News

Julie Taylor-Browne, an independent researcher, looks at the role of consultation in improving services for women who are abused by their partners.

Consultation, participation and involvement of service users are ideas that have been accepted in various branches of social services (for example, in mental health and more recently in children's services) for a number of years. Introducing these ideas into an area that is largely dominated by multi-agency work has been slower and more piecemeal, although consultation with female service users has always been a part of the approach taken by organisations providing refuge, outreach and advocacy services.

It can be argued that it is vital to involve survivors wherever services are provided in cases of domestic violence, regardless of the agency providing them. The concept of empowerment, necessary to turn victims into survivors, has as one of its central tenets the need for consultation, involvement and feedback.

In the area of domestic violence, notorious for under-reporting, there is a particular need to increase reporting, and to encourage disclosure earlier in the abuse. On average, women suffer 35 attacks before calling the police for the first time. There is clearly a need to build confidence in women that agencies can and will respond appropriately and constructively.

Mullender and Hague¹ found that women survivors rate more positively those services that routinely consult them about their needs. These include refuges, helplines and outreach and advocacy services. Often these services are staffed by women who are themselves survivors.

They found that women survivors are less satisfied with the statutory services, citing factors such as internal inconsistency (different members of staff might be helpful, indifferent or hostile), and the inability of some to convey information about local women's organisations. The danger of post-separation violence, both to women and children, is not well recognised by agencies dealing with child care and contact issues. There is a consequent lack of urgency, little attention to safety, and failure to tackle the man's behaviour or to understand the situation from the woman's or the children's perspective. Some women end up with negative views of all agencies involved in their and their children's lives.

In addition, the lack of provision of information and language difficulties have been highlighted by survivors from ethnic minorities, and disabled women cite a poor understanding of their needs. Most writing on safety planning, for example, is based on an assumption that the woman can leave of her own volition. Agencies need to consider how to adapt policies for women who need help to get out of bed, for example.

In comparing the experience of consultation, Mullender and Hague found that Women's Aid has a positive record in seeking survivors' views of its own services, with 90 per cent of refuges undertaking direct consultation with survivors, as opposed to only 40 per cent of inter-agency forums doing so.

There are many examples of feedback, both in the UK and the US from women on what they want from the services they use. Davidson et al,² for example, cite the overwhelming message from women users of GPs, A&E departments and other health providers that they want to be asked whether they are suffering domestic violence as a matter of routine. Upon disclosing, they want a sympathetic and constructive response that will refer them on to appropriate sources of help.

The arguments in favour of consultation and involvement are that there is potential for improvements to be made in a number of areas.

- It can foster better relations and mutual understanding, creating a supportive atmosphere that can encourage victims to come forward. This addresses the need to increase reporting and provide help and support to women earlier in a series of attacks.

- It can also help to establish priorities within a strategic framework agreed by multi-agency partnerships.

- Streamline services to meet needs and avoid inappropriate, unsuccessful interventions.

- Break down the professional and victim dichotomy that can sustain the victim in their role as victim.

- Empower women and help them to regain control over decisions affecting their lives.

- Provide insights to inform new services, new ways of working and development of good practice that can then be standardised across agencies including earlier interventions.

The costs of consultation, which may involve paying survivors for their time, paying the cost of child care, conducting surveys and other mechanisms may seem unjustifiably high in an area starved of resources in terms of both money and time. But the costs of inappropriate services and inadequate responses both in terms of human suffering, money and organisational resources are enormous. The recorded incidence of domestic violence is horrifying (see panel) and points to the fact that despite government campaigns and guidance and the plethora of domestic violence forums which now exist we are still not achieving a significant enough reduction in this area.

As well as the direct impact of violence itself on the woman and her children, violence against women has serious consequences for their physical and mental health. There is evidence that domestic violence is a factor in at least one in four suicide attempts by women. Abused women are more likely to suffer from depression, anxiety, psychosomatic symptoms, eating problems and sexual dysfunction. Social services and local housing departments are contacted in only 3 per cent of assaults.

Multi-agency partnerships have to deal with issues of equality and power differences. Hague suggests using consultation mechanisms of various sorts with women and children who have experienced domestic violence, such as community meetings, focus and exit questionnaires. Partnerships can also set up domestic violence survivors' forums, or advisory groups such as for example, the London Borough of Westminster Domestic Violence Forum. These should monitor the work of the forum (if possible with support, training, crŠche provision, translation, accessible venues and compensation or payment, and with attention to issues of representation, accountability, and equal opportunities). They should also agree specific mechanisms for refuges and Women's Aid to relay information and decision-making between groups of abused women and the local forum and vice versa.

Consultation with women survivors of domestic violence may appear at first to be yet another task that hard pressed multi-agency groups have to consider. Yet many successful organisations working in the area of domestic violence have already integrated it into their ways of working. By listening to women, they have discovered that they are able to deliver, with very scarce resources, what women both want and need. The challenge remains, therefore, for the rest of us to do the same.  

Harsh figures

- Of all crimes reported more than one in 20 were classified as domestic violence.

- Domestic violence accounts for almost a quarter (23 per cent) of all violent crime.

- No other crime has such a high rate of repeat offences on the same victim.

- The police receive an average of 1,300 calls every day about domestic violence.

- In 1999, 37 per cent of women homicide victims were killed by their present or former partners (compared to 6 per cent of men) - more than two every week.

Source: The British Crime Survey 2000 Home Office Statistical Bulletin 18/00, Home Office, 2000

Julie Taylor-Browne is an independent consultant and researcher in sexual violence and child abuse and can be contacted at julie@taylor.browne.clara.net  

References

¹ Mullender and Hague,"Women survivors' views", in J Taylor-Browne, ed, What Works in Reducing Domestic Violence? A Comprehensive Guide for Professionals, Whiting and Birch, 2001

² Davidson et al, "What role can the health services play?" in above

Background Reading

1 C Kershaw, TBudd, G Kinshott, JMattinson, PMayhew, A Myhill, The British Crime Survey 2000 Home Office Statistical Bulletin 18/00, Home Office, 2000

2 C Mirlees-Black, Domestic Violence: Findings from a New British Crime Survey self-completion questionnaire. HORS 191 Home Office, 1999

3 B Stanko, B. (2000) The Day to Count http://www.domesticviolencedata.org  

4 B Stanko, D Crisp, C Hale, H Lucraft, Counting the Costs, Crime Concern, 1998

5 J Taylor-Browne, ed, What Works in Reducing Domestic Violence? A Comprehensive Guide for Professionals, Whiting and Birch, 2001

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Smaller, but better formed?

As more looked-after children find themselves in residential homes in the private sector as opposed to local authority care, social services inspector Paul Clark looks at whether private homes are offering better value.

While the number of council-run children's homes is falling steadily, the number of privately run homes is growing, and small homes with fewer than four beds almost doubled in number over the three years to March 2000. There were then 1,146 children's homes in England - a 7 per cent decline since 1997 and a 14 per cent decline in the number of local authority children's homes (also known as "maintained community homes").¹

In contrast, the number of private children's homes has increased by 16 per cent in the same period. And this figure does not include the surge in the number of small (less than four bedded), private children's homes which have only needed to be registered since 1 January 2001. During the year ending 31 March 2000, local authorities reported that there were 172 small (at that time unregisterable) private children's homes. This is a 93 per cent increase since 1997. The Department of Health has evidence that the next audit will show an even higher increase in the number of small, private children's homes.

Fewer children now live in children's homes (9,164 in 2000, compared to 10,869 in 1997) - a sign that other placements such as fostering are increasingly preferred. The average capacity of the homes has dropped significantly with the number of homes containing less than six beds showing a rapid increase.

The trend therefore is the replacement of the medium-sized (eight or nine beds), local authority children's homes by smaller, private children's homes. The average weekly fee for placing a child in a private home (drawn from the findings of the research study described below) is around £3,500. The average weekly cost of a placement in a local authority children's home (based on both the estimates of the local authorities in the study and Department of Health annual expenditure figures) is around £1,500.

These comparisons suggest that councils are taking the view that their children's homes cannot match the specialist form of residential child care that can be purchased from the private sector. But those who believe that residential child care has a crucial part to play in the provision of children's services must ask the question: "What evidence is there to suggest that the private sector provides 'best value' and the best service to children in residential care?"

To answer this fully would require a major research programme. In this small study, we compared the use of physical restraint in four private and four public sector residential childrens homes as a starting point for exploring how well the homes were able to mesh policy, procedure and practice.

The private homes, run by three different agencies and the maintained homes which were in two different authorities, were studied over 16 months from April 2000 to July 2001.

The study found that 15 per cent of girls placed in the homes were involved in physical restraint incidents compared with 42 per cent of the boys. Of the children who were physically restrained, more than half were involved in at least three incidents. A smaller proportion were physically restrained on a larger number of occasions including one child who experienced five physical restraint incidents on one day.

The records held by the homes showed that the number of physical restraint incidents occurring for individual children generally diminishes over the period of placement, perhaps because the application of restraint itself contributes to reducing the behaviour that leads to the need for restraint.

Local authority homes are generally bigger than the private homes and have a higher turnover of children placed, their placements being usually short term.

A much higher number of restraints occurred in the private homes with a much higher percentage of children experiencing multiple restraints over the period of their placement. This is not surprising when the more protracted and chaotic personal care histories of the children placed in the private homes is considered. Although almost all (85 per cent) of the children placed in the eight establishments, had travelled through a succession of unsuccessful foster care placements, the average number of foster placements for children in the private homes was much higher (4.5 compared with 2.4). All the children in the private homes were excluded from school, compared with 91 per cent of the total in all the homes. One in five of those in the private homes had been in a secure unit, compared to 2.1 per cent in the local authority homes.

More than half (55 per cent) of children in the private homes had also spent periods in local authority children's homes suggesting that council homes represent something of a "staging post" between foster care and private, residential care provision.

But how far do private and local authority homes really differ in the service they provide?

During the period of study all eight homes were subject to inspection visits by local authority registration and inspection units. The inspection reports indicated that record-keeping, care planning and reviewing was of a good standard. Both types of home had dedicated and clearly written "Incidents of Physical Restaint" record books, as recommended by the Utting Report² and the application of sanctions was consistent across the two sectors.

A general weakness, seen in both types of home, was the absence of clear behaviour management policies. There was no evidence that children were given information (either verbally or written) upon admission on what conduct was deemed unacceptable and what sanctions could be applied. Indeed, it was often not until much later in the placement (usually after incidents of restraint had occured) that children were made aware of the steps that the home would be applying to address unacceptable behaviour.

Another common failing was that managerial monitoring systems (looking into the incidents of physical restraint) were poor. There was little routine scrutiny of the events and no systematic checking for malpractice. This could lead to the growth of cultures that might lead to inappropriate "regimes of control".³

By far the biggest difference between the two types of home was the level and nature of staff training in the use of physical restraint. For council staff such training was received within six months of appointment and topped-up annually by refresher training. Staff were trained as "unit teams" with identified members of the staff team being additionally trained as physical restraint instructors. There was evidence that the team approach courses attended by local authority staff were well evaluated and that the expected knowledge and skills outcomes had been achieved.

The training in the private homes was much more fragmented. Only one of the homes included this training in their staff induction programme. Individual staff (rather than staff teams) attended courses and in a number of the private homes several staff had attended courses provided by different training agencies. Since no universal approach or methodology for this type of training has been given by the Department of Health - a common criticism of their guidance document on the issue⁴ - there was a tendency for the staff in the private homes to use a mixed variety of methods and theoretical approaches and none of the courses attended by the staff from the private homes had formally evaluated their level of effectiveness.

The study found that while private homes offered higher staffing levels and a willingness to care for children who are unable to be cared for elsewhere, there is little evidence to suggest that levels of skill and expertise among their staff are any greater than those of the local authority homes they are rapidly replacing.  

Paul Clark is an inspector of children's and adult's services and is an associate lecturer in social sciences and social work law with The Open University.

References

¹ Department of Health, Statistical Bulletin, Children's Homes at 31 March 2000, DoH, 2000

² W Utting, People Like Us: The Report of the Review of the Safeguards for Children Living Away from Home, The Stationery Office, 1997

³ A Levy, B Kahan, The Pindown Experience and the Protection of Children, Staffordshire County Council, 1991

⁴ Department of Health, Permissible Forms of Control in Children's Homes, DoH, 1993