A number of factors may influence whether or not as well as the extent to which family violence is included in health professional training. Accreditation, licensure, and certification requirements do not consistently and explicitly address family violence and thus do not appear to be significant influences encouraging such training for health professionals. Without such requirements, health professionals may perceive family violence education as unnecessary, and educators may have little incentive to provide it. The influence of other stakeholder groups, including advocates, victims, and payers, has not been studied and so it is difficult to gauge what impact they may have. For individual health professionals, as for other individuals, personal and professional factors may influence beliefs about the desirability of education about family violence and how such education is received and applied. Health care professionals have concerns regarding inadequate time or preparation, discomfort with dealing with family violence, and beliefs that it is a private issue in which they should not be involved (e.g., Sugg and Inui, 1992; Newberger, 1977; Cohen et al., 1997). Overcoming these concerns is another challenge to be addressed. In addition, health care professionals may themselves have had personal experience with victimization (e.g., Ellis, 1999) or be affected by trauma experienced by their patients (“vicarious traumatization”; McCann and Pearlman, 1990; Neumann and Gamble, 1995; Talbot et al., 1992). Training programs therefore need to be sensitive to health professionals’ specific needs and concerns.

The committee was particularly mindful of the use and effects of mandatory reporting and education legislation. Reporting suspected abuse and neglect has become common in health practice (Zellman, 1990a), but some health care professionals express concerns that reporting can be more harmful than helpful to the victim. The advantages of mandatory reporting include the increased likelihood that the health care provider will respond to family violence, refer victims for social and legal services, and assist with perpetrator prosecution. However, with regard to intimate partner violence in particular (Rodriguez et al., 1999; Tilden et al., 1994), some health professionals and others voice concern that mandatory reporting is a breach in confidentiality that undermines autonomy, trust, and privacy in the health care setting (Kalichman and Craig, 1991; Kalichman et al., 1989; NRC and IOM, 1998; Rodriguez et al., 1998, 1999; Vulliamy and Sullivan, 2000; Warshaw and Ganley, 1998); interferes with efforts to ensure the safety of victims (Levine and Doueck, 1995; NRC and IOM, 1998; Rodriguez et al., 1998, 1999; Tilden et al., 1994; Warshaw and Ganley, 1998; Zellman, 1990b); serves to deter perpetrators from obtaining treatment (Berlin et al., 1991; Kalichman et al., 1994); precipitates violent retaliation by perpetrators (Gerbert et al., 1999; Gielen et al., 2001; Rodriguez et al., 1999); decreases victims’ use of health care services (Gerbert et al., 1999; Rodriguez et al., 1999); and discourages inquiries by health care professionals who believe that if they do not ask, they have nothing to report (Gebert et al.,1999).

Although the relationship between mandatory reporting requirements and



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