Intimate Partner Violence: Adolescent Relationship Abuse

Educational Objectives

The goal of this program is to improve the ability of providers to counsel young adults on adolescent relationship abuse. After hearing and assimilating this program, the clinician will be better able to:

1. Promote discussion of adolescent relationship abuse with young adults.
2. Direct adolescents with experiences of relationship abuse to local resources.

Summary

Adolescent relationship abuse (ARA): ARA is a type of intimate partner violence (IPV) which occurs when one partner in a dating relationship exerts control and power over the other; ARA is rooted in power dynamics and frequently follows a pattern of abuse; the abusive partner uses various forms of intimidation, control, manipulation, or violence to assert dominance over their dating partner

Teen dating violence: often referred to ARA; the term “dating” has different meanings, which include hanging out, hooking up, texting, talking, or social media interactions; may occur in group settings or in a one-on-one setting; the words and perspectives that young people use to describe dating should be respected; adult concepts of relationships should not be imposed; providers should use the term “adolescents” instead of “teens”; brain development continues during the period of adolescence; the developmental differences between a 12-yr-old and a 22-yr-old are significant

Prevalence of ARA: 69% of high school students in the United States may experience psychological, physical, or sexual abuse in their lifetime, according to a study; other studies have shown that 1 in 11 females and 1 in 14 males experienced physical ARA in the past year, and 1 in 8 females and 1 in 26 males reported sexual ARA in the past year; 25% to 41% of teens have reported experiencing digital ARA (eg, cyberstalking, harassment); 20% of adolescent females have reported reproductive coercion (RC), which is a form of control over a person’s reproductive capacities

Impact of ARA: researchers have found higher rates of depression, anxiety, disordered eating, suicidal thoughts, sexually transmitted infections, unintended pregnancies, and increased risk for violence in future adult relationships in persons who have experienced ARA; nonconforming and transgender youth are commonly grouped under the lesbian, gay, bisexual, and transgender umbrella; however, efforts are being made to separate gender identity and sexual orientation to gain a deeper understanding of the experiences of gender and sexually marginalized individuals; providers should be inclusive of different genders and acknowledge the impact of toxic masculinity and transphobia on cisgender women and nonconforming youth in the context of ARA

Addressing ARA: a study showed that 11% of 11 to 14 yr old children and 24% of 15 to 18 yr old adolescents were asked about safe relationships during pediatric well-child visits; healthcare providers should incorporate healthy relationship conversations in their care for young adults; the approach should be based on “healing centered engagement,” which prioritizes a holistic and trauma-informed approach to support young people; it focuses on improving relational health; the approach shifts the provider's perspective from “what is wrong with you” to “what happened to you” and “what is right with you”; asking young people about their priorities is important; the speaker recommends a universal education approach for ARA, that involves providing education and resources to all, without pushing for disclosure; persons may choose to disclose their experiences in a healing centered environment

ARA education: universal education and resources should be provided to everyone; information about healthy and unhealthy relationship behaviors should be illustrated; a resource sheet with red and green flags for relationships may be used to start a conversation; the national ARA hotline uses the motto “Love is Respect”; local resources may be helpful; all persons should receive education, not only those experiencing ARA

Initiating conversations: confidentiality must be established before discussion of sensitive topics; providers must inform patients <18 yr of age that they are mandated reporters and may need to involve trusted adults if patients disclose information about harm to themselves or others; patients should understand the limits of confidentiality in order to feel comfortable sharing their experiences; assessment for ARA may be done by asking direct questions; the process may be normalized by informing patients that everyone is asked the same questions

Action items: providers should listen and provide validation to young persons who disclose experiences of ARA; information on crime reduction, contraceptive options to reduce a partner's control, and safety planning may be offered; patients should be referred to an IPV advocate; providers should respect the wishes of children who do not want to their parents to be informed, but also encourage them to talk to a trusted adult; a warm handoff to other resources (eg, IPV advocates) is helpful

Working with teenagers: working with teenagers presents a good opportunity to involve parents; parents play a crucial role in preventing ARA and they should be encouraged to discuss what constitutes a safe and healthy relationship with their children; discussing relationships portrayed in the media may be an effective communication strategy, instead of directly addressing the teenager's relationship; young people may find it easier to talk about the healthy and unhealthy relationships that they have seen in a movie or TV show; some parents may face challenges in discussing healthy relationships with their children due to past experiences with abuse; parents also should receive support

Conclusion: effectively addressing ARA requires the medical team to be educated on the topic and be familiar with local resources (eg, National Domestic Violence Hotline); adolescent and young adult patients may be seen alone during visits; posters with helpline numbers create a safe environment for patients; providers should strive to become a resource for teens and advocates for evidence-based relationship education at schools and community centers; recommended resources for patients include “ThatsNotCool.com”, “LoveisRespect.org”, “YoungWomensHealth.org” and “YoungMensHealthsite.org”; recommended resources for parents include “FuturesWithoutViolence.org/start-strong”, and “HealthyChildren.org”

Readings

Ellyson AM, Adhia A, Lyons VH, Rivara FP. Prevalence, age of initiation, and patterns of co-occurrence of digital dating abuse behaviors nationwide. Child Youth Serv Rev. 2021;122:105921. doi:10.1016/j.childyouth.2020.105921; Haynie DL, Farhat T, Brooks-Russell A, et al. Dating violence perpetration and victimization among U.S. adolescents: prevalence, patterns, and associations with health complaints and substance use. J Adolesc Health. 2013;53(2):194-201. doi:10.1016/j.jadohealth.2013.02.008; Khetarpal SK, Tiffany-Appleton S, Mickievicz EE, et al. Sexual health and relationship abuse interventions in pediatric primary care: a systematic review [published online ahead of print, 2023 Jan 7]. J Adolesc Health. 2023;S1054-139X(22)00784-4. doi:10.1016/j.jadohealth.2022.11.011; Kogan SM. Disclosing unwanted sexual experiences: results from a national sample of adolescent women. Child Abuse Negl. 2004;28(2):147-165. doi:10.1016/j.chiabu.2003.09.014; Miller E, Jones KA, McCauley HL. Updates on adolescent dating and sexual violence prevention and intervention. Curr Opin Pediatr. 2018;30(4):466-471. doi:10.1097/MOP.0000000000000637; Miller E. Prevention of and interventions for dating and sexual violence in adolescence. Pediatr Clin North Am. 2017;64(2):423-434. doi:10.1016/j.pcl.2016.11.010; Smith AU, Singer R, Jann J, et al. Teen dating violence interventions for sexual minority youth: a scoping review. Published online July 5, 2022. doi:https://doi.org/10.21203/rs.3.rs-1813041/v1; Tiffany-Appleton S, Mickievicz E, Ortizay Y, et al. Adolescent relationship abuse prevention in pediatric primary care: provider, adolescent, and parent perspectives [published online ahead of print, 2022 Dec 27]. Acad Pediatr. 2022;S1876-2859(22)00633-7. doi:10.1016/j.acap.2022.12.005; Wiebelhaus JN, Miller MK, Sherman AK, et al. Adolescent and parent perspectives on confidentiality after adolescent relationship abuse disclosure. J Adolesc Health. 2021;69(2):242-247. doi:10.1016/j.jadohealth.2020.09.042.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Ragavan was recorded exclusively for Audio Digest. Audio Digest thanks the speakers and presenters for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.75 CE contact hours.

Lecture ID:

OB700702

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.