A pilot study of this intervention was conducted in 2010 in South Florida involving two agencies that served adolescents who were in the process of transitioning from foster care to independent living. A total of 31 participants between the ages of 12 and 23 completed both an intake questionnaire and an exit questionnaire. Youth who participated in the program reported higher rates of talking to a trained counselor about sex and sexual health and using contraception at last sexual encounter after the program ended.
In 2015, The Policy & Research Group (PRG) received a grant from the Office of Adolescent Health Teen Pregnancy Prevention Program to evaluate the effectiveness of PS-R using a randomized controlled trial. The study took place in five states with over 100 masters-level clinicians in various therapeutic settings that serve youth ages 14-19 who have experienced trauma.
Although an impact study to assess the efficacy of PS-R was originally planned, federal funding disruptions in 2017 interrupted recruitment and enrollment efforts mid-way through the project. The target sample size for the impact study was 600 youth; this was exceptionally large because according to the program’s theory of change, the confirmatory outcomes (sexual behaviors) were indirectly influenced and distal to much of the program content, which was focused primarily on awareness and regulation of affect and practice of self-regulation. However, at the end of the enrollment period only 432 participants had been enrolled. As a result, there was an insufficient number of participants for adequate statistical power to detect effects on confirmatory outcomes.
In consultation with the Office of Population Affairs, it was decided that impact findings on confirmatory outcomes could not be produced because they would not have represented a fair test of the efficacy of PS-R. Thus, data provided here come from the implementation study, an exploratory study of impact on behavioral antecedents directly targeted by the program, and a subsequent qualitative study that was conducted to better understand the challenges of conducting rigorous research of a manualized intervention in a therapeutic setting. The qualitative study reflects the perceptions of 22 therapists who participated as PS-R facilitators in the implementation study and were interviewed once the impact and implementation study had been completed.
Participant Characteristics:
The evaluation team enrolled 432 participants into the impact study. At the time of enrollment, Participants’ average age was 16 years, and on average had completed 10 years of schooling. The majority of participants identified as White (45.7%), followed by multi-racial (11.1%), Black (10.2%), and another race (5.8%); 41.5% participants identified as Hispanic ethnicity. Youth in the study reported an average of 6 adverse childhood experiences (ACEs). The literature indicates that three or more ACEs are typically associated with emotional and physical impairment. On the K-6 Distress Scale, participants had an average score of 12.3, which is very close to the cut-point of 13 indicating “serious mental illness.” These data demonstrate just how vulnerable youth were who enrolled in this study.
Promising data from the implementation study indicate that:
The majority of program participants favorably rated the quality of the PS-R intervention, with large percentages selecting the words useful (71%), helpful (67%), and interesting (62%) to describe the program. Of the 167 participants who provided feedback data and received at least one PS-R session, 76% reported that they would recommend the program to other teens.
Facilitators delivered PS-R sessions with very high fidelity, with observers reporting that an average of 93% of required activities were completed in each session.
Participants report that they intend to use the PS-R content received in their own lives. On a scale from 1 to 5, with higher scores indicating greater agreement, PS-R participants rated the sexual health information and skills provided in the PS-R intervention as 4.4.
Promising data from the exploratory study indicate that:
Participants may experience short-term positive impacts in contraceptive knowledge, beliefs, attitudes, and self-perceived skills. Specifically, when comparing participants assigned to PS-R relative to participants assigned to the control group, we observed significant or marginally significant differences in the desired direction immediately after the intervention period had ended in:
- Contraceptive knowledge
- Intention to practice sexual self-regulation
- Beliefs regarding the malleability of emotions
- Importance of and intention to practice affect regulation
- Affect regulation self-efficacy
In 2016, the Policy & Research Group (PRG) received a PREIS grant from the U.S. Department of Health & Human Services to evaluate e-PS-R, an online adaptation of the PS-R workbook. While PS-R is delivered through 10 one-on-one sessions with therapists, e-PS-R expands access for youth in under-resourced and rural areas. Using a blended-learning model, e-PS-R offers 8 online sessions paired with 4 in-person meetings with trained program facilitators.
Download the ePS-R version of this entire section in one PDF
In 2016, the Policy & Research Group (PRG) received a PREIS grant from the U.S. Department of Health & Human Services to evaluate e-PS-R, an online adaptation of the PS-R workbook. While PS-R is delivered through in-person sessions with therapists, e-PS-R expands access for youth in under-resourced and rural areas. Using a blended-learning model, e-PS-R offers 8 online sessions paired with 4 in-person meetings with trained program facilitators.
Promising data from the qualitative study indicate that:
Facilitators like the structure of PS-R, specifically as a way to address sexual health content. They mentioned that it helped them to “normalize” some topics that can be uncomfortable. They were attracted to it as a way to guide and empower adolescents in health decision-making processes to try and mitigate some of the riskier choices they may be inclined to make, teach emotional self-regulation, and talk about healthy relationships. Some therapists also felt that the intervention was designed in a way where it could be used either in its intended format or as piecemeal activities that they could pick and choose when relevant.
Concerns identified in each of the studies include:
- Effects of funding disruption on the impact study
- Challenges experienced in providing treatment participants with all 10 PS-R sessions during the implementation study time period which resulted in condensing materials to 8 sessions
- Attenuation of program impact on the beliefs, attitudes, and self-perceived skills of PS-R participants in the long-term, as observed in the exploratory study
- Some facilitators’ discomfort in providing sexual health content to PS-R participants, expressed in the qualitative study
In 2016, PRG received a grant from the Family and Youth Services Bureau (FYSB) to evaluate the effectiveness of e-PS-R, the blended learning version of PS-R which involves eight on-line sessions and four facilitator meetings. This study took place in two states with juvenile justice involved youth ages 14-19. This study ended in 2020, and results will be posted when the analysis is complete in 2021-2022.
