Domestic violence and abuse affects around a quarter of women and a fifth of men in the UK. Health services are crucial in responding to and helping prevent further abuse, by intervening early, providing information, and referring patients to specialist services. Sexual health services are particularly well placed to intervene, because people who experience domestic violence and abuse often use these services because of unintended pregnancies and sexual health problems.
The IRIS (Identification and Referral to Improve Safety) programme is an evidence-based training package for staff working in GP surgeries. It helps them to identify and respond to women who are experiencing domestic violence and abuse, and refer them on to specialist services. In areas where the IRIS programme has been piloted, there has been a significant increase in women being referred to domestic violence agencies.
Following this success in primary care, the IRIS ADViSE (Assessing for Domestic Violence in Sexual Health Environments) pilot looked at using the IRIS approach in a sexual health setting. It provided IRIS-based training to the sexual health workforce, with the aim of increasing professional awareness and improving their responses to women experiencing domestic violence and abuse.
We wanted to understand the views and experiences of sexual health clinic staff and domestic violence and abuse advocate workers involved in the IRIS ADViSE pilot.
What we did
We interviewed 17 staff who had been involved in the IRIS ADViSE pilot. Both sexual health clinic staff and domestic violence and abuse advocate workers were included.
What we found and what this means
All the people we interviewed felt that asking about and referring women on to domestic violence and abuse specialist services was appropriate and valuable in a sexual health setting.
The staff described feeling confident and prepared after the training. They were able to tailor how they asked about domestic abuse to suit the patient. Some staff did describe initial difficulties with ensuring a ‘comfortable’ consultation. Also, when a patient disclosed that they’d been abused, the resulting time pressure could also be difficult to manage.
The staff reported that some disclosures were considered relatively simple and easy to handle, when patients can be easily referred to the partner domestic violence and abuse organisation or provided with information.
However, cases with an immediate risk of harm to the patient or their children were more complex in terms of managing the patient’s wishes and navigating safeguarding procedures. This added to the already busy workloads of the staff, and increased the pressure on their limited time.
Increased recognition of the issues around domestic violence and abuse referrals is essential at the policy and commissioning level. And more resources are needed to support the referral process. Commissioners and local NHS trusts need to engage and commit to training workers to identify and support women who have been abused. This should include supporting programmes such as IRIS ADViSE.
We are investigating if the IRIS approach could be used by community pharmacists.
CLAHRC BITE (Brokering Innovation Through Evidence)
Links and downloads
- Assessing for domestic violence in sexual health environments: a qualitative study Read the full paper
- Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention Read the companion quantitative paper from Queen Mary University London and University of Bristol
- BMJ STI editorial on this project Routine enquiry for domestic violence and abuse in sexual health settings
- BMJ STI editor Jackie Cassell talks to Neha Pathak and Gene Feder about this research BMJ STI podcast