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ASK & ACT Group 2 Full Day Version

TRAINER NOTES

WELSH GOVERNMENT INTRODUCTION TO ASK AND ACT:

“Ask and Act” is a Welsh Government policy of targeted enquiry, to be practiced across Local Authorities, Local Health Boards, Fire and Rescue Authorities and NHS Trusts, to identify violence against women, domestic abuse and sexual violence. The term targeted enquiry describes the recognition of indicators of violence against women, domestic abuse and sexual violence as a prompt for a professional to ask their client whether they have been affected by any of these issues. The National Institute of Health and Care Excellence (NICE) and the World Health Organisation recommend a system of targeted clinical enquiry across Health and Social Care to better identify and therefore respond to domestic abuse.1 2 The Welsh Government takes this recommendation and identified good practice further by supporting the use of such enquiry across the Public Service (to include those in a safeguarding role, education, Fire and Rescue and those within housing services). It also proposes a slightly wider focus on violence against women, domestic abuse and sexual violence. It is the role of the entire Public Service to provide an effective response to those experiencing violence against women, domestic abuse and sexual violence.

This involves collaboration in its broadest sense to create consistency and standardisation of response, no matter which gateway (housing, health, social care

etc.) a client uses to access service provision.

1 Responding to Intimate partner violence and sexual violence against women. World Health Organisation clinical and policy guidelines (2013)

2 Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively. NICE public health guidance 50 (February

2014)

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The aims of “Ask and Act”

to increase identification of those experiencing violence against women, domestic abuse and sexual violence;

to offer referrals and interventions for those identified which provide specialist support based on the risk and need of the client;

to begin to create a culture across the Public Service where addressing violence against women, domestic abuse and sexual violence is an accepted area of business and where disclosure is expected supported, accepted and facilitated;

to improve the response to those who experience violence against women, domestic abuse and sexual violence with other complex needs such as substance misuse and mental health; and

to pro-actively engage with those who are vulnerable and hidden, at the earliest opportunity, rather than only reactively engaging with those who are in crisis or at imminent risk of serious harm.

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Health warning

It is statistically likely that you will have at least one victim / survivor amongst the delegates and as the trainer, the onus is on you to ensure that the training

session is not re-traumatising for them. This means challenging offensive remarks about victims / survivors and taking steps to minimise them being viewed as

‘out there’ rather than in the room with you.

The odds are also high that there will be at least one perpetrator. Similarly, any excusing remarks should be challenged since without this, your training could

end up being used by the abuser as justification for their behaviour.

Violence against women, domestic abuse and sexual violence is a subject that arouses strong feelings – whether or not this is as a consequence of direct

personal experience. Most people want to strongly disassociate themselves from both victims and perpetrators and are heavily invested in distinguishing their

own ‘normal’ relationships from abusive ones; indeed this is the source of many of the prevalent myths and stereotypes.

As the trainer, you have a responsibility to educate yourself about the dynamics of violence against women, domestic abuse and sexual violence and to make

sure during the delivery of this training package that you focus not only on the content of what you provide, but also monitor the dynamics and well-being of

the delegates.

Language

Throughout this training pack, victims/survivors of domestic violence are referred to as female and perpetrators as male. This is to reflect the overwhelming

majority of domestic violence incidents as well as those who use existing services. For example, the most recent Crime Survey of England and Wales found

that in the year prior to interview, there were an estimated 786,000 male victims (a rise from previous years) and 1.6 million female victims (an increase on

previous years). Moreover, while the commonly cited figures of domestic violence affecting one in four women and one in six men might suggest a degree of

parity, this conceals that 47 per cent of male victims experienced a single incident with a mean average of seven incidents per victim compared with only 28

per cent of female victims experiencing a single incident with a mean average of 20 incidents per victim.

Gender does play a role in violence and abuse. This does not mean all victims are female and all abusers male. What it does mean is that the gender of both

victim and offender influences the behaviours of both. For example, women victims are more likely to be injured, more likely to be frightened, more likely to be

repeatedly abused and more likely to be murdered. Male victims may be less likely to access existing services, often fearing ridicule should they disclose

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abuse at the hands of a woman. Gender also influences the type of abuse. Male perpetrators are far more likely than female abusers to abuse post-

separation. Indeed this is the most common high-risk situation for female victims.

It is sometimes claimed that male violence and abuse victims have no services. This is untrue. Although some refuge projects generally provide services only

to women and their children, almost all other services are available to both genders. Additionally, it should be noted that capacity limitations mean that not all

women seeking refuge accommodation can find an available space. All other housing options are available irrespective of gender. Since, with this one

exception, very few domestic violence services are gender or sexuality specific, it is inaccurate to claim this means there are no services for male victims.

Nevertheless, violence and abuse can and does occur in same sex relationships and in some instances, by women against men. Male victims do not have to

be numerically equal to female victims to deserve our sympathy and support and with the exception of referrals to refuges, should be treated in exactly the

same way as female victims. In this pack, where female victims are specified, this is because it is referencing evidence on female victims and should not be

made gender neutral. Far from being inclusive, this actually renders male victims less visible by assuming that their experiences are identical to those of

women when what evidence we have suggests that this is rarely true.

Knowledge check:

You shouldn’t need to do the knowledge check because participants should bring copies of their certificates to the session to demonstrate that they did the e-

learning!

Learner Outcomes:

1. Be able to deliver Violence Against Women, Domestic Abuse and Sexual Violence (VAWDASV) – Ask and Act training

Checklist:

1. Certificates from e-learning;

2. Any comments/reflections or feedback from the e-learning?

3. Any specific learner needs?

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Be aware of:

Unconscious bias and subtle discrimination - particularly in terms of class and poverty and challenge it. In training on violence against women,

domestic abuse and sexual violence we are challenging deep seated and entrenched views at a personal and institutional level. As a result many

participants may express views that reveal unconscious bias, subtle racism or misogyny and it is our role as trainers to challenge those viewpoints. For

example, in discussing forced marriage or FGM we must be cautious as trainers that we are not othering particular communities and making it a ‘them’

and ‘us’ conversation. VAWDASV is rooted in gender inequality and gender social norms and these must be challenged in a safe and empowering way

to ensure that we can effectively integrate Ask and Act at an institutional level and transform the way we address VAWDASV.

Highlight the gendered nature of VAWDASV and it is important to ensure that our response is gender responsive rather than gender neutral.

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Day One (Full day version of A&A2)

ACTIVITY: Notes:

Slide 1 to 4 Welcome, hsekping, Intros, Health warning

Refer your learners to Handout: “Myths & Realities Questionnaire” and ask delegates to complete as they are waiting to begin.

Slide 2 5m

Housekeeping “Taking care of yourself and others” – Explain that this is an emotive subject and people respond differently, and therefore are encouraged to deal with any emotions the way they think is best for themselves. This can be staying in the room, standing up for a little while, going out of the room for fresh air, etc. If anyone feels they can’t come back in the room if they could let trainer or fellow learner know so that one of the trainers can speak to them briefly to make sure they are OK.

Slide 3 5m

Give health warning that the material might stir up strong emotions and what to do if upset. Mention that a representative from a specialist agency or Welsh Women’s Aid is present or available (Handout “Local Specialist Contact Details”). Provide details about the IDVA or VAWDASV lead or Group 3 Champion “Confidentiality & Respect” – invite learners to contribute any anecdotes they have from previous experiences in order to enrich today’s learning plus they must be de-personalised, i.e., no names or addresses, etc. Some learners may find aspects challenging to their current understanding. Encourage learners to ask questions but that they must do so respectfully. “Agreement” - silence is seen as agreement, it is important that learners speak up if they feel something is not correct or they disagree with.

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Slide 4 15m

Introduce self (1 min) and ask each delegate to introduce themselves by name and job title. Ask them to keep it quick (i.e. 15 seconds each) so as to keep to timetable. Ask each participant to answer two questions:

1. What do you bring to the session? (In terms of skills, experience, knowledge etc.)

2. What would you like to take away? Gather up the sticky notes and put them on flipchart paper to refer back to at the end of the session.

VAWDASV Act – what is it about? Brief overview. Slide 5

5m

Brief overview of the Act – emphasise the three pillars – PREVENTION, PROTECTION and SUPPORT.

Slide 6 5m

1. Mention that this training is part of group 2. It is compulsory for everyone to complete the group 1 e-learning or any equivalent local training on offer. Check that everyone completed the e-learning or local training and ask the following:

2. Any feedback from the e-learning (in terms of content)? 3. Any gaps that requires clarification?

Slide 7 5m

What are these sessions about? These are the learner outcomes presented as objectives for the session (they will have received this information in an email).

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Language, terms & definitions Slide 8

10m

These are terms commonly used. Within survivor groups and some specialist sectors we refer to men, women and children so as not to “other” those who have, or are, experiencing abuse

Slide 9 5m

Refer your learners to Handouts: “WAG Definitions of VAWDASV” and “Who does it happen to?” which includes WG, Home Office and international definitions. Home Office definition: The cross-government definition of domestic violence and abuse is: any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. Mention new coercive control legislation that demonstrates the significance of emotional/psychological abuse.

Slide 10 5m

Emphasise that these sessions will build on all the experiences that professionals already have and we hope the sessions will be an opportunity to share experiences. Ask and Act builds on what we already know. Within public services this improved culture extends to those working within the sector

not just those we support.

Targeted Enquiry Slide 11

15m

Targeted enquiry – good opportunity to discuss the distinction between routine enquiry and targeted enquiry. Group exercise: For slide 11, give learners 10 minutes in small groups to have a discussion about what they think Targeted Enquiry is, and what they think the benefits are in comparison to routine enquiry.

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Slide 12 5m

Plenary discussion.

Slide 13

5m

Prevalence – Refer your learners to Handout: “Statistics” See Prompt Sheet “Prevalence”

What is VAWDASV? Duluth Power & Control Wheel Slides 14

5m

See Prompt Sheet “Duluth Model” 1st Wheel is the original, which assumes heterosexual intimate relationship male to female violence

Slide 15

2ndWheel, example of same sex intimate relationship

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Slide 16 10m

See Prompt Sheet “Entrapment Process” Emphasise that this is not a linear process and many survivors talk about the complex experience of violence. In Ask and Act interviews a number of survivors talk about ‘not being sure when or how it started’. This is not a one size fits all model, but it is a useful way to understand the experience of coercive control, whether from an intimate partner or family members.

Slide 17 5m

Important to mention that coercive control is mainly in terms of domestic abuse, however, as the power and control wheels that we just looked at demonstrated, controlling and coercive behaviour can be displayed by family members, social norms and expectations. The clip from Evan Stark pre-dates the legislation in the UK, however, it is useful in terms of his use of language. Ask the participants what they think about the terms he uses to describe the experience of coercive control.

Slide 18 5m

The legislation on coercive and controlling behaviour, Section 76 of the Serious Crimes Act, came into force in December 2015. It is important for professionals to understand coercive control and the impact in order to more effectively support clients/patients/service users with whom they work and engage with.

Slide 19 5m

See Prompt Sheet: “Liz Kelly’s six stages of leaving.” Important to highlight that this is applicable in different situations. For example, it can be

applied to grooming for sexual exploitation

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Slide 20 20m

See Prompt Sheet: “Myths & Realities Trainer’s sheet” Group Exercise:

1. Divide the participants into groups (ideally no more than four participants per group);

2. Allocate each group at least three statements each; 3. Ask them to discuss if the statements are true or false.

20 mins Plenary feedback and discussion

Slide 21 15m

Group exercise: Learners into groups to answer two questions. Give them 10 mins to answer both questions. Ask for feedback from each of the groups. See Prompt Sheet: “Barriers” for possible responses During the feedback session highlight what might make it more difficult to disclose some

forms of VAWDASV.

Add to trainers’ notes a list of possible responses

Slide 22 2m

This is not the totality of what survivors want but this is to emphasise that time and again survivors tell us that they are as concerned with how a service is delivered as they are with what is delivered. Unsurprisingly, survivors tell us that they want a response that sees them as a person with a problem – not as the problem. This means being responsive to her uncertainty and shame about disclosing and taking a pro-active approach – creating an environment that encourages disclosure, making active enquiries and then supporting her through the maze of different organisational responses that may need to be involved. General guidelines for addressing diversity: • Be aware that perpetrators will exploit different characteristics or experiences the survivor has. For example, if the survivor has limited mobility due to having a physical disability, the perpetrator may remove mobility devices that enable independence.

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• Remember that a survivor’s ethnicity, culture, gender, age, sexual orientation, ability and/or class may affect how and when she seeks help and the type of support she needs. • Everyone is a unique and multifaceted individual. Whilst one person’s sexuality or ethnicity, for example, is an integral part of how they see themselves and live their life, it may not be the same for the next person. Do not make assumptions about what might be important or relevant to a survivor. (Adapted from AVA Project’s Complicated Matters Toolkit

Creating safe space to disclose:

Slide 23

10m

PLENARY DISCUSSION: Show slide and ask delegates to call out ways in which they

might encourage disclosure / what people do now to encourage disclosure.

Three points to emphasise:

1. Do not demand a disclosure; 2. Do not feel disappointed/frustrated if you don’t get a disclosure; 3. Be prepared for a disclosure – come prepared and with all the relevant

numbers/contact details/let a colleague know that you’ll be some time etc.

Slide 24 10m

Show just the title first. Plenary discussion: On flipchart paper with whole class, write responses to the question – “how do you build rapport at the moment with your clients?” After getting responses then you can show the rest of the slide. Disclosures: 1. do not demand; 2. do not expect; 3. do not be disappointed

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Slide 25 10m

DEPENDING ON TIME either choose Group or plenary exercise: 1. Put people in groups to list relevant indicators; OR 2. Ask delegates to quickly call out some of the indicators that abuse may be

occurring, particularly in their experience

Remember to cover those of specific relevance to the professions being taught (e.g. it’s no use asking staff who see clients on a one-off basis to notice changes in demeanour).

Slide 26 5m

For the purposes of this training the term indicators is used to encompass four triggers for enquiry with clients about their experience of violence against women, domestic abuse and sexual violence; signs, symptoms, cues and settings. Whilst clients will manage their experience of VAWDASV differently, these are commonly recognisable indicators of the issue which professionals should be aware of and which should prompt further enquiry. These indicators could reflect a range of issues and also prompt safeguarding concerns for children or adults at risk. As such, acknowledgment and exploration of them should already be an integral part of good practice.

Slide 27 & 28 10m

No matter the other characteristics of the client, where one of the four indicators is observed, this is an indicator of the potential experience of violence against women, domestic abuse and sexual violence and the professional should follow the continued stages of the process of “Ask and Act” as outlined below. Remind delegates that these are only indicators – not certainties so it is important to introduce the question properly. Mention that these questions would not be used in isolation and may be part of a conversation. You might need to consider the most appropriate question at that time.

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Signs, symptoms, cues, indicators & settings: Slide 29 to 33

10m

This list is also not exhaustive and many of them might apply mainly to healthcare practitioners, however, it is useful and important for all professionals to be aware of possible symptoms that should trigger an enquiry.

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NB: Vaginal Bleeding pointing to FGM but also could be Sexual Violence, and

could therefor include Genital Bleeding as a whole to be inclusive of boys

Slide 34 10m

Small group exercise: In table groups, pick one specific type of VAWDASV and discuss what cues might be observed by a professional

Slide 35 2m

This list is not exhaustive, for example, some early adopter sites

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How to respond to a disclosure: Slide 36

5m

Show the Dr Gene Ask & Act short video clip (make a note on flipchart paper of the four questions to ask).

Slide 37 10m

DEPENDING ON TIME: Group or plenary exercise: 1. You could just use this as an introductory slide OR 2. You could put them into groups to discuss and share questions that they have

used in the past to elicit responses about sensitive topics. Emphasise the following:

You are choosing questions based on the relationship that you have with your client already;

The questions on the handout are gender neutral so could be used with anyone;

These questions are ‘follow-up’ questions rather than opening questions;

There is no script so you can also ask advice of colleagues and your Group 3 champion.

Handout Sample Questions. It is generally best practice to “ask” in a conversational style which is why this training focusses on this method. However, questioning techniques should be adapted to best suit the needs of the professional setting and client group. In some work areas it may be preferential to utilise a screening tool due to time and capacity pressures within this area.

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Slide 38 5m

Emphasise:

For many survivors, just having someone listen to them is all they need. This can be reassuring for professionals who may not feel they are in a position to offer high quality, specialist interventions that perfectly match women's needs. We can all, however, at the very least make a personal and professional commitment to listen to abused women and children and not to deny or minimise their experiences.

It is advisable to give honest, validating responses that are genuine in a phrase or sentence that you feel comfortable using to respond to a disclosure.

Slide 39 2m

This just reinforces the importance of how the service is delivered. The behaviour of the practitioner is critical to building rapport and trust.

Risk: Slides 40 to 42

15m

Risk identification Refer your learners to HANDOUT “DA Risk Indicators”, “SV Risk Factors”, “Rape Trauma Syndrome”, MARAC” and “Safe Lives RIC” Risk identification is not a compulsory part of the “Ask and Act” process. However, it might be a step that organisations choose to include if they believe it would work well for their client group. This training will discuss risk identification as a concept but does not offer full training on how risk identification, assessment and subsequent action planning should be undertaken. Training on this may be available in your local area if you would like to access this in the future. Risk identification is generally a process best undertaken by a specialist in violence against women, domestic abuse and sexual violence. An organisational approach which refers clients to specialist services for risk identification is an acceptable method

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of providing this service to the client. (Refer to the local care pathway) However, even if a formal process of risk identification is not taken forward organisationally, it will still be necessary for every professional who practices “Ask and Act” to have a broad understanding of what risk means in this context and consider whether the person who has made a disclosure to them is in immediate danger and what needs to happen to offer them protection. Discuss with the group how it might be obvious that someone is in immediate danger? Illicit responses such as: They phone your office during an incident They flee to your office immediately following an incident An incident happens in your presence The client has obvious injuries In cases such as these, it is unlikely that there will be a need to “ask” following the identification of indicators. In such cases it is more important to address the client’s immediate needs. It will not always be obvious that someone is in immediate danger or has needs that must be addressed urgently. In order to understand whether the client is in immediate danger you may wish to consider the following questions:

Where is the perpetrator now?

Is it safe for you to return home?

Are you worried about returning home?

Are you worried about what will happen when you leave here today?

Are you injured?

Where are your children, are they injured?

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If a client is in immediate danger you should phone 999 for police or ambulance services. Either:

1. Ask if participants have had experience with DASH – would anyone be willing to share?

2. If no one has seen the DASH then recommend taking some time to look through it

3. Emphasise that the DASH is quite domestic abuse focused although there is reference to sexual violence, stalking, harassment and honour based abuse

You will not be expected to do a DASH with a client after this session so please seek additional advice and support.

Slide 43 2m

See Prompt sheet “VAWDASV services”

Data & information handling: Slide 44

5m

Explain that these are the legislation that deals with data gathering, processing, storing and sharing. Explain that each one of the learners needs to make themselves familiar with their own organisation’s policy and procedures relating to data. See Prompt Sheet “GDPR”

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Local & Wales wide specialist support services Slide 45

15m

Refer back to the Local Specialist Service available handout. The latter will be locally developed handouts (see Gwent as an example). This is an opportunity for the specialist trainer to highlight local services available. To mention the Refuges Online service etc.

Slide 46 10m

Give out copies of the local referral pathway. Explain the aspects of the local referral pathway. Highlight issues such as:

1. Is the person safe or in imminent danger? 2. What were the indicators that prompted you to ask? 3. How do we understand contact between parties (bearing in mind the recent

findings about the increased use of social media for harassment etc.)

Ask & Act Skills Practice Slide 47 & 48

30m

Whole class exercise: With 2 trainers, or if there is only one, then ask one of the learners to volunteer. Explain to the learners that they will be calling out suggestions to the “Service Provider” of good questions, comments, signposting, etc.

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Slide 49 5m

Slide 50 5m

Survivors tell us that they would only disclose to a professional that they felt confident would be able to act or offer some help. Always be prepared for a disclosure, but never demand a disclosure. Remember you are not the only professionals making a targeted enquiry - Ask and Act is creating more space for action - for survivors to get the help and services that they want based on their needs.

Slide 51 5m

Thank and close