In the penultimate of our 16 blogs for 16 days, Miranda Pio, Pathfinder Programme Manager, writes about how Pathfinder has helped pioneer the whole health approach and the legacy the project will leave.
Pathfinder is a pilot project run by five expert consortium partners STADV, IRISi, AVA, Imkaan, SafeLivesuntil March 2020. It has aimed to establish comprehensive health practice in relation to domestic violence & abuse (DVA) in acute hospital trusts, mental health trusts and community-based IRIS programmes in GP practices in 8 sites across the UK. A priority, based on years of collective experience working to improve NHS trust responses to DVA, was to connect health partners to each other and their local specialist services to improve the local whole-health response to DVA.
What is the Pathfinder Whole-Health Approach?
We know there are NHS trusts around the country with robust strategies to tackle and respond to DVA safely. Pathfinder has aimed to link these pockets of great practice to different parts of their local health economy to ensure a robust and consistent response to DVA across all health services that a survivor may come into contact with. This is important to ensure a survivor receives the same level of support from any health professional they present to regardless of the health care setting they work in and what the health concern they are presenting with is (sexual health, mental health, burns, pregnancy etc). We refer to this as a ‘whole-health response to DVA’.
During the life of the project we have successfully linked in with existing governance structures or set up new DVA steering groups to ensure there is a regularly attended meeting for acute health, mental health, CCG, the local authority and local specialist services to meet. Through this approach we have seen:
- The successful building of relationships between health partners and local DVA services.
- Sharing of information, policies and procedures, training strategies and other examples of good practice.
- More robust referral pathways for survivors from health into local DVA services
- Innovative project ideas and roles that span several NHS trusts to most effectively use the limited funding available to health services
What does a robust response to DVA look like in general practice?
A best practice response to DVA in primary care involves training for administration & clinical staff and strong working relationships between GP surgeries and the specialist DVA sector including a robust referral process. IRIS is widely accepted to be the DVA training, support and referral programme for General Practices and has been positively evaluated in a randomised controlled trial. Prior to the Pathfinder Project 3 of our sites had already commissioned IRIS & during the project we have implemented in 3 more of our sites.
What does a robust response to DVA look like acute & mental health trusts?
When the Pathfinder project initially commenced in sites, we took the opportunity to acknowledge the successes of our health partners and learn from interventions & strategies that have been working for them and the survivors that present to them. We took the knowledge gained by this initial scoping work and worked with the steering groups and in consultation with local specialist services in each site to agree the best use of Pathfinder funding to plug the gaps in the whole-health response to DVA.
We have seen a great success so far with many of these roles and from these initial outcomes have highlighted the key areas we believe a trust should focus on to improve their response to DVA:
1: A Domestic Abuse Coordinator
The role of a DA Coordinator has been widely praised in sites. The post should be responsible for monitoring the trusts response to DVA, maintaining relationships with key stakeholders and referral pathways to specialist services. The role should also be responsible for the trust’s training strategy, policies & procedures and for ensuring the sustainability of funding for the trust’s IDVA provision.
2: Co-located health based IDVA
The success of the co-located health IDVA is evident across the UK and the provision of multiple IDVAs across every NHS trust is widely accepted as best practice. For IDVA provision to be sustainable it is vital that the role is permanently funded by the trust. It is also vital that this role is co-located with the local specialist service or receives ongoing case management support and supervision from the local service. For this working relationship to be maintained and for the IDVA to be adequately supported by both agencies a working agreement should be in place covering the operational detail of the post.
3: Policies & procedures
During the life of the project the need for robust policies & procedures around responding to DVA in patients and staff have been highlighted by the sites we’ve worked with. Sites have identified the need to have a clear protocol in respect of responding to perpetrators who are employed by the trust. Pathfinder have developed a Policy Assessment Tool to support trusts to improve their DVA policies. This will be published as part of the Pathfinder Toolkit in March 2020.
4: Training strategies
A robust training strategy is necessary to ensurehealth professionals feel confident to respond to DVA. Pathfinder recommends that Trusts follow NICE guidelinesand ensure that all staff have received Level 1 training to equip them to respond appropriately to a disclosure of DVA. Pathfinder will be publishing a Training Assessment Tool for Trusts to assess the content of their existing training packages & have developed a Train the Trainer package for Trusts looking to embed a new training strategy.
5: Data collection
Thorough data collection is important in order to accurately monitor the Trust’s response to DVA & its impact on the lives of survivors. Most importantly all trusts should be recording whether DVA enquiry has happened, whether the patient discloses abuse, whether a referral was made & if there are any safeguarding concerns. It is important for all information recorded to use the survivor’s own words to accurately portray what was disclosed in a factually neutral manner. Learn more here. As part of the Pathfinder project we are working with researchers at Bristol University to produce a consensus & guidance on recording DVA in electronic medical records across health settings to ensure ease of information sharing.
Look out for thePathfinder Toolkit which we will be launching on 27thMarch 2020. This will include tools to help local health areas respond more effectively to survivors of DVA including:
- Health IDVA & DA Coordinator Job Descriptions
- Business case & working agreement to adequately embed a health-IDVA
- Training Assessment Tool
- Policy Assessment Tool & Template
- Guidance around data collection
Miranda Pio is Pathfinder Programme Manager and works for Standing Together. For more information on the project please contact her firstname.lastname@example.org.