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“The pressure on general practice to be alert for signs of domestic abuse in patients has never been greater”. IRISi interviewed leading researchers and key specialists to talk about the impact of the pandemic on Domestic Violence and Abuse in the UK – and here are 3 responses to our Look Beyond campaign questions from Dr. Eszter Szilassy, Research Fellow at the Centre for Academic Primary Care (University of Bristol).


As we continue with our “Look Beyond the Pandemic” campaign, IRISi interviewed leading researchers and key specialists to talk about the impact of the pandemic on Domestic Violence and Abuse in the UK. Here is what Dr. Eszter Szilassy, Research Fellow at the Centre for Academic Primary Care, Bristol Medical School at the University of Bristol, and a member of the Domestic Violence and Health Research Group, told us.

Dr. Eszter Szilassy, Research Fellow at the Centre for Academic Primary Care (University of Bristol)
Dr. Eszter Szilassy, Research Fellow at the Centre for Academic Primary Care (University of Bristol)

1) How did the pandemic change the health care response to domestic violence and abuse? What were the main difficulties that clinicians had to face once the lockdown was put in place?

The pandemic is having a detrimental impact on the health and wellbeing of people affected by domestic violence and abuse. As usual routes to support and safety are shut down or limited, general practices play a vital role in responding to patients and families at risk and to suspected cases or self-disclosure.

The pressure on general practice to be alert for signs of domestic abuse in patients has never been greater, and the potential consequences for unsafe or no response never more stark. Yet a drop in consultations during the pandemic has reduced the opportunity for detection. Domestic violence and abuse also remained easily hidden by the many varied presentations around general anxiety linked to the pandemic.

A consultation in a safe space is the key for disclosure of abuse of violence. Yet there has been a shift from face-to-face to phone and video consultations, making it more difficult and potentially dangerous for clinicians to ask about abuse and patients to disclose. In the context of an already heavy general practice workload, the requirement for additional skills and competencies for the management of telemedicine have also emerged.

2) How has the new guidance provided by Royal College of General Practitioners (RCGP) and IRISi has benefited primary care clinicians – and why is that important?

The necessary transition to remote clinical consultations has uncovered a knowledge gap about how GPs can safely ask about abuse, respond appropriately and provide ongoing support. RCGP and IRISi were quick to develop step-by-step guidance for clinicians, raising awareness about the heightened risks and providing advice on overcoming barriers to identification and referral to specialist services. They also recommended that surgeries display information on their patient-facing websites about GP and specialist support available for survivors. These quick interventions, together with the roll-out of COVID-19 GP webinars, helped survivors connect safely with specialist support from very early on in the pandemic.

3) What has the pandemic taught us about the primary care response to DVA? Are there any new insights that have emerged due to the pandemic?

Although early feedback from clinicians indicates that GPs were quick to respond to the new challenges, there is uncertainty about how they adapted their engagement more generally with patients affected by domestic abuse. We also want to understand more about the extent to which clinicians were able to implement national guidance and online training on safe remote consultations. PRECODE, our new study on the GP response to domestic violence and abuse during the pandemic, is exploring the impact of COVID-19 on domestic abuse referrals and patient support. Using practice-level referral data, online clinician training observations and interviews with GPs, practice managers and IRIS Advocate Educators, we are assessing the utility, feasibility and safety of GP responses to violence and abuse during the pandemic and its aftermath. Our findings, we believe, will remain relevant even in more ordinary times as GPs will, no doubt, continue to use remote consultations beyond national lockdowns.

Finally, it is important to add that whilst we are keen to understand the scale and impact of violence and abuse during the pandemic, researchers have been also reminded of the possibility of harm caused by scientific inquiry. The World Health Organization, for example, specifically warned researchers worldwide against measuring abuse in large population-based surveys during the lockdown due to heightened risks to research participants. Others raised awareness about the hidden impact of researching sensitive subjects on researchers during the lockdown and beyond. These recommendations contributed to a more nuanced understanding of the mechanisms and complex impact of domestic abuse and health research. They also led to more innovative research capturing the experiences of survivors, perpetrators, and their children. COVID-19 findings emerging from these studies during the next few months will inform national policy on the general practice response to domestic violence and abuse in the post-pandemic world.  

Dr Eszter Szilassy is a Research Fellow at the Centre for Academic Primary Care, Bristol Medical School at the University of Bristol, and a member of the Domestic Violence and Health Research Group. Her research is focused on the primary health care response to domestic violence and abuse.

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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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