513857
research-article2013
VAWXXX10.1177/1077801213513857Violence Against WomenSzilassy et al.
Article
Outcomes of Short Course Interprofessional Training in Domestic Violence and Child Protection
Violence Against Women 19(11) 1370–1383 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1077801213513857 vaw.sagepub.com
Eszter Szilassy1, John Carpenter1, Demi Patsios1, and Simon Hackett2
Abstract The interrelationship between domestic violence and child protection is well established, yet deficiencies in interprofessional collaboration have been reported and training is advocated as a solution. This study evaluates the outcomes of short interagency and interprofessional training in domestic abuse. Participants’ attitudes and knowledge were assessed using a self-report scale and compared in a doublebaseline time-series design. Participants (N = 177) were recruited from a range of agencies in England. There were consistent, statistically significant improvements in participants’ attitudes, knowledge, and self-confidence between the start and end of course (p < .001). The long-term outcomes of training and the implementation of learning, however, remain uncertain. Keywords child protection, domestic violence, evaluation, interagency training, interprofessional education, interprofessional training
Introduction According to the citations database Scopus in April 2010, the most cited article in Violence Against Women was a review by Edleson (1999) on the overlap between child maltreatment and woman battering. Edleson argued that societal responses to these 1University 2Durham
of Bristol, UK University, UK
Corresponding Author: Eszter Szilassy, University of Bristol, Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. Email: [email protected]
Szilassy et al.
1371
two forms of victimization had developed on “different tracks,” although there was substantial evidence that “very many children and adults in the same families are victims of abuse directed against them” (p. 149). More recently, a symposium in the journal stimulated by an article from Australia (Douglas & Walsh, 2010) re-examined the relationship between mothers, domestic violence, and child protection. Perhaps little has changed in the intervening 11 years. As one of the contributors (Hester, 2010) argued, it is as if domestic violence and child protection services, as well as family contact (visitation), existed on separate planets. This is self-evidently an important issue. From the perspective of child welfare services, exposure to domestic violence can have serious effects on children’s safety, development, and emotional well-being (Kitzmann, Gaylord, Holt, & Kenny, 2003); in the most extreme cases, it may put children at risk of serious injury or death. Yet, a naïve approach to protecting children without an appreciation of the nature of domestic violence can be dangerous; domestic violence is more than a “risk factor” for child abuse. Douglas and Walsh (2010), like many others before them, stressed the need for services to work together to support women and children caught up in domestic violence. The recognition of the co-occurrence of family violence and child abuse has highlighted the deficiencies of interprofessional collaboration in the area of child protection (e.g., Mills et al., 2000; Ward & Peel, 2002). Douglas and Walsh (2010) concluded that the failure to recognize and identify signs of domestic violence, and the particular power dynamics associated with it, may have a significant impact on child welfare workers who may implicitly, if not explicitly, believe that mothers are responsible for putting an end to the violence. Furthermore, it was suggested that some women may be faced with an ultimatum either to leave their partner and keep the children or stay and lose them. Humphreys (2010) commented that the consistency of these findings with previous research indicates that the problems are structural, going beyond the attitudes and practice of individual workers. Similarly, too narrowly or inaccurately identifying the type and cause of domestic violence, or focusing only on micro-level factors and denying the importance of macro-level characteristics, may expose victims to further risk (Button & Payne, 2009). In England in 2006, detailed policy and practice guidance was issued by the government departments responsible for health and children’s welfare, emphasizing that “Everyone working with women and children should be alert to the frequent interrelationship between domestic violence and the abuse and neglect of children” (HM Government, 2006, Sec 11.45). The guidance strongly advocated an interagency approach involving the police and health and welfare professionals, and stressed the contribution of specialist domestic violence services (Sec. 11.48). Nevertheless, lack of knowledge and shared understanding of domestic violence and child protection protocols and procedures have been identified as major reasons for the limited involvement of these specialist services in England (Cleaver, Nicholson, Tarr, & Cleaver, 2008). Finally, child protection workers’ lack of confidence in intervening in situations of domestic violence has serious implications for ensuring the safety of mothers and children. Cleaver et al. (2008) argued that interagency training
1372
Violence Against Women 19(11)
can promote an understanding of the roles and responsibilities of professionals working in different organizations, their different thresholds for services, the legal frameworks within which they work, and issues surrounding confidentiality and information sharing. It will also provide opportunities to develop inter-agency networks, increase levels of trust, and provide insights into the philosophy and work of each other’s organizations. (p. 16)
The authors, however, did not provide evidence to support this contention.
Evaluations of Training Although there have been numerous papers and policies advocating training on child protection and domestic violence (e.g., Buckley, Holt, & Whelan, 2007; Mills et al., 2000), those training programs whose evaluations have been published (e.g., Mills & Yoshihama, 2002) have focused on teaching child welfare professionals about domestic violence rather than interprofessional training about the relationship between the two issues. Furthermore, as a recent review by Collins, Kim, and Amodeo (2010) concluded, the evidence base for training in the field of child welfare is generally weak. For example, one evaluation used a pre–post design to evaluate a 2-day program on domestic violence for staff in a family support agency in the United States (Saunders & Anderson, 2000). At the end of the course, participants were more likely to say that they would provide assessment and brief interventions, hold the abuser responsible, substantiate emotional abuse of a child, and empathize with victims than at the start of the course. Participants also reported less likelihood of holding the victim responsible for stopping the violence and telling the woman that she must end the relationship. Unfortunately, participation in the evaluation was poor: Out of more than 300 attendees, matched responses at the start and end of training were available for only 36 participants, which seriously undermined the reliability of the conclusions.
Aims The aim of the present study was to contribute to the evidence base by evaluating the outcomes of short-course interagency training in England on domestic violence and safeguarding children (child protection). As explained below, these courses are intended specifically to address the interrelationship between these issues together with interagency and interprofessional collaboration. The research was part of a larger study of the organization, outcomes, and costs of interagency training undertaken jointly for the Department of Health and the Department for Children, School and Families in England between 2007 and 2009.
Study Sites and Training Courses In England, Local Safeguarding Children Boards (LSCBs) have a legal responsibility for ensuring that all health, local authorities, the police, and voluntary organizations cooperate to safeguard and promote the welfare of children in their area, including the
Szilassy et al.
1373
provision of interagency training (HM Government, 2010). The organizational contexts and mechanisms for providing the courses are described elsewhere (Patsios & Carpenter, 2010). Seven LSCBs in four regions of England collaborated in this study. The courses that are the focus of this article were open to any staff who had a frontline responsibility for the protection and safeguarding of children. Each course offered 20 to 25 places and lasted for 1 day. The courses shared the same aims and learning outcomes (see below) but were delivered by local trainers with contributions from domestic violence workers and consequently, there were some minor variations in program design and teaching methods. The courses were described as follows: Participants will work together to gain an increased awareness of the links between domestic violence and child abuse and the impact on children, young people and family members. The trainers will highlight the need to promote earlier intervention and support to prevent risk situations. There will be a focus on interagency procedures and local developments. They aim to promote a greater understanding of how all agencies can communicate and work together to safeguard children and young people where domestic violence and abuse impacts on their well-being.
The learning objectives were defined as being able to •• Review definitions of domestic violence •• Reflect on the incidence of domestic violence locally and nationally •• Investigate the assessment process and good practice guidance in relation to domestic violence and child protection •• Develop ability to assess risk in relation to children who are in families where domestic violence is prevalent •• Gain greater understanding of the interagency approach to working with families who have experienced domestic violence •• Develop ideas to improve their own practice •• Identify ways to keep themselves safe. The courses all used interactive learning and teaching methods as well as presentations of case studies drawn from child abuse inquiries, research findings, and statutory guidance. They included videos of parents and children talking about the effects of living with domestic violence. Plenty of time was allowed for discussion and exploration of personal attitudes to domestic violence. Participants were asked to draw on their own experiences of multi-agency work, trying to identify the strengths and challenges of working interprofessionally, including the different philosophies and practice orientations of their agencies. Participants were invited to share where their agency featured on a flowchart illustrating the process from referral to de-registration on the statutory child protection register. This was followed by a quiz based on local procedures relating to child protection. Participants worked together in mixed interprofessional groups and were allowed to consult a local procedures manual to help identify the answers. The contribution of different agencies to assessment and intervention planning was emphasized.
1374
Violence Against Women 19(11)
Interactive sessions were interspersed with role-plays and practical communication exercises, for example, on how to talk to clients/patients about abuse. Informal opportunities to network over lunch and tea breaks were an important part of the program.
Method Research Design The evaluation used a repeated-measures design with a double baseline. Successful applicants were asked to complete the questionnaire at the time they registered for the course (T0), 6 weeks before the start of the training. They completed it again at the beginning of the course (T1) and again at the end (T2). They were subsequently followed-up 3 months later (T3). This design aims to test the hypothesis that, in the absence of any training intervention, there would be no change in mean total scale ratings between T0 and T1. If at T2, there was an improvement in mean scores compared with T1, this could then be attributed to the training intervention, with all other factors held constant. Because data were collected from 10 courses in different parts of England, it was possible to assess the outcomes for each independently. If the effects of the training intervention were consistent, this would strengthen the claim that they were associated with the training intervention, rather than some confounding factor.
Measures A demographic questionnaire was constructed requesting information about age, gender, ethnicity, profession, service experience, and reasons for attending the training course. A search of the literature identified a self-report scale used to evaluate the outcomes of a short course for dentists in England (Warburton, Hanif, Rowsel, & Coulthard, 2006). This had been adapted from questionnaires used in previous evaluations of professionals’ attitudes toward, and knowledge of, domestic violence (Cann, Withnell, Shakespeare, Doll, & Thomas, 2001; Maiuro et al., 2000; McCauley, Jenckes, & McNutt, 2003). With the help of two experts on domestic violence and reference to the course learning objectives (stated above), 15 relevant items were selected. To these were added additional items focusing on the effects of domestic violence on children and knowledge of relevant child protection policies and procedures and confidence in their use. The statements were presented alongside 5-point Likert-type scales, and respondents were asked to indicate the strength of their agreement (strongly agree– strongly disagree). Eleven of the 28 statements were designed for reverse scoring to reduce potential response bias. A first draft of the questionnaire was piloted with a class of 16 students undertaking a postgraduate course in social work. The test–retest reliability was assessed by comparing ratings made at the beginning and end of the class. There were no statistically significant changes in mean responses to any of the items, and overall scores at both time points were highly correlated. The new Domestic Abuse and Safeguarding Children (DASC) scale comprising 28 items was then piloted with participants on an
Szilassy et al.
1375
interprofessional training course on domestic abuse and safeguarding. The internal reliability of the draft scale was assessed again and the scale showed no inconsistencies. The DASC scale showed statistically significant changes in responses before and after the course intervention. The 28-item version of the scale used in the study is presented in Table 1 below. The reverse-scored items are indicated.
Procedures Following registration for each course, participants were sent an invitation to take part in the evaluation, together with an information sheet explaining how confidentiality would be ensured, along with the T0 questionnaire, which they were asked to complete and bring with them to the first day of training. These procedures were approved by the relevant university research ethics committee (institutional review board). The questionnaire was administered again by the course trainer at the start of the training (T1), following the introductions and before any training took place. At the end of the training, the second questionnaire was distributed (T2). Participants were asked not to confer. Responses were placed in an envelope and returned to the course administrator who forwarded them to the research team for data input. Three months later, participants were emailed the questionnaire again by the course administrator and asked to complete them once more. The research team had no direct contact with the course participants at any time.
Participants One hundred seventy-seven staff out of an approximate 250 (71%) elected to participate in the evaluation, and 155 provided complete demographic data. A very high proportion (92%) were White women. Most (89%) had between 1 and 5 years service experience. In total, 70 (45%) were social workers or family support workers, 45 (29%) were nurses and midwives, and 11 (7%) were teachers. The remaining participants included doctors, community workers, probation officers, and counselors. Almost all (90%) were voluntary participants; the remainder had been instructed to attend by their line manager. Ninety-eight participants in the evaluation (55%) returned pre-course (T0) questionnaires. However, only 26 (15%) responded to the follow-up questionnaire. Reminders were not permitted by the ethics committee, and these results have been discounted.
Results In general, there were no statistically significant differences between respondents according to their demographic characteristics at the time points T0, T1, and T2. The internal reliability of the scale (Cronbach’s α = .7) was acceptable for exploratory research of this nature. Principal components analysis, the scree plots and analysis of item loadings suggested that the scale comprised four factors accounting for
1376
Violence Against Women 19(11)
Table 1. Domestic Abuse and Safeguarding Children Scale Item Means at T1 and T2 (Wilcoxon Test).
1 I feel comfortable asking clients about domestic abuse 2 I have clients whose personalities cause them to be abused 3 Abused women should leave their partners 4 It is not my place to interfere with how a couple chooses to resolve conflicts 5 Separation will not put women and children at greater risk of further abuse 6 There are strategies I can use to help “victims” of domestic abuse change their situation 7 I understand how my own experiences may influence my capacity and willingness to engage with issues of domestic abuse 8 Women experiencing abuse are deeply ashamed 9 Mothers in abusive relationships cannot be expected to have their children’s welfare as their top priority 10 I feel confident in talking to perpetrators about domestic abuse 11 Domestic abuse may be associated with just about any physical complaint I see in my practice 12 I have a good understanding of local information-sharing policies for domestic abuse 13 Babies under one will hardly be affected in their health when they witness domestic violence 14 Abused women should leave their partners, whatever the circumstances 15 In assessment of risk to a child, you should take into account differences in cultural norms in the acceptability of violence
T1
SD
T2
SD
Z
p (twotailed)
3.4
1.01
4.0
0.78
−6.295
research-article2013
VAWXXX10.1177/1077801213513857Violence Against WomenSzilassy et al.
Article
Outcomes of Short Course Interprofessional Training in Domestic Violence and Child Protection
Violence Against Women 19(11) 1370–1383 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1077801213513857 vaw.sagepub.com
Eszter Szilassy1, John Carpenter1, Demi Patsios1, and Simon Hackett2
Abstract The interrelationship between domestic violence and child protection is well established, yet deficiencies in interprofessional collaboration have been reported and training is advocated as a solution. This study evaluates the outcomes of short interagency and interprofessional training in domestic abuse. Participants’ attitudes and knowledge were assessed using a self-report scale and compared in a doublebaseline time-series design. Participants (N = 177) were recruited from a range of agencies in England. There were consistent, statistically significant improvements in participants’ attitudes, knowledge, and self-confidence between the start and end of course (p < .001). The long-term outcomes of training and the implementation of learning, however, remain uncertain. Keywords child protection, domestic violence, evaluation, interagency training, interprofessional education, interprofessional training
Introduction According to the citations database Scopus in April 2010, the most cited article in Violence Against Women was a review by Edleson (1999) on the overlap between child maltreatment and woman battering. Edleson argued that societal responses to these 1University 2Durham
of Bristol, UK University, UK
Corresponding Author: Eszter Szilassy, University of Bristol, Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK. Email: [email protected]
Szilassy et al.
1371
two forms of victimization had developed on “different tracks,” although there was substantial evidence that “very many children and adults in the same families are victims of abuse directed against them” (p. 149). More recently, a symposium in the journal stimulated by an article from Australia (Douglas & Walsh, 2010) re-examined the relationship between mothers, domestic violence, and child protection. Perhaps little has changed in the intervening 11 years. As one of the contributors (Hester, 2010) argued, it is as if domestic violence and child protection services, as well as family contact (visitation), existed on separate planets. This is self-evidently an important issue. From the perspective of child welfare services, exposure to domestic violence can have serious effects on children’s safety, development, and emotional well-being (Kitzmann, Gaylord, Holt, & Kenny, 2003); in the most extreme cases, it may put children at risk of serious injury or death. Yet, a naïve approach to protecting children without an appreciation of the nature of domestic violence can be dangerous; domestic violence is more than a “risk factor” for child abuse. Douglas and Walsh (2010), like many others before them, stressed the need for services to work together to support women and children caught up in domestic violence. The recognition of the co-occurrence of family violence and child abuse has highlighted the deficiencies of interprofessional collaboration in the area of child protection (e.g., Mills et al., 2000; Ward & Peel, 2002). Douglas and Walsh (2010) concluded that the failure to recognize and identify signs of domestic violence, and the particular power dynamics associated with it, may have a significant impact on child welfare workers who may implicitly, if not explicitly, believe that mothers are responsible for putting an end to the violence. Furthermore, it was suggested that some women may be faced with an ultimatum either to leave their partner and keep the children or stay and lose them. Humphreys (2010) commented that the consistency of these findings with previous research indicates that the problems are structural, going beyond the attitudes and practice of individual workers. Similarly, too narrowly or inaccurately identifying the type and cause of domestic violence, or focusing only on micro-level factors and denying the importance of macro-level characteristics, may expose victims to further risk (Button & Payne, 2009). In England in 2006, detailed policy and practice guidance was issued by the government departments responsible for health and children’s welfare, emphasizing that “Everyone working with women and children should be alert to the frequent interrelationship between domestic violence and the abuse and neglect of children” (HM Government, 2006, Sec 11.45). The guidance strongly advocated an interagency approach involving the police and health and welfare professionals, and stressed the contribution of specialist domestic violence services (Sec. 11.48). Nevertheless, lack of knowledge and shared understanding of domestic violence and child protection protocols and procedures have been identified as major reasons for the limited involvement of these specialist services in England (Cleaver, Nicholson, Tarr, & Cleaver, 2008). Finally, child protection workers’ lack of confidence in intervening in situations of domestic violence has serious implications for ensuring the safety of mothers and children. Cleaver et al. (2008) argued that interagency training
1372
Violence Against Women 19(11)
can promote an understanding of the roles and responsibilities of professionals working in different organizations, their different thresholds for services, the legal frameworks within which they work, and issues surrounding confidentiality and information sharing. It will also provide opportunities to develop inter-agency networks, increase levels of trust, and provide insights into the philosophy and work of each other’s organizations. (p. 16)
The authors, however, did not provide evidence to support this contention.
Evaluations of Training Although there have been numerous papers and policies advocating training on child protection and domestic violence (e.g., Buckley, Holt, & Whelan, 2007; Mills et al., 2000), those training programs whose evaluations have been published (e.g., Mills & Yoshihama, 2002) have focused on teaching child welfare professionals about domestic violence rather than interprofessional training about the relationship between the two issues. Furthermore, as a recent review by Collins, Kim, and Amodeo (2010) concluded, the evidence base for training in the field of child welfare is generally weak. For example, one evaluation used a pre–post design to evaluate a 2-day program on domestic violence for staff in a family support agency in the United States (Saunders & Anderson, 2000). At the end of the course, participants were more likely to say that they would provide assessment and brief interventions, hold the abuser responsible, substantiate emotional abuse of a child, and empathize with victims than at the start of the course. Participants also reported less likelihood of holding the victim responsible for stopping the violence and telling the woman that she must end the relationship. Unfortunately, participation in the evaluation was poor: Out of more than 300 attendees, matched responses at the start and end of training were available for only 36 participants, which seriously undermined the reliability of the conclusions.
Aims The aim of the present study was to contribute to the evidence base by evaluating the outcomes of short-course interagency training in England on domestic violence and safeguarding children (child protection). As explained below, these courses are intended specifically to address the interrelationship between these issues together with interagency and interprofessional collaboration. The research was part of a larger study of the organization, outcomes, and costs of interagency training undertaken jointly for the Department of Health and the Department for Children, School and Families in England between 2007 and 2009.
Study Sites and Training Courses In England, Local Safeguarding Children Boards (LSCBs) have a legal responsibility for ensuring that all health, local authorities, the police, and voluntary organizations cooperate to safeguard and promote the welfare of children in their area, including the
Szilassy et al.
1373
provision of interagency training (HM Government, 2010). The organizational contexts and mechanisms for providing the courses are described elsewhere (Patsios & Carpenter, 2010). Seven LSCBs in four regions of England collaborated in this study. The courses that are the focus of this article were open to any staff who had a frontline responsibility for the protection and safeguarding of children. Each course offered 20 to 25 places and lasted for 1 day. The courses shared the same aims and learning outcomes (see below) but were delivered by local trainers with contributions from domestic violence workers and consequently, there were some minor variations in program design and teaching methods. The courses were described as follows: Participants will work together to gain an increased awareness of the links between domestic violence and child abuse and the impact on children, young people and family members. The trainers will highlight the need to promote earlier intervention and support to prevent risk situations. There will be a focus on interagency procedures and local developments. They aim to promote a greater understanding of how all agencies can communicate and work together to safeguard children and young people where domestic violence and abuse impacts on their well-being.
The learning objectives were defined as being able to •• Review definitions of domestic violence •• Reflect on the incidence of domestic violence locally and nationally •• Investigate the assessment process and good practice guidance in relation to domestic violence and child protection •• Develop ability to assess risk in relation to children who are in families where domestic violence is prevalent •• Gain greater understanding of the interagency approach to working with families who have experienced domestic violence •• Develop ideas to improve their own practice •• Identify ways to keep themselves safe. The courses all used interactive learning and teaching methods as well as presentations of case studies drawn from child abuse inquiries, research findings, and statutory guidance. They included videos of parents and children talking about the effects of living with domestic violence. Plenty of time was allowed for discussion and exploration of personal attitudes to domestic violence. Participants were asked to draw on their own experiences of multi-agency work, trying to identify the strengths and challenges of working interprofessionally, including the different philosophies and practice orientations of their agencies. Participants were invited to share where their agency featured on a flowchart illustrating the process from referral to de-registration on the statutory child protection register. This was followed by a quiz based on local procedures relating to child protection. Participants worked together in mixed interprofessional groups and were allowed to consult a local procedures manual to help identify the answers. The contribution of different agencies to assessment and intervention planning was emphasized.
1374
Violence Against Women 19(11)
Interactive sessions were interspersed with role-plays and practical communication exercises, for example, on how to talk to clients/patients about abuse. Informal opportunities to network over lunch and tea breaks were an important part of the program.
Method Research Design The evaluation used a repeated-measures design with a double baseline. Successful applicants were asked to complete the questionnaire at the time they registered for the course (T0), 6 weeks before the start of the training. They completed it again at the beginning of the course (T1) and again at the end (T2). They were subsequently followed-up 3 months later (T3). This design aims to test the hypothesis that, in the absence of any training intervention, there would be no change in mean total scale ratings between T0 and T1. If at T2, there was an improvement in mean scores compared with T1, this could then be attributed to the training intervention, with all other factors held constant. Because data were collected from 10 courses in different parts of England, it was possible to assess the outcomes for each independently. If the effects of the training intervention were consistent, this would strengthen the claim that they were associated with the training intervention, rather than some confounding factor.
Measures A demographic questionnaire was constructed requesting information about age, gender, ethnicity, profession, service experience, and reasons for attending the training course. A search of the literature identified a self-report scale used to evaluate the outcomes of a short course for dentists in England (Warburton, Hanif, Rowsel, & Coulthard, 2006). This had been adapted from questionnaires used in previous evaluations of professionals’ attitudes toward, and knowledge of, domestic violence (Cann, Withnell, Shakespeare, Doll, & Thomas, 2001; Maiuro et al., 2000; McCauley, Jenckes, & McNutt, 2003). With the help of two experts on domestic violence and reference to the course learning objectives (stated above), 15 relevant items were selected. To these were added additional items focusing on the effects of domestic violence on children and knowledge of relevant child protection policies and procedures and confidence in their use. The statements were presented alongside 5-point Likert-type scales, and respondents were asked to indicate the strength of their agreement (strongly agree– strongly disagree). Eleven of the 28 statements were designed for reverse scoring to reduce potential response bias. A first draft of the questionnaire was piloted with a class of 16 students undertaking a postgraduate course in social work. The test–retest reliability was assessed by comparing ratings made at the beginning and end of the class. There were no statistically significant changes in mean responses to any of the items, and overall scores at both time points were highly correlated. The new Domestic Abuse and Safeguarding Children (DASC) scale comprising 28 items was then piloted with participants on an
Szilassy et al.
1375
interprofessional training course on domestic abuse and safeguarding. The internal reliability of the draft scale was assessed again and the scale showed no inconsistencies. The DASC scale showed statistically significant changes in responses before and after the course intervention. The 28-item version of the scale used in the study is presented in Table 1 below. The reverse-scored items are indicated.
Procedures Following registration for each course, participants were sent an invitation to take part in the evaluation, together with an information sheet explaining how confidentiality would be ensured, along with the T0 questionnaire, which they were asked to complete and bring with them to the first day of training. These procedures were approved by the relevant university research ethics committee (institutional review board). The questionnaire was administered again by the course trainer at the start of the training (T1), following the introductions and before any training took place. At the end of the training, the second questionnaire was distributed (T2). Participants were asked not to confer. Responses were placed in an envelope and returned to the course administrator who forwarded them to the research team for data input. Three months later, participants were emailed the questionnaire again by the course administrator and asked to complete them once more. The research team had no direct contact with the course participants at any time.
Participants One hundred seventy-seven staff out of an approximate 250 (71%) elected to participate in the evaluation, and 155 provided complete demographic data. A very high proportion (92%) were White women. Most (89%) had between 1 and 5 years service experience. In total, 70 (45%) were social workers or family support workers, 45 (29%) were nurses and midwives, and 11 (7%) were teachers. The remaining participants included doctors, community workers, probation officers, and counselors. Almost all (90%) were voluntary participants; the remainder had been instructed to attend by their line manager. Ninety-eight participants in the evaluation (55%) returned pre-course (T0) questionnaires. However, only 26 (15%) responded to the follow-up questionnaire. Reminders were not permitted by the ethics committee, and these results have been discounted.
Results In general, there were no statistically significant differences between respondents according to their demographic characteristics at the time points T0, T1, and T2. The internal reliability of the scale (Cronbach’s α = .7) was acceptable for exploratory research of this nature. Principal components analysis, the scree plots and analysis of item loadings suggested that the scale comprised four factors accounting for
1376
Violence Against Women 19(11)
Table 1. Domestic Abuse and Safeguarding Children Scale Item Means at T1 and T2 (Wilcoxon Test).
1 I feel comfortable asking clients about domestic abuse 2 I have clients whose personalities cause them to be abused 3 Abused women should leave their partners 4 It is not my place to interfere with how a couple chooses to resolve conflicts 5 Separation will not put women and children at greater risk of further abuse 6 There are strategies I can use to help “victims” of domestic abuse change their situation 7 I understand how my own experiences may influence my capacity and willingness to engage with issues of domestic abuse 8 Women experiencing abuse are deeply ashamed 9 Mothers in abusive relationships cannot be expected to have their children’s welfare as their top priority 10 I feel confident in talking to perpetrators about domestic abuse 11 Domestic abuse may be associated with just about any physical complaint I see in my practice 12 I have a good understanding of local information-sharing policies for domestic abuse 13 Babies under one will hardly be affected in their health when they witness domestic violence 14 Abused women should leave their partners, whatever the circumstances 15 In assessment of risk to a child, you should take into account differences in cultural norms in the acceptability of violence
T1
SD
T2
SD
Z
p (twotailed)
3.4
1.01
4.0
0.78
−6.295
