Preventing Sexual Violence
An Educational Toolkit for Health Care Professionals
WEB VERSION

Introduction
What Is Sexual Violence?
How Do I Prevent It?
Overview of Web version

Tools

Conclusion


Sexual Violence Prevention Toolkit
Younger Adolescent Visit Vignette Script

Focus:  Dating/relationships
Scenario:  Annual/sports physical - pediatrician briefly meeting with 13-year-old boy (Bill) and his mother (Mrs. Morris) then asking mother to leave to meet with boy only

Green light

General assessment (HEADSS) as part of well visit; Bill is doing well in school, has a group of friends, no real problems but not an overachiever either; discussion about dating, respect of others as part of anticipatory guidance

Dr:                      Hi, Bill.  Hi, Mrs. Morris.  How are you?
Mrs. Morris is visibly on edge.  Bill slouches in chair throughout much of visit.
Mrs. Morris:       We’re good.
Bill:                     Fine. 
Dr:                      How can I help you today?
Bill:                     I’m just here to get checked out.
Mrs. Morris:       It’s just his annual physical and we need to get a form filled out so he can play basketball.
Dr:                      Are you having any health problems?
Bill:                     No.
Dr:                      Have there been any changes at home?
Mrs. Morris:       No.
Dr:                      You’re in eighth grade now, right?  What school do you go to?
Bill                      Lincoln Middle School.
Dr:                      How are you doing in school?
Bill:                     Pretty good.
Mrs. Morris:       He’s doing really well.  He gets all A’s and B’s.
Dr:                      Great.  What do you like to do after school?
Bill:                     Mostly sports.  I like baseball and basketball.
Dr:                      Great.  Mrs. Morris, is there anything else you’d like to ask me about at this point?
Mrs. Morris:       No, he’s doing well.  We mostly just want to get his form signed for basketball.
Dr:                      Thanks.  Now I’m going to talk to Bill by himself and ask him about some behaviors or activities he may be involved in or that his friends might do.  Anything Bill tells me will be confidential unless I’m worried he’s going to hurt himself or someone else.
Mrs. Morris:       OK.  I know the drill.
Bill grimaces and shrinks down in chair.  Mrs. Morris leaves the room.
Dr:                      OK, Bill, now as I told your mom, anything you tell me will be just between us unless I think you’re going to hurt yourself or someone else.
Bill:                     ‘K.
Dr:                      Have there been any changes at home, like in who lives at home?
Bill:                     Nah.
Dr:                      How do you and your parents get along?
Bill:                     Fine.  Sometimes they bug me about homework and stuff, but I guess they’re OK.
Dr:                      Now I am going to ask you some questions about what you may be doing or not doing with your friends.  Do any of your friends smoke?
Bill:                     Some kids do, but they aren’t exactly friends.
Dr:                      Have you ever smoked?
Bill:                     No.
Dr:                      Do any of your friends drink?
Bill:                     Nah.
Dr:                      Have you ever tried alcohol?
Bill:                     Nope.
Dr:                      What about drugs?  Have any of your friends or you ever tried drugs?
Bill:                     No way.
Dr:                      Have you or any of your friends ever used medications for some reason other than how they’re supposed to be used?
Bill:                     What do you mean?
Dr:                      Well, do you or any of your friends ever take medicine from your parents’ medicine cabinets or from other people and try them.
Bill:                     No.
Dr:                      Great.  So, tell me a little about your friends.  Who do you hang out with?
Bill:                     There’s, like, a group of kids from school I hang out with?
Dr:                      And are most of your friends guys, girls, or both?
Bill:                     It’s mostly guys, but there are some girls who hang out with us too.
Dr:                      Are any of them dating?
Bill:                     Rolls eyes. 
No one really dates.  We all just hang out in a group.  But some of the guys have girlfriends, I guess.
Dr:                      Do you?
Bill:                     Well, there’s this girl I like, but she’s not really my girlfriend.  We go to the movies together and stuff, but in a group with all our other friends.
Dr:                      When you all go out, who chooses what you’re going to do?
Bill:                     I guess we all decide together.  But me and some of the other guys are more like the leaders.
Dr:                      Do the girls have a say?
Bill:                     Yeah, but sometimes they just let us do what we want.
Dr:                      What do you mean?
Bill:                     Well, like the girls want to go see these sappy movies, but we usually talk them into going to see stuff with we like, like with more action and stuff.
Dr:                      Well, it’s really important for friends to respect each other.  Dating – or even just hanging out as a group of buys and girls together – should be fun for everyone, don’t you think?
Bill:                     I guess.
Dr:                      Do you think the guys and girls could compromise on movies?  Some movies, like, say, the Spiderman movies, have action and love stories, right? 
Bill:                     Shrugs.
Yeah, I guess.
Dr:                      So maybe you and your friends can try to find movies and other activities that everyone will enjoy.  I’m going to give you this brochure about relationships so you can think more about this, especially as you and your guy friends figure out how to get along with all your girl friends.
Bill:                     I guess that will be good. 

 

Yellow light

Bill describes his coed group of friends more and reveals that there is a girl he “likes”; his best friend says he has had sex with a girl and other friends tease Bill about not having sex

Bill:                     We’re hanging out this weekend and my friend Chris’s house and we may rent a movie.
Dr:                      So is this like a party at Chris’s.
Bill:                     I guess, kinda.  It’s mostly just hanging out.
Dr:                      Are his parents going to be there?
Bill:                     I dunno.
Dr:                      Well, what do you do at these parties?
Bill:                     Shrinks down, averts eyes.
Nothin.
Dr:                      Is there drinking?
Bill:                     No.
Dr:                      Do you guys play games?  Like, I know I’m going to sound like I’m from the 1950s, but do you play games like spin the bottle?
Bill:                     No, not really.  But sometimes some guys and girls go off into a room alone.
Dr:                      What about you?
Bill:                     No, I’m not really into that.
Dr:                      Does it make you uncomfortable when your friends do it?
Bill:                     No.  You know, whatever…  They can do what they want.
Dr:                      Do your friends try to pressure you into going into a room with a girl?
Bill:                     Not really.  But sometimes my best friend Eric teases me because I haven’t done it with Lisa yet – that’s the girl I like.  He says he’s had sex with three girls already.
Dr:                      Well, it’s good that you’re being respectful of Lisa.
Bill:                     Yeah, I guess.  But it’s not just that.  I just don’t want to.  I guess I’m just not ready.
Dr:                      Well, that’s OK too.  How does it make you feel when Eric gives you a hard time about it?
Bill:                     It’s not that big a deal.  I mean, he may not even have done it with all those girls like he says.
Dr:                      Yeah, sometimes people exaggerate, don’t they?  Well, it’s great that you’re taking things at your own pace.  Is there an adult you can talk to about girls and dating and sex?
Bill:                     Well, I guess so.  My older sister’s away at college, but we text and IM and stuff. 
Dr:                      That’s good; it can be really helpful to have someone you trust to talk about this kind of stuff with.  I also want you to know that you can talk to me about girls and dating and sex including things that others may do or say that are confusing or uncomfortable for you.  If you have any questions about this stuff I would be happy to try to help.
Bill:                     Yeah, I know.

 

Red light

Bill expresses frustration that all of his friends are having sex with their girlfriends but the girl he likes won’t; Bill’s brother says that he hits his girlfriend to get her to do what he wants; Bill witnesses his father pushing his mother around to get what he wants

Dr:                      So, do you consider yourself a happy, sad, or middle-of-the-road kind of person?
Bill:                     I guess pretty middle-of-the-road.  Sometimes I get happy and sometimes I’m sad.
Dr:                      Who do you talk to if you’re feeling sad or have a problem?  I know you text and IM your sister, but what about when you really need to talk to someone in person?
Bill:                     I guess it’s usually my older brother.
Dr:                      What about your parents?
Bill:                     My mom’s OK, but I don’t really talk to my dad about this kinda stuff.
Dr:                      Why not?
Bill:                     Shrugs.  I guess I don’t really trust his opinion.
Dr:                      Hmm.  Why not?
Bill:                     I dunno.  Sometimes he pushes my mom around, and I don’t really like it.
Dr:                      Have you talked to anyone about this?
Bill:                     Not really.  I can’t talk to my brother about it.
Dr:                      Why can’t you talk to him about this?
Bill:                     Well, he’s even worse with his girlfriend.  He hits her and makes her do things she doesn’t want to, like with sex and stuff. 
Dr:                      Well, have you talked anyone about that?
Bill:                     My mom and I have talked about it some, but she can’t even help herself.
Dr:                      How do you feel about how your brother treats his girlfriend?
Bill:                     It’s really bad. 
Dr:                      What do you mean?
Bill:                     Well, I guess he shouldn’t hit her.  But he shouldn’t make her do stuff she doesn’t want to do either.  Sometimes he tells me I should just make Lisa go in the other room at a party and, like, have sex with her.  But I don’t think that’s right.
Dr:                      Why not?
Bill:                     Well, she might not want to.  I mean, they always say “no means no,” right?
Dr:                      Absolutely.  Bill, I’m really concerned about what’s going on in your home.  I think you and our mom could both use someone to talk to about this more.  Would it be OK if I brought your mom back in here so we can talk about this some?
Bill:                     Yeah, I guess that might be good.
Doctor opens door and invites Mrs. Morris into room.  Mrs. Morris comes back in the room and sits down.
Dr:                      Mrs. Morris, Bill has told me some about what’s going on at home.  It worries him that your husband pushes you around sometimes, and he said his older brother treats his girlfriend pretty poorly too.
Mrs. Morris:       Well, I guess that’s kinda true, but I didn’t really think Bill paid attention.
Bill:                     Of course I do!  How could I not notice when dad’s totally yelling at you?
Mrs. Morris:       I guess I never thought about it that way.
Dr:                     As Bill gets older and more interested in girls and starts dating, it’s really important that he have positive role models for how couples treat each other.
Mrs. Morris:       I guess that makes sense.
Dr:                     You know, the local women’s shelter has some great…
Mrs. Morris:       Interrupts.  I don’t need to go to a shelter!
Dr:                     I’m not saying you do.  What I was going to say is that the local women’s shelter has some great programs where you and Bill could talk to some other people about this more.  They have this one program for boys Bill’s age, where they discuss things like dating and sex and how to treat girls respectfully. 
Bill:                     It would be nice to have someone to talk to about that stuff.
Dr:                     And they have similar programs that you might find useful, Mrs. Morris.
Mrs. Morris:       I guess doesn’t sound too bad.
Dr:                     Tell you what.  Let’s go out to the front desk and get you checked out and I’ll get you the information about how to contact the shelter.
Mrs. Morris:       OK.
Dr:                     Then I’d like to follow up with you in about a month just to check in and see how things are going.
Mrs. Morris:       OK.  Thanks.
Bill:                     Thanks