Can we improve the response of primary care to children exposed to domestic violence? A mixed method evaluation of a pilot intervention in English general practices
Domestic violence is a form of child maltreatment that damages children's mental health with persistent detrimental effects on health, educational attainment and employment into adulthood. Yet many primary care clinicians remain uncertain of their role in safeguarding children exposed to domestic violence, often not responding to their needs and safety. We developed, piloted and evaluated the feasibility, acceptability and short-term outcomes of a primary care team-centred training intervention on domestic violence and child safeguarding.
The intervention was a two-hour training session for general practice clinical teams delivered by a domestic violence advocate and a social worker. We used a mixed method evaluation design, including a pre-post questionnaire survey, qualitative observations during the intervention, and post-intervention interviews with trainers and training participants. The questionnaire survey used a validated scale to measure participants’ knowledge, confidence/ self-efficacy, and beliefs/ attitudes towards domestic violence and child safeguarding before training, post training and three months later.
Eleven UK general practices were recruited (response rate 55%) and 88 primary care clinicians attended the training. Thirty- seven participants (42%) completed all three questionnaires and nine were interviewed. Primary care clinicians valued the training materials and teaching styles, opportunities for reflection and delivery by trainers from both health and local children’s services. Three months post-training, the mean total outcome score was 10.8 units higher than pre-training (F (2, 73) = 57.62, P < 0.001). The mean sub score of participants’ knowledge was 7.8 points higher (F (2, 73) = 57.87, P < 0.001), while the sub score of confidence/ self-efficacy was 6.3 points higher (F (2, 73) = 54.61, P < 0.001). Qualitative interviews supported these findings. However, the mean sub- score of beliefs and attitudes did not change (F (2, 73 = 0.25, P = 0.78) and the qualitative results were rather mixed. Two interviewees described changes in reflective practice. Participants’ suggestions for improving the training included incorporating more ethnic and class diversity in the material, using cases with multiple deprivation and socio economic disadvantages, and addressing examining multi-agency collaboration in the context of changing and under-resourced services for to which they refer children.
The RESPONDS intervention is promising and has the potential to improve primary care clinicians’ knowledge and confidence/ self-esteem in relation to the interface between domestic violence and child protection. It is uncertain to what extent clinical behaviour changed, but there are indications of changes in practice for some individuals. The intervention requires further refinement and evaluation before implementation.