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

青少年关系受害(ARV)，特征是身体、性、网络或心理虐待， 生殖胁迫或性剥削仍然非常普遍，尽管有证据表明-- 以学校和社区环境为基础的干预措施。负面结果，包括学业成绩不佳 成就、怀孕、性传播感染、饮食失调、自杀和杀人，导致 给个人和社会带来了巨大的代价。急诊科(ED)提供独特的机会 在高危青少年人群中促进健康的人际关系，减轻抗逆转录病毒的负面影响。 然而，当前基于ED的关系干预受到以下限制：1)基于披露的交付；2) 解决有限形式的虐待，3)有限的疗效，4)错过提供护理点的机会 减少危害资源。青少年人际关系的健康教育评估与应对 (心脏)干预可以通过1)普遍提供教育和咨询来解决这些关切， 2)全面解决抗逆转录病毒药物的问题。米勒博士(共同导师)之前的研究 证明了心脏对降低ARV的有效性。然而，心脏需要适应ED设置， 鉴于教育署与原定环境之间的重大背景差异，学校健康 中锋。兰德尔医生，儿科急救内科医生，也是这一职业发展的候选人 大奖，致力于以患者为中心的临床研究事业，有针对性地进行干预，促进健康 青春期的关系。她的五年职业发展计划包括结构化的指导和正式的 通过获得行为改变理论的专业知识来解决她在培训中的关键差距的教学方法， 青少年行为研究、实施科学和青少年研究伦理的临床试验。这个 建议的研究通过提供干预实践经验来补充其他培训活动 适应和随机对照试验。在确定心脏需要的增强措施之后 在ED环境下，兰德尔博士将进行一项随机对照试验，以评估八项可行性 构造。假设心脏在急诊室是可行的，如以下主要结果所定义 降低ARV的可接受性和有效性。理由是，这项研究将产生第一个以ED为基础的 采取干预措施，利用普及教育全面应对抗逆转录病毒病毒，同时提供 护理点减少伤害资源。研究结果将为开发更大的混合药效提供信息- 实施研究，由K23授权期内提交的R01支持。这项培训和 研究计划符合美国国立卫生研究院和美国国立卫生研究院的使命 儿童健康和人类发展，美国国务院制定的2020年健康人目标 卫生与公众服务部和2009年学术急诊医学共识建议 在教育部门解决公共卫生问题。

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.