Domestic abuse

Domestic abuse pathway for primary care

The aim of the Primary Care referral pathway is to provide healthcare professionals with a guide to decision making when faced with patients experiencing Domestic Abuse. It includes referral issues such as patient consent, those at serious risk of harm or homicide and where to access advice and resources on risk assessment. 

Last updated on 29/04/2019 by TraceyRobinson
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What is domestic abuse?

The 2013 home office definition of domestic abuse is:

HM Government ‘Ending violence against women and girls in the UK’

“Any incident or pattern of incidents of controlling, coercive or 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. This can encompass, but is not limited to, the following types of abuse: psychological, physical, sexual, financial, emotional.  This definition includes so called 'honour’ based violence, female genital mutilation (FGM) and forced marriage.
Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.”
Research shows that households experiencing Domestic Abuse have between 3 and 8 times more contact with health professionals than those living without abuse.

As well as being an abuse of human rights Domestic Abuse can have devastating health consequences with an estimated annual healthcare cost of £1.4 billion (2004). Due to the long-term health consequences for people who have experienced Domestic Abuse and for their children who witness the overt violence and coercion the Royal College of General Practitioners has made it a Clinical Priority for 2011 – 2014.

Sheffield Clinical Commissioning Group continues to recognise the important role of GPs in relation to victims of domestic abuse and their families and that appropriate training, guidance and support is provided including how to identify the risk factors associated with perpetrator behaviour.

NHS Sheffield CCG is working with Sheffield Domestic Abuse Partnership to improve the identification and support for victims of Domestic Abuse accessing healthcare services. With appropriate training, specific referral pathways and on-going support for NHS staff the aim is to provide a positive experience for domestic abuse victims who turn to healthcare professionals for help.

When relationship difficulties have been disclosed, many professionals might suggest referral to relationship counselling.  However, in cases where domestic abuse is known, it has been shown that involvement of relationship counselling (such as Relate) can exacerbate the situation and a referral to domestic abuse services would be more appropriate.  Nottingham Relate provide further information re this, that can be accessed at: Nottinghamshire Relate

Domestic Homicide Reviews

The CCG participates in DHR’s and works in partnership with the Local Authority and other key agencies to ensure all cases are reviewed and lessons learned. We also have a responsibility to ensure that cases are reviewed from the perspective of General Practice and improvements are made to practice following case reviews.

 

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Referral re domestic abuse

Having considered risk factors for your patient (Dynamic Risk Assessment ) and followed the Sheffield Domestic Abuse Pathway, a referral to the Multi-Agency Risk Assessment Conference (MARAC) by completion of a DASH Risk Assessment form may be indicated.(Combined DASH Risk Assessment and MARAC Referral Form)

MARACs are where agencies come together to discusses options for increasing individuals safety and develop an action plan.

Specialist Domestic Abuse workers can support health staff to complete the DASH Risk Assessment Form.  The team can be contacted via the Helpline and Assessment service on 0808 808 2241.

Assessing potential risk of harm from domestic abuse and deciding if a MARAC referral is needed is difficult even with the use of the DASH tool.  CAADA have developed a “case management pack for IDVAs – section one”  toolkit with lots of useful information for specialist in this field. The grid on page 23 can help highlight concerning behaviours and aid our “professional judgement”.  http://www.caada.org.uk/dvservices/resources-for-domestic-abuse-practitioners.html

Click here for information regarding GPs supporting MARACs and forms for clinical systems.

Further information re MARACs is available in the CAADA document:
Saving lives, saving money: MARACs and high risk domestic abuse

A MARAC Operating Protocol and Information Sharing Protocol for Domestic Abuse is available.  This document supports professionals in their decision making re information sharing

Support for Perpetrators of Abuse

The following are useful resources/services for perpetrators of domestic abuse in Sheffield:

  • DACT (Domestic Abuse Coordination Team)
  • RESPECT – there is lots of information on the webpage, and information on a free phone line service.
  • “Choose to Stop” is a phone app that may be suitable for some patients to use Referrals to safeguarding must be considered if there are any children or vulnerable adults within the household.
  • Inspire to Change - a programme for men and women (over the age of 16yrs) who have been abusive, controlling or violent towards their partner. The course combines learning andsupporttailoredtoanindividual’s need. It is free for those who are motivated to make a change in their behaviour and work to improve their relationships.  The course aims to help participants learn new skills and find ways to manage and control their abusive behaviour. It encourages participants to think and behave more positively to prevent harm to their partner, children and family in the future.  Taking part in Inspire to Change gives participants:
    • an understanding of how to recognise the signs of domestic abuse
    • a better understanding of why they use violence or aggression in their relationships
    • an awareness of how attitudes and beliefs can affect behaviour
    • the practical tools to develop and maintain change
    • an improved and better life for themselves, their children and others affected by their behaviour

    Referrals can be made, via the Inspire to Change website, by any professional working with an individual, partner or family, or self-referrals can also be made.

  • Consideration of other issues such as mental health and alcohol or substance misuse is important and appropriate referrals should be made. 

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Training

The 2010 Parliamentary Taskforce report ‘Responding to Violence Against Women and Children – the Role of the NHS’ stated that ‘Increased awareness, training and education are critical for shaping attitudes and providing skills’ in order to sustain actions to improve the NHS response to violence and abuse.

The following links also provide useful training and support:

A broad range of free multi-agency Domestic Abuse training is accessible through
Sheffield Safeguarding Partnership for Children & Young People (SSP) or Vida Sheffield

An e-learning training programme.  Available at: 
VIDA Sheffield Domestic Abuse e-learning

General Practitioners can also access e-learning via the Royal College of General Practitioner’s website, registration is required. 

The RCGP also produce guidance entitled:
Domestic Violence in families with children

Additionally the RCGP with IRIS (Identification & Referral to Improve Safety) and CADDA (Co-ordinated action against domestic abuse), have produced ‘Responding to domestic abuse: Guidance for general practices’

Further reading:

Tackling domestic violence: is increasing referral enough? - Kelsey Hegarty, Paul Glasziou. General Practice and Primary Health Care Academic Centre,
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne


Identification and Referral to Improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: a cluster randomised controlled trial - Gene Feder, Roxane Agnew Davies, Kathleen Baird, Danielle Dunne, Sandra Eldridge, Chris Griffiths, Alison Gregory, Annie Howell, Medina Johnson, Jean Ramsay, Clare Rutterford, Debbie Sharp. Academic Unit of Primary Health Care, a member of the NIHR English School for Primary care Research, School of Social and Community Medicine, University of Bristol

Domestic Violence Basic Awareness E-learning

New on-line domestic abuse basic awareness training is now available on the national learning management system in ESR for all Trusts and NHS organisations in the Yorkshire and the Humber region. The course name on ESR is 000 YH Domestic Violence Basic Awareness Level 1.

This e-learning module is designed to provide Level 1 training in accordance with the NICE guideline PH50 "Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively", and is suitable for all health and social care staff (clinical and non-clinical) in primary, secondary and community care; not just staff who have contact with the people who use our services.

If your organisation does not use ESR and would like to use this e-learning module in your local LMS please ask your e-learning lead or training department to contact Elearning Support elearningsupport@yas.nhs.uk for the URL.

map of main and branch GP Practices

General Practice - Practice policy

To ensure easy access to information, it is recommended that GP practices have a domestic abuse policy.  This should detail staff member’s responsibilities including how to recognize potential domestic abuse and how to refer to appropriate domestic abuse services.  The RCGP provides information that can be incorporated into a policy.

The Sheffield GP Template Safeguarding Policy contains a template General Practice Domestic Abuse Policy that practices can adopt or amend’

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READ Codes

Following reviews that are undertaken when a homicide has occurred where domestic abuse is a factor (Domestic Homicide Reviews), the patient's records are examined to produce a detailed chronology.

It has been established that although relevant information was obtained in previous consultations, subsequent practitioners did not always utilize this important information in their subsequent contacts with the patient(s).  It is therefore recognised that if the visibility of key facts is increased then so would awareness of potential domestic abuse triggers e.g. alcohol abuse, substance misuse and mental health issues. 

To this end, it is recommended that in order for practices to continue to improving practice, the use of READ codes is strongly encouraged.  Practices are encouraged to discuss how best to document important information in a uniform manner.

The attached READ codes in respect of Domestic Abuse and Alcohol are recommended for use.

READ codes for sexual abuse and offences can be seen here.

 

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Resources

Displaying information about Domestic Abuse and sources of support for victims helps to facilitate a safe atmosphere for individuals to disclose their experiences.  The aim is to provide a range of resources to display, offer to patients and also to inform and support professional’s decision making.

Sanctuary Scheme

The Sanctuary Scheme is a service run by ACTION (who provide a number of other Domestic Abuse Support Services within Sheffield), for people who cannot leave their homes but fear an attack from an ex-partner or family member. They can provide home security including window and door locks, personal alarms, fire-proof letter boxes and in extreme cases, safe rooms within the property. For referrals to Action for support under the Sanctuary Scheme please contact Cairen Brown, Sanctuary Scheme Officer, ADAS - Action Domestic Abuse Service, Action, 22 Wilkinson Street, Sheffield, S10 2GB.  Tel: 01142 706999 or 07793601595.  The secure email address for sending referrals to the Sanctuary scheme is Cairen.brown@actionorg.uk.cjsm.net