Domestic Violence – Leeds

1. Scope and Development of Pathway

This pathway was developed to guide clinicians when managing domestic violence issues.

Developed by NHS Leeds Clinical Commissioning Group in partnership with Leeds City Council/Safer Leeds
Date of pathway: April 2014
Date of review: March 2019 by Mary Kearney, Named Nurse for Safeguarding Adults and Children, NHS Leeds Clinical Commissioning Group
Date of review: July 2020

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2. Training and Further Resources

The Safer Leeds Domestic Violence Team are currently offering free Domestic Violence Awareness and training to all health professionals across Leeds including GP Practices.

A high number of Domestic Homicide Reviews, both locally and nationally, reveal that GPs are often one of the only statutory bodies who come into contact with both victims and perpetrators.

The Safer Leeds Domestic Violence Team have also completed a GP Routine Enquiry Pilot, this has evaluated positively and is now being rolled out across Leeds. Following the GP Routine Enquiry Primary Health Care settings across the North of England are exploring how this can be incorporated into their practices.

The training session covers –

  • What is Domestic Violence and Abuse including Coercive Control
  • Impact on Health and Why Women Stay
  • Additional Issues for Marginalised Groups
  • High Risk and MARAC (Multi Agency Risk Assessment Conference)
  • DHRs (Domestic Homicide Reviews) & Lessons Learned
  • Routine Enquiry - asking the question and responding appropriately
  • Good Practice and Support Available

The sessions usually last around three hours however, this can be reduced if necessary. The team can also discuss the Safer Leeds Domestic Abuse Quality Mark, if this is something you would like to pursue.

Please note this training will be delivered at level three and therefore will contribute to ongoing training arrangements around adult and child safeguarding.

If you would like to arrange a training session or would like any further information please contact dvteam@leeds.gov.uk or telephone 0113 3789682

Further resources can be found at:-

SAFE LIVES http://www.safelives.org.uk/gp

NICE GUIDANCE ON DOMESTIC ABUSE www.nice.org.uk/guidance/ph50

Royal College of General Practitioners Guidance:
RCGP domestic violence clinical resources
https://www.rcgp.org.uk/clinical-and-research/resources/a-to-z-clinical-resources/domestic-violence.aspx

Department of Health. Responding to domestic abuse. A resource for health professionals.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/597435/DometicAbuseGuidance.pdf

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3. Referral Information and Useful Contacts

Providing information supports the person experiencing domestic abuse to make informed decisions towards a safer lifestyle and where they can receive further help.

Local and National Support Agencies can be found at https://www.leeds.gov.uk/domesticviolence/Documents/Local and National Support Agencies.pdf

Local Services

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4. Domestic Violence & Abuse

What Is Domestic Violence and Abuse

The Home Office (2013) definition of domestic 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 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.

Domestic abuse can include:

  • sexual abuse and rape
  • punching, kicking, cutting, hitting with an object
  • withholding money or preventing someone from earning money
  • taking control over aspects of someone's everyday life, which can include where they go and what they wear
  • not letting someone leave the house
  • reading emails, text messages or letters
  • Threatening to kill or harm them, a partner, another family member or pet.

Witnessing domestic abuse is really distressing and scary for a child, and causes serious harm. Children living in a home where domestic abuse is happening are at risk of other types of abuse too. Children can experience domestic abuse or violence in lots of different ways. They might:

  • see the abuse
  • hear the abuse from another room
  • see a parent's injuries or distress afterwards
  • be hurt by being nearby or trying to stop the abuse

Domestic abuse can happen in any relationship, and it affects young people too.

They may not realise that what's happening is abuse. Even if they do, they might not tell anyone about it because they're scared of what will happen, or ashamed about what people will think.

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5. Immediate Danger

Women should be advised if they are or feel in immediate danger to call 999.

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6. GP Role

As a healthcare professional, and possibly the first or only agency a patient experiencing violence may contact, your reaction to their disclosure is crucial. It is important to recognise that domestic violence and abuse is a widespread problem that cannot be ignored. Everyone has the right to live their life free from fear, intimidation, violence and abuse and therefore:

  • Incorporate routine enquire with all female patients over the age of 16 where safe and appropriate to do so
  • Treat all reports of domestic violence and abuse seriously
  • Listen and believe
  • State the abuse is not their fault
  • Remain calm, even when the descriptions of violence are graphic
  • Provide appropriate, sensitive responses to those using our practice who are experiencing domestic violence and abuse

Routine Enquiry

See AAA Model-Tackling Domestic Abuse in General Practice

Routine enquiry involves asking all women seen alone at assessment about abuse regardless of whether there are any indicators or suspicions of abuse.

Ask the question-

  • Directly
  • Without conveying discomfort
  • From a position of sympathy
  • With the aim of supporting her
  • With an understanding of the dynamics in an abusive relationship
  • WHEN THE PATIENT IS ALONE

Direct questions, such as:

  • Has anyone ever hit you? Who was it? What happened? When?
  • What help did you seek?
  • Are you ever afraid at home or in your relationship?
  • We know that domestic abuse affects many women, are you experiencing any violence or abuse at home?
  • Have you been pressured or made to do anything sexually that you did not want to?

Dealing with Disclosure
It is essential to promote an open, non-judgemental approach to anyone disclosing that they are experiencing domestic violence and abuse and those interventions are person centred and offer choices. The priority is to protect the person experiencing domestic violence from further harm not to fix or end a relationship.

If a patient discloses they are experiencing domestic violence or abuse:

  • Respond appropriately, sensitively and from a position of sympathy:
  • Offer contact cards/leaflets if safe to do so.
  • Contact Leeds Domestic Violence Services or other appropriate agency to assist with risk assessment and safety planning.
  • Consider the potential risks posed by a violent family member, not only for the victims but also for children and other family members
  • If there are any concerns regarding children or adults at risk staff will contact the appropriate Safeguarding Agency.
  • In case of an emergency those at risk will always be encouraged to ring 999.

Confidentiality and Record Keeping

Discussions with patients who disclose domestic violence and abuse, and any actions agreed must be documented. Domestic violence is often difficult to prove and information may be required for evidence in legal proceedings and Domestic Homicide Reviews, therefore:

  • Any disclosure of domestic violence and abuse must be recorded on the patients’ records, along with details of the abuse and any action taken.
  • Any disclosures of domestic violence and abuse will be dealt with confidentially
  • Confidentiality will only be breached if it is felt that someone is at risk of significant harm if the information is not shared or there are other safeguarding or legal issues that compel staff to disclose information to others
  • The limitations of confidentiality will always be discussed and explained to those making a disclosure of violence or abuse
  • Complete a DASH risk assessment and refer to the Multi-Agency Risk Assessment Conference MARAC

Safeguarding

Consideration of all safeguarding measures must be taken into account; a referral to Children’s Social Work Service or adult Social Care must be made when safeguarding concerns arise

Children Social Work Service
Monday to Friday 9.00 to 17.00 hrs
Duty & Advice Team (for Practitioners) 0113 3760336
Out of Hours 0113 5350600

Record of Contact form

Adult Social Care
Monday to Friday 08.00 to 18.00 hrs Contact Centre: 0113 222 4401
Out of Hours 07712106378

Referral Form

Male Victims

When a man presents as a victim it is important to assess them because it is important to assess their needs appropriately and there may be other family members at risk.

  • He may be the victim- someone who has been abused by a current or ex-partner and in need of legal practical protection and emotional support.
  • He may be the perpetrator – someone who has been using controlling or violent behaviour with a current or ex-partner and may need perpetrator intervention.
  • He may be a victim who has used violence to protect himself.
  • He may be a perpetrator whose victim has used violence to protect herself.
  • Explore the relationship and consider which category he may fit.
    Who does it seem feels intimidated, frightened and wary?
    What is the history of the relationship and each partner’s experience of abuse?

The Respect toolkit contains useful questions to ask and can be downloaded at www.respect.uk.net

There is local specialist support available for Health Care Professionals from the Leeds City Council Domestic Violence Team; ask for the Health and Domestic Violence Coordinator. Tel 0113 3789682

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7. Leeds 24 Hour Helpline

Leeds Domestic Violence 24 Hour Helpline provides help for all victims of abuse in Leeds aged 16 or older. Refuge accommodation (for women) and outreach and advice for all can be accessed via this number.

Telephone: 0113 246 0401

https://ldvs.uk/

Referral form can be found at https://ldvs.uk/resources/

See box 3 for useful contacts and further information/training.

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8. Multi Agency Risk Assessment Conference (MARAC)

A domestic violence MARAC is a meeting of relevant multi-agency professionals who provide or influence the provision of services. The MARAC process provides a structured response to high risk cases of domestic abuse through a partnership approach. It allows all relevant statutory and voluntary agencies to give a consistent and structured response to managing high risk cases of domestic violence. The meeting combines sharing up-to-date risk information with a comprehensive assessment of a victim’s needs, and seeks to link those identified needs directly to the provision of appropriate services. Services are considered for all those involved in a case: victim, children, suspect and any other vulnerable persons in the household.

The aims of the MARAC are to:

  • share information to increase the safety, health and well-being of victims; adults and their children;
  • jointly develop and implement a risk management plan to reduce the risk of harm that provides professional support to all those at risk;
  • determine whether the perpetrator poses a significant risk to any particular individual or to the general community;
  • improve support for staff involved in the very high risk domestic violence and abuse cases;
  • identify those situations that indicate a need for the Local Safeguarding Children Board Child Protection procedures to be initiated;
  • identify those situations that indicate a need for the Local Adult Safeguarding procedures to be initiated;
  • reduce repeat victimisation and
  • improve agency accountability.

The responsibility to take appropriate actions rests with individual agencies; it is not transferred to the MARAC. The role of the MARAC is to facilitate, monitor and evaluate effective information sharing to enable appropriate actions to be taken to increase public safety.

The ownership of information is not transferred to the MARAC. Information shared at a MARAC is solely for the purposes of risk management.

Agencies do not and should not wait until a case has been discussed at MARAC before taking action, giving advice or providing access to services. Information regarding immediate and interim actions and information provided can be subsequently discussed at a MARAC.

Partner agencies will use the Safe Lives Risk Assessment in cases where there has been a disclosure of domestic violence and abuse

SafeLives Dash Risk checklist

SafeLives Dash Risk Form

MARAC Referral Form

Please return MARAC Referral form and Safe Lives Risk Assessment to:
ld.domesticabuse@westyorkshire.pnn.police.uk and ldvs.fdsh@lwa.cjsm.net

Leeds MARAC Coordinator:
Tel: 0113 3760292

MARAC LEAFLET- https://www.leeds.gov.uk/domesticviolence/Documents/MARAC leaflet - English.pdf

This leaflet is available in different languages and can be found at https://www.leeds.gov.uk/domesticviolence/maracs

SAFE LIVES
http://www.safelives.org.uk/gp

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9. Referral to Social Care

Consideration of all safeguarding measures must be taken into account; a referral to Children’s Social Work Service or adult Social Care must be made when safeguarding concerns arise

Children Social Work Service
Monday to Friday 9.00 to 17.00 hrs
Duty & Advice Team (for Practitioners) 0113 3760336
Out of Hours 0113 535 0600
Record of Contact form

Adult Social Care
Monday to Friday 08.00 to 18.00 hrs Contact Centre: 0113 222 4401
Out of Hours 07712106378
Referral Form

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