Provider evaluation of a multifaceted system of care to improve recognition and management of pregnant women experiencing domestic violence

This article describes the provider evaluation of a multifaceted system of care for pregnant women experiencing domestic violence and who receive prenatal care in an urban family practice site, one of four national demonstration projects. Providers reported changes in their own self-efficacy and behavior, but showed little improvement in overall attitudes or knowledge. Focus groups revealed that an easily accessible domestic violence coordinator was important, whereas providers stated that most domestic violence protocol materials were not useful. Guidelines that rely on training and protocols have had limited national success, suggesting that additional systems of care such as written chart prompts, quality improvement, and on-site domestic violence services may be necessary. This intervention was well received by providers, a key factor in any effort to alter provider behavior.