Practice blog

Violence in young people’s relationships – Reflections on two serious case reviews

Dr Christine Barter is a Reader in Young People and Violence Prevention in the Connect Centre for International Research on New Approaches to Prevent Violence and Harm, at the University of Central Lancashire. In this blog, Dr Barter reflects on what professionals can learn from two serious case reviews regarding the deaths of two young women aged 16 and 17 years respectively, who were murdered by their partners. For an audio version of this blog, visit our Soundcloud profile or scroll down to the bottom of the page.

In 2016 two serious case reviews occurred due to the deaths of ‘Lucy’ and ‘Jayden’, aged 16 and 17 respectively, who were murdered by their partners. The reviews showed that both young women experienced very high levels of coercive control alongside other forms of intimate violence. The review into the death of ‘Lucy’, who was pregnant at the time, documented a relationship which started when she was 15 and quickly became controlling and abusive, with her teenage partner banning her from going out alone or seeing friends and family, stopping her wearing make-up and telling her how to dress, accompanied by incidents of physical violence. Jayden’s abusive relationship followed a similar path.  

Unfortunately, these are not isolated incidents. We know from national and international evidence that abuse and violence in young people’s relationships represents a substantial problem. A recent evidence synthesis (Stonard et al 2014) which brings together findings from high resource countries, including the UK, demonstrates the magnitude of the problem: 

  • Half of all young people (irrespective of gender) reported emotional abuse, most often being shouted at and/or called names 

  • One fifth (irrespective of gender) reported physical violence – although a greater proportion of females report severe physical violence 

  • A third of adolescent girls and a quarter of boys reported sexual violence through pressure or physical force - higher rates for girls if only physical force is included in the definition.  

  • Between 50-70% of all young people, reported experiencing abuse through new technologies most often controlling behaviour and surveillance through messaging or social networking sites -  although pressured sexting was most commonly reported by girls.  

Research which addresses both prevalence and impact shows that girls more frequently report a negative subjective impact, and more physical injuries, compared to boys. In our interviews with young people, girls repeatedly reported feeling too scared either to challenge the control and abuse or to end the relationship due to the possible repercussions (Barter et al 2009; Wood et al 2010; Barter et al 2015). Boys rarely reported this worry and most stated they would simply end a relationship if their partner didn’t stop.   

However, girls’ fears are not unfounded. At the time of their deaths Lucy was attempting to leave the relationship and Jayden had recently separated from her abusive partner. We know from adult survivors that these are the most dangerous periods. It is therefore imperative that age specific safety plans are in place. The NSPCC and ATL have produced an age appropriate plan which includes discussions with the young person around safe adults and peers.  

The serious case reviews also highlight that Lucy and Jayden experienced additional vulnerabilities and challenges.  However, professionals in both cases failed to see them as children requiring protection with significant risks in their lives and instead positioned them as difficult adolescents. Research has identified a range of risk factors which increases a young person’s vulnerability to relationship abuse including: domestic violence and child abuse; attitudes which normalise violence including gender roles; anti-social peers; psychological factors – including low-self-esteem; bullying; early sex, and alcohol and drug use. 

In addition, US longitudinal studies show that young women victimised in adolescent relationships are significantly more likely to experience domestic violence in adulthood. Some young people also experience specific risk factors including young mothers, young people in same-sex relationships and young people who may be at risk of forced marriage or honour based violence.  

Professionals need to recognise the impact of these risk factors and understand that being in a controlling and abusive relationship will have an impact on a young woman’s ability to recognise the abuse, and affect their decision making.  

These dynamics mean that assessments and practice responses need to respond to the different risk and needs of young survivors. However, practice developed in this area has been slow and although some resources, such as Young People's version of DASH Risk Identification Checklist or the Duluth Teen Power and Control Wheel, are available we remain unsure how effective these tools are.  

SafeLives have produced a useful resource based on their own practice experience with young women which stresses the importance of: building a rapport before entering discussing about what healthy relationships/norms look like; exploring with the young person how their own relationships reflect these components and highlighting professional concerns and their reasoning behind these. Other useful recourses include a web-based tool developed and produced by young people.

We can’t simply dictate to young people what to do, they have had enough of that from their abusive partners. We need to work collaboratively with young survivors over time to break down the barriers their partners have erected around them by supporting survivors to realise this is not ‘normal’ or their fault and by providing new routes to self-esteem away from their harmful relationships.

Keep an eye on our Spotlight page for more insight, resources, and to add your voice to the conversation

Barter, C., McCarry, M., Berridge, D. and Evans, K. (2009) Partner Exploitation and Violence in Teenage Intimate Relationships, London, NSPCC.  https://www.nspcc.org.uk/globalassets/documents/research-reports/partner...

Barter, C., Stanley, N., Wood, M., Aghtaie, N., Larkins, C., Øverlien, C., ... Lesta, S. (2015). Safeguarding Teenage Intimate Relationships. http://stiritup.eu 

Stonard, K., Bowen, E., Lawrence, T. and Price, S. A. (2014) The relevance of technology to the nature, prevalence and impact of Adolescent Dating Violence and Abuse: A research synthesis. Aggression and Violent Behavior, 19 (4), pp.390–417. 

Wood, M., Barter, C. and Berridge, D. (2010) Standing on my own two feet: Disadvantaged young people and partner violence. London, NSPCC. https://www.nspcc.org.uk/globalassets/documents/research-reports/standin...  

Stonad, E.  (2016) The role of New Technology in adolescent Dating Violence and Abuse , PhD, Coventry University

Living with domestic abuse as an ACE (adverse childhood experience)

Dr Kat Ford is a researcher at Public Health Wales. In this blog, she talks about the importance of considering adverse childhood experiences (ACEs) when responding to domestic violence.

For an audio version, scroll down to the bottom or visit our Soundcloud page.

Growing up in an environment where domestic violence and abuse (DVA) occurs is likely to be a traumatic and stressful negative experience. Children growing up in these environments can experience feelings of blame and responsibility, and negative impact on their social development and relationships that can lead to lasting harms such as the uptake of risk taking behaviours (e.g. smoking and alcohol use)[1]. Yet children exposed to DVA may have also experienced other stressful adversities in their lifetime.

An increasing number of studies around the world have identified that certain adverse experiences during childhood can have long-term negative impacts on our health and wellbeing. The term adverse childhood experiences (ACEs) is used to describe these and includes experiences that directly hurt a child (e.g. physical, sexual or emotional abuse) or affect them through the environment in which they live. This includes growing up in a household where: domestic violence, parental separation, mental illness, alcohol abuse, or drug abuse is present, or where someone has been incarcerated.

The early years of our lives are critical for our development, including brain development and how we learn empathy and trust. If children experience chronic stress and trauma, the way their brain develops is altered as they become ‘locked’ into a higher state of alertness in preparation for experiencing future trauma. This can result in: a ‘wear and tear’ effect on their body thus increasing risks of disease; psychological problems such as anxiety; and the adoption of harmful behaviours such as smoking, heavy alcohol consumption and early sexual activity. Children raised in environments where violence, assault and abuse are common will often come to believe this behaviour is normal and therefore find it difficult to establish and maintain healthy relationships.

In 2016 Public Health Wales conducted the first survey of ACEs in Wales. It highlighted that ACEs are common, with almost half the population in Wales experiencing one and 14% experiencing four or more[2] ACEs. Figure 1 shows the prevalence of ACEs among adults in Wales.

FIGURE 1: Prevalence of ACEs in Wales

There is a cumulative impact of ACEs. Compared to someone with no ACEs, someone with 4 or more is more likely to experience a range of negative outcomes in adulthood. For example, they are 16 times more likely to perpetrate violence and 20 times more likely to be incarcerated at some point in their lifetime.

Many people experience ACEs but go on to lead productive and healthy lives. Protective factors (i.e. that mitigate risks), such as one or more stable caring child-adult relationship, feeling you can overcome hardship and guide your own destiny, feeling involved and connected with others, and having the skills to manage your own behaviour and emotions can build resilience, which allows individuals to grow and endure crisis and stress. Enhancing these protective factors, and taking a trauma-informed approach (i.e. understanding and integrating knowledge on the trauma a person has experienced) in response to individuals experiencing ACEs including DVA, has been shown to mitigate and prevent negative outcomes.

Preventing ACEs or reducing their impacts in one generation can also benefit future generations. The Welsh Government has prioritised tackling ACEs, defining them as a major threat to well-being and economic prosperity in Wales[3]. In South Wales a unique collaboration has been developed to use the research evidence surrounding ACEs to develop policies for prevention and early intervention, aimed at reducing ACEs and supporting those affected by them. Public Health Wales, the Police and Crime Commissioner for South Wales, South Wales Police (SWP), National Society for the Prevention of Cruelty to Children (NSPCC) Cymru, Barnardos and Bridgend County Borough Council are partners on the Early Intervention and Prevention Project; a two year project funded through the Police Innovation Fund.

By viewing the policies and strategies for DVA through an ACE lens we would be able to not just treat the symptoms, but hopefully break the generational cycle of harm and adversity.
 

Listen to this blog post

 

Useful resources:

Report: ACEs and their association with chronic disease and health service use in the Welsh population

Report: ACEs and their association with mental wellbeing in the Welsh adult population

Report: ACEs and their association with health-harming behaviours in the Welsh adult population

 

Keep an eye on our Spotlight page for more information and guidance on supporting young people affected by domestic abuse.

 

 

[1] Safelives 2015

[2] Bellis, M.A., et al. (2016). Adverse Childhood Experiences and their impact on health-harming behaviours in the Welsh adult population. Cardiff: Public Health Wales NHS Trust. Available from http://www.wales.nhs.uk/sitesplus/888/page/88504

Understanding disabled women's experiences of domestic abuse

Dr Ravi K. Thiara is a principal research fellow at the Centre for the Study of Safety and Wellbeing, University of Warwick. In this blog she discusses how the concept of intersectionality can help us to understand the ways in which disabled women experience domestic abuse, and how services can help to remove barriers to access. 

Gender and disability affect the risk of domestic violence and abuse (DVA) and how it is experienced in our society. Research in the UK, albeit limited, and elsewhere makes the consistent suggestion that disabled women are more likely to experience DVA and that they endure DVA which is more severe, more frequent and lasts for longer periods. They are also subjected to DVA in additional ways, where disability specific abuse leads to increased power and control, which multiplies the vulnerability and isolation they are likely to experience. These factors combine to create greater barriers to escape. According to Public Health England (2015), 15.7% of disabled women had experienced DVA in the last year compared to 7.1% of non-disabled women (8.4% of disabled men had experienced this compared to 4% of non-disabled men).

It is often said that the way in which we understand an issue affects the solutions we seek for it. In explaining DVA in disabled women’s lives, both the ‘social model’ and the concept of ‘intersectionality’ are particularly helpful.

The ways in which disability is defined and explained remain highly contested. However, the social model, developed by disability activists to contest the medical model which held sway for many years, argues that disability is socially constructed and the problems experienced by disabled people result from socially disabling attitudes and practice, which aggravate the impact of a person’s physical condition. Thus, disability is the interaction of the impairment with social and environmental restrictions and the way that society is organised, not the impairment itself, excludes disabled people from full participation in society.

Intersectionality refers to a way of understanding the interconnected nature of the social categories of gender, race, class, age, and dis/ability, which create unique and complex experiences of oppression and discrimination and of power and privilege. This intersection is key to understanding both the positioning of groups in society as well as individual experiences, which are complex and contradictory.

For example, knowing that a woman lives in a sexist society is not enough to describe her experiences and we have to also consider her race/ethnicity, dis/ability, class etc, along with societal attitudes toward each of these, to fully understand her position within society. Intersectionality allows us to examine how both power and marginality operate, as relational processes, across the major social categories and systems of domination and also within each one.

For example, without being too simplistic, if we look at white men across race and gender systems, they generally have power over black men and over black and white women; black men are marginal to white men and white women but have power over black women. Of course, factors such as class and dis/ability further complicate this. What this suggests is that the re/production of power and privilege and of marginality is not a simple linear process but complex and contradictory. It is also reflected at the material and discursive levels (how we ‘speak’ about these), which in turn is reflected in policies and practices. Thus, as noted at the start, the ways in which gender and disability are structured in society impact the risk of DVA and how it is experienced. 

A study involving women with physical and sensory impairment found that they experienced multiple forms of violence across the life course from multiple perpetrators. For women, being disabled significantly worsened the abuse they were subjected to and abusers commonly used women’s impairments to perpetuate particular kinds of abuse, including ridicule and insults about the woman’s condition. Abuse was especially acute where the abusive partner was also the carer, and increased power and control over women as well their neglect.

Disabled women spoke about how abusive partner-carers presented themselves as ‘caring heroes’ to outsiders but in fact used this to exert greater damage, also making it harder for women to ‘name’ abuse and to do anything about it. A woman described the collusion of agencies and professionals thus: “People pity him because he is taking care of you… people are reluctant to criticise this saint or to think he could be doing these terrible things.” The representation of abusive partner-carers as ‘caring heroes’, combined with the dominant construction of disabled women as asexual, serves to reinforce abuse in women’s lives.

Disabled women in this study gave the following tips for improving responses to their experiences of DVA:

  • Be informed about disabled women’s needs.
  • Take advice from / consult disabled women.
  • Provide accessible well-publicised DV services that disabled women know about:  tell women about them!
  • Do not threaten women with institutionalisation.
  • Develop disability equality schemes with input from disabled women.  Write us into the strategies.
  • Take disabled women seriously and do not patronise us.

Given the widely reported barriers encountered by disabled women experiencing DVA in accessing support, services can address this through:

  • Address lack of knowledge and understanding about disabled women’s experiences and needs to better recognise and respond.
  • Training on the issues for all professionals.
  • Improve accessibility through internal scrutiny.
  • NICE guidelines – introduce strategy to overcome barriers; better screening by health and social care and referral to specialist support services.
  • Integrated response across major service providers – increase opportunities for disclosure, referral and support.
  • Involvement of and engagement with disabled women.

Keep an eye on our Spotlights page for more content and guidance around supporting disabled victims of domestic abuse.

Recognising and supporting disabled victims of domestic abuse

Ruth Bashall is the Director of Stay Safe East, an organization run by disabled people which supports disabled survivors of domestic and sexual violence, hate crime and other abuse, and works for change in policy and strategies at London and national level. For more information about our work, including our training programme, please contact director@staysafe-east.org.uk

Ruth is writing about her and Stay Safe East’s reasons for the discrepancy between the high levels of violence disclosed by disabled women, and the low percentage of disabled women referred to Maracs. Recognising domestic violence against disabled women: the key to increasing Marac referrals. 

Stay Safe East’s experience shows that change can happen, if agencies recognise the particular forms that violence against disabled women may take, and if agencies focus not on vulnerability but on disabled women as victims of gender and disability based abuse. In Waltham Forest, one of the London boroughs where we work, 24% of referrals to Marac are for disabled people, of which around 90% are women. 

By disabled women, I mean women who face barriers and exclusion because of society’s response to our having an impairment – be it physical, sensory, a learning disability, a mental health condition, neuro-diversity or a long-term health condition.   

Yet how often is the fact that a woman is disabled identified before a Marac meeting? If we do not know that survivors are disabled, we will not be able to meet their needs. We may even not be able to communicate with them. Agencies making Marac referrals must identify the individual communication, access or support needs and share this information on the Marac referral form. If this doesn’t happen, the best opportunity to engage with the survivor may be lost. 

Secondly, we need to understand what is different about domestic abuse against disabled women. Of course we experience much of the same range of physical, psychological and financial abuse as other women, but the specific circumstances of our lives mean we also face specific disability related abuse (some of which I would also call hate crime) or abuse where the perpetrator(s) uses our impairment to their advantage.

To give an example (case studies are based on our clients’ experience but some details have been changed):

Asha is a 57 year old woman with long-term mental health issues who lives with her adult son and daughter-in-law. Her son manages her medication. At times she is overmedicated and virtually sedated, at other times he refuses to let Asha have her meds, so they are no longer effective in dealing with her symptoms. He confuses Asha by moving things around, she thinks she is losing her mind. He insults her, calling her ‘schizo’, threatening to tell the neighbours she is mad. She is now struggling to make decisions and is becoming more and more afraid and depressed.      

Changes to domestic violence legislation to include coercive control can potentially help professionals to identify more easily how specific abuse against disabled women may manifest itself in a variety of ways. For example:  

a. The abuser controls the victim through their impairment or support needs for example by:

  • Denying access to mobility or communication aids, food or medication
  • Controlling communication for example by acting as a Deaf woman’s communicator
  • Refusing external assistance or a support package
  • Forced feeding or other forms of rough ‘assistance’

b. The abuser uses the life experiences of the disabled woman to control her, for example:

  • Persuading her she should accept a marriage because ‘no one else will want a disabled woman’ . ‘If you leave, they will put in you in a home’- the threat of institutionalization is the most powerful threat to any disabled women. Threats to ‘out’ someone as disabled e.g. mental health, HIV, epilepsy, learning disability are also frequently used, and given the stigma attached to some impairments, are also powerful. 

c. The abuser uses the discrimination faced by disabled women to control the victim:

  • Inaccessible environments make escape impossible from her own home and there are few accessible refuges
  • Inaccessible reporting processes (Our Deaf clients rarely know about the 999 SMS service until we tell them about it)
  • Her lack of knowledge of support services because information is not accessible to her, or she cannot identify with those services (‘it’s not for me, it’s for women who are not disabled)
  • Less support for disabled people to live independently
  • Fear that her children will be removed

A disabled abuser will also manipulate assumptions about disabled people not being perpetrators themselves.

If we do not understand the many forms which disability related domestic violence takes, we do not understand the risk. Disabled women may score low on the risk assessment so do not meet the threshold for automatic Marac referral. Professional judgements may be skewed by assumptions about the perpetrator ‘caring’ for the victim. Stay Safe East has developed a simple risk assessment which covers all the issues above. If you would like to know more, and would like some training around how to use it, please contact us.

We must see disabled victims of abuse as just that: victims/survivors, rather than defining them by their disability. The reason we are more at risk is that we have less power and fewer choices in our lives, and face many more barriers to accessing support.

Case study:

Maria, a disabled woman, is denied access by her partner to the specialist nurse for her condition; the partner refuses to have handrails installed in their home. She stops Maria from using a walking stick, and Maria tries to walk without it, mocks her walking and tells her to stand up straight, knowing she will fall and hurt herself. Her partner has pushed and shoved Maria but never hit her- she doesn't need to, the falls Maria has had over many years were put down to ‘accidents’ due to her impairment. Maria’s partner controls her money, and Maria cannot leave the house without her partner’s help as the access is poor. Her partner has threatened to disclose their relationship to Maria’s family. A safeguarding alert was raised by the specialist nurse but the investigation found that there were no concerns, except that Maria needed access to Dial-a-Ride to get to appointments.    

Across the UK, since the implementation of the Care Act, adult safeguarding now has a duty to consider domestic violence; even where a disabled woman is subject to adult safeguarding, domestic violence protocols must be followed . It can work - Stay Safe East has now developed a positive partnership with our local adult safeguarding practitioners, working together to keep victims safe.   

Disabled people come into frequent contact with statutory services – adult social care, health, housing, mental health – but if those services are not trained to recognise or ask about abuse, why would a disabled victim speak out?  We recommend that social workers, health professionals and housing officers see disabled clients alone, not with a family member present.

Additionally, we need to ensure that when a disabled person comes into contact with us as professionals, whether Idvas or other domestic violence practitioners, police, adult social care, children’s services, health or housing, they get a response which will help them to make decisions about keeping safe. Appropriate referral to Marac is only one part of that process, but it is an essential one. Get this right and we start to break the barriers to effective safeguarding of disabled victims and survivors.

Keep an eye on our Spotlight page for more blogs, guidance and resources for supporting disabled victims of domestic abuse. 

Disability and domestic violence

Dr Justin Varney is the National Lead for Adult Health and Wellbeing at Public Health England. In this blog, he talks about the ways that people living with impairments are affected by domestic abuse, and the ways in which barriers to accessibility further disable individuals seeking help.

For an audio version of this blog, scroll down to the bottom of the page.

About 1 in 5 of the population live with an impairment which leads to them being disabled in their interactions with the world around them.

Impairments are not always inherited or congenital at birth, but can be acquired throughout the life course. The proportion of adults with an impairment increases with age. Around 6% of children have an impairment, compared to 16% of working age adults and 45% of adults over state pension age[i].

In 2015 Public Health England published a report on disability and domestic violence. The report reviewed the published evidence and statistical information about domestic violence affecting disabled people. It highlighted that disabled people experience disproportionately higher rates of domestic abuse. They also experience domestic abuse for longer periods of time, and more severe and frequent abuse than non-disabled people[ii][iii].

The differences between genders in experiences of domestic abuse are similar among disabled people. Disabled women are significantly more likely to experience domestic abuse than disabled men and experience more frequent and more severe domestic abuse than disabled men[iv]. However, as being disabled carries further risk of domestic abuse, disabled men also experience higher rates of abuse than non-disabled men. Disabled men experience a similar rate of domestic abuse as non-disabled women[v].

People with disabilities may also experience domestic abuse in wider contexts and more often from significant others, including intimate partners, family members, personal care assistants and health care professionals. Disabled people encounter differing dynamics of domestic abuse, which may include more severe coercion, control or abuse from carers. Abuse can also happen when someone withholds, destroys or manipulates medical equipment, access to communication, medication, personal care, meals and transportation.

Domestic violence is one of those topics for disabled people that society tends to shy away from. Much of the data and the evidence in the report was not new, and the disproportionately higher levels of domestic violence were clearly visible in the data. Yet this is not a topic that we hear much about.

Society tends to avoid discussion of disabled people’s relationships, particularly their sexual relationships, and it may well be that domestic violence falls under this curtain of paternalistic discretion. But we are doing disabled people a major disservice by not acknowledging their sexual and reproductive health and wellbeing, and talking about issues of domestic violence and sexual abuse is a key part of this.

This invisibility and avoidance has implications beyond the individual interactions for people enduring or perpetrating domestic violence, as the exclusion of disabled people in domestic violence discourse extends to research and many data collections and surveys. This invisibility in the research and evidence base further compounds the marginalisation of disabled people’s experiences of domestic violence, and makes it harder for services to be commissioned or provided with their needs in mind.

Not only do disabled people experience higher rates of domestic abuse, they also experience more barriers to accessing support, such as health and social care services and domestic abuse services. The poor accessibility of services is one of the barriers that creates the disability for the individuals living with the impairment. The lack of a sign language translator, information which is not available in audio or large print, or a staircase only entrance, all disable the individual from engaging with services in the same way as people without impairments.

Accessibility barriers can also be cultural: if staff aren’t trained to consider the needs of people with impairments and if they aren’t trained about domestic violence, then they will not be able to support the people who need them most.

Closing the gap will require whole system approaches to inclusion and diversity, which ensure all services working with people with impairments across their life course are educated about domestic violence and abuse. It will also require that services for people enduring and perpetrating domestic violence are accessible for people with impairments.

Alongside addressing the access and education issues in services and providers, it is also important that this issue is visible in the social narrative and discussions within disability communities.

Although many impairments happen in adult life, it is essential that those who have an impairment in childhood are given the tools to negotiate healthy relationships. Relationship education within special schools should explicitly discuss coercion and control in the context of relationships and should be empowering young people with impairments to have healthy and safe sexual and reproductive lives.

The issue of domestic violence affecting people living with impairments is one where the lack of awareness, barriers to accessibility and a prevailing reluctance of society to acknowledge sexual relationships in this community further disables those affected by domestic violence and abuse.

Keep an eye on our Spotlights page for all the latest podcasts, blogs and other content in our series on disabled people and domestic abuse.

 

 

[i] Department for Work & Pensions, Office for Disabilities. Statistics: Disability facts and figures. Department for Work & Pensions, Office for Disabilities, 2014

[ii] Prevalence of abuse of women with physical disabilities. Young, M. et al. 1997, Archives of Physical Medicine and Rehabilitation, Vol. 78, pp. 34-38

[iii] Partner violence against women with disabilities: prevalence, risk and explanations. Brownridge, D. 2006, Violence against women, Vol. 12, pp. 805-822.

[iv] Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Cohen, M. et al. 8, 2006, Annals of Epidemiology, Vol. 16, pp. 644-651.

[v] Flatley, J., et al. Crime in England and Wales 2009/2010: Findings from the British Crime Survey and police recorded crime. London : Home Office, 2010.