title: An evaluation of a system-change training model to improve emergency department response to battered women.
abstract: OBJECTIVE
  To evaluate a system-change model of training from the Family Violence Prevention Fund and the Pennsylvania Coalition Against Domestic Violence for improving the effectiveness of emergency department (ED) response to intimate partner violence (IPV).
  
  
  METHODS
  An experimental design with outcomes measured at baseline, 9-12, and 18-24 months post-intervention. Twelve hospitals in Pennsylvania and California with 20,000-40,000 annual ED visits were randomly selected and randomly assigned to experimental and control conditions. Emergency department teams (physician, nurse, social worker) from each experimental hospital and a local domestic violence advocate participated in a two-day didactic information and team planning intervention.
  
  
  RESULTS
  The experimental hospitals were significantly higher than the control hospitals on a staff knowledge and attitude measure (F = 5.57, p = 0.019), on all components of the "culture of the ED" system-change indicator (F = 5.72, p = 0.04), and in patient satisfaction (F = 15.43, p < 0.001) after the intervention. There was no significant difference in the identification rates of battered women (F = 0.411, p = 0.52) (although the linear comparison was in the expected direction) in the medical records of the experimental and control hospitals.
  
  
  CONCLUSIONS
  A system-change model of IPV ED training was effective in improving staff attitudes and knowledge about battered women and in protocols and staff training, as well as patient information and satisfaction. However, change in actual clinical practice was more difficult to achieve and may be influenced by institutional policy.
authors.affiliation: Johns Hopkins University, School of Nursing, Baltimore, MD 21205-2110, USA. jcampbel@jhmi.edu
authors.forename: J C
authors.initials: JC
authors.lastname: Campbell
authors.forename: J H
authors.initials: JH
authors.lastname: Coben
authors.forename: E
authors.initials: E
authors.lastname: McLoughlin
authors.forename: S
authors.initials: S
authors.lastname: Dearwater
authors.forename: G
authors.initials: G
authors.lastname: Nah
authors.forename: N
authors.initials: N
authors.lastname: Glass
authors.forename: D
authors.initials: D
authors.lastname: Lee
authors.forename: N
authors.initials: N
authors.lastname: Durborow
mesh_terms: D001291:Attitude of Health Personnel; D018585:Battered Women; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D017146:Models, Organizational; D011634:Public Health / Q000193:education; D014481:United States