Identification Assessment and Management of Domestic Abuse Policy

CLINICAL POLICY
Identification, Assessment and Management of Domestic Abuse
Policy
For use in:
PCT-wide
Target Audience:
Midwifery, School Health and Health Visiting
Services
Purpose
To provide a structured approach to
procedures in relation to Domestic Abuse
Document Author:
Family Health Co-ordinator Health Visiting
Approved by:
Policy Sub-Committee
Ratified by:
Governance Assurance Committee
Policy Indexed:
HStHCL067
Version Number: 1.0
Effective From: February 2010
Review Date: February 2013
Statutory and legal requirements
Implementation Lead
Implementation Process
Policy based on recommendations from DOH
(2006) Responding to Domestic Abuse – A
Handbook for Professionals
Family Health Co-ordinator
Refer to the attached implementation plan
The Trust is committed to creating an environment that promotes equality and embraces
diversity, both within our workforce and in service delivery. This document should be
implemented with due regard to this commitment
This document seeks to uphold the duties and principles contained within the Human Rights
Act. All Staff within the PCT should be aware of its implications
This policy is due for review by February 2013. After this date, this policy and associated
process documents may become invalid. All users should ensure that they are consulting the
current version of this document.

Key individuals involved in developing the document
Name
Designation
Carol Hornby
Libby Evans
Pauline Pinder
Carmel Hilton
Sue Bennett
Madeleine Ashcroft
Family Health Co-ordinator – Health Visiting.
Halton
Health Co-ordinator School Health – Halton
Domestic Abuse Midwife- Halton
Named Nurse Child Protection- St Helens
Family Health Co-ordinator- Halton
Family Health Co-ordinator- Halton
Distributed to the following for comments and approval
Committee
Members of the Policy Sub Committee
Members of the Clinical Guidelines Group
Cheshire Police
Survivor Group – Women’s Aid
Individual
Designation
Karen Worthington
Peter Connaulty
Charlie Whelan
Sally Clarke
Lucy Phillips
Hayley Sanson
Linda Spooner
Lorna Hutcheon
Women’s Aid Forum
Margaret Evans
Corina Casey-Hardman
Pat Byrne
Julie Banat
Lesley Brownlow
Preschool Children’s Manager-Halton
Information Governance
Senior Nurse Child Protection-Halton
Halton Domestic Abuse Coordinator-Halton
Supervisor of Midwives
Clinical Audit Manager
Professional Development Manager
Cheshire Police
Halton
Caldicott Guardian
Head of Midwifery-Halton
School Health Nursing Service Mger-Halton
Health Visiting Manager-St Helens
School Health Nursing Service Manager-St
Helens
Page 2 of 41

Table of Contents
Introduction ..................................................................................................................................4
Purpose........................................................................................................................................4
Definition ......................................................................................................................................5
Prevalence and Effects of Domestic Abuse .................................................................................5
Indicators of Abuse ......................................................................................................................6
The Effects of Domestic Abuse....................................................................................................7
Multi-agency working ...................................................................................................................9
Equal Opportunities ...................................................................................................................11
References.................................................................................................................................22
Associated Documentation ........................................................................................................25
Appendix 1 .................................................................................................................................26
Appendix 2 .................................................................................................................................27
Appendix 3 .................................................................................................................................28
Appendix 4 .................................................................................................................................29
Appendix 5 .................................................................................................................................35
Appendix 6 .................................................................................................................................40
Appendix 7 .................................................................................................................................41
Page 3 of 41

INTRODUCTION
Domestic Abuse is a widespread, often hidden, problem. Its impact upon victims and their
families is difficult to assess and remains a challenge for health professionals. However, there
are many clear messages from the government and research that indicates that professionals
should be proactive in their response to this significant public health issue.
The child health and midwifery services provide a universal community based service to
pregnant women, families and children that is, perceived as non stigmatising and accessible. It
offers:
The delivery of a broad range of health improvement programmes based on a health
needs assessment.
The provision of support services to mothers in the antenatal and post natal period.
The provision of preventative health care.
Supporting vulnerable children and families.
Ensuring appropriate referrals to other agencies.
The identification of potential risk to health.
Given the unique form of access that the services have to clients and their families, they are in a
strong position to identify and respond to domestic abuse.
PURPOSE
The purpose of this policy is to provide staff working in Midwifery, Health Visiting and School
Health Services within Family and Children’s Services with information and guidance about the
identification, assessment and management of domestic abuse and their responsibilities within
it, following an identified pathway (Appendix 1). It is underpinned by 10 standards of good
practice, documented below.
Objectives
The following policy will assist services in the identification, assessment and management of
domestic abuse. The policy focuses on women and children, given the higher prevalence of
male violence towards women but also as domestic abuse often begins or escalates during
pregnancy or shortly after childbirth. It is recognised however that men also experience abuse
and abuse occurs in same sex relationships, and this policy is applicable to all sexes and types
of relationships.
This policy will be supported by education and training which will enable the child health and
maternity service to support women, children and others with the issue of domestic abuse
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The overall objectives of the child health and midwifery service are to:
Place domestic abuse on the agenda, incorporating it as a normal part of health
assessment
Perform routine enquiries at key times e.g. antenatal booking, antenatal contacts,
antenatal health needs assessment and within the first year of life
Empower people to make informed choices about their lives
Promote awareness of the nature and impact of domestic abuse
Ensure information is available
Refer to specialist agencies where appropriate
Provide regular support to women’s refuge and their residents
To work effectively within interagency partnerships
DEFINITION
“Any incident of threatening behaviour, violence or abuse (psychological, physical,
sexual, financial or emotional) between adults, who are or have been intimate partners or
family members, regardless of gender or sexuality”
The Department of Health (2005) and the Home Office (2003) both use the following definition
of Domestic Abuse.
PREVALENCE AND EFFECTS OF DOMESTIC ABUSE
Two women are killed every week by a current or former partner.
20% of women state they have been physically assaulted by a partner at some point.
30% of domestic violence occurs in pregnancy starts during pregnancy.
35% of households that experience a first assault will experience a second within 5
weeks.
52% of child protection cases involve domestic violence.
54% of rapes are committed by current or former partner.
70% of children living in refuges have been abused by their father.
75% of the cases of domestic violence result in physical injury or mental health
consequences to women.
90% of domestic violence happens when children are in the same or next room.
The police in the UK receive a call to stop domestic violence every minute.
These are reported cases. They will therefore be underestimates of the true figure.
(Dept of Health 2005)
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INDICATORS OF ABUSE
Possible indicators of domestic abuse
As follows:
Suspicious injury
Partner always present and answers for the woman or demands early discharge from
medical care
Evasive presentation
Depression, alcohol and drug abuse
Self neglect
Regular non-attendance for appointments
Babies presenting with indicators e.g. sleep problems, behavioural problems
Victims may exhibit physical, emotional or behavioural symptoms
Physical
Unexplained burns or bruises, multiple injuries in various stages of healing, repeated
of chronic injuries
Injuries in areas of the body inconsistent with falls, walking into doors or other
explanations given
Injuries to the breast, chest, abdomen, face head or neck
Evidence of sexual abuse or frequent gynaecological problems
Frequent complaints of vague illness and symptoms
Emotional
Feelings of isolation
Suicide attempts
Panic attacks/anxiety/depression
Alcohol or drug abuse
Post traumatic stress reaction/disorder
Behavioural
Person may be frightened, evasive, ashamed or embarrassed
Partner accompanies victim, intent on staying close and answers questions directed
at her
Reluctance of victim to speak or disagree
Denial or minimisation by partner or victim
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THE EFFECTS OF DOMESTIC ABUSE
Effects on the Victim
The consequences of domestic abuse on the victim can vary greatly with each individual and
may depend on frequency of the abuse suffered. It may include:
The following is a list of possible effects of Domestic Abuse, although it is not a comprehensive
or exhaustive list.
Physical
Physical ill health
Tiredness and lack of energy or too much energy
Children could be conceived as a result of rape
Violence escalates in pregnancy
Emotional
Continual and persistent fear
Feelings of worthlessness and inadequacy
Lack of confidence
An erosion of self-esteem
Feeling undermined and blamed
Not allowed to develop
Inability to maintain meaningful relationships
Isolation from family, friends and community
Feeling there is no way out of the situation
Behavioural
Inability to think clearly
Inability to settle and lack of sleep
Reliance on alcohol and/or drugs as a coping mechanism
Eating disorders/self harm/suicide
Mental ill-health or the appearance of mental health symptoms
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Complications in Pregnancy
still birth,
repeated miscarriage,
bleeding, premature rupture of membranes,
placental abruption,
low birth weight,
ruptured uterus, liver or spleen,
recurrent urine infections,
anxiety and depression
RCOG (2004)
Effects of Domestic Abuse on Children
Children may become directly involved in domestic abuse through attempting to protect their
mother or through being encouraged or forced to participate in the abuse and humiliation of
their mother.
Children’s responses vary enormously with some children being affected far more than others
and children within the same family can be affected differently. Each child’s experience and
reaction will be unique. It will be hard to discern the impact if living with domestic violence on
children, especially as some resulting behaviours also occur in children experiencing other
forms of abuse and neglect (Hester et al 2004) However a report recently issued by the United
Nations on the impact of aggressive behaviour in the home, states that nearly 1 million children
in Britain may be suffering the physical and emotional scars of domestic violence.
The effects of domestic abuse on children tend to vary according to;
Age
The level of violence
The length of time the abuse has been happening
Whether they are directly involved
The extent to which they have witnessed the violence
How much support they get from other people
Refer to the leaflet on Domestic Violence the Effects on Children for more specific effects on
children.
Or enter the following into your address bar to search for the form on the intranet.
http://sharepointcompliance/Appendices/Forms/AllItems.aspxb
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The Effects of Domestic Abuse on Parenting
Experiencing Domestic Abuse can affect the parent’s ability to parent. Some victims can
achieve a consistent level of parenting, however, for others the reaction of altering states of
hyper arousal and numbing associated with trauma can serve to diminish their ability to parent
effectively. (Calder 2004)
Victims, (usually the mother) may have difficulty controlling their emotions and it should be
remembered how this could affect their children.
Violent, irrational or withdrawn behaviour frightens children
Highly critical parenting can lead to insecure attachment
Exposure to Domestic Abuse can lead to the victim suffering from depression,
increased isolation and the abuse of alcohol/drugs may be used as a coping
mechanism. This can result in ineffective and inconsistent parenting
The abuser generates high levels of arousal and fear within the household. This
impacts negatively on both the victim and the children’s self esteem and erodes their
confidence.
(Cleaver et al 1999, Hester et al 2000)
Women (and her children) become more vulnerable when:
They enter relationships when they are young
They become pregnant
They try to leave the relationship
They fail to recognise the warning signs in their partners personality and behaviour
Once separated, during contact visits with the children
The Interconnection between Domestic Abuse and Child Abuse
Documents such as “Domestic Violence and social care” (1995), “Messages from the Research”
(DOH 1995) and “Working together to safeguard children” (2006) all indicate that domestic
abuse and child abuse are significantly intertwined.
MULTI-AGENCY WORKING
Sharing of information in cases of concern about children’s welfare will enable professionals to
consider jointly how to act in the best interests of the child. The key principles that guide
decision making on information sharing are
Professionals must explain to children and their families at the outset what information
could be shared with other professionals, and why. Their agreement should be
sought, except:
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o Where to do so would put the child or any other person at risk of harm
o If it would undermine the prevention, detection or prosecution of a serious
crime
The safety and welfare of the child must be the overriding consideration when
professionals are deciding whether to share information
Professionals should, wherever possible, respect the wishes of children and families,
who do not consent to information being shared, but may still share that information if,
from a judgement on the facts of the case, they feel there is sufficient need.
Professionals must seek advice from their line manager if they are in doubt
Any information shared must be accurate and up to date, necessary for the purpose
for which it is being shared, shared only with those who have a need to know, and
shared in a secure way
Professionals must always record the reasons for their decision, whether it is to share
information or not.
If a child / children are deemed to be at risk of significant harm, a referral should be
made to Children’s Social Care under local safeguarding procedures.
Halton Safeguarding Board (2007)
Multi-Agency Risk Assessment Conferences (MARAC)
MARACs are aimed primarily at protecting very-high risk victims of domestic abuse from serious
injury/homicide.
The aim of a MARAC is to:
Share information to increase the safety, health and wellbeing of victims, other
vulnerable adults and their children;
Determine whether the perpetrator poses a significant risk to any particular individual
or to the general community
Jointly construct and implement a risk management plan that provides professional
support to all those at risk and that reduces the risk of harm;
Reduce repeat victimisation;
Improve agency accountability; and
Improve support for staff involved in high-risk cases.
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Risk assessment is the main factor that underpins the MARAC. Risk assessment tools can
provide a structured way to assess the relevant information. It should be clear that there is not
an expectation of those completing the initial risk assessment to have high levels of knowledge
about domestic abuse and its assessment. Halton Domestic Abuse Forum (2007).
The Department of Health (2005) acknowledge that it is important to determine the extent of the
danger faced by a woman and her children. The assessment and management of risk can
never be an exact science, it involves working with uncertainty and undertaking continuing and
complex levels of analysis (CAFCASS 2005).In considering the risk, the responsibility as a
health professional is to support the woman in the decisions and choices she makes (SWLHP
2005).
The risks outlines in the Victim Risk Indicator (Refer to appendix 4) can be used by practitioners
in identifying and assessing the behaviours that could indicate an escalation in violence or a
continued risk to the children or parent even after separation. If a client is deemed to be at veryhigh
risk of homicide or serious injury, a referral should be made to MARAC. (Refer to appendix
5).
The client’s immediate risks should be addressed by referral to appropriate local services such
as the Police, Independent Domestic Violence Advocate, Women’s Aid, Accident Emergency
Department. This policy should be read in conjunction with the relevant borough local agency
procedures, protocols and supporting documentation.
EQUAL OPPORTUNITIES
Practitioners working with Domestic Abuse should be alert to the dangers of stereotyping on the
grounds of race, gender, sexual orientation or ability. Do not attempt to justify Domestic Abuse
on cultural grounds and be aware that some societies are open to other forms of oppression,
which may compound and complicate their situation. For example, belonging to an ethnic
minority, having a disability, suffering from physical or mental illness, being an older or very
young person, being in a same sex relationship, belonging to a travelling community, or being a
drug or alcohol user.
Page 11 of 41

STANDARD ONE – CONFIDENTIALITY
Standard Action Rationale
Professionals need to be
aware of the need to
maintain confidentiality
All professionals
recognise the duty to
respect the woman’s
confidentiality but must
be aware of its
limitations when
protection of the child or
adult takes priority
If the woman withholds
consent, or if consent
cannot be obtained, sharing
of information may be made
where:
They are required by
law or by order of a
court
Where there are
potential child protection
issues
The professional is
justified and has a duty
to share information with
social services, the
police or other agencies,
where there is an
increased risk to the
woman/child protection
concerns
The law recognises significant
exceptions to the duty of
confidentiality
To act in accordance with national
and local policies and guidance
To protect the woman or child and
to follow PCT procedures
KPI information shared with/without consent. Rationale documented when consent not given.
Page 12 of 41

STANDARD TWO – ROUTINE ENQUIRY
Standard Action Rationale
All women will be
routinely asked about
domestic abuse in the
antenatal period and
within the first year of life
Women should be alone
when asked about
domestic abuse
Information to be given
to women as a matter of
course
Ensure lone contact
with the woman at least
once in pregnancy and
at least once in the first
year of life
If unable to see the
woman alone, highlight
this as a priority for
follow up
Routine enquiry should
not be a one-off. It
should be opportunistic
throughout the
pregnancy and during
contacts with the family
particularly where there
are possible indicators
of abuse
Ensure the provision of
a safe supportive
environment
Ensure effective
communication takes
place between
midwife/health
visitor/school health
nurse
If communication difficulties
exist,
Arrange professional
interpreter(not family
member)
Signer or advocate for
learning difficulties
To raise awareness of nature of
domestic abuse
To provide opportunity for
disclosure to take place
KPI women routinely asked at booking or during pregnancy, ante-natal or within1 year following
delivery
Page 13 of 41

STANDARD THREE – DISCLOSURE
Standard Action Rationale
Women who disclose will
be given support and
information
They will be offered
referrals to appropriate
agencies
Provide time for the
woman
Re-enforce that the
abuse is not acceptable
Respect the need for
confidentiality
Give accurate up to
date information of
relevant agencies
(Appendix 2)
Give women opportunity to talk
openly
To ensure woman has an
informed choice of action
Ask the woman for
consent to refer to other
agencies or provide the
woman with details on
how to self refer
Consider use of CAF
To ensure child is protected.
Offer the woman
helpline numbers
If you are concerned
about the welfare of a
child refer to Child
protection
nurse/midwife in
accordance with local
guidance
KPI appropriate referrals/ actions taken, Consent obtained for information sharing, Liaison with
safeguarding team where indicated.
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STANDARD FOUR – DOCUMENTATION
Standard Action Rationale
Keep detailed, accurate
and clear records in
relation to domestic
abuse
Ensure records are as
detailed as possible
Use the patient’s own
words (in quotation
marks) where possible
Document injuries in as
much detail and the
clients explanation
Document the full extent
of abuse as known
To ensure record keeping
standards are met
To comply with recording keeping
policy
To ensure records are
comprehensive if required for legal
purposes
Provide a diagram of
injuries together with a
written description of
any injuries (Appendix
3)
To facilitate multi-agency working.
Domestic abuse should
never be recorded in
hand held notes
Document whether
children were present or
witness at time of abuse
Record your
assessment and actions
Sharing of information
between professionals
should be recorded.
Record keeping in relation to domestic abuse is detailed
Page 15 of 41

STANDARD FIVE - RISK ASSESSMENT
Standard Action Rationale
Assess risk to the
woman, unborn baby or
any other children in the
house
The practitioner should
be aware of the DOH
guidelines
Assess level of risk to
the client using clinical
judgement.
When assessment
indicates client maybe
at risk of serious
physical injury/
homicide or evidence of
current injuries
complete the victim risk
indicator. (Refer to
appendix 4)
To have an understanding of
domestic violence.
To identify issues around
domestic abuse.
To identify the level of risk and to
ensure appropriate referral.
N.B. Very high risk should
be referred to MARAC
(Multi-Agency Risk
Assessment Conference
(via police) (Appendix 5)
and a referral made to
Children’s Social Care
To maintain the safety of the client
Immediate safety needs
should be addressed.
KPI Victim Risk indicator completed. Referrals to MARAC for very high risk score.
Page 16 of 41

STANDARD SIX – CHILD PROTECTION
Standard Action Rationale
Where actual or the
likelihood of significant
harm is identified, a
referral under Child
Protection Procedures
must be made
The welfare of any child
is paramount, including
the unborn child
Consider also the
implications for the
pregnant teenager under
19 yrs old
Establish whether
children are present in
the home when abuse
is taking place
Assess impact on
children and their
health and wellbeing
Consider other
situations which may
impact on the health
and wellbeing of the
child and take
appropriate action
Involve multi-agency
partnerships, as
appropriate
Ask the woman for her
consent for referral to
other agencies
Consider Common
assessment framework
Named Nurse/Midwife
must be informed of
any concerns of a child
protection nature.
If you are unsure of the
risk to unborn child,
children seek guidance
from/refer to Child
Protection Nurse
,/Midwife/ Specialist/
Framework for
Assessment of
Children in Need and
their families
Consent is not essential
where there are
Child protection
concerns/imminent threats
to her safety.
To ensure safety of child
To ensure a holistic assessment of
child’s needs.
To ensure best support for family.
To provide targeted specialist
services
To ensure child’s needs are
identified.
To comply with local guidance
To seek appropriate advice.
KPI. Appropriate information sharing with consent. Appropriate information sharing with no
consent and rationale. Referrals made to children’s social care for all clients with high risk score.
Page 17 of 41

STANDARD SEVEN – SAFETY PLANNING FOR STAFF AND VICTIM
Standard Action Rationale
Ensure women are
equipped with accurate
and appropriate advice
to stay safe
To ensure health
professionals are not
placed in situations of
threat or danger
Process of safety planning.
Support the woman:
Build a trusting, non
judgemental
relationship
Encourage the woman
to assess her safety
needs
Review current risk – to
her own life and to her
children/unborn child
Be an advocate for the
woman with other
agencies(with consent)
Undertake a risk
assessment of your
environment e.g. when
visiting a woman in her
own home
Report incidents using
incident reporting
mechanisms. Liaise
with other
professionals as
appropriate
To ensure woman has access to
health professionals.
To ensure safety of woman.
To ensure staff safety.
NB Ensure that you do
not place yourself or
your colleague in a
potential violent
situation when
supporting someone
else
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STANDARD EIGHT – PROVISION OF INFORMATION AND REFERRAL
Standard Action Rationale
Provide woman with
accurate information i.e.
Resources, help and
Agencies available
Adopt a calm, open
approach
All women will be
offered contact
numbers of local
support services
To ensure woman can make an
informed choice.
To ensure best outcome for
woman.
Ensure multi-agency
working
Give information that is
non judgemental and
accurate. Be courteous
and empathic to her
needs
To ensure staff and public have
access to information
Provide written
information should the
woman want it.
To aid communication.
Display information on
services available in
the Trust
Where possible
engage the client with
Specialist Services
Address
language/communicati
on difficulties
To prevent further episodes of
abuse.
Provide information as
to where the
perpetrator can seek
help as well as the
woman
KPI Contact numbers/ support information provided.
Page 19 of 41

STANDARD NINE – SUPPORT AND SUPERVISION OF STAFF
Standard Action Rationale
Adequate support should
be provided to staff
dealing with domestic
abuse issues
Safety and disclosure
of information by
support staff should be
discussed with line
manager
Seek specialist advice
from safeguarding
team as appropriate
Access to clinical
supervision/midwifery
supervision to be
provided in order to
allow staff to debrief,
seek advice and
reflect.
Explore own issues
which may influence
practice and seek
advice accordingly
Develop skills and
identify training needs
Seek advice from
specialist services if
necessary
Consider services of
occupational health
Access and offer
support to colleagues
KPI All staff dealing with Domestic Abuse access regular supervision.
To ensure all staff dealing with
domestic abuse access regular
supervision.
Specialist support is available to
staff if required.
Page 20 of 41

STANDARD TEN – EDUCATION AND TRAINING
Standard Action Rationale
Staff will be offered
training to enable them to
deal with issues involving
domestic abuse.
Staff should be aware
of the prevalence and
indicators of abuse
The effects of abuse
on the victim and
children
Types of abuse
Staff should identify
their own training
needs
Midwives and Health
visitors should use
routine enquiry as part
of antenatal
care/antenatal Health
Needs Assessment
Ensure Health
Professional
representation on local
and strategic
Safeguarding Boards
and Operational/
professional forum.
Induction of new staff
to include awareness
on issues relating to
domestic abuse
KPI All staff have attended awareness raising training
To ensure staff have skills and tool
required to identify and support
clients suffering from domestic abuse
Refer to the leaflet on Domestic
Violence the Effects on Children for
more specific effects on children.
Or enter the following into your
address bar to search for the form
on the intranet.
http://sharepointcompliance/Appe
ndices/Forms/AllItems.aspxb
Page 21 of 41

REFERENCES
Reference
CAFCASS (2005)
http://www.ofsted.gov.uk/content/download/1765/11903/file/dome
stic%20violence,%20safetyand%20and%20family%20proceeding
s%20(PDF%20format).pdf
Relevance
(whole
document or
section, please
state)
Evidence
Grade
Government
Document
Calder C.(2004)
Children living with Domestic Violence, Lyme Regis: Russell
House
Cleaver H, Unell I, & Aldgate J (1999)
Children’s Needs – Parenting capacity. The impact of mental
illness, Problem Alcohol and Drug Misuse, and Domestic
Violence and Children’s Development. London HMSO
DOH (1995)
Child Protection. Messages from the research. London
HMSO
DOH (2005)
Responding to domestic abuse: A handbook for
Professionals
http://www.dh.gov.uk/en/Publicationsand
statistics/PublicationsPolicyAndGuidance/DH_4126161
Domestic Violence and Social Care (1995)
Domestic Violence and Social Care (SSI 1995)
Halton Domestic Abuse Forum (2007)
Multi-Agency Risk Assessment Conference. Procedures,
protocols and supporting documents
Halton & St Helens (2007)
Policy on Clinical Supervision
Halton & St Helens (2004)
E
E
E
1
E
Policy
Policy
Policy
Page 22 of 41

Zero Tolerance and Lone Worker Policy
Halton Safeguarding Children Board(2007) Procedures to
safeguard and promote the welfare of children
Hester M, Pearson C, and Harwin N. (2000)
Making an impact: children and Domestic Violence. London:
Jessica Kingsley
Policy
E
1
Home Office (2003)
http://www.archive2.officialdocuments.co.uk/document/cm58/5847/5847.pdf
RCOG(2004)
Confidential Enquiry into Maternal Deaths – Why
mothers
die 2002-2002 RCOG Press, London, England
St Helens Local Safeguarding Children Board (2006)
Procedures to Safeguard children
St Helens Domestic Abuse (Sep 2008)
Sharing of information procedures
SWLHP (2005)
South Wales Local Healthcare Partnership
A guide for Healthcare staff in Primary Care
Working Together to Safeguard Children (2006)
http://everychildmatters.gov.uk/resources_and-practice/IG00060/
Zachary et al (2002). Multifaceted system of care to
improve recognition and management of pregnant women
experiencing domestic violence.
NMC(2008) The code of standards for conduct,
Performance and Ethics for Nurses and Midwives
Whole
NMC
Guidance
Halton Safeguarding Children Board(2007) Procedures to
safeguard and promote the welfare of children
Whole
Policy
Page 23 of 41

St Helens Borough Council child protection Procedures
Whole
Policy
Home Office 2004 Safety and Justice: Sharing Personal
Information in the context of Domestic Violence – an
Overview.
Home Office Development and Practice Report
Communication, Development Unit. Home Office, London,
England
Whole
Whole
I
I
RCOG(2004) Confidential Enquiry into Maternal Deaths –
Why mothers die 2002-2002 RCOG Press, London, England
NICE (2008) Antenatal Care – Clinical guideline 62
Section 5.3
Standard 2
Enquiry
DOH (2004) National Service Framework for Children
Standard 11 – Maternity Services
Whole
DOH2005) Responding to domestic abuse: A handbook for
professionals
Zero Tolerance and Lone Worker Policy – Halton & St
Helens (2004)
Halton Domestic Abuse Forum Interagency Partnership
Agreement 2007
St Helens Local Partnership Agreement
Standard 7
Standard 5
Whole
Whole
1
Policy
Policy
Every Child Matters Dfes 2003 Framework for Assessment
of children in need and their families.
Hughes H (1992) Impact of Spouse Abuse on Children of
Battered Women.
Whole
Policy
NCH Action for Children, London England, Reynolds J
(2001)
Whole
Not in Front of the Children, One Plus One, London,
England
1
DOH (2003) What to do if you suspect a child is being
Policy
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abused leaflet.
Home Office (1999) Domestic Violence – breaking the chain.
Multi agency guidance for addressing domestic violence.
Whole
Halton & St Helens Policy on Clinical
Supervision/professional support (2007)
E
NMC (2004) Midwives Rules and Standards
Zachary et al (2002). Multifaceted system of care to
improve recognition and management of pregnant women
experiencing domestic violence.
ASSOCIATED DOCUMENTATION
Halton Safeguarding Children Board (2007) Procedures to Safeguard and promote the
welfare of Children
St Helens Local Safeguarding Children’s Board.(2006) Safeguarding Procedures
Halton & St Helens PCT. Clinical Supervision Policy
Halton & St Helens PCT. Zero Tolerance and Lone Worker Policy
Halton Domestic Abuse Forum. Multi-Agency Risk Assessment Conference (MARAC)
Procedures, Protocols and Supporting Documents (Feb 2007)
St Helens Domestic Abuse. Sharing of Information Procedures (Sep 2008)
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APPENDIX 1
Client disclosure at
antenatal
assessment or
routine visit
Domestic abuse assessment
Assess risk to woman.
Assess risk to child/ren/unborn
child
Assess clients needs
St Helens
Project (HV
only)
Third party contact
(Police, marac, social
services, health, other
agency
Standard and
medium risk of
serious injury or
homicide to client
High risk of serious
injury or homicide to
client
Very high risk of
serious injury or
homicide to client
Significant risk to
children or unborn
child
Provide information
Make appropriate referral.
Obtain consent
Liaise with other professionals
Consider CAF
Seek guidance if unsure
Liaise with safeguarding team
as appropriate.
A
i i
Refer to MARAC
Discuss with
Safeguarding team
Refer to
Children’s
Social Care
Discuss with
safeguarding
team
Document
and discuss
at next
appropriate
contact
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APPENDIX 2
INFORMATION AND CONTACT DETAILS
St Helens
Child in Need Advisor/ Named Nurse 01744 627576
Women’s Aid 01744 454438
Family Support Unit 0151 777 6183
Domestic Violence Project 0151 777 1579
01744 743200
Halton
Safeguarding Team 0151 495 5071/72
Women’s Aid
Refuge 0151 495 2778
Outreach Service 0151 420 1230
Cheshire Police
Police Protection Unit 01244 614 941
Police Referral Unit 01244 614878
Fax 01244 613809
Halton Domestic Abuse Helpline (24 hour) 0800 783 9636
Giving access to:
Relationship Centre 01925 246910
Counselling Sanctuary Scheme
Positive You Course 01925 246910
Rape and Sexual Abuse Service 01928 588523
Women’s Centre 01928 569528
(IDVA)
CAF Co-ordinator 0151 906 4841
Children’s Social Care 01928 70434
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APPENDIX 3
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APPENDIX 4
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APPENDIX 5
MARAC NOTIFICATION FORM (Halton)
DATE OF NOTIFICATION:
Name of person notifying:
REFERRING AGENCY:
Contact number:
Notification to MARAC (please specify)
SCHEDULED/EMERGENCY
ALLEGED VICTIM
ALLEGED PERPETRATOR
SURNAME:
SURNAME:
FORENAME(S):
FORENAME(S):
ALIAS:
ALIAS:
DOB:
DOB:
ADDRESS:
ADDRESS
ETHNIC ORIGIN:
ETHNIC ORIGIN:
OCCUPATION:
OCCUPATION:
RELIGION:
RELIGION:
STATUS OF RELATIONSHIP:
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IF REFUGEE/ASYLUM SEEKER: (victim only)
NATIONALITY:
STATUS:
GP DETAILS (victim only):
OTHER PERSONS LIVING IN THE HOUSEHOLD
NAME: DOB: Relationship to victim
CONSENT:
Service User’s Consent
obtained/attached?
If not, can you satisfy the requirement to
share information without consent?
YES/NO
LIST ALL CHIDREN of victim/perpetrator
NAME DOB SCHOOL ADD, IF DIFFERENT
FROM ABOVE
LIST OTHER VULNERABLE ADULTS LIVING OR STATING AT ADDRESS
NAME
DOB
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No of ‘ticks’ on checklist (possible total 20):
Reasons for Referral:
Background and Risk issues:
Why does this case require a multi-agency approach?
Is the person referred aware of the MARAC referral?
Yes/No
(Attach Risk Assessment where completed)
Referrer:
Designation:
Contact No:
Agency:
SIGNED………………………………………………
DATE………………………….
Fax 01244 613809 Tel 01244 614878
ST HELENS MARAC REFERRAL FORM
Date:
FAX 0151-777-1588
Victim: Name and date of birth:
Address of victim:
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Perpetrator: Name and Date of birth:
Address of perpetrator
Children
Names and date of birth
G.P
School
Address of children
Safe address/phone numbers to send support letters/make calls to etc
Reasons for referral
Background issues
Is the person aware of a MARAC referral? Yes No
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Do they give consent?
(Attach MERIT assessment) Bronze Silver Gold
Who is the victim afraid of? (To include all potential threats and not just
primary perpetrator)
Who does the victim feel safe to talk to?
Who does the victim believe it is not safe to talk to?
Referring Officer name and Agency
Contact details of referrer.
Please forward this form, assessment and information form to DV
Co-ordinator/ Admin Assistant
Tel: 01744 677453 / 454
Fax: 0151 777 1588
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APPENDIX 6
EQUALITY IMPACT ASSESSMENT TOOL
To be completed and attached to any corporate document when submitted to the appropriate
committee for consideration and approval.
1. Does the policy/guidance affect one group less or
more favourably than another on the basis of:
Yes/No
Race NO
Ethnic origins (including gypsies and travellers) NO
Nationality NO
Comments
Gender YES Policy targeted at
women
Culture NO
Religion or belief NO
Sexual orientation including lesbian, gay and
bisexual people
Age YES Targeted at families
with young children
Disability - learning disabilities, physical disability,
sensory impairment and mental health problems
2. Is there any evidence that some groups are affected
differently?
3. If you have identified potential discrimination, are
there any exceptions valid, legal and/or justifiable?
4. Is the impact of the policy/guidance likely to be
negative?
5. If so can the impact be avoided?
6. What alternative are there to achieving the
policy/guidance without the impact?
7. Can we reduce the impact by taking different
action?
If you have identified a potential discriminatory impact of this corporate document, please refer it
to [insert name of appropriate person], together with any suggestions as to the action required
to avoid/reduce this impact. For advice in respect of answering the above questions, please
contact [insert name of appropriate person and contact details].
NO
NO
NO
NO
NO
NO
NO
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APPENDIX 7
DISSEMINATION PLAN
Title of document:
Policy on the Identification Assessment and
Management of Domestic Abuse
Dissemination Lead: (Print name and
contact details)
Carol Hornby
Family Health Co-ordinator
Hallwood Health Centre
Runcorn
Proposed action to retrieve out-of-date
copies of the document:
N/A
To be disseminated to:
All Health Visitors, Midwives and school nurses
within PCT
Date finalised: January 2009
Previous document already being used?
delete as appropriate)
If yes, in what format and where?
Who will
disseminate
it
Timescale
(Date)
Status
Carol Hornby Jan-March Both
Paper
or
Electronic
Yes/No (Please
Comments
TRAINING PLAN
Event (Please provide details of where and training dates available to
educate staff about this policy)
3 Sessions starting Monday 19 th January
Timescale Owner Status
Jan-March
C. Hornby
Training Plan Lead (Please provide details of staff who will be responsible
for overseeing this training)
Carol Hornby
Additional information (Please provide details of any processes in place
to support implementation)
Denotes: Action not yet taken or deadline for action not met. Action plan to address this must be provided.
Denotes: Action partially implemented.
Denotes: Action complete.
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