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IRISi is a social enterprise committed to improving the healthcare response to gender-based violence through health and specialist services working together. In 2021, IRISi’s “16 Days of Activism against Gender-Based Violence” campaign is themed as “16 ways for the 16 days of action: how health care settings can improve their response to Violence Against Women and Girls”. Our aim is to reinforce that health care professionals have an undeniable and fundamental role in identifying victims and perpetrators so we can end violence against women and girls.

In order to do this, healthcare interventions such as the IRIS and ADViSE programmes, which were developed by IRISi to enable these professionals to recognise Domestic Violence and Abuse, can make a big and lasting difference. The positive outcomes in terms of referral and identification levels, as well as the cost-effectiveness of these interventions, have already been confirmed by several evaluations led locally and nationally.

To finish our campaign, we invited our board members to talk about the relevance of these interventions and to consider the following questions: “How have interventions like IRIS and ADViSE become paramount to improve the health care response to Domestic Violence and Abuse?”. These are the answers of those who responded and joined our campaign!

“There are generic lessons I have learned in the context of primary care about how clinicians can respond to patients experiencing abuse which may be relevant to my colleagues.

  1. Training in asking about DVA and responding to patients disclosing abuse must be integrated with safeguarding training. Otherwise we potentially do more harm than good.
  2. Ensure that in at least one consultation you can speak to the woman on her own.
  3. Ask about abuse as if you want to know the answer. If asked in a long list of screening questions, women are unlikely to disclose.
  4. The immediate response to disclosure needs to be non-judgemental and supportive.
  5. Don’t press for more details if the woman is reluctant to disclose them in the initial consultation. That can feel coercive.
  6. There has to be a simple, direct referral route to specialist DVA advocate. Clinicians cannot manage disclosure on their own.
  7. Data on disclosures and referrals must be collected, reviewed by your trust and fed back to frontline clinicians and managers.
  8. Your trust must have a policy on supporting clinicians and other staff who are experiencing domestic abuse.”

Gene Feder MD FRCGP OBE. Professor of Primary Health Care at the Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol. Gene was the principal investigator on the original IRIS trial and has been closely involved with the development of the programme and IRISi ever since.


“A spotlight has been shone on the damaging impacts of gender-based violence on people directly experiencing this and also children witnessing this. The impacts can be long-lasting and have wider impacts on the life outcomes of women and children. Interventions like IRIS increase the likelihood of women experiencing domestic violence and abuse to be identified and given the right support through their GPs. This relationship may be one of very few where there is a private moment away from the abuser and with someone who may be a trusted figure in the woman’s life. Research has shown the effectiveness of IRIS and the importance of a health care response to domestic violence and abuse. Partnerships between health and social care are incredibly important for tackling gender-based domestic violence and abuse.”

Daphne Amevenu has previous experience of working with IRISi and the IRIS Programme, since she used to work at the Health Foundation who supported the development of our social franchise programme of work.


“I spent 32 years working as a GP in central Cardiff. I was for many years the Safeguarding lead at my practice. Despite this I had a very poor understanding of the true prevalence of domestic abuse and its potentially profound effects on my patient’s health.

South Wales, unfortunately, has some of the highest recorded incidents of DVA in the UK. South Wales police receive a call every 15 minutes about an episode of abuse, approximately 96 calls every day of the year. Despite this prevalence, very few referrals for support were being received by local services from primary care. Between 2011 and 2014 local support services in Cardiff received only 7 referrals from GP teams.

In 2014 a steering group lead by the PCC and involving local service providers and health representatives agreed to set up a pilot project covering 25 practices in Cardiff and Vale. Funding was provided by the PCC. I am delighted to report I was recruited in September 2014 as the Clinical lead for this pilot.

Training started in spring 2015. By the end of our first year, we had received 127 referrals and by the end of year 2 we had received 265. These referrals produced a very high level of engagement with specialist support services. By October 2019 we had received 806 referrals from Cardiff and Vale practices and 627 from Cwm Taf practices. 12% of our referrals have been for survivors over 60. We have even received a referral for one woman aged 89. 79% of patients referred had known mental health issues and 60% had children in the home. Unexpectedly we had high numbers of cases from our most affluent areas and over 60% of cases were first time disclosures.

There are three key lessons that I would highlight. Firstly, try to find out locally who are the key people who will assist you, but also watch out for those who will block you. It is not always the people you would expect.

Secondly, the success of the scheme is based on the relationships forged with practices. This role relies on having highly motivated AEs, in this I have been blessed.

Finally, in my view IRIS is a rare example within the health sector of intelligent kindness in action. It provides practices with both the skills and support to transform the response to this vital health issue. It allows patients to disclose abuse and receive prompt specialist input.”

Jacqueline Gantley, a recently retired GP who worked in central Cardiff for over 30 years.

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The IRIS Programme provides specialist advocacy and support to patients registered at IRIS-trained practices who have experienced domestic abuse.

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Partners

AVA
AVA
AVA

AVA is an expert, groundbreaking and independent charity working across the UK.

Their vision is a world without gender based violence and abuse. They aim to  inspire innovation and collaboration and encourage and enable direct service providers to help end gender based violence and abuse particularly against women and girls.AVA’s work is focused around those areas where they can make the best contribution to ending violence and abuse. They do this by making sure that survivors get the help and support they need in the here and now, through providing innovative training that has a proven direct impact on the professional practice of people supporting survivors of violence and abuse

developing a range of toolkits, e-learning and other material that supports professionals to provide effective and appropriate support to survivors of violence and abuse

using our influence and networks to ensure survivors voices are heard. We work closely with AVA in many areas including the Pathfinder project

https://avaproject.org.uk

SafeLives
SafeLives
SafeLives

SafeLives are a national charity dedicated to ending domestic abuse, for good. We combine insight from services, survivors and statistics to support people to become safe, well and rebuild their lives. Since 2005, SafeLives has worked with organisations across the country to transform the response to domestic abuse, with over 60,000 victims at highest risk of murder or serious harm now receiving co-ordinated support annually. SafeLives are members of the Pathfinder consortium.

http://www.safelives.org.uk/about-us

IMKAAN
IMKAAN
IMKAAN

Imkaan is a UK-based, Black feminist organisation. We are the only national second-tier women’s organisation dedicated to addressing violence against Black and minoritised women and girls i.e. women and girls which are defined in policy terms as Black and ‘Minority Ethnic’ (BME). The organisation holds nearly two decades of experience of working around issues such as domestic violence, forced marriage and ‘honour-based’ violence.

They work at local, national and international level, and in partnership with a range of organisations, to improve policy and practice responses to Black and minoritised women and girls. Imkaan works with it’s members to represent the expertise and perspectives of frontline, specialist and dedicated Black and minoritised women’s organisations that work to prevent and respond to violence against women and girls. Imkaan delivers a unique package of support which includes: quality assurance; accredited training and peer education; sustainability support to frontline Black and minoritised organisations; and facilitation of space for community engagement and development. They are a part of the Pathfinder Consortium.

https://www.imkaan.org.uk

The University of Bristol CAPC
The University of Bristol CAPC
The University of Bristol CAPC

The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research.  It is part of Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

A dedicated team of researchers at the Centre work on domestic abuse projects and IRISi is a co-collaborator and partner on some of these projects including ReProvide, HERA and DRiDVA.

The Health Foundation
The Health Foundation
The Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The Health Foundation’s Exploring Social Franchising programme aims to generate a deeper understanding of the potential of social franchising models for scaling effective health and social care interventions within the NHS.

We are one of four project teams participating in the programme to develop a social franchise to enable the sustainable spread of our intervention, the IRIS Programme. We receive funding and support from the Health Foundation, including technical expertise on social franchising, and attend programme learning events. The Health Foundation has also commissioned a programme-wide evaluation to support understanding of the use of social franchising in the UK health and care system. We and our franchisees will support the evaluation through co-designing data collection requirements, providing access to data as requested, hosting site visits and attending learning events.

https://www.health.org.uk

STADV
STADV
STADV

Standing Together Against Domestic Violence is a UK charity bringing communities together to end domestic abuse. They bring local services together to keep people safe

Most public services weren’t designed with domestic abuse in mind, and they often struggle to keep people safe. Poor communication and gaps between services put survivors at risk.

STADV aim to end domestic abuse by changing the way that local services respond to it. They do this through an approach that they pioneered, called the Coordinated Community Response. The Coordinated Community Response brings services together to ensure local systems truly keep survivors safe, hold abusers to account, and prevent domestic abuse.

Their model of a coordinated local partnership to tackle and ultimately prevent domestic violence is now widely accepted as best practice. They are also a part of the Pathfinder consortium.

http://www.standingtogether.org.uk

Spring Impact
Spring Impact
Spring Impact

Spring Impact is a not-for-profit social enterprise born out of the frustration of seeing social organisations constantly reinventing the wheel and wasting scarce resources. Spring Impact uses a combination of tested commercial and social principles and extensive practical expertise to support organisations to identify, design and implement the right social replication model to scale their social impact.

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