A study by a Children's Hospital of Pittsburgh of UPMC researcher provides the first evidence of the potential benefits of a brief, provider-delivered universal education and counseling intervention in school-based health centers to address and prevent the major public health problem of adolescent relationship abuse. The study appears online in Pediatrics.
In collaboration with the California Adolescent Health Collaborative of the Public Health Institute, California School-Based Health Alliance and Futures Without Violence, the study was conducted during the 2012-2013 academic year at eight school-based health centers in California where students receive confidential clinical health services. Researchers surveyed 1,062 teens ages 14 to 19 for exposure to adolescent relationship abuse (including cyber dating abuse), sexual behavior, and care-seeking for sexual and reproductive health at their initial visit and again three months later.
Providers and staff in four school-based health centers received training on how to talk about healthy and unhealthy relationships; received palm-sized brochures about relationship abuse and available resources to hand out to patients; and learned how to refer youth to additional services and supports. No changes were implemented at the other four school-based health centers.
The researchers found students at the intervention sites were more likely than those at the other sites to recognize sexual coercion. Among students who reported relationship abuse at an initial visit on a confidential survey, students at intervention schools were significantly less likely to report such abuse on the follow-up survey 3 months later.
"This study shows that a universal education and brief counseling approach in health care settings may be a useful way to address relationship abuse among adolescents," said lead investigator Elizabeth Miller, M.D., Ph.D., chief, Division of Adolescent and Young Adult Medicine. "Clinicians talking about healthy and unhealthy relationships with all of their patients can make a difference."
Among almost 400 youth who reported experiencing relationship abuse at an initial visit, 65 percent of students in intervention schools reported still experiencing such abuse about three months later, compared to 80 percent of students in the other schools. In addition, youth in the intervention clinics were much more likely to discuss being in an unhealthy relationship with their health care provider. "Embedding prevention messages and information about relevant resources within clinical settings for adolescents may be an effective way to reduce relationship abuse," said Lisa James, the director of Health at Futures Without Violence and a co-investigator on the study.
"Youth seeking care in adolescent health settings appear to have more exposure to relationship abuse and associated poor health outcomes," said Dr. Miller, also an associate professor of pediatrics, University of Pittsburgh School of Medicine. "Finding an intervention that may make a difference for these youth who are at higher risk for relationship abuse is encouraging."
"This study effectively combined school-based clinical interventions with youth-led promotion of healthy adolescent relationships," said co-investigator Samantha Blackburn, formerly with the California School-Based Health Alliance, and now an assistant professor of nursing at California State University Sacramento. "Not only did students receive needed services, they were also empowered to help their peers be healthy and safe."
"Prevention of relationship abuse among adolescents requires a range of strategies from educating youth and adults about the extent of the problem; connecting youth to relevant supports and services; and engaging schools, parents, and other influential adults to talk about healthy relationships," said co-investigator Alison Chopel from the Public Health Institute's California Adolescent Health Collaborative. "This intervention is a part of the prevention solution."
Dr. Miller and her collaborators are hopeful that these findings will encourage schools and adolescent health care providers to implement this program. For parents and educators, she adds, "This study suggests that creating spaces for young people to learn about healthy and unhealthy relationships and how to help their friends can really help to reduce adolescent relationship abuse."
Collaborators with Dr. Miller on the study were: Heather L. McCauley, Sc.D., Kelley Jones, MPH, Rebecca Dick, MS, all with Children's Hospital of Pittsburgh of UPMC; Sandi Goldstein, MPH, Johanna Jetton, California Adolescent Health Collaborative, Public Health Institute; Jay G. Silverman, Ph.D., Division of Global Public Health, University of California, San Diego School of Medicine; Samantha Blackburn, RN, MSN, PNP, California School-Based Health Alliance and California State University Sacramento School of Nursing; Erica Monasterio, RN, MN, FNP-BC, University of California San Francisco School of Nursing; Lisa James, Futures Without Violence; and Daniel J. Tancredi, Ph.D., University of California Davis School of Medicine.
The study was supported by Award No. 2011-MU-MU-0023 of the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice.