Becoming a Responsible Teen (BART)

Program Overview

Developer(s)

Janet S. St. Lawrence, Ph.D.

Program Summary

Becoming a Responsible Teen (BART) is an HIV prevention curriculum developed for African American adolescents, that is based on ethnic pride and can be delivered in non-school, community-based settings. BART consists of eight sessions, which are 1.5 to 2 hours each. The program uses interactive group discussions and role plays that have been created by teens.

Although the focus of Becoming a Responsible Teen is HIV/AIDS prevention, the curriculum 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 include correct condom use, assertive communication, refusal techniques, self-management, and problem solving. Also, abstinence is woven throughout the curriculum and is discussed as the best way to prevent HIV infection and pregnancy.

Target Population

The program was designed for youth ages 14 to 18. It was tested with African-American youth who were ages 14 to 18. Some studies separated participants by gender while others did not.

Program Setting

The program was designed to be implemented in non-school settings, including after school or in health clinics. It was evaluated in community-based organizations, health clinics, high schools, and correctional facilities.

Contact and Availability Information

For curriculum, materials, and pricing information, please contact:

Nancy Gonzalez-Caro, MPH Evidence-Based Product Specialist
ETR
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Ph: 800-321-4407 x237
Website: http://www.etr.org/ebi/

For training and support, please contact:

See above

Sample of curriculum available for review prior to purchase: Yes

Adaptation guidelines or kit available: Yes

Languages available: English

Program Components

Program Objectives

The program seeks to prevent HIV among African-American youth by:

  • Increasing knowledge of HIV transmission and prevention.
  • Changing attitudes toward HIV prevention and safer sex.
  • Changing perceptions of risk and social norms regarding HIV.
  • Increasing behavioral intent to avoid behaviors that could lead to contracting HIV.
  • Clarifying values about sexual decisions and pressures.
  • Increasing skills to reduce sexual risk-taking including, correct condom use, assertive communication, refusal techniques, self-management, and problem solving. 

Program Content

Becoming a Responsible Teen is an 8 session program focused on HIV prevention.  BART incorporates Social Learning Theory and Self-Efficacy Theory. The BART curriculum has four major components designed to reflect these theories:

  1. Information that increases adolescents’ knowledge and their awareness of risk.
  2. Training in the skills adolescents need to translate the information into action.
  3. Opportunities to practice and receive corrective feedback and using the skills in a safe environment before they face the challenges of using them in risky situations.
  4. Social support to help make the desired behaviors the norm in the social environment.
The program covers core content on:
  • Knowledge and attitudes about HIV, how drugs and alcohol use may influence sexual decision making, and condom use.
  • Skills and self-efficacy related to condom use, preventing risky situations, problem solving, and communication.
  • Perception of risk related to HIV transmission and living with HIV.
  • Social/peer norms about HIV prevention, safer sex, and promoting the use of effective (assertive) communication.
  • Behavioral beliefs and goal-setting.
  • Connectedness to culture.
  • Values about preventing HIV, promoting safer sex, and communicating with a partner about safer sex.
  • Communication with parents or other adults.

The program logic model can be found on ETR's website: http://www.etr.org/ebi/programs/becoming-a-responsible-teen/.

Program Methods

The program is delivered through videos, role plays, worksheets, and practice of skills.

Implementation Requirements and Guidance

Program Structure and Timeline

BART program structure includes the following:

  • The program is delivered in 8 weekly 90-120-minute sessions.
  • When focusing on skill development, participants may be separated by gender.
  • The program should be implemented in a non-school setting.
  • Parental consent and support should be obtained prior to delivering the program.

Staffing

Two co-leaders, one male and one female, should facilitate the classes. Providers should select program leaders who are as similar to youth as possible and have credibility with youth.

Program Materials and Resources

Core intervention materials are the Leader's Guide, Student Workbooks, and The Monster DVD from Scenarios USA.

Additional Needs for Implementation

None specified

Fidelity

ETR provides a fidelity log, adaptation kit, a BART Student Knowledge Survey that can be administered as a pre-test/post-test, and a survey answer key. These materials can be found here: http://www.etr.org/ebi/programs/becoming-a-responsible-teen/.

Training and Staff Support

Staff Training:

It is recommended that educators who plan to teach BART receive research-based professional development to prepare them to effectively implement the curriculum with its intended target group. Training on BART is available through ETR’s Professional Learning Services. Training options include:

  1. Two-day Training of Educators (TOE)—the learning process includes pre-work, skill-based instruction and post-training follow-up support.
  2. Four-day Training of Trainers (TOT)—available for seasoned trainers who have experience in delivering the intervention. Completion entitles participants to use ETR’s research-based training designs to conduct TOEs for their organization or designated affiliate group. TOT attendees who have completed the four-day TOT are eligible to attend a condensed TOT course on additional EBIs.

Technical Assistance and Ongoing Support:

ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation.   ETR also provides evaluation support for EBI implementation. Services address process and outcome evaluation and include assistance with evaluation planning, instrument design and development, implementation fidelity, data management and analysis, performance measurement, continuous quality improvement (CQI) protocols, and effective tools and strategies for reporting results.

Allowable Adaptations

In-depth adaptation guidelines and tools are available through ETR at the following link: http://www.etr.org/ebi/programs/becoming-a-responsible-teen/.

Examples of allowable adaptations include updating statistics or facts; lengthening skills-based classes beyond 90-minutes without cutting the number of classes; and tailoring the content (e.g. for visual learners or particular gender or racial/ethnic groups).

Implementation Readiness Assessment

The review team conducted an independent assessment of the program’s readiness for implementation. This assessment is based on the team’s review of available program materials and documents. The team also requested input from program developers and distributors about the availability of implementation materials and resources.

On the basis of this assessment, the team calculated an implementation readiness score comprised of three component scores: (1) curriculum and materials, (2) training and staff support, and (3) fidelity monitoring tools and resources. The component scores are combined into a total score, which ranges from 0 to 8, with higher scores indicating the programs most ready to implement.

Curriculum and Materials

Has defined curriculum with lesson plans and/or activities?Yes
Has defined core or required components?Yes
Has facilitator’s guide or instructions?Yes
Component Score3/3

Training and Staff Support

Formal pre-implementation training (by qualified trainers) available?Yes
Supplemental training or ongoing technical support available?Yes
Component Score2/2

Fidelity Monitoring Tools and Resources

Has defined logic model?Yes
Defines fidelity guidelines and benchmarks?Yes
Offers monitoring and evaluation tools?Yes
Component Score3/3

Total Implementation Readiness Score

8/8

Reviewed Studies

CitationHigh-Quality Randomized TrialModerate-Quality Randomized TrialModerate-Quality Quasi-experimentLow Study RatingDid Not Meet Eligibility Criteria

St. Lawrence et al. 1995

Yes    

St. Lawrence et al. 1999

Yes    

Butts and Hartman 2002

   Yes 

Malow et al. 2009

    Yes

Robertson et al. 2011

Yes    

The Policy & Research Group 2015a

Yes    

Ruwe et al. 2016

Yes    

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample.

Study Characteristics

CitationSettingMajority Age GroupMajority Racial/Ethnic GroupGenderSample Size

St. Lawrence et al. 1995

After school/Community based14 to 17African AmericanBoth246

St. Lawrence et al. 1999

Juvenile justice facilities14 to 17African AmericanMale361

Butts and Hartman 2002

n.a.n.a.n.a.n.a.n.a.

Malow et al. 2009

n.a.n.a.n.a.n.a.n.a.

Robertson et al. 2011

Juvenile justice facilities14 to 17African AmericanFemale333

The Policy & Research Group 2015a

After school/Community based14 to 17African AmericanBoth850

Ruwe et al. 2016

Program was implemented and evaluated in public high schools and community settings.14 to 17African AmericanBoth552

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample.

Information on study characteristics is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.

Study Findings

Citation Sexual Activity Number of Sexual Partners Contraceptive Use STIs or HIV Pregnancy

St. Lawrence et al. 1995

Uniformly positive impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain A mix of positive, null, and/or adverse impacts across the outcomes examined in this domain

St. Lawrence et al. 1999

Uniformly null impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain

Butts and Hartman 2002

n.a. n.a. n.a. n.a. n.a.

Malow et al. 2009

n.a. n.a. n.a. n.a. n.a.

Robertson et al. 2011

Uniformly null impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain

The Policy & Research Group 2015a

Uniformly null impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain

Ruwe et al. 2016

Uniformly null impacts across the outcomes examined in this domain Uniformly null impacts across the outcomes examined in this domain
CitationDetails

St. Lawrence et al. 1995

The program’s evidence of effectiveness was first established in a randomized controlled trial involving low-income African American adolescents recruited from a community-based health center in the southern United States. Study participants were randomly assigned to either a treatment group that received the program or a control group that participated in a one-session program on HIV-AIDS education. Surveys were administered immediately before random assignment (baseline), immediately after the intervention, and 6 and 12 months after the intervention ended.

The study found that, averaged across the three follow-up surveys, adolescents who were assigned to the treatment group reported statistically significantly fewer occasions of unprotected oral and anal intercourse and more occasions of condom-protected intercourse. The study found no statistically significant program impacts measures of the number of sexual partners, number of occasions of unprotected vaginal intercourse, or number of occasions of condom-protected anal intercourse. For the 12-month follow-up survey, the study found that for subgroups of youth defined by sexual activity at baseline, those in the treatment group were statistically significantly less likely to have had sex in the past two months.

The study also examined program impacts on the percentage of intercourse occasions that were unprotected. Findings for this outcome were not considered for the review because they did not meet the review evidence standards. Specifically, the outcome was measured for a subgroup of youth defined by sexual activity at follow up.

The study also examined program impacts on measures of condom attitudes, AIDS knowledge, self-efficacy, assertion skills, and substance use. Findings for these outcomes were not considered for the review because the outcomes fell outside the scope of the review.

St. Lawrence et al. 1999

A subsequent study by the same group of researchers evaluated the effectiveness of the program among a different target population of incarcerated male adolescents. The study used a randomized controlled trial involving adolescents recruited from a state reformatory in the southern United States. The study randomly assigned participants to either a treatment group that received the program in six one-hour sessions over three weeks or a control group that received an anger management intervention. Surveys were administered immediately before random assignment (baseline) and again six months after study participants were released from the correctional facility.

The study found that at the time of the six-month follow-up survey, there were no statistically significant program impacts on measures of the frequency of unprotected and condom-protected sexual activity in the past three months, or on having had oral intercourse, the number of sex partners, or the percentage of intercourse occasions protected by condoms. These findings are not directly comparable with those reported in the prior study of the program (St. Lawrence et al. 1995) because of differences in the definition of the outcome measures and the analytic methods used to estimate program impacts.

Butts and Hartman 2002

This study received a low rating because it did not have an external comparison group.

Malow et al. 2009

This study did not meet the review eligibility criteria.

Robertson et al. 2011

This study evaluated an adapted version of the program designed for incarcerated adolescent females. The study used a cluster randomized controlled trial involving female adolescents recruited from a correctional facility in the southern United States. The study randomly assigned small groups of newly admitted detainees to either a treatment group that received the adapted program or a control group that received a health education curriculum. Surveys were administered immediately before the program started (baseline), immediately after the program ended, and nine months after participants were released from the correctional facility.

The study found that at the time of the nine-month follow-up survey, there were no statistically significant program impacts on measures of (1) the frequency of unprotected vaginal or anal sex or (2) the incidence of STIs (chlamydia and gonorrhea).

The Policy & Research Group 2015a

A more recent study evaluated the program using a randomized controlled trial that involved 850 adolescents recruited from youth summer employment programs in New Orleans. Adolescents were randomly assigned to either a treatment group that received BART or a control group that received Healthy Living, a general health and nutrition program. The study collected outcome data before the program started (baseline) and six months after the end of the program.

Six months after the program ended, the study found no evidence of statistically significant program impacts on measures of frequency of sexual activity and inconsistency of condom use in the past three months.

Ruwe et al. 2016

A separate recent study evaluated a cultural adaptation of BART designed for Haitian teens living in the U.S. called Haitian-American Responsible Teen (HART). The study examined the effectiveness of HART using a randomized controlled trial that involved 552 youth of Haitian descent attending 9th through 11th grades in schools located in the greater Boston area. Adolescents were randomly assigned to either a treatment group that received the eight lessons of the BART curriculum plus two additional lessons as part of the adaptation—one lesson on anatomy and the other on post-traumatic stress disorder—or a control group that received a fitness and nutrition program. Surveys were administered before the program started (baseline), and again immediately, six, and 12 months after the program ended.

The study examined program impacts on ever having sex, having sexual intercourse in the past three months, and having sex without using a condom or using any birth control method in the past three months. Six months after the end of the program, the study found no evidence of statistically significant program impacts on any of the sexual behavior outcome measures that were examined.

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample. A blank cell indicates the study did not examine any outcome measures within the particular outcome domain or the findings for the outcome measures within that domain did not meet the review evidence standards.

Information on evidence of effectiveness is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.