Theory of Change
The theory of change for this intervention integrates current research on adolescent development and brain processing that reflects the neuroscience of decision-making and behavior (Jensen & Nutt, 2015; Steinberg, 2104; van der Kolk, 2014). While the goal is to prevent pregnancy, infection, disease, and harm to self and/or others, the means for accomplishing such a goal involves three interactive components. As a participant’s knowledge about safe sex practices increases, so does their knowledge about the impact of trauma on sexual decision-making through both the Workbook (Schladale, 2016) and multi-sensory activities created to enhance memory retention and optimal decision-making.
Exploring the impact of trauma helps participants recognize harmful habits and consider motivation to change harmful behaviors. In addition to knowledge, the intervention addresses impulsivity and skills to improve affect regulation. The combination of self-awareness, skills, and motivation for change results in increased self-efficacy to both negotiate and practice safe sex. The program should result in an increase in harm-free sex, condom use, a decrease in number of sexual partners, and ultimately reduce the chance of the youth getting pregnant or impregnating a partner before age 20.
The Facilitator’s Guide includes theoretical underpinnings for the intervention. They include theories of attachment, human ecology, family systems, and social learning.
Attachment: Attachment is an instinctual biological bond that a child has with significant caregivers. Human capacity for self-regulation develops through attachment. Secure infant attachment occurs when attuned caregivers meet a child’s needs. A child learns trust through this process, which produces chemical changes in the brain that influence self-regulation. When secure attachment is threatened, significant chemical changes occur in an infant’s brain. When caregivers are not consistently predictable, or responsive, infants can fail to develop a capacity to self soothe. (Bowlby, 1988; Siegel, 1999; Applegate & Shapiro, 2005).
As youth experience secure relational connections, their belief system about relationships can change. Throughout the intervention, facilitators model benevolent connection, provide psychoeducation, support youth’s exploration of attachment, and provide mentoring. When healing occurs, relationship patterns are positively changed.
Human Ecology: The narrative approach of this workbook utilizes a life course perspective based on theories of human and family ecology. Ecology is simply the relationship between a person and the various elements of their environment (Bronfenbrenner, 1979). In this case, a youth’s ecology is made up of their living environment, neighbors, school, church, and broader community. Addressing challenges participants face in their day to day lives enhances potential for them to develop and practice self-awareness focused on learning to take good care of themselves.
Family Systems: Research recognizes that the behavior of a youth receiving services may reflect the pain of an over-stressed family system (Saunders, Berliner, & Hanson, 2004; Thornton, Craft, Dahlberg, Lynch & Baer, 2002; Kagan & Schlosberg, 1989). Systems theory provides a relational way of viewing behavior. It emphasizes reciprocity, relationships, context, and patterns (Becvar & Becvar, 1988).
Integrating underlying assumptions of systems theory (Hoffman, 1981) is central to this intervention. Maintaining a belief that the whole is greater than the sum of its parts illustrates the importance of engaging youth in the setting in which they live. This philosophy embraces an assumption that many people working together have a greater opportunity for success than a few working in isolation. It also illuminates the phenomenon that adults actively influence similar emotional states in children (Stein & Kendall, 2004). While negative parent-child experiences hinder development and brain functioning, positive interactions with other adults can facilitate restorative processes that promote stress reduction, memory retention, maturation, health and well-being. Such interaction has a ripple effect in which all participants can embrace a commitment for sexual health.
Social Learning: This explains how behavior is learned and maintained (Bandura, 1985). It occurs through observation of others in the context of relationships or obtained symbolically through media presentation. Witnessing violence increases childhood vulnerabilities (Groves, 2002; Dodge, Pettit & Bates, 1997). When children are raised in an environment that glorifies violence and/or models the use of violence as an acceptable way of meeting needs, they may choose to sustain relationships in a similar manner. Youth are often unable to understand complex elements of violence and abuse; hence they perpetuate it without clearly understanding the impact on self and others.
Life experiences influence brain development and trauma can cause significant impairment. Helping young people who have experienced trauma make sense of how adverse childhood experiences (ACEs) impact their relationships and sexual decision-making can influence motivation for sexual health and well-being.
