By Blaire Bryant, MPH, NACCHO and Melanie Ruhe, MPH, NACCHO

February marks Teen Dating Violence Awareness Month. Teen Dating Violence (TDV) – the physical, sexual, psychological, or emotional violence within a dating relationship – is a serious matter that affects many teenagers. According to a 2011 Centers for Disease Control and Prevention (CDC) survey, 23% of females and 14% of males who experienced rape, physical violence, or stalking by an intimate partner, first experienced some form of partner violence between the ages of 11 and 17 years. The 2013 Youth Risk Behavior Surveillance System (YRBSS) survey found that approximately 10% of high school students reported physical victimization and 10% reported sexual victimization from a dating partner in the 12 months before they were surveyed. As teens (individuals aging from 13 to 19 years old) mature into adulthood, initial relationships are formative and shape expectations that persist throughout life. Unhealthy experiences can result in negative long- and short-term consequences, therefore it is essential to emphasize teen dating violence prevention early on.

Taking into account these alarming facts, advocates now join together every year to highlight TDV Awareness month in February. Many organizations such as loveisrespect.org, Break the Cycle, The Domestic Violence Awareness Project and the CDC provide TDV prevention resources for youth, families, communities, service providers, and healthcare professionals. They also provide support and referrals for victims of TDV. By bringing awareness to this issue, and equipping local public health agencies with tools and resources, we can decrease the prevalence of dating violence everywhere.

Dating Matters®: A Local Approach to Addressing Dating Violence
The CDC created the Dating Matters® (DM®) initiative to determine indicators related to violence utilizing school and neighborhood data from four major cities: Baltimore, MD; Chicago, IL; Fort Lauderdale, FL; and Oakland, CA. The program sought to educate youth and parents/caregivers on respectful, nonviolent relationships, using the CDC DM® curriculum, to decrease emotional, physical and sexual dating violence. Dating Matters® focused on early intervention strategies, adapting evidence-based prevention approaches for economically disadvantaged communities, and advertising the importance of preventing TDV. Additionally, as part of the initiative, CDC funded NACCHO to develop the Dating Matters® Guide to Informing Policy – a framework for evaluating TDV and TDV-related policies and synthesizing the information to inform policy – and the web-based Dating Matters® Tool.

Following the five-year program implementation period, the four sites participated in key informant interviews to discuss facilitators and barriers to program implementation. The following themes arose from the interviews as useful guidance for other local health departments:

• Partnerships (especially with schools) increase data availability, accessibility, and the sustainability of the initiative.
  With DM® being a collective initiative that includes preventative strategies around TDV for individuals, peers, families, schools and neighborhoods, it was important that test sites leveraged partnerships in every stage of implementation. In particular, school buy-in is vital: not only is it the easiest way to reach the target audience of the initiative (11-14 year old youth and their parents), it builds community capacity to educate youth on TDV as teachers are trained to facilitate the curriculum. In such instances, the partnership then becomes a mechanism for sustainability of the initiative, as was the case for the Oakland test site, which received funding to create an evidence-informed sex education curriculum that incorporates elements from the DM® initiative.

  In Baltimore, a unique partnership was forged between the city health department and the police department, which allowed them to share data that indicated the climate of violence in the community. This serves as a critical example of how these partnerships can be extremely beneficial in reinforcing the findings of public health interventions by providing a comprehensive look at key indicators. By partnering with local organizations such as hospitals, police departments, schools, and judicial systems, local health departments (LHDs) are able to access ‘exclusive’ data that enhance their program and intervention outcomes. To learn more about the benefits of data sharing, download this NACCHO publication.

• Adaptation is key.
  Although the essential elements of the DM® initiative were the same across the test sites, the implementation approach varied by location. While the Oakland, CA site relied heavily on school sites for facilitation, Baltimore, who had initial difficulty getting school buy-in and sustaining parent engagement due to childcare issues, took to a more youth driven approach. The city health department partnered with community organizations to recruit a bevy of youth ambassadors that engaged peers in activities and programs that advanced the aims of the initiative.

  With regards to program content, both sites stressed the importance of speaking within the context and climate of their respective communities to better engage the target audience, which is why the adaptation phase of the initiative is key to its success. Baltimore has a long history of successfully addressing violence amongst its youth through innovative public health programming and policy initiatives such as Safe Streets, which was adapted and laid the foundation for the teen dating violence prevention focus of the DM® initiative. In Oakland, the need for a trauma-informed curriculum drove the adaptation process, as a large number of students had identified themselves as being victims of TDV or other forms of violence at some point. Additionally, Oakland was faced with the difficult challenge of scaling the initiative to work around large school enrollment numbers.

• Use policy development and reformation as a means of sustainability.
  Not only did the sites create and sustain relationships with external organizations, they also were able to develop additional resources and policies surrounding TDV prevention as a means of sustaining the initiative. Using the evidence-based data from DM® and survey data from students and community organizations, schools in both California and Baltimore improved their sexual education policies to include TDV curriculum. Baltimore schools also changed their health and wellness policies and were able to attain five more years of funding for TDV awareness, a crucial step in sustaining the efforts of the DM® initiative.

Learn more about the Dating Matters® Initiatives in Oakland and Baltimore.

What’s to Come: TDV Indicator Resource & Webinar
NACCHO is currently collaborating with CDC to create a resource tool that hopes to further teen dating violence prevention through the identification and validation of community level indicators of teen dating violence. This tool will provide LHDs with the information and examples they need to effectively utilize publicly-available health indicator data at the community level, and then evaluate the by-proxy impact of their respective TDV prevention. Additionally, be on the lookout for a NACCHO webinar announcement surrounding this topic with more in-depth examples from Dating Matters® sites. The webinar will take a deep dive into Teen Dating Violence indicators and related data sources, as well as data sharing techniques, resources, and tools for Local Health Department TDV programs. The webinar is planned to be held in late March or early April. Please email Melanie Ruhe at [email protected] or Blaire Bryant at [email protected] for more information or questions.