IRIS Identification and Referral to Improve Safety

“If they ask I would answer”

Judy Barber Islington IRIS Advocate Educator

© Bristol University 2007 – 2014

Cross government definition as of 31-3-13

Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality.

The definition includes ‘honour’ based violence, female genital mutilation (FGM) and forced marriage.

The abuse can encompass but is not limited to psychological, physical, sexual, financial and emotional abuse

Domestic violence & abuse

1,000 women study To measure the prevalence of DVA among women attending general

practice, the extent of recording of DVA in records and the acceptability of screening for DV by general practitioners (GPs) and Practice Nurses (PNs)

1207 women (over 15 years of age) completed a survey. Medical records reviewed.

13 selected general practices in Hackney, London. 41% had experienced physical violence, 74% had experienced any form

of controlling behaviour and 46% had been threatened. 17% had experienced physical violence and 35% had felt afraid in the last

12 months. Only 15% of women had any reference to violence in their medical record.

IRIS Randomised ControlledTrial (RCT)

48 practices recruited in total in Bristol & Hackney

24 practices trained; 24 used as control group

Practices received training and a named advocate

Identification & referral measured over 12 months

IRIS Randomised ControlledTrial Results

Results6 fold increase in referrals to specialist DVA service3 times more likely to have a recorded identification

in the medical record

Cost effectiveNHS savings of £1/woman registered/yearSocietal savings of £37/woman registered/year

Advocate Educator

Clinical Lead

IRIS advocateoffers emotional and practical supportprovides choices and empowers is patient led – provides a flexible approach

according to the woman’s situation, pace, readiness to change and individual goals

offers referrals to wide range of services, including MARAC, housing, counselling, legal support

provides case updates and advice to primary care professionals

IRIS educator

provides training for entire practice team is consultant to primary care professionals is named contact for referral provides ongoing support to practice team is the main source of domestic violence information

and materials feeds back data on disclosure and referral work in partnership with the clinical lead

Clinical lead Delivers session 1 IRIS training for clinicians in partnership with

the IRIS Advocate Educator encourage clinicians to ask patients about their experience of

abuse and respond, record, assess immediate risk and refer provide peer support to general practice colleagues maintain an effective relationship with general practice teams promote awareness of the experiences and needs of women

living with current or historic DVA, particularly in relation to their health

respond to queries from clinicians regarding DVA

Clinician’s voice“…I’m now convinced that Violence Against

Women and Girls is a major public health problem with long term consequences for

women and their families. As an experienced GP, the whole project has been nothing short of transformational.”

Survivor’s voice• “…the only doctor who ever asked…I was just so

relieved that somebody just said something. And he gave me the box of tissues and I just sat and cried…and he said, tell me when you’re ready, he said, there is somebody out there to help me. I’m not on my own. And if I want help, it’s there and not to be ashamed of it. Which I was, really ashamed of it and he said, you’re not on your own. We can get you this help. And he did. He really did.”