A primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a multicentre cluster randomised trial with economic and process evaluation. IRIS+ RCT

Funding

This project is funded by the National Institute for Health and care Research (NIHR) – Public Health Research (PHR) funding stream: NIHR153788.

What’s the research question?

Is the IRIS+ intervention effective, cost-effective and scalable with regards to referring adults and children affected by domestic abuse from primary care for specialist advocacy support?

What is the problem?

Domestic abuse affects nine million adults in England and Wales. It damages health with societal costs over £66 billion a year. A large minority of adults and children consulting general practice are experiencing domestic abuse. Survivors are more likely to tell GPs than other professionals. Getting specialist domestic abuse support can improve survivors’ health, quality of life, and safety.

What is the aim of the research?

We will assess whether a general practice training and support programme for women, men and children, called IRIS+, works, whether it provides good value for money, and whether it is possible to deliver it at scale in different areas in England and Wales. If IRIS+ is effective and cost-effective, the study will inform the commissioning of IRIS+ as a new service. Future implementation of a successful intervention could significantly improve the safety, wellbeing, and health of domestic abuse survivors and their children. This could create large downstream economic benefits for the NHS and society.

How will this be achieved?

IRIS (Identification & Referral to Improve Safety) is an effective and cost-effective training and support programme for GP staff. It helps them to understand the signs of domestic abuse among women, to ask them if they are experiencing it, and to refer them to specialist support.

In our patient and public advisory groups, women domestic abuse survivors have said that IRIS should also support children affected by domestic abuse. Men survivors have said that IRIS should support men. In our previous research, GPs told us that they wanted to better respond to everyone affected. In response, we developed and  . IRIS+ adds to IRIS by broadening the focus from women only to men and children as well, without diminishing the responses to women.

In IRIS+, an advocate educator and a clinical lead train GP staff. Training covers the signs of domestic abuse and how to refer people for support. Advocate educators advise GP staff, receive patient referrals, support survivors, and signpost perpetrators to local programmes. Dedicated children’s workers support affected children and young people.

In our new study, we will deliver IRIS+ in many general practices in 3 areas.

In all areas, we will assign practices by chance to either take part in IRIS+ or IRIS. We will then test whether IRIS+, compared to IRIS, is effective and cost-effective for men and children and whether delivering it on a large scale is possible.

Who is leading the research?

Dr Eszter Szilassy, Senior Research Fellow, Centre for Academic Primary Care, University of Bristol.

For more information or to get involved with this project, please contact bnssg.research@nhs.net