Posts tagged ‘CAADA DASH’

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’.

Tags: , , ,
February 11, 2013

More thoughts on the proposed ACPO domestic abuse risk assessment pilots

Diana Barran talks about CAADA’s concerns at the proposed ACPO pilot to give frontline officers discretion about the use of the risk assessment tool when attending domestic abuse incidents.

Tags: , , ,
January 23, 2013

The Slippery Slope (and I don’t mean the snow)

ACPO’s announcement this week about a pilot to reduce police bureaucracy through discretionary use of risk assessment at domestic incidents’ feels like a very slippery slope in terms of the safety of victims and children.  It sends a very different message than those coming from other experts about the importance of addressing domestic abuse.  

Let’s start with Chief Superintendent John Sutherland of the Met Police.  At a recent conference on Tackling Britain’s Gang Culture he said: “I think we’ve barely begun to understand the secondary impact that violence has on these people whose homes it’s happening in.  I promise you, it’s having a devastating effect. I regard domestic violence is the single greatest cause of harm in society.”  We would agree with that – all those working with children, women or young people constantly see domestic abuse at the centre of the suffering and dysfunction that they are dealing with.  

Similarly, the Home Office has just extended the definition of domestic abuse to include 16 and 17-year-olds and also patterns of coercive and controlling behaviour.  This recognises the risks not just in physical and sexual violence, but also in coercion, stalking and control –  as well as specifically highlighting the typical characteristics of an abusive relationship which includes a pattern of behaviour and escalation in severity.

Finally, the IPCC ( Independent Police Complaints Commission) has highlighted in a number of domestic homicides, the need for consistent and high quality risk assessment even in cases where the victim is minimising what has happened to her. For those who want to read more see the reports on the murders of Casey Brittle and Christine and Shania Chambers.  In the case of Casey Brittle, the Commissioner wrote about the response of the police, saying that it “was borne of a lack of knowledge and a willingness to accept the word of a woman who had suffered years of abuse when she said she did not want or need their help.” 

So why are we so worried about ACPO’s announcement?  Some parts are perfectly sensible – the risk identification checklist which we developed together with ACPO was not designed to be used in cases of ‘two brothers fighting over a remote control’.  Indeed, we didn’t think that anyone would call the police in such a situation but obviously we were wrong!  But the other areas such as ‘one off incidents reported by a neighbour’, no previous history or no record of violence in the relationship simply go against everything we know about domestic abuse.  We estimate that in the highest risk cases only about 50% of people tell the police.  Where the risk is lower, the level of reporting to the police falls sharply.  Our research shows that about 10% of MARAC cases have never told the police about their abuse despite they, and their children, being at risk of murder or serious harm.  A significant number of women who are killed have never called the police.  How are we going to spot which ones those are, if they do decide to seek help that way?

Secondly, the focus on bureaucracy misses two crucial points.  The checklist was developed in the first place because it was clear that the police did not feel competent to judge and assess risk without it.  It just isn’t bureaucracy – it is a practical tool that allows officers to do their job better in a world where resources for training and supervision are shrinking. Every question on the list relates to a risk factor for domestic homicide.  The real issue is how well the checklist is completed, how the information is used and what other services are brought in to support the family.  The quality of risk assessments has been variable and in some cases left much to be desired – see the Christine and Shania Chambers IPCC report for more on this.  But describing the process as bureaucratic is missing the point – paper only gets shuffled when the information on it is of poor quality.  We see risk assessments forming a central role in safety planning in many areas – in others people whisper that they are ‘filled out in the back of the car’  This is a supervision issue, not bureaucracy.

So back to the slippery slope…Hampshire police is now moving on to allow officers complete discretion in when they judge it worth asking the risk questions and we are really concerned that other forces might follow.  This is a big step backwards and goes against everything that we are striving to achieve in terms of helping families in sooner and using a multi agency approach to ensure that public resources are put to best effect.  

To quote the IPCC once more: “Victims of domestic violence are frequently most at risk from a coercive and controlling partner when they seek external help or try to end the relationship.”

Safety or bureaucracy?  You choose.