Health professionals, school nurses and counselors see the consequences of sexual violence and harassment regularly.  Victims of physical and sexual violence are more likely to report sadness, hopelessness or suicidal ideation, engage in substance use, and eating disorders.  They are more likely to become pregnant or become infected with an STI or HIV, and experience increased risk for school dropout lower grades and less connectedness to school. Because of this, health providers and centers are vital components of a response to sexual violence and harassment. New research finds that by discussing healthy and unhealthy relationships and offering brief interventions can reduce the risk of violence, cyber abuse and unplanned pregnancy.

Health providers can play also play an essential role in violence prevention and health promotion by discussing healthy, consensual and safe relationships with all patients.  Health settings may be the sole place an adolescent experiencing abuse may be identified and connected to resources to stay safe.

Tips:

Promote Privacy and Confidentiality:

Always set aside time to talk alone with student or patient before discussing abuse and disclose any limits of confidentiality (see below for more detail).

Talk to students and patients about healthy and unhealthy relationships:

Let students or patients know that you are talking to everyone about healthy and unhealthy relationships and harassment and sexual violence. Futures Without Violence has resources that provide information on healthy and respectful relationships, textual harassment, sexual and reproductive coercion and hot to get help or help a friend. Providers should review these materials with youth and encourage them to share them with their friends.

Promote Prevention and peer to peer support:

If the patient or student is not experiencing abuse or harassment:

Let them know you are glad that is not happening to them and let them know that if they ever need health you are there for them. Share extra resources and let the not that you give the resources to everyone in case they have a friend or family member who needs it

Support survivors: if someone disclose assault, abuse or harassment:

• Let patients know that you support and believe them:

        “I’m sorry that happened.   It happens way too often.”

        “You don’t deserve this and it is not your fault.”

         “I’m glad you told me.”

• Address the health issues (including offering emergency contraception, sexual assault exams and treatment for other health issues commonly associated with exposure to violence).
• Offer referrals to community based advocates who can help and/or hotlines such as: Love Is Respect and RAINN.  For additional resources, click here. (link to resources/tools page)

What not to say to Survivors:

      “You should definitely report immediately and go get a rape kit.”

      “You are definitely in an abusive relationship.”

      “That does not sound like rape to me…”

      “Were you drunk? Were you using the buddy system?” or “What did you do to set them off?”

      “So what happened after that, and what happened after that?”

Disclosing limits of confidentiality and Trauma informed Reporting

Navigating the balance between confidentiality and abuse reporting requirements is a fundamental challenge and as a provider it is critical to understand the state’s minor consent and confidentiality, physical and sexual abuse laws so that you can articulate them to your patients.   This is critical to building trust with your patients.

Provider tips for discussing conditional confidentiality

• Be direct: Discuss confidentiality and the conditions under which it might be breached at the beginning of the visit.
• Keep it simple: Tailor your discussion to the youth’s age and context.
• Communicate care and concern: Frame your need to breach confidentiality in the context of “getting them the help that they might need,” rather than using the law, policy or phrase “I am a mandated child abuse reporter,” as a reason to breach confidentiality.
• Assure two-way communication: Let your patient know if you are going to share information that they told you in confidence.
• Know the law.

Sample Script for disclosing limits of confidentiality:  

“Before we get started I want you to know that everything here is confidential, meaning I won’t talk to anyone else about what is happening unless ou tell me that you are (add state specific here: being hurt physically or sexually, planning on hurting yourself or planning on hurting someone else).  Those things I would have to report ok?”

Watch this video between a healthcare professional and patient who discloses she may have been sexually assaulted at a party for tips on what to say and how to handle a disclosure of sexual violence if you are a mandatory reporter.

Resources for Healthcare Professionals on address teen relationship abuse.

Hanging Out & Hooking Up: Teen victims of relationship abuse are more likely to report unhealthy diet behaviors, engage in substance abuse, and report having suicidal thoughts. Given these sobering facts, adolescent relationship abuse is a major health concern facing teens today, and healthcare providers have a unique role to play in preventing it. Not only can they provide valuable prevention messages to help their patients build healthy relationships, but medical professionals are also uniquely positioned to help those exposed to abuse find the resources they need. And now, healthcare providers have a new tool that will make it easier than ever to integrate screening for relationship abuse and prevention into their practice.

• Guidelines: An Integrated Approach to Prevention and Intervention, focusing on the transformative role of the adolescent health care provider in preventing, identifying and addressing adolescent relationship abuse.
• Poster: Raise awareness and hang in your office or clinic.
• Teen Safety Card: Distribute to teens so they can self-assess if they are in a healthy or unhealthy relationship.

As seen in the film Audrie and Daisy, sexual violence is a singularly complex crime to investigate, prosecute and adjudicate. It is a uniquely degrading and violent assault that is often complicated with questions about substance abuse, misconceptions about consent, and age old myths around sexual entitlement. This is perhaps the only crime in which a victim is more likely to be seen as a liar than the perpetrator, her character besmirched and sexual history laid out as proof of culpability in her own tragedy.  Crimes of sexual violence, particularly against young people today, are further exacerbated by the use of technology and social media as weapons to shame, coerce, and intimidate victims. This conflation of issues create a challenge for the justice system and demands a tailored approach so that offenders will be held accountable and constitutional rights are protected without eviscerating the lives of victims and deterring other victims from coming forward. Law enforcement, prosecutors and judges can utilize this film to begin conversations around how to approach crimes of sexual violence against young people and to lay a foundation for further education  and policy changes around how these crimes are investigated, charged, prosecuted and adjudicated.

Resources for Law Enforcement:

• International Association of Chiefs of Police (IACP) offers a variety of tools and resources for law enforcement to strengthen their response and investigation of sexual assault cases.
• Resource for Prosecutors on address alcohol and drug facilitated sexual assaults.

Adolescent relationship abuse, or teen dating violence, affects up to one-third of U.S. adolescents, many who are involved in abusive relationships from as early as middle school. Even with these epidemic rates of relationship abuse, a recent study found that 81 percent of the school counselors reported that they did not have a protocol on how to respond to an incident and 90 percent had not been trained on how to respond to students by relationship abuse.

There is a significant gap between the serious issue of adolescent relationship abuse and the ability to respond to this abuse within our current school systems. There is even less support for schools on how to prevent this abuse and promote healthy relationships.

Young people have the capacity to change behavior patterns, reframe and redefine their relationships, become more empowered, and make healthier choices. System change approaches have been shown to reduce teen dating violence and other peer-to-peer conflicts like sexual harassment and bullying.

When systems support young people in making healthy relationship choice, and providing timely and appropriate responses, youth have the opportunity to develop the relationship skills that will allow them to become engaged adults and powerful community members. This section provides resources for systems change on the school level through policy adoption.

1.                 Why Policy?

Policy is an important piece of the overarching goal to prevent adolescent relationship abuse because it underscores an agency/school/institution’s commitment to responding to and preventing this issue. Policy is a key strategy in both public health and social justice frameworks for lasting change. Goals for an adolescent relationship abuse and healthy relationship promotion policy in your school should include:

• Educate students and school staff about promoting healthy relationships and preventing teen dating violence;
• Ensure that all school staff know how to respond to an incident of teen dating violence;
• Encourage students to approach school staff as a resource who can help them stay safe;
• Ensure staying power and long-term impact even with changes in budget, priorities and personnel;
• Provide for the protocols and procedures to demonstrate compliance with Title IX requirements that schools not discriminate on the base of sex;
• Pave the way for program development that reinforce healthier norms and behaviors; and
• Be an integral part of a coordinated school and community approach to building healthy adolescent relationships and preventing teen dating violence.

1.               Get to Know Your System

The first step in effective advocacy is to get to know the system that you are trying to impact. This means tracking the various ways that the system changes. For example in the school context this could mean changes through school board mandates as well as superintendent decisions. Some suggestions for how to learn more about the system include:

• Conduct a local assessment of your existing school policies. Review local and state school discipline code for the definitions of behaviors that describe teen dating violence and other forms of peer-to-peer abuse and harassment, as well as threatening behavior. Read over the School & District Policies to Increase Student Safety & Improve School Climate: Promoting Healthy Relationships and Preventing Teen Dating Violence, available at http://www.startstrongteens.org/resources/policy . Use the Scorecard to track your progress on page 44 of the Model Policy.

• Explore district and school websites to find out about existing policies and procedures—focus on how your school system responds to and prevents sexual harassment, bullying, teen dating violence, and other violence prevention and intervention work on campus. See if your district uses a positive school climate approach or a school climate survey tool which could support your policy and healthy relationship promotion approach. Download your school district and school handbooks given to students and/or parents.

• Map out how a policy gets passed in your school district. This may include multiple routes of policy change.
• Find out if your school board or system has open listening sessions and how they solicit ideas from the community as well as how they get feedback from the community.
• Find out if your state has passed any relevant laws such as:
  • An adolescent relationship abuse law: http://www.ncsl.org/?tabid=17582
  • Civil domestic violence protection order laws that allows teens to seek protection from abusive relationships: http://www.breakthecycle.org/state-law-report-cards.

• Investigate your state’s mandatory reporting of child abuse laws and statutory rape laws, since issues of relationship abuse can be linked to sexual activity, as well as child abuse in some cases, triggering child abuse reporting systems. It is important to know who is a mandatory reporter for child abuse in your state, as well as the standards for making child abuse reports. When working with young people it is imperative for the trust-building process to be upfront about your responsibilities and limits to confidentiality. These sites can help you understand confidentiality and child abuse mandatory reporting requirements:
  •  http://www.aspe.hhs.gov/hsp/08/sr/statelaws/summary.shtml
  • http://www.teenhealthlaw.org

• Title IX of the Education Amendments of 1972, a federal law prohibiting sex discrimination in schools, can hold schools responsible for response to dating violence and sexual violence. It is important to make the argument to general counsel or school legal advisor that:
  • a) Adolescent relationship abuse can be a form of sexual harassment because it involves unwanted touching, sexual demands, verbal abuse and physical coercion of a sexual nature (68 5 C.C.R. § 4916(a)) (2007);
  • b) Failure to adopt and implement policies on sexual harassment and adolescent relationship abuse that qualifies as sexual harassment may qualify as “deliberate indifference” and exposes school districts to civil liability under Title IX;6 and
  • c) Title IX regulations require that each educational institution has a written policy and protocol for responding to sexual harassment.

III.      Get to Know Your Policymakers

Policymakers are put in place to represent the voice and needs of their constituents. This makes them public servants that should be interested in feedback and ideas from the people they represent. Getting to know the people that make the decisions that impact your school and community is an important step in building the momentum for system changes.

• Learn early on if the school board has ever considered this issue before or similarly related issues such as violence prevention or violence against women issues or sexual harassment. Find out what the outcome from proposed policy changes in this area have been.
• Create a list or map of connections to people in decision making positions. Think about personal and professional connections to those that already exist. 6 Davis v. Monroe County Board of Education, 526 US 629 (1999).
• Interview district staff, attend a school board meeting and/or arrange a meeting with a school board member to introduce yourself, educate, get to know the policymaker’s priorities, and gauge their views about the importance of policy adoption on this issue.
  • Each school designates a Title IX Coordinator to handle claims of sex discrimination. These person can be a significant policymaker or policy influencer.

For further steps on developing comprehensive systems change school and district wide, please refer to the advocacy toolkit.

For sample school and district wide policies to promote healthy relationships and prevent teen dating violence click here.