Safer Sex Intervention (SSI)

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

Featured Grant OpportunityShare with Youth: NOAA Student Opportunities Database

Developers

Lydia A. Shrier, M.D., M.P.H.

Program Summary

Safer Sex Intervention (SSI) is an individual intervention intended to reduce STIs and improve condom use among female adolescents and young adults at high-risk for contracting an STI. The program is delivered one-on-one through a 30- to 50-minute session with a health educator, with three 10- to 30-minute follow-up sessions over the following six months.

Intended Population

The program was designed for sexually active females ages 12 to 23 who have been diagnosed with an STI. It was evaluated with sexually active African American females who were 14 to 19 years old, and sought treatment for STIs at an adolescent health clinic.

Program Setting

The program is designed for and was tested in health clinics.

Contact and Availability Information

Sociometrics Corporation
1580 W. El Camino Real, Suite 8
Mountain View, CA 94040
Ph: 650-949-3282
Email: socio@socio.com

Website: https://www.socio.com/products/pasha-safer-sex-intervention

Dr. Lydia Shrier
Boston Children's Hospital
333 Longwood Avenue, 5th Floor
Boston, Massachusetts 02115
Ph: 617-355-8306
Email: Lydia.shrier@childrens.harvard.edu

Sample of curriculum available for review prior to purchase

Adaptation guidelines or kit available

Yes

Languages available

English

Program Core Components

Category	Component	Core Component	Component present	Notes	Lesson number(s) / activities where present
Content	Contraception - Condoms	Yes	Yes (both versions)		Facilitator's Manual, pages 10-12, 23-25, 33
Content	Anatomy/physiology	No	Yes (both versions)	The health educator is instructed to use a female anatomical model to briefly demonstrate ascension of infection when discussing STIs as a potential consequence of unprotected sex.	Facilitator's Manual, pages 6, 19
Content	Other
Content	Volunteering/civic engagement		No
Content	Spirituality		No
Content	Morals/values	Yes	Yes (both versions)		Facilitator's Manual, pages 1-30
Content	Identity development		No
Content	Social support/capital		No
Content	Social influence/actual vs. perceived social norms		No
Content	Social competence		No
Content	Parenting skills		No
Content	Normative beliefs		No
Content	Leadership		No
Content	Gender roles		No
Content	Gender identity		No
Content	Cultural values		No
Content	Connections with trusted adults		No
Content	Conflict resolution/social problem solving		No
Content	Communication skills	Yes	Yes (both versions)		Facilitator's Manual, pages 15, 28-30
Content	Child development		No
Content	Boundary setting/refusal skills	Yes	Yes (both versions)		Facilitator's Manual, pages 13-15, 26-30
Content	Substance use cessation		No
Content	Substance use - Other drugs		No
Content	Substance use - Alcohol		No
Content	Substance use - Abstinence		No
Content	Brain development and substance use		No
Content	Vocational/skills training		No
Content	Supplemental academic services		No
Content	School engagement		No
Content	Graduating from high school		No
Content	College preparation		No
Content	Alternative schooling		No
Content	Self-regulation		No
Content	Self-esteem	No	Yes (both versions)		User's Guide, page 2
Content	Self-efficacy/empowerment	Yes	Yes (both versions)	The intervention uses motivational interviewing techniques that empower the participant to be in control	User's Guide, page 2
Content	Resilience		No
Content	Sexual health	Yes	Yes (both versions)		Facilitator's Manual, pages 5-33
Content	STIs - Treatment		No
Content	STIs - Screening		No
Content	STIs - Prevention	Yes	Yes (both versions)		Facilitator's Manual, pages 8-14, 21-27
Content	STIs - Information	Yes	Yes (both versions)		Facilitator's Manual, pages 5-6, 18-19
Content	Sexual risk reduction	Yes	Yes (both versions)		Facilitator's Manual, pages 8-15, 21-30
Content	Sexual risk discontinuation	Yes	Yes (both versions)		Facilitator's Manual, pages 13-14, 26-27
Content	Sexual risk avoidance	Yes	Yes (both versions)		Facilitator's Manual, pages 8-15,21-30
Content	Sexual orientation		No
Content	Maternal health		No
Content	Contraception - Long-acting reversible contraceptives	Yes	Yes (both versions)		Facilitator's Manual, pages 8-9, 21-22
Content	Contraception - Other	Yes	Yes (both versions)		Facilitator's Manual, pages 8-9, 21-22
Content	Contraception - Pills, patches, rings, and shots	Yes	Yes (both versions)		Facilitator's Manual, pages 8-9, 21-22
Content	Reproduction		No

Program Objectives

The intervention's primary objective is to reduce risky sexual behaviors and reduce HIV and other STI infections by increasing participants' knowledge of condoms, HIV and STIs, pregnancy, and abstinence.

Program Content

SSI draws upon Social Cognitive Theory, the Transtheoretical Model of Behavior Change, and motivational interviewing models. The sessions are designed to be conducted at the time of an STI diagnosis or treatment, when the participant is most likely to be thinking about her diagnosis relative to sexual risk behaviors.

There are two SSI curricula - Precontemplation Stage and Contemplation Stage. The Precontemplation version focuses on risk perception, motivation, education, and skills building. The Contemplation version focuses on education, skills, self-efficacy, and self-esteem. The participant self-assesses her level of risk using a Wheel of Change assessment, which helps the facilitator determine which curriculum to deliver.

Although the education sessions are tailored based on the participant's feedback and stated priorities, all consist of discussion on the consequences of sexual risk behaviors and methods for preventing pregnancy and STIs such as secondary abstinence and consistent condom use. The sessions teach condom use and negotiation skills.

After the initial session, there are three booster sessions to:

Reassess the participant's risk level
Discuss sexual history
Review the video
Review program materials

Participants are given condoms, a condom key chain, a Proud Pete booklet, and written materials.

Program Methods

The program is delivered through individual education sessions that incorporate discussion, role play (in the Contemplation curriculum, optional in the Precontemplation curriculum), condom demonstration, and video.

Program Structure and Timeline

The initial session lasts between 30 and 50 minutes, including viewing a 7-minute video. The initial session is followed by three 10- to 30-minute individual booster sessions at a health clinic. The three booster sessions are held at one, three, and six months after the initial session. Booster sessions typically coincide with the participant's clinical treatment schedule. All sessions are individual.

Staffing

Sessions are conducted by a female health educator who is trained in motivational interviewing techniques.

Program Materials and Resources

The following program materials are available through the distributor:

Safer Sex Intervention User's Guide
Safer Sex Intervention Curriculum Manual
Private Lives, HIV and STI Education DVD
Photocopy Masters: Handouts and Booster Session
Proud Pete Flipbook
Condom Keychains
Each of the following six brochures: STD Facts,
Birth Control Choices, Condoms: How to Use Them, 101 Ways of Saying No, 101 Ways of Making Love without Doin' It, and Safer Sex: Talking with Your Partner.
Fidelity toolkit
Set of Original Evaluation Instruments
Prevention Minimum Evaluation Data Set (PMEDS)
Local Evaluator Consultant Network Directory

While a free sample curriculum is not available, providers may purchase an automatic digital download of the user’s guide to review program components, core competencies for facilitators, and scientific evidence of effectiveness. If providers decide to purchase the program, the price of the download is deducted.

Additional Needs for Implementation

The program requires a video/DVD player, male and female anatomical models, condoms, personal lubricants, and a private space for sessions.

Fidelity

SSI has a fidelity toolkit/checklist, and tools for monitoring program implementation. These may be accessed on the Sociometrics website: https://www.socio.com/products/pasha-safer-sex-intervention

Staff Training

Training is not required, but is highly recommended. Training lasts two to three days and is provided through consultation with the developer. Providers interested in formalized training should contact Dr. Shrier (Email: Lydia.shrier@childrens.harvard.edu) .

Technical Assistance and Ongoing Support

Sociometrics provides telephone technical support on implementation and evaluation for one year with purchase of the program materials.

Allowable Adaptations

The developer has noted several allowable adaptations:

Updating or customizing statistics and facts about youth sexual behavior, pregnancy risk, STIs, and the effectiveness of condoms and other contraception in order to keep the program up-to-date and accurate.
Using different information in materials or brochures that is more up-to-date or relevant for a particular community's population, as long as the new material covers the same information and delivers the same messages.
Adding or replacing incentives/giveaways, such as pens, condoms, bracelets, or Post-it pads, particularly with the clinic's contact information or with messages such as "use protection" or "it's never too late to abstain."
Providing additional resources, such as referrals to other clinics or educational activities or a list of places to get condoms, as long as they are consistent with the intervention's messages and/or promote other clinic sessions.

Reviewed Studies

Citation	High-Quality Randomized Trial	Moderate-Quality Randomized Trial
Abt Associates 2015b Kelsey et al. 2016e Kelsey et al. 2016f	✓
Shrier et al. 2001		✓
The Policy Research Group 2015b	✓

Study Characteristics

Citation	Setting	Majority Age Group	Majority Racial/Ethnic Group	Gender	Sample Size
Abt Associates 2015b Kelsey et al. 2016e Kelsey et al. 2016f	Health clinic or medical facility	14 to 17	African American or Black	Young women	1809
Shrier et al. 2001	Health clinic or medical facility	14 to 17	African American or Black	Young women	123
The Policy Research Group 2015b	Health clinic or medical facility	14 to 17	African American or Black	Young women	319

Study Findings

Evidence by Outcome Domain and Study

Citation	Sexual Activity	Number of Sexual Partners	STIs or HIV	Pregnancy
Abt Associates 2015b Kelsey et al. 2016e Kelsey et al. 2016f
Shrier et al. 2001	n.a.		n.a.	n.a.
The Policy Research Group 2015b		n.a.	n.a.	n.a.

Detailed Findings

Citation	Details
Abt Associates 2015b Kelsey et al. 2016e Kelsey et al. 2016f	A subsequent study conducted by a separate group of researchers evaluated the program when implemented on a broader scale and with a more broadly-defined target population. The study used a randomized controlled trial involving young women recruited from 37 clinics across three states (Florida, Minnesota, and Tennessee). The study focused on young women who were sexually active or about to become sexually active. Participants were randomly assigned to either a treatment group that received the intervention or to a control group that received the standard clinic services. Data were collected immediately before random assignment (baseline) and again nine and 18 months after study enrollment. The study found that nine months after enrolling in the study, adolescents in the treatment group were significantly less likely to report having had sexual intercourse without birth control in the previous 90 days. The study also found that among the subgroup of adolescents who were sexually inexperienced at baseline, those in the treatment group were significantly less likely to report having had sex or having had more than one lifetime sexual partner. These program effects did not persist 18 months after enrollment in the study. In particular, the study found no evidence of statistically significant program impacts, for the full sample and for any of the subgroups of youth defined by sexual experience at baseline, on rates of sexual activity or sexual activity without birth control in the last 90 days, or on having had more than one lifetime sexual partner. At the 18-month follow-up, the study also found no evidence of statistically significant program impacts on becoming pregnant or being diagnosed with a STI in the last 12 months for either the full sample or the subsample of youth who were sexually inexperienced at baseline. At both the 9- and 18-month follow-ups, the study found no statistically significant program impacts on the percentage of participants who reported having had sex without a condom in the past 90 days. The study also examined program impacts on measures of knowledge of pregnancy risk and STI risk, attitudes toward protection, attitudes toward risky sexual behavior, motivation to delay childbearing, condom negotiation and refusal skills, and intentions to engage in sexual risky behavior. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.
Shrier et al. 2001	The program's evidence of effectiveness was first established in a randomized controlled trial involving young women recruitment from the adolescent health clinic of an urban children's hospital. The sample was limited to women younger than 24 who were seeking treatment for cervicitis or pelvic inflammatory disease. Study participants were randomly assigned to either a treatment group that received the intervention or a control group that received the usual clinic services. Surveys were administered immediately before the program started (baseline) and again one, three, six, and 12 months after study enrollment. The study found that six months after the intervention ended, adolescents in the intervention group were significantly less likely to report having had another sexual partner (in addition to their main partner) in the previous six months. The study found no statistically significant program impacts on having another sexual partner or on condom use at their last sexual encounter at the time of the one-month follow-up survey. Findings from the 3-month and 12-month follow-ups were not considered for the review because they did not meet the review evidence standards. Specifically, both the 3- and 12-month follow-ups had a high rate of sample attrition, and the study did not establish baseline equivalence for the remaining sample members. The study also examined program impacts on four measures of condom use (frequency and consistency of use with main partner, and frequency and consistency of use with another partner, in the past six months). 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 defined by sexual activity at follow-up.
The Policy Research Group 2015b	Six months after the program ended, the study found no evidence of statistically significant program impacts on the number of times in the past three months the study participants reported having had sex. The study also found no statistically significant program impacts on the proportion of times in the past three months that the young women in the study's sample had sex without using a condom or without using any type of contraceptives.

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Safer Sex Intervention (SSI)

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