Domestic violence, mental health and substance misuse - shared issues, integrated solutions

Transcription

1 Domestic violence, mental health and substance misuse - shared issues, integrated solutions Analysis Report of Pre- and Post-Training Questionnaires and Training Evaluation Forms Maria Harvey Birmingham & Solihull Women s Aid June 2010

2 Contents A Executive Summary 3 Introduction 4 Pre- and Post-Training Questionnaire Evaluation Notes: Mental Health Practitioners/ Drug & Alcohol Practitioners Domestic Violence Practitioners B C 5 10 Pre- and Post-Training Questionnaire Results: Mental Health Practitioners/ Drug & Alcohol Practitioners 16 Domestic Violence Practitioners 21 Training Evaluations Domestic Violence Training for Mental Health Practitioners 26 Domestic Violence Training for Drug & Alcohol Practitioners 32 Mental Health Training for Domestic Violence Practitioners 38 Drug & Alcohol Training for Domestic Violence Practitioners 43 2

3 Executive Summary Domestic violence is a serious health issue which affects one in four women in their lifetimes. If either the victim or the abuser (or both) have mental health difficulties and/ or substance misuse problems, it can both affect the nature of the abuse and throw up additional barriers to victims seeking help. This Project developed a series of practitioner training courses, based on existing good practice but with input from the practitioners themselves. The courses were: Domestic Violence Awareness training for Mental Health Practitioners Domestic Violence Awareness training for Drug & Alcohol Practitioners Mental Health Awareness training for Domestic Violence Practitioners Drug & Alcohol Awareness training for Domestic Violence Practitioners All of the practitioners were asked to complete a pre-training questionnaire to study their knowledge, attitudes and experience. They were also asked to repeat the questionnaire at least three months after the training. All practitioners were asked to complete the standard Evaluation Forms that Birmingham & Solihull Women s Aid Training Team provide; 399 were completed. The training was provided by professionals from Birmingham & Solihull Women s Aid (domestic violence) together with Birmingham & Solihull Mental Health NHS Foundation Trust (mental health) and Aquarius (drugs & alcohol). The training evaluation form was completed by: 93 (drug & alcohol training) and 86 (mental health training) domestic violence practitioners (some practitioners completed both training days) 74 mental health practitioners 146 drug & alcohol practitioners The pre- and post-questionnaires were completed by: 70 (pre) and 21 (post) domestic violence practitioners 124 (pre) and 17 (post) mental health practitioners and drug & alcohol practitioners The course content, delivery and organisation were rated very good or good by: 97% (drug & alcohol training) and 96% (mental health training) of domestic violence practitioners 100% of mental health practitioners 98% of drug & alcohol practitioners 3

4 Introduction As Information Worker for Birmingham & Solihull Women s Aid, I have been asked to provide evaluation for the training element of the Complex Needs Project. Two separate elements have been evaluated: 1. The responses to a survey questionnaire which was to be completed by practitioners before attending any training, to establish a baseline for their knowledge, experience and confidence in tackling domestic violence issues (for mental health, drug and alcohol practitioners) or mental health and/ or drugs and alcohol issues (for domestic violence practitioners). The same practitioners were asked to complete an identical questionnaire some time after the training, to see what changes it had brought about, if any. The pre/ post training questionnaire was devised by myself in consultation with the project s steering group. The questions, best answers and rationale for those answers are given in Section A of this report. This evaluation compares the aggregate data from before and after, in Section B. 2. The responses to the standard evaluation forms that practitioners were asked to complete at the end of each training session. The training evaluation forms were drawn from a pre-existing form used by Birmingham & Solihull Women s Aid s Training Team, suitably adapted to cover the different aspects covered in each course. This evaluation presents the aggregate data; where written responses are given, they have been grouped by themes as closely as possible, although some quotes are also given directly for illustrative purposes, in Section C. 4

5 A: Pre-training Questionnaire Evaluation Notes These notes give the questions and correct or best answers, with explanations. Monitoring questions are not included. Mental Health Practitioners/ Drug & Alcohol Practitioners Part 1: Knowledge of Domestic Violence The number of right answers before and after will be compared. It may be that the number of right answers is quite high to start with, indicating a good level of knowledge; however, it would be hoped that the number would be higher at follow-up. 1. Domestic violence can be caused by alcohol: TRUE / FALSE Although it can be a factor in the type and/ or severity of abuse, alcohol does not cause it. Abusers will abuse when they re sober. 2. Domestic violence happens more often in Asian families than in others: TRUE / FALSE There is no statistical evidence to point to any one group being more at risk; however, Asian women may find additional barriers to accessing services. 3. Domestic violence can continue after the relationship has ended: TRUE / FALSE Ending a relationship is no guarantee to the end of abuse; research has suggested that 26% of women have been stalked by ex-partners (Coleman et al. 2007). 4. Abusers should be offered anger management: TRUE / FALSE Abusers target their violence against their partners and often children, they often don t abuse others. DV is about power and control, not about an inability to keep one s temper. 5. How many women a week are killed in the UK by a current or former partner? Department of Health, How many Domestic Violence incidents were reported to the police in Birmingham in 2007/8? 2,000 5,000 10,000 15,000 15,000-20,000 Over 20,000 Birmingham Community Safety Partnership, How many women mental health service users are estimated to have experienced domestic violence nationally? 10-20% 25-40% 40-50% 50-60% Bowstead, Janet Compared to women in general, how much more likely are women experiencing domestic violence to be misusing alcohol? Up to five times Up to 10 times Up to 15 times Up to 30 times Stark, E. and Flitcraft, A

6 Part 2: Domestic Violence in your practice This exercise is intended to find out whether or not participants have bought into certain myths and stereotypes. Some are less clear cut than others and there may be no right answer, so each is graded Good, OK and Not good, with rationales. 1. Consider the following situations, and tick whether they would make you Highly concerned, Possibly concerned or Not really concerned that domestic violence may be taking place. Highly concerned Possibly concerned Not really concerned a. A row with both partners shouting at each other. Not good: Possibly being interpreted as DV being any isolated incident, rather than a pattern of controlling behaviour. Good: It may still be an unequal relationship. OK: No evidence that one partner exerting control over the other. b. One partner calling the other often to find out what they are doing. Good: Can indicate controlling behaviour. OK: Requires further info: could be explained as insecurity. Not good: Being interpreted as loving rather than controlling? c. One partner pointing out the other one s faults on a regular basis. Good: Definitely abusive behaviour. OK: Requires further info: she may be ignoring. Not good: Should be concerned about verbal abuse. d. One partner working full time while the other is not in employment. Not good: Buying into myth that lower social status causes DV. OK: Requires further info: woman may be pressured into being homemaker Good: Not in itself an indicator of DV. e. Being married means you should have sex with me when I want to. Good: Definitely abusive behaviour, could indicate rape and/ or sexual abuse. OK: So long as woman isn t acquiescing to this demand. Not good: Buying in to myth that marriage means the husband owns the wife? f. One partner has parents who divorced because he beat her up. Not good: Buying into intergenerational cycle of abuse theory? Good: Although not inevitable, could be a risk factor. OK: No assumption of inter-generational cycle of abuse theory 6

7 2. g. One partner often asks the other do you love me?. Not good: There are better indicators that could be looked into. Good: Could lead to discussion of context; may be controlling behaviour. OK: Not in itself a cause for concern. h. One partner is a heavy alcohol user. Not good: Buying into myth that alcohol causes DV? Good: Where abuse present, alcohol is a factor in type and/ or severity, ability to defend oneself, etc. OK: Not in itself an indicator of DV, although should be concerned about adverse effects on children, work, etc. i. The family is living in poverty. Not good: Buying into myth that poverty causes DV. Good: If DV present, poverty will be a factor in ability to get away. OK: Poverty in itself is not an indicator of DV. j. Everything needs to be tidied up before daddy gets home. Good: Definitely implies controlling behaviour. OK: Could be a mutual agreement between parents. Not good: Should be concerned about consequences if not tidy. If you suspect that your client is suffering domestic violence, what would you usually do (please tick one)? Not bring it up, unless she does. Not good: She may not have identified her experiences as DV, and even if she has you have given her no confidence that she is safe to disclose to you. Ask her directly if she is suffering domestic violence. Good: provided it is done in a sensitive way. This demonstrates that the service acknowledges that DV can happen to any client, takes DV seriously and that it will offer a supportive response. Explain that some of your clients suffer domestic violence and they are welcome to discuss this with you (then leave it up to her). OK: Although it is good to inform clients that DV will be dealt with appropriately, you are not acknowledging this client s situation. If it is not discussed, she may not ever disclose, especially if she has not yet labelled her experiences as DV. 3. If your client discloses domestic violence to you, what would you usually do (please tick one)? Explain this is not in your remit, but that she could contact a specialist service. 7

8 Not good: Even if this is beyond your work boundaries, it is important to recognise that it takes courage to disclose DV, and this response could be considered dismissive and is unhelpful if you don t give her contact information. Your response could mean she is less likely to disclose to another agency or access a DV specialist service. Explain this is not in your remit, but give her information you have about services (e.g. Women s Aid leaflet). OK: You may not be able to give further support due to your work boundaries, but you have acknowledged, and therefore validated, her experience and equipped her with information to get support. Explain this is not in your remit, but offer her the use of your phone to call a helpline there and then. Good: You may not be able to give further support due to your work boundaries, but you have acknowledged, and therefore validated, her experience and have offered her a safe place to contact a DV service. Even if she doesn t take you up on the offer at the time, she will know she can when she s ready. Discuss this with her and include this in her support plan. Best: DV will be having an effect on both her presenting condition and her ability to achieve her treatment goals. Acknowledging the DV and incorporating it into her support plan, with multi-agency partnership support where appropriate, is most likely to lead to the best possible outcome. 4. On a scale of 1 to 5, how confident do you feel about talking about domestic violence with a client (please circle one)? 1(very) (not at all) There is no right answer to this, but it is hoped that the level of confidence will be demonstrated to have risen at the post-training stage. 5. How do you give information about domestic violence services to your client (please tick one)? I have numbers in a directory/ on a poster, etc. and will write them out for her. OK: It is good to demonstrate a supportive response by having this information available, although numbers alone may not give her enough information. I have leaflets/ cards, etc. from agencies to give her. Good: It is good practice to have information available, in different formats/ languages if possible, for a client to take away and consider. I don t have access to this information. Not good: If your client trusts you, it may be that she feels safe to discuss subjects outside your immediate remit and you should be prepared for this eventuality. 8

9 6. Do you record information about domestic violence in your client records (please tick one)? I don t have the facility to record it, otherwise I would like to. OK: Although you could consider setting up a system for additional information. I would never record it. Not good: This would imply that it is not being acknowledged as an ongoing concern which will have an effect on the client s treatment/ support programme. I put it as an additional information note in her records. Good: Although this information may be lost depending on how much notice is generally taken of additional notes. I record it in a specific section of her records. Best: if this option is available. It demonstrates your agency acknowledges DV as an important factor (where present) in a client s treatment/ support programme. 7. Which do you think is the best way to approach domestic violence as an issue with your clients (please tick one)? To ask all female clients about it at the initial assessment, just once. Good: This may give them the confidence to bring it up in the future, research has shown that some women find it easier to disclose if they ve been asked directly. To ask all female clients about it at the initial assessment and at a subsequent appointment. Best: If you routinely question all female clients, and explain why, this will make clear that DV can happen to anyone at any time and that although a woman may not be ready to disclose the first time you ask, she may at a future time; research has shown that some women find it easier to disclose if they ve been asked directly. To discuss it as a support need if she brings it up herself. OK: Research has shown that some women find it easier to discuss if asked directly, rather than the onus being on them - they may consider it inappropriate to bring up. To provide information if she brings it up, but not discuss it in depth. Not good: See above. This is also a negative response which may put the woman off raising the issue with you or other professionals. 8. How would you best describe your knowledge of specialist domestic violence services and/ or networks (please tick one)? I don t know about any domestic violence agencies. Not good: All mental health, drug and/ or alcohol workers should have access to information on services they don t themselves provide. I know the national helpline number. I know the national and local helpline numbers. 9

10 I have information on local domestic violence services. Good: These three options are increasingly good ; it may be that the service user is more likely to take up another service if it is local - and therefore convenient - and she knows what it entails beforehand. I have information on local domestic violence services and I am aware of/ get information from the local DV Forum/ Network. Best: Not only is information available, but being linked in to networks keeps this up-to-date and the worker can find out about new services. I have information on local domestic violence services and I am a member of the local DV Forum/ Network. Although this option is not available to all workers, it was included as a way to gauge the level of direct engagement in local networks. 9. Do you think there is too much focus on women as victims of domestic violence (please tick one)? This has not been rated: the question is a barometer of professional opinion. Although the first response is correct, the lower profile of male victims may lead to the second response being expressed. No, as they are most likely to be the victims. Yes; there is not enough said/ done about male victims. Don t know. 10

11 Domestic Violence Practitioners Part 1: Knowledge of Mental Health and Substance Abuse The number of right answers before and after will be compared. It may be that the number of right answers is quite high to start with, indicating a good level of knowledge; however, it would be hoped that the number would be higher at follow-up. 1. All women with mental health problems should be seen by a psychiatrist: TRUE / FALSE The majority of mental health problems are appropriately dealt with at primary care level by women s GPs. 2. A woman should sort out her alcohol/ drug dependency before attempting to access DV services: TRUE / FALSE DV and substance abuse often go hand-in-hand; the woman may use these as coping mechanisms or may have a pre-existing condition which the abuser exploits. Either way, the issues of DV and substance misuse will be connected and should be dealt with concurrently, as any attempt to sort out one problem in isolation is unlikely to be successful. 3. Domestic violence and other abuse is the main cause of depression in women: TRUE / FALSE Citation? 4. Even if your service user is using an illegal drug, you are not breaking the law if you discuss her drug use with her: TRUE / FALSE It is legal to discuss drug use, especially if this is in an effort to support the treatment. It is also legal to discuss the effects of drugs and safer drug use, to minimise harm. Furthermore, workers are not obliged to report disclosed drug use to the police. 5. What is the national prevalence of mental health in the general population? One in 4 One in 50 One in 100 One in 1000 Astbury, J How many women of Asian origin who have attempted suicide or self-harm are DV survivors? 10% 20% 30% 50% Chantler, K, et al How many women mental health service users are estimated to have experienced domestic violence nationally? 10-20% 25-40% 40-50% 50-60% Bowstead, Janet Compared to women in general, how much more likely are women experiencing domestic violence to be misusing alcohol? Up to five times Up to 10 times Up to 15 times Up to 30 times Stark, E. and Flitcraft, A

12 Part 2: Working with women with complex needs in your practice Unlike the evaluation for mental health and substance misuse workers, this doesn t contain a section asking for level of responses to different situation examples. It was decided that as DV workers tend to be multi-disciplinary, we would not be able to learn anything from this exercise, unlike mental health and substance misuse workers who may have the option to engage or not engage with DV disclosure as part of their accepted practice. However, there are different levels of engagement, some of which are scored best, good, etc. as per the other evaluation. 1. If you suspect that your service user is using self-harm, what would you usually do (please tick one)? Not bring it up, unless she does. Ask her directly if she is using self-harm. Best: Whilst this may not be suitable as an assessment questions, where the service user may not have met the worker before and not feel able to disclose what is a very secretive practice, the question implies that the worker and service user already have a working relationship, so asking the direct question both shows concern for the service user and knowledge of the indicators of self-harm. Explain that some of your service users use self-harm as a way to cope and they are welcome to discuss this with you (then leave it up to her). Good: This approach acknowledges that self-harm is an issue the worker understands and will be empathetic towards. 2. If your (non-resident) service user mentions intravenous drug use to you, what would you usually do (please tick one)? Explain this is not in your remit, but that she could contact a specialist service. Explain this is not in your remit, but give her information you have about services. Explain this is not in your remit, but offer her the use of your phone to call a helpline there and then. OK: Ideally, DV services should include this in their remit, but in the absence of that, offering direct practical help is a good option. Discuss this with her and include this in her support plan. Best: IV drug use can put the service user at risk of coming into contact with the DV perpetrator again, as well as being detrimental to her health and ability to rebuild her life. 3. On a scale of 1 to 5, how confident do you feel about talking about mental health issues with a service user (please circle one)? 1 (very) (not at all) There is no right answer to this, but it is hoped that the level of confidence will be demonstrated to have risen at the post-training stage. 12

13 4. How do you give information about mental health or substance abuse services to your service user (please tick one)? I have numbers in a directory/ on a poster, etc. and will write them out for her. Good: It is good to demonstrate a supportive response by having this information available, although numbers alone may not give her enough information. I have leaflets/ cards, etc. from agencies to give her. Best: Leaflets contain more information than just contact numbers; cards are discreet and often have several agencies on them. I don t have access to this information. Not good: All DV workers should have access to information on services they don t themselves provide. 5. Do you record information about substance abuse or mental health needs in your service user records (please tick one)? I don t have the facility to record it, otherwise I would like to. OK: Although you could consider setting up a system for additional information. I would never record it. Not good: This would imply that it is not being acknowledged as an ongoing concern which will have an effect on the client s treatment/ support programme. I put it as an additional information note in her records. Good: Although this information may be lost depending on how much notice is generally taken of additional notes. I record it in a specific section of her records. Best: It is important that details of complex needs are both accurate and recorded in such a way as to assist with support for the service user. An added benefit of systematic recording is that it provides an evidence base for developing and resourcing this support work. 6. How would you best describe your knowledge of specialist mental health services and/ or networks (please tick one)? I don t know about any mental health agencies. Not good: DV workers should ensure they have access to information about services they don t provide that their service users may require. I m aware of a national helpline number. I know the national and local helpline numbers. I have information on local mental health services. Good: These three options are increasingly good ; it may be that the service user is more likely to take up another service if it is local - and therefore convenient - and she knows what it entails beforehand. 13

14 I have information on local domestic violence services and I am aware of/ get information from the local mental health services networks. Best: Not only is information available, but being linked in to networks keeps this up-to-date and the worker can find out about new services. I have information on local mental health services and I am a member of the local mental health services network. Although this option is not available to all workers, it was included as a way to gauge the level of direct engagement in local networks. 7. How would you best describe your knowledge of specialist substance abuse services and/ or networks (please tick one)? I don t know about any substance abuse agencies. Not good: All DV workers should have access to information on services they don t themselves provide. I m aware of a national helpline number. I know the national and local helpline numbers. I have information on local substance abuse services. Good: These three options are increasingly good ; it may be that the service user is more likely to take up another service if it is local - and therefore convenient - and she knows what it entails beforehand. I have information on local substance abuse services and I am aware of/ get information from the local substance abuse services networks. Best: Not only is information available, but being linked in to networks keeps this up-to-date and the worker can find out about new services. I have information on local substance abuse services and I am a member of the local substance abuse services network. Although this option is not available to all workers, it was included as a way to gauge the level of direct engagement in local networks. 8. Which of the following would prevent your agency working directly with a woman (please tick all that apply)? Depression (unipolar) or manic-depression (bipolar). Schizophrenia/ psychotic illness. A personality disorder. Intravenous drug use. Methadone programme participant. Self-admitted alcoholic (i.e. physically addicted). 14

15 There is no right answer to this question, as this very much depends upon the working practices of the agency itself. However, it can give an indication of both the service provision available to women with complex needs and the support needs these services may require to expand their provision. Where different workers from the same agency have given different answers, this could indicate they are acting on assumptions, rather than their agency s actual practice. 15

16 B: Pre- and Post-Training Questionnaire Results Mental Health Practitioners/ Drug & Alcohol Practitioners Number of questionnaires analysed: Before = 124 After = 17 Part 1: Knowledge of Domestic Violence %age giving best answer Question Before After 1. Domestic violence can be caused by alcohol Domestic violence happens more often in Asian families than in others Domestic violence can continue after the relationship has ended How many women a week are killed in the UK by a current or former partner? How many Domestic Violence incidents were reported to the police in Birmingham in 2007/8? How many women mental health service users are estimated to have experienced domestic violence nationally? Compared to women in general, how much more likely are women experiencing domestic violence to be misusing alcohol? Abusers should be offered anger management. 16

17 Part 2: Domestic Violence in your practice 1. Consider the following situations, and tick whether they would make you Highly concerned, Possibly concerned or Not really concerned that domestic violence may be taking place. %age giving best answer Scenario Before After A row with both partners shouting at each other One partner calling the other often to find out what they are doing One partner pointing out the other one s faults on a regular basis One partner working full time while the other is not in employment Being married means you should have sex with me when I want to One partner has parents who divorced because he beat her up One partner often asks the other do you love me? One partner is a heavy alcohol user The family is living in poverty Everything needs to be tidied up before daddy gets home

18 %age giving best answer Question Before After 2. If you suspect that your client is suffering domestic violence, what would you usually do? If your client discloses domestic violence to you, what would you usually do? How do you give information about domestic violence services to your client? Do you record information about domestic violence in your client records? Which do you think is the best way to approach domestic violence as an issue with your clients? How would you best describe your knowledge of specialist domestic violence services and/ or networks?

19 4. On a scale of 1 to 5, how confident do you feel about talking about domestic violence with a client? Before (%age) After (%age) 1 = Very = Not at all 9. Do you think there is too much focus on women as victims of domestic violence? Response Before (%age) After (%age) 1. No, as they are most likely to be the victims Yes; there is not enough said/ done about male victims Don't know no answer

20 Conclusions Overall, improvements have been made in knowledge, confidence and practice since completing the training, alongside a greater appreciation of the need to focus on women as victims/ survivors of domestic violence. However, it should be noted that a low number of completed questionnaires were submitted post-training. 20

21 Domestic Violence Practitioners Number of questionnaires analysed: Before = 70 After = 21 Part 1: Knowledge of Mental Health and Substance Abuse %age giving best answer Question Before After 1. All women with mental health problems should be seen by a psychiatrist A woman should sort out her alcohol/ drug dependency before attempting to access DV services Domestic violence and other abuse is the main cause of depression in women Even if your service user is using an illegal drug, you are not breaking the law if you discuss her drug use with her What is the national prevalence of mental health in the general population? How many women of Asian origin who have attempted suicide or self-harm are DV survivors? How many women mental health service users are estimated to have experienced domestic violence nationally? Compared to women in general, how much more likely are women experiencing domestic violence to be misusing alcohol?

22 Part 2: Domestic Violence in your practice %age giving best answer Question Before After 1. If you suspect that your service user is using self-harm, what would you usually do? If your (non-resident) service user mentions intravenous drug use to you, what would you usually do? How do you give information about mental health or substance abuse services to your service user? Do you record information about substance abuse or mental health needs in your service user records? How would you best describe your knowledge of specialist mental health services and/ or networks? How would you best describe your knowledge of specialist substance abuse services and/ or networks?

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24 4. On a scale of 1 to 5, how confident do you feel about talking about domestic violence with a client? Before (%age) After (%age) 1 = Very = Not at all 8. Which of the following would prevent your agency working directly with a woman? (Not given as percentages, as each respondent could give more than one response) Response Before After Depression (unipolar) or manic-depression 0 1 Schizophrenia/ psychotic illness 6 1 A personality disorder 11 2 Intravenous drug use 6 2 Methadone programme participant 8 2 Self-admitted alcoholic (i.e. physically addicted)

25 Conclusions Overall, improvements have been made in knowledge, confidence and practice since completing the training. The mental health, drug or alcohol needs of women are generally seen as a lot less problematic for practitioners agencies. 25

26 C: Training Evaluations Domestic Violence Awareness Training for Mental Health Practitioners Number of completed forms analysed = 74 26

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28 All trainees who responded said they d recommend the training to others. I got a lot of knowledge from this training. Now can do first assessment with domestic violence people. How can deal with them and how can solve the problem. Meeting with the other agencies - mental health domestic abuse is closely related. It was good to get their perspective. Reasons why women find it difficult to leave - I hadn t previously considered the multiple barriers. 28

29 Dispelling the myths surrounding domestic violence to enable me to fully understand why and how domestic violence takes place. When we looked at different forms of abuse because it challenged my thinking about overgeneralising issues. Absolutely everything! So informative. Will share with other team members. Reinforcement that we are on track with doing things right. Greater awareness of incidence rates and that there is need to ask routinely about DV. Very useful using the model of what happens to an abused woman. How to spot indicators, patterns of abuse, in terms of how it s a CYCLE. Check out certain areas in our policy for domestic violence. 29

30 Overall I enjoyed the training - I felt engaged all day due to the activities - much better than being talked at all day & I feel I took on board much more because of this. Thank you! Really enjoyed meeting other professionals from other disciplines. Trainers are really engaging & passionate about the subject. Thought the activities were good and practical enough to help us realise the actual pressure that those suffering domestic violence are under. Changes perception and challenges thinking. I feel this was a very important and informative course, which has developed my awareness of domestic violence in mental health sector. This training needs to be given to every SW, CPN, doctor, hospital, policeman, etc. etc. etc. Many thanks. It did a good job of engaging us with the material & facilitating genuine & interesting discussions of the issues. 30

31 Encouraged to challenge beliefs and how society views women and domestic violence. Conclusions Generally, awareness of domestic violence, and confidence in dealing with it, improved after training. Most practitioners found the course content very good and there were very few who found any part of the training unhelpful. Practitioners felt able to take increased knowledge and understanding, good practice measures and information on other services to their place of work, although many did want more training on what other services were available and how to access them. There were some criticisms of the course structure, content or levels of participation; however, the other main criticism was to ask for more case studies, as this would give practitioners chance to practice their responses. Overall, comments were very positive. 31

32 Domestic Violence Awareness Training for Drug & Alcohol Practitioners Number of completed forms analysed =

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34 99% of trainees who responded said they d recommend the training to others. Looking at types of abuse, things I ve never considered 1 human being would do to another. The interactive learning very thought provoking discussions related to the tasks. Patterns of abuse - made me more aware of the variety of ways women can be abused. The group discussions - got me to really question and develop a deeper understanding of the multiple issues involved. Very informative and relaxed style of presenting which was excellent. 34

35 Recognising signs & symptoms & feeling confident to refer to Women s Aid as I know what they offer. Confidence that I will be able to assist my clients, through a greater understanding of the issues involved, and also relevant services that can help. Awareness of types of abuse and signs of abuse, how to respond and be clear about what will happen with information in a supportive manner. Awareness of more issues than before & a strategy for raising issues and recording them. I am now going to be able to identify problems more accurately and be able to ask directly are you experiencing domestic violence and be more prepared if the answer is yes. 35

36 Follow up resources to ensure they are available to all workers - ensure consistency. It was very informative, enjoyable and invaluable to enhancing my future practice. Now I know more about the issues relating to DV I actually feel I need to know more about what I can do to help. This course has definitely opened my eyes and I m keen to attend further training. Tutors very passionate about their work which is great!! Very good presentation, informative and friendly and providing difficult issues in a nonthreatening, safe manner. Trainers had an excellent knowledge base & approach. Very patient & inclusive. Overall a very good and informative training. Gained a better understanding of DV with this field of work. 36

37 Conclusions Generally, awareness of domestic violence, and confidence in dealing with it, improved after training. Most practitioners found the course content very good and there were very few who found any part of the training unhelpful: the main criticism being that the training was too focussed on women as victims/ survivors. Practitioners felt able to take increased knowledge and understanding, good practice measures and information on other services to their place of work. Training on direct questioning was specifically highlighted on many forms, indicating practitioners appreciation for the need to enquire about domestic violence specifically at assessment and during support. Overall, comments were very positive. 37

38 Mental Health Training for Domestic Violence Practitioners Number of completed forms analysed = 86 38

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40 All trainees who responded said they d recommend the training to others. For me it was gaining useful information to how mental health is linked in with domestic violence, in particular how it affects women, and how this information sharing can be adapted to a situation of this kind. The beginning. Everyone has a mental health. Quite obvious now, but it actually wasn t at the beginning. Finding out about the spectrum of mental health difficulties and what signs to look out for, and that sometimes we need to challenge diagnosis and perceptions. Small group - sharing experiences, was nice atmosphere and environment. 40

41 Not all mental health problems are the end of the scale where help is needed. Symptoms, and the fact that work is being done to facilitate better working relationships with mental health facilities. 41

42 Very good, jargon free which is important to me. No improvements needed - excellent. Very valuable, well delivered by an appropriately trained/ experienced professional. Course was informative to help act out my role as a Floating Support worker and working with mental health sufferers in support accommodation. Excellent training. Boosted my confidence in the links between DV and mental health and best practice that can be implemented. Professional. Really looking forward to the partnership working creating clear pathways to offer holistic support packages. This course has been very well presented. I feel that my knowledge of mental health has improved massively. Conclusions Generally, awareness of mental health, and confidence in dealing with it, improved after training. It is interesting to note that the Signs & Symptoms section of the training was highlighted as both the most and least useful part of the training by many respondents; on the one hand, this reflected the belief that knowledge took the fear out of dealing with mental health issues, on the other, there were those who saw this as medicalising the issue. Practitioners felt able to take increased knowledge and understanding to their place of work, and requested further training on accessing the support of other services. Overall, comments were overwhelmingly positive. 42

43 Drug & Alcohol Training for Domestic Violence Practitioners Number of completed forms analysed = 93 43

44 All trainees who responded said they d recommend the training to others. 44

45 Cycle of change - the difficult stages where people are in changing their behaviour and what can hinder them. Understanding the cycle of change - helps put you in the frame of mind of a service user. Doing the activity about the cycle of change as a group. As this helped, using my own personal experiences helped understand how a person who has addiction may feel the difficulties faced. 45

46 Also I feel that I can confidently raise issues with women around drugs and alcohol during support work especially if they are not open and direct. The training was useful and informative and I will be able [to take] this invaluable information into my work practice by using it more effectively. 46

47 Good training, think this work is much needed to raise awareness between both fields to ensure that service users have access to the appropriate service. Good training, informative, relevant, practical, good trainers - very good. Thoroughly enjoyable and informative. This training will definitely have a positive effect upon my practice with offenders who are victims of domestic violence and who use drugs/ alcohol. I really enjoyed the course, issues around drug & alcohol, and has made more confident in working with service users. Very useful and good to see. So much work often appears offender orientated and so very useful to have info re victims/ survivors. Conclusions Generally, awareness of drugs and alcohol issues, and confidence in dealing with them, improved after training. Broaching the subject with service users, and the cycle of change were felt to be most useful. Some practitioners did feel the course didn t go into enough depth and this was also the most popular request for further training. Practitioners felt able to take information on support services back to their places of work. Overall, comments were overwhelmingly positive. 47