DVRAM: messages from Northern Ireland and Barnet pilot evaluations

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DVRAM messages from Northern Ireland and Barnet
pilot evaluations

• Martin C Calder
• Calder Training and Consultancy
• www.caldertrainingandconsultancy.co.uk

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Focus of presentation

• Emergence of NI model and development
• Focus and content of NI evaluation
• Parallel work in other local authorities
• Starting point of London work
• Pilot issues in Barnet
• Messages for the future

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DVRAM origins and initial extension

• How do we assess the multiple impacts of domestic
  violence on women and children?
• When we have collected the information how do we
  use it to analyse what it means and what to do
  next?
• How are the outcomes of any continued harm or
  intervention measured?
• How can such information inform safety planning?

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INPUTS TO OUTCOMESAchieving Success in Child
Protection and Domestic Violence

• Local research in N.I. conducted by Patricia
  Nichol Programme Manager, UCHT in 2001. into how
  domestic violence referrals from police were
  managed by Social Services
• SHSSB had identified a need in their risk
  assessment processes for a specific risk
  assessment model for domestic violence to be
  incorporated into the Needs Assessment Framework

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First steps

• Steering Groups were established to manage pilot
  project within SHSSB UCHT.
• Timeframe six months
• SHSSB Oct 03 Mar 04
• UCHT Nov 03 Apr 04
• Barnardos provided 3 days training and 12 days
  mentoring to 3 social work teams within SHSSB and
  a similar package to 4 teams within UCHT
  (including SSWs and APSWs when available).
• Barnardos provided Childrens Services Manager,
  who had expertise in domestic violence and child
  protection work and a research officer to
  evaluate the projects.
• 50 manuals on model were provided by Barnardos.

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Importing and extending the ONTARIO model
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Outcome Measurement the process of Risk
Assessment

• Risk Assessment-Collection of information on the
  situation and risk factors within a family
  situation using a consistent framework- Nine
  Assessment Areas in Domestic Violence model and a
  Pro-forma to collate information to support Core
  Assessment Framework
• Risk Analysis- Use of specific threshold scales
  of risk factors and protective factors to measure
  outcomes of assessment process
• Risk Management- Use of assessment and threshold
  scales in deciding how the case should be
  managed, specifically the interventions offered
  to family a child protection or family support
  type of intervention.

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How do we measure the outcomes from this
assessment?

• Cardiffs Womens Safety Unit-15 high risk
  factors associated with domestic abuse
• Research Home Office Research paper 217-
  Domestic Violence Offenders characteristics and
  offending related needs. 2003
• Evidence based practice of Barnardos Domestic
  Violence Outreach Project in N.I.
• Pilot Research on the application of the model
  with N.Ireland with social work assessment teams.

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Domestic Violence Threshold Scales

• There are five scales which rate the domestic
  violence from Minimum to Moderate to Severe
  through a range of facts that refer to the
• Evidence of domestic violence,
• Protective factors/strengths within situation
• Potential vulnerabilities.

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Domestic Violence Threshold Scales

• Additional Vulnerabilities
• Age of victim
• Victims personal vulnerabilities-isolated-
  locality.
• Age of perpetrator
• Disability Issues for Victim, children and/or
  perpetrator
• Cultural Issues within family

• The above must all be considered in each case
• Severity of the incidences
• Pattern, frequency and duration of violence
  incidences
• Perpetrator 's use of the children /children
  caught up in the abuse
• Escalation of violence and use of isolation
• Sexual violence/abuse
• Perpetrators attitude to the abuse

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Additional Factors

• Victim has recently separated from the
  abuser-risk of separation violence
• Victim has autonomy ( taking control with
  support)
• Perpetrator wants to reconcile with woman
• Woman uses physical force in self-defence
• Children use violence-siblings/others
• Woman has begun new relationship

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• Perpetrator has history of abuse in personal
  relationships/woman has experiences abuse in
  previous relationships/childhood abuse
• Perpetrator will soon be released from prison
• The woman and children have moved to a more
  isolated community with or without the
  perpetrator
• Pattern of inappropriate system response.
• An adult victim being unable to care for the
  child as a result of trauma from an assault

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OUTCOMES - USE OF MODEL

• Systematic format for the consistent recording of
  domestic violence in SW case files.
• Referral Screening, Initial, Comprehensive
  Assessment (Second stage assessment).
• Child Protection Case Conferences - information
  gathering, child protection planning, and
  intervention planning.
• Case planning meetings - Threshold regarding
  family support and child protection.
• Format for court reports for care orders and
  contact/ residence orders.
• In the SHSSB the model was an additional tool in
  the Assessment Framework

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Outcomes For Staff

• Training and mentoring increased staff awareness
  and understanding of the dynamics of domestic
  violence.
• Social Work staff increased knowledge base
  facilitated their information gathering and
  confidence when dealing with domestic violence.

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Outcome Identifying the risks presented to
children from domestic violence

• Enabled staff to examine and gather information
  and assisted them in identifying the risks
  present to children.
• Assessment process aided staff in rating the
  severity of the risks presented by domestic
  violence.
• Safety work intervention training with women and
  children was highlighted as extremely useful and
  effective.

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Decision making in Case Planning -Child
Protection Family Support

• Threshold scales provided a consistent framework
  to assess and rate the level of risk.
• Threshold scales enabled consistent decisions on
  case clarification - child protection or family
  support.
• Increased awareness of risks to children and
  informed decision making.

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Decision Making appropriate support
interventions for children

• Model emphasises risks presented to children and
  enables staff to focus on the needs of victim,
  children and direct response to perpetrator.
• Identifies different interventions required for
  children, victim and perpetrator
  safety/educative work and recovery work for
  children/victim.
• Maintains focus of domestic violence as main
  concern within the Assessment Framework but did
  not exclude other significant concerns.

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• Provides detailed information on which to base
  decision making.
• Enabled clarity regarding the level and type of
  intervention needed.
• Evidencebased practice of Barnardos Domestic
  Violence Outreach Project-safety work for women
  and children.

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Compatibility with current practice and policies

• Initial assessment teams used the safety and
  domestic violence education during their work and
  found this extremely useful.
• Once model used a detailed case record can be
  maintained in file - this will be significant if
  case later entered the child protection or/and
  court arena.

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Adjustments to Threshold Scales

• Data collected during the pilot confirmed that
  the threshold scales were accurate in rating
  cases into family support and/or child
  protection.
• Additional risk factors were added to threshold
  scales during the pilot which expands the risk
  factors.
• Work was undertaken to adapt the scales so they
  could be used directly with service users to
  discuss risk factors to children.

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Mentoring Sessions

• Sessions provided support to implement model and
  without the focus and support of sessions, staff
  would have struggled to implement this into their
  practice.
• Mentoring facilitated practice, consultation,
  learning, reflection on practice, provided
  research information.
• Use of team approach SSW attendance at sessions
  was crucial as they are responsible for
  decision-making for case management and support
  to their SW staff.

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Usefulness of the model to different social work
teams

• Initial Response/Assessment Teams Model useful
  for structuring initial information.
• Model readily identified gaps in information.
• Provided tangible record of all instances of
  domestic violence.
• In new cases not all information readily
  available.
• Children Families Teams - Initial assessment
  using the framework at IRT assisted in longer
  term case planning.
• Provided consistent clear record of decision
  making.

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Future Use of Model

• Consideration to be given to multi-agency use of
  threshold scales in determining risk and
  appropriate referral to Social Services.
• Consideration of piloting the threshold scales
  with Police Service NI
• Consideration to be given to aligning training in
  domestic violence risk factors and threshold
  scales with existing child protection training.

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Calder Comments

• Consistent thinking with RASSAMM
• Model allows for information collection and
  analysis and helps measure outcomes
• It is an initial assessment and core assessment
  tool and could be a screening tool
• It informs the Needs Led Assessment Framework
• Need to balance risk and assets in threshold
  scales
• Model is actuarially informed-based on research
  and professional knowledge
• It considers stable, static and dynamic risk
  factors

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Recommendations of Martin Calder

• It is an holistic assessment model which could
  benefit from a re-ordering of the threshold
  scales-this has been completed.
• Users perspective on the impact of the assessment
  tool would be beneficial.
• Threshold scales of risk factors provides an
  accurate analysis of risk - this could be
  improved with gravity scoring used in the Graded
  Care Profile and AIM.

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Step 2

• In June 2005 the NI Regional Steering Group
  agreed to fund the mentoring component of the
  implementation of the model.
• The training component would be paid for by
  individual Trusts and the mentoring component by
  the Regional Steering Group
• Evaluation of mentoring by me 2007-9

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Mid point evaluation January 2008

• Mentoring
• Training
• DVRAM

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Mentoring

• Predominantly for social care although parallel
  processes for health and occasionally
  multi-agency
• Provided support and practical guidance on
  applying model to cases (excused supervisors from
  familiarity with the model) thus consolidating
  the training
• Attendance often precluded by caseload pressures
  so should be mandatory and linked to professional
  development hours

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• Also provided input on engaging with perpetrator,
  childrens resilience and female perpetrators
  etc.
• Staff found themselves mentoring colleagues and
  managers
• Unrealistic for one person, no matter how
  committed
• Shift mentoring within newly developed Principal
  Practitioner Posts

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Training

• Well received and competently delivered
• Should be mandatory
• Needs to be compulsory to first line managers
• Refresher training needs to be considered as many
  staff didnt apply immediately and lacked
  confidence down the road

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DVRAM

• Extremely accessible and easy to use
• Provided roadmap of complicated territory
• Legitimises questioning of gut feelings
• Confusion about linkage with UNOCINI
• Anxiety that it will identify more work
• Variable use if case not initially referred as DV
• DVRAM as core assessment tool or one of a number?
  It is not an end in itself

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DV requires many assessments
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Indirect tools

• Centile charts
• GCP
• NOFT
• Adult mental health
• Substance misuse

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• Refinement of vocabulary
• Greater guidance on differentiation between
  severity levels
• One threshold scale per child?
• Requires clear mandate of adoption and
  application
• Instils confidence in staff offering structure,
  clarifies roles and responsibilities and is
  usable with families

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Integrated risk assessment tools and focus
child care

• Strengths-loaded
• Risk adverse
• Safeguarding predominates
• Expansion of harm
• General not specific
• Time-limited
• Evidence-based practice
• Use of professional judgement

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CAFCASS Toolkit (versions 12)
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Different risk focus (Bell, 2006)
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Integrated risk assessment tools and focus
criminal justice

• Actuarial risk tools
• Numerous risk frameworks
• VAI
• CBI
• SARA
• SPECCSVO
• Matrix 2000

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DVRAM as integrative framework?
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Differential risk focus

• Risk of actual or likely significant harm?
• Risk of re-offending?
• Risk of relapse?

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Common language and focus?
Criminal Justice Probation, police and prison inc MAPPA Risk of re-offending (no timeframe indicated and restricted to index offence)
Criminal Justice (MARAC) High risk victims in need of protection
Social care Risk of actual or likely significant harm
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Case file analysis highlighted areas

• The displacement of responsibility on to the
  mother
• Little evidence of perpetrator work to reduce the
  risk and hold him accountable for his behaviour
• Evidence of a high level of co-existence of
  physical abuse, neglect and emotional abuse of
  children
• Evidence of high levels of maternal mental health
  problems yet not in the perpetrator
• Scores of 4 did not always initiate a core
  assessment
• Staff changes and lack of continuity/ training
  linked to above

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• Some evidence of downplaying of threshold scale
  scores
• Huge coexistence of alcohol and drug issues and
  challenge of assessment and intervention
  focus/priority

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Coventry Commission

• How to develop specific DVRAM factors for their
  growing ethnic population
• Principally South Asian, Portuguese, Arabic and
  Refugee/Asylum seekers
• The Silent minority literature review (Calder,
  2007)

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London pilots

• Benefited from prior evaluations and parallel
  commissions
• Adopted and testing ethnic threshold scales
• Threshold scales refined to match CAF levels and
  brought forward within identification and
  intervention process
• Updating of model with emerging evidence-base

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• Production of an accessible flowchart for staff
• Greater guidance on
• Understanding the dynamics of an abusive
  relationship
• Womens processes of help-seeking in domestic
  violence
• Offering case examples to help staff
  differentiate between the severity levels

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• Broader suggested usage e.g. education and
  prevention
• Revised DVRAM for core assessment
• More detailed and identified evidence-based
  materials
• How domestic violence affects the parenting of
  perpetrators
• Greater details relating to the risks to children
  from contact with the perpetrator

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Areas not resolved

• Differentiation of static, stable and dynamic
  risk factors
• Supporting modules for female perpetrators, same
  sex, domestic violence from young people
• Inclusion of risk profile for adult victims of
  domestic violence

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Areas for debate

• Boundaries of the model e.g. when is a specialist
  assessment indicated and what format should that
  take?
• DVRAM as integrative model to unify social care
  and criminal justice models and processes
• Use when victims are not mothers

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4-pronged model

• Multi-agency DV threshold scale
• Social Care Initial Assessment
• Social Care Core Assessment
• Safety intervention with children and mothers

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Barnet evaluation

• Briefing (half-day to 200 staff)
• Training (2 days on initial and core assessments
  and 1 day on safety planning interventions)
• Mentoring (3/4 sessions on monthly basis for 5/6
  staff)
• DVRAM

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Briefing

• Awareness raising of DVRAM and threshold scales
• Variability of ownership of CAF completion and
  knowledge regarding DV
• Challenges the practice of couple work and
  mediation in DV
• Useful but not sufficiently bedded down to
  evaluate potential

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• Threshold scales clear and accessible providing
  a useful compass and map
• Supports more informed referral (using CAF)
• Can help bring CAF alive and populate social care
  systems
• Doesnt necessarily dovetail with other agency
  positions in relation to contact with the
  perpetrator

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Training

• Staff felt multi-agency audience would have been
  better to promote greater clarity of roles and
  responsibilities
• Manager training key to supporting staff in case
  application
• Training clear and delivery encouraged motivation
  and reflection

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Mentoring

• Positive when able to attend able to elicit
  direction and apply to cases immediately
• Focus on case application as well as areas not
  well served by the model same sex violence etc.
• Need it to continue for some time until model
  embedded and they feel safe flying solo
• Felt stretched mentoring managers and colleagues
  in a new model if they hadnt attended the
  training

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DVRAM

• Provides great structure and focus
• Provides new information and confidence
• Captures and organises complexity into accessible
  tool
• Workload pressures may preclude such in-depth
  assessments
• Greater clarity about fit with CAF and ICS
  needed little evidence of use to date
• Confusion about relationship with MERLIN

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• MERLIN will use SPECCSVO
• MARAC now measuring whether DVRAM has been
  completed and if so at what level

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• Very useful in working with adult victims you
  can see the penny dropping as you work through
  the materials
• Shortened version (prompt card) suggested
• Not seen as a stand-alone tool but as part of a
  pick n mix portfolio
• Challenged practice immediately in relation to
  babies/younger children
• Not yet tested in courts but advance notification
  of its status would help workers
• DVRAM and safety planning links with local
  resources allows work to be transferred

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• Threshold weighting correlated with professional
  experience and thus some evidence of differential
  interpretation
• Little evidence of shifting practice toward
  greater engagement of perpetrators
• Staff frustrated about limited time to work
  through the model with mothers

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Messages from Barnet

• Rolling programme of training required and useful
  to embrace adult-orientated services such as
  mental health, substance misuse etc. and link
  into existing Safeguarding Board Training
• Use application of DVRAM to identify deficits in
  resource provision
• Re-emphasizing focus on safety work with children
  and young people
• Link DVRAM explicitly with CAF, ICS and
  preventive strategy Building resilience,
  supporting independence
• Map possible portfolio of assessment tools to use
  in conjunction with DVRAM

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• Cross-pilot site contacts to share information
  and good practice and avoid duplication
• Examine how ongoing mentoring can be achieved
• Consider case analysis to examine whether
  outcomes are more focused attained

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Future work

• Conceptual and practice refinement of DVRAM
• Development of supporting modules
• Linkage with other assessment tools and processes
• Clear positioning and adoption of DVRAM Training
  and mentoring support package

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References

• Calder MC (2007) The silent minority domestic
  abuse perpetrated within ethnic communities A
  review of the literature with recommendations for
  risk assessment. Leigh Calder Training and
  Consultancy
• Calder MC (2007b) Domestic violence and child
  protection challenges for professional practice.
  Context 84 11-14
• Calder MC (2008) Evaluation of domestic violence
  training and mentoring programme in Northern
  Ireland Mid-point summary analysis. Leigh
  Calder Training and Consultancy
• Calder MC with Harold G and Howarth E (2004)
  Children living with domestic violence Toward a
  framework for assessment and intervention.
  Dorset Russell House Publishing.
• WOMAN ABUSE Increasing Safety for Abused Women
  and Their Children (CAS/VAW JOINT TRAINING -
  FACILITATOR MANUAL Ontario Ministry of Community
  and Social Services Ontario, CANADA, JULY 2001