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Trends in outcomes used to measure the effectiveness of domestic and sexual violence and abuse services: a scoping review

    In the UK, domestic and sexual violence and abuse (DSVA) is prevalent, and a range of support services and interventions are available to those who have experienced or perpetrated it. Currently, there is no consensus on how the effectiveness and impact of these services should be measured, nor is it clear what outcomes and outcome measures are currently being used by service providers and researchers.

    In 2022, VISION researchers, led by Dr Sophie Carlisle, co-designed and conducted a scoping review with an advisory group of representatives from six UK-based DSVA organisations, to summarise, map and identify trends in outcome measures used in evaluations and studies of DSVA services and interventions in the UK.

    They searched eight databases, four grey literature databases, put out a call for evidence and searched relevant DSVA websites and identified a total of 80 studies describing 87 interventions and services that were relevant to the review.

    A total of 426 outcome measures were extracted, of these there were 282 unique outcome measures. The most commonly used outcome, reported in 11 studies, was the cessation of abuse, as measured by the Severity of Abuse Grid. Over time, both the number of studies and the variety of outcome measures has increased.

    This research highlights inconsistencies in measurements of effectiveness in evaluations of DSVA services and research. As this area matures, there is an increased need for a core of common, reliable metrics.

    For further information please see: Trends in outcomes used to measure the effectiveness of UK-based support interventions and services targeted at adults with experience of domestic and sexual violence and abuse: a scoping review | BMJ Open

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    Unleashing social media potential to research violence against women and girls in Iran

      Researching violence against women and girls (VAWG) in low- and middle-income countries (LMICs) presents unique challenges, primarily due to various contextual factors that hinder conventional survey methodologies. These challenges include limited funding, political obstacles, and safety concerns for both researchers and participants. Consequently, traditional survey approaches may prove unfeasible or inadequate in capturing the complex realities of VAWG in these settings.

      VAWG is a particularly pressing issue in Iran, a Middle Eastern country marked by its patriarchal structure and systematic and pervasive gender discrimination. The patriarchal and legal structure of the country perpetuates gender inequalities and reinforces societal norms that tolerate or even condone violence against women. Yet, understanding the full scope of VAWG in Iran remains hindered by a lack of robust data.

      In a recently published study, VISION researchers, Ladan Hashemi and Sally McManus, collaborated with counterparts from Bristol University (Nadia Aghtaie) and Iran (Fateme Babakhani) to explore the effectiveness of social media in recruiting victims of violence in Iran, shedding light on their experiences and the potential of social media as a research tool.

      The findings revealed valuable insights into the manifestation and context of VAWG in Iran. Social media recruitment proved to be effective in reaching a diverse sample of victims and provided crucial insights into the dynamics of violence, the identities of perpetrators, and the settings where violence occurs. Victims often reported experiences from more than one type of perpetrator, spanning both public and domestic spheres. While social media recruitment offers broad reach and a safer environment for data collection, it also presents challenges such as sampling biases which affect the generalisability of findings.

      For further information please see: Social Sciences | Free Full-Text | Using Social Media to Recruit Seldom-Heard Groups: Reaching Women and Girls with Experience of Violence in Iran (mdpi.com)

      Or contact Ladan at ladan.hashemi@city.ac.uk  

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      Referral outcomes for victim-survivors of sexual violence accessing specialist services

        Sexual violence and abuse (SVA) is highly prevalent globally, has devastating and wide-ranging effects on victim-survivors, and demands the provision of accessible specialist support services.

        In the UK, Rape Crisis England & Wales (RCEW), a voluntary third sector organization, is the main provider of specialist SVA services. Understanding the profile of victim-survivors who are referred to RCEW and their referral outcomes is important for the effective allocation of services.

        Using administrative data collected by three Rape Crisis Centres in England between April 2016 and March 2020, VISION researchers Annie Bunce, Niels Blom and Estela Capelas Barbosa, used multinomial regression analysis to examine the determinants of victim-survivors’ referral outcomes, controlling for a wide range of potentially confounding variables.

        They discovered that support needs, more so than the type of abuse experienced, predicted whether victim-survivors were engaged with services. Particularly, the presence of mental health, substance misuse and social, emotional, and behavioral needs were important for referral outcomes. The referral source also influenced referral outcomes, and there were some differences according to demo-graphic characteristics and socioeconomic factors.

        This research was co-produced with stakeholders from RCEW, who informed interpretation of these findings.

        For further information please see: Determinants of Referral Outcomes for Victim–Survivors Accessing Specialist Sexual Violence and Abuse Support Services (tandfonline.com)

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

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        Bystander experiences of domestic violence and abuse during COVID

          VISION researchers Alex Walker, Bryony Perry, Emma R Barton, Lara Snowdon and Mark Bellis surveyed people in Wales about their experiences of being a bystander to domestic violence and abuse (DVA) during the COVID-19 pandemic, with their colleagues at University of Exeter, Public Health Wales, and University of Durham.

          This research provides a unique perspective on DVA during a global pandemic, and therefore offers important new evidence that can contribute to DVA prevention during public health emergencies. 

          Globally, professionals voiced concern over the COVID-19 restrictions exacerbating conditions for DVA to occur. Yet evidence suggests this also increased opportunities for bystanders to become aware of DVA and take action against it. This mixed methods study consists of a quantitative online survey and follow-up interviews with survey respondents. Conducted in Wales, UK, during a national lockdown in 2021, this article reports on the experiences of 186 bystanders to DVA during the pandemic.

          The researchers found that while public health restrictions exacerbated DVA, they also increased the opportunity for bystanders to become aware of DVA, and to take prosocial action. Results support the bystander situational model whereby respondents have to become aware of the behaviour, recognise it as a problem, feel that they possess the correct skills, and have confidence in their skills, before they will take action.

          Having received bystander training was a significant predictor variable in bystanders taking action against DVA; this is an important finding that should be utilised to upskill general members of the community.

          For further information please see: Bystander experiences of domestic violence and abuse during the COVID-19 pandemic in: Journal of Gender-Based Violence – Ahead of print (bristoluniversitypressdigital.com)

          Or contact Lara at lara.snowdon@wales.nhs.uk  

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          Prevalence of sexual violence victimisation amongst mental health service users

            Researchers from King’s College London, Anjuli Kaul, Laura Connell-Jones, Sharli Anne Paphitis and Sian Oram (VISION researcher), have published a systematic review and meta-analyses in Social Psychiatry and Psychiatric Epidemiology which provides up-to-date estimates on the prevalence and risk of sexual violence victimisation amongst mental health service users.

            This review pooled data from 26 studies encompassing a total of 197,194 participants. Sexual violence included any sexual acts, comments or advances (or attempts at said behaviours) made towards a person without their consent. Mental health service users included any person who had been in contact with a psychiatric inpatient, outpatient, community, perinatal, liaison, addiction, veteran psychiatric inpatient, or forensic mental health service.

            The researchers searched 3 electronic databases (Medline, Embase, and PsychINFO) for peer-reviewed publications from their dates of inception until 18th July 2022. There were no restrictions on the geographic location of the included studies.

            Key findings

            The review found that studies consistently showed a high prevalence of past year and adult lifetime (since the age of 16) sexual violence victimisation in psychiatric service users, with higher rates found in women than men. Additionally, both male and female psychiatric service users were found to have an increased risk of experiencing sexual violence compared to non-psychiatric service users. This was the case regardless of whether the study measured past year or adult lifetime sexual violence or sampled a population of inpatients, outpatients or both.

            The meta-analyses revealed high levels of heterogeneity within the data, which was likely partly due to the varied instruments used across studies to measure mental health and sexual violence. Additionally, there was not enough data available to calculate the pooled odds ratio of sexual violence victimisation for male or female psychiatric service users, nor was it possible to adjust odds ratios for known confounders such as age, ethnicity, income level or substance abuse.

            The findings emphasise the need for healthcare practitioners to effectively recognise and respond to sexual violence in mental health services, and the need for a comprehensive and consistent measurement framework for sexual violence to enable reliable and comparable prevalence data to be collected.

             For further information please see: Prevalence and risk of sexual violence victimization among mental health service users: a systematic review and meta-analyses | Social Psychiatry and Psychiatric Epidemiology (springer.com)

            Or contact Anjuli at anjuli.1.kaul@kcl.ac.uk  

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            Differentiating risk: The association between relationship type and risk of repeat victimization of domestic abuse

              Much of the literature on domestic abuse focuses on those in intimate partner relationships or ex-partners, however, in the UK the Home Office definition also includes those in familial relationships. The Domestic Abuse, Stalking, and Harassment and Honour-Based Violence Risk Assessment assumes homogeneous risk factors across all relationships.

              This paper, Differentiating risk: The association between relationship type and risk of repeat victimization of domestic abuse, therefore examines the risk factors for repeat victimization of domestic abuse by relationship type between the victim and perpetrator in a UK police force.

              Using police-recorded domestic abuse incident and crime data, a logistic regression model found that the most similar repeat victimization risk profiles for 14,519 victims were amongst partners and ex-partners, with both relationships demonstrating the greatest degree of gender asymmetry, compared with other familial relationships. Physical violence was the strongest predictor of repeat victimization and was a statistically significant predictor for ex-partners, partners, and all familial relationships. Coercive behaviour was also a significant predictor for all relationships apart from partners, but not at the same magnitude as physical abuse.

              Recognizing the difference in risk by relationship type may assist the police in deciding the most appropriate response and interventions to reduce the risk of further harm. 

               For further information please see: https://academic.oup.com/policing/article/doi/10.1093/police/paae024/7641219?login=false

              Or contact Ruth at ruth.weir@city.ac.uk  

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              Prevalence of physical violence against people in insecure migration status 

                VISION researchers from the Systematic Review working group (Andri Innes, Sophie Carlisle, Hannah Manzur, Elizabeth Cook, Jessica Corsi and Natalia Lewis) have published a systematic review and meta-analysis in PLOS One, estimating prevalence of physical violence against people in insecure migration status. This is the first review of its type, synthesizing global data on violence against migrants in all types of insecure status. 

                The review finds that around 1 in 3 migrants in insecure status experience physical violence. Violence included physical interpersonal, community and state violence. Insecure status was conceptualised encompassing undocumented status, lapsed statuses, asylum seeking and other pending applications, and any status that embeds a form of insecurity by tying status to a particular relationship (such as spousal or employer-employee). Studies were only included in the review if the violence happened while the victim was in insecure status. 

                The VISION team reviewed academic literature published between January 2000 and May 2023, across social and health sciences. The study was global in scope, although data was limited by the English language search.  

                Key Findings 

                More than one in four migrants in insecure status disclosed intimate partner violence specifically. Spousal visas embed a particular risk of violence because the visa status is connected to an intimate partner relationship, creating an important power disparity. Nevertheless, there was no significant difference in prevalence of violence by gender across the dataset. Prevalence also did not differ meaningfully across geographic region, perpetrator, status type or time frame.  

                The most significant findings included that violence exposure is not meaningfully different for people in undocumented status than in other types of insecure status. Physical violence is a concern across all types of insecure migration status types. 

                The findings were limited because of high levels of heterogeneity in the data. It was also difficult to consider intersectional identity characteristics such as age, race or ethnicity, nationality, religion, marital status, socio-economic status, education level or motivation for migration because these were not standardised across included studies. This suggests that further and specified research is needed in this area. 

                The review is open access and is available to read in full here. 

                If you have any comments or feedback for the authors, please contact Andri at alexandria.innes@city.ac.uk  

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                Better utilisation of healthcare data to measure violence

                  Despite violence being recognised as a harm to health, it is not consistently or adequately captured in healthcare data systems. Administrative health records could be a valuable source for researching violence and understanding the needs of victims, but such datasets are currently underutilised for this purpose.

                  VISION researcher Dr Anastasia Fadeeva, with input from Dr Estela Capelas Barbosa, Professor Sally McManus and Public Health Wales’ Dr Alex Walker, examined violence indicators in emergency care, primary care, and linked healthcare datasets in the paper Using Primary Care and Emergency Department datasets for Researching Violence Victimisation in the UK.

                  Anastasia worked with Hospital Episode Statistics Accident and Emergency (HES A&E) and the Emergency Care Data Set (ECDS) while on secondment at the Department of Health and Social Care (DHSC), with helpful review provided by researchers in the department.

                  Among the datasets reviewed in the study, the South Wales Violence Surveillance dataset (police and emergency department data linked by Public Health Wales) had the most detail about violent acts and their contexts, while the Clinical Practice Research Datalink (CPRD) provided the more extensive range of socioeconomic factors about patients and extensive linkage with other datasets. Currently, detailed safeguarding information is routinely removed from the ECDS extracts provided to researchers, limiting its utility for violence research. In the HES A&E, only physical violence was consistently recorded.

                  Addressing these limitations and increasing awareness of the potential utility of health administrative datasets to violence-related research has the potential to provide insight into the health service needs of victims.

                  For further information please see: Social Sciences | Free Full-Text | Using Primary Care and Emergency Department Datasets for Researching Violence Victimisation in the UK: A Methodological Review of Four Sources (mdpi.com)

                  Or contact Dr Anastasia Fadeeva at anastasa.fadeeva@city.ac.uk

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                  Working with specialist services’ administrative data

                    VISION researchers Dr Annie Bunce and Dr Estela Capelas Barbosa have been working with administrative data provided by specialist domestic and sexual violence and abuse (DSVA) support services.

                    Whilst the wealth and breadth of the data collected creates exciting opportunities for improving our understanding of patterns in experiences of violence and service use, the process of preparing the data for analysis has its challenges. Such challenges- and potential strategies for overcoming them- are not well documented, creating missed opportunities for improving the utilisation of specialist services’ data.

                    In their new publication, Annie and Estela, along with City, University of London PhD student, Katie Smith, and Dr Sophie Carlisle, a former VISION researcher, reviewed the scope and merits of administrative data generally, and that collected by specialist DSVA services specifically, and the evidence to date for its use by researchers.

                    They found that the extent to which new insights on violence from specialist services’ data can be used to inform policy and practice is limited by three interrelated challenges: different approaches to the measurement of violence and abuse; the issue of disproportionate funding and capacity of services, and the practicalities of multi-agency working.

                    Nonetheless, the authors maintain the unique contribution to knowledge on violence that can be provided by DSVA services’ administrative data, and are hopeful that the paper will encourage further discussion about how to better utilise it. Additional resources, collaboration between multiple agencies, service providers and researchers, and the integration of specialist services’ data with other sources of data on violence are needed to maximise policy impact. Given the benefits individuals and society stand to gain, this is a worthwhile endeavour.

                    For further information please see: Challenges of using specialist domestic and sexual violence and abuse service data to inform policy and practice on violence reduction in the UK in: Journal of Gender-Based Violence – Ahead of print (bristoluniversitypressdigital.com)

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

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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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