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

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?

INPUTS TO OUTCOMESAchieving Success in Child Protection and Domestic Violence 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

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

Steering Groups were established to manage pilot project within SHSSB & UCHT.

Timeframe – six monthsSHSSB Oct 03 – Mar 04UCHT 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? Cardiff’s Women’s Safety Unit-15 high risk

factors associated with domestic abuse Research Home Office –Research paper 217-

Domestic 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.

Domestic Violence Threshold Scales

The above must all be considered in each case

Severity of the incidencesPattern, 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/abusePerpetrator’s attitude to

the abuse

Additional Vulnerabilities

Age of victimVictim’s personal

vulnerabilities-isolated- locality.

Age of perpetratorDisability Issues for Victim,

children and/or perpetratorCultural 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

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

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

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 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 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 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.

Provides detailed information on which to base decision making.

Enabled clarity regarding the level and type of intervention needed.

Evidence–based practice of Barnardos Domestic Violence Outreach Project-safety work for women and children.

Compatibility with current practice and policies

Initial assessment teams used the safety and domestic violence education during their work and found this extremely useful.

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

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

Sessions provided support to implement model and without the focus and support of sessions, staff would have struggled to implement this into their practice.

Mentoring facilitated practice, consultation, learning, reflection on practice, provided research information.

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

Initial Response/Assessment Teams – Model useful for structuring initial information.

Model readily identified gaps in information.

Provided tangible record of all instances of domestic violence.

In new cases not all information readily available.

Children & Families Teams - Initial assessment using the framework at IRT assisted in longer term case planning.

Provided consistent clear record of decision making.

Future Use of Model

Consideration to be given to multi-agency use of threshold scales in determining risk and appropriate referral to Social Services.

Consideration of piloting the threshold scales with Police Service NI

Consideration to be given to aligning training in domestic violence risk factors and threshold scales with existing child protection training.

Calder Comments

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 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

Mid point evaluation January 2008

Mentoring

Training

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

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

DVRAM

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

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

PROPOSALS FOR RISK MODEL REFINEMENT AND EXTENSION

Links to other domestic abuse risk assessment

tools in the system

(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

Treatability/ prognosis/ resilience building interventions

Screening/ initial assessment advice

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

Integrated risk assessment tools and focus: child care 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 Stimulation

Family and Social Child Relationships Safeguarding Guidance & and promoting Boundaries Social Presentation welfare Selfcare Skills Stability

Family History

Wider Family

Housing

Employment

Income

Family’s Social Integration

Community Resources

CAFCASS Toolkit (versions 1&2)

Areas of Development

Impacts of Domestic Violence 0-2 years Protective Factors Warning signs

Health 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.

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.

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.

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.

The presence of an alternative or supplementary caring adult who can respond to the child’s developmental needs.

Poor language skills in the infant.

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.

As above As above

Different risk focus (Bell, 2006)

Victim and siblings

Offender Partner

Integrated risk assessment tools and focus: criminal justice

Actuarial risk tools Numerous risk

frameworks VAI CBI SARA SPECCSVO Matrix 2000

Matrix 2000 (Risk of violent offending)

1. Age at commencent of risk Points under18 4 18 to 24 3 25 to 34 2 35-44 1 older 0 2. Violent appearances Points 0 0

1 1 2,3 2

4+ 3 3. Any burglaries? Points No 0 Yes 2 TOTAL POINTS CATEGORY 0 1,2 3,4 5+

Low risk Medium risk High risk Very high risk

DVRAM as integrative framework?

Professional RATS (Calder, 2007b)

Criminal Justice

Social Care

Actuarial

Prescriptive

Risk Loaded

Strength Adverse

OASYs Matrix 2000

Police and CPs Tools

Professional Judgment

General

Risk Adverse

Strengths Loaded

CAFCASS DV RAT

Differential risk focus

Risk of actual or likely significant harm?

Risk of re-offending?

Risk of relapse?

Common language and focus?

Criminal Justice

Probation, police and prison inc MAPPA

Risk of re-offending (no timeframe indicated and restricted to index offence)

Criminal Justice (MARAC)

High risk victims in need of protection

Social care Risk of actual or likely significant harm

Case file analysis – highlighted areas

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

Coventry Commission

How to develop specific DVRAM factors for their growing ethnic population

Principally South Asian, Portuguese, Arabic and Refugee/Asylum seekers

‘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 evidence-base

Production of an accessible flowchart for staff

Greater guidance on 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

Broader suggested usage e.g. education and prevention

Revised DVRAM for core assessment 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

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

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

4-pronged model

Multi-agency DV threshold scale

Social Care Initial Assessment

Social Care Core Assessment

Safety intervention with children and mothers

Barnet evaluation

Briefing (half-day to 200 staff)

Training (2 days on initial and core assessments and 1 day on safety planning interventions)

Mentoring (3/4 sessions on monthly basis for 5/6 staff)

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

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

Mentoring

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

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

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

Messages from Barnet

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

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

References

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

Calder MC (2007b) Domestic violence and child protection: challenges for professional practice. Context 84: 11-14

Calder MC (2008) Evaluation of domestic violence training and mentoring programme in Northern Ireland: Mid-point summary analysis. Leigh: Calder Training and Consultancy

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.

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