Implementation of health independent Domestic Violence Advisors (hIDVA): A qualitative study in five NHS Trusts.

Background People who experience domestic abuse report increased use of healthcare services, compared to those not experiencing abuse. Independent Domestic Violence Advisors (IDVA) are evidence-based programmes that provide emotional and practical support to people experiencing domestic abuse. They are well established in community settings. It remains unclear, however, what the key elements to implementation success are when adapting this model for use in hospital settings. This study therefore aimed to understand the key areas of consideration when implementing health IDVAs (hIDVA) within hospital settings to ensure the hIDVA role can be appropriately commissioned and delivered. Methods Interviews with hIDVAs and NHS staff were conducted at three time points in the evaluation study: baseline, follow-up (around 3 months) and final interview (around 6 months). Data were transcribed verbatim and thematically analysed. Results Four key themes emerged: 1) The nuances of the hIDVA role, 2) Learning to manage competing priorities, 3) Exposure to acute injuries and vicarious trauma, 4) The necessity and consequences of raising the profile of the hIDVA role. Conclusion Our findings and key recommendations highlight the necessity of preparatory work with hIDVAs before they begin their role, including how to navigate the hospital landscape recognising hierarchies and structures and responding to acute and dynamic needs across multiple departments. hIDVAs should receive specific training around exposure to acute injuries and how to manage vicarious trauma, with ongoing clinical supervision. The hIDVA role is demanding and requires practitioners to manage competing priorities. To adequately meet the demands of the role, hIDVAs must have robust line management support and careful monitoring of time and resources to ensure these role objectives can be effectively delivered.