A Review of Parent- and Family-based Prevention Efforts for Adolescent Dating Violence

Abstract

Prevention efforts for adolescent dating violence (ADV) have largely focused on adolescent-based interventions with little emphasis on parent- and family-based interventions, despite the integral role parents serve in adolescent relationship development. This literature review provides an overview of the existing parent- and family-based intervention efforts for ADV. This review highlights that some programs are geared toward a universal audience, whereas others are more targeted towards populations believed to be at greater risk for ADV. Some programs primarily target parents, whereas others integrate parent-based components into primarily adolescent-focused or comprehensive programs. Aspects to consider when selecting a program are discussed, as well as future directions. Suggested future directions involve broadening existing parent- and family-based programming for ADV to include a focus on secondary and tertiary prevention, gender differences, and gender and sexual minorities. This review also highlights the need for existing programs to expand their evaluation of behavioral outcomes and comparison of programs to one another.

Adolescent dating violence (ADV) perpetration and victimization is a serious public health concern (Vagi et al., 2015). ADV involves a cluster of behaviors that occur within the context of a close or dating relationship that can inflict harm, pain, or injury (Centers for Disease Control and Prevention, 2012; Stonard et al., 2014). ADV varies in scope and is commonly broken into several subtypes or categories, namely physical, sexual, and psychological/emotional. More recently, researchers have also included cyber dating abuse into the category of abusive behaviors that occur within relationships.

In addition to concerns about its prevalence, ADV is concerning due to its association with a host of negative outcomes in adolescence that may continue into adulthood. For instance, ADV is linked with depression, substance use, poor self-esteem, poor school performance, truancy, suicide, pregnancy, and risky sexual behavior (Ackard & Neumark-Sztainer, 2002; Alleyne-Green et al., 2012; Banyard & Cross, 2008; Coker et al., 2000; Exner-Corten et al., 2013). Furthermore, adolescents who are involved in ADV are at risk for engagement in intimate partner violence in adulthood (Exner-Cortens et al., 2017; Gomez, 2010; Halpern et al., 2009). Given the prevalence of ADV and associated risk factors, considerable efforts have been made to prevent and reduce ADV.

These efforts have largely included adolescent-specific programs (De La Rue et al., 2017; Leen et al., 2013), which refer to programs that target individuals who are in the developmental stage between ages 10 and 19 (World Health Organization, 2020). Existing adolescent-based programs typically address common themes and targets. These targets include 1) providing psychoeducation about the features of healthy relationships; 2) increasing awareness and knowledge of ADV; 3) shifting attitudes toward traditional gender roles and acceptance of dating violence; and, occasionally, 4) improving healthy relationship skills and decreasing engagement in ADV (De La Rue et al., 2017; Leen et al., 2013). Most often they are delivered to adolescents in the school setting (De La Rue et al., 2017; Stanley et al., 2015). Some adolescent-specific programs for ADV are effective at increasing ADV knowledge and shifting attitudes toward gender or ADV (De La Rue et al., 2017; Fellmeth et al., 2013; Ting, 2009). However, there is little support for adolescent-based interventions fostering ADV behavioral change. There are a few exceptions, such as Safe Dates (Foshee et al., 1998; Foshee et al., 2005) and Fourth R (Wolfe et al., 2009), both of which include a focus on skill development and report evidence of ADV behavioral change following intervention (Foshee et al., 2005; Foshee & Langwick, 2010; Wolfe et al., 2009). Further review of adolescent-specific programs extends beyond the scope of this paper, as several comprehensive reviews currently exist (e.g., Cornelius & Resseguie, 2007; Crooks et al., 2019; De La Rue et al., 2017; Leen et al., 2013). Although some adolescent-based programs are effective and necessary, interventions that include parents are also important in reducing incidence of ADV. Yet, interventions that incorporate parents are less common. The present paper aims to critically review existing parent- and family-based programs for ADV.

1. Parent- and Family-based Prevention Programs

Parent- and family-based interventions for adolescent risk behaviors are critical opportunities for change. Although peers have a large impact on adolescent attitude formation and behavior, parents continue to have an influential role into adolescence (Burrus et al., 2012; Devore & Ginsburg, 2005; Grusec, 2011; Resnick et al., 1997; Steinberg & Silk, 2002). Given the role that parents serve in the development of adolescent risk behaviors, it is not surprising that parent- or family-based interventions have been effective in reducing adolescent engagement in these same risky behaviors (Burrus et al., 2012; Rowe, 2012). Adolescent risk behaviors that have been targeted by parent- or family-based interventions include aggression and violence (e.g., Henggeler et al., 2009), substance use (e.g., Henggeler et al., 2002; Koning et al., 2014; Lee & Goddard, 2005; Spoth et al., 2001), sexual risk behavior (e.g., Brown et al., 2014; Dinaj-Koci et al., 2015; Long et al., 2004), suicidal behavior (e.g., Hooven et al., 2010), weight management (e.g., Jelalian et al., 2014), and driving (e.g., Peek-Asa et al., 2014), among others. Despite some variation, these parent- or family-based programs tend to focus on related concepts, including parent knowledge or education of risk behavior, positive parent-child relationships, communication skills, and monitoring or supervision (Lightfoot, 2012). Less common, but occasional, components include parental teaching or modeling of preferred behavior or skills, such as in an intervention targeting HIV risk behavior (Dancy et al., 2006) and driving (Peek-Asa et al., 2014). Notably, there is some indication that programs that include parents are more efficacious than those addressing adolescents in isolation or treatment as usual (Baldwin et al., 2012; Carr, 2019; Esposito-Smythers et al., 2017; Vidal & Connell, 2019). Yet, despite the clear benefits of parent- and family-based programming for other adolescent risk behaviors, to date such programming for ADV has been limited.

2. Family-of-Origin and Adolescent Dating Violence

Parent- and family-based programming around ADV is likely to be especially salient given the established links between parent-child relationships and romantic relationship development. Indeed, parents have been shown to serve an integral role in their child’s dating relationships (Foshee et al., 2012). For one, according to social learning theory, children learn ways of interacting with others in close relationships by observing and mirroring the attitudes and behaviors of others, especially their parents (Bandura, 1986; Bandura, 1977). Relatedly, children who are exposed to violence by parents learn scripts for such behaviors and may mimic violence in their own close relationships (Black et al., 2010; Franklin & Kercher, 2012; Kwong, 2003). It has been further theorized that the intergenerational transmission of violence is fostered through belief systems, such that children who witness or experience parent-to-child or parent-to-parent violence view these behaviors as appropriate or normative ways to resolve conflicts or treat others in close relationships (Dardis et al., 2015; Lewis & Fremouw, 2001).

Consistent with the focus of existing parent- and family-based prevention programming for adolescent risk behaviors (Lightfoot, 2012), parental attitudes, parent-child relationship quality, parent-child communication, and parental monitoring have also been linked to ADV (Giordano et al., 2016; Lavoie et al., 2002; Leadbeater et al., 2008; Mumford et al., 2016). For example, ADV perpetration is positively correlated with parent support of aggression and negatively correlated with support for nonaggression (Garthe et al., 2018; Miller et al., 2009). Additionally, positive bonds and communication between parents and adolescents are associated with lower risk for ADV (Howard et al., 2005; Kast et al., 2016; Maas et al., 2010; Ombayo et al., 2019; Yan et al., 2010), such that adolescents report being more likely to talk about dating concerns with their parent if they have a history of a close, trusting relationship with their parent and open communication (Shaffer et al., 2018). Comparatively, parents who utilize negative communication tactics (e.g., criticism, shouting) with greater frequency are more likely to have children with higher rates of ADV (Giordano et al., 2016). Low parental monitoring has also been cited as a risk factor for ADV perpetration among adolescents (Esplelage et al., 2020; Lavoie et al. 2002; Schnurr & Lohman, 2013). Finally, parenting styles characterized by support of violence in response to conflict, poor family relationships, and low levels of parental monitoring are linked to greater risk of ADV involvement among adolescents compared to more positive parenting styles (Garthe et al., 2019). Based on this data, parent- and family-based interventions appear to be important avenues to reduce risk for ADV.

3. Review of Existing Parent-based Adolescent Dating Violence Prevention Efforts

This paper sought to review existing parent- and family-based programs for ADV. To do so, literature searches were conducted using PsycINFO, PsycARTICLES, PubMed, Academic Search Premier, and ERIC. To identify literature and programs beyond these databases, Google and Google Scholar were also searched. When available, program websites or health organization websites were also reviewed to gather additional details about relevant programs. Identified programs were included in this review if they targeted ADV and included a component or focus for parents or families. It is important to note that this review includes little access beyond publications and publicly available resources to review the programs (e.g., the specific curriculums and materials of each program were not reviewed as part of this paper).

As all the programs included in this review paper are best described as primary prevention (i.e., intended to prevent onset of ADV among adolescents for whom ADV has yet to occur) (Kerig et al., 2010), the programs have been grouped by either universal or targeted focus. Universal focus refers to programs that are geared toward any adolescent, parent, or family, regardless of risk (Shorey et al., 2012). By contrast, targeted programs refer to those that are designed to serve populations who are believed to be at greater risk. Populations may be believed to be at greater risk based on factors such as, but not limited to, demographics or prior experiences. Next, we also examined differences by degree of parental involvement, sorting by whether the program is adolescent-based with a parent component, parent- or family-based, or comprehensive. “Adolescent-based programs with a Parent component” include programs that are primarily delivered to the adolescent yet also include some parent integration. “Parent- or family-based programs” refer to programs in which the primary recipients of the intervention are parents or parent-adolescent dyads. Lastly, “Comprehensive programs” refer to those that are simultaneously offered to multiple systems within adolescents’ ecological framework to prevent ADV. As such, these programs may include separate programming for the adolescent, the family system, the educational system, and the community (Miller et al., 2015; Tharp et al., 2011; Tharp, 2012).

3.1. Universal Focus

3.1.1. Adolescent-based Programs with a Parent Component.

To date, two adolescent-based programs exist that also incorporate a parent component. These programs are Fourth R and Safe Dates. Fourth R is school-based and delivered by school personnel in health classes. The core program is intended for 9th grade students, although extension versions of the program are available for other age groups. The adolescent-focused portion of the program includes 21 skills-based sessions with an objective to promote healthy relationships and prevent relationship violence, sexual risk behavior, and substance use. The curriculum includes a skills component utilizing role-plays to enhance conflict resolution and communication skills. Additionally, Fourth R incorporates a community-based component consisting of outreach to school staff, teachers, and parents, as well as student-led committees to enhance connections with community partners (Crooks et al., 2008). The Fourth R program’s parent component consists of four newsletters sent to parents. The newsletters provide psychoeducation on adolescent development, healthy relationships, online risk behavior, sexual health, and substance use. This content is provided in a manner to highlight what their adolescent is learning at school in the Fourth R program, as well as to provide general parenting strategies (e.g., communication starters tips for these topics). Parents of 9^th graders also attend an orientation session (Crooks et al., 2008; Wolfe et al., 2009). Evaluation of Fourth R reveals lower rates of physical ADV, greater use of condoms, and greater skill acquisition (e.g., skills to negotiate and resist peer pressure) at 2-year follow-up compared to adolescents from schools that did not implement the intervention (Crooks et al., 2008; Wolfe et al., 2009; 2012). Of note, the former two outcomes were only evident among boys (Wolfe et al., 2009) and the unique contribution of the parent component was not considered in these analyses.

Similar to Fourth R, the Safe Dates program is school-based and initially intended for younger adolescents (i.e., 8th and 9th grade students) (Foshee et al., 1996; 2000). The program has been widely distributed and used with a diverse sample of adolescents (Foshee et al., 2014). Safe Dates includes ten 45-minute sessions delivered to students by school personnel. The stated goals of the program are to raise awareness of healthy and unhealthy relationships, increase knowledge of ADV and its causes and consequences, and enhance student skills for managing abusive relationships and helping peers (Foshee & Langwick, 2010). Skills components included in the program include positive communication, anger management, and conflict resolutions (Foshee & Langwick, 2010). In addition to the curriculum-based content, the program also includes a 45-minute theatre production about ADV and a poster contest for students. The parent component of Safe Dates includes a letter to inform parents about the Safe Dates program and content covered, as well as an educational newsletter (Foshee & Langwick, 2010). Delivery of Safe Dates in the school setting combined with community supports was compared to a control condition, in which only community-based supports were offered (e.g., crisis lines, support groups, parent materials). Evaluations of Safe Dates reveal longitudinal reductions in adolescent psychological, physical, and sexual ADV perpetration, as well as moderate physical and sexual victimization (Foshee et al., 1998; 2005). The program was also successful in shifting attitudes toward ADV and gender norms, as well as increasing awareness of community services available when compared to controls (Foshee et al., 1998; 2000; 2005). The unique contribution of the parent component of Safe Dates has not been assessed.

3.1.2. Parent- or Family-based Programs.

Expanding beyond adolescent-based programs with a parent component, several parent- or family-based programs have been developed to address ADV. Families for Safe Dates is primary prevention focused, such that it is designed to serve all families, regardless of level of risk or dating history. Families for Safe Dates is intended for families with early- and mid- adolescents (i.e., 15 and younger) and is designed to be conducted in families’ homes. The structure of the program is self-administered through the delivery of six individual pamphlets mailed to families’ homes. Aside from one module of the program, the program is to be completed with parents and the adolescent together. The creators of the program set out to reduce ADV through two main objectives: 1) reduce risk factors for ADV and 2) enhance caregiver motivation and engagement in preventing ADV in their child’s life (Foshee et al., 2012). The risk factors targeted by the intervention include: adolescent and caregiver acceptance of ADV, adolescent perception of negative consequences associated with ADV, adolescent conflict resolution skills, awareness of ADV, prevention of ADV, and caregiver establishment of rules and monitoring. Caregiver motivation and engagement in ADV prevention is targeted via modules on caregiver beliefs, awareness, acceptance about ADV, and parental involvement in ADV prevention. The program also includes content on caregiver communication skills (Foshee et al., 2012).

The Families for Safe Dates program has several strengths. The program eliminates many barriers to family- or parent-based interventions, namely coordinating schedules of parents to attend the program at out-of-the-home locations and paying for trained staff to facilitate the program (Foshee et al., 2012). Outcomes based upon a randomized controlled trial (RCT) revealed that caregivers enrolled in the program increased their perception of the severity of ADV, knowledge of ADV, belief in the importance of involvement in their adolescent’s dating, and self-efficacy of talking with their child about ADV and preventing ADV when compared to controls who did not enroll in the program. Findings also revealed a decrease in adolescent and caregiver acceptance of ADV and parent negative communication with their adolescent. Notably, the decrease in negative communication was only evident based on caregiver report, not adolescent report. Similarly, caregiver belief about the importance of involvement in their child’s dating was only evident for caregivers of males (Foshee et al., 2012). Despite these strengths, the program did not lead to changes in adolescents’ perception of negative consequences from ADV, adolescent conflict resolution skills, or caregiver rule setting and monitoring (Foshee et al., 2012). Furthermore, the program’s objectives and assessment of outcomes do not include changes in adolescent dating behavior, nor ADV specifically. Notably, among the adolescents included in the RCT, only about half of the sample endorsed ever being in a relationship. Additionally, few endorsed history of ADV perpetration or victimization (Foshee et al., 2012). As such, further evaluation of the efficacy of Families for Safe Dates is needed, especially among families for whom adolescent dating and ADV is more relevant.

Project STRONG is a web-based intervention designed for middle school boys and their caregiver to reduce ADV risk. Project STRONG is comprised of six modules completed in four sessions, each about 30 minutes in length. However, the first module of the program is shorter and completed by parents only. This session is intended to enhance parent engagement, efficacy, and perceived value of the program. The subsequent five modules are completed with the adolescent and parent together (Rizzo et al., 2020). Primary targets of Project STRONG include relationship health, emotion regulation, and communication. These concepts are addressed in the form of a space-themed game in which the planet is filled with violent dating relationships. Parent-adolescent dyads complete a series of activities across the modules to strengthen skills and “combat” relationship violence (Rizzo et al., 2020). Due to the web-based nature of the program, dyads are able to access the intervention from their homes or wherever they access internet.

Evaluation of Project STRONG indicated that adolescents in the intervention condition exhibited fewer incidents of ADV perpetration and victimization at nine-month follow-up compared to a waitlist control group, with more pronounced benefits among those who endorsed dating at baseline (Rizzo et al., 2020). Changes in attitudes were also exhibited among parents in the intervention condition at both three- and nine-month follow-up, such that parents who were randomized to the intervention endorsed less favorable attitudes toward ADV compared to parents in the waitlist control condition. No changes in adolescent attitudes were noted. Finally, adolescents in the intervention condition endorsed positive changes in emotion regulation skills at follow-up compared to adolescents in the control condition. At three-month follow-up, parent-adolescent dyads who completed STRONG endorsed discussion of a greater number of dating- and sex-related topics within the dyad compared to dyads in the control condition (Rizzo et al., 2020).

3.1.3. Comprehensive Programs.

The Start Strong: Building Healthy Teen Relationships initiative incorporates a comprehensive approach to ADV prevention. The goals of the Start Strong program include building knowledge among adolescents both in and out of school, educating parents, teachers, and other community stakeholders, influencing policy change, and implementing marketing and social outreach (Miller et al., 2015). Start Strong is specifically geared toward middle school adolescents. The initiative builds upon the success of Safe Dates and Fourth R, two teen-based ADV prevention programs delivered in school settings (Crooks et al., 2008; Foshee et al., 1996), by offering either of these programs to adolescents in the school system. Other components include engaging high school students to serve as ambassadors for younger adolescents and utilizing Facebook to transmit messages about healthy relationships (Miller et al., 2015). The parent component of the Start Strong initiative is designed for parents of middle school students and consists of a single-session parent workshop. The workshop content covers awareness of common adolescent online behavior, adolescent dating, and ADV. Skill content in the workshop entails comfort discussing issues with their adolescent and modeling appropriate online and interpersonal behavior. Start Strong’s website also offers handouts and informational readings about adolescent online and dating behavior (Futures Without Violence, 2018). Evaluation of the Start Strong initiative is promising, however evaluation includes all aspects of the program, including adolescent involvement in either Safe Dates or Fourth R and the community outreach component, and does not uniquely evaluate the efficacy of the parent-focused tools. For the initiative as a whole, short- and long-term outcomes include reductions in favorable attitudes toward violence and gender role stereotypes among those who participated in the initiative compared to those who did not. Notably, behavioral differences in ADV perpetration or victimization were not found (Miller et al., 2015; RTI International, 2013).

3.2. Targeted Focus

3.2.1. Adolescent-based Programs with Parent Component.

None of the existing adolescent-based programs that include a parent component meet the targeted focus criteria.

3.2.2. Parent- or Family-based Programs.

Teach One Reach One is another family-based program with a focus on improving healthy relationships and sexual health among adolescents. Program creators used a community-based participatory research approach and intervention mapping to create the intervention. The Teach One Reach One program was designed for African American families with early adolescents (i.e., age 14 and below) who live in rural areas (Ritchwood et al., 2015; 2017). The program focuses on African American and rural families based on the theoretical rationale that these demographic factors increase risk for unhealthy relationships (Ritchwood et al., 2015; 2017). The program includes 12 90-minute sessions conducted by a program instructor; parent and adolescents engage in these sessions separately but integrate during the final 30 minutes of each session. Once parents and adolescents join together for the end of session, the remaining session time is focused on processing and practicing newly acquired skills. The sessions are designed to be different for parents and adolescents but to cover related content. The parent aspect addresses parental monitoring and communication, whereas the adolescent component addresses behavioral (age of sexual debut, condom use, dating practices, relationship dynamics), social (parental influence, sexual norms, social networks), and environmental (recreational facilities, access to alcohol/drugs) factors (Ritchwood et al., 2015). An interesting feature of this program includes its incorporation of training dyads who participate in the intervention (referred to as “Ambassadors”) to teach other parent-adolescent dyads (referred to as “Allies”) the content from the program (Ritchwood et al., 2015).

Evaluation of the Teach One Reach One program at a 9-month follow-up assessment revealed that adolescents who participated in the program (i.e., “Ambassadors”) had significantly lower rates of acceptance of couple violence after participating in the program compared to baseline, whereas both Ambassadors and adolescents who were taught program content from Ambassadors (i.e., “Allies”) had higher rates of self-efficacy for avoiding an abusive relationship compared to baseline (Ritchwood et al., 2015). Parents enrolled in the intervention also improved their self-reported frequency of general communication and communication of sensitive topics between caregivers and adolescents. When compared to a control group of participants who did not participate in the Teach One Reach One program, parents in the intervention condition also increased their self-efficacy surrounding these topics; however, no differences were found between groups with regard to knowledge or attitudes about sex communication (Ritchwood et al., 2017). More specifically, parents did not shift their beliefs about the importance of using appropriate body language, actively listening, avoiding judgments, or utilizing effective communication techniques when talking with their child about sensitive topics. Notably, the authors did not assess behavior change and as such it is unknown whether Teach One Reach One contributes to reduced adolescent engagement in sexual risk behavior or ADV (Ritchwood et al., 2017). Similarly, no findings to date have been published on adolescent report of communication outcomes following participation in the program.

An adaptation of Families for Safe Dates, Moms and Teens for Safe Dates, was also created (Foshee et al., 2015). Moms and Teens for Safe Dates is intended to serve caregivers and adolescents who have been exposed to domestic violence. Similar to Families for Safe Dates, this adapted program includes six pamphlet-based modules to be self-administered in the home. The program is also geared toward families with younger adolescents. The objectives of the program are largely similar, including 1) reducing risk factors for ADV and 2) increase caregiver motivation and engagement in ADV prevention for their adolescent. An additional area of focus was included for the second objective, namely to improve family closeness and cohesion. This addition, as well as other adaptions to the original program, were based on feedback during focus groups from families with prior domestic violence exposure. Changes included an increased focus on gender stereotyping, recognition of psychological abuse, adolescent management of anger, and caregiver rule setting and monitoring. The program also decreased a focus on parent and adolescent communication surrounding contentious topics (Foshee et al., 2015). These changes were intended to better serve the needs of families with exposure to domestic violence.

The Moms and Teens for Safe Dates program was evaluated via an RCT comparing adolescents with domestic violence exposure enrolled in the intervention to a control group who did not receive the intervention. Outcomes include a reduction in victimization of psychological and physical ADV and in perpetration of psychological and cyber abuse among adolescents. However, these reductions were only seen for adolescents with the highest degree of exposure to domestic violence. Reductions were not found among those with average to low exposure (Foshee et al., 2015). The Moms and Teens for Safe Dates program also increased mother perception of ADV severity, mother self-efficacy for ADV prevention, mother comfort communicating with their adolescent, mother monitoring of adolescent, and adolescent conflict resolution skills. Similar to the pattern seen for ADV specifically, each of these factors were only improved among families for whom the adolescent was exposed to high rates of domestic violence (Foshee et al., 2015). Regardless of the degree of domestic violence exposure, Moms and Teens for Safe Dates decreased mothers’ perceived susceptibility of their adolescent’s ADV, which was contrary to expectations. The program also increased adolescent report of family closeness and cohesion and decreased adolescent acceptance of ADV (Foshee et al., 2015).

3.2.3. Comprehensive Programs.

The Dating Matters: Strategies to Promote Healthy Teen Relationships initiative, launched by the Centers for Disease Control and Prevention is another comprehensive prevention program. Dating Matters was designed for high-risk, urban communities and younger adolescents (i.e., between ages 11 and 14).. The Dating Matters program includes components for adolescents, peers, parents, schools, communities, and technology/social media. Although the initiative is geared toward those deemed at high risk for ADV involvement, the initiative is delivered in middle school regardless of onset of dating or ADV and is intended as a primary prevention program (Tharp et al., 2011; Tharp, 2012). Similar to the Start Strong initiative, Dating Matters utilizes existing programming. Specifically, the adolescent curriculum component delivers the Safe Dates program to 8^th grade students. A separate curriculum developed by CDC is delivered to 6^th and 7^th grade students, which includes additional content, such as social media use and risk factors associated with ADV. An online, interactive educator training component is also offered, as well as a parent component, the content of which varies based on the adolescents’ grade level (Tharp et al., 2011; Tharp, 2012).

Within the parent-focused components, three variations are offered (Tharp et al., 2011). For parents of 6th grade students, parents are offered Parents Matter!, which is an adapted curriculum of an existing, group-based program by the same name. The original Parents Matter! program is designed for African American families to delay the onset of adolescent sexual activity and reduce sexual risk behavior (Long et al., 2004), whereas the adapted program incorporates additional information on healthy relationships and ADV. Content includes positive parenting strategies for effective communication on relationships and sexual behavior. Parents of 8^th grade students are offered the Families for Safe Dates program, which is described above. Parents of 7^th graders are offered a hybrid of the 6^th and 8^th grade parent-focused components, which includes three in-person sessions and three home-based sessions. The 7^th grade content covers positive parenting skills (e.g., monitoring), open communication, and conflict resolution strategies (Tharp et al., 2011). Similar to the Start Strong program, evaluation of the Dating Matters program includes all components of the program, such that the individual benefit of the parent component is not known. However, results of a recent RCT indicated that adolescents who participated in the Dating Matters program reported lower ADV perpetration and victimization and fewer negative conflict resolution strategies than adolescents who participated in only the Safe Dates program (Niolon et al., 2019).

4. Summary

In sum, a variety of programs have been created to date that either incorporate or focus on parents to promote healthy adolescent relationships and reduce risk of ADV. Through review of these programs, there appear to be four major areas to consider when parents, schools, practitioners, or community providers are choosing a program. The first is the population served. Notably, all of the programs reviewed serve adolescents or parents of adolescents in middle school or 9^th grade. However, some programs were universally focused (e.g., Safe Dates, Families for Safe Dates, Project STRONG), such that the program could be offered to any adolescent and/or parent. Others were targeted toward specific populations believed to be at greater risk for ADV, such as for families from urban (i.e., Dating Matters) or rural communities (i.e., Teach One Reach One), or for families who have been exposed to parental domestic violence (i.e., Moms and Teens for Safe Dates). Secondly, the content and amount of content delivered are important to consider. The content across programs is largely similar, which includes psychoeducation about healthy relationships and ADV, attitudes or social norms about dating and ADV, communication, and parental monitoring. This is consistent with prior parent- and family-based programs targeting adolescent risk behavior (e.g., Kuntsche & Kutntsche, 2016; Lightfoot, 2012). Several programs also included aspects about sexuality and sexual risk prevention and one included specific content about substance use. With the exception of communication skills, skills-based knowledge was less commonly integrated. However, one program included emotion regulation strategies and two included conflict resolution techniques. With regard to amount of content offered to parents, some were sparse (e.g., a single workshop in conjunction with online resources) compared to in-depth (e.g., multiple sessions spanning three years). Despite overarching similarities with regard to content, the programs vastly differ in the mode of intervention delivery, the third area to consider. Program modalities included newsletters, self-directed home-based pamphlets, web-based interactive games, and instructor-led, in-person groups. Furthermore, some programs and resources were designed for parents to access individually, whereas others were intended for parents and adolescents to engage together.

The final consideration to make with regard to program selection includes intervention outcomes. The most common outcomes included changes in awareness and attitudes toward ADV, as well as enhanced self-efficacy to talk about ADV. Notably, only a select few programs showed a reduction in ADV involvement compared to either a control condition or baseline report. Similarly, few programs reported changes in skills acquisition. Furthermore, the adolescent-based and comprehensive parent- or family-based programs did not specifically assess the role of the parent-based component separately. The limited evidence of behavior- and skill-based outcomes, as well as the benefit of parent inclusion, should be carefully considered when selecting a program. Programs that have shown success with such outcomes may be favorable. Alternatively, one should consider evaluating short- and long-term program outcomes, especially ADV involvement and the unique contribution of parent involvement.

Future work in this area should further pursue the mechanisms of change for these programs, such as the content and mode of delivery. As the content areas covered in the programs are largely similar, future studies should consider the unique contributions of each topic on healthy relationships and ADV. Specifically, it is relevant to know whether adding skills-based content for parents, such as conflict resolution and emotion regulation, enhance outcomes beyond those seen for adolescent-only interventions. The additive benefit of motivational enhancement sessions, such as is included in Families for Safe Dates and Project STRONG, should also be assessed. Relatedly, more work is needed to better understand how particular modes of intervention (e.g., in-person vs. web-based; individual vs. group; parent vs. parent-adolescent dyads) and dosage influence the acquisition of information and skills. Among parent- or family-based programs for substance use, program intensity (i.e., the amount of intervention provided) was linked with greater effectiveness compared to less intense programs (Kuntsche & Kuntsche, 2016). However, due to ongoing challenges with time and resources to implement time-intensive programs, future studies would benefit from assessing appropriate intensity levels for optimal effects. Similarly, the adaptions or variations to in-person programming (e.g., web-based) should be considered and assessed, as they may be particularly important to enhance accessibility for underserved or high stress populations.

5. Limitations

Despite their significance and success, these programs have limitations. Few of the existing studies assessed program behavioral outcomes, namely ADV behaviors themselves. Even though outcomes included changes in attitudes and communication behaviors, these improvements may not be sufficient to foster behavioral changes (Shorey et al., 2008; 2012). Indeed, evidence suggests that without the inclusion of skills, prevention programs are unlikely to foster behavior change (Cornelius & Resseguie, 2007). One necessary feature of evaluating behavioral change may be the inclusion of long-term follow-ups, including tracking adolescents into high school when dating violence behaviors are known to increase (Stonard et al., 2014). Further, the literature is limited by a lack of comparison between existing programs. Instead, programs tend to be compared to controls or treatment as usual. Such comparisons limit the ability of others to determine whether new or adapted programs are, in fact, more effective than existing options to inform program selection. Thus, further comparison of programs to one another and across various populations would be beneficial, as it may provide insight into when, and for whom, modes of intervention delivery and content topics are most effective.

Lastly, another limitation of the existing programs is that they all target adolescents regardless of whether the adolescent has begun dating or endorsed ADV. In many of the studies, either little is reported on how many adolescents have started dating or few participants endorsed dating histories. Although prevention programming often targets problem behavior before it starts, it is ultimately unclear whether the existing programs are effective only for adolescents who have yet to begin dating or whether program benefits extend to adolescents who have begun dating. Indeed, some evidence suggests that programs work differentially for those with dating experience (e.g., Rizzo et al., 2020). Moreover, although primary prevention programs for ADV are essential, secondary and tertiary prevention programs are also necessary. Overall, the limitations of the parent- and family-based programs closely mirror the limitations of the youth-based programs, such that the latter similarly place an overemphasis on attitudinal outcomes, are plagued by short-term follow-ups, and struggle with measurement consensus across studies (Shorey, et al., 2012).

6. Future Directions

6.1. Secondary and Tertiary Prevention

As suggested above, it is likely necessary to expand upon the primary prevention focus of the existing resources and supports available to parents and families to include secondary or tertiary prevention. Although primary prevention programs are crucial, secondary and tertiary programs are needed for parents and families for whom risk factors or ADV are present. Indeed, one could expect that the tools needed to intervene upon existing violence are greater than those needed to prevent violence. Similar to primary prevention programs, parents of affected adolescents are likely to benefit from psychoeducation, communication skills, and parent training; however, this content is unlikely to be sufficient. Existing programs lack comprehensive skill practice and parent coaching to facilitate skill use and address barriers. Parents engaged in secondary or tertiary prevention programming are also likely to benefit from affect and stress management skills to regulate their own response to having an adolescent at risk for or involved in violence. Furthermore, parents may benefit from enhanced psychoeducation, such as discussion of the intergenerational transmission of violence, adolescent experiences and attitudes about ADV and help-seeking, state and federal laws and regulations pertaining to ADV, and where and how to access local and national services for their adolescent.

Similar to their parents, when considering adolescents who are already at risk or involved in an abusive relationship, it is plausible their needs will be greater than those who are just starting to navigate romantic relationships. For instance, these adolescents may be further entrenched in behavioral patterns that take time to shift. They may also be coping with emotional reactions to the ADV, or other factors that place them at higher risk of ADV involvement, and thus in need of trauma-informed responses from their parents. This information is not covered in the existing programs for ADV. As such, a more intensive, skills-based program should be considered for families with ADV histories. This is consistent with prior research conducted on other parent-based prevention programs, such that more intensive programs were required for parents of adolescents identified as high-risk (Kuntsche & Kuntsche, 2016).

6.2. Gender Differences

Parent- and family-based prevention programming for ADV may be wise to consider gender-specific programs for parents of adolescent males and females. Among adolescent-focused ADV prevention programs, the majority are geared toward all adolescents. However, there are a select few that are gender-specific, such as Coaching Boys into Men (Miller et al., 2012), WiseGuyz (Claussen, 2017), and Date SMART (Rizzo et al., 2018). Gender-specific programming addresses unique, gender-based factors that are thought to contribute to ADV risk and differing trajectories. Indeed, boys more often engage in perpetration of sexualized aggression and controlling behaviors compared to females, who perpetrate physical and emotional aggression at greater rates (Hokoda et al., 2012; McNaughton Reyes et al., 2019; Wincentak et al., 2017). With regard to gender differences and parent-adolescent relationships, there are additional considerations that may warrant gender-specific programming. For instance, when talking with their adolescent, parents exhibit preferences toward teaching sons about violence perpetration and daughters about violence victimization, rather than the risks for both (Insetta et al., 2015). Relatedly, parents tend to portray ADV as an act primarily perpetrated by men instead of addressing its highly bi-directional nature (Akers et al., 2011). Moreover, parental monitoring has also been shown to be particularly beneficial for males compared to females in protecting against ADV (Foshee et al., 2001). Males and females also differ in their help- or support-seeking preferences and tendencies, which may have implications for parent-based programming. For instance, females are more likely than males to seek help from both formal and informal supports for ADV (Bundock et al., 2020; Lachman et al., 2019). This may be due to societal influences discouraging males from expressing emotions or support from others, or from differing norms about males being victimized or perpetrating violence (Lachman et al., 2019; Reeves & Orpinas, 2012). As such, males may be less receptive to parents’ efforts, suggesting that parents of males may need additional or different skills and knowledge to navigate and monitor ADV risk. These differences suggest that differential program targets for parents of males versus females may be indicated. The potential benefit, as well as the potential drawbacks, of gender-specific, parent-based programming should be considered.

6.3. Gender and Sexual Minorities

Beyond gender-based programming, consideration is also needed for adolescents who identify as sexual or gender minorities, which includes approximately 15% of adolescents nationally (Kann et al., 2018). Adolescence is also a time characterized by exploration and experimentation, such as with one’s sexuality or identity (McNeely & Blanchard, 2010). As such, even among adolescents who do not identify with a minority group, they may engage in relational or sexual behavior with same and opposite sex partners. As such, parents need to be informed and prepared to support and educate their adolescents about all types of healthy relationships and relationship risks. Indeed, rates of ADV among individuals who identify as sexual minorities are greater than heterosexual adolescents (Edwards et al., 2015; Martin-Storey & Fromme, 2016; Olsen et al., 2017). Rates are even higher among individuals who engage in sexual activity with same-sex and other-sex partners compared to only same-sex partners (Martin-Storey & Fromme, 2016). To date, few ADV-based programmatic resources are available that incorporate this content.

Not only do few programs address this content area, evidence suggests that parents struggle when it comes to discussing and educating their adolescents on LGBTQ+ issues or relationships. With regard to sexual health education, barriers to communication between parents and adolescents have included limited knowledge of sexuality specific to LGBTQ individuals (Flores et al., 2019; Newcomb et al., 2018; Rose & Friedman, 2016) and discomfort or lack of support (Feinstein et al., 2018; LaSala, 2015). Some parents have also expressed difficulty about knowing how to monitor and set restrictions for their adolescents who identify as LGBTQ+ compared to adolescents who identify as heterosexual (Newcomb et al., 2018), a notion that has also been recognized by adolescents (Feinstein et al., 2018). Lack of communication about sexual risk and parental monitoring has been linked with enhanced sexual risk behavior among sexual minority adolescents (Bouris et al., 2015; Thoma, 2017; Thoma & Hueber, 2014). Although further research is needed, it is plausible that similar risk patterns may emerge for ADV. Likewise, more evidence is needed to suggest whether existing programs are efficacious for adolescents of LGBTQ+ identities. For instance, without specific awareness and knowledge, parents may make heteronormative assumptions about their adolescent’s relationships and behaviors, which may be unhelpful and hurtful.

7. Conclusion

This review has examined multiple existing programs designed to promote healthy adolescent dating and limit ADV. As with many adolescent risk behaviors, literature points to the critical role of parents and family in the emergence of ADV. This recognition is reflected in the development of universal (e.g., Families for Safe Dates) and targeted (e.g., Moms and Teens for Safe Dates) primary prevention programs with a parent focus. These programs are varied in modality and degree of involvement, yet relatively similar in terms of content provided. Outcomes indicate that parent- and family-based programs for ADV reduction are beneficial in changing attitudes and self-efficacy, but few indicate reduced ADV behaviors. Thus, more comprehensive assessment of such programming is warranted. Efforts should include further assessment of behavioral outcomes and the unique role of parent- and family-based content, as well as comparison of existing programs, to better understand effectiveness. Future programming efforts should also consider the specific and unique needs of families of adolescents with prior ADV exposure, gender-specific programming, and more inclusive programming for LGBTQ+ adolescents and their families. To date, parent- and family-based programming has been a secondary feature of ADV prevention programs. It is our hope this review serves to highlight the critical role of parents in the effort to reduce ADV and that future work will include, measure, and assess the function of parent-based content in ADV prevention programming.

Highlights.

• Parent- and family-based prevention efforts for dating violence are reviewed

• Some programs are universal focused; others target high risk populations

• Program outcomes include changes in awareness and attitudes toward dating violence

• Outcomes reveal limited evidence of change in dating violence behavior or skills