Accreditation, licensure, and certification requirements do not consistently and explicitly address family violence and thus do not encourage training to address it. 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, 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. In addition, health care professionals may themselves have had personal experience with victimization or be affected by trauma experienced by their patients. 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. Advantages of mandatory reporting include an 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, mandatory reporting is seen by some as a breach in confidentiality that undermines autonomy, trust, and privacy in the health care setting, particularly for intimate partner violence; interferes with efforts to ensure the safety of victims; serves to deter perpetrators from obtaining treatment; precipitates violent retaliation by perpetrators; decreases victims’ use of health care services; and discourages inquiries by health care professionals who believe that if they do not ask, they have nothing to report.
Although the relationship between mandatory reporting requirements and education is unclear, the committee found that existing curricula, particularly for child abuse and neglect, often focus in part or in whole on legal reporting requirements. While reporting requirements may encourage education about screening and reporting family violence, given the time constraints on training, that may come at the cost of training about treating, referring, and preventing family violence.
A few states mandate family violence education for health professionals. The committee could find no formal evaluations of the impact of the education provided in accordance with those laws. However, studies demonstrate that health professionals who have obtained any continuing education about child maltreatment (not necessarily mandated) are no more likely—and in some study samples are less likely—to report child abuse and neglect than are those who have not attended such training.