Pathfinder, The Solution?

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.

What’s next?

Look out for thePathfinder Toolkit which we will be launching on 27^thMarch 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 m.pio@standingtogether.org.uk.

Partners

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 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 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 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 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

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 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.