IRIS+ Programme: amplifying the healthcare response to Domestic Abuse; £2.2M for clinical trial to improve general practice response to men and children affected by domestic abuse

IRISi is pleased to share the findings of our collaborative research with the University of Bristol, evaluating the IRIS+ domestic abuse programme. The recently published study, available for full reading here, has shown promising feasibility and potential cost-effectiveness. This may mark a significant advancement in addressing the broader spectrum of domestic violence and abuse (DVA) affecting men, children and young people through primary care.

IRIS+ builds upon the successful IRIS (Identification and Referral to Improve Safety) model, renowned for its effectiveness in identifying and supporting women affected by domestic abuse. Recognising a gap in the identification and referral processes for men, children, and young people, researchers from Bristol’s Centre for Academic Primary Care, in collaboration with IRISi and DVA agencies, have developed and rigorously tested the IRIS+ intervention to address this crucial need.

Outlined below are key findings from the recently published study:

The study, funded by the National Institute for Health and Care Research, showcased the successful identification and direct referral of 44 children and young people (15% of total 300 referrals), 29 men (mostly survivors, 10% of total referrals) and 227 women (75% of total referrals).
The referral rate for women doubled from the rate in the original IRIS trial (21.6 referrals/year/IRIS+ practice, compared to 9.29 referrals/year/IRIS practice), indicating that the added intervention components on men and children heightened clinicians’ alertness for DVA without weakening responses to women.
Over two-thirds of referred women and children and young people, and almost half of all referred men, received direct support from the service. The study demonstrated health and quality of life benefits for men and children supported by IRIS+.

An economic model suggested that IRIS+ is likely to be cost-effective or even cost-saving from a societal perspective.

Research Methodology

Researchers employed mixed methods to assess the feasibility of the intervention in two urban areas in England and Wales, encompassing a mixture of IRIS-trained and non-IRIS-trained general practices. This included before-and-after intervention questionnaires, data extraction from medical records and DVA agencies, and semi-structured interviews with clinicians and patients.

Dr Eszter Szilassy, Senior Research Fellow at the Centre for Academic Primary Care and study lead, emphasised, “Domestic abuse affects nine million adults in England and Wales, with societal costs exceeding £66 billion annually. Our findings show that primary care is well-placed to provide a pathway for specialist support to all patients affected by DVA. The next step involves exploring the effectiveness and cost-effectiveness of IRIS+ on a larger scale.”

Medina Johnson, CEO at IRISi, added, “Domestic violence and abuse is a gendered issue but recognising the significance of responding comprehensively to all those impacted – be they victims/survivors or perpetrators – we acknowledge the crucial role of our health system in providing support. By expanding and improving programmes and responses within healthcare to encompass men and children, we strive to aid everyone affected, contributing to the collective effort for a safer society for all.”

The IRIS+ Study was part of the REPROVIDE (Reaching Everyone Programme of Research On Violence in diverse Domestic Environments) programme, an independent research initiative funded by the National Institute for Health and Care Research.

New clinical trial of IRIS+ to start in May 2024

Following the publication of the feasibility study results, the clinical trial of IRIS+ was announced to begin in May 2024 thanks to a £2.2 million National Institute for Health and Care Research (NIHR) award to University of Bristol researchers, in partnership with Oxford University and IRISi.

According to Dr Eszter Szilassy, “Domestic violence and abuse present a significant public health challenge, affecting nine million adults in England and Wales. The IRIS programme has already proven effective in enhancing general practice responses to DVA among women. However, uncertainty persists regarding interventions for men and children. IRIS+ steps in to fill this gap, providing GP training, care pathways and specialist domestic abuse advocacy support for all family members experiencing or perpetrating DVA. If effective and cost-effective, IRIS+ could significantly improve the safety, well-being, and health of DVA survivors and their children. Future implementation of a successful intervention could create large downstream economic benefits for the NHS and society.”

For Medina Johnson, “In a landscape in which public funding is increasingly limited and decision-makers prioritise evidence-based outcomes, we are excited to be involved in this new clinical trial. By acknowledging and addressing the diverse needs of all individuals impacted by DVA, we underscore our dedication to equity and equality in healthcare provision and, above all, to increasing early identification to prevent the escalation of abuse.”

The study, a cluster-randomised controlled trial, will begin in May 2024 and run until the end of 2027. It will compare outcomes in IRIS+ practices with outcomes in IRIS practices over the study period.

Watch the space to find out more about IRIS+.

Partners

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 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 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 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 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

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 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.