Program reaches out to at-risk runaway girls
How can your program reach out to sexually assaulted or exploited girls with a history of running away? Take a tip from the Minnesota Runaway Intervention Program (RIP), a nurse-led initiative to help such teens reconnect to family, school, and health care resources. The program is located at the Midwest Children's Resource Center, within Children's Hospitals and Clinics of Minnesota in St. Paul.
Through a combination of home visits and group counseling, the program aims to re-establish girls' positive development, reduce trauma, and improve health and coping behaviors. The program has been shown to reduce risky behaviors and sexually transmitted infections while improving family and school connectedness and grades.1 Such intervention is needed. Research indicates that teens who run away at an early age are more likely than older teens to run away multiple times, to be sexually victimized, and to be involved in substance use.2
Established in 2004, the program provides initial assessments to between 140 and 200 youth each year and offers intensive visitation services to about 70 youth per year. Girls who have run away from home at least once, and also have a history of extra-familial sexual assault or sexual exploitation, are referred to the program through a variety of sources, including schools, the court system, law enforcement, community outreach workers, social service agencies, and current or former participants. Girls are considered eligible for the program if they are between the ages of 12 and 15, have been sexually abused by more than one person outside of their family, and do not currently have an open case with child protective services.
How does it work?
Those who are referred to the program receive an initial assessment, both to determine eligibility and to obtain an extensive history of runaway behavior and sexual exploitation. The assessment, conducted by an advanced practice nurse and a pediatrician, includes a thorough health care examination, with a review of medical, family health, and social history and an assessment of risks and protective factors.
Once enrolled in the program, girls receive an intensive set of home or school visits. This participation requires the parent or guardian to sign a consent form and attend an informational conference with staff at the program office or in the home, depending on the family's preference. Once permission is secured, each youth receives four visits from an advanced practice nurse at home or school during the first month of participation, followed by two visits per month for the next two months. Visits then continue at a frequency of once every three or four weeks, for up to one year.
Services included in these visits include immediate access to health care, an important part of the program, says Elizabeth Saewyc, PhD, RN, professor at the University of British Columbia School of Nursing and Division of Adolescent Medicine. Saewyc was affiliated with the University of Minnesota when the RIP program was founded and is a co-author of research on the program.1,3
To eliminate barriers to accessing reproductive and sexual health care, advanced practice nurses provides teens with in-home access to screening for pregnancy and sexually transmitted infections. Nurses also can provide condoms, prescribe or initiate birth control, and help with changes to existing birth control prescriptions. By working with the teens, who often have little knowledge of basic health services, advanced practice nurses help connect them to community health services, as well as guide them toward specialty services if trauma, substance use, or mental health issues are detected, Saewyc notes.
During each client-centered visit, the advanced practice nurse focuses on building on an individual's strengths and reducing the potential for harm, using education to improve skills and self-esteem and help set and achieve personal goals. Topics available for education include safe sex and contraception, mental health issues, substance use and abuse, family conflict, nutrition, physical fitness, injury prevention, and skills for daily living, such as making appointments and using public transportation. A portion of each visit is set aside to discuss issues related to school connectedness. This time can include discussions about school and any conflicts being experienced there, helping with homework or locating sources of homework assistance, and working with the school to identify key personnel who can help the youth become better connected within the school environment.
Program participants also can choose to meet with a therapist-facilitated weekly therapeutic empowerment group. Issues such as problem-solving, family and peer conflicts, and addressing and healing from trauma are covered in the after-school sessions.
In addition to meeting with the teens, the advanced practice nurse also provides assistance to parents and guardians by helping them access support and services from the legal, health, and social systems. By working with parents, the nurse aids in increasing awareness of their child's traumatic experiences and how they can help in the child's healing process.
The program employs one full-time coordinator and two part-time advanced practice nurses, and it contracts with an outside therapist to facilitate the weekly therapeutic empowerment sessions. The program has an annual budget of $160,000.
Every girl with a history of running away has a unique set of circumstances, issues, and needs and, therefore, requires individualized intervention to restore a supportive environment to help her heal, says Laurel Edinburgh, MS, PNP, RNC, a nurse practitioner at the Midwest Children's Resource Center. These interventions can range from working with the school's police officer to make the school a safe environment, free from threats of gang members, to helping find free piano lessons as a reward for ongoing school attendance, Edinburgh notes.
"A vital element of the program is utilizing the specialized training of nurses to bring well-rounded health care to these girls, identifying their unique issues and working with each girl and their support networks, including family, school, and the community to address them head on," she says.
References
- Saewyc EM, Edinburgh LD. Restoring healthy developmental trajectories for sexually exploited young runaway girls: fostering protective factors and reducing risk behaviors. J Adolesc Health 2010; 46:180-188.
- Rotheram-Borus MJ, Mahler KA, Koopman C, et al. Sexual abuse history and associated multiple risk behavior in adolescent runaways. Am J Orthopsychiatry 1996; 66:390-400.
- Edinburgh LD, Saewyc EM. A novel, intensive home-visiting intervention for runaway, sexually exploited girls. J Spec Pediatr Nurs 2009; 14:41-48.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content