1) How has IRISi been improving the healthcare response to Gender-Based Violence?

IRISi, established in 2017, is a social enterprise dedicated to enhancing healthcare responses to gender-based violence (GBV). Collaborating with partners, we develop evidence-based interventions, and provide expert advice and consultancy in the field of Domestic Abuse (DA) tailored for different healthcare settings. 

2) Understanding the scale: what is the impact of domestic abuse on health?

Domestic abuse affects 26% of women in their lifetime, escalating to 41% for those attending general practice (CSEW, 2016; Richardson et al., 2002). With devastating health impacts, the annual cost of domestic abuse to health is £1.7bn (Walby, 2009). We aim to address this by supporting the local commissioning, implementation and sustainability of our programmes, which are tailored according to the specific needs of each healthcare setting. 

3) What is the IRIS Programme?

IRIS, our flagship intervention, operates in primary care and is a specialist training, support and referral programme for General Practices. Positively evaluated in a randomised controlled trial, it significantly improves the healthcare response to DA.

4) How does IRISi provide local support to expand the IRIS Programme?

We actively support the local commissioning and growth of the IRIS programme, providing bid development, training for trainers, ongoing support and national analysis. This collaborative is crucial not only in bringing this initiative to more areas, but also in developing innovative, evidence-based health interventions for those affected by GBV.

5) How does IRIS work?

IRIS is a collaboration between primary care and third-sector domestic abuse specialist services. The initiative focuses on  providing ongoing training, education and consultancy for clinical and administrative staff. Core areas include care pathways for practitioners and an enhanced referral pathway to a named specialist in a local DA service for patients.

6) What is the role of the Advocate Educator (AE)? 

Every general practice joining the IRIS programme is supported by a named Advocate Educator, who provides crucial support to both the practice and patients identified during consultations. This ensures a personalised and effective response to DA.

7) What type of support do survivors receive?

The IRIS programme is designed and based on a survivor-centred model. This framework ensures that every patient identified and referred to our programmes receives support through a comprehensive approach by the AE, making sure that they have assistance tailored to their individual needs.

8) What does IRIS bring to General Practices? 

General practices benefit from in-house, specialist DA training, ongoing support, health promotion materials, and enhanced safeguarding responses. The programme streamlines the referral pathway for patients and reducing response time.   All those who complete the IRIS training gain CPD points.

9) Does IRIS increase referrals from General Practices?

Our ongoing evidence indicates that  the IRIS programme increases referrals from general practice for patients affected by DA. Sustained funding for IRIS programmes is crucial for maintaining these positive outcomes.

10) What are the outcomes of the IRIS Programme for funders and commissioners?

The IRIS programme is nationally recognised and evidence-based, providing a cost-effective intervention for Integrated Care Boards (ICBs) and other commissioning bodies. Its positive impact includes improving the safety, quality of life and well-being of survivors, who reportedly see  their GP and other general practice clinicians less frequently after being identified and supported through the programme. 

11) Is it worth investing in the IRIS Programme?

The first areas implemented IRIS in 2010. From that point onwards, many other studies have been conducted to show the amplitude of this intervention, which is now running across the UK in more than 50 localities. Produced in 2022, “The social value of improving the primary care response to domestic violence and abuse: A mixed methods Social Return on Investment analysis of the IRIS programme” is one of those studies and it concludes:

• For each pound invested in the IRIS Programme, a monetary return of £16.79 is expected.
• For each pound invested in the IRIS Programme, a social return of £10.71 was obtained.

12) Has IRIS been nationally endorsed?

In 2021, the UK implemented the Domestic Abuse Act to enshrine a  a comprehensive response to DA in legislation. The accompanying Domestic Abuse Statutory Guidance, issued by the Home Office in July 2022, targeted both statutory and non-statutory bodies, and recommended: “Implementing the IRIS (Identification and Referral to Improve Safety) Programme. IRIS is an evidence-based intervention to improve the general practice response to domestic abuse through training, support to practice teams and having a DA specialist embedded in practices. It is nationally recognised as best practice and has informed NICE guidance.”

13) What is the ADVISE Programme?

The ADViSE programme extends the success of IRIS to sexual health clinics, supporting clinicians to identify and respond to patients affected by Domestic & Sexual Violence and Abuse (D&SVA). This evidence-based programme also ensures a simple referral pathway to a named specialist in a local frontline service.

14) How does ADViSE identify and support a wider range of patients?

Aligned with the demographic typically served by sexual health clinics, ADViSE also facilitates the identification of a more extensive and diverse range of patient groups, providing visibility and support for individuals from minority groups. 

15) How does ADViSE work?

ADViSE supports staff in recognising and responding to patients affected by D&SVA, offering direct referrals to specialist services. As with IRIS, the programme also strengthens local networks, increases safety and boosts staff confidence in responding to D&SVA.

16) Why sexual health clinics? 

Women affected by Domestic Abuse are three times more likely to face gynaecological and sexual health problems. ADViSE, which was piloted successfully in Bristol and East London, addresses this gap by training sexual health practitioners to identify, respond and refer effectively.

To find out more about our work, please visit www.irisi.org.