Catherine Powell Safeguarding Children Consultant Visiting Academic, University of Southampton Fellow Institute of Health Visiting

1. Overcoming barriers to the recognition and
response to domestic violence and abuse
(DVA) in families with young children:
solutions from the frontline
BASPCAN Congress
April 2015
Catherine Powell
Safeguarding Children Consultant
Visiting Academic, University of Southampton
Fellow Institute of Health Visiting

2. Background
Institute of Health Visiting (iHV) was
commissioned by the Department of
Health (England) to develop & deliver a
two day training package on DVA at 10
sites across the country;
Undertaken in conjunction with an ‘Expert
Advisory Group’ including colleagues
from Women’s Aid
Overarching aim to support the learning
and development of a cohort of expert
DVA practitioners to provide local
leadership and to cascade the learning
to health visitors in their locality.

3. Content
 Evidence-based four
module programme
structured around the
model of HV services
 Complementary E-learning
package (NELH)
 Recognised the unique role
of the HV in providing home
& community based public
health care to all families –
pre-birth up to five years of
age
 Comprehensive pack,
training notes etc, USB &
CD ‘ready to go’.

4. Delivery

5. Participants
 11 two-day sessions delivered
across the NHS England
regions (December 2013-April
2014)
 253 participants who became
iHV-accredited DVA Experts
 Prepared to ‘train on’ & using
skills to ‘influence leadership’
 Gave permission to share
‘outputs’ from the group
activities (and their
photographs!)
 Positive evaluations

6.  'The evidence was not only research based but
practice based too.'
 'Networking; refresher; accessible; long awaited for
health visiting service which is uniquely placed for
early identification of DVA; knowledgeable
facilitators.'
 ‘….makes me feel proud to be a part of the
profession.'
 'Worth cancelling my annual leave for …’
 ‘Group work was some of the best I've done in many
years’.

7. ‘Overcoming Barriers’ exercise
Opening exercise of Module Two
Small group work (max. six)
Took place in ‘rounds’ with flip
chart passed to next table:
1. Identify possible indicators of DVA
that you might come across in
practice
2. Identify barriers that prevent
identification or a helpful response
3. Suggest how those barriers can be
overcome
Groups were highly competitive!

8. Indicators
House repair (e.g. doors
punched in)
Overhear abuse
Missed appointments
Victim looks fearful
Constant texts
Avoiding
appointments/questions
Police reports
Making excuses not to discuss
A&E attendances
Child discloses
Flinching from partner
Partner always
present/answers questions
Checking answers with partner
Anxiety (adult/child)
Poverty
Truanting
Gut feeling
Over-familiar child
Disclosure
Physical injuries
STD (infections)
Pregnancies/miscarriage

9. Barriers
 Victim makes
excuses/avoids
engagement
 Home visiting & respect for
privacy
 Fear for personal
safety/reprisal
 Denial
 Chaotic lifestyle
 Assumptions (practitioner)
of normality
 Time/workload pressures
 Fear factor (not having a
reason to visit)
 Awkwardness in bringing it
up
 Fear of dealing with the
consequences of making
contact & asking the
question
 Partner/Perpetrator present
 Lack of training/resources
 Culture
 Language barriers

10. Overcoming barriers
 Recourse to public funds
 Cultural challenge/travellers
 Staff supervision
 Advertising - zero tolerance
 Reflection/staff attitudes
 Staff safety, lone working
policies
 Improved interpreter services
 Understanding CAADA DASH
tool/MARAC referrals
 Strengthening links with drug
and alcohol services
 Reason for perpetrator to be
away from victim (e.g. EPDS
score)
 More professional & inter-
agency training
 Improve relationships with
multi-agency colleagues
 DVA pathway
 Clear policy
 Designated professionals
 Sharing of information
supported by policy and
guidelines
 Provision of supporting
information/numbers - insert in
PHR
 Routine questioning
 Training improvements for
police/legal systems
 One stop shops for DVA
 Strategic decision making with
DVA at the forefront
 Preventative work in schools
 More DVA services in
appropriate locations
 Organisations such as
Women's Aid
 Influencing commissioners.

11. Solutions from the frontline ..
 ‘Holistic and layered’
 Challenge and inform practice at an
individual, organisational and strategic
level
 Of wider interest outside of the HV
profession
 Demonstrates practice knowledge and
experiences: informs commissioning
intentions
 Motivational for the practitioners taking
part.

12. Concluding comments
 DVA is increasingly recognised as a global public health issue
that impacts on the health and well-being of children, families
and communities;
 Health visitors are well-placed to recognise and respond to
emerging concerns of DVA within families with young children
and to offer timely help and support to those affected; including
sign-posting or referral on to specialist services;
 This simple training exercise provided an opportunity both to
celebrate the knowledge and understanding of practitioners in
identifying potential DVA and to generate solutions to
overcoming the barriers in practice that may prevent a timely
response to concerns.

13. Acknowledgements
 DH/Institute of Health Visiting
 Women’s Aid
 Expert Advisory Group
 The HV who participated in the programme & taught me
so much.
Thank you for listening!
catherine.powell@soton.ac.uk