April 17, 2015

A new home…

I’m now blogging on the SafeLives website  – you can find all of my posts there, as well as those of SafeLives’ other experts and guest bloggers. You can see everything I’ve posted so far on my profile here.

I will continue to post here as well for the time being, but this page will soon be closing. To follow what I am up to, I suggest you subscribe to the SafeLives policy blog  – and why not sign up for the practice blog while you’re at it?

Thank you so much for your support for this blog over the years – I hope that you enjoy the new site and that you will continue to follow me and SafeLives as we set out how we think we can make ending domestic abuse a reality

June 9, 2015

No return to first-come-first-served for victims of domestic abuse

Anyone who’s worked with victims knows the situation. She’s sat in front of you, uncertain, nervous. You’re talking because she called the police last night after a violent incident with her ex. In the cold light of day, she’s not sure what to do – or even if it was right to call for help.

You give her plenty of time and space, working through her life story – but the questions you’re asking are hard. “Has he ever tried to strangle you?” “Has he threatened your kids?” “Do you feel safe?”  From her answers it’s clear she’s in significant danger.

Getting help for domestic violence used to be a matter of first-come-first-served. But now, conversations like this happen all the time, across the country. The questions come from a tool called the Dash (the domestic abuse, stalking and honour-based violence risk checklist). It means we can spot victims who are at high risk of murder or serious harm – and get them the right help, fast.

Every police force uses the Dash (or something like it). Most domestic abuse specialists do too. And so do thousands of other professionals – housing officers, social workers, GPs, nurses, A&E staff and many more. It’s given workers who aren’t domestic abuse specialists the confidence to know what to do if they spot abuse. Now, 40% of referrals to multi-agency meetings (Maracs) for victims at high risk come from agencies other than the police – which is positive, given that many women don’t want to involve the police.

And that’s helping us find more and more victims. Over the last year, the number of cases of high-risk domestic abuse that we know about have gone up 18%. That’s around 8,400 additional victims that we can now help, rather than them being hidden.

It’s one of the best-kept secrets in the social sector: the evolution of a new evidence-based model, now implemented nationwide, that transformed how we deal with victims of domestic abuse. So it’s sad to see continued misunderstanding of the risk-led approach.

Some suggest that risk assessment is primarily about rationing. And it’s true that the UK does not yet have a system that finds every victim fast and get her the right help straightaway. We have just 50% of the specialist Idva numbers we need across England and Wales, and there are few extra resources to help the 8,400 extra high-risk victims who have come forward in the last year. Victims at medium or low risk still often don’t get much help. But that’s an argument for spending the money we have better and arguing for more – not abandoning the best universal tool we have to identify abuse.

We’d never claim that everyone uses the Dash in the same way. An Idva (domestic abuse specialist) will use it in an in-depth conversation, whereas a frontline housing officer may use it to make sure that someone she’s concerned about gets help from a specialist fast. And that’s fine. But there are still some who regard the Dash as red tape or just a tickbox exercise. We do need to reinforce how to use it properly – and we’re pleased that police forces are taking this more seriously since the 2014 HMIC inspection.

At its heart, a risk-led approach is the way to get the right help to each victim. The vast majority of high-risk victims experience physical injuries, strangulation, rape, stalking or extreme controlling behaviour like threats to harm children. Every domestic violence professional would choose to help these victims first – rather than asking them to wait their turn in a queue.

So that’s what a risk-based approach is: it’s about understanding the situation of that victim and her children – and then responding in a tailored way to them. Meeting their needs and reducing the risks they face. Not applying a one-size-fits-all intervention regardless of their circumstances.

SafeLives will continue to promote a risk-led approach to dealing with domestic abuse – one that evolves to meet more victims’ needs as we find out more about what works. And in the long run, we have to turn the UK’s approach on its head: rather than reacting to abuse by just helping the victim, we have to get involved to stop the perpetrator abusing her too. So that’s the next challenge: let’s start putting as much effort into making perpetrators stop as we do into helping victims escape.

View this post on the SafeLives blog

May 5, 2015

Whose truth is it anyway?

We often wonder how those with a history of domestic abuse view the results of their behaviour – not least the damage they cause to both their partners and their children. This weekend, millions of people will watch the fight between Floyd Mayweather and Manny Pacquiao. Mayweather of course pled guilty to abusing his partner and mother of three of his children. As a result, he does not get to see his children as much as he might like. But what should we make of Mayweather’s version of the ‘truth’ when asked for how he feels about this?  His answer: “You know how women are sometimes”.  Hmm, no mention of his part in this…

Mayweather has a long and protracted history of perpetrating domestic abuse, with convictions reaching back as far as 2001. Just last year he made claims that “there are a lot worse things that go on in other people’s households”, adding that there’d never been any photographic evidence of bruises and bumps he’d caused. But we know that the truth of domestic abuse is often hidden behind closed doors.

Only yesterday, the Independent Police Complaints Commission published a report into the death of Hollie Gazzard, a hairdresser from Gloucester. She was brutally murdered by her ex-partner in front of horrified customers and colleagues at the salon where she worked.

Hollie and hundreds of other women who died at the hands of current or ex-partners will never be able to tell their truth. They’ll never be able to share the fear of living with abuse, how it affected their children and how they were hoping that someone would notice and ask the question.

It’s this truth – the horrendous reality of domestic abuse – that drives us to make sure all families live in safety.

We think that there are three truths that victims of abuse would want Floyd to hear.

The first truth is that all too often we miss opportunities to spot abuse and stop it: in the year before they get the help they need, most victims will have five contacts with public services and it will take almost three years before they get help. For professionals, it’s about knowing how to start the conversation. It’s knowing what to do if a victim or child tells them things aren’t right at home. But to help families become safe, we first need to find them.

The second truth is that victims of domestic abuse need to work with a skilled, trusted professional who can help them address the risk they face and meet their needs. Properly trained and well-resourced specialist domestic violence workers – Idvas – make all the difference. More than 60% of those helped by an Idva and Marac report that the abuse stops.

The third truth is that we need to resource these services properly. But the reality is that, despite ever-increasing caseloads, we still only have half the Idva capacity we need. No matter how good and dedicated the Idva, that level of work will impact on how well they are able to do their job.  Look at our Facebook page if you want to see powerful examples of how they are trying to meet the needs of their clients with ever rising caseloads.

If we create a model response to domestic abuse in every area, all families will get safe more quickly, and stay safe in the long-term. It’s a huge challenge, but one we’ve thought long and hard about. And our new strategy sets out how we begin to achieve this.

This is our truth to ending domestic abuse. What’s yours?

Oh and Floyd, if you are reading this, think again.

View this post on the SafeLives blog

April 17, 2015

Idva-Marac – a great model but not a revolution on its own

View this post on the SafeLives policy blog

I received a great email from the Resolutions Consultancy this week. It called for nothing less than a revolution in child protection in Australia, ahead of the upcoming Signs of Safety conference.

The point that resonated so strongly for me was the clear distinction that they made between the value of a particular model (Signs of Safety), and the context in which it operates:

Signs of Safety is the most comprehensive practice approach currently available to the child protection field. Signs of Safety has been refined by thousands of practitioners across 17 countries since 1988.

While the Signs of Safety is completely grounded in what works in practice, the model alone will not change how child protection work gets done. Practice decisions are always shaped by myriad factors including organisational anxiety, leadership, workload levels, workforce experience and stability, cultural confidence, political vulnerability, information recording systems and compliance – not to mention the actions of courts, police, mental health services, non-government collaborators, politicians and many more.

To transform practice requires a sophisticated, whole of system approach to implementing the Signs of Safety. That’s the revolution.

Here in the UK, we share that revolutionary spirit. We want to see a revolution in the way that we respond to domestic abuse – one that builds on the advances of the past 10 years.

We are rightly proud that all over the UK, victims and their children now get support from a dedicated professional Idva, who co-ordinates a range of other agencies at a Marac meeting.

But it’s also right that there is some healthy challenge about the Idva-Marac model.

Just as with Signs of Safety, we have to be honest that a good model on its own will not change the whole response to domestic abuse – especially where it is not being implemented faithfully. For example, we are concerned to hear about Idva contracts being awarded where the practitioners are not required to be trained by us, or to follow the national definition of the Idva role.

And just as the extract above highlights, we have to live with (and try to address) the operating environment in which we operate. In the multi-agency approach we advocate, issues such as workforce stability, workload, leadership and confidence are key.

Throughout it helps if we are clear about what the Idva-Marac model actually is. It’s not short-term, and it’s not criminal justice focused. It’s about achieving long-term safety built on a trusting relationship with an Idva who in turn coordinates the resources of partner agencies to manage and reduce risk and meet needs.

We’ve spent the last ten years advocating for the Idva-Marac model – and we will continue to push for every multi-agency partner to get better at helping high-risk victims become safe, and for enough trained and well-supported Idvas so that every high-risk victim gets the right help.

But a revolution in domestic abuse response needs more than the Idva-Marac model. There are other significant gaps to be filled – and we’ve set out how we’re going to approach them in our new vision and strategy.

We are excited about our new vision. It builds on the Idva-Marac model and sets out a practical approach to system change. We would love to know your thoughts.

It will be a great revolution if we achieve it.

Read more about Signs of Safety

This blog will soon be closing down as I am now blogging on the SafeLives website. If you enjoy this blog and want to keep reading, you can sign up for the SafeLives policy blog

February 25, 2015

The artist formerly known as……

So it’s official. We are no longer C***A.  We will now be pushing forward with our new name, a new strategy and new resolve as the charity that aims to end domestic abuse. We are SafeLives.  Please go to our lovely new website and watch the animation on the front page which says it all. More to follow…

And keep track of the news on Twitter from our national conference today where we are going to be talking about Getting it Right First Time.

#SafeLives

February 22, 2015

A taster for Wednesday….

On Wednesday we are holding our annual national conference with the theme of ‘Getting Right First Time.’ We will be looking at different ways to respond sooner to victims, children and perpetrators.  Our keynote speaker in the morning with be Dr Eamon McCrory from UCL who will talk about the impact of domestic abuse on the brain development of young children.  In case you want a bit more information about this – and the wider impact on the health of adults.  See this TED talk from Dr Nadine Burke Harris http://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime with some amazingly powerful messages.

Ok, maybe more than a taster….this talk has had 320,000 views already.

February 16, 2015

Piecing together the evidence-2

Last month I noted the evidence from some recent DHRs which showed the high percentage of women murdered by their partners who were still in a relationship. This was reconfirmed by the evidence from the Femicide Census published last week which reflects the tireless work of Karen Ingala Smith on this subject.

In the Femicide Census data, which spans almost 700 murders from 2009-2013, 58% of women were still in a relationship with the person who killed them. Over half had been in the relationship for over 5 years.

So this is where the gap lies – services for women who can’t or don’t leave for whatever reason and for older women. Our data across all types of practitioners- not just IDVAs – shows that about 80% of clients who engage are separated or separating.

Where is the exception to this? IDVAs working in hospitals where half their clients are still in the relationship.

So location matters. And so do the choices we offer women to ‘stay’ safely.

February 8, 2015

Catching up on some reading…

Like most of us, I tend to carry around a pile of articles and research findings to read.

Today I caught up on the findings from the Provide conference held in Bristol before Christmas. This programme is led by Prof Gene Feder and includes both pilot trials followed by randomised control trials.

Of particular interest I think are the findings of the PATH (psychological advocacy towards healing) trial. In PATH, women are offered not only conventional advocacy such as given by an IDVA, but also the advocate delivers some psychological therapy. This helps bridge the gap between women experiencing much higher levels of mental illness than the average, but also the reality that even those who do disclose mental health issues are unlikely to get an effective intervention from mental health services. For more information go to http://www.bristol.ac.uk/social-community-medicine/projects/provide/evidence-into-practice/provide-conference/

The study showed firstly that PATH filled a gap and secondly that the intervention gave enduring benefit for over a year.

We are keen to make the links between practical advocacy and longer term ‘recovery’ support. This looks like a promising example. Please let us know if you have emerging good ideas in your area.

January 24, 2015

Inspired by the Reith lectures

One doesn’t immediately expect that the distinguished thoughts of a Reith lecturer would have immediate relevance to our work to address domestic abuse – but this year’s lecturer, Atul Gawande, who spoke so eloquently about different issues affecting the future of healthcare, mentioned three points that felt highly relevant. You can listen to the lectures which are brilliant at http://www.bbc.co.uk/programmes/b00729d9

His second lecture talks about systems – how medicine is moving from the ‘magic bullet’ of penicillin to complex systems involving many practitioners, technology and inter-related problems. You will see the link with making a proper safety plan for a victim and children – it involves the resources of several agencies, clear communication and attention to detail as every case is different and the risk of getting it wrong is high. He suggests (I hope I do his lecture justice) that not only do the really complex aspects of a surgical procedure need to be done well, but also all the mundane but vital (literally) elements such as hand washing by nursing staff. To ensure consistency of practice he recommends….using a checklist. Does this sound familiar? And just like the CAADA-DASH risk checklist which was not/is not uniformly popular, nor was his checklist for medical staff. While many practitioners did not welcome the new medical checklist, nearly all of them said that they would want the procedure to be followed in exactly this way if they were undergoing an operation. Why didn’t we think to ask that about the risk checklist?! Of course any sensible person would want to have all those elements covered by an IDVA or police officer before a safety plan was made. The types of abuse suffered, the additional vulnerabilities and needs of a victim or particular risks associated with a perpetrator need to be identified if they are present. You can read more about his thoughts on this at http://www.nytimes.com/2007/12/30/opinion/30gawande.html?_r=2&oref=slogin&

Secondly, in a later talk, he comes back to the idea of how we implement systems. He talks about developing standards, writing guidance, and last of all when there is still a lack of consistent quality, he notes that there are sanctions for individuals who do not ‘follow the guidelines’. Again, this sounds all too familiar. In fact, we have done our fair share of guideline writing… Rather he argues, we should reward good practice and encourage those who are doing it right. A message for those responsible for driving culture change following the HMIC inspection?

Finally, and most importantly, he argues eloquently that the medical profession needs to listen to the patient. Radical. The same is true as we develop our response to domestic abuse – ensuring that lived experience is at the heart of what we do. For the group of victims, family members, survivors and thrivers who are helping us to shape our thinking at CAADA, I can only say, ‘Thank you – your input is vital – literally’.

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January 17, 2015

Piecing together the evidence

One of the questions that goes round and round is why the overall rate of domestic homicide has not budged really over the past 10 or 20 years despite the efforts of so many people locally and nationally to improve services for victims of domestic abuse. I was struck by two things this week which might hold a clue.

Firstly, we are presenting some of the early learning from our Insights data to a group of funders this week and so we were looking at some of the messages from the data. As a reminder, Insights data is collected from IDVAs, outreach workers, refuge workers, and a handful of other specialist roles such as ISVAs and Women’s Safety Workers. We collect data on several thousand cases a year from many different services, so it is a pretty good general reflection. I was struck that about 80% of women who engage with specialist services are separated/separating from their partner. Of course this links in part to the risks associated with the point of separation and the readiness of women to engage with help at this point.

Secondly, I looked at the notes a colleague had sent me from the DVCN conference just before Christmas where there was a focus on the Domestic Homicide Review process and the learnings from this. In contrast, Standing Together reported that out of the 30 DHRs that they had chaired, in about 2/3 of cases, the couple were living together.

Does this suggest that we need to work harder on offering support to women who do not wish to separate or for whom it is too dangerous to do so?

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