How do we move from knowledge to application, from willing to doing?

The effort to integrate violence prevention strategies in Pediatric Practice provides some context to look at the barriers to engaging health care fields in violence prevention and some of the opportunities to inform practice through a provider-informed approach. Citing the deleterious effect of witnessing violence in the home or community on child development and the high percentage of youth deaths that are attributable to violence, the American Academy of Pediatrics formally adopted Violence Prevention as a primary focus for pediatricians in 1999.

While the state of science has advanced in the intervening decade, pediatricians cite the same barriers to engaging their patients in violence prevention. A lack of knowledge about how to intervene effectively and/or prevent violence and abuse is a primary obstacle cited by pediatric physicians.

The American Academy of Pediatrics recommends two practices to be incorporated into routine practice with content adjusted to meet the developmental needs and events in a given family’s life. The first, anticipatory guidance is the practice of educating patients about events that have not yet occurred. Speaking to parents of an infant about keeping firearms inaccessible to young children or using nonviolent discipline techniques are some examples. The second, screening is the process of using interviews, checklists or observation to evaluate a patient for specific characteristics. Examples of characteristics that a pediatrician would want to screen for include: exposure to violence, physical signs of child abuse, or an adolescent’s media use.

Several promising interventions have demonstrated that professional development regarding how to introduce violence prevention topics to parents and their children increase the frequency with which these conversations occur. One example focuses on a 150 minute training that uses lecture, role playing, a printed guide, and supplementary reading to provide a framework for pediatric residents in a hospital setting. The participating residents are taught to structure the process into three phases: setting the stage, assessing needs, and targeting advice. Participants reported increased knowledge and skills (80%) that they would use in the future (93%). Patients of those physicians who participated in the training were twice as likely (19.1%) to report that violence was discussed during their appointment than before the training (9.7%).

To enhance both the violence prevention anticipatory guidance and assessment that Pediatricians offer to both parents and children, the American Association of Pediatrics has developed a program entitled “Connected Kids: Safe, Strong, Secure”. The program provides pediatricians with background information, counseling schedule to pair topics to developmental stages and educational brochures for distribution to families. Each component promotes both child and parent well being, encourages community connections, and outlines how a family can build protective factors against violence commission or victimization.

Co-sponsored by the Illinois Dept of Public Health and the Illinois Violence Prevention Authority, the Illinois Health Cares initiative (IHC) offers another promising model to addressing the barriers to administering violence informed health services by facilitating local multi-disciplinary coalitions. IHC is “a statewide, effort that draws on the strengths of many collaborative partners who are committed to improving health care provider response to and prevention of domestic/intimate partner violence, elder abuse, and sexual violence.” The coalitions include representatives from local hospitals and healthcare clinics, social service providers, and community advocacy organizations.

The Illinois Center for Violence Prevention conducted key informant interviews of these coalitions to gather information about the work of the initiative over the first 5 years of the initiative including both successes and challenges encountered. In general, ICVP found that respondents believe that the Illinois Health Cares initiative has done a lot to bring community agencies, public health agencies and hospitals together in coordinating efforts and service delivery. “Collaborative effort is necessary- one agency alone could not do this work.”

In the past in these IHC communities, many violence prevention and intervention strategies were solely associated with the “social service” arena. However, by broadening the scope of understanding about issues of domestic violence (DV), elder abuse (EA), and sexual violence (SV) as public health issues, violence prevention/intervention advocates have had the opportunity to have a voice in the “medical” and health care field. As one coalition respondent stated, “IHC addresses a clear need within the healthcare system on a statewide level.” As a result, many IHC sites believe that “health care providers have improved their knowledge and changed their practices [in support of improved health care response to DV, EA, and SV].”

By extending one’s focus from individual patients to the community at large, a practitioner can engage in the most promising opportunities that all health care providers have. The medical perspective on violence can inform one’s work in education, research, or advocacy. If a community does not have the resources that are necessary to keep patients healthy and safe from violence, health care workers can use their expertise to advocate for them. Applying one’s expertise in violence prevention to community groups, coalitions, and local media can help promote the belief that everyone deserves to be safe, healthy, and free from violence.