Evaluation of an acute trust Domestic Abuse Coordinator role: Impact findings and a budget impact model

Domestic Abuse Coordinators (DACs) work strategically across National Health Service (NHS) hospital and other off-site clinical settings to support clinical staff in domestic abuse enquiry and response, and to co-lead the development and implementation of effective clinical policies and procedures for the management of domestic abuse and the support of survivors. Drawing on data from a large NHS acute trust in central London, we analyse the impact of the DAC role in increasing the rate of referrals of high-risk domestic abuse cases, and generate plausible estimates of the budget impact of the DAC role in respect of costs accrued to NHS trusts. Using eight quarters of clinical data and an interrupted time series design, we find that evidence that implementation of a DAC role is linked with an increase in the rate of high-risk referrals of between 18% and 21% per quarter, indicating improved responses to victim-survivors at highest risk of imminent harm. Under a range of reasonable assumptions, initiation of the DAC role is shown to be cost-saving to an employing acute trust. Future work should seek to quantify the direct impacts to survivor health and wellbeing of the implementation of the DAC role.

Identifying demographics of high risk male and LGBTQ+ survivors of domestic abuse from acute London hospital referrals - case review

BACKGROUND

Heterosexual men, and lesbians, gay men, bisexual, transgender and queer (LGBTQ+) people are under-described in research and resources relating to domestic abuse (DA), compared to heterosexual cisgender female survivors. Many of the identified DA cases within our hospital organisation that warrant onward multidisciplinary referral, due to ongoing high harm risk, are for male and LGBTQ+ survivors. We aimed to describe demographics and risk patterns of these cases, to inform and equip our specialist Independent Domestic Violence Advocacy (IDVA) service.

METHOD

We performed a retrospective case-note review of all Multi-Agency Risk Assessment Conferences (MARAC) referrals for DA, featuring male & LGBTQ+ subjects, across Chelsea and Westminster Hospital NHS Foundation Trust (CWFT), London, UK between April 2019 - December 2020. We recorded demographic data of referral subjects and perpetrators; the origin of referral; the nature of the initial presenting complaint and whether the DA was identified by the subject or by the healthcare provider on enquiry; and recorded rates of co-marginalising and harm risk factors (dependent children, disability, mental health comorbidity, HIV status, drug use, homelessness).

RESULTS

We identified 33 cases: 10.2% of CWFT's total MARAC referrals were for men, and 6.7% for LGBTQ+ people (cf. national figures from the same period: 0.1% and 1.3% respectively). Nearly half (48.5%, 16) of the referrals came from sexual health services, just under half (45.5%, 15) from Emergency Departments. 42% (14) disclosures were elicited incidentally during routine enquiry. Six (18%) subjects were also known survivors of sexual violence in addition to DA. The majority (79%, 26) of perpetrators were current or ex-intimate partners. Eight (24%) of the subjects had children under 18. High rates of co-marginalisation factors were present, including use of recreational drugs (45.5%, 15), belonging to an ethnic minority (39.4%, 13), living with HIV (24.2%, 8), living with a disability (18%, 6), mental health comorbidity (27.3%, 9), and experience or risk of homelessness (9%, 3).

CONCLUSIONS

Our trust reports a high rate of male and LGBTQ+ high-risk DA referrals, and amongst these there is a high rate of intersecting disadvantages and risk factors. This underlines a need for inclusivity for marginalised groups, inbuilt into domestic abuse health responses. The high rate of disclosure during routine enquiry for domestic abuse supports the use of DA routine enquiry in sexual health settings, and points towards the utility of selective enquiry in other settings (for example, heterosexual males presenting with injuries to emergency departments). We hope that by working with a specialised LGBTQ+ IDVA, we will improve both prompt identification and better outcomes for more GSM patients.

Acceptability of routine domestic abuse enquiry within sexual health services

BACKGROUND

Our sexual health services (SHS) introduced routine domestic abuse (DA) enquiry in April 2018 following targeted staff training. A survey was undertaken to ascertain attitudes towards the initiative.

METHODS

Between October 2019 and March 2020, patients were invited to respond to an anonymous questionnaire by SMS. Clinical staff were emailed a separate survey.

RESULTS

The patient response rate was 40% (226/562): 72% (161/226) female, 80% (179/226) heterosexual, 19% (42) LGBT, 47% (106) aged 25-34 and 25% (57) aged 18-24. Almost all (97%, 220) recalled routine enquiry at their clinic appointment; 91% (206) felt comfortable when asked, and 95% (214) found this acceptable. Fifty-one staff responded (36% response rate), 67% (34) female, 55% (28) heterosexual, 35% (18) LGBT. 43% (22) were nurses, 31% (16) doctors, 12% (6) health advisers and 8% (4) healthcare assistants. The majority of staff 96% (49) were confident with conducting routine enquiry, 92% (47) agreed patients found it acceptable; 92% (47) felt routine enquiry was appropriate and 92% (47) had received targeted training.

CONCLUSION

Respondents were overwhelmingly in favour of routine DA enquiry within SHS, and this initiative could be easily adapted in other specialties alongside staff training.

Survivors of domestic abuse and sexual violence within sexual health services, how we responded, who is missing and what should be done?

Background

Reports of domestic abuse (DA) and sexual violence (SV) continue to rise across the UK, and sexual health services are well situated to offer a safe setting for disclosure.

Methods

We performed a retrospective analysis of all safeguarding proformas completed between April and September 2019 across three sexual health clinics in London.

Results

158 patients reported current and/or historical DA and/or SV during the collection period. 70% of cohort identified as female, 28% as male and 2% as transgender. 25% of the cohort identified as gay men. Black and Asian attendees were disproportionately represented in the survivor cohort. 86% were offered a same-day appointment with the health advisor team and assessment for onward referral to specialist services. Almost half of the cohort were asymptomatic at the time of attendance and disclosure.

Discussion

With changes to access due to ongoing COVID-19 restrictions, asymptomatic survivors may not receive opportunities to disclose as they are directed to online platforms. Healthcare services must adapt routine enquiry practices to ensure safe disclosure is possible to make all contacts count and expand these practices into other healthcare specialities to provide further disclosure opportunities for survivors not attending sexual health services.