Intervention Summary
Say It Straight (SIS)
Say It Straight (SIS) is a communication training program designed to help students and adults develop empowering communication skills and behaviors and increase self-awareness, self-efficacy, and personal and social responsibility. In turn, the program aims to reduce risky or destructive behaviors such as substance use, eating disorders, bullying, violence, precocious sexual behavior, and behaviors that can result in HIV infection. SIS began as a school-based program for use in grades 3-12. Its application has been expanded to include students in detention and treatment, student mentors and mentees, parents, high-risk communities, adults in treatment, college students, and the homeless. SIS is based in social learning and positive psychology, emphasizing values such as resiliency, courage, compassion, and integrity. The change process in SIS begins with the recognition of one's own disempowering behaviors and leads to awareness of one's own deepest wishes to choose empowering behaviors for wellness. These changes lead from relationships of submission and dominance to relationships of equal value. Building on SIS's principle of "rooting diversity in sameness," participants learn to identify with others even when they may disagree or have differences with them. By using a technique called "body sculpting" and creating and acting in role-plays or "movies," they explore how they feel when they engage in empowering and disempowering communication/behavior. In body scuplting, the participants place their bodies in postures that intensify and make overt their internal experiences; for example, a begging posture can be used to represent placating. The movies enable participants to act out difficult interpersonal situations that are important in their lives (e.g., alcohol or drug abuse, drinking and driving, speeding, cheating, stealing, bullying, violence, vandalism, sexual behavior). Movies can be videotaped to give participants the opportunity to observe themselves. SIS also incorporates feedback, journaling, and small- and large-group discussion. Through these processes, participants learn that by empowering themselves, they gain respect and empower others. In school settings, SIS is delivered in 5 to 10 sessions, each 45-50 minutes in duration. The sessions can be held once per week or on consecutive days. One or two trainers facilitate the program with groups as large as 35 students. With participants other than students, SIS is delivered in 5 to 15 sessions, 1-3 hours each, depending on group size and group needs.
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
The following populations were identified in the studies reviewed for Quality of
Research.
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
The measures generally were reliable and had, at a minimum, face validity. The authors present compelling documentation of fidelity, demonstrating that considerable time and attention were dedicated to assuring fidelity of implementation. Previous fidelity assessments had helped to identify common implementation problems and yielded approaches to avoid and correct them, including a fidelity guide that became part of the training packet. For some studies and outcomes, attrition was low. There were no missing data in the analyses of the outcomes dealing with criminal offenses and school-related suspensions since all trained and untrained students were included. Most analyses were appropriate for the study design, the data collected, and the outcomes assessed. Attrition was high for the three self-report outcomes measured using surveys, although it was low for the behavioral outcomes measured using school data and police reports. In two of the three studies reviewed, no analyses were reported focusing on the potential effects of this attrition or describing differences between students retained and students lost to attrition. In all three studies, missing data and methods to address missing data were not described. One study used a weak one-group pretest/posttest design. Major confounds include the voluntary nature of participation in the intervention, across-study variations in the instrument measuring students' intentions and comfort with good decisionmaking, and the infeasibility of random assignment to study conditions. The use of multiple t-tests may have compounded the error factor in the analyses. For the two studies with a quasi-experimental design, the statistical tests used were not the most appropriate given the difference in sample sizes.
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials. Posters: Questionnaires: Say It Straight Foundation. Say It Straight challenge for ages 9 to adult: Three to eight players/actors take turns making movies. Carlsbad, CA: Author.
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria: For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
A nicely formatted, scripted manual outlines each session and includes specific hints for accomplishing tasks with participants. Participant workbooks are available for various grade levels to assist leaders in program delivery. Several well-made videos are also available to support implementation. The developer offers training and ongoing assistance to interested sites. Measures for assessing participant outcomes are provided to support quality assurance. Some student materials include concepts or text that may be above typical reading and comprehension levels for the suggested grade levels noted on the workbooks. No information is provided to site administrators on organizational or personnel requirements. Some session content could be difficult for participants who have experienced abuse, warranting additional leader training in addressing trauma issues. While fidelity is addressed in the training-of-trainers workshop and trainer manual, no tools or measures are provided to directly assess fidelity and ensure adherence to the model.
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements. Descriptive Information
Areas of Interest
Mental health promotion
Substance use disorder prevention
Outcomes
1: Alcohol- and drug-related school suspensions
2: Intentions to use assertive refusal skills
3: Criminal offenses
4: Communication skills
5: Intentions to use assertive refusal skills in sexual situations
Outcome Categories
Alcohol
Crime/delinquency
Drugs
Education
Social functioning
Ages
6-12 (Childhood)
13-17 (Adolescent)
18-25 (Young adult)
26-55 (Adult)
Genders
Male
Female
Races/Ethnicities
Data were not reported/available.
Settings
School
Other community settings
Geographic Locations
Urban
Suburban
Rural and/or frontier
Implementation History
It has been implemented in urban and rural schools in a number of States, as well as with Native American youth in schools and summer camps and with Native Canadian youth and adults. More recently, implementation has expanded to a broader range of settings and populations (e.g., HIV prevention and treatment; substance abuse treatment; developmentally challenged children and adults; juvenile justice; men and women in prison; the homeless). SIS has been used with a wide range of populations and age groups, ranging from pre-teenagers to older adults. Evaluations of SIS have been conducted with students starting in grade 3, and some implementations have included children in grade 2. One of the SIS studies reviewed in this summary was conducted in schools in high-risk areas (i.e., easy access to drugs, drug abuse, poor school performance, high drop-out rates), and some of the schools had large percentages of African American and Hispanic students (40% or higher).
SIS also has been used in a number of countries outside the United States, including Canada, Costa Rica, Hong Kong, and Slovakia.
NIH Funding/CER Studies
Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations
All printed materials have been translated into Spanish. Some adaptations have been made to support SIS's expansion to a broader range of settings and populations (e.g., components originally developed for older students have been adapted for younger students).
Adverse Effects
No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories
Universal
Indicated
Documents Reviewed
Outcomes
Outcome 1: Alcohol- and drug-related school suspensions
Description of Measures
Alcohol- and drug-related school suspensions (excluding those related to the use of tobacco) were monitored for all students in grades 5-9 in the city in which the intervention took place. This information was gathered by the school system's Auxiliary Services from the Office of the Superintendent.
Key Findings
Students who had received the intervention in either the current school year (grades 6-8) or the previous school year (grade 9) had a lower number of alcohol- and drug-related suspensions than students in the same grades who had not received the intervention (p < .03). No alcohol- or drug-related school suspensions were incurred by students in grade 5, whether or not they had received the intervention, so these students were dropped from the analysis.
Studies Measuring Outcome
Study 1
Study Designs
Quasi-experimental
Quality of Research Rating
3.4
(0.0-4.0 scale)
Outcome 2: Intentions to use assertive refusal skills
Description of Measures
This outcome was measured using the SIS Social Skills Situations Survey, a questionnaire based on Prince's Social Skills Situation Survey. Students were asked to indicate how they would respond to certain situations on a 6-point scale, with 1 indicating the most desirable response and 6 indicating the least desirable. (One study used a 4-point scale for students in grades 3-8.) Sample items include, "You are at a party. A close friend is smoking and offers you a cigarette," and "You have been standing in the ticket line at the movies for 20 minutes. Just as you get close to the box office, three people, whom you know only slightly from school, come up to you and ask if you would let them 'cut' in front of you." Students chose one of the following responses:
Key Findings
In one study, students in grades 5-8 received a shortened form of the intervention over a 5- or 7-day period. Both the 5- and 7-day models were effective in increasing students' intentions to use assertive refusal skills and their comfort in doing so (p < .0001 to p < .0094, respectively). Further, an analysis of students who received a 10-day version of the intervention during the previous year revealed no significant difference in the change in scores as a function of length of the intervention.
In a study that involved students in grades 9-12, those who received the 5-day version of the intervention showed a pre- to posttest increase in intentions to use assertive refusal skills. Findings were significant for students in 9th grade (p < .0001), 10th grade (p < .0001), and 12th grade (p < .001) and for female students in 11th grade (p < .007).
In another study, students in grades 3-12, a small group of students in detention, and chemical dependency treatment students who received the intervention made gains from pre- to posttest in their willingness to use assertive refusal skills and in their comfort in doing so (p values ranging from < .001 to < .048 depending on grade level/group).
Studies Measuring Outcome
Study 1, Study 2, Study 3
Study Designs
Quasi-experimental, Preexperimental
Quality of Research Rating
2.9
(0.0-4.0 scale)
Outcome 3: Criminal offenses
Description of Measures
Offenses (e.g., assault, burglary, larceny, possession of stolen property, driving offenses, vandalism) committed by juveniles were monitored for a 2-year period by the police department in the city in which the study took place. As these offenses occurred, police recorded the type of offense, the birth date and grade of the offender, whether or not the offender had received the SIS intervention, and the date of the intervention, if applicable.
Key Findings
In a study with students in grades 9-12, the number of juvenile offenders was lower among students who received the intervention than among students who did not, both during the 7-month period after the intervention (the rest of the school year and following summer months; p = .008) and during the second postintervention period (spanning the next school year and following summer months; p = .011). In addition, an analysis was conducted to compare the rate of offenses between one group of 9th graders who had received the intervention and another group of 9th graders from the following school year who did not receive the intervention, using an equivalent time period. As with the same-year analyses, the number of students committing offenses was lower in the intervention group than in the comparison group (p = .015).
Studies Measuring Outcome
Study 2
Study Designs
Quasi-experimental
Quality of Research Rating
3.5
(0.0-4.0 scale)
Outcome 4: Communication skills
Description of Measures
The communication skills of parents and other adults participating in the intervention were measured using the self-report SIS Communication Skills Questionnaire. The questionnaire consisted of 29 statements representing effective and ineffective communication styles, such as the following:
For each item, respondents indicated the degree to which the statement described their communication style, using a 5-point scale ranging from "not at all" to "very much."
Key Findings
Parents and other adults who received the intervention showed pre- to posttest decreases in ineffective communication styles (placating, p < .001; passive-aggressive, p < .001; blaming/bullying, p < .001; irrelevant, p < .002; and super-reasonable, p < .001) and an increase in effective communication (saying it straight, p < .01).
Studies Measuring Outcome
Study 3
Study Designs
Preexperimental
Quality of Research Rating
2.6
(0.0-4.0 scale)
Outcome 5: Intentions to use assertive refusal skills in sexual situations
Description of Measures
For high school students (grades 9-12) in a few of the participating schools, five items pertaining to sexual behavior were added to the SIS Social Skills Situations Survey. These items were:
To respond to each question, students chose one of the following responses:
Key Findings
From pre- to posttest, high school students receiving the intervention showed an increase in their intentions to use assertive refusal skills to avoid risky sexual behavior and their comfort in doing so (p < .002).
Studies Measuring Outcome
Study 3
Study Designs
Preexperimental
Quality of Research Rating
3.2
(0.0-4.0 scale)
Study Populations
Study
Age
Gender
Race/Ethnicity
Study 1
6-12 (Childhood)
13-17 (Adolescent)
Data not reported/available
Data not reported/available
Study 2
13-17 (Adolescent)
51.6% Male
48.4% Female
Data not reported/available
Study 3
6-12 (Childhood)
13-17 (Adolescent)
18-25 (Young adult)
26-55 (Adult)
51.8% Female
48.2% Male
Data not reported/available
Quality of Research Ratings by Criteria (0.0-4.0 scale)
Outcome
Reliability
of Measures
Validity
of Measures
Fidelity
Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Alcohol- and drug-related school suspensions
3.5
3.5
3.5
3.8
2.3
3.8
3.4
2: Intentions to use assertive refusal skills
3.3
3.0
3.7
1.9
2.2
3.6
2.9
3: Criminal offenses
3.5
3.5
3.8
3.8
3.0
3.8
3.5
4: Communication skills
3.0
2.0
3.5
2.0
2.5
2.5
2.6
5: Intentions to use assertive refusal skills in sexual situations
3.3
3.3
3.5
3.0
2.8
3.5
3.2
Study Strengths
Study Weaknesses
Materials Reviewed
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
2.8
3.1
3.3
3.0
Dissemination Strengths
Dissemination Weaknesses
Item Description
Cost
Required by Developer
Trainer manual (includes all quality assurance tools except age-specific pretests/posttests)
$250 each
Yes
Age-specific workbook/journal
$6.75-$11.50 each
Yes
Posters (nine)
$15 per set; reproducible
Yes
Say It Straight Challenge Game
$25 each
No
Guided visualization audio CD
$20 each
No
Training DVDs (three)
$75 each ($180 per set)
No
4-day training-of-trainers workshop (includes all implementation and quality assurance materials and sample workbooks)
$750 per participant
Yes
Review and evaluation process to certify a Master Trainer-of-Trainers
$750 per participant
Yes
Ongoing technical assistance
Varies depending on site needs
No
Age-specific pretests/posttests (four)
$10 each ($40 per set); reproducible
No