Finding a better way to identify children experiencing domestic violence

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Natalia Lewis, University of Bristol

Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. When adults are involved in an abusive relationship, their children bear the consequences.

The effects of domestic violence on a child can range from emotional and behavioural problems to physical injury and death when children are caught up in the violence between adults.

Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences.

Health and social care workers are often the first professionals to have contact with a child experiencing these situations. This could be when the abused parent seeks help, or when children undergo health checks. It can happen during assessments for emotional or behavioural problems, or when social services, a child’s school or the police become involved.

The World Health Organisation (WHO) recommends that health professionals who see women with clinical signs of domestic violence should ask them about safety in their relationship and at home. They advise that responses to disclosure should follow what is known as the “LIVES” principles: Listen, Inquire about needs and concerns, Validate, Enhance safety, and provide Support.

But there are no equivalent recommendations for children, and there is no agreed approach regarding how best to identify and respond to children who are exposed to domestic violence. So far, there has also been only limited evidence on which to base future guidance.

Now researchers at universities in the UK (Bristol, Queen Mary and Cambridge) and Canada (McMaster and Western) have combined existing evidence on the best ways to identify and respond to children experiencing domestic violence. This synthesis, the first of its kind, integrates findings from 11 studies with 42 children, 220 parents, and 251 health care and social services professionals.

We found that study participants’ opinions were strikingly consistent, and matched the LIVES principles. Children, parents (mostly mothers) and professionals agreed that identification of the problem should happen in the context of a good patient-professional relationship, and in a safe and supportive environment.

Health care professionals should enquire about the child’s safety when they see clinical signs of domestic violence and abuse in children. The ideal initial response should include emotional support, discussion about domestic violence and advice on local specialist services.

We also discovered that a professional’s ability to identify and respond to children’s exposure to domestic violence was heavily influenced by constraints within the health and social service system. Lack of time, funding cuts and poor inter-agency collaboration all have an impact. Professionals needed more training and resources to be able to respond to these children and their families in an appropriate and safe way.

However, there was a difference of opinion when it came to engaging directly with children and managing their safety.

A direct approach?

Children and mothers wanted professionals to talk to children directly and engage them in safety planning. Professionals, on the other hand, preferred to engage with children via the parent – and did not perceive children exposed to domestic violence as patients or clients in their own right. Also, professionals were not happy with existing safety guidelines and practices for children and mothers exposed to domestic violence. These elements are certainly subjects for future research and training.

Given the scale of the problem, and the long-term emotional, behavioural and physical impacts on children, we hope that the results of this study can form the basis of new, internationally agreed guidelines.

Our research findings have already been used to inform point-of-care responses to adults and children in Canada’s VEGA (Violence, Evidence, Guidance, Action) Project. That program is already developing the “Recognising and Responding Safely to Family Violence” Handbook for health and social care professionals.

And we hope our evidence will inspire development of professional training and resources elsewhere – so that front line practitioners feel better equipped to appropriately and safely respond directly to the needs of children. Too many children’s lives and futures could depend upon it.

Natalia Lewis, Research Fellow in Primary Care, University of Bristol

This article was originally published on The Conversation. Read the original article.

Continuing Professional Development at your fingertips

Part of the CLAHRC’s mission is to raise awareness of new research evidence, and get it to the front-line where it can used by NHS staff. We are working with our host Trust NHS Bart’s Health to translate the new knowledge we generate into everyday practice among NHS professionals.

Bart’s Education Academy has developed an eCPD app available to download for free for users of Android and iPhone smartphones. The eCPD app aims to reduce the time staff have to leave the frontline to attend training courses in person, and give them more flexible learning they can fit around their busy schedules. The app allows staff to log in and create personal and professional development plans (including mandatory training) and optional learning modules. Once completed a notification is sent to both the member of staff and their supervisor, to show they have carried out the necessary training and are credited with CPD points where appropriate.

The CLAHRC has provided learning modules focused on our research findings, and more of our work will appear on the App in the near future.

We are now rolling out some of our popular CLAHRC Academy courses so that they can be accessed via the App – our Academy Director Dr Nora Pashayan (below right) and Academy Teaching Fellow Dr Silvie Cooper (below left) recently met Director of Academic Health Sciences at Barts Health NHS Trust Professor Jo Martin to launch our Introduction to Evaluation course via the App.

The Barts Education Academy provides clinical placements for 2,500 medical undergraduate students and trains 1,040 junior doctors, over 800 children, adult nursing and midwifery students and 275 allied health professionals. The Education Academy offers resuscitation skills training, moving and handling, simulation and clinical skills training and a range of skills based short courses, as well as ensuring the trust achieves high levels of compliance for its statutory and mandatory training.

Privacy Notice

Using patient information

How will this be operated?

Getting It Right First Time (GIRFT) is a national programme designed to improve care for patients within the NHS, by reducing unwarranted variations. Our evaluation of the NHS Getting it Right First Time programme could not happen without access to patients’ data and this will play a vital role in our ability to get a picture of how the programme is working and the difference it is making to patient care. We want to be clear about how your data is stored, used and protected in our research. One aspect of this study looks at ‘what works and at what cost?’

We are trying to look at whether the Getting it Right First Time programme in orthopaedic surgery has reduced variations in orthopaedic practice and costs, and improved outcomes for patients. To do this, we are requesting confidential patient data for a group of patients who have undergone elective orthopaedic surgery between 1st April 2009 and 31st March 2018.

The data we would like to use include Hospital Episode Statistics (HES), a database containing details of all admissions to NHS hospitals in England, which is collected so that hospitals can be paid for the care they deliver. We would also like to include Patient Reported Outcome Measures (PROMs) for patients who have had hip or knee replacements. NHS patients who have had these procedures have been invited to fill in Patient Reported Outcome Measures (PROMs) questionnaires as part of the Department of Health’s PROMs programme. The NHS asks patients about their health and quality of life before they have their operation, and about their health and the effectiveness of the operation afterwards at six months. These data can also be processed and used for other purposes, such as research and planning health services. We would also like to use data from the National Joint Registry (NJR). The NJR was set up by the Department of Health to collect information on all hip, knee, ankle, elbow and shoulder replacement operations across the NHS, to make sure joint replacement implants were working and to also ensure the different types of surgery for these operations were safe and effective.

Secure storage and processing of patient information

This study has already received research ethics approval – a process designed to make sure researchers’ can benefit from accessing data while minimising risk of any harm to patients – and Health Research Authority Confidential Advisory Group Section 2.51 approvals. The legal basis for processing are covered under Article 6 (1) (e) and Article 9 (2) (j).

Personal data of patients – including NHS number, date of birth, sex, postcode and the study ID will only be securely transferred between two organisations – Northgate Public Services (who control NJR data) and NHS Digital (who control HES and PROMs data). This is considered to be personal data according to European data protection rules – the General Data Protection Regulation (or GDPR). As these two organisations currently hold the data, and are involved in processing, they are called data processors. The purpose of sending this personal data between the two organisations is so NHS Digital can link these data together for the same patients, to provide more accurate and complete information for researchers who can track a patient’s journey through the NHS system. However, researchers will not have access to any personal identifiable data, and will not be able to identify patients, using the information that they are given by the two organisations (Northgate Public Services and NHS Digital).

Both organisations will securely transfer pseudonymised data to researchers at UCL. Pseudonymisation means the most identifying fields within a database are replaced with artificial identifiers, or pseudonyms so patient information can be processed without researchers being able to identify patients. This means that UCL will be the final and only data controller for the data that is disseminated for the purposes of looking at ‘what works and at what cost?’ UCL will determine the purposes for which and the manner in which any personal data are to be processed. All pseudonymised patient information will be stored on a secure network that is password-protected and can only be accessed by those with specialised training and access for the duration of the study.

The data will be stored by researchers at UCL until 2021 for analysis and dissemination purposes, and thereafter will be securely destroyed.

UCL Data Protection:

UCL is required by law to comply with data protection legislation. The UK’s regulator for the legislation is the Information Commissioner’s Office.  It is the commitment of the university to ensure that every current employee and registered student complies with this Act to ensure the confidentiality of any personal data held by UCL, in whatever medium. This Act came into force on 25 May 2018.

UCL processes the personal data of living individuals such as its staff, students, contractors, research subjects and customers. UCL has a data protection policy as a commitment to the safeguarding of personal data processed by its staff and students, and to ensure compliance with the legislation. It is the duty of data controllers such as UCL to comply with the data protection principles with respect to personal data.  This policy describes how UCL will discharge its duties in order to ensure continuing compliance with the Act in general and the data protection principles and rights of data subjects in particular.

Data Protection Officer Contact details:

Stephanie Hume
Research Department Administrator
PA to Professor Rosalind Raine and Professor Naomi Fulop
Department of Applied Health Research, UCL
Visiting Address: 1-19 Torrington Place, London WC1E 7HB, Rm 112
Postal Address: UCL, Gower Street, London WC1E 6BT
Tel: 020 3108 3269
E-mail: stephanie.hume@ucl.ac.uk

Opting-out

We are happy to discuss your rights to protect your data, and how exactly it will be used in our research. If you would like further information about the use of your data in this research study, or would like to lodge a complaint to a supervisory authority – please contact us on the details given below. If you would like to request that your confidential patient information is not included in this study, please aim to contact us between 1st May – 24th August 2018 to discuss.

Contact details:
Dr Sarah Jasim
NIHR CLAHRC North Thames
Department of Applied Health Research
University College London
1-19 Torrington Place
London WC1E 7HB
Tel: 020 3105 3233
E-mail: clahrc.girft-evaluation@ucl.ac.uk

My health in school website up and running

CLAHRC researchers based at Queen Mary University working to positively transform the health of young people have launched the My health in school initiative and website.

‘My Health in School’ aims to support young people’s health via school-based projects.

The My health in school team (below) also includes researchers and communications experts from Queen Mary University of London, and will initially focus will on asthma in young people aged 11-13, building on CLAHRC research and engagement with young people.

Previous collaborations with pupils, teachers and parents has spawned a number of innovations to engage and educate young people living with asthma and their peers. Outputs already developed include board and computer games, a drama being delivered in a number of schools and a short film.

The team is working with Professor Jonathan Grigg, who leads several studies about asthma and lung health in children and young people.

As well as support from NIHR CLAHRC North Thames other key collaborators, include:

  • Centre of the Cell
  • GLYPT (Greenwich and Lewisham Young People’s Theatre)
  • Healthy London Partnership
  • Asthma UK Centre for Applied Research

The project is recruiting secondary schools across London – schools that are interested are encouraged to get in touch with the team – find out more about what being involved means here.

 

 

Two PhD studentships jointly funded by CLAHRC and the School for Public Health Research

Two National Institute for Health Research funded PhD studentships available

The National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames and the NIHR School for Public Health Research (SPHR) based at UCL invite applications for two jointly-funded 3-year PhD studentships at UCL to begin September 2018. Supervisors are drawn from across both the NIHR CLAHRC North Thames and NIHR SPHR. PhD projects align with the following NIHR CLAHRC North Thames and NIHR SPHR themes:

  • Children and Young People
  • Public Mental Health
  • Inequalities

The benefit of this collaborative initiative include joint funding from two high profile NIHR research collaborations, which facilitates the opportunity for unparalleled access to leading applied and public health experts, supervisors who are leaders in their field, channels for dissemination of research and participation in bespoke training and a strong network and community of graduate students and researchers. From the four topics outlined below, two will be funded through these joint studentships.

PhD Research Topics

  1. Integrated legal advice and health services

Supervised by Prof Rosalind Raine (NIHR CLAHRC North Thames, NIHR SPHR, UCL), Prof Dame Hazel Genn (UCL Centre for Access to Justice) and Dr Charlotte Woodhead (NIHR CLAHRC North Thames, NIHR SPHR, UCL)

  1. Exploring the value of linked health and council data to examine associations between adverse childhood experiences and its consequences using linked population and health datasets

Supervisory panel includes Dr Jessica Sheringham (NIHR CLAHRC North Thames, UCL), Dr Manuel Gomes (UCL) and Dr Sarah Dougan (London Borough of Islington)

  1. Exploring the value of linked health and council data to examine the clustering of multimorbidity and associated unplanned service use

Supervisory panel includes Dr Jessica Sheringham (NIHR CLAHRC North Thames, UCL), Dr Manuel Gomes (UCL) and Dr Sarah Dougan (London Borough of Islington)

  1. Closing the gap in adverse physical health outcomes for people with poor mental health: exploring the role of healthcare provision and care pathways

Supervised by Dr Kate Walters (NIHR SPHR, UCL) and Prof David Osborn (NIHR SPHR, UCL)

Further details of all topics and methodological expertise or experience required can be found here: PhD Studentships – CLAHRC SPHR Full Description 2018 

Eligibility

Candidates should hold a Master’s qualification (or complete their Master’s by September 2018) in an appropriate discipline and have a minimum of a 2:1 or equivalent in their first degree. Applicants should preferably have knowledge of the UK health and care system. All applicants are required to have excellent written and verbal communication skills. They should also be willing to work collaboratively in multi-disciplinary and multi-professional teams.

Due to funding restrictions applicants must be UK/EU nationals. Please refer to UK Council for International Student Affairs (UKCISA) for details of these criteria.

How to apply

Your application should consist of a CV, contact details of two academic referees, and a personal statement (1,000 words maximum) describing your suitability for the proposed project(s) including how your research experience, skills and interests relate to the NIHR CLAHRC North Thames and NIHR SPHR project(s). In your application, please indicate which project(s) you wish to be considered for.

Please send your application or queries about projects to Dr Silvie Cooper, NIHR CLAHRC North Thames Academy Teaching Fellow (silvie.cooper@ucl.ac.uk).

Closing date for applications: 17.00, 15 May 2018

Interviews: 25 May 2018

PhD start date: 01 September 2018 (or earlier if desired)

Duration: 3 years, full time

Stipend:  £19,158

 

Improving NHS orthopedic care – your views and experience needed

There are big variations in care for people receiving orthopedic services in the NHS –  orthopedics covers conditions involving the musculoskeletal system including hip and knee replacement surgery. We are evaluating the Getting it Right First Time programme – or GIRFT – which aims to improve services and make sure people get more consistent care across the whole NHS.

Part of our evaluation involves asking two sets of people –

i) patients over 60 who have had orthopaedic surgery in the last two years
and
ii) people over 60 

about their views on orthopaedic surgery and improving outcomes.

We’re running focus groups in April and May at the UCL Farr Institute

UCL Farr Institute, 222 Euston Road, London, NW1 2DA

i) People who have had a hip or knee replacement in a NHS hospital within the last two years Aged over 60

ii) People over 60

Contacts to register your interest are below –

Dr Jean Ledger: j.ledger@ucl.ac.uk or 020 7679 2000 / x53274
Dr Sarah Jasim: sarah.jasim@ucl.ac.uk or 020 7679 2000 / x53233

New research – Improving the response to domestic violence and abuse in sexual health clinics

The findings of the joint CLAHRC West and CLAHRC North Thames study of the IRIS ADViSE pilot, which aimed to improve sexual health professionals’ response to women who have experienced domestic violence, are now available as a CLAHRC BITE.

Women who have experienced domestic violence and abuse (DVA) are three times more likely to have gynaecological and sexual health problems such as sexually transmitted infections, urinary tract infections and unintended pregnancy. Forty-seven per cent of women attending sexual health services will have experienced DVA at some point in their lives.

These services can be the first point of contact for women who have experienced DVA, so sexual health practitioners can have a key role in supporting women to access advocacy services. But most sexual health professionals haven’t had much training in identifying and responding to DVA, despite National Institute for Health and Care Excellence (NICE) recommendations.

The IRIS (Identification and Referral to Improve Safety) programme is an evidence-based training intervention for general practice staff to identify, respond and appropriately refer women who are affected by DVA. It is being implemented in general practice nationwide. IRIS ADViSE (Assessing for Domestic Violence in Sexual Health Environments) adapts the IRIS approach for sexual health staff.

This project looked at the feasibility and acceptability of the IRIS ADViSE pilot in sexual health clinics in Bristol and East London. The pilot aimed to encourage sexual health staff to ask patients whether they were experiencing DVA, and to make referrals to specialist services.

IRIS ADViSE included all staff training, patient information materials, an enquiry prompt in the electronic patient record and a simple referral pathway to DVA advocacy services.

In the east London clinic over seven weeks:

  • 267 out of 2,568 women attending were asked about DVA
  • 16 of those (6 per cent) said that they were affected by abuse
  • Overall, eight of the women affected by abuse (50 per cent) were referred to specialist services

In the Bristol clinic over 12 weeks:

  • 1,090 out of 1,775 women attending were asked about DVA
  • 79 of those (7 per cent) said they were affected by abuse
  • Overall, eight of the women affected by abuse (10 per cent), were referred to specialist services

During the three months before the pilot started, there were no referrals to DVA specialist services at either site.

We also interviewed sexual health clinic staff and DVA advocate workers in Bristol.

All the people we interviewed felt that asking about and referring women on to DVA services was appropriate and valuable in a sexual health setting. They responded favourably to the training and felt more confident about asking about DVA and managing disclosures.

Staff said that patients’ welcomed being asked about it, even if they’ve not ever been involved in an incident of domestic abuse themselves, that they appreciate that people are asking that question.

The staff reported that some disclosures were considered relatively simple and easy to handle, where patients can be easily referred to the partner DVA organisation or given information.

However, cases with an immediate risk of harm to the patient or their children were more complex in terms of managing the patient’s wishes and navigating existing safeguarding procedures. This added to staff’s already limited time and busy workloads.

Dr Jeremy Horwood (pictured below), lead researcher from the Centre for Academic Primary Care at University of Bristol and NIHR CLAHRC West, said:

“Sexual health staff are definitely supportive of asking their patients about domestic violence and abuse. But it’s crucial that they have support to do so, as these patients must be dealt with sensitively and referred on appropriately.

“At the policy and commissioning level, stronger recognition of the issues around domestic violence and abuse referrals, and resources to support them, are needed. Commissioners and local NHS trusts need to engage and commit to support domestic violence and abuse training, and to support programmes such as IRIS ADViSE.”

The study shows that it is feasible and acceptable to develop and implement the IRIS ADViSE training and referral package for sexual health clinics. At the policy and commissioning level, stronger recognition of the issues around DVA referrals, and more resources to support them, are needed. Commissioners and local NHS trusts need to engage and commit to financially support IRIS ADViSE to maximise its potential.

This study is part of CLAHRC North Thames’ wider collaboration with our colleagues at CLAHRC West.  Researchers and staff work across London and Bristol sites each bringing their own expertise and experience to produce high-quality research.  Our teams regularly meet to coordinate their work, and develop bids for funding for future work.

For this IRIS ADViSE project CLAHRC North Thames led on the work at the initial pilot site, focusing on the quantitative analysis; whereas CLAHRC West led on the qualitative analysis.

Links and downloads

BMJ talk medicine
Domestic violence affects a quarter of UK women: the role of sexual health practitioners
Listen to a podcast hosted by Editor in Chief of Sexually Transmitted Infections Jackie Cassell who is joined by Neha Pathak (Wellcome Trust Clinical PhD Fellow, Institute for Epidemiology & Healthcare, University College London) and Gene Feder (University of Bristol, Centre for Academic Primary Care) to discuss the various forms of the abuse and how healthcare practitioners can intervene.

 

Read our CLAHRC BITE summarising the research
Improving the response to domestic violence in sexual health clinics

Read the full research papers –

Sohal AH, Pathak N, Blake S, Apea, V. Berry, J. Bailey, J. Griffiths, C. Feder, G. (2018)
Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention
SexuallyTransmitted Infections doi: 10.1136/sextrans-2016-052866

Horwood J, Morden A, Bailey JE, Pathak, N and Feder, G. (2018)
Assessing for domestic violence in sexual health environments: a qualitative study
Sexually Transmitted Infections. doi: 10.1136/sextrans-2017-053322

Pathak N, Sohal AH, Feder G.(2017)
How to enquire and respond to domestic violence and abuse in sexual health clinics.
Sexually Transmitted Infections. 2017 May;93(3):175-178. doi: 10.1136/sextrans-2015-052408. Epub 2016 Jul 25.