Confronting Chronic Neglect The Education and Training of Health Professionals on Family Violence (2002) / Chapter Skim
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5 Evaluation of Training Efforts
5 Evaluation of Training Efforts
Pages 84-107
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From page 84... ...
Some studies have found modest positive correlations between individuals' reported involvement in training and family violence assessment and management practices (Currier et al., 1996; Flaherty et al., 2000; Lawrence and Brannen, 2000; Tilden et al., 1994~. Although this observed relationship cannot be mistaken for evidence that these practices are a direct product of training, it does suggest more careful examination of what is known about the effectiveness of family violence curricula and other training strategies on clinician behaviors and indicates the need for more explicit examination of causation.
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From page 85... ...
Due to the dearth of published studies on elder abuse training, the focus is on outcomes and effectiveness of child abuse and intimate partner violence training. SEARCH STRATEGY Four bibliographic databases were systematically searched for studies that evaluated training efforts in family violence and were published prior to November 2000.
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From page 86... ...
evaluated trauma training, which included both intimate partner violence and child abuse, and the Thompson et al.
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From page 87... ...
. 5Summaries of these studies in terms of training characteristics, outcomes assessed, evaluation designs, measurement strategies, and major results are provided in Appendix F for intimate partner violence training and Appendix G for child abuse training evaluations.
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From page 88... ...
For example, no study examined outcomes of child abuse training efforts for medical students; in contrast, 13 percent of the intimate partner violence evaluations examined formal medical school courses, modules, and other intenTABLE 5.1 Overview of Training Interventions Assessed in the Evaluations of Intimate Partner Violence and Child Abuse Training Area of Family Violence Addressed Intimate Partner Violence (n = 7) Child Abuse (n = 30)
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From page 89... ...
of the seven training evaluations in child abuse were directed at professionals who are most likely to encounter child maltreatment casesnamely, pediatric residents and child protective services workers (Cheung et al., 1991; Dubowitz and Black, 1991; Leung and Cheung, 1998; Palusci and McHugh, 1995; Sugarman et al., 1997~. No assessments of intimate partner violence or child maltreatment training efforts designed for the dental or physician assistant professions have been conducted.
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From page 90... ...
ASSESSING THE AVAILABLE EVIDENCE Understanding the effectiveness of family violence training programs necessitates estimating the unbiased effects of training (i.e., the impact of training above and beyond the influence of other variables that may have contributed to the observed outcomes)
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From page 91... ...
Furthermore, if reliable change in outcomes is repeatedly not found, attention can be directed at understanding the reasons for these no-difference findings (e.g., poor engagement of participants, unreliable or insensitive measures, loss of organizational support for identification and management of family violence, poorly designed training curricula) so as to improve the development of training strategies and the choice and measurement of outcomes in the future.
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From page 92... ...
There was a clear difference in the attention paid to the three outcome domains, depending on the type of training. About 57 percent of intimate partner violence training evaluations measured improvements in knowledge, attitudes, and beliefs.
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From page 93... ...
These same researchers also assessed overall competency as indicated by supervisor job ratings (Leung and Cheung, 1998~. Evaluators of training efforts on intimate partner violence were more likely to measure multiple outcomes in the same study: 30 percent of the evaluations in this area reported findings on two outcomes, and another 10 percent assessed outcomes in all three domains.
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From page 94... ...
With regard to measuring screening prevalence, identification rates, documentation, and referrals, evaluations of intimate partner violence training relied on reviewing patient charts. The typical practice was to use standardized forms
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From page 95... ...
A handful of intimate partner violence training evaluations also assessed knowledge levels after a much longer time had elapsed (e.g., Campbell et al., 2001; Ernst et al., 2000; Short et al., 2000; Thompson et al., 2000~. This is not true for child abuse training evaluations, for which there are no available data on the degree to which participants retained what they learned more than six months after training.
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From page 96... ...
FIGURE 5.1 Timing of measurement in evaluations by type of training and outcome domain. IPV = intimate partner violence; CA = child abuse and neglect; KABB = knowledge, attitudes, beliefs, behaviors.
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From page 97... ...
Approximately 63 percent of the studies assessing knowledge in both intimate partner violence and child abuse training relied on this design, and of this group, two-fifths limited their study to examining only changes that occurred immediately after the training session had concluded. The remaining studies were more ambitious, either incorporating a comparison group that received no training or a different type of training, but assignment to these comparison groups was nonrandom.
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From page 98... ...
98 .~ o an o o be .= ·_' Em o an EM Cal an o C)
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From page 99... ...
For more direct indicators of clinical competency, Leung and Cheung (1998) found that child protective services workers who had received three months of focused training on child abuse improved between their six-month, nine-month, and first annual evaluation and between their first annual and second annual evaluation as measured by supervisor job performance ratings that covered such behaviors as case interviewing and documentation)
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From page 100... ...
The extent to which they are sustained or can confidently be attributed to the training interventions themselves is unclear. Training on Intimate Partner Violence The degree to which health professionals involved in training on intimate partner violence actually change their knowledge, attitudes, and beliefs was addressed by 13 of the 15 training evaluations.l° Typically, these evaluations did not go beyond examining changes before and after training, and posttests were usually administered immediately upon training completion or shortly thereafter (within one month)
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From page 101... ...
Nearly 2 years after a focused, 2-day training workshop, emergency department staff evinced less blaming attitudes toward victims and were more knowledgeable about intimate partner violence and their role in addressing this problem than prior to training (Campbell et al., 2001~. Furthermore, this group, which worked in hospitals that were randomly assigned to the training intervention, outperformed their counterparts at other hospitals who had not received the training.
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From page 102... ...
Based on follow-ups conducted anywhere between 1 and 12 months after "raining, 7 (or 54 percent) of the evaluations found that the percentage of women who were positively identified as abused increased significantly in those emergency departments or clinics in which staff had received intimate partner violence training.
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From page 103... ...
Overall, the above results suggest that if training is to result in increased screening for intimate partner violence, it must include instruction in and use of screening protocols and other types of standardized assessment materials. Clearly attesting to this are the findings from McLeer et al.
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From page 104... ...
Training on Elder Abuse As previously noted, the training of health professionals to identify elder abuse and neglect and intervene appropriately has received little attention in the literature. Descriptions of formal curricula and training models are few in number.
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From page 105... ...
QUALITY OF THE EVIDENCE BASE A previous National Research Council and Institute of Medicine report (1998) concluded that the quality of the existing research base on family violence training interventions is "insufficient to provide confident inferences to guide policy and practice, except in a few areas.
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From page 106... ...
However, only seven formal assessments, all of which suffered from methodological weaknesses, could be found. Training efforts in intimate partner violence also can benefit from more serious scrutiny.
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From page 107... ...
and must include those who are responsible for creating the necessary infrastructure to support and reward practitioners for paying attention to identifying and intervening with family violence victims. Although the evidence for this conclusion derives mostly from evaluations of intimate partner violence training efforts, it is likely that the same could be said about child and elder maltreatment training activities.
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