RISE With Residents (RISE Residents)

Evaluating an Educational Intervention for Improving Residents' Recognition and Response to Child Maltreatment - A Mixed Method Acceptability and Feasibility Study With a Pilot Randomized Trial

Prevention of child maltreatment (CM) remains a public health priority in Canada; approximately one-third of Canadians report exposure to at least one form of CM. Physicians play an important role in recognizing and responding to CM and its associated sequelae. However, increasing evidence indicates that physicians receive insufficient training related to recognizing and responding to CM. CM education is especially pertinent during the pediatric and psychiatry residency period but it remains unclear what the optimal approach is for preparing Canadian physicians with the knowledge and skills to effectively recognize and respond to CM. Those educational interventions that have been evaluated in medical education contexts have comparatively little emphasis on the complex overlap between IPV, children's exposure to IPV, and other forms of CM. The Violence, Evidence, Guidance, Action Project (VEGA) is a novel educational intervention that has the potential to improve the preparation of physicians to be able to effectively recognize and respond to CM in their clinical encounters and takes into account this complex overlap. The purpose of this study is to assess the acceptability and feasibility of a future randomized-controlled trial comparing two approaches to administering the VEGA intervention, facilitator-led or self-directed VEGA and whether/how these approaches can support residents' education.

The investigators hypothesize that there will be significant increases in preparedness, knowledge and skills, and self-efficacy to recognize and respond to CM in both the experimental and AC arms from Time 1 (baseline) to Time 2 (immediately after the intervention) and Time 1 (baseline) to Time 3 (3 month follow-up). The investigators also predict that these improvements will be slightly attenuated in the experimental arm. Qualitative data pertaining to perceived value and impact will corroborate the quantitative findings.

Study Overview

• Status: Completed
• Conditions: Pediatric ALL; Domestic Violence; Child Maltreatment; Psychiatry; Education, Medical, Graduate
• Intervention / Treatment: Other: Violence, Evidence, Guidance, Action Project (VEGA) Education Intervention

• Study Type: Interventional
• Enrollment (Actual): 84
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Hamilton, Ontario, Canada, L8L 0A4
      • McMaster University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Participant is a resident at a Canadian University.
• Participant is fluent in written and spoken English.

Exclusion Criteria:

• Participant has previously accessed VEGA intervention materials.
• Participant is currently enrolled in or plans to enroll in any other educational intervention focused on family violence within the study time period (approximately next 3 months).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Facilitator-Led VEGA; Facilitator-led VEGA uses a group-based approach where participants complete the Violence, Evidence, Guidance, Action Project (VEGA) content as a virtual or face-to-face workshop. In this study, all workshops will be virtual to prevent social gathering during COVID-19. If a participant is randomized to this arm, the active control (AC) arm, they will be informed that they need to attend a facilitator-led VEGA session via virtual workshop format. The AC intervention will be facilitated via Zoom technology, by two trained facilitators with between 10 to 20 participants in each workshop (keeping the recommended 10:1 participant-to-facilitator ratio) and will last approximately 3 hours. The workshop approach is delivered by trained facilitators and is standardized via the use of a flexibly structured facilitator's guide. Facilitator-led VEGA will deliver material didactically with synchronous lecturing, use case-based role play, and include group-based polling.	Other: Violence, Evidence, Guidance, Action Project (VEGA) Education Intervention; VEGA is a novel education intervention that has the potential to improve the preparation of healthcare and social service providers (HHSPs) to be able to effectively recognize and respond to intimate partner violence (IPV) and related forms of family violence, including child maltreatment (CM), in their clinical encounters. VEGA was developed based on systematic reviews and consultation with individuals belonging to 22 national healthcare and social service organizations, including the Royal College of Physicians and Surgeons of Canada. VEGA follows a competency-based framework and a participatory, encounter-based curriculum that includes four learning modules: (a) the epidemiology of IPV and CM; (b) strategies for safely recognizing and responding to (i) IPV and (ii) CM; and (c) principles for ensuring safe clinical encounters for IPV and CM discussions.; Other Names: VEGA Family Violence Education Resources
Experimental: Self-Directed VEGA; Self-directed VEGA uses an approach where participants complete the Violence, Evidence, Guidance, Action Project (VEGA) content online as a self-directed educational activity, at their own pace in a series of modules. Individuals will register to access the VEGA Educational Resources site. Participants have the option of completing the self-directed VEGA arm in either English or French as the VEGA Educational Resources site offers the content in French and English. If a participant is randomized to the experimental arm, they will be asked to complete the self-directed VEGA at their convenience, within one week of when they are informed they have been asked to complete the self-directed VEGA program. It will take approximately 3 hours for participants to complete all modules. Participants will read didactic material, complete case-based animated simulations, and complete individual multiple-choice questions with response feedback.	Other: Violence, Evidence, Guidance, Action Project (VEGA) Education Intervention; VEGA is a novel education intervention that has the potential to improve the preparation of healthcare and social service providers (HHSPs) to be able to effectively recognize and respond to intimate partner violence (IPV) and related forms of family violence, including child maltreatment (CM), in their clinical encounters. VEGA was developed based on systematic reviews and consultation with individuals belonging to 22 national healthcare and social service organizations, including the Royal College of Physicians and Surgeons of Canada. VEGA follows a competency-based framework and a participatory, encounter-based curriculum that includes four learning modules: (a) the epidemiology of IPV and CM; (b) strategies for safely recognizing and responding to (i) IPV and (ii) CM; and (c) principles for ensuring safe clinical encounters for IPV and CM discussions.; Other Names: VEGA Family Violence Education Resources

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Residents Who Meet Eligibility Criteria	The RC will track the number of residents who meet eligibility criteria, our aims are that we will recruit a total of 80 participants within 8 weeks, an average of 10 residents per week.	Through study completion, an average of 4 months
Number of Residents who Consent	The RC will track the number of residents who consent to the study and agree to be randomized to either self-directed or facilitator-led VEGA education approaches, both overall and per week of recruitment. Our aim is that the proportion of residents who contact the research team about participation and who consent to randomization will be 75% or greater.	Through study completion, an average of 4 months
Number of Residents who Complete Assigned Intervention	The RC will track the proportion of residents who are randomized and complete each arm, with completion consisting of reviewing all module content and the animated simulations in the case of self-directed VEGA and full attendance of the virtual workshop in the case of facilitator-led VEGA. Our goal is that the proportion of residents who are randomized and complete the assigned intervention will be 75% or greater for each arm. The acceptability of the facilitator-led and self-directed educational approaches as well as their value and impact will be determined via the coding of qualitative interview data from a sub-sample of participants.	Through study completion, an average of 4 months
Number of Residents who Complete Assessments	The RC will track the feasibility of collecting trial outcome data (survey assessments) at Time 1, Time 2, and Time 3. Our goal is that the proportion of missing data for each time point will be less than 20%. Qualitative description will be used to expand and extend what we learn about acceptability and feasibility of implementing the associated research activities, we anticipate participants will not identify any fatal flaws related to the conduct of an RCT.	Through study completion, an average of 4 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Child Maltreatment Knowledge and Skills Questions (Developed by VEGA Team)	Participants will be asked a series of questions about their knowledge and skills related to recognizing and responding to child maltreatment. These were developed by the VEGA training research team to capture specific aspects of child maltreatment knowledge directly addressed in the VEGA intervention and which are outside the scope of the child maltreatment vignette scale. The questions ask about the following topics (and more not mentioned here): parental/family risk factors for family violence, what future outcomes are associated with child maltreatment, other possible signs of child abuse, and principles for good documentation and providing ongoing care to children experiencing maltreatment. Including this measure in our study will allow us to make cross sample comparisons.	Time 1 (one week before intervention), Time 2 (immediately after the intervention), Time 3 (3 month follow-up)
Mandatory Reporting Self-Efficacy Scale (MRSES)	The MRSES is a 7-item self-report measure that asks respondents to indicate the extent to which they perceive their ability to implement a series of behaviours related to mandatory reporting of CM (Ayling, 2019). Informed by Bandura's self-efficacy theory and recommendations for self-efficacy scales (Bandura, 2006), response options are anchored on a scale from 0 to 100 with: "cannot do at all (0)"; moderately can do (50)"; and "highly certain can do (100)." A total score is generated by summing items across the scale for each participant, with higher scores indicative of greater self-efficacy related to recognizing and reporting suspected CM. We anticipate that this measure will be a key mediator of interest in a future definitive RCT given that across provincial and territorial jurisdictions in Canada (including Ontario), a suspicion of CM meets the threshold for a report to child protection authorities (Dubowitz, 2014; Mathews and Kenny, 2008).	Time 1 (one week before intervention), Time 2 (immediately after the intervention), Time 3 (3 month follow-up)
Child Maltreatment Vignette Scale	Child Maltreatment Vignette scale (Pelletier et al., 2014; Pelletier & Knox, 2017) is a psychometrically validated measure of knowledge and skill accuracy related to recognizing and responding to child maltreatment. Respondents will be prompted to review 14 distinct analog vignettes that depict a range of signs and symptoms of possible CM exposure and asked if they suspect child maltreatment and if they would report to Child Welfare Services. Changes to the question wording and small changes to the wording of the scenarios were made to align the measure with the Canadian context. A mean "knowledge and skill accuracy" score will be produced for analysis, with higher scores indicative of greater knowledge and skill accuracy related to CM. In a future RCT, this would be one of the primary outcomes of interest since this is a robust measure of knowledge and skills related to CM.	Time 1 (one week before intervention), Time 2 (immediately after the intervention), Time 3 (3 month follow-up)
The Physician Readiness to Manage Intimate Partner Violence Survey: Preparedness Subscale	The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) is a 67-item self-report tool that was developed to assess physician management of intimate partner violence across 10 subscales (Short et al.,2006; Connor et al., 2011). The preparedness subscale of PREMIS asks respondents to indicate the extent to which they feel prepared to address various aspects of IPV recognition and response when working with their clients across 10 items, including asking appropriate questions about IPV and responding to IPV disclosures. Response options are on a 7-item Likert type scale ranging from "Not prepared" (1) to "Quite Well Prepared" (7) and items are averaged to generate a mean score for practitioner preparedness, with higher scores indicative of greater perceived preparedness to recognize and respond to IPV. All items will be changed to be related to child maltreatment instead of IPV, several items were dropped as they are not relevant in the case of CM.	Time 1 (one week before intervention), Time 3 (3 month follow-up)
Brief Individual Readiness for Change Scale (BIRCS)	The BIRCS scale is a 5-item readiness for change tool (Goldman, 2009). The scale's purpose is to screen for practitioners' readiness for change, in other words their receptivity to learning and applying new evidence-based research practices. For the purpose of this study, the items were adapted to assess provider's readiness to recognize and respond to all forms of child maltreatment (CM) in their clinical encounters. Response options range from '0' Strongly Disagree to '4' Strongly Agree. Two items were added, "I believe recognizing and responding to child maltreatment in my practice improves outcomes for my clients," and "I am motivated to learn about child maltreatment" to capture other aspects of residents' readiness to learn about CM and their belief's about how this will impact their practice.	Time 1 (one week before intervention)
Achievement Goals for Work Domain (AGWD)	The Achievement Goals for Work Domain (AGWD) scale is a 23-item, psychometrically validated measure of work-related achievement goals that map onto the four goal orientations described by Achievement Goal Theory (Daniels & Daniels, 2018; Baranik et al., 2007). Respondents are asked to indicate their agreement with 23 statements, response options range from '1' strongly disagree to '7' strongly agree and responses are summed to generate a total score for each subscale corresponding to each type of goal orientation; higher scores are more indicative of the respondent's affinity to that goal orientation. In this study, they will be asked about their achievement goals for residency.	Time 1 (one week before intervention)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Satisfaction with VEGA Training	Participants will complete a series of multiple choice and short-answer questions asking what they thought about the VEGA training. These questions will apply to all participants whether they completed self-directed or facilitator-led VEGA. Questions will include whether they believe the intended learning outcomes were achieved, what they thought of the instructional materials and educational scenarios, and how they would rate the usefulness of VEGA.	Time 2 (immediately after the intervention)
Demographics	Sociodemographic characteristics will be collected for all participants who are screened for the study, whether they are ineligible or eligible. These will include their age, their program (psychiatry or pediatrics), their sex at birth and their self-identified gender.	Pre-Intervention
Previous Training in Child Maltreatment	Participants will be asked questions to gauge their previous education or training in various areas of CM. Participants will be given a definition of CM and asked in what areas they have received education or training related to CM, in what environment(s) they have learned about CM, and in which of these environments they have learned the most.	Time 1 (one week before intervention)
Thoughts and Beliefs about Recognizing and Responding to CM in Professional Roles	Participants will be asked to rate their agreement with two statements about how much they believe (1) recognizing and (2) responding to CM is a part of their professional role. In qualitative interviews we will ask participants how often they believe they will encounter family violence in their future practice (how relevant it is to their future professional role as a psychiatrist or pediatrician), the purpose of these questions is to gauge this in our entire sample.	Time 1 (one week before intervention)

Collaborators and Investigators

• Sponsor: McMaster University
• Collaborators: Royal College of Physicians and Surgeons of Canada
• Investigators: Principal Investigator: Melissa Kimber, PhD, MSW, RSW, McMaster University

Publications and helpful links

General Publications

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• MacMillan HL, Kimber M, Stewart DE. Intimate Partner Violence: Recognizing and Responding Safely. JAMA. 2020 Sep 22;324(12):1201-1202. doi: 10.1001/jama.2020.11322. No abstract available.
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• Kimber M, McTavish JR, Couturier J, Le Grange D, Lock J, MacMillan HL. Identifying and responding to child maltreatment when delivering family-based treatment-A qualitative study. Int J Eat Disord. 2019 Mar;52(3):292-298. doi: 10.1002/eat.23036. Epub 2019 Feb 6.
• Kimber M, McTavish JR, Luo C, Couturier J, Dimitropoulos G, MacMillan H. Mandatory reporting of child maltreatment when delivering family-based treatment for eating disorders: A framework analysis of practitioner experiences. Child Abuse Negl. 2019 Feb;88:118-128. doi: 10.1016/j.chiabu.2018.11.010. Epub 2018 Nov 23.
• McTavish JR, Kimber M, Devries K, Colombini M, MacGregor JCD, Wathen CN, Agarwal A, MacMillan HL. Mandated reporters' experiences with reporting child maltreatment: a meta-synthesis of qualitative studies. BMJ Open. 2017 Oct 16;7(10):e013942. doi: 10.1136/bmjopen-2016-013942.
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• Kimber M, McTavish JR, Couturier J, Boven A, Gill S, Dimitropoulos G, MacMillan HL. Consequences of child emotional abuse, emotional neglect and exposure to intimate partner violence for eating disorders: a systematic critical review. BMC Psychol. 2017 Sep 22;5(1):33. doi: 10.1186/s40359-017-0202-3.
• Pignatelli AM, Wampers M, Loriedo C, Biondi M, Vanderlinden J. Childhood neglect in eating disorders: A systematic review and meta-analysis. J Trauma Dissociation. 2017 Jan-Feb;18(1):100-115. doi: 10.1080/15299732.2016.1198951. Epub 2016 Jun 9.
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• Lewis NV, Feder GS, Howarth E, Szilassy E, McTavish JR, MacMillan HL, Wathen N. Identification and initial response to children's exposure to intimate partner violence: a qualitative synthesis of the perspectives of children, mothers and professionals. BMJ Open. 2018 Apr 28;8(4):e019761. doi: 10.1136/bmjopen-2017-019761.
• McTavish JR, Kimber M, Devries K, Colombini M, MacGregor JCD, Wathen N, MacMillan HL. Children's and caregivers' perspectives about mandatory reporting of child maltreatment: a meta-synthesis of qualitative studies. BMJ Open. 2019 Apr 4;9(4):e025741. doi: 10.1136/bmjopen-2018-025741.
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• Sullivan GM. Getting off the "gold standard": randomized controlled trials and education research. J Grad Med Educ. 2011 Sep;3(3):285-9. doi: 10.4300/JGME-D-11-00147.1. No abstract available.
• Kimber M, Baker-Sullivan E, Stewart DE, Vanstone M. Improving Health Professional Recognition and Response to Child Maltreatment and Intimate Partner Violence: Protocol for Two Mixed Methods Pilot Randomized Controlled Trials. JMIR Res Protoc. 2024 Mar 21;13:e50864. doi: 10.2196/50864.

Helpful Links

• This is the VEGA Project website, where the public can access VEGA Family Violence Education Resources. More information can be found here about the development of VEGA.

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2022
• Primary Completion (Actual): August 31, 2023
• Study Completion (Actual): August 31, 2023

Study Registration Dates

• First Submitted: July 28, 2022
• First Submitted That Met QC Criteria: August 3, 2022
• First Posted (Actual): August 5, 2022

Study Record Updates

• Last Update Posted (Actual): May 8, 2026
• Last Update Submitted That Met QC Criteria: May 4, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Medical Education; Family Violence; Education Scholarship; Health Professions Education; Mandatory Reporting; Child Maltreatment
• Additional Relevant MeSH Terms: Neoplasms; Immune System Diseases; Neoplasms by Histologic Type; Hematologic Diseases; Lymphatic Diseases; Lymphoproliferative Disorders; Immunoproliferative Disorders; Leukemia, Lymphoid; Leukemia; Hemic and Lymphatic Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Health Services; Health Care Facilities Workforce and Services; Community Health Services; Behavioral Disciplines and Activities; Mental Health Services; Counseling
• Other Study ID Numbers: HiREB #14381

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Requests for data for analyses (e.g. by Research Team Members, graduate trainees) will be managed by the research coordinator and overseen by the PI, including Dr. Melissa Kimber. This will not include identifying information of participants, only de-identified data would be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No