Rapid Evidence Overview Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence

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1 Rapid Evidence Overview Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence Jointly prepared by: Michael Lloyd Research (MLR), Office of the Police and Crime Commissioner for Merseyside (OPCCM) Date submitted: May 2014 Rapid Evidence Overview: Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence 1

2 READER INFORMATION Title Reviewer(s) Circulated to Version Status Rapid overview of interventions to facilitate coping and recovery for victims of domestic violence Michael Lloyd, Principal Researcher/Owner, MLR>> Helen Selby, Director of Commissioning & Research, Office of the Police and Crime Commissioner for Merseyside. Public Final Version Date of release February 2015 Review Date(s) Purpose Description Superseded documents Contact details Related information For information. Primarily to support Merseyside PCC bids to the Competed Fund for victim service commissioning in May This document provides a brief overview of the effective interventions to facilitate coping and recovery for victims of domestic violence, based on the NICE (2013) Review of Interventions to Identify, Prevent, Reduce and Respond to Domestic Violence. Its primary purpose is to support Merseyside PCC bids to the Competed Fund for victim service commissioning in May N/A NICE (2013) Review of Interventions to Identify, Prevent, Reduce and Respond to Domestic Violence. Knowsley Council - Health Needs Assessment: Domestic Violence Rapid Evidence Overview: Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence 2

3 1 Introduction This document summarises the information from the NICE (2013) review of effective interventions to facilitate coping and recovery in victims of domestic violence. 1.1 Background Statistics from the 2009/ 2010 Home Office Statistical Bulletin show that 29.4%, or 4.8 million women in England and Wales between the ages of 16 and 59 have been victims of domestic violence (Flatley et al., 2010). Whilst girls and women are the majority of targets, men are also victims. Findings from the same report reveal that 15.8%, or approximately 2.6 million men in the UK between the ages of 16 and 59 have been the victims of domestic violence. Domestic violence is associated with a wide range of health issues, including mental health issues, alcohol and substance use issues, trauma, unwanted pregnancy and sexual health issues (Taskforce on the health aspects of violence against women and children, 2010). The Department of Health (Itzin, 2006) also revealed that 64% of women who experienced domestic violence reported symptoms of post-traumatic stress disorder, 48% reported depression, and 18% had committed suicide. Homelessness has also been found to be associated with domestic violence, particularly for mothers and children who are leaving an abusive home (Stanley, 2011). Connected to intimate partner violence, is the issue of children s exposure to domestic violence. The second national survey conducted by the National Society for the Prevention of Cruelty to Children (NSPCC) on child maltreatment, revealed that the rates for children or young people in the UK who had witnessed at least one incidence of violence in the past year was 3.3% for children under the age of 11, 2.9% for year olds, and 12% for year olds (Radford et al., 2011). Rates reported for witnessing at least one incidence of domestic violence during the course of childhood were greater yet, with 12% reported by children under 11, 18.4% for young people year olds and 24.8% for year olds. Rapid Evidence Overview: Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence 3

4 Other forms of domestic violence are also a significant issue within the UK. Honour based violence includes acts of domestic abuse (Home Office, 2012) and incidents of forced marriage in the UK are estimated at 5,000-8,000 cases per year (96% female victims; 4% male victims) (Kazimirski et al., 2009). In September 2013, the Home Secretary commissioned HMIC to conduct an inspection that evaluated the effectiveness of the police approach to domestic violence and abuse, focusing on the outcomes for victims and whether risks to victims of domestic violence and abuse are adequately managed. Following on from this, the Police and Crime Commissioner for Merseyside is reviewing the support available to support victims in coping and recovering from the effects of domestic abuse. This summary forms part of the review. (HMIC, 2014) 2 Effective Interventions for Responding to Domestic Violence This Chapter is taken from the NICE (2013) review of interventions to identify, prevent, reduce and respond to domestic violence. 2.1 Interventions for Victims of Domestic Violence Advocacy interventions are those that inform, guide and help victims of domestic violence to access a range of services and supports, and ensure their rights and entitlements are achieved. There is moderate evidence that advocacy services may improve women s access to community resources, reduce rates of intimate partner violence, improve safety, decrease depression, reduce various stressors, and improve parenting stress and children s well-being. While the majority of studies received a moderate quality rating, all studies reported improvements for women, suggesting that this may be a promising approach for responding to domestic violence. There is moderate evidence that skill building (teaching, training, experiential or group learning) on a range of topics with victims of partner violence has positive effects on victims coping, well-being, decision-making abilities, safety and reduction of coercive and violent behaviour. While all studies reported improvements, interventions varied widely focusing on building skills such as: coping skills, safety Rapid Evidence Overview: Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence 4

5 planning and conflict resolution skills, knowledge of reproductive coercion and harm reduction in a reproductive context, decision-making and danger-assessment skills, economic education, and sleep training. Counselling/ brief interventions promote a range of outcomes, such as reducing depression and increasing empowerment among those who have experienced domestic violence, through interventions based on brief educational, cognitivebehavioural, and motivational interviewing approaches. There is moderate evidence that counselling interventions may improve: PTSD (post-traumatic stress disorder) symptoms, depression, anxiety, self-esteem, stress management, independence, support, re-occurrence of violence, birth outcomes for pregnant women, motivational level, readiness to change, and/ or forgiveness. Diverse groups of women were included in these studies, such as: pregnant African American women, pregnant and postpartum women, women in shelters, Hispanic immigrant women and rural women. Therapeutic interventions promote improvement in mental health impacts of violence, through more intensive treatments than counselling interventions such as group therapy. There is moderate evidence that therapy interventions may be effective for improving various PTSD symptoms, depression, trauma symptoms, psychological and social outcomes, parenting/ family-related outcomes and in some cases may reduce likelihood of future IPV or re-abuse. Several studies were conducted with low-income women, and the majority of women captured in these interventions were Caucasian. There is moderate evidence that behavioural couples therapy (BCT) included within substance use treatment is associated with improved abuse outcomes, and in some studies with improved substance use measures. However these studies were conducted with primarily White samples and therefore the effectiveness of these approaches for ethnically diverse couples and non-substance using couples has not been identified. Rapid Evidence Overview: Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence 5

6 2.2 Interventions for Children Exposed to Domestic Violence We found moderate to strong evidence that single component therapeutic interventions aimed at both mother and child are effective in improving child behaviour, mother-child attachment and stress and trauma-related symptoms in mothers and children. All studies included ethnically diverse samples of children and mothers. Intervention approaches varied, including: mother-child therapy, shelterbased parenting interventions, and play/ activity based therapies. There is inconsistent evidence that single-component psycho-educational interventions aimed at mothers and children are effective in building coping skills, increasing knowledge of domestic violence and improving children s behaviour and mothers parenting skills. While the majority of studies reported improvements on the outcomes measured for children and mothers, in some studies improvements were not sustained at follow-up, while other studies had significant methodological weaknesses (small sample size, weak analysis, lack of information on intervention, etc.), limiting the formation of strong evidence of impact. There is moderate evidence that single-component psycho-educational interventions aimed at children, addressing skills such as: stress and conflict management, coping and relationship skills, understandings of violence, etc., are effective in improving children s coping skills, behaviour, emotional regulation, conflict resolution skills and knowledge about violence. There is moderate evidence that multi component interventions with a focus on advocacy are effective in reducing the trauma symptoms and stress in both children and families, and in improving child behaviours such as aggression. Interventions included: community-based service planning, nurse case management, and nonparental child care for disadvantaged families. Overall, these studies reported improvements in psychological and behavioural outcomes for children, with some indicating greater improvement with increased intensity. There is moderate evidence of effectiveness of multi component interventions including both therapy and advocacy among diverse populations of women and children, some with co-occurring issues of substance use and mental health issues. Rapid Evidence Overview: Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence 6

7 All studies were conducted with ethnically diverse samples. These interventions increased knowledge and awareness about violence and safety planning, improved self-esteem and self-competence and improved interpersonal relationships. 2.3 Partnership Interventions There is moderate evidence that partnerships to address domestic violence are effective at: increasing referrals, reducing further violence supporting victims of DV. Studies found that partnership approaches were associated with improvements in various abuse-related measures including: family conflict, risk of mistreatment for elders, re-victimization or threat of violence, response to and safety for victims, and referrals to support services. There is also moderate evidence that partnership approaches have been effective in improving relationships, practices and policies of partner agencies to address domestic violence. Findings from these studies were typically based on stakeholder reports, revealing improvements in: relationships and collaboration between partners, training, knowledge and sharing of information and resources, the development of policies and protocols, involvement of key agencies/ stakeholders. There is moderate evidence regarding both enabling factors and barriers to partnership working. These studies examined member/ stakeholder responses to identify factors associated with the perceived success of the partnership. Studies identified the following enabling factors as key to partnership working: strong leadership, management and coordination, active membership, community involvement, strong relationships and communication, training and resources. Rapid Evidence Overview: Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence 7

8 However, the following barriers were reported: lack of resources (financial and human), differences in the culture of agencies/ organisations, leadership and management issues, lack of commitment, limited monitoring, addressing diverse populations. Issues related to the inconsistent following of protocols or guidelines, and confidentiality issues among multi-disciplinary case review teams were commonly cited challenges. The lack of diverse representation in partnerships, and challenges in addressing DV among specific vulnerable groups including LGBT, Black and Minority Ethnic (BME) groups and women who experience sexual abuse was also highlighted. 3 Conclusion and Recommendations The NICE (2014) review states that "Working in a multi-agency partnership is the most effective way to approach the issue of domestic violence at both an operational and strategic level. Initial and on-going training and organisational support is also needed". NICE (2014) makes 17 recommendations documenting how local services can effectively respond to the issue of domestic violence and it is suggested that these are reviewed against local service provision, insight from victims, perpetrators and children, local Health Needs Assessments (HNA) and the effective interventions outlined above. This will enable the comprehensive provision of domestic violence services that are both evidence based and meet the needs of the local community. It is also recommended that the HMIC (2013) report on improving the Police response to domestic abuse is considered. The report details recommendations which are designed to tackle any risks identified in the service to victims of domestic abuse. Rapid Evidence Overview: Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence 8

9 These should also be reviewed against the specific actions for Merseyside, in particular those around victim support which included: Educating frontline officers on access to support available to victims and what their responsibilities are in relation to on-going victim care Reviewing the contact officers and staff have with victims throughout their involvement and ensuring that appropriate levels of support and safeguarding are given at all three levels of risk To review the use of neighbourhood teams to provide victim support and assistance in a more consistent way. Rapid Evidence Overview: Interventions to Facilitate Coping and Recovery for Victims of Domestic Violence 9

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