Practice blog

Top tips: 'Asking the question'

This content originally appeared in our newsletter between April and May 2014 and reflected our views at the time. Caada is the previous name of SafeLives.

To encourage a young person to share details about their personal life and the abuse they are experiencing, you first need to build a relationship with them, explains Jill Prodenchuk, Senior Regional Development Officer at Caada for the Young People's Programme.

Creating a suitable environment for disclosure

  • Remember that it may take a few meetings before you build a relationship with the young person and they open up.
  • Always try to use a familiar location where the young person will feel comfortable opening up to you, taking into account any safety concerns. For example, if you are meeting a young person at school, make sure that their partner does not attend the same school or that your meeting can be disguised as something else so that it doesn't cause suspicion.

Useful resources

Discussing healthy relationships

  • Start the conversation by discussing confidentiality. You should be clear that, in most cases, the experience of relationship abuse by a young person will be a safeguarding issue and will require a referral to the safeguarding children team. This will create transparency and clarity for the young person about how and when the information they disclose might be used and shared and it will prevent them from feeling betrayed. It's important to handle this carefully, so that the young person doesn't shut down and disengage. A practical and genuine approach will be most effective. You may wish to use words such as: If we talk about things that concern me, I will need to tell other agencies so that we can help keep you safe. How do you feel about that?
  • Young people may not be aware they are in an abusive relationship. Have a conversation about what a healthy relationship is, and then ask the young person questions such as: How do you think your relationship compares to this? Where is it similar or dissimilar?
  • Use tools to help you guide the conversation, such as the Teen Power and Control Wheel which gives a thorough list of example abusive behaviours.
  • You could discuss the young person's ideal relationship and encourage them to think about how their current relationship compares to this. For example: Describe to me what your perfect boyfriend/girlfriend would be like . Following this, ask: Is (name of partner) anything like this?
  • View an online video and encourage the young person to spot the signs of abuse, or use an online quiz and discuss the results. See links below for examples.
  • Don't be afraid to challenge young people if their understanding of what a healthy relationship is makes them unsafe.

Useful resources

  • Download the Teen Power and Control Wheel, a visual display of different types of abuse that occur in abusive relationships, developed by the National Center on Domestic and Sexual Violence.
  • Access resources including videos, quizzes and information on what abuse at the This is Abuse' website or visit The Hideout website for more resources on how to help young people understand domestic abuse and what to do if it is happening to them.

Identifying risk

  • Use the Young People's Version of CAADA-DASH Risk Identification Checklist which will guide you through a conversation with the young person to identify the levels of risk they face.
  • The outcome of the Checklist can be used to highlight to the young person that they are in an abusive relationship. It is important that this is handled in a sensitive manner. Revealing to a young person that they are at high risk of serious harm or homicide may well be frightening and overwhelming. State what your concerns are exactly by using the answers the young person gave to you and by explaining your professional reasoning/judgement.
  • Explain to the young person what the next steps are to be, eg risk management; safety plans; referrals to children's safeguarding teams and a Multi-Agency Risk Assessment Conference (Marac). In every case that is referred to a Marac, a referral to children's social care should also be made.

Useful resources

  • Access the Young People's Version of CAADA-DASH Risk Identification Checklist.
  • Read the accompanying Frequently Asked Questions.
  • Access the Young People's Programme care pathway and the accompanying guidance.

We would also like to include special thanks to Young People's Violence Advisors: Shirin Taherzadeh and Amy Byrum for their input in composing this guidance.

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By Kate

Top tips: Working with victims of gang violence

Conflict is inevitable in young people's lives, but practitioners can empower young people to understand and manage it, says Nik Pitcher, Senior Trainer at Leap Confronting Conflict and the organisation's lead for the Young People's Programme.

Here, Nik gives some advice to help practitioners engage young women affected by gang-related abuse.

  • Help young women to understand risk. When supporting young women, it is important to first understand what they feel they are gaining from a gang relationship. You will also support them by helping to define what abuse means, and what the potential risks of being associated with a gang member are. Help them understand how to make informed choices to reduce risk.
  • Build resilience and strength. Our research suggests just one positive, non-abusive relationship in which a young woman's authenticity, life experience, skill, ability and achievements are affirmed can significantly increase self-esteem and self-efficacy. That one person could be you.
  • Address multiple factors. A comprehensive and holistic service is needed to address the issues of immediate safety, physical, emotional, sexual and mental health, parenting, drug and alcohol awareness, education and employment. You can also help young women by providing space to affirm self-image and build confidence and esteem.
  • Provide trusted support. Tackling negative relationships needs to happen on two levels: by establishing trustworthy and supportive relationships between you and the young women you work with, and by supporting young women to reflect on their current and previous experiences. It is particularly important to offer a female-only space to talk about and tackle the difficult challenges of rape and sexual exploitation.
  • Engage with immediate family. Girls and young women who are siblings of young people actively involved in gang activity cannot be forgotten. They are relatively easy to identify and they need targeted support to help them deal with their situation.

Find out more

This content originally appeared in our newsletter in January 2014 and reflected our views at the time.
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By Kate

Top tips for Marac coordinators

This content originally appeared in our newsletter between July and October 2013 and reflected our views at the time. 

From administrative to strategic management duties, Marac coordinators can cover a whole multitude of roles. Coordinators from across the country offer their top tips for effective working.

Building awareness

Creating promotional materials
“As part of my role, I'm responsible for identifying and engaging with new agencies to ensure they're represented at Marac. To help with this, I've put together a leaflet and poster, asking professionals to 'Remember Marac', which explains what the Marac is and how to refer in a case. I have circulated these to all Marac representatives and asked them to leave them in key places around their offices to help encourage a wide range of agency referrals.” Beth Aynsley, Cardiff

Holding events
“I've been a coordinator for five years now, and helped to set up the Marac process in this area. We've had good relationships with agencies throughout this time, and I think one of the things that has helped this are the ongoing Marac awareness events, which we run twice a year. This helps to promote Marac within agencies: particularly those where staff turnover is high. It gives a real insight into domestic abuse and Marac, and explores how partner agencies fit into the process. Where appropriate, we also invite survivors who have been through the Marac process themselves to speak, which really helps to emphasise to attendees why they should be referring into Marac. I also follow this up with specific team training for agencies if they require it.” Pip Burrows, North Worcestershire

Training and collaboration

Be visible
“In Cumbria we are always looking to recruit other organisations who may benefit the Marac process, as well as increase referrals. Delivering free training throughout the county and attending team meetings to raise awareness has helped to increase the number of referrals we receive.” Joanne Belas, Cumbria

A point of contact
“My role is really varied: I obviously work closely with our main partner agencies, but I also liaise with a wide range of potential referral agencies. While communication and organisation are key, collaborating with such a large number of teams means it's the little things make a huge difference too: always being available as a point of contact for any queries, giving positive feedback when things have worked well and generally making the Marac meeting a comfortable and welcoming environment can really help. Biscuits always go down well too – especially chocolate!” Sonia Knight, West Sussex

Local links
“In addition to a regional Humberside steering group, here in North Lincolnshire we regularly hold one at a local level too. This means that our key agencies can all input into any decisions that are made regarding the running of the Marac. I think this helps to make everyone feel as though Marac is something that belongs to us all and is a big support to me as coordinator.” Kristy Burns, North Lincolnshire (Scunthorpe)

Before and after the meeting

Engaging with agencies
“I check outstanding actions and chase agencies prior to the meeting by emailing them a copy of their outstanding actions. Similarly, if the number of referrals seems low, I often send a polite reminder to agencies informing them of the cut-off date and inviting them to submit their referrals.” Karen Lolotte, Suffolk

Planning ahead
“All the reps are given the dates for the following year's Marac meeting every October, so they can plan ahead more easily and ensure they are available to attend.” Alan Thompson, Oxfordshire

Feeding back
“I record statistics on all Marac cases for our strategic public protection unit, such as contributory factors and case analysis (whether it's a repeat, how many children are in the home, pregnancies, vulnerable people etc). I also provide a breakdown according to whether the victim is from a BAMER community, identifies as LGBT, is disabled, whether they are male and, more recently, if the victim or perpetrator is aged 16–17 years. This information is then used to review local services by our strategic group.” Wendy Whiteley, Halton and Warrington

Multi-agency engagement at MARAC: a good practice case study

 

Gaining referrals across a range of agencies is a key indicator of a healthy Marac, but keeping so many partners in the loop can be hard. One Marac currently recording cases from all 13 referring agencies is Swansea in South Wales. For Amanda Stone (Marac Co-ordinator) and Bryan Heard (Chair), working as effectively as possible with a range of key partners is central to continued identification of, and support for, victims of domestic abuse and their families.

A single point of contact

“I would definitely say that communication is important,” Amanda, a retired police sergeant, explains. “When I was first in-post, I made sure I talked through the Marac toolkit with all the agencies we work with, so they knew exactly what was required and where to come if they had any issues. Having a single point of contact is also really important – that way, practitioners know you're only ever a phone call away, and I strongly encourage all our agencies to get in touch if they have any questions about a referral, no matter how trivial it might seem.”

Building relationships

Offering a training package for all partner agencies is a key way to increase referrals. For Swansea, it's about being proactive too: working on their initiative to reach out to partners who might not automatically think to refer into Marac. “Whenever he gets the opportunity,” Amanda says, “Bryan makes a point of setting up meetings with professionals within partner agencies we particularly want to encourage referrals from. These introductions allow us to explain more effectively what the Marac does and why it is important to refer in, as well as allowing people to put a face to a name.”

“These professionals may want to help, but might lack a full understanding of the dynamics of abuse,” Bryan explains. “Victims will have such engrained coping mechanisms that they find it incredibly difficult to leave the relationship or to disclose the abuse they're experiencing. By meeting with headteachers and GPs directly, I can explain more about the ways in which abuse manifests, using examples which are directly relevant to their roles.

“With teachers, for example, it's about asking them to look out for a child who becomes suddenly withdrawn – does mum have a new boyfriend? With doctors, we might encourage them to pay extra attention to the emotional and mental health of a patient who has presented with suspicious injuries.

“These professionals may already have an instinct that something isn't right but are unsure about what to do next. This kind of targeted discussion has really helped to drive up our referrals, as it helps them to join up the dots and gives them the confidence to take the next step.”

Referrals

The team also makes certain that all referrals sent to the Marac are added to the agenda and discussed. This ensures no cases are overlooked, and emphasises to all agencies the significance of their ongoing contribution, strengthening the multi-agency aspect of the Marac and allowing it to continue to operate successfully.

Bryan explains: “It demonstrates to the professionals making the referrals that we appreciate their concern and trust their judgement. If you were a teacher, for instance, and the referrals you were making repeatedly failed to make it through to the Marac, despite your own concerns, there could be a tendency to think, ‘I'm obviously doing it wrong – maybe I won't bother.' We work hard to convey to referring agencies that it's their gut instinct that counts. We also make sure that we keep the professional who has made the referral updated on the outcomes of the case, to reaffirm the positive impact their awareness has.”

Be consistent

Both Amanda and Bryan cite good organisation and regular attendance as other reasons for the strength of their multi-agency relationships. “We strongly encourage all agencies to attend wherever possible,” Amanda explains. “Even if the person who made the initial referral is unable to attend, we'd still advocate that another representative comes in their place.”

Bryan adds that this consistent approach is reflected in the presentation of cases. “We also make sure that cases are kept concise and relevant to ensure that each receives as much attention as the first. The cases we discuss at Marac are, by nature, very demanding; something as simple as making time for a tea break is really important as, not only does it help to stop concentration levels dropping, it also allows practitioners to get to know each other on a more informal level which, in turn, makes for a stronger Marac.”

This content originally appeared in our newsletter in May 2013 and reflected our views at the time.
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By Kate

How to run an effective hospital-based IDVA service: a best practice case study

Data gathered for CAADA's 2012 policy report, A place of greater safety , shows that victims identified through health services were more likely to reflect vulnerable, hard-to-reach groups, such as B&ME or younger patients and those with complex needs, including mental health and substance/alcohol misuse issues.

CAADA's Themis project, launched last November, has joined together with hospital-based services to find out more about the positive impacts of co-locating IDVAs in A&E and maternity units. One team taking part is The Bristol Royal Infirmary (BRI) Emergency Department IDVA service. As the city's main hospital, the BRI's A&E unit sees between 190 and 200 patients each day. Having an IDVA team based within this department ensures that victims are not only more readily identified, but that they are also offered a full care package: from immediate medical assistance and IDVA support, to alcohol/substance misuse services and psychiatric care, where appropriate. The majority of the service's referrals come from the Minor Injury Unit, with patients typically arriving at the hospital 24-28 hours after an incident has taken place.

Punita Morris, the BRI's Emergency Department IDVA Service Manager, speaks to CAADA about how she delivers an effective IDVA service within a hospital setting.

How do you ensure people are aware of your service?

“Our service is available 9am – 5pm, seven days a week, including bank holidays. Reports of domestic abuse to the police typically increase at weekends – Sundays are currently our busiest day for referrals - so it's important we're here to reflect this.

“Furthermore, having a set routine ensures that practitioners always know where to find us. We also publicise our work across the hospital: through leaflets, promotional products – such as lip balms - and gender neutral posters to reach as many patients as possible.

“Being based within the emergency department itself has a positive effect on referrals: during a recent refurbishment, we were temporarily located elsewhere and noticed a drop in the number of cases being referred.”

To what extent does training play a part in improving referrals?

“Referrals to our service work best when practitioners are confident in their ability to recognise the signs of domestic abuse. It's crucial that we're able to provide them with specific training on how to screen for domestic abuse in an empathetic manner: particularly as the BRI has a relatively high turnover of staff, on account of the continual rotation of clinicians in A&E. Being located on-site means ad-hoc ‘bitesize' sessions can easily take place when staff are available, and we're often invited to tag along to the compulsory site liaison study days. This awareness means that other practitioners will also mention our service when delivering training themselves: for instance, during Adult Safeguarding or Child Protection training.

“With so much training already taking place, there's a risk that domestic abuse can become a ‘take it or leave it' topic, so it's really important to get involved with mandatory training to ensure your service becomes better known.

“Training also provides a great opportunity to dispel those myths about victims of domestic abuse – for instance, that it only happens in low-income households – as well as a chance to engage directly with those practitioners who appear more reluctant to participate or are less aware of the topic.”

How else do you collaborate with clinicians?

“The BRI's Emergency Department sees such a large number of patients each day that it's simply not practical to risk assess every one; it's important for staff to understand how to ‘sift through' and identify patients who are potentially experiencing domestic abuse. They may approach us if patients' explanations of their injuries don't match up with the practitioner's professional judgement, and cooperate with us to separate the patient from the suspected perpetrator under the guise of a medical examination/procedure.

“We're also fortunate to be Trust employees, so we feel very much part of the team. Staff know our service and remit and, like other specialist services on site, we have pagers to ensure we're contactable whenever a referral comes in. We have access to the Emergency Department's patient management system, which means we can view all patients and their injuries as they come in and flag appropriate cases for screening to staff, enabling more interventions to be made.”

What happens when your team is not available to support a patient?

“As I mentioned earlier, the service doesn't run 24 hours a day, so handover procedures are very important. Staff undertake risk assessments for any patient arriving out of hours who is suspected to be experiencing domestic abuse, and these are stored in a dedicated folder. If the victim is shown to be particularly high risk, a bed in the observation unit will be offered to ensure an immediate place of safety, and allow them to speak to an IDVA in the morning. If this is not possible, where appropriate, the IDVA will contact the patient the following day by telephone to ensure they do not miss out on support.”

Who else do you work with?

“Within the hospital itself, we work across a number of departments outside of A&E: particularly maternity, alcohol and substance misuse specialist nurses, the psychiatry liaison team and adults' safeguarding services. The BRI's proximity to the Bristol Eye Hospital, Heart Institute and Children's Hospital means we often receive referrals from these services, so it's important to build and nurture links with health staff as much as possible.

“Where interventions are made and positive outcomes created, feeding this information back to staff is hugely beneficial, as it gives them the confidence to make referrals again in future.”

What other steps do you take to improve referrals?

“We're continually reviewing our referral processes. In the not-so-distant future, we hope to establish additional screening among groups which are recognised as having a higher prevalence of domestic abuse: for example pregnant women; those with mental health issues; those with self-harm injuries; and young women.

“Where possible, under certain circumstances, we also manually flag patient files. For instance, if the patient is discussed at MARAC and they are regularly visiting A&E with domestic abuse injuries, we are in the fortunate position of being able to physically stamp the patient's records. This ensures clinicians are immediately aware when the patient is in a potentially high risk situation, allowing them to offer information about the IDVA service and gently ask if they'd like a referral to be made. While the patient is within their rights to refuse, it plants that seed in their mind and makes them aware that the BRI A&E is a place of safety, with dedicated IDVAs who can act immediately on their behalf and provide personalised support.”

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