Buffalo HealthCast

Gender Based Violence in Adolescents, with Kate Rogers of Crisis Services

December 02, 2021 University at Buffalo Public Health and Health Professions Season 1 Episode 11
Buffalo HealthCast
Gender Based Violence in Adolescents, with Kate Rogers of Crisis Services
Show Notes Transcript

Buffalo HealthCast co-host and MPH student Rachel Wenner speaks with University at Buffalo PhD candidate Kate Rogers about gender-based violence among adolescents and the work that Crisis Services of Buffalo and Erie County is doing to combat this problem throughout Western New York.

More information on Crisis Services can be found here.

Host/Writer/Researcher - Rachel Wenner
Guest - Kate Rogers, MPH
Audio Editor - Omar Brown
Production Assistant - Sarah Robinson

Rachel Wenner: Hello, and welcome to Buffalo HealthCast - a podcast by students, faculty, and staff of the University of Buffalo's School of Public Health and Health Professions.  I'm your host, Rachel Wenner.  In this podcast, we cover topics related to health equity here in Buffalo, around the US, and globally.  In the second semester of the podcast, we’re taking a deeper look at health inequities with a broader lens - focusing on a wide range of health topics.  We’ll be talking with experts around the US, as well as individuals here on campus and in the Buffalo community who are working to remove inequities to improve population health and wellbeing.  You'll hear from practitioners, researchers, students, and faculty from other universities, who have made positive changes to improve health equity and inclusion.  I'd like to note that today's episode focuses on sexual and domestic violence prevention, and includes discussion around topics on this matter.  The team and HealthCast recognizes that these topics may be difficult for some listeners, and we encourage you to engage with this podcast in a way that is supportive of your needs.  Today, our guest is Kate Rogers, a current PhD student in the Department of Community Health and Health Behavior within the School of Public Health and Health Professions here at UB.  Kate is also a graduate of the Master of Public Health program, and former Sexual Violence Prevention Coordinator at Crisis Services Erie County, and Erie County in Buffalo.  She is currently working with the organization doing a hospital response.  Kate, thank you for joining us today.

Kate Rogers: Thanks so much for having me.  It’s my first podcast.

Rachel Wenner:  Mine as well.  To start, do you want to give us a brief overview of some of the work that Crisis Services does to prevent violence, and some of the roles you've played in your time with the organization and at UB?

Kate Rogers: Yeah sure, you did a great primer with your bio.  Crisis Services is the area county’s crisis response agency, so we offer a lot of different services.  The department that I worked in is called the Advocate Department, and we are responsible for both prevention and response work in the domestic and sexual violence arena.  Fun fact: we are Erie County’s only Rape Crisis Center and basically what that means is that we partner with every hospital in Erie County to do response.  If someone shows up at the hospital, we will be paged out by a provider to offer advocacy services, help with law enforcement.  If someone has questions about that, we offer court advocacy - all the things that go along with reporting or experiencing domestic or sexual abuse.  I currently work for crisis services in a per diem capacity, doing just hospital response, because those PhD demands got to be a little too much, but I was the Sexual Violence Prevention Coordinator for quite a while.  I actually had a number of different roles in the agency.  I started as a case manager, working with domestic violence survivors, and moved into a campus advocate role which sort of straddled domestic and sexual violence advocacy, case management, and prevention work, and we have a really unique prevention program.  We would do a lot of bystander trainings, we’d enroll the community and the broader social ecological model of folks, if you will, who can help with response and prevention of sexual violence.  And then, once I left the campus advocacy role, I moved into the role of Sexual Violence Prevention Coordinator, managing a grant that worked on sexual violence prevention, primarily in adolescents, so our focus was 8 to 24 year-olds, but really on our project we worked with high school populations in Erie, Niagara, and Monroe counties.  Obviously, all of that work has rolled over into my studies.  When I was working on the MPH - my first day of the MPH program was also my first day working at crisis services - so it was a lot of new things starting back in 2018.  It was just really cool to see in real time, things I was learning from the program play out in my day to day life.  I can remember looking at the social ecological model in a health behavior class and I'd be like, “Oh, oh wow, this is also in a prevention presentation that I'm learning about,” and all of the factors, and brief crisis advocacy, and domestic violence tends to fall a lot in the social work realm.  But I was fortunate - I had supervisors who were public health folks, and we really took a public health holistic approach to this work, particularly in prevention and it just synced up so amazingly with the program and ultimately, it's kind of what drove me to want to get a PhD in it, too.

Rachel Wenner:  That's incredible, thank you for sharing.  I know that from personal experience just having real world, real time public health experiences, whether it be volunteer or field training, while simultaneously taking classes really helps to connect the dots between what you're learning on paper and what's going to be applicable once you're done with whatever program, so that's awesome that you've been able to get a wide range of experience within your specific academic interest as well.  Could you tell us a little bit about the background on teen dating violence prevalence and how it's a problem today in Erie County and Western New York region?

Kate Rogers: How much time do you have Rachel?  We could do that all night.  Yeah, so basically an overview - teen dating violence is essentially intimate partner violence experienced by adolescents and teenagers.  It tends to show up a little bit differently than it does in adults, but essentially, it's a power disparity in relationships.  Somebody in a relationship has an upper hand and they’re taking the power away from someone else in the relationship.  The way that it manifests in adolescents, a lot of the time, especially younger adolescents, is a lot of emotional, psychological, verbal abuse, interestingly.  From a gender perspective, I feel like a lot of us tend to think of intimate partner violence in general as something that men perpetrate and women experience. In adolescents, it can tend to manifest the opposite, so adolescent girls - there's been a lot of studies, where they are meaner to their boyfriends and more emotionally abusive to their boyfriends, but as they get older there tends to be more of the aggressive forms of abuse - physical abuse, sexual abuse, that are perpetrated by men to adolescent women.  It's estimated that one in four teens does experience teen dating violence.  I would say, take that number with a grain of salt because it's also highly underreported.  Adolescents, as a whole, don't really want to talk about this stuff with anybody, but especially they don't want to report to adults.  There's a myriad of issues that happen with reporting that can prevent someone from wanting to report, and so we know that these numbers are probably lower reported than what's actually happening.  And we've seen that, going back to this as a harp on the social ecological model, we've seen that when there is a lot of rape culture and victim blaming culture in a school - again, the experience I have is doing this in school settings - if the faculty and the teachers and the adults in the school have that very heteronormative, victim blaming, rape culture - a rape myth acceptance vibe, if you will - the students tend to mirror that in a lot of ways.  That stuff that happened at the community level tends to trickle down to the relationship and the individual level.  A lot of the goals in teen dating violence prevention will get not only talking to the teens themselves, enrolling the entire school- it's an easy space to do it because most adolescents are in school - enroll in the whole school, instead of saying, “This is what we're seeing, these attitudes and rape myth acceptance, victim blaming/victim shaming attitudes are not great.”  Some people are not even aware that they're doing it because it's so embedded in our culture, and by working with both the teachers, the faculty and the students sort of simultaneously, the intention is to create a safer environment.

Rachel Wenner:  Awesome, so you touched on the different level factors that affect adolescents’ willingness to seek help and support if they're experiencing something along these lines.  How does this translate into negative outcomes, either in adolescents, with their health status or their educational attainment, however that translates, later into adulthood?

Kate Rogers:  There's so much research about this.  If anyone is unfamiliar, I highly recommend just googling the ACE study (Adverse Childhood Experiences).  It was a groundbreaking study - I won't go into too much detail about it because I’m sure a lot of listeners are already familiar, but essentially, the crux of it is that we know that if an individual experiences violence in childhood, whether that's community level violence, so if you live in a place that there's a lot of gun violence prevalent, or just other community violence or domestic violence in the home, it internalizes violence as a conflict resolution mechanism, and normalizes it as a way to handle conflict going forward.  So, interestingly, a lot of adolescents - we know adolescents are very influenced by their peer group - it's a time when gender norms are being solidified and worldviews are coming together, and there's been some really incredible studies that have shown that peer groups that normalize violence as conflict resolution tend to have more violence happening in them, and often the victims of violence are not actually even aware that what they're experiencing is violence, because it's been so normalized.  So, case in point, again, this is very prevalent with adolescents, because of the ubiquitous use of technology in the form of our little computer - pocket computers or phones - I thought that made me sound really old - but there's a lot of coercive sexting that can happen, or pressure to send nudes or to do something that they're uncomfortable with, and a snap of yourself nude or something like that.  A lot of times, adolescents don't even recognize that as problematic behavior, because it's just something that all of their friends do, all of their peer group does, and being pressured to do it seems like it's par for the course.  This is abuse that's happening because we know that once that happens in the technological space, it's more likely that abuse is going to happen offline as well.  Even if it doesn't transfer offline, there's a whole host of issues happening with technological sexting stuff, if you will.  But it's so normalized – it’s part of what adolescents do with each other - they don't know that it's not okay to have someone pressure them for that.  Sorry, I got a little bit off on a tangent there, but basically, all of this to say that once this behavior is normalized, you're more likely to see this power disparity and see these kinds of coercive tactics as normal in future, adult relationships and the long term impacts of abuse…It usually starts off with technological or emotional or psychological abuse, and then moves into physical or sexual.  It may not, but usually it starts off with the things that are not noticeable to other people, and then gets more into the sphere of things that may or may not be noticeable.  What ends up happening is that, as we move into adulthood, you have all these chronic stressors of gaslighting, all the markers of psychological abuse, where one person is controlling another person and that manifests in really negative health outcomes like depression and anxiety.  Depending on the level of violence in the relationship, PTSD can be really big issue.  Being victim to abusive relationships in the future, if you normalize that this is what happens in a relationship when you're young, it's probably how they're going to happen in a relationship as you’re older.  And those negative health outcomes - all that chronic stress, ultimately can lead to risky sexual behavior, unwanted pregnancies.  The risk is pretty high to not preventing or understanding dating violence as a teen.

Rachel Wenner: Thank you, you touched on some of the ways in which this translates into health outcomes.  I was just wondering - I know that your specific area of interest has been in young adults and the 8 to 24 range, but have you noticed any disparities during equities relating to the prevalence of violence in different racial or ethnic groups or different socioeconomic statuses among schools?

Kate Rogers: Yes, I feel like anecdotally, a lot of the schools that we've worked with - that we were able to have access to - were mostly affluent middle class, predominantly white student populations.  The prevention work that has been done in a lot of these arenas has been done in affluent upper middle class white populations, but all the literature and all the evidence show, that particularly black adolescent girls are some of the most at risk for experiencing intimate partner violence, so there's a huge disparity in the prevention research and what the response on the ground research is telling us.  We also know that any gender non-conforming LGBTQ+ folks are at higher risk for experiencing sexual violence in particular.  Most of the prevention research has been done on heterosexual students, so there's a disparity in the way the research is being done.  I can't say for sure why that is because I haven't done any of the violence prevention research, per se, that has led to these programs like Green Dot and Bringing in the Bystander.  All I can say is that everything that I have read has said more research needs to be done in different communities to see how this holds up and I think that - I could get on my soapbox for a second - that's a really important thing for us as researchers to be looking into.  It's easier to gain access, sometimes, especially if researchers are working at a college and the college has a good relationship with a local high school, they can just slide into that.  There's a number of barriers to researching minors as anyone who's tried to do research in that arena has experienced, but it's not an excuse, and we need to figure out how these prevention programs can both reach and be tailored to populations that are not that heterosexual, white, cisgender population that has been studied so much in all of this.
Rachel Wenner: Absolutely, and you mentioned how there was different barriers that students face, whether it's in the relationships, like their teachers or authority figures, and I know that you had done some work to study how different policing practices or even the youth attitudes in the schools or the school policies that are in place, can help to either promote and facilitate violence within schools or kind of work against it.  How might some of these be evident, either within the schools you're working with, or in other programs across the area?

Kate Rogers: The most important thing is, as I was saying earlier, when there is higher level of rape myth acceptance, and to clarify for folks who aren't familiar – rape myth acceptance is a scale that was developed in the late 90s, I think, but don't quote me on that, and it essentially measures how much a community is willing to accept victim blaming.  So, it has things on the scale, like “I think if a girl gets drunk, it's her fault that she’s sexually assaulted,” or “if a guy drinks too much, it's not his fault if he rapes someone,” - those kinds of things.  And I think that the way that - the research plays out the way that my experience has played out - when those rates are higher of rape myth acceptance in a school or in a community setting, it's more likely that there's going to be some victim blaming that happens, so that's a huge barrier to coming forward. You’re a 16-year-old kid - you're afraid that if you come forward to your teacher and you say, “Hey, my boyfriend has sexually assaulted me - I don't know what to do” and your teacher says, “Well, you were at a party and you were drunk, what did you think was going to happen?”  That's an enormous barrier to reporting.  You don't want to feel that kind of shame.  I think in the larger setting, in general, police response - it can be very officer dependent.  You can have an officer who gets it and who has gone through a lot of cultural sensitivity training and who is wonderful.  And you can have an officer who may have seen this person report multiple times, multiple rapes, and they're just like, “I don’t believe this person anymore.”  So, unfortunately, at the response level – it’s pretty individual.  Overall, community to community, it's more individualistic than it is as a whole.  I can say, “I'm going to go to this police department and they're going to respond great.”  It's very dependent on the officer that you get.  I think in terms of making it better, what schools could do specifically - is train their staff, train their faculty.  There's something called disclosure training, where someone from a Rape Crisis Center will come in, and they'll basically say, “Here's how to do this in a trauma informed way.”  So, I've done some trainings with various security officers at different campuses, and I get it, you know?  A law enforcement official or security official’s job is to figure out what happened.  My job as an advocate is not to question someone.  It’s just to believe them because I'm their advocate.  I'm not - my question needs to hold up in a court of law for them - I'm here to be their support network.  But if you're a police officer, you need to figure out what's going on, so you can bring a case to the DA’s office.  You may have to ask them questions that are going to be a little different than what I'm talking about as an advocate, and so a lot of what that disclosure training looks like is ways that you can make it more trauma informed, more sensitive.  So instead of saying, “Oh yeah, you were really drunk.  Why'd you take that sixth shot?”, you can say, “You were drinking - do you want to tell me a little bit more about what happened when you were at the bar?”  So, it's not an accusing way - it's, “I need to understand what you drank, for whatever purposes,” but I'm not going to ask it in a way that says, “You were drunk, so of course it's happened,” if that makes sense.

Rachel Wenner: Yes, thank you, and the work that you've done on the grant within Crisis Services focuses on the Bringing in the Bystander curriculum, which works to integrate some of these different concepts that you've mentioned into supportive environments.  How has this been effective in preventing violence, and do you mind just touching a little bit more on what the program encompasses?

Kate Rogers: Yeah, so, bystander intervention training - there's several different programs.  The one that I'm the most familiar with is Bringing in the Bystander.  It was developed by Soteria Solutions.  There's another one called Green Dot, which is very similar.  They both have college campus and high school level and community level bystander training.  It originated with college campuses after there were very high rates of sexual violence on campus.  And then, once they saw the success of that, it was adapted for adolescents.  So, there have been many iterations of many programs that have worked up until this point.  I'm personally partial to Bringing in the Bystander because I'm the most familiar with it, but they're all good.  It's interesting - the evaluation processes for a lot of them - so my entire cumulative project - is that what they're calling it now for the MPH?  It was called something different when I got it, but my whole project was basically evaluating these programs and sort of evaluating their evaluations.  By and large, they've done great work showing, while the program was implemented, rates of sexual violence have dropped.  Particularly extensive research on college campuses, which is great.  There's not really longitudinal data to show what these attitudes look like, once the program has stopped being administered, so the way that Bringing in the Bystander is structured: it's a seven-week program for adolescents.  The college one looks different, so we'll focus on the high school one here.  It's a seven-session [program], I should say, and it can be administered across seven days - it can be administered across seven weeks.  Typically, in my experience, it’s been administered across seven weeks, and then it gives a little bit of time for them to percolate on the information they've been given.  There's a pre-test given at the start, and a post-test given at the end - very classic evaluation mechanism.  It just assesses what they've learned, it assesses their attitudes, and that's about it.  We know in that seven-week time frame, typically generally speaking, attitudes have shifted a little bit from the start.  Someone will maybe say they'll agree with something that's a little more victim shaming and by the end they'll say, “No, I understand that that's not the right way to do it anymore,” which is great, but there's a lot of testing bias that happens in that, because at the end of the seventh session, this stuff is really fresh in your brain.  You’re probably going to remember it better than if we tested you six months from now.  There is a lot of social desirability bias, so people know how they're supposed to answer these questions, for the most part.  The data is maybe not as reliable as it could be, and really, we don't know how this information continues into later adolescence and adulthood, because we're not tracking anyone.  It would be an enormous undertaking, but it would be a really important thing to learn, to see how this programming sustains long-term violence prevention and there's not really a good answer for that, that I'm aware of right now.

Rachel Wenner: How does the curriculum work within norms in place within a school, whether this be gender norms, injunctive norms - that work to promote a healthier environment, or provide a barrier for one?

Kate Rogers: This is a tricky question, Rachel.  There's a lot of different dynamics that play when you're working with the school, and some more conservative school districts don't love it.  There have been instances where parents don't want their kids involved.  Typically, the school will say, “We want this programming to happen,” and then the Rape Crisis Center will go in, but parents have to be notified that the kid is receiving this.  A typical model would be coming into a health class because it's an easy place to slide this topic into.  Parents have the right to refuse their kid this education, so they could pull their kid out.  You have to notify the parents. If you're in a - not to stereotype - but if you're in a really conservative district, or a space where people aren't comfortable talking about sex, this is a very taboo topic.  It can either result in some kids not getting the education, it can result in a lot of really interesting pushback from the students.  The administration can sometimes use it as a way to check a box and say, “We did this violence prevention, cool,” and then they don't necessarily want to involve the rest of their staff or faculty.  There's a lot of different situations when the greater school, as a whole, doesn't want to be involved, it doesn't really work.  We're just giving this education to the kids and we're saying, “This is what a healthy relationship looks like,” and “This is what healthy gender norms look like.”  It's great for them, except if the whole structure around them is still supporting a more patriarchal, heteronormative view of things, it's not reinforcing what they've learned, and if they're going to feel ostracized, it's just not going to be effective.  It works better when everybody wants to get on the same page, and everybody wants to learn.  We recognize that these are hard things to talk about, and they are still, in 2021.  Talking about sex isn’t normalized, and talking about gender roles and gender disparity isn't normalized the way that it could and should be to really make this task easier.  It's a heavy lift.

Rachel Wenner:  When you're working with these schools, who might be experiencing some sort of prevalence of teen violence, and you provide them with this data, whether it be the pre- and post-test results, or some of the findings that you've come across through working with the students themselves.  What are some suggestions that you might make to the schools themselves, or the parents or the students within the classes that you're teaching to bring this information that you're bringing to the students, beyond just the seven-week period, or create more of a community or institutional-level changes, you might think?

Kate Rogers: The model is, of course, meant to be really holistic.  It's the same concept - you want to go in as the guide, but you're not the one making the decision.  Essentially, if I'm coming in and I'm implementing bystander training somewhere, I can say, “Here's the information we collected - what are your thoughts on this?”  I can offer my recommendations, but I think working with any community, like any good public health strategy would do, you let the community decide what those findings will dictate, and sometimes schools are ready, and sometimes they're not.  Sometimes you'll have a few faculty who are so genuinely excited about it and so jazzed about the work, and you know they're on the ground and they've seen a lot of things, and they really want to be able to support their students.  There are administrations that, for whatever reason, aren't ready to buy in, and that's okay.  It's not something that can be forced, and I think if you don't have the buy-in from the top, it's very, very difficult to get things rolling on the ground.  The best practice is that administrators and school boards, and all the decision-making stakeholder powers that be are really bought in and really involved.  I've worked on some college campuses where that's happened, and it's been phenomenal.  You've got people at the top, who are just firing off stuff and “This is great - we want to have presentations, we want to have better support services, we want to have this, that, and the other,” and it's wonderful.  I worked in schools where it hasn't really gone over that great, and it puts a lot of burden on the one or two faculty members who are very excited to do it, and they're always restraining against their administrators.  Ultimately, it's the institution's decision whether or not they want to do anything with the information that we've provided, and if they do, we're here, and even if they don't, we're still here.  There's a lot of instances where they're not ready for the prevention portion, but you know we're here to back up any kind of response that anybody needs.  It’s tricky. 

Rachel Wenner: Yes, and that is a perfect example of probably something we both heard multiple times, and the key component, engaging stakeholders, and the complex events that occur between trying to communicate data and guide some sort of action, whether it be implemented or not, but I think that the educational work that you guys are doing is incredible.  As a society, whether it's on a college campus, or something we could do to support the students and the adolescents in our local communities…What are some steps that we can take as individuals or groups to try and break down some of these more traditional normative beliefs and facilitate a more supportive environment?

Kate Rogers: I think the best way to do it, and this is one of my favorite things to talk about, is to work from the bottom up.  We like to call it the “Pyramid of Violence”, where the base of the pyramid is all the norms that uphold the stuff in a society that makes things like gender based violence okay.  The bottom of the pyramid is racist jokes, sexist jokes, homophobic jokes - things that are normalized in our culture as “funny,” (air-quoting ‘funny’ because they're not funny).  Calling those behaviors out with our friends is hard to do when we're living in a very politically and emotionally charged time around all of this.  For the better part of the last two years, a lot of us have been having really hard conversations with people we love when we have differing views.  Whether you're talking about the coronavirus vaccine, or you're talking about sexual violence, it's kind of the same thing, and calling people out when they make jokes or say things that are maybe inappropriate, that are quote unquote “funny”, is the best way to do it.  Once we start to normalize that that stuff's not okay, it makes it harder and harder for this up the pyramid.  That objectification of people who are different from us, the othering of people who don't look like us, or behave like us or sound like us.  It makes it harder for that to be okay.  I think that's the best way to do it, really, it sounds cheesy, but truly be kind to each other and look out for each other.

Rachel Wenner:  That’s an awesome message, thank you.  Is there anything that you'd like to share, about your work, either within the school or professionally, or advice you'd like to give us as we wrap up?

Kate Rogers: Oh boy, I don't know if I'm qualified to give anybody any advice.  I think I’ll keep my message the same: just be kind to each other.  I feel like that's something someone famous says… I think, at the end of the day, everything that we do, and most of everything that happens in public health, is hard work.  We certainly don't do it for the accolades, and we don't do it for the awards, but I think the most important thing is, whether you're working one to one with someone, or with a big community is public health officials and public health folks - we're not the experts in that.  The people who live the experience are, and I think the more we listen, and the more we really work to understand the populations that we are working with, the better the outcomes will be, and it might sound cliché, but I really believe that.  I guess that would be it - my advice would be to listen and be nice.  Thank you.

Rachel Wenner: Well, thank you so much for joining us, and I know that it must be absolutely crazy busy this time of the semester as you're going through your PhD program, so thank you so much for taking the time out of your busy schedule to talk about this important health issue and shed some light on the ways in which it might be affecting our communities in ways that we might not even know.
Kate Rogers: And I really appreciate you all having me on as well, and I would say to offer support.  Crisis Services does have a hotline that's 24/7, so if any listeners need anything: 716-834-3131.

Rachel Wenner: Thank you, and we'll be sure to link any additional resources with the episode description as well, in case anyone would like to know more, or is looking to get some support themselves or share it for friend, for that matter.  Thank you.

Kate Rogers: Thank you, Rachel.

Rachel Wenner: This has been another episode of Buffalo HealthCast produced by the University at Buffalo. Tune in next time to hear more about health equity in Buffalo, the US, and around the globe.