Domestic Violence and Abuse Policy

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Policy Title:

Domestic Violence and Abuse Policy Executive Summary:

Domestic abuse is rarely a one off event, more usually it is part of a complicated and escalating pattern of control and abuse. It often has a devastating effect on the lives of the victims both the adult and the children of the family. Research has shown many survivors of domestic abuse desperately wanted someone to ask them about what was happening at home when in contact with a health professional. No one agency on its own can address the full range of problems created by domestic abuse. Addressing the health inequalities and issues raised by domestic abuse involves society as a whole and is best challenged by a multiagency approach. This policy give gives guidance on best practice and should be read in conjunction with Local Safeguarding Children Guidance. Supersedes: Domestic Abuse Policy East Cheshire Trust 2012 Description of This Policy has been amended to reflect NICE Guidance 50, Amendment(s): 2014: Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively To include the role of the Hospital IDVA and the Cheshire East Domestic Abuse Hub This policy will impact on: All business units Financial Implications: None Known Policy Area: Version

East Cheshire Trust 4

Document Reference: Effective Date:

November 2015

Community Business Unit Melanie Barker

Review Date:

Nov 2017

Impact Assessment Date:

May 2014

Number: Issued By: Authors:

APPROVAL RECORD Committees / Group Consultation Phase:

Date

SQS Information Governance

May 2009

Adult Safeguarding

March 2012

Safeguarding Assurance group Domestic Abuse IDVA

November 2015

Signed Off

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Contents

Introduction Scope Principles Roles and Responsibilities Definition of Domestic Violence and Abuse Context - Facts about Domestic Abuse Associated risk factors The Impact of Domestic Abuse If a woman is assaulted during her pregnancy For Possible Indicators of Domestic Abuse Responding to Domestic Abuse Following a Disclosure of Domestic Abuse Risk Assessment following disclosure Risk Assessment of Children Safety Planning Adopting a Multi-Agency Approach Referring a Case to the MARAC Domestic Abuse Family Safety Unit (DAFSU) Cheshire East Domestic Abuse Hub The Role of the Independent Domestic Violence Advocate(IDVA) Confidentiality and Information Sharing MARAC MARKER in the Accident and Emergency Training and Education Monitoring and Review Reference List Appendix 1: 10 Point guidelines to assist in the process of disclosure of domestic abuse Appendix 2: Guidance for Managers Dealing with Employees who are Experiencing Domestic Abuse Appendix 3: Indicators of Domestic Abuse Appendix 4: Pathway following a Disclosure of Domestic Abuse Appendix 5a: Cheshire East Domestic Abuse HUB REFERRAL FORM Appendix 5b: CAADA/DASH Risk Identification Checklist (RIC) Appendix 6: Legal Grounds for Sharing Information Local Agencies that can help 1

4 4 4 5 6 6 7 8 9 11 11 12 13 13 14 14 15 16 16 16 16 17 17 18 18 19 21 23 25 26 33 37 42

Introduction

Domestic abuse is rarely a one off event and is more frequently experienced as a pattern of coercive behaviours escalating in frequency and severity over time. It can have a devastating effect on the lives of the victims both the adult and the children of

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the family. Research has shown many survivors of domestic abuse desperately wanted someone to ask them about what was happening at home when in contact with a health professional. This document will refer to domestic abuse rather than domestic violence unless quoting from other references. This document must be used in conjunction with  The Local Safeguarding Children’s Board Procedures for Cheshire East and Chester and Cheshire West  The No Secrets Adult Protection Inter-agency Procedures for Cheshire  NICE Guidance 50, 2014: Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively.  The East Cheshire Trust Safeguarding Children Policy  The East Cheshire Trust Safeguarding Adult Policy 2.

Scope This policy applies to all individuals employed by East Cheshire NHS Trust including voluntary workers, students, locums and agency staff and contractors. It provides guidance on creating a culture within the organisation in which disclosure is encouraged through:  Re-iteration that abuse in any form is unacceptable  Creating safe opportunities and environments for disclosure

Actively displaying publicity about available sources of help and support

3.

Principles

The overall purpose of this policy is to increase safety for any children and the nonabusing parent or adult in an abusive relationship and to improve reporting by recognising that domestic abuse is a crime that adversely affects the health of individuals, families and communities. Therefore health service providers should: 

Proactively seek to identify victims of domestic abuse

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Ensure that key staff groups such as Accident and Emergency doctors and Nurses, Midwifery staff, sexual health staff, Health Visitors and School Nurses and staff working with vulnerable adults ask service users if they have experienced domestic abuse

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Adhere to domestic abuse guidelines for professionals to assist with dealing with disclosure (see Appendix 1).

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Provide appropriate, responsive support and onward referral, which will help to empower those experiencing domestic abuse to take control of their own lives.

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Promote multi agency working and co-operation by sharing information with other agencies involved in needs assessment and intervention from the Common Assessment Framework (CAF) through to the Multi-Agency Risk Assessment Conference process (MARAC)

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Be represented at Strategic multi agency MARAC steering group and initiatives

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Raise awareness through the safeguarding training programme to enable front line staff to recognise the indicators of abuse and to ask relevant questions to help people disclose their experiences of domestic abuse. More in depth multiagency training will be provided by the Cheshire East Domestic Abuse Partnership and Local Safeguarding Children’s and Adult’s Boards

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Establish website link to the Cheshire Domestic Abuse Partnership

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http://www.cheshireeast.gov.uk/care-and-support/healthylifestyles/domestic_abuse/domestic_abuse.aspx

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Demonstrate a positive response to domestic abuse and create an environment for disclosing domestic abuse by displaying information throughout health premises that highlights the detrimental effects of domestic abuse and provide advice on support available.

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Regularly review and revise the effectiveness of this policy and training programme.

4. Roles and Responsibilities Specific responsibilities in relation to this policy are as follows: 4.1 Chief Executive Has ultimate responsibility for the implementation and monitoring of the policies in use in the Trust. This responsibility may be delegated to an appropriate colleague. 4.2 The Executive Director East Cheshire NHS Trust has a Board Level Director who has executive responsibility for safeguarding children and Adults as part of their portfolio of responsibilities The Executive Director at East Cheshire NHS Trust holding this responsibility is the Director of Nursing, Performance and Quality 4.3 Associate Directors It is the responsibility of the Associate Directors to ensure that their areas of management and accountability deliver safe and effective services in accordance with statutory, national and local guidance for domestic abuse and to provide adequate resources to create safe opportunities and environments for disclosure and the display of information. 4.4 Senior Managers It is the responsibility of managers to ensure that all their employees are aware of their responsibilities under this policy, and that it is fully implemented within their area of responsibility.

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Be responsible for providing staff with appropriate support and information to implement this policy in practice Be responsible for dealing with employees who are experiencing domestic abuse (See Appendix 2) 4.5 Employees All Health employees should be alert to the potential indicators of domestic violence and abuse and know how to act on those concerns in line with local guidance; Ensure that they are working in a proactive preventative, protective manner that promotes effective multi-agency networking and action on domestic abuse. Ensure that they access training and clinical supervision in relation to domestic abuse as appropriate to their role. All health employees should understand the principles of confidentiality and information sharing in line with local and government guidance and should contribute to, when requested, the Multi Agency Risk Assessment Conference (MARAC) Comprehensive and contemporaneous records of all concerns, discussions and decisions made including telephone conversations in relation to domestic violence and abuse should be maintained in line with East Cheshire Trust policy on records and record keeping. 5. Definition of Domestic Violence and Abuse Domestic Abuse is defined as:Any incident of or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16yrs or over, who are, or have been intimate partners or family members, regardless of gender or sexuality. This includes: psychological, physical, sexual, financial and emotional abuse. It also includes 'honour'-based violence and forced marriage. For the purposes of this document, it does not include female genital mutilation. (NICE Guidance 50 Feb 2014) The main characteristic of domestic abuse is that it is a pattern of behaviour which is intentional and calculated to exercise power and control within a relationship. 6. Context - Facts about Domestic Abuse At least 1.2 million women and 784,000 men aged 16 to 59 in England and Wales experienced domestic abuse in 2010/11 – 7.4% of women and 4.8% of men. (Domestic violence and abuse here is defined as: physical abuse, threats, nonphysical abuse, sexual assault or stalking perpetrated by a partner, ex-partner or family member.) At least 29.9% of women and 17.0% of men in England and Wales have, at some point, experienced it (Smith et al. 2012). These figures are likely to be an underestimate, because all types of domestic violence and abuse are under-reported in health and social research, to the police and other services.

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Both men and women may perpetrate or experience domestic violence and abuse. However, it is more commonly inflicted on women by men. This is particularly true for severe and repeated violence and sexual assault. Lesbian and bisexual women experience domestic violence and abuse at a similar rate to women in general (1 in 4), although a third of this is associated with male perpetrators (Hunt and Fish. 2008). Compared with 17% of men in general, 49% of gay and bisexual men have experienced at least 1 incident of domestic violence and abuse since the age of 16. This includes domestic violence and abuse within samesex relationships (Stonewall Gay and Bisexual Men's Health Survey 2012). A focus on specific incidents and episodes is of limited value in understanding the experience of domestic abuse. (NICE Guidance 50 Feb 2014) 7. Associated risk factors The risk of experiencing domestic violence or abuse is increased if someone: 

Is female

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Is aged 16–24 (women) or 16–19 (men) (Smith et al. 2011)

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Has a long-term illness or disability – this almost doubles the risk (Smith et al. 2011)

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Has a mental health problem (Trevillion et al. 2012)

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Is a woman who is separated (Smith et al. 2011) – there is an elevated risk of abuse around the time of separation (Richards 2004).

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The risk is also increased if a woman is pregnant or has recently given birth. Although pregnancy appears to offer protection for some women (Bowen et al. 2005) for others it increases the risk (Harrykissoon et al. 2002). In addition, there is a strong correlation between postnatal depression and domestic violence and abuse.

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The majority of transgender people (80%) experience emotional, physical or sexual abuse from a partner or ex-partner (Roch et al. 2010).

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Just under 40% (38.4%) of bisexual, gay and lesbian people class themselves as having experienced domestic violence and abuse. However, many more respondents reported behaviours that could be classed as domestic violence and abuse (Donovan et al. 2006).

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The role played by alcohol or drug misuse in domestic violence and abuse is poorly understood. Research has indicated that 21% of people experiencing partner abuse in the past year thought the perpetrator was under the influence of alcohol and 8% under the influence of illicit drugs (Smith et al. 2012).

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People are thought to be at increased risk of substance dependency as a consequence

(NICE Guidance 50 Feb 2014)

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8. The Impact of Domestic Abuse Domestic Abuse is a complex problem often involving the inter-relationship of factors such as: 

Child Abuse

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Mental health Issues

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Deprivation and Social Exclusion

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Alcohol and/or Substance Misuse

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Homelessness and housing issues

8.1 Partner Abuse among Adults Partner abuse is the most prevalent form of domestic abuse. At least 26.6% of women and 14% of men have, at some point, experienced this since they were 16 (Smith et al. 2012). The prevalence is consistently higher among people in healthcare settings (Feder et al 2009). Women are more likely than men to experience repeated partner abuse, partner abuse over a longer period of time, violence and more severe abuse (Smith et al. 2010). Women's reports of partner abuse are also more likely to indicate that it is part of a system of fear and coercive control (Hester and Westmarland 2005; Hester (2013). Men are less likely to report abuse to the police, and more likely to say this is because they consider it too trivial or not worth reporting (Smith et al. 2010). Each year since 1995, approximately half of all women aged 16 or older murdered in England and Wales were killed by their partner or ex-partner. Around 12% of men murdered each year from 1995 were killed by their partner or ex-partner (Smith et al. 2012; Thompson 2010). 8.2 Partner Abuse among Young People Partner violence is also prevalent in young people's relationships. In the UK in 2009, 72% of girls and 51% of boys aged 13 to 16 reported experiencing emotional violence in an intimate partner relationship, 31% of girls and 16% of boys reported sexual violence, and 25% of girls and 18% of boys experienced physical violence (Meltzer et al. 2009). Some form of severe domestic violence and abuse inflicted on them by a partner (Barter et al. 2009) was reported by 1 in 6 girls. In line with research among adults, girls described more abuse, and more severe abuse, more direct intimidation and control, and more negative impacts. Young people in same sex relationships were at greater risk than those in heterosexual relationships. 8.3 Domestic Violence and Abuse between Parents and its Impact on their Children

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Domestic violence and abuse between parents is the most frequently reported form of trauma for children (Meltzer et al. 2009). In the UK, 24.8% of those aged 18 to 24 reported that they experienced domestic violence and abuse during their childhood. Around 3% of those aged under 17 reported exposure to it in the past 12 months (Radford et al. 2011). The impact of living in a household where there is a regime of intimidation, control and violence differs by children's developmental age. However, whatever their age, it has an impact on their mental, emotional and psychological health and their social and educational development. It also affects their likelihood of experiencing or becoming a perpetrator of domestic violence and abuse as an adult, as well as exposing them directly to physical harm (Stanley 2011; Holt et al. 2008). There is a strong association between domestic violence and abuse and other forms of child maltreatment: it was a feature of family life in 63% of the serious case reviews carried out between 2009 and 2011 (Brandon et al. 2012). 8.4 Children and Young People affected by Domestic Violence and Abuse Children under the age of 16yrs and young people aged 16-18yrs can experience domestic violence and abuse in a variety of ways which includes  Fearing, hearing or seeing it within their families, or worrying about its effects on someone else.  Within their own intimate relationships Young people can also perpetrate domestic violence and abuse in their own intimate relationships and on their parents and carers 8.5 Pregnant Women A woman and her unborn child are at increased risk during pregnancy. Domestic abuse is more likely to begin or to escalate during pregnancy. If a woman is assaulted during her pregnancy a referral must be made to children’s social care All pregnant women should be seen alone by a midwife at least once in their pregnancy and asked about domestic abuse. During the booking history all women will be given a card/leaflet? for the Cheshire East Domestic Abuse Hub During a consultation with a midwife any midwife who feels there could have been a domestic abuse incident must gain an opportunity to talk sensitively to the woman on her own to ask her if she has been deliberately harmed in any way. If a disclosure of domestic abuse is made a then the guidance within this policy must be adhered to. In addition the midwife must complete a Special Circumstance Form and notify the Named Midwife for Safeguarding Children so that the safeguarding children issues can be considered. The Health Visitor, GP and other agencies working with the family as appropriate will also need to be informed of the events and any referrals made. Any risks to professionals visiting the home must be considered. When a woman where domestic abuse has been suspected or disclosed is discharged from the maternity unit everything possible must be done to maximise her safety. If the case is high risk it should be referred to the MARAC. If the case is low or medium risk or the midwife is unsure about the risk level it should be referred to

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the Cheshire East Domestic Abuse Hub or the hospital based IDVA. If the woman is low or medium risk and wants no support from outreach services, ensure she has a Cheshire East Domestic Abuse Hub contact number card. A Summary Discharge Letter for where there have been Safeguarding concerns raised in the antenatal period Should be sent to the Health Visitor, GP and other agencies working with the family as appropriate. (See Safeguarding Children Policy) 8.6 Lesbian, Gay, Bisexual and Transgender Individuals Domestic Abuse in LGBT relationships is not restricted to solely to the abuse between partners and ex partners. Lesbian, gay, bisexual and transgender individuals may also experience domestic abuse perpetrated by family members on grounds of their sexual orientation. 8.7 “Honour”- based Violence and Forced Marriage When dealing with potential victims of domestic abuse it is important to recognize the seriousness/immediacy of the risk. Always consider the possibility of forced marriage, abduction, missing persons and murder. A forced marriage is one in which one or both spouses do not (or, in the case of some adults with learning or physical disabilities, cannot) consent to the marriage but are forced into it using physical, psychological, financial, sexual or emotional pressure. ('Handling cases of forced marriage', HM Government 2008) It is distinct from an arranged marriage that both partners enter into freely.    

Hundreds of young people, some as young as 13, are taken abroad each year and forced into marriage Forced marriage can involve child and sexual abuse including abduction, violence, rape, enforced pregnancy and enforced abortion. Rejection can place a young person at risk of murder, also known as “Honour Killing”. Forced marriage is not sanctioned within any culture or religion. “Forced Marriage is an abuse of human rights” Universal Declaration of Human Rights Article 16 (2)

“Honour” violence is a crime or incident committed (or possibly committed) to protect or defend the perceived 'honour' of a family or community. Often this term is enclosed in quote marks, or prefaced with 'so-called', to emphasise that the concept of honour in these cases is contested and that it is generally invoked as a means of power and control. It is difficult to estimate the prevalence of so-called 'honour'-based violence and forced marriage, but we do know that the incidences of both are underreported. Both can occur in Christian, Jewish, Sikh, Hindu, Muslim and other communities. They are probably more common in some groups, for example, some Pakistani, Kurdish, and Gypsy and Traveller communities, reflecting a more oppressive patriarchal ideology. (Home Affairs Select Committee 2008; Brandon and Hafez 2008) Both often involve wider family members and affect men, as well as women: 22% of the 1468 cases looked at by the Forced Marriage Unit involved a male being forced to marry. It is estimated that between 5000 and 8000 cases of forced marriage were reported to local and national organisations in England in 2008. In 41% of cases reported to local organisations the person forced to marry was younger than 18 (Kazmirski et al. 2009).

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8.8 Older People Domestic elder abuse refers to the maltreatment of an older person by someone who has a special relationship with the older person, which occurs in either their home, or in the home of the care giver. More than 250,000 older people (aged 66 and older) living in England in private households reported experiencing maltreatment from a family member, close friend or care workers in the past year (O'Keefe et al. 2007). Maltreatment included neglect and psychological, physical, sexual and financial abuse. Of those experiencing maltreatment, 51% experienced it from a partner, 49% from another family member, 5% from a close friend and 13% from a care worker. Women were more likely to experience maltreatment than men (3.8% of women and 1.1% of men in the past year), and men were more often the perpetrators. 8.9 Abuse of Parents by Children The prevalence of abuse of parents by their children is very difficult to ascertain and 'still lies in a veil of secrecy' (Kennair and Mellor 2007). It is 'a pattern of behaviour that uses verbal, financial, physical or emotional means to practise power and exert control over a parent' (Holt 2012). It is more commonly experienced by mothers than fathers – and is more common among single parents. It can bring stress, fear, shame and guilt, as well as physical, emotional and psychological harm to the person who experiences it. Those inflicting the abuse may feel inadequate, hopeless and alone (Holt 2012; Kennair and Mellor 2007). A large proportion of those inflicting the abuse will themselves have been physically or sexually abused or have witnessed abuse. 8.10 Disabled People Disabled individuals can experience the same forms of domestic abuse as non disabled individuals but may be more vulnerable. Disabled people are more likely to experience abuse over a longer period of time and can suffer more severe injuries as a result of violence. 9. For Possible Indicators of Domestic Abuse See Appendix 3 10. Responding to Domestic Abuse Isolation is one of the biggest problems facing victims trapped in or under threat of domestic abuse or child abuse. An interview with a health professional may be the only opportunity to tell anyone what is happening. It is imperative that health professionals are prepared to use these limited opportunities to openly discuss the issues. Health professionals should know how to “ask the question” and be able to understand the dangers faced.

Ask the Question “How are things at home?” “Do you get out much?”

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‘Does your partner stop you from going out?’

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10. Following a Disclosure of Domestic Abuse (See Appendix 4) It must be remembered that the time that a person discloses abuse is extremely important as research had identified that a victim is likely to have suffered abuse as many as 35 times before they seek help and that on average a woman has to approach 11 agencies before she receives the help she needs. This figure rises to 17 times in the cases of black and ethnic minority women. Victims of domestic abuse are most at risk of increased, life threatening or fatal abuse when they start to disclose abuse or try to leave an abusive relationship. It is of paramount importance those disclosing abuse are safe and that the delicacy of the situation is understood. Staff should be aware of their own limitations and competence. Practitioners should be fully aware of their own safety, both in working in situations where clients are known to be violent, but also regarding the emotional impact of the issue. It is not a health workers role to encourage the victim to leave their partner or to take any other particular course of action. This could lead to problems including increased danger for them and their children. When a disclosure has been made the role of the health worker in responding to domestic abuse should be: Following a Disclosure of Domestic Abuse Receive. Adopt a believing approach, acknowledge the courage needed to make a disclosure Respect. Explain the boundaries and responsibilities of confidentiality, informing the person what needs to happen next, reassure that disclosure is a positive step, enabling support to be offered. React. Prioritise safety and plan to reduce risk. Complete risk assessment focussing on the victim’s safety and that of any dependant children Respond. To consider referral to Safeguarding Adults, Safeguarding Children, Social Care the Police, MARAC and ongoing support. For advice and support contact the Domestic Abuse Hub on 03001235101 11. Risk Assessment following disclosure In the hospital setting a referral must be made to the Hospital IDVA on 663342 or 07823372754 The following questions must be considered when assessing risk in domestic abuse If the case is high risk a referral should be made to the MARAC cases:

 Separation: Is the victim planning to leave or has recently left the perpetrator? Record. the contact, clearly documenting any visible injuries, any referrals,  AreFully theredocument issues around child contact? decisions and plans made. Never record in client held records.  Is the victim pregnant/ recently delivered

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     

Escalation: Are the attacks becoming worse in severity or more frequent in occurrence? Have there been threats to kill? Were weapons used or threats to use weapons? Have there been any attempts to strangle or suffocate? Are there any cultural issues? Is there any report of stalking? Is there any report of sexual assault or forced sexual behaviour? Are they afraid? The victims perception of their own risk must always be taken into account Is there a risk to any others eg elderly living within the household?

Answering yes to any of these questions indicates high risk and a Referral to Safeguarding Adults must be made and a MARAC Risk Assessment Tool must be completed. See Appendix 5 12. Risk Assessment of Children Evidence shows there is a close link between domestic abuse and child abuse (Adoption & Children’s Act 2002: Living with or witnessing domestic violence is identified as a source of significant harm for children, HMSO 2002). If you think a person is being abused always think about the implications for their children, including the possibility that the children themselves might be the subject of domestic abuse. Similarly, if you suspect that a child is being abused be alert to the possibility of domestic abuse in the family. All safeguarding concerns must be referred to Children’s Social Care as directed in the Local Safeguarding Children Board Procedures. Questions to ask include:  Are the children present during the abuse?  What does the child do when he is witnessing, or hearing abuse?  Does the child try to intervene?  How often does the abuse occur?  What usually happens during the abuse?  Have the children ever been physically injured during the abuse?  Are they showing signs of emotional disturbance, e.g. bedwetting, sleep disturbance, nightmares, eating problems with associated weight loss or weight gain?  Are there behaviour problems, e.g. anxiety, aggression, fearfulness, agitation, feelings of guilt, withdrawn?  Are the children showing signs of prolonged sadness which may progress to depression?  Is there a child less than 2yrs in the home?  Is the victim afraid for the safety of the children?  Are there any concerns about parental substance misuse and mental health? Answering yes to any of these questions indicates that there are concerns about the welfare of a child and a consultation with the Cheshire East Consultation Service (ChECS) should be undertaken. The procedures for what to do if a child is being abused must be followed as identified in East Cheshire Trust Safeguarding Children policy.

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Safety Planning

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Safety planning can be effective in helping the victim to protect themselves in the event of domestic abuse. In most cases a plan may not be written down, but the person should be prompted into thinking about what they can do to reduce the risks in an emergency situation. It is important the plan is based on the individuals needs. Safety in the relationship  Places to avoid when abuse starts e.g. the kitchen where there may be potential weapons.  People the victim can turn to for help or let know that they are in danger.  Asking friend or neighbour to call 999 if they hear anything to suggest that the person or child are in danger.  Places to hide phone numbers, such as helpline numbers.  How to keep the children safe when the abuse starts, e.g. teaching the child to find safety when the abuse starts, or teaching them to phone 999.  Keep personal documents in one place so they are easily accessible if he/she needs to leave suddenly.  Stress that the victim should call the police if they are in immediate danger. 14. Adopting a Multi-Agency Approach In an emergency, consider referring to the Police, Social Care Services, Specialist Domestic Abuse Agency, Local and National Support Groups and Counselling Services http://www.cheshire.gov.uk/domesticabuse 14.1 Multi Agency Risk Assessment Conference (MARAC) Establishment of the MARAC is a home office initiative and is a requirement of the Specialist Domestic Violence Court (SDVC). The MARAC model is commended as being very successful in reducing repeat victimisation. There has been a SDVC in Chester since September 2006. Aim of MARAC: • To share relevant information to increase the safety and wellbeing of victimsadults 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 • To improve support for staff involved in high risk domestic abuse cases The main outcomes of the MARAC’s are to reduce risk for the victim and move some of the responsibility for addressing the domestic abuse from the victim to a broader group of agencies. The role of the MARAC is to facilitate, monitor, and evaluate effective information sharing to enable appropriate actions to be taken to increase individual and public safety. 14.2 MARAC Risk Assessment

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The MARAC Risk Assessment Tool was devised as a result analysis of risk factors associated with domestic homicides, serious assaults, Serious Case reviews of child deaths and life threatening incidents involving children. Appendix 5 CAADA / DASH Risk Identification Checklist (RIC). The RIC forms part of the Cheshire East Domestic Abuse Hub referral form The Risk factors are divided into 5 main categories: • Nature of the abuse e.g. emotional, physical, sexual • Historical patterns of behaviour e.g. previous convictions or abusive behaviour • Victim’s perceptions of risk e.g. specific fears for themselves and children or pets • Specific factors associated with an incident e.g. use of a weapon, threats to kill • Aggravating factors e.g. drugs, alcohol, financial problems 15. Referring a Case to the MARAC Health care professionals in East Cheshire should complete the Cheshire East Domestic Abuse Hub referral form incorporating the RIC. (Appendix 5a) If the risk is high, indicate on the form that the referral is to the MARAC. In West Cheshire professionals should complete the RIC. (Appendix 5b) and refer to the MARAC. Discussion of the case with the Named Nurse for Safeguarding Children or Adults must take place in order to consider all safety options. For advice and support contact the Cheshire East – Domestic Abuse Hub on 03001235101. Cheshire West - DAFSU 01606 364234 If you are hospital based you can also contact the Hospital IDVA who can complete the risk assessment with your client. 01625 66 3342

16. Domestic Abuse Family Safety Unit (DAFSU) A DAFSU is a team of specialist workers responding to referrals on domestic abuse to reduce risk and increase long term safety and wellbeing. Referrals are made to the DAFSU West via the “victim” themselves or by an “agency” on behalf of the victim. All “High” or “Very High” risk victims are then proactively contacted by the Independent Domestic Violence Advocate (IDVA) to offer safety planning, and support through the criminal justice process. In Cheshire East Victims and agencies are encouraged to refer to the Domestic Abuse Hub. For advice and support contact the Cheshire East – Domestic Abuse Hub on 03001235101. Cheshire West - DAFSU 01606 364234 If you are hospital based you can also contact the Hospital IDVA who can complete the risk assessment with your client. 01625 66 3342 17. The Cheshire East Domestic Abuse Hub This is a single point of access for all domestic abuse cases whatever the level of risk in Cheshire East. If you are unsure about the level of risk an IDVA will triage the level

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of risk and refer to the appropriate domestic abuse agency. Referrals can be made by the victim themselves or by professionals. Cheshire East – Domestic Abuse Hub on 03001235101 18. Independent Domestic Violence Advocate The main purpose of independent domestic violence advisors (IDVA) is to address the safety of victims at high risk of harm from intimate partners, ex-partners or family members to secure their safety and the safety of their children. Serving as a victim’s primary point of contact, IDVAs normally work with their clients from the point of crisis to assess the level of risk. They also discuss the range of suitable options leading to the creation of a workable safety plan. Macclesfield Hospital has an IDVA based on site who staff can refer patients/clients to if there are concerns in relation to domestic violence or abuse. The IDVA is also able to support staff who maybe experiencing domestic violence or abuse. The Hospital IDVA is also available to provide training to staff groups. 19. Confidentiality and Information Sharing Respect for confidentiality is an essential requirement for the preservation of trust between patients and health care professionals. Consent from the patient should be sought before disclosing information to a third party. The right to confidentiality is not absolute and may be countered when the rights of others to be protected from harm are jeopardised. (Public Interest Disclosure Act) A balance must be struck between the importance of maintaining confidentiality and the harm that could be avoided if confidentiality was breached, for example, where there are reasons to believe that children are at risk of significant harm as a result of domestic abuse. Protection must take precedence over confidentiality. For guidance on the legal grounds for sharing information see appendix 6 Where the risk of harm is high and a referral to the MARAC is to be made then the MARAC Information Sharing Protocol comes into play and confidentiality can be breached in order to protect the victim and her children All health care professionals must be honest with others about the limits of confidentiality. Where there is police involvement in a domestic abuse incident and there are children in the household, or the woman is pregnant, the Police officer generates a 40A form which is risk assessed by the Public Protection Unit and shared with Social Care, Health and other relevant Agencies. The Police are responsible for obtaining consent in this instance. 20. MARAC MARKER in the Accident and Emergency When a MARAC MARKER is highlighted on the Special Register Domestic abuse should always be considered as a reason for the current presentation at the ED. If it is in relation to a child and domestic abuse is thought to be a feature of this presentation

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or if there are professional concerns the What to do if you have concerns about the welfare of a child flowchart should be followed. Enquiries of Social Care should be made. This policy should be read in conjunction with the Safeguarding Children Policy. If the presentation is in relation to an adult and a there is further incident of domestic abuse within 12 months then a new referral to MARAC must be made. A referral to the hospital IDVA on 663342 or 07823372754 must also be made. During office hours, the hospital IDVA may be able to come to A and E and complete the RIC with the patient. 21. Training and Education Domestic Violence and Abuse is covered in the Trust Mandatory Safeguarding Children and Young People and Safeguarding Adult training programmes at levels 1,2 and 3. Specific Multi-Agency Domestic Abuse Training is available to all staff. The Hospital IDVA can provide bespoke training to any team, individual or staff group within the hospital 22. Monitoring and Review Safeguarding training and Multi-agency Domestic Abuse Training is monitored through staff evaluation.

REFERENCE LIST

British Crime Statistics 2005/06 Black MC (2011) Intimate partner violence and adverse health consequences; implications for clinicians. American Journal of Lifestyle Medicine 5 : 428-39

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Cheshire County Council (2002) There can be no Secrets Advice and Information on Protecting Vulnerable Adults from Abuse in Cheshire Cheshire County Council (2005) Children in Need Census Cheshire Domestic Abuse Partnership Children & Young People’s Strategy 2008 Cheshire County Council (2006) Local Safeguarding Children Board Procedures Children Act (1989) HMSO Children Act (2004) HMSO HM Government (2006) Working Together to Safeguard Children: A Guide to InterAgency Working to Safeguard and Promote the Welfare of Children Guidance, London HMSO HM Government (2006) Common Assessment Framework for Children and Young People, London HMSO HM Government (2006) Information Sharing: Integrated Working to Improve Outcomes for Children and Young People, London HMSO Department of Health (2006) Responding to Domestic Abuse: A handbook for Health Professionals, London – DH Publications Domestic Violence, Crime and Victims Act (2004), HMSO Equality Act (2006) HMSO Home Office (2007) Dealing with Cases of Forced Marriage: Practice Guidance for Health Professionals Human Rights Act (1998), HMSO NICE Guidance 50 (2014) Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively

Appendix 1

10 Point guidelines to assist in the process of disclosure of domestic abuse 1. Provide a confidential space Inform about confidentiality and its limitations. Be clear about the time you can offer, check whether they need an interpreter or would prefer a woman or someone from their own background to speak with. Give time, allowing them to come to the point in their own way. 2. Ask open-ended, non-threatening questions like: “How are things at home?”

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3. Explain there are many people in this situation: 1 in 4 women experience domestic abuse in their adult life. They are not alone. Never ask for graphic details of the abuse they have suffered. Be aware that men too experience domestic abuse and need support and services. 4. Avoid using stereotypes in your wording. Use words that they do to describe their experiences, avoid using the term ‘domestic abuse’ until they use it. 5. Listen carefully Asking for help is not easy, it can be embarrassing and distressing so they may ‘talk around’ the subject before coming to the point. Be non-judgemental – an expression of disbelief or shock could dissuade them from telling you anymore. Acknowledge how hard it is for them to talk about it. 6. Reassure them Re-assure them they are not to blame, no-one has to put up with abuse and responsibility for the abuse lies with the abuser. If they deny it and you suspect that they are being abused, tell them they can come back to talk later. 7. Offer Options….. ……that help them to think logically about what they need first and from whom. Avoid instructing what should be done but encourage them to decide on the best plan of action for them. 8. Be clear and honest Give reliable information; explain what you can and cannot do and what delays or uncertainties there might be. 9. Deal with the request You need to understand exactly what they are asking for so you can respond effectively. Make sure they have the information required and they know that they can come back to your agency again. 10. Be safe. Ask for help from colleagues: The minimum you can do is to look at safety planning with the person. You have the right to withdraw from any situation where you feel your personal safety is at risk. See CEDAP web for safety planning information. If you are seriously concerned for someone’s safety you can refer them, with or without consent, to the Domestic Vi For advice and support contact the Cheshire East – Domestic Abuse Hub on 03001235101. Cheshire West - DAFSU 01606 364234 If you are hospital based you can also contact the Hospital IDVA who can complete the risk assessment with your client. 01625 66 3342

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Appendix 2

Guidance for Managers Dealing with Employees who are Experiencing Domestic Abuse 

Employees experiencing domestic abuse should consider informing their line manager if they are involved in a domestic situation which impacts on their work.

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

Managers should treat all requests for assistance and support sympathetically and confidentially.



Managers should establish with the employee what they want to do about the situation and respect their decision.



Managers should give information about support services including the hospital IDVA and offer an occupational health appointment and confidential staff counselling if appropriate.



Managers should consider security measures for staff that work alone and ensure that personal details about work place are not divulged to a third party.

Good Practice in Responding to Staff 

ensuring the immediate safety and security of self and others



being non-judgmental - taking the matter seriously, listening and believing the person



ensuring that any discussion with a member of staff about their circumstances, takes place in privacy



respecting confidentiality - the consequences of domestic violence are serious, and managers and colleagues need to respect this



understanding staff may not wish to approach their line manager, and may prefer to involve a third party such as a colleague or trade union representative



finding out what staff want - being aware of what support is available, and exploring these options with the member of staff

Good Practice in Responding to Perpetrators of Domestic Abuse 

Staff should be aware that domestic violence is a serious matter and could lead to a criminal conviction.



As is the case with any member of staff who is found guilty of a crime, if the Service views that there is conflict between the conviction for violence, and the job s/he is employed to do, disciplinary action may be taken. Proven harassment and intimidation of staff by their partner or ex-partner who also works for the Service will be viewed seriously, and may lead to disciplinary action being taken.



Serious consideration should be given to whether the actions of any member of staff who has a criminal conviction for domestic violence

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brings the Service into disrepute, and should be regarded as gross misconduct. This may result in dismissal. 

The fact that a member of staff is a perpetrator of domestic violence may make certain job duties inappropriate, and justify redeployment. For example, it may not be appropriate for this person to be providing services to vulnerable persons, and a change or a transfer, may need to be considered in such circumstances.



The perpetrator of abuse may want to change their behaviour. Cheshire East have a voluntary programme for people who want to stop their abuse. It is called LIFELINE. The member of staff may also want a referral to staff counselling service

In an emergency dial 999 National 24 Hour Helpline – 0808 2000 247 http://www.cheshireeast.gov.uk/care-and-support/healthylifestyles/domestic_abuse/help_for_perpetrators.aspx For advice and support locally contact the Cheshire East – Domestic Abuse Hub on 03001235101. Cheshire West - DAFSU 01606 364234 If you are hospital based you can also contact the Hospital IDVA who can advise and support staff. 01625 66 3342

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Appendix 3 Indicators of Domestic Abuse The first step in identifying domestic abuse is the acceptance that it may occur, the forms it may take and the impact it can have. There are a number of indicators (not proof) of domestic abuse 

The average person will visit A&E 3 times in their lifetime. A study of survivors of domestic abuse revealed they had visited an A&E department on an average of 30 occasions. Therefore frequency of visits to an A&E dept should be seen as an indicator of domestic abuse.



Frequent admissions to any area within the Trust with vague complaints or symptoms of an unknown clinical cause or with obvious physical injuries.



Problems with central nervous problems, haring loss



Unexplained bruises, lacerations, areas of erythema consistent with slapping injuries, lacerations, burns, multiple injuries in various stages of healing or any injuries consistent with shaking for example whiplash.



Any Injuries that are inconsistent with the explanation of the cause.



Accidental injuries explained with a delayed, hesitant, embarrassed or evasive explanation.



Repeated or chronic injuries or injuries that are of several different ages, (check previous medical/obstetric records).



Physical symptoms related to stress or other anxiety problems or depression, panic attacks, suicide attempts, post traumatic stress disorder, sleep disorder, deliberate self harm.



Alcohol and substance misuse (often cries for help) because of a feeling isolation. Fear or inability to cope any longer (50% of women receiving mental health services have or are victims of domestic abuse)



Frequent use of antidepressants or pain medications.



Rape, sexual assault or injury to genitals.



Increased infections



Intrusive “other person” in consultations including partner or husband, parent, grandparent or an adult child (for elder abuse).

gynaecological

system-

problems

and

headaches,

sexually

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cognitive

transmitted

23

PREGNANCY RELATED ABUSE  Partner always present and seems to speak for the woman 

Unplanned / unwanted pregnancy



Increased risk of miscarriage



Injuries to the head, neck, breasts, abdomen and genitals and repeated chronic injuries.



Frequent admissions often with a vague history for example abdominal pain, reduced fetal movements or query urinary tract infection.



Intrauterine Growth Retardation / Small For Dates



Placental abruption



Removal of Perineal sutures



Substance misuse



History of pre-term labour



Concealed pregnancy

Behavioural Signs Abused women are: 

15x more likely to abuse alcohol



9x more likely to abuse drugs



3x more likely to be diagnosed with depression/psychosis



5x more likely to attempt suicide may be reluctant to speak or disagree in the abuser presence



Intense irrational behaviour or possessiveness may be demonstrated toward the client by the abuser



Post-traumatic shock, client may react with an attitude of shock, denial, shaking, crying, anger, or minimisation and self-blame for the abusers behaviour towards them. (Adapted from Black 2011)

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Appendix 4

Pathway following a Disclosure of Domestic Abuse

Assess any immediate danger to the individual Discuss Safety Planning and give contact card for the “Cheshire East Domestic Abuse Hub”

Professional Contact the Police if any concern risk to immediate safety or suspected criminal; offence

Practitioner completes CADA/DASH Risk Identification Checklist (RIC) (For patients in the acute setting contact the hospital IDVA on 663342 or 07823372754) High Risk Score of 14+ Or 3 or more domestic abuse incidents in the last 12 months Or Professional concern

Score less than 14 but other safeguarding adult vulnerabilities highlighted.

Complete referral to Safeguarding Adults following the “What to do if you are concerned an Adult is being Abused” Flowchart. If Hospital based contact hospital IDVA. 3342 If High Risk Complete referral to MARAC using Cheshire east Domestic Abuse Hub Form For advice and support contact the Domestic Abuse Hub on 03001235101(East) or DAFSU West 01606 364234 File copies of referrals in patient records

Score less than 14 and no other Safeguarding adult concerns

Ensure that safety planning and local contact numbers for support agencies using the “Cheshire East Domestic Abuse Hub” have been discussed If hospital based refer to hospital IDVA If hos Are their any Children?

Yes Access Risk to Children Were the children present during the abuse? Did the child try to intervene? Is the abuse happening frequently/ escalating? Have the children ever been physically injured during the abuse? Do the children show signs of emotional distress or behavioural problems? Is the victim pregnant? Is there a child aged less than 2yrs in the home? Is the victim afraid for the safety of the children or themselves? Are there any concerns re drugs, alcohol and mental health?

No risks identified

AE and Paediatric Ward Staff Record details in HV Liaison Book

No

No Further Action

Risks Identified

Complete Consultation with Children Social Care following the “What to do if you are concerned a Child is being Abused” Flowchart. File referrals in patient records and copy to the Safeguarding team AE and Paediatric Ward Staff Record details in HV Liaison Book and Domestic Violence book

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Appendix 5a

Cheshire East Domestic Abuse HUB REFERRAL FORM Please send completed referrals to [email protected] 0300 123 5101 Fax for MARAC referral 01606 363552 Referring agency

Telephone / Email

Contact name(s)

Date

Victim name

Victim DOB

Address

Diversity Data (if known) Gender LGBT

Telephone number

M/F

Ethnicity

Y/N

Disabled Y / N

Safe to call?

Y / N

Please insert any relevant contact information e.g. times to call, interpreter required Alleged Perpetrator(s) name

Alleged

Address Alleged Perpetrator(s)

Relationship to victim

Perpetrator(s) DOB

Relationships status Children

DOB

(please add extra rows if necessary)

Relationship to victim

Relationship to perpetrator

Address

School (If known)

Please indicate whether the referral is for MARAC or Other HUB service HUB service (assessment/referral) Have you completed a Risk Identification

MARAC Referral Y/N

Have you completed the RIC and

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Y/N

26

Checklist – p 3-5

information required for a MARAC Referral – p5

Is the client aware of this referral?

Y/N

Is the client aware of this referral

Y/N

Does the client consent to this referral?

Y/N

Does the client consent to this referral

Y/N

RISK AND NEED INFORMATION BACKGROUND (Please include factors relating to risk and the victim’s or other family needs which will help us identify an appropriate pathway for support)

SAFETY/SUPPORT TO DATE (Please list actions already taken to address risk and need for the victim and their family)

OTHER FACTORS (What other information may help us address risk and need? Consider factors relating to added vulnerability such as age, disability, substance misuse, mental health issues, cultural/language barriers on ‘honour-based systems’, geographic isolation and minimisation.)

NAME/DATE of person making referral

CHILD AND ADULT SAFEGUARDING Are there any identified risks or concerns for children or ‘adults at risk’? Have you considered a referral to ChECS or Adult Social Care? If so, has a referral been made?

SERVICE/S REFERRER BELIEVES MAY HELP IDVA/MARAC Service (high risk)

1 to 1 support for child/young person

1 to 1 support in the community (lower risk)

Recovery programme for child/YP

Recovery programme (adult victim)

Change programme for child/YP

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Change programme (adult perpetrator)

Refuge/emergency housing

Survivor Support group

OTHER …..

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Please explain that the purpose of asking these questions is for the safety and protection of the individual concerned.

YES

NO

KNOW

Please put a ‘x’ in the relevant column (yes, no, don’t know) – add any detail in the Comments section. 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

1. Has the current incident resulted in injury? (please state what and whether this is the first injury) Comment: 2. Are you very frightened? Comment: 3. 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) Self 

Children 

Other (please specify) 

Further injury and violence: Self 

Children 

Other (please specify) 

Self 

Children 

Other (please specify) 

Kill:

Other (please clarify): Comment:

4. 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: 5. Are you feeling depressed or having suicidal thoughts? Comment: 6. Have you separated or tried to separate from (name of abuser(s)….) within the past year? Comment: 7. Is there conflict over child contact? (please state what) Comment: 8. 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)

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DON’T

29

9.

Are you currently pregnant or have you recently had a baby (in the past 18 months)?

DOMESTIC ABUSE HISTORY 10. Is the abuse happening more often? Comment: 11. Is the abuse getting worse? Comment: 12. 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 stalking and specify the behaviour) Comment: 13. Has (…..) ever used weapons or objects to hurt you? Comment: 14. Has (…..) ever threatened to kill you or someone else and you believed them? Comment: 15. Has (…..) ever attempted to strangle/choke/suffocate/drown you? Comment: 16. Does (….) do or say things of a sexual nature that makes you feel bad or that physically hurt you or someone else? (Please specify who and what) Comment: 17. Is there any other person that has threatened you or that you are afraid of? (If yes, consider extended family if honour based violence. Please specify who)

18. Do you know if (…..) has hurt anyone else? (Children/siblings/elderly relative/stranger, for example. Consider HBV. Please specify who and what) Children  Another family member  relationship  Other (please specify) 

Someone from a previous

19. Has (…..) ever mistreated an animal or the family pet? Comment:

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ABUSER(S) 20. Are there any financial issues? For example, are you dependent on (…..) for money/have they recently lost their job/other financial issues? Comment: 21. Has (…..) had a problem in the past year with drugs (prescription or other), alcohol or mental health leading to problems in leading a normal life? (Please specify what) Drugs  Alcohol  Mental Health  22. Has (…..) ever threatened or attempted suicide? Comment: 23. Has (…..) ever breached bail/an injunction and/or any agreement for when they can see you and/or the children? (Please specify what) Bail conditions  Non Molestation/Occupation Order  Child Contact arrangements  Forced Marriage Protection Order  Other  24. 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 NUMBER OF TICKS (14+ requires an immediate MARAC referral)

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Information required for MARAC referral

Reason for referral

Professional judgement

Y / N

Visible high risk (14 ticks or more on CAADA - DASH RIC)

Y / N

Potential escalation (3 or more incidents reported to the Police in the past 12 months)

Y / N

MARAC repeat (further incident identified within twelve months from the date of the last referral)

Y / N

If a repeat, please provide the date listed / case number (if known) Who does the victim believe it is safe to talk to? Who does the victim believe it is not safe to talk to? Has the referral been discussed with your line manager? Has the referral been discussed with your agency’s MARAC representative? (They present your case)

PLEASE SEND COMPLETED REFERRALS TO: [email protected] On receipt of a MARAC referral you will receive a confirmation email informing you of the date the case will be heard at MARAC. For further MARAC queries contact the Domestic Abuse Family Safety Unit on 01606 363531 For all other HUB REFERRALs you will receive an email or call to confirm next steps. Call the HUB on 0300 123 5101 to discuss further Fax for MARAC referral 01606 363552 ( For use only if you are unable to email referral)

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Appendix 5b

CAADA/DASH Risk Identification Checklist (RIC) DASH = Domestic Abuse, Stalking and Harassment Guidance on undertaking the RIC can be downloaded from the (CAADA) website @ http://www.caada.org.uk/practitioner_resources/RIC%20with%20Quick%20Start%20Guidanc e%20%20Disclaimer%2021052009.pdf TH PLEASE COMPLETE ALL THREE PAGES BELOW AND USE THE 4 PAGE TO MAKE A MARAC REFERRAL IF THE COMPLETED RIC SHOWS THAT YOUR CLIENT IS AT HIGH RISK Victim name or code ______________________________________ 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. 1. Has the current incident resulted in injury? (Please state what and whether this is the first injury.) 2. Are you very frightened?

Y E S

N O

Don’t know

State source of info if not the victim eg. police officer

Comment: 3. 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: 4. 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: 5. Are you feeling depressed or having suicidal thoughts? 6. Have you separated or tried to separate from (name of abuser(s)….) within the past year? 7. Is there conflict over child contact? 8. 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.) 9. Are you pregnant or have you recently had a baby (within the last 18 months)? 10. Is the abuse happening more often? 11. Is the abuse getting worse? 12. Does (……) try to control everything you do and/or are they excessively jealous? (In terms of relationships, who you see, being

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‘policed’ at home, telling you what to wear for example. Consider ‘honour-based violence’ and specify behaviour.) 13. Has (……..) ever used weapons or objects to hurt you?

CAADA/DASH Risk Identification Checklist (RIC)

Y E S

N O

Don’t Know

State source of info if not the victim eg. police officer

14. Has (……..) ever threatened to kill you or someone else and you believed them? (If yes, tick who.)

You

Children

Other (please specify)

15. Has (………) ever attempted to strangle/choke/suffocate/drown you? 16. 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.) 17. 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.) 18. 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) 19. Has (……….) ever mistreated an animal or the family pet? 20. Are there any financial issues? For example, are you dependent on (…..) for money/have they recently lost their job/other financial issues? 21. 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

22. Has (……) ever threatened or attempted suicide? 23. 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 Contact arrangements Forced Marriage Protection Order Other

Child

24. 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

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PAGE 3 OF CAADA/DASH RISK INDICATOR CHECKLIST 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?

Consider abuser’s occupation/interests - could this give them unique access to weapons?

Has the abuser used or threatened arson? Yes/No If yes, please give more detail:

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:

What are the victim’s greatest priorities to address their safety?

Do you believe that there are risks facing the children in the family? If yes, please confirm if you have made a referral to safeguard the children: Date referral made …………………………………………….

Yes / No Yes / No

If the adult survivor is ‘vulnerable’ (eligible for community care services) please ensure that you have considered Safeguarding Vulnerable Adult procedures. Signed Name Date PRACTITIONER’S NOTES

What next? If your client is at high risk (14+ ticks, 3 or more domestic abuse incidents in the last 12 months, professional concern) discuss the case with a manager and make a MARAC referral using the form on the next page. If you are unsure ring the number below to discuss. If your client is at lower risk please undertake essential safety planning and signposting

For advice and support contact the Domestic Abuse Hub on 03001235101 (East Cheshire) DAFSU WEST 01606 364234 (West Cheshire) For patients in the acute setting contact the hospital IDVA on 663342 or 07823372754 S:\Policies\Policies\ECT002403\Domestic Abuse Policy ECT2403.doc

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MARAC REFERRAL FORM based on CAADA/DASH 2009 REFERRING AGENCY INFORMATION Name of practitioner Agency Contact details Date of referral

Phone

Email

MARAC CLIENTS INFORMATION Name of adult victim/including alias DoB adult victim Address adult victim Ethnicity Adult victim GP adult victim Victim housing status Victim immigration status Name of alleged perpetrator (AP)/alias DoB AP Address AP Ethnicity AP Child 1 (name, DoB, address, school) Child 2 (name, DoB, address, school) Child 3 (name, DoB, address, school)

RISK INFORMATION Reasons for referral:

Background and risk issues

Is the victim aware of the MARAC referral? Yes/no Has the victim given consent? Yes/no Is it safe to contact them? – yes/no If yes, give number Please add anything you know about: - who the victim is afraid of (other than alleged perpetrator) - who does the victim believe it’s safe to talk to? - Who does the victim believe it’s NOT safe to talk to? Has a RIC been completed?

Yes/no

Is the RIC attached?

Yes/no

Please send a copy of your MARAC referral and Risk Indicator Checklist to the MARAC Co-ordinator: Mel Barker - Safeguarding Team Fax: West: 01244 613271

Ring 01244 614234 to arrange fax, email or post

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Appendix 6 Legal Grounds for Sharing Information

1. Safety Consider risk factors – how great is the risk?  Children – careful consideration should be given to disclosure even about low risks to children  For an adult, a relatively high risk is necessary before considering over-riding the duty of confidentiality 2. Consent With consent disclose can take place. Without consent, you must make a professional judgement balancing the following considerations. Do you have the legal authority to disclose? See sheet of authorities Balancing against  Duty of confidentiality  Respective risks to those affected  Pressing need  Need of other agencies to know 3. Make the decision If you decide not to disclose:  Record decision, going through checklist  Consider ways to reduce risk to survivor and/or any children  Consider ways to help client access help from other agencies herself If decide to disclose:  Record decision, going through checklist  Make decisions/enquiries about the amount of information to disclose, how and to whom  Discuss with survivor, if appropriate  Note when/whether the survivor was informed and reasons why they were if not informed (for example, that it would increase risk)  Disclose  Note a time to review this situation again  Review the advocate’s safety and the repercussions for the project

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Appendix 6a Legal Grounds When Considering Sharing Information Without Consent Protection against Disclosure Legal issues Protection of personal data Duty of confidentiality Right to private and family life

Source Data Protection Act 1998 Common law Human Rights Act, Article 8

Main Lawful Grounds For Sharing Without Consent Purpose Legal authority Prevention and detection of crime Crime and Disorder Act 1998 Prevention and detection of crime and/or the Section 29, Data Protection Act apprehension or prosecution of offenders (DPA) To protect vital interests of the data subject; Schedule 2 & 3, DPA serious harm or matter of life or death For the administration of justice (usually bringing Schedule 2 & 3, DPA perpetrators to justice) For the exercise of functions conferred on any Schedule 2 & 3, DPA person by or under any enactment (police/social services) In accordance with a court order Overriding public interest Common law Child protection – disclosure to social services Schedules 2 & 3, DPA or the police for the exercise of functions under the Children Act, where the public interest in safeguarding the child’s welfare overrides the need to keep the information confidential Right to life Human Rights Act, Articles 2 & 3 Right to be free from torture or inhuman or degrading treatment Balancing Principles Proportionate response  Respective risks to those affected  Pressing need  Need to know of other agencies Public interest in disclosure

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Checklist for Use When Sharing Information without Consent If you are in a situation where you feel that you have to disclose information without the consent of the client, you must record your decision and the reasons for making it. These are always very difficult decisions and ones where you may be concerned about the impact that they will have on the trust that a client has placed in you. Remember, you need to take defensible not defensive decisions, but neither must you put yourself in a situation where you are effectively joining with the client to prevent critical information being disclosed. 1.

You must record that a decision has been made to share/disclose information without consent.

2.

What are the protocols/guidance that you referred to and which agencies or colleagues have been consulted about this decision? Set these out clearly in your records. (e.g. Home Office guidance, OIC helpline, own protocols?).

3.

What is the legal basis for sharing without consent in this case? Record it clearly. It will usually be for the Crime and Disorder Act (prevention or detection of crime) or under the DPA, or the Children Act.

4.

Are you clear exactly what details of the information is to be shared and with whom? Set this out in your records.

5.

Think through the balancing exercise that you have undertaken; that you have considered the interest of the other agency/person in receiving the information and the degree of risk posed to any person by disclosure/nondisclosure; that you have considered the duty of confidentiality, human rights and the public interest. Record this. Record whether the sharing is proportionate and there is a pressing need and summarise why in one or two sentences.

6.

What is the amount of information to be disclosed and the number of people/agencies disclosed to? Is this no more than strictly necessary to meet the need for disclosure? Record why this is the case.

7.

Set out whether and when the survivor/person affected has been informed that the information will be disclosed and to whom, whether reasons have been given and whether details of next steps explained. Has this been done in advance of the information been disclosed? If the survivor/person affected has not been informed set out reasons why.

8.

If in doubt, ALWAYS seek specialist advice from the Named Nurse for Safeguarding Children, the Adult Safeguarding Lead, ECT Legal Services.

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Appendix 6b Information sharing without consent form (it may be appropriate to complete and keep with patient record) (copies kept in MARAC folder in clinical areas) Client Information

Date________ Name/address of Client: Names and D.O.B. of children:

Concern Risk identified through risk assessment Immediate risk/crisis Child(ren) at risk/Danger to child(ren) Danger to client Client poses a risk to self or others Risk Assessment ________ (No. of ticks out of 20) (You may not have the opportunity to complete a formal RA in an emergency. If you have, please attach it.) Details of incident/information causing concern: (include source of information)

Legal Authority to share  Protocol relevant MARAC information sharing protocol And:  Legal grounds (please tick 1 or more grounds below)  Prevention and detection of crime (Crime and Disorder Act 1998)  Prevention/detection or crime and/or apprehension or prosecution of offenders (DPA, s. 29)  To protect vital interests of the data subject; serious harm or matter of life or death (DPA, Sch. 2 & 3)  For the administration of justice (usually brining perpetrators to justice (DPA, Sch. 2 & 3)  For the exercise of functions conferred on any person by or under any enactment (police/social services) (DPA, Sch. 2 & 3)  In accordance with a court order  Overriding public interest (Common law)  Child protection – disclosure to social services or police for the exercise of functions under the Children Act, where the public interest in safeguarding the child’s welfare overrides the need to keep the information confidential (DPA, Sch. 2 & 3)  Right to life (Human Rights Act, Art. 2 & 3)  Right to be free from torture or inhuman or degrading treatment (Human Rights Act, Art. 2 & 3)  Pressing need  Respective risks to those affected   

Risk of not disclosing Interest of other agency/person in receiving it Public interest in disclosure

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 

Human rights Duty of confidentiality

Comments:

Internal consultations: (Names, dates and advice/decisions)

External consultations: (Home Office guidance, Information-sharing Helpline) (020 7273 4015)

Client notification Client notified of disclosure(s)? Yes/No If not, why not?

Date:

Record following details of information sharing in client notes: (not in any paper work they may take home)  Date info shared  Agency and named person informed  Method of contact (by email, letter, phone call)

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Local Support agencies East Cheshire The Domestic Abuse Hub on 03001235101 West Cheshire The DAFSU West 01606 364234 Forced Marriage Unit- 020 7008 0151 Help and advice for people being forced into marriageTelephone: +44 (0) 20 7008 0151    

Email: [email protected] Email for outreach work: [email protected] Facebook: Forced Marriage page Twitter: @FMUnit

Worried about a child/vulnerable adult? Child East Cheshire Chester and Cheshire West Adult East Cheshire

Chester and Cheshire West

0300 123 5012 (out of hours 0300 123 5022) 01606 275099 (out of hours 01244 977277) Acute 01625 661503 Community 03001235010 (out of hours 0300 123 5022) 0800 1238123 (out of hours 01244 977277)

IN AN EMERGENCY RING 999

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Equality Analysis (Impact assessment) 1. What is being assessed? Domestic Abuse Policy Details of person responsible for completing the assessment:  Name: Melanie Barker  Position: Named Nurse for Safeguarding Children  Team/service: Safeguarding Children

State main purpose or aim of the policy, procedure, proposal, strategy or service:

(usually the first paragraph of what you are writing. Also include details of legislation, guidance, regulations etc which have shaped or informed the document)

Domestic abuse is rarely a one off event and is more frequently experienced as a pattern of coercive behaviours escalating in frequency and severity over time. It can have a devastating effect on the lives of the victims both the adult and the children of the family. Research has shown many survivors of domestic abuse desperately wanted someone to ask them about what was happening at home when in contact with a health professional. This document will refer to domestic abuse rather than domestic violence unless quoting from other references. This document must be used in conjunction with The Local Safeguarding Children’s Board Procedures for Cheshire and The No Secrets Adult Protection Inter-agency Procedures for Cheshire

2. Assessment of Impact

RACE: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, racial groups differently? Yes  Explain your response: This document has no negative impact on any groups – all patients/staff what ever their race have the equal right to be protected from the impact of domestic abuse. All process within this policy apply to all. All staff receive training in Equality and diversity. _____________________________________________________________________ __________ GENDER (INCLUDING TRANSGENDER):

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No x

From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, different gender groups differently? Yes  No x  Explain your response: This document has no negative impact on any groups – all patients/staff what ever their gender orientation have the equal right to be protected from the impact of domestic abuse. All process within this policy apply to all. All staff receive training in Equality and diversity.

DISABILITY From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, disabled people differently? Yes  No x Explain your response: _ Disabled people are more likely to experience abuse over a longer period of time and can suffer more severe injuries as a result of violence. This document has no negative impact on any groups – all patients/staff have the equal right to be protected from the impact of domestic abuse. All staff receive training in Equality and diversity _____________________________________________________________________ _______________ AGE: From the evidence available does the policy, procedure, proposal, strategy or service, affect, or have the potential to affect, age groups differently? Yes  Explain your response: This document has no negative impact on any groups – all patients/staff have the equal right to be protected from the impact of domestic abuse. This policy includes risk assessments that apply to both adults and children

No x

LESBIAN, GAY, BISEXUAL: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, lesbian, gay or bisexual groups differently? Yes  No x  Explain your response: Domestic Abuse in same sex couples is not restricted to just the abuse between partners and ex partners. Lesbian, gay, bisexual and transgender individuals may also experience domestic abuse perpetrated by family members on grounds of their sexual orientation. This document has no negative impact on any groups – all patients/staff what ever their sexual orientation have the equal right to be protected from the impact of domestic abuse. All process within this policy apply to all. All staff receive training in Equality and diversity _____________________________________________________________________ ________________ RELIGION/BELIEF: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, religious belief groups differently? Yes  No x Explain your response:

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When dealing with potential victims of domestic abuse it is important to recognize the seriousness/immediacy of the risk. Always consider the possibility of forced marriage, abduction, missing persons and murder. A forced marriage is a marriage conducted without the full consent of both parties and where duress is a factor.    

Hundreds of young people, some as young as 13, are taken abroad each year and forced into marriage Forced marriage can involve child and sexual abuse including abduction, violence, rape, enforced pregnancy and enforced abortion. Rejection can place a young person at risk of murder, also known as “Honour Killing”. Forced marriage is not sanctioned within any culture or religion. “Forced Marriage is an abuse of human rights”

Universal Declaration of Human Rights Article 16 (2)

This document has no negative impact on any groups – all patients/staff what ever their religious beliefs have the equal right to be protected from the impact of domestic abuse. All process within this policy apply to all. Safeguarding training is mandatory for all staff and domestic abuse is included in all safeguarding children and adults training. _____________________________________________________________________ _______________ CARERS: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, carers differently? Yes  No x Explain your response: _ This document has no negative impact on any groups – all patients/staff have the equal right to be protected from the impact of domestic abuse. All process within this policy apply to all. Any measures that are taken to protect an individual who is a carer would be undertaken as part of an holistic assessment _____________________________________________________________________ _______________ OTHER: EG Pregnant women, people in civil partnerships, human rights issues. From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect any other groups differently? Yes x  No Explain your response: _ Pregnant Women A woman and her unborn child are at increased risk during pregnancy. Domestic abuse is more likely to begin or to escalate during pregnancy. This policy actively seeks to high light the risk to women during pregnancy and puts in processes to identify vulnerable women. This policy then can be said to have a positive impact for pregnant women and the unborn child. _____________________________________________________________________ _______________

3. Safeguarding Assessment - CHILDREN

a. Is there a direct or indirect impact upon children? Yes x No  b. If yes please describe the nature and level of the impact (consideration to be

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given to all children; children in a specific group or area, or individual children. As well as consideration of impact now or in the future; competing / conflicting impact between different groups of children and young people: Children can witness domestic abuse in a variety of ways and suffer a broad range of physical and psychological consequences as a result. A child’s behavioural and emotional functioning can be severely influenced by living within a household where domestic abuse is occurring. Children living in abusive family environments can suffer neglect if they are left to look after themselves at an age where hands on parenting would normally still be occurring. This policy promotes a risk assessment to identify vulnerable children due to domestic abuse and sets out a clear guideline on how to respond to protect children. This p[policy then can be said to have a positive impact on children c. If no please describe why there is considered to be no impact / significant impact on children

4. Relevant consultation

Having identified key groups, how have you consulted with them to find out their views and that the made sure that the policy, procedure, proposal, strategy or service will affect them in the way that you intend? Have you spoken to staff groups, charities, national organisations etc? This Policy has been reviewed by the members of the Safeguarding Assurrance group members

5. Date completed: 01/05/2014

Review Date: 30/11/2017

6. Any actions identified:

Have you identified any work which you will need to do in the future to ensure that the document has no adverse impact? Action Lead Date to be Achieved

7. Approval

– At this point, you should forward the template to the Trust Equality and Diversity Lead [email protected]

Approved by Trust Equality and Diversity Lead:

Date: 01/05/14

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