Domestic violence and abuse within Roma and Traveller communities: a scoping review

Domestic Violence and Abuse Is Our Issue.

<b>PB-PG-0712-28011 – NIHR Research for Patient Benefit Programme – Final report</b><br /> <br /> <b>Project title: </b>Learning from women’s experiences: improving our understanding of the physical, psychological and emotional health impacts of domestic violence and abuse (DVA), help-seeking trajectories and outcomes<br /> <br /> <b>Authors:&nbsp;</b><br /> Dr Maggie Evans - NHS Bristol CCG&nbsp;&nbsp;<br /> ProfessorGene Feder - University of Bristol<br /> Dr Fiona Duxbury - Blackbird Leys Health Centre<br /> Dr Helen Salisbury - University of Oxford<br /> Professor Sue Ziebland - University of Oxford<br /> <br /> <b>Plain language summary</b><br /> <br /> It is estimated that 1 in 4 women experience Domestic Violence and Abuse (DVA) during their lifetime and may approach multiple agencies before they get help. On average women try to leave abusive relationships 7 or 8 times, but may encounter repercussions from their partner and difficulty in disclosing their situation to family members, friends, health care or other professionals. This can lead to extreme social isolation. We aimed to develop a web-based resource which gives real-life accounts of women's experiences of DVA and their outcomes. This may help to increase the options for women in an abusive relationship, suggest ways to improve their self-care, where to seek help and how to make plans to leave.<br /> <br /> We conducted in-depth video- and audio-taped interviews with 40 women across the UK, with a range of ages and ethnic backgrounds, who have experienced DVA, asking about the impacts on their physical and mental health, their help-seeking experiences, outcomes and any barriers experienced. The interviews are being used to develop (i) a web-based resource for women experiencing DVA, family members and friends, as part of www.healthtalkonline.org. (ii) a training resource for medical and allied health and social care professionals. Participants were recruited through Patient and Public Involvement groups, advertisements in the media, a dedicated website and specialist third sector agencies. Women were interviewed at a safe location by an experienced female researcher.<br /> <br /> We were very careful to ensure participants’ safety. Women who felt uncomfortable about videos or audio-recordings being available online are represented by actors, and real names of people and places are deleted.<br /> We found consistent themes in the women’s narratives, which have been written up as Topic Summaries for the website. For example, the data provide new insights into the experience of Coercive Control which is now a criminal offence but is poorly understood. We found new insights into the difficulties and dangers faced by women who want to leave an abusive relationship, which counter the often asked question: ‘Why didn’t you just leave’. We also found that women themselves were so isolated and controlled in the abusive relationship that they generally did not understand that they were experiencing DVA. Our study highlights the need for wide-ranging education into the reality of DVA, which will be part of the dissemination process.<br /> <br /> <b>Keywords</b><br /> Domestic Violence, Domestic Abuse, Women's Narratives, Women's Help-seeking, Women's Health, Qualitative study, Website study.<br /> <br /> <b>Summary of research findings</b><br /> <br /> Methods<br /> <br /> We recruited a purposive sample of 40 women across the UK who have experienced DVA. They had a range of ages and ethnic backgrounds. Women were recruited via DVA support agencies, patients at GP practices which operate the IRIS model for the identification and referral of women to DVA support agencies, a website set up for our study, twitter and FaceBook.<br /> <br /> Women were interviewed in a safe, convenient location using a topic guide that covered all aspects of their experience of DVA. Interviews were video- and/or audio- recorded. Women could chose the form in which clips of their interview will appear on the website, either video, audio, written or spoken by an actor. Three women decided not to have their data included on the website. All participants had the opportunity to check and give approval for the use of their interview data, making deletions if they wished to.<br /> <br /> Interviews were transcribed, anonymised and the data were entered into NVIVO software. The research team carried out a thematic analysis which was used as the basis for writing 27 Topic Summaries for the website, illustrated by clips from the interviews. These summaries represent the full range of women’s experiences of DVA, and reflect the most important themes. The topic summaries and associated clips are being processed by the technical team at the DiPEx charity in order for them to appear on the website. All video and audio tapes will be professionally edited.<br /> Some of the participants, DVA professionals and GPs, along with the research team formed an Advisory Panel that met twice during the study, to comment on the process and to advise on the content of the proposed Topic Summaries. They evaluated the material that had been prepared by the research team in June 2016 and, as a result, major changes were made to the format and content of the Topic Summaries, feedback that was valuable in developing the finished product.<br /> <br /> Key Findings<br /> <br /> We found consistent themes in the women’s narratives, which formed the Topic Summaries for the website. For example, the data provide new insights into the experience of Coercive Control which is now a criminal offence but is poorly understood. We found new insights into the difficulties and dangers faced by women who want to leave an abusive relationship, which counter the often asked question: ‘Why didn’t you just leave’.<br /> <br /> Women's narratives confirmed the devastating impacts of DVA on their mental health and also on that of their children, impacts that did not stop when the relationship ended. Specialized therapy may be needed to help women and their families recover from the trauma of DVA, and yet women's accounts reveal a widespread lack of understanding or appropriate support across a range of key professionals in healthcare, the police and children's services including CAFCASS.<br /> <br /> We also discovered a number of significant barriers to women in seeking help, which form a Topic on the website entitled ‘Obstacles to seeking help’. Women across all educational levels revealed a lack of knowledge about DVA, so they were not able to understand their partner’s behaviour. Women described being manipulated into believing their partner’s behaviour was their fault and therefore they had no ‘right’ to ask for help.<br /> <br /> Other constraints to asking for help included a deep fear amongst women that they might lose custody of their children if their home situation was known about by professionals. Women also said that it was hard for them to open up to anybody about their experiences and urged professionals, family and friends to ask more questions but to be non-judgmental. The very real repercussions in terms of violence from their partner when a woman left was highlighted in the interviews and underlines the need for greater support at this time. For many women, getting a place in a women’s refuge was impossible owing to lack of availability and the need to be eligible for public funding. This was particularly difficult for first generation migrant women.<br /> <br /> Our study highlights the need for wide-ranging education into the reality of DVA, which will be part of the dissemination process. Our participants frequently experienced being let down by, for example, the police who had, in the participants’ view, little understanding of DVA beyond physical violence.<br /> <br /> Expected impact<br /> <br /> The study will be published online as part of the award-winning website www.healthtalkonline.org, a growing resource that specialises in disseminating qualitative studies of experiences of health and illness. The impact of a website is difficult to measure. The site currently covers over 70 health conditions and receives over 5 million hits per month. Following the launch of the DVA module, which is likely to be in March 2017, we will undertake dissemination work to maximise potential impact. We will receive regular bulletins of the number of hits per page from the website charity, so that we can monitor usage over time.<br /> <br /> We plan to expand on dissemination and impact measurement following the launch which will include a Press release and media coverage. We are working closely with Women’s Aid to facilitate dissemination. The DVA module will be introduced on the website by some video clips from key informants in the field of DVA. We have made an introductory video of Jenni Murray, Patron of Women’s Aid and presenter of Radio 4 Woman's Hour. Radio 4 has been covering DVA in the last two years through a storyline in the radio series ‘The Archers’ and Women’s Hour has made several reports on the topic. We hope to use this forum to advertise the website module.&nbsp;<br /> <br /> We have already taken steps to include findings and video clips in teaching modules for medical students and in academic and non-academic conferences and events. Clips and data from the DVA module will be incorporated in the training for the IRIS model for GPs and other staff in primary care (see www.irisdomesticviolence.org.uk). We hope that the range of topics addressed in the DVA module will strengthen the likelihood that primary health care and other commissioners will commission IRIS and other DVA resources. Small cards and/or posters giving the web address of the DVA module will be available to be distributed to interested parties, for example GP practices, hospitals, police stations, DVA agencies, other public places. Attempts till be made to disseminate into other professional areas such as the training of police or the education of young people. One potential method for doing this is to create a piece of ‘verbatim theatre’ in which actors speak the words of women survivors of DVA, taken from their narratives, and developed into a piece of theatre. We plan to apply for funding for dissemination and impact assessment work.<br /> <br /> The balance of the grant (under &pound;4,000) will be retained for 12 calendar months so that we can undertake planned dissemination work, which will include professionals' study and information days and attending international conferences about DVA (please see spreadsheet for details).<br /> <br /> Conclusions<br /> <br /> A resource such as the www.healthtalk.org&nbsp; module about DVA could be used in a variety of health care, social care and educational settings, to increase public and professional understanding of DVA. Most of the women said that, had they known about DVA in all its various forms, they might not have stayed so long in an abusive relationship, and they would have sought help earlier.<br /> <br /> A positive outcome was the number of women who experienced support from other survivors of DVA. For many women, simply talking to someone else who understood, was the beginning of their own journey away from abuse. Providing and evaluating information, resources and training to facilitate women in setting up and advertising peer support groups could be valuable future research proposals.<br /> <br /> <br /> <b>Patient and public involvement</b><br /> <br /> Working with our PPI group of women survivors of DVA has been essential to the success of the study. I feel strongly that PPI representation should not be tokenistic, such as one or two PPI members on a steering group that mainly comprises academics and other professionals, which will enable only the more confident or articulate to participate. I also resist the move towards the 'semi-professionalisation' of PPI members that I see in evidence around me, whereby individuals with a particular illness condition are recruited because of current or past professional skills that are relevant to the research rather than for their personal experience of the condition that is being studied. I have witnessed formal application forms and interviews for PPI positions, which I wholly disagree with. Our role as professionals is to objectify the condition under study and as far as PPI members are concerned it is important to prioritise their subjective experiences, not their confidence or articulate-ness or professional skills.<br /> <br /> With this in mind, we recruited a group of women survivors, some of whom had worked with us on previous studies, and who met regularly during the lifetime of the study. Meetings were held at the University, pre-paid taxis were booked to enable women to attend, lunch was provided and shopping vouchers of &pound;20 were provided in appreciation of their time and contribution. Four members of this group volunteered to join the project Advisory Panel that also included professionals from Women's Aid, the local DVA agency, the IRIS programme, GPs with expertise in DVA and the core research team.<br /> <br /> PPI members were involved in developing the funding application, helping to prioritise the research aims and develop the methodology. They provided important insights into issues of confidentiality and safety in terms of recruitment, data collection and use of the data on the website. When funding was secured, PPI members assisted in the development of participant information resources, commenting on the design and wording of all research documents such as participant information sheets, consent forms and topic guides. We agreed to implement a safety button on each page that instantly closes the website down should a woman be disurbed while One innovation that arose from this process was the design and use of a coloured flyer which was widely disseminated. It showed a woman's face with speech bubbles asking key questions to identify DVA. This was used as the initial stage of recruitment, before the full information sheets were provided. Another example was the agreement to include a safety button on each page that quickly closes the website down if a woman is disturbed while accessing the site.<br /> <br /> We held two Advisory Panel meetings during the lifetime of the study, which were lengthy working sessions. All members were sent data in advance and invited to comment. At the second of the two meetings, we drafted the Topic Summaries for the website and we had a very lively meeting following which I changed the focus of the data analysis in line with the feedback from the survivors. Drawing on their own experience they were able to steer the way in which the data was analysed, so that we reduced the emphasis on some topics and expanded others. One example of this is the use of a large amount of data in the interviews relating to the effects of DVA on children, some very long-term, and women's struggles to get help and support for their children. We had not originally processed this data as it seemed to take the focus off the women and we also feel that we have enough data on children to potentially write another healthtalk module! However,&nbsp; all the women felt that impact on children was one of their prime concerns. When we analysed the data we realised that the impact on children was both a reason for women to stay in an abusive relationship and also a reason for women to get away. Although the analysis and processing of this data provided a lot of extra work, we feel that the module is better as a result. Our panel representative from the HERG unit at Oxford (which leads the research for the website) commented that it was one of the best, well attended and inclusive meetings she had attended.<br /> <br /> The PPI women continue to be involved, some have offered to proof-read the material for the website, others are personally attending conferences and meetings to speak about their experiences of DVA and their experiences as research advisors. When the module is ready, we will involve PPI women in a short evaluation and checking, followed by the&nbsp; launch. We will continue to consult and involve the women in our dissemination plans.<br /> <br /> <b>Data sharing statement</b><br /> See link <a href="https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253">[https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253</a>] for the NIHR position of the sharing of research data.&nbsp; The NIHR strongly supports the sharing of data in the most appropriate way, to help deliver research that maximises benefits to patients and the wider public, the health and care system and which contributes to economic growth in the UK.&nbsp; All requests for data should be directed to the award holder and managed by the award holder.<br /> <br /> <b>Disclaimer</b><br /> This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0712-28011). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.<br /> <br /> This project was carried out between September 2014 and November 2016 . This final report has not been peer-reviewed. The report was examined by the Programme Director at the time of submission to assess completeness against the stated aims.

BackgroundAwareness of domestic violence and abuse (DVA) as a problem among military personnel (serving and veterans) has grown in recent years, and there is a need for research to inform improvements in the identification of and response to DVA in this population. This study aimed to explore the experience of health and welfare professionals in identifying and responding to DVA among the UK military population (serving personnel and veterans).MethodsThirty-five semi-structured telephone interviews were conducted with health and welfare staff who work with serving UK military personnel and veterans. Interviews were analysed using thematic analysis.ResultsThree superordinate themes were identified: i) patterns of DVA observed by health and welfare workers (perceived gender differences in DVA experiences and role of mental health and alcohol); (ii) barriers to identification of and response to DVA (attitudinal/knowledge-based barriers and practical barriers), and iii) resource issues (training needs and access to services). Participants discussed how factors such as a culture of hypermasculinity, under-reporting of DVA, the perception of DVA as a “private matter” among military personnel, and lack of knowledge and awareness of emotional abuse and coercive controlling behaviour as abuse constitute barriers to identification and management of DVA. Healthcare providers highlighted the need for more integrated working between civilian and military services, to increase access to support and provide effective care to both victims and perpetrators. Furthermore, healthcare and welfare staff reflected on their training needs in the screening and management of DVA to improve practice.ConclusionsThere is a need for increased awareness of DVA, particularly of non-physical forms of abuse, and of male victimisation in the military. Standardised protocols for DVA management and systematic training are required to promote a consistent and appropriate response to DVA. There is a particular training need among healthcare and first-line welfare staff, who are largely relied upon to identify cases of DVA in the military. Employing DVA advocates within military and civilian healthcare settings may be useful in improving DVA awareness, management and access to specialist support.

Domestic violence and abuse (DVA) are a breach of human rights and a major public health problem which have a significant, long-lasting impact on people’s physical and mental health and well-being. Studies report that 21–55% of women will suffer DVA in their lifetime, however its prevalence is difficult to measure as it remains predominantly hidden. This chapter explores further: The health impacts of domestic violence and abuse. Domestic violence and abuse presentations in healthcare. How to ask, respond, risk assess and refer patients suffering domestic abuse. How to record disclosures of domestic violence and abuse safely. Understanding local specialist domestic violence and abuse services.

A growing body of knowledge suggests many mental health practitioners will work therapeutically with women who have experienced domestic violence and abuse (DVA). Relatively little research has focused specifically on the felt readiness of counselling psychologists when working with this group of clients. The present study adopts a qualitative approach to explore the private and public experiences of counselling psychologists in their work with women who have experienced DVA. The analytic aim is exploratory and aims to provide insight into the ways counselling psychologists understand DVA and the practices which establish and sustain therapeutic interventions undertaken. Semi-structured in-depth interviews were carried out with six counselling psychologists who had worked with women living with DVA. The narratives produced were mapped using Interpretative Phenomenological Analysis (IPA) highlighting understandings of DVA as well as some of the dilemmas and challenges that the participants engaged in as they negotiated their therapeutic work with their women clients. Four master themes emerged from the IPA analysis – “privately owned and professional/institutional/public ideological tensions”, “disclosure of domestic violence and abuse affects the therapeutic boundaries and goals”, “working with domestic violence and abuse provokes human, humanitarian and humanistic responses” and “hermeneutic repositioning”. These collectively demonstrate the multi-layered private and public conflicts that make up counselling psychologists therapeutic work with women experiencing DVA. The study also discusses the importance of raising awareness of the private and public clashes that working with DVA has the potential to ignite and the need to increase readiness in counselling psychology trainees to engage in the angst potentially triggered by working with DVA. The strategic role in increasing readiness to work with DVA, of therapeutic guidelines for DVA, reflective practice, self-care and supervision are discussed. This study also acknowledges the importance of specialist care for women experiencing DVA and calls for specialist DVA training for practitioners.

BackgroundReported cases of Domestic Violence and Abuse (DVA) have increased since the advent of the COVID-19 pandemic and ensuing lockdowns. Understanding the general public’s view about DVA is vital, as it would help develop targeted interventions and effective public policies to tackle this rising problem in society. Our qualitative study investigated the public awareness, attitudes and perceptions towards DVA, and explored mechanisms to tackle DVA in the community setting in the UK.MethodsThe research team conducted personal interviews with 29 community dwelling adults who responded to study invitations and adverts on social media. We used a topic guide to ensure consistency across the interviews, which were audio-recorded, transcribed and analysed thematically to detect emergent themes concerning DVA.ResultsAll respondents were aware of the concept of abuse. Thirty-eight percent declared either having experienced DVA directly or that they knew someone close to being abused. More than half of the respondents were not aware of existing DVA supportive services in the UK. Overarching themes generated from the contextual analysis included contributing factors for DVA, challenges and barriers facing victims and proposals for future interventions.ConclusionsCommunity dwelling adults have a good understanding of the impacts of DVA, but many fail to recognise specific instances or events in their daily lives contributing to DVA. Raising public awareness, particularly in children through the school curriculum, highlighting existing support services and introducing the routine use of short screening tools for DVA in health and social care settings can increase awareness, early identification and signposting to effective interventions. Sustained, multi-level community facing interventions are recommended to reduce stigma and fear associated with DVA.

Understanding the general public's view about Domestic Violence and Abuse (DVA) is vital, as it would help with the development of targeted interventions and effective public policies to tackle this rising problem in society. Our interview-based study investigated the public awareness, attitudes and perceptions towards DVA, and explored mechanisms to tackle DVA in the community setting in the UK. We conducted semi-structured interviews with 29 community-dwelling adults who responded to study invitations and adverts on social media. We used a topic guide to ensure consistency across the interviews, which were audio recorded, transcribed and analysed thematically to detect emergent themes. All responders were aware of the concept of abuse. Thirty-eight percent declared either having experienced DVA directly or that they knew someone close to being abused. More than half of the responders were not aware of existing DVA supportive services in the UK. Overarching themes generated from the contextual analysis included contributing factors for DVA, challenges and barriers facing victims and proposals for future interventions. Community-dwelling adults acknowledge the impacts of abuse, but many fail to recognise specific instances or events in their daily lives contributing to DVA. Raising public awareness, particularly in children through the school curriculum, highlighting existing support services and introducing the routine use of short screening tools for DVA in health and social care settings can increase awareness, early identification and signpost to effective interventions. Sustained, multi-level community-facing interventions are recommended to reduce the stigma and fears associated with DVA.

This exploratory and formative study draws from discursive psychology to gain insights into how young people construct their experiences of parental domestic violence and abuse (DVA) and how they claim to understand the occurrence of DVA within their home. Data from interviews with 13 young people (18–26 years old) who reported DVA in their families of origin were analyzed using a discursive psychological approach. Analysis revealed two interrelated themes. Theme 1, ‘“How it was”: constructions of DVA’ identified that the young people had difficulty in recognizing psychological aspects of this phenomenon as DVA. However, as these behaviors also deviated from the normative expectations of intra-parental behaviors, the occurrence of psychological DVA led to ambiguity and confusion. Paradoxically, the occurrence of extreme physical DVA was readily recognized as DVA, and this worked to facilitate disclosure, discussion, and help-seeking. Theme 2, ‘Barriers and facilitators to talking with mothers about DVA’, identified how young people’s reported perceptions of their mother’s role in DVA were related to the likelihood that they had conversations about DVA with their mothers. The occurrence of extreme physical DVA, which unambiguously placed responsibility for the DVA with the perpetrator, who in the cases presented here were male, was reported to enable conversations around DVA between the young people and their mothers. Findings suggest a need to adapt discourses to make understandings of the psychological aspect of DVA more accessible to young people, so they can name and make sense of their experiences.

To evaluate a training intervention for general practice-based doctors and nurses in terms of the identification, documentation, and referral of male patients experiencing or perpetrating domestic violence and abuse (DVA) in four general practices in the south west of England. Research suggests that male victims and perpetrators of DVA present to primary care clinicians to seek support for their experiences. We know that the response of primary care clinicians to women patients experiencing DVA improves from training and the establishment of referral pathways to specialist DVA services. The intervention consisted of a 2-h practice-based training. Outcome measures included: a pre-post, self-reported survey of staff practice; disclosures of DVA as documented in medical records pre-post (six months) intervention; semi-structured interviews with clinicians; and practice-level contact data collected by DVA specialist agencies. Results show a significant increase in clinicians' self-reported preparedness to meet the needs of male patients experiencing or perpetrating DVA. There was a small increase in male patients identified within the medical records (6 pre- to 17 post-intervention) but only five of those patients made contact with a specialist DVA agency identified within the referral pathway. The training increased clinicians' confidence in responding to male patients affected by DVA. The increase in recorded identification of DVA male patients experiencing or perpetrating DVA was small and contact of those patients with a specialist DVA support service was negligible. We need to better understand male help seeking in relation to DVA, further develop interventions to increase identification of male patients experiencing or perpetrating DVA behaviours, and facilitate access to support services.

This paper sets out to interrogate the use of master and counter narratives in UK Parliamentary Select Committee debates surrounding the passage of the Domestic Abuse Bill (now Domestic Abuse Act 2021) in Parliament. These debates are a site that allow for the telling of counter narratives in order to challenge the narrative of the normative socio-legal position regarding domestic violence and abuse (DVA). With its roots in the patriarchy and stereotypical gender roles that foster violence and abuse, the issue with such a narrative is that it fails to recognise the complex, nuanced nature of domestic violence and abuse. As a result, it maintains the status quo and is disconnected from the realities of DVA. The work of this paper, then, is to consider the dialogue between the masterplot of DVA, the Domestic Abuse Bill, and the attempts of counter narratives to act as discursive resistance. It will consider what is the true power of these anti-hegemonic stories in exposing the problems with the master-narrative. Counter narratives submitted by organisations, activists, academics and survivors of DVA during the Committee Stage of the debates were not uniform, monolithic or pure, and were often plagued with inconsistencies and contradictions with one another. Characterised as the same but different, these counter narratives did not act in strict opposition to the hegemonic master narrative. As a result, this paper will draw on a case study which examines three different reports submitted during the Committee Stage of the Debates to consider the following questions: in what way can counter narratives act as discursive resistance in law reform efforts and why are some more successful than others in dismantling the master narrative through the mechanism of the law? Overall, the argument put forward is that it is the counter narratives with a greater illocutionary force and greater narratological power which can be a successful tool in law reform and effect a shift in the master narrative of domestic violence and abuse.

BackgroundReporting of domestic violence and abuse (DVA) increased globally during the pandemic. General Practice has a central role in identifying and supporting those affected by DVA. Pandemic associated changes in UK primary care included remote initial contacts with primary care and predominantly remote consulting. This paper explores general practice’s adaptation to DVA care during the COVID-19 pandemic.MethodsRemote semi-structured interviews were conducted by telephone with staff from six localities in England and Wales where the Identification and Referral to Improve Safety (IRIS) primary care DVA programme is commissioned. We conducted interviews between April 2021 and February 2022 with three practice managers, three reception and administrative staff, eight general practice clinicians and seven specialist DVA staff. Patient and public involvement and engagement (PPI&E) advisers with lived experience of DVA guided the project. Together we developed recommendations for primary care teams based on our findings.ResultsWe present our findings within four themes, representing primary care adaptations in delivering DVA care: 1. Making general practice accessible for DVA care: staff adapted telephone triaging processes for appointments and promoted availability of DVA support online. 2. General practice team-working to identify DVA: practices developed new approaches of collaboration, including whole team adaptations to information processing and communication 3. Adapting to remote consultations about DVA: teams were required to adapt to challenges including concerns about safety, privacy, and developing trust remotely. 4. Experiences of onward referrals for specialist DVA support: support from specialist services was effective and largely unchanged during the pandemic.ConclusionsDisruption caused by pandemic restrictions revealed how team dynamics and interactions before, during and after clinical consultations contribute to identifying and supporting patients experiencing DVA. Remote assessment complicates access to and delivery of DVA care. This has implications for all primary and secondary care settings, within the NHS and internationally, which are vital to consider in both practice and policy.

BackgroundIt is unknown whether interventions known to improve the healthcare response to domestic violence and abuse (DVA)—a global health concern—are effective outside of a trial.MethodsAn observational interrupted time series study in general practice. All registered women aged 16 and above were eligible for inclusion. In four implementation boroughs’ general practices, there was face-to-face, practice-based, clinically relevant DVA training, a prompt in the electronic medical record, reminding clinicians to consider DVA, a simple referral pathway to a named advocate, ensuring direct access for women to specialist services, overseen by a national, health-focused DVA organisation, fostering best practice. The fifth comparator borough had only a session delivered by a local DVA specialist agency at community venues conveying information to clinicians. The primary outcome was the daily number of referrals received by DVA workers per 1000 women registered in a general practice, from 205 general practices, in all five northeast London boroughs. The secondary outcome was recorded new DVA cases in the electronic medical record in two boroughs. Data was analysed using an interrupted time series with a mixed effects Poisson regression model.ResultsIn the 144 general practices in the four implementation boroughs, there was a significant increase in referrals received by DVA workers—global incidence rate ratio of 30.24 (95% CI 20.55 to 44.77, p < 0.001). There was no increase in the 61 general practices in the other comparator borough (incidence rate ratio of 0.95, 95% CI 0.13 to 6.84, p = 0.959). New DVA cases recorded significantly increased with an incident rate ratio of 1.27 (95% CI 1.09 to 1.48, p < 0.002) in the implementation borough but not in the comparator borough (incidence rate ratio of 1.05, 95% CI 0.82 to 1.34, p = 0.699).ConclusionsImplementing integrated referral routes, training and system-level support, guided by a national health-focused DVA organisation, outside of a trial setting, was effective and sustainable at scale, over four years (2012 to 2017) increasing referrals to DVA workers and new DVA cases recorded in electronic medical records.

Background The poor health of unpaid carers is well-documented. Evidence also highlights that carers can experience high levels of domestic violence and abuse (DVA). However, links between DVA victimisation and health outcomes in carers remains largely overlooked. We examined DVA prevalence in carers and non-carers, and the relationship between carers’ DVA experience and health morbidities. Methods We analysed data from a general population probability sample survey of 6,971 adults (aged ≥ 16 years) in England. Multivariable logistic regression models examined associations between caregiving, DVA experience, and mental and physical health morbidities (i.e., common mental disorders (CMD), probable post-traumatic stress disorder (PTSD), harmful alcohol use and chronic physical health conditions), adjusting for demographic and socioeconomic factors. Results One person in five reported caring responsibilities. Caring was associated with higher odds of CMD and chronic physical health conditions. One in three carers reported experiencing DVA in adulthood, and carers were more likely to be victims of DVA than non-carers. In carers who experienced DVA, compared to carers reporting no DVA, adjusted odds of CMD (aOR 2.88, 95% CI 2.11–3.95); probable PTSD (aOR 5.67, 95% CI 3.12–10.30); hazardous alcohol use (aOR 1.53, 95% CI 1.09–2.15) and chronic physical health conditions (aOR 1.53, 95% CI 1.14–2.06), were significantly higher. Conclusions The risk of DVA victimisation among carers and the associated vulnerability to poorer health outcomes were highlighted. The need for greater awareness and identification of carers’ risk of DVA, and better provision of support for the negative health consequences are emphasised.

BackgroundThe current evidence for child maltreatment (CM) and domestic violence and abuse (DVA) interventions is limited by the diversity of outcomes evaluated and the variety of measures used. The result...

Rationale: Despite interventions to improve detection rates, domestic violence, and abuse (DVA) remains largely undetected by healthcare services. We therefore aimed to examine the acceptability, feasibility, and sustainability of an intervention aiming to improve DVA detection rates, which included a clear referral pathway (i.e., the BRAVE intervention) and to explore the acceptability and feasibility of DVA management and referrals in general, in the context of low detection rates.Methods: Qualitative study design with four focus groups of 16 community mental health (CMH) clinicians from both control and intervention arms. The focus groups discussed managing DVA in clinical practice and staff experiences with the BRAVE intervention in particular. Focus groups continued until saturation of the subject was reached. Interviews were analyzed using a thematic analysis approach.Results: DVA was seen to be highly relevant to mental healthcare but is also a very sensitive subject. Barriers in CMH professionals, institutions, and society meant CMH professionals often refrained from asking about DVA in patients. Barriers included communication difficulties between CMH professionals and DVA professionals, a fear of disrupting the therapeutic alliance with the patient, and a lack of appropriate services to help victims of DVA.Conclusion: The BRAVE intervention was acceptable but not feasible or sustainable. Personal, institutional, and public barriers make it not feasible for CMH professionals to detect DVA in mental healthcare. To increase the detection of DVA, professional standards should be combined with training, feedback sessions with peers and DVA counselors, and routine enquiry about DVA.Clinical Trial Registration: ISRCTN, trial registration number: ISRCTN14115257.