February 25, 2015
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.
February 22, 2015
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
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
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
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’.
January 17, 2015
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?
January 11, 2015
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
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.
August 14, 2014
Last month we held our regular national MARAC Scrutiny Panel where we examined a number of anonymised cases which involved high levels of coercive control and risk. Tomorrow we will publish on our website (and I am sure on Twitter as well) the guidance that we prepared together with all the experts who attended the Panel. There is advice for IDVAs, MARAC chairs and partner agencies both before and at the MARAC.
Coercive control may be part of the vast majority of cases that IDVAs and other DV specialists deal with (it is called the Power and Control Wheel after all), but it is not so obvious to other agencies who might deal with cases on an incident based approach rather than looking at patterns of behaviour. Equally, the impact of growing up in a climate of coercion and fear is sometimes missed by those focusing on the adult victim of abuse (Marianne Hester’s planets sneak in again…).
Our briefing seeks to address this in just 2 pages. Ok, the font is very small….
Go to our website tomorrow to download it. As ever, all feedback welcome – we really want every MARAC in the country to use it. Any questions, please ask your MARAC Development Officer. To remind yourself who they are go to: http://www.caada.org.uk/marac/Regional_support_for_MARACs.html
August 13, 2014
Pretty much every year for the past 9 years we have promised ourselves that we will do a proper count of how many practising IDVAs there are across the country. The terms ‘back of the envelope calculation’ and ‘guesstimate’ are beginning to wear a bit thin, so we have finally decided to take a step forwards and actually find out exactly the figure.
Over the next week, every member of the CAADA team will be calling every single IDVA service in the country to find out how many IDVAs they employ, how many are qualified and some brief details about the profile of victims that they work with. We will be reporting this back to the Home Secretary in September as part of her HMIC National Oversight Group. So if you get a call from CAADA in the next week….please answer.