Program Profile: Real Talk Dating Abuse Intervention

This program is a dating abuse intervention for youth, ages 15-19, which uses motivational interviewing with the goal of changing self-reported dating abuse perpetration. The program is rated No Effects. There were no statistically significant differences found between the intervention and control groups in any self-reported dating abuse perpetration, including physical, sexual, psychological, and cyber abuse, at the 6-month follow up.

A No Effects rating implies that implementing the program is unlikely to result in the intended outcome(s) and may result in a negative outcome(s).

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

Program Goals/Target Population

Real Talk is a dating abuse intervention program with the goal of changing participants’ self-reported dating abuse perpetration, including physical, sexual, psychological, and cyber abuse. The program is designed for youth of any gender or sexual orientation, ages 15–19.

Program Components/Key Personnel

The Real Talk intervention is one highly structured, 30–45-minute, manual-based, motivational interviewing-style, in-person session. The session is conducted by interventionists, who are trained, non-clinician local community members with prior experience in dating abuse education with youth (including social workers, nurses, patient navigators, child life specialists, or substance abuse treatment specialists).

The interventionists follow the 10 steps of Real Talk, which are 1) establishing rapport with the youth; 2) eliciting information about dating abuse perpetration; 3) providing individualized, tailored feedback; 4) assessing youth’s readiness to change; 5) discussing healthy relationship approaches; 6) thinking about the pros and cons of behavior change; 7) identifying barriers to that change; 8) re-assessing youth’s readiness to change; 9) making referrals to services; and 10) reaching out via telephone or email to program participants up to three times over the 6 weeks following the session to administer a “booster,” to remind participants about the intervention and how they can change behavior.

Program Theory

Real Talk is rooted in the theory of planned behavior, the stages of change model, and the theory of motivational interviewing (Ajzen 1991; Norcross et al. 2011; Rollnick and Miller 1995). The program design is based on previous research findings that showed that individuals with behavior problems are in one of the following five “stages of change:” 1) precontemplation, 2) contemplation, 3) action, 4) maintenance, and 5) relapse (Cohen et al. 2005; Prochaska and Diclemente 1983). Therefore, a “readiness to change” was incorporated as one of the 10 steps of Real Talk (Rothman and Wang 2016).

Further, the theory of planned behavior suggests that for individuals to change a behavior, they must first develop an intention to change based on believing there is a good reason to do so, that they are capable of making the change, and that other people will approve of them if they make the change, as reflected in Real Talk steps six and seven. The intervention was also scripted with a motivational interviewing style, which recognizes that successful behavior change counseling sessions must incorporate the interventionist relating with empathy and evoking “change talk” from the individual (Miller and Rose 2009).

Study

Rothman and colleagues (2019) conducted a two-arm randomized controlled trial of the Real Talk dating abuse intervention program in the outpatient department of a large, urban, Safety Net hospital in the Northeast. Patients were recruited for participation from the waiting room, and considered to be eligible if they had perpetrated more than one act of physical or sexual dating abuse in the preceding 3 months, based on a 23-item inventory; spoke English; had not been seeking health care because of dating or sexual assault victimization; and were medically stable. The total sample included 172 adolescents, ages 15–19, who were assigned to either the treatment (n = 81) or control (n = 91) conditions using permuted block randomization via index cards in sequenced envelopes that were opened by study staff after baseline assessments were completed. Those in the intervention group participated in one, 30–45-minute brief motivational interviewing-style intervention conducted by a trained non-clinician; and participants in the control condition were given a booklet about dating abuse perpetration and hotline numbers for domestic violence, sexual assault, runaways, and suicide.

The total study sample was 85 percent female. The sample was mostly Black (74 percent) and Hispanic (14 percent), with 2 percent white and 9 percent multiracial. The mean age of the intervention group was 17.7 years, and 17.6 years for the control group. There were no statistically significant differences between the groups on demographics at baseline, but those in the intervention group were more likely to report being in the “contemplation” stage of readiness to change their dating abuse behavior. Researchers considered additional baseline sociodemographic characteristics for the sample, including dating abuse victimization and substance use. Sixty-four percent of the intervention group reported dating abuse victimization (psychological, physical, or sexual), and 65 percent of the control group reported dating abuse victimization. Fifty-four percent of the intervention group reported use of alcohol, and 63 percent reported using marijuana. Fifty-seven percent of the control group reported use of alcohol, and 60 percent reported any marijuana use.

Dating abuse perpetration was assessed using a 23-item measure, which included subscales for physical, sexual, and psychological dating abuse (Goncy and Rothman 2019). Physical abuse was characterized as participants’ perpetration of at least one of 16 acts: 1) scratched, 2) slapped, 3) physically twisted another person’s arm, 4) slammed or held another against a wall, 5) kicked them, 6) bent their fingers, 7) bit them, 8) tried to choke them, 9) gave them an injury (or hurt them so that they needed medical attention), 10) threw something at them that hit them, 11) burned them,12) hit them with a fist, 13) hit them with something hard besides a fist, 14) beat them up, 15) assaulted them with a knife or gun, and 16) pushed, grabbed, or shoved them. Sexual dating abuse was characterized as participants forcing their partners to have sex or forcing them to do other sexual things that they did not want to do. Psychological abuse was assessed by four items: 1) threatened to kill them, 2) “said that I would die or kill myself if we broke up,” 3) spread nasty rumors about them, and 4) made them feel afraid. Cyber abuse was assessed by one question about breaking into another person’s email or cell phone.

Youth baseline outcomes were assessed immediately prior to the intervention via self-report paper-based surveys, and 3- and 6-month follow up data were collected through email surveys to participants, paper surveys at the participants’ location of choice (hospital, library), or over the telephone. To examine the effects of the intervention, researchers used generalized estimating equations log-binomial regression for longitudinal data, with an unstructured correlation matrix to model the relative risk of dating abuse perpetration at follow-up. Separate analyses were conducted for each type of dating abuse perpetration. Researchers fit a multiplicative interaction model, with an interaction term between study group and time, to estimate differential intervention effects on dating abuse perpetration at 3 and 6 months. Subgroup analyses were conducted to look at the effects of the program by gender.

This Real Talk intervention is administered in English. In the Rothman and colleagues (2019) study, interventionists were required to go through a standardized 20-hour training on didactic information about motivational interviewing and brief interventions, including at least three rounds of role playing the intervention with the principal investigator. The principal investigator also assessed the fidelity of 20 percent of the sessions by scoring audio recordings of intervention sessions, using a checklist that scored the intervention on introduction and assessment (15 points), detailed assessment (20 points), feedback (20 points), eliciting a change plan (15 points), strategies for addressing barriers (15 points), and reassessing readiness to change (15 points). The remaining 80 percent were assessed by a trained research assistant.

Additional information about the Real Talk intervention can be found on the Rothman Violence Prevention Research Lab website: http://sites.bu.edu/rothmanlab/real-talk/

Subgroup Analysis

Rothman and colleagues (2019) conducted subgroup analyses by gender. For males, the results showed that intervention group males had a statistically significant lower likelihood of perpetrating any dating abuse, compared with control group males, at the 6 month follow up. There were no statistically significant effects for males on any other forms of dating abuse perpetration. There were also no statistically significant differences between females in the intervention and control groups on any measure of dating abuse perpetration.

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

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Programs to Reduce Dating and Sexual Violence for Youth and Young Adults

This practice involves a range of prevention and intervention programs that are designed to address problems associated with dating violence for youth and young adults. The practice is rated Effective for reducing the perpetration of dating violence and improving dating violence knowledge and attitudes. The practice is rated No Effects for reducing dating and sexual violence victimization, reducing sexual violence perpetration, and for improving bystander behaviors.

Evidence Ratings for Outcomes

	Attitudes & Beliefs - Dating violence knowledge
	Attitudes & Beliefs - Dating violence attitudes
	Crime & Delinquency - Violent offenses
	Victimization - Bystander behavior and intentions
	Crime & Delinquency - Sex-related offenses
	Victimization - Sexual abuse/exploitation
	Victimization - Domestic/intimate partner/family violence

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?