ASK & ACT – Half day

TRAINER NOTES

WELSH GOVERNMENT INTRODUCTION TO ASK AND ACT:

“Ask and Act” is a Welsh Government policy of targeted enquiry, to be practiced across Local Authorities, Local Health Boards, Fire and Rescue Authorities and NHS Trusts, to identify violence against women, domestic abuse and sexual violence. The term targeted enquiry describes the recognition of indicators of violence against women, domestic abuse and sexual violence as a prompt for a professional to ask their client whether they have been affected by any of these issues.

The National Institute of Health and Care Excellence (NICE) and the World Health Organisation recommend a system of targeted clinical enquiry across Health and Social Care to better identify and therefore respond to domestic abuse.1 2

The Welsh Government takes this recommendation and identified good practice further by supporting the use of such enquiry across the Public Service (to include those in a safeguarding role, education, Fire and Rescue and those within housing services). It also proposes a slightly wider focus on violence against women, domestic abuse and sexual violence.

It is the role of the entire Public Service to provide an effective response to those experiencing violence against women, domestic abuse and sexual violence. This involves collaboration in its broadest sense to create consistency and standardisation of response, no matter which gateway (housing, health, social care etc.) a client uses to access service provision.

The aims of “Ask and Act”

· to increase identification of those experiencing violence against women, domestic abuse and sexual violence;

1 Responding to Intimate partner violence and sexual violence against women. World Health Organisation clinical and policy guidelines (2013)

2 Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively. NICE public health guidance 50 (February 2014)

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· to offer referrals and interventions for those identified which provide specialist support based on the risk and need of the client;

· to begin to create a culture across the Public Service where addressing violence against women, domestic abuse and sexual violence is an accepted area of business and where disclosure is expected supported, accepted and facilitated;

· to improve the response to those who experience violence against women, domestic abuse and sexual violence with other complex needs such as substance misuse and mental health; and

· to pro-actively engage with those who are vulnerable and hidden, at the earliest opportunity, rather than only reactively engaging with those who are in crisis or at imminent risk of serious harm.

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Health warning

It is statistically unlikely that you will not have at least one victim / survivor amongst the delegates and as the trainer, the onus is on you to ensure that the training session is not re-traumatising for them. This means challenging offensive remarks about victims / survivors and taking steps to minimise them being viewed as ‘out there’ rather than in the room with you.

The odds are also high that there will be at least one perpetrator. Similarly, any excusing remarks should be challenged since without this, your training could end up being used by the abuser as justification for their behaviour.

Domestic violence is a subject that arouses strong feelings – whether or not this is as a consequence of direct personal experience. Most people want to strongly disassociate themselves from both victims and perpetrators and are heavily invested in distinguishing their own ‘normal’ relationships from abusive ones; indeed this is the source of many of the prevalent myths and stereotypes.

As the trainer, you have a responsibility to educate yourself about the dynamics of domestic violence and to make sure during the delivery of this training package that you focus not only on the content of what you provide, but also monitor the dynamics and well-being of the delegates.

Language

Throughout this training pack, victims/survivors of domestic violence are referred to as female and perpetrators as male. This is to reflect the overwhelming majority of domestic violence incidents as well as those who use existing services. For example, the most recent Crime Survey of England and Wales found that in the year prior to interview, there were an estimated 700,000 male victims (a reduction from previous years) and 1.4 million female victims (an increase on previous years). Moreover, while the commonly cited figures of domestic violence affecting one in four women and one in six men might suggest a degree of parity, this conceals that 47 per cent of male victims experienced a single incident with a mean average of seven incidents per victim compared with only 28 per cent of female victims experiencing a single incident with a mean average of 20 incidents per victim.

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Gender does play a role in domestic violence. This does not mean all victims are female and all abusers male. What it does mean is that the gender of both victim and offender influences the behaviours of both. For example, women victims are more likely to be injured, more likely to be frightened, more likely to be repeatedly abused and more likely to be murdered. Male victims may be less likely to access existing services, often fearing ridicule should they disclose abuse at the hands of a woman. Gender also influences the type of abuse. Male perpetrators are far more likely than female abusers to abuse post-separation. Indeed this is the most common high-risk situation for female victims.

It is sometimes claimed that male domestic violence victims have no services. This is untrue. Although refuge projects generally provide services only to women and their children, almost all other services are available to both genders. Additionally, it should be noted that capacity limitations mean that not all women seeking refuge accommodation can find an available space. All other housing options are available irrespective of gender. Since, with this one exception, very few domestic violence services are gender or sexuality specific, it is inaccurate to claim this means there are no services for male victims.

Nevertheless, domestic violence can and does occur in same sex relationships and in some instances, by women against men. Male victims do not have to be numerically equal to female victims to deserve our sympathy and support and with the exception of referrals to refuges, should be treated in exactly the same way as female victims. In this pack, where female victims are specified, this is because it is referencing evidence on female victims and should not be made gender neutral. Far from being inclusive, this actually renders male victims less visible by assuming that their experiences are identical to those of women when what evidence we have suggests that this is rarely true.

Knowledge check:

You shouldn’t need to do the knowledge check because participants should bring copies of their certificates to the session to demonstrate that they did the e-learning!

Learner Outcomes:

LO2:1 Recognise signs and symptoms of violence against women, domestic abuse and sexual violence:

· Overview of violence against women, domestic abuse and sexual violence;· Identifying sector-specific indicators of VAWDASV.

LO2.2 Understand purpose and ability to undertake targeted enquiry:4

· Exploring why targeted enquiries are necessary and important;· How to encourage disclosure;· How to ask questions that work;· How to build rapport;· How to respond to disclosures;· Skills practice session.

LO2:3 Demonstrate knowledge of data protection and confidentiality duty:

· Gathering and sharing information (how that is currently undertaken);· The type of information agencies may possess;· Date Protection Act, Caldicott Principles and other relevant legislation;· The importance of sharing information

LO2:4 Understand the purpose of risk identification* in relation to some forms of violence against women, domestic abuse and sexual violence:

· Purpose of risk assessment;· Risk factors of serious harm and homicide;· Offering resources (referrals to IDVA, MARAC, Helpline etc.).

LO2.5 Be able to implement the targeted enquiry care pathway:

· Multi-agency work;· Which agencies might be involved and why?· Referral pathway developed by the regional consortia.

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Checklist:

1. Certificates from e-learning;2. Any comments/reflections or feedback from the e-learning?3. Any specific learner needs?

Be aware of:

· Unconscious bias particularly in terms of class and poverty and challenge it!· Highlight the gendered nature of VAWDASV and it is important to ensure that our response is gender responsive rather than gender neutral.

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ASK & ACT: Half day:

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Activity Time Supplementary resources Trainer Role:

Intros – house-keeping

SLIDES 2 & 3

10 min

Slides on intro / housekeeping / aims / health warning

Introduce self (1 min) and ask each delegate to introduce themselves by name and job title. Ask them to keep it snappy (i.e. 15 seconds each) so as to keep to timetable. Cover housekeeping and aims of session (1 min).

Ask each participant to answer two questions: 1. What do you bring to the session? (In terms of skills, experience, knowledge

etc.)2. What would you like to take away?

Gather up the sticky notes and put them on flipchart paper to refer back to at the end of the session.

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GROUND RULES AND HEALTH WARNING

SLIDE 4

Give health warning that the material might stir up strong emotions and what to do if upset. Mention that a representative from a specialist agency or Welsh Women’s Aid is present or available (provide a number or contact details). Provide details about the IDVA or VAWDASV lead or Group 3 Champion (HANDOUT ONE – LOCAL SPECIALIST CONTACT DETAILS. This will be provided by the Local training consortia )

Do a plenary feedback about the e-learning asking the following questions:1. Any particular issues that surprised or shocked you from the e-learning?

Any questions or concerns from the e-learning?VAWDASV Act – what is it about? Brief overview.

SLIDE 5

5min

Brief overview of the Act – emphasise the three pillars – PREVENTION, PROTECTION and SUPPORT.

Language we are usingSLIDE 6

5min

Handout Definitions of VAWDASVDefinitions of VAWDASV – refer to handout, which includes WG, Home Office and international definitions. Home Office definition: The cross-government definition of domestic violence and abuse is: any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality.Mention new coercive control legislation that demonstrates the significance of emotional/psychological abuse.

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Learning Outcomes

SLIDE 7

5min

What are these sessions about? These are the learner outcomes presented as objectives for the session (they will have received this information in an email).

You can review the specific learner outcomes (write them on flipchart paper so that participants are aware of the LOs for the session).

Benefits of Ask & Act

SLIDE 8

5min

Emphasise that these sessions will build on all the experiences that professionals already have and we hope the sessions will be an opportunity to share experiences. Ask and Act builds on what we already know.

Why have targeted enquiry

SLIDE 9

10min

Benefits of Ask and Act and why targeted enquiry – good opportunity to discuss the distinction between routine enquiry and targeted enquiry.

Who does it happen to

SLIDE 10

15 min

See Trainer Prompt Sheet 1

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Prevalence of VAWDASV

SLIDE 11

Statistics – HANDOUT THREE: Statistics.

Group Activity

SLIDE 12

20min

Get people into groups to answer two questions. Give them 10 mins to answer both questions. Ask for feedback from each of the groups. (Prompt Sheet 2 for possible responses + prompt sheet 3 information about the Liz Kelly six stages.)

What survivors want

SLIDE 13

10min

This is not the totality of what survivors want but this is to emphasise that time and again survivors tell us that they are as concerned with how a service is delivered as they are with what is delivered. Unsurprisingly, survivors tell us that they want a response that sees them as a person with a problem – not as the problem. This means being responsive to her uncertainty and shame about disclosing and taking a pro-active approach – creating an environment that encourages disclosure, making active enquiries and then supporting her through the maze of different organisational responses that may need to be involved.

LO2.2

Encouraging disclosure

SLIDE 14

10 min

PLENARY DISCUSSION: Show slide and ask delegates to call out ways in which they might encourage disclosure. Three points to emphasise:

1. Do not demand a disclosure;2. Do not feel disappointed/frustrated if you don’t get a disclosure;3. Be prepared for a disclosure – come prepared and with all the relevant

numbers/contact details/let a colleague know that you’ll be some time etc.

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Building Rapport

SLIDE 15

10 min

On flipchart paper write responses to the question – how do you build rapport at the moment with your clients?

After getting responses then you can show the rest of the slide.

LO2.1

Indicators of abuse

SLIDE 16 - 18

15 min

DEPENDING ON TIME either choose one or two:1. Put people in groups to list relevant indicators;2. Ask delegates to quickly call out some of the indicators that abuse may be

occurring, particularly in their experienceRemember to cover those of specific relevance to the professions being taught (e.g. it’s no use asking staff who see clients on a one-off basis to notice changes in demeanour).

Remind delegates that these are only indicators – not certainties so it is important to introduce the question properly. Mention that these questions would not be used in isolation and may be part of a conversation. You might need to consider the most appropriate question at that time.

Make clear that not all of these will apply to each department, but they are a useful overview of some of the critical indicators.

Video Clip – How to respond

SLIDE 19

Show short video clip on “How to Ask and Respond” (make a note on flipchart paper of the four questions to ask).

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Questions that work

SLIDE 20

10min

DEPENDING ON TIME: 1. You could just use this as an introductory slide OR2. You could put them into groups to discuss and share questions that they

have used in the past to elicit responses about sensitive topics. Emphasise the following:

· You are choosing questions based on the relationship that you have with your client already;

· The questions on the handout are gender neutral so could be used with anyone;

· These questions are ‘follow-up’ questions rather than opening questions;· There is no script so you can also ask advice of colleagues and your Group 3

champion.

Handout Sample Questions. Responding to disclosures

SLIDE 21

5min

Emphasise:· For many survivors, just having someone listen to them is all they need. This

can be reassuring for professionals who may not feel they are in a position to offer high quality, specialist interventions that perfectly match women's needs. We can all, however, at the very least make a personal and professional commitment to listen to abused women and children and not to deny or minimise their experiences

· This can be scripted and you could chose a phrase or sentence that you feel comfortable using to respond to a disclosure.

Do not behave like the abuser

SLIDE 22

5min

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Identifying risk

SLIDE 23

10min

Deliver this as a plenary discussion with the Handout Risk Factors.

Risk in relation to DA means risk of serious harm or death. This should NOT be confused with the risk of becoming a victim as these are different. There are currently no recognised risk assessments for sexual violence or VAW.However for all forms of abuse, the biggest single risk is being in the presence of an abuser.

Additional Resources

SLIDE 24

10min

Either:1. Ask if participants have had experience with DASH – would anyone be

willing to share? 2. If no one has seen the DASH then recommend taking some time to look

through it and reference the risk factors handout. 3. Emphasise that the DASH is quite domestic abuse focused although there is

reference to sexual violence4. You will not be expected to do a DASH with a client after this session so

please seek additional advice and support. Support Agencies

SLIDE 25

10min

Give out the Other Agencies involved Handout. Refer back to the Local Specialist Service available handout.

This is an opportunity for the specialist trainer to highlight local services available. To mention the ROL service etc.

Local Referral Pathway

SLIDE 26

15min

Give out copies of the local referral pathway.

Explain the aspects of the local referral pathway.

Highlight issues such as:1. Is the person safe or in imminent danger?2. What were the indicators that prompted you to ask? 3. How do we understand contact between parties (bearing in mind the recent

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findings about the increased use of social media for harassment etc.)LO2.2

Role Play

SLIDE 27

20 mins

Divide delegates into groups of three (worker / client observer) and distribute role play cards / observer sheets. Let each role play last for 5-7 minutes; allow ‘client’ to feedback for 2-3 minutes and then swap. After each role play ask the professional to look at the pathway and decide what action they would take. Discuss as a group what would be the course of action.

Take feedback at end, noting any key points on the flipchart.

Key messages

SLIDE 28

5min

Round up and evaluation

SLIDE 29

10min

Refer back to the flipchart paper with responses about what participants would like to take away from the session – take ten minutes to check that everyone feels comfortable and happy with all the information.

Hand out Evaluation Forms

Total:

3 hours

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Refer to:

Should health professionals screen women for domestic violence? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC117773/

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