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Healthcare responding to violence and abuse in Brazil

Domestic violence against women (DVAW) is a public health issue and a breach of human rights, yet evidence on effective interventions remains limited, particularly in low-income and middle-income countries. In Brazil, around one third of women have reported current or previous experiences of DVAW, especially perpetrated by intimate partners. Brazil has a comprehensive policy framework on DVAW, however, their implementation has been piecemeal and low priority.

The research team, led by VISION co-Deputy Director Dr Estela Capelas Barbosa, aimed to evaluate changes in identification and referral to specialist support associated with system-level strategies implemented within Brazilian primary healthcare (PHC) to strengthen the response to DVAW as part of the Healthcare Responding to Violence and Abuse (HERA) programme.

The HERA Programme was an international collaboration, involving research partners in the UK, Brazil, Sri Lanka, Nepal and Palestine, which aimed to strengthen the healthcare system response to DVAW, in order to ultimately ensure better outcomes for women and children.

The researchers explored before and aftereffects using difference-in-difference techniques in a quasi-experimental design, using observational data. HERA intervention in Brazil was implemented in eight PHC clinics, while 33 served as controls. Data on DVAW identification and referral were obtained from the national Epidemiological Surveillance System.

Results indicated that the HERA implementation strategies were effective in increasing identification and referral of women who experienced violence and presented at primary care clinics. By prioritising the needs and experiences of women, under a gender and human rights perspective, the strategies may also have enhanced the quality of interactions between healthcare providers and patients.

To the research team’s knowledge, this is the first Brazilian study using a quasi-experimental design to evaluate a system-level set of implementation strategies to DVAW. It provides compelling evidence for the effectiveness of culturally tailored strategies aimed at improving the response of PHC settings to DVAW. The findings reveal significant improvements in both identification and referral rates. The evidence not only underscores the intervention’s potential but offers a valuable framework for policymakers and healthcare providers seeking to implement effective strategies in similar contexts, particularly in low- and middle-income settings.

To download: Healthcare responding to violence and abuse in Brazil: a quasi-experimental difference-in-differences analysis – ScienceDirect

To cite: Estela Capelas Barbosa, Stephanie Pereira, Loraine J. Bacchus, Manuela Colombini, Gene Feder, Lilia Blima Schraiber, Ana Flávia Pires Lucas d’Oliveira, Healthcare responding to violence and abuse in Brazil: a quasi-experimental difference-in-differences analysis, The Lancet Regional Health – Americas, Volume 47, 2025, 101114, ISSN 2667-193X, https://doi.org/10.1016/j.lana.2025.101114.

For further information, please contact Estela at e.capelasbarbosa@bristol.ac.uk

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The impact of parental intimate partner abuse on young adult relationships

Intimate partner violence and abuse (IPVA) has the potential to be physically and psychologically damaging across generations. Childhood exposure to IPVA may place young people at greater risk of IPVA within their own relationships. It is estimated that a quarter of UK adults have grown up in a household where parental IPVA has taken place.

The research team, including VISION Director Professor Gene Feder and led by Dr Annie Herbert (University of Bristol), aimed to provide estimates for the relationship between IPVA among mothers, and IPVA in their children’s own relationships as young adults.

They studied the intergenerational effects of prospectively-reported IPVA in a UK general population birth cohort and examined effects according to different subtypes of maternal IPVA victimisation (psychological [and to an extent, controlling behaviours], and physical) and young adult IPVA victimisation and perpetration (psychological [including controlling behaviours], physical, and sexual). This is the first prospective longitudinal study on intergenerational effects of IPVA in the UK.

The researchers found a modest association between maternal IPVA (partner-to-mother victimisation) and IPVA victimisation among their children as young adult women, and between maternal IPVA and IPVA perpetration in young adult men.  After adjusting for potential confounding factors, the association for victimisation among women lessened, but a weak positive association for perpetration among young men remained. This finding was consistent with some previous reviews of studies on intergenerational effects of IPVA. The strongest association was for perpetration by men growing up around physical IPVA victimisation.

The findings showed that maternal IPVA victimisation is responsible for up to 10% of cases of IPVA in young adult relationships, largely concentrated amongst young people who experienced complex adversity including child maltreatment. Services supporting domestic violence cases in families should consider wider trauma, including history of child maltreatment.

To download: The impact of parental intimate partner violence and abuse (IPVA) on young adult relationships: a UK general population cohort study – The Lancet Regional Health – Europe

To cite: The impact of parental intimate partner violence and abuse (IPVA) on young adult relationships: a UK general population cohort study. Herbert, Annie et al. The Lancet Regional Health – Europe, Volume 0, Issue 0, 101278

For further information, please contact Annie at annie.herbert@bristol.ac.uk

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Researching the impact of Black and Asian women leadership within East of England domestic abuse services

The East of England is a region with minimal presence of ‘by and for’ (BFR) domestic abuse (DA) specialist services despite being home to Black and Asian communities. A VISION-funded research project, ‘Nothing about us without us’: Investigating the impact of the leadership of ethnic minority women on domestic abuse service provision in East England’, is exploring the impact of the leadership of Black and Asian women within DA service provision in the region.

As part of the work, researchers Dr Mirna Guha (Anglia Ruskin University) and Dr Katherine Allen (University of Suffolk), hosted a leadership event on 3 April 2025 for racially and culturally diverse women. Held at a venue provided by the City of London police, the event was part of a leadership programme implemented through the HUM (‘Us) : A Place-based Emerging-Leaders Model designed and piloted by Mirna and Katherine to diversify leadership in domestic abuse and sexual violence services. Research aims include ensuring culturally responsive and representative support for minoritised victims-survivors in East England.

Prior to the April event, Mirna and Katherine researched the leadership needs of 19 overstretched frontline practitioners i.e. ‘emerging leaders’ from racialised communities working within White-majority and at times professionally isolating generalist services across Bedfordshire, Suffolk and Cambridgeshire. East England is home to scattered racialised and diasporic communities where women’s leadership in local politics and policymaking is low. Based on this, three events on trauma-informed, culturally responsive and diverse styles of leadership have been co-produced with national DASV experts. Participants were invited to also join a regionally pioneering Community of Practice (CoP).

At the April event in London, 15 emerging leaders from racialised backgrounds gained insights into the strategies, opportunities and challenges of practising culturally and racially representative leadership through an inspiring keynote by Superintendent Jasvinder Kaur, Domestic Abuse Lead at Suffolk Constabulary and co-founder of the National Women of Colour in Policing network. Furthermore, nine Black and racialised women speakers associated with statutory institutions viz. Cambridge City Council and the National Police Chief’s Council.

Voluntary organisations also spoke including Apna Haq in Rotherham, Asian Women’s Resource Centre in London, and Karim Foundation in Cambridge. Others also shared their experiences of navigating rural and predominantly White spaces, and their strategies for claiming space, giving voice to community members and creating opportunities for other culturally and racially diverse women leaders. One notable theme was the pathbreaking role each panellist had assumed during her career, opening (or at times creating) doors for herself and those who followed. Discussions across the day dwelled on temporality and the changing political landscapes as well as place-based challenges linked to rurality.

Overall, the leadership model, including this event and others and the growing leadership CoP, with a current membership of 25 emerging women leaders, aims to address these contextual and temporal challenges by bolstering and diversifying racialised women’s leadership in public services to ensure equity for minoritised victims-survivors.

By laying the groundwork for a regional advisory board through the CoP, the model challenges the epistemic erasure of racially and culturally minoritised women within the design of DASV, and broadly, public services which exacerbate the postcode lottery of services across England and Wales. Inspired by Pawson and Tilley’s (1997)[1] approach to realist evaluation (which seeks to understand what works for whom and in which circumstances) Mirna and Katherine aim to evaluate the impact of the leadership programme and CoP on how emerging leaders navigate specific challenges rooted in specific professional, relational and spatial contexts.

[1] Pawson, R. and Tilley, N., 1997. Realistic evaluation.

For further information, please contact Mirna at mirna.guha@aru.ac.uk

Photograph courtesy of Dr Mirna Guha and Dr Katherine Allen.

Start for Life Outcomes Framework: Identifying candidate indicators

In 2021, the Government in England recognised the importance of supporting parents to give their babies and young children under two years of age the best start in life. There was a public commitment to publish a Start for Life Outcomes Framework. The Department of Health and Social Care in England then commissioned the NIHR Children and Families Policy Research Unit to undertake a five-month rapid responsive study to identify and provide a commentary on candidate indicators for this framework.

The research team, including VISION Deputy Director and Senior Lecturer at University of Bristol, Dr Estela Capelas Barbosa, identified candidate indicators to monitor population health of babies, young children, and their families. The project’s secondary focus generated principles for a framework to monitor service performance for this population. 

They conducted two rapid reviews with systematic searches to identify existing outcomes frameworks and core outcome sets that recommended relevant indicators for monitoring both population health and service performance.

Forty-seven candidate indicators were identified, of which 36 met the priority criteria. Many indicators featured in existing frameworks and had some relevant data already collected at scale in England. However, data were often not reported/available separately for adults or households with children and/or by age of child.

Significant further work is needed to develop frameworks to monitor population-level outcomes for babies or assess the quality of services. Frameworks require a clear purpose and consideration of unintended consequences from focusing on some indicators and not others.

The Public Health Outcomes Framework is already a rich resource with 24 (66%) of the 36 priority
indicators already featuring in some form.

To download the summary and / or report: Start for Life Outcomes Framework: Identifying candidate indicators

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A Scoping Review: Black and Minoritized Women’s Experiences of Specialist Domestic Violence Services in the UK

Domestic violence and abuse (DVA) harms individuals from all backgrounds, yet the experiences and needs of different communities vary significantly. The Crime Survey for England and Wales (CSEW) estimated that over 1.4 million women and 751,000 men experienced DVA in the year ending March 2023. Black and minoritized women may face heightened vulnerability to DVA due to factors such as socio-economic deprivation, racism, and exposure to specific forms of violence such as so-called honor-based abuse, female genital mutilation or forced marriage.

In addition, minoritized “survivor–victims” of DVA may face intersecting challenges within their socio-political and community context that impede their ability to disclose DVA and may experience social stigma and fears of racism from service providers for example.

This scoping review maps the existing available literature on Black and minoritized women’s experiences with specialist DVA services in the UK to summarize current understanding and identify knowledge gaps.

The research team, comprised of Penelope E. Lowe from University of Roehampton, VISION researchers Sally McManus, Ravi K. Thiara, Estela Capelas Barbosa and Ladan Hashemi, and Pardis Asadi Zeidabadi from City St George’s UoL, and Sumanta Roy of Imkaan and a VISION Advisory Board member, conducted a comprehensive search across multiple databases and gray literature sources. 

Thematic analysis of the findings revealed three main themes: additional service needs, barriers to accessing support, and the pivotal role of “by and for” services. The team concluded that “by and for” services—provided by and for minoritized women—which adopt an intersectional approach are crucial in addressing the unique needs of Black and minoritized “survivor–victims”, particularly in terms of language support, practical assistance, and community-related support. There is a need for more peer-reviewed literature to recognize the role of “by and for” services, using diverse methodologies to support Black and minoritized communities better.

To download the article: Black and Minoritized Women’s Experiences of Specialist Domestic Violence Service in the United Kingdom (UK): A Scoping Review

To cite: Lowe, P. E., McManus, S., Asadi Zeidabadi, P., Thiara, R. K., Roy, S., Capelas Barbosa, E., & Hashemi, L. (2025). Black and Minoritized Women’s Experiences of Specialist Domestic Violence Services in the United Kingdom (UK): A Scoping Review. Trauma, Violence, & Abuse, 0(0).  https://doi.org/10.1177/15248380251335038

For further information, please contact Penelope at penelope.lowe@rutgers.edu

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VISION member awarded UKDS Impact Fellow to study violence and mental health impacts in older age

Dr Anastasia Fadeeva

VISION Research Fellow, Dr Anastasia Fadeeva, has been awarded a UK Data Service (UKDS) Fellowship.

Anastasia’s interest and education in medicine increased her awareness of the impact of social determinants on people’s health. This led to an MSc in Public Health at London Metropolitan University followed by a PhD at Northumbria University and a career in health services and public health research.

As a UKDS Fellow, Anastasia will look at the issues of violence in older age, the long-term impacts of violence on mental health, and the lack of reliable data.

For more information about Anastasia and her work, see her blog on the UKDS website or email her at anastasia.fadeeva@citystgeorges.ac.uk.

The UKDS is funded by the UKRI and houses the largest collection of economic, social and population data in the UK. Its Data Impact Fellowship scheme is for early career researchers in the academic or the voluntary, community, and social enterprise (VSCE) sector. The purpose of the programme is to support impact activities stemming from data-enhanced work. For further information on the UK Data Service please see: UK Data Service

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The economic burden of child maltreatment and co-occurring parental domestic violence and abuse in the UK

Child maltreatment (CM) and parental domestic violence and abuse (pDVA) impose considerable lifelong adverse outcomes on those affected. Approximately 8.5 million adults in England and Wales are estimated to have been exposed to CM (physical, sexual or emotional abuse or emotional or physical neglect of a child by a parent or caregiver) before their 16th birthday. Despite sharing multiple family and environmental risk factors, the economic burden of child exposure where they co-occur has not previously been estimated in detail.

VISION researcher Professor Gene Feder estimated average lifetime societal costs resulting from CM or childhood exposure to pDVA, and incremental costs for scenarios where they co-occur with lead researcher Dr Kevin Gilbert at the University of Cambridge and others.

The findings showed that lifetime costs for childhood exposure to CM and/or pDVA, were £71,309 per child (non-fatal exposure), and £1,292,377 per CM fatality, with £27.8 billion projected costs (2013 UK birth cohort).

Total costs for exposure to pDVA alone was £1.0 billion (£16,639 per child exposed), rising to £2.0 billion (£71,037 per exposed child) for children reporting awareness of pDVA. Co-occurring CM and pDVA imposed greater costs than either alone, including costs from child perpetration of intimate partner violence.

As a result of the research the team concluded that CM and/or pDVA exposure incurs large personal and societal economic burdens. Costs from both pDVA exposure and intergenerational transmission of IPV perpetration highlight the importance for policies to address both CM and domestic violence and abuse in affected households.

Given the scale of burden accrued over the life course after CM and/or pDVA exposure, this model can provide a framework upon which policy makers can identify the best use of resources to maximise the societal benefits from the effective interventions needed to tackle a complex social issue.

To download the article: The economic burden of child maltreatment and co-occurring parental domestic violence and abuse in the UK

To cite: Herbert K, Feder G, Gilbert R, Powell C, Howarth E, Morris S. The economic burden of child maltreatment and co-occurring parental domestic violence and abuse in the UK. Child Abuse Negl. 2025 Mar 31;163:107435. doi: 10.1016/j.chiabu.2025.107435. Epub ahead of print. PMID: 40168916.

For further information, please contact Kevin at kch28@medschl.cam.ac.uk

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Evaluation of a domestic violence training and support intervention in Palestinian primary care clinics in the west bank: a mixed method study

Domestic violence (DV) is a violation of human rights and a major public health problem that damages the health of women and their families. In the occupied Palestinian territories, 29% of women have a lifetime exposure to intimate partner violence, the most prevalent form of DV.

Despite the existence of national policies to prevent and respond to DV, implementation within the Palestinian primary health care system has been weak. The research team, including VISION researcher Professor Gene Feder, developed, piloted, and evaluated a system-level intervention, including training for health care providers and care pathways for women patients. The aim of the evaluation was to determine the feasibility and acceptability of the HEalthcare Responding to violence and Abuse (HERA) intervention.

The adaptation of a previous (HERA) intervention was implemented in primary health care
settings in Palestine, informed by stakeholder meetings, interviews with clinic managers and health care providers (HCP), facility-level readiness data, and findings of a previous pilot study. The training component of the intervention, delivered by the Palestinian Counseling Centre, included a train-the-trainer session, two clinic-based training sessions, and reinforcement sessions for front-line healthcare providers in four clinics.

Healthcare providers were trained to ask about DV, give immediate support, and offer a referral to a nurse case manager. The care pathway beyond the case manager was either referral to a primary-care based psychologist or social worker or to a gender-based violence focal point external to the clinic that coordinated referrals to appropriate external services (e.g. police, safe house, psychologist, social worker).

For the evaluation, the researchers employed a thematic analysis of post-intervention semi-structured interviews with HCP and trainers, and observations of training sessions and field notes. Provider Intervention Measure (PIM) data on changes in HCP attitudes and practice were analysed with descriptive statistics. Identification and referral rates for women disclosing DV 12 months before and 12 months after the intervention were obtained from clinic registries. The research team also developed a theory of change to triangulate the qualitative and quantitative data.

Results showed that the training proved acceptable to HCPs and there was evidence of positive change in attitudes and readiness to engage with women patients experiencing DV. Compared to the year before the intervention, there was a reduction in the number of patients disclosing DV during the intervention and of referrals in three of the four clinics. This reduction may be explained by the impact of the Covid 19 pandemic on clinic priorities, lack of time, persisting HCP fear about engaging with DV, and HCP rotation between clinics.

The delivery of the training component of the HERA intervention within the Palestinian primary
healthcare system proved partly feasible and was acceptable to HCPs, but contextual factors limited HCP implementation of the training in practice.

To download the article: Evaluation of a domestic violence training and support intervention in Palestinian primary care clinics in the west bank: a mixed method study

For further information, please contact Nagham at naghamjoudeh@gmail.com

Multiple adverse childhood experiences and mental and physical health outcomes in adulthood: New systematic review protocol assessing causality

Research suggests that adverse childhood experiences can have a lasting influence on children’s development that result in poorer health outcomes in adulthood. Like other exposure-outcome relationships, however, there is uncertainty about the extent to which the relationship between adverse childhood experiences and health is causal or attributable to other factors.

The aim of this systematic review is to better understand the nature and extent of the evidence available to infer a causal relationship between adverse childhood experiences and health outcomes in adulthood.

A comprehensive search for articles will be conducted in four databases (Medline, CINAHL, PsycInfo and Web of Science) and Google Scholar. The team, led by Dr Lisa Jones of Liverpool John Moores University, and includes VISION researchers Professor Mark Bellis and Professor Sally McManus, will review studies published since 2014:

  • of adults aged 16 years or over with exposure to adverse childhood experiences before age 16 years from general population samples;
  • that report measures across multiple categories of childhood adversity, including both direct and indirect types; and
  • report outcomes related to disease morbidity and mortality.

To download the protocol: Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality

To cite: Jones L, Bellis MA, Butler N, et al. Interpreting evidence on the association between multiple adverse childhood experiences and mental and physical health outcomes in adulthood: protocol for a systematic review assessing causality. BMJ Open 2025;15:e091865.  doi: 10.1136/bmjopen-2024-091865

For further information, please contact Lisa at l.jones1@ljmu.ac.uk

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Systematic review: Effectiveness of UK-based adult domestic and sexual violence support interventions and services

Recommendations

  • Further high-quality research into the effectiveness of domestic and sexual violence and abuse (DVSA) interventions and evaluations of perpetrator programmes are required, including randomised controlled studies where appropriate and ethical, to improve certainty regarding the effect estimates generated from evidence syntheses. Published protocols, adherence to reporting guidelines, such as CONSORT, STROBE and SQUIRE 2.0, and considering and accounting for confounding factors where randomisation is not feasible, will strengthen the research.
  • Developing a core outcome set via co-production with survivors, practitioners and service providers, commissioners, policy makers and researchers will increase consistency in reported outcomes and create the cohesion necessary to develop a robust evidence base to aid understanding of how effective various support services are.

In the United Kingdom, there are a range of support services and interventions for people who have experienced domestic and sexual violence and abuse (DSVA), including refuges, advocacy such as Independent Domestic Violence Advisors (IDVAs), referral, outreach, and helplines. These are often provided by the Voluntary and Community Sector (VCS), although may also be located in the public or private sector. Due to the lack of consensus on outcomes used to assess effectiveness, evidence syntheses in this field have been limited.

Dr Sophie Carlisle led a team of VISION researchers, Dr Annie Bunce, Prof Sally McManus, Dr Estela Capelas Barbosa, Prof Gene Feder, and Dr Natalia V Lewis, and Prof Matthew Prina from Kings College London. They used findings from their scoping review to identify the common reported outcomes, to direct and inform an evidence synthesis on the effectiveness of UK-based interventions and services for DSVA.

The team conducted a systematic review and, where possible, meta-analysis. They searched relevant peer reviewed and grey literature sources. The following were included: randomised controlled trials, non-randomised comparative studies, pre-post studies, and service evaluations of support interventions or services for adults who had experienced or perpetrated DSVA. The intervention typology and selection of outcomes was determined based on co-production with stakeholders from specialist DSVA organisations. The quality of the studies was assessed independently by two reviewers. Where meta-analysis was not possible, the researchers synthesized studies with vote counting based on the direction of effect.

The review demonstrates that there appear to be benefits of UK-based advocacy and outreach services, psychological support interventions, and perpetrator programmes. However, risk of bias and methodological heterogeneity means that there is uncertainty regarding the estimated effects.

A co-produced core-outcome set is needed to develop a more robust evidence base and facilitate future research in this field. Research practices such as publishing of study protocols, following reporting guidelines and, for research where randomisation is not feasible, considering and accounting for potential confounding factors, would greatly improve the quality of research.

To download the paper: Effectiveness of UK-based support interventions and services aimed at adults who have experienced or used domestic and sexual violence and abuse: a systematic review and meta-analysis – PMC

To cite: Carlisle S, Bunce A, Prina M, McManus S, Barbosa E, Feder G, Lewis NV. Effectiveness of UK-based support interventions and services aimed at adults who have experienced or used domestic and sexual violence and abuse: a systematic review and meta-analysis. BMC Public Health. 2025 Mar 14;25(1):1003. doi: 10.1186/s12889-025-21891-5. PMID: 40087589; PMCID: PMC11908015.

For further information, please contact Sophie at sophie.carlisle4@nhs.net

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