncomfortable, that they didn’t always feel prepared to have those conversations with their youth, or they wanted a space to hear from other parents as times and modes of communication are constantly changing with technology and social media.
- While our healthcare system is far from perfect, there were lots of organizations providing clinical services for young people, but youth were not accessing these services for a number of reasons including, lack of awareness of free services, intimidation to seek out services, or stigma surrounding the act of going to seek help for things like sexual and mental health. This is key in a time when we are seeing some of the scariest mental health statistics for young people, nearly 20% of the most recent HIV diagnosis among youth aged 13-24, and obesity and physical issues continue to plague young people. All of these health factors affect young people nationwide, but those living in urban areas are disproportionately affected.
So we developed Grassroots Fam and Grassroots Connect:
- Grassroots Fam, a two-session after-school workshop focused on improving health literacy and health communication for our middle school participants’ parents and caregivers.
- Grassroots Connect, an end-of-semester celebration that also serves as a “linkage-to-care” program. At Grassroots Connect, we have connected students to more than 10 different neighborhood-based youth-friendly health services, including mental health counseling, nutritional health programming, and family planning.
Building Innovative Curricula in Mental and Nutritional Health
The second way we knew we could increase our impact in DC was to add other curriculum topic areas to our model. Over the course of several years, Jane Wallis, Grassroots Health Associate Director, led a thorough and community-driven process of building two new 10-session, sports-based health promotion curricula — one in nutrition, and one in mental health, while also updating the sexual health curriculum to be more inclusive of current student voices and community needs and assets. This process invovled.
- Reviewing local and national health education standards and the existing evidence on effective adolescent health promotion programs.
- Conducting focus groups with current middle school students, high school students, parents and caregivers, and P.E. and health teachers to understand community perspectives around mental, nutritional, and sexual health. We sought to understand the “real” story, to understand not just challenges, but also community assets, as we sought to think about the best way to present information so that young people felt safe and comfortable having challenging health conversations.
- We synthesized published research, we transcribed and coded all of our focus group sessions, and we laid them side by side to try and get a sense of what topics we should prioritize in our 10-week curricula. Each curriculum focuses on health literacy, but even more so, the factors that influence young people’s decisions and comfort around these health topics.
- Finally, the curriculum development team, composed of Grassroots Health staff and athletes, came together to gamify these prioritized health topics using sports and games as metaphors to better explain and discuss these challenging health topics. One of the challenges we often see is that schools have cut back scheduling time for both P.E. and health, so we wanted to build a curriculum that could use sports and movement to instill key health messages and make learning and talking about health more fun. That way, schools could teach health AND have students moving without needing additional time or separate gym and classroom spaces. Not only did this solve a system-wide scheduling challenge in schools, but, put simply…it made the health material much more fun and engaging for our students.
We now have a robust partnership model in which, at every school where we work, we work with every single middle school student for all three years of middle school, delivering our nutrition curriculum in 6th grade, our sexual health curriculum in 7th grade, and our mental health curriculum in 8th grade. Each curriculum adds new layers and topics with the same underlying theme in positive youth development: young people will be making their own choices, and we want to provide the information, tools, and self-esteem to be able to make choices that they are proud of. In addition, we provide Grassroots Fam and Grassroots Connect in all of our schools. The goal is to not only reach health education standards in each school, but to also build a culture of health for these school communities.
Evidence
So…does it work!? We have seen significant improvements across the majority of our validated survey scales (which we assess pre-program and post-program) on health knowledge, attitudes, self-efficacy, and beliefs. We have also heard directly from students, teachers, and family members that our programs are creating a safe space for them to ask tough questions, prioritize their health, learn the basics, and navigate what can sometimes be uncomfortable or confusing routes to seeking care and help. We are in the process of working with evaluation partners to measure our impact through experimental trials, as part of governmental tiered-evidence programs. We would love our other school districts and health equity advocates to have access to our programming through federal and state funding, and we believe this path can help us exponentially increase the impact of our program model.
Scale and Systems Change
So what’s next? Our long-term vision is to scale up Grassroots Health in order to not only impact youth nationally, but to also influence national policies around in-school health education and P.E. For us, the inequitable resources invested in health and P.E., particularly in urban areas, has created a health equity issue that impacts students both immediately and over the long term. Young people are telling us they want more health resources, and they want these topics prioritized during the school day. We believe our programs can support students where they need it most right now, but can also build a case for support to take to policymakers who have the power to build policies and budgets that change the game for school health.
