Archive for January, 2015

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

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

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.