Table 2 Description of the hospital-based IDVA service

1

BRIEF NAME

Wrightington, Wigan and Leigh Teaching Hospitals (WWLTH) NHS Foundation Trust (the Trust) Independent Domestic and Sexual Violence Advocate (IDVA). A secondary care based intervention, aimed at providing enhanced support for victims of domestic and/or sexual violence and abuse at one hospital trust.

2

WHY (rationale, theory or goals)

A need to improve rates of identification of domestic violence and abuse (DVA) was ascertained. Previously, DVA had a low profile in the Trust, and the response to victims had been insufficient, with no DVA trust policy or clear referral pathway. Staff often lacked awareness of the signs of DVA, confidence or skills to enquire or act when DVA was suspected or disclosed.

For a previous IDVA pilot in the Trust, an IDVA was seconded from a voluntary organisation and worked in A&E. The employment arrangements for the current pilot aimed to improve on this, the direct employment of the IDVA meant that they were line managed entirely within the trust and their location within the safeguarding team was designed to improve their reach across the trust (deemed important in identifying victims) and to raise their profile (by engaging with staff across all departments).

The IDVA service follows guidelines and pathways for responding to DVA, these recommend a dual approach, with: (i) specialist DVA services run by specialist staff with high levels of training in DVA; (ii) all staff having lower level DVA training, to increase awareness of the signs of DVA and skills to perform selective routine enquiries in a sensitive manner, so that when DVA is suspected or disclosed, referrals are made to specialist services [3, 11].

The service is based on the safeguarding model ‘Triage and Make safe’ deemed suitable for the hospital environment; the IDVAs provide an immediate response and aim to work intensively with cases in a short timeframe then refer them elsewhere.

The goals of the service are to:

• Increase WWLFT staff awareness of the indicators of DVA

• Increase identification of cases, through staff initiating sensitive routine enquiry of patients.

• To ensure staff have the following skills and attributes: awareness of the indicators of DVA; sufficient professional curiosity to recognise suspected DVA; skills to initiate sensitive enquiry and respond to disclosures, including referral to adequate support.

3 and 4

WHAT (process and materials)

Staff training

The IDVAs provide structured training on DVA to Trust staff, this has become part of mandatory safeguarding training. The focus is on equipping staff with the skills outlined in section 2. The IDVAs also provide ongoing, ad hoc training and developmental support, e.g. updating staff on the outcomes of referrals, successes and areas for improvement such as when a case could have been identified earlier.

Risk assessment, referral and case management

Process:

Cases are referred by Trust staff to the IDVA who performs a risk assessment. After the risk assessment, the patient is either (i) supported by the IDVA, (ii) referred to a local agency (ies), (iii) referred to the MARAC or (iv) declines support. Most patients return to their own homes, but some are discharged straight to refuges for their safety.

The IDVAs work with the MARAC on a daily basis. They prepare referrals with the DASH and supporting information and present the case to the MARAC; if taken on they are usually supported by a community IDVA. The IDVA also liaise with voluntary organisations, local authorities, and the police. They provide various types of support: signposting, safety planning; support with applications (e.g. for housing) legal processes, arranging legal aid, completing paperwork if legal aid is unavailable, attending court with victims.

Materials:

The DASH form is completed for all risk assessments. The service is publicised via posters displayed in the hospital, with tear-off strips with contact details on.

5

WHO PROVIDED

Two IDVAs, both experienced domestic violence practitioners (not healthcare professionals) completed formal IDVA training whilst working in the community. One is an experienced manager and a qualified Independent Sexual Violence Advisor (ISVA) was undertaking ISVA training.

6

HOW

The staff training is provided by the IDVAs, to groups of staff at the Trust. Ongoing, ad hoc support and developmental feedback is provided to individuals.

Staff often call the IDVA for immediate support when they have a patient with them, the IDVA comes and performs the risk assessment If the IDVA is unavailable, the staff member completes an initial risk assessment and sends it through the hospital safeguarding system, via email or an incident reporting system (for staff based outside the hospital e.g. walk in centre) or on paper (out of hours A&E). The IDVA picks up the referral as soon as possible and undertakes a full risk assessment.

7

WHERE

• The service is based in an acute care organisation in North West England; a medium-sized NHS Foundation Trust with three hospital sites, a walk in centre and community services including health visiting.

• Case identification happens on Trust premises and also in the community, for example, during a Health visitor appointment at the patient’s home.

• Risk assessments and follow up appointments take place on the Trust premises, in a private room. The IDVAs also work outside the trust premises as necessary, for example attending court.

• Previously, the MARAC took place at the local police station, since the COVID-19 restrictions it has been held via teleconference.

8

WHEN AND HOW MUCH

The IDVAs provide an immediate response to DVA disclosures, going to the patient as soon as possible. One risk assessment is undertaken for each patient (unless a staff member performs an initial one in the absence of an IDVA then two are done). The service runs from 8 am to 6 pm Monday to Friday.

Support is provided to the patient as required. One IDVA attends each MARAC, previously the MARAC was held once a week, currently it runs daily Monday to Friday.

• In some cases the IDVA’s input ends soon after completion of the risk assessment – for patients who require brief input such as signposting to a relevant agency and for those who decline support.

• Due to the range of presentations, the support provided varies in terms of length, intensity and nature and be long term. The IDVA retains cases which are members of staff at WWLFT.

• The IDVAs retain all cases who are staff members at WWLFT and support them as long as necessary. They also support cases who do not meet the MARAC threshold but require ongoing support.

• Some victims decline support initially and contact the IDVA after the consultation, when they feel ready to access support and/or when it is safe for them to do so; the IDVAs emphasise to victims that the service is available to them later on, not just immediately.

9

TAILORING

The service is designed to provide tailored support.

10

MODIFICATIONS

• The service initially operated with one full time IDVA post, in 2019 this increased to two posts.

• In addition to domestic abuse, the service also received referrals for sexual assaults in a domestic abuse situation; this support has now been built into the service.