health care delivery systems, the use of techniques to address practitioners’ biases or beliefs about victims, and the use of health care outcome measurement to inform evidence-based practice.
Studies demonstrate that traditional forms of didactic education designed to increase knowledge about a particular topic are ineffective to enhance skills and change clinical practice to improve patient outcomes. Research on behavior change and principles of adult learning instead support the use of teaching methods that employ multifaceted, skill-building, practice-enabling strategies as more effective at changing behavior in health care delivery. Such strategies involve interactive techniques, such as case discussion, role play, hands-on practice sessions, guided clinical experiences, and evaluative feedback to trainees about their behavior.
Strategies to change behavior are referred to as “systems change models.” A number of such models exist, generally involving identifying areas in which change is needed, determining objectives, testing approaches, and assessing their impact. A few managed care organizations and hospitals are beginning to apply such approaches to the education and training of health professionals to identify and manage cases involving family violence. Early experiences with these techniques are demonstrating positive effects.
Techniques to reduce the assumptions that health professionals have about who family violence victims are and why they are maltreated may also be useful in developing effective education curricula. Research suggests that errors in victim identification and risk assessment could be reduced through exercises in which trainees compare their own judgments and assumptions about victims with data describing real victims.
Research on outcome measurement and evidence-based practice suggests potential for the creation of a standard set of expectations about effective practice to deal with family violence. Measurement using the Healthplan Education Data Information Set has demonstrated significant effects on the behavior of practitioners and health care delivery organizations in areas other than family violence. And evidence-based practice, which involves efforts to apply the best-available scientific evidence to day-to-day practice, is recognized as essential to ensure quality health care, yet even in areas in which best-practice standards are well established, incorporation into practice is extremely slow and uneven.
Challenges to developing, implementing, and sustaining training programs on family violence for health professionals include the nature of accreditation, licensure, and certification; characteristics of health professional organizations; the views of stakeholder groups; the attitudes of individual health professionals; and the existence of mandatory reporting laws and education requirements.