How much training is enough? Evaluating clinician self-reported family violence response skills following a 3-year transformational change project in a major trauma hospital.

BACKGROUND: Rates of family violence are high in many societies, with disproportionate impacts on women and children. Healthcare services have an important gateway role for victim-survivors requiring assistance. There is limited evidence regarding how much training is required for hospital clinicians to be adequately prepared to work effectively with clients experiencing family violence. OBJECTIVES: This study aimed to investigate the impact of different levels of training in family violence, on the knowledge and confidence of hospital clinicians. DESIGN: A cross-sectional, online, survey of hospital clinicians in a major trauma hospital was conducted. The study evaluated the impact of level of family violence training (no training, some training, clinical champions) on staff self-reported family violence knowledge and confidence levels. METHODS: The Assisting Patient/Clients Experiencing Family Violence: Royal Melbourne Hospital Clinician Survey tool was utilised, and open for clinicians to complete, anonymously over a 6-week period. RESULTS: In total, 526 clinical staff participated across a range of profession groups (Allied Health, 47%; Nursing 40%; Medical 13%). Staff with some training (mean training hours 3.25, SD 5.23) rated their knowledge and confidence levels at least two-thirds higher than those with no training. Those trained as clinical champions (mean training hours 14.60, SD 9.14) rated their knowledge and confidence at least 50% higher than staff with some training. An even more pronounced elevation across training levels was seen with specific family violence clinical skills - identifying the signs of family violence, knowing how to screen patients and providing an appropriate response to disclosures. CONCLUSIONS: Training in family violence clinical response significantly increased self-reported knowledge and confidence levels of hospital staff, with the extra time and resourcing required to train clinical champions, showing clear benefits. The provision of evidence-based and well-resourced family violence education for healthcare professionals is required to drive clinical practice improvements for victim-survivors.

Training requirements for healthcare workers helping patients with family violence issues.Rates of family violence are high in many communities. Women and children are most affected by this violence. Healthcare workers have an important role to play in helping people with family violence issues. There is little information about how much training healthcare workers need to do this effectively. This study evaluated the effect of different levels of training in family violence on the knowledge and confidence of hospital clinicians. Healthcare workers in a large trauma hospital were surveyed. 526 clinical staff responded, including Allied Health (47%), Nursing (40%), and Medical (13%) staff. Clinicians with some training rated their knowledge and confidence levels at least two-thirds higher than those with no training. Those trained as clinical champions rated their knowledge and confidence at least 50 percent higher than staff with some training. An even more pronounced difference was seen across training levels for specific family violence clinical skills. These included identifying the signs of family violence, knowing how to screen patients, and providing an appropriate response to disclosures. Overall, training in family violence clinical response significantly increased self-reported knowledge and confidence levels of clinicians, with the extra time and resourcing required to train clinical champions, showing clear benefits. Well-resourced and designed family violence education for healthcare professionals is required for appropriate care and support to be provided for victim-survivors of family violence.

Successful strategies for preventing and controlling violence against people with intellectual disabilities: a scoping review.

BACKGROUND: Violence against people with intellectual disabilities is unfortunately a reality all over the world, as they are one of the populations most vulnerable to various forms of aggression. Assertive prevention and control measures are crucial to tackle and reduce this problem. The aim of this study was to map and summarize the main measures for preventing and controlling domestic violence against people with intellectual disabilities.  METHODS: This was a scoping review conducted in accordance with the JBI guidelines. The databases consulted were: National Library of Medicine (PubMed); Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science; Excerpta Medica DataBASE (EMBASE); Latin American and Caribbean Health Sciences Literature (LILACS) and SCOPUS. Studies included in this review reported on strategies to address domestic violence against people with intellectual disabilities, published in  the last ten years, in Portuguese, Spanish or English. RESULTS: A total of 11 studies were included in this review. Six studies had high methodological quality and five had moderate. Cognitive-behavioral intervention programs, educational  technologies and/or auxiliary tools, along with the full participation of people with intellectual disabilities in domestic violence prevention measures are appropriate strategies for dealing with this issue. CONCLUSION: Domestic violence against people with intellectual disabilities is relatively unexplored in the health-field scientific literature. Prevention and control measures should be developed with the active involvement of people with intellectual disabilities, generating engagement and knowledge. Preventive measures should be adapted to the personal context and conditions of individuals with special needs, such as those with persistent or chronic mental disorders.

Adaptation of the RESPECT framework to prevent violence against women, Indonesia.

Problem: Violence against women is a global health problem. Effectively preventing such violence requires locally adapted strategies. Approach: The World Health Organization in Indonesia, in collaboration with United Nations (UN) Population Fund, UN Women, United Nations Children's Fund, United Nations Development Programme and Joint United Nations Programme on HIV/AIDS, launched capacity-building initiatives to introduce RESPECT as an evidence-based framework to address violence against women. The initiatives included stakeholder engagement, module development, sensitization training, a workshop and evaluation sessions. These sessions introduced RESPECT strategies to government officials, UN officers and community representatives, mapped best practices and developed action plans. Local setting: Indonesia has a substantial burden of violence against women, despite numerous laws and policies to combat it. The 2021 Indonesian violence against women survey showed that 26.1% (3341/12 800) of women aged 15-64 years had experienced violence in their lifetime, with 8.7% (1114/12 800) experiencing violence in the past year. Relevant changes: The initiatives to introduce RESPECT led to securing government support, and verbal commitment was given by the Director for the Protection of Women's Rights against Domestic Violence and Vulnerability to integrate RESPECT into the 2025-2029 National Development Plan and National Strategy for Reducing Violence Against Women. Lessons learnt: RESPECT can be adapted to local contexts through customization and capacity-building and by ensuring initial government support, dedicated personnel, resource allocation and use of established relationships with key stakeholders. Improved research, monitoring and evaluation are vital to promote evidence-informed decision-making, together with community engagement and multistakeholder collaboration. The UN can facilitate these efforts.

[Intra-family violence: identification and ways forward]. / Les violences intrafamiliales : repérage et pistes de réflexion.

For many professionals, coercive control is still a new concept. Yet all caregivers should be familiar with it, in order to be aware of and understand domestic violence. This article, based on the experience of a nursery nurse, looks at the ways in which such violence can be identified, particularly during maternal and child protection missions.

[Coercive control: Health, victims' rights and the ethics of care]. / Contrôle coercitif : santé, droits des victimes et éthique de soin.

This article provides healthcare professionals with an overview of research on coercive control, a paramount concept for understanding domestic violence, primarily targeting women and children. It aims to foster interdisciplinary dialogue and integrate advances into professional practices and (psycho)education. To this end, we present the conceptual evolution of coercive control and the perpetrators' behavioral patterns, their risks for victims and professionals, their devastating impact on the rights and biopsychosocial health of adult and child victims, and the challenges posed by technology, particularly generative artificial intelligence.

[Coercive control: From Diké to Hygée, a judicial and health revolution]. / Le contrôle coercitif : de Diké à Hygée, une révolution judiciaire et sanitaire.

By reversing the questions and focusing on the perpetrator's behavior, the notion of coercive control revolutionizes the apprehension and understanding of violence within the family for all its members. This heuristic approach, which represents a genuine paradigm shift, has legal, semiological and diagnostic effects. It creates a new professional ecosystem that enables us to respond differently to two fundamental missions: caring and justice.

[Social support through the prism of coercive control]. / L'accompagnement social sous le prisme du contrôle coercitif.

Combating domestic violence involves mobilizing a myriad of players throughout the victim's life cycle, including children: health professionals, social workers, law enforcement officers, judges, associations, etc. The mechanisms behind this kind of violence are complex, and every professional needs to have a good understanding of them to be able to identify and provide support. To be more effective, the fight against domestic violence must continue to be thought through. For example, the Observatoire des Violences Intrafamiliales of the Conseil Départemental de l'Allier organized an awareness-raising day on a new concept - coercive control - which is set to make its entry into the Penal Code, and which could change everything.

The effect of a behavioural intervention package on quality of life of pregnant women experiencing domestic violence: a randomised controlled trial.

BACKGROUND: Domestic violence during pregnancy is especially concerning due to its significant detrimental impact on a woman's health and that of her unborn child. The study aims to evaluate the effects of a behavioural intervention package (BIP) delivered during pregnancy on the quality of life (QOL), domestic violence (DV), and reproductive and child health (RCH) of women experiencing DV. METHODS: A randomised controlled trial was conducted on 211 pregnant women recruited between 18 and 20 weeks of pregnancy and randomly assigned to one of two groups: intervention (n = 105) or control (n = 106). The intervention group received BIP and standard care, while the control group received only standard care for 28 weeks. Study tools included socio-demographic variables, a short-form health survey, an abuse assessment screening tool, and an RCH checklist. The tools were completed once before the intervention and again at 6 weeks postnatal. The tools and their subscales were compared pre- and post-intervention using a paired t-test, or Wilcoxon signed test as appropriate to estimate the effect size at baseline and post-intervention. RESULTS: Post-intervention, the QOL scores were found to be significant, with a positive effect favouring the intervention as compared to the control group. The BIP intervention, which was found to be significantly effective (P ≤ 0.001) in reducing DV for pregnant women experiencing DV, was higher in the intervention group than in the control group. CONCLUSION: The BIP may be an appropriate method for treating pregnant women experiencing DV from low socioeconomic strata who attend public hospitals in India to improve their QOL. The approach may offer an intervention that healthcare institutions or other organizations in contact with women at risk of violence can implement. TRIAL REGISTRATION: Indian Registry of Clinical Trials CTRI/2019/01/017009. Registered on 09/01/2019.

An evaluation of education videos for women experiencing domestic and family violence in healthcare settings: protocol for a mixed methods systematic review.

BACKGROUND: Domestic and family violence (DFV) is a significant public health issue that poses a high risk to women, globally. Women experiencing DFV have higher rates of healthcare utilisation than women not experiencing DFV. Healthcare services are therefore well placed to address DFV and deliver education and awareness interventions to women. Video interventions are a strategy to deliver education to women, while overcoming barriers such as language, literacy, lack of rapport with clinician, or unwillingness to disclose. The current review will aim to further understand the characteristics, methods of evaluation, and outcomes of DFV video education interventions for perinatal women. METHODS: The review will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. A systematic search will be conducted of the following databases: Medline, Embase, PsycINFO, PsycArticles, Scopus, and Web of Science Core Collection. Two independent reviewers will screen titles and abstracts against the inclusion criteria, followed by a full text screening of eligible articles. A third reviewer will resolve discrepancies. All study types will be included. Only studies published in English will be included. Risk of bias will be assessed using the Quality Assessment with Diverse Studies (QuADS) tool. Data will undergo an aggregate mixed method synthesis informed by The Joanna Briggs Institute, before being analysed using a thematic approach. DISCUSSION: This systematic review will provide evidence on best practice for the creation, delivery, and evaluation of DFV video interventions for women in the peripartum. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42023475338.

Integrating Trauma-Informed Clinical Interviewing Skills in Medical Education for Screening Domestic Violence and Abuse.

A pre-post-training workshop was conducted among 22 postgraduate trainees of the Psychiatry and Emergency Department of a public sector hospital in Karachi. The workshop aimed to build the capacity of postgraduate trainees in trauma management by providing training on screening, clinical interviewing skills, and Psychological first aid to those exposed to domestic violence (DV). The effectiveness of each training module was evaluated by conducting a brief assessment before and after each module and scores were compared using the Wilcoxon signed-rank test. The post-test showed significant improvement in participants' knowledge on screening of domestic violence and trauma symptoms (p = 0.026) and psychological first aid (p <0.001). Postgraduate training programmes need to integrate trauma screening and management education, to prepare healthcare professionals to deal with sensitive clinical presentations at their work settings. Key Words: Postgraduate trainees, Trauma, Domestic violence, Medical education, Workshop.

Evaluation of an intervention to improve Primary Health Care's response to cases of domestic violence against women - São Paulo, Brazil. / Avaliação de intervenção para aprimorar a resposta da Atenção Primária à Saúde ao cuidado de casos de violência doméstica contra a mulher - São Paulo, Brasil.

The aim was to analyse and improve the Primary Health Care (PHC) response to domestic violence against women (DVAW) by developing, implementing and evaluating an intervention. A pilot study evaluating the before and after of intervention implementation, using mixed methods and carried out in three phases - formative, intervention and evaluation - between August 2017 and March 2019 in two Basic Health Units (UBS) in the city of São Paulo. In this paper, we present the details and evaluation of the intervention, carried out six to twelve months after its implementation. The intervention was developed based on the findings of the formative phase and in line with the health policy that establishes the Violence Prevention Nucleus (NPV) and consisted of stablishing a care pathway; general training for all workers and specific training for the NPV; drawing up educational material and monthly case discussions over 6 months. The evaluation showed acceptability among the workers, increased identification and repertoire for caring for cases of DVAW, strengthening internal referral and the intersectoral network. We identified obstacles to the full implementation and sustainability of the intervention.

O objetivo foi analisar e aprimorar a resposta da Atenção Primária à Saúde (APS) ao cuidado dos casos de violência doméstica contra a mulher (VDCM), desenvolvendo, implementando e avaliando uma intervenção. Pesquisa piloto de avaliação do antes e depois da implementação de uma intervenção, utilizando métodos mistos e realizada em três fases - linha de base, intervenção e avaliação - entre agosto/2017 e março/2019 em duas Unidades Básicas de Saúde (UBS) do Município de São Paulo. Apresentamos neste artigo o detalhamento e a avaliação da intervenção, realizada 6-12 meses após implementação. A intervenção foi desenvolvida com base nos achados da primeira fase e em consonância com a política de saúde que estabelece os Núcleos de Prevenção à Violência (NPV), consistindo em: elaboração de fluxo assistencial; capacitação geral para todos os trabalhadores e específica para o NPV; elaboração de material educativo e discussões mensais de caso durante 6 meses. A avaliação mostrou aceitabilidade entre os trabalhadores, aumentou a identificação e repertório para o cuidado dos casos de VDCM, fortalecendo o encaminhamento interno e à rede intersetorial. Identificamos obstáculos para plena implementação e sustentabilidade da intervenção.

The Supreme Court Decision on Firearm Ownership for People Subject to Restraining Orders.

This Viewpoint explicates the complex reasoning the US Supreme Court has used in rulings on gun control and raises concerns that the recent Rahimi decision poses more questions than it settled on the future of the Second Amendment.

Integrated domestic violence and reproductive health interventions in India: a systematic review.

BACKGROUND: Domestic violence is a leading cause of poor health outcomes during pregnancy and the postpartum period. Therefore, there is a need for integrated domestic violence interventions in reproductive health care settings. India has one of the highest maternal and child mortality rates. This review aimed to identify characteristics of existing evidence-based integrated domestic violence and reproductive healthcare interventions in India to identify gaps and components of interventions that demonstrate effectiveness for addressing domestic violence. METHODS: A systematic review of intervention studies was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Three research team members performed independent screening of title, abstracts and full-texts. RESULTS: The search resulted in 633 articles, of which 13 articles met inclusion criteria for full text screening and analysis. Common components of integrated violence and reproductive health interventions that were effective in addressing domestic violence included: psychoeducation/education (n = 5), skill building (n = 5), counseling (n = 5), engaging stakeholders with use of trained lay peer facilitators (n = 3), and engaging male spouses (n = 3). CONCLUSIONS: Interventions in India for domestic violence that are integrated with reproductive health care remain few, and there are fewer with effective outcomes for domestic violence. Of those with effective outcomes, all of the interventions utilized psychoeducation/education, skill building, and counseling as part of the intervention.

Domestic violence is a leading cause of poor health outcomes during pregnancy and the time after pregnancy. Thus, there is a need for integrated domestic violence interventions in reproductive healthcare settings. India has one of the highest maternal and child death rates. This review aimed to identify features of existing evidence-based integrated domestic violence and reproductive healthcare interventions in India to identify gaps and components of interventions that demonstrate effectiveness for addressing the problem of domestic violence among women in reproductive healthcare settings. A systematic review of intervention studies was conducted. The search resulted in 633 articles, of which 13 articles met the criteria to be included in this review. Common components of effective integrated domestic violence and reproductive health interventions included: psychoeducation/education (n = 5), skill building (n = 5), counseling (n = 5), engaging stakeholders with use of trained lay peer facilitators (n = 3), and engaging male spouses (n = 3). The key takeaways are that interventions in India for domestic violence that are integrated with reproductive healthcare remain few, and there are fewer with effective outcomes for domestic violence. Psychoeducation/education, skill building, and counseling were commonly used strategies in interventions that were effective in addressing domestic violence.

Health professionals' intervention in the context of domestic violence against women: exploring perceptions and experiences of providing healthcare.

Domestic violence against women is a complex social phenomenon and a widely recognised issue of public health, which requires that all sectors of society, including the health sector, take the necessary action to prevent and address it. This paper aims to contribute to the discussion on the role of the primary health care in addressing domestic violence against women, by analysing health professionals' perceptions of their practice as well as the difficulties they experience in providing healthcare to victims. To fulfil this aim, a qualitative approach was chosen, using focus groups with health professionals working in the area of primary health care in an inland region of Portugal. The main findings point to the lack of a specific protocol and insufficient information and skills to respond to domestic violence situations, which hinders health professionals' confidence to intervene and tends to orientate them towards a more medical response. Resulting from these findings, implications for practice are discussed: the need for clear and specific orientations to guide health professionals' intervention; the need to offer training that enables them to provide appropriate healthcare to women experiencing domestic violence; and the need to position themselves in the context of an integrated, multi-sectoral intervention.

A review study on forensic optometry: new insights in forensic science to solve crime scenes, domestic violence and sexual assaults.

Forensic science has made a lot of progress in the medical field, but still ocular signs are not so well known to forensic scientists, whereas ocular signs play a very important role in forensic science. The major goal of this study to describe the importance of eye related clues in forensic science to solve the crime scenes and know the actual cause of death for the conviction of the criminals and save an innocent persons. Narrative review was done to review the articles available on the PubMed, Google Scholar, Research Gate, Web of Science and Medline related to the forensic optometry about the various methods of identification and strategies to deal with the forensic cases. The review covered studies that focused on interventions for forensic optometry and eye-related clues to the current study target. Twenty-seven of the 54 studies that met the inclusion criteria yielded good results, and all examined the significance of eye-related clues in forensic optometry. Peer reviewed articles/studies were referred to ascertain the eye related clues in the forensic science. Some authors suggest that eye related clues are very important aspects towards the forensic science and done the clinical research on that aspects. Criminal cases, domestic abuse and sexual assault affect people of all socioeconomic backgrounds. As a result, these traits would be highly valuable in determining the way of death and the chronological history of events leading up to a crime.