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

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.