A school health center intervention for abusive adolescent relationships: a cluster RCT

• Published in: Pediatrics (Evanston) Vol. 135; no. 1; p. 76
• Main Authors: Miller, Elizabeth, Goldstein, Sandi, McCauley, Heather L, Jones, Kelley A, Dick, Rebecca N, Jetton, Johanna, Silverman, Jay G, Blackburn, Samantha, Monasterio, Erica, James, Lisa, Tancredi, Daniel J
• Format: Journal Article
• Language: English
• Published: United States 01.01.2015
• Subjects: Adolescent; Adolescent Behavior; Counseling; Female; Humans; Male; School Health Services; Sex Offenses - prevention & control; Violence - prevention & control; Young Adult; adolescent relationship abuse; primary prevention; cyber dating abuse; school health services; sexual violence; intervention study
• ISSN: 1098-4275
• DOI: 10.1542/peds.2014-2471

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). 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). Intervention versus control adjusted mean differences (95% confidence interval) on changes in primary outcomes were not statistically significant: recognition of abuse = 0.10 (-0.02 to 0.22); intentions to intervene = 0.03 (-0.09 to 0.15); and knowledge of resources = 0.18 (-0.06 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 = -0.17 [-0.21 to -0.12]). 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]). This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.