Basic Principles

Establish the needs of the woman

• Check if she needs an interpreter and if there is any particular dialect that she speaks. Do NOT use her children or family members to interpret.
• Get the full picture of the situation, but realise it may be hard for her to tell you, and give her the time she needs. Reassure her that you believe her and that she is not alone.
• Recognise her need for a positive response and let her know that you are willing to help and support her.
• Be sensitive and attentive. It is important to understand exactly what her needs are, so you can respond effectively.
• Discuss her fears and anxieties. Remember, her problems may be compounded by racism, sexism, language and cultural barriers. Some black and ethnic minority women may be fearful of racism. Also some migrant women may lose their right to stay in the country if they separate from the abuser. Some women will fear being ostracised by their community, so reassure them that there are agencies and support groups that will understand and help.
• Find out what she wants. Explain the ways in which you can help her and take action on what she decides. Discuss the situation and the options open to her. Listen to what she wants — do not decide that you know what is best for her. Remember perpetrators of violence frequently tell their victims that the violence is for their own good! Do not become another oppressor in her life. The perpetrator of the violence tells her what to do all the time, don’t simply become someone else who tells her what to do. Instead give her options. Encourage and empower her to make her own decisions.

Maintain confidentiality

• Assure her of confidentiality. It is important to keep records of your meetings and explain to the woman who has access to these records. Be open about this, and let her know that the information recorded can be used as evidence in support of her case if she was to go to court and/or with her application for housing. Clarify any limits to confidentiality before you start, for example, in relation to child protection policies.
• Check if it is all right to send her letters or phone her at home, and respect her wishes if she does not want you to make contact at all.
• Check if there are any particular circumstances that you need to be aware of that may require additional security arrangements (e.g. if her abuser works for the council or the Benefits Agency).

Listen and empathise

• Interview in a private space.
• • Take her and her problems seriously and allow her time to arrive at a decision. Listen carefully because asking for help can be embarrassing and distressing, and women may talk around the subject or drop hints (e.g. she may talk about "relationship problems") before getting to the point. In such circumstances, it is appropriate for you to gently, but directly, ask questions.
• Be courteous, reassuring and non-judgmental. Probe gently and reassure her that the violence is not her fault, and that the abuser is responsible for his use of violence. Let her know that she is not alone in being abused. Tell her you know how common domestic violence is and that no one should have to put up with abuse in their relationship.
• Show empathy by understanding her feelings.

DO’S and DON’TS

Do

• Give priority to her safety — explore ways of maximising her safety whether she decides to leave her partner or not.
• Take her seriously, believe what she tells you.
• Respond positively, give her your support.
• Take her fears seriously, her life may be in danger.
• Tell her the violence is not her fault.
• Let her know she is not alone, tell her she can always see you again.
• Find out what she wants to do and help her achieve it.
• Bear in mind that she may have been exposed to racism and language and cultural barriers.
• Respect her wishes and accept her decisions.
• Explore the options with her and talk through with her how she can avoid being abused.
• Keep in contact if at all possible.

Don’t

• Don’t tell her what she should do next.
• Don’t try solving all her problems - the decisions are hers.
• Don’t pressurise her into agreeing to action with which she is uncomfortable.
• Don’t make choices for her.
• Don’t be judgmental of her actions and choices.
• Don’t be sceptical or fob her off when she comes to you for help.
• Don’t ask her what she did to provoke the violence.
• Don’t give up on her, just because things are taking longer than you think that they should or if she hasn’t taken your advice or because she has gone back to her partner.
• Don’t promise to pass messages or facilitate contact with the partner in any way, as this may endanger both you and the woman.
• Don’t give anyone the address or phone number of where she is staying. This includes other professionals, unless there is a very strong over-riding reason for them to know, such as child protection, as abusers often persuade others to make enquiries on their behalf. Where there are over riding child protection concerns, make enquiries to establish the identity of the professional that you are passing the information to and ensure that the number you are telephoning is the correct office number for the department they claim to represent.
• Don’t set pre-conditions for supporting her, such as she must prosecute him, obtain an injunction or leave him.
• Don’t withdraw your support if she decides to stay in the relationship. Indeed, this situation may require more support rather than less.

Referrals

Domestic violence creates a complex set of needs. This requires a range of responses from various agencies, so there will be a need to consult with specialist agencies and individuals and make referrals to them, but do not do this without the woman’s consent. All those experiencing domestic violence must be offered referral to a specialist agency. (See Part 2 for a list of the specialist agencies, both local and national.)

• Let the woman know what these agencies can offer. Explain what you can and cannot do, including any delays or uncertainties there may be. Make sure that she has all the information that is required, and take responsibility when referring her elsewhere. Make sure that the referral is appropriate. This means thinking about things like: is the agency open when she can get to it? Can she afford the bus fare? Does she have to make an appointment? If needed, are there interpreters? Are there black and ethnic minority staff? Are you sure that the organisation does what you think it does? Can she take her children with her? Can you make an introduction for her? Be careful about referrals to groups that her family and/or friends may belong. If you are not sure about the confidentiality policy of an organisation — check first.
• Do not make referrals or contact with other agencies against her wishes, even if you think that it is for her own good. The exception to this is where the child protection procedures apply.
• If your agency is part of Newham’s Domestic Violence Inter-agency Procedure use the form DV1 to make referrals.

Publicity

Advice workers should make information about domestic violence available in public localities, such as local women’s groups, advice centres, libraries, health centres, GP surgeries, hospitals, police stations and so on. This will enable the public to know that domestic violence is an issue we are concerned about and are willing to discuss.

Information should include addresses and telephone numbers so that women can choose to make contact directly with the specialist domestic violence agencies. It should also reflect the different cultures and languages in our community. The wording and visual images on posters are as important as the information they contain.

Posters should be displayed in both public areas, such as waiting rooms and interviewing rooms, and in more private areas, such as toilets and changing rooms, so that women are able to write down numbers without being seen. This should include material in local community languages, advertising local community groups that deal with domestic violence. (Posters are available from most of the agencies listed in Part 2.)

Leaflets must be readily available in all waiting areas and toilets, and should contain information on local services, as well as national services. (Leaflets are available from most of the agencies listed in Part 2 and the government’s "Break the Chain" leaflet is available free of charge from the Home Office by faxing 020 7273 2568.) Where possible leaflets on local government services and local health services should also include contact numbers for domestic violence agencies, enabling women to obtain help without alerting perpetrators. These leaflets should also be available in local community languages.

Enhanced Evidence Collection

Ask the client about domestic violence

All service users must be routinely asked about whether or not they are experiencing domestic violence. It is important to ask about domestic violence in a sympathetic and non-judgemental way. Many victims are just waiting for someone to ask them. An Australian study showed that the main reason women did not discuss domestic violence with their doctor was because they were not asked! A poll of women in an Accident & Emergency Department showed that 96% supported routine screening for domestic violence. An active screening protocol can increase the level of domestic violence detection from 5.6% to 30%. (It must be noted that personal interviewing is four times more likely to detect domestic violence than questionnaires.) Evidence from practice shows that most women do not mind being asked routine questions regarding domestic violence, when it is explained to them that the same inquiry is being made of all women because domestic violence is widespread and often hidden.

So ask routine, direct, sensitive questions about domestic violence, without the presence of someone known to the woman and preceded by a discussion on confidentiality and why the question is being raised (e.g. routine departmental procedure, type of service user injury or ailment, etc.). Actually asking the service user is particularly important with domestic violence, as the associated clinical features lack specificity and cannot be relied upon as the only means of identifying service users who have experienced domestic violence.

It is important to create an environment that encourages disclosure by the those experiencing domestic violence: by having posters and leaflets in visible positions, ensuring privacy and by being approachable and ready to listen to what the woman has to say.

Staff should initially question the service user by asking non-threatening questions in an empathic manner. Some questions to chose from:

• It is policy here to routinely ask service users about domestic violence. Has your partner ever hurt you in any way?
• I notice you have a number of bruises. Could you tell me how they happened?
• You seem frightened of your partner. Has he ever hurt you?
• You mention your partner loses his temper with the children. What does he do to the children when he loses his temper? Does he ever lose his temper with you? What happens when he loses his temper with you?
• You mentioned your partner uses drugs/alcohol. How does he act when drinking or on drugs?
• • Sometimes, when others are over-protective and as jealous as you describe, they react strongly and use physical force. Is this happening to you?
• Your partner seems very concerned and anxious. That can mean he feels guilty. Was he responsible for your injuries?
• Do you ever feel afraid of your partner?
• Has your partner ever physically hurt or threatened you?
• Does your partner sometimes put you down and try to control your actions?
• Has your partner ever destroyed things that you cared about?
• Are you getting the support you need at home?
• Has your partner ever threatened or abused your children?
• Has your partner ever forced you to have sex when you didn’t want to? Does he ever force you to engage in sex that makes you feel uncomfortable?
• Has your partner ever prevented you from doing things, e.g. leaving the house, seeing friends, getting a job or continuing your education?
• Does your partner ever treat you badly, such as shout at you, call you names, put you down, push you around or threaten you?
• With disabled service users it is important to ask questions in relation to their care needs, e.g. You are dependent on your partner for your meals, daily care, medication, living aids and money, has he ever withheld these or threatened to withhold these?

Note that none of the above questions refer to the term "domestic violence". This is quite deliberate because many women that are abused by their partners, do not see the abuse they are experiencing as "domestic violence". For example, some women differentiate between slapping and punching and will not see being slapped as "domestic violence", hence the importance of using more general terms, such as those used above, to ensure that domestic violence in all its forms will be disclosed.

It is vital to ask direct questions rather than let an improbable explanation pass without saying anything.

Women often need to be asked on a number of different occasions before they are able to disclose abuse; and it is important not to assume that because abuse has been denied in the past, the possibility can be discounted.

Record any findings or suspicions

Any suspicions of domestic violence (regardless of whether or not the service user confirms these suspicions) must be recorded in the agency’s records (not in any notes held by the service user), identifying the reasons for the suspicions. This record is vital to ensure appropriate responses by the agency, as well as possibly providing the woman with vital evidence should she later decide to pursue legal remedies, seek rehousing or tackle immigration/deportation problems.

Record:

• The size, pattern, age, description and location of all physical injuries. (A record of "multiple contusions and lacerations" will not convey a clear picture to a judge or jury but "contusions and lacerations to the throat" will back up allegations of attempted strangulation.) Include signs of sexual abuse. If possible make a body map of the injuries.
• The amount of pain and emotional distress.
• Any medical attention given.
• Time, date, place and witnesses to the incident.
• The presence of the children, either in the house or in the same room, and whether or not the children have been directly abused or threatened.
• If the service user states that abuse is the cause of the injury, preface service user’s explanation by writing: "Service user states…" It is important to record the service user’s actual words, rather than précis them, e.g. "Service user states that the injuries were caused by: ‘My husband hit me twice with his cricket bat’"; rather than just writing "Service user states she is experiencing domestic violence".
• The service user’s description of the behaviour of the perpetrator, e.g. shouting, destroying possessions, pulling hair, hitting, etc.
• The perception of the service user, e.g. does she believe that the perpetrator will seriously injure or kill her, whether or not the violence is escalating in either frequency or severity, etc.
• If the service user denies being assaulted, write: "The service user’s explanation of the injuries is inconsistent with the physical findings" and/or "The injuries are suggestive of domestic violence."
• Data from previous records which is suggestive of prior abuse.
• Any previous history of the domestic violence: past and present physical, emotional, sexual and/or financial abuse and social isolation, etc.
• Attempts by the service user to remedy the situation (e.g. through police, etc.).
• Also record environmental information, e.g. information about damage to the home, state of clothing (torn and/or amount of blood staining) and objects used as weapons. Ideally clothing and weapons used should be kept as forensic evidence in case the woman decides to prosecute or be involved in other legal proceedings.
• Indication of information provided (e.g. telephone numbers of specialist agencies) and any action taken (e.g. referral to another agency).

Body map

A "Body Map", also known as an "Injury Documentation Chart" should also be used to record physical injuries. It has a front and back picture of a human body on to which injuries can be mapped, so as to pinpoint the exact position and extent of physical injuries. See page 8 for a Body Map that can be photocopied for use. Body Maps should not be used instead of writing in the client’s records or instead of taking photographs, but supplement other forms of evidence.

Photographs

Photographs can convey the severity of injuries much more effectively than verbal description. Whenever possible, photographs should be taken of all service users with visible injuries. If this is not possible, advise the service user to have photographs taken elsewhere. (Cameras are currently held at Newham General Hospital Accident & Emergency Department, Plaistow Police Station and will be held by many of the specialist domestic violence agencies from late 2000.)

The procedure for taking photographs:

• Explain to the service user that the photographs will provide very useful evidence should she decide to prosecute the abuser, wish to obtain alternative housing, want to obtain an injunction or pursue an exception to the immigration One Year Rule, either now or in the future.
• Inform the service user that the photographs will become part of the service user’s records and, as such, can only be released with the service user’s permission.
• Obtain written consent from the service user to take the photographs by completing the consent form.
• Use a Polaroid Image Camera with colour film and flash bulbs to take the photographs.
• The photographs should be taken in the brightest light possible.
• Take a close-up photograph of the injury, including an identifiable feature of the service user. If this is not possible, a long shot photograph should be followed by a close-up. A ruler should be used to indicate the size of the injury, particularly if only the injury is in the photograph.
• On the back of each photograph write the following:
  • Service user’s name.
  • Agency reference number, e.g. hospital number, etc.
  • Date and time photograph taken.
  • Signature of the member of staff taking the photographs.
• The photographs must be placed in a sealed envelope and attached securely to the service user’s records. The envelope must be marked with:
  • Date
  • Service user’s name
  • The notation: "Photographs of service user’s injuries".

Bruising often becomes more obvious two or three days after an injury. In this event, the service user must be advised to return for further photographs to be taken. If this is not practical, then encourage the service user to contact the Community Safety Unit at Plaistow Police Station to have the subsequent photographs taken by the police photographer.