Advertisement

Journal of Family Violence

, Volume 28, Issue 8, pp 833–847 | Cite as

Healthcare Can Change from Within: Sustained Improvement in the Healthcare Response to Intimate Partner Violence

  • Bruce Ambuel
  • L. Kevin Hamberger
  • Clare E. Guse
  • Marlene Melzer-Lange
  • Mary Beth Phelan
  • Amy Kistner
RESPONSES TO INTIMATE PARTNER VIOLENCE

Abstract

There is a great need to demonstrate sustained improvement in healthcare-based inquiry, intervention, and prevention provided to patients exposed to intimate partner violence (IPV). We evaluated implementation of the Healthcare Can Change from Within model (HCCW) in three primary care clinics and an emergency department within a large healthcare system, using two other primary care clinics for a usual-care comparison on selected variables. Outcome measures included individual-level variables (staff knowledge and attitudes) and system characteristics (clinic policies, procedures, patient education materials, and IPV documentation in patient records). Doctors and nurses reported increased self-efficacy, understanding of referral resources, and understanding of legal issues; IPV knowledge was unchanged. Intervention clinics implemented new policies and procedures, increased patient education, and increased documentation of IPV screening, an improvement which was sustained at 2-year follow-up. Results suggest HCCW is a promising practice for improving the healthcare response to IPV.

Keywords

Intimate partner violence Domestic violence Intimate partner violence screening and inquiry Systems change Healthcare quality improvement Violence prevention Primary care Emergency medicine 

Notes

Acknowledgement

This project was supported by grants from the Healthier Wisconsin Partnership Program Foundation #2004II-0088, B. Ambuel, P.I., and Centers for Disease Control and Prevention R49/CE001175, L.K. Hamberger, P.I.

References

  1. Ambuel, B., Hamberger, L. K., & Lahti, J. L. (1997). The family peace project: A model for training health care professionals to identify, treat and prevent partner violence. In L. K. Hamberger, S. Burge, A. Graham, & A. Costa (Eds.), Violence issues for health care educators and providers (pp. 55–81). Binghamton: The Haworth Press.Google Scholar
  2. Ambuel, B., Phelan, M. B., Hamberger, L. K., & Wolff, D. (2009). Healthcare can change from within: A sustainable model for intimate partner violence prevention and intervention. In V. Banyard, V. Edwards, & K. Kendall-Tackett (Eds.), Trauma and physical health: Understanding the effects of extreme stress and psychological harm (pp. 202–237). New York: Routledge.Google Scholar
  3. American Academy of Pediatrics Committee on Child Abuse and Neglect. (1998). The role of the pediatrician in recognizing and intervening on behalf of abused women. Pediatrics, 101, 1091–1092.CrossRefGoogle Scholar
  4. American College of Emergency Physicians. (1995). Emergency medicine and domestic violence. Annals of Emergency Medicine, 25, 442–443.Google Scholar
  5. American Congress of Obstetricians and Gynecologists (2012). Intimate partner violence. Committee opinion, Number 518. Retrieved from http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Intimate_Partner_Violence.
  6. American Medical Association (2012). Opinion 2.02: Physicians’ obligations in preventing, identifying, and treating violence and abuse. Chicago, IL: American Medical Association. Retrieved from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion202.
  7. American Medical Association, Council on Scientific Affairs. (1992). Violence against women: relevance for medical practitioners. Journal of the American Medical Association, 267, 3184–3195.CrossRefGoogle Scholar
  8. Bergman, B., & Brimar, B. (1991). A 5-year follow-up study of 117 battered women. American Journal of Public Health, 81, 1486–1488.PubMedCrossRefGoogle Scholar
  9. Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., et al. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 summary report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.Google Scholar
  10. Bonomi, A. E., Thompson, R. S., Anderson, M., Reid, R. J., Carrell, D., Dimer, J. A., et al. (2006). Intimate partner violence and women’s physical, mental, and social functioning. American Journal of Preventive Medicine, 30, 458–466.PubMedCrossRefGoogle Scholar
  11. Buetow, S. (2010). Thematic analysis reconceptualized as ‘saliency analysis’. Journal of Health Services Research Policy, 15, 123–125.PubMedCrossRefGoogle Scholar
  12. Campbell, J. C. (1994). Child abuse and wife abuse: the connections. Maryland Medical Journal, 43, 349–350.PubMedGoogle Scholar
  13. Campbell, J. C., Coben, H., McLoughlin, E., Dearwater, S., Nah, G., Glass, N., et al. (2001). An evaluation of a system-change training model to improve emergency department response to battered women. Academic Emergency Medicine, 8, 131–138.PubMedCrossRefGoogle Scholar
  14. Coben, J. (2002). Delphi instrument for hospital based domestic violence programs. Washington, DC: Agency for Healthcare Research and Quality. Retrieved from http//archive.ahrq.gov/research/domesticviol/index.html.
  15. Coker, A. L., Davis, K. E., Arias, I., Desai, S., Sanderson, M., Brandt, H. M., et al. (2002). Physical and mental health effects of intimate partner violence for men and women. American Journal of Preventive Medicine, 23, 260–268.PubMedCrossRefGoogle Scholar
  16. Coker, A. L., Weston, R., Creson, D. L., Justice, B., & Blakeney, P. (2006). PTSD symptoms among men and women survivors of intimate partner violence: the role of risk and protective factors. Violence & Victims, 20, 625–643.Google Scholar
  17. Crandall, M. L., Nathens, A. B., & Rivara, F. P. (2004). Injury patterns among female trauma patients: recognizing intentional injury. Journal of Trauma – Injury, Infection & Critical Care, 57(1), 42–55.CrossRefGoogle Scholar
  18. Cronholm, P. F., Fogarty, C. T., Ambuel, B., & Harrison, S. L. (2011). Intimate partner violence. American Family Physician, 83(10), 1165–1172.PubMedGoogle Scholar
  19. Devine, A., Spencer, A., Eldridge, S., Norman, R., & Feder, G. (2012). Cost-effectiveness of identification and referral to improve safety (IRIS), a domestic violence training and support programme for primary care: A modelling study based on a randomised controlled trial. BMJ Open, 2:e001008. doi: 10.1136/bmjopen-2012-001008. Retrieved from http://bmjopen.bmj.com/content/2/3/e001008.full.pdf+html.
  20. Dutton, M. A., Mitchell, B., & Haywood, Y. (1996). The emergency department as a violence prevention center. Journal of the American Medical Women’s Association, 51, 92–117.PubMedGoogle Scholar
  21. Edleson, J. L. (2000). Children’s witnessing of adult domestic violence. Journal of Interpersonal Violence, 14, 839–870.CrossRefGoogle Scholar
  22. Gleason, W. (1993). Mental disorders in battered women: an empirical study. Violence and Victims, 8, 53–68.PubMedGoogle Scholar
  23. Hamberger, L. K., & Phelan, M. B. (2004). Domestic violence screening and intervention in medical and mental health settings: Research and practice. New York: NY Springer.Google Scholar
  24. Hamberger, L. K., & Phelan, M. B. (2006). Domestic violence screening in medical and mental health care settings: overcoming barriers to screening, identifying and helping partner violence victims. Journal of Aggression, Maltreatment, and Trauma, 13, 61–99.CrossRefGoogle Scholar
  25. Hamberger, L. K., Saunders, D. G., & Hovey, M. (1992). Prevalence of domestic violence in community practice and rate of physician inquiry. Family Medicine, 24, 83–287.Google Scholar
  26. Hamberger, L. K., Ambuel, B., Marbella, A., & Donze, J. (1998). Physician interaction with battered women: the women’s perspective. Archives of Family Medicine, 7, 575–582.PubMedCrossRefGoogle Scholar
  27. Hamberger, L. K., Guse, C., Boerger, J., Minsky, D., Pape, D., & Folsom, C. (2004). Evaluation of a healthcare provider training program to identify and help partner violence victims. Journal of Family Violence, 19, 1–11.CrossRefGoogle Scholar
  28. Hamberger, L. K., Ambuel, B., & Guse, C. E. (2007). Racial differences in battered women’s experiences and preferences for treatment from physicians. Archives of Family Medicine, 22, 259–265.Google Scholar
  29. Hamberger, L. K., Guse, C. E., Patel, D., & Griffin, E. (2010). Increasing physician inquiry for intimate partner violence in a family medicine setting: placing a screening prompt on the patient record. Journal of Aggression, Maltreatment, and Trauma, 19, 839–852.CrossRefGoogle Scholar
  30. Houry, D., Feldhaus, K., Peery, B., Abbott, J., Lowenstein, S. R., Nontero, S., et al. (2004). A positive domestic violence screen predicts future domestic violence. Journal of Interpersonal Violence, 19, 955–966.PubMedCrossRefGoogle Scholar
  31. Houry, D., McNutt, L. A., Rosenberg, E., Kaslow, N., Ceruli, C., Lu, C., et al. (2008). Does screening in the emergency department hurt or help victims of intimate partner violence? Annals of Internal Medicine, 51, 433–442.Google Scholar
  32. Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288.PubMedCrossRefGoogle Scholar
  33. Institute of Medicine. (2011). Clinical preventive services for women: Closing the gaps. Washington, DC: The National Academies Press.Google Scholar
  34. Johnson, M., & Elliott, B. A. (1997). Domestic violence among family practice patients in midsized and rural communities. Journal of Family Practice, 44, 391–399.PubMedGoogle Scholar
  35. Kramer, A., Lorenzon, M. S., & Mueller, G. (2004). Prevalence of intimate partner violence and health implications for women using emergency departments and primary care clinics. Women’s Health Issues, 14, 19–29.PubMedGoogle Scholar
  36. Krasnoff, M., & Mascoti, R. (2002). Domestic violence screening and referral can be effective. Annals of Emergency Medicine, 40, 485–492.PubMedCrossRefGoogle Scholar
  37. Le, B. T., Dierks, E. J., Ueeck, B., Homer, L. D., & Potter, B. F. (2001). Maxillofacial injuries associated with domestic violence. Journal of Oral and Maxillofacial Surgeons, 59, 1277–1283.CrossRefGoogle Scholar
  38. Leung, T. W., Leung, W. C., Ng, E. H. Y., & Ho, P. C. (2005). Quality of life of victims of intimate partner violence. International Journal of Gynecology and Obstetrics, 90, 258–262.PubMedCrossRefGoogle Scholar
  39. Lipsky, S., Field, C. A., Caetano, R., & Larkin, G. L. (2005). Posttraumatic stress disorder symptomatology and co-morbid depressive symptoms among abused women referred from emergency department care. Violence & Victims, 20, 645–659.Google Scholar
  40. McCloskey, L. A., Lichter, E., Ganz, M. L., Williams, C. M., Gerber, M. R., Sege, R., et al. (2005). Intimate partner violence and patient screening across medical specialties. Academic Emergency Medicine, 12, 712–722.PubMedCrossRefGoogle Scholar
  41. McFarlane, J. M., Groff, J. Y., O’Brien, J. A., & Watson, K. (2006). Secondary prevention of intimate partner violence: a randomized controlled trial. Nursing Research, 55, 52–61.PubMedCrossRefGoogle Scholar
  42. McKibben, L., DeVos, E., & Newberger, E. (1989). Victimization of mothers of abused children: a controlled study. Pediatrics, 4, 531–535.Google Scholar
  43. McLeer, S. V., & Anwar, R. (1989). The study of battered women presenting in an emergency department. American Journal of Public Health, 79, 65–66.PubMedCrossRefGoogle Scholar
  44. McLeer, S. V., Anwar, R., Herman, S., & Maquiling, K. (1989). Education is not enough: a systems failure in protecting battered women. Annals of Emergency Medicine, 18, 651–653.PubMedCrossRefGoogle Scholar
  45. Minsky-Kelly, D., Hamberger, L. K., Pape, D. A., & Wolff, M. (2005). We’ve had training, now what? Qualitative analysis of barriers to domestic violence screening and referral in a health care setting. Journal of Interpersonal Violence, 20, 1288–1309.PubMedCrossRefGoogle Scholar
  46. Muelleman, R. L., & Liewer, J. D. (1998). How often do women in the emergency department without intimate violence injuries return with such injuries? Academic Emergency Medicine, 5, 982–985.PubMedCrossRefGoogle Scholar
  47. Muelleman, R. L., Lenaghan, P. A., & Pakeiser, R. A. (1998). Nonbattering presentations to the ED of women in physically abusive relationships. American Journal of Emergency Medicine, 16, 128–131.PubMedCrossRefGoogle Scholar
  48. Nelson, H. D., Bougatsos, C., & Blazina, I. (2012). Screening women for intimate partner violence: a systematic review to update the 2004 U.S. Preventive Services Task Force Recommendation. Annals of Internal Medicine, 156(11), 796–808.PubMedCrossRefGoogle Scholar
  49. Olson, L., Anctil, C., Fullerton, L., Brillman, J., Arbuckle, J., & Sklar, D. (1996). Increasing emergency physician recognition of domestic violence. Annals of Emergency Medicine, 27, 741–746.PubMedCrossRefGoogle Scholar
  50. Perciaccante, V. J., Ochs, H. A., & Dodson, T. B. (1999). Head, neck, and facial injuries as markers of domestic violence in women. Journal of Oral and Maxillofacial Surgery, 57, 760–762.PubMedCrossRefGoogle Scholar
  51. Rennison, C. M., & Welshers, S. (2000). Bureau of Justice Statistics special report on intimate partner violence. Washington, DC: National Institute of Justice.Google Scholar
  52. Rhodes, K. V., Kothari, C. L., Dichter, M., Cerulli, C., Wiley, J., & Marcus, S. (2011). Intimate partner violence identification and response: time for a change in strategy. Journal of General Internal Medicine, 26(8), 894–899.PubMedCrossRefGoogle Scholar
  53. Richardson, J., Feder, G., Eldridge, S., Chung, W. S., Coid, J., & Moorey, S. (2000). Women who experience domestic violence and women survivors of childhood sexual abuse: a survey of health professionals’ attitudes and clinical practice. British Journal of General Practice, 51, 468–470.Google Scholar
  54. Rivara, F. P., Anderson, M. L., Fishman, P., Bonomi, A. E., Reid, R. J., Carrell, D., et al. (2007a). Healthcare utilization and costs for women with a history of intimate partner violence. American Journal of Preventive Medicine, 32, 89–96.PubMedCrossRefGoogle Scholar
  55. Rivara, F. P., Anderson, M. L., Fishman, P., Bonomi, A. E., Reid, R. J., Carrell, D., et al. (2007b). Intimate partner violence and health care costs and utilization for children living in the home. Pediatrics, 120, 1270–1277.PubMedCrossRefGoogle Scholar
  56. Rodriguez, M. A., Szkupinski Quiroga, S., & Bauer, H. M. (1996). Breaking the silence: battered women’s perspective on medical care. Archives of Family Medicine, 5, 153–158.PubMedCrossRefGoogle Scholar
  57. Rodriguez, M. A., Bauer, H. M., McLoughlin, E., & Grumbach, K. (1999). Screening and intervention for intimate partner abuse practices and attitudes of primary care physicians. Journal of the American Medical Association, 282, 468–474.PubMedCrossRefGoogle Scholar
  58. Rodriguez, M. A., Heilemann, M. V., Fielder, E., Ang, A., Nevarez, F., & Mangione, C. M. (2008). Intimate partner violence, depression, and PTSD among pregnant Latina women. Annals of Family Medicine, 6, 44–52.PubMedCrossRefGoogle Scholar
  59. Rumm, P. D., Cummings, P., Kraus, M. R., Bell, M. A., & Rivara, F. P. (2000). Identified spouse abuse as a risk factor for child abuse. Child Abuse & Neglect, 24, 1375–1381.CrossRefGoogle Scholar
  60. Short, L. M., Cotton, D., & Hodgson, C. S. (1997). Evaluation of the module on domestic violence at the UCLA School of Medicine. Academic Medicine, 72, 75–92.Google Scholar
  61. Stark, E., & Flitcraft, A. H. (1988). Women and children at risk: a feminist perspective on child abuse. International Journal of Health Services, 18, 97–119.PubMedCrossRefGoogle Scholar
  62. Stark, E., & Flitcraft, A. (1995). Killing the beast within: woman battering and suicidality. International Journal of Health Services, 25, 43–64.PubMedCrossRefGoogle Scholar
  63. Thompson, R. S., Rivara, F. P., Thompson, D. C., Barlow, W. E., Sugg, N. K., Maiuro, R. D., et al. (2000). Identification and management of domestic violence: a randomized trial. American Journal of Preventive Medicine, 19(4), 253–263.PubMedCrossRefGoogle Scholar
  64. Tomasulo, G. C., & McNamara, J. R. (2007). The relationship of abuse to women’s health status and health habits. Journal of Family Violence, 22, 231–235.CrossRefGoogle Scholar
  65. Trautman, D. E., McCarthy, M. L., Miller, N., Campbell, J. C., & Kelen, G. (2007). Intimate partner violence and emergency department screening: computerized screening versus usual care. Annals of Emergency Medicine, 49(4), 526–534.PubMedCrossRefGoogle Scholar
  66. United States Department of Health and Human Services (2012). Affordable Care Act ensures women receive preventive services at no additional cost. Retrieved from http://www.hhs.gov/news/press/2011pres/08/20110801b.html.
  67. United States Preventive Services Task Force (2012). Screening for intimate partner violence and abuse of elderly and vulnerable adults: U.S. Preventive Services Task Force recommendation statement: DRAFT. Retrieved from http://www.uspreventiveservicestaskforce.org/uspstf12/ipvelder/draftrecipvelder.htm.
  68. Usta, J., Anton, J., Ambuel, B., & Khawaja, M. (2012). Involving the health care system in domestic violence: what women want. Annals of Family Medicine, 10(3), 213–220.PubMedCrossRefGoogle Scholar
  69. Waalen, J., Goodwin, M. M., Spitzer, A. M., Petersen, R., & Saltzman, L. (2000). Screening for intimate partner violence by healthcare providers: barriers and interventions. American Journal of Preventive Medicine, 19, 230–237.PubMedCrossRefGoogle Scholar
  70. Wiist, W. H., & McFarlane, J. (1999). The effectiveness of an abuse assessment protocol in public health prenatal clinics. American Journal of Public Health, 89, 1217–1221.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Bruce Ambuel
    • 1
  • L. Kevin Hamberger
    • 1
  • Clare E. Guse
    • 1
  • Marlene Melzer-Lange
    • 2
  • Mary Beth Phelan
    • 3
  • Amy Kistner
    • 1
  1. 1.Department of Family and Community MedicineMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of PediatricsMedical College of WisconsinMilwaukeeUSA
  3. 3.Department of Emergency MedicineMedical College of WisconsinMilwaukeeUSA

Personalised recommendations