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      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

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          Abstract

          Introduction

          Interventions related to the perpetration of Domestic Violence and Abuse (DVA) have gained traction over the past several years, in response to dissatisfaction by victims, an inadequate response from the criminal justice system, increased demand on police time and a lack of rehabilitative responses to the perpetration of domestic abuse. The CARA model is a conditional diversionary caution, offered by police for first time offenders of ‘standard’ or ‘medium risk’ domestic abuse, that engages perpetrators in awareness raising workshops and signposts them onto further services. Although quasi-experimental studies have indicated that CARA showed promise at reducing reoffending, the CARA model has yet to be evaluated nationally and there is no qualitative evidence related to understanding or learning about the lived experience of perpetrators and victims as they engage with the intervention.

          Methods

          Using a concurrent pragmatic mixed methods design model we will undertake a national evaluation of CARA by triangulating quantitative data from up to nine police forces, and routine data from service providers, with qualitative data from workshop participants, victims and professional stakeholders to: (1) understand the long-term impact of CARA implementation on DVA reoffending and engagement with services and (2) explore perceptions and experiences of both delivery and receipt of CARA. We will use qualitative methodologies that draw on interpretivist and phenomenological perspectives, as well as quantitative methodologies using interrupted time series models, Poisson regression models, Geo mapping and a cost benefits analysis.

          Ethics and dissemination

          Where currently the CARA model is being introduced as a national option for standard risk first-time offending, we will engage with policymakers and academics nationally in the live debate on its effectiveness and suitability during its roll-out. Ethical approval was approved by the University of Southampton on the 1 st June 2022 (Ref: ERGO ID: 71818.A1).

          Plain Language Summary

          Over 2 million incidents relating to domestic violence and abuse (DVA) were reported to the police in England and Wales in the year leading up to March 2023. DVA leads to poor health and social outcomes for both victims and perpetrators. Consultation suggests that the system is struggling to support victims of domestic abuse and prevent repeat offending. Hampshire were keen to test an intervention that would improve outcomes for victims and their families. They developed a conditional diversionary caution called CARA offered by the police to those who have committed a crime related to domestic violence and abuse for the first time, where the incident was considered as ‘standard’ according to a domestic abuse risk checklist and professional judgement. Offenders are required to undertake two mandatory workshops that increase awareness of their behaviour and the safety of partners and children. They are further signposted onto services that support improvements in their health and social care needs that may contribute towards their offending behaviour. CARA cautions are now being offered across several regions. However, we don’t understand how offenders and victims feel about this intervention and we don’t know whether engagement in CARA leads to change in abusive behaviours over a longer period, such as 12 months after the intervention. We will interview offenders, victims and those involved in delivering CARA. We will aim to understand what worked and what didn’t work. We will look at what happens to offenders and the costs associated with this and examine whether there may be any differences in outcomes for those of different ethnic backgrounds or from different areas. To develop this plan, we consulted with both victim and offender groups. We will consult with both groups to improve our methodology, data collection and how we share our results with the public.

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          Most cited references37

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          Reflecting on reflexive thematic analysis

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            Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study.

            The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.
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              Interrupted time series regression for the evaluation of public health interventions: a tutorial

              Abstract Interrupted time series (ITS) analysis is a valuable study design for evaluating the effectiveness of population-level health interventions that have been implemented at a clearly defined point in time. It is increasingly being used to evaluate the effectiveness of interventions ranging from clinical therapy to national public health legislation. Whereas the design shares many properties of regression-based approaches in other epidemiological studies, there are a range of unique features of time series data that require additional methodological considerations. In this tutorial we use a worked example to demonstrate a robust approach to ITS analysis using segmented regression. We begin by describing the design and considering when ITS is an appropriate design choice. We then discuss the essential, yet often omitted, step of proposing the impact model a priori. Subsequently, we demonstrate the approach to statistical analysis including the main segmented regression model. Finally we describe the main methodological issues associated with ITS analysis: over-dispersion of time series data, autocorrelation, adjusting for seasonal trends and controlling for time-varying confounders, and we also outline some of the more complex design adaptations that can be used to strengthen the basic ITS design.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data CurationRole: Formal AnalysisRole: Funding AcquisitionRole: InvestigationRole: MethodologyRole: Project AdministrationRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: Data CurationRole: Formal AnalysisRole: Funding AcquisitionRole: InvestigationRole: MethodologyRole: Project AdministrationRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: Writing – Original Draft PreparationRole: Writing – Review & Editing
                Role: Data CurationRole: Formal AnalysisRole: Funding AcquisitionRole: Project AdministrationRole: Writing – Review & Editing
                Role: InvestigationRole: MethodologyRole: SupervisionRole: Writing – Review & Editing
                Role: MethodologyRole: SupervisionRole: Writing – Review & Editing
                Role: Funding AcquisitionRole: InvestigationRole: MethodologyRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – Review & Editing
                Role: Formal AnalysisRole: MethodologyRole: Writing – Review & Editing
                Role: Data CurationRole: Formal AnalysisRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – Review & Editing
                Role: Formal AnalysisRole: InvestigationRole: MethodologyRole: ResourcesRole: Writing – Review & Editing
                Role: ConceptualizationRole: Funding AcquisitionRole: MethodologyRole: ResourcesRole: SupervisionRole: Writing – Review & Editing
                Journal
                NIHR Open Res
                NIHR Open Res
                NIHR Open Research
                F1000 Research Limited (London, UK )
                2633-4402
                1 August 2024
                2024
                : 4
                : 43
                Affiliations
                [1 ]Centre for Population Health Sciences, University of Southampton, South Academic Block, Southampton General Hospital, England, SO16 6YD, UK
                [2 ]Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, England, NE1 4LP, UK
                [3 ]Institute of Applied Health Research, University of Birmingham, University of Birmingham, England, B15 2TT, UK
                [4 ]Birmingham Health Partners, Birmingham, B15 2TT, UK
                [5 ]University of Huddersfield, Huddersfield, England, HD1 3DH, UK
                [6 ]NIHR Applied Research Collaboration Wessex, School of Health Sciences, University of Southampton, Southampton, England, SO17 1BJ, UK
                [7 ]Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, England, NE7 7QA, UK
                [8 ]School for Policy Studies, University of Bristol, Bristol, England, BS8 1TZ, UK
                [9 ]Sheffield Centre for Health and Related Research, School of Medicine and Population Health, The University of Sheffield, Sheffield, England, S1 4DA, UK
                [1 ]Kingston University, London, England, UK
                [1 ]Waypoint Centre for Mental Health Care, Waypoint Research Institute, Penetanguishene, Ontario, Canada
                Author notes

                No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Competing interests: No competing interests were disclosed.

                Author information
                https://orcid.org/0000-0001-8346-6655
                https://orcid.org/0000-0001-8164-7727
                Article
                10.3310/nihropenres.13609.1
                11474160
                39411229
                8aaa13c5-0704-4975-b9ca-f6f520dc4473
                Copyright: © 2024 Morgan SA et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 June 2024
                Funding
                Funded by: National Institute for Health and Care Research (NIHR) North East and North Cumbria
                Award ID: NIHR200173
                Funded by: National Institute for Health and Care Research (NIHR) Consortium for the National Priority Area of Health and Care Inequalities
                Award ID: NIHR201889
                This work is funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaborations (ARCs) Consortium for the National Priority Area of Health and Care Inequalities (NIHR201889). This Consortium is hosted by the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
                The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Study Protocol
                Articles

                domestic violence and abuse,diversionary cautions,prevention,perpetrator workshops

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