Violence and Abuse Issues

• Home
• About the Authors
• International Collaborators
• Curriculum Development Resources
• Course Syllabus Samples
• Continuing Education Samples
• Offender Program Resources
• Additional References/Resources
• Student/Practitioner Self-care and Reflection
• Discussion/Contacts

Curriculum Development Resources

• Implementation Strategies: Curriculum Design, Formal and Practicum Instruction – Canada and USA
• Interdisciplinary Faculty Workshop – University of Ottawa and Collaborators – Canada
• Criteria and Strategies for Engaging Victim/Survivors
• Cross-cultural Curriculum Examples – Portugal and London
• Faculty Preparation in Victimology and Violence Prevention
  .......................…

Implementation Strategies: Curriculum Design, Formal and Practicum Instruction1

A Health Service Paradigm
Violence Content in the Health Service Paradigm: Introduction, Elaboration, Synthesis
Curriculum Designs and Recommended Hours of Instruction

• Single separate course
• Curriculum thread
• Series of short courses
• Problem-based learning (PBL)
• Online study and distance learning

The nationwide consultations by Health Canada, survey databases and related research and professional conference reports for this book (e.g. Report, 1986; Ross, et al., 1998; Sugg & Inui; 1992; Tilden et al., 1994; Woodtli & Breslin, 1996; 2002) revealed wide interest and commitment among health professionals on the topic of violence and considerable curriculum activity toward integrating findings into health professions curricula. Particularly in nursing, family medicine, and the mental health professions, the abuse of children, women, and older adults were all addressed in some way, ranging from "reading only" to several hours of classroom instruction. Overall, however, clinical instruction on abuse is incidental more than planned. Nearly all faculty surveyed or interviewed for this project cited "time pressures" and inadequate faculty preparation as barriers to adequate coverage of this "new" topic.
With these findings in mind, and building on CORE content and issues (see Chapter 3), the following guidelines can assist faculty in moving from incidental to systematic coverage of victimization and abuse in concert with other health education curricular demands. The approach taken here also assumes:

• Principles of academic freedom among faculty, including "theoretical pluralism" and diverse methods for achieving curriculum goals.
• Current educational trends emphasizing critical thinking, adult learning, experiential and problem-based learning approaches (Bevis & Watson, 1989; Knowles, 1980).
• Confidence in the wealth of teaching-learning ideas and creativity among faculty themselves who accept the principles of CORE content presented in Chapter 3; as one faculty member put it , at the risk of understatement: "It’s really quite simple once you’re committed to the idea."
• Acceptance of national and international trends set by governments and the World Health Organization emphasizing community-based health care delivery, prevention, and primary care.
• The complementary goals of all health professionals to promote, preserve, and restore health.
• That curriculum development is a living process reflecting the ebb and tide of problems, values, and issues among the people served – in this case, victim/survivors who rightfully can look to health professionals for advocacy, treatment, and continued care.

The consultation process and survey data used to develop these curriculum development resources revealed the historic tensions between grassroots advocates for abuse survivors and professionals in health and mental health disciplines, especially hospital-based physicians and nurses. Earlier widespread perceptions about mainstream health professionals (springing from the women’s health movement) still linger in some circles: Medicine has been castigated for having ignored, labelled, and/or blamed victims rather than helping them (Kurz & Stark, 1988); while nursing is still assumed by many clients and some professionals as a mere extension of medicine and therefore, like medicine, is perceived as part of the problem rather than the solution to preventing violence and caring for abused women and children.
Medical, nursing, and other health professions faculty are in an unquestioned and historically strategic moment to undo this perception by forging links with community caretakers of abused citizens – as many have already done. Meanwhile, grassroots pioneers in the violence prevention movement are facilitating the preparation of a new generation of health professionals willing and able to work collaboratively to stem the tide of violence against women and children. With health professionals now on board in this movement, it is important that they refrain from co-opting or superimposing narrow standards on the work already demonstrated to be effective (Ahrens, 1980). In other words, this book is a continuation of a fruitful process already begun. By no means is it the last word.

A Health Service Paradigm: (Health) Provider, Person2, Health, Environment

Recognizing, then, that there are many paths to the same goal (Cohen & Wardell, 1992; Kerr, 1992; Mandt, 1993); that diversity is a treasure, not a problem; and that faculty participants in this project have requested concrete suggestions, following are examples of how this content might be approached, and some pitfalls to be avoided, given the nature and complexity of the issue. As already noted, this book is not a substitute for basic texts on the topic covering the broad spectrum of violence. Accordingly, the citation of particular theorists is left to faculty of the various disciplines. Here the focus is on a Health Service Paradigm which highlights four key concepts and their relevance to victim care and violence prevention across health and social service workers on the front lines: The Provider, the Person, Health, the Environment.
Figure 1 depicts the Health Service Paradigm’s key (or anchor) concepts (Provider, Person, Health, Environment) and how these concepts relate to violence at progressive levels of a professional health curriculum. This model is presented for consideration or adaptation by any faculty or individual instructors who find it useful.
Not all health educators are enamored of conceptual or theoretical models. Indeed, models are neither necessary nor sufficient in designing curricula. They are merely inexact visual depictions of reality – in this case, the domain of health care for abused people – designed to help clarify and respond appropriately to that reality. Models thus can serve as a frame of reference for addressing violence content in a way that fits the educational philosophy, assumptions, and mission of particular disciplines and student levels.
Among those consulted for developing this book, nursing and occupational therapy use models. The Health Service Paradigm (model) presented here is adapted and broadened to the book’s interdisciplinary scope from general literature in the international nursing community. Discussion illustrates how violence and abuse can be addressed within the Health Service Paradigm at three levels of complexity: Introduction, Elaboration, Synthesis.
This approach to curriculum planning around violence content approximates the discussion by Candib (1992, pp. 29-30) on family medicine education at increasing levels of complexity:
Elementary: A focus on prevalence and detection. (description)
Intermediate: Why does it happen? (analysis)
Advanced: What is my role in it? Or, how do I as a clinician bring this all together? (synthesis)
These curriculum concepts are not unique to family medicine or nursing; they tend to characterize education and clinical preparation in any health profession.
Another key concept that characterizes education for practice in all health professions is the problem-solving process,3 borrowing heavily from the scientific method and including broadly the following steps:

1. Assessment and diagnosis (using observation, interviewing, and other data-gathering methods).
2. Planning a course of treatment (of injury – medical, dental or physical therapy), crisis intervention, or continued care (nursing, rehabilitation, etc.).
3. Implementing the plan (of treatment, nursing care, or rehabilitation therapy, e.g. counseling, pharmacotherapy, psychotherapy, OT, PT).
4. Evaluation and follow-up (of whatever was done).

The first two steps of this process are encompassed in the acronym, SOAP:
S – Subjective;
O – Objective;
A – Assessment;
P – Planning, often used in professional record-keeping.

Violence Content in the Health Service Paradigm: Introduction, Elaboration, Synthesis

The following paragraphs contain suggestions of how faculty might address violence and abuse content using the Health Service Paradigm as an organizing framework. This approach assumes that faculty have defined social science and humanities pre- and co-requisites to the health major with its emphasis on clinical courses and professional issues. For example, if social science/humanities prerequisites require a sociology course, faculty can specify that the course include several concepts basic to understanding violence and victim care: e.g. the family; deviance; gender, race, class and diversity issues; social institutions and their impact on individuals.
On the other hand, if there are no prerequisites to the health major, and/or students are left to elect such a course, faculty must deal with the coverage of such concepts elsewhere. Similar assessments can be made vis-a-vis concepts from psychology (e.g. self-esteem, "learned helplessness," aggression); and anthropology (e.g. values, ethnocentrism, cross-cultural differences). Since many of the concepts are germane across disciplines, students from various disciplines would attend at least some of these pre- and co-requisite courses together, thus encouraging interdisciplinary collaboration.

Introduction

Students’ (future providers) introduction to the professional health major will include violence as an interdisciplinary, international public health issue intersecting with social-psychological, ethical, and legal ramifications of service. Beginners are alerted to the sociocultural milieu and various power disparities as the context or environment in which violent behavior is born and nurtured. Just as a toxic waste dump or nuclear power plant leak has deleterious effects on health, so does a cultural climate of violence, especially for the most vulnerable persons in society: children, women, older persons, those in double jeopardy for being "different." The concept of person invites the student to consider her/his own personal experience with abuse (physical or sexual abuse as a child; observation of parental violence; rape) and attend to any memories or traumas stirred up by the prospect of treating or caring for abuse victims in various clinical practice situations.
Learning activities at this level might include assigned reading and analysis of newspaper and campus media sources regarding the extent of the problem and its relevance for clinicians; e.g. attendance and discussion of events associated with the anniversary of the "Montreal massacre" of university women might alert students to make the connection between their personal vulnerability and the larger social issues demonstrated by this dramatic illustration of a violent backlash against recent advances by women. News of current shooting rampages in learning environments might inspire student inquiries about safety issues on their own campus.

Elaboration

During this phase of the curriculum, students are taught the details of environmental hazards, including these facts:

• one’s greatest risk is from family members and intimates who have absorbed the larger society’s deeply embedded values regarding violence, women, etc.;
• major stressors and the dynamics of victimization occur in various forms (e.g. incest, rape, battering);
• the varying traumatic effects of abuse on the person who experiences it (child, woman, older person, immigrant, refugee);
• specific treatment protocols and crisis intervention strategies (identification, assessment, planning, intervention, evaluation/follow-up) which providers can offer to provide safety, heal wounds, and promote physical and emotional health.

Learning activities during this level might include:

• observation, journal writing, role-playing, and discussion to aid understanding and appreciation of victims’ trauma (e.g. documentary or training films, storytelling by survivors);
• collaboration with clinical experts caring for victims (e.g. rape crisis hotline; shelter for abused women; children’s aid; adult protective services, offender treatment programs);
• immersion in assigned reading, popular film, and/or fiction dealing with abuse, followed by seminar discussion;
• inclusion of victimization, suicide, and assault/homicide risk assessment in all clinical practice assignments, followed by seminar discussion.

Synthesis

In the spirit of Patricia Benner’s (1984) "novice to expert" concept, students at this phase ideally can integrate what they have learned by implementing treatment plans and crisis intervention strategies on behalf of various victims. For example, the generalist function of victimization assessment, diagnosis, treatment of physical injuries, crisis intervention, and appropriate referral should be routine on behalf of any person at risk and in any home, community, or health care setting. Because of the complexity of victim/survivor care, students may not necessarily feel expert at this point; nor is expertise expected in any other area of professional health practice upon graduation. Indeed, internships, preceptor arrangements, and residencies are the norm rather than the exception following formal education.
Nevertheless, if victim/survivor treatment and care are systematically addressed throughout the curriculum, graduates are less likely to experience the surprise and shock that interviewees described during this project development, or be left to learn about such care primarily "on the job." The clinical protocol resources already available in accredited community and hospital-based settings serve as adjuncts to formal education on violence issues, and should not be a new graduate’s first exposure to the topic. The next section discusses four curriculum designs and comprehensive health service components (including crisis intervention) that can be applied on behalf of victim/survivors of violence and offenders. This is followed by suggestions for class/seminar planning at beginning, intermediate, and advanced levels.

Curriculum Designs and Recommended Hours of Instruction

Consideration of these curriculum concepts addresses frequently asked questions by collaborators for this book: Should there be a special course on violence/abuse; should the content be "integrated" through curriculum levels; and/or will problem-based learning eventually become the universal norm?
The majority of faculty and students interviewed do not believe a special course is the best approach for generic (undergraduate) students in any of the health disciplines: If such a course is introduced early and focuses on theory, the students may not be ready for some of its shocking content, especially those who have been very sheltered or have suffered abuse themselves. Nor will they have the necessary clinical background to make connections between theory and practice. On the other hand, if students have no theoretical introduction to the topic, they almost invariably will be surprised and feel unprepared for various tasks on behalf of victimized persons among general clinical assignments at beginning levels. The example of the student assessing "physical responses only" of a 14-year-old girl who gave birth following rape, presented in Chapter 12, dramatically illustrates this point.
It is up to particular faculty groups to specify a curriculum design appropriate for their discipline and designate the number of instructional hours (classroom and practicum) faculty should allocate to violence and victimization content. Increasingly, faculty and students experience time constraints related to knowledge explosion, advances in health care technology, and new topics – including, now, violence – flowing from the contemporary value of health care as a basic right. Interviewees and focus group participants acknowledge the problems of an "add-on" approach to these issues.

Faculty deciding on total hours of theory and practice in this content area for undergraduates of any discipline may find this reference point helpful: Internationally recognized standards (Hoff & Adamowski, 1998) for general crisis content, including victim/survivor care suggest the rough equivalent of a 3 or 4 semester-credit course which ideally emphasizes analysis of case examples. This recommendation should be considered in the context of a discipline’s overall mission and its functions in violence prevention and victim care among disciplines, as discussed in Chapters 1 and 3. Faculty and students alike stress the need to carefully examine curricula for:

• repetition and a tendency to focus on the dramatic exception rather than broad principles;
• refinement of critical thinking;
• emphasis on case examples for analysis and application of practice skills;
• application of concepts across practice boundaries as an approach to broaden survivor care teaching and learning.

Adhering, then, to the book’s purpose in assisting faculty to move from incidental to systematic coverage of this content, faculty need to clearly designate three areas at beginning, intermediate, and advanced levels of learning: theory coverage in formal classroom sessions; clinical practice assignments; clinical seminar discussions.
There is no single best curriculum design for addressing this CORE content in a manner that prepares students for practice with the population of abused persons and assailants. The issue is more complex for professions (e.g. nursing and social work) with both baccalaureate and graduate level entry points to clinical practice. Following are four curriculum approaches for faculty consideration vis-a-vis generic (undergraduate) and graduate programs in the health professions: a single separate course; a curriculum thread; a series of short courses; and problem-based learning.

Single Separate Course

This approach is, of course the most straightforward. However, as already noted, it has disadvantages except for graduate students (family medicine, nurse practitioners, the mental health disciplines) and post-RN nursing students. Most of these students have the educational and clinical background for mastering complex violence content in a single course. If an entire course cannot be fit into total curriculum requirements, violence content can be addressed in substantive units of courses such as women’s health; crisis theory and intervention; family dynamics and treatment; sociocultural issues in health care.

Curriculum Thread

This approach corrects some of the disadvantages of a separate course for undergraduate students. As one faculty interviewee emphasized: "Violence and abuse can constitute a curriculum thread in health promotion and the three levels of prevention: primary, secondary, tertiary." However, this approach presents the serious challenge of continuous all-faculty vigilance to avoid "losing the thread" somewhere along the line – the "needle in a haystack dilemma."
If the "thread" approach is selected, the following undergraduate course titles most readily lend themselves to addressing victimization and related crisis content (keeping in mind variation in course titles from school to school, and pre- or co-requisites which students may take with other disciplines):

Dental Hygiene

Dentistry

Medicine

Nursing

Occupational Therapy

Pharmacy

Physical Therapy

Psychology

Social Work (clinical and policy tracks)

Series of Short Courses

This approach represents the middle way between the single separate course and curriculum thread designs, thereby addressing some of their disadvantages and challenges. To illustrate: Three courses of two credits each could cover broadly:

• communication skills;
• the interpersonal relations and health counselling skills needed by all health providers;
• crisis content (including violence, victim care, and suicidology); and
• the psychosociocultural context of crisis and victimization.

In health sciences faculties of several disciplines, the series could be offered under an interdisciplinary course number, e.g. INT 100, 200, 300: Psychosociocultural Issues in Health Care. The three INT courses would correspond roughly to the three levels illustrated in Figure 1, the Health Service Paradigm: Introduction, Elaboration, and Synthesis, or Beginning, Intermediate, and Advanced, which apply across disciplines. They could be offered in a parallel arrangement with the clinical courses in the various disciplines at the three levels. This arrangement affirms the reality that students will encounter abused persons in all clinical settings. That is, the clinical component of such a short course series would be assumed in the parallel clinical courses across disciplines. Accordingly, students have the occasion for routine crisis and victimization assessment, prevention, and intervention across the spectrum of clinical experiences and within the context and mission of particular disciplines.
This curriculum design also addresses the need for students’ grounding in their own discipline (through parallel clinical courses in respective disciplines), while progressively exploring interdisciplinary issues as they emerge in the classroom and real world of clinical experience. A clearly defined short-course series like this provides students a systematic framework for examining and applying the theoretical, attitudinal, and skills content relevant to the abuse situations encountered in various clinical placements at progressive levels of complexity. Instruction would include the "big picture," interdisciplinary facets, and each discipline’s distinct role with survivors and offenders. This design also reduces the faculty challenge of keeping track of curriculum threads, and allows for easier designation of faculty responsibility for crisis and victimology concepts according to preparation and interest. For example, when mid-level students work with seriously disturbed psychiatric clients with a history of abuse (in tertiary care settings) they are already grounded in the primary and secondary prevention concepts illustrated by the case examples presented in this book.

Problem-Based Learning (PBL)

 In this approach, pioneered at McMaster University’s Faculty of Health Sciences (Mustard, 1982), victim-survivor care and the prevention of violence would constitute some of the case situations and health care issues students examine in small group format with a tutor and through clinical experience in diverse settings. The case situations and expectations of student research and analysis are tailored to beginning, intermediate, and advanced student levels. In some health professions – especially medicine – the entire curriculum is organized around problem-based learning. But even in other curriculum designs, many educators use facets of this teaching model, particularly in clinical seminars.
This approach is very learner-centered and interactive, thereby lending itself as particularly appropriate for addressing the violence content illustrated by the book’s case examples. On the other hand, a potential pitfall in the problem-based curriculum is that survivor care and violence prevention may receive only incidental coverage, a common problem revealed in survey and consultation outcomes informing this book. However, this limitation might be mitigated by specifying victimization and abuse situations as "required" cases in tutorial seminars and clinical experience at progressive levels of complexity.

Online Study and Distance Learning

Increasingly, online and distance learning formats are offered at many institutions preparing health and social service students for professional practice. As the global village shrinks via the Internet, international travel, and the flow of immigrants and refugees from war or human trafficking, cross-cultural exchange around commonalities and differences in victimization experiences afford rich learning opportunities.
Yet, several features of the teaching-learning process must be carefully considered when employing online formats:

• The greater the learner’s involvement, the greater the prospect of mastering subject matter.
• Such involvement includes the opportunity to process with others the meaning of concepts and controversial issues, especially on a topic as sensitive and value-laden as violence.
• Preparation of human service professionals requires opportunities to practice and refine communication and other skills essential for appropriate service for victim/survivors and violence prevention.

These features suggest the increasing use of the recommended hybrid model that employs online and traditional classroom formats in complementary arrangements. The victimization experience and student learning process share a feature common to both: Victim/survivors typically feel isolated and alone as they ponder their lives and their future at risk; in the learning arena, the most lasting part usually occurs not in the lecture hall, but in the student’s often lonely wrestling with the connections between a professor’s wisdom, critical reading, and – for a human service provider – one’s first-hand experience with people in physical and emotional pain. If a hybrid model is not possible – for geographic or other reasons – online assignments must include substitutes for live classroom interaction; e.g. engaging a family member, friend, colleague, or church member on violence topics and doing an analysis of the results such as “blaming the victim,” stereotypes about the roots of violence, cross-cultural differences, etc.
Some of these students are survivors of childhood sexual abuse or dating violence which they have never shared with anyone. For them, the anonymity of an internet chat room might afford the first occasion for them to disclose their hidden pain – an antecedent to eventual resolution and healing through live interpersonal exchange with fellow students, and perhaps professional counseling. Sensitive faculty and fellow student responses may be the occasion for embarking on such a personal healing course so important as a premise for their successful clinical work with victim/survivors.
These curriculum design suggestions assume that students will have varying amounts of direct contact with victim/survivors, but that all will have some direct contact, even if gained through a classroom visit by survivors willing to share their experience. They also assume that regardless of overall design, all educational approaches ideally will emphasize interaction between learner and teacher, as well as case situations for critical inquiry and problem-solving. Finally, recommendations assume introduction to theoretical underpinnings, as noted in Chapter 2 and above, regarding sociology, psychology, human development, and anthropology pre- and co-requisites.

References of Particular Relevance to Curriculum Development

 Benner, P. (1984). From novice to expert. Menlo Park, CA: Addison-Wesley.
Hoff, L.A. & Ross, M. (1995). Violence content in nursing curricula: Strategic issues and implementation. Journal of Advanced Nursing, 21, 137–42.
Report: U.S. Department of Health and Human Services. (1986). Surgeon General’s workshop on violence and public health. Washington, D.C.: Author.
Ross, M., Hoff, L. A., & Coutu-Wakulczyk, G. (1998). Nursing curricula and violence issues: A study of
Canadian schools of nursing. Journal of Nursing Education, 37(2), 53–60.
Sugg, N. K. & Inui, T. (1992). Primary care physicians’ response to domestic violence: Opening Pandora’s
box. Journal of American Medical Association, 267(23), 3157–60.
Tilden, V.P., Schmidt, T.A., Limandri, B.J., Chodod, G.T., Garland, M.F., & Loveless, P.A. (1994). Factors that influence clinicians’ assessment and management of family violence. American Journal of Public Health, 84(4), 628–33.
WHO – World health Organization. (2004). Handbook for the documentation of interpersonal violence prevention programs. Geneva: Author.
Woodtli, A. & Breslin, E. (1996). Violence-related content in the nursing curriculum. Journal of Nursing
Education, 35, 367–74.
Woodtli, A., & Breslin, E. (2002). Violence-related content in the nursing curriculum: A follow-up
national survey. Journal of Nursing Education, 41(4), 340–8.
Back to top
...........................

Interdisciplinary Faculty Curriculum Development Workshop – A Project of Ontario Ministry of Health

Announcement – Invitation

Workshop Description, Objectives, etc.
Student Survey (pre-workshop) – Violence Issues
Criteria for Engaging Victim/Survivors
Interview Guide: Survivor Panel for Faculty Workshop
Faculty Worksheet I – Draft Model
Faculty Worksheet II – Implementation Plan
Evaluation tools (available on request)

One of the most hallowed traditions in the education and training of health professionals is the use of “case examples” to illustrate theoretical and practice points. In teaching about the care and treatment of victim/survivors of violence, however, the instructional arena is still haunted by “ghosts of the past” in which un witting patients were exploited and used with impunity to advance scientific knowledge about disease and its treatment (as in the Tuskegee experiment discussed in Chapter 2).

Decades later, health professions educators of good will confronted lingering resistance from survivors and their advocates to participate in research and related clinical projects out of lingering fears of exploitation in projects where personal values to them and possible dangers were not clear. As noted from a news in a shelter where I was a volunteer and kept my “professional” identity as invisible as possible (see Preface), I was struck by this message about “academic researchers”: “You come in, grab and record our stories, write your books, collect your royalties, and what do we get? Nothing.”
This led to my amalgamation of traditional teaching methods in health sciences with the ethics-based determination not only to protect survivors from exploitation” in telling their stories for student learning, but also; to pay them for their time commensurate with payment of other “guest lecturers”; and to transform their role to “teachers” of those professing commitment to ethical care and to “do no harm.”
The following workshop example, conducted for Health Sciences Faculties across Canada, offers guidelines for faculty of good will who want to enhance teaching/learning opportunities in health professions faculties on violence issues and its particular relevance for the future providers in these professions. Of special note is the placement of a carefully orchestrated panel of victim/survivors who did not lambast the faculty audience with their experiences of less-than adequate care and treatment, but focused on what they had learned as a way forward for health professions practitioners.
Interdisciplinary Faculty Workshop: Educating Future Health Professionals On Violence Issues4

Announcement – Invitation

To: Health Sciences Faculty
From: Lee Ann Hoff, Adjunct Professor and Project Coordinator, University of Ottawa
You are invited to attend an Interdisciplinary Curriculum Development Workshop on violence issues on (date) from 8:00 to 4:30.
Funded by the Ontario Ministry of Health, Women’s Bureau, the goal of this workshop and follow-up consultation is to develop an interdisciplinary teaching/learning model aimed at systematic (vs. incidental) inclusion of violence issues content in curricula preparing health professionals. Increasingly, at federal, provincial, faculty, and community practice levels, interdisciplinary collaboration is stressed as the wave of the future. Accordingly, this workshop provides a unique opportunity to move from ideals to actualization of an interdisciplinary teaching and learning model regarding violence issues and the care of survivors and their assailants. (A draft of the workshop program is attached.)
If you are currently addressing violence content (in either a discipline-specific or interdis­ciplinary format) or plan to, and wish to attend this workshop, please complete the attached pre-registration form by (date) and return to (name), the research team member in your School.
The design and anticipated outcomes of this workshop require that we limit attendance to approximately 40 persons. Besides faculty, attendees will include clinical instructors or preceptors, and representative survivors and community-based experts.
While a curriculum and its outcomes for future health practitioners are owned by the faculty as a whole, it is understood that not all individual faculty members are expected to teach specific content such as violence issues. Therefore, we suggest faculty negotiation and consensus around representation at this workshop.
A copy of VIOLENCE ISSUES: AN INTERDISCIPLINARY CURRICULUM GUIDE FOR HEALTH PROFESSIONALS (Hoff, 1994) will be sent to each faculty member and clinical person registered for the workshop, along with a pre-workshop evaluation form.
Thank you for considering attendance at this workshop. We look forward to working with you on this urgent issue and the central role of health professionals in violence prevention and comprehensive service for survivors of abuse.

Workshop Description

This workshop provides a forum for health professions educators, clinical preceptors, survivors and community-based experts to communicate and collaborate around the issue of violence prevention and the compreh­ensive care of victims/survivors of abuse. The workshop and follow-up consultation goal is to develop an interdisciplinary curriculum model to prepare health professions students for violence prevention and professional practice with survivors of abuse.
Funded by the Ontario Ministry of Health, Women’ Bureau, the workshop builds on provincial and national initiatives on violence prevention, including the role of health care providers in community-wide efforts to stem the tide of traumatic abuse against scores of women and children. It assumes that health professions educators, clinicians, and grassroots providers have some common service goals on behalf of victims/surv­ivors; but it also recognizes that each group has a distinct perspective and role in an interdisciplinary approach to violence and abuse. Accordingly, the workshop envisions discussion, interdisci­plinary collaboration and sharing of insights and strategies for the systematic inclusion of violence issues and clinical preparation of health professionals to identify and assure comprehen­sive service for abused persons of all ages, and their assailants.

Workshop Objectives (from funding mandate and focus group data)

• Examine the relevance of interdisciplinary practice from the perspective of survivors and community-based experts.
• Consider a video illustration of interdisciplinary practice for its usefulness in an interdis­ciplinary teaching/learning model on violence issues.
• Review participants’ pre-workshop examination of the INTERDISICIPLINARY CUR­RICULUM GUIDE as a basis for developing a draft interdisciplinary teaching/learning model.
• Select an interdisciplinary curriculum model (or combination of models) for which struct­ure and implementation strategies will be developed in health professions curricula (interdisciplinary small groups).
• Designate parameters of an implementable draft model, i.e. the structural and implementa­tion strategies (e.g. courses, modules, timeline, engaging key stakeholders, etc.) for an interdisciplinary teaching/l­earn­ing model (small groups – interdisciplinary).
• Reconcile commonalities, differences, and issues in draft models (large group).
• Develop implementation plan and anticipated follow-up consultation needs (small groups).

Program

Methods

This workshop and consultation process will employ collaborative and interdisciplinary small group methods, as well as pre-workshop assignments and critique of draft models.

Eligibility

Faculty and clinical preceptors who have current or anticipated responsibility (or plans for same) in teaching theory and practice regarding violence prevention and comprehensive service for survivors of abuse and/or their assailants in one or several categories of abuse over the life span (child abuse, battery of partner, sexual assault, elder abuse). To maximize the probability of actually producing an implementable interdisciplinary teaching/learning model, workshop participants are expected to read the INTERDISCIPLINARY CURRICULUM GUIDE and complete a self-assessment (regarding teaching and clinical practice on violence topics) prior to the workshop itself.

STUDENT SURVEY – Violence Issues (one page only)

Directions: The University of Ottawa Faculty of Health Sciences and Faculty of Medicine are sponsoring an Interdisciplinary Curriculum Development Workshop on violence issues on _________. Students’ suggestions about their curriculum and preparation for clinical practice with survivors of abuse is vital to the success of this workshop, which will include faculty, clinical instructors and/or preceptors, survivors, students, and community-based experts on violence issues. Your response to the following questions is greatly appreciated.
[research team: suggested content areas:]
Rating of preparation for practice in 4 areas of abuse ... Likert scale
Rating of preparation on diversity issues applied to violence and survivors of abuse
Rating on preparation for interdisciplinary practice
Suggestions to faculty about how to increase student preparation for interdisciplinary practice with survivors of abuse
Additional comments and/or suggestions
I am interested in representing my class at this all-day workshop: Yes _______ No ______
.........................

Draft of thank-you letter to students in Focus Group

Just a note to thank you for your energetic participation in the (date) focus group on developing an interdisciplinary teaching/learning model on violence issues. Your contributions are most useful to our planning process.
I will keep you informed of the final date selected for the workshop, and hope that you might be able to take part in the all-day workshop.
Again, my sincere thanks for taking the time to participate in this important data-gathering phase of the curriculum development project.
Sincerely,
Lee Ann Hoff, PhD
Adjunct Professor & Project Coordinator
.........................

Criteria and Strategies for Engaging Victim/Survivors

Vignettes for Survivor Panel Presentation and Discussion

The following vignettes were developed by clinicians as a starting point for panel discussion by survivors and faculty workshop participants. They are intended as an avenue for eliciting survivors’ perspectives regarding interdisciplinary practice, while refraining from asking survivors to share their personal stories. The attached criteria for enlisting survivor workshop participants should aid the planning committee in recruiting survivors for this workshop. In general, we would like four survivors representing the four major areas of abuse: childhood physical and sexual; battery of intimate partner; sexual assault; abuse of older persons, as well as the diversity facets such as ethnicity, aboriginal status, sexual identity, disability.
In no way are survivors expected to prepare a "formal" speech, but rather, are asked to share spontaneous reactions to the vignettes. Each survivor recruited will be paid a $50 honorarium.
Survivor panelists will receive the vignettes ahead of time and be asked to respond to the following questions during the workshop:
a) how you or another survivor might feel in such a situation
b) what suggestions you have for health professionals and interdisciplinary practice
1. A woman, age 29, with broken rib and black eye, is treated in ED, and kept in a general waiting area waiting for X-ray results ... no one to talk with. A similar thing happened a couple months ago when she had a broken tooth repaired. She doesn’t know how she could bring herself to confide the cause of her injuries.
2. A woman, now in 40s, was sexually and physically abused as a child. Her husband currently is abusive. Entire family has been in psychiatric care periodically, including occupational therapy. During a treatment session with the physiotherapist for TMJ and fibromyalasia, she says to the therapist: "I don’t know how long I can go on like this."
3. A woman, now age 64, has been widowed for five years. She has been treated in a psychiatric facility for depression, and is seen routinely by a visiting nurse around her treatment protocol for diabetes. Her son, age 35, with a drinking history and recently divorced, has lost his job and returned home to live with his mother. During drinking binges he abuses his mother, who tells the nurse she can’t cope with him much longer, but doesn’t know what to do. She takes antidepressant drugs.
4. A woman in her 40s sees her general practitioner periodically for problems with fecal incontinence and depression. She also has back pain and has been referred to physiotherapy for same. She has had six children and confides to the PT that her incontinence problem began after her husband, a respected CEO in a small community, routinely demanded anal intercourse since she is no longer "tight enough" to suit his pleasure. When the PT suggests she share this problem with her physician, she says doesn’t think she can do because her husband and the physician belong to the same golf club and she fears that everyone in her small town would find out.

Criteria for Enlisting Survivors

1. The survivor should represent at least one of the forms of abuse (childhood physical and/or sexual; adult sexual assault; violent abuse by intimate partner; elder abuse).
2. Survivors should be beyond the crisis point in healing. Usually this means at least a year or longer from time of acute situation.
3. They would not be expected to divulge facets of their experience they are not ready to share or which do not directly address the issue of interdisciplinary education and its impact on survivors.
4. They should be willing to discuss their perspective, as survivors, on the vignettes provided, and perhaps relate any positive and not-so-positive experience they may have had which bears on these vignettes or similar situations they are familiar with. For example: How helpful it was when everyone seemed to work together; how they may have felt "caught in the middle" of observed staff conflict or failure to communicate; how it feels to have to repeat their story one too many times, receive conflicting "advice" etc.
5. They should be generally confident that they have something to offer; that their contribution is central to the success of interdisciplinary teaching/learning about violence issues.
6. Their privacy will be protected.
7. Results of the project will be shared with them.
8. They will be paid an honorarium for their contribution.
Back to top
.........................

Interview Guide: Survivor Panel for Faculty Workshop [developed by Lee Ann Hoff from interviews and focus groups with survivors]

Note: This panel presentation was strategically placed as the “opening” item of the interdisciplinary faculty workshop. It had the intended effect of dissolving the resistance of some in addressing the topic, and enhancing the role of patients as “teachers” – not merely “subjects” of research and educational seminars – by emphasizing survivors’ positive experiences, avoiding a critical or “blaming” attitude toward health professionals, and eliciting useful suggestions.
Most helpful experience in receiving care or treatment from health professionals?
Any disappointing experiences? And what one could do to make things better for survivors?
Any particular observations about team work? Health care professionals working together? For example, have you been caught in the middle of “failed communication”? ... or had to tell your story one too many times?
Any particular suggestions about the possible trauma of medical examinations or procedures?
Views on students as participants or observers of your treatment program?
Special “words of wisdom” or “must” things every health professional should know about care and treatment of survivors?
Note: Besides the overwhelming positive response of health professions faculty to these panels across several Health Sciences Faculties, was the item about students as participants in various treatment programs. Survivors in Focus Groups complained that they felt like “guinea pigs” if treated by students, and that they could sense the students’ lack of experience. But further discussion revealed that indeed, students were left alone or not adequately supported in complex treatment situations. When asked how future health professionals can become competent if never allowed to participate in survivors’ treatment, but also upholding patients’ right of refusal, they quickly acknowledged that “blanket refusal” of all student involvement was not a long-range solution to the issue, and that a “team” approach was best for meeting both education and service delivery objectives.

Faculty WORKSHEET I: Draft Model of Interdisciplinary Teaching/Learning Model

Directions: The model developed assumes the principle of CORE content for all students (not merely an elective course, for which many models already exist). Thus, the goal is to outline specific steps in moving from incidental to systematic coverage of violence issues and the care and treatment of victim/survivors in health professions curricula.
Brief description of setting for which the model is designed, e.g. Health Sciences Faculty, including which health professions are represented; several different Faculties, etc.
Current curriculum structure (e.g. discrete courses, Problem Based Learning, combination of the two) and possible “revisions in process” or anticipated, which could provide a “window of opportunity.”
Broad designation of content (Knowledge, Attitudes, Skills) and instructional approach, keeping in mind curriculum context in # 2. (Consult: Chapter 3, Hoff, 2010).
Beginning Level:
Intermediate Level:
Advanced/Senior Level:
Designate a target date for implementing the proposed interdisciplinary teaching/learning model, and what – if any – changes are necessary in current curriculum structures and discipline-specific boundaries in order to implement the model.
Designate available faculty and prospects of successful recruitment of them for implement the proposed model (or, new faculty, or in-service training programs needed (see Faculty Preparation in Victimology).
Identify community agencies which might collaborate in implementing the proposed model (e.g. for guest lectures and/or clinical practicum placements).
Describe how you would evaluate the outcomes of the interdisciplinary teaching/learning model (i.e. students’ grasp of essential Knowledge, Attitudes, and Skills, as well as faculty satisfaction, barriers, frustrations, etc.)

Faculty WORKSHEET II: Implementation Plan

Directions: Ideal models – even those that appear implementable – are one thing. To actualize them is another. Success often depends on a specific action plan that incorporates principles and strategies of social change, particularly when the subject matter is one that entails denial, fear, myths, and a legacy of resistance based on the earlier assumption that violence issues are not the proper business of health professionals, or that there is not enough time in crowded curricula – not to mention the bureaucratic issues facing any change in the higher education arena. An implementation plan helps to deal constructively with these issues vis-a-vis an interdisciplinary approach to violence issues.

• Describe in concrete steps how the model developed (Worksheet I) can be implemented. That is:

• What will you do after this workshop? e.g. share results of workshop and goals with colleagues and major stakeholders.

• How will you engage the major stakeholders and get entire faculty to “buy in” to the issue and its importance ,even though all faculty will not be assigned to teach specific content? e.g.: Report the results in writing to your Faculty/Department colleagues? Or will you put the issue on agenda for the next Curriculum Committee meeting?

• Who will be involved? e.g. Will you form a working committee of those in attendance at the workshop, plus a few others?

• When will this occur? i.e. What is a reasonable time frame?

• What obstacles do you anticipate encountering as you attempt to implement your action plan?

• What major resources (besides Hoff, 2010 Violence and Abuse Issues) can you draw upon to overcomes obstacles and actualize your action plan to implement an interdisciplinary teaching/learning model in your Faculty/Department?

• What additional assistance do you anticipate needing in order to function effectively in your specific faculty or clinical preceptor role toward actualizing an interdisciplinary teaching/learning model on violence issues?

Back to top
.......................…….

Cross-Cultural Curriculum Examples – Portugal and London

Graduate Program: Genero, Poder e Violencia – Instituto Superior de Psicologia Aplicada (ISPA) & University of Massachusetts Lowell – Lisboa, Portugal

This graduate degree program was developed following a pilot Certificate program of the same title that included the following courses for nine students in psychology, social work, nursing, and staff of a women’s shelter:

Clinical/Direct Care Courses:

1. Emergency and Crisis Response to Violence and Abuse
2. Criminal Justice and Psycho-social Follow-up Service

Social Science and Prevention Courses:

3. Historical and Sociocultural Roots of Violence
4. Public Education and Community Organization regarding Violence

Teaching and Service Program Development Courses:

5. Pre-service Curriculum and In-service Training Development
6. Development and Evaluation of Service and Prevention Programs

Courses Geared toward Student Background and Career Goals:

7. Elective or Independent Study (e.g.: Medical/Forensic Protocols; Research Strategies: Critique and Community Collaboration; Literary Sources Addressing Violence; Self-Care and Mind/Body Connections; Workplace Violence and Abuse)
8. Project (practice, teaching, consultation, or research) and Synthesis Seminar
The Certificate program was developed collaboratively between ISPA faculty and the staff of Portugal’s first women’s shelter. It was built on the following assumptions about violence issues and the teaching/learning process.

Theoretical Assumptions Underpinning the Program

• Roots of violence: Cultural values, social structures, unfair policies
• Violence is viewed as a CONTINUUM from interpersonal to global levels
• Interconnectedness of interpersonal violence across the life span
• Violence: Essentially an INTERDISCIPLINARY topic
• Violence is an abuse of power: COLLABORATION (vs. cooptation and control)       models how NOT to abuse power
• Violence defined in MORAL, social action terms, NOT as psychopathology or madness
• Students have a right to be taught in their own language
• Healthcare and social service providers have enormous potential to stem the tide of violence

It also recognizes the distinct but related missions of educational and service agencies in health care:
Health and social service faculties: PREPARE PROVIDERS for expert service delivery, teaching, research and consultancy.
Healthcare agencies: PROVIDE SERVICE to victim/survivors and their families.
At ISPA, the graduate program, Genero, Poder e Violencia, is in process of revision in concert with EU higher education criteria, and includes a plan for a doctoral-level program on the topic. See ISPA web site Link for further information.
In Boston, networking and preliminary planning is underway to establish an international consortium of universities that would offer a Certificate program building on the above assumptions and the course titles, with this working title: Violence, Crisis, and Human Rights. Interested faculty are invited to contact Lee Ann Hoff at: leeann.hoff@comcast.net, and/or the Discussion – Contact item of this web site.
………………………..

MSc/PG Diploma in Interprofessional Practice: Society Violence and Practice – City University, London

This two-year graduate course, City Community and Health Sciences at City University, London, was developed in collaboration with national and international experts from a range of disciplines including healthcare, social care and voluntary services. It incorporates the values and theoretical assumptions noted throughout this book, including those underpinning the pilot Certificate program at ISPA described above, in which Philippa Sully was a guest lecturer on health/police collaboration. It is unique as the only provider of this course in the UK. Besides its clear interprofessional practice focus, some of its special features include collaborative practice with police officers and the importance of self-reflection in journals for exploring learning experiences and milestones as discussed in this book’s Chapter 12 on professional issues and vicarious traumatization. For further information and possible registration in this program, contact Philippa Sully, Acting director at P.A.Sully@city.ac.uk or, www.city.ac.uk/ippr . International students are most welcome.
Back to top
.........................

Faculty Preparation in Victimology and Violence Prevention

As already noted, faculty preparation needs vary according to individual background and teaching assignments. Survey results and the consultation process for developing this book revealed that most faculty and clinical preceptors perceive the need for explicit preparation such as through curriculum development workshops to increase their knowledge and confidence in addressing violence content.
 A workshop such as described above might be offered in a collaborative format including health educators, practitioners serving as mentors, and community-based experts delivering care to victims/survivors of abuse. Also, faculty who are expected to teach in this topical area, but who have had minimal or no direct experience working with victims, ideally should prepare themselves further by volunteering, for example, in a battered women’s refuge or sexual assault crisis centre, arranging for a police patrol ride-along experience or observation in court, working several shifts in an emergency medical centre treating victims, or a similar experience that would supplement professional education attained at a time when victim/survivor care was not a focal part of health curricula. The interdisciplinary workshop example may assist faculty to prepare themselves to incorporate violence-related content into existing curricula for assure systematic (vs. incidental) coverage of essential content on this topic. Back to top
....................................

Back to top

• Skip to navigation
• Skip to content