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Center for Adolescent Health

Center for Adolescent Health Blog

Keyword: lifeskills training

Israel Jurado, a student at University of California-Berkeley studying nutritional science, interned at the Center for Adolescent Health (CAH) over the summer under the direction of Dr. Terri Powell. As a California native, Jurado had to get used to the hot, humid weather typical to Baltimore summers as he dove into assessing the implementation quality of the Center's core research project. In November, Dr. Powell and colleagues will present a paper on based Jurado’s findings at the American Public Health Association 2018 Annual Meeting. Thank you for your hard work, Israel!

Israel Jurado

Reflections on a Summer in Baltimore

By Israel Jurado

This summer I was given the opportunity to participate in summer research relating to public health thanks to the Diversity Summer Internship Program and Health Careers Opportunities Program. I interned for the Center for Adolescent Health at the Johns Hopkins School of Public Health. I was provided with mentorship by Dr. Terri Powell who allowed me to work with her on her research study and learn more about the field of public health and research.

The project I took on related to the field of implementation science and my job was to assess factors relating to implementation quality of the LifeSkills Training intervention in Baltimore City public middle schools. LifeSkills Training (LST) is a skills-based cognitive behavioral prevention intervention for students in grades 6-8.  This project was developed to address the growing need for behavioral health interventions that tackle multiple health risk factors among Baltimore youth. After reviewing the numerous problem behaviors of Baltimore’s adolescents and the research on LST, Baltimore City Public Schools (City Schools), the local health department, and behavioral health organizations decided to expand the delivery of LST in City Schools but also add modules explicitly focusing on sexual risks.

I assisted Dr. Powell by collecting fidelity logs completed by teachers, observation logs completed by CAH research staff, and reviewing principal interviews conducted before the intervention. Using SPSS statistical software to interpret the quantitative data and examining the principal interview transcripts, I was able to put together the information and present the findings to Dr. Powell and her team at the Center for Adolescent Health. With the guidance from Dr. Powell, I completed a research paper with our results, completed a research poster to present at Johns Hopkins Medicine’s Cultivating Future Scientists and Health Providers Symposium, and gave a presentation about the findings to the DSIP cohort and director at the Bloomberg School.

Finally, I would like to thank everyone again, in my cohort and mentors for this opportunity in expanding my experience in public health research. Coming in with a background in nutritional science, I took on the challenge being open to learning a different field of science I had no prior knowledge of and how I may relate to it in the future in my field of study. After finishing this summer research project, I now have an interest in learning more about the field of implementation science and applying it to nutrition public health interventions. I am thankful for Dr. Powell's guidance, kindness, insight on graduate school, and patience throughout this summer as all of this was a new experience for me. The staff at the Center for Adolescent Health were welcoming and supportive throughout my time there, and I will not forget this experience. I would recommend any future summer undergraduate intern to work with this team of amazing researchers.


teachers at the fall LST training

LifeSkills Training is a substance abuse prevention program proven effective by over 30 research studies. The curriculum was created by Dr. Gilbert Botvin, a health behavior and prevention expert. Teachers follow the LST curriculum to provide teens the skills and knowledge needed on to handle changing situations.

The Johns Hopkins Center for Adolescent Health (CAH) is taking big strides to build on the efforts of the already effective LifeSkills Training program by expanding the middle school curriculum to include new modules on sexual risk reduction. The Center began implementing LST and the new modules (LST+) at six Baltimore City public schools in 2014.

“We thought a good way to reach an awful lot of young people in the city would be to work in Baltimore City Schools. One way you can do that is by finding or creating evidence-based programs that fit within a normal school day, while meeting the state and city standards for health education,” said Meghan, the Center for Adolescent Health’s senior research program coordinator.

CAH was awarded funding from the Centers for Disease Control and Prevention for 2014-2019 to implement LST as its core research project. This project was designed to build on City Schools’ and Behavioral Health Systems Baltimore’s Sixth-Grade Expanded School Behavioral Health Initiative, which targets sixth graders at risk of dropping out. The initiative supports implementation of LST in small groups of sixth graders at 35 Baltimore City schools. However, CAH’s strategy focuses on universal implementation. In the project’s third year, all students in 6th-8th grades at the five schools participate in LST and at 3 of the schools, students participate in additional modules focused on sexual and reproductive health.

The additional modules on sexual and reproductive health students receive in 7th and 8th grade follow the same pedagogy and decision making model that is the core of LST. Meghan said what often happens is that there are several health programs, each on a specific risk behavior like smoking or alcohol misuse, in one school. “So young people may be learning three different ways to say ‘no’ to something rather than learning one technique and framework to apply [in] a lot of different health situations,” she said.

LST and the Center’s new modules (LST+) equip young people with skills on how to handle difficult situations related to drugs, alcohol, smoking, violence, and sexual activity. “The school administration itself decides whether it's going to be taught and how, like during the PE class or some schools do it as a part of their science curriculum,” said Courtney, a research assistant at CAH.

Asari trained new teachers who will implement the modified curriculum earlier in the fall. Asari, now a doctoral student at Johns Hopkins Bloomberg School of Public Health, previously implemented LST in schools and community centers in New York City as a Children’s Aid Society prevention specialist. While working for Children’s Aid Society, Asari attended the LifeSkills Training-of-Trainers workshop through National Health Promotion Associates, a research and development firm founded by Botvin.

As an evidence-based program, LST was meant to be taught exactly how the curriculum was written. When taught with fidelity, it has positive results for young people. “We don't really know what happens if a lot of changes start happening. We don’t know if it would be more effective or if it would actually detrimental to young people so the safest bet is to implement as closely as we can to how it was tested,” Meghan said.

To ensure LST is implemented with fidelity, teachers complete fidelity logs after each lesson to track how much material they covered, changes they made and why. Teachers are also observed at least once by CAH staff.

“As our funding cycle winds down, we'll be thinking more about sustainability and being able to continue with the schools,” Meghan said. By the end of the research project, CAH hopes to provide information about feasibility, implementation quality, and feedback from teachers and administrators to staff at other schools who are considering implementing the program. “Part of the way it's set up right now is to look for just feasibility of implementing LifeSkills at a universal level and feasibility and acceptance of the new modules. So the next steps will be to look more into impact,” she said.