Archive for ‘MARAC’

March 1, 2014

Thoughts from Michael Johnson’s work – Practical Implications

We had a terrific keynote speech from Professor Mike Johnson at our National Conference on Wednesday.  He explained his work around typologies of relationship in domestic abuse.  He highlighted three main types (see http://www.caada.org.uk/events/CAADA_conference_2014.htm for more info) – Intimate Partner Terrorism where one partner – usually a man in heterosexual relationships – ‘terrorises’ the other, Situational Couple Violence where there is typically an equal split between male and female victims and perpetrators (although not necessarily in terms of impact) and finally ‘Violent Resistance’, where the partner of an ‘intimate terrorist’ will try and defend themselves in a violent way.  The first category is much smaller in number than the second, but with a much higher percentage of high risk cases because of the persistent existence of coercive control.  The second is by far the largest in terms of number of cases but most of these never come to the attention of public or specialist agencies such as police, IDVAs, refuges etc because the level of severity is typically much lower – although a significant percentage (about a quarter) do involve severe violence albeit without coercion and control.  The last category is very small.

So what are the implications of his research?  Firstly, it gives us a clear way to unlock the prevalence debate around 1 in 4 women and 1 in 6 men.  Both figures are right.  But the bulk of the violence where men are victims fits into the Situational Couple Violence category and we need to treat it in a different way.  In Situational Couple Violence, Mike’s research shows that about one third of cases involve men being violent to women, one third involve women being violent to men and one third are bi-directional.  Most do not involve patterns of violence and none involve coercion.  These are typically arguments and conflict that get out of control and where there is a violent incident.  In many cases this is a one off.  This is borne out by the crime survey for England and Wales which shows that about a third (I quote from memory) of cases are resolved in a month.  This is not the sort of coercion, violence and control that we see in our work.

Secondly, it has clear implications for the family courts in particular in relation to children.  Mike describes the impact of Intimate Partner Terrorism as the ‘poison’ that infects a family and leaves children exposed to constant stress.  You will all be familiar with the literature about the impact of this on the neurological development of small children.  The courts and those arranging contact between children and their parents need to get real clarity around this.

Thirdly, at a time when the police and others are reviewing the use of risk assessment, does this have a message for front line officers?  My sense is no.  There is a level of sophistication in distinguishing between different types of relationship which probably won’t be done most effectively at 3 in the morning. Front line officers need to collect evidence, safeguard the parties involved in an incident and manage the immediate risk that they are faced with.

Does it have implications for the work of specialists in the field?  My sense is yes.  At its most basic, many people in our field still speak about high risk as if it didn’t include coercion and control.  I feel as if there can’t be anyone left who doesn’t understand that coercion is totally linked to risk – as well of course as significant physical violence.  However, apparently there are!  When I listen to people saying: “Half of the homicide reviews were of standard risk cases” I do want to say that they really were NOT!  But they might have been hidden to public agencies or we didn’t spot the coercion and control because there was little or no physical violence disclosed, or because the person doing the risk assessment didn’t understand its significance.  I really would commend to practitioners the severity of abuse grid that we have put in the IDVA version of the DASH checklist (http://www.caada.org.uk/dvservices/RIC_and_severity_of_abuse_grid_and_IDVA_practice_guidance.pdf  see pages 8 and 9).  Look at the examples of coercion and control included under sexual abuse, stalking and harassment and jealous and controlling behaviour.  As an aside, we are in favour of streamlining the DASH tool for police – but anxious not to confuse the tool itself from the training and supervision required to implement ANY tool effectively.  College of Policing please note!!

More broadly, I think that the options we offer those in Intimate Partner Terrorism relationships are broadly appropriate.  However, we offer the same interventions to those experiencing Situational Couple Violence – and Mike argued very convincingly that the dynamics are not the same.  Our data show that only about 15% of victims supported by IDVA services do not disclose jealous and controlling behaviour – perhaps they are in  situational couple violence relationships? Mike’s research shows that a significant percentage of these do not want to split up – but this is broadly the only option we are offering them today.  I say this with great caution – BUT – if someone is genuinely in a Situational Couple Violence relationship, surely we should be looking at work with the couple and even anger management?  These are all interventions that are traditionally seen as unsafe where Intimate Partner Terrorism is involved.

Mike was very clear that our starting point must be to assume Intimate Partner Terrorism and safety plan as if this was the case.  However, his analysis does give us a few more options if, and only if, a real risk expert, with a capital ‘E’, establishes that this is not the case.

November 20, 2012

A Place of Greater Safety – Insights 1

It was a proud moment today when we published our first major policy report ‘A Place of Greater Safety’, using data collected by domestic abuse practitioners all around the country.  It is important because:

  1. It includes data from about 2500 victims and their children – highlighting the type of abuse they suffer and putting the real experience of victims at the heart of our recommendations, of practice and of policy.
  2. It makes the case for mainstreaming funding for IDVAs and MARACs
  3. It shows how putting IDVAs in hospital settings could help identify 10,000 high risk victims and their children who are getting no support today
  4. It includes the first substantial information on the abuse suffered by teenagers – a group who will become more visible with the change in the definition of domestic abuse to include 16 and 17 year olds.
  5. It highlights the impact of domestic abuse on children and gives commissioners simple actions to address this.
  6. It is aimed at local commissioners – those with the responsibility and the funding to address the problems.
  7. It gives clear objective evidence which we hope will underpin local and national policy.
  8. And it is part of a body of data that is growing every year so there is CAADA Insights 2, 2013 to look forward to!

I would really like to thank those practitioners who use the CAADA Insights service and our early funders who had the vision to back this approach before its benefits and value were really visible.  And also the fantastic team at CAADA who have worked day (and all too often at night) to put this together.

Please make sure your local commissioners know that this is now available – it could make all the difference.  You can download the report from our website at http://bit.ly/XkJXy6

Despite my best efforts #aPOGS may not be trending yet on Twitter…but there is still time….

July 27, 2012

What have standard bed charts in hospital and MARAC got in common?

This blog post may not be immediately catchy and appealing as it deals with forms, recording, and consistency.  But it is important – so please read on….

There was a lot of attention in the news this morning about the need for standard records to be used in hospital to record a patient’s vital signs, with the suggestion that 6,000 lives a year could be saved by this simple step.  http://bbc.in/MpciKi

We couldn’t save 6,000 lives if everyone used the standard MARAC forms that already exist  (see http://www.caada.org.uk/marac/Resources_for_MARAC_Chairs_and_Coordinators.html  but we could be much more confident of getting the full picture of a victim’s experience and the risks that they face if everyone used them.  If you aren’t using them at your MARAC, please let me know why not.  This is still the most likely place that we can get the full picture of risk, and where we have the most options to safety plan in a coordinated way.

It may sound a bit dull but almost every time we hear of a serious case review or homicide review, the same things come up about not seeing the whole picture.  Getting some simple basic things right can change that for adult and child victims alike.

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July 22, 2012

Leading Lights Lunch – 2

About six months ago, we held the first working lunch for the managers of the Leading Lights accredited IDVA services.  It was an experiment based on your feedback, that it would be a good idea to bring service managers together, to share their experiences, hear about each other’s plans, and feed in to shaping CAADA’s plans.  I wrote at the time about how energising and uplifting it was to be in the same room with a group of such committed and competent people.  Everyone agreed that we had all benefited from the time together and that we should meet again in 6 months.

So this week, we had LL2 – the sequel….and it was as good, if not better than LL1.  There were four official things on the agenda – an update from CAADA (including an introduction to our new Director of Services, Christine Christie), contributions from two of the managers present, and an outside speaker to give us all a better picture of how the Police and Crime Commissioners will work in practice.  There were lots of contributions from all who attended.

Christine focused mainly on the launch of the revised MARAC programme (see my last post for more on this) and I talked a bit about some of the policy work that we are involved with.  I also mentioned our National Dataset report which will be launched in the autumn, and will include information from the Insights data that we collect.  We are really hopeful that this will have some strong policy and practice messages which will be relevant to practitioners, managers, and of course commissioners.  We also discussed the new Ofsted consultation about multi agency inspections of Safeguarding arrangements, which includes a proposal that the MARAC should be inspected.  I will write more about this in a future post, but suffice to say that in combination with the Domestic Homicide Reviews, we believe that this represents a helpful and important lever to help ensure that the quality of MARAC work is as high as possible.

Becky Rogerson, Director of My Sister’s Place in Middlesbrough (www.mysistersplace.org.uk ) gave us a fascinating presentation about her trip around North, Central and South America as part of her research as a Winston Churchill fellow.  You can read the whole report here http://www.wcmt.org.uk/reports/887_1.pdf  Personally, my ability to take in the whole thing was slightly hampered by my jealousy at having such a great opportunity!  It was really interesting to hear about the differences in approach both between individual States, the role of the IDVA (or equivalent), the availability of perpetrator work and the simply the amount of resource in the US compared to the UK.  We have a way to go.  Conversely of course, central and south America highlighted a complete lack of resource in every sense and quite different relationships with the police and courts.  Absence of electricity, cars and perhaps most importantly trust, acted as a big barrier to getting help.  However, Becky did highlight the strength of more grass roots women’s initiatives which perhaps we have lost in some ways.

Caitlyn McCarthy, who manages learning and development at the Worth Project in West Sussex talked about the important work that she has led in relation to two projects.  The first is the 2020 Think Tank (see http://www.westsussex2020vision.org.uk/ ) which has been a two year project to set the vision, strategy and action plan for domestic and sexual violence services for West Sussex.  Caitlyn talked about the time it had taken to get everyone’s buy in to the importance of setting a common set of goals and objectives – but by now there are literally hundreds of signatories for all agencies across the county and the project has uncovered both new approaches, and the existence of more resources to support victims of both forms of abuse – both adults and children.  It was instructive since so many of us are struggling to get domestic abuse given the importance it warrants in local strategies.

Caitlyn also talked about the new questions we have been working on to use with mothers to establish any additional needs of their children which some of her colleagues have been piloting.  The aim of this is to be used across disciplines (DV, mental health, substance misuse) as an early identification tool to highlight children at risk of harm.  The reality is that asking these questions is time consuming and practitioners need to be very clear about who the support agencies are in their area to whom they can make referrals for the children before starting.  However, the feedback overall was that almost all the mothers in the initial small sample welcomed being asked and felt that it cemented their relationship with their IDVA, as well as identifying a group of children who were getting no support and who needed it.  We hope to pilot this formally but would like to make sure we capture the information in a robust way – so just need time to think that bit through.

Finally, Linda Pizani-Williams from CLINKS came and spoke about the role of the Police and Crime Commissioners.  They will obviously be very important for all of us going forward and she set out clearly the extent of their remit and gave resources which you can find at http://www.clinks.org/services/sfc/policy-briefings#PB1

So a real mixture of inputs.  I think I am fair in saying that just as valuable as the formal parts of the meeting, are the informal ones and the networking between everyone.  To all of you, especially our speakers and those of you how crossed half the country to be there, thank you.

July 15, 2012

Outnumbered….working with MARACs this year

We recently finalised our plans for working with all 260 MARACs across England and Wales this year.  We do feel a bit outnumbered – 260 MARACs, over 55,000 adult cases and 75,000 children’s cases heard annually and a mighty CAADA team of 5 MARAC development officers based around England and Wales – each supporting about 50 MARACs.  A challenge?  Of course.

So how will we make it work? Our plan is to make the most of our assets which we think include:

a)     a full time focus on MARAC activity and information – agency representatives are engaged with their ‘day jobs’,

b)     an overview position – developed from engaging with MARACs across the region and country,

c)      reach – which enables us to disseminate learning points, models of good practice and outcomes to all the MARACs, and

d)     influence – in being able to channel upwards to Government consolidated MARAC information from across the country

Each MARAC Development Officer (MDO in CAADA-speak) will work in several different ways with the MARACs in their region.  Firstly, they will each have a specific time-limited project which can be shared for all MARACs to learn from e.g. reviewing the challenges & successes of referrals for disabled victims and/or minority ethnic victims.  They will also visit the MARACs in their region, and support some in the use of the new CAADA self assessment tool which is currently being piloted.  (Thank you to those MARACs who are part of this pilot).  All will continue to have access to our workshops for IDVAs, Coordinators and Chairs in their region as well as the option of working directly with the MDO on specific issues either arising from practice or policy.

All of this will be complimented by our continued commitment to the use of data to inform this work.  You will be aware of our recent outcome analysis, looking at police data for 350 cases at 15 different MARACs for 12 months pre and post MARAC.  We are now working to develop this further both by extending the number of MARACs where we do the analysis and by adding more agencies to the outcome analysis.  Our MARAC help desk (marac@caada.org.uk ) is available for all practitioners to use.  If we don’t have the answer, we usually can find someone who does. Finally, we hope you have noticed the best practice examples that we are including in our e-newsletter.  These will continue, so please tell us if you feel you are doing something particularly well at your MARAC.  We are also exploring social media as a way of linking MARAC practitioners…but I am not sure that is official yet so I had better stop there!

For more information about the programme, do go to our website at http://www.caada.org.uk/marac/Information_about_MARACs.html

And do please share your best ideas….and if anyone has the answer to rising volume, and complex repeat cases, we would love to hear from you!

June 5, 2012

Updated MAPPA Guidance – the links with MARAC – clarity or confusion?

Version 4 of the MAPPA Guidance 2012 has recently been published, so I thought it was worth highlighting the areas that touch on MARACs given the continuing discussion about how the two processes fit together.  This guidance will replace the earlier version 3 published in 2009.  For the super conscientious, you can find the whole document at http://www.justice.gov.uk/downloads/offenders/mappa/mappa-guidance-2012-part1.pdf The pages relevant to MARAC are on 108-9.  Sadly, it seems that despite some consultation some of the points are still unclear.

The updated guidance is much shorter than the previous one.  It also uses ‘standards’ (what we at CAADA might describe as principles) for each element.  The standard in relation to MARACs is:

“MAPPA and MARAC work together to manage the risk of serious harm posed by offenders convicted of domestic abuse.”

We think clarification is needed on two points:

  1. The two processes should work together to manage the risk of serious harm posed by offenders convicted of any offence to victims of domestic abuse.  In our experience the majority of MARAC perpetrators are not subject to MAPPA.  For those who are subject to MAPPA, it is normally as a result of other offending, not domestic abuse.  If the domestic abuse is visible at MAPPA, i.e. is the index offence, then we would expect MAPPA to deal with it appropriately, with input from the IDVA and other agencies as set out in the guidance.  The concern relates to MAPPA offenders where the DV is ‘invisible’ and where the input of the MARAC is essential.
  2. The guidance says that the MAPPA should take precedence over the MARAC.  Of course it is a statutory set of arrangements – but in practice, a MARAC might be the better place to manage risk to the victim, and children, because of the wider range of agencies present.  Our expectation is that often a MARAC would be called before a MAPP meeting.

Finally, the referral form specifically asks whether a MARAC referral has already taken place and what actions arose from the MARAC meeting.

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May 2, 2012

Feedback on MARACs and GPs

I got some really interesting ideas following my last post through from Sheila Brookes, Domestic Abuse Strategy Team Leader for Cheshire West and Chester which I have reproduced below.  Do note the consultation from the Institute of Health Equity on the role of the NHS Workforce in addressing the social determinants of health.  I would just add that we do not really expect to see many referrals from GPs to MARACs – our aspiration at this stage is rather to ensure that proportionate information is shared in both directions so that all have the clearest picture of risk and can respond safely and appropriately.  I am still very glad to hear from anyone else with good practice examples that we can put into the discussion, ahead of publishing our toolkit which will have a few options in it.

We have  a slot on an annual  Child Health Promotion Course through the Safeguarding Consultant and Safeguarding GP Lead on the LSCB which enables newly qualified doctors on rotation as GPs & hospital  staff to hear about what issues patients might present in relation to domestic abuse, what they can do, what the MARAC process is, what further training is available locally through our core DA training courses (including practice using the CAADA DASH RIC,  learning about agency roles in MARAC  and where they can refer onto). We have also run  workshops for the local Clinical Commissioners Group at  GP/Practice Nurse Half Day Rolling Programme  Education events (elective workshop). A local Safeguarding Nurse  (MARAC rep) completed the MARAC Champion training and cascades to health visitors  staff and offers advice to GPs

 

Our core training programme has been used as an example of good practice by the Institute of Health Equity (IHE) in their recent paper which is out for consultation (http://www.instituteofhealthequity.org/projects/what-a-nhs-workforce-can-do-to-tackle-health-inequalities)

 

However locally responses from GPs are still dependent on individual responses – currently their information is presented through the Lead Safeguarding Nurse but they make very few direct referrals

 

April 30, 2012

Developing our MARAC thinking – what is the role of GPs?

Some of you will have read in our e-News about the work that is going on in relation to supporting MARACs around the country.  The joy of having a blog is that I can sometimes sneak out information about what we are doing before it is 100% official.  It is a habit that makes me universally popular with my colleagues!

As you will know by now, we see working more effectively with health practitioners as a key way of helping to address domestic abuse and achieving our goals of halving the number of high risk victims from 100,000 to 50,000 and halving the time it takes to get effective help from 5 to 2.5 years. Lots of people ask us about how they can be engaging GPs with their local MARAC as a way to reach just about everyone who experiences DV.  We were really fortunate to be able to hold a small workshop last week with some of the dedicated MARAC practitioners who faithfully advise on these sorts of practical issues as well as the IRIS team who have done such great work engaging with GPs in relation to DV.

The short answer is that there is a huge range of practice occurring from no contact at all with the local MARAC in most areas, to regular GP referrals in a handful of areas.  Some safeguarding nurses are actively liaising with GPs ensuring that relevant information is shared both with the MARAC and from the MARAC.

Our plan is to hold another similar event in Bristol in a few weeks and then draft a toolkit which will give a few different care pathways – hopefully offering everyone something realistic and helpful for their area.

Do you have any practical ideas to share?  If so, do let me know – either via the blog comments, or to our help desk at marac@caada.org.uk – thank you.


April 18, 2012

Striking the Balance – Guidance for Caldicott Guardians about MARAC

I can’t count how many times we have been asked about what information health practitioners can share at a MARAC meeting.  There have been real variations in practice around the country but now this could all change.  Perhaps not exciting for everyone, but for the hardened MARAC anoraks (not sure that sounds very pleasant) the news that the Dept of Health has published guidance for all Caldicott Guardians about what information they can and cannot share with a MARAC is really important.  We cannot stress enough the importance of the contribution of health practitioners to a MARAC and it is essential that they are able to act with confidence in this setting.  You can find it here Striking the Balance: Practical Guidance on the application of Caldicott Guardian Principles to Domestic Violence and MARACs

We are glad to have been able to contribute to the guidance and really hope it will help all of you who work with MARACs.  It can now sit with the guidance for the other former information sharing riddle, namely requests for disclosure from the Family Courts.  It reflects lots of dedication from Chris Fincken, until recently Chair of the Caldicott Guardian Council who wrote the guidance and attended his local MARAC for several years.

November 30, 2011

How to scale up social enterprise – A Synergistic Model of Scale — Social Edge

I thought that the article below from Social Edge, was really interesting and worth thinking about for all of us involved in delivering solutions to social problems.  We can see around us examples of quick, government funded responses and also many small social entreprises which struggle to scale up.  In our world, how do we help grow the best of the local work from domestic abuse services?  How do we build the best feedback loop into our MARAC work?  I will try and answer some of these questions but would love your thoughts!

A Synergistic Model of Scale

Hosted by Eric Glustrom (November 2011)

incorporating solutions

As the social change agents of our time, we keep our eyes peeled for any opportunity to grasp that idolized holy grail of social entrepreneurship: a sustainable, market-based approach to scale. However, especially for many Social Edge readers, it’s easy to let advocacy – the process of scaling a solution through policy change or partnership with larger institutions – slip into the distance.

Consider the following diagram:
Synergy
The social enterprise is the wedge, driving forward its solution. It has a few paths to scale:

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