SELECTING AND VALIDATING OUTCOME MEASURES FOR THE DOMESTIC VIOLENCE AND ABUSE CORE OUTCOME SET (DVA-COS)
By Shivi Bains, Elizabeth Dunk, Lazaros Gonidis, Jenna Harewell,Emma Howarth, Claire Powell
Background - The domestic violence and abuse core outcome set (DVA-COS) is an agreed set of five outcomes intended for use in evaluating interventions for children and their families with experience of domestic abuse. The purpose of a core outcome set is to harmonise outcome measurement, helping to reduce variation in outcome selection and measurement across studies, with the aim of preventing research waste. This minimum, but not exclusive, set of outcomes also aims to ensure interventions capture impact meaningful to all stakeholders, whether through routine data collection within domestic abuse services or as outcomes in trials and research evaluations. Since the development of the DVA-COS, work has been undertaken to consolidate and validate outcome measurement instruments (OMIs) to use within the core outcome set. The work reported here builds on and extends these efforts (Powell, Clark, et al., 2022; Powell, Feder, et al., 2022). Aims Foundations, the national What Works Centre for Children & Families, commissioned a programme of work, comprised of two work packages, to develop and validate OMIs for use in the DVA-COS. This report focuses on work package 1, which sought to identify and appraise measurement tools, using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Process, to assess three of the five core outcomes of the DVA-COS: family relationships, feelings of safety, and freedom to go about daily life. Work package 2 sought to validate the Short Warwick–Edinburgh Mental Wellbeing Scale (SWEMWBS) for use with child and young people populations with experience of domestic abuse and is reported separately. Methods To meet the aim of work package 1, this project adopted a four-stage process. Within stage A, OMIs were identified through rapid reviews of the domestic abuse literature (peer-reviewed and grey) and through targeted searches of the non-domestic abuse literature; these searches were informed by concept workshops with 15 key stakeholders to highlight priority concepts within the outcomes. In stage B, candidate OMIs and their associated studies were quality appraised, using the COSMIN protocol, and the highest-scoring tools were shortlisted for assessment of their acceptability and feasibility. Feedback workshops and stakeholder votes, held within stage C, determined which tools should proceed to the consensus workshop. Concluding this process (stage D), a consensus workshop was held with 29 domestic abuse practitioners, commissioners, researchers, and survivors to allow stakeholders to discuss and reach agreement on recommending OMIs for the three outcomes. Key findings In total 144 OMIs were identified across all evidence sources and from previous work. A systematic process of conceptual mapping, quality appraisal, and examination of acceptability and feasibility issues resulted in a shortlist of 18 OMIs (seven OMIs mapping to family relationships, six mapping to feelings of safety, and five capturing freedom to go about daily life) for discussion by three stakeholder groups. Of these, eight OMIs (three OMIs for family relationships, three for feelings of safety, and two for freedom to go about daily life) progressed to the final consensus workshop. Votes held during the consensus workshop identified the Children and Families Against Domestic Abuse (CAFADA) Wellbeing and Safety as the preferred OMI to assess two outcomes: family relationships (81.5%) and feelings of safety (74.1%). A provisional recommendation for use of this tool was agreed, given that it was recently developed and so it lacks psychometric validation. Therefore it is recommended that before widespread use, this OMI is subject to further adaptation and evaluation in cooperation with the tool developers. In particular, thought is needed about the tool’s suitability for a wider range of interventions, including those supporting perinatal families or services including the person that harms. No agreement, and therefore no recommendation, was reached for an OMI capturing freedom to go about daily life. Feedback from the consensus workshop highlighted a range of positive attributes that explained the CAFADA Wellbeing and Safety’s high acceptability for use within domestic abuse contexts, such as visually appealing design, trauma-informed and strengths-based language, and the complementary adult and child versions. The consensus workshop also highlighted key areas of development such as removing gendered language, being inclusive of non-traditional family structures, and being accessible to children of different ages or cognitive maturity. Conclusion This work makes important strides towards the realisation of a DVA-COS. It establishes a consensus with respect to the provisional recommendation for use of the CAFADA Wellbeing and Safety scale, in research and practice contexts, to assess feelings of safety and family relationships. This provisional recommendation is dependent on further work being carried out to refine the tool and to evaluate its implementation in real-world contexts and in relation to different types of childand family-focused interventions. The not insignificant challenges of implementing a core outcome set are discussed, including the importance of creating trauma-informed guidance to ensure the DVA-COS adopts a care-first approach and to mitigate any unintended consequences. Key findings In total 144 OMIs were identified across all evidence sources and from previous work. A systematic process of conceptual mapping, quality appraisal, and examination of acceptability and feasibility issues resulted in a shortlist of 18 OMIs (seven OMIs mapping to family relationships, six mapping to feelings of safety, and five capturing freedom to go about daily life) for discussion by three stakeholder groups. Of these, eight OMIs (three OMIs for family relationships, three for feelings of safety, and two for freedom to go about daily life) progressed to the final consensus workshop. Votes held during the consensus workshop identified the Children and Families Against Domestic Abuse (CAFADA) Wellbeing and Safety as the preferred OMI to assess two outcomes: family relationships (81.5%) and feelings of safety (74.1%). A provisional recommendation for use of this tool was agreed, given that it was recently developed and so it lacks psychometric validation. Therefore it is recommended that before widespread use, this OMI is subject to further adaptation and evaluation in cooperation with the tool developers. In particular, thought is needed about the tool’s suitability for a wider range of interventions, including those supporting perinatal families or services including the person that harms. No agreement, and therefore no recommendation, was reached for an OMI capturing freedom to go about daily life. Feedback from the consensus workshop highlighted a range of positive attributes that explained the CAFADA Wellbeing and Safety’s high acceptability for use within domestic abuse contexts, such as visually appealing design, trauma-informed and strengths-based language, and the complementary adult and child versions. The consensus workshop also highlighted key areas of development such as removing gendered language, being inclusive of non-traditional family structures, and being accessible to children of different ages or cognitive maturity. Conclusion This work makes important strides towards the realisation of a DVA-COS. It establishes a consensus with respect to the provisional recommendation for use of the CAFADA Wellbeing and Safety scale, in research and practice contexts, to assess feelings of safety and family relationships. This provisional recommendation is dependent on further work being carried out to refine the tool and to evaluate its implementation in real-world contexts and in relation to different types of childand family-focused interventions. The not insignificant challenges of implementing a core outcome set are discussed, including the importance of creating trauma-informed guidance to ensure the DVA-COS adopts a care-first approach and to mitigate any unintended consequences
Work Package 1.
Foundations UK: 2025. 126p.
