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

Abstract

Abstract 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 female victim-survivorsof 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, 11% of total referrals). Despite an increase in self-reported clinician preparedness to respond to all patient groups, the intervention generated a low number of male 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.