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Domestic Abuse Summit

News and presentations from todays conference chaired by Christopher Fincken Independent Member UK Caldicott Guardian Council

Keynote Opening Address - Supporting victims of domestic violence
Penny East Head of Communications SafeLives

In her presentation Penny stated:

‘85% of victims of domestic abuse seek help five times on average before they get effective support.’

‘Four out of five victims of domestic abuse do not call the police.’

‘We need to understand the whole picture for an individual and family, to give an effective response’

‘Professionals and agencies need to share information and work together to see the whole picture for individuals and families.’

‘Fewer than 1% of perpetrators receive any specialist intervention to change or be challenged.’

‘Domestic abuse costs the NHS £1.73 billion. That’s nearly 70,000 nurses.’

‘The estimated total cost of domestic abuse is £5.5 billion a year. ‘

‘Nearly 40% of children in households where domestic abuse was taking place were not known to children’s services.’

A primary care response to domestic abuse from research to mainstream: the IRIS story
Gene Feder OBE Professor of Primary Care University of Bristol Board member IRISi Chief Investigator  PROVIDE & REPROVIDE Chair NICE Domestic violence and abuse programme development group Chair Intercollegiate & Agency National Domestic Violence & Abuse 

In his presentation Professor Feder discussed:

• core components of the IRIS model

• sustainability and spread in primary care

• the role of evidence in a harsh (de-)commissioning environment

• relevance and applicability to other health care settings

Gene commented ‘Domestic violence is a violation of human rights and a society-wide challenge, particularly to the education and criminal justice system.’

Full powerpoint presentation

Early identification and prevention of domestic abuse 
Donna Covey CBE Director AVA – Against Violence and Abuse
Pre-event abstract
This presentation focusses particularly on the role of health and social care services in supporting victims of domestic violence and abuse. It begins by emphasising the fluid nature of risk, and the importance of not measuring risk at a single point in time. It talks about the help seeking model, and the importance of understanding that women’s perception of risk, and willingness to disclose domestic violence and abuse, will depend on where they are in this process. The single biggest indicator of risk is whether the woman feels frightened by her partner’s behaviour. 
As set out in the NICE guidance, health and social care professionals have a vital role to play in identifying, and supporting victims of, domestic violence and abuse. It is, therefore, important to understand the barriers both to survivors disclosing their abuse, and to professionals asking about abuse. Research (Rose et al, BJP 2011) shows that the main barriers to enquiry by mental health professionals, e.g. are lack of knowledge and expertise in the area, and thinking that it was not part of their role.  These findings are particularly relevant a 69% of women with serious mental health issues have experienced DV in their lifetime(Khalifeh et al 2014) , and people with extensive experience of violence and abuse are five times more likely to experience a common mental disorder than those with little or no abuse (UK Psychiatric Morbidity Survey 2007) 
Education and training are, therefore, essential to give professionals the confidence and skills to enquire about domestic violence, respond appropriately to disclosure and understand why it is an important part of their role.  It is also important for the health and social care environment to reinforce the message that it is a safe place to disclose through displaying leaflets etc. 
Public Health England funded AVA to produce e learning aimed at supporting the introduction of the NICE guidelines. This is available free at http://avaproject.org.uk/ava-training/elearning/
The presentation also looks at how IDVAs in health and social care settings can help encourage routine enquiry amongst professionals, and refers to the Themis projects findings on Hospital IDVAs (Safe Lives June 2013) 
The presentation also emphasises the importance of combining professional judgement with risk assessment tools. 
The final section of the presentation touches on other forma of violence against women and girls, including forced marriage and so called Honour based violence, highlighting useful resources, including the film “Our Girl” 
https://avaproject.org.uk/resources/?categories=forced-marriage#content-anchor
It makes the point that these, like domestic violence, are all forms of violence against women and girls and that many of the same guidelines about how and when to encourage disclosure apply. 
It ends by reminding delegates that prevention is better than intervention, and refers them to the free resource www.preventionplatform.co.uk 
Full powerpoint presentation

Developing the role of IDVA in hospitals
Emma O’Kane, Safeguarding Adults Nurse Practitioner
Blackpool Teaching Hospitals NHS Foundation Trust
Emma O’Kane is an Adult Safeguarding Practitioner at Blackpool Teaching Hospitals NHS Foundation Trust. 
Emma was an Accident & Emergency Nurse for ten years, prior to taking up posts in general practice and unscheduled care. 
Emma’s passion for safeguarding adults and children led to her current role where she has championed the adult safeguarding agenda and been instrumental in developing the role of the Health IDVA
Pre-event abstract
The number of domestic abuse cases throughout the UK is increasing along with the growing population. Currently an estimated 1.9 million people suffer some form of domestic abuse each year, the vast majority of victims are yet to be identified and remain unsupported.
With nearly half a million victims having experienced domestic abuse in the past year seeking medical assistance, but only 1 in 5 victims reporting to the police, this clearly identifies a potential opportunity to recognise and respond to domestic abuse effectively within health settings. This highlights an obvious requirement for domestic abuse awareness, knowledge and training to be available to health professionals so that the safeguarding needs of patients can be addressed as a priority alongside their physical or mental health needs. Often a victim may not present with obvious complaints, and indicators of abuse may be initially difficult to recognise, but health professionals are in a position of trust and often have valid reason to engage with their patients, providing a golden opportunity for victims to disclose and seek support safely away from their abuser. 
A recognised lack of knowledge and expertise in domestic abuse across most NHS acute providers has been impacting negatively on the victim’s experience and outcome, the pressured time constraints and financial implications on health services. Simply by introducing and developing a Health IDVA within a hospital can positively influence the amount of referrals, the outcomes for the victims of abuse can be life altering, and it can ultimately prevent hospital re-admissions or future health deterioration as well as huge cost savings to the NHS.
This presentation focuses on the benefits of having an Independent Domestic Violence Advisor available to emergency departments, in patient wards, district services, maternity and mental health services to provide a safe pathway for victims to access advice, support and safety planning tailored to individual needs, wishes and pace. It also empowers health professionals to feel confidant to ask appropriate questions, and respond effectively to disclosures knowing that support is on hand to advise and assist them in safeguarding their patient and hopefully preventing further health implications as a result of abuse.
Through data evidence and reviewing case studies, you will see how early intervention from Health IDVA can be beneficial and often imperative to the ongoing health and wellbeing of patients affected by domestic abuse, and how to develop such a service. You will recognise how Health IDVA and multi-agency working opens up opportunities for signposting victims of domestic abuse to the most appropriate service to support the social needs of patients, whilst enabling health professionals to address their physical and mental health needs.
Safeguarding is everybody’s responsibility and within the health service we cannot ignore this huge risk to our patients. It is widely acknowledged that 2 women in the UK are killed each week and up to 4 women take their own lives each week as a direct result of domestic abuse, and many men and transgender people are known to be suffering also.
Full powerpoint presentation


Recognising, responding and referring victims of domestic abuse who come through the emergency department
Dr Adrian Boyle Consultant Emergency Physician and Caldicott Guardian,
Addenbrookes Hospital in Cambridge, Chair of the Quality Emergency Care Committee, The Royal College of Emergency Medicine
Dr Adrian Boyle is a Consultant Emergency Physician at Addenbrookes Hospital in Cambridge, and Honorary Visiting Senior Research Fellow at Cambridge University. He has a long standing research interest in reducing the harms of intentional injury, obtaining his Doctorate from Cambridge University in 2008. He was a Clinical Guideline Development Group member for the NICE Guideline on Domestic Abuse. He served on the Joint Home Office and Department of Health's committee to implement Information Sharing to Tackle Violence (ISTV) 
Pre-event abstract 
Dr Boyle presented an overview of how domestic abuse victims in hospital differ from those in the community. He described some of the challenges implementing the NICE Guidelines in hospital practice and describes how his hospital has organised its response to domestic abuse. Addenbrookes hospital has a monthly domestic violence meeting, attended by the safeguarding nurses and midwives, the IDVAs, and staff from the Emergency Department and aims to share information about case loads. The work of the domestic violence meeting and training a large diverse workforce can only effectively happen if the pathway for victims is clearly defined and understood
Full powerpoint presentation


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4 May 2018

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