Background
Methods
Intervention development
IRIS+ intervention
Intervention delivery
Evaluation of feasibility
Results
Reaching clinicians
Engagement with and acceptability of the IRIS+ intervention
It was useful to know that there is support available for both victims and perpetrators. Having that more rounded view of trying to resolve or help people in domestic abuse situations … (Clinician2T1).
That’s one of the advantages of having clapped eyes on them and spoken to them. It’s one of the benefits of the training, really, that you have a face that you can put a name to. (Clinician3T1)
We’ve had much better access. It’s been quick – noted a GP. (Clinician5T2)
You’re probably more likely to identify things because you know there’s a support service there. (Clinician6T2)
There is so little available for people who are perpetrating abuse [ … ] actually all you can do is often, as a professional involved, to make suggestions or requirements for the non-abusive parent. IRIS+ is different in that way. (IRIS+ AE1)
You feel sometimes that social service referrals are a bit punitive, whereas IRIS+ just feels more supportive for the patients.[…] I think the feeling is that it’s a service that is very useful. […] You realise that things have been under our nose for quite a long time, so I think that’s probably why there are quite a few referrals relatively quickly. (Clinician6T2)
Impact on clinical practice
PIM+ questionnaire domains | n | T1 mean score | T2 mean score | Median change | 95% CI | Signed rank test P-value |
---|---|---|---|---|---|---|
Ask about DVA | ||||||
Female victims | 18 | 2.9 | 4.3 | 1.5 | [2.0, 1.0] | 0.0006 |
Female perpetrators | 18 | 1.5 | 3.6 | 2.0 | [2.5, 1.5] | 0.0002 |
Male victims | 18 | 2.1 | 4.1 | 2.0 | [2.5, 1.5] | 0.0002 |
Male perpetrators | 18 | 1.9 | 3.6 | 1.5 | [2.5, 1.0] | 0.0005 |
Parents | 18 | 2.1 | 3.7 | 1.5 | [2.0, 1.0] | 0.0002 |
Children and young people | 17 | 2.3 | 3.6 | 1.0 | [1.5, 1.0] | 0.0004 |
Identify signs and symptoms of DVA | ||||||
Female victims | 18 | 3.1 | 4.4 | 1.5 | [2.0, 1.0] | 0.0005 |
Female perpetrators | 18 | 1.6 | 3.8 | 2.0 | [3.0, 1.5] | 0.0002 |
Male victims | 18 | 2.2 | 4.0 | 2.0 | [2.0, 1.5] | 0.0002 |
Male perpetrators | 18 | 2.1 | 3.9 | 2.0 | [2.5, 1.0] | 0.0001 |
Parents | 17 | 2.4 | 4.0 | 1.5 | [2.0, 1.0] | 0.0003 |
Children and young people | 18 | 2.6 | 4.1 | 1.5 | [2.0, 1.0] | 0.0002 |
Respond to initial disclosure of DVA | ||||||
Female victims | 18 | 2.9 | 4.4 | 1.5 | [2.0, 1.0] | 0.0002 |
Female perpetrators | 18 | 1.7 | 4.2 | 2.5 | [3.0, 2.0] | 0.0002 |
Male victims | 18 | 2.5 | 4.3 | 2.0 | [2.0, 1.5] | 0.0002 |
Male perpetrators | 18 | 1.9 | 4.2 | 2.5 | [3.0, 1.5] | 0.0002 |
Parents | 18 | 2.4 | 4.2 | 1.5 | [2.0, 1.0] | 0.0002 |
Children and young people | 18 | 2.7 | 4.1 | 1.5 | [2.0, 1.0] | 0.0004 |
Refer | ||||||
Female victims | 18 | 2.9 | 4.6 | 1.5 | [2.5, 1.0] | 0.0005 |
Female perpetrators | 18 | 1.6 | 4.2 | 2.5 | [3.5, 2.0] | 0.0002 |
Male victims | 18 | 2.2 | 4.6 | 2.5 | [3.0, 2.0] | 0.0002 |
Male perpetrators | 18 | 1.9 | 4.2 | 2.5 | [3.0, 1.5] | 0.0003 |
Parents | 18 | 2.4 | 4.4 | 2.0 | [2.5, 1.5] | 0.0002 |
Children and young people | 18 | 2.6 | 4.4 | 2.0 | [2.5, 1.0] | 0.0002 |
Record information about DVA | ||||||
Female victims | 18 | 2.8 | 4.2 | 1.5 | [1.5, 1.0] | 0.0005 |
Female perpetrators | 18 | 2.2 | 4.1 | 2.0 | [2.5, 1.5] | 0.0003 |
Male victims | 18 | 2.6 | 4.1 | 1.5 | [2.0, 1.0] | 0.0003 |
Male perpetrators | 18 | 2.4 | 4.0 | 1.5 | [2.5, 1.0] | 0.0004 |
Parents | 18 | 2.6 | 3.9 | 1.5 | [2.0, 1.0] | 0.0006 |
Children and young people | 17 | 2.9 | 4.0 | 1.0 | [1.5, 0.5] | 0.0015 |
Provide ongoing support | ||||||
Female victims | 18 | 2.6 | 3.9 | 1.5 | [2.0, 1.0] | 0.0005 |
Female perpetrators | 18 | 1.6 | 3.5 | 2.0 | [2.5, 1.5] | 0.0002 |
Male victims | 18 | 2.1 | 3.8 | 1.5 | [2.0, 1.0] | 0.0002 |
Male perpetrators | 18 | 1.8 | 3.4 | 1.5 | [2.0, 1.0] | 0.0001 |
Parents | 18 | 2.2 | 3.6 | 1.0 | [2.0, 1.0] | 0.0002 |
Children and young people | 18 | 2.3 | 3.6 | 1.0 | [1.5, 1.0] | 0.0007 |
[T]hat’s been one of the things that’s changed for me from the training, is that it’s part of my standard routine for people with depressive or panic attack type symptoms particularly, is to include that. (Clinician3T2)
[I]t has certainly made me more aware […] of the potential of patients who are either victims, mainly victims, but also perpetrators of domestic abuse, what kind of other issues they may present with. […] alcohol and mental health issues being the more obvious things but also a variety of other more physical health issues. Other more subtle ways in which patients may present. It is sometimes worth just exploring that a little bit in consultations. (Clinician2T1)
‘Does it ever get scary?’ - I have actually used that - mentioned a doctor (Clinician8T1).
I wasn’t asking as directly about domestic violence before. Clearly, if someone was beaten up, I’d ask. Obviously, you do that. But not necessarily, say, implementing that in with depression. Whereas, as a result, since, I have actually directly asked people. […] I would now specifically say, ‘Do you get hurt by your partner?’ That’s a change, and I think that’s probably a good result. It’s been quite interesting seeing women - there have been women since - just take that completely in their stride. (Clinician3T1)
That was a key learning for me actually […] How we record things in the notes and how in some cases actually recording might increase the risk for a person. […] It actually led to a change in our practice about how we do that. (Clinician6T1)
Since the training, I feel definitely more comfortable broaching things with perpetrators. ‘Do you worry about your behaviour?’ … That sort of stuff […] It is a bit more difficult when they’ve come about other things, like, substance misuse or their mood and then actually asking them, but when the opportunity has arisen, definitely, I’ve got more awareness. (Clinician6T2).
It’s easy enough to say to a bloke, ‘The way you’re feeling at the moment, does it boil over into anger and is it causing problems at home?’ I don’t think that would be a particularly difficult thing to ask. […] If someone said that they were drinking a lot, ‘Has it made you violent? Does it make you violent when you drink?’ But I haven’t incorporated these into my routine. (Clinician3T2)
Identifications and referrals
If it wasn’t for IRIS+, I wouldn’t be sitting here with you. […] I saw her [the AE] and I left smiling, I was like, ‘I can fight, I can do it. Today, I’ll smile’. (Adult7).
Practice | Number of registered patients in 2018 | Recorded number of DVA identifications (EMR data) | Recorded number of referrals to the IRIS+ hub | ||||
---|---|---|---|---|---|---|---|
Adults | Children | Adults | Children | ||||
Female | Male | Female | Male | ||||
Practice A | 15700a | 14 | 0 | 1 | 7 | 0 | 2 |
Practice B | 11300a | 23 | 1 | 1 | 22 | 2 | 29 |
Practice C | 10000a | 4 | 0 | 1 | 2 | 0 | 0 |
Practice D | 6500a | 41 | 4 | 46 | 3 | 0 | 4 |
Total | 82 | 5 | 49 | 34 | 2 | 35 | |
IRIS+ support offered and accepted | 28 | 1 | 22 (6 direct support and 16 support for children via mother) |
Somebody should be coding it appropriately, and it should be part of the record, and accessible as part of the record, because potentially it’s important. And then beyond that, I should be considering it the same way that I consider all the bits of the jigsaw that might be relevant to a particular presentation by a particular patient. (Clinician9T2)
We have a lot of patients who are recorded that there’s domestic abuse. […] Yes, it’s a vast number. […] We normally deal with the medical issue that they’re presenting with. […] Patients would find this a little bit odd if you kept asking them about their domestic violence when they’ve come for something completely different. (Clinician4T1)
Reaching children
[T]here is a large amount of suspicion in our area, certainly for social services. There are a lot of people with child protection plans. I think probably people don’t make a finer distinction, necessarily, between any kinds of statutory agency. […] Almost the first thing that people say when there’s any suggestion of, well, even depression, people will say, ‘What matters to me most is not having someone thinking about taking my children away’. (Clinician3T2)
I tried to take an overdose. I just couldn’t cope anymore. I knew I had to do something because of the children. I’m the only thing they’ve got. So that was a big push for me to see the GP and to tell him what had happened. (Adult12)
The wrist-cutting stopped completely. She [CYPW] talked to her […] Before she would always say, ‘I don’t want to live.’ She said no-one loved her, no-one wanted her... Now it’s not like that. She no longer harms herself. (Adult6)
Just have a chat, just have adult conversations with someone in an environment that isn’t home. Yes, just having that safe space that I can talk about stuff and know that I’m going to be getting quite personal advice because she [CYPW] knew everything. […] It felt like there was always someone there for us. (Child3)
Not reaching men
We do see chaps that have got anger issues... I am definitely asking more about ‘Do you think anyone at home is scared of your behaviour?’ or ‘Do you think you frighten anyone?’, those sort of less confrontational questions […] whereas before I probably wouldn’t, other than maybe checking if there are children in the house or whether they’ve been violent. I wouldn’t have thought about the overall picture of domestic violence. […] I think I am going to try and push more with people that do come with mood swings, and similar things. (Clinician6T2)
I’m not conscious of having seen any strong evidence that any of these things make a great deal of difference. […] Patients sometimes do, unsurprisingly, ask questions like, ‘Well, what’s the point in me taking this treatment? What will it do? What potentially have I got to gain from this?’ and if you can’t answer that question, then it puts you in a difficult situation. (Clinician9T1)
My gut feeling is that it’s probably one of those things that’s accepted, like drink driving was and like not wearing your seatbelt was. (Clinician4T1)
Certainly, there were some of the GPs in the training who were on board and I think who really would have been doing their best to identify those male perpetrators, but a lot of the GPs found that very difficult, and those barriers, I think, were just insurmountable. It was just too big of an ask to be able to ask those questions in that timeframe. (IRIS+ AE1)