Description of the Respecting the Circle of Life Program Delivery
sexual behaviors, RCL
PMT
RCL is delivered through peer group lessons followed by a parent-youth lesson. The peer group component consisted of eight educational lessons, each lasting 90–120 min, delivered by two trained Native paraprofessionals to self-selected same-sex peer groups of 8–10 Native teens. The eight lessons were delivered once per day during an 8-day summer basketball camp. (Note while the camp primarily offered basketball as the non-study-related activity, other activities were offered to youth who did not enjoy basketball such as drawing, painting, arts and crafts, and photography.) The youth-parent component was one educational lesson lasting 90–120 min delivered by a trained Native paraprofessional who also taught the peer group lessons within 3 months after camp to the youth participant and enrolled TA together in their home. On the first day, youth were brought to the gym and asked to find a group of their friends/peers that were similar in age/grade and the same sex and go with that group to a number on the wall (the numbers were used to track group progress). Study staff then went to each group to ensure participants were of similar age (not more than 3 years between the oldest and youngest) in each group. Groups that were too large (> 12 youth) were separated. Groups were then assigned the morning or afternoon RCL lesson, the opposite of which they spent playing basketball or completing other activities as listed previously. The RCL study was conducted over three cohorts (cohort 1: July 2016, cohort 2: July 2017; cohort 3: June 2018). For cohort 1, RCL was delivered for 8 consecutive days (Friday–Friday). For cohorts 2 and 3, RCL was delivered for 8 consecutive weekdays with a break over the weekend (Weds–Friday and Monday–Friday).The RCL program was delivered by two facilitators who were trained in the RCL program and PMT model. To identify facilitators, we advertised widely in the local community for applicants and met with current staff to discuss the opportunity. The local leadership team interviewed applicants/discussed the position with current staff and determined their fit for the position based on (1) cultural fit, (2) reliability, and (3) past teaching experience and/or ability to work with youth. All facilitators attended an initial week-long (40 h) RCL training. At the training, each facilitator was paired up with a co-facilitator who they would work with throughout the implementation of RCL. They then completed “co-facilitator worksheets” for each lesson indicating their role and their co-facilitator’s role on each activity within a lesson. They then attended an average of eleven, 1-h meetings with the trainer and their co-facilitator (these were conducted in person or via phone) where they roleplayed a lesson and received feedback. In total, facilitators completed on average 51 h of initial training. Finally, all facilitators passed a comprehensive exam before teaching the program. This exam focused on curriculum content (e.g., “What are three styles of communication discussed with the youth?”), curriculum concepts (e.g., “Why do the youth guess and discuss statistics related to youth sexual behaviors?”), reproductive and sexual health knowledge (e.g., “Please label the male reproductive system parts”), and program implementation (e.g., “Who should attend the parent/youth session?”). The entire 51-h training for facilitators along with completion of the exam was conducted prior to implementation of each cohort. Thus, facilitators may complete the training up to three times. Each facilitator pair worked with two groups (morning and afternoon). These groups and facilitators remained the same throughout the 8-day camp. Each morning, the Curriculum Director met with the facilitators for 30 min to prepare for the lesson. Additionally, all facilitators attended a daily 30-min debrief inclusive of a review of how the lessons went, discussion of questions, and an overview of the next day. At times, one facilitator would teach a lesson alone. While rare, this did occur during two of the cohorts. The majority of facilitators were female, from the local tribal community, and all had a high school diploma (see Table Facilitator characteristics
Within 3 months following the last peer group lesson, facilitators delivered the 9th, parent-youth lesson to the youth to the identified TA in the home or location of the youth/TA’s choosing. Although facilitators did all they could to ensure the parent-youth lesson included both the TA and the youth, if one was unavailable for a long period of time or refused to complete the lesson, the facilitator completed with just one member of the dyad.