Title: Bridging the knowledge and practice gap between domestic violence and child safeguarding: developing policy and training for general practice
Funder: Department of Health (England)

Abstract: Background This proposal is premised on two issues: (i) insufficient engagement of general practice in responding to domestic violence (DV) against women and children; (ii) uncertainty about best practice for primary care clinicians at the interface between DV and child safeguarding (CS) (i) Despite systematic reviews (Feder et al 2009, Ramsay et al 2006) and explicit DH guidance (Department of Health 2005), the health care response to DV remains inadequate. Within general practice, the majority of victims are not even identified by clinicians. Draft GMC guidance highlights the uncertainty among GPs in relation to their CS responsibilities in the context of DV. (ii) DV and CS are related issues because of the damaging effects on children of exposure to DV, the overlap between child maltreatment and DV, and DV's negative effects on parenting (Hester et al 2007; Stanley 2011). Yet policy has largely developed on separate “planets” (Hester 2004). This is particularly striking within the health sector where CS and DV are often separate components of policy. Aims (i) To inform policy for primary care clinicians on the interface between DV and CS (ii) To enhance the DV content of mandatory CS training for primary care clinicians to improve engagement and role definition on the interface between DV and child maltreatment (iii) to improve engagement and role definition on the interface between DV and child maltreatment and ultimately improve outcomes for families Research plan and methods of investigation Objectives: (i) To analyse DV content of CS training for GPs, practice nurses and practice managers (ii) To review evidence on primary care responses to disclosure of DV when children are exposed and to identification of child maltreatment when DV is present (iii) To understand the barriers to developing practice at the interface of DV and CS in the context of general practice. (iv) To identify and analyse examples of positive practice in this field (v) To formulate specific guidance for general practice about the interface between DV and CS (vi)To integrate that guidance into training curricula (vii) To evaluate acceptability and utility of that guidance when applied in general practice training sessions Methods (i) obtain general practice curricula used by stratified sample of CS trainers (ii) review of primary research and guidance documents that address effectiveness of procedures at interface between DV and CS (iii) interviews with a national purposive sample of GPs, practice nurses and practice managers (iv) survey of DV fora and local safeguarding children boards (LSCB) for good practice examples (v) 2-stage consensus process with participation from general practice, CS and DV sectors (vi) writing of a model curriculum (vii) piloting and evaluation of enhanced training on CS in the context of DV for clinicians in 12 practices in two regions Research team Gene Feder: GP and Prof. of primary health care, University of Bristol Marianne Hester: Prof. of Gender, Violence and International Policy, University of Bristol Nicky Stanley: Prof. of Social Work, University of Central Lancashire Diana Barran: chief executive, Coordinated Action Against Domestic Abuse Kelsey Hegarty: GP and associate Prof. of primary care, University of Melbourne Adam Firth: GP and academic clinical fellow, University of Manchester Jessica Drinkwater: GP trainee and academic clinical fellow, University of Manchester Potential impact/influence on the relevant policy field, users and wider stakeholders: The study includes review of existing evidence on engagement of primary care clinicians, specification of guidance, and implementation in the primary care training context. If training proves acceptable and useful, it can be disseminated nationally and incorporated into the mandatory training that these clinicians already receive, improving identification, support and referral of women and children experiencing DV.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: DISPUTED AETIOLOGY AND OTHER