University of Southern California Dissertations and Theses

CEASE Intimate Partner Violence (IPV): A healthcare-based intervention program

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CEASE Intimate Partner Violence (IPV): A healthcare-based intervention program

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Content 1
CEASE INTIMATE PARTNER VIOLENCE (IPV): A HEALTHCARE-BASED
INTERVENTION PROGRAM
Capstone Project Proposal
Melissa Doiron-Min, LMFT
University of Southern California
Suzanne Dworak-Peck School of Social Work
DSW Program
Renee Smith-Maddox, PhD
May 2024

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Table of Contents
I. Abstract................................................................................................................................3
II. Acknowledgements .............................................................................................................4
III. Positionality Statement........................................................................................................5
IV. Problem of Practice and Literature Review.........................................................................6
V. Theoretical Framework .....................................................................................................12
VI. Methodology......................................................................................................................15
VII. Project Description ............................................................................................................19
VIII. Implementation Plan……………………………………………………………………..25
IX. Conclusion and Implications.............................................................................................30
X. References .........................................................................................................................33
XI. Appendix A: Logic Model.................................................................................................52
XII. Appendix B: Design Criteria .............................................................................................53
XIII. Appendix C: High Fidelity Prototype: Equitable Solutions to Intimate Partner
Violence in Healthcare Settings ........................................................................................54
XIV. Appendix D: Posttest Qualtrics Survey.............................................................................55
XV. Appendix E: Theory of Change.........................................................................................56
XVI. Appendix F: CEASE IPV Line-Item Budget......................................................................57
XVII. Appendix G: Journey Map ................................................................................................58
XVIII. Appendix H: CEASE IPV Handbook ................................................................................59

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Abstract
Intimate partner violence (IPV) is a highly stigmatized societal epidemic, represented by
10 million incidents of violence in the United States each year. Although IPV transcends all
racial and socioeconomic boundaries, women of color are disproportionately impacted and
subject to severe physiological and psychological injuries, including death. Healthcare
professionals (HCPs) are uniquely positioned to aid in the detection and intervention in IPVrelated cases, representing vital life-saving opportunities. Unfortunately, IPV victims often go
unrecognized during their medical visits and are frequently misdiagnosed with non-IPV
etiologies. The Community Engagement, Advocacy, and Staff Education (CEASE) Intimate
Partner Violence (IPV) program aims to close these critical gaps and create an efficacious patient
experience, accomplished by increasing HCPs’ knowledge of IPV, confidence in initiating IPVrelated conversations, and correcting implicit biases that may influence responsiveness to IPV. A
selection of CEASE IPV educational curriculum was delivered to a sample of HCPs via a 60-
minute live presentation. Preliminary survey data revealed CEASE IPV improved knowledge of
IPV and related issues in 98% (n = 15) of HCPs. Further, 98% of HCPs would recommend this
program to colleagues, which supports the acceptability and feasibility of this approach. Further
analysis revealed statistically significant differences in HCPs’ perceived abilities to recognize
hidden signs of abuse, understand the barriers to disclosure and dynamics of abuse, and engage
in IPV-related discussions with patients (p = .003). Additional testing is required to determine if
CEASE IPV influences HCP behavior and improves patient outcomes.

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Acknowledgements
This capstone is inspired by my mother, Cynthia Ann Miller, whose bravery, resilience,
and fortitude provided the foundation for this work; her support means the world to me. I am
incredibly grateful for my partner and best friend, Eddie Min, for his strength, dependability, and
patience; I couldn’t ask for a better husband. I am also thankful for my Trojan family, Daniel
Kennedy, Tracy Vega, Jessica Shriner, Ann Lefebvre, Pamela Powell, and Elizabeth Ressler.
Their support, encouragement, and humor lifted me throughout this program!
Mentorship is an integral component of doctoral work, and I had the great fortune to
work with Renee Smith-Maddox, PhD, Sandi Dheensa, PhD, and Elizabeth Swart, PhD. Their
patience, confidence, and thoughtful feedback has taught me so much about navigating these
challenges with humor, grace, and humility. I am also grateful for the encouragement and
insights shared by Terence “Dr. T” Fitzgerald, PhD and John Oberg, DSW.
I would also like to acknowledge my passionate and talented Kaiser Permanente leaders,
Maribel Villarosa, MD, Rhonda Chabran, LCSW, Linda Rohn, LCSW, and Liza Eshilian-Oates,
MD. Additionally, Jonathan Kim, MD, who teased me relentlessly (“C’mon Dr. Min!”) and
remained a steadfast thought partner and devil’s advocate.
I am deeply indebted to my community partners and fellow survivors, Nai’lah and
Johannah. Thank you for your strength, resolve, and commitment to helping others through your
lived experiences. I am truly humbled by the spirit, resolve, and sheer will of our IPV
community.
Finally, this doctoral capstone is dedicated to my wonderful daughters, Hannah and
Emilia. We must make the world a safer place for you and all women; you inspire me every day
to keep fighting.

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Positionality Statement
In many ways, the experiences of abuse survivors are emblematic of my family’s story.
My mother is an IPV survivor, and we, as her children, witnessed the profound suffering she
endured, both by her then-husband and later, by the criminal justice system. Our current systems
of care are ill-equipped to meet the needs of abuse victims and survivors and that must change.
This doctoral capstone was developed during a period of U.S. history in which women
have been denied their reproductive rights and bodily autonomy, resulting in threats of
persecution, and in some cases, life-threatening medical emergencies (Darney & Reid, 2020).
Further, Black women are murdered at a rate 9x higher than their White counterparts (Harper et
al., 2021) and Indigenous women are missing by the thousands (Indiana Affairs, n.d.). These
injustices are further compounded by persistent wage gaps between men and women (Aragão,
2023), meager prosecutorial consequences for IPV offending, and widespread tolerance of
gender-based violence.
By my 20th birthday, I survived childhood abuse, suicide loss, and the IPV-related
homicides of two dear friends. Although I would most certainly win Trauma Bingo if were there
such a thing, it does not define me; rather, it inspires me to leverage my power and privilege as
an educated, cisgender, White woman, and my position as a leader in the United States’ largest
integrated healthcare system, to improve systems of care; reduce barriers to victims and
survivors seeking support; and prevent needless harm, trauma, and femicide. My position as an
IPV advocate and agent for change has been, and will continue to be, shaped by the courage,
support, and generosity of people who have survived interpersonal violence. Working together,
our collective voices will not be silenced.

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Problem of Practice and Literature Review
The Grand Challenge of Social Work, Build Healthy Relationships to End Violence, was
developed in response to growing incidence of family violence, including intimate partner
violence (IPV), in the United States (Grand Challenges, n.d.). Like a contagion, IPV spreads
easily in families by normalizing violent responses and manifestations of anger, power, and
control. Social learning pathways enable IPV to reproduce itself in future generations, known as
the intergenerational transmission of violence, serving to trap families in endless cycles of
violence (Finkelhor et al., 2015; Peskin et al., 2014).
IPV is characterized by a range of physiologically and psychologically abusive behaviors
including, coercion, threats of violence, slapping, shoving, degradation, and physical battery
(Gary et al., 2023). In its more severe forms, IPV includes burning, subjugation, coercive
control, strangulation, and sexual violence. Psychological abuse is the most prolific form of IPV,
affecting nearly 50% of women (Dokkedahl et al., 2019) and is often a precursor to physical
abuse. Despite these prevalence rates, psychological abuse is only legally recognized in 10% of
the United States (i.e., California, Washington, Connecticut, Colorado, and Hawaii; California
Courts, n.d.; Baker, 2023). This significant judicial oversight, coupled with a paucity of red flag
laws, or extreme risk protection orders (ERPOs), leaves millions of vulnerable individuals and
families without legal recourse, standing, or protections (Bloomberg American Health Initiative,
n.d.). In the absence of these protections, intimate partner homicide (IPH) is a significant risk. In
the United States, four women a day are murdered by an intimate partner (Smith, 2022). Between
2003 and 2014, IPH accounted for more than 55% of all femicide (Petrosky et al., 2017).
Additionally, as many as 67%–80% of IPH victims experienced physical abuse prior to their

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murders (Campbell et al., 2002). Early detection and swift intervention strategies are essential to
preventing serious injury or death.
The relationship between IPV and adverse health outcomes is well-established. Because
IPV has a propensity to worsen over time, victims present to emergency departments with
multiple injuries, particularly to the head, face, and neck (Haag et al., 2022; Monahan &
O’Leary, 1999). These injuries place victims and survivors at further risk of developing chronic
illnesses such as neurological disorders, memory loss, asthma, diabetes, reproductive and
gynecological issues (Akbari et al., 2021), cardiovascular diseases, chronic pain disorders
(Akbari et al., 2021), gastrointestinal disorders, and unplanned pregnancy (Akbari et al., 2021;
CDC, 2022; Khurana et al., 2020; NCADV, n.d.; Rakovec-Felser, 2014). IPV is also the leading
cause of injury in pregnant people (Brignone & Gomez, 2017), particularly in the latter part of
the pregnancy (Mendez & Figueroa, 2013). According to the National Partnership for Women
and Families (2021) greater than 324,000 pregnant people in the United States were battered by
their intimate partners each year, increasing risk of significant harm to both the pregnant person
and the fetus (Intimate Partner Violence, 2021; Akbari et al., 2021).
The consequences of prolonged stress associated with IPV cannot be understated.
Victims and survivors of IPV are at substantial risk of developing numerous mental health
disorders, such as major depressive disorder (Akbari et al., 2021), posttraumatic stress disorder
(PTSD), substance use disorders, and generalized anxiety disorder (Akbari et al., 2021). Because
of intersectionality, women of color are disproportionately impacted (Kelly et al., 2022). The
development of maladaptive coping strategies to manage these disorders is also common, which
includes engaging in risky sexual behaviors, self-injurious behaviors (e.g., cutting, burning),

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disordered eating, substance use disorders, and suicidal ideation (Karnitschnig & Bowker, 2020;
NCADV, n.d.).
The damages associated with IPV extend well beyond the victim. IPV is a significant
contributor to the labor shortage, occurring via absenteeism, reduced job performance, work
disruption, and/or termination of employment (McLean & Bocinski, n.d.). Additionally, abused
women incur up to 42% higher healthcare costs than nonabused peers (McLean & Bocinski,
n.d.), and have greater utilization of services (Bonomi et al., 2009; Fishman et al., 2010; Peterson
et al., 2018), continuing even after cessation of abuse (Fishman et al., 2010). In sum, the lifetime
costs associated with healthcare services (i.e., $2.1 trillion), legal fees, and lost productivity (i.e.,
$1.3 trillion) is as high as $81,960 per victim and $3.6 trillion for all U.S. victims (Peterson et
al., 2018).
Healthcare professionals (HCPs) are uniquely positioned to aid in the detection and
intervention in IPV-related cases (Akbari et al., 2021; Lovi et al., 2018; Wu et al., 2010).
Unfortunately, IPV victims often go unrecognized, and in many cases, misdiagnosed with nonIPV etiologies (Banks, 2007; Haag et al., 2022). In healthcare settings, studies have
demonstrated that IPV victims, and women in general, want to be asked about IPV and routinely
provided with IPV-related information (Chang et al., 2005); however, IPV victims are less likely
to disclose abuse if they are not directly asked (Gomez et al., 2019; Rodriguez et al., 2001).
Consequently, up to 95% of IPV victims pass through emergency department visits undetected,
unprompted, and unprotected (Aboutanos et al., 2019; Ali et al., 2016), representing vital, missed
opportunities to connect and intervene (Gomez-Bravo et al., 2019).
The World Health Organization (WHO) asserted HCPs must be prepared to provide
referral assistance and supportive care to IPV victims (Crombie et al., 2016). Research has also

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shown healthcare is an integral component of an effective, coordinated response to IPV (Akbari
et al., 2021; Colombini et al., 2017; García-Moreno et al., 2015; Sapkota et al., 2020). However,
the lack of standardized IPV HCP education and training, negativistic beliefs, and lack of
confidence in treating IPV continue to be limiting factors (Akbari et al., 2021; Ison et al., 2021;
Lovi et al., 2018; Martins et al., 2023; Sapkota et al., 2020), which has a significant impact on
care delivery. According to a scoping review of 65 peer-reviewed, healthcare-based curricula,
Sprague et al. (2018) discovered a range of approaches to this knowledge deficit, including
variations in content, duration, and teaching methodologies. Interestingly, majority of desired
outcomes were provider focused; only four of the included studies pursued patient-related
outcomes. Consequently, it is difficult to determine if improvements in knowledge translates into
better, more favorable patient outcomes. Evidence-based curriculum, coupled with collaborative
partnerships with local agencies and resources, are key to managing IPV in healthcare settings
effectively and improving patient outcomes (Sapkota et al., 2020).
The most comprehensive, integrated healthcare model embodying these qualities is based
in the United Kingdom. The integrated U.K. model consists of three central components: the
Identification and Referral to Improve Safety (IRIS), Independent Domestic Violence Advocate
(IDVA), and Multi-Agency Risk Assessment Conference (MARAC). Used independently, each
of these programs serve to increase IPV identification and aid in connecting victims to services;
used together, IRIS, IDVA, and MARAC produce immediate and lasting results (Akbari et al.,
2021).
The U.K.’s MARAC model mitigates several of the shortcomings plaguing the U.S.-
based approach to managing IPV in healthcare, which is accomplished by integrating IPV
prevention within their medical model (Dheensa et al., 2020). Feder (2011) developed the IRIS

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method, which consists of an algorithm built into the electronic medical record that serves to
remind physicians to inquire about IPV and/or refer to a specialist (e.g., IDVA) when specific
diagnostic information is entered. Not only does this add an additional layer of safety (e.g.,
creating a back-up to the physicians’ clinical assessment) but also normalizes conversations
about abuse. This approach has been widely successful in connecting survivors to services during
their healthcare visit (Akbari et al., 2021; Dheensa et al., 2020; Feder et al., 2011).
Survivors face numerous obstacles when attempting to exit violent relationships (Hulley
et al., 2023); having to piecemeal their care through a multitude of agencies and service
providers should not an additional burden. MARACs represent a solution to this issue by
bringing agencies, law enforcement, and community supports together where they can
communicate, collaborate, and work collectively to ensure all survivors’ needs are met. From
2019–2020, U.K. MARACs reviewed over 100,000 cases (Walklate et al., 2021), providing lifesaving resources to survivors and families. The MARAC approach is also associated with
significant cost savings to the U.K. healthcare system, estimated at £6 in savings for every £1
spent (SafeLives, 2022). Although survivors are not in attendance during these conferences, they
are represented by an IDVA who serve as their advocate and their voice.
The presence of an IDVA is a critical, survivor-facing component of the U.K. model
(Dheensa, et al., 2020). During times of crisis and uncertainty, IDVAs serve as an anchor,
providing needed support, guidance, and encouragement. Further, their ability to conduct risk
assessments, develop individualized treatment plans, and identify high-risk cases confirms their
versatility. IDVAs are associated with high survivor satisfaction, feelings of safety, and cessation
of abuse (Piispa, 2016; SafeLives, 2014). IDVAs are truly the glue that hold the MARAC model

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together. Unfortunately, in a post-COVID era of financial insecurity, budgetary constraints, and
staffing shortages, the future of IDVAs remains unclear.
U.S.-based healthcare systems have tested similar, albeit less comprehensive, models
with some success (Kaiser Permanente Antioch, 2017; Aboutanos et al., 2019). From 2013–
2016, Kaiser Permanente Antioch and STAND! For Families Free of Violence embarked on a
pilot to test an integrated, healthcare model. The pilot involved the colocation of a community
health worker (e.g., STAND! IPV advocate) in the Kaiser Permanente Antioch emergency
department who would be available to provide support and community linkage to IPV victims at
point of service. According to a Kaiser Permanente Antioch (2017) report, referrals to the
STAND! advocate increased substantially within the first 3 years of the pilot, increasing from 24
to 200, identification of IPV in the emergency department doubled (i.e., 1.4% to 2.8%), the
number of advocacy services provided to identified patients increased by 395%, and utilization
of hospital-based services decreased by 50% for half of participants. Despite the benefits
associated with this approach, there were some logistical and staffing challenges that could not
be overcome. Consequently, STAND! was not funded beyond the initial grant.
This proposal posits that using and leveraging existing hospital resources (e.g., hospitalbased social workers) may serve to mitigate the challenges associated with reliance on
community-based health workers. Further, engaging in hospital-wide, HCP education may
reduce abuse-related knowledge gaps (e.g., how to recognize and respond to IPV) and support
the ability to achieve similar outcomes, such as increased IPV diagnoses and referrals to
community resources and/or social medicine.

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Theoretical Framework
Ecological systems theory (EST) serves as a foundational element to elucidate the
complexities associated with IPV and environmental influences on individuals (Bronfenbrenner,
2005). EST posits that violent behavior is shaped by four systemic levels: the macrosystem (i.e.,
cultural beliefs and values), microsystem (i.e., family system), exosystem (i.e., community), and
ontogenetic factors (i.e., personal development). The interactions between each of these levels
exerts influence on the individual and their behavior (Lawson, 2012); thus, although conflict is
inevitable, the familial response to the conflict, and subsequent normalization of violent conflict,
is ultimately what determines how and why the utilization of violence is used (Lawson, 2012).
Feedback loops, which serve to reinforce and maintain abusive behaviors, have the capability to
reproduce themselves in future generations via the intergenerational transmission of violence.
The cycle of violence is an example of feedback loops in action (Burrell et al., 2021). It is
characterized by alternating periods of tension-building, acute crisis (i.e., explosion), and calm
(Loggins, 2022). Due to the deleterious effects of psychological abuse and coercive control, it
can take a battered woman an average of seven attempts to leave the abusive relationship before
she is successful (Virginia Physicians, 2019), further exposing any children to the negative
effects of cyclical abuse. Regrettably, childhood exposure to IPV represents the greatest
independent risk factor for IPV perpetration and/or victimization in adulthood (Black et al.,
2010; Duncan at al., 2021). Because the family system is a major institution for socialization,
exposure to interpersonal violence teaches children that the use of violence is normative and
acceptable and may have direct implications in their adult relationships (Black et al., 2010;
Ehrensaft et al., 2003), in a phenomenon known as the intergenerational transmission of
violence. Fortunately, EST supports the assertion that interventions in the family system, familial

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environment, and community can result in positive behavioral changes, including the disruption
of negative behavioral pathways (Stormshak & Dishion, 2002). The healthcare system is poised
to be the catalyst for disrupting this process and altering the trajectories for millions of women,
children, and families.
There has been a preponderance of evidence supporting the assertion that IPV is a
healthcare issue (Aboutanos et al., 2019; Garcia-Moreno et al., 2015; Kippert, 2023; Manuel et
al., 2020; Szilassi et al., 2021). However, HCPs are simply not equipped with the knowledge,
tools, and skills to do so effectively (Aboutanos et al., 2019; Akbari et al., 2021; Ison et al.,
2021; Manuel et al., 2020; Sapkota et al., 2020; Szilassi et al., 2021) and are further constrained
by a lack of resources, time, and support (Furniss et al., 2007; Gutmanis et al., 2007; MinskyKelly et al., 2005). This proposal seeks to remediate this issue and create a best practice model to
promote HCP learning and growth, creating more equitable and positive patient care experiences.
To enact meaningful change, it is insufficient to simply increase HCPs’ knowledge of IPV;
rather, their knowledge must be translated into action and changes in practice (see Appendix A).
This proposal seeks to accomplish this task by grounding educational elements in andragogy,
otherwise known as adult learning theory.
Andragogy asserts that adults often require relevancy (i.e., the why) when obtaining and
applying new forms of knowledge (Western Governors, 2020). The proposal was intentional in
establishing a clear connection between IPV and healthcare, aiding to solidify the assertion that
IPV is a healthcare crisis, and must be treated accordingly. In the absence of this connection, an
HCP may avoid or withdraw from abuse-related discourse or perhaps overlook IPV-related
symptomatology. In contrast, an HCP with a deeper, more comprehensive understanding of IPV
may be more likely to identify subtle signs of abuse and intervene accordingly. In this case, this

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proposal seeks to build upon HCPs’ existing knowledge, explore any barriers or resistance, and
expand their perspective to include a more balanced, culturally informed approach.
Opportunities for hands-on practice is a key indicator supporting adults’ acquisition and
application of new skills (Western Governors, 2020). To meet this need, this proposal
incorporates a variety of tools to promote critical thinking and application of acquired
knowledge, such as clinical vignettes, patient care simulations, and reflective exercises. These
tools enable HCPs to build upon their existing knowledge base and apply new techniques and
viewpoints to the treatment of IPV survivors. By doing so in a simulated environment, HCPs are
afforded the opportunity to make mistakes without incurring lasting damage to patients.
Additionally, feedback integrated in the simulation (e.g., “Hmm, that may not be the best
approach because . . . let’s try again”) allows HCPs to better understand the nuances associated
with this work.
Adult learning can be constrained by insufficient resources or lack of support, frequently
resulting in frustration and resistance (Western Governors, 2020). This proposal serves to
mitigate these barriers by appointing departmental champions to serve as mentors, guides, and
thought partners. Departmental champions will also be responsible for challenging and
disrupting common norms that hold IPV in place. For example, it is not uncommon for HCPs to
believe that leaving an abusive relationship is the only viable option; consequently, they may
judge or blame a victim for not heeding this advice. Unfortunately, this belief is rooted in
stereotypes and fails to recognize victims’ rights to self-determination or any consideration of
their individual needs. To maintain a nonjudgmental, supportive environment, HCPs may require
coaching from peer champions or administrative leaders as these situations arise.

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Methodology
Understanding an intractable societal problem, such as IPV, necessitates a
comprehensive, analytical approach. This included synthetization of empirical data using a
variety of tools gathered from The Designing for Growth Field book (Liedtka et al., 2014), such
as notetaking matrices, journey mapping, design criteria, solutions template, research plans, and
ethnographic conversations. IPV prevalence and incidence data were collected from U.S.
government sites, such as the CDC, Federal Bureau of Justice Statistics, Office on Women’s
Health, National Institutes of Health (NIH), Health Resources and Services Association (HRSA),
Department of Justice (DOJ), and the National Institute of Corrections. U.S. community
organizations were also referenced and included the National Coalition Against Domestic
Violence (NCADV), Family Justice Center (FJC), National Domestic Violence Hotline, and
Women of Color Network. Incidence data were also gathered from the United Kingdom, using
the Office of National Statistics, National Health Services, and U.K.-based community
organizations (e.g., Safe Lives, Women’s Aid).
To identify best practices, areas of opportunity, and potential solutions, 20 key
stakeholders participated in semi structured interviews from February 2023 through January
2024. These stakeholders included IPV survivors, family violence prevention physician leads,
community partners, law enforcement officers, detectives, mental health providers, a United
Nations delegate, and consultation with national and international subject matter experts.
Analysis of key takeaways identified that inadequate funding, coupled with unstable revenue
streams and an absence of working agreements between systems, threatens the continuity of care
for IPV survivors. Furthermore, inconsistent practices, lack of understanding, and HCP response
to IPV survivors adversely impacts the patient experience. To enact meaningful change, gaps in

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HCP knowledge and those between systems of care must be closed (see Appendix B). This,
among other principles, helped to inform the design criteria and design justice ideology for the
proposed solution.
Design justice operates under the premise that current societal systems (e.g., healthcare,
child welfare, criminal justice) are intrinsically biased toward marginalized populations, cater to
the White majority, and serve to uphold systemic racism and practices of oppression. Replicating
systems of oppression would be discordant with design justice principles that demand equity,
equality, inclusion, and diversity. Ethnographic conversations with IPV survivors necessitate that
any programming involving them must support these principles and respect their autonomy,
agency, and right to self-determination. Further, design criteria requires that trauma-informed
care practices are used throughout the proposal to reduce risk of further traumatization.
This framework was applied to the development of an HCP-facing, continuing medical
education (CME) curriculum (see Appendix C), which served as the high-fidelity prototype.
Prior to testing, the curriculum was reviewed by a sample of subject matter experts, including
Kaiser Permanente physicians, department leaders, the associate dean of a community-based
medical school, a Doctor of Social Work, and the owner of a private medical practice. Based on
their feedback, the program elements, structure, and cadence were further refined and prepared
for delivery in Kaiser Permanente’s Physician Grand Rounds. Final subject areas consisted of
femicide, overview of IPV, IPV and chronic disease, adverse childhood experiences (ACEs),
implicit bias awareness, and supportive patient management strategies. Cultural considerations
and population-specific information were also integrated.
The course, titled Equitable Solutions for Intimate Partner Violence in Healthcare
Settings, was delivered to Kaiser Permanente HCPs via a 60-minute, live presentation using a

17
virtual platform. During the presentation, HCPs were encouraged to consider their current
understanding of IPV, etiology, and the relationship to healthcare (e.g., injuries, disease). HCPs
were subsequently provided with a variety of empirical sources, evidence, and cases designed to
broaden and deepen their understanding of IPV and how it relates to their medical practice.
Two sessions of this course were offered, followed by an optional, anonymous survey
(see Appendix D). Session 1 was delivered during Physician Grand Rounds to an audience of 79
Kaiser Permanente HCPs. A preliminary postintervention survey was offered but yielded few
responses. Of the received responses (n = 7), 100% of HCPs felt better equipped to recognize
hidden signs of abuse in their patients, 83% (n = 6) would participate in IPV-related campaigns if
offered the opportunity, and 83% (n = 6) believed this program would benefit their practice (see
Figure 1).
Figure 1
HCPs Post training Feedback
100%
83% 83%
0
20
40
60
80
100
120
As a result of this
training, I feel better
equipped to recognize
hidden signs of abuse.
This training benefits my
clinical practice.
I would participate in an
IPV educational
campaign, if available.
Session 1
HCPs Posttraining Impressions

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Session 2 was delivered to an audience of 24 HCPs (see Figure 2) and yielded higher
survey response rates of 66% (n = 16). In concordance with previous results, 98% (n = 15) of
HCPs indicated the course improved their knowledge of IPV and would recommend it to their
colleagues. Further analysis of Session 2 survey data revealed statistically significant differences
(p < .01) in HCPs’ perceived levels of knowledge following the training. As a result, HCPs
reported feeling better equipped to recognize hidden signs of abuse, understand the barriers to
disclosure, dynamics of abuse, and engage in IPV-related discussions with patients (see Figure
2).
Figure 2
Changes in HCPs’ Confidence Levels: Pretest and Posttest Comparison
1.68
1.56
1.75
1.62
2.25 2.25
2.12 2.18
0
0.5
1
1.5
2
2.5
Recognizing hidden
signs of IPV
Understanding the
barriers to disclosure
Understanding the
dynamics of abuse.
Having IPV-related
discussions with
patients.
Session 2
Changes in HCPs' Levels of Confidence:
Pretest and Posttest Comparison
Pre-Intervention Post-Intervention

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The preliminary results of the high-fidelity prototype are encouraging but should be
interpreted with caution. The small sample size limits the generalizability of these results; any
future testing should be done with a larger, more diverse pool of participants. Additionally, the
sampling methodology also threatens the internal validity of findings. Due to time constraints,
HCPs were tasked with estimating their preintervention degree of confidence retrospectively. In
the future, this limitation can be mitigated by conducting separate, and more comprehensive,
pretest and posttest surveys. Additionally, further testing will be needed to determine whether
increases in HCPs’ knowledge translates into positive changes in practice and improved patient
outcomes.
Despite these limitations, results are encouraging and suggestive of the acceptability and
feasibility of this approach. Thus, the proposed solution to the IPV crisis has been crafted as a
healthcare-based, coordinated community response model, inspired by the U.K.’s MARAC
approach. Market analysis of similar approaches have yielded few results in the United States,
attributed to the absence of universal healthcare and the fragmentation of current care delivery
systems. This gap provides an opportunity to test a new, healthcare-based, innovative sustaining
solution (Satell, 2017) to the IPV crisis: CEASE IPV.
Project Description
CEASE IPV was developed to bridge the gap between healthcare systems and the larger
community, which will allow for a more affirming and positive care experience for IPV
survivors (see Appendix A). CEASE is an acronym that encapsulates three primary concepts:
community engagement, advocacy, and staff education. The key governing principles assert that
effective community engagement requires knowledge of existing resources, cultivation of
relationships, and maintenance of connection pathways. Advocacy requires a committed,

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compassionate, and knowledgeable team of HCPs that are prepared to perform the heavy lifting
for individuals and families in need, shifting the burden of responsibility from IPV survivors to
the broader community. To do so, staff education is required to ensure HCPs are effectively
equipped to be change agents in IPV-related situations.
In the absence of a universal healthcare system in the United States, hospitals, care
providers, agencies, and social services are disjointed and siloed. IPV survivors are faced with
the insurmountable task of navigating these complex systems independently, while
simultaneously trying to remain alive and fulfill other basic needs such as safety, shelter, and
food. Predictably, these barriers result in poor adherence to treatment recommendations
(Kulkarni et al., 2010; National Coalition, 2017), frustration (Kulkarni et al., 2010), and
disincentivizes future help-seeking behaviors (Maryville University, 2020). Thus, the simple act
of receiving help becomes yet another barrier to overcome. CEASE IPV seeks to eliminate this
barrier by shifting the burden of responsibility from the survivor to the larger community. This
type of reorientation is characteristic of a coordinated community response (CCR) model, which
serves as the theory of change (ToC) for this proposal (see Appendix E).
The CCR model is a whole person approach that recognizes the significance of the social
determinants of health, and the influence of community engagement (Hetzel-Riggin, 2022; Ogbe
et al., 2020; Shorey et al., 2014). The enhanced communication, care navigation, and advocacy
services that occur in this ToC have been associated with better psychological outcomes for care
recipients (DePrince et al., 2012; Ogbe et al., 2020) and reduced incidence of revictimization
(Piispa, 2016; Robinson, 2006; SafeLives, 2014).
CEASE IPV will mobilize several prominent community pillars from a variety of sectors,
including healthcare organizations (e.g., Kaiser Permanente), advocacy groups (e.g., domestic

21
violence shelters), universities, justice system affiliates (e.g., Family Justice Center, police
departments, victim compensation), and social services. By incorporating a community impact
approach (Kania et al., n.d.), these organizations will be unified around a common goal of
eliminating IPV, reducing inequities and barriers to care, and centering support around survivors
and their families.
CEASE IPV’s objectives will be accomplished via the establishment of a governing
board, development of memorandums of understanding (MOUs), standardized workflows, and a
structured monthly meeting, designed to enhance mutual understanding of available services,
strengthen intra-agency relationships, and create a network of interdependency. Together, these
objectives serve to enhance and optimize care coordination for survivors of interpersonal
violence. Additionally, the cost savings associated with this ToC model (Coordinated Action
Against Domestic Violence, 2010; Robinson et al., 2006), coupled with reduced medical service
utilization (Halliwell et al., 2019; Kaiser Permanente, 2017), and greater patient satisfaction
(Dheensa et al., 2020; Kaiser Permanente, 2017) further incentivizes key stakeholders to remain
committed to CEASE IPV.
To support this work, an HCP-facing, culturally informed, and empirically based
educational program has been developed and can be easily implemented in healthcare systems.
Thus, CEASE IPV begins as a web based, 60-minute asynchronous training for HCPs, which will
be implemented at a national level in Kaiser Permanente. As the largest integrated healthcare
system in the United States. Kaiser Permanente has become a recognized leader in the healthcare
landscape, particularly due to its focus on preventative medicine and ability to provide efficient
and affordable care (Kaiser Permanente Bernard J. Tyson, n.d.). As the recipient of numerous
awards (Kaiser Permanente, 2023), designations (McHugh et al., 2016), and presidential

22
accolades (American Medical Association, 2009; Kaiser Permanente, n.d.), Kaiser Permanente is
well-equipped to implement this model and reduce IPV from the healthcare space. CEASE IPV
represents the first IPV-related course on the Kaiser Permanente Learn platform. To date, Kaiser
Permanente HCP trainings have leaned toward other healthcare-related issues such as child and
elder abuse, ethics and compliance, and waste management, among others. The development and
arrival of the CEASE IPV program, coupled with anticipated regulatory guidelines, is ushering in
a new era for the management of IPV in healthcare settings.
The CEASE IPV training is comprised of four distinct modules that will enhance HCPs’
current levels of IPV-related knowledge and understanding through a variety of teaching and
learning exercises and methodologies. The modules include (a) Introduction to Intimate Partner
Violence, (b) Trauma-Informed Care, (c) Assessment Techniques, and (d) Intervention Strategies
(see Appendix H). Training content was informed by empirical data, evidence-based practices,
survivor feedback, and curricula recommendations established by the American Association of
Medical Colleges (Berman et al., 2023; Darling, 2022), World Health Organization (2019), and
Family Violence Curricula in Europe (Gomez-Bravo et al., 2019). Prior to delving into the
content, HCPs will participate in a mandatory pretest that will assess their baseline level of IPVrelated knowledge and understanding. Each module will take approximately 15 minutes to
complete and will be comprised of a variety of instructional methods, including prerecorded
subject matter experts, narrations, animations, and a variety of transfer of learning activities such
as reflection exercises, knowledge checks, and case reviews. HCPs will be required to complete
all items in each module, including a posttest, prior to receiving organizational and continuing
medical education (CME) credit.

23
Data for CEASE IPV will be gathered and analyzed in the form of a quasi-experimental
research design with pretest and posttest assessments. Because CEASE IPV will be offered
internally to Kaiser Permanente HCPs, data collection, processing, and monitoring will easily be
captured and analyzed. The first aim of this study will examine changes to HCPs’ IPV-related
knowledge and understanding. A second aim will focus on the effects of the CEASE IPV training
on HCP response and patient outcomes (e.g., referrals to social medicine for further follow up).
Impact will also be measured in the form of anonymous patient satisfaction surveys, analysis of
IPV-related sentinel events, and user data gathered from the Articulate Storyline 360 learning
platform, such as post training satisfaction and feedback. CEASE IPV is not the first model to
incorporate HCP education in its approach. Although robust curriculums have been developed
(Sprague et al., 2018), issues with study design and data sampling methods have failed to
associate them with positive changes in HCP behaviors and responses. In contrast, the aims of
the CEASE IPV research study will explore and determine whether the training content will
translate to more proactive care and a better patient experience.
Family violence is truly an insidious phenomenon, and prevention is desperately needed.
In 2013, the National Survey of Children’s Exposure to Violence surveyed 4,000 households
across the United States to determine the prevalence of violent experiences for youth aged 0 to
17 (Finkelhor et al., 2015). Their findings indicated 5.8% of children witnessed an assault
occurring between parents, which is specifically linked to an increased risk of future
victimization and/or perpetration via the intergenerational transmission of violence (Finkelhor et
al., 2015; Peskin et al., 2014). Numerous other adverse effects of childhood exposure to
interpersonal violence include youth suicide (Castellvi et al., 2017); depression, anxiety, and
somatic complaints (Margolin et al., 2010); PTSD (Office of Juvenile Justice and Delinquency

24
Prevention, 2000); psychiatric hospitalization (Kisiel et al., 2014); and antisocial behavior,
substance abuse, teen pregnancy, and delinquency (Sousa et al., 2011). The CEASE IPV training
represents a key starting point for future program development, particularly around family
violence prevention.
To mitigate risks associated with family violence, the Grand Challenges for Social Work
(n.d.) established a goal to Build Healthy Relationships to End Violence, which is measured by
reduction and prevention of violence by 10% via increased availability of services to support the
development and strengthening of relationships, and 10% reduction in interpersonal violence
over the next 10 years due to promotion of healthy, violence-free relationships. CEASE IPV
seeks to contribute to these goals by granting HCPs the knowledge and tools required to
recognize the hidden signs of IPV in their patients, intervene with supportive dialogue and
community resources, and engage in upstream methods to prevent IPV from occurring. CEASE
IPV’s ToC also supports this notion, enabling HCPs to advocate on behalf of survivors, ensuring
they are not left to navigate complex systems of care alone.
CEASE IPV also works to resolve the shortcomings associated with the U.S. Violence
Against Women Act (VAWA), specifically, VAWA’s predilection for a criminal justice
response to IPV (National Network to End Domestic Violence, 2017). Case in point, VAWA
was enacted in 1994 and administered by the DOJ and Health and Human Services (HHS).
VAWA serves to provide gender-based violence victims and survivors with necessary resources
(e.g., housing, legal aid), legal protection, and preventative programs (National Network to End
Domestic Violence, 2017) . Although rates of IPV have decreased by 53% since VAWA was
enacted, 85% of VAWA funds are funneled to the criminal justice system (Goodmark, 2022).
Not only does this approach fail to address the root causes of IPV, namely poverty and the

25
intergenerational transmission of violence, it also has a propensity to harm low-income
communities of color (Goodmark, 2022) who are already disproportionately incarcerated relative
to their White counterparts. CEASE IPV’s design criteria prohibit this type of response and will
strive to decrease incidence of IPV without contributing to the overincarceration of people of
color.
IPV is a phenomenon in constant flux; thus, it is essential that advocates, allies, and
helping professionals maintain a level of understanding on par with IPV’s unrelenting evolution.
Thus, combating IPV requires a commitment to evidence-based practices, careful attention to
detail, and a systematic approach to execution. Thus, the exploration, preparation,
implementation, and sustainment (EPIS) framework will serve as an implementation guide for
the CEASE IPV program.
Implementation Plan
The EPIS framework is comprised of four distinct phases: exploration, preparation,
implementation, and sustainment, and aids complex organizations such as Kaiser Permanente in
considering inner contexts (e.g., individual, organizational, systemic), and outer contexts (e.g.,
sociopolitical, leadership, funding-related) that facilitate implementation of evidence-based
practices (EBPs; Aarons et al., 2011; EPIS Framework, n.d.). By using the EPIS framework,
anticipated referral volumes, staffing ratios, capacity models, and performance outcomes can be
accounted for in advance, which will reduce unnecessary iterations and aid in scaling this
program enterprise wide.
CEASE IPV is currently in the exploration phase, which has consisted of semi structured
interviews and ethnographic conversations with internal (i.e., Kaiser Permanente) and external
(i.e., community-based) stakeholders to gather feedback pertaining to the model framework,

26
training content, implementation barriers and facilitators, care gaps, and consideration of any
existing memorandums of understanding (MOUs), service-line agreements (SLAs). Once the
framework was established, training content was compiled, tested, and delivered to a sample of
HCPs. As a result of this work, an IPV consortium was assembled and tasked with translating
this work into an asynchronous, virtual training available to all 195,000 KP HCPs and
employees.
The initial start-up costs associated with the CEASE IPV training were provided by
Kaiser Permanente National Prevention of Workplace Violence (NPWV). Their generous in-kind
contribution (i.e., valued at $30,000–$60,000) facilitated the development of the CEASE IPV
training using the Articulate Storyline 360 virtual learning platform (see Appendix F). In turn,
the IPV consortium provided the content and curriculum. The salaries of consortium members
were provided by their respective departments. The consortium anticipates the CEASE IPV
training will serve as a proof of concept and facilitate future funding opportunities; consortium
members are currently pursuing internal and external research grants to expand this body of
work. Preliminary evaluation techniques will include quantitative measures, such as changes in
HCPs IPV-related knowledge, changes in HCP behavior (e.g., increased IPV-related ICD-10
diagnoses and coding and increased referrals to social medicine) and qualitative measures, such
as HCPs’ subjective experiences, and continued ethnographic conversations with IPV survivors.
During the preparation phase, the IPV consortium intends to draft and present workflows,
policies, practices, and procedures; delineate roles and responsibilities; determine programrelated metrics and indictors; develop communication pathways; and with respect to HIPAA,
consult Kaiser Permanente’s legal team to confirm whether additional communication
agreements, such as releases of information (ROIs) are warranted. The preparation phase also

27
requires that HCP training materials (e.g., presentation slide decks, handouts, videos, oral
presentations) are developed, approved by Kaiser Permanente compliance, and readied for
deployment. Patient-facing educational materials also requires approval from Kaiser
Permanente’s legal and compliance teams prior to distribution.
Successful implementation of the CEASE IPV care delivery model (and eventual scaling)
will be accomplished by creating internal (i.e., Kaiser Permanente specific) and external (i.e.,
community-related) workflows and processes to identify IPV survivors, manage crises in real
time, and connect survivors to community services (see Appendix G). Early detection and swift
intervention strategies are essential to preventing serious psychological and physiological
injuries (CDC, 2021; Gartland et al., 2014; Feletti et al., 1998). This proposal represents a
significant departure from the current referral-based standard of practice, which is characterized
by ineffectiveness (Coker et al., 2012; Van Parys et al., 2017) and lack of survivor engagement
(Kaiser Permanente, 2017). Throughout the implementation phase, it will be necessary to engage
in continuous data collection, analysis and monitoring, quality assurance reviews, and to remain
connected with key stakeholders, and most importantly, survivors.
The sustainment efforts associated with CEASE IPV will be guided by empirical and
clinical outcomes collected during the implementation phase and further supported by any IPVrelated regulatory requirements. In anticipation of budgetary constraints, the CEASE IPV
program was developed from a scarcity mindset, meaning most program elements can be
implemented using existing resources. Case in point, medical social workers are already
employed throughout Kaiser Permanente medical centers and are routinely consulted in IPV
cases. An increase in IPV referrals may support specialized designation of two or three social
workers from each medical center to focus primarily on IPV cases, including initial disclosure

28
and continuous follow up. Similarly, Kaiser Permanente’s telehealth infrastructure could be used
to increase the capacity of each social worker. Thus, rather than having a social worker
physically co-located in a department, they could be remotely deployed to multiple departments,
broadening their coverage and capacity. In practice, this approach may also serve to reduce
indirect work (e.g., unbillable time) and produce billable, patient-facing opportunities.
CEASE IPV represents a significant step toward institutional change and has the potential
for tremendous scalability. As the program sponsor, Kaiser Permanente NPWV will market
CEASE IPV nationally, offering a possible penetration rate of 195,000 HCPs and employees.
Further, IPV will be featured on the NPWV’s Microsoft SharePoint site, which is a national
platform. This platform will serve as a central information hub, which will allow users to access
all KP’s IPV-related resources in one convenient location, rather than being parceled out to each
individual region. This simple, fundamental change will expand the reach of the CEASE IPV
program significantly and allow for interdisciplinary and inter-regional exchanges of ideas,
partnership, and networking. Marketing will also take the form of formal announcements, huddle
messages, internal Microsoft message boards, regional Family Violence Prevention Program
meetings, and department meetings. Kaiser Permanente department leaders also have the
discretion to assign CEASE IPV as a mandatory learning assignment, as indicated by the needs of
their department.
Similarly, a CEASE IPV handbook will be developed, allowing department leaders and
HCPs to distribute IPV-related educational information, resources, and support networks to the
general patient population (see Appendix H). The presence of a unified message and approach to
IPV strengthens branding allows for consistent messaging and helps to integrate this body of
work into Kaiser Permanente’s current mission, vision, and values. If CEASE IPV’s assertions

29
are supported by empirical evidence, there will be unlimited growth potential to expand the
CEASE IPV model to other markets, including universities, medical schools, managed care
organizations, and community-based agencies.
The future of CEASE IPV not only lies in its ability to achieve meaningful results, but
also the ability to navigate the storms ahead. In the wake of the COVID-19 global pandemic,
healthcare systems, including Kaiser Permanente, continue to experience soaring care delivery
costs (Hwang & Ibarra, 2022) and increased competition (Pearl, 2023). The consortium
anticipates earlier intervention in IPV-related cases will result in reduced service utilization (e.g.,
few acute care visits), and lower lifetime medical costs, which supports longitudinal cost
effectiveness. Fortunately, the original CEASE IPV course will not require any additional
investments unless revisions to the curriculum are required. However, any future associated
courses would require an active Articulate Storyline 360 license (i.e., estimated at $1,200 per
user annually), time to develop, and subject matter experts’ willingness to supply content.
Despite the obvious benefits associated with increased HCP responsiveness to IPV, there
are potential unintended consequences that warrant consideration. It is important to stress that
abuse disclosure is not the goal. Rather, the goal is to build affirmative, trusting relationships
with HCPs and encourage help-seeking behaviors. HCPs must be aware of the systemic and
institutionalized racism that serves to oppress and further marginalize vulnerable populations,
especially populations of color. In the case of mandated reports to law enforcement, HCPs
should be aware that Black women are more likely to be regarded as co-aggressors and arrested
alongside perpetrators (Bent-Goodley, 2009). Additionally, Black women are also more likely to
have their children removed by child protective services than other racial groups (Bent-Goodley,
2009). Thus, HCPs must have discussions with patients about informed consent, confidentiality,

30
and limits to confidentiality. Barring any obvious IPV-related injuries, giving survivors the
choice about whether to disclose abuse increases their feelings of agency and self-efficacy. If a
survivor declines to disclose, HCPs can still proceed with providing survivors with resources and
extend an invitation to share their story in the future, on their terms.
Similarly, IPV myths and stereotypes have perpetuated a false narrative that remaining in
an abusive relationship is a choice. Sweeping generalizations and conjecture serve no purpose at
this juncture other than to jeopardize victim and survivor safety. Victims and survivors face
numerous barriers to leaving an abuser, and the risk of death is paramount (AbiNader et al.,
2023; Bray, 2019; NCADV, n.d.; Tjaden & Thoennes, 2000). Prior to making any
recommendations about the future of the relationship, HCPs must be knowledgeable about the
risks of intimate partner homicide, and must engage victims in safety planning, resourcing, and
other protective measures. Further, victims and survivors must be equipped with all the facts and
supports necessary to make an informed decision about the future of their relationship.
Conclusion and Implications
IPV is a silent disease, mired in stigma (Murvartian et al., 2023), shame, and fear. When
IPV reveals itself, HCPs must respond as if it was a life-threatening emergency; in many cases, it
is. Regrettably, healthcare organizations have been complicit in the IPV crisis, claiming that IPV
is a serious public health issue, without taking any meaningful action to correct injustices that
IPV victims and survivors’ encounter. This proposal ensures that promises and assertions are
followed by actions, accomplished by closing existing care gaps, ensuring identified victims are
guided to supportive services, and taking great care to avoid practices that cause retraumatization. To accomplish this goal, practices and procedures must be met with cultural
sensitivity, cultural humility, and most importantly, provided with empathy and compassion.

31
The development of CEASE IPV was an iterative process that required numerous,
ongoing ethnographic conversations with survivors and semi-structured interviews with key
stakeholders. The initial scope of this project was centered around creating a healthcare
environment conducive to self-disclosure for women of color and other marginalized
populations. However, constructive feedback and empirical evidence suggested the potential to
take a more responsive, proactive approach. Although the program design and functionality may
have evolved over the course of development, the goal remained unchanged: saving lives. This
led to the development of the high-fidelity prototype, Equitable Solutions for Intimate Partner
Violence in Healthcare Settings, which further evolved into the three-tiered model known as
CEASE.
CEASE IPV may be the first IPV HCP training course in Kaiser Permanente’s vast digital
library, but it will not be the last. The development of the IPV consortium, in conjunction with
conversations with key stakeholders, revealed a hidden network of allies, advocates, and
“wounded healers” (Dheensa et al., 2023, p. 1291). The desire to engage in IPV prevention
efforts was always there; however, the path forward was concealed by bureaucratic red tape.
KP’s IPV work now rests at a national level, creating a network of like-minded individuals to
advance this work. Plans are in motion to develop additional learning content, resources, and
practice recommendations. Once the CEASE IPV training is published on the Kaiser Permanente
Learn platform, testing, analysis, and processing of user data and clinical outcomes will be
conducted. These results will aid in determining the efficacy of this approach and support
securing additional funding and resources. However, at minimum, HCPs will be better equipped
to recognize IPV, identify the warning signs associated with escalating violence, and respond in
a culturally sensitive manner.

32
Ultimately, the success of CEASE IPV will be dependent upon the bridges that are built,
communication pathways that are established, and relationships that are developed, nurtured, and
sustained. This proposal represents a significant step toward achieving justice and equitable
health outcomes for survivors of interpersonal violence. Further, CEASE IPV also serves as a
model for other communities and healthcare systems to replicate and scale. By working
collectively with a common purpose, rather than in silos, HCPs and other IPV service providers
will be better positioned to have a greater impact and provide a more comprehensive and
effective service to victims and survivors of violence, and the communities in which they reside.
In sum, “Education is needed. Pro-active intervention is needed. Lives and well-being are at risk
when care is mishandled” (IPV survivor, personal communication, January 4, 2024).

33
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Appendix A: Logic Map

53
Appendix B: Design Criteria
Criteria Wider Opportunities
Must
• Medical Center-wide trauma-informed, family
violence prevention training.
• Consider the psychological, physical, social, and
financial needs of each survivor.
• Practice cultural sensitivity, fluency, and humility.
• Respect and support survivors' autonomy, agency,
and right to self-determination.
• Personalized linkage to community supports.
• Recognize and respect the influence of medical
mistrust and racial trauma.
• Refrain from labeling survivors.
• Measure current systems of care against NASW
Code of Ethics.
• Client/patient outcome assessment.
• Provide a variety of opportunities for staff to
engage in trauma-informed practices and training.
• Creating a multi-agency network in each region
and establish communication pathways.
• Encourage participation by community
stakeholders.
Could
• Offer IPV education and training to the local
community.
• Engage in annual road show within each service
area to highlight successes and continue to keep
“the why” in the forefront.
• Ensure that basic needs of victims and families are
met.
• Offer mentoring to providers to support their
professional growth.
• New employee orientation/trainings to include
information about IPV, trauma, and the social
determinants of health.
• Regardless of their position, highlight their role in
promoting these principles in their daily work.
• Facilitate Town hall meetings.
• Form a patient-advisory council and/or governing
board.
Should
• Conduct, smaller group trainings to allow for more
in-depth dialogue.
• Consider spiritual health as an essential
component for those who desire it.
• Cultivate positive relationships with involved
systems and community partners.
• Clear communication and regular information
exchanged with the involved system.
• Close care gaps.
• Eliminate redundancies that result in retraumatization.
• Encourage providers to engage in introspection
and reflection.
• Reflect on what has been normalized in their role
re: treatment of IPV, including victims and
survivors.
• Provide routine refresher trainings about trauma,
ACEs, and the social determinants of health.
• Consult with other providers/systems that are
engaged in similar work to learn and disseminate
best-practices.
Won’t
• Engage or support practices that re-traumatize
victims/survivors.
• Continue practices that maintain systemic racism.
• Examine and rectify policies and procedures that
favor the White majority.
• Create and implement policies that support equity,
inclusion, and diversity (EID).

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Appendix C: High Fidelity Prototype Equitable Solutions to Intimate Partner Violence in
Healthcare Settings
Section Included Subjects/Discussion Items Associated
Slides
Femicide Epidemic § History of gender-based violence in the U.S.
§ Affected populations.
§ Consequences of inaction.
§ Drivers of violence.
4-5
Understanding
Domestic Violence
§ Differentiation between DV, IPV, and child abuse.
§ Description of common forms of abuse. Statistical
data, including prevalence.
§ Barriers to spontaneous disclosure
6-10
IPV is a Healthcare
Crisis
§ Cost analysis
§ Impact to service utilization
§ Pros and cons of universal screening
§ Role of the healthcare provider
§ Hidden signs and indicators of violence.
11-14
Etiology of Intimate
Partner Violence
§ Costs of continued violence.
§ Etiology (ACEs, childhood exposure, poverty, etc.).
15-18
Implicit Bias and
Cultural Competence
§ Intersectionality.
§ Abuse myths and stereotypes.
§ Racial and cultural biases.
§ Healthcare related power imbalances.
§ Victim blaming.
19-23
Why People Remain
in Abusive
Relationships
§ Overview of stigma/shame.
§ Abuse dynamics.
§ Cycle of violence.
§ Intimate partner homicide
§ Current judicial processes and legislation.
24-27
Supportive PatientManagement
Strategies
§ Current hospital-wide approaches.
§ Creating psychological safety.
§ Engaging compassionately
§ Mandated reporting guidelines for physicians
§ Risk assessment strategies.
§ Safety planning.
§ Provider support resources.
28-35
Are you Safe at
Home?
§ Program description.
§ Benefits and clinical necessity.
§ Summary and review.
36-37
References § Cited literature 38-42
Appendices § Campbell’s Danger Assessment
§ HITS Assessment
43-45

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Appendix D: Posttest Qualtrics Survey
Survey Question Response Options
1. Please identify your gender identity. • Male
• Female
• Non-binary/Third gender
• Prefer not to say
2. What is your identified ethnicity? Check all that apply. • Hispanic
• Asian American Pacific Islander
• Black/African American
• Bi/Multiracial
• Other
• Prefer not to say
3. What is your occupation/position? • Physician/MD/OD
• Advanced Practice Provider
• Administrator
• Student
• Other
4. Prior to this training, rate your confidence pertaining to the topic below.
a. Recognizing hidden signs of IPV.
b. Understanding barriers to disclosure.
c. Understanding dynamics of abuse.
d. Having IPV-related discussions with patients.
• Not at all confident.
• Somewhat confident
• Confident
• Very confident
5. As a result of this training, rate your confidence pertaining to the topic
below.
a. Recognizing hidden signs of IPV.
b. Understanding barriers to disclosure.
c. Understanding dynamics of abuse.
d. Having IPV-related discussions with patients.
• Not at all confident.
• Somewhat confident
• Confident
• Very confident
6. What is your biggest takeaway of “aha” moment? • Fill in the blank
7. What interested you in this topic? Check all that apply. • I am a DV survivor.
• I treat patients that have been impacted
by DV/IPV.
• I needed CME credits.
• I wanted to enhance my understanding of
this topic.
• I personally know a DV/IPV victim or
survivor.
• Other
8. Please share your opinion of the following:
a. Intimate Partner Violence is a healthcare issue.
b. This presentation improved my knowledge of IPV-related issues.
c. I would recommend this presentation to my colleagues.
• Strongly disagree
• Slightly disagree
• No opinion
• Slightly agree
• Strongly agree
9. As a result of this presentation, what action(s) are you committed to doing? • Recognizing hidden signs of abuse.
• Initiating abuse-related discussions with
my patients.
• Making abuse-related diagnoses.
• Engaging social workers in cases of
suspected or confirmed abuse.
• Other.
10. In the presentation, we introduced the Are you Safe at Home program.
Would this be helpful to your practice? Why of why not.
• Yes
• No
11. If provided the opportunity, would you wear an Are you Safe at Home?
Badge buddy, lanyard, or badge reel?
• Yes
• No

56
Appendix E: Theory of Change

57
Appendix F: Line-Item Budget
Category Total Comments
REVENUE
Revenues are not directly generated by this program,
though member co-payments generated by services
provided could contribute to the revenues of the larger
organization. The program outputs could result in
indirect benefits to the organization (e.g., decreased
service utilization, decreased risk of developing acute
injuries or chronic disease).
Grant request $15,000.00 KP Research Committee, application due 3/1/24
Total REVENUE NA NA
EXPENSES
Personnel Exp. $286,000.00 Salaries of Program Manager, Consultant for First
Year
Personnel campaign materials $2516.25 Personnel equipment includes customized healthcare
provider worn badge buddies $1061.50 (500 x $1.93
each), customized healthcare provider badge reels
$1166.00 (500 x $2.12 each), and customized, patientfacing buttons $288.75 (750 x $0.35 each). Total price
of badge buddies and badge reels is inclusive of 10%
California sales tax.
Wages/Salaries $286,000.00
Subtotal $286,000.00
Benefits (@21%) $60,060.00
Total personnel exp. $358,576.25
Other Operating Exp. $10,000 Per-diem research assistant costs
Educational Supplies $4,462.50 5,000 patient-facing, educational brochures
Tech/Computers $2000.00 Equipment for (2) FTEs: Program Manager and
Consultant
Tel/Utilities $1200.00 Remote work expenditures for (2) FTEs
Training/Prof. development
Travel $5000.00 Estimated mileage reimbursements and misc. travelrelated expenses
Office Supplies $2500.00
IN-KIND Contributions
Articulate Storyline License $1200/user annually
Articulate Storyline
development
$30,000-$60,000
TOTAL IN-KIND $31,200-$61,200
TOTAL EXPENSES $383,738.75
SURPLUS/DEFICIT ($337,538.75-
$307,538.75)

58
Appendix G: Journey Map

59
Appendix H: CEASE IPV Handbook

60
Table of Contents
Overview of Intimate Partner Violence (IPV).................................................................................3
Program Description........................................................................................................................6
Shifting Responsibility ....................................................................................................................8
Designing for Social Justice ..........................................................................................................10
Closing Knowledge Gaps..............................................................................................................13
Facilitator Guide............................................................................................................................15
Implementation Strategies.............................................................................................................19
References .....................................................................................................................................23

61
Overview of Intimate Partner Violence
Intimate partner violence (IPV) is a highly stigmatized societal epidemic,
represented by 10 million incidents of violence in the United States each year. IPV is
characterized by a wide range of abusive behaviors, including:
Tragically, 4 women a day are murdered by a current or former intimate partner (Smith,
2022) and as many as 20% of all U.S. homicides represent children, neighbors, friends,
and family members caught in the crossfire (NCADV, n.d.).
IPV transcends all genders, races, ethnicities, and socioeconomic classes.
However, women experience significantly higher prevalence rates than men. Up to
25% of women will experience severe IPV during her lifetime, compared to prevalence
rates of 14% for men (NCADV, n.d.). These disparities are further pronounced in
women of color, exhibited by prevalence rates as high as 84% for Indigenous women
(Fotheringham et al., 2021) and 40% for Black women (Stockman et al., 2015). Systemic
racism and discrimination are known contributors to this problem. To enact meaningful
• Physical battery
• Name-calling
• Isolation
• Limiting resources
• Degradation
• Threats of violence
• Slapping
• Shoving
• Burning
• Sexual
assault/trafficking
• Strangulation
• Coercive Control

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change, healthcare professionals will need to eliminate any bias and/or stigma that
holds this problem in place.
IPV is a Healthcare Crisis
In the past, IPV has been regarded as a personal issue or characterological flaw,
which has served to uphold stereotypes and perpetuate IPV-related myths. IPV is a
healthcare crisis, characterized by a wide range of chronic and acute psychological and
physiological injuries, such as injuries to the head, neck, and face, as well as
neurological disorders, memory loss, asthma, diabetes, reproductive and gynecological
issues (Akbari et al., 2021), cardiovascular diseases, chronic pain disorders (Akbari et
al., 2021), gastrointestinal disorders, and unplanned pregnancy (Akbari et al., 2021;
Centers for Disease Control and Prevention, 2021; Khurana et al., 2020; NCADV, n.d.;
Rakovec-Felser, 2014). Survivors of IPV are also at substantial risk of developing
psychological disorders, including major depressive disorder (Akbari et al., 2021),
posttraumatic stress disorder (PTSD), and generalized anxiety disorder (Akbari et al.,
2021).
Interestingly, the lifetime risk of experiencing IPV is higher than that of many
health conditions, yet rarely receives the same level of recognition or attention (see
Figure 1). Further, few medical departments routinely screen for IPV. The U.S.
Preventative Services Task Force (2019) recommended all women of reproductive age
be screened for IPV (U.S. Preventive Services Task Force, 2018); however, the risk of

63
experiencing IPV persists beyond child-bearing years. Thus, it is important that
healthcare professionals be aware of signs, symptoms, risks, and other factors
associated with IPV.
Figure 1
Lifetime Prevalence Rates of Disease in Adult Females
Note. American Cancer Society, 2020; Centers for Disease Control and Prevention,
2023; National Cancer Institute, 2018a, 2018b; NCADV, n.d.; Yoon & Bushnell, 2023.
The Role of Healthcare Professionals
As many as 95% of IPV survivors and victims are unrecognized during their
medical visits (Aboutanos et al., 2019; Ali et al., 2016) and in many cases, are
misdiagnosed with non-IPV etiologies. Numerous barriers discourage survivors from
disclosing incidents of abuse, including stigma, shame, fear of judgement, worry about
the perpetrator finding out, concern about law enforcement involvement, and/or may
not recognize that their relationship is abusive.

64
Studies have demonstrated that IPV survivors, and women in general, want to be
asked about IPV and routinely provided with IPV-related information (Chang et al.,
2005); however, they are less likely to disclose abuse if they are not directly asked
(Gomez et al., 2019; Rodriguez et al., 2001). Healthcare professionals are uniquely
positioned to aid in the detection and intervention in IPV-related cases (Akbari et al.,
2021; Lovi et al., 2018; Wu et al., 2010), representing vital life-saving opportunities.
Unfortunately, they are not typically equipped with the knowledge, tools, confidence,
and resources needed to recognize IPV consistently or intervene effectively. CEASE IPV
was developed to close this knowledge gap and create a better, patient experience.
Words Matter
The term “victim” is often used to describe people who have been personally
affected by interpersonal violence. Although this term has important implications (e.g.,
access to victim compensation, legal protections, reporting a crime), it is generally
avoided in the IPV community. The preferred term to use is “survivor,” which serves to
empower people who have been personally impacted by these egregious acts of
violence.
Program Description
CEASE IPV bridges the gap between healthcare systems and the larger
community, which allows for a more affirming and positive care experience for IPV
survivors. CEASE is an acronym that encapsulates three primary concepts: community

65
engagement, advocacy, and staff education. These concepts have been integrated into
one central model and serve as the foundation of this approach (see Figure 2):
• Community engagement requires knowledge of existing resources,
cultivation of relationships, and maintenance of connection pathways.
• Advocacy requires a committed, compassionate, and knowledgeable team of
healthcare professionals that are prepared to perform the heavy lifting for
individuals and families in need.
• Staff education ensures that healthcare professionals are effectively equipped
to be change agents in IPV-related situations.
CEASE IPV was designed for healthcare organizations; however, it can be adapted and
applied in multiple settings, such as schools, universities, court systems, workplaces,
and any other public-facing environments.
Figure 2
CEASE IPV Model

66

Shifting Responsibility
In the absence of a universal healthcare system in the United States, hospitals,
care providers, agencies, and social services are disjointed and siloed. Thus, survivors
have to navigate these complex systems of care alone, which can result in worsening
symptoms of depression and anxiety. Thus, the simple act of receiving help becomes
another obstacle to overcome. CEASE IPV eliminates this barrier by shifting the
burden of responsibility from the survivor to the larger community. This type of
reorientation is characteristic of a coordinated community response (CCR) model,
which serves as CEASE IPV’s theory of change (ToC; see Figure 3).
Figure 3
CEASE IPV Theory of Change Model

67
The CCR model is a whole person approach that recognizes the significance of
the social determinants of health, and the influence of community engagement (HetzelRiggin, 2022; Ogbe et al., 2020; Shorey et al., 2014). The enhanced communication,
care navigation, and advocacy services that occur within this ToC are associated with
better psychological outcomes for care recipients (DePrince et al., 2012; Ogbe et al.,
2020) and reduced incidence of revictimization (Piispa, 2016; Robinson, 2006;
SafeLives, 2014).
CEASE IPV will mobilize several prominent community pillars from a variety of
sectors, including healthcare organizations, advocacy groups, criminal justice system
affiliates, and social service agencies. By using a collective, community impact

68
approach, these organizations will be unified around a common goal of eliminating
IPV, reducing inequities and barriers to care, and centering support around survivors
and their families (see Figure 4).

Figure 4
CEASE IPV’s Community Alignment

Designing for Social Justice
Design justice principles operate under the premise that current societal systems
(e.g., healthcare, child welfare, criminal justice) are intrinsically biased toward
marginalized populations, cater to the White majority, and serve to uphold systemic
racism and practices of oppression. Replicating systems of oppression would be
discordant with design justice principles that demand equity, equality, inclusion, and

69
diversity. To mitigate these risks, CEASE IPV developed specific design criteria to
support design justice principles, while simultaneously omitting practices that would be
incongruent with this approach (see Table 1).
Table 1
CEASE IPV Design Criteria
Criteria Wider Opportunities
Must
• Medical Center-wide trauma-informed, family
violence prevention training.
• Consider the psychological, physical, social,
and financial needs of each survivor.
• Practice cultural sensitivity, fluency, and
humility.
• Respect and support survivors' autonomy,
agency, and right to self-determination.
• Personalized linkage to community supports.
• Recognize and respect the influence of
medical mistrust and racial trauma.
• Measure current systems of care against
NASW Code of Ethics.
• Client/patient outcome assessment.
• Provide a variety of opportunities for staff to
engage in trauma-informed practices and
training.
• Creating a multi-agency network in each
region and establish communication
pathways.
• Encourage participation by community
stakeholders.
Could
• Offer IPV education and training to the local
community.
• Engage in annual road show within each
service area to highlight successes and
continue to keep “the why” in the forefront.
• Ensure that basic needs of victims and
families are met.
• Offer mentoring to providers to support their
professional growth.
• New employee orientation/trainings to
include information about IPV, trauma, and
the social determinants of health.
• Regardless of their position, highlight their
role in promoting these principles in their
daily work.
• Facilitate Town hall meetings.
• Form a patient-advisory council and/or
governing board.
Should
• Conduct, smaller group trainings to allow for
more in-depth dialogue.
• Consider spiritual health as an essential
component for those who desire it.
• Cultivate positive relationships with involved
systems and community partners.
• Reflect on what has been normalized in their
role re: treatment of IPV, including victims
and survivors.
• Provide routine refresher trainings about
trauma, ACEs, and the social determinants of
health.

70
Criteria Wider Opportunities
• Clear communication and regular information
exchanged with the involved system..
• Eliminate redundancies that result in retraumatization.
• Consult with other providers/systems that are
engaged in similar work to learn and
disseminate best-practices.
Won’t
• Engage or support practices that retraumatize victims/survivors.
• Continue practices that maintain systemic
racism.
• Examine and rectify policies and procedures
that favor the White majority.
• Create and implement policies that support
equity, inclusion, and diversity (EID).
The design criteria was further informed by semi structured interviews with key
stakeholders, such as:
Most importantly, ethnographic conversations with IPV survivors revealed that they
sometimes felt judged and misunderstood by their healthcare professionals.
Additionally, lack of information sharing, and absence of care coordination, often
resulted in survivors having to continuously recount their story, causing further trauma.
CEASE IPV addresses these challenges by integrating trauma-informed care principles
• Social Service Agencies
• Detectives
• Mental Health providers
• Healthcare leaders
• University faculty
• Subject Matter Experts
• Police Officers
• Physicians
• Principle Investigators
• Hospital administrators

71
into procedures, practices and workflows. CEASE IPV also strives to close knowledge
gaps for healthcare professionals, eliminate bias, and instill cultural sensitivity.
Cultural Considerations
CEASE IPV requires an acknowledgement and understanding of cultural norms,
practices, and procedures that oppress and marginalize vulnerable populations.
Although this may not be intentional, healthcare professionals should be aware that
they exist and consider their own possible sources of bias. It is necessary that
healthcare providers, allies, and advocates refrain from making assumptions about
survivors and instead seek to understand and support them in their journey.
Closing Knowledge Gaps
CEASE IPV is a web-based, 60-minute asynchronous training for healthcare
professionals. The training is comprised of four distinct modules that will enhance
healthcare professionals’ current level of IPV-related knowledge and understanding,
accomplished through a variety of teaching and learning exercises and methodologies.
Each module will take approximately 15 minutes to complete and will be comprised of
a variety of instructional methods, including prerecorded subject matter experts,
narrations, animations, and learning activities, such as reflection exercises, knowledge
checks, and case reviews. The modules include:
1. Introduction to Intimate Partner Violence
2. Trauma-Informed Care

72
3. Assessment Techniques
4. Intervention Strategies
Training content was informed by empirical data, evidence-based practices, survivor
feedback, and curricula recommendations established by the American Association of
Medical Colleges (Berman et al., 2023; Darling, 2022), the World Health Organization
(2019), and Family Violence Curricula in Europe (Gomez-Bravo et al., 2019). This
content has also been approved for Continuing Medical Education (CME) credit as
authorized by the American Medical Association.
Prior to delving into the content, healthcare professionals will participate in a
mandatory pretest that will assess their baseline level of IPV-related knowledge and
understanding. Healthcare professionals will be required to complete all items within
each module, including a posttest, prior receiving organizational and CME credit.
Training Objectives
Following completion, healthcare professionals will be better equipped to
recognize hidden signs of abuse, understand the barriers to disclosure, engage in
compassionate inquiries, and gain a fuller understanding of their role when abuse is
identified. Healthcare professionals will also be more knowledgeable about IPV-related
resources, reporting mandates, and more confident in their ability to engage
meaningfully with this vulnerable population.

73
Facilitator Guide
CEASE IPV: Healthcare based intimate partner violence (IPV)
training program. This course will be integrated within Kaiser
Permanente’s KP Learn and Physician Learning libraries and
available to all physicians and staff, enterprise wide.
Platform:
Articulate
Storyline 360,
virtual,
asynchronous
program
Learning Outcomes:
The learning outcomes set forth by this course are in alignment
with the six general competencies for physicians, as described by
the Accreditation Council for Graduate Medical Education
(ACGME):
• Patient Care
• Medical Knowledge
• Systems-based Practice
• Professionalism
• Interpersonal and Communication Skills
• Practice-based Learning
Instructional Methods:
This is an asynchronous course based within a virtual, learning
platform, available on PC, iOS, and mobile systems. Course
includes a variety of learning modalities, such as visual graphics
and representations, videos, animations, first-person narratives,
and a variety of prompts to promote critical thinking, clinical
decision making, and risk analysis.

Overview:
Throughout this course, participants will receive comprehensive
information pertaining to IPV, including definitions, clinical
presentations, assessment strategies, intervention techniques,
and recommendations for treatment and follow-up care.
Additionally, mandated reporter guidelines, and coding and
diagnosis expectations will be reviewed. Participants will be
further challenged to examine their own personal beliefs on this
topic and consider how they may be inadvertently contributing
to this problem. Goals include correcting misinformation,
eliminate stereotypes and stigma, and mobilizing physicians and
Program
Overview

74
healthcare providers to take an active, equitable, and culturally
sensitive approach to IPV in their medical and professional
practices.
Prework Outline:
I. Presenters’ biography
a. Melissa Doiron-Min, DSW(c) & Liza Eshilian-Oates,
MD
II. Course Overview
III. CME and CEU information

Module 1: Introduction to Intimate Partner Violence in
Healthcare Settings
Module duration: 15 minutes
Outline:
I. Pre-Assessment
II. Femicide Epidemic
III. IPV Overview
a. Manifestations of abuse.
b. General prevalence rates.
IV. Hidden in Plain Sight
a. Signs, symptoms and indicators.
V. Barriers to Disclosure
a. Systemic and cultural barriers to disclosure
VI. Prevalence Rates and Costs
a. Impact on healthcare utilization and costs.
b. Workplace violence and gun/firearm violence
VII. IPV, Childhood Trauma, and Chronic Disease
a. Brief discussion of adverse childhood experiences
(ACEs) and etiology of IPV.
b. Reflection activity.
VIII. Section Summary
Video Segments:
• KP’s responsibility and commitment to IPV prevention.
Transfer of Learning Activities:
• Reflection exercise

Module 1
Overview
Module 2: Trauma-Informed Care
Module duration: 15 minutes
Module 2
Overview

75
Outline:
I. Vulnerable Populations
a. Highlight populations at risk of abuse and/or
populations with higher prevalence rates.
i. Women of color
ii. Women with disabilities
iii. Dependent adults
iv. LGBTQIA+ population
v. Pregnant women
b. Brief discussion of systemic and institutional racism.
c. Other associated risk factors
II. Cycle of Violence
a. Understanding the intergenerational transmission
of violence and familial legacies of trauma.
III. Intersectionality and Implicit Bias
a. Understanding the sociocultural factors present in
the exam room.
b. Challenge personal norms, schemas, and attitudes.
c. Reflection activity.
IV. Strategies to Avoid Re-traumatization
a. Language (verbal and nonverbal), terminology, and
pace.
b. Culturally sensitive practices.
c. Engaging in compassionate dialogues.
d. Highlighting patients’ strengths.
e. Fill in the blank activity.
V. Section Summary
Video Segments:
• Understanding intersectionality and implicit bias.

Transfer of Learning Activities:
• Fill in the blank
• Reflection
Module 3: Assessment
Module duration: 15 minutes
Outline:
I. Pattern Injuries, Unusual Injury Patterns, and Other Red
Flags
Module 3
Overview

76
a. Case examples/vignettes.
b. Common comorbidities and other risks.
c. Knowledge check.
II. Recognizing the Signs of Escalating Violence
a. Intimate Partner Homicide (IPH).
b. Risk factors.
III. Stalking, E-Surveillance and Other Risks
a. Define and describe stalking behaviors (physical
and electronic).
b. Downloadable patient-facing checklist.
IV. Assessment Tools
a. RADAR method
b. Highlight EPIC flowsheets. Include:
i. Campbell’s Danger Assessment (full and
abbreviated).
ii. HITS questionnaire.
iii. PHQ9, C-SSRS, and GAD7
V. Section Summary
Video Segments:
• Recognizing injury patterns and other red flags.

Transfer of Learning Activities:
• Knowledge check/quiz
Module 4: Intervention
Module duration: 15 minutes
Outline:
I. Diagnoses, Coding, and Mandated Reporter
Guidelines
a. Downloadable Pocket Guide, Badge Buddy, and
workstation tag.
b. Link to state-specific mandated reporting
guidelines.
II. Safety Planning
a. Review EPIC flowsheets.
b. Safety plan examples and resources (hard copies,
Apps, general precautions).
III. Resourcing with Patients
a. Thrive Local
Module 4
Overview

77
b. Building on patients’ existing supports.
IV. Collaborative Care
a. Strategies for working with Social Workers,
Psychiatry, Law Enforcement, and other community
partners.
b. Treatment options.
c. Journey Map.
V. Section Summary
VI. Post-Assessment
Video Segments:
• Treating IPV Survivors.

Downloadable Materials:
• KP-branded materials
o CEASE Family Violence toolkit:
§ Staff education guidelines
§ Implementation strategies
§ Sample Memorandum of Understanding
(MOU)
§ Pocket Guide, Badge Buddy, and
workstation tag.
§ Patient-facing educational brochures (English
and Spanish)
§ Provider-facing IPV intervention cheat sheet.
§ Staff and patient talking points.
§ Huddle messages.
§ Domestic Violence Awareness Month
Campaign ideas.
• State-specific mandated reporting guidelines.
• National Domestic Violence Hotlines

Implementation Strategies
Enhancing healthcare professionals’ IPV-related knowledge is just the beginning!
CEASE IPV seeks to close care gaps by connecting survivors of violence to community-

78
based supports and fulfilling other medical and psychological needs. By working
together, rather than separately, healthcare professionals can ensure that survivors are
successfully linked to the resources and services they require. CEASE IPV’s approach
represents s a deviation from the business-as-usual methods of managing IPV in
healthcare settings (see Figure 5). By connecting survivors to social workers at the point
of visit, the risk of survivors falling through the cracks are drastically reduced.

79
Figure 5
The Patient Journey
Thus, it is important that healthcare professionals and their respective
department leaders establish positive, working relationships with key stakeholders
(e.g., social workers, administrators, community-based agencies) to generate a warm
hand-off for survivors. Additionally, social workers can serve as a consistent point of
contact for survivors and community partners, forming a link between healthcare

80
services and essential community networks. CEASE IPV supports a phased approach to
implementation, which allows healthcare professionals to gradually build integral
support networks and develop meaningful, collaborative relationships and partnerships
with the community (see Figure 6).
Figure 6
Building on Successes

81
References
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(2019). Critical call for hospital-based domestic violence intervention: The Davis
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Akbari, A. R., Alam, B., Ageed, A., Tse, C. Y., & Henry, A. (2021). The identification and
referral to improve safety programme and the prevention of intimate partner
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18(11), Article 5653. https://doi.org/10.3390/ijerph18115653
Ali, P., McGarry, J., & Dhingra, K. (2016). Identifying signs of intimate partner violence.
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Rush, P., Sciolla, A., Stillerman, A., Trennepohl, C., Weil, A., & Potter, J. (2023).
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competency set. Academic Medicine, 98(8), 882–888.
https://doi.org/10.1097/ACM.0000000000005196

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Centers for Disease Control and Prevention. (2021, November 2). Preventing intimate
partner violence, violence prevention/injury/center/CDC.
https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html.
Centers for Disease Control and Prevention. (2023, May 15). Women and heart disease.
https://www.cdc.gov/heartdisease/women.htm
Chang, J. C., Decker, M. R., Moracco, K. E., Martin, S. L., Petersen, R., & Frasier, P. Y.
(2005). Asking about intimate partner violence: Advice from female survivors to
health care providers. Patient Education and Counseling, 59(2), 141–147.
https://doi.org/10.1016/j.pec.2004.10.008
Darling, A., Ullman, E., Novak, V., Doyle, M., & Dubosh, N. M. (2022). Design and
evaluation of a curriculum on intimate partner violence for medical students in
an emergency medicine clerkship. Advances in Medical Education and Practice,
13, 1279–1285. https://doi.org/10.2147/AMEP.S365450
DePrince, A. P., Belknap, J., Labus, J. S., Buckingham, S. E., & Gover, A. R. (2012). The
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Abstract (if available)

Abstract Intimate partner violence (IPV) is a highly stigmatized societal epidemic, represented by 10 million incidents of violence in the United States each year. Although IPV transcends all racial and socioeconomic boundaries, women of color are disproportionately impacted and subject to severe physiological and psychological injuries, including death. Healthcare professionals (HCPs) are uniquely positioned to aid in the detection and intervention in IPV-related cases, representing vital life-saving opportunities. Unfortunately, IPV victims often go unrecognized during their medical visits and are frequently misdiagnosed with non-IPV etiologies. The Community Engagement, Advocacy, and Staff Education (CEASE) Intimate Partner Violence (IPV) program aims to close these critical gaps and create an efficacious patient experience, accomplished by increasing HCPs’ knowledge of IPV, confidence in initiating IPV-related conversations, and correcting implicit biases that may influence responsiveness to IPV. A selection of CEASE IPV educational curriculum was delivered to a sample of HCPs via a 60-minute live presentation. Preliminary survey data revealed CEASE IPV improved knowledge of IPV and related issues in 98% (n = 15) of HCPs. Further, 98% of HCPs would recommend this program to colleagues, which supports the acceptability and feasibility of this approach. Further analysis revealed statistically significant differences in HCPs’ perceived abilities to recognize hidden signs of abuse, understand the barriers to disclosure and dynamics of abuse, and engage in IPV-related discussions with patients (p = .003). Additional testing is required to determine if CEASE IPV influences HCP behavior and improves patient outcomes.

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Asset Metadata

Creator Doiron-Min, Melissa Marie (author)

Core Title CEASE Intimate Partner Violence (IPV): A healthcare-based intervention program

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Degree Conferral Date 2024-05

Publication Date 10/08/2024

Defense Date 03/20/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag adverse health outcomes,curriculum,domestic violence prevention,Family violence,health disparities,healthcare,healthcare interventions,intimate partner homicide,intimate partner violence,IPV,OAI-PMH Harvest,partner abuse,physician education,trauma-informed care

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Advisor Dheensa, Sandi (committee chair), Smith-Maddox, Renee (committee chair), Swart, Elizabeth (committee chair)

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