Healthcare professionals as domestic abuse survivors: workplace impact and support-seeking.

BACKGROUND: Healthcare professionals (HCPs) are expected to identify and respond to domestic abuse (DA) among their patients. Although research suggests that a high proportion of HCPs are affected by DA, the impact of their experiences has been under-researched. AIMS: To assess UK HCPs' experiences of DA and develop a broad understanding of its impact on work and HCPs' support needs. METHODS: An online cross-sectional survey was promoted via multiple professional channels (October to December 2022). We adopted convenience sampling and analysed data descriptively. RESULTS: Among the 192 HCP survivors who responded, all abuse subtypes-psychological, sexual, economic and physical-were common. Ninety per cent of abusers were male (ex)partners. Eighty-five per cent reported abusers directly interfered with their work and 92% reported their work and career were affected. Almost all reported physical and mental health consequences. Eighty-nine per cent reported their own experiences shaped their responses to patient survivors. On average, per year, HCP survivors reported they had 13 sick days, 5 days' leave, 10 days' lateness and 6 days' early departure due to DA. Only 20% reported their workplace had a staff DA policy, and over 50% were unsure what workplace support mechanisms were available. Just over half disclosed at work; concerns that others would question their fitness to practice were common. Twenty-two per cent reported aspects of work, for example, long hours, stopped them from seeking support outside work. CONCLUSIONS: HCPs face unique barriers to DA disclosure and support-seeking and may benefit from tailored support from specialists who understand both DA and the healthcare context.

Domestic violence and injuries: prevalence and patterns-a pilot database study to identify suspected cases in a UK major trauma centre.

BACKGROUND: Victim-survivors of domestic violence and abuse (DVA) present to secondary care with isolated injuries to the head, limb or face. In the UK, there are no published studies looking at the relationship of significant traumatic injuries in adults and the relationship to DVA.The primary objective was to assess the feasibility of using a tailored search method to identify cases of suspected DVA in the national audit database for trauma. The secondary objective was to assess the association of DVA with clinical characteristics. METHODS: We undertook a single-centre retrospective observational cohort pilot study. Data were analysed from the local Trauma and Audit Research Network (TARN) database. The 'Scene Description' field in the database was searched using a tailored search strategy. Feasibility was evaluated with notes review and assessed by the PPV and prevalence. Secondary objectives used a logistic regression in Excel. RESULTS: This method of identifying suspected cases of DVA from the TARN database is feasible. The PPV was 100%, and the prevalence of suspected DVA in the study period was 3.6 per 1000 trauma discharges. Of those who had experienced DVA, 52.7% were male, median age 43 (IQR: 33-52) and mortality 5.5%. Subgroup analysis of older people demonstrated longer hospital stay (p=0.17) and greater likelihood of admission to intensive care (OR 2.60, 95% CI 0.48 to 14.24). CONCLUSION: We have created a feasible methodology to identify suspected DVA-related injuries within the TARN database. Future work is needed to further understand this relationship on a national level.

Peer-led groups for survivors of sexual abuse and assault: a systematic review.

Background: There are current concerns about whether appropriate support is provided for sexual abuse and assault survivors. We reviewed the published evidence for peer-led groups in the care of survivors.Aims: To determine the health and wellbeing outcomes of peer-led, group-based interventions for adult survivors who have experienced sexual abuse and assault and describe the experiences of participants attending these groups.Method: Systematic review. The following databases were searched: Medline, PsycINFO, Embase, Cochrane Library, Web of Science, Sociological Abstracts, IBSS. Papers focusing on adults using any research methodology were included. Quality appraisal was completed using the Mixed Methods Appraisal Tool (MMAT). Thematic analysis was undertaken using methods of constant comparison.Results: Initial, and updated searches identified 16,724 potentially eligible articles. Of these, eight were included. Thematic analysis revealed that peer-led group-based interventions have positive impact on participants' psychological, physical and interpersonal well-being. Participation also presents challenges for survivors. However, there is a mutuality and interconnected benefit between the triggering of difficult emotions due to participation and the healing experiences gained.Conclusions: Scientific evidence of peer-led, group-based, approaches for adult survivors of sexual abuse and assault is limited, although generally suggestive of benefits to such individuals.

Social support network of family members of abused children and adolescents: Perspectives and possibilities.

AIMS AND OBJECTIVES: To analyse the network of care and social support from the perspectives of family members of children and adolescents who have been abused. BACKGROUND: The theoretical-methodological background of the ecological model for understanding violence and the Paradigm of Complexity provide a broad perspective of violence. The paradigm considers all aspects that constitute a phenomenon as well as particular features. DESIGN: Qualitative research based on the Paradigm of Complexity, developed by Edgar Morin, the primary philosopher. We have adhered to the COREQ Checklist guidelines for qualitative research. METHODS: Data were collected through Minimal Maps of Personal Social Networks, and semi-structured interviews were held with 15 families who were assisted by a nongovernmental organisation in a Brazilian city. The notions of comprehension and contextualisation guided the data analysis. RESULTS: Two categories emerged from the data analyses: "Social isolation" and "Affective relationships needs." The maps revealed a weakened and limited network with low-density, homogeneous bonds and few significant bonds. Therefore, the network provided predominantly instrumental and material social support with few important effective relationships. The participants disclosed some strategies to empower their lives. CONCLUSIONS: We conclude that it is urgent to develop strategies in a broad manner to promote family empowerment, especially on education and employment dimension, and to construct supportive and respectful relationships between services and families as well. RELEVANCE TO CLINICAL PRACTICE: The present study contributes to international clinical nursing, especially in low- and middle-income countries, by discussing (a) looking at and caring for family members of children and adolescents who have been abused in a contextualised manner; (b) family empowerment, which enables them to have access to healthier environments and to educational/employment opportunities; and (c) broad comprehension of health care among the family members, which provides perspectives not only for looking at violence but also for strengthening supportive social relationships.

Plasma membrane-located purine nucleotide transport proteins are key components for host exploitation by microsporidian intracellular parasites.

Microsporidia are obligate intracellular parasites of most animal groups including humans, but despite their significant economic and medical importance there are major gaps in our understanding of how they exploit infected host cells. We have investigated the evolution, cellular locations and substrate specificities of a family of nucleotide transport (NTT) proteins from Trachipleistophora hominis, a microsporidian isolated from an HIV/AIDS patient. Transport proteins are critical to microsporidian success because they compensate for the dramatic loss of metabolic pathways that is a hallmark of the group. Our data demonstrate that the use of plasma membrane-located nucleotide transport proteins (NTT) is a key strategy adopted by microsporidians to exploit host cells. Acquisition of an ancestral transporter gene at the base of the microsporidian radiation was followed by lineage-specific events of gene duplication, which in the case of T. hominis has generated four paralogous NTT transporters. All four T. hominis NTT proteins are located predominantly to the plasma membrane of replicating intracellular cells where they can mediate transport at the host-parasite interface. In contrast to published data for Encephalitozoon cuniculi, we found no evidence for the location for any of the T. hominis NTT transporters to its minimal mitochondria (mitosomes), consistent with lineage-specific differences in transporter and mitosome evolution. All of the T. hominis NTTs transported radiolabelled purine nucleotides (ATP, ADP, GTP and GDP) when expressed in Escherichia coli, but did not transport radiolabelled pyrimidine nucleotides. Genome analysis suggests that imported purine nucleotides could be used by T. hominis to make all of the critical purine-based building-blocks for DNA and RNA biosynthesis during parasite intracellular replication, as well as providing essential energy for parasite cellular metabolism and protein synthesis.

"Even 'Daily' is Not Enough": How Well Do We Measure Domestic Violence and Abuse?-A Think-Aloud Study of a Commonly Used Self-Report Scale.

This article explores the challenges of providing a quantitative measure of domestic violence and abuse (DVA), illustrated by the Composite Abuse Scale, a validated multidimensional measure of frequency and severity of abuse, used worldwide for prevalence studies and intervention trials. Cognitive "think-aloud" and qualitative interviewing with a sample of women who had experienced DVA revealed a tendency toward underreporting their experience of abuse, particularly of coercive control, threatening behavior, restrictions to freedom, and sexual abuse. Underreporting was linked to inconsistency and uncertainty in item interpretation and response, fear of answering truthfully, and unwillingness to identify with certain forms of abuse. Suggestions are made for rewording or reconceptualizing items and the inclusion of a distress scale to measure the individual impact of abuse. The importance of including qualitative methods in questionnaire design and in the interpretation of quantitative findings is highlighted.

Are people with chronic diseases interested in using telehealth? A cross-sectional postal survey.

BACKGROUND: There is growing interest in telehealth-the use of technology to support the remote delivery of health care and promote self-management-as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. OBJECTIVE: This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. METHODS: Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. RESULTS: Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs, access difficulties, technology-related factors, and prior use of telehealth, interest in telehealth had largely no association with sociodemographic variables. For both patient groups and for each of the three technology mediums, the most important constructs related to interest in telehealth were having the confidence to use the associated technology, as well as perceiving greater advantages and fewer disadvantages from using telehealth. To illustrate, greater confidence using phone technologies (b=.16, 95% CI 0.002-0.33), while also perceiving more benefits (b=.31, 95% CI 0.21-0.40) and fewer drawbacks (b=-.23, 95% CI -0.28 to -0.17) to using telehealth were associated with more interest in using phone-based telehealth technologies for patients with depression. CONCLUSIONS: There is widespread interest in using phone-based and email/Internet-based telehealth among patients with chronic diseases, regardless of their health status, access difficulties, age, or many other sociodemographic factors. This interest could be increased by helping patients gain confidence using technologies and through highlighting benefits and addressing concerns about telehealth. While the same pattern exists for social media telehealth, interest in using these technologies is minimal.

Training Informal Supporters to Improve Responses to Victim-Survivors of Domestic Violence and Abuse: A Systematic Review.

Informal supporters (friends, family, colleagues, and community members) play a crucial role in societal-wide responses to victim-survivors of domestic violence and abuse. Familial and social networks, however, report a sense of helplessness and difficulties in knowing how to respond. This mixed method systematic review examines the effectiveness, and perceived effectiveness, of training informal supporters to improve their responses to victim-survivors. A novel conceptual framework was developed to underpin the review. A systematic search of four electronic databases, specialist repositories, and websites were used to identify empirical research (in academic or gray literature). Eleven included studies examined educational interventions that aimed to improve responses from informal supporters. Quality appraisal was undertaken, and studies were judged to be "good enough" for synthesis. The studies in the review indicated that informal supporters recognized the value of training for building understanding and equipping them with the skills to respond to victim-survivors. The synthesis identified statistically significant improvements in the knowledge and attitudes of informal supporters in the immediate and short-term following training. Using a behavior change model to frame the evidence, the review found that training/educational activities prime informal supporters to respond to victim-survivors, as well as enhancing their capacity and motivation to do so. This increases the likelihood that informal supporters will take action to support victim-survivors of abuse. We don't know, however, what type of support they will provide and/or whether it would be judged to be helpful by victim-survivors.

Healthcare Professionals' Own Experiences of Domestic Violence and Abuse: A Meta-Analysis of Prevalence and Systematic Review of Risk Markers and Consequences.

Background: Globally, healthcare professionals (HCPs) are increasingly asked to identify and respond to domestic violence and abuse (DVA) among patients. However, their own experiences of DVA have been largely ignored.Aim: To determine the prevalence of current and lifetime DVA victimisation among HCPs globally, and identify risk markers, consequences and support-seeking for DVA.Method: PubMed, EMBASE, PsycINFO, CINAHL ASSIA and ProQuest were searched. Studies about HCPs' personal experience of any type of DVA from any health service/country were included. Meta-analysis and narrative synthesis were adopted.Results: Fifty-one reports were included. Pooled lifetime prevalence was 31.3% (95% CI [24.7%, 38.7%] p < .001)) and past-year prevalence was 10.4% (95% CI [5.8%, 17.9%] p <.001). Pooled lifetime prevalence significantly differed (Qb=6.96, p < .01) between men (14.8%) and women (41.8%), and between HCPs in low-middle income (64.0%) and high-income countries (20.7%) (Qb = 31.41, p <.001). Risk markers were similar to those in the general population, but aspects of the HCP role posed additional and unique risks/vulnerabilities. Direct and indirect consequences of DVA meant HCP-survivors were less able to work to their best ability. While HCP-survivors were more likely than other HCPs to identify and respond to DVA among patients, doing so could be distressing. HCP-survivors faced unique barriers to seeking support. Being unable to access support - which is crucial for leaving or ending relationships with abusive people - leaves HCP-survivors entrapped.Conclusion: Specialised DVA interventions for HCPs are urgently needed, with adaptations for different groups and country settings. Future research should focus on developing interventions with HCP-survivors.

Trauma-specific mindfulness-based cognitive therapy for women with post-traumatic stress disorder and a history of domestic abuse: intervention refinement and a randomised feasibility trial (coMforT study).

BACKGROUND: Women who have experienced domestic violence and abuse (DVA) are at increased risk of developing post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). In 2014-2015, we developed a prototype trauma-specific mindfulness-based cognitive therapy curriculum (TS-MBCT) for the treatment of PTSD in a DVA population. This study aimed to refine the prototype TS-MBCT and evaluate the feasibility of conducting a randomised controlled trial (RCT) testing its effectiveness and cost-effectiveness. METHODS: Intervention refinement phase was informed by evidence synthesis from a literature review, qualitative interviews with professionals and DVA survivors, and a consensus exercise with experts in trauma and mindfulness. We tested the refined TS-MBCT intervention in an individually randomised parallel group feasibility trial with pre-specified progression criteria, a traffic light system, and embedded process and health economics evaluations. RESULTS: The TS-MBCT intervention consisted of eight group sessions and home practice. We screened 109 women in a DVA agency and recruited 20 (15 TS-MBCT, 5 self-referral to National Health Service (NHS) psychological treatment), with 80% follow-up at 6 months. Our TS-MBCT intervention had 73% uptake, 100% retention, and high acceptability. Participants suggested recruitment via multiple agencies, and additional safety measures. Randomisation into the NHS control arm did not work due to long waiting lists and previous negative experiences. Three self-administered PTSD/CPTSD questionnaires produced differing outcomes thus a clinician administered measure might work better. We met six out of nine feasibility progression criteria at green and three at amber targets demonstrating that it is possible to conduct a full-size RCT of the TS-MBCT intervention after making minor amendments to recruitment and randomisation procedures, the control intervention, primary outcomes measures, and intervention content. At 6 months, none of the PTSD/CPTSD outcomes ruled out a clinically important difference between trial arms indicating that it is reasonable to proceed to a full-size RCT to estimate these outcomes with greater precision. CONCLUSIONS: A future RCT of the coMforT TS-MBCT intervention should have an internal pilot, recruit from multiple DVA agencies, NHS and non-NHS settings, have an active control psychological treatment, use robust randomisation and safety procedures, and clinician-administered measures for PTSD/CPTSD. TRIAL REGISTRATION: ISRCTN64458065 11/01/2019.

Identification and Referral to Improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: a cluster randomised controlled trial.

BACKGROUND: Most clinicians have no training about domestic violence, fail to identify patients experiencing abuse, and are uncertain about management after disclosure. We tested the effectiveness of a programme of training and support in primary health-care practices to increase identification of women experiencing domestic violence and their referral to specialist advocacy services. METHODS: In this cluster randomised controlled trial, we selected general practices in two urban primary care trusts, Hackney (London) and Bristol, UK. Practices in which investigators from this trial were employed or those who did not use electronic records were excluded. Practices were stratified by proportion of female doctors, postgraduate training status, number of patients registered, and percentage of practice population on low incomes. Within every primary care trust area, we randomised practices with a computer-minimisation programme with a random component to intervention or control groups. The intervention programme included practice-based training sessions, a prompt within the medical record to ask about abuse, and a referral pathway to a named domestic violence advocate, who also delivered the training and further consultancy. The primary outcome was recorded referral of patients to domestic violence advocacy services. The prespecified secondary outcome was recorded identification of domestic violence in the electronic medical records of the general practice. Poisson regression analyses accounting for clustering were done for all practices receiving the intervention. Practice staff and research associates were not masked and patients were not aware they were part of a study. This study is registered at Current Controlled Trials, ISRCTN74012786. FINDINGS: We randomised 51 (61%) of 84 eligible general practices in Hackney and Bristol. Of these, 24 received a training and support programme, 24 did not receive the programme, and three dropped out before the trial started. 1 year after the second training session, the 24 intervention practices recorded 223 referrals of patients to advocacy and the 24 control practices recorded 12 referrals (adjusted intervention rate ratio 22·1 [95% CI 11·5-42·4]). Intervention practices recorded 641 disclosures of domestic violence and control practices recorded 236 (adjusted intervention rate ratio 3·1 [95% CI 2·2-4·3). No adverse events were recorded. INTERPRETATION: A training and support programme targeted at primary care clinicians and administrative staff improved referral to specialist domestic violence agencies and recorded identification of women experiencing domestic violence. Our findings reduce the uncertainty about the benefit of training and support interventions in primary care settings for domestic violence and show that screening of women patients for domestic violence is not a necessary condition for improved identification and referral to advocacy services. FUNDING: Health Foundation.

'I Think it Just Made Everything Very Much More Intense': A Qualitative Secondary Analysis Exploring The Role Of Friends and Family Providing Support to Survivors of Domestic Abuse During The COVID-19 Pandemic.

The COVID-19 pandemic, and associated social restrictions, have amplified women's experiences of domestic abuse (DA). In usual times, female DA survivors reach out to those around them (friends, family members, neighbors, and colleagues) for support. Accessing of both professional and informal support by survivors has increased during the pandemic. Informal supporters are often deeply invested and immersed in situations of DA because of the closeness of relationships. The accounts of informal supporters are rarely sought, yet these are people who may have a considerable awareness of what is happening. The aim of this study was to explore how the pandemic had impacted people's assessment of abusive situations and their ability to provide informal support. This paper reports a secondary analysis of qualitative data collected in 2020 in England. The data were gathered in 18 in-depth interviews with people who knew a female friend, relative, neighbor, or colleague who had experienced DA. The age range of participants was 25-69 years, three were men and fifteen were women. A reflexive thematic analysis was carried out. Findings indicated: (i) the pandemic had changed people's ability to read situations and assess risk (ii) perpetrators were exploiting the pandemic to further abuse (iii) within the context of the pandemic there was additional challenge to offering support (iv) informal supporters found creative ways to remain in-touch and to continue offering support. Further research with informal supporters is needed to ascertain how best to support and equip people, without imposing an impossible burden.

Perceptions of Peer Support for Victim-Survivors of Sexual Violence and Abuse: An Exploratory Study With Key Stakeholders.

Experiences of sexual violence, childhood sexual abuse, and sexual assault are common across all societies. These experiences damage physical and mental health, coping ability, and relationships with others. Given the breadth and magnitude of impacts, it is imperative that there are effective, accessible services to support victim-survivors, ease suffering, and empower people to cope, recover and thrive. Service provision for this population in the United Kingdom is complex and has been hit substantially by austerity. Since positive social support can buffer against negative impacts, peer support may be an effective approach. The aim of this exploratory study was to capture the views and perspectives of professional stakeholders concerning service provision for victim-survivors, particularly perceptions of peer support.In-depth semistructured interviews were conducted in the UK during 2018 with six professional stakeholders, highly experienced in the field of service provision for victim-survivors of sexual violence and abuse. An abductive approach to analysis was used, applying principles from thematic analysis. Our sample comprised four females and two males, and their roles included psychiatrist, general practitioner, service improvement facilitator, and senior positions within victim-survivor organizations.Interviews highlighted models of peer support for this population, good practice and safety considerations, and a lack of uniformity regarding quality and governance standards across the sector. Findings indicated that current funding models impact negatively on victim-survivor services, and that provision is fragmented and insufficient across statutory and not-for-profit sectors. The influence of the medical model upon service provision was evident, which resulted in apprehension around support delivered in less-usual forms-including peer support. Further research is needed to explore the potential of peer support for victim-survivors of sexual violence and abuse.

". . . The Forgotten Heroes": A Qualitative Study Exploring How Friends and Family Members of DV Survivors Use Domestic Violence Helplines.

Many women who experience domestic violence (DV) seek support from friends, relatives, colleagues, and neighbors. There are substantial knock-on effects for informal supporters, and they may seek help themselves. Tailored services for this group are rare, but DV helplines can provide listening and signposting support. The aim of this exploratory study was to understand which informal supporters contact DV helplines and what form these calls take. Three focus groups, following a topic guide, were conducted with staff and volunteers for DV helplines during autumn 2015. Discussions were digitally recorded, transcribed verbatim, and imported into NVivo10 software. Transcripts were coded line-by-line, and a thematic analysis carried out. All participants were female, aged between 22 and 54 years, with between 2 months' and 8 years' experience of taking helpline calls. Findings indicate that people with broad ranging connections to a survivor call a helpline. Calls can be triggered by disclosures, abuse escalation, witnessing incidents, feeling overwhelmed, and media highlighting of DV. Informal supporters respond to survivors, and experience impacts, in differing ways, often associated with their gender and their relationship with the survivor. Frequently, they feel a sense of responsibility and a desire to rescue the survivor, often calling a helpline to reduce feelings of helplessness and to seek a "magic" solution. Many people are concerned about the legitimacy of their involvement and seek reassurance about the validity of their own help-seeking. Helpline workers feel that informal supporters would benefit from opportunities to reduce isolation, have their predicament acknowledged, and learn from peers. DV helplines have an important role in helping informal supporters of survivors. The help requested is predominantly to equip and empower the informal supporter, so that they feel more adept at coping themselves and, are thus, better able to offer support to the survivor.

Hope, Agency, and the Lived Experience of Violence: A Qualitative Systematic Review of Children's Perspectives on Domestic Violence and Abuse.

There is a large body of research on the impact of domestic violence and abuse (DVA) on children, mostly reporting survey data and focusing largely on psychological outcomes. Qualitative research on the views of children has the potential to enable a child-centered understanding of their experience of DVA, so their needs can be better met by professionals. This systematic review reports general findings from the ViOlence: Impact on Children Evidence Synthesis (VOICES) project that synthesized published qualitative research on the experiences of DVA from the perspective of children and young people. A thematic synthesis of 33 reports identified six themes: lived experience of DVA, children's agency and coping, turning points and transitions, managing relationships postseparation, impact of DVA on children, and children's expressions of hope for the future. We conclude that professionals working with children affected by DVA should be mindful of the diversity in children's experiences and listen carefully to children's own accounts.

Primary care identification and referral to improve safety of women experiencing domestic violence (IRIS): protocol for a pragmatic cluster randomised controlled trial.

BACKGROUND: Domestic violence, which may be psychological, physical, sexual, financial or emotional, is a major public health problem due to the long-term health consequences for women who have experienced it and for their children who witness it. In populations of women attending general practice, the prevalence of physical or sexual abuse in the past year from a partner or ex-partner ranges from 6 to 23%, and lifetime prevalence from 21 to 55%. Domestic violence is particularly important in general practice because women have many contacts with primary care clinicians and because women experiencing abuse identify doctors and nurses as professionals from whom they would like to get support. Yet health professionals rarely ask about domestic violence and have little or no training in how to respond to disclosure of abuse. METHODS/DESIGN: This protocol describes IRIS, a pragmatic cluster randomised controlled trial with the general practice as unit of randomisation. Our trial tests the effectiveness and cost-effectiveness of a training and support programme targeted at general practice teams. The primary outcome is referral of women to specialist domestic violence agencies. Forty-eight practices in two UK cities (Bristol and London) are randomly allocated, using minimisation, into intervention and control groups. The intervention, based on an adult learning model in an educational outreach framework, has been designed to address barriers to asking women about domestic violence and to encourage appropriate responses to disclosure and referral to specialist domestic violence agencies. Multidisciplinary training sessions are held with clinicians and administrative staff in each of the intervention practices, with periodic feedback of identification and referral data to practice teams. Intervention practices have a prompt to ask about abuse integrated in the electronic medical record system. Other components of the intervention include an IRIS champion in each practice and a direct referral pathway to a named domestic violence advocate. DISCUSSION: This is the first European randomised controlled trial of an intervention to improve the health care response to domestic violence. The findings will have the potential to inform training and service provision. TRIAL REGISTRATION: ISRCTN74012786.

Children's experiences and needs in situations of domestic violence: A secondary analysis of qualitative data from adult friends and family members of female survivors.

Estimates suggest that 15% of children in the United Kingdom have been exposed to at least one form of domestic violence (DV) during their childhood, with more than 3% having witnessed an incident during the past year. This exposure increases the risk of children suffering both short-term and long-term impacts, including effects on their behaviour, social development, physical and mental health, educational attainment and quality of life. In addition, children living in environments where there is DV are at higher risk of maltreatment. Adult relatives and friends of the family often observe the experiences of children in situations of DV, and have the potential to shed light in a way that children and survivors may struggle to articulate, or be reluctant to acknowledge or disclose. Such accounts are largely absent from existing research, and yet bring a perspective which can broaden our understanding of the impact that DV has on children. This paper reports a secondary analysis of qualitative data collected during 21 in-depth interviews with people across the United Kingdom who were a friend or family member of a woman experiencing DV. An inductive thematic analysis was undertaken and the themes generated were as follows: 'the context of DV: a chaotic and unpredictable home life'; 'the roles children assume within households where there is DV including: witness of, victim of and conduit of violence and abuse',; 'the impacts of DV on children'; and 'children's coping and resilience'. The implications of these findings are discussed using a basic needs model lens.

The coMforT study of a trauma-informed mindfulness intervention for women who have experienced domestic violence and abuse: a protocol for an intervention refinement and individually randomized parallel feasibility trial.

BACKGROUND: Domestic violence and abuse (DVA) is common and destructive to health. Post-traumatic stress disorder (PTSD) is a major mental health consequence of DVA. People who have experienced DVA have specific needs, arising from the repeated and complex nature of the trauma. The National Institute for Health and Care Excellence recommends more research on the effectiveness of psychological interventions for people who have experienced DVA. There is growing evidence that mindfulness-based interventions may help trauma symptoms. METHODS: Intervention refinement and randomized controlled feasibility trial. A prototype trauma-informed mindfulness-based cognitive therapy (TI-MBCT) intervention will be co-produced following qualitative interviews and consensus exercise with stakeholders. Participants in the feasibility trial will be recruited from DVA agencies in two geographical regions and randomized to receive either TI-MBCT or usual care (self-referral to the Improving Access to Psychological Therapies (IAPT) service). TI-MBCT will be delivered as a group-based eight-week program. It will not be possible to blind the participants or the assessors to the study allocation. The following factors will inform the feasibility of progressing to a fully powered trial: recruitment, retention, intervention fidelity, and the acceptability of the intervention and trial design to participants. We will also test the feasibility of measuring the following participant outcomes before and 6 months post-randomization: PTSD, dissociative symptoms, depression, anxiety, DVA re-victimization, self-compassion, and mother-reported child health. Process evaluation and economic analysis will be embedded within the feasibility trial. DISCUSSION: This study will lead to the development of a TI-MBCT intervention for DVA survivors with PTSD and inform the feasibility and design of a fully powered randomized controlled trial (RCT). The full trial will aim to determine the effectiveness and cost-effectiveness of a TI-MBCT intervention in improving the clinically important symptoms of PTSD in DVA survivors. TRIAL REGISTRATION: ISRCTN, ISRCTN64458065, Registered 11 January 2019.

'We're all wounded healers': A qualitative study to explore the well-being and needs of helpline workers supporting survivors of domestic violence and abuse.

Domestic violence and abuse (DVA) can include physical, psychological, sexual, emotional or financial abuses, and is a globally widespread problem across all age groups, cultures and socioeconomic groups. Alongside the impacts of DVA experienced by survivors, there is a growing recognition that other people, who form the support network of survivors, may also be affected by the situation. Domestic violence organisations such as helplines are important third sector services supporting survivors. However, there has been little research into the impact on those providing the support. This qualitative study of domestic violence helpline workers explored their needs and well-being. We used qualitative methodology, conducting interviews with staff recruited from a selection of different helplines who all undertook direct client-focused work. The interviews used a semi-structured format and followed a topic guide covering the training received before commencing work, self-care strategies, the impact of work on their daily life and support offered by their employer. Ten helpline staff were interviewed, all female. Following analysis of the qualitative data, a number of themes emerged. Participants disclosed numerous ways in which their work challenged their well-being, including burnout, impact on personal relationships, and lack of training and support at work. Participants used some self-care strategies in order to "switch off" from work, but they also wanted clinical supervision to support them with the difficulties they experienced at work. This study suggests that helpline staff should receive more education about trauma triggers, and ongoing support to reduce the impact on their home and social life, thus improving mental well-being and job satisfaction. This work begins the debate on the well-being needs of frontline helpline workers, and whether better meeting these needs can facilitate the provision of better support.