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Responding effectively to violence and abuse (REVA project)

Trauma and abuse
Researchers: Sally McManus
Published: October 2015

Research team 

  • Dr Sara Scott and Dr Jennie Williams, DMSS Research
  • Dr Carol McNaughton Nicholls, Truth Consulting
  • Sally McManus and Shannon Harvey, Research Associate
  • Prof Liz Kelly and Joanne Lovett, CWASU, London Metropolitan University

Aims

The main aim of this major study was to look at how the NHS and other services respond to the effect of violence and abuse among service users.

Key research objectives included to:

  • Understand the effect of violence and abuse on survivors.
  • Assess and provide guidance on how NHS and other services can sensitively identify survivors of violence and abuse (using routine inquiry).
  • Involve survivors and service providers at all stages of the research, including exploring service users’ pathways and the outcomes of different types of support.
  • Develop a practical outcome measurement founded on service users’ experiences that can be used by services and commissioners.

Findings

Five briefing papers have now been published with findings from the project.

Briefing 1: Population patterns in violence, abuse and mental health

  • Our analysis of national survey data found that a quarter of the population have had experience of violence and abuse.
  • The research highlights strong links between experience of violence and abuse and mental health. 

Download the full REVA Briefing Paper 1

Briefing 2: Guidance for Trust managers: Implementing and sustaining routine enquiry about violence and abuse in mental health services 

  • Department of Health policy is that adult service users should be asked about experience of violence and abuse in mental health assessments (routine enquiry). 
  • Interviews with service providers found some staff to be reluctant to ask, in part due to lack of confidence in how to respond to disclosure. 
  • This briefing highlights key recommendations and good practice guidelines for Trust managers, focusing on the need for strategic leadership and commitment; training provision; data collection requirements; knowledge sharing and awareness raising.

Download the full REVA Briefing Paper 2

Briefing 3: A briefing for mental health professionals: Why asking about abuse matters to service users

  • Interviews with users of mental health services found that people are positive about routine enquiry. Those asked by a professional about their experience of violence and abuse welcomed this.
  • Service users had recommendations for service providers. The question:
      • should be asked as early as possible,
      • with interest and concern (rather than like a ‘tick box’ requirement),
      • more than once (as people may not feel able to respond at first),
      • of everyone, and
      • responses to any disclosure should be full, helpful, and followed up with good services, when possible. 

Download the full REVA Briefing Paper 3

Briefing 4: A briefing for commissioners: What survivors of violence and abuse say about mental health services 

  • Survivors of abuse and violence identified the following as needing to be in place if services are to be effective:
      • Routine enquiry occurs across a wide range of child and adult settings;
      • Well-trained and supported staff are able to make direct referrals to specialist services;
      • Group and peer support is available for both male and female survivors;
      • Appropriate crisis provision is available; and 
      • Services know about, talk to, and coordinate with each other.
  • This vision of good service provision has implications for the types and range of services that get commissioned, and for the details of commissioning specifications.

Download the full REVA Briefing Paper 4

Briefing 5: A briefing for service providers and commissioners: Measuring outcomes for survivors of abuse and violence 

  • Outcome-focused commissioning is supported by services and survivors, but needs to needs to reflect the outcomes that matter to survivors.
  • Services need to demonstrate effectiveness for funders. However, there is a lack of standardised sector-specific outcome measures available. To address this, the Supporting Survivor Outcomes (SSO) tool was developed with survivors of abuse and violence who use services.
  • The tool was piloted in different settings and found to be accessible, to resonate with people’s experiences, to helpfully capture progress and improvement, and was found to work across groups and service types.

Download the full REVA Briefing Paper 5 

These briefings report independent research commissioned and funded by the Department of Health Policy Research Programme (Effective Responses to Long-Term Consequences of Violence, Trauma and Abuse, 115/0005). The views expressed are those of the author(s) and not necessarily those of the Department of Health. 

Research team 

Dr Sara Scott and Dr Jennie Williams, DMSS Research

Dr Carol McNaughton Nicholls, Truth Consulting

Sally McManus

Shannon Harvey

Prof Liz Kelly and Joanne Lovett, CWASU, London Metropolitan University

Methods

The study involved survivors, as key users of services, throughout. We also drew on a Reference Group of key stakeholders who provided feedback on the study as it developed.

There were three stages of research:

Stage One

Secondary analysis of data from the Adult Psychiatric Morbidity Survey

Stage Two

Case study research in four PCT or Mental Health Foundation areas, which included:

  • Interviews and focus groups with practitioners and service providers, including the NHS and voluntary sectors.
  • Interviews with survivors of violence and abuse concentrating on their life experiences, including experiences of services used and outcomes experienced.

Stage Three

Development of an outcome measurement framework, piloted in a range of different settings.

Technical report

REVA Strand 1: Technical report