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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence
professionals at all. For example, only about 1 in 10 women victimized by an intimate partner seeks professional medical treatment (Greenfeld et al., 1998). Therefore, the true size of the problem is larger than what available data suggest.
A comparison of incidence data suggests that family violence is equally or more prevalent than other serious health conditions (Putnam, 1998, 2001). For example, 1996 data reveal 3,195,000 reported cases of child abuse, of which 1,054,000 were substantiated. Based on substantiated cases, the incidence rate was 15 per 1,000 children/year, which represents a 47 percent increase over about a decade (Department of Health and Human Services [DHHS], 1998). Data on cancer from the same year reveal 1,339,156 cases with an incidence rate of 3.95 per 1,000 individuals/year, reflecting a 2.7 percent decrease over about 3 years (Ries et al., 1999).
In addition to the medical implications for individuals, family violence has been recognized as a public health problem that requires attention to its societal impact and opportunities for intervention (Mercy et al., 1993; White, 1994). Family violence is associated with numerous other problems that affect health, such as homelessness, alcohol and substance abuse, and delinquency (NRC and IOM, 1998).
The nature of their work suggests that health care professionals play a particularly important role in addressing health conditions associated with family violence. Beyond their role in direct treatment of health problems, the long-term and privileged nature of the provider-patient relationship creates unique opportunities to identify family violence victims and respond to their needs. Contact with actual and potential victims affords health professionals the occasion to screen, diagnose, treat, refer, and even prevent abuse and neglect. For example, health care professionals account for the reporting of up to about 23 percent of cases of child abuse and neglect (Administration for Children and Families [ACF], 1998). Work in the context of public health could move health professionals and others beyond the treatment of individual symptoms resulting from family violence to addressing the problems underlying the violence itself (Marks, 2000).
Yet studies consistently describe the lack of education for health professionals on family violence as a major barrier to the identification, treatment, and provision of assistance to family violence victims (e.g., Chiodo et al., 1994; Ferris, 1994; Hendricks-Matthews, 1991; King, 1988; Reid and Glasser, 1997; Sugg and Inui, 1992; Tilden et al., 1994). Some health professionals have expressed concern that they have never had the opportunity to learn how to ask patients about possible abuse; even with training, many report that they are ill equipped or are not encouraged in the practice setting to address family violence (Cohen et al., 1997; Schechter, 1996). Others express anxiety and frustration regarding their ability to respond appropriately if abuse is suspected or disclosed (e.g., Ferris, 1994; Sugg and Inui, 1992).