The IRIS in 7 boroughs Programme officially ended in June 2022 and this was marked at an in-person event that took place at the Royal College of General Practitioners. Developed by IRISi and delivered in partnership with third-sector specialist providers, the IRIS Programme was funded by the Violence Reduction Unit (VRU) from 2019, providing specialist domestic violence and abuse (DVA) training, support and a referral programme for General Practices in 7 boroughs in the capital.
Using IRISi’s expertise, the VRU commissioned the organisation to deliver a 12-month programme divided into 2 phases. The first three sites – Tower Hamlets, Croydon, and Barking and Dagenham – launched the week before the first lockdown at the start of the Covid-19 pandemic, which brought up several challenges, especially because the programme had to be immediately adapted from face-to-face delivery to online training, advocacy and support. For the same reason, the remaining four sites – Brent, Ealing, Westminster, and Hammersmith and Fulham – went into hibernation until they could be launched in October 2020, with recruitment and training of the trainers being completed in the following month.
IRIS programme delivery is rooted in partnership work and the 7B project was no different, being run in collaboration with local, specialist DA organisations. Asian’s Women Resource Centre, Advance, Bromley and Croydon Women’s Aid, FJC , nia and Solace Women’s Aid were the IRISi partners throughout the project. Together, their teams trained 183 general practices and received a total of 838 referrals from clinicians.
Of the 838 women referred to the 7B programme by the end of March 2022, 691 (82%) had received support from an AE. There were 95 cases referred to the local MARAC, 20 to adult social care and 69 to children’s social care.
Once again, data reinforces the effectiveness of the IRIS model
To present the results obtained by the IRIS in the 7B Programme, IRISi ran an event on the 21st of June 2022, attended by many professionals directly involved with the project – including colleagues from the partner organisations, clinical leads, and the Director of the VRU, Lib Peck.
The CEO of IRISi, Medina Johnson, started the event by briefly presenting the project and its achievements. “Towards the end or after the end of support provided by the IRIS Programme, we ask the patients to complete a questionnaire. All the self-reported outcomes from the 7B project are fantastic, but there is one that needs to be highlighted: 73% of the service users said they visited the GP/nurse less because of the support they received from the AE. This data speaks for itself: IRIS really can and does impact positively on both the patients supported and staff in the health care setting”.
An independent evaluation of the IRIS 7 Boroughs project was carried out by Di McNeish and Sara Scott, from DMSS Research. As described in their final report (click here to read it in full), “DMSS Research was commissioned by IRISi as evaluation and learning partner to the 7B programme. This work has had two purposes: a) to assess the effectiveness of the implementation of IRIS across the 7B programme and b) to feedback lessons as it has progressed and encouraged the sharing of learning across the programme”.
Also invited to speak during the event, Di and Sara explained their methodology and presented their main findings. “Interviewees told us that the training had succeeded in increasing their awareness of the issue of domestic abuse; made them feel confident and comfortable talking to patients about abuse or about ‘asking the question’ and about what to do once the can of worms had been opened. It had also raised their consciousness about lower-level risk and how this could escalate; about the barriers to disclosure that might be experienced by particular groups such as disabled, older, Black, Asian or traveller women and about abuse perpetrated by ex-partners or by other family members.”
The report also reveals that a wide range of positive outcomes has resulted from the IRIS programmes across the boroughs. “These included ‘hard’ outcomes such as prosecutions and convictions of perpetrators; obtaining Restraining Orders; women returning to work and education; children back in school or college; families being re-housed and benefits being accessed”.
For survivors, “the IRIS service provides important support at different stages of recovery”
Besides the evaluation produced by DMSS, IRISi also commissioned an “IRIS 7 Borough Programme Survivor Consultation”, produced by AVA. The report is an overview of the key findings following consultation with survivors of domestic violence and abuse who engaged in the IRIS service in 7B and captures the experiences and voices of survivors who engaged with the programme (click here to read it in full).
Among several findings, this report concluded: “The findings suggest that GPs are an important first point of contact for survivors who may not directly disclose their experiences of domestic violence and abuse. Having a GP that understands abuse and its impacts, supports Clinicians’ ability to identify survivors of domestic violence and abuse. The findings also suggest that the IRIS service provides important support for survivors at different stages of recovery, this includes providing effective safety and wellbeing support for survivors post-crisis and for those who are currently experiencing domestic abuse”.
“[The] GPs are the ones that helped me get support for IRIS, I didn’t call asking for support around domestic abuse, I called up with the symptoms and they asked the right questions.” – (Survivor, Brent)
For clinicians and commissioners, the Programme is extremely helpful, and the results should serve as further evidence to expand it to all London boroughs
The health perspective of the IRIS Programme in the 7 boroughs was also one of the topics approached during the in-person event. Dr Saral Anand, Clinical Lead in Westminster, presented the context and the feedback from general practices professionals who took part in the training sessions. “As GPs, we do care about our patients, and we want to make difference in their lives. Even though we were experiencing this huge amount of pressure due to the pandemic, we could see increased referrals to MARAC in Westminster, plus a huge increase in referrals of domestic abuse compared to the year before IRIS. Many of the trained GPs said that, with IRIS in place, the referral process became a lot easier, that it wasn’t paper heavy or complicated at all”.
“In healthcare, we see a lot of patients with PTSD. They come in with their symptoms, but they have never been able to talk openly about how the domestic abuse has impacted them. In many cases, because it happened years ago, they don’t understand or see how it still impacts their lives, both physically and emotionally. In this scenario, as a clinician, being able to support that patient and to connect those dots is incredibly helpful and powerful”, Dr Saral says.
“We’ve all found it immensely helpful in keeping the potential for domestic abuse at the forefront of our minds, which is particularly pertinent during this difficult time. We have all learnt how to ask safely and sensitively about this and also how to ensure that the victim is kept safe and referred on to support services such as IRIS. Our experience of working with the IRIS Advocate Educators has been extremely positive and we have received positive feedback from patients as well as staff.“
(GP trained trough the 7B Programme in London)
To close the event, Lib Peck, Director of VRU, congratulated everyone for the work: “We have a big thing to celebrate here, which is a model that works and works for a lot of different people. Our work from now on must be going out and talking about this impact and talking about how we need to move from relatively few boroughs to all the 32 in London. We need to advocate for the mainstream funding of an initiative like this, which we know works”.
Six out of seven sites funded by VRU to implement IRIS have continuation funding from the NHS to run the programme for at least six months. “We are delighted that local health partners recognise the value and importance of the programme and the difference it makes to clinical practice and most importantly to the response for and support available to women affected by domestic abuse”, says the CEO of IRISi.
[VRU in 7B in figures]
[ABOUT THE IRIS PROGRAMME]
IRIS is a specialist domestic abuse (DA) training, support and referral programme for General Practices that has been positively evaluated in a randomised controlled trial.
IRIS is a collaboration between primary care and third sector organisations specialising in DA. Core areas of the programme include ongoing training, education and consultancy for the clinical team and administrative staff, care pathways for primary health care practitioners and an enhanced referral pathway to specialist domestic violence services for patients with experience of DA.