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Systems analysis of service coordination in domestic abuse, primary care and child mental health services

The impact of intimate partner violence (IPV) on parental and child mental health is well documented, as is the associated increased use of healthcare services by survivors of IPV. UK policy emphasises the importance of partnership working between health services and domestic abuse agencies, along with clear referral pathways for victims of violence and abuse and co-ordinated local responses. However, in general, current policy and guidance is focused on the response to adult victims with more limited advice as to how this should be operationalised for working with children.

With first author Dr Claire Powell (University College of London), VISION researchers Dr Olumide Adisa and Professor Gene Feder and others explored how services work together to support parents and children experiencing both parental IPV and parental or child mental health problems by drawing on the perspectives of professionals working in primary care, children and young people’s mental health services (CYPMHS), and domestic abuse services.

The team conducted a qualitative study, interviewing professionals in geographically contrasting local authority areas in England. They carried out framework analysis using a systems approach and mapping techniques to understand the service interrelationships and boundary judgements of professionals.

Results showed that

  • The relationships between domestic abuse services, CYPMHS, and primary care were complex, involving funders and commissioners, local authority strategic groups, and wider services such as schools and children’s centres.
  • Participants consistently identified a gap in the relationship between statutory CYPMHS and domestic abuse services.
  • There were mental health service gaps were for children living with ongoing or intermittent IPV and for children and parents with needs falling below or between service thresholds.
  • There was a gap in services for users of abusive behaviour to prevent future IPV.
  • Staff perspectives revealed differing views on treating the effects of trauma, and the co-ordination and sequencing of care.

Improving the response to children and adults experiencing mental health problems in the wake of IPV requires a systems perspective to understand the barriers to service co-ordination. The findings indicate a particular need to address the gap between CYPMHS and domestic abuse services.

To download the paper: Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives – ScienceDirect

To cite the paper:  Claire Powell, Olumide Adisa, Lauren Herlitz, Shivi Bains, Sigrún Eyrúnardóttir Clark, Jessica Deighton, Shabeer Syed, Ruth Gilbert, Gene Feder, Emma Howarth, Domestic abuse, primary care and child mental health services: A systems analysis of service coordination from professionals’ perspectives, Children and Youth Services Review, Volume 169, 2025, 108076, ISSN 0190-7409, https://doi.org/10.1016/j.childyouth.2024.108076

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Natural Language Processing: Interrogating free text in mental healthcare records to capture experiences of violence

Violence can be categorised in a variety of ways for example physical, sexual, emotional, and domestic but all cause significant physical and mental morbidity within general populations. Individuals with a severe mental illness have been found to be significantly more likely to experience domestic, physical, and sexual violence compared to the general population. For these individuals, experiences of violence are important risk factors however, this is not routinely collected by mental health services.

In general data on all forms of violence has been inadequately available from healthcare records. This is partly due to the lack of routine enquiry by professionals at points of clinical contact, and partly because instances of violence are difficult to identify in healthcare data in the absence of specific coding systems.

A general challenge for using health records data for research is that the most valuable and granular information is frequently contained in text fields (e.g., routine case notes, clinical correspondence) rather than in pre-structured fields; this includes mentions of violence whether experienced as a victim or perpetrated. Capturing violence experiences across mental healthcare settings can be challenging because most instances are likely to be recorded as unstructured text data. Therefore, natural language processing (NLP), is increasingly in use to extract information automatically from unstructured text in electronic health records, particularly in mental healthcare, on clinical entities.

Dr Ava Mason from Kings College London and VISION researchers Professor Robert Stewart, Dr Angus Roberts, Dr Lifang Li, and Dr Vishal Bhavsar worked with colleagues to apply NLP across different clinical samples to investigate mentions of violence. They ascertained recorded violence victimisation from the records of 60,021 patients receiving care from a large south London NHS mental healthcare provider during 2019. Descriptive and regression analyses were conducted to investigate variation by age, sex, ethnic group, and diagnostic category.

Results showed that patients with a mood disorder, personality disorder, schizophrenia spectrum disorder or PTSD had a significantly increased likelihood of victimisation compared to those with other mental health diagnoses. Additionally, patients from minority ethnic groups for Black and Asian had significantly higher likelihood of recorded violence victimisation compared to White groups. Males were significantly less likely to have reported recorded violence victimisation than females.

The researchers demonstrated the successful deployment of machine learning based NLP algorithms to ascertain important entities for outcome prediction in mental healthcare. The observed distributions highlight which sex, ethnicity and diagnostic groups had more records of violence victimisation. Further development of these algorithms could usefully capture broader experiences, such as differentiating more efficiently between witnessed, perpetrated and experienced violence and broader violence experiences like emotional abuse.

To download the paper: Frontiers | Applying neural network algorithms to ascertain reported experiences of violence in routine mental healthcare records and distributions of reports by diagnosis

To cite: Mason AJC, Bhavsar V, Botelle R, Chandran D, Li L, Mascio A, Sanyal J, Kadra-Scalzo G, Roberts A, Williams M, Stewart R. Applying neural network algorithms to ascertain reported experiences of violence in routine mental healthcare records and distributions of reports by diagnosis. Frontiers in Psychiatry 2024 Sep 10. doi:103389/fpsyt.2024.1181739

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Centring otherness with migrant women affected by domestic abuse

Victims-survivors with insecure immigration status in the UK are subject to complexities that limit their access to safety, support, and justice. While campaigners have been advocating for more equitable pathways for provision and support over the years, migrant women continue to navigate hostile environments characterised by dehumanising language and anti-migrant bureaucratic systems.

This chapter, written by VISION researcher Dr Olumide Adisa for the book, Otherness in Communication Research: Perspectives in Media, Interpersonal, and Intercultural Communication, reports on how a feminist dialogic approach (characterised by open, inclusive dialogue and a foundational understanding of social, economic, and political equality for women) was used to centre the often ‘silent voices’ of migrant women affected by domestic abuse.

Feminist dialogical approach acknowledges the complexities that characterise the migrant victim’s journey through the system—the relationship between the self-other, in a peculiar hostile environment which views the other as a ‘threat’. Migrant women continue to endure this othering within agencies as they seek safety and support. For example, some professionals conflating ‘foreignness’ with ‘insecure immigration statuses’, when confronted with difference. This theorisation of self and other lends itself to a social justice-oriented practice.

Using different art forms (co-produced with migrant women) and purposeful conversations, attendees were able to encounter migrant women as not a distant ‘other’ whom ‘we’ observe and theorise but as equal partners in the creating and reshaping on knowledge systems on safety, support, and justice.

This chapter draws on quotes from survivors to funnel through a hopeful lingering over otherness that positions migrant women as deserving of consideration and care, and considers empowering aspects about the other that may often be dismissed in professional circles, but nonetheless are important as a protective element of a safety net.

To download the chapter: Centring Otherness with Migrant Women Affected by Domestic Abuse | SpringerLink

To cite: Adisa, O. (2025). Centring Otherness with Migrant Women Affected by Domestic Abuse. In: Magalhaes, L. (eds) Otherness in Communication Research. Palgrave Studies in Otherness and Communication. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-73788-6_16

For further information, please contact Olumide at olumide.adisa@city.ac.uk

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Intimate partner violence impacts affected by relationship status and offence type

Intimate partner violence and abuse has a detrimental impact on victim-survivors’ health and wellbeing. However, intimate partners include a range of different relationship types, which are rarely differentiated or contrasted in research. In this paper, VISION researchers, Dr Niels Blom and Dr Polina Obolenskaya, investigate with Dr Jessica Phoenix and Merili Pullerits, whether different types of intimate partners commit different types of violence/abuse and whether the injury and wellbeing impact on victim-survivors varies by intimate partner relationship type.

They estimate models for victim-survivors’ emotional impact and injuries using the Crime Survey for England and Wales (2001–2020). Intimate partner relationships are differentiated into four groups (current versus former partner, and spouses/partners versus boy/girlfriends). Violence and abuse are grouped into physical violence/abuse, sexual violence/abuse, threats, and economic crimes.

The team found that for both men and women, offences committed by current partners are more likely to involve physical violence/abuse than offences by former partners. Ordered logit models indicate that female victim-survivors of physical violence/abuse or economic crimes experience more severe emotional impacts when the perpetrator is their current or former spouse/partner compared to a current or former boy/girlfriend. Women’s risk of injuries from physical violence and economic offences are higher when committed by current compared to former partners. Few differences are identified for men’s emotional impact and injuries.

The type of intimate partner relationship is associated with type of violence/abuse experienced, and for women, with the resulting emotional impact and injury. Future research and policies aimed at reducing harms from intimate partner violence and abuse and supporting victim-survivors should therefore consider distinctions in relationships to deliver more targeted interventions.

To download the paper: Physical and Emotional Impacts of Intimate Partner Violence and Abuse: Distinctions by Relationship Status and Offence Type | Journal of Family Violence

To cite: Blom, N., Obolenskaya, P., Phoenix, J. and M. Pullerits. Physical and Emotional Impacts of Intimate Partner Violence and Abuse: Distinctions by Relationship Status and Offence Type. J Fam Viol (2024). https://doi.org/10.1007/s10896-024-00786-w

For further information, please contact Niels at niels.blom@manchester.ac.uk

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Deputy Chief Constable awarded Practitioner in Residence at Violence and Society Centre

Katy Barrow-Grint, Deputy Chief Constable, Gloucestershire

City St George’s, UoL, offers a Practitioner in Residence programme at the School for Policy and Global Affairs. It is for mid-level and senior policy practitioners within the UK and provides a platform to grow and explore their practice in partnership with the school.

Katy Barrow-Grint, Deputy Chief Constable in Gloucestershire and an executive leader in national policing, became aware of the opportunity via her work with VISION Senior Research Fellow, Dr Ruth Weir,  on the VISION adolescent domestic abuse (ADA) research programme. Having recently written a book entitled ‘Policing Domestic Abuse’ with Ruth and others, the research identified a national gap academically and in policing with how ADA is understood.

Katy’s focus will be on how police constabularies document ADA and developing a better understanding of the impact of the statutory age limitations on the practical work police officers do on the front line.

Forces do not routinely record ADA as the statutory guidance states that domestic abuse occurs in relationships where both parties are aged 16 or over. As a result, whilst crimes against young people will be recorded and investigated, they are not necessarily classified as domestic abuse, and it may be that child protection, domestic abuse or front-line response teams deal with the case.

Her project work will seek to understand how forces are recording such incidents, and what type of officer and role is investigating. Katy will work with policing nationally through the National Police Chief‘s Council (NPCC) domestic abuse and child protection portfolios and collate an up-to-date picture across all forces in England and Wales to understand how they are recording and who is investigating ADA.

Katy is also undertaking specific localised work in Oxfordshire, Gloucestershire and Northumbria, hosting roundtables with Dr Ruth Weir and  practitioners from all relevant agencies to gain a qualitative understanding of the problems staff encounter when dealing with ADA.

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Migrants’ experiences of violence while in insecure migration status

Violence is a major public health issue. Moreover, there is evidence that violence is significantly related to social inequality. Existing studies have found links between violence and gender, ethnicity, place of residence and socioeconomic status.

Although economic globalization impacts trade, goods, and services, the movement of people has been increasingly restricted since the 1990s. The number of people globally who live with insecure migration status is difficult to estimate, but includes people worldwide undertaking irregular journeys and crossing international borders without authorization, people living without the correct immigration documentation, and people in temporary or dependent statuses in destination countries.

The global movement of people in the context of strict immigration laws and policies places significant numbers of people in insecure migration status worldwide. Insecure status leaves people without recourse to legal, governmental or social protection from violence and abuse.

This review synthesized qualitative studies that reported how migrants associated physical and physically enforced sexual violence they experienced with their insecure migration status. VISION researchers, Andri Innes, Annie Bunce, Hannah Manzur, and Natalia V. Lewis, generated robust qualitative evidence showing that women experienced sexual violence while in transit or without status in a host state, and that they associated that violence with their insecure migration status. This was the case across the various geographic routes and destination countries.

They found evidence that women associated intimate partner violence with lacking (legal) access to support because of their insecure migration status. Women connected their unwillingness to leave violent circumstances, and therefore their prolonged or repeated exposure to violence, with a fear of immigration removal produced by their insecure migration status.

To protect people in insecure migration status from experiencing violence that they associated with their migration status, it’s necessary to ensure that the reporting of violence does not lead to immigration enforcement consequences for the victim.

To download the paper: Experiences of violence while in insecure migration status: a qualitative evidence synthesis | Globalization and Health | Full Text

To cite: Innes, A., Bunce, A., Manzur, H. et al. Experiences of violence while in insecure migration status: a qualitative evidence synthesis. Global Health 20, 83 (2024). https://doi.org/10.1186/s12992-024-01085-1

For further information, please contact Andri at alexandria.innes@city.ac.uk

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VISION/VASC Webinar Series: Into the Light Index

This event is in the past.

We are pleased to announce our next webinar for the VISION and Violence & Society Centre (VASC) Webinar Series on Tuesday, 21 January, 1100 – 1150.

Deborah Fry, Director of Data at Childlight – Global Child Safety Institute and Professor of International Child Protection Research at University of Edinburgh, will present on the Into the Light Index, published last year on the prevalence of technology-facilitated child sexual exploitation and abuse. She will also discuss some of the measurement challenges in this field and how they are documenting and exploring those challenges.

Professor Fry undertakes primary research to measure the magnitude, drivers and consequences of violence against children, barriers and enablers to appropriate prevention and response systems including in school settings and the effectiveness of existing interventions.

She leads the data division at Childlight – Global Child Safety Institute. The Data Institute, funded by the Human Dignity Foundation, aims to take a data driven, evidence-based approach to understanding the prevalence of child sexual exploitation and abuse across the globe and translating that data into sustainable action that safeguards children. The mission is to establish a world leading independent institute that gathers, translates and visualises the prevalence of child sexual exploitation and abuse across the world.  

To register for the event in order to receive the Teams invitation, please contact: VISION_Management_Team@city.ac.uk

The purpose of the VISION/VASC webinar series is to provide a platform for academia, government and the voluntary and community sector that work to reduce and prevent violence to present their work / research to a wider audience. This is a multidisciplinary platform and we welcome speakers from across a variety of fields such as health, crime, policing, ethnicity, migration, sociology, social work, primary care, front line services, etc. If interested in presenting at a future Series webinar, please contact: VISION_Management_Team@city.ac.uk

This webinar series is sponsored by the UK Prevention and Research Partnership consortium, Violence, Health and Society (VISION; MR-V049879) and the Violence and Society Centre at City St George’s, University of London.

Domestic abuse in cancer care: Improving the identification and support

Although few studies have explored people’s experiences of domestic abuse and cancer, we know the two co-occur. The few studies we do have show that cancer can trigger an escalation of abuse. But there are no published domestic abuse interventions in the cancer setting.

In an attempt to plug that gap, Sandi Dheensa, University of Bristol researcher, and colleagues, including VISION Deputy Director Estela Capelas Barbosa, have conducted a service evaluation on a domestic abuse intervention for hospital-based cancer professionals. Their study, Identifying and responding to domestic abuse in cancer care: a mixed methods service evaluation of a training and support intervention – European Journal of Oncology Nursing, is the first to evaluate a DA training (and support) intervention for cancer professionals in England.

The key findings demonstrate that cancer and DA frequently co-occur, and that training and support intervention of hospital-based cancer staff increased the rate of DA identifications. There is an appetite for DA and cancer training amongst hospital-based cancer staff.

The evaluation contributes further evidence of the benefit of hospital-based domestic abuse coordinator roles and contributes new evidence for the feasibility of adapting the role for a specific context.

To read the article or download the paper free of charge:

Identifying and responding to domestic abuse in cancer care: a mixed methods service evaluation of a training and support intervention – European Journal of Oncology Nursing

To cite:

Identifying and responding to domestic abuse in cancer care: a mixed methods service evaluation of a training and support intervention. Dheensa, Sandi et al. European Journal of Oncology Nursing, Volume 0, Issue 0, 102724

Or for further information, please contact Sandi at sandi.dheensa@bristol.ac.uk

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VAWG data dashboard consultation highlights usefulness of tool

The UK Office for National Statistics (ONS) developed a prototype violence against women and girls (VAWG) data dashboard in 2022. The webpages presented statistics and charts on violence against women and girls in England and Wales, drawing on multiple sources. However, due to reprioritisation at ONS, maintenance of the dashboard stopped and as of April 2024 it was no longer accessible.

VISION developed a consultation to ascertain the usefulness of a VAWG data dashboard as a result. The call was open from March to May 2024, and 102 responses were received. Most participants responded in their capacity as individuals (n=61), although 25 stated that they were responding on behalf of an organisation and four on behalf of a group. Some participants both responded as an individual and on behalf of an organisation or group.

Consultation participants responded as people from across a variety of roles and sectors. The
most commonly cited were working in research or education (n=40) and in policy or planning
(n=28), 27 people responded as someone with lived experience and 13 as members of the
public. The remainder comprised those in service provision (n=17), a campaign role (n=10) or
some other capacity (8).

Consultation results

Many participants had heard of the data dashboard before the VISION consultation (n=51), although 28 reported that they had not. Of those who had heard of the dashboard before, most had made use of it (n=39).

Most participants reported that having a dashboard that brought together data on violence
and abuse would help them either ‘somewhat’ (n=12) or ‘a lot’ (n=39).

Participants were asked what they found to be useful about the data dashboard:

  • Data discovery
  • Finding data and finding it faster
  • Breakdowns and local profiles
  • Comparisons
  • Authoritative context
  • Source material

Participants were asked for their thoughts on the limitations or what was missing from the dashboard:

  • Wider coverage in relation to topics (health, disability, suicide, law, family courts, policy), types of violence and abuse (homicide, forced marriage, sexual violence), and particular groups (men, perpetrators)
  • Deeper context in terms of much more nuanced contextual discussion of what the data means, ‘data without context is misleading’
  • Critical interrogation such as the highlight of methodological limitations
  • Interactive functionality with more scope for further breakdowns by local authority areas and police forces for example
  • Improved search function
  • Positive action such as a ‘section about work being done to support victims/reduce cases’
  • Human stories meaning to go beyond numbers and to tell the human stories that underpin them

Recommendations

Through this consultation, approximately 100 people told VISION that a VAWG data dashboard is
something that they valued having and wish to have again. These included people with lived
experience of violence and abuse, people working in health, justice, specialist and other
services, researchers and academics across disciplines, and members of the wider public.

A violence and abuse data dashboard is needed because it has:

  • Symbolic value: indicating that violence against women and girls matters to the
    Government, and
  • Practical value: as a functional and easy to use tool facilitating access to high
    quality data spanning a range of types of violence, groups, areas and years.

In April 2024, ONS’ prototype VAWG data dashboard was withdrawn due to reprioritisation of
resources within that organisation. Since then, a new Government has come into office with a
stated mission to halve violence against women and girls within the decade. How progress towards this commitment is monitored will be essential to its success. General population health and crime surveys, alongside other data sources, will be key and that includes a revitalised, fit for purpose VAWG data dashboard. To instill trust and collective investment in this goal, a public platform for transparent monitoring is needed and the dashboard could be an effective, useful tool.

Next steps

VISION is a cross-sectoral consortium of academics and government and service partners
working with UK data on violence and abuse. We are aware that further development and relaunching of a data dashboard will require a collaborative effort from relevant departments of
state, data providers (not least ONS) and external funding. Drawing on our work in this area
we aim to coordinate this effort, with three initial objectives:

  • Resource: Identify partners and funding source(s)
  • Define: Agree clear definitions to best capture and monitor subgroup and temporal
    trends in VAWG and violent crime in the population
  • Design and test a revised violence and abuse data dashboard with people from
    across sectors

To download the report:

Consultation: Is there a need for a Violence Against Women and Girls (VAWG) data dashboard

Or for further information, please contact Sally at sally.mcmanus@city.ac.uk

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Report launch: A transformative justice framework to address adolescent relationship abuse

This event is in the past.

Despite a general awareness of the prevalence of harm young people are experiencing in their relationships, there is little data and evidence supporting the prevention of and responses to such harm through the adoption of a survivor centred transformative justice approach.

Talia Kensit, founder and former CEO of Youth Realities, explored adolescent domestic abuse as a Fellow with the Churchill Fellowship, a UK charity which supports individual UK citizens to follow their passion for change, through learning from the world and bringing that knowledge back to the UK.

Her travels and research resulted in Prevention, Intervention and Healing: Addressing Adolescent Relationship Abuse, a framework of best practice upheld by the theory of transformative justice. It is Talia’s recommendation that in order to address the epidemic of harm experienced by young people in their intimate relationships, we must implement polices and practice through prevention, intervention and healing.

The Violence & Society Centre at City St George’s, UoL, and the UK Prevention Research Partnership VISION consortium are pleased to host Talia’s Churchill report launch on Wednesday 6 November from 4 – 6 pm at City St George’s, UoL, Clerkenwell campus.

Talia will also be joined by:

  •  Ruth Weir, City St George’s, UoL, Taking a collaborative approach to understanding more about abuse in teenage relationships
  • Christine Barter, University of Central Lancashire, Qualitative findings looking at the nature and impact of IPVA in young people’s relationships
  • Jeff Temple, University of Texas, Dating violence prevention program: implementation and effectiveness

Seating, drinks and nibbles will be provided.

To register for the event: Select tickets – Report launch: A transformative justice framework to address adolescent relationship abuse – City St George’s , University of London, Clerkenwell campus (tickettailor.com)

For questions about the event: violenceandsociety@city.ac.uk

All those registering will receive an email by 30 October from the Violence and Society Centre with the room and building number where the launch will be held on our Clerkenwell campus.