Overcoming barriers to the recognition and response to domestic violence and abuse (DVA) in families with young children: solutions from the frontline

BASPCAN CongressApril 2015

Catherine PowellSafeguarding Children Consultant

Visiting Academic, University of SouthamptonFellow Institute of Health Visiting

BackgroundInstitute of Health Visiting (iHV) was

commissioned by the Department of Health (England) to develop & deliver a two day training package on DVA at 10 sites across the country;

Undertaken in conjunction with an ‘Expert Advisory Group’ including colleagues from Women’s Aid

Overarching aim to support the learning and development of a cohort of expert DVA practitioners to provide local leadership and to cascade the learning to health visitors in their locality.

Content Evidence-based four

module programme structured around the model of HV services

Complementary E-learning package (NELH)

Recognised the unique role of the HV in providing home & community based public health care to all families – pre-birth up to five years of age

Comprehensive pack, training notes etc, USB & CD ‘ready to go’.

Delivery

Participants

11 two-day sessions delivered across the NHS England regions (December 2013-April 2014)

253 participants who became iHV-accredited DVA Experts

Prepared to ‘train on’ & using skills to ‘influence leadership’

Gave permission to share ‘outputs’ from the group activities (and their photographs!)

Positive evaluations

'The evidence was not only research based but practice based too.'

'Networking; refresher; accessible; long awaited for health visiting service which is uniquely placed for early identification of DVA; knowledgeable facilitators.'

‘….makes me feel proud to be a part of the profession.'

'Worth cancelling my annual leave for …’

‘Group work was some of the best I've done in many years’.

‘Overcoming Barriers’ exercise

Opening exercise of Module TwoSmall group work (max. six)Took place in ‘rounds’ with flip

chart passed to next table:

1. Identify possible indicators of DVA that you might come across in practice

2. Identify barriers that prevent identification or a helpful response

3. Suggest how those barriers can be overcome

Groups were highly competitive!

Indicators

House repair (e.g. doors punched in)

Overhear abuseMissed appointmentsVictim looks fearfulConstant textsAvoiding

appointments/questionsPolice reportsMaking excuses not to discuss

A&E attendancesChild disclosesFlinching from partner

Partner always present/answers questions

Checking answers with partnerAnxiety (adult/child)PovertyTruantingGut feelingOver-familiar childDisclosurePhysical injuriesSTD (infections)Pregnancies/miscarriage

Barriers Victim makes

excuses/avoids engagement

Home visiting & respect for privacy

Fear for personal safety/reprisal

Denial Chaotic lifestyle Assumptions (practitioner)

of normality Time/workload pressures

Fear factor (not having a reason to visit)

Awkwardness in bringing it up

Fear of dealing with the consequences of making contact & asking the question

Partner/Perpetrator present Lack of training/resources Culture Language barriers

Overcoming barriers Recourse to public funds Cultural challenge/travellers Staff supervision Advertising - zero tolerance Reflection/staff attitudes Staff safety, lone working

policies Improved interpreter services Understanding CAADA DASH

tool/MARAC referrals Strengthening links with drug

and alcohol services Reason for perpetrator to be

away from victim (e.g. EPDS score)

More professional & inter-agency training

Improve relationships with multi-agency colleagues

DVA pathway

Clear policy Designated professionals Sharing of information

supported by policy and guidelines

Provision of supporting information/numbers - insert in PHR

Routine questioning Training improvements for

police/legal systems One stop shops for DVA Strategic decision making with

DVA at the forefront Preventative work in schools More DVA services in

appropriate locations Organisations such as

Women's Aid Influencing commissioners.

Solutions from the frontline .. ‘Holistic and layered’

Challenge and inform practice at an individual, organisational and strategic level

Of wider interest outside of the HV profession

Demonstrates practice knowledge and experiences: informs commissioning intentions

Motivational for the practitioners taking part.

Concluding comments DVA is increasingly recognised as a global public health issue

that impacts on the health and well-being of children, families and communities;

Health visitors are well-placed to recognise and respond to

emerging concerns of DVA within families with young children and to offer timely help and support to those affected; including sign-posting or referral on to specialist services;

This simple training exercise provided an opportunity both to celebrate the knowledge and understanding of practitioners in identifying potential DVA and to generate solutions to overcoming the barriers in practice that may prevent a timely response to concerns.

Acknowledgements

DH/Institute of Health Visiting Women’s Aid Expert Advisory Group The HV who participated in the programme & taught me

so much.

Thank you for listening!

catherine.powell@soton.ac.uk