Overview
Using motivational interviewing techniques and normative resetting, SafERteens is a brief intervention designed to decrease aggression and alcohol use in adolescents receiving care in the emergency department.
The SafERteens intervention is an interactive, one-session intervention that can be delivered on a computer tablet or by a therapist. The computer program presents adolescent patients with alcohol and aggression-related role-play situations. Situations appearing in the program are individualized to each participant based on responses from a risk survey. A virtual buddy is used to guide patients through the program and provide feedback on choices made in the program. The buddy also helps patients identify motives to avoid drinking and aggression.
Delivery:
Computer Tablet
In-Person
Theoretical Approaches:
Motivational Interviewing (MI)
Normative Resetting
Skills Training
Target Substance(s):
Alcohol
Target Outcome(s):
Alcohol use
Violent behavior
Ages:
Adolescents (11-17)
Young Adults (18-30)
Genders:
Male
Female
Races/Ethnicities:
African American
Caucasian
Hispanic/Latino
Other
Setting:
Emergency department
Geographic Location:
Urban
Country:
USA
Language:
English
Evaluations
Three-month follow-up of brief computerized and therapist interventions for alcohol and violence among teens.
Summary: In this randomized controlled trial, teenagers in an emergency department were screened for violent behavior and alcohol use. Teenagers (n=533) who had engaged in violent behaviors and had consumed alcohol a minimum of two times in the past year were eligible for study participation. Participants were randomly assigned to receive a therapist-delivered brief intervention (TBI), a computer-delivered brief intervention (CBI), or an educational brochure (control). Both the TBI and CBI groups received the SafERteens brief intervention. In the TBI condition, participants met with a therapist. The CBI condition completed the SafERteens intervention through a tablet computer program. Readiness to change, alcohol and violence attitudes were measured at baseline, post-intervention, and 3-months after the intervention. Results showed that participant attitudes about the SafERteens intervention were mostly positive. 97% of participants reported finding at least one part of the intervention helpful. Participants rated the TBI more favorably than the CBI. After completing the SafERteens intervention, participants’ attitudes about alcohol use, violence, and weapons carriage changed significantly. Participants getting either TBI or CBI had greater changes in attitudes than participants in the control condition. Readiness to change was not affected by the SafERteens intervention. At 3 months, participants receiving SafERteens via therapist or computer had significantly greater changes in self-efficacy for avoiding violence, and alcohol and violence attitudes than participants in the control condition. Additionally, participants getting TBI had significant decreases in self-efficacy to avoid alcohol use, compared to the control group.
Take Away: For teenagers, both therapist-delivered and computer-delivered versions of the SafERteens intervention were feasible and changed alcohol and violence attitudes more than an educational brochure. Participants rated the TBI more favorably than the CBI.
Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: A randomized controlled trial.
Summary: In this randomized controlled trial, teenagers in an emergency department were screened for violent behavior and alcohol use. Teenagers (n=533) who had engaged in violent behaviors and had consumed alcohol a minimum of two times in the past year were eligible for study participation. Participants were randomly assigned to receive a therapist-delivered brief intervention (TBI), a computer-delivered brief intervention (CBI), or an educational brochure (control). Both the TBI and CBI groups received the SafERteens brief intervention. In the TBI condition, participants met with a therapist. The CBI condition completed the SafERteens intervention through a tablet computer program. Readiness to change, alcohol and violence attitudes were measured at baseline, post-intervention, and 3-months after the intervention. Results showed that participant attitudes about the SafERteens intervention were mostly positive. 97% of participants reported finding at least one part of the intervention helpful. Participants rated the TBI more favorably than the CBI. After completing the SafERteens intervention, participants’ attitudes about alcohol use, violence, and weapons carriage changed significantly. Participants getting either TBI or CBI had greater changes in attitudes than participants in the control condition. Readiness to change was not affected by the SafERteens intervention. At 3 months, participants receiving SafERteens via therapist or computer had significantly greater changes in self-efficacy for avoiding violence, and alcohol and violence attitudes than participants in the control condition. Additionally, participants getting TBI had significant decreases in self-efficacy to avoid alcohol use, compared to the control group.
Take Away: For teenagers, both therapist-delivered and computer-delivered versions of the SafERteens intervention were feasible and changed alcohol and violence attitudes more than an educational brochure. Participants rated the TBI more favorably than the CBI.
Brief motivational interviewing intervention for peer violence and alcohol use in teens: One-year follow-up.
Summary: Continuing the randomized controlled trial described by Cunningham (2009), additional teenage emergency department patients (n=726) were enrolled in a trial of the SafERteens intervention to decrease alcohol use and violence. Teenagers with past-year engagement in alcohol use and aggression were randomly assigned to either a therapist-delivered brief intervention (TBI), a computer-delivered brief intervention (CBI), or a control condition. Participants in the TBI and CBI intervention groups completed the SafERteens intervention, while participants in the control condition received a brochure with community resources. Alcohol use, alcohol consequences, violent behaviors, and violence consequences were assessed at baseline, post-intervention, 3-month, and 6-month follow-ups. At 3-months, participants in the SafERteens TBI group were less likely to report severe peer aggression, peer victimization, and violence consequences, compared to control participants. At 6-months, participants in both the SafERteens TBI and CBI groups were less likely to report violence consequences than participants in the control group. Participants in the TBI and CBI groups reported fewer alcohol consequences than control participants at 6 months. No other differences in alcohol use were detected between the three groups.
Take Away: Compared to a brochure, the SafERteens brief intervention leads to a reduction in violence and alcohol use behaviors in teenagers. Preliminary results suggest that the therapist-delivered version of SafERteens may be more effective than the computer-delivered version for this population.
Related Articles
Cunningham RM, Chermack ST, Zimmerman MA, Shope JT, Bingham CR, Blow FC, Walton MA. Pediatrics. 2012. 129(6): 1083-1090. PMCID: PMC4074654.
Summary: This article presented results of the SafERteens randomized controlled trial at one year. Participant enrollment and methods were described in the Cunningham (2009) and Walton (2010) articles. Teenagers (n=726) enrolled in the study were randomly assigned to a computer-delivered SafERteens intervention (CBI), a therapist-delivered SafERteens intervention (CBI), or to receive an educational brochure. Alcohol use, alcohol consequences, violence, and violence consequences were assessed one year after randomization. At the one-year follow-up, participants in the TBI SafERteens group were less likely to report severe peer aggression and peer victimization compared to participants receiving the brochure or getting the CBI version of SafERteens. While participants in the TBI group had a 43% reduction in peer aggression from baseline, participants in the CBI and control groups had roughly a 26% reduction. No differences were detected in alcohol use or alcohol consequences between the three groups. Reductions in alcohol use present at the 6 month follow-up were not seen at one-year.
Take Away: The therapist-delivered SafERteens brief intervention is associated with greater decreases in violent behaviors than an educational brochure or the computer-delivered SafERteens intervention. Changes in alcohol use present at 6-months post-intervention were not enduring at one year.