Teen Dating Violence: Coordinated Adolescent Behavioral Health: The community feedback period for this idea began on 12/11/19 and ended on 2/9/20

What is the problem that needs to be addressed? Please describe how it is related to mental health.
Teen dating violence is a serious and prevalent problem, in fact, research has estimated that it occurs in one third of teen dating relationships. Dating violence has serious long-term and short-term effects and often intersects with substance abuse and behavioral health issues amongst teens. Dating violence may include acts of physical, psychological, and sexual violence. Youth who are victims of dating violence are more likely to experience symptoms of depression and anxiety, engage in unhealthy behaviors like the use of tobacco, alcohol and other drugs, and think about suicide. Teen victims of physical dating violence are more likely than their non-abused peers to smoke, use drugs, and engage in unhealthy diet behaviors (taking diet pills or laxatives and vomiting to lose weight). In the research study “Physical and Sexual Dating Violence and Nonmedical Use of Prescription Drugs” (Clayton HB, et al. Pediatrics. Nov. 20, 2017, https://doi.org/10.1542/peds.2017-2289), researchers found links between teen dating violence and nonmedical use of prescription drugs. Previous research has shown dating violence is associated with risky behaviors, but studies linking it to nonmedical use of prescription drugs have been limited. Roughly 16.8% of high school students have used prescription drugs to get high, according to the 2015 National Youth Risk Behavior Survey (YRBS). Roughly 21.4% of females and 9.6% of males reported experiencing dating violence in the past year. “It is likely that the association operates in both directions, as research has suggested that substance use behaviors may increase the risk for violence victimization, but also that youth who have been victimized may be more likely to engage in substance use behaviors,” authors wrote. They said the link between NMUPD and dating violence should be considered when screening teens and when undertaking local violence or substance use prevention efforts. This illustrates to need for service providers to better understand the connection between teen dating violence and behavioral health in order to improve health outcomes amongst teens.

In order to improve the behavioral health of teens in Orange County, we need to improve linkages between behavioral health providers and those providers that work in the teen violence prevention sector. Collectively we need to address the intersection of dating violence, substance abuse and mental health. At present, service providers working within these sectors are addressing the issues in silos, we need to collaborate to systematically address the intersection, for the chance of being successful with one issue is reduced if we don’t systematically address them all.

Why is this a concern for Orange County? What can Orange County and other counties learn from this project?
There are a myriad of human service and health care providers for the 220,000+ teens in OC, where 12% of residents live in poverty and 60% of the population are minorities, predominantly Hispanic and Asian. Yet services for teens are siloed and uncoordinated, leading to fragmented services, duplication of resources, inconsistent intimate partner screenings, and lack of awareness of teen dating violence; how such abuse impacts adolescents’ health, and how to access resources. All of these factors contribute to a less healthy teen population in OC, as evidenced by OC data on teens’ mental health and dating violence. 28% of 9th graders in OC report experiencing depression and 17% of 9th and 11th graders report suicidal ideations (Cal. Dept. of Public Health, “Adolescent Sexual and Reproductive Health, OC 2016”). According to a recent by study by Chapman University of 206 participants ages 18-21 who live in Orange County, and attended at least one year of high school in Orange County and had romantic relationships in their high school years (14-18), 69% reported experiencing some form of dating abuse while in high school (Miller-Day, M. PhD, Dorros, S., PhD. Teen Dating Violence in Orange County, CA. Chapman University School of Communications).

Orange County must do a better job of documenting and screening for the coexisting needs of teens, connecting them to existing mental health and intimate partner services as deemed appropriate. Ultimately, intimate partner violence, mental health, and substance abuse services should be integrated, teen-friendly, culturally competent, and accessible. As depicted in the Orange County Women’s Health Policy Brief: Domestic Violence, Mental Health and Substance Abuse (April 2017), the Orange County Health and Domestic Violence Task Force conducted a needs assessment to address the intersections and gaps and ultimately recommended cross-training providers about the intersection of domestic violence, mental health, and substance use/abuse; co-locating and coordinating these services; and preparing materials and checklists for first responders.

Orange County needs to engage in a collective impact approach to address the intersection of teen dating violence, mental health and substance abuse in order to develop recommended strategies for synchronized implementation and evaluation. The lessons learned and promising strategies can be shared with other counties at statewide convenings, presentations, and via white papers/web-based learning.

What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?
There is nothing currently being done in our county to address the intersection of these issues in a collaborative manner. Currently, behavioral health and teen dating violence amongst teens are being addressed independently. We need to conduct a landscape analysis to better understand the intersection, gaps and what can be done collectively to improve the health and well-being of teens in Orange County. It is not clear, as per a brief literature scan, that at present there is a recommended model to address these coexisting conditions on the national level.

What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.
Styled as a Collective Impact Model, the goal would be to create systems change, especially around building interconnectivity between service provider sectors in Orange County. A comprehensive planning process and needs assessment would be the first step. An inclusive planning process would engage a multitude of behavioral health providers, social service providers, nonprofits, universities/education systems and county agencies to develop a set of recommended strategic activities that can be implemented and evaluated to arrive at a promising replicable model. Strategies would be developed and implemented in a coordinated manner that support the integration of services in Orange County, rather than strategies that are implemented as a set of parallel activities. Approaches will support the leveraging of existing resources and focus on prevention and early intervention. A shared data collection system will be developed to measure outcomes and impact across the integrated system. Collaboration would be promoted to create a sustainable system at the community level to address the intersection of teen dating violence, mental health and substance abuse.

Supplementary Research:

Campbell, Jacquelyn C., et al. “Health Consequences of Intimate Partner Violence.” The Lancet, vol. 359, no. 9314, 2002, pp. 1331-1332, doi:10.1016/S0140-6736(02)08336-8.

Exner-Cortens D, Eckenrode J, Rothman E. Longitudinal associations between teen dating violence victimization and adverse health outcomes. Pediatrics 2013; 71:71-78.

Foshee VA, McNaughton Reyes HL, Gottfredson NC, Chang LY, Ennett ST. A longitudinal examination of psychological, behavioral, academic, and relationship consequences of dating abuse victimization among a primarily rural sample of adolescents. Journal of Adolescent Health 2013; 53:723-729.

Miller-Day, M. PhD, Dorros, S., PhD. Teen Dating Violence in Orange County, CA. Chapman University School of Communications. Prepared for Laura’s House. Hereinafter “TDV in OC.”

Roberts TA, Klein JD, Fisher S. Longitudinal effect of intimate partner abuse on high- risk behavior among adolescents. Archives of Pediatric Adolescent Medicine 2003; 157:875-881.

TDV in OC, citing Centers for Disease Control and Prevention. National Intimate Partner and Sexual Violence Survey (2010). Available at https://www.cdc.gov/violenceprevention/datasources/nisvs/summaryreports.html.

What is the project idea? Please describe how this project will operate.
A two-phased project approach would be implemented to promote teen behavioral health. Phase One–Planning will include a landscape analysis to: assess teens’ health needs around teen dating violence, mental health and substance abuse, the availability of services and barriers to address their needs, the training of care providers on teen dating violence, mental health and reproductive health, and the extent of coordination between behavioral health and other service providers for teens. Planning will enlist a collaborative process involving healthcare and social service providers, domestic violence agencies, teens, and other key stakeholders that serve teens to review the results of this landscape analysis and develop targeted strategies to strengthen data collection, analysis, and dissemination regarding teen health; train providers so they are better prepared to do effective and compassionate screenings for teen dating violence, mental health and substance abuse; promote teens’ seamless and confidential access to services; and build broader public awareness of the spectrum of intersecting teen health issues. The planning process will build on relationships and existing county initiatives to reduce duplication of efforts and leverage resources.

Phase Two–Implementation will include a coordinated collective approach to execute the recommended prioritized and integrated strategies developed in Phase One. Strategies may include cross training, a centralized teen friendly resource that is accessible for and appropriate for teens, and a public awareness campaign to improve awareness of resources and how teen dating violence impacts teens’ behavioral health. The recommendation would be to have a lead agency act as the Backbone that would subcontract with partner agencies to implement each of the strategies in a coordinated manner, creating a collective impact-styled initiative that would include a comprehensive evaluation process. Data would be shared to promote collaboration and break down siloes. It is anticipated that teen dating violence providers will partner with behavioral health providers to collaborate, refer, share resources and develop sustainable relationships.

Additional Information:
Respondent skipped this question


November 25, 2019


Thank you for your submission. The Innovation team will review this idea and post comments and updates when available.

This project is incredibly important and needed in Orange County, particularly within the framework of a collaborative effort. Though there are some organizations addressing Teen Dating Violence, some addressing sexual health, some addressing sexual assault, and some addressing mental health, there are few resources available for orchestrating a truly intersectional effort to address these epidemics that overlap, co-occur, and exacerbate each other. To address mental health, we must incorporate that which is causing so much distress for young people. An effort such as this can have far-reaching affects; bold strategies are needed to address the skyrocketing health disparities experienced across OC and California.

WTLC recognizes the urgent need for a collective response to the overwhelming gap in collaborative efforts in addressing the mental health and well-being of teens in Orange County. This project will provide the necessary lens to leverage resources and expertise in responding to this immediate crisis; as well as alleviate future generations from experiencing the negative behavioral health impacts of teen dating violence. WTLC fully supports this initiative that will generate strategic responses and create space for teens to live into their full potential.

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