Abstract
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 knowledge and confidence 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 in the tested study timeframe. The study also revealed that information provided to general practices by other agencies is an important source 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 was 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.
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 knowledge and confidence 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 in the tested study timeframe. The study also revealed that information provided to general practices by other agencies is an important source 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 was 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.
| Original language | English |
|---|---|
| Article number | 19 |
| Number of pages | 17 |
| Journal | BMC Family Practice |
| Volume | 22 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 12 Jan 2021 |
Bibliographical note
Funding Information:IRIS+ is part of the REPROVIDE programme (Reaching Everyone Programme of Research On Violence in diverse Domestic Environments) [], an independent research programme funded by the National Institute for Health Research (Programme Grants for Applied Research), (RP-PG-0614-20012). The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. KP’s General Practice Academic Clinical Fellowship was funded by the National Institute for Health Research.
Publisher Copyright:
© 2021, The Author(s).
Keywords
- Domestic violence and abuse
- Male and female victims
- Male and female perpetrators
- Children and young people
- Training
- Intervention
- General Practice
- Primary Care
- Feasibility study
