title: Making the links between domestic violence and child safeguarding: an evidence-based pilot training for general practice.
abstract: We describe the development of an evidence-based training intervention on domestic violence and child safeguarding for general practice teams. We aimed - in the context of a pilot study - to improve knowledge, skills, attitudes and self-efficacy of general practice clinicians caring for families affected by domestic violence. Our evidence sources included: a systematic review of training interventions aiming to improve professional responses to children affected by domestic violence; content mapping of relevant current training in England; qualitative assessment of general practice professionals' responses to domestic violence in families; and a two-stage consensus process with a multi-professional stakeholder group. Data were collected between January and December 2013. This paper reports key research findings and their implications for practice and policy; describes how the research findings informed the training development and outlines the principal features of the training intervention. We found lack of cohesion and co-ordination in the approach to domestic violence and child safeguarding. General practice clinicians have insufficient understanding of multi-agency work, a limited competence in gauging thresholds for child protection referral to children's services and little understanding of outcomes for children. While prioritising children's safety, they are more inclined to engage directly with abusive parents than with affected children. Our research reveals uncertainty and confusion surrounding the recording of domestic violence cases in families' medical records. These findings informed the design of the RESPONDS training, which was developed in 2014 to encourage general practice clinicians to overcome barriers and engage more extensively with adults experiencing abuse, as well as responding directly to the needs of children. We conclude that general practice clinicians need more support in managing the complexity of this area of practice. We need to integrate and further evaluate responses to the needs of children exposed to domestic violence into general practice-based domestic violence training.
authors.affiliation: Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Eszter
authors.initials: E
authors.lastname: Szilassy
authors.affiliation: Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Jess
authors.initials: J
authors.lastname: Drinkwater
authors.affiliation: Centre for Gender & Violence Research, School for Policy Studies, University of Bristol, Bristol, UK.
authors.forename: Marianne
authors.initials: M
authors.lastname: Hester
authors.affiliation: School of Social Work, Care and Community, University of Central Lancashire, Preston, UK.
authors.forename: Cath
authors.initials: C
authors.lastname: Larkins
authors.affiliation: School of Social Work, Care and Community, University of Central Lancashire, Preston, UK.
authors.forename: Nicky
authors.initials: N
authors.lastname: Stanley
authors.affiliation: Centre for Gender & Violence Research, School for Policy Studies, University of Bristol, Bristol, UK.
authors.forename: William
authors.initials: W
authors.lastname: Turner
authors.affiliation: Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Gene
authors.initials: G
authors.lastname: Feder
mesh_terms: D000328:Adult; D002648:Child; D002649:Child Abuse / Q000517:prevention & control; D019548:Crime Victims / Q000706:statistics & numerical data; D017579:Domestic Violence / Q000517:prevention & control*; D004739:England; D005260:Female; D058006:General Practice / Q000379:methods*; D058005:General Practitioners / Q000193:education*; D006801:Humans; D010819:Physician's Role; D010865:Pilot Projects; D012017:Referral and Consultation; D020377:Self Efficacy
keywords: child protection; child safeguarding; domestic violence and abuse; general practice; primary care; training