IRISi celebrates the success and expansion of the ADViSE Programme in sexual clinics across Greater Manchester

A special event took place in May 2023 to celebrate the success of ADViSE in Greater Manchester, the first area to ever implement the programme for victims and survivors of Domestic & Sexual Violence and Abuse (D&SVA) accessing sexual health clinics. Since its launch in 2021, the intervention developed by IRISi has made a great impact by providing comprehensive training and establishing an enhanced referral pathway for healthcare professionals and administrative staff working in these settings, enabling them to better identify and respond to the signs of D&SVA during consultations. The event brought together stakeholders and partners directly involved with the great results achieved during the first year with survivors who shared their experiences of the initiative.

“We were honoured to have survivors joining us at the event. Some shared their thoughts remotely, while others attended in person to express how ADViSE has positively impacted their lives. The overwhelming message from survivors, Advocate Educators (AEs), and clinicians was that ADViSE is invaluable, and we must work together to ensure its continuation”, said Charlotte Chappell, ADViSE Lead and Senior Regional Manager.

ADViSE has been running in Manchester, Stockport, Tameside and Trafford in partnership with Manchester Women’s Aid, Stockport Without Abuse, Trafford Domestic Abuse Services (TDAS), JIGSAW Support, and Locala. The Greater Manchester Health and Social Care Partnership has provided funding for sexual health clinics operating across these areas, which are all covered by The Northern Contraception, Sexual Health & HIV Service at Manchester Royal Infirmary (MRI), a part of the Manchester University NHS Foundation Trust (MFT). Recently, the commissioning team announced the extension of the programme for another year.

Present at the event, Kate Green, Deputy Mayor of Greater Manchester for policing, crime, criminal justice and fire said: “We know that victims and survivors of domestic abuse are most likely to disclose information to a health professional, but many staff will not have had the training to identify and respond appropriately. I’m proud that Greater Manchester is once again leading the way and supporting innovative ways to tackle gender-based violence. The results of the pilot have been really impressive. I hope to see the programme roll out to help people across all of our city-region.”

Debs Thompson, spokesperson for the NHS Greater Manchester-funded pilot, said: “The ADViSE pilot demonstrates the impact of embedding a ‘no wrong door approach’ in order to reach diverse populations and vulnerable groups. It confirms that sexual health services can play a key role in the recognition of previously undisclosed or unidentified domestic and sexual violence and abuse. They can help support survivors who may not otherwise disclose their experiences and access much-needed support. This includes patients with multiple and complex needs including long histories of abuse (…), as well as those impacted by inequalities”.

“Violence can occur in all relationships, across all genders and sexualities. Sexual health clinics are safe places for LGBTQ+ people, who may not feel comfortable attending their GP or non-specialist health settings. The past year in ADViSE has enabled us to work with a range of clients and offered varied support to individuals who previously may not have accessed support for domestic abuse and sexual violence, showing a potential gap in service. It has been a privilege to be a part of the partnership between IRISi, the 4 DA partners and the sexual health service; an effective example of how collaborative work can lead to the best outcomes for people using the service. I think the work and feedback so far shows how essential it is that we are recognising domestic abuse and sexual violence as a health issue and using effective referral pathways across Greater Manchester”, says Malaika Baldwin, ADViSE Coordinator and Advocate Educator at Trafford Domestic Abuse Services.

Evaluation reinforces the good outcomes of ADViSE during its first year in Greater Manchester

DMSS Research was commissioned to conduct a qualitative ‘snapshot’ to evaluate the ADViSE Programme’s progress and outcomes. Presented during the event, the final report was based on information collected during the pilot’s first year of delivery, including case studies produced by and interviews with AEs, clinical leads, staff in sexual health clinics, and monitoring and progress information provided to the pilot’s steering group. The evaluation aimed to gather independent data to complement the pilot’s internal monitoring, providing a comprehensive understanding of the programme’s effectiveness.

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Among other things, the sexual health clinic staff interviewed during the evaluation expressed positive feedback about their experience with the AEs and the referral process. They highlighted the significant improvement compared to previous options for seeking advice or support. The ease, speed, and flexibility of the ADViSE response to referrals were also commended. Moreover, clinic staff valued the presence of AEs as part of their team, benefiting from their expertise and the ability to consult and receive guidance.

In terms of the future of the intervention, the interviewees expressed strong support for the continuation of ADViSE beyond the pilot phase, emphasising its integral and valued role within sexual health services in Greater Manchester. Concerns were raised about the potential vulnerability of individuals without access to ADViSE’s direct support and high-quality referrals, highlighting the importance of maintaining the service for meaningful routine enquiry about violence and abuse.

Here are some quotes from the sexual health clinic staff:

“I’m much more vigilant now. I listen for cues and I’m more aware of the impact of historical abuse. For example, I referred a young woman who had been sexually assaulted in her teens. Before the training I’d never have done that”.

“I’ve had a couple of disclosures from gay men who’ve been surprised to be asked but were pleased to have it acknowledged even though they didn’t want a referral.”

“The fact we can refer across such a range of issues: rape and DV but also grooming. And men as well as women. Previously I’d have suggested Rape Crisis or the SARC and said ‘take a photo of this number’. Having ADViSE is completely different: you are saying I can refer you to [AE], she works here, she really knows her stuff on this. It’s a person not a helpline and you feel so much more confident about encouraging someone.”

“It’s excellent. From my knowledge of cases I’ve been involved with the referrals have been picked up really quicky and responded to very flexibly.“

“If ADVISE did disappear it would leave a big hole. I’d be devastated to lose it.”

Patient feedback and case studies show that ADViSE is providing the needed support

Direct feedback from patients indicated that they felt welcomed, supported, and provided with a better overall service through ADViSE referrals. The impact of the service was evident in various cases, such as facilitating access to legal advice, housing support, and coordinating multiple agencies’ involvement to ensure comprehensive assistance for vulnerable individuals. The timely support and immediate availability of AEs in the clinic setting were also highlighted as valuable aspects of the service. Here are some quotes from ADViSE service users:

“I feel very fortunate to have had access to the service for many reasons. Although it doesn’t fix you, it aids you, supports and encourages you to heal. I am very lucky and can only speak for my Advocate Educator who has been incredible. I have accessed services I didn’t know existed. I have received personal support through the worst times. I have felt safe, encourages and able to speak freely with no judgement.”

‘It has been nice to have someone I can speak to who I have been able to trust, someone who has been able to tell me that it has not been my fault and I’m not going mad, but it was my ex’s behaviour that was wrong and was making me feel that way. I’m now better able to understand how much he controlled and abused me.’

‘I’ve been able to come and talk about things when sat on my own I don’t know where to start. I just want to say thank you and listening to you has helped me gets things off my mind. Everything’s been fantastic. You’ve arranged so many things and I’m meeting new people.’

‘I’m glad of the support that I’ve has through this difficult time. Without the help, I would no longer be here, as I would have gone to sleep and never woke up again.”

ADViSE in Greater Manchester: figures and demographics of the first year.

Number of referrals

• Manchester: 107
• Tameside: 40
• Trafford: 37
• Stockport: 33
• Total: 217

As ADViSE has become more embedded, referrals have steadily increased, as shown below:

• Quarter 1 (Jan-Mar 2022): 10
• Quarter 2 (Apr-Jun 2020): 46
• Quarter 3 (Jul- Sept 2022): 89
• Quarter 4 (Oct – Dec 2022): 72

Ethnicity

These figures show that 28.6% (over 1 in 4) referrals were of people from minoritised ethnic groups.

Gender

The following table shows the self-identified gender of people referred (in 4 cases the male or female gender assigned at birth differed from the current self-identified gender). 71% of the 217 referrals were for females and 16.1% for males.

Sexuality

Just over half of those referred described themselves as heterosexual. 22.6% described themselves as either gay, bisexual or pansexual, which supports the argument that ADViSE is reaching populations not commonly reached by other services.