It is impossible to tell the story of IRIS without mentioning one of the first sites to ever deliver the programme. Hackney held its first training sessions in 2007, alongside Bristol, right after the Health Foundation awarded funding for a randomised controlled trial of the initiative in both areas. In the trial, 24 practices received the IRIS programme and a further 24 practices were controls and did not receive the intervention.
The primary outcome measure was the recorded referral of patients to named advocates based in specialist Domestic Violence and Abuse (DVA) agencies. Secondary outcome measures included disclosure of DVA recorded in patient records. After the trial, there were no doubts about how efficient the IRIS Programme was: women attending the intervention practices were 22.1 times more likely than those attending the control practices to have a discussion with their clinician about a referral to an Advocate Educator (AE), which resulted in them being six times more likely to be referred to the AE. At the same time, women attending the intervention practices were also 3.1 times more likely to have a recorded identification of DVA in their medical records.
Despite the great results, the IRIS Programme almost didn’t progress to the implementation phase since the Primary Care Trust at the time had not agreed to fund the project. Thankfully, they decided to keep running the initiative, which allowed 40 General Practices teams to be trained in how to identify and respond to DVA. As a result, between 2014 and 2021, over 900 women from Hackney were recognised, referred into, and assisted by the IRIS Programme in partnership with the nia project, as explained below by Emma Mc Manus*, Senior IRIS Advocate Educator from nia.
How did you first get the IRIS programme to Hackney? Could you tell me a little bit more about this trajectory?
IRIS is an evidence-based model developed through research led by Bristol University with nia in Hackney and Next Link in Bristol hosting the original AEs in the two trial sites (2007 – 2010). nia continued to be part of both the development work of the IRIS model after the trial and the national steering group until the launch of IRISi as an independent social enterprise in February 2017. The new organisation has a separate governing body and ends nia’s formal involvement with the work of IRIS nationally.
The IRIS programme locally provides an evidence-based domestic violence and abuse training, support and referral programme to 40 Hackney GP practices. IRIS City and Hackney is staffed by two full-time AEs, one of whom is a Senior AE leading on the engagement and training of GP practices. The service also works in partnership with a local clinical lead. nia was re-awarded the IRIS City and Hackney contract in 2016 following a competitive tendering process.
How has the IRIS programme helped you to improve the response to domestic violence and abuse in Hackney?
Most women will access their GP surgeries at some point; therefore, I think IRIS provides a vital opportunity to train GPs so they are equipped to ask women about domestic abuse in a safe and confidential space. The IRIS programme has educated me on the correlation between health and domestic abuse, and how essential it is in understanding those links in a healthcare setting, and an appropriate intervention offered. It also reassures women that their GP surgeries are places that they can go to for help and support. Domestic Violence and Abuse is a public health issue and should be prioritised as such. I think a lot of women would end up without support if not for their GPs making a referral to IRIS, as there may be no other place for them to go to and talk about what’s going on. We have come across some cases where a GP appointment is the only appointment a woman is ‘allowed’ to attend on her own, and without the abusive partner.
How was your experience in delivering the IRIS programme until now?
Having joined nia at the height of the pandemic, all of my experience has come from remote training, and I have found the training package to be really well put together. The revised webinar training package seems to offer a really accessible opportunity for clinical, administration and reception staff at practices to attend, consequently, we have observed increased levels of engagement in training and higher numbers able to access IRIS training. During 2021, quarter one, we delivered IRIS training to 91 professionals – the highest number trained in one quarter to date. I think that’s fantastic as it means the more professionals that are trained, the more referrals we receive, meaning women are being offered specialist support through an evidence-based pathway.
What are the most challenging and most satisfying aspects of delivering the IRIS programme for you?
The most challenging aspect of delivering IRIS is when practices do not engage! Though with the help of the clinical lead and colleagues, we continue to promote IRIS and highlight that continued engagement from general practice teams plays a crucial role in preventing homicides, as evidenced in the Domestic Homicide Review Case Analysis (Standing Together and London Metropolitan University 2016).
The most satisfying parts of the job have been observing an increased interest in the IRIS training from general practice teams at practices, and this offers hope, and demonstrates a commitment from practices to recognise the links between health and domestic violence, and to take action at a time when nationally rates of domestic violence and abuse have soared. Alongside this, our referrals have also increased, reflecting the national patterns.
We have also received some fantastic feedback from clinicians and staff on the training which is always reassuring to hear. As well as this, we have received some very touching feedback from clients themselves which I think shows us that our work is benefiting our clients in a positive and meaningful way.
Site of the Month: Hackney
- Launch date: September 2007.
- Specialist Partner organisation: the nia project.
- Practices trained: 40 practices trained to date.
- Women referred by year:
- 2014/2015 = 151
- 2015/2016 = 187
- 2016/2017 = 152
- 2017/2018 = 171
- 2018/2019 = 100
- 2019/2020 = 126
- 2020/2021 = 160
Service user’s feedback
“It cannot be underestimated what a lifeline nia’s IRIS Advocate Educator service has been for me – and by extension – my son. Without their ongoing commitment and dedicated input, I fear that there may have been a very different outcome for my son and me. Instead, they have prevented us from being isolated, given me courage and offered us hope.”
“Without this support, I would have been completely isolated, especially because friends, family and non-specialist professionals either drop away or offer misguided or damaging commentary.”
“AE’s support was the best I got from this horrendous experience. She made me feel safe, secure, protected, and well looked after. I have not words to describe how well I felt knowing that she was supporting me through with all this situation and not only to me but also to my children as well and therefore I be always thankful for that.”
“You all are doing an amazing job making people who goes through these experiences know that they are not alone.”
“A highly relevant and well-organised presentation. The slides and video were designed to maximize the impact and will be memorable and therefore useful when faced with potential DVA incidents and cases. It is highly relevant to have this presentation given the increased risk of DVA during Covid lockdown and as we come out of the restrictions.”
“This session helped me reflect on my own and my team’s knowledge and hopefully will lead to more professional curiosity and asking about how things are at home when consulting.”
“Beautifully presented, very clear, good flow, good response to audience’s questions and comments. Really helpful thank you!”
“Very approachable trainer which makes all the difference to how one engages with the training. Thank you.”
*In collaboration with Head of Operations Caroline Murphy.