The three-levels of integrated intervention that comprise the School Health Center Healthy Adolescent Relationships Program (SHARP) are: 1) Individual-level - a brief clinical intervention for SHC male and female clients delivered by SHC providers utilizing HEART (evaluated via client pre and post surveys and chart review); 2) Clinic-level -- development of an ARA-informed SHC staff and clinic environment utilizing HEART (evaluated via a clinic-level quality improvement tool and provider pre and post-training surveys); and 3) School-level -- SHC-based youth-led outreach activities within the school to promote healthy relationships and improve student safety (evaluated by baseline and follow-up assessments with youth leaders and measures of school climate).
Evaluation of the intervention will involve random assignment of ten comparable SHCs in California that provide comprehensive health services, to either intervention or control conditions. In the intervention sites, providers located in SHCs will be trained to address ARA with adolescent clients via the use of HEART. The SHC-based intervention will be enhanced by SHC student outreach teams disseminating ARA educational materials in school and encouraging students to utilize the SHC for ARA related concerns. The control schools will provide standard of care in the SHCs. Multilevel regression analyses will be used to assess intervention effects on specified individual-level, clinic-level, and school-level outcomes.