My Bit Domestic Violence ScenarioDocument Transcript
Domestic Violence scenario 2 – Lucy
‘Promoting Health: A practical guide’ – Linda Ewles and Ina Simnett – 5th
Ed – Balliere Tindall – 2003.
Chapter 14 – Helping people towards healthier living
Models of the process of changing health-related behaviour:
Look at people’s motivation, beliefs, values and attitudes, and to make and
carry out decisions that will lead to improved health and well-being.
The Health Action model (Tones):
Boosting people’s self-esteem and skills
Identifies influences for health behaviour and works on them
-could break the cycle of abuse
-builds confidence and assertiveness
-responsibility on victim, may feel it’s their fault
Stages of change model (Prochaska and DiClemente):
Considers the stages in the process, and how to move from one stage to
Pre-contemplation; Contemplation; Commitment; Action; Maintenance;
Relapse or Exit.
DoH – Responding to domestic abuse: a handbook for health
professionals. Dec 2005.
Domestic abuse accounts for a quarter of all violent crime. Costs the taxpayer
£3.1 billion in England and Wales in 2004.
90% of cases are men against women.
Government initiative: bring perpetrators to justice; support victims; prevent
Success depends on a MULTI-AGENCY APPROACH
- many cases of domestic abuse start during pregnancy
The Crime reduction Programme’s ‘Violence Against Women’ initiative –
evidence led programme that aimed to find out which approaches and
practices were effective in supporting survivors of domestic and sexual abuse,
and in reducing incidents of abuse.
MUTLI-AGENCY PARTNERSHIPS – strongly recommended by govt.
-midwife/nurse consultant have strategic responsibility for a coordinated
-educate/ cascade info to other health professionals and represent trust in
Approach – routine enquiry about domestic violence (DV) as part of taking a
social history; ensuring an appropriate response when abuse is disclosed.
CDRP: Crime and Disorder Reduction Partnership – April 2004 – PCTs
statutory duty to work with CDRPs to reduce crime.
Women’s Aid website:
On average 35 ASSAULTS happen before the police are called.
Home Office – ‘tackling domestic violence: the role of the health
professional.’ 2nd Ed – 2004.
Health professionals can make an important contribution to tackling DV:
By asking women directly about whether they have experienced abuse
By enabling women to access specialised services
By supporting them in changing their situation
1 in 4 women will experience DV in their lives
- includes physical; psychological; emotional; sexual and economic abuse.
-preferable terms – domestic abuse/partner abuse
…Health service is uniquely placed to help change public attitudes to DV…
ENQUIRY-BASED APPROACH – ASK WOMEN!
R – Routine enquiry
A - Ask direct Qs
D – document findings safely
A – assess womens safety
R – resources: give info/ respect choices
Home Office Research study 276 – ‘Domestic violence, sexual assault
and stalking: findings from the British Crime Survey – Sylvia Walby and
Jonathan Allen – March 04.
1 in 20 women have experienced serious sexual assault
1 in 5 women and 1 in 10 men have experienced DV
Women and younger people
Low income households (<10K) 3 and a half times more likely to suffer DV
In rented accommodation
No regional variance but more likely in inner city than rural
Home Office – ‘Developing domestic violence strategies – a guide for
partnerships.’ – violent crime unit – dec 2004.
Prevention and early detection – focus on next generation of victims and
perpetrators by raising public awareness of DV, and by changing attitudes.
Use of existing contact points (such as SureStart), also info packs etc to reach
Also, routine enquiry about DV, and a multi-agency approach recommended.
Govt. ‘Saving Lives. Reducing Harm. Protecting the Public.’ An Action
plan for tackling violence 2008-11.
To tackle DV:
-plan to double number of Specialist DV courts to ensure safe/protected
-Multi-Agency Risk Assessment Conferences (MARACs) to be rolled out
nationally to reduce repeat victimisation
-Partnership working to share info
-manage ‘at risk’ individuals
Nursing Standard – vol 21 (14-16) 2006 – Domestic Violence: the role of
health professionals – Du Plat-Jones
Cottrell (2001) believes that the most effective way to stop parental abuse is
for health professionals, including health visitors and school nurses, to raise
awareness and ‘to break the silence’ that surrounds this important public
The lack of interagency training courses and provision of support by
healthcare providers mean that all health professionals and staff working in
health settings will have difficulty in dealing with the problems surrounding
domestic violence and so fail to identify the patterns of domestic violence and
address the abue (James-Hanman 1998)
> Reasons why health professionals are reluctant to confront domestic
- fear that the situation will get out of control
-lack of knowledge about what action to take
-concerns about causing offence
-belief that domestic violence is a private matter between partners
-anxiety about breaking up a family
Healthcare professionals are the first line response for many people who
experience domestic violence. Good policies and protocols for practice should
be developed and implemented to identify and record domestic abuse.
Information packs containing contact telephone numbers for women’s aid
groups and helplines for men should be developed and the public need to be
educated on how unacceptable violence is in the family.
Pahl (1995) suggests that women seeking help to cope with domestic
violence are more likely to be in contact with health professional than any
Staff should understand the power and control issues associated with partner
abuse, accept the person’s choices non-judgementally, offer support and
initiate appropriate referral procedures.
Hall and Elliman (2004) recommend that nurturing and developing long term
relationships with families provides health visitors and school nurses with the
opportunity to identify those who may be at risk of domestic violence or
Hegarty and Taft (2001) suggested women will disclose information about
abuse more readily if health professionals ask them to.
Developing good multi-agency relationships and referral systems are
essential to enable safe disclosure of information. Staff require appropriate
training and supervision to increase awareness and knowledge of how to
recognise and deal with domestic violence.
…different agencies…should collaborate to undertake public awareness
campaigns, to reinforce the message that domestic violence is a crime and
that no level of violence between partners is acceptable.
All health professionals should become actively involved in breaking the
silence surrounding violence, so that they can provide an appropriate and
Nursing Standard – vol 21 (39) – june 2007 – Home Sweet Home – Alison
The Worth project (based at Worthing Hospital A & E) – routine screening for
domestic violence. Being extended throughout West Sussex and has won
national attention for it’s achievements through an NHS Best of Health award.
One day training for staff – All adults patients who attend the department are
now asked about the topic, and other departments in the hospital are adopting
the system for selected patients.
Evidence is strong that asking about domestic violence in a healthcare setting
does help people make disclosures…
Someone who gives an affirmative response to the enquiry can then be seen
by a domestic violence advocate.
All project staff have police training on statement taking and preserving
Apart from the benefits to individuals, the scheme could help the NHS. If
people get out of abusive relationships or manage to change that relationship,
they are less likely to attend A&E repeatedly. Domestic violence is estimated
to cost the NHS £1.2 billion a year and nearly two thirds of women receiving
mental health care have a history of domestic violence.
A woman who is killed by her partner will have typically attended A&E
Health Promotion – foundations for practice. “nd Ed – Jennie Naidoo
and Jane Wills. Balliere Tindall- RCN – London 2000.
P95 – Behaviour change approach
-views health as a property of individuals
-people can choose to change their lifestyle
-they are responsible for the consequences if they don’t change.
P97 – Educational approach
-provides information and is led by a facilitator
P98 – Empowerment approach
WHO defines health promotion as enabling people to gain control over their
lives (WHO 1986)
-identify own concerns and gain the skills and confidence to act upon them
P108 – Tones’ Empowerment Model 1994
-Health promotion is
Healthy Public Policy x health Education