Behavioral
Emergencies Update
spring 2000
In this issue...
Section VII Programming at APA Convention
Training Providers of Emergency Services for Children in Violence Prevention
News from the American Association of Suicidology Conference
The Critical Need for Valid and Reliable Assessment
Training
Providers of Emergency Medical Services
for Children in Violence Prevention
by Anthony Spirito, Ph.D.
Brown University School of Medicine
Editor's Note: The American Psychological Association Public Interest Directorate issued several major reports in the 1990's on violence-related topics. These included reports by the Committee on Women in Psychology Task Force on Male Violence Against Women; The Commission on Violence and Youth; Working Groups on Treatment, Interventions, and Legal Issues on Child Abuse and Neglect; and The Task Force on Violence in the Family. The APA Committee on Children, Youth, and Families also sponsored a conference on violence against children. In addition, the Public Interest Directorate produced two documents for the Emergency Medical Services for Children (EMSC) program at the Maternal and Child Health Bureau related to violence in emergency medical settings. Below is a brief synopsis of one of these reports to the EMSC by Anthony Spirito, Ph.D. Dr. Spirito chaired the consensus conference which ultimately resulted in the APA document for EMSC. We hope in the future to have other reports of these APA activities which are drectly relevant to the members of our section.
-Julie Boergers, Ph.D.In 1996, the Office of Emergency Medical Services for Children (EMSC) of the Maternal and Child Health Bureau, Public Health Service, contracted with the American Psychological Association to submit recommendations for the training of EMSC providers in violence prevention. In July 1997, APA convened a one-day working conference for APA members who had expertise in violence prevention and professionals from five other disciplines (emergency medical technicians/paramedics, emergency nurses, emergency physicians, trauma surgeons, and social workers) concerned about violence in emergency medical settings. The APA Public Interest Directorate asked me to chair this meeting. The result of the meeting was a document published by APA in January 1998, entitled, "Training EMSC Providers in Violence Prevention." The document contained three major sections: the effects of violence on the work of EMSC personnel; training recommendations for EMSC personnel; and strategies for violence prevention and intervention efforts in EMSC settings.
The first section of the document contains concise information about violence-related injuries treated in hospital emergency departments. Victims of sexual abuse, physical abuse, spousal abuse, stranger assault, rape, peer violence, intimate violence, hate crimes, and in utero violence often present first to the emergency department. The psychological impact of violence on children and families is also briefly described, as well as the potential benefits of intervening early to reduce the psychological sequelae of violence.
The participants in the conference agreed that EMSC personnel have relatively limited knowledge of violence, and that training recommendations for EMSC personnel vary considerably across disciplines. Although it was agreed that all EMSC professionals should have a core knowledge base on violence prevention and should work as a team in violence prevention efforts, the training requirements and roles in the intervention process differ across these disciplines. With this caveat in mind, the document lists 14 key areas of knowledge for all EMSC personnel (for example, the effects of witnessing violence). It was recommended that this knowledge base be incorporated in the curricula for EMSC personnel at all stages of professional development.
With the help of our colleagues in the other disciplines, we listed special training requirements for the various EMSC personnel in the second portion of the document. For example, for emergency medical technicians and paramedics, we recommended "being aware of any children that might have witnessed violence and were not transported to the hospital, and reporting the information to hospital mental health staff." For emergency nurses, we noted, for example, that nurses "must develop techniques and instruments for questioning that will not inflict greater harm upon the patient who has been a victim of violence." Similar recommendations were made for emergency physicians and trauma surgeons, as well as for mental health professionals working in emergency settings.
The final section of the document outlines strategies for violence prevention and intervention efforts in EMSC settings. The difficulty identifying child victims of violence has led some experts to advocate universal screening for all emergency department patients. We recommended using the universal violence prevention screening protocol developed by the George Washington University Emergency Department. We also noted, however, that not all healthcare professionals agree with the concept of universal screening, and that some hospital ethic boards have not approved proposals for universal screening.
Several other key recommendations were made. For example, the ED waiting room was identified as a place where family members who accompany victims of violence might be introduced to prevention materials that could be used following discharge from the hospital. Also, post-intervention follow-up and referral is a significant concern for many medical professionals. That is, will their efforts at screening and identification result in any help received following discharge from the hospital? The need to establish a smooth referral process to appropriate referral sources was emphasized. Linking ED care to community resources is particularly important. For example, a paid youth advisory board to Children's National Medical Center in Washington, D.C. meets in the communities of high-risk youth to assess needs that might be addressed by linking to the ED. Finally, the effects of violence can be traumatizing for EMSC professionals, and it was recommended that the emotional needs of EMSC personnel be recognized and that care be available to them as needed.
The convening of a group of healthcare professionals for the purpose of discussing violence prevention highlights the need for psychologists to look across disciplinary boundaries to improve effectiveness and disseminate information in a manner that will have the greatest impact on problems such as violence. The professionals who attended this meeting were clearly "on the same page" in the need for addressing this critical issue of violence in medical settings and societally. However, it is clear that given the multiple demands upon emergency services personnel and the wide range of knowledge and abilities necessary to function effectively as a healthcare professional in these settings, violence and violence prevention concerns are secondary to other aspects of day-to-day work and training. It was further noted that if the recommendations developed by APA are to have an effect on EMSC services, there will need to be a concerted follow up effort and continued emphasis on the importance of such training over the next decade.