Program Profile: School Health Center Healthy Adolescents Relationships Program (SHARP)

This is a high school-based, relationship abuse prevention program. The goal of the program was to identify students’ knowledge of abusive behaviors and teach them about relationship abuse and resources for its prevention. The program was rated Ineffective. There was no statistically significant impact on recognition, use, and knowledge of adolescent relationship abuse resources, and intentions to intervene, but participants had greater increases in recognition of sexual coercion.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

School Health Center Healthy Adolescents Relationships Program (SHARP) was a universal intervention that addressed adolescent relationship abuse (ARA) in high school settings. The aim of the program was to determine students’ knowledge about ARA and ARA resources, and to teach them about relationship abuse and the availability of ARA resources. 

Target Population

The program targeted high school students between the ages of 14 and 19 who visited the school health center (SHC). SHARP targeted all students, exclusive of gender, sexual orientation, and reason for clinic visit.

Program Components

The intervention was delivered during routine SHC visits. The intention of the program was to train students on the impact of ARA on their health. The intervention addressed a range of abusive behaviors including cyber-dating abuse and abuse through social media.

Providers were trained on introducing the information and materials, conducting an assessment, and making referrals to advocates. The staff engaged students in very brief discussions on healthy and unhealthy relationships, while going over a palm-sized brochure that they provided to each student, regardless of the reasons for the visits. The brochure, shared with every student, provided information on heathy relationships, ARA resources, and how to help friends. Discussions typically lasted less than a minute, but went longer when ARA was disclosed.

Youth advisory boards organized schoolwide outreach events that provided ARA information, and encouraged students to come to the SHCs.

Study

Miller and colleagues (2015) evaluated the School Health Center Healthy Adolescents Relationships Program (SHARP) program at 11 school health centers (SHCs) in the California School Based Health Alliance in Northern California. Schools were randomized into clusters, and the final sample comprised 7 clusters: 4 intervention schools and 3 control schools. The intervention was delivered to patients aged 14 to 19 years old in grades 9 through 12 seeking care in any of the SHCs of the participating schools. Although the survey was delivered in both English and Spanish, all students opted for English.

Participants were recruited between September and December 2011 (n = 1062), and follow-up surveys were completed 3 months postintervention in 2013. Upon their first visit to the SHC during the timeframe of the study, patients were informed about the study, screened if interested in participating, and (if eligible) escorted to a private area to give consent and participate in the study. A total of 1011 patients completed baseline surveys during their first visits to the SHCs. The pool included students of both genders (females = 771, males = 240), and the majority were in 12th grade (n = 326). Nearly all of the students identified as nonwhite (5 percent white), with no significant differences between intervention and controls by race/ethnicity. The full sample included students who were Asian (15 percent), African American (27 percent), Hispanic or Latina/Latino (36 percent), Native American or Pacific Islander (5 percent), white (5 percent), and multiracial/other (11 percent). Survey data was collected via computer with questions read through headphones. Follow-up surveys were given at the SHCs at times that were convenient for the participating students (n = 939).

Staff at the intervention schools were trained on the SHARP intervention process and required to report the time allocated for reviewing the brochure with the patients during their first SHC visits. Students at the control schools (n = 516) were provided the usual care received at the SHCs. In instances in which there was a disclosure of abuse, schools followed traditional protocol, including referring patients to advocacy services.

Existing and researcher-developed scales were used to assess recognition of adolescent relationship abuse (ARA), recognition of sexual coercion, intentions to intervene, and knowledge and use of ARA resources.

These sources were used in the development of the program profile: