Program Profile: TakeCARE

This is an online video program that seeks to promote and increase high school and college students’ efficacy in performing helpful bystander behavior in instances of relationship or sexual violence, to reduce sexual violence among young adults and adolescents. The program is rated Promising. The treatment group showed statistically significant increases in observed and self-reported bystander behavior and in efficacy to intervene, compared with the control group.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals/Target Population

TakeCARE is an online video program that seeks to promote and increase high school and college students’ efficacy in performing helpful bystander behaviors–contextualized as “friends helping friends”–in instances of relationship or sexual violence. Bystander behaviors include stopping a friend who is escorting an intoxicated person to a bedroom during a party or confronting a person who attempts to make excuses for the abusive behavior of others. The goal of the program is to reduce sexual violence among adolescents and young adults.

Program Components

TakeCARE is a brief 24-minute video that was developed with input from high school and college students and school staff and administrators. With college students, the video is individually self-administered in a monitored computer lab; with high schoolers, the video is administered by school staff, such as counselors, and is sometimes viewed in a group format.

The video starts by acknowledging the demands placed on students, whether in high school or college; emphasizes the importance of friendships; explains the likelihood of sexual assault happening to someone they know; and explains how students can help to prevent these events from happening.

The TakeCARE video presents three vignettes to demonstrate the different ways students can intervene when they witness sexual coercion or violence or when they see risky situations that may lead to some form of sexual violence. The vignettes demonstrate situations where friends could be at risk of perpetrating or being victims of sexual coercion or violence and illustrate effective bystander responses such as 1) preventing the situation from happening, 2) stopping the situation from continuing or escalating, or 3) providing support for a friend after a situation like this takes place. The vignettes also provide information on sexual pressure, relationship violence, and dating abuse, and define consent within the context of sexual behavior.

The video’s narrator explains the situation in each vignette and describes how friends can respond to prevent their friends from being harmed. The narrator also links the letters in “CARE” to the tenets of successful bystander behavior demonstrated throughout the video: “C” means the individuals are confident they can help their friends avoid risky situations; “A” means the individuals are aware that their friends could get hurt in these situations; “R” means the individuals are responsible for helping; and “E” means the individuals are effective in how they help. The video content is designed to build bystanders’ self-efficacy and emphasizes that, “it’s not so important what you do, but that you do something.”

Program Theory

The TakeCARE program operates on the theory that the importance of peer relationships in late adolescence will motivate college or high school students to engage in behaviors that will ensure the well-being of their friends. Developmental theory suggests that encouraging students to take action to protect friends, compared with strangers or acquaintances, contributes to successful intervention effects (Levine et al. 2002). Further, in order for bystanders (i.e., friends) to act, they need to feel confident in their ability to intervene effectively in violent or potentially violent situations; that is, they need to possess self-efficacy (Banyard 2015; Burn 2009). Therefore, TakeCARE focuses on promoting students’ self-efficacy by presenting them with several different risky situations and those in which relationship or sexual violence has occurred and giving them concrete examples of actions they can take to help.

Study

Jouriles and colleagues (2016) conducted two randomized controlled trials (RCTs) to examine the effectiveness of TakeCARE. The two RCTs consisted of nearly identical procedures. The first was conducted across two universities, with a sample of 209 students recruited from psychology courses, and assessed students? engagement in bystander behavior and efficacy after viewing either the TakeCARE or the control video at a 1-month follow up. In the second RCT, participants were recruited from a required course at a midsized private university in the southwestern United States. The Crime Solutions review of this study focused on the second RCT.

The sample in the second RCT consisted of 211 students. Of this group, 180 were randomized to view the TakeCARE video, and 103 were randomized to view the control study skills video ?How to Get the Most Out of Studying.? The sample comprised an almost equal distribution of males and females, and the average age was 18.3 years. Participants were predominately white (68.2 percent); the rest identified as Asian (15.6 percent), Hispanic (10.9 percent), Black (4.3 percent), bi- or multiracial (9 percent), and other (2.8 percent). There were no statistically significant differences between the TakeCARE treatment group and control group on demographic characteristics at baseline.

At baseline and at the 2-month follow up, participants took the Bystander Behavior Scale for Friends (Banyard et al. 2014). The 49-item scale examined four dimensions of bystander behavior: 1) risky situations, 2) accessing resources, 3) proactive behavior, and 4) party safety. Risky situations involved identifying and interrupting situations in which the risk of sexual and relationship abuse seemed to be escalating. Accessing resources involved calling for professional help. Proactive behavior involved having an individual make a plan in advance of a risky situation and engaging in conversations about violence with others. Party behaviors involved describing any behaviors individuals could engage in to stay safe at parties. Participants self-reported whether they had engaged in these bystander behaviors in the past month. The study authors used the number of ?yes? responses to provide an index of responsive bystander behaviors. Participants also completed the Bystander Efficacy Scale (Banyard, Plante, and Moynihan 2005), which assessed confidence in the ability to perform bystander behaviors at three time points: at baseline, 1 week after viewing the video, and at a 2-month follow up. Through this questionnaire, students rated how confident they were that they could perform each of 14 bystander behaviors on a scale from 0 to 100 (0 = can?t do; 100 = very certain can do). The study authors performed two analyses: mixed effects model with participants nested within instructors and analysis of covariance (ANCOVA). No subgroup analyses were conducted.

Study

Sargent and colleagues (2017) conducted an RCT to evaluate TakeCARE?s effectiveness among high school students. The authors explored the types of situations that high school students may encounter that call for bystander behavior and examined whether the likelihood of engaging in helpful bystander behaviors differs across those situations.

Five school counselors assisted with the evaluations. The classrooms (n = 66) of participating students were randomly assigned to either the TakeCARE treatment condition or control condition. The treatment group viewed the TakeCARE video, and the control group viewed a video that included topics such as adolescent well-being, bullying, and suicide prevention. Students in control classrooms were also shown TakeCARE after all data were collected. Randomization resulted in the following condition assignments to the five school counselors (C1 through C5):

• C1: 5 TakeCARE, 5 control classrooms (234 students)
• C2: 9 TakeCARE, 9 control classrooms (348 students)
• C3: 8 TakeCARE, 8 control classrooms (319 students)
• C4: 10 TakeCARE, 7 control classrooms (288 students)
• C5: 1 TakeCARE, 4 control classrooms (106 students)

The sample consisted of 1,295 students from an economically disadvantaged urban public high school where more than 84 percent of students qualified for free or reduced lunch. A slight majority (52.5 percent) of the sample was female, and the average age was 15.3 years. The sample comprised 34.7 percent freshmen, 43.7 percent sophomores, 19.2 percent juniors, and 0.5 percent seniors. Participants were predominantly Hispanic (72.3 percent); the rest of the sample identified as Black (18.0 percent), more than one race (1.4 percent), Asian (1.2 percent), other race/ethnicity (0.8 percent), white (0.5 percent), American Indian/Alaska Native (0.3 percent), and Native Hawaiian or Other Pacific Islander (0.08 percent). Seventy-one students (5.5 percent) did not provide their race or ethnicity. The final sample (for which data analyses were conducted) included 921 students with complete data (71 percent). There were no statistically significant differences between the treatment and control groups on demographic characteristics at baseline.

Students completed the 18-item Friends Protecting Friends Bystander Behavior Scale (Jouriles and McDonald 2016) at baseline before watching either the TakeCARE or control videos, and again at a follow up no later than 3 months after the viewings. For the first 12 questions, participating students were asked to select what was ?most true for the past 3 months? to assess bystander responses to discrete situations of relationship or sexual violence among friends. This scale distinguishes reasons for the absence of bystander behavior in each situation by asking 1) if the situation was not encountered, or 2) if the situation was encountered but the student did not respond with a helpful bystander behavior. The second part of the scale assessed proactive behavior and information gathering; for example, ?I tried to get more information about sexual abuse and/or relationship abuse and what I can do about it.? Helpful bystander behavior was scored as: 0 = ?student did not intervene as a helpful bystander, regardless of whether the situation was encountered;? or 1= ?student encountered the situation and responded with helpful behavior.? Scores on all 18 items were summed to derive a scale score.

The authors conducted the generalized linear mixed model (GLMM) equivalent of an ANCOVA to evaluate TakeCARE?s effects on helpful bystander behavior, using age, sex, and Hispanic ethnicity as additional covariates. Subgroup analysis was conducted to compare Hispanic high school students? self-reported helpful bystander behavior with that of non-Hispanic high school students.

Study

Jouriles and colleagues (2019) also used an RCT to examine TakeCARE?s effects on bystander behavior in another sample of high school students. The study authors used a multimethod assessment of bystander behavior, including both questionnaire and virtual reality technology, which placed participants in an immersive virtual environment where they interacted with an avatar, or a computer-generated representation of a person, to see how they acted within the new environment.

Study participants (n = 165) were randomly assigned to view either the TakeCARE video (n = 85) or a control video (n = 80) on study skills. Study participants were recruited from a low-income urban public high school in the southern United States, where approximately 65 percent of the students qualified for free or reduced lunch. The sample was 51.5 percent female, had a median age of 15.7 years, and consisted of 44.8 percent freshmen, 28.5 percent sophomores, and 26.7 percent juniors. About 74.0 percent of the sample reported their race as Black (41.1 percent), white (22.6 percent), more than one race (16.9 percent), Asian (3.2 percent), and other (19.4 percent). The sample also included 79 participants who identified as Hispanic. There were no statistically significant differences between conditions on any of the measured demographic characteristics at baseline.

The postintervention assessment occurred 1 week after the viewings and involved students? completion of questionnaires and participation in virtual reality simulations. During the simulations, students wore goggles to experience sitting inside a parked car during a rainstorm at night with a male driver. The simulations provided participants with opportunities to engage in bystander behavior in situations that included or were at risk of including relationship or sexual violence There were also ?distractor simulations,? which centered on peer pressure or academic cheating to distract from the purpose of the research. The four relationship violence simulations were called ?drunk night,? ?stormy relationship,? ?homecoming dance,? and ?the hook-up.? The 6-month follow up also involved students individually completing questionnaires and participating in virtual reality simulations.

In addition, at baseline, 1-week postintervention, and the 6-month follow up, students completed a shortened version of the 14-item Bystander Efficacy Scale (Banyard, Plante, and Moynihan 2005), which included only situations pertinent to high school students. On this scale, students rated their confidence in the ability to perform designated behaviors on a scale of 0 (cannot do) to 100 (very certain can do). Participants also completed four items from the Bystander Behaviors Scale (Banyard et al. 2014), which was selected for use in this study based on its relevance to high school students and to the TakeCARE video. Students reported whether they had engaged in certain behaviors (0 = no; 1 = yes) in the past 6 months, such as ?I saw a friend in a heated argument. I asked if everything was okay.? and ?I confronted a friend who made excuses for the abusive behaviors of others.?

Multilevel models were used to analyze the data. The study authors conducted a subgroup analysis by gender, based on prior research that suggested that females perform more instances of bystander behavior than males (Banyard 2008; Hoxmeier et al. 2017).

Subgroup Analysis

Sargent and colleagues (2017) conducted a subgroup analysis comparing Hispanic high school students with non-Hispanic high school students. The study authors found that Hispanic students reported engaging in more helpful bystander behaviors than non-Hispanic students, at the 3-month follow up. This difference was statistically significant. Jouriles and colleagues (2019) conducted a subgroup analysis on bystander behavior by gender. For the outcome of observed bystander behavior in virtual reality simulations, the study authors found that females performed a statistically significant greater number of bystander behaviors, compared with males. There was also a greater number of self-reported bystander behaviors for males in the TakeCARE condition, compared with males in the control condition. This difference was statistically significant; however, there were no statistically significant differences across the conditions for females.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Banyard Victoria L., Elizabethe G. Plante, and Mary M. Moynihan. 2005. Rape Prevention Through Bystander Education: Final Report to NIJ for Grant 2002-WG-BX-0009. Durham: University of New Hampshire.

Banyard, Victoria L. 2008. “Measurement and Correlates of Prosocial Bystander Behavior: The Case of Interpersonal Violence.” Violence and Victims 23: 83–97.

Banyard, Victoria L., Mary M. Moynihan, Alison C. Cares, and Rebecca Warner. 2014. “How Do We Know If It Works? Measuring Outcomes in Bystander-Focused Abuse Prevention on Campuses.” Psychology of Violence 4(1):101–15.

Banyard, Victoria. 2015. Toward the Next Generation of Bystander Prevention of Sexual and Relationship Violence: Action Coils to Engage Communities. New York, N.Y.: Springer.

Burn, Shawn M. 2009. “A Situational Model of Sexual Assault Prevention Through Bystander Intervention.” Sex Roles 60:779–92.

Hoxmeier, Jill C., Alan C. Acock, and Brian R. Flay. 2017. “Students as Prosocial Bystanders to Sexual Assault: Demographic Correlates of Intervention Norms, Intentions, and Missed Opportunities.” Journal of Interpersonal Violence, advance online publication.

Jouriles, Ernest N., and R. McDonald. 2016. Friends Protecting Friends Bystander Behavior Scale. Unpublished measure.

Kleinsasser, Anne, Ernest N. Jouriles, Renee McDonald, and David Rosenfield. 2015. “An Online Bystander Intervention Program for the Prevention of Sexual Violence.” Psychology of Violence 5(3):227–35.

Latane, Bibb, and John M. Darley. 1970. The Unresponsive Bystander: Why Doesn’t He Help? New York, N.Y.: Appleton-Century-Crofts.

Levine, Mark, Clare Cassidy, Gemma Brazier, and Stephen Reicher. 2002. “Self-Categorization and Bystander Non-Intervention: Two Experimental Studies.” Journal of Applied Social Psychology 32:1452–63.

Following are CrimeSolutions-rated programs that are related to this practice:

Bystander Education Programs for Sexual Assault Prevention on High School and College Campuses

This practice comprises programs designed to decrease the prevalence of sexual assault among adolescents and college students by educating would-be bystanders (i.e., witnesses) about sexual assault, and promoting the willingness to intervene in risky situations. The practice is rated Effective for reducing rape myth acceptance, increasing bystander efficacy, and increasing intent to help. It is rated Promising for increasing bystander helping behavior and decreasing rape supportive attitudes.

Evidence Ratings for Outcomes

	Attitudes & Beliefs - Bystander Efficacy
	Attitudes & Beliefs - Intent to Help
	Attitudes & Beliefs - Rape Myth Acceptance
	Attitudes & Beliefs - Rape Supportive Attitudes
	Victimization - Actual Helping Behavior

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?