Hanging Out or Hooking Up: - Futures Without Violence

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Hanging Out or Hooking Up: Clinical Guidelines on Responding to Adolescent Relationship Abuse to promote routine assessment and effective responses by health care providers. This new resource is adapted from a California publication co-produced by the California Health Adolescent Collaborative and Futures Without Violence, entitled The Healthcare Education, Assessment, and Response Tool for Teen Relationships (HEART) Primer. In October 2009, California Adolescent Health Collaborative, in partnership with Futures Without Violence and University of California Davis School of Medicine, received funding from the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice to develop a toolkit and accompanying in-person training for California health care providers for addressing adolescent relationship abuse in the clinical setting. Over the course of a year, the HEART Primer and Training Program provided training to over 500 providers throughout the state of California. At the same time, Futures Without Violence implemented Project Connect: A Coordinated Public Health Initiative to Prevent Violence against Women (Project Connect), a national public health initiative funded by the Office of Women’s Health to prevent domestic and sexual violence in reproductive, perinatal/MCH, and adolescent health settings. As part of the initiative, state level partners across the country began to train their adolescent health providers on how to respond to ARA. It became clear that a national version of the HEART primer was needed—with a robust focus on prevention of violence through anticipatory guidance about respectful and safe relationships. These guidelines are also informed by a set of reproductive health guidelines created through the Project Connect initiative for adults and adolescents that provide direction on an integrated response to violence and reproductive coercion. (See discussion below) The Adolescent Relationship Abuse Clinical Guidelines Include: • Definitions, prevalence, and dimensions of ARA • An overview of confidentiality and reporting issues and patient-centered reporting • Clinical strategies to promote universal education about healthy relationships • Clinical strategies to provide direct assessment and harm reduction strategies for reproductive coercion and ARA • An overview of preparing your practice to address ARA • Keys for success, including developing relationships with local domestic violence advocates and community programs • Policy recommendations 4 FUTURES WITHOUT VIOLENCE These guidelines are applicable, but not limited to, the following settings serving adolescents: • Adolescent health clinics and programs • Pediatric settings • Family planning clinics • School-based health centers • School nurse programs • OB/GYN and women’s health • Prenatal care and programs • STI/HIV clinics • Title X clinics • HIV prevention programs • Abortion clinics and services
Adolescent health care providers play an essential role in violence prevention by discussing healthy, consensual, and safe relationships with all patients. The clinical setting may be the sole place an adolescent experiencing abuse may be identified and connected to resources to stay safe. • Health care providers serving adolescents can offer confidential, safe spaces in which to discuss behaviors that may be abusive and that may be affecting a young person’s health. • Discussions in the clinical context of how abusive behaviors are linked to health risk may facilitate adolescents’ recognition of ARA, as well as provide an opportunity to introduce harm reduction behaviors to increase safety and protect their health. • New research finds that by conducting an assessment and a brief intervention, reproductive health providers can dramatically decrease risk for violence AND unplanned pregnancy. 3 Unfortunately, the standard-of-care within adolescent health settings does not currently include specified protocols to assess for or intervene to reduce ARA. These guidelines are written with a goal that all adolescents are given universal education on safe, consensual and healthy relationships, and strategies to respond to health issues in a trauma-informed manner. (See box below) Definitions One of the challenges in the field of domestic violence research has been a lack of standardized definitions. This is even more so for ARA, also known as dating violence. Although ARA is included in the definition of IPV, experts in the field have noted that while many aspects of ARA are similar to IPV, there are also distinct characteristics relative to the age of the victims and/or perpetrator and different patterns of abusive behaviors. Adolescent Relationship Abuse A pattern of repeated acts in which a person physically, sexually, or emotionally abuses another person of the same or opposite sex in the context of a dating or similarly defined relationship, in which one or both partners is a minor. Similar to adult IPV, the emphasis on repeated controlling and abusive behaviors distinguishes relationship abuse from isolated events (e.g. a single occurrence of sexual assault at a party with two people who did not know each other). Sexual and physical assaults often occur in the context of relationship abuse, but the defining characteristic is a repetitive pattern of behaviors aiming to maintain power and control in a relationship. Such behaviors can include monitoring cell phone usage, telling a partner what she/he can wear, controlling whether the partner goes to school that day, and interfering with contraceptive use. Part 1: Introduction What is Trauma-Informed Care? According to Substance Abuse and Mental Health Services Administration (SAMSHA): Most individuals seeking public behavioral health services and many other public services, such as homeless and domestic violence services, have histories of physical and sexual abuse and other types of trauma-inducing experiences. These experiences often lead to mental health and co-occurring disorders such as chronic health conditions, substance abuse, eating disorders, and HIV/AIDS, as well as contact with the criminal justice system. When a human service program takes the step to become trauma-informed, every part of its organization, management, and service delivery system is assessed and potentially modified to include a basic understanding of how trauma affects the life of an individual seeking services. Trauma-informed organizations, programs, and services are based on an understanding of the vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may exacerbate, so that these services and programs can be more supportive and avoid re-traumatization. http://www .samhsa .gov/nctic/trauma .asp FUTURES WITHOUT VIOLENCE 5
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About the National Health Resource
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