Appendix 4.3 MEETING: DATE: TITLE: LEAD DIRECTOR/ MANAGER: AUTHOR: CONTACT DETAILS: Haringey Clinical Commissioning Group Governing Body Meeting Thursday, 28 November 2013 Domestic and Gender Based Violence in Haringey Jeanelle de Gruchy, Director of Public Health Althea Cribb, Strategic Domestic and Gender Based Violence Lead [email protected], 020 8489 1501 SUMMARY: The purpose of this item is to provide the CCG Governing Body with data on the prevalence of domestic and gender based violence in Haringey, information about the importance of health service responses, and an update on the work in progress to address the partnership’s response to the issue. Domestic and gender based violence is a significant issue in Haringey, and requires responses from all organisations involved in the partnership. Health services have been highlighted as having a specific, and essential, role in this partnership response. The presentation provides the prevalence of domestic and gender based violence in Haringey. This paper supports that data with contextual information on the importance of health services’ response, and goes on to outline what actions are currently in progress to address domestic and gender based violence. The shared definition of domestic and gender based violence is: 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. 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. This Government definition, which is not a legal definition, includes so called 'honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group. SUPPORTING PAPERS: Please see the presentation and the report below. RECOMMENDED ACTION: The Governing Body is asked to: COMMENT on the actions agreed at the health meeting, outlined in the report below. COMMIT TO SUPPORTING the DGBV partnership in the implementation of these actions, and in ensuring health services delivery quality services to those affected by DGBV (adult victims and perpetrators, and children and young people). Objective(s) / Plans supported by this paper: Work to address DGBV impacts on the following Health and Wellbeing Strategy outcomes: Outcome 1 – Every child has the best start in life Through ensuring that all areas of work and responses to domestic and gender based violence recognise and address the needs of children and young people. This includes: children and young people living in a home with a perpetrator; children and young people perpetrating abuse/violence against parents and/or family; young people perpetrating / experiencing domestic and sexual violence who are involved in gangs. Outcome 3 – Improved mental health and wellbeing The experience of domestic and gender based violence from a partner/ex-partner/family member has been shown to have significant impacts on the mental health, safety and wellbeing of victims, and the partnership is working to ensure they are identified and offered help as early as possible. Audit Trail: Data in the presentation has been gathered by Haringey Council’s Public Health Team and Strategy and Business Intelligence Unit. Patient & Public Involvement (PPI): None for this report. Equality Analysis: Domestic and gender based violence fall within the UN definition of violence against women and girls; that is: Any act of gender-based violence that is directed at a woman because she is a woman or acts of violence which are suffered disproportionately by women. The greatest risk factor for experiencing domestic and gender based violence is being female. However, men and boys also experience it and responses must address this. Responses must also be sensitive to the additional needs victims/survivors have due to their particular circumstances that can impact on help-seeking, e.g. sexual orientation, ethnicity, disability, religion/faith. Research shows that there are no causal links between socio-economic position, employment status or poverty and the experience of domestic and gender based violence. There are no additional risk factors relating to ethnicity or religion. Risks: Failure to address domestic and gender based violence, at its most extreme, leads to the death of women, men and children and young people. Resource Implications: There are no financial implications arising directly from this report. Most of the actions identified link in with existing work plans and can be met from existing resources. If new activity is identified then a business case will need to be made. Domestic and Gender Based Violence in Haringey and the Health Service Response 1. HEALTH RESPONSE Haringey has a high prevalence of domestic violence – up to 8,900 victims every year A significant amount of it goes unreported – or is reported but not recorded Health services have an essential role to play in supporting those affected Health services already respond to domestic and gender based violence; just not necessarily very effectively / efficiently The long term health impacts are costly: victims have been shown to attend health settings more frequently, and therefore cost health services more than non-victims1 Health has almost unique levels of public trust for public sector, and so victims are more likely to disclose in these settings Health are universal services – and so attendance is stigma free There is sometimes unmonitored access to people in health services, leading to greater opportunities to ask about domestic violence Health practitioners see people in states of undress (and so are likely to see what would otherwise be hidden) It is good clinical practice to address the whole of someone’s need, not just the presenting one CAADA2 data: services supporting victims based in hospitals see a different profile of victims than other community based services: o more complex needs (mental health, drug/alcohol use, no recourse to public funds) o younger o earlier in their experience of DGBV, having made no previous attempts to leave and often still with perpetrator Data from Multi-Agency Risk Assessment Conferences3 shows the disparity between high risk victims actual use of healthcare, and the extent to which they are identified in these settings: All health Primary care Acute Mental health 1 All national MARAC3 referrals – one year 4.4% 2.2% 1.5% 0.8% IDVA4 clients attending health service in one year (not same sample) N/K 45% 21% 31% had issues with mental health; though not necessary attending a service Health services have a duty to response proactively and effectively to domestic and gender based violence, as they have a unique opportunity to intervene earlier, thereby reducing harm, reducing costs, improving the wellbeing of victims and children, and ultimately savings lives. Wisner et al, 1999 Coordinated Action Against Domestic Abuse, www.caada.org.uk 3 Information sharing monthly meetings between key partner agencies for the purpose of safety planning for victims and their children 4 Independent Domestic Violence Advocacy Services – working with high risk victims referred via the MARAC 2 2. WORK IN PROGRESS The second ‘Haringey Stat’ meeting, led by the Local Authority Chief Executive, focused on domestic and gender based violence. One of the outcomes was the recognition of the crucial role of the health service response, and how this response was either unclear, or lacking, in many areas. A follow up meeting has been held focusing on health, which was able to gather more data – local or from literature reviews – as well as to understand more about the current response and where development is needed. The meeting established that there are many well developed responses to DGBV in health settings in Haringey; but that these are not consistent, and that data is not collected to demonstrate the process, or the effectiveness of the response. The most developed response is in maternity and health visiting services; the least developed are in Accident and Emergency Departments and General Practice. The data shows the high number of victims who attend these services – demonstrating that this is about improving the quality of the services already delivered to them, rather than creating new services. Further development is needed in all areas to: Ensure pathways are in place for appropriate response and referral following disclosure Systematise the response through training, policies and procedures Gather data on disclosures and outcomes Implement models of best practice where possible, i.e. IRIS The data list is below. Data Sought Accident & Emergency Departments (Whittington Health; North Middlesex Hospital) Literature review Local data gathered A&E data from two London hospital-based studies From North Middlesex Hospital Maternity Services Any other hospital data Data from research study with fracture clinics Mental Health Data in development Whittington A&E– audit planned North Middlesex A&E – audit request submitted Data requested from Whittington but unable to provide due to change in IT systems National research: people who have experienced abuse and violence, and their experience of common mental disorder Admissions data for Haringey women attending any hospital for assault North Middlesex child safeguarding referrals for domestic violence Women referred to Whittington Female Genital Mutilation specialist service Whittington: data can be provided but wasn’t ready in time for workshop Sexual Health services Health visiting Whittington data on domestic violence prevalence in their caseload where there are safeguarding concerns Multi-Agency Risk Assessment Conference Number of referrals from health agencies Children’s Social Care Referrals where domestic violence is the presenting factor 3. ACTION REQUIRED The following table outlines the actions agreed at the meeting: Actions / Points for consideration Owner Explore training on offer and required (North Middlesex, Whittington Health, Barnet, Enfield & Haringey Mental Health Trust as priorities): with regard to Public Health prevention budget which may be available to support training; and look at NICE guidance recommendations on training required for health professionals Jeanelle de Gruchy, Director of Public Health Chief Executives: BEHMHT; North Middlesex; Whittington Policies and procedures to be developed, alongside training – working towards responses being systemic Jeanelle de Gruchy, Director of Public Health Chief Executives: BEHMHT; North Middlesex; Whittington Continue to progress IRIS for primary care (Identification and Referral for Improved Safety, a targeted enquiry model to improve early identification and appropriate referral for domestic violence victims in General Practice) Karen Baggaley, Haringey CCG with Nicole Klynman, Public Health Look at this ‘targeted enquiry’ model, with referral pathway for victims (like IRIS), for other health settings Karen Baggaley, Haringey CCG with Nicole Klynman, Public Health Explore with North Middlesex, Whittington Health and BEH Mental Health Trust how they can ‘flag’ or code electronic files when DV is disclosed – particularly as BEH Mental Health Trust (some teams), maternity services in North Middlesex and Whittington Health, and Whittington Health Visiting carry out routine enquiry North Middlesex are addressing their response to (and recording of) Female Genital Mutilation cases, looking at how Whittington Health already do this; we also need to look at the wider inter-agency working in relation to actual FGM and girls at risk Consider where support services for victims are based; whether there may be scope in future for service to be based in health organisations Continue to develop the ‘minimum standard’, including ensuring that it aligns with the NICE guidance that will be published in February 2014, and work with health providers to achieve it North Middlesex are looking at midwifery practice in relation to ensuring that women are seen on their own on at least one visit, so that they can be asked about domestic violence Althea Cribb, Strategic DGBV Lead Chantel Palmer, Named Nurse Child Protection, North Middlesex Althea Cribb, Strategic DGBV Lead Althea Cribb, Strategic DGBV Lead Chantel Palmer, Named Nurse Child Protection, North Middlesex
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