Independent Review of Survivors Manchester ISVA Service by We Are Survivors

Findings from an Independent Review of Survivors Manchester Independent Sexual Violence Adviser (ISVA) Service Prepared by LimeCulture Community Interest Company (CIC)

December 2015

LimeCulture CIC info@limeculture.co.uk www.limeculture.co.uk Registered Office The Coach House 2a Carr Road Hale Cheshire WA15 8DX 1

Table of Contents 1. Information and Background

2. Review Methodology

3. Overview of Survivors Manchester ISVA Service

4. Part 1 Findings: Strategic Oversight of the ISVA Service

5. Part 1 Findings: Partnership Arrangements

6. Part 1 Findings: Service Provision

7. Part 1 Findings: Care Pathways

8. Part 2 Findings: Update on Progress

9. Part 2 Findings: Action Taken on Key Recommendations

10. Part 2 Findings: New or Remaining Challenges

11. Conclusion

Annex A The Project Team

Annex B Key Informants

Information and Background

Purpose of the Review 1.1

In November 2014, the Chief Executive Officer of Survivors Manchester approached LimeCulture CIC to undertake an independent review of the Independent Sexual Violence Adviser (ISVA) service that is currently being piloted by the organisation.

1.2

LimeCulture proposed to undertake a two-stage review in order to allow key findings and/or recommendations from part 1 of the independent review to be embedded into the service following the pilot phase. The proposal was agreed in December 2014 and the first part of the review took place in January 2015. The second part of the review took place in October 2015.

1.3

The aim of the independent review is to ensure the pilot ISVA Service is fit for purpose and to ensure the operating model is correctly aligned for the future, should the ISVA Service continue beyond the life of the pilot.

1.4

It is intended that the independent review of the Survivors Manchester ISVA Service will have many benefits. Ultimately, it is hoped that the review will support the Survivors Manchester ISVA Service to better meet the needs of victims of sexual violence and provide an opportunity to: • Gather information to strengthen the provision of the ISVA Service;; • Provide an insight into current service provision, which can be used to evaluate and measure the progress of changes that are implemented;; • Help identify any barriers to effective ISVA Service provision for victims, facilitating how better access to the ISVA Services could be improved;; • Stimulate a more responsive ISVA Service by involving staff and community stakeholders;; • Support current and future commissioners in their understanding of the ISVA Service that is provided / required.

1.5

This document provides the interim findings and recommendations of the independent review conducted by LimeCulture CIC during January 2015. It is intended that a final report will be developed at the end of the pilot phase in March 2015.

Independent Sexual Violence Adviser (ISVA) Services 1.6

It is now widely accepted that tackling violence and abuse, particularly sexual violence, requires a joined-up approach at a local level through partnership with relevant stakeholders. It is also important that victims of sexual violence have good access to effective services, whether or not they wish to report to the police1.

1.7 Over the last few years, the UK government has focused on improving the response to victims of sexual violence. However, despite progress in recent years, it is estimated that up to 9 in 10 cases of rape go unreported and 38% of serious sexual assault victims tell no one about their experience2. 1.8 It is accepted that many people who have been subjected to a sexual assault do not feel able to report it to the police in the first instance, despite improved police efforts to be more responsive to the needs of victims. Instead, victims may engage with other services such as health services, third sector organisations or other seemingly unrelated services such as housing support services. 1.9 The long-term effects of sexual violence on victims can include depression, anxiety, post traumatic stress disorder, drug and substance misuse, self- 1

Department of Health and Association of Chief Police Officers. Response to Sexual Violence Needs Assessment Toolkit (2011) 2 HM Government The Government Response to the Stern Review: An independent review into how rape complaints are handled by public authorities in England and Wales (April 2011)d Wales

harm and suicide. However, when victims receive the support they need when they need it, they are much more likely to take positive steps to recovery3. 1.10 The role of the Independent Sexual Violence Adviser, or ISVA as they are often known, plays an important role in supporting victims of sexual violence. ISVAs are victim-focused advocates, who work with people who have experienced rape and sexual assault to help them to access the services they need. 1.11 There is no nationally agreed definition of an ISVA, nor is there a nationally accepted or recognised job description for an ISVA role. However, in 2010 the Home Office described the ISVAs role as follows4: ‘The support provided by an ISVA will vary from case to case, depending upon the requirements of the victim and their particular circumstances. However, the core role of an ISVA includes making sure that victims of sexual abuse have the best possible practical advice on what counselling and other services are available to them, on the process involved in reporting a crime to the police, and on taking their case through the criminal justice process, should they choose to do so’. 1.12 The Home Office originally championed the role of the ISVA in 2005/6, following the success of the role of the Independent Domestic Violence Adviser (IDVA), The Home Office was keen to adapt this role to meet the needs of victims of sexual violence and over the following few years, the Home Office has provided funding5 to specialist sexual violence organisations and Sexual Assault Referral Centres (SARCs) to increase the 3

Revised National Service Guide: A Resource for Developing SARCs (2009) Department of Health, Home Office and ACPO. 4

The Home Office used this definition on guidance for voluntary and community sector and SARC applications for the ISVA fund available between 2010-15 5 5 In 2011/12 following the publication of ‘A Call to End Violence Against Women and Girls’ , the Home Office made a commitment to match-fund 87 ISVAs until 2015. The Home Office has also made funding available for a number of years for ISVAs to attend accredited training.

workforce of ISVAs across England and Wales. 1.13 In 2009, the Department of Health, Home Office and Association of Chief Police Officers (ACPO) issued guidance for providers and commissioners to support them in developing Sexual Assault Referral Centres (SARCs).6 This guidance outlined 10 ‘minimum elements’ of SARC service that local areas should work toward achieving in order to reduce the postcode lottery for victims. Element 77 states that all SARCs should provide ‘Access to support, advocacy and follow-up provided through an independent sexual violence adviser (ISVA) service, including support throughout the criminal justice process, should the victim choose that route’. The guidance also states that ‘ISVAs are trained and have access to continued professional development’. 1.14 Since its introduction, the role of the ISVA has broadly been considered a great success. In 2010, when Baroness Stern conducted her independent review ‘How Rape Complaints are Handled’8, she ran a series of focus groups and visited organisations throughout the country during which she found unanimous praise for the work done by ISVAs from every organisation. Baroness Stern stated;; ‘ISVAs support victims through the process, whether or not the case goes to trial (and indeed their support is particularly welcomed in dealing with the reactions when it is decided that the case is not going to trial), and afterwards. They do an impressive, important and very difficult job. The value of their support should not be underestimated.’

Revised National Service Guide: A Resource for Developing SARCs (2009) Department of Health, Home Office and ACPO. 7 Page 24 8

http://webarchive.nationalarchives.gov.uk/20110608160754/http:/www.equalities.gov.uk/PD F/Stern_Review_acc_FINAL.pdf 6

Review Methodology

Outline of Process 2.1 Part 1 of the independent review of the Survivors Manchester ISVA Service was undertaken over a 2-day period (7th and 8th January 2015). However, preparatory work was undertaken in advance of the review period and desk- based research was conducted before and after the 2-day review period. 2.2 The LimeCulture project team (see appendix A for further information) consisted of 2 individuals with complimentary professional backgrounds that enable the team to have extensive, holistic knowledge and expertise of: •

policy development and implementation

•

service planning, (re)design and review,

•

commissioning and delivery,

•

effective clinical intervention and governance

•

safeguarding,

•

law and the criminal justice system.

2.3 A questions framework was developed to undertake the Independent Review of the Survivors Manchester ISVA Service in order to assess current provision. As part of the independent review, and based on discussions with key professionals, stakeholders and partners, LimeCulture has been able to make recommendations to Survivors Manchester based on the findings of the review. 2.4 A mixed methodology was utilised by the project team in order to achieve Part 1 of the independent review of the Survivors Manchester ISVA Service. Two core elements of methodology were used to support triangulation of evidence. These were: •

Desk-based research and analysis of key data and

•

Key Informant Interviews/Focus Groups

Desk-based Research 2.5 The project team conducted a review of key data, information and relevant documentation that was provided by Survivors Manchester relating to their pilot ISVA Service. Documents included operational policies and procedures, referral pathways, data collection information etc. This component of the project framed the analytical process and provided contextual information about the circumstances within which the ISVA Service is operating.

Key Informant Interviews 2.6 Key Informant Interviews brought a further level of intelligence to the independent review of Survivors Manchester ISVA Service. In total, the project team conducted 7 interviews/focus groups with key stakeholders including, staff from Survivors Manchester, Greater Manchester Police, St Mary’s Sexual Assault Referral Centre (SARC), Crown Prosecution Service, Youth Offending Team and Mens Room. 2.7 The purpose of the interviews was for the project team to seek to understand and explore: •

Standards of the ISVA Service provision:

•

Gaps in service provision and where needs could be better targeted;;

•

The effectiveness of local partnerships, communication and pathways in support of the ISVA Service;;

•

What are effective responses – where can ‘best practice’ be identified?;; and

•

What are the current operational barriers to implementation and delivery?

2.8 The project team developed a semi-structured question framework that was employed as a method to collect qualitative data and information from interviews. The key interviews focused on the following topics: • Governance and accountability • Leadership and responsibility • ISVA service provision (including operational practices) • Pathways (including health and wellbeing, and criminal justice outcomes) • Partnership arrangements 2.9 In order for the project to be delivered within a short timeframe, the project team required the support of Survivors Manchester to identify and organise the interviews of key informants. Stakeholder management was critical to the success of this project and without the support of local partners;; the project could not have been delivered within the suggested timeframe or to budget. 2.10 The project methodology was based on stakeholder engagement as a key method of collecting and analysing qualitative information about the ISVA Service. Therefore, it was an important aspect of the project to ensure appropriate engagement with the right people in the right way in order to achieve the project objectives. The LimeCulture project team would like to thank all of the individuals involved in the project who generously gave their time, insight and knowledge. 2.11 Part 2 of the independent review of the Survivors Manchester ISVA Service was undertaken over a 1-day period (2 October 2015). Part 2 consisted of a review meeting between the LimeCulture CIC project team and the key members of the Survivors Manchester ISVA Service. The aim of the review meeting was to: • update on progress (since part 1 of the review), • action taken to achieve key recommendations, • identify any new or remaining challenges affecting the ISVA Service.

Overview of Survivors Manchester ISVA Service

“We know that we can always pick up the phone to Survivors Manchester and talk things through with them. They are all really open and easy to work with.” Key Informant, January 2015

About Survivors Manchester 3.1.

Survivors Manchester is a specialist voluntary and community sector organisation providing support to male survivors of sexual abuse and rape. Survivors Manchester provides therapeutic services (including a variety of 1:1 counselling and psychotherapy, emotional support and group support) direct to male survivors, their friends and families.

3.2.

Survivors Manchester also provides training to police, counsellors and psychotherapists, and other allied health care professionals; and professional support and consultancy to public authorities, health care professionals and third sector organisations.

3.3.

The small but dedicated team at Survivors Manchester have all been affected by sexual violence, in one way or another, and are 100% committed to empowering survivors to ‘break the silence of the sexual abuse and rape of men in order to empower those affected to defeat the legacy of abuse and move towards positive futures’9.

9 www.survivorsmanchester.org.uk 10

The Pilot 3.4.

In September 2014, Survivors Manchester was successful in being awarded a Ministry of Justice Grant Fund via the Greater Manchester Police and Crime Commissioner to pilot a Criminal Justice Male Support Worker. This funding has enabled the establishment of the Survivors Manchester ISVA Service.

3.5.

While there is currently a single Criminal Justice Male Support Worker operating within the Survivors Manchester ISVA Service, the focus of the independent review and the findings contained within this report is on the ISVA service as a whole, rather than the individual employed to undertake the role of Criminal Justice Male Support Worker or indeed the wider services offered by Survivors Manchester.

3.6.

An individual was recruited to the post of Criminal Justice Male Support Worker in August 2014 and worked with clients to support them to access the support services that they require. Due to staff changes within Survivors Manchester, a new individual was appointed to undertake the role in March 2015. Survivors Manchester has sent both staff members on the LimeCulture

Independent

Sexual

Violence

Adviser

Development

Programme, which is an accredited professional training programme for ISVAs that meets the Home Office ISVA training requirements and the Skills for Justice National Occupational Standards (NOS) relevant to ISVAs. 3.7.

Of particular note is the unique nature of the Survivors Manchester ISVA service. Although there are a very small number of males currently in post providing ISVA support in the UK10, the project team is not aware of any other ISVA Service providing dedicated male-only ISVA support.

3.8.

Between the beginning of the pilot and January 2015, the Survivors

10 LimeCulture conducted an Audit of ISVAs in England and Wales during 2014 and is aware of 2 male ISVAs operating in England, both providing support to male and female clients. 11

Manchester ISVA Service has provided support to 38 clients. At the time of conducting Part 1 of the independent review, the ISVA Service had a caseload of 28 active clients.

4. Part 1 Findings: Strategic Oversight of the ISVA Service “We are all determined to make the ISVA Services for Greater Manchester as good as they can possibly be. We are all willing to work together to make that happen.” Key Informant, January 2015

Commissioning arrangements 4.1.

The project team was informed that the funding for the Survivors Manchester ISVA Service pilot has been provided by a Ministry of Justice Grant Fund via the Police and Crime Commissioner for Greater Manchester. It is clear to the project team that Survivors Manchester are keen to continue with the ISVA Service beyond the life of the pilot and will seek to find additional funding to allow the service to continue.

4.2.

As part of the grant conditions, the Ministry of Justice required the Police and Crime Commissioner to provide a return on the activities of the ISVA Service. In order to support the return, in November 2014 Survivors Manchester provided a Payment and Financial Monitoring Report which included additional information about the ISVA Service.

Performance Management 4.3.

It is clear to the project team that Survivors Manchester are committed to the robust monitoring and ongoing review of the ISVA Service to ensure they are able to provide a high-quality ISVA service for male survivors across Greater Manchester.

4.4. 13

The management of Survivors Manchester is keen to ensure relevant

information is collected and monitored by the ISVA Service in order to evidence the impact of the service and the value that it provides to its clients. There is clearly a willingness to provide information and data to commissioners on request and it was reported that commissioners have commended the quality of the organisation’s data collection and reporting.

Governance & Accountability 4.5.

The project team was satisfied that the Survivors Manchester Board of Trustees currently have a significant role in the continued development of the ISVA Service and can provide the strategic oversight for the ISVA Service as well as the organisation as a whole.

4.6.

The current line-management arrangements that are in place within the organisation provide the operational oversight and management for the ISVA Service. The project team is of the view that these arrangements currently have the ability to support delivery of the current ISVA Service. However, should the ISVA Service expand in size in the future, the project team recommends that the management arrangements are reviewed to ensure they are fit for purpose. For example, it may be appropriate to appoint a dedicated ISVA Manager or ISVA Team Leader.

Recommendation 1: Survivors Manchester should regularly review the line management arrangements for the ISVA Service to ensure they continue to meet the needs of an expanding service.

Policies and Procedures

4.7.

It was clear to the project team that the ISVA Service has been developed alongside and in addition to the well-established therapeutic services provided by Survivors Manchester, with the existing policies and procedures used by the therapeutic service adopted for use by the ISVA Service. However, as the nature of support provided by an ISVA Service is significantly different to that of a counselling and psychotherapy service, it is important to ensure that the policies and procedures used within the ISVA service reflect these important differences, particularly as much of the ISVA service support is routed in the criminal justice process.

Recommendation 2: Review the policies and procedures used by the ISVA Service to ensure they are fit for purpose and meet the requirements of support routed in the criminal justice process.

5. Part 1 Findings: Partnership Arrangements “ We need to make sure that victims are given the best support possible. An ISVA is a great way of doing just that”

Key Informant, January 2015

Perceptions of the ISVA Service 5.1

It was clear to the project team that there is overwhelming support for Survivors Manchester and the services the organisation provides to male survivors of sexual abuse is very highly regarded. The feedback from stakeholders interviewed as part of the independent review was extremely positive, reporting that the organisation provides access to a safe, effective and accessible service for males.

5.2

Key informants reported that their experience of working with the Survivors Manchester ISVA Service is also excellent, with the Criminal Justice Male Support Worker considered to be extremely committed and dedicated to supporting male survivors to access the support they need.

Role of Partners 5.3

The project team was keen to understand the role that other agencies play in supporting the development and delivery of the Survivors Manchester ISVA Service. The interviews highlighted a range of individuals from a range of organisations that have a role in supporting male survivors of sexual violence across Greater Manchester. It was clear to the project team that these organisations fully accept their responsibility for supporting male survivors and demonstrated a willingness to contribute to supporting the provider to deliver effective ISVA Service provision. For example, the police and Crown Prosecution Service have worked closely with Survivors Manchester to support the ISVA Service in relation to specific queries or cases (e.g. confidentiality issues and disclosure).

5.4

However, in spite of the clear willingness to support the ISVA Service it was reported that the relationship between the Survivors Manchester ISVA Service and other ISVA service providers in Manchester could benefit from being more closely aligned, in order to support the care pathways, ensure consistency of ISVA service provision across the police force area and ensure clients have options relating to ISVA provision. For example, it would be of benefit to work with other ISVAs across Greater Manchester to ensure that all clients are being offered a choice of gender of ISVA.

Recommendation 3: Work with other ISVA services across Greater Manchester to ensure clear referral pathways that provide the client with the choice of gender of ISVA.

6. Part 1 Findings: Service Provision “A well-trained ISVA is invaluable. They can provide the continuity of support between all the different agencies and help the victim through a court case” Key Informant, January 2015

Awareness of the ISVA Service 6.1 The project team was informed that a significant amount of work went into promoting the ISVA Service pilot by raising the awareness amongst professionals and other organisations of the availability of the service. The general view of the stakeholders that were interviewed as part of the independent review was that awareness of the Survivors Manchester ISVA Service is good, with an increasing number of clients entering the ISVA service from referrals made from other professionals. 6.2 The project team was informed by one Key Informant, that she decided to make a referral to the ISVA Service for one of her clients after being sent an email about the ISVA Service pilot, which included a link to the Survivors Manchester website. The Key Informant told the project team that she had read the description of the Criminal Justice Male Support Worker and – although not familiar with the ISVA role - realised that this kind of support would be of benefit to her own client who was engaged in the criminal justice process following a sexual offence.

Key Benefits of the ISVA Service 6.3 Key informants reported that in relation to feedback, both professionals and survivors who have had contact or indeed accessed the ISVA Service regarded the support provided to them very positively. 6.4 Key informants reported to the project team that the service provided by the Survivors Manchester ISVA Service is of a consistently high standard with 18

steps being taken by the organisation to ensure the quality of service provision is on going and can be maintained. 6.5 Of particular note, were the powerful examples provided by a number of the Key Informants about some of their most challenging clients who were previously not willing - or able - to engage with other professionals or support services yet who the ISVA Service were successful in engaging and then supporting to enable these clients to access other ongoing support. 6.6 Specifically, the project team was informed of a young male who, in spite of the many professionals working with him, refused to access counselling or any other support that was offered to him. However, he agreed to meet the Criminal Justice Male Support Worker and following a successful meeting, engaged with the ISVA Service who were then able to support him to seek further help and support from other services relating to both his mental and physical healthcare. This was considered to be a significant achievement by the Key Informant who told the project team that she had been trying to achieve this for some time.

ISVA Service Scope 6.3 The project team was informed that the Survivors Manchester ISVA Service has been established to provide support to clients over the age of 18 years old. However, there has been an occasion where an ISVA service was provided to a 17-year-old male following careful consideration of the facts of the case and the support required. 6.4 The management of Survivors Manchester expressed a desire to expand current service provision to provide a male-only ISVA service to males under the age of 18 years old. This was discussed with the Key informants, who expressed strong support for the service to be expanded. While it was acknowledged that the (female) ISVAs located within St Mary’s Sexual 19

Assault Referral Centre (SARC) could provide an ISVA service to males under the age of 18 years old, there is currently a gap in provision for males who would like to access a male ISVA. Recommend 4: The Management Team for Survivors Manager should consider expanding the ISVA Service to make ISVA support available for males under the age of 18 years old.

ISVA Service Staff 6.5

It is clear that the staff employed by Survivors Manchester are a small but dedicated and passionate team. Key informants praised the commitment and professionalism of all the Survivors Manchester staff, and particularly the Criminal Justice Support Worker’s commitment.

6.6

Key Informants raised concerns about the resilience of the ISVA service. The Service currently has only 1 full-time Criminal Justice Male Support Worker providing support to clients with no other member of staff trained to carry out this role. Consequently, in the event that the Criminal Justice Male Support Worker is on annual leave, sick or indeed decides to move on from the role, the ISVA Service clients would be left without support from a trained ISVA .

Recommend 5: The Management Team for Survivors Manchester should review the resilience of the ISVA Service and consider expanding to ensure there is more than 1 trained ISVA.

7. Part 1 Findings: Care Pathways “The ISVA has been attending multi-agency meetings and has made a great contribution. He has worked collaboratively and made sure that the right referrals are being made” Key Informant, January 2015

Referrals ‘to’ the ISVA Service 7.1 The project team was informed that there is a single referral form for all clients accessing Survivors Manchester. On receipt of the referral form, Survivors Manchester conduct an assessment of the referral to ascertain which services are appropriate for the person, either therapeutic services (i.e., 1:1, group work or emotional support) or ISVA services. 7.2 Key informants informed the project team that there is no option to refer directly into the Survivors Manchester ISVA Service. Key Informant expressed concern that a single organisational referral form might delay a client accessing ISVA support, while the referral is being assessed internally. It is recommended that the referral form is adapted to include a direct referral to the ISVA Service. Recommendation 6: Survivors Manchester should review the referral forms to ensure that it is possible to make a direct referral to the ISVA Service. 7.3 Furthermore, the project team was informed that the Survivors Manchester Clinical Lead currently conducts the assessment following receipt of the referral and decides what services would be most appropriate for the potential client. Although this is an entirely appropriate process for referrals to the therapeutic services, it is recommended that a trained ISVA be involved in the decision as to whether ISVA services are appropriate for a potential client. 21

Recommendation 7: Survivors Manchester should review the assessment process to ensure that a trained ISVA is involved in the decision as to whether support provided by the ISVA Service is appropriate for new referrals. 7.4 The project team was informed that the referral process to the ISVA Service is well understood by key partners across Greater Manchester. However, the project team recommends that Survivors Manchester should monitor referrals to the ISVA Service to ensure partner organisations are making appropriate and timely referrals. Recommendation 8: Survivors Manchester should monitor referrals to the ISVA Services to ensure partner organisations are making appropriate and timely referrals.

Referrals ‘from’ the ISVA Service 7.5 The Survivors Manchester ISVA Service plays a key role in supporting males to access other support services such as counselling, medical treatment, advice and support relating to benefits, housing employments etc. The project team was informed that the Criminal Justice Male Support Worker has been successfully able to engage males who have otherwise not engaged with other professionals or services, and acted as an important conduit by supporting them to accessing other services.

Case Management 7.6 The ISVA Service is able to input information relating to case management on to the data collection system that is used by the organisation. However, the project team is unclear whether this system is appropriate for collection 22

and monitoring ISVA Client cases effectively. The project team recommends that the organisation regularly review the effectiveness of this data collection system to ensure that it is appropriate for use by the ISVA Service.

Recommendation 9: Survivors Manchester should regularly review the data collection system to ensure that it is effective for use by the ISVA Service. 7.7 The Criminal Justice Support Male Worker is currently being supported by LimeCulture CIC to apply for ‘Special Measures’ for a victim in a sexual offence case. It is recommended that this experience be documented to capture the learning from this ‘test-case’ and ensure that it is available to benefit other ISVAs.

Recommendation 10: The learning from the current application for ‘Special Measures’ should be documented to capture the learning from this ‘test-case’.

8. Part 2 Findings: Update on Progress 8.1

Part 2 of the independent review of Survivors Manchester ISVA service took place on Friday 2 October 2015. The LimeCulture project team met with the key members of the Survivors Manchester ISVA Service in order to discuss progress since part 1 of the review in January 2016 and identify what actions had been taken by the ISVA Service in order to meet the key recommendations that were made following part 1 of the review. The meeting was also intended to be used to discuss any ongoing or new challenges faced by the ISVA service.

8.2

The LimeCulture Project Team was informed that following part 1 of the independent review, Survivors Manchester ISVA Team had experienced a change in personnel. The individual appointed to the role of Criminal Justice Worker left the organisation in March 2015, which coincided with the end of the pilot. However, the Project Team was informed that due to the success of the pilot, Survivors Manchester Senior Management Team had agreed to continue the provision of the ISVA Service and appointed a new individual to undertake the role beyond the life of the project.

8.3

The individual appointed to undertake the role of the Criminal Justice Worker beyond the life of the pilot has now been in post for a number of months and is working in a full-time capacity with a full case load. The new Criminal Justice Worker has also undertaken (and successfully completed) the ISVA Development Programme accredited training for ISVAs.

8.4

The LimeCulture project team was informed that Survivors Manchester has also appointed an Operations Manager. This has enabled the creation of a Senior Management Team which provides a clearly defined structure for the ISVA Service to operate within and which is distinct from the rest of the services provided by Survivors Manchester. It was reported to the LimeCulture project team that this new structure is working well and has provided a clear space for the ISVA Service to flourish in its own right with clear boundaries, policies and

procedures, while also become embedded as part of the wider Survivors Manchester organisation. 8.5

Due to the nature of the support provided by ISVAs, it is imperative that the providers of ISVA Services recognise the skills and professional boundaries that are required to effectively and safely support people through the criminal justice process. Therefore, when a single organisation provides an ISVA Service along side other existing support services, e.g., counselling support, it is imperative that the ISVA Service elements are developed to take account of the unique skills and professional boundaries that are required to ensure safe practice. By putting these structures in place to allow the Survivors Manchester ISVA Service to work independently while existing along side – and working with - other services provided by Survivors Manchester, the project team is of the view that this is a key achievement which will allow the ISVA Service to operate safely moving forward.

8.6

The project team was also updated on additional actions that had been put in place by the Survivors Manchester ISVA Service in order to raise the profile of the ISVA service amongst key stakeholders and potential clients. The project team was shown some excellent marketing material that had been developed to promote the Survivors Manchester ISVA Service more broadly across Greater Manchester. The material has been professionally designed and utilises the Survivors Manchester branding, which is useful to show potential clients that the ISVA Service is part of a well established and trusted organisation. The material clearly explains the support that can be offered by the Survivors Manchester ISVA Service. The project team is of the view that marketing of this nature will have many benefits, including raising the profile of the service amongst potential clients, as well as other professionals who may come across the material when it is distributed in a variety of settings such as doctors surgery waiting rooms.

8.7

The project team was also updated on some of the future plans and ideas that Survivors Manchester has for their ISVA Service. The project team was impressed with the level of commitment that staff members have to their service

and the obvious desire for it to be as effective as possible in support of their current and future clients. The staff at Survivors Manchester are encouraged to think creatively in order to deliver the best possible services that they can, and this has lead to an innovative approach to the development of the service. The project team was informed about a number of forward-thinking projects that are currently under development but will clearly support the ISVA Service moving forward, including a web-chat initiative in development with partner agencies. 8.8

In summary, the project team was extremely impressed by the commitment of the Survivors Manchester to develop their Survivors Manchester ISVA Service beyond the life of the pilot. A huge amount of work has gone into ensuring the service is embedded within the wider organisation, while ensuring that the Survivors Manchester ISVA Service is able to retain its independence, with the creation of specific policies and procedures and of course, the professional boundaries required by an ISVA to support somebody through the criminal justice process.

9. Part 2 Findings: Action Taken on Key Recommendations 9.1

The project team was informed of the specific work that has been undertaken by Survivors Manchester ISVA Team in order to achieve the key recommendations that were made following part 1 of the independent review in January 2016. The Survivors Manchester ISVA Service had committed to accept each recommendation made by the LimeCulture project team and has clearly undertaken a significant amount of work to ensure that each recommendation could be achieved as fully as possible.

9.2

Taking each recommendation in turn, the project team was informed of the work that had been put in place by Survivors Manchester to ensure the key recommendations could be implemented. The following table shows the action taken by Survivors Manchester ISVA Service in order to achieve the key recommendations.

Recommendation

Action Taken by Survivors Manchester ISVA Service

Survivors Manchester should regularly review the line management arrangements for the ISVA Service to ensure they continue to meet the needs of an expanding service.

The board of trustees have agreed to the appointment of an Operations Manager and the creation of a Senior Management Team. This will ensure that the ISVA is well supported and that there is an appropriate channel of escalation should there be any concerns or issues with regards to service provision, accountability and professional practice.

Review the policies and procedures used by the ISVA Service to ensure they are fit for purpose and meet the requirements of support routed in the criminal justice process.

The Survivors Manchester ISVA service pathway has been finalised and the protocol for response times and channels of service provision have been refined and implemented.

The ISVA now contacts clients 24hrs after an initial assessment or initial informal discussion about the service in order to ensure the client understands the criminal justice process, how the ISVA can support clients from initial report to court, the service boundaries that are in place, and how the ISVA service is clearly demarcated from clinical services offered at Survivors Manchester. A pathway and protocol for how ISVA case files should be presented has been created to ensure compliance with the criminal justice process. This ensures greater accountability and transparency and reduces risk should CPS request case files. As ISVAs are restricted regarding what information pertaining to the case they can be privy to, it is vital that a clear and consistent method of data recording and storage is adhered to so that ISVA support can be maintained and the rigour of the service cannot be called into question.

Work with other ISVA services across Greater Manchester to ensure clear referral pathways that provide the client with the choice of gender of ISVA

The ISVA service at Survivors Manchester has built strong links with St. Mary’s SARC to offer a choice of gender for ISVA service provision. Referrals have been passed to to Survivors Manchester from SARC, and vice versa, in line with the client’s wishes. A discussion around the client’s preferred gender is something that is handled with great sensitivity at the point of initial assessment to ensure that the client does not feel coerced into making a particular choice.

Survivors Manchester ISVA service needs to develop links with further ISVA support services in the Greater Manchester area to ensure that the service can best support clients to tap into other ISVA services where appropriate. However, it is important to be mindful of the specific issues and barriers that male survivors face;; furthermore, a thorough knowledge of services is required to avoid inappropriate referrals to services that centre on the provision of services to females. 4

The management team at Survivors Manchester should consider expanding the ISVA service to make ISVA support available for men and boys under the age of 18 years old.

Whilst the management team support the notion of providing a service for men and boys under the age of 18, this is dependent on securing funding for the service, in addition to liaising with services such as St. Mary’s SARC with regards to their service provision for under 18s. Furthermore, it would be advisable for Survivors Manchester’s ISVA service to conduct some research with regards to the demand and viability of the provision of male specific services for under 18s.

The management team for Survivors Manchester should review the resilience of the ISVA service and consider expanding to ensure there is more than 1 trained ISVA.

Although Survivors Manchester would benefit from funding to expand the current ISVA service, the full- time ISVA is currently able to cope with demand. However, this may need to be reviewed in the future – particularly if the service is to be opened up to support men and boys under the age of 18. As it stands, the ISVA has benefitted from receiving professional, personal and case supervision to ensure resiliency and that the quality of the work conducted by the service remains consistent. ISVA files have been prepared in a manner that allows clinical staff to conduct rudimentary ISVA tasks in the ISVAs absence. Staff have also received training on the ISVA role and the criminal justice process more generally.

Survivors Manchester should review the referral forms to ensure that it is possible to make a direct

Rather than the creation of an ISVA specific referral for assessment form (CA1), Survivors Manchester have included a tick box option for referring agencies and/or clients to opt in for specific ISVA support. Furthermore,

referral to the ISVA service.

Survivors Manchester should review the assessment process to ensure that a trained ISVA is involved in the decision as to whether support provided by the ISVA service is appropriate for new referrals.

Survivors Manchester should monitor referrals to the ISVA Service to ensure partner organisations are making appropriate and timely referrals.

in the Impact Information section of the form, if a police report and/or investigation is confirmed or victim support engagement has been noted, changes to the service pathway dictate that the referral will go to the ISVA service in the first instance. There is now an ISVA specific comprehensive assessment form (CA3), which is completed at the initial assessment stage – this allows the ISVA to ascertain if the client is best served by the ISVA service, or by the clinical team. Alternatively, clients may benefit from support from both services, in which case the ISVA will make an internal referral to the appropriate service.

It has been agreed across both services that any incomplete referral forms from other agencies are returned to the referring agent/agency to be completed in full. Further information on how to complete the referral form is provided to individuals and agencies in order to prevent further delays in service review and provision .

Survivors Manchester should regularly review the data collection system to ensure that it is effective for use by the ISVA service.

Survivors Manchester ISVA service has booked time with DC and CS to look at report monitoring options on CORS, with a view to collating a monthly report, and a quarterly analysis. In the future as the organisation moves towards IAPT compliancy any changes to monitoring and data collection need to be consonant with how the ISVA service can monitor data and outcomes.

10. Part 2 Findings: New or Remaining Challenges 10.1 The final part of the review meeting was focused on any new or remaining challenges that are affecting the Survivors Manchester ISVA Service. While the project team and Survivors Manchester agree that the ISVA Service is currently in a good place, having come a long way to secure the service following the pilot, there remain a few challenges for the services. These challenges include: • uncertainty around future funding for the ISVA Service, • impact of the potential increase in future demand on the ISVA Service, • lack of standardised documents and tools to support ISVAs carry out their role. 10.2 In the main, the most significant challenge facing the Survivors Manchester ISVA Service, and Survivors Manchester more broadly, relate to uncertainty of future funding arrangements for the service moving forward. Decisions at both national and local levels will have an impact on local commissioning decisions, which could effect how Survivors Manchester is required to operate in the future. For example, the Government’s Comprehensive Spending Review will undoubtedly have an impact on the amount of money available to fund services for victims and survivors of sexual violence. However, the impact of the spending review is not yet known and as a result, many local commissioners do not have clarity around their budgets for the coming years. This of course, makes it impossible for medium-long term commissioning decisions to be made and therefore services such as Survivors Manchester are unable to plan effectively for the future. That said, the majority of provider organisations also find themselves in a very similar situation. However, the excellent reputation of Survivors Manchester, and their ability to evidence the impact of their services, and show value for money, means that they will be well placed to be commissioned once budget priorities become clearer. 31

10.3 The project team was informed that Survivors Manchester is keen to ensure that the service is available to support as many males as possible. Consequently through work done nationally in the last few years, the organisation’s Senior Management Team has spent a lot of time and effort expanding the service and raising the profile of the service across Greater Manchester and beyond,. This effort has clearly been successful as the organisation has seen both an increase in the number of males accessing the service for support, and an increase in investment in the service by funders and commissioners. 10.4 Due to the current context surrounding sexual violence in the UK, including an increase in media and political attention following a number of high-profile cases, coupled with an increase in the number of reported sexual offences, the expectation is that many more victims and survivors will come forward to access support. It remains unclear whether commissioners’ budgets will be increased to reflect this increased demand.. However, service providers will clearly want to position their services in order to meet any increase in demand that they experience. 10.5 The project team was informed that Survivors Manchester are committed to meeting any potential increase in demand that their service experiences over the next few years and are taking every opportunity in order to prepare for an increase, including seeking out potential funding opportunities and expanding the number of staff employed by the organisation. They also have an ambition to increase the capacity of the Survivors Manchester ISVA Service and potentially increase the number of ISVAs who work within the service to ensure the needs of their clients are met moving forward. However, in order to meet any future demands on the Survivors Manchester ISVA Service, it is acknowledged that it will be necessary to seek an increase in funding to enable provision of a safe service for those who need the support. 10.6 The project team was informed that Survivors Manchester has sought to develop all of the documentation (such as referral forms, risk assessment and care plan record keeping) required for use by the ISVA service in-house. This is due to the 32

lack of availability of any standardised documentation, including assessment tools, developed for use by the ISVA workforce across the UK. Thus, whilst this has enabled Survivors Manchester to develop documentation and put in place assessment tools that meets the needs of their service, it is difficult to benchmark the service provided by the Survivors Manchester ISVA service against other ISVA service providers. However, it is important to note that the project team is of the view that the documentation that has been developed by Survivors Manchester for use within the Survivors Manchester ISVA Service is of high quality and adequately meets the needs of managers and commissioners in order to monitor the effectiveness of the Survivors Manchester ISVA Service. Furthermore, the project team are of the view that the approach taken by the Survivors Manchester ISVA Service to record keeping and data collection is significantly more sophisticated than that adopted in many other ISVA Services across England and Wales. 10.7 It is important to note that the challenges identified by Survivors Manchester, and outlined and discussed above, are not unique to the organisation nor the ISVA Service. They are challenges that apply equally to the majority of providers of services that support victims of sexual violence and are created by external influences and factors that are outside of the control of the organisation and the Survivors Manchester ISVA Service. That said, moving forward it will be important for the Senior Management Team to monitor the impact of these challenges and continue to raise awareness of them amongst commissioners and key funders where it is possible to do so.

11. Conclusion 11.1 The aim of this Independent Review was to support Survivors Manchester to ensure that the pilot ISVA Service was fit for purpose and to ensure the operating model is correctly aligned for the future (beyond the life of the pilot). 11.2 A mixed methodology was utilised by the project team in order to achieve the Independent Review. Two core elements of methodology were used to support triangulation of evidence. These were desk-based research (and analysis of key quantitative and qualitative data) and key informant interviews. 11.3 The first part of the independent review took place in January 2015. The second part of the review is took place in October 2015. 11.4 In September 2014, Survivors Manchester was successful in being awarded a Ministry of Justice Grant Fund via the Greater Manchester Police and Crime Commissioner to pilot a Criminal Justice Male Support Worker. This funding has enabled the establishment of the Survivors Manchester ISVA Service. 11.5 Of particular note is the unique nature of the Survivors Manchester ISVA service. Although there are a very small number of males currently in post providing ISVA support in the UK, the project team is not aware of any other ISVA Service providing dedicated male-only ISVA support. 11.6 It was clear to the project team that there is overwhelming support for Survivors Manchester and the services the organisation provides to male survivors of sexual abuse is very highly regarded. The feedback from stakeholders interviewed as part of the independent review was extremely positive, reporting that the organisation provides access to a safe, effective 34

and accessible service for males. 11.7 Of particular note, were the powerful examples provided by a number of the Key Informants about some of their most challenging clients who were previously not willing - or able - to engage with other professionals or support services yet who the ISVA Service were successful in engaging and then supporting to enable these clients to access other ongoing support. 11.8 The ISVA Service has been developed alongside and in addition to the well- established therapeutic services provided by Survivors Manchester, with the existing referral forms, initial assessments, policies and procedures used by the therapeutic service adopted for use by the ISVA Service. However, as the nature of support provided by an ISVA Service is significantly different to that of a counselling and psychotherapy service, it is important to ensure that the referral form, initial assessment, policies and procedures used within the ISVA service reflect these important differences, particularly as much of the ISVA service support is routed in the criminal justice process. 11.9 Following part 1 of the independent review, the project team has made the following key recommendations as part of the interim findings following part 1 of the independent review: 1 Survivors Manchester should regularly review the line management arrangements for the ISVA Service to ensure they continue to meet the needs of an expanding service 2 Review the policies and procedures used by the ISVA Service to ensure they are fit for purpose and meet the requirements of support routed in the criminal justice process. 3 Work with other ISVA service across Greater Manchester to ensure clear referral pathways that provide the client with the choice of gender of ISVA. 4 The Management Team for Survivors Manchester should consider expanding the ISVA Service to make ISVA support available for 35

males under the age of 18 years old. 5 The Management Team for Survivors Manchester should review the resilience of the ISVA Service and consider expanding to ensure there is more than 1 trained ISVA. 6 Survivors Manchester should review the referral forms to ensure that it is possible to make a direct referral to the ISVA Service. 7 Survivors Manchester should review the assessment process to ensure that a trained ISVA s involved in the decision as to whether support provided by the ISVA Service is appropriate for new referrals. 8 Survivors Manchester should monitor referrals to the ISVA Services to ensure partner organisations are making appropriate and timely referrals. 9 Survivors Manchester should regularly review the data collection system to ensure that it is effective for use by the ISVA Service. 10 The learning from the current application for ‘Special Measures’ should be documented to capture the learning from this ‘test-case’. 11.10 Part 2 of the independent service review has shown that significant progress has been made by Survivors Manchester in order to deliver and implement the key recommendations. Significantly, due to the success of the pilot, Survivors Manchester Senior Management Team have agreed to continue the provision of the Survivors Manchester ISVA Service (beyond the life of the pilot). It is clear to the Project Team that a huge amount of work has gone into the ensuring the service is embedded within the wider organisation, while ensuring the Survivors Manchester ISVA Service is able to retain its independence, with the creation of specific policies and procedures and of course, the professional boundaries required by an ISVA to support somebody through the criminal justice process.

Annex A The Project Team

Kim Doyle Kim Doyle is responsible for training and development at LimeCulture Community Interest Company. Kim qualified as a barrister and joined the Crown Prosecution Service in the UK in April 1986. Since 1995 Kim has worked closely with the police, health, lawyers and other third sector agencies at the St Mary’s Sexual Assault Referral Centre to improve the standard of rape and child abuse investigations and prosecutions across the Greater Manchester Area and beyond. She was instrumental in the development of the children’s service at St Mary’s following research work in the USA. Kim became involved in training and development in 1996 and regularly provides training to lawyers, forensic physicians, medics, social workers, police officers and forensic services in child and adult protection both nationally and internationally. She also works in multi‐ agency settings facilitating the development of joint working protocols and arrangements in child protection, with a specific focus on child sexual harm. In May 2011, Kim was invited to Australia and New Zealand to undertake work with the Police and Education Authorities to review and develop their child protection response, information sharing protocols and partnership arrangements. She was invited back in December 2011 to work with the police in Perth and Melbourne and academics to review the criminal justice response to child and adult victims of sexual violence. Kim was one of the authors of ‘Without Consent’;; a thematic review of the investigation and prosecution of rape published in 2007. In 2008 Kim was appointed as a ‘Children and Young Person’s Expert as part of a small team of experts commissioned by the Department of Health in the UK to advise upon the response to sexual violence by key agencies. During this time, Kim reviewed the paediatric and partnership response to children and young people affected by sexual violence, both acutely and historically. This included a review of commissioning structures, joint working arrangements, risk management procedures, forensic and after-care pathways. Kim is currently working with a team of professionals, including the NSPCC, who are developing processes to manage the risk posed by potential offenders who sit within sport environments. Kim is chair of the Greater Manchester Family Justice Council Domestic Violence sub group and a member of the Case Management Group for British Golf. 37

Stephanie Reardon Stephanie Reardon is responsible for the operational management and delivery at LimeCulture Community Interest Company. She has specialist knowledge in response to sexual violence policy and service delivery. Stephanie is also a member of the Home Office’s Independent Advisory Group on Ending Gang and Youth Violence and acts as a Peer Reviewer to ensure that the response to gang related sexual violence is incorporated into local area gang and youth violence strategies. Until March 2011, Stephanie was the Delivery Manager for the Department of Health’s National Support Team for Response to Sexual Violence where she supported all 39 Police Force Areas and their partner Primary Care Trusts (PCTs) across England as part of the NST work stream to improve the provision of Sexual Assault Referral Centre (SARC) services. This gives Stephanie a unique perspective to her work and makes her ideally qualified to conduct independent service review. As part of that role, Stephanie commissioned, edited and published the Revised National Service Guide: A resource for developing Sexual Assault Referral Centres on behalf of the Department of Health and Home Office (2009) and Response to Sexual Violence Needs Assessment Toolkit (2011) on behalf of the Department of Health (DH) and Association of Chief Police Officers (ACPO). Stephanie has held a number of challenging posts in central government;; as National Delivery Manager for the Improving Access to Psychological Therapies (IAPT) Programme (2007-2009), she co-ordinated the delivery of new psychological therapies services across the NHS as part of £173million national programme. From 2005‐2007, Stephanie was the National Programme Manager for the joint Home Office and Department of Health Violence and Abuse Prevention Programme ‐ a complex policy and research programme focusing on the effects of domestic and sexual violence and abuse. She was also seconded to the Serious Organised Crime Agency (SOCA) Child Exploitation and Online Protection (CEOP) Centre. Stephanie has a legal background and is also a qualified project manager and holds the Prince 2 Practitioner level qualification.

Annex B

Key Informants

The project team would like to thank the following key informants who took part in the independent review: Duncan Criag

Survivors Manchester

Ian Feis-Bryce

Survivors Manchester

Dave Jones

Greater Manchester Police

Charlotte Rimmer Crown Prosecution Service Bernie Ryan

St Mary’s Sexual Assault Referral Centre

Rifat Shaheen

Youth Offending Team

Damian Simpson Graater Manchester Police Hayley Speed

Mens Room