Making a Difference! - INACTIVE

Inactive Reason
This program is inactive because it has evidence of favorable impacts that is more than 20 years old. It no longer meets the inclusion criteria for the TPPER.
Developers
Loretta Sweet Jemmott, Ph.D., R.N., F.A.A.N., John B. Jemmott III, Ph.D., and Konstance McCaffree, Ph.D.
Program Summary
"Making A Difference!" An Abstinence Approach to Prevention of STDs, HIV and Teen Pregnancy is an eight module curriculum that provides young adolescents with the knowledge, confidence, and skills necessary to reduce their risk of sexually transmitted diseases (STDs), HIV, and pregnancy by abstaining from sex. The curriculum is designed for middle school youth and is delivered by trained facilitators.
Intended Population
The curriculum is designed for middle-school youth. It was evaluated with African American 11-13 year-olds in urban areas. The developer suggests the program can be used with older youth and with both same-sex or male and female groups.
Program Setting

The program was designed to be delivered in the classroom, either in-school or in community-based locations. The program was evaluated in an outside-of-school community-based setting.

Contact and Availability Information
Nancy Gonzalez-Caro, MPH
Evidence-Based Product Specialist
ETR
100 Enterprise Way, Suite G300
Scotts Valley, CA 95066
Phone: 1-800-321-4407
Website: http://www.etr.org/ebi/programs/making-a-difference/
 
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/making-a-difference/
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 primary goals of Making A Difference! are to increase knowledge about prevention of HIV, STDs and pregnancy, reinforce positive attitudes/beliefs about abstinence, and increase confidence in participants' ability to negotiate abstinence. The program works to lower the incidence of STD/HIV risk-associated sexual behavior among youth, by inculcating a sense of pride and responsibility among its participants, providing them with the knowledge and skills they need, and motivating them to make a difference in their lives.
Program Content

Making A Difference! draws on three theories of change: 1) The Social Cognitive Theory; 2) The Theory of Reasoned Action; and 3) The Theory of Planned Behavior. This framework relies on the concepts of self-efficacy or perceived behavioral control beliefs (beliefs about the ability to conduct the behavior), and outcome expectancies (beliefs about the consequences of the behaviors).

The eight session curriculum addresses three types of core behavioral beliefs and outcome expectancies:

  • Goals and Dreams Beliefs — the belief that sexual involvement might interfere with one's goals and dreams for education and a career. In Session 1, the participants engage in a goals and dreams activity and discuss obstacles to goals and dreams. Having sex is listed and discussed as an obstacle. This belief is incorporated throughout the curriculum.
  • Prevention Beliefs — the belief that abstinence can eliminate the risk of pregnancy, STDs and HIV/AIDS. This belief is incorporated throughout the curriculum.
  • Partner-Reaction Beliefs — the belief that one's boyfriend/girlfriend would not approve of abstinence behaviors and react negatively to it, which may prevent a person from negotiating abstinence. In Sessions 7 and 8, participants learn how to get out of a risky situation, set physical limits, and use negotiation and refusal skills to communicate with their partners about abstinence.

The Making A Difference! curriculum modules are as follows:

  • Module 1: “Getting to Know You and Steps to Making Your Dreams and Goals Come True” provides an introduction to the curriculum, sets up the theme of proud and responsible behavior, and asks participants to identify short-term and long-term goals and dreams.
  • Module 2: “Understanding Adolescent Sexuality and Abstinence” provides an overview of reproductive anatomy, discusses messages about sex, discusses how people express themselves sexually, and the benefits of abstinence.
  • Module 3: “The Consequences of Sex: HIV/AIDS” includes information on HIV etiology, transmission and prevention.
  • Module 4: “Attitudes, Beliefs, and Giving Advice about HIV/STDs and Abstinence” includes activities that explore how self-esteem affects decision-making, especially in relation to giving advice about abstinence.
  • Module 5: “The Consequences of Sex: STDs” includes activities that teach information about STD etiology, types, transmission and prevention.
  • Module 6: “The Consequences of Sex: Pregnancy” includes activities that teach knowledge about pregnancy and prevention, as well as how to respond to peer pressure.
  • Module 7: “Responding to Peer Pressure and Partner Pressure” includes interactive activities that address participants’ problem-solving and negotiation skills regarding abstinence.
  • Module 8: “Role Plays: Refusal and Negotiation Skills” includes activities for participants to further practice refusal and address partner and peer pressure.Teach correct information about puberty and adolescent sexual development
Program Methods

Making A Difference! aims to create a youth-centered, positive learning environment. Activities are designed to increase comfort with practicing abstinence, address concerns about practicing abstinence, and provide strategies for overcoming concerns and obstacles to practicing abstinence.

The activities incorporate social cognitive-behavioral skill-building strategies (i.e., presentation, modeling, and the practice of abstinence negotiation skills). The curriculum involves culturally sensitive video clips, games, brainstorming, role-playing, skill-building activities and small group discussions that build group cohesion and enhance learning. Each activity lasts a brief time, and most are active exercises in which the adolescents get out of their seats and interact with each other.

Program Structure and Timeline

The curriculum consists of eight modules, each of which is 60 minutes long. The modules should be delivered in the order presented, and should ideally be completed in two weeks. Ideal group size is 8 students per facilitator.

Developers have also adapted Making A Difference to be implemented in schools (See Making A Difference - School Edition), which consists of thirteen 40-minute modules.

Staffing
Providers are expected to use 1-3 facilitators (depending on number of participants), a program manager, and one or more support staff. Facilitators should be health educators, social workers, nurses, and others who provide social service programs to youth.
  • They must be able to use highly participatory and interactive skills.
  • They must be able to work with youth and relate to them and their life circumstances. 
  • They must believe in the teens and believe in their resilience. 
  • Facilitators should have a comprehensive understanding of adolescent development; the developing sexual needs of youth, and the relevance of HIV/AIDS, STDs, and pregnancy for youth.

Staffing should consist of 1 facilitator for 8-10 youth and support staff to assist when implementing the program in larger class size settings. 

Program Materials and Resources

The Making A Difference! curriculum package consists of:

  1. Facilitator Curriculum;
  2. Activity Set (student handouts, role-plays, posters);
  3. Student workbooks (classroom set of 30); and
  4. Curriculum DVDs:
    • Tanisha & Shay
    • The Subject Is: HIV (Abstinence Only)
    • The Subject Is: Puberty (Abstinence Only)

The distributor also provides access to a table of contents and sample lesson on their website: http://www.etr.org/ebi/programs/making-a-difference/

Additional Needs for Implementation

The curriculum requires the use of a TV monitor and DVD player.

Other materials and infrastructure necessary for working in school settings includes:

  • A private room that fits the size of the group comfortably with movable chairs
  • Space on walls to tape curriculum specific posters and newsprints
  • Audiovisual equipment and electrical outlets.
Fidelity
The program has fidelity benchmarks, a logic model, and monitoring tools for providers implementing the program. Adherence to the program's core elements and completion of all 8 modules is required for program fidelity. Additional guidelines include:
  • The curriculum modules should be delivered in the order presented.
  • Delivery of the intervention must be highly participatory. 

Adaptation guidance for Making a Difference! can be found on ETR’s Program Success Center website: http://www.etr.org/ebi/programs/making-a-difference/
 

Staff Training

It is highly recommended that educators who plan to teach Making a Difference! receive research-based professional development to prepare them to effectively implement and replicate the curriculum with fidelity for the intended target group.

Training on Making a Difference! is available through ETR's Professional Learning Services. Visit http://www.etr.org/ebi/training-ta/types-of-services/training-of-educators/ for more information or submit a Training & TA Request Form (http://www.etr.org/solutions/professional-development/training-ta-request-form/).

 

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. Contact ETR’s Professional Learning Services through the Program Support Help Desk (https://programsupport.etr.org/) or visit http://www.etr.org/ebi/training-ta/.
Allowable Adaptations
The developers note several ways the program may be adapted:
  1. The curriculum may be delivered in other settings such as community-based organizations. The curriculum may also be delivered in schools either during the regular school day or in after-school programming. However, the activities must remain interactive and all of the youth must have a chance to participate in role plays and practice new skills.
  2. If integrating the curriculum into the school period, implementers may use Making A Difference - School Edition.
  3. The eight-hour intervention may be delivered in different ways, such as 2 modules per day over 4 days or 1 module per day over 8 days. However, the developer recommends that the entire intervention be completed within 2 weeks if possible.
  4. The program may be delivered to either single gender or mixed gender groups.
  5. The original study used African-American adults, who were community leaders, counselors, or teachers, as facilitators. The program may be implemented using facilitators of different ethnic or professional backgrounds, so long as the facilitators possess the skills and characteristics of a good facilitator and have experience working with teens.
  6. Peer educators are allowed, as long as they are paired with an appropriate adult.
  7. In the original study, the participants were placed in groups of 6-8 teens. Larger groups are allowable, provided that additional time is built into the schedule to ensure that the youth are able to participate in activities and practice skills.
  8. Teens of different racial and ethnic groups may participate, and changing the names and settings of the situations in the role plays to reflect the culture of participants is allowed.
  9. Use of the intervention with teens older than 13 is allowed, provided that older teens would not be grouped with younger teens. The developers recommend dividing youth into groups of similar ages.
Reviewed Studies
Citation High-Quality Randomized Trial Moderate-Quality Randomized Trial Moderate-Quality Quasi-experiment Low Study Rating Did Not Meet Eligibility Criteria

Jemmott et al. 1998

 		✓
Study Characteristics
Citation Setting Majority Age Group Majority Racial/Ethnic Group Gender Sample Size

Jemmott et al. 1998

 		After school 13 or younger African American or Black Youth of any gender 438
Study Findings

Evidence by Outcome Domain and Study

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

Jemmott et al. 1998

 		Potentially favorable evidence n.a. Indeterminate evidence n.a. n.a.
Detailed Findings
Citation Details

Jemmott et al. 1998

 		The program was evaluated in a randomized controlled trial involving middle school students in Philadelphia, PA. Students were randomly assigned to either a treatment group that received the program or to a control group that received a general health-promotion curriculum on diet, exercise, cancer awareness, and smoking. Both the control and intervention programs were delivered outside of regular school hours over two consecutive Saturdays. Surveys were administered immediately before the program (baseline), immediately after the program, and three, six, and 12 months after the program.

The study found that three months after the program ended, adolescents participating in the intervention who were sexually inexperienced at baseline were significantly less likely to report having had sexual intercourse in the previous 3 months. The study did not find any statistically significant program impacts on rates of sexual intercourse for adolescents who were sexually experienced at baseline, or on frequency of sexual intercourse, condom use, or unprotected sexual intercourse for the full sample. The study found no statistically significant program impacts for the follow-ups conducted six and 12 months after the program ended.

Program impacts were also examined on measures of condom use consistency. Findings for these outcomes were not considered for the review because they did not meet the review evidence standards. Specifically, findings were reported only for subgroups of youth defined by sexual activity at follow up. The study also examined program impacts on attitudes toward abstinence, as well as condom use knowledge, skills, and beliefs. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

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.