Confronting Chronic Neglect The Education and Training of Health Professionals on Family Violence (2002) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-12
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They are often the first to encounter victims of family violence and consequently can play an important role in ensuring that victims, and also perpetrators, get the help they need. Health professionals provide care for the physical and psychological problems associated with abuse and neglect, ranging from acute injuries to chronic medical conditions to psychiatric and psychological disorders.
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On the basis of its assessment and deliberations, the committee draws a number of conclusions regarding the current state of health professional training on family violence and makes recommendations to direct future efforts. These conclusions and recommendations address two major concerns: resources and coordination for education research and curricular development to expand the knowledge base and inform policy and practice, and curricular content and teaching strategies.
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. A better understanding of baseline problems, health care needs, and costs associated with family violence could reinforce the need for more focused attention by health professionals, provide guidance on
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Similarly, clarity and consistency in data sources and research methods are needed to accurately describe the prevalence of family violence as encountered in health care settings and the health care needs of victims. Such an evidence base could shed new light on the roles of health professionals and their opportunities to intervene and respond more effectively to family violence and also provide a foundation for their more effective education.
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These centers should be charged with conducting research on the magnitude and impact of family violence on society and the health care system, conducting research on training, and addressing concerns regarding the lack of comparability in current research. The ultimate goal of these centers will be to develop training programs based on sound scientific evidence that prepare health professionals to respond to family violence.
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Conclusions Curricula on family violence for health professionals do exist, but the content is incomplete, instruction time is generally minimal, the content and teaching methods vary, and the issue is not well integrated throughout their educational experiences. Moreover, studies indicate that health professionals and students in the health professions often perceive existing curricula on family violence to be inadequate or ineffective.
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. Existing education theories about behavior change suggest useful teaching methods and approaches to planning educational interventions for health professionals tailored to the issue of family violence.
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. 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.
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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.
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Efforts by the American Association of Colleges of Nursing, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, 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. 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.
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The committee's review of existing training programs for health professionals and the evaluation of those programs suggest evaluation is often not specifically funded. Funders should require that evaluations be conducted as a condition of funding and should provide funding at appropriate levels or the resources and support to ensure that evaluation is possible.
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Yet studies consistently describe the lack of education for health professionals on family violence as a major barrier to the identification, treatment, and provision of assistance to family violence victims (e.g., Chiodo et al., ~ 994; Ferns, 1994; Hen~icks-Matthews, 1991; King, 1988; Reid and Glasser, 1997; Sugg and Inui, 1992; Tilden et al., 19941. Some health professionals have expressed concern that they have never had the opportunity to learn how to ask patients about possible abuse; even with training, many report that they are ill equipped or are not encouraged in the practice setting to address family violence (Cohen et al., 1997; Schechter, 19961.
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