In partnership with

1. Complex needs & maximising the resources that already existCathy Davies, Hafan CymruMorgan Fackrell, Cardiff WA In partnership with

2. Hafan Cymru PREVENTING ABUSE AND PROMOTING INDEPENDENCE OVER TWENTY ONE YEARS OF TACKLING DOMESTIC ABUSE The Nuts and Bolts of Providing Domestic Abuse Services – Complex Needs: Maximising Existing Resources 2nd February 2011

3. Who are We and What do we do? Charitable housing-related support provider Grew out of Women’s Aid movement in Wales In 2009/10 we supported 2,277 people: 987 women,35 men,1,223 children Supporting over 530 adults daily, mainly women with children Key principles of user involvement and equality and diversity Supporting women and children exp. Domestic Abuse for 21+years Men supported since early 2008 - still small numbers/low demand Service delivery in 18 of 22 local authorities BUT Spectrum schools preventative programme in all authority areas Services include: refuge/safe houses, floating support, temporary supported housing, young women’s and young person’s projects, in house accredited learning and work, IDVAs in 3 counties, Women’s Safety Work in 4 counties alongside Probation, Multi Agency Centres for domestic abuse, schools programme, work with young women offenders

4. What Do We Mean By Complex Needs? UK evidence base around complex needs and domestic abuse is small – literature review on multiple and complex needs reveals little substantial research linked to domestic abuse Usually defined in this context as a combination of inter-related issues of mental health, alcohol and other drugs and domestic violence Sometimes referred to as ‘dual diagnosis’ when applied to combination of mental health and substance misuse

5. What Do We Mean By Complex Needs? Also refers to Complex PTSD (Judith Herman, Trauma and Recovery,1992) Describes symptoms resulting from short-live trauma and syndrome following prolonged,repeated trauma as in domestic abuse Forms of trauma include sexual abuse (especially child sexual abuse), physical abuse, emotional abuse, domestic violence or torture Add to this offending behaviour as many women involved in the criminal justice system have experienced domestic abuse – 39% in 2006 (see Corston Report, 2007 and Corston update 2010)

6. What do We Mean By Complex Needs Therefore we’re referring to multiple vulnerabilities often requiring specialist interventions and high levels of expertise around: Domestic abuse and alcohol misuse Domestic abuse and drug misuse Includes both prescribed and non-prescribed drugs from diazepam to cannabis, crack, cocaine, heroin Domestic abuse and offending behaviour Often linked to the above Domestic abuse and mental illhealth Includes depression, anxiety, ptsd, complex ptsd,self-harm, eating disorders through to psychopathic tendencies, schizophrenia And one or more combinations of the above

7. Breakdown of People We Supported in 2009/2010

8. Combinations of Complex Needs in the Last 12 Months

9. Current Issues Around Complex Needs Women excluded from refuge (and other?) provision because of level of need Women excluded from service provision because of service providers’ lack of expertise and perceived management issues Women excluded from service provision because of lack of understanding in wider community Little or no service provision for men with complex needs around domestic abuse Provision therefore not ‘fit for purpose’

10. Issues Around Complex Needs- Some Solutions Identify the need and therefore service required appropriately Dual diagnosis/ complex needs around e.g. substance misuse often considered as primary need Ensure effective inter-agency working Address appropriateness of service provided and whether appropriate key worker appointed – recognise expertise /share information Use Service Framework for D.A. and Substance Misuse - complex needs care pathway Ensure accommodation/support is appropriate Separate housing provision usually most effective where needs are multiple and behaviour can be challenging Work in partnership with other expert providers to enable best possible support to/housing for the individual – no silo thinking!

12. Hafan Cymru Contact Details: Cathy Davies, Chief Executive 01267 225555 www.hafancymru.co.uk

13. NUTS AND BOLTS CONFERENCE How can we meet the needs of clients with complex needs including mental health issues more effectively? Cardiff Women’s Aid is the largest local specialist domestic violence/abuse service in Wales

14. NUTS AND BOLTS CONFERENCE • What to we mean by complex needs? • Prolonged experience of severe physical, physiological and emotional violence/abuse • Multiple experience of disadvantage • Substance misuse/abuse/dependency • Mental health issues • Self harm • Chaotic lifestyle Cardiff Women’s Aid new service delivery model is part of the modernising support services pilot’s

15. NUTS AND BOLTS CONFERENCE • Services fit for purpose • Must meet the needs of all women who need to access refuge/ emergency supported accommodation • Not to the detriment of other women who are also in crisis Cardiff Women’s Aid has over 35 years experience in developing and delivering services to meet the needs of women and children affected by domestic violence/abuse

16. NUTS AND BOLTS CONFERENCE • Staff • Continuous training and up-skilling • Effective systems and procedures to support staff dealing with difficult situations • Effective risk management (and not risk aversion) • Clear communication about expectations Cardiff Women’s Aid holds both Investors in People and Investors in Volunteers

17. NUTS AND BOLTS CONFERENCE • Architecture, Infrastructure and Systems • Start with a blank sheet of paper • Start with the results your service users need - outcomes • Start with what you need to deliver to your service users • Don’t be afraid to make the changes Cardiff Women’s Aid has a wide portfolio of services including cutting edge refuge/emergency supported housing provision

18. NUTS AND BOLTS CONFERENCE • What we did in Cardiff • Re-Configured our staff team • Re-Configured our refuge provision behind our new cutting edge intake and assessment house • Re-Configured our service portfolio to support our new vision Cardiff Women’s Aid delivers behaviour change programmes, education and group work sessions for young people

19. NUTS AND BOLTS CONFERENCE • Intake and Assessment • Full assessments in a fully supported setting for up to 14 days • Seamless referral onto most appropriate in house or external services • Focus on returning families home with appropriate support (after full risk assessment) Cardiff Women’s Aid delivers an exemplar counselling service to adults, children and young people : including a service for young people who have experienced sexual assault

20. NUTS AND BOLTS CONFERENCE • Specialist refuge • Need to provide fully supported specialist refuge for substance misuse or dual diagnosis service users – able to design package of support provided by a range of agencies with key worker to coordinate • And specialist refuge for those experiencing mental health issues Cardiff Women’s Aid delivers 24 hours a day, 7 days a week crisis intervention – including working with out of hours social services and housing

21. NUTS AND BOLTS CONFERENCE • Overview • You need to focus on the outcomes for the service users not what your organisation is set up to deliver • Leadership, training and the values of your service are the keys to effective change • You can change what you do with what you have Cardiff Women’s Aid delivering modern, effective and relevant services fit for 21st Century service users