Appendix B. Inventory of Training Programs, Policy Statements and Practice Protocols

Training Program/Policy Statement/Practice Protocol: 7474747411
Practice Parameters for the Forensic Evaluation of Children and Adolescents Who May Have Been Physically or Sexually Abused
Source: American Academy of Child and Adolescent Psychiatry
Address: 3615 Wisconsin Ave., N.W., Washington, D.C. 20016
Description: These practice parameters describe the forensic evaluation of children and adolescents who may have been physically or sexually abused. The recommendations are drawn from guidelines that have been published by various professional organizations and authors and are based on available scientific research and the current state of clinical practice. They consider the clinical presentation of abused children, normative sexual behavior of children, interview techniques, the possibility of false statements, the assessment of credibility, and important forensic issues.
Audience: Mental health professionals who may be called upon to: 1) provide forensic evaluations; 2) to conduct mental health assessments or to provide treatment, and 3) to provide consultations regarding public policies.
Dissemination/Usage: Published in the October 1997 Journal of the American Academy of Child and Adolescent Psychiatry 36(10 supplemental):37S-57S.

Training Program/Policy Statement/Practice Protocol: 7474747422
Care of the Adolescent Sexual Assault Victim
Source: American Academy of Pediatrics, Committee on Adolescence
Address: 141 Northwest Point Blvd., PO Box 927, Elk Grove Village, Il 60009-0927
Description: Guideline on the care of the adolescent sexual assault victim, developed by the American Academy of Pediatrics, Committee on Adolescence. The guidelines recommend that pediatricians should:

• Be knowledgeable about the epidemiology of sexual assault in adolescence.
• Be knowledgeable about the current reporting requirements for sexual assault in their communities.
• Be knowledgeable about sexual assault and rape evaluation services available in their communities and when to refer adolescents for a forensic examination.
• Screen adolescents for a history of sexual assault and potential sequelae.
• Be prepared to offer psychological support or referral for counseling and should be aware of the services in the community that provide management, examination, and counseling.
• Provide preventive counseling to adolescent patients regarding avoidance of high-risk situations that could lead to sexual assault.

Audience: Pediatricians
Dissemination/Usage: Published in the June, 2001 issue of Pediatrics 107(6):1476-9.

Training Program/Policy Statement/Practice Protocol: 7474747433
Child Abuse and Forensic Pediatric Medicine Fellowship Curriculum Statement
Source: American Academy of Pediatrics (AAP) Section on Child Abuse and Neglect, and the Forensic Pediatrics Physician Leadership Group, Committee on Fellowship Curriculum
Description: This is a model curriculum developed by a joint working group of the American Academy of Pediatrics Section on Child Abuse and Neglect and the Forensic Pediatrics Physician Leadership Group, Committee on Fellowship Curriculum. The purpose is to expand the number of training programs and to standardize curricula in existing fellowships to prepare physicians for the diagnosis and treatment of victims of child abuse and neglect, and to provide expert consultation at the request of medical, investigative and legal professionals.
Dissemination/Usage: Published in the February 2000 issue of Child Maltreatment 5(1):58-62.

Training Program/Policy Statement/Practice Protocol: 7474747444
Educational Activities of the American Academy of Pediatrics
Source: American Academy of Pediatrics (AAP)
Address: 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007-1098
Phone: (847) 434-4000
Web site: www.aap.org
Description: The Committee on Child Abuse and Neglect (COCAN) provides an educational forum for AAP members to discuss problems and treatments relating to child abuse. COCAN is also active in developing resources to assist in diagnosing and preventing child abuse. The AAP has developed the following educational materials with the assistance of COCAN.

• The Visual Diagnosis of Child Abuse
  The most common physical injuries from child abuse are presented in 150 vivid photographic slides, accompanied by a detailed study guide. An effective tool for enhancing diagnostic skills or educational presentations. Developed with the C. Henry Kempe National Center.
• Visual Diagnosis of Child Sexual Abuse
  This unique, comprehensive presentation uses slides and a study guide to assist in diagnosing cases of child sexual abuse and in medical evaluation of abuse accusations. 166 powerful photographic slides show examples of abuse, as well as normal anatomy and non-abusive injury. Study guide enables self-teaching and review of visual material.
• A Guide to References and Resources in Child Abuse and Neglect, 2nd Edition
  Knowing where to find the facts to enhance your ability to help children in crisis is the focus of this manual. Resource includes annotated bibliographies, summary, US child abuse and neglect programs and AAP policy statements.
• Focus on Child Abuse: Resources for Prevention, Recognition's and Treatment, 2nd Edition CD-ROM.

CD-ROM technology, including high-speed navigator search and integration functions, makes it easy to access vital data. Key components include: more than 200 color slides; the Visual Diagnosis of Child Physical Abuse; visual self-assessment; parent and patient education/information; results of 50-state child abuse survey; AAP policies; manual experts; full-text articles from Pediatrics, and AAP Speaker's Kit of slides, lecture notes, and handouts.

Audience: Physicians, primarily pediatricians.
Dissemination/Usage: The educational materials were developed by the AAP with assistance from COCAN and are available for purchase through the AAP publications catalog and the AAP Web site.
Additional Comments: In addition to the above materials, COCAN also sponsors educational sessions at the AAP's National Conference and Exhibitions Sessions. COCAN also publishes a newsletter which is distributed to section members.

Training Program/Policy Statement/Practice Protocol: 7474747455
Gonorrhea in Pre-Pubertal Children Policy Statement
Source: American Academy of Pediatrics, Counsel of Child and Adolescent Health
Address: 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007-1098
Phone: (847) 434-4000
Web site: www.aap.org
Description: A policy statement by the Committee on Child Abuse and Neglect (COCAN) of the American Academy of Pediatrics concerning gonorrhea in pre-pubertal children. The purpose of the guideline is to remind physicians that sexual abuse should be strongly considered when gonorrheal infection is diagnosed in a child after the newborn period and before the onset of puberty. Frequently a sexually-transmitted disease may be the only evidence of sexual abuse. The Centers for Disease Control (CDC) and Prevention states, "the identification of a sexually-transmitted agent from a child beyond the neonatal periods suggests sexual abuse." While the risks of acquiring sexually-transmitted diseases as a result of sexual abuse is unknown reported rates of gonocchial infection have ranged from 3 to 20 percent among sexually abused children. The policy statement discusses clinical findings and laboratory findings and also provides a list of references.
Audience: Pediatricians.
Dissemination/Usage: The material is on the AAP Web site and was published in the Journal of the American Academy of Pediatrics.

Training Program/Policy Statement/Practice Protocol: 7474747466
Guidelines for the Evaluation of Sexual Abuse of Children: Subject Review
Source: American Academy of Pediatrics
Address: 141 Northwest Point Boulevard, Elk Grove Village, Illinois 60007-1098
Phone: (847) 434-4000
Web site: www.aap.org
Description: The guidelines are prepared and approved by the Committee on Child Abuse and Neglect (COCAN), of the American Academy of Pediatrics. Focus is on the physical, sexual, and mental abuse and neglect of children and adolescents. This is one of a number of current policy statements which has been developed by COCAN to provide advice to practicing pediatricians. The guidelines point out that few areas of clinical pediatric practice have expanded as much as sexual abuse in the last 25 years.

Sexual abuse occurs when a child is engaged in sexual activities that they cannot understand, for which they are not developmentally prepared, or that violate either laws or social taboos of society. Besides seeing possibly abused children in the normal course of practice, pediatricians may see the potentially abused child when 1) the child is brought in by parents for evaluation of possible sexual abuse, 2) the child is brought to the pediatrician by child protective services or law enforcement professionals for a medical evaluation of possible sexual abuse or 3) the child is brought to an emergency department after a suspected episode of sexual abuse for evaluation, evidence collection, and crises management.

The guidelines provide information and guidance on the following topics:

1. Taking a history and interviewing the child.
2. Physical examination.
3. Laboratory data.
4. Diagnostic considerations.
5. Record.
6. Treatment.
7. Legal issues.

It is important that interviews be conducted by the designated agency or person to avoid repetitive questioning of the child. The American Academy of Child and Adolescent Psychiatry and the American Professional Society on Abusive Children have published specific guidelines for interviewing sexually abused children.

The guidelines were prepared by the Committee on Child Abuse and Neglect in 1998 and 1999, and published in Pediatrics in 1999. The guidelines include a bibliography.

Target Audience: These guidelines are intended for all health professionals caring for children. In addition to these guidelines, the Academy has also produced guidelines for dealing with the sexually abused adolescent.
Dissemination/Usage: Available on the AAP Web page. Published in the Academy Journal, Pediatrics.

Training Program/Policy Statement/Practice Protocol: 7474747477
Oral and Dental Aspects of Child Abuse and Neglect
Joint Statement of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry
Source: American Academy of Pediatrics and American Academy of Pediatric Dentistry
Address: 141 Northwest Point Boulevard, Elk Grove Village, Illinois 60007-1098
Phone: (847) 434-4000
Web site: www.aap.org
Description: A joint policy statement designed to aid the pediatrician in identifying oral or dental aspects of child abuse and neglect. The policy statement points out that, physicians receive limited education in oral health and dental injury and therefore may have difficulty in identifying child abuse in the oral cavity. The oral cavity is a frequent site of sexual abuse in children. The presence of oral and perioral gonorrhea or syphilis in pre-pubertal children is pathonomonic of sexual abuse. When gonorrhea or syphilis are diagnosed in a child, public health authorities must be notified and a multi-disciplinary child abuse evaluation should be undertaken. The policy statement describes the specific cultures and tests that need to be conducted in the case of suspected gonorrhea. The statement also indicates that during the examination of the child suspected of experiencing oral sex, cotton swabs should be used to obtain samples with the swabs preserved for laboratory analysis of the presence of semen. The policy statement also advises the physician to look for unexplained erythema or petechiae of the pallet, particularly at the junction of the hard and soft pallet since this may be indicative of forced oral sex.
Target Audience: Pediatricians.
Dissemination/Usage: Distributed by the academy and also published in Pediatrics 104(22), August 1999.

Training Program/Policy Statement/Practice Protocol: 7474747488
Policy Statements Regarding Sexual Assault and Abuse of Children
American Academy of Pediatrics
Source: American Academy of Pediatrics (AAP)
Committee on Child Abuse and Neglect (COCAN)
Address: 141 Northwest Point Boulevard, Elk Grove Village, Illinois 60007-1098
Phone: (847) 434-4000
Web site: www.aap.org
Description: The Committee on Child Abuse and Neglect (COCAN) is responsible for policy development and related issues concerning the physical, sexual, and mental abuse and neglect of children and adolescents. The COCAN has developed a number of policy and educational statements related to the sexual abuse of children. The following policy statements developed by COCAN and approved by the American Academy of Pediatrics relate to treatment and diagnosis of the sexually assaulted or physically abused child.

• Distinguishing sudden infant deaths syndrome from child abuse (February 2001).
• The medical necessity for the hospitalization of the abused and neglected child (April 1998).
• Shaken Baby Syndrome (Inflicted Cerebral Trauma, December 1993, currently being revised).
• Investigation and Review of Unexpected Infant and Child Deaths (November 1999).

Audience: Pediatricians
Dissemination/Usage: The material is on the AAP Web page and was published in the AAP Journal, Pediatrics.

Training Program/Policy Statement/Practice Protocol: 7474747499
Sexual Assault and the Adolescent: Policy Statement
Source: American Academy of Pediatrics (AAP)
Address: 141 Northwest Point Boulevard, Elk Grove Village, Illinois 60007-1098
Phone: (847) 434-4000
Web site: www.aap.org
Description: The current policy statement on sexual assault and the adolescent was developed in 1994 and published in November 1994, volume 94, no. 5 issue of Pediatrics. The Committee on Adolescents is in the process of revising the policy statement which briefly outlines the problem of rape and provides various definitions. The policy statement points out that while there is a common perception of rape as something perpetrated by strangers, about half of adolescent sexual assaults are committed by acquaintances.

The policy indicates that victims of rape have a difficult adjustment to the assault since they tend to blame themselves, frequently suffer diminished self-esteem, and may have difficulty establishing trust in future relationships. The policy statement describes the appropriate management of the rape victim and identifies the goals of rape intervention to include identification and treatment of injury and infection, pregnancy prevention, evidence collection, and psychological assessment with referral for counseling. Findings must be carefully and accurately documented in the medical record.

The position paper recommends that when a pediatrician is consulted about a possible sexual assault within 72 hours of the event, the adolescent should be evaluated by a pediatrician knowledgeable in forensic procedures or referred to a rape crisis center or an emergency facility. The American Academy of Pediatrics recommends that pediatricians:

1. Be knowledgeable about the incidence of stranger and acquaintance sexual assault.
2. Participate in the establishment of rape protocols.
3. Understand the legal aspects of forensic examination.
4. Be prepared to offer preventive counseling, immediate medical referral, and psychological support to the adolescent patients in their practice who may be victims of sexual assault.

The policy statement includes a sexual assault and rape protocol and an extensive bibliography.

Target Audience: Pediatricians
Dissemination/Usage: Widely disseminated by the American Academy of Pediatrics. The policy statement was published in the Journal of Pediatrics, and was made available electronically.

Training Program/Policy Statement/Practice Protocol: 747474741010
Organization: American Academy of Physician Assistants
Address: 950 N. Washington Street, Alexandria, VA 22314
Web site: www.aapa.org
Contact: Bob McNellis, Director of Clinical Affairs & Clinical Education
Phone: (703) 836-2272
Description: The American Academy of Physical Assistants (AAPA) has a number of policy statements relating to various aspects of violence and violence education and training.

• PA programs are encouraged to include in their curricula techniques of violence prevention, assessment and intervention.
• AAPA supports educational programs concerning the prevention, recognition, reporting and treatment of child abuse.
• The AAPA recognizes family violence as a public health problem and supports medical care of battered individuals.
• The examination for PA certification and re-certification may include questions on both child abuse and domestic violence.

Target Audience: Physician assistants.

Training Program/Policy Statement/Practice Protocol: 747474741111
Advancing Women's Health: Health Plans' Innovative Programs in Domestic Violence
Source: American Association of Health Plans and The Commonwealth Fund
Description: A report developed by the American Association of Health Plans in partnership with HealthPartners Research Foundation (Minneapolis, MN) with support from The Commonwealth Fund. The report summarizes the key findings from AAHP's assessment of four health plans that have implemented innovative practices, including provider training, patient education, philanthropic efforts, community awareness programs, and public policy advocacy, to address the health issues arising from domestic violence and other forms of violence against women. Lessons learned include:

• Reach out to other concerned clinicians within the health plan.
• Build relationships with community-based nonprofit agencies.
• Invite the participation of a diverse group including providers, community leaders and advocates.
• Provide education to health care professionals during natural meeting times, such as staff meetings and lunches.

Audience: AAHP member health plans, consumers, and organizations in women's health, public health, and maternal and child health.

Training Program/Policy Statement/Practice Protocol: 747474741212
Child Abuse: ACEP Policy Statement
Source: American College of Emergency Physicians (ACEP)
Address: 1125 Executive Circle, Irving, TX 75038-2522
Phone: (972) 550-0911
(800) 798-1822
Web site: www.acep.org
Description: This Policy Statement, approved January 2000 by ACEP, recommends that:

1. Emergency physicians be familiar with signs and symptoms of child abuse.
2. Evaluations of pediatric patients include assessments for child abuse in appropriate physical and psychosocial settings.
3. Emergency medical services, medical school, and emergency medicine residency curricula include training in recognition, assessment and interventions in child abuse.
4. Hospitals be encouraged to participate in interdisciplinary approaches to child abuse that include policies; protocols for recognition, assessment, and intervention; and reporting and referring victims and their families.
5. An interdisciplinary approach should be used to collect data on various forms of child abuse and to promote and develop research on child abuse.

Target Audience: Emergency Medicine Physicians.

Training Program/Policy Statement/Practice Protocol: 747474741313
Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient—A Handbook
Source: American College of Emergency Physicians
Address: Sales and Service, PO Box 619911, Dallas, Texas 75261-9911
Phone: (800) 798-1822, Touch 6
Web site: www.acep.org
Description: Appropriate management of the sexually assaulted patient requires the clinician to address the medical and emotional needs of the patient while addressing the forensic requirements of the criminal justice system. Medical issues include acute injuries and evaluation of potential sexually transmitted disease and pregnancy. Emotional needs include acute crisis intervention and referral for appropriate followup counseling. Forensic tasks include thorough documentation of pertinent historical and physical findings, proper collection and handling of evidence, and presentation of findings and conclusions in court. This handbook has been written to provide a consensus-based set of recommendations. When possible, evidence-based recommendations are incorporated. The main document contains the core elements. Modules are attached that provide additional information and instructional guidance in greater detail. Appropriate portions of the handbook should be adapted to the circumstances of the individual community consistent with Federal, State, and local laws.
Target Audience: Physicians and other health care providers who may examine and treat victims of sexual assault including child molestation.
Dissemination/Usage: Widely distributed and also available on the Internet.
Other Comments: The Handbook was developed by a task force under the direction of the American College of Emergency Physicians. Representatives of the following organization participated in the project:

American Academy of Pediatrics
American Prosecutors Research Institute
American Society of Crime Laboratory Directors
Federal Bureau of Investigation
National Alliance of Sexual Assault Coalitions
National Network Children's Advocacy Center
American College of Emergency Physicians
American College of Obstetricians and Gynecologists
American Medical Association
Centers for Disease Control and Prevention
Emergency Nurses Association
International Association of Chiefs of Police
International Association of Forensic Nurses
Public Health Service/Office on Women's Health
STOP Violence Against Women Grants Technical Assistance Project

List of Key Elements of Family Violence Protocols

Training Program/Policy Statement/Practice Protocol: 747474741414
Source: American College of Emergency Physicians
Address: 1125 Executive Circle, Irving, TX 75038-2522
Phone: (800) 798-1822
Web site: www.acep.org
Description: The 1993-94 Emergency Medicine Practice Committee's Subcommittee on Key Elements of Domestic Violence Protocols developed a list of the key elements which should be covered in emergency department domestic violence protocols for both practice and reporting purposes. This list was based on a review of a variety of organizational and hospital protocols and on comments received from the Domestic Violence Task Force. Major topics addressed include:

1. Criteria for Identification.
2. Procedure for evaluation.
3. Consideration of patients and provider staff safety.
4. Referral to other locations and organizations as appropriate.
5. After care.
6. Medical record documentation.
7. Plans for staff education.
8. Prevention.
9. Quality assessment and management.

The protocols cover physical assaults, sexual assault, as well as abuse and neglect.

Training Program/Policy Statement/Practice Protocol: 747474741515
Management of Elder Abuse and Neglect: ACEP Policy Statement
Source: American College of Emergency Physicians
Address: 1125 Executive Circle, Irving, TX 75038-2522
Phone: (972) 550-0911
(800) 798-1822
Web site: www.acep.org
Description: This statement, approved October 1997, replaces a previous statement by ACEP on the same subject. ACEP recommends that emergency departments should have written protocols on recognition and treatment of elder abuse; that hospitals should have appropriate staff to aid victims of elder abuse and neglect; that hospitals and emergency departments should establish relationships with agencies that oversee the management and investigation of elder abuse; that professionals subject to mandatory reporting should be immune from liability for good faith efforts to comply, and; that further research should be done in the field of elder abuse and neglect. The ACEP opposes mandatory reporting of elder abuse and neglect but encourages voluntary referrals to social services, victims' services, the criminal justice system, or any other appropriate resource agency.
Target Audience: Emergency Medicine Physicians
Other Comments: As an adjunct to the policy statement, ACEP's Emergency Medicine Practice Committee has developed a Policy Resources and Education Paper (PREP) entitled, Guidelines for the Recognition and Management of Elder Abuse.

Training Program/Policy Statement/Practice Protocol: 747474741616
Management of the Patient with the Complaint of Sexual Assault: ACEP Policy Statement
Source: American College of Emergency Physicians
Address: P.O. Box 619911, Dallas, TX 75261-9911
Phone: (972) 550-0911
Web site: www.acep.org
Description: This policy statement was reaffirmed by the ACEP Board of Directors in June 1999. The policy states that the sexual assault patient, whether adult or child, has special medical, psychological, and legal needs. All patients who report a sexual assault are entitled to prompt access to emergency medical care and competent collection of evidence that will assist in the investigation and prosecution of the incident. The guidelines provide that:

1. Each county, State, or other appropriate political jurisdiction should establish a community plan to deal with the sexually assaulted patient. The plan should provide capable, trained personnel and appropriate equipment.
2. Each plan should address the medical, psychological, safety and legal needs of the sexually assaulted patient.
3. Each hospital should provide access to appropriate medical, technical and psychological support for the patient.
4. Specially trained non-physician medical personnel should be allowed to conduct evidentiary examinations where evidence collected in such manner is admissible in criminal cases.
5. Health professionals who collect evidence in good faith and follow protocols should be immune from civil or criminal penalties.
6. The community plan should provide for a primary referral center for pediatric patients.
7. Emergency department staff should be provided with ongoing training and education in the management of the sexually assaulted patient.

Audience: Emergency medicine physicians and others involved in the care and treatment of sexually assaulted patients.
Dissemination/Usage: The policy statement and the handbook are both available from ACEP's customer service department and on ACEP's Web site.
Additional Comments: In addition to the policy statement, ACEP's emergency medicine practice committee developed a handbook entitled, Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient.

Training Program/Policy Statement/Practice Protocol: 747474741717
Recognition and Management of Elder Abuse
Policy Resource and Education Paper
Organization: American College of Emergency Physicians
Address: 1125 Executive Circle, Irving, TX 75038-2522
Phone: (972) 550-0911
Contact: Margaret Montgomery, (972) 550-0911, ext. 3230
Description: The purpose of this paper is to increase awareness by emergency health care providers and to provide a format for the development of individual emergency department protocols. The paper defines physical, sexual, and behavioral abuse, identifies indicators of abuse and suggests possible interventions.
Target Audience: Emergency medicine physicians and other health care professionals involved with treating victims of sexual or physical abuse.
Dissemination/Usage: Available on the ACEP Web site: www.ACEP.org

Training Program/Policy Statement/Practice Protocol: 747474741818
ACOG Educational Bulletin: Adolescent Victims of Sexual Assault
Source: American College of Obstetricians and Gynecologists (ACOG)
Address: 409 12th Street, SW, PO Box 96920, Washington, D.C. 20090-6920
Description: This Educational Bulletin was developed under the direction of the Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists (ACOG) as an educational tool presenting current information as an aid to obstetricians and gynecologists. The bulletin addresses: definitions; prevalence; adolescent perceptions; identification of adolescent sexual assault victims; behavioral and psychological sequelae suggestive of history of sexual assault; physical health problems suggestive of history of sexual assault; and intervention and prevention.
Audience: Obstetricians and gynecologists.

Training Program/Policy Statement/Practice Protocol: 747474741919
Domestic Violence: The Role of the Physician in Identification, Intervention, and Prevention—A Slide Lecture Presentation
Source: American College of Obstetricians and Gynecologists (ACOG)
Address: 409 12th St., S.W., Washington, D.C. 20024-2188
Description: A 30- to 60-minute slide lecture presentation developed by the ACOG Family Violence Work Group, a body or respected physician/educators, many of whom have implemented domestic violence education programs at their respective institutions. The slide presentation is designed to:

• Provide background information on the definition, epidemiology, and demography of woman battering.
• Encourage and support physician's routine inquiry about battering to all patients in the office, clinic, or hospital.
• Help physicians identify presenting symptoms and signs of abuse through history and examination.
• Aid in formulating action plans to support battered women returning to unsafe environments.
• Identify components of long-term support and intervention in the community; facilitate access to community support services.
• Create clinical environments conducive to women learning more about battering.
• Identify barriers that prevent physician recognition of woman battering.
• Eliminate abuse in clinical settings.

Audience: Obstetric and gynecology residents; ACOG Fellows and Junior Fellows; third year medical students on obstetric-gynecology clinical rotation; first and second year medical students; other health providers, including emergency department personnel, dentists, nurse midwives, nurse practitioners, and mental health providers.

Training Program/Policy Statement/Practice Protocol: 747474742020
Intimate Partner Violence During Pregnancy: A Guide for Clinicians (Slide Lecture)
Source: American College of Obstetricians and Gynecologists (ACOG) and Centers for Disease Control and Prevention (CDC)
Address: 409 12th Street, SW, Washington, D.C. 20024-2188
Description: This 30 to 60 minute slide presentation on intimate partner violence during pregnancy is designed as an introductory or supplementary training tool for clinicians to increase understanding of the important role they can play in identifying, preventing, and reducing intimate partner violence. It also emphasizes the critical window of opportunity that prenatal care provides for the screening and referral of pregnant women. Included with the slide set are a bibliography and resource lists.
Audience: Obstetrics and gynecology residents; ACOG Fellows and Junior Fellows; third-year medical students on obstetric-gynecologic clinical rotation; first and second year medical students for whom the content is integral to courses such as "Introduction to Clinical Medicine" and "Medical Ethics;" other health care providers,including emergency department personnel, dentists, nurse-midwives, nurse practitioners, and mental health care providers

Training Program/Policy Statement/Practice Protocol: 747474742121
Book on Ambulatory Medicine
Organizations: American College of Physicians; American Society of Internal Medicine
Address: 190 N. Independence Mall West, Philadelphia, PA 19106-1572
Web site: hhtp://www.acponline.org
Contact: Patrick C. Alguire, Director, Education and Career Development
Phone: (215) 351-2845
E-Mail: palguire@mail.acponline.org
Description: As part of its continuing education program, the American College of Physicians produces written material to allow internists to assess their current state of knowledge and update their knowledge in key areas. The book on ambulatory medicine has brief sections on domestic violence, elder abuse and adolescent sexual abuse.
Target Audience: Internists
Distribution: Available from the American College of Physicians Book Division.

Training Program/Policy Statement/Practice Protocol: 747474742222
Diagnostic and Treatment Guidelines on Child Physical Abuse and Neglect
Source: American Medical Association (AMA)
Address: 515 North State Street, Chicago, IL 60610
Phone: (312) 464-5000
Web site: www.ama-assn.org
Description: The Guideline describes symptoms of child abuse and neglect and the diagnosis of abuse or neglect. The role of historical, behavioral and physical findings as well as the interview and examination of the victim are discussed. The Guideline also addresses the ethics of reporting an abuser who is known to the physician, how to document the examination, obtaining an order of temporary custody, giving testimony, risk management, and trends in treatment and prevention. The Guidelines reflect the views of scientific experts and reports in scientific literature as of March 1992.
Dissemination/Usage: Published and distributed by the AMA. Available for sale on their Web site.

Training Program/Policy Statement/Practice Protocol: 747474742323
Diagnostic and Treatment Guidelines on Child Sexual Abuse
Source: American Medical Association
Address: 515 North State Street, Chicago, IL 60610
Phone: (312) 464-5000
Web site: www.ama-assn.org
Description: The Guideline is intended to familiarize the physician with facts about sexual abuse: the ethical considerations of reporting parents who are know to the physician; how abused children presents; the interviewing process; and the physical exam. The Guideline discusses documenting the examination, reporting requirements for the examiner, how to obtain an order of temporary custody, giving testimony, risk management, and trends in treatment and prevention. The Guideline reflects the views of scientific experts and reports in the scientific literature as of March 1992. State reporting agencies are listed.
Target Audience: Physicians
Dissemination/Usage: Published and distributed by the AMA. Available for sale on their Web site.

Training Program/Policy Statement/Practice Protocol: 747474742424
Diagnostic and Treatment Guidelines on Domestic Violence
Source: American Medical Association
Address: 515 North State Street, Chigago, Illinois 60610
Phone: (312) 464-5000
Web site: www.ama-assn.org
Description: These guidelines are intended for physicians in all practice settings. They are intended to:

• Familiarize physicians with the magnitude of the problem.
• Describe how to identify abuse and violence through routine screening and recognition of clinical presentations.
• Help physicians assess the impact of abuse and violence on patients' health and well-being.
• Provide examples of how to ask questions in ways that can elicit meaningful responses and help women explore their options and take action.
• Provide information on appropriate resources for referral and address frequently encountered obstacles.
• Familiarize physicians with the legal aspects of medical care, including reporting requirements.

Audience: Physicians in all practice settings
Dissemination/Usage: Published in 1992 and distributed by the AMA. Available for sale on their Web site.

Training Program/Policy Statement/Practice Protocol: 747474742525
Diagnostic and Treatment Guidelines on Elder Abuse and Neglect
Source: American Medical Association
Address: 515 North State Street, Chicago, IL 60610
Phone: (312) 464-5000
Web site: www.ama-assn.org
Description: The purpose of the Guideline is to:

1. Sensitize clinicians to the fact that elder abuse and neglect occur commonly and that the problem is likely to be encountered in their medical practices.
2. Present information on the epidemiology, clinical manifestations and history of elder mistreatment.
3. Describe barriers to the proper identification and management of elder mistreatment.
4. Outline an approach that physicians can use to facilitate recognition of elder abuse and neglect in a variety of clinical settings.
5. Identify strategies for the management and prevention of elder mistreatment.
6. Discuss relevant ethical and medicolegal issues surrounding the detection and reporting of elder abuse and neglect.

References and resources are also listed.

Target Audience: Physicians
Dissemination/Usage: Published in 1992 and distributed by the AMA. Available for sale on their Web site.

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