MULTIPLE AND COMPLEX NEEDS INITIATIVE TAYSIDE DOMESTIC ABUSE & SUBSTANCE MISUSE PROJECT FINAL PROJECT REPORT

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1 MULTIPLE AND COMPLEX NEEDS INITIATIVE TAYSIDE DOMESTIC ABUSE & SUBSTANCE MISUSE PROJECT FINAL PROJECT REPORT JUNE 2009

2 OUR HEADLINE ACHIEVEMENTS The difference we have made: Produced a number of resources - good practice toolkit, training DVD, publicity materials and children's exhibition for use within services to raise awareness of both issues and inspire changes in practice. Worked with substance misuse services to establish women only elements within existing service provision in order to better meet the needs of women with complex needs. Raised awareness of the links between substance misuse and domestic abuse amongst services and practitioners, both at a local level and nationally. Worked with practitioners and services to facilitate disclosure of issues by women and appropriate responses from practitioners. Contributed to the establishment of an evidence base supporting the experiences of women affected by domestic abuse and substance misuse. Improved local understanding of children and young people's experiences and perceptions of living with domestic abuse and substance misuse. Improved knowledge, understanding and skills base of practitioners working with both issues in order to better respond to the needs of women, children and young people. Built sustainable links at a strategic level between relevant multi-agency partnerships and individual organisations. 2

3 EXECUTIVE SUMMARY The Tayside domestic abuse and substance misuse project, funded by the Scottish Government between August 2006 and December 208, targeted women (and their children) who had experienced, or were experiencing, the dual issues of domestic abuse and substance misuse. The project brought together partners from Dundee, Perth and Kinross and Angus, and was managed by a multi-agency management group supported by a project development worker. The main aims of the project was: to ensure a co-ordinated and consistent multi-agency response to women (and their children) with dual experiences of domestic abuse and their own substance misuse across Tayside. An initial research project was conducted to explore the links between domestic abuse and substance misuse for local women, and to identify how well their needs were being met by services. Findings from the research project led the project development work to be focussed on the "getting in" stage of service provision. Four major work streams were established (women only environments, training, policy and practice and children and young people) in order to work with existing services across the domestic abuse and substance misuse sectors to develop and enhance current service provision to the target group. The children and young people work stream focussed on the implementation of a practitioner consultation and event and subsequent development and implementation of an action research project with children and young people currently accessing services. The project had not been able to involve children and young people directly in the initial research project due to ethical issues and time constraints. The action research project involved children and young people age 8-16 years in exploring their perceptions of "alcohol", "drugs" and "violence" and producing a poster exhibition for public display and awareness raising. Evaluation of this work stream showed increased knowledge and understanding of the links between substance misuse and domestic abuse for practitioners involved and for those who have viewed the exhibition following its completion. The women only space work stream involved close collaboration with a range of substance misuse services in order to pilot women only provision within existing services. The provision aimed to support services to establish environments were women felt comfortable and able to approach and engage with workers. Four services ran pilots, all undertaking different models of provision (group-work, peer support group, drop-in). Evaluation data suggests that the provision of women only space would have been unlikely to take place without encouragement and support from the Tayside project. Although the number of staff and service users involved in pilots was relatively small the monitoring data collected highlighted a number of positive impacts and areas for future improvement. Three of the four pilot sites received disclosures of domestic abuse from women attending, all staff found the training provided extremely valuable, and many report increased confidence amongst women, improved relationships with staff and that women felt less stigmatised when accessing service in this way. The policy and practice work stream focussed on referral, information sharing and routine enquiry following a scoping exercise around best practise in working with 3

4 women who experience the dual issues of domestic abuse and substance misuse. A multi-agency working group was established who produced a toolkit (based on one previously developed by the Camden Domestic Violence Forum) containing model procedures for information sharing and referral between agencies, service user consent forms, referral protocols, assessment forms and guidance around routine enquiry for substance misuse and domestic abuse. The working group also produced referral flowcharts for practitioners working in both sectors. The project completed production and distribution of the toolkit, however timescales did not allow for a full implementation to be undertaken and this will now be taken on by local domestic abuse / violence against women partnerships and alcohol and drug partnerships. In addition, the working group were also central to the production of joint publicity materials which highlight the link between the two issues and encourage women, children and young people to access support. These materials were distributed widely across services and public spaces in Tayside and evaluation of their impact is ongoing. The training work stream consisted of a number of training events for staff involved in women only pilots, the development and implementation of a forum theatre training event using live drama and the development of a skills based training course for practitioners (developed in partnership with Scottish Women's Aid and STRADA). All of the training developed and implemented through the Tayside Project showed significant positive impacts on practitioner knowledge and understanding of the issues of domestic abuse and substance misuse. In addition, the skills based course showed impact on practise over the initial follow-up evaluation period. Overall, prior to the establishment of the Tayside project domestic abuse services and substance misuse services largely worked in isolation (both at an operational and strategic level). The projects greatest success has been in raising awareness of the links between the issues amongst practitioners, managers and strategic planners in order that the need for further work can be recognised and prioritised. Actions are now incorporated within all areas domestic abuse / violence against women partnership and alcohol and drug partnership strategic plans. The learning from the Tayside project has largely been in relation to the process of encouraging and supporting change within partner organisations in order that they provide a focussed and needs-led response to clients with multiple and complex needs. In relation to what worked well in instigating and supporting change the project management group have identified several key factors; the presence of a dedicated development work, the use of both top-down and bottom-up approaches, linking theory to changes in practice, the establishment of women only service provision, the use of sustainable resources, national dissemination and a multiagency management approach. However, the project was also able to identify some significant challenges and barriers to progress that could helpfully be considered in any future work; the challenges of partnership working, the management of research projects, limited agency capacity, strategic prioritisation, project timescales and change management issues. 4

5 CONTENTS Headline Achievements 2 Executive Summary 3 Contents 5 Chapter 1 - Introduction to our Project 6 Chapter 2 - Research Report 9 Chapter 3 - Children and Young Peoples Action Research Project 12 Chapter 4 - Women Only Spaces 15 Chapter 5 - Referral, Information Sharing and Routine Enquiry 22 Chapter 6 - Joint Publicity Materials 27 Chapter 7 - Training 30 Chapter 8 - Local and National Dissemination 35 Chapter 9 - Project Impact and Learning 37 5

6 CHAPTER ONE INTRODUCTION TO OUR PROJECT Our project The Tayside domestic abuse and substance misuse project targeted women (and their children) who had experienced, or were experiencing, the dual issue of domestic abuse and substance misuse. The project worked with the following definitions of domestic abuse and substance misuse: "Domestic abuse (as gender based abuse), can be perpetrated by partners or expartners and can include physical abuse (assault and physical attack involving a range of behaviour), sexual abuse (acts which degrade and humiliate women and are perpetrated against their will, including rape) and mental and emotional abuse (such as threats, verbal abuse, racial abuse, withholding money and other types of controlling behaviour such as isolation from family and friends)." Scottish Government (2000) The use of substances (alcohol, prescription drugs and illicit drugs) with serious negative consequences of a physical, psychological, social and interpersonal, financial and legal nature for users and those around them. Adapted from Hidden Harm (2003: 7) definition of problem drug use. An initial research project was established to explore the links between domestic abuse and substance misuse for local women and to identify how well their needs were being met by services. From the research findings it was agreed to focus development work on the "getting in" stage, with four major work streams being established; women only environments, training, policy and practice and children and young people. The project brought together partners from Dundee, Perth & Kinross and Angus, and was managed by a multi-agency management group 1. The Project also involved a small number of service users in the training, policy and practice and children and young peoples work streams. Project rationale The view was taken that it would not be desirable to set up a new service to cater for this particular client group, but rather to work with existing services to build their capacity to respond appropriately to the client group. The decision to focus on women only was taken in line with the Scottish Government's gender-based definition and understanding of domestic abuse, this also reflected the limited resources within the project which would not have allowed focussed work on perpetrators of domestic abuse who also have a substance misuse issue. The project aimed to raise awareness of the links between the two issues, promote best practice (within and between services) and develop joint working to better meet the 1 Management group members were drawn from Angus Partnership on Domestic Abuse, Angus Drug and Alcohol Action Team, Dundee Violence Against Women Partnership, Dundee Drug and Alcohol Action Team, Perth and Kinross Domestic Abuse and Violence Against Women Forum, Perth and Kinross Drug and Alcohol Action Team, Tayside Council on Alcohol, NHS Tayside, Scottish Women's Aid and the Scottish Government. 6

7 needs of the client group. Tayside has approximately 50 drug and alcohol services and 4 domestic abuse services that were largely providing interventions in isolation and not engaging with pro-active partnership working with the other sector. A development worker was appointed to champion the project and develop a coordinated and consistent multi-agency response to the client group across Tayside. Project aim(s) The aims of the project were 2 fold: To ensure a co-ordinated and consistent multi-agency response to women with dual experience of domestic abuse and their own substance misuse across Tayside. To ensure a co-ordinated and consistent multi-agency response to children and young people across Tayside who have specific needs as a result of their experiences of both domestic abuse and the impact of parental substance misuse. The objectives of the project were to: Improve access to appropriate services for women, children and young people - women only spaces work stream and joint publicity work stream. Develop cross-disciplinary responses to the provision of services for the target group - referral, information sharing and routine enquiry work stream. Improve satisfaction with services and outcomes for the target group - children and young people action research work stream. Ensure professionals are knowledgeable and adequately trained to support the target group - training work stream. Project goals 1. Commission action research to identify the needs and barriers to service provision faced by women (and their children) who experience domestic abuse and substance misuse. 2. Assist services to create a positive environment for disclosure, including piloting of women only spaces within substance misuse services. 3. Encourage substance misuse services to refer to domestic abuse agencies through clear policy and procedure, and vice versa. 4. Develop information sharing protocols between domestic abuse and substance misuse services. 5. Develop and implement routine enquiry, policy and procedure with domestic abuse and substance misuse services. 6. Develop joint publicity material for services and services users, and implement an advertising campaign. 7. Develop and implement training packages for practitioners working with domestic abuse and substance misuse issues. 8. Increase practitioner knowledge of service roles and remits through a multi agency training event. 9. Raise awareness of the work of the Tayside Project and disseminate resources to local and national partners. 7

8 10. Monitor and evaluate the work of the project and produce an end of project report for public dissemination. Monitoring and Evaluation The Project Lead took an active role in the wider evaluation of the MCN Funding stream commissioned by the Scottish Government. In addition to this individual projects were required to undertake any necessary monitoring and evaluation of their own local project. Both qualitative and quantitative evaluation methods were used to evaluate the work of the Tayside project. The evaluation of some work streams was more successful than others, with the project being largely dependent on the cooperation of individual partner agencies in returning monitoring forms and attending interviews / focus groups. More detail regarding the methods used to evaluate individual work stream is contained throughout this report. Structure of this report The following report presents information about each of the work streams undertaken by the Tayside Domestic Abuse and Substance Misuse Project. Chapter two focuses on the research project commissioned by the project, chapters three to seven review each of the individual project work streams. Chapter eight examines the local and national dissemination strategy employed by the project, and chapter nine summarises and reviews the outcomes and learning of the project. 8

9 CHAPTER TWO RESEARCH PROJECT The Project commissioned research exploring a number of issues with women currently engaging with domestic abuse or substance misuse services in Tayside: The extent of overlap between the issues of domestic abuse and substance misuse. The nature of the overlap between domestic abuse and substance misuse. The women's' experiences, positive or negative, of accessing services in the local area. The women's' views of the support available to their children if they had any. The research also explored the nature of current service provision with practitioners and managers working within domestic abuse and substance misuse services. This largely focussed on factors which facilitated access to and use of services, and conversely factors which were a barrier to accessing and using services. The research project was modelled on Humphreys, Thiara and Regan (2005) "Domestic Violence and Substance Misuse: Overlapping Issues in Separate Services?". The original research project distributed 233 questionnaires to women through key domestic abuse and substance misuse agencies across Tayside. In total 41 women completed and returned questionnaires to the project. Following the return of questionnaires face-to-face interviews were held with 12 women and 28 workers based in substance misuse or domestic abuse services. Following the data collection stage it became apparent the project management group that there were significant problems with the quality of the data collection and initial research report. It emerged that the original distribution of the questionnaires and interviews lacked significant focus on the intended target group of women experiencing the dual issues of domestic abuse and substance misuse. In addition, interviews with service providers had tended to focus on providers general views of 9

10 service delivery, rather than their views in relation to delivering services to the specific target group. At this stage the project management group felt it was important to find a way of using the data gathered, and honouring the commitment of those who had participated, and therefore spent a significant amount of time retrieving the original data, and sourcing a suitable person to undertake a secondary analysis and report. A secondary analysis of the original data and production of a full research report was completed by Rona Dolev. The full research report and summary of key findings can be found at Work stream targets To establish a reliable figure for the level of overlap between domestic abuse and substance misuse for women currently accessing domestic abuse and / or substance misuse services in Tayside. To establish an evidence base indicating key factors which successfully support women experiencing both issues to engage with domestic abuse and substance misuse services. To establish an evidence base indicating key barriers preventing women experiencing both issues from engaging with domestic abuse and substance misuse services. Key achievements Due to the problems experienced with the original data collection for the research study the Project does not feel that it achieved its initial target of establishing a reliable local overlap figure for the issues of domestic abuse and substance misuse. Although this was disappointing the research project did yield some interesting information about what does and does not encourage women to access services operating in the substance misuse and domestic abuse sectors. The second research report did yield some interesting evidence regarding factors in the local area which influence women s ability to access services. The factors identified were largely in line with previous research conducted in the UK and elsewhere, and provided a basis for the development of pro-active work undertaken with services by the project following the initial research phase. In summary, the key targets for this work stream were only partially meet as ultimately the research data and conclusions are not fully reliable and robust. Key learning points The experience of commissioning and implementing a research project highlighted a number of learning points for the project management group. The project feels that some of these lessons could be useful to other organisations and projects across Scotland in commissioning successful small-scale social sciences research projects. Ethical approval: Although gaining ethical approval for research is vital, the time involved in doing so should always be realistically estimated and built in to project timelines. Where project participants are to be accessed through 10

11 NHS services commissioners should be aware that their ethics procedures are designed for medical research projects, rather than social sciences projects, and therefore can be challenging and time consuming to negotiate. Full economic costing: Where a University is involved in the research project they will charge FEC to cover overheads. This can add a significant cost to the research project (up to 40%) and can be prohibitive to the involvement of academic institutions. If a University is to be involved in any research project the issues of FEC should be discussed and agreed before the project begins. The Tayside project believes this is also a key learning point for the Scottish Government. Recruiting a researcher: Recruiting a suitable research at short-notice can be very challenging, particularly when a specific knowledge base is required. Commissioners should take adequate time to contact potential researchers from a wide variety of backgrounds (academic and non-academic) and to gather suitable references and previous research examples before engaging a researcher. If no-one is available that meets the criteria required the research project should not go ahead. Timescales: When estimating the time required project commissioners need to be realistic about what can be achieved and how long this will take. If you have a set time period then it is likely you will have to compromise on the amount of work that can be achieved. Alternatively, if you have a set amount of work / outcomes you wish to achieve you should be prepared for it to take significantly longer than you might want. The issue of timescales in complicated further where the researcher does not have direct access to the research participants i.e. they will have to access them through third party organisations. Where the project relies on the co-operation of partners whose priority is service delivery there will inevitably be delays in accessing participants and gathering data. Overall, the Tayside Project learnt that although flexibility is always necessary when commissioning a research project that on occasion it is better to recognise that a piece of work is not possible within the time / resources allocated rather than to try, at all costs, to make desired outcomes / actions happen. The Tayside project believes that this is also a key learning point for the Scottish Government when commissioning and monitoring local projects. The Project invested significant time and resources in enabling the research project to happen, and to navigate the barriers to this, however, on reflection it is questionable whether the results achieved were of significant value to justify this initial input. 11

12 CHAPTER THREE CHILDREN AND YOUNG PEOPLES ACTION RESEARCH PROJECT The Project was not able to involve children and young people directly in the formal research study due to time constraints and ethical issues. Instead a consultation event was held with practitioners working with children and young people to establish how children's views might best be incorporated in the work of the project. The consultation event, which took place in May 2007, involved practitioners from across Tayside who work directly with children and young people. The aim of the event was to explore good practice and effective research methods / techniques when involving children and young people as research participants in a study examining the impact of domestic abuse and parental substance misuse on them. Practitioners who attend were asked to speak to children and young people within their service prior to attending, Practitioners who attended each produced a creative project that identified the main elements of a successful research project which engages children and young people. The main elements identified included using creative techniques, linking in to existing services / support networks, providing follow-up support to participants, using a multi-agency and multi-activity approach. From this event it was agreed to develop a Summer Action Research Project for children and young people aged 8-16 years. Children currently accessing local domestic abuse and substance misuse services were brought together to explore their perceptions and experiences of "Alcohol", "Drugs" and "Violence". Workers The children used words and photographs to produce posters that reflected their experiences. Support Workers from Tayside Council on Alcohol, Dundee Women's Aid and Perth Women's Aid worked with project staff to run the sessions with children. A student from Perth College assisted the children to use I.T. packages to create their posters. Once finished the posters, photographs and words were assembled into a touring exhibition (on canvas panels) named "A Day in the Life...", which can be used to raise awareness of children and young people's experiences of domestic abuse and parental substance misuse. A lunch event was held with senior managers from relevant local agencies and children received certificates and a digital camera in return for their efforts. The event was chaired by Sheriff Stein and the children's friends and family were also invited to attend. Young people gave presentations about the work they had undertaken and the posters they had created. The exhibition is now available for access by any organisation and has since been displayed at our own Project conference, at a Fife based training event, a Women's Aid AGM, and at various awareness raising events 12

13 for the 16 Days of Action for the Elimination of Violence Against Women. The exhibition information leaflet can be found at Work stream targets To develop a suitable model to involve children and young people in the work of the project. To establish an evidence base indicating children and young peoples experiences of and perceptions of domestic abuse and substance misuse. To raise awareness of practitioners working in local services of the impacts of domestic abuse and substance misuse on children and young people. Monitoring and evaluation Practitioners who attended the initial consultation event were asked to evaluate the session by writing comments (positive or negative) on post-it notes and leaving them on a board at the front of the room. This gave the project qualitative data about their experiences of the day and ways in which it might have been improved. The main themes emerging from practitioners evaluation of the event were; positive networking opportunities, lots of opportunity for interaction and creativity, and that the event had inspired thinking about the two subject areas and the links between them Children and Young People who took part in the Summer Project provided feedback about their experiences following the activities they took part in: "I had fun, it was great" "I had the time of my life" "I think today was really good and I would say I was excellent at being patient and taking pictures on the cameras" "I had a really GREAT day today" Practitioners who staffed the project were also asked to complete evaluations using the standard form provided by Cambridge Policy Consultants. However, the vast majority of staff did not return these and as many of them were sessional summer workers the Development Worker was not able to contact them later to retrieve the required data. Anyone borrowing the exhibition is provided with a comments book where those viewing it can leave comments and feedback for the Project. Feedback received so far, through the comment book, and verbally from staff at organisations who have borrowed the exhibition indicates that the images and words have had a powerful affect on audiences and generated significant interest and discussion. Key achievements The project was able to work with local partners to develop a suitable model to involve children and young people in the work of the project. The practitioners' consultation event held in 2007 was well attended by a range of front line 13

14 practitioners and managers. Not only did this lead to the identification of a model for engaging with children and young people, but evaluation data contributed by participants also indicated increased awareness of the links between the two issues and how these might impact on children and young people. The children s exhibition A Day in the Life represents a long-term resource highlighting children s experiences of domestic abuse and substance misuse. The exhibition is available in a format that can tour around Scotland raising awareness within the public and professionals. The children who participated in the project evaluated this as a very positive experience, with the key themes being the enjoyment / fun they had and the new skills they acquired. The exhibition has been lent to three external partners within Scotland and both have commented that all who saw it were shocked by its content and spoke positively about the impact it had on their awareness and understanding. The consultation day and exhibition launch were also successful in raising the awareness of local practitioners of the impacts of domestic abuse and substance misuse on children and young people. Those involved indicated that the experience had helped them to think about the links between the two issues and to relate this to the experiences of children affected. 14

15 CHAPTER FOUR WOMEN ONLY SPACES The Project worked closely with a range of substance misuse services to pilot women only provision within existing services. None of the services taking part had previously offered consistent and ongoing forms of gender specific provision. The development and implementation of women only provision within substance misuse services was firmly placed within the requirements of the Gender Duty. The aim of the provision was therefore not simply to increase the number of women accessing substance misuse services, but to improve the quality of provision available to women accessing these services and to ensure this provision more closely met their needs. Specialist services operating within the domestic abuse sector already operate as women only services and therefore this work stream was focussed on providers in the substance misuse sector. Women only spaces were not specifically targeted at women with dual issues of domestic abuse and substance misuse; the intention was not to establish "domestic abuse groups" within substance misuse services. Instead provision was targeted at all women, with the recognition that based on research evidence of the overlap between the two issues at least some women using the facilities would be affected by the dual issues. The Project wanted to encourage service providers in the substance misuse sector to begin to consider the different needs of women service users and to think about how they could best begin to respond positively to these needs. Overall, the Project wanted to support substance misuse services to establish environments where women felt comfortable and able to approach and engage with workers. The project Development Worker assisted services to agree an appropriate model of provision, and provided preparatory training around basic awareness and disclosure. The Development Worker targeted key services within the care pathway, attempting to involve services from both the drug and alcohol fields, services from across Tayside and services at different points in the care pathway. The Project also provided financial support for the pilots and assisted with the advertising of services to women and other relevant services. Throughout the life of the project a number of pilots took place. Addaction The Dundee based, voluntary sector Direct Access service ran a 6 week women only drop in session. This was a 2-hour slot on a Thursday morning and was staffed by female workers only. The drop-in sessions did not offer an enhanced service above and beyond that offered by Addaction during regular drop-in hours, the important difference was the all female environment. This new service element was advertised with assistance from the Development Worker both on Addaction premises and in 15

16 key services throughout the area. All women who attended during the women only drop-in time were given a "goody bag" (funded by the project). Tayside Council on Alcohol The Tayside wide voluntary sector alcohol service ran a peer support group from their Dundee premises. This ran over several months and was staffed by women only. As well as providing opportunities for peer support and discussion, the group acted as a consultation mechanism for the service and offered women a safe space for disclosure. The group was promoted to all female clients across Tayside who had been offered an appointment by TCA over the preceding 3-month period and transport was provided to some women to assist them to access the group. Group activities focussed on promoting confidence, self-esteem and personal resources, and many women went on to access additional activities and service provision through their involvement in the group. TCA are now planning to expand the service into Angus and Perth and Kinross areas with support from the Tayside Project. Eclipse The Dundee based, voluntary sector Moving On service (part of Cair Scotland) ran a 6 week group work programme. The group aimed to provide a relaxed atmosphere where woman could come together and engage in activities that would boost their self-esteem and develop confidence in their appearance in preparation for interviews or work. External facilitators worked alongside Eclips staff to deliver a range of sessions that aimed to prepare women for coping in new situations (aromatherapy and relaxation), inform them how to prepare healthy meals (healthy eating and food hygiene), help them to express themselves (creative writing), encourage them to care for their skin (beauty therapy), and equip them to dress on a budget. On completion of the group sessions women were offered the opportunity to receive a free hair treatment. Cairn Centre The Dundee based, needle exchange project operated by Cair Scotland ran a 5 week group work programme. The "Women's Feel Good Group" ran from November to December 2007 and involved staff from Cair Scotland and Dundee Women's Aid. The sessions were focussed on women using the needle exchange project, who were a particularly hard to reach group. There were twelve women involved in the planning of sessions which were then delivered by external facilitators (funded by the Project). Sessions included arts and crafts, poetry and linguistics, aromatherapy and cookery. At the end of the group sessions all woman who had taken part attended a Christmas Dinner. At the end of the lifetime of the project various members were progressing discussions with other relevant partners in Perth and Kinross, Angus and Dundee to further develop the work around women only space. Following the end of the Tayside Project this work was passed on to the local multi-agency domestic abuse / violence against women partnerships and drug and alcohol action teams. The funds generated from fees for the final project conference have been retained by the project and will be used to fund women only provision in substance misuse services over the next few years. Services will be able to apply to the fund using a simple application form. 16

17 Work stream targets Establish women only pilots within local substance misuse services where these have not already been established. Pilot different models of women only provision; drop-in, group work programme, peer support group, women only appointment times. Increase the number of women who are accessing women only service provision in substance misuse services. Increase the number of disclosures of domestic abuse (and other forms of violence against women) received by substance misuse services from women accessing women only provision. Monitoring and evaluation To evaluate the women only pilots' one to one interviews were conducted with the majority of women who attended, although a focus group was also used with one service. Due to the chaotic circumstances of some of the women, it has not been possible to follow-up all of those who attended women only space. Practitioner evaluations were also one to one interviews, again a focus group was planned but people had difficulty attending on the same day. In the group work sessions practitioners were asked to complete client outcome forms (adapted from those provided by CPC) with women throughout their attendance at groups. Practitioners did not always do this with women, and some women did not return to the group regularly enough for outcomes to be tracked. However, a small amount of data was able to be gathered by the Project from these forms. Key achievements The Project was successful in its aim to establish women only pilots within local substance misuse services where these have not already been established. As described above, pilots took place within 4 services, with other services considering future provision. The project does not have any knowledge of women only provision in the substance misuse sector which was taking place prior to the specific pilots funded and supported by them. The implementation of the pilot sessions was considered by the project management group to be a key success as initially there had been some difficulties in progressing this work stream. Across services strategic managers and planners found it difficult to support the prioritisation of resources to establish the pilots, especially as they do not have any statutory performance indicators relating to women only service provision. Work with frontline practitioners, service managers and the introduction of information about the requirements of the gender duty were key to overcoming these initial challenges in some services. The Project successfully piloted different models of women only provision; drop-in, group work programme and peer support groups. The only form of provision that was not piloted within the life of the project was women only appointment times. The project took a non-directive approach when initially contacting services about the possibility to establishing women only provision. The Development Worker was clear that their aim was to work with the service to support them to introduce some element of women only provision, but that the exact model used would best be identified by staff from the service in question. The Development Worker took on a facilitative role assisting staff to think through the possible advantages and 17

18 disadvantages of the various models, organising and delivering staff training, providing funding and assisting with advertising. This non-directive approach was valuable in ensuring individual service had ownership of the work and were comfortable with the new element of service being introduced. As prior to the projects occurrence there was no consistent and ongoing women only provision within substance misuse services the project did, inevitably, increase the number of women who are accessing women only service provision in substance misuse services and increase the number of disclosures of domestic abuse. However, attendance at the different women only pilots varied widely; o Eclips Group work sessions: 5 out of 10 invited women attended the initial session. Of these 5 women all attended the second week, 2 the third week, all 5 the fourth week, 3 the fifth week and 4 in the final week. This group was drawn from a service which is focussing on employability and stability and it is thought that the nature of the service meant attendance was more regular than in other pilots. One disclosure of domestic abuse was received. o Needle Exchange Group work sessions; this group ran over a 4 week period, with only 4 women attending the initial session and 2 women attending all sessions. This was the most chaotic service user group so low attendance was expected. One disclosure of domestic abuse was received. o Addaction drop-in sessions attracted 6 women over a 6 week period. This is a direct access service which facilitates referrals to treatment agencies; therefore, clients are often at their most chaotic and disengaged when accessing the service. Two disclosures of domestic abuse were received. o TCA's women only group was attended by between three and nine women each week during its initial seven week run. The service did not record any disclosures of domestic abuse. Although the numbers of women accessing the women only provision were relatively few, other monitoring and evaluation information suggests that this was a very positive experience for women who did become involved. Project staff and practitioners within partner agencies suggested that levels of engagement would be expected to increase over time should the provision continue. There was a strong sense from practitioners that new elements of service provision take some time (certainly more than 6-8 weeks) to fully "bed-in" to service provision, to be properly advertised and for word-of-mouth to encourage attendance by other service users. In addition, some services suggested ways in which they felt accessibility had been restricted that they would address should further provision be rolled out. For example, Addaction identified that an afternoon slot would be more beneficial and that an alternative venue linked to other women only provision might encourage engagement by a larger number of women. All the services who piloted women only spaces fed back to the project that they would consider implementing further women only provision, however, all of them also stated that they would take on board learning about the structure of this provision from their experiences of the initial pilots. Overall, to gain a true picture of the level of demand for and engagement with women only provision pilots would have to be run again for a more significant period 18

19 of time before an informed decisions about their value / prioritisation could be made by individual services. The services involved generally felt that the pilots had been a relatively easy service element to set-up and implement. Although this often involved a lot of work the support offered by the Development Worker was seen as being very valuable at the planning and immediate implementation stage. The majority of services who participated in the pilots started by setting up a structured group work programme, however some then went on to offer a more client-led approach once they had completed the initial pilot stage and felt more familiar and confident with the service model. All services who have participated have indicated that they would wish to continue and further develop their pilot model in the future. However, one service has said this is not suitable at the moment as they feel the demand from women currently using the service is not significant enough. Some of the barriers / challenges highlighted by services who participated included; Level of resources (in particular staff time) available to support such service developments Dynamics between the women attending the group i.e. dominant members and contact out with the facilitated group. Complaints from male service users about a lack of gender specific services for them. Getting women to attend group work programmes can be challenge given their often chaotic lifestyle and their conflicting priorities. A need to re-examine the location and timing of services for any further provision. It was felt it would be helpful to move provision to local areas and to think about providing sessions in the late morning / early afternoon. Resistance from service managers who did not recognise the need to provide women only service element. Concerns about restricting access in any way within the local direct access service. All of the services who took part highlighted the value of the domestic abuse and substance misuse training offered to them by the Tayside Project prior to their women only space beginning. In particular it was felt that this embedded awareness of the links between the two issues and increased staff confidence to deal with the issues. This also helped staff to clarify that the aim of such pilots was not to generate as many disclosure as possible and to help them to understand that where disclosures did come their role was not to fix the problem for the woman. However, some services did identify a need for further staff training during the process of piloting women only space, in particular in delivering group work, violence against women, prostitution, abuse and trauma, dealing with disclosure and safety planning. Staff from service reported various benefits / advantages that they saw during the piloting of women only spaces; Providing a service where women s partners can not go makes it easier for some women to access services. Development of good relationships with clients has underpinned disclosure of both substance misuse and domestic abuse issues. 19

20 Within group work taking the focus of the drug agenda helped staff to develop better relationships with clients. Increased self-confidence amongst women. Less stigmatising for the women and encouraged staff to recognise the variety of needs that women have. Feedback from clients was gathered in a number of different ways. Many of the women who attended group work models provided positive comments about their experiences, these focussed on some distinct themes: Feeling more relaxed in the women only environment I feel that a woman only space is less intimidating than mixed groups Appreciating having something to do in their spare time one woman commented that this had distracted her from using drugs. Enjoying the activities which were on offer. Relating how the activities they had undertaken would help them in their life Using creative writing will be really helpful when I m angry and need to get everything out Feeling better about themselves (physically and mentally), built self-esteem and self-confidence Making new friends and meeting other people who are experiencing similar issues This group has been great, I ve made new friends and learnt a lot over the past few weeks. Learning about new things and acquiring new skills. Some women reported that their experiences of using the women only pilots had been better than their previous experiences of engaging with services. This was mainly attributed to positive relationships with staff and to the presence of other women to offer peer support. However, women also had some suggestions for improvements; More resources might have meant that sometimes activities would not have been as limited i.e. better equipment would have been available, more participation rather than just demonstration. Encouraging more women to attend so that the group is more dynamic. Eclips were the only service who managed to complete Baseline Client Characteristics and Outcomes forms originally provided to the project by CPC. Other services found the forms to be inappropriate to the client group they were targeting or impossible to complete due to irregular attendance by women. Five women who attended the Eclips group work programme completed templates providing a baseline score, reassessment in December 2007 and final assessment in March The women identified a need to work on a wide range of issues, with all women identifying multiple and complex needs. All of the women reported either sustaining the status quo or positive progress in every issues identified as being problematic for themselves. Feedback was also gathered from women who participated in the Addaction drop-in pilot. Women were asked to rate various aspects of their experience on a scale of 1-20 (with 1 being a low score and 20 a high score). Five of the six women who used the service completed these initial contact monitoring forms; 20

21 The average overall rating given to the women s first experience of the service was 16 (with 1 being a negative experience and 20 being very positive). Women commented that staff had been friendly and welcoming. When asked whether the availability of a women only service had encouraged them to access the service women gave an average rating of 15 with 1 being not at all and 20 being a lot). Of the five women, two gave a 20 rating indicating that their engagement with the service had been heavily influenced by the existence of the pilot. Women were also asked whether the woman only environment had made it easier for them to discuss issues with staff, on average they gave a rating of 16 (1 being not at all and 20 being a lot), with two women giving a maximum rating of 20. Women were asked to comment on whether or not they would have accessed the service if a woman only time had not been available. The average rating was 12 (1 being not at all and 20 being easily). Finally, women were asked whether or not they would like to see the women only drop-in continue, the average rating was 18 (with 1 being not at all and 20 being a lot). Women commented that they thought this would encourage more women to attend, and help women to be more open and honest about their drug use. Four of the women who attended the pilot also participated in follow-up interviews and highlighted a number of key themes regarding their experiences of using the women only space at Addaction; Felt that some women would prefer the opportunity to speak to a female worker Being able to speak more freely and openly. Not being embarrassed to talk about the issues facing them. Reported feeling more positive about seeking further help and support. Pro-active advertising of the service by Addaction had been useful and some women had passed this information on to friends who had not previously been in touch with the service. One woman reported having an extremely controlling partner who would not allow her to go anywhere by herself. The existence of women only time meant she could access treatment without her partner being able to involve himself. One woman commented that she was happy using the mainstream mixed gender service, however could see that other women might prefer this approach. Most women reported positive progress in terms of their drug use since accessing the woman only pilots. The majority of women reported having went on to access further services following a referral from Addaction. Some women highlighted a need to provide childcare along with any service. The establishment of gender specific services within 4 local services has been a key achievement of the Project, and feedback from all those involved suggest that this would have been unlikely to take place without encouragement and support from the development worker. The monitoring data collected from both staff and service users involved in the pilot has provided evidence of the positive impact the pilots have made and also highlighted areas for further consideration and development. The 21

22 numbers of staff and service users involved were small, and it was particularly difficult to gather monitoring and evaluation data from the women involved, as many were / are in chaotic circumstances. 22

23 CHAPTER FIVE REFERRAL, INFORMATION SHARING AND ROUTINE ENQUIRY The Project Development Worker conducted a scoping exercise around best practice in working with women who experience the dual issue of domestic abuse and substance misuse during the initial stages of their employment. Members of the project management group visited two projects in London (The NIA Project and The Stella Project) which proved fruitful in gathering information about good practice in working with women in the target group. The London projects provided information and resources that highlighted the need for training, publicity, women only spaces within services and for clear policy and procedure within which staff could work to deliver high quality services / interventions to women affected by domestic abuse and substance misuse. In particular the visit highlighted a document produced by Camden Domestic Violence Forum ("Refining the Routes: Domestic Violence and Substance Misuse: Policies, Procedures and Protocols for Partnership Working in Camden") which provided a comprehensive package of policies, procedures and accompanying documentation for services working with women in the Camden area. A multi-agency working group was then established by the project management group and the development worker bringing in representation from agencies across Tayside and from service users. The working group were tasked to develop best practice guidelines for practitioners working with the issues of domestic abuse and substance misuse. The group's remit was to gather examples of good practice from across the UK and to adapt this work for use in Tayside. Over a period of 13 months, covering 12 meetings, the working group were successful in producing the No Boundaries Toolkit. The toolkit was adapted from Camden Domestic Violence Forum document (with the Forum's permission) to take into account differing Scottish legislation and the local context within Tayside. The toolkit contains procedures for information sharing and referral between services, service user consent forms, referral protocols, assessment forms, and guidance around routine enquiry for substance misuse and domestic abuse. The pack also contains policy statements which agencies can adapt for use, a section on risk assessment and safety planning. The toolkit working group also worked together to produce a referral flowchart leaflet that would sit alongside the toolkit. This built on work previously undertaken by the Perth and Kinross Domestic Abuse Forum, who had produced a screening and referral flowchart for women experiencing domestic abuse for use by non-specialist services. The working group members used this existing model to create a similar flowchart for women who are misusing substances. The two flow charts were then developed into a double sided leaflet with contact information for key domestic abuse 23

24 and substance misuse services across Tayside. Practitioners in substance misuse services can display the domestic abuse side of the leaflet as a poster and vice versa. The leaflet aims to encourage staff working in each sector to take basic steps to enquiry about "the other" issue and to provide an appropriate initial response. The flowcharts emphasise that practitioners have core transferable skills when dealing with disclosure but also acknowledge that staff are not expected to provide specialist support for all of the issues faced by the woman. Alongside the development of training for practitioners (see chapter seven) the production and subsequent implementation of the toolkit was used by the project management group and Development Worker to promote the introduction of routine enquiry within substance misuse and domestic abuse services. This was particularly encouraged in substance misuse services, where the initial research project had indicated that enquiry regarding domestic abuse was, at best, patchy. The toolkit offers services all the necessary model policies, procedures, protocols and accompanying forms to establish a programme of routine enquiry within their service. The project Development Worker spent a significant period prior to the end of the Tayside Project presenting the toolkit at conferences, forums and events (both local and national) and speaking to individual staff teams within key local services. When engaging with key local services the Development Worker encouraged staff teams to consider and discuss how they could start to implement elements of the toolkit within their service provision and, over the long-term, work towards implementing routine enquiry. Toolkits were distributed by the project to each domestic abuse and substance misuse service operating across Tayside. Each service received multiple hard copies of the toolkit and referral flowchart. Toolkits were also distributed to every multiagency domestic abuse / violence against women partnership in Scotland and every Drug and Alcohol Action Team. Following this national distribution a number of other local authority areas request further information regarding project resources. Unfortunately, project timescales did not allow the Development Worker to undertake intensive work with individual services in order to support them to operationalise the toolkit. The project management group had initially envisaged that this would be a key element of the Development Workers role, and recognised that in order to change policy, practice and culture services would require support from the dedicated project worker. However, production of the toolkit took substantially longer than had originally been forecast and changes in personnel within the project team meant that intensive implementation work did not take place over the project's lifetime. Some agencies have already incorporated some of the basic elements, for example displaying agency policy statements (for example, Aberlour) and adding questions to standard assessments (for example, Addaction and New Begginings). Responsibility for supporting toolkit implementation has now passed back to the domestic abuse / violence against women partnerships and drug and alcohol action teams in each local area to take forward within the context of their strategic plans. In the months prior to the completion of the Tayside Project the Scottish Government issued a Chief Executive's Letter to NHS Boards across Scotland. This letter gave direction about the introduction of routine enquiry for gender-based violence within key health services, including addiction services. The toolkit developed by the 24

25 Tayside Project has been passed to the Scottish Government team who are supporting NHS Boards to develop this area of work and they are currently considering how it can be used across Scotland to facilitate this process. Work stream targets Agree local protocols and procedures between domestic abuse and substance misuse services covering; routine enquiry, information sharing and referral. Ensure all local domestic abuse and substance misuse services have access to copies of protocols and procedures. Support all local domestic abuse and substance misuse services to implement (and adapt if necessary) standard policies and procedures within their individual service. Monitoring and evaluation A focus group was planned for the toolkit working group but it proved difficult to get all members to attend together. An alternative approach was attempted where questionnaires were prepared and sent out to all who were involved, with follow-up telephone calls to encourage completion. Although the most active core members of the group returned their feedback questionnaires, overall response rates were low. This meant that it was difficult for the project to evaluate members overall experiences of the working group and that information gathered was skewed towards those who had been the most active members. The long-term implementation and impact of the toolkit cannot yet be evaluated. Implementation work has now been taken up by the local domestic abuse / violence against women partnerships and drug and alcohol action teams across the three areas. They will be responsible for developing implementation plans which meet the needs of their areas and for evaluating the success of this work over the long-term. Monitoring and evaluation procedures will require to cover evidence of individual elements of the toolkit actually having being operationalised and the subsequent impact on practice, disclosures and outcomes for service users. Key achievements The development, agreement and production of the toolkit and referral leaflet covering all aspects of service delivery around disclosure of domestic abuse and / or substance misuse was a significant achievement for the working group and for the overall Tayside Project. These new resources provide a sustainable outcome for the project, which will be available to services across Tayside on an ongoing basis. One working group members comment that the toolkit "...provides a good resource to staff in order to reinforce and extend worker skills." The toolkit is also valuable to others working in the domestic abuse and substance misuse sectors across Scotland, particularly in light of the introduction of the CEL for gender-based abuse. The Tayside Project has been successful in 25

26 ensuring that all local domestic abuse and substance misuse services have access to copies of the toolkit, both in hard copy and electronically through a number of local and national sites websites. The national distribution of the toolkit has led to further enquiries from four local authority areas who are all currently considering how to adapt the toolkit for local implementation. The project management group viewed the establishment and operation of the toolkit working group as a key work stream of the project and collected monitoring data from staff that participated in its work on an ongoing basis. Members have highlighted some of the key achievements / benefits of being in the working group as; o Increased awareness of the needs / issues faced by women who experience domestic abuse and substance misuse. Although this was not the aim of the group, training and networking benefits have been an important by-product. o Changed attitudes towards women experiencing the dual issues, in particular the recognition of a need / responsibility for services to develop a specific response to the issues. o Helped practitioners to recognise that their core skill sets are transferable to the other issue and therefore, have built confidence. o Development of new skills and sharing of information that have helped people to think of and begin to implement new ways of working within their own services. o Increased knowledge of other services roles and remits. o Informal networking and relationship building opportunities. One member commented that "The project has most certainly helped me to develop links with agencies...in the past I was aware that existed but seemed very separate from what I was doing. Hopefully this realisation can help me, and in turn the staff I supervise, provide more integrated...effective help for service users." One agency who participated commented that without the catalyst of the initiative I believe that these links may not have been made. The core members of the working group (in the main drawn from the substance misuse sector) provided feedback which clearly demonstrated the benefit and value drawn from their full involvement in the process of producing the toolkit. Members who had been less involved in the group or who had dipped in and out of meetings across time drew less benefit from their involvement. This less consistent approach was often necessary due to the limited capacity of individual workers / services to take on additional needs or the requirement for front-line workers to respond to ongoing / emergency operational issues. However, the project management group felt that it was important that operational staff were involved in the production of the toolkit in order that the final product took account of day-to-day operational issues, was realistic and could be implemented within existing systems. To allow consistent involvement of these staff groups any future working groups may have to carefully consider their structure, meeting times etc. in order to fully accommodate the ongoing demands of service provision. A small number of members provided feedback that highlighted the dominance of substance misuse based services within the working group. Tayside has 26

27 approximately fifty specialist drug and / or alcohol services and four specialist domestic abuse services, and it was therefore inevitable that the membership of any Tayside wide group would be dominated by the substance misuse sector. However, the project management group took the view that it was the quality of input from each sector rather than the absolute number of people involved that was important in ensuring a balanced agenda. The working group was facilitated by a management group member and the development worker (one with a background in substance misuse and the other with a background in domestic abuse) who strove to ensure that both sectors views were taken into account. The core working group members (of whom there were eight) included representatives from two of the local Women's Aid groups who provided consistent input from the domestic abuse perspective. Overall the production of the toolkit and referral leaflet was a significant achievement for all those involved. However, to some degree the production of this resource was a by-product of a process that brought together services from the different sectors and encouraged discussion, communication and mutual learning. The monitoring and evaluation data collected for the representatives that gave a consistent commitment to the working group clearly demonstrates the networking and awareness raising they gained from this experience. These benefits will be essential in underpinning any future work undertaken in the individual local areas with a view to embedding the materials contained within the toolkit into local practice. 27

28 CHAPTER SIX JOINT PUBLICITY MATERIALS The project worked with relevant partners to develop a range of publicity materials which make explicit links between the issues of domestic abuse and substance misuse, and which direct women to appropriate service providers. The materials make use of quotes contributed by women during the research project and of key statistics relating to domestic abuse and substance misuse. Prior to this work no joint publicity materials on the issue existed, indeed no local services based in either sector provided targeted information on the other issue (other than service leaflets). During the project's visit to services in London and from contributions made by service providers during the research project it was apparent that materials were required that explicitly link the two issues, which were eye-catching and appealing to women and could be displayed both in public settings and within services. Service providers were particularly keen to have materials that when displayed in services communicate to women that staff know about both issues and that women can talk to any member of staff if they are affected by or concerned about either / both issues. The Project produced: A set of 5 posters highlighting the links between domestic abuse and substance misuse and displaying key agencies contact details. A leaflet targeted at women which highlights links, reassures women they are not alone and encourages them to seek help from appropriate services. beer mats providing contact details for key services. A leaflet targeted at children and young people highlighting the links, reassuring them they are not alone and encouraging them to seek help from appropriate services. 28

29 A referral flowchart leaflet for practitioners taking them through the process of disclosure and providing key agency contact details (see chapter five for more details). An eye catching, women-friendly brand was designed by Dundee City Council Public Relations for the project which was used on all publicity materials and across other resources and reports produced by the project. The text for posters and leaflets was developed by the project Development Worker and was discussed and approved through the toolkit working group (which also allowed input from a service user). Selection of key phone numbers for display on posters was a particularly challenging task; the project management group wanted to ensure that numbers reflected key access points for domestic abuse and substance misuse services across Tayside, however, this sometimes meant that key partners who had contributed significant time and effort to the project did not have their numbers included as they held a position further on in the care pathway. Despite the fact that it was not appropriate (or possible) to included contact details for all services across all areas the contribution of a wide range of services (specifically Cair Scotland and SAMH) in developing and producing the posters was essential to their success. Following the development of the publicity materials the Development Worker undertook to distribute materials to premises / services across the Tayside area. Working with other project staff they identified locations where women were likely to come into contact with the publicity materials (for example, schools, leisure centres, cafes, libraries, pubs, health centres, dentists), as well all services dealing with domestic abuse and / or substance misuse. A distribution company was engaged to deliver publicity packs (consisting of posters, leaflets and beer mats) to the locations identified. Additional beer mats and posters were distributed to licensed premises through partners in Tayside Police and Perth and Kinross Community Safety Partnership. Premises were asked to display materials in visible areas or in women only spaces (i.e. female toilet facilities). Where materials were sent to service providers staff were asked to make themselves aware of materials and to actively distribute these to women who may benefit from the information enclosed. Distribution of materials was a resource and time intensive process and was conclude shortly before the project wound up in December Surplus materials left after the initial distribution has been allocated to each of the local domestic abuse / violence against women partnerships and drug and alcohol action teams across Tayside. These materials are promoted by them at conferences and events and can be accessed by local service where their individual stocks have run out. In addition, the templates for all publicity materials have been made available to the equivalent organisations across Scotland and agreement has been reached that materials can be adapted and reproduced in other areas where they are to be used for non-profit making activities. Work stream targets To develop dedicated materials making the links between domestic abuse and substance misuse. Increase women, children and young people's awareness of the links between the issues and services available. Increase the general public's awareness of the links between the issues. 29

30 All domestic abuse and substance misuse services display publicity materials within their public environments. Materials are available through key public outlets, specifically, health centre, leisure centre, community centres and voluntary organisations. Monitoring and evaluation Two months following the distribution of publicity packs follow-up telephone call were made to a random sample drawn from the initial distribution list. Due to the short lag time between distribution and follow-up calls the project did not aim to gather information about the impact of the publicity materials, but rather to check whether services were displaying materials and to ascertain any initial feedback to the materials from staff and / or service users. Due to the limited timescale available to the Tayside project it was not possible to measure the impact of publicity materials either on public perceptions / attitudes or on women's perceptions of the issues and their rates of engagement with services named on the materials. In addition, the frontline services included on the materials did not feel it was appropriate to dedicate limited service capacity to undertaking time consuming monitoring of client awareness levels and routes to referral. This limitation was discussed through the toolkit working group and with the Scottish Government at an early stage. Key achievements The Tayside project was successful in developing a range of dedicated materials which clearly highlight the links between domestic abuse and substance misuse to a range of audiences (current service users, potential service users, general public, children and young people and staff). All services working in the domestic abuse and substance misuse sector received a full set of publicity materials and follow-up phone calls indicate that all services are displaying the posters and leaflets within their services where they are visible to clients. In addition, follow-up calls across the range of services which received publicity packs (including specialist services, nonspecialist services and private businesses) indicates that just under 80% of those services contacted re-called receiving the packs. Of those services who re-called receiving packs only one had not displayed the materials at all, with a small number of others commenting that they only used one specific element of the pack (i.e. leaflets as they have no wall space to display posters). Services had displayed materials in a range of locations; most commonly in staff rooms, female toilets, public information folders, consulting rooms, waiting rooms, reception desks, foyers and pram bays. Just under 2/3 of services reported that the posters and other materials would be displayed on a permanent basis, the rest of the services reported display periods would range between one week and 12 weeks. For services, who reported short-term displays the majority had a policy or rotating materials on a regular basis due to limited space. Medical services (doctors' surgeries, pharmacies etc.) and specialist substance misuse and domestic abuse services were most likely to display materials in prominent locations on a permanent basis. None of the services had yet received any feedback from service users or staff; with most feeling it was too early to comment on this as, in many locations, materials had only been available for a short time. 30

31 Unfortunately at this point the Tayside project is unable to comment on the success of the publicity materials in relation to increasing women, children and young people's awareness of the links between the issues and services, and increasing the general public's awareness of the links between the issues. 31

32 CHAPTER SEVEN TRAINING The training work stream undertaken by the Tayside project had a number of key elements; training with practitioners in preparation for the introduction of women only spaces, the development and implementation of a forum theatre table top training event and the development of a practice-based training course in partnership with STRADA (Scottish Training Agency for Drugs and Alcohol). Training for Practitioners Two training events were delivered to local practitioners working within Addaction, Eclips, Time Tay Change, Cair Scotland and Tayside Council on Alcohol. A third session was planned prior to the end of the project but was cancelled due to staff absence. These were delivered to staff prior to the commencement of women only pilots within services by the Development Worker in conjunction with Scottish Women's Aid representative from the project management group. The training events aimed to develop participants understanding of the links between domestic abuse and substance misuse, and to develop good practice pathways for women engaging with services. Each session was attended by between 10 and 17 workers. As the training was being targeted at workers based in substance misuse services there was a clear focus on understanding the nature of domestic abuse and its links with substance misuse. In addition the training covered issues such as creating environments that allow women to speak, understanding abuse, listening to children, understanding perpetrators, indicators of domestic abuse, asking about domestic abuse and safety planning. 32

33 Forum Theatre Training The Project commissioned an external media company to work with the Development Worker, staff based in both sectors and service users to develop a forum theatre table top training event. The aim of the event was to ensure that practitioners working locally were aware of other services working within the domestic abuse and substance misuse sectors; focussing on their roles and remits and routes for referral. A multi-agency group, which also involved a number of services users, met to develop a number of scenarios highlighting the overlap between domestic abuse and substance misuse. Actors from the media company and volunteers from services performed the scenarios live at the training day and participants were then asked to discuss and feedback on a number of key questions. A variety of local agencies gave short spotlight presentations highlighting the role, remit and referrals routes for their agency. Following events the scenarios were recorded and a training DVD was produced, alongside guidance notes which explain how local areas can undertake a similar process. Clips from the DVD were later incorporated into training sessions delivered by the project and have been used within presentations. Practise- based Training The Project Development Worker worked closely with Scottish Women's Aid to develop a 2 day practice based training course. This work took place in partnership with STRADA in order to facilitate the possible national roll out of the course following the pilot phase. This partnership took a significant amount of time to establish and was facilitated by relevant staff from the Scottish Government. The Tayside Project and Scottish Women's Aid complete course development, with significant input from STRADA, and organised, administered and delivered two pilot courses in early 2009 (which were attended by a total of 36 participants). A further pilot is planned for the Scottish Women's Aid network of local groups later this year. Following the deliver of the first two pilot courses, evaluation data was collected, collated and feedback to Scottish Women's Aid, STRADA and the Scottish Government. The Scottish Government are continuing to facilitate discussions about the potential inclusion of the course in STRADA's ongoing national training programme. Following the end of the Tayside Project these negotiations will be taken forward by the Violence Against Women Team within the Scottish Government, under the work stream associated with the National Training Strategy for Violence Against Women. Dependent on the outcome of current discussions Scottish Women's Aid may also work alongside the Tayside Domestic Abuse and Violence Against Women Training Consortium to deliver training the trainers events where colleagues from across Scotland (based in Violence Against Women Training Consortiums and Drug and Alcohol Teams) will be provided with the resources and guidance necessary for them to facilitate the delivery of the course within their own local area. 33

34 Work stream targets Provide focussed domestic abuse and substance misuse training to all staff to be involved in women only pilots within substance misuse services. Raise practitioner awareness of local domestic abuse and substance misuse services, including their role, remit and referral routes. Increase practitioners' confidence and competence in dealing with the dual issues of domestic abuse and substance misuse. Develop and roll out across Scotland a skills based training course focussing on domestic abuse and substance misuse. Monitoring and evaluation Training provided to staff involved in women only pilots was evaluated using selfcompletion questionnaires immediately following the event. The trainers then collated this information into a summary report for the project management group. In addition, participants also completed a less formal evaluation following the training event where they left responses to five key questions on post-it notes. The five questions related to the achievement of learning objectives, course content, possible improvements to the course, catering and venue and any other relevant issues. The forum theatre training event was evaluated by participants in a variety of ways. Participants who attended the final event completed evaluation questionnaires on the day of the event. There was a high completion rate of "on the day" evaluations from those who attended, however, 6 month follow-up questionnaires which were issued received an extremely poor response rate, making it impossible to track clearly the impact of the event on practice. In addition, to these formal questionnaires participants were asked to write their thoughts and feelings on graffiti blocks and post-it-notes during the course of the event. Staff from the media company and staff and service users who took part in the development work for this element of the project were asked to complete questionnaires about their experience of being involved in this work. Again, response rates were very low, however, the Development Worker did receive a significant amount of informal feedback from people involved about their experiences. Training provided to staff involved in women only pilots was also evaluated using questionnaires on the day. The pilots for the practise based training course, developed in conjunction with Scottish Women's Aid and STRADA were evaluated in a number of ways. Postcourse evaluations were completed immediately after each course by participants. This was a paper based form based on those already in use by STRADA. All participants on both courses completed this form. Post-course verbal feedback was also recorded immediately following completion of the course. Participants had a group discussion facilitated by an independent party who recorded major themes on flipchart paper. All participants on both courses took part in these sessions. A followup post-course evaluation was completed during April 2009 which involved follow-up phone calls to participants in order to conduct short telephone interviews. Finally, a post-course evaluation was completed by an independent observer who attended each training sessions. 34

35 Key achievements All services who agreed to pilot women only spaces were provided with domestic abuse and substance misuse training by the Tayside project. The feedback received from participants on the day highlighted the following; o Better understanding of domestic abuse o Better equipped to deal with disclosure o Interesting, relevant and informative training o Good opportunity to reflect on the issues and the links between them o Participants sense that this was training that they and their colleagues needed o General enjoyment of the day (atmosphere, trainers and group dynamics) Overall, participants were satisfied that the learning objectives of the course had been fully achieved. The course facilitators reported that rooting the training in both theory and practice, and highlighting the links between them was an important contributor to the success of the course. Participants had "buy-in" to the course as they were attending with a clear view to piloting women only spaces, giving their learning a sense of purpose. These points were reinforced by Cambridge Policy Consultants final evaluation of the overall Multiple and Complex Needs funding stream. The Tayside project was successful in raising practitioner awareness of the roles and remits of local domestic abuse and substance misuse services through the implementation of the forum theatre table top training event. All participants rated this day as being either very good or excellent. Participants highlighted that the scenarios and group discussions, networking opportunities and information about individual agency roles and remits had been the most useful aspects of the event. Some of the comments offered by participants were: "Felt the dramatic approach was very innovative and powerful - stimulated discussion" "Realistic scenarios - makes you think and relate more to situations individuals could find themselves in" "All of it, everything was useful. Very good opportunity to think about what our clients go through and networking" "A great day! Using actors was much better than just reading about scenarios. Much more impactful. Perhaps other trainings should be delivered in the manner. Actors were brilliant!" Just over half of all participants highlighted that as a consequence of the training they intended to gather more information about other agencies working in the field and / or to work more closely with partner agencies on a regular basis. Others reported they would identify and attend further training, make links into their local multi-agency domestic abuse partnerships, discuss the issue with colleagues at team meetings. Overall, the informal and formal feedback received from those involved in the planning of the event and from those who attended on the day was overwhelmingly positive. The project team received numerous contacts following the 35

36 event reinforcing the positive experience participants had had on the day and are aware that the scenarios captured on the DVD have been used at numerous events, team meetings and conferences since. The development and piloting of a practise based training course in partnership with Scottish Women's Aid and STRADA was key to achieving the Tayside project's aims of improving practitioners' confidence and competence in dealing with the dual issues, and of developing a national skills based course. Comprehensive evaluation data was collected at the pilot stage in order to inform further discussions with STRADA and the Scottish Government with regards to a national roll out. The key points highlighted by the range of evaluation methods employed were: learning objectives had been achieved through well thought out course content that balanced the inclusion of domestic abuse content and substance misuse content well. well organised course delivered by very knowledgeable, skilled and flexible facilitators. a good mix of learning methods / styles, with a particularly strong impact of the experiential learning elements. participants reported increased awareness of the subject area, improved confidence and competence and reported intentions to undertake follow-up actions (further training, cascading information to colleagues, increased referrals, further networking, changes to assessment practice). positive experience of networking opportunities to share expertise, knowledge and understanding. In addition, follow-up evaluations indicated that between two and three months following the course a number of participants had undertaken pro-active follow-up actions. These included: Many had shared information with colleagues, done presentations at team meetings, made handouts available to colleagues etc. Ordered extra copies of the toolkit produced by the project and begun discussions about implementing this within services A range of actions in relation to screening; ranged from simply being more aware of this issue / signs to having incorporated questions into formal assessment / screening processes. Recommended training to others, including line managers. Attended further training on the issues Sourced and displayed publicity materials on the issues Development of group work / women focussed services; from incorporation of materials into existing provision to discussing and planning new provision Changed approach to specific ongoing cases where the course had made participants aware of new information, circumstances or issues Incorporation of materials into other training courses Referral of clients to specialist service providers There was a mixed response from participants about whether engagement with clients had increased following their attendance at the course. A significant number felt it had engaged and were able to name ways in which they had changed practice 36

37 to achieve this. Many felt there had been no change to engagement levels; either because it is an issue they work with on an ongoing basis or because it simply has not yet presented amongst any clients they are working with. Participants also provided mixed responses when asked if there are asking about issues of domestic abuse and substance misuse more often. Some said they had increased inquiry, others said they had made no changes in this area, and some had not yet had the opportunity to work with clients affected by dual issues. Overall, the evaluation data gathered in relation to the course pilots was overwhelmingly positive, with the majority of participants showing some degree of change to practice over the follow-up period. Where evaluation highlighted practical changes that could be made to the course design and delivery these comments will be incorporated prior to the next pilot for the Scottish Women's Aid network. However, the project management group are satisfied that the training course is of a quality that would merit national roll-out (either through STRADA or through a training for trainers strategy) and view this area of work as one of the major achievements of the Tayside project and as a positive reflection of partnership working arrangements with Scottish Women's Aid and the Scottish Government. 37

38 CHAPTER EIGHT LOCAL AND NATIONAL DISSEMINATION The Tayside Project held a conference event in July 2008 which aimed to further raise awareness of the links between domestic abuse and substance misuse, report on the work of the project and disseminate resources to relevant partners. The conference was attended by local partners, but also by a large number of organisations from across Scotland and elsewhere in the UK. The almost 200 delegates who attended were drawn from a wide range of professional backgrounds, and ranged from frontline practitioners to chief officers. The conference was opened by the Minister for Communities and Sport and was chaired by Scottish Women's Aid. Presentations were given by Marai Larasi (Nia Project) and Sarah Galvani (university of Warwick), followed by an overview of the Tayside project's work and achievements and a performance of a drama by the Geese Theatre Company. In the afternoon, delegates participated in workshops covering the Tayside project's main work streams (research, policy and practice, training, and children and young people), where they were encouraged to think about how they could adapt and implement resources and ideas from the Tayside project in their own local area. Participnats also had a chance to view the "A Day in the Life... " exhibition, to collect toolkits, forum theatre DVDs, research reports and publicity materials, and to interact with service who had provided displays and stall in the marketplace area. Following the conference the Project have been approached to give presentations at a number of events and to provide further resources to specific areas, as listed below: Glasgow Grand Event organised by Glasgow Women's Support Project Fife Conference on Domestic Abuse and Substance Misuse and follow-up seminar Gingerbread children's project, Fife Eva Service, Coatbridge Substance Misuse Service, West Lothian Domestic Abuse Strategic Development Officer, Scottish Borders Substance Forum, Dundee Cair Scotland Staff Team, Dundee Drug Treatment and Testing Orders, Dundee 38