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In the first of our 16 blogs for 16 days, Miranda Pio, Caitlin Webb and Elizabeth Jones explain the importance of the Pathfinder Project. Together they make up the Pathfinder team at Standing Together Against Domestic Violence (STADV).

The Problem

“I found that when I went to go the doctors…. there were so many hints and bits of pieces, but nobody ever asked me if I was alright, was there anything underlying? Nobody triggered a question or something that even got me thinking about it, right down to the fact that when I was aged 32 and had a hysterectomy my ex-husband forced me to say I wanted my ovaries out too because I would be put on hrt and he thought I’d be more likely to have a physical relationship with him. And they never asked… I pushed and I pushed, and nobody ever asked me. I just felt that people thought that I was neurotic. Nobody asked me why I was going in so often.” Annie, DVA survivor

Annie’s experience highlights the desperate need for healthcare professionals to pick up on the signs of domestic abuse and enquire when appropriate. There is an alarming body of evidence that has been presented over the last decade that points to health settings being the key places to offer support early and to the broadest range of domestic abuse survivors, particularly those experiencing multiple disadvantage.

At Standing Together, through our work on Domestic Homicide Reviews, we have found that health professionals have a unique role to play in intervening earlier and help prevent a homicide from happening. In some cases, health professionals may be the only statutory agency to have contact with the victim and perpetrator and will hold critical information around the risks to that family.  

We know that there is both a human and economic cost to domestic abuse.

Each year an estimated 1.9 million people in the UK experience some form of domestic abuse.[1]1.3 million of these were women (8.2% of the population) and 700,000 men (4%). The cost of domestic abuse to health services has been estimated at £2.4 billion.[2]It is clearer than ever, that there is a pressing need to find cost effective and safe ways of supporting survivors.

‘They diagnose and then you are on your own. And it’s like, until you are on the waiting list for stuff, you’ve got nowhere to go to…you’ve just got to fight to live.’ (Alexa, survivor) 

Due to the prevalence of domestic abuse within our society, we know that NHS staff willbe in contact with adult and child survivors (and perpetrators) across the full range of health services. The mental and physical health consequences of domestic abuse mean that the NHS spends more time dealing with the impact of domestic abuse on women and children than almost any other sector and is often the first point of contact for women who have experienced abuse. 

The high prevalence of domestic abuse also means that a high proportion of NHS staff are likely to have experienced domestic abuse. It is therefore paramount that NHS staff are provided with the appropriate support from their employers. We can only expect health professionals to respond appropriately to domestic abuse if a supportive system is in place to enable this work. 

What do survivors tell us they need?

‘Sometimes it’s so exhausting. You have so many memories of how you’ve been told that you’re worthless that you are still taking on board those things. So, when somebody in authority tells you or doesn’t believe you or doesn’t ask the questions, you go away feeling worse than when you went in.’ (Sarah, survivor) 

Survivors have told us that they want health professionals to understand how abuse plays out and be able to recognise signs that it is occurring.Survivors want to be believed, and for their experiences to be taken seriously, with an appropriate response taken.When a survivor discloses abuse to a health professional it may be the first time they have disclosed to anyone. Health professionals need to be trained to respond appropriately by validating their experiences and reassuring them that everyone has the right to live free from fear, violence and abuse. 

‘I am an asylum seeker, and I have some other trauma, and this woman is not able to understand that. When I tell her things, she goes ‘oh really’. I felt like she doesn’t believe me… like she doesn’t understand me.’ (Aisha, survivor) 

Survivors want to be treated with dignity & respect. They have articulated the need for services that understand their experiences of multiple disadvantage and are able to meet their particular needs rather than providing a one size fits all approach. Some feel that the services available to them are not sufficiently specialist, or able to understand their specific experiences.

(It’s) ‘Difficult to answer as people don’t have time to talk to you as they are so busy. (We) need specialist workers/information available.’ (Helena, survivor) 

The survivors we spoke to as part of our consultation recognised that health professionals are often under-resourced and have limited time to appropriately respond. This is why it is so critical to have specialist workers such as Health IDVAs on site to provide specialist support, information and guidance for NHS staff. 

Pathfinder – the solution?

Pathfinder is a pilot project funded by the Department of Health and Social Care and the Department of Culture Media and Sport until March 2020. It aims to establish comprehensive health practice in relation to domestic abuse and wider issues related to violence against women and girls in acute hospital trusts, mental health trusts and community-based IRIS programmes in GP practices. 

We are working with 8 sites across England that we identified as already having a good response to domestic abuse in at least two health settings. We are learning from this good practice, sharing examples across the sites and plugging the gaps with our expertise to create a more robust response where necessary. This includes updating domestic abuse policies and training strategies, bridging relationships between health partners and local specialist services and embedding specialist intervention roles (IRIS in GP settings, co-located health IDVAs & DA coordinators). 

The learning we get from the Pathfinder pilot project will inform a Toolkit which will be free and accessible to any healthcare provider from March 2020. The Toolkit will provide resources to support healthcare organisations to assess their response to DA and implement policies and a range of interventions to bridge the gaps that they identify. 

To learn more about the Pathfinder Project, our events and our upcoming Toolkit please visit our website: www.PathfinderToolkit.org

Miranda Pio is the Project Manager for Pathfinder. Caitlin Webb is Pathfinder Project Manager and Elizabeth Jones is Pathfinder Project Officer.

The team work together at Standing Together Against Domestic Violence (STADV).

[1]https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/domesticabusefindingsfromthecrimesurveyforenglandandwales/yearendingmarch2018

[2]https://www.gov.uk/government/publications/the-economic-and-social-costs-of-domestic-abuse

[3]http://www.safelives.org.uk/sites/default/files/resources/Pathfinder%20Evaluation%20Specification%20FINAL.pdf

[4]http://www.safelives.org.uk/sites/default/files/resources/SAFJ4993_Themis_report_WEBcorrect.pdf

[5]https://www.mappingthemaze.org.uk/wp/wp-content/uploads/2017/08/Complicated-Matters-A-toolkit-addressing-domestic-and-sexual-violence-substance-use-and-mental-ill-health.pdf

[6]http://www.safelives.org.uk/sites/default/files/resources/SAFJ4993_Themis_report_WEBcorrect.pdf

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Partners

AVA
AVA
AVA

AVA is an expert, groundbreaking and independent charity working across the UK.

Their vision is a world without gender based violence and abuse. They aim to  inspire innovation and collaboration and encourage and enable direct service providers to help end gender based violence and abuse particularly against women and girls.AVA’s work is focused around those areas where they can make the best contribution to ending violence and abuse. They do this by making sure that survivors get the help and support they need in the here and now, through providing innovative training that has a proven direct impact on the professional practice of people supporting survivors of violence and abuse

developing a range of toolkits, e-learning and other material that supports professionals to provide effective and appropriate support to survivors of violence and abuse

using our influence and networks to ensure survivors voices are heard. We work closely with AVA in many areas including the Pathfinder project

https://avaproject.org.uk

SafeLives
SafeLives
SafeLives

SafeLives are a national charity dedicated to ending domestic abuse, for good. We combine insight from services, survivors and statistics to support people to become safe, well and rebuild their lives. Since 2005, SafeLives has worked with organisations across the country to transform the response to domestic abuse, with over 60,000 victims at highest risk of murder or serious harm now receiving co-ordinated support annually. SafeLives are members of the Pathfinder consortium.

http://www.safelives.org.uk/about-us

IMKAAN
IMKAAN
IMKAAN

Imkaan is a UK-based, Black feminist organisation. We are the only national second-tier women’s organisation dedicated to addressing violence against Black and minoritised women and girls i.e. women and girls which are defined in policy terms as Black and ‘Minority Ethnic’ (BME). The organisation holds nearly two decades of experience of working around issues such as domestic violence, forced marriage and ‘honour-based’ violence.

They work at local, national and international level, and in partnership with a range of organisations, to improve policy and practice responses to Black and minoritised women and girls. Imkaan works with it’s members to represent the expertise and perspectives of frontline, specialist and dedicated Black and minoritised women’s organisations that work to prevent and respond to violence against women and girls. Imkaan delivers a unique package of support which includes: quality assurance; accredited training and peer education; sustainability support to frontline Black and minoritised organisations; and facilitation of space for community engagement and development. They are a part of the Pathfinder Consortium.

https://www.imkaan.org.uk

The University of Bristol CAPC
The University of Bristol CAPC
The University of Bristol CAPC

The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research.  It is part of Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

A dedicated team of researchers at the Centre work on domestic abuse projects and IRISi is a co-collaborator and partner on some of these projects including ReProvide, HERA and DRiDVA.

The Health Foundation
The Health Foundation
The Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The Health Foundation’s Exploring Social Franchising programme aims to generate a deeper understanding of the potential of social franchising models for scaling effective health and social care interventions within the NHS.

We are one of four project teams participating in the programme to develop a social franchise to enable the sustainable spread of our intervention, the IRIS Programme. We receive funding and support from the Health Foundation, including technical expertise on social franchising, and attend programme learning events. The Health Foundation has also commissioned a programme-wide evaluation to support understanding of the use of social franchising in the UK health and care system. We and our franchisees will support the evaluation through co-designing data collection requirements, providing access to data as requested, hosting site visits and attending learning events.

https://www.health.org.uk

STADV
STADV
STADV

Standing Together Against Domestic Violence is a UK charity bringing communities together to end domestic abuse. They bring local services together to keep people safe

Most public services weren’t designed with domestic abuse in mind, and they often struggle to keep people safe. Poor communication and gaps between services put survivors at risk.

STADV aim to end domestic abuse by changing the way that local services respond to it. They do this through an approach that they pioneered, called the Coordinated Community Response. The Coordinated Community Response brings services together to ensure local systems truly keep survivors safe, hold abusers to account, and prevent domestic abuse.

Their model of a coordinated local partnership to tackle and ultimately prevent domestic violence is now widely accepted as best practice. They are also a part of the Pathfinder consortium.

http://www.standingtogether.org.uk

Spring Impact
Spring Impact
Spring Impact

Spring Impact is a not-for-profit social enterprise born out of the frustration of seeing social organisations constantly reinventing the wheel and wasting scarce resources. Spring Impact uses a combination of tested commercial and social principles and extensive practical expertise to support organisations to identify, design and implement the right social replication model to scale their social impact.

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