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Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
Substance-dependent adolescents
Goals of Intervention
- Increase abstinence
- Increase safer sex behaviors
- Eliminate or reduce sex risk
behaviors
Brief Description
Assisting in Rehabilitating Kids
(ARK) is a small group, 12-session
intervention consisting of educational,
behavioral skills training, and
motivational risk-sensitization
manipulation components designed to
reduce and maintain reductions of risky
sexual behaviors among
substance-dependent adolescents. The
intervention is delivered to groups of
6-10 mixed-gender youth over a period of
28 days after their initial
detoxification while the youth are still
in the drug treatment program facility.
The first 2 intervention sessions
provide standard HIV/STD information.
Five sessions addressing behavioral
skills are based on the Becoming a
Responsible Teen (BART) intervention and
provide specific training and practice
regarding correct condom use, partner
negotiation, refusal of unwanted sex,
and communicating this information and
newly acquired skills to peers. Four
other sessions are used to teach
problem-solving skills and anger
management skills important for
drug-dependent adolescents. One
additional session focuses on the
motivational aspects of behavior change,
particularly the level of perceived
risk, by introducing an emotion-based
risk-sensitization manipulation. A
digital photograph of each adolescent is
taken at baseline, downloaded into a
computer, electronically transformed to
visually depict how the adolescent might
appear at end-stage AIDS. After
adolescents complete their skills
training sessions, the original and
digitally transformed images are given
to each adolescent. Next, discussion
focuses on adolescents’ emotional
responses to the images, how these
images may affect their willingness to
engage in risky or safer sexual
behaviors, and emphasizes that the
adolescents already have the necessary
skills to avoid HIV/STDs. This
risk-sensitization manipulation is
designed to increase awareness of
personal vulnerability and, along with
their improved self-efficacy, to
motivate youth to adopt and be able to
maintain risk reduction behaviors. |
Theoretic Basis
- Information Motivation Behavior (IMB)
Model
- Extended parallel process model
(EPPM)
Intervention Duration
Twelve 90-minute sessions delivered over 28
days
Intervention Settings
Off-site research office
Deliverer
Two co-facilitators (one male and one
female) with degrees in psychology
Delivery Methods
- Games
- Group Discussion
- Lectures
- Practice
- Training
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Intervention Package Information
An intervention package is not available at this time. Please contact Dr.
Janet S. St. Lawrence, Mississippi State University, Meridian, 1000 Highway 19
North, Meridian, MS 39307. email:
jlawrence@meridian.msstate.edu
for details on intervention materials.
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Evaluation Study and Results
The original evaluation was conducted in
Mississippi between 1995 and 1999.
Key Intervention Effects
- Increased abstinence
- Reduced unprotected sex
- Increased protected sex and condom
use
Study Sample
The enrolled study sample of 161 adolescents is characterized by the
following:
- 75% White, 22% African American,
2% Native American, 1% Hispanic
- 68% Male, 32% Female
- Mean age of 16 years
- Mean education of 10 years
Recruitment Settings
Two residential drug treatment programs in
Mississippi serving adolescents
Eligibility Criteria
Adolescents were eligible for the study if
they were admitted to one of the two youth
residential drug treatment programs in
Mississippi, completed the 3-week
detoxification program, and had informed
consent provided by the parent or guardian.
Assignment Method
Participants (N = 161) were grouped in 24 cohorts based on entry
into drug treatment, where each cohort was
randomly assigned to 1 of 3 groups: ARK
Behavior Skills + Risk Sensitization
intervention (n = 54), Behavior Skills only
intervention (n = 54), or Health Education
comparison (n = 53).
Comparison Group
The Health Education comparison
consisted of 12 sessions, including 2
sessions of basic information on the
epidemiology of HIV/STD and 10 sessions of
standard health education curriculum. The
curriculum included information on birth
control, drinking, peer pressure, drug
education, smoking, gangs, weapons, and
handling stress. The curriculum was
delivered in a developmentally appropriate
format and included educational games and
group discussions, changing the focus every
10 to 15 minutes.
Relevant Outcomes Measured and Follow-up Time
- Sex behaviors during past three
months (including frequency of
unprotected and condom-protected
vaginal, oral, and anal sex; and number
of sex partners) were measured at 6- and
12 -month follow-ups.
- Frequency of drug use during the
past three months was measured for each
of thirteen drugs (e.g., alcohol,
marijuana, inhalants, crack cocaine,
speed) at 6- and 12 -month follow-ups.
Participant Retention
- Overall study sample:
97% retained at 6 months
89% retained at 12 months
- ARK Intervention (retention not
reported, but if all lost-to-follow-up
participants were lost from this group,
retention rates would be 93% and 83%,
respectively):
≥ 93% retained at 6 months
≥ 83% retained at 12 months
- Behavioral skills training
Intervention (retention not reported,
but if all lost-to-follow-up
participants were lost from this group,
retention rates would be 93% and 83%,
respectively):
≥ 93% retained at 6 months
≥
83% retained at 12 months
- Health education Comparison
(retention not reported, but if all
lost-to-follow-up participants were lost
from this group, retention rates would
be 91% and 81%, respectively):
≥ 91% retained at 6 months
≥ 81% retained at 12 months
Significant Findings
- A significantly greater percent of
ARK intervention participants reported
abstinence at the 6-month (p < .05) and
12-month (p < .05) follow-ups when
compared to the health education
participants and at the 12-month
follow-up (p < .05) when compared to the
behavioral skills training participants.
- ARK intervention participants
reported a significantly lower frequency
of unprotected vaginal sex and greater
frequency of condom-protected sex than
the health education participants at the
6-month and 12-month follow-ups (all p’s
< .05).
- ARK intervention participants also
reported a significantly lower frequency
of unprotected vaginal sex (p < .05) and
greater frequency of condom-protected
sex (p < .05) than participants in the
behavioral skills training intervention
at the 12-month follow-up.
- ARK intervention participants
reported significantly greater
percentages of condom-protected sex at
the 6-month (p < .05) and 12-month (p <
.05) follow-ups when compared to the
health education participants and at the
12-month follow-up (p < .05) when
compared to the behavioral skills
training participants.
Considerations
- This intervention fails to meet the best-evidence criteria due to
assigning groups of individuals to study condition while analyzing at the
individual level and small analytical sample sizes.
- This intervention is based on the Becoming a
Responsible Teen (BART) intervention, which already has an intervention
package available and is identified by PRS as a best-evidence intervention.
BART is an 8-session small-group intervention that was originally tested
with African American adolescents in family public health clinics. This
intervention was designed for substance-dependent adolescents and included
additional sessions focusing on problem-solving skills, anger management
skills, and motivating youth to change behavior.
- All participants in this study received the standard 3-week
detoxification program provided by the drug treatment facilities and
remained in the facility for 30 days after initial detoxification. Drug
treatment programs were based on the 12-step Alcoholics Anonymous program
and involved group sessions around substance abuse, educational classes, and
recreational activities.
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References and Contact Information
- St. Lawrence, J. S., Crosby, R. A., Brasfield, T. L., & O'Bannon III, R.
E. (2002). Reducing STD and HIV risk behavior of substance-dependent
adolescents: A randomized controlled trial. Journal of Consulting and
Clinical Psychology, 70, 1010 – 1021.
Researcher: Dr. Janet St. Lawrence,
Mississippi State University – Meridian, Division of Arts & Sciences,
1000 Hwy 19 North, Meridian, MS 39307-5799. email:
jlawrence@meridian.msstate.edu
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