Woman s Trust Project Evaluation. East London Domestic Violence Counselling & Support Service

Transcription

1 Woman s Trust Project Evaluation East London Domestic Violence Counselling & Support Service

2 WOMAN S TRUST PROJECT EVALUATION SUMMARY East London Domestic Violence Counselling & Support Service, INTRODUCTION Women affected by domestic violence (DV) predominate on the margins of society, failing in the immediacy to be engaged by protective social care systems, struggling long-term to rebuild their lives. Women may not seek help, believing their experience is unique, deserved or shameful. The perpetrator may actively isolate them or they may fear reprisal violence. Unsupported, they may begin to believe they deserve abuse. If they seek help from family and friends, they may be rejected if they don't leave the abuser, or conversely, they may be pressured to keep silent. Isolated within a violent or abusive relationship, women remain at risk of psychological abuse, physical harm or death, as do any children they may be unable to protect....in all my 13 years of marriage, it didn t occur to me that everything I was suffering - the put downs, the comments, the beatings, the manipulations, the rapes, it didn t occur to me that I was in a DV relationship. Mental health effects can be enduring i and unaddressed can leave women vulnerable to deterioration ii and further DV iii, by affecting their functioning and ability to judge, increasing the chances that they enter further unsafe relationships and environments. Women who leave are subject to additional traumas including reprisal violence, homelessness, poverty, stigmatisation, loss of family, community, locality, employment and childcare, which in turn exacerbate the mental health impact, compounding anxiety, low self-esteem, depression, drug/alcohol abuse, suicidal ideation and self-harm. Unaddressed, the mental health impact of DV affects a mother s ability to safeguard her children within a DV relationship, and help them overcome the impact afterwards, increasing the risk that they will enter the same cycles through learnt behaviours iv. Children who have observed DV in the home are more likely to become involved in delinquency, crime and youth violence later in life v. Unaddressed, the mental health impact of DV can reduce a woman, and her child s life chances. We do this by delivering direct services in the form of: One-to-one counselling Support groups, and self-development workshops We also provide training presentations to, and work with statutory, voluntary and private partners locally to enable a woman to receive the best possible support she can get, to meet all her needs

3 In 2013/14 WT received 1,198 referrals for counselling for women aged 18 plus. 563 women accessed 5,399 hours of counselling. 102 women accessed 334 places at 37 self-development workshops. BACKGROUND This is a summary of the evaluation of our East London Counselling & Support Service, which had first been funded by the Big Lottery Fund between 2006 and 2009 and then sustained through 5 year funding from the Big Lottery Fund s Reaching Communities programme between 2010 and 2015, though smaller grants and contracts enabled some of the work to be further developed. The funding ended in May 2015, but this evaluation drew its data to the end of February 2015, coinciding with the time of writing. The project provided specialist DV therapeutic support to women in the 8 east London boroughs of Barking and Dagenham, Greenwich, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest, and worked in 3 ways. It provided: 1. One to one person centred counselling to women to help them recover from their experiences, it provided day long, 2. Self-development (psychodynamic) workshops to help women understand their experiences and learn skills to help them move forward, 3. Training presentations to agencies in the area, so that they could identify women affected by domestic violence, support them better, and make onward referrals to meet their holistic needs. The project received 2248 referrals over its life, and served 843 women through counselling, 875 women through workshops, and provided 67 agency presentations. I think the first thing I need to say is that Woman's Trust saved and mended my life. It has helped me to see I am a valuable woman and I have a right to say 'no' and to make the right choices. Learning more about my own strengths has given me a deep sense of awareness. This self-evaluation was carried out to examine the following: a) The on-going need for domestic violence services in East London b) The effectiveness and impact of Woman s Trust s service in the area c) Areas for development d) Learning that could be shared

4 Our approach was: To look at extensive feedback from clients through exit questionnaires, a survey, and focus groups; To analyse clinical outcomes for women, though data collected from CORE forms, initial session forms and exit questionnaires; To map comparable services in the area and identify gaps in support; To look at independent clinical and domestic violence research; To analyse policy approaches to the issue in the area. FINDINGS Need The area the project is situated in suffers socio economic deprivation, with factors such as overcrowding or poor housing, unemployment, low income, low educational attainment, all contributing to the incidence of DV. Analysis of recorded DV crimes in the eight boroughs showed that there was a growth in DV offences vi in the area. WT s mapping of available services, referrals received and referring sources confirmed that WT s service in East London was relevant, well-respected by statutory and voluntary agencies in the field and fitted well within the provision provided by other DV advocacy, advice, counselling or housing services. Amongst the eight boroughs served, the largest referrers were Barking & Dagenham (B&D), Redbridge, Tower Hamlets, Waltham Forest and Hackney. There was a sparsity of comparable support in those boroughs due to a lack of funding, or a focus in some boroughs on BME communities or sexual violence. It was clear that the few providers that did cover those areas did not have the capacity to meet the demand for specialist DV therapeutic support. Our capacity itself was dictated by funding and did not match demand. This was reflected in long waiting times for one to one counselling. On average, a third of our annual referrals were from IDVA services, in recognition of the need for therapeutic support. 14% of referrals (2014/15) were from NHS IAPT and other mental health service providers who sought specialised DV counselling for their clients. We also received referrals from other specialist DV counselling providers (including Solace, Hackney DV team, Her Centre, Aanchal, Ashiana Network), indicating that they could not meet the demand they faced.

5 Costs The cost per person of providing cognitive trauma therapy has been estimated at 1,600, which includes 9 sessions of therapy by a psychologist (NICE February 2014, Costing Statement: Domestic Violence and Abuse). NICE 2014, also recognised that reducing DV could save on the costs of treating and supporting someone after abuse, by reducing the hospital costs A&E, plus medication costs. Combined, what this means in real terms is that the therapeutic counselling provided by Woman s Trust, could have a substantial impact on the ongoing financial costs to the eight east London boroughs, as a result of DV (approx. 132 million), the lost economic output (approx. 44 million) and human and emotional costs (approx. 227 million. All figures based on our derivation of the cost to the female population taken from Sylvia Walby s work in ). It does this by helping a woman recover sooner, and take back control of her life thereby reducing some of the associated health costs, reducing some of the need for social services and policing interventions; by enabling her to safeguard and support her children, so that the costs associated with the impact of DV upon them is reduced; and where she is able and chooses to, by enabling her to return to work sooner, thereby reducing lost economic output. Outcomes Evaluation showed that clinical outcomes for women as a result of the service were high, with women reporting significant improvements to their health and stress levels, to their autonomy, their ability to function, and their feeling of safety. Given the volume of research on the ongoing impact of DV on mental health many years after exiting a relationship, and the recent BACP (2014) research that points to the deterioration of women s mental health if left unsupported, it would be fair to deduce that the change measured post counselling can to a large extent be attributed to the intervention provided, and can not simply be put down to natural recovery. This is especially true given the relatively short period of intervention, after which the change is measured. Outcomes for women averaged over the lifetime of the project showed: Women were healthier 68% reported decrease in stress and anxiety, 65% in depression, 66% improvement in self-esteem and 64% felt less isolated. 78% were less suicidal and 77% less likely to self-harm (all from CORE data) Women had greater autonomy and more life choices 78% reported improved knowledge of their rights, 82% improved knowledge of other support services, 89% improved selfconfidence, and 84% felt more in control of their future (all from Exit Questionnaire data)

6 Women were better able to function 90% reported an improvement in their ability to interact with others, 86% in their ability to self-care and 62%% reported an improvement in their relationships with their children FEEDBACK Feedback collected from service users indicated that women valued WT for providing: a) Relevant services that they needed; b) A women-only, empathetic, non-judgemental and safe environment, which gave them a voice; c) Quality one-to-one counselling and workshops which saved lives; d) Support with childcare and travel expenses making the service accessible e) Opportunities for breaking isolation and gaining peer support through workshops Clients identified the following areas where WT could do more to better address their needs: a) Clients told us that they found it hard to cope whilst they waited for counselling. This sometimes led to deterioration in their condition. They requested shorter waiting lists and providing immediate crisis support; b) Women said that they felt judged by many of the even specialist women s agencies that they had turned to for support. They asked for WT to help by either acting as a go between, as an advocate, providing more of the support they needed ourselves, or by providing training to other agencies so they could respond better and non-judgementally to DV; c) Clients were concerned about the impact of DV on their children. They requested therapeutic support for their children; d) Through workshops women realised the benefit of peer support in breaking isolation and asked for more peer support networks for women who had experienced DV; e) Clients fed back that had they had the workshop information beforehand it could have help them minimise the harm that they experienced, by exiting DV relationships early or recognising them and not entering them at all. Client asked that we make workshop materials more widely accessible and consider taking it to school age children before they entered relationships; f) WT also noted an increase in women presenting with complex mental health issues, who needed a greater range of support from multiple agencies, which came at the right time in order to stop deterioration in women s mental health.

7 Referring agencies were on the whole satisfied with their partnership with Woman s Trust, however they also suggested several areas of improvement: a) Increased capacity and shorter waiting times for counselling; b) More effective cooperation and information sharing; c) Services provided in community languages; d) The importance of providing childcare support; e) More and lengthier training presentations as they realised the depth to the issue LEARNING A. There is a continuing need for the project. The prevalence of DV in east London remains an issue, with a flow of new entrants to the pool of those affected. There is a lack of accessible, specialist therapeutic support for women. Women felt judged by many of the services that were there to help them, reinforcing the importance of WT s training presentations to agencies. B. Women benefited differently from workshops and counselling, and the combination was effective in enabling a longer period of therapeutic support to women, and to help them cope with the wait for counselling, due to waiting lists. C. Women needed an array of services to ensure their holistic needs were met. WT recognised the need for partnership working to ensure these needs were met in a timely manner. D. Increase in number of cases with complex mental health needs. These clients needed longer term, and greater support. The best way to address this given the different specialisms that would need to be covered in order to fully meet the needs of a complex needs client, was by working in partnership with other practical support, medical and therapeutic providers. This would ensure that a woman received timely and holistic support. Additionally WT recognised the need for further training for counsellors to help them manage their support to clients with complex needs, and updated policies around this. E. The change to the definition of DV to include 16 to 17 year olds resulted in WT considering how this may be supported with counselling. A pilot in west London drew few clients due to lack of publicity and awareness of DV amongst young women. Though this is no longer a pilot and is open across London, we would expect work with the group to take a few years to establish. F. Feedback from clients on the difficulties coping with waiting for counselling has led to the development of a Crisis counselling pilot, for which funds are currently being sought. The crisis counselling will allow a woman already registered and waiting for counselling to receive up to 3

8 sessions of immediate counselling to help them cope with the difficulties impacting on them and stop them deteriorating further whilst waiting for counselling. G. Women with children who made up the majority of WT s clients to this project over the years aired concerns they had for their children and requested counselling specifically for them. WT has looked at this and decided that this can be met immediately through liaison and support to counsellors in schools and tertiary colleges, through training presentations and partnership on cases. Longer term WT is committed to seeking funds to develop children s counselling in partnership or alone. DEVELOPMENTS We found that the existing person centred therapeutic approach and combination of counselling and workshops was successful, but women raised some issues which we explored and identified for development. 1. Women said waiting times for long term counselling were difficult. Some deteriorated, as they averaged a 3.5 month wait. We will address this through short term crisis intervention counselling; partnership work with key agencies (IDVAs, IAPTs, social services, voluntary sector) to enable timely and holistic support; & use of workshops. 2. Increased cases with complex mental health needs & suicidal ideation (also noted in data analysis) - women wanted immediate & higher levels of support. We will address this through short term crisis counselling, partnership & CPD training for our counsellors. 3. Harm reduction through workshops women said they wished they had known earlier what they learned later in workshops, as it could have helped safeguard them. We will address this by increasing those workshop topics identified as contributing to harm reduction, by introducing written and online psycho-educational information accessible to any woman, and publishing lists of complementary support agencies across London. 4. Lack of understanding or support from other agencies - women found access difficult or felt judged, including from women s organisations, crisis helplines, social services and police. We will address this by repeating awareness raising presentations. 5. Support for children women were concerned that their children also needed specialist therapy. We will address this through awareness raising presentations to schools & colleges so their counsellors may immediately better support children, and by looking at the development of a specialist WT children s service, outside this project. We will be taking all these issues on board as we further develop the work of this project.

9 CONCLUSION Our findings are that the project has been effective in meeting its outputs. Whilst the resources needed to meet the targets were significantly underestimated, many targets were met. Over its lifetime the outcomes for women showed positive, significant change, with women being impacted in different ways depending on how ready and able they were to absorb the support made available to them. Whilst the project is unable to undertake long-term tracking, due to a fear of re-triggering trauma, and a lack of resources to do this work sensitively, it is clear from research that we could expect positive repercussions as a result of the support provided. The service remained over-subscribed, with referrals from a large cohort of statutory providers, validating the absence of sufficient alternative support in the area. When compared to the cost of providing 9 sessions of NHS therapeutic support at 1,600 per person (NICE 2014), the cost of therapeutic counselling through this project at approximately 500 per woman is far lower (calculation based on project costs of 100,000/annum divided by 200 women in counselling. It does not account for women attending workshops, which would take the cost lower). Our evaluation also showed that domestic violence was still a pressing issue in the project area. Yet despite policy rhetoric about eliminating violence against women and girls, the financial climate was leading to a reduction in specialist support services and a lack of comparable support for our clients. It was therefore clear that if our East London Counselling and Support Service Project was to shut, it would create an unsafe environment for the women we sought to serve. i Dillon et al (2013), Mental and Physical Health and Intimate Partner Violence against Women: A Review of the Literature, International Journal of Family Medicine Volume 2013 ii BACP (2014), Psychological therapies and parity of esteem: from commitment to reality iii Trevillion.K, Oram.S, Feder.G, Howard.L, (2012) Experiences of domestic violence and mental disorders: A systematic review and meta-analysis iv Cunradi.c, Mair,c. Todd.M, (2014) Alcohol Outlet Density, Drinking Contexts and Intimate Partner Violence: A Review of Enviromental Risk Factors. J Drug Educ, 2014:44 0) v NSPCC (2011), Child Cruelty in the UK 2011; WHO (2013), European Report on Preventing Child Maltreatment vi Analysis of Metropolitan Police Crime Figures Borough figures for the 12 months to date January 2015 & Accessed at on 18/03/15.