Powys Teaching Local Health Board
Directorate: Women’s and Children’s Directorate
Author: Marie Lewis / Title: Domestic Abuse
Code: MAT 036

Domestic Abuse Guideline

Document
Code
/
Date
/ Version Number / Planned Review Date
PtHB / Mat 036 / October 2013
February 2009
November 2013 / Reviewed and updated with national guidance
Reviewed and updated by Powys Domestic Abuse task and Finish Group
Reviewed and updated with Home Office definition for Domestic abuse and minor alterations / Jan 2017
March 2012
January 2017
Document Owner / Approved by / Date
Director of nursing / Women’s and Children’s Directorate
Clinical Effectiveness Committee / 26/11/13
27/01/2014
Document Type / Guidelines

Bwrdd Iechyd Addysgu Powys yw enw gweithredol Bwrdd Iechyd Lleol Addysgu Powys

Powys Teaching Health Board id the operational name of Powys Teaching Local Health Board

Contents / Page
Validation Form / 3
Consultation / 4
Equality Assessment / 5
Relevant to / 6
Purpose / 5
Definitions / 5
Responsibilities / 5
Process / 5
References / 5
Appendices
Appendix 1 / 9
Appendix 2 / 10
Appendix 3 / 12

For Reviewed &/or Updated Policies Only:

Relevant Changes / Date
Updated with MARAC information and All Wales Domestic Abuse strategy and Home Office definition for domestic abuse / November 2013

VALIDATION FORM

Title: Domestic Abuse Guideline
Author:Marie Lewis Practice Development Midwife
Directorate:Women’s and Children’s
Reviewed/Updated by: Marie Lewis Practice Development midwife. December 2013
EVIDENCE BASE
Are there national guidelines, policies, legislation or standards relating to this subject area?
If yes, please include below:
All Wales Domestic Abuse Strategy [2009]
Domestic abuse toolkit WG
All Wales Child Protection procedures.
Wales interim protection of vulnerable adults procedures
DOING WELL, DOING BETTER - STANDARDS FOR HEALTHSERVICES IN WALES
Please state which Health ServicesStandards this policy will support / link to:
For Example.
  • Standard 2 – Equality and Diversity and Human Rights
  • Standards 9 – Patient Information & Consent
  • Standard 10 – Dignity & Respect
  • Standard 11 – Safeguarding children and vulnerable adults
  • Standard 18 – Communicating effectively

CONSULTATION
Please list the groups, specialists or individuals involved in the development & consultation process:
Name / Date
Midwives / Oct 2013
Health Visitors / Oct 2013
Women’s and Children’s directorate leads / Oct 2013
Safeguarding team / Oct 2013
Implications
Please state any training implications as a result of implementing the policy / procedure.
No additional training required
Please state any resource implications associated with the implementation.
  • No additional resources.
Please state any other implications which may arise from the implementation of this policy/procedure.
  • No additional implications identified

For Completion by Quality & Safety Unit
I confirm that this document has been checked for formatting, spelling, grammar & completion of the validation sections.
This check does not guarantee the information given is accurate or the evidence base quoted is the current
Checked by: / Date:
Submitted to: / Date:

Equality Assessment Statement

Please complete the following table to state whether the following groups will be adversely, positively, differentially affected by the policy or that the policy will have no affect at all

Equality statement
No impact / Adverse / Differential / Positive / Comments
Age / x
Disability / x
Gender / x
Race / x
Religion/ Belief / x
Sexual Orientation / x
Welsh Language / x
Human Rights / x
Risk Assessment
Are there any new or additional risks arising from the implementation of this policy?
  • None identified

Do you believe that they are adequately controlled?
  • None identified

Are there any Information Governance issues or risks arising from the implementation of this policy?
  • None identified

Domestic Abuse Guideline

  1. Relevant to:

Midwives and Health Visitors

  1. Purpose

To provide guidance to midwives and health visitors to support evidenced based practice, education and training with regard to the use of routine enquiry [RE] for domestic abuse to help support women, children and the wider community around issues of domestic abuse.

  1. Definitions

THE CROSS GOVERNMENT DEFINITION OF DOMESTIC VIOLENCE AND ABUSE [2013] 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. The abuse can encompass but is not limited to:

• psychological

• physical

• sexual

• financial

• emotional

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 behavior 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.

  1. Process

Women must always be alone when being asked about domestic abuse. Midwives and Health Visitors must make every effort to ensure that there is at least one contact with a woman on her own in order to carry out routine enquiry.

Suggested introduction to routine enquiry:

“Because abuse or violence is so common in women’s lives, we routinely ask all women about their relationships so that we can give everyone information about agencies and information that can help.”

Suggested Questions for routine enquiry are found on the DA1 [See appendix 2] Refer to All Wales Clinical Pathway for routine enquiry for possible indirect and direct questions.

Whatever the response to the DA1 all women should still be given the All Wales Domestic Abuse information card to ensure women have the information they need regardless of whether or not they are ready to disclose. They may also be able to pass the information to others who need support.

Disclosure:

Disclosure should be received in a non judgmental way. Health professionals should reinforce that any abusive behavior is wrong and is not the fault of the victim.

Ensure the woman has the All Wales information card.

The free phone national Domestic Violence Helpline number is:

08082000247

All Wales Domestic Abuse Helpline is:

08088010800

Following a disclosure a risk assessment [CAADA DASH] should be completed to ascertain the level of risk. See appendix 2].

A woman should never be advised to leave a violent situation as this is likely to be the most dangerous time for her. Women should be asked for verbal consent to inform other agencies or health professionals of concerns and risks. Where a women is deemed at high risk this will include the police.Where there is a High leveldisclosure all professionals providing care for a woman and or her children should, with victims consent, directly refer to the Powys Domestic Abuse Multi Agency Risk Assessment Committee [MARAC] via the police. [See appendix 3]

Where there are safeguarding concerns the safeguarding specialist nurse should be contacted for advice and support. MARAC referrals should be discussed with the safeguarding team and where possible the person making the referral should attend the MARACto present the case. However where this is not possible the safeguarding team will be in attendance to represent women’s and Children’s services. Where a woman or child is thought to be in a situation where there is significant threat to life or safety, professionals have a duty to inform police and social services with or without consent.

When a disclosure of domestic abuse is made, an initial Notification report for Children and families in Need form should be completed and forwarded to the lead Midwife and Supervisor of midwives/ Lead health Visitor [as appropriate], Powys Safeguarding children’s team and the multi-disciplinary team involved in the families care. During the antenatal period it will be the responsibility of the midwife to ensure that the paper work is completed and distributed appropriately.

Child and Vulnerable Adult Protection:

Domestic Abuse is an indicator of potential child protection concernsand/or concerns for a vulnerable adult. Please refer to All Wales Child Protection Procedures, the All Wales Domestic Abuse Practice Guide and The Wales interim protection of vulnerable adult’s procedures.

Documentation:

Midwifery:

Midwives are expected to record who accompanies the woman for antenatal care as part of their routine clinical observations.

When routine enquiry has been carried out the midwife must record this on the hospital tracer card or record the reason why it was not carried out [e.g. partner present] in the woman’s hospital notes. The DA1 form should be filed in the hospital notes. No details of the disclosure to be recorded in the hand held records.

In the event of a CAADA DASH being completed the midwife must inform all agencies as appropriate and document in the hospital date and to whom information given.

Details of any disclosure should be kept in the hospital record and should include the details of the disclosure, woman’s composure [crying, frightened], any injury present including description and where possible a body map diagram. Recording should also be made of any person present when the disclosure occurs and any persons particularly children present during the incident being described.

Midwives should inform the Health visitor of any disclosure and pass on details of routine enquiry and current partners when handing over care.

Health Visitors:

The health Visitor must record routine enquiry carried out or why it hasn’t been carried out in the Health Visitor family record not in the child Health Record.

Routine enquiry should be carried out in the first eight weeks postnatal and thereafter whenever an opportunity presents particularly if there is achange of family circumstances such as a new partner.

Details of any disclosure should be kept in the Health Visitor family record and should include the details of the disclosure, woman’s composure [crying, frightened], any injury present including description and where possible a body map diagram. Recording should also be made of any person present when the disclosure occurs and any persons particularly children present during the incident being described.

Health visitor should inform the School Nursing Service of any disclosure when handing over care.

It is important for all health professionals to remember that records can form part of the future protection for and abused woman and they have a duty of care to record domestic abuse disclosures without the consent of the victim.

Extreme care should be taken to protect the safety of the woman and no information should be disclosed which might breach their safety. Attention should be given to information and documentation if a woman’s partner or family work within the health professions and may be able to access records

  1. Responsibilities

Midwives and Health Visitors are responsible for:

  • Promoting Domestic Abuse routine enquiry as part of the woman’s health history in routine care.
  • Ensuring that poster and the All Wales Domestic Abuse information cards are displayed in public places and toilets.
  • Ensuring that the All Wales Domestic Abuse information is given to all women as per the All Wales Pathway minimum standard.
  • To carry out routine enquiry for domestic abuse with all women at the first available opportunity.
  • Ensure that any disclosure of domestic abuse is appropriately followed up and the relevant support mechanisms are in place.
  • Accurately document routine enquiry results in away that does not place a woman in danger.
  • Ensure that no member of staff is knowingly placed in a position of danger.
  1. Training

All Health professionals shall receive mandatory training about the awareness and routine enquiry for domestic abuse prior to carrying out clinical questioning as part of their induction training. Further update training will be carried out by all staff at regular intervals not less than three yearly.

  1. Monitoring Compliance/ Audit

Heads of service will be responsible for ensuring that audit of this guideline and compliance with the pathways will be conducted at least six monthly by record keeping audit. At least 10% of records should be audited within a twelve month period.

Audit will include compliance with routine enquiry 100% carried out or reason why not carried out documented. Number of CAADA DASH risk assessments required. Number carried out appropriately. Number of referrals, to whom and whether correct referral procedure carried out.Audit results should be reported to the safeguarding children operational forum and safeguarding adults operational forum via the Heads of service.

Staff Support:

Decisions about safety and disclosures of information should be discussed with the line manager in the first instance and the Powys tHB Safeguarding Children’s team for support. Both Clinical supervision and Child Protection supervision should provide professional support to staff undertaking routine enquiry. Lead midwives and Health visitors should be familiar with the complex issues surrounding domestic abuse and respond appropriately to requests for support. Dealing with cases of domestic abuse can be distressing for staff some of whom may have personal experience of domestic abuse.

All staff have access to the Powys teaching Health Board staff counseling service via occupational health department should they require additional support. Please refer to the domestic Abuse in the workplace policy.

  1. References

All Wales Domestic Abuse Practice Guidelines [2009]Safeguarding Children andYoung People Affected byDomestic Abuse. WG

All Wales Child Protection Procedures.

  1. Appendices

Appendix 1:

Appendix 2:

Appendix 3:

1. CAADA-DASH Risk Identification Checklist (RIC) for MARAC Agencies

Aim of the form:

  • To help front line practitioners identify high risk cases of domestic abuse, stalking and ‘honour’-based violence.
  • To decide which cases should be referred to MARAC and what other support might be required. A completed form becomes an active record that can be referred to in future for case management.
  • To offer a common tool to agencies that are part of the MARAC[1] process and provide a shared understanding of risk in relation to domestic abuse, stalking and ‘honour’-based violence.
  • To enable agencies to make defensible decisions based on the evidence from extensive research of cases, including domestic homicides and ‘near misses’, which underpins most recognised models of risk assessment.

How to use the form:

Before completing the form for the first time we recommend that you read the full practice guidance and Frequently Asked Questions and Answers[2]. These can be downloaded from

Risk is dynamic and can change very quickly. It is good practice to review the checklist after a new incident.

Recommended Referral Criteria to MARAC

  1. Professional judgement: if a professional has serious concerns about a victim’s situation, they should refer the case to MARAC. There will be occasions where the particular context of a case gives rise to serious concerns even if the victim has been unable to disclose the information that might highlight their risk more clearly. This could reflect extreme levels of fear, cultural barriers to disclosure, immigration issues or language barriers particularly in cases of ‘honour’-based violence. This judgement would be based on the professional’s experience and/or the victim’s perception of their risk even if they do not meet criteria 2 and/or 3 below.
  2. ‘Visible High Risk’: the number of ‘ticks’ on this checklist. If you have ticked 14 or more ‘yes’ boxes the case would normally meet the MARAC referral criteria.
  3. Potential Escalation: the number of police callouts to the victim as a result of domestic violence in the past 12 months. This criterion can be used to identify cases where there is not a positive identification of a majority of the risk factors on the list, but where abuse appears to be escalating and where it is appropriate to assess the situation more fully by sharing information at MARAC. It is common practice to start with 3 or more police callouts in a 12 month period but this will need to be reviewed depending on your local volume and your level of police reporting.

Please pay particular attention to a practitioner’s professional judgement in all cases. The results from a checklist are not a definitive assessment of risk. They should provide you with a structure to inform your judgement and act as prompts to further questioning, analysis and risk management whether via a MARAC or in another way.

The responsibility for identifying your local referral threshold rests with your local MARAC.

What this form is not: This form will provide valuable information about the risks that children are living with but it is not a full risk assessment for children. The presence of children increases the wider risks of domestic violence and step children are particularly at risk. If risk towards children is highlighted you should consider what referral you need to make to obtain a full assessment of the children’s situation.

CAADA-DASH Risk Identification Checklist for use by IDVAs and other non-police agencies[3] for MARAC case identification when domestic abuse, ‘honour’- based violence and/or stalking are disclosed

Please explain that the purpose of asking these questions is for the safety and protection of the individual concerned.
Tick the box if the factor is present.Please use the comment box at the end of the form to expand on any answer.
It is assumed that your main source of information is the victim. If this is not the case please indicate in the right hand column / Yes
(tick) / No / Don’t
Know / State source of info if not the victim e.g. police officer
  1. Has the current incident resulted in injury?
    (Please state what and whether this is the first injury.)

  1. Are you very frightened?
Comment:
  1. What are you afraid of? Is it further injury or violence? (Please give an indication of what you think (name of abuser(s)...) might do and to whom, including children).
Comment:
  1. Do you feel isolated from family/friends i.e. does (name of abuser(s) ………..) try to stop you from seeing friends/family/doctor or others?
Comment:
  1. Are you feeling depressed or having suicidal thoughts?

  1. Have you separated or tried to separate from (name of abuser(s)….)
    within the past year?

  1. Is there conflict over child contact?

  1. Does (……) constantly text, call, contact, follow, stalk or harass you?
    (Please expand to identify what and whether you believe that this is done deliberately to intimidate you? Consider the context and behaviour of what is being done.)

  1. Are you pregnant or have you recently had a baby
    (within the last 18 months)?

  1. Is the abuse happening more often?

  1. Is the abuse getting worse?

  1. Does (……) try to control everything you do and/or are they excessively jealous? (In terms of relationships, who you see, being ‘policed at home’, telling you what to wear for example. Consider ‘honour’-based violence and specify behaviour.)

Tick box if factor is present. Please use the comment box at the end of the form to expand on any answer. / Yes
(tick) / No / Don’t Know / State source
of info if not the victim
  1. Has (……..) ever used weapons or objects to hurt you?

  1. Has (……..) ever threatened to kill you or someone else and you believed them? (If yes, tick who.)
You  Children  Other (please specify) 
  1. Has (………) ever attempted to strangle/choke/suffocate/drown you?

  1. Does (……..) do or say things of a sexual nature that make you feel bad or that physically hurt you or someone else? (If someone else, specify who.)

  1. Is there any other person who has threatened you or who you are afraid of? (If yes, please specify whom and why. Consider extended family if HBV.)

  1. Do you know if (………..) has hurt anyone else? (Please specify whom including the children, siblings or elderly relatives. Consider HBV.)
Children  Another family member 
Someone from a previous relationship  Other (please specify) 
  1. Has (……….) ever mistreated an animal or the family pet?

  1. Are there any financial issues? For example, are you dependent on (…..) for money/have they recently lost their job/other financial issues?

  1. Has (……..) had problems in the past year with drugs
    (prescription or other), alcohol or mental health leading to problems in leading a normal life? (If yes, please specify which and give relevant details if known.)
Drugs  Alcohol  Mental Health 
  1. Has (……) ever threatened or attempted suicide?

  1. Has (………) ever broken bail/an injunction and/or formal agreement for when they can see you and/or the children? (You may wish to consider this in relation to an ex-partner of the perpetrator if relevant.)
Bail conditions  Non Molestation/Occupation Order 
Child Contact arrangements  Forced Marriage Protection Order  Other 
  1. Do you know if (……..) has ever been in trouble with the police or has a criminal history? (If yes, please specify.)
DV  Sexual violence  Other violence  Other 
Total ‘yes’ responses
For consideration by professional: Is there any other relevant information (from victim or professional) which may increase risk levels? Consider victim’s situation in relation to disability, substance misuse, mental health issues, cultural/language barriers, ‘honour’- based systems and minimisation. Are they willing to engage with your service? Describe:
Consider abuser’s occupation/interests - could this give them unique access to weapons? Describe:
What are the victim’s greatest priorities to address their safety?
Do you believe that there are reasonable grounds for referring this case to MARAC? Yes / No
If yes, have you made a referral? Yes/No
Signed: Date:
Do you believe that there are risks facing the children in the family? Yes / No
If yes, please confirm if you have made a referral to safeguard the children: Yes / No
Date referral made …………………………………………….
Signed:
Name: / Date:

Practitioner’s Notes