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To celebrate International Nurses Day, we are taking a closer look at one of our biggest champions, Louise Knight. 

Louise is a nurse practitioner at the Kingskerswell and Ipplepen Medical Practice and is also the IRIS Clinical Lead for South Devon and Torbay.

IRIS is a specialist domestic violence and abuse (DVA) training, support and referral programme for general practices. It has been running in the South Devon and Torbay area for just under a year. It is a partnership between health and the specialist DVA sector, providing in-house, DVA training for general practice teams and support from a named advocate educator, a specialist DVA worker, to whom patients can be referred for support. The programme has been available to be commissioned in the UK since 2010. At the centre of the programme is the local clinical lead, in this case Louise. The clinical lead not only provides training, but also supports practices and advocate educators in identification and referral of patients affected by DVA . 

IRIS launched in Devon and Torbay July 2018 and the service is divided into three geographical clusters: South Devon and Torbay, Exeter and East Devon, and North Devon. Louise joining as clinical lead for South Devon and Torbay in autumn of the same year. In Devon and Torbay, for the first time, the IRIS Programme has been broadened to encompass sexual violence as well as domestic abuse. The training provided to general practice teams covers both sexual violence and domestic abuse, and patients affected by either form of violence and abuse can be referred for specialist support from the local advocate educators. As of end March 2019, 8 practices in South Devon and Torbay were fully trained and 52 referrals had been received by the advocate educator. 

I first heard about IRIS when saw the position for clinical lead for Torbay advertised in a local nurse bulletin” explains Louise. “I have always been passionate about womens health and welcomed the opportunity to try and improve the services offered in our area for patients who are experiencing or have experienced domestic violence and abuse or sexual violence”  

Louise found her own training not only hugely educational, but also inspiring and motivating.  

I really enjoyed the training” says Louise. “The signs that a patient is a victim of DVA are not always physical. The training showed us that there is a lot more to identification than what is presented physically by the patient. That then raises the question ‘is she experiencing domestic violence and abuse or sexual violence’? The training included periods ofroleplay which are vital in this setting. Roleplay allows you to develop the words and language that you feel easily able to use with a vulnerable patient within a ten minute consultation to get to the root of the matter. 

In South Devon and Torbay there are now 8 surgeries fully trained in the IRIS programme. There are a further 7 surgeries that are part trained, with more being trained this year. This equates to access to specialist SV and DVA service support for nearly 145,000 patients.  

But there is still work to do. With 112 GPs and clinicians now trained in the area, as well as 94 ancillary and reception staff, referrals have gone up to 74 since January 2019 and continue to rise.  

For me the post positive experience has been the responses from the clinicians that I have trained” says Louise.  

Many GPs feel like they don’t have the time to take on the training in practice, the reality being that with specialist trained staff, return visits to surgeries are actually less frequent, freeing up the staff to see more patients.  

Louise explains “I was asked to speak about IRIS to a local group of GPs, to try and persuade them to get on board with the programme. It was a lively discussion and I faced some difficult questions. But the response afterwards was amazing.” 

“The lead GP, and organiser of the event said that in all the years he has been organising, they have never had a speaker prompt so much discussion and debate. I also had a GP tell me that until that point, he had advised his surgery they did not need to take on the IRIS programme but had now 100% changed his mind”  

“When we know better, we do better, and raising awareness of the scale of the problem of DVA and SV is so important.” 

Specialist DVA service providers rarely receive referrals from primary care, and historically, general practice has been absent from community domestic violence partnerships. Women report wanting health services and professionals to have a duty to identify and respond to violence against women and girls, but healthcare professionals are largely unaware of appropriate interventions and have not received effective training.  

Some of the IRIS training sessions provide ‘lightbulb’ moments, for even the most experienced GPs. “I had an email the day after training from a GP who had asked the question to a long- term patient who had fibromyalgia” says Louise “The patient had disclosed she was a DVA victim and he was then able to signpost her to support. These conversations are now taking place all over the country, raising awareness and changing lives for so many women.” 

Feedback from the practice supports this, with one patient reporting I have seen that there were agencies that could support people with abuse, but I would never have called or seen anyone if it wasn’t for my GP referring me to see someone in my surgery, what a difference this has made to my life & future” 

The IRIS programme relies on solid teams of clinical leads, advocate educators and third sector, specialist DVA agencies to be able to make a difference. It is nurses like Louise who champion our cause and are passionate and committed to recognising gender-based violence as a health issue that we applaud on International Nurses Day. Their continued enthusiasm and passion will mean that more women and children are given the opportunity to live happier, safer lives.  

We all have a role to play in educating our society, both as individuals and clinical professionals” says Louise “We need more advocate educators to help with referrals and more training across the board”  

Medina Johnson is CEO of IRISi, a social enterprise established to promote and support the health care response to gender based violence.  She was one of the two original IRIS advocate educators and IRISi now supports sites delivering the IRIS programme and encourages new sites to sign up to and fund the programme. 

“We know that our nurse colleagues in primary care are pivotal to the change in practice we need to see to ensure better support in primary care for patients affected by DVA.  It is great to hear the positive feedback from both clinicians and patients in the Devon and Torbay area.  The response to DVA is everyone’s responsibility and our nurse colleagues are great advocates.” 

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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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