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Viewpoint

Confronting Chronic Neglect: Training Health Professionals On Family Violence

Krugman, MD

Richard D. Krugman, M.D., Dean, University of Colorado School of Medicine

On Tuesday, Sept. 11, 2001, the National Academy of Sciences (NAS) convened a news conference at 9 a.m. in Washington, D.C. The occasion was the release of a new report, mandated by the Health Professions Education Partnerships Act of 1998 (P.L. 105-392) and sponsored by the U.S. Centers for Disease Control and Prevention. The report was titled Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence.

Fifteen professionals from a variety of disciplines within the health sciences, mental health, and law, with expertise in the three areas of child maltreatment, domestic violence, and elder abuse, had worked for nearly two years to prepare the report that few of us have since heard about because of what else happened that morning.

For those of us who have worked in the area of family violence for a long time, the shelving of another report calling attention to the problem is not news. There have been at least five major reports released over the last dozen years dealing with the problem of child abuse and neglect that have led to noticeable change in federal policy - including four by the U.S. Advisory Board on Child Abuse and Neglect, and one by the National Research Council.

What is it about this area that leads to persistent gaze aversion by professionals and the public? There are many reasons, of course. One is the reality that many view family violence as a social or legal problem, rather than a health or public health problem.

This in spite of the reality that the annual morbidity and mortality from all forms of family violence far exceeds that of all forms of terrorism (and many other more traditional health conditions) in the United States. For this reason, I have chosen to highlight this latest report, in the hope that those responsible for health professional education will heed some of the NAS recommendations.

The committee's task was to review:

available research on the training needs of health care providers from the various disciplines that come into contact with family or acquaintance violence, and the appropriateness of the training provided;
available curricula for screening, detecting, and referring family violence in health care delivery settings, the effectiveness of these curricula and training activities, and the outcomes associated with these interventions; and
existing efforts, coalitions, and initiatives intended to foster the knowledge and skills base of health care providers in dealing with family violence victims.

The conclusions of the committee were that family violence is common and results in significant health effects, and that the effects of family violence on the health care system and society have not been adequately studied and need to be consistently and systematically documented.

With regard to current activities by health professional schools, the conclusions were that:

curricula on family violence for health professionals exist and appear to be increasingly prevalent;
studies indicate that health professionals often perceive family violence curricula as inadequate or ineffective;
formal curricula content on family violence is limited, instruction time is minimal, and content and teaching methods vary; and
the issue is not well integrated throughout the educational experience.

What, then, needs to happen? At the spring meeting of the AAMC Council of Deans, the last morning was spent discussing this report and bioterrorism. These subjects - along with a host of others, such as nutrition and complementary/integrative medicine - are curricular orphans.

How should we ensure that schools of medicine and other health professional schools include these subjects in their curricula? It is clear from the NAS study that there are many schools that have one or two faculty who work in each of the three areas of family violence. These faculty are responsible for the bulk of the teaching and clinical work in the area. In the view of the NAS committee, a sustained effort is needed to build a research and training infrastructure in each of the three areas of family violence if we are to make progress.

Whether Congress will respond to the call, or whether another report will begin the dust-gathering process, remains to be seen. Family violence is a health problem and, as such, health professional students need to acquire the competencies necessary to recognize, treat, and prevent it.