Program

Apr 12, 2013

OVERVIEW

Assisting in Rehabilitating Kids (ARK) is based on the information-motivation-behavioral skills model (IMB) of AIDS-preventive behavior and is designed to increase safer sex behaviors in substance-dependent adolescents who are high-risk of becoming infected with HIV/AIDS. The program involves an information component, a motivation component, and a behavioral component. An experimental evaluation comparing the information component (I), the information and behavioral components (I+B), and the information, motivation, and behavioral components (I+M+B) found that the I+B and I+M+B conditions had positive impacts compared with the I condition on several outcomes, including attitudes toward condoms, social competency, and anger skills. The two areas where the I+M+B group was superior to both of the other groups were perceived risk of getting HIV/AIDS and risky sexual behavior. There was a positive impact for all three groups on AIDS knowledge and drug use, but there were no differences between groups.

DESCRIPTION OF PROGRAM

Target Population: Substance-dependent adolescents

Assisting in Rehabilitating Kids (ARK) is designed to increase safer sex behaviors in substance-dependent adolescents who are high-risk of becoming infected with HIV/AIDS. The program involves three components and is based on the information-motivation-behavioral skills model (IMB) of AIDS-preventive behavior. The information or I component involves a standard health education curriculum including instruction, educational games, and group discussion. The curriculum includes sessions focused on STD and HIV information. The motivation or M component involves a motivational manipulation that addresses personal perceptions of risk to motivate participants to practice safer sex or abstinence using an emotion-based strategy. A photo is taken of the participant at baseline, and the image is then altered to show how they might appear in end-stage AIDS. The photos are distributed to participants during session 10 and participants discuss their emotional response to the image and how the photos might affect their willingness to engage in safer sexual behaviors. The behavioral or B component is based on Becoming a Responsible Teen, with additional sessions that teach problem solving skills based on a program developed for drug users and sessions that teach anger management skills based on the PACT program. The program has 90-minute sessions three times a week for four weeks in mixed gender groups of six to ten adolescents. The sessions are led by one male and one female facilitator. The facilitators have degrees in psychology and receive extensive training and supervision.

EVALUATION OF PROGRAM

Evaluated Population: This study involved 161 participants recruited from residential drug treatment programs in Mississippi that served adolescents between 1995 and 1998. The mean age of participants was 16 years. The sample was 68 percent male and 32 percent female, and it was 75 percent Caucasian, 22 percent African American, 1 percent Hispanic, and 2 percent Native American. Ninety-seven percent of the participants were sexually experienced at baseline, and the mean age of first consensual intercourse was 12.3 years. Participants had a number of other risk factors related to sexual activity and drug use.

Approach: Each cohort of 6-10 adolescents was randomly assigned to the information only (I) condition, information plus skills-based safe sex training (I+B), or information plus skills-based safer sex training plus a risk-sensitization manipulation (I+M+B). The intervention was in addition to drug treatment at the facilities, which was based on Alcoholics Anonymous. Data were collected at post-treatment, and 6 and 12 months after discharge from the drug treatment facilities. Data were collected on AIDS risk knowledge, attitudes regarding condom use, attitudes related to HIV prevention, self-efficacy related to ability to lower HIV risk, perceived risk of  getting HIV/AIDS, role play assessments of social competency and anger management skills, self-reported sexual behavior, and self-reported substance use. There were no differences at baseline between the groups.

Results:

Knowledge, Attitudes, and Beliefs

All three groups increased their knowledge about AIDS and improved their self-efficacy from baseline to post-intervention, but there were no differences between groups. All groups improved their attitudes toward prevention, but the I condition did not improve as much as the other two groups. The impact on attitudes toward prevention was sustained through the following year for only the I+ B participants, though scores for the I+M+B group remained higher at follow up than they were at baseline. Both the I+M+B and the I+B groups had positive impacts sustained through the follow-up year on attitudes toward condoms, but there was no impact for those in the I group. All groups decreased their perceived risk, with all but the I+M+B group remaining lower through the last follow-up

Behavioral Measures

There was a positive impact on social competency and anger management skills for the I+B and I+M+B groups, compared with those in the I condition, but there was no difference between I+B and I+M+B groups. There was a positive impact on risky sexual behavior for the I+B and I+M+B groups, compared with those in the I condition, but the I+M+B group maintained their decrease in risky sexual behavior more than the I+B group at the one-year follow-up. There was also a positive impact on abstinence (no sexual activity during the previous 90 days) for those in the I+B and I+M+B groups, compared with those in the I group, and this impact was sustained through the follow-up year. All groups decreased their drug use, with no differences between groups. This reduction in drug use was maintained through the one-year follow-up.

SOURCES FOR MORE INFORMATION

Website: http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.ebpDetail&PageID=594

References

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.

KEYWORDS: Adolescents, Males and Females, High-Risk, White/Caucasian, Clinic/Provider-based, Skills Training, Other Substance Use, Social Skills/Life Skills, Other Social/Emotional Health, Sexual Activity, Condom Use and Contraception, Other Reproductive Health

Program information last updated on 4/12/13.