Appendices

Appendix a: Project partners

University Clinic for Medical Psychology, Psychotraumatology and Trauma Therapy department, Austria

The Psychotraumatology and Trauma Therapy department is part of the University Clinic for Medical Psychology at Innsbruck Medical University. Besides a psychotherapeutic treatment of patients suffering from posttraumatic stress disorders, the members of this department do several research. So the effects of specific trauma-therapeutic treatment in patients with complex post-traumatic stress disorders and in patients with dissociative disorders. In this project the group works together with European research groups.

The members of this group were also involved in the foundation of the victim protection team at the University Hospital of Innsbruck. The mission of this team is the sensitisation of the hospital’s staff domestic and/or sexual violence and the identification of victims of violence. In this connection the effects of training measures to sensitize medical professionals for domestic violence are reviewed in the project “identification of domestic violence in health service system“ and possible negativeconsequences of traumatic events are surveyed regarding the prevalence for illnesses.

S.I.G.N.A.L. e.V., Berlin, Germany

S.I.G.N.A.L. e.V. Intervention im Gesundheitsbereich gegen häusliche und sexualisierte Gewalt (Intervention in health care against domestic and sexual violence), supports and develops interventions in the healthcare sector to address gender based violence. S.I.G.N.A.L. e.V. was the first Germany NGO to focus on domestic violence prevention and interventions in the health care sector. S.I.G.N.A.L. e.V. is a not for profit organisation and offers training, train-the-trainer seminars, support for hospitals implementing IPV and SV intervention programs, develops materials for health care staff and patient information leaflets, provides seminars for student nurses, medical schools, vocational trainees in health, gives lectures and presentations and provides networking and information services.

Target groups are health care providers (hospitals, clinics, physicians, medical practices and public health services), health care policy makers, health insurances and medical associations, teachers, trainees and students as well as women and men who have experienced gender based violence.

S.I.G.N.A.L. e.V. has taken part in and led a range of European and German projects. The organisation continues to lobby for improving the health sector’s response to IPV and sexual violence. S.I.G.N.A.L. e.V. has recently translated the WHO guidelines (2013) and handbook (2014) for responding to IPV and sexual violence against women into GermanPlease refer to www.signal-intervention.de for more information.

SACYL, Spain

SACYL is the Public Health Service of Castilla and Leon, and the Regional Health Management is its provider agency and manager of the health services as it is part of the NHS.

Our Autonomous Community addressed the development of the comprehensive law against gender violence from the national level since late 2004 and has its own regional plans for equality and against VG. Protocols and guidelines against GBV were developed and protocols of coordination between different levels as well. In 2006, a training plan in GV for health care professionals was launched, establishing priorities for intervention (Primary care professionals, emergency services, obstetrics services and mental health). A network of trainers was created to bring training in GV to theworkplace. Since then, more than 9,000 professionals Sacyl professionals, mostly Primary Care , have received some training in GV, and has been a priority to sensitize professionals, enable them for detection and involve them in the process of caring.

In 2008, the portfolio of Primary Care Services incorporated the screening services (asking a question systematically to all the women over 14 years old) and the care for victims of GBV and their children. In the last years, a healthcare guide for the detection and attention to GBV has been incorporated in the electronic medical records, that although is a very promising and useful tool, still needs wider use in allthe consultations.

The Spanish team is formed by several medical health professionals of Primary Care and other different specialties, nurses and midwives, who belong to SACYL, some of them belong to the regional team of trainers in GV and others are under training on this subject actually. We have counted on the help and the cooperation of a doctor of the National Society of Family Medicine (silent member of the project), which has become a member of the team and has given valuable support for the communication and translation with the other members of the team. We have also had the collaboration of an English student of the University of Valladolid for the translations.

In addition, our working group has experience an intersectoral collaboration between primary care professionals and high school students, and security forces in community interventions. One of these experiences have had the recognition of a Good Practice for the NHS Quality Agency (2012)

Our team is also participating in a primary care research group in these lines of Gender Violence and Mental Health; we have developed several projects on these issues and various publications.

Sacyl: www.saludcastillayleon.es/es

GenderViolence: http://www.saludcastillayleon.es/profesionales/es/violencia-genero

The Havens, United Kingdom

The Havens are the sexual assault referral centres (SARCs) for London, funded and commissioned by NHS England and the Mayor of London’s Office for Policing & Crime (MOPAC). They are run and managed by King’s College Hospital NHS Foundation Trust.

The Havens’ multidisciplinary team provides holistic and non-judgemental services to complainants who present within one year of the allegation. This may include forensic medical examinations, acute and follow-up sexual health care, counselling, psychology and advocacy. Where the Havens are unable to offer the service a complainant needs, we offer to liaise with and refer to other services.

The Havens provide their services to adults and children: our youngest patient was a few weeks old, the oldest over 90. This reflects the ethos of the NHS: providing care from the cradle to the grave and free at the point of delivery.

Clinical governance is the responsibility by which all NHS services must ensure the quality and continuous improvement of their services. Amongst other things this is underpinned by education and training, continuing professional development (CPD), audits and research. The Havens run a number of training courses so their staff are educated and trained appropriately and further supported by CPD.

They also deliver teaching and bespoke training to police, lawyers and other healthcare staff. Along with audits and research, The Havens’ training programme aims to provide properly equipped staff to deliver the best care to their patients and clients. Please refer to the Havens website www.thehavens.org.uk for more details.

Appendix b: Needs assessment process and results Summary of the interview results

Method
Using the same guided interview in all four participating countries, attendants in training sensitising for domestic and sexual violence were asked about their needs and expectations of the trainings. Following a literature research it was hypothesised that:

a. Barriers such as a lack of knowledge about domestic violence, the needs of the victims of violence, information about support services, own uncertainty of dealing with victims and bad basic conditions are existing. These factors hinder medical staff to deal with victims of violence in an appropriate way (Elliott et al. 2002, Hellbernd et al. 2004, Gerlach et al. 2013).

b. Helpful training methods for implementation are role plays, interactive exercises and information about support and counselling (Brzank 2003, Hellbernd et al. 2004).

c. After training, medical staff feel more secure referring to the contact with victims of violence and they feel less anxious (Hellbernd et al. 2004).

d. After training, medical staff are more able to inform about support and counselling and to clarify the safety of the victim (Hellbernd et al. 2004).

e. The confrontation with victims of violence can cause feelings like fear, anger or indignation or even refresh own former traumatic experiences (Fausch, Wechlin 2007).

Based on this hypothesis, an interview guide was drafted and carried out with the help of two pretest interviews. The results of those two pretest interviews caused eight categories (a to h) and one open category (i):

a. motivation and training aims
b. useful aspects of the course
c. useful training methods and suggestions
d. support for dealing with emotions
e. readiness to implement training in practice
f. employer’s support to implement
g. barriers to practical implementation
h. changes to practice
i. other ideas.

The four participating countries chose a variety of approaches of data collection, so it was collected via face-to-face interviews, emails or phone calls.

Participants

Overall, 42 people (13 UK, 12 Germany, 10 Spain and 7 Austria) were interviewed in the four participating countries. Most of them were female medical doctors aged between 26 and 60.

Results

Motivation and training aims

A lot of different factors were mentioned as motivations and aims for the training in the four participating countries. That it was mandatory to attend training was the most common answer in all countries (21), followed by wanting to learn more about how to assist patients suffering from domestic violence (15), and enhance their own competence and expertise in domestic violence and voluntarily attending training (13).

Some very personal motivations such as “knowing someone affected“ or “difficulty in controlling own aggression“ were also mentioned (for details, see table 1 below)

toolner-appendices-table-1

Useful aspects of the course

Facts and figures (16), followed by role plays (14) and good course materials (14) were the most useful aspects of the course in the respondents´ opinion. It is interesting that aspects such as “identifying domestic violence“, “to develop empathy/understanding“ and “how to deal with the violent partner“were mentioned rarely (for details, see table 2 below).

toolner-appendices-table-2

Useful training methods and suggestions

Role plays were identified as the most useful training method (18), although two respondents said that they felt they were not useful. By a large margin, small group work (10) and presentations (8) were seen as useful by the respondents (for details, see table 3 below).

toolner-appendices-table-3

Suggestions for improving training

The most common suggestions for improving training was to offer more discussion of cases (12), more practical tools (8) and more frequent training (6). Only one respondent mentioned the need to get more information about help seeking behaviour (typical behaviour displayed when people seek help) and how to build a relationship with the victim. Also, one respondent said that there was no need for further training (for details, see table 4 below).

toolner-appendices-table-4

Support for dealing with emotions

Respondents said the most important support for dealing with their own emotions is a peer support group at work (11) and having access to supervision if needed (11). They also said other participants were supportive (9). Many respondents (7) said that they did not need support for dealing with their own emotions because they felt safe (for details, see table 5 below).

toolner-appendices-table-5

Readiness to implement training into practice

There were 24 respondents who said they considered themselves ready to implement training into practice and 18 said they were not fully ready after attending training. One person said: “You are never ready about this issue.“ (For details, see table 6 below.)

toolner-appendices-table-6

Employer support with implementation

Asked about their employers‘ support with implementing training, 17 respondents said their organisation was supportive. This was followed by two critical statements indicating that there was no guidance and protocols in place (9) and no formal structure for feeding back on training courses (6). One person said they did not tell their employer about the course (for details, see table 7 below).

toolner-appendices-table-7

Barriers to practical implementation

The most common barriers expressed were the respondents’ own insecurity (12), having less time to deal with patients once domestic violence was identified (8) and having less time to ask about domestic violence (5). Three respondents had experienced no barriers, while three said they had neverseen or identified cases (for details, see table 8 below).

toolner-appendices-table-8

Changes to practice

The most important changes after attending training were identified as improved communication skills (5) and being generally more aware of domestic violence (5). Respondents also reported better documentation skills (3) and being able to take a new role at work (3) (for details, see table 9 below).

toolner-appendices-table-9

Other ideas

For details, see table 10 below.

toolner-appendices-table-10

Conclusions

The results of the survey show consistent factors in all participating countries. It is interesting that 58% of the respondents felt ready to put training into practice and 42% did not. It is not clear whether those who considered themselves not to be fully ready thought they needed more training or that they were unsettled by the training. Both options should be respected. In terms of motivations, apart from training being mandatory, three factors seemed to be important.

Most of the respondents wanted to learn how to assist DV patients, to enhance their own competence and expertise referring to SV / DV, and to learn how to recognise the symptoms of SV / DV. So these three topics seem to be the most important cornerstones of training.

Facts and figures, role plays, communication skills and the documentation of injuries, case discussions and course materials are the most useful aspects of the course.

Dealing with their own emotions was also identified an important. Most of the respondents preferred a peer support group or supervision. Peer support groups need appropriate training to be able to provide effective support. There is no doubt that there needs to be mandatory supervision of peer support groups. The allocation of trained peer support groups and supervision should be an employer´s duty.

The employer´s support is seen ambivalent in general. The employer is experienced to be supportive on the one hand, but on the other hand structural weaknesses are criticised.

The most common barrier to practical implementation is own insecurity. This shows that there is a need to optimise the offered trainings.

Summing up a training should consist of theoretical inputs dealing with communication skills how to assist SV / DV patients and how to recognise symptoms of SV / DV, information about SV / DV to be able to enhance the own competence and expertise referring to SV / DV, and how to document in a correct way. Good course material has to be provided, too. Those theoretical contents should be practised with role plays and case discussions. Concurrent peer support groups and the possibility ofsupervision has to be guaranteed.

Appendix c: Contact details

Austria
University Hospital for Medical Psychology
Schöpfstraße 23a
A-6020 Innsbruck
Tel: +43 512 504 26117
Email: lki.ps.opferschutz@tirol-kliniken.at
Website: www.i-med.ac.at/patienten/kliniken/med_psychologie.html

Germany
S.I.G.N.A.L. e.V.
Sprengelstraße 15
13353 Berlin
Tel: +49 30 275 95 353
Email: info@signal-intervention.de
Website: www.signal-intervention.de

Spain
Gerencia Regional de Salud de la Junta de Castilla y Leon
Paseo de Zorrilla, 1
47070 Valladolid
Tel +34 983 328000
Email: mcfernandeza@saludcastillayleon.es
Website: Sacyl www.saludcastillayleon.es/es
Gender violence: http://www.saludcastillayleon.es/profesionales/es/violencia-genero

UK
The Havens
King’s College Hospital
Denmark Hill
London SE5 9RS
Tel: +44(0)20 3299 1599
Email: kch-tr.havenseducation@nhs.net
Website: www.thehavens.org.uk

Appendix d: Acknowledgements

This toolkit was developed in order to support the implementation of learning from violence against women training, delivered to all those working in the healthcare sector and supporting women who have been victims of sexual or domestic violence.

From Gerencia Regional de Salud de la Junta de Castilla y Leon, Spain:
Carmen Fernandez Alonso with help from Sonia Herrero Velázquez, Yolanda Valpuesta Martin, Susana Sánchez Ramon, Raquel Gómez Bravo, Marta Menéndez Suárez, Mar de la Torre Carpente, Irene Repiso Gento, Mar González Fernández-Conde and Abel Sánchez Fernández.

From the Havens, UK:
Victoria Poon-McFarlane with help from Kate Bowler, Bernadette Butler, Simon Cordon, Kath Evans, Sukhmeet Sawhney and Muriel Volpellier.

From S.I.G.N.A.L. e.V, Germany:
Marion Winterholler with help from Hilde Hellbernd, Karin Wieners and Katrin Wolf.

From University Clinic for Medical Psychology, Psychotraumatology and Trauma Therapy department, Austria:
Thomas Beck with help from Astrid Lampe, Ulrike Smrekar, Iris Trawoeger, Sabine Abenthung and Deborah Verdorfer.

Special thanks to:
· All participants in the project interviews from the four countries
· Sexual Offences Exploitation and Child Abuse Team at the Metropolitan Police, London, UK
· Mag. Markus Wirtenberger, Dr.Manfred Krampl: Ministry of the Interior, Austria
· Dr Heiderose Ortwein and Heike Rössig, Charité Universitätsmedizin
· Venetia Clarke, the Havens
· The Spanish Society of Family and Community Medicine (semFYC)
· Rosa Lopez Rodriguez from the Ministry of Health, Spain
· Luisa Velasco Riesgo, Salamanca Police Department
· The Centre of European Studies at the University of Valladolid
· All colleagues and students who have participated in training as part of this project

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