Abstract
BackgroundHealth services are often the first point of professional contact for people who have experienced domestic violence and abuse. We report on the evaluation of a multi-site, hospital-based advocacy intervention for survivors of domestic violence and abuse. Independent Domestic Violence Advisors (IDVAs), who provide survivors with support around safety, criminal justice, and health and wellbeing, were located in five hospitals in England between 2012 and 2015 in emergency departments and maternity services. We present views about IDVAs’ approaches to tackling domestic violence and abuse, how the IDVA service worked in practice, and factors that hindered and facilitated engagement with survivors.MethodsWe adopted a convenience sampling approach and invited participation from all who offered to take part within the study timeframe. Sixty-four healthcare professionals, IDVAs, IDVA service managers, and commissioners at all sites were interviewed. Interviews were analysed using a thematic approach: familiarising ourselves with the data through repeated readings and noting initial ideas; generating initial codes through double coding notable features of the data across the dataset; collating codes into potential themes; and reviewing themes to ensure they captured the essence of the data.ResultsTwo key themes emerged. The first was Hospital-based IDVAs fulfil several crucial roles. This theme highlighted that healthcare professionals thought the hospital-based IDVA service was valuable because it enhanced their skills, knowledge, and confidence in asking about domestic violence and abuse. It enabled them to immediately refer and provide support to patients who might have otherwise been lost along a referral pathway. It also reached survivors who might otherwise have remained hidden. The second theme was Success hinges on a range of structural factors. This theme illustrated the importance of ongoing domestic violence and abuse training for staff, the IDVA having private and dedicated space, and the service being embedded in hospital infrastructure (e.g. featuring it in hospital-wide policies and enabling IDVAs access to medical records).ConclusionHospital-based IDVAs offer a unique and valued way to respond to domestic violence and abuse in a healthcare setting. Further work must now be done to explore how to implement the service sustainably.
Highlights
Health services are often the first point of professional contact for people who have experienced domestic violence and abuse
Given the shortness of some interviews and our desire to capture a range of voices –i.e. healthcare professionals from different specialties, we interviewed 64 participants across sites: forty-nine hospital staff, six hospital Independent domestic violence advisor (IDVA), four IDVA managers, and five commissioners
IDVAs enhance healthcare professionals’ skills, knowledge, and confidence Healthcare professionals considered the IDVA service to be “incredible” (Location 1, Emergency Department Lead Nurse) and “integral” (Location 1, Adult Safeguarding Nurse) to the hospital. They felt that the training that IDVAs delivered helped them to ask patients questions about domestic violence and abuse more effectively and sensitively and to detect subtler signs of domestic violence and abuse
Summary
Health services are often the first point of professional contact for people who have experienced domestic violence and abuse. We report on the evaluation of a multi-site, hospital-based advocacy intervention for survivors of domestic violence and abuse. An estimated two million adults in England and Wales aged 16 to 59 experienced domestic violence and abuse in the year ending March 2018, two-thirds of whom were women [1]. Healthcare professionals are wellplaced to respond to domestic violence and abuse. The UK’s National Institute for Health and Care Excellence [4] recommends that NHS staff should be trained to identify and respond to domestic violence and abuse and to refer survivors to specialist services. Training varies across the UK and across different clinical specialties
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