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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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sandi goldstein mph robin kirkpatrick lcsw mph california adolescent health collaborative
Sandi Goldstein, MPH

Robin Kirkpatrick, LCSW, MPH

California Adolescent Health Collaborative

Building Partnerships Among Adolescent Health and Violence Prevention

what is adolescent relationship abuse
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.

adolescent relationship abuse why is it important
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)

health consequences of ara
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.

ara and sexual risk for adolescents
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

ara and sexual risk for adolescents cont
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.)
intimate partner violence ipv and pregnancy
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

voices of youth
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….”

voices of youth cont d
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.

partner violence and reproductive coercion
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)

healthcare providers role needs assessment
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
healthcare providers role in ara
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
healthcare providers role in ara cont d
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
the healthcare education assessment response tool for teen relationships heart primer training
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

program goals
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

community linkages
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.

community linkages cont d
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
community linkages cont d19
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.

how can heart support your work
How can HEART support your work?

Train community Providers to use HEART Primer as a mechanism for engaging that healthcare community with dv community.

for more information
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