Domestic abuse - improving outcomes for children and families

Sarah Tyndall, Clinical Quality Lead, FNP National Unit

Domestic abuse is a serious public health issue which disproportionately affects women and children (Office for National Statistics, 2019). It is also a prominent risk factor in Serious Case Reviews where a child has died or been seriously injured (Sidebotham et al 2016).  So if we are to improve outcomes for children and families, then we have to look for more effective ways of tackling domestic abuse – something the FNP National Unit has been collaborating on with international NFP colleagues.

The negative impact of an abusive relationship can mean that clients who are working with a family nurse are unable to fully benefit from the opportunities for change that FNP offers. Imagine being a client on a programme which is focussed on behaviour change while at the same time being in a relationship in which your partner limits your freedom to say and do anything without fear of the consequences. For example, a client may want to respond to her baby when he cries but be prevented from doing so by a partner who says she is ‘spoiling him and he needs to learn’. This can leave clients unable to make healthy choices for themselves and can undermine their ability to provide sensitive and response caregiving to their baby (Domoney et al 2019)

The complexity is compounded by the love they feel for their abusive partner and is often accompanied by the desire to ensure that their baby has a family by staying with their partner. The majority of those who experience domestic abuse will experience some level of coercive control which can be physical and/or psychological and which limits their ability to say and do things without fear.  At the start of a relationship, control can easily be mistaken for someone being ‘loving’ and wanting to ‘take care of you’. For FNP clients this is often further complicated by their economic and social situation which makes it harder to seek support, take action to keep themselves and their children safe and, if they make the decision, to safely leave an abusive relationship.

FNP in England has collaborated on international work led by Dr Susan Jack, a professor of nursing from McMaster University in Canada, who specialises in research into violence against women and girls. As a result of this work we have adopted a more trauma informed approach to conversations about relationships and provided new documentation to support this approach.

In addition, we have tested a new Intimate Partner Violence intervention as part of the ADAPT project with eight sites across the country. This has led to important learning and we are continuing to work with supervisors and family nurses to plan how we effectively implement this across all sites in the future.

Some of the things that nurses and supervisors have said about this intervention as part of qualitative data collection:

• A trauma informed approach to any conversation about relationships is far more likely to elicit useful discussion and disclosure.
• It enhances understanding of why making changes to keep herself and her baby safe can be so difficult for clients.
• Focussing on this area of work has increased nurse confidence in asking the questions and responding to disclosures.
• Domestic abuse is always kept in mind as a possible factor when working with all clients
• It has encouraged a move away from seeing domestic abuse as a series of single events and, instead, seeing incidents as part of a more complex pattern of behaviour
• It highlights the importance of working alongside clients and not making decisions for them – as this is exactly what their abusive partner does – even when safeguarding action is required.

Domestic abuse has serious, negative and lifelong impact across all three of the FNP programmes key objectives: supporting a healthy pregnancy; supporting healthy child development; and supporting positive life course development. Recognising the primary importance of this work is essential, not only to safeguard clients and their children but to give them the best chance of improving their life chances.

These objectives are shared by colleagues working across the early year’s sector and it has been a privilege to recently work with colleagues at the Institute of Health Visiting to update the Domestic Abuse Training Pack for Health Visitors. The opportunity to share learning and expertise has been mutually beneficial, reflecting how important a joined up approach to practice is and never more so than in this, one of the most challenging areas of practice.

References:

Domoney, J., Fulton, E., Stanley, N. McIntyre, A., Heslin, M., Byford, S., Bick, D., Ramchandani, P., MacMillan, H., Howard, L. & Trevillion K. (2019). For Baby’s Sake: Intervention Development and Evaluation Design of a Whole-Family Perinatal Intervention to Break the Cycle of Domestic Abuse. Journal of Family Violence. 34(6): 539- 551. https://doi.org/10.1007/s10896-019-00037-3

Office for National Statistics (2018a). Domestic abuse in England and Wales overview: November 2019

Sidebotham P., Brandon M, Bailey S, Belderson P., Dodsworth J., Garstang J., Harrison E. Retzer A. & Sorensen P. (2016) Pathways to harm, pathways to protection: a triennial analysis of serious case reviews 2011 to 2014. Final report. Department for Education, London.