Few interventions target abuse in adolescent relationships, which is a significant public health problem. School health centers are unique settings that offer multiple advantages for educating, preventing, and engaging teenagers at risk of or experiencing adolescent relationship abuse.
Elizabeth Miller led a team of researchers to conduct a study that examines the effectiveness of the School Health Center Healthy Adolescent Relationship Program (SHARP). The SHARP model provides a brief education and counseling intervention aimed to improve teenagers’ recognition of adolescent relationship abuse. In so doing, SHARP uses adolescent relationship abuse resources to shape attitudes and behaviors that reduce adolescent relationship abuse.
The SHARP intervention had three levels that were administered by school health center providers and student outreach teams:
- Individual level: School health center providers delivered a brief clinical intervention regarding healthy and unhealthy relationships for all patients seeking services.
- Clinic level: All school health center staff underwent adolescent relationship abuse training in order to create an environment that was conducive to helping youth seeking services.
- School level: Student-led outreach teams were created to encourage students to use the school health center services, as well as promote healthy relationships and student safety.
The research team evaluated each level using data collected during the 2012-2013 academic year at eight northern California high schools that were randomly assigned to the SHARP intervention or a control condition. A total of 1,011 students completed surveys before a clinic visit, and 939 completed surveys three months later (76 percent female, 5 percent white). Researchers surveyed providers in the intervention school health centers prior to training and six months after training. Focus groups with the student outreach teams were also conducted at schools to get feedback on the SHARP intervention, the range of activities they included to raise awareness about adolescent relationship abuse, and the school health center as a resource.
At the individual level, researchers found no overall differences between intervention and control participants on recognition of adolescent relationship abuse, intentions to intervene, knowledge of and recent use of resources related to adolescent relationship abuse, or self-awareness to use harm reduction strategies. Intervention participants did show improved recognition of sexual coercion at follow-up.
In addition, participants in intervention clinics who reported recent adolescent relationship abuse at the start of the study showed greater recognition of adolescent relationship abuse and knowledge of relevant resources compared to controls, and they were less likely to experience such abuse at follow-up.
Those in intervention clinics who had ever been in an unhealthy relationship were also more likely to report disclosing this fact during the school health center visit, suggesting that the intervention may help adolescents at highest risk for adolescent relationship abuse identify, disclose, and seek help when there is abuse in their relationships. Those in intervention clinics who did not experience adolescent relationship abuse at baseline were also less likely to have experienced adolescent relationship abuse at follow-up.
Regarding clinic-level results, at six months post-training, 33 percent of providers reported increased counseling about harm reduction strategies with their clients and 65 percent reported being more comfortable working with a client to identify a safe adult with whom they could share abuse concerns. Interviews with the providers also highlighted effective ways in which they were able to integrate the intervention strategies into their routine practices.
At the school level,there was improvement in perceived safety of school climate in the intervention schools compared to the control schools. Specifically, school staff in the intervention schools perceived students as engaging in less risky behavior, conflict, and disruptive behavior, and perceived those schools to have overall safer climates for both students and staff after intervention. School staff in intervention schools also indicated they had higher levels of resources for students and felt that student discipline had changed to a more case-by-case approach. In addition, focus group discussions with the student outreach teams revealed how little exposure students have to education on healthy relationships and identified key strategies for increasing adolescent relationship abuse awareness (e.g., information posted in bathrooms).
This is the first study to provide evidence of a potential benefit of a school health center intervention to address adolescent relationship abuse, and suggests that integrating this kind of system into schools and communities may be a promising tool for prevention and intervention.
About this Article
The research discussed in this article was funded under award 2011-MU-MU-0023 to the Public Health Institute. The research was conducted by a team of researchers from the Public Health Institute, other organizations, and universities.
This article is based on the grant report “Integrating Prevention and Intervention: A School Health Center Program to Promote Healthy Relationships,” (pdf, 18 pages) by Elizabeth Miller, M.D., Ph.D., Alison Chopel, Ph.D., Kelley A. Jones, M.P.H., Rebecca N. Dick, M.S., Heather L. McCauley, Sc.D., Johanna Jetton, Jay G. Silverman, Ph.D., Samantha Blackburn, R.N., M.S.N., P.N.P., Erica Monasterio, R.N., M.N., F.N.P.-B.C., Lisa James, M.S., and Daniel J. Tancredi, Ph.D.