Improving the Adolescent Relationship Abuse (ARA) Screening Program at an Urban Teen Clinic: A Mixed-Methods Process Evaluation Public
Bennett, Nicole Rose (2012)
Published
Abstract
Background: Approximately 15% to 40% of adolescents
experience relationship abuse (ARA) as victims and/or perpetrators.
Visits to reproductive health clinics offer an opportunity
for prevention through screening programs, yet few programs exist
for adolescents. Teen Services at Grady Memorial Hospital is a
reproductive health clinic in Atlanta, which implemented a
screening program over 20 years ago.
Objectives: This research project applied a process
evaluation methodology to examine how to improve the ARA
screening program at Teen Services. To answer the main evaluation
question, three sub-questions were developed: (1) how do
health care workers (HCWs) currently experience the ARA screening
program, (2) what do HCWs need in order to improve ARA screening
program, and (3) what ARA screening instrument should be used at
Teen Services.
Methods: A literature review of ARA instruments was conducted to develop two new screening instruments, a 'linear' and 'bundled' instrument. Key informant interviews with HCWs (N=5) were used to gather feedback on instruments, assess current experiences with ARA disclosure, identification, and follow up. The linear, bundled, and current instruments were pilot tested in the clinic with patients (N=98). Descriptive and psychometric properties were assessed. An online survey was administered to HCWs (N=8) to assess needs, attitudes, and self-efficacy for ARA screening. Qualitative data was triangulated with quantitative results.
Results: Analysis indicated a distinction between
identifying abuse and disclosing abuse among HCWs; some HCWs
noticed signs of abuse, without patient disclosure. HCWs responded
to abuse disclosure disparately, with many different documenting
locations and follow up procedures. HCWs unanimously agreed upon
training needs, such as how to initiate conversations about ARA,
had supportive attitudes, yet varying comfort levels. The ARA
linear and bundled instruments classified more participants than
the current screening instrument (48.9%, 32.0%, 12.25%,
respectively).
Discussion: This project indicates the utility of a process evaluation methodology. Findings of supportive attitudes among HCWs indicate a window of opportunity to build capacity to enhance the program at Teen Services. The new screening instruments classified more patients than the current instrument. After a period of capacity building and program development, the current instrument should be replaced.
Table of Contents
I. Introduction...1
II. Background and Significance...6
III. Methodology...25
IV. Results...37
How do HCWs currently experience the ARA
screening program at Teen Services?...37
What do HCWs need in order to improve ARA screening
program?...44
What ARA screening instrument should be used at Teen
Services?...48
V. Conclusion and Discussion...58
VI. References...68
VII. Appendixes...78
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