Have patience for patients

Early identification of domestic and accessing support for victims

Gloucestershire Domestic Abuse Support Service Inside

4 Recording information 6 How victims may present 7 Possible indicators of domestic abuse 8 Victims’ Bill of Rights Coercive control 10 Exhaustion 11 Degradation/ 12 Isolation 13 Threats 14 One chance 15 High risk indicators

2 Have patience for patients Are you Do you feel comfortable safe? disagreeing with your partner?

Would you describe Is someone hurting you? yourself as happy in your Are you relationship? Notice ever frightened I believe of your you partner or Ask a member? Take your time Refer It’s not your Is everything all right at home? fault

What do you want to happen now?

GDASS 3 When recording information, remember to:

Describe exactly what Take photographs happened as proof For example, patient states “my husband kicked me twice in Record concern stomach” rather than “patient Or disclosure of domestic abuse on assaulted”. the records of dependent children.

Use patient’s own words Keep it confidential With quotation marks. Ensure that nothing about domestic abuse is visible on the opening Document injuries screen (which could be seen by a perpetrator or another member of in detail staff). Use body maps to show injuries, and record whether injury and victim’s Devise a code explanation are consistent. To indicate whether the question Eg “patient has four small two- has been asked and information pence-sized bruises on her upper provided – to alert staff to potential arm 2cm apart. Patient reported ‘I risks. fell down, I can’t really remember what happened”.

CAADA-DASH Sample Legal Aid Letter Tool for assessing risk of http://bit.ly/2yasalu Domestic Abuse & can be found online: http://bit.ly/2jMa8zM

4 Have patience for patients Include in notes

• Suspicion of domestic abuse even • Presence of increased risk factors. if no disclosure. • Results of completed Domestic • Details of enquiry and the Abuse, Stalking and Honour Based response. Violence (DASH) risk assessment for the adult and a Domestic • Relationship to and name of Violence Risk Identification Matrix perpetrator. (DVRIM) or DASH assessments for each child, if relevant. • Whether the woman is pregnant. • Indication of information provided • Any children in the home and on local sources of help. their ages. • Indication of action taken – for • Nature of psychological and / or example, direct referrals. and any injuries.

• Description of the types of domestic abuse / any other abuse experienced and reference to specific incidents.

• Whether this is the first episode, or how long regular abuse has been going on.

GDASS 5 How victims may present

JJ Overly compliant OR overly JJ Recognition of risk and resistant / defensive prioritising safeguarding JJ Differing “stories” to different JJ May use the perpetrator’s professionals language – be aware of the perpetrator’s (invisible) presence Not “following through” on JJ in the room actions Jumpy behaviour / Not disclosing or minimising of JJ JJ hypervigilance incidents Use of self-blaming statements JJ Range of / inconsistent JJ emotions JJ Evidencing low self-esteem JJ Withdrawing as the process becomes more directive JJ Body language: “leaving the room”

6 Have patience for patients Possible indicators of domestic abuse

Victim

JJ Bruising / broken bones / cuts / JJ Appears anxious / helpless / lost teeth afraid / demoralised / ashamed / angry JJ Repeat / missing appointments for no reason JJ Nightmares / sleeplessness JJ Pregnancy / terminations / STI / JJ Difficulty in concentrating / UTI missing school / work JJ Low confidence / depressed / JJ Multiple injuries / inconsistent / guilty explanations JJ Poor hygiene / no money / JJ Victim is never unaccompanied chronic pain JJ Dependency on substances PTSD / panic attacks / flashbacks JJ JJ Evidence of self-harm / suicidal thought

Children

JJ Low birth weight / JJ Eating disorders / alopecia premature birth JJ ADHD Developmental delays JJ JJ Self-harm Poor school performance JJ JJ Bedwetting Sleeping difficulties JJ JJ Unhealthy attachment JJ Asthma to

GDASS 7 Victims have the right to:

✓✓Be asked, asked ✓✓Be treated with and asked again respect

✓✓Be believed and ✓✓Be made listened to aware of what resources are available locally ✓✓Talk to someone who will be sympathetic not ✓✓Be told their sceptical! safety is paramount

8 Have patience for patients ✓✓Be given ✓✓Not feel judged information and time ✓✓Be taken somewhere ✓✓Be able to quiet – don’t make their own expect a decisions disclosure in a crowded room ✓✓Have control over decisions ✓✓Be made to feel affecting them comfortable about disclosing their experiences

GDASS 9 Coercive control Coercive control is when someone repeatedly behaves in a way which makes you feel controlled, dependent, isolated or scared. The following types of behaviour are common examples of coercive control: Exhaustion

• ‘You don’t me enough’, go • Childcare all on mum / dad as everywhere ‘together’ authoritarian

• Negative about her family / friends • Physical violence – fear affects / money management / household everything responsibilities / you look tired / are you putting on weight? • Trauma bonding; perpetrator Negative comparisons remorseful; / romantic terrorism • Makes her feel guilty, is unpredictable; mood swings; •  / loss of identity / moving goalposts – can never get low self-esteem it right • Dependency on substances • Loss of sleep / ; meds; re- • High levels of hypervigilance for her and children • Coercive sexual demands / / blurred boundaries • May provoke violence in order to end anticipation / walking on • Pregnancy – perpetrator jealous eggshells before violent incident and victim vulnerable / keeping her pregnant; abuse escalates to ensure silence

10 Have patience for patients Degradation / humiliation

•  of her friends / • Sexual degradation / rejection: appearance / performance filming; rape; with objects; made to watch pornography; • Dehumanisation: rejection of prostitution food offered • Abuse of children / pets • Infidelity; flaunting affairs • Forced dependency on substances • Permission to do basic things: go to toilet; wash; dress; made • Spitting / public humiliation to sleep / eat on floor; permission withheld on occasions, in public

• Have mouth washed out with bleach

• Have food smeared on face / in hair

• Destroying personal possessions; made to beg

GDASS 11 Coercive control Coercive control is when someone repeatedly behaves in a way which makes you feel controlled, dependent, isolated or scared. The following types of behaviour are common examples of coercive control: Isolation

• No time apart – friends / family • Moving in together: dependency; drop away single car; tenancy; bank; she may give up work • Calls / texts / social media; checking in / possessive and • Tying up, locking in jealous

• Influence their evening out with friends: I’ll take you / pick you up/ send texts / call

• Unplanned excuses/interrupt plans

• Influence what she wears through concern: “it’s chilly, cover up”

• ‘Us vs the world’ mentality OR resistance to meeting her family / friends

12 Have patience for patients Threats

• I’ll go elsewhere for sex • Silent treatment; sinister looks

• If you leave, I’ll find you • Aggressive / damage to possessions • I’ll kill you / myself / children / pets • I’ll take the children away / • No one will believe you / you’re contact Social Services mad • You can’t have drugs / medication • I’ll leave you – you’ll never / money manage without me • I’ll use photos / videos against • No one else will want you / if I you; internet / social media can’t have you no one will

• You’ve got no one to go to, no friends

• I’ll hurt friends / family / future partners / neighbours

GDASS 13 One chance

– You may be the first and only person that the victim has disclosed to. – You should try to maintain a non-judgemental, comfortable and accessible environment. – The victim may feel discouraged from disclosing again in future, depending on the response they receive. – Complete a DASH Risk Assessment.

Always assume this is the ONE CHANCE to engage and support! Notice

Ask

Refer

14 Have patience for patients High risk indicators

The following are significant indicators of the risk of high harm or death relating to Domestic Abuse

Circumstantial Physical • Separation / new • Strangulation relationship • Threats to kill / of • Pregnancy / new birth / suicide termination • Sexual assault • Financial hardship • Abuse to children / pets

Victim perception of harm

Characteristics Behaviours • Substance misuse • Stalking • Mental health • Escalation • Marginalised / isolated • Controlling / excessive jealousy

GDASS 15 Gloucestershire Free and confidential service Domestic Abuse Support Service 0845 602 9035 [email protected]

Professional line 01452 726561

GP Development Workers

Emma Hazan [email protected]

Emma Beckett [email protected]

Sarah Pinkney [email protected]

Other numbers Gloucestershire Rape and Sexual Abuse Centre: 01452 536 770

Teens in Crisis: 01594 546117

Women’s Aid: 0808 2000 247

NSPCC: 0808 800 5000

Turnaround – Splitz (Programme for Perpetrators): 01225 775276