rics, and the American College of Nurse Midwives provide promising examples of how health professional organizations can actively work to encourage and implement education initiatives on family violence among their members. The organizations provide insight into strategies to overcome barriers to developing, implementing, and sustaining curricula and to promote changes in behavior. In addition, their experiences suggest promising directions for other organizations. The committee encourages other organizations to undertake similar initiatives and evaluate the impact of their efforts. The models developed could help to inform educational efforts. The education and research centers recommended above can undertake further research into these issues as well.

Recommendation 3: Health care delivery systems and training settings, particularly academic health care centers and federally qualified health clinics and community health centers, should assume greater responsibility for developing, testing, and evaluating innovative training models or programs.

In addition to federal efforts supporting research, scholarship, and curriculum development, leadership from the health sector, including health care delivery systems and training settings, is needed to develop, test, and evaluate practical and effective health professional training on family violence. Much health professional training occurs in the health care delivery setting, so these settings provide an opportunity to develop practices that enhance the care of victims of family violence. Efforts to develop training curricula should be linked to clinical evidence, include outcome measurement, provide incentives, and respond to factors that challenge development, implementation, and sustainability of training programs.

The literature on the principles of adult education, theories of behavior change, and performance measurement techniques offer informative models. Instruction should be based on clinical evidence and emphasize task-centered (problem-based) learning approaches. Mechanisms for the ongoing collection, analysis, and feedback of process and outcome data are needed for progressive improvements in education and practice; in this way, evaluation becomes integral to training. Evaluation is important to identifying effective curricula and determining areas in which change is needed. The goal of evaluation is not simply to assess a particular program but to determine how to change behaviors and create systems of practice that improve the health outcomes of victims of family violence. Working with evaluated materials is an important step in developing effective and sustainable education efforts.

Kaiser Permanente of Northern California, the GroupHealth Cooperative, and the University of Virginia offer examples of health care delivery systems making innovations in education techniques and overcoming barriers to behavior change. These organizations are or have been actively involved in developing, testing, and improving training programs.

Other health care delivery system and training leaders can likewise take



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