Complete a case analysis of Avon Corporation
A formal, in-depth case analysis requires you to utilize the entire strategic-management process. Assume your group is a consulting team asked by Avon Corporation to analyze its external/internal environment and make strategic recommendations. You will be required to make exhibits/matrices to support your analysis and recommendations. The case analysis must encompass 10–12 pages plus the exhibits/matrices, cover page, and reference page. The cover page must include the company name, your group name, and the date of submission. The matrices must not be part of the analysis body but exhibits.
The completed case must include:
Executive summary;
Existing vision, mission, objectives, and strategies;
SWOT analysis;
Porter's 5 Forces;
Value Chain Analysis;
Financial Ratio Analysis;
Balance Score Card;
Intellectual Assets: Human Capital, Social Capital, Technology;
Organizational Design;
A list of alternative strategies, giving advantages and disadvantages for each;
A recommendation of specific strategies and long-term objectives;
An action timetable/agenda.
Have your group leader place the results of the case analysis in a single document and post it to the Group Case Analysis 2 forum of your Group Discussion Board Forum. Be sure that the assignment is in a business-professional format; include current APA citing and referencing.
Research Article
CHOICES-TEEN: Reducing Substance-
Exposed Pregnancy and HIV Among
Juvenile Justice Adolescent Females
Danielle E. Parrish
1
, Kirk von Sternberg
2
, Laura J. Benjamins
3
,
Jacquelynn Duron
4
, and Mary Velasquez
2
Abstract
Objective: The feasibility and acceptability of CHOICES-TEEN—a three-session intervention to reduce overlapping risks of
alcohol-exposed pregnancy (AEP), tobacco-exposed pregnancy (TEP), and HIV—was assessed among females in the juvenile
justice system. Method: Females aged 14–17 years on community probation in Houston, TX, were eligible if presenting with
aforementioned health risks. Outcome measures—obtained at 1- and 3-months postbaseline—included the Timeline Followback,
Client Satisfaction Questionnaire-8, session completion/checklists, Working Alliance Inventory–Short, and open-ended ques-
tions. Twenty-two participants enrolled (82% Hispanic/Latina; mean age ¼ 16). Results: The results suggest strong acceptability
and feasibility with high client satisfaction and client/therapist ratings, 91% session completion, and positive open-ended
responses. All youth were at risk at baseline, with the following proportions at reduced risk at follow-up: AEP (90% at
1 month, 71.4% at 3 months), TEP (77% of smokers [n ¼ 17] at reduced risk at 1 month, 50% at 3 months), and HIV (52.4% at
1 month, 28.6% at 3 months).
Keywords
adolescent, HIV infections, alcohol, juvenile justice, substance-exposed pregnancy
Adolescent females detained or on probation in juvenile justice
settings often engage in multiple health behaviors that place
them.
Living with HIV/AIDS and use of online support groups [4 1530 Aud Coulson]Gunther Eysenbach
The document summarizes a study that examined the use of online support groups among individuals living with HIV/AIDS. The study found that more frequent users of online support groups reported poorer physical health and health-related quality of life compared to infrequent and non-users. Frequent users also reported greater use of coping strategies like active coping and emotional support. The study was limited by its cross-sectional design and recruitment method, but provides interesting findings on how online support group use relates to health status and coping among HIV/AIDS patients. Future research could explore participation levels, empowerment processes, and reasons for leaving online support groups.
Prevalence and characteristics of adults with fetal alcohol spectrum disorder...BARRY STANLEY 2 fasd
Results
We identified a high rate of FASD (17.5, 95% CI [9.2, 25.8%]) in this sample, and this rate could have been as high as 31.2%
with confirmation of prenatal alcohol exposure. Most participants in this study presented with significant neurodevelopmental and cognitive deficits in at least two domains of functioning, irrespective of diagnosis, with only five of 80 participants (6.3%) demonstrating no cognitive impairment.
National studies have demonstrated that LGBTQ adolescents are disproportionately impacted by negative health outcomes including STDs, HIV, and unplanned pregnancy. In 2014, Essential Access Health surveyed LAUSD school-based Wellness Centers; gaps in current knowledge and practice related to inclusive clinical care of LGBTQ patients were identified. In 2016, we implemented staff trainings to improve LGBTQ-inclusive services. Based on training evaluation, areas for further technical assistance were identified, and used to develop online training resources. This presentation will discuss tools and best practices for implementing trainings on inclusive care.
The document summarizes 18 studies on preventing HIV among older adults. It finds that while HIV rates are rising in older populations, few prevention programs have targeted this group. The studies examined universal prevention programs for the general older population (3 studies), indicated prevention for older adults already infected (5 studies), and strategies/recommendations (10 studies). Most interventions showed improved HIV knowledge, though more research is needed due to the growing numbers of older adults at risk of infection.
The proposed Slow and Steady substance abuse treatment program for juvenile offenders includes mentoring, parenting groups, family therapy, and online support. Youth participants will be mentored by former clients and have opportunities to become mentors or counselors. Parents will participate in parenting groups and family therapy to support treatment. Online support groups will help maintain a community for clients and their families during and after the program. The goal is to successfully treat substance abuse and prevent future drug use through mentoring and family involvement.
ORIGINAL ARTICLEPartner Violence Entrapment Scale Develop.docxgerardkortney
ORIGINAL ARTICLE
Partner Violence Entrapment Scale: Development
and Psychometric Testing
Anna Torres1,6 & Purificación Navarro2 & Fernando Gutiérrez3 &
Maria Jesús Tarragona2 & Maria Luisa Imaz1 & Carlos Ascaso4 &
Zoe Herreras5 & Manuel Valdés3 & Lluïsa Garcia-Esteve3
Published online: 7 July 2015
# Springer Science+Business Media New York 2015
Abstract This article describes the development and testing
of the psychometric properties of the Partner Violence Entrap-
ment Scale (PVES), an instrument that evaluates the women’s
perceived reasons for staying in violent partner relationships.
After initial pilot testing, the scale was administered to 213
Spanish womenwhowere victims of intimate partner violence
(IPV). An exploratory factor analysis identified six factors:
Socio-Economic Problems, Attachment and Fear of Loneli-
ness, Blaming Oneself and Resignation, Impact on Children,
Fear of Harm and Worry for the Partner, and Feelings of Con-
fusion. Discriminant validity was established by demonstrat-
ing associations between PVES factors and socio-demograph-
ic, clinical and abuse variables. The scale appears to be a
useful assessment tool for social and clinical settings. Its factor
structure, reliability, and validity need to be replicated in other
populations and samples.
Keywords Batteredwomen . Remaining in an abusive
relationship . Domestic violence . Perceived reasons .
Scale development . Partner violence
The stay/leave decision process among battered women has
attracted a considerable amount of research attention. The
stay/leave decision is the most important and difficult choice
that women victims of intimate partner violence (IPV) may
face (Lerner and Kennedy 2000). In fact, it has been estimated
that women who experience IPV return an average of 3–4
times (Walker 1994), while the average relationship duration
of women who seek help spans more than 12 years (Amor
et al. 2002). The process of separation is a stressful life event
regardless of partner violence, but it becomes qualitatively
different in the context of victimization, with multiple barriers
to leaving (Walker et al. 2004). At the same time, contrary to
misconceptions about IPV, most women in violent relation-
ships do leave, and violence is associated with increased like-
lihood of separation (Walker et al. 2004). Leaving an abusive
partner is better understood as a process rather than a dichot-
omous decision (Khaw and Hardesty 2009). In this context,
the Transtheoretical Model has been used to explain the stay/
leave decision-making process in abusive relationships, ap-
plying specifically the stages and the process of change, as
well as the intervening variables -self-efficacy and decisional
balance- to IPV women (Eckstein 2011; Khaw and Hardesty
2009; Lerner and Kennedy 2000).
In light of the above, the more important concerns may be
the internal and external barriers that make leaving the rela-
tionship more difficult; as well as the perceived reasons to
stay.
Development of a Sleep Education Program for College Students at UDDana Alexander
The document describes a proposed sleep education program for college students at the University of Delaware. The 14-week program would meet weekly and teach students about sleep habits, time management, and goal setting to help reduce anxiety caused by lack of sleep. Unhealthy sleep habits are common among college students due to late nights, early classes, and poor time management. The program aims to provide resources to improve students' sleep quality and mental health through interactive discussions, personal scheduling assistance, and social support components.
The document discusses issues related to substance abuse among teens. It notes that teens who abuse drugs and alcohol are more likely to engage in criminal behavior and end up in the juvenile justice system. Four out of five teens in the justice system have substance abuse problems. Treatment is more effective and cheaper than incarceration, but many teens do not receive treatment. Effective treatment requires a coordinated, long-term, family-focused approach addressing multiple needs.
Living with HIV/AIDS and use of online support groups [4 1530 Aud Coulson]Gunther Eysenbach
The document summarizes a study that examined the use of online support groups among individuals living with HIV/AIDS. The study found that more frequent users of online support groups reported poorer physical health and health-related quality of life compared to infrequent and non-users. Frequent users also reported greater use of coping strategies like active coping and emotional support. The study was limited by its cross-sectional design and recruitment method, but provides interesting findings on how online support group use relates to health status and coping among HIV/AIDS patients. Future research could explore participation levels, empowerment processes, and reasons for leaving online support groups.
Prevalence and characteristics of adults with fetal alcohol spectrum disorder...BARRY STANLEY 2 fasd
Results
We identified a high rate of FASD (17.5, 95% CI [9.2, 25.8%]) in this sample, and this rate could have been as high as 31.2%
with confirmation of prenatal alcohol exposure. Most participants in this study presented with significant neurodevelopmental and cognitive deficits in at least two domains of functioning, irrespective of diagnosis, with only five of 80 participants (6.3%) demonstrating no cognitive impairment.
National studies have demonstrated that LGBTQ adolescents are disproportionately impacted by negative health outcomes including STDs, HIV, and unplanned pregnancy. In 2014, Essential Access Health surveyed LAUSD school-based Wellness Centers; gaps in current knowledge and practice related to inclusive clinical care of LGBTQ patients were identified. In 2016, we implemented staff trainings to improve LGBTQ-inclusive services. Based on training evaluation, areas for further technical assistance were identified, and used to develop online training resources. This presentation will discuss tools and best practices for implementing trainings on inclusive care.
The document summarizes 18 studies on preventing HIV among older adults. It finds that while HIV rates are rising in older populations, few prevention programs have targeted this group. The studies examined universal prevention programs for the general older population (3 studies), indicated prevention for older adults already infected (5 studies), and strategies/recommendations (10 studies). Most interventions showed improved HIV knowledge, though more research is needed due to the growing numbers of older adults at risk of infection.
The proposed Slow and Steady substance abuse treatment program for juvenile offenders includes mentoring, parenting groups, family therapy, and online support. Youth participants will be mentored by former clients and have opportunities to become mentors or counselors. Parents will participate in parenting groups and family therapy to support treatment. Online support groups will help maintain a community for clients and their families during and after the program. The goal is to successfully treat substance abuse and prevent future drug use through mentoring and family involvement.
ORIGINAL ARTICLEPartner Violence Entrapment Scale Develop.docxgerardkortney
ORIGINAL ARTICLE
Partner Violence Entrapment Scale: Development
and Psychometric Testing
Anna Torres1,6 & Purificación Navarro2 & Fernando Gutiérrez3 &
Maria Jesús Tarragona2 & Maria Luisa Imaz1 & Carlos Ascaso4 &
Zoe Herreras5 & Manuel Valdés3 & Lluïsa Garcia-Esteve3
Published online: 7 July 2015
# Springer Science+Business Media New York 2015
Abstract This article describes the development and testing
of the psychometric properties of the Partner Violence Entrap-
ment Scale (PVES), an instrument that evaluates the women’s
perceived reasons for staying in violent partner relationships.
After initial pilot testing, the scale was administered to 213
Spanish womenwhowere victims of intimate partner violence
(IPV). An exploratory factor analysis identified six factors:
Socio-Economic Problems, Attachment and Fear of Loneli-
ness, Blaming Oneself and Resignation, Impact on Children,
Fear of Harm and Worry for the Partner, and Feelings of Con-
fusion. Discriminant validity was established by demonstrat-
ing associations between PVES factors and socio-demograph-
ic, clinical and abuse variables. The scale appears to be a
useful assessment tool for social and clinical settings. Its factor
structure, reliability, and validity need to be replicated in other
populations and samples.
Keywords Batteredwomen . Remaining in an abusive
relationship . Domestic violence . Perceived reasons .
Scale development . Partner violence
The stay/leave decision process among battered women has
attracted a considerable amount of research attention. The
stay/leave decision is the most important and difficult choice
that women victims of intimate partner violence (IPV) may
face (Lerner and Kennedy 2000). In fact, it has been estimated
that women who experience IPV return an average of 3–4
times (Walker 1994), while the average relationship duration
of women who seek help spans more than 12 years (Amor
et al. 2002). The process of separation is a stressful life event
regardless of partner violence, but it becomes qualitatively
different in the context of victimization, with multiple barriers
to leaving (Walker et al. 2004). At the same time, contrary to
misconceptions about IPV, most women in violent relation-
ships do leave, and violence is associated with increased like-
lihood of separation (Walker et al. 2004). Leaving an abusive
partner is better understood as a process rather than a dichot-
omous decision (Khaw and Hardesty 2009). In this context,
the Transtheoretical Model has been used to explain the stay/
leave decision-making process in abusive relationships, ap-
plying specifically the stages and the process of change, as
well as the intervening variables -self-efficacy and decisional
balance- to IPV women (Eckstein 2011; Khaw and Hardesty
2009; Lerner and Kennedy 2000).
In light of the above, the more important concerns may be
the internal and external barriers that make leaving the rela-
tionship more difficult; as well as the perceived reasons to
stay.
Development of a Sleep Education Program for College Students at UDDana Alexander
The document describes a proposed sleep education program for college students at the University of Delaware. The 14-week program would meet weekly and teach students about sleep habits, time management, and goal setting to help reduce anxiety caused by lack of sleep. Unhealthy sleep habits are common among college students due to late nights, early classes, and poor time management. The program aims to provide resources to improve students' sleep quality and mental health through interactive discussions, personal scheduling assistance, and social support components.
The document discusses issues related to substance abuse among teens. It notes that teens who abuse drugs and alcohol are more likely to engage in criminal behavior and end up in the juvenile justice system. Four out of five teens in the justice system have substance abuse problems. Treatment is more effective and cheaper than incarceration, but many teens do not receive treatment. Effective treatment requires a coordinated, long-term, family-focused approach addressing multiple needs.
Section 2- Literature Review and Problem Statement Synt.docxrtodd280
Section 2- Literature Review and Problem Statement
*Synthesis of Peer-Reviewed Scholarly Resources
In the United States, teen pregnancy rates declined nine percent from 2013 to 2013 but
adolescent teen pregnancy is still a pressing public health issue. A synthesis of the literature
reflects the differences in state policies and the effect of funding on reproduction and sexual
education and the availability of family planning and abortion services (Beltz, Sacks, Moore &
Terzian, 2015). An overview of recent research and theory concerning adolescent sexual and
reproductive health suggests that public health leaders implement evidence-based teen pregnancy
prevention initiatives that expand access to low-cost or free contraception and family planning
services and educational and media campaigns that promote safe sexual activity (Thomas, 2012).
Thomas (2012) indicates that new research has shown that efforts made by public health
leadership to expand rather than limit teen pregnancy prevention policies, on a state and federal
level, could produce economic savings to taxpayers. A review of the literature also suggest a
need for extensive social research to examine the deficiencies in state-level policies that may
restrict access to abortion services, public assistance benefits and contraceptive and reproductive
care for sexually active adolescents and use the data gathered to support policy-level changes
(Thomas, 2012).
Santelli, Lindbergh, Fine & Singh (2007) examined the effect of the overall effectiveness
of contraceptive use among sexually active adolescents as the primary determinant of declining
teen pregnancy rates. The authors note that the call for abstinence-only education programs
supported by leaders from the federal government has increased since 1998, even though there is
a deficient lack of evidence-based research support for abstinence –based programs for
reproductive and sexual health for adolescents (Santelli et al., 2007). Based on their study, using
an overall pregnancy risk index and the combined impact of changes in adolescent sexual
activity and effective contraception use, the author’s findings showed a large decline in
pregnancy risk among 15 to 17 year olds, from 9.7 to 4.4 from 1995 to 2002 (Santelli et al.,
2007). The authors also suggested that public health leadership in the United States that
promotes abstinence-based education as the primary strategy to delay initiation of sexual
activity, prevent teen pregnancy, and sexually transmitted illness (STIs) as a failure and
ineffective (Santelli et al., 2007).
Other literature reviews recommend public health leaders look to identify changes in
adolescent’s sexual behavior that may provide insight and an understanding of the social forces,
which influence behavior and motivation in the use or non-use of contraception (Kraft et al.,
2010). Overall, public policy recommendations for pregnancy prevent.
1) The document discusses analyzing health-related risks by considering social determinants of health like age, gender, ethnicity, and environment when building a patient's health history.
2) It focuses on the case of an adolescent Hispanic/Latino boy living in a middle-class suburb and how communication techniques should be tailored to effectively interview this patient.
3) Key factors like the patient's age, ethnicity, and environment are examined to understand potential health risks and inform targeted questions using the HEEADSS risk assessment tool.
This study examined the relationship between gender and sexual risk behaviors among males and females. A mixed methods approach was used, including focus groups with 12 participants and an online/hard copy survey completed by 90 participants. The survey assessed demographics, sexual activity levels, and risk behaviors. Results found no statistically significant difference between males and females in terms of risk behaviors. However, qualitative findings suggested alcohol and drug use contribute to higher risk behaviors. In conclusion, gender alone did not predict risk, though other factors like substance use were implicated.
This is awareness campaign report during health teaching in a rural community within the Philippines to increase awareness of increasing trend of teenage pregnancy especially among low poverty income and less educated residents in a certain community in the Philippines
This document describes a population-based case-control study examining the relationship between alcohol use and crash risk. A population-based case-control study is appropriate as it reduces selection bias and allows results to be generalized to the population. Data is collected through biological samples, standardized questionnaires, medical records, and employment records to minimize bias. The study analyzes how alcohol and marijuana use can increase crash risk due to impaired functioning. Driver demographics and a random sample population are examined. The results help understand how alcohol in particular may be a leading factor in traffic crashes, though other exposures could also play a role.
This document summarizes a study on systems-level barriers that contribute to secondary conditions in individuals with fetal alcohol spectrum disorders (FASD). The study involved interviews and focus groups with parents of children with FASD and service providers.
The key findings were:
1) A pervasive lack of knowledge about FASD exists throughout multiple systems, including healthcare, education, and social services. This lack of knowledge contributes to barriers across different systems.
2) Systems-level barriers that interfere with preventing secondary conditions include delayed diagnosis of FASD, difficulty qualifying for and accessing services, poor implementation of services, and challenges maintaining services long-term.
3) Broad system changes are needed using a public
This document discusses strategies that can influence change for women and girls living with HIV/AIDS. It begins by outlining the disproportionate burden faced by these groups, then examines prevalence data showing women, especially minorities in the US South, are at high risk. Risk factors like gender inequality, poverty and violence are discussed. Effective strategies are proposed that target multiple levels - behavioral approaches educate women, environmental strategies address living conditions, and policy aims to improve integrated healthcare access. A woman-centered approach recognizes women's experiences and empowers them as leaders. Comprehensive, sustainable interventions across all levels throughout the life course are needed to promote gender equity and alleviate disparities.
The document discusses research on health care access disparities among Latino populations and their families. It notes that Latinos are more likely than other groups to have uninsured family members. Research shows socioeconomic factors play a role, but people of color experience different health care even with similar insurance and conditions. The document then outlines several research implications and opportunities for systemic interventions to address barriers Latinos face in accessing health care.
Example of an Annotated Bibliography (APA Style)Gipson, T., .docxelbanglis
Example of an Annotated Bibliography (APA Style)
Gipson, T., Lance, E., Albury, R., Gentner, M., & Leppert, M. (2015). Disparities in
identification of comorbid diagnoses in children with ADHD. Clinical Pediatrics, 54(4): 376-381.
The authors examine ADHD children with relevant comorbid conditions and medication prescribing habits based on comprehensive neurodevelopmental evaluations versus insurance limited evaluations to behavior management and medication. This was done using a retrospective review of medical records at the Center for Development and Learning Clinic. Data for demographics, comorbidities, medications, and interventions were analyzed for associations between groups. Results demonstrated that kids who received comprehensive evaluations had a greater degree of diagnosis for comorbidities. This stimulates the question of income levels and comprehensive evaluations in ADHD kids and comorbid conditions.
Hinojosa, M., Hinojosa, R., Fernandez-Baca, D., Knapp, C., & Thompson, L. (2012). Parental strain, parental health, and community characteristics among children with attention deficit-hyperactivity disorder. Academic Pediatrics, 12(6): 502-508.
The authors examined the impact on parents who have a child with ADHD and comorbidities. Using the National Survey of Children’s Health dataset, they conducted a bivariate, multivariate, and descriptive analysis to look for associations between kids with ADHD and comorbid conditions and the strain on parents, social support, mother’s mental health, and local amenities. Results showed an increase in parental strain when caring for an ADHD child with a co-occurring condition. It also showed that lack of social support and lack of access to community amenities were predictors of increased parental strain. This study demonstrates the impact on the health of caregivers to ADHD children with comorbidities.
Radigan, M., Lannon, P., Roohan, P., & Gesten, F. (2005). Medication patterns for attention-deficit/hyperactivity disorder and comorbid psychiatric conditions in a low-income population. Journal of Child and Adolescent Psychopharmacology, 15(1): 44-56.
The authors examined the psychotropic medications usage of low-income kids who have been diagnosed with ADHD comparing those with and without comorbid conditions. The New York State Department of Health Medicaid Encounter Data System was used to extract information on 6,922 kids 3-19 years of age. A multivariate logistic regression was conducted to look at associations between ADHD with comorbid conditions and medication usage. Results showed the strongest predictors of medication use to be comorbid conditions and Social Security Income Medicaid eligible status. This study stimulates the question of the possibility for ADHD children with comorbidities to have treatment variations based on income status.
Rockhill, C., Violette, H., Vander Stoep, A., Grover, S., & Myers, K. (2013). Caregivers’ distress: Youth with attentio ...
Maternal Alcohol Use Disorder and Risk of Child Contact with the Justice Syst...BARRY STANLEY 2 fasd
These finding were actually first described in - Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome [FAS] and Fetal Alcohol Effects [FAE] - Final Report, August 1996: Ann P Streissguth et.al. Often ignored, but never refuted.
Perhaps the most important point of this 20 year old report was that early diagnosis was a major contributing factor in reducing subsequent involvement with the justice system.
I was disappointed, but not surprised, that this paper did not mention the importance of an early diagnosis.
Barry Stanley
This document outlines a research proposal that aims to analyze how public policy affects teen pregnancy and birth rates. The study will use mixed methods, including surveys, focus groups, interviews, and policy analysis. The hypothesis is that policies restricting abortion access, evidence-based sex education, and reproductive healthcare will increase unintended teen pregnancy and births. The study plans to recruit 50 participants and collect data at baseline, during interventions, and after 12 months to evaluate the impact of policy changes on teen attitudes and behaviors. The goal is to provide evidence that certain restrictive policies should be modified to reduce teen pregnancy rates.
This document provides an introduction to a research study examining adolescent risky sexual behaviors. It discusses how adolescents are susceptible to HIV/AIDS, unwanted pregnancies, and STDs. The study aims to examine adolescent attitudes and behaviors regarding sexual activity and determine if a comprehensive intervention program can reduce risky behaviors. It outlines the theoretical orientation using models of behavior change. A literature review discusses previous research on factors influencing adolescent risky sex. The proposed research methods include surveys and interviews of adolescents to study the relationship between risky sex and variables like gender, race, self-esteem, parental involvement and sexual education. Data will be analyzed to determine if a comprehensive intervention program can positively impact adolescent risky behaviors.
This document discusses internet use among children and adolescents in the United States. It provides the following key points:
- 97% of youth ages 12-18 use the internet, primarily for 1 hour or less per day. Boys and girls use the internet equally.
- 76% of older teens search for health information online, especially about STDs, HIV/AIDS, and mental health issues like depression. Over half discuss what they learn with caregivers.
- While general internet use is not associated with depression, those with depressive symptoms are more likely to experience online harassment.
- Early internet-based interventions for issues like smoking cessation and eating disorders have shown promise, though more research is needed, especially
The document discusses the health belief model, which is a theoretical framework used in healthcare to guide health promotion plans and disease prevention. It has five stages: precontemplation, contemplation, preparation, action, and maintenance. The model focuses on perceived susceptibility, severity, benefits, and confidence. It can be used to understand behaviors like substance abuse in youth. Barriers to implementing it include lack of resources. Benefits are improving health knowledge and behaviors.
This document discusses treatment as prevention (TasP) for HIV. It acknowledges that while clinical trials provide good evidence for TasP, they have limitations in real-world settings. It poses questions about how to implement TasP as part of combination prevention, whether it can replace condoms, how to communicate its benefits to HIV-negative people, and the legal and ethical implications. The document proposes developing guidance on practical community-based health promotion around TasP through member consultations, with the goal of answering many open questions and providing suggestions on how to proceed by the end of the year.
Models of Integrated Care for Adolescent Alcohol and Drug Use in Pediatrics P...HMO Research Network
This document summarizes several studies on models of integrated care for adolescent alcohol and drug use in pediatrics. Key findings from the studies include:
1) Only around half of pediatricians routinely screen adolescents for substance use and few use standardized instruments.
2) Screening, brief intervention, and referral to treatment (SBIRT) models have been shown to increase identification of behavioral health problems and treatment utilization compared to usual care.
3) Non-physician delivered SBIRT may have better adoption rates than physician-delivered SBIRT based on adult studies, but this comparison has not been tested for adolescents. The current study aims to test effectiveness of PCP-delivered vs behavioral health clinician-delivered
The article reviews 53 home-visiting programs aimed at preventing child maltreatment. It finds that only 7 programs that had clear objectives, theories of change, targeted populations and program components consistent with the theory achieved statistically significant positive outcomes in reducing child maltreatment. Programs with partial consistency had intermediate success, while those with no consistency had no success. Having a theory-driven approach with consistency between these elements can help explain the varying performance of home-visiting programs in preventing child abuse.
Consider the following quote by the philosopher Ludwig Wittgenst.docxzollyjenkins
Consider the following quote by the philosopher Ludwig Wittgenstein, who believed that thought without language was impossible: “The limits of my language are the limits of my life.” For more information on Wittgenstein and his analysis on the importance of language, watch the video
Ludwig Wittgenstein (1889 – 1951) The Limits of Language
.
Please respond to the following:
Examine whether it is possible to think without using language.
If you believe it is possible, describe the primary ways in which a person might enact so-called languageless thinking.
If you believe it is not possible, describe what you foresee as major problems with "languageless" thinking.
.
Consider the following questions as you review 1. Is the conten.docxzollyjenkins
Consider the following questions as you review:
1. Is the content of the presentaiton clear? Is there a clear focus?
2. Is the presentation supported with evidence?
3. Does the presentation have a coherent structure? If it is a podcast or video clip, are the transitions effective? If it is an infographic, or opinion letter, is there a progression of ideas?
4. What is the presenter doing particularly well? What do they still have to work on to make the presentation better?
Finish it by today
.
More Related Content
Similar to Complete a case analysis of Avon Corporation A formal, in-depth .docx
Section 2- Literature Review and Problem Statement Synt.docxrtodd280
Section 2- Literature Review and Problem Statement
*Synthesis of Peer-Reviewed Scholarly Resources
In the United States, teen pregnancy rates declined nine percent from 2013 to 2013 but
adolescent teen pregnancy is still a pressing public health issue. A synthesis of the literature
reflects the differences in state policies and the effect of funding on reproduction and sexual
education and the availability of family planning and abortion services (Beltz, Sacks, Moore &
Terzian, 2015). An overview of recent research and theory concerning adolescent sexual and
reproductive health suggests that public health leaders implement evidence-based teen pregnancy
prevention initiatives that expand access to low-cost or free contraception and family planning
services and educational and media campaigns that promote safe sexual activity (Thomas, 2012).
Thomas (2012) indicates that new research has shown that efforts made by public health
leadership to expand rather than limit teen pregnancy prevention policies, on a state and federal
level, could produce economic savings to taxpayers. A review of the literature also suggest a
need for extensive social research to examine the deficiencies in state-level policies that may
restrict access to abortion services, public assistance benefits and contraceptive and reproductive
care for sexually active adolescents and use the data gathered to support policy-level changes
(Thomas, 2012).
Santelli, Lindbergh, Fine & Singh (2007) examined the effect of the overall effectiveness
of contraceptive use among sexually active adolescents as the primary determinant of declining
teen pregnancy rates. The authors note that the call for abstinence-only education programs
supported by leaders from the federal government has increased since 1998, even though there is
a deficient lack of evidence-based research support for abstinence –based programs for
reproductive and sexual health for adolescents (Santelli et al., 2007). Based on their study, using
an overall pregnancy risk index and the combined impact of changes in adolescent sexual
activity and effective contraception use, the author’s findings showed a large decline in
pregnancy risk among 15 to 17 year olds, from 9.7 to 4.4 from 1995 to 2002 (Santelli et al.,
2007). The authors also suggested that public health leadership in the United States that
promotes abstinence-based education as the primary strategy to delay initiation of sexual
activity, prevent teen pregnancy, and sexually transmitted illness (STIs) as a failure and
ineffective (Santelli et al., 2007).
Other literature reviews recommend public health leaders look to identify changes in
adolescent’s sexual behavior that may provide insight and an understanding of the social forces,
which influence behavior and motivation in the use or non-use of contraception (Kraft et al.,
2010). Overall, public policy recommendations for pregnancy prevent.
1) The document discusses analyzing health-related risks by considering social determinants of health like age, gender, ethnicity, and environment when building a patient's health history.
2) It focuses on the case of an adolescent Hispanic/Latino boy living in a middle-class suburb and how communication techniques should be tailored to effectively interview this patient.
3) Key factors like the patient's age, ethnicity, and environment are examined to understand potential health risks and inform targeted questions using the HEEADSS risk assessment tool.
This study examined the relationship between gender and sexual risk behaviors among males and females. A mixed methods approach was used, including focus groups with 12 participants and an online/hard copy survey completed by 90 participants. The survey assessed demographics, sexual activity levels, and risk behaviors. Results found no statistically significant difference between males and females in terms of risk behaviors. However, qualitative findings suggested alcohol and drug use contribute to higher risk behaviors. In conclusion, gender alone did not predict risk, though other factors like substance use were implicated.
This is awareness campaign report during health teaching in a rural community within the Philippines to increase awareness of increasing trend of teenage pregnancy especially among low poverty income and less educated residents in a certain community in the Philippines
This document describes a population-based case-control study examining the relationship between alcohol use and crash risk. A population-based case-control study is appropriate as it reduces selection bias and allows results to be generalized to the population. Data is collected through biological samples, standardized questionnaires, medical records, and employment records to minimize bias. The study analyzes how alcohol and marijuana use can increase crash risk due to impaired functioning. Driver demographics and a random sample population are examined. The results help understand how alcohol in particular may be a leading factor in traffic crashes, though other exposures could also play a role.
This document summarizes a study on systems-level barriers that contribute to secondary conditions in individuals with fetal alcohol spectrum disorders (FASD). The study involved interviews and focus groups with parents of children with FASD and service providers.
The key findings were:
1) A pervasive lack of knowledge about FASD exists throughout multiple systems, including healthcare, education, and social services. This lack of knowledge contributes to barriers across different systems.
2) Systems-level barriers that interfere with preventing secondary conditions include delayed diagnosis of FASD, difficulty qualifying for and accessing services, poor implementation of services, and challenges maintaining services long-term.
3) Broad system changes are needed using a public
This document discusses strategies that can influence change for women and girls living with HIV/AIDS. It begins by outlining the disproportionate burden faced by these groups, then examines prevalence data showing women, especially minorities in the US South, are at high risk. Risk factors like gender inequality, poverty and violence are discussed. Effective strategies are proposed that target multiple levels - behavioral approaches educate women, environmental strategies address living conditions, and policy aims to improve integrated healthcare access. A woman-centered approach recognizes women's experiences and empowers them as leaders. Comprehensive, sustainable interventions across all levels throughout the life course are needed to promote gender equity and alleviate disparities.
The document discusses research on health care access disparities among Latino populations and their families. It notes that Latinos are more likely than other groups to have uninsured family members. Research shows socioeconomic factors play a role, but people of color experience different health care even with similar insurance and conditions. The document then outlines several research implications and opportunities for systemic interventions to address barriers Latinos face in accessing health care.
Example of an Annotated Bibliography (APA Style)Gipson, T., .docxelbanglis
Example of an Annotated Bibliography (APA Style)
Gipson, T., Lance, E., Albury, R., Gentner, M., & Leppert, M. (2015). Disparities in
identification of comorbid diagnoses in children with ADHD. Clinical Pediatrics, 54(4): 376-381.
The authors examine ADHD children with relevant comorbid conditions and medication prescribing habits based on comprehensive neurodevelopmental evaluations versus insurance limited evaluations to behavior management and medication. This was done using a retrospective review of medical records at the Center for Development and Learning Clinic. Data for demographics, comorbidities, medications, and interventions were analyzed for associations between groups. Results demonstrated that kids who received comprehensive evaluations had a greater degree of diagnosis for comorbidities. This stimulates the question of income levels and comprehensive evaluations in ADHD kids and comorbid conditions.
Hinojosa, M., Hinojosa, R., Fernandez-Baca, D., Knapp, C., & Thompson, L. (2012). Parental strain, parental health, and community characteristics among children with attention deficit-hyperactivity disorder. Academic Pediatrics, 12(6): 502-508.
The authors examined the impact on parents who have a child with ADHD and comorbidities. Using the National Survey of Children’s Health dataset, they conducted a bivariate, multivariate, and descriptive analysis to look for associations between kids with ADHD and comorbid conditions and the strain on parents, social support, mother’s mental health, and local amenities. Results showed an increase in parental strain when caring for an ADHD child with a co-occurring condition. It also showed that lack of social support and lack of access to community amenities were predictors of increased parental strain. This study demonstrates the impact on the health of caregivers to ADHD children with comorbidities.
Radigan, M., Lannon, P., Roohan, P., & Gesten, F. (2005). Medication patterns for attention-deficit/hyperactivity disorder and comorbid psychiatric conditions in a low-income population. Journal of Child and Adolescent Psychopharmacology, 15(1): 44-56.
The authors examined the psychotropic medications usage of low-income kids who have been diagnosed with ADHD comparing those with and without comorbid conditions. The New York State Department of Health Medicaid Encounter Data System was used to extract information on 6,922 kids 3-19 years of age. A multivariate logistic regression was conducted to look at associations between ADHD with comorbid conditions and medication usage. Results showed the strongest predictors of medication use to be comorbid conditions and Social Security Income Medicaid eligible status. This study stimulates the question of the possibility for ADHD children with comorbidities to have treatment variations based on income status.
Rockhill, C., Violette, H., Vander Stoep, A., Grover, S., & Myers, K. (2013). Caregivers’ distress: Youth with attentio ...
Maternal Alcohol Use Disorder and Risk of Child Contact with the Justice Syst...BARRY STANLEY 2 fasd
These finding were actually first described in - Understanding the Occurrence of Secondary Disabilities in Clients with Fetal Alcohol Syndrome [FAS] and Fetal Alcohol Effects [FAE] - Final Report, August 1996: Ann P Streissguth et.al. Often ignored, but never refuted.
Perhaps the most important point of this 20 year old report was that early diagnosis was a major contributing factor in reducing subsequent involvement with the justice system.
I was disappointed, but not surprised, that this paper did not mention the importance of an early diagnosis.
Barry Stanley
This document outlines a research proposal that aims to analyze how public policy affects teen pregnancy and birth rates. The study will use mixed methods, including surveys, focus groups, interviews, and policy analysis. The hypothesis is that policies restricting abortion access, evidence-based sex education, and reproductive healthcare will increase unintended teen pregnancy and births. The study plans to recruit 50 participants and collect data at baseline, during interventions, and after 12 months to evaluate the impact of policy changes on teen attitudes and behaviors. The goal is to provide evidence that certain restrictive policies should be modified to reduce teen pregnancy rates.
This document provides an introduction to a research study examining adolescent risky sexual behaviors. It discusses how adolescents are susceptible to HIV/AIDS, unwanted pregnancies, and STDs. The study aims to examine adolescent attitudes and behaviors regarding sexual activity and determine if a comprehensive intervention program can reduce risky behaviors. It outlines the theoretical orientation using models of behavior change. A literature review discusses previous research on factors influencing adolescent risky sex. The proposed research methods include surveys and interviews of adolescents to study the relationship between risky sex and variables like gender, race, self-esteem, parental involvement and sexual education. Data will be analyzed to determine if a comprehensive intervention program can positively impact adolescent risky behaviors.
This document discusses internet use among children and adolescents in the United States. It provides the following key points:
- 97% of youth ages 12-18 use the internet, primarily for 1 hour or less per day. Boys and girls use the internet equally.
- 76% of older teens search for health information online, especially about STDs, HIV/AIDS, and mental health issues like depression. Over half discuss what they learn with caregivers.
- While general internet use is not associated with depression, those with depressive symptoms are more likely to experience online harassment.
- Early internet-based interventions for issues like smoking cessation and eating disorders have shown promise, though more research is needed, especially
The document discusses the health belief model, which is a theoretical framework used in healthcare to guide health promotion plans and disease prevention. It has five stages: precontemplation, contemplation, preparation, action, and maintenance. The model focuses on perceived susceptibility, severity, benefits, and confidence. It can be used to understand behaviors like substance abuse in youth. Barriers to implementing it include lack of resources. Benefits are improving health knowledge and behaviors.
This document discusses treatment as prevention (TasP) for HIV. It acknowledges that while clinical trials provide good evidence for TasP, they have limitations in real-world settings. It poses questions about how to implement TasP as part of combination prevention, whether it can replace condoms, how to communicate its benefits to HIV-negative people, and the legal and ethical implications. The document proposes developing guidance on practical community-based health promotion around TasP through member consultations, with the goal of answering many open questions and providing suggestions on how to proceed by the end of the year.
Models of Integrated Care for Adolescent Alcohol and Drug Use in Pediatrics P...HMO Research Network
This document summarizes several studies on models of integrated care for adolescent alcohol and drug use in pediatrics. Key findings from the studies include:
1) Only around half of pediatricians routinely screen adolescents for substance use and few use standardized instruments.
2) Screening, brief intervention, and referral to treatment (SBIRT) models have been shown to increase identification of behavioral health problems and treatment utilization compared to usual care.
3) Non-physician delivered SBIRT may have better adoption rates than physician-delivered SBIRT based on adult studies, but this comparison has not been tested for adolescents. The current study aims to test effectiveness of PCP-delivered vs behavioral health clinician-delivered
The article reviews 53 home-visiting programs aimed at preventing child maltreatment. It finds that only 7 programs that had clear objectives, theories of change, targeted populations and program components consistent with the theory achieved statistically significant positive outcomes in reducing child maltreatment. Programs with partial consistency had intermediate success, while those with no consistency had no success. Having a theory-driven approach with consistency between these elements can help explain the varying performance of home-visiting programs in preventing child abuse.
Similar to Complete a case analysis of Avon Corporation A formal, in-depth .docx (20)
Consider the following quote by the philosopher Ludwig Wittgenst.docxzollyjenkins
Consider the following quote by the philosopher Ludwig Wittgenstein, who believed that thought without language was impossible: “The limits of my language are the limits of my life.” For more information on Wittgenstein and his analysis on the importance of language, watch the video
Ludwig Wittgenstein (1889 – 1951) The Limits of Language
.
Please respond to the following:
Examine whether it is possible to think without using language.
If you believe it is possible, describe the primary ways in which a person might enact so-called languageless thinking.
If you believe it is not possible, describe what you foresee as major problems with "languageless" thinking.
.
Consider the following questions as you review 1. Is the conten.docxzollyjenkins
Consider the following questions as you review:
1. Is the content of the presentaiton clear? Is there a clear focus?
2. Is the presentation supported with evidence?
3. Does the presentation have a coherent structure? If it is a podcast or video clip, are the transitions effective? If it is an infographic, or opinion letter, is there a progression of ideas?
4. What is the presenter doing particularly well? What do they still have to work on to make the presentation better?
Finish it by today
.
Consider the discussion in Texass Shift from Blue to Red Informs 2.docxzollyjenkins
Consider the discussion in "Texas's Shift from Blue to Red Informs 2014 Races." The "red-blue" debate in Texas is essentially an issue of party realignment. The transformation of Texas from a one-party Democratic state to that of essentially a one-party Republican state occurred over several years in which there was a convergence of many different factors, including economics,demographics, trends in national politics, and the role of key political actors. For those predicting the possibility of Texas becoming a "blue" state with the resurgence of the Democratic Party, what lessons might be drawn from the Republican realignment that produced the party's current domination of the state government and many local governments throughout Texas?
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Consider the different views of happiness discussed in Chapter 12, i.docxzollyjenkins
The document discusses four views of happiness - Hedonism, Epicureanism, Stoicism, and Buddhism - from chapters 12 and 14 and asks which view seems most life-denying and which seems most life-affirming, requiring the reader to explain their reasoning for each. It also instructs the reader to review the chapters discussed to answer the questions.
Consider some of your primary interests (hobbies, favorite media, pr.docxzollyjenkins
Consider some of your primary interests (hobbies, favorite media, preferable activities). How did you develop an interest in these things? What experiences helped you develop an interest? Did you have any mentors or guides who aided the process? What would you do to introduce someone to similar interest?
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consider how time series analysis can be applied.a. Research.docxzollyjenkins
consider how time series analysis can be applied.
a. Research completed research
studies
that have used time series analysis.
b. Provide a brief summary that includes the type of study, its purpose, and its final conclusions.
c. Based on your research-based knowledge, provide your evaluation on the role of time series analysis in the study's outcome.
d. Provide an APA formatted reference and a .pdf of the study.
Note: Paraphrase, cite, and reference per APA.
.
Consider Lydia’s and John’s cognitive and physical limitations as .docxzollyjenkins
Consider Lydia’s and John’s cognitive and physical limitations as well as their social support. If you were presenting this case to a team of other human services providers, what developmental theories, concepts, and principles help explain this case?
What other information might you need to fully evaluate the situation in which Lydia and John live?
If you were the protective service worker, what are the options for this couple? Identify several feasible plans with explanation and support from a source of information. Include the risks and benefits of each option. Then, identify what your final recommendation would be and why.
Case Study
Lydia and John were a couple in their nineties who lived in their own home and had been married over sixty years. Both were confused and forgetful. They had two sons who were in their seventies and lived in nearby towns. One son was estranged from them. The other was somewhat involved in their lives, but he had a mentally ill wife and health problems of his own to deal with. The couple first came to the attention of a protective service worker when John was hospitalized after a fall. When left on her own, Lydia’s confusion became more pronounced. A referral was made for home care services, but, when a worker went out to assess the couple, their son was present and refused services. Based on concerns of benign neglect, a protective services report was issued. A caseworker investigated and substantiated the report, citing the son’s interference with services and the couple’s own inability to provide adequate care for each other. The protective services worker found both John and Lydia to be very forgetful and somewhat confused, though Lydia was more impaired. Due to their increased physical frailty, they had been using only the first floor of their home. Since the bedrooms and bathroom were upstairs, the living arrangement presented several problems for the couple. Lydia had a regular bed, but John was sleeping on a cot. The low height of the cot caused him to lose his balance easily, resulting in several falls. Since there was no toilet downstairs, they were using a bucket in the kitchen and emptying it outside. They were unable to maintain their home and conditions became unsanitary. The son tried to help, but he had his own limitations. The elderly couple was well able to afford assistance, but they did not want to spend the money. Furthermore, even though the son who helped with paying the bills was not taking advantage of his parents financially, he was obviously concerned with “preserving his inheritance.” Meanwhile, John and Lydia were extremely conservative in terms of how they chose to spend their money; they insisted they could not afford help.
.
Consider how classification can be applied.a. Research compl.docxzollyjenkins
Consider how classification can be applied.
a. Research completed research
studies
that have used classification.
b. Provide a brief summary that includes the type of study, its purpose, and its final conclusions.
c. Based on your research-based knowledge, provide your evaluation on the role of classification in the study's outcome.
d. Provide an APA formatted reference and a
.pdf
of the study.
Note: Paraphrase, cite, and reference per APA.
.
Consider experienced nurses you know or imagine the qualities requir.docxzollyjenkins
Consider experienced nurses you know or imagine the qualities required of nurses to be efficient at accomplishing their daily work. How do these nurses plan and organize their daily assignments? How do the more experienced nurses interact with other members of the health care team? Identify and list several management skills that help nurses accomplish their work more efficiently.
.
Consider Furos transformation in A. Igoni Barretts novel, Blackass.docxzollyjenkins
Furo undergoes a transformation in the novel Blackass. The document asks what Furo transformed out of and into, questioning whether he became a white man or something else, even other than human. It prompts critical thinking on what Furo was before and after his transformation, and to provide evidence from the text to support the claim.
consider a solution of Al(no3)3 in water. A)what ion pairs would be .docxzollyjenkins
consider a solution of Al(no3)3 in water. A)what ion pairs would be expected to form? write thier formulas B) would the activity of al3 be great or less than molar concentration? explain! C) as the solution is dilutes with water, how does the activity of al3+ ion change with respect to molar concentration? explain!
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consider a work of art (film, song, painting, play, novel, nonfictio.docxzollyjenkins
consider a work of art (film, song, painting, play, novel, nonfiction work) with a nature theme. Analyze the attitude toward nature that the work of art supports. Use many details to support and illustrate your point.
I. Choose an artwork with a nature theme.
II. Identify the attitude toward nature the work supports.
III. Provide details and examples to support the argument.
.
Consider a recent event, either in your personal life or in the news.docxzollyjenkins
Consider a recent event, either in your personal life or in the news. In a few sentences, describe a way that a past historical event could inform your understanding of the recent event. Briefly describe a strategy for how you could be conscious of presentism (the use of modern values to interpret past events) in the study of those past events.
.
Consider a community that you are familiar with. What issuesthre.docxzollyjenkins
Consider a community that you are familiar with. What issues
threaten the ability for that community to thrive? (Links to an external site.)
Refer to the sample topics page to help choose an issue, if you need some guidance. You will be providing context/background for the topic as well as evaluating strategies, models, programs, or initiatives associated with it. Do these strategies or programs work? Examine the challenges and successes. Develop an argument for "best practices or solutions". the issue can be related to these -
Suggested Paper Ideas:
Cosmopolis: local cultures, globalization, diaspora
Cultural, heritage (or traditional) preservation
Architectural erasure & preservation of communities, landscape, communities
The meaning of cultural sustainability and sustainable heritage development
Belonging and identity: their environmental, economic, and social significance
Changing patterns and cultures of consumption
Women and men, children and the elderly, families and sustainability
Cultural dimensions of childbearing and population growth
Cultural tourism & impacts to local economy
Indigenous peoples: self-government, self-management, and cultural autonomy
Indigenous knowledge and traditional practices of sustainability: broadening the scope of valid knowledge
Equity, Diversity, & Social Justice
Gender and sustainability
Poverty and its eradication
Health in its environmental, cultural, economic, and social contexts (social determinants of health)
Prison System & Recidivism
Environmental preservation -land, culture, identity
Urbanization and the sustainability of human settlement & gentrification
Self -determination & cooperative economics
.
Connect the story of Pinocchio with the characteristics of Italian n.docxzollyjenkins
Connect the story of Pinocchio with the characteristics of Italian nationalism. How does the story reflect Italian culture? Describe how the original story differs from what you expected.
How Giuseppe Verdi's Music Helped Bring Italy Together" opens in a new window
, via
BBC
https://www.nytimes.com/2019/05/10/books/review/pinocchio-carlo-collodi-lorenzini.html
2 paragraphs
.
Consent, Confidentiality, and Privileged Communication can be tr.docxzollyjenkins
Consent, Confidentiality, and Privileged Communication can be tricky concepts in the profession of counseling particularly when working with minors. FIRST, define each term. SECOND, review the two vignettes below address points A and B below. I expect you all to have healthy debate around these issues.
You may need to review laws in the state where you hope to practice as the "age of consent" may vary by state based on the chronological age of the child and/or the reason why they are seeking treatment.
1. Susie (16-years-old) and Susie’s parents came in to discuss treatment with LMFT Mark. LMFT Mark reviewed his standard informed consent with both Susie and her parents, including a section on confidentiality which briefly mentioned reasons for a breach of confidentiality including “harm to self.” After the third session, Susie admitted to LMFT Mark that she was sexually active with a few different people in her high school, and that she smoked marijuana on weekends. LMFT Mark determined that this did not rise to the level of “harm to self” worthy of a breach of confidentiality but instead he would work with her clinically. After the fifth session, she told LMFT Mark that she had been “cutting” but never near an artery. LMFT Mark again determined not to breach confidentiality. After the seventh session, Susie told LMFT Mark that she had been drinking heavily, and had started blacking out at parties, waking up in strange beds (clearly having had sexual intercourse). LMFT Mark decided to tell Susie’s parents about the drinking and blackouts.
2. LMFT Mable has been seeing Davey (5-years-old) for almost a year. Throughout the treatment, Davey has talked about his relationship with his parents and how their divorce makes him sad. Davey has indicated that while he loves his Mom, he likes spending time with his Dad more because his Dad doesn’t yell at him as much and Mom seems to always “be out.” Recently, Mom has called LMFT Mable and asked for a copy of Davey’s file so she can “use it in the custody battle.” LMFT Mable is not sure whether she is legally mandated to turn over the file to Mom. Also, she recently received a subpoena from Dad’s attorney for Davey’s file. LMFT Mable is not sure if she can legally or clinically should turn over the files.
A. Discuss whether or not, in your opinion, the therapist’s conduct is appropriate in the context of any and all laws, regulations, and ethical standards that may apply.
B. Explore any other options that are available to the therapist and any potential consequences of those options. Indicate what you believe to be the best course of action, in light of the applicable laws, regulations, and ethical standards.
.
Connecting Knowledge with Research in Case StudiesTolulope Mos.docxzollyjenkins
Connecting Knowledge with Research in Case Studies
Tolulope Moses
6200 WEEK 8 Assignment
Connecting Knowledge with Research in Case Studies
Introduction
One of the core elements of social work is the comprehensive assessment of a situation in a case which aids in developing effective interventions. In this regard, the understanding and application of knowledge are imperative in making the most profound decisions. In cases involving adolescents, among the most important knowledge is that on human behavior and social environment which is described as understanding how people relate to their environment including social interactions and relationships. According to Zastrow and Kirst-Ashman (2016), it is important to set realistic goals with the client consistent with the needs and requirements while applying obtained knowledge to implement the developed interventions. This paper entails a case study on Eboni Logan, proposed goals, and relating it with a peer-reviewed article.
Eboni Logan Case
The case used in this project is that of Eboni Logan, a 16-year-old biracial African American/Caucasian female who is two months pregnant. Eboni lives with her mother Darlene, and grandmother, May. She has been working at a fast food restaurant for 10 hours per week. Eboni has a boyfriend named Darian with whom they have been engaging in sexual activities without contraceptives. Both Eboni and Darian have no criminal records nor do they manifest alcohol or drug abuse although they take these elements occasionally. While Eboni’s mother works as an administrative assistant at a local manufacturing company, her father is a mechanic who supports Ebony through social and financial wellbeing. Eboni has recently learned she is pregnant, an aspect that introduces a number of problems for her and the social environment.
Case Problems
The case problems involve Eboni’s pregnancy. First, all her social environment including the grandmother and mother are upset with the situation. Her mother in particular hurled insults while calling her a slut. Her father was also upset although he agreed to provide her with a place to stay. The first challenge in this regard entails the broken relationship with her social environment and especially her mother. The second challenge is that Darian, who is the child’s father, states that he is not ready to support the baby and although he has not mentioned it explicitly, he prefers an abortion which Eboni does not want. The issue in this regard is how Eboni will nature her pregnancy and the baby yet she is still an adolescent and at school which might be forced to terminate for the moment. In addition, it may be worrying about how she will live with her father and stepmother considering the situation.
Goals
The goals, in this case, are informed by the above-identified problems and Eboni as the main client in the situation. The first goal would entail re-establishing the relationship with her social environme.
Conjecture Every card that has an even number on one side is .docxzollyjenkins
Conjecture: Every card that has an even number on one side is red
on the other side.
Which cards does one have to turn over to find out whether the
conjecture is true?
PHIL 110; Spring 2020; Lecture 15 1
Every card has a colour on one side and a number on the other.
Is this a valid inference?
Premise: Every person at the party was a twentysomething.
Conclusion: Every person at the party who was wearing a jacket was
a twentysomething.
Valid! Not valid!
PHIL 110; Spring 2020; Lecture 15 2
13: Everything
PHIL 110; Spring 2020; Tom Donaldson
Things to be getting on with
• Take it easy – relax after the midterm.
• There will be an assignment next week.
PHIL 110; Spring 2019; Lecture 13 4
1: Beyond Statement
Logic
Beyond Statement Logic
• There are certain inferences which cannot be adequately
evaluated using the tools we’ve discussed so far.
• Let’s look at some examples.
PHIL 110; Spring 2020; Lecture 15 6
Tense Logic
Premise: Ashni will swim and Ben will swim, but Ashni won’t
swim while Ben swims.
Conclusion: Either Ashni will swim and then Ben will, or Ben will
swim and then Ashni will.
PHIL 110; Spring 2020; Lecture 15 7
Deontic Logic
Premise: You may have coffee.
Premise: You may have tea.
Conclusion: You may have coffee and tea.
Premise: C
Premise: T
Conclusion: (C & T)
PHIL 110; Spring 2020; Lecture 15 8
The Logic of Quantification
Premise: Every dog is a mammal.
Premise: Fido is a dog.
Conclusion: Fido is a mammal.
PHIL 110; Spring 2020; Lecture 15 9
We’ll focus on the logic of quantification …
• Tense isn’t relevant in (pure) mathematics.
• Deontic notions (such as obligation and permission) are also not
relevant.
• But “every” is everywhere in mathematics!
• Every natural number has a unique prime factorization.
• Every polynomial of degree three has a real root.
• Every polynomial is differentiable.
• The negation of an “every” statement is equivalent to a “some”
statement.
• So we’ll focus on “every” and “some”.
PHIL 110; Spring 2020; Lecture 15 10
2: Introducing “Every”
Universal Generalizations
Universal generalizations in English often contain the word “every”, or
“everything” or “everyone”, or “any”, or “all”:
• Every whale is a mammal.
• Everything is broken.
• All dogs are hairy.
But there are exceptions:
• Dogs have four legs.
• A bear is a mammal.
• Man is born free, but everywhere he is in chains.
PHIL 110; Spring 2020; Lecture 15 12
The Need for Symbols
Compare:
• A bear is a mammal.
• A bear goes through my trash can every night.
As we said earlier in the term, English is extremely complicated, so
in logic we need to use artificial symbols instead.
We won’t introduce any new symbols today, however.
PHIL 110; Spring 2020; Lecture 15 13
Strict vs. Loose
• There are two sorts of universal generalization – strict and loose.
• Strict: “Every single dog without exception is a mammal.”
• Loose: “Dogs have four legs.”
• A s.
Congress and the Presidency An Unequal RelationshipThe .docxzollyjenkins
Congress and the Presidency: An Unequal Relationship?
"The tyranny of the legislature is really the danger most to be feared, and will continue to be so for many years to come. The tyranny of the executive power will come in its turn, but at a more distant period."
- Thomas Jefferson
In 1783 American colonists, defying incredible odds, had just beaten the United Kingdom, western hemisphere's preeminent power, in the
American War for Independence
. (NPS.gov, n.d.) Now, these thirteen colonies, saddled with a new governmental charter, the onerous
Articles of Confederation
, sought to chart their own, independent path. (Gilderlehrman, n.d.) As a result, in 1787 disgruntled colonists sent delegates to Philadelphia in order to revise the dysfunctional Articles of Confederation. Yet, in a radical departure, most delegates decided not to amend the current constitution, but instead to craft a new Constitution. (OConnor & Sabato, 2019)
During the four month Constitutional Convention the delegates readily agreed upon James Madison’s basic premise of a new, United States government delineated along three branches: legislative, executive, and judicial. That said, most delegates envisioned a strong legislative body and a weak executive office. (Maier, 2011)
Today, many historians and political scientists argue that the institution of the presidency has dramatically increased in power since the end of WWII at the expense of Congress.
This notion of a modern, expansive presidential power, stands in steadied contrast to Congress’ Constitutional ability to “check” the executive branch.
The U.S Congress has three, broad powers that, as per the founding fathers, act as a “check” against the executive branch:
Lawmaking Power. Only Congress can propose and pass legislation.
An example of Congress’s lawmaking function is the
Declaration of War with Japan of 1941
. More information about Congress’s ability to declare war can be found on the official
House of Representatives’ website
.
Budgetary Power. Only Congress has the authority to pass and fund the federal budget. Whereas the president request monies for the federal bureaucracies, Congress actually controls the purse strings.
An example of Congress’s budgetary function is the
Congressional Budget Act of 1974
. More information about the Congressional Budget Act of 1974 can be found on the official
House of Representatives’ website
.
Oversight Power. As per Whitehouse.gov, “Oversight of the executive branch is an important Congressional check on the President’s power and a balance against his discretion in implementing laws and making regulations. A major way that Congress conducts oversight is through hearings. The House Committee on Oversight and Government Reform and the Senate Committee on Homeland Security and Government Affairs are both devoted to overseeing and reforming government operations, and each committee conducts oversight in its policy area.” (Whitehouse, .
Congratulations! The members of the United Nations found great value.docxzollyjenkins
Congratulations! The members of the United Nations found great value in the two analyses you provided. They are now asking you to develop a PowerPoint presentation that addresses the four most critical threats to the global environment. They are listed in the table below.
Energy sources
Civil war
Globalization
Poor health of entire populations
Lack of educational opportunities
Cultural taboos
Inappropriate uses of technology
Climate change
To complete this task, you must do the following:
Step I. Narrow the List from Eight to the Four Most Critical Threats
To complete this step, complete the following tasks in order:
Review research on each of the eight threats listed in the table.
Determine what you believe to be the current and potential future impacts of each threat on the global environment.
Choose the four threats that you see as the most critical by considering which pose the greatest or most immediate risk to us.
Step II. Create the PowerPoint Presentation
The completed version of this presentation will include a minimum of
19 slides.
Your audience consists of the United Nations General Assembly.
PPT Content and Structure
1.
A Title Slide
: Include your name, course title, current date, and the name of your instructor.
2.
An Introduction Slide
: List the four threats you chose, and in the Notes section offer a brief narrative justifying these choices
3.
Body Slides:
The slide content is listed in the outline below. For each body slide you develop, please include a paragraph in the Notes section explaining how the details you have provided in the slide are pertinent to the United Nations’ discussion on selecting and prioritizing goals.
I.
For your first threat
(this is the threat you consider to be the greatest risk/highest priority)
a. One slide on a brief history and assessment of the threat
b. One slide on the countries most affected by the threat, and how those countries are affected (please give examples)
c. One slide on the effects of this threat on the world population as a whole
d. One slide including a chart, graph, or compelling visual that relates to the content you present in body slides a–c
II.
For your second threat (this is the threat you consider to be the second greatest risk/second highest priority)
One slide on a brief history and assessment of the threat
One slide on the countries most affected by the threat, and how those countries are affected (please give examples)
One slide on the effects of this threat on the world population as a whole
One slide including a chart, graph, or compelling visual that relates to the content you present in body slides a–c
III.
For your third threat (this is the threat you consider to be the third greatest threat/highest priority)
a. One slide on a brief history and assessment of the threat
b. One slide on the countries most affected by the threat, and how those countries are affected (please give examples)
c. One .
MATATAG CURRICULUM: ASSESSING THE READINESS OF ELEM. PUBLIC SCHOOL TEACHERS I...NelTorrente
In this research, it concludes that while the readiness of teachers in Caloocan City to implement the MATATAG Curriculum is generally positive, targeted efforts in professional development, resource distribution, support networks, and comprehensive preparation can address the existing gaps and ensure successful curriculum implementation.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Complete a case analysis of Avon Corporation A formal, in-depth .docx
1. Complete a case analysis of Avon Corporation
A formal, in-depth case analysis requires you to utilize the
entire strategic-management process. Assume your group is a
consulting team asked by Avon Corporation to analyze its
external/internal environment and make strategic
recommendations. You will be required to make
exhibits/matrices to support your analysis and
recommendations. The case analysis must encompass 10–12
pages plus the exhibits/matrices, cover page, and reference
page. The cover page must include the company name, your
group name, and the date of submission. The matrices must not
be part of the analysis body but exhibits.
The completed case must include:
Executive summary;
Existing vision, mission, objectives, and strategies;
SWOT analysis;
Porter's 5 Forces;
Value Chain Analysis;
Financial Ratio Analysis;
Balance Score Card;
Intellectual Assets: Human Capital, Social Capital, Technology;
Organizational Design;
A list of alternative strategies, giving advantages and
disadvantages for each;
A recommendation of specific strategies and long-term
objectives;
An action timetable/agenda.
Have your group leader place the results of the case analysis in
a single document and post it to the Group Case Analysis 2
forum of your Group Discussion Board Forum. Be sure that the
assignment is in a business-professional format; include current
APA citing and referencing.
2. Research Article
CHOICES-TEEN: Reducing Substance-
Exposed Pregnancy and HIV Among
Juvenile Justice Adolescent Females
Danielle E. Parrish
1
, Kirk von Sternberg
2
, Laura J. Benjamins
3
,
Jacquelynn Duron
4
, and Mary Velasquez
2
Abstract
Objective: The feasibility and acceptability of CHOICES-
TEEN—a three-session intervention to reduce overlapping risks
of
alcohol-exposed pregnancy (AEP), tobacco-exposed pregnancy
(TEP), and HIV—was assessed among females in the juvenile
justice system. Method: Females aged 14–17 years on
community probation in Houston, TX, were eligible if
presenting with
aforementioned health risks. Outcome measures—obtained at 1-
3. and 3-months postbaseline—included the Timeline Followback,
Client Satisfaction Questionnaire-8, session
completion/checklists, Working Alliance Inventory–Short, and
open-ended ques-
tions. Twenty-two participants enrolled (82% Hispanic/Latina;
mean age ¼ 16). Results: The results suggest strong
acceptability
and feasibility with high client satisfaction and client/therapist
ratings, 91% session completion, and positive open-ended
responses. All youth were at risk at baseline, with the following
proportions at reduced risk at follow-up: AEP (90% at
1 month, 71.4% at 3 months), TEP (77% of smokers [n ¼ 17] at
reduced risk at 1 month, 50% at 3 months), and HIV (52.4% at
1 month, 28.6% at 3 months).
Keywords
adolescent, HIV infections, alcohol, juvenile justice, substance-
exposed pregnancy
Adolescent females detained or on probation in juvenile justice
settings often engage in multiple health behaviors that place
them at risk of HIV and substance-exposed pregnancies
(Lawrence, Snodgrass, Robertson, & Baird-Thomas, 2008;
Rosengard et al., 2006). Specifically, they engage in frequent
sexual behaviors that put them at risk of unplanned pregnancy,
sexually transmitted infections (STIs; Belenko et al., 2008),
and HIV (Committee on Pedatric AIDS, 2006) while also
smoking (Helstrom, Bryan, Hutchison, Riggs, & Blechman,
4. 2004) and engaging in alcohol use (Lawrence et al., 2008),
which further place them at risk of both tobacco-exposed preg-
nancy (TEP) and alcohol-exposed pregnancy (AEP; Delpisheh,
Attia, Drammond, & Brabin, 2006; Helstrom et al., 2004).
There are well-documented health consequences of smoking
and drinking during pregnancy for both female youth and the
fetus (Delpisheh et al., 2006; Kulig, 2005; Wiemann &
Berenson, 1998). While many cease alcohol or cigarette use
after discovering they are pregnant (Forray, Merry, Lin, Ruger,
& Yonkers, 2015), nearly half of the U.S. pregnancies are
unplanned (Finer & Zolna, 2016) with females unaware of their
pregnancy continuing to drink or smoke during the early and
critical weeks of gestation. Compared with adult women, ado-
lescents are more likely to have an unplanned pregnancy, take
longer to recognize they are pregnant (De Genna, Larkby, &
Cornelius, 2007), and are less likely to reduce alcohol or
tobacco consumption once they find out they are pregnant
(Cornelius et al., 1994), putting them at higher risk of TEP or
5. AEP. These pregnancies are also at risk for mother-to-child
HIV or STI, as many of these youth may not seek early or
regular prenatal care (CDC, 2018a).
The association between substance use and STI/HIV sexual
risk behavior among youth is well-documented, with younger,
female, and racially/ethnic minority populations at highest risk
of HIV infection through heterosexual contact (CDC, 2018b;
Howard & Wang, 2004). Co-occurring substance use and sex-
ual risk behaviors are more pronounced among juvenile justice
populations, with females in these settings presenting with a
unique, multirisk profile (Rosengard et al., 2006; Teplin,
Mericle, McClelland, & Abram, 2003). While nationally rep-
resentative samples are generally lacking for this population,
1 Baylor University, Houston, TX, USA
2
University of Texas at Austin, Austin, TX, USA
3
University of Texas Mc Govern Medical School, Houston, TX,
USA
4 Rutgers University, The State University of New Jersey, New
6. Brunswick, NJ,
USA
Corresponding Author:
Danielle E. Parrish, Baylor University, 4100 Main St., Houston,
TX 77002, USA.
Email: [email protected]
Research on Social Work Practice
2019, Vol. 29(6) 618-627
ª The Author(s) 2018
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several trends have been identified in the literature. Alcohol use
and smoking are more prevalent and comorbid among females
in criminal justice settings (Helstrom et al., 2004; Parrish et al.,
2011), with delinquent adolescent females reporting more fre-
quent smoking than males and nearly a third meeting clinical
7. criteria for a substance use disorder (Cropsey, Linker, & Waite,
2008; Domalanta, Risser, Roberts, & Risser, 2003; Helstrom
et al., 2004; Lederman, Dakof, Larrea, & Li, 2004). In addition,
most (90%) are sexually active and less than half use condoms
or contraception (Crosby et al., 2004; Kingree, Braithwaite, &
Woodring, 2000; Lawrence et al., 2008; Teplin et al., 2003).
Approximately a third of female youth in these settings have
previously been pregnant one or more times (Lawrence et al.,
2008; Lederman et al., 2004; Schmiege, Broaddaus, Levin, &
Bryan, 2009). Compared with community female youth sam-
ples, this population engages in earlier and more frequent
sexual risk behavior with multiple partners (Lederman
et al., 2004).
Females in juvenile justice settings are also consistently at
high risk of STIs and sexually transmitted HIV compared to
their noninvolved peers and at an even higher risk than their
male involved counterparts (Belenko et al., 2008), reporting
less frequent condom use (Belzer et al., 2001; Broaddus &
Bryan, 2008; Committee on Pedatric AIDS, 2006; Kelly,
8. Lesser, & Paper, 2008; Robertson, Stein, & Baird-Thomas,
2006) and more frequent acquisition of STIs placing them at
further risk of HIV infection (CDC, 2018a).
Despite this population’s unique, multirisk health profile
and the critical opportunity to intervene while youth are on
community probation, there is a paucity of gender-specific
prevention programming to reduce these risks (DiClemente
et al., 2014; Lawrence et al., 2008). This presents a challenge
for prevention and highlights an urgent need to develop effica-
cious, gender-specific, multirisk “bundled” (targeting more
than one behavior) prevention approaches for this vulnerable
population (Belenko et al., 2008; Committee on Pediatric
AIDS, 2006; Ickovics, 2008). Bundling efficiently aggregates
services to promote synergistic gain when intervening with
high-risk populations that do not routinely seek services
(Ickovics, 2008) and is increasingly being used in medical or
other opportunistic settings. While not yet tested with adoles-
cents, a bundling (Ickovics, 2008; Parrish et al., 2011) or
9. multiple-behavior approach (Geller, Lippke, & Nigg, 2017;
Nigg, Allegrante, & Ory, 2002) has shown promise in more
efficiently reducing health risk behavior (Werch, 2007). There
is a need, however, to conduct research to better understand
which and how many behaviors can be bundled and for which
target populations (Werch, 2007).
The CHOICES Line of Research
and CHOICES-TEEN
One possibility to meet these overlapping needs among the
female juvenile justice population is to adapt an existing
empirically supported prevention intervention for adult women
called the CHOICES preconception intervention. This
intervention utilizes the transtheoretical model of behavior
change, motivational interviewing (MI), and content aimed to
increase participants’ motivation to change risky alcohol use,
smoking, and contraception use, along with a referral for con-
traception education and services (Velasquez, von Sternberg, &
Parrish, 2013). The need for the CHOICES intervention and its
10. efficacy has been demonstrated through a line of epidemiolo-
gical and intervention research funded by the Centers for Dis-
ease Control and Prevention (CDC; Floyd et al., 2007; Project
CHOICES Intervention Research Group, 2003; Velasquez
et al., 2017). In the first multisite randomized controlled trial
testing the efficacy of a four-session version of CHOICES
among high-risk women of childbearing age (18–44), the
CHOICES intervention group, relative to a brief advice group,
significantly reduced their risk of AEP (69.1% vs. 54.3%) and
had 2-fold greater odds of being at reduced risk of AEP at
9 months (Floyd et al., 2007). This intervention has been
broadly disseminated to the public, with the original manual
and related training materials available on the CDC website
(https://www.cdc.gov/ncbddd/fasd/choices-implementing-choi
ces.html). This first aforementioned efficacy study highlighted
the need (and opportunity) to also prevent nicotine-exposed
pregnancies, as more than 70% of those at risk of AEP were
also smoking (Floyd et al., 2007). Analysis of study data also
indicated that women receiving two sessions were as likely to
11. reduce their risk of AEP as those receiving four. Consequently,
a second efficacy trial was funded by the CDC to test a two-
session version of CHOICES, called CHOICES Plus, that
would also focus on reducing the overlapping risk of TEP
within a large, public medical setting (Velasquez et al.,
2017). This study also supported the efficacy of CHOICES Plus
in significantly reducing the risk of both AEP and TEP among
women aged 18–44 years compared to a brief advice group
(Velasquez et al., 2017).
CHOICES-TEEN was adapted from the original CHOICES
and CHOICES Plus preconception interventions to be devel-
opmentally appropriate for adolescent females and reduced
HIV/STI risk in addition to reducing risks of AEP and TEP
(Floyd et al., 2007; Project CHOICES Intervention Research
Group, 2003; Velasquez et al., 2010; Velasquez et al., 2017).
CHOICES-TEEN builds upon the CHOICES line of research
by expanding the reach of this intervention to high-risk adoles-
cent females who are—compared to adult women—more
12. likely to have an unplanned pregnancy, take longer to realize
they are pregnant, and less likely to stop using substances once
they realize they are pregnant (Cornelius et al., 1994; Cnattin-
gius, 2004; De Genna et al., 2007). This intervention, which
will be described in more detail in the Methods section, con-
sists of two sessions with a master’s level counselor, a session
with an adolescent medicine specialist to discuss HIV/STI and
pregnancy prevention, possible referral for HIV/STI testing
and contraceptive services, and a referral to a phone-based
smoking cessation program called the Texas Quitline. The
intervention was delivered to female youth on intensive juve-
nile community probation.
Parrish et al. 619
https://www.cdc.gov/ncbddd/fasd/choices-implementing-
choices.html
https://www.cdc.gov/ncbddd/fasd/choices-implementing-
choices.html
The aims of this one-arm pilot study were to further under-
stand the feasibility of targeting multiple bundled health risks
13. in high-risk adolescents as well as to evaluate the feasibility
and potential promise of an adapted gender-specific prevention
intervention—CHOICES-TEEN—in reducing the risks of
HIV/STI, TEP, and AEP among adolescent females on com-
munity probation.
Materials and Method
Following Stage 1a/1b intervention development guidelines
(Rounsaville, Carroll, & Onken, 2001), a one-arm design was
used to assess the reductions of risk (among an all-risk sample
at baseline) following the CHOICES-TEEN intervention at 1-
and 3-month follow-up. Supplemental data were collected to
assess client adherence, retention, acceptability, and the feasi-
bility and quality of treatment delivery. Data were collected by
research assistants trained in the study protocol. This study was
approved by the Harris County Juvenile Justice, University of
Houston and University of Texas Health Science Center at
Houston Institutional Review Boards.
Female adolescents aged 14–17 years were recruited from
14. three community probation programs in Houston, TX. Youth
assent and the parent/guardian permission were obtained in
person or by phone to conduct eligibility screenings. To be
eligible, participants were at risk of HIV/STI, AEP, and TEP
and had all of the following behaviors in the prior 3 months:
(1) sexual intercourse with a male, (2) inconsistent/ineffec-
tive condom use, (3) inconsistent/ineffective contraception
use, (4) drinking at risky levels (>3 drinks in 1 day or >7
drinks in a week), and (5) current smoking. Given that this
was a feasibility study, and the initial recruitment numbers
were lower than expected, the smoking inclusion criterion
was relaxed after 6 months to ensure an adequate sample.
Of the 150 females screened, 31 (21%) were at risk of both
AEP and TEP and 37 (25%) at risk of AEP. If eligible, the
voluntary nature and details of the study were described to
the youth and guardian using IRB-approved assent and per-
mission documents, questions were elicited and answered,
and written informed consent was obtained from youth and
parent/guardians prior to study participation. As shown in
15. Figure 1, three (8.1%) declined participation and six
(16.2%) did not return to the site for various reasons (e.g.,
additional criminal charges and noncompliance with the pro-
gram). Of the 28 who returned for assent/parental permission
and baseline assessment, 2 were identified as ineligible, leav-
ing a pool of 26 from which 4 did not return for similar
aforementioned reasons. Of the 22 participants who started
the intervention, 20 completed all three sessions (91%) and 2
completed one session. One- and 3-month follow-up assess-
ments were obtained for all 21 of the 22 (95%) youth who
received the intervention. While two youth initiated the
smoking Quitline fax referral, none of them completed this
component of the program.
CHOICES-TEEN Intervention
CHOICES-TEEN was adapted from the original CHOICES
and CHOICES Plus preconception interventions to be devel-
opmentally appropriate for adolescent females and reduced
HIV risk (Floyd et al., 2007; Project CHOICES Intervention
Research Group, 2003; Velasquez et al., 2010, 2017). The effi-
cacy of the CHOICES and CHOICES Plus bundled preconcep-
16. tion interventions in reducing the risks of AEP and TEP among
adult women in high-risk settings has been established through
a series of CDC-funded studies (Floyd et al., 2007; Project
CHOICES Intervention Research Group, 2003; Velasquez
et al., 2017). CHOICES-TEEN builds upon this work by
expanding the reach of this intervention to high-risk adolescent
females. As shown in Table 1, CHOICES-TEEN includes two
motivational counseling sessions with a master’s level counse-
lor, one session with an adolescent medicine physician, and a
referral to the Texas Tobacco Quitline. The Quitline accepts
fax referrals from physicians of youth who are ready to quit
smoking. A Quitline counselor then assesses the youth for one
or more of the following referrals: telephone counseling,
community-based cessation services, and youth friendly smok-
ing cessation materials.
Master’s level counselors, previously trained for prior
CHOICES intervention studies, provided the counseling ses-
sions and were supervised by experts in MI and the CHOICES-
17. TEEN intervention. The majority of sessions (68.2%) were
provided by one of the three master’s level counselors, and
outcome did not differ by counselor at 3-month outcome. All
sessions were audio-recorded, and 15% were reviewed for
quality and fidelity using the Motivational Interviewing Integ-
rity Scale 3.1.1 and CHOICES-TEEN protocol checklist. All
counselors were deemed as proficient in the intervention by a
CHOICES expert who is also a member of the Motivational
Interviewing Network of Trainers. The adolescent medicine
physicians, who provided the second session focused on HIV
and pregnancy risk reduction education and the development of
a healthy behavior plan, received a 3-hr training on the use of
MI in a medical context and the CHOICES-TEEN protocol.
Measures
Demographic and background health variables. Demographic
and
background health variables, including sexual activity/risk
behaviors and substance use history/frequency, were collected
using an audio computer-assisted self-administered interview
(ACASI). The AUDIT, a 10-item questionnaire used to mea-
18. sure alcohol use and problems, was also used to describe the
sample with regard to harmful drinking (Babor, de la Fuente,
Saunders, & Grant, 1992).
Timeline followback interview (TLFB). The TLFB interview,
which
collected detailed self-report behavior data using a calendar
recall method, was administered by a trained interviewer at
baseline (i.e., 90 days prior), 1-month postbaseline follow-up,
and 3-month postbaseline follow-up (Floyd et al., 2007; Sobell,
620 Research on Social Work Practice 29(6)
Brown, Leo, & Sobell, 1996; Velasquez et al., 2017). Data
collected included number of daily alcohol drinks, sexual activ-
ity, condom use, effective contraception, and smoking. These
data were divided into 30-day increments to calculate the fol-
lowing: (1) risk drinking (>3 drinks in 1 day or >7 drinks in a
week), (2) risk of pregnancy (any occurrence of vaginal inter-
course without effective contraception including condoms), (3)
HIV risk (any occurrence of vaginal or anal sex without a
19. condom), (4) AEP risk (any occurrence of risk drinking plus
any occurrence of vaginal intercourse without effective contra-
ception during the same time period), and (5) TEP risk (any
smoking plus any occurrence of vaginal intercourse without
effective contraception during the same period).
Client Satisfaction Questionnaire–8 (CSQ-8). Client satisfaction
was measured using the CSQ-8 (Attkisson & Zwick, 1982).
This standardized measure consists of eight questions followed
by a 4-point Likert-type scale, with possible scores ranging
between 8 and 32, and higher scores indicating higher levels
of satisfaction. This questionnaire was administered, along
with five open-ended questions about the intervention, using
the ACASI in a private setting at the end of the 3-month follow-
Assessed for eligibility (n=150)
Excluded (n= 122)
♦ Not meeting inclusion criteria (n= 83)
■ No risk of pregnancy (n=83)
■ No sex (n=64)
■ No risk drinking (n=84)
■ No smoking (n=83)
♦ Declined to participate (n= 3)
20. ♦ Other reasons; program attrition (n= 6)
Lost to follow-up 1-month (n=1)
Lost o follow-up 3-months (n=0)
Allocated to intervention (n= 22)
■ Completed Counseling Session One (n=22)
■ Completed Adolescent Fellow Session (n=20)
■ Completed Counseling Session Two (n=20)
■ Accepted Smoking Referral (n=3)
■ Health Clinic Visit (n=7)
Program Attrition, Did Not Return
(n=4)
Found Ineligible at Baseline (n=2)
Returned for Parental
Permission/Assent (n= 28)
Figure 1. Study flow diagram.
Parrish et al. 621
up. The five open-ended questions solicited comments/sugges-
tions, what was liked about the intervention, what was liked
least about the intervention, suggestions for improvement, and
the most important aspects of the intervention.
Working-Alliance Inventory–Short (client/therapist). This
21. measure is
used to assess three key aspects of the therapeutic alliance—
agree-
ment on the goals of therapy, tasks of therapy, and the develop-
ment of an affective bond (Hatcher & Gillaspy, 2006). This
scale
consists of 12 items followed by a 7-point Likert-type scale,
which
ranges from never to always. This scale was administered to
both
the youth and the counselor at each of two counseling sessions.
Data Analysis
The Statistical Package for Social Sciences (SPSS Version 23)
was used to conduct all analyses. Descriptive statistics were
used to describe the sample, reductions in dichotomous risk of
AEP, TEP, and HIV among an all risk sample at baseline,
feasibility and acceptability measures, and responses to the
CSQ-8 at 3-month follow-up. Inferential statistics were not
used to assess behavior change, as all youth were considered
to be at risk of AEP, TEP, and HIV at baseline. A simple
thematic analysis was conducted of brief open-ended responses
22. concerning the acceptability of the intervention provided by the
youth when completing the CSQ-8 at 3-month follow up. These
questions asked about what was liked most and least about the
intervention and suggestions for improving the intervention.
Results
Participants ranged in age from 14 to 17, with a mean age of
16 years (SD ¼ .89). Eighty-two percent were Hispanic/Latina,
with 55% reporting Mexican origin. The sample was racially
Table 1. CHOICES-TEEN Intervention Session Components.
Session 1
Provided by Master’s Level
Counselor
Session 2
Contraceptive/HIV Risk
Reduction Counseling
Provided by Adolescent
Physician
Session 3
Provided by Master’s
Level Counselor
Smoking Cessation Referral
Provided by American
Cancer Society’s Texas
23. State Quitline, Which Serves
Adolescents 13 and Older
� Rapport building
� Review of fact sheets:
� Important things for young
women to know about alcohol,
smoking, pregnancy, and birth
control
� Important facts for young
women about HIV/STDs
� Abstinence or safer sex
� Introduce and encourage
contraceptive and HIV risk
reduction counseling visit
� Advice and referral to smoking
cessation program if currently
smoking
� Decisional balance for pros and
cons of
� Drinking
� Smoking
� Contraceptive use
� Condom use
� Complete Self-evaluation rulers
addressing readiness to change
drinking, smoking, condom use,
and contraception
24. � Introduce Daily Journal for drinking,
smoking, intercourse, and
contraception (including condoms)
� Brochures on alcohol, smoking,
HIV, contraceptive methods, and
community resources
� Summarize session
� Discuss and answer questions
about HIV transmission and
ways to reduce risk
� Determine appropriate and
suitable contraceptive
methods including the option
of abstinence
� Provide referral for HIV
testing at most convenient
testing site that provides
condoms
� Complete a healthy behavior
plan, which details plans/
referral for preventing
pregnancy and HIV
� Provide condoms if desired
(parental permission was
required by site)
� Provide follow-up clinical care
or referral as needed
25. � Provide personalized
feedback (derived from
baseline assessment)
� Discussion of
temptation and
confidence profiles for
all four behaviors
� Review and discussion
of information recorded
in the Daily Journal
� Discuss contraception
and counseling/HIV risk
reduction visit
� Review smoking
brochure and discuss
smoking cessation
referral (as applicable)
� Review of decisional
balance exercises for
each behavior
� Completion of initial
goal statement and
change plans for each
behavior
� Provide community
resource list (if
applicable)
� Summarize session
26. � Determine readiness to
change
� Provide behavioral counseling
for smoking cessation
Note. STDs ¼ sexually transmitted diseases.
622 Research on Social Work Practice 29(6)
diverse with 18% Black, 18% White, 9% American Indian/
native Hawaiian, 4.5% multiracial, and 27% reporting race
as Hispanic/Mexican American. The youth were all English
speaking. However, we did have a Spanish-speaking counse-
lor available to provide the intervention in Spanish if needed
and to communicate with Spanish-speaking parents/guar-
dians. Prior arrests ranged from 1 to 10 or more, with 59%
only having 1 or 2. Participants reported prior arrests for the
following reasons: 45% assault, 41% petty theft, 27% truancy,
22% possession of marijuana or other drugs, 18% running
away, and 14% trespassing. With regard to sexual orientation,
73% were heterosexual and 23% bisexual. All youth reported
using drugs in the last 6 months, and among those who
smoked, five were daily smokers. The mean AUDIT score
was 2.5 (SD ¼ 2.87).
27. Risk of AEP, TEP, and HIV/STI
Of the 22 participants who received the intervention, one did
not complete the follow-up assessments. Reduction of AEP,
TEP, and HIV risk was based on the frequency of youth in the
at-risk or reduced risk category based on the TLFB at each
follow-up period. Successful change was categorized as
“reduced risk” instead of “no risk” because all contraception
methods, including condoms, fail a certain percentage of the
time even with perfect use. As noted previously, these data
were divided into 30-day increments to calculate the presence
of combined or single risk behaviors within each time frame
over a continuous 7-month period: 3-month baseline (3
months prior to baseline), 1-month follow-up (from baseline
to 1 month later), and 3-month follow-up (from 1 month to 3
months postbaseline). AEP risk was defined as the presence of
risk drinking and risk of unplanned pregnancy during the
same time period, TEP risk was defined as any smoking plus
risk of unplanned pregnancy during the same period, and
28. HIV/STI risk as any occurrence of vaginal or anal sex without
a condom.
Ninety percent (n ¼ 19) of participants were at reduced risk
of AEP at 1 month, and 71.4% (n ¼ 15) were at reduced risk at
3 months. Using an intent-to-treat analysis (treating the drop
out as a failure), 86.4% were at reduced risk at 1 month and
68.2% were at reduced risk at 3 months.
Seventeen of the 22 (77%) participants were smokers and at
risk of TEP at baseline. Of those at risk at baseline, 68.8% (n ¼
11) were at reduced risk at 1 month and 50% (n ¼ 8) were at
reduced risk at 3 months. With the intent-to-treat analysis,
64.7% were at reduced risk at 1 month and 47.1% were at
reduced risk at 3 months. Of those who smoked at baseline,
71.4% reported currently smoking cigarettes at 1 month and
73.3% at 3 months.
All 22 participants who received the intervention were at
HIV/STI risk at the baseline. Fifty-two percent were at reduced
risk at 1 month, and 28.6% were at reduced risk at 3 months. Of
the 11 who were not at risk of unplanned pregnancy at
3 months, only 2 were not using condoms while sexually active
and using another contraceptive method. Using an intent-to-
treat analysis, 50% were at reduced risk for HIV/STI at 1 month
and 27.3% were at reduced risk at 3 months.
29. The route by which the youth reduced their AEP and TEP
risk is provided in Figure 2.
A = Used Effective Contraception/Abstinence A = Used
Effective Contraception/Abstinence
B= Reduced Risk Drinking Only B= Smoking Cessation Only
AB = Reduced Both Risks AB = Reduced Both Risks
AB
33.3%
(n=5)
B
26.7%
(n=4)
A
40%
(n=6)
B
36.8%
(n=7)
AB
42.1%
(n=8)
A
21.1%
(n=4)
Routes of Reduced AEP Risk
30. 1 month
3 months
Routes of Reduced TEP Risk
B
18.2%
(n=2)
AB
27.3%
(n=3)
A
54.5%
(n=6)
A
75%
(n=6)
AB
25%
(n=2)
B
(n=0)
Figure 2. Distribution of youth achieving reduced risk of
alcohol-exposed pregnancy and tobacco-exposed pregnancy at 1
month and 3 months.
Parrish et al. 623
31. Feasibility
The CHOICES-TEEN intervention checklist indicated that all
aspects of the intervention were delivered and that the sessions
did not exceed the planned 45- to 60-min duration. The
CHOICES-TEEN MI Scale, which assessed the degree to
which counselors believed they emphasized various aspects
of an MI approach, was rated as over a 4 on a 1–5 scale for
all items. CHOICES-TEEN counselors indicated per structured
session notes that all participants appeared to comprehend ses-
sion tasks. The average per-item mean for youth on the task
(M¼ 5.99, SD¼ .97), bond (M¼6.04, SD¼ .95), and goal (M¼
5.56, SD ¼ 1.12) subscales of the Working Alliance Inventory–
Short ranged between 5 (often) and 7 (always) on a 1–7 scale.
Participant Acceptance/Satisfaction With Intervention
All except one of the 22 youth enrolled in the intervention
completed all three sessions delivered on site at a weekly
community-based probation program. In response to the anon-
ymously administered CSQ-8 at 3-month follow-up, female
32. youth (n ¼ 20) reported high levels of satisfaction (M ¼ 24,
SD ¼ .71; average per-item mean ¼ 3) with the intervention,
with scores ranging from 23 to 25. Specifically, 60% described
the quality of services as “excellent” and 40% described the
services as “good.” Despite being a nontreatment seeking pop-
ulation, fifty-five percent of youth indicated that they
“definitely” received the service desired, with 45% indicating
they “generally” did. Sixty percent indicated “most” of their
needs have been met by the intervention, while 35% indicated
“almost all” of their needs were met, and one youth indicated
their needs were not met. All youth indicated they would refer a
friend in need of similar help to the program. Ninety-five per-
cent of youth reported being “mostly” or “very” happy with the
amount of help they received. With regard to overall satisfac-
tion, 65% reported being very satisfied, and 35% mostly satis-
fied. Ninety-five percent indicated they would return to the
program if they were to seek help again. Twenty of the 22
participants provided anonymous written feedback to the
open-ended questions that followed the CSQ-8. Responses
indicated that youth valued the opportunity to be honest in a
relational, confidential setting and that the counselors and doc-
tors provided useful information that they did not know or had
33. not considered. In particular, the youth appreciated the oppor-
tunity to have a conversation with a physician to obtain accu-
rate information about their options for preventing unplanned
pregnancy and HIV/STIs. Youth suggested the program may be
more successful if assistance was provided for transportation
and appointment setting with the health clinics. They also sug-
gested that the program expand to reduce the health and preg-
nancy risks associated with marijuana and other drugs.
Discussion
This one-arm feasibility study suggests that the CHOICES-
TEEN intervention is feasible, acceptable, and promising with
regard to reducing the risk of AEP, TEP, and HIV/STI among
female youth involved with the juvenile justice system. The
retention of youth who began the intervention was 91% for all
three sessions, and youth reported feeling positively about the
intervention, suggesting that the intervention was acceptable.
With regard to feasibility, all intervention components were
completed with ease within the designated session time frames.
34. Taken together, these findings suggest that it is feasible to
target multiple health-risk behaviors (smoking, risk drinking,
contraception use, and condom use) simultaneously with this
high-risk population. However, future research with a control
group will be necessary to test the efficacy of this intervention.
The reductions in risk of AEP were comparable to reduc-
tions of risk found in CHOICES intervention studies with
women (Floyd et al., 2007; Velasquez et al., 2017). With regard
to TEP, the reduction of risk was 50% in this study and 69.8%
in the CHOICES Plus study (Velasquez et al., 2017). However,
this sample only included five youth reporting daily smoking,
suggesting many of these youth may be engaging in light and
intermittent smoking which often mistakenly perceived by
youth as less harmful or addictive (Amrock & Weitzman,
2015). This may be one of the reasons that few youth accepted
and followed up with the smoking cessation referral. In addi-
tion, open-ended feedback from the youth suggested that smok-
ing was a temporary replacement for marijuana, while they
were being randomly drug tested by probation. This suggests
35. a need to better understand the patterns of smoking and mar-
ijuana use among high-risk females in these settings for pur-
poses of preventing substance-exposed pregnancy.
The proportions of youth reducing HIV/STI risk at 3-month
follow-up were not as high compared to AEP and TEP, which
is not surprising as there is only one way to reduce this risk—
condom use. While it is most ideal that youth reduce their risk
of pregnancy by either abstinence or using both condoms and
other contraceptive methods, it is encouraging that the large
majority of youth who reduced their risk of pregnancy in the
study were using condoms, which protect against both
unplanned pregnancy and HIV/STIs. In addition, HIV/STI pre-
vention research with juvenile justice populations has generally
resulted in more modest effect sizes for behavioral change
(Tolou-Shams, Stewart, Fasciano, & Brown, 2010), highlight-
ing a need to develop more robust interventions.
Despite encouraging findings, these results should be inter-
preted with some caution, given the small sample size and lack
36. of a control group. Also, while self-report measures are a major
data source for clinical and resource purposes, they have been
criticized for potential bias. However, retrospective self-reports
of behavior collected in settings which minimize these poten-
tial biases have been shown to be reliable and valid. Still, future
research would benefit by incorporating biological measures
that further substantiate self-report. Finally, given feedback
from the youth and the providers, it may be useful to expand
the CHOICES-TEEN model to incorporate marijuana and other
drugs as well as to explore the utility of providing all of the
aspects of the intervention in a postadjudication placement
624 Research on Social Work Practice 29(6)
setting to reduce client transportation challenges and the time
commitment for travel of providers.
Implications for Practice and/or Policy
Given the limited research on gender-sensitive interventions
with female youth in juvenile justice settings, this research
37. highlights several implications for practice and policy. First,
this is the first study to report on the prevalence of substance-
exposed pregnancy in a sample of female youth in the juvenile
justice system. Of the 150 youth screened, 25% were at risk of
AEP in this study, which is much higher than the 3.4% at risk in
the general population (Cannon et al., 2015). This finding,
combined with the aforementioned literature documenting
these overlapping risks in multiple, larger samples of female
youth, suggests an urgent need for interventions and/or policy
to reduce these risks. Specifically, programming should be
provided that informs female youth of these risks as well as
efficient, prevention interventions that have promise for broad
prevention impact. AEP is 100% preventable, has been recently
estimated to be more prevalent than autism (May et al., 2018),
and can lead to costly lifelong cognitive, behavioral, emotional,
and adaptive functioning deficits. Smoking and HIV/STIs can
also severely affect the health of both female youth and their
children both during and after pregnancy (e.g., second-hand
smoke; HHS, 2014; Delpisheh et al., 2006; Kulig, 2005; Wie-
38. mann & Berenson, 1998). As such, the development of and
funding for early prevention programs for one of the society’s
highest risk populations that rarely receives integrated health
care are essential.
Second, this study suggests integrated, multirisk bundled
motivational enhancement interventions provided at opportu-
nistic times can be feasible, acceptable, and potentially promis-
ing for female youth in the juvenile justice system. As such,
programs that focus on more than just one risk behavior during
times of detention or community probation may be more effi-
cient and cost-effective. Finally, youth appreciated the oppor-
tunity to receive individualized information about their sexual
health and substance use in an accepting and supportive con-
text. Such efforts can be further bolstered by ensuring better
access to referrals by providing transportation to follow-up
medical visits, as this can be a major service barrier for this
population. Finally, none of the youth in this study accepted the
incoming smoking cessation Quitline referral phone calls. As
39. such, nontelephonic options, such as the U.S. Health and
Human Service’s QuitSTART technology application, may
be a better fit for some youth.
Conclusions
CHOICES-TEEN is acceptable and feasible and appears pro-
mising for reducing overlapping, bundled health risks—AEP,
TEP, and HIV—among high-risk female youth in juvenile jus-
tice settings. Given the potential for impacting multiple, over-
lapping health risks in an opportunistic manner, future research
should examine the efficacy of this intervention with a more
robust sample.
Acknowledgments
Harris County Juvenile Probation provided essential support of
this
project by facilitating essential partnerships and space in the
field.
Robin Harris provided coordination of the project in the field,
and
Barbie Atkinson, Matiko Bivens and Lisa Connelly were the
CHOICES-TEEN counselors. Rebecca Beyda, M.D. and Laura
40. Grubb M.D., provided the Adolescent Medicine risk reduction
coun-
seling sessions. Alicia Kowalchuk, M.D. provided Motivational
Interviewing training for the Adolescent Medicine Fellows, and
Nanette Stephens provided fidelity monitoring and training for
the
CHOICES-TEEN counselors. Ralph DiClemente, Ph.D. and
Carrie
Randall, Ph.D. provided consultation to support the
implementation
of this project.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with
respect to
the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support
for the
research, authorship, and/or publication of this article: This
study was
funded by Grant Number 1R03DA034099 from the National
Institute
41. of Drug Abuse, National Institutes of Health.
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Research Article
CHOICES-TEEN: Reducing Substance-
Exposed Pregnancy and HIV Among
Juvenile Justice Adolescent Females
Danielle E. Parrish1, Kirk von Sternberg2, Laura J. Benjamins3,
Jacquelynn Duron4, and Mary Velasquez2
Abstract
Objective: The feasibility and acceptability of CHOICES-
TEEN—a three-session intervention to reduce overlapping risks
of
alcohol-exposed pregnancy (AEP), tobacco-exposed pregnancy
(TEP), and HIV—was assessed among females in the juvenile
justice system. Method: Females aged 14–17 years on
community probation in Houston, TX, were eligible if
presenting with
aforementioned health risks. Outcome measures—obtained at 1-
and 3-months postbaseline—included the Timeline Followback,
64. Client Satisfaction Questionnaire-8, session
completion/checklists, Working Alliance Inventory–Short, and
open-ended ques-
tions. Twenty-two participants enrolled (82% Hispanic/Latina;
mean age ¼ 16). Results: The results suggest strong
acceptability
and feasibility with high client satisfaction and client/therapist
ratings, 91% session completion, and positive open-ended
responses. All youth were at risk at baseline, with the following
proportions at reduced risk at follow-up: AEP (90% at
1 month, 71.4% at 3 months), TEP (77% of smokers [n ¼ 17] at
reduced risk at 1 month, 50% at 3 months), and HIV (52.4% at
1 month, 28.6% at 3 months).
Keywords
adolescent, HIV infections, alcohol, juvenile justice, substance-
exposed pregnancy
Adolescent females detained or on probation in juvenile justice
settings often engage in multiple health behaviors that place
them at risk of HIV and substance-exposed pregnancies
(Lawrence, Snodgrass, Robertson, & Baird-Thomas, 2008;
Rosengard et al., 2006). Specifically, they engage in frequent
sexual behaviors that put them at risk of unplanned pregnancy,
sexually transmitted infections (STIs; Belenko et al., 2008),
and HIV (Committee on Pedatric AIDS, 2006) while also
smoking (Helstrom, Bryan, Hutchison, Riggs, & Blechman,
65. 2004) and engaging in alcohol use (Lawrence et al., 2008),
which further place them at risk of both tobacco-exposed preg-
nancy (TEP) and alcohol-exposed pregnancy (AEP; Delpisheh,
Attia, Drammond, & Brabin, 2006; Helstrom et al., 2004).
There are well-documented health consequences of smoking
and drinking during pregnancy for both female youth and the
fetus (Delpisheh et al., 2006; Kulig, 2005; Wiemann &
Berenson, 1998). While many cease alcohol or cigarette use
after discovering they are pregnant (Forray, Merry, Lin, Ruger,
& Yonkers, 2015), nearly half of the U.S. pregnancies are
unplanned (Finer & Zolna, 2016) with females unaware of their
pregnancy continuing to drink or smoke during the early and
critical weeks of gestation. Compared with adult women, ado-
lescents are more likely to have an unplanned pregnancy, take
longer to recognize they are pregnant (De Genna, Larkby, &
Cornelius, 2007), and are less likely to reduce alcohol or
tobacco consumption once they find out they are pregnant
(Cornelius et al., 1994), putting them at higher risk of TEP or
66. AEP. These pregnancies are also at risk for mother-to-child
HIV or STI, as many of these youth may not seek early or
regular prenatal care (CDC, 2018a).
The association between substance use and STI/HIV sexual
risk behavior among youth is well-documented, with younger,
female, and racially/ethnic minority populations at highest risk
of HIV infection through heterosexual contact (CDC, 2018b;
Howard & Wang, 2004). Co-occurring substance use and sex-
ual risk behaviors are more pronounced among juvenile justice
populations, with females in these settings presenting with a
unique, multirisk profile (Rosengard et al., 2006; Teplin,
Mericle, McClelland, & Abram, 2003). While nationally rep-
resentative samples are generally lacking for this population,
1 Baylor University, Houston, TX, USA
2 University of Texas at Austin, Austin, TX, USA
3 University of Texas Mc Govern Medical School, Houston, TX,
USA
4 Rutgers University, The State University of New Jersey, New
Brunswick, NJ,
USA
Corresponding Author:
67. Danielle E. Parrish, Baylor University, 4100 Main St., Houston,
TX 77002, USA.
Email: [email protected]
Research on Social Work Practice
2019, Vol. 29(6) 618-627
ª The Author(s) 2018
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several trends have been identified in the literature. Alcohol use
and smoking are more prevalent and comorbid among females
in criminal justice settings (Helstrom et al., 2004; Parrish et al.,
2011), with delinquent adolescent females reporting more fre-
quent smoking than males and nearly a third meeting clinical
criteria for a substance use disorder (Cropsey, Linker, & Waite,
2008; Domalanta, Risser, Roberts, & Risser, 2003; Helstrom
et al., 2004; Lederman, Dakof, Larrea, & Li, 2004). In addition,
68. most (90%) are sexually active and less than half use condoms
or contraception (Crosby et al., 2004; Kingree, Braithwaite, &
Woodring, 2000; Lawrence et al., 2008; Teplin et al., 2003).
Approximately a third of female youth in these settings have
previously been pregnant one or more times (Lawrence et al.,
2008; Lederman et al., 2004; Schmiege, Broaddaus, Levin, &
Bryan, 2009). Compared with community female youth sam-
ples, this population engages in earlier and more frequent
sexual risk behavior with multiple partners (Lederman
et al., 2004).
Females in juvenile justice settings are also consistently at
high risk of STIs and sexually transmitted HIV compared to
their noninvolved peers and at an even higher risk than their
male involved counterparts (Belenko et al., 2008), reporting
less frequent condom use (Belzer et al., 2001; Broaddus &
Bryan, 2008; Committee on Pedatric AIDS, 2006; Kelly,
Lesser, & Paper, 2008; Robertson, Stein, & Baird-Thomas,
2006) and more frequent acquisition of STIs placing them at
69. further risk of HIV infection (CDC, 2018a).
Despite this population’s unique, multirisk health profile
and the critical opportunity to intervene while youth are on
community probation, there is a paucity of gender-specific
prevention programming to reduce these risks (DiClemente
et al., 2014; Lawrence et al., 2008). This presents a challenge
for prevention and highlights an urgent need to develop effica-
cious, gender-specific, multirisk “bundled” (targeting more
than one behavior) prevention approaches for this vulnerable
population (Belenko et al., 2008; Committee on Pediatric
AIDS, 2006; Ickovics, 2008). Bundling efficiently aggregates
services to promote synergistic gain when intervening with
high-risk populations that do not routinely seek services
(Ickovics, 2008) and is increasingly being used in medical or
other opportunistic settings. While not yet tested with adoles-
cents, a bundling (Ickovics, 2008; Parrish et al., 2011) or
multiple-behavior approach (Geller, Lippke, & Nigg, 2017;
Nigg, Allegrante, & Ory, 2002) has shown promise in more
70. efficiently reducing health risk behavior (Werch, 2007). There
is a need, however, to conduct research to better understand
which and how many behaviors can be bundled and for which
target populations (Werch, 2007).
The CHOICES Line of Research
and CHOICES-TEEN
One possibility to meet these overlapping needs among the
female juvenile justice population is to adapt an existing
empirically supported prevention intervention for adult women
called the CHOICES preconception intervention. This
intervention utilizes the transtheoretical model of behavior
change, motivational interviewing (MI), and content aimed to
increase participants’ motivation to change risky alcohol use,
smoking, and contraception use, along with a referral for con-
traception education and services (Velasquez, von Sternberg, &
Parrish, 2013). The need for the CHOICES intervention and its
efficacy has been demonstrated through a line of epidemiolo-
gical and intervention research funded by the Centers for Dis-
ease Control and Prevention (CDC; Floyd et al., 2007; Project
71. CHOICES Intervention Research Group, 2003; Velasquez
et al., 2017). In the first multisite randomized controlled trial
testing the efficacy of a four-session version of CHOICES
among high-risk women of childbearing age (18–44), the
CHOICES intervention group, relative to a brief advice group,
significantly reduced their risk of AEP (69.1% vs. 54.3%) and
had 2-fold greater odds of being at reduced risk of AEP at
9 months (Floyd et al., 2007). This intervention has been
broadly disseminated to the public, with the original manual
and related training materials available on the CDC website
(https://www.cdc.gov/ncbddd/fasd/choices-implementing-choi
ces.html). This first aforementioned efficacy study highlighted
the need (and opportunity) to also prevent nicotine-exposed
pregnancies, as more than 70% of those at risk of AEP were
also smoking (Floyd et al., 2007). Analysis of study data also
indicated that women receiving two sessions were as likely to
reduce their risk of AEP as those receiving four. Consequently,
a second efficacy trial was funded by the CDC to test a two-
session version of CHOICES, called CHOICES Plus, that
72. would also focus on reducing the overlapping risk of TEP
within a large, public medical setting (Velasquez et al.,
2017). This study also supported the efficacy of CHOICES Plus
in significantly reducing the risk of both AEP and TEP among
women aged 18–44 years compared to a brief advice group
(Velasquez et al., 2017).
CHOICES-TEEN was adapted from the original CHOICES
and CHOICES Plus preconception interventions to be devel-
opmentally appropriate for adolescent females and reduced
HIV/STI risk in addition to reducing risks of AEP and TEP
(Floyd et al., 2007; Project CHOICES Intervention Research
Group, 2003; Velasquez et al., 2010; Velasquez et al., 2017).
CHOICES-TEEN builds upon the CHOICES line of research
by expanding the reach of this intervention to high-risk adoles-
cent females who are—compared to adult women—more
likely to have an unplanned pregnancy, take longer to realize
they are pregnant, and less likely to stop using substances once
they realize they are pregnant (Cornelius et al., 1994; Cnattin-
73. gius, 2004; De Genna et al., 2007). This intervention, which
will be described in more detail in the Methods section, con-
sists of two sessions with a master’s level counselor, a session
with an adolescent medicine specialist to discuss HIV/STI and
pregnancy prevention, possible referral for HIV/STI testing
and contraceptive services, and a referral to a phone-based
smoking cessation program called the Texas Quitline. The
intervention was delivered to female youth on intensive juve-
nile community probation.
Parrish et al. 619
https://www.cdc.gov/ncbddd/fasd/choices-implementing-
choices.html
https://www.cdc.gov/ncbddd/fasd/choices-implementing-
choices.html
The aims of this one-arm pilot study were to further under-
stand the feasibility of targeting multiple bundled health risks
in high-risk adolescents as well as to evaluate the feasibility
and potential promise of an adapted gender-specific prevention
intervention—CHOICES-TEEN—in reducing the risks of
74. HIV/STI, TEP, and AEP among adolescent females on com-
munity probation.
Materials and Method
Following Stage 1a/1b intervention development guidelines
(Rounsaville, Carroll, & Onken, 2001), a one-arm design was
used to assess the reductions of risk (among an all-risk sample
at baseline) following the CHOICES-TEEN intervention at 1-
and 3-month follow-up. Supplemental data were collected to
assess client adherence, retention, acceptability, and the feasi-
bility and quality of treatment delivery. Data were collected by
research assistants trained in the study protocol. This study was
approved by the Harris County Juvenile Justice, University of
Houston and University of Texas Health Science Center at
Houston Institutional Review Boards.
Female adolescents aged 14–17 years were recruited from
three community probation programs in Houston, TX. Youth
assent and the parent/guardian permission were obtained in
person or by phone to conduct eligibility screenings. To be
75. eligible, participants were at risk of HIV/STI, AEP, and TEP
and had all of the following behaviors in the prior 3 months:
(1) sexual intercourse with a male, (2) inconsistent/ineffec-
tive condom use, (3) inconsistent/ineffective contraception
use, (4) drinking at risky levels (>3 drinks in 1 day or >7
drinks in a week), and (5) current smoking. Given that this
was a feasibility study, and the initial recruitment numbers
were lower than expected, the smoking inclusion criterion
was relaxed after 6 months to ensure an adequate sample.
Of the 150 females screened, 31 (21%) were at risk of both
AEP and TEP and 37 (25%) at risk of AEP. If eligible, the
voluntary nature and details of the study were described to
the youth and guardian using IRB-approved assent and per-
mission documents, questions were elicited and answered,
and written informed consent was obtained from youth and
parent/guardians prior to study participation. As shown in
Figure 1, three (8.1%) declined participation and six
(16.2%) did not return to the site for various reasons (e.g.,
additional criminal charges and noncompliance with the pro-
gram). Of the 28 who returned for assent/parental permission
76. and baseline assessment, 2 were identified as ineligible, leav-
ing a pool of 26 from which 4 did not return for similar
aforementioned reasons. Of the 22 participants who started
the intervention, 20 completed all three sessions (91%) and 2
completed one session. One- and 3-month follow-up assess-
ments were obtained for all 21 of the 22 (95%) youth who
received the intervention. While two youth initiated the
smoking Quitline fax referral, none of them completed this
component of the program.
CHOICES-TEEN Intervention
CHOICES-TEEN was adapted from the original CHOICES
and CHOICES Plus preconception interventions to be devel-
opmentally appropriate for adolescent females and reduced
HIV risk (Floyd et al., 2007; Project CHOICES Intervention
Research Group, 2003; Velasquez et al., 2010, 2017). The effi-
cacy of the CHOICES and CHOICES Plus bundled preconcep-
tion interventions in reducing the risks of AEP and TEP among
adult women in high-risk settings has been established through
a series of CDC-funded studies (Floyd et al., 2007; Project
77. CHOICES Intervention Research Group, 2003; Velasquez
et al., 2017). CHOICES-TEEN builds upon this work by
expanding the reach of this intervention to high-risk adolescent
females. As shown in Table 1, CHOICES-TEEN includes two
motivational counseling sessions with a master’s level counse-
lor, one session with an adolescent medicine physician, and a
referral to the Texas Tobacco Quitline. The Quitline accepts
fax referrals from physicians of youth who are ready to quit
smoking. A Quitline counselor then assesses the youth for one
or more of the following referrals: telephone counseling,
community-based cessation services, and youth friendly smok-
ing cessation materials.
Master’s level counselors, previously trained for prior
CHOICES intervention studies, provided the counseling ses-
sions and were supervised by experts in MI and the CHOICES-
TEEN intervention. The majority of sessions (68.2%) were
provided by one of the three master’s level counselors, and
outcome did not differ by counselor at 3-month outcome. All
78. sessions were audio-recorded, and 15% were reviewed for
quality and fidelity using the Motivational Interviewing Integ-
rity Scale 3.1.1 and CHOICES-TEEN protocol checklist. All
counselors were deemed as proficient in the intervention by a
CHOICES expert who is also a member of the Motivational
Interviewing Network of Trainers. The adolescent medicine
physicians, who provided the second session focused on HIV
and pregnancy risk reduction education and the development of
a healthy behavior plan, received a 3-hr training on the use of
MI in a medical context and the CHOICES-TEEN protocol.
Measures
Demographic and background health variables. Demographic
and
background health variables, including sexual activity/risk
behaviors and substance use history/frequency, were collected
using an audio computer-assisted self-administered interview
(ACASI). The AUDIT, a 10-item questionnaire used to mea-
sure alcohol use and problems, was also used to describe the
sample with regard to harmful drinking (Babor, de la Fuente,
Saunders, & Grant, 1992).
79. Timeline followback interview (TLFB). The TLFB interview,
which
collected detailed self-report behavior data using a calendar
recall method, was administered by a trained interviewer at
baseline (i.e., 90 days prior), 1-month postbaseline follow-up,
and 3-month postbaseline follow-up (Floyd et al., 2007; Sobell,
620 Research on Social Work Practice 29(6)
Brown, Leo, & Sobell, 1996; Velasquez et al., 2017). Data
collected included number of daily alcohol drinks, sexual activ-
ity, condom use, effective contraception, and smoking. These
data were divided into 30-day increments to calculate the fol-
lowing: (1) risk drinking (>3 drinks in 1 day or >7 drinks in a
week), (2) risk of pregnancy (any occurrence of vaginal inter-
course without effective contraception including condoms), (3)
HIV risk (any occurrence of vaginal or anal sex without a
condom), (4) AEP risk (any occurrence of risk drinking plus
any occurrence of vaginal intercourse without effective contra-
ception during the same time period), and (5) TEP risk (any
80. smoking plus any occurrence of vaginal intercourse without
effective contraception during the same period).
Client Satisfaction Questionnaire–8 (CSQ-8). Client satisfaction
was measured using the CSQ-8 (Attkisson & Zwick, 1982).
This standardized measure consists of eight questions followed
by a 4-point Likert-type scale, with possible scores ranging
between 8 and 32, and higher scores indicating higher levels
of satisfaction. This questionnaire was administered, along
with five open-ended questions about the intervention, using
the ACASI in a private setting at the end of the 3-month follow-
Assessed for eligibility (n=150)
Excluded (n= 122)
♦ Not meeting inclusion criteria (n= 83)
■ No risk of pregnancy (n=83)
■ No sex (n=64)
■ No risk drinking (n=84)
■ No smoking (n=83)
♦ Declined to participate (n= 3)
♦ Other reasons; program attrition (n= 6)
Lost to follow-up 1-month (n=1)
Lost o follow-up 3-months (n=0)
81. Allocated to intervention (n= 22)
■ Completed Counseling Session One (n=22)
■ Completed Adolescent Fellow Session (n=20)
■ Completed Counseling Session Two (n=20)
■ Accepted Smoking Referral (n=3)
■ Health Clinic Visit (n=7)
Program Attrition, Did Not Return
(n=4)
Found Ineligible at Baseline (n=2)
Returned for Parental
Permission/Assent (n= 28)
Figure 1. Study flow diagram.
Parrish et al. 621
up. The five open-ended questions solicited comments/sugges-
tions, what was liked about the intervention, what was liked
least about the intervention, suggestions for improvement, and
the most important aspects of the intervention.
Working-Alliance Inventory–Short (client/therapist). This
measure is
used to assess three key aspects of the therapeutic alliance—
agree-
ment on the goals of therapy, tasks of therapy, and the develop-
82. ment of an affective bond (Hatcher & Gillaspy, 2006). This
scale
consists of 12 items followed by a 7-point Likert-type scale,
which
ranges from never to always. This scale was administered to
both
the youth and the counselor at each of two counseling sessions.
Data Analysis
The Statistical Package for Social Sciences (SPSS Version 23)
was used to conduct all analyses. Descriptive statistics were
used to describe the sample, reductions in dichotomous risk of
AEP, TEP, and HIV among an all risk sample at baseline,
feasibility and acceptability measures, and responses to the
CSQ-8 at 3-month follow-up. Inferential statistics were not
used to assess behavior change, as all youth were considered
to be at risk of AEP, TEP, and HIV at baseline. A simple
thematic analysis was conducted of brief open-ended responses
concerning the acceptability of the intervention provided by the
youth when completing the CSQ-8 at 3-month follow up. These
83. questions asked about what was liked most and least about the
intervention and suggestions for improving the intervention.
Results
Participants ranged in age from 14 to 17, with a mean age of
16 years (SD¼ .89). Eighty-two percent were Hispanic/Latina,
with 55% reporting Mexican origin. The sample was racially
Table 1. CHOICES-TEEN Intervention Session Components.
Session 1
Provided by Master’s Level
Counselor
Session 2
Contraceptive/HIV Risk
Reduction Counseling
Provided by Adolescent
Physician
Session 3
Provided by Master’s
Level Counselor
Smoking Cessation Referral
Provided by American
Cancer Society’s Texas
State Quitline, Which Serves
Adolescents 13 and Older
� Rapport building
� Review of fact sheets:
84. � Important things for young
women to know about alcohol,
smoking, pregnancy, and birth
control
� Important facts for young
women about HIV/STDs
� Abstinence or safer sex
� Introduce and encourage
contraceptive and HIV risk
reduction counseling visit
� Advice and referral to smoking
cessation program if currently
smoking
� Decisional balance for pros and
cons of
� Drinking
� Smoking
� Contraceptive use
� Condom use
� Complete Self-evaluation rulers
addressing readiness to change
drinking, smoking, condom use,
and contraception
� Introduce Daily Journal for drinking,
smoking, intercourse, and
contraception (including condoms)
� Brochures on alcohol, smoking,
85. HIV, contraceptive methods, and
community resources
� Summarize session
� Discuss and answer questions
about HIV transmission and
ways to reduce risk
� Determine appropriate and
suitable contraceptive
methods including the option
of abstinence
� Provide referral for HIV
testing at most convenient
testing site that provides
condoms
� Complete a healthy behavior
plan, which details plans/
referral for preventing
pregnancy and HIV
� Provide condoms if desired
(parental permission was
required by site)
� Provide follow-up clinical care
or referral as needed
� Provide personalized
feedback (derived from
baseline assessment)
� Discussion of
86. temptation and
confidence profiles for
all four behaviors
� Review and discussion
of information recorded
in the Daily Journal
� Discuss contraception
and counseling/HIV risk
reduction visit
� Review smoking
brochure and discuss
smoking cessation
referral (as applicable)
� Review of decisional
balance exercises for
each behavior
� Completion of initial
goal statement and
change plans for each
behavior
� Provide community
resource list (if
applicable)
� Summarize session
� Determine readiness to
change
� Provide behavioral counseling
87. for smoking cessation
Note. STDs ¼ sexually transmitted diseases.
622 Research on Social Work Practice 29(6)
diverse with 18% Black, 18% White, 9% American Indian/
native Hawaiian, 4.5% multiracial, and 27% reporting race
as Hispanic/Mexican American. The youth were all English
speaking. However, we did have a Spanish-speaking counse-
lor available to provide the intervention in Spanish if needed
and to communicate with Spanish-speaking parents/guar-
dians. Prior arrests ranged from 1 to 10 or more, with 59%
only having 1 or 2. Participants reported prior arrests for the
following reasons: 45% assault, 41% petty theft, 27% truancy,
22% possession of marijuana or other drugs, 18% running
away, and 14% trespassing. With regard to sexual orientation,
73% were heterosexual and 23% bisexual. All youth reported
using drugs in the last 6 months, and among those who
smoked, five were daily smokers. The mean AUDIT score
was 2.5 (SD ¼ 2.87).
Risk of AEP, TEP, and HIV/STI
Of the 22 participants who received the intervention, one did
not complete the follow-up assessments. Reduction of AEP,
88. TEP, and HIV risk was based on the frequency of youth in the
at-risk or reduced risk category based on the TLFB at each
follow-up period. Successful change was categorized as
“reduced risk” instead of “no risk” because all contraception
methods, including condoms, fail a certain percentage of the
time even with perfect use. As noted previously, these data
were divided into 30-day increments to calculate the presence
of combined or single risk behaviors within each time frame
over a continuous 7-month period: 3-month baseline (3
months prior to baseline), 1-month follow-up (from baseline
to 1 month later), and 3-month follow-up (from 1 month to 3
months postbaseline). AEP risk was defined as the presence of
risk drinking and risk of unplanned pregnancy during the
same time period, TEP risk was defined as any smoking plus
risk of unplanned pregnancy during the same period, and
HIV/STI risk as any occurrence of vaginal or anal sex without
a condom.
Ninety percent (n ¼ 19) of participants were at reduced risk
89. of AEP at 1 month, and 71.4% (n ¼ 15) were at reduced risk at
3 months. Using an intent-to-treat analysis (treating the drop
out as a failure), 86.4% were at reduced risk at 1 month and
68.2% were at reduced risk at 3 months.
Seventeen of the 22 (77%) participants were smokers and at
risk of TEP at baseline. Of those at risk at baseline, 68.8% (n ¼
11) were at reduced risk at 1 month and 50% (n ¼ 8) were at
reduced risk at 3 months. With the intent-to-treat analysis,
64.7% were at reduced risk at 1 month and 47.1% were at
reduced risk at 3 months. Of those who smoked at baseline,
71.4% reported currently smoking cigarettes at 1 month and
73.3% at 3 months.
All 22 participants who received the intervention were at
HIV/STI risk at the baseline. Fifty-two percent were at reduced
risk at 1 month, and 28.6% were at reduced risk at 3 months. Of
the 11 who were not at risk of unplanned pregnancy at
3 months, only 2 were not using condoms while sexually active
and using another contraceptive method. Using an intent-to-
treat analysis, 50% were at reduced risk for HIV/STI at 1 month
and 27.3% were at reduced risk at 3 months.
The route by which the youth reduced their AEP and TEP
risk is provided in Figure 2.
A = Used Effective Contraception/Abstinence A = Used
90. Effective Contraception/Abstinence
B= Reduced Risk Drinking Only B= Smoking Cessation Only
AB = Reduced Both Risks AB = Reduced Both Risks
AB
33.3%
(n=5)
B
26.7%
(n=4)
A
40%
(n=6)
B
36.8%
(n=7)
AB
42.1%
(n=8)
A
21.1%
(n=4)
Routes of Reduced AEP Risk
1 month
3 months
91. Routes of Reduced TEP Risk
B
18.2%
(n=2)
AB
27.3%
(n=3)
A
54.5%
(n=6)
A
75%
(n=6)
AB
25%
(n=2)
B
(n=0)
Figure 2. Distribution of youth achieving reduced risk of
alcohol-exposed pregnancy and tobacco-exposed pregnancy at 1
month and 3 months.
Parrish et al. 623
Feasibility
The CHOICES-TEEN intervention checklist indicated that all
92. aspects of the intervention were delivered and that the sessions
did not exceed the planned 45- to 60-min duration. The
CHOICES-TEEN MI Scale, which assessed the degree to
which counselors believed they emphasized various aspects
of an MI approach, was rated as over a 4 on a 1–5 scale for
all items. CHOICES-TEEN counselors indicated per structured
session notes that all participants appeared to comprehend ses-
sion tasks. The average per-item mean for youth on the task
(M¼ 5.99, SD¼ .97), bond (M¼ 6.04, SD¼ .95), and goal (M¼
5.56, SD ¼ 1.12) subscales of the Working Alliance Inventory–
Short ranged between 5 (often) and 7 (always) on a 1–7 scale.
Participant Acceptance/Satisfaction With Intervention
All except one of the 22 youth enrolled in the intervention
completed all three sessions delivered on site at a weekly
community-based probation program. In response to the anon-
ymously administered CSQ-8 at 3-month follow-up, female
youth (n ¼ 20) reported high levels of satisfaction (M ¼ 24,
SD ¼ .71; average per-item mean ¼ 3) with the intervention,
with scores ranging from 23 to 25. Specifically, 60% described
the quality of services as “excellent” and 40% described the
services as “good.” Despite being a nontreatment seeking pop-
93. ulation, fifty-five percent of youth indicated that they
“definitely” received the service desired, with 45% indicating
they “generally” did. Sixty percent indicated “most” of their
needs have been met by the intervention, while 35% indicated
“almost all” of their needs were met, and one youth indicated
their needs were not met. All youth indicated they would refer a
friend in need of similar help to the program. Ninety-five per-
cent of youth reported being “mostly” or “very” happy with the
amount of help they received. With regard to overall satisfac-
tion, 65% reported being very satisfied, and 35% mostly satis-
fied. Ninety-five percent indicated they would return to the
program if they were to seek help again. Twenty of the 22
participants provided anonymous written feedback to the
open-ended questions that followed the CSQ-8. Responses
indicated that youth valued the opportunity to be honest in a
relational, confidential setting and that the counselors and doc-
tors provided useful information that they did not know or had
not considered. In particular, the youth appreciated the oppor-
tunity to have a conversation with a physician to obtain accu-
94. rate information about their options for preventing unplanned
pregnancy and HIV/STIs. Youth suggested the program may be
more successful if assistance was provided for transportation
and appointment setting with the health clinics. They also sug-
gested that the program expand to reduce the health and preg-
nancy risks associated with marijuana and other drugs.
Discussion
This one-arm feasibility study suggests that the CHOICES-
TEEN intervention is feasible, acceptable, and promising with
regard to reducing the risk of AEP, TEP, and HIV/STI among
female youth involved with the juvenile justice system. The
retention of youth who began the intervention was 91% for all
three sessions, and youth reported feeling positively about the
intervention, suggesting that the intervention was acceptable.
With regard to feasibility, all intervention components were
completed with ease within the designated session time frames.
Taken together, these findings suggest that it is feasible to
target multiple health-risk behaviors (smoking, risk drinking,
contraception use, and condom use) simultaneously with this
95. high-risk population. However, future research with a control
group will be necessary to test the efficacy of this intervention.
The reductions in risk of AEP were comparable to reduc-
tions of risk found in CHOICES intervention studies with
women (Floyd et al., 2007; Velasquez et al., 2017). With regard
to TEP, the reduction of risk was 50% in this study and 69.8%
in the CHOICES Plus study (Velasquez et al., 2017). However,
this sample only included five youth reporting daily smoking,
suggesting many of these youth may be engaging in light and
intermittent smoking which often mistakenly perceived by
youth as less harmful or addictive (Amrock & Weitzman,
2015). This may be one of the reasons that few youth accepted
and followed up with the smoking cessation referral. In addi-
tion, open-ended feedback from the youth suggested that smok-
ing was a temporary replacement for marijuana, while they
were being randomly drug tested by probation. This suggests
a need to better understand the patterns of smoking and mar-
ijuana use among high-risk females in these settings for pur-
96. poses of preventing substance-exposed pregnancy.
The proportions of youth reducing HIV/STI risk at 3-month
follow-up were not as high compared to AEP and TEP, which
is not surprising as there is only one way to reduce this risk—
condom use. While it is most ideal that youth reduce their risk
of pregnancy by either abstinence or using both condoms and
other contraceptive methods, it is encouraging that the large
majority of youth who reduced their risk of pregnancy in the
study were using condoms, which protect against both
unplanned pregnancy and HIV/STIs. In addition, HIV/STI pre-
vention research with juvenile justice populations has generally
resulted in more modest effect sizes for behavioral change
(Tolou-Shams, Stewart, Fasciano, & Brown, 2010), highlight-
ing a need to develop more robust interventions.
Despite encouraging findings, these results should be inter-
preted with some caution, given the small sample size and lack
of a control group. Also, while self-report measures are a major
data source for clinical and resource purposes, they have been
97. criticized for potential bias. However, retrospective self-reports
of behavior collected in settings which minimize these poten-
tial biases have been shown to be reliable and valid. Still, future
research would benefit by incorporating biological measures
that further substantiate self-report. Finally, given feedback
from the youth and the providers, it may be useful to expand
the CHOICES-TEEN model to incorporate marijuana and other
drugs as well as to explore the utility of providing all of the
aspects of the intervention in a postadjudication placement
624 Research on Social Work Practice 29(6)
setting to reduce client transportation challenges and the time
commitment for travel of providers.
Implications for Practice and/or Policy
Given the limited research on gender-sensitive interventions
with female youth in juvenile justice settings, this research
highlights several implications for practice and policy. First,
this is the first study to report on the prevalence of substance-
98. exposed pregnancy in a sample of female youth in the juvenile
justice system. Of the 150 youth screened, 25% were at risk of
AEP in this study, which is much higher than the 3.4% at risk in
the general population (Cannon et al., 2015). This finding,
combined with the aforementioned literature documenting
these overlapping risks in multiple, larger samples of female
youth, suggests an urgent need for interventions and/or policy
to reduce these risks. Specifically, programming should be
provided that informs female youth of these risks as well as
efficient, prevention interventions that have promise for broad
prevention impact. AEP is 100% preventable, has been recently
estimated to be more prevalent than autism (May et al., 2018),
and can lead to costly lifelong cognitive, behavioral, emotional,
and adaptive functioning deficits. Smoking and HIV/STIs can
also severely affect the health of both female youth and their
children both during and after pregnancy (e.g., second-hand
smoke; HHS, 2014; Delpisheh et al., 2006; Kulig, 2005; Wie-
mann & Berenson, 1998). As such, the development of and
funding for early prevention programs for one of the society’s
highest risk populations that rarely receives integrated health
99. care are essential.
Second, this study suggests integrated, multirisk bundled
motivational enhancement interventions provided at opportu-
nistic times can be feasible, acceptable, and potentially promis-
ing for female youth in the juvenile justice system. As such,
programs that focus on more than just one risk behavior during
times of detention or community probation may be more effi-
cient and cost-effective. Finally, youth appreciated the oppor-
tunity to receive individualized information about their sexual
health and substance use in an accepting and supportive con-
text. Such efforts can be further bolstered by ensuring better
access to referrals by providing transportation to follow-up
medical visits, as this can be a major service barrier for this
population. Finally, none of the youth in this study accepted the
incoming smoking cessation Quitline referral phone calls. As
such, nontelephonic options, such as the U.S. Health and
Human Service’s QuitSTART technology application, may
be a better fit for some youth.
100. Conclusions
CHOICES-TEEN is acceptable and feasible and appears pro-
mising for reducing overlapping, bundled health risks—AEP,
TEP, and HIV—among high-risk female youth in juvenile jus-
tice settings. Given the potential for impacting multiple, over-
lapping health risks in an opportunistic manner, future research
should examine the efficacy of this intervention with a more
robust sample.
Acknowledgments
Harris County Juvenile Probation provided essential support of
this
project by facilitating essential partnerships and space in the
field.
Robin Harris provided coordination of the project in the field,
and
Barbie Atkinson, Matiko Bivens and Lisa Connelly were the
CHOICES-TEEN counselors. Rebecca Beyda, M.D. and Laura
Grubb M.D., provided the Adolescent Medicine risk reduction
coun-
seling sessions. Alicia Kowalchuk, M.D. provided Motivational
101. Interviewing training for the Adolescent Medicine Fellows, and
Nanette Stephens provided fidelity monitoring and training for
the
CHOICES-TEEN counselors. Ralph DiClemente, Ph.D. and
Carrie
Randall, Ph.D. provided consultation to support the
implementation
of this project.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with
respect to
the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support
for the
research, authorship, and/or publication of this article: This
study was
funded by Grant Number 1R03DA034099 from the National
Institute
of Drug Abuse, National Institutes of Health.
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