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Domestic violence and abuse overview

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Domestic violence and abuse

About

What is covered

This pathway covers how to help identify, prevent and reduce domestic violence and abuse. Although it does not cover 'child abuse', it does include support for children who are affected by domestic violence and abuse.
Domestic violence and abuse is a complex issue that needs sensitive handling by a range of health and social care professionals. The cost, in both human and economic terms, is so significant that even marginally effective interventions are cost effective.
Women and men can experience this type of violence in heterosexual and same-sex relationships. The prevalence of physical assaults from a partner or adult family member is higher among heterosexual women than among men. Moreover, heterosexual women experience more repeated physical violence, more severe violence, much more sexual violence, more coercive control, more injuries and more fear of their partner.
The recommendations cover the broad spectrum of domestic violence and abuse, including violence perpetrated on men, on those in same-sex relationships and on young people.
Working in a multi-agency partnership is the most effective way to approach the issue at both an operational and strategic level. Initial and ongoing training and organisational support is also needed.
The guidance is for health and social care commissioners, specialist domestic violence and abuse staff and others whose work may bring them into contact with people who experience or perpetrate domestic violence and abuse. In addition, it may be of interest to members of the public.

Updates

Updates to this pathway

29 February 2016 Domestic violence and abuse (NICE quality standard 116) added to this pathway.
24 November 2015 Link to NICE pathway on attachment difficulties in children and young people added.
3 September 2014 Minor maintenance updates.
22 August 2014 Minor maintenance updates.

Definitions

Domestic violence and abuse

The term 'domestic violence and abuse' is used in this pathway to mean: 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 are family members. This includes: psychological, physical, sexual, financial and emotional abuse. It also includes 'honour'-based violence and forced marriage. For the purposes of this pathway, it does not include female genital mutilation.

People who experience domestic violence and abuse

Throughout this pathway, 'people who experience domestic violence and abuse' refers to those who are victims or survivors of the violence and abuse.

Children and young people affected by domestic violence and abuse

Children (aged under 16) and young people (aged 16 to 18) can experience domestic violence and abuse:
  • when they are affected by it; this includes fearing, hearing or seeing it within their families, or worrying about its effects on someone else
  • within their own intimate relationships.
Young people may also perpetrate domestic violence and abuse in their own intimate relationships and on their parents or carers.

Protected characteristics

The Equality Act (2010) makes it illegal to discriminate against anyone because of:
  • age
  • being or becoming a transsexual person
  • being married or in a civil partnership
  • being pregnant or having a child
  • disability
  • race including colour, nationality, ethnic or national origin
  • religion, belief or lack of religion/belief
  • sex
  • sexual orientation
These are called 'protected characteristics'.

Indicators

Indicators are presenting problems or conditions that are associated with domestic violence and abuse. They can include:
  • symptoms of depression, anxiety, post-traumatic stress disorder, sleep disorders
  • suicidal tendencies or self-harming
  • alcohol or other substance use
  • unexplained chronic gastrointestinal symptoms
  • unexplained reproductive symptoms, including pelvic pain and sexual dysfunction
  • adverse reproductive outcomes, including multiple unintended pregnancies or terminations, delayed pregnancy care, miscarriage, premature labour and stillbirth
  • unexplained genitourinary symptoms, including frequent bladder or kidney infections
  • vaginal bleeding or sexually transmitted infections
  • chronic pain (unexplained)
  • traumatic injury, particularly if repeated and with vague or implausible explanations
  • problems with the central nervous system – headaches, cognitive problems, hearing loss
  • repeated health consultations with no clear diagnosis
  • intrusive 'other person' in consultations including partner or husband, parent, grandparent or an adult child (for elder abuse).
(Adapted from Black MC (2011) Intimate partner violence and adverse health consequences: implications for clinicians. American Journal of Lifestyle Medicine 5: 428-39)

Short Text

Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively

What is covered

This pathway covers how to help identify, prevent and reduce domestic violence and abuse. Although it does not cover 'child abuse', it does include support for children who are affected by domestic violence and abuse.
Domestic violence and abuse is a complex issue that needs sensitive handling by a range of health and social care professionals. The cost, in both human and economic terms, is so significant that even marginally effective interventions are cost effective.
Women and men can experience this type of violence in heterosexual and same-sex relationships. The prevalence of physical assaults from a partner or adult family member is higher among heterosexual women than among men. Moreover, heterosexual women experience more repeated physical violence, more severe violence, much more sexual violence, more coercive control, more injuries and more fear of their partner.
The recommendations cover the broad spectrum of domestic violence and abuse, including violence perpetrated on men, on those in same-sex relationships and on young people.
Working in a multi-agency partnership is the most effective way to approach the issue at both an operational and strategic level. Initial and ongoing training and organisational support is also needed.
The guidance is for health and social care commissioners, specialist domestic violence and abuse staff and others whose work may bring them into contact with people who experience or perpetrate domestic violence and abuse. In addition, it may be of interest to members of the public.

Updates

Updates to this pathway

29 February 2016 Domestic violence and abuse (NICE quality standard 116) added to this pathway.
24 November 2015 Link to NICE pathway on attachment difficulties in children and young people added.
3 September 2014 Minor maintenance updates.
22 August 2014 Minor maintenance updates.

Sources

NICE guidance and other sources used to create this pathway.
Domestic violence and abuse (2016) NICE quality standard 116

Quality standards

Domestic violence and abuse

These quality statements are taken from the domestic violence and abuse quality standard. The quality standard defines best practice in identifying, preventing and reducing domestic violence and abuse and should be read in full.

Quality statements

Asking about domestic violence and abuse

This quality statement is taken from the domestic violence and abuse quality standard. The quality standard defines best practice in identifying, preventing and reducing domestic violence and abuse and should be read in full.

Quality statement

People presenting to frontline staff with indicators of possible domestic violence or abuse are asked about their experiences in a private discussion.

Rationale

Some people who present to frontline health and social care practitioners have indicators of possible domestic violence or abuse. Services should ensure that they can provide a safe and private environment in which people feel able to disclose that they are experiencing domestic violence and abuse. In some healthcare settings (for example, mental health and drug or alcohol services, and sexual health services), more people will have indicators of possible domestic violence or abuse than in other settings.

Quality measures

Structure
Evidence of local arrangements to ensure that people presenting to frontline staff with indicators of possible domestic violence or abuse are asked about their experiences in a private discussion.
Data source: Local data collection.
Process
Proportion of people presenting to frontline staff with indicators of possible domestic violence or abuse who are asked about their experiences in a private discussion.
Numerator – the number in the denominator who are asked if they have experienced domestic violence or abuse in a private discussion.
Denominator – the number of people presenting to frontline staff with indicators of domestic violence or abuse.
Data source: Local data collection. The Adult Social Care Outcomes Framework indicator 1.11 gives the number of domestic abuse incidents reported to the police per 1,000 population.
Outcome
Incidence of domestic violence and abuse.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners and commissioners

Service providers (primary, community including third sector, secondary and tertiary care providers of health and social care services, including prison health services) ensure that health and social care practitioners are trained to recognise the indicators of possible domestic violence and abuse. They provide facilities which enable trained health and social care practitioners to ask people presenting with indicators of possible domestic violence or abuse about their experiences in private discussions.
Health and social care practitioners recognise indicators of possible domestic violence and abuse and respond appropriately. They make sensitive enquiries of people presenting with indicators of domestic violence or abuse about experiences as part of a private discussion and in an environment in which the person feels safe.
Commissioners (NHS England local area teams, clinical commissioning groups and local authorities) commission services that ensure that health and social care practitioners are trained to recognise the indicators of possible domestic violence and abuse, and to make sensitive enquiries about experiences as part of a private discussion with the person presenting with such indicators.

What the quality statement means for service users

People who go to health or social care services with signs of possible domestic violence or abuse are offered a private discussion about their experiences. This may help them to talk about any domestic violence or abuse, to know that they are not alone, to feel that they will be believed and that their experiences are not unusual. They will be offered help and support.

Source guidance

Domestic violence and abuse (2014) NICE guideline PH50, recommendation 6.

Definition of terms used in this quality statement

Indicators of possible domestic violence or abuse
The following symptoms or conditions are indicators of possible domestic violence or abuse:
  • symptoms of depression, anxiety, post-traumatic stress disorder, sleep disorders
  • suicidal tendencies or self-harming
  • alcohol or other substance misuse
  • unexplained chronic gastrointestinal symptoms
  • unexplained gynaecological symptoms, including pelvic pain and sexual dysfunction
  • adverse reproductive outcomes, including multiple unintended pregnancies or terminations
  • delayed pregnancy care, miscarriage, premature labour and stillbirth
  • genitourinary symptoms, including frequent bladder or kidney infections
  • vaginal bleeding or sexually transmitted infections
  • chronic unexplained pain
  • traumatic injury, particularly if repeated and with vague or implausible explanations
  • problems with the central nervous system – headaches, cognitive problems, hearing loss
  • repeated health consultations with no clear diagnosis
  • intrusive 'other person' in consultations, including partner or spouse, parent, grandparent or an adult child (for elder abuse).
[Adapted from Domestic violence and abuse (NICE guideline PH50)]
Frontline staff
Frontline staff include:
  • nurses
  • accident and emergency doctors
  • adult social care staff
  • ambulance staff
  • children's centre staff
  • children and family social care staff
  • GPs
  • mental health professionals
  • midwives
  • health visitors
  • paediatricians
  • obstetricians and gynaecologists
  • health and social care practitioners in education (including school nurses)
  • prison staff
  • alcohol and drug misuse workers
  • youth workers.
[Adapted from Domestic violence and abuse (NICE guideline PH50) recommendation 15]

Equality and diversity considerations

Health and social care practitioners should understand equality and diversity issues and ensure that assumptions about people's beliefs, values, gender identity or sexuality do not stop them from recognising and responding to domestic violence and abuse.
When interpreters are needed for discussions, these should be professional interpreters who are impartial and have a duty to maintain confidentiality. Family members or friends should not act as interpreters for enquiries or discussions.

Response to domestic violence and abuse

This quality statement is taken from the domestic violence and abuse quality standard. The quality standard defines best practice in identifying, preventing and reducing domestic violence and abuse and should be read in full.

Quality statement

People experiencing domestic violence and abuse receive a response from level 1 or 2 trained staff.

Rationale

People experiencing domestic violence or abuse should expect staff to respond consistently and appropriately. Training staff to respond to disclosure (level 1) and how to ask about domestic violence and abuse (level 2) is essential for safe enquiry about experiences of domestic violence and abuse and a consistent and appropriate response. People experiencing domestic violence or abuse should be questioned sensitively and responded to with empathy and understanding. Private discussion with trained staff should allow assessment of the person’s immediate safety in order to prevent further incidents.

Quality measures

Structure
Evidence of local arrangements to ensure that staff are trained to level 1 or 2 to respond to domestic violence and abuse.
Data source: Local data collection.
Process
Proportion of people experiencing domestic violence or abuse who receive a response from level 1 or 2 trained staff.
Numerator – the number in the denominator who receive a response from level 1 or 2 trained staff.
Denominator – the number of people who disclose or are asked if they are experiencing domestic violence or abuse.
Data source: Local data collection.
Outcome
Safety of people experiencing domestic violence and abuse.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (primary, community including third sector, secondary and tertiary care providers of health and social care services, including prison health services) ensure that frontline staff are trained to provide a level 1 or 2 response appropriate to their role. They should work in partnership with voluntary and community agencies to develop training. Training should be provided by qualified trainers, use accredited materials where possible and include face-to-face contact, as well as online content.
Health and social care practitioners are trained to provide a level 1 or 2 response to disclosures of domestic violence or abuse. They should ask about domestic violence in a way that facilitates disclosures, in a private discussion, in a sensitive manner and in an environment in which the person feels safe. They should respond sensitively to disclosures in a way that ensures the person's safety; they should offer referral to specialist services. They should document discussions, agreed actions and outcomes.
Commissioners (NHS England local area teams, clinical commissioning groups and local authorities) ensure that they commission services in which frontline staff are trained to provide a level 1 or 2 response at a level appropriate to their role and document discussions. Services should raise awareness and address misconceptions about domestic violence and abuse. They should ensure that frontline staff have the skills and training to provide effective support.

What the quality statement means for service users

People who experience domestic violence or abuse are helped to talk about their experiences by trained staff. They know that they are not alone, that they can get help and support, that their experiences are not that unusual and that they will be believed.

Source guidance

Domestic violence and abuse (2014) NICE guideline PH50, recommendation 15.

Definitions of terms used in this quality statement

Response
Frontline staff should be trained and able to respond to disclosures of domestic violence and abuse to a level appropriate to their role.
Level 1 staff should be trained to respond to a disclosure of domestic violence or abuse sensitively and in a way that ensures people's safety. They should also be able to direct people to specialist services. This level of training is for physiotherapists, speech therapists, dentists, youth workers, care assistants, receptionists, interpreters and non-specialist voluntary and community sector workers.
Level 2 staff should be trained to ask about domestic violence and abuse in a way that makes it easier for people to disclose it. This involves an understanding of the epidemiology of domestic violence and abuse, how it affects people's lives and the role of professionals in intervening safely. Staff should also be able to respond with empathy and understanding, assess someone's immediate safety and offer referral to specialist services. Typically this level of training is for nurses, accident and emergency doctors, adult social care staff, ambulance staff, children's centre staff, children and family social care practitioners, GPs, mental health professionals, midwives, health visitors, paediatricians, health and social care professionals in education (including school nurses), prison staff and alcohol and drug misuse workers. In some cases, this level of training will also be relevant for youth workers.
[Adapted from Domestic violence and abuse (NICE guideline PH50)]

Equality and diversity considerations

Health and social care practitioners need to understand equality and diversity issues and ensure that assumptions about people's beliefs, values, gender identity or sexuality do not stop them from recognising and responding to domestic violence and abuse.
When interpreters are needed for discussions, these should be professional interpreters who are impartial and have a duty to maintain confidentiality. Family members or friends should not act as interpreters for enquiries or discussions.

Referral to specialist support services for people experiencing domestic violence or abuse

This quality statement is taken from the domestic violence and abuse quality standard. The quality standard defines best practice in identifying, preventing and reducing domestic violence and abuse and should be read in full.

Quality statement

People experiencing domestic violence or abuse are offered referral to specialist support services.

Rationale

It is important that people who disclose that they are experiencing domestic violence or abuse can access appropriate support. This should include support for any children in their family who are affected. Specialist support services can help to address the emotional, psychological, physical and sexual harms arising from domestic violence and abuse. They can offer advice, help to develop plans for the future and increase the safety of those affected.

Quality measures

Structure
a) Evidence of local referral pathways to ensure that people experiencing domestic violence or abuse are referred to specialist support services.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that specialist support services are available for people experiencing domestic violence or abuse.
Data source: Local data collection.
Process
Proportion of people who disclose that they are experiencing domestic violence or abuse who are referred to specialist support services.
Numerator – the number in the denominator who are referred to specialist services.
Denominator – the number of people who disclose that they are experiencing domestic violence or abuse.
Data source: Local data collection.
Outcome
Satisfaction with specialist support services.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (primary, community, including third sector, secondary and tertiary care providers of health and social care services, including prison health services and criminal justice agencies) work with commissioners to design local referral pathways for domestic violence and abuse and ensure that health and social care practitioners offer referrals to these specialist support services to people who need them.
Health and social care practitioners are aware of local referral pathways for domestic violence and abuse and offer referrals to specialist support services to people who need them.
Commissioners (NHS England local area teams, clinical commissioning groups and local authorities) ensure that referral pathways and a full range of specialist support services are in place for people experiencing domestic violence and abuse. These include specialist community based advocacy services.

What the quality statement means for service users

People who experience domestic violence or abuse are offered referral to specialist support services, such as refuges. This will mean that they can get the help and support that they need.

Source guidance

Domestic violence and abuse (2014) NICE guideline PH50, recommendations 4, 5, 6, 8 and10.

Definitions of terms used in this quality statement

People experiencing domestic violence or abuse
This refers to those aged 16 and over who are experiencing or have experienced domestic violence or abuse, and to children (under 16s) who are affected by domestic violence or abuse.
[Domestic violence and abuse (NICE guideline PH50)]
Specialist support services
Specialist support services for domestic violence and abuse aim to improve the safety and well-being of those affected. Services include advocacy, advice, floating support, outreach support, refuges and provision of tailored interventions for victims and their children. They also include housing workers, independent domestic violence advisers and multi-agency risk assessment conferences for those at high risk. Services should be tailored to the level of risk and specific needs of people experiencing domestic violence or abuse.
[Domestic violence and abuse (NICE guideline PH50)]

Equality and diversity considerations

Services should be tailored to address the specific needs of people experiencing domestic violence or abuse. Services should include those to help prevent forced marriages, to help men, and lesbian, gay, bisexual or transgender people affected by domestic violence or abuse, and to help people subjected to 'honour' violence or stalking.
Services should provide support in different languages and be accessible to people with additional needs such as physical, sensory or learning disabilities. When interpreters are needed for discussions, these should be professional interpreters who are impartial and have a duty to maintain confidentiality. Family members or friends should not act as interpreters for enquiries or discussions.

Referral to specialist services for people perpetrating domestic violence or abuse

This quality statement is taken from the domestic violence and abuse quality standard. The quality standard defines best practice in identifying, preventing and reducing domestic violence and abuse and should be read in full.

Quality statement

People who disclose that they are perpetrating domestic violence or abuse are offered referral to specialist services.

Rationale

People who disclose that they are perpetrating domestic violence or abuse should be able to access evidence-based specialist services. Health and social care practitioners should identify available local services and know how to access these. Providing support for perpetrators can reduce the incidence of domestic violence and abuse.

Quality measures

Structure
a) Evidence of local referral pathways to ensure that people who disclose that they are perpetrating domestic violence or abuse are referred to specialist services.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that specialist services are available to support people who disclose that they are perpetrating domestic violence or abuse.
Data source: Local data collection.
Process
Proportion of people who disclose that they are perpetrating domestic violence or abuse who are referred to specialist services.
Numerator – the number in the denominator who are referred to specialist services.
Denominator – the number of people who disclose that they are perpetrating domestic violence or abuse.
Data source: Local data collection.
Outcome
Reduction in repeated domestic violence and abuse.
Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (primary, community, including third sector, secondary and tertiary care providers of health and social care services, including criminal justice agencies) work with commissioners to design local referral pathways for domestic violence and abuse and ensure that health and social care practitioners offer referrals to these specialist services to people perpetrating domestic violence or abuse.
Health and social care practitioners are aware of local referral pathways and offer people perpetrating domestic violence or abuse referrals to specialist services.
Commissioners (NHS England local area teams, clinical commissioning groups and local authorities) ensure that referral pathways and a full range of specialist services are in place for people perpetrating domestic violence or abuse.

What the quality statement means for service users

People who are violent towards or abuse people close to them are offered referral to specialist services that can help them to change their views and understand more about violence. These specialist services can make it easier for them to get the help and support that they need to change their behaviour.

Source guidance

Domestic violence and abuse (2014) NICE guideline PH50, recommendations 4, 5, 6, 10 and 14.

Definitions of terms used in this quality statement

People who perpetrate domestic violence or abuse
People aged 16 or over who are violent towards or try to control, coerce, threaten or abuse family members or people who are, or have been, intimate partners. This includes psychological, physical, sexual, financial and emotional abuse. It also includes 'honour'-based violence and forced marriage.
[Domestic violence and abuse (NICE guideline PH50)]
Specialist services for people perpetrating domestic violence or abuse
Specialist services for people who perpetrate domestic violence or abuse might include initiatives and interventions to deal with their behaviour and any related issues. Interventions should be tailored, evidence-based, meet national standards and be based on the local needs assessment. Interventions should primarily aim to increase the safety of the person’s partner and children (if they have any). Health and social care practitioners should report on the person’s attitudinal change, their understanding of violence and accountability, their ability and willingness to seek help, and the safety of their partner (or ex-partner) and children. These interventions, when commissioned, should include robust evaluation.
[Adapted from Domestic violence and abuse, recommendation 14 (NICE guideline PH50)]

Equality and diversity considerations

Services should be tailored to address the specific needs of people perpetrating domestic violence and abuse.
Services should provide support in different languages and be accessible to people with additional needs such as physical, sensory or learning disabilities. When interpreters are needed for discussions, these should be professional interpreters who are impartial and have a duty to maintain confidentiality. Family members or friends should not act as interpreters for enquiries or discussions.

Effective interventions library

Effective interventions library

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Implementation

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Pathway information

Definitions

Domestic violence and abuse

The term 'domestic violence and abuse' is used in this pathway to mean: 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 are family members. This includes: psychological, physical, sexual, financial and emotional abuse. It also includes 'honour'-based violence and forced marriage. For the purposes of this pathway, it does not include female genital mutilation.

People who experience domestic violence and abuse

Throughout this pathway, 'people who experience domestic violence and abuse' refers to those who are victims or survivors of the violence and abuse.

Children and young people affected by domestic violence and abuse

Children (aged under 16) and young people (aged 16 to 18) can experience domestic violence and abuse:
  • when they are affected by it; this includes fearing, hearing or seeing it within their families, or worrying about its effects on someone else
  • within their own intimate relationships.
Young people may also perpetrate domestic violence and abuse in their own intimate relationships and on their parents or carers.

Protected characteristics

The Equality Act (2010) makes it illegal to discriminate against anyone because of:
  • age
  • being or becoming a transsexual person
  • being married or in a civil partnership
  • being pregnant or having a child
  • disability
  • race including colour, nationality, ethnic or national origin
  • religion, belief or lack of religion/belief
  • sex
  • sexual orientation
These are called 'protected characteristics'.

Indicators

Indicators are presenting problems or conditions that are associated with domestic violence and abuse. They can include:
  • symptoms of depression, anxiety, post-traumatic stress disorder, sleep disorders
  • suicidal tendencies or self-harming
  • alcohol or other substance use
  • unexplained chronic gastrointestinal symptoms
  • unexplained reproductive symptoms, including pelvic pain and sexual dysfunction
  • adverse reproductive outcomes, including multiple unintended pregnancies or terminations, delayed pregnancy care, miscarriage, premature labour and stillbirth
  • unexplained genitourinary symptoms, including frequent bladder or kidney infections
  • vaginal bleeding or sexually transmitted infections
  • chronic pain (unexplained)
  • traumatic injury, particularly if repeated and with vague or implausible explanations
  • problems with the central nervous system – headaches, cognitive problems, hearing loss
  • repeated health consultations with no clear diagnosis
  • intrusive 'other person' in consultations including partner or husband, parent, grandparent or an adult child (for elder abuse).
(Adapted from Black MC (2011) Intimate partner violence and adverse health consequences: implications for clinicians. American Journal of Lifestyle Medicine 5: 428-39)

Supporting information

Glossary

In general, advocacy for people who have experienced domestic violence includes:
  • legal, housing and financial advice
  • access to and use of community resources such as refuges, emergency housing and psychological interventions
  • safety planning advice.
The activities may differ according to the level of risk facing the person. Crisis advocacy involves working with someone for a limited period of time (they may then be referred on to more specialised agencies).
Practitioners providing advocacy can also provide ongoing support and informal counselling. The intensity of the advocacy provided may vary. It may last for a year – or longer, if the person is particularly vulnerable.
This includes: health, social care, education, criminal justice, probation and voluntary and community sector commissioners and service providers involved with those who experience or perpetrate domestic violence and abuse.
For the purpose of this pathway, 'disclose' means any occasion when an adult or child who has experienced or perpetrated domestic violence or abuse informs a health or social care worker or any other third party.
For the purpose of this pathway, disclosure is defined as any occasion when an adult or child who has experienced or perpetrated domestic violence or abuse informs a health or social care worker or any other third party.
In the context of this pathway, floating support is a housing service designed to prevent tenancy breakdowns. Floating support can also provide help with:
  • keeping safe and security measures
  • accessing legal advice and options
  • welfare benefits
  • budgeting and debts
  • life skills
  • resettlement or re-housing
  • accessing community services
  • form filling
  • pre-tenancy support
  • training, education and employment.
A forced marriage is one in which one or both spouses do not (or, in the case of some adults with learning or physical disabilities, cannot) consent to the marriage but are forced into it using physical, psychological, financial, sexual or emotional pressure. ('Handling cases of forced marriage', HM Government 2008). It is distinct from an arranged marriage that both partners enter into freely.
A crime or incident committed (or possibly committed) to protect or defend the perceived 'honour' of a family or community. Often this term is enclosed in quote marks, or prefaced with 'so-called', to emphasise that the concept of honour in these cases is contested and that it is generally invoked as a means of power and control.
A crime or incident committed (or possibly committed) to protect or defend the perceived 'honour' of a family or community. Often this term is enclosed in quote marks, or prefaced with 'so-called', to emphasise that the concept of honour in these cases is contested and that it is generally invoked as a means of power and control.

Independent domestic violence advisers (IDVAs)

Also known as independent domestic violence advocates, IDVAs work primarily with people at high risk of domestic violence and abuse, independently of any one agency, to secure their safety and the safety of their children. Serving as the primary point of contact, IDVAs normally work with their clients from the point of crisis to assess the level of risk, discuss the options and develop plans that address their immediate safety, as well as longer-term solutions. In many areas they are funded by the local community safety partnership. In some areas they are funded by the police or local authorities.

Multi-agency risk assessment conference (MARAC)

Regular meetings at which information about people experiencing domestic violence or abuse and who are at high risk (those at risk of homicide or serious harm) is shared between local agencies. Whenever possible, the person who experiences the violence is represented by an independent domestic violence adviser or advocate (IDVA). Participants aim to draw up a coordinated safety plan to support the person. In many areas they are funded by the local community safety partnership. In some areas they are funded by the police or local authorities.
Royal colleges and professional organisations responsible for setting training and registration standards for relevant clinical, social workers and social care staff; heads of health, social care and related services; universities and other providers of health and social care training for professionals who come into contact with services users, including interpreters.
'No recourse to public funds' is a term used for people who are not entitled to welfare benefits, home office asylum support, public housing and other public funds and services. The term derives from the 'no recourse to public funds' condition applied to certain immigration statuses. 'Public funds' refers to a range of benefits including housing support, carer's allowance, child benefit, disability living allowance, housing benefit, income support and social fund payments

Refuge

A residential service – a safe house – provided for adults (usually women) and children who are experiencing domestic violence and abuse.
This process is undertaken with people who have disclosed that they are the victims of domestic violence and abuse. The aim is to evaluate their risk of further harm. Practitioners with level 2 training assess their immediate safety, for example, whether it is safe for the person to go home. Practitioners with level 3 training identify the risks faced in more detail to inform safety planning, referrals to specialist support services and to aid any police investigation. Almost all police forces in England and Wales use the DASH (domestic abuse, stalking and harassment and 'honour'-based violence) risk identification tool and guidance. A multi-sectoral version, CAADA-DASH, is used by independent domestic violence advisers, some domestic violence advocates and support workers, other specialist domestic abuse services and some health and social care practitioners.
An intervention to help people judge their risk of violence, identify the warning signs and develop plans on what to do when violence is imminent or is happening.
Strategic partnerships include, for example, health and wellbeing boards, local domestic violence partnerships and community safety partnerships.
A structured psychological or psychiatric treatment delivered by professional clinicians, such as psychologists. Therapeutic interventions may be delivered in an individual or group format.
Trans is an umbrella term. It includes cross-dressers, transgender and transsexual people as well as anyone else who is in any way gender-variant.

Who should identify those at risk?

This includes: local safeguarding children boards and other local partnerships with a responsibility for safeguarding children; providers of services where children and young people who are affected by domestic violence and abuse may be identified in the public, community and voluntary sectors. The latter includes: accident and emergency departments, child and adolescent mental health services, dental services, GP practices, health visiting, maternity services, sexual health services and other health services; early years services, schools and colleges, school nursing services; social care; specialist paediatric services for child safeguarding and looked after children; alcohol and drug misuse services; youth services; youth justice services.

Who should provide support for people with mental health conditions?

This includes: clinical commissioning groups and specialist commissioners; police and crime commissioners; health and wellbeing boards; providers of primary care and mental health care services in the private, voluntary and community sectors. The latter includes: health and social care professionals working in alcohol and drug misuse services, detention centres and criminal justice settings.

Who should provide specialist services for children and young people?

This includes: local safeguarding children boards and other local partnerships with a responsibility for safeguarding children; commissioners and providers of specialist services for children and young people who are affected by domestic violence and abuse in the public, community and voluntary sectors. The latter includes: child and adolescent mental health, health visiting, sexual health, social care and specialist paediatric services for child safeguarding and looked after children, and youth services.

Who should provide tailored support?

This includes: managers of domestic violence and abuse services; staff in all health and social care settings, including the public, voluntary and community sectors, and those they work with. The latter includes: criminal justice, including prisons, early years and youth services, housing, the police, schools and colleges, and services for older people.
This includes: health and social care commissioners and service providers in the public, voluntary and community sector; managers and commissioners of interpreting services.
This includes: health and social care commissioners (including clinical commissioning groups, local authority commissioners and police and crime commissioners); health and wellbeing boards; frontline practitioners in specialist domestic and sexual violence services (for example, domestic violence and abuse advisers, people working in refuges or outreach services).
This includes: Royal colleges and professional organisations responsible for setting training and registration standards for clinical, social workers and social care staff; commissioners; Health Education England; heads of health, social care and related services; universities and other providers of health and social care training, including interpreting.
This includes: Royal colleges and professional organisations responsible for setting training and registration standards for relevant clinical, social workers and social care staff; heads of health, social care and related services; universities and other providers of health and social care training for professionals who come into contact with service users, including interpreters.

Paths in this pathway

Pathway created: February 2014 Last updated: February 2016

© NICE 2016

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