Knowsley Safeguarding Children Board Spring Conference 21 May 2013 Working Together to Defeat Domestic Abuse and its Impact on Children & Young People

Housekeeping PLEASE SWITCH OFF MOBILE PHONES OR PUT ON SILENT THERE IS NO FIRE ALARM DUE SO IF WE HEAR THE ALARM PLEASE EXIT USING MARKED EXITS LUNCH WILL BE AT: 12.00 – 1.00pm Ground Floor past reception & First Floor facing staircase

Knowsley Safeguarding Children Board David Hume Independent Chair Knowsley Safeguarding Children Board

Domestic Abuse in Knowsley A Draft Health Needs Assessment Richard Holford Head of Public Health Strategy & Intelligence

Aims of Presentation Provide an overview of needs assessment to date Share the emerging needs and issues to enable a discussions about future priority areas for development To collect insight to inform the domestic abuse needs from stakeholders

Background Domestic abuse is a significant public health issue, having a major impact upon those directly affected and their families. Locally, it has been raised as a significant issue at the Safeguarding Children Board and through the wider Partnership. Domestic abuse is known to be a significant issue in Knowsley, previous needs assessments have been developed from a Community Safety perspective. Findings will be used to develop a new strategy and evidence base for developing and commissioning services to address the needs of those affected.

Definition of Domestic Abuse The current UK Government definition is: “Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality”. This can encompass but is not limited to the following types of abuse: psychological physical sexual financial emotional

Aims of Needs Assessment The aims of the Independent needs assessment are:   To assess the levels of domestic abuse and health and wellbeing needs of those affected in Knowsley To identify the causes and drivers of domestic abuse To explore the links between domestic abuse and other risk taking behaviours To investigate the extent to which current service provision is addressing the needs.

The Needs Assessment Process Covers all individuals directly and indirectly affected by domestic abuse. Focuses upon domestic abuse only and the health and wellbeing needs of victims, their children and perpetrators.   Key stages: A literature review on national and local policy, prevalence, risk factors and evidence of what is effective to prevent and reduce incidents. A scoping and analysis of local sources of data and intelligence on domestic abuse to identify needs. Including insight from stakeholders (partly through this event). A review of the extent and nature of current service provision for victims, perpetrators and affected children collated from organisations (both local and national). Data reviewed against local provision to identify gaps against need and evidence of what is effective to prevent, reduce incidences and support victims and their families. Production of recommendations to inform local improvements

Levels of Need: Prevalence Nationally estimated that 1/3 of women and 1/5 of men have experienced abuse since age of 16. Locally, this would mean estimated 15,049 women and 8,162 men. Police Incident / offences Approx 5% of all recorded crime Over a two year period, 5,977 incidents, with 908 crimes/offences (2011 & 2012) Slight decrease in incidents in 2012, but 13% rise in offences. Incidents – one address had 40 separate incidents and 35 addresses had 10 or more (accounts for 10% of all incidents)

Levels of Need: Prevalence Domestic Abuse Incidents – Police data (2012) Overall incident rate 41 per 1,000 population Top five wards – Whitefield (72), Northwood (71), Kirkby Central (63), Page Moss (62), Stockbridge (60) Domestic Abuse Offences – Police data (2012) Overall offence/crime rate 2.5 per 1,000 population Top five wards – Page Moss (5.1), Whitefield (3.9), Halewood West (3.9), Prescot East (3.8), Stockbridge (3.7) For both, lowest rates are in Roby, with Swanside and Halewood North.

Levels of Need: Prevalence Hospital Admissions (A&E) – “Assaults in home”

Overview of trend Domestic abuse Offences/crimes Knowsley Domestic Abuse Service Referrals Housing issues / homelessness presentations Incidents (police) A & E - Home Assaults National Survey prevalence

Levels of Need: Prevalence (Children) Estimated 1 in 20 children and young people affected by domestic abuse (Stanley, 2011) In Knowsley this would mean, 1,529 affected. MERIT police incident (snap shot) Almost 1/2 (48%) of domestic abuse reports had a child (under 18) in household. Of these in approx 2/3 of incidents child was present in home at time. Many households had more than one child. Just under ½ (45%) of children affected were 5 and under.

Levels of Need: Prevalence (Children) Social Care Assessments Social care practitioners estimate that 85% of all assessment have an element of domestic abuse. In 2012, there were 3,424 started assessments on 2,348 children, meaning potentially around 2,900 had an element of domestic abuse involved. Child Protection Plans National figures suggest that ‘almost 3/4 of children on such plans live in households where domestic abuse occurs. In 2012, this would mean 154 out of 206 plans would of involved domestic abuse.

Levels of Need: Emerging issues Children and Young people committing abuse on elders Parentline and other national surveys – noted growing trend Likely to be significantly under-reported. Limited understanding and knowledge on this area Young people as victims / Intimate teenage partner violence Limited local intelligence on this area Strong links to gang culture, youth offending, sexual exploitation and teenage conceptions NSPCC research found that ¼ of girls, 1/5 of boys had experienced physical violence in a relationship (Barter et al, 2008) Disadvantaged girls twice as likely to experience abuse. More disadvantaged girls stated integral part of intimate relationships MARAC data – suggestive of growing trend of young perpetrators (high risk)

Financial Impact in Knowsley £56m human and emotional £11m housing, civil, legal employment and other costs. £3.8m physical and mental health care costs. £2.4m criminal justice costs. £452,000 social care costs. Calculated using estimates from (Järvinen et al, 2008) for domestic violence. Total annual cost to Knowsley economy estimated as £73 million.

Who is at risk?

Health and Wellbeing Needs - Victims Short term Physical health (minor – severe) Sexual health Eating disorders / self harm Fear and safety concerns (safety primary concern) Short and long term Mental health and wellbeing (depression, suicide, self harm, confidence, self esteem) Substance misuse (particularly alcohol) Housing Employment & Poverty Difficulties with relationships (intimacy, trust) Isolation

Health and Wellbeing Needs - Perpetrators Emotional, psychological, social and mental health support. Deal with past experiences (witnessing domestic abuse / child abuse) Substance misuse (particularly alcohol) Education, employment and housing needs

Health and Wellbeing Needs Children and Young People Mental health and wellbeing Behavioural and emotional problems Links with substance misuse Child Maltreatment and Child abuse – identifying and dealing with it Education / housing Unsettled childhoods, links with troubled families Long term impacts affecting life chances Links with crime, gangs and violence.

Emerging Needs / Issues (1) Data / intelligence Incomplete data, identification, data coding issues and linking of population level sources (particularly health) No definitive source of intelligence - Actual numbers of victim/survivors unknown, Lack of intelligence/evidence on; sibling on parent/elder abuse intimate teenage partner relationships, locally linked to drugs, gangs etc...

Emerging Needs / Issues (2)  Systems / Strategy No lead Commissioner to oversee whole life approach to supporting this agenda.  No discrete funding for domestic abuse. No single pathway - is one needed? Systematic approach to screening (Health settings) Primary prevention violence strategy?

Emerging Needs / Issues (3) Primary Prevention No systematic approach No specific relationship counselling services – are they needed? Lack of anger management, empathy and emotional support in schools, particularly boys Awareness raising of the impact of domestic abuse in schools to tackle cultural norms No evaluation of programmes delivered in schools on domestic abuse awareness, PSHE, SEAL delivery etc. The views of children and young people on domestic abuse are not collected

What would Early Help look like? What does it mean for services? Emerging Needs / Issues (4) Specialist support services, set up and delivered from traditional gender based approach (males as perpetrators and victims – females): Are support needs being met for those experiencing abuse in gay, lesbian relationships, female perpetration against males; sibling on parent relationships? What would Early Help look like? What does it mean for services?  Support for victim / survivors Sustainability, funding and capacity of housing support schemes Low percentage of reported incidents ends in a conviction Limited long term evidence on effectiveness of victim/support programmes, post support

Emerging Needs / Issues (5) Support for children – passive victims of domestic abuse Low / medium mental health and wellbeing support for children affected by domestic abuse (below CAMHS criteria) Supportive interventions to build strong parent-child relationships in the early years after DA Limited insight from children and young people locally on domestic abuse Evaluation of the effectiveness of programmes to support the needs of children affected / impacts on family The need to ensure a child-centred safeguarding focus that supports the journey of the child (Working Together to Safeguard Children 2013)  

Emerging Needs / Issues (6) Support for perpetrators Limited health and wellbeing support for perpetrators, not going through probation service Limited long term evaluation of the impact and effectiveness of probation programmes on reoffending rates. InPACT Perpetrator Service –low numbers involved – potential to expand/ change referral criteria?

Next steps Sense check the emerging needs Collate insight from this event Develop recommendations to inform commissioning intentions and plans

Table Exercise 1 – Needs Assessment Using the sheet provided on your table discuss each question and note your collective responses. These will be gathered in and used to inform the ongoing development of the needs assessment. Identify a scribe on your table to take notes. You have 20 mins

Table Exercise 2 – Emerging Areas of Need Using the sheet provided on your table discuss what you believe are the issues or gaps in relation to each of the emerging areas of need and note your collective responses. These will be gathered in and used to inform the ongoing development of the needs assessment. Identify a scribe on your table to take notes. You have 20 mins

Lunch Break

Table Exercise 3 – Case Studies On your table is a case study. Once you have all read this discuss the questions on the sheet provided and note your collective responses. Identify a scribe on your table to take notes. You have 20 mins

Annual Conference last year we spoke about: Review of approach Successes and challenges Five priority outcomes moving forward

Research The psychological impact of living with domestic abuse is no smaller than the impact of being physically abused. Children often develop anxiety, depression, aggression and even post-traumatic stress disorder as a consequence of living with domestic abuse. Approximately two thirds of child witnesses show more emotional or behavioural problems than the average child.

5 Priority Outcomes Commitment to working with vulnerable families as a unit and as individuals to ensure the best possible outcome for all Safeguarding children and young people Increase the safety of survivors Reducing the risk of harm from perpetrators Decreasing the social tolerance Increase in Knowledge Wider community activity to address domestic abuse

Table Exercise 4 - Safeguarding Children and Young People How will we know we have made a difference in the life journey of children and young people affected by domestic abuse? What will success look like? How will we know the voice of children and young people has been heard? Discuss each priority and note your responses to the questions on the sheet provided giving consideration to the needs assessment data you have been presented with this morning and the local intelligence you have from your own service/agency perspective. Identify a scribe on your table to take notes. You have 30 minutes

Although by no means inevitable, exposure to domestic abuse is one of the most powerful predictors of becoming a perpetrator and a victim as an adult. [1] Holt S, Buckley H and Whelan S, ‘The impact of exposure to domestic violence on children and young people: A review of the literature’, Child Abuse & Neglect, 32, 2008, pp797–810

Knowsley Safeguarding Children Board Closing Remarks David Hume Independent Chair Knowsley Safeguarding Children Board