The IRIS ADViSE Programme and commissioning prospectus will be officially launched on the 24th of March 2021, during a one-hour online webinar (please, register here if you would like to attend). The initiative supports sexual health staff to identify and respond to patients affected by domestic violence and abuse (DVA), helping to refer them on to specialist services, and has originated from a successful, evidence-based programme in general practice which responded to patients affected by domestic abuse, IRIS (Identification and Referral to Improve Safety).
Whilst the positive impact of IRIS was rapidly expanding, it was recognised that there were some diverse and harder to reach patient populations who may not come into contact with general practice or other primary care services. Sexual health services were seen as a potential avenue to bridge this gap and an adapted version of IRIS, IRIS ADViSE (Assessing for Domestic Violence and Abuse in Sexual Health Environments), developed.
If you work within sexual health services, here is everything you need to know about the IRIS ADViSE programme.
How ADViSE enables sexual health staff to improve assessment for Domestic Violence and Abuse?
ADViSE has been co-developed with clinicians, commissioners, IRISi, DVA agency staff and DVA survivors. The initiative supports staff teams to recognise and respond to patients affected by domestic violence and abuse (DVA), and to offer them a direct referral into specialist services via a simple, local care pathway. Each local team includes an Advocate Educator (AE) and a Sexual Health Clinical Lead (CL.).
The AE is a named specialist based in a local DVA advocacy service who runs training for the team and is the point of contact for referrals for patients who would like support and advocacy around DVA. The CL is a local, sexual health practitioner who is committed to improving the staff response around DVA which improves the response for patients affected.
What are the results of the ADViSE pilot on Domestic Violence and Abuse and sexual health services?
ADViSE was piloted at two sites. In Tower Hamlets over seven weeks there was a 10% DVA enquiry rate, a 4% disclosure and eight patient referrals were made. In Bristol over 12 weeks there was a 61% enquiry rate, 7% DVA disclosure and eight patient referrals. In the three months prior to the pilot, there were no DVA referrals at either site.
The networks formed during the pilot and increase in referrals have continued since the pilot in Bristol despite the end of dedicated funds and support. For all genders, 12 months post the ADViSE training, the clinic reported a 55.9% DVA enquiry rate, a 3.9% disclosure rate and a 4.2% referral rate, equating to 28 direct referrals for patients.
ADViSE increases DVA enquiry, response and referral, and staff confidence regarding DVA. It strengthens local networks between sexual health services and the DVA and can increase safety for those patients affected by DVA.
Why sexual health staff should be trained to recognise and address Domestic Violence and Abuse?
Domestic Violence and Abuse (DVA) is a severe breach of human rights with profound health consequences, particularly for women who, compared with men, experience more sexual violence, more severe physical violence, and more coercive control from their partners.
DVA has a devastating effect on health and the individuals it affects. It has far-reaching consequences for families, children, communities, and society as a whole.
The best estimates suggest that in the UK just over 26% of heterosexual women, 32% of gay/lesbian women, 45% of bisexual women, 27% of gay men, 14% of heterosexual men and 80% of transgender people will experience domestic violence and abuse at some point in their lifetimes (ONS, 2018).
In total, 47% of women attending sexual health services will have experienced DVA at some point in their lives. Alongside gynaecological problems, sexual health is the most prevalent and persistent physical health consequence of Domestic Violence and Abuse (DVA). DVA is also associated with increased sexually transmitted infections, including HIV, and unintended pregnancy.
Why locate Domestic Violence and Abuse interventions in sexual health services?
Sexual health services can be the first point of contact for people affected by DVA and therefore sexual health practitioners can have a key role to play in supporting those who have experienced DVA to access advocacy services. However, most sexual health professionals have had minimal training in identifying and responding to DVA.
Sexual health clinicians are already trusted by their patients with highly confidential, potentially stigmatising information and are particularly adept at working in diverse populations and with vulnerable groups, who may not access other health care services. Sexual health services are therefore in a strong position to support early recognition of undisclosed or unidentified DVA and offer an appropriate response. This can improve and save lives. The anonymity offered by sexual health services can support those affected by DVA who do not want to disclose to services where they are known.
What NICE and BASHH have to say about Domestic Violence and Abuse and sexual health services?
NICE identifies sexual health services as a setting in which service users should be asked about DVA. The British Association for Sexual Health and HIV (BASHH) guidance similarly recommends DVA enquiry but acknowledges that this is not without its challenges. Sexual health clinicians receive little training in DVA and may be unconfident about asking, uncertain about responding to DVA disclosure and lack knowledge about management and referral.
The NICE standards around DVA state that clinicians should:
- Know how to ask about DVA.
- Know how to respond to disclosures.
- Refer survivors to specialist support services.
- Refer perpetrators to specialist support services.
IRIS ADViSE meets all of the above in one streamlined, evidence-based package.
ADViSE does not replace existing services. It is established within the local service provision and so enhances and supports existing practice. The ADViSE programme is hosted and delivered by a local third sector DVA organisation (an ‘IRIS Partner’) who employs and line manages the AE, thus strengthening and supporting existing relationships and referral pathways.
The IRIS ADViSE programme launch: assessing for domestic violence and abuse in sexual health services
IRISi invites you to the official launch of “The IRIS ADViSE Programme” on the 24th of March 2021, during a one-hour online webinar, from 10 to 11 am. Speakers include:
- Dr. Jeremy Horwood, from the University of Bristol and co-lead of the Behavioural and Qualitative Science Team for National Institute for Health Research Collaborations for Leadership in Applied Research Collaboration West (NIHR ARC West), who led the evaluation of IRIS ADViSE.
- Dr Judith Berry, Consultant in sexual health at Unity Sexual Health.
- And Medina Johnson, Chief Executive at IRISi.
Jeremy Horwood, Associate Professor of Social Sciences and Health at University of Bristol and NIHR ARC West, said: “Sexual health problems are common for people experiencing domestic violence and abuse. Sexual healthcare staff can have a key role in supporting patients’ access to advocacy services, but most staff have not had much training in identifying and responding to DVA. Our findings demonstrated that IRIS ADViSE can help sexual healthcare staff support patients experiencing DVA. We hope the ADViSE commissioning prospectus will help its wider roll out.”
Medina Johnson, Chief Executive at IRISi, said: “We invite all sexual health clinicians to take part in this event, where we will be presenting the methods and results of the IRIS ADViSE Programme. It will be a great opportunity to learn how to improve the identification and response to patients affected by domestic violence and abuse, and facilitate referral to specialist services.”