and

IRIS PROGRAMME

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AANCHAL AND IRIS PROGRAMME

IRIS is a specialist domestic violence and abuse(DVA) training, support and referral programme for general practices that has been positively evaluated in a randomised controlled trial. It is a partnership between health and the specialist DVA sector. IRIS is a specialist domestic violence and abuse(DVA) training, support and referral programme for general practices that has been positively evaluated in a randomised controlled trial. It is a partnership between health and the specialist DVA sector.

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IRIS

IMPROVING THE GENERAL PRACTICE RESPONSE TO DOMESTIC VIOLENCE AND ABUSE

Identification & Referral to improve safety

How the IRIS programme can support
your practice and your patients

What is
IRIS

IRIS is a specialist domestic violence and abuse(DVA) training, support and referral programme for general practices that has been positively evaluated in a randomised controlled trial. It is a partnership between health and the specialist DVA sector. IRIS provides in-house DVA training for general practice teams and a named advocate to whom patients can be referred for support. Since 2010, IRIS has received 10,369 referrals and fully trained an estimated 695 general practices in 36
localities nationwide.

Behind every one of these referrals is a women being
provided with validation of her experiances and a safe spance
to articulate what is happening to her.

The reality in genaral practice...

1/4

One in four women will experience domestic abuse in their life time. Between 6% and 23% of women attending general practice will have experienced physical or sexual abuse from their partner or a previous partner in the preceding year. On average two women in England and Wales are killed by a male partner or expartner each week. (The Health Foundation, 2011. Home Office, 2005)

80%

Eighty percent of women in a violent relationship seek help from health services at least once (usually general practice) and this may be their first or only contact with professionals. (Department of Health, 2000)

15%

Domestic violence is a common problem that is almost invisible in primary healthcare, even though women would most like to receive support from their doctors. Only around 15% of women with a history of domestic violence have any reference to abuse in their medical record in primary care. (Richardson et al, 2002)

The IRIS Model

RIS provides in-house DVA training for general practice teams and a named advocate to whom patients can be referred for support

INPUTS

Training and
on-going
support

Care
pathways
including
safeguarding
children &
adults

Medical
record
prompts
(HARKS)

Recording
and flagging
system

Practice
champion

Health
education
materials

Clinical inquiry

Validation

Documentation

Immediate risk
assessment

Advocate
educator

OUTPUTS

Identification

Referral

Emotional &
practical
support

Evaluation &
monitoring

OUTCOMES

PATIENTS
Improved
quality of life

Improved
physical &
mental
health

Reduction in
abuse

PRIMARY CARE
PROFESSIONALS
Improved DVA
response

Provision of
holistic care

Continued
professional
development

PRACTICES
DVA aware &
resourced

75% of cases of domestic
violence result in
physical injuryor mental
health consequences
towomen.
(Department of Health,
2005)

The advocate educator

The model rests on one Full-time advocate educator working with up to 25 practices.
The advocate educator is a Specialist DVA worker who is linked to the practices and based in a local specialist DVA service.
The advocate educator provides training to the practice teams and acts as an ongoing consultant as well as the person to whom they directly refer patients for expert advocacy.
The advocate educator works in partnership with a local clinical lead to engage with practices and co-deliver training.

How we help

Knowledge and training supports clinicians to recognise domestic violence and abuse.

General practices receive:

In house training for the whole practice
team

Clinical team training – Two training sessions, each lasting two hours. Content focuses on how to recognise DVA and how to respond, refer and record disclosures. Administrative team training – One training session, lasting one hour. The training focuses on understanding DVA, responding to patients, resource provision, confidentiality and safety.
Refresher training and additional sessions for new staff are
available to all practices.

Named contact for patient referrals

Victims and survivors can be referred to the advocate educator. The advocate educator provides emotional and practical support, carries out risk assessments, safety plans and advocates on behalf of the patient as appropriate.

Ongoing support and consultancy

The advocate educator will attend practice meetings quarterly to discuss all aspects of the programme and is available to support the entire practice and individual professionals on a day to day basis by phone, email and when
in the practice.

The evidence base for the IRIS model is that it is effective for female patients. However, every practice that is IRIS trained is given a male patient referral pathway so that they will be signposted towards services that support male survivors. Referral pathways for perpetrators of domestic abuse are also provided.

Victims and survivors
attending an IRIS
trained practice are six
times more likely to
be referred to an
advocate.
(Feder et al, 2011)

How clinicians feel about IRIS DVA training

What has improved according to
clinicians and general practice staff

Knowledge and skills around DVA
understanding of health consequences around DVA
confidence to deal with and respond to disclosure ability to assess immediate risk knowledge of where to refer patients awareness of support services

How does IRIS DVA training benefit you?

“What an excellent
clinical teaching session
– one of the best I’ve
been to in eight years
of medicine”
IRIS trained clinician

Ultimately the whole programme is to the benefit of patients, practices
and practice teams. It:

Improves safety, quality of life and wellbeing for your patients and their children.
Provides access to advocacy which benefits victims and survivors of DVA.
Develops DVA aware practices with fully informed, resourced and equipped practice teams.
Saves general practices and the wider NHS time and resources.
Provides holistic care thus achieving better patient outcomes in terms of improved quality of life, physical and mental health and wellbeing.

“I’m now convinced that Violence against Women and Children 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.” – IRIS GP

Don’t have enough time for training?

How is IRIS different from other DVA referral pathways?

IRIS provides a referral to a named contact, the advocate educator. This referral is made by the clinician, not by the patient, providing a pro-active approach that patients tell us they prefer. Patients can be referred regardless of their level of risk, or whether she wants to leave the relationship or not. Referring clinicians are notified when the advocate educator has received their referral. The practice will also have ongoing support and consultancy, provided by the advocate educator.

What happens to the patient afte they have been referred?

Referring clinicians receive updates from the advocate educator, including information about the support their patient is receiving and other services to which they have been referred. This sharing of information enables monitoring of risk
and safety planning.

How does IRIS help your patients?

“Hugely grateful that the Dr
referred me. I wouldn't have
done myself. I was in a very
bad place. I was really lonely
and she didn't push anything
at me, but made it clear
there were options.”

IRIS service user

Clinical team training consists of two sessions, each lasting two hours. In the long term, this investment of time could save hours of appointment time as 70% of service users report visiting their GP less after being referred to an advocate educator.

Service user outcomes

(IRIS national data report, 2018)

Percentage of service
users that agreed

Pleased to be asked by their clinician

95%

Pleased to be referred to the advocate educator

98%

Felt listened to

99%

Found support helpful

95%

Know where to go for support

97%

Feel safer

86%

Feel more confident

85%

Feel more able to cope

83%

Feel good about myself

95%

Feel optimistic about future

95%

Visit GP less

95%

“I have slowly got my freedom back and
am so happy to be making my own
decisions, planning my own way in life.
This is not just for me, it’s for my children
and women like me out there.”

-IRIS service user