Policies, Procedures, Guidelines and Protocols

Title Policies, Procedures, Guidelines and Protocols Document Details Trust Ref No 2078-28878 Local Ref (optional) Main points the document covers Who is the document aimed at? Author Approved by (Committee/Director) Domestic Abuse Policy This Policy sets out the arrangements for Shropshire Community Health NHS Trust staff to be aware of the processes in place to identify, assess risk and respond to Domestic Abuse. All employees of Shropshire Community Health NHS Trust Julie Harris/Liz Watson Approval process Safeguarding Group Approval Date 01/09/2017 Initial Equality Impact Screening Full Equality Impact Assessment Lead Director Category Sub Category Yes No Executive Director of Nursing and Operations, Corporate Safeguarding Children Review date 01/09/2019 Who the policy will be distributed to Method Required by CQC Required by NHSLA Other No Date Amendment 1 2 3 4 5 Distribution All employees of Shropshire Community Health NHS Trust Safeguarding Children mandatory training, publication on the Trust Intranet and distribution to key managers Document Links Amendments History

Contents 1 Introduction...2 2 Purpose.2 3 Definitions.2 4 Duties.3 4.1 Chief Executive...3 4.3 Designated Doctor and Nurse 3 4.4 Named Doctor...3 4.5 Named Nurse 4 4.6 Nurse Specialist 4 4.7 Safeguarding Leads...4 4.8 Staff 4 5 Muti-agency Risk Assessment conference (MARAC)...5 6 Multi Agency Public Protection Arrangements (MAPPA)...5 7 IDVA..5 8 Health Visitor Roles and responsibilites..5 School Nurse Roles and Responsibilities 6 10 Responding to domestic abuse notifications.6 11 Minor Injury Staff Roles and Responsibilities...8 12 Documentation processes relating to MARAC..8 13 Consultation 9 14 Dissemination and Implementation.9 15 Monitoring Compliance.9 16 Care Quality Commission.9 17 References...10 18 Associated Documents...10 19 Appendices...10 Domestic Abuse Policy Datix Ref: 2078-28878 1 11/17

1 Introduction Domestic Abuse is evident across all social, geographical and cultural groups and has potentially a devastating impact on those affected by it. The effects of Domestic Abuse on victims, children and families is one that without the right help, support and justice can have a lasting impact on all, its affects are not just physical but impact on emotional wellbeing, health, work and therefore have subsequent impact on housing and income and relationships with families and friends. This policy has been written to support Shropshire Community Health NHS Trust staff in their identification and assessment of the impact of domestic abuse, and to clarify the Trust s expectations around their responses to victims, perpetrators and their families. 1.1 Health Visitors, School Nurses and Urgent Care professionals (such as staff in Minor Injury Units), are ideally placed to identify victims of domestic abuse. Health Visitors assess and support families from the antenatal stage and offer universal support to families as well as targeted and more focused intervention dependent upon need. School Nurses provide services to children and young people who may be affected by, or disclose domestic abuse experiences, as well as providing services to adolescents who may be involved in abusive relationships. Urgent Care Staff, including Minor Injury Unit staff, may assess and treat the victims of domestic abuse. 1.2 However any member of Shropshire Community Health NHS Trust staff may identify a victim of domestic abuse and be required to take actions to assess the victim, and provide or refer to, support services for them. The assessment and any further services must take into account any children or vulnerable adults affected by the situation. 2 Purpose The purpose of this Policy is to ensure all Shropshire Community Health NHS Trust staff are aware of their responsibilities in identifying domestic abuse, assessing risk and supporting victims of Domestic Abuse and their families, ultimately aiming to reduce maternal and child morbidity, (DH, 2010). This document has been written to ensure all Trust staff, particularly groups such as Health Visiting, School Nursing and Minor Injury Units, who are most likely to have contact with victims and perpetrators of domestic abuse, follow safe and effective processes when managing domestic abuse situations 3 Definitions Home Office Definition of Domestic Abuse: Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, the following types of abuse: psychological physical sexual financial emotional Domestic Abuse Policy Datix Ref: 2078-28878 2 11/17

4 Duties Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim. For the purpose of this policy, a child is defined as anyone who has not yet reached their 18th birthday. The fact that a child has reached 16 years of age, is living independently or is in further education, is a member of the Armed Forces, is in hospital or in custody in the secure estate, does not change his/her status or entitlements to services or protection (HM Government 2013). 4.1 Chief Executive All health care organisations have a duty to make arrangements to safeguard and promote the welfare of children and young people, and to co-operate with other agencies to protect individual children and young people from harm. The UN Convention on the Rights of the Child includes the requirement that children live in a safe environment and be protected from harm. Statutory guidance on making arrangements to safeguard and promote the welfare of children under Section 11 of the Children Act (2004) was published in August 2005, with health organisations having a duty to cooperate with Social Services under section 27 of the Children Act (1989). These duties are an explicit part of NHS employment contracts, with Chief Executives having responsibility to have in place arrangements that reflect the importance of safeguarding and promoting the welfare of children within organisations. 4.2 Executive Director Lead for Safeguarding The Executive Director Lead for Safeguarding takes leadership responsibility at Board level, for the organisation s safeguarding arrangements; 4.3 Designated Doctor and Nurse The Designated role sits within the Clinical Commissioning Group. The term Designated Doctor or Nurse denotes professionals with specific roles and responsibilities for safeguarding children, including the provision of professional and strategic advice and guidance to organisational Boards across the health economy. This may include, health professionals, particularly Named Safeguarding Health Professionals, Local Authority Children s Services Departments, the Clinical Commissioning Group and the LSCB. 4.4 Named Doctor Their role is to support other professionals in their agencies to recognise the needs of children, including rescue from possible abuse or neglect. Domestic Abuse Policy Datix Ref: 2078-28878 3 11/17

To promote good practice within the Trust To safeguard children within the organisation To provide advice and expertise to staff To liaise with colleagues in other health economies when necessary To co-ordinate child protection training for medical staff To provide child protection supervision for medical staff To participate in internal management and serious case reviews 4.5 Named Nurse Named professionals have a key role in promoting good professional practice within their organisation, providing advice and expertise for fellow professionals, and ensuring safeguarding training is in place. They should work closely with their organisation s Safeguarding Lead, Designated professionals and the LSCB. The Named Nurse will provide safeguarding and child protection advice, support and training to all staff within the Trust. This includes domestic abuse issues that affect children and families. 4.6 Nurse Specialist The Nurse Specialist works with the Named Nurse to provide safeguarding and child protection advice, support and training to all staff within the Trust. This includes domestic abuse issues that affect children and families. 4.7 Safeguarding Leads Safeguarding Leads are identified professionals who have completed the NSPCC Safeguarding Supervision training and provide advice, support and supervision to staff regarding safeguarding children issues. Safeguarding leads will participate in safeguarding supervision with either the Named Nurse or Nurse Specialist for Safeguarding Children. Safeguarding Leads will be expected to maintain their professional development, knowledge and skills through attendance at safeguarding leads meetings and specific identified training. 4.8 Staff Health Professionals are in a strong position to identify welfare needs or safeguarding concerns regarding individual children and where appropriate, should provide support or make a referral to children s social care. All members of staff that come into contact with children and young people have a responsibility to safeguard and promote their welfare and should know what to do if they have concerns about safeguarding issues, including child protection. Domestic Abuse Policy Datix Ref: 2078-28878 4 11/17

This responsibility also applies to staff working primarily with adults who have dependent children that may be at risk because of their parent/carers health or behaviour. To fulfil these responsibilities, it is the duty of healthcare organisations to ensure that all their staff have access to appropriate safeguarding training, supervision, learning opportunities and support to facilitate their understanding of the clinical aspects of safeguarding and information sharing. 5.0 Multi-Agency Risk Assessment Conference (MARAC) Multi-Agency Risk Assessment Conference (MARAC) takes place once a month and is a multi-agency forum for agencies to share information and establish a safety plan for the high risk victims of domestic abuse. By bringing all agencies together at a MARAC, and ensuring that whenever possible the voice of the victim is represented by the Independent Domestic Violence Advocate, a risk-focused, coordinated safety plan can be drawn up to support the victim and any dependent children or other adults at risk. Both of the MARAC s in Shropshire and Telford have representation from Shropshire Community Health NHS Trust. Shropshire Community Health NHS Trust staff can refer into MARAC. See the safeguarding children webpage for a copy of the MARAC referral form and where the forms should be sent. 6.0 Multi Agency Public Protection Arrangements (MAPPA) These are monthly meetings at which agencies share risk information related to offenders of violent and/or sexual harm. The focus is to manage the risks posed to victims and the public. The MAPPA is not a statutory body in itself, but is a mechanism though which agencies can discharge their statutory responsibilities and protect the public in a coordinated manner. Partner agencies share information and develop effective, risk focused and coordinated plans to safely manage the risks to the public. 7.0 Independent Domestic Violence Advocates Independent Domestic Violence Advocates identify and assess risk to domestic abuse victims and their families, and manage this risk with the victim, providing the most effective support. Referral to this service requires the victim to be assessed as high risk. 8.0 Health Visitor Roles and Responsibilities Health Visitors are ideally placed to make routine enquiries about domestic abuse, due to their universal contact with parents or carers, including during the ante-natal and post-natal periods. This should be in line with the NICE guidance on domestic abuse and violence (February 2016) https://www.nice.org.uk/guidance/qs116 and the Department of Health guidance for health professionals on domestic violence (June 2013) which can be found at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/211018/9576- TSO-Health_Visiting_Domestic_Violence_A3_Posters_WEB.pdf Domestic Abuse Policy Datix Ref: 2078-28878 5 11/17

Parents or carers who respond positively to screening questions can be managed in a variety of ways and this will be dependent on professional judgement and information. This may include the provision of further advice, information and support or referral to other specialist support agencies. This may include the Freedom programme, Women s Aid or MARAC. Specific consideration should also be given to pregnant women and whether they may benefit from a referral to the vulnerable women s group. Health visitors should also consider bringing any cases of concern to their safeguarding supervision. The Trust Safeguarding leads may also be contacted for advice on domestic abuse cases. 9.0 School Nurse Roles and Responsibilities The School Nursing Service will not routinely screen school-age children for domestic abuse. However, School Nurses must be knowledgeable about the signs, symptoms and risk factors relating to domestic abuse. They must consider the risk wherever there are concerns that a child may be witnessing domestic abuse between adults within their family, or when they may be a victim or perpetrator within a peer relationship. Where an older child, usually a teenager, is thought to be in a domestic abuse relationship the CAADA-DASH assessment tool can be used, providing the child is deemed to have the capacity to undertake the assessment. Children who respond positively to screening questions ion the CAADA DASH assessment can be managed in a variety of ways. This will be dependent upon professional judgement and may include the provision of further advice, information and support or referral to other specialist support agencies. If a child makes a disclosure of domestic abuse then they should be managed as per the Safeguarding children policy and a referral made to Children s Social Care. School Nurses should also consider bringing any cases of concern to their safeguarding supervision. The Trust Safeguarding leads may also be contacted for advice on domestic abuse cases 10.0 Responding to Domestic Abuse Notifications Received From the Police The Police forward copies of all domestic abuse notifications (where there are children in the household or the victim or perpetrator has a child), to the First Point of Contact in Children s Social Care (Telford, Shropshire and Dudley) and to Shropshire Community Health NHS Trust. The notifications are then disseminated to specific health professionals within the Trust; currently this includes Health Visitors, School Nurses, Family Nurse Partnership and Special School Nurses. Upon receipt of the domestic abuse notification, the health professional should review the information within the notification and ascertain if any action has already been taken and recorded on the notification by Police or Children s Social Care. Further clarification can be sought from the Police via 101 or Children s Social Care if necessary. The health professional should review the records they hold for the child/family and ascertain if there is any information that may be relevant to share with Children s Social Care. This will be based upon professional judgement and any knowledge of the family. Domestic Abuse Policy Datix Ref: 2078-28878 6 11/17

Where appropriate the health professional should inform Children s Social Care of this information and this action should be recorded on the child s progress note on RiO. If the child or other children connected with the incident have a child protection plan and/or an allocated Social Worker, contact must be made with the Social Worker, and a plan of action decided, including clear allocation of responsibilities. This must be detailed on the child s progress notes within RiO and may include a plan to refer to MARAC and/or to seek the involvement of an IDVA. Upon receipt of the domestic abuse notification, the health professional should record this on the patient s progress notes on RiO. If the domestic incident is a paper copy, then the health professional should sign, date and record their designation on the notification prior to scanning the document onto RiO. If it is an electronic copy, then it should be saved directly onto the child s record on RiO. An alert should also be added to RiO to indicate domestic abuse. Please follow the separate Trust guidance on adding an alert to Rio as the alert will require monitoring and review. The date that the incident happened should be recorded together with the risk assessed by Police (and Children s Social Care where applicable) and the action taken by the health professional. If no action is required, then this should also be recorded and the reasons why. The domestic abuse notification should also be marked as a significant event, so that it populates the significant event sheet on the patient s record. If the notification relates to a pregnant woman, the health professional should liaise with the Community Midwife and identify the most appropriate professional to follow up the incident. This decision and the rationale for agreed action must be recorded on the progress notes on RiO. If the health professional has not previously been aware of concerns about domestic abuse, they must either discuss this with the victim at the next planned routine contact if this is imminent. If no planned contact is imminent, the health professional should contact the victim offering an appointment. The health professional should also consider both their own safety and that of the victim and children when discussing any incident of domestic abuse in the presence of the alleged perpetrator. However, this should not be a barrier to safe discussions regarding the effects of domestic abuse on the children with either the victim or the perpetrator. If the health professional is unsure how to manage the contact, advice should be sought from a member of the Trust Safeguarding Children Team. The representative for the Trust at MARAC may also be contacted for advice and support. If a victim does not disclose, but the health professional suspects there is domestic abuse within the family, they should accept what is being said but offer other opportunities to talk. The health professional may consider giving relevant information to the alleged victim for a friend if the alleged victim won t accept it on their own behalf. At all contacts where domestic abuse is discussed, the health professional should focus on safety, assessing the immediate safety of the victim and child/ren. This includes asking if it is safe for them to return home with the child using tools such as the CAADA-DASH. It may be necessary to discuss a basic safety plan with the victim and where appropriate discuss a referral to MARAC. Domestic Abuse Policy Datix Ref: 2078-28878 7 11/17

If the health professional requires any further advice or guidance around responding to domestic abuse notifications then they should either contact their Safeguarding Lead or a member of the Safeguarding Children Team. 11.0 Minor Injuries Staff Roles and Responsibilities The Minor Injury Service will not routinely screen patients for domestic abuse when they attend a Minor Injury Unit. However, health professionals must be knowledgeable about the signs, symptoms and risk factors relating to domestic abuse and must consider the risk wherever there are concerns that: an adult may be the victim of domestic abuse a child or young person may be witnessing domestic abuse between adults within their family a child or young person may be witnessing domestic abuse between young people within, or linked to, the family a child or young person may be a victim or perpetrator within peer relationships Consideration must be given to the needs of adult victims who may be defined as Vulnerable Adults / Adults at Risk. Minor Injury Unit (MIU) staff should document any disclosure of domestic abuse and follow the Trust Safeguarding Children policy or the Vulnerable Adults Policy at all times. All concerns regarding potential domestic abuse and actual disclosures of domestic abuse must be documented on the progress notes for the patient on RiO. Any actions taken must be documented with appropriate reference to Children s Social Care or Adult Safeguarding if this is a concern. 12.0 Documentation Processes Relating to MARAC The Trust MARAC Leads are responsible for communicating the relevant MARAC information to and from the health professionals who have caseload responsibility for the child/family being heard at MARAC. This is irrespective of whether the health professional has current active involvement. Currently, the MARAC Coordinator for West Mercia Police forwards the MARAC agenda to the MARAC leads for SCHT. The child is identified on RiO and information reviewed in preparation for attendance at MARAC. The MARAC lead will then share information at MARAC. The information shared will be in accordance with Trust information sharing guidance and multi-agency procedures relating to safeguarding. Following MARAC, the MARAC lead will then record pertinent information shared at MARAC on RiO and once the agreed actions have been received from the MARAC Coordinator at West Mercia Police, these will also be added to RiO. The MARAC lead will be responsible for checking that the progress note is added as a significant event, so that the significant event sheet is populated. They will also need to ensure that an alert is on RiO to indicate domestic abuse. A high alert should be added where the child lives with the Offender or/and victim or has direct contact with the Offender A medium alert should be added where the child lives with/or has direct contact with the victim, away from the Offender, and the victim has been assessed by Social Care and the Police to be able to be a protective factor for the children Domestic Abuse Policy Datix Ref: 2078-28878 8 11/17

A low alert should be added where the child lives with neither the Offender not the victim, however they do or could have direct contact with either party in the future. Once the agreed actions have been added to RiO, an email will be sent to the health professional/team to advise them that this has been completed and to review the information on RiO. The health professional will be responsible for the ongoing monitoring and review of the alert in accordance with Trust Guidance on adding an alert to RiO. Health professionals will update themselves by accessing the relevant professional records for families they are involved with and whether there any actions that they need to complete resulting from MARAC. They may discuss the MARAC minutes and any actions, with the MARAC Lead. Health professionals will also need to consider communicating the domestic abuse and MARAC information to other professionals in the Trust, who have some involvement with the family, such as Allied Health professionals. Entries on electronic records alone, which are shared between services but which are accessed infrequently, are not adequate communication. An email between involved professionals is an appropriate means of communication to alert colleagues to an entry about domestic abuse on the family record. 13.0 Consultation This policy will be forwarded to Steve Gregory, Executive Director of Nursing & Operation, Jo France Head of Nursing and Quality (Children & Families Service Delivery Group), Andrew Thomas, Adult Safeguarding Lead, Dr Sam Postings, Named Doctor for CDOP & Safeguarding Children and Dr Mahadeva Ganesh, Consultant Paediatrician, Designated Doctor, Medical Director and Executive Director with Safeguarding Responsibility for consultation. 14.0 Dissemination and Implementation This policy will be disseminated and implemented through Service Leads and Line Managers. 15.0 Monitoring Compliance Compliance will be monitored through local internal audit. This will include peer audits, and records audits completed by Safeguarding Leads. External audits will include the Multiagency case file audits which are organised through the Local Safeguarding Children Boards. 16.0 Care Quality Commission All NHS Trusts are required to register with the Care Quality Commission for the services they provide. As part of this registration each Trust must declare its position with regard to compliance with the Health and Social Care Act (Regulated Activities) Regulations 2008, and the Care Quality Commission (Registration) Regulations (2009). Safeguarding is covered by Regulation 11 and by Outcome 7 in the associated guidance. The Care Quality Commission may seek evidence that regulations and guidance have been complied with. Domestic Abuse Policy Datix Ref: 2078-28878 9 11/17

17.0 References Care Quality Commission (Registration) Regulations 2009 Available at: http://www.cqc.org.uk/file/4981 (Accessed 10th August 2015) 18.0 Associated Documents The following Shropshire Community Health NHS Trust Policies may be useful to read in conjunction with this policy: Safeguarding Children Policy Safeguarding Adults Policy Domestic Abuse Policy Datix Ref: 2078-28878 10 11/17