Transcript Center on Adolescent Sexuality, Pregnancy and Parenting Veronica E. Stovall Project Coordinator University of Missouri Extension Making Proud Choices.

Center on Adolescent
Sexuality, Pregnancy and
Parenting
Veronica E. Stovall
Project Coordinator
University of Missouri Extension
Making Proud Choices
Steps to Prevention for
Adolescences
 Perceived
Vulnerability;
 Empower
the Youth;


Providing them with Medically Correct Sexual
Health information.
Provide them with Self Efficacy (skills)
• Use condoms correctly and consistently,
• Negotiate condom use.
Making Proud Choices
Center On Adolescents Sexuality,
Pregnancy and Parenting.
The Mission of CASPP is to :
Bring together a Multi-disciplinary Team
of Professionals and Laypersons to
Collaborate to provide Educational
Programs and Conduct Applied Research
to better understand how to Prevent and
Eliminate the Negative Effects of High
Risk Sexual Behaviors and Early
Childbearing.
Making Proud Choices
Programming objectives
 Helping
adolescents and young adults
develop healthy relationships and sexual
decision making skills.

This is achieved by providing services to
community professionals as well as direct
services to youth and their parents through
regional HDFS extension faculty and
community partnerships.
Making Proud Choices
Programs We Implement

Missouri Volunteer Resource Mothers;

Maltreatment and Adolescent Pregnancy and
Parenting Program;

Adolescent Mother Journaling Program;

Making Proud Choices;

Healthy Relationships and Marriage Education
Training project.
Making Proud Choices
Funding
 MO
Department of Elementary and
Secondary Education (DESE);
 MO
Department of Social Services (DSS);
 US
Department of Health and Human
Services.
Making Proud Choices
Other Resources
 Technical
assistance to organizations
implementing these programs;
 Up-to-date
research and information for
professionals and educators in the field;
 Assistance
with grant writing.
Making Proud Choices
Please Share with the Group
 Hearts
 Condoms
 Ribbons
Making Proud Choices
Three Epidemics Among Youth
•
Persons aged 13-29 accounted for an estimated 34 percent of
new HIV infections reported in 2006 surveillance data.1
•
Approximately 19 million new STD infections occur each year
with 48 percent among young people aged 15 – 24. An
estimated 1 in 4 teenaged girls between the ages of 14 and
19, or 3.2 million, are infected with a STD 2.
•
Each year there are over 745,000 teenage pregnancies3.
Source
1
Available at http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/incidence.htmf#18
2
Available at http://www.cdc.gov/std/stats/pdf/trends2006.pdf
3
Available at http://www.guttmacher.org/pubs/fb_ATSRH.html#ref27
9
What Is Risky Sexual Behavior?
Early initiation of sexual
intercourse
 Unprotected intercourse
 Multiple sexual partners
 Sex while under the
influence of drugs or
alcohol

Risk and Protective Factors for HIV, STD,
and Teen Pregnancy
Risk Factors
• Unprotected Vaginal
and Anal Sex
Protective Factors
• Sexual abstinence
• Consistent and
correct condom* use
• Abstinence from
AOD**
HIV
STD
Pregnancy
* Male and female condoms
** Alcohol and other drugs
11
Making Proud Choices
Making Proud Choices
Training Goals
Goal



To Provide Educators with knowledge of Adolescence Sexual
Decision Making as it relates to their Risky Sexual Behaviors;
which may lead to HIV/STD and unwanted Pregnancy,
Educators will obtain those Skills necessary to Empower Young
Adolescents to Change their Behavior in ways that will Reduce
their Risk for STDs, HIV, and Pregnancy.
To Provide Educators with the Knowledge and Skills to
Implement the Making Proud Choices! curriculum Effectively and
with a High Degree of Reliability.
Making Proud Choices
Making Proud Choices
A Safer Sex Approach to HIV/STD Teen
Pregnancy Prevention
 The


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
Modules:
Module 1: Getting to Know You and Steps to
Making Your Dreams Come True
Module 2: The Consequences of Sex: HIV
Infections
Module 3: Attitudes and Beliefs about
HIV/AIDS and Condom Use
Module 4: Strategies for Preventing HIV/
Infections STOP THINK and ACT
Making Proud Choices
Making Proud Choices
A Safer Sex Approach to HIV/STD Teen
Pregnancy Prevention

Module 5:
The Consequences of Sex:
STD’s and Correct Condom Use;

Module 6:

Module 7:

Module 8:
The Consequence of Sex:
Pregnancy;
Developing Condom Use and
Negotiation Skills;
Enhancing Role Plays: Refusal
and Negotiation Skills.
Making Proud Choices
Foundation of a Healthy Relationship
MPC Theory to
Practice
KNOWLEDGE
Teens need to learn
relevant and correct
information.
Making Proud Choices Modules2,5, & 6
MPC Theory to
Practice
PERCEIVED
VULNERABILITY
Teens need to believe
they are VULNERABLE
to being infected with
HIV/ STDs and getting
someone pregnant.
Making Proud Choices Modules 2,
3, 4 & 5
MPC Theory to
Practice
Outcome
Expectancy Beliefs
Teens need to believe:
-Using Condoms will not
interfere with sexual pleasure;
-When Partners react
negatively and not approve of
using a condom, they will feel
confident in their ability to
respond to their partner and
handle the situation;
Condoms can prevent
HIV/STDs and that condoms
and other contraceptives can
prevent teen pregnancy.
Making Proud Choices Module 4,
7&8
MPC Theory to
Practice
SKILLS
Teen Needs to Learn:
-Skills
-Practice using the skills,
-Build confidence in
using skill.
Making Proud Choices 4,7, & 8
MPC Theory to
Practice
Self Efficacy
Teens need to build
confidence in their ability
to :
•Use condoms correctly
and consistently;
•Negotiate
condom use
and get their partner to
use a condom.
Making Proud Choices 4, 5,7 & 8
Curriculum Teaching Strategies
 Setting
the Environment: The Group
Rules;
 Brainstorming;
 Interactive Activities and Competitive
Games
 Processing a Video or Game;
 Working in Small Groups;
 Role Playing/Practice.
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Group Rules

Developing guidelines
as a group builds
group cohesion and
increases the
likelihood that the
rules will be followed.
Module 1
Making Proud Choices
Brain Storming

Remember in
Brainstorming you
just say whatever
comes to mind about
a particular issue or
question.
Module 1
Making Proud Choices
Harm and Reduction
Framework Key Components
 People
will continue to Engage in
Behaviors that Society may Disapprove of
like Early Sexual Activity and Drugs;
 Rather than Responding to these
Behaviors with Punishment and
Prohibition, We need to Build Trust by
Helping Teens Minimize the Potential
Hazards associated with their Behaviors,
therefore,
Making Proud Choices
Harm Reduction Framework
Key Continues
 Your
Program Should Help Youth see the
Risks They are Taking and Recommend
Safer Behaviors including Abstinence but
Start Where the Youth is Now and
Attempts to Move Him/ Her in a Positive
Direction.
Making Proud Choices
Making Proud Choices
Americans Overwhelmingly Favor
Broader Sex Education
 93%
of parents reported their child has
benefited from sex education;
 94%
of parents say that sex education
should cover contraception;
 Only
15% of Americans want abstinenceonly education taught in the classroom.

The Guttmacher Institute 2005
Making Proud Choices
What Type of Sex
Education is Right for Your Teen?
 Abstinence-only
Education;
 Abstinence plus or Abstinence Based
Sexual Education;
 Comprehensive Sexual Education;
 Holistic Sex Education.
Making Proud Choices
What is Adolescence?
 What
period do you think of when you
hear the word” adolescence”? Decide
when you think it begins and ends.
 What
words or images come to your mind
when you hear the word “teenager”? Make
a list.
Making Proud Choices
Adolescence
 It
also refers to the age period between
childhood and adulthood. Phases of
Adolescences

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
TWEENS: 11-14 years (Early)
TEENS: 13-16 years. (Middle)
EMERGING ADULTHOOD: 16-18 (Late)
Making Proud Choices
Making Proud Choices
Puberty Begins
 Puberty
is a period of rapid physical
growth and sexual maturation;
 The
sequence of physical changes is
universal, but the timing varies (typically
lasting 3-5 years).
 Age of onset ranges between 8-15 years.
Making Proud Choices
Adolescence

Awkward period between sexual maturational
and the attainment of adult roles and
responsibilities;
 Begins with the domain of physical/biological
changes related to puberty, but it ends in the
domain of social roles;
 Encompasses the transition from the status of a
child (one who requires monitoring) to that of an
adult. (responsible for behavior)
Making Proud Choices
Adolescence
 Adolescence
is much broader and longer
than the teenage years alone (has
changed significantly over the past 150
years);
 Adolescence now stretches across more
than a decade, with puberty onset often
beginning by age 9-12 and adult roles
delayed until mid twenties (Worth man,
1995).
Making Proud Choices
33.2
28.5
26.7
30
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35
30.9
25
26.0
20
25.1
WOMEN
15
17.4
10
12.6
AGE
14.0
MEN
16.9
Young people are at high risk of unintended
pregnancy and STDs for many years
Adolescence
Puberty
Romantic Motivation
Sexual Interest
Emotional Intensity
Sleep Cycle Changes
Appetite
Risk for Affective
Disorders (girls)
Increase in risk seeking,
and novelty seeking
Age/Experience
Planning
Logic, Reading
Inhibitory Control
Problem Solving
Understanding
Consequences
Affect regulation
Goal Setting and pursuit
Judgment and abstract
thinking
Making Proud Choices
Puberty T/F

1 in 7 Caucasian girls starts to develop breasts
or public hair by age 8

1 in 2 African American girls starts to develop
breasts or pubic hair by age 12

Average age of menarche (first menstruation)
has fallen from 20-10.

African American girls are about 6 months
earlier
Making Proud Choices
Adolescent Brain Still Under
Construction
Teens (left) used less of the prefrontal (upper) region than adults (right) when
reading emotions.
Making Proud Choices
FRONTAL LOBE
 As
the “prefrontal cortex” area of the
frontal lobe matures, through experience
and practice, teens can reason better,
develop more impulse control, and make
better judgments
 Prefrontal cortex is one of the last areas of
the brain to fully develop
 Increased need for structure, mentoring, guidance.
Making Proud Choices
Incarcerated Youth Risky
Behaviors Continue
 39%
had used alcohol and/or other drugs
before sex:
 64%
had not used a barrier form of
protection during last intercourse.
Educational Training and Research 2008
Making Proud Choices
Factors that Influence Risky Sexual
Behaviors
 Environmental

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
Factors:
Community Characteristics;
Family Characteristics;
Peer Characteristics;
Characteristics of Romantic partners.
Making Proud Choices
Factors that Influence Risky Sexual
Behaviors
 Individual

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




Factors:
Biological Factors-age, physical development
and gender;
Race/ethnicity;
Connection to family;
Connection to school and success in school;
Connection to faith communities;
Connection to other community organization;
Child Abuse i.e Physical, Sexually, Neglect
Making Proud Choices
Factors that Influence Risky Sexual
Behaviors

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Involvement in gangs;
Alcohol and drug use;
Aggression;
Involvement in problem or sensation-seeking
behavior;
Paid work;
Involvement in Sports;
Cognitive and personality traits;
Sexual beliefs, attitudes and skills.
Making Proud Choices
How do these changes affect
teens?
 Adolescents
are uniquely vunerable to risk
taking:


Novelty & sensation seeking increase
dramatically at puberty
Development of self-regulation lags behind
Making Proud Choices
What Can Adults Do?
 Expect
inconsistency in responsibility
taking and in decision making;
 Provide opportunities for “safe: risk taking;
 Avoid criticizing /comparing to others;
 Encourage enough sleep;
 Encourage/model healthy eating;
 Encourage /model activity
 Provide honest answers about sex.
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The Youth Risk Behavior
Surveillance System (YRBSS):
2007
National, State, and Local Data
http://dese.mo.gov/divimprove/c
urriculum/newwebpages/docum
ents/yrbs_95_07.pdf
Making Proud Choices
What Happening in your neck of
the Woods?
Making Proud Choices
Where do you stand?
Making Proud Choices
Teaching the Adolescence Brain

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A young adolescent brain can hold seven
items of information, plus or minus two items,
in working memory;
The addition of emotion can help students
remember;
The brain is social and requires interaction in
order to develop properly;
Practice/rehearsal is critical to learning for the
long term.
Making Proud Choices
Teaching the Adolescence Brain
 We
take in more information visually than
through any other sense.
Making Proud Choices
Teaching At-Risk Youth
 Things



to Remember:
Have poor auditory memory. They learn best
visually;
They want to do well but are hampered by
their inability to remember facts through
lecture, discussion or reading.
They learn differently from the high achievers
and the gifted, but they also learn differently
from one another.
Making Proud Choices
What Do I Say?
 Teach
Age-Appropriate Information;
 Be Prepared;
 Know Your Group;
 Establish a Baseline;
 Teach Sexuality as Positive and
Pleasurable;
 Teach the Right to Refuse;
Making Proud Choices
What Do I Say?
 Remember
that Content is Everything
 Help Youth to Practice Appropriate
Affection;
 Recognize the Importance of feeling.
Making Proud Choices
Different Types of Student
Questions
 Request
 “Am

I Normal”
Generally focus on adolescent concerns
about their bodies and the emotional and
physical changes occurring in them.
 Value

for Information;
Questions
How old should you be to have sex?
Making Proud Choices
Different Types of Student
Questions (Continued)
 Slang

Questions
“What is a blow job?’
 Personal

Questions/Permission Seeking
“When did you lose your virginity?”
 Questions
You Don’t Know the Answer To
Making Proud Choices
Healthy Relationship
A relationship that
includes love,
trust, mutual
respect, and
honesty.
Making Proud Choices
Foundations of a
Healthy Relationship
Sex
Commitment/marriage
Trust
Similar expectations/ambitions
Honoring boundaries
Similarities in backgrounds
Being friends
Shared values
Shared experiences
Dating
Talk
Making Proud Choices
Teen Dating and Domestic
Violence
Teen Dating Violence is a pattern of
physically, sexually ,verbally, and/or
emotionally abusive behavior in a
dating relationship.
Making Proud Choices
Teen Dating Violence Statistics
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About one in 11 teens reports being a victim of
physical dating abuse each year;
About one in five teens reports being a victim of
emotional abuse;
The overall occurrence of dating violence is higher
among black (13.9%) than Hispanic (9.3%) or white
(7.0%):
About 72% of students in 8th and 9th grade report
“dating” by the time they are in high school, 54% report
dating violence among their peers;
Almost 70% of young women who have been raped
knew their rapist either as a boyfiend, friend or casual
acquaintance.
Teen Dating Abuse most often takes place in the home
of one of the partners.
Chooserepect.org
Making Proud Choices
Making Proud Choices
Teen Dating Domestic Violence
Making Proud Choices
What Are the Reasons?
 Lack
of information from parents/
other important adults;
 Lack of communication between
parents and children;
 Lack of quality sexuality education
programs;
 Influence of the media;
 Influence of peers.
Making Proud Choices
How Can You Tell if a Teen is
Experiencing Dating Violence?
 Withdrawing
from school and/or other
activities;
 Has become very secretive, ashamed, or
hostile to parents, friends, family because
of the relationships;
 Apologizes for partner’s behavior;
 Doesn’t do things that he/she wants to
because of his /her partner.
Making Proud Choices
What Parents Could Do….
 Tune
in and Talk
 Question Choices
 Speak Up
 Understand
 Encourage
 Educate
 Be real
 Model
Making Proud Choices
What Schools Could Do
 Improve


School Sexuality Education.
Curricula should:
Not only focus on content (e.g.,
statistics on STDs and Reproductive
Anatomy & Physiology) ;
• but should focus on social skills building
and sexuality valuing.
Making Proud Choices
Teen Dating Violence Prevention
website

Dating and Violence
Should Never Be a
Couple

http://www.abanet.org/ab
astore/index.cfm?section
=main&fm=Product.AddT
oCart&pid=3070001
Making Proud Choices
Helping Teens Change Behavior
Youth Empowerment:

Youth Need to feel Empowered to make Responsible
Safer Sex Decisions:
• Adolescence feel empowered when they have the
belief that they are bright, worthy and have the
skills to engage in safer behaviors and the belief
that their behaviors affects not only themselves,
but their sexual partners, friends, family and
community, and a belief in a POSTIVE FUTURE.
Making Proud Choices
Helping Teens Change Behavior
Continues
 Encourage
teens practicing healthy
behaviors to continue to do so;
 Encourage teens practicing unhealthy
behaviors to change their behaviors;
 Screening for risky behaviors, followed
by your brief advice and assistance, is
a powerful agent for personal behavior
change.
Making Proud Choices
Helping Teens Change Behaviors

Barriers for you:




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


Lack of problem awareness
Lack of time
Lack of training
Belief that teens can’t or won’t change their behavior;
Personal values and attitudes’
Personal behaviors;
Personal characteristics
Personal history.
Making Proud Choices
Making A Difference! Be Proud ! Be
Responsible! Brainstorm

Making Proud
Choices?

To Be Proud?

To Be Responsible?
Making Proud Choices
Why Some Teens Have Sex
Making Proud Choices
Consequences of Sex
AIDS
Pregnancy
Making Proud Choices
STDs
Proud and Responsible Prevention
Strategies
 What
are some ways to Prevent the
Negative consequences of SEX?
Making Proud Choices
Goals and Dreams
What are your Dreams and Goals?
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Goals and Dreams
 What
are some obstacles that may hinder
you from reaching your dreams and
goals?
 How
can we avoid these obstacles?
 What
can you do to make sure you don’t
get pregnant, get someone pregnant, or
get an STD, like HIV?
Making Proud Choices
Setting Goals
HOW TO SET GOALS
1.
2.
3.
4.
Define the goal.*
Outline the steps needed to achieve it.
Consider possible obstacles and ways of dealing with them.
Set deadlines.
Not every wish can be a goal. For instance, you may wish you could live and
stay young forever, but since there's nothing you can do to make that
happen, it could never be considered a goal.
In order for something to be a goal:
• It has to be important to you, personally.
• It has to be within your power to make it happen through your own
actions.
• It has to be something you have a reasonable chance of achieving.
• It must be clearly defined and have a specific plan of action.
Making Proud Choices
HIV/AIDS Frame
 How
do people get HIV/AIDS? (3 ways)
 Through what 4 body fluids has HIV been
transmitted?
 What are the 3 sexual practices that are
HIV-risk related?
 How can you prevent HIV?
Making Proud Choices
AIDS Key Words
1.
What is HIV?
2.
What is AIDS?
3.
How is AIDS different from HIV?
4.
What is the immune system?
Making Proud Choices
AIDS Key Words
5.
What happens when someone gets the
virus that cause AIDS?
6.
What is the HIV antibody test?
7.
What is a condom?
8.
What is Spermicide?
Making Proud Choices
Myths and Facts about AIDS
Game
After the 1st Team gets 4 points (2
points answering myth or fact
correctly and 2 points for explaining
why correctly and 0 points if they
answer it incorrectly .
Making Proud Choices
ATTITUDES AND BELIEFS ABOUT
HIV/AIDS AND CONDOM USE
AIDS
CONDOM USE
Making Proud Choices
Strategies for Preventing HIV
Infection: STOP, Think, And Act
 STOP-Stay
Calm, take a deep breath, be
in control of myself.
 THINK-What
is the problem or conflict
about?
 ACT-Evaluate.
Make the best choice.
Making Proud Choices
The Consequences of Sex:
STDs and Correct Condom Use




What is STD?
What are some of the STDs ?
How do you Think People get STDs?
How would you Feel if you had an STD?

Making Proud Choices
National STD Teen Crisis!
1
out of 4 14 to 19 year old women have at
least one sexually transmitted disease.
 Almost
HALF of the African American
teens surveyed had an STD.
Making Proud Choices
Four most common STDs:
HPV
 Human




Papilloma Virus [HPV]:
Most common, no treatment or test
available
Most infected people do not know they
have it, more than 50% sexually active
Americans have it (20 million people)
Some strains cause genital warts and
cervical cancer (most dangerous because
no symptoms until cancer is present).
New vaccine available.
http://www.cdc.gov/STD/HPV/STDFact-HPV.htm
Making Proud Choices
Vaginal Genital Warts
Penile Genital Warts
Four Most Common STDs:
Chlamydia
Bacteria that can damage women’s
reproductive organs with little or no
symptoms (pelvic inflammatory disease)
 Can be tested and treated, also reinfection
possible
 Young women especially vulnerable to
Chlamydia and other STDs due maturing
cervixes.
 CDC recommends yearly testing for women
over 25 years old, women with multiple
partners, and pregnant women.


Making Proud Choices
http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm
Four Most Common STDs:
Trichomaniasis
 Caused
by a parasite
 Most common curable STD among young
women
 Men usually show no symptoms
 Causes genital inflammation in women
and increases risk of HIV infection
Making Proud Choices
Four Most Common STDs:
Herpes Simplex Virus






Caused by two viruses: HSV-1 and HSV-2
Most infected show no signs;
Those who have symptoms have sores
around genital region that last weeks and
then disappear: can be deadly for babies;
Infection can be passed during outbreak or in
between outbreaks;
At least 45 million adolescents and adults are
infected;
Can be tested, no cure, just treatment.
http://www.cdc.gov/std/Herpes/STDFact-Herpes.htm
Making Proud Choices
Making Proud Choices
Primary herpes, female
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Activity B








Listen very Carefully;
Write your Name on the side of the index card that has the letter on
it;
You are going to walk around the group until I say “STOP”;
Then You STOP in front of the Person closer to you;
I will read you an Unfinished Sentence;
The two of you will complete the Sentence and discuss why you
feel that way;
At the end of that discussion; you will sign each others card on the
side without the letter; and return it to the original owner;
You will continue this process for six brief discussion.
Making Proud Choices
Who gets STD? Don’t answer this just think
about .
Making Proud Choices
Condom Use Skills
 What
is a Condom?
 What
are some of the nick-names
or slang terms for condom?
Making Proud Choices
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How to Put on a Condom
 Check
the expiration date on the package;
 Open the condom package ;
 The condom must be put on when the
man’s penis is hard and before any
contact near the partner’s sexual organs;
 Unroll the condom down the hard penis so
that it covers the length of the penis;
 Leave space at the tip of the condom to
collect the semen.
Making Proud Choices
Continuation on How to Put on a
Condom
 After
the man ejaculates, hold the base of
the condom so that no semen spills out as
the man pulls out of his partner;
 Remove the used condom and throw it in
the garbage;
 Use each condom only once.
Making Proud Choices
Consequences of Sex-Pregnancy
Myths and Facts about Pregnancy

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


You can get pregnant by kissing?
A a boy cannot get a girl pregnant unless he
has had a wet dream?
If a girl misses her period, she is definitely
pregnant?
A girl can get pregnant if she has sexual
intercourse standing up?
Vaseline makes a good lubricant for condoms
during sex and prevents pregnancy?
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What’s happing at home?
In Missouri, the pregnancy incidence rate among
Hispanics from 1995 to 2005:
increased 140%; Caucasian teens declined from 46.1 to 35.9 per
1000 teens and African American teens decreased from 109.8
per 1000 71.6 per 1000 teens in 2005.
Teen Pregnancy rate in Missouri per 1000 girls ages 1319 was 42.5 making Missouri rank 31 in the Country for
Teen Pregnancy.
MissouriFamilies. Org
National Teen Pregnancy Campagin.org
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Increase in Teen Births

Decline in Teen contraceptive use has played
some part in the teen birth rate increase;
 Recent decline in teen sexual activity;
 Economic hardship and the rising cost of
certain birth control has made certain
contractive less affordable;
 A decline in the % of students who report
having received a formal contraceptive
education.
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Reasons Why
According to the National Institute of
Health [NIH], 79% of white and
70% of African American teens stated
Lack of
communication
that the lack
of communication
between a girl and her
parents is often the reason teen girls
have babies (NIH, 2006). It is believed
that with improved communication and
active listening, parents and their children
can avoid teen pregnancy.
Lack of education
VanLenten, 2007
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Genesis
 One
of the oldest references to birth
control comes from the Bible. In the
book of Genesis men are called upon to
practice coitus interruptus, commonly
known as the "withdrawal" method.
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Birth Control Methods
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Contraceptives

Over-the-Counter
Methods:

Prescribed Methods:

Condoms

Birth Control Pills

Spermicide

Depo-Provera Shots

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The Diaphragm or
Cervical Cap
Talk Show
 Type
of Method;
 Effectiveness;
 Advantages;
 Disadvantages.
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Condom Line Up
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Developing Condom Use and
Negotiation Skills
S
W
A
T
“NO” to unsafe behavior.
Be prepared to explain “Why” you
want to be safe.
Provide “Alternatives”
“Talk” it out.
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ENHANCING ROLE-PLAYS: REFUSAL
AND NEGOTIATION SKILLS.
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