Becoming a Responsible Teen

Transcription

Becoming a
Responsible Teen
Adaptation Kit
Tools and Resources for Making Informed Adaptations to
BART: Becoming a Responsible Teen
Rev. October 2011
Lori A. Rolleri, MSW, MPH
Nicole Lezin, MPPM
Julie Taylor, BA
Claire Moore, MPH
Mary Martha Wilson, MA
Taleria R. Fuller, PhD
Regina Firpo-Triplett, MPH
Janet S. St. Lawrence, PhD
Funding was made possible by Contract #GS10F0171
from the Centers for Disease Control and Prevention (CDC).
Adaptation Kit
Tools and Resources for
Making Informed Adaptations to
Nicole Lezin, MPPM
Julie Taylor, BA
Claire Moore, MPH
Mary Martha Wilson, MA
Regina Firpo-Triplett, MPH
Janet S. St. Lawrence, PhD
ETR Associates
2011
Funding was made possible by Contract # GS10F0171T from
the Centers for Disease Control and Prevention (CDC).
About ETR Associates
ETR Associates (Education, Training and Research Associates), established in 1981, is a
national, nonprofit organization whose mission is to enhance the well-being of individuals, families
and communities by providing leadership, educational resources, training and research in health
promotion with an emphasis on sexuality and health education.
ETR's Program Services Division offers comprehensive services for the development,
implementation, evaluation and dissemination of critical public health initiatives. The division
works directly with community-based programs, state and local education agencies, health care
providers, health educators and public health organizations.
ETR's Publishing Division produces authoritative health education and health promotion
resources that empower young people and adults to lead healthier lives. Thousands of ETR
pamphlets, books and other materials are used in hundreds of health care settings, schools and
workplaces across the United States and around the world.
For more information about ETR, visit www.etr.org.
About CDC's Division of Reproductive Health
The CDC's Division of Reproductive Health (DRH) promotes optimal reproductive and infant
health through leadership, scientific and programmatic expertise, support to impact public policy,
health care and community practices, and individual behaviors. This mission is accomplished
through partnership to conduct research, support national and state-based surveillance systems,
provide technical assistance and training, and translate research findings into health care
practices and health promotion strategies. CDC DRH priority areas include infant and maternal
health, women’s reproductive health, global reproductive health, and unintended and teen
pregnancy prevention.
www.cdc.gov/reproductivehealth/DRH/index.htm
© 2011 by ETR Associates
4 Carbonero Way
Scotts Valley, CA 95066-4200
Suggested Citation
Rolleri, L.A., N. Lezin, J. Taylor, C. Moore, M.M.Wilson, T. Fuller, R. Firpo-Triplett, and
J. St. Lawrence. 2011. Becoming a Responsible Teen Adaptation Kit. Santa Cruz, CA:
ETR Associates.
ETR Associates and CDC Division of Reproductive Health, 2011
ii
Table of Contents
Acknowledgments ........................................................................................................... v
Introduction .....................................................................................................................1
How to Use This Kit .........................................................................................................5
Becoming a Responsible Teen BDI Logic Model ............................................................. 9
BDI Logic Model at-a-Glance .................................................................................................... 11
Comprehensive BDI Logic Model .............................................................................................. 17
Becoming a Responsible Teen Core Components ........................................................ 37
Core Content Components at-a-Glance .................................................................................... 39
Core Content Components in Depth ......................................................................................... 41
Core Pedagogical Components at-a-Glance ............................................................................. 51
Core Pedagogical Components in Depth .................................................................................. 52
Core Implementation Components at-a-Glance ........................................................................ 59
Core Implementation Components in Depth ............................................................................. 60
Becoming a Responsible Teen Green/Yellow/Red Light Adaptations ............................ 63
General Adaptations .................................................................................................................. 65
Activity-Specific Adaptations ..................................................................................................... 69
Becoming a Responsible Teen Adaptation and Fidelity Monitoring Logs ....................... 85
Glossary ...................................................................................................................... 109
iii
iv
Acknowledgments
Many talented, experienced and energetic people were involved in the conceptualization,
development, review and production of the Becoming a Responsible Teen Adaptation Kit.
First, we acknowledge the wisdom and innovation of Dr. Janet St. Lawrence, the developer of the
Becoming a Responsible Teen program. Becoming a Responsible Teen is making a difference in
the reproductive health of thousands of young people in the United States and abroad. We
express special appreciation to Dr. Janet St. Lawrence for reviewing this document and giving the
writing team critical feedback.
Funding for this adaptation kit was largely made possible by a grant from the Division of
Reproductive Health (DRH) at the Centers for Disease Control and Prevention. The Adolescent
Reproductive Health team at CDC DRH responded to numerous requests from its grantees for
guidance on how to effectively adapt evidence-based programs such as Becoming a Responsible
Teen. Thank you, CDC, for responding to this need. Thank you also for the vision, expertise,
patience and flexibility of several CDC DRH staff who contributed to the conceptualization and
development of these adaptation kits, especially Claire Moore, Lorrie Gavin, Taleria R. Fuller,
Catherine Lesesne, Alison Spitz, Carla P. White and Trisha Mueller.
CDC DRH awarded funding to ETR Associates to develop adaptation guidance for evidencebased programs in the Fall of 2006. ETR assembled a team of multidisciplinary staff with years of
experience in developing, evaluating and disseminating evidence-based programs, including Julie
Taylor, Dr. Karin Coyle and Dr. Douglas Kirby. Their in-depth understanding of how evidencebased programs are constructed has been an invaluable asset to the team.
Other senior staff at ETR served as writers and reviewers of these kits, including Pamela Drake,
Michelle Bliesner, Bayla Greenspoon and Regina Firpo-Triplett. ETR’s top-notch editing staff who
copyedited and formatted the adaptation kits include Suzanne Schrag, Pat Rex, Charlene Foster,
Laura Patton and Dorothy Keefe-Hungerford. ETR’s senior leadership, Marsha Weil, Francisco
Buchting and Coleen Cantwell, provided the team with ongoing executive support and
encouragement. Finally, we want to acknowledge Lanett Beard, Logistics Specialist on this
project, who tended to numerous administrative details that made all of our jobs much easier.
ETR was fortunate to have two trusted consultants on the adaptation guidance team: Nicole Lezin
of Cole Communications, a brilliant writer who epitomizes the definition of team player, and Mary
Martha Wilson of Healthy Teen Network, who brought valuable practitioner perspectives to the
team, served on our writing team and made sure the team was having fun.
An Adaptation Work Group (AWG) was established during the first few weeks of the Adaptation
Guidance project. The AWG provided important guidance on the development of an adaptation
framework, criteria for selecting evidence-based programs, and process for developing
adaptation tools. Members of the AWG represent behavioral scientists from CDC, and
practitioners from the field. Thank you to Joan Helmich, Forrest Alton, Polly Edwards, Mary
Prince, Kim Nolte, Mary Schauer, Lisa Barrios, Lisa Romero, Camilla Harshbarger, Joan Kraft,
Jennifer Galbraith, Kelly Lewis and Mary Martha Wilson.
v
Becoming a Responsible Teen Adaptation Kit
Acknowledgments
After the team developed drafts of various adaptation tools and resources (which later became
part of the adaptation kits), we assembled several groups of practitioners to provide feedback on
content, format and usability. Thank you to Erica Fletcher of the Massachusetts Alliance on Teen
Pregnancy, who coordinated six local practitioners to review drafts of these materials in
November 2007, and to Tina Devlin, Erin Johnson and Forrest Alton of the South Carolina
Campaign to Prevent Teen Pregnancy, who brought together eight practitioners in Columbia,
South Carolina, in December 2007. We are indebted to these individuals whose feedback helped
us streamline these kits and make them practitioner friendly.
In February 2008, our team held a final review meeting in Atlanta, Georgia, with representatives
from each of the CDC DRH Promoting Science-Based Approaches grantees, including the
National Campaign to Prevent Teen and Unplanned Pregnancy; Healthy Teen Network;
Advocates for Youth; the Massachusetts Alliance on Teen Pregnancy; the South Carolina
Campaign to Prevent Teen Pregnancy; the Adolescent Pregnancy Prevention Campaign of North
Carolina; the Colorado Youth Matter; the Hawaii Youth Services Network; the Minnesota
Organization on Adolescent Pregnancy, Prevention and Parenting; the Oklahoma Institute for
Child Advocacy; the Pennsylvania Coalition to Prevent Teen Pregnancy; the Center for Health
Training Resource Group; JSI Research & Training Institute, Inc.; Family Planning Council,
TRAINING 3; and Health Care Education and Training. The feedback we received from this
meeting helped to further streamline and simplify many of the tools found in this kit.
It has been an honor to work with so many generous and talented individuals from across the
country. We hope you find the Becoming a Responsible Teen Adaptation Kit a useful tool as you
customize the program for the youth you serve in your communities. This kit was created for you,
and your feedback is always welcomed. Please contact the Project Director, Regina FirpoTriplett, at reginaf@etr.org.
With gratitude,
Former Director, Adaptation Guidance Project
ETR Associates
Health Scientist
CDC Division of Reproductive Health
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Introduction
Overview of Becoming a Responsible Teen 1
Goal of the Curriculum
Although the primary goal of Becoming a Responsible Teen (BART) is to decrease HIV infection
among African-American adolescents and other youth ages 14 to 18, the curriculum also includes
topics and activities relevant to teen pregnancy prevention. Teens learn to clarify their own values
about sexual decisions and pressures, as well as practice skills to reduce sexual risk taking.
These skills include correct condom use, assertive communication, refusal techniques, selfmanagement and problem solving. Abstinence is woven throughout the curriculum and is
discussed as the best way to prevent HIV and pregnancy.
Target Audience
The target audience for BART is African-American, Hispanic and White adolescents, ages 14–18,
in a non-school setting.
Implementation of the Curriculum
BART was designed to be used with small groups ranging from 6 to 12 participants, but it can
also be implemented with larger numbers of youth. The curriculum can be implemented in various
community settings, including facilities for after-school programs or youth-serving agencies.
Length
The curriculum has 12 hours of content divided into 90-minute sessions. It could be implemented
in eight sessions of 90 minutes each or in six two-hour sessions.
Curriculum Objectives
At the completion of BART, youth will be able to:
• State accurate information about HIV and AIDS, including means of transmission, prevention
and current community impact.
• Clarify their own values about sexual decisions and pressures.
• Demonstrate skills in correct condom use, assertive communication, refusal, information
provision, self-management, problem solving and risk reduction.
Curriculum Sessions
Session 1: Understanding HIV and AIDS
Session 2: Making Sexual Decisions and Understanding Your Values
Session 3: Developing and Using Condom Skills
Session 4: Learning Assertive Communication Skills
Session 5: Practicing Assertive Communication Skills
Session 6: Personalizing the Risks
Session 7: Spreading the Word
Session 8: Taking BART with You
1
This overview section on Becoming a Responsible Teen was adapted from ETR’s Resource Center for Adolescent
Pregnancy Prevention (ReCAPP): http://www.etr.org/recapp/index.cfm?fuseaction=pages.ebpDetail&PageID=2
1
Introduction
Types of Activities
BART includes interactive group discussions and roleplays that have been created by teens.
Teens learn to "spread the word" to their friends about HIV risks. They are encouraged to practice
skills outside the group and share the results. The group provides creative solutions to reported
problems.
Theoretical Framework
BART is based on the knowledge that information and awareness are preconditions that set the
stage for change and that people learn by seeing others model the desired behaviors and values.
Social Learning Theory and the Information-Motivation-Behavioral (IMB) Model for Behavior
Change provide the theoretical basis for BART.
Unique Features of the Curriculum
BART has features that distinguish it from other HIV prevention curricula:
•
•
•
•
•
Teens had an active role in developing all aspects of the curriculum.
It focuses on the needs of African American adolescents, ages 14 to 18.
It was implemented in non-school, community-based settings.
It was designed to be used with gender-specific groups, each group facilitated by both a male
and female group leader.
It has been demonstrated to be effective with both sexually experienced and sexually
abstinent youth.
Ordering a Copy of BART
BART includes session outlines, instructions for group leaders, handouts for duplication, parent
consent forms, and general guidelines for setting up the program.
To receive more information and to order BART, contact ETR Associates at 1-800-321-4407,
www.etr.org/pub.
Evaluation Facts 2
Intervention
African-American adolescents, separated by gender, attended eight weekly sessions of a
sexuality education program (BART) that included behavioral skills training. In addition to
information about AIDS and prevention of HIV infection, the youth participated in activities to build
skills in correct condom use, assertive communication, refusal, information provision, self
management, problem solving and risk recognition. Group sizes ranged from 5 to 15, and
sessions lasted from 90 to 120 minutes each. Fourteen sets of sessions were conducted over
three years in a comprehensive community health center serving predominately low-income
minority residents in a Southern urban area of 400,000 residents.
Research Design
In the study, 246 adolescents were randomly assigned either to a control condition or to the
experimental intervention (BART). The control condition consisted of a single two-hour session
2
These Evaluation Facts were adapted from ETR’s Resource Center for Adolescent Pregnancy Prevention (ReCAPP):
http://www.etr.org/recapp/
2
Introduction
that provided information about HIV/AIDS, including its nature, prevention and impact on the local
community. Interactive discussions were interspersed with games, activities and problem solving.
The first session of the experimental intervention was identical to the control condition.
Participants completed questionnaires before, immediately after, and at 6-month intervals for one
year after the intervention. Of the original 246 participants, 91.5% completed the 12-month followup. Measures included HIV risk, sexual behaviors, self-efficacy, attitude toward condoms and
HIV/AIDS knowledge.
Behavioral Findings
Of the youth who were sexually abstinent prior to the intervention, only 11.5% of the BART
participants were sexually active one year later compared with 31% of participants in the control
group. Among those sexually active prior to the intervention, 42% of the control group remained
so after one year versus only 27% of the intervention group. In comparison to their behavior
before the intervention, and in comparison with those in the control group, youth who participated
in BART were more likely to use condoms and less likely to engage in unprotected vaginal or anal
intercourse.
Other Significant Findings
Despite the fact that both groups received the same basic information component, the BART
group scored higher on the AIDS knowledge test than the control group and maintained that lead
across the 12-month follow-up period. Moreover, youth from the intervention group were more
skillful than those in the control group in handling pressures to engage in unprotected sex and in
providing information to peers.
Research Study Citation
St. Lawrence, J.S., T. Brasfield, K.W. Jefferson, E. Alleyne, R.E. O'Bannon and A. Shirley. 1995.
Cognitive-behavioral intervention to reduce African-American adolescents' risk for HIV infection.
Journal of Consulting and Clinical Psychology 63 (2): 221–237.
3
Introduction
Janet S. St. Lawrence, Ph.D.
Dr. Janet S. St. Lawrence is Professor Emerita of Arts & Sciences at Mississippi State
University. She completed a Ph.D. in Clinical Psychology from Nova University in Florida,
followed by a post-doctoral year as Chief Resident in the Department of Psychiatry and Human
Behavior at the University of Mississippi Medical Center 1. Following the residency, she because
an Assistant Professor at the University of Mississippi from 1980-1987, then Associate to full
Professor at Jackson State University from 1987 - 1996. From 1996 - 2006, she was Chief of the
Behavioral Research and Interventions Branch in the Division of Sexually Transmitted Diseases
at the Centers for Disease Control and Prevention. After retiring from the CDC, Dr. St. Lawrence
returned to academe at Mississippi State University.
Dr. St. Lawrence has received numerous awards and recognition: The American Psychological
Associations' Psychology and AIDS Award; the Association for the Advancement of Behavior
Therapy's Outstanding Research Award; NAFEO's National Research Award; the Mississippi
Psychological Association's Research Achievement Award (twice), and Outstanding Teaching of
Psychology Award. Her research career focuses on developing and evaluating STD/HIV risk
reduction interventions, primarily in community settings. While in clinical practice from 1980-1996,
she specialized in individuals and families who were living with HIV/AIDS. She served on the
National Institute of Mental Health's Immunology and AIDS study section that reviewed NIH grant
applications from 1992-1995 and again on the Behavioral and Social Prevention of HIV/AIDS
Study Section from 2007-2011 and on CDC's Behavioral Science Peer Review Panel in 1994.
In addition to being the author of more than 200 books, book chapters, and articles in
professional journals, Dr. St. Lawrence developed and evaluated Becoming a Responsible Teen,
an evidence-based HIV risk reduction program for 14 to 18 year olds.
4
How to Use This Kit
What is the purpose of the Becoming a Responsible Teen Adaptation Kit?
The goal in developing the Becoming a Responsible Teen (BART) Adaptation Kit is to provide
practitioners with practical tools and resources to guide them in maintaining fidelity to BART’s
core components and in making effective adaptations. Most practitioners will make adaptations to
evidence-based curricula such as BART in order to have the activities resonate better with the
particular group of youth they are serving in their communities. This is good practice and is
encouraged. However, sometimes these adaptations are made with very little guidance,
information or understanding about the curriculum’s core components that are essential for its
effectiveness. This kit was developed to give practitioners better clarity about how BART is
designed, its core components and the types of adaptations that are considered safe and unsafe.
What tools are found in the BART Adaptation Kit and how were they
developed?
ETR Associates and the Division of Reproductive Health (DRH) at the CDC worked together to
develop the tools in this kit using a six-step process. With the exception of the first step, each
step resulted in adaptation tools found in this kit. Each of these tools underwent extensive
reviews by frontline practitioners in the field, behavioral scientists, and, most important, BART’s
chief developer, Dr. Janet St. Lawrence. The steps and tools are described below.
1. Determinant-Activity Matrix: The team initially reviewed each activity in every lesson of
BART and coded them for answers to two questions: (1) what psychosocial determinant(s) is
this activity trying to change? and (2) what teaching method is being used to teach it?
Determinants are the psychosocial and environmental factors that have a causal influence on
sexual behaviors. Determinants can include factors such as knowledge, attitudes, skills or
conditions. Teaching methods are things such as roleplays, videos, lectures, etc. This matrix
is not included in the kit, but it was instrumental in the development of the BehaviorDeterminant-Intervention (BDI) logic model for BART.
2. Behavior-Determinant-Intervention (BDI) Logic Model: With an analysis of BART’s
activities complete, the team built a BDI logic model for the curriculum. The BDI logic model
is a program planning tool that guides program developers in four sequential and clearly
linked steps starting with: (1) establishing a health goal, (2) identifying and selecting the
individual or group behaviors directly related to that health goal, (3) identifying and selecting
the determinants related to those behaviors, and (4) developing intervention activities directly
related to those determinants. In effect, a BDI logic model uncovers the developer’s theory of
change—that is, what factors (determinants) need to be changed in order to get teens to
change their sexual behaviors. A complete BDI logic model for BART is found in this kit, as
well as a “BDI Logic Model at-a-Glance.”
3. Core Components: With the BDI logic model complete, the team was able to better identify
BART’s core content, pedagogical and implementation components. Core components are
the essential pieces of a curriculum that are responsible for its effectiveness. Tables
describing the core content, pedagogical and implementation components (in comprehensive
and at-a-glance versions) are found in this kit.
5
How to Use This Kit
4. Green/Yellow/Red Light Adaptations: With the core components complete, the team was
then able to develop a tool for identifying green/yellow/red light adaptations. As the metaphor
suggests, this tool tells practitioners what kind of adaptations are safe (green), which should
be made with caution (yellow), and which should be avoided (red). The first part of this tool
describes green, yellow and red light adaptations as they apply generally to BART. The
second part is a table formatted to describe green, yellow and red light adaptations per
activity in each of BART’s eight sessions.
5. Fidelity and Adaptation Monitoring Logs: Using the Core Components Tables and the
Green, Yellow, Red Light Adaptation Tables, the team developed a tool called Fidelity and
Adaptation Monitoring Logs. This tool provides a place for facilitators of the evidence-based
program to record their fidelity to each session’s core content and pedagogical components,
as well as the effectiveness of planned and unplanned adaptations made to each model. It
also provides a log to assess their overall fidelity to the curriculum’s core implementation
components. (This log is completed after the curriculum is implemented in its entirety.)
6. Glossary: A glossary of terms is included at the end of the kit.
How do I use the BART Adaptation Kit?
Although people may not always think of making program adaptations as “program planning,”
making effective adaptations to a curriculum involves comprehensive planning. For example,
assessments of the youth you are going to serve and your organization’s capacity will yield
important data that you can use to inform your adaptations. An understanding about how to select
the best matching program for your youth will help limit the number of adaptations you may need
to make. Evaluating the adaptations you make can help you improve future implementations of
BART. It’s recommended that you review a program planning, implementation and evaluation
model such as Promoting Science-Based Approaches to Teen Pregnancy Prevention using
3
Getting to Outcomes before making adaptations to BART. This model was developed
specifically for practitioners working in the field of adolescent reproductive health and will help
you think about program adaptation throughout the program planning process.
The kit was designed with flexibility in mind. There is no particular order in which you must use
these tools. One suggestion is that you review the tools as they were developed (and as they are
presented in this kit) and take what you need from them. For example, if you are interested in the
underlying theory of change used by BART and how the curriculum was put together, look at the
BART Logic Model. If you are interested in knowing what parts of BART contribute to its
effectiveness, review the Core Content, Pedagogical and Implementation Components. If you
want to make changes, additions, deletions or adaptations to BART, look at the
Green/Yellow/Red Light Adaptations Tables. If you do not find the exact kind of adaptation that
you want to make to the program in this section, go to the Core Components Tables and make
sure that the adaptation does not compromise or delete them. If you are looking for a process
monitoring tool, the Fidelity and Adaptation Monitoring Logs are a good choice. Finally, if you are
3
Lesesne, C.A., K.M. Lewis, C. Moore, D. Fisher, D. Green and A. Wandersman. 2007. Promoting science-based
approaches to teen pregnancy prevention using Getting to Outcomes: Draft, June 2007. Atlanta, GA: CDC Division of
Reproductive Health. (Unpublished manual.)
6
How to Use This Kit
looking for a particular resource to help you make an adaptation, access the Companion
Resources. (See below for more information.)
The following table illustrates the different purposes of the sections of the adaptation kit.
BDI Logic
Model
I want to better understand
the underlying theory of
change used by BART
and how the curriculum
was put together.
Core
Components
Green/Yellow/
Red Light
Adaptations
Fidelity &
Adaptation
Logs
Companion
Resources
(see below)

I want to understand what
parts of BART are
essential.

I want to make effective
adaptations to BART
without compromising
fidelity.

I need a process
monitoring tool to track my
fidelity to core components
and the planned and
unplanned adaptations I
make.



I want recommendations
for resources that might
help me in making
effective adaptations.

Companion Resources. The Companion Resources are a useful supplement to this adaptation
kit. Here you will find links to the latest health information and research that you can use to
update information in the curricula and make informed decisions about program planning,
assessment and evaluation. You will also find ideas for alternate activities, information about
specific ethnic and cultural groups, which is broken down by group and will be invaluable if you
want to adapt a curriculum for another youth population, and many other handy resources. These
include: a list of websites specifically for teens, a compilation of print materials on fidelity and
adaptation, and links to information on teaching skills such as classroom management and
leading group discussions. This companion piece is available at:
http://www.etr.org/recapp/index.cfm?fuseaction=pages.AdaptationsHome.
For more information about this adaptation kit, please contact Regina Firpo-Triplett at ETR
Associates, reginaf@etr.org.
7
How to Use This Kit
8
Becoming a Responsible
Teen
BDI Logic Model
9
BDI Logic Model
10
BDI Logic Model at-a-Glance
What is a “BDI Logic Model”?
The Behavior-Determinant-Intervention (BDI) logic model is a program planning and analysis tool
4
developed by Douglas Kirby. A BDI logic model graphically shows the links or connections
between the health goal of a curriculum or program, the adolescent sexual behaviors directly
5
related to that health goal (e.g., condom use), the determinants (e.g., knowledge, attitude, skills)
that influence those sexual behaviors, and the intervention activities specifically designed to
change those determinants (e.g., roleplays, large-group discussion, etc.).
The BDI logic model graphically depicts the developer’s theory of change for a program, i.e., what
needs to be changed in order for teens to engage in healthy sexual behaviors.
Intervention
Activities
Determinants
Behaviors
Health Goal
For more information about BDI logic models, visit
http://www.etr.org/recapp/documents/BDILOGICMODEL20030924.pdf
How do I use the Becoming a Responsible Teen BDI Logic Model?
The Becoming a Responsible Teen (BART) BDI logic model is a useful tool for practitioners
preparing to implement and/or adapt BART. The logic model can help you better understand the
rationale/logic behind the learning activities found in BART by showing how these activities were
intentionally designed to change important determinants of adolescent sexual behavior. This
understanding will help you implement BART with greater fidelity and purpose. If you better
understand the link between learning activities and determinants, you are more likely to recognize
their value.
The BDI logic model is the foundation for identifying BART’s core content and pedagogical
components. If you are considering adaptations to BART, the BDI logic model can serve as a
map to guide adaptations so that changes or additions are consistent and responsive to the
“logic” presented in the model and the core content and pedagogical components derived from it.
BART’s BDI Logic Model at-a-Glance is presented first to offer a quick overview of the logic in the
BART curriculum. Immediately following, you will find the in-depth version of BART’s BDI logic
model.
4
Kirby D. 2004. BDI logic models: a useful tool for designing, strengthening and evaluating programs to reduce
adolescent sexual risk-taking, pregnancy, HIV and other STDs. Santa Cruz, CA: ETR Associates.
5
Determinants of behaviors are sometimes also called risk and protective factors.
11
Definitions of Common Determinants Found in
Evidence-based Sex and STD/HIV Education Programs
Attitude
An attitude is a state of mind, feeling or disposition. Attitudes are often expressed in the way
people think, feel and act. They demonstrate an individual’s opinions, dispositions, perspectives
or positions on a particular issue or topic. Attitudes are somewhat different from values.
Belief
A belief is an individual’s perception that a proposition or premise is true. For example, in the
Theory of Planned Behavior, normative beliefs are perceptions about the normative expectations
of others, and behavioral beliefs are perceptions about the likely consequences of specific
behaviors.
Communication with a Parent or Adult
This type of communication is the act of giving, receiving and understanding messages between
a parent/adult and a teen. Messages may include information or education, value sharing,
support or encouragement, advice, etc. Messages may be relayed via oral, written or nonverbal
methods.
Connectedness to Culture
Culture can relate to a person’s ethnicity, race, religion, geography, socio-economic status, age,
gender, and sexual orientation or identity. Feeling connected to culture may include awareness,
understanding, acceptance and pride about the norms, values, beliefs and history of that culture
and how it affects sexual decision making.
Empowerment
Empowerment is a process through which individuals feel competent and confident that they have
the needed competencies to successfully undertake a course of action and carry out a behavioral
plan.
Intentions
An intention is a decision, determination or plan to behave in a particular way in specific
situations. Even if a person intends to do something, it doesn’t mean that she/he will actually do
it. For example, a person who is thinking about quitting smoking intends or plans to quit but may
or may not actually follow through on that intention.
Knowledge
Knowledge refers to the awareness and understanding of information, statistics, facts, principles,
frameworks, and the characteristics/descriptions, causes and consequences related to a problem
(e.g., unintended pregnancy or HIV infection).
Motivation
Motivation is the desire to carry out a course of action or a behavior.
Outcome Expectations
Outcome expectations refer to the individual’s beliefs about what will result from engaging in a
certain behavior and the desirability of those results. The behavior could result in negative
consequences or positive consequences. For example, a teen may have negative outcome
12
expectations for using condoms because she believes her boyfriend will get mad at her or that
using condoms will ruin the pleasure of sex. Alternatively, another teen might have positive
outcome expectations for using condoms because he knows that his girlfriend will appreciate him,
that he will protect himself from pregnancy or an STD and/or that condoms can be fun to use.
See definition of “Attitude.”
Perception of Risk
Perception of risk relates to an individual’s understanding and belief about the likelihood that
he/she could experience negative consequences, such as unintended pregnancy or STD/HIV, by
engaging or not engaging in certain behaviors (e.g., having sex with a condom, having sex
without a condom). Perception of risk may reflect perceived susceptibility or vulnerability, severity
and seriousness of some possible outcome.
Skill
Skill refers to the ability to do something adequately or well (e.g., to use a condom correctly,
refuse sex, or negotiate condom use with a partner). Having the skill to do something means that
the individual understands the correct steps required for executing the action and knows how to
execute those steps. However, knowing how to do something does not mean that a person will
behave or act in the desired way in real-life situations. See definition of “Self-Efficacy.”
Self-Efficacy
Self-efficacy is a person’s confidence in his/her ability to perform particular behaviors well enough
to control events that affect his/her life. If someone has high self-efficacy, then she believes she
can perform behaviors well enough to change her environment and achieve a goal, and, as a
result, she has more confidence. She is then more likely to try to perform the behavior or achieve
a goal again. Conversely, if she has low self-efficacy, she believes she can’t achieve that goal,
has less confidence, and is less likely to try.
Social Norms
Social norms are standards of acceptable behavior or attitudes within a community or peer group.
Social norms come in two varieties—actual norms and perceived norms. Actual norms are the
true social norms for a particular attitude or behavior. For example, if the majority of a group of
sexually active individuals uses some form of birth control, then the actual norm for the group is to
use birth control. Going without birth control is "non-normative" in that group. Perceived norms
are what an individual believes to be the social norm for a group. If, for example, a young man
believes that most of his peers do not use condoms, for that young man, the perceived norm is
non-use of condoms.
Values
Values are principles or beliefs that serve as guidelines in helping people make decisions about
behaviors or life choices. They reflect what an individual believes about the “rightness” or the
“wrongness” of things. Values tell us what a person believes about something.
13
•
•
•
•
•
•
•
•
•
•
•
•
•
Who Is at Risk for HIV and Why?
(Session 1, Activity 2)
Introduction to HIV Terms
Exploring Drug Risks for HIV
(Session 2, Activity 6
Using Condoms Correctly
Problem-Solving Skills
Assertive Communication Review
Getting Out of Risky Situations
KNOWLEDGE about:
Introduction to BART
Attitudes and Risks
Overcoming Embarrassment About
Buying Condoms
Video: Are You With Me?
Different Communication Styles
Meeting People with HIV
Spreading the Word Practice
What Are You Doing to Protect Yourself?
ATTITUDES about:
•
•
•
•
•
•
•
•
•
•
•
•
•
HIV (definitions, transmission,
testing and prevention)
how drugs and alcohol use may
influence sexual decision
making
correct and consistent condom
use
problem-solving skills
communication styles
avoiding situations that could
lead to unhealthy sexual
decisions
•
•
•
•
•
Delay onset of sexual
intercourse
Increase use of condoms
Decrease unprotected oral, anal
and vaginal intercourse
Decrease frequency of sex
Decrease number of sexual
partners
BART’s
Health Goal
Decrease HIV infection
among AfricanAmerican adolescents
ages 14 –18.
talking about HIV and sex
obtaining condoms
HIV prevention and safer sex,
including condom use
using effective (assertive)
communication
people who have HIV
protecting oneself and others
from HIV
making a difference by sharing
with others information and
skills related to preventing HIV
14
•
Teen Behaviors Directly
Related to BART’s Health
Goal
Determinants of Teen Sexual
Behaviors Addressed in
BART
BART Intervention Activities
Designed to Change Determinants
(continued)
€
•
•
•
•
•
•
•
•
•
•
•
•
•
•
15
•
Overcoming Embarrassment About
Buying Condoms
Negotiating Safer Sex
(Session 4, Alternate Activity 2)
Assertive Communication Tips
Ways to Say No
Getting Out of Risky Situations
SKILLS AND
SELF-EFFICACY related to:
Who is at Risk for HIV and Why?
Deciding Your Level of Risk
PERCEPTION OF RISK/
VULNERABILITY related to:
Countering Barriers to Using Condoms
Spreading the Word Demonstration
Assertive Communication in the Real
World
Negotiating Safer Sex
(Session 4, Alternative Activity 2)
Ways to Say NO
SOCIAL/PEER NORMS about:
•
•
•
•
•
•
•
•
•
•
•
obtaining condoms and using
them correctly
negotiating condom use
using effective (assertive)
communication
refusing sex
communicating about HIV
prevention to others
preventing risky situations and
handling those that arise
•
•
•
•
•
intercourse
partners
BART’s
Health Goal
ages 14 –18.
susceptibility to HIV infection
consequences of HIV infection
(how life would be altered) (“It
could happen to me”)
•
Goal
BART
BDI Logic Model at-a-Glance (continued)
supporting the prevention of
HIV and promoting safer sex
(including condom use)
promoting use of effective
(assertive) communication
refusing sex
(continued)
•
•
AIDS and African Americans
CONNECTEDNESS TO CULTURE:
•
•
•
•
•
•
•
Goal
BART
Reinforcing African-American
values supporting individual
responsibility/pride and caring
for the greater community
Assertive Communication in the Real
World
Spreading the Word Demonstration
VALUES about:
INTENTIONS:
Support Systems
COMMUNICATION with parents or
other adults about:
•
•
•
•
•
•
•
•
intercourse
partners
ages 14 –18.
to avoid behaviors that could
lead to HIV infection
what has been learned in BART
what adults can do to support
them in learning about and
preventing HIV infection
16
•
•
preventing HIV and promoting
safer sex
communicating with a partner
about safer sex
using knowledge and skills
gained through BART to make
a difference to family members,
friends and peers
•
BART’s
Health Goal
BDI Logic Model at-a-Glance (continued)
Pages
Behaviors Addressed in BART
•
1.2 Who Is at Risk for HIV and Why—
Activity includes a short lecture on
definitions associated with HIV/AIDS.
18–23
1.
1.3 Introduction to HIV Terms—Activity
that uses strips of paper with important
words on them to review definitions
associated with HIV, includes a lecture on
HIV progression and incubation and
large-group discussion on how you can
and cannot get HIV, and how to protect
yourself from getting HIV.
24–32
•
1.4 Facts and Myths—Team game that
clears up myths about HIV transmission
and AIDS.
33–34
•
1.5 Deciding Your Level of Risk—Activity
that uses a traffic light game to clarify
which behaviors are high risk, some risk
and no risk, as well as a worksheet that
asks youth to individually think about
behaviors that will and will not lead to HIV
infection, followed by large-group
discussion.
35–37
•
1.6 Spreading the Word—Homework
assignment has youth share the
information they learned today with others
and correct myths they hear about HIV.
38
•
2.1 Definitions Review—Large-group
discussion/review of HIV definitions.
60
•
2.2 HIV Transmission Review—Largegroup discussion on how to avoid HIV
transmission, including specific behaviors
that can lead to HIV.
61
Goal
BART’s
Health Goal
KNOWLEDGE
•
HIV Definitions, Transmission,
Testing and Prevention
1.
intercourse
2.
3.
Decrease unprotected oral,
anal and vaginal intercourse
4.
5.
partners
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
Comprehensive BDI Logic Model
17
(continued)
Pages
Goal
•
2.3 AIDS and African Americans—Largegroup discussion/review about how HIV is
affecting African Americans in general
and lecture about how it is affecting
African Americans in a given state.
62–63
1.
1.
intercourse
2.
3.
2.4 HIV Feud Game—Team game in
which youth match behaviors with risk
level cards (can be done in two different
ways).
64–65
4.
5.
partners
•
2.5 “Seriously Fresh”—Video about a
group of African-American friends’
experiences with HIV, followed by largegroup discussion of specific questions.
66–67
•
6.2 Discussion and Debrief—Large-group
discussion about the presentations by
HIV-positive guest speaker(s).
231
•
8.1 Final Review of HIV Facts—Team
myth/fact game reviews information about
HIV.
268–270
•
8.2 What Are You Doing to Protect
Yourself?—Includes a short lecture
reminding youth to keep themselves safe,
that they have choices, and that they
should keep practicing what they have
learned in BART.
271–272
•
2.6 Exploring Drug Risks for HIV—Largegroup discussion about drug use and how
it can put one at risk for HIV, followed by
a lecture about how the use of drugs
and/or alcohol can affect the immune
system.
70
•
2.
HIV Definitions, Transmission,
Testing and Prevention
(continued)
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
How Drugs and Alcohol Use May
Influence Sexual Decision Making
(continued)
18
Comprehensive BDI Logic Model (continued)
Pages
Goal
•
3.2 Learning the Facts About Condoms—
Lecture with some large-group discussion
about condoms in general, lubricants and
how to store condoms.
156–157
2.
1.
intercourse
2.
158–159
3.
3.3 Overcoming Embarrassment About
Buying Condoms—Large-group
discussion that explores where to get
condoms and strategies for overcoming
embarrassment about buying them.
4.
5.
partners
•
3.4 Using Condoms Correctly—Lecture
and demonstration of how to put on and
remove a condom correctly, followed by
youth practice, while facilitators circulate
and give feedback.
160–162
•
4.1 Correct Condom Use Review—
Review of basic information about
condoms and beginning discussion on
talking about condoms with a partner.
170
•
4.3 Problem-Solving Skills—Lecture
about a six-step problem-solving
framework, followed by a brainstorm and
large-group discussion about each of the
six steps.
176–179
•
7.1 Assertive Communication in the Real
World—Activity that includes a review of
the problem-solving steps, with an
emphasis on the value of communicating
about safer sex with a partner.
238–240
•
3.
4.
How Drugs and Alcohol Use May
Influence Sexual Decision Making
(continued)
Condom Use
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
19
(continued)
•
4.4 Different Communication Styles—
Facilitators roleplay three communication
scenarios that demonstrate passive,
aggressive and assertive communication.
Participants discuss observations and
why they think each style works or doesn’t
work, and facilitators explain the styles.
Then facilitators present three more
roleplay scenarios at the end of the
activity, and youth have to identify the
communication style being demonstrated.
180–185
5.
Communication Styles (Assertive,
Passive and Aggressive)
1.
intercourse
2.
3.
4.
5.
partners
1.
intercourse
2.
3.
4.
5.
partners
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
BEHAVIORAL BELIEFS
•
•
•
194–196
World—Large-group discussion reviews
assertive communication skills, including
benefits.
238–240
7.2 Getting Out of Risky Situations—
Large-group discussion about how to get
out of risky situations, including walking
away, and lecture about how to use selftalk to stay safe. Includes a handout titled
“10 Steps to Put Good Intentions into
Practice.”
241–245
1.
2.
Communication Styles (Assertive,
Passive and Aggressive)
(continued)
Avoiding Situations That Could
Lead to Unhealthy Sexual
Decisions
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
(continued)
20
5.1 Assertive Communication Review—
Large-group discussion reviews the
definitions and characteristics of the three
communication styles.
Pages
Goal
BART’s
Health Goal
ATTITUDES
•
14–17
Buying Condoms—Activity that includes a
large-group discussion about where to
obtain condoms, brainstorm about
obstacles to purchasing condoms and
ways to overcome these obstacles, and
visualization exercise where youth
imagine successfully buying condoms.
158–159
•
3.3 Overcoming Embarrassment about
obstacles to purchasing condoms and
ways to overcome these obstacles, and a
visualization exercise in which youth
158–159
•
3.5 Countering Barriers to Using
Condoms—Activity in which youth
brainstorm a list of excuses that teens
give for not using condoms, followed by a
large-group discussion to come up with
counterarguments for each of the
excuses.
163–164
•
1.
2.
3.
Comfort in Talking about HIV and
Sex
Comfort about Obtaining a
Condom
1.
intercourse
2.
3.
4.
5.
partners
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
Positive Attitude about Condom
Use
(continued)
21
1.1 Introduction to BART—Includes a
large-group discussion about how youth
felt when they found out someone they
knew had HIV.
Pages
Goal
•
3.1 Attitudes and Risks—Activity includes
an opportunity for youth to ask questions
and share experiences of talking to
friends/family about what they have
learned in BART, followed by a review of
the “Seriously Fresh” video, especially the
part about using condoms, and a short
lecture about African-American teen sex
statistics and the importance of using
condoms.
54–155
4.
1.
intercourse
2.
3.
4.
5.
partners
•
Buying Condoms—Youth brainstorm
ways to overcome embarrassment about
purchasing condoms, followed by an
exercise in which they imagine
successfully buying condoms and then
discuss.
158–159
•
excuses.
163–164
•
4.2 Video: Are You With Me?—Video that
demonstrates ways to negotiate safer
sex, followed by large-group discussion
about discussing condom use with a
partner.
171–172
•
4.3 Problem-Solving Skills—Brainstorm
and large-group discussion about each of
the six steps of the problem-solving
framework, followed by a short lecture
about the importance of both partners in a
relationship taking responsibility for
having safer sex.
176–179
5.
Positive Attitude about Safer Sex
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
22
Positive Attitude about HIV
Prevention
(continued)
Pages
Goal
•
7.3 Spreading the Word Demonstration—
Activity in which youth brainstorm ways to
bring up safer sex with family and friends
so that they can be HIV prevention peer
leaders in their community. Includes a
handout of tips about how to spread the
word effectively and demonstration
roleplays.
246–248
5.
1.
intercourse
2.
3.
4.
•
7.4 Spreading the Word Practice—Small
groups practice roleplays on spreading
the word about HIV to others.
249–250
5.
partners
•
Yourself?—Large-group discussion about
how BART has affected participants,
followed by a short lecture reminding
youth to keep themselves safe, that they
have choices, and that they should keep
practicing what they have learned.
271–272
•
180–185
•
World—Large-group discussion in which
youth are asked to share some examples
from the past couple of weeks when they
used assertive communication.
238–240
6.
Positive Attitude about HIV
Prevention (continued)
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
Comfort in Using Effective
(Assertive) Communication
23
(continued)
Pages
Goal
•
6.1 Meeting People with HIV—
Presentation by an HIV-positive speaker,
followed by an opportunity for youth to
ask questions. Facilitator emphasizes the
behaviors that put one at risk for HIV.
230
7.
1.
intercourse
2.
3.
knew had HIV.
14–17
4.
5.
partners
•
1.2 Who Is at Risk for HIV and Why?—
Lecture, with some large-group
discussion, about who is at risk for HIV,
behavior that puts one at risk, and how
AIDS is affecting the African-American
community, using multiple pie charts to
show statistics. The “Strength for
Prevention” activity consists of a lecture
and large-group discussion about seven
principles of Kwanzaa and how these
principles can be protective against HIV
infection. Youth then discuss what they
can do to prevent HIV in their community.
18–23
•
includes a large-group discussion about
how to protect yourself from getting HIV.
32
•
2.5 Video: Seriously Fresh—Video about
a group of African-American friends’
66–67
•
2.5A Personalizing HIV Risks—Youth
complete a worksheet about how HIV
would change their lives and then
discuss.
68–69
•
8.
Reduced Stigma about People
Who Have HIV
Motivation to Protect Self and
Others from HIV
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
24
(continued)
Pages
Goal
•
230
8.
1.
intercourse
2.
3.
Yourself?—Activity concludes with a short
motivational discussion reminding youth
to keep themselves safe, that they have
choices, and that they should keep
practicing what they have learned.
271–272
4.
5.
partners
•
38
•
2.3 AIDS and African Americans—Largegroup discussion about how teens can
make a difference in their community in
preventing HIV.
62–63
•
2.7 Support Systems—Activity concludes
by encouraging youth to pass the
information they have learned thus far on
to others.
71–72
•
3.1 Attitudes and Risk—Activity includes
learned in BART.
154–155
•
9.
Motivation to Protect Self and
Others from HIV (continued)
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
Motivation or Empowerment to
Make a Difference by Sharing with
Others Information and Skills
Related to Preventing HIV
(continued)
25
Pages
Goal
•
so that they can be HIV-prevention peer
roleplays, followed by youth feedback.
246–248
9.
1.
intercourse
2.
3.
4.
5.
8.1 Final Review of HIV Facts—Includes
large-group discussion in which youth are
encouraged to pass along information
about HIV prevention to others in their
community.
268–270
partners
1.
intercourse
2.
3.
4.
5.
partners
•
Motivation or Empowerment to
Make a Difference by Sharing with
Others Information and Skills
Related to Preventing HIV
(continued)
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
SKILLS & SELF-EFFICACY
•
158–159
1.
Obtaining Condoms
•
3.4 Using Condoms Correctly—Lecture
and demonstration of how to put on and
remove a condom correctly, followed by
youth practice, while facilitators circulate
and give feedback.
160–162
2.
Using a Condom Correctly
•
4.2A Negotiating Safer Sex—After
facilitators perform a roleplay
demonstration about saying no to sex and
negotiating condom use, youth complete
a worksheet titled “What I Can Do to Stay
Safe,” followed by large-group discussion.
173–175
3.
Negotiating Condom Use
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
26
(continued)
3.3 Overcoming Embarrassment about
obstacles to purchase condoms and ways
to overcome these obstacles, and
visualization exercise in which youth
Pages
Goal
•
5.4 Assertive Communication
Demonstration—Facilitators act out three
roleplays demonstrating assertive
communication, while youth discuss each
roleplay using their “Assertive
Communication Tips” handout and
provide feedback.
200–202
3.
1.
intercourse
2.
3.
4.
•
Large-group discussion examines
experiences youth had in the last week
when they used or could have used
assertive communication.
194–196
5.
partners
•
5.2 Assertive Communication Tips—
Lecture and handout offer tips on being
assertive and reinforce the importance of
staying safe.
197–198
•
5.5 Assertive Communication Practice—
Activity in which youth practice what
they’ve learned about assertive
communication through roleplaying eight
different scenarios (some dealing with sex
and some with drug use) in groups of
three and giving each other feedback.
203–205
•
4.2A Negotiating Safer Sex—Facilitators
perform roleplay demonstrations about
saying no to sex and negotiating condom
use, then youth complete a worksheet
titled “What I Can Do to Stay Safe.”
173-175
•
5.3 Ways to Say NO—Large-group
discussion about ways to say NO and
reinforcement of assertive responses is
followed by discussion of a handout with
suggestions about how to say no.
199
Negotiating Condom Use
(continued)
4.
Using Effective (Assertive)
Communication
5.
Refusing Sex
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
(continued)
27
Pages
Goal
•
7.4 Spreading the Word Practice—Youth
use roleplays to practice spreading the
word about HIV.
249-250
6.
Communicating about HIV
Prevention to Others
1.
intercourse
2.
uses a traffic light game to clarify which
behaviors are high risk, some risk and no
risk, as well as a worksheet that asks
youth to individually think about behaviors
that will and will not lead to HIV infection,
followed by large-group discussion.
35–37
7.
Preventing Risky Situations and
Handling Those That Arise
3.
4.
5.
partners
•
4.3 Problem-Solving Skills—Lecture
about a six-step problem-solving
framework includes a brainstorm and
large-group discussion about each of the
six steps, followed by a short lecture
about the importance of both partners in a
relationship taking responsibility for
having safer sex.
176–179
•
7.2 Getting Out of Risky Situations—
Large-group discussion about how to get
out of risky situations, including walking
away, and lecture about how to use selftalk to stay safe. Includes a handout titled
“10 Steps to Put Good Intentions into
Practice.”
241–245
•
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
(continued)
28
Pages
Goal
BART’s
Health Goal
PERCEPTION OF RISK
•
18–23
that includes a lecture on HIV progression
and incubation and large-group
discussion on how you can and cannot
get HIV, and how to protect yourself from
getting HIV.
24–32
•
uses a traffic light game to clarify which
behaviors are high risk, some risk and no
risk, as well as a worksheet that asks
youth to individually think about behaviors
that will and will not lead to HIV infection,
35–37
•
2.3 AIDS and African Americans—Largegroup discussion/review about how HIV is
affecting African Americans in general
and lecture about how it is affecting
African Americans in a given state.
62–63
•
2.4 “HIV Feud”—Team game in which
youth match behaviors with risk level
cards (can be done in two different ways).
64–65
•
66–67
•
1.
Susceptibility to HIV Infection
1.
intercourse
2.
3.
4.
5.
partners
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
(continued)
29
Who Is at Risk for HIV and Why—Lecture,
with some large-group discussion, about
who is at risk for HIV, behavior that puts
one at risk, and how AIDS is affecting the
African-American community, using
multiple pie charts to show statistics.
Pages
Goal
•
6.2 Discussion and Debrief—Large-group
discussion about the presentations by
HIV-positive guest speaker(s).
231
1.
Susceptibility to HIV Infection
(continued)
1.
intercourse
2.
•
knew had HIV.
14–17
2.
Severity of Being Infected with HIV
3.
4.
•
66–67
5.
partners
•
230
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
SOCIAL/PEER NORMS
The “Strength for Prevention” activity
consists of a lecture and large-group
discussion about seven principles of
Kwanzaa and how these principles can be
protective against HIV infection. Youth
then discuss what they can do to prevent
HIV in their community.
18–23
•
38
•
preventing HIV.
62–63
1.
Preventing HIV
30
(continued)
•
Pages
Goal
•
to others.
71–72
1.
1.
intercourse
2.
249–250
3.
7.4 Spreading the Word Practice—Youth
use roleplays to practice spreading the
word about HIV.
4.
•
community.
268–270
5.
partners
•
8.3 What Are You Doing to Educate
Others?—Short lecture that reviews what
youth learned over the last eight weeks in
BART and discussion about what can
happen when they share what they’ve
learned. Includes a diagram showing the
multiplicative effects of talking about HIV
with others.
273–274
•
excuses.
163–164
•
4.2A Negotiating Safer Sex—After
facilitators perform a roleplay
demonstration about saying no to sex and
negotiating condom use, youth complete
a worksheet titled “What I Can Do to Stay
Safe,” followed by large-group discussion.
173–175
•
2.
Preventing HIV (continued)
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
Using Condoms
31
(continued)
Pages
Goal
•
4.3 Problem-Solving Skills—Includes a
short lecture about the importance of both
partners in a relationship taking
responsibility for having safer sex.
246–248
3.
1.
intercourse
2.
180–185
3.
roleplays, followed by youth feedback.
4.
5.
partners
•
180–185
•
Large-group discussion examines
experiences youth had in the last week
when they used or could have used
194–196
•
World—Large-group discussion in which
youth are asked to share some examples
from the past couple of weeks when they
used assertive communication.
238–240
•
4.
Promoting Safer Sex
BART’s
Health Goal
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
Communication
(continued)
32
Pages
•
199
4.
5.3 Ways to Say NO—Large-group
discussion about ways to say NO and
reinforcement of assertive responses is
followed by discussion of a handout with
suggestions about how to say no.
Goal
BART’s
Health Goal
Communication (continued)
CULTURE
•
18–23
•
preventing HIV.
62–63
•
community.
268–270
1.
1.
intercourse
2.
3.
4.
5.
partners
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
(continued)
33
Lecture, with some large-group
discussion, about who is at risk for HIV,
behavior that puts one at risk, and how
AIDS is affecting the African-American
community, using multiple pie charts to
show statistics. The “Strength for
Prevention” activity consists of a lecture
and large-group discussion about seven
principles of Kwanzaa and how these
principles can be protective against HIV
infection. Youth then discuss what they
can do to prevent HIV in their community.
Pages
•
273–274
1.
8.3 What Are You Doing to Educate
Others?—Short lecture that reviews what
youth learned over the last eight weeks in
BART and discussion about what can
happen when they share what they’ve
learned. Includes a diagram showing the
multiplicative effects of talking about HIV
with others.
Goal
BART’s
Health Goal
(continued)
VALUES
•
18–23
1.
Preventing HIV and Promoting
Safer Sex
•
5.2 Assertive Communication Tips—
Lecture and handout offer tips on being
assertive and reinforce the importance of
staying safe.
197–198
•
World—Activity includes a review of the
problem-solving steps, with an emphasis
on the value of communicating about
safer sex with a partner.
238–240
2.
Communicating with a Partner
about Safer Sex
•
38
3.
Using Knowledge and Skills
Learned through BART to Make a
Difference with Family Members,
Friends and Peers
•
preventing HIV.
62–63
1.
intercourse
2.
3.
4.
5.
partners
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
(continued)
34
The “Strength for Prevention” activity
consists of a lecture and large-group
discussion about seven principles of
Kwanzaa and how these principles can be
protective against HIV infection. Youth
then discuss what they can do to prevent
HIV in their community.
Pages
Goal
•
to others.
71–72
3.
1.
intercourse
2.
154–155
3.
3.1 Attitudes and Risks—Activity includes
learned in BART.
4.
5.
partners
•
roleplays.
246–248
•
community.
268–270
•
Using Knowledge and Skills
Learned Through BART to Make a
Difference with Family Members,
Friends and Peers (continued)
•
includes a worksheet that asks youth to
individually think about behaviors that will
and will not lead to HIV infection, followed
by large-group discussion.
35–37
1.
Avoid Behaviors that Could Lead
to HIV Infection
COMMUNICATION
•
35
2.7 Support Systems—Large-group
discussion about adults that youth can
talk to for support/education about sex
and HIV; includes a worksheet titled
“Understanding Each Other” that helps
them identify their support systems.
71–72
1.
Communication with Parents or
Other Adults
Decrease HIV
infection among
AfricanAmerican
adolescents
ages 14 –18
INTENTIONS
BART’s
Health Goal
36
Core Components
37
Core Components
38
Core Content Components
at-a-Glance
What are core content components?
Core content components are the essential parts of a program that relate to what is being taught,
that is, the knowledge, attitudes and skills addressed in the program’s learning activities that are
most likely to change sexual behaviors.
This “Core Content Components at-a-Glance” was designed to give you a quick overview of the
core content components of the Becoming a Responsible Teen (BART) curriculum. A quick
overview may be especially helpful when making a decision about a program’s fit with your
priority population and your organization’s capacity. For more detailed information about the core
content components listed here, see the following section titled Core Content Components in
Depth.
Core Content Components of BART include:
KNOWLEDGE about:
• HIV (definitions, transmission, testing and prevention)
• how drugs and alcohol use may influence sexual decision making
• correct and consistent condom use
• problem-solving skills
• communication styles (assertive, passive and aggressive)
• avoiding situations that could lead to unhealthy sexual decisions
ATTITUDES about:
• talking about HIV and sex
• HIV prevention and safer sex, including condom use
• obtaining condoms
• using effective (assertive) communication
• people who have HIV
• protecting oneself and others from HIV
• making a difference by sharing with others information and skills related to preventing HIV
SKILLS AND SELF-EFFICACY related to:
• obtaining condoms and using them correctly
• negotiating condom use
• using effective (assertive) communication
• refusing sex
• communicating about HIV prevention to others
• preventing risky situations and handling these situations should they arise
PERCEPTION OF RISK related to:
• susceptibility to HIV infection
• consequences of HIV infection (how life would be altered)
39
Core Components at-a-Glance
SOCIAL/PEER NORMS about:
• supporting the prevention of HIV and promoting safer sex (including condom use)
• promoting use of effective (assertive) communication
• refusing sex
CONNECTEDNESS TO CULTURE:
• reinforcing African-American values that support individual responsibility/pride and caring for
the greater community
VALUES about:
• preventing HIV and promoting safer sex
• communicating with a partner about safer sex
• using knowledge and skills gained through BART to make a difference to family members,
friends and peers
INTENTIONS to:
• avoid behaviors that could lead to HIV infection
COMMUNICATION with:
• parents or other adults about what has been learned in BART and identifying adults who can
support them in learning about and preventing HIV infection
40
Core Content Components in Depth
What are core content components?
Core content components are the essential parts of a program that relate to what is being taught,
that is, the knowledge, attitudes and skills that are addressed in the program’s learning activities
that are most likely to change sexual behaviors. The core content components of a program
generally map with the determinants (or risk and protective factors) addressed by the program.
The determinants addressed in the Becoming a Responsible Teen (BART) curriculum and
definitions of common determinants are listed in the section on the BDI logic model.
Core content components do not describe the important teaching methods and strategies used in
BART. These are described in the section on core pedagogical components. Core content
components (along with core pedagogical and implementation components) are considered
critical to the program’s effectiveness.
Which health behavior change theories inform BART’s core content
components?
BART is based on two behavior changes theories: Social Learning Theory (SLT) and the IMB
model (informational needs, motivational influences and behavioral capacities). These theories
guided BART’s developer in deciding what kind of content (e.g., knowledge, attitudes, skills) to
include. Having an understanding of these two theories is critical to understanding the core
content components for the BART curriculum.
SLT is comprised of six broad determinants of behavior. According to this theory, a curriculum
would have to make an impact on the following six determinants in order to effect behavior
change.






Outcome Expectations: An individual’s belief about the likely results of his/her actions
Behavioral Capability: Knowledge and skills needed to influence behavior. These include
practicing/rehearsing skills until mastery is achieved
Self-Efficacy: Confidence in ability to take action, persist in action, and obtain desired
outcome
Observational Learning: An individual's beliefs based on observing others like self and/or
visible physical results of desired behavior and the positive or negative consequences of
these behaviors
Reciprocal Determinism: Behavior changes resulting from interactions between individual
and environment; change is bidirectional
Reinforcement: Responses to an individual’s behavior that increase or decrease the
chances of recurrence. Reinforcement can come from within the person or from external
sources (e.g., peer, parent, teacher)
The IMB model of behavior change states that in order to achieve behavior change, programs
need to simultaneously attend to participants’ informational needs (I), motivational influences (M)
and behavior (B).
41
Core Components in Depth
How do I use BART’s Core Content Components Table?
BART’s core content components are described on the following pages in a three-column table.
In the first column, you will find nine categories or core areas of content found in BART. Under six
of these core content categories, you will find more specific descriptions of the category. For
example, “knowledge” is one of the nine core content categories, but BART does not teach
knowledge about everything associated with HIV/AIDS and sexuality. Specifically, it teaches
about six areas of knowledge related to preventing HIV infection. You will notice that the nine
categories of content components map very closely to the determinants of sexual behavior
presented in the BART’s BDI logic model.
In the second column, you will find a justification or rationale for why this category is considered a
core content component. The justifications are clearly linked to the health behavior change
theories that form the foundation for BART. All of the justifications were approved by Dr. Janet St.
Lawrence, BART’s developer.
The third column lists activity examples from the BART curriculum that illustrate the core content
components listed in the first column. Note that these are examples only, not an exhaustive list.
For a list of each activity and the core content components it addresses, see the BDI logic model.
Why should I use BART’s Core Content Components Table?
BART’s Core Content Components Table is a useful tool for practitioners who are preparing to
implement and/or adapt BART. By connecting activities to core content components and the
underlying theories of behavior change, the table can help you better understand why BART’s
developer included activities that focus on certain topics. The topics covered in BART are not at
all random—they were purposely selected to reflect SLT and the IMB model.
Understanding this link between the theories and activities will help you implement BART with
greater fidelity and purpose. If you are considering making adaptations to BART, you must not
delete or compromise the core content categories or the subcategories listed in this table
because doing so would weaken the theory of change that has been rigorously evaluated and
shown to be effective at changing youth sexual behavior. If you are considering “yellow light
adaptations,” you may add core content components to the list as long as they do not
compromise the core content components listed in the table.
In addition to the comprehensive version of the core content components, the Core Content
Components at-a-Glance was designed to give you a quick overview of BART’s core content
components.
42
Core Content Component
Justification
Curriculum Examples
KNOWLEDGE
•
1.1 Introduction to BART—Includes a brainstorming
activity to surface common names for sex, etc.
1.
2.
3.
4.
5.
6.
Knowledge about HIV (definitions,
transmission, testing and prevention)
Knowledge about how drugs and alcohol use
may influence sexual decision making
Knowledge about correct and consistent
condom use
Knowledge about problem-solving skills
Knowledge about three communication styles
(assertive, passive and aggressive)
Knowledge about avoiding situations that could
lead to unhealthy sexual decisions
•
Teaching basic and accurate knowledge about
the topics to the left is a critical element of SLT
and the IMB model. Knowledge (behavioral
capability in SLT and information in the IMB
model) is a necessary foundation or a
precondition for learning skills and changing
behaviors.
Many youth either do not learn the basic
information they need about HIV prevention
from home or school or they receive
misinformation. It is important that they have
correct and current information on which to
base their sexual decisions.
1.2 Who Is at Risk for HIV and Why?—Short
lecture and discussion on definitions associated
with HIV/AIDS.
2.6 Exploring Drug Risks for HIV—Large-group
discussion covers drug use and how drug use can
put one at risk for HIV.
3.4 Using Condoms Correctly—Lecture and
demonstration on the correct steps for putting on
and removing a condom.
4.3 Problem-Solving Skills—Lecture about a sixstep problem-solving framework.
Becoming a Responsible Teen Core Content Components Table
5.1 Assertive Communication Review—Largegroup discussion that reviews the definitions and
characteristics of three communication styles.
7.2 Getting Out of Risky Situations—Large-group
discussion about how to get out of risky situations.
(continued)
43
Justification
Curriculum Examples
ATTITUDES
•
3.3 Overcoming Embarrassment About Buying
Condoms—Brainstorming activity about ways to
overcome embarrassment about purchasing
condoms.
1.
2.
3.
4.
5.
6.
7.
Comfort in talking about HIV and sex
Positive attitude about HIV prevention and
safer sex, including condom use
Comfort in obtaining a condom
Comfort in using effective (assertive)
communication
Reduced stigma about people who have HIV
Motivation to protect self and others from HIV
Motivation to make a difference by sharing with
others information and skills related to
preventing HIV
•
A positive attitude toward the issues listed to
the left is important in motivating youth to take
action. A positive attitude relates to the
outcome expectations construct of SLT and the
motivation and conviction constructs of the IMB
model.
When positive attitudes in individual
participants of BART are developed, eventually
a group norm is created about the issues listed
to the left. Positive group norms about these
issues lead to greater motivation and social
support for desired sexual behaviors (IMB).
Positive group norms are also related to the
reciprocal determinism in SLT – i.e., behavior
change is influenced by a person’s interaction
with his/her environment, and this change is
bidirectional.
6.1 Meeting People with HIV—An HIV-positive
speaker tells his/her story, followed by the
opportunity for youth to ask questions. The
facilitator emphasizes the behaviors that put one at
risk for HIV.
7.4 Spreading the Word Practice—Youth work in
groups of three to roleplay spreading the word
about preventing HIV.
4.4 Different Communication Styles—Facilitators
roleplay three communication scenarios that
demonstrate passive, aggressive, and assertive
communication. After each roleplay, participants
discuss observations and why they think each style
works or doesn’t work, and facilitators explain each
communication style.
Core Content Components Table (continued)
4.2 Video: Are You with Me?—Youth watch a video
that demonstrates ways to negotiate safer sex and
then have a large-group discussion about
negotiating condom use with a partner.
44
(continued)
Justification
Curriculum Examples
SKILLS and SELF-EFFICACY
•
3.3 Overcoming Embarrassment About Buying
Condoms—Large-group discussion about where to
obtain condoms.
1.
2.
3.
4.
5.
6.
7.
Skills and self-efficacy to obtain a condom
Skills and self-efficacy to use condoms
correctly
Skills and self-efficacy to negotiate condom
use
Skills and self-efficacy to use effective
Skills and self-efficacy to refuse sex
Skills and self-efficacy to communicate about
HIV prevention to others
Problem-solving skills to prevent risky
situations and handle these situations should
they arise
•
•
Practicing skills and gaining self-efficacy to
practice skills are critical pieces of SLT, which
says that individuals need the knowledge and
skills (behavioral capability) in order to change
behavior. Moreover, individuals need the
opportunity to practice these skills in a safe
environment before facing the challenges of
using them in risky situations, so that they can
develop the confidence (self-efficacy) they
need to take action when appropriate.
SLT stresses that people learn by seeing
others model desired behaviors (observational
learning). BART provides multiple examples of
facilitators modeling important skills, as well as
opportunities for youth to model skills in front of
each other and receive feedback. Receiving
feedback or reinforcement for performing skills
effectively is also a key component of SLT.
The opportunity to learn and practice skills is
also related to the IMB model. Youth begin to
believe in themselves and develop conviction
to perform desired behaviors when they
experience mastery of those skills and are
given support to do so.
3.4 Using Condoms Correctly—Small groups of
youth practice condom steps with a condom and
penile model while facilitators circulate and give
feedback.
4.2A Negotiating Safer Sex—In this alternate
activity, facilitators roleplay saying no to sex and
negotiating condom use. Youth complete a
worksheet on what they can do to stay safe and
then have a large-group discussion about it.
5.1 Assertive Communication Review—Largegroup discussion about an experience youth had in
the last week when they used or could have used
5.2 Assertive Communication Tips—Lecture about
tips that can be used to be assertive (including a
handout) that also reinforces the importance of
staying safe.
(continued)
45
7.4 Spreading the Word Practice—Youth work in
groups of three to roleplay spreading the word
about preventing HIV.
Justification
Curriculum Examples
PERCEPTION OF RISK
•
Perception of risk (also known as vulnerability
or susceptibility) is an important component of
the IMB model. Perceiving that one is at risk
for HIV, as well as understanding the severity
of a disease such as HIV/AIDS, creates a
motivation to avoid infection.
1.2 Who is at Risk for HIV and Why?—Lecture, with
some large-group discussion, about who is at risk
for HIV, behavior that puts one at risk, and how
AIDS is affecting the African-American community,
using multiple pie charts to show statistics.
•
Perception or risk for HIV is also related to
SLT. One way an individual forms beliefs and
attitudes is based on observing others like
himself/herself and the visible physical results
of desired behavior. When youth talk about
other African-American teens and young adults
who have been infected with HIV, the
perception of risk increases (observational
learning and outcome expectations).
1.
2.
Perception of risk/susceptibility to HIV infection
Perception of severity of being infected with
HIV, that is, how life would altered if infected
with HIV
1.5 Deciding Your Level of Risk—Traffic light game
helps youth group behaviors as high risk, some risk
or no risk.
6.1 Meeting People with HIV—An HIV-positive
speaker tells his/her story, followed by the
opportunity for youth to ask questions. The
facilitator emphasizes the behaviors that put one at
risk for HIV.
(continued)
46
Justification
Curriculum Examples
SOCIAL/PEER NORMS
•
1.2 Who Is at Risk for HIV and Why?—The
“Strength for Prevention” activity consists of a
lecture and large-group discussion about seven
principles of Kwanzaa and how these principles can
be protective against HIV infection. Youth then
discuss what they can do to prevent HIV in their
community.
1.
2.
3.
Social norms that support the prevention of
HIV and promote safer sex, including the use
of condoms
Social norms that promote use of effective
Social norms to refuse sex
•
Creating positive social norms about the issues
listed on the left is part of several key
constructs of SLT. When positive social norms
are created about condom use, for example,
individuals in that social environment are more
likely to feel supported to use condoms. The
more youth use condoms, the stronger the
social norm and the greater likelihood that a
desirable reciprocal relationship between
individuals and the social environment is
created. In SLT, this is called “reciprocal
determinism.”
By modeling and discussing condom use
among participants in the BART sessions, and
by taking the messages of BART outside the
classroom, opportunities for learning through
observation are created (observational
learning) that support the adoption of condom
use behavior. By observing successful use of a
particular behavior (e.g., condom use),
individuals are more likely to have a positive
expectation or attitude about the behavior,
which will increase the likelihood that they will
adopt the behavior (outcome expectations).
3.5 Countering Barriers to Using Condoms—Youth
brainstorm a list of excuses that teens give for not
using condoms, and then the large group comes up
with counterarguments for each of these excuses.
7.3 Spreading the Word Demonstration—Youth
brainstorm ways to bring up safer sex with family
and friends so that they can be HIV prevention peer
leaders in their community. They receive a handout
with a list of tips for spreading the word.
7.1 Assertive Communication in the Real World—
Large-group discussion in which youth are asked to
share some examples from the past couple of
weeks when they used assertive communication.
(continued)
47
4.2A Negotiating Safer Sex—As part of this activity,
youth complete a worksheet on what they can do to
stay safe and then have a large-group discussion
about it.
Justification
Curriculum Examples
BEHAVIORAL BELIEFS
•
Outcome expectations are an individual’s
beliefs about the results of one’s actions. If
youth believe that having sex will have a
negative outcome on their goals and dreams,
they will be less likely to engage in sex. If they
believe that abstinence will prevent HIV, STDs
and pregnancy, they will have a more positive
attitude about abstinence and be more likely to
practice it. Finally, if youth believe that their
partners will most likely react negatively to
abstinence, they will be more open to learning
new skills that will help them successfully
negotiate.
Overall Theme—Most of the activities in each
session are summarized by stating that the “proud
and responsible choice is to abstain from sex” and
that by abstaining from sex, participants will be able
to reach their goals and dreams.
•
By creating positive beliefs about abstinence,
individuals are more likely to abstain. In
addition, if they believe that key individuals and
groups approve of abstaining, they are more
likely to abstain themselves. The more youth
abstain, the stronger the normative beliefs
become and a desirable reciprocal relationship
between individuals and the social
environment is created. In SLT, this is called
“reciprocal determinism.”
1.
2.
3.
Goals and Dreams Beliefs—belief that sexual
involvement might interfere with one’s
educational and career goals and dreams.
Prevention Beliefs—belief that abstinence can
eliminate the risk of HIV, STDs and pregnancy.
Partner Reaction Beliefs—belief that one’s
partner would not approve of abstinence and
react negatively to it. BART addresses this
belief and builds confidence to overcome this
situation.
(continued)
48
Justification
Curriculum Examples
CONNECTEDESS TO CULTURE
•
1.2 Who Is at Risk for HIV and Why?—The
“Strength for Prevention” activity consists of a
lecture and large-group discussion about seven
principles of Kwanzaa and how these principles can
be protective against HIV infection. Youth then
discuss what they can do to prevent HIV in their
community.
VALUES
2.
3.
Values about preventing HIV and promoting
safer sex
Values about communicating with a partner
about safer sex
Values about using the knowledge and skills
learned through BART to make a difference to
family members, friends and peers
•
Creating opportunities to better connect with
the participants’ culture is also related to the
IMB model. By learning the facts about how
HIV is disproportionately affecting AfricanAmerican communities, youth may feel a
greater motivation to adopt healthy and
responsible behaviors.
•
There are multiple places in the BART
curriculum where the facilitator reinforces
values consistent with preventing HIV infection.
Delivering repetitive messages about these
values relates to both SLT and the IMB model.
Participating youth who hear/observe these
values are more likely to take on these values
than youth who do not receive this type of
reinforcement. As youth start to model these
values in small-group exercises, their impact
upon each other also contributes to developing
a social norm encouraging adoption of these
values.
2.3 AIDS and African Americans—Large-group
discussion about how teens can make a difference
in their community in preventing HIV.
5.2 Tips for Assertive Communication—Lecture and
handout about tips that can be used to be assertive
that also reinforce the importance of staying safe.
7.1 Assertive Communication in the Real World—
Lecture that reviews problem-solving steps, with an
emphasis on the value of communicating about
safer sex with a partner.
(continued)
49
1.
BART provides multiple opportunities for youth
to learn about how HIV/AIDS is affecting
African-American communities and to reinforce
African-American values that support individual
responsibility/pride and responsibility for caring
for the greater community. These values
support the reciprocal determinism construct of
SLT. The more individuals act responsibly
about preventing HIV, the greater the influence
on the community as a whole. The more
unified the community becomes about
preventing HIV, the greater the influence on
the individual to behave in a healthy and
responsible way. It is important to identify the
communal values that are relevant and
motivating to the youth you are serving.
Justification
Curriculum Examples
INTENTIONS TO AVOID BEHAVIORS THAT
COULD LEAD TO HIV INFECTION
•
Asking youth to clarify and state their intentions
related to HIV prevention behavior is related to
the IMB model of behavior change. Youth who
are motivated and express a conviction to
avoid HIV are more likely to engage in desired
behavior than youth who are not motivated and
have little or no conviction.
1.5 Deciding Your Level of Risk—Activity includes a
worksheet that asks youth to individually think
about behaviors that could lead to HIV infection,
COMMUNICATION WITH PARENTS OR OTHER
ADULTS
•
There are several places in BART where youth
are asked to take home what they have
learned in BART to family. They are also asked
to think about adults who can support them in
learning about and preventing HIV infection.
This type of activity is supportive of SLT. Youth
who discuss HIV with caring and
knowledgeable adults are more likely to feel
supported to engage in desired behaviors, to
observe positive behaviors and values
supportive of HIV prevention, and to have
positive expectations of desirable sexual
behaviors than those who do not engage in
discussions with supportive adults.
2.7 Support Systems—Large-group discussion
about adults youth can talk to for support and
education about sex and HIV. Includes a worksheet
titled “Understanding Each Other.”
50
Core Pedagogical Components
at-a-Glance
What are core pedagogical components?
Core pedagogical components are the essential parts of a program that relate to how its content
is taught. Core pedagogical components identify the teaching methods, strategies and youthfacilitator interactions that contribute to the program’s effectiveness.
“Core Pedagogical Components at-a-Glance” was designed to give you a quick overview of the
core pedagogical components of the Becoming a Responsible Teen (BART) curriculum. A quick
overview may be especially helpful when making a decision about a program’s fit with your
priority population and your organization’s capacity. For more detailed information about the core
pedagogical programs listed here, see the following section on Core Pedagogical Components in
Depth.
Core Pedagogical Components of BART include:
Creating the Learning Environment
•
•
•
•
Set a positive learning environment
Establish/maintain group ground rules
Elicit information, opinions and ideas from youth whenever possible (instead of relying on
lecturing)
Use praise and reinforcement
Facilitating the Learning Activities
•
•
•
•
•
•
•
•
Tailor language to reflect the culture of the participants
Encourage youth to think about, discuss and apply what they’ve learned outside the
classroom
Reinforce learning with reviews and repetition
Present data visually
Use four steps to teach skills: (1) explain the steps to using the skill; (2) demonstrate correct
use of the skill; (3) allow time for youth to practice; and (4) provide youth feedback
Reinforce skills with skill practice
Address multiple learning styles and use different experiential activities, including videos,
worksheets, roleplays, skill practice
Personalize information about risk
51
in Depth
What are core pedagogical components?
Core pedagogical components are the essential parts of a program that relate to how its content
is taught. Core pedagogical components identify the teaching methods, strategies and youthfacilitator interactions that contribute to the program’s effectiveness. Along with core content and
implementation components, they are considered critical to the program’s effectiveness.
What does “pedagogy” mean?
Pedagogy is the science and art of teaching. The pedagogy used in a curriculum such as BART
refers to the methods, strategies, and techniques facilitators use to effectively transmit
knowledge, values and skills to youth participants. For example, most people have experienced
what it is like listen to a lecture. Lecture is a pedagogical method that has its place in learning but
is generally not considered the most effective method for teaching about pregnancy or HIV
prevention.
How do I use BART’s Core Pedagogical Components Table?
BART’s core pedagogical components are described on the following pages in a three-column
table.
In the first column, you will find a list of 21 core pedagogical components.
In the second column, you will find a justification or rationale for why these pedagogical practices
are considered core components. These justifications come from descriptions found in the
curriculum, published journal articles about the curriculum, and/or through discussions with
BART’s developer, Janet St. Lawrence, PhD.
The third column lists examples or descriptions of each core pedagogical component from the
BART curriculum. (These are examples only, not an exhaustive list.)
Why should I use BART’s Core Pedagogical Components Table?
BART’s Core Pedagogical Components Table is a useful tool for practitioners preparing to
implement and/or adapt BART. The table can help you better understand the reasoning behind
the teaching methods used in BART and how to best prepare for BART implementation. This
table will also help you understand the content knowledge, facilitation skills, and comfort level you
will need to implement BART effectively, which will help you implement BART with greater fidelity.
If you are considering making adaptations to BART, you must not delete or compromise the core
pedagogical components listed in this table.
In addition to the comprehensive version of the core pedagogical components, the Core
Pedagogical Components at-a-Glance was designed to give you a quick overview of BART’s core
pedagogical components.
52
Core Pedagogical Components Table
Justification
Curriculum Examples
Including a well-thought-out
introduction to BART.
Intentionally deliver an introduction to
the program that includes ground
rules, program overview, group
introductions and confidentiality
statements.
Setting the tone with regard to behavioral and learning
expectations lays an important foundation for youth
participating in BART.
See pages 11–17 in Session One, “Understanding HIV &
AIDS.”
Establishing and maintaining
ground rules.
Establish ground rules in the first
session and remind youth of ground
rules if a group member fails to
observe them in later sessions. Ask for
each participant’s public and verbal
agreement to respect ground rules; in
this way, you are creating a more
intentional behavior contract between
you and participants. It is also
important to remind the group of
ground rules when they are about to
start an activity that may be sensitive.
Ground rules help to support a comfortable and safe
environment in which youth can learn. Behavioral
contracting is a more intentional way of setting up
guidelines for behavioral expectations.
For examples, see pages 15, 66 and 230.
Tailoring language.
Tailor the language imbedded in the
activities to better reflect the culture
and norms of the youth you serve.
Tailoring language increases relevance and, therefore,
retention of the information and skills taught in the
curriculum. BART recommends that facilitators do this
type of adaptation when appropriate. (See green light
adaptations).
An example could be changing the names and language
in the roleplay scenarios used in BART to better reflect
youth culture, language and expressions. For examples,
see the roleplays/scenarios described on pages 173–
175, 204 and 248.
(continued)
53
Core Pedagogical Components in Depth
Core Pedagogical Component
Justification
Curriculum Examples
Encouraging youth to spread the
word.
Wrap-up each lesson by encouraging
youth to think about, apply or talk about
what they learned in the session.
Encourage youth to try out newly learned
skills.
Creating social norms supportive of preventing HIV is an
important objective of the BART curriculum. Encouraging
youth to talk to others outside of the program helps create
this norm and develop social support. It is also an important
component in empowering youth to become behavior change
agents within their social networks and communities.
For examples, see pages 38, 71–72, 246 and 249.
Reviewing previous session.
Open each lesson with a
review/synopsis of the previous session,
and make sure youth understand the key
points. Ask youth about their
experiences in sharing information they
learned from the previous session with
others or about the new skills they
practiced. If youth faced
challenges/difficulties, problem solve
with them, rehearse skills again,
roleplay, or coach until they feel
confident about information and skills.
Spending time at the beginning of each session reviewing the
learning from the previous session helps you:
Keeping Youth at Center of Learning.
Facilitate learning activities in a youthcentered way as much as possible.
Assess well how youth are integrating new information
and skills.
2.
Support youth in problem solving challenges they
experience with the information and/or skills and
reinforce their new skills.
3.
Provide an opportunity for group members to become
role models for their peers and support a positive social
norm.
4.
Anchor the new session so that youth can better
integrate new learning.
5.
Warm up and get the group cognitively ready to take in
new information. Be sure to elicit as much of the review
as possible from the group, rather than lecture.
54
Wherever possible, elicit information, opinions and ideas
from participating youth rather than conveying information in
a lecture. Avoid the “I talk, you listen” method of teaching.
Youth are more likely to feel engaged and to learn and
integrate information and skills when activities include their
participation. While there are times when you must give a
short lecture to present a new idea or new information, you
should keep this approach to a minimum.
Session 4: Page 170
Session 5: Pages 194–196
Session 6: None (guest speaker introduction)
Session 7: Page 238
For examples, see pages 71, 158 and 176–177.
(continued)
(Note: The importance of conducting this
type of comprehensive review is not
made as clear as it should be in BART’s
written curriculum. However, after
discussions with BART’s developer,
Janet St. Lawrence, PhD, it was clear
that this type of review is very important
and considered a core pedagogical
component.)
1.
Session 3: Page 154
Core Pedagogical Components Table (continued)
Justification
Curriculum Examples
Addressing multiple learning styles
and using experiential activities.
Address a variety of learning styles
(e.g., visual, kinesthetic, auditory). Be
sure to include all of the experiential
activities—discussion, roleplays, and
skill-building exercises. Keep
participants’ attention spans in mind to
keep youth actively engaged.
Individuals learn in different ways. Some learn more from
seeing, others from hearing and others from doing. BART
uses a variety of teaching methods to appeal to different
learners and to keep the flow and pace interesting and
fun for youth.
For examples of how BART addresses different learning
styles, see pages 158 (visualization), 66 (visual and
auditory), 175 (writing), and 249 (skill practice).
Presenting data visually.
Present data in a visual way to
demonstrate perception of risk.
Simply telling youth what HIV statistics are or giving them
a list of numbers to look at is not enough. Graphic
representations of the data, such as pie charts, provide a
visual and stronger presentation that can better affect
their perception of risk. A graphic demonstration of the
data is often more dramatic and can motivate youth to
want to do something to address disparities because it
shows very clearly that there is an HIV/AIDS problem and
that youth have a responsibility to be part of the solution.
For examples, see pages 18–21, 41–48 and 62–62.
Reinforcing and repeating.
Preserve reinforcement and repetition
of information and key messages,
even though it may seem redundant at
times.
People often need to hear new information or skills
multiple times before they can remember and integrate
new learning.
For examples of the multiple messages related to
teaching youth about behaviors that put one at risk for
HIV infection, see pages 35–37, 64–65 and 66–68.
Personalizing risk.
To increase perception of risk (a core
content component), things need to be
personalized.
It is not sufficient to simply talk about HIV data relevant to
the youth participating in BART. Youth need to personally
understand the risks they face. Activities designed to
personalize risk should not be removed.
For examples, see pages 36–37 (traffic light activity), 67
(personalization questions in video debrief), and 68
(worksheet).
For examples of experiential learning activities, see
pages 161–162, 204–205 and 249–250.
Do not eliminate any of the experiential learning activities
such as roleplays, skill practice and discussions from
BART. Youth learn the most from these experiential
opportunities. Experiential activities are vital to learning
and mastering new skills.
(continued)
55
Justification
Curriculum Examples
Being comfortable with sexuality.
Co-leaders need to be comfortable
with sexual content/terminology and
behaviors depicted/discussed in
activities.
You need to acquire a minimum level of comfort with
adolescent sexuality and the language used to talk about
it. Youth are very savvy at interpreting nonverbal cues
that communicate embarrassment, avoidance or shame.
This type of communication can send the wrong
message to youth about sexuality. To avoid putting the
facilitator or themselves in an uncomfortable position,
youth may shut down. Alternatively, some youth may
interpret discomfort as a weakness and use it to act out
or distract you.
For examples of times when facilitators need to feel
comfortable discussing teen sexuality, see pages 16–17,
35–36 and 155–157.
Being comfortable with
demonstrations.
Co-leaders need to be comfortable
modeling and conducting roleplays
and demonstrations (e.g., correct
condom use) as effective ways of
addressing numerous determinants.
You need to feel comfortable with demonstrating
communication and condom use skills. Rehearsing
demonstrations is essential.
For examples of facilitator demonstrations, see pages
160, 180–185 and 247–248.
Giving clear directions.
Directions for interactive activities
(e.g., a game or small-group work)
must be provided in a clear and
succinct way to ensure that the activity
will be carried out as it was intended.
When instructions for small-group work are not presented
clearly, youth might miss important tasks or complete
tasks incorrectly. This outcome is likely to frustrate you
and them. Additionally, when participants are not clear
about what is expected of them, they are likely to become
distracted, act out or ignore the activity. It is
recommended that you rehearse delivering activity
directions and instructions at least once.
For examples, see pages 36–37, 161–162 and
249–250.
Using videos.
BART includes two sessions that use
the videos Seriously Fresh and Are
You With Me?
You can implement BART without the videos, if
necessary. The curriculum provides alternative activities
as substitutes for activities that use videos.
For examples, see pages 66–69 and 171–175.
Debriefing videos.
After showing a video, debrief its major
points.
It is not sufficient to simply show the video without some
type of discussion about what the video teaches. BART
includes large-group discussion questions to stimulate
discussion after showing each video.
56
(continued)
Justification
Curriculum Examples
Using guest speakers.
In Session 6, BART includes a visit
from a guest speaker who is HIV
positive.
BART provides an alternative activity in case a guest
speaker is not available. When the evaluation data was
analyzed, both youth who received the guest speaker talk
and those who did not receive the guest speaker talk fared
equally well in comparison.
See pages 230–232.
Using worksheets.
Written worksheets increase
commitment and personalization.
If the “official” worksheet provided in BART is not used,
youth should be given some opportunity to think about and
write down ideas, opinions and intentions. The act of
writing down the information engages youth and can help
personalize information. Worksheets also provide youth
with an opportunity to think carefully about a situation and
plan ahead. Do not remove these opportunities.
Using four steps to teach skills.
BART typically uses a four-step
sequential model for teaching skills
that includes “3 Ds” and an “R.” These
four steps include: (1) facilitator
describes the steps or components of
the skill, (2) facilitator demonstrates
the correct use of the skill, (3)
participants do or practice the skill,
and (4) facilitator and peers provide
feedback or reinforce correct skill
implementation.
Individuals are more likely to adopt skills when they are
clear about the components of the skill, learn what the skill
looks like in real life, and have an opportunity to practice
and master the skill. This process is the most essential
ingredient for behavior change.
Providing skill practice.
Youth practice effective (assertive)
communication, refusal, condom
negotiation, problem solving, and
condom use skills.
BART teaches several important skills including condom
use, assertive communication, refusal, condom negotiation
and problem solving. It is not sufficient to simply present
the steps of the skill and model it for youth. Youth must
have an opportunity to practice each of these skills until
they can use them effectively and comfortably and receive
positive feedback on their improvement and eventual
correct performance of each skill.
For examples, see pages 160 and 204–205.
(continued)
57
Justification
Curriculum Examples
Providing praise and reinforcement.
Providing positive reinforcement after a skill is effectively
performed is an important part of building self-efficacy to
use the skill in real-life situations.
BART is intended to train youth in critical skills and
encourage them to share what they have learned with
others. Through the reviews at the beginning of each
session, youth have shared their successes and worked
to help one another to problem solve when barriers
arose. Some recognition of their success in completing
the program is a large part of empowering them to carry
what they have learned into the community and share
their knowledge and skills with their families and friends.
It also reinforces the changes they are making.
See pages 265–275.
Give praise when youth successfully
demonstrate a skill. It is important that
you understand the components of the
skill that youth are practicing and
provide specific feedback about the
skill. In other words, it is not sufficient
to simply say, “That was great!”
Comment also on what part of the skill
youth did well –e.g., “I really liked the
way you made eye contact,” or, “When
you looked away, it seemed as if you
were losing interest.” Ask youth to
think about what they think went well
about their practice and what they
think could have made their practice
better.
Concluding the BART program with
review and celebration.
The last session should involve some
reinforcement/repetition of the learning
and some type of celebration.
58
Core Implementation Components
at-a-Glance
What are core implementation components?
Core implementation components are the essential logistical elements of a program that lead to
an environment that is conducive to learning. These include: program setting, facilitator-youth
ratio, dosage and sequence of sessions, etc.
How do I use the “Core Implementation Components at-a-Glance”
document?
“Core Implementation Components at-a-Glance” was designed to give you a quick overview of
BART’s core implementation components. A quick overview may be especially helpful when
making a decision about a program’s fit with your priority population and your organization’s
capacity. For more detailed information about the core implementation programs listed below,
see the “Comprehensive Implementation Contents Table” for BART, which follows.
Theme/Messages
•
The message of cultural pride and responsibility is central.
Implementation Schedule
•
Eight weekly sessions, each lasting 90–120 minutes.
Program Leaders
•
•
Two trained co-leaders, one male and one female, facilitate each session.
Select program leaders who are as similar to youth as possible, have credibility with youth
and are comfortable with discussing sexuality and demonstrating skills.
Preparation
•
•
•
•
•
Develop safeguards for confidentiality.
Promote awareness and attendance.
Obtain parental consent and support (optional but suggested; may be required in some
settings).
Secure a private meeting space to implement BART.
Obtain needed materials (e.g. videos, BART t-shirts) ahead of time.
Audience and Setting
•
•
Conduct in non-school setting.
Limit to 5–15 participants, aged 14–18, separated by gender for some skill-building sessions.
59
in Depth
What are core implementation components?
Core implementation components are essential logistical elements of a program that lead to an
environment that is conducive to learning. These elements include program setting, facilitatoryouth ratio, dosage and sequence of sessions, etc. Core implementation components (along with
core content and pedagogical components) are considered critical to the program’s effectiveness.
How do I use BART’s Core Implementation Components Table?
BART’s core implementation components are described on the following pages in a two-column
table. In the first column, you will find a list of 14 core implementation components. In the second
column, you will find a justification or rationale for why these implementation practices are core.
These justifications came from descriptions found in the curriculum, published journal articles
about the curriculum, and discussions with BART’s developer, Janet St. Lawrence, PhD.
Why should I use BART’s Core Implementation Components Table?
BART’s Core Implementation Components Table is a useful tool for practitioners who are
preparing to implement and/or adapt BART. The table can help you better understand how to set
the stage and prepare for BART implementation, and, as a result, implement BART with greater
fidelity. If you are considering adaptations to BART, you must not delete or compromise the core
implementation components listed in this table. If you are considering yellow light adaptations,
you may add core implementation components to the list as long as they do not compromise the
components listed in the table.
In addition to the comprehensive version of the Core Implementation Components, the Core
Implementation Components at-a-Glance was designed to give you a quick overview of BART’s
core implementation components.
60
Core Implementation Components Table
Justification
Eight-session program in which participants meet once a week for 90–120
minutes for 8 weeks.
Sessions should NOT be dropped. “Clumping” of sessions to less than six 2hour sessions should be avoided. Clumping lessons may provide youth with
BART’s content but reduces the weekly review of their efforts to take what they
are learning from BART and apply it in their lives. This review time also
provides opportunities to develop peer role models from within the group,
reinforce efforts to use what they are learning, and problem solve and correct
problems as they initiate changes.
Girls and boys are separated by gender when focusing on skill development.
BART’s pre-study research demonstrated that there were gender differences to
take into account. Separating youth by gender for skill practice allows for
greater comfort. Separating by gender may be less of a concern for groups in
which boys and girls are equally sexually experienced.
Two co-leaders are needed to facilitate sessions. Unless working with a samesex group, one facilitator should be male, and the other should be female.
By having facilitators of both genders, participants have the opportunity to
observe men and women relating to one another using the skill elements that
BART is teaching. An effort should be made to use facilitators who are as
similar as possible to the participants. Youth should also have the opportunity
to observe female-to-female and male-to-male interactions (using youth
participants).
Implement in a non-school setting.
Schools often have more restrictions with regard to time availability and
curriculum content. Community-based organizations (CBOs) are often
embedded in youth environments and can better tailor programs to the
language and values of the communities they serve. They are perceived as
credible sources of information and are often known and trusted by their
communities. CBOs may also have access to out-of-school youth.
Train program leaders.
Facilitators will need to have good youth facilitation skills and should become
familiar with the curriculum content/pedagogy, logistics and preparations
needed to facilitate the curriculum effectively. Facilitators should practice using
the skills they will be teaching the youth until they are comfortable and skilled
at using these skills.
Choose program leaders who will have credibility with youth and whom youth
can trust.
If youth cannot connect with or trust facilitators, the facilitators will have a
difficult time implementing BART effectively.
61
(continued)
Core Implementation Components in Depth
Justification
Develop safeguards for confidentiality.
It is essential that youth feel free to participate openly and honestly.
Promote awareness and attendance by communicating to youth that you are
happy to see them, making reminder phone calls, providing teasers at the end
of each session, and/or other activities that will encourage youth to attend.
Youth have to attend in order to acquire knowledge, motivation and skills.
Obtain parental consent and support.
BART encourages youth to go home after each session and share knowledge
and skills with family and friends. Giving parents a “heads up” through a
parental consent letter may support these efforts. In some cases, given the
sensitive nature of the information taught in BART, parental consent may be
required by the organization facilitating the program.
Participating youth receive a BART T-shirt or other items with BART logo at the
completion of the program.
These items help to stimulate conversational opportunities. Others see the logo
and may ask participants what BART is about, opening an opportunity for
youth to share what they have learned.
A private meeting space is secured for implementing BART and the leader(s)
is/are present at all times.
Privacy better ensures confidentiality and fewer interruptions, which makes
group learning easier to manage. Co-leaders provide an advantage because if
one leader has to leave to deal with a difficult situation, the other leader can
stay with the group.
Each BART implementation group should be limited to 5–15 youth participants.
BART requires a lot of group discussion, practice and rehearsal that would be
difficult with groups larger than 15 or smaller than five. Facilitating BART with
larger groups would mean running the risk of some participants not getting
sufficient skill practice and feedback.
Participants should be ages 14 to 18.
The learning activities used in BART are designed for the cognitive and
emotional maturity of youth 14 to 18 years of age. During the BART study,
most participating youth were between 14 and 16 years of age.
Review preparation needs and obtain needed materials (e.g., videos, data,
etc.).
Basic preparation, including the gathering of necessary materials, is a core
implementation component of all curricula.
62
Core Implementation Components in Depth
Core Implementation Components Table (continued)
Green/Yellow/Red Light
Adaptations
63
Green/Yellow/Red Light Adaptations
64
Green/Yellow/Red Light Adaptations
This section details the ways in which the Becoming a Responsible Teen (BART) curriculum may
be adapted and customized, both in general and by specific activity.
General Adaptations
The general adaptations listed below pertain to BART as a whole rather than to specific lessons
or activities. The list of general adaptations is followed by a table that lists specific green, yellow
and red light adaptations for each BART activity.
General Green Light Adaptations: Go for It!






Changing the program title.
You may change the name of the program from Becoming a Responsible Teen to another
name that resonates better with the youth you are serving. You may also want to change
activity titles (e.g., “HIV Feud”) if you think another title would be more relevant.
Changing cultural references.
You may substitute fact sheets, pie charts, data and cultural descriptions of other ethnic/racial
groups (e.g., Latinos, Native Americans, etc.) for the information presented in BART about
African Americans.
Updating/adapting HIV myths.
Myths about how HIV is transmitted may differ from one community to the next. It is important
that you know about the myths that are circulating among the group you are serving and talk
about them during the BART program.
Customizing drug and alcohol use terminology.
BART talks about avoiding drugs and alcohol, as they may impair a person’s judgment and
lead to unsafe sexual behaviors. You should become knowledgeable about the kind of drug
use, if any, prevalent in the community in which the youth you are serving live, as well as the
words they use to describe those drugs.
Changing cultural references for ending quotes.
African quotes end each BART session. Although these quotes are relevant to all people,
they are not considered a core component of BART. You may choose to use quotes from
other cultures that convey a similar meaning or drop the quotes altogether.
Using different videos.
Two videos are used in BART: Seriously Fresh and Are You With Me? Both of these videos
use African-American actors and are somewhat dated. You may choose to use other videos,
but you should make sure the new videos are culturally appropriate and address the same
determinants as the original videos. The characters in the video should represent the same
race/ethnicity, age and gender as the participants. BART provides alternate activities if you
are unable or choose not to use the videos.
65




General Adaptations
Updating data.
Much of the data presented in the 2005 edition of BART comes from the 2003 Youth Risk
Behavior Surveillance (YRBS) Survey or from CDC HIV/AIDS Surveillance. Data from the
most current YRBS should be used instead. The following link will take you directly to the
most current YRBS data: http://www.cdc.gov/HealthyYouth/yrbs/.
Reinforcing information with visuals.
In different BART sessions, lists, tips and messages are provided verbally. Some people
learn better with visual reinforcement using tools such as PowerPoint slides, flipcharts,
posters or handouts. Repetition, especially when the information is presented in different
ways, is generally considered good pedagogical practice. (Examples include what youth will
learn in the BART program; seven Kwanzaa principles; how to avoid HIV transmission; key
points about three communication styles; key value messages about staying safe; second
chances list.)
Changing roleplays.
BART uses roleplays in several places to demonstrate or give youth the opportunity to
practice skills. You may change names, settings, language and even some of the details of
the roleplay as long as you do not change the meaning, significantly shorten or remove the
roleplay. Assessment data gathered from your students can help guide these types of
adaptations. For example, you can get their suggestions for wording or ideas for places
where they usually socialize. Factors such as literacy levels and the general life style of your
students (rural vs. urban youth, for example) are also important considerations.
Adding debriefing or processing questions.
There are several places in BART where the facilitator leads a large-group reflection or
debrief discussion. Questions to guide the discussion are provided in the curriculum.
Depending on the situation, you may want to add a question or two to the discussion to make
it more relevant for local youth. This is acceptable as long as the additional questions do not
take the group away from the primary topic(s).
General Yellow Light Adaptations: Proceed with Caution (and Guidance)


Changing the sequence of activities.
BART sessions and activities are presented so that each session builds upon the previous
one. It is important that youth receive basic information, perceive that they are at risk, and
develop supporting attitudes, norms and motivations before learning new skills. Changing the
order of sessions could decrease the understandability and mastery of skills and information.
A curriculum or learning theory specialist would be able to advise you about appropriate ways
to shift sessions or activities, if necessary.
Adding activities to address additional risk and protective factors.
After conducting an assessment of the youth with whom you will be implementing BART, you
may learn that they face other important determinants of sexual risk-taking behavior that are
not addressed in BART. You may want to add activities or sessions to better address these
determinants. For example, you may find out that your youth have very little knowledge about
basic reproductive anatomy and physiology and would therefore benefit from instruction in
66
General Adaptations
these topics before they talk about sexual intercourse and condom use. Another example
might be a group of youth for whom alcohol and/or drug use is quite prevalent. You may
decide to add one or more activities on avoiding drugs and alcohol to strengthen how BART
has addressed this determinant. It is important, however, not to add too many additional
activities or sessions so that the program becomes too long and youth retention becomes a
problem. A curriculum or health behavior theory specialist would be able to assess how much
additional time would be appropriate to add to BART and how activities might be designed.


Shifting from a voluntary after-school format to in-school classroom sessions.
BART is designed to be conducted with small groups of youth (5–15) in an after-school
setting. Small group size allows for more engaging group discussion and more time for skill
practice and feedback, which are core pedagogical components of BART. Moving BART to a
school-based classroom setting may have a negative effect on outcomes because: (1)
classroom size is typically larger than 15 youth, (2) youth attending an after-school program
are attending voluntarily as opposed to mandatory school attendance, (3) school teachers
may not have the same enthusiasm or interest in teaching a sexual education program as
community-based sexuality educators, (4) youth may be tired by the time they get to the
school class in which BART is being taught, and (5) youth may have a different reaction to
BART if they feel they are being evaluated by their school teacher. A curriculum specialist
would be able to advise about changing teaching settings for BART.
Changing facilitators from adults to peers.
A core implementation component of BART is to use both a male and female facilitator.
Although it might be possible to substitute one of these facilitators with a peer educator, that
peer educator would need to receive appropriate training. It is not acceptable to replace both
adult facilitators with peer facilitators. A curriculum specialist would be able to advise you
about using peer educators for BART.
General Red Light Adaptations: Avoid



Shortening the program.
Substantially shortening evidence-based programs such as BART may reduce their
behavioral impact. Several replication studies of evidence-based sex and HIV education
programs have demonstrated a negative effect on outcomes when these programs were
shortened. Each risk and protective factor addressed in a curriculum is likely to be addressed
by multiple activities. Substantially reducing the number of activities designed to affect each
risk and protective factor may have a negative effect on behavioral outcomes.
Reducing or eliminating activities that allow youth to personalize risk.
It is not sufficient to simply talk about HIV data relevant to the youth participating in BART.
Youth need to personally understand the risks they face. Activities designed to personalize
risk should not be removed.
Reducing or eliminating opportunities for skill practice (e. g., roleplays).
Individuals are more likely to adopt skills when they are clear about the components of the
skill, know what it looks like in real life, and have a chance to practice and master it. These
are essential ingredients for behavior change. BART teaches several important skills,
including condom use, assertive communication, refusal, condom negotiation and problem
67
General Adaptations
solving. It is not sufficient to simply present the steps of each skill and model it for youth.
Youth must have an opportunity to practice each of these skills until they can use them
effectively and comfortably, receive positive feedback when they improve, and eventually be
able to perform the skill correctly.

•




Deleting condom activities.
As with any skill, learning how to use a condom involves practice. If you wish to see a change
in behavior regarding condom use, you must include condom demonstration and practice
activities.
Deleting positive message about abstinence.
Abstinence as the only certain way to avoid HIV, other STIs, or unwanted pregnancy is one of
BART's core messages. It is discussed throughout the curriculum and should not be deleted.
Eliminating risk and protective factors.
The list of BART’s core content components clearly shows the important risk and protective
factors addressed by BART’s learning activities. These core content components are
grounded in Social Learning Theory and the Information-Motivation-Behavior model. By
removing one or more of the risk or protective factors, you may be compromising the “recipe”
for success that BART’s developer created.
Contradicting, competing with or diluting the program’s focus.
BART was designed to reduce sexual risk-taking behaviors directly associated with
contracting HIV. (See BART’s BDI Logic Model for a graphic depiction of how these
behaviors link to the program’s overall goal.) If you add additional goals such as “reduce drug
use” or “reduce sexual violence,” these may start to compete with, or, in some cases,
contradict BART’s goal. It is a better idea to prioritize health goals and decide which ones you
want to tackle first. Choose evidence-based programs to address each of these health
problems, but do not try to combine programs or “cut and paste” to meet multiple health goals
with one program.
Failing to repeat/reinforce new information.
Although repeating the key behavioral messages throughout BART may seem redundant, it is
important that you do so. People often need to hear new learning multiple times before it is
remembered and integrated.
Reducing efforts put into classroom management.
BART explicitly talks about several classroom management techniques that are also part of
its core pedagogical or implementation components. It is essential that you allow sufficient
time to set the tone for youth. This includes time for introductions and ground rules, practicing
and delivering clear directions for activities, providing reinforcement and specific feedback
when youth are practicing skills, engaging and eliciting ideas and questions from youth, etc.
For more information about classroom management, see:
http://www.etr.org/recapp/index.cfm?fuseaction=pages.EducatorSkillsDetail&pageID=78&Pag
eTypeID=3.
68
The activity-specific adaptations in the “Green” and “Yellow” columns below are options the developers and curriculum reviewers agree would not
jeopardize the intended outcomes. The “Red” column differs from the “Green” and “Yellow” columns in that it explains why that activity—or
significant elements of it—should not be adapted. As with the general adaptations above, the message of the “Red” column in this table is “Avoid
making these types of changes.”
Session 1: Understanding HIV & AIDS
Activity Title
Green
Yellow
Red
Activity 1:
Introduction to
BART
Youth introductions can be
done in other ways, as long as
youth have a chance to let
others know their names, ages,
schools and what they’d like to
get out of the program.
None
There are three critical elements
to Activity 1. All should be
included for the following
reasons:
1.
Some youth prefer the term
“group agreements” rather than
“ground rules,” which can have
a negative connotation.
2.
3.
Data and cultural strengths
from other racial and ethnic
groups may be substituted for
those that focus on the AfricanAmerican experience.
Data from the most current
YRBS should be used:
http://www.cdc.gov/HealthyYout
h/yrbs/
None
How?
Introductions set the tone for
group interaction, build trust,
and encourage participation.
Setting ground rules or
group agreements helps
participants feel comfortable
and safe when talking about
HIV, sex and drugs in front
of their peers.
Developing a common
language for discussing
sexuality also creates a
comfort level for discussing
HIV and protection.
This activity clarifies a key BART
message: It’s not who people
are, but what they do that puts
them at risk for HIV. It also
introduces the cultural strength
theme that is prominent in the
curriculum. While this activity
could be adapted for other
cultures, it should not be
shortened or omitted.
69
(continued)
Activity-Specific Adaptations
Activity 2:
Who Is at Risk
for HIV and
Why?
Intend to
Adapt?
Green
Yellow
Red
Activity 3:
Introduction to
HIV Terms
You are encouraged to update
the information on HIV/AIDS
terminology, especially on
testing, that is presented in this
activity. Updated information
can be found at:
www.cdc.gov/hiv/.
None
Accurate information is a
building block for BART’s
subsequent activities (e.g.,
comparing facts and myths in the
next activity) and should not be
omitted or shortened. BART is
based on the knowledge that
information and awareness are
preconditions that set the stage
for change.
Activity 4:
Facts and
Myths
You are encouraged to seek
information on local myths
about how HIV is transmitted,
which may differ from one
community to another. In
particular, you should learn
about myths circulating among
the group of youth you are
serving to be sure they are
discussed during this activity.
None
Many beliefs about HIV are
commonly held but are untrue.
This activity is essential to
differentiating these myths from
accurate facts and should not be
omitted or shortened.
Activity 5:
Deciding Your
Level of Risk
To make this activity as
relevant as possible to the
participating youth, you should
become knowledgeable about
the types of sexual behaviors in
which the youth in your
community are engaging, as
well as the language they use
to talk about these behaviors.
None
This activity is essential because
it begins the process of
personalizing risk and
understanding different levels of
risk. It therefore should not be
shortened or omitted. Rather
than being lectured to, it is
essential that youth analyze the
facts for themselves (through the
traffic light exercise in this
activity) and arrive at the
conclusions about risk levels.
Intend to
Adapt?
How?
(continued)
70
Activity Title
Session 1 (continued)
Activity Title
Green
Yellow
Red
Activity 6:
Spreading the
Word
None
None
This activity empowers youth to
use their new knowledge to
begin influencing others in a
positive way, shaping norms
among their peers and relatives.
It should not be omitted or
shortened.
Wrap-Up
Although the African proverb
that ends this and other
sessions is meant to offer a
universal message, a different
quote may be used to replace it
if it would be more relevant to
the cultural background(s) of
the youth you are serving.
None
None
Intend to
Adapt?
How?
71
Green
Yellow
Red
Activity 1:
Definitions
Review
None
None
Reviews of new information (in
this case, definitions relevant to
HIV/AIDS) are a critical part of
reinforcement and should not be
shortened or omitted, even if
they seem repetitive.
Activity 2:
HIV
Transmission
Review
None
None
See above.
Activity 3:
AIDS and
African
Americans
Data about other racial and
ethnic groups may be
substituted for those that focus
on the African-American
experience.
None
This activity dispels stereotypes
about HIV, notes its prevalence
among African Americans, and
encourages participants to take
action to prevent HIV. It is an
important element of BART’s
case for taking preventive action
and should not be omitted or
shortened (although, as noted in
the “Green Light” column, it may
be adapted to other racial/ethnic
groups).
Activity 4:
“HIV Feud”
None
None
Games and other interactive
features of BART are deliberate
ways to engage youth in the
knowledge-building activities (in
this case, about the risk levels
associated with a variety of
behaviors and activities). It is not
acceptable to replace this or
other interactive elements with
passive lectures or individual
work.
Intend to
Adapt?
How?
(continued)
72
Activity Title
Session 2: Making Sexual Decisions & Understanding Your Values
Green
Yellow
Red
Activity 5:
Video:
Seriously Fresh
The Seriously Fresh video,
made in 1990, is likely to seem
dated to participants.
Facilitators can stress that the
messages about choices, risks
and vulnerability are still
important, even though times
have changed.
The video features a set of
African-American friends talking
about sex and HIV. You may
substitute another video that
reflects participants’
race/ethnicity, age and gender.
If a replacement video is not
available, an alternative activity
is suggested.
None
This activity and the alternate,
below, help personalize the
concept of risk for HIV. One or
the other activity (or a
combination) should be included
in any adaptation of BART.
Activity 5A:
Personalizing
HIV Risks
The worksheet for this activity,
“How HIV Could Change My
Life,” could also be used with
the video in Activity 5 (instead
of as a replacement for the
video).
None
See above.
Activity 6:
Exploring Drug
Risks for HIV
Facilitators should become
knowledgeable about the kind
of drug use, if any, that is most
prevalent in the community,
including the words used to
describe common drugs.
None
This activity encourages youth to
explore a link between drug use
and HIV infection and should not
be omitted or shortened.
Activity 7:
Support
Systems
None
None
This activity helps participants
understand their own support
networks for information and
discussions about safer sex and
HIV, as well as their own role as
potential support systems for
others. It builds communication
with adults and social norms
about discussing sex and HIV
and should not be omitted.
Intend to
Adapt?
How?
(continued)
73
Activity Title
Activity Title
Green
Yellow
Red
Wrap-Up
None
None
Intend to
Adapt?
How?
74
Green
Yellow
Red
Activity 1:
Attitudes and
Risk
Additional questions may be
added to the discussion of the
Seriously Fresh video or
alternative, as long as they do
not take the group too far away
from the primary topic (in this
case, attitudes towards condom
use shown in the video).
The “Who’s Using Condoms”
handout refers to sexual activity
and condom use among
African-American high school
students; this should be
adapted if youth are from a
different ethnic/racial group.
For data about other groups,
review the most current Youth
Risk Behavior Survey summary
report:
http://www.cdc.gov/HealthyYout
h/yrbs/
None
Attitudes toward condom use are
a determinant of whether or not
people use them; this activity is
an important precursor for the
condom use and negotiation
skills activities that follow and
should not be omitted or
shortened.
Activity 2:
Learning the
Facts About
Condoms
None
None
Learning basic knowledge about
the types of condoms and
lubricants and how to store
condoms is the first step in
learning how to use them. If you
wish to see a change in behavior
regarding condom use, you
should not drop this or other
condom-related activities from
the curriculum.
Activity 3:
Overcoming
Embarrassment
About Buying
Condoms
None
None
Embarrassment is a common
and preventable barrier to
condom use by adolescents.
This activity should not be
Intend to
Adapt?
How?
(continued)
75
Activity Title
Session 3: Developing and Using Condom Skills
Activity Title
Green
Yellow
Red
Activity 4:
Using Condoms
Correctly
None
None
This activity builds the skill of
correct condom use through
demonstration (by the facilitator),
practice (by the youth) and
feedback. It should not be
Activity 5:
Countering
Barriers to
Using Condoms
None
None
This is another skill-building
activity that helps youth examine
the reasons people may give for
not using condoms, as well as
identify (and practice using)
effective counterarguments. It
should not be shortened or
omitted.
Wrap-Up
None
None
Intend to
Adapt?
How?
76
Green
Yellow
Red
Activity 1:
Correct
Condoms Use
Overview
None
None
this case, correct condom use)
are a critical part of
Activity 2:
Video: Are You
with Me?
The Are You With Me? video is
somewhat dated and uses
African-American actors. Another
video could be substituted to
better reflect local youth’s culture,
as long as it addresses ways
people can negotiate safer sex
with partners. An alternative
activity is also available.
None
This activity and the alternate
help introduce and reinforce the
skill of negotiating safer sex with
a partner. One or the other
activity (or a combination) should
be included in any adaptation of
BART.
Activity 2A:
Negotiating
Safer Sex
The worksheet from this activity,
“What I Can Do to Stay Safe,”
could be combined with the above
video (instead of replacing it).
None
See above.
Activity 3:
ProblemSolving Skills
None
None
This activity introduces a six-step
problem-solving method so that
youth can begin applying it to the
problem of persuading a partner
about safer sex. It should not be
omitted or shortened.
Activity 4:
Different
Communication
Styles
You can modify the situations to
make them more relevant for local
youth, as long as they continue to
illustrate different communication
styles.
None
This activity demonstrates
different communication styles
and helps youth see why some
are more effective than others. It
is an element of building
communication skills and should
not be omitted or shortened.
Wrap-Up
Although the African proverb that
ends this and other sessions is
meant to offer a universal
message, a different quote may
be used to replace it if it would be
more relevant to the cultural
background(s) of the youth you
are serving.
None
None
Intend to
Adapt?
How?
77
Activity Title
Session 4: Learning Assertive Communication Skills
Green
Yellow
Red
Activity 1:
Assertive
Communication
Review
None
None
this case, communication styles)
are a critical part of
Activity 2:
Assertive
Communication
Tips
None
None
This activity gives youth
concrete, practical tips for using
assertive communication
techniques, which they will
practice later in the session in
Activity 5. It should not be
Activity 3:
Ways to Say
NO
None
None
This activity helps youth
understand a specific aspect of
assertive communication – a
clear NO. It is an essential skill
for negotiating safer sex and
omitted.
Activity 4:
Assertive
Communication
Demonstration
You can modify the roleplay
scripted lines to make them
more relevant to local youth, as
long as they illustrate pressure
to have unsafe sex.
None
Facilitators demonstrate a
roleplay of assertive
communication skills, which
youth practice in the next
activity. The demonstration
models the skill and is an
essential part of skill-building, so
it should not be shortened or
omitted.
Intend to
Adapt?
How?
(continued)
78
Activity Title
Session 5: Practicing Assertive Communication Skills
Activity Title
Green
Yellow
Red
Activity 5:
Assertive
Communication
Practice
It’s fine for participants to
change the language in the
roleplays to something that
feels more natural to them, as
long as the type of situation and
practice is maintained.
None
This activity allows youth to
practice assertive
communication and refusal skills
for sexual situations, drugs or
both. It also gives youth an
opportunity to learn how to give
constructive feedback. Repeated
practice through roleplays is an
important part of BART and
omitted. In fact, if possible, the
developers suggest extending
the length of time (45 minutes) to
give all youth a chance to
practice all three roleplays.
Wrap-Up
None
None
None
Intend to
Adapt?
How?
79
Activity Title
Green
Yellow
Red
Activity 1:
Meeting
People with
HIV
A video in which young people
talk about how HIV has affected
their lives may be used if
speakers are not available. (See
alternative activity.)
None
This activity helps build
awareness about HIV among
young people and personalizes
HIV risk. Either a speaker or the
alternative video should be
included.
Activity 2:
Discussion and
Debrief
The facilitator may wish to add
discussion questions as long as
they do not move the discussion
too far afield from the effects of
HIV on young people and
participants’ reactions to what
the speaker shared.
None
Reflection and discussion help
youth process new information
as well as their feelings and
reactions. The discussion/debrief
shortened; it is a key element of
the awareness building of this
activity.
Alternate
Activity:
Video
See above.
None
See above.
Wrap-Up
be used to replace it if it would
be more relevant to the cultural
are serving.
None
None
Intend to
Adapt?
How?
Session 6: Personalizing the Risks
80
Green
Yellow
Red
Activity 1:
Assertive
Communication
in the Real
World
None
None
This activity includes a review of
problem-solving and assertive
communication skills, reinforcing
new information from earlier
sessions. It also begins linking
these techniques to youths’ own
lives, which is important in terms
of adopting the new skills as
useful and relevant. This activity
shortened.
Activity 2:
Getting Out of
Risky
Situations
The goal of this activity is to get
participants to think about
situations that might be difficult
to handle and develop a specific
plan for disengaging themselves
from that situation when it arises.
Any activity or tool that
accomplishes this goal would
suffice. “If It’s Not On, It’s Not
On” was developed by BART
pilot participants and may or may
not resonate with the youth you
are serving. Youth could develop
their own version of this
approach if it is appropriate for
your local community.
None
This activity introduces ways to
get out of risky situations and the
concept of self-talk, based on
positive beliefs and respecting
oneself. It also addresses the
issue of intent to change behavior
through the “10 Steps to Put
Good Intentions into Practice”
handout. This activity is an
important link between skills,
intent and future behavior change
and should not be shortened or
omitted.
Activity 3:
Spreading the
Word
Demonstration
You may modify the situations
for spreading the word to make
them more relevant for local
youth.
None
This activity begins to reposition
youth as peer leaders—teens
who are able to talk to other
teens—so that they can share
positive messages based on
what they have learned. It sets up
the practice roleplay in Activity 4,
builds communication skills and
self-efficacy, and influences
social and peer norms. It should
not be shortened or omitted.
Intend to
Adapt?
How?
81
(continued)
Activity Title
Session 7: Spreading the Word
Activity Title
Green
Yellow
Red
Activity 4:
Spreading the
Word Practice
You may modify the roleplay
situations for spreading the word
to make them more relevant for
local youth, as long as the
roleplays give youth practice in
talking with family and friends
about HIV and protection.
None
The practice in this roleplay is an
essential element of skill building
so that youth can share BART’s
prevention messages. Practice in
this and other roleplays should
not be shortened or omitted.
Wrap-Up
be used to replace it if it would
be more relevant to the cultural
are serving.
None
None
Intend to
Adapt?
How?
82
Green
Yellow
Red
Activity 1:
Final Review of
HIV Facts
You may want to add other myths
to be debunked by the youth, if
these were raised earlier.
None
Reviews of new information (in this
case, HIV facts that youth have
learned throughout the curriculum)
are a critical part of reinforcement
omitted, even if they seem
repetitive. It’s also important to
structure this activity as a game, not
a test, to keep it interactive.
Activity 2:
What Are You
Doing to
Protect
Yourself?
None
None
This activity reinforces several key
elements of BART—positive
messages about prevention, selfefficacy to make safer choices, and
modeling of these behaviors among
peers, which shapes social norms. It
should not be omitted or shortened.
Activity 3:
What Are You
Doing to
Educate
Others?
None
None
See above.
In addition, this activity emphasizes
the social support that youth can
access and offer one another. In
BART, protecting oneself and
educating/protecting others are dual
themes; both activities are critical
omitted.
Activity 4:
Graduation
Ceremony
There are multiple ways that
participating youth can be
celebrated, including a party, field
trip or other outing.
None
Participants have learned a great
deal through the BART sessions.
No matter what form “graduation”
takes, they deserve to be
recognized for this accomplishment
and for the fact that what they have
learned can lead to a safer and
healthier sexual future.
Intend to
Adapt?
How?
83
Activity Title
Session 8: Taking BART with You
84
Adaptation and Fidelity
Monitoring Logs
85
Adaptation and Fidelity Monitoring Logs
86
What is the purpose of this tool?
The purpose of this log is to help you keep track of your experiences in implementing the eight
sessions of the Becoming a Responsible Teen (BART) curriculum so that you can assess your fidelity
to the curriculum’s core components as well as any adaptations you think are necessary. This log can
also assist you in assessing what help you might need to improve future implementations of BART.
After completing several logs over time, you might want to look at all of them simultaneously to
identify any patterns in implementation or adaptations. For example, after reviewing several
completed logs, you might notice that you made multiple adaptations because of inadequate time to
complete activities or discomfort with a particular teaching method and/or classroom
management/behavior issues. Identifying these types of patterns can guide you in thinking about
further support you might need to better implement the BART program in the future.
Most important, use the data you gather from these logs to validate what worked well for you with
regard to your implementation and adaptation of BART and to strengthen the areas that did not work
as well.
How is this tool organized?
Following this introduction are nine logs—one for each of the eight sessions in BART, and one for the
core implementation components. All of the logs include tables for you to record your
answers/thoughts. Feel free to use additional paper if needed.
The log for each session contains two sections with questions for you to consider:

“Did you maintain fidelity to the core content and pedagogical components in Session X?”
This section will help you determine whether or not you maintained fidelity to the core content and
pedagogical components represented in each BART session.
If you believe you maintained fidelity to each of the content and pedagogical core components
listed in the two tables for this session, check the YES column. If you believe you may have
compromised or deleted a core component, check the NO column. Calculate the “Total %
Fidelity” to give you a general idea about how well you are implementing BART with fidelity.
Remember, core components are considered critical elements that contribute to the effectiveness
of the program. If you checked NO for any of the core components, think about how you might be
able to better address this component in your next implementation. (Note: For more information
about the core content and pedagogical components of BART, please see the sections on Core
Content and Core Pedagogical Components.)
87

“Did you adapt any of the activities in Session X?”
This section will help you reflect on the adaptations (both planned and unplanned) you may
have made to the activities in each session.
Indicate whether you made a planned or unplanned adaptation to the activities in this
session. (Eliminating an activity is also considered an adaptation.) Describe the adaptation
you made, why you chose to make it, how effective you think the adaptation was, and any
recommendations you have for the next implementation in the appropriate columns. Use
what you learn the next time you implement BART.
The final log, “Did you maintain fidelity to BART’s core implementation components?,” will
help you determine whether or not you maintained fidelity to BART’s core implementation
components. When answering these questions, think about your implementation of BART as a
whole.
88
BART Session 1: Understanding HIV & AIDS
Did you maintain fidelity to the core content and pedagogical components
in Session 1?
Core CONTENT components relate to WHAT is being taught in a curriculum—the knowledge,
attitudes, values, norms, skills, etc., that are likely to influence and change sexual behaviors.
Did you cover each of the core CONTENT components in Session 1?
1.
KNOWLEDGE about sex
2.
KNOWLEDGE about HIV
3.
ATTITUDES about talking about sex and HIV
4.
PERCEPTION of risk of HIV
5.
VALUE of prevention HIV
6.
CULTURAL CONNECTEDNESS to values that are protective against HIV
7.
SOCIAL NORMS re preventing HIV (personally, and for community)
YES
NO
REMARKS
TOTAL % Fidelity (# YES / 7)
Core PEDAGOGICAL components relate to HOW the content is taught—the teaching methods,
strategies and youth-facilitator interactions that contribute to the program’s effectiveness.
Did you use each of the core PEDAGOGICAL components in Session 1?
1.
INTRODUCE BART and give an overview of the program.
2.
Establish and maintain GROUND RULES (via BRAINSTORMING).
3.
TAILOR LANGUAGE to reflect youth norms and culture (via
BRAINSTORMING in Finding a Common Language activity).
4.
MINI-LECTURES (on HIV/AIDS, HIV Progression and Incubation, Who is
at Risk, Strength for Prevention), using VISUALS whenever possible.
5.
LARGE-GROUP DISCUSSIONS to share personal experiences, assess
who is at risk, define key terms, discuss getting/avoiding HIV).
6.
Play GAMES (dispelling myths, traffic light game).
7.
Complete WORKSHEET (Making Decisions) and DISCUSS.
8.
Encourage youth to APPLY what they’ve learned and spread the word
(HOMEWORK).
9.
WRAP-UP to encourage attendance at Session 2.
YES
NO
REMARKS
10. Give CLEAR INSTRUCTIONS for games, homework, etc.
89
Did you adapt any of the activities in Session 1?
Please describe the adaptations
you made to the activities
below.
Introduction to BART
2.
Who Is at Risk for HIV and
Why?
3.
Introduction to HIV Terms
4.
Facts and Myths
5.
6.
Spreading the Word
7.
Wrap-Up
Describe the
adaptation you
made.
Why did you make
this adaptation?
How effective was
the adaptation?
Recommendations
for the next
implementation.
90
1.
Was your adaptation
planned or
unplanned?
BART Session 1: Understanding HIV & AIDS
BART Session 2: Making Sexual Decisions & Understanding Your Values
of Session 2?
1.
KNOWLEDGE about HIV and its severity
2.
PERCEPTION of risk for HIV
3.
SOCIAL NORMS promoting HIV prevention
4.
KNOWLEDGE about alcohol and drugs
5.
COMMUNICATION with parent or other adult about HIV
YES
NO
REMARKS
1.
REINFORCE material from Session 1 by reviewing definitions.
2.
LARGE-GROUP DISCUSSIONS of HIV definitions, avoiding HIV
transmission, what statistics mean, how teens can make a difference, HIV
transmission and protection, drugs and HIV, identifying support systems,
“Seriously Fresh” video.
3.
LECTURE about how HIV is affecting African Americans; drugs, alcohol
and AIDS.
4.
Play GAME (HIV Feud).
5.
Complete WORKSHEETS (How HIV Could Change My Life and
Understanding Each Other).
6.
View VIDEO (“Seriously Fresh”) and DISCUSS/DEBRIEF.
7.
Encourage youth to APPLY and SHARE information learned so far.
8.
WRAP-UP to encourage attendance at Session 3.
9.
Give CLEAR INSTRUCTIONS for game, worksheets.
YES
NO
REMARKS
10. TAILOR LANGUAGE, as needed, to make more relevant to youth.
91
below.
1.
Definitions Review
2.
HIV Transmission Review
3.
AIDS and African Americans
4.
“HIV Feud”
5.
Video: Seriously Fresh
6.
Exploring Drug Risks for HIV
7.
Support Systems
8.
Wrap-Up
Describe the
adaptation you
made.
Why did you make
this adaptation?
How effective was
the adaptation?
Recommendations
for the next
implementation.
92
5A. Personalizing HIV Risks
(alternate)
Was your adaptation
planned or
unplanned?
BART Session 2: Making Sexual Decisions & Understanding Your Values
BART Session 3: Developing & Using Condom Skills
of Session 3?
1.
ATTITUDES about condom use
2.
KNOWLEDGE about condoms
3.
SKILLS to obtain condoms
4.
SELF-EFFICACY to use condoms
5.
SOCIAL NORMS supporting condom use
YES
NO
REMARKS
1.
GROUP DISCUSSIONS on experiences of talking to friends/family about
BART, where to obtain condoms.
2.
REVIEW "Seriously Fresh" VIDEO and DISCUSS (focusing on condom
use content).
3.
LECTURES on African-American teen sex statistics (using VISUALS),
importance of using condoms, how to use condoms correctly.
4.
BRAINSTORM ways to overcome embarrassment buying condoms;
excuses teens give for not using condoms; counterarguments for excuses.
5.
Conduct VISUALIZATION exercise (imagine successfully buying condoms)
and DISCUSS/DEBRIEF.
6.
DEMONSTRATE proper condom use.
7.
SMALL-GROUP SKILL PRACTICE for condom use
8.
WRAP-UP to remember conversations teens hear about not using
condoms and to encourage attendance at Session 4.
9.
Give CLEAR INSTRUCTIONS for small group/skill practice and
visualization exercise.
YES
NO
REMARKS
10. Facilitator is COMFORTABLE discussing condom use.
93
below.
1.
Attitudes and Risk
2.
Learning the Facts About
Condoms
3.
Overcoming Embarrassment
about Buying Condoms
4.
5.
Countering Barriers to Using
Condoms
6.
Wrap-Up
Was your adaptation
planned or
unplanned?
Describe the
adaptation you
made.
Why did you make
this adaptation?
How effective was
the adaptation?
Recommendations
for the next
implementation.
BART Session 3: Developing & Using Condom Skills
94
BART Session 4: Learning Assertive Communication Skills
of Session 4?
1.
2.
ATTITUDES about safer sex and negotiation skills
3.
SKILLS to refuse sex
4.
SKILLS to negotiate condom use
5.
SOCIAL NORMS supporting safer sex, negotiating safer sex or refusal of sex
6.
KNOWLEDGE about problem-solving skills
7.
KNOWLEDGE about communication styles
8.
ATTITUDES about assertive communication
9.
SOCIAL NORMS about using assertive communication techniques
YES
NO
REMARKS
1.
REINFORCE/REVIEW basic information (from Session 3) about proper
condom use.
2.
View VIDEO (Are You With Me?) and DISCUSS/DEBRIEF discussing
condom use with a partner.
3.
DEMONSTRATE ROLEPLAY on how to say no to sex and/or negotiate
condom use (facilitator).
4.
Complete WORKSHEET (What I Can Do to Stay Safe?) on negotiating skills
and DISCUSS.
5.
LECTURE to introduce six-step problem-solving framework.
6.
BRAINSTORM and conduct LARGE-GROUP DISCUSSION about six steps.
7.
LECTURE on importance of both partners taking responsibility for safer sex
and on communication styles.
8.
DEMONSTRATE ROLEPLAY of communication styles followed by
DISCUSSION and REVIEW.
9.
Give CLEAR INSTRUCTIONS for roleplays and worksheet.
YES
NO
REMARKS
10. Facilitator is COMFORTABLE discussing condoms.
11. TAILOR LANGUAGE, as needed, for roleplays.
12. WRAP-UP to encourage youth to share how to protect themselves from HIV
and encourage attendance at Session 5.
95
YES
NO
REMARKS
96
below.
1.
Correct Condoms Use Review
2.
Video: Are You with Me?
2A. Negotiating Safer Sex
(alternate)
3.
4.
Different Communication
Styles
5.
Wrap-Up
Was your adaptation
planned or
unplanned?
Describe the
adaptation you
made.
Why did you make
this adaptation?
How effective was
the adaptation?
Recommendations
for the next
implementation.
BART Session 4: Learning Assertive Communication Skills
97
BART Session 5: Practicing Assertive Communication Skills
of Session 5?
1.
2.
ATTITUDES about safer sex and negotiation skills
3.
SKILLS to refuse sex
4.
SKILLS to negotiate condom use
5.
SOCIAL NORMS supporting safer sex, negotiating safer sex or refusal of
sex
6.
7.
KNOWLEDGE about communication styles
8.
ATTITUDES about assertive communication
9.
SOCIAL NORMS about using assertive communication techniques
YES
NO
REMARKS
1.
LARGE-GROUP DISCUSSION about experiences youth had when they
could have used assertive communication. REVIEW characteristics of 3
communication styles.
2.
LECTURE with tips about more assertive communication (with
HANDOUT).
3.
LARGE-GROUP DISCUSSION about ways to say no (with HANDOUT).
4.
DEMONSTRATE ROLEPLAYS of assertive communication using 4-step
process to teach skills (describe, demonstrate, do, reinforce).
5.
ROLEPLAY practice in small groups.
6.
WRAP-UP encouraging practice of assertive communication.
7.
REVIEW/MINI-LECTURE on types of questions appropriate for guest
speaker (Session 6).
8.
Give CLEAR INSTRUCTIONS for roleplays.
9.
TAILOR LANGUAGE/NAMES, as necessary, for roleplays.
YES
NO
REMARKS
98
below.
1.
Assertive Communication
Review
2.
3.
Ways to Say NO
4.
Demonstration
5.
Practice
6.
Wrap-Up
Was your adaptation
planned or
unplanned?
Describe the
adaptation you
made.
Why did you make
this adaptation?
How effective was
the adaptation?
Recommendations
for the next
implementation.
BART Session 5: Practicing Assertive Communication Skills
99
BART Session 6: Personalizing the Risks
of Session 6?
1.
PERCEPTION OF RISK for/severity of HIV
2.
ATTITUDES about people with HIV
3.
KNOWLEDGE about HIV
YES
NO
REMARKS
1.
HIV-positive GUEST SPEAKER.
2.
LARGE-GROUP DISUCSSION to reflect on guest speaker’s presentation.
3.
View VIDEO and follow with LARGE-GROUP DISCUSSION, if there is not
a guest speaker.
4.
WRAP-UP and reinforce how what youth are learning will help them stay
safe.
YES
NO
REMARKS
100
below.
1.
2.
Discussion and Debrief
3.
Video (alternate)
4.
Wrap-Up
Was your adaptation
planned or
unplanned?
Describe the
adaptation you
made.
Why did you make
this adaptation?
How effective was
the adaptation?
Recommendations
for the next
implementation.
BART Session 6: Personalizing the Risks
101
BART Session 7: Spreading the Word
of Session 7?
1.
KNOWLEDGE about assertive communication skills
2.
ATTITUDES about assertive communication skills
3.
SOCIAL NORMS to use assertive communication
4.
5.
VALUES about communicating with partners about safer sex
6.
KNOWLEDGE about avoiding risky situations
7.
SOCIAL NORMS promoting safer sex
8.
ATTITUDES about safer sex
9.
SELF-EFFICACY to communicate about HIV prevention
YES
NO
REMARKS
10. ATTITUDES about HIV prevention
11. SOCIAL NORMS about HIV prevention
1.
REVIEW/LARGE-GROUP DISCUSSION of assertive communication skills
and benefits.
2.
LARGE-GROUP DISCUSSIONS (Examples from Life, Knowing When It’s
Time to Get Out, Walking Away).
3.
LECTURE to review problem-solving skills and how to use self-talk to stay
safe; encouragement to be peer leaders in community (including tips).
4.
BRAINSTORM about becoming peer leaders bringing up safer sex with
peers/family.
5.
DEMONSTRATE ROLEPLAYS about spreading the word, using 4-step
process to teach skills (describe, demonstrate, do, reinforce).
6.
ROLEPLAY practice in small groups.
7.
Give CLEAR INSTRUCTIONS for roleplays.
8.
TAILOR LANGUAGE/NAMES, as necessary, for roleplays.
9.
WRAP-UP and review to summarize lesson and encourage continued
practice of problem-solving steps.
YES
NO
REMARKS
102
below.
1.
Assertive Communication in
the Real World
2.
Getting Out of Risky
Situations
3.
Spreading the Word
Demonstration
4.
5.
Wrap-Up
Was your adaptation
planned or
unplanned?
Describe the
adaptation you
made.
Why did you make
this adaptation?
How effective was
the adaptation?
Recommendations
for the next
implementation.
BART Session 7: Spreading the Word
103
BART Session 8: Taking BART with You
of Session 8?
1.
KNOWLEDGE about HIV and HIV prevention
2.
SOCIAL NORMS promoting HIV prevention
3.
CONNECTEDNESS to culture
4.
ATTITUDES about HIV prevention
YES
NO
REMARKS
1.
Play GAME to review myths and facts about HIV.
2.
LECTURES on passing along information to others in the community;
second chances; looking back on BART, and looking forward.
3.
CELEBRATION/graduation ceremony with participation certificates, BART
T-shirts, refreshments, etc.
YES
NO
REMARKS
104
below.
1.
Final Review of HIV Facts
2.
What Are You Doing to
Protect Yourself?
3.
What Are You Doing to
Educate Others?
4.
“Graduation” Ceremony
Was your adaptation
planned or
unplanned?
Describe the
adaptation you
made.
Why did you make
this adaptation?
How effective was
the adaptation?
Recommendations
for the next
implementation.
BART Session 8: Taking BART with You
105
BART: Overall Implementation of Core Components
How well did you maintain fidelity to BART’s Core Implementation
Components?
Directions: Consider each of the 14 core implementation components in BART listed in the left-hand
column. In the second column, indicate the percentage of time that you believe you followed this
implementation guidance (across all the BART lessons as a whole). If you did not follow the
implementation guidance 100% of the time, please explain where/when it did not occur, and why, for
example, “2. We separated boys and girls for most (75%), but not all, of the skill development
sessions.”
(Note: For more information about BART’s core implementation components, please see the section
on Core Implementation Components.)
BART Core Implementation Components
1.
Implement eight weekly sessions of BART, with each
session lasting between 90 and 120 minutes.
2.
Separate girls and boys by gender when the
curriculum focused on skill development.
3.
Include two co-leaders on the facilitation team—one
male and one female.
4.
Hold the BART sessions in a non-school setting
(e.g., a community-based organization).
5.
Train the two co-leaders to deliver the BART
curriculum.
6.
The co-leaders have credibility with youth and can
earn their trust.
7.
Create a safe environment for teens that protects their
confidentiality.
8.
Promote awareness and attendance at BART
sessions with reminder phone calls, “teasers” at the
end of each session, and other activities and
communication to encourage attendance.
9.
Obtain parental consent and support.
%
If not 100%...where / when / why not?
10. Provide youth who complete the program with T-shirts
and/or other items featuring the BART logo.
11. Secure a private meeting space for all the BART
sessions and have the co-leader(s) present at all
times.
12. Include at least 5 and no more than 15 youth in the
group of youth participants.
13. The youth participants should be 14 to 18 years old.
106
14. Prepare for each session by obtaining any needed
materials (e.g., videos, data, etc.) ahead of time.
107
108
Glossary
109
Glossary
110
Glossary
Adaptation
The process of making changes to an evidence-based program to make it more suitable for a
particular population and/or an organization’s capacity, without compromising or deleting its core
components.
BDI Logic Model
Behavior-Determinant-Intervention Logic Model. The BDI logic model is a program planning tool
that guides program developers in four sequential and clearly linked steps: (1) establishing a
health goal, (2) identifying and selecting the individual or group behaviors directly related to that
health goal, (3) identifying and selecting the determinants related to those behaviors, and (4)
developing intervention activities directly related to those determinants.
Brainstorming
Brainstorming is a great way to generate ideas and lists. In brainstorming, all ideas are valid and
recorded. For example, a facilitator may ask a group of youth, "What are some reasons why
young people have sex?" All answers to this question are accepted and recorded. This technique
encourages broad participation and helps students consider all possibilities.
Core Components
Program characteristics that must be kept intact when the intervention is being replicated or
adapted for it to produce program outcomes similar to those demonstrated in the original
evaluation research. Core components can be organized into three categories: content,
pedagogical and implementation.
Core Content Components
Relate to what is being taught, specifically the knowledge, attitudes, values, norms, skills, etc.,
addressed in the program’s learning activities that are most likely to change sexual behaviors.
Relate to some of the logistics responsible for a conducive learning environment, such as
program setting, facilitator-youth ratio, dosage and sequence of sessions.
Relate to how the content is taught, including the teaching methods, strategies and youthfacilitator interactions that contribute to the program’s effectiveness.
Demographics
Social and vital statistics associated with a particular population. Examples of variables typically
described by demographics include age, sex, socioeconomic status, ethnicity/race, immigration
status, sexual orientation, etc.
Demonstrations
Demonstrations are "hands on" practice of a skill or an activity. A classic example of a
demonstration in sexuality education is asking students to properly put a condom on an
object/model that resembles a penis.
111
Glossary
Determinants
The psychosocial and environmental factors that have a causal influence on sexual behaviors.
Determinants can include factors such as knowledge, attitudes, skills or conditions. Determinants
include both risk factors (e.g., “being in love” is a risk factor for having sex) and protective factors
(e.g., a positive attitude about condoms is a protective factor for using condoms during sex).
Evidence-Based Program (EBP) or Evidence-Based Intervention (EBI)
A program that has been rigorously evaluated and shown to change sexual risk-taking behavior,
e.g., increase condom use or delay sexual onset.
Fidelity
The faithfulness with which a curriculum or program is implemented; that is, how well the program
is implemented without compromising the core content, pedagogical and implementation
components essential for the program’s effectiveness.
Forced Choices/Values Clarification
In a forced choice activity, youth are given the opportunity to consider two sides of an issue and
then make a "forced" choice (agree or disagree) based on their values. For example, "sexual
intercourse should be saved for marriage" and "sexual intercourse outside of marriage is OK."
After the youth make their choices, the facilitator encourages discussion so the youth can learn
about different points of view and clarify personal values. This activity can be facilitated using a
pencil and paper survey or a standing continuum.
Getting to Outcomes (GTO)
A ten-step program planning model: (1) conduct a needs and resources assessment, (2) set
program goals, (3) explore evidence-based programs, (4) select an evidence-based program for
fit with priority population, (5) assess organizational capacity to implement selected program, (6)
plan for program implementation, (7) implement program and conduct process evaluation, (8)
conduct outcome evaluation, (9) conduct continuous quality improvement, and (10) sustain
effective programs.
Green Light Adaptations
Adaptations that do not compromise the core components and internal logic of an evidencebased program. In fact, many of the green light adaptations are encouraged. For example, most
evidence-based programs can be improved by changing the names or situational contexts in
roleplays and updating reproductive health information and statistics to better address the youth
who will participate in the program. Green light adaptations generally do not require a lot of time
or resources. Practitioners can feel comfortable making these types of changes.
Guest Speakers
Invited speakers from the community who have a special area of expertise or experience and are
skilled at talking with youth. Guest speakers can be an interesting way for youth to learn about
different issues (e.g., inviting a guest speaker who has been living with HIV to share his/her
experience with the group).
Guided Imagery
In guided imagery, the facilitator asks the group to get into a relaxed position through deep
breathing, stretching, closing eyes, etc. After the group is in a relaxed position, the facilitator talks
the group through an experience (e.g., going to a health clinic to get tested for HIV) and
112
Glossary
periodically asks them to notice their feelings, thoughts, worries, etc. After the guided imagery is
completed, a processing discussion is held.
Large-Group Discussion
Large-group discussions are generally led by a facilitator. Information to be discussed is
presented through lecture, video, skit, etc. After this information is presented, the facilitator leads
a discussion that allows for recall, analysis, generalization and personalization of the information.
For example, to start a discussion (introduction), a teacher might present some statistics about
STDs and teenagers and then ask the youth some questions about the statistics (recall). Youth
discuss why STD rates are so high for youth (analysis). Then they list the ways they can prevent
STDs (generalization) and how they will use this new information in their lives (personalization).
Lecture
A lecture is a prepared oral presentation that may or may not use visual aids (charts, diagrams,
slides, etc.). A lecture is generally used to present factual material in a direct and logical manner
to inform, entertain or inspire an audience. Lectures appeal to those people who learn by
listening.
Needs and Resource Assessment
A systematic gathering of information that describes in detail the priority population and
community resources that serve the population.
Pedagogy
The art and science of teaching. Refers to the instructional methods, learning activities and
student-teacher interactions that build knowledge and students’ skills.
Priority Population
The group of people chosen for intervention activities.
Protective Factor
Any factor or quality whose presence is associated with increased protection from a disease or
condition. For example, self-efficacy to use condoms is a protective factor for actual use of
condoms.
Red Light Adaptations
Adaptations that substantially compromise the core components of an evidence-based program.
These adaptations include changes such as shortening the program, reducing or diminishing
activities that allow youth to personalize information and practice skills, and eliminating or
reducing condom practice activities. Red light adaptations should be avoided, and practitioners
should “stop” and rethink these types of proposed changes.
Risk Factor
Any factor whose presence is associated with an increased risk of a disease or condition. For
example, social norms that support sex are a risk factor for adolescent pregnancy.
Roleplays
Scripted and unscripted roleplays provide an opportunity for youth to practice skills. For example,
after learning the steps for refusal, youth might act out a roleplay in which they actually apply the
steps in a hypothetical situation.
113
Glossary
Sexual Behaviors
Actions that can directly put an individual at risk for pregnancy, STD and HIV. Effective pregnancy
and STD prevention programs typically address one or more of the following sexual behaviors:
(1) delaying the onset of sexual intercourse, (2) increasing the correct use of condoms, (3)
increasing the correct use of contraception, (4) decreasing the number of sexual partners, (5)
increasing testing for and treatment of STDs, (6) increasing vaccination against HPV and
Hepatitis B, (7) decreasing the frequency of sex, (8) decreasing the frequency of sex with
concurrent partners or with partners who have concurrent partners, and (9) increasing the time
gap between sexual partners.
Small-Group Discussions
Small-group discussions generally allow for more youth to feel involved and express their ideas.
Generally, the small group is given a set of guidelines or instructions for completing a task
together (e.g., generate a list of reasons why teenagers have sex and write those reasons on
flipchart paper). Small groups report their work to the larger group.
Worksheets
A worksheet requires youth to think about the topic at hand and review important/critical points.
Worksheets are better used when the product is authentic. For example, asking youth to write a
letter to a friend about preventing HIV is more authentic than asking youth to answer ten straightforward questions about HIV prevention methods.
Yellow Light Adaptations
Yellow light adaptations are somewhere between green and red light adaptations and should be
made with caution. Yellow light adaptations are more complex than green light adaptations and
generally require more time and resources. They may include changes such as adding activities,
changing the sequence of activities and replacing videos. These changes have the potential to
compromise the program’s core components and, as a result, diminish its effectiveness. When
practitioners are considering these types of adaptations, it’s best to work with a skilled curriculum
developer and someone who understands behavioral health and health education theory.
114
NOTICE of RIGHT to REPRODUCE MATERIALS
These materials were produced for the CDC Division of Reproductive Health by ETR
Associates of Scotts Valley CA (www.etr.org) based on original research by Janet S. St.
Lawrence, PhD. CDC/DRH and ETR invite unrestricted and cost-free access to, reproduction and
distribution of these materials, under the following conditions:
•
All electronic or printed copies of these materials, in whole or in part, shall contain this
Notice of Right to Reproduce Materials or equivalent. In particular, such copies shall
acknowledge the source of the materials as CDC/DRH, ETR Associates and Janet S. St.
Lawrence, PhD.
•
The content of the materials shall not be edited, rewritten or reconfigured in any manner
without the express written permission of CDC/DRH and ETR or Janet S. St. Lawrence.
Any requests for such permission should be addressed to Regina Firpo-Triplett at
reginaf@etr.org; ETR will assume responsibility for obtaining permission from the other
party or parties.
These materials are available at for free, on-line at www.etr.org/recapp. They can also be
disseminated through other websites and within curriculum packages that are sold with the
expressed written permission of CDC/DRH and ETR.
Your comments on these documents are welcomed at any time. Please send them via e-mail to
Regina Firpo-Triplett at reginaf@etr.org.
115
116

Becoming a Responsible Teen

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