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.
- 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.
- Ensure that in at least one consultation you can speak to the woman on her own.
- 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.
- The immediate response to disclosure needs to be non-judgemental and supportive.
- Don’t press for more details if the woman is reluctant to disclose them in the initial consultation. That can feel coercive.
- There has to be a simple, direct referral route to specialist DVA advocate. Clinicians cannot manage disclosure on their own.
- Data on disclosures and referrals must be collected, reviewed by your trust and fed back to frontline clinicians and managers.
- 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.