The ADViSE pilot: Using sexual health services to support people who have experienced domestic violence and abuse
Domestic violence and abuse affects around 26 per cent of heterosexual women, 32 per cent of gay / lesbian women, 45 per cent of bisexual women, 27 per cent of gay men, 14 per cent of heterosexual men and 80 per cent of transgender people in the UK.
Domestic violence and abuse often leads to sexual health and gynaecological problems, with increased sexually transmitted infections, including HIV, and unintended pregnancy.
Sexual health services can be the first point of contact for those experiencing domestic violence and abuse. This means sexual health staff can have a key role to play in supporting these patients to access specialist advocacy services. However, most sexual health professionals have had minimal training in identifying and responding to domestic violence and abuse.
The evidence-based IRIS (Identification and Referral to Improve Safety) programme supports staff working in GP surgeries. It helps them to identify and respond to women who are experiencing domestic violence and abuse, and refer them on to specialist services. In areas where the IRIS programme has been piloted, there has been a significant increase in these referrals.
ADViSE (Assessing for Domestic Violence and Abuse in Sexual Health Environments) adapts the GP IRIS programme for use in sexual health clinics. It is a training and referral programme that supports sexual health staff to recognise the signs and symptoms of domestic violence and abuse, teaching them how to respond to these patients. It also provides patients with direct referrals to specialist services through a simple, local care pathway, as recommended by British Association for Sexual Health and HIV (BASHH) guidance.
Project aims
This project aimed to find out whether the IRIS ADViSE programme could work in this setting and was acceptable to sexual health staff and patients, alongside developing commissioning guidance to support its roll out.
What we did
We piloted ADViSE in sexual health clinics in Bristol and East London, evaluating the pilot using a variety of research methods. We interviewed 17 staff who had been involved in the pilot. Both sexual health clinic staff and domestic violence and abuse advocate workers were included.
We used these findings to further refine ADViSE, in collaboration with domestic violence and abuse survivors, commissioners, sexual health staff and patients. Working with IRISi, the social enterprise that promotes the IRIS package of interventions, we also developed a commissioning prospectus (PDF).
What we found and what this means
The evaluation showed that ADViSE works in sexual health settings, and is acceptable and welcomed by staff and patients.
The programme increased the number of staff enquiries about domestic violence and abuse, responses to patients who disclose and referrals to specialist support services.
Everyone we interviewed felt that asking about domestic violence and abuse, and referring patients on to specialist services was appropriate and valuable in a sexual health setting. After the training sexual health staff described feeling confident about asking about domestic violence and abuse 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.”
What next?
ADViSE has been officially endorsed by BASHH. With IRISi, we have developed the ADViSE commissioning prospectus which gives:
- The background and context to the ADViSE programme, including the impact of domestic violence and abuse on health, and the role of sexual health teams in responding to it
- The evidence-base
- A description of the ADViSE programme
- Steps to implementing ADViSE
Download the ADViSE prospectus (PDF).
We are also investigating if the IRIS approach could be used by community pharmacists.
Paper
Assessing for domestic violence in sexual health environments: a qualitative study
Read the paper
Related research
We have also investigated if the IRIS approach could be used by community pharmacists, and are evaluating the implementation of ADViSE in sexual health services.
Links and downloads
- Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention Read the companion quantitative paper from Queen Mary University London and University of Bristol
- BMJ STI editorial on this project Routine enquiry for domestic violence and abuse in sexual health settings
- BMJ STI editor Jackie Cassell talks to Neha Pathak and Gene Feder about this research BMJ STI podcast
- IRISi commissioning prospectus for IRIS ADViSE Download the prospectus
Lead collaborators
- Gene Feder, University of Bristol
- Dr Jayne Bailey, University of Bristol
Partners on this project
Avon and Wiltshire Mental Health Partnership NHS Trust
Avon and Wiltshire Mental Health Partnership NHS Trust provides services for people with mental health needs, drug or alcohol dependency and people with learning disabilities. It covers Bath and North East Somerset, Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire and provides a specialist service throughout the South West.
Bristol City Council
The council plays a vital role in the health community as public health is part of its remit. Its role is to prevent disease, promote health, and prolong life among the population of Bristol. Its activities aim to provide conditions in which people can be healthy and it focuses on the population as a whole, not on individual patients or diseases.
University Hospitals Bristol and Weston NHS Foundation Trust
University Hospitals Bristol and Weston NHS Foundation Trust is a dynamic group of hospitals in the heart of Bristol and Weston-Super-Mare, with over 100 clinical services across ten sites. They offer care to the people of Bristol, Weston-Super-Mare and the South West, and have an international reputation for cardiac surgery, paediatric services, oncology and bone marrow transplantation. They are the largest centre for medical training and research in the South West.
University of Bristol
The University of Bristol is internationally renowned and one of the very best in the UK, due to its outstanding teaching and research, its superb facilities and highly talented students and staff. Its students thrive in a rich academic environment which is informed by world-leading research. It hosts the Elizabeth Blackwell Institute for Health Research.