Teen Dating Violence: Developing a Research Agenda to Meet Practice Needs - Day 1

December 5, 2007

Part 3 — Programs Exemplifying Different Approaches to TDV Intervention — Moderated by Catherine Pierce

Presentation 1: School-Based Approaches — Review of Research — Daniel Whitaker, Ph.D.

Dr. Whitaker, HHS/CDC, presented a review of evaluations of 11 school-based Teen Dating Violence (TDV) programs. All but one of the interventions was universal, that is targeted to everyone in the school/setting; all included both males and females and the mean age of the targeted population was 14.6. All evaluations measured knowledge and attitudes; four measured behavior change, of these only two appeared to have a positive impact. Only four of the interventions followed the youths for more than four months. After Dr. Whitaker concluded the review, he had an opportunity to review three more ongoing school-based programs and concluded the following:

  • Most dating violence prevention programs have focused on dating behavior and gender roles.
  • Are there underlying skill deficits that need to be addressed, as well? If so, the dating age (i.e., middle school) is probably too late to intervene.
    • We could intervene earlier, but we can't "see" dating violence.
  • Several longitudinal studies find that early conduct disorder/generalized violence predicts dating violence perpetration.
    • Lavoi, et. al (2002); Capaldi & Owen (2005); Ehrensaft, et. al (2003); Magdol, et. al (1998); Brendgen, et. al (2001)
  • Would preventing conduct problems prevent dating violence?

Dr. Whitaker's slides were made available to the attendees.

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Presentation 2: Family Approach — Vangie Foshee, Ph.D.

Dr. Foshee, University of North Carolina at Chapel Hill, presented on her program, Families for Safe Dates, which is based on Family Matters, a family-targeted program originally developed to prevent substance abuse among youths. Family Matters was evaluated in a national randomized trial and was found to reduce the prevalence of adolescent substance use. In the Families for Safe Dates program, 12- to 14-year-old adolescents and their families were targeted and sent four booklets over the course of a few months. These booklets included material based on the Safe Dates curriculum and activities for families to do together. Families were identified by Random Digit Dialing (RDD). Each mailing was followed two weeks later by a telephone call from a health educator. Dr. Foshee noted that it is uncommon for prevention programs to involve family intervention as a critical component of overall prevention among youth. Nevertheless, the approach of intentional parental interaction has resulted in a marked improvement. A CDC-funded evaluation of Families for Safe Dates is currently underway.

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Presentation 3: Community Approach — Choose Respect — Rita Noonan, Ph.D.

CDC's Choose Respect Initiative was highlighted by Rita Noonan, Ph.D., HHS/CDC, who has worked on this project for six years. The program was highlighted as an example of a community-based approach to prevent teen dating violence. The framework speaks to different levels of social ecology. It started as a media campaign and is designed to promote positive behavior. There are challenges in media that prompt us to see how we can prevent dating violence; however, this is still uncharted territory for the most part. Based on research and focus data, it was decided that the target audience for Choose Respect would be children 11-14 years of age. While this is the target group and age, there is a need for efforts to reach younger children. While many children at this time are not dating, there is an opportunity to create an environment for prevention. Input from parents, caring adults and caregivers should be considered when developing solutions. Statistics speak to the alarming rates at which TDV occurs: one in four youths reports verbal, physical, emotional or sexual abuse each year. Consequences include physical injury, illness, psychological symptoms, economic costs and death. It was also noted that the kids who talked about TDV are at risk for a wide range of health risk behaviors, including sexual activity and suicide.

Outreach efforts were conducted in conjunction with marketing and consumer research. While a top-tier marketing agency was employed to move the efforts forward, greater value was placed on feedback from young people. These findings revealed that many youths resent "middle-aged" paradigms that are used in the context of TDV; thus consideration needs to be given to gossiping, pushing and other behavioral trends that are related to levels of violence. The tagline for the effort was "choose respect," which has proven over time to be an effective theme with the target audience. Technology was also noted as a critical piece in developing youth programs that address TDV. Public service announcements are another tool used to disseminate a clear message and appropriate approaches for solutions.

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Presentation 4: Multilevel Approach — Expect Respect — Barbara Ball, Ph.D., LPC-AT

Barbara Ball, Ph.D., LPC-AT, SafePlace, discussed Expect Respect: Taking an Ecological Approach to Prevention. This multilevel, ecological program partners closely with schools and emphasizes strengthening relationships. The program includes statewide collaboration, community engagement and three school-based components: 1) school-wide prevention, 2) youth leadership training, and 3) support groups for at-risk youths who have been exposed to violence in their lives.

Expect Respect is responsive to students' and schools' needs by fitting into the school environment, building capacity in the schools and integrating prevention into existing school programs. The extent of each program component is tailored to students' needs. Support groups provide an intensive 24-week program for vulnerable youths (selective prevention), whereas school-wide prevention activities (universal prevention) are designed to engage all students with a minimum of two classroom lessons. Youth leadership training (eight lessons) is a critical component of Expect Respect because students are most likely to confide in peers, listen to them and are strongly influenced by their peer groups. Teen leaders educate and support their peers and mobilize the "silent majority" to take a stand against interpersonal violence. Key strategies in all program components include experiential learning, skill-building, mentoring and opportunities for developing strong, positive relationships among youths and adults.

Over the last five years, Expect Respect support groups were the focal point for program evaluation. The support group curriculum for at-risk youths focuses on increasing social support, recognizing abusive relationships and learning skills for healthy relationships. Youths meet in separate gender groups for 24 sessions that take place during regular school days. A mixed-gender meeting is included toward the end of the program so that boys and girls can discuss and hear the others' perspective. The evaluation of Expect Respect support groups included group interviews and a quantitative evaluation. Pre- and post-test scores were reviewed on a number of issues, including sexual victimization, aggressive and healthy conflict resolution, constructive coping skills, relational insecurity and identification of abuse. Preliminary analyses and findings were culled and begin to indicate that support groups are a promising intervention with vulnerable youth. Mediators were examined as well. Some of the challenges regarding this evaluation were cited, such as reliance on self-report data, and lack of control group and follow-up data.

The evaluation of all components of the Expect Respect program is ongoing. Slides of the presentation were made available to the attendees. More information is available at www.SafePlace.org Exit Notice.

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Presentation 5: Justice Approach — Specialized Teen Dating Violence Courts — Judge Miriam Cyrulnik and Amanda Cissner

Judge Miriam Cyrulnik, Criminal Court of the City of New York, and Amanda Cissner, Center for Court Innovation, gave a presentation about the development and ongoing evaluation of the Brooklyn Youthful Offender Domestic Violence Court (YODVC), a pilot specialized court for teen offenders. Judge Cyrulnik indicated that 10 percent of the domestic violence cases involve people under the age of 20. Prior to December 2003, the TDV cases were treated as any domestic violence case. Many times the cases would just be dismissed. In 2002, a brief review revealed 67 cases involving teens. Many involved allegations of injury, use of a weapon, included partners who had a child in common or the woman was expecting a child. Seventy-three percent of these cases were dismissed. After one year of planning, the YODVC opened in 2003 to hear cases of defendants specifically between the ages of 16 and 19. The court hears misdemeanor cases that involve intimate partner violence and convenes every Thursday at 2:15 p.m. The court has adopted a schedule that accommodates school schedules. Additionally, there is a dedicated judge who hears all of the cases and has a specialized teen victim advocate. Her job is to connect them with resources and encourage these witnesses to sign a supporting deposition. This statement is needed in order for the case to move forward. The court refers youths to a 12-week long specialized, free program — STEPS to End Family Violence (STEPS). While STEPS has been helpful, the program is only available in English and has only been developed for men. In this construct, the participants discuss gender roles, communication, power and control, the impact of behavioral trends on children and elements of a healthy relationship. Youths are referred to the program based on their criminal history and the type of charges. Many first-time offenders are afforded an opportunity to participate in the program.

Before individuals accept a plea, they are interviewed by a STEPS representative. The judge then reviews the cases and clearly relays to adolescents the expectations and related consequences. If the adolescents are compliant (i.e., getting to court and to the program at the scheduled time) their specific cases are reviewed first. Those who are not compliant do not receive priority attention. In an effort to make a difference in the future of the young people, Judge Cyrulnik indicated that she will speak more with a teen offender than an adult offender. She makes it clear to the offender that violence is unacceptable, and that all court orders and mandates must be obeyed. She referred to herself as being tough, but wants to be considered fair. She expressed excitement about the work being done as a result of the conference and is hopeful that future efforts will minimize the cases that ultimately come through her office.

In the 16 months between December 2003 and March 2005, 360 cases involving 279 defendants were heard. Eighty-eight percent of defendants were male, and the average age was 18.3. Nearly half of the defendants had a child in common with the complaining witness. Of the 130 complaining witnesses contacted, 85 percent reported a history of prior abuse, although not necessarily with the defendant.

Lessons learned from the STEPS program included:

  • Complaining witnesses with whom the victim advocate was able to contact at least once were much more likely to sign corroborative affidavits than those witnesses never successfully contacted.
  • Beyond signed corroborative affidavits, much of the success achieved by the victim advocate came in the form of unmeasured service referrals.
  • Program participants reported that both personal interactions with the YODVC judge and a set jail alternative motivated them to complete the STEPS program.
  • Defendants generally felt that they were treated fairly and with respect in the YODVC.

Evaluation of the program is continuing. In addition, the Center for Court Innovation made their slides available to participants. More information can be found at www.courtinnovation.org Exit Notice.

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Plenary: Synthesis of Research and Practice Issues — Jacquelyn Campbell, Ph.D.

Dr. Jackie Campbell, Johns Hopkins University School of Nursing, led a lively discussion that focused on questions and issues raised by the presentations and breakout sessions so far. Issues and concerns raised during the plenary included:

  • Which teen batterer intervention programs work, and what do they look like? How long should they be? What components are necessary for a successful program? Does it work best if the program is court-ordered? Do different programs work better for boys vs. girls?
  • Research is needed that targets interventions for girls who are already experienced with the juvenile justice and/or child advocacy system. Similarly, research linking prior post-traumatic stress disorder with current TDV needs to be explored.
  • Programs — both existing and promising new programs — need to be rigorously evaluated.
  • High-risk youth in correctional settings or clinical settings need special attention. We need to determine how to work with this particular population and consider not only the immediate problem of TDV, but also the potential public health consequences this could have for them and their children.
  • We need to develop good data on both TDV within and programs targeting runaway and homeless youth.
  • Programs need to move beyond curricula and school-based interventions. Skill-building models need to be explored. What works? How do we take what has been learned about building healthy relationships and apply it?
  • What about integrating sports leagues, churches and other community institutions into combating TDV? What about the secondary impact of these institutions on rates of TDV?
  • We need to evaluate programs that focus on youth leadership — what is impact of peer-led programming vs. adult-led programming?
  • Is existing curricula being used repeatedly (with impact) over time? Are we using the tools we have? More money will be needed to look at curricula (evidence-based).
  • What about adolescent intimate partner homicide? Are there enough of these to be able to evaluate the data, or to better understand what factors lead to the escalation of violence.
  • What impact does access to technology (or the lack thereof) have? For example, we need data on stalking, emotional abuse, etc., that is playing out in technology, including instant messaging, etc.
  • How can schools be used to address TDV beyond curriculum development? For example, could school counselors be recruited to intervene?
  • We need to remember to include and not marginalize gay, lesbian, bisexual and transgendered youths. We need to examine the impact of bullying and isolation on all youth, regardless of sexual orientation.
  • We need to look beyond our own borders and learn from the experiences of other countries.
  • We need to look at a restorative justice approach.
  • Family Violence Prevention Fund's "coaching boys into men" is another approach that needs to be considered.
  • Can we leverage public fascination with this issue as part of the research agenda?
  • We need to think about this in terms of costs. If we deal with this problem strategically, what will be the overall economic impact? From an advocacy and funding perspective, that can help us make the case.
  • More research needed to help us understand the heterogeneity typology of dating violence.
  • We will also need better longitudinal studies and trajectory analyses, as well as examinations of dosage effects of various interventions.
  • We need to assist communities in providing direct services to teens who have come forward to report abuse. If services exist already, they need to be publicized.
  • We need to carefully consider how to manage responses to outreach campaigns by victims. For example, one victim service provider was unclear how to respond to girls who had come forward.
  • How can adults legally do no harm when teens disclose to them? Further, adults can inadvertently do more harm by their actions. What impact do adult beliefs and actions have?
  • What impact on communities do school policies have?
  • We need to develop outreach programs to unskilled, dysfunctional parents.
  • As we develop interventions and test them, we also need to consider how, if appropriate, to scale up these efforts.
  • What are the multiple, comprehensive strategies we need for implementation?
  • We need to keep the link between researchers and practitioners. Would a national clearinghouse to partner practitioners with researchers be possible?
  • We need to think carefully about the challenges of limited funding and innovation requirements of funding institutions.
  • We need to think about piggybacking on other adolescent programming such as HIV prevention activities. How do we expand those interventions and test their impact on teen dating violence?
  • What are the physical and mental health outcomes of TDV (e.g., eating disorders)? We need to explore these linkages and develop effective interventions that target a broad range of outcomes.
  • We know that dating violence is more prevalent among populations with disparate health outcomes (unplanned pregnancy, suicide, substance abuse). These linkages with dating violence have not been established. How can we help incorporate our evidence-based interventions into these other interventions?
  • We need to think about the overlap between teen dating violence and autism, conduct disorders, ADHD and the like. Are there different interventions that need to be developed for youth with those problems?
  • How do we account for dwindling variables (number of kids engaged)? (Partner with researcher so that design is rigorous from the beginning.)
  • How do we incorporate flexibility and innovation into curriculum development?
  • We need to consider the role of the overall level of violence in a community to the level of dating violence.
  • What is the role of prior victimization in dating violence, and who do the interventions work for?
  • We need to look at the work of the McArthur Foundation on incarcerated girls.
  • What kinds of interventions work after someone has been victimized? What models can we develop based on group counseling and similar therapeutic interventions, particularly those that provide girls with support. For example, look at empowerment intervention at primary and secondary stages.

A series of breakout sessions followed Dr. Campbell's plenary. Summary points developed and presented to the larger group from each breakout session are listed below.

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Breakout Sessions

Group 1 — Couples and Family Interventions

Family-Based Program Research
  • No evaluations of family-based programs for addressing teen dating violence.
  • More research to understand family-based processes that influence TDV (i.e., is it good parenting vs. violent-specific parenting practices).
  • Take advantage of opportunities to determine whether programs that have been evaluated for preventing other behaviors (e.g., conduct disorder, youth aggression, teen pregnancy) influence TDV.
  • Do family-based risk factors that influence TDV vary across adolescent stages?
  • More research to identify moderators of the associations between poor family processes and TDV (e.g., child abuse, domestic violence).
  • More research to determine what types of families are appropriate for intervention (vs. which ones need alternative interventions).
  • More research that compares the effectiveness of different modes of family-based interventions (e.g., FSD with booklets vs. coming to a central location).
  • More research to determine potential iatrogenic effects (negative side effects) of intervening with families.
  • More research to determine if effectiveness varies by gender of the parent and teen match.
  • More TDV intervention research with teens and children who have been exposed to domestic violence.
Couples-Based Programs
  • More research to determine if couples programs are appropriate for teens in violent relationships.
  • No evaluations of couples-based program for teen dating violence prevention.
  • Do more research to understand the relationship context, risks and relationship dynamics — including gender dynamics — that can inform intervention.
  • More research to understand dynamics of relationship transitions (e.g., break ups).
  • More research to determine what types of couples are appropriate for intervention (vs. which ones need alternative interventions).
  • More research to determine potential iatrogenic effects (negative side effects) of intervening with couples.

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Group 2 — Peer and School-Based Interventions

  • What impact do multilevel programs have on dating violence prevalence (e.g., policy, state legislation, teacher/administration training, plus programs, SROs)?
  • Need to focus our school-based prevention/intervention with middle school students.
  • Consider addressing healing trauma beyond attitude/knowledge change as attitude change is limited in changing behavior.
  • Need to consider pre-service teacher training models of prevention/intervention.
  • Extent to which universal programs have an impact on a wide range of outcomes.
  • How can we influence social norms regarding violence toward girls and women?
  • How do we, as a research community, advocate for the "waiver-off active consent" and address the need to ask the right questions, despite inherent sensitivity?
  • Need to have a clearinghouse of items, measures, ideas for asking difficult/challenging questions.
  • How can you build comfort-level and capacity among school administrators/schools to increase sustainability?
  • Studies need to focus on the distribution of prevention programming across middle and high school years (e.g., delayed delivery of program, longitudinal dose).
  • The value of afterschool programs.

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Group 3 — Criminal Justice Interventions

  • How involved are justice systems regarding the issues related to TDV? Is intervention being measured or tracked?
  • Who owns the TDV problem at the justice level and who should respond?
  • Given the small number of cases that end up in court, what is the response to cases that do not reach the court level? What makes the cases that reach the court level different?
  • How does the system define TDV and count it? For example, it may be recorded as another type of crime.
  • How does the crafting of legislation affect the way we track, define and respond to the problem? Is there an effect due to the lack of legislation (silence on the issue)?
  • What is the threshold where there is law enforcement, criminal justice or juvenile justice responses to dating violence issues?
  • Need to consider adult juvenile justice literature for both successful and unsuccessful interventions.
  • What are the benefits of a justice response?
  • Under or over response-dosage question.
  • Victim safety and message that behavior is wrong.
  • What is the effect of a justice system response to the natural trajectories of perpetrators/victims of teen dating violence? Might there be deleterious affects from a justice system intervention?
  • Justice and other system coordination.
  • How do the different courts coordinate cases (i.e., adult and family court)?
  • Coordination with other systems, such as schools. Is this research already happening?
  • Is there a different response role for the justice system for victims or perpetrators? How is this complicated by the issue of bidirectionality?

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Group 4 — Community-Based, Multilevel Interventions

  • To what extent do practitioners understand teen dating violence and/or need training?
  • Needs assessment.
  • Impact on the community/health care sector, school nurses, nurses in the community; prenatal and postnatal care for pregnant and parenting teens; involve mental health professionals (need assessment and intervention skills)/law enforcement/child protective services.
  • Impact of mandatory reporting on youth behavior.
  • Barriers to reporting, study to compare states with different mandatory reporting laws, legislative efforts to change mandatory reporting laws.
  • Services for kids outside of school.
  • What are the best places to reach kids who are not in school? In what context does dating violence occur (i.e., homeless and runaway youth, community, cyber community)?
  • Informative research.
  • Law enforcement's response.
  • Law enforcement is not taking teen dating violence seriously.
  • What is the victim's experience when reporting to law enforcement?
  • What do law enforcement personnel need to know to respond more appropriately?
  • Look at judicial responses and need for services.
  • Innovative evaluation needed.
  • Community level change.
  • What collaborations are needed to develop developmentally appropriate services (SA/DV agencies and youth serving organizations)?
  • What is the availability of services?
  • Evaluate youth-led approaches, activism and civic engagement.
  • Collaboration among community partners.
  • Local community.
  • Look internationally at communities with lower rates of violence.
  • Address individuals as potential victims and perpetrators.
  • Developmentally appropriate interventions with youths.
  • What are we learning from working with youths that may lead us to rethink how we work with adults?
  • What are we learning from working with adults that transfers to youths?
  • Labels (e.g., victim, perpetrator) and their impact.
  • Don't play the blame game.
  • Developmentally appropriate services.
  • How do you measure developmental stage?

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Group 5 — Macrolevel (media, legislative/policy) Interventions

  • Very little research in this area.
  • What are intended and unintended outcomes and processes?
  • Process of implementing policies.
  • Need to educate people to get them on board.
  • How do policies get implemented on the ground; do they compete with other policies?
  • How to make them fit within unique environments.
  • How to get effective implementation and sustainability. What mechanisms are in place for implementation?
Policy Linkages: Outcomes
  • Shared risk factors-we need to collaborate. Reproductive health professionals should screen for violence.
  • Child protective systems (disclosure, services).
Policies
  • Mini-policies: confidentiality, reaching youths.
  • Social-emotional learning.
  • What is the effect of requiring parental consent?
  • Primary prevention policies.
  • Many kids in institutionalized care settings. Opportunity to design policies in these settings.
  • How to get people to buy into policy initiatives that can prevent violence.
  • FCPF work to give simple steps that they can take.
  • Effects of policies on services.
  • Policies regarding resources.
  • Policy creation without youth voices.
Adoption Issues
  • Early adopters, innovators.
  • Targeting players who have a stake in it.
  • Changing hearts and minds. How to make adoption more attractive.
Media
  • Background.
  • Kaiser Family Foundation's work on media and children's outcomes.
  • Responsibility rests on parents to regulate children's exposure.
  • AMA, APA, violence in the media is "causal."
  • Educate the media and advocates to make better use of these resources.
  • Policy: could tax a product to decrease profit motives. Fines for selling to minors.
  • Incentives for creation of health promotion and safety.
  • Music, artistic expression may have outlets to use technology productively.
  • What makes some of these products so attractive?
  • More research on positive deviance.
  • What about exposure is really harmful? Can we refine the critique?

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Closing Sessions

Reflections and Wrap-Up — David Wolfe, Ph.D.

David Wolfe, Ph.D., University of Toronto, offered the following comments. He noted that how you form relationships will impact future relationships. We've discovered environmental changes carry a lot of weight on how young people enter into violent relationships. The majority of kids may have discontinuity versus continuity. There are multiple causes and influences. Most if not all of these are cultural and familial. Dr. Wolfe noted that engaging men and boys in TDV exercises has been challenging. There is rampant ignorance of the problems and related issues. People just do not understand the importance. Youths are interested in their issues and they are a necessary part of the solution. Violence is easier to prevent than it is to treat, and it is a lot more effective to prevent something than to try to change a pattern of behavior. We learned that methods of prevention rely on ongoing skill development. Too much emphasis is placed on quick fixes and trying to find the bad guys. Public health strategies are also needed. He then described the 21-lesson curriculum he has developed called "The Fourth R" — the "R" stands for relationships. The curriculum, which is being used in some Ontario schools, aims to teach ninth-graders about healthy relationships and includes information on violence prevention. The curriculum is based on the idea that, like the other "R's," reading, writing and arithmetic, relationships should be taught as part of the core curriculum for middle schoolers.

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Final Thoughts and Future Directions — Conference Co-Chairs: Deborah Capaldi, Barri Rosenbluth

  • Start early (integrate health curricula).
  • Add on to the training periodically.
  • It should be developmentally informed (basic information).
  • We need to be strategic…girls and boys have different needs and one size does not fit all.
  • We need it to be culturally sensitive…each community has to have some input.
  • Centered on building relationship skills.
  • We shouldn't wait until it is a crisis.
  • Involve more youths in the solution to make it more relevant to them.
  • Need to involve men, parents, our community partners in a more meaningful way.
  • Need to add information on media literacy and educate the educators.
  • We need to build positive networks to make sure we are not just repeating the same mistakes.
  • Optimistic that the next generation of kids will be introduced to this information at an early age.

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Date Modified: February 9, 2011