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!