Domestic Abuse Services:

1. Domestic Abuse Services: Commissioning Quality & Value

3. Domestic Abuse: The Effects • Health and wellbeing of victims adversely affected. • Closely associated with child abuse and neglect. • Impacts social issues eg, homelessness & substance abuse. • Cost to tax payer is an estimated £3.9bn pa with high risk domestic abuse representing £2.4bn of this.* * Source: CAADA (2010) ‘Saving lives, saving money: MARACs and high risk domestic abuse’.

4. A Need for Partnership Working • Challenging issue for commissioners – involves many different policy agendas. • Multi-agency cooperation necessary for effective management. • Public sector is now operating within harsh financial conditions: Necessary to align funding demands to ensure public services offer quality and value for money.

5. The Landscape for Domestic Abuse Services

6. Independent Domestic Violence Advisors (IDVAs) • Specialist emotional and practical support for adult victims at the point of crisis. • Engage with and mobilise local agency resources to keep victims and their children safe. • 63% of victims report a total cessation of abuse at case closure with an IDVA.

7. Multi-Agency Risk Assessment Conferences (MARACs) • Safeguard highest risk cases through coordinated information sharing and safety planning by statutory and voluntary sector partners. • The higher and more co-ordinated the number of interventions, the better the service user outcomes. • Recognised for achieving significant improvements in abuse cessation, risk reduction etc.

9. National Context Over 44,000 adults living with 57,500 children were supported through 260 MARACs and an estimated 500 IDVAs in the twelve months to March 2013. The Government part-funds 144 IDVAs and 54 MARAC coordinators as part of its Call to End Violence Against Women and Girls Strategy. National MARAC coverage has now been achieved. There are gaps in IDVA provision across the country. Research shows that 650 are needed to effectively support all high risk victims in the UK. As well as failing to meet victims’ needs, this shortfall represents a public cost in social and health services.

10. National Policy Recent legislative and policy developments have moved domestic abuse up the public agenda: • Updated definition of Domestic Abuse (2013). • Health and Social Care Act establishes local Health and Wellbeing Boards (2012). • Stalking Offence (2012). • Domestic abuse made a strategic priority by Royal College of General Practitioners. • Mandatory Domestic Violence Homicide Reviews (2011). • Dept of Health guidelines for commissioners of health services on violence against women (2011).

11. CAADA Strategic Recommendation #1 • Fund a minimum of 4 IDVAsand 1 MARAC coordinator for every 100,000 adult females: 100,000 ADULT FEMALES • Helping victims in abusive relationships is a clear public health and social care priority. • High risk services cost an estimated £70M pa. • Investing in this level of provision, £2.90 could be saved in public services for every £1 spent. (Source: A place of greater safety 2012)

12. CAADA Strategic Recommendation #2 • Locate additional IDVAs in A&E and maternity units: • Victims referred through health agencies are often vulnerable, hard-to-reach groups. Co-located services provide easier access to crucial services eg, drugs & alcohol, mental health etc. • The Bristol Royal Infirmary reported seeing a decrease in re-presentations after funding two IDVAs in A&E. • CAADA estimates show that an extra £6M spent on 150 additional co-located IDVAs could increase the return in every £1 of public money spent from £2.90 to £3.40. (Source: A place of greater safety 2012)

13. Themis Research Project • Research Objectives: • Who accesses help via hospital-based IDVA services? • How are they different to those accessing help via IDVAs located in other settings? • Summary of Interim Findings (June 2013): • Hospital IDVAs are reaching a more vulnerable group who are younger, experiencing higher severity abuse, and more of whom present with complex needs. • They may reach victims earlier. • They may reach victims who are hidden from other agencies.

14. Finding 1.1: Reaching Younger Victims • 19% of hospital IDVA clients aged under 20 years, compared to 9% of non-hospital IDVA clients. Proportion of young clients

15. Finding 1.2: Higher Severity Abuse • Higher proportions of hospital IDVA clients experience physical and sexual abuse and jealous and controlling behaviours at intake. • 41% of hospital IDVA clients experience high severity physical abuse compared to 32% of non-hospital clients. • 11% of hospital IDVA clients experience high severity sexual abuse compared to 8% of non-hospital clients. Proportion of clients experiencing physical abuse, sexual abuse, harassment and stalking and jealous and controlling behaviours

16. Finding 1.3: Complex Needs • Higher proportions of hospital IDVA clients present with complex needs across all additional vulnerabilities at intake into their service than non-hospital IDVA clients: Proportion of clients with additional vulnerabilities at intake

17. Finding 2: Reaching Victims Earlier • 39% of hospital IDVA clients are still living with their abuser when they access the IDVA service, compared to 26% of non-hospital clients. • 54% of hospital IDVA clients are still in an intimate relationship with their abuser when they access the IDVA service, compared to 33% of non-hospital clients. • 32% of hospital IDVA clients had never attempted to leave the perpetrator before accessing the IDVA service, compared to 25% of non-hospital clients. • The length of the abusive relationship before accessing the IDVA service is slightly shorter for hospital IDVA clients than non-hospital clients (2.5 years compared to 3 years).

18. Finding 3:Reaching Clients Hidden from Other Agencies • Police contact: • Only 59% of hospital IDVA clients had made reports to the police before accessing the service; in non-hospital services 73% of clients had made a report to the police • Health agency contact: • 45% of hospital IDVA clients report previous attendances at A&E compared to 14% of non-hospital clients. • Hospital IDVA clients have an average of 5 GP attendances annually compared to 3.9 attendances for non-hospital clients. • 31% of hospital IDVA clients are pregnant compared to 4% of non-hospital clients. Therefore, health services may represent the best opportunity for identifying and engaging these victims. • NB: More detailed data on health service use before and after accessing the participating hospital and non-hospital based IDVA services will be collected. The ‘Reach’ of Hospital IDVAs: The evidence so far.

19. CAADA Strategic Recommendation #3 • Fund specialist support for children and young people: • 66% of victims have children - most are under 5 and have lived with abuse most of their lives. • MARACs identified 75,000 children and young people’s cases over 2012. • Increased risk of behavioural problems, emotional trauma and mental health difficulties in adult life.

20. National Young People’s Violence Advocacy Programme: 2013-15 • Two-year partnership programme involving CAADA, Barnardo’s, Leap Confronting Conflict, the Iranian and Kurdish Women’s Rights Organisation (IKWRO) & the Marie Collins Foundation. • Aimed at helping local areas develop a consistent local response for young people of 13 years and older, who are experiencing a range of intimate partner abuse. • The Department for Education funded programme provides: • Comprehensive free training for a local Young People’s Violence Advocate in each local authority area. • A Young People’s Regional Advisor providing free support to each local authority area. • The first National Young People’s Dataset.

21. CAADA’s Commissioning Services

22. Get in touch... Julia Carver, Partnership Development Manager: • 07880 387-036 / commissioning@caada.org.uk • uk.linkedin.com/in/juliacarver/