Feasibility of a reconfigured domestic violence and abuse training and support intervention responding to affected women, men, children and young people through primary care

BACKGROUND

Identification in UK general practice of women affected by domestic violence and abuse (DVA) is increasing, but men and children/young people (CYP) are rarely identified and referred for specialist support. To address this gap, we collaborated with IRISi (UK social enterprise) to strengthen elements of the IRIS + intervention which included the identification of men, direct engagement with CYP, and improved guidance on responding to information received from other agencies. IRIS + was an adaptation of the national IRIS (Identification and Referral to Improve Safety) model focused on the needs of women victim-survivors of DVA. Without diminishing the responses to women, IRIS + also responded to the needs of men experiencing or perpetrating DVA, and CYP living with DVA and/or experiencing it in their own relationships. Our study tested the feasibility of the adapted IRIS + intervention in England and Wales between 2019-21.

METHODS

We used mixed method analysis to triangulate data from various sources (pre/post intervention questionnaires with primary care clinicians; data extracted from medical records and DVA agencies; semi-structured interviews with clinicians, service providers and referred adults and children) to assess the feasibility and acceptability of the IRIS + intervention.

RESULTS

The rate of referral for women doubled (21.6/year/practice) from the rate (9.29/year/practice) in the original IRIS trial. The intervention also enabled identification and direct referral of CYP (15% of total referrals) and men (mostly survivors, 10% of total referrals). Despite an increase in self-reported clinician preparedness to respond to all patient groups, the intervention generated a low number of men perpetrator referrals (2% of all referrals). GPs were the principal patient referrers. Over two-thirds of referred women and CYP and almost half of all referred men were directly supported by the service. Many CYP also received IRIS + support indirectly, via the referred parents. Men and CYP supported by IRIS + reported improved physical and mental health, wellbeing, and confidence.

CONCLUSIONS

Although the study showed acceptability and feasibility, there remains uncertainty about the effectiveness, cost-effectiveness, and scalability of IRIS + . Building on the success of this feasibility study, the next step should be trialling the effectiveness of IRIS + implementation to inform service implementation decisions.

Primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a cost-effectiveness feasibility model

OBJECTIVES

This study aimed to evaluate the prospective cost-effectiveness of the Identification and Referral to Improve Safety plus (IRIS+) intervention compared with usual care using feasibility data derived from seven UK general practice sites.

METHOD

A cost-utility analysis was conducted to assess the potential cost-effectiveness of IRIS+, an enhanced model of the UK's usual care. IRIS+ assisted primary care staff in identifying, documenting and referring not only women, but also men and children who may have experienced domestic violence/abuse as victims, perpetrators or both. A perpetrator group programme was not part of the intervention per se but was linked to the IRIS+ intervention via a referral pathway and signposting. A Markov model was constructed from a societal perspective to estimate mean incremental costs and quality-adjusted life years (QALYs) of IRIS+ compared with to usual care over a 10-year time horizon.

RESULTS

The IRIS+ intervention saved £92 per patient and produced QALY gains of 0.003. The incremental net monetary benefit was positive (£145) and the IRIS+ intervention was cost-effective in 55% of simulations at a cost-effectiveness threshold of £20 000 per QALY.

CONCLUSION

The IRIS+ intervention could be cost-effective or even cost saving from a societal perspective in the UK, though there are large uncertainties, reflected in the confidence intervals and simulation results.

Stakeholder opinion-led study to identify canine priority diseases for surveillance and control in the UK

BACKGROUND

Many pathogens cause disease in dogs; however, meaningful surveillance in small companion animals is often only possible for the most impactful diseases. We describe the first stakeholder opinion-led approach to identify which canine infectious diseases should be prioritised for inclusion in surveillance and control strategies in the UK.

METHODS

Participants were identified through a stakeholder analysis. A multicriteria decision analysis was undertaken to establish and weight epidemiological criteria for evaluating diseases, and a Delphi technique was employed to achieve a consensus among participants on the top-priority canine diseases.

RESULTS

Nineteen stakeholders from multiple backgrounds participated in this study. Leptospirosis and parvovirus were identified as the top two endemic diseases of concern, while leishmaniosis and babesiosis were the top two exotic diseases. Respiratory and gastrointestinal diseases were identified as the top two syndromes of concern.

LIMITATIONS

Due to the COVID-19 pandemic, the number of participants was reduced. Despite this, a representative multidisciplinary sample of relevant stakeholders contributed to the present study.

CONCLUSIONS

Findings from this study are being used to inform the development of a future UK-wide epidemic response strategy. This methodology could provide a blueprint for other countries.

General practice as a place to receive help for domestic abuse during the COVID-19 pandemic: a qualitative interview study in England and Wales

BACKGROUND

General practice is an important place for patients experiencing or perpetrating domestic violence and abuse (DVA), and for their children to seek and receive help. While the incidence of DVA may have increased during the COVID- 19 pandemic, there has been a reduction in DVA identifications and referrals to specialist services from general practice. Concurrently there has been the imposition of lockdown measures and a shift to remote care in general practices in the UK.

AIM

To understand the patient perspective of seeking and receiving help for DVA in general practice during the COVID-19 pandemic. This was then compared with experiences of general practice healthcare professionals.

DESIGN AND SETTING

A qualitative interview study in seven urban general practices in England and Wales, as part of a feasibility study of IRIS+, an integrated primary care DVA system-level training and support intervention.

METHOD

Semi-structured interviews with 21 patients affected by DVA and 13 general practice healthcare professionals who had received IRIS+ training. Analysis involved a Framework approach.

RESULTS

Patients recounted positive experiences of seeking help for DVA in general practice during the pandemic. However, there have been perceived problems with the availability of general practice and a strong preference for face-to-face consultations, over remote consultations, for the opportunities of non- verbal communication. There were also concerns from healthcare professionals regarding the invisibility of children affected by DVA.

CONCLUSION

Perspectives of patients and their families affected by DVA should be prioritised in general practice service planning, including during periods of transition and change.

Adapting domestic abuse training to remote delivery during the COVID-19 pandemic: a qualitative study of views from general practice and support services

BACKGROUND

Identifying and responding to patients affected by domestic violence and abuse (DVA) is vital in primary care. There may have been a rise in the reporting of DVA cases during the COVID-19 pandemic and associated lockdown measures. Concurrently general practice adopted remote working that extended to training and education. IRIS (Identification and Referral to Improve Safety) is an example of an evidence-based UK healthcare training support and referral programme, focusing on DVA. IRIS transitioned to remote delivery during the pandemic.

AIM

To understand the adaptations and impact of remote DVA training in IRIS-trained general practices by exploring perspectives of those delivering and receiving training.

DESIGN AND SETTING

Qualitative interviews and observation of remote training of general practice teams in England were undertaken.

METHOD

Semi-structured interviews were conducted with 21 participants (three practice managers, three reception and administrative staff, eight general practice clinicians, and seven specialist DVA staff), alongside observation of eight remote training sessions. Analysis was conducted using a framework approach.

RESULTS

Remote DVA training in UK general practice widened access to learners. However, it may have reduced learner engagement compared with face-to-face training and may challenge safeguarding of remote learners who are domestic abuse survivors. DVA training is integral to the partnership between general practice and specialist DVA services, and reduced engagement risks weakening this partnership.

CONCLUSION

The authors recommend a hybrid DVA training model for general practice, including remote information delivery alongside a structured face-to-face element. This has broader relevance for other specialist services providing training and education in primary care.

Young People and Intimate Partner Violence: Experiences of Institutional Support and Services in England

Purpose

Young people (YP) are at greater risk of experiencing intimate partner violence and abuse (IPVA), with high prevalence rates at 18-25 years and potentially severe short and long-term health and social impacts. YP often view adult support services as not for them and more research is needed to understand effective responses to IPVA among different groups.

Methods

Semi-structured interviews alongside Life History Calendars were undertaken to explore 18 young peoples' (18-25 years) experiences of community and service level responses to their IPVA between 2019-2020. Thematic analysis and case studies were carried out.

Results

Participant accounts commonly described what did or did not help within: education; primary care physicians and maternity services; third sector or non-government support organisations; and counselling and support workers. YP wanted clearer information on identifying abuse from a younger age in schools and better access and signposting to specialist services. They benefited the most from equal power dynamics in relationships with professionals where they were supported to make their own decisions.

Conclusions

Professionals in all sectors (including schools) need IPVA trauma-informed training that encourages equal power dynamics, with a clear understanding of and access to referral pathways, to be able to respond to the needs of YP experiencing IPVA.

General practice wide adaptations to support patients affected by DVA during the COVID-19 pandemic: a rapid qualitative study

BACKGROUND

Reporting of domestic violence and abuse (DVA) increased globally during the pandemic. General Practice has a central role in identifying and supporting those affected by DVA. Pandemic associated changes in UK primary care included remote initial contacts with primary care and predominantly remote consulting. This paper explores general practice's adaptation to DVA care during the COVID-19 pandemic.

METHODS

Remote semi-structured interviews were conducted by telephone with staff from six localities in England and Wales where the Identification and Referral to Improve Safety (IRIS) primary care DVA programme is commissioned.  We conducted interviews between April 2021 and February 2022 with three practice managers, three reception and administrative staff, eight general practice clinicians and seven specialist DVA staff. Patient and public involvement and engagement (PPI&E) advisers with lived experience of DVA guided the project. Together we developed recommendations for primary care teams based on our findings.

RESULTS

We present our findings within four themes, representing primary care adaptations in delivering DVA care: 1. Making general practice accessible for DVA care: staff adapted telephone triaging processes for appointments and promoted availability of DVA support online. 2. General practice team-working to identify DVA: practices developed new approaches of collaboration, including whole team adaptations to information processing and communication 3. Adapting to remote consultations about DVA: teams were required to adapt to challenges including concerns about safety, privacy, and developing trust remotely. 4. Experiences of onward referrals for specialist DVA support: support from specialist services was effective and largely unchanged during the pandemic.

CONCLUSIONS

Disruption caused by pandemic restrictions revealed how team dynamics and interactions before, during and after clinical consultations contribute to identifying and supporting patients experiencing DVA. Remote assessment complicates access to and delivery of DVA care. This has implications for all primary and secondary care settings, within the NHS and internationally, which are vital to consider in both practice and policy.

Categories of Intimate Partner Violence and Abuse Among Young Women and Men: Latent Class Analysis of Psychological, Physical, and Sexual Victimization and Perpetration in a UK Birth Cohort

BACKGROUND

In the UK, around one-third of young people are exposed to Intimate Partner Violence and Abuse (IPVA) by 21 years old. However, types of IPVA victimization in this population (psychological, physical, sexual), and their relationship with impact and perpetration are poorly understood.

METHODS

Participants in a UK birth cohort reported IPVA victimization and perpetration by age 21. We carried out a latent class analysis, where we categorized IPVA by types/frequency of victimization, and then assigned individuals to their most probable class. Within these classes, we then estimated rates of reported: 1) types of negative impacts (sad, upset/unhappy, anxious, depressed, affected work/studies, angry/annoyed, drank/took drugs more); 2) types/frequency of perpetration.

RESULTS

Among 2130 women and 1149 men, 32% and 24% reported IPVA victimization (of which 89% and 73% reported negative impact); 21% and 16% perpetration. Victimization responses were well represented by five classes, including three apparent in both sexes: No-low victimization (characterized by low probabilities of all types of victimization; average probabilities of women and men belonging to this class were 82% and 70%); Mainly psychological (15% and 12%); Psychological and physical victimization (4% and 7%), and two classes that were specific to women: Psychological and sexual (7%); Multi-victimization (frequent victimization for all three types; 4%). In women, all types of negative impact were most common in the Psychological and sexual and Multi-victimization classes; for men, the Psychological and physical class. In women, all types of perpetration were most common for the Mainly psychological, Psychological and physical and Multi-victimization classes; in men, the Mainly psychological and Psychological and physical classes.

DISCUSSION

In this study of young people, we found categories of co-occurrence of types and frequency of IPVA victimization associated with differential rates of negative impact and perpetrating IPVA. This is consistent with emerging evidence of IPVA differentiation and its variable impact in other populations.

Child and family-focused interventions for child maltreatment and domestic abuse: development of core outcome sets

BACKGROUND

The current evidence for child maltreatment (CM) and domestic violence and abuse (DVA) interventions is limited by the diversity of outcomes evaluated and the variety of measures used. The result is studies that are difficult to compare and lack focus on outcomes reflecting service user or provider priorities.

OBJECTIVE

To develop core outcome sets (COSs) for evaluations of child and family-focused interventions for: (1) CM and (2) DVA.

DESIGN

We conducted a two-stage consensus process. Stage 1: a long list of candidate outcomes across CM and DVA was developed through rapid systematic reviews of intervention studies, qualitative and grey literature; stakeholder workshops; survivor interviews. Stage 2: three-panel, three-round e-Delphi surveys for CM and DVA with consensus meetings to agree with the final COSs.

PARTICIPANTS

287 stakeholders participated in at least one stage of the process (ie, either CM or DVA COS development): workshops (n=76), two e-Delphi surveys (n=170) and consensus meetings (n=43). Stakeholders included CM and DVA survivors, practitioners, commissioners, policymakers and researchers.

RESULTS

Stage 1 identified 335 outcomes categorised into 9 areas and 39 domains. Following stage 2, the final five outcomes included in the CM-COS were: child emotional health and well-being; child's trusted relationships; feelings of safety; child abuse and neglect; service harms. The final five outcomes in the DVA-COS were: child emotional health and well-being; caregiver emotional health and well-being; family relationships; freedom to go about daily life; feelings of safety.

CONCLUSIONS

We developed two COSs for CM and DVA with two common outcomes (child emotional health and well-being; feelings of safety). The COSs reflect shared priorities among service users, providers and researchers. Use of these COSs across trials and service evaluations for children and families affected by CM and DVA will make outcome selection more consistent and help harmonise research and practice.

Being silenced, loneliness and being heard: understanding pathways to intimate partner violence & abuse in young adults. a mixed-methods study

BACKGROUND

International research shows the significance and impact of intimate partner violence and abuse (IPVA) as a public health issue for young adults. There is a lack of qualitative research exploring pathways to IPVA.

METHODS

The current mixed-methods study used qualitative interviews and analysis of longitudinal cohort data, to explore experiences of pathways to IPVA. Semi-structured Interviews alongside Life History Calendars were undertaken to explore 17 young women's (19-25 years) experiences and perceptions of pathways to IPVA in their relationships. Thematic analysis was undertaken. Based on themes identified in the qualitative analysis, quantitative analysis was conducted in data from 2127 female and 1145 male participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort study. We fitted regression models to assess the association of child maltreatment, parental domestic violence, and peer-to-peer victimisation, by age 12, with loneliness during adolescence (ages 13-14), and the association of loneliness during adolescence with IPVA (age 18-21). Mediation analysis estimated the direct effects of maltreatment on IPVA, and indirect effects through loneliness.

FINDINGS

All women interviewed experienced at least one type of maltreatment, parental domestic violence, or bullying during childhood. Nearly all experienced IPVA and most had been multi-victimised. Findings indicated a circular pathway: early trauma led to isolation and loneliness, negative labelling and being silenced through negative responses to help seeking, leading to increased experiences of loneliness and intensifying vulnerability to further violence and abuse in young adulthood. The pathway was compounded by intersectionality. Potential ways to break this cycle of loneliness included being heard and supported, especially by teachers. Quantitative analysis confirmed an association between child maltreatment and loneliness in adolescence, and an association between loneliness in adolescence and experience of IPVA in young adult relationships.

CONCLUSION

It is likely that negative labelling and loneliness mediate pathways to IPVA, especially among more disadvantaged young women. The impact of early maltreatment on young people's wellbeing and own relationships is compounded by disadvantage, disability and ethnicity. Participants' resilience was enabled by support in the community.

Impact of the first national COVID-19 lockdown on referral of women experiencing domestic violence and abuse in England and Wales

BACKGROUND

The lockdown periods to curb COVID-19 transmission have made it harder for survivors of domestic violence and abuse (DVA) to disclose abuse and access support services. Our study describes the impact of the first COVID-19 wave and the associated national lockdown in England and Wales on the referrals from general practice to the Identification and Referral to Improve Safety (IRIS) DVA programme. We compare this to the change in referrals in the same months in the previous year, during the school holidays in the 3 years preceding the pandemic and the period just after the first COVID-19 wave. School holiday periods were chosen as a comparator, since families, including the perpetrator, are together, affecting access to services.

METHODS

We used anonymised data on daily referrals received by the IRIS DVA service in 33 areas from general practices over the period April 2017-September 2020. Interrupted-time series and non-linear regression were used to quantify the impact of the first national lockdown in March-June 2020 comparing analogous months the year before, and the impact of school holidays (01/04/2017-30/09/2020) on number of referrals, reporting Incidence Rate Ratio (IRR), 95% confidence intervals and p-values.

RESULTS

The first national lockdown in 2020 led to reduced number of referrals to DVA services (27%, 95%CI = (21,34%)) compared to the period before and after, and 19% fewer referrals compared to the same period in the year before. A reduction in the number of referrals was also evident during the school holidays with the highest reduction in referrals during the winter 2019 pre-pandemic school holiday (44%, 95%CI = (32,54%)) followed by the effect from the summer of 2020 school holidays (20%, 95%CI = (10,30%)). There was also a smaller reduction (13-15%) in referrals during the longer summer holidays 2017-2019; and some reduction (5-16%) during the shorter spring holidays 2017-2019.

CONCLUSIONS

We show that the COVID-19 lockdown in 2020 led to decline in referrals to DVA services. Our findings suggest an association between decline in referrals to DVA services for women experiencing DVA and prolonged periods of systemic closure proxied here by both the first COVID-19 national lockdown or school holidays. This highlights the need for future planning to provide adequate access and support for people experiencing DVA during future national lockdowns and during the school holidays.

Exploring the causal role of intimate partner violence and abuse on depressive symptoms in young adults: a population-based cohort study

BACKGROUND

Previous studies have shown an association between experience of intimate partner violence and abuse (IPVA) and depression. Whether this is a causal relationship or explained by prior vulnerability that influences the risk of both IPVA and depression is not known.

METHODS

We analysed data from the Avon Longitudinal Study of Parents and Children prospective cohort (N = 1764 women, 1028 men). To assess the causal association between IPVA at 18-21 years old and logged depressive symptom scores at age 23, we used (i) multivariable linear regression, (ii) inverse probability of treatment weighting (IPTW), and (iii) difference-in-difference (DiD) analysis, which compared the mean change in logged depressive symptom scores between ages 16 and 23 between those who experienced IPVA and those who did not.

RESULTS

Women who experienced IPVA had on average 26% higher depressive symptom scores after adjustment for measured confounders (ratio of geometric means 1.26, 95% CI 1.13 to 1.40). In men, the difference was 5% (ratio of geometric means 1.05, 95% CI 0.92 to 1.21). Results from IPTW analysis were similar. In the DiD analysis, there was no evidence that being exposed to IPVA affected the change in depressive symptom scores over time compared to being in the non-exposed group for either women (difference-in-differences 1%, -12 to 16%) or men (-1%, -19 to 20%).

CONCLUSIONS

Multivariable linear regression and IPTW suggested an association between IPVA and higher depressive symptom score in women but not men, but DiD analysis indicated a null effect in both women and men. This suggests the causal origins of higher depressive symptoms in this young adult population are likely to reflect prior vulnerability that leads to both higher depressive symptoms and increased risk of IPVA exposure.

'It felt like there was always someone there for us': Supporting children affected by domestic violence and abuse who are identified by general practice

One in five children in the UK are affected by domestic violence and abuse. However, primary care clinicians (GPs and nurses) struggle to effectively identify and support children and young people living in homes where it is present. The IRIS+ (Enhanced Identification and Referral to Improve Safety) training and advocacy support intervention aimed to improve how clinicians respond to children and young people affected by domestic violence and abuse. IRIS+ training was delivered as part of a feasibility study to four general practices in an urban area in England (UK). Our mixed method design included interviews and questionnaires about the IRIS+ intervention with general practice patients, including children and young people as well as with clinicians and advocacy service providers. We collected the number of identifications and referrals by clinicians of children experiencing domestic violence and abuse through a retrospective search of medical and agency records 10 months after the intervention. Forty-nine children exposed to domestic violence and abuse were recorded in medical records. Thirty-five children were referred to a specialist domestic violence and abuse support service over a period of 10 months. Of these, 22 received direct or indirect support. The qualitative findings indicated that children benefitted from being referred by clinicians to the service. However, several barriers at the patient and professional level prevented children and young people from being identified and supported. Some of these barriers can be addressed through modifications to professional training and guidance, but others require systematic and structural changes to the way health and social care services work with children affected by domestic violence and abuse.

Protocol for developing core outcome sets for evaluation of psychosocial interventions for children and families with experience or at risk of child maltreatment or domestic abuse

INTRODUCTION

Recognition that child maltreatment (CM) and domestic violence and abuse (DVA) are common and have serious and long-term adverse health consequences has resulted in policies and programmes to ensure that services respond to and safeguard children and their families. However, high-quality evidence about how services can effectively intervene is scant. The value of the current evidence base is limited partly because of the variety of outcomes and measures used in evaluative studies. One way of addressing this limitation is to develop a core outcome set (COS) which is measured and reported as a minimum standard in the context of trials and other types of evaluative research. The study described in this protocol aims to develop two discrete COSs for use in future evaluation of psychosocial interventions aimed at improving outcomes for children and families at risk or with experience of (1) CM or (2) DVA.

METHODS AND ANALYSIS

A two-phase mixed methods design: (1) rapid reviews of evidence, stakeholder workshops and semistructured interviews with adult survivors of CM/DVA and parents of children who have experienced CM/DVA and (2) a three panel adapted E-Delphi Study and consensus meeting. This study protocol adheres to reporting guidance for COS protocols and has been registered on the Core Outcome Measures for Effectiveness Trials (COMET) database.

ETHICS AND DISSEMINATION

We will disseminate our findings through peer-reviewed and open access publications, the COMET website and presentations at international conferences. We will engage with research networks, journal editors and funding agencies to promote awareness of the CM-COS and DVA-COS. We will work with advisory and survivor and public involvement groups to coproduce a range of survivor, policy and practice facing outputs.Approval for this study has been granted by the Research Ethics Committee at University College London.

PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic (PRECODE): protocol of a rapid mixed-methods study in the UK

Background

The implementation of lockdowns in the UK during the COVID-19 pandemic resulted in a system switch to remote primary care consulting at the same time as the incidence of domestic violence and abuse (DVA) increased. Lockdown-specific barriers to disclosure of DVA reduced the opportunity for DVA detection and referral.

The PRECODE (PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic) study will comprise quantitative analysis of the impact of the pandemic on referrals from IRIS (Identification and Referral to Improve Safety) trained general practices to DVA agencies in the UK and qualitative analysis of the experiences of clinicians responding to patients affected by DVA and adaptations they have made transitioning to remote DVA training and patient support.

Methods/Design

Using a rapid mixed method design, PRECODE will explore and explain the dynamics of DVA referrals and support before and during the pandemic on a national scale using qualitative data and over four years of referrals time series data.

We will undertake interrupted-time series and non-linear regression analysis, including sensitivity analyses, on time series of referrals to DVA services from routinely collected data to evaluate the impact of the pandemic and associated lockdowns on referrals to the IRIS Programme, and analyse key determinants associated with changes in referrals.

We will also conduct an interview- and observation-based qualitative study to understand the variation, relevance and feasibility of primary care responses to DVA before and during the pandemic and its aftermath.

The triangulation of quantitative and qualitative findings using rapid analysis and synthesis will enable the articulation of multiscale trends in primary care responses to DVA and complex mechanisms by which these responses have changed during the pandemic.

Discussion

Our findings will inform the implementation of remote primary care and DVA service responses as services re-configure. Understanding the adaptation of clinical and service responses to DVA during the pandemic is crucial for the development of evidence-based, effective remote support and referral beyond the pandemic.

Trial registration

PRECODE is an observational epidemiologic study, not an intervention evaluation or trial. We will not be reporting results of an intervention on human participants.

Risk factors for intimate partner violence and abuse among adolescents and young adults: findings from a UK population-based cohort

Background: Approximately one-third of young people in the UK have suffered intimate partner violence and abuse (IPVA) on reaching adulthood. We need interventions to prevent IPVA in this population, but there is a lack of evidence on who is at greatest risk. Methods: We analysed questionnaire data from 3,279 participants of the Avon Longitudinal Study of Parents and Children population-based birth cohort. We estimated the prevalence of IPVA victimisation and perpetration by age 21, by sex, demographic, parenting, mental health, externalising behaviour (e.g. smoking), educational, employment, and adverse childhood factors. Results: Overall, 29% of males and 41% of females reported IPVA victimisation, with 20% and 25% reporting perpetration, respectively (16% and 22% both). The most common type of IPVA was emotional, followed by physical, then sexual. History of anxiety, self-harm, anti-social behaviour, cannabis or illicit (non-cannabis) drug use, or risky sexual behaviour among males and females were associated with a 50% increase in likelihood of IPVA (victimisation or perpetration). Males reporting depression, sexual abuse (not by an intimate partner), witnessing domestic violence, or parental separation were also more likely to experience IPVA. Extreme parental monitoring, high academic achievement during adolescence, and NEET (not being in education, employment, or training) status in young adulthood were associated with reduced risks of IPVA. Conclusions: A range of demographic, mental health, and behavioural factors were associated with increased prevalence of IPVA victimisation or perpetration. Further study of likely complex pathways from these factors to IPVA, to inform primary prevention, is needed.

Reaching everyone in general practice? Feasibility of an integrated domestic violence training and support intervention in primary care

Background

Primary care needs to respond effectively to patients experiencing or perpetrating domestic violence and abuse (DVA) and their children, but there is uncertainty about the value of integrated programmes. The aim of the study was to develop and test the feasibility of an integrated primary care system-level training and support intervention, called IRIS+ (Enhanced Identification and Referral to Improve Safety), for all patients affected by DVA. IRIS+ was an adaptation of the original IRIS (Identification and Referral to Improve Safety) model designed to reach female survivors of DVA.

Methods

Observation of training; pre/post intervention questionnaires with clinicians and patients; data extracted from medical records and DVA agency; semi-structured interviews with clinicians, service providers and referred adults and children. Data collection took place between May 2017 and April 2018. Mixed method analysis was undertaken to triangulate data from various sources to assess the feasibility and acceptability of the intervention.

Results

Clinicians and service providers believed that the IRIS+ intervention had filled a service gap and was a valuable resource in identifying and referring women, men and children affected by DVA. Despite increased levels of preparedness reported by clinicians after training in managing the complexity of DVA in their practice, the intervention proved to be insufficient to catalyse identification and specialist referral of men and direct identification and referral (without their non-abusive parents) of children and young people. The study also revealed that reports provided to general practice by other agencies are important sources of information about adult and children patients affected by DVA. However, in the absence of guidance about how to use this information in patient care, there are uncertainties and variation in practice.

Conclusions

The study demonstrates that the IRIS+ intervention is not feasible in the form and timeframe we evaluated. Further adaptation is required to achieve identification and referral of men and children in primary care: an enhanced focus on engagement with men, direct engagement with children, and improved guidance and training on responding to reports of DVA received from other agencies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-020-01297-5.

Help seeking by male victims of domestic violence and abuse: an example of an integrated mixed methods synthesis of systematic review evidence defining methodological terms

Background

Domestic violence and abuse is a violation of human rights which damages the health and wellbeing of victims, their families and their friends. There has been less research on the experiences and support needs of male victims than those of women. Historically research on men’s experiences has not focused on what constitutes effective, needs-led service provision. The aim of this paper was to conduct an integrated mixed methods synthesis of systematic review evidence on the topic of help-seeking by male victims of domestic violence and abuse.

Methods

An integrated mixed methods synthesis approach was taken to enhance our understanding of the complex phenomenon of help seeking by, and service provision to male victims. This process also identifies gaps in the evidence. Using previously identified systematic review data; mixed methods data from four primary-level service evaluation studies, along with expert and patient consultation were used to develop research propositions. Primary-level qualitative interview and survey data from 12 studies of men experiences were mapped onto the propositions to support them.

Results

Fourteen propositions were composed. Seven propositions were supported or at least partly supported by the qualitative data. These supported propositions were used to make recommendations for policy and practice particularly concerning service preferences of male victims. The remaining seven propositions were not specifically supported by the qualitative data. These unsupported propositions were used to develop research recommendations concerning the need to further understand the potential blurred boundaries of victim–perpetrator, hybrid perpetrator-victim experiences, men who are/have been victims of childhood sexual abuse and determining the level of risk for men. They also highlight the need to produce better guidance for the response of the police & the criminal justice system. Finally, they highlight the need to produce the most appropriate service for men in terms of access, linkage, substance/alcohol abuse, mental health, sexuality, and race.

Conclusion

Integrated mixed-methods synthesis of systematic review evidence is a relatively novel approach. This approach can lead to recommendations for policy and practice as well as highlighting gaps in the research agenda as shown in this example.

Risk factors for intimate partner violence and abuse among adolescents and young adults: findings from a UK population-based cohort

Background: Approximately one-third of young people in the UK have suffered intimate partner violence and abuse (IPVA) on reaching adulthood. We need interventions to prevent IPVA in this population, but there is a lack of evidence on who is at greatest risk. Methods: We analysed questionnaire data from 3,279 participants of the Avon Longitudinal Study of Parents and Children population-based birth cohort. We estimated the prevalence of IPVA victimisation and perpetration by age 21, by sex, demographic, parenting, mental health, externalising behaviour (e.g. smoking), educational, employment, and adverse childhood factors. Results: Overall, 29% of males and 41% of females reported IPVA victimisation, with 20% and 25% reporting perpetration, respectively (16% and 22% both). The most common sub-type was emotional, followed by physical, then sexual. History of self-harm, anti-social behaviour, cannabis or illicit (non-cannabis) drug use among males and females were associated with a two-fold increase in likelihood of IPVA (victimisation or perpetration). Males reporting risky sexual behaviour, sexual abuse (not by an intimate partner), or witnessing domestic violence, and females reporting sexual minority status in adolescence were also twice as likely to experience IPVA. Extreme parental monitoring during adolescence was associated with a reduced risk of IPVA in males and females, as was high academic achievement, and NEET (not being in education, employment, or training) status for young adult men. Conclusions: A range of demographic, mental health, and behavioural factors were associated with increased prevalence of IPVA victimisation or perpetration. Further study of likely complex pathways from these factors to IPVA, to inform primary prevention, is needed.

Risk factors for intimate partner violence and abuse among adolescents and young adults: findings from a UK population-based cohort

Background: Approximately one-third of young people in the UK have suffered intimate partner violence and abuse (IPVA) on reaching adulthood. We need interventions to prevent IPVA in this population, but there is a lack of evidence on who is at greatest risk. Methods: We analysed questionnaire data from 3,279 participants of the Avon Longitudinal Study of Parents and Children population-based birth cohort. We estimated the prevalence of IPVA victimisation and perpetration by age 21, by sex, demographic, parenting, mental health, externalising behaviour (e.g. smoking), educational, employment, and adverse childhood factors. Results: Overall, 29% of males and 41% of females reported IPVA victimisation, with 20% and 25% reporting perpetration, respectively (16% and 22% both). The most common sub-type was emotional, followed by physical, then sexual. History of self-harm, anti-social behaviour, cannabis or illicit (non-cannabis) drug use among boys and girls was associated with a two-fold increase in likelihood of IPVA (victimisation or perpetration). Males reporting risky sexual behaviour, sexual abuse (not by an intimate partner), or witnessing domestic violence, and females reporting sexual minority status in adolescence were also twice as likely to experience IPVA. Extreme parental monitoring during adolescence was associated with a reduced risk of IPVA in males and females, as was not being in education, employment, or training for young adult men. Conclusions: A range of demographic, mental health, and behavioural factors were associated with increased prevalence of IPVA victimisation or perpetration. Further study of likely complex pathways from these factors to IPVA, to inform primary prevention, is needed.

Sharing reports about domestic violence and abuse with general practitioners: a qualitative interview study

BACKGROUND

Domestic violence and abuse (DVA) is common and damaging to health. UK national guidance advocates a multi-agency response to DVA, and domestic homicide reviews consistently recommend improved information-sharing between agencies. Identification of patients experiencing DVA in general practice may come from external information shared with the practice, such as police incident reports and multi-agency risk assessment conference (MARAC) reports. The aim of this study was to explore the views of general practitioners (GPs) and the police about sharing reports about DVA with GPs.

METHODS

Qualitative semi-structured interviews were conducted with GPs, police staff and a partnership manager. Participants were located across England and Wales. Thematic analysis was undertaken.

RESULTS

Interviews were conducted with 23 GPs, six police staff and one former partnership manager. Experiences of information-sharing with GPs about DVA varied. Participants described the relevance and value of external reports to GPs to help address the health consequences of DVA and safeguard patients. They balanced competing priorities when managing this information in the electronic medical record, namely visibility to GPs versus the risk of unintended disclosure to patients. GPs also spoke of the judgements they made about exploring DVA with patients based on external reports, which varied between abusive and non-abusive adults and children. Some felt constrained by short general practice consultations. Some police and GPs reflected on a loss of control when information about DVA was shared between agencies, and the risk of unintended consequences. Both police and GPs highlighted the importance of clear information and a shared understanding about responsibility for action.

CONCLUSION

GPs regarded external reports about DVA as relevant to their role, but safely recording this information in the electronic medical record and using it to support patients required complex judgements. Both GPs and police staff emphasised the importance of clarity of information and responsibility for action when information was shared between agencies about patients affected by DVA.

Help-seeking by male victims of domestic violence and abuse (DVA): a systematic review and qualitative evidence synthesis

OBJECTIVES

To understand help-seeking by male victims of domestic violence and abuse (DVA) and their experiences of support services by systematically identifying qualitative and mixed-method studies and thematically synthesising their findings.

DESIGN

Systematic review and qualitative evidence synthesis. Searches were conducted in 12 databases and the grey literature with no language or date restrictions. Quality appraisal of the studies was carried out using the Critical Appraisal Skills Programme tool. Reviewers extracted first and second order constructs related to help-seeking, identified themes and combined them by interpretative thematic synthesis.

SETTING

DVA experienced by male victims and defined as any incident or pattern of incidents of controlling coercive or threatening behaviour, violence or abuse among people aged 18 or over who are or have been intimate partners or family members, regardless of gender or sexuality.

PARTICIPANTS

Male victims of DVA.

INTERVENTIONS

Any intervention which provides practical and/or psychological support to male victims of DVA including but not limited to DVA-specific services, primary healthcare and sexual health clinics.

PRIMARY AND SECONDARY OUTCOME MEASURES

Qualitative data describing help-seeking experiences and interactions with support services of male victims of domestic violence RESULTS: We included twelve studies which were published between 2006 and 2017. We grouped nine themes described over two phases (a) barriers to help-seeking: fear of disclosure, challenge to masculinity, commitment to relationship, diminished confidence/despondency and invisibility/perception of services; and (b) experiences of interventions and support: initial contact, confidentiality, appropriate professional approaches and inappropriate professional approaches.

CONCLUSION

The recent publication of the primary studies suggests a new interest in the needs of male DVA victims. We have confirmed previously identified barriers to help-seeking by male victims of DVA and provide new insight into barriers and facilitators to service provision.

PROSPERO REGISTRATION NUMBER

CRD42016039999.

Identification and initial response to children's exposure to intimate partner violence: a qualitative synthesis of the perspectives of children, mothers and professionals

OBJECTIVES

To synthesise evidence on the acceptable identification and initial response to children's exposure to intimate partner violence (IPV) from the perspectives of providers and recipients of healthcare and social services.

DESIGN

We conducted a thematic synthesis of qualitative research, appraised the included studies with the modified Critical Appraisal Skills Programme checklist and undertook a sensitivity analysis of the studies scored above 15.

DATA SOURCES

We searched eight electronic databases, checked references and citations and contacted authors of the included studies.

ELIGIBILITY CRITERIA

We included qualitative studies with children, parents and providers of healthcare or social services about their experiences of identification or initial responses to children's exposure to IPV. Papers that have not been peer-reviewed were excluded as well as non-English papers.

RESULTS

Searches identified 2039 records; 11 studies met inclusion criteria. Integrated perspectives of 42 children, 212 mothers and 251 professionals showed that sufficient training and support for professionals, good patient-professional relationship and supportive environment for patient/clients need to be in place before enquiry/disclosure of children's exposure to IPV should occur. Providers and recipients of care favour a phased enquiry about IPV initiated by healthcare professionals, which focuses on 'safety at home' and is integrated into the context of the consultation or visit. Participants agreed that an acceptable initial response prioritises child safety and includes emotional support, education about IPV and signposting to IPV services. Participants had conflicting perspectives on what constitutes acceptable engagement with children and management of safety. Sensitivity analysis produced similar results.

CONCLUSIONS

Healthcare and social service professionals should receive sufficient training and ongoing individual and system-level support to provide acceptable identification of and initial response to children's exposure to IPV. Ideal identification and responses should use a phased approach to enquiry and the WHO Listen, Inquire about needs and concerns, Validate, Enhance safety and Support principles integrated into a trauma-informed and violence-informed model of care.

Making the links between domestic violence and child safeguarding: an evidence-based pilot training for general practice

We describe the development of an evidence-based training intervention on domestic violence and child safeguarding for general practice teams. We aimed - in the context of a pilot study - to improve knowledge, skills, attitudes and self-efficacy of general practice clinicians caring for families affected by domestic violence. Our evidence sources included: a systematic review of training interventions aiming to improve professional responses to children affected by domestic violence; content mapping of relevant current training in England; qualitative assessment of general practice professionals' responses to domestic violence in families; and a two-stage consensus process with a multi-professional stakeholder group. Data were collected between January and December 2013. This paper reports key research findings and their implications for practice and policy; describes how the research findings informed the training development and outlines the principal features of the training intervention. We found lack of cohesion and co-ordination in the approach to domestic violence and child safeguarding. General practice clinicians have insufficient understanding of multi-agency work, a limited competence in gauging thresholds for child protection referral to children's services and little understanding of outcomes for children. While prioritising children's safety, they are more inclined to engage directly with abusive parents than with affected children. Our research reveals uncertainty and confusion surrounding the recording of domestic violence cases in families' medical records. These findings informed the design of the RESPONDS training, which was developed in 2014 to encourage general practice clinicians to overcome barriers and engage more extensively with adults experiencing abuse, as well as responding directly to the needs of children. We conclude that general practice clinicians need more support in managing the complexity of this area of practice. We need to integrate and further evaluate responses to the needs of children exposed to domestic violence into general practice-based domestic violence training.

Training on domestic violence and child safeguarding in general practice: a mixed method evaluation of a pilot intervention

Background

Children’s exposure to domestic violence is a type of child maltreatment, yet many general practice clinicians remain uncertain of their child safeguarding responsibilities in the context of domestic violence. We developed an evidence-based pilot training on domestic violence and child safeguarding for general practice teams. The aim of this study was to test and evaluate its feasibility, acceptability and the direction of change in short-term outcome measures.

Methods

We used a mixed method design which included a pre-post questionnaire survey, qualitative analysis of free-text comments, training observations, and post-training interviews with trainers and participants. The questionnaire survey used a validated scale to measure participants’ knowledge, confidence/ self-efficacy, and beliefs/ attitudes towards domestic violence and child safeguarding in the context of domestic violence.

Results

Eleven UK general practices were recruited (response rate 55%) and 88 clinicians attended the pilot training. Thirty-seven participants (42%) completed all pre-post questionnaires and nine were interviewed. All training sessions were observed. All six trainers were interviewed. General practice clinicians valued the training materials and teaching styles, opportunities for reflection and delivery by local trainers from both health and children’s social services. The training elicited positive changes in total outcome score and knowledge and confidence/ self-efficacy sub scores which remained at 3-month follow up. However, the mean sub score of beliefs and attitudes did not change and the qualitative results were mixed. Two interviewees described changes in their clinical practice. Participants’ suggestions for improving the training included incorporating more ethnic and class diversity in the material, using cases with multiple socio economic disadvantages, and addressing multi-agency collaboration in the context of changing and under-resourced services for children.

Conclusions

The pilot training for general practice on child safeguarding in the context of domestic violence was feasible and acceptable. It elicited positive changes in clinicians’ knowledge and confidence/ self-esteem. The extent to which clinical behaviour changed is unclear, but there are indications of changes in practice by some clinicians. The pilot training requires further refinement and evaluation before implementation.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-017-0603-7) contains supplementary material, which is available to authorized users.

Interventions to Improve the Response of Professionals to Children Exposed to Domestic Violence and Abuse: A Systematic Review

Exposure of children to domestic violence and abuse (DVA) is a form of child maltreatment with short- and long-term behavioural and mental health impact. Health care professionals are generally uncertain about how to respond to domestic violence and are particularly unclear about best practice with regards to children's exposure and their role in a multiagency response. In this systematic review, we report educational and structural or whole-system interventions that aim to improve professionals' understanding of, and response to, DVA survivors and their children. We searched 22 bibliographic databases and contacted topic experts for studies reporting quantitative outcomes for any type of intervention aiming to improve professional responses to disclosure of DVA with child involvement. We included interventions for physicians, nurses, social workers and teachers. Twenty-one studies met the inclusion criteria: three randomised controlled trials (RCTs), 18 pre-post intervention surveys. There were 18 training and three system-level interventions. Training interventions generally had positive effects on participants' knowledge, attitudes towards DVA and clinical competence. The results from the RCTs were consistent with the before-after surveys. Results from system-level interventions aimed to change organisational practice and inter-organisational collaboration demonstrates the benefit of coordinating system change in child welfare agencies with primary health care and other organisations. Implications for policy and research are discussed. © 2015 The Authors. Child Abuse Review published by John Wiley & Sons Ltd. 'We searched 22 bibliographic databases and contacted topic experts'.

KEY PRACTITIONER MESSAGES

We reviewed published evidence on interventions aimed at improving professionals' practice with domestic violence survivors and their children.Training programmes were found to improve participants' knowledge, attitudes and clinical competence up to a year after delivery.Key elements of successful training include interactive discussion, booster sessions and involving specialist domestic violence practitioners.Whole-system approaches aiming to promote coordination and collaboration across agencies appear promising but require funding and high levels of commitment from partners. 'Training programmes were found to improve participants' knowledge, attitudes and clinical competence up to a year after delivery'.

General practice clinicians' perspectives on involving and supporting children and adult perpetrators in families experiencing domestic violence and abuse

BACKGROUND

Government and professional guidance encourages general practice clinicians to identify and refer children who experience domestic violence and abuse (DVA) but there is scant understanding of how general practice clinicians currently work with DVA in families.

OBJECTIVES

The study explored general practice clinicians' practice with children and their parents experiencing DVA and reflected on the findings in the light of current research and policy guidelines.

METHODS

Semi-structured interviews with 54 clinicians (42 GPs and 12 practice nurses/nurse practitioners) were conducted across six sites in England. Data were analysed using current literature and emerging themes. Data presented here concern clinicians' perspectives on engaging with family members when a parent discloses that she is experiencing DVA.

RESULTS

When a parent disclosed DVA, clinicians were more likely to consider talking to abusive fathers than talking to children about the abuse. Perspectives varied according to whether consultation opportunities arose, risks, consent and confidentiality. Perceptions of 'patienthood', relationships and competence shaped clinicians' engagement. Perpetrators were seen as competent informers and active service users, with potential for accepting advice and support. Clinicians were more hesitant in talking with children. Where this was considered, children tended to be seen as passive informants, only two GPs described direct and ongoing consultations with children and providing them with access to support.

CONCLUSION

Clinicians appear more inclined to engage directly with abusive fathers than children experiencing DVA. Clinician skills and confidence to talk directly with children experiencing DVA, in child sensitive ways, should be developed through appropriate training.

Outcomes of Short Course Interprofessional Training in Domestic Violence and Child Protection

The interrelationship between domestic violence and child protection is well established, yet deficiencies in interprofessional collaboration have been reported and training is advocated as a solution. This study evaluates the outcomes of short interagency and interprofessional training in domestic abuse. Participants’ attitudes and knowledge were assessed using a self-report scale and compared in a double-baseline time-series design. Participants ( N = 177) were recruited from a range of agencies in England. There were consistent, statistically significant improvements in participants’ attitudes, knowledge, and self-confidence between the start and end of course ( p < .001). The long-term outcomes of training and the implementation of learning, however, remain uncertain.