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Understanding the impact of training to identify and refer women affected by domestic violence and abuse

Identification and Referral to Improve Safety (IRIS) is a primary-care-delivered, evidence-based intervention to improve the health, safety and experience of women affected by domestic violence and abuse.

Identification and Referral to Improve Safety (IRIS) is a primary-care-delivered, evidence-based intervention to improve the health, safety and experience of women affected by domestic violence and abuse. Since its initiation in 2007, IRIS has been delivered in 10 London boroughs. The intervention was boosted in 2020, when the London Mayor’s Violence Reduction Unit announced a £1 million investment to expand the training from 10 to 17 boroughs.

The NIHR Applied Research Collaboration (ARC) North Thames, part of UCLPartners, has been conducting an implementation study of IRIS across east London. Data collection for this study took place from November 2012 to the end of March 2017, and the results of the study were published in March 2020.

Challenge

Domestic violence and abuse is a significant public health problem, with devastating impacts on the women affected, and substantial associated health and societal costs. Some 1.3 million women aged 16-59 years (7.9% of the population) in England and Wales are affected by domestic violence and abuse.  

What we did

IRIS encapsulates a training, support and referral programme that encourages clinicians to ask about domestic violence and abuse when clinically relevant; recognise domestic violence and abuse in a woman’s life; discuss its impact on her health/wellbeing; and offer referral to a specialist domestic violence and abuse service within that clinical setting.

NIHR ARC North Thames conducted an implementation study, using interrupted time series design across 200 east London general practices, to determine the real-life impact of rolling out IRIS training in general practice on identification and referral of women experiencing domestic violence and abuse.

Impact

The implementation study demonstrated that IRIS is a simple intervention that does not require major service redesign, is likely to be cost-effective and cost-saving to society, and cost-effective to the health service

The study showed IRIS had sustained effectiveness over four years when implemented in routine care in four northeast London boroughs (Sohal et al, BMC Medicine). The analysis demonstrated a 30-fold increase in referrals received by domestic violence and abuse service providers from the 144 general practices in the four boroughs.

A cost-effectiveness analysis estimated that IRIS outside the trial setting is cost-effective from a health service and societal perspective; good value for the NHS and cost saving for society, with an estimated societal cost saving of £14 per woman registered in an IRIS practice.

Since 2007, IRIS has been commissioned in 40 clinical commissioning groups (CCGs) across England, including 33 outside the North Thames region. Approximately 800 general practices have been trained, with a reach of over a million women.

A local GP described IRIS as “…undoubtedly the most successful project of its kind…”.

Next steps

Since the announcement from the London Mayor’s Violence Reduction Unit in January 2020 that they would invest £1 million to expand IRIS training from 10 to 17 London boroughs, NIHR ARC North Thames have begun working closely with UCLPartners’ AHSN to increase awareness and implementation of the IRIS intervention with the STPs in our region.