Article
The Impact of Adolescent
Dating Violence Training
for Primary Care Providers
Katrina J. Debnam, PhD, Sarah Lindstrom Johnson, PhD,
Sarah Colomé, MS, Jacqueline V. Bran, MHS, & Krishna K. Upadhya, MD
ABSTRACT
Objective: This study presents results from an educational
training to increase adolescent dating violence (ADV) screen-
ing among primary care clinicians and provides adolescents’
perceptions regarding discussing ADV with their clinicians.
Methods: A national dating violence advocacy group pro-
vided a training in ADV to 16 clinicians serving an urban
health clinic. Knowledge, self-efficacy, and expectations were
examined before training, after training, and at a 6-month
follow-up. Forty-five adolescent patients of the clinicians were
also surveyed.
Results: Analysis shows significant increases in clinician knowl-
edge, self-efficacy, outcome expectancies, and outcome
expectations after training and at the 6-month follow-up. About
half of adolescents reported that they would disclose if they
were in an abusive relationship and believed that their pro-
viders could help them.
Katrina J. Debnam, Assistant Professor, University of Virginia, School
of Nursing, Charlottesville, VA.
Sarah Lindstrom Johnson, Assistant Professor, Arizona State Uni-
versity, Tempe, AZ.
Sarah Colome, Training and TA Program Manager, Break the Cycle,
Culver City, CA.
Jacqueline V. Bran, Research Project Assistant, Johns Hopkins
School of Medicine, Baltimore, MD.
Krishna K. Upadhya, Assistant Professor of Pediatrics, Johns
Hopkins School of Medicine, Baltimore, MD.
Conflicts of interest: None to report.
The present study was supported by a grant from the Johns
Hopkins Urban Health Institute.
Correspondence: Katrina J. Debnam, PhD, University of Virginia,
School of Nursing, McLeod Hall, P.O. Box 800782,
Charlottesville, VA 22908-0782; e-mail: kjd2m@virginia.edu
0891-5245/$36.00
Copyright © 2017 by the National Association of Pediatric Nurse
Practitioners. Published by Elsevier Inc. All rights reserved.
Published online December 15, 2017.
https://doi.org/10.1016/j.pedhc.2017.09.004
www.jpedhc.org
Discussion: This training successfully improved clinician
self-efficacy, outcome expectancies, knowledge, and behav-
ioral capability regarding ADV. Additional research is needed
to determine whether the training leads to improved ADV
screening and intervention. J Pediatr Health Care. (2018) 32,
e19-e26.
KEY WORDS
Adolescent dating violence, adolescent health care, social cog-
nitive theory, teen dating violence, relationship abuse
Adolescent dating violence (ADV) is a significant public
health problem as a result of its persistently high preva-
lence and the vast range of negative outcomes including
psychological, mental, emotional, and physical impacts
(Vagi, Olsen, Basile, & Vivolo-Kantor, 2015). Given the
potential long-term impact of dating violence on the
lives of adolescents, several school and community-
based interventions have been developed to reduce
its prevalence. Few interventions have been devel-
oped to address ADV in health care settings. The study
sought to fill this gap by examining the impact of an
ADV training on primary care clinicians’ self-efficacy,
outcome expectations, outcome expectancies, knowl-
edge, and behavioral capability to discuss with and screen
for dating violence with their adolescent patients.
ADOLESCENT Few interventions
DATING VIOLENCE
Adolescent dating
have been
violence is often un- developed to
derestimated compared address ADV in
with the rates of do-
mestic and sexual
health care
violence among adults. settings.
In actuality, the rates of
ADV are quite high, such that 9.6% of adolescents in
grades 9 through 12 who were surveyed in the na-
tional Youth Risk Behavior Surveillance System had
March-April 2018 e19
experienced physical dating violence (i.e., been punched result of speaking out Adolescents may
or slapped intentionally by their partner; Kann, 2016). (Martin et al., 2012).
The Youth Risk Behavior Surveillance data results also Research suggests that
be more likely to
noted that in the year prior, 10.6% of adolescents in educating peer groups accept assistance
grades 9 through 12 were forced to do sexual things on how to respond to from trained
(i.e., kissing, touching, or being physically forced to friends asking for help
have sexual intercourse) that they did not want to do when experiencing ADV
professionals in
by someone they were dating or going out with (Kann, could be helpful (Ashley mental health and
2016). Another study examined which types of ADV & Foshee, 2005). in different primary
behaviors had the highest prevalence and found that However, adolescents
controlling behavior; put downs, name calling; insults, may be more likely to
care, community,
yelling, swearing; and unwanted calls, texts, visits had accept assistance from and school settings
the highest rates for both male and female adoles- trained professionals in that use a youth-
cents (Bonomi et al., 2012). mental health and in
Research shows that adolescents who report dating different primary care,
centered and
violence experience negative consequences due to that community, and school empowered
violence. Data from the National Intimate Partner and settings that use a approach to their
Sexual Violence Survey showed that male and female youth-centered and em-
victims of dating violence experienced being fearful powered approach to
care.
and concerned for safety, needing medical care, needing their care.
legal services, and missing at least 1 day of work or
school (Black et al., 2011). Many victims also re- THE PRIMARY CARE SETTING
ported symptoms of posttraumatic stress disorder such Adolescent dating violence prevention programs focus
as nightmares, feeling numb, and being easily startled on many risk factors, including family and environ-
(Black et al., 2011). Depression and increased psy- mental factors, as well as on preventing youth risk
chological vulnerability have also been reported as behaviors that are pertinent to dating violence (Vagi
common effects of ADV, with the correlation between et al., 2013). Through a holistic approach that values
ADV and depression higher among male victims the intersection of prevention and intervention, in-
(Levesque, Johnson, Welch, Prochaska, & Paiva, 2016). cluding the importance of interrupting unhealthy dating
Furthermore, some victims experience contracting a behaviors before they become abusive, future dating
sexual transmitted infection or becoming pregnant (Black violence has the potential to be prevented. A poten-
et al., 2011). Other effects of ADV include overall poor tially effective context for dating violence screening and
physical and mental health, irritable bowel syn- intervention is in the primary care setting. Adoles-
drome, asthma, high blood pressure, frequent headaches, cents may be more likely to attend a primary care clinic
chronic pain, sleeping difficulties, and activity limita- than to visit a psychotherapist or professional mental
tions for females (Black et al., 2011). Adolescents who health clinic. Thus, using this setting to prevent and
have experienced dating violence also have a higher intervene in ADV has potential. Despite recommen-
prevalence of substance use, including cigarettes dations and requirements for screening women (14-
(Exner-Cortens, Eckenrode, & Rothman, 2013; Haynie 46 years old) for intimate partner violence, screening
et al., 2013), alcohol (Exner-Cortens et al., 2013; Haynie in primary care settings remains suboptimal (< 10%;
et al., 2013), and marijuana (Haynie et al., 2013). Finally, Alvarez, Fedock, Grace, & Campbell, 2016). These low
experiencing dating violence places adolescents at screening rates have been attributed to lack of time,
higher risk for experiencing adult partner violence comfort, and support in the event of an affirmative re-
(Exner-Cortens, Eckenrode, Bunge, & Rothman, 2017). sponse (Alvarez et al., 2016).
Indeed, Zeitler et al. (2006) found that 80% of eth-
HELP-SEEKING BEHAVIORS nically diverse females ages 15-24 years thought that
Most adolescents experiencing dating violence do not seek health care clinicians should ask patients about past
help (Ashley & Foshee, 2005). Of those who do seek help, or current partner violence. Nearly 90% of this sample
most victims of ADV seek nonprofessional help, such as thought universal screening for intimate partner vio-
family or friends (Ashley & Foshee, 2005; Martin, Houston, lence by a health professional was a very good or
Mmari, & Decker, 2012). Ashley & Foshee reported that somewhat good idea (Zeitler et al., 2006). However,
after experiencing dating violence, only 25% of adoles- only 11% of the adolescent females who had said they
cents sought help: 12% of adolescents from a counselor had been abused stated that they had told a clinician
or social worker outside of the school, 7% from the health about intimate partner violence (Zeitler et al., 2006).
department, and 6% from a hospital (Ashley & Foshee, This supports the importance for pediatric clinicians
2005). Victims are often afraid that the severity or fre- to screen for dating violence and to be trained on how
quency of abuse will be increased by their abusers as a to manage potential discoveries or disclosures of that

e20 Volume 32 • Number 2 Journal of Pediatric Health Care

violence. Women-centered first-line support has also
been suggested as an appropriate health sector re-
sponse to women experiencing intimate partner violence
(García-Moreno et al., 2015). A woman-centered re-
sponse would include health providers who are
knowledgeable and prepared to respond to intimate
partner violence, have protocols to guide their action,
and offer environments that facilitate screening, dis-
closure, and resources for appropriate response.
Previous research supports the use of health care
settings in partner violence intervention.With a con-
venience sample of young women visiting a pediatric
emergency department, Erickson, Gittelman, and Dowd
(2010) found a dating violence prevalence of 37% after
screening. Although Erickson, et al. (2010) were unable
to screen every adolescent, it was well received by both
parents and patients. Wagers et al. conducted a similar
study in a pediatric emergency department focusing
solely on adolescent males and found an equally high
prevalence of 20% in the sample. Unfortunately, because
of the time constraints of the visit and the nature of
the clinician/patient relationship, both studies were able
to provide referrals to community resources only with
a positive screening result (Erickson et al., 2010; Wagers,
Gittelman, Bennett, & Pomerantz, 2013; Walton et al.,
2011). In a primary care setting where providers gen-
erally have a closer relationship with their patients that
has been developed over multiple visits, there is the
potential for increased screening and direct interven-
tion. For these reasons, the study explored the impact
of providing dating violence education to adolescent-
serving providers in a primary care clinic.
SOCIAL COGNITIVE THEORY
Social cognitive theory (SCT) is a psychological theory
that has historically been used to encourage behav-
ior change. The theory assumes that human behavior
works around a triadic cycle where behavior, per-
sonal factors, and environmental influences reciprocate
and interact with each other (Baranowski, Perry, &
Parcel, 2002). SCT has been used to encourage clini-
cians to implement specific behaviors in their practice
through beliefs of personal capability, intentions, and
past behavior (Godin, Bélanger-Gravel, Eccles, &
Grimshaw, 2008). For example, a Web-based training
for sexual counseling interventions was found to be
significantly effective for undergraduate nursing stu-
dents working with cardiovascular patients (Steinke,
Barnason, Mosack, & Hill, 2016). While using social
cognitive theory principles, the training increased the
frequency that students discussed and counseled these
patients—sexual counseling is an important part of car-
diovascular treatment—on sex in general, specific sexual
activities, and speaking about sex with both genders
(Steinke et al., 2016). In the current study, constructs
from the SCT were used to encourage clinicians to
discuss dating violence with their patients.
www.jpedhc.org
CURRENT STUDY
More research is needed to show the utility and fea-
sibility for adolescent clinicians to be trained in ADV.
Clinicians must be prepared to recognize the risk factors,
signs, and symptoms of victimization in their patients
and be prepared to give them support and commu-
nity resources. Therefore, the study’s primary purpose
was to determine whether a 2-hour ADV prevention
training workshop for adolescent health clinicians in-
creased self-reported (a) knowledge regarding ADV;
(b) self-efficacy, behavioral capability, outcome ex-
pectancies, and expectations for discussing ADV with
patients; and (c) screening behaviors, as evidenced in
the pre-/post-training and 6-month follow-up survey
data. In addition, more research is needed to show that
adolescents who are involved in a violent relation-
ship would be willing to disclose to their primary care
providers. Therefore, the study also explored adoles-
cents’ perceptions of discussing dating violence with
their providers.
METHODS
Intervention
Break the Cycle is a leading national nonprofit
organization that inspires and supports young people
to build healthy relationships and create a culture
without abuse. In its 20th year of existence, the
national organization has three signature programs
dedicated to youth mobilization and education, policy,
and legal services and training and capacity building
for caring adults and professionals who work with
adolescents. Clinicians at an adolescent health clinic
in an urban setting voluntarily attended, in person,
Break the Cycle’s 2-hour training, entitled “The
Clinical Response to Dating Abuse.” The interactive
training included education on the definition of
dating abuse, the prevalence and scope of dating
abuse, and methods for recognizing dating abuse, its
risk factors, and the warning signs of victimization
and perpetration. Participants at the training also
learned about various screening questions and methods
for building trust with young patients, listening to
disclosures, and responding to disclosures. Consider-
ations surrounding confidentiality laws were discussed,
as was the importance of having a list of referrals
and creating workplace policy such as mandatory
adolescent dating abuse training. The training was
steeped in the assumption that medical clinicians are
capable of being change makers in the movement to
prevent and end adolescent dating abuse.
Institutional Review Board
All study procedures were approved by the first and
last authors’ university institutional review board before
the recruitment of participants.
March-April 2018 e21
Sample
Providers
Participation was open to those who were providers
at a specific university-affiliated adolescent health clinic.
There were no exclusion criteria otherwise. Sixteen cli-
nicians out of a total 21 consented to participate in
the study, resulting in a participation rate of 76%. Cli-
nicians voluntarily attended the in-person “The Clinical
Response to Dating Abuse” 2-hour training and, there-
fore, were included in the pre- and post-training and
follow-up survey sample.
Adolescents
Inclusion criteria for adolescents included being cur-
rently seen as patients by consenting clinicians at the
university-affiliated adolescent health clinic and being
between the ages of 12 and 21 years. A total of 45
adolescent patients consented to participate in the
project.
Measures
All survey measures were based on concepts from the
SCT. Measures were developed by the research team
for the specific purposes of this study.
Health care providers
Knowledge, behavioral capability, self-efficacy, outcome
expectations, and outcome expectations were the SCT
concepts assessed from the clinician. First, knowl-
edge was assessed using three questions that asked
how well clinicians were able to define ADV, under-
stand key influencers, and identify warning signs and
obstacles. Second, behavioral capability was assessed
by asking how well clinicians were able to respond
to adolescent victims. The knowledge and behavioral
capability items used Likert scales of ability (poor, fair,
neutral, good, excellent).
Self-efficacy operationalization consisted of an item
that assessed confidence in talking with patients about
ADV, while behavioral capability was measured by
having the knowledge and ability to talk with pa-
tients about ADV. Outcome expectations and
expectancies were measured through clinicians’ per-
ception of the importance of talking to patients about
ADV, believing that having a discussion about ADV
with patients will reduce the young person’s involve-
ment in ADV, and the importance of receiving training
on ADV. These items used Likert scales of agreement
(strongly disagree, disagree, neither agree/disagree, agree,
strongly agree) and importance (not important, im-
portant, very important).
Lastly, participating providers reported the number
of times in the past week they had screened for dating
violence, had a conversation with a patient about dating
violence, and provided a referral for support around
dating violence. Participants were asked to choose from
e22 Volume 32 • Number 2
the following response options: Never, 1-2 times, 3-4
times, 5-6 times, 7-9 times, and 10 or more times.
Adolescents
Consistent with SCT, knowledge, self-efficacy (confi-
dence), and comfort level were assessed for adolescents.
First, knowledge was assessed using eight short sce-
narios and asking what type of relational behavior each
scenario represented (e.g., “Kelly tells Dean that she
is going to be studying for her test in Chemistry tonight,
but Dean texts her every five minutes and she is unable
to concentrate until she turns her phone off”). The
options were abusive, unhealthy, neutral, healthy, and
very healthy. All scenarios were developed by members
of the research team. Second, self-efficacy was as-
sessed by asking how confident adolescents were that
they could: (a) “identify signs of an unhealthy or abusive
relationship,” (b) “create healthy relationships,” (c) “get
help if they experience dating violence,” and (d) “ap-
proach conflicts and communications in a healthy
manner.” The answer options were a Likert scale of
agreement (strongly disagree, disagree, neither agree/
disagree, agree, and strongly agree). The third section
of the survey was about experiences with clinicians.
It included a 5-point Likert scale (i.e., strongly agree
to strongly disagree) to measure adolescents’ beliefs
that a clinician would be able to help them if they were
in an abusive relationship and whether they would be
comfortable telling their clinician if they were cur-
rently in an abusive relationship.
Procedure
Health care providers
Before beginning the training, clinicians were asked
to review and sign the consent form and complete the
pre-training survey. Immediately after the training work-
shop, consenting participants completed the post-
training survey. Approximately 6 months after the
workshop, participants were again contacted to com-
plete a follow-up survey. Participants were provided
a $25 gift card in appreciation for completing the survey.
Adolescents
Adolescents aged 18 through 21 years were ap-
proached in the clinic waiting room by members of
the research tea and were asked to review and sign
a consent form and complete the adolescent survey.
For those younger than 18 years, a guardian must have
been present to sign a consent form, or the adoles-
cent had the opportunity to mail the signed consent
forms and survey to the principal investigator. Partici-
pants were provided a $25 gift card in appreciation
for completing the survey.
Analysis
Data analyses were conducted using the statistical soft-
ware SPSS, version 22. For analyses on the clinicians’
Journal of Pediatric Health Care
surveys, variance tests were performed for each pre-
dictor of behavior construct to examine if there were
any statistically significant differences in pretest, posttest,
and follow-up data. Fisher’s least significant differ-
ence post hoc test was used to determine which
timepoints held the mean score differences. Indepen-
dent t tests were used to examine if there were any
statistically significant differences in clinician actual
screening behaviors at pretest and follow-up. Inves-
tigators used an alpha level of .05 for all statistical tests.
Frequency and descriptive statistics were performed
for data from the adolescent surveys.
Ethical Approval
All procedures performed in the current study are con-
sistent with the 1964 Helsinki declaration to ensure
proper treatment, safety, and confidentiality of all
participants.
Informed Consent
Signed consent was obtained from the clinicians, ado-
lescents, and parents of adolescents who participated
in the study.
RESULTS
Health Care Providers
Most clinician participants were female (n = 11) and
most were medical doctors (n = 13). The remaining
clinicians were nurses or medical student fellows. Fifty
percent had been practicing for 5 years or less (n =
8). Before the training, 56% said they had screened
for ADV during the past week never (n = 3) or 1-2
times (n = 6).” A total of 81% reported that during the
past week they had had a conversation with a patient
about ADV never (n = 5) or 1-2 times (n = 8). Par-
ticipants said that they had rarely provided a referral
for support around ADV during the past month, never
(n = 13) or 1-2 times (n = 3).
Analysis of variance show significant increases in
clinician knowledge at post-training and follow-up. The
means and standard deviations are presented in Table 1.
Specifically, analyses show a significant increase in
clinicians’ ability to define ADV (F(2, 41) = 4.82, p =
.013). Post hoc tests showed that the increase in cli-
nicians’ ability to define ADV was statistically significantly
higher at post-training and follow-up compared with
the pre-training. There were no statistically signifi-
cant differences between the post-training and the
follow-up time points (p = .68). A significant increase
in understanding key influencers of dating abuse among
youth (F(2, 41) = 12.82, p < .01) was observed. Post
hoc tests showed greater understanding at post-
training and follow-up compared with pre-training but
no statistical significance from post-training to follow-
up (p = .53). Clinicians also reported an increase in
their ability to identify warning signs and obstacles of
dating abuse (F(2, 41) = 11.31, p < .01). Again, post
hoc tests showed greater knowledge about warning
signs at post-training and follow-up compared with pre-
training but no statistical significance from post-
training to follow-up (p = .79). Finally, data show a
significant increase in clinicians’ knowledge about how
to respond to youth experiencing dating violence (F(2,
41) = 9.76, p < .01). The least significant difference post-
hoc test showed higher ability at post-training and
follow-up compared with pre-training. There were no
statistically significant differences between the post-
training and follow-up time points (p = .59).
Analyses of variance show significant increases in
clinician behavioral capability, outcome expecta-
tions, and outcome expectancies at post-training and
follow-up. Clinicians reported a significant increase in
their behavioral capability to talk with patients about
ADV (F(2, 41) = 3.68, p = .03). Post hoc tests show a
significant increase in behavioral capability from pre-
training to post-training (p < .05) but not to follow-
up. Results show that clinicians’ outcome expectancies,
or perceived importance of talking to patients about
ADV, significantly increased (F(2, 41) = 3.41, p = .04)
from pre-training to post-training. Clinicians’ outcome
expectations or the belief that discussing ADV with their
patients will reduce their involvement in ADV in-
creased (F(2, 41) = 3.71, p = .03). Post hoc tests show
a significant increase from pre-training to follow-up.

TABLE 1. Means and standard deviation for pre-, post-, and follow-up survey
Pre Post 6-Month Follow-Up
Question M (SD) M (SD) M (SD) F p
Knowledge: Define ADV 3.94 (0.68) 4.53 (0.62) 4.64 (0.67) 4.82 .01
Knowledge: Key influences of ADV 3.19 (0.83) 4.35 (0.61) 4.18 (0.60) 12.82 .01
Knowledge: Warning signs 3.44 (0.81) 4.47 (0.62) 4.55 (0.69) 11.31 .01
Knowledge: Response to ADV 3.31 (0.87) 4.29 (0.69) 4.45 (0.69) 9.76 .01
Self-efficacy 3.94 (0.77) 4.53 (0.51) 4.18 (1.17) 2.23 .12
Behavioral capability 3.63 (0.89) 4.41 (0.51) 4.18 (1.17) 3.68 .03
Outcome expectancies: Importance of talking to patients about ADV 4.94 (0.25) 4.94 (0.24) 4.36 (1.21) 3.41 .04
Outcome expectancies: Importance of receiving training in ADV 4.75 (0.45) 4.94 (0.24) 4.91 (0.30) 1.40 .26
Outcome expectations: Talking will reduce ADV 3.63 (0.72) 4.35 (0.79) 3.64 (1.12) 3.71 .03

Note. Alpha level p < .05. M, mean; SD, standard deviation; ADV, adolescent dating violence.

www.jpedhc.org March-April 2018 e23

 TABLE 2. Means and standard deviation for pre-test and follow-up survey
Question
How many times did you screen for adolescent dating violence during the past week?
How many times did you have a conversation with a patient about adolescent dating
violence during the past week?
How many times did you provide a referral for support around adolescent dating violence
during the past week?
Note. Alpha level p < .05. M, mean; SD, standard deviation.
Finally, there was an observed significant increase in
the number of times, from pre-training to follow-up,
that clinicians referred a patient for support around ADV
in the past week (F(2, 41) = 5.90, p = .02). Although
not statistically significant, findings also show an in-
crease in number of times participants screened their
patients for ADV (see Table 2; M = 1.56, SD = 1.21;
M = 1.82, SD = 0.87) and had conversations about ADV
(M = 1.00, SD = 0.97; M = 1.45, SD = 1.21).
Adolescents
Most youth were female (73%) and heterosexual (80%).
The mean age of youth was 18.3 years (SD = 1.9). Pre-
liminary analysis shows that, on a scale of 0 through
7, youth mean knowledge about ADV was 3.40 (SD
= 1.67). About half of the youth participants (51.1%)
reported feeling confident in their ability to identify
signs of an unhealthy/abusive relationship. Approxi-
mately 56% of youth felt confident in their ability to
create a healthy relationship, and 58% felt confident
in their ability get help if they experience dating vio-
lence. Most youth participants (66.7%) also reported
that they talk about healthy relationships with their
doctor and that they are comfortable discussing this
topic with their clinician (88.9%). Finally, almost half
of participants strongly agreed that they would share
with their clinician if they were in an abusive rela-
tionship (48.9%) and think their clinician would help
them (46.7%).
DISCUSSION
The purpose of holding “The Clinical Response to Dating
Abuse” training was to better equip existing clini-
cians in their screening of, and response to, ADV. The
clinicians were not only informed about matters per-
taining to ADV, they were also encouraged to recognize
that they play a significant role in the movement to
end that same abuse. This represents one of the first
interventions with primary care clinicians, and results
support improvement in their knowledge, behavioral
capability, and outcome expectations. Methods for build-
ing trust that were emphasized in the Break the Cycle
training included nonjudgmental responses to patient
experiences and values, validation of patient experi-
ences and concerns, and affirmation of the patient’s
e24 Volume 32 • Number 2
Pre 6-Month Follow-Up
M (SD) M (SD) t p
1.56 (1.21) 1.82 (0.87) 1.57 .22
1.00 (0.97) 1.45 (1.21) 2.68 .11
0.19 (0.40) 0.91 (1.51) 5.90 .02
autonomy. Post-training data showed that clinicians’
general knowledge about ADV increased, as did ex-
pectation that they can play a role in reducing their
patients’ involvement in ADV. It is notable that per-
ceptions of behavioral capability and self-efficacy did
not decrease from post-training levels, which is po-
tentially related to positive experiences discussing dating
relationships facilitated by these rapport-building
strategies.
Using the tools provided in Break the Cycle’s train-
ing allows health care clinicians to actualize the
intersection of prevention and intervention in their work.
Commonly identified as the levels of prevention, this
intersection speaks to the role that health care clini-
cians play in preventing abuse, intervening in abuse,
and preventing further abuse (Chamberlain &
Rivers-Cochran, 2008). Beyond the opportunities for
engagement at the primary prevention level, this po-
tential for change at the secondary and tertiary levels
includes interrupting unhealthy dating behaviors before
they become abusive, reducing the harms of abuse,
and preventing revictimization. Coupled with the strat-
egies shared for building patient trust, and engaging
with young patients, the position that health care cli-
nicians hold as change makers reestablishes their
opportunity to empower patients to recognize their right
to safe and healthy relationships. In a study on the
role of trust in patient–physician relationships and patient
activation, findings showed that a supportive patient–
physician relationship, based in trust, ultimately
contributes to patients taking a more positive role in
their health care management (Becker & Roblin, 2008).
At each level of prevention, clinicians have the ca-
pacity to share tools for asserting and maintaining control
over one’s own health through the lens of patient-
centered care. This capacity for influence can include
sharing vital information that can equip young pa-
tients to mitigate, and even avoid, the effects that dating
abuse can have over one’s own health. The potential
for health care clinicians to serve as both interrupters
and preventers of dating abuse while asserting patient
autonomy as a means of empowerment highlights the
need for further integration of dating abuse preven-
tion and intervention education in the field of health
care.
Journal of Pediatric Health Care
 Health care clinicians Health care
are in a unique place
to counsel adolescents
clinicians are in a
about ADV because unique place to
they can provide a level counsel
of confidentiality and
privacy in an environ-
adolescents about
ment focused on the ADV because they
adolescent’s health and can provide a level
well-being. Clinicians
engage in conversa-
of confidentiality
tions that often reveal and privacy in an
warning signs of dating environment
violence and can con-
sistently respond to the
focused on the
impacts of dating adolescent’s health
abuse. Therefore, in- and well-being.
volving health care
clinicians in ADV pre-
vention efforts may have a lasting impact on the dating
behaviors of adolescents. The development of a train-
ing model and screening tool could have widespread
impact with dissemination to primary care clinicians
throughout the United States. However, future work
would be needed to evaluate actual health behav-
ioral risk outcomes resulting from the intervention with
health care clinicians.
The results of this study are promising; however,
additional questions must still be answered to effec-
tively engage and train health care clinicians as players
in the movement to end dating abuse. Future re-
search efforts, particularly with larger sample sizes
and more comprehensive measurement, should be
made to assess the longitudinal impact of a training
like “The Clinical Response to Dating Abuse” on
clinicians’ knowledge of dating abuse, self-efficacy,
behavioral capability, outcome expectancies, and
outcome expectations. Additionally, more work is
needed to understand how the health care clinicians’
attitudes and beliefs translate into their rates of screen-
ing and discussion of dating abuse. Finally, although
the study was conducted in an urban adolescent
health clinic, results have implications for clinicians
serving adolescents in any setting.
Results also showed that youth were willing and ac-
cepting of discussing dating abuse with their clinician.
Youth also shared that they would disclose with their
clinician if they experienced abuse in their relation-
ship. These findings support the use of health care
providers to screen for ADV. Nurses as well as clini-
cians are in a unique position to discuss ADV with youth
and can assist with the response to dating abuse. Wider
dissemination and implementation of this training model
and screening methodology to primary care provid-
ers throughout the United States has significant potential
to identify and provide support for youth at risk of
and experiencing dating violence.
www.jpedhc.org
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