manage cases involving family violence (Thompson et al., 2000; Campbell et al., 2000). Early experiences with these techniques are demonstrating positive effects.
In addition to efforts to change systems, techniques to reduce health professionals’ biases—the assumptions health professionals have about who family violence victims are and why they are maltreated—may be useful in developing effective education on family violence. As with other professions that deal with family violence, cognitive biases held by health practitioners may have particular effects on the identification of victims and attributions of risk in cases of actual or suspected family violence. Research on techniques to address these assumptions or biases, known as “debiasing,” suggests that errors in identifying victims and assessing risk could be reduced if training programs on family violence included exercises in which trainees compared their own judgments and assumptions about victims with data describing real victims.
Research on outcome measurement, such as measures included in the Healthplan Employer Data Information Set (HEDIS), and evidence-based practice suggest potential for the creation of a standard set of measures for effective practice for family violence. HEDIS measurement, in its short existence, has demonstrated profound effects on the behavior of health care delivery organizations and on practitioners (Bader et al., 1999; Eddy, 1998; Epstein, 1998; Harris et al., 1998; Hill and Spoeri, 1997; Kelly, 1997). For example, managed care organizations have made major changes to meet new requirements, and training of health care personnel is widely conducted as part of this process (National Committee for Quality Control, 1999). Examples of the success of HEDIS measures include changing health care delivery for immunizations (Hughes, 1997; Family Violence Education, 1996; Thompson, 1996), the management of hypertension (Elliott et al., 1999), and diabetes care (Peters et al., 1996). Currently, no HEDIS measures exist for diagnosing and treating family violence.
Evidence-based practice currently appears to be another strong and emerging force in health care professional education. Evidence-based practice is recognized as essential to ensure quality health care (e.g., Green and Ellis, 1997; Norman and Shannon, 1998). As it involves efforts to apply the best-available scientific evidence to day-to-day practice, the drive for it could serve as a stimulus for effectiveness research on family violence interventions. Yet research shows that even in areas in which best-practice standards are well established, incorporation into practice is extremely slow and uneven (IOM, 2001).
Challenges to developing, implementing, and sustaining training programs for health professionals on family violence include the nature of accreditation, licensure, and certification; characteristics of health professional organizations; views of stakeholder groups; attitudes of individual health professionals; and the existence of mandatory reporting laws and education requirements.