Expanding the IRIS (Identification and Referral to Improve Safety) domestic abuse programme to include men and children and young people is both feasible and potentially cost-effective, University of Bristol researchers have found.
Success in identifying women affected by domestic abuse through IRIS — a specialist domestic violence and abuse (DVA) training, support and referral programme for general practices — is growing. However, men and children and young people are rarely identified and referred for specialist support. Recognising this gap, a study by researchers from Bristol's Centre for Academic Primary Care has looked at the feasibility of expanding the scope of support to include them.
IRIS has been positively evaluated in a randomised controlled trial. Maintained by IRISi, the programme is now running in around 50 areas across the UK. While continuing to address the needs of women, the IRIS+ intervention, developed and tested by Bristol researchers in collaboration with IRISi and DVA agencies, extends support to men experiencing or perpetrating DVA and children and young people living with or experiencing DVA in their relationships.
The National Institute for Health and Care Research-funded study found that IRIS+ successfully enabled the identification and direct referral of 44 children and young people (15% of total 300 referrals) and 29 men (mostly survivors, 10% of total referrals).
It also revealed a high referral rate for women, doubling from the rate in the original IRIS trial. This suggests that the added intervention components on men and children, rather than potentially weakening clinicians' responses to women, heightened their general alertness for DVA.
Over two-thirds of referred women and children and young people, and almost half of all referred men received direct support from the service. The study demonstrated health and quality of life benefits for men and children supported by IRIS+.
An economic model indicated that IRIS+ is likely to be cost-effective or even cost-saving from a societal perspective.
The researchers used mixed methods to assess the feasibility of the intervention in two urban areas in England and Wales in a mixture of IRIS-trained and non-IRIS trained general practices, including:
- before and after intervention questionnaires
- data extraction from medical records and DVA agencies, and
- semi-structured interviews with clinicians and patients.
Dr Eszter Szilassy, Senior Research Fellow at the Centre for Academic Primary Care, and study lead, said: "Domestic abuse affects nine million adults in England and Wales, with societal costs exceeding £66 billion annually. Our findings show that primary care is well-placed to provide a pathway for specialist support to all patients affected by DVA. The next step involves exploring the effectiveness and cost-effectiveness of IRIS+ on a larger scale."
Medina Johnson, CEO at IRISi, added: "Domestic violence and abuse is a gendered issue but recognising the significance of responding comprehensively to all those impacted – be they victims/survivors or perpetrators – we acknowledge the crucial role of our health system in providing support. By expanding and improving programmes and responses within healthcare to encompass men and children, we strive to aid everyone affected, contributing to the collective effort for a safer society for all."
Papers
'Feasibility of a reconfigured domestic violence and abuse training and support intervention responding to affected women, men, children and young people through primary care' by Eszter Szilassy et al.in BMC Primary Care
'Primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a cost-effectiveness feasibility model' by Madeleine Cochrane et al. in BMJ Open
