A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

Abstract

BACKGROUND AND OBJECTIVES: Few evidence-based interventions address adolescent relationship abuse in clinical settings. This cluster randomized controlled trial tested the effectiveness of a brief relationship abuse education and counseling intervention in school health centers (SHCs). METHODS:In 2012-2013, 11 SHCs (10 clusters) were randomized to intervention (SHC providers received training to implement) or standard-of-care control condition. Among 1062 eligible students ages 14 to 19 years at 8 SHCs who continued participation after randomization, 1011 completed computer-assisted surveys before a clinic visit; 939 completed surveys 3 months later (93% retention).RESULTS: Intervention versus control adjusted mean differences (95% confidence interval) on changes in primary outcomes were not statistically significant: recognition of abuse = 0.10 (20.02 to 0.22); intentions to intervene = 0.03 (20.09 to 0.15); and knowledge of resources = 0.18 (20.06 to 0.42). Intervention participants had improved recognition of sexual coercion compared with controls (adjusted mean difference = 0.10 [0.01 to 0.18]). In exploratory analyses adjusting for intensity of intervention uptake, intervention effects were significant for increased knowledge of relationship abuse resources and self-efficacy to use harm reduction behaviors. Among participants reporting relationship abuse at baseline, intervention participants were less likely to report such abuse at follow-up (mean risk difference = 20.17 [20.21 to 20.12]). Adolescents in intervention clinics who reported ever being in an unhealthy relationship were more likely to report disclosing this during the SHC visit (adjusted odds ratio = 2.77 [1.29 to 5.95]).CONCLUSIONS: This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.WHAT'S KNOWN ON THIS SUBJECT: Adolescent relationship abuse (ARA) is prevalent in confidential clinic settings such as school health centers (SHCs) and is associated with poor health outcomes. No evidence-based interventions target reduction of ARA in the SHC setting.

Dating Violence and Injury Among Youth Exposed to Violence

“…Another promising strategy, brief clinical interventions and counseling for students in school health clinics, demonstrated reductions in relationship abuse. 37 Pediatricians could potentially provide education about the appropriateness of sexually coercive behaviors and how to respond to young boys that have been victims, just as they could for girls in later adolescence. Likewise, pediatricians treating older adolescents for injuries should consider and screen for potential victimization by a dating partner for boys and girls alike among high-risk youth.…”

A cluster-randomized trial of a college health center-based alcohol and sexual violence intervention (GIFTSS): Design, rationale, and baseline sample

“…A summary score is calculated by adding one point for each additional resource endorsed as known by a participant (baseline Cronbach α=0.77). Items are based on earlier work by the investigators 48,49 and have been updated for use with this college sample.…”

“…Ten items (modified from earlier research) 48,53,54 are used to assess respondents’ proclivity to intervene when witnessing disrespectful and harmful behaviors among peers by asking them, “if you see a friend or peer doing any of the following things, how likely are you to try to stop it?” Scenarios presented include “fighting with a partner and starting to cuss at or threaten that person” and “constantly talking or calling their dating or sexual partner to find out who they were with, where they were, or what they were doing.” For each item, respondents rate their willingness to intervene on a 5-point Likert scale from “very unlikely” to “very likely”; responses are averaged across the 10 items, with a higher mean score indicating greater likelihood to intervene (baseline Cronbach α=0.92). Intentions to intervene is assessed on baseline, T2, and T3 surveys.…”

Cluster randomized controlled trial protocol: addressing reproductive coercion in health settings (ARCHES)

“…Women ages 16-29 years seeking care in family planning (FP) clinics report higher rates of intimate partner violence (IPV) compared to their same-age peers; [1][2][3][4][5][6][7] these negative experiences are, in turn, associated with unintended pregnancy and related poor sexual and reproductive health outcomes [8][9][10][11][12][13][14][15][16][17][18][19]. A growing body of literature on male partner influences on contraception and pregnancy decision-making has identified a range of male partner pregnancy-controlling behaviors that contribute to poor reproductive and sexual health outcomes for women [7,[20][21][22][23].…”