Adolescent Girls As Change Agents “Girls Take Charge”
Judith R. Mathews, Ph.D., BCBA, Therese L. Mathews, Ph.D., APRN, and Rachael Bates, B.A.
Munroe-Meyer Institute at the University of Nebraska Medical Center
Results
Systems Change
Girls Inc.
Photos of North Omaha environmental concerns:
Introduction
ƒ
Health disparities, based on socioeconomic status, race, ethnicity and gender, remain prominent in the U.S.
ƒ
One approach to minimize disparities involves facilitating people to initiate community changes at the
grassroots level.
Community Based Participatory Research (CBPR) is an important method to facilitate community change.
ƒ
Daycare with peeling
paint
Park with unsafe picnic
tables
2. Community Changes:
ƒ Lead Poisoning Awareness Fair
- Distribution of home lead testing kits
Identification of 2 children with
elevated lead levels
- Increase in knowledge of lead
poisoning by children (based on
completion of pre and post test at fair)
1. Coalition Building
ƒ Girls, Inc.
ƒ Munroe-Meyer Institute
ƒ Omaha Healthy Kids
ƒ Douglas County Health
Department
Burnt out building
ƒ
ƒ CBPR = a partnership approach to research that equitably involves community members, organizational representatives, and
researchers in all aspects of the research process, and in which all partners contribute expertise and share decision making and
ownership” (Israel, Eng, Schulz & Parker, 2005).
About 150
Interventions are developed that support changing the environmental conditions that may maintain the problem
Expected outcomes =
• Community & system changes
• Individual & widespread population behavioral changes
The Community Toolbox http://ctb.ku.edu/
= website that provides a road map for communities in conducting & evaluating CBPR
ƒ developed by ABA researchers from the University of Kansas
ƒ didactic curriculum = 16 learning modules
Module 3: Analyze Problems and Goals
ƒ Problems were analyzed and goals were developed
based on:
• Frequency
• Seriousness
• Feasibility of interventions to produce change
• Chronicity
• Importance of the problem
Identified Problem –
ƒ Elevated rates of lead poisoning among Omaha
children
ƒ Lack of awareness of lead poisoning in Omaha
Goals –
ƒ Increase awareness of lead poisoning among students
and staff at Girls, Inc.
Exclusive Criteria
- cognitive impairment
ƒ
Utilization of the Community Tool Box
Module 1 : Create and Maintain Coalitions and
Partnership
ƒ
Development of a Advisory Board
Recruited 5 Community members from:
- School
- Government
- Parent
- Media
- Community Organization
Module 2: Assess Community Needs and Resources
Photovoice assessment tool
• Enables people to record and reflect community’s strength
and concerns
• Promotes critical dialog and
• knowledge about important community issues
• Reaches policy makers and others who can be mobilized for
change
Supported (in full or part) by grant T73MC00023 from the Maternal and Child Health Bureau, Health Resources
and Services Administration, Department of Health and Human Services.
Difference
18
83%
82%
+ 8%
- 1%
Family
Involvement
Intrapersonal
Strength
School
Functioning
Pre
Post
Pre
Post
Pre
Post
Pre
Post
Pre
Post
Participant 1
37
5
84
37
91
63
95
37
37
25
91
91
Participant 2
25
9
75
95
84
84
37
37
16
37
91
91
84
25
91
63
99
84
95
75
63
25
63
91
75
37
75
75
75
50
50
16
9
9
9
25
Participant 4
Consumer Satisfaction – Youth
20
Participant 2
21
Participant 3
25
Participant 4
24
Piers-Harris Self Concept
(T scores)
Career
Strength
Child Behavior Checklist- Youth Self Report
(T scores)
Likert Scale
(Total of 25 points)
Participant 1
Affective
Strength
Activities
Social
Pre
Post
Pre
Post
Participant 1
49
65
38
54
Participant 2
45
52
56
84
Participant 3
45
35
50
47
Participant 4
56
38
45
56
Total
Locus of Control
Participant 1
Girls Take Charge to
Get the Lead Out
Participant 4
Pre
Post
75
65
65
69
56
51
54
54
External (Mean for
9th graders
= 11.65) (Higher
scores = more
external
orientation)
Pre
Post
Participant 1
12
13
Participant 2
15
14
Participant 3
13
17
Participant 4
16
10
Discussion
ƒ
Module 12: Evaluate the Initiative
ƒ Systems level – What community changes occurred?
What steps were made to improve community health
and development?
ƒ
ƒ
Independent Variable
14+ yrs
+
Adults
87%
Post
Intervention –
Lead Poisoning Awareness Fair
To determine if participating in the CBPR process would change the girl’s self-concept, social competence and achievement,
strength in relationships and school functioning, and direction of locus of control.
Participants
• 5 adolescent females (1 drop-out)
• Inclusion Criteria
- females aged 11-14 years
- attend Girls, Inc. (an after-school program) in economically disadvantaged area
Post-test
79%
Pre
Participant 3
Module 7: Develop an Intervention
ƒ Structure interventions and strategies to meet their
goals
ƒ Develop a step by step action plan
ƒ Identify who will do what, by when
ƒ Consider empirically validated interventions and
cultural influences
It was expected that the girls would facilitate changes in their community with the goal of improving community health and
development.
ƒ
6 (2 high)
Interpersonal
Strength
Participant 3
Methods
23
Individual Girls’ Outcomes
Purpose
ƒ
8-13 yrs
Behavioral and Emotional Rating Scales (Percentile Ranks)
provides “workstations” for agencies to collect and analyze data across sites
used locally and internationally, with adults and adolescents
To teach adolescents girls the skills to become change agents in their own community through process of CBPR implementation
of the Community Tool Box.
Pre-test
10
10 (0 with lead)
Children Tested for Lead
Participant 2
ƒ
N
44
Home Lead Testing Kits Distributed
Home Items Tested
Community problems are identified by analyzing:
• Antecedents
• Community problem behaviors
• Their contingencies
The function of the problem behaviors are identified
ƒ
ƒ
Participants
People Who Completed All Booths
Pollution
Applied Behavior Analysis is a Central Component of CBPR
ƒ
ƒ
No sidewalk
Malcolm X birthplace
ƒ Many studies have shown effectiveness in producing community change with CBPR, but few studies have
been evaluated with adolescents.
ƒ
Results of Lead Poisoning Awareness Health Fair
Knowledge about Lead Poisoning
Results of Lead Poisoning Awareness Health Fair
ƒ The CBPR framework =
1. Assessing, prioritizing & planning
2. Implementing targeted action
3. Community and system change
4. Achieving widespread change in behavior
5. Improving population-level outcomes
(Fawcett et al., 2000; Institute of Medicine, 2003)
ƒ
Policy change at Girls Inc:
- Yearly lead testing of all children
under 6 years old
Individual level – Did the girls show growth in selfconcept, relationship building, school achievement and
competence? Was there a change in their locus of
control?
ƒ
Evaluation of CTB – Were there changes to the CTB to
make it more“ adolescent friendly”?
Dependent Variables
Systems Outcomes:
1. Coalitions Built and Description of Process
2. The number of community changes that occurred based on
the intervention developed by the adolescent girls.
3. Consumer satisfaction
Individual Outcomes: (Pre- and Post Testing)
1. Activities and Social Competence (CBCL-Youth Self Report
Child Behavior Checklist)
2. Self-concept (Piers-Harris Children Self-Concept Scales)
3. Locus of control (Nowicki-Strickland Internal/External locus of
control scale)
4. Strength in relationships (Behavioral and Emotional Rating
Scales – BERS-2)
The Girls Take Charge CBPR project resulted in numerous positive community
changes in North Omaha Girls Inc. including:
• increased the awareness of lead poisoning
• increased knowledge in children of lead poisoning (from 79% to 87%) but no change
in adult knowledge
• participation of approximately 150 children & adults
• adoption by Omaha Healthy Kids for replication at the south Omaha Girls, Inc.
• offering on-site lead testing at Girls Inc. for all children 1-6 years of age
The Girls Take Charge CBPR project resulted in positive individual girls’outcomes
for the four participating girls:
• High youth consumer satisfaction, both by written report and by willingness of 3 of 4
girls to participate in future projects
• Opportunity to present results at the Public Health Association of Nebraska conference
in Sept. 2007
• Letters of recognition from Senator Chuck Hagel
• There were no significant changes in the individual girls outcome measures.
However, all the girls were selected for this project due to being identified as highachieving and competent adolescents.
Future Directions
ƒ
ƒ
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This project was a pilot and will be replicated in the winter of 2008.
Changes to the project will include:
• Selection of 6-8 girls by application process (i.e., not selected based on current levels
of competence)
• Shorter duration for the project (ca. 16 weeks)
• Development of a workstation on the Community Toolbox
• Focus of the project will be child health
Based on the outcomes of this project, Girls Inc. National will be contacted to discuss its
adoption across sites