Confronting Chronic Neglect The Education and Training of Health Professionals on Family Violence (2002) / Chapter Skim
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4 Forces Influencing Health Professionals' Education
4 Forces Influencing Health Professionals' Education
Pages 45-83
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From page 45... ...
The factors considered include training environment issues; accreditation, licensure, and certification requirements; individual issues for health professionals; the influence of health professional organizations and other stakeholder groups; laws mandating reporting and education about family violence; and funding. Throughout its discussion of challenges to training, the committee struggled with two issues.
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From page 46... ...
Traditionally, when confronted by the circumstances of violence, the health professionals have deferred to the criminal justice system....
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From page 47... ...
Progress appears to have been made on health professionals' recognition of family violence as a health issue. For example, in 1991, the American Nurses Association published guidelines for identifying and treating intimate partner violence (ANA, 1991~; the American Medical Association did the same in 1992 (AMA, 1992~.
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From page 48... ...
Educational Needs and Priorities Health professional curriculum development occurs in an environment of competing needs in which diverse curricular objectives must be sorted and prioritized. With the continuing increase of knowledge and expertise in health care as more research is conducted and published, potential topics for education increase while the educational time available remains the same.
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From page 49... ...
Allocation of Training Time and Adequacy of Training Despite the numbers of existing curricula and beliefs about the need for family violence education, the amount of time allocated to this subject matter has been minimal (MMWR, 1989; Alpert, 1995; Alpert et al., 1998; Kassebaum, 1995~. A total of 33 percent of a sample of physicians, nurses, social workers, psychologists, dentists, and dental hygienists reported that they have received no education about child abuse, intimate partner violence, or elder abuse during graduate school, residency training, or continuing professional education (Tilden et al., 1994~.
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From page 50... ...
In addition, approximately two-fifths of mental health workers reported that they had not received any training on intimate partner violence (Campbell et al., 1999~. Recognizing these issues, the APA Working Group on Implications for Education and Training of Child Abuse and Neglect (Haugaard et al., 1995)
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From page 51... ...
Like the general public, health professionals are raised and trained in a society in which public intervention in "private" family matters has been proscribed until recent years and in which victims of family violence, particularly women and children, historically have had relatively little public recourse. American society has a long history of maintaining the privacy of family matters.
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From page 52... ...
The beliefs about private family matters reflected in the legal system also appear to affect health professionals. Health professionals have expressed concern or discomfort with intervening in situations they view as private matters and may demonstrate these reservations when teaching or supervising students.
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From page 53... ...
Social norms may also result in the marginalization of health professionals who do assume leadership roles in family violence. Students may make their career choices, in part, based on others' perceptions of particular fields (Hunt et al., 1996~.
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From page 54... ...
An example of this phenomenon has been published in the intimate partner violence literature (McLeer et al., 1989~. The initial success of a novel emergency department screening program for intimate partner violence reverted to its inadequate baseline screening rate following the departure of the individuals primarily involved with the intervention.
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From page 55... ...
Certain subspecialty areas do have education or training requirements in specific types of family violence. For example, the American Board of Obstetrics and Gynecology requires intimate partner violence training, and the American Board of Pediatrics requires training on child abuse and neglect.
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From page 56... ...
However, specific content for exam questions can change from year to year and is dependent on the makeup of the committees assigned by the practice organizations. INDIVIDUAL ISSUES: PROFESSIONAL AND PERSONAL FACTORS The development and impact of health professional education on family violence may be affected by professional or personal concerns, beliefs, or experiences.
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From page 57... ...
Even if time were not an issue, health care providers have expressed concerns regarding inadequate preparation, uncertainty about how to proceed if maltreatment is disclosed, and frustration with the inability to ensure positive outcomes for the victims. For example, one study indicates that many health professionals believe they have not had adequate medical education or training on intimate partner violence (Reid and Glasser, 1997; see also Chapter 3, this volume)
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From page 58... ...
A causal relationship between these interventions that include education and screening, however, has not been established. Some health professionals indicate that they are frustrated even when they do offer treatment and provide referrals.
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From page 59... ...
Some personal values regarding family violence and difficulty in addressing it may stem from personal experiences with victimization. Many health professionals report personal experiences with family abuse.
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From page 60... ...
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.
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From page 61... ...
provided a general review of relevant research and considered psychology's potential contributions to responses to child abuse and neglect, intimate partner violence, and elder maltreatment. The task force appeared to start from an assumption that training about family violence for psychologists and other service providers has typically been inadequate, a perception echoed by most clinical psychologists themselves, especially those trained prior to 1985 (Pope and Feldman-Summers, 1992~.
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From page 64... ...
In addition, a number of advocates have expressed concerns about involvement with the health professions, believing health professionals may create obstacles to advocacy efforts and health professional education on family violence, if they do not understand or support the work the advocates are doing. Systematic efforts were initiated in the 1960s and 1970s to integrate child maltreatment into the curricula of all of the health professions.
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From page 65... ...
65 E ct a)
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From page 66... ...
Victims of both intimate partner violence and childhood sexual abuse have recounted how the health care system has failed them and how individual health care providers have made the situation worse (Herman, 1992; Sipes and Hall, 1996; Yllo and Bograd, 1998~. To address these concerns and to encourage health professional involvement with family violence issues and victims, advocates have been at the forefront in the training of health care professionals about family violence, particularly violence against women.
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From page 67... ...
Victims of elder abuse, however, are often unable to advocate for themselves due to illness and incapacitation. At least in the area of intimate partner violence, victims have also begun to have a voice in research about needed directions in the health care system (e.g., Gielen, 2001; Rodriguez, 1998, 1999; Sipes and Hall, 1996~.
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From page 68... ...
, financial incentives or disincentives associated with the current coding systems, and the implications of coding practices for patients and health care service delivery.6 Further examination of the role third-party reimbursement plays in health professional training about family violence is needed and may result from this meeting. LAWS MANDATING REPORTING AND EDUCATION Mandatory reporting and mandated education laws have been conceived as possible means for ensuring that health professionals receive training in family violence.
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From page 69... ...
. Every state also requires reporting by some subset of allied health professionals, but this term is defined differently across jurisdictions and may include paramedics, emergency medical technicians, physical therapists, dental hygienists, chiropractors, "practitioners of the healing arts," or "persons having responsibility for care or treatment of children." Intimate Partner Violence.
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From page 70... ...
The typical legal standard that triggers these reporting requirements is "reasonable cause to suspect" or "reasonable cause to believe." Kentucky requires physicians, dentists, mental health professionals, nurses, social workers, and some allied health workers to report intimate partner violence. California and Rhode Island do not apply this requirement to mental health professionals or social workers.
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From page 71... ...
It is not uncommon for health professionals to refrain from reporting suspected child maltreatment that they do not regard as serious or clear-cut (Finlayson and Koocher, 1991; Kalichman and Brosig, 1993; Kalichman and Craig, 1991; Kalichman et al., 1988, 1989; Watson and Levine, 1989; Zellman, 1990a)
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From page 72... ...
Reporting requirements appear to succeed in providing a place within health professional curricula for the issue of family violence and increasing attention to health professionals' responsibility for identifying and reporting it. However, existing curricula may focus on required reporting procedures to the exclusion of health professionals' roles in treating, referring, and preventing family violence.
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From page 73... ...
Intimate Partner Violence. Three states Alaska, Florida, and Kentuckymandate that health professionals receive education about intimate partner violence.
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From page 74... ...
Federal fundingl° may be provided through agencies such as the Health Resources and Services Administration of the Department of Health and Hu1OA number of foundations (e.g., Commonwealth, Conrad-Hilton) have previously funded or currently fund family violence research and training initiatives.
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From page 75... ...
A review of individual federally funded projects indicates that few involve the training of health professionals in family violence research. The National Institute of Mental Health currently funds five pro- or postdoctoral research training grants related to family violence (see Table 4.2~.
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From page 76... ...
NIMH Medical Kilpatrick, Child and Adult Trauma JAN 98- X X University of Dean G. Victims: A Training JUN 03 South Carolina Program (T32MH18869) NSF, HUD, NLT Carnegie Blumstein, National Consortium on MAY 95 Mellon Alfred Violence Research APR03 University (SBR-9513040)
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From page 77... ...
State Victim Compensation and Assistance and Victim Assistance and Law Enforcement funds, allocated through the U.S. Department of Justice, have sometimes been used for the continued training of professionals in evaluating criminal forms of maltreatment, but the focus is not on health professionals.
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From page 78... ...
Title IV-E of the Social Security Act also provides for training in the area of elder welfare. That training can include activities to educate health professionals collaborating with workers in social services.
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From page 79... ...
Louis, and Wellesley College, was funded at approximately $500,000. Federal funds for health professional training are closely linked to the priorities that are named by institutions such as HHS.
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From page 80... ...
Furthermore, developing the human resources necessary may not be achieved among health professionals at the teaching rates and hours currently evidenced in the literature (Alpert et al., 1998; Woodtli and Breslin, 1996~. The problem becomes circular: research and training deficits yield few well-prepared educators, and an inadequate supply of educators and researchers results in inadequate training and research.
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From page 81... ...
Individual health professional concerns, beliefs, and experiences can create challenges to educating health professionals about family violence. Notable individual concerns include perceptions of inadequate time or preparation, personal values, and personal experience with victimization and traumatization.
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From page 82... ...
. The impact of mandatory reporting laws on family violence for health professionals is unclear, but the existence of such laws suggests a need for educational content about them.
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From page 83... ...
Funding for training programs in family violence education in the health professions does not appear to be a priority and does not appear to be consistently available. Information about funding is fragmented.
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