REQUIREMENTS FOR IL LEARNERS

k = Knowledge based objective, s = Skill based objective, a = Attitude based objective

Individual Learner Competency

Educational Objectives Learners should be able to:

A.    Demonstrate general knowledge of violence and abuse.

Video/PowerPoint/Website/PDF

• Corporal Punishment - Website

o Child Exposure to Violence - Website

• Child abuse and neglect - Website

o Elder Abuse – Mosqueda 2011 – PPT

• Training on Violence - Website

o Addressing Violence and Abuse in a changing Healthcare System - Website

• Economics of Violence and Abuse - PPT

o Economics of Violence and Abuse #2 -PPT

• Economics of violence and Abuse # 3 -PPT

o Economics of Violence and Abuse #4 -PPT

• Teen Dating and Violence - Website

o Animal Cruelty (Boat 2014 PPT)

• Military Sexual Trauma - PPT

o Bullying / Cyberbullying – Friend 2011 -PPT

• The Long Term Effects of Child Maltreatment - Website

o Spiritual Abuse - When Faith Hurts - PPT

• Recognizing and Responding to the Spiritual Impact of Trauma – (Vieth 2014PPT)

o Making Violence Prevention Urgent – (Mercy - Video)

• Toxic Stress (Block 2013 - Video)

1. Understand the definitions of abuse and violence. (k)
2. Understand the interpersonal dynamics of violence
   and abuse, and the varied and changing types of violence and abuse.(k)
3. Know the epidemiology of violence and abuse in the general population and in specific clinical populations.(k)
4. Distinguish between myths and facts about violence and abuse. (k)
5. Know risk factors for continued abuse, morbidity and mortality including suicide, homicide. (k, s)
6. Understand the acute and chronic physical and behavioral health effects of violence and abuse. (k)
7. Understand the functions of violence and barriers to help- seeking (individual, social, institutional and cultural). (a)
8. Understand the social and cultural context of violence
   and abuse, including factors such as gender, sexual orientation, social class, ethnicity, religion, developmental stage, immigrant or refugee history, and local, regional and national variations. (k)
9. Understand individual and population based models for intervention and primary prevention of violence and abuse. (k)
10. Acknowledge pre-existing values, attitudes, beliefs and experiences related to abuse among health care professionals and how these affect interaction with patients and clients. (a)

B.     Demonstrate clinical skills appropriate to one’s profession and specialty including the ability to identify, assess, intervene and prevent violence and abuse.

Video/PowerPoint

• Physical Manifestation of Exposure to Violence

o ACE study – Long Term Effects. (Alexander 2014 - Video; Humphreys 2011 Telomere Shortening - PPT)

• Patient Abuse, Neglect, and Exploitation (Franchek-Roa 2014 - Video)

o Screening for Trauma (Keeshin 2014Video / PPT)

• Improving Health Outcomes – Mitigating Trauma (Boat 2014 Video)

o Chronic Effects of Abuse and Neglect – (Felitti 2010 - Video; PDF)

• Guidelines - Trauma Informed Care (PDF)

o Gathering in a desert – (Wiet 2014 -  Video)

• Mandatory Reporting Laws by State (Website)

o Peer Victimization and Aggression

• They Will Not Suffer from Our Neglect (Block 2014 - Video)

o Violence, Sex Work, and Trafficking (Decker 2013 - Video)

• Effects of Early Adversity on Brain Development and Mental Health of Very Young Children – (Weiss 2013 - Video /PPT; McCollum PPT)

o Intergenerational Child Maltreatment & Adversity (Putnam 2013 PPT / Video)

• Differential Diagnostic Issues in Child Sexual Abuse (Wherry 2011 - PPT)

1. Assess patients/clients via interview, questionnaire, history taking and health examination processes. Use reliable, valid and normed instruments developed for the assessment of abuse, violence and its symptoms where available. (s)

2. Intervene using evidence-based and evidence-informed treatments. (s)
3. Prevent violence using evidence-based and evidence- informed methods of primary, secondary and tertiary prevention. (s)
4. Recognize risk factors for victimization and perpetration of violence. (k)
5. Recognize physical and behavioral presentations and signs of abuse and neglect, including patterns of injury across the life span. (k)
6. Educate patients and clients regarding limits of confidentiality and reporting requirements.
7. Identify and address the problems associated with emotional, physical, and sexual abuse and neglect. (s)
8. Offer continuity of care and appropriate referrals to community resources. (s)
9. Provide thorough documentation of patient’s and client’s statements, clinical observations, and visual documentation of injuries, using body maps and photographs. (s)
10. Be aware of and comply with state reporting laws, collaborating with the victim of violence to make reports whenever appropriate. (s)
11. Organize and prioritize to provide an accurate, profession- specific assessment of the problem, and safe, efficient, effective care. (s)
12. Acknowledge that achieving safety is often a long-term goal that is achieved by the patient/client, requires significant preparation, and that many successful interventions can be applied during the course of this process (i.e. naming the abuse, offering support, identifying resources, safety planning, etc.). (k, a)
13. Utilize models of health behavior change, advocacy and empowerment to promote harm reduction strategies as part of an intervention. (k, s)

C.    Communicate effectively with the patient/client and family.

• Clinical Guidelines and Protocols (Website; PDF)

o  Outline Training for Family Violence (Website; Video)

• Inter Partner Violence – A Necessity to Identify – Franchek-Roa (Video)

1. Convey concern and support within appropriate professional boundaries. (s, a)
2. When responding to patients/clients exposed to violence or abuse, demonstrate self-awareness of one’s emotional response, beliefs, assumptions and potential biases.
3. Demonstrate appropriate and effective ways of asking about patients’/clients’ exposure to violence or abuse. (s)
4. Communicate appropriate responses to disclosure, non-disclosure and indicators of abuse despite non-disclosure.(s)
5. Acknowledge patients’/clients’ responses in a non-judgmental, supportive way. (s, a)
6. Acknowledge and respect each patient’s/client’s right
   to self-determination and understand that empowerment is a primary goal of intervention. (s, a, k)
7. Review with patient/client available local resources. (s, k)
8. Discuss legal obligations on disclosure of abuse for protected categories of patients/clients. (s)

D.    Communicate effectively with the physical and behavioral health care team.

1. Be able to communicate documented injuries and health effects, using forensic guidelines in obtaining and recording evidence (such as recording specific, concise and objective information utilizing body maps and photographs). (s)
2. Understand and appreciate the role and contribution of other professions in preventing and managing exposure to violence and abuse. (a)
3. Explicitly negotiate roles and responsibilities for the treatment plan. (s)
4. Maintain patient and client confidentiality in communications with health care team.

E.     Intervene to promote safety and reduce vulnerability.

• Clinical Guidelines and Protocols (Website; PDF)

o  Outline Training for Family Violence (Website; Video)

1. Perform focused assessment of immediate risk/safety including routine inquiry, screening and case-finding. (s)
2. Assess for immediate danger. (s)
3. Promote safety planning with victims and families. (k)
4. Consult with and refer to specialists and community resources for safety, education, caretaking, and support services (such as protective services, social work, shelter, child abuse hotlines, legal, mental health, substance abuse, and criminal justice) as appropriate. (k)
5. Maintain appropriate clinical follow-up. (s)

• Recognize the individual and cultural variation in relationships and distinguish healthy from abusive patterns.

• Building Trauma/Resilience Informed Communities (Hart 2014 – video; Stone 2014video; Tiwari 2015 Video; Anderson 2014 -Video)

o   Community Interventions (Campbell – 2014PPT)

• Elder Abuse (Mosqueda - Featured Video2011, Video 2013)

o   Trauma Informed Care for Veterans (Allen 2014 - Video)

• Learning from successful implementation of a Systems Model to improve IPV services in Kaiser Permanente. (Kotz/McCaw - PPT)

o    HIV risk, Partner Violence and Relationship Power: Testing a Theoretical Model in Young Filipino Adults (Lucea – 2011 PPT)

• Perpetration of IPV: Translating research into an innovative online curriculum (Mason – 2011 PPT)

1. Demonstrate awareness of cross-cultural health issues. (a)
2. Recognize that cultural factors influence the responses communities have to family violence. (k)
3. Provide culturally competent assessment and care to victims and perpetrators of violence and abuse. (s)
4. Recognize potential barriers to providing care and accessing resources that may arise from cultural differences. (a, k)
5. Utilize professional translation services effectively. (s)
6. Know how to assess cultural explanatory models for causation and acceptance/non-acceptance of violence and abuse. (s)
7. Recognize the potential for complex legal and cultural issues related to a refugee’s or immigrant’s exposure to violence
   in their country of origin. (a)

F.     Identify and assess relationship health.

·         Domestic Violence Programs in Healthcare Organizations: Rising to the Challenge(Delgado 2011 PPT)

·         Prevalence of Intimate Partner Violence Among Caregivers of Abused and Non-Abused Pediatric Emergency Department Patients – (Franchek 2011 PPT)

·         Hidden Costs in Health Care: The Economic Impact of Violence and Abuse - PDF

·         Adolescent Health and Development

- Website

·         CAN - Childhood Adversity Narratives, PDF / PPT

·         Brain Consequences of Early Trauma -PPT

·         LBGTQ Youth in Foster Care (Simonton – 2014 PPT)

·         LGTB – Healthy Relationships - Website

1. Explain that a person’s relationship health has a significant impact on their physical and mental health. (s)
2. Understand that relationships are dynamic processes that impact people differently. (k)
3. Recognize that healthy relationship dynamics are the standard on which an assessment of the status of relationship health should be based. (a)
4. Demonstrate effective communication strategies with patients and clients regarding elements of healthy and unhealthy relationships in the context of health and wellness. (s)
5. Demonstrate the ability to refer patients and clients to the appropriate resources depending on their relationship health needs. (s)

G.    Intervene to promote safety and reduce vulnerability.

·         Trauma Prevention in the Community – Panel Discussion (Taylor et al - Video)

·         Trauma Programs for Families with Young Children (Miller 2014 - Video)

·         Health After Trauma - Website

1. Perform focused assessment of immediate risk/safety including routine inquiry, screening and case-finding. (s)
2. Assess for immediate danger. (s)
3. Promote safety planning with victims and families. (k)
4. Consult with and refer to specialists and community resources for safety, education, caretaking, and support services (such as protective services, social work, shelter, child abuse hotlines, legal, mental health, substance abuse, and criminal justice) as appropriate. (k)
5. Maintain appropriate clinical follow-up. (s)

H.    Know the ethical requirements of one’s profession regarding violence and abuse.

·         Addressing Violence in the Clinical Setting - Website

1. Know ethical principles that apply to patient and client confidentiality for patients/clients exposed to violence and abuse as well as the limits of that confidentiality. (k)
2. Be able to explain the limits of confidentiality. (k)
3. Be aware of the formal ethical positions of the learner’s discipline. (k)

6. Incorporate these ethical requirements in the learner’s personal ethical system regarding care. (a)

·         Child Advocacy Studies (Vieth 2013 – PDF /PPT)

1. Know how to identify resources in a state and local community and build collaborative relationships with these resources. (k)
2. Understand the impact of community outreach programs on the prevention of physical, emotional and sexual abuse and neglect. (a)
3. Understand the principles of prevention of interpersonal violence. (k)
4. Demonstrate the ability to collaborate with other disciplines to create a comprehensive response within a clinic, organization, hospital, or emergency department; including prevention, identification, intervention and follow-up. (s, a)

Demonstrate understanding and ability to collaborate with individuals, disciplines, professions, and agencies that may be directly and indirectly involved with advocacy to end violence. (a)

K. Practice effective self-care.

1. Acknowledge how one’s own experiences with violence and abuse may influence one’s ability to respond appropriately to situations, to ask for assistance resolving biases, and developing competencies. (k, a)
2. Be aware of the potential effects on providers of caring
   for patients and clients exposed to violence and abuse. (a, k)

4. Know how to access support for effective self-care. (k)

L. Obtain the training and skills necessary to advance the field.

1. 1. Understand how to acquire additional teaching skills, research and advocacy skills. (k)
2. 2. Take responsibility for personal and professional development and identify appropriate learning activities. (a)

M. Apply the concept of systems-based practice.

1. Understand how to develop a patient-centered, systems- based, inter-professional intervention in an outpatient office, emergency department, or health care system. (k)

Be able to describe the prevention, recognition, treatment and management of exposure to violence and abuse in terms of organized systems of care. (s)