1. Building Healthier Relationships Megan Waters Utah Department of Health

2. Defining Violence Teen Dating Violence o Physical o Emotional/Psychological o Verbal o Sexual o Stalking Sexual Violence o Unwanted, non-consensual sexual actions or words

3. Healthy Behaviors? Now that we’ve defined what unhealthy behaviors may look like in a relationship, what are some healthy ones?

4. Espelage et al., University of Illinois

5. What’s happening in Utah?

8. 78.7% of victims reported that their first sexual assault occurred before their 18 th birthday. (2007 Rape in Utah Survey) (higher than national numbers) What’s happening in Utah?

9. Warning Signs Checking cell phone or email without permission Constant put downs Extreme jealousy or insecurity Explosive temper Isolation from family/friends Making false accusations Mood swings Physically hurting partner in any way Possessiveness Telling partner what to do or wear Pressuring/forcing sexual activity

10. Health Outcomes http://oregonalliance.org/advocacy/you-and-yours/

11. Dating Violence Symptoms of depression & anxiety Thoughts of suicide Unhealthy risk behaviors – tobacco & drug use, alcohol Risky sexual behaviors Involvement in antisocial behaviors Unhealthy diet

12. Sexual Violence Physical Chronic pain; GI & gynecological complications; migraines/headaches; STIs; cervical cancer; genital injuries Psychologica l Shock; denial; fear; confusion; anxiety; withdrawal; guilt/shame; nervousness; distrust; PTSD (sleep problems, emotional); chronic psychological consequences (depression, anxiety, suicide); low self-esteem/self-blame; and diminished interest/avoidance of sex Social Strained relationships with family, friends, partners; less emotional support from family/friends; less frequent contact with friends/family; lower likelihood of marriage; isolation/ostracism from family or community Health Risk Behavior High-risk sexual behaviors (unprotected sex, early initiation, unhealthy partners, multiple partners, trading sex); using harmful substances (tobacco, drugs, alcohol); unhealthy diet- related behaviors (fasting, vomiting, diet pills, overeating); delinquency & criminal behavior; failure to engage in healthy behaviors (ex. seat belt use)

13. Intimate Partner Violence Physical Asthma Bladder/kidney infection Circulatory conditions Fibromyalgia Irritable bowel syndrome Chronic pain syndromes CNS disorders GI disorders Joint disease Migraines/headaches Reproductive Gynecological disorders Pelvic inflammatory disease Sexual dysfunction STIs Delayed prenatal care Preterm delivery Pregnancy difficulties, like low birth weight & perinatal death Unintended pregnancy Psychological Anxiety, depression, PTSD Antisocial behavior Suicidal behavior low self-esteem Distrust Fear of intimacy Emotional detachment Sleep disturbances Social Restricted access to services Strained relationships with health providers & employers Isolation from social networks Homelessness Health Behaviors High-risk sexual behavior – unprotected sex, decreased condom use, early initiation, choosing unhealthy and multiple sex partners, trading sex for food/money/etc Smoking cigarettes Drinking alcohol Drinking & driving Illicit drug use Unhealthy diet-related behaviors – fasting, vomiting, abusing diet pills, overeating Overuse of health services

14. Academic Consequences Witnessing violence associated with decrease in attendance and poor school performance 20% of students with mostly D and failing grades have engaged in dating violence in the last year o 6% of students with mostly A’s Nearly half of students who experienced dating violence reported some of the abuse took place on school grounds (U.S. Dept of Education)

15. Potential of Prevention! Quality of Life Health Costs

17. What is Primary Prevention?

18. Dr. Camara Phyllis Jones, http://www.vdh.virginia.gov/OMHHE/healthequity/documents/cliff-analogy.pdf

20. Principles of Effective Prevention 1.Comprehensive 2.Various methods of teaching 3.Sufficient dose & duration 4.Theory-driven & evidence-based 5.Positive relationship building and modeling 6.Developmentally appropriate, audience-specific, tailored 7.Socio-culturally relevant 8.Evaluation to ensure desired outcomes 9.Skilled trainers

23. Risk & Protective Factors

24. Belief that dating violence is acceptable Depression, anxiety, other trauma symptoms Aggression towards peers and other aggressive behavior Substance use Early sexual activity, having multiple sex partners Having a friend involved in dating violence Conflict with partner Witnessing or experiencing violence in the home RISK Family support /connectedness Connection to a caring adult Association with pro- social peers Connection/commit ment to school Skills in solving problems non- violently PROTECTIVE

25. Individual-Level Risk Factors

26. Relationship-Level Risk Factors

27. Community-Level Risk Factors

28. Societal-Level Risk Factors

29. Protective Factors

34. What’s working (so far)

35. Safe Dates – MS/HS o 10-session curriculum addressing attitudes, social norms, and healthy relationships skills; 45 minute student play; poster contest

36. Shifting Boundaries (building-level) – MS o policy and safety concerns, including hot spot mapping, staff monitoring, building-based restraining orders, poster campaign

37. What might work

38. Coaching Boys Into Men – HS o coach-delivered, norms-based; 11 brief discussions (10-15 min)

39. Bringing in the Bystander – College o Bystander education and training program IDENTIFY behaviors on a continuum of violence DEVELOP empathy for those who have experienced violence PRACTICE safe and appropriate intervention skills COMMIT to intervene before, during and after an incident of sexual abuse, relationship violence and stalking occurs

42. List of programs which no effect was found, a few with iatrogenic effects Awareness-based, low-dosage More research is needed What (probably) doesn’t work

43. Not Primary Prevention Victim-blaming Risk reduction Interventions and response services

44. What’s your role?

45. modeling

46. Promote and instill safe, healthy, respectful behaviors in your students

47. If you see something, say something

48. Intolerance for Violence

49. Building safety

50. Frequent interactions, identification of behaviors

51. Policy School policies o notalone.gov resources Title IX applies to you and your students o protects against all forms of sex discrimination, including based on gender identity or failure to conform to stereotypical notions of masculinity/femininity

54. Local Efforts RPE Funding from the CDC o 15 grantees around the state Box Elder Cache Ric h Weber Tooel e Salt Lake Morgan Summ it Daggett Utah Wasatch Duches ne Uintah Jua b Sanpete Carbon Emery Grand Millar d Piute Garfiel d Sevier Wayn e San Juan Iron Beav er Washington Kane Davis

56. Healthy Relationships Taskforce Collaborative Multi-disciplinary Cross-cutting

60. More … New – Funding appropriated by the Utah Legislature from Department of Workforce Services New – Prevention funding from Human Services for tribal communities In Development – Bystander Intervention Program

61. Resources Download the Healthy Relationships Toolkit: http://health.utah.gov/vipp/teens/dating- violence/resources.html http://health.utah.gov/vipp/teens/dating- violence/resources.html Purchase Safe Dates: http://www.hazelden.org/web/go/safedates http://www.hazelden.org/web/go/safedates

62. Resources National TDV Line : 1-866-331-9474 Utah Rape & Sexual Assault Crisis Line: 1-888-421-1100 Utah DV Link Line: 1-800-897-LINK loveisrespect.org vetoviolence.cdc.gov health.utah.gov/vipp notalone.gov

63. Questions?

64. Thank you! Megan Waters mewaters@utah.go v (801)538-6626