Healthcare Can Change from Within: Sustained Improvement in the Healthcare Response to Intimate Partner Violence
- 1.1k Downloads
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.
KeywordsIntimate partner violence Domestic violence Intimate partner violence screening and inquiry Systems change Healthcare quality improvement Violence prevention Primary care Emergency medicine
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.
- 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
- 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
- American College of Emergency Physicians. (1995). Emergency medicine and domestic violence. Annals of Emergency Medicine, 25, 442–443.Google Scholar
- 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.
- 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.
- 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
- 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.
- 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
- 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.
- 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
- 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
- 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
- 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
- Institute of Medicine. (2011). Clinical preventive services for women: Closing the gaps. Washington, DC: The National Academies Press.Google Scholar
- 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
- McKibben, L., DeVos, E., & Newberger, E. (1989). Victimization of mothers of abused children: a controlled study. Pediatrics, 4, 531–535.Google Scholar
- Rennison, C. M., & Welshers, S. (2000). Bureau of Justice Statistics special report on intimate partner violence. Washington, DC: National Institute of Justice.Google Scholar
- 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
- 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
- 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.
- 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.