DOMESTIC ABUSE POLICY
Responsible Directorate:
Director of Patient Care and Professions
Date Approved
13th February 2008
Committee
PEC
Signature of Accountable Director
Print Name
Sheila Dilks
Version Control.
Document Title Document number Author Contributors Version Date of Production Review date Post holder responsible revision Primary Circulation List Web address Restrictions
Domestic Abuse Policy for Kirklees Primary Care Trust 1 Gillian Buckingham 1 December 2007 2010 for
Standard for Better Health Map.
Domain Core / Development Standard Reference Performance Indicators
Core Standard 2 First Domain Safety Core Standard 4 C13B C24
1. The percentage of staff who feel well supported in child protection practice. 2. The percentage of staff who feel professionally competent to carry out necessary child protection tasks. - The percentage of staff who attend individual and group child protection supervision.
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Contents
Section 1 2 3 3.1 3.2 4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 5 6 7 8 9 10 11
Page 3 3 5 6 6 7 8 8 8 8 8 9 10 10 10 11 11 11 12 12 12 12 13
Policy Statement Introduction Associated Policies and Procedures Aims and Objectives Aim Objectives Kirklees PCT Responsibilities Trust Responsibilities Managers Responsibilities Individuals Responsibility Training and Supervision Record Keeping Corporate Accountability Arrangements Data Collection Confidentiality and Disclosure of Information Multi-agency Partnership Linguistic Support Serious Case Review Counselling and Support for Staff Allegations Against Staff Equality and Diversity Auditing References and Bibliography
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Policy Statement. Kirklees Primary Care Trust (KPCT) is committed to ensuring patients / clients / carers receive appropriate care and support from its healthcare team. The PCT has a duty under the Children Act 2004 to make arrangements to ensure that, in discharging their functions, they have regard to the need to safeguard and promote the welfare of children, and will ensure that systems are in place to co-ordinate activities in a way that protects the best interests of all children who come into contact with services, which will include guidance for staff in all areas. The PCT recognises the serious, adverse affect that domestic abuse tends to have on children who live in affected households and the potential for both short and long term damage to their health & development. Within this context they acknowledge their child protection responsibilities (McGee C, 2000) The PCT believes that victims of domestic abuse should receive the same high standard of care irrespective of age, race, gender, culture, sexuality, religion or ability and that equality underpins all its service provision. The PCT is committed to promoting the health and well-being of clients and staff and, as such, recognises that domestic abuse is a crime, which adversely affects the health of individuals, families and communities (DOH 2002). The PCT is therefore committed to ensuring that domestic abuse is recognised, and that both clients and staff are provided with information and support to minimise their risk. In order to carry this out effectively, depends on joint working between agencies and information sharing across organisational boundaries. Through its commitment to Multi-agency and partnership working, the PCT will engage with other agencies to develop strategies and in facilitation for information sharing and collaboration in working towards the reduction of domestic abuse and, to hold perpetrators responsible. Putting in place effective inter-agency arrangements to work with children and families affected by domestic abuse is an important role of the Kirklees Safeguarding Children Board.
1.
Introduction.
Throughout this policy, we use the term ‘domestic abuse’ instead of ‘domestic violence’ wherever possible, because we are concerned that the latter might be interpreted as physical abuse only. Many people think of domestic abuse as a physical assault by a man on a woman in their home. But women’s experience of domestic abuse extends much further than that, and it can be difficult to come up with a simple description. The Inter-Ministerial Group on Domestic Violence has adopted the following Home Office definition: ‘Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality.’ (Home Office)
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An adult is defined as any person aged 18 years and over and family members are defined as mother, father, son, daughter, brother, sister and grandparents, whether directly related, in-laws or step family. The definition has been widened to incorporate violence by family members as well as between adults who are, or were intimate partners. Home Office Violent Crime Unit, Dec 2004 In accepting this definition it must be recognised that children are witness to and subject to much of this abuse and that there is some correlation between domestic abuse and child abuse. It must also be recognised that, particularly among black and ethnic minority ethnic communities, other family members may be involved or may participate in the abuse of the woman. In tackling domestic abuse against women, it is necessary to take account of the specific experiences of particular groups of women and to ensure that any action/provision is relevant and appropriate to them. The needs of women, children and young people who experience additional discriminations, e.g. black and minority ethnic women and children, women with no recourse to public funds, disabled women and children including those with learning disabilities, older women, lesbians, gypsy travelers, refugee women and children asylum seekers, women and children living in rural areas, women with mental illness or mental health issues and women with addictions should be mainstreamed through all actions and provisions. Whilst it is recognised that Domestic Abuse, is most commonly perpetrated by men against women, it is acknowledged that some men are abused by their women partners. Same sex partners, bisexual and transgender communities can also experience domestic abuse. Whilst research indicates that male victims experience of abuse is less frequent, abuse is never acceptable, regardless of the gender of the victim or the perpetrator. The term ‘domestic violence’ obviously covers a wide range of abuse – physical and otherwise. It also covers issues that mainly concern women from minority ethnic backgrounds, such as forced marriage, female genital mutilation and so-called ‘honour violence’. We have, however, made use of information and statistics on ‘domestic violence’ and so have kept to that terminology in those instances. Domestic Violence accounts for around one-fifth of violent crime and claims the lives of two women every week (Simmons and Dodd, 2003). Research studies estimate that both women and children are abused in 30-60 per cent of cases (Mullender, 2000). In addition the health service treats both acute and chronic injuries or conditions that result from this abuse. (Women’s Aid, 1998; British Crime Survey, 2000) The Adoption and Children Act 2002 established that children suffer harm as a result of witnessing violence and abuse. Domestic violence is also strongly identified within Every Child Matters: Change for Children (2003), the Government’s approach to the well being of children and young people, as a cause of vulnerability which has a negative impact across the five outcomes identified: -
Be healthy Stay safe Enjoy and achieve Make a positive contribution Page 4 of 15
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Achieve economic well being
Prolonged and/or regular exposure to domestic abuse can have a serious impact on a child’s development and emotional well-being, despite the best efforts of the victim’s parent to protect the child. Domestic abuse has an impact in a number of ways. It can pose a threat to an unborn child, because assaults on pregnant women frequently involve punches or kicks directed at the abdomen, risking both injury to mother and foetus. Older children may also suffer blows during episodes of violence. Children may be greatly distressed by witnessing the physical and emotional suffering of a parent. Both the physical assaults and psychological abuse suffered by adult victims who experience domestic violence can have a negative impact on their ability to look after their children. The negative impact of domestic violence is exacerbated when the violence is combined with drink or drug misuse; children witness the violence; children are drawn into the violence or are pressurised into concealing the assaults. Children’s exposure to parental conflict, even where violence is not present, can lead to serious anxiety and distress. Increasing research and clinical evidence suggests that there are inter-relationships, between animal abuse, child abuse and domestic violence. Where serious animal abuse has occurred in a household there may be an increased likelihood that some other form of family violence is also occurring and that children present may also be at increased risk of abuse. Acts of animal abuse may in some circumstances be used to coerce, control and intimidate women and children to remain in, or be silent about, their abusive situation. The threat or actual abuse of a pet can prevent women leaving situations of domestic violence. There are well established links between domestic abuse and child protection. The fact that children are impacted by living within a home where domestic abuse is perpetrated against their mother is actually now well researched and documented and the Government paper ‘Working Together to Safeguard Children’ (2006), highlights that child protection agencies must take the connections between the abuse of children and their mothers, and include it in all levels of their policies, strategies and practice. The Government wants to encourage earlier reporting by making domestic violence part of routine inquiry and comprehensive assessment processes in primary health and social care settings. This will require a greater co-operation between agencies and a greater willingness to share sensitive information in order to protect victims. 2.
Associated Policies and Procedures.
This policy should be read in accordance with the following PCT policies, procedures and guidance. • • • • •
Kirklees PCT Child Protection Policy Kirklees PCT Child Protection Training Policy Kirklees PCT Records Management Policy Kirklees Multi Agency Adult Protection Procedures ww.kirklees.gov.uk West Yorkshire Consortium Safeguarding Children Procedures www.kirklees.gov.uk/safeguarding Page 5 of 15
This policy has been developed in line with current national guidance of good practice and legislation; specifically: • • • • • • • • • • • • • • • • •
Children Act 1989; Adoption and Children Act 2002; Children Act 2004; The Victoria Climbie Inquiry. Report of an Inquiry by Lord Laming 2003; Every Child Matters 2003; Working Together to Safeguard Children 2006; Kirklees Safeguarding Children’s Board Procedures European Convention of Human Rights Act 1998. Living without Fear (2000); Breaking the Chain (1999); United National Convention on the Elimination of Violence Against Women (1993), Dept. of Health publication Domestic Abuse: Resource Manual for Health Care Professionals (2000). Forced Marriages Guidelines Female Genital Mutilation Act (2003) Freedom of Information Act 2005 Safety and Justice – sharing of information in the context of domestic violence Crime and Disorder Act (1998) including section 17
These documents endorse a proactive and supportive approach to domestic abuse. 3. Aims and Objectives 3.1 Aim This document outlines Kirklees PCTs’ policy on Domestic Abuse in respect of all clinical and non-clinical staff who through the course of their work have contact with children and young people and their families. The policy aims to provide a framework to facilitate community health care professionals to identify and work with situations of domestic abuse. The provision of an overarching Domestic Abuse Policy and clear Good Practice Guidelines for community based health care professionals when dealing with domestic abuse will offer support and clarify professional boundaries, reflecting professional accountability and standards of clinical governance. The PCT will use the broad public health agenda to challenge the use of violence and through health education, promote non-violent relationships and a more stable future for children and young people. The document has been developed with reference to the ‘Children Act’ (2004) ‘Working Together to Safeguard Children’ (2006), and will be supported by literature and advice taken from ‘Domestic Abuse: Resource Manual for Health Care Professionals (2000).
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3.2 Objectives Section 11 of the Children Act 2004 places a duty on key people and organisations to make arrangements to ensure that their functions are discharged with regard to the need to safeguard and promote the welfare of children. The application of this duty will vary according to the nature of each agency and its functions. Staff have a duty to make clear to parents that they have professional responsibilities to safeguard children and that they may have to override parental wishes regarding a referral to Children & Young Peoples Care Services (CYPCS) formally social services. Domestic abuse guidelines in relation to the safeguarding of children will be compatible with Safeguarding Children procedures. Whilst many women experiencing abuse may use other services, the role of the Health Service is pivotal since virtually all women will at some point interact with health services, either on their own or on their children’s behalf. The nature of the issues arising from domestic abuse are manifold since the impact of abuse inevitably leads to women utilising a whole range of health services including Accident and Emergency Departments, Mental Health Services, Sexual Health Services Primary Care and Maternity Services. “The Health Service is in a unique position to contribute to helping people who suffer violence at home get the support they need. Health services have a pivotal role to play in the identification, assessment and response to domestic violence on health, but critically the health service may be the only point of contact with professionals who could recognise and intervene in the situation” Domestic Violence: A resource manual for Health Care Professionals (DOH, 2000). Ensuring staff are equipped to provide an effective and appropriate response is thus a prerequisite of the PCT for the provision of a sensitive service. There are a number of impediments to such a provision, including professional and personal reluctance to encroach on what is often perceived as private problems. Despite the increase in awareness around this issue, it remains the case that domestic abuse remains largely unacknowledged as a significant factor in the aetiology of a range of health problems and that those health problems remain persistent and intractable as a result. Routine enquiry for domestic abuse is already included in health assessments to reflect domestic abuse guidelines and in response to potential indicators. Staff will be expected to give information and can do this by using domestic abuse information leaflets, and referring to the Kirklees Domestic Violence Forum Domestic Violence Directory (2005). The National Service Framework for Children clearly states that routinely enquiring about domestic abuse and developing appropriate pathways for referral is critical to children’s health, safety and welfare. The spirit of the Children Act 2004 is to regard these children as ‘In Need’, and to provide the family with a holistic approach to their problems. The use of the Common Assessment Framework (CAF) would provide a method of assessing needs as well as the level of risk. Assessment will also include the member of staff accessing supervision for advice and support, with Child Protection Policy and Procedures being followed if child abuse is suspected.
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Children who have experienced, witnessed or lived with domestic abuse are at risk. They are at greater risk of exposure to poverty and homelessness, and detrimental effects on their short term welfare and long term life chances. As such, these children will benefit from the wide-ranging Government reforms of children’s services envisaged in Every Child Matters (2003) and legislated for in the Children Act 2004. The overall aim of the Act is to encourage integrated planning, commissioning and delivery of services as well as to improve, multi-disciplinary working, remove duplication, increase accountability. 4. Kirklees PCT Responsibilities 4.1 Trust Responsibilities The PCT is committed to ensuring that staff receive support and training to appropriately respond to issues of domestic abuse. It is responsible for ensuring all staff working within the PCT receive appropriate training to undertake their roles. It is intended that this policy will be adhered to by all the health care professionals within and contracted to Kirklees PCT with welfare of the child being of paramount consideration. All children, regardless of age, disability, gender, racial or ethnic origin, religious belief and sexual identity have a right to be protected from harm 4.2 Managers Responsibilities It is the responsibility of all managers within Kirklees PCT to make sure that all staff for whom they have responsibility are aware of and understand the importance of this policy and the related documents. It is also their responsibility to ensure all staff have access to this policy and receive sufficient training / knowledge and support to undertake their role. 4.3 Individuals Responsibility This policy refers to all PCT staff, it relates to all those who come into contact with children and their families in their everyday work, including people who do not have a specific role in relation to child protection; they all have a duty to safeguard and promote the welfare of children. It is the responsibility of all employees to ensure they receive sufficient training / knowledge and information around the PCT Safeguarding Children Policy and domestic abuse to undertake their role. In the event that the individual does not feel competent and / or confident to undertake their role, they must identify this with their line manager. If a member of staff is informed of an incident of domestic abuse they must follow guidelines set out in the West Yorkshire Consortium Safeguarding Children procedures at www.kirklees.gov/safeguarding. 4.4 Training and Supervision The PCTs’ child protection training policy (April 2007), has been developed in line with National and Local child protection guidance, detailing the training requirements of all members of staff working in the PCT, and the links with multi agency training arrangements as required in ‘Working Together to Safeguard Children’ (2006) to ensure that staff working within the PCT are aware of the predisposing factors, and Page 8 of 15
signs and indicators of abuse and know what to do if they suspect a child is at risk or being harmed. All training provided by the PCT will be monitored by the Kirklees PCT Training and Education Department. The PCT shall continue to provide training and support for its staff to enable them to respond sensitively and with due care to the needs of those who may be experiencing abuse, and is committed to providing a comprehensive child protection training programme, including training around Vulnerable Young Adults and MultiAgency Risk Assessments (MARAC). In addition to service specific training, there is a need for multi-agency training to bring together representatives of all partner agencies and determine how an effective response can be provided across agency boundaries. This should also include training on joint working. Multi-agency training is required in addition to training in each sector, and neither is an alternative to the other. All staff within the PCT may in the course of their work come into contact with children and families and have the responsibility to ensure that they know what to do if they encounter it or are concerned that a child is at risk of harm. The Kirklees PCT Child Protection Policy is for all staff who may come into contact with children and young people outlines the structures and lines of accountability of those responsible for safeguarding children, and it clarifies lines of accountability and defines what is expected in relation to supervision in child protection. Lord Laming’s report into the death of Victoria Climbie (2003) concluded that; “The suffering and death of Victoria was a gross failure of the system” and that “All staff must have placed upon them a clear expectation that their primary responsibility is to he child and his or her family”. Child protection supervision in practice is therefore critical to the quality of service delivered to vulnerable groups and the development and sustaining of staff. Supervision will be undertaken as per PCT Child Protection Policy, Supervision Policy and Clinical Supervision policy support for staff dealing with abuse is crucial in facilitating a sustained and effective response. ‘Supervision is a process in which one worker is given responsibility to work with another worker(s) in order to meet certain organisational, professional and personal objectives. These objectives are competent, accountable performance, continuing professional development and personal support’ (Morrison, 1993 – Adapted from Harris, 1987). 4.5 Record Keeping When recording concerns relating to a child in paper or electronic records, the standards outlined in the Kirklees Records Management Policy and the NMC guidelines should be followed. Good record keeping is an important part of the accountability of professionals. This must be a full and accurate contemporaneous record of the events, their findings and concerns.
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It is important to differentiate between information that has been passed on directly or that which others have passed on, and to record the source of information received. It is important to differentiate between fact, hearsay and assumption. Records may be viewed in court and used in the making of statements therefore as professionals the NMC guidelines for record keeping should be followed. Discussions held about children and families should be recorded in the records, this includes telephone discussions, with the name of the person spoken to, date and time of discussion and content of the discussion. The proper recording of injuries and/or mental health problems sustained as a result of domestic violence will be underpinned by the Electronic Patient Records (EPR) system. EPR will contain specific diagnostic codes for domestic violence which will be primary codes in domestic violence incidents. 4.6 Corporate Accountability Arrangements The Trust is committed to safeguarding and promoting the welfare of children in line with legislation and good practice guidance. The designated and named professionals of the Trust will, where appropriate, work with key partner agencies and local children safeguarding boards to ensure that both local and national priorities are agreed and met. Key performance indicators will be developed to ensure that robust Governance procedures are in place by auditing the compliance with the policy and procedures. These will be reported to the Clinical Governance Sub Committee. 4.7 Data Collection For the purpose of data collection, domestic abuse is defined as that which occurs between adults in a close (intimate) relationship where there is the exercise of control and the misuse of power. 4.8. Confidentiality and Disclosure of Information Health professionals have a legal and ethical duty to share information without breaching confidentiality as defined by the Data Protection Act (1998) when there is no need to do so. Information should be shared with relevant people on a need to know basis. In deciding when to share information the health professional has to determine whether disclosure of that information is justified. If the professional decides, in exceptional circumstances to break confidentiality, the reason for doing so should be clearly recorded in the records. Disclosure of patient identifiable clinical information is lawfully permitted in instances where there are child welfare investigations by the LA children’s social care, the police or other statutory partners. The overriding principle in safeguarding children is to protect the child and secure the best possible outcome for the child. The needs of children must always be regarded as paramount as their age and vulnerability renders them powerless to protect their own interests.
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The General Medical Council has statutory powers, which include the provision of advice for the medical profession on standards of professional conduct and on medical ethics including professional confidence. Nursing staff should consult the Nursing and Midwifery Council (2004) guidelines on confidentiality. Other professions allied to medicine/health should consult guidelines produced by their own professional organisations. 5. Multi-agency Partnership A multi-agency partnership approach where the individual roles and joint responsibilities in relation to tackling domestic abuse and supporting victims have been clearly defined can enable partnerships to effectively address domestic abuse. The same principle of defined responsibilities applies in the sharing of information. Each agency must be aware of what information they can share with other agencies in the partnership and for what purpose. Responsible information-sharing plays a key role in enabling organisations and professionals to protect domestic abuse victims and their children to save lives. Casework, advocacy, conducting risk assessments and providing support and protection may all require information about individuals to be shared with other agencies. Guidance has been made available in the form of the inter-agency guidance Working Together to Safeguard Children and the guidance What to do if you are worried a child is being abused. Multi-agency/partnerships should demonstrate a commitment to safeguarding adults and children and indeed whole communities from harm due to domestic abuse. 6. Linguistic Support The facility of language line is available to all staff. It enables a conference call to take place between the client, staff member and interpreter. This facility may be used if the woman’s preferred language is not English and it also allows an accurate interpretation as the interpreter is impartial. 7. Serious Case Reviews When a child dies, and abuse or neglect is known or suspected to be a factor in the death, the Kirklees Children Safeguarding Board are required by statute to undertake a serious case review. The purpose of which is for organisations to consider whether there are lessons to be learnt about the ways in which they work together to safeguard and promote the welfare of children. The Assistant Director of Safeguarding as the named professional for the Trust will contribute to serious case review reports when required and ensure that any organisational learning outcomes are implemented.
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8. Counselling and Support for Staff Staff who are themselves the victim of domestic abuse can approach their line manager for support and also the Trust counselling services through Occupational Health with all disclosures treated with the utmost confidence, 9. Allegations Against Staff Any allegations of harm against staff must be reported to a senior member of staff immediately and the duty manager on call. A clinical incident form must be completed. Local trust policy will determine any further actions. 10. Equality and Diversity All public bodies have a statutory duty under the Race Relation (Amendment) Act 2000 to “set out arrangements to assess and consult on how their policies and functions impact on race equality.� This obligation has been increased to include equality and human rights with regard to disability age and gender. The PCT aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. In order to meet these requirements, a single equality impact assessment is used to assess all its policies/guidelines and practices. This Policy / procedure / guidance was found to be compliant with this philosophy. Child protection work with families is offered with a child focus, based on careful assessment of each individual child’s needs. The approach should be sensitive to the different family patterns and lifestyles that take place in a multi cultural society, and to the various child rearing patterns that are offered in different racial, ethnic and cultural groups. Professionals should be clear that child abuse or domestic abuse, cannot be condoned for religious or cultural reasons. All children, whatever their religious or cultural background must receive the same care and safeguards with regard to abuse and neglect. The safeguarding work of staff is offered to all children regardless of any disability. There is a commitment to high standard of safeguarding work with all children, with a culture of openness and honesty with children and families. 11. Auditing Compliance with this policy and the child protection policy will be assessed by regular audit. The Named Nurses, Child Protection will have responsibility for undertaking the audit, and developing action plans to address issues which arise from the audit, in order to ensure that there is compliance with the guidance in both documents.
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References and Bibliography HM Govt (1989) Children Act 1989. London. TSO HM Govt (2002) Adoption and Children Act 2002. London. TSO HM Govt (2004) Children Act 2004. London. TSO HM Govt (2003) The Victoria Climbie Inquiry. Report of an Inquiry by Lord Laming. London. TSO HM Govt (2003) Every Child Matters 2003. London. TSO www.everychildmatters.gov.uk HM Govt (2005) Domestic Violence; A National Report. London TSO. HM Govt (2006) Working Together to Safeguard Children 2006. London. TSO European Convention of Human Rights Act 1998. Women’s Equality Unit (1999) Living without Fear; an integrated approach to tackling violence against women. Breaking the Chain (1999); United National Convention on the Elimination of Violence Against Women (1993), Dept. of Health publication Domestic Abuse: Resource Manual for Health Care Professionals (2000). www.doh.gov.uk/pdfs/domestic.pdf HM Govt (2006)Information sharing: Guidance for practitioners. London. TSO www.ecm.gov.uk/informationsharing Nursing and Midwifery Council (2005) Guidelines for records and record keeping. NMC publications HM Govt (2006) CAF practitioners Guide. London. TSO www.ecm.gov.uk/caf Knapton, J and Morrison, M (1998) Making the Most of Supervision in Health and Social Care. Brighton Pavillion Morrison, T (1993) Staff Supervision in Social Care – An Action Learning Approach. Brighton Pavillion HM Govt (2006) What to do if you’re worried a child is being abused. London. TSO www.everychildmatters.gov.uk Women’s Aid Federation website www.womensaid.org.uk Data source on domestic violence www.domesticviolencedata.org Simmons, J. Dodd, T (2003) Crime in England and Wales 2002/03. Home Office Statistical Bulletin Page 13 of 15
Mullender, A (2000) Child Protection and Domestic Abuse (Practitioners Guide). Routledge. London Home Office (2000) British Crime Survey 2000. London. TSO
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