Online Program

Student response to a healthy relationship intervention in school based health centers

Monday, November 4, 2013

Rebecca Dick, MS, Division of Adolescent Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
Sandi Goldstein, MPH, California Adolescent Health Collaborative, Public Health Institute, Oakland, CA
Jay G. Silverman, PhD, Division of Global Public Health School of Medicine, University of California San Diego, La Jolla, CA
Daniel Tancredi, PhD, Department of Pediatrics, UC Davis School of Medicine, Sacramento, CA
Johanna Jetton, California Adolescent Health Collaborative, Public Health Institute, Oakland, CA
Sami Newlan, School of Public Health, University of California Berkeley, Oakland, CA
Samantha Blackburn, RN, MSN, California School-Based Health Alliance, Oakland, CA
Lisa James, M.A., Administration, Futures Without Violence, San Francisco, CA
Erica Monasterio, MN, FNP, Division of Adolescent Medicine and Family Health Care Nursing, University of California, San Francisco, San Francisco, CA
Elizabeth Miller, MD, PhD, Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
Background Adolescent relationship abuse (ARA) is prevalent and associated with poor physical, sexual and mental health outcomes. School based health centers (SBHC) offer a unique opportunity to address this serious public health problem. Purpose The School Health Center Healthy Adolescent Relationships Program trained SBHC providers to discuss healthy relationships and to respond to ARA among their adolescent patients. This cluster randomized controlled trial examined the effectiveness of a brief safety card intervention among adolescents ages 14-19 seeking care at SBHCs. Methodology Before a SBHC visit, students (n=793, 76% female) completed a computer-based survey about their ARA experiences and their knowledge of harm reduction strategies. A post-visit survey assessed for healthy relationship discussions during the visit. Results Approximately 27% (n=197) of students experienced ARA, 63% experienced technology-based abuse, and 10% of females experienced reproductive coercion. A majority of students (87%, n=688) identified their SBHC as an ARA resource at baseline. Post-visit, intervention SBHC students were significantly more likely to have discussed ARA with their provider compared to control students, controlling for group differences in abuse history and demographics (aOR 3.01, 95% CI 2.21, 4.10). Among those who had experienced ARA, intervention SBHC students were more likely to disclose this history of abuse to a provider compared to controls, but this did not persist in adjusted analysis (aOR 2.09, 95% CI 0.92, 4.77). Conclusions/Recommendations Given the prevalence of ARA, findings indicate the utility of a brief safety card intervention in SBHCs to improve discussion of ARA and promote healthy and safe relationships.

Learning Areas:

Implementation of health education strategies, interventions and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
Explain the study design of the School Health Center Healthy Adolescent Relationships Program, an intervention that incorporates healthy relationship discussion and adolescent relationship abuse response into school based health centers. Describe the prevalence of adolescent relationship abuse, including technology-based abuse and reproductive coercion, in this sample of school based health center clients. Describe the health center intervention effects on adolescent relationship abuse discussions and disclosures. Discuss how the School Health Center Healthy Adolescent Relationships Program expands the capacity of school based health centers to become a tool for relationship abuse harm reduction and increased case identification.

Keyword(s): School-Based Health Care, Violence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the clinical research coordinator for the SHARP intervention which is the topic of this abstract. I am responsible for data management and analysis for this intervention. I have a master's degree in health promotion and have over 4 years experience in research coordination. Among my varied public health interests is the integration of sexual health and violence prevention into school health centers.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.