O3257: Using Quality Improvement to Increase Adolescent Relationship Abuse Awareness in a School Based Health Center

Purpose/Objectives: Adolescent relationship abuse (ARA) is a significant danger for teens. One third of adolescents will experience an abusive relationship and 1 in 4 will be impacted by digital dating violence (DDV). This abuse carries lifelong risks including poor academic outcomes, suicidal ideation, eating disorders, substance use, and violence in future relationships. School based health centers (SBHC) are uniquely positioned to address ARA with accessible care in an adolescent-friendly environment. We present a biphasic quality improvement (QI) intervention including addressing ARA in the school-based health setting and then progressing into a Tier II intervention in collaboration with school administrators and counselors.

Design/Methods: Phase one included ARA focused QI infrastructure, including Plan Do Study Act (PDSA) cycles. Initial PDSA testing investigated feasibility and sustainability of addressing ARA universally in adolescent well visits. Electronic medical record alerts and standardized documentation were used to operationalize the intervention. Adolescents presenting for well care were screened for ARA using a validated instrument. Disclosure of abuse was not the goal of the discussion; limits of confidentiality were addressed. Regardless of outcome, education was provided about healthy relationships and boundaries.

Phase two was a Tier II evidence-based curriculum in partnership with school staff and again features QI framework. The team offered a multidisciplinary approach educating students on healthy relationships, boundaries, and digital safety interventions. Special attention was paid to topics of DDV and monitoring behaviors as Phase I indicated this as an area of knowledge deficit. School staff collaborated with SBHC in selection of students, providing curriculum support, and promoting awareness in the school community.

Results: At outset of this QI project, 8% of well checks at a single site received ARA focused intervention. With expansion, 47% at five sites received the intervention. At most recent analysis, ARA focused QI has resulted in over 55% of well visits at seven sites including screening, guidance, counseling, and/or referrals for this need. The project has been adopted as a standard of care. This approach destigmatized conversation around ARA and resulted in wraparound support allowing youth to feel safe navigating complex social connection. The SBHC has been asked to partner with other departments in disseminating these lessons and modules more broadly.

Conclusion/Discussion: By addressing ARA in collaboration with schools, the SBHC offers multiple opportunities to provide knowledge to teens about safe relationships and healthy boundaries. The co-location of school and healthcare means there are prospects for programming utilizing the expertise of both educators and healthcare staff. This biphasic continuing QI innovation contributed to a comprehensive and adolescent-friendly experience while also strengthening the relationship between SBHCs and school teams. Future plans include both a middle and high school classroom offering at multiple sites along with integration into Health class curricula.