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SH CP 78

Domestic Violence and Abuse Policy


Version: 1

Summary:

This policy sets out how Southern Health Foundation NHS Trust (SHFT) will ensure that its patients, employees and those in the care of patients and employees such as vulnerable adults and children are supported and protected., This policy is intended to ensure that the response by SHFT to Domestic violence and abuse fully supports victims and maintains and enhances public confidence. Domestic violence and abuse, support for staff, impact of domestic violence and abuse on children. This policy applies to all staff/professionals who have contact with children and adults where domestic violence and abuse is suspected or identified. May 2014 Safeguarding Committee Date of meeting: 9 April 2013

Keywords (minimum of 5): (To assist policy search engine) Target Audience:

Next Review Date: Approved and ratified by:

Date issued: Author:

May 2013 Barbara Goff and Cathy Barnes, Named Nurses Safeguarding Children Fiona Gallagher, Specialist Nurse Safeguarding Children Sue Harriman, Chief Operating Officer

Sponsor:

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Version Control Change Record


Date Author Version Page Reason for Change

Reviewers/contributors
Name Sue Kewell Eliot Smith Debbie McGregor Linda Batty Julie Yalden Fiona Butt Jane Mills Jane McQuillan Carole Bralee Sam Fellows Julia Baker Caz Maclean Liz Taylor Kath Clark Naomi Black Position Head Of Safeguarding Adults Safeguarding Specialist Practitioner/Trainer Specialist Nurse Safeguarding Adults Named Nurse Safeguarding Children Safeguarding Specialist Nurse Children Safeguarding Specialist Nurse Children Safeguarding Specialist Nurse Children Safeguarding Specialist Nurse Children Safeguarding Children Practitioner Safeguarding Children Practitioner Safeguarding Children Practitioner Childrens Safeguarding Lead Call to Action Lead Modern Matron Locality Clinical Manager Designated Nurse Children in Care Version Reviewed & Date

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Contents

Page 1. 2. 3. 4. 5. 6. 7, 8. 9. 10. 11. 12. 13. 14. 15. A1 A2 A3 A4 Introduction Scope Definition Duties/ responsibilities General Support to all Victims of Domestic Violence and Abuse Information Sharing Direct Questioning for Domestic Violence and Abuse Response and Risk Assessment Following Disclosure of Domestic Abuse Safety Planning Supervision Training requirements Monitoring compliance Policy review Associated documents Supporting references Training Needs Analysis (TNA) Equality Impact Assessment (EqIA) Assessing Children Flow chart Assessing Vulnerable Adults Flow chart 4 4 5 5 6 8 9 9 9 9 9 9 10 10 10 12 15 24 25

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Domestic Violence and Abuse

1. 1.1

Introduction Domestic Violence and Abuse is a significant issue in Hampshire with 56,000 women and girls aged 16 -59 having been a victim of domestic violence and abuse in the past year (2012) (Hampshire Domestic Abuse Forum). This policy also recognises that although both men and women can be victimised through Domestic Violence and Abuse, a greater proportion of women experience all forms of Domestic Violence and Abuse, and are more likely to be seriously injured, killed by their partner, ex-partner or lover. The effects of Domestic Violence and Abuse can be wide-ranging and people experience it regardless of their social group, gender, age, ethnicity, marital status, disability, sexuality or lifestyle. In particular, Domestic Violence and Abuse has significant health implications including serious injury, exacerbation of other medical conditions, stress and mental illness. The legal obligations, which underpin this policy, include the duties within the Human Rights Act 1998 and European Convention on Human Rights to protect life and to protect individuals from inhuman and degrading treatment. The document, Striking the Balance Practical Guidance on the application of Caldicott Guardian Principles to Domestic Abuse and MARACs (Multi Agency Risk Assessment Conferences) 2012, is intended to assist those involved in information sharing between agencies about Domestic Violence and Abuse to make decisions. It identifies the underlying ethical considerations so that tensions between confidentiality and information sharing may be resolved. The document, Mental Health Act 2007 - guidance on extension of victims' rights to information under the Domestic Abuse, Crime and Victims Act 2004, offers guidance on extension of victims' rights to information under the Domestic Abuse, Crime and Victims Act 2004. This act describes new duties for hospital managers, responsible clinicians, approved mental health professionals and NHS bodies in respect of the rights of victims of certain mentally disordered offenders subject to the Mental Health Act 1983. This is regarding information that should be shared with victims. The Department of Health and NHS Employers are founding members of the UK Corporate Alliance against Domestic Violence (UK CAADV). This alliance aims to encourage public and private sector employers to commit to promoting better awareness of Domestic Violence and Abuse in their own workforce. Southern Health recognises and accepts its responsibilities in accordance with the Health and Safety at Work Act 1974, and Good Employment Practice. Scope This policy applies to all SHFT employees. It must be used in conjunction with the current 4 LSCB Practice Guidelines (2012), Safeguarding Children Exposed to Domestic Abuse and the Department of Health Guidance, DH (2009) Improving safety, Reducing harm a practical toolkit for front-line practitioners.
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1.2

1.3

1.4

1.5

1.6

1.7

2. 2.1

Domestic Violence & Abuse Policy Safeguarding Department Version 1 May 2013

2.2

In fulfilling these obligations, this policy recognises that appropriate partnership working with criminal justice agencies and other statutory and voluntary sector services is essential. SHFT fully participates in Multi Agency Risk Assessment Conference (MARAC) arrangements and the Multi Agency Safeguarding Hub for the triage of Domestic Violence and Abuse forms. Vulnerable adults may also be subjected to Domestic Violence and Abuse. The principles contained within this policy must be followed to ensure that vulnerable adults are afforded the same protection from domestic violence and abuse. This policy will be applied without discrimination, regardless of gender/transgender, race, disability, sexual orientation, age, religion/belief or cultural practice. Definition Following a wide consultation the cross government definition of Domestic Violence and Abuse has been agreed. This definition has been implemented in March 2013. The definition is: Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or violence between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, the following types of violence: psychological; physical; sexual; financial; emotional. Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other violence that is used to harm, punish, or frighten their victim. This definition, which is not a legal definition, includes so called 'honour based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group. Home Office 2012.

2.3

2.4

3. 3.1

4. 4.1

Duties/Responsibilities All employers have a responsibility to provide a safe and healthy working environment for their staff and it is this that underpins the Southern Health policy on Domestic Violence and Abuse. The Trust recognises that Domestic Violence and Abuse can affect an individuals health and well-being which may also impact on their work performance. Divisional Heads and all Managers Divisional Heads and Managers should ensure that all staff have read and are made aware of their roles and responsibilities in relation to this policy and be aware of what actions they need to take to identify any additional training and support needs required to enable their teams to perform their duties.
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. 4.2

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4.3

Employees All employees of SHFT have a responsibility to support victims of Domestic Violence and Abuse. The main responsibility for this support will lie with the person with primary responsibility for providing health care to the victim. Staff are responsible for seeking further advice and guidance where they are unclear about the application of any aspect of this policy or associated guidance.

5. 5.1

General Support to all Victims of Domestic Violence and Abuse Southern Health endorses the Governments view that violence and abuse within the domestic context amounts to a fundamental breach of trust and contravenes an individuals right to feel safe both in their home and within a personal relationship (DoH 2005) and is therefore committed to ensuring that domestic violence and abuse is recognised, and that service users and staff are provided with information and support to minimise risk. To underpin this, the Trust will engage with partner agencies in working towards the reduction of domestic violence and abuse. The aims of this section of the policy are to: Raise awareness of Domestic Violence and Abuse Ensure that Southern Health employees are enabled to provide help and support to patients who are experiencing Domestic Violence and Abuse

5.2

5.3

All employees of Southern Health have a responsibility to support victims of Domestic Violence and Abuse. The main responsibility for this support will lie with the person with primary responsibility for providing health care to the victim. Domestic Violence and Abuse and Children Where it is identified that a child is suffering or is likely to suffer significant harm due to domestic abuse, an immediate referral to Children Services (Social Care) is required. The referral procedures are located in Hampshire, Isle of Wight, Portsmouth and Southampton Safeguarding Children Boards Procedures http://4lscb.procedures.com Domestic Abuse is a significant safeguarding and child protection issue. The issue of children living with Domestic Abuse is now recognised as a matter of concern in its own right by both Government and key childrens services and agencies. The impact of Domestic Abuse on an individual child will vary according to the childs resilience and the strengths and weaknesses of their particular circumstances, as well as a range of factors in respect of the violence. The two key imperatives of any intervention for children living with Domestic Abuse are: To protect the child/ren. To empower the victim to protect themselves and their child/ren.

5.4 5.4.1

5.4.2

5.4.3

Where it is known that a child/ren is living with Domestic Violence and Abuse, it is important to assess the risk of harm to the mother and her child/ren. Further guidance on assessing risk and safety planning is available in the Department of Health Guidance DH (2009) Improving Safety, Reducing harm: a practical toolkit for front-line practitioners.
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5.5 5.5.1

Domestic Violence and Abuse and Vulnerable Adults The aim of this policy is to ensure that service users who have experienced domestic abuse in the past or present are supported safely and appropriately. Deliver your own service response to specific issues and appropriate to the risk level. If the risk is high, refer to MARAC (Multi Agency Risk Assessment Conference). Carry out safety planning with the client appropriate to the risk level. Contact local specialist agencies for advice, information and / or to make a referral for specialist support. http://hampshiredomesticabuse.org.uk/find-a-local-service/ Southern Health is committed to the welfare of its service users and seeks to support and assist any service users who are experiencing problems related to domestic abuse. Southern Health recognises that domestic abuse is not only unacceptable but it is also a crime. It also seeks to raise awareness of domestic violence and abuse and develop a culture where domestic abuse is recognised as unacceptable. Southern Health aims to deliver a service of the highest quality and safety standards. It has a commitment to the care and health and safety of service users experiencing domestic violence and abuse, to promoting good health and good practice to our service users; and to provide relevant information and resources in adherence to professional safeguarding responsibilities. Domestic Abuse and Employees All employers have a responsibility to provide a safe and healthy working environment for their staff. Southern Health recognises that the effects of domestic abuse can not only impact on mental wellbeing but also on punctuality, attendance, health and safety, work performance and productivity. Southern Health is committed to the welfare of its employees and seeks to support and assist any employee who is experiencing problems related to domestic violence and abuse. Southern therefore has a legal responsibility to protect the health, safety and welfare of all employees whilst at work. Where the victim is an employee of Southern Health, the main responsibility for support will lie with the employees immediate line manager. The aims of this section of the policy are to: Raise employees awareness of Domestic Violence and Abuse Encourage and enable reporting of Domestic Violence and Abuse in the workplace Provide help and support to employees who are experiencing Domestic Violence and Abuse Enable managers to deal with disclosures in an appropriate manner Deal with employees who are identified as perpetrators. The Occupational Health Department may also be able to offer practical advice in relation to health issues and also for referral to the counselling service (0800243 458 available 24 hours a day, 7 days a week, 365 days a year).
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5.5.2

5.5.3 5.5.4

5.5.5

5.5.6

5.5.7

5.6 5.6.1

5.6.2

5.6.3

Domestic Violence & Abuse Policy Safeguarding Department Version 1 May 2013

5.7 5.7.1.

Dealing with Employees who are Accused of Domestic Abuse Where it is alleged that an employee of the Trust is the perpetrator of domestic abuse then the manager should meet with the employee concerned at the earliest opportunity to discuss the allegation and hear their response. The employee should be made aware that domestic abuse is a serious matter that could potentially lead to a criminal conviction. Employees should also be made aware that conduct outside of work could lead to an investigation under the Trusts Management Action When A Concern Arises Policy (HRP 40) because of its impact on the Trust. In addition, such conduct may make certain duties inappropriate, for example, it may be inappropriate for an employee accused of domestic abuse to be providing services to vulnerable adults or children. In this event, the manager, in consultation with the Director of Operations, should consider temporary restrictions of practice, redeployment or exclusion from work whilst an investigation is carried out. Such action must be carried out in line with Trust policy and after taking advice from Human Resources. Every care must be taken during investigations to ensure that the focus of the investigation is the impact on the Trust and the employees suitability to undertake their role. The investigation needs to take into account the sensitive and personal nature of the issues involved and the fact that a police investigation may be underway. The investigating officer should be supported by a senior member of Human Resources. The employee concerned should be reminded of the right to be supported by a Trade Union Representative or a workplace colleague during any meetings connected with an investigation. The manager should also ensure that they are aware of the counselling services available through the Occupational Health Service (see below). Situations where both the victim and the alleged perpetrator work for SHFT or where a victim of Domestic Violence and Abuse needs to access services at a location where the alleged perpetrator is employed, need to be handled sensitively. Ensuring safety for the victim and any relevant colleagues in the workplace may involve the suspension or redeployment of the alleged perpetrator pending a disciplinary investigation. Information Sharing and Confidentiality in Relation to Domestic Abuse Consideration of confidentiality is essential to provide a trusting relationship between victims of domestic violence and abuse and healthcare staff. However, the right to confidentiality is not absolute. There may be circumstances where the safety of the victim and their children overrides their right to confidentiality (DCSF, 2008). Remember that the Data Protection Act is not a barrier to sharing information, but provides a framework to ensure that personal information about living persons is shared appropriately(DCSF, 2008:4) When sharing information always consider whether it is necessary, proportionate, relevant, accurate, timely and secure. Refer to DCSF (2008) Information Sharing document.

5.7.2

5.7.3

5.7.4

5.7.5

5.7.6

6. 6.1

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7. 7.1

Direct Questioning for Domestic Abuse Research has identified that direct questioning gets more positive results than vague enquiries. It demonstrates to the victim that the health professional worker has an understanding of the issue of domestic violence and abuse. If all clients are given basic information about the unacceptability of domestic abuse it is more likely to lead to a change in societal attitudes and is less likely to compromise the safety of those experiencing abuse. Guidelines for Enquiry (Appendix 2 South Gloucester guidance) Response and Risk Assessment Following Disclosure of Domestic Abuse Following disclosure of domestic violence and abuse, a professional assessment has to be made regarding the level of threat, danger and violence posed to the victim and or any children and the appropriate action taken. For those staff trained in formal risk indicator assessment the CAADA (Dash) Risk Indicator Form can be used. Appendix 3 provides additional risk factors to consider. Safety Planning It is vital that when health professionals are working with victims of domestic abuse that they appreciate Women are at greatest risk of homicide at the point of separation or after leaving a violent partner (Lees 2000 cited by Hanmer, J and Itzin (2001) It is therefore necessary for health professionals to recognise the limitations in their knowledge and signpost victims to relevant support services.

8. 8.1

9. 9.1

10. 10.1

Supervision All health staff can access supervision from the safeguarding team if they have concerns about Domestic Violence and Abuse. Training Requirements [see TNA in Appendix 1)] All clinical staff should access level 2 domestic abuse training. This is available via an e-learning package from the Hampshire Domestic Abuse Forum. Level 3 Advanced training is available for clinicians who are working with children and families. Please see the attached training needs analysis for further detail. Monitoring Compliance The following table outlines the arrangements for monitoring compliance with this policy and its associated procedures.

11. 11.1

12.

Element to be monitored Duties and responsibilities of staff


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Lead Safeguarding Steering

Tool Work plan

Frequency Quarterly

Reporting arrangements Safeguarding Steering


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Basic record-keeping standards, which must be used by all staff

Committee Clinical Information Assurance Steering Group

Clinical audit

Annual audit

Committee Clinical Information Assurance Steering Group

13.

Policy Review This policy will be reviewed annually.

14.

Associated Documents Buckinghamshire Safeguarding Children Board Procedure: http://www.buckslscb.org.uk/bscb-procedures Swindon, Wiltshire Bath and North East Somerset - South West Child Protection Procedures: http://www.swcpp.org.uk/ Pan-Dorset Inter-Agency Safeguarding Procedures: http://www.dorsetlscb.co.uk/site/advice-for-people-working-with-children/localinter-agency-procedures/ Safeguarding Adults Policy Hampshire, Isle of Wight, Portsmouth and Southampton Safeguarding Children Boards: http://4lscb.proceduresonline.com/ Oxfordshire Safeguarding Children Board Procedures http://oxfordshirescb.proceduresonline.com

15.

Supporting References Home Office (2012) Cross-Government Definition Of Domestic Abuse A Consultation Summary Of Responses. CAADV News (2011) Employers role in tackling Domestic Abuse. Association of Chief Police Officers of England, Wales and Northern Ireland (2008) Honour Based Violence Strategy London: ACPO. Brandon, M., Belderson, P., Warren, C., Howe, D., Gardner, R., Dodsworth, J. and Black, J (2008) Analysing child deaths and serious injury through abuse and neglect: what can we learn? A biennial analysis of serious case reviews 2003- 2005 Nottingham: Department of Children, Schools and Families. Cawson, P. (2002) Child maltreatment in the family: the experience of a national sample of young people London: NSPCC Children Act 2004: Elizabeth II. Chapter 41. (1989) London: The Stationary Office. Data Protection Act 1998 (1998) London: The Stationary Office Department for Children, Schools & families (DCSF) (2008) Information Sharing: Guidance for practitioners and managers Nottingham: DCSF. DH (2009) Improving safety, Reducing harm A practical toolkit for front-line practitioners: The Stationery Office.
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Department for Children, Schools and Families (2010) Working Together to Safeguard Children. A guide to interagency working to safeguard and promote the welfare of children DH (2005) Responding to domestic abuse: a handbook for health professionals. Itzin, C. (2006) Tackling the Health and Mental Health Effects of Domestic and Sexual Violence and Abuse. DH (2012) Striking the Balance Practical Guidance on the application of Caldicott Guardian Principles to Domestic Abuse and MARACs (Multi Agency Risk Assessment Conferences). 4LSCB Practice Guidance (2012) Safeguarding Children Exposed to Domestic Abuse Home Office (March 2013) Information for Local Areas on the change to the Definition of Domestic Violence and Abuse.

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APPENDIX 1 - LEaD (LEADERSHIP, EDUCATION AND DEVELOPMENT) TRAINING NEEDS ANALYSIS If there are any training implications in your policy, please complete the form below and make an appointment with the LEAD department (Louise Hartland, Strategic Education Lead or Sharon Gomez, Essential Training Lead on 02380 774091) before the policy goes through the Trust policy approval process. Level 2 Training Training Programme Frequency Course Length
How long will the programme run (April April?) and how long will each course take (3 hours?)

Delivery Method
How and where do you intend delivering this programme (face to face, e-learning, Essential Training Days)?

Trainer(s)
Who will be delivering this programme if delivery method is face to face?

Recording Attendance
Who do you anticipate recording attendance?

Strategic & Operational Responsibility


Who is accountable for this training strategically and who is operationally accountable?

Domestic

How often will the target audience need to attend this course?

Directorate

Division
Adult Mental Health Learning Disability Services

Target Audience
All clinical support staff and all qualified clinical staff and Any person with responsibility to manage others. All clinical support staff and all qualified clinical staff and Any person with responsibility to manage others All clinical support staff and all qualified clinical staff and Any person with responsibility to manage others All clinical support staff and all qualified clinical staff and Any person with responsibility to manage others All clinical support staff and all qualified clinical staff and Any person with responsibility to manage others All clinical support staff and all qualified clinical staff and Any person with responsibility to manage others All clinical support staff and all qualified clinical staff and Any person with responsibility to manage others All clinical support staff and all qualified clinical staff and Any person with responsibility to manage others All clinical support staff and all qualified clinical staff and Any person with responsibility to manage others

MH/LD

Older Persons Mental Health Specialised Services TQtwentyone Adults

ICS

Childrens Services Specialist Services

Corporate Services

All (Workforce & Development, Finance & Estates, Commercial)

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Level 3 Training Training Programme Frequency Course Length Delivery Method


How and where do you intend delivering this programme (face to face, e-learning, Essential Training Days)

Trainer(s)

Recording Attendance

Strategic & Operational Responsibility


Who is accountable for this training strategically and who is operationally accountable?

Domestic Abuse

How often will the target audience need to attend this course? 3 yearly

Adult Mental Health Learning Disability Services MH/LD Older Persons Mental Health Specialised Services TQtwentyone Adults ICS Childrens Services Specialist Services Corporate Services All (Workforce & Development, Finance & Estates, Commercial)

Sue Harriman Operationally Karen Safeguarding Team Face to Face Rudland and Sue Kewell Advanced training for staff who have significant contact with children and young people and adults who are parents/carers of children and young people. Not applicable Not applicable Not applicable Advanced training for staff who have significant contact with children and young people and adults who are parents/carers of children and young people. Not applicable Advanced training for staff who have significant contact with children and young people and adults who are parents/carers of children and young people Not applicable Not applicable

How long will the programme run (April April) and how long will each course take (3 hours)

Who will be delivering this programme if delivery method is face to face?

Who do you anticipate recording attendance? LMS LEaD

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APPENDIX 2 EQUALITY IMPACT ANALYSIS SCREENING TOOL Equality Impact Assessment (or Equality Analysis) is a process of systematically analysing a new or existing policy/practice or service to identify what impact or likely impact it will have on protected groups. It involves using equality information, and the results of engagement with protected groups and others, to understand the actual effect or the potential effect of your functions, policies or decisions. The form is a written record that demonstrates that you have shown due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations with respect to the characteristics protected by equality law. For guidance and support in completing this form please contact a member of the Equality and Diversity team. Name of policy: Policy Number: Department: Lead officer for assessment: Domestic Violence and Abuse Policy SH CP 78 Safeguarding Department Barbara Goff: Named Nurse Safeguarding Children Barnes Cathy: Named Nurse for Safeguarding Children MH/LD - Ricky Somal: Equality and Diversity Lead Date Assessment Carried Out: January 2013

1. Identify the aims of the policy and how it is implemented. Key questions Answers / Notes Briefly describe purpose of the policy including How the policy is delivered and by whom Intended outcomes Domestic Violence and Abuse can affect any individual within society however some specific groups are more vulnerable especially women from existing data both national and local. Domestic Violence and Abuse cuts across ethnicity, age, gender, sexuality, disability and religion or beliefs and class/status. The purpose of this policy is to increase awareness of domestic abuse within the organisation and its health impact on those experiencing it and to provide evidence for best practice in detecting domestic abuse and managing risk and supporting victims. It also provides appropriate information and support for practitioners and staff in the management of domestic violence and abuse issues and to signpost staff appropriately to expert agencies. 2. Consideration of available data, research and information Monitoring data and other information involves using equality information, and the results of engagement with protected groups and others, to understand the actual effect or the potential effect of your functions, policies or decisions. It can help you to identify practical steps to tackle any negative effects or discrimination, to advance equality and to foster good relations. Please consider the availability of the following as potential sources:
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Demographic data and other statistics, including census findings Recent research findings (local and national) Results from consultation or engagement you have undertaken Service user monitoring data Information from relevant groups or agencies, for example trade unions and voluntary/community organisations Analysis of records of enquiries about your service, or complaints or compliments about them Recommendations of external inspections or audit reports Key questions 2.1 What is the equalities profile of the team delivering the service/policy? Data, research and information that you can refer to The Equality and Diversity team will report on Workforce data on an annual basis.

2.2

What equalities training have staff received?

All Trust staff have a requirement to undertake Equality and Diversity training as part of Organisational Induction (Respect and Values) and EAssessment The Trust Equality and Diversity team report on Trust patient equality data profiling on an annual basis

2.3

What is the equalities profile of service users?

2.4

What other data do you have in terms of service users or staff? (e.g results of customer satisfaction surveys, consultation findings). Are there any gaps? DH (2009) Improving safety, Reducing harm A practical toolkit for front-line practitioners: The Stationery Office. DH (2005) Responding to domestic abuse: a handbook for health professionals. Itzin, C. (2006) Tackling the Health and Mental Health Effects of Domestic and Sexual Violence and Abuse. DH (2012) Striking the Balance Practical Guidance on the application of Caldicott Guardian Principles to Domestic Violence and MARACs (Multi Agency Risk Assessment Conferences). 4LSCB Practice Guidance (2012) Safeguarding Children Exposed to Domestic Abuse What internal engagement or consultation has been undertaken as part of this EIA and

The Trust is preparing to implement the Equality Delivery System which will allow a robust examination of Trust performance on Equality, Diversity and Human Rights. This will be based on 4 key objectives that include: 1. 2. 3. 4. Better health outcomes for all Improved patient access and experience Empowered, engaged and included staff Inclusive leadership

2.5

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2.6

with whom? What were the results? Service users/carers/Staff What external engagement or consultation has been undertaken as part of this EIA and with whom? What were the results? General Public/Commissioners/Local Authority/Voluntary Organisations

In the table below, please describe how the proposals will have a positive impact on service users or staff. Please also record any potential negative impact on equality of opportunity for the target: In the case of negative impact, please indicate any measures planned to mitigate against this.

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Positive impact (including examples of what the policy/service has done to promote equality)

Negative Impact

Action Plan to address negative impact

Age

Disability

Women under the age of 30 are at considerably greater risk than those over the age of 40 years. (British Crime Survey, Walby & Allen, 2004) Previous research of The Equality and Diversity Lead will which there is very little provide support and - suggests that advise relating to the disabled women experience more impact of domestic abuse than nonabuse across all protected disabled women, and their impairments may characteristics. Up to date research can also be used by their abusers in order to be promoted to raise awareness. increase both the abusers power and control, and the womans vulnerability and isolation. Victims of domestic violence and abuse aged 16 and 17 will be recognised under a new cross-government definition: Significant barriers to reporting exist, which include fear of losing a caregiver, inability to verbally communicate

Actions to overcome problem/barrier Service and Policy developments to help identify the needs of people across all age groups. Service and Policy developments to help identify the needs of disabled people.

Resources required

Responsibility

Target date

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as a result of a disability, and fear of not being taken seriously, among others. Out of sight, out of mind? LGBT Domestic Abuse Project and the Scottish Transgender Alliance launched new research report into transgender people's experiences of domestic abuse. This is available from the equality and Diversity Lead Out of sight, out of Mind? The report reveals extremely high levels of prejudice and abuse in transgender peoples relationships and home lives, coupled with unacceptable negative experiences of accessing fundamental services and support during the times when they are most needed. A forced marriage is a marriage that is performed under duress and without the full and informed consent or free will of both parties. Victims of forced marriage may be the subject of physical violence, rape, abduction, false imprisonment, enslavement, Service and Policy developments to help identify the needs of transgender people

Gender Reassignment

Marriage and Civil Partnership

The Civil Partnership Act 2004 enables same-sex couples to obtain legal recognition of their relationship. Couples who form a civil partnership have a new legal status, that of 'civil partner'. Civil partners have equal treatment to married couples in a wide range of legal

Service and Policy developments to help identify the needs of diverse cultural groups.

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matters, including protection from domestic violence

emotional abuse, and murder. It is important not to confuse forced' marriage with arranged' marriage. In the instance of an arranged' marriage both parties freely consent. Domestic violence has been identified as a prime cause of miscarriage or stillbirth. Mezey, Gillian (1997) "Domestic Violence in Pregnancy" in Bewley, S., Friend, J., and Mezey, G.: (1997) (ed.) Violence against women (Royal College of Obstetricians and Gynaecologists) Midwives usually do not raise the subject of domestic violence, and women often feel silenced and unable to talk about it with their midwife. Aston, Gill, 2004: "The silence of domestic violence in pregnancy NSF (National Standard Framework) for Children, Young people and Maternity Services includes points on identification of and response to domestic violence in pregnancy: women should be offered "a supportive environment and the opportunity to disclose" and maternity service staff should be "aware of the importance of domestic violence and competent in recognising the Healthcare professionals have a duty to record anything that might impact on the health of their patients including domestic violence.

Pregnancy and Maternity

All clinical staff should access level 2 domestic abuse training. This is available via an elearning package from the Hampshire Domestic Abuse Forum. Level 3 Advanced training is available for clinicians who are working with children and families.

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during women's encounters with healthcare professionals" in Midwives Vol.7, no.4, April 2004.

symptoms and presentations" and "able to make a sensitive enquiry" and "provide basic information" and referral to local services. Promotion and use of interpreting and translation services Service and Policy developments to help identify the needs of diverse cultural groups. Engagement activity to raise awareness of appropriate services

Race

The Equality and Diversity Lead can provide information and signpost to community groups to engage and involve BME people in the development of services and policies.

An inability to communicate in English and lack of understanding of the health, social and legal services available pose considerable barriers Female Genital Mutilation (FGM)

Religion or Belief

The Equality and Diversity Lead can provide information and signpost to community groups to engage and involve people in the development of services and policies. This policy also recognises that although both men and women can be

Victims of domestic abuse may seek help from religious leaders. A lack of awareness of appropriate services may have a negative impact on signposting victims for appropriate support Gender is a "significant risk factor" as women are more likely than men to

Sex

Service and Policy developments to help identify the


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victimised through domestic violence, a greater proportion of women experience all forms of domestic violence, and are more likely to be seriously injured, killed by their partner, ex-partner or lover.

experience interpersonal violence, especially sexual violence, and to experience severe and/or repeated incidents of violence and abuse. "Women are the overwhelming majority of the most heavily abused group. Among people subject to four or more incident of domestic violence from the perpetrator of the worst incident (since age 16) 89 per cent were women". (British Crime Survey, Walby & Allen, 2004) Poverty and of public transportation may have a negative impact on people living in rural areas who may be a victim on domestic abuse.

needs of males and females.

Sexual Orientation

Stonewall has collated evidence/research into the impact and effects of domestic abuse in the LGB community. This is available from

LGB people are less likely to tell a health care practitioner that they are experiencing domestic violence if they do not feel able to

Service and Policy developments to help identify the needs of LGB people
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the Equality and Diversity Lead.

disclose their sexual orientation to them. Research indicates that LGB people are reluctant to disclose their sexual orientation to their GP because they think they will experience discrimination. They might also be reluctant to demonstrate a problem within a relationship, especially if they think that the health care practitioner thinks gay relationships are generally unstable or unsustainable. LGB people may not want to perpetuate that view by admitting domestic violence. Stonewall

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APPENDIX 3 - ASSESSING CHILDREN FLOW CHART


What you would see if the risk to the child is moderate
Single or up to 3 minor incidents of physical domestic abuse which were short in duration and the victim did not require medical treatment Occasional intense verbal abuse Children were not present or not drawn into the incident Victims relationship to the child is nurturing, protective and stable Abuser accepts responsibility for the abuse indicting remorse and willingness to engage in services to address abusive behaviour.

What you can do if the risk is moderate


Consult your manager Provide single agency family support Complete a CAF (if not already completed) Complete safety plan with/for victim and child/ren Refer perpetrator for intervention if willing If CAF refused review risk level with manager

What you would see if the risk to the child is moderate to serious
History of minor/moderate incidents of physical violence of short duration Victim received minor injury that did not lead to medical attention being sort Evidence of intimidation/bullying behaviour to victim but not towards the child/ren Destruction of property Family, relatives, neighbours report concerns regarding the victim and children Intense verbal abuse Abuser attempts to control victims activities or movements Children were present in the home during the incident but did not directly witness it Mental health issues for victim or abuser Substance misuse for victim or abuser Victims relationship to the child is nurturing, protective and stable and despite abuse was not prevented from attending to the child/rens needs

What you can do if the risk is moderate to serious

In addition to the actions above: Attend a multi agency team around the child (TAC) Implement and monitor single agency or joint actions from TAC Seek Childrens Social Care views on whether this is a Child in Need

What you would see if the risk to the child is serious


Incidents of serious and/or persistent physical violence increasing in severity, frequency and duration Victim and/or children indicate that they are frightened of the abuser Victim required medical attention or explanation for injuries implausible 1 WHAT DOES THE TERM COVER? Requests for police intervention Incidence of abuse occur in presence of children Threat of harm to is children/and adult victim Domestic abuse definedor by the 4LSCB as: Physical assault on a pregnant woman Abuser has history of domestic abuse in previous relationships Mental health issues for victim or abuser Substance misuse by victim and/or abuser APPENDIX 4: ASSESSING VULNERABLE ADULTS Strong likelihood of emotional abuse of children e.g. may display behaviour problems/ self harm Abuser suspected of physically abusing child/ren Domestic Violence & Abuse Policy Minimisation by abuser, lack of remorse/guilt Safeguarding Department The DASH assessment indicates the level of risk to be HIGH and there are children in the household.

What you can do if the risk is serious

If analysis of what you see indicates that child is suffering or at risk of suffering significant harm... Refer for assessment and planning led by CSC Refer for a Multi Agency Risk Assessment Conference (MARAC)

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Version 1 May 2013

APPENDIX 4 - ASSESSING VULNERABLE ADULTS FLOW CHART

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