Alcohol and domestic abuse prevention programme Evaluation report

Transcription

1 Alcohol and domestic abuse prevention programme Evaluation report

2 Alcohol and domestic abuse prevention programme Evaluation report 2

3 Executive summary This report summarises Swanswell s innovative six-session pilot programme for alcohol workers working with both perpetrators and victims of domestic abuse. Alcohol misuse has strong links with violence. Each year, in England alone, 360,000 incidents of domestic violence (around a third) are linked to alcohol misuse (NICE online, 2010) 1. In 2008, domestic violence cost the nation (and taxpayers) nearly 16 billion (Walby, S., 2009) 2. We estimate that each incident costs around 9,000. With many local authorities struggling to reduce their NI32: Repeat incidents of domestic violence targets, Swanswell recognised a unique opportunity to train its alcohol workers to identify and work with abusers and victims who might otherwise have been overlooked. Our programme reduces reoffending by people arrested for alcohol-related domestic violence, and supports the victims of domestic abuse. The main goals of the project were to: enable alcohol workers to identify victims and perpetrators of domestic abuse train alcohol workers to deliver a brief domestic abuse intervention, working with both abusers and victims develop strong working relationships and referral pathways with appropriate partners evaluate and develop the interventions One of the outcomes from the pilot programme is an astonishing 73% zero-re-offending rate (Warwickshire Police, 2010) 3. If we could replicate that figure nationwide, we could help reduce the annual figure for domestic violence incidents from 360,000 to 97,200, and help save an estimated billion on the associated costs of dealing with them. We look forward to repeating and building on this phenomenal success nationwide. Alcohol and domestic abuse prevention programme Evaluation report 3

4 Report Acknowledging the strong link between alcohol and domestic abuse, our alcohol workers in Coventry and Warwickshire have been trained to identify and deliver treatment to both perpetrators and victims of alcohol-related domestic abuse, in a series of six one-to-one sessions. The sessions are tailored so that they can be used, regardless of gender, with an emphasis on relapse prevention (for abusers) and safety planning (for victims). In addition, we ve recognised the need to develop effective referral pathways and partnership working in order to complement other services and to ensure that those not suitable for Swanswell s Alcohol and domestic abuse prevention programme are pointed towards other appropriate services. This report summarises the key points and outcomes of the 12-month pilot programme and touches briefly on emerging post-pilot results. The main goals of the project were to: enable alcohol workers to identify victims and perpetrators of domestic abuse train alcohol workers to deliver a brief domestic abuse intervention, working with both abusers and victims develop strong working relationships and referral pathways with appropriate partners evaluate and develop the interventions Background on alcohol and domestic abuse Alcohol misuse has strong links to domestic abuse (Home Office, 2004) 4, (Flake, D.F., 2005) 5, (Zaleski, M., 2009) 6. We know that alcohol can influence the likelihood and severity of violence in domestic abuse incidents (Graham, K., 2004) 7, (Ito, T.A., et al, 1996) 8. But on the flip side, we also know from our work with victims of domestic abuse that alcohol can also be used as way of coping with that abuse, placing them at increased risk of the associated harms. Each year, in England alone, 360,000 incidents of domestic violence (around 33%) are linked to alcohol misuse (NICE online, 2010) 1 Even moderate doses of alcohol can increase aggressive responses, suggesting that either abusers or victims alcohol use can worsen a domestic incident (White, H.R. and Chen, P.H., 2002) 9 In 2008, domestic violence cost the nation (and taxpayers) nearly 16 billion (Walby, S., 2009) 2. We estimate that each incident costs around 9,000. Alcohol and domestic abuse prevention programme Evaluation report 4

5 Programme methods and measurement The main goals of the project were to: enable alcohol workers to identify victims and perpetrators of domestic abuse train alcohol workers to deliver a brief domestic abuse intervention, working with both abusers and victims develop strong working relationships and referral pathways with appropriate partners evaluate and develop the interventions To do this we: developed two six-session treatment programmes for working with both abusers and victims of abuse trained a number of alcohol workers to screen for domestic abuse and deliver the interventions to appropriate clients and to those referred in from other agencies used (and adapted) Swanswell s online data collection system (known as HALO ) to monitor and assess progress of those on the programme Routes to treatment screening and referrals Clients can be referred onto the programme from a variety of sources. In addition to Swanswell practitioners screening and identifying suitable clients when they engage with our alcohol service, they can also be referred from another service or agency, which they are already involved with (for example criminal justice system, police etc.) or present themselves for treatment. The screening tool used by Swanswell workers is an adapted version of that used by the Stella Project (Against Violence and Abuse, 2011) 10. In addition, workers have been trained to use the Duluth Model (Domestic Abuse Intervention Programmes, 2011) 11 a tool which assesses the range of abusive behaviours an abuser uses to maintain power and control over a partner. The Duluth power and control wheel (which was developed using anecdotal evidence) helps to identify abuse from both an abuser s and a victim s perspective, and helps workers to be more explicit about what constitutes abuse. The interventions Two six-session programmes for abusers and victims of abuse were developed, incorporating different therapeutic tools for working with people at each stage of the Stages of Change Model (Prochaska, J.O., and DiClemente, C.C. 1984) 12. Since the completion of the pilot, 29 of our alcohol workers in Coventry, Warwickshire and Birmingham have been trained to deliver both programmes. Working with abusers As already mentioned, we know that there is a strong link between alcohol and domestic abuse, and that alcohol can influence the likelihood and severity of violence in such situations. The aim of the abuser sessions (as detailed in Table 1) is to reduce their drinking levels and hence the impact on their victims. Alcohol and domestic abuse prevention programme Evaluation report 5

6 Table 1: Working with abusers Session Themes 1 Alcohol education and goal setting, including exploration of effects of alcohol in abusive behaviour 2 Breaking down myths associated with domestic abuse, domestic abuse and alcohol, and understanding what constitutes abusive behaviour 3 Looking at motivation to change through the decisional balance exercise and identifying (from drink diaries and past experience) what triggers problematic alcohol use 4 Looking at risky or unhelpful thinking around alcohol use and domestic abuse; introducing the ABC (Activating event, Beliefs and thoughts, Consequences) model of thinking 5 The traffic light model, which shows how events and triggers can build up and lead to different behaviours such as drinking and domestic abuse. This model allows the service user to begin to take responsibility for their behaviour and develop strategies for identifying and managing difficult situations 6 Relapse prevention planning The aim of the abusers sessions is to reduce drinking behaviour and the impact on the victim and wider society. Through examining their thinking, behaviour and actions, service users are required to reconsider the choices they make. Working with victims We know from our work with victims of domestic abuse that alcohol can also be used as way of coping with that abuse, placing them at increased risk of the associated harms. The victims sessions (as detailed in Table 2) are similar to that of abusers, but with an added emphasis on safety planning i.e. identifying potential future risks and specifying actions which reduce them. Table 2: Working with victims Session Themes 1 Education and awareness about domestic abuse; beginning the process of safety planning 2 Looking at the change process relating to alcohol and domestic abuse and increasing the client s understanding of the patterns of their alcohol use for themselves and others 3 Looking at motivation to change through the decisional balance exercise and identifying (from drink diaries and past experience) what triggers problematic alcohol use 4 Focusing on risky or unhelpful thinking around alcohol use and domestic abuse; introducing the ABC model of thinking 5 The traffic light model, which shows how events and triggers can build up and lead on to different behaviours such as drinking and domestic abuse. This model allows the service user to begin to take responsibility for their behaviour and develop strategies for identifying and managing difficult situations 6 Relapse prevention planning Safety planning is an opportunity for the victim to identify times/places/situations when they are more likely to be at risk so that they can plan what they would do in those cases. For example, who Alcohol and domestic abuse prevention programme Evaluation report 6

7 can they tell? What code words can they use when talking to family/friends to indicate that they are at risk? It could involve getting advice about security in the home and planning for the future. A discrete safety plan template was developed, in credit card format, to minimise risk of discovery by an abuser. Partnerships with others Swanswell s Alcohol and domestic abuse prevention programme is designed to complement other services. Anyone not suitable for our service is signposted to an alternative, appropriate service as quickly as possible. We recognise that the brief intervention, however effective, is only the beginning of a journey in changing abusive behaviour. That s why we ve developed effective partnership working and referral pathways. Partner organisations involved in the pilot included: Victim Support Warwickshire police: custody staff; Domestic Abuse Unit (DAU); Multi Agency Risk Assessment Conference (MARAC) Warwickshire refuge, which provides the IDVAs (Independent Domestic Violence Advocates) Ashram provider of BME (black and minority ethic) refuge Warwickshire Domestic Violence Support Services Warwickshire refuges Addaction arrest referral National Probation Service Domestic Abuse Counselling Service (DACS) Rugby Rape or Sexual Abuse (ROSA) Relate Crisis Team and Community Mental Health Team Housing providers Children s services Cranstoun, a national charity offering support and treatment to those affected by drug use We provided training on alcohol awareness and screening to many of these organisations in order to improve referral processes and joint working. Case studies Peter s and Jane s stories (below) highlight how Swanswell s Alcohol and domestic abuse prevention programme changed an abuser s and a victim s life for the better. Peter: moving forward without alcohol For three years, Peter had been drinking much more than the recommended amount. His drinking affected his health and resulted in incidents of domestic abuse. Eventually, he reached the point where he decided he needed help, and referred himself to Swanswell. Swanswell offered Peter interventions focussing on alcohol and domestic abuse. Sandeep, a Swanswell worker, explored patterns of alcohol misuse with Peter, his triggers for alcohol use, and ways of using coping strategies and avoiding risky behaviour. While Peter found the work difficult, he enjoyed the process and felt happier after completing the sessions. With help and support from Swanswell, Peter has now reduced his alcohol consumption to within the safe drinking guidelines. There have been no further reports of domestic abuse. As a result of the sessions, says Peter, My health is much better, and I ve been rewarded with a happy family life. Alcohol and domestic abuse prevention programme Evaluation report 7

8 Jane: escaping the cycle of abuse Jane is a 56 year old woman who has been with her husband for 30 years. Having been the victim of abuse as a child, she was homeless at 16. Jane suffers emotional and psychological abuse on a daily basis; she is beaten twice a week and sexually abused at least once a week. To cope with this, she turned to alcohol, drinking 24 cans of Carling daily, becoming physically dependent. With Swanswell s help, Jane gradually reduced her use of alcohol alongside the 6-session victim programme. She learned about patterns of abuse and reached a point where she no longer thought it was her fault, and began to think about her future. Jane s safety was paramount and she already had safety plans in place. We also referred Jane to Warwickshire Domestic Abuse Support Services for some more in-depth advice on safety and planning, and to psychological services for support with anxiety and panic attacks. Safety planning continued to be paramount throughout as the less Jane drank and the more she became empowered, the more abuse she endured. Over time, Jane felt more in control and her husband felt out of control and began abusing her in other ways, e.g. by withdrawing all of the money out of their bank account. For a victim this is a high risk time. Jane was aware of this and had extra measures in place for her safety (e.g. a dog that protected her, and her son stayed at home). Jane is now free from alcohol, is physically well, and is planning to leave the relationship. Alcohol and domestic abuse prevention programme Evaluation report 8

9 Results Screening Following the training, our case management reporting system showed that Swanswell alcohol workers used the screening tool effectively within our core services. Over the course of the 12- month pilot they identified 105 abusers and 70 victims. Referrals During the 12-month pilot we received referrals from external agencies for: 121 abusers, of which 95 were assessed by a Swanswell worker as appropriate for the programme. Of those who started the programme, 90.5% (86 people) completed it 81 victims, of which 66 were assessed by a Swanswell worker as appropriate for the programme. Of those who started the programme, 86.4% (57 people) completed it Table 3 outlines the referrals received between April 2009 and March 2010 where domestic abuse has been identified, and reflects the range of services referring in. Domestic abuse referrals accounted for 14% (8% perpetrators and 6% victims) of the total referrals into the main alcohol service across Warwickshire. Table 3: Referrals received during 12-month pilot where domestic abuse has been identified Referral source Number of abusers Number of victims Self Concerned other 1 1 Statutory service Criminal Justice 21 6 Voluntary sector 5 2 Other 22 6 (Total) Reducing reoffending Following the pilot police reported an astonishing 73% zero-re-offending rate of incidents of domestic violence for those they referred to the programme (Warwickshire Police, 2010) 3. Reducing alcohol use As mentioned previously, one of the aims of the programme is to reduce clients alcohol intake, as a form of harm minimisation. We regularly monitor the effectiveness of clients alcohol treatment programmes using a method known as the Christo Inventory for Substance-Misuse Services (CISS). A client s Christo score (which can range from 0 20) results from a ten-item questionnaire which gives a general indication of the level of their problems. Over the course of the pilot, for those referred and accepted onto the programme and completed it: abusers completed treatment with an average 46% reduction in their Christo scores victims completed treatment with an average 28% reduction in their Christo scores Alcohol and domestic abuse prevention programme Evaluation report 9

10 What others say about our programme Following our pilot we ve had great feedback those we ve worked with. The results of the project have been very impressive with a vast majority of clients accepting the scheme and attending the sessions demonstrating a complete stop or a significant reduction in reported abuse... this is proving to be a significant initiative in dealing with what has long been recognised as a major trigger towards domestic abuse. DS Simon Timerick. Protecting Vulnerable People Unit, Warwickshire Police I was tremendously impressed with your professionalism and commitment Your work is vital in trying to break the cycle of abuse. DCI James Essex. Chairman, Warwickshire MARAC Conclusions The pilot has been phenomenally successful in making a real difference to both re-offending targets and to individual s lives, and as a result our commissioners in Warwickshire have invested further and extended the programme. Our pilot statistics show how effective the programme is in reducing re-offending rates of people arrested for alcohol-related domestic abuse. And the take-up and completion rates for clients accessing the treatments are similarly impressive. Where next? The pilot project differs from other abuser/victim programmes in that it embeds our knowledge and experience of alcohol-related issues within the treatment. In doing so we ve enhanced our core services and the skills of our workers. Success of the pilot project has been influenced by our excellent tradition of strong links and partnership working. We expect to continue to develop these working relationships both locally and nationally. Following the pilot we rolled out the programme to Swanswell workers in Coventry, Warwickshire and Birmingham. Initial results look promising. Over the most recent 12-month period: of 241 abusers who started the programme, 88% of them completed, 47% with a reduced Christo score of 182 victims who started the programme, 84% of them completed, 41% with a reduced Christo score Swanswell s Alcohol and domestic abuse prevention programme offers practitioners a unique tool in managing complex clients and the risks they pose. The success of this programme has exciting implications for its further development and widespread use. If we could replicate pilot reoffending results nationwide, we could help reduce the annual figure for domestic violence incidents from 360,000 to 97,200, and help save around billion on the associated costs of dealing with them. Our model needs to be shared nationwide, and we welcome the opportunity to support other teams in delivering it. Alcohol and domestic abuse prevention programme Evaluation report 10

11 References 1. National Institute for Health and Clinical Excellence, Alcohol-use disorders: preventing harmful drinking, costing report. [Online]. Available at: [Accessed 5 July 2010]. 2. Walby, S., The Cost of Domestic Violence, update by Sylvia Walby. Lancaster: Lancaster University. 3. Figures supplied by Warwickshire Police, Home Office, Alcohol and intimate partner violence: key findings from the research. Home Office. 5. Flake, D.F., Individual, family and community risk markers for domestic violence. Violence Against Women. 6. Zaleski, M., Intimate partner violence and contribution of drinking and sociodemographics. Journal of Interpersonal Violence. 7. Graham, K., The effect of the safer bars programme on physical aggression in bars: results of a randomised trial. Drug and Alcohol Review. 8. Ito, T.A., Miller, N. & Pollack, V.E., Alcohol and aggression. Psychological Bulletin. 9. White, H.R. and Chen, P.H., Problem drinking and intimate partner violence. Journal of Studies on Alcohol. 10. Against Violence and Abuse (AVA), Stella project. Available at [Accessed 3 August 2011]. 11. Domestic Abuse Intervention Programmes, The Duluth model. [Online]. Available at [Accessed 3 August 2011]. 12. Prochaska, J.O., and DiClemente, C.C., The transtheoretical approach: crossing the traditional boundaries of therapy. Homewood, IL. Dow-Jones/Irwin. Alcohol and domestic abuse prevention programme Evaluation report 11