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Promoting Healthy Relationships among At-Risk Adolescents: A Feasibility Trial in the Emergency Department

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Adolescent relationship victimization (ARV), characterized by physical, sexual, cyber or psychological abuse, reproductive coercion, or sexual exploitation, remains highly prevalent despite implementation of evidence- based interventions in schools and community settings. Negative outcomes, including suboptimal academic achievement, pregnancy, sexually transmitted infections, disordered eating, suicidality, and homicide, result in significant costs to individuals and society. The emergency department (ED) offers unique opportunities to promote healthy relationships and mitigate negative impact of ARV among an at-risk adolescent population. However, current ED-based relationship interventions are limited by 1) disclosure-based delivery, 2) addressing limited forms of abuse, 3) limited efficacy, and 4) missed opportunities to provide point-of-care harm reduction resources. The Healthcare Education Assessment and Response for Adolescent Relationships (HEART) intervention may address these concerns through 1) universal delivery of education and counseling, and 2) comprehensively addressing the full range of ARV. Previous study by Dr. Miller (co-mentor) demonstrated efficacy of HEART to decrease ARV. However, HEART requires adaptation for the ED setting, given significant contextual differences between the ED and the originally intended setting, school health centers. Dr. Randell, a pediatric emergency medicine physician and candidate for this career development award, is committed to a patient oriented clinical research career targeting interventions to promote healthy adolescent relationships. Her five-year career development plan includes structured mentoring and formal didactics to address critical gaps in her training through acquisition of expertise in theories of behavior change, clinical trials for adolescent behavioral research, implementation science, and adolescent research ethics. The proposed study complements other training activities by enabling hands-on experience in intervention adaptation and a randomized control trial. Following identification of enhancements necessary for HEART in the ED setting, Dr. Randell will conduct a randomized controlled trial to enable evaluation of eight feasibility constructs. The hypothesis is that HEART in the ED will be feasible as defined by primary outcomes of acceptability and efficacy to decrease ARV. The rationale is that this study will produce the first ED-based intervention to utilize universal education to comprehensively address ARV in conjunction with provision of point-of-care harm reduction resources. Study findings will inform the development of a larger hybrid efficacy- implementation study, supported by an R01 submission during the K23 award period. This training and research plan are consistent with the mission of the National Institutes of Health and the National Institute of Child Health and Human Development, the Healthy People 2020 objectives from the United States Department of Health and Human Services, and the 2009 Academic Emergency Medicine consensus recommendations for addressing public health problems in the ED setting.
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