Atrium Clinic Domestic Abuse Policy

Atrium Clinic Domestic Abuse Policy
Revised May 25

INTRODUCTION & PURPOSE

Domestic Abuse happens to people from all different areas of society regardless of age, gender, race, culture, nationality, religion, sexuality, disability, educational level and social economical group.  Overall, 26% of women and 15% of men aged 16-59 had experienced some form of domestic abuse since the age of 16. These figures were equivalent to an estimated 4.3 million female and 2.4 million male victims, (ONS 2018.Seven women a month are killed by a current or former partner in England and Wales. 130,000 children live in homes where there is high-risk domestic abuse, 62% of children living with domestic abuse are directly harmed by the alleged perpetrator of the abuse, in addition to the harm caused by witnessing the abuse of others. (SafeLives (2015). Evidence also indicates three quarters of teenage girls and up to half of teenage boys have reported violence in their intimate relationships, with more than half of the boys perceiving violence as playful and accepted in relationship behaviour. There is also increasing recognition of abusive females in both heterosexual and same sex relationships.

Domestic abuse is a complex issue that needs sensitive handling by a range of professionals. The cost, in both human and economic terms, is so significant that even marginally effective interventions are cost effective. (NICE, 2016). It is widely recognised that domestic abuse can have a significant impact upon the health of those experiencing it. Most victims, children and alleged perpetrators will see a health professional at some stage; therefore, health professionals are viewed as being in a unique position to undertake a significant role in domestic abuse screening, signposting and providing on-going support. Health Professionals are frequently in the frontline in their work dealing with both the physical, emotional and psychological consequences of domestic abuse on victims and children; they are also ideally placed to raise the issue of domestic abuse with service users and routinely provide information or refer to appropriate support agencies, (NICE, 2016).

Atrium Clinic also extends the same duty of care to its employees and sub-contractors who are in relationships with others, and we want you to feel free to disclose your concerns to your manager and know that we will follow the same steps to safeguard you with your consent as we would to our clients.

 

SCOPE & DEFINITIONS

This policy applies to all Atrium Clinic Staff, both clinical and non-clinical, who hold a contract of employment or engagement with the Clinic and extends to the treatment of our clients too.

Definitions

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 and emotional 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 or other abuse that is used to harm, punish, or frighten their victim. Honour-based violence is a crime or incident which has or may have been committed to protect or defend the honour of the family and/or community. Forced marriage is where one or both people do not (or in cases of people with learning disabilities or reduced capacity, cannot) consent to the marriage as they are pressurised, or abuse is used, to force them to do so.

When does an adult choice become a safeguarding responsibility?

Responsibilities for safeguarding adults are set in legislation by the Care Act 2014 and through regulations. The main difference between vulnerable adults and children is that adults have a legal right to make decisions where they have the capacity to do so, even if their choices seem unwise. However, decisions that put an adult at risk of significant harm fall under safeguarding. Care giver stress is a condition of exhaustion, anger, rage or guilt that results from unrelieved caring for a chronically ill or disable dependent and differs from domestic abuse in that it is non-intentional, so needing a different approach. The caregiver may need support recognising their stress and there is a statutory duty to carry out carer’s assessment to establish carers need to sustain caring role. However, any abuse of an adult with care and support needs should be reported to social care adult safeguarding by the Atrium safeguarding lead subject to a discussion with the practitioner and others as appropriate.

Atrium staff responsibilities

• Be open to the possibility of Domestic Abuse as a feature in client’s story or behaviour.
• Be open to the notion that the client may not be safe to share their story; they may be being monitored. Ask if your client can speak safely or from a confidential space.
• Is there a better time for your sessions when the client will be able to talk freely.
• In case your client is being monitored or overheard, be sensitive about what you ask or say and encourage caution until you are more confident in your client’s safety.
• Always implement safety planning and actions as a prerequisite to the situation becoming more unsafe.
• Offer signposting to other agencies but ensure you communicate information safely, e.g. emails can be monitored.
• Complete a DASH 14 form /available from pathway team to understand risk severity and seek manger/supervisor advice if you have concerns.
• Consider these factors of DA as possibilities in formulation in clinical supervision case reviews.
• If a client is at risk of ongoing/current domestic abuse or is receiving relationship support and is experiencing abuse, you need to take urgent action and seek advice from your supervisor on next steps and potentially whether you can continue to work with this client.
• Consider systemic formulations of client difficulties to understand more about their relational context.
• Help clients to understand the possibilities of abusive and controlling behaviours and its impact.
• Identify, assess and discuss with your clinical supervisor concerns where domestic abuse may be evident. (Risk assessment and safety planning)
• Staff have a responsibility to familiarise themselves with signs of domestic abuse in adults and children.
• Confidentiality is not absolute; there may be circumstances where the safety of the victim and their children overrides their right to confidentiality. The Data Protection Act 2018 is not a barrier to sharing information and would be based on the assessed risk in each case
• Discuss any situations of concern with safeguarding lead.
• Always consider if your actions will put others at further risk or harm.
• If uncertain of risk or actions, then always seek guidance from clinical supervisor/lead.

Additional employer duties to our staff

We are all people with lives outside work and we know that some of you will experience difficulties in your relationships away from work at some time or another. We know that what happens outside work also impacts your work with our clients and your ability to deliver services to others, so it is important that you let us know if you are struggling in those relationships, feel unsafe or your mental health is impacted. We commit to

• We will take all staff concerns seriously
• Work with you to assess your needs professionally and safely.
• Offer you a wellbeing plan and signposting to additional professional and specialist support in your area.
• Provide you with additional support inhouse as per your choice, such as counselling and make reasonable adjustments to your working arrangements e.g. Flexibility, consider reasonable adjustments for salary payments and their notification (e.g. different bank accounts) to avoid financial abuse, an additional mobile, enable you to make phone calls from work or use your work email for personal communications .

 

Appendix

Potential Signs of Domestic Abuse

The NICE Domestic abuse quality standard (QS116) highlights symptoms or conditions which are indicators of possible domestic abuse: (this list is not exhaustive and practitioners must not disregard other presenting factors that may be of concern, nor do they automatically indicate domestic abuse but should raise suspicion and prompt practitioners to make every attempt to see the person alone to ask about their welfare).

1. Symptoms of depression, anxiety, post-traumatic stress disorder, sleep disorders with no explanation.
2. Suicidal tendencies or self-harming
3. Alcohol or other substance misuse
4. Unexplained chronic gastrointestinal symptoms
5. Unexplained gynecological symptoms, including pelvic pain and sexual dysfunction
6. Adverse reproductive outcomes, including multiple unintended pregnancies or terminations
7. Delayed pregnancy care, miscarriage, premature labour and stillbirth or concealed pregnancy
8. Genitourinary symptoms, including frequent bladder or kidney infections
9. Vaginal bleeding or sexually transmitted infections
10. Chronic unexplained pain
11. Traumatic injury, particularly if repeated and with vague or implausible explanations
12. Problems with the central nervous system – headaches, cognitive problems, hearing loss
13. Repeated health consultations with no clear diagnosis. The person may describe themselves as ‘accident prone’ ‘silly’
14. Intrusive ‘other person’ in consultations, including partner or spouse, parent, grandparent or an adult child (for elder abuse).

 

Potential signs of children witnessing domestic abuse

(This list is not exhaustive, and practitioners must not disregard other presenting factors that may be of concern, nor do they automatically indicate domestic abuse but should raise suspicion and prompt practitioners to follow policy, NICE Guidelines (when to suspect child abuse and neglect) and safeguarding policy.

1. Incontinence or soiling issues due to emotional distress, especially if children have not previously had any issues
2. Delay in development especially speech and language
3. Eating disorders, faltered growth or obesity, emotional eating.
4. Being withdrawn, depressed or suffering from anxiety.
5. Sudden behavior changes, maybe from confident to withdrawn or calm to aggressive.
6. Particularly clingy to a parent or others becoming notably distressed when removed from that person.
7. Aggressive behavior including language that would indicate the child was acting out what they had witnessed.
8. Sleeping issues including persistent nightmares
9. Risk taking behavior, including drug use, alcohol, missing from home, unhealthy sexual relationships, and gang involvement.
10. Missing or poor educational attendance; school avoidance.
11. Change in educational attainment, poor concentration and focus including hyperactivity.
12. Obsessive behaviors
13. Self-harm and thoughts about suicide ie. children missing appointments, and avoidance with professionals
14. Changes in presentation or behavior when in the presence of certain people such as the perpetrator and or the victim.