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Cost effectiveness of primary care training & support programme for secondary prevention of DVA

Recent research evaluated the cost-effectiveness of the Identification and Referral to Improve Safety plus (IRIS+) intervention compared with usual care using feasibility data derived from seven UK general practice sites.

IRIS+ is a training and support programme for clinicians working in primary care to aid in their identification of those experiencing or perpetrating domestic violence / abuse (DVA).

VISION Deputy Director, Dr Estela Capelas Barbosa and Director, Professor Gene Feder, worked with their University of Bristol colleagues to conduct a cost–utility analysis, a form of economic evaluation comparing cost with patient-centred outcome measures, as a means to measure the benefit obtained from the treatment or intervention.

The specific cost-utility analysis they conducted assessed the potential cost-effectiveness of IRIS+ which assists primary care staff in identifying, documenting and referring not only women, but also men and children who may have experienced DVA as victims, perpetrators or both.

The analysis showed that in practices that adopted the IRIS+ intervention, a savings of £92 per patient occurred. The incremental net monetary benefit was positive (£145) and the IRIS+ intervention was cost-effective in 55% of simulations (when the model is repeated with different assumptions).

The research team therefore concluded that the IRIS+ intervention could be cost-effective in the UK from a societal perspective though there are large uncertainties. To resolve these the team will conduct a large trial with further economic analysis.

For further information please see: Primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a cost-effectiveness feasibility model | BMJ Open

Or contact Dr Estela Capelas Barbosa at e.capelasbarbosa@bristol.ac.uk

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COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse

Dr Estela Capelas Barbosa, VISION Deputy Director has recently published, COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse: a mixed methods rapid study in the BMC Primary Care journal, with Lucy Downes, IRIS Network Director.

Increased incidence and/or reporting of domestic abuse (DA) occurred during the COVID-19 pandemic. As a result of the lockdowns across the UK, services providing support to victims had to adapt and consider adding methods of remote outreach to their programmes.

Identification and Referral to Improve Safety (IRIS) is a programme to improve the response to domestic abuse in general practice, providing training for general practice teams and support for patients affected by DA. The COVID-19 pandemic required those running the programme to adapt to online training and remote support.

Estela and Lucy employed a mixed methods rapid approach to this research in order to gather evidence around the relevance, desirability and acceptability of IRIS operating remotely. Quantitative IRIS referral data were triangulated with data from surveys and interviews. They found that the adaptation to online training and support of IRIS was acceptable and desirable.

This study contributes to practice by asserting the desirability and acceptability of training clinicians to be able to identify, ask about DA and refer to the IRIS programme during telephone/online consultations. The findings from this study may be of interest to (public) health commissioners when making commissioning decisions to improve the general practice response to domestic abuse.

For further information please see: COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse: a mixed methods rapid study | BMC Primary Care (springer.com)

Or contact Dr Estela Capelas Barbosa at e.capelasbarbosa@bristol.ac.uk

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Criminology hindered by lack of longitudinal data to study consequences of victimisation

VISION researchers Dr Vanessa Gash and Dr Niels Blom write in their latest publication, Measures of Violence within the United Kingdom Household Longitudinal Survey and the Crime Survey for England and Wales: An Empirical Assessment, that the field of criminology has been hampered by a lack of longitudinal data to examine the consequences of victimisation.

However, recently, ‘Understanding Society’, the United Kingdom Household Panel Survey (UKHLS), began fielding a small battery of questions relating to violence experience. Here, we examined the strengths and weaknesses of these UKHLS measures with similar indices from the Crime Survey for England and Wales (CSEW), a widely used and regarded but cross-sectional survey.

Vanessa and Niels empirically assessed the extent to which the UKHLS variables are comparable with those in the CSEW to determine the viability of the UKHLS for the longitudinal study of (fear of) violence and its consequences.

Overall, they regarded the UKHLS to provide an important resource for future panel research on the consequences of victimisation. They found the indicators measuring physical assault to be similar in both sets of data, but also noted differences in prevalence and/or different distributions by socioeconomic group for the indices relating to being threatened and of feeling unsafe.

Nonetheless, Vanessa and Niels maintain their utility for researchers in this field, allowing researchers to uncover new inequalities in violence exposure.

For further information please see: Measures of Violence within the United Kingdom Household Longitudinal Survey and the Crime Survey for England and Wales: An Empirical Assessment

Or contact Dr Vanessa Gash at vanessa.gash.1@city.ac.uk

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Measuring violence using administrative data collected by specialist domestic and sexual violence and abuse support services

Interpersonal violence, which can include various forms of domestic and sexual violence and abuse (DSVA) is a leading cause of death, particularly among young adults. In the UK, specialist DSVA services provide much-needed support to victim-survivors of these types of violence, and some provide support for perpetrators to change their behaviour. To monitor and support their work, specialist services collect data on violence. This data has the potential to improve understanding of violence but presents unique challenges.

In this review, VISION researchers Dr Annie Bunce, Dr Sophie Carlisle and Dr Estela Capelas Barbosa describe and discuss some of the key challenges facing the data collected by specialist services.

Inconsistencies in data collection arise due to the differing remits and priorities of specialist services, which mean violence and abuse are defined and measured in slightly different ways by these organisations. Particularly, the review highlights the significant variation in outcomes and outcome measurement tools used to evidence the effectiveness of services and interventions.

Specialist support services collect valuable data on many and multiple types of violence, the wide impacts of violence on victim-survivors’ lives, and information about perpetrators. As the data are not collected for research purposes, a considerable amount of work is often required to make the data suitable for statistical analysis. Critically, the piecemeal and insecure funding of specialist services limits their capacity to collect and analyse data.

Together these issues make it challenging to collate data from specialist services and use it to inform measurements of violence. 

The researchers recommend the development of a core outcomes framework, exploration of methods for linking specialist services data with other sources of administrative data on violence, and sustainable funding for third sector specialist support services.

For further information please see: Social Sciences | Free Full-Text | The Concept and Measurement of Interpersonal Violence in Specialist Services Data: Inconsistencies, Outcomes and the Challenges of Synthesising Evidence (mdpi.com)

Or contact Dr Annie Bunce at annie.bunce@city.ac.uk

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Young People and Intimate Partner Violence: Experiences of Support and Services in England

Although estimating the prevalence of victimisation among young people is challenging, previous research indicates that around a fifth of young people have experienced physical violence from an intimate partner, half experienced emotional victimisation, and a quarter report some type of unwanted sexual contact. National UK crime surveys consistently find young women to be at greater risk of victimisation than those over 25, and intimate partner violence and abuse (IPVA) is one of the leading risks of death globally for younger women (aged 20–24).

In this paper, VISION Director Professor Gene Feder and colleagues from the University of Bristol and University of Central Lancashire, explored young people’s experiences of seeking or receiving institutional help and support in relation to IPVA.

Semi-structured interviews were carried with 18 young people aged 18 to 25, using Life History Calendars. Experiences of range of types of services in relation to intimate partner violence were explored, including support from education; primary and maternity services; third sector organisations; and counselling and support workers.

Participants said that they wanted clearer information to be provided in schools on identifying abuse from a younger age and better signposting and access to specialist services. They described how they benefited from equal power dynamics in relationships with professionals where they were supported to make their own decisions.

The authors found that young people often view adult support services as not for them and more needs to be done to understand effective responses to IPVA among different groups. Professionals in all sectors (including schools) need IPVA trauma-informed training that encourages equal power dynamics, with a clear understanding of and access to referral pathways, to be able to respond better to the specific needs of young people experiencing IPVA.

For further information please see: Young People and Intimate Partner Violence: Experiences of Institutional Support and Services in England | SpringerLink

Or contact Dr Maria Barnes at maria.barnes@bristol.ac.uk

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Varying definitions and measurements of violence limit reduction strategies

Violence reduction is a United Nations (UN) sustainable development goal (SDG) and is important to both the public health and criminology fields. The collaboration between the two has the potential to create and improve prevention strategies but has been hampered by the usage of different definitions and measurements.

In this paper, VISION researchers Dr Niels Blom, Dr Anastasia Fadeeva and Dr Estela Capelas Barbosa explore the definitions and measurements of violence by the World Health Organization, UN, and Council of Europe to arrive at a harmonized framework aligned with the SDGs.

Violence and abuse are defined by these organizations as intentional actions that (are likely to) lead to harm, irrespective of physicality or legality. When recording violence and abuse, health- and justice-based administrative systems use different codes which cannot directly be translated without resorting to broad overarching categories.

The researchers propose a framework to record violence that includes individual and event identifiers, forms of violence and abuse (including physical, sexual, and psychological), harm, and individual and event characteristics.

For further information please see: Social Sciences | Free Full-Text | The Concept and Measurement of Violence and Abuse in Health and Justice Fields: Toward a Framework Aligned with the UN Sustainable Development Goals (mdpi.com)

Or contact Niels at Niels.Blom@city.ac.uk

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Different childhood adversities lead to different health inequalities

Even experiencing just one type of adverse childhood experience (ACE) increases the risks of poor health outcomes in adulthood, including health-harming behaviours, poor sexual and mental health, and crime and violence.

Among people experiencing one type of ACE, this study examined which ACEs were most strongly related to each type of health harms, using a combined study sample of 20,556 18–69 years living in England and Wales. The research team, including VISION researcher Mark Bellis, found that sexual abuse in childhood strongly predicted subsequent obesity. Sexual abuse also showed the biggest increase in later cannabis use. Household alcohol problems in childhood was the ACE most strongly associated with violence and incarceration in adulthood. 

Toxic stress can arise from ACEs such as physical and sexual abuse, but other more prevalent ACEs, for example verbal abuse and parental separation, may also contribute substantively to poorer life course health.

For further information, please see: Comparing relationships between single types of adverse childhood experiences and health-related outcomes: a combined primary data study of eight cross-sectional surveys in England and Wales | BMJ Open

Or contact Mark Bellis at M.A.Bellis@ljmu.ac.uk

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Training GPs remotely during COVID-19: Lessons learned

There may have been a rise in domestic abuse during the COVID-19 pandemic. At the same time general practice adopted remote working, which extended to training and education being delivered online.

IRIS (Identification and Referral to Improve Safety) is an example of an evidence-based UK healthcare training support and referral programme, focusing on DVA, which transitioned to remote delivery during the pandemic.

To understand the adaptations and impact of remote DVA training in IRIS-trained general practices a group of researchers – including VISION members Estela Barbosa and Gene Feder – explored the perspectives of those delivering and receiving training. 

It was found that remote DVA training in UK general practice widened access to learners. However, it may have reduced learner engagement compared with face-to-face training. DVA training is integral to the partnership between general practice and specialist DVA services, and reduced engagement risks weakening this partnership.

The researchers recommend a hybrid DVA training model for general practice, including remote information delivery alongside a structured face-to-face element. This has broader relevance for other specialist services providing training and education in primary care.

For further information please see: Adapting domestic abuse training to remote delivery during the COVID-19 pandemic: perspectives from general practice and support services | British Journal of General Practice (bjgp.org)

Or contact Estela Barbosa Capelas at estela.barbosa@city.ac.uk

Mental health service use in perpetrators of partner violence

Perpetration of partner violence is more common in people with recent mental health service use compared to the general household population of England.

Research conducted by Dr Vishal Bhavsar, Kings College London (KCL); VISION Co-Investigator Professor Louise M. Howard, KCL; VISION Deputy Director Sally McManus, City, University of London; and Dr Katherine Saunders, KCL, has demonstrated this correlation is not affected by criminal justice involvement or by social demographics(e.g. class, education), but seems to be explained by greater exposure to childhood adversities and exposure to partner violence.

The researchers think this work highlights an important potential role for health services in responding to perpetrators of domestic abuse, especially services which provide care for people with mental health conditions. Effective strengthening of the healthcare system’s response to perpetrators of domestic abuse has the potential to reduce violence.

For further information please see: Intimate partner violence perpetration and mental health service use in England: analysis of nationally representative survey data | BJPsych Open | Cambridge Core

Or contact Dr Vishal Bhavsar at vishal.2.bhavsar@kcl.ac.uk

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Disclosing domestic violence on Reddit during the pandemic

Domestic violence (DV) is a huge social issue and during the COVID-19 pandemic, DV and intimate partner violence (IPV) increased. Frequently imposed quarantine increased contact between perpetrators and victims, potentially leading to underlying increases in the occurrence of violence at home.

Social media sites such as Reddit represent an alternative outlet for disclosing experiences of violence where healthcare access has been limited. This study analysed seven violence-related subreddits to investigate different violence patterns from January 2018 to February 2022, developing a new perspective and methodology for violence research. Specifically, we collected violence-related texts from Reddit using keyword searching and identified six major types of violence with supervised machine learning classifiers: DV, IPV, physical violence, sexual violence, emotional violence, and nonspecific violence or others. Among IPV-related posts, the number with COVID-related keywords was highest in the middle-pandemic phase.

The findings highlight the importance of the role of social media as a platform for disclosing and describing experiences of violence and support the role of social media site monitoring as a means of informative surveillance for help-providing authorities and violence research groups.

For further information please see: Characterizing the Differences in Descriptions of Violence on Reddit During the COVID-19 Pandemic – Lifang Li, Lilly Neubauer, Robert Stewart, Angus Roberts, 2023 (sagepub.com)

Or contact Lifang at lifang.li@kcl.ac.uk or Angus at angus.roberts@kcl.ac.uk

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