Domestic Abuse and Sexual Violence - Torbay

Key Messages

Domestic abuse is physical, sexual, psychological, emotional or financial abuse that takes place within an intimate or family-type relationship and forms a pattern of coercive and controlling behaviour. Stalking, harassment and violence can persist after separation. The risk of domestic homicide is greatest at the point of separation and for the months following. It can include forced marriage and so-called 'honour crimes'.

Sexual violence is an umbrella term for abuse of a sexual nature that can occur within or outside of an intimate relationship. It includes child sexual abuse, rape, sexual assault, sexual harassment, and grooming.

Physical injuries, chronic pain, neurological symptoms, gastrointestinal disorders, gynaecological problems, increased CVD risk, depression, self-harm, PTSD, anxiety, insomnia, increased alcohol and drug use and suicidal ideation are all more common in people who have experienced interpersonal abuse.

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ITRS is the commissioned domestic abuse and sexual violence (DASV) service for General Practice. Each surgery will be provided training to support the identification of clinical indicators of DASV. ITRS takes referrals exclusively from Devon GP practices. Each surgery will have a named Interpersonal Trauma Practitioner (ITP).

ITRS offers trauma stabilisation, emotional and practical support to those referred (see referral section for details).

ITRS will contact referred patients within 48 hours to triage.

More information on the service can be found at Devon Interpersonal Trauma Response Service (youtube.com)

Domestic abuse is a risk factor for suicide and clinicians should consider this when patients disclose.

Domestic abuse and sexual violence can affect anyone. ITRS is also commissioned to support people working in General Practice who have or are experiencing abuse (see referral section).

To refer patients, surgeries must have undertaken their ITRS training. Training can be arranged to suit the needs of the surgery. Enquiries should be directed to itrs@fearfree.org.uk.

ITRS will accept referrals for:

Adults who have experienced any form of domestic abuse or sexual violence whether current, recent or non-recent,
Children who have experienced domestic abuse,
Adults who are concerned about the harm they are causing in their own intimate relationships (perpetration of domestic abuse)

And

People working in General Practice who have experienced a form of domestic abuse or sexual violence.

If you are working in General Practice and would like to self-refer to ITRS you can request to speak to an Interpersonal Trauma Practitioner (ITP) who is not assigned to your surgery if you prefer.

Considerations

If the (adult) patient has experienced a sexual assault in the last 10 days, you should also contact SARC (Sexual Assault Referral Centre) who provide forensic examination and appropriate medical care for victims of sexual assault Timescales for medical care - Devon & Cornwall SARC - NHS (sarchelp.co.uk).

SARC provide a paediatric service Paediatric service - Devon & Cornwall SARC - NHS (sarchelp.co.uk)

If the adult patient is showing indicators of high-risk domestic abuse you should contact your Interpersonal Trauma Practitioner (ITP) and consider making your own referral to MARAC.

Self-referral.

Evidence shows us that referral to ITRS is more effective than relying on patients to self-refer. Should a patient prefer to self-refer, they can access the following services. Please note that these services will have their own thresholds and acceptance criteria.

Torbay domestic abuse service 01803 698869

Devon domestic abuse service 0345 155 1074

Plymouth domestic abuse service 0800 458 2558

Sexual Assault Referral Centre 0300 303 4626

Multi Agency Risk Assessment Conferences (MARAC) are the process for managing the safety of people identified at being at risk of domestic homicide or serious harm.

A domestic abuse specialist (Independent Domestic Violence Advisors, IDVAs), police, children's social services, health and other relevant agencies share information on the risks to the family and create an action plan to increase safety. The meeting is confidential. The IDVA represents the wishes of the victim in the process.

MARAC accepts referrals for people experiencing current high risk domestic abuse. Risk level is determined on the basis of one of these criteria:

a) professional judgement – where in your professional opinion there is high probability that the person will come to serious harm or be killed. High levels of control are a significant factor in risk.

b) DASH risk assessment – a simple, actuarial tool that helps practitioners from any organisation identify the most common indicators of high risk domestic abuse. 14 ticks or more indicates MARAC is appropriate.

c) Escalation or repeat – the victim is describing an escalation in severity or frequency of the abuse or their case has been heard at MARAC within the last 12 months but the abuse is persisting.

The Domestic Abuse, Stalking and Honour Based Violence (DASH) risk checklist can be downloaded and used with patients.

MARAC does not replace safeguarding protocols. If you are concerned about risk to a child or children, or to a vulnerable adult you should follow the safeguarding protocols alongside a MARAC referral.

MASH