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

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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January 11, 2015

As we approach the election, how about ‘yes and’ rather than ‘either/or’?

As we get closer to the next election, the pressure to present the case for funding specialist domestic abuse services gets ever more pressing. There have begun to be some of the ‘either/or’ arguments sneaking into the debate. I think that there are three problems with this line of thinking.

Firstly, we must not forget that domestic abuse remains one of the most under-funded sectors in this country. We started CAADA when several charities working in the children’s sector told me that domestic abuse was the biggest human problem in this country that was the hardest to raise money for. Things have improved since then but there is still a long way to go. The ‘either/or’ argument loses sight of the reality which is ‘not enough’. We need the services we have. We need them to be delivered to a high standard and in strong partnerships.

Secondly, the either/or argument risks some muddled thinking. For example, there is some talk of ‘either’ early intervention ‘or’ working with high risk cases. Actually, our data shows that we reach high risk victims earlier than medium or standard risk. But clearly we need to try and respond to all levels of risk. There is the ‘either’ refuge ‘or’ community based provision question. Women and children need both. Or ‘either’ MARAC ‘or’ MASH’. Again, a misunderstanding about how they work and what families need.

Finally, ‘either/or’ stifles innovation. I would be tempted to say that there is no one working in our sector who thinks that we have all the answers. If there someone out there, shout loudly. ‘Yes, and…’ encourages us to aim higher and build on what we know works today but develop it still further as well as look at other sectors too and learn from their work.

So, please, let’s look at a ‘yes, and’ model rather than an ‘either/or’ one. As pressures on funding increase further, let’s use our creativity to reconfigure and improve our response – building domestic abuse into services more broadly so that we multiply the impact of what we spend today rather than step back to an ever more siloed approach which won’t make families safer.

October 5, 2014

More evidence on why early intervention matters

We have two long term goals at CAADA.  One is to halve the number of high risk victims of domestic abuse and the other is to halve the time it takes for them to get effective help.  Surprisingly to many people, our evidence confirms that we actually support high risk victims at an earlier stage than other levels of risk – in part because the combination of violence and abuse that they suffer makes them more visible to both the police, health practitioners and others.  Our focus on reducing the time that victims live with abuse has two aims – to support them but also to limit the amount of time that their children are living with it too.

A new working paper published from the Center on the Developing Child at Harvard University entitled ‘Excessive Stress Disrupts the Architecture of the Developing Brain’ underlines just how important this is.  It describes how exposure of young children to toxic stress – namely strong, frequent or prolonged stress – can impact the development of those parts of the brain that manage fear, anxiety and impulsive responses.  This is just the sort of stress experienced by children, particularly very young children, living with domestic abuse.  The long term impacts include a range of stress related disorders depression, alcoholism and drug abuse and physical disorders including cardiovascular disease, diabetes and stroke. (http://developingchild.harvard.edu/resources/reports_and_working_papers/working_papers/wp3/ )

More optimistically, the paper argues that responses to early stress vary dramatically with positive early care-giving being crucial to decrease the likelihood of adverse outcomes.  This links to another paper, published in June this year in the journal of Early Child Development and Care, entitled ‘Early childhood education as a resilience intervention for maltreated children’ (Ellenbogen, Klein and Wekerle), which argues for the value of high quality early childhood education, particularly for disadvantaged and vulnerable families.

There is no question that the vast majority of children growing up with domestic abuse experience the kind of toxic stress that the Harvard team outlined.  Our children’s Insights data highlights how much children benefit from early support and what difference it can make to their view of the world and of themselves.  The most basic example of 60% of the children in our research being unable to fall asleep says it all for me.  Are we surprised if they don’t perform well at school the next day? And find it hard to make friends?  And then display ‘behavioural difficulties’? We need not just more specialist support for children, but also universal practitioners, friends and family to understand the impact of domestic abuse on their lives and how we can help build their resilience.

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