1. IRIS Identification and Referral to Improve Safety “If they ask I would answer” Judy Barber Islington IRIS Advocate Educator © Bristol University 2007 – 2014

2. Cross government definition as of 31-3-13 Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. The definition includes ‘honour’ based violence, female genital mutilation (FGM) and forced marriage. The abuse can encompass but is not limited to psychological, physical, sexual, financial and emotional abuse Domestic violence & abuse

3. 1,000 women study  To measure the prevalence of DVA among women attending general practice, the extent of recording of DVA in records and the acceptability of screening for DV by general practitioners (GPs) and Practice Nurses (PNs)  1207 women (over 15 years of age) completed a survey. Medical records reviewed.  13 selected general practices in Hackney, London.  41% had experienced physical violence, 74% had experienced any form of controlling behaviour and 46% had been threatened.  17% had experienced physical violence and 35% had felt afraid in the last 12 months.  Only 15% of women had any reference to violence in their medical record.

4. IRIS Randomised Controlled Trial (RCT)  48 practices recruited in total in Bristol & Hackney  24 practices trained; 24 used as control group  Practices received training and a named advocate  Identification & referral measured over 12 months

5. IRIS Randomised Controlled Trial Results  Results  6 fold increase in referrals to specialist DVA service  3 times more likely to have a recorded identification in the medical record  Cost effective  NHS savings of £1/woman registered/year  Societal savings of £37/woman registered/year

6. Advocate Educator Clinical Lead

7. IRIS advocate  offers emotional and practical support  provides choices and empowers  is patient led – provides a flexible approach according to the woman’s situation, pace, readiness to change and individual goals  offers referrals to wide range of services, including MARAC, housing, counselling, legal support  provides case updates and advice to primary care professionals

8. IRIS educator  provides training for entire practice team  is consultant to primary care professionals  is named contact for referral  provides ongoing support to practice team  is the main source of domestic violence information and materials  feeds back data on disclosure and referral  work in partnership with the clinical lead

9. Clinical lead  Delivers session 1 IRIS training for clinicians in partnership with the IRIS Advocate Educator  encourage clinicians to ask patients about their experience of abuse and respond, record, assess immediate risk and refer  provide peer support to general practice colleagues  maintain an effective relationship with general practice teams  promote awareness of the experiences and needs of women living with current or historic DVA, particularly in relation to their health  respond to queries from clinicians regarding DVA

10. Clinician’s voice “… I’m now convinced that Violence Against Women and Girls is a major public health problem with long term consequences for women and their families. As an experienced GP, the whole project has been nothing short of transformational.”

11. Survivor’s voice “…the only doctor who ever asked…I was just so relieved that somebody just said something. And he gave me the box of tissues and I just sat and cried…and he said, tell me when you’re ready, he said, there is somebody out there to help me. I’m not on my own. And if I want help, it’s there and not to be ashamed of it. Which I was, really ashamed of it and he said, you’re not on your own. We can get you this help. And he did. He really did.”