Adolescent dating violence has been characterized as a public health concern due to its magnitude and the negative health outcomes associated with victimization. Despite prevention efforts existing for multiple decades, rates of dating violence have failed to decline. Even when prevention efforts are finally disseminated, it is unlikely that dating violence will be entirely eradicated. Therefore, programs focusing on the resiliency of survivors are needed. The increased emphasis in recent years on trauma-informed care provides the foundation for the proposed program: a resilience-informed Dating Matters program. This program will incorporate trauma-informed principles at multiple levels of the social-ecological model to promote resiliency for survivors of adolescent dating violence.
Trauma-Informed Principles Utilized
A resilience-informed Dating Matters program incorporates both trauma-informed implementation domains and principles. The program will utilize the implementation domain of screening, assessment, treatment services (SAMHSA, 2014). Incorporated trauma-informed principles include self-empowerment and peer support (SAMHSA, 2014).
The proposed program calls for a rural Nebraska hospital to start providing adolescent dating violence screenings. Screenings and treatment referrals are a critical component to trauma-informed care (SAMHSA, 2014). Nurses providing adolescent dating violence screenings should use the local language used by youth to describe dating violence in their screenings (Martin et al., 2012). If not possible to use the local language, nurses should check that youth understand the terminology being used in the screening (Richman et al., 2017). Per trauma-informed principles, screenings and referred mental health services should maintain patient safety and recognize gender-specific needs (SAMHSA, 2014).
Evidence of adolescents’ perceived helpfulness of parent responses to admission of dating violence implies the importance of incorporating the self-empowerment principle into youth resiliency. Survivors appreciate the distinction between guilt and responsibility (Preble et al., 2018). Youth do not find statements of blame that undermine self-esteem as helpful (Preble et al., 2018). Self-empowerment interventions for adult intimate partner violence have shown a decrease in victimization (Sharps et al., 2016). Therefore, teens in the adapted program will be empowered to identify and build strengths that can be used to overcome struggles such as help-seeking and conflict resolution strategies (Hedge et al., 2017). Parent programming will encourage parents to recognize and respond to dating violence in empowering ways.
The trauma-informed principle of peer support is incorporated through survivor support groups. Other targeted interventions for youth who are exposed or involved with violence, such as Expect Respect, have shown promise for reducing aggression, victimization, perpetration (Reidy et al., 2017). Therefore, having programs that utilize fellow survivors for peer support may be protective and promote resiliency.
Level(s) of the Social Ecological Model Utilized
This program is grounded in Bronfenbrenner’s Social Ecological Model. The individual, microsystem, mesosystem, and exosystem are considered (Bronfenbrenner, 1992). The individual level includes lessons on self-empowerment to promote decision-making in recovery. The microsystem includes systems that directly impact individuals, such as family, peers, schools, and health services. At this level, participants will have access to hospital screenings for dating violence and be able to receive educational programming from the local high school. Additionally, the resiliency-informed adaptation includes peer (survivor) support groups, targeting the peer microsystem. The mesosystem is the interaction between systems within the microsystem. Health educators (health microsystem) will lead members of the family microsystem through the parent programming. Lastly, there is programming at the exosystem level which targets larger cultural systems such as politics, neighbors, and social services. The media communication program targets youth cultural media.
These levels were considered as these have the most direct impact on the individual (Bronfenbrenner, 1992). Further, to emphasize Bronfenbrenner’s concept of proximal process, it is anticipated that the proposed program will produce regular interaction between the individual and various programmatic efforts (Tudge et al., 2009). Regular interaction allows for individual understanding of a person’s role in the world, and in the case of the proposed program, in preventing and recovering from dating violence. Therefore, providing programming at multiple levels of the social ecological model stresses an individual role in providing positive programming in preventing adolescent dating violence and support for survivors.
Public Health Framework
A resiliency-informed Dating Matters program takes on a public health approach (Feuer-Edwards et al., 2016). The original Dating Matters model focused on primary prevention to prevent disease (or problem behavior) before it occurs (Feuer-Edwards et al., 2016, p. 20). Dating Matters uses an upstream approach by targeting the risk factors found on the causal pathways of dating violence (Braveman et al, 2011). However, the resiliency-informed adaptation will put an increased emphasis on protective factors (e.g., parent and peer support) in order to buffer associations between victimization and negative outcomes. Primary prevention components include implementing Safe Dates, a school-based prevention program shown to reduce perpetration and victimization (Foshee et al., 2005).
Secondary prevention works to reduce the impact of problem behaviors once they have developed (Feuer-Edwards et al., 2016, p. 20). The proposed programming seeks to implement improved dating violence screenings at Boone County Health Center (Nebraska) so that youth can be referred to treatment services that a part of the tertiary prevention efforts.
Resiliency concepts will be added through tertiary prevention efforts. Tertiary efforts treat ongoing conditions in order to improve one’s quality of life (Feuer-Edwards et al., 2016, p. 20). Tertiary treatment efforts will be trauma-informed. Trauma-informed treatment services offered include mental health services to address mental health outcomes associated with dating violence victimization (Exner-Cortens et al., 2013; Bonomi et al, 2013).
References
Bronfenbrenner, U. (1992). Ecological systems theory. In R. Vasta (Ed.), Six theories of child development: Revised formulations and current issues (p. 187–249). Jessica Kingsley Publishers.
Bonomi, A.E., Anderson, M.L., Nemeth, J., Rivara, F.P., & Buettner, C. (2013). History of dating violence and the association with late adolescent health. BMC Public Health, 13(821), 1-12.
Exner-Cortens, D., Eckenrode, J., & Rothman, E. (2013). Longitudinal associations between teen dating violence victimization and adverse health outcomes. Pediatrics, 131(1), 71-78.
Feuer-Edwards, A., O’Brien, C. & O’Connor, S. (2016). Trauma-Informed Philanthropy. Forum Network Knowledgebase.
Hedge, J.M., Sianko, N., & McDonell (2017). Professional help-seeking for adolescent dating violence in the rural south: the role of social support and informal help-seeking. Violence Against Women, 23(12), 1442-1461.
Martin, C.E., Houston, A.M., Mmari, K.N., Decker, M.R (2012). Urban teens and young adults describe drama, disrespect, dating violence and help-seeking preferences. Maternal and Child Health Journal (16), 957-966.
Preble, K.M., Black, B.M, & Weisz, A.N. (2018). Teens’ and parents’ perceived levels of helpfulness: An examination of suggested “things to say” to youth experiences teen dating violence. Children and Youth Services Review, 85, 326-332.
Reidy, D.E., Holland, K.M., Cortina, K., Ball, B., & Rosenbluth, B. (2017). Evaluation of the expect respect support group program: A violence prevention strategy for youth exposed to violence. Preventive Medicine, 100, 235-242.
Richman, A.R., Webb, M.C., Eicher, L., Adams, P. & Troutman, J. (2017) “Facebook Official,” “Hooking Up,” “Friends with Benefits”: Decoding the terminology, relationship status, and sexual behaviors of female college students to best target health needs, American Journal of Sexuality Education, 12(2), 136-147.
Sharps, P. W., Bullock, L. F., Campbell, J. C., Alhusen, J. L., Ghazarian, S. R., Bhandari, S. S., & Schminkey, D. L. (2016).Domestic violence enhanced perinatal home visits: the DOVE randomized clinical trial. Journal of Women’s Health, 25(11), 1129-1138.
Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884.
Tudge, J.R.H., Mokrova, I., Hatfield, B.E., & Karnik, R.B. (2009). Uses and misuses of Bronfenbrenner’s bioecological theory of human development. Journal of Family Theory & Review, 1, 198-210.
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