Christine Wekerle, Ph.D. Associate, Professor, Pediatrics, McMaster University

Transcription

1 Adolescent Christine Wekerle, Ph.D. Associate, Professor, Pediatrics, McMaster University International Network of Child and Adolescent Resilience International Journal of Child and Adolescent Resilience (2013; 2014) ResilienceInYou

2 Quick Quiz (1) By age 15, teens can use advanced reasoning skills? True or False? (2) The part of the brain that controls emotions does not fully develop until the 20s? True or False? (3) The adolescent brain is more sensitive to rewards? True or False? (4) Family risk factors impact adolescent dating violence? True or False? o Risks highest if experienced childhood sexual abuse, inter-parental violence, parent with a mental illness (ACE Study)

3 Learning Objectives 1. To define adolescent dating violence and current tools for assessment. 2. To understand the dynamics of and associated issues in adolescent dating violence and adolescent healthy relationships. 3. To overview current practical strategies in adolescent dating violence, especially Ontario initiatives, The Youth Relationships Project (YRP; Wolfe, Wekerle, and colleagues)

4 DEFINITION A pattern of violent behavior that one person uses against their partner to cause pain. It can include emotional, physical and sexual violence. (US CDC) 10% Violence against Women and Girls refers to any act that results in, or is likely to result in, physical, sexual, or psychological harm or suffering to women or girls, including threats of such acts, coercion, or arbitrary deprivation of liberty (World Bank, 2014) 35% Issues for Teens: Lack of experience base; Vulnerable to messages (emotional abuse) from partner Misperceive controlling behaviours as love Early dating/dating an adult (girls)/dating younger (boys) Autonomy and peer affiliation does not support out-reach to responsible adult

5 Types of Adolescent Dating Violence Physical abuse: Slapping, choking, or punching. Sexual abuse: Using threats, intimidation, or physical force into unwanted sexual acts (e.g., sexting). Need to teach consent explicitly Emotional or verbal abuse: threatening, demeaning, controlling & isolating behaviours Top Reasons Teens Say Prompted Dating Violence: (1) jealousy/rumors; (2) angry/bad mood

6 Rice et al. (2014) in Pediatrics L.A. Middle School Survey 20% youth report receiving a sext 5% of youth report sending a sext Students who text 100/day were 2.4 more likely to receive a sext and 4.5 more likely to send a sext Sext involvement linked with being sexually active, unprotected sex Pediatricians should discuss sexting as early sexual debut is linked with STIs and teen pregnancies Child maltx at higher risk: More likely to meet in person

7 Tech safety checklist Create your protective barrier with: (1)Change your passwords (2)Block/remove phone numbers, Twitter followers etc. (3)Update your privacy settings (4)Turn off check-in (& identifiable selfies, ask friends not to tag you in pictures) (5)Check for spyware Source: Resource: thatsnotcool.com (start talking back create your Avatar; games; become an ambassador)

8 Prevalence of Adolescent Dating Violence - US - 1 in 4 teens experience violence (Finkelhor et al. 2015) - 1 in 10 teens experience gun violence (Hamby et al., 2015) million US families have children exposed to partner abuse -Among 7 th graders, 2 in 5 tweens report friends victims of verbal abuse in dating relationships futureswithoutviolence.org Youth Risk Behavior Study (CDC) In the past 12 months, has your boyfriend/girlfriend hit, slammed you into something, or injured you with an object or a weapon on purpose? 73.9% dating; > 10.3% physically victimized o 13% female; 7.4% males > 10.4% kissed, touched, or physically forced to have sexual intercourse o 14% females; 6.2% males

9 Prevalence Cont d. Adolescent Survey (BC) % Dating 6% Victim of Physical Dating Violence DV Victims 2X Victims of Bullying (2X), youth w/ no close Longitudinal Study (ON) Maltreatment and Adolescent Pathways (MAP) Study 50% dating violence at 1 assessment child welfare teens 10% repeated dating violence (Tanaka & Wekerle, 2014) Emergency Room Screenings (Singh, 2014; M age=17.5 yrs) 10.6% victimization; 14.6% perpetration FEMALES 11.7% victimization; 4.9% perpetration MALES Any male DV alcohol misuse, drug use, depression Any female DV - public assistance, low academic grades, alcohol misuse, drug use, depression, past ED visit for intentional injury

10 Australian Prevalence ADV Strauss 2004 surveys in various international universities, Australia university prevalence low Using 2010 National Drug Strategy Household Survey (Tait, 2015) ages 14 years and older: Controlling for alcohol, tobacco and illicit drug use, age group, mental health, Indigenous status and socioeconomic factors, the odds of both verbal [adjusted odds ratio (AOR) = 1.52] and physical abuse (AOR=2.04) were greatest for lesbians, while gay men had the greatest odds (AOR=2.25) of feeling threatened. Victimization (physical, verbal, threatening) by an intoxicated person in last 12 months at nearly 50% for gay men and bisexual women (compared to 30% or less) Safety with substances; drinking culture norms

11 Dating Violence Impact on Youth Health Females physical-sexual dating violence at increased risk for: Cigarette smoking; cocaine, sedative, alcohol use Depressive symptoms/suicidality, PTSD symptoms Disordered eating Sexual risk (5+ sex partners; anal sex) Males non-physical dating violence: Cigarette smoking, marijuana and alcohol use Disordered eating, PTSD symptoms More likely to be polyvictims (Hamby et al., 2012) Bonomi et al. (2013); Bossarte et al. (2008); Brown et al. (2009);Exner-Cortens et al., 2013; Temple et al. (2013);Wolfe et al. (2004); Wekerle et al. (2009)

12 RIGHTS & RED FLAGS **On-line training (about 1 hr.) available at: US National Teen Dating Violence Hotline No Canadian National Hotline except KidsHelpPhone Rights, Respect, Resilience in Relationships can be part of context-setting as a way to talk with teens about building healthy relationships At-risk youth mild-to-moderate intellectual disability; maltreatment backgrounds report > DV (Weiss et al., 2011)

13 Screening/Assessment No recognized gold standard Case-finding approach at-risk contexts: Past dating violence experience Alcohol/drug use (driving w/ intoxicated person/partner) Depression, anxiety, suicidality Irregular medical care histories/pregnancy High risk sexual behaviors Child maltreatment history, including exposure to adult partner violence Bullies at school Screening Questions: Are you dating or going out with anyone? Have you ever felt controlled by someone you were dating? Have you ever felt afraid or threatened by someone you were dating? Have you ever been physically hurt or injured by someone you were dating? Have you ever felt pressured to do something sexual when you didn t want to? Is anybody in your life hurting you or someone you know? Has your dating partner made unwanted phone calls, send unwanted text messages, s, or gifts, or showed up in person and waited for you when you didn t want them to?

14 Responding Options depend on age If age 16 and under: Maybe child protection involvement If someone is in immediate danger, call 911 or the emergency number in your community. Put her safety first. Never talk to anyone about abuse in front of their suspected abuser. Unless she specifically asks for it, never give her materials about domestic abuse or leave information through voice messages or s that might be discovered by her abuser. However, abuse thrives in secrecy, so speak up if you can do so safely. If she wants to talk, listen. If she doesn t, simply tell her she does not deserve to be harmed and that you are concerned for her safety. Ask her if there is anything you can do to help, but don t offer to do anything that makes you uncomfortable or feels unsafe. If she decides to stay in the relationship, try not to judge her. Remember, leaving an abuser can be extremely dangerous. Sometimes, the most valuable thing you can offer a woman who is being abused is your respect. Learn about emergency services in your community, such as your local women s shelter or sexual assault centre. Search on-line, or consult the front pages of your telephone directory. SAFETY PLAN important numbers, strategies for increasing safety at home, school, work, violence prevention apps Circle of 6, 24-hour helpline, community services etc.

15 Principles of Prevention Course To understand levels of prevention in the ecological model To understand the features of violence prevention programs Dating is developmentally appropriate for teens, new learning personal power part of autonomy Healthy Relationships Wheel ( Key Messages: Adolescent dating violence is a preventable problem. It is a matter of education, practicing the positive behaviours, and dealing with personal issues (aggression, trauma symptoms, substance abuse).

16 Cdn School-based & Community programs B.C. Saltspring Islands Respectful Relationship Program ( The Fourth R (ON, National) ( Making Waves/Vague par vague (based in New Brunswick) ( Healthy Relationships for Youth (based in Antigonish, Nova Scotia)( h.html) Red Cross RespectED ( Healthy Relationships 101 (CanadianWomen s Foundation, 2012) Download at: DF%20-%20Healthy%20Relationships%20101.pdf

17 Youth Relationship Project (YRP) Co-educational small group, 18 session x 4 mo. Manualized intervention Mid-adolescent teens (ages 14-17) Male/Female Facilitator Pairs Guest Speakers former batterer/counsellor ( Changing Ways ); former victim (METRAC; shelter programs) Human rights approach Rights to safety, protection from violence, to develop to potential (Saewyc, ) Healthy Relationship concept development Skills practice role-plays; scenario solving Mastery/Advocacy/Social action activity

18 YRP Impact Wolfe et al., 2003 Population of youth receiving child welfare services Stronger methodology than most Decreased self-reported dating violence % of intervention males, females reporting 1 or more physical and emotional violence perpetration in line with high school sample Increased self-reported interpersonal competence Trend for decreased trauma symptoms Over a 2.5 year follow-up period No long-term follow-up (police records) No observation of dating partner behavior No repeated RCTs in different sites

19 Summary Dating violence significant issue high levels in known at-risk groups At-risk groups, smaller % persist over time Health and relationship impacts in young adulthood Prevention in schools (universal) weak effects Promising effects in secondary/targeted prevention Parental monitoring of dating negatively correlated with adolescent dating violence; Parental IPV linked with less dating monitoring (Latxman et al. ) Need to energize this area for further developments (World Bank, 2014 report) New Directions: Target impact of emotional abuse on self-system directly e.g., Tanaka et al, 2011 Emotional abuse only sign. Maltx predictor of youth self-compassion in MAP Study Target emotion regulation with routines running, swimming, yoga, mindfulness

20 Thank you for your attention!