Responding to Domestic Abuse - Guidelines for Health Care Workers in NHSScotland

RESPONDING TO DOMESTIC ABUSE - GUIDELINES FOR HEALTH CARE WORKERS IN NHSSCOTLAND

PART 4: PLANNING AND MANAGEMENT

NHS Boards and NHS Trusts must play their part in raising awareness of domestic abuse as a significant social and health problem and ensure effective participation in local frameworks to implement A National Strategy to Address Domestic Abuse in Scotland. Each NHS board should ensure that the health component of their local strategy to address domestic abuse is included in their Local Health Plan. Boards will be held accountable for the quality of strategy and performance through the Performance Assessment Framework for the NHS in Scotland.

Planning

Each NHS Board should develop a policy for women's health improvement as an overarching framework in which domestic abuse/violence is addressed.The health service is one partner in a multi-agency response to domestic abuse and should contribute effectively to the development of multi-agency strategies. Local Domestic Abuse Forums will oversee development of a multi-agency strategy to address domestic abuse and ensure that local agencies develop appropriate links. Each NHS Board should identify a lead officer at Director level to co-ordinate the planning of a local strategy for local NHS organisations, and an operational adviser to provide advice and support for front line practitioners.

The development of guidelines for each health service setting should be linked to clinical governance and to a robust system of audit. Systems must be put in place in order that guidance for staff is cascaded to all health care settings.

Locally appropriate systems should be devised to involve women who have experienced domestic abuse, and Scottish Women's Aid and local Women's Aid Groups, in service planning and delivery.

DOMESTIC ABUSE - GOOD PRACTICE IN SCOTLAND The Scottish Executive Domestic Abuse Development Fund, has funded Domestic Abuse Training Co-ordinators in Forth Valley NHS Board. Lanarkshire NHS Board has contributed to the staffing costs associated with the establishment of a Domestic Abuse Co-ordinator's post in North Lanarkshire

Implementing the guidance

NHS Boards and NHS Trusts should put in place a local strategy for implementation of these national guidelines on domestic abuse and how to identify and respond to it.

DOMESTIC ABUSE - GOOD PRACTICE IN SCOTLAND NHS Greater Glasgow has included tackling domestic abuse in its local health plan and identified dedicated resources for development in this area.

When putting together local policies and guidance, NHS Boards and Trusts should:

• adopt the Scottish Executive's definition of domestic abuse;

• base guidance on best available current evidence, audit and risk management;

• ensure professional and user experiences and views are taken into account;

• include prevention as well as intervention;

• take into account codes of professional conduct and professional guidelines on best practice and advice from trades unions such as Unison.

In addition, any guidance produced should take into account local child protection processes , as domestic abuse may be an indicator of child abuse. The policy should also link across to other policies such as the Framework for Mental Health, the Drug Action Team's Corporate Action Plan and any plans developed by the Alcohol Misuse Co-ordinating Committees and local WellWoman services and support services for children.

Education and training should be addressed, including issues regarding the potential for litigation, negligence, breach of duty of care and breach of confidentiality. Documents explaining these should be included in the guidance. Policies must also be regularly evaluated.

DOMESTIC ABUSE - GOOD PRACTICE IN SCOTLAND The EVA project is currently funded by Motherwell North Social Inclusion Partnership (SIP) and is managed by Motherwell LHCC. It has a number of objectives including direct service delivery, research and staff training. In relation to training, the project has worked with the LHCC to provide multi-agency training to groups of nursing staff, police, Procurator Fiscal staff, social workers and voluntary sector staff. Subject to a positive evaluation, this will be rolled out to other SIP areas.

Service provision

Specific services may need to be developed, or existing services adapted, to create a comprehensive service for women, children and young people who have been abused. Screening for domestic abuse during antenatal care should be introduced and advocacy offered for those who need it, such as women with a mental illness or a learning disability who are experiencing abuse, as outlined in Our National Health (2000), Independent Advocacy (2001) and Patient Focus and Public Involvement (2001). Resources, including time, must be made available for implementing NHS guidance on domestic abuse.

Normally, women experiencing abuse should have the option of access to female staff in any setting, at all levels of the service, including cervical screening and post rape screening. A female interpreter service should also be available where possible (see Fair for all: working together for culturally competent services, NHS HDL (2002). Professionals who understand the needs of children and young people who are experiencing domestic abuse should be involved as appropriate.

Staff development

Effective staff development must be in place, and education and training should be updated regularly. All health care workers should be made aware of the services and resources available locally to women, children and young people experiencing domestic abuse, and should use this guidance to help them create health care environments that give women confidence to disclose.

As part of the partnership approach, Ayrshire and Arran NHS Board is taking the lead in mapping a woman's journey through the various services available. This will enable seamless and integrated provision for a person suffering the consequences of domestic abuse.

Advanced training of key staff should create a network of link contacts who could act as local 'experts' on issues such as referral, support and advice.

Staff support

Domestic abuse is an emotive issue. NHS employers, through line managers, must ensure that staff are appropriately supported when involved in any aspect of domestic abuse, irrespective of whether they are supporting others or are experiencing abuse themselves. Where health care workers are involved in criminal proceedings, for example in a child abuse case, it is the responsibility of the NHS employer to ensure that staff are given support, time and supervision to prepare statements and that they have appropriate legal advice. The NHS employer should make sure that the staff member:

• Is familiar with local court procedures.

• Has the opportunity to discuss statements or evidence with a lawyer.

• Is supported by being accompanied to court when giving evidence.

• Has the opportunity, following court proceedings, to discuss the case and receive further clinical supervision.

Education and training

Education and training for all health service staff on domestic abuse should be available in order that they have the opportunity to gain an awareness and understanding of domestic abuse and familiarise themselves with NHS Board or Trust guidance on the detection of abuse and response to it. While domestic abuse crosses all sectors of society and is not confined to certain groups, specialist training will be required on some issues, such as the specific needs of people who use drugs and/or work in the sex industry. More detailed training for specialist staff e.g. in obstetrics and gynaecology, accident and emergency, primary care and paediatrics should be available.

NHS employers, with Higher Education Institutions, should ensure that domestic abuse is included in pre-registration, post registration, undergraduate and postgraduate education and training programmes of all health related disciplines, with particular emphasis on health care practice. Staff should be instrumental in raising awareness of the issues of women and children experiencing domestic abuse. Staff should emerge from training confident in asking safe questions appropriately and understanding the link with child protection.

Where possible shared learning should be available on ethics, legal issues and interpersonal/ communication skills for doctors, nurses, midwives, social workers etc, using a variety of educational approaches. The use of voluntary organisations to 'train the trainers', should be explored as a means of taking this forward, such as Scottish Women's Aid staff, and their training pack which will be available at the end of 2002.

As part of the educational process, health care workers must have had the opportunity to examine their own beliefs and attitudes towards domestic abuse. Education and training programmes must emphasise that:

• Domestic abuse is a serious problem, as well as a criminal offence; it is not a private matter between partners.

• Abuse is not an inevitable part of 'normal' relationships.

• Women do not provoke or 'ask for it'.

• Women can be supported if they decide to stay with an abusive partner.

• Misuse of alcohol or drugs is not an excuse for domestic abuse and does not exonerate the abuser from responsibility for his behaviour.

DOMESTIC ABUSE - GOOD PRACTICE IN SCOTLAND Training to change attitudes and raise awareness has been taken forward as part of the organisational response in Ayrshire and Arran NHS Board. Several members of staff have already completed the training and awareness raising with Scottish Women's Aid and the Strathclyde Police.

Employers' responsibility for staff and the development of an employee policy

NHS employers should be aware that health care workers may experience distress in working with cases where abuse has occurred and they may need extra support (see section 4.7).

Furthermore, health care workers are not immune to abuse themselves and may be experiencing it outside the work environment. In such situations, staff members may be reluctant to approach their employer due to fear of the response or concern for the impact on their employment and promotion prospects. It is generally acknowledged that such cases are under reported.

It is essential that a climate of belief is created whereby staff can approach their employer for support. This needs to be addressed by producing an employee policy, which should be discussed with trade unions. Domestic abuse policies constitute an essential part of the NHS employers' strategy to achieve equal opportunities in the workplace. Support for employees should be available from the Occupational Health Service and employee counselling programmes.

Support and security at work play a vital part in the well being of any organisation. Staff should feel fully supported and confident in approaching their employer for help. This can also increase their commitment to their organisation. A workplace policy is a good investment, helping to retain skilled and experienced staff, and contributing to motivation and job satisfaction. Employers who have a policy on domestic abuse are demonstrating a powerful commitment to the principles of equal opportunities and community investment.

Human Resources staff or contact officers must be suitably trained and equipped to support and advise health care workers who are experiencing distress over a domestic abuse case, who are themselves experiencing abuse or who are perpetrators of abuse.

A checklist for negotiating a policy for staff is available in Annex C.