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  • Title: Teaching refusal skills to sexually active adolescents.
    Author: Warzak WJ, Page TJ.
    Journal: J Behav Ther Exp Psychiatry; 1990 Jun; 21(2):133-9. PubMed ID: 2148750.
    Abstract:
    Refusal skills training was extended to sexually active handicapped female adolescents who lacked an effective refusal strategy. Role-plays for assessment and training were developed using the who, what, when and where of situations which resulted in unwanted intercourse. Refusal skills were trained following the format of rationale, modeling, rehearsal, feedback, and reinforcement. Baseline rates of most target behaviors were quite low. High frequencies of target behaviors were observed as each behavior became the focus of training. Generalization across staff and time was also observed. The skillfulness and effectiveness of the subjects' refusal skills were judged to be improved as a function of training. One-year follow-up showed decreased sexual activity for each girl. In an attempt to curtail adolescent pregnancy, refusal skills were taught to 2 sexually active and handicapped female adolescents. The goal was to surpass the just say no philosophy by 1) socially validating each girl's effectiveness and skill, and 2) extending refusal skills training to special populations, where skill deficits may be more prevalent and the need the greatest. One child Amy, 16 years) was dead and was being treated for sexual disorders, and the other (Karen, 14 years) was developmentally delayed and sexually precocious. Both desired refusal skills. Training was designed to teach skills to effectively refuse sexual advances when they deemed it necessary and desirable to do so. An assessment was made for each girl. A role play vignette was developed for each girl which relied on her past experiences. The performance of the role play was videotaped in order to identify the particular deficits in refusal assertion. Refusal, specification, leaving the situation, and eye contact were situations that were categorized as either an occurrence or nonoccurrence for the pre- and postassessments. Skills were taught based on rationale, feedback, modeling, behavioral rehearsal, and reinforcement. 8 randomly ordered play roles were analyzed by 2 observers to evaluate social perception of client refusal skills and effectiveness. Reliability was evaluated using Cohen's Kappa (K). The K for eye contact was .84; refusal , .85; leaving the situation, 1.0; and specifying objectionable behavior, .90. The deaf child, Amy, initially showed only eye contact skills, while Karen used only verbal refusal before skills training. The intervention created long and shortterm effects, i.e., use of target behaviors posttraining, at a 2-week follow up with nonintervention staff, and a 1-year telephone follow up which indicated decreased sexual activity for each girl. Significant differences were found in the baseline and posttreatment performance ratings for both refusal and effectiveness (F=103.02, df=27.3, p=.001; and F=243.7, df=27.3, p.001). For Karen only refusal skill rating was significantly changed (F=22.06, df=27.3, p=.001). There is a need to provide additional research to verify the actual effectiveness of refusal skills packages and their impact on the occurrences of unwanted sexual behavior. Refusal components, developmental factors, societal norms, familial and peer pressure that are most critical need to be determined. Generalizability is limited.
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