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

NCJ Number
Pediatrics Volume: 135 Issue: 1 Dated: January 2015 Pages: 76-85
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
Date Published
January 2015
10 pages
This article examined evidence-based interventions to address adolescent relationship abuse in clinical settings through cluster randomized controlled trial tests of the effectiveness of a brief relationship abuse education and counseling intervention in school health centers.

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 1,062 eligible students ages 14 to 19 years at 8 SHCs who continued participation after randomization, 1,011 completed computer-assisted surveys before a clinic visit; 939 completed surveys 3 months later (93% retention). Interventions 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. (Published Abstract)