Health Inequalities National Priority Project in conjunction with ARC West, ARC NENC, ARC WM, ARC Y & H

Principle Investigator: Dr Sara A Morgan, ARC Wessex, Lecturer in Public Health, School of Primary Care, Population Sciences and Medical Education Faculty of Medicine, University of Southampton Email: s.a.morgan@soton.ac.uk

ARC North East and North Cumbria, Dr Steph Scott, NIHR ARC NENC Senior Research Fellow Email: steph.scott@newcastle.ac.uk 

ARC West, Dr Jessica Roy, Lecturer in Child and Family Welfare Email: jessica.roy@bristol.ac.uk 

ARC West Midlands, Professor Kate Jolly, Professor of Public Health & Primary Care Email: c.b.jolly@bham.ac.uk 

ARC Yorkshire and Humber, Professor Rachel Armitage, Professor of Criminology and Crime Prevention 

Background: Over one year, nearly 1,200,000 incidents relating to domestic violence and abuse (DVA) in England and Wales were documented by police, with almost half recorded as criminal offences [1]. DVA leads to an adversity package of poor health and social outcomes, such as alcohol misuse and poorer reproductive health. [2] Stakeholder consultation suggests that the criminal justice system (CJS) are struggling to constructively support victims, deter offenders or reduce reoffending, by means of an early intervention. Victims have voiced dissatisfaction and, collectively, professionals feel that they could do better. Furthermore, recent evidence suggests that COVID-19 has had a huge impact on the CJS, creating a backlog of up to 10 years.

Hampshire Constabulary were ambitious to test an alternative response via an early intervention that would improve outcomes for victims and their families. Project CARA was developed in 2011 as a conditional caution offered by the police to first time adult offenders of DVA of standard risk. Offenders are required to undertake two mandatory workshops that increase awareness of their abusive behaviour and the safety of partners and children. In contrast to restorative justice, CARA is an awareness raising intervention for offenders, that utilises a trauma informed approach and motivational interviewing techniques across the pair of workshops. In these workshops offenders are further signposted onto services that support improvements in the wider determinants of their offending behaviour, such as to their GP, drug and alcohol services or onto a community perpetrator programme. An initial randomised controlled trial of CARA was undertaken in Southampton custody suite, showing a reduction in the frequency of re-arrest and prevalence of domestic abuse in the intervention arm, one year following randomisation. [3]

Aims: Our aim is to evaluate the impact of Project CARA following its wider rollout nationally, including in Hampshire, Avon & Somerset, Dorset, West Midlands, Leicester, West Yorkshire, Cambridgeshire and Norfolk. This will be a mixed methods evaluation study over two years aimed at examining harm to victim and their families whose partners (or former partners) took part in CARA.

Methodology: Currently 1500 offenders take part in the CARA intervention annually. Of these, approximately 50% of their victims are also engaged in the process. A longitudinal qualitative study (n=30) using thematic/inductive analysis will be undertaken with offenders and survivors to explore their perceptions and experiences of CARA [4]. This will be conducted at different time points (e.g. before and after CARA). Alongside this, interviews with police staff (n=20) will be conducted in order to explore the barriers and facilitators to implementation, and feasibility of rollout in further areas, and therefore sampling will be stratified to include wider areas that are not delivering CARA.

The main quantitative outcomes will relate to reoffending of DVA. Using the IMPACT Toolkit questionnaire during victim contact, the safety of the victim will be assessed prior to completing and up to 3 months following the workshops [5]. This data will be triangulated with DVA reoffending data collected by the police, reporting incidents as suspects or charged. Alongside descriptive analysis of reoffending data nationally, the rates of DVA for eligible offenders will be compared retrospectively using historical data; between counties in the North East, where currently CARA is not being delivered, and at least two other counties including Hampshire and the West Midlands. Using regression adjustment of covariates, such as index multiple deprivation scores, the association of DVA reoffending across the two comparison groups will be examined alongside a time to first event analysis.

Co Investigators:

Professor Rachel Armitage Professor of Criminology and Crime Prevention School of Human and Health Sciences University of Huddersfield Huddersfield HD1 3DH Email: r.a.armitage@hud.ac.uk

Dr Joht Singh Chandan, NIHR Academic Clinical Lecturer in Public Health, Murray Learning Centre University of Birmingham Edgbaston Birmingham B15 2TT Email: j.s.chandan.1@bham.ac.uk

Dr David Culliford, Senior Medical Statistician NIHR CLAHRC Data Science Hub School of Health Sciences University of Southampton Southampton General Hospital (Room AA71, MP11) Southampton SO16 6YD Email: djc202@soton.ac.uk

Dr Tracey Long, Professor in Health Economics and Outcome Measurements School of Health and Related Research 208, West Court 2 Mappin Street Sheffield S1 4DT Email: t.a.young@sheffield.ac.uk

Mrs Fiona Maxwell Public Health Registrar, School of Primary Care, Population Sciences and Medical Education Faculty of Medicine, University of Southampton Email: f.maxwell@soton.ac.uk

Dr Ruth McGovern, Lecturer in Public Health Research/NIHR Post Doctorate Fellow Population Health Sciences Institute, Newcastle University Baddiley-Clark Building Richardson Road Newcastle upon Tyne NE2 4AX Email: r.mcgovern@newcastle.ac.uk

Dr Will McGovern Senior Lecturer, Social Work, Education and Community Wellbeing M005 Manor House, Coach Lane Campus (West) Northumbria University, Newcastle upon Tyne NE7 7TR Email: william.mcgovern@northumbria.ac.uk

Dr Jessica Roy, Lecturer in Child and Family Welfare School for Policy Studies, University of Bristol 8 Priory Road Bristol BS8 1TZ Email: jessica.roy@bristol.ac.uk  

References

[1] Home Office (2019) The economic and social costs of domestic abuse. 

[2] Golding J.M (1999) Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis. Journal of Family Violence. Vol 14; 99- 132. 

[3] Strang, H., Sherman, L., Ariel, B. et al. (2017) Reducing the Harm of Intimate Partner Violence: Randomized Controlled Trial of the Hampshire Constabulary CARA Experiment. Camb J Evid Based Polic 1, 160–173. https://doi.org/10.1007/s41887-017-0007-x 

[4] Braun V, Clarke V (2008) Using thematic analysis in psychology. Qualitative research in psychol-ogy 3 (2):77-101 

[5]Jones, C. (2015) Implementing the IMPACT Toolkit (Part II) Accessed online at https://www.work-with-perpetrators.eu/fileadmin/WWP_Network/redakteure/Expert%20Essays/Implementing_Impact_Jones.pdf 

[6] Hartfiel, N., & Edwards, R.T. (2019). Cost–consequence analysis of public health interventions.