A Supporting document for Domestic Abuse Commissioning in Sheffield

Transcription

1 A Supporting document for Domestic Abuse Commissioning in Sheffield Louise Potter August 2013 Sheffield Domestic Abuse Co-ordination Team (DACT)

2 Revision History Version Author Purpose / reason Date 1 L. Potter Initial document May L. Potter Following the consultation the following information was updated or 8 July August added: Summary Split into two parts, there is now a data summary and gaps summary. 2. Summary 1 Data - The data summary has been reviewed and re-written, adding information on refuges and additional information added as per the amendments to sections 1 to Summary 2 Gaps identified - Gaps listed after the summary section to make these easier to find, linked to the Domestic Abuse Implementation plan and added to, following the additional data and feedback received. 4. Section 1 -Methodology - added a paragraph on the consultation. 5. Section 2 added the revised ACPO Definition of Domestic Abuse (2013). 6. Section 4 - Children and Young People Service Provision added & a Safeguarding children s section added. 7. Section 5 Pregnancy section includes activity data from the DA support services and moved to Section 5 on risk factors. 8. Section 5 LGBT, Ethnicity & disability data updated. 9. Section 5 - Age section expanded to specify abuse in the 60+ years population group. 10. Section 5 - Safeguarding Adult section added. 11. Section 6 Police activity data now shows incidents reported over the last five years, updated DHR information and additional prosecution data. 12. Section 7 - Sexual Violence SARC activity data added and section revised. 13. Section 9 revision of the perpetrator definition, new information on the age of perpetrators. 14. Section 10 updated with 2012/13 risk information. 15. Section 11 Section on General Practitioners added, including questionnaire feedback, section divided into high risk, medium, standard, helpline advice / information, refuge support and other. 16. Section 11 - High risk section updated with new data including MARAC data (for 2012/13). 17. Section 11 - Added the revised DA support pathway, revised the list of adult support services. 18. Section 12 - Updated National Changes 19. Appendix 1 - Added an appendix on the ready reckoner tool viability, limitations, advantages, testing its robustness and methodology applied to the tool and to the document. 20. Appendix 3 - Added an appendix on the Consultation undertaken. 21. Appendix 5 - Added a Glossary of Terms This document was signed off by the Domestic Abuse Strategic Board on 5 September Supporting document for Domestic Abuse Commissioning in Sheffield Page 2

3 CONTENTS Section Title of section Page Summary 1 Summary 1 - Data 4 Summary 2 Summary 2 Gaps and Needs Identified 9 1 Background, Methodology and Consultation 12 2 Definition and National Overview 14 3 Sheffield Domestic Abuse Prevalence data - Adults 16 4 Young People, Children & Safeguarding Children 20 5 Demographics, Diversity and Risk Factors 25 6 Domestic Abuse Police Activity and Prosecutions 34 7 Sexual Violence /Abuse 39 8 Forced Marriage, Honour Based Violence and FGM 44 9 Perpetrators Commissioning of Domestic Abuse Support Services in Sheffield Domestic Abuse Services in Sheffield & Risk 56 11A Referrals in and Waiting Times to Domestic Abuse Support Services 61 11B High Risk Support (MARAC and IDVA) 63 11C Information & Advice (Helpline & Website), Medium & Standard Risk 67 Commissioned Support, and Health Service provision 11D Refuge & Temporary Accommodation Support 71 11E Floating Support, Volunteer Support, The Sanctuary Scheme & Service 75 User Consultation 12 The effectiveness of Domestic Abuse Support (Outcomes) National Changes ahead / recent changes Recommendations for use and future reports 81 A1 Appendix 1 Ready Reckoner 82 A2 Appendix 2 Domestic Abuse Services Implementation Plan 84 A3 Appendix 3 Consultation 85 A4 Appendix 4 - Sheffield Services Available to Individuals affected by 87 Domestic Abuse A5 Appendix 5 Glossary of Terms 88 Supporting document for Domestic Abuse Commissioning in Sheffield Page 3

4 SUMMARY 1 - Data The summary is divided into two parts, the first part (Summary 1) provides a summary of activity data and the second (Summary 2) provides a comprehensive list of needs / gaps in service provision. National data (full references found in section 2.6) In 2009/10 there were 290,000 domestic abuse (DA) incidents reported in England and Wales. One in four women and girls will experience domestic abuse in their lifetime. One in seven males will experience domestic abuse in their lifetime. There is an average of two domestic homicides per a week in the UK 1. There is an estimated prevalence of 5.8% of 16 to 59 year olds experiencing domestic violence in the last year; this is 6.6% of women and 3.6% of men (BCS 2009/10). An estimated 41% of domestic abuse incidents are reported to the police (BCS 2009/10). There are over 266 MARACs nationally which handled 58,351 high risk domestic abuse cases in 2012/ % of all domestic abuse victims are repeat victims and these victims experience 76% of all domestic violence incidents. 53% of domestic violence victims are victimised once, 17% twice and 30% three or more times in a 12 month period. 73% of domestic abuse victims are female, 15% of domestic violence incidents include a weapon, and 68% of all incidents result in an injury. The victim believes the offender to be under the influence of alcohol in 37% of incidents and drugs in 18% of incidents. 31% of National funding to domestic violence and sexual abuse sector was cut between 2010/11 and 2011/12 3, although the Government provides a core funding of 40 million to support specialist domestic abuse and sexual violence services and this is protected until 2015 (A Call to End Violence Against Women and Girls Action Plan 2013). Sheffield Estimated cost of domestic abuse and sexual abuse The estimated cost of domestic abuse and sexual abuse Sheffield, (excluding emotional and human costs) is 106,517,214. Of which; Physical and mental health costs 22,952,949 Criminal justice costs 14,457,273 Social service costs 2,722,585 Other costs including housing, civil, legal and employment 66,384,407 Source - The Estimated Cost of Domestic Abuse in Sheffield (Home Office 2009) Sheffield - Estimated Prevalence of domestic abuse The Ready Reckoner tool (see Appendix 1 for full details) has been used to estimate the number of women and girls aged between 16 and 59 who have in the past 12 months been a victim of:- Domestic abuse is 10,584 (+/- 95% = 7,667 to 13,501) Sexual assault is 6,940 (+/- 95% = 4,552 to 9,328) Stalking 12,489 (+/- 95% = 9,456 to 15,522) (Based on 173,000 women in Sheffield between 16 and 59 years, using mid 2010 population estimates) Around 7,000 (66%) victims are likely to be a victim of domestic abuse only however 33% are likely to experience more than one form of domestic, sexual and/or stalking thereby highlighting an overlap 1 Office of National Statistics (2013) Focus on : Violence Crime and Sexual offences, 2011/12 2 CAADA Co-ordinated Action Against Domestic Abuse MARAC data and performance 3 Walby, S and Towers, J. (February 2012) Measuring the impact of cuts in public expenditure on the provision of services to prevent violence against women and girls, Report for the Northern Rock Foundation and Trust for London, Supporting document for Domestic Abuse Commissioning in Sheffield Page 4

5 between the estimates. 7.5% of females (BCS, 2009/10) are a victim of domestic abuse annually, which applied to Sheffield female population data this would be around 10,584 victims, which compares well to the Ready Reckoner estimate for domestic abuse. Male prevalence 4.2% of males (BCS, 2009/10) are a victim of domestic abuse annually; applied to Sheffield population data this would be around 6,500 male victims. Evidence suggests that a male victim will on average experience less incidents of domestic abuse than a female (seven times compared with 20 times for a female over a 12 month period). Males equate to 5% of individuals accessing support services, 2.3% of cases going to MARAC and 17% of victims in incidents reported to the police. Children & Young People (Local calculation based on, BCS 2009/10, ready reckoner and activity data). Around 12,000 children and young people (aged 0-17) are likely to be living with a female domestic abuse victim in Sheffield. Around 3, to 19 year olds are likely to be victims of DA in the last year (based on BCS, 2009/10). Around 1,500 young people aged 16 to 19 years old are likely to have been a victim of Sexual Abuse in the last year (based on BCS, 2009/10). These estimates provide an indication; there is no national ready reckoner for these calculations. Safeguarding Children 6% of children on the local child protection register will have been a victim of sexual abuse 4. 39% of all Sheffield children on a child protection plan have domestic abuse occurring in the household and 38% (124 of 328) of initial conferences have domestic abuse discussed 5. Safeguarding Adults 38% (177) of abuse referrals to Safeguarding adults are domestic abuse related. Evidence suggests that elderly victims of domestic abuse are often hidden ; in Sheffield less than 3.4% of those aged 65 plus access domestic abuse support services and less than 3% of police incidents include victims aged 65+ years old. Diversity & Risk Factors The proportion of BME individuals accessing community domestic abuse support services is around 30% of the total accessing support and 43% for those accessing a refuge, these proportions are both higher than the 17% Sheffield BME population and the 15% of reported incidents to the police that have a BME victim. Less than 1% of those accessing support services are LGBT, whilst Co-ordinated Action Against Domestic Abuse (CAADA) recommends this proportion should be around 5%. 25% of individuals accessing support reported a mental health problem (Paloma Modus, 2012/13), with evidence suggesting 50% of individuals with a mental health problem have experienced domestic abuse at some point in their lifetime. 9% of domestic abuse victims disclose a disability when accessing support (Paloma Modus, 2012/13). 26% of individuals accessing domestic abuse support are aged 31 to 40 years old, 25% are aged 19 to 25 years and 3.4% 60+ years. 45% of reported domestic abuse incidents were alcohol related (2012) & 3% drug related (SY Police data). 4 Department of Health (2011) Commissioning services for women and children who are victims of violence a guide for health commissioners, gateway All Safeguarding Information provided by Lindsey Savage, Safeguarding Children s Service from data presented at the Safeguarding Children s board (April 2011 to March 2011). Supporting document for Domestic Abuse Commissioning in Sheffield Page 5

6 Research suggests that 30% of DA starts when the victim becomes pregnant, (DoH, 2004), studies suggests between 7% and 17% of pregnant women suffer domestic abuse. There were 247 Jessop Wing referrals to support services in 2012/13. Sheffield Domestic Abuse Crime / Police Reported Activity One in three female suicides nationally are domestic violence related (Stark and Flitcraft, 1996; Mullender, 1996). CAADA research suggests that on average a victim is in an abusive relationship for 5 years. There have been 13 domestic violence homicides in Sheffield between 2006/7 and 2012/13. In Sheffield 26% (1,281) of all violence against a person are DA crimes. In South Yorkshire (2011/12) there were a total of 1,667 DA prosecutions (2011/12) and 74% were successful. 10,475 Domestic abuse police incidents were reported in 2012/13, an increase of 1,266 incidents compared to the previous financial year; of incidents classified as a crime 74% resulted in an arrest. There were a reported 6,314 unique victims; with 1,795 (28.4%) of victims reporting two or more incidents over a twelve month period. 83% of these victims are female, 15% BME, 19% are aged 19 to 25 years. 12% (1,070) of incidents had an injury recorded with 888 classified as a slight injury, 32 incidents serious and two were fatal. The wards with the highest number of recorded police incidents in 2012 were Burngreave, Southey and Firth Park. Sexual violence (sexual assault and rape) 2.3% of females and 0.5% of males were a victim of sexual assault in the last year nationally (BCS 2009/10). Applied to Sheffield this would be around 3,990 female and 900 male victims per year, although the female estimate is less than the Ready Reckoner findings of around 6,940 female victims of sexual assault each year and is less than the lowest confidence intervals +/- 95% that were between 4,552 and 9,328 individuals). The crude rate of sexual offences in Sheffield is a rate of 0.65 (+/- 95% = 0.58 to 0.72) per 1,000 population, with Sheffield ranked 87 of 326 local authorities, (1 being area with the lowest rate), Sheffield also has a lower rate compared with the regional average rate of 0.9 per 1,000 (Source, Violence Indicator Profiles for England resource, VIPER data) The Sheffield rate of reported rape is 37.2 per 100,000 female populations (+/-95% CI 30.3 to 45.2), and is lower than the Yorkshire and Humber rate of 49.8 ( /-95% CI) per 100,000 female populations in 2010/11 (VIPER data). There were 102 reported rapes in Sheffield in 2010/11, which was a third year increase compared with 75 in 2008/9 and 88 in 2009/10) (Sexual Health Scorecard). Perpetrators Police data shows perpetrators are: 93% male, 46% an ex-partner and 32% a current of the victim, the highest age grouping is 20 to 29 years, 69% are unemployed and 80% are White British. 47 Sheffield adult offenders started the probation-run perpetrator programme (IDAP and CDAP programmes) and over a one year period 32 perpetrators completed (68%) the course. Research suggests that 50% of male victims could also (in some incidents) be the primary perpetrator. A summary of Service Provision, Access and Prevalence (over latest 12 month period) There is a range of domestic abuse support services for victims in Sheffield, including a citywide helpline, IDVA service, one to one and group outreach support, peer support, floating support, refuge and temporary accommodation provision. These are available for women, men (excluding refuge), LGBT individuals, all ethnicities and nationalities, with interpretation services available. There is an observed difference between the number of reported police victims and the number of individuals who go onto access some type of domestic abuse support:- Supporting document for Domestic Abuse Commissioning in Sheffield Page 6

7 Prevalence (female) DA Police victims reported In contact with support services 6 Of whom 10,500 (rounded) 6,200 (rounded) Around 4,000 individuals Around 550 MARAC (High risk) Around 300 supported accommodation 2,800 helpline calls 370 outreach (121 & group work) 141 floating support (10 months data) 186 Sexual Assault Referral Centre (SARC) in calls to the sexual violence helpline 80 received sexual violence counselling Of those accessing domestic abuse support services:- In 2012/13 20% of those assessed were high risk, 57% medium risk and 22% standard risk (using the ACPO DASH risk assessment tool). Referrals into support services have increased over the last two financial years, with a current average of 1,059 per quarter in 2012/13 compared to the observed average of 996 in 2011/12. This has impacted on the number of (high risk) cases going to MARAC; which has increased to 546 in 2012/13 from 463 in 2011/12. Whilst remaining lower than the 930 cases CAADA recommends for Sheffield (based on an expected level of 40 cases per 10,000 of the adult female population using police reporting rates and the likelihood of high risk victims of domestic abuse reporting to the police) there are indications that MARAC cases will continue to grow. Waiting times for community support were between one week and five months in 2012/13. There is a breadth of referrals (11 sources); with the police contributing the most with around 700 per quarter and 90 referrals per quarter from the health sector. The average time in support is 50 days but this varies by service. Information taken from clients exiting the services found that 35% had seen a reduction in abuse, 49% said it remained the same and 16% said it was worse however around 50% said they felt safe or very safe after the support. Refuge & temporary supported accommodation: The Council s Housing Solutions service is the front line for homelessness in Sheffield and in the last five years between 13-16% of homelessness referrals were related to domestic abuse. In 2012/13 a total of 311 households were re-housed due to domestic abuse and homelessness; with 159 placed in a domestic abuse refuge and 155 in temporary supported accommodation (HIS 2012/13). 47% of these households are women with children and 60% were a Sheffield resident. 282 left such accommodation in 2012/13, with a median stay between 35 to 75 days. The governance structure of domestic abuse services has changed and developed over the last financial year and there are on-going changes to the commissioning of domestic abuse services which will develop throughout 2013/14 and 2014/15. Summary Section 2 highlights the current areas of development and additional observed gaps in service provision based on the above observations. Conclusion The data shows there has been an increase in the number accessing support services however when compared with prevalence data and reported police incidents there remains a significant number of victims who are not accessing support services and as the national Call to End Violence Against Women and Girls strategy says there is a lot more to be done to tackle violence against women and girls to those affected by domestic or sexual abuse feel confident in coming forward to report their experiences and are fully supported for doing so. 6 This figure includes police referrals contacted via the helpline and may have not necessarily taken up the offer of support. Supporting document for Domestic Abuse Commissioning in Sheffield Page 7

8 Summary 2 outlines the Gaps and Needs identified highlighting where progress is being made and where there are additional opportunities to be explored. Supporting document for Domestic Abuse Commissioning in Sheffield Page 8

9 SUMMARY 2 - Gaps and Needs Identified The gaps/areas of need listed below are found highlighted in bold throughout the document, in the relevant section. Some of these areas of need were already identified as per the consultation led by Jo Daykin-Goodall in 2012 and formed part of the Domestic Abuse Implementation Plan (Appendix 2), these actions are identified by an asterisk (*). This report has also identified a number of additional areas of need; some which are already being addressed and others which require consideration. Gaps 1 to 24 are being addressed as part of the DACT commissioning and performance management of two new domestic abuse contracts Gaps 25 to 35 are in progress and due for completion in 2013/14. Gaps 36+ are for consideration. The commissioning of new contracts (*) during 2013/14 will look to address some of the gaps identified:- 1. Increase the referrals from Healthcare professionals into support services 2. Work towards 100% clients triaged at any domestic abuse service to have a DASH risk assessment undertaken, where domestic abuse has occurred in the last six months (not historic abuse) 3. Promote the use of the DASH assessment tool across services with a view to increasing referrals 4. Service specifications to introduce a target for waiting times 5. Introduce quality standards for waiting times and outcomes (planned completions) for all providers 6. Commission an average time in support 7. Introduce re-assessment targets for all providers for clients who are still in support after 12 weeks of support 8. Create consistency in targets across services (noted below are targets that do not exist or that are not consistent) 9. Introduce performance frameworks for DACT commissioned services (*) including: 10. Services to record data in accordance with the Equalities Act Increase the number of volunteers working/ contributing to DA services (*) 12. The introduction of a quarterly performance monitoring process (*) Data capture and consistency reported to DACT needs to be improved by all services:- 13. Introduce a new consent form to all services, to ensure clients are explicitly informed about the uses of their data and add an additional section to enable the use of clients anonymised data for performance, research and needs analysis purposes. 14. Write a citywide information sharing protocol for domestic abuse support services. 15. Improve the quality of the citywide data collection of client data by all commissioned services using Modus, in line with their contract clauses. 16. Maximise opportunities to retrieve data from Modus, test the robustness of the software and review currently provided information; including the intake and exit forms. 17. Create a minimum data set locally for all services for clients in support services for domestic abuse. This will include a summary of outcomes monitoring. 18. Start recording data and collecting it centrally for Honour Based Violence, Forced marriage and FGM, and include on the local Minimum dataset. 19. Consider introducing a proforma for services to report to the DACT where they are not commissioned directly by DACT 20. Improve the recording and reporting of client disability data to meet the requirements of the Equalities Act 2011, so the 9% citing a disability can be ratified and, where required, for disability issues to be addressed accordingly by services. 21. Continue to monitor the number of sexual violence cases on the ISVA caseload. 22. Monitor the monthly high risk referrals into IDVAs, MARAC data and subsequent engagement to Supporting document for Domestic Abuse Commissioning in Sheffield Page 9

10 ensure the commissioned IDVA service meets need. 23. Understanding the gap between the number of high risk IDVA referrals and the number of referrals to MARAC is required for future capacity planning and commissioning of the IDVA Service. 24. Continue to monitor translation services used to ensure the language needs of those accessing support services are met. Actions in progress (but not part of the Commissioning or Performance Management of services) 25. Write and agree a No Recourse for Public Funds (NRPF) Policy, rollout to all services and monitor the impact. 26. Update the Domestic Abuse section of the DACT Website Agree a formal process for reporting citywide performance to the JCG (*) 28. Launch the Domestic Abuse Service User Reference Group (*) 29. Complete the review of the current MARAC model in Sheffield; to ensure it is fit for purpose; it meets the 10 principles of a successful MARAC, and it has the capacity to take on an ever increasing number of cases. This review started in June 2013 with the DACT working in partnership with South Yorkshire Police & CAADA. It is very likely new actions will be identified as part of this process. 30. There is a need for a complete referral list of cases to MARAC to identify clearly those services referring a low number of referrals and those services who would be expected to refer to MARAC but have yet no done so, to understand the reason behind the low referrals and where possible aim to increase future referrals by these services to MARAC. 31. Ascertain via a questionnaire the work undertaken by the 28 services identified as working with children and young people and understand the governance of such services alongside mapping such services to see where gaps in support are. This action is in progress and an initial report including a list of children and young people s services has been taken to the Provider Consultation Group (PCG) and following updates will be taken to the next Joint Commissioning Group. 32. Review the impact of the change in the domestic abuse definition on safeguarding children s services and pathways for referral into domestic abuse support. 33. Continue to monitor the number of 16 and 17 year olds seen in support services. 34. To have a section in the DA strategy on young people and be explicit on who is taking the lead for this work (Home Office, 2013). 35. There is an on-going need to increase the use of the ACPO DASH assessment tool and the comms tools in Sheffield within referral sources, to ensure risk assessments are standardised and more individuals are identified, so support for their domestic abuse can be provided and an onward referral made where required and where appropriate. Other areas of need:- 36. There is a need for service user feedback and for surveys to be undertaken over the next year; to gain further understanding of how well services are known, how individuals got into support, where there may be perceived gaps in provision and how/where client needs can be further supported. 37. Identify opportunities to promote the use of Children and Young people s services for those affected by domestic abuse working in collaboration with Children s Social Care and MAST. 38. The CYT service believes that a specialist therapeutic counselling service would best meet the needs of a section of these young people but there is not an immediate service on offer for this cohort, therefore opportunities could be explored on how best this perceived need could be met. 39. DACT to keep informed of the progress made to the introduction of a young people s perpetrator programme currently in the process of being developed by YJS & CYT. 40. Given the national strategy to address the behaviour of perpetrators and that there is a recognised gap in Sheffield for commissioned voluntary perpetrator support there is a need for a feasibility study to understand the benefits of commissioning a local voluntary referrals Perpetrator Programme, although waiting for the outcome of Action 103 of the Strategy Update (April 2014) would be advisable. 41. There has been an increase in the number of ISVA clients in the last few years and whilst the commissioning will be led by the NHS there is a need for the DACT to be a stakeholder in the future Supporting document for Domestic Abuse Commissioning in Sheffield Page 10

11 commissioning of the SARC and ISVA provision for Sheffield residents. 42. The Government s aim is to establish a register of all ISVAs, raise the profile of the role amongst statutory agencies and introduce quarterly regional focus groups, Sheffield needs to be a stakeholder in such developments. 43. Sheffield provides a Child Assessment unit for victims of sexual assault aged 18 years or younger and does not fund a children s ISVA post at the SARC. Further consideration should be given to fully understand the benefits that this Sheffield approach gives to those victims aged less than 18 years compared to the other areas in South Yorkshire. 44. All Housing Independent Service (HIS) and Local Authority contracts with domestic abuse services include providing support to victims of sexual violence; therefore work with sexual abuse victims in all support services needs to be better understood. 45. There is a need for SRASACS to use the ACPO DASH assessment, to reduce the waiting time for assessment and to have an effective approach to discharging clients successfully in a shorter period of time. 46. The Government s A Call to End Violence Against Women and Girls Action Plan 2013 has an action (17) to review the suitability of existing risk assessment tools for 16 and 17 years (March 2014 time frame) and therefore it would be mindful of Sheffield to observe the outcome of this review. 47. Increase our understanding of the support needs of the LGBT population group, including service user feedback where possible; apply known best practice with a view of increasing the proportion of LGBT individuals accessing support services. 48. There is a continued need to ensure all services are accessible to all ethnic groups; with particular focus on the following ethnicity groups; Pakistani 7, Indian, Chinese and Black African populations. 49. There is a need to better understand the effectiveness of the referral pathway between Domestic Abuse support services and adult social care services and vice versa to understand whether there is a gap in identification and/or a gap in referrals. 50. There is a need to better understand how compliant services are with the Mental Capacity Act (2005), review policies and procedures and ascertain where there may be training needs. 51. There is a need to better understand if cases over the age of 60 plus are more likely to present at Safeguarding Adults services rather than police and domestic abuse support services, and whether these cases are shared with anyone. Alongside this there is a need to review whether support services meet the needs of those aged 60 plus. 52. There is a need to better understand the offer available for domestic abuse support victims who have a mental health problem; including the current use of counselling services for victims, how support services refer into counselling services and where there may be opportunities to explore this offer further. 7 These groups are currently less proportionally represented in support services compared to their proportion of the Sheffield population. Supporting document for Domestic Abuse Commissioning in Sheffield Page 11

12 SECTION 1 Background and Methodology 1.1 Background and methodology This report is part of the process for the new commissioning structure in Sheffield. It is recognised that the intended purpose of this needs analysis of domestic abuse in Sheffield document is twofold; to be used as a document to support the writing of the Domestic Abuse Strategy and to inform the analysis part of the commissioning cycle. 1.2 The aim is to provide enough information to enable commissioning decisions to be made, by ascertaining prevalence and activity of domestic abuse incidents and access to support services in Sheffield whilst recognising that domestic abuse is a complex issue and therefore the document includes sections on a number of factors. 1.3 The report includes national data and presents the local Sheffield position, taking note of where there may be gaps in provision and processes. 1.4 The report is not a comprehensive needs assessment although some of the methodology applied throughout the document uses this approach. The methodology used has been to review a number of strategies and needs assessments published by other local authorities, use of the Ready Reckoner, aligned with BCS data and the use of recognised research publications to support findings alongside local data. 1.5 Local data has been used where possible, and has been collected from a number of sources. There are however a number of issues with the support service data. Services are relatively new (e.g. helpline started in 2010) which means there is limited data available over time to observe trends. Additionally Paloma Modus is the main reporting tool for commissioned domestic abuse support services but information is again limited due to the lack of uniformity in its use citywide, by the unusual reporting function of the database and by the amount of comparative data. The software is only entering its second year of use and during this time data fields have been developed and there is better recording of data than previously, so comparing Q1 to Q1 in the previous year is not a direct comparison. Where possible Modus data has been used and explanatory notes are provided. 1.6 Domestic Abuse and Sexual Abuse have both been discussed in the document thus applying the same approach taken in Call to End Violence Against Women and Girls (2010), however it is also recognised these could have been discussed separately and there is a recognised bias in this report towards domestic abuse. 1.7 The document provides a summary of the key points; but does not in any way attempt to cover the whole of each subject area. Where further information and questions arise on specific sections, then it is being recommended that this is undertaken as individual standalone pieces of work. 1.9 Consultation The consultation process was comprehensive, with presentations written summarising the key information and presented at the following domestic abuse meetings:- The Joint Commissioning Group (JCG) The Provider Consultation Group (PCG) The DA Civil and Criminal Justice Subgroup (DACCJ) The Domestic Abuse Strategic Board These meetings are attended by a range of key partners from health, social care, criminal justice, children and young people services and domestic abuse support services. All those in attendance at these meetings had a presentation on the summary of findings leading to a discussion where Supporting document for Domestic Abuse Commissioning in Sheffield Page 12

13 initial feedback and questions were answered. All those on the circulation list for each meeting were circulated a draft version to read and provide structured feedback over a five week long consultation process, including consulting service users where possible, and it was clearly explained that this was their opportunity to feedback formally. A period of five weeks was given to feedback comments and a structured set of questions was asked of each section in the document (see Appendix A3). Supporting document for Domestic Abuse Commissioning in Sheffield Page 13

14 SECTION 2 Definitions and National Overview 2.1 Definition of Domestic Abuse (ACPO) The New Association of Chief Police officer s (ACPO) definition of Domestic Abuse was introduced on the 31 March Whilst the definition is not a legislative change, the aim is to provide a clear definition to what constitutes domestic violence and abuse. 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 Family members are defined as: mother, father, son, daughter, sister and grandparents whether directly related, in-laws or step-family. Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim. * *This definition includes so called 'honour based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group. 2.2 This definition has been applied in this document. Although data prior to 2012/13 is in relation to the previous definition and is likely to reflect that old definition, which did not include coercive behaviour or 16 and 17 year olds, although MARAC started to discuss 16 and 17 year old victims part way through 2012/ Government Guidelines and Action Plan The publication of the Call to End Violence Against Women and Girls (2010) strategy outlined the Government s long term ambition of ending all violence against women and girls by implementing 100 actions. The document explained that partnership work will be required; national and local government, key partners and working with families and communities. 2.4 There are four key areas to the actions:- Prevent Provide Partnership Reduce the risk (increase awareness, intervene early, responding in the right way) (frontline services and funding, effective practice and training, sustainability of the sector) (working with sector organisations and communities and international work) (legislations and the criminal justice system outcomes and reducing the risk for victims (MARACs) and supporting women offenders) 2.5 The most recent Action Plan update was published in March 2013 providing an update to all actions, and adding a number of new actions Supporting document for Domestic Abuse Commissioning in Sheffield Page 14

15 2.6 National Data 8 In 2009/10 there were 290,000 domestic violence incidents reported in England and Wales. This constitutes 14% of ALL violence crime incidents. One in four women and girls will experience domestic abuse in their lifetime. One in seven males will experience domestic abuse. On average there are two homicides per week, killed by their current or former partner or lover 9. The detailed BCS self-completion questionnaire found a prevalence of 5.8% of 16 to 59 year olds experiencing domestic violence in the last year, (6.6% of women and 3.6% of men). However only 41% of incidents are reported to the police (BCS 2009/10), (based on the principle that 41% of incidents are reported and 290,000 are reported, then 461,100 (100%) domestic violence incidents could occur in England and Wales annually. Over 266 MARACs nationally reported 58,351 cases went to conference in 2012/13, of which 24% of cases were repeats, 13.4% were BME, 0.7% LGBT, 3.2% the victim had a disability and 4% were male victims % of all victims are repeat victims and these experience 76% of all domestic violence incidents. 53% of domestic violence victims are victimised once in a year, 17% twice and 30% three or more times. 73% of victims are female and 15% of domestic violence incidents include a weapon. 68% of all domestic violence incidents result in an injury. With 38% experiencing minor bruise / black eye, 15% cuts, 24% severe bruising and 17% scratches. 2% have a hospital stay and 12% need some form of medical attention. The victim believes the offender to be under the influence of alcohol in 37% of incidents and drugs in 18% of incidents. 31% of National funding to domestic violence and sexual abuse sector was cut between 2010/11 to 2011/12 11, although the Government provides a core funding of 40 million to support specialist domestic abuse and sexual violence services and this is protected until 2015 (A Call to End Violence Against Women and Girls Action Plan 2013). 8 British Crime Survey 2009/10, Chapter 2 Extent and trends and Chapter 3 Violence and Sexual Crime. 9 Office of National Statistics (2013) Focus on : Violence Crime and Sexual offences, 2011/12 10 CAADA co-ordinated action against domestic abuse MARAC data and performance 11 Walby, S and Towers, J. (February 2012) Measuring the impact of cuts in public expenditure on the provision of services to prevent violence against women and girls, Report for the Northern Rock Foundation and Trust for London, Supporting document for Domestic Abuse Commissioning in Sheffield Page 15

16 SECTION 3 Sheffield Domestic Abuse Prevalence data Adults 3.1 The Estimated Cost of Domestic Abuse in Sheffield 12 (Home Office 2009) The Domestic Abuse Ready Reckoner (Appendix 1) suggests the estimated total cost of domestic abuse and sexual abuse in Sheffield is 106,517,214 (excluding emotional and human costs). 3.2 Of the total, the physical and mental health costs are an estimated 22,952,949, criminal justice costs are estimated at 14,457,273, social service costs 2,722,585 and other costs including housing, civil, legal and employment are 66,384, The Prevalence of Domestic Abuse The Ready Reckoner is currently being updated however since there is no alternative at present the tool has been used. Appendix One explains the theory applied to using the Ready Reckoner and the advantages and disadvantages to using the tool. 3.4 When applied to Sheffield, the female year old mid 2010 population data of 173,000 females was used 13. Using this data in the Ready Reckoner tool estimates the number of women and girls aged 16 and 59 who have in the past 12 months been A victim of domestic abuse is 10,584 (+/- 95% = 7,667 to 13,501) A victim of sexual assault is 6,940 (+/- 95% = 4,552 to 9,328) A victim of stalking is 12,489 (+/- 95% = 9,456 to 15,522) 3.5 The ready reckoner does not provide a complete prevalence figure since we know that not all victims are female and that victims of domestic abuse are over the age of 59 years old (around 4% of police victims in Sheffield are aged over the age of 60). Female victims account for 83% (7,483) of the total domestic abuse police incidents, and that 23% (1,432) of these victims are repeat victims within a twelve month period. We also know that 97% of the MARAC caseload is female, around 95% of those accessing support services are female (on average 850 clients per quarter in 2011/12) and from support service and police information we also know there are female victims who are older than the ready reckoner s upper age of 59 years. 3.6 British Crime Survey (2010/11) 14, now known as The Crime Survey for England and Wales Since the publication of the Ready reckoner tool, there has been more recent estimates on the extent of domestic abuse in the British Crime Survey 2009/10 (this survey has been used as it undertook a comprehensive survey on Domestic Abuse in addition to the annual questions and this data was available at the time of writing). The BCS 2009/10 findings are useful as it provides both a comparison to the Ready Reckoner (which used BCS 2007/8 data) and also provides estimates for male victims, see Table The Home Office (2009) Using findings from the British Crime Survey enables commissioners of services from a range of providers such as health, policing and housing, to estimate the need for local services for domestic violence, sexual violence and stalking in their area. The cost of domestic abuse is calculated using figures from 'The Cost of Domestic Violence' by Sylvia Walby (2004). The tool does not have estimates for men or for females below 16 and older than The mid 2010 Sheffield population figure for women aged 16 to 59 is 173,500 (Sheffield City Council website) 14 The Crime Survey for England and Wales (formerly British Crime Survey) asks people aged 16 and over living in households in England and Wales about their experiences of crime in the last 12 months. These experiences are used to estimate levels of crime in England and Wales. Supporting document for Domestic Abuse Commissioning in Sheffield Page 16

17 Table 3.1 Domestic Abuse Prevalence Estimates Domestic Abuse Prevelence estimates Sheffield Mid 2010 population estimates (15 to 59 years) Source: Total Males Females 353, , ,500 Any Domestic abuse (DA, Sexual Abuse and stalking) Total Males Females 5.80% 4.20% 7.50% Prevelence based on British Crime Survey (2009/10) 20,491 6,480 11,451 Domestic Abuse Total Males Females Ready reckoner (2009) using 2010 mid population data 10, % 2.6% 4.6% Partner abuse - Prevelence based on British Crime Survey (2009/10) 12,719 4,680 7, % 1.4% 2.3% Non Partner abuse - Prevelence based on British Crime Survey (2009/10) 6,713 2,520 3,991 Any Sexual assault Total Males Females 1.30% 0.50% 2.30% Prevelence based on British Crime Survey (2009/10) 4, ,991 Ready reckoner (2009) using 2010 mid population data 6,940 Stalking Total Males Females 2.9% 4.4% 3.6% Prevelence based on British Crime Survey (2009/10) 10,246 7,920 6,246 Ready reckoner (2009) using 2010 mid population data 12,489 Source - British Crime Survey 2009/10 page 73, Table The table shows that the total estimate for any form of domestic violence in Sheffield (16 to 59 years, male and female) is around 20,500, with 11,500 women and 6,500 men. These estimates are combined unlike the ready reckoner which separates the three forms of violence (Domestic abuse, sexual abuse and stalking). 3.8 The Ready Reckoner and the BCS suggest that the prevalence of female victims in the last year is fairly similar (around 10,500 victims), and therefore gives support to both figures however the sexual assault and stalking figures for estimates differ quite considerably, and are both less than the -95% Confidence Interval levels for these forms of abuse given on the Ready Reckoner however Section 7 on Sexual Violence provides the current method of measurement for sexual violence using the VIPER rates. 3.9 Victims of all three forms of domestic violence? Evidence from the Home Office Research Study 276 (2004) using findings from the British Crime Survey (2001) found that of those individuals who had been a victim of domestic abuse; 85% men and 66% of women had been a victim of only one of the three forms of domestic violence, 27% of women and 13% of men had been a victim of two forms 7% of women a victim of all three forms of violence compared with 1% of men. Based on this research, then using the findings from the ready reckoner around 7,000 (66%) of the 10,500 Ready reckoner abuse female victims would be a victim of one form of abuse. Supporting document for Domestic Abuse Commissioning in Sheffield Page 17

18 3.10 Male victims The Ready Reckoner (2009) does not provide estimates for the men who are a victim of domestic abuse and there is no other national standardised measure to identify the prevalence of male victims. Therefore other Needs Assessments from Nottingham (2011/12) and East Sussex (2010) use the BCS information to estimate prevalence. Whilst this is not necessarily the most robust method, given the confidence in the BCS is varied (survey methodology, with a relatively small sample size), it appears the most consistent method used and has therefore being applied If 4.2% of males (BCS 2010) are a victim of domestic violence in a 12 month period when applied to Sheffield male population 15 of 180,000 (males aged years), around 6,480 men could be a victim in a 12 month period Number of repeat incidents of male victims - Evidence from the BCS 2010 suggests that men in general experience less incidents than female e.g. women were a victim an average 20 times in the latest 12 months compared to men with an average of 7 times Level of risk male victims A difference in level of risk/ injury is observed by Professor John Archer, University of Central Lancaster (cited in the Guardian, July 2012) who in a meta analytic review 17 found that men are as likely to be a victim of domestic violence (different to the BCS where there was a difference in prevalence) but men were less likely to be injured or killed during a domestic assault (women were twice as likely to be) Based on these pieces of research on the likelihood of incidents involving males to be lower risk, lower level of injury and less frequent incidents it could be suggested that the estimated 6,500 male victims in Sheffield (based on BCS findings) are proportionally less likely than female victims to present for support The Domestic Abuse against men in Scotland (2002) 18 report concluded that there was no specific need for a male only support agency in Scotland, including refuge although it did recognise that the current services were likely to be underused by male victims, that males could benefit from the housing advice available and that services could do more to publicise their offer to male victims. There is a free national telephone helpline and website for male victims to access provided by Respect, In Sheffield male victims are 17% (1,536) of the total police incidents 19, of whom 186 (which is 15% of male victims) are a repeat victim in a twelve month period, which means males are less likely to be a victim of repeat incidents, 2.4% of the MARAC caseload 20 are male and on average 5% of those who received support were male (on average 50 males per quarter) in 2011/ From discussions with providers in Sheffield and the level of observed activity (including police activity) it would appear that the numbers of male victims in support is small and is not feasible for a male only service. 15 Mid 2010 estimates based on Census 2001 data 16 BCS 2009/10 17 Graham-Kevan, N The invisible domestic violence against men, The Guardian, Tuesday 7 June Gadd, D., Farrell,S., Lonbard, N., & Dallimore, D. (2002) Domestic Abuse against men in Scotland, 19 Police incident data for 2011, based on 9019 incidents reported, of which 1536 were a male victim. This is incidents and not unique individuals. 20 Performance Results 2012/13 21 Department of Health 2002 as cited on Supporting document for Domestic Abuse Commissioning in Sheffield Page 18

19 3.17 In summary Table 3.2 shows the Male and Female prevalence, police victims and the number receiving support by quarter (where the 12 month prevalence has been divided into 4, to compare to police activity and support activity) so one can quickly see the difference between gender and the proportions of victims compared with the proportion who seek support. Table Based on prevalence, the table shows a clear difference with a potential 75% of female victims accessing support compared to 16% of male victims whilst around 31% of the female prevalence accessed support compared with 3% of the male prevalence. Supporting document for Domestic Abuse Commissioning in Sheffield Page 19

20 SECTION 4 Young People, Children & Safeguarding Children 4.1 Children and Young people are affected in a number of ways by domestic violence; be it living in a household where domestic abuse happens, sometimes witnessing the violence, or as the new ACPO definition recognises for 16 and 17 year olds being in an abusive relationship either as a victim or a perpetrator or by being moved physically from the family home to a refuge with their mother (this list is not exclusive). Previously victims aged 16 and 17 years was hidden as it was not classified as domestic abuse. 4.2 National Information on Children & Young People A minimum of 750,000 children a year witness domestic violence and Three-quarters of children on the child protection register in England, live in a household where domestic violence occurs 21. Three-quarters of domestic abuse incidents are witnessed by a child, with 9 out of 10 children in the same or in the room next to where the abuse is taking place 22. There are numerous studies looking at the impact of living with domestic violence as a child:- o Children in violent homes face three risks: the risk of observing traumatic events, the risk of being abused themselves, and the risk of being neglected (Mullender et al. 2003). Radford et al (2009) found that 2.5% under 11s and 6% 11 17s had one or more experiences of physical, sexual or emotional abuse or neglect by a parent or guardian in the past year. o Whitfield et al (2003) as cited in a NSPCC commissioned report by Asmussen 2010) 23 found that persons who had experienced childhood physical abuse, sexual abuse and growing up with a mother who was a victim of domestic abuse the risk of victimisation and o perpetration was increased 3.5-fold for women and 3.8-fold for men. Similarly Anda et al, 2005 as cited in Protecting People, Promoting Health, 2012 found individuals suffering an Adverse Childhood Experience (ACE), (e.g. domestic violence, family breakdown) were more likely to suffer higher levels of violence as an adult and more likely to become a perpetrator of domestic violence. As adolescents they were more likely to perpetrate bullying, fighting and date violence, to carry weapons, to have selfharmed and attempted suicide than those who had not. The more frequent and number of types of ACE incidents experienced, the more likely this could happen. o A meta-analysis 24 reviewed 41 studies and found consistency in their findings; a significant relationship between childhood exposure to domestic violence and internalising and externalising problems in children. Such behaviours included violence and aggression but also included hostility, aggression, depression, anxiety, amnesia and low self-esteem. CAADA 25 found that teenage victims of domestic abuse experienced similar levels of abuse to adult victims; of the total victims studied 76% were physically abused, 78% were victims of controlling behaviour and 53% were harassed. Young Victims (aged 16 to 19 years) 4.3 Young People s Prevalence data where the victim is aged between 16 and 19 years The 2009/10 British Crime Survey found that 12.7% of females and 6.2% of males aged 16 to 19 had experienced some form of domestic abuse in the last year (Smith et al, ). Anecdotal evidence has also shown that there are worryingly high levels of acceptance of 21 Department of Health 2002 as cited on 22 Hughes 1992 as cited on 23 Dr K. Asmussen (2010) Research Briefing: Key facts about child maltreatment 24 Wolfe, D.A., Crooks, C. V, Lee, V., McIntyre-Smith, A., Jaffe, P. G,. (2003) The Effects of Children s Exposure to Domestic Violence: A Meta-Analysis and Critique, Clinical Child and Family Psychology Review, Vol. 6, No. 3, September CAADA (2012) Insights Factsheet: Teenage victims of domestic abuse 26 Smith, K., Coleman, K., Eder, S & Hall, P (2011) Homicides, Firearm offences and intimate partner violence 2009/10, Home Office statistical Bulletin Supporting document for Domestic Abuse Commissioning in Sheffield Page 20

21 abuse in teenage relationships (as cited in Specialist Domestic Violence Courts (SDVCs): Application of System to Young Offenders and Victims). Based on the BCS findings, an estimated Sheffield prevalence using 2011 census information 27 could be as follows:- Table 4.1 Males Females Total 16 to 19 years Total 16 to 19 years+ 16,668 17,243 33,911 Domestic abuse prevalence* 6.2% 12.7% Estimated Prevalence 1,033 2,190 3,223 +Mid-2011 Population Estimates: Single year of age and sex for local authorities in England and Wales; estimated resident population; based on the results of the 2011 Census. *Prevalence based on BCS 2009/ An estimated 3,223 domestic abuse victims are aged between 16 and 19 years old, of which 2,190 are female (and 1,033 are male). This is a significant proportion of the 10,500 domestic abuse prevalence for females aged 16 to 59 years although a direct comparison cannot be made. 4.5 The prevalence of sexual abuse (BCS 2009/10) is 1.2% of males and 7.9% of females aged 16 to 19 years in the last year. Based on these percentages the estimated prevalence for Sheffield is found in Table 4.2 showing that around 1,562 victims are aged between 16 and 19 years old, of which 1,362 are female and 200 are male. Table 4.2 Males Females Total 16 to 19 years Total 16 to 19 years 16,668 17,243 33,911 Sexual Abuse prevalence* 1.2% 7.9% Estimated Prevalence 200 1,362 1,562 +Mid-2011 Population Estimates: Single year of age and sex for local authorities in England and Wales; estimated resident population; based on the results of the 2011 Census. *Prevalence based on BCS 2009/10, Table 3.06 Homicides, Firearm offences and intimate partner violence 2009/10, Smith et al (2011) 4.6 Cautionary notes The 16 to 19 years prevalence estimates should be used with caution, as there is no official ready reckoner and this is a national figure applied to Sheffield census population data, therefore it does not take into account where geographic differences may apply. There is an overlap with the adult prevalence estimates, which provides estimates for 16 to 59 year olds. A person can experience a number of types of abuse, one cannot reduce the any form of abuse by the sexual abuse prevalence figure, however the sexual abuse figure can be used on its own as an indication of the number of victims per annum in Sheffield. 4.7 Children Prevalence data living in a household where the victim is the parent There is no specific national calculation to estimate locally the number of children affected/ living with a female victim of domestic abuse in Sheffield. However efforts have been made using the Ready Reckoner data and those accessing support services during 2012/13 to provide estimation, Table 4.3 shows the calculations applied. 27 Mid 2011 population estimates for Sheffield UA Supporting document for Domestic Abuse Commissioning in Sheffield Page 21

22 Table 4.3 Prevalence (over 12 month period) Estimation Based on Total female victims (16-59 years old) 10,584 Ready Reckoner Proportion of clients in support with a child/ children 58% Modus Q2 data Number of victims with a child 6,138 Based on 58% of those in support had a child Average number of children per victim 2 Modus Q2 data indicating that victims with children have on average two children Total number of children with a parent suffering domestic abuse 12, An estimated 12,300 children (aged 0 to 17) are potentially living with a female victim of domestic abuse in Sheffield (based on the proportion of women accessing support services who have a child/ren and the average number of children those victims have). Note This figure should be used with caution, and only as an indication. 4.9 Sheffield Children and Young People Data available A snap shot of Quarter 2 activity in 2012/13 found that of those referred to support:- o 614 victims (58% of all adults referred) had a total of 1,207 children (averaging had at least one child 28 ). o 73% of the children to those accessing DA support were aged under 11 years. o 42 women were pregnant. A total of 643 children had a parent supported by the IDVA service (1 st July 2011 to 30 th June 2012) and were therefore living in a high risk domestic abuse situation. 75 (47%) of the 159 households entering domestic abuse refuges during a year (2011/12) had children and there were a total of 144 children 29 which means there are a significant number of children living in these Sheffield based refuges CAADA Insight data in its survey of data found that 66% of 2,653 high risk individuals had children 30. During 2010/11 20 referrals were made to the Youth Offending Service Prevention Team relating to domestic violence (13 were male, 70% White British, age range of 8 to 17 years, and an average age of 13.3 years 31 ). This work is being continued by the Community Youth Teams in 2013/14. The Local Authority Grant Aid budget provided 10,000 of funding to two DA refuges in 2012/13. A snapshot of Quarter One 2012/13 activity found 54 children living in the refuges had access to up to three forms of support; an average of 27 hours of free play per week (accessed by around 28 children per week), eight hours of free play with mother and child (provided to 13 children) and five hours per week of one to one support (provided to less than 10 children). At the point of discharge the majority had increased their trust in adults, their enjoyment of activities, more confidence and reduced isolation and increased Support Services for Children and or Young People and Domestic Abuse It has been identified by the Domestic Abuse JCG that there are a number of non-statutory services in Sheffield providing some level of support to children and young people affected by domestic abuse but there is no central knowledge of what these services do, what age they work with, who funds them and what level of domestic abuse expertise and training workers have had. Need identified - Work is currently on-going (June 2013) to ascertain via a questionnaire the work undertaken by the 28 services identified as working with children and young people 28 Paloma Modus data, using information provided by commissioned domestic abuse services during Q2 2012/ /12, Supporting People data 30 CAADA Insights National dataset Youth Crime Prevention Team, Domestic violence referrals analysis 2010/11 Supporting document for Domestic Abuse Commissioning in Sheffield Page 22

23 living with domestic abuse to understand the governance, the funding, the level of training staff had received on domestic abuse and mapping these services to see where gaps in support are Safeguarding Children Based on National research, an estimated 6% of children on a local child protection register or the subject of a child protection plan in the UK were under a category that included sexual abuse on 31 March Sheffield Safeguarding Children 33 data (2011/2012) finds that 39% (122) of the 311 children on a child protection plan live with domestic abuse and 38% (124 of 328) of initial conferences have domestic abuse discussed A new development in Sheffield impacting on Safeguarding Children and Young People affected by domestic abuse will be the imminent introduction of the Sheffield Wide Family Common Assessment Framework (CAF). This will aim to assess resilience and support needs within the whole family, thereby ensuring the impact of domestic abuse is fully explored (adult victims, the children and young people in the family and young people who are a victim or perpetrator of domestic abuse) In addition, the Home Office Information for local areas on changes to the definition of domestic violence and abuse (March 2013) highlights the challenges ahead following the change in the domestic abuse definition to include 16 and 17 years. The report states there are strategic and practical pathway implications for Local Safeguarding Children s Boards to provide an effective approach to Safeguarding and promotion of the welfare of children, including ensuring that Children s services and domestic abuse services develop shared protocols for joined up working and identify appropriate referral pathways Sheffield MARAC Children living with an adult victim and victims aged 16 and 17 years Children s and Young People s services are represented on the MARAC 34, in order to provide information on the children of victims and share work on-going with young adult victims. The MARAC in Sheffield changed their Terms of Reference to include cases for 16 and 17 years old victims, thereby adopting the same processes for 16 to 17 years old victims as adult victims. Whilst MARAC activity numbers are low for this age group the numbers are monitored at each conference, cases are being identified and referred and then presented at the MARAC and it is expected these numbers will increase in time Community Youth Teams (CYT) are a targeted youth support service 35. The CYT work with young people involved in low level offending and anti-social behaviour; and young people who are or who are at risk of becoming NEET (Not in Education, Employment or Training). They also take referrals for young people assessed as at low risk of sexual exploitation. As part of this work, the service employs a 0.6wte specialist officer who works with young people who have experienced or witnessed domestic abuse and are at risk of offending. In order to develop capacity within the service for this area of work, the service has a manager lead for DA and has trained up six DA champions. The specialist worker and champions currently work with DA referrals on a one-to-one basis; deliver a group work programme for victims of DA who meet the core criteria; and support colleagues with completion of the DASH risk assessment. 32 Department of Health (2011) Commissioning services for women and children who are victims of violence a guide for health commissioners, gateway All Safeguarding Information provided by Lindsey Savage, Safeguarding Children s Service from data presented at the Safeguarding Children s board (April 2011 to March 2011). 34 A MARAC is a multi-agency meeting where statutory and non-statutory agency representatives share information about high risk victims of domestic abuse to generate a joint action plan to work towards increasing victim safety. 35 CYT information from Gail Gibbons, Service Manager - Community Youth Teams Supporting document for Domestic Abuse Commissioning in Sheffield Page 23

24 4.17 Over the past few months, the CYTs have been receiving a small number of referrals for young people affected by DA who do not meet core criteria. Typically these young people are attending school and are well behaved but are showing other signs of distress as a result of their situation. For example, anxiety, low in confidence, low level mental health problems which may not meet the CAMHS threshold. This is a potential area of need CandyP fulfils this need currently however funding of this service is vulnerable. CandyP 36 provides support to families with children aged 5-16 years old, where the mother has left the domestic abuse situation, is living safely, and is able to emotionally support her child who has low levels of mental health problems There are concerns that whilst referrals for this cohort of children and young people are currently small, that this could grow in light of there being no other service available other than possibly inhouse in school Counselling can also be spot purchased from Sheffield Interchange (and presumably from other private counsellors working with young people although the activity numbers are unknown) A local bid for an under 18s IAPT (psychological therapies) is also currently being submitted by Sheffield Children s NHS Foundation Trust Need identified - The CYT service believes that a specialist therapeutic counselling service would best meet the needs of these young people but there is not an immediate service on offer for this cohort Young People s Perpetrators support YJS/CYT perpetrator programme - Each service is in the process of developing a perpetrator programme. There will be some cross-over in the programmes, therefore the service leads are working collaboratively and sharing information although ultimately there will be an early intervention/prevention programme (CYTs) and a post court programme There is a need for the forthcoming local strategy for domestic abuse to include a section on Children and Young People 37 :- To have specific reference to young people, and be clear who is taking the lead for this work (Home Office, 2013). Develop a local plan of how Sheffield will respond to young perpetrators of abuse. Review the impact of the change in the domestic abuse definition on safeguarding children s services and pathways for referral into domestic abuse support. 36 CandyP information from The Haven House Project 37 Information for local areas on changes to the definition of domestic violence and abuse (March 2013) Supporting document for Domestic Abuse Commissioning in Sheffield Page 24

25 SECTION 5 Demographics, Diversity and Risk Factors 5.1 This section focuses on the demographical and diversity information of Domestic Abuse victims and additional risk factors in some cases (i.e. substance misuse and mental health). Each topic is discussed independently however often cases can be complex and can involve more than one risk factor. 5.2 Lesbian, Gay, Bisexual and Transgender (LGBT) Information on the prevalence of domestic abuse in LGBT relationships is limited nationally and also locally. Research by Henderson (2003) who surveyed 1,911 LBGT individuals found 22% of Gay and Bisexual women had ever experienced abuse from a same sex partner and 19% had experienced repeat abuse % of men reported ever having experienced abuse from a same sex partner, with 24% citing repeat abuse. Both proportions are higher than that found in the BCS 2009/10 that almost one eighth (12.4%) reported ever being a victim of Domestic abuse. The variation here is likely due to the sources of the information and the relatively small sample sizes. A recent survey presented at a LGBT Domestic Abuse conference found that anecdotally one in three transgender individuals were a victim of domestic abuse The LGBT population in the UK was estimated at 1 in 16 people, or 6% of the national population 40 in 2005 following research undertaken by the Treasury actuaries when analysing the financial implications of the Civil Partnerships Act (2005). There are no local projections available. A 6% population rate therefore has been applied to the Sheffield model (Nottingham Needs Assessment applied the same methodology but selected a 6-10% population size). This estimate is also based on ever been a victim, and not in the last 12 months as the ready reckoner. Based on these assumptions, the LGBT population in Sheffield is around 21,000 individuals, and between 2,600 and 5,400 have ever been a victim of domestic violence, see Table 5.1. Table 5.1 LGBT proportion of the UK population 6% Total Males Females Sheffield LGBT population based on 6% of the population 21,198 10,800 10,410 LGBT Ever experiencing domestic abuse based on findings by 29% 22% Henderson (2003) Sheffield Projected prevalence based on Henderson, 2003) 5,422 3,132 2,290 Projected prevalence based on (BCS) findings 12.4% Sheffield projected prevalence based on Ever experiencing DA using BCS, 2009/10) 5.4 Henderson (2003) found of those LGBT victims 56% of women and 54% men reported physical abuse and 14% women and 18% men had required medical attention. 5.5 LGBT Access to support services - CAADA recommends a 5% LGBT client base on the MARAC caseload nationally; however the MARAC Performance results show less than 1% of 2, Henderson, L (2003) Prevalence of Domestic Violence among lesbians and gay men. The report used a questionnaire to survey a total of 3,302 LGBT individuals. Women were consulted via community based events in 2000 via an anonymous questionnaire and returned the questionnaire on the day of being handed out. Men were consulted via the 2000 National gay Men s Sex Survey and via health promoters working with gay, Bisexual and Transgender individuals with both sources containing the same six questions. 39 Emma Roebuck, and James Rowlands, CAADA presentation called what to do? What not to do? 40 Campbell, D. 3.6m people in Britain are gay official The Observer, Sunday 11 December Supporting document for Domestic Abuse Commissioning in Sheffield Page 25

26 Sheffield LGBT victims go to MARAC 41 which is a similar proportion to the England Average, Sheffield s most similar forces and the Yorkshire and Humber region. A similar percentage (<1%) is found for those accessing community support services in Sheffield. Therefore based on the prevalence which shows that a significant proportion of LGBT individuals will suffer some form of DA, that LGBT individuals are around 6% of the population, that CAADA suggests 5% of the victims presented at MARAC should be LGBT then the proportion of LGBT individuals accessing support services is less than one would expect and this issue is not just local to Sheffield. 5.6 A recent conference hosted by the LGBT Domestic Abuse Forum s Transforming Domestic Abuse (2012) 42 supports these findings as its aim was to improve domestic abuse service provision for trans communities by sharing best practice, new research and to pool expertise held by sector organisations, activists and trans people to increase engagement of LGBT individuals in support services. 5.7 In Sheffield there is a need to increase our understanding of the support needs of the LGBT population group, apply known best practice and increase the proportion of LGBT individuals accessing support services. To start this process DACT contracts (2013/14) will aim to increase these proportions initially from less than 1% to 1%. Whilst this is still relatively low it will be an improvement on current levels. In addition better activity information is required in line with the Equality Act 2011, and sexuality asked as matter of routine by all local authority commissioned services. A publication of The Lesbian, Gay, Bisexual and Trans Public health Outcomes Framework Companion Document (2013) states that the local Joint Strategic Needs Assessment should include explicitly the needs of the local LGBT community and this has been applied in 2013/ Ethnicity The BCS (2009/10) indicates there is little difference in the proportion of White British and BME individuals suffering abuse in the last 12 months; for example 7.5% white British women to 7.4% BME women and 4.3% of white British men compared with 3.4% of BME men 43. Therefore based on this premise one would expect the proportion of BME individuals accessing support services to be around the same proportion of the Sheffield BME population, which is currently 17% (2011 Census) The proportion of BME clients accessing support services nationally differ according to reports; a Women s Aid Federation England week long survey in June found that 34% of refuge residents on the 16 June 2011 and 25% of individuals accessing non-refuge services were BME. Whilst CAADA Insight data 2011/12 reported 15% accessing support services were BME Research also suggests different ethnic groups have different experiences of the type of abuse received and also in how they access support services. For example CAADA 46 found that the dual heritage victims were more likely to be referred via health services, black victims were more likely to be health or self-referrals and less likely to be referred by the police, and Asian victims were more likely to be experiencing abuse perpetrated by a current family member or an adult family member/s and were more likely to be living with a perpetrator. 41 CAADA data for the 12 month period between April 2012 and March The conference was hosted in partnership with Gendered Intelligence, Gender Matters, Broken Rainbow and Galop 43 Smith, K., Coleman, K., Eder, S & Hall, P (2011) Homicides, Firearm offences and intimate partner violence 2009/10, Home Office statistical Bulletin 44 Population estimates BME excludes White Irish, White other, White British and White Gypsy/ traveller 45 The day to count snapshot survey, Women s Aid Federation of England, Annual Survey of Domestic Violence Services , page 21 and page CAADA Insight National dataset Supporting document for Domestic Abuse Commissioning in Sheffield Page 26

27 5.11 Sheffield BME Activity South Yorkshire Police records for 2011 indicate that for all domestic crime offences in Sheffield the ethnicity of the victims was White: 85%, Asian: 7%, Black: 6%, SE Asian: 1%, Middle Eastern: 1% 47. Commissioned Domestic abuse support services (High, Medium and Standard risk) find the proportion of BME victims in their services varies by Quarter, e.g. 22% in Q2 2012/13 compared with 30% in Q4 2011/ (or 273/979 individuals). Refuges - The percentage of BME women accessing refuge accommodation is over 100% higher than the ethnicity breakdown of the South Yorkshire Police ethnicity breakdown (with 43% BME client base was (or 45 of the 104) women (Ashiana, Haven House and Women s Aid activity) in 2011/12. According to the HIS team this is partly because the BME population is over-represented in homeless accommodation, but largely because of level of out of city usage for Asian women 50 (74% of those in the refuge were not Sheffield residents). 18% of all cases going to MARAC in 2012/13 had a BME victim 51, which is close to the 19% MARAC population CAADA would indicate one would expect to go to MARAC. Despite the difference observed in quarters all show a greater proportion than the 19.8% citywide BME population. The only difference observed in these proportion is victims accessing the local SARC (Sexual Assault Referral Centre 52 ) which finds that 14% of the victims they supported in 2012/13 were BME. Table Differences are observed however when each ethnic ONS definition is scrutinised. Table 5.2 suggests that the Other Asian and Other black ethnic groups are slightly higher in their representation in support services proportion than their citywide proportion of their population, whilst some ethnic groups are slightly underrepresented: - Pakistani, Indian, Chinese and Black African 53. There is a continued need to ensure all services are accessible to all ethnic groups; with particular focus on those groups that are slightly under represented Interpretation services A snap shot of one quarters activity shows that of the 979 victims seeking support for domestic abuse in Q4 2012/13, 38 (3.8%) received support in a non-english ONS 2011 Ethnicity Breakdown % of total accessing support services White: English/Welsh/Scottish/Northern Irish/British 80.8% 77.8% White: Irish 0.5% 0.2% White: Gypsy or Irish Traveller 0.1% 0.6% White: Other White 2.3% 3.0% Mixed/multiple ethnic group: White and Black Caribbean 1.0% 0.6% Mixed/multiple ethnic group: White and Black African 0.2% 0.2% Mixed/multiple ethnic group: White and Asian 0.6% 0.5% Mixed/multiple ethnic group: Other Mixed 0.6% 0.8% Asian/Asian British: Indian 1.1% 0.3% Asian/Asian British: Pakistani 4.0% 3.0% Asian/Asian British: Bangladeshi 0.6% 0.5% Asian/Asian British: Chinese 1.3% 0.0% Asian/Asian British: Other Asian 1.0% 6.1% Black/African/Caribbean/Black British: African 2.1% 1.5% Black/African/Caribbean/Black British: Caribbean 1.0% 0.3% Black/African/Caribbean/Black British: Other Black 0.5% 4.2% Other ethnic group: Arab 1.5% Other ethnic group: Any other ethnic group 0.7% 1.0% Data Source: - MODUS Q2 2012/13 and the ONS 2011 Census data 2011 'Census: KS201EW Ethnic group, local authorities in England and Wales' speaking language; with Urdu and Polish the most frequent used languages ( Other was the highest, but there was no further breakdown). The helpline offers a translation service and all commissioned services have access to an interpretation service. There is a continued need to 47 South Police data, Karen Jackson 48 The full data shows 52% White British (551) with 18% of clients unassigned/ not known. 49 Paloma Modus activity 2011/12 and 2012/13 50 Ann Ellis, HIS Manager 51 CAADA Data, MARA performance results for 2012/13 provided on June The SARC is located in Rotherham but provides the service for victims of rape and sexual violence for residents of Sheffield. 53 Comparing 2011 Census data to Paloma Modus support services data (Q /13) Supporting document for Domestic Abuse Commissioning in Sheffield Page 27

28 ensure support is available in the languages used by service users Religion Religion can be of significance for some victims presenting at support services, for example beliefs can influence a victim s response to domestic abuse e.g. domestic abuse is accepted and perceived as a cultural norm. This can impact on whether an individual will accept support, and/ or their interpretation of their own situation therefore support services need to factor religion into their response. In 2011/12 only 27% of the service user population were asked their / had a religion recorded in 2011/2012, therefore showing that asking and recording of this data needs to be improved. Of those asked and responding the findings have been compared to the Census 2011 data. 120 (45%) were Christian (Census was 56%), 86 (32%) were Atheist or of no religion compared to 33% on the Census and 55 (21%) were Muslim which was much higher than the 8% found in the Sheffield Census data Safeguarding Adults Making connections between adult safeguarding and domestic abuse has been recognised nationally as an area that requires further development Adult safeguarding and domestic abuse published in May The current the definition of a vulnerable adult is a person who is or may be in need of community care services by reason of mental of other disability, age or illness; and who is or may be unable to take care of him or herself or unable to protect him of herself against significant harm or exploitation, however the vulnerable adult term has become more widely recognised as adult at risk and the proposed new definition in the draft of the Care and Support Bill to be published in 2015 is someone who has needs for care and support (whether or not the authority is meeting any of those needs), is experiencing, or is at risk of abuse or neglect or as a result of those needs is unable to protect him or herself against the abuse or neglect or the risk of it Sheffield has two factors on identification of domestic abuse and vulnerable adults: for domestic services to identify safeguarding issues and refer/ sign post to safeguarding adults, where the need is identified in line with the current definition and for safeguarding adult services to identify domestic abuse issues with their clients and refer into domestic abuse support services Adult social care for Sheffield City Council have been trained on the use of the ACPO DASH assessment tool, they attend and contribute to the MARAC. In 2011/12 adult social care had a total of 457 abuse referrals made, of which 38% of these abuse cases were due to domestic abuse (the perpetrator was a family member (130) or a partner (47)). These proportions are larger than the findings in a national report Abuse of vulnerable adults in England (2011/12) citing 22% of those abused was domestic abuse by a family member or partner There is a need to better understand the effectiveness of the referral pathway between Domestic Abuse support services and adult social care services and vice versa to understand whether there is a gap in identification and/or a gap in referrals For those vulnerable adults experiencing domestic abuse, a capacity assessment needs to be undertaken in line with the Mental Capacity Act (2005) to ascertain whether the individuals has the capacity to undertake decisions on their own safety. 54 Religion Census Wards Adult safeguarding and domestic abuse: a guide to support practitioners and managers Local Government Association (2013) Supporting document for Domestic Abuse Commissioning in Sheffield Page 28

29 5.21 There is a need to:- Understand how compliant services are with the Mental Capacity Act (2005) and review policies and procedures Ascertain where there may be training needs 5.22 Disability Research shows that females with a disability are twice as likely to be a victim of domestic abuse in their lifetime than females without a disability (one in two compared to one in four), 2005 BCS findings as cited by Women s Aid website 56 and The Guardian, The domestic violence can take unique forms that are different to those individuals without a disability. For example those who are reliant on a family member acting as a carer could find medicine is deliberately not provided or they are not taken to the toilet There is also a suggestion that leaving a domestic abuse situation can be more difficult for a disabled person. For example the victim is often supported by another when attending the GP so disclosing the situation is not possible when the abuser is present or an example of moving out of the situation is physically difficult due their reliance on another to physically move out or where their current property is adapted for their use Further research also shows that support services may need to factor in their response since identification and disclosure within this cohort of individuals could be hidden E.g. the abuser may be present in the referral meeting (acting as carer) thereby affect an individual s ability to address the situation and also individuals may have more complex needs accessible accommodation and transport, assistance with personal care or sign language interpreters, and possibly for specialised emotional support (Nosek et al, 1998; 2001 as cited in Making the Links, Disabled women and domestic violence 59 ) CAADA insight data found that 7% of the 2,653 accessing support services had a disability, with the majority having a physical disability (4%), 1% learning and 2% another disability 60 however the national Women s Aid residents snap shot survey, indicates that around 12% of those in refuges on the 16 June 2011 had a disability (information was not available for non-resident support services) In Sheffield domestic abuse support services are getting better at recording whether a client has a disability. A snap shot of activity (Q2 2012/13) finds that 69% of all service users were asked whether they had a disability and had a response recorded. Of those asked 9% had a disability (64/688), which is between the 7% (CAADA) 62 and 12% (Women s Aid) 63 snapshots There is a continued need to improve the recording and reporting of client disability data to meet the requirements of the Equalities Act 2011, so all clients are asked about disability and so the 9% citing a disability can be ratified and any issues can be addressed accordingly by services Ryan, F Domestic violence and disabled women: an abuse of power, The Guardian, 19 November Ibid CAADA insights national dataset The day to count snapshot survey, Women s Aid Federation of England, Annual Survey of Domestic Violence Services , page CAADA insights national dataset Supporting document for Domestic Abuse Commissioning in Sheffield Page 29

30 5.29 Age The table below (Table 5.3) shows the annual activity of clients accessing support services by age grouping. The age grouping with the highest proportion of clients is 31 to 40 years (26%) followed closely by those aged 19 to 25 years (25%). The graph also shows activity for young adults (aged 16-18) - see Section on Children and Young People for more information) Evidence suggests that domestic abuse in elderly adults is under identified, and this is supported in findings from Serious Case reviews concerning elderly victims 64. A report by Women s Aid in 2007 found that there was no firm data about the extent of domestic violence against older women 65 and to support this finding, evidence from British Crime Surveys suggest elderly women are less likely to report an incident of domestic abuse than individuals who are younger (25 years to 40 years) Women s Aid (2007) explored a number of reasons why the elderly may not report or disclose their abuse; shame of disclosure, longevity of the abuse, fear of change (may care for abuser or housing situation), abuse by an adult child, not associating their situation to domestic abuse situations highlighted by media campaigns, lack of awareness on support available, low level of identification by support services per se and potential frailty and disability were all raised as potential issues. Therefore whilst we know that in Sheffield over a five year period 4% 66 of all domestic abuse incidents reported to the police were aged 60 years or more given the Women s Aids findings those in this age group are less likely to report abuse to the police and this issue is not unique to Sheffield Sheffield Domestic abuse support services in 2012/13 had 1.7% aged 61 to 70 and 1.4% aged 71 plus in support which is slightly higher than the CAADA Insights national dataset where 2% of 2,653 clients were aged 61 or more years old Services are commissioned to provide support to all clients of all ages and given that 4% of police incident involved a person age 60+ and support services are similar to this proportion there are indications that services are responding to the needs of those aged 60 and over. However the Sheffield Safeguarding Adults Service raised age as an issue during the consultation suggesting that hidden cases may more likely be reported to their services, than the police or other services. This appears a reasonable argument and there is a need to understand if cases over the age of 60 plus are more likely to present at Safeguarding Adults services rather than police and domestic abuse support services, and whether these cases are then referred into specialist domestic support Whilst the activity figures suggest support services are responding to the needs of clients aged 60 plus, there is a need to review whether support services meet the need of those aged 60 plus Mental Health Evidence suggests that over 50% of women within the mental health system have been a victim 64 Older domestic violence victims feel helpless in the face of long-term abuse, 65 Jackie Barron (2007) Older women and domestic violence:- An Overview, Women s Aid 66 Police data, Karen Jackson, South Yorkshire Police Supporting document for Domestic Abuse Commissioning in Sheffield Page 30

31 of violence and abuse 67. A meta-analysis of 18 studies into the relationship between domestic violence and mental health problems found a strong association (Golding 1999 as cited in Walby 2004). Golding found that 48% of female victims had depression, 18% had suicidal thoughts and 64% had post-traumatic stress disorder 68. Findings from the BCS (2010/11) showed that 39% of victims had experiences mental or emotional issues rising to 54% in victims of sexual assault Local data 50 (25%) of the 203 individuals had disability mental health recorded on their intake data form sign postings to mental health services in Q2 2012/ There is no specific domestic abuse psychological counselling services commissioned in Sheffield for victims who also have mental health problems however EVA provides some limited support for such individuals. In addition there are a number of generic services offering psychological therapies; e.g. Improving Access to Psychological Therapies (IAPT), Sheffield Health and Social Care Foundation Trust and a number of voluntary sector services. IAPT data does not specify a diagnosis of domestic abuse; therefore it is not possible to quantify the activity undertaken with this service and Domestic Abuse Victims There is a need to better understand the generic psychological therapies available for domestic abuse victims who have a mental health problem, to ascertain whether referrals are made routinely by support services, where there are issues with access, and for those who used psychological services how well it met their needs Drugs and Alcohol The National Coalition against domestic violence 71 provides a useful summary to drug and alcohol use and domestic violence. While substance abuse does not cause domestic violence, there is a statistical correlation between the two issues (1). Studies of domestic violence frequently indicate high rates of alcohol and other drug use by perpetrators during abuse (2). Not only do batterers tend to abuse drugs and alcohol, but domestic violence also increases the probability that victims will use alcohol and drugs to cope with abuse (3). The issues of domestic violence and substance abuse can interact with and exacerbate each other and should be treated simultaneously (4) National Data The BCS 2009/10 findings in the Homicides, Firearms and Intimate Partner Violence report considered the use of alcohol and drugs by the perpetrator and by the victim in serious sexual assault incidents. They found that 73 :- o 36% of victims thought the perpetrator was under the influence of alcohol and 9% under the influence of drugs o 25% of victims were under the influence of drink at the time of their most recent 67 Department of Health 2003, Women s Mental Health: into the main stream, p Walby, S (2004) The Cost of Domestic Violence 69 Protecting people, Promoting Health: A public health approach to violence prevention in England, (October 2012) NWPHO 70 Source: - Q3, 2012/13 intake forms on Modus The National Coalition Against Domestic Violence (NCADV) cites the following references 1 Fazzone, Patricia Anne, et al. Substance Abuse Treatment and Domestic Violence: Treatment Improvement Protocol. U.S. Department of Health and Human Services and SAMHSA s National Clearinghouse for Alcohol and Drug Information. 2, 3 Making the Link: Domestic Violence & Alcohol and Other Drugs. U.S. Department of Health and Human Services and SAMHSA s National Clearinghouse for Alcohol and Drug Information. 4 Fazzone, Patricia Anne, et al. 73 Smith K, Coleman K, Eder S, & Hall, P (2011) Homicides, firearm offences and intimate partner violence 2009/10: supplementary volume 2 to Crime in England and Wales 2009/10 London: Home Office, page 78 Supporting document for Domestic Abuse Commissioning in Sheffield Page 31

32 assault and 2% were under the influence of drugs they had chosen to take. o 6% reported that the perpetrator had drugged them prior to the serious sexual assault. A Women s Aid report cites the following data on drug and alcohol misuse:- 74 that 37% of domestic cases have alcohol as a factor and that domestic abuse victims are 15 times more likely to abuse alcohol and nine times more likely to abuse drugs than individuals who are not victims of domestic violence. Howarth et al (2009) found that 54% of MARAC cases had a perpetrator who misused alcohol and 39% who misused drugs Local data In 2012 (Jan Dec) there were a total of 1,281 domestic violence crimes for violence against a person of which:- o 45% (573) were alcohol related compared with 75 o 3% (34) were drug related. In the last year, all drug and alcohol treatment services have been asked to report quarterly the number of referrals they make specifically to a commissioned domestic abuse service and the number of referrals they receive from domestic abuse support services activity on both sides remains low, this is despite the introduction to the recording of Referrals from domestic abuse support services to drug, alcohol and mental health services in Q4 2011/12. Drug and alcohol services refer to and attend MARAC The Sheffield alcohol screening tool is not used routinely by DA support services, although questions on drug and alcohol misuse are asked by support services. Better links between services could be made particularly as the DACT commissions support services for drugs, alcohol and domestic abuse in Sheffield Pregnancy and Domestic Abuse Pregnancy can be a vulnerable time for women; McWilliams and McKiernan 1993 found that in 30% of cases, pregnancy is when domestic abuse starts in a relationship (DoH, 2004; as cited in RCM Domestic abuse). In terms of the proportion of pregnancies where domestic abuse is happening, there are a number of different statistics. A study in Hull (Johnson et al, 2003) found a domestic abuse prevalence rate of 17% among 500 pregnant women however other research suggests 7% (McFarlane et al, 1994) and 17% (Amaro et al, 1990). Based on the 6,510 live births in Sheffield during in 2011 (Area Health Profiles, NHS Sheffield) if the lower percentage of 7% is applied, then a potential 500 (if 7% applied) pregnancies may have had some form of domestic abuse. However studies also show that violence during pregnancy can lead to an increased risk of miscarriage, premature birth, low birth-weight, foetal injury and even foetal death (Stark et al, 1979; Bohn 1990; Webster et al, 1996), therefore the estimation will not include women who had a termination, miscarriages or foetal death where domestic abuse may have factored NICE Guidance 110 Pregnancy and complex factors indicates that support should be provided to pregnant women who are suffering from domestic abuse, via specialist training of midwives, with better identification of health care professionals and by making information available and tailored to meet the needs of women who are, or who are a risk of domestic abuse. Coordinated care is recommended during pregnancy for those at risk including flexibility of appointments to open opportunities to discuss domestic abuse. 74 As cited on 75 Data from Karen Jackson, South Yorkshire Police Supporting document for Domestic Abuse Commissioning in Sheffield Page 32

33 5.45 The Royal College supports routine enquiry of domestic abuse throughout the pregnancy, which is encouraged in Sheffield, though it is unknown as to whether this is indeed routine in all cases, given that research (national and local) has found some midwives find it difficult to ask women about domestic abuse, particularly if a partner was present. (The Royal College of Midwives survey of over 700 midwifes and a survey undertaken in 2010 at the Jessop Wing in Sheffield found similar responses, although there was a relatively low response rate (12% = 62) In Sheffield the offer of domestic abuse support to those who are pregnant has undergone a process change in 2013/14. Previously the IDVA service (who also supported medium and standard clients at the time) had a presence in Jessops Wing. This was a specific project commissioned which was anticipation to identify 250 high risk cases (between Jessops Wing and A&E annually, not all would be pregnant). A review of the project found that only 71 of the 371 cases identified (18%) were high risk. Whilst the project is likely to have identified individuals of medium to standard risk who would not otherwise have been identified the IDVA service is a high risk, intensive service and recognised nationally as working with high risk individuals and since the number of high risk referrals did not meet the expected levels and the cost effectiveness of the service was questioned Referrals into the IDVAs service based at Jessops Wing during 2012/13 are shown in the following table (Table 5.4) (Source: Modus data, 2012/13 for IDVA Jessop Wing activity) A total of 247 pregnant new cases started support, with 64 cases identified as high risk (this is not dissimilar to the distribution of risk of all who entered support services at 26%, found in section 11. If the lower estimate of potentially 500 pregnant women who suffer domestic abuse per annum in Sheffield IDVAs (Jessops) High/very high Medium Standard New cases starting support Q Q Q Q Total Proportion of total 23.90% 51.50% 24.60% (based on 7% of pregnancies, however this could be an underestimate since some studies suggest this could be as high as 17% of pregnancies) is applied then the 2012/13 activity levels suggest a significant proportion of pregnant women who suffer domestic abuse are either not identified or chose not to seek specialist domestic abuse support In 2013/14 a specific comms form has been created for use by the clinical staff working with pregnant women in Jessop Wing so referrals can be made in the same manner they were before, but into the High risk IDVA team (where high risk) and all others to the DASH risk assessor based in the Standard and Medium team. This risk assessor role is to support clinical staff in referrals, offer advice and support in the process and to keep domestic abuse at the forefront of those working in the clinical services to mitigate against the risk of domestic abuse referrals from Jessops Wing dropping The need is to monitor the level of referrals from Jessop Wing and the effectiveness of the DASH risk assessor role The midwifery public health contribution to compassion in practice though maximising wellbeing and improving health in women, babies and families includes the midwifery public health actions throughout the maternity pathway. Therefore there is a need to ensure consistency in service provision within each community in terms of domestic abuse identification, sign posting and appropriate specialist referrals, domestic abuse disclosure and safeguarding issues and the DASH risk assessor role is the key to this. Supporting document for Domestic Abuse Commissioning in Sheffield Page 33

34 SECTION 6 Domestic Abuse Police Activity & Prosecutions 6.1 Police Activity of Domestic Abuse related incidents In Sheffield there was a total of 10,475 police recorded domestic abuse incidents in 2012/13, which was an increase of 1,266 incidents reported compared with the previous financial year. 6.2 The chart on the right (Table ) shows the incidents reported over the last five years, with the number of crimes (where a perpetrator was charged) and the number of non-crimes (e.g. not enough evidence). It shows that as crimes have reduced consistently over the last five years the number of non-crimes has consistently increased at a faster rate, meaning 83% of all domestic abuse incidents are now non-crimes compared with 72% in 2008/ Discussions with police, probation and domestic abuse support services suggest that the noncrime figure has increased due to a combination of factors which include the change to police reporting of domestic abuse incidents that happened in 2009 and has continued to improve identification and recording, direct referral links between the police and domestic abuse support services, increased public awareness, increased cases going to MARAC, more effective partnership working and more domestic abuse support services available % of domestic abuse crimes result in an arrest, with 1,283 arrests in 2012/13. 26% of all violence against a person offences are domestic abuse incidents. 6.5 A significant number of domestic abuse incidents are unlikely to be reported to the police; the British Crime Survey (2009/10) 77 found that nationally only 41% of all domestic violence incidents are reported. Given this information, and if this reflects the 10,475 reported domestic abuse police incidents in 2012/13 reflects 41% of total incidents, then 100% incidents could be around 25,000. Thus indicating that domestic abuse reported incidents are likely to continue to increase in the years ahead (as more work continues to highlight domestic abuse to the general public) thus allowing more opportunities for early intervention work and referrals into domestic abuse support services. 6.6 Total Victims of domestic abuse incidents report to the Police There has been an increase in the number of unique individuals involved in domestic abuse incidents that are reported to the police. There were 6,314 unique victims 78 in March 2013 (Police data looking at the last 12 month rolling period) compared with 5,717 victims in March 2011/12. The number of repeat victims increased to 1,795 repeat victims in March 2012/13 from 1,582 in March 2011/12 (they had had at least one other domestic abuse incident reported within the 12 month period prior to their latest reported incident). The proportion of repeat victims has changed from 27.6% to 28.4% of the total victims. 6.7 Of the 1,795 repeat victims in 2012/13, 491 individuals had been a victim of three or more reported incidents over the 12 month period (started from the data of the latest incident), Data Source Stats for DV Co-ordinators, South Yorkshire Police 2008/9 to 2012/13 77 The British Crime Survey has a specific (more detailed) section that uses an anonymous process in some years asking specific domestic violence questions. The survey has found that reported domestic violence is higher than when the survey is not anonymous (i.e. an interviewer asks the questions directly) and therefore add some degree of confidence. 78 Police data contained in the Sheffield First Sustainable Communities Partnership: Sheffield Joint Strategic Intelligence Assessment Supporting document for Domestic Abuse Commissioning in Sheffield Page 34

35 victims had reported five or more incidents and 57 ten or more incidents (bearing in mind, this does not include those which went unreported). 6.8 Demographics of victims Local analysis of the data shows that around 83% of victims are female, 15% are from an ethnic minority population with the highest age grouping was 25 and 29 years (19% of the total victims). The BCS and Ready reckoners do not account for victims over the age of 65, however in Sheffield 3% of police victims were over 65 (177) individuals. 6.9 CAADA data 79 shows that the average number of years of the abusive relationship is five years, with the median (the middle value) three years; therefore an individual could report incidents over a number of years to the police Level of injury 12% had an injury recorded (see table 6.2 right) with the majority recorded as slight (888 or 10%), 32 incidents were recorded as serious and two were fatal Crimes The top ten crimes recorded for victims of domestic violence are show in table 6.3. The top two were Harm (OAPA section 47 and Common Assault. Table Domestic Abuse reported Incidents by Ward and Community Assembly areas There has been an increase in the average number of domestic abuse related reported incidents per ward (there are 28 wards in Sheffield), from an average of 322 per ward in 2011 to 360 in Of the incidents in 2012, Firth Park was the ward with the highest number of incidents Ecclesall had the least, with a range of 815 to 69 reported incidents. The five wards with the highest reported incident rate are (in order) Firth Park, Burngreave, Southey, Arbourthorne and Gleadless Valley with all four wards in the North East Community Assembly in the top six for total domestic abuse crimes reported Homicides In the last six financial years (2006/7 to 2012/13) there have been thirteen domestic violence homicides in Sheffield, this averages at just over two per year, however as the graph displays in two of these years there were no homicides and in one year there were five. In 2012/13 there 79 CAADA Insight dataset Domestic Violence reported in Sheffield January December 2012, South Yorkshire Police Supporting document for Domestic Abuse Commissioning in Sheffield Page 35

36 were two domestic violence homicides Domestic Homicide Reviews Since April 2011, there is a statutory requirement to carry out Domestic Homicide Reviews (DHR), under Section 9 of the Domestic Violence, Crime and Victims Act (2009) 82 The DHR will aim to review the circumstances in which the death of a person aged 16 or over has or appears to have resulted from violence, abuse or neglect by (a) a person to whom he was related or with whom he was or had been in an intimate personal relationship, or (b) a member of the same household as himself, held with a view to identifying the lessons learnt from the death A local process has been written in accordance with the DHR guidelines and was implemented in 2011/12. The process also includes suicides where it is ascertained the suicide has resulted from or is directly related to Domestic abuse (see DHR definition above) Since April 2011 there have been four deaths relating to domestic abuse in Sheffield, with all four having a Domestic Homicide Review undertaken. There have also been two Serious Incident Reviews undertaken in the same time period on incidents classified as near misses Once a DHR is completed the Action plan is monitored quarterly by the Quarterly DHR / SIR review panel DHRs are thorough and take time to complete, with each case taking six months from start to finish, however DHRs have been overlapping, with one already in progress and another starting. This is likely to continue, given the average of two deaths from domestic abuse over the past five years. There is a continued need for all stakeholders, including DACT to respond within set timeframes and for all stakeholders to add work on DHRs in their work plans Suicides Research shows that Domestic violence commonly results in self-harm and attempted suicide: abused women are five times more likely to attempt suicide; and one third of all female suicide attempts can be attributed to current or past experience of domestic violence. (Stark and Flitcraft, 1996; Mullender, 1996) 84. Research by Walby (2004) as cited in NICE Commissioning Services for women and children who experience violence or abuse a guide to commissioners (2011) has also found that 500 women who have suffered domestic violence in the last six months commit suicide every year, and suggests that just under 200 of these individuals attended hospital for domestic violence on the day they committed suicide The actual number of domestic abuse related suicides in Sheffield is currently limited however 6.21 Violence Indicator Profiles for England Resource (VIPER) shows that the Mortality from suicide or injury undetermined for female rate is 2.7 per 100,000 populations in Sheffield. The regional 81 Police data, Karen Jackson 82 Multi-agency statutory guidance for the conduct of domestic homicides reviews, Home Office, page 3 83 Ibid page 6 84 Report on Statistics: Domestic Violence, Women s Aid 85 Commissioning services for women and children who experience violence or abuse a guide for health commissioners NICE Gateway ref: February 2011 Supporting document for Domestic Abuse Commissioning in Sheffield Page 36

37 average is slightly higher, with a crude rate of 3.3 per 100, The female Sheffield population is 173,000 (aged 15 years to 60 years), so applying the rate of 2.7 per 100,000 this would indicate the female crude rate per annum was 4.7 for mortality from suicide or injury undetermined. Given that research (Stark and Flitcraft, 1995; Mullender, 1996 as cited in Walby ) indicates one in three female suicides could be attributed to domestic violence, then based on this research and the VIPER rate there is an estimated three female mortality from suicide or injury undetermined over a two year period in Sheffield related to domestic abuse Conviction Rates for domestic violence In 2011/12 national domestic violence conviction rates were the highest they had been - 73% (66,860 cases) of referrals to prosecution resulting in a conviction compared with 69% in 2007/ South Yorkshire prosecution data ,953 pre-charge decisions were made in South Yorkshire in 2011/ % (1,224) of cases resulted in a charge and request for file (evidential and expedited) however 562 did not lead to a prosecution decision (based on evidential and public interest), which is 28.8% of the total precharge decisions. This percentage was better than the most similar grouping average 89 of 25.9% no prosecution decisions Trial dates following a not guilty plea should take place within a recommended six week time period. Between April 2011 and February 2012 the time period in which trials were listed following a not guilty plea was as follows:- the YTD averages were 35% within the recommended period of 6 weeks however 39% were held within 8 weeks, 18% within 10 weeks and 7% over 10 weeks. The percentage that happened within six weeks fluctuated monthly, with 11% the lowest (November) and 51% (April) the highest Between April 2011 and March 2012 there were a total of 1,667 prosecutions for domestic violence offences in South Yorkshire, with 1,239 (74%) successful and 428 unsuccessful. This South Yorkshire percentage was the same as the average for the Most Similar Group (MSG) 91. In Q2 2012/13 YTD figure is 75% (272) had a successful conviction, just up from 2011/12 but less than the MSG average of 76.3% In Q2 2012/13 the main reason for no prosecution decisions in South Yorkshire was due to victim issues (46.4%), which is a combination of victim retraction, victim non-attendance and evidence from the victim does not support the case. The other 53.6% issues were mainly due to conflict of evidence (15.5%) and essential legal element missing (17.9%) In Sheffield there were 26 criminal court outcomes (for cases closed between April 2012 and September 2012) that went through the court process and in both quarter all victims were supported by an IDVA, which was better than the South Yorkshire average of 91% in Q1 and 57% in Q2. 86 Violence Indicator Profiles for England Resource (VIPER) 87 Walby, S (2004) The cost of domestic violence, page South Yorkshire Criminal Justice Board, South Yorkshire Police. 11 th June 2012 (Draft) provided by Alison Higgins (member of SDVC steering Group) 89 The Most Similar Grouping (MSG) that South Yorkshire is compared to are Cleveland, Durham, Humberside, Lancashire, Northumbria, Nottinghamshire and South Wales. 90 South Yorkshire Criminal Justice Board, South Yorkshire Police. 11th June 2012 (Draft) provided by Alison Higgins (member of SDVC steering Group), page 7. Using the table with the Percentage of trails listed within the various target periods (Period 2011/12). 91 Ibid. 92 South Yorkshire DV/ SDVC Performance report, South Yorkshire Domestic violence data, (Draft), November Supporting document for Domestic Abuse Commissioning in Sheffield Page 37

38 6.30 In 2012/13 a total of 234 restraining orders were granted in South Yorkshire The Police and referrals into Domestic Abuse Support services. There are agreed processes in place for the police to refer into MARAC and the IDVA service for victims in domestic abuse incidents they attend who are identified as high risk (see Section 11B) The police have agreed links and protocols in place to refer victims of domestic abuse incidents who are identified as standard or medium risk and who give their consent for their data to be shared with the helpline service provider, so the helpline can return the call within a set time period following the incident (Section 11C, point 11.45). Supporting document for Domestic Abuse Commissioning in Sheffield Page 38

39 SECTION 7 Sexual Violence/ Abuse 7.1 Sexual violence includes sexual assault, rape, sexual coercion, sexual bullying and female genital mutilation and the perpetrator is not always a relation/ family member of the victim. 7.2 In 2011/12 there were (VIPER):- 50,371 sexual offences reported to police in England. 4,511 sexual offences reported to police in Yorkshire and Humber. 359 sexual offences reported to police in Sheffield However there is a significant proportion of crimes that happen but do not get reported (the BCS 2009/10 suggests that only 11% of serious sexual assaults are reported to the police) 94 and locally in Sheffield we know that around 60% of crimes reported then get recorded as crimes 95. Therefore if 11% of the total occurring was 359 in 2011/12, then there is a potential that over 3000 sexual offences crimes occur in Sheffield but do not get reported. 7.4 The BCS 2009/10 indicates that 2.3% of females and 0.5% of males were a victim of sexual assault in the last year. Applying these national rates to the Sheffield population would suggest that around 3,991 females and 900 males per annum (which is less than the number estimated by the Ready Reckoner which estimates there are 6,940 (+/- 95% = 4,552 to 9,328) female victims of sexual assault each year in Sheffield). 7.5 VIPER data indicates that the crude rate of sexual offences in Sheffield is 0.65 rate per 1,000 population (+/- 95% = 0.58 to 0.72), and the Sheffield rate is ranked 87 out of 326 local authorities (the lower the rank, the lower the rate). The Sheffield rate is lower than the Yorkshire and Humber regional average which VIPER reports is a crude rate of 0.9 per 1,000 population VIPER does not separate the type of sexual offence from the total reported however the Sexual Health Balanced Scorecard (Home Office data) shows reported rape and sexual violence data separately: Rape 7.7 Females: The number of reported rape of a female in England was 12,104 in 2008/9, this increased to 13,995 in 2010/11. This reflects a rate of 49.8 (CI +/-95% ) per 100,000 female populations in 2010/11 compared with a rate of 43.8 in 2008/9. The rate of reported rape of a female in Yorkshire and Humber has changed from 43.7 in 2008/9 to 49.8 ( /-95% CI) per 100,000 female populations in 2010/11. The Sheffield rate of reported rape is per 100,000 female populations (+/-95% CI 30.3 to 45.2) in 2010/11 compared with a rate of 27.7 in 2008/9 98. The change in the Sheffield rate is therefore reflected in the number of reported rapes of females; there were 75 in 2008/9, 88 in 2009/10 and 102 in 2010/ VIPER, data source for sexual offences 2011/12 94 Smith K, Coleman K, Eder S, & Hall, P (2011) Homicides, firearm offences and intimate partner violence 2009/10: supplementary volume 2 to Crime in England and Wales 2009/10 London: Home Office. 95 Information provided by Mel Simmonds, SARC Manager, May North West Public Health Observatory Violence Indicator Profiles for England resource 97 Rate police recorded rape in women, by Strategic Health Authority and Primary Care Trust, England 2010/11 rate per 100,000 female population (Scorecard Autumn 2011 release) 98 Rate police recorded rape in women, by Strategic Health Authority and Primary Care Trust, England 2008/9 rate per 100,000 female population (Scorecard Autumn 2011 release) 99 Ibid Supporting document for Domestic Abuse Commissioning in Sheffield Page 39

40 7.8 Males The number of reported rape of a male in England was 963 in 2008/9 (7% of the total) and increased to 1,173 (8% of the total) in 2009/ In 2009/10 there were 7 reported rapes of male victims in Sheffield. In 2008/9 activity was less than 5 and therefore cannot be reported. Male victims account for 6% of reported rape victims in Sheffield, in 2009/ There are a number of reasons why the increase in the number of reported rapes has been observed. Those consulted suggesting people are more likely to report than they were a few years ago, as there have been significant focus of domestic violence in the police service, plus both national and local promotions raising public awareness Sexual violence is also monitored in the Public Health Outcomes Framework. The Public Health Outcomes Framework has two performance indicators that cover violent crime, and include sexual violence. The indicators show how Sheffield compares to the England average and where Sheffield is ranked in the Yorkshire and Humber region Indicator 1.12i is Violence crime (including sexual violence) hospital admissions for violence 103. Between 2009/10 to 2011/12 Sheffield performance is 68.1 per 100,000 compared to the England average of 67.7, and ranks 11 out of 15 from the Yorkshire and Humber region (where 15 is the lowest ratio) Indicator 1.12ii is Violence crime (including sexual violence) violence offences is 9.3 compared to the England average of and ranks 13 out of 15 from the Yorkshire and Humber region (where 15 is the lowest ratio) The Police Apollo unit (soon to be changed to the Rape Investigation Team) is a South Yorkshire wide team working on rape and sexual assault cases. In 2012/13 the team recorded crimes on over 300 adult offences for rape and/or sexual assault and 131 for children (under 18 years). It is very likely that the number recorded is significantly less than those which are happening given that approximately 60% of crimes are recorded (BCS, 2009/10) On average Sheffield cases represent 36% of the Apollo Unit s workload (Data Source: - Mel Simmonds, SARC Manager) Sexual Assault Referral Centres (SARC) The SARC is located in Rotherham and provides support and care for victims of sexual violence. The service includes a health care service, forensic examination, assistance with the criminal justice system and support from an Independent Sexual Violence Advisor (ISVA), which provides an advocacy service following the initial support from the SARC The majority of the sexual violence offences were for rape (68%, or 118 cases) in The second most frequent offence was for other sexual assault (13% or 23 incidents) in 2012 but was serious sexual assault (12%, 20 cases) in Over the last three years SARC has seen (see Table 7.1, right) a three year increase in the number of cases for Sheffield victims; there 100 Rate police recorded rape in women, by Strategic Health Authority and Primary Care Trust, England 2010/11 rate per 100,000 female population (Scorecard Autumn 2011 release) Selected recorded sexual offences by offence category and by Local Authority, England and Wales 2008/9 to 2009/10 (Home Office data) 102 Ibid. 103 The number of emergency hospital admissions for violence (external causes: ICD-10 codes X85 to Y09). Directly age standardised rate per 100,000 population. 104 Violence against the person offences, based on police recorded crime data, crude rate per 1,000 population Supporting document for Domestic Abuse Commissioning in Sheffield Page 40

41 were 186 clients in 2013, 174 clients in 2012 and 167 in SARC Demographics and risk factors of sexual assault and rape victims In 2012 the majority of victims at SARC were female, however 10 were male victims and 86% were White British. Fourteen victims were aged 17 years or younger, with 18 to 25 years (49%) the age range with the highest number of victims. In 20 cases the victim was registered disabled. South Yorkshire wide data 105 suggests that risk factors presented include drug/alcohol (26%), sexual exploitation (4%) and prostitution (1%) Of cases reported to the police 70 were reported within one to three days of the incident taking place and 84 (52%) were reported between 4 days and 4 weeks of the incident taking place Changes to the commissioning of SARC SARCs according to 2005 National Service Guidelines for Developing Sexual Assault Referral Centres (SARCs) can be funded by a number of different local sources, which can include Police Forces, The Health Service, Local authorities, local CDRPs/Community Safety Partnerships, Local Criminal Justice Boards and donations from businesses and private benefactors. Local funding from Sheffield to the SARC in Rotherham comes from Health and South Yorkshire police New SARC guidance securing excellence in commissioning sexual assault services for people who experience sexual violence published in June 2013 changes the commissioning structure of what will be named Sexual Assault Services (SAS), making NHS England the lead on health care provision of the SAS working in collaboration with police and local authorities. The priority is to drive up SARC standards, by providing greater consistency and a focus on outcomes. The aim is for victims to have seamless access to support to address all aspects of the crime: police, forensic, assessment, clinical interventions, crisis support and counselling amongst others with the guidance explaining that the commissioning of specialist sexual advice support in the voluntary and community sector will be by local commissioners. The transfer will happen during 2013/ ISVA support for victims of rape and serious sexual offences The development and increased efficiency of the ISVA role is one of the new actions in the VAWG strategy (action 38). The Government s aim is to establish a register of all ISVAs, raise the profile of the role amongst statutory agencies and introduce quarterly regional focus groups There is currently one ISVA post working with Sheffield and Rotherham victims and this post (as of May 2013) has an annual caseload of 155 individuals, of which the majority (99) cases are Sheffield victims. ISVA support is given to the client whilst the case is in the process of going to court, with the offer of one to one support or telephone support based on client need. The funding of this post is from a Home Office sexual advisors grant ending in 2014/15. There are no national of local guidelines on the size of an ISVA caseload and this has been an on-going debate between SARCs. Following discussions with the local SARC manager a caseload of The data here is for South Yorkshire wide victims, data for Sheffield is unavailable at the time of writing. 106 P. Townsend, South Yorkshire Police. Rape and serious sexual offences steering group performance report, 2012/13 yearend report (draft). 107 Information provided by Mel Simmonds, SARC Manager, January 2013 Supporting document for Domestic Abuse Commissioning in Sheffield Page 41

42 would provide a comprehensive service. Based on current activity of 151 cases per annum, even if the caseload was 100 per annum (as per the high risk IDVA service) it would appear that the current ISVA caseload is stretched Sheffield will no doubt be involved in these developments and the DACT needs to be a stakeholder Children and young people A significant proportion of Sheffield victims accessing SARC (14 in 2012) are less than 18 years old, the securing excellence in commissioning sexual assault services for people who experience sexual violence report cites a reference to an NSPCC survey undertaken in 1998 that 16% of girls in the UK experience sexual abuse Sheffield does not fund a Children s ISVA unlike the other three South Yorkshire regions. Instead Sheffield provides a Child Assessment Unit located at the Sheffield Children s Hospital, with access to a psycho-therapist. Whilst this is not the advocacy service that a children s ISVA would provide the service provides a level of support that would otherwise not be available. Further consideration should be given to fully understand the benefits that this Sheffield approach gives to those victims aged less than 18 years compared to the other areas in South Yorkshire There is a need to continue to monitor the number of cases on the ISVA caseload, and there is a need to ensure DACT is included in the partnership working between the Local Authority and the NHS In addition to the SARC and ISVA support there is additional local commissioning of support for victims of sexual abuse. All HIS and Local Authority contracts with domestic abuse services include providing support to victims of sexual violence, therefore work with sexual abuse victims in all support services needs to be better understood The is also one specific service, the Sheffield Rape and Sexual Abuse Counselling Service are commissioned by the Voluntary Sector Liaison team using Grant Aid funding to provide a counselling service for women (aged 13 and over) who have experienced rape or sexual abuse at any time in their lives. The service is commissioned to provide one to one counselling, telephone information and helpline service In terms of activity, the service received more telephone calls (over 500) compared with their target of 400, with a significant increase in the number of short term intervention and support calls. The service appears to have a large number of new volunteers each quarter (12, between January and March 2013) providing around 13 hours of support per week. Most of the volunteer support is on the helpline which has doubled its operational hours in the nine month period from 8 hours to 16 hours per week One to one support is in demand, with a waiting list of 37 individuals (and an average wait of four months. There were 80 clients who received one to one counselling, which is just below their target of 85 however a significantly small number of clients left support during this time period, therefore the waiting list whilst less than in July to October (12 clients chose to leave the list, thereby decreasing the number waiting) is high and clients remain in support According to Grant Aid Outcome reporting data this service did not assess any new client using this tool between July 2012 and March There is a need for the SRASACS service to 108 NHS England (2013) Securing excellence in commissioning sexual assault services for people who experience sexual violence Supporting document for Domestic Abuse Commissioning in Sheffield Page 42

43 use the ACPO DASH assessment tool as the recognised assessment tool for Sheffield victims of domestic abuse There is a need for this service to reduce the waiting time for assessment and to have an effective approach to discharging clients successfully in a shorter period of time. Supporting document for Domestic Abuse Commissioning in Sheffield Page 43

44 SECTION 8 Forced Marriage (FM), Honour Based Violence (HBV) and Female Genital Mutilation (FGM) The national strategy Action Plan 2013 Update has 10 actions 109 that are currently addressing the issues of FM, HBV and FGM. Actions included a number of legal changes to tackle these issues and increasing awareness and understanding of the issue to both potential/victims and towards changing attitudes. 8.1 Forced Marriage (FM) A Forced marriage is a marriage in which one or both spouses do not (or, in the case of some vulnerable adults, cannot) consent to the marriage and duress is involved There is no specific criminal offence for forcing someone to marry another 111 but there is a current list of other offences that perpetrators could be convicted of i.e. kidnapping, harassment, false imprisonment, child abduction, assaults etc but this will change following a Home Office consultation in 2012 and a public announcement on 8 July Currently the Forced Marriage (Civil Protection) Act provides some protection for such individuals via Forced Marriage Protection Orders, of which 339 were issued between November 2008 and June Prevalence A report by Kazimirski et al (2009) suggests there are an estimated 5,000-8,000 reported cases of forced marriage in England each year 114. There is no further breakdown by region or city. Kazimirski suggest that of the reported cases 38% relate to those already in a forced marriage and 62% to a marriage that has not as yet taken place. 8.5 The majority of FMs involve a young female victim (4/5), and around one third of the cases handled by the Forced Marriage Unit (FMU) involve children aged less than 18 years and 97% were identified as Asian. This closely reflects the data regarding country of origin held by the FMU for the cases which have come to their attention, in % of cases related to Pakistani, 15% related to Bangladeshi, and 8% Indian victims % of FM cases reported to local organisations related to female victims and only 4% to male victims, with 41% of reported cases having a victim aged less than The Jan Trust report (March 2012) indicates that a consultation of over 1,000 Pakistani women ( ) found that 85% of women reported a forced marriage within their family, but only 77% would approach the police if faced by or was in a forced marriage. 90% of the women felt there was a need to raise awareness of forced marriage, a need to eradicate incorrect ideology and signpost to further support The FMU (provides direct assistance to victims) supported 1,700 individual cases/victims in 109 Actions 19,20, 21, 34, 35, 75, 91, 92, 96, Kazimirski K, Keogh P, Kumari V, Smith R, Gowland S, Purdon S & Khanum N, (2009) Forced Marriage:- Prevalence and Service Response, National Centre for Social Research 111 Forced marriage consultation, Home Office, December The Forced Marriage (Civil Protection) Act Forced marriage consultation, Home Office, December Kazimirski K, Keogh P, Kumari V, Smith R, Gowland S, Purdon S & Khanum N, (2009) Forced Marriage:- Prevalence and Service Response, National Centre for Social Research 115 Consent matters: towards an effective prevention of forced marriages within the Pakistani community in the UK, as cited in the Domestic and Gender based violence in Haringey: Needs assessment, June Supporting document for Domestic Abuse Commissioning in Sheffield Page 44

45 Local Information on FM, HBV and FGM In Sheffield commissioned services are required to work with individuals fleeing a forced marriage. Forced marriage victims can access support via the generic services of the helpline, the IDVAs, outreach and refuge, and evidence from Modus suggests that individuals are doing so (although activity data is low) Similar to national activity, data is also very limited in Sheffield. Once FM and HBV can be recorded as crimes then data will be available for the number of recorded crimes. The police however do have files for HBV and FM individuals and anecdotally there are around three forced marriages per week being investigated The number who are accessing support is again limited, however based on the information available (a snapshot of Quarter three 2012/13 activity data) 117 the number of individuals at risk of forced marriage and accessing support services could be around 20 per year (see footnote for calculation) Safeguarding and Forced Marriage Safeguarding children with disabilities and vulnerable adults from forced marriage should form part of existing child and adult protection structures, policies and procedures including those that relate specifically to children and adults with a learning disability. (Forced Marriage and Learning Disabilities: Multi-Agency Practice Guidelines, page 6) In Sheffield local protocols have been agreed between multi-agency support services, in line with national guidance and implemented. Training was held during November 2012 to launch the safeguarding process for those who were victims of forced marriage and/ or who had a disability (often found to be a learning difficulty) or was a vulnerable adult. These processes direct services to the relevant safeguarding service: where such victims are under the age of 18 to safeguarding children s services and those aged 18 plus to safeguarding adult services. There is on-going work to provide a seamless service for those transferring from children to adult safeguarding services There is a cross-over between Honour based violence and forced marriage, however in this report they have been discussed under separate headings Honour based violence (HBV) The CPS and ACPO have a common definition of HBV: Honour based violence is a crime or incident, which has or may have been committed to protect or defend the honour of the family and/or community There is no specific criminal offence for honour based violence; however the actions of such practice, i.e. murder, kidnap, rape and violence are criminal offences There are no known prevalence estimates for HVB in this country. An FOI request by The Iranian and Kurdish Women s Rights Organisation (IKWRO) found there are 2,823 honour 116 Forced marriage consultation, Home Office, December 2011.page Paloma Modus Intake and exit data % of those who consented to their data being shared (consent given and high risk victims), therefore applied to total for the quarter (303) and multiplied by 4 quarters the total would be around 20 individuals per annum accessing services Supporting document for Domestic Abuse Commissioning in Sheffield Page 45

46 crimes a year, which is over 7 per day and the national helpline for victims of domestic violence caused by honour based violence have doubled in the four years since it was set up, to 500 calls a month Commissioned DA services and refuges in Sheffield support individuals who are victims of HBV; with some new contracts specifically stating the provision of HBV support Activity data is very limited for HBV. The intake and out-take forms used by those services using Modus list HBV as a vulnerability A citywide protocol for forced marriage and HBV was launched in Q3 2012/13 leading to increased awareness of these types of abuse and an increase in the number of cases reported by workers The number of police incidents reported HBV is unknown because it is not currently recorded as a crime (as cited above this is due to change) however the police do have cases where such crimes are being investigated Female Genital Mutilation (FGM) A person is guilty of committing FGM if they excise, infibulate or otherwise mutilate the whole or any part of a girl s labia majora, labia minora or clitoris 122. To date there has not been a prosecution against any individuals for performing or assisting in FGM despite being a criminal offence since The FGM Act (2003) has made it illegal for UK citizens of permanent residence to take a child from the UK abroad for cutting, even to a country where the practice is legal. These offences carry up to a maximum of a 14 year maximum prison sentence Prevalence Data A FORWARD report 124 estimates that around 20,000 children are at risk each year from FGM , and a report from 2010 indicates that a London clinic has observed a rise in the number of patients with FGM year on year 127. A report from Bristol has found that their social services department has on average one case of FGM per month 128. There is no local data to understand the number of service users accessing support services due to FGM in Sheffield. FORWARD s report provides an estimate for the number of live births each year to mothers who potentially had FGM (originated from a country where FGM is practiced and where the risk of FGM has been calculated). For Sheffield the FORWARD estimate was 2.14% of live births in 2004 were to women who have undergone FGM, which equated to around 130 babies at risk. FORWARD s report also shows increasing projections between 2001 and The report does however have limitations including the assumption that if the mother had FGM then the baby may undergo FGM too. It does not factor in that the baby may not undergo FGM (the mother may have been born outside of the UK) and how the risk of a baby undergoing FGM maybe different (i.e. lower) than if the baby had been born in the country of the mother s origin. 121 'Honour' crime victims living in fear in the UK, Monday, 19 March 2012, BBC Panorama Section 1 (1) The Female Genital Mutilation Act (2003) 123 CPS to crack down on female genital mutilation, The Guardian, Friday 23 rd November Dorkenoo, E., Morison, L., MacFarlane, A. (2007) A statistical study to estimate the prevalence of female genital mutilation in England and Wales, Summary report, FORWARD CPS to crack down on female genital mutilation, The Guardian, Friday 23rd November Rise in female genital mutilation in London, 22 August 2010, BBC News, Bristol women protest against FGM, 16 June 2010, BBC news. Supporting document for Domestic Abuse Commissioning in Sheffield Page 46

47 8.24 Support for those with FGM or at risk of FGM FGM is usually performed on young girls and in some cases on teenage girls and therefore would not come under the ACPO definition of adult abuse (16 or over). It would be defined as child abuse and therefore would fall under the remit of child support services Commissioned adult domestic abuse services can provide support to individuals over the age of 16 when FGM is an issue in the family and adult sexual violence services can provide support to those who are an adult survivor of FGM. Supporting document for Domestic Abuse Commissioning in Sheffield Page 47

48 SECTION 9 Perpetrators 9.1 Identification of perpetrators can be complex, as a result of counter allegations or situations that appear to not conform with known statistical profiles e.g. around 83% (SY Police data) of domestic abuse incidents are committed by men against women, this can be further complicated in same sex relationships and where the history of abuse includes report incidents on both sides. The national organisation Respect 129 has done a lot of work in this area and their guidance provides the following explanation:- It is very rare to find someone who is both using and experiencing violence and abuse of equal severity, risk and consequences to and from an intimate partner or ex-partner. The situation is often complex. Victims may well be using legal reasonable force but nevertheless present a higher risk of injuring their abusive partner than vice versa. Perpetrators may be escalating their own use of violence, which could be leading to an increased risk that the victim will retaliate. If the man is presenting or being described as being in a mutually violent relationship, this indicates the need for more detailed assessment, using if possible a range of sources of information from the client, their partner or other agency working with their partner, other agencies and professional judgement if the worker is skilled and experienced at responding to domestic violence. Perpetrator who is actually a victim Sometimes, if the victim has used violence in resistance, self-defence, and retaliation or to defend children or others they may be wrongly identified or wrongly present as a perpetrator. This mis-identification can be further exacerbated if the person concerned does not want to identify themselves as a victim. Victim who is actually a perpetrator Sometimes, if the person using intimate partner violence has experienced force used by their victim as self-defence, defence of children, resistance or retaliation they may be wrongly identified or wrongly present as a victim. In these cases they may have used this incident or incidents to distract attention away from their own abusive behaviour, or other agencies may have identified them as both as bad as each other. 9.2 Perpetrators are considered in this report in two ways:- Victim domestic abuse support services There is a need for victim support services to be aware of the risk associated with perpetrators, who may attempt to access support themselves as a way of getting to the victim. To combat this there is a screening tool contained within the Respect Toolkit which is used by commissioned support services on all male referrals, and commissioned contracts include the use of this tool. Support for Perpetrators Support provided aims to to encourage the perpetrator to take responsibility for his behaviour, to recognise internal and external triggers for violence, and to understand and take responsibility for the consequences of his actions Royal College of Psychiatrists, Domestic Violence Council report Supporting document for Domestic Abuse Commissioning in Sheffield Page 48

49 9.3 Perpetrator Profiles: Relationship to victim The perpetrator is the individual who commits the violence towards another family member. In Sheffield the majority of perpetrators are violent to a current (32%) or ex-partner (46%) 131 with 11% by another family member, 3% by an adult child and 0.7% committed by a partner or ex-partner of the same sex, (see Table 9.1 to the right). 9.4 Perpetrator Profiles: Age of Alleged Perpetrator The age of the alleged perpetrator shows an interesting observation: 9.5 Police activity shows that the highest age category is perpetrators aged 20 to 29 years (41%) 132, however Paloma Modus activity (June 2012 to July 2013) shows the age of the perpetrator at the point where the victim seeks support (see Table 9.2 to the right). 9.6 Here the data shows that 25% of all perpetrators of those accessing domestic abuse support services are aged 31 to 40 years grouping, with 22% of perpetrators aged 19 to 25 years. These are the same highest groups as found with the victim s in support profiles. The graph also shows that there are number of young adult perpetrators, with 30 perpetrators aged 18 years of less (of those who seek support), whilst police data shows that 20% of perpetrators were aged up to 19 years old. 9.7 Therefore suggesting there is a period leading up to when a victim seeks support, where incidents are reported but help is not sought (which would explain the difference between the highest age group of perpetrators reported to the police and the highest age group of the perpetrator at the point where the victim seeks support) and that data 133 suggests there is an average of 5 years in the life of the abuse. 9.8 Gender Research undertaken by Hester (2009) 134 suggests that the majority of perpetrators are male (92%) in her study of the North East and this was not dissimilar to that found nationally. Police data in Sheffield reflects this research, with 93% of domestic abuse incidents having a male perpetrator. 131 Of 1,064 clients referred to support services in Q2 2012/ Domestic Violence reported in Sheffield January to December 2012, South Yorkshire Police 133 Insights National dataset Hester, M (2009) Who does what to whom? Gender and Domestic violence perpetrators Bristol: University of Bristol in association with the Northern Rock Foundation Supporting document for Domestic Abuse Commissioning in Sheffield Page 49

50 9.9 Occupation Unemployment is a risk factor, with nearly 60% of perpetrators unemployed at the time of the incident. This is a significant proportion, given that in April 2012, the proportion of the working age population in Sheffield that were claiming Job Seekers Allowance (JSA) was 4.6% (national average of 3.7%), and some wards experiencing a greater proportion than others (e.g. Brightside 7.9%) Ethnicity Police data shows that 80% of perpetrators are White North European, 10% are Black and 7% are Asian Perpetrator support The Strength to Change report (2010) 136 reviews the outcomes of a voluntary perpetrator support project located in Hull that provided support to the perpetrator, their partners, expartners and children. There was a mix of support provided:- support to the perpetrators included telephone advice, assessment and support, one to one signposting to relevant services, one to one courses for up to 10 weeks and group courses for up to 40 weeks. Support to partners, ex-partners and families included unlimited one to one support and telephone advice The findings of the report found that after 16 months duration there was an observed reduction in the number of re-offences committed by perpetrators who had been on the course, a reduction in the number of police call outs and when incidents did occur, a lower severity of violence. The report provides a comprehensive cost benefit analysis, however in summary the findings estimated that for every 1 spent there would be a return on investment of 2.24 for reduced criminality, of 2.57 in net saving for health services, of 10 to all public agencies and up to 14 for human and emotional costs. Due to the report being produced within sixteen months of the start of the project there is no longitudinal findings or social findings e.g. social benefits to the family. The report did recognise that these factors could (if known) add further financial benefits than those observed in the report e.g. a child did not have to enter foster care or had ended social services interventions Other studies support the findings of the Strength to Change report, Gondolf s (1999, 2002 and 2004) 137 found a longer term reduction in re-assault but whilst on the programme most men committed a further assault. Westmarland et al, 2010) focused more on the social impact: the victim felt safer, had freedom from a violent relationship, had more empowerment, were more positive in their parenting and had enhanced self-awareness From a programme viewpoint Gondolf found the best outcomes (as above) were following programmes that were of high quality, had a good course completion rate, had interaction with the female victim alongside the male perpetrator and consequences (i.e. legal) for course compliance National Support available for Perpetrators Jeremy Browne MP, in the VAWG writes on page 6 this plan recognises that to fully protect victims we must address the behaviours of perpetrators. National Perpetrator support is via the Probation Service, which runs the IDAP and CDAP 135 State of Sheffield 2013, Sheffield First Partnership 136 Lancaster, J (2010) Strength to change: Return on investment, NHS Hull 137 D. Alex Heckert and Edward W. Gondolf (2004) Predicting Abuse and Re-assault Among Batterer Program Participants Westmarland, N., Kelly, L. & Chalder-Mills, J. (2010) What counts as Success? London: Respect Supporting document for Domestic Abuse Commissioning in Sheffield Page 50

51 courses (more on the next page) and some cities (but not all) provide specific locally commissioned support. The VAWG Strategy has an action that relates to perpetrators; action 103 to support the evaluation of local perpetrator pilots with the outcome expected March Respect have a national perpetrators helpline, and a website providing information. The number of people accessing this service from Sheffield is unknown, although a request was asked of Respect Providers of a perpetrator service require an accreditation, which can be gained via Respect Local Support available for Sheffield residents There are no current statutory requirements to commission local perpetrator support and in Sheffield there is no voluntarily perpetrator programme commissioned Therefore the only current active perpetrator support for Sheffield residents is the Probation Service South Yorkshire Integrated Domestic Abuse Programme (IDAP) and CDAP which are South Yorkshire wide perpetrator programmes (both are similar but IDAP is for 26 weeks and CDAP is for 10 weeks duration). The probation officer assesses the individual s 140 suitability to change and risk level (e.g. High Risk definition here is how like the perpetrator is too commit domestic abuse in the future) and for those suitable it is recommended a part of their order which has then been granted by court CDAP is a nationally accredited group work programme designed to reduce re-offending by adult male domestic abuse offenders against female victims 141. The programmes are structured according to the Duluth model 142 using the Power and Control Wheel Post evaluation measure reports are undertaken by the Probation Officer and with the offender. The men have a midway and a final review with Tutors and Probation Officers. The men also provide programme feedback i.e. how useful they found the group programmes, how they will feel it will help and what they have learned The multi-agency programme (Police and Probation supported) also provides Women Safety Workers (WSW). These are involved from the start and visit the woman if she wishes when the individual is on the programme. This has been found to be a tricky time as the men get angrier at having to be on the programme so risk is heightened. The WSW s also visit the woman three months after the programme has finished The service is currently unavailable to probation clients who are deemed medium or standard risk at committing further domestic abuse, which means a fraction of the people who could benefit from such support and training do so In Sheffield 47 adult offenders started the programmes (over a one year period) and 32 completed (68%) 143. South Yorkshire data for the last three years shows the number of completions were 90 in 2010, 86 in 2011 and around 90 in Information provided by Barbara Williams, Team Manager, Group Programmes and Victim Contact, (IDAP, CDAP, WSW's & VCO's), South Yorkshire Probation Trust, Group Programmes Division Police data contained in the Sheffield First Sustainable Communities Partnership: Sheffield Joint Strategic Intelligence Assessment Information provided by Barbara Williams, Team Manager, Group Programmes and Victim Contact, (IDAP, CDAP, WSW's & VCO's), South Yorkshire Probation Trust, Group Programmes Division Supporting document for Domestic Abuse Commissioning in Sheffield Page 51

52 9.25 Given the A Call to End Violence Against Women and Girls Action Plan 2013 aims to address the behaviour of perpetrators and that there is a recognised gap in Sheffield for commissioned voluntary perpetrator support, the recommendation is that a feasibility study should be undertaken to understand the benefits of commissioning a local voluntary referrals perpetrator programme, although waiting for the outcome of Action 103 (April 2014) would be advisable. Supporting document for Domestic Abuse Commissioning in Sheffield Page 52

53 SECTION 10 Commissioning of Domestic Abuse Support Services in Sheffield 10.1 Since April 2012 the Sheffield Domestic Abuse Co-ordination Team 145 (DACT) has been the lead for the co-ordination of commissioning domestic abuse support services in Sheffield The DACT held a consultation on Domestic Abuse with all key stakeholders in Sheffield to review governance, the commissioning model and service provision. The outcome of the consultation was written into an Implementation Plan (see Appendix 2). Many of the actions are already completed or are on the way to being completed Funding of Domestic Abuse Services in Sheffield The funding of DA services in Sheffield has historically been complex due to the number of different funding streams: the Safer and Sustainable Communities Partnership, DACT, Voluntary Sector Liaison Team, Supporting People and NHS Sheffield. One of the main actions has been to remove the complexity of commissioning and pool the funding of DA services in Sheffield (as per the Consultation action plan), remove duplication and simplify access to support for both service users and professionals The commissioning of domestic abuse services has been guided by the following best practice:- The Government s Call to End Violence against women and girls strategy states:- 146 :- a. The government will prioritise Home Office funding for ISVAs, SARCs, IDVAs, MARAC coordinators and the national helpline over the spending review period. The guidance also accepts that most funding will be provided locally and that the majority of services will be provided at a local level. b. Joint commissioning, for example is one example of an important means of providing services by getting rid of duplication and inefficiencies. (pg. 18) c. Value for money is a key driver in commissioned services (page 18) d. Consider new models of working and models to aid sustainability. e. Improved accountability. NICE best practice guidance for the commissioning services for women and children who are victims of violence 147 which highlights/recommends:- a. Many main stream health services provide care, treatment and recovery services to victims of domestic abuse, including primary care, maternity, secondary care, emergency services, health visitors, mental health services and sexual health services. b. There is a need for commissioners to consider how health services will best support the processes identified for domestic abuse victims, such as working with MARACs, making referrals into local services and providing for individual victims. c. There is a need for clear pathways so professionals easily know how to refer into local domestic abuse services. d. Commissioners should take into account the need for both domestic abuse support services and safe spaces for women to recover with dignity. A domestic abuse web assessment tool resource allows commissioners to:- a. Evaluate domestic abuse service performance and identify areas for improvement. b. Explore the characteristics of a successful service and shows where practical changes can 145 Previously named the Drug and Alcohol Action Team in April 2012, the name change to incorporate domestic abuse happened on the 1 st December Call to end violence against women and girls, HM Government. 147 Commissioning services for women and children who experience violence or abuse a guide for commissioners (NICE) Gateway 15911, February 2011 Supporting document for Domestic Abuse Commissioning in Sheffield Page 53

54 be made with partners to improve services 148. c. Explains that local domestic abuse commissioners need to understand what national commissioning is available for local people to access, what is mainstreamed, what are statutory requirements and what local additional requirements are to meet the needs of Sheffield residents Therefore commissioners need to ensure there is effective co-ordination between public sector services, effective communication between services (both domestic abuse services and public sector services), have an agreed and working referral process in place for victims to receive support, for effective performance management of domestic abuse support services all underpinned by a robust governance structure and nationally recognised guidance and best practice Domestic Abuse Governance Structure & Commissioning The following governance, strategic and consultation arrangements are now in place in Sheffield: - a Domestic Abuse Strategic Board, a Joint Commissioning Group, a redesigned Operational group a Provider Consultation Group (PCG) (a quarterly meeting where representatives for a range of services working with domestic abuse victims are consulted on both national and local issues). There remains the need for a Service User Representation Group, which will be a formal method of consulting with Service Users and service user representatives which will be starting in the Autumn of Each Group provides a summary of their decisions and actions which then feed formally into the Strategic Board Changes in commissioning of Domestic Abuse Support services in 2013/14 Domestic abuse provision in 2013/14 includes a high risk service (IDVA), a standard to medium service (Helpline and Outreach), floating support, and three refuge providers (HIS has a business case to move towards commissioning a one refuge provider model (moving from the current three provider model) in addition to Temporary Supported Accommodation Needs Assessments Local commissioning will informed by local need, using this Supporting Document and other relevant data sources. Domestic Abuse will be a section in the Sheffield Joint Strategic Intelligence Assessment (the citywide needs assessment for the Sheffield First Safer and Sustainable Communities Partnership) and the Joint Strategic Health Needs Assessment (JSNA) Domestic Abuse Performance data Domestic Abuse performance data is included in the Portfolio Leadership Team (PLT) quarterly performance report and the Public Health Outcomes framework. The PLT performance framework has the following targets for Domestic Abuse in its dashboard of indicators. Number of new cases supported via the helpline Number of new standard / medium cases supported by the outreach service Number of new high risk cases supported via the IDVAs Completion of the Implementation Plan Supporting document for Domestic Abuse Commissioning in Sheffield Page 54

55 10.11 The Public Health Outcomes framework has two domestic abuse indicators, 1.11 Domestic Abuse (where the measure is still to be confirmed) 1.12ii Violent crime (including sexual violence) Performance Management of services The formal performance management of services is in a process of change and will be fully implemented for the first time during Quarter /14. The process will be for each DACT provider to complete and return an activity Performance Monitoring Framework report and to meet formally with Commissioners quarterly to discuss performance against contracted targets. Supporting document for Domestic Abuse Commissioning in Sheffield Page 55

56 SECTION 11 Domestic Abuse Support Services in Sheffield 11.1 There are a number domestic abuse services in Sheffield providing support/ advice to:- victims of domestic abuse - aged 16 and over victims of sexual abuse - all ages perpetrators of domestic abuse aged 18 and over professionals working with those affected by domestic abuse Individuals who are concerned about the domestic abuse situation of another, e.g. family member Service provision includes: IDVA, one to one support for domestic abuse and those affected by sexual abuse, group support, refuge provision, floating support, a helpline for domestic abuse, a helpline for sexual abuse, SARC, training for professionals and a number of voluntary sector services that are not commissioned by the local authority, but by other grants e.g. National Lottery These services provide a range of support covering all three risk areas; Standard, Medium and High risk. Table 11.1 below shows a summary of the service provision. Table A full list of service provision in Sheffield Type of Service Provision Name of provider Domestic Abuse Commissioner Who is the service for? Risk Female Male 1 Helpline DAOS DACT Victim, Professional, perpetrator All Yes Yes Yes 2 Domestic Abuse website - DACT Victim, Professional, perpetrator All Yes Yes Yes Independent Domestic Violence Advocacy Service (IDVA) service providing support to high risk 3 individuals (citywide, A&E and Jessops) VIDA DACT Victim High Yes Yes No 4 Multi-Agency Risk Assessment Conference (MARAC) Police and Probation chair Victim High Yes Yes No 5 Citywide Floating support Ashiana Sheffield, Young Women's Standard to Housing Project, Action Housing HIS Victim medium Yes No No 6 Outreach service - Power to change group work and one to one support) DAOS Grant Aid Victim Standard to medium Yes Yes No 7 Refuge Provision Ashiana Sheffield, Haven House Project, Women's Aid, HIS Victim High Yes No Yes 8 Refuge Young Womens Housing Project Supporting People Victim High Yes Yes Yes 9 Counselling for sexual abuse victims Sheffield Rape and Sexual Abuse Counselling Service. HIS Sexual Abuse Victim All Yes Yes Telephone helpline support for sexual abuse 10 victims Sheffield Rape and Sexual Abuse Counselling Service. Grant Aid Sexual Abuse Victim All Yes Yes Sexual Assault Referral Centre (SARC), with ISVA support (Forensic Medical Examination, Emergency Contraception, Immediate Crisis Support, Sign-posting to Service, Police Interview 11 Suite) ISIS South Yorkshire NHS and Police Sexual Abuse Victim All Yes Yes Yes Service to protect individuals in their own homes 12 by providing security solutions Sanctuary Scheme Housing Solutions Victim All Yes Yes Yes Domestic abuse training for health and public 13 sector services VIDA DACT Professionals 14 South Yorkshire wide IDAP perpetrator course Probation Probation Perpetrator High (Perpetrators) Yes 15 South Yorkshire wide CDAP perpetrator course Probation Probation Perpetrator High (Perpetrators) Yes 16 Eva Therapy Service & Group work VIDA Not Commissioned Victim All 17 Support to Female street sex workers Sheffield Working Women s Opportunities Project (SWWOP) Not Commissioned Victim Yes No Support & Advocacy Service, counselling, children and Young people support service & Perpetrator 18 programme Sheaf Domestic Abuse Services Not Commissioned Victim, Perpetrator Yes Yes Helpline, support and advocacy for BAMER women citywide and all women in the Burngreave 19 area Burngreave Domestic Abuse Project Not Commissioned Victim Yes Victim support, further support in the courts via the Witness Service and provide other specialist 20 services including the Homicide Service Victim Support Not Commissioned Victim Young People (0-18 years) Supporting document for Domestic Abuse Commissioning in Sheffield Page 56

57 11.4 A list of services specifically to support children and Young People affected by domestic Abuse (victim aged 16 to 19 years victim, perpetrator or living with a victim of abuse) is in progress, as part of the exercise outlined in Section 4 Young people, Children and Safeguarding What number access domestic abuse support services? Ascertaining the exact number of individuals accessing support for domestic abuse is complex. The following issues & actions to be taken are as follows:- There is no national minimum dataset for Domestic abuse services, which makes identifying the level of need and demand for support difficult. An anonymised dataset would assist the commissioners in understanding the total annual activity, based on the total unique individuals who have accessed support in the last year, to have comparable between years, have robust performance management information and direct numeric comparisons could be made to prevalence and police activity data. Minimum datasets have started to be introduced on a local level and one will be introduced to commissioned services of domestic abuse in Sheffield during 2013/14. The DACT is working with provider services to agree data collection fields, complete robust data information sharing agreements with explicit consent processes and work with Paloma Modus (the case management software provider) to ensure IT software matches and meets requirements. Commissioned services are not all utilising the Paloma Modus Software system in the same way, which is not surprising given the combination of it being complex software 149, known reporting issues and personal opinions from some providers over the sharing of information and data security. Training has been provided a number of times, there has been a working group and there has been updates made to the software. All LA contracts contain a specific clause stating the provider should report to the database and in 2013/14 there is a focus on getting all commissioned services to use the software. Data sharing agreements will be rewritten to reflect new/ recent guidance (e.g. Cauldicott & NICE recommendations (Draft)); compliance monitored and therefore should remove some misgivings that individuals have. Some domestic abuse services are not commissioned and therefore do not use the Paloma Modus software. There has to be recognition that activity in these services cannot be tracked. Service user feedback would provide an insight into victim use of both commissioned and those not commissioned by DACT support services. Work with domestic abuse individuals is not mutually exclusive to domestic abuse support services, e.g. GP practices and mental health services. There is currently no routine central reporting system for all services into the LA i.e. HIS and Grant Aid do not routinely send DACT their quarterly data. Work is in progress to address this within the Joint Commissioning Group during 2013/ Information therefore has been identified as a gap because to have a better understanding of how services are accessed will enable greater performance management of all services and ascertain a greater understanding of local need and demand. Section 11 does attempt to provide an overview of commissioned activity, using annual activity figures where possible, but often using one quarter s data to provide a snapshot of activity. These data issues need to be considered when reading this next section The Sheffield Domestic Abuse Pathway The pathway has been redesigned for professionals to identify, refer and signpost individuals to the most appropriate point to meet their needs. Understanding the level of identified risk of a victim is the key to directing a person to a domestic abuse support service, as per the pathway outlined (see table 2.12). 149 Note there is a separate project reviewing the viability of Paloma Modus and the long term future of software needs in Sheffield lead by James Newcomb, DACT Supporting document for Domestic Abuse Commissioning in Sheffield Page 57

58 Table 11.2 The Sheffield Domestic Abuse Pathway April 2013 (pre implementation of Supported Accommodation Pathway) All agencies are encouraged to use the ACPO DASH risk indicator checklist (see Each agency will have identified triggers for completing an ACPO DASH based on key risk factors * Universal health and other services (GPs etc.) can contact the Helpline and Assessment Team for help / support in completing a DASH or to ask for a DASH to be undertaken High Risk? Yes Sheffield Domestic Abuse Pathway Victim presents at service or agency Screen for ongoing abuse and severity If risk issues are evident Risk Assess - using ACPO DASH Medium or standard risk? Signpost or refer (if consent given) to: Helpline and Assessment Service No current risk issues or No consent signpost or refer to Helpline or to seek support* with ACPO DASH Safeguarding Where children or vulnerable adults are living with or at risk from domestic abuse, agencies must follow their usual Safeguarding processes and ensure appropriate referrals are made. Supported Accomm Pathway to be implemented 2014 Housing Related Support primary need? If high risk Housing Related Support issue? Supported Accommodation Pathway (to be implemented 2014) No Yes Refer to High Risk Service and MARAC Medium / standard risk service Yes Consent? No Brief advice / signposting Emergency Accommodation or Floating Support** ** The emergency accommodation options offered would be: 1. Refuge in Sheffield 2. Temporary accommodation in Sheffield (via Housing Solutions) 3. Refuge out of Sheffield (if client does not want to stay in the city) 11.8 Identified Risk: Risk level of victims A risk level associated to a case is given at the start of the support process. There are two nationwide tools available for assessing the level of risk (to the victim) and of these the ACPO DASH risk assessment tool is used in Sheffield. A DASH assessment should be undertaken on all cases (regardless of client age) where domestic abuse is on-going or likely to occur again. Consent is asked but is not required due to the level of associated risk) and on all medium and standard where consent is given The DASH assessment tool has been launched and rolled out, and is included on all domestic abuse contracts. On-going promotion of the DASH continues locally with particular focus in health services in 2013/14. The aim is to get all domestic abuse victims seeking support to have a DASH assessment regardless of where they seek support (e.g. GP practice) Risk levels are monitored and recorded by all domestic abuse services. 4,047 individuals had an assessed risk level in 2012/13. 87% clients had an assigned level of risk and the distribution is shown in Table 11.3 below. Supporting document for Domestic Abuse Commissioning in Sheffield Page 58

59 Table 11.3 Assessed Risk level of victims referred to domestic abuse support services Total without High Medium Standard Unassigned Total unassigned Q , Q ,190 1,018 Q ,261 1,112 Q , Total ,633 4,047 Total (%) 20% 57% 22% Of the 4,047 assessed (note there will be repeat victims included in this number) 20% recorded as high risk, 57% medium risk and 22% standard risk. There is no national benchmark to compare this breakdown too however the East Sussex Safer Communities Partnership Needs Assessment 2010 contains their proportions: 28% high, 58% medium and 14% standard with 11% unassigned). Graph 11.3A shows the proportions by quarter and the total figure, with the figure showing that the proportions did not vary much by quarter. Graph 11.3A The medium risk clients are a similar proportion although in Sheffield there is a lower proportion of high risk clients, which as Section 11B on High risk clients discusses Sheffield has an increasing high risk client base but CAADA suggesting the number of high risk clients should be higher than it is based on their estimates One additional factor to bear in mind is that higher risk individuals are more likely to access services, therefore Graph 11.3A shows the distribution for individuals accessing support services what it does not show is the distribution of risk across the estimated Ready Reckoner of 10,500 female victims each year in Sheffield There is an on-going need to increase the use of the ACPO DASH assessment tool and the comms tools in Sheffield within referral sources, to ensure risk assessments are standardised and more individuals are identified, so support for their domestic abuse can be provided and an onward referral made where required and where appropriate Action 17 in the A Call to End Violence Against Women and Girls Action Plan 2013 has is to review the suitability of existing risk assessment tools for 16 and 17 years (March 2014 time frame) and therefore it would be mindful of Sheffield to observe the outcome of this review. Supporting document for Domestic Abuse Commissioning in Sheffield Page 59

60 11.16 The next sections explore the Domestic Abuse support services in the following order:- A. Referrals in and waiting times to Domestic Abuse Support Services B. High risk support MARAC & IDVA, and Helpline Support and Website C. Medium & standard risk Commissioned Support, and Health Service provision D. Refuge support, including No recourse for public funds E. Floating support, Volunteer Support and Outcomes F. The effectiveness of Domestic Abuse Support (Outcomes) Note - Support provision to victims, including the SARC and ISVA provision for victims of Sexual Violence is discussed in Section 7. Supporting document for Domestic Abuse Commissioning in Sheffield Page 60

61 SECTION 11A Referrals In and Waiting Times to Domestic Abuse Support Services 11.17What do we know about referrals into Support services? (Commissioned domestic abuse services, using Paloma Modus) There was an increase in domestic abuse referrals into Support Services between 2011/12 and 2012/13. In 2011/12 referrals averaged 996 per quarter compared with 1,059 per quarter in 2012/13 (first two quarters) A snapshot of activity has been taken using quarter /13 data to explore the 1,125 referrals made during this quarter. The map below (Table 11.4) shows where referrals for each service came from and where referrals from these DA services went to. Table Referral Map Referrals made into support services using Paloma modus between June and September (note this was the support commissioned prior to 2013/14) Domestic abuse referral pathway, Q2 2012/13 IDVAS Police Self Health Housing Refuge Floating Support Specialist DV Services SV Services Childrens and Young People Other Helpline 798 Outreach 89 IDVAs Snig Hill 119 IDVAs Jessops 78 IDVAs A&E 36 IDVAs Primary Care 119 IDVAs GUM The pathway shows there are over eleven different sources of referrals, which is encouraging; however there are some notable issues: The helpline received the highest number of referrals, (798) showing that it does act as the main route into support services. Self-referrals go directly to the Helpline, Outreach services and the IDVA service at Snig Hill. There are very few referrals from refuges (less than 10) to other commissioned services. The police refer the highest number of individuals (698), which is as expected given the protocols in place. Health Services refer the second highest, referring 90 individuals, which averages one referral per day. The number of health referrals appears low, particularly when compared to evidence from the BCS 2009/10 as cited in Protecting People, Promoting Health (2012) that suggests nationally that 28% of individuals suffering physical or emotional effects of violence in the past year sought medical advice, with 80% of them accessing their GP surgery as a point of contact. Sexual violence services referrals into the DA services is extremely low and needs to be further understood Health referrals will be a priority in 2013/14, with the new Medium and Standard service commissioned to promote referral pathways, support professionals in completing the DASH, or undertaking the DASH on their behalf when necessary. In settings where it is not appropriate or practical to use the full DASH, a new smaller succinct screening tool has been produced in the Supporting document for Domestic Abuse Commissioning in Sheffield Page 61

62 form of comms forms Waiting times for support following referral The time taken to access support is an issue and is one of the areas that has been attempted to be rectified in the new commissioned service specifications. Of the information available Quarter / clients had an intake form completed and consented to the information being used); 149 (75%) had a waiting time less than 2 weeks, and 162 (82%) waited less than 3 weeks. Table 11.5 shows this information by service. Table 11.5 Average wait (Days) Referral date to intake date (waiting time) DAOS Helpline team IDVA s Sheffield A and E IDVAS Sheffield Central IDVAS Sheffield Jessops IDVAS Average days Sheffield Primary Care IDVAS Notice the waiting time for the helpline was an 18 day wait for a call back and over 49 days to get into outreach support. Targets have now being put into place; with outreach support a target of an average of a three week wait and for the helpline to make three attempts to make contact with the victim from police call backs to be completed within two days or three days based on the level of risk. Waiting times will be performance managed with the new contracts during Quarter 3 using Quarter 2 performance data. Supporting document for Domestic Abuse Commissioning in Sheffield Page 62

63 Number of Cases Discussed Number of Repeat cases % of repeat cases Number of children in the household Number of cases from black and minority ethnic community Number of LGBT cases Number of cases where victim has a registered disability Number of male victims SECTION 11B High Risk Support (MARAC and IDVA) All identified high risk domestic abuse cases should be referred to MARAC and ideally should have an IDVA support worker. MARAC and IDVAs are a national approach but with locally agreed processes Multi-Agency Risk Assessment Conference (MARAC) CAADA (2010) has estimated that for every 1 spent on MARAC 6 was saved on direct costs to supporting agencies. The main aim of MARACs nationwide is to get all key support services in a room at the same time to discuss each high risk case individually, to identify what is happening in the case, where each service is supporting the individual and to identify gaps in support, to generate key actions to be undertaken so risk is mitigated MARACs are held in all core cities, and can take different forms, i.e. in some cities there is more than one MARAC and the frequency held varies, however key findings from the VAWG review of MARACs (2011) found ten key principles to a successful MARAC: - information sharing, appropriate agency representations, IDVA engagement and victim representation, a strong leader (Chair), good co-ordination, strong partnership work and the availability of training and induction The MARAC model in Sheffield currently is as follows: a MARAC is held each fortnight, with around 25 cases discussed in each MARAC and chaired by the Public Protection Unit. The frequency of the MARAC can be increased to weekly, to respond to an increase in the number of referred cases cases went to MARAC during 2012/13 of which 23% were repeats Table 11.6 displays the local data held for MARAC cases since its inception in 2007, showing an annual increase in the number of cases to MARAC over a five year period. Table 11.6 MARAC cases Date Held 2007/8 TOTAL % /9 TOTAL % /10 TOTAL % /11 TOTAL % /12 TOTAL % However according to CAADA, Sheffield currently takes a ratio of 23.6 of cases per 10,000 female population to MARAC, which remains less than the National ratio (24.9 per 10,000) and also that of the most similar forces group ratio of 31.6 per 10, Thus indicating that the ratio of cases to MARAC for Sheffield is lower than what it ought to be (comparatively to the national and most similar forces ratios) CAADA also provides an estimation of the number of cases it would expect to go to MARAC in Sheffield. Their estimation is that 920 cases should go to MARAC annually (and a methodology based on an expected level of 40 cases per 10,000 of the adult female population using police 150 MARAC performance results, 2012/13 Supporting document for Domestic Abuse Commissioning in Sheffield Page 63

64 reporting rates, population and the likelihood of high risk victims of domestic abuse reporting to the police) 151 which is significantly less than the 546 cases in 2012/13 (59% of the recommendation, see Graph which shows the number of MARAC referrals compared to the CAADA estimation (Green line on the Graph) Graph Identification and onward referral appear to the main area of focus to increase the number of individuals going to MARAC, in line with CAADA s recommendation: South Yorkshire Police refer the majority of cases to MARAC, although as partner agencies referrals have increased locally the proportion of cases referred by the police has reduced (this however is not necessarily negative). In 2012/13 the police made 267 referrals (49% of the total) in 2011/12 they made 244 referrals (53% of the total) and in 2010/11, 247 referrals (67%) shown pictorially in Graph 11.7 (Blue bars). It is expected that police referrals will continue to increase CAADA provides more estimates for the proportion of police and partner agency referrals (of the total), suggesting the police referrals should be 60-75% of referrals and partner agencies 25-40% however in Sheffield partner referrals have started to refer a greater proportion (49%). This is as a result of the increased promotion of the DASH tool undertaken with partner agencies over the last financial year; resulting in an increase in voluntary sector, housing and probation referrals and not due to less police identification (as shows police referrals continue to increase in volume). Further work is required to increase MARAC referrals from mental health and adult social care because these remain low. Additionally data reports do not show which voluntary sector service made a referred and it would be useful have a complete referral list of cases to MARAC to understand where promotion needs to happen within these individual services Given that referrals continue to increase annually and that CAADA s estimation that Sheffield is not currently seeing as many cases at MARAC as expected i.e. there is a continued growth potential in particular with the future commissioning focus and that sometimes weekly MARAC conferences have been held it has been identified that a review of MARAC is required to ensure it is fit for purpose; it meets the 10 principles of a successful MARAC, and it has the capacity to take on an ever increasing number of cases. This review started in June 2013 with the DACT working in partnership with CAADA HIGH RISK - Independent Domestic Violence Advocacy (IDVA) It is recommended that all high risk cases going to MARAC should be supported by an IDVA Supporting document for Domestic Abuse Commissioning in Sheffield Page 64