“One day, I was with a patient that I knew very well. She was an outgoing girl, doing really well. She was in a new relationship that she was excited about. I asked my normal safety screening questions, like, ‘Do you feel safe at home and in your relationships?’ She said, ‘Absolutely.’ When I started the physical assessment, I saw that she had bruising on her forearms and her neck. I asked about it, and she was really straightforward. She explained that it was from her boyfriend – he got mad sometimes, but she didn’t see it as a big deal, and she really liked him. My first thought was, ‘This is a situation we need to address immediately.’ And then I thought, ‘How inappropriate is my questioning that I missed this? How many others have I missed?’ It started from there.” – Meg Kane, Pediatric Nurse Practitioner and Pediatric Mental Health Specialist
To address experiences like these, Health Partners on IPV + Exploitation, led by Futures Without Violence, and the School-Based Health Alliance’s Youth Safety Net Project are working together with school-based health centers (SBHCs) nationwide to strengthen skill-building around adolescent relationship abuse and healthy relationships. To develop and maintain healthy relationships, adolescents need coordinated support from a range of community systems, including schools, health providers, and domestic violence advocates. School-based health providers in particular play an essential role in promoting the early identification and prevention of abuse, with everyday opportunities to offer easily accessible resources and supports in a place young people already spend a significant portion of their time.
“What I hear from kids is that they’re not going to talk about anything if they’re not comfortable…so my job is to kind of make a safe space for top-notch health care and to communicate that my job is to be here for you, explain that I can make recommendations, but I can’t make you do anything. This is something we talk about consistently with everybody. Every single person who comes in here, we have this conversation… You have this conversation, and kids go back into their lives. We’re finding that they sit and they think about the conversation, and then they come back to us. They’ll maybe ask for help or make a disclosure or bring a friend. There’s a variety of ways that you’ll find that they’ve been processing this at their own speed.” – Meg Kane, Pediatric Nurse Practitioner and Pediatric Mental Health Specialist
So, what are some action steps for an SBHC team looking to do more around adolescent relationship abuse?
- Clinicians, support staff, and administrators must first deepen their understanding of the relationship spectrum, the dynamics of adolescent relationship abuse, and its impact on young people’s health and safety.
- Implement a universal education approach to ensure that all youth receive education about healthy and unhealthy relationships, regardless of whether they disclose abuse. This evidence-based approach, CUES – Confidentiality, Universal Education, Empowerment, and Support, was developed by Futures Without Violence. CUES is associated with increased awareness of relationship abuse resources, improved health and safety, and a greater likelihood of disclosing unhealthy relationships to healthcare providers. Part of the intervention involves offering the “Hanging Out and Hooking Up” card to young people (available free of charge here).
- SBHC teams can also work to build relationships with community-based domestic violence programs. Through these partnerships, domestic violence (DV) programs may offer services like safety planning, counseling, and case consultation to support young people who need help. Connect with your state or territorial Domestic Violence Coalition to identify local DV programs near you. Finally, SBHC teams can implement plans to support staff as they navigate these conversations with youth (for example, through reflective practice groups and mindfulness-based interventions).
School-based health providers don’t have to do it alone. One potential partner group is other school professionals. SBHCs can coordinate prevention efforts with existing school-wide efforts (e.g., health curricula, Title IX coordinator, etc.), classroom-based programming, school wellness committees, and nontraditional partners in school communities, such as athletic coaches. One evidence-based program that works with coaches to teach young people healthy relationships skills and positive bystander behavior is Coaching Boys Into Men (CBIM). You can read more about CBIM here.
Partner with youth to increase awareness. Another impactful and sometimes overlooked way to increase awareness of relationship abuse and build healthy relationship skills is for SBHC staff to partner with youth:
- Informally gather interested adolescents or create a formal youth advisory council.
- SBHC staff might work with youth to implement youth participatory action research (YPAR), which can help adults learn what adolescents know about relationships and what kinds of support they need. (Click here for an example!)
- Similarly, SBHC staff can engage youth in developing strategies to shift conversations and culture within the school and SBHC, such as using current media and role play.
- Youth can deliver peer education and support through lunchtime, classroom, or assembly presentations and workshops.
- Social media can be used to uplift their stories and spread awareness.
- Lessons learned from Break the Cycle’s Let’s Be Real program may offer a useful guide.
Regardless of the approach, the first step for adults who want to partner with youth to promote healthy relationships is to talk to young people because they know what will work.
“If anything, having these conversations with youth has made me more aware of how difficult it is to exist as an adolescent, but also has made me more in awe of how awesome these kids are… I already had a lot of respect for them, but they’re pretty incredible.” – Meg Kane, pediatric nurse practitioner and pediatric mental health specialist
Young people support conversations about relationships and sexual health. In a qualitative survey conducted by the Washington Coalition against Domestic and Sexual Violence teens made the following statements:
- “I like to know about things even if I don’t need it yet.”
- “It’s okay to say you don’t know.”
- “One person needs to be comfortable in this conversation; it would be helpful if it was the adult!”
School-based health center staff are a trusted resource for many youth and can play a crucial role in supporting their patients in having healthy, safe relationships. If your team wants to learn more about addressing adolescent relationship abuse, please reach out to us at EBaldi@sbh4all.org or CSanchez@futureswithoutviolence.org.
This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of awards totaling $625,000 with 0% financed with non-governmental sources, and $650,000 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
