Shared learning database

Against Violence and Abuse (AVA)
Published date:
August 2014

Against Violence & Abuse delivered The Stella Project Young Women's Initiative to improve responses to young women with experiences of domestic violence and/or sexual violence and substance misuse in two London boroughs.

The NICE domestic violence and abuse guidance recognises that young people can experience domestic violence and abuse directly in their own intimate relationships (rec 10). It highlights the need for frontline staff in all health and social care services to be trained to recognise the indicators of domestic violence and abuse and to ask relevant questions to help people disclose their past or current experience of such violence or abuse (rec 6). In respect of domestic violence and abuse services, the guidance notes that if there are indications that someone has alcohol or drug misuse problems they should be referred to the relevant alcohol or drug misuse service (rec 8).

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

This project was divided into two sections, with the following objectives:
- To conduct research to develop the evidence base on the intersecting issues of domestic violence, sexual violence, alcohol and other drug use and young age as experienced by 14 to 25 year old women accessing specialist violence against women and girls or specialist substance misuse services in two London boroughs.
- To provide training and consultancy support with the intention of improving practitioners' responses to intersecting issues faced by such young women.

Reasons for implementing your project

AVA's Stella Project has been working to improve services for adult women affected by overlapping domestic violence and problematic substance use for over ten years. Through provision of training and development work with practitioners, the organisation received frequent requests to advise agencies about how these matters affected younger women.

Although this was an issue that was increasingly identified by practitioners, the UK evidence base on how to effectively support such young women was weak. In 2010, AVA successfully sought funding from the John Paul Getty Jnr Charitable Trust for a research and development project to address this gap in the evidence base.

Two London boroughs were selected to participate in the project, Enfield and the Royal Borough of Kensington and Chelsea. They were selected based on their strategic commitment to the project and the existence of relevant agencies to participate in the project.

In both boroughs there was representation from the independent domestic violence advocacy services, the young people's substance misuse services and the drug intervention services. In Enfield there was also representation from the youth offending service.

How did you implement the project

In the first year of the project research was conducted to develop the evidence base on the intersecting issues of domestic violence, sexual violence, alcohol and other drug use and young age. The research included monitoring data on the disclosure of intersecting issues made by young women accessing services (strand 1). The specialist agencies in each borough were asked to incorporate screening tool questions into their existing assessments.

Other aspects of the research included an online questionnaire for frontline staff that covered issues relating to staff confidence, knowledge and skills (strand 2) and an analysis of the policies and procedures from participating agencies and strategic documents produced by the local borough strategic partnerships (strand 3).

The key research findings were that:
- Monitoring data on disclosures was limited
- Practitioners did not feel prepared to ask questions about sexual violence
- There was a lack of formal referral pathways in place
- Practitioners didn't always know what help was available for the intersecting issues. In the second year, three new training courses based on the research findings were delivered to 126 professionals from 49 agencies across the two boroughs. These were 'Working in Partnership' and 'Working with young people experiencing sexual violence, domestic violence and problematic substance use' basic level 1 and advanced level 2. Details of these courses can be found here. Borough action plans were developed and agreed with the Community Safety Team and Young People's Substance Misuse Commissioners in both boroughs.

And an online forum was set up to share information and put practitioners in touch with each other. Initially, the number of practitioners using the forum was low and extra time and effort had to be spent adding material to engage users.

The final year of the project comprised four days of multi-agency training for both boroughs and tailored workshops for targeted groups of professionals, for example school nurses. Presentations were also delivered at strategic forums in the two boroughs. The project also resulted in the publication of two pieces of guidance which are available on the AVA website.

Key findings

The project was evaluated by Middlesex University. The monitoring data obtained were far more limited than anticipated. In terms of the effectiveness of the intervention monitoring of disclosures tended to decrease over the length of the project. This may be because many services had their funding significantly reduced over the course of the evaluation which may have impacted on the capacity to release staff to engage with the intervention and/or evaluation or that fewer young women used the services.

Staff questionnaire
By the post-intervention stage practitioners who were 'not well' or 'not very well' prepared to ask questions about sexual violence had fallen from 80% to 44%. Post-intervention questionnaires revealed that most practitioners were able to give an account of how they would go about effectively sharing information about young women's experiences of violence and problematic substance use.

In the post-intervention questionnaires some practitioners reflected on some of the reasons that victims/survivors and perpetrators might use substance abuse problematically, making reference to the "use of alcohol and drugs to either control a person, or to support and mask difficulties in life" or "to help them manage other issues", demonstrating a more intersectional appreciation of problematic substance use.

Policies and procedures:
The expectation that there would be greater evidence of strategic-level policies and implementation of procedures at the agency level after the intervention was only partly met. The lack of data provided by participating agencies meant that this was not possible to asses at an agency level, however there was some evidence of an increasing recognition of some of these intersecting issues for young women in strategic-level polices at borough level. For example, the Enfield Safeguarding Children Board Protocol for Working with Sexually Active and Possible Sexual Exploitation of under 18's underscores the importance of these intersecting issues for young women, and includes substance use as a risk factor in their risk assessment framework for sexual exploitation.

Key learning points

The project recommended that:

1. Practitioners have further training and support focused on how to identify and act on the intersecting issues of domestic and sexual violence and problematic substance use, including appropriate referral pathways.

2. Practitioners should have a regularly updated directory of relevant agencies.

3. Practitioners need to develop their understanding of young women's own perspectives regarding their apparent 'reluctance' to disclose.

5. Young women are provided with further information on these intersecting issues, and the options available to them, to include practical sources of assistance.

6. Practitioners should develop procedures to enable them to do some basic work with each young woman on intersecting issues in order to facilitate the referral on to another service. Ideally a cross-service screening measure should be developed to facilitate both the start of such work and referrals onwards. The project resulted in the publication of two pieces of guidance which are available on the AVA website:
- 'Commissioning guidance: Developing effective services for young women experiencing domestic and sexual violence who have substance use and mental health problems'
- 'Practice guidance: Engaging with young women experiencing domestic and sexual violence, substance use and mental ill-health.'

Contact details

Davina James-Hanman
Against Violence and Abuse (AVA)

Is the example industry-sponsored in any way?

The project was funded by The John Paul Getty Jnr Charitable Trust.