Domestic violence and abuse

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Domestic violence and abuse

• SDVC (special domestic violence court)
• Domestic violence and abuse

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• 14 of all reported crime is domestic abuse

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• On average 2 women are killed by a male partner
  or former partner every week

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• It is estimated that 1 in 4 women between 16
  59y have experienced DVA since the age of 16

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• It is estimated that 17 men between
• 16 59 years old have experienced DVA since the
  age of 16

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• Repeat victimisation accounts for 66 of domestic
  violence incidents

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• In 77 incidents of domestic violence women were
  the victim

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• Between June 2008 and July 2009,
• 29,702 cases were discussed at MARAC meetings in
  the UK

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• The 29,702 cases reviewed at the MARAC involved
  40,974 children

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• Every 60 seconds the police receive a report of
  domestic violence

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• At least 750,000 children a year witness domestic
  violence

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• There are 294 womens refuges in England
• There are 6 mens refuges

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• There are no voluntary perpetrator programmes in
  Northumberland

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• There are 5 IDVAs (independent domestic violence
  advisors) in Northumberland.
• The IDVA service received approximately 803
  referrals in 2009
• There are 4 IDVAs in North Tyneside

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• There is one dedicated domestic violence
  childrens worker in Northumberland
• North Tyneside have a Childrens Service and a
  new Childrens IDVA

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• 54 of UK rapes are committed by a womans
  current or former partner

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Working together

• Dr Riaan Swanepoel Named GP Northumberland/ N
  Tyneside
• Lesley Pyle Domestic Abuse Coordinator North
  Tyneside
• Morris Winning
• Policy/Coordinator OfficerDomestic abuse and
  sexual violence
• Northumberland

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Working together
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GROUND RULES

• Value Each Others Contribution
• Constructive Feedback
• Support for Each Other
• Confidentiality
• Please ask Questions

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What is safeguarding?

• Definition
• arrangements to take all reasonable measures to
  ensure that risks of harm to childrens welfare
  are minimized
• 2 components
• protecting children from maltreatment
• preventing impairment of childrens health or
  development

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What is child protection?

• Term used to refer to the activity taken to
  protect children who are suffering or are at
  risk of suffering significant harm

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Definition of Domestic Abuse

• any incident of threatening behaviour, violence
  or abuse (psychological, physical, sexual,
  financial or emotional) between partners who are
  or have been intimate partners or family members,
  regardless of gender or sexuality
• Home Office 2005

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Definition of Domestic Abuse

• Domestic violence is physical, sexual,
  psychological or financial violence that takes
  place within an intimate or family type
  relationship and that forms a pattern of coercive
  and controlling behaviour. This can include
  forced marriageDomestic Violence may include a
  range of abusive behaviours, not all of which are
  in themselves inherently violent
• Womens Aid 2007

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Definition of Domestic Abuse

• Domestic violence is the abuse of one partner
  within an intimate or family relationship. It is
  the repeated random and habitual use of
  intimidation to control a partner
• Refuge 2008

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Definition of Domestic Abuse

• Any incident of threatening behaviour, violence
  or abuse (psychological, physical, sexual,
  financial or emotional) between adults who are or
  who have been intimate partners or family
  members, regardless of gender or sexuality.
  (Family members are defined as mother, father,
  son, daughter, brother, sister and grandparents,
  whether directly related, in-laws or step
  family.)
• This definition includes offences arising from
  Forced Marriage, female genital mutilation and
  honour based violence with victims of any age.
• North Tyneside Domestic Abuse Partnership

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Children Act 1989/ 2004
Paramount - the childs welfare is the
paramount. Their racial, cultural, religious
linguistic needs should be considered Parental
responsibility - defined as the duty of parents
to care for their child physically, emotionally
and morally. Explore the impact of abuse to
sustain this. Partnership - professionals and
families are to work together for the welfare of
children. Process of MARAC is now
used Participation - The wishes and feelings of
the child should be taken into consideration.
Acknowledging DV is not recognised by police
unless gt 18.
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Victoria Climbié

• Died on the 25th February 2000
• Aged 8 years 3 months

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Victoria Climbié (the facts)

• Victorias body had 128 separate injuries
• She was beaten with a range of sharp and blunt
  implements
• The food would be cold and would be given to her
  on a piece of plastic while she was tied up in
  the bath. She would eat it like a dog, pushing
  her face to the plate. Except, of course that a
  dog is not usually tied up in a plastic bag full
  of its excrement. To say that Kouao and Manning
  treated Victoria like a dog would be wholly
  unfair she was treated far worse than a dog.
• 
  

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Victoria Climbié(the problem)

• She was known to
• 3 Housing Authorities
• 4 Social Services departments
• 2 police child protection teams
• Specialist NSPCC centre
• 2 hospitals
• Faith Church
• Childminder

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Laming Report

• Child Protection a low priority
• Lack of accountability right through the
  organisations to the most senior level
• Repeated failures of basic professional practice
  (regular awareness training and keeping up to
  date with changes in support systems)
• Too much, and outdated local practice
• Staff inadequately trained in child protection
• Problems in the way information was exchanged and
  understood.

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Every Child Matters and
children act 2004 Five Outcomes
Be healthy
Stay safe
Enjoy and achieve
Make a positive contribution
Achieve economic well being
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Baby Peter
Baby Peter Died 2007 Aged 17 months
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Baby Peter

• June 2007 - a social worker observed marks on
  baby Peter suggests the probability of
  non-accidental injury
• August 2007 - mother of baby Peter called LAS and
  he was pronounced dead at hospital
• Cause of death fracture / dislocation of the
  spine. In addition he had numerous serious
  injuries including eight fractured ribs

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Baby Peter

• He was seen
• 60 times in 8 months (average of twice weekly) by
  professionals
• 18 times by children services staff
• (announced and unannounced)
• 37 times by health staff including 3
• home visits
• 5 times at home by Family Welfare Association

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Baby Peter (the problem)

• Mother always co-operative and open
• No re-assessments (safety planning?)
• At the time of his death, baby Peter was the
  subject of a multi-agency child protection plan
• Seen 8x by health professionals in last month
  missed signs
• No-one knew about other people in the house
  (MARAC may have enabled agencies to work to
  target information needed).
• Individuals providing extra support were
  unsuitable (training is essential)

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Why are we here?
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Why are we here?

• We are here to kind of float through and enjoy
  the trip, and have as much "fun" as possible
  (a.k.a. "The Universe As Our Personal Disneyland)

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Why are we here?

• Recommendation 87
• All GPs should receive training in child
  protection
• Recommendation 88
• Training should also be considered for all
  general practice staff
• Recommendation 89
• All GPs should maintain procedures to ensure
  that they and their practice staff are aware of
  whom to contact in the event of child protection
  concerns

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Why is the PHCT well placed to safeguard
children?

• Knowledge of families
• Access to complete medical record
• First point of contact for most health needs in
  children (and can examine)
• Only professionals seeing a pre-school child
• However, you may not know information regarding
  the criminal / violent history of family members

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Case 1
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Types of abuse

• emotional abuse
• neglect
• sexual abuse
• physical abuse

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Bruising

• Treatment delay
• History inconsistent,
• vague, not compatible or no history
• Past history of unexplained injuries
• See in context of social history, development,
  full clinical examination

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What do you do next ?

• Do full examination of
• the child
• Document and log
• Be open and honest
• CSC referral
• Record discussions, decisions and actions
• Confirm referral in writing within 48hours

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Processes for safeguarding children
When there is a likelihood of continuing
significant harm
s47 enquiries core assessment
child protection conference
recognition and referral
initial assessment
child protection plan
strategy discussion
review
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Assessment Framework
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Bruising

• Bruises are the commonest sign of physical abuse
  in children
• Those who dont cruise rarely bruise!
• Things to avoid
• Do not do nothing
• Do not admit without discussion

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Case 2 domestic violence
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Facts and Figures for DV

• 1 in 4 women and 1 in 6 men are experiencing, or
  have experienced DA
• DA claims the lives of 2 women per week
• 16 of all violent incidents were DA
• 1/3rd of all abuse occurs post separation

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Facts and Figures for DV

• On average nationally the police receive 1 report
  of DA every minute
• 1/3rd of of abuse starts or escalates in
  pregnancy
• DA has more repeat victims than any other crime
• In over 90 of DA incidents children are either
  in the same room or the room next door

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• In relationships where there is domestic abuse,
  children witness about ¾ of the abusive incidents
• Children will experience domestic abuse in many
  ways seeing it, hearing it, becoming involved in
  it, seeing its aftermath, sensing it

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• Children can experience significant harm through
  seeing or hearing the abuse of others (Working
  Together to Safeguard Children 2006)
• Children are also at risk of direct violence and
  physical harm strong link between child
  physical abuse and domestic violence

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Power and Control Wheel
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Power Control

• He was always watching me. He controlled where
  I went, who I was with, and what I wore. I had to
  be covered from head to toe, and if I wore a
  v-neck top he would insist that I got fing
  changed before going to work. We had sex when he
  said. If a meal was late, he would be verbally
  abusive and would say he didnt want it or
  sometimes he would throw the food at me. He
  demanded to know what I bought and wanted to
  check receipts to make sure I had not spent money
  on anything else. He didnt like me talking to my
  friends when they came around you could cut the
  air with a knife, so they stopped coming around.
  If I spoke to a man, it was even worse he
  wanted to know who I was slagging around with.
  It was like walking on eggshells having to be so
  wary.
• (Quote from a mother whoses child was killed by
  abusive partner as a result of contact Twenty
  Nine Child Homicides Womens Aid 2004

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What does MARAC mean?

• Multi
• Agency
• Risk
• Assessment
• Conference

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What is a MARAC?

• A MARAC is a meeting, that brings together
  members and information from a number of
  agencies. Individual cases are discussed and
  actions are agreed for the provision of
  appropriate services to support the victim any
  children and also to deal effectively with the
  perpetrator.

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Aims of a MARAC

• To share information to increase the safety,
  health and well being of victims adults and
  their children
• To determine whether the perpetrator poses a
  significant risk to any particular individual or
  to the general community
• To construct jointly and implement a risk
  management plan that provides professional
  support to all those at risk and that reduces the
  risk of harm
• To reduce repeat victimisation
• To improve agency accountability
• Improve support for staff involved in high risk
  DA cases
• To identify those situations that indicate a need
  for the LSCB CP procedures to be initiated

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MARAC

• MARACs are recognised nationally as best practice
  for addressing cases of DA that are categorised
  as High Risk
• In a single meeting a MARAC combines up to date
  risk information with a comprehensive assessment
  of a victims needs and links those directly to
  the provision of appropriate services for all
  those involved in a DA case victim, children and
  perpetrator.
• By using the knowledge and expertise of different
  agencies the identified risks will be either
  reduced or managed in the most appropriate and
  effective way.

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Case 3
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Why share concerns?

• Information sharing is essential to enable early
  intervention and preventative work, for
  safeguarding and promoting welfare and for wider
  public protection
• In SCR and death reviews inadequate information
  sharing has frequently been cited as a major
  contributing factor the Achilles heel of
  effective safeguarding

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7 Golden RulesInformation Sharing
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Pocket Guide Seven Rules

• Data Protection Act is a framework not a barrier
• Open and honest about why, what, how, with whom
  and seek agreement
• Seek advice if in doubt
• Necessary proportionate relevant accurate
  timely secure
• Record your decision with reasons
• Share with consent but without if public interest
  overrides
• Consider safety and well-being of all involved

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GMC 0-18 years (guidance for all doctors)

• First concern must be the safety of children and
  young people
• Children, young people and parents/ carers may
  not want information shared but doctor should not
  delay if delay involves risk
• Threshold to share set quite low as long as
  limited and shared with honesty, promptly, on the
  basis of reasonable belief and through
  appropriate channels
• niggling concerns

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Sharing without consent

• Seven Golden Rules apply
• Consent if you can
• Only share minimum on a need to know basis
• Assure yourself and document it that level of
  concern warrants disclosure without consent

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MARAC Information Sharing

• The consent of a victim should be requested, but
  it does not prevent information being shared if
  they refuse.
• There are more reasons to share information than
  there are not to!

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Summary

• In general seek consent
• It is essential for child safeguarding
• Disclosing without consent is OK if first concern
  is for safety of the child and you can justify it
• Document all information sharing with or
  without consent
• If you are asked for information by another
  agency ask if consent obtained and if not why not

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Case 4 contribution
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Report writing for CPC

• GPs should participate fully in child protection
  procedures
• A good report is a reasonable substitute
• The report should be shown to parents prior to
  the conference
• Information may be sought in line with 3 areas
  set out in assessment framework
• childs development needs
• parenting capacity
• family and environmental factors

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Recording of safeguarding information

• Information needs to be easily entered and easily
  retrieved (codes and templates)
• What to record
• hx of abuse, parental substance misuse and
  mental illness, DV in the household, contact with
  the CSC, social and development hx
• When to record
• at registration, opportunistically

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Domestic Abuse in pregnancy

• Almost a third of domestic abuse begins with
  pregnancy.
• Feedback from pregnant women already in abusive
  relationships is that existing abuse often
  intensifies during pregnancy.
• The abuse has a major impact on the mental and
  physical health of the wider family especially
  other children.

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POSSIBLE SIGNS/ SYMPTOMS OF DOMESTIC ABUSE

• Stress related ailments (headache, irritable
  bowel)
• Frequent gynae problems (STIs, infections)
• Miscarriages, terminations, still births
• Premature labour, low birth weight babies
• Fractures to the foetus
• Forced removal of sutures
• Bruising to body, particularly breasts abdomen
• Injuries to face, head, neck, various stages of
  healing, burns (cigarette, rope)
• Unexplained injuries or inconsistent history

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What Needs To Be Done By The Health Service?

• Improving availability of information on domestic
  abuse and services for those who experience it
• Providing appropriate training for health
  professionals
• Instituting systems of enquiry about domestic
  abuse
• Home Office Development and Practice Report 2004

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ASK ME !
A survivor talks about how she wanted her GP to
ask her directly about the abuse Told him Id
fell..He didnt quiz me about it. I just said I
fell and the look he gave was well I dont think
you have butI remember sitting there and
thinking quiz me, quiz me, ask me, and he never
did.because he didnt, I didnt tell.
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Why Ask?

• It uncovers significant numbers of previously
  hidden cases
• It forms the basis for providing women with
  information about local services
• Many women will not disclose without being asked
• It helps change social attitude to domestic
  violence
• It is less likely to make women feel stigmatised

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Why Ask?

• It gives all women basic information about the
  unacceptability of domestic abuse
• It may highlight issues for a friend, relative,
  neighbour
• It gives a clear message to women experiencing
  domestic abuse that they are not alone

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When Will I Ask?

• When it is safe to do so - not in front of her
  partner, other adults or children (unless
  infants)
• In a private area where no one can over hear the
  conversation

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Examples

• As domestic abuse is so common in the home we now
  ask all women about it routinely
• Do you ever feel frightened of your partner? Do
  you ever feel in danger?
• Have you ever been physically hurt by your
  partner? Has your partner ever threatened to hurt
  you or someone you care about?

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Examples

• Are there any problems with your partner? Do you
  ever argue or fight? Do the fights become
  physical? Are you ever afraid?
• Do you feel controlled and isolated by your
  partner? Does your partner belittle and insult
  you?

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What If She Says Yes?

• Ask if she is safe (at the time of questioning)
• Children, where are they?
• Let the woman know you are concerned
• Tell her you will offer help/information
• Tell her she does not deserve to be abused
• Explain she will not be forced to do anything
• Try to assure privacy

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VALIDATE THE WOMANS FEELINGS LET HER KNOW SHE
IS NOT RESPONSIBLE FOR THE ABUSE
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SCR process

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END