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.
Increased incidence and/or reporting of domestic abuse (DA) occurred during the COVID-19 pandemic. As a result of the lockdowns across the UK, services providing support to victims had to adapt and consider adding methods of remote outreach to their programmes.
Identification and Referral to Improve Safety (IRIS) is a programme to improve the response to domestic abuse in general practice, providing training for general practice teams and support for patients affected by DA. The COVID-19 pandemic required those running the programme to adapt to online training and remote support.
Estela and Lucy employed a mixed methods rapid approach to this research in order to gather evidence around the relevance, desirability and acceptability of IRIS operating remotely. Quantitative IRIS referral data were triangulated with data from surveys and interviews. They found that the adaptation to online training and support of IRIS was acceptable and desirable.
This study contributes to practice by asserting the desirability and acceptability of training clinicians to be able to identify, ask about DA and refer to the IRIS programme during telephone/online consultations. The findings from this study may be of interest to (public) health commissioners when making commissioning decisions to improve the general practice response to domestic abuse.
VISION researchers Dr Polina Obolenskaya, Dr Elouise Davies and Dr Niels Blom will present at the Crime Surveys User Conference 2024 on 6 February 2024 in Islington, London.
The event brings data producers and data users together to share updates on the development of the surveys and to showcase research that is being carried out using the data. It is organised by the UK Data Service in collaboration with the Office for National Statistics, Scottish Government and the Home Office.
Polina – The rise, fall and stall of violence in England and Wales: How have risks of violence changed for groups in the population?
Elouise – When there’s more than one assailant: Understanding variation in victims’ needs
Niels – New Crime Survey for England and Wales integration code: Impact for investigating rare events such as different intimate partner perpetrator types
If registered, please enter through the main entrance in the University Building, across from Northampton Square, a green space with a gazebo. There is also a silver sculpture in front of University Building.
Only those that registered will be able to enter the conference room.
Thursday 18th April 2024, 10:00 – 17:00 followed by a reception Oliver Thompson Lecture Theatre (Tait Bldg), City, University of London, EC1B 0HB
Adolescent domestic abuse, which includes physical, emotional, and/or sexual abuse that occurs between young people who are, or were, dating, is often overlooked in research, policy and practice. The current definition of domestic abuse leaves those aged under 16 in teenage relationships falling into the gap between child protection procedures and adult-focused domestic abuse policy.
The conference brings together academics, practitioners, and policy makers to share existing research, policy and practice.
Registration is required and free. This is an in person conference only and catering will be provided. If you cannot attend but would like the slides, please contact the email listed below.
The programme:
9:30 – 10:00Registration & refreshments
10:00 – 10:20 Welcome & setting the scene, Dr Ruth Weir, Violence and Society Centre, City, University of London and Katy Barrow-Grint, Assistant Chief Constable, Thames Valley Police
10:20 – 10:40Introductory Speaker, Louisa Rolfe OBE, Metropolitan Police and National Police Chief Council lead for Domestic Abuse
10:40 – 11:00Rapid evidence review on domestic abuse in teenage relationships, Flavia Lamarre, and Dr Ruth Weir, City, University of London
11:00 – 11:30Learning from the lived experience, SafeLives Changemakers
11:30 – 12:00Researching abuse within teenage relationships: A critique of a decade’s work and what we could do better, Professor Christine Barter, Co-Director of the Connect Centre for International Research on Interpersonal Violence and Harm, University of Central Lancashire
12:00 – 13:00Lunch
13:00 – 14:20Panel 1: Teenage relationships and abuse: What the research says, chaired by Professor Sally McManus, Director of the Violence and Society Centre and Deputy Director of the VISION research project
Panel 1: Step up, Speak Out: Amplifying young people’s voices in understanding and responding to adolescent domestic abuse, Janelle Rabe, Centre for Research into Violence and Abuse, Durham University
Panel 1:‘In practice it can be so much harder’: Young people’s approaches and experiences of supporting friends experiencing domestic abuse, Jen Daw and Sally Steadman South, SafeLives
Panel 1: Healthy relationships: children and young people attitudes and influences, Hannah Williams and Sarah Davidge, Women’s Aid
Panel 1: Intimate partner femicide against young women, Dr Shilan Caman, Karolinska Institutet, Sweden
14:20 – 14:35Break
14:35 – 15:35Panel 2: Sexual violence in teenage relationships, chaired by Katy Barrow-Grint, Thames Valley Police
Panel 2: “Always the rule that you can’t say no”: Adolescent women’s experiences of sexual violence in dating relationships – Dr Kirsty McGregor, Loughborough University
Panel 2: Empowering Youth: Addressing Online Pornography and Adolescent Domestic Abuse – Insights from the CONSENT Project – Berta Vall, Elena Lloberas and Jaume Grané, Blanquerna, Barcelona, Spain and The European Network for Work with Perpetrators of Domestic Violence, Berlin, Germany
Panel 2: Image-Based Sexual Abuse as a Facet of Domestic Abuse in Young People’s Relationships – Dr Alishya Dhir, Durham University
15:35 – 15:50Break
15:50 – 16:50Panel 3: Specialist services and local government, chaired by Dr Olumide Adisa, University of Suffolk
Panel 3: The role and value of Early Intervention Workers in supporting children and young people aged 11–18 in a domestic abuse service context – Elaha Walizadeh and Leonor Capelier, Refuge
Panel 3: Prevention, Identification, Intervention and Protection: Learning on teenage domestic abuse from a multi-agency model in the London Borough of Islington – Aisling Barker, Islington Borough Council
Panel 3: Tackling adolescent domestic abuse in Lambeth – Rose Parker, Erika Pavely, Ariana Markowitz, and Siofra Peeren, Lambeth Health Inequalities Research and Evaluation Network
16:50 – 17:00Closing remarks and next steps
17.00 – onwardsDrinks reception, Conference attendees are invited to a drinks reception in the Oliver Thompson foyer
The abstracts
The abstracts and information on the poster presentations and stands are below for downloading.
VISION Director and Professor of Primary Care at the University of Bristol Medical School, Gene Feder, was a keynote speaker at the webinar: Making change happen in primary care – The IRIS story, on 28 November 2023.
With his co-presenter, Medina Johnson, CEO of IRIS, they shared the story of the concept and ambition that led to the beginning of the social enterprise established in 2017 to promote and improve the healthcare response to domestic violence and abuse (DVA).
DVA is a violation of human rights that damages the health of women and families. The health care sector, including primary care, has been slow to respond to the needs of patients affected by DVA, not least because of uncertainty about the effectiveness of training clinicians in identification and engagement with survivors of abuse.
To address that uncertainty, Gene and Medina conducted a cluster-randomised trial in Hackney and Bristol, finding that both identification and referral to specialist DVA services substantially increased in the intervention practices.
In the webinar they mapped the (not always smooth) trajectory from trial results to a nationally available programme commissioned by Integrated Care Boards (ICBs) and local authorities in over 50 areas to date, including getting into guidelines/policy, further implementation research, negotiating with commissioners, and setting up a social enterprise (IRISi) to drive the scaling up of the intervention.
For further information please watch the webinar video below.
For any questions or comments, please contact IRISi at info@irisi.org
However, recently, ‘Understanding Society’, the United Kingdom Household Panel Survey (UKHLS), began fielding a small battery of questions relating to violence experience. Here, we examined the strengths and weaknesses of these UKHLS measures with similar indices from the Crime Survey for England and Wales (CSEW), a widely used and regarded but cross-sectional survey.
Vanessa and Niels empirically assessed the extent to which the UKHLS variables are comparable with those in the CSEW to determine the viability of the UKHLS for the longitudinal study of (fear of) violence and its consequences.
Overall, they regarded the UKHLS to provide an important resource for future panel research on the consequences of victimisation. They found the indicators measuring physical assault to be similar in both sets of data, but also noted differences in prevalence and/or different distributions by socioeconomic group for the indices relating to being threatened and of feeling unsafe.
Nonetheless, Vanessa and Niels maintain their utility for researchers in this field, allowing researchers to uncover new inequalities in violence exposure.
Consultation, evidence and inquiry submissions are an important part of our work at VISION. Responding to Parliamentary, government and non-government organisation consultations ensures that a wide range of opinions and voices are factored into the policy decision making process. As our interdisciplinary research addresses violence and how it cuts across health, crime and justice and the life course, we think it is important to take the time to answer any relevant call and to share our insight and findings to support improved policy and practice. We respond as VISION, the Violence & Society Centre, and sometimes in collaboration with others. Below are the links to our published responses and evidence from June 2022.
UK Parliament – Women and Equalities Committee – Inquiry: The rights of older people. Our submission was published in November 2023
UK Parliament – Women and Equalities Committee – Inquiry: The impact of the rising cost of living on women. Our submission was published in November 2023
UK Parliament – Women and Equalities Committee – Inquiry: The escalation of violence against women and girls. Our submission published in September 2023
Home Office – Legislation consultation: Machetes and other bladed articles: proposed legislation (submitted response 06/06/2023). Government response to consultation and summary of public responses was published in August 2023
Race Disparity Unit (RDU) – Consultation: Standards for Ethnicity Data (submitted response 30/08/2022). Following the consultation, a revised version of the data standards was published in April 2023
UK Parliament – The Home Affairs Committee – Call for evidence: Human Trafficking. Our submission was published in March 2023
UK Parliament – The Justice and Home Affairs Committee – Inquiry: Family migration. Our submission was published in September 2022 and a report was published following the inquiry in February 2023
Home Office – Consultation: Controlling or Coercive behaviour Statutory Guidance. Our submission was published in June 2022
As an early career researcher in Criminology, I am interested in violent crime, domestic violence and threats to kill. Specifically, my research has focused on the measurement and outcomes of violence and how the harms of violence differ for different types of victims.
In Comparing Single Perpetrator and Multiple Perpetrator Violent Events in the Crime Survey for England and Wales (CSEW) I look at the complex structure of violent events reported by CSEW participants. My aim was to compare the needs of victims of violence perpetrated by groups, with the needs of victims of violence perpetrated by a single offender.
Victimisation surveys are the gold standard in measuring crime (Tilley and Tseloni 2016). They supplement police data. While police data can only capture crimes that are reported to the police, the CSEW captures up to 50% more by also including those events not reported to the police (ONS, 2020). We can use this to understand which types of crime and which victims are not appearing in police data.
My analyses of CSEW data have revealed that victims of multiple perpetrator violent events more often report their experiences to the police than victims of single perpetrator violent events. They were also more likely to receive medical attention and treatment at hospital after the violent incident and were also more likely to have contact with victims’ services.
These findings highlight how victims of violent events with one perpetrator may well be underrepresented in records drawn from police, health, and specialist services. It is important that research based on such data sources are aware of this issue in coverage.
Further research is needed to investigate why some victims do not access services and how access to services can be improved for those who are currently underrepresented.
Tilley, N., & Tseloni, A. (2016). Choosing and Using Statistical Sources in Criminology: What Can the Crime Survey for England and Wales Tell Us? Legal Information Management, 16(2), 78-90. https://doi.org/10.1017/S1472669616000219
On Thursday 19th October 2023, Dr Elizabeth Cook was invited to contribute to an event organised by Public Policy Exchange on Combatting Knife Crime in the UK. With contributions from Professor Lawrence Sherman, Professor Kevin Browne, Bruce Houlder CB KC DL, Nathaniel Levy, Dr Sue Roberts, and Sammy Odoi, the event examined current government strategy and policy responses to knife crime. Applying Carol Bacchi’s (1999; 2009) ‘What’s the problem represented to be?’ (WPR) approach, Elizabeth made the case for a gender analysis of ‘knife crime’, a summary of which is provided below.
What’s the problem represented?
Knife crime is a policy priority that ranks consistently high on the government agenda, appearing in key strategic areas such as serious violence, ‘gang’ involvement and exploitation, and children, young people, and vulnerability. Cutting across these strategic areas is a particular attention to tackling county lines and the misuse of drugs, restrictions on weapon-carrying and possession, early intervention and prevention programmes with young people, and community partnership responses and safeguarding.
What are the assumptions underpinning these representations?
There are key assumptions that underpin these representations of knife crime in public policy, each linked to specific ideas about:
who exactly is at risk,
where is considered to be safe,
who is vulnerable to harm,
and, on the whole, what forms of violence are deemed to be ‘serious’.
Constructions of knife crime as they currently stand, depict the problem as one committed primarily by and against men, occurring in public spaces, often between young people, and as an issue that is increasingly racialised in media and public discourse. The evidence base for each is not to be ignored and there are key takeaways from each policy approach which contribute one piece of a puzzle.
However, taking a WPR approach, there are questions to be asked: What is left unproblematic and what harms and whose voices are missed as a result?
There are key elements that are omitted from current policy approaches to knife crime and lessons to be learned from the violence against women and girls sector which have been relatively absent so far.
What is left unproblematic? Can the problem be thought about differently?
Various sources of evidence highlight that knives are consistently the most frequent method of killing in the context of intimate partner homicide by men against women. While the proportions fluctuate (e.g., ONS 2023; Femicide Census, 2020; VKPP, 2023), it stands that when women are killed by men, they are most likely killed using a knife.
What effects are produced by this problem representation?
Considering that up to 1 in 3 victims of homicides using a knife are women, it is problematic that there is so little analysis of sex/gender in policy responses (see, MOPAC 2017, for an exception). This has serious implications for how interventions are identified.
For example, efforts to regulate offensive weapons through legislation hit a wall when it comes to domestic abuse committed within the home. There have been several proposals over the years to either blunt kitchen knives or confiscate particular knives in the possession of known domestic abuse perpetrators – the assumption here being that the removal of the weapon is the removal of risk. However, the fundamental issue in domestic abuse is that anything is a weapon.
These raise questions about what (or who) is considered to be a source of risk and what can be done to reduce it.
How can we disrupt the problem representation?
While public health approaches to violence frequently invoke the need for multi-agency and partnership working, this must also translate to policy and implementation in strategy as well as practice. This means further work to avoid and break down policy siloes and assumptions in problem representations.
See the article, free to access, here:
Cook, E. A., & Walklate, S. (2022). Gendered objects and gendered spaces: The invisibilities of ‘knife’ crime. Current Sociology, 70(1), 61-76. https://doi.org/10.1177/0011392120932972
References
Bacchi, C. (1999) Women, Policy and Politics: The construction of policy problems, London: Sage.
Bacchi, C. (2009). Analysing policy: What’s the problem represented to be? Frenchs Forest, NSW: Pearson Australia
The Crime Survey for England and Wales (CSEW) and its predecessor, the British Crime Survey (BCS), are widely used by both academics and government to assess the level of crime and its impact on society. While the survey has run since 1982, combining the multiple years of the survey can be complex and mistakes are easily made. As a researcher in criminology who frequently uses the CSEW and its predecessor, I have produced detailed Stata code to combine data from multiple survey years to support other researchers who also analyse the CSEW in Stata (or would like to start). I worked with the UK Data Service (UKDS) and the Office for National Statistics (ONS) to share the code and develop guidance for its use.
With this code, you can specify what you need, namely, which years of the Crime Survey you want to merge and if you want the adolescent and young adult panels, the bolt-on datasets that provide uncapped codes, and/or if you want to use the ethnic minority booster samples. As a result, the code can be easily tailored for each researcher’s needs.
By combining multiple survey sweeps, analysts can examine temporal trends. A combined file also enables analysts to look at low prevalence offences, population groups, or consequences, that do not have a high enough frequency in a single year.
Two examples are given below on how this integrated dataset provides new and exciting opportunities.
Example 1: Revealing gender and age differences in trends in experiencing violence
We used our integrated crime survey dataset to examine temporal trends in different types of violence, and whether these varied by gender and age.
After a rise in violent crime in the 1980s, there was a decade of steady decline followed by a decade of stability (blue line, Figure 1a). However, for other crimes, which can also be considered violent, the patterns observed are different. After a short period of decline in the 1990s, sexual violence against women remained relatively stable until around 2010 when it began to increase, reaching the 20 years high by 2020. Additionally, there has been a sharp rise in threats reported by women in the last 5 years of data, making threats almost as prevalent as at its peak in the late 1990s.
The trends in violent crime for men follow a broadly similar pattern as for women, but at a higher rate. Unlike women, however, men did not experience an increase in threats in the more recent period.
Figure 1. Prevalence of violence by type of violence and gender, 1982 to 2020
a) Proportion of women experiencing violence by type of violence
b) Proportion of men experiencing violence by type of violence
Source: Authors’ analysis using CSEW/BCS data from 1982 to 2019/2020.
Notes: Weighted proportions. Violent crime includes the following offences: Serious wounding, other wounding, common assault, attempted assault, serious wounding with sexual motive, other wounding with sexual motive. Sexual violence includes the following offences: rape, attempted rape and indecent assault. Due to low frequencies, sexual violence is not reported here for men.
Figure 2 reveals that there has been major change in the age profile of victims over the past 40 years. 16- to 19-year-olds were almost 3 times as likely to become a victim of violence as people aged 30 to 39 in the mid-1990s. But violence against this group has declined rapidly since then: while they continue to be the group that is most likely to be victim of violence with 7.2% annual victimization in 2020, this used to be over 28% in the mid-1990s. While risk of violence has declined for all the ages under 40, the shift has been the largest for the younger groups.
Relatively few people over 50 become victims of violence compared to younger age groups in each time period. However, closer inspection reveals there is a significant increase in the risks of violence among the older age groups (60-69 and 70 and older) since the late 1990s, and particularly since 2015.
Overall, the age profile of victims has shifted massively over the decades, there is now much less variation in rates between age groups.
Figure 2 Prevalence of violence (including violent crime, threats, robberies, and sexual violence) by age group, 1982 to 2020.
Source: Authors’ analysis using CSEW/BCS data from 1982 to 2019/2020.
Example 2: Investigating smaller groups: Differences in wellbeing impact between intimate partner perpetrators
Our integrated crime survey dataset allows for the study of minority groups that are relatively small or forms of violence that are not often reported.
For example, only by combining twenty years of the crime survey (2001 to 2020) do we have sufficient sample size to study the impact physical intimate partner violence has on wellbeing and health, and how it differs between various types of intimate partner perpetrator.
Firstly, it is important to note that physical violence by any type of intimate partner has a higher risk of high emotional impact (Figure 3a) and a higher risk of injury (Figure 3b) than violence by other types of perpetrators.
Figure 3a below shows that the emotional impact reported by female victims is higher when the violence was committed by a current or former spouse/partner compared to if it was done by a current or former boy/girlfriend. Women were more likely to say they were ‘very much’ affected by the violence when it was committed by a current or former spouse/partner. It could be that the proximity of spousal relationships, which are often cohabitating, and their average longer duration account for some of the greater report impact. However, in contrast to emotional impact, figure 3b (below) shows that women are more likely to get an injury(ies) by violence by current spouses than by former spouses.
Overall, this study highlighted that physical violence by an intimate partner has a more severe wellbeing and health impact than violence by others, but also the need to differentiate intimate partner violence and abuse by not only the type of violence/abuse but also the type of intimate partner.
Figure 3 Estimated emotional wellbeing and risk of injuries for women following physical intimate partner violence, differences between intimate partner perpetrators.
a) Respondent’s reported emotional impact (showing the highest category).
b) Respondent’s reported physical health impact (showing the risk of injury)
Source: Authors’ analysis using CSEW/BCS data from 2001 to 2019/2020.
Notes: Respondent’s self-assessed emotional impact measured in four categories: not impacted, little impact, quite a lot, very much impacted. Respondent’s self-assessed risk of injuries is measured in three categories: no force was used, force was used but no injury was sustained, force was used that led to an injury. Figures are based on average marginal effects following ordered logit models controlling for key (socio)demographics. Significance was tested in additional models.
What the merger code does and doesn’t do
The Stata code enables users to merge the raw CSEW/BCS datasets. Consequently, at the moment, this code does not harmonize variables that change (slightly) over different years. Considering the measurement of many variables changes over the years, the users of this combined file need to make their own decisions on what operationalisations work best for their research and for the years they use.
Most of the time new variable names are used when a new measurement is used. However, for a few variables, different measurements seem to be used in different years, but they have the same variable name (for instance for household income variables such as tothhin2). In the current code, these variables are treated as being the same. Therefore, users need to carefully check the variables that they use for the relevant years.
Next, this code does not work in the secure researcher environment as provided by UKDS or ONS because the datasets in these environments have different names and the structure of the folders is different.
Overall, the merger code will save researchers precious time in combining the surveys that they want to use. As we have shown here, combining survey sweeps can benefit the study of trends in victimisation. The code can also be used for studying groups or crimes that are too rare to study using only a single sweep, therefore, this code may provide an incentive for studying marginalised groups and specific crimes, contributing to new insights into victimisation.
Citation for merged code
Blom, Niels (2023). Code for Merging Waves of the Crime Survey of England and Wales and the British Crime Survey, 1982-2020. [Data Collection]. Colchester, Essex: UK Data Service. 10.5255/UKDA-SN-856494
Examples in this blog are from
Blom, N., Obolenskaya, P., Phoenix, J., and Pullerits M. (2023, September 11-13). Differentiating intimate partner violence by perpetrator relationship type. Types of crimes committed and consequences for victims’ health and wellbeing by different types of intimate partner perpetrators [Conference Presentation]. European Conference on Domestic Violence, Reykjavik, Iceland.
Obolenskaya, P. & Blom, N. (2023, September 6-9). The rise, fall and stall of violence in England and Wales: how have risks of violence changed for different groups? [Conference Presentation]. EuroCrim 23rd Annual Conference of the European Society of Criminology, Florence, Italy.
Data reference
Office for National Statistics. Crime Survey for England and Wales, 2001-2002 to 2019-2020 and British Crime Survey 1982 to 2001 [data collections]. UK Data Service SN: 8812, 8608, 8464, 8321, 8140, 7889, 7619, 7422, 7252, 6937, 6627, 6367, 6066, 5755, 5543, 5347, 5324, 5059, 4787.
