Exploring the role of facial trauma clinics as 'reachable 'moments in improving the support and outcomes for survivors of intimate partner violence.

BACKGROUND: Intimate partner violence (IPV) can be conceptualised as a continuum of abuse, including physical assault, sexual assault, psychological abuse, including harassment, coercion and intimidation (1).

Prevalent in England and Wales, 5.0% of adults aged 16-years and over experienced IPV in 2022; this equates to an estimated 2.4 million adults (2).

Within London, some of the highest rates of IPV offenses were reported in East London, including Newham and Tower Hamlets(3). It is increasingly reported and has considerable human and economic costs.

It is thus a huge burden for public health as it occurs regardless of age, socio-economic status, gender, and sexuality and can result in a number of negative outcomes such as poor mental health (i.e. post-traumatic stress disorder) and physical injuries (i.e. head and facial injuries) (4-6).

IPV may be under-reported amongst underserved populations due to issues around social/cultural desirability, fear and difference in understanding of what constitutes as violence and abuse.

This may consequently result in decrease ins service use and highlights issues surrounding barrier to accessing care (7).

It is thus imperative to explore alternative environments in which help and support for IPV can be delivered and accessed. Facial trauma clinics may be a candidate, as 76%-94% of IPV survivors sustain facial injuries (8, 9).

Individuals are referred due to a physical injury which requires care, rather than for psychological or IPV support which is often associated with stigma. Thus oral and maxillofacial surgery trauma teams are ideally suited to screen and support IPV survivors.

Using mixed methods this PhD will: 1) Systematically review and synthesise current literature exploring the presence of facial injuries amongst survivors of IPV and the role of facial trauma clinics as 'reachable' moments for providing support and improving outcomes for survivors of IPV. 2) Explore the individual and environmental characteristics of IPV survivors who suffer facial trauma in East London.

For example, demography, prevalence across groups, mechanisms of trauma, severity of injury, presence of mental health conditions, and linking to other services. 3) Investigate the role of facial trauma clinics in East London as potential 'reachable' gateways for providing support and improving outcomes amongst survivors of IPV and co-design a vision of provision.

Research Questions: RQ1: What is the prevalence of facial trauma amongst survivors of intimate partner violence and how does this differ by individual and environmental characteristics?

RQ2: What role do/can facial trauma clinics and allied practitioners play in facilitating support amongst survivors of intimate partner violence who attend the clinics?

METHODS: Study 1: Review of literature: Map and synthesise current evidence on 1) presentation of facial trauma amongst survivors of IPV. 2) How are facial trauma clinics being used as 'reachable' moments to provide support to survivors of intimate partner violence.

A systematic PRISMA compliant review of the current literature will be conducted, including published and grey literature. It will identify profiles of those at the highest risk of experiencing facial trauma resulting from IPV.

It will detail evidence base underlying the use of facial trauma clinics as a source for potential support and intervention.

Study 2: Quantitative study: Utilising routine data collected at the Centre for Oral and Maxillofacial Surgery Trauma Clinic at the Royal London Hospital, statistical analyses will be conducted to estimate the prevalence of facial trauma amongst survivors of IPV and explore whether this differs by individual and environmental characteristics, mechanism of trauma, severity of injury, presence of mental health conditions and links with allied services.

The Centre for Oral and Maxillofacial Surgery Trauma Clinic at the Royal London Hospital reviews 30-50 patients weekly, amongst