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The unintended consequences of the NHS’s Partnership with Amazon’s Alexa service

Aliya Bakheit is the Digital Strategy Analayst at SafeLives. In this blog she discusses why the new partnership with Amazon Alexa and the NHS may be detrimental for those living with domestic abuse.

Last week, we learnt that the UK government has announced a new partnership with Amazon Alexa and the NHS. The output of which will allow people who have access to Amazon’s voice-assisted technology to get expert health advice via the device. The technology will automatically search the official NHS website when UK users ask for health-related advice.

The idea is to support patients, especially the elderly, blind and those with accessibility issues to take more control over their healthcare and to ultimately reduce demand on our already overwhelmed NHS. Security experts have already warned about the lack of privacy surrounding the partnership, but Amazon is making it clear that it doesn't share information with third parties or build profiles on its customers. In a statement to the Times, the firm has said: "All data was encrypted and kept confidential. "Customers are in control of their voice history and can review or delete recordings."

While this initiative is certainly an innovative development in utilizing digital tools to address healthcare needs, here at SafeLives, we believe that further research is required to fully investigate the safety implications for people living with domestic violence in coercive and controlling relationships. And considering that one in five people will experience domestic violence in their lifetime, this is not an insignificant concern. This technology often has default settings that exposes the user’s search history, and this information could potentially be weaponised should a perpetrator obtain these transcripts - which are easily downloadable - putting the survivor at significant and increased risk as well as blocking potential routes for seeking support.

In this specific context also, this initiative could lead to more health-related questions being asked of Alexa (perhaps around pregnancy or birth control) which could be discovered by perpetrators. We know that a third of all domestic abuse begins in pregnancy, so this is a particularly risky time for survivors, and makes them ever more vulnerable to the abuse escalating should the perpetrator uncover the Alexa transcripts.

In order to understand these potential risks, gaps and opportunities presented by technology in the context of domestic violence and abuse, SafeLives, Snook and Chayn undertook a collaborative research project, 'Tech vs Abuse’, commissioned by Comic Relief in January 2017. This research was carried out over six months and gathered insights from over 200 survivors of domestic abuse (over 18 years old) and 350 practitioners who support them. There were concerns about the potential for further coercive control made possible by the ‘internet of things’ within people’s homes, such as the Amazon Alexa device. Overall, there was a sense that the perpetrator was always one step ahead. This resulted in a lasting fear of using technology, both by survivors and practitioners. They viewed technology as potentially dangerous, both during abusive relationships and recovery. Women chose, or were often advised, to remove all technology from their lives. This left them further socially isolated and with less control.

Making health information more accessible by all is generally to be welcomed, we know that GPs, nurses and other health professionals are really well placed to identify and respond to domestic abuse – there is no substitute for a trained, empathetic person who can ask the right questions at the right time. The research highlighted in our Cry for Health report, shows that nearly nine out of ten (86%) referrals to hospital Idvas came from hospital departments and we know that a high percentage of domestic abuse cases are first uncovered during a visit with a health care practitioner, midwife or community nurse practitioner in particular. There are obvious risks associated with obtaining your health advice online; however not being physically seen by someone who is trained to spot for signs of distress and abuse is a considerable one.

As part of the Government’s new Domestic Abuse Bill launched on Tuesday, it has been outlined that ‘from April 2020, NHS England are planning for Independent Domestic Violence Advisors (IDVAs) to be integral to every NHS Trust Domestic Violence and Abuse Action Plan, as part of the NHS Standard Contract.’ This is of course a great step in the right direction, however we believe that anything that prevents potential victims from being seen in person, such as this new partnership with Alexa, could be detrimental to them accessing services and support, ultimately delaying or even obstructing any support that could be provided with potentially unthinkable consequences for the victim and the wider family.

We believe that tech giants have a responsibility and duty to respond to the ever growing need to ensure that the internet is a safe place for all, but particularly for the women and girls who are most likely to be targeted in acts of digital violence that reflect the pattern of abuse experienced offline. The tech industry and the health sector must do more to understand how inextricably linked domestic abuse is with them – and technologies must not be developed without thinking through the unintended implications for those living with abuse, sadly far more than we ever realise.

For more information read the Tech vs Abuse report 

Domestic abuse and the family court

Toni Mayo is a social worker who has worked with children and families, and later specialised in family court social work for Cafcass, where she still practices and supervises other social workers. She has experience of training social workers in equality and diversity issues and in court work. Recently she has begun writing and delivering training for SafeLives.  

Domestic Abuse and the Family Court 

Many families who have experienced domestic abuse find themselves in family court. Some are subject to care proceedings, where children are removed from mothers who have been assessed as “unable to protect” their children from the domestic abuse they are experiencing themselves. A higher number of families are subject to proceedings under the child arrangements programme (CAP). Under this, the Court will determine where a child should live, and who they should spend time with, the new language of residence and contact.

Applications under the CAP can be for a variety of reasons - including a parent applying for their children to live with them, be returned from an abusive ex-partner, or attempting to place legal security around their existing arrangements. In some cases, however, a parent may be making an application after their partner has left due to domestic abuse, taking their children. They may have responded to this by either applying for their children to live with them instead, or to spend time with them.

The world of child arrangements proceedings is uncomfortable, if not frightening and harmful for survivors of domestic abuse. The adversarial nature of family court and the nature of domestic abuse means that survivors are almost certainly going to experience the following things:

  1. Gaslighting – by the perpetrator making false allegations, reiterated by their skilled legal representatives, if they have them.
     
  2. Bureaucracy – without the assistance of a solicitor, a service user will have to navigate the process themselves.
     
  3. Lack of empathy from professionals – Cafcass officers are highly skilled and experienced social workers. Often, they can identify a victim and a perpetrator of domestic abuse respectively and analyse any resulting complexities. Cafcass officers are not, however, allowed to determine issues of fact, only the Court can. If a Cafcass officer was considered partisan within a case, then it would disadvantage the victim/survivor, and certainly the children. Therefore, often survivors will find themselves feeling like they have not been believed.

When applications are made by abusive parents, what is the motivation? Are these applications a final and malicious attempt to control and abuse their ex-partner, who is attempting to extricate themselves from the relationship? That may be true in some cases, but in my experience, it is only the minority who are solely motivated by cynical objectives. I think it is a fair conclusion that most parents wish to know where their children are, and to spend time with them, even if at times their need to exercise control and dominate the other parent overrides this.

Many women feel forced to leave a violent partner due to Children and Young People’s Services (CYPS) intervention. They are given an ultimatum, either end the abusive relationship, or your children are removed. When they do leave, and they or the perpetrator make an application under the CAP, they find themselves needing to meet the means and merit thresholds or paying for solicitors as a result of the reforms to legal aid in 2012.

I am not seeking to argue that women should not leave violent relationships, or that CYPS should not be frank with victims about the likely consequences of remaining within them. But specialists understand the most dangerous period for victims is immediately after they leave. The factors above demonstrate that there is other potential harm as well, one that resonates greatly with victims of domestic abuse – the risk that their children may be removed by CYPS or the perpetrator.

Determining the best interest of the child

Sturge and Glaser1 wrote the definitive article regarding post-separation “contact” in cases of domestic abuse, which is still widely referenced in Cafcass. For contact to take place safely, there needs to be a welfare analysis undertaken which considers several factors: does the child want contact? Have they witnessed violence and/or are imitating violent behaviour? Are they afraid? Is the resident parent afraid or undermined? Does the perpetrator accept and regret their behaviour? Can the contact be safe? Will it maintain a positive relationship for the child with the adult or indeed repair a broken one, or at least contribute to a child’s identity?

Practice direction 12J has revised the assumption that children should always spend time with both parents. It clearly states that domestic abuse is harmful to children, who experience it directly – previously they were considered to have “witnessed” it. Domestic abuse now needs to be carefully considered in issues of contact. This is of course highly ambiguous, and I have seen the test of best interests applied differently by Cafcass officers, Local Authority social workers and the Judiciary. Although uneven, I do consider that this “best interests’ model” is likely to be more person centred and safer than the “forfeiture model”, which suggests that abusive parents relinquish their parental rights and responsibilities. Of course, safe contact is not always possible and, in these cases, it should not happen, but we should have clear evidence and arguments for why it is unsafe. The welfare checklist allows a holistic analysis of children’s needs when considering their best interests and contact.

Accountability and support to change

My time in private law proceedings has confirmed my long held social work values. All people are trying their best and the world is hard to live in. All human beings fall short, both as people and parents. Therefore, as Social Workers we should not judge adult behaviour, but focus on the impact on children. To support change means that we need to analyse the cause of the adult behaviour. Sometimes that is by removing the perpetrator from the children’s lives. More often it is by holding perpetrators to account for their behaviour and then supporting them to make changes. Sometimes survivors of domestic abuse, who are traumatised and impacted in terms of their parenting will also need support in this regard.

This work relies on a social work practice that demonstrates unconditional positive regard and empathy for all people, but also holds people accountable for the impact of their behaviour on others.

(1) Sturge and Glaser (2000) Contact and domestic violence – the experts’ court report In Family Law:  615

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Developing our multi-agency domestic abuse response

Jackie Milton qualified as a social worker over 20 years ago.  During her early career Jackie worked within adult mental health services but moved to children’s services after a period working in an early intervention team funded by the Children’s Fund which was part of the 1997 Labour Government’s War on Poverty strategy.

Jackie is currently employed by North Somerset as a Service Leader. Her passions centre around social justice and the empowerment of communities to become equal partners in services; encouraging positive change by raising expectations and recognising human rights. Throughout her career the lasting impact of trauma and adversity has been evident both in her work supporting adults, children and their families. 

Being chosen to be one of the pilot sites for SafeLives One Front Door project was a complete honour and as North Somerset were the only pilot site that didn’t already have an established MASH arrangement, we very much felt that we were bottom of the class. Whilst we had enthusiastic partners in both health and Avon and Somerset Police, we knew we had many challenges to overcome.

We started with the end goal in mind. SafeLives’ vision of a multi-agency response for everyone impacted by domestic abuse, is compelling and radical; something that every agency can identify with and buy in to. Having said that, you can’t eat an elephant in one go, so we have phased our programme to first establish a pathway for police notifications of domestic abuse where there are children involved.

We have had a few false starts, but we eventually got the right people in the same room together. We assembled a core team of professionals including drug and alcohol services, Idva, health, police, housing, CSC, Early Help, DOFA (Designated Officer For Allegations), HIF (High Impact Families/Troubled Families) and attended numerous events to spread the vision to GPs and the Designated Safeguarding in Education leads. Probation and mental health were keen to join but the low numbers of cases they were involved in meant that the resource implication for them wasn’t an effective use of their time. Due to this we are currently experimenting with virtual attendance and measuring its effectiveness. We are really excited that schools are playing an ever-increasing role.

We found that each agency had their own agenda and unspoken cultural views on what was needed to tackle domestic abuse (usually, it was another agency needing to do more and do it sooner).

As we did not have an established MASH arrangement, we found we had to create an entire process from scratch. This would not have happened if we didn’t have the support from our SafeLives project lead, Deidre Cartwright. Deidre met with the strategic leads and supported us to create a process (out of our ramblings) that would work for all the organisations involved and also fit into the One Front Door model.

The team started working together in October 2018. It started very simply, with a book of handwritten notes before progressing to a spreadsheet. We had endless debates about BRAG1 (blue, red, amber green) ratings – does a police red top trump a housing red? Can you BRAG if you’ve no previous knowledge of the person? What time should the information sharing meeting be held bearing in mind the health rep had to research every family member? Slowly, the team members started to take ownership of the project and came together to agree what tweaks were needed. 

The joint working quicklygave us great results, which gave everyone confidence in the new system and motivated them to persevere, which was especially helpful when the going got tough. 

Relationships between the agencies felt different. As a small local authority, we know everyone in the professional network but we each started appreciating the specific skills and knowledge of our partners and got a deeper understanding of each other’s service delivery requirements. There grew a collective responsibility for the children and families that had been discussed and even if an agency had no role within the safety planning they felt connected to the outcomes. The focus on domestic abuse has raised its profile locally. We became acutely aware (and slightly ashamed) of the fragmented, disjointed, linear way services are delivered and are hopeful that the One Front Door model could bring about effective change. Our conversations around domestic abuse have changed and our frustrations about a lack of response to the perpetrator have grown.  

Listening to the other pilot sites we began to realise that by not having an established MASH, starting with a blank canvas was actually quite liberating and gave us the blank canvas that we needed to create and implement key changes to our system.

Currently we are about to have our bespoke Liquid Logic system go live which talks to both early help and children’s social care systems and we are planning our next development phase. We are also arranging a social get together as we forgot to schedule some fun into our project planning.

The success of the pilot has emboldened us and we are about to trial an early intervention into family conflict which has been created by our collective desire to target potential perpetrators.  But the best news of all is that victims of domestic abuse in North Somerset are getting a holistic and timely offer of support.

(1) Brag ratings are widely used in our One Front Door Pilot

For more information on One Front Door please contact OFD@safelives.org.uk

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A whole family, whole picture approach

Jo is Director of Quality and Innovation at SafeLives. Within this role she is responsible for designing and piloting exciting new and effective interventions to end domestic abuse, providing expert advice on activities, policy messages and practice. She works with national and local commissioners, funders, policy makers and partners to make this happen. Jo was previously was Director of Professional Development at SafeLives, has been senior consultant at the NSPCC in Cardiff and previously worked for the police for ten years in the public protection unit and at the Women's Safety Unit. 

A Whole Family, Whole Picture Approach  

Just like children’s safeguarding, domestic abuse is everyone’s problem, and every agency has a role to play in supporting the whole family.  Frequently, however, the response to parents is so separated from the response to their children, that we’re not joining up and looking at the impact of domestic abuse on the whole family.  The child protection and domestic abuse response can become separated from each other, with assessments of children and parents made without the active involvement of domestic abuse practitioners and vice versa. This often means no one is seeing the bigger picture and interventions can be unsafe, ineffective and unsustainable.  

We know that family members and their vulnerabilities interconnect; people do not operate in silos, but this is not reflected in the way we work.   Often, we support one person, one concern at a time.  We refer to one agency for mental health support, another for domestic abuse support, another for substance use support. Practitioners are working in a silo and in doing so there is a duplication of effort, strained resources, practitioners giving disjointed or contradictory messages to families, and uncoordinated interventions.  We are missing opportunities to help people at an early stage and lives are being put at risk.   In a nutshell, we are safeguarding adults and children in a way that suits us not them.  

Seeing the whole family  

Children and young people need the right support, at the right time, to keep them safe and help them rebuild and recover. If this doesn’t happen, the consequences can be long-term and devastating.  A decision of ‘No Further Action’ is not an appropriate response for families where there is domestic abuse. We should consider which universal or non-statutory services can be provide a little support, even for those families who don’t meet the threshold for children's social care intervention. It costs more in the long run, both financially and in resources, when supportive actions are not implemented at the earliest opportunity, but the cost is greatest for the families we aim to help. We have not heard from children and young people with lived experience that say- don’t worry it sorts itself out in the end. “No Further Action” rarely ends in happily ever after does it? 

For every person being abused, there is someone else responsible for that abuse: the perpetrator.  Yet perpetrators of domestic abuse are too often invisible within safeguarding action plans.  Child protection approaches focus on scrutinising the survivor’s ability to protect, rather than managing the risk that the perpetrator poses.   Children’s social care teams often struggle to engage with perpetrators in meaningful ways and have very little access to appropriate interventions, reducing opportunities to address abusive behaviour before it escalates.  If we really want to work with the whole family, we need to work with the person responsible for the harm. We can help them to challenge these behaviours and where possible, support them to change. How many family agreements where domestic abuse is evident do you see the perpetrators signature? 

Practitioners are exhausted by seeing the revolving door of families being re-referred into domestic abuse services, being bounced around services and offered only short-term sticking plaster solutions. What does that feel like for our families? 

One Front Door 

One Front Door aims to support vulnerable adults and children to get a swift and effective response.  It is our vision for a transformation of local systems, processes and responses. 

The One Front Door (OFD) project aims to integrate pathways into child safeguarding and domestic abuse services by organisations working together to identify and safeguard vulnerable families at the earliest opportunity.  Pilots have been developed in seven sites across England to trial this approach and support agencies to develop processes including referrals and consent, risk assessment, information sharing, collaborative working and information systems. 

In the OFD model,a multi-agency specialist team will identify the needs and risks to all family members at the same time, facilitating early intervention and pre-emptive action. In this way, a team of co-located expert practitioners from a range of agencies will work collaboratively to assess risk in all its guises, whenever there is a safeguarding concern raised about any family member.  By pooling expertise and sharing information at the earliest opportunity, we enable professionals to get the most comprehensive picture of risk for each family member, avoiding those cases of ‘No Further Action’ where risk had been assessed for a single person and single criterion. Using this method, we can identify links between people who pose significant risk and those who are vulnerable. This is key to identifying potentially dangerous situations for children and young people, such as child sexual exploitation, gangs and organised crime. 

In our pilot sites, multi-agency teams use a whole family assessment system which enables them to quickly identify what level of information sharing is crucial and lawful.  Information is not just shared within hours of the referral being made; it’s used meaningfully. By collaborating, practitioners from different disciplines can understand different presentations of risk and need, and what that means for the entire family. Then, a plan of next steps can be created within 24 hours. 

Unlike a MASH, OFD sees key agencies coming together from the moment the referral comes in. Multiple experts work together and are equally responsible for the decision making. This means we are reducing the risk of families falling through the gaps. We’re not reliant on one particular agency’s perspective, but rather sharing the responsibility and making the most of the expertise each partner can offer. We don’t expect children's social workers to be experts in everything; One Front Door helps experts to contribute to safeguarding straight away, so Childrens social care can do their job well, safe in the knowledge that they have experts in mental health, substance misuse, criminal justice and domestic abuse on their side. 

One Front Door is underpinned by six principles which are required to meet the needs of families experiencing domestic abuse: 

A transformation of systems, processes and responses      

Better support for children and young people who live in fear  

Creating long term change, not short-term fixes  

Disrupting those that abuse; perpetrators challenged and held to account.  

Engaging the ‘whole family’ means more opportunity to make people safe, sooner.   

Families do not operate in silos, and neither must we   

 We are in the final stages of our evaluation of One Front Door. In one site, the number of contacts that were not closed with a ‘no further action’ outcome increased by 25%. This is a 25% increase in the number of families accessing support at the earliest opportunity. Families who would otherwise come back through the revolving door with a worsened situation, with children experiencing being scared at home again and again and again. Would this be good enough for your best friends' children? 

We are currently looking for funding opportunities to continue to build OFD as an effective whole family response. For more information, please email OFD@safelives.org.uk 

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Three ways to make sure families are safe and seen

Vicky was a victim of domestic abuse, coercive and controlling behaviour, threats to share sexualised images and stalking.  She had known her perpetrator for 10 years prior to  their relationship. They moved in together and within months Vicky found out she was pregnant.  His behaviour towards her changed quickly and Vicky found herself isolated, scared and unable to make decisions without permission from her partner. Vicky eventually left, but was stalked for a year after separation and until the day he was arrested. Vicky’s ex-partner was charged and convicted of stalking and was subsequently sentenced to custody. Vicky also went through the family court process which led to an Order being made that ensured her child was to have no contact with their father. Shortly after this, Vicky was introduced to SafeLives and became a Pioneer, helping to drive our work. Vicky also works with victims of similar offences. 

In this blog Vicky shares her experience of being involved with children’s social care and what three things she thinks children’s social care can do to make sure all victims within the family are seen and safe.   

My first social worker told me to maintain contact between my daughter and my ex-partner.  He said that from what he could tell my ex-partner was professional, articulate and presented as low risk as he hadn’t physically harmed me or my daughter.  He told me that it would be in my child’s best interest to maintain contact with her father.  He didn’t ask me what I thought was in her best interests or if I thought there was any risk to my daughter.  

My ex-partner kept making malicious reports and calls to my social worker.  He would claim our daughter was being abused by my new partner, say that I had taught her to swear and accuse us of many other things. A further five malicious calls later, my social worker said to me ‘look, you have two choices. Keep allowing your daughter to see her dad as if you do, and we will keep turning up when he calls. Or you can stop all contact and go through family court’.  

I felt he had put the decision in my hands at the worst time and without considering that stopping contact would escalate the risk from my ex-partner towards us. It was around the time the criminal process had just started and my ex-partner was angry. Stopping contact would make him angrier and give him another reason to threaten me or turn up to my home. I was scared to be the one to do thisIn some of the final times he saw my daughter he taught her to call me a slut and sent me a video of it. He also bruised her legs and accused my new partner of doing this. This all led social services to stop my daughter having contact with my partner.  This left me feeling isolated, at-risk and scared.  

Due to the contact the social worker had had with my ex-partner he was called as a witness in the criminal court case.  It was at this point my social worker was changed due to conflict of interest within the criminal case. At court my old social worker apologised to me. He said that he didn’t have the training to see the danger myself and my daughter were in.  

I was given a new social worker who understood it all.  She understood the physical risk but also the psychological risk to my daughter.  Eventually, a family court issued an order that meant my daughter never had to see her father again. The new social worker had had appropriate training, she understood the manipulative tactics perpetrators can use and how they can use services to abuse their victims. It only took one person to listen and believe how the psychological abuse and coercive control were impacting our lives, to make the right decision and protect us.  

The three things that children’s social care can do to make sure children and the non-abusive parent are safe and seen are: 

  1. Understand the psychological impact not just the physical risks. 

  1. Understand how perpetrators can manipulate the system and professionals within it to further control and abuse  

  1. Know what will make victims safer and not put them at further risk.   

 

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