The IRIS Programme is a specialist domestic violence and abuse (DVA) training, support and referral programme for General Practices. It has been delivered in the West Midlands since 2015. Sandwell was the first area to commission the initiative followed by Birmingham (2015), Solihull (2017), Walsall (2017), Coventry (2018) and Dudley (2018). Together, all the IRIS trained practices across this region had referred approximately 2,500 women up to April 2020. Each woman was contacted and offered assistance, choices and support from an IRIS Advocate Educator.
The positive outcomes in terms of referral and identification levels, as well as the cost-effectiveness of this model had already been confirmed by several evaluations led locally and nationally, but, for the IRIS Evaluation Team from the Risk, Abuse and Violence Research Programme at the University of Birmingham, there were still some aspects of the model to be studied.
“There is a great deal of data available about the impacts of IRIS, but there has not been a focus on the difference that it might make longer term, especially in relation to mental health”, explains Professor Caroline Bradbury-Jones, lead author of the recently launched report “Evaluation of the Identification and Referral to Improve Safety (IRIS) Intervention in the West Midlands: A Focus on Health and Deprivation”. Alongside Professor Siddhartha Bandyopadhyay and Dr Shazia Zafar, Professor Bradbury-Jones conducted a cross-Midlands’ evaluation to provide a fuller picture of IRIS. “The team have significant experience in domestic violence and in conducting robust evaluations, so we were ideally placed to undertake this piece of work”, says Professor Bradbury-Jones.
The study took place between March 2019 and February 2021 and the evaluation comprised both quantitative and qualitative strands. The aims of the study were to explore:
- 1) What impacts does IRIS have on long term health outcomes as captured in GP and IRIS data in the West Midlands?
- 2) What are the linkages between IRIS as an intervention, deprivation indices and long-term health impacts?
- 3) How do survivors of DVA who have accessed IRIS support, describe its impacts on their health and wellbeing?
“We decided to adopt this research design because we needed to collect quantitative data on, for example, the health conditions of women who had received IRIS support. By itself, though, this would have been insufficient in capturing the experience of any changes in health conditions from the perspectives of survivors. This is why we conducted the interviews with women. This type of mixed methods research provides the best of both worlds as regards obtaining a full picture of the impacts of the intervention (IRIS). The quantitative approach provides factual evidence and the qualitative approach portrays lived experiences demonstrating powerful voices behind the facts.”
Semi-structured telephone interviews were conducted with 21 women who had experiences of DVA and had received IRIS support. Data were analysed thematically. The qualitative findings were reported under six key themes: Life before accessing IRIS support; Driving forces for help-seeking; Experiences of IRIS support; Perceived impacts of IRIS; Recovery as a journey; Looking to the future. “The six themes were organised to map a women’s journey through IRIS, capturing her life before accessing support, through to her perception of life in the future. The project took place in the midst of the COVID-19 pandemic, and we gained some useful insights from the women who took part, about surviving domestic violence and abuse in the pandemic”, explains Professor Bradbury-Jones.
Across all themes, women were overwhelmingly supportive of IRIS as an intervention and recognised its positive impacts on their health and those of their children. “I was the researcher who worked on the evaluation. I was responsible for liaising with the project partners, interviewing women, collating data from different sources and analysing the data. We focused on the broader health and mental health impacts of IRIS and found that IRIS had a positive effect.”, explains Dr Shazia Zafar.
Looking to the future, most women who had been referred into the IRIS programme believed that the impacts of the referral and support would be sustained over time. The women were all interviewed during COVID-19 restrictions and for those who discussed this aspect of service delivery, most had found remote support to be effective. A minority of women reported the potential protective impacts of lockdown on post-separation DVA survivors; an issue that warrants further investigation.
GP records of 294 patients were matched with records from referrals made to IRIS Advocate Educators. This helped to build a picture of the types of health conditions women affected by DVA suffer from as well as information on lifestyle, pregnancies, abuse and violence currently suffered, historical abuse as well as the support IRIS provided. “I was the quantitative lead for the evaluation, using data from various sources to portray the impact of IRIS on a number of physical and mental health indicators, while also capturing the socio-economic profile of these women.”, explains Professor Siddhartha Bandyopadhyay.
Descriptive statistics indicated that the patients referred to IRIS had a variety of health conditions, like mental illness, suicidal ideation, self-harm, PTSD, Personality Disorder, Gynecological problems 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 show similar positive impacts across a range of health conditions (including non-chronic ones) and these are all consistent with the qualitative findings.
The women who took part in the qualitative phase of the evaluation reported that IRIS had impacted positively on their health and, importantly, they perceived that these impacts will be long lasting. Almost all participating women emphasised the importance of retaining the intervention so that it can continue to provide support to DVA survivors. The quantitative data support the qualitative findings, showing a decrease in a range of recorded conditions post-IRIS.
Combined insights from both phases provide important, new insights into the beneficial longer-term impacts of IRIS as regards impacts on health (particularly mental health).
Identification and referral responses that lead to support from that AE are contingent on health professionals being aware of the nuanced indicators of DVA and who know the referral pathways. This is why IRIS programmes exist: to provide the healthcare workforce with tools and support in relation to the recognition of and response to DVA.
“Artwork speaks in ways that words cannot”
Besides presenting the findings of their research in its usual format, the IRIS Evaluation Team from the Risk, Abuse and Violence Research Programme at the University of Birmingham wanted to present the data more creatively and so decided to work with specialists in visual communication to literally draw each part of their study as you can see throughout this article.
“The team are publishing articles in academic journals and these will be of interest and use to other research teams and clinicians who want to read about the study. However, we believe that it is vital that we communicate the findings of the research as widely as possible; to people and communities who do not have access to and do not want to read academic papers. That is why we chose to work with an artist, in order to help us present our work in a visual and accessible way so that more people are able to engage with it and find out what we did and what we found. Artwork speaks in ways that words cannot.”, concludes Professor Bradbury-Jones.
Evaluation Team from University of Birmingham, UK:
- Professor Caroline Bradbury-Jones
- Professor Siddhartha Bandyopadhyay
- Dr Shazia Zafar