The IRIS Programme was first implemented in Sandwell in 2015. Two years later, the intervention was expanded to Walsall and then, in 2018, Dudley also came on board. More recently, in October 2022, IRIS was implemented in Wolverhampton, which means that it’s now running across the whole Black Country area with one main goal: to enable local General Practices to better identify and refer women being affected by Domestic Abuse to specialist support.
The launch is being celebrated not only by the IRISi team, the host organisation of the IRIS Programme, but also by the local healthcare professionals, who are happy to see the intervention expanding its reach, benefiting more and more people. Marie Kelly, Designated Nurse for Adult Safeguarding in Sandwell, said: “as it was previously commissioned in 3 of the 4 Black Country areas, we had developed professional relationships with regional and national leads within IRISi which aided discussions. Since IRIS was implemented in Sandwell, six years ago, and then rolled out across Walsall and Dudley, the ICB has seen tangible outcomes for survivors of domestic abuse accessing primary care services. There are 6 PCNs in Wolverhampton, which will be offered IRIS training and support.”
Sally Roberts, Chief Nursing Officer and safeguarding executive lead for NHS Black Country Integrated Care Board, said: “Home should be the safest place in the world, but sadly we know that for some people, whose lives are blighted by domestic abuse and violence, this is not the case. The NHS and our partners are committed to safeguarding the most vulnerable people in our community, and this means that we have a duty to identify domestic abuse risks and take the appropriate actions. IRIS is a high-quality, holistic package of training, support and referral pathways, which will provide local GPs with an essential tool to help them spot the signs of abuse and provide the right interventions at the right time – which could potentially save lives.”
In Wolverhampton, IRIS will be delivered in partnership with Black Country Women’s Aid, as it is in all other areas. Carol Kelly, Regional Domestic Abuse Operational Manager of this organisation, says that delivering IRIS has been a positive experience, “especially seeing that the IRIS Advocate Educator role has made a significant positive impact on the patients being supported. This is demonstrable from quantitative and qualitative data supplied on a regular basis to commissioners and the managing agent, and also from patient feedback records.”
IRIS offers a holistic and sustainable approach for women who are affected by Domestic Abuse
The IRIS Programme can be defined as a holistic intervention based on a two-step approach: firstly, it provides ongoing training and support to clinicians and admin staff, so they become better prepared to identify the signs of Domestic Abuse among patients; secondly, by embedding an Advocate Educator within the general practice setting, the intervention provides an essential direct referral to a named specialist.
For Carol Kelly, the AE role is integral for the success of IRIS, as it cements the link between awareness raising in Primary Care settings and the actual intervention needed for the empowerment of patient populations who have experienced domestic abuse and who need that support. “AE training helps GP staff to appreciate the impact of prolonged stress and/or experience of trauma on the body from living with domestic abuse – both current and historic. This also informs them of best practice methods of enabling patients to talk about their experience and also how they can respond effectively to a disclosure and ensure local effective support is made available.”
“AE support enhances the medical interventions which are taking place, or which are being awaited. Often the intervention of regular scheduled emotional support from the AE can retain stability for the patient who is on a lengthy waiting list for counseling and ’talking therapy’. The support of the AE reduces the need for GP appointments and prescriptions. The trauma-informed support of the AE can offer appropriate information, advice, and guidance which helps the patient understand the symptoms they are experiencing and reduce the need for GP appointment time. The local AE is the available expert to help all surgery staff develop their expertise and knowledge of DA.”, explains the Regional Domestic Abuse Operational Manager.
Latest reports confirmed that IRIS has already positively impacted the general practices across the Black Country area
A study produced by the University of Birmingham study between March 2019 and February 2021 has validated the effectiveness of IRIS in the West Midlands. The research “Evaluation of the Identification and Referral to Improve Safety (IRIS) Intervention in the West Midlands: A Focus on Health and Deprivation” revealed that women were overwhelmingly supportive of IRIS as an intervention and recognised its positive impacts on their health and those of their children.
Descriptive statistics indicated that the patients referred to IRIS had a variety of health conditions, like mental ill-health; suicidal ideation, self-harm, PTSD, Personality Disorder and also Gynecological conditions; and STI, among others. Considering mental health specifically, pre-IRIS, 57% of the sample had depression recorded, and 44% had anxiety recorded. These are consistent with rates recorded nationally, with 59.1% of women referred to IRIS experiencing mental ill health, mainly depression and/or anxiety. Insights from the evaluation also show that post-IRIS, depression and anxiety were recorded at 32% and 28%, respectively. The quantitative results of the study show similar positive impacts across a range of health conditions (including non-chronic ones) and these are all consistent with the qualitative findings.
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