Barnett Brown, V., Harris, M. & Fallot, R. (2013). Moving toward Trauma-Informed Practice in Addiction Treatment: A Collaborative Model of Agency Assessment. Journal of psychoactive drugs, 45 (5): 386 | Trauma-informed self-assessment and walk through protocol (Fallot & Harris) | US | Qualitative – theoretical article with case studies | Addiction programmes in the US | Between 30–50% of individuals with substance use disorders have lifetime diagnoses of PTSD. Trauma is prevalent and causally-linked to behavioural health issues. Yet involuntary, coercive and non-gender responsive techniques such as restraint, seclusion and male nurses conducting night checks risk re-traumatising patients | Self-assessment protocols can aid healthcare services in identifying and correcting potentially retraumatising policies and practices at minimal or no cost |
Beckett, P., Holmes, D., Phipps, M., Patton, D. & Molloy, L. (2017). Trauma-Informed Care and Practice: Practice Improvement Strategies in an Inpatient Mental Health Ward. Journal of Psychosocial Nursing, 55 (10). pp. 34–38 | Trauma-informed self-assessment protocol with trauma workshops | Australia | Qualitative – case study of applying self-assessment protocol in mental health ward | 27 bed acute admissions ward, Melbourne hospital | Implementing trainings, self-assessment and staff working groups resulted in significant changes over three years: 80% reduction in seclusions, introduction of women-only section of ward, reduction in pharmacological sedation | Given the traumagenic nature of MH issues, all mental health services should deliver trauma-informed care |
26 Brady, M. (2018). UK Paramedics Confidence in Identifying Child Sexual Abuse: A Mixed-Methods Investigation. Journal of Child Sexual Abuse 27 (4): pp. 439–458 | Online survey – Likert five-point attitudinal scale to measure confidence in ability to recognise, CSA, CSE and FGM | UK | Mixed methods – survey and focus groups | 276 UK paramedics | Current training often brief, generic and competing for time with other service priorities. Paramedics’ expressed low-self-efficacy in relation to their ability to recognise CSA/E and FGM. Perception that CSA/E is rare and only prevalent among certain populations | Need for further in-depth training, with focus on recognising diverse non-physical indicators that abuse may be occurring, as well as dispelling misapprehensions about prevalence and risk factors |
10 Colthart, I., Bagnall, G., Evans, A., Allbutt, H., Haig, A., Illing, J. & McKinstry, B. (2008). The effectiveness of self-assessment on the identification of learner needs, learner activity, and impact on clinical practice: BEME Guide no. 10. Medical Teacher 30 (2). pp. 124–145 | Systematic review of self-assessment as a tool for identifying learner needs, and improving learning activity, clinical practice and patient outcomes | Global – included studies from US, UK, Canada, Australia, Sweden and elsewhere | Systematic review | 32 papers met inclusion criteria, including methodological quality requirements | No high-quality papers provided insight into whether self-assessment results in a learning activity change, or an accurate perception of learning needs Only two papers considered whether self-assessments can improve clinical practice or patient outcomes. Neither presented compelling evidence that self-assessments contribute to improvements in either area Findings in relation to subsidiary research questions showed that learners are more accurate in assessing their peers than themselves; that demographic factors such as sex are associated with more or less accurate self-assessments, and that the less competent are liable to over-estimate their performance. Self-assessment of practical skills was more in line with peer/expert assessments than self-assessment of knowledge/cognitive skills | There is a need for more high-quality research in this area |
Connor, P., Nouer, S., Mackey, S., Banet, M. & Tipton, N. (2011). Dental Students and Intimate Partner Violence: Measuring Knowledge and Experience to Institute Curricular Change. Journal of Dental Education, 75 (8). pp. 1010–1019 | PREMIS self-assessment tool | US | Quantitative – survey | 318 dental, medicine, nursing and social work students at the University of Tennessee | 70% of survey respondents reported having had no IPV training prior to dental school The entire cohort reported low levels of preparedness and knowledge for supporting survivors of IPV relative to other respondents | There is a strong need for a standardised IPV training curriculum for dental professionals |
13 Davis, D., Mazmanian, P., Fordis, M, Van Harrison, R., Thorpe, K. & Perrier, L. (2006). Accuracy of Physician Self-assessment Compared with Observed Measures of Competence: A Systematic Review. JAMA. 296(9). pp. 1094–1102. https://doi.org/10.1001/jama.296.9.1094 | Systematic review of evidence on accuracy of individual self-assessments relative to peer/’objective’ external measures | Studies from US, UK, Canada, Australia and New Zealand | Systematic review | 17 studies relevant for inclusion | Positive associations between self-assessed expertise and observed/demonstrated competence in seven domains, including in 'highly specialised' areas such as the identification of signs of CSA (a pre-2000 study). They sub-defined self-assessments as either predictive, concurrent or summative | Develop more detailed learning and practice objectives to guide professionals Incorporate 'objective measurements or benchmarks of performance', so that professionals are more attuned to what is expected of them and are better equipped to self-assess performance and learning needs Consider incorporating 'multisource feedback’ (360° evaluations) when assessing communication or interpersonal skills Develop external measures and guides to facilitate more accurate/ useful self-assessments A greater role for specialist societies, who could provide up to date, evidence-based learning objectives |
DeCorby-Watson, K., Mensah, G., Bergeron, K., Abdi, S., Rempel, B. & Manson, H. (2018). Effectiveness of capacity building interventions relevant to public health practice: a systematic review. BMC public health 18 (1). pp. 684 − 15 | Systematic review of capacity building interventions | Global – English language literature published 2005 onwards | Systematic review | 14 studies examining six intervention types: 1) Internet-based instruction 2) Training and workshops 3) Technical assistance 4) Education using self-directed learning 5) Communities of practice 6) Multi-strategy interventions | Reviewers assessed outcomes related to learner knowledge, self-efficacy, perceived support, changes in policies or practice, skills, or support environments Internet-based instruction was found to be more effective than no intervention, but less effective than other interventions studied Self-directed learning increased knowledge but not skills Communities of practice and traditional educational strategies produced the most significant improvements across impact domains | There is a need to strengthen the evaluation of capacity building interventions, particularly organisational and systems level interventions |
15 Fetters, M. Motohara, S., Ivey, L., Narumoto, K., Sano, K., Terada, M., Tsuda, T. & Inoue, M. (2017). Utility of self-competency ratings during residency training in family medicine education-emerging countries: findings from Japan. Asia Pacific Family Medicine, 16 (1). https://doi.org/10.1186/s12930-016-0031-1 | 142 item online survey measuring self-perceived competency in different subject areas within family medicine/general practice | Japan | Quantitative – cross-sectional longitudinal study over a four-year period | 20 medical residents (11 women, nine men) | Scores improved annually from baseline to graduation, with the composite score across subject areas increasing from 31–65%. All subcategories showed improvement, with the greatest increase in women’s health care, screening and geriatrics | Self-assessment represents a feasible method of monitoring resident progress and inform programme development |
28 Fraser, J., Griffin, ., Barto, B. Lo, C., Wenz-Gross, M., Spinazzola, J., Bodian, R., Nisenbaum, J. & Bartlett, J. (2014). Implementation of a workforce initiative to build trauma-informed child welfare practice and services: Findings from the Massachusetts Child Trauma Project. Children and Youth Services Review 44. pp. 233–242 | Trauma-informed self-assessment protocol, with dissemination of trauma training and trauma-informed leadership teams | US | Qualitative | 192 clinicians and 1096 child welfare workers from 20 MH and social care agencies across Massachusetts | Following dissemination of trauma training and formation of Trauma Informed Leadership Teams, 298 children were enrolled in evidence-based treatments. This fell short of enrolment goals | Issues such as time and budgetary constraints, high staff turnover due to burnout/vicarious trauma affect implementation and must be accounted for in planning and pilot stages |
27 Horwood, J., Morden, A., Bailey, J., Pathak, N. & Feder, G. (2018). Assessing for domestic violence in sexual health environments: a qualitative study. Sexually transmitted infections 94 (2). pp. 88–92 | Evaluation of a pilot training intervention to promote DVA screening – Identification and Referral to Improve Safety (IRIS) | UK | Qualitative – semi-structured interviews | 17 sexual health clinic staff and DVA advocate workers | Most patients responded well to screening, particularly women. The addition of an automatic prompt to electronic patient records was seen as positive and impactful Staff struggled with time constraints, the added administrative burden of evidencing/logging enquiry and other priorities (e.g. asking about smoking or alcohol use). There were a lack of available services to refer male victim-survivors to | Interviewees emphasised the need for ongoing feedback and refresher training sessions Contextual barriers that emerged during interviews show that leadership buy in and support from NHS Trusts and commissioning groups are crucial to ensure sustainability and staff morale. Additional work associated with screening should be recognised and reimbursed, with time allowances if necessary |
Jones, K. M. (2016). Obstetrician/gynaecologists’ readiness to manage intimate partner violence. PhD thesis in Clinical Psychology. American University Washington DC | PREMIS self-assessment tool | US | Quantitative | 194 members of the American College of Obstetricians and Gynaecologists, 981 patients | * Only 20.2% of ob/gyn survey respondents reported routinely screening all patients for IPV * Non-White patients were significantly more likely to be screened than White patients * First-time patients were significantly more likely to be screened than returning patients | Research suggests that patients respond favourably or neutrally to routine enquiry, but physicians remain reluctant to screen. It is therefore imperative to address physician reported barriers to enquiry, such as discomfort about raising the subject of IPV Future training and educational programmes could emphasise patient satisfaction with routine IPV screening |
Moskovic, C.S., Guiton, G., Chirra, A., Núñez, A., Bigby, J., Stahl, C., Robertson, C., Thul, E., Miller, E., Sims, A., Sachs, C., & Pregler, J. (2008). Impact of Participation in a Community-Based Intimate Partner Violence Prevention Program on Medical Students: A Multi-Centre Study. Journal of General Internal Medicine, 23. pp. 1043–1047 | Pre-post survey to test actual knowledge, attitudes and confidence | US | Quantitative/randomised controlled trial. Students randomly assigned to didactic training with or without participation in community-based programme | 117 students attending four medical schools | Both conditions demonstrated significant increase in knowledge and a greater increase in confidence for participants who completed didactic training, whether assisted with community-based IPV programme or not | Survey instrument suggests self-reported confidence not only contingent on theoretical knowledge but on practical experience |
Murray, H. (2017). Evaluation of a Trauma-Focused CBT Training Programme for IAPT services. Behavioural and Cognitive Psychotherapy 45 (5). pp. 467–482 | Pre-post training self-rated PTSD competencies on an adapted/ bespoke assessment tool | UK | Mixed methods – actual knowledge, self-reported competencies, training feedback, supervisor feedback, patient outcomes | 20 therapists from 10 IAPT services | The training programme was successful in improving trauma-focused CBT knowledge, skills and outcomes. Feedback from participants indicated that they found the training highly acceptable | High staff turnover and institutional barriers within participating services suggest that sustainability is contingent on trained staff remaining with services and successfully disseminating training |
14 Pierides, K.,Duggan, P., Chur-Hansen, A. and Gilson, A. (2013). Medical student self-reported confidence in obstetrics and gynaecology: development of a core clinical competencies document. BMC Medical Education, 13 | Core competencies list – administered as part of an 81-item survey | Australia | Mixed methods – a candidate list of core competencies was reviewed at two focus groups, then administered as online survey | 172 medical students | Confidence in history-taking skills was low in relation to patients presenting with signs of sexual violence or abuse (less than 46%) | Open ended responses suggested class sizes and a lack of clinical experience adversely impacted confidence. More research needed in these areas |
Ramsay, J., Rutterford, C., Gregory, A., Dunne, D., Eldridge, S., Sharp, D. and Feder, G. (2012). Domestic violence: knowledge, attitudes, and clinical practice of selected UK primary healthcare clinicians. British Journal of General Practice. https://doi.org/10.3399/bjgp12X654623 | PREMIS self-assessment tool | UK | Quantitative – prospective observational cohort study | 272 clinicians from 48 general practices in Hackney and Bristol (59% response rate) | Findings showed that most participants had only minimal previous DVA training and basic knowledge. Low frequency of enquiry/screening in response patients who present with possible indicators that they are experiencing abuse | Both GPs and practice nurses require more training on DVA, including available support services locally |
Ritchie, M, Nelson, K. Wills, R, & Jones, L. (2014). Development of an Audit Tool to Evaluate the Documentation of Partner Abuse Assessments within a Provincial Emergency Department: An Exploratory Study. Journal of Family Violence 29 (2): pp. 215–221 | Clinical audit tool | New Zealand | Mixed methods – five stage development process, including systematic review, selecting review criteria, piloting and testing for inter-rater reliability | Documentation of women aged 16 + attending hospital emergency department for IPV | | Quality assessment and documentation are vital to support effective intervention with patients who have experienced IPV |
Ritchie, M., Nelson, K., Wills, R. & Jones, L. (2013). Does Training and Documentation Improve Emergency Department Assessments of Domestic Violence Victims? Journal of Family Violence, 28 (5): pp. 471–477 | Clinical audit tool | New Zealand | Quantitative – 80 randomly selected clinical records from a nine-year period scored using Family Violence Identification Form (FVIF) and scores entered into the Statistical Package of Social Science Research (v18) | 80 clinical records of women aged 16 + attending emergency department for IPV | Trends throughout the stages of programme development showed that training alone led to no improvement in assessment or documentation – training plus the introduction of the FVIF yielded significant improvement | In order to successfully implement change, leadership need to understand the barriers and facilitators to improving practice; for example, why staff members may feel hesitant to ask about IPV |
22 Short, L., Alpert, E., Harri, J. & Surprenant, Z. (2006). A tool for measuring physician readiness to manage intimate partner violence. American Journal of Preventive Medicine 30 (2). pp. 173–180 | PREMIS self-assessment tool | US | Quantitative – psychometric survey instrument development, testing and refinement | 166 practicing physicians – subscribers to a continuing medical education website | The final 67 item survey tool demonstrated good internal consistency reliability, with Cronbach’s alpha greater than or equal to 0.65 for 10 final scales. The developed scales were closely correlated with theoretical constructs and predictive of self-reported behaviours. | The tool could contribute to effective healthcare responses to IPV victim-survivors, by assessing HCP’s knowledge and preparedness and identifying areas for improvement. Future studies should investigate the relationship between self-reported KABB (knowledge, attitudes, beliefs and behaviours) physician behaviours, and patient outcomes |
Sohal, A., Pathak, N., Blake, S., Apea, V., Berry, J., Bailey, J., Griffiths, C. and Feder, G. (2018). Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention. Sexually transmitted infections, 94 (2): p. 83 | Pre-post training self-assessment surveys (for Site 2 only, as low response rate at Site 1) | UK | Adaptive mixed methods pilot study – intervention comprised multidisciplinary training sessions electronic prompts, | Two women’s walk in sexual health clinics | Self-rated knowledge about DVA health consequences, enquiry, response and advocacy referrals rose by 40%. All feasibility outcomes met | Further evaluation required to confirm intervention effectiveness prior to scaling up nationally |
Songer, T., Stephens-Stidham, S., Peek-Asa, C., Bou-Saada, I., Hunter, W., Lindemer, K. & Runyan, C. (2009). Prevention and Preparedness: Core Competencies for Injury and Violence Prevention. American Journal of Public Health 99 (4): pp. 600–606. | Core competencies framework | US | Qualitative – consulted expert advisory panel and public to arrive at consensus on essential and desirable competencies for public health professional working in violence and injury prevention | 52-person expert panel, public comment from 32 relevant agencies | Consensus around nine key competencies: * Define and explain injury and violence as a social and health problem, including conceptual models and risk factors * Access, use, interpret and prevent violence and injury data * Design and implement prevention activities * Evaluate prevention activities * Build and manage a prevention programme * Stimulate change through policy, advocacy, enforcement and education * Maintain and develop competencies as a professional * Demonstrate competence in a specific violence or injury topic | Core competencies framework is designed to provide public health professionals working in violence or injury prevention with a standard set of skills for practice, to guide professional development and learning |
Trevillion, K.., Agnew-Davies, R. and Howard, L. M. (2011). Domestic violence: responding to the needs of patients. Nursing Standard 25 (26): pp. 48–56; quiz 58, 60 | Self-assessment questionnaire | UK | NA – article offering overview of DVA facts and questionnaire | Guidance for nurses | NA | Promotes testing subject knowledge as a means of consolidating and directing learning |
Williamson, E., Jones, S., Ferrari, G.,Debbonaire, T., Feder, G. and Hester, M. (2015). Health professionals responding to men for safety (HERMES): feasibility of a general practice training intervention to improve the response to male patients who have experienced or perpetrated domestic violence and abuse. Primary Health Care Research Development. 16 (3): pp. 281–288 | PREMIS self-assessment tool | UK | Mixed methods – pre-post completion of PREMIS, disclosures documented in clinical records, semi-structured telephone interviews | 25 survey participants, 7 interviewees. All physicians from 4 general practices in Bristol | Post-training surveys showed an increase in self-reported ability to respond to disclosures and statistically significant improvements in perceived competence in responding to male patients | Further research needed to better understand men’s help-seeking behaviours. Clinician feedback shows a need to consolidate DVA training to accommodate time constraints |
World Health Organisation (2019). Caring for women subjected to violence: a WHO curriculum for training health-care providers. Available at: https://www.who.int/reproductivehealth/publications/caring-for-women-subject-to-violence/en/ | Training curriculum, including pre- and post-training self-assessment tools | Global, with a particular focus on low- and middle-income countries | NA – 13 training sessions to deliver over two and a half days | NA – the training curriculum is primarily designed for primary healthcare providers | NA | The four objectives of the training are: 1. Demonstrate general knowledge of violence against women as a public health problem 2. Demonstrate behaviours and understand values contributing to safe and supportive services for survivors 3. Demonstrate clinical skills appropriate to one’s profession and specialty to respond to violence against women 4. Demonstrate knowledge of how to access resources and support for patients and for oneself (3) |
Royal College of Nursing (2017). National Curriculum and Competency Framework Emergency Nursing (Level 1) | Core competency framework | UK | NA | NA | NA | Recommendation to set realistic development goals at one-to-one meetings and revisit and review regularly. Meet with mentor at three-month intervals during year 1, and then six-month intervals during year 2 to review progress in core competencies |
Royal College of Nursing (2017). National Curriculum and Competency Framework Emergency Nursing (Level 2) | Core competency framework | UK | NA | NA | NA | Recommendation to set realistic development goals at one-to-one meetings and revisit and review regularly. Meet with mentor at three-month intervals during year 1, and then six-month intervals during year 2 to review progress in core competencies |