Epidemiology of Trauma History and Body Pain: A Retrospective Study of Community-Based Australian Women.

OBJECTIVE: To assess whether body pain was associated with different trauma histories (physical injury vs. interpersonal injury [IPI]) within Australian women, along with body pain and trauma history associations with biological and psychological (biopsycho) confounders. METHODS: A retrospective cross-sectional analysis was conducted on the Australian Longitudinal Study on Women's Health (ALSWH) 1973-1978 birth cohort wave 6 data. Relevant life events were categorized into two types of traumatic experience and included as exposure variables in a multinomial regression model for body pain subgroups. Also, subgroup analyses considered trauma and pain effects and interactions on biopsycho burden. RESULTS: The unadjusted multinomial regression model revealed that a history of physical injury was found to be significantly associated with body pain severity, as was a history of IPI trauma. After the model was adjusted to include biopsycho confounders, the association between IPI and body pain was no longer significant, and post hoc analysis revealed the relationship was instead mediated by biopsycho confounders. Women with a history of IPI and body pain were also found to have the greatest biopsycho (physical functioning, stress, anxiety, and depression) burden. DISCUSSION: The relationship between IPI and body pain was found to be mediated by biopsycho burden, whereas the relationship between physical injury and body pain was not. Also, a history of IPI was associated with a greater biopsycho burden than was a history of physical injury. These results suggest there is clinical value in considering the comprehensive trauma history of patients with pain when developing their biopsychosocial model of care.

Medical education too: sexual harassment within the educational context of medicine - insights of undergraduates.

BACKGROUND: Assessment of the presence and characteristics of sexual harassment in academic medicine is a global issue. Only limited international data are available so far. METHODS: Aim: To assess the extent of sexual harassment and identify the perpetrators in the student population of the medical school of Münster, Germany. A survey was undertaken, using the Medical Women's International Association sexual harassment questionnaire translated into German. The anonymous online questionnaire was sent as a link to all medical undergraduates at Münster Medical School via a mailing list between 1 October and 30 November 2018. Identifying or potentially identifying data were not collected. Data were analysed by descriptive statistical methods such as categorical variables. Baseline characteristics, e.g. answers by male or female medical students, were correlated with their individual sexual harassment experiences and perpetrator groups by means of univariate analysis. RESULTS: A total of 2162 medical students were asked to participate, with 623 (28.8%) completing the survey. Sexual harassment is a significant issue among medical students at Münster Medical School with over half (58.9%) of all undergraduates being exposed to sexually harassing behaviour. In total, 31.8% of all participants reported having experienced unwanted physical sexual contact such as unwanted physical touching, with 87.6% of the victims being female. Overall, 41.3% personally experienced verbal sexual harassment of which 87.4% were female. Furthermore, 8.5% of undergraduates faced forced sexual contact such as oral, anal or vaginal penetration, intercourse and rape, with all victims being female. Perpetrators in these cases were mostly male medical superiors (7.0%) and male patients (18.3%). In general, most perpetrators were patients, followed by medical superiors and educators, and less frequently by colleagues. CONCLUSIONS: Sexual harassment in medical education and the medical workplace is a significant problem in a German medical school. Most students experiencing sexual harassment are females. Female students also experience the more serious forms of sexual harassment more often.

Paramedics as a New Resource for Women Experiencing Intimate Partner Violence.

Intimate partner violence (IPV) has a major impact on the health and well-being of women. The need for a coordinated response from health care professions encountering IPV patients is well established, and guidelines for individual health care professions are needed. Paramedics are believed to frequently encounter IPV patients, and this study aims to create a guideline to direct their response based on expert opinion. A clinical guideline for paramedics was created using current evidence and recommendations from health agencies. A panel of family violence researchers and service delivery experts such as physicians, family violence support agencies, and police commented on the guideline via a Policy Delphi Method to obtain consensus agreement. A total of 42 experts provided feedback over three rounds resulting in 100% consensus. Results include clinical indicators to recognize IPV patients in the prehospital environment, a description of how paramedics should discuss IPV with patients, recommended referral agencies and pathways, and appropriate documentation of case findings. This study has created the first comprehensive, consensus-based guideline for paramedics to recognize and refer IPV patients to care and support. The guideline could potentially be modified for use by ambulance services worldwide and can be used as the basis for building the capacity of paramedics to respond to IPV, which may lead to increased referrals to care and support.

Student dignity during work-integrated learning: a qualitative study exploring student and supervisors' perspectives.

While University students increasingly participate in work-integrated learning (WIL), their dignity is often violated during WIL. The current literature is limited in so far as it typically focuses on student perspectives within healthcare contexts and does not use the concept of 'dignity'. Instead, this study explored student and supervisor perspectives on student dignity during WIL across healthcare and non-healthcare disciplines. Research questions included: What are: (1) types of student dignity experiences and patterns by groups; (2) factors contributing to experiences; (3) consequences of experiences? Sixty-five semi-structured interviews were conducted using narrative interviewing techniques with 30 supervisors and 46 students from healthcare (medicine, nursing and counselling) and non-healthcare (business, law and education) disciplines. Data were analyzed using framework analysis. Nine common narrative types were identified within 344 stories: verbal abuse, right for learning opportunities, care, inclusion, reasonable expectations, right for appropriate feedback, equality, trust, and right to be informed. Factors contributing to dignity experiences and consequences were often at the individual level (e.g. student/supervisor characteristics). We found some salient differences in perceptions of experiences between students and supervisors, but few differences between healthcare and non-healthcare disciplines. This study extends WIL research based on student perspectives in healthcare, and provides practice and further research guidance to enhance student dignity during WIL.

#MindinBody - feasibility of vigorous exercise (Bikram yoga versus high intensity interval training) to improve persistent pain in women with a history of trauma: a pilot randomized control trial.

BACKGROUND: The neurobiology of persistent pain shares common underlying psychobiology with that of traumatic stress. Modern treatments for traumatic stress often involve bottom-up sensorimotor retraining/exposure therapies, where breath, movement, balance and mindfulness, are used to target underlying psychobiology. Vigorous exercise, in particular Bikram yoga, combines many of these sensorimotor/exposure therapeutic features. However, there is very little research investigating the feasibility and efficacy of such treatments for targeting the underlying psychobiology of persistent pain. METHODS: This study was a randomized controlled trail (RCT) comparing the efficacy of Bikram yoga versus high intensity interval training (HIIT), for improving persistent pain in women aged 20 to 50 years. The participants were 1:1 randomized to attend their assigned intervention, 3 times per week, for 8 weeks. The primary outcome measure was the Brief Pain Inventory (BPI) and further pain related biopsychosocial secondary outcomes, including SF-36 Medical Outcomes and heart rate variability (HRV), were also explored. Data was collected pre (t0) and post (t1) intervention via an online questionnaire and physiological testing. RESULTS: A total of 34 women were recruited from the community. Analyses using ANCOVA demonstrated no significant difference in BPI (severity plus interference) scores between the Bikram yoga (n = 17) and the HIIT (n = 15). Women in the Bikram yoga group demonstrated significantly improved SF-36 subscale physical functioning: [ANCOVA: F(1, 29) = 6.17, p = .019, partial eta-squared effect size (ηp2) = .175 and mental health: F(1, 29) = 9.09, p = .005, ηp2 = .239; and increased heart rate variability (SDNN): F(1, 29) = 5.12, p = .013, ηp2 = .150, scores compared to the HIIT group. Across both groups, pain was shown to decrease, no injuries were experienced and retention rates were 94% for Bikram yoga and 75% for HIIT . CONCLUSIONS: Bikram yoga does not appear a superior exercise compared to HIIT for persistent pain. However, imporvements in quality of life measures and indicator of better health were seen in the Bikram yoga group. The outcomes of the present study suggest vigorous exercise interventions in persistent pain cohorts are feasible. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( ACTRN12617001507370 , 26/10/2017).

The psychometric properties of an intimate partner violence education outcome measure.

BACKGROUND: The need for increased education on intimate partner violence (IPV) for healthcare practitioners has been well established. Most Australian healthcare practitioners are educated at university, where educational interventions could be delivered to students. Specific IPV outcome measurement instruments demonstrating sound psychometric properties would enable accurate evaluation of educational interventions to ensure effectiveness. METHODS: The psychometric properties of the Modified Physician REadiness to Manage Intimate partner violence Scale (Modified PREMIS) were measured when delivered to a cohort of Australian paramedic and nursing students, performing principal component analysis, and evaluating dimensionality, internal consistency, and test-retest reliability. RESULTS: In total, 260 responses were received, participants were primarily paramedicine students (85.0%) with the remainder double degree nursing and paramedicine students (15.0%). Actual and Perceived Knowledge and Perceived Preparation subscales demonstrated variable validity and reliability. Principal component analysis of opinion items revealed a 5-factor solution, with identified subscales demonstrating mostly low internal consistency (Cronbach's alpha between 0.47 and 0.80). Correlations between subscales demonstrated few significant correlations above r = 0.3 which may indicate problems with construct validity. Medium to high test-retest reliability was found for subscales with spearman's rho values between 0.63 and 0.88. CONCLUSIONS: The scale did not demonstrate robust psychometric properties and some items may not be appropriate for use with Australian healthcare student cohorts. Pending revisions and subsequent psychometric appraisal the instrument should be used with caution; however an updated instrument may contribute as a valuable tool for IPV educational research and this paper provides several findings which may be of use when revising the scale.

Adverse Childhood Experiences and Healthcare Costs in Adult Life.

The current study aims to present the prevalence of adverse childhood experiences and examine the healthcare costs associated with primary, allied, and specialist healthcare services. The Australian Longitudinal Study on Women's Health is a general health survey of four nationally representative age cohorts. The current study uses 20 years of survey and administrative data (1996-2015) from the cohort born 1973-1978. Overall, 41% of women indicated at least one category of childhood adversity. The most commonly reported type of childhood adversity was having a household member with a mental illness (16%), with the most commonly reported ACES category being psychological abuse (17%). Women who had experienced adversity in childhood had higher healthcare costs than women who had not experienced adversity. The healthcare costs associated with experiences of adversity in childhood fully justify a comprehensive policy and practice review.

Evaluating the Feasibility and Effectiveness of an Australian Safety Planning Smartphone Application: A Pilot Study Within a Tertiary Mental Health Service.

OBJECTIVE: The purpose of this study was to examine the feasibility and effectiveness of a suicide prevention smartphone application. METHOD: Thirty-six non-Aboriginal Australians aged between 16 and 42 years (67% female) were recruited from a tertiary mental health service where they were receiving treatment for suicide risk. Participants were asked to use the BeyondNow safety planning smartphone application to manage their suicide safety plan during a 2-month trial, as an adjunct to treatment as usual. A survey battery designed to measure feasibility and effectiveness of the smartphone app plus treatment as usual intervention was completed at baseline and follow-up. RESULTS: A vast majority of participants used the app to view and edit their safety plans and reported that the app was easy to use. A reduction was observed in participant severity and intensity of suicide ideation, and suicide-related coping increased significantly. No significant changes were observed in suicide resilience. CONCLUSIONS: The BeyondNow safety planning smartphone application was shown to be feasible and effective as an adjunct to mental health treatment among patients at risk of suicide.

Staff conceptualisations of elder abuse in residential aged care: A rapid review.

OBJECTIVE: The purpose of this rapid review was to explore how residential aged care staff conceptualise and identify elder abuse. METHODS: English-language publications, between 2000 and 2017, about elder abuse in residential aged care in developed countries were sought from three academic databases. Only perspectives on staff-to-resident and resident-to-resident abuse were included. RESULTS: Over 2000 articles were screened, and 19 journal articles were included in the review. A wide range of abusive behaviours was identified, but there was little common understanding of what constituted elder abuse. Furthermore, disparities in conceptualisations were greater for certain types of abuse (e.g. verbal, psychological and caregiving). CONCLUSION: Elder abuse in residential aged care was conceptualised and identified by staff in diverse and different ways. This lack of common understanding hinders the development of effective interventions and prevention strategies, which include staff education and training as well as significant structural and institutional changes.

Paramedic Students' Knowledge, Attitudes, and Preparedness to Manage Intimate Partner Violence Patients.

BACKGROUND: Intimate partner violence (IPV) refers to abuse transpiring between people in an intimate relationship. Intimate partner violence is a leading cause of morbidity and mortality for women that paramedics frequently report encountering and yet paramedics rarely receive formal education or training to manage. The response of paramedics to IPV is likely to be directed by their individual knowledge, attitudes, and preparedness; all of which are currently unknown. This study aimed to measure paramedic students' knowledge, attitudes, and preparedness to manage IPV patients, and provides baseline data to inform the development of contemporary curricula. METHODS: We surveyed a cohort of paramedic students from two Australian universities using the Modified Physician REadiness to Manage Intimate partner violence Survey (PREMIS). Internal consistency of previously identified scales was calculated and multiple linear regression was used to measure the association between previous training, knowledge, attitudes, and preparation. RESULTS: We received 260 surveys (80.5% response rate). Results show that actual knowledge, perceived knowledge, and preparedness to manage IPV patients were low. Students with previous training reported higher perceived knowledge (p <.05) and preparedness (p <.01). Participants reported low self-efficacy, confidence, and preparation to manage IPV patients and demonstrated mostly neutral attitudes toward women and patients. CONCLUSIONS: Results indicate students require increased IPV education. Education should improve knowledge and preparedness to recognize and refer IPV patients, as well as change neutral and inappropriate attitudes. Incorporating such education and training into the paramedic curricula may improve the preparedness of practitioners, resulting in an improved response to IPV patients.

The Effects of Mindfulness on Older Adults with Mild Cognitive Impairment.

BACKGROUND: The current lack of an effective cure for dementia would exacerbate its prevalence and incidence globally. Growing evidence has linked mindfulness to cognitive and psychological improvements that could be relevant for mild cognitive impairment (MCI). OBJECTIVE: To investigate whether mindfulness practice can improve health outcomes of MCI. METHODS: The study is the first longitudinal mixed-methods observational study with a one-year follow-up period, that customized an eight-week group-based mindfulness training program for older adults with MCI (n = 14). Measures included cognitive function, psychological health, trait mindfulness, adherence to mindfulness practice, and everyday activities functioning as assessed at pre-intervention, post-intervention, and one-year follow-up. Repeated measures ANOVAs, Pearson's correlation analyses, and Mann-Whitney U tests were performed. RESULTS: The MCI participants showed significant improvements in cognitive function (p < 0.05) and trait mindfulness (p < 0.05) after completing the intervention. Between program intervention and one-year follow-up (59 weeks), positive correlations were found between their cognitive function (p < 0.05) and everyday activities functioning (p < 0.05) with the duration of mindfulness meditation; and between trait mindfulness and the level of informal mindfulness practice (p < 0.05). Those who meditated more during these 59 weeks, showed greater improvements in cognitive function (p < 0.05) and everyday activities functioning (p < 0.05), with large effect sizes at the one-year follow-up. Qualitative findings will be reported separately. CONCLUSION: Long-term mindfulness practice may be associated with cognitive and functional improvements for older adults with MCI. Mindfulness training could be a potential efficacious non-pharmacological therapeutic intervention for MCI.

A systematic review of intimate partner violence educational interventions delivered to allied health care practitioners.

CONTEXT: Intimate partner violence (IPV) is a significant cause of morbidity and mortality in women worldwide. Numerous health organisations have called for increased education for health care practitioners who encounter IPV patients and the first clinical guidelines for health services responding to IPV were recently published. This renewed focus has created a need to examine the current evidence for IPV education so that it may inform the next generation of educational interventions. OBJECTIVES: This study was designed to examine the effects of IPV educational interventions on the knowledge, attitudes, skills and behaviours of allied health care practitioners (AHCPs). METHODS: We conducted a systematic search of multiple databases up to the end of May 2015. We selected studies that included IPV educational interventions for AHCPs and that measured knowledge, attitude, skill or behavioural outcomes. Studies were evaluated based on methodological quality, education context and outcome measurement. RESULTS: We found 2757 articles from which 18 were selected for inclusion. Study participants included nurses, dentists, social workers and paramedics. Educational interventions ranged widely in length, delivery format and topics covered. Findings indicate that improvements in some knowledge, attitudes, skills and behaviours are associated with education, although the lack of high-quality studies indicates that conclusions should be treated with caution. CONCLUSIONS: Future studies should be conducted using rigorous methodology and validated instruments to measure evidence-based outcomes and should target a wider range of AHCPs. Recommendations are provided on education content and delivery, study methodology and outcome measurement based on insights gained from selected studies.

The Effects of Mindfulness on Persons with Mild Cognitive Impairment: Protocol for a Mixed-Methods Longitudinal Study.

INTRODUCTION: Mild cognitive impairment (MCI) not only negatively impacts upon a person's life, but it is also seen as an intermediate stage on the progression to Alzheimer's Disease (AD), and therefore warrants early intervention. However, there is currently no effective pharmacological treatment approved for MCI. There is a paucity of evidence that non-pharmacological interventions such as cognitive training could result in improvements in the daily activities functioning of persons with MCI. Growing evidence has shown that mindfulness meditation increases gray matter volume and concentration in brain regions such as the hippocampus and prefrontal cortex, strengthens brain functional connectivity, and enhances psychological well-being which could be beneficial to counteract the memory and cognitive decline of MCI. AIMS: We aim to quantitatively investigate whether mindfulness practice can improve the cognitive function, psychological health, mindfulness and functional abilities in activities of daily living of the MCI participants over time; the relationship between the amount of mindfulness practice and degree of improvement in these health outcomes; and the differential effects and interactions of both formal and informal mindfulness practices. We will also qualitatively address the issues about the MCI participants' and familiar support persons' engagement with the program, the nature of group interactions, their program experience, their perceived effects and expectations of mindfulness practice, and the challenges encountered in practicing mindfulness. METHODS: Our study is one of the first mixed-methods longitudinal studies with a 1-year follow-up using a pre- and post-intervention design. It involves the MCI participants and their familiar support person in a customized 8-week group-based mindfulness training program. The outcome measures will use the Montreal Cognitive Assessment, Depression Anxiety Stress Scales, Freiburg Mindfulness Inventory and Bayer Activities of Daily Living Scale. The qualitative methods will include participant observation during the program and semi-structured interviews at post-intervention and 1-year follow-up. SIGNIFICANCE: This customized MCI group mindfulness training program presents as a promising and feasible non-pharmacological therapeutic intervention option for MCI and a possible preventive strategy for Alzheimer's disease. This study has been registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) (URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366695) and allocated the ACTRN: ACTRN12614000820606.

Breastfeeding Duration after Childhood Sexual Abuse: An Australian Cohort Study.

BACKGROUND: Childhood sexual abuse (CSA) is prevalent across the world. Childhood sexual abuse is associated with poorer health, but information on its impact on breastfeeding is limited. In this study, the authors investigated the link between CSA and duration of breastfeeding for 6 months or more. OBJECTIVE: The purpose of this study was to determine the association between CSA and breastfeeding duration for Australian women. METHODS: Data from 3778 women from the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health were used. A stepped approach was used to assess the association between CSA and breastfeeding the first child for 6 months or more with logistic regression modeling, adjusting for significant sociodemographic characteristics, health behaviors, and adult violence. RESULTS: The 15.5% of women who had experienced CSA were less educated, younger, and more likely to be smokers and to have experienced adult violence. The CSA group was less likely to breastfeed for 6 months or more (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.65-0.93), even after adjusting for smoking (OR, 0.81; 95% CI, 0.68-0.98) and adult violence (OR, 0.80; 95% CI, 0.67-0.96). There was no longer a significant association once sociodemographic factors were adjusted for, which remained true in the fully adjusted model (OR, 0.90; 95% CI, 0.75-1.09). CONCLUSION: Women who experienced CSA were successfully able to maintain breastfeeding at a level similar to those who had not experienced CSA after controlling for sociodemographic factors. Further testing of whether the effects of CSA are mediated through social variables is warranted to investigate whether addressing social factors in service provision may be key to improving breastfeeding duration.

Preventing and reducing the impacts of intimate partner violence: Opportunities for Australian ambulance services.

BACKGROUND: Violence against women is pervasive worldwide, and a high proportion of the most damaging violence is perpetrated by male intimate partners. The Australian government is committed to action to prevent such violence; however, strategies require input and collaboration from all agencies engaging patients, including ambulance services. To date no Australian ambulance service has published comprehensive guidelines or strategies to improve health outcomes for intimate partner violence patients in line with national strategies. OBJECTIVE: To propose key actions for Australian ambulance services to undertake to reduce the impacts of intimate partner violence in line with national strategies. METHODS: We reviewed the Australian government's National Plan to reduce violence towards women and its supporting literature, and created key actions for Australian ambulance services. RESULTS: Our review has yielded four key actions that Australian ambulance services could undertake immediately for the benefit of intimate partner violence patients. Actions include collaboration with external agencies, education, data collection and championing values promoting zero tolerance of violence towards women. CONCLUSIONS: Australian ambulance services are currently underserving intimate partner violence patients and must undertake immediate action. Successful strategies to address knowledge and policy gaps will require significant input and guidance from key organisations, including advocacy groups, police and EDs. It is likely that EDs will need to take the lead in creating comprehensive policies and guidelines from which ambulance services can derive their own policies. Failure to address this practice gap might result in paramedics becoming a barrier for intimate partner patients to receive appropriate care and support.

General practice service use and satisfaction among female survivors of childhood sexual abuse.

BACKGROUND: Because childhood sexual abuse (CSA) and adult violence are associated with poorer physical and mental health of women, our aim was to investigate the associations between CSA, adult violence experiences and general practice service use and satisfaction in a community sample of Australian women aged 28-33 years. METHODS: Data of 9058 women from the 1973-78 cohort who completed Survey 4 of the Australian Longitudinal Study on Women's Health were analysed. RESULTS: Logistic regressions conducted indicated that after controlling for demographic variables, women with experiences of lifetime violence were more likely to have higher general practice service use compared to those without violence experiences. CSA was not associated with an increase in service use but was significantly associated with a decrease in service satisfaction. This find-ing remained significant even when they visited the general practice more frequently. DISCUSSION: Implementing trauma-informed care is suggested as a way to improve the satisfaction of this patient group with complex needs.

Childhood sexual abuse and its association with adult physical and mental health: results from a national cohort of young Australian women.

Childhood sexual abuse (CSA) occurs across the world, with a prevalence of 20% internationally. Our aim was to investigate the associations between CSA, CSA plus adult violence experiences, and selected self-reported physical and mental health in a community sample of women. Data from 7,700 women aged 28-33 years from the 1973-1978 cohort who completed Survey 4 of the Australian Longitudinal Study on Women's Health (ALSWH) were analyzed. Questions about prior abuse experience such as child sexual abuse, IPV, adult physical and sexual assaults, andphysical and mental health. Women who experienced CSA were 1.4 times more likely to experience bodily pain (adjusted odds ratio [AOR] = 1.37, confidence interval [CI] = [1.19, 1.58]), 1.3 times more likely to have poorer general health (AOR = 1.33, CI = [1.15, 1.54]), and 1.4 times more likely to be depressed in the past 3 years (AOR = 1.44, CI = [1.22, 1.71]) compared with those without abuse.. Women who experienced both CSA and adult violence were 2.4 to 3.1 times more likely to experience poor general (AOR = 2.35, CI = [1.76, 3.14]) and mental health (AOR = 2.69, CI = [1.98, 3.64]), and suffer from depression (AOR = 2.84, CI = [2.13, 3.78]) and anxiety (AOR = 3.10, CI = [2.12, 4.53]) compared with women with no abuse. This study demonstrates the importance of CSA in pain and poorer long-term mental and physical health.. It emphasizes how prior CSA may amplify pain and poorer long-term mental and physical health among women who are again exposed to violence in adulthood.

A qualitative exploration of researcher trauma and researchers' responses to investigating sexual violence.

Vicarious trauma can be a problem for those who work and research in areas where clients or participants are survivors of sexual violence. The aim of this study was to explore the trauma experiences of sexual violence researchers from different countries, identifying the issues that traumatized them and the protective strategies they found effective. This article reports on a moderated electronic discussion board run for 4 weeks from September to October 2009 and four purposeful interviews. A total of 15 researchers participated, 4 males and 11 females. Institutions and organizations researching in this area should consider researcher safety in project design.

"Preventing the pain" when working with family and sexual violence in primary care.

Primary care professionals (PCPs) are increasingly being expected to identify and respond to family and sexual violence as the chronic nature and severity of the long-term health impacts are increasingly recognized. This discussion paper reports the authors' expert opinion from their experiences running international workshops to prevent trauma among those who work and research sexual violence. It describes the burnout and secondary traumatic stress literature which provides the evidence supporting their work. Implications for practicing basic training in response to trauma and ongoing education are a key area for responding to family violence and preventing professional stress. A professional culture that supports and values caring well for those who have experienced family violence as well as "caring for the carer" is needed. Working in teams and having more support systems in place are likely to protect PCPs from secondary traumatic stress and burnout. Undergraduate and postgraduate training of PCPs to develop trauma knowledge and the skills to ask about and respond to family violence safely are essential. In addition, the healthcare system, workplace, and the individual practitioner support structures need to be in place to enable PCPs to provide safe and effective long-term care and access to other appropriate services for those who have experienced family violence.