IN·CLUED: Inclusive Healthcare – Youth & Providers Empowered
Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky
IN·clued is an educational program that addresses the sexual health disparities affecting lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) youth. The program aims to address teen pregnancy and sexually transmitted infection (STI) rates among LGBTQ+ youth ages 14 to 19. The IN·clued program takes a dual approach to address the sexual health outcomes for LGBTQ+ young people: (1) a three-hour workshop for LGBTQ+ youth on sexual health and accessing health care, and (2) two 90-minute workshops for health care providers and clinic staff on best practices for providing care to LGBTQ+ young people. The health center workshop is co-facilitated by adult facilitators and peer educators. This combination ideally results in the outcome of these youth seeking and receiving sexual health services more consistently.
The program is made up of two workshops that serve different populations: (1) LGBTQ+ youth and (2) health care providers and clinic staff.
The youth workshop serves youth ages 14 to 19 who identify as LGBTQ+ in some way; however, participants do not have to identify as LGBTQ+ or disclose their sexual orientation. The workshop can be facilitated with groups of youth who are already members of an established group (for example, a queer-straight alliance, LGBTQ+ community youth activism group, etc.), as well as groups of youth recruited specifically for the purpose of this program. The participants should always be attending the workshop willingly, and have the choice not to participate at any time. For example, if a young person is reliant on an organization for housing, food, job stability, and so on, at no point should their receipt of services be contingent on participation in this program.
The health center workshop is for all health care providers and clinic staff who provide care to LGBTQ+ youth.
The IN·clued youth workshops take place in community-based settings and can be implemented in urban, suburban, and rural communities of all sizes. The health center workshops take place at local health care providers or clinics.
For curriculum, materials, and pricing information, please contact:
To purchase the program (as individual workshops or together as a bundle): https://www.etr.org/store/curricula/in-clued/.
To learn more about the program: https://www.etr.org/ebi/programs/in-clued/.
For training and support, please contact:
For information on training or further support, please contact: INclued@ppgnhaik.org.
| Category | Component | Core Component | Component present | Notes | Lesson number(s) / activities where present |
|---|---|---|---|---|---|
| Content | Goal setting | No | No | ||
| Content | Spirituality | No | No | ||
| Content | Morals/values | No | Yes (evaluated version) | Health Center Workshop Session 1, Section 2, Activity 3: Exploring Messages and Beliefs, Session 1, Section 2, Activity 4: Binary Thinking and Sexual Identities | |
| Content | Identity development | No | No | ||
| Content | Social support/capital | No | No | ||
| Content | Social influence/actual vs. perceived social norms | No | Yes (evaluated version) | Youth Workshop Section 1 Activity 6: Why Us?, Section 2: Activity 1: Let's Talk About Sex!; Zine page 3 Health Center Workshop Session 1, Section 2, Activity 3: Exploring Messages and Beliefs, Session 1, Section 2, Activity 4: Binary Thinking and Sexual Identities |
|
| Content | Social competence | No | Yes (evaluated version) | Health Center Workshop Session 1, Section 3, Activity 1: What Not to Do Role-Play, Session 1, Section 3, Activity 2: Six Practice Recommendations, Session 1, Section 3, Activity 3: What to Do Role-Play | |
| Content | Parenting skills | No | No | ||
| Content | Normative beliefs | Yes | Yes (evaluated version) | Youth Workshop Section 2: Activity 1: Let's Talk About Sex! Health Center Workshop Session 1, Section 2, Activity 3: Exploring Messages and Beliefs, Session 1, Section 2, Activity 4: Binary Thinking and Sexual Identities |
|
| Content | Leadership | No | No | ||
| Content | Gender roles | No | Yes (evaluated version) | Health Center Workshop Session 1, Section 2, Activity 3: Exploring Messages and Beliefs, Session 1, Section 2, Activity 4: Binary Thinking and Sexual Identities | |
| Content | Gender identity | Yes | Yes (evaluated version) | Youth Workshop Section 2 Activity 1: Let's Talk About Sex! Health Center Workshop Session 1, Section 1 Activity 4: LGBTQ Terms & Definitions |
|
| Content | Cultural values | No | No | ||
| Content | Connections with trusted adults | No | No | ||
| Content | Conflict resolution/social problem solving | No | No | ||
| Content | Communication skills | Yes | Yes (evaluated version) | Youth Workshop Section 3 Activity 1: Chat Groups, Section 3 Activity 2: Exam Room Practice; Zine pages 23-24 Health Center Workshop Session 1, Section 3, Activity 1: What Not to Do Role-Play, Session 1, Section 3, Activity 2: Six Practice Recommendations, Session 1, Section 3, Activity 3: What to Do Role-Play, Session 1, Section 3, Activity 4: Implementing Inclusive Practices, Session 2, Section 1, Activity 2: Review and Preparation, Session 2, Section 2, Activity 2: Patient Simulations |
|
| Content | Child development | No | No | ||
| Content | Boundary setting/refusal skills | Yes | Yes (evaluated version) | Youth Workshop Section 3, Activity 1: Chat Groups, Section 3, Activity 2: Exam Room Practice; Zine pages 22-24, and 26 | |
| Content | Substance use cessation | No | No | ||
| Content | Substance use - Other drugs | No | No | ||
| Content | Substance use - Alcohol | No | No | ||
| Content | Substance use - Abstinence | No | No | ||
| Content | Brain development and substance use | No | No | ||
| Content | Vocational/skills training | No | No | ||
| Content | Supplemental academic services | No | No | ||
| Content | School engagement | No | No | ||
| Content | Graduating from high school | No | No | ||
| Content | College preparation | No | No | ||
| Content | Alternative schooling | No | No | ||
| Content | Self-regulation | No | No | ||
| Content | Self-esteem | No | No | ||
| Content | Self-efficacy/empowerment | Yes | Yes (evaluated version) | Youth Workshop Section 2, Activity 3: Safer Sex and Me, Section 3 Activity 1: Chat Groups, Section 3 Activity 2: Exam Room Practice, Section 3 Activity 3: Debrief and Workshop Reflection; Zine pages 18-25 Health Center Workshop Session 1, Section 3, Activity 4: Implementing Inclusive Practices, Session 2, Section 1, Activity 2: Review and Preparation, Session 2, Section 2, Activity 2: Patient Simulations |
|
| Content | Resilience | No | No | ||
| Content | Personal vulnerability | No | Yes (evaluated version) | Youth Workshop Section 3, Activity 1: Chat Groups, Section 3, Activity 2: Exam Room Practice | |
| Content | Motivational interviewing | No | No | ||
| Content | Mindfulness | No | No | ||
| Content | Meditation | No | No | ||
| Content | Puberty/development | No | No | ||
| Content | Sexual risk reduction | No | Yes (evaluated version) | Youth Workshop Section 2 Activity 2: INclued video and Video Debrief, and Section 2 Activity 3: Safer Sex and Me; Zine pages 6-17 | |
| Content | Sexual risk discontinuation | No | No | ||
| Content | Volunteering/civic engagement | No | No | ||
| Content | Sexual risk avoidance | No | No | ||
| Content | Sexual orientation | Yes | Yes (evaluated version) | Youth Workshop Section 2 Activity 1: Let's Talk About Sex! Health Center Workshop Session 1, Section 1 Activity 4: LGBTQ Terms & Definitions |
|
| Content | Sexual health | Yes | Yes (evaluated version) | Youth Workshop Section 1 Activity 6: Why Us? Health Center Workshop Session 1, Section 2 Activity 2: Believe It or Not |
|
| Content | Risk of STIs and Pregnancy | Yes | Yes (evaluated version) | Youth Workshop Section 1 Activity 6: Why Us?, Section 2 Activity 2: INclued video and Video Debrief; Zine pages 3, 6-7, and 15-16 | |
| Content | Reproduction | Yes | Yes (evaluated version) | Youth Workshop Section 2 Activity 2: INclued video and Video Debrief, and Section 2 Activity 3: Safer Sex and Me; Zine page 15 | |
| Content | Contraception - Long-acting reversible contraceptives | Yes | Yes (evaluated version) | Youth Workshop Section 2 Activity 2: INclued video and Video Debrief, and Section 2 Activity 3: Safer Sex and Me; Zine pages 14-15 | |
| Content | Other | ||||
| Content | Anatomy/physiology | No | No | ||
| Content | Contraception - Condoms | Yes | Yes (evaluated version) | Youth Workshop Section 2 Activity 2: INclued video and Video Debrief, and Section 2 Activity 3: Safer Sex and Me; Zine pages 8-12 |
IN·clued is grounded in the Health Belief Model Theory of Change and is intended to lower teen pregnancy and STI rates among LGBTQ+ young people ages 14 to 19. IN·clued aims to increase sexual health knowledge and skills, provide the tools for youth to advocate for their sexual health, and educate health center staff directly to provide LGBTQ+-inclusive sexual health care. IN·clued also aims to uplift the voices of LGBTQ+ youth. It uses a systems change approach to education by providing referrals to appropriate clinical services and sexual health care that centers the needs of LGBTQ+ people.
Specific goals of the youth workshop intended to improve sexual health outcomes are to:
- Increase LGBTQ+ young people’s knowledge of protective and relevant sexual health information
- Increase LGBTQ+ young people’s self-efficacy around accessing sexual health services
- Decrease LGBTQ+ young people’s rates of unprotected oral, anal, and vaginal sex
The IN·clued youth workshop covers topics such as (1) learning about sexual health needs of LGBTQ+ youth, (2) redefining sex for LGBTQ+ youth, (3) increasing knowledge of STI and pregnancy prevention methods, and (4) learning how to access sexual health care and advocate with a provider practice. The workshop includes the following sessions:
- Let’s Talk About Sex
- Safer Sex and Me
- Health-IQ Steps
- Exam Room Practice
- Know Your Rights
The health center workshop focuses on teaching health center staff to provide LGBTQ+-inclusive health care. It covers best practices for working with LGBTQ+ youth, including how to make the health center LGBTQ+ friendly and how to engage these youth in the exam room so they feel safe, comfortable, and open to sharing their sexual health behaviors. Workshop sessions include the following:
- Remember Me
- Believe It or Not
- Exploring Messages and Beliefs
- Binary Thinking and Sexual Identities
- Recommendations for Practice
- Implementing Inclusive Practices
- Patient Simulations
Additional details about program context can be found here: https://www.etr.org/ebi/assets/File/INclued-Program-Summary.pdf.
Both the youth and health center workshops are interactive and include debriefs, peer education, and opportunities to practice the skills and knowledge discussed during the group’s time together.
Two components of the IN·clued program can be implemented in a community, either in combination with one another or separately:
- The IN·clued youth workshop: Delivered in one three-hour session and facilitated by adult facilitators or co-facilitated by adult facilitators and youth peer educators. This workshop includes an optional component for providing text messages, to which participants can opt in to receive at the end of the workshop.
- The IN·clued health center workshop: Co-facilitated by adult facilitators and youth peer educators, and delivered in two 90-minute sessions or one three-hour session. The two sessions can either be implemented one after the other or take place on different days. This workshop includes two e-learning modules and an online resource page for health center staff participants after the workshop is complete.
The two sessions can be implemented one after the other or can take place on different days.
The ideal group size for both the youth and health center workshops is 12 to 15 participants, although both workshops have been facilitated successfully with both far more and fewer participants. For especially large or small groups, adaptations will need to be made to the activities and space.
The youth workshop can be facilitated by adult facilitators or co-facilitated by adult facilitators and teen peer educators. Adult facilitators should be community-based educators or staff with sexual health education experience, sufficient health knowledge, and facilitation skills. The program encourages the use of facilitators who have demonstrated connection to, identity with, or experience with the LGBTQ+ community participating in the workshop.
The health center workshop is co-facilitated by adult facilitators and teen peer educators. The program suggests that the adult facilitators be community-based educators working with a pre-existing peer education program. The peer educator component of the health center workshop is required—in particular for the patient simulations component.
All adult facilitators implementing the program should be knowledgeable about the content, comfortable discussing the material and answering sensitive questions about sexual behavior and LGBTQ+ sexual health care, and experienced in using interactive teaching strategies.
The youth workshop includes a youth program manual, facilitator curriculum, peer educator training materials, and workshop materials and resources (IN·clued zine, mp4 workshop video, adaptations guidance, and more).
The health center workshop includes a facilitator curriculum, peer educator training materials, and workshop materials and resources (adaptations guidance, e-learning modules, and more).
Required materials, including the IN·clued zine, Q Cards©, and more; as well as additional optional materials, including stickers, shirts, pronoun pins, and more, can be found online here: https://www.etr.org/store/categories/topics/inclued/?orderBy=rank%7CASC.
None
To meet the intended outcomes for this program, the entirety of the three-hour youth and three-hour health center workshops each need to be completed.
For more information about fidelity forms, please contact INclued@ppgnhaik.org.
It is highly recommended that all IN·clued adult facilitators participate in the training of facilitators (TOF), available both virtually and in person for the youth and health center workshops. The TOF process for each workshop consists of a four-hour virtual or one-day full in-person training for a team delivered by IN·clued trainers. The in-person training delves deeper into the IN·clued program and builds the knowledge and skills for facilitating the program. Both TOFs include an interactive learning process in which educators will be trained to implement the curriculum using an LGBTQ+-centered approach to sex education.
For more information about the IN·clued TOF, go to https://sparked.net/courses/inclued/. Additional virtual professional development for facilitators is available through Spark*ED’s e-learning program, including “LGBTQ+ Affirming and Inclusive Facilitation,” “Facilitating from a Trauma-Informed Lens,” “Cultural Humility and Responsive Facilitation,” and “Facilitating Sex Ed.” More information about these trainings can be found at http://SparkED.net/.
A separate training for peer educators occurs after purchase of the program.
For technical assistance, support, and additional information with about IN·clued, please contact INclued@ppgnhaik.org.
Adaptation guidelines for the IN·clued youth workshop can be found here: https://www.etr.org/ebi/assets/File/Adaptations/IN-clued_Youth_Adaptations_Guidance-ETR.pdf.
Allowable adaptations for the youth workshop include updating materials with more up-to-date language and to reflect more identities and new or more community-specific research, enhancing interactivity and games in an activity, adding discussions and materials, and updating names in role-play activities.
Adaptation guidelines for the health center workshop are outlined here: https://www.etr.org/ebi/assets/File/Adaptations/IN-clued_Health_Center_Adaptations_Guidance-ETR.pdf.
Allowable adaptations for the health center workshop include enhancing interactivity, lengthening introductions, adding trauma-informed best practices, making language changes to reflect more identities, using props and wardrobe changes, bringing in clinic-specific information, and necessary changes to accommodate health center group size.
| Citation | High-Quality Randomized Trial | Moderate-Quality Randomized Trial | Moderate-Quality Quasi-experiment | Low Study Rating | Did Not Meet Eligibility Criteria |
|---|---|---|---|---|---|
| Philliber, 2021 |
✓ |
| Citation | Setting | Majority Age Group | Majority Racial/Ethnic Group | Gender | Sample Size |
|---|---|---|---|---|---|
Philliber, 2021 |
After school, Community-based organization, Other setting | 14 to 17 | White | Youth of any gender | 1401 |
Evidence by Outcome Domain and Study
| Citation | Sexual Activity | Number of Sexual Partners | Contraceptive Use | STIs or HIV | Pregnancy |
|---|---|---|---|---|---|
Philliber, 2021 |
|
n.a. |
|
|
|
| Citation | Details |
|---|---|
Philliber, 2021 |
INCLUDED was evaluated using a randomized controlled trial design involving LGBTQ youth recruited through 16 Planned Parenthood affiliates in these states: Alaska, California, Connecticut, Iowa, Massachusetts, Michigan, Minnesota, Montana, Nebraska, North Carolina, Oregon, Rhode Island, Texas, Utah, Washington, and Wisconsin. Groups of participants were randomly assigned to either a treatment group that received a one-time, three-hour workshop or a control group that participated in an activity on a topic unrelated to sexual health or accessing sexual health care. Surveys were administered immediately before the program and 12 months after the end of the program, or nine months after the conclusion of an opt-in, 12-week supplemental text message service. The study found that 12 months after the workshop, youth participating in INCLUDED were significantly less likely to report having had vaginal sex without using a condom in the past three months (effect size: -0.20). The study also found that, 12 months after study enrollment, youth participating in the treatment group reported having significantly less vaginal sex without using a condom in the past three months (effect size: -0.15). The study found that 12 months after study enrollment, there were no statistically significant program impacts on the following outcomes: lifetime vaginal sex, lifetime pregnancies, lifetime frequency of pregnancy, having vaginal sex in the past three months, having vaginal sex without the use of birth control in the past three months, frequency of vaginal sex without the use of birth control in the |