'It felt like there was always someone there for us': Supporting children affected by domestic violence and abuse who are identified by general practice.

Jessica Roy,Emma Williamson,Eszter Szilassy,Katherine Pitt,Nicky Stanley,Gene Feder,Mei‐See Man

doi:10.1111/hsc.13385

Abstract

One in five children in the UK are affected by domestic violence and abuse. However, primary care clinicians (GPs and nurses) struggle to effectively identify and support children and young people living in homes where it is present. The IRIS+ (Enhanced Identification and Referral to Improve Safety) training and advocacy support intervention aimed to improve how clinicians respond to children and young people affected by domestic violence and abuse. IRIS+ training was delivered as part of a feasibility study to four general practices in an urban area in England (UK). Our mixed method design included interviews and questionnaires about the IRIS+ intervention with general practice patients, including children and young people as well as with clinicians and advocacy service providers. We collected the number of identifications and referrals by clinicians of children experiencing domestic violence and abuse through a retrospective search of medical and agency records 10months after the intervention. Forty-nine children exposed to domestic violence and abuse were recorded in medical records. Thirty-five children were referred to a specialist domestic violence and abuse support service over a period of 10months. Of these, 22 received direct or indirect support. The qualitative findings indicated that children benefitted from being referred by clinicians to the service. However, several barriers at the patient and professional level prevented children and young people from being identified and supported. Some of these barriers can be addressed through modifications to professional training and guidance, but others require systematic and structural changes to the way health and social care services work with children affected by domestic violence and abuse.

Highlights

In the United Kingdom (UK), domestic violence and abuse (DVA) is defined as any incident or pattern of incidents of controlling coercive or threatening behaviour, violence or abuse between people aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality (House of Commons Library, 2018)
TA B L E 1 Identification of children affected by DVA in Electronic medical records (EMR) by practice
The remaining 47 children were identified as a result of information shared for safeguarding purposes by an external organisation with the GP which was coded on the EMR

Summary

Introduction

In the United Kingdom (UK), domestic violence and abuse (DVA) is defined as any incident or pattern of incidents of controlling coercive or threatening behaviour, violence or abuse between people aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality (House of Commons Library, 2018). It is estimated that one in five children are affected by DVA (Radford, Corral, et al, 2011), and this can have a significant negative impact on health and wellbeing across the life course (Holt et al, 2008; McTavish et al, 2016). General practice is well placed to identify and respond to children affected by DVA. This is because the GP is often the first place families will go to for help when experiencing DVA (Drinkwater et al, 2017). Clinicians have a duty to consider referral to children's social care where there are child protection concerns, which is known to be a factor in some situations where there is DVA (Department for Education, 2018; GMC, 2012)

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Conclusion