Academic journal article Violence and Victims

A Training Program to Improve Domestic Violence Identification and Management in Primary Care: Preliminary Results

Academic journal article Violence and Victims

A Training Program to Improve Domestic Violence Identification and Management in Primary Care: Preliminary Results

Article excerpt

Domestic violence as encountered in day-to-day practice is greatly underidentified. It is estimated that only 3% of cases are presently being identified, and practitioners are uncertain of what to do if a case is discovered. In this paper, a training program to improve identification and management of domestic violence (DV) in primary care and the providers' responses to the program are described. A multimodal training program was undertaken to demonstrate and practice the incorporation of didactic content into practice for the health care teams. Two medical centers from a large staff-model HMO were chosen at random from five volunteering for training. The entire adult health care medical center teams, including physicians, physician assistants, RNs, LPNs, medical assistants, and receptionists, were the recipients of the training. Assessment of provider valuation of the components of the training program was performed by administering a standardized 5-point Likert-scaled questionnaire 9 months after the training. This time interval was chosen because we were interested in lasting program effects. Core didactic content, such as the epidemiology of DV, identification and management of victims and batterers, and legal issues, was highly rated. Delivery of the content through role-playing, start-stop videos and presentations by former victims received lesser but solid support. Follow-up assessment 9 months post training demonstrates solid support for many components of the program: highest for specific information content areas, but strong for techniques and processes. The training program appears to be a promising method to improve provider skills in DV management.

Domestic violence, defined as physical or sexual abuse of an adult by a current or former intimate partner or spouse, is a common problem, affecting about 16% of North American couples in a given year, according to self-report (Straus & Gelles, 1986). Estimates of prevalence in primary care practice range from 3.9% to 22% (Gazmararian et al., 1996; Gin, Ruchter, Frayne, Cygan, & Hubbell, 1991; Hamberger, Saunders, & Hovey, 1992; McCauley et al., 1995). Yet the problem is identified by practitioners far less frequently than it occurs (McLeer, Anwar, Herman, & Maquiling, 1989). It is estimated that only 1%-15% of adults seen in primary care are even asked about DV (Gelles & Straus, 1988; McCauley et al., 1995; Straus, Gelles, & Steinmetz, 1980; Straus & Smith, 1993).

Primary care providers find it difficult to discuss domestic violence with patients. Barriers elicited from practitioners include lack of training, fear of offending patients, a sense that there isn't much one can do, and lack of time in a busy schedule to deal with a complex social issue (Sugg & Inui, 1992; Sugg, Thompson, Thompson, Maiuro, & Rivara, in press, 1998).

We have conducted an intensive 1 year longitudinal multifactorial intervention at two primary care clinics of a large staff model health maintenance organization. The intervention employs a systems approach and is based conceptually on the Precede/Proceed Model of Green and Kreuter (1991). The objective is to achieve sustained improvement in the identification and management of DV as encountered in primary care practice. A key component of the overall approach used was the provider training program. While a number of training protocols have been proposed for managing domestic violence in emergency medical settings (American Medical Association, 1992; Harborview Medix Training Protocol, 1988; Isaac & Sanchez, 1994; Klingbeil & Boyd, 1985; McLeer, Anwar, Herman, & Maquiling, 1989; Olson et al., 1996; Reece & Grodin, 1985; Snyder, 1994; Waller, Hohenhaus, Shah, & Stern, 1996), few have focused upon attempts to improve health care provider response in primary care settings (Ambuel, Hamberger, & Lahti, 1996; Hamberger, 1992; Sassetti, 1992).

The objectives of the present paper are to (a) to describe a training model to improve the response of primary care providers to domestic violence; (b) to discuss the process of implementing such a training model; and (c) to provide survey data documenting the providers' responses to the training 9 months later as a measure of effect duration. …

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