California Adolescent Health Collaborative

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A School Health Center Intervention for Abusive Adolescent Relationships: A Cluster RCT

Elizabeth Miller, Sandi Goldstein, Heather L. McCauley, Kelley A. Jones, Rebecca N. Dick, Johanna Jetton, Jay G. Silverman, Samantha Blackburn, Erica Monasterio, Lisa James, Daniel J. Tancredi

Abstract

BACKGROUND AND OBJECTIVES

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).

METHODS

 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).

RESULTS

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]).

CONCLUSIONS

This is the first evidence of the potential benefit of a SHC intervention to address abusive relationships among adolescents.

CITATION

Miller E., Goldstein S., McCauley H. L., Jones K. A., Dick R. N., Jetton J., Silverman J. G., Blackburn S., Monasterio E., James L., Tancredi D. J. A school health center intervention for abusive adolescent relationships: A cluster RCT. Pediatrics. In press (Volume 135, Number 1, January 2015).