All4You!

Featured Grant OpportunitySchool Emergency Response to Violence (Project SERV) (Funding Opportunity) 

Featured Grant OpportunityShare with Youth: NOAA Student Opportunities Database

Developers

Karin K. Coyle, Ph.D.; Jeffery Douglas, Jr., B.A., Cherry Gardner, M.A., Lisa Sterner, James Walker, B.S., and Vicki Williams, M.S.

Program Summary

All4You! is designed to reduce the number of students who have unprotected sexual intercourse, which is associated with increased risk of HIV, other sexually transmitted infections (STIs), and unplanned pregnancy. The program also aims to change key determinants related to sexual risk taking, such as attitudes, beliefs, and perceived norms. The All4You! program has two primary instructional components—a skills-based HIV, other STD and pregnancy prevention curriculum and service- learning visits in the community—that are integrated and delivered as a 14-session program (about 26 hours total).

An adapted version of the program, All4You2!, is also available. It is designed to reduce the number of students who have unprotected sexual intercourse and to change key determinants related to sexual risk taking, but does not include the service-learning component of the original All4You!. The target audience for both All4You! and All4You2! is students in alternative high school settings who are ages 14 to 18.

Intended Population

The program was designed for high-school aged participants, ages 14 to 18. Both versions were evaluated with alternative high school youth.

Program Setting

The program was designed for and evaluated in alternative high schools.

Contact and Availability Information

Nancy Gonzalez-Caro, MPH
Evidence-Based Product Specialist
ETR
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Ph: 800-321-4407 x 237
Website: http://www.etr.org/ebi/programs/all4you/ and http://www.etr.org/ebi/programs/all4you2/

Cody Sigel, MPH, CHES
Health Education Training Coordinator
ETR
1333 Broadway, Suite P110
Oakland, CA 94612
Phone: 510-858-0995
Website: http://www.etr.org/ebi/programs/all4you/ and http://www.etr.org/ebi/programs/all4you2/

Sample of curriculum available for review prior to purchase

Yes

Adaptation guidelines or kit available

Yes

Languages available

English

Program Core Components

Program Objectives

The program's goals are to reduce the number of students who have unprotected sex, and to change the key determinants related to sexual risk-taking, such as attitudes, beliefs, and perceived norms.

The program aims to achieve these goals by:

Increasing knowledge of STIs
Changing attitudes toward condom use and risk of STIs
Increasing positive norms
Increasing refusal and negotiation skills and condom use skills.

Program Content

All4You! is a 14 session program that is based on Social Cognitive Theory, the Theory of Planned Behavior and Social Development Theory. It focuses on the following topics:

HIV, STIs, and pregnancy prevention risk factors
Negotiation and refusal skills
Contraception and condom use skills
Handling risky situations
Attitudes and beliefs regarding perceived risk of STIs/pregnancy and barriers to condom use
Development of positive norms
Community engagement through service learning visits

All4You2! is a 15-session program based on Social Cognitive Theory and Theory of Planned Behavior. It focuses on:

HIV, other STI and pregnancy risk factors
Negotiation and refusal skills
Contraception and condom use skills
Influence of multiple partners on STIs
Handling risky situations
Attitudes and beliefs regarding perceived risk of STIs/pregnancy and barriers to condom use
Development of positive norms
Healthy relationships
HIV/STI and pregnancy testing

The program logic models can be found on ETR's website as part of the supplemental information provided for each curriculum at the following links:

All4You!: http://www.etr.org/ebi/programs/all4you/

All4You2!: http://www.etr.org/ebi/programs/all4you2/

Program Methods

All4You! is delivered through mini-lectures, brainstorming, games, small-group work, role-plays, guest speakers, videos, reflection activities, and service-learning. All4You2! uses similar approaches, but does not include the service learning visits.

Program Structure and Timeline

All4You! consists of 14 sessions spanning about 26 hours:

Nine 70 to 90-minute skills-based lessons
Five 140-minute service-learning visits, including travel to and from the site.

Ideally, the program should be implemented 2–3 times per week for a period of 5–7 weeks.

All4You2! consists of 15 sessions of 50 minutes each, overall approximately 12.5 hours. Ideally, the program should be implemented 2-3 times per week for a period of 5 to 7 weeks.

Staffing

The program should be delivered by classroom teachers or community-based educators who have good rapport with youth. Peer leaders are used to facilitate some activities in both versions of the program.

Program Materials and Resources

Core intervention materials are a teacher guide, teacher background materials, student workbooks with activity sheets, handouts, and a DVD on STDs.

Additional Needs for Implementation

None specified

Fidelity

ETR provides a fidelity log, adaptation kit, an All4You! Student Knowledge Survey that can be administered as a pre-test/post-test, and a survey answer key . These materials can be found on ETR's website at the following links:

All4You!: http://www.etr.org/ebi/programs/all4you/

All4You2!: http://www.etr.org/ebi/programs/all4you2/

Staff Training

It is highly recommended that educators who plan to teach All4You! receive professional development to prepare them to effectively implement the curriculum with its intended target group.

Training on All4You! and All4You2! is available through ETR’s Professional Learning Services. Training options include:

Two- or three-day Training of Educators (TOE)—the learning process includes pre-work, skill-based instruction and post-training follow-up support.
Four-day Training of Trainers (TOT)—available for seasoned trainers who have experience in delivering the intervention. Completion entitles participants to use ETR’s 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 for All4You! are available through ETR at the following links:

All4You!: http://www.etr.org/ebi/programs/all4you/

All4You2!: http://www.etr.org/ebi/programs/all4you2/

Examples of allowable adaptations include adding more service learning visits; 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).

Reviewed Studies

Citation	High-Quality Randomized Trial	Moderate-Quality Randomized Trial	Moderate-Quality Quasi-experiment	Low Study Rating	Did Not Meet Eligibility Criteria
Coyle et al. 2006		✓
Coyle et al. 2013 Glassman et al. 2014	✓

Study Characteristics

Citation	Setting	Majority Age Group	Majority Racial/Ethnic Group	Gender	Sample Size
Coyle et al. 2006	Alternative school	14 to 17	Hispanic or Latinx of any race	Youth of any gender	998
Coyle et al. 2013 Glassman et al. 2014	Alternative school	14 to 17	Hispanic or Latinx of any race	Youth of any gender	652

Study Findings

Evidence by Outcome Domain and Study

Citation	Sexual Activity	Number of Sexual Partners	Contraceptive Use	STIs or HIV	Pregnancy
Coyle et al. 2006				n.a.	n.a.
Coyle et al. 2013 Glassman et al. 2014				n.a.	n.a.

Detailed Findings

Citation Details

Citation	Details
Coyle et al. 2006	The program's evidence of effectiveness was first established in a cluster randomized controlled trial involving 24 alternative high schools in four large urban counties in northern California. Thirteen schools were randomly selected for a treatment group that implemented the program and eleven schools were selected for a control group not offered the program. Surveys were administered immediately before the program started (baseline) and again six, 12, and 18 months after baseline. The study found that six months after the baseline survey, students in the treatment schools reported a significantly lower frequency of sexual intercourse and lower frequency of intercourse without a condom in the previous three months, and were significantly more likely to report using a condom at last intercourse. The study found no statistically significant impacts on the number of sexual partners in the previous three months, on two measures of contraceptive use (number of partners without a condom in the previous three months, and use of effective pregnancy prevention method at last intercourse), and on initiation of sexual intercourse (among sexually inexperienced at baseline). For the 12- and 18-month follow-up surveys, the study found no statistically significant impacts on any of these outcomes. The study also examined program impacts on measures of HIV and condom knowledge, self-efficacy, attitudes, beliefs, and intentions. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.
Coyle et al. 2013 Glassman et al. 2014	A more recent study by the same group of researchers sought to evaluate the effectiveness of the individual components of the All4You! program. The study used a cluster randomized controlled trial involving eleven continuation high schools in northern California. In each school, students were randomly assigned by classroom to one of four research groups: (1) a treatment group that participated in a curriculum-only version of the program; (2) a treatment group that participated only in the program service learning activities; (3) a treatment group that participated in both the curriculum and service learning activities; or (4) a control group that received an alternative program on nutrition and exercise. Surveys were administered immediately before the program started (baseline) and again six and 18 months after baseline. For both the 6- and 18-month follow-up surveys, the study found no statistically significant differences in sexual risk behaviors across the three treatment groups. On the basis of this result, there is no evidence to conclude that any one component of the program is more effective than the others. Relative to the control group, the study found that for the 6-month follow-up survey, adolescents participating in the curriculum-only version of the program were significantly less likely to report having had unprotected sexual intercourse in the past 3 months. The study found no statistically significant program impacts on the number of sexual partners, frequency of intercourse, or sexual initiation for any of the three treatment groups. The study findings for these outcomes are not directly comparable with those of the prior study of All4You! (Coyle et al. 2006) because of differences in the definition of the outcome measures and the analytic methods used to estimate program impacts. The study also examined program impacts on measures of frequency of unprotected sex with steady and non-steady partners, HIV and STI testing, reports of volunteering, exposure to risky situations, condom and HIV knowledge, perceived self- efficacy, refusal and communication skills, and attitudes toward sex and contraceptive use. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

Coyle et al. 2006

The program's evidence of effectiveness was first established in a cluster randomized controlled trial involving 24 alternative high schools in four large urban counties in northern California. Thirteen schools were randomly selected for a treatment group that implemented the program and eleven schools were selected for a control group not offered the program. Surveys were administered immediately before the program started (baseline) and again six, 12, and 18 months after baseline.

The study found that six months after the baseline survey, students in the treatment schools reported a significantly lower frequency of sexual intercourse and lower frequency of intercourse without a condom in the previous three months, and were significantly more likely to report using a condom at last intercourse. The study found no statistically significant impacts on the number of sexual partners in the previous three months, on two measures of contraceptive use (number of partners without a condom in the previous three months, and use of effective pregnancy prevention method at last intercourse), and on initiation of sexual intercourse (among sexually inexperienced at baseline). For the 12- and 18-month follow-up surveys, the study found no statistically significant impacts on any of these outcomes.

The study also examined program impacts on measures of HIV and condom knowledge, self-efficacy, attitudes, beliefs, and intentions. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

Coyle et al. 2013

Glassman et al. 2014

A more recent study by the same group of researchers sought to evaluate the effectiveness of the individual components of the All4You! program. The study used a cluster randomized controlled trial involving eleven continuation high schools in northern California. In each school, students were randomly assigned by classroom to one of four research groups: (1) a treatment group that participated in a curriculum-only version of the program; (2) a treatment group that participated only in the program service learning activities; (3) a treatment group that participated in both the curriculum and service learning activities; or (4) a control group that received an alternative program on nutrition and exercise. Surveys were administered immediately before the program started (baseline) and again six and 18 months after baseline.

For both the 6- and 18-month follow-up surveys, the study found no statistically significant differences in sexual risk behaviors across the three treatment groups. On the basis of this result, there is no evidence to conclude that any one component of the program is more effective than the others. Relative to the control group, the study found that for the 6-month follow-up survey, adolescents participating in the curriculum-only version of the program were significantly less likely to report having had unprotected sexual intercourse in the past 3 months. The study found no statistically significant program impacts on the number of sexual partners, frequency of intercourse, or sexual initiation for any of the three treatment groups. The study findings for these outcomes are not directly comparable with those of the prior study of All4You! (Coyle et al. 2006) because of differences in the definition of the outcome measures and the analytic methods used to estimate program impacts.

The study also examined program impacts on measures of frequency of unprotected sex with steady and non-steady partners, HIV and STI testing, reports of volunteering, exposure to risky situations, condom and HIV knowledge, perceived self- efficacy, refusal and communication skills, and attitudes toward sex and contraceptive use. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

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