title: Improving detection and quality of assessment of child abuse and partner abuse is achievable with a formal organisational change approach.
abstract: OBJECTIVE
  To improve detection and quality of assessment of child and partner abuse within a health service.
  
  
  METHODS
  A formal organisational change approach was used to implement the New Zealand Family Violence Intervention Guidelines in a mid-sized regional health service. The approach includes obtaining senior management support, community collaboration, developing resources to support practice, research, evaluation and training. Formal pre-post evaluations were conducted of the training. Barriers and enablers of practice change were assessed through 85 interviews with 60 staff. More than 6000 clinical records were audited to assess rates of questioning for partner abuse. Identifications of partner abuse and referrals made were counted through the Family Violence Accessory File. Referrals to the Department of Child, Youth and Family Services (CYFS) were recorded routinely by the CYFS. Audits assessed quality of assessment of child and partner abuse, when identified.
  
  
  RESULTS
  More than 700 staff were trained in dual assessment for child and partner abuse. Evaluations demonstrate improved confidence following training, though staff still need support. Barriers and enablers to asking about partner abuse were identified. Referrals from the health service to the CYFS increased from 10 per quarter to 70 per quarter. Identification of partner abuse increased from 30 to 80 per 6-month period. Routine questioning rates for partner abuse vary between services.
  
  
  CONCLUSIONS
  Achieving and sustaining improved rates of identification and quality of assessment of child and partner abuse is possible with a formal organisational change approach.
authors.affiliation: Hawke's Bay District Health Board, Hastings, New Zealand. russell.wills@hawkesbaydhb.govt.nz
authors.forename: Russell
authors.initials: R
authors.lastname: Wills
authors.forename: Miranda
authors.initials: M
authors.lastname: Ritchie
authors.forename: Mollie
authors.initials: M
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002649:Child Abuse / Q000145:classification / Q000175:diagnosis / Q000517:prevention & control*; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D013179:Spouse Abuse / Q000145:classification / Q000175:diagnosis / Q000517:prevention & control*