for forensic purposes during diagnosis or history-taking coursework; to recognize the emotional and psychological manifestations of family violence during case-based or simulated patient instruction; and to understand culturally relevant issues during clinical rotations in diverse settings. Such an approach may build on knowledge and skills for addressing family violence and emphasize the importance of family violence as an important health care issue.

Health professional schools appear to be moving from offering specific courses on each topic to an integrated approach. With such an approach, content on a particular issue is woven throughout the curriculum both horizontally (in different courses that occur simultaneously) and vertically (reinforced throughout the length of the curriculum). Current time constraints and limits on financial and human resources may make the addition of another course difficult.

In addition to integrating components of family violence into health professional education, the literature also suggests incorporating multidisciplinary resources into training efforts. Given the complexity of family violence as a medical and social issue, no amount of training will allow health professionals alone to solve the problems of family violence. Education should include community-based professionals such as law enforcement, legal services, victim advocacy, batterer intervention, elder services, and child protection experts (Alpert et al., 1998). Brandt (1997) pointed out that a curriculum that involves a variety of professionals “models respect and collaboration, attributes that are essential to developing an effective team approach to caring for victims of violence” (p. S55), thus allowing students the opportunity to negotiate community-specific roles and competencies. This point was reiterated by the Committee on the Assessment of Family Violence Intervention Programs (NRC and IOM, 1998, pp. 261-262).

The Alaska Family Violence Prevention Project offers an important example of collaborative work (http://www.hss.state.ak.us/dph/mcfh/domesticviolence/Backgnd.htm). Since 1993, the project has developed and provided community-based training to health care and other service professionals, including those in law, protective services, and education, and to advocates for victims of intimate partner violence throughout Alaska. In addition, the Alaska project is involved in the development of a statewide plan for a comprehensive health care system response to intimate partner violence. Other models of collaboration also exist. For example, the Pennsylvania Coalition Against Domestic Violence has developed a program to coordinate community and justice system responses to intimate partner violence (http://www.pcadv.org/coalition.html, June 4, 2001). Such collaborative programs have not yet been evaluated.

The Use of Systems Change Models

While research indicates that education that merely imparts knowledge is often insufficient to lead to improved skills, changed practices, and improved patient outcomes, a consensus is emerging that other strategies are more effec-



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