Time to tackle family violence the fresh start project

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Time to tackle family violence the fresh start
project Tanya Dennis Health Visitor
Specialist/Domestic Violence Lead Harrow PCT
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Breaking the cycle of domestic violence Fresh
Start Programme

• Dr. Tanya Dennis
• HV/DV Lead Harrow PCT

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Domestic Violence How Big is the Issue?

• We know that DV accounts for ¼ of all recorded
  violent crime in the UK and it may be much higher
  in reality (Debash et al. (1990)
• The WHO (2000) estimated that 28 of women in
  the USA had been attacked by an intimate partner
  in the last year, similarly 25 of women in
  Belgium, 25 of women in Norway, and 17 in New
  Zealand ( Cooper and Vetere 2005)
• Rape is a significant element of domestic
  violence. 7 of women have been raped or
  seriously sexually assaulted and in 54 of cases
  the rapist is the current or ex- partner of the
  victim (Walby and Allen, 2004)

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The face of domestic violence

• Affects one in four women (Merecek,1999)
• Occurs every 14 seconds (Murphy-Millano, 1996)
• In 1999, 37 of women homicide victims were
  killed by present or formal partners (Home office
  1999)
• Women are 95 of all DV victims (Berry,2004)
• 5000 children a year experience domestic violence
  (Stanco et al,1998)
• Accounts for a 23 of all violent crime (British
  Crime Survey,2000)

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DV is a public health problem

• In 2001 domestic violence alone was estimated to
  cost the economy 23 billion
• The total annual cost of violence against women
  comes to 40.1billion per year
• 44 of DV starts or escalates during pregnancy
  (BMA 1998)
• 60-80 of women receiving support for alcohol
  problems suffered DV in the previous 6-12months
  (Chase et al, 2006)
• More than 50 of women in contact with mental
  health services have experienced abuse and/or
  violence in the past (Naz, 2003 while up to 20
  are experiencing current abuse (Barron, 2005)
• Each rape is estimated to cost 76,000 in
  emotional and physical impact, cost to health
  service, criminal justice system and work output.

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Some explanations of domestic abuse-

• No single theory or academic discipline can
  claim to offer understanding of these experiences
  and reactions in all their complexity Hooper and
  McClusky (2006)
• Biological theory
• Psychopathology theory
• Interaction theory
• Social Learning Theory
• Societal structure theory
• There is a growing body of interdisciplinary
  work which is extremely interesting and useful
  for informing work with families

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Is woman-as-victim the only face of domestic
violence?

• Child abuse
• There is an established correlation between woman
  abuse and child abuse (Kelly, 1997)
• In over 50 of known domestic violence cases,
  children are directly abused (NSPCC, 1998)
• Domestic violence featured in 52 of cases on the
  child protection register (Farmer and Owen, 1995)
  
• So called honour crimes
• female genital mutilation, abduction and forced
  marriage, arranging for another family member or
  a paid accomplice to behave abusively or murder
  the victim of honour crime
• Abuse between generations
• elder abuse
• children behaving abusively and violently towards
  their mothers
• Men victims of domestic violence

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Is there a typical DV abuser or victim?

• Women of all socio-economic groupings experience
  domestic violence to similar degrees. Domestic
  violence occurs across all social classes,
  religions, ethnic groups and geographical areas,
  although the number of cases known may be skewed
  by various factors including the womans
  financial circumstances, dependency on statutory
  bodies for help, language difficulties, cultural
  pressures (WHO, 2002 BMA, 1998).
• Of women who had experienced domestic violence,
  25 had never lived with the partner who had
  committed the worst act of violence against them.
  (Walby and Allen, 2004).

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Research clearly shows that women are most likely
to be victims of domestic abuse

• Although the widely cited figure of 1 in 4 women
  and 1 in 6 men may suggest a degree of parity,
  47 of male victims and 28 female victims report
  a single incident, with an average of 7 incidents
  for male victims and 20 incidents for female
  victims (Walby Allen, 2004)
• Across England Wales over 2002-2003, 60 of
  female murder victims were killed by their
  partner, ex-partner or lover, in contrast to 12
  of male victims (BCS HOSB 02/05)
• Men are more likely to abuse after separation
• Women report more frequent assaults, more severe
  injuries and are more frightened as a result of
  domestic violence (Walby Allen, 2004)
• This is not to negate the terrible experience of
  any individual man who is suffering domestic
  violence

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Domestic violence impacts on womens health in at
least three ways

• Traumatic injuries following an assault
• E.g. fractures, miscarriage, facial injuries,
  puncture wounds bruises and haemorrhages
• Physical problems or chronic illness consequent
  on living with abuse
• E.g. headaches, gastrointestinal disorders, low
  birth rate, inflammation
• Psychological or psychosocial problems secondary
  to the abuse
• E.g. attempted suicide, substance use,
  depression, anxiety
• (Williamson,
  2000 Schornstein, 1997)

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Potential affects on the mothering role

• Mothers experiencing domestic abuse can
• Be undermined as an individual and a parent
• Find it difficult to bond with or stay
  emotionally distant from the child
• Believe the child is fine and has not witnessed
  abuse
• Be unable to address the childrens behaviour
• Rely on them to behave in ways to minimise the
  risk to her or them
• Take out her frustration on the children
• Be unable to provide appropriate structure,
  security, boundaries or
• safety
• Be triggered by the childrens behaviour into
  re-living past abuse
• Women often attribute their eventual escape from
  domestic abuse to the emotional and practical
  support provided by their children (Hoff, 1990)
  
• 
  
• 
  

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Domestic Violence impact on children

• M, Age 4

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• Violence affects childrens view of the world
  and of themselves, their ideas about the meaning
  and purpose of life, their expectations for
  future happiness and their moral development.
  This disrupts childrens progression through
  age-appropriate developmental tasks. (Margolis
  et al, 2000)

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The effects of witnessing harm to another

• What children see or hear when their mother are
  being abused can not only include physical
  violence but also the emotional abuse and
  putdowns, threats and intimidation, sexual
  jealousy and abuse
• Children may witness the family being kept short
  of money or the abuser taking money from other
  family members, and also experience isolation
  from family and friends
• Children typically know far more of what is going
  on then their parents think. They may be the next
  room listening , or lying awake in bed, or they
  may pick up the atmosphere the next day

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Impact on children continue

• Abusers may involve children in a range of ways
  such as making them watch or encouraging them to
  be abusive towards mothers
• There is also recognized overlap between
  domestic violence, and child sexual and physical
  abuse
• Some make threats against the children, or hurt
  them to frighten their mother
• Many children want to protect their mothers and
  may put themselves at risk in the process(
  Mullender 2000)

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A three pronged approach to reducing the overall
incidence of DV, making survivors safer

• 1. Find more effective ways to make family
  relationships safer- assist perpetrators to
  change their attitudes and long term behavior
  patterns
• 2. Change widespread social attitudes about the
  acceptability of the use of violence and abuse,
  by developing educational programmes that teach
  children how to have respectful relationships,
  and how to manage personal conflicts in
  non-violent ways
• 3. Develop and deliver a variety of therapeutic
  and rehabilitative child and family support
  programme , which will help the family recover
  from the trauma and psychologically damaging
  after- effects of family abuse

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• Fresh Start The coordinated community group
  model
• Funded by the Community Grant
• an integrated model to deal with survivals of
  domestic violence , drawing on lots of different
  perspectives

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Why Fresh Start ?

• After taking hundreds calls from survivors of
  domestic violence, I realised that I always asked
  the questions, "Have you thought of going to a
  refuge? Have you called the police?"
• I witnessed how many women refused the very
  options I offered refuge for survivors, the
  criminal justice system for abusers
• I saw how many people wanted to stop the
  violence, but did not know how or where to start

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Guiding Principles Core Concepts

• Validation of experience
• Safety planning
• Identification of abuse
• Exploration of issues related to responsibility
• Exploration of issues related to the appropriate
  versus inappropriate expressions of emotions
• Healthy relationships

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Fresh Start programme Aims

• to provide an opportunity for victims to discuss
  and share experiences
• to reduce isolation and self-blame of victims
• to start the process of recovery from abuse
• to increase self-respect and self-esteem of
  victims/survivors. Increase their safety
• to foster the ability of victims to identify and
  express their feelings
• to develop an understanding of domestic violence
  and its effects on their children
• to encourage participants to take responsibility
  for their own behaviour

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What can we offer?

• Single point access referral through programme
  coordinator, including self-referrals
• Pre-group meeting
• Nursery for children aged 2-5 years. Supported
  by a play worker and a nursery nurse
• Length of group 15 2 weeks, 3 ½ hours per
  session. Closed group
• Group size 10-12 mothers. Safe and confidential
  environment
• Group co-facilitated by a trained counsellor and
  a Health Visitor DV/Lead. Multi-agency
  involvement
• Offer individual counselling to cope with trauma
• The setting Kenton Learning Centre Partnership
  with Glebe school .

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Structure of the weekly sessions

• check in
• topic
• activity/workshop
• discussion
• play/healthy eating session with children
• check out
• homework

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SESSIONS
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WORKSHOPS
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For children (Every Child Matters)

• Space to play
• Things to learn
• Social skills learning
• Healthy eating
• Recreation and leisure activities

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Group evaluation process

• Primary outcomes To evaluate the satisfaction of
  service users with the programme and to evaluate
  subjective changes at 6/12 and 12/12 after the
  programme completion
• Secondary outcomes To foster partnership working
  and community links with other services

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Pilot-Methodology

• Pre-group individual interview
• Halfway questionnaire
• Post-group client satisfaction questionnaire and
  semi-structural interviews. Sub-sample of mothers
  (n4), in depth interview
• 6 months questionnaire / sub-sample interview
• 12 month questionnaire
• Telephone Interviews with children-coordinators
  and referral agency

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Sample

• Group 1 (28.2-08 - 2-6-2008)
• 10 mothers - mean age 28, ethnically diverse
• 9 children - age range 1-5
• Group 2 (15.12.08 - 12 6.09)
• 11 mothers mean age 26 , ethnically diverse
• 7 children age range 1-4

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What the mothers said ----

• Fresh Start Project offered them the opportunity
  to share their experiences with others and learn
  new strategies for living in an abuse-free
  environment.
• Becoming aware of habits, language, and other
  patterns of behaviour helped them to improve
  communication with their children
• Individual counseling increased their confidence
  and self-worth which have been diminished by the
  violence in their lives.
• Parenting is never an easy task, but the group
  helped them to learn new skills to manage their
  childrens behaviour
• They learned about resources and help available

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Evaluation

• Mothers felt supported in dealing with their
  children and the impact of being exposed to
  domestic violence
• They met other mothers in similar situations
  decreased isolation, increased safety and had
  some fun
• They got help to think through their problems
• Support and they were connected with other
  services and community resources
• Somebody to talk to, whom they trust and who will
  listen to them

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Findings

• Positive satisfaction ratings of the groups were
  given by most mothers. Children enjoyed group
  activities and play time with their mothers
• Mother reported that their children improved in
  their behaviour. Mother used taught strategies in
  interpersonal conflicts management.
• Mothers stated that they understand now how best
  to help their children. Mother-child bond
  strengthened.
• Mothers improved in their ability to identify
  abusive actions and behaviours.

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What mother said about the group

• I wish I had been aware earlier about the things
  I learned in this group. My problems were not
  taken seriously. G (29) G 1
• Fresh Start helped me a lot because I met other
  women there they have been in the samebut
  different situations. You can relate back to the
  things that happened to you. C (19) G1
• It was better than I thought it would be. I hate
  the groupsbut, it was good, honestly and I made
  some friends. M (22) G 2

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