Adolescent Prevention and Intervention Tools

1. Adolescent Prevention and Intervention Tools Lesley Cottrell, PhD West Virginia University, Department of Pediatrics Section Chief: Epidemiological, Psychosocial, & Behavioral Research

2. Overview • Adolescent and Adult Therapeutic Comparisons • Similarities • Differences • Example of Intervention Research • Focus on Kids and ImPACT • Guiding Therapeutic Tips

3. Adolescents and Adults: Similarities • Self-efficacy and perceived control • Social support/ influence • Correlated risk behaviors • Basic information about risks and outcomes • Condom demonstration & practice • Identifying triggers for unsafe sex • Communication skills

4. Adolescents and Adults: Differences • Perceived audience • Developing control and efficacy • Focus on future impact • Inclusion of goal setting • Greater attention on peer group and social impact

5. Bringing It All Together In Session • Clinicians obtain information from adolescent patients regarding their sexual activity and inform them how to prevent other health issues. • Adolescents prefer information from their health-care providers • Fewer than half of clinicians provide such guidance

6. Sample Programs, Activities, & Tools

7. Target Population Goal of Intervention Reduce adolescent truancy, substance abuse, and sexual risk behaviors Intervention Duration 9 sessions (8 for FOK and 1 for ImPACT) Intervention Setting Community locations Delivery Methods Exercises/Games Group discussion Lectures Role-plays Risk-reduction supplies (condoms) Videos Focus on Youth with ImPACT

8. Protection Motivation Theory Intrinsic Rewards Severity Threat Appraisal Environment Extrinsic Rewards Vulnerability Decision Regarding Risk Behavior Cultural and Family Influences Response Efficacy Response Cost Self Efficacy Coping Appraisal

9. The Challenge • Contextualize the constructs of PMT to be developmentally and culturally appropriate • Develop risk assessment tool and intervention

10. Community Participation: Key Processes • Defining & reaching the community • Involving community residents • Considering cultural differences • Recognizing tensions among service, research and community participation

11. The Evaluation Target audience: Naturally occurring friendship groups of African American youth ages 9-15 from 8 urban recreation centers Design: randomized controlled trial (206 intervention youth and 177 control youth) Follow-ups: Youth followed at six month intervals for three years and again at four years

12. FOK Effect on Unprotected Sex * * * =P<.05

13. How can the behavior change associated with Focus on Kids be sustained?

14. Informed Parents and Children Together (ImPACT) • Parental monitoring & communication intervention • Home-delivered, video-based plus role-play & condom demonstration • Talk with your children about sex before they have sex; it is okay if discussions are awkward; know how to use a condom; know where, what ,with whom your child is • Outcomes: Broadening and sustaining intervention effect across sexual, drug, substance-use risk at 12 months and 24 months

16. Focus On Kids Program Outline • Trust Building and Group Cohesion • Risks and Values • Educate Yourself: Obtaining Information • Education Yourself: Examining Consequences • Skill Building

17. Trust Building & Group Cohesion • Introduction Game • Group Cohesion Activity • Family Tree • Urban version • Rural version • SODA Decision-Making Model • Stop – Options – Decide -- Action

18. Risks and Values • How Risky Is It? • Why Do People Feel Invulnerable? • Rank Your Values • Values Voting

19. Educate Yourself: Obtaining Information • Finding Information for Good Decisions • Telephone Exercise • Field Assignments • Condom Hunt • Parent Interview • Talk with Parent • Calls to Hotline, etc. • Other

20. Educate Yourself: Examining Consequences • Parent Roleplay • M & M’s Game: How Many Kids Are Really…? • Condom Demonstration • Condom Race

21. Skills Building: Communication • Communication Game: Changing Messages • Communication Styles: Aggressive, Assertive, and Non-assertive • Communicating without Words • Sex: A Decision for Two

22. Information About Sexual Health • Ways to Show You Care • HIV Transmission Game • Contraception Lesson

23. Attitudes & Skills for Sexual Health • Goal Setting: My Future • Roleplay: Saying NO or Asking to Use a Condom

24. Practice Concepts • Tailor programs to the audience • Offer job training and career services in addition to reproductive health services • Offer free condoms • Hire gender-specific staff or “gender friendly” • Assist adolescents in healthy parenthood.

25. Practice Concepts • Utilize mass media, especially television • Work with teen couples to help them maintain responsible behaviors and communicate well • Address substance use proactively. • Deal with complex issues contributing to violence and sexual assault. • Create an inviting, male-positive environment

26. Gather information about the community and the population • Find out what participants are interested in. • Consider the things that are important and connect with those activities. • Partner with a local leagues or community centers

27. Develop strong ties with the community and work • Use messages that are positive • Create opportunities for young men to redefine “manliness” what it means to “be a man” in their own terms • Offer incentives for participation that appeal to males (movie tickets, gift certificates, music, CDs, etc.)