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This community-partnered participatory study will work within high school health centers (SHCs) to test, via a 2-armed cluster randomized controlled trial, a multi-level intervention to reduce adolescent relationship abuse (ARA) among adolescents ages 14-19. The goal of this study is to examine the effectiveness of the School Health Center Healthy Adolescent Relationships Program (SHARP) intervention in SHCs on individual SHC clients, the SHC clinic environment, and the schools in which the SHCs are located. Evaluation of the intervention will involve random assignment of eight comparable SHCs in the Greater Bay Area of California that provide comprehensive health services, to either intervention or control sites. Adolescent females and males ages 14-19 seeking care at any of these SHCs (N=1200) will be assessed via audio computer-assisted survey instrument (ACASI) at baseline and 16-20 weeks follow-up to examine intervention effects on knowledge and self-efficacy regarding ARA, harm reduction and ARA-related resources as well as intentions to intervene with peers. For youth reporting recent ARA victimization, the investigators will assess for increases in ARA disclosure, resource utilization, as well as reduction in ARA victimization.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| SHARP Intervention | Experimental | School health centers randomized to the SHARP Intervention will be trained to address adolescent relationship abuse with school health center clients. |
|
| Control | No Intervention | School health centers randomized to Control will provide standard of care. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| SHARP Intervention | Behavioral | Providers and staff located in high school school health centers (i.e., nurse practitioners, nurses,physicians, health educators, medical assistants) will be trained to address adolescent relationship abuse with school health center clients using knowledge, skills, and resources gained through the SHARP Intervention training. The training includes strategies to help youth recognize adolescent relationship abuse among themselves and their peers, to learn strategies to increase safety (harm reduction), and to utilize adolescent relationship abuse-related resources. |
| Measure | Description | Time Frame |
|---|---|---|
| Recognition of adolescent relationship abuse | "Recognition of abusive behaviors" -- Between-arm adjusted mean differences on a 9-item summary scale | 4 months |
| Intentions to positively intervene in adolescent relationship abuse among peers | "Intentions to intervene" -- Between-arm adjusted mean differences on a 9-item summary scale | 4 months |
| Knowledge of violence victimization resources | "Knowledge of resources" -- Between arm differences of summary score of single items which assess the extent to which participants are aware of places they could go for specific support services. | 4 months |
| Measure | Description | Time Frame |
|---|---|---|
| Disclosure of adolescent relationship abuse to school health center providers | Between-arm adjusted differences in proportion disclosing adolescent relationship abuse (ARA) to school health providers at baseline. Comparisons restricted to subgroup of clients reporting ARA on ACASI survey at baseline. | baseline (after clinic visit) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sandi Goldstein | Pubic Health Institute | Principal Investigator |
| Elizabeth Miller, MD, PhD | University of Pittsburgh, Children's Hospital of Pittsburgh of UPMC | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Public Health Institute | Oakland | California | 94607 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25535265 | Result | Miller E, Goldstein S, McCauley HL, Jones KA, Dick RN, Jetton J, Silverman JG, Blackburn S, Monasterio E, James L, Tancredi DJ. A school health center intervention for abusive adolescent relationships: a cluster RCT. Pediatrics. 2015 Jan;135(1):76-85. doi: 10.1542/peds.2014-2471. Epub 2014 Dec 22. | |
| 25404724 | Result |
| Label | URL |
|---|---|
| U.S. Department of Justice Final Report | View source |
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| ID | Term |
|---|---|
| D040261 | Harm Reduction |
| ID | Term |
|---|---|
| D001519 | Behavior |
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|
| Uptake of adolescent relationship abuse harm reduction and utilization of resources |
Between-arm adjusted differences in proportion reporting any use of ARA resources in the 3-month period prior to the follow-up survey. Comparisons restricted to clients reporting ARA on ACASI survey at baseline. |
| 4 months |
| Adolescent relationship abuse victimization | Between-arm adjusted differences in proportion screened positive for at least one adolescent relationship abuse (ARA) behavior, based on screening tests for reproductive coercion, intimate partner and sexual violence victimization and psychological abuse. Comparisons restricted to clients reporting ARA at baseline. | 4 months |
| Knowledge of harm reduction strategies | Participants are presented with a series of harm reduction behaviors to reduce risk for ARA, and asked to what extent they are aware of these strategies and self-efficacy in enacting these behaviors based on a 7-point Likert-type scale | 4 months |
| Dick RN, McCauley HL, Jones KA, Tancredi DJ, Goldstein S, Blackburn S, Monasterio E, James L, Silverman JG, Miller E. Cyber dating abuse among teens using school-based health centers. Pediatrics. 2014 Dec;134(6):e1560-7. doi: 10.1542/peds.2014-0537. Epub 2014 Nov 17. |
| 24962502 | Result | McCauley HL, Dick RN, Tancredi DJ, Goldstein S, Blackburn S, Silverman JG, Monasterio E, James L, Miller E. Differences by sexual minority status in relationship abuse and sexual and reproductive health among adolescent females. J Adolesc Health. 2014 Nov;55(5):652-8. doi: 10.1016/j.jadohealth.2014.04.020. Epub 2014 Jun 21. |
| 31306331 | Derived | Hill AL, Jones KA, McCauley HL, Tancredi DJ, Silverman JG, Miller E. Reproductive Coercion and Relationship Abuse Among Adolescents and Young Women Seeking Care at School Health Centers. Obstet Gynecol. 2019 Aug;134(2):351-359. doi: 10.1097/AOG.0000000000003374. |