An adapted curriculum based on Focus on Kids

Focus on Youth is a community-based 8-session HIV, STD and pregnancy prevention intervention for African American youth. It provides youth with the skills and knowledge to make healthy decisions that will prevent unplanned pregnancy, HIV and other sexually transmitted diseases. The curriculum uses fun, interactive activities such as games, role plays and discussions, and community projects to convey prevention knowledge and skills. The intervention was updated from Focus on Kids, a community-university linked research and intervention program.

Focus on Youth includes information and skills about: decision making, values, how to access information, communication, negotiation, goals for the future, teen pregnancy, abstinence, contraception, STD, HIV, alcohol and other drug use, and facts about a healthy sexual lifestyle.

The most current edition of Focus on Youth (2009) provides updated information and more tools to facilitate implementation and increase the relevance of the program for African-American youth between ages 12 and 15 who are at risk for HIV infection. Eight agencies were selected to participate in a pilot of the Focus on Youth revision. Over a 6-month period, each of the agencies piloted the new program with 8-10 youth. Their feedback has been incorporated in the final version.

In the spring of 1993, African American youth were recruited from nine recreation centers associated with three public housing developments to attend eight weekly sessions of an AIDS risk reduction intervention. Grounded in a social-cognitive theory (Protection Motivation Theory) and developed to be culturally appropriate for the target audience, the intervention provided facts about HIV and AIDS and emphasized skills development with regard to communication, decision making, and condom use. The youth formed intervention groups consisting of two to 10 same-gender friends who were within three years of age of each other. In addition to condom use and abstinence, avoidance of substance use and drug trafficking were emphasized in the curriculum.

The 76 naturally formed peer groups consisting of 383 African American youth were randomly assigned to receive the Focus on Kids intervention (n=206) or a control condition (n=177). The control condition consisted of eight sessions which provided facts about HIV and AIDS prevention but did not emphasize skills development with regard to negotiation, communication or condom use and was not delivered to the naturally occurring groups of friends.

Participants completed questionnaires via a "talking" Macintosh computer at baseline and six months after the intervention. Measures assessed actual risk behaviors, perceptions of risk behaviors, and intentions.

At baseline, condom use rates did not differ significantly between the intervention and control groups. However, at the six-month follow-up, rates were significantly higher among the intervention group than the control group (85% versus 61%, P<.05). The intervention was especially strong among boys (85% versus 57%, P<.05) and among teens aged 13 to 15 years (95% versus 60%, P<.01).

Youth did not differ in their intentions to use condoms at baseline, but in the post-intervention period, intervention youth were significantly more likely than control youth to intend to use a condom. Likewise, in the post-intervention period, intervention youth perceived greater peer use of condoms and increased personal vulnerability to HIV.

At the completion of the program, youth will be able to:

State correct information about HIV and other STDs

including modes of transmission and prevention. State correct information about abstinence and

various methods of contraception including the correct way to use condoms.

Identify their own personal values and understand how their values relate to decisions about relationships, sexuality and sexual risk behaviors.

Be skilled in communicating and negotiating with other youth regarding sexual topics and in decision making that supports sexual health.

Focus on Youth includes the following features that distinguish it from other HIV and STD prevention curriculum

It serves African American youth, ages 12-15, in community-based settings.

It is designed for small groups of no more than 6-10 youth.

It uses two skilled facilitators, with at least one matching the ethnicity of the majority of the participants.

It makes use of naturally occurring friendship groups to strengthen peer support of alternatives to risky activities.

It uses culturally and linguistically appropriate interactive activities, such as games, role plays, discussions and community projects.

It includes a “family tree” to contextualize and personalize abstract concepts e.g., decision-making and risk assessment.

Focus on Youth is based on the Protection Motivation Theory, a social cognitive theory which emphasizes the balance between pressures to engage in the risk behavior, the risks involved, and the consideration of alternatives.

An example of this would be a youth named Jamal is being pressured to run a train on Heather(who is drunk) with his boys……utilizing this theory, Jamal would be able to assess the risk(this involves multiple modes of transmission, many dudes and a chick who may turn around and accuse rape!!)…..maybe I am better off with calling Pat, who I know will be down to get it in and let me bring a condom while I'm at it.

Focus on Youth addresses each of these critical elements of the theory by:

Providing opportunities to consider the personal and social rewards (pressures) of engaging in sexual risk-taking behavior. Through all its varied learning activities, youth learn to create positive feelings about themselves without engaging in risky behaviors. In addition, in Session Two, youth dispel the myth that all peers approve of risky behavior.

Examining the health risks involved in unprotected sexual behavior. Sessions Two, Three, Four and Seven increase youth's awareness of their vulnerability to HIV, STD, and unplanned pregnancy if they engage in sexual risk-taking behaviors and their knowledge about the difficulties of living with HIV.

Identifying the alternatives to sexual risk-taking behavior. Through the SODA Decision Making model, the Family Tree Activities, and role play activities, youth learn to consider the alternatives to risk-taking behavior and practice decision making, communication and condom use skills necessary to act on healthy decisions.

Core Elements Core elements are those parts of an

intervention that must be done and cannot be changed. They come from the behavioral theory upon which the intervention or strategy is based; they are thought to be responsible for the intervention’s effectiveness. Core elements are essential and cannot be ignored, deleted, or changed.

Deliver intervention to youth in community‐based settings.

Use two skilled facilitators to model communication, negotiation and refusal skills for the youth.

Use “friendship” or venue‐based groups (i.e., a basketball team, a scout troop,

church group, an existing youth group) to strengthen peer support.

Use culturally appropriate interactive activities proven as effective learning strategies to help youth capture the important constructs in the theory.

Include a “family tree” to contextualize and personalize abstract concepts, such as decision-making and risk assessment. In this activity, youth are given a skeleton of a family tree and asked to create the circumstances of and the relationships between the family members. The characters in the family are used throughout the curriculum to put decision-making into a personal context for the youth.

Enable participants to learn and practice a decision‐making model such as Stop, Options, Decide and Act (SODA).

Train participants in assertive communication and refusal skills specifically related to negotiation of abstinence or safer sex.

Teach youth proper condom use skills

Focus on Youth has the following key characteristics: Include between 6 and 10 youth in the program. New members should not join once the series of sessions

has begun. If youth join after first session, a make-up session should be offered.

Each session should last approximately 90-120 minutes Use skilled facilitators who are the same gender as the

youth target population. Have at least one facilitator who is of the same race and

ethnicity as the majority of the participants. Embed culturally and linguistically based activities for the

target population. Form groups that contain members of the same gender

and age group. Youth groups should have no more than a 3-year age difference between members in a group.

Inform parents about the program and its goals and activities, and tell them that

they should sign a parental permission form

Focus on Youth includes the following 8 sessions:

Session 1:

Trust Building and Group Cohesion

Session 2:

Risks and Values

Session 3:

Educate Yourself: Obtaining Information

Session 4:

Educate Yourself: Examining Consequences

Session 5:

Building Skills: Communication

Session 6:

Information About Sexual Health

Session 7:

Attitudes and Skills for Sexual Health

Session 8:

Review and Community Project

Art and crafts Exercises Games Group discussion Lecture Risk reduction supplies (condoms) Role play Social event Storytelling Video

Purpose: To establish a cohesive group, set ground rules and allow youth to begin learning skills for

decision making. Key Message: The decisions you make

as an adolescent affect you when you become an adult.

Purpose: Youth will examine risk behaviors and look at why they might feel invincible or invulnerable in order to understand how this can place them at risk

for HIV/STD or unplanned pregnancy. In addition, youth will identify

their values through discussion, ranking and voting activities.

Key Messages: Certain situations can make individuals feel invulnerable

and invincible. This can cause them to make decisions that could lead to unwanted pregnancy or contracting HIV.

Everyone has different values and it is okay to listen to different points of view.

Identifying and ranking personal values, as well as developing an understanding of those with differing values, helps with decision making.

Knowing your values can help you make decisions to prevent HIV and other STD

Purpose: Youth will learn ways to obtain information in order to make

good decisions by applying the decision-making model and

researching answers to questions. Key Messages: Being informed about local resources

and HIV and STD prevention can aid in the decision‐making process.

Discussing HIV and other STD prevention with parents or guardians promotes healthy choices.

Purpose: Youth will learn how to weigh the positive and negative consequences

of options as they make decisions. Session provides skills-building through

condom demonstration. Key Messages: Understanding proper steps for condom use

and being comfortable with saying you want to use condoms increases the chances of actually using them.

Understanding the good consequences (pros) and bad consequences (cons) of various options can help you make better decisions.

Purpose: Youth will learn communication and negotiation skills to assist in carrying out

responsible decisions. Participants practice aggressive, assertive and non-assertive

communication styles.

Key messages: Understanding that certain styles of communication

can help your point of view be better understood by others.

Using body language to enhance communication with others.

Understanding the importance of being aware of the nonverbal messages others are communicating.

Understanding the consequences of miscommunication and ways to avoid it

Purpose: Youth will engage in role-play to explore various ways to show they care without having sex

and will learn information about sexual health. Key Messages: Understanding that sex is a normal, healthy part of life, but it is

important to wait to have sex in a way that is safe, healthy and in line with one’s values.

Learning that there are many ways to show one cares without having sexual intercourse.

Understanding the advantages, disadvantages and effectiveness of each method of contraception.

Purpose: The retreat offers an opportunity for boys' and girls' groups to work together as well be inspired by an outside speaker.

Sample Agenda:

Introduction Game and Opening Ritual

Review of Session 5

Ways to Show You Care

HIV Transmission Game

Recreational Activities

Lunch

Outside Speaker

Purpose: Youth will learn attitudes and skills that support sexual health through listening to a

speaker, completing a goal-setting activity and role-playing refusal and negotiation skills.

Key Messages: Understanding that there is value in setting both long‐

term and short‐term goals and tracking your progress toward reaching those goals.

Understanding the process and consequences of decision making and self-awareness of values and goals to avoid or prevent obstacles.

Recognizing that while some obstacles to goals cannot be prevented, having solutions for each obstacle including the presence of supportive people are keys to reaching goals.

Purpose: Youth will build self-efficacy about HIV/STD prevention through analyzing their concerns and how they can take responsibility; testing their HIV knowledge, affirming each other and planning community projects.

Key Messages: Reviewing the components of safer-

decision making about sex and other important decisions, taking responsibility for one’s actions and effective communication.

Recognizing the potential for being a positive force in the community.

Purpose: To build increased monitoring and communication skills for parents, and enhance parent-child relationships.

Format: Parent’s home, preferably; however, a private space at the agency can also be considered.

Timing: Preferably before the first session or by the third session in order to set the stage for youth and their parents to discuss and learn what the program is about.

Who Should Attend: one or both parents can participate with their child.

Childcare: Agencies should make provision for childcare if the intervention cannot be delivered at the parent’s home.

Vignette activities: The facilitator may make changes to the names or locations in the vignettes to make them more relevant to their group.

Refreshments: Agencies should provide light refreshments.

During this session, the facilitator will : Explain the purpose of the session. Review the purpose of the Focus on Youth intervention. Conduct an icebreaker activity. Provide HIV 101 information. Show and discuss parent documentary. Demonstrate the steps for proper condom use. Conduct the condom demonstration game or condom use

card activity. Engage parents and their child in role-playing of various

vignettes. Ask parents and youth for questions related to any of the

activities or the intervention. Review with parents some basic tips about communicating

with their youth about abstinence, sex, HIV, and condoms.

The Focus on Youth parent documentary is short film documentary designed to teach

parents effective ways to talk to their teenaged children about sex and HIV/AIDS. The video

stresses the importance of open communication between parents and teens. This video tackles these issues head-on in an effort to increase open and honest communications with the

teenage children before they start having sex. The film allows teens, their parents and experts

to talk openly about their feelings about sex and HIV/AIDS. The film shows these topics

through various points of view, including teens, parents and educators.