Evaluating models of health-based mateRnIty Violence Advisor (RIVA) provision in maternity services

Background

Domestic violence and abuse (DVA) is the use of controlling, coercive or threatening behaviour, violence or abuse towards a relative, partner or ex-partner. It affects up to 1 in 5 women during pregnancy and is associated with an increased risk of obstetric complications (e.g. low-birth weight, pre-term birth) and perinatal mental health problems.

Exposure to DVA in utero and early childhood is associated with a range of adverse outcomes, including poor mental and physical health, lower academic achievement and impaired social development in children and adolescents. DVA is also implicated in perinatal domestic homicides, as documented in Confidential Enquiries into Maternal Deaths.

Pregnancy is a time during which women are in repeated contact with health services so it is an opportune time to intervene. Research also suggests that women are likely to disclose DVA in the maternity setting, particularly in the presence of a trusted professional.

The aim of Independent Domestic Violence Advisors (IDVAs) is to secure the safety of those at risk of harm from intimate partners, ex-partners, or family members. They work with those affected to assess risk, develop safety plans, reduce abuse and ultimately improve health and wellbeing in women and children.

IDVAs receive specialist accredited training and hold a nationally recognised qualification. While there is now evidence for the effectiveness of IDVAs across a range of health settings, less is known about their implementation or impact within maternity services. In addition, there have been no formal evaluations of health-based IDVA models since the Covid-19 pandemic. This is notable as maternity services have undergone significant operational changes during this time, including reductions in antenatal and postnatal appointments, remote delivery of care and changes in child-birth delivery practices. Such changes continue today and may influence the operation and possibly potential impact of IDVA models in maternity services. Little practical implementation advice is currently available for those tasked with implementing IDVA models in health settings.

Research Questions

1. What configurations of health-based IDVA provision exist in English NHS Trusts with maternity services?

2. What implementation and improvement strategies can support the successful implementation of the health-based IDVA models in settings with maternity services?

3. Does health-based IDVA provision lead to increased identification of DVA by maternity services’ professionals?

4. Does health-based IDVA provision lead to increased identification of potential risks of harm to mothers and infants and subsequent referral to DVA risk management conferences?

Aims

1. To describe core model and contextual adaptations of health-based IDVA provision within settings that include maternity services

2. To generate learnings, using implementation and improvement science, to support the sustainability and future scale up of health-based IDVA provision in settings with maternity services

3. To evaluate the implementation of health-based IDVA provision in 5 NHS Trusts that have maternity services in:

• increasing awareness and identification of DVA by maternity services’ professionals;
• increasing referrals to DVA risk management conferences for mothers identified at high-risk of harm;
• increasing timely referral and access to domestic violence and abuse services via IDVAs.