16 Days of Activism - Day 9

16 Days of Activism - Day 9 - IRISi

PEGS Admin • Nov 30, 2023

Improving healthcare responses to Domestic Abuse: IRISi's mission against Gender-Based Violence

Navigating 16 essential insights from our work: delving into IRISi's impact through IRIS and ADViSE Programmes in a special feature for PEGS' 16 Days campaign.

1) How has IRISi been improving the healthcare response to Gender-Based Violence?

IRISi, established in 2017, is a social enterprise dedicated to enhancing healthcare responses to gender-based violence (GBV). Collaborating with partners, we develop evidence-based interventions, and provide expert advice and consultancy in the field of Domestic Abuse (DA) tailored for different healthcare settings.

2) Understanding the scale: what is the impact of domestic abuse on health?

Domestic abuse affects 26% of women in their lifetime, escalating to 41% for those attending general practice (CSEW, 2016; Richardson et al., 2002). With devastating health impacts, the annual cost of domestic abuse to health is £1.7bn (Walby, 2009). We aim to address this by supporting the local commissioning, implementation and sustainability of our programmes, which are tailored according to the specific needs of each healthcare setting.

3) What is the IRIS Programme?

IRIS, our flagship intervention, operates in primary care and is a specialist training, support and referral programme for General Practices. Positively evaluated in a randomised controlled trial, it significantly improves the healthcare response to DA.

4) How does IRISi provide local support to expand the IRIS Programme?

We actively support the local commissioning and growth of the IRIS programme, providing bid development, training for trainers, ongoing support and national analysis. This collaborative is crucial not only in bringing this initiative to more areas, but also in developing innovative, evidence-based health interventions for those affected by GBV.

5) How does IRIS work?

IRIS is a collaboration between primary care and third-sector domestic abuse specialist services. The initiative focuses on providing ongoing training, education and consultancy for clinical and administrative staff. Core areas include care pathways for practitioners and an enhanced referral pathway to a named specialist in a local DA service for patients.

6) What is the role of the Advocate Educator (AE)?

Every general practice joining the IRIS programme is supported by a named Advocate Educator, who provides crucial support to both the practice and patients identified during consultations. This ensures a personalised and effective response to DA.

7) What type of support do survivors receive?

The IRIS programme is designed and based on a survivor-centred model. This framework ensures that every patient identified and referred to our programmes receives support through a comprehensive approach by the AE, making sure that they have assistance tailored to their individual needs.

8) What does IRIS bring to General Practices?

General practices benefit from in-house, specialist DA training, ongoing support, health promotion materials, and enhanced safeguarding responses. The programme streamlines the referral pathway for patients and reducing response time. All those who complete the IRIS training gain CPD points.

9) Does IRIS increase referrals from General Practices?

Our ongoing evidence indicates that the IRIS programme increases referrals from general practice for patients affected by DA. Sustained funding for IRIS programmes is crucial for maintaining these positive outcomes.

10) What are the outcomes of the IRIS Programme for funders and commissioners?

The IRIS programme is nationally recognised and evidence-based, providing a cost-effective intervention for Integrated Care Boards (ICBs) and other commissioning bodies. Its positive impact includes improving the safety, quality of life and well-being of survivors, who reportedly see their GP and other general practice clinicians less frequently after being identified and supported through the programme.

11) Is it worth investing in the IRIS Programme?

The first areas implemented IRIS in 2010. From that point onwards, many other studies have been conducted to show the amplitude of this intervention, which is now running across the UK in more than 50 localities. Produced in 2022, “The social value of improving the primary care response to domestic violence and abuse: A mixed methods Social Return on Investment analysis of the IRIS programme” is one of those studies and it concludes:

For each pound invested in the IRIS Programme, a monetary return of £16.79 is expected.
For each pound invested in the IRIS Programme, a social return of £10.71 was obtained.

12) Has IRIS been nationally endorsed?

In 2021, the UK implemented the Domestic Abuse Act to enshrine a a comprehensive response to DA in legislation. The accompanying Domestic Abuse Statutory Guidance, issued by the Home Office in July 2022, targeted both statutory and non-statutory bodies, and recommended: “Implementing the IRIS (Identification and Referral to Improve Safety) Programme. IRIS is an evidence-based intervention to improve the general practice response to domestic abuse through training, support to practice teams and having a DA specialist embedded in practices. It is nationally recognised as best practice and has informed NICE guidance.”

13) What is the ADVISE Programme?

The ADViSE programme extends the success of IRIS to sexual health clinics, supporting clinicians to identify and respond to patients affected by Domestic & Sexual Violence and Abuse (D&SVA). This evidence-based programme also ensures a simple referral pathway to a named specialist in a local frontline service.

14) How does ADViSE identify and support a wider range of patients?

Aligned with the demographic typically served by sexual health clinics, ADViSE also facilitates the identification of a more extensive and diverse range of patient groups, providing visibility and support for individuals from minority groups.

15) How does ADViSE work?

ADViSE supports staff in recognising and responding to patients affected by D&SVA, offering direct referrals to specialist services. As with IRIS, the programme also strengthens local networks, increases safety and boosts staff confidence in responding to D&SVA.

16) Why sexual health clinics?

Women affected by Domestic Abuse are three times more likely to face gynaecological and sexual health problems. ADViSE, which was piloted successfully in Bristol and East London, addresses this gap by training sexual health practitioners to identify, respond and refer effectively.

To find out more about our work, please visit www.irisi.org.

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Grandparents can be abused too.

By Amanda Warburton-Wynn • 03 May, 2024

'Oh, we love having the grandchildren, especially because we can give them back!' How many times have you heard that? But have you heard 'We dread our grandchild coming to visit, we never feel safe until they've gone home'? Child to Parent Abuse is increasingly a topic of research but there is currently no formal definition and, if the consultation carried out by the Home Office in 2023 results in one, it's likely that grandparents won't get a mention in the main title. Of course, the age of grandparents can vary hugely but for those in the older age groups abuse from a child can be hard to understand and even harder to speak about. Whilst in many cases abusive behaviours are not linked to a health or mental health issue, some of the diagnoses involved in some cases of child to parent abuse weren't known until fairly recent times – ADHD was first recognised when mentioned in a National Institution of Clinical Excellence (NICE) report in 2000! Children who we now categorise as being victims of abuse and trauma were often just seen as 'naughty' back in the day and their behaviour needed to be dealt with by punishment. It's essential that we now recognise when children are asking for help – even if that is demonstrated by negative behaviours – but the impact of these behaviours on the whole family needs to be considered. Information Now say that In the past two generations, the number of children being cared for by their grandparents has increased substantially from 33% to 82% - almost two-thirds of all grandparents regularly look after their grandchildren. The UK Government add that 41% of mothers are working full time so it's clear that grandparents are spending more time with their grandchildren than ever before. There are myriad reasons for this including the changing demographics of an ageing population where many grandparents are now more physically active so spending time with grandparents can be more fulfilling than in the past (anyone else remember sitting in silence listening to the adults talk and drink team and hoping it would be time to go home soon?) But for all those positives, abuse of older people is a negative that's featuring more and more in research and in the news. Whilst several studies on both domestic abuse and elder abuse victimisation have reported that adult sons or grandsons, and a smaller proportion of adult daughters or granddaughters, are perpetrators in around half of all abuse against older adults (see Bows et al . 2022), there is little research into abuse by grandchildren who are aged under 18. One reason for this is likely to be the reluctance, by family members, professionals and society as a whole, to label children as 'perpetrators' or 'abusers Parents experiencing abuse from children have told PEGS that the abuse most commonly starts before the age of six and often continues post the child turning 18. It is probable that some children who display abusive behaviours towards parents will also abuse their grandparents but it's possible that some children abuse grandparents only. What is pretty much definite is that grandparents will feel the same emotions as parents if a child is abusing them – shame, guilt, worry about consequences of speaking out and concerned about causing problems within the family, especially if they appear to be the only targets of the abuse. It's also common to look for a reason for the abuse, something that has happened to the child perhaps or something that the grandparent has/hasn't done and to try to rationalise the abuse. As well as more research, there needs to be more recognition from organisations working with older people – statutory and voluntary – that Child to Parent Abuse can and does include children abusing grandparents and those grandparents need support. Abuse from a child is often no less dangerous than abuse from an adult so it shouldn't be laughed off or seen as grandparents not having enough 'control' over their grandchildren. More awareness of the issue, more open discussions and acknowledgement of the impact of this type of abuse will hopefully lead to appropriate support for grandparents who come forward to ask for help, and more of them doing so. Amanda Warburton-Wynn is an independent researcher and consultant specialising in support for domestic abuse and sexual violence survivors with disabilities and older people. You can find out more about Amanda and her work on her website www.awdaconsultancy.com