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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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    The benefits system: source of support or hindrance to victims of violence?

      Previous VISION research showed how 4% of domestic violence victims lose their job as a result of abuse and that half of unemployed women have experienced intimate partner violence in their lives.

      A report just published by the Department for Work and Pensions (DWP) further confirms high levels of trauma and mental distress among people not in employment and approaching benefits services for support. The report focuses on those in receipt of Employment and Support Allowance (ESA) aimed at people with an impairment or health condition that affects how much work they do.

      VISION researcher Sally McManus, with colleagues Claire Lapham and Ann Conolly from the National Centre for Social Research, analysed the government’s main mental health study. They found that nearly one in three (30%) ESA recipients screened positive for post-traumatic stress disorder. This was more than twice the rate for Jobseeker’s Allowance (JSA) claimants (12%), and ten times that of employed people (3%). The analyses show that the claimant population experienced high levels of stress, in which self-confidence was low and anxiety high. Compared to those in employment, few ESA claimants owned their home and many faced serious debt arrears.

      Sally presented findings from this study as oral evidence to the Work and Pensions Committee’s Inquiry into Safeguarding Vulnerable Claimants, including domestic violence victims. She drew attention to calls from Women’s Aid for reform they highlight is needed to make the benefits system the lifeline survivors need, rather than a source of re-traumatisation and further harm.

      Women’s Aid recommendations include implementing a named domestic abuse lead in every Jobcentre Plus and ensuring staff receive regular, specialist domestic abuse training, so that work coaches and other frontline staff are better able to recognise claimants experiencing domestic abuse. Specialist domestic abuse services need to be properly funded to support and advocate for survivors in making their claims to DWP. Extending the domestic violence easement to up to a year would also help, alongside exempting those who are moving to or from refuges from repayment of Jobcentre Plus advances.

      The report can be downloaded from the DWP website: A health, social and economic profile of ESA recipients: Adult Psychiatric Morbidity Survey 2014 – GOV.UK

      To cite:

      Claire Lapham, Anne Conolly, Sally McManus (2024): A health, social and economic profile of ESA recipients: Adult Psychiatric Morbidity Survey 2014 DWP ad hoc research report no.79.

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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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        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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          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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