Improving how professionals can identify and support children experiencing domestic violence

New CLAHRC research has highlighted a lack of guidance for health and social professionals who encounter children exposed to domestic violence.

Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. Children can be directly impacted – leading to emotional and behavioural problems and risks of physical injury and death when children are caught up in the violence between adults.  Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences. Health and social care workers are often the first professionals to have contact with a child experiencing these situations.


In a collaboration with CLAHRC East of England and international colleagues from the McMaster and Western Universities in Canada we examined the evidence on child, parent and professional views on acceptable approaches to identifying and responding to children exposed to domestic violence.

The resulting research paper, published in BMJ Open, highlighted conflicting views of children and mothers on the one hand and professionals on the other when it came an ideal response. Children and mothers wanted professionals to talk to children directly and engage them in safety planning. Professionals preferred to engage with children via the parent and they often did not perceive children exposed to domestic violence as patients or clients in their own right.

Guidelines for health professionals who encounter women who have experienced domestic violence provide various questions and prompts they can use in discussions, and a set of principles to follow. There are no equivalent recommendations on how to identify and respond to children exposed to domestic violence and limited evidence on which to base future guidance. Our analysis also revealed that professionals were not happy with the existing safety guidelines for children and mothers exposed to domestic violence and wanted changes.

The research was funded by the Public Health Agency of Canada through funding to the VEGA (Violence, Evidence, Guidance and Action) project. The VEGA Project is part of the Canadian Government’s Public Health Response to Family Violence. This research will inform the development of public health guidance, protocols, curricula and tools for health and social service providers. The research was supported by the NIHR CLAHRC North Thames and NIHR CLAHRC East of England.

Resources supporting this new research include a blog in The Conversation by lead researcher Dr Natalia Lewis, and we have worked with CLAHRC East of England on a joint BITE – a summary of the research with key learning for busy professionals interested in this work.

Read the paper

Natalia V. Lewis, Gene S. Feder, Emma Howarth, Eszter Szilassy, Jill R. McTavish, Harriet L. MacMillan, Nadine Wathen.

Identification and initial response to children’s exposure to intimate partner violence: a qualitative synthesis of the perspectives of children, mothers and professionals.

BMJ Open 2018. Published in BMJ Open. April 2018. Doi:. http://bmjopen.bmj.com/content/8/4/e019761

Read a BITE sized summary

How should health and social care professionals identify and respond to children experiencing domestic violence?

Finding a better way to identify children experiencing domestic violence

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Shutterstock

Natalia Lewis, University of Bristol

Around one in five children in the UK have been exposed to domestic violence or abuse between their parents or caregivers. When adults are involved in an abusive relationship, their children bear the consequences.

The effects of domestic violence on a child can range from emotional and behavioural problems to physical injury and death when children are caught up in the violence between adults.

Even when not directly involved, children’s exposure continues through witnessing and being aware of the violence – and through its health, social and financial consequences.

Health and social care workers are often the first professionals to have contact with a child experiencing these situations. This could be when the abused parent seeks help, or when children undergo health checks. It can happen during assessments for emotional or behavioural problems, or when social services, a child’s school or the police become involved.

The World Health Organisation (WHO) recommends that health professionals who see women with clinical signs of domestic violence should ask them about safety in their relationship and at home. They advise that responses to disclosure should follow what is known as the “LIVES” principles: Listen, Inquire about needs and concerns, Validate, Enhance safety, and provide Support.

But there are no equivalent recommendations for children, and there is no agreed approach regarding how best to identify and respond to children who are exposed to domestic violence. So far, there has also been only limited evidence on which to base future guidance.

Now researchers at universities in the UK (Bristol, Queen Mary and Cambridge) and Canada (McMaster and Western) have combined existing evidence on the best ways to identify and respond to children experiencing domestic violence. This synthesis, the first of its kind, integrates findings from 11 studies with 42 children, 220 parents, and 251 health care and social services professionals.

We found that study participants’ opinions were strikingly consistent, and matched the LIVES principles. Children, parents (mostly mothers) and professionals agreed that identification of the problem should happen in the context of a good patient-professional relationship, and in a safe and supportive environment.

Health care professionals should enquire about the child’s safety when they see clinical signs of domestic violence and abuse in children. The ideal initial response should include emotional support, discussion about domestic violence and advice on local specialist services.

We also discovered that a professional’s ability to identify and respond to children’s exposure to domestic violence was heavily influenced by constraints within the health and social service system. Lack of time, funding cuts and poor inter-agency collaboration all have an impact. Professionals needed more training and resources to be able to respond to these children and their families in an appropriate and safe way.

However, there was a difference of opinion when it came to engaging directly with children and managing their safety.

A direct approach?

Children and mothers wanted professionals to talk to children directly and engage them in safety planning. Professionals, on the other hand, preferred to engage with children via the parent – and did not perceive children exposed to domestic violence as patients or clients in their own right. Also, professionals were not happy with existing safety guidelines and practices for children and mothers exposed to domestic violence. These elements are certainly subjects for future research and training.

Given the scale of the problem, and the long-term emotional, behavioural and physical impacts on children, we hope that the results of this study can form the basis of new, internationally agreed guidelines.

Our research findings have already been used to inform point-of-care responses to adults and children in Canada’s VEGA (Violence, Evidence, Guidance, Action) Project. That program is already developing the “Recognising and Responding Safely to Family Violence” Handbook for health and social care professionals.

And we hope our evidence will inspire development of professional training and resources elsewhere – so that front line practitioners feel better equipped to appropriately and safely respond directly to the needs of children. Too many children’s lives and futures could depend upon it.

Natalia Lewis, Research Fellow in Primary Care, University of Bristol

This article was originally published on The Conversation. Read the original article.

Continuing Professional Development at your fingertips

Part of the CLAHRC’s mission is to raise awareness of new research evidence, and get it to the front-line where it can used by NHS staff. We are working with our host Trust NHS Bart’s Health to translate the new knowledge we generate into everyday practice among NHS professionals.

Bart’s Education Academy has developed an eCPD app available to download for free for users of Android and iPhone smartphones. The eCPD app aims to reduce the time staff have to leave the frontline to attend training courses in person, and give them more flexible learning they can fit around their busy schedules. The app allows staff to log in and create personal and professional development plans (including mandatory training) and optional learning modules. Once completed a notification is sent to both the member of staff and their supervisor, to show they have carried out the necessary training and are credited with CPD points where appropriate.

The CLAHRC has provided learning modules focused on our research findings, and more of our work will appear on the App in the near future.

We are now rolling out some of our popular CLAHRC Academy courses so that they can be accessed via the App – our Academy Director Dr Nora Pashayan (below right) and Academy Teaching Fellow Dr Silvie Cooper (below left) recently met Director of Academic Health Sciences at Barts Health NHS Trust Professor Jo Martin to launch our Introduction to Evaluation course via the App.

The Barts Education Academy provides clinical placements for 2,500 medical undergraduate students and trains 1,040 junior doctors, over 800 children, adult nursing and midwifery students and 275 allied health professionals. The Education Academy offers resuscitation skills training, moving and handling, simulation and clinical skills training and a range of skills based short courses, as well as ensuring the trust achieves high levels of compliance for its statutory and mandatory training.

Using patient information

One aspect of the GIRFT study uses statistical methods, including economic analysis, to examine ‘what works and at what cost?’

We are trying to assess whether the GIRFT programme has reduced variations in orthopaedic practice and costs, and improved patient outcomes. To do this, we are requesting confidential patient data for a group of patients who have undergone elective orthopaedic surgery between 1st April 2009 and 31st March 2018.

The data we would like to use include Hospital Episode Statistics (HES), a database containing details of all admissions to NHS hospitals in England, which is collected so that hospitals can be paid for the care they deliver. These data can also be processed and used for other purposes, such as research and planning health services. We would also like to use data from the National Joint Registry, which records details of joint replacement operations in order to monitor the results of surgery and protect patient safety.

Secure storage and processing of patient information

Researchers will not be able to identify patients, using the information that they are given by the organisations (National Joint Registry and NHS Digital). Personal identifiers of patients will only be securely transferred between these two organisations, so NHS Digital can link them together, to provide more accurate and complete information for researchers.

Both organisations will securely transfer pseudonymised data to researchers at UCL, so patient information can be processed without researchers being able to identify patients.

All pseudonymised patient information will be stored on a secure network that is password-protected, and can only be accessed by those with specialised training and access for the duration of the study.

Opting-out

If you would like further information about the use of your data in this research study, or would like to request that your confidential patient information is not included in this study, please contact us between 1st May – 1st June 2018 to discuss.

Contact details:

Dr Sarah Jasim

NIHR CLAHRC North Thames

Department of Applied Health Research

University College London

1-19 Torrington Place

London WC1E 7HB

Tel: 020 3105 3233

E-mail: clahrc.girft-evaluation@ucl.ac.uk


 

My health in school website up and running

CLAHRC researchers based at Queen Mary University working to positively transform the health of young people have launched the My health in school initiative and website.

‘My Health in School’ aims to support young people’s health via school-based projects.

The My health in school team (below) also includes researchers and communications experts from Queen Mary University of London, and will initially focus will on asthma in young people aged 11-13, building on CLAHRC research and engagement with young people.

Previous collaborations with pupils, teachers and parents has spawned a number of innovations to engage and educate young people living with asthma and their peers. Outputs already developed include board and computer games, a drama being delivered in a number of schools and a short film.

The team is working with Professor Jonathan Grigg, who leads several studies about asthma and lung health in children and young people.

As well as support from NIHR CLAHRC North Thames other key collaborators, include:

  • Centre of the Cell
  • GLYPT (Greenwich and Lewisham Young People’s Theatre)
  • Healthy London Partnership
  • Asthma UK Centre for Applied Research

The project is recruiting secondary schools across London – schools that are interested are encouraged to get in touch with the team – find out more about what being involved means here.