RISE With Veteran Service Providers

The RC will track the number of providers who meet eligibility criteria, our aims are that we will recruit a total of 80 participants within 16 weeks, an average of 5 providers per week.

The RC will track the number of providers 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 providers who contact the research team about participation and who consent to randomization will be 70% or greater.

The RC will track the proportion of providers 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 providers who are randomized and complete the assigned intervention will be 70% 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.

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.

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 practitioner knowledge and skills related to CM.

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.

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 IPV knowledge section, consisting of multiple answer, multiple choice, and true-false questions will be used to measure IPV knowledge and skills. An IPV "knowledge score" will be computed following previous scoring guidelines (Short et al., 2006). In a future RCT, this would be a primary outcome of interest to measure practitioner knowledge and skills related to IPV.

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; these aspects include the conduct of safety assessments, asking appropriate questions about IPV, responding to IPV disclosures, among others. 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 generally greater preparedness to recognize and respond to IPV. For the purposes of this study, two adapted versions of the preparedness subscale were used to assess preparedness to recognize and respond to IPV and CM.

The Opinions section of the PREMIS asks respondents to indicate their level of agreement/disagreement with various statements about care of those with IPV across 32 items. Response options are on a 7-item Likert type scale ranging from (1) Strongly Disagree to (7) Strongly Agree. Our adapted version will be used to measure provider attitudes and beliefs about IPV and care of those with IPV in five subscales: (1) preparation, (2) workplace issues, (3) self-efficacy (which will also be assessed at Time 2), (4) alcohol/drugs, and (5) victim understanding. We will follow previous methods to calculate these subscales by averaging the responses to items that make up the subscale (Short et al., 2006). The three items comprising the self-efficacy subscale will be a primary outcome of interest in a future RCT as a measure of provider's self-efficacy to recognize and respond to IPV.

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).

The Brief Individual Readiness for Change (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 (a) IPV and (b) CM in their practice. Response options range from '0' Strongly Disagree to '4' Strongly Agree. Two items were added, "I believe recognizing and responding to [IPV/CM] in my practice improves outcomes for my clients," and "I am motivated to learn about [IPV/CM]" to capture other aspects of providers' readiness to learn about IPV and CM and their belief's about how this will impact their practice.

Participants will be asked questions to gauge their previous education or training in IPV and CM. Participants will be given a definition of IPV and CM and asked in what subject areas of IPV and CM they have received education and training in, and which of these environments (up to three) have been the most helpful.

Participants will be asked to rate their agreement with four statements asking how much they believe (1) recognizing IPV (2) recognizing CM (3) responding to IPV and (4) responding to CM is a part of their professional role. We will report, on average across the sample, how participants rate their agreement on a Likert scale for statements 1-4. We are recruiting a wide variety of HHSPs that we anticipate may vary in their self-perceptions of how relevant recognizing and responding to IPV and CM is in their professional roles. In qualitative interviews we will ask participants how often they believe they will encounter family violence in their practice (and how relevant it is to their professional role), the purpose of this outcome measure is to gauge this in our entire sample.

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.

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, province of practice, highest level of education attainment, their major discipline, their sex at birth and their self-identified gender. We will also collect some characteristics about the current organization they work for, specifically what populations among military and/or RCMP veterans and their families they serve and if consent is required by the veteran for the participant to provide services to a family member.