Identification and Referral to Improve Safety (IRIS) programme

Executive summary: Domestic violence and abuse (DVA) is recognised as a significant global public health issue (World Health Organisation (WHO) 2013). DVA is a serious, multifaceted societal issue with profound health and mental wellbeing consequences with the potential for longer term health care needs in supporting survivors. The Office for National Statistics (2015) crime survey for 2013-2014 estimates that at least 1.4 million women and 700,000 men aged between 16 and 59 experienced DVA in England and Wales equating to 8.5% of women and 4.5% of men reporting a DVA crime (ONS, 2015). Furthermore, new data reports that 85% of DVA victims sought help, on average five times from professionals, including healthcare professionals, in the year before they received effective help (Safe Lives 2015). The cost to public services of domestic abuse (uprated to 2013 prices) is £4.3 bn with the majority of costs attributed to the health service (£1.9 bn) (Walby 2004, 2009). In 2011 the findings from a cluster randomised controlled trial (RCT); funded by the Health Foundation, for the Identification and Referral to Improve Safety (IRIS) programme was published in The Lancet (Feder et al., 2011). The trial was based on two urban primary care Trusts; Bristol and Hackney in London with a total of 48 general practices involved in the study from 2007 - 2010. The IRIS intervention programme comprises of a structured approach to support and management of DVA by providing training to clinical and non-clinical staff located within GP surgeries, ongoing consultancy to the practice team, a prompt within the patient’s medical records and a defined referral pathway to an advocate educator (AE) working locally. In November 2010 the IRIS National Steering group was formed. The current membership of this group comprises Donna Covey (Chair) – CEO, AVA, Professor Gene Feder – University of Bristol, Carol Metters – CEO, Next Link, Karen Ingala-Smith – CEO, nia, Val Lunn – CEO, WAIS, Dr. Roxane Agnew Davis – DVTraining Ltd. The IRIS DVA intervention model has received national recognition and strategic relevance in over seven key UK documents on domestic violence and abuse. This independent review of the national IRIS intervention is based on national and local data that is widely available since the publication of the IRIS RCT study (Feder et al., 2011). This report has been conducted independently of the national IRIS steering group but in consultation as part of the review process to compile this report for the Department of Health (DOH) 3 year funding criteria (2013 – 2016). The review is solely based on the literature available at the time of submitting this report (June 2016) and includes the annual IRIS data reports (2013, 2014, 2015) published peer review articles (Feder et al., 2011, Devine et al., 2012), local IRIS service evaluations (5 independent reports) from commissioned IRIS sites and an evaluation of the IRIS train the trainers report.