Becoming a Responsible Teen

Transcription

1 Becoming a Responsible Teen Adaptation Kit Tools and Resources for Making Informed Adaptations to BART: Becoming a Responsible Teen Rev. October 2011 Lori A. Rolleri, MSW, MPH Nicole Lezin, MPPM Julie Taylor, BA Claire Moore, MPH Mary Martha Wilson, MA Taleria R. Fuller, PhD Regina Firpo-Triplett, MPH Janet S. St. Lawrence, PhD Funding was made possible by Contract #GS10F0171 from the Centers for Disease Control and Prevention (CDC).

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3 Becoming a Responsible Teen Adaptation Kit Tools and Resources for Making Informed Adaptations to Becoming a Responsible Teen Lori A. Rolleri, MSW, MPH Nicole Lezin, MPPM Julie Taylor, BA Claire Moore, MPH Mary Martha Wilson, MA Taleria R. Fuller, PhD Regina Firpo-Triplett, MPH Janet S. St. Lawrence, PhD ETR Associates 2011 Funding was made possible by Contract # GS10F0171T from the Centers for Disease Control and Prevention (CDC).

4 About ETR Associates ETR Associates (Education, Training and Research Associates), established in 1981, is a national, nonprofit organization whose mission is to enhance the well-being of individuals, families and communities by providing leadership, educational resources, training and research in health promotion with an emphasis on sexuality and health education. ETR's Program Services Division offers comprehensive services for the development, implementation, evaluation and dissemination of critical public health initiatives. The division works directly with community-based programs, state and local education agencies, health care providers, health educators and public health organizations. ETR's Publishing Division produces authoritative health education and health promotion resources that empower young people and adults to lead healthier lives. Thousands of ETR pamphlets, books and other materials are used in hundreds of health care settings, schools and workplaces across the United States and around the world. For more information about ETR, visit About CDC's Division of Reproductive Health The CDC's Division of Reproductive Health (DRH) promotes optimal reproductive and infant health through leadership, scientific and programmatic expertise, support to impact public policy, health care and community practices, and individual behaviors. This mission is accomplished through partnership to conduct research, support national and state-based surveillance systems, provide technical assistance and training, and translate research findings into health care practices and health promotion strategies. CDC DRH priority areas include infant and maternal health, women s reproductive health, global reproductive health, and unintended and teen pregnancy prevention by ETR Associates 4 Carbonero Way Scotts Valley, CA Suggested Citation Rolleri, L.A., N. Lezin, J. Taylor, C. Moore, M.M.Wilson, T. Fuller, R. Firpo-Triplett, and J. St. Lawrence Becoming a Responsible Teen Adaptation Kit. Santa Cruz, CA: ETR Associates. ETR Associates and CDC Division of Reproductive Health, 2011 ii

5 Table of Contents Acknowledgments... v Introduction... 1 How to Use This Kit... 5 Becoming a Responsible Teen BDI Logic Model... 9 BDI Logic Model at-a-glance Comprehensive BDI Logic Model Becoming a Responsible Teen Core Components Core Content Components at-a-glance Core Content Components in Depth Core Pedagogical Components at-a-glance Core Pedagogical Components in Depth Core Implementation Components at-a-glance Core Implementation Components in Depth Becoming a Responsible Teen Green/Yellow/Red Light Adaptations General Adaptations Activity-Specific Adaptations Becoming a Responsible Teen Adaptation and Fidelity Monitoring Logs Glossary ETR Associates and CDC Division of Reproductive Health, 2011 iii

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7 Acknowledgments Many talented, experienced and energetic people were involved in the conceptualization, development, review and production of the Becoming a Responsible Teen Adaptation Kit. First, we acknowledge the wisdom and innovation of Dr. Janet St. Lawrence, the developer of the Becoming a Responsible Teen program. Becoming a Responsible Teen is making a difference in the reproductive health of thousands of young people in the United States and abroad. We express special appreciation to Dr. Janet St. Lawrence for reviewing this document and giving the writing team critical feedback. Funding for this adaptation kit was largely made possible by a grant from the Division of Reproductive Health (DRH) at the Centers for Disease Control and Prevention. The Adolescent Reproductive Health team at CDC DRH responded to numerous requests from its grantees for guidance on how to effectively adapt evidence-based programs such as Becoming a Responsible Teen. Thank you, CDC, for responding to this need. Thank you also for the vision, expertise, patience and flexibility of several CDC DRH staff who contributed to the conceptualization and development of these adaptation kits, especially Claire Moore, Lorrie Gavin, Taleria R. Fuller, Catherine Lesesne, Alison Spitz, Carla P. White and Trisha Mueller. CDC DRH awarded funding to ETR Associates to develop adaptation guidance for evidencebased programs in the Fall of ETR assembled a team of multidisciplinary staff with years of experience in developing, evaluating and disseminating evidence-based programs, including Julie Taylor, Dr. Karin Coyle and Dr. Douglas Kirby. Their in-depth understanding of how evidencebased programs are constructed has been an invaluable asset to the team. Other senior staff at ETR served as writers and reviewers of these kits, including Pamela Drake, Michelle Bliesner, Bayla Greenspoon and Regina Firpo-Triplett. ETR s top-notch editing staff who copyedited and formatted the adaptation kits include Suzanne Schrag, Pat Rex, Charlene Foster, Laura Patton and Dorothy Keefe-Hungerford. ETR s senior leadership, Marsha Weil, Francisco Buchting and Coleen Cantwell, provided the team with ongoing executive support and encouragement. Finally, we want to acknowledge Lanett Beard, Logistics Specialist on this project, who tended to numerous administrative details that made all of our jobs much easier. ETR was fortunate to have two trusted consultants on the adaptation guidance team: Nicole Lezin of Cole Communications, a brilliant writer who epitomizes the definition of team player, and Mary Martha Wilson of Healthy Teen Network, who brought valuable practitioner perspectives to the team, served on our writing team and made sure the team was having fun. An Adaptation Work Group (AWG) was established during the first few weeks of the Adaptation Guidance project. The AWG provided important guidance on the development of an adaptation framework, criteria for selecting evidence-based programs, and process for developing adaptation tools. Members of the AWG represent behavioral scientists from CDC, and practitioners from the field. Thank you to Joan Helmich, Forrest Alton, Polly Edwards, Mary Prince, Kim Nolte, Mary Schauer, Lisa Barrios, Lisa Romero, Camilla Harshbarger, Joan Kraft, Jennifer Galbraith, Kelly Lewis and Mary Martha Wilson. ETR Associates and CDC Division of Reproductive Health, 2011 v

8 Becoming a Responsible Teen Adaptation Kit Acknowledgments After the team developed drafts of various adaptation tools and resources (which later became part of the adaptation kits), we assembled several groups of practitioners to provide feedback on content, format and usability. Thank you to Erica Fletcher of the Massachusetts Alliance on Teen Pregnancy, who coordinated six local practitioners to review drafts of these materials in November 2007, and to Tina Devlin, Erin Johnson and Forrest Alton of the South Carolina Campaign to Prevent Teen Pregnancy, who brought together eight practitioners in Columbia, South Carolina, in December We are indebted to these individuals whose feedback helped us streamline these kits and make them practitioner friendly. In February 2008, our team held a final review meeting in Atlanta, Georgia, with representatives from each of the CDC DRH Promoting Science-Based Approaches grantees, including the National Campaign to Prevent Teen and Unplanned Pregnancy; Healthy Teen Network; Advocates for Youth; the Massachusetts Alliance on Teen Pregnancy; the South Carolina Campaign to Prevent Teen Pregnancy; the Adolescent Pregnancy Prevention Campaign of North Carolina; the Colorado Youth Matter; the Hawaii Youth Services Network; the Minnesota Organization on Adolescent Pregnancy, Prevention and Parenting; the Oklahoma Institute for Child Advocacy; the Pennsylvania Coalition to Prevent Teen Pregnancy; the Center for Health Training Resource Group; JSI Research & Training Institute, Inc.; Family Planning Council, TRAINING 3; and Health Care Education and Training. The feedback we received from this meeting helped to further streamline and simplify many of the tools found in this kit. It has been an honor to work with so many generous and talented individuals from across the country. We hope you find the Becoming a Responsible Teen Adaptation Kit a useful tool as you customize the program for the youth you serve in your communities. This kit was created for you, and your feedback is always welcomed. Please contact the Project Director, Regina Firpo- Triplett, at reginaf@etr.org. With gratitude, Lori A. Rolleri, MSW, MPH Former Director, Adaptation Guidance Project ETR Associates Taleria R. Fuller, PhD Health Scientist CDC Division of Reproductive Health ETR Associates and CDC Division of Reproductive Health, 2011 vi

9 Introduction Overview of Becoming a Responsible Teen 1 Goal of the Curriculum Although the primary goal of Becoming a Responsible Teen (BART) is to decrease HIV infection among African-American adolescents and other youth ages 14 to 18, the curriculum also includes topics and activities relevant to teen pregnancy prevention. Teens learn to clarify their own values about sexual decisions and pressures, as well as practice skills to reduce sexual risk taking. These skills include correct condom use, assertive communication, refusal techniques, selfmanagement and problem solving. Abstinence is woven throughout the curriculum and is discussed as the best way to prevent HIV and pregnancy. Target Audience The target audience for BART is African-American, Hispanic and White adolescents, ages 14 18, in a non-school setting. Implementation of the Curriculum BART was designed to be used with small groups ranging from 6 to 12 participants, but it can also be implemented with larger numbers of youth. The curriculum can be implemented in various community settings, including facilities for after-school programs or youth-serving agencies. Length The curriculum has 12 hours of content divided into 90-minute sessions. It could be implemented in eight sessions of 90 minutes each or in six two-hour sessions. Curriculum Objectives At the completion of BART, youth will be able to: State accurate information about HIV and AIDS, including means of transmission, prevention and current community impact. Clarify their own values about sexual decisions and pressures. Demonstrate skills in correct condom use, assertive communication, refusal, information provision, self-management, problem solving and risk reduction. Curriculum Sessions Session 1: Understanding HIV and AIDS Session 2: Making Sexual Decisions and Understanding Your Values Session 3: Developing and Using Condom Skills Session 4: Learning Assertive Communication Skills Session 5: Practicing Assertive Communication Skills Session 6: Personalizing the Risks Session 7: Spreading the Word Session 8: Taking BART with You 1 This overview section on Becoming a Responsible Teen was adapted from ETR s Resource Center for Adolescent Pregnancy Prevention (ReCAPP): ETR Associates and CDC Division of Reproductive Health,

10 Becoming a Responsible Teen Adaptation Kit Introduction Types of Activities BART includes interactive group discussions and roleplays that have been created by teens. Teens learn to "spread the word" to their friends about HIV risks. They are encouraged to practice skills outside the group and share the results. The group provides creative solutions to reported problems. Theoretical Framework BART is based on the knowledge that information and awareness are preconditions that set the stage for change and that people learn by seeing others model the desired behaviors and values. Social Learning Theory and the Information-Motivation-Behavioral (IMB) Model for Behavior Change provide the theoretical basis for BART. Unique Features of the Curriculum BART has features that distinguish it from other HIV prevention curricula: Teens had an active role in developing all aspects of the curriculum. It focuses on the needs of African American adolescents, ages 14 to 18. It was implemented in non-school, community-based settings. It was designed to be used with gender-specific groups, each group facilitated by both a male and female group leader. It has been demonstrated to be effective with both sexually experienced and sexually abstinent youth. Ordering a Copy of BART BART includes session outlines, instructions for group leaders, handouts for duplication, parent consent forms, and general guidelines for setting up the program. To receive more information and to order BART, contact ETR Associates at , Evaluation Facts 2 Intervention African-American adolescents, separated by gender, attended eight weekly sessions of a sexuality education program (BART) that included behavioral skills training. In addition to information about AIDS and prevention of HIV infection, the youth participated in activities to build skills in correct condom use, assertive communication, refusal, information provision, self management, problem solving and risk recognition. Group sizes ranged from 5 to 15, and sessions lasted from 90 to 120 minutes each. Fourteen sets of sessions were conducted over three years in a comprehensive community health center serving predominately low-income minority residents in a Southern urban area of 400,000 residents. Research Design In the study, 246 adolescents were randomly assigned either to a control condition or to the experimental intervention (BART). The control condition consisted of a single two-hour session 2 These Evaluation Facts were adapted from ETR s Resource Center for Adolescent Pregnancy Prevention (ReCAPP): ETR Associates and CDC Division of Reproductive Health,

11 Becoming a Responsible Teen Adaptation Kit Introduction that provided information about HIV/AIDS, including its nature, prevention and impact on the local community. Interactive discussions were interspersed with games, activities and problem solving. The first session of the experimental intervention was identical to the control condition. Participants completed questionnaires before, immediately after, and at 6-month intervals for one year after the intervention. Of the original 246 participants, 91.5% completed the 12-month followup. Measures included HIV risk, sexual behaviors, self-efficacy, attitude toward condoms and HIV/AIDS knowledge. Behavioral Findings Of the youth who were sexually abstinent prior to the intervention, only 11.5% of the BART participants were sexually active one year later compared with 31% of participants in the control group. Among those sexually active prior to the intervention, 42% of the control group remained so after one year versus only 27% of the intervention group. In comparison to their behavior before the intervention, and in comparison with those in the control group, youth who participated in BART were more likely to use condoms and less likely to engage in unprotected vaginal or anal intercourse. Other Significant Findings Despite the fact that both groups received the same basic information component, the BART group scored higher on the AIDS knowledge test than the control group and maintained that lead across the 12-month follow-up period. Moreover, youth from the intervention group were more skillful than those in the control group in handling pressures to engage in unprotected sex and in providing information to peers. Research Study Citation St. Lawrence, J.S., T. Brasfield, K.W. Jefferson, E. Alleyne, R.E. O'Bannon and A. Shirley Cognitive-behavioral intervention to reduce African-American adolescents' risk for HIV infection. Journal of Consulting and Clinical Psychology 63 (2): ETR Associates and CDC Division of Reproductive Health,

12 Becoming a Responsible Teen Adaptation Kit Introduction Janet S. St. Lawrence, Ph.D. Dr. Janet S. St. Lawrence is Professor Emerita of Arts & Sciences at Mississippi State University. She completed a Ph.D. in Clinical Psychology from Nova University in Florida, followed by a post-doctoral year as Chief Resident in the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center 1. Following the residency, she because an Assistant Professor at the University of Mississippi from , then Associate to full Professor at Jackson State University from From , she was Chief of the Behavioral Research and Interventions Branch in the Division of Sexually Transmitted Diseases at the Centers for Disease Control and Prevention. After retiring from the CDC, Dr. St. Lawrence returned to academe at Mississippi State University. Dr. St. Lawrence has received numerous awards and recognition: The American Psychological Associations' Psychology and AIDS Award; the Association for the Advancement of Behavior Therapy's Outstanding Research Award; NAFEO's National Research Award; the Mississippi Psychological Association's Research Achievement Award (twice), and Outstanding Teaching of Psychology Award. Her research career focuses on developing and evaluating STD/HIV risk reduction interventions, primarily in community settings. While in clinical practice from , she specialized in individuals and families who were living with HIV/AIDS. She served on the National Institute of Mental Health's Immunology and AIDS study section that reviewed NIH grant applications from and again on the Behavioral and Social Prevention of HIV/AIDS Study Section from and on CDC's Behavioral Science Peer Review Panel in In addition to being the author of more than 200 books, book chapters, and articles in professional journals, Dr. St. Lawrence developed and evaluated Becoming a Responsible Teen, an evidence-based HIV risk reduction program for 14 to 18 year olds. ETR Associates and CDC Division of Reproductive Health,

13 How to Use This Kit What is the purpose of the Becoming a Responsible Teen Adaptation Kit? The goal in developing the Becoming a Responsible Teen (BART) Adaptation Kit is to provide practitioners with practical tools and resources to guide them in maintaining fidelity to BART s core components and in making effective adaptations. Most practitioners will make adaptations to evidence-based curricula such as BART in order to have the activities resonate better with the particular group of youth they are serving in their communities. This is good practice and is encouraged. However, sometimes these adaptations are made with very little guidance, information or understanding about the curriculum s core components that are essential for its effectiveness. This kit was developed to give practitioners better clarity about how BART is designed, its core components and the types of adaptations that are considered safe and unsafe. What tools are found in the BART Adaptation Kit and how were they developed? ETR Associates and the Division of Reproductive Health (DRH) at the CDC worked together to develop the tools in this kit using a six-step process. With the exception of the first step, each step resulted in adaptation tools found in this kit. Each of these tools underwent extensive reviews by frontline practitioners in the field, behavioral scientists, and, most important, BART s chief developer, Dr. Janet St. Lawrence. The steps and tools are described below. 1. Determinant-Activity Matrix: The team initially reviewed each activity in every lesson of BART and coded them for answers to two questions: (1) what psychosocial determinant(s) is this activity trying to change? and (2) what teaching method is being used to teach it? Determinants are the psychosocial and environmental factors that have a causal influence on sexual behaviors. Determinants can include factors such as knowledge, attitudes, skills or conditions. Teaching methods are things such as roleplays, videos, lectures, etc. This matrix is not included in the kit, but it was instrumental in the development of the Behavior- Determinant-Intervention (BDI) logic model for BART. 2. Behavior-Determinant-Intervention (BDI) Logic Model: With an analysis of BART s activities complete, the team built a BDI logic model for the curriculum. The BDI logic model is a program planning tool that guides program developers in four sequential and clearly linked steps starting with: (1) establishing a health goal, (2) identifying and selecting the individual or group behaviors directly related to that health goal, (3) identifying and selecting the determinants related to those behaviors, and (4) developing intervention activities directly related to those determinants. In effect, a BDI logic model uncovers the developer s theory of change that is, what factors (determinants) need to be changed in order to get teens to change their sexual behaviors. A complete BDI logic model for BART is found in this kit, as well as a BDI Logic Model at-a-glance. 3. Core Components: With the BDI logic model complete, the team was able to better identify BART s core content, pedagogical and implementation components. Core components are the essential pieces of a curriculum that are responsible for its effectiveness. Tables describing the core content, pedagogical and implementation components (in comprehensive and at-a-glance versions) are found in this kit. ETR Associates and CDC Division of Reproductive Health,

14 Becoming a Responsible Teen Adaptation Kit How to Use This Kit 4. Green/Yellow/Red Light Adaptations: With the core components complete, the team was then able to develop a tool for identifying green/yellow/red light adaptations. As the metaphor suggests, this tool tells practitioners what kind of adaptations are safe (green), which should be made with caution (yellow), and which should be avoided (red). The first part of this tool describes green, yellow and red light adaptations as they apply generally to BART. The second part is a table formatted to describe green, yellow and red light adaptations per activity in each of BART s eight sessions. 5. Fidelity and Adaptation Monitoring Logs: Using the Core Components Tables and the Green, Yellow, Red Light Adaptation Tables, the team developed a tool called Fidelity and Adaptation Monitoring Logs. This tool provides a place for facilitators of the evidence-based program to record their fidelity to each session s core content and pedagogical components, as well as the effectiveness of planned and unplanned adaptations made to each model. It also provides a log to assess their overall fidelity to the curriculum s core implementation components. (This log is completed after the curriculum is implemented in its entirety.) 6. Glossary: A glossary of terms is included at the end of the kit. How do I use the BART Adaptation Kit? Although people may not always think of making program adaptations as program planning, making effective adaptations to a curriculum involves comprehensive planning. For example, assessments of the youth you are going to serve and your organization s capacity will yield important data that you can use to inform your adaptations. An understanding about how to select the best matching program for your youth will help limit the number of adaptations you may need to make. Evaluating the adaptations you make can help you improve future implementations of BART. It s recommended that you review a program planning, implementation and evaluation model such as Promoting Science-Based Approaches to Teen Pregnancy Prevention using Getting to Outcomes 3 before making adaptations to BART. This model was developed specifically for practitioners working in the field of adolescent reproductive health and will help you think about program adaptation throughout the program planning process. The kit was designed with flexibility in mind. There is no particular order in which you must use these tools. One suggestion is that you review the tools as they were developed (and as they are presented in this kit) and take what you need from them. For example, if you are interested in the underlying theory of change used by BART and how the curriculum was put together, look at the BART Logic Model. If you are interested in knowing what parts of BART contribute to its effectiveness, review the Core Content, Pedagogical and Implementation Components. If you want to make changes, additions, deletions or adaptations to BART, look at the Green/Yellow/Red Light Adaptations Tables. If you do not find the exact kind of adaptation that you want to make to the program in this section, go to the Core Components Tables and make sure that the adaptation does not compromise or delete them. If you are looking for a process monitoring tool, the Fidelity and Adaptation Monitoring Logs are a good choice. Finally, if you are 3 Lesesne, C.A., K.M. Lewis, C. Moore, D. Fisher, D. Green and A. Wandersman Promoting science-based approaches to teen pregnancy prevention using Getting to Outcomes: Draft, June Atlanta, GA: CDC Division of Reproductive Health. (Unpublished manual.) ETR Associates and CDC Division of Reproductive Health,

15 Becoming a Responsible Teen Adaptation Kit How to Use This Kit looking for a particular resource to help you make an adaptation, access the Companion Resources. (See below for more information.) The following table illustrates the different purposes of the sections of the adaptation kit. BDI Logic Model Core Components Green/Yellow/ Red Light Adaptations Fidelity & Adaptation Logs Companion Resources (see below) I want to better understand the underlying theory of change used by BART and how the curriculum was put together. I want to understand what parts of BART are essential. I want to make effective adaptations to BART without compromising fidelity. I need a process monitoring tool to track my fidelity to core components and the planned and unplanned adaptations I make. I want recommendations for resources that might help me in making effective adaptations. Companion Resources. The Companion Resources are a useful supplement to this adaptation kit. Here you will find links to the latest health information and research that you can use to update information in the curricula and make informed decisions about program planning, assessment and evaluation. You will also find ideas for alternate activities, information about specific ethnic and cultural groups, which is broken down by group and will be invaluable if you want to adapt a curriculum for another youth population, and many other handy resources. These include: a list of websites specifically for teens, a compilation of print materials on fidelity and adaptation, and links to information on teaching skills such as classroom management and leading group discussions. This companion piece is available at: For more information about this adaptation kit, please contact Regina Firpo-Triplett at ETR Associates, reginaf@etr.org. ETR Associates and CDC Division of Reproductive Health,

16 Becoming a Responsible Teen Adaptation Kit How to Use This Kit ETR Associates and CDC Division of Reproductive Health,

17 Becoming a Responsible Teen BDI Logic Model ETR Associates and CDC Division of Reproductive Health,

18 Becoming a Responsible Teen Adaptation Kit BDI Logic Model ETR Associates and CDC Division of Reproductive Health,

19 BDI Logic Model at-a-glance What is a BDI Logic Model? The Behavior-Determinant-Intervention (BDI) logic model is a program planning and analysis tool developed by Douglas Kirby. 4 A BDI logic model graphically shows the links or connections between the health goal of a curriculum or program, the adolescent sexual behaviors directly related to that health goal (e.g., condom use), the determinants 5 (e.g., knowledge, attitude, skills) that influence those sexual behaviors, and the intervention activities specifically designed to change those determinants (e.g., roleplays, large-group discussion, etc.). The BDI logic model graphically depicts the developer s theory of change for a program, i.e., what needs to be changed in order for teens to engage in healthy sexual behaviors. Intervention Activities Determinants Behaviors Health Goal For more information about BDI logic models, visit How do I use the Becoming a Responsible Teen BDI Logic Model? The Becoming a Responsible Teen (BART) BDI logic model is a useful tool for practitioners preparing to implement and/or adapt BART. The logic model can help you better understand the rationale/logic behind the learning activities found in BART by showing how these activities were intentionally designed to change important determinants of adolescent sexual behavior. This understanding will help you implement BART with greater fidelity and purpose. If you better understand the link between learning activities and determinants, you are more likely to recognize their value. The BDI logic model is the foundation for identifying BART s core content and pedagogical components. If you are considering adaptations to BART, the BDI logic model can serve as a map to guide adaptations so that changes or additions are consistent and responsive to the logic presented in the model and the core content and pedagogical components derived from it. BART s BDI Logic Model at-a-glance is presented first to offer a quick overview of the logic in the BART curriculum. Immediately following, you will find the in-depth version of BART s BDI logic model. 4 Kirby D BDI logic models: a useful tool for designing, strengthening and evaluating programs to reduce adolescent sexual risk-taking, pregnancy, HIV and other STDs. Santa Cruz, CA: ETR Associates. 5 Determinants of behaviors are sometimes also called risk and protective factors. ETR Associates and CDC Division of Reproductive Health,

20 Becoming a Responsible Teen Adaptation Kit BDI Logic Model at-a-glance Definitions of Common Determinants Found in Evidence-based Sex and STD/HIV Education Programs Attitude An attitude is a state of mind, feeling or disposition. Attitudes are often expressed in the way people think, feel and act. They demonstrate an individual s opinions, dispositions, perspectives or positions on a particular issue or topic. Attitudes are somewhat different from values. Belief A belief is an individual s perception that a proposition or premise is true. For example, in the Theory of Planned Behavior, normative beliefs are perceptions about the normative expectations of others, and behavioral beliefs are perceptions about the likely consequences of specific behaviors. Communication with a Parent or Adult This type of communication is the act of giving, receiving and understanding messages between a parent/adult and a teen. Messages may include information or education, value sharing, support or encouragement, advice, etc. Messages may be relayed via oral, written or nonverbal methods. Connectedness to Culture Culture can relate to a person s ethnicity, race, religion, geography, socio-economic status, age, gender, and sexual orientation or identity. Feeling connected to culture may include awareness, understanding, acceptance and pride about the norms, values, beliefs and history of that culture and how it affects sexual decision making. Empowerment Empowerment is a process through which individuals feel competent and confident that they have the needed competencies to successfully undertake a course of action and carry out a behavioral plan. Intentions An intention is a decision, determination or plan to behave in a particular way in specific situations. Even if a person intends to do something, it doesn t mean that she/he will actually do it. For example, a person who is thinking about quitting smoking intends or plans to quit but may or may not actually follow through on that intention. Knowledge Knowledge refers to the awareness and understanding of information, statistics, facts, principles, frameworks, and the characteristics/descriptions, causes and consequences related to a problem (e.g., unintended pregnancy or HIV infection). Motivation Motivation is the desire to carry out a course of action or a behavior. Outcome Expectations Outcome expectations refer to the individual s beliefs about what will result from engaging in a certain behavior and the desirability of those results. The behavior could result in negative consequences or positive consequences. For example, a teen may have negative outcome ETR Associates and CDC Division of Reproductive Health,

21 Becoming a Responsible Teen Adaptation Kit BDI Logic Model at-a-glance expectations for using condoms because she believes her boyfriend will get mad at her or that using condoms will ruin the pleasure of sex. Alternatively, another teen might have positive outcome expectations for using condoms because he knows that his girlfriend will appreciate him, that he will protect himself from pregnancy or an STD and/or that condoms can be fun to use. See definition of Attitude. Perception of Risk Perception of risk relates to an individual s understanding and belief about the likelihood that he/she could experience negative consequences, such as unintended pregnancy or STD/HIV, by engaging or not engaging in certain behaviors (e.g., having sex with a condom, having sex without a condom). Perception of risk may reflect perceived susceptibility or vulnerability, severity and seriousness of some possible outcome. Skill Skill refers to the ability to do something adequately or well (e.g., to use a condom correctly, refuse sex, or negotiate condom use with a partner). Having the skill to do something means that the individual understands the correct steps required for executing the action and knows how to execute those steps. However, knowing how to do something does not mean that a person will behave or act in the desired way in real-life situations. See definition of Self-Efficacy. Self-Efficacy Self-efficacy is a person s confidence in his/her ability to perform particular behaviors well enough to control events that affect his/her life. If someone has high self-efficacy, then she believes she can perform behaviors well enough to change her environment and achieve a goal, and, as a result, she has more confidence. She is then more likely to try to perform the behavior or achieve a goal again. Conversely, if she has low self-efficacy, she believes she can t achieve that goal, has less confidence, and is less likely to try. Social Norms Social norms are standards of acceptable behavior or attitudes within a community or peer group. Social norms come in two varieties actual norms and perceived norms. Actual norms are the true social norms for a particular attitude or behavior. For example, if the majority of a group of sexually active individuals uses some form of birth control, then the actual norm for the group is to use birth control. Going without birth control is "non-normative" in that group. Perceived norms are what an individual believes to be the social norm for a group. If, for example, a young man believes that most of his peers do not use condoms, for that young man, the perceived norm is non-use of condoms. Values Values are principles or beliefs that serve as guidelines in helping people make decisions about behaviors or life choices. They reflect what an individual believes about the rightness or the wrongness of things. Values tell us what a person believes about something. ETR Associates and CDC Division of Reproductive Health,

22 ETR Associates and CDC Division of Reproductive Health, BART Intervention Activities Designed to Change Determinants Who Is at Risk for HIV and Why? (Session 1, Activity 2) Introduction to HIV Terms (Session 1, Activity 3) Exploring Drug Risks for HIV (Session 2, Activity 6 Using Condoms Correctly (Session 3, Activity 4) Problem-Solving Skills (Session 4, Activity 3) Assertive Communication Review (Session 5, Activity 1) Getting Out of Risky Situations (Session 7, Activity 2) Introduction to BART (Session 1, Activity 1) Attitudes and Risks (Session 3, Activity 1) Overcoming Embarrassment About Buying Condoms (Session 3, Activity 3) Video: Are You With Me? (Session 4, Activity 2) Different Communication Styles (Session 4, Activity 4) Meeting People with HIV (Session 6, Activity 1) Spreading the Word Practice (Session 7, Activity 4) What Are You Doing to Protect Yourself? (Session 8, Activity 2) BDI Logic Model at-a-glance Determinants of Teen Sexual Behaviors Addressed in BART KNOWLEDGE about: HIV (definitions, transmission, testing and prevention) how drugs and alcohol use may influence sexual decision making correct and consistent condom use problem-solving skills communication styles avoiding situations that could lead to unhealthy sexual decisions ATTITUDES about: talking about HIV and sex obtaining condoms HIV prevention and safer sex, including condom use using effective (assertive) communication people who have HIV protecting oneself and others from HIV making a difference by sharing with others information and skills related to preventing HIV Teen Behaviors Directly Related to BART s Health Goal Delay onset of sexual intercourse Increase use of condoms Decrease unprotected oral, anal and vaginal intercourse Decrease frequency of sex Decrease number of sexual partners BART s Health Goal Decrease HIV infection among African- American adolescents ages Becoming a Responsible Teen Adaptation Kit BDI Logic Model at-a-glance (continued)

23 ETR Associates and CDC Division of Reproductive Health, BDI Logic Model at-a-glance (continued) BART Intervention Activities Designed to Change Determinants Overcoming Embarrassment About Buying Condoms (Session 3, Activity 3) Using Condoms Correctly (Session 3, Activity 4) Negotiating Safer Sex (Session 4, Alternate Activity 2) Assertive Communication Tips (Session 5, Activity 2) Ways to Say No (Session 5, Activity 3) Spreading the Word Practice (Session 7, Activity 4) Getting Out of Risky Situations (Session 7, Activity 2) Who is at Risk for HIV and Why? (Session 1, Activity 2) Deciding Your Level of Risk (Session 1, Activity 5) Meeting People with HIV (Session 6, Activity 1) Who Is at Risk for HIV and Why? (Session 1, Activity 2) Countering Barriers to Using Condoms (Session 3, Activity 5) Spreading the Word Demonstration (Session 7, Activity 3) Assertive Communication in the Real World (Session 7, Activity 1) Negotiating Safer Sex (Session 4, Alternative Activity 2) Ways to Say NO (Session 5, Activity 3) Determinants of Teen Sexual Behaviors Addressed in BART SKILLS AND SELF-EFFICACY related to: obtaining condoms and using them correctly negotiating condom use using effective (assertive) communication refusing sex communicating about HIV prevention to others preventing risky situations and handling those that arise PERCEPTION OF RISK/ VULNERABILITY related to: susceptibility to HIV infection consequences of HIV infection (how life would be altered) ( It could happen to me ) SOCIAL/PEER NORMS about: supporting the prevention of HIV and promoting safer sex (including condom use) promoting use of effective (assertive) communication refusing sex Teen Behaviors Directly Related to BART s Health Goal Delay onset of sexual intercourse Increase use of condoms Decrease unprotected oral, anal and vaginal intercourse Decrease frequency of sex Decrease number of sexual partners BART s Health Goal Decrease HIV infection among African- American adolescents ages Becoming a Responsible Teen Adaptation Kit BDI Logic Model at-a-glance (continued)

24 ETR Associates and CDC Division of Reproductive Health, BDI Logic Model at-a-glance (continued) BART Intervention Activities Designed to Change Determinants Who Is at Risk for HIV and Why? (Session 1, Activity 2) AIDS and African Americans (Session 2, Activity 3) Assertive Communication Tips (Session 5, Activity 2) Assertive Communication in the Real World (Session 7, Activity 1) Spreading the Word Demonstration (Session 7, Activity 3) Deciding Your Level of Risk (Session 1, Activity 5) Support Systems (Session 2, Activity 7) Determinants of Teen Sexual Behaviors Addressed in BART CONNECTEDNESS TO CULTURE: Reinforcing African-American values supporting individual responsibility/pride and caring for the greater community VALUES about: preventing HIV and promoting safer sex communicating with a partner about safer sex using knowledge and skills gained through BART to make a difference to family members, friends and peers INTENTIONS: to avoid behaviors that could lead to HIV infection COMMUNICATION with parents or other adults about: what has been learned in BART what adults can do to support them in learning about and preventing HIV infection Teen Behaviors Directly Related to BART s Health Goal Delay onset of sexual intercourse Increase use of condoms Decrease unprotected oral, anal and vaginal intercourse Decrease frequency of sex Decrease number of sexual partners BART s Health Goal Decrease HIV infection among African- American adolescents ages Becoming a Responsible Teen Adaptation Kit BDI Logic Model at-a-glance

25 ETR Associates and CDC Division of Reproductive Health, BART Intervention Activities Designed to Change Determinants 1.2 Who Is at Risk for HIV and Why Activity includes a short lecture on definitions associated with HIV/AIDS. 1.3 Introduction to HIV Terms Activity that uses strips of paper with important words on them to review definitions associated with HIV, includes a lecture on HIV progression and incubation and large-group discussion on how you can and cannot get HIV, and how to protect yourself from getting HIV. 1.4 Facts and Myths Team game that clears up myths about HIV transmission and AIDS. 1.5 Deciding Your Level of Risk Activity that uses a traffic light game to clarify which behaviors are high risk, some risk and no risk, as well as a worksheet that asks youth to individually think about behaviors that will and will not lead to HIV infection, followed by large-group discussion. 1.6 Spreading the Word Homework assignment has youth share the information they learned today with others and correct myths they hear about HIV. 2.1 Definitions Review Large-group discussion/review of HIV definitions. 2.2 HIV Transmission Review Largegroup discussion on how to avoid HIV transmission, including specific behaviors that can lead to HIV. Comprehensive BDI Logic Model Pages Determinants of Teen Sexual Behaviors Addressed in BART KNOWLEDGE HIV Definitions, Transmission, Testing and Prevention Teen Behaviors Directly Related to BART s Health Goal 1. Delay onset of sexual intercourse 2. Increase use of condoms 3. Decrease unprotected oral, anal and vaginal intercourse 4. Decrease frequency of sex 5. Decrease number of sexual partners BART s Health Goal Decrease HIV infection among African- American adolescents ages (continued) Becoming a Responsible Teen Adaptation Kit Comprehensive BDI Logic Model

26 ETR Associates and CDC Division of Reproductive Health, Comprehensive BDI Logic Model (continued) BART Intervention Activities Designed to Change Determinants 2.3 AIDS and African Americans Largegroup discussion/review about how HIV is affecting African Americans in general and lecture about how it is affecting African Americans in a given state. 2.4 HIV Feud Game Team game in which youth match behaviors with risk level cards (can be done in two different ways). 2.5 Seriously Fresh Video about a group of African-American friends experiences with HIV, followed by largegroup discussion of specific questions. 6.2 Discussion and Debrief Large-group discussion about the presentations by HIV-positive guest speaker(s). 8.1 Final Review of HIV Facts Team myth/fact game reviews information about HIV. 8.2 What Are You Doing to Protect Yourself? Includes a short lecture reminding youth to keep themselves safe, that they have choices, and that they should keep practicing what they have learned in BART. 2.6 Exploring Drug Risks for HIV Largegroup discussion about drug use and how it can put one at risk for HIV, followed by a lecture about how the use of drugs and/or alcohol can affect the immune system. Pages Determinants of Teen Sexual Behaviors Addressed in BART HIV Definitions, Transmission, Testing and Prevention (continued) How Drugs and Alcohol Use May Influence Sexual Decision Making Teen Behaviors Directly Related to BART s Health Goal 1. Delay onset of sexual intercourse 2. Increase use of condoms 3. Decrease unprotected oral, anal and vaginal intercourse 4. Decrease frequency of sex 5. Decrease number of sexual partners BART s Health Goal Decrease HIV infection among African- American adolescents ages (continued) Becoming a Responsible Teen Adaptation Kit Comprehensive BDI Logic Model

27 ETR Associates and CDC Division of Reproductive Health, Comprehensive BDI Logic Model (continued) BART Intervention Activities Designed to Change Determinants 3.2 Learning the Facts About Condoms Lecture with some large-group discussion about condoms in general, lubricants and how to store condoms. 3.3 Overcoming Embarrassment About Buying Condoms Large-group discussion that explores where to get condoms and strategies for overcoming embarrassment about buying them. 3.4 Using Condoms Correctly Lecture and demonstration of how to put on and remove a condom correctly, followed by youth practice, while facilitators circulate and give feedback. 4.1 Correct Condom Use Review Review of basic information about condoms and beginning discussion on talking about condoms with a partner. 4.3 Problem-Solving Skills Lecture about a six-step problem-solving framework, followed by a brainstorm and large-group discussion about each of the six steps. 7.1 Assertive Communication in the Real World Activity that includes a review of the problem-solving steps, with an emphasis on the value of communicating about safer sex with a partner. Pages Determinants of Teen Sexual Behaviors Addressed in BART How Drugs and Alcohol Use May Influence Sexual Decision Making (continued) Condom Use Problem-Solving Skills Teen Behaviors Directly Related to BART s Health Goal 1. Delay onset of sexual intercourse 2. Increase use of condoms 3. Decrease unprotected oral, anal and vaginal intercourse 4. Decrease frequency of sex 5. Decrease number of sexual partners BART s Health Goal Decrease HIV infection among African- American adolescents ages (continued) Becoming a Responsible Teen Adaptation Kit Comprehensive BDI Logic Model

28 ETR Associates and CDC Division of Reproductive Health, Comprehensive BDI Logic Model (continued) 4.4 Different Communication Styles Facilitators roleplay three communication scenarios that demonstrate passive, aggressive and assertive communication. Participants discuss observations and why they think each style works or doesn t work, and facilitators explain the styles. Then facilitators present three more roleplay scenarios at the end of the activity, and youth have to identify the communication style being demonstrated. 5.1 Assertive Communication Review Large-group discussion reviews the definitions and characteristics of the three communication styles. 7.1 Assertive Communication in the Real World Large-group discussion reviews assertive communication skills, including benefits. 7.2 Getting Out of Risky Situations Large-group discussion about how to get out of risky situations, including walking away, and lecture about how to use selftalk to stay safe. Includes a handout titled 10 Steps to Put Good Intentions into Practice Communication Styles (Assertive, Passive and Aggressive) BEHAVIORAL BELIEFS Communication Styles (Assertive, Passive and Aggressive) (continued) Avoiding Situations That Could Lead to Unhealthy Sexual Decisions 1. Delay onset of sexual intercourse 2. Increase use of condoms 3. Decrease unprotected oral, anal and vaginal intercourse 4. Decrease frequency of sex 5. Decrease number of sexual partners 1. Delay onset of sexual intercourse 2. Increase use of condoms 3. Decrease unprotected oral, anal and vaginal intercourse 4. Decrease frequency of sex 5. Decrease number of sexual partners Decrease HIV infection among African- American adolescents ages Decrease HIV infection among African- American adolescents ages (continued) Becoming a Responsible Teen Adaptation Kit Comprehensive BDI Logic Model

29 ETR Associates and CDC Division of Reproductive Health, Comprehensive BDI Logic Model (continued) BART Intervention Activities Designed to Change Determinants 1.1 Introduction to BART Includes a large-group discussion about how youth felt when they found out someone they knew had HIV. 3.3 Overcoming Embarrassment About Buying Condoms Activity that includes a large-group discussion about where to obtain condoms, brainstorm about obstacles to purchasing condoms and ways to overcome these obstacles, and visualization exercise where youth imagine successfully buying condoms. 3.3 Overcoming Embarrassment about Buying Condoms Activity that includes a large-group discussion about where to obtain condoms, brainstorm about obstacles to purchasing condoms and ways to overcome these obstacles, and a visualization exercise in which youth imagine successfully buying condoms. 3.5 Countering Barriers to Using Condoms Activity in which youth brainstorm a list of excuses that teens give for not using condoms, followed by a large-group discussion to come up with counterarguments for each of the excuses. Pages Determinants of Teen Sexual Behaviors Addressed in BART ATTITUDES Comfort in Talking about HIV and Sex Comfort about Obtaining a Condom Positive Attitude about Condom Use Teen Behaviors Directly Related to BART s Health Goal 1. Delay onset of sexual intercourse 2. Increase use of condoms 3. Decrease unprotected oral, anal and vaginal intercourse 4. Decrease frequency of sex 5. Decrease number of sexual partners BART s Health Goal Decrease HIV infection among African- American adolescents ages (continued) Becoming a Responsible Teen Adaptation Kit Comprehensive BDI Logic Model