Multimedia Circle of Life
Multimedia Circle of Life (mCOL) is a prevention program designed to serve American Indian and Alaska Native youth ages 10–12 that aims to reduce risky behaviors and enhance resilience. mCOL’s theoretical model is represented as a medicine wheel, a Native American cultural symbol, divided into four equal parts each representing one facet of well-being: mental, physical, emotional, and spiritual. mCOL teaches youth to use their volition, that is, the power to make their own decisions, to strengthen and balance their medicine wheel.
The program’s trauma-informed lessons are designed to help youth learn how to set goals, make decisions, and manage peer pressure. Lessons cover prevention-focused topics such as how the use of drugs and alcohol can affect well-being, how to prevent the spread of sexually transmitted infections, how sexually transmitted infections affect health, and how to prevent teen pregnancy. The program includes online lessons and complementary in-person group lessons. Youth complete online lessons independently and teachers deliver in-person group lessons. Online lessons offer educational content, stories, games, and videos. In-person group lessons reinforce the online content through demonstrations, games, and crafts, and provide opportunities for questions and discussion.
A re-review of mCOL was conducted in March 2026 based on additional outcomes from Study 14376 being eligible for review under the Handbook of Standards and Procedures, Version 2.0.
The Prevention Services Clearinghouse’s independent systematic review of mCOL found that no studies of the program that achieved a rating of moderate or high on design and execution demonstrated a favorable effect on a target outcome.
As of December 2025, the ACF Assistant Secretary has final approval authority over the determination of the program or service rating. For more information, please visit the FAQ on the rating determination policy.
Date Last Reviewed by the Prevention Services Clearinghouse (Handbook Version 2.0): Mar 2026
Date Program or Service Description Last Updated: Mar 2026
Date Originally Reviewed by the Prevention Services Clearinghouse (Handbook Version 1.0): Sep 2022
Sources
The program or service description, target population, and program or service delivery and implementation information were informed by the following sources: the program or service manual and the program or service developer’s website.
This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, download the Handbook of Standards and Procedures, Version 2.0
Target Population
mCOL is designed to serve American Indian and Alaska Native youth ages 10–12.
Dosage
mCOL is typically delivered through seven 20–25-minute online lessons and seven 45–60-minute in-person group lessons. After youth have completed each online lesson independently, teachers deliver the corresponding in-person lesson to groups of 15–20 youth. Delivering each online and corresponding in-person lesson on different days is recommended, but both can be delivered on the same day. Implementing entities can also choose to deliver just one type of lesson (i.e., online only or in-person only) and have the flexibility to adjust session frequency to fit the needs and schedules of participating youth.
Location/Delivery Setting
Recommended Locations/Delivery Settings
mCOL online lessons are typically delivered in schools or participants’ homes. mCOL group lessons are typically delivered in schools but also can be delivered in community settings.
Education, Certifications and Training
mCOL has no education, certification, or training requirements. mCOL provides optional teacher training resources and training videos for each group lesson on its website. mCOL provides resources for parents and mentors who want to aid youth with the online lessons.
Program or Service Documentation
Book/Manual/Available documentation used for review
The Circle of Life User Guide is implemented in conjunction with The Circle of Life Teacher’s Notes and Online Videos.
Bennett-Barnes, E., & Naswood, E. (2012). The Circle of Life: User guide. KAT Communications.
Bennett-Barnes, E., & Naswood, E. (2012). The Circle of Life curriculum: Teacher’s notes. KAT Communications.
Bennett-Barnes, E., & Naswood, E. (2012). Circle of Life curriculum. [Online Videos]. KAT Communications. http://native-circle-of-life.com/#student/new-before-students
Available languages
mCOL materials are available in English.
Other supporting materials
For More Information
Website: http://native-circle-of-life.com
Phone: (800) 444-6472
Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.
| Results of Search and Review | Number of Studies Identified and Reviewed for Multimedia Circle of Life |
|---|---|
| Identified in Search | 3 |
| Eligible for Review | 1 |
| Rated High | 0 |
| Rated Moderate | 1 |
| Rated Low | 0 |
| Reviewed Only for Risk of Harm | 0 |
| Outcome | Effect Size
|
95% Confidence Interval
|
Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
|---|---|---|---|---|---|---|
| Child well-being: Behavioral and emotional functioning | -0.02 | [-0.43, 0.40] | 0 | 1 (2) | 93 |
Favorable:
0 No Effect: 2 Unfavorable: 0 |
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention condition and a negative number favors the comparison condition. A range of comparison conditions, including no intervention, minimal intervention, placebo or attention, treatment as usual, and head-to-head comparison conditions are eligible for review (see Section 4.1.7 of the Handbook Version 2.0). Different types of comparison conditions may affect the magnitude of the effect sizes across studies. For example, an intervention compared to a no treatment comparison condition may produce a larger effect size than the same intervention compared to another intervention because the other intervention may itself be effective. The effect sizes shown may be derived from samples that overlap across studies. See the Individual Study Findings table for information about the specific comparison conditions used in each study and the Studies Reviewed section for information about any overlapping samples. The effect sizes presented here are provided for informational purposes only and are not used in determining a program or service rating.
| Outcome | Effect Size
|
Implied Percentile Effect
|
Months after treatment when outcome measured
|
Number of Participants | |
|---|---|---|---|---|---|
| Child well-being: Behavioral and emotional functioning | |||||
| Study 14376 - mCOL vs. After-School Science Plus (Kaufman, 2018) | |||||
| Self-Perceived Volition | 0.15 | 6 | 3 | 93 | |
| Self-Efficacy to Resist Peer Pressure | -0.18 | -7 | 9 | 89 | |
*p <.05
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention condition and a negative number favors the comparison condition. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Version 2.0, Sections 6.4 and 6.5 and may not align with effect sizes reported in individual publications. The Prevention Services Clearinghouse uses information reported in study documents and, when necessary, information provided by study authors in response to author queries to assign study ratings and calculate effect sizes (see Section 8.4.2 in the Handbook of Standards and Procedures, Version 2.0). The Prevention Services Clearinghouse typically relies on study-reported p-values to form the basis of the assessment of statistical significance for a finding, but will perform its own statistical test of a finding using any available information in study documents or author queries, as needed (see Section 6.3 in the Handbook of Standards and Procedures, Version 2.0). As a result, the effect sizes and statistical significance reported in the table may not align with the estimates as they are reported in study documents.
Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.
Full citations for the studies shown in the table are available in the "Studies Reviewed" section.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Demographic Characteristics
|
Populations of Interest*
|
Household Socioeconomic Status
|
||
| Study 14376 - mCOL vs. After-School Science Plus | ||||||
| Characteristics of the Children and Youth | ||||||
| North Dakota and South Dakota, USA | 2012 |
Average age: 11.17 years; Age range: 10-12 years
91% American Indian and Alaska Natives
53% Female
|
-- | -- | ||
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated Moderate
Study 14376Schwinn, T., Kaufman, C. E., Black, K., Keane, E. M., Tuitt, N. R., Big Crow, C. K., Shangreau, C., Schaffer, G., & Schinke, S. (2015). Evaluation of mCircle of Life in tribes in the Northern Plains. Office of Adolescent Health. https://opa.hhs.gov/sites/default/files/2020-07/ucd-final-report.pdf
Kaufman, C. E., Schwinn, T. M., Black, K., Keane, E. M., Big Crow, C. K., Shangreau, C., Tuitt, N. R., Arthur-Asmah, R., & Morse, B. (2018). Impacting precursors to sexual behavior among young American Indian adolescents of the Northern Plains: A cluster randomized controlled trial. The Journal of Early Adolescence, 38(7), 988-1007. https://doi.org/10.1177/0272431617708055
Kaufman, C. E., Black, K., Keane, E. M., Big Crow, C. K., Shangreau, C., Arthur-Asmah, R., Keith, C., Morse, B., Schaffer, G., & Tuitt, N. (2014). Planning for a group-randomized trial with American Indian youth. The Journal of Adolescent Health, 54(3 Suppl), S59-S63. https://doi.org/10.1016/j.jadohealth.2013.12.028
This study was conducted in a usual care or practice setting (Handbook Version 2.0, Section 7.2.2)Studies Not Eligible for Review
Study 14370
Kaufman, C. E., Whitesell, N. R., Keane, E. M., Desserich, J. A., Giago, C., Sam, A., & Mitchell, C. M. (2014). Effectiveness of Circle of Life, an HIV-preventive intervention for American Indian middle school youths: A group randomized trial in a Northern Plains tribe. American Journal of Public Health, 104(6), e106-e112. https://doi.org/10.2105/AJPH.2013.301822
Kaufman, C. E., Mitchell, C. M., Beals, J., Desserich, J. A., Wheeler, C., Keane, E. M., Whitesell, N. R., Sam, A., & Sedey, C. (2010). Circle of Life: Rationale, design, and baseline results of an HIV prevention intervention among young American Indian adolescents of the Northern Plains. Prevention Science, 11(1), 101-112. https://doi.org/10.1007/s11121-009-0153-x
Asdigian, N. L., Whitesell, N. R., Keane, E. M., Mousseau, A. C., & Kaufman, C. E. (2018). Effects of the "Circle of Life" HIV-prevention program on marijuana use among American Indian middle school youths: A group randomized trial in a Northern Plains tribe. The American Journal of Drug and Alcohol Abuse, 44(1), 120-128. https://doi.org/10.1080/00952990.2016.1265122
Mitchell, C. M., Kaufman, C. E., Whitesell, N. R., Beals, J., & Keane, E. M. (2017). Self-efficacy about sexual risk/protective behaviors: Intervention impact trajectories among American Indian youth. Journal of Research on Adolescence, 27(3), 697-704. https://doi.org/10.1111/jora.12308
This study is ineligible for review because it is not a study of the program or service under review (Handbook Version 2.0, Section 4.1.9)Study 14373
Kaufman, C. E., Litchfield, A., Schupman, E., & Mitchell, C. M. (2012). Circle of Life: HIV/AIDS prevention intervention for American Indian and Alaska native youth. American Indian and Alaska Native Mental Health Research, 19(1), 140-153. https://doi.org/10.5820/aian.1901.2012.140
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)