Engaging Together for Healthy Relationships

Highlights

• Adolescent relationship abuse is a pervasive issue impacting 1-in-3 adolescents.
• Pediatric primary care is a unique and underutilized setting for engaging adolescents and their caregivers together in preventative education regarding healthy relationships and relationship abuse.
• Engaging Together for Healthy Relationships is a comprehensive, multicomponent resource for family engagement during regular pediatric care visits and at-home parental training.
• PInCh award supports resource development and a pilot trial that includes adolescents, parents, and violence prevention experts.
• Recipient of $35,000 PInCh Award.

Problem

About 1-in-3 adolescents will experience relationship abuse from a romantic partner before they turn 18. This number gets even higher when looking at unhealthy friendships and puts these teens at increased risk of anxiety, depression, suicide, substance use and abuse, and adulthood intimate partner violence.

Parental monitoring and active communication helps to lower relationship abuse victimization and perpetration in adolescence. However, most preventative education is reserved for in-school programs, which often excludes parents and caregivers from engaging in the conversation.

School-based programs do not focus on child-parent communication – the key developmental relationship during early adolescence (11-15), when young people experience their first dynamic friendships and romantic interests.

Solution

Pediatric primary care offers a unique opportunity to engage adolescents (11-15) and caregivers together in education on relationship abuse prevention from a trusted physician. Our interviews highlighted the need and enthusiasm for a primary care-based program to support families and initiate healthy communication on relationships at home.

The program resources will be comprehensive across types of relationship abuse, inclusive for LGBTQIA+ young people, developmentally inclusive, mindful and supportive of families with histories of violence, and easily adapted into the existing pediatric care visit.

Through Engaging Together for Healthy Relationships (ETHR), pediatric caregivers will deliver brief scripts to accompany the resources provided to the adolescent and their caregiver during their regular visit. ETHR uniquely utilizes the time that caregivers are in waiting rooms and during the typical confidential history to engage with specific resource guides before receiving recommendations for at-home conversation and communication.

All ETHR materials will be developed in collaboration with adolescents, caregivers, and violence prevention experts, and will be reviewed further by pediatric healthcare providers. Community and consumer involvement is often ignored in typical program development, but ETHR’s collaboration is our key strengths to improve interest, relevance, usability, and ease of adoption into regular pediatric care visits.

Team

• Maya Ragavan, MD, MPH, MS serves as Principal Investigator and Assistant Professor of Pediatrics at Pitt.
• Joseph Amodei, MFA is a consultant on immersive media during program material development.
• Daniel Rosen, PhD, MSW serves as Co-Investigator and Pitt Professor of Social Work.
• Ana Radovic, MD, MSc serves as Co-Investigator and Assistant Professor of Pediatrics at Pitt.
• Elizabeth Miller, MD, PhD serves as Co-Investigator and Professor of Pediatrics, Public Health, and Chair of Pediatric Medical Education at Pitt.
• Erin Mickievicz & Sarah Tiffany-Appleton serve as Research Assistants.

Path to Impact Plan

Materials developed in partnership with providers, adolescents, parents, and violence prevention experts will be piloted by multiple doctors at 3 pediatric and adolescent health clinics through PInCh funding. Surveys will be collected to assess barriers and facilitators to usability and engagement from all parties.

Materials and models will be updated and formatted for a cluster randomized clinical trial (CRT) and submitted for grant funding from the NIH. A CRT will appropriately assess the effectiveness of the ETHR model navigate implementation barriers on a larger scale.

In partnership with local community organizations, and partners at Futures Without Violence and the Center for Disease Control and Prevention (CDC), we will scale the program in preparation to nationally disseminate provider training and intervention materials. Dissemination will be done through Futures Without Violence, the CDC, and other national partners in stages, allowing us to track usage, field questions from providers and payors, and adjust resources as needed for successful adoption and sustainability.

Frequently Asked Questions

• Why primary care instead of schools, community settings or other spaces? Primary care is a unique space to engage in adolescent IPV because families meet with a trusted provider and adolescents are accompanied by the caregivers and parents. In fact, one of the pieces of feedback that school-based programs have gotten is that it is hard to engage caregivers.
• How will you disseminate this? We are working with national partners including the Centers for Disease Control and Prevention and Futures Without Violence who are experts in disseminating violence prevention interventions. ETHR also have the potential to be reimbursable through insurance.
• Why did you choose a universal intervention instead of one culturally tailored to specific groups? We are focusing on an intervention that can be used widely, although we recognize that certain groups may have different needs (i.e., LGBTQIA youth, parents who have experienced partner violence). We are working with adolescents, parents, and violence prevention experts to ensure that ETHR is inclusive and affirming for all families.