Training clinicians to recognize and respond to family violence
Harriet MacMillan, CM, MD, FRCPC, and her team at McMaster University have developed the Violence Evidence Guidance Action (VEGA) project – online resources to educate health care and social service providers and students across Canada in recognizing and responding to family violence. The team collaborated with national organizations in the design of VEGA to address this major public health problem. VEGA was launched in February 2020 and is publicly available.
According to Dr. MacMillan, physicians in every medical specialty have patients who have experienced family violence.
“Studies show that family violence affects at least one in three people in Canada,” said Dr. MacMillan, who is a pediatrician, psychiatrist and distinguished university professor at McMaster University’s Departments of Psychiatry and Behavioural Neurosciences, and Pediatrics. “Yet I still hear some physicians say that understanding family violence is not relevant to their practice. We need to have both a willingness and the education to help patients who are experiencing family violence.”
VEGA is a no-cost, bilingual, four-module interactive learning pathway that walks learners through essential topics about family violence. These include facts about family violence in Canada, how to create safety for people experiencing family violence, and how to recognize and respond to child maltreatment and intimate partner violence, with subsections on children’s exposure to intimate partner violence.
A flexible platform focused on patient safety
Dr. MacMillan’s team designed VEGA with funding from the Public Health Agency of Canada (PHAC) in collaboration with 22 national health care and social service organizations. The platform was designed to fill gaps in how providers and students are educated about family violence during their training and while in practice.
“Programs today tend to focus on the epidemiology of family violence without providing opportunities to learn how to ask about violence and how to respond when a patient discloses this is happening in their life,” said Dr. MacMillan. Unless clinicians learn how to assist in ways that are evidence-based, safe and appropriate, they can do more harm than good, she said.
“As one example, a clinician might ask a patient if they are experiencing violence, without ensuring that no one, including a partner, can overhear. If you’re speaking to a patient over the phone, is the connection private? Are children or a partner listening in the background? Has the patient been appropriately advised that when discussing intimate partner violence, if a child is at risk, this would require the clinician to contact child protection services?”
Using care pathways, scripts, how-to videos, interactive educational scenarios and a handbook, VEGA moves learners through modules that address these pressing issues at whatever pace suits the individual, and in whatever order. The VEGA resources are designed for maximum flexibility.
McMaster received additional funding from PHAC to undertake a three-year evaluation of VEGA. Led by McMaster’s Melissa Kimber, PhD, the Researching the Impact of Service provider Education (RISE) project is a collaboration between McMaster, three other universities, and eight professional associations, including the Royal College. The organizations will evaluate the use of VEGA materials within their provider and student memberships.
The three-phase evaluation will
- examine the best ways to mobilize and sustain family violence education among clinicians
- conduct user testing to ensure the technology meets learners’ needs in recognizing and responding to family violence
- conduct an open pilot trial in a primary care setting to gauge VEGA’s success in improving the knowledge, clinical skills and attitudes of users
Represented by Jonathan Sherbino, MD, FRCPC, DRCPSC(CE), professor of medicine and assistant dean of health professions education research at McMaster University, the Royal College will participate on the RISE implementation team, which meets every three months to advise the RISE team on the best ways to roll out VEGA and support learners.
“The implementation team will give us advice on whether self-directed online learning is enough, whether we need to offer complementary workshops, and how we engage learners who might not perceive family violence as a priority area in their practice,” said Dr. Kimber. “How do we get these learners to see that family violence is relevant to their practice?”
The Royal College will work to recruit learners through its online communities. “We hope that when Fellows receive that invitation, they will be willing to participate in the evaluation,” said Dr. Kimber.