(from 1/10/10 onwards)

Responsibility for the overview of implementation of violence and abuse mental heatlh policy was transferred from the National Team to each Strategic Health Authority Mental Health Leads as at 1/4/10 but they are not responsible for ensuring trust access to and delivery of the one day sexual abuse training course. Therefore there are a number of resources available to facilitate trusts’ implementation of the policy and delivery of the training course to their staff.

a) Fundamental principles

• Establishing violence and abuse as core business is challenging for organisations and clinical staff but eminently ‘doable’ as demonstrated by the pilot implementation process. It is far preferable to take sufficient time for thorough planning - and ensuring the quality of the staff training which flows from this – rather than to merely adopt a ‘tick box’ approach. This will ensure that the process is genuinely qualitative in nature.
• It underpins and facilitates a range of priorities that trusts are currently tackling, not merely an ‘add-on’ eg improvement of inpatient care; compliance with the Equality Act 2010; Safeguarding Children and Adults; revised Care Programme Approach; suicide prevention; personalisation.
• Disclosures don’t suddenly overwhelm clinicians, they build slowly as more staff receive the training giving them time to build their confidence and clinical expertise.
• Clinicians shouldn’t feel that they need to have ‘all the answers at their fingertips’, they won’t have and shouldn’t have. They need to focus on their relationship with their clients rather than the abuse itself; to convey compassion; listen intently to, and learn from, what their clients are saying; empower them to take control of the pace of their recovery process.
• This process does not increase referrals to Psychological Therapies as often assumed. In trusts who are further along the implementation journey, as the multi-disciplinary teams take clinical responsibility for meeting the needs of survivors in their care, so referrals for formal therapy recede; where they do occur, they are more specific in focus.
• Most importantly, placing equal emphasis on the causes and symptoms of mental ill health facilitates correct diagnosis and genuine needs-led care and treatment and, in the longer term, will greatly diminish survivors’ long term reliance on secondary care.

b) Planning for implementation

i) Putting the building blocks in place

There are as follows:

• insert abuse question in assessment documentation - “Have you experienced physical, sexual or emotional abuse at any time in your life?”;
• identify trainers and provide them with ‘protected time’ to be adept at course delivery;
• provide effective staff support and supervision; o enable staff, who are survivors of abuse, to access confidential counselling;
• establish staff opportunities to develop their clinical practice; o work in partnership with the voluntary sector;
• embed in clinical audit procedures;
• establish, when required, survivor groups;
• ensure the implementation process complies with the Equality Act 2010.

For those trusts who are have not yet started implementation, it is recommended that the trusts’ Senior Violence and Abuse Leads refer to the Best Practice Guidance for Planning Purposes which outlines

Section One: First steps

Section Two: Building blocks to be in place before commencement of staff training.

Section Three: Building blocks to plan for.

Section Four: Underpinning themes (ongoing).

ii) Resources for specific building blocks

Delivery of the sexual abuse training to staff

Trusts have the opportunity to invite an independent observer - at no cost - to evaluate one of the training sessions, give ‘on the spot’ verbal feedback to the training team followed by a confidential written report to their Violence and Abuse Lead and said Training Team. This could serve as a valuable supplement to trusts’ internal quality assurance process. If you are interested in taking advantage of this opportunity, do not delay as there are a limited number of visits available and they will be dealt with on a ‘first come, first served’ basis. Contact:

Jennie Williams, Inequality Agenda Limited, 4 Court Street, Faversham. Kent, ME13 7AW Email: info@inequalityagenda.co.uk Telephone: 01795 597744 / 07792 707896.

Continuing professional development (CPD)

Here’s the specification for the Multi-Agency Practice Development Forum on Sexual Abuse referred to in Section 3.1 of the Trust Checklist, Continuing Professional Development (CPD).

The following DVDs are also highly recommended:

‘Not Mad or Bad but Traumatised’, affecting testimonies of women and men survivors of child sexual abuse (45 minutes). Access free of charge from CiSters, PO Box 119, Eastleigh, Hampshire SO50 9EL, telephone 02380-338080 (leave message on ansaphone) or email admin@cisters.org.uk. Orders should be directed through the Chief Executive’s office.

Jake’s Justice, a powerful, explicit DVD (with Resource Book) about the sexual abuse endured by a man with learning disabilities who lives in a care home. A Sunny Arts production, order online: www.sunnyarts.co.uk, by email info@sunnyarts.co.uk or telephone 01273 596222 (£44-00 plus £5 p&p).

Someone to watch over me, a moving drama film about an older woman in the early stages of dementia who is being abused by her son-in-law. Order from Lincolnshire County Council by email: safeguardingadults_training@mouchel-lincoln.com or telephone 01522 550926 (£100-00 incl p&p).

Establishing survivor groups if and when required

If any clinicians are considering establishing survivor groups, they may be interested in consulting the following New Horizons framework for a psycho-educational survivor developed by Heather Morfett and Lorna Coulson, Sexual Abuse Team, Plymouth NHS Trust

iii) Addressing potential resistance to routine enquiry

Whilst resistance to the principle of routine enquiry of abuse in assessments has greatly diminished, if this is encountered to any extent in individual trusts, Trust Leads may find the following documents helpful:

Useful responses to routine enquiry ‘doubters’

Why, when and how to ask about childhood abuse (Read J, Hammersley P & Rudegeair T, 2007).

c) Delivery of staff training course in child sexual abuse:

Materials for trainers

There are a number of materials/resources (outlined below) relating to the one day training course in child sexual abuse - to equip staff to conduct routine enquiry in all mental health assessments; respond appropriately to disclosures and provide effective ongoing support to survivor of abuse in their care.

These are designed for:

• New trust trainers to equip them to deliver the course effectively.
• Existing trust trainers if they need to revisit the course - in its entirety or specific sections.
• Lecturers in the higher education sector to assist them: - in the incorporation of sexual abuse issues into the pre-registration curriculum - for all mental health disciplines, and/or - in the delivery of the one day course as it stands. In addition, the course has been revised - in terms of sequence and content (including tailoring for staff who work with adults with learning disability services) - to further facilitate the efficacy of the cascading process.

The National Mental Health Development Unit (NMHDU) is the agency charged with supporting the implementation of mental health policy in England by the Department of Health in collaboration with the NHS, Local Authorities and other major stakeholders.