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Building Partnerships Among Adolescent Health and Violence Prevention

Sandi Goldstein, MPH Robin Kirkpatrick, LCSW , MPH California Adolescent Health Collaborative. Building Partnerships Among Adolescent Health and Violence Prevention. What is adolescent relationship abuse?.

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Building Partnerships Among Adolescent Health and Violence Prevention

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  1. Sandi Goldstein, MPH Robin Kirkpatrick, LCSW, MPH California Adolescent Health Collaborative Building Partnerships Among Adolescent Health and Violence Prevention

  2. What is adolescent relationship abuse? Adolescent relationship abuse (ARA) refers to an escalating pattern of repeated acts that physically, sexually, or emotionally abuse a member of a heterosexual or homosexual couple in which one or both partners is a minor. Range of controlling behaviors: monitoring cell phone usage, telling a partner what s/he can wear, controlling where s/he goes, and manipulating contraceptive use. ARA is often minimized by adults.

  3. Adolescent Relationship Abuse:Why is it important? Retrospective studies suggest that patterns of battering in adolescent relationships may be reproduced in partner abuse in adulthood Few adolescents report experiences of violence to adults, and adolescents make up a small proportion of clients utilizing domestic violence services. (Foshee et. al, 2000)

  4. Health Consequences of ARA Studies have found that victims of physical and sexual dating violence were more likely to: engage in substance use more likely to report sadness, hopelessness or suicide ideation, more likely to use vomiting for weight loss, more likely to carry weapons and engage in physical fighting.

  5. ARA and Sexual Risk for Adolescents Partner violence among teen girls linked with: (Silverman et al. 2004) [YRBS data] Early sexual intercourse (before age 15) Condom non-use at last sex Multiple partnering (3+) in past 3 months Pregnancy

  6. Girls reporting IPV 3 times more likely to have been tested for STI/HIV and 2.6 times more likely to report STI diagnosis (Decker et al. 2005) Coercive sexual experiences linked to HPV infection and cervical dysplasia (Kahn et al. 2005) ARA and Sexual Risk for Adolescents (cont.)

  7. Intimate Partner Violence (IPV) and Pregnancy Teens in abusive relationships are 4-10 times more likely to become pregnant than non-abused teens. Pregnant adolescents 2-3 times more likely to have experienced violence during and after pregnancy than older pregnant women

  8. Voices of Youth “He [used condoms] when we first started, and then he would fight with me over it, and he would just stop [using condoms] completely, and didn't care. He got me pregnant on purpose, and then he wanted me to get an abortion….”

  9. Voices of Youth (cont’d) “I was on the birth control, and I was still taking it, and he ended up getting mad and flushing it down the toilet, so I ended up getting pregnant. I found out that [before this] he talked to my friends and he told them that we were starting a family. I didn't know that. I didn't want to start a family. I wanted to finish school.” Miller E, Decker MR, Reed E, Raj A, Hathaway J, Silverman JG. Male Partner Pregnancy Promoting Behaviors and Adolescent Partner Violence: Findings From a Qualitative Study With Adolescent Females. Ambulatory Pediatrics 2007;7:360-66.

  10. Partner Violence and Reproductive Coercion Key Findings from first quantitative study of IPV, reproductive coercion, and unintended pregnancy: Approximately 1 in 5 young women said they experienced pregnancy coercion 15% said they experienced birth control sabotage 53% of respondents said they experienced physical or sexual violence from and partner 35% of the young women who reported partner violence also reported either pregnancy coercion or birth control sabotage. Elizabeth Miller, Michele R. Decker, Heather L. McCauley, Daniel J. Tancredi, Rebecca R. Levenson, Jeffrey Waldman, Phyllis Schoenwald, Jay G. Silverman. Pregnancy coercion, intimate partner violence and unintended pregnancy , Contraception April 2010 (Vol. 81, Issue 4, Pages 316-322)

  11. Clinic-based Survey IPV Prevalence

  12. Healthcare Providers’ Role:Needs Assessment • Key Findings from needs assessment of health care providers working in school health centers. • While 33% of the providers reported screening their adolescent clients for ARA all of the time, 34% reported that they are unsure how to ask questions. • Providers reported feeling uncomfortable asking questions about ARA when the visit appeared not to be violence related. • Additional barriers: • √ Time • √ Mandated reporting requirements • √ Not sure what questions to ask • √ Partner present for visit

  13. Healthcare Providers’ Role in ARA • Provider interventions can have a significant effect on teens’ knowledge, skills, and health behavior • Opportunity for assessment and intervention • Chances to provide education around a sensitive topic in the course of routine care

  14. Healthcare Providers’ Role in ARA (cont’d) • Encourage adolescent recognition of ARA in their lives and lives of their peers • Increase knowledge of ARA resources available • Ensure that adolescent-friendly, confidential, inclusive clinic practice in place

  15. The Healthcare Education, Assessment & Response Tool for Teen Relationships (HEART) Primer & Training A collaborative project of: California Adolescent Health Collaborative, a project of the Public Health Institute UC Davis School of Medicine Family Violence Prevention Fund

  16. Program Goals Develop and produce HEART Primer and Training to assess and screen for ARA in clinic settings to: decrease the incidence of ARA among California youth through improved case identification and clinic based interventions increase teen health and safety by promoting healthy relationships, and improve healthcare systems capacity to prevent ARA

  17. Community Linkages A Team Approach is Beneficial Providers should not feel that they must have “all the answers.” In these moments, having a team in place to call upon is necessary so the provider is not left carrying the weight of the situation alone.

  18. Community Linkages (cont’d) Information on where employees in abusive relationships can access assistance Consultation with on-site or off-site: • ARA advocates • legal and forensic experts • counselors with expertise in trauma treatment • experts from diverse (LGBT, disability, teen, ethnic specific and immigrant) communities • Local rape crisis centers

  19. Community Linkages (cont’d) Other Common resources may include: Local community domestic violence programs that offer advocacy, groups, training, and shelter services Domestic violence specialist within the police department in cases where a young person might need a restraining order or other legal intervention The child protection service may also have a domestic violence unit and can assist in balancing services for the minor as well as the provider’s role as a mandated reporter.

  20. How can HEART support your work? Train community Providers to use HEART Primer as a mechanism for engaging that healthcare community with dv community.

  21. For More Information California Adolescent Health Collaborative 555 12th Street, 10th Floor Oakland, California 94607 510.285.5712 sandig@californiateenhealth.org robink@californiateenhealth.org www.californiateenhealth.org

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