Program

Sep 13, 2011

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

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

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

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

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