SafERteens

Guide to Effective Programs
for Children and Youth

SafERteens

OVERVIEW

The SafERteens program is a brief intervention aimed at changing adolescent behavior pertaining to alcohol and violence. Through either a computerized or therapist-driven approach, the program uses principles of motivational interviewing to impact adolescent decision-making, goal-setting, feelings of responsibility, and the desire to achieve behavioral change. Multiple experimental evaluations of the program have yielded somewhat different results. One evaluation found significant improvements at a 3-month follow-up for participants in both the computerized and therapist-lead interventions, on measures of alcohol-related attitudes, violence-related attitudes, and self-efficacy for avoiding violence, but no significant improvements in self-efficacy for avoiding alcohol, or in readiness to change behaviors related to alcohol or violence. The other evaluation found that, at a 3-month follow-up, participants in the therapist-led intervention were less likely to report any severe peer aggression, experiences of peer violence, and experiencing (negative) consequences from violent behavior, but no significant differences were found for the group receiving the computerized intervention on any measure, and no differences for the therapist-led intervention on measures of alcohol misuse, binge drinking, or experiencing (negative) consequences from behavior pertaining to alcohol. At a 6-month follow-up, both intervention groups were significantly less likely than the control group to report consequences related to alcohol, and those in the computerized intervention were less likely to report any experience of peer violence. No other differences existed between all three conditions on any of the other measures.

DESCRIPTION OF PROGRAM

Target Population: Inner-city adolescents

SafERteens is a brief intervention that uses motivational interviewing techniques to help move adolescents engaging in behavior involving violence and alcohol, toward behavioral change. This type of approach emphasizes several principles that include increasing problem-recognition abilities, encouraging choice and responsibility, improving self-efficacy for changing risky behaviors, distinguishing between current behavior and future goals/values, enhancing motivation for change that is nonjudgmental and non-confrontational, and rolling with resistance (avoiding being confrontational or argumentative in advocating for change). The program also aims to reset values pertaining to social norms, and teach skills through role-playing scenarios that involve anger management skills, refusal skills (for alcohol and risks related to alcohol use), and conflict resolution skills.

There are two versions of the intervention that may be administered. For the therapist-driven approach, adolescents are given a tablet computer that they use to complete checklists that identify reasons to avoid violence and alcohol. Based on risky behaviors reported by the adolescent, the computer utilizes an algorithm to produce more personalized role-playing scenarios, which the therapist then leads the participant through. These sessions are audio-recorded and coded by independent raters to ensure appropriate performance by the therapists. In the computerized approach, participants use tablets with touch-screens and audio (through headphones) to interact with a specially designed multimedia program. Through a cartoon-style program, participants select a “buddy,” appropriate to their age, sex, and race, that will guide them through the various elements of the intervention. These include identifying reasons to avoid fighting and drinking, and tailored role-play scenarios and feedback based on participants’ survey responses and reported risky behavior. Participants make choices about their behavior and interact with peers, with consequences and ideal outcomes explained by the “buddy.” Both versions of the intervention were specifically designed to have cultural relevance to inner-city youth.

EVALUATION(S) OF PROGRAM

Cunningham, R.M., Walton, M.A., Goldstein, A., Chermack, S.T., Shope, J.T., Bingham, R., Zimmerman, M.A., & Blow, F.C. (2009). Three-month follow-up of brief computerized and therapist interventions for alcohol and violence among teens. Academic Emergency Medicine, 16, 1193-1207

Evaluated population: Participants consisted of 533 adolescents (ages 14-18 years) that had been admitted to an urban emergency department for either injury or medical illness. To be included in the study, participants had to complete an initial, self-administered screening survey. Following completion of the screening, participants had to confirm that they had been involved in some type of violent, physical fighting, and had used alcohol, within the past year. Adolescents were excluded from the study if they were receiving treatment for suicidal ideation or sexual assault, had been diagnosed with schizophrenia, or if they demonstrated abnormal vital signs. Fifty-five percent of the sample was African American, 42 percent male, and there were no significant differences between the three groups at baseline.

Approach: Participants were randomly assigned to either the computerized intervention (N=185), the therapist-led intervention (N=164), or the control condition (N=184). Youth assigned to the control condition each received a brochure that contained phone numbers for relevant community organizations, as well as information about violence and alcohol. To measure the effectiveness of the interventions, data were collected on violent behavior, weapon carrying and use, substance use, past-year medical services received, past-year violent injuries sustained, attitudes about alcohol use and violence, self-efficacy with regard to avoiding alcohol consumption and violence, readiness to change behavior related to violence and alcohol, and reason for current emergency department visit. Data were collected at baseline and at a three-month follow-up interview for participants in all three conditions. Participants in the computerized and therapist interventions also completed a post-test survey.

Results: Pre-/post-test paired comparisons for the computerized and therapist interventions on measures of self-efficacy, readiness to change, and attitudes showed significant positive changes for both intervention groups in terms of self-efficacy to avoid such behaviors, and attitudes towards alcohol and violence. No significant changes were found for readiness to change.

Comparisons from baseline to the three-month follow-up found significant improvements in attitudes toward alcohol (therapist ES=0.39, computer ES=0.39), attitudes toward violence (therapist ES=0.25, computer ES=0.22), and self-efficacy to avoid violence (therapist ES=0.22, computer ES=0.31) for the two interventions compared to the control group. No significant differences existed for self-efficacy to avoid alcohol, or for readiness to change behavior.

Walton, M.A., Chermack, S.T., Shope, J.T., Bingham, C.R., Zimmerman, M.A., Blow, F.C., & Cunningham, R.M. (2010). Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: A randomized control trial. Journal of the American Medical Association, 304(5), 527-535

Evaluated population: Participants consisted of 726 adolescents (ages 14-18 years) that had been admitted to an emergency department in Flint, Michigan, for medical illness or injury. To be included in the study, participants had to complete an initial, self-administered screening survey. Following completion of the screening, participants had to confirm that they had been involved in some type of aggression (weapon carrying/use, dating, peer), and had consumed alcohol, in the past year. Adolescents were excluded from the study if they were receiving treatment for suicidal ideation or sexual assault, altered mental status, or if they demonstrated abnormal vital signs. Fifty-six percent of the sample was African American, and 44 percent was male.

Approach: Participants were randomly assigned to either the therapist-led intervention (N=254), the computerized intervention (N=237), or the control condition (N=235). At baseline, computerized intervention participants were significantly more likely to have dropped out of school than those in the therapist-led or control groups. There were no other significant differences between groups at baseline. Youth assigned to the control condition each received a brochure that contained phone numbers for relevant community organizations, as well as information about violence and alcohol. To assess the effectiveness of the interventions, data were collected on alcohol use/consequences, frequency of aggression, consequences of fighting, and reason for current admission to the emergency department. Data were collected at baseline and at 3- and 6-month follow-ups.

Results: At the 3-month follow-up, participants in the therapist-led intervention were significantly less likely than those in the control condition to report any severe peer aggression, experience of peer violence, and violence consequences. No significant differences existed between the computerized intervention group and controls for any of those outcomes, and no significant differences existed among the three groups on measures of alcohol misuse, binge drinking, or alcohol consequences. At the 6-month follow-up, participants in the computerized intervention were significantly less likely than those in the control group to report any experience of peer violence. Both the computerized intervention and therapist-led intervention groups were significantly less likely than those in the control condition to report alcohol consequences. There were no other significant differences among the three groups on any of the other measures.

SOURCES FOR MORE INFORMATION

References

KEYWORDS: Adolescents, Youth, Young Adults, Males and Females (Co-ed), Urban, Clinic/Provider-Based, Computer-Based, Counseling/Therapy, Alcohol Use, Dating Violence, Aggression

Program information last updated 9/13/11