Fourth ‘R’: Strategies for Healthy Youth Relationships

Program snapshot

Age group: Adolescence (12-17)

Gender: Mixed (male and female)

Population served: Aboriginal/Indigenous

Topic: Alcohol and/or drug use; Bullying/cyberbullying; Teen dating violence

Setting: Rural/remote area; Urban area; School-based

Location: Alberta; British Columbia; Manitoba; New Brunswick; Newfoundland and Labrador; Northwest Territories; Nova Scotia; Nunavut; Ontario; Prince Edward Island; Quebec; Saskatchewan; Yukon

Number of completed Canadian outcome evaluation studies: 1

Continuum of intervention: Primary crime prevention

Brief Description

The Fourth ‘R’: Strategies for Healthy Youth Relationships (Fourth ‘R’) program is an interactive classroom curriculum that aims to reduce youth dating violence by addressing youth violence and bullying, unsafe sexual behaviour, and substance use.

The program is centered on a youth-focused, gender-strategic harm-reduction strategy that encompasses knowledge, positive relationship skills, and decision making coverage of target and related issues.


The main goals of the Fourth ‘R’ program are to:

  • Reduce three interconnected risk behaviours in adolescence, particularly violence (bullying, peer and dating violence), substance abuse, and unsafe sex.


The appropriate clientele for the original version of the Fourth ‘R’ program is all grade 9 or 10 students (14-16 years old, male and female youth). Several adaptations have now been completed and extensions have been made to other grades and areas (e.g., Fourth ‘R’ Grade 10 English Curriculum). Several adaptations have also been developed for specific groups of youth, such as Aboriginal youth, in recognition that specific sub-groups or settings have more distinct needs than can be met with a universal approach. These adaptations include a version for use in Alternative Education settings, an Aboriginal Perspective Fourth ‘R’ version, and a version that matches the Ontario Catholic curriculum expectations.

Core Components

The individual student-level intervention consists of 21 lessons integrated into existing Health and Physical Education curriculum requirements that is administered in sex-segregated classrooms.Footnote1 The 21 lessons are composed of three units of seven 75-minute classes. The three units focus on the following topics:

  • Unit 1: Personal Safety and Injury Prevention
  • Unit 2: Healthy Growth and Sexuality
  • Unit 3: Substance Use and Abuse

Rather than addressing these topics independently, an underlying theme of healthy, non-violent relationship skills is woven throughout the units to increase generalization across risk situations and behaviours. Detailed lesson plans, video resources, role-playing exercises, rubrics, and handouts are provided for all lessons. School-level components include additional teacher training on dating violence and healthy relationships, information for parents, and student-led “safe school committees.”

Implementation Information

Some of the critical elements for the implementation of this program or initiative include the following:

  • Organizational requirements: The lead organization should have a strong and stable relationship with local schools and school boards.
  • Partnerships: Organizations should collaborate with schools and school boards, parent advisory committees, and safe school committees.
  • Training and technical assistance: Training is strongly recommended. Online training is included with the purchase of several of the Fourth ‘R’ programs. All trainings – including those for which online training is available and those for which online training is not currently available – are also offered in-person for a fee.
  • Risk assessment tools: Limited information on this topic.
  • Materials & resources: The curriculum packet can be purchased online and includes teacher friendly lessons, including lesson objectives, learning expectations, teaching and learning strategies, handout and overhead masters, marking rubrics, DVDs and CD-ROMs.

International Endorsements

The most recognized classification systems of evidence-based crime prevention programs have classified this program or initiative as follows:

  • Blueprints for Healthy Youth Development: Not applicable.
  • Crime Solutions/OJJDP Model Program Guide: No Effects - More than one study
  • SAMHSA's National Registry of Evidence-based Programs and Practices: 4.0
  • Coalition for Evidence-Based Policy: Not applicable.

Gathering Canadian Knowledge

Canadian Implementation Sites

The first version of the Fourth ‘R’ program was piloted in a schools in Southwestern Ontario in the fall of 2001. Over the next several years, the program was revised based on teacher and student feedback and implemented in 350 schools across Ontario. In 2005, pilot programs were started in both British Columbia and Saskatchewan schools. Since then, the Fourth ‘R’ has expanded to over 1,200 schools across Canada (all provinces and territories) and the United States (9 states).

Main Findings from Canadian Outcome Evaluation Studies

An outcome evaluation study of the Fourth ‘R’ program was conducted in 2009 by Wolfe and colleagues. This study was conducted in schools in Southwestern Ontario between 2004 and 2007 using a cluster randomized trial with a 2.5 year follow-up.

Results from this evaluation showed the following:

  • Teaching youth about healthy relationships as part of their required health curriculum reduced physical dating violence and increased condom use 2.5 years later. Physical dating violence was greater in control versus intervention students and the intervention effect was greater in boys than in girls. There was no significant difference in levels of peer violence between the control and intervention schools, or in reported alcohol and drug use. However, a significant difference was found in condom use in sexually active boys who received the intervention.

For more information, refer to the Wolfe et al.’s (2009) publication.

Cost Information

In 2011, the cost per youth involved in the Fourth ‘R’ program was approximately $16 (CAD). This amount includes expenses for teacher release time for training and the cost of curriculum materials. These are one-time costs for implementation in the first year (Wolfe et al., 2009).


Wolfe, D. A. et al.  (2009). A school-based program to prevent adolescent dating violence. Archives of Pediatrics & Adolescent Medicine, 163(8), 692–699. Available from:  

For more information on this program, contact:

CAMH Centre for Prevention Science
100 Collip Circle, Suite 100
London, Ontario N6G 4X8
Telephone: (519) 858-5144

Record Entry Date - 2018-02-22
Record Updated On - 2021-04-29
  1. 1

    The Fourth ‘R’ program meets the Ontario curriculum requirements for the Grade 9 Health and Physical Education course. The program material has been expanded to include curriculum for grade 8 Health and Physical Education, and grades 10 and 11 English classes.

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