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

Co Investigators:

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

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

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

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  

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. DVA leads to an adversity package of poor health and social outcomes, such as alcohol misuse and poorer reproductive health. 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.

What we found out

We found that CARA is likely to reduce the likelihood of reoffending both in the long term and immediate term, using domestic arrests as the outcome. Further evidence indicates that CARA led to immediate changes in the number of overall re-arrests and their severity. As involvement in CARA led to a reduction in the likelihood of rearrests for domestic abuse, CARA can be cost effective: with an estimated £5402 additional spending avoided (per domestic abuse offence).

When comparing risk categories of standard, medium and high risk, there was no difference in the DVA arrests between categories. Whilst policy discussions indicate that medium risk cases may not be offered to CARA, they were commonly included (50%) and findings from qualitative work indicate that CARA was the best option for such cases, where there was no alternative available. Despite being a condition, victims may not be informed, nor consented, during the CARA process.

•Through our participation with the CARA National Oversight Group, we are informing future service/commissioning of CARA through our recommendations.

•We are also informing the Joint Justice Plan that is due to be developed by contacts with the National Police Chiefs Council in October.

•We have also been approached by commissioners in New South Wales (Australia) for emerging evidence as they develop their DVA strategy.

Publication: A national evaluation of Project Cautioning And Relationship Abuse (‘CARA’) awareness raising workshops for first time offenders of domestic violence and abuse: protocol for a concurrent mixed-methods evaluation design - read