Transcript DVRAM: messages from Northern Ireland and Barnet pilot

DVRAM: messages from Northern
Ireland and Barnet pilot evaluations
Martin C Calder
Calder Training and Consultancy
www.caldertrainingandconsultancy.co.uk
Focus of presentation
Emergence of NI model and development
 Focus and content of NI evaluation
 Parallel work in other local authorities
 Starting point of London work
 Pilot issues in Barnet
 Messages for the future
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DVRAM: origins and initial
extension
How do we assess the multiple impacts of
domestic violence on women and children?
 When we have collected the information
how do we use it to analyse what it means
and what to do next?
 How are the outcomes of any continued
harm or intervention measured?
 How can such information inform safety
planning?
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INPUTS TO OUTCOMES
Achieving Success in Child
Protection and Domestic Violence
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Local research in N.I. conducted by Patricia
Nichol Programme Manager, UCHT in 2001.
into how domestic violence referrals from
police were managed by Social Services
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SHSSB had identified a need in their risk
assessment processes for a specific risk
assessment model for domestic violence to
be incorporated into the Needs Assessment
Framework
First steps
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Steering Groups were established to manage pilot
project within SHSSB & UCHT.
Timeframe – six months
SHSSB
Oct 03 – Mar 04
UCHT
Nov 03 – Apr 04
Barnardos provided 3 days training and 12 days
mentoring to 3 social work teams within SHSSB and a
similar package to 4 teams within UCHT (including
SSWs and APSWs when available).
Barnardos provided Children’s Services Manager, who
had expertise in domestic violence and child protection
work and a research officer to evaluate the projects.
50 manuals on model were provided by Barnardos.
Importing and extending the
ONTARIO model
1
Severity of
Domestic
Violence
3
Risks of
Lethality and
Danger
2
Risks to Child
from
Perpetrator
4
Perpetrator’s
Pattern of
Assault and
Coercion
5
Impact of
Violence on
the Woman
6
Impact of
Violence on
the Children
7
Impact of the
Abuse on
Parenting
8
Protective
Factors
9
Outcomes of
Woman’s Past
Help-Seeking
Outcome Measurement –the
process of Risk Assessment
•
Risk Assessment:-Collection of information on the
situation and risk factors within a family situation
using a consistent framework- Nine Assessment Areas
in Domestic Violence model and a Pro-forma to collate
information to support Core Assessment Framework
•
Risk Analysis:- Use of specific threshold scales of risk
factors and protective factors to measure outcomes of
assessment process
•
Risk Management:- Use of assessment and threshold
scales in deciding how the case should be managed,
specifically the interventions offered to family – a child
protection or family support type of intervention.
How do we measure the
outcomes from this
assessment?
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Cardiff’s Women’s Safety Unit-15 high risk
factors associated with domestic abuse
Research Home Office –Research paper 217Domestic Violence Offenders: characteristics
and offending related needs. 2003
Evidence based practice of Barnardos Domestic
Violence Outreach Project in N.I.
Pilot Research on the application of the model
with N.Ireland with social work assessment
teams.
Domestic Violence Threshold Scales
There are five scales which rate the domestic
violence from Minimum to Moderate to
Severe through a range of facts that refer to
the:
Evidence of domestic violence,
 Protective factors/strengths within situation
 Potential vulnerabilities.
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Domestic Violence Threshold Scales
The above must all be considered in each case
Severity of the incidences
Pattern, frequency and
duration of violence
incidences
Perpetrator 's use of the
children /children
caught up in the
abuse
Escalation of violence and
use of isolation
Sexual violence/abuse
Perpetrator’s attitude to
the abuse
Additional Vulnerabilities
Age of victim
Victim’s personal
vulnerabilities-isolatedlocality.
Age of perpetrator
Disability Issues for Victim,
children and/or perpetrator
Cultural Issues within family
Additional Factors
Victim has recently separated from the
abuser-risk of separation violence
 Victim has autonomy ( taking control with
support)
 Perpetrator wants to reconcile with woman
 Woman uses physical force in self-defence
 Children use violence-siblings/others
 Woman has begun new relationship
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Perpetrator has history of abuse in personal
relationships/woman has experiences abuse in
previous relationships/childhood abuse
Perpetrator will soon be released from prison
The woman and children have moved to a more
isolated community with or without the
perpetrator
Pattern of inappropriate system response.
An adult victim being unable to care for the child
as a result of trauma from an assault
OUTCOMES - USE OF MODEL
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Systematic format for the consistent recording
of domestic violence in SW case files.
Referral Screening, Initial, Comprehensive
Assessment (Second stage assessment).
Child Protection Case Conferences - information
gathering, child protection planning, and
intervention planning.
Case planning meetings - Threshold regarding
family support and child protection.
Format for court reports for care orders and
contact/ residence orders.
In the SHSSB the model was an additional tool in
the Assessment Framework
Outcomes For Staff
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Training and mentoring increased staff
awareness and understanding of the
dynamics of domestic violence.
Social Work staff increased knowledge
base facilitated their information
gathering
and
confidence
when
dealing with domestic violence.
Outcome: Identifying the risks
presented to children from
domestic violence
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Enabled staff to examine and gather
information and assisted them in
identifying the risks present to
children.
Assessment process aided staff in
rating the severity of the risks
presented by domestic violence.
Safety work intervention training with
women and children was highlighted
as extremely useful and effective.
Decision making in Case Planning Child Protection & Family Support
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Threshold scales provided a consistent
framework to assess and rate the level
of risk.
Threshold scales enabled consistent
decisions on case clarification - child
protection or family support.
Increased awareness of risks to
children
and
informed
decision
making.
Decision Making – appropriate
support & interventions for
children
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Model emphasises risks presented to
children and enables staff to focus on
the needs of victim, children and
direct response to perpetrator.
Identifies different interventions
required for children, victim and
perpetrator – safety/educative work
and recovery work for children/victim.
Maintains focus of domestic violence
as main concern within the
Assessment Framework but did not
exclude other significant concerns.
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Provides detailed information
which to base decision making.
on
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Enabled clarity regarding the level and
type of intervention needed.
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Evidence–based practice of Barnardos
Domestic Violence Outreach Projectsafety work for women and children.
Compatibility with current
practice and policies
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Initial assessment teams used the
safety and domestic violence
education during their work and
found this extremely useful.
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Once model used a detailed case
record can be maintained in file this will be significant if case later
entered the child protection
or/and court arena.
Adjustments to Threshold Scales
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Data collected during the pilot confirmed
that the threshold scales were accurate in
rating cases into family support and/or child
protection.
Additional risk factors were added to
threshold scales during the pilot which
expands the risk factors.
Work was undertaken to adapt the scales so
they could be used directly with service
users to discuss risk factors to children.
Mentoring Sessions
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Sessions provided support to implement model
and without the focus and support of sessions,
staff would have struggled to implement this into
their practice.
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Mentoring facilitated practice, consultation,
learning, reflection on practice, provided
research information.
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Use of team approach: SSW attendance at
sessions was crucial as they are responsible for
decision-making for case management and
support to their SW staff.
Usefulness of the model to
different social work teams
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Initial Response/Assessment Teams – Model useful for
structuring initial information.
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Model readily identified gaps in information.
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Provided tangible record of all instances of domestic
violence.
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In new cases not all information readily available.
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Children & Families Teams - Initial assessment using
the framework at IRT assisted in longer term case
planning.
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Provided consistent clear record of decision making.
Future Use of Model
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Consideration to be given to multiagency use of threshold scales in
determining risk and appropriate referral
to Social Services.
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Consideration of piloting the threshold
scales with Police Service NI
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Consideration to be given to aligning
training in domestic violence risk factors
and threshold scales with existing child
protection training.
Calder Comments
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Consistent thinking with RASSAMM
Model allows for information collection and
analysis and helps measure outcomes
It is an initial assessment and core
assessment tool and could be a screening
tool
It informs the Needs Led Assessment
Framework
Need to balance risk and assets in threshold
scales
Model is actuarially informed-based on
research and professional knowledge
It considers stable, static and dynamic risk
factors
Recommendations of
Martin Calder
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It is an holistic assessment model
which could benefit from a re-ordering
of the threshold scales-this has been
completed.
Users perspective on the impact of the
assessment tool would be beneficial.
Threshold scales of risk factors provides
an accurate analysis of risk - this could
be improved with gravity scoring used
in the Graded Care Profile and AIM.
Step 2
In June 2005 the NI Regional Steering
Group agreed to fund the mentoring
component of the implementation of the
model.
 The training component would be paid for
by individual Trusts and the mentoring
component by the Regional Steering Group
 Evaluation of mentoring by me 2007-9
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Mid point evaluation January 2008
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Mentoring
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Training
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DVRAM
Mentoring
Predominantly for social care although
parallel processes for health and
occasionally multi-agency
 Provided support and practical guidance on
applying model to cases (excused
supervisors from familiarity with the model)
thus consolidating the training
 Attendance often precluded by caseload
pressures so should be mandatory and
linked to professional development hours
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Also provided input on engaging with perpetrator,
children’s resilience and female perpetrators etc.
Staff found themselves mentoring colleagues and
managers
Unrealistic for one person, no matter how
committed
Shift mentoring within newly developed Principal
Practitioner Posts
Training
Well received and competently delivered
 Should be mandatory
 Needs to be compulsory to first line
managers
 Refresher training needs to be considered as
many staff didn’t apply immediately and
lacked confidence down the road
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DVRAM
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Extremely accessible and easy to use
Provided roadmap of complicated territory
Legitimises questioning of ‘gut feelings’
Confusion about linkage with UNOCINI
Anxiety that it will identify more work
Variable use if case not initially referred as DV
DVRAM as core assessment tool or one of a
number? It is not an end in itself…
DV requires many assessments
What is the mental health diagnosis?
Treatability? Prognosis?
Capacity to meet own needs?
Capacity to meet child’s needs?
Evidence and nature of co-morbidity?
Level of couple ability and allocation
of roles and responsibilities?
Child
Indirect tools
Centile charts
 GCP
 NOFT
 Adult mental health
 Substance misuse
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Refinement of vocabulary
 Greater guidance on differentiation between
severity levels
 One threshold scale per child?
 Requires clear mandate of adoption and
application
 Instils confidence in staff: offering
structure, clarifies roles and responsibilities
and is usable with families
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PROPOSALS FOR RISK MODEL REFINEMENT AND EXTENSION
Links to other
domestic abuse
risk assessment
tools in the
system
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Screening/ initial
assessment advice
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(ORIGINAL) DV RAM
Potential to differentiate perpetrator factors from victim
vulnerability factors
Add in examples of gradients of harm to narrow subjectivity
Reorganise model to static, stable and dynamic risk factors
Recognise within GCP bipolar continuum structure
Map threshold scales across to UNOCINI
Specific risk considerations
 Ethnic and rotational risk
factors
 Female perpetrators
 Same-sex abuse
 Young people as perpetrators
 Kinship care consideration
 Contact considerations
 Pre-birth risk assessment
 Impact of DV on children and
young people across age groups
Treatability/
prognosis/
resilience building
interventions
Integrated risk assessment tools and
focus: child care
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Strengths-loaded
Risk adverse
Safeguarding
predominates
Expansion of harm
General not specific
Time-limited
Evidence-based practice
Use of professional
judgement
Figure 1: Assessment Framework Triangle
Health
Basic Care
Education
Ensuring Safety
Emotional & Behavioural
Development
Emotional Warmth
Identity
Family and Social
Relationships
Social Presentation
Stimulation
Child
Safeguarding
and promoting
welfare
Selfcare Skills
Guidance &
Boundaries
Stability
Family History
Wider Family
Housing
Employment
Income
Family’s Social Integration
Community Resources
CAFCASS Toolkit (versions 1&2)
Areas of
Development
Health
Impacts of Domestic Violence 0-2 years
Foetal damage could result from physical
violence against the mother. This could include
foetal fracture, brain injury and organ damage.
Spontaneous abortion, premature birth, low birth
weight and still birth. Young children may suffer
physical assault as part of the violence against a
parent.
Intellectual
Development
Depressed parents have been shown to respond
less frequently to their baby’s cues or modify
their behaviour according to that of their infant.
Some research suggests this can lead to delays
in an infant’s expressive language and ability to
concentrate on and complete simple tasks.
Identity
The infant may develop identity problems if
parents or carers call the child by different
names or if they are highly critical of the child
and show little warmth.
Protective Factors
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An alternative safe
and supportive
residence for the
expectant mothers
subject to violence
and threats;
Regular support &
help from a primary
health care team,
and/or social
services and
relevant voluntary
sector support
agency.
The presence of an
alternative or
supplementary
caring adult who can
respond to the
child’s
developmental
needs.
As above
Warning signs
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Depressed,
withdrawn mother;
Signs of current or
previous physical
abuse of parent and
baby;
The baby is jumpy,
nervous and crying
a lot;
The baby has sleep
& eating
disturbances;
The baby is not
responsive or
cuddly.
Poor language skills
in the infant.
As above
Different risk focus (Bell, 2006)
Victim and siblings
Offender
Partner
Integrated risk assessment tools and
focus: criminal justice
Matrix 2000 (Risk of violent offending)
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Actuarial risk tools
Numerous risk
frameworks
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VAI
CBI
SARA
SPECCSVO
Matrix 2000
1.
Age at commencent of risk
under18
18 to 24
25 to 34
35-44
older
2.
4
3
2
1
0
Violent appearances
Points
0
1
2,3
4+
3.
0
1
2
3
Any burglaries?
Points
No
Yes
TOTAL POINTS
0
1,2
3,4
5+
Points
0
2
CATEGORY
Low risk
Medium risk
High risk
Very high risk
DVRAM as integrative framework?
Professional RATS (Calder, 2007b)
Criminal Justice
Social Care
Actuarial
Professional Judgment
Prescriptive
General
Risk Loaded
Risk Adverse
Strength Adverse
Strengths Loaded
OASYs
Matrix 2000
Police and CPs Tools
CAFCASS DV RAT
Differential risk focus
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Risk of actual or likely significant harm?
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Risk of re-offending?
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Risk of relapse?
Common language and focus?
Criminal Justice
Probation, police and
prison inc MAPPA
Criminal Justice
(MARAC)
Social care
Risk of re-offending (no
timeframe indicated and
restricted to index
offence)
High risk victims in need
of protection
Risk of actual or likely
significant harm
Case file analysis – highlighted areas
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The displacement of responsibility on to the mother
Little evidence of perpetrator work to reduce the risk and
hold him accountable for his behaviour
Evidence of a high level of co-existence of physical abuse,
neglect and emotional abuse of children
Evidence of high levels of maternal mental health
problems yet not in the perpetrator
Scores of 4 did not always initiate a core assessment
Staff changes and lack of continuity/ training linked to
above
Some evidence of downplaying of threshold
scale scores
 Huge coexistence of alcohol and drug issues
and challenge of assessment and
intervention focus/priority
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Coventry Commission
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How to develop specific DVRAM factors
for their growing ethnic population
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Principally South Asian, Portuguese, Arabic
and Refugee/Asylum seekers
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‘The Silent minority’ literature review
(Calder, 2007)
London pilots
Benefited from prior evaluations and
parallel commissions
 Adopted and testing ethnic threshold scales
 Threshold scales refined to match CAF
levels and brought forward within
identification and intervention process
 Updating of model with emerging evidencebase
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Production of an accessible flowchart for
staff
 Greater guidance on
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Understanding the dynamics of an abusive
relationship
 Women’s processes of help-seeking in
domestic violence
 Offering case examples to help staff
differentiate between the severity levels
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Broader suggested usage e.g. education and
prevention
 Revised DVRAM for core assessment
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More detailed and identified evidence-based
materials
 How domestic violence affects the parenting of
perpetrators
 Greater details relating to the risks to children
from contact with the perpetrator
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Areas not resolved
Differentiation of static, stable and dynamic
risk factors
 Supporting modules for female perpetrators,
same sex, domestic violence from young
people
 Inclusion of risk profile for adult victims of
domestic violence
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Areas for debate
Boundaries of the model e.g. when is a
specialist assessment indicated and what
format should that take?
 DVRAM as integrative model to unify
social care and criminal justice models and
processes
 Use when victims are not mothers
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4-pronged model
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Multi-agency DV threshold scale
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Social Care Initial Assessment
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Social Care Core Assessment
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Safety intervention with children and mothers
Barnet evaluation
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Briefing (half-day to 200 staff)
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Training (2 days on initial and core assessments
and 1 day on safety planning interventions)
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Mentoring (3/4 sessions on monthly basis for 5/6
staff)
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DVRAM
Briefing
Awareness raising of DVRAM and
threshold scales
 Variability of ownership of CAF
completion and knowledge regarding DV
 Challenges the practice of couple work and
mediation in DV
 Useful but not sufficiently bedded down to
evaluate potential
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Threshold scales clear and accessible – providing
a useful compass and map
Supports more informed referral (using CAF)
Can help bring CAF alive and populate social care
systems
Doesn’t necessarily dovetail with other agency
positions – in relation to contact with the
perpetrator
Training
Staff felt multi-agency audience would have
been better to promote greater clarity of
roles and responsibilities
 Manager training key to supporting staff in
case application
 Training clear and delivery encouraged
motivation and reflection
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Mentoring
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Positive when able to attend: able to elicit
direction and apply to cases immediately
Focus on case application as well as areas not well
served by the model – same sex violence etc.
Need it to continue for some time until model
embedded and they feel safe flying solo
Felt stretched mentoring managers and colleagues
in a new model if they hadn’t attended the training
DVRAM
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Provides great structure and focus
Provides new information and confidence
Captures and organises complexity into accessible
tool
Workload pressures may preclude such in-depth
assessments
Greater clarity about fit with CAF and ICS
needed: little evidence of use to date
Confusion about relationship with MERLIN
MERLIN will use SPECCSVO
 MARAC now measuring whether DVRAM
has been completed and if so at what level
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Very useful in working with adult victims – ‘you can see
the penny dropping as you work through the materials…’
Shortened version (prompt card) suggested
Not seen as a stand-alone tool but as part of a pick ’n’ mix
portfolio
Challenged practice immediately in relation to
babies/younger children
Not yet tested in courts but advance notification of its
status would help workers
DVRAM and safety planning – links with local resources
allows work to be transferred
Threshold weighting correlated with
professional experience and thus some
evidence of differential interpretation
 Little evidence of shifting practice toward
greater engagement of perpetrators
 Staff frustrated about limited time to work
through the model with mothers
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Messages from Barnet
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Rolling programme of training required and useful to
embrace adult-orientated services such as mental health,
substance misuse etc. and link into existing Safeguarding
Board Training
Use application of DVRAM to identify deficits in resource
provision
Re-emphasizing focus on safety work with children and
young people
Link DVRAM explicitly with CAF, ICS and preventive
strategy ‘Building resilience, supporting independence’
Map possible portfolio of assessment tools to use in
conjunction with DVRAM
Cross-pilot site contacts to share
information and good practice and avoid
duplication
 Examine how ongoing mentoring can be
achieved
 Consider case analysis to examine whether
outcomes are more focused attained
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Future work
Conceptual and practice refinement of
DVRAM
 Development of supporting modules
 Linkage with other assessment tools and
processes
 Clear positioning and adoption of DVRAM
Training and mentoring support package
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References
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Calder MC (2007) The silent minority: domestic abuse perpetrated within
ethnic communities: A review of the literature with recommendations for risk
assessment. Leigh: Calder Training and Consultancy
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Calder MC (2007b) Domestic violence and child protection: challenges for
professional practice. Context 84: 11-14
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Calder MC (2008) Evaluation of domestic violence training and mentoring
programme in Northern Ireland: Mid-point summary analysis. Leigh: Calder
Training and Consultancy
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Calder MC with Harold G and Howarth E (2004) Children living with
domestic violence: Toward a framework for assessment and intervention.
Dorset: Russell House Publishing.
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WOMAN ABUSE: Increasing Safety for Abused Women and Their Children
(CAS/VAW JOINT TRAINING - FACILITATOR MANUAL Ontario
Ministry of Community and Social Services Ontario, CANADA, JULY 2001