order after they hear accounts of victimization. Furthermore, clinicians’ concepts of interpersonal situations (e.g., their perceptions of trustworthiness) may be affected adversely, although such an effect was not observed in the one large survey about therapists’ experience with vicarious traumatization (Brady et al., 1999). Brady et al. did find that post-traumatic symptoms were positively related to therapists’ level of work with survivors of child or adult sexual abuse. Whether this relationship reflected a selection factor or a causal linkage is unclear. The anecdotal reports of vicarious traumatization are sufficiently common to suggest a need for preparation of clinicians in training for the emotional reactions that they may have to victims’ stories.

PROFESSIONAL ORGANIZATIONS AND STAKEHOLDER GROUPS

This section reviews the impact of health professional organizations and several stakeholder groups on professional education in family violence. Included in these stakeholder groups are advocacy groups, victims, and health care payers and providers.

Health Professional Organizations

Health professional organization statements, guidelines, positions, and policies that address health professional education or training on family violence explicitly are noted in Appendix B. Organizations such as the American Medical Association, the American Academy of Physician Assistants, the American Academy of Pediatrics, the American Nurses Association, the American Psychological Association, the American Dental Association, and the National Association of Social Workers have issued positions, policy statements, and guidelines designed to encourage or require training in family violence. For example, in 1992, the American Medical Association (AMA) issued a series of educational pamphlets about family violence to provide practicing physicians with background and clinical direction in caring for victims. Many state medical associations held statewide educational campaigns for their members following that AMA initiative. In 1972, the American Academy of Pediatrics published a slide series on child maltreatment, which was updated in 1996, and published guidelines on child maltreatment for the first time in 1991, updating them in 1999.

The American College of Obstetricians and Gynecologists (ACOG) was the first health care professional organization to address intimate partner violence systematically. In 1989, it sent all members a technical bulletin giving information on abuse during pregnancy, assessment, and referral. ACOG has continued its leadership in this area (see Figure 4.1), and its screening guidelines have been endorsed by other health professional organizations (Frye, 2001).

The American Nursing Association passed resolutions on violence against



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