Posts tagged ‘DV’

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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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.

August 14, 2014

Coercive Control – how should MARACs respond?

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 

May 14, 2014

Would I know one if I fell over one?

I am talking about an ‘abridged Cochrane systematic review with meta-analysis’. And honestly I don’t think I would. Thankfully, the research paper in the BMJ from a range of experts (O’Doherty, Taft, Hegarty, Ramsay, Davidson and Feder) is clear and well explained.

The paper analyses several studies which assess the impact of screening women for intimate partner violence in healthcare settings. It even includes a brief video (blogging skills don’t permit me to embed it here…) setting out the main findings. The researchers found that while screening results in higher identification of domestic abuse, it was still well below the prevalence estimates in the population. Further it did not clearly lead to higher referrals to specialist domestic abuse services. Screening did not appear to cause harm.

In short, my view would be in a far less scientific way, that asking the question routinely to every woman in a health care setting without having a clear and effective referral pathway does not make a material difference to the support she receives and is not a good use of resource. In a more measured way, the researchers concluded: ‘As the primary studies did not detect improved outcomes for women screened for intimate partner violence, there is insufficient evidence for screening in healthcare settings.’

But, if you have a dedicated DV practitioner either on site or clearly identified and linked to the practice/hospital, then that makes all the difference…

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.

March 1, 2014

Michael Johnson on different typologies of domestic violence

Brief excerpt of Michael Johnson’s speech for the CAADA National Conference 2014 including implications for children. See more on our website at http://www.caada.org.uk/events/CAADA_conference_2014.htm

August 1, 2013

MARAC and Perpetrators

We recently held our first National MARAC Scrutiny Panel, chaired by the Home Office and with attendance from a very wide range of expert practitioners and policy leads.  Although I say it myself, it was a simply fascinating morning.

One the privileges of working for CAADA, is that we get lots of feedback (I mean lots) from local practitioners about ‘what needs to happen’.  Sadly, we still haven’t found the magic wand to make it all happen, but one theme that has been coming through pretty loudly in the past few months, is that the victim focus at MARAC has sometimes meant that, in some areas, the perpetrator has become pretty invisible.  Obviously, without addressing the behaviour of the perpetrator (you know what I am going to say next) we cannot assure the safety of the current victim and children, nor of future partners and their children.

So the aim of the morning was to review a number of cases where the response to the victim had been good, but where the perpetrator had somehow ‘slipped through’. We owe a big thank you to the areas who contributed the cases – not the most comfortable moment to have 20 experts scrutinise your cases, with three times as much time as usual to think in!  We explored a few themes.  Firstly we looked at whether existing powers allow us to address these cases effectively or do we need new measures or policies?  What other practical options can be used to manage perpetrator behaviour?  Can we learn from programmes such as Troubled Families?

We will be publishing more formally our findings and recommendations and will make sure that the very practical conclusions that came from the session are communicated with all of you who attend MARACs through our eNews, website and of course the MARAC Development Officers.  However, some of the headlines included:

  • We need to ensure that relevant and proportionate information about perpetrators is brought to MARAC so that a partners have a clear picture of risk and that the safety plan is comprehensive;
  • The right people need to be round the table.  Without mental health and substance use experts at the meeting, we cannot make effective safety plans.
  • We need to stay really proactive with perpetrators whether by engaging them through an Integrated Offender Management programme, or by what the police call ‘disruption’.  
  • We need to make sure that the links with MAPPA are working well.

More broadly, there were several calls for MARAC to be placed on a statutory footing as participants felt it would help secure attendance and resources for the process.

I really commend the Scrutiny Panel process to you as a great way of reflecting on practice – both for practitioners and strategic leads – stepping back and seeing patterns in our response and allowing us to improve it before there is a tragedy.  We will be publishing more from this panel in the coming weeks and months so please keep an eye on our e-News and website for more details.  We hope to run another one in 6 months, so let me know what theme or issue you think we should look at.

April 6, 2013

The Philpott Case – separating the exceptional from the ‘normal’

A friend emailed me yesterday saying: “Shouldn’t you be writing something about the Philpott case and domestic abuse?” In one sense it is understandable that the domestic abuse has not been central to the media coverage of this terrible tragedy – focusing rightly on the awful loss of six children’s lives. But, the domestic abuse was there of course – in terms of coercion and control, violence and abuse.

There is no question that the final outcome of the web of abusive relationships around Mick Philpott was extreme and hopefully exceptional but the information that has been made public about his behaviour is chillingly ‘normal’ in the context of high risk domestic abuse. Based just on what we know from the papers, his girlfriend would almost certainly have been deemed to meet the MARAC referral threshold. Thinking of the questions on the CAADA DASH risk checklist – separation, conflict around child contact, coercion, sexual abuse, financial abuse, history of violence to previous partners, attempted suicide, victim fear, escalation – the list goes on. Every single day, IDVAs all around the country receive referrals where women are living with all these risks, and for every one that is referred for help, there is another invisible woman who is not identified (in this case his wife?), tells no one and suffers alone.

There is much talk in the domestic abuse field about homicide prevention. Of course we want to prevent and reduce homicides. But let’s not fool ourselves that the ‘typical’ homicide looks so very different to the typical high risk case. It just doesn’t. There are 100,000 high risk families in this country. About half of those cases are heard at a MARAC each year. With the exception of the number of children involved – and the unusual cohabitation arrangements – many look very similar to this case. It is essential that we fund adequate services for these families and that we are clear that homicide reduction will only happen if we address high risk cases much more widely.

Similarly, we need to be clear about a few things if, as a society we want to protect our children. Social care professionals talk about domestic abuse ‘impairing parenting capacity’. It feels like a terrible understatement in this case but yes, domestic abuse does ‘impair parenting capacity’. This was a very extreme example, but if we don’t acknowledge this, and support women who suffer domestic abuse to parent and protect their children, then we are failing those children. This has to start with links being made between risks to children and risks to women and vice versa.

I go back to the last question on the CAADA DASH risk checklist, that list of questions that needs to be asked every time someone discloses domestic abuse. It reads: “Do you believe that there are risks facing the children in the family? If yes, please confirm if you have made a referral to safeguard the children?” Let’s make sure we never overlook this one.

Finally I would like to acknowledge the extraordinary work done by specialist DV practitioners, IDVAs and their MARAC partners every day – working to prevent tragedies like this. The tragedy avoided does not create headlines but it does save lives.

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March 23, 2013

Farewell to Beryl

It was both a pleasure and a sadness to go to Beryl Foster’s retirement party this week.  A pleasure because it was a great reminder of just what a special person she is – leading the charity Standing Together Against Domestic Violence for many years, staying resolutely positive in the face of relentless challenges, and being a quiet and long suffering mentor to many newcomers to the world of DV (including me).  The air was thick with compliments to Beryl – all of them sincerely meant.  She epitomises integrity, wisdom and kindness – mention was made of a steely gaze at times but I think that this is just imagined!  Certainly CAADA probably wouldn’t exist if it hadn’t been for her encouragement and support to me personally and to the organisation in the early days.

But there was sadness too.  People like Beryl are pretty special and her approach (‘praise people a lot’ and ‘keep listening to women’) is not found very frequently. Her vision in the early days regarding specialist courts, support for women and children, partnership work and embedding good practice were so sensible but equally very brave at the time.  So, this blog is just to say a huge ‘thank you’ to Beryl, to acknowledge her contribution nationally and to make a resolution to try not to forget her wise advice.