Promoting systems change in the health care response to domestic violence

Community psychologists have a long-standing interest in promoting systems change to improve the lives of individuals and communities. To more fully illuminate a multilevel model of those factors involved in the promotion of systems change, the current study examined individual- and organizational-level characteristics related to health care providers' implementation of a desired reform in the community response to intimate partner violence, namely, universal screening practices. Efforts to reform the health care system's response to domestic violence prove to be difficult. The current study surveyed 209 providers across 12 health care settings to examine those factors related to reform implementation. Findings indicate that individual characteristics (perceived capacity to screen and positive beliefs about screening) and the presence of an organizational climate for implementation (e.g., consequences for implementation or failure to implement, resources to support implementation, policies and procedures consistent with desired practices) affect the extent to which health care providers engage in routine screening practices. The implications of these findings for promoting systems change, in general, and the health care system's response to domestic violence, in particular, are discussed.