The health service plays an integral role in addressing the issue of and transforming responses to domestic violence and abuse (DVA). The IRIS (Identification and Referral to Improve Safety) programme is a training, referral and advocacy model to support clinicians to better support their patients affected by DVA and to increase the awareness of domestic violence and abuse within general practice. IRIS provides specialist DVA training to clinical professionals, alongside administration staff, within local general practices. Our training supports clinicians to recognise and respond to DVA, and the programme provides a direct and trusted source for advocacy for patients following disclosure. The IRIS programme is an evidence-based, effective and cost-effective intervention to improve the primary care response to DVA and is nationally recognised.
IRIS is cited by the Department of Health as the best practice for a primary care response to DVA (2010, 2011, 2017), and IRIS informed the NICE guidance and standards on DVA (2014 and 2016).
The programme is predominantly funded and commissioned by health. The IRISi team will work with local commissioners to successfully establish, implement and maintain the programme in your area. With IRISi’s support, a local DVA specialist service is selected to deliver the programme, and the local IRIS team is recruited. The team consists of an Advocate Educator (AE) and Clinical Lead, who is a local practicing clinician (usually a GP). The AE and Clinical Lead work in partnership to deliver the training and offer continued support to practices. The AE also provides specialist DVA support to the patients referred into the service. The IRIS team is supported by a local IRIS steering group, and IRISi’s Regional Managers provide ongoing expert advice and consultancy. The IRIS programme is a collaboration between health and the specialist third sector.
What are the results? In eight years IRIS programmes have received 14,000 referrals and fully trained an estimated 850 general practices in 36 localities nationwide. The result of IRIS programmes is not only better-informed practice, improved responses and support for patients experiencing DVA, but ultimately lives are changed and saved as a result of its successful implementation.
Pathfinder is a pilot project run by a consortium of five expert partners with the aim of establishing comprehensive health practice in relation to domestic abuse and wider issues related to Violence Against Women & Girls in acute hospital trusts, mental health trusts and community-based IRIS programmes in GP practices. The project will be evaluated by Cardiff University.
The five consortium members involved are IRISi, Standing Together Against Violence and Abuse, Imkaan, Safelives and AVA.
For more information on the Pathfinder project visit www.pathfindertoolkit.co.uk
Women affected by DVA are three times more likely to have gynaecological and sexual health problems. 47% of women attending sexual health services will have experienced DVA at some point in their lives and these services can be the first point of contact for support. Sexual health practitioners can have a key role in supporting women to access advocacy services but most haven’t had much training in identifying and responding to DVA.
ADViSE (Assessing for Domestic Violence and Abuse in Sexual Health Environments) adapts the IRIS programme for use in sexual health clinics to support sexual health staff to recognise the signs and symptoms of patients affected by DVA, ask them whether they are affected, give a validating response and to then offer and make referrals to specialist services in line with British Association for Sexual Health and HIV (BASSH) DVA guidance.
ADViSE has been piloted in sexual health clinics in Bristol and East London. The quantitative evaluation found that eight patients from each clinic were referred to specialist services. During the three months before the pilot, there were no referrals to DVA services at either site. The qualitative evaluation found that sexual health clinic staff felt that asking about and referring patients on to DVA services was appropriate and valuable. They responded favorably to the training and felt more confident about asking about DVA and managing disclosures.
We are now working to develop ADViSE as a programme that be commissioned in local areas just like IRIS.
Since 2016, we have been working with researchers at the University of Bristol, CLAHRC West (Collaboration for Leadership in Applied Health Research and Care), and Queen Mary University to explore whether there is potential to adapt the IRIS model for use in pharmacy settings. A systematic review conducted by our research partners confirmed an association between domestic violence and abuse (DVA) and use of emergency contraception (EC). Women with experience of DVA are 1.5 to 6.5 times more likely to request emergency contraception than non-abused women. In a study of UK electronic patient records, women with experience of DVA in the past year were twice as likely to have had at least one consultation for emergency contraception than other women. As UK pharmacists supply 50% of all EC, they may be ideally placed to implement an adapted IRIS.
Some work in pharmacies has already taken place. The IRIS teams in Islington and in Enfield, with some extra funding, provided standard IRIS training for community pharmacists in 2015. However, this training didn’t result in any referrals into the IRIS programme. To understand the reasons for no referrals and explore pharmacists’ views on identifying and responding to domestic violence, our research collaborators interviewed 20 pharmacists from Enfield and the South West. The interviews found that pharmacists were confident in providing public health services but lacked skills and confidence in identifying and responding to DVA. The pharmacists welcomed training on DVA, alongside organisation and system-level support, and public awareness raising on the role of community pharmacies in multisectoral response to DVA.
In 2018, two stakeholder consultations took place to examine whether an adapted version of IRIS is feasible and acceptable for pharmacies and to explore how the model could be adapted to make it more pertinent to pharmacies. A programme theory and a logic model for an IRIS model for pharmacy are being developed (this means identifying all the different elements of what the adapted model should look like in a pharmacy setting and how these fit together to result in the desired outcomes). An application for funding will be made by our research partners to finalise and test the proposed adapted version of IRIS for pharmacy.
IRIS+ is one work stream of the REPROVIDE research currently being undertaken by the Centre for Academic Primary Care at the University of Bristol. At present the IRIS model only has an evidence base for asking and supporting female victims, as we know DVA is a gender-based crime. IRIS+ aims to explore the viability of an adaptation of IRIS to work with both male and female victims, male and female perpetrators and children. IRISi acts as a consultant on this project, advising around the development of the training materials and the delivery of this to clinicians.
At present the project is in its second phase and is working with several surgeries across Bristol and Cardiff. These surgeries will receive an adapted version of the IRIS training and will be provided with referral routes for both male and female victims, perpetrators and a specialist support worker for children.
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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
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.
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.
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.
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.
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.
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.