Foundation Doctor training

1. Foundation Doctor training Sexual and Domestic Violence

2. Aim of this session • To familiarise you with the materials • So that we benefit from your feedback: • Online materials • Would you like similar resources for any other topics? • To keep you awake after lunch

3. Objectives To provide materials to support relevant training for foundation doctorseg a one hour interactive session At the end of the session foundation doctors should: • be aware of the associations and presentations of violence and abuse* • have an understanding of how to broach the issue sensitively and confidently with patients • be aware of local referral pathways and documentation *the session focuses on adults, as additional training on safeguarding training should be provided separately

4. Contents of the pack

5. QUIZ

6. Q1 What percentage of women in England and Wales say they have been physically assaulted by a partner at some point? A) 5% B) 20% C) 30%

7. Q1 Answer Correct answer is b - 20%

8. Q2 What percentage of domestic violence occurs when children are in the same or next room? A) 50% B) 70% C) 90%

9. Q2 Answer Correct answer is c – 90%

10. Q3 What is the cost to the NHS of dealing with physical injuries alone caused by domestic violence? a) £800 million b) £1.2 billion 3) £3 billion

11. Q3 Answer Correct answer is B – £1.2 billion

12. Q4 What is the biggest health difference between abused and non-abused women? • more gynaecological problems b) more broken bones c) higher blood pressure

13. Q4 Correct answer a – more gynaecological problems

14. Q5 How many women are raped in the UK every week? a) 500 b) 1000 C) 2000

15. Q5 Correct answer c - 2000

16. Exploring abuse • Privacy and sensitivity • Setting the scene first, eg: • ‘how are things at home?’ • ‘I am concerned that we have already seen you in A&E three times this year . . and it is important that I ask about your safety’ • ‘I am concerned that this injury seems to be more severe than I would expect from tripping…’ • ‘it is good that you have asked for emergency contraception . . can I just ask whether the sex that happened was with your consent?’ • ‘are you safe to go home?’

17. Many different questions can be used to explore The HARK questions are one model, developed for use in general practice • H HUMILIATION • In the last year, have you ever been humiliated or emotionally abused in other ways by your partner or ex-partner • A AFRAID • In the last year, have you been afraid of your partner or ex-partner? • R RAPE • In the last year have you been raped or forced to have sexual activity of any kind • K KICK • In the last year, have you been kicked, hit slapped or otherwise physically hurt by your partner

18. Role plays with scenarios • In your envelope you each have a sheet with 1 ‘doctor’ and 1 ‘patient’ scenario, and possible questions to ask • Working in pairs, take it in turns to explore each role for 5 minutes • In your pairs, briefly feedback to each other: • what went well? • was anything difficult / made you feel awkward? • Think about what next steps might help the patient in each scenario?

19. Break for role plays and feedback in pairs

20. Feedback after role plays – important considerations for all scenarios Always ask for advice eg senior doctor / safeguarding lead (senior nurse will know who this is)

21. Good documentation • detailed, objective, legible, date and time, signature and name in capitals • record words used verbatim eg ‘I said no but he wouldn’t listen’ • record details of any assault eg ‘kicked twice in abdomen’ rather than ‘assaulted’ • record injuries on body maps if necessary (in case you are later asked for a police statement)

22. Feedback after role plays – Scenario - Amy • Amy has presented to A&E asking for emergency contraception. She is tearful and has brought a young child with her • Last night her husband raped her while her 3 year old daughter was in the same room asleep • What next steps might be helpful?

23. Interventions for Amy • Is she safe to go home? • Emergency contraception • Discussion with senior colleagues / safeguarding staff as regards child • Does she want to report to police / local sexual assault referral centre (SARC)? • Sexual health referral / follow-up • Discussion about local domestic violence services • Good documentation

24. Scenario - Paul Paul is brought in by ambulance with the police following a severe physical assault by a group of young men. Besides his fractured ribs and pneumothorax, he was anally raped by three of them. He is very upset, concerned about how he will tell his girlfriend, and worried about whether he could have caught HIV • Next steps?

25. Interventions for Paul • Post-exposure prophylaxis against HIV (as soon as possible/ within 72 hours) • Sexual health follow-up • Does he want to tell police / report to sexual assault referral centre (SARC)? • If not going to SARC, other sources of support for him (and partner) • Good documentation

26. Scenario - Mrs Brown • Mrs Brown was admitted following a fall, and is bruised on her upper arms and backs of her legs, with a bite mark on her shoulder • She is a retired widowed headmistress living with her son and daughter-in-law and their child, who has cerebral palsy. Since breaking her wrist last month she has needed more help, and her daughter-in-law has become frustrated and took it out on her by hitting and biting her. Mrs Brown fell last night in an attempt to get away from her • Next steps?

27. Interventions for Mrs Brown • See Mrs Brown without any of her relatives present • Management of injuries including human bite • Safeguarding adults team (and safeguarding children team re grandson) • Ask her what action she would like to take eg police / not go home • If she does not want to go home, social services • Good documentation

28. Scenario - Fatima • Fatima, aged 17, comes to see the GP with her 45 year old husband. He does all the talking, although she can speak English, and says she is pregnant. Fatima makes no eye contact and looks thin and withdrawn • Her marriage was arranged against her wishes. Her husband does not let her out alone, and has sex with her against her wishes several times a week, and hits her if she refuses. She is only allowed food if she has done all the housework for her mother-in-law, who lives with them • Next steps?

29. Interventions for Fatima • See Fatima without her husband or other relatives • Ask senior colleague • Confirm pregnancy and document any injuries • Find out what she would like to do as regards to pregnancy and husband – but consider breaking confidentiality (following advice) for her safety so that police are informed • Provide information about domestic violence services • Make TOP referral / involve antenatal team and safeguarding midwife • Involve safeguarding children team (as under 18 plus unborn child)

30. Other resources Local resources for patients (and staff) Trainer - Research and identify local resources (useful contact names and numbers for your area) and place in this slide for information: • Use the list of resources/local services in the pack to identify your local domestic and sexual violence services • List your nearest SARC/Haven • Contact your local DV or MARAC co-ordinator(s) as they are the best source of information. Where not in place, Safer Neighbourhood teams and Community Safety Teams should be knowledgeable, as are national DV helpline staff For further resources, please go to http://www.stfs.org.uk/faculty/trainingabout-sexual-and-domestic-violence