Sexual Crime Strategy - Scoping and Mapping

Services for Victims and Survivors of Sexual Crime in Hampshire: Mapping and Scoping Document

September 2015

Office of the Police and Crime Commissioner, Hampshire and the Isle of Wight

Daphne Ingham Sitra Associate

Contact us

Email

Office of the Police and Crime Commissioner, Hampshire and the Isle of Wight, St George’s Chambers, St George’s Street, Winchester, Hampshire,

opcc@hampshire.pnn.police.uk

SO238AJ

Telephone 01962 871595

CONTENTS 1

Introduction and Purpose of this Document ........................................................3

2

Executive Summary ..............................................................................................10

3

Summary of Initial Recommendations ................................................................17

4

Commissioning Framework .................................................................................19

5

Victim/Survivors of Sexual Crime: Volume and Profile .....................................22

6

Independent Sexual Violence Advisor (ISVA) Services.....................................24

7

Specialist Rape and Sexual Assault Services, Including Counselling ............ 37

8

Treetops: the Sexual Assault Referral Centre (SARC) ...................................... 50

9

Missing, Exploited and Trafficked People ..........................................................53

10 Female Genital Mutilation.....................................................................................66 11 Prevention and Education ....................................................................................76 12 Multi Agency Partnerships ...................................................................................83 13 Further Information and Contact Details ............................................................89 Appendix 1: Maps .........................................................................................................90 Appendix 2: Who Commissions What? ......................................................................91 Appendix 3: Reported Crime Figures: Numbers And Geography............................93 Appendix 4: ISVA Services: Training, Management, Caseloads, and Kpi’s ............ 98 Appendix 5: ISVA Provision: Recommendations Of 2015 ISVA National Audit.... 102 Appendix 6: ISVA Services: Needs Mapping - Client Groups.................................103 Appendix 7: Specialist Counselling Services: Training, Accreditation, Standards, Caseloads, and KPI’s ..............................................................................107 Appendix 8: Specialist Counselling: Needs Mapping Detail................................... 109 Appendix 9: Tables Showing Current Specialist Sexual Crime Counselling Services In Detail ........................................................................................................112 Appendix 10: Details From Medaille Trust (Slavery/Trafficking) ............................ 116 Appendix 11: Gap Analysis: Specialist Counselling ...............................................119 Appendix 12: FGM: Health & Social Care Information Centre Statistics .............. 123 Appendix 13: Further Details of Multi-Agency Partnerships .................................. 125 Appendix 14: Directory of Organisations Providing Specialist Services .............. 128 Appendix 15: Sitra.......................................................................................................135

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1 INTRODUCTION AND PURPOSE OF THIS DOCUMENT 1.1 Purpose and Status of this Mapping and Scoping document Purpose and status of this document The Hampshire Police and Crime Commissioner’s 2014-17 Commissioning Plan identifies sexual abuse (alongside domestic abuse) as one of its eight core themes.

To address this, the Police and Crime Commissioner, as a commissioning partner, requires a baseline understanding of “where we are now” across the whole area, in terms of existing and emerging needs, services, models of good practice, and gaps in service provision. The OPCC commissioned Sitra 1 to research and capture this overview, with an emphasis on qualitative, victim/survivor-focused input alongside key facts and figures, in order to support the development of the new OPCC Sexual Crime Strategy for October 2015 to March 2018.

This in-depth Mapping and Scoping document, current at summer 2015, describes the specialised support to victim/survivors of sexual crime across the Hampshire Police and Crime Commissioner’s area of operation: the county of Hampshire, and the three Local Authorities of Portsmouth, Southampton, and the Isle of Wight.

The document that follows is not a formal report; rather it is a record of the work and its findings, including  The research undertaken  The research findings  Analysis of the context and some of the implications of those findings  Those initial, draft recommendations that emerged throughout the process.

The brief was not to produce a “polished” report for publication, but to provide a primary source of intelligence and information for the development of the Sexual Crime Strategy. This document draws the information together in a form that has successfully been used for consultation with the Sexual Crime Reference Group (See Paragraph 2.6 below) and can be used for reference during the implementation of the Strategy.

The Sexual Crime Strategy, developed subsequently, has refined some of these findings and recommendations. Therefore, where differences occur between the two documents, the published Sexual Crime Strategy takes precedence.

1.2 What the document includes, and how it is structured This is a long document. Its subject matter is an area of hidden, unreported crime.

Much remains unknown or is little-understood beyond those services that specialise in sexual crime. Responses to sexual crime have evolved on a reactive basis, resulting in a complex, fragmented picture. Some areas, for example trafficking and FGM, are relatively new, so less information is available, both on needs and on best practice in supporting victim/survivors.

The brief and scope of the exercise has been adjusted at key stages since the outset to clarify “what’s in and what’s out”, and to determine the priority lines of enquiry for the research.

1

Details of Sitra are at Appendix 15 Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 3

The document starts with background and context, (Sections 3 - 5), then each of the following six Sections (6 to 11) considers a core area of need and/or provision.

Finally, in a separate section we map out Multi-Agency Partnership arrangements, which will be a fundamental element of the strategic response required.

Further background detail is provided in 14 Appendices, including a listing of the organisations identified during the project that are dedicated to working in the areas of sexual violence (at Appendix 14).

We have used green-shaded boxes for quotations and other items that serve to illustrate the subject and bring it to life. A pink shaded table appears at the end of each section, containing the recommendations drawn from that section.

Qualitative, victim/survivor-focused information is given alongside facts and figures, on the following themes: Main research themes, by section heading in the document Theme Available data on sexual crime Key target groups and service models Examples of local prevention initiatives Strategic systems and networks

Headings

Section #

Victim/survivors of Sexual Crime: Volume and Profile Independent Sexual Violence Advisors (ISVAs) Specialist Rape and Sexual Assault services, including counselling and support Missing, Exploited and Trafficked People Female Genital Mutilation

9 10

Prevention and Education

11

Commissioning Framework

4 12

Multi-Agency Partnerships Appendices 1-13 give additional detail.

5 6 7

We have opted to use the term “victim/survivor”, to acknowledge the problematic nature of “victim” terminology, and the term “sexual crime” to describe the core strategic issue that is the focus of this exercise.

Points of emphasis Decisions on emphasis have been necessary to shape this mapping and scoping exercise and to maintain it as a manageable piece of work. We recognise that some of these decisions may have led to under-emphasis of important issues, and acknowledge that some lack of balance may be inevitable.  Overlapping issues: The report does not explore several interrelated issues, including o Domestic Abuse o Exploited sex workers o Specific links between trafficking and child sexual exploitation.  Children and Adults: We acknowledge that, relative to vulnerable adults, there is a very high level of policy attention and current work in the field of child sexual exploitation/abuse. We acknowledge the associated risk of under-emphasising the needs of those victims/survivors who are above the age of consent.  Detailed mapping of certain types of service: We report in more detail on: Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 4



o Independent Sexual Violence Advisors, and o Specialist sexual crime counselling.

“Missing Exploited Trafficked”: This terminology, already in use in panHampshire partnerships, has proved useful in drawing together a number of related themes under a single broad heading that encompasses sexual exploitation and modern slavery.

1.3 Acknowledgements The Police and Crime Commissioner and Sitra are extremely grateful to everyone who has contributed to this research, many of whom have devoted considerable time and effort to this work, providing us with detailed information and expert advice, and to the “virtual” Sexual Crime Reference Group that has made a major contribution by reviewing, commenting on, and correcting earlier drafts of this document.

1.4 Support to cope and through recovery The Ministry of Justice Victims Code is part of the wider Government strategy to transform the criminal justice system by putting victims of crime first. As well as addressing the justice process connected with reporting a crime, a core principle of the Code is to support victims to cope and recover. Sexual crime can cause severe and long-lasting harm to victim/survivors, including depression, anxiety, posttraumatic stress disorder, drug and substance misuse, self-harm and suicide. When victim/survivors receive the support they need at the point they need it, they are more likely to be able to cope and take positive steps to recovery. It is important, therefore, that victim/survivors of sexual crime have good support and access to effective services at the time they seek help, whether or not they report incidents to the police.

“So much focuses on the justice process, but commissioners MUST commit to services to people whether they have reported or not. There will be growing waiting lists and a forever-unquantifiable number of unreported victim/survivors. Post Saville, and the ongoing big enquiries, will bring people out in droves and some helplines have seen huge increases”.

Fay Maxted, Chief Executive, The Survivors Trust – interviewed December 2014 A good service for victim/survivors of sexual crime should offer  Helpline services which offer quick, practical information and support  Advocacy, including ISVA  Clear procedures that ensure links to statutory safeguarding services  Emotional support including individual counselling and group work  Preventive work e.g. with schools and with the night time economy  Engagement with a range of diverse groups and organisations.

A joined up approach to the delivery of these services is required, for two main reasons. Firstly, it is beyond the remit of any single commissioner to fund this overall service, and secondly, an approach that encourages service integration should lead to improvements in the quality of responses to the victim/survivor.

1.5 Brief and Methodology The project brief Sitra was appointed in mid-2014 to assist the OPCC with the development of the sexual crime strategy. The provisional work plan has been refined at key stages.

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The final brief is summarised below, and this Scoping and Mapping document represents the completion of Stage 2:

Stage 1

Stage 2

Stage 3:

Support to develop Sexual Violence Strategy: Project Brief ISVA and Specialist Counselling Services: Detailed mapping and scoping of ISVA and specialist counselling services, with a focus on voluntary sector provision and partnership work. The brief included sourcing information as it became available on partnerships and on education and prevention. This first stage was launched at the November 2014 Victim Journey event described below at paragraph 3.7.

Additional research and completion of the Mapping and Scoping Document: in March 2015, following delivery of a Stage 1 draft, the OPCC commissioned Sitra to carry out additional research in the areas of Missing Exploited and Trafficked people, Female Genital Mutilation, Prevention, and multi-agency partnerships, and to add these to the Stage 1 findings to compile this full document.

Based on these two stages, the OPCC commissioned a further, final stage: to draft the Sexual Violence Strategy October 2015-March 2018.

Steering Group (commissioning) and Virtual Reference Group The OPCC has convened a Sexual Crime Project Steering Group of commissioners and partners in the sexual crime field, which meets at intervals to collaborate, prioritise and plan action; this group maintains an overview of the project and will work in partnership to implement the new Sexual Crime Strategy.

A “virtual” Reference Group of over 35 individuals representing a range of providers, practitioners, commissioners, and victims/survivors came forward in response to an invitation at a Victim Journey event held in November 2014 (described below). This group provides an invaluable “sounding board” for consultation by email.

Research methodology Sitra used the following research methods:  Desktop web research, used extensively throughout  A trawl of known specialist provider organisations in the OPCC area. The providers were identified by the OPCC and by a small group of recommended organisations, and cross checked against various listings. A web-based survey with a long list of questions was distributed to 12 organisations, to “fish” for mapping information. 11 replied, answering those questions that related to their own expertise and services, and the 12thorganisation was contacted and provided relevant information directly  Face-to-face interviews with 13 individuals and one team, representing ten organisations. These included all providers of Independent Sexual Violence Advisors (ISVAs) and three of the four specialist counselling services (the fourth being contacted by telephone and email). Additionally, one NHS team member was interviewed by phone  Two rounds of structured telephone interviews: o On good practice issues, with national bodies including The Survivors Trist, Rape Crisis England and Wales, SafeLives, and Limeculture and with commissioners in other areas o On Stage Two research (MET, FGM, prevention, and partnerships), with 12 individuals working within the OPCC area (commissioners, providers, and other stakeholders)  Regular updates and email contact with the OPCC Commissioning Manager to identify additional information and sources.

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Victim/Survivor engagement It was agreed in discussion with specialist providers that direct contact with people using their services would be inappropriate. The providers distributed a short questionnaire to victim/survivors on Sitra’s behalf, with a range of questions about their experience of finding, accessing and using the services. Just six responses were received, providing sample that is not large enough on which to base overall conclusions. The responses included a number of helpful individual comments.

Several members of the virtual reference group who are victims/survivors have provided very useful detailed responses to consultations.

1.6 Terminology “Victim” Terminology For the purposes of this exercise, we predominantly use the term “victim/survivor”.

“Victim” it is the term that the majority of statutory agencies use and understand, and is the term officially used in policies and legislation. However, it is important to acknowledge that this term is often laden with negative and/or disempowering connotations. Voluntary sector services and their clients promote, wherever possible, the use of terminology that recognises the empowerment models of working that they use.

“Victim” terminology 2 “…’victims’ are often believed to be either vulnerable, weak, and helpless; naïve and easily duped; or considered to be culpable for their own victimisation by being careless, negligent or exposing themselves to greater risks through their own behaviour.

“Such negative connotations create a label that few would wish to be associated with and it is of little surprise that self-acknowledgement of being a “victim” is often resisted. This has an impact upon three crucial decisions for someone who has experienced victimisation, whether to:  tell anyone (seek informal support)  report the crime (seek formal assistance)  seek help from specialist services (seek formal support). .. many non-statutory agencies eschew the term “victim” and prefer to use the word “survivor”… but this is not a term accepted by everyone.”

“Sexual Crime” and “Sexual Violence” We use the term “sexual crime” throughout, to provide a consistent description of the core issue that the Strategy seeks to address. Other terms in widespread use, such as “Sexual Violence”, and “Sexual Abuse” may be more appropriate in certain contexts, for example, where it is important to give a clear message to victim/survivors that the service is for them whether or not they ever report a crime.

The “Victim/Survivor Journey” Mapping and understanding the “Victim Journey” helps to place the victim/survivor at the heart of the criminal justice system, and individual victim/survivors at the heart of

2

From “A Strategic Assessment of support services for victims of crime in the South East”, Tapley& Stark, University of Portsmouth 2014 Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 7

support services. 3Hampshire OPCC has undertaken detailed work to map the Victim Journey locally and work is ongoing.

People who have experienced sexual crime have a distinct journey from other victims of crime generally. Many wait years and even decades to disclose the crime. The perpetrator is often known to both the victim/survivor and to the community to which the victim/survivor belongs. When the crime is disclosed, the victim/survivor faces scrutiny which may seem to question whether or not they ‘invited’ the crime.

Geographical terminology To avoid confusion, this document uses the term pan-Hampshire 4 throughout to refer to all four Local Authority areas: Hampshire County Council, Portsmouth City Council, Southampton City Council and Isle of Wight Council. This is the area covered by the Office of the Police and Crime Commissioner and by Hampshire Constabulary.

For individual Council issues we have used the name of the council or the place. We avoid using the word “Hampshire” on its own, preferring the term “Hampshire CC” for the County Council area and “pan-Hampshire” as above.

For District Councils, Borough Councils and Winchester City Council, which together form the 11 “second tier” councils in the Hampshire CC area, we have used the collective term “District Councils”.

Interviewees and Consultees This document sometimes refers to “interviewees” and consultees”. The interviewees are those people we interviewed for the research. The consultees are those members of the virtual reference group who commented on the first full draft.

1.7 Geography There are four Local Authority areas covered by Hampshire Police and Crime Commissioner. Hampshire CC, a large County Council, has 11 Districts and includes rural areas, significant market towns and population centres, and well-populated coastal areas adjacent to the two port cities. Much of the densely populated north is in commuting distance from London. The coastal area is also densely populated, including the maritime cities of Portsmouth and Southampton, both of which are Unitary Authorities. The Isle of Wight, only accessible by ferry, is governed by its own Unitary Authority.

Maps are provided at Appendix 1, showing the top-tier Local Authority and the District Council boundaries.

1.8 National crime trends Overall crime figures are reducing, reported by the Office of National Statistics as 7% down across England and Wales in the year to December 2014. However, total sexual offences in that year rose by 32%, with the numbers of rapes (26,703) and other sexual offences (53,559) being at the highest level ever recorded since the introduction of the National Crime Recording Standard in 2002/03. As well as

3

The complex journey for “generic” victims of crime is mapped in an interactive flowchart at http://icjs.port.ac.uk/Victims'ServicesMap/Victims'Services/story.html.

4 With apologies for this rather irritating term, which is not grammatically ideal. We have deliberately avoided using the word “County” to describe the OPCC area as a whole.

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improvements in recording, this is thought to reflect a greater willingness of victim/survivors to come forward to report such crimes. 5 The increase in reporting of sexual crime presents an opportunity to bring this crime out of the shadows. Aiding victim/survivors to cope and recover will improve their lives and also increase public trust that sexual crime is taken seriously.

1.9 Starting point: Victim Journey Day November 2014 The 2014 South East Strategic Assessment 6 remarked that: “…. a complex network of support services can exist in some areas, whilst the provision of services can be patchy or non-existent in others, leaving victims of crime exposed to a postcode lottery of service provision. This has resulted in the underfunding of some essential services, an inability to sustain successful initiatives and has created tensions between service providers, inhibiting them from sharing information and working in multi-agency partnerships in order to assist victims to cope and recover.”

Given this context, in November 2014, Hampshire OPCC and Hampshire Constabulary ran a Victim Journey Day, at the Police Training School in Netley, to discuss the journey taken by those who report rape or serious sexual assault. The aim was “to provide an arena for communication and networking between partner agencies, from the statutory and non-statutory sectors”. The objectives of the day, which worked through every aspect of the victim/survivor journey, were to:     

Improve safeguarding for victims Prevent repeat victims Support vulnerability Improve service delivery for victims by working better together Create a “virtual” reference group to support the development of the OPCC Sexual Violence Strategy.

The day was well attended by practitioners from across the pan-Hampshire area.

Themes highlighted on the day were:    

The victim/survivor focus - wrapping services round the person; listening to the victim/survivor and acting on what you hear Integration - Pooling together not only funds but people, organisations and expertise in order to make best use of what we have A wealth of information about service delivery, especially in terms of those victim/survivors who report a crime, as they report and subsequently Making services for victim/survivors of sexual violence available to those who have not and may never report the crime to the police.

5

http://www.ons.gov.uk/ons/rel/crime-stats/crime-statistics/year-ending-december2014/index.html 6 “A Strategic Assessment of support services for victims of crime in the South East”, Tapley& Stark, University of Portsmouth 2014: page 23 Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 9

2 Executive Summary This summary section has been compiled in order to help develop the main strands of the new Sexual Crime Strategy, outlining key points contained in the detailed document that follows.

2.1 Commissioning Framework 



Headlines The funding and commissioning framework for supporting sexual violence victim/survivors is disjointed and insecure. This compromises the organisational resilience and consistency that should characterise an effective service to victim/survivors of sexual violence.

The work of the Sexual Crime Project Steering Group, convened by the Office of the Police and Crime Commissioner, will seek to improve this position.

The research outlines how the (predominantly voluntary sector) provider market is operating within an uncoordinated funding framework, characterised by the use of short term contracts. This scenario presents risks to service effectiveness and organisational resilience, and ultimately, outcomes for victim/survivors.

The diverse and complex nature of the needs of victim/survivors strengthens the case for improving collaboration between commissioners and seeking efficient ways for organisations to work in partnership. In turn this underlines the key role that the Sexual Crime Project Steering Group will fulfil and the solution-focused approach required.

2.2 Profiling the needs of victim/survivors  

Headlines Reported sexual crime figures, rising sharply, are informative yet should be treated with caution as it is widely accepted that around 85% are unreported.

Further work may be needed to profile the needs of particular groups of victim/survivors.

There is a broad national consensus, supported by Home office figures 7 that approximately 85% of serious sexual crime is unreported. This leads to inherent grounds for caution in interpreting known figures, and a reliance (for better or worse) on evidence from providers. Provider information is helpful as an indicator of underprovision and underlying trends, and is a source of a wealth of qualitative information.

However, there is an underlying risk that where there is currently little data, and little or no provision for victim/survivors, (e.g. those affected by FGM), disproportionally few resources will be allocated.

There will be some groups where victim/survivors (such as men, or women who have experienced FGM) are even less likely to report than others. Where we can, we identify such groups and in some cases recommend further research.

Levels of reported sexual crime are rising sharply, both nationally and locally. We supply some local data, from the year 2014-15. Interviews with ISVA and counselling providers confirmed that they see a matching rise in numbers of victim/survivors 7

https://www.gov.uk/government/statistics/an-overview-of-sexual-offending-in-england-andwales Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 10

seeking help who have not (and may never) report the crime. The recent national focus on historic crime will be a partial explanation. It is not clear how many of these crimes, reported or otherwise, relate to sexual abuse or exploitation in childhood.

2.3 Provision of Independent Sexual Violence Advisors (ISVAs)      

Headlines There is under provision of ISVAs across Hampshire.

ISVAs across Hampshire have very high caseloads far in excess of recommended levels, and increasing numbers of referrals across the service.

ISVA services often disproportionately serve victim/survivors who have reported a crime and should be offered to all.

The geographical spread of resources is disproportionately uneven.

There is under-provision of, or absence of, ISVA services to children and young people (especially under-13s).

There are concerns that services do not or may not reach certain vulnerable groups of victim/survivors.

The brief required a comprehensive review of this element of service. Whilst nationally, the role is not completely defined and developed, there is available guidance on good practice. Commissioners elsewhere have produced standard specifications, for ISVA services, and this route is recommended for the OPCC and partners to consider. The mapping and scoping research outlines some of the recognised good practice requirements.

Current ISVA provision in OPCC area (June 2015): Summary Number of full time equivalent (FTE) ISVAs Just over 9.4 Number of ISVA posts 15 Number of ISVA providers 8 Number of voluntary sector providers include in the total 6 Proportion of the FTE capacity provided by voluntary sector 85% As it is vital to offer an ISVA service to victim/survivors whether or not they have reported, or intend to report, the crime, reported crime figures can only give very limited indications of true need. Nevertheless, reported crime trends are useful in considering some aspects of need, as are referral levels and caseloads. Crime figures help identify some key client groups to consider, and Appendix 6 provides more detail on these particular groups of victim/survivors.

We report the strong case for ISVAs, who often work alone or in small teams, to be managed by organisations with appropriate capacity and expertise, and the advantages to ISVAs in working alongside other services to sexual crime victim/survivors. We make some very approximate caseload-based capacity estimates at Appendix 4.

We found including evidence that ISVAs in the OPCC area operate with caseloads in excess of national recommendations. The mapping and scoping exercise highlights evidence of under-provision both locally and nationally, and notably in services to children and young people.

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2.4 Specialist Rape and Sexual Assault Services, Including Counselling Headlines  Specialist sexual crime counselling has been historically marginalised in the commissioning process, for example, its exclusion from “mainstream” NHS counselling and psychotherapy.  There is under-provision, a shortage of available referrals to counselling, and growing demand.  Whilst this unmet need is challenging to quantify in any meaningful way, we tried a crude method of calculating and illustrating overall potential need based on extrapolating from reported sexual crime figures and assuming potential take-up rates of specialist counselling.  There is marked under-provision of specialist counselling for children and young people, and services struggle to reach key vulnerable groups.  Specialist counselling should be offered to all victim/survivors whether or not they have reported, and where they have reported, pre-trial therapy should be offered.  There are misunderstandings amongst various stakeholders on issues of pre-trial counselling and disclosure, which should be addressed.  The diverse service portfolio offered by the specialist counselling providers, all locally based, has advantages in delivering effective services, and responding creatively to urgent individual need. However, this diversity contributes to inconsistencies in the overall service.  Services have good local relationships, and may benefit further from closer work with “mainstream” NHS counselling and therapy services.  Where, (for example) NHS clients are referred on to specialist counselling, victim/survivors may benefit if ways could be found for funding to follow the client.

Sexual crime counselling is a vital element of this specialist support field. Nationally, in terms of capacity to develop and support this specialism, the Government has recently recognised a growing workforce gap at a time of fast-growing need, and has funded a three year specialist training initiative. Appropriate pre-trial therapy is an important aspect of the specialism, for those who have reported a crime. Pre-trial therapy delivered by trained practitioners takes full account of the critical issues around what counsellors may or may not be required to disclose in court. The widespread misunderstandings around this issue should be addressed through commissioning, and via training and awareness programmes amongst teams and partners.

While “mainstream” counselling, or counselling targeted at other particular groups, has an important role to play, this is often a in a role of “triage” and onward referral to specialists, yet specialist providers are not necessarily adequately funded to be able to respond effectively.

We found a well-established “community of expertise”, with five voluntary sector organisations able to offer appropriate support, (four offering specialist counselling) albeit at a scale that is much constrained by funding issues. The review also covers one organisation that does not provide counselling, that is dedicated to supporting victim/survivors. This document profiles the varying portfolios of services offered by these five specialist providers, all of which are independent, locally based voluntary sector organisations.

We then analyse the counselling provision. Demand certainly exceeds supply, yet numbers are difficult to gauge. It is clear that there is uneven geographical coverage, with the Hampshire County Council area on the whole comparatively under-served in comparison to the rest of the pan-Hampshire area.

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There is a mixed picture regarding provision for certain needs groups. For children and young people, there is good local expertise, but this is limited to small-scale, localised services. Services for male victim/survivors are sparse and uneven.

2.5 Treetops: the Sexual Assault Referral Centre (SARC)  

Headlines The key role of Treetops, the SARC serving the whole OPCC area, with provides a valuable overall perspective.

Treetops confirms service gaps identified by others, and particularly highlights the negative impact of court delays on victim/survivors.

The document outlines the distinctive role played by this service, designed to respond quickly to the needs of all sexual violence victim/survivors in a crisis, which covers the whole of the OPCC area, has long-term (5 year) core funding and is commissioned as a specialist service by NHS England. Numbers of referrals, around 450-550 per year, appear to be increasing.

Treetops highlighted many issues notably shortages of available specialist counselling and ISVA referrals, the negative impacts of long (and growing) court delays, and the gap in ISVA provision for under-13s.

2.6 Missing, Exploited and Trafficked People (MET) Headlines  The research identified concerns around how the ongoing funding squeeze is affecting front-line responses to Child Sexual Exploitation/Abuse. Resources are projected to shrink further, and onward referral options, such as youth services, are also shrinking or closing. Yet paradoxically, as demand and awareness grows, services related to child sexual crime may also grow in relation to other services.  Responses to the needs of vulnerable adults at risk of exploitation differ, due to consent and other issues, and require further capacity building, resource, and partnership work.  Further work is needed (and planned) to understand the prevalence of trafficking/slavery in relation to sexual crime, and to develop the specialist response.

For the purpose of this document, “MET” refers to several groups of victim/survivors and people at risk, including:  Children victim/survivors of, and children who are vulnerable to, sexual crime  Adult victim/survivors of and those vulnerable to, sexual crime  Victim/survivors of modern slavery, itself linked to sexual exploitation.

Our findings on prevalence and need were characterised by the hidden nature of sexual crime, and highlighted the necessity to address it through close operational partnership work. We were frequently advised that numerical data, although useful, will only represent the “tip of the iceberg”. Hampshire Constabulary provided panHampshire figures of known children at risk, and we explored this avenue further with Hampshire County Council. The constraints of the project did not allow this exercise to cover all four top-tier Local Authorities.

In terms of children, the statutory position means that it is (comparatively) easier to assess the risk of a child under 16 becoming/being a victim/survivor of sexual crime Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 13

than it is once an individual has reached the age of 16. Issues around consent present challenges in terms of identifying vulnerable adults at risk of sexual exploitation and/or determining that a crime is likely to have been committed.

We found a small group of services that are specifically designed to meet the MET “sub groups” of need. However, much of the provision required (especially therapeutic provision and ISVA services) is within the areas of expertise of the organisations already identified as sexual crime specialists. Funding constraints mean they are often unable to respond in a timely way, or fully develop the specialisms required. There is therefore an opportunity to build provider capacity.

Regarding trafficking, hard evidence of prevalence and need is scarce. There are acknowledged links with the issue of sex workers who are exploited. Our research supports the rationale for the recent OPCC grant award to the new Anti-Slavery Partnership.

2.7 Female Genital Mutilation      

Headlines FGM is an extremely hidden issue with a profile that is different and distinct from other “victim/survivor groups”.

Although FGM has been illegal for ten years, practical progress has been slow on enforcement, prevention, and how to support victim/survivors. Campaigning has led to more decisive Government action and guidance in the last year.

The major safeguarding issues are increasingly recognised, and detailed Department of Health guidance has now been issued.

The immediate focus in pan Hampshire is on training, awareness, capacity building, and prevention.

It will be important to continue monitoring the national picture.

A local research project with affected diaspora communities has produced valuable local intelligence and recommendations for further development.

This area of sexual violence, exclusively concerning women and girls, is among the most hidden of sexual crimes. Reporting of a crime is extremely rare, and prevention, education and awareness stood out locally as the most prominent issues. Best practice in supporting victim/survivors is only beginning to develop nationally. Current priorities include extensive training and awareness, further work with diaspora communities, and service development among existing organisations to add skilled capacity to respond both directly and in partnership.

We found a number of recent local and national training initiatives and identified national work led by children’s charities including a national helpline.

FGM has been illegal in the UK for many years and 2003 legislation clarified that it is a crime to take girls abroad for FGM whether or not it is lawful in that country. More recently, the pressing need for a national action plan came to the fore though the 2014 Parliamentary Home Affairs Select Committee. 8 New data and multi-agency guidance is emerging via the Department of Health. Maternity services are at the front line of identifying and recognising the incidence of FGM and young children who may be at risk, and new mandatory data reporting requirements are in force for NHS clinicians. Current figures from Hampshire hospitals start to give a feel for the local

8

Serious Crime Act also worth checking, likely to be of relevance (Late suggestion by ref group member) Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 14

distribution and prevalence of FGM. The key role of the NHS underlines the critical importance of partnership working in relation to FGM. Locally, a small, charitably-funded partnership research project working with affected diaspora communities in Portsmouth/Southampton has recently published its findings. Although attitudes within the communities are mixed, many would welcome more support to help eliminate the practice, and there is a pressing need for information including on where to seek help and support. More resource, over a longer time period, is recommended to work towards meeting those needs. In the meantime, small-scale, short-term ongoing work within these affected communities has been commissioned.

2.8 Prevention and education   



Headlines The mapping exercise captured a range of initiatives (not a full-scale trawl), and local specialist providers are all active in this field.

Early intervention with children and young people is a need emphasised across all groups and specialisms, and may influence potential perpetrators as well as empowering those who may be vulnerable.

Maximising opportunities for evaluation and feedback, and maintaining a watching brief on new work by national charities (who have published academic evaluations), could help improve understanding of the effectiveness of prevention initiatives.

The document considers how to identify the most effective ways to engage with schools.

The brief was to gather examples found of local, current education and prevention initiatives, with no expectation that we would carry out a comprehensive trawl of achieve complete coverage. The examples are presented in three broad categories of prevention: Category: For example:

Universal Awareness campaigns

Focused Schools programmes

Targeted Work with particular vulnerable groups

As this project has a strong focus on specialist providers, we naturally heard most about those initiatives where those providers are actively involved.

Section 11(Prevention & Education) considers some of the issues involved in working with schools, and suggests that existing relationships between schools and specialist organisations could be built on, in preference to supporting fragmented and timeconsuming efforts to establish new relationships.

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 15

2.9 Multi-Agency Partnerships 

  

Headlines Having sought agreement from key partners at a senior level to direct future ‘sexual crime related work’ around the outcomes of this Strategy, the Sexual Crime Project Steering Group should identify and encourage relevant partners/groups to take ownership of certain recommendations within this strategy.

Partnership work should link to the statutory Local Safeguarding Children Boards and Local Safeguarding Adults Boards, their joint groups that cover all four Local Boards, and their five MET Sub Groups (again, individual and joint).

Work with the new Hampshire Anti-Slavery Partnership in relation to trafficking and sexual exploitation will be an important strand of the Strategy.

The OPCC and the Steering Group should maintain awareness of the roles of the additional partnerships detailed in Appendix 13, when considering issues of relevance to the work of those partnerships.

In the initial stages of the project, as this element is integral to each area of work, we had planned to list relevant partnerships in each section of the mapping document.

This proved impractical due to the multiple and overlapping roles of the partnerships, and the need to understand detail of how each key partnership works. We therefore decided to map this out in Section 12 of the document, which describes those partnerships with a leading part to play, and to provide a further set of relevant partnerships at Appendix 13.

The statutory Safeguarding Boards for children and for adults, including their associated pan-Hampshire structures and MET sub-groups, emerged as core structures to engage with in relation to sexual crime, alongside the new panHampshire Anti-Slavery Partnership. All these groups have, or directly link to, a panHampshire strategic overview. A diagram in Section 12 shows the current structure of the five MET sub-groups of the Safeguarding Children Boards.

Multi-agency working will change over time. The partnerships listed in Appendix 13 all have key roles to play, and some may become increasingly involved in the sexual crime agenda, for example, the Health and Wellbeing Boards, or the pan-Hampshire Community Safety Alliance.

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 16

3 SUMMARY OF INITIAL RECOMMENDATIONS These tables are drawn from the detail given at the end of each section of the document. The initial recommendations are suggestions only. Please refer to the Sexual Crime Strategy for the final Action Plan priorities.

Summary Recommendations Table 1: Overarching, long-term recommendations #

Overarching, Long-Term Recommendations

1

Support all victim/survivors of sexual crime

The new strategy should support victim/survivors whether or not they report the crime to police.

2

Increase capacity, responsiveness and flexibility

3

Address service inconsistencies

4

Promote service integration

5

Sexual Crime Project Steering Group

6

Organisational resilience: Voluntary Sector Providers

7

Work in partnership

Adopt a long-term aim to address under-provision for victim/survivors across all services, and to deliver services that are available at the point of need, to victim/survivors wherever located pan-Hampshire.

Coordinate and ideally, unify Outcomes Frameworks and Service Specifications. Consider developing, service by service (starting with ISVAs) a unified Service Specification for support to victims/survivors of sexual crime.

Adopt a core principle of seamless, accessible services to victim/survivors. Consider co-locating certain services, and using unified outcomes frameworks and service specifications to encourage and require better linkages.

5a: The OPCC should continue and strengthen its work through an Action Plan with the Sexual Crime Project Steering Group of commissioners of services and other partners. This group should make links with other relevant partners and groups to promote and progress recommendations within this strategy.

5b: Develop coordinated and joint commissioning in accordance with this strategy’s recommendations, by identifying specific grant opportunities, and, wherever feasible, incorporating longer contract periods in jointlyfunded services.

Use the commissioning process to foster the high level of organisational resilience required to deliver effective services - for example, through joint commissioning of ISVAs with contracts, developing an agreed outcomes framework, considering how KPIs will be used when developing data requirements.

Work throughout with established partnerships notably the Safeguarding Boards and their sub groups.

Summary Recommendations Table 2: by service type or needs group Actions and timescales are to be developed separately.

Summary of the detailed recommendations that appear at the end of each section 4 to 12  Work with others to grow ISVA provision. Where possible this should begin with a focus on comparatively under-served areas ISVA services: and on children/young people Section 6  Develop unified service specifications and standards for young people’s and for adult ISVA services Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 17

   

Specialised Sexual Crime Counselling: Section 7

Specialist providers: Section 7

        

Criminal  justice system(CJS): Sections 7 and 8   Missing Exploited Trafficked Section 9

   

Female Genital Mutilation: Section 10



   Prevention and Education: Section 11

  

Grow capacity to support target under-served groups Consider co-location issues and flexible cover Strengthen mental health and substance misuse linkages Strongly promote the ISVA role within the criminal justice system.

Increase overall volume and capacity Develop a counselling section for the Standard Specification Address under-provision - children, families, men, LGBT people Support providers to improve capacity and expertise in serving particular groups including people with Learning Disabilities Address geographical inequities Provide timely pre-trial therapy delivered by trained counsellors Cultivate specific collaborations e.g. with NHS provision Consult on how best to rationalise information on how to access counselling e.g. via a centralised information point.

Recognise the contribution of providers’ service portfolios, e.g. creative provider responses that help manage demand for overstretched counselling services (support groups, peer support, “triage” to prioritise the most urgent, help-lines).

Support action to help address negative impacts on the “Victim/Survivor Journey” that arise from the length of the court process, for example, by providing evidence of these impacts to decision makers Promote awareness for Criminal Justice teams, incl. court staff.

Prioritise partnership work, especially where associated with the Safeguarding Boards (adults and children), and MET awareness, training and development across all sectors Develop further capacity within existing specialised services to meet the needs of MET victim/survivors Consider further collaborative work to understand need, e.g.: o Children “at risk” in each of the 4 Local Authorities o Trafficking linked with sex workers who are exploited Utilise investment in the Anti-Slavery Partnership to better understand needs of trafficked people and to grow awareness.

Partnership work (to include NHS) to provide effective support to victim/survivors of FGM, whether or not a crime is reported Take early opportunities to promote FGM training and awareness as a high priority, e.g. media work, possible grant funded projects enabling agencies to better support FGM victim/survivors Consider implementing the local research recommendations Keep FGM response under active review.

Pan-Hampshire awareness programme to educate young people that targets young people across the whole area.

Focus on work that engages with schools most effectively, e.g. using existing school relationships.

Engage with Public Health on prevention.

Target organisations representing/engaging with underserved groups, and with BME/diaspora groups.

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 18

4 COMMISSIONING FRAMEWORK Services for victim/survivors of sexual crime operate within a fragmented, complex, and volatile commissioning and operating environment. The sector is characterised by the use of short-term contracts and funding awards including grants.

Impacts of short term contracts “Short funding spaces of 12 or 18 months are very tough. Services become difficult to staff - staff may not want to stick around. You get the funding and you get the project up and running and you report on it and it’s over. Given that each client lasts around 6 months, you don’t give the service a lot of time to develop an expertise in the service or a reputation/knowledge of a community. This is not good for institutional stability. You want low staff turnover, but you need the experienced staff. In an organization that relies on volunteers, you need the continuity even more.”

Interview – manager of a voluntary sector counselling service 4.1 Fragmented funding and commissioning There is a continuing risk that the effectiveness of a whole range of services is compromised if it is driven by organisations that may have varying priorities, for example, Local Authorities focus on social care and public health targets as part of their wide-ranging statutory responsibilities, while CCGs commission secondary and community health services.

Fragmented commissioning and services: examples and implications Theme

Commentary

Level of priority given to victim/survivors of unreported crime

Experienced practitioners consistently emphasise the principle that services must be offered to all victim/survivors of sexual crime, whether or not they report the crime to police. Indeed, many will never do so. Tension could arise as criminal justice agencies must respond promptly to reported crime.

Many victim/survivors have complex needs, requiring ready access to health, social care, housing and peer support/self-help services.

OPCC commissioning of services to support sexual crime victim/survivors presents an opportunity to use influence. Those consulted welcome a specific strategy for sexual violence, as a new and positive move towards the integrated, joined-up approach required, for example in relation to mental health and substance misuse.

Competition and collaboration is a prominent issue in the provider sector, impacting disproportionately on small providers. For example, the shift from grants to procurement, bringing more direct competition, may compromise their capacity to deliver an integrated service, e.g. when a tender or retender is anticipated or underway.

Complex needs

Voluntary sector provider market

Victim/survivors demonstrate a preference for accessing nonstatutory services 9 and this will be a key consideration in commissioning sexual crime services.

9

Survivors’ Journeys, Survivors’ Voices, The Survivors Trust and RCEW Conference, October 2014 Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 19

Contracting for provider collaboration and partnership working Distinct identity of sexual crime services Role of grant making Inconsistent service specifications

Commissioners value the diversity, local knowledge and innovation of small providers, yet this diversity can lead to inconsistencies in services and to problems with efficiency and organisational resilience. An option appraisal approach is recommended in order to tackle issues on working with small and diverse local providers.

In recent years, lead provider and consortium models have been widely used in the voluntary sector, and can be very successful, provided the associated risks are addressed and understood.

The research identified some views that there are major risks associated with “lumping together” sexual crime services with (currently) larger-scale Domestic Abuse services. This approach could perpetuate current perceptions of the sexual crime specialism as a smaller-scale need.

The ongoing OPCC grant programme has a continuing key role especially where innovation is required (e.g. the new Anti-Slavery Partnership) Working to a variety of service specifications and outcomes frameworks to provide the same service can be a barrier to integrating services and an excessive burden on provider management time, compromising the focus on front-line work.

4.2 Joined-up commissioning There is a widespread move across the public sector towards integrated, person centred services.

Appendix 2: “Who commissions what?” provides a table summarising which body commissions which services in the field of sexual crime victim/survivor services, some further detail on NHS commissioning, and a schedule of NHS Clinical Commissioning Groups (CCGs) within pan-Hampshire. The commissioning bodies included are  Police & Crime Commissioner  Police  Top tier Local Authorities (in pan Hampshire these are Unitary and County Councils)  District Councils  NHS England  NHS CCG’s.

Role of Sexual Crime Project Steering Group In terms of this strategy, the Sexual Crime Project Steering Group of commissioners and other key partners will support delivery of the strategy by identifying relevant partners and existing groups to take ownership of, and implement, its recommendations.

As a task-based group, this Steering Group will require clear Terms of Reference and an agreed Action Plan. The Group should maintain a consistent core membership that is small enough to develop and follow through practical actions at its meetings. We anticipate that core membership will be the OPCC, the four top-tier Local Authorities, and appropriate CCG representation.

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 20

Service Specifications and Outcome Frameworks The research suggested a need for unified specifications and outcome frameworks to be developed and agreed with partners, in respect of ISVA provision, and possibly for specialist counselling services. Such frameworks could potentially, in the longer term become part of a whole – a new set of outcomes and specifications to describe the whole support service available to victim/survivors of sexual crime.

Joint commissioning Police and Crime Commissioners across the country are collaborating with other local commissioners to develop and support integrated victim/survivor services.

There are innovative examples developing in Cumbria, Northumbria, and Avon & Somerset. Here is a recent joint commissioning example from Cheshire: Example of joint commissioning: ISVA service in Cheshire Cheshire OPCC is the lead commissioner in a joint commissioning exercise which has awarded a contract (in January 2015) to The Rape and Sexual Abuse Support Centre (RASASC) for Cheshire and Merseyside.

“The contract was awarded after an alliance was formed between the funding partners: the Police & Crime Commissioner, Cheshire Constabulary, NHS England and the four local councils, who had the aim to jointly commission a new ageless aftercare service for all survivors of rape and sexual assault.” 10 4.3 Recommendations: Commissioning Framework

(a) (b)

(c)

Commissioning framework The new strategy should support victim/survivors across all aspects of sexual crime, whether or not they report the crime to police.

Having sought agreement from key partners at a senior level to direct future ‘sexual crime related work’ around the outcomes of this Strategy, the Sexual Crime Project Steering Group should identify and encourage relevant partners/groups to take ownership of certain recommendations.

The Sexual Crime Project Steering Group should develop Terms of Reference and work to an Action Plan that supports this approach.

10

http://www.cheshire-pcc.gov.uk/News-andEvents/News/2015/01/Newservicesforsurvivorsofrapeandsexualassault.aspx Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 21

5 VICTIM/SURVIVORS OF SEXUAL CRIME: VOLUME AND PROFILE “PCCs naturally have a focus on ISVAs and criminal justice referrals but it’s critically important to highlight that 85% of victim/survivors will not ever report the crime to police.

About two thirds of service users’ issues are actually about past childhood abuse.”

Rape Crisis England and Wales, interviewed 2-14 5.1 Crime trends and under-reporting: national data The number of police recorded sexual offences in the year to March 2014 showed a 20% increase compared with the previous year, rising to a total of 64,205 incidents across England and Wales. 11 Rape accounted for 20,745 incidents, an increase of 26%. This is the highest ever figure recorded on a financial year basis.

Despite this very substantial rise in the number of recorded sexual offences, sex offences remain the most under-reported crime. A joint statistical bulletin published in 2013 by the Home Office, the Ministry of Justice and Office of National Statistics 12 found that 85,000 women and 12,000 men were victim/survivors of rape, attempted rape or sexual assault on average per year. This is over four and a half times higher than the reported crime figure.

As well as massive under-reporting, there are many reasons to approach sexual crime data with caution. For example, the figures we have obtained for this research do not provide an indication of how many adults are reporting experiences of childhood sexual abuse/rape.

5.2 Patterns of engagement for victim/survivors of rape and sexual abuse/assault It is common for victim/survivors of sexual crime not to report, or to delay reporting the crime. All of the service providers that we spoke to stated that a significant percentage of their clients were seeking services for events that occurred over a year ago. Providers told us that many victim/survivors will not disclose the crime to anyone, and attempt to deal with the trauma on their own for many years or indefinitely, and this can result in patterns of self-harm including dangerous behaviours and drug and alcohol misuse.

5.3 Hampshire Constabulary data: reported rape and sexual assault 13 Between April 2013 and January 2015, reported sexual crimes pan-Hampshire increased sharply for some categories of crime and the rate of increase accelerated,

11

Office for National Statistics (ONS) report on violent and sexual crime dated 12 February 2015 which incorporates police records and the Crime Survey for England and Wales (CSEW). Available online at http://www.ons.gov.uk/ons/dcp171776_394474.pdf 12 An Overview of Sexual Offending in England and Wales. Available online at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/214970/sexualoffending-overview-jan-2013.pdf 13 This section analyses the sexual crime statistics provided by Hampshire Constabulary in January 2015. These take us right up to the end of December 2014, and go back to 2013, indicating a range of recent and current trends in reported sexual crime.

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 22

particularly in respect of reported rape. There were 716 reports in the first 9 months of 2014-15 compared to 418 in the whole of 2012-13.   



Numbers for all types of reported sexual offence except rape of a male age 16 or over are increasing, some very sharply 2013/14 saw an overall increase of 20% compared to 2012/13 By the end of December 2014, the first 9 months figures already exceeded the 2013/14 totals. If the same trend continued the 2014/15 overall total will have increased by 41% since April 2012, and the 2014/15 figures for reported rape will have increased by 39% in a single year.

There were big percentage increases in the (relatively small) numbers of reported crimes against male children and the grooming of female children.

Hampshire Constabulary provided a set of detailed Sex Offence crime data to this project in January 2015, covering the previous nine months from April 2014. These figures appear at Appendix 3 along with analysis of them to indicate, overall trends, trend by type of offence, age, gender, and ethnicity of victim/survivors. Findings include:  An overall upward trend, with a sharp rise in reported rape  A higher density of reported sexual crime in predominantly urban areas  Victim/survivor profile information as follows: For all reported sexual crimes over the whole period: Of the total no of crimes,

Of crimes against females, and for males, When ethnicity is stated

85% were against females, 15% were against males 48% were against victim/survivors under 16 45% of victim/survivors were under 16 62% of victim/survivors were under 16 96% of victim/survivors are white European.

Caution is required when interpreting these figures in view of the vast under-reporting of sexual crime. One reason why young people under the age of 16 make up such a high percentage of the total maybe that the safeguarding requirements on adults who work with them will result in a crime being reported. However, young people are generally more likely than people over the age of 24 to be a victim of violent crime in general 14, underlining the continuing need to link closely to LSCB’s and safeguarding services.

Regarding adult victim/survivors, the limited availability of numerical data in relation to specific vulnerabilities and disability could lead to an unintentional lack of attention to those important areas of need.

5.4 Recommendation: Data Data to support sexual crime victim services commissioning (a)

Maintain a ‘watchful eye’ on data collected, through an annual review process or similar; to make sure it continues to inform commissioning. Include a focus on adult vulnerabilities and disabilities, and on specific groups and crime types.

14

Office for National Statistics (ONS) report on violent and sexual crime dated 12 February 2015 which incorporates police records and the Crime Survey for England and Wales (CSEW). Available online at http://www.ons.gov.uk/ons/dcp171776_394474.pdf Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 23

6 INDEPENDENT SEXUAL VIOLENCE ADVISOR (ISVA) SERVICES "Having an ISVA to support you through the hardest time you have to face is invaluable.

I can honestly say that without this support and dedication I would not have had the courage to face the jury when I went into court".

Quote from an ISVA client (Southampton Rape Crisis) 15 “ISVAs at Southampton Rape Crisis were amazing and really helped with my recovery. I could not have got to court without them.”

“I found out about ISVA by a private counsellor. When I reported to the police, they did not inform me of their existence. I did not hear from victim support; which I later found out that they had a time frame in which to contact me after reporting the crime. My friend’s house was burgled and victim support was there the next day. No one communicates! It’s not about the best interests of the victim. For the police it’s about how best they protect their evidence. I.e. By telling the victim as little as possible, as to not damage the strength of their possible conviction is of paramount importance. ISVA is to help them achieve their goal!”

Anonymous survey respondents, March 2015 In order to provide a pan-Hampshire overview, this section of the document goes into considerable detail regarding ISVA services. This enhanced focus reflects the approaching shift of previously central (Home Office) funding for ISVA services to Police and Crime Commissioners; the current Home Office contracts will expire at the end of March 2016.

6.1 What is an ISVA? National picture The role of an ISVA Many participants and consultees emphasised that the ISVA role will always just be one specific element of the whole system of services for victim/survivors of sexual crime, for example “…with the emphasis on ISVA funding, funders may then overlook the variety of other pathways that might or might not include an ISVA”. 16Some organisations are therefore cautious in promoting a major focus on ISVAs where there could be a risk of under-emphasis on other vital services.

Home Office definition 17

15

http://www.southamptonrapecrisis.com/isva.html Consultee June 2015 17 https://www.gov.uk/government/policies/ending-violence-against-women-and-girls-in-theuk/supporting-pages/sexual-violence 16

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 24

The support provided by an ISVA will vary from case to case, depending on the needs of the victim and their particular circumstances. However, the main role of an ISVA includes making sure that victims of sexual abuse have the best advice on:  what counselling and other services are available to them  the process involved in reporting a crime to the police  taking their case through the criminal justice process, should they choose to do so.

The definition also states ‘practical and emotional support and provision of information and guidance’. It should also include facilitating access to other relevant services, either through signposting or accompanying.

One example of a customer-facing definition 18 What does an ISVA do?  An ISVA is a trained independent specialist offering practical and emotional support to anyone19 who has reported rape or sexual abuse to the police, or is considering doing so  An ISVA is a friendly face who will support you though the whole process, from your initial reporting, all the way through the legal process and beyond. This process can be lengthy and difficult, and your ISVA is here to make it a little easier through support, advocacy and information.

There is no national body with oversight of the ISVA role or formal professional accreditation. This means that there is no uniform job description for an ISVA and the service provided is not uniform across agencies. However, there is a full suite of Skills for Justice National Occupational Standards for ISVA Services, developed with contributions from The Survivors Trust, Rape Crisis England and Wales, and legal and health experts. (see Appendix 4).

National organisations and local providers view this lack of consistency as frustrating and unhelpful because it makes the role widely open to local interpretation. 20 These local definitions vary from area to area and provider to provider, leading to confusion for people looking to use the service as well as people referring into the service.

Variations have also arisen as a result of funding constraints. As a training provider in contact with many ISVAs, The Survivors Trust has found that some ISVAs are restricted in the number of face to face meetings they can have with their clients, and others face barriers in attending court with their clients due to lack of cover for their role. It is regrettable that these variations can arise due to errors in commissioning effectively and The Survivors Trust is working with the Home Office and other sector agencies to address these inconsistencies.

However, some aspects of the ISVA role are widely accepted and demonstrate the complex nature of the job. ISVAs: 

Are client focused: this means meeting the client where they are, emotionally, as well as meeting face-to-face

18

From a Cornwall service Different services will have different minimum ages or may be gender specific 20 It is often contrasted with the IDVA role (Independent Domestic Violence Advisor), for which there are clear definitions, guidance and training. It should be noted that the nature of the service and the service user are different and the roles are not equivalent.

19

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 25

   

Have knowledge of criminal law and processes, up to and through the court process Are locally networked, with up to date knowledge of the local services and options available to clients, including specialist counselling, housing, medical care, drug and alcohol services and other social services Need to have a compassionate approach in an emotionally demanding position Must understand a broad range of mental health issues including trauma, selfharm, depression, anxiety, the effects of medication and the role of alcohol and drugs.

People contacted during research for this exercise have emphasised that ISVAs are not counsellors. The term “advocate” may be seen as more accurate, yet this term has a different meaning in law, referring both to a legal representative and also legally representing someone. The ISVA’s role in courts has led to the current consensus that ‘Advisor’ is the best description in their title to avoid any misunderstanding.

ISVAs told us that many survivors of sexual crime view the court process as a revictimisation where they have no control. The ISVA must be independent of that system and stand firmly for what the client wants. In this way an ISVA’s role is critical in order to put the victim/survivor at the heart of the court process.

Clinical supervision and organisational support For the ISVA, face to face clinical supervision 21, case management, and line management are all required, to do their job effectively and to manage risks that can quickly have a negative impact on the workers as well as the victim/survivors. ISVAs must be able to rely on clinical support and supervision to manage this risk, which can quickly impact on victim/survivors if things go wrong. Also, ‘burn-out’ and ‘vicarious trauma’ are significant risks in the day-to-day work.

Good line management and caseload management are also critically important.

What is a Young Person’s ISVA? A specialist Children’s/Young Person’s ISVA service for people under the age of 18 22 is hugely beneficial. The range of issues for young victim/survivors of sexual crime markedly differ to those for adults, and the emotional impact of sexual crime on a young person raises particular support needs including issues around school and educational attainment.

Safeguarding issues must be addressed within a different legal framework for under 16s and care leavers, with other parties involved, including the family and statutory agencies. Children cannot always travel on their own, and the ISVA must also travel to meetings (generally at school, home or other setting local to the client). Finally the services available for young people in general are distinct from services for adults, and an ISVA needs to have a solid understanding of these services in order to provide clients with the best service.

These factors require a Young Person’s ISVA to work in a different way from an adult ISVA, and to do so from a different knowledge set, with a lower caseload (see below).

21

All ISVA providers operating in pan-Hampshire provide clinical supervision.

The age of consent in England is 16 so sexual crimes are distinguished at this age.

However, safeguarding responsibilities extend to age 18.

22

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 26

Training standards, management, caseloads, and Key Performance Indicators for ISVA services An overview of each of these key aspects of managing and running a good quality ISVA service appears at Appendix 4. Headlines include:  No standard accreditation or single training programme exists for ISVAs although good quality training is available, and future service specifications should provide for appropriate training. The main training providers offer ISVA training linked to the Skills for Justice National Occupational Standards for ISVAs.  Running an ISVA service is “management-heavy” requiring clinical supervision and case management as well as line management  There is no nationally accepted guidance on caseloads, but crude estimates are possible and Appendix 4 includes an approximate estimate of yearly capacity at 70 new clients per year for a full time ISVA supporting adults, or 60 for a young persons’ service. The Survivors Trust suggests a (full time) ISVA caseload of 50 adult clients at any one time, with a mix of high, medium and low needs and risks for those working with adults, and for those working with children and young people, a maximum of 30 at any one time  A range of KPIs (Key Performance Indicators) are already collected, and we recommend that further consideration be given, when designing future KPIs, to how the data collected will be used.

6.2 Benefits of an ISVA service “ISVAs put the victim/survivor’s voice in the process and offering the victim/survivor a voice much sooner means healing can start much sooner.”

(ISVA manager, Aurora New Dawn, interview) Interviewees have outlined to us that ISVA services have the following benefits:      

Allowing police, and others referring people to an ISVA, to feel confident of what that referral could provide Improving rates of referral to other support services Promoting more frequent interaction, and smoother communication, between police and ISVA services Establishing the ISVA as a regular, recognised presence in the criminal justice system (further reinforcing the professionalism of the role) Keeping the victim/survivor far better informed throughout - a key goal for any victim/survivor-focused service Ultimately, amplifying the victim/survivor voice in court proceedings.

The research evidenced significant further potential. The role is relatively poorly understood and inconsistently defined, and this is a barrier cited by many interviewees. Our research has reinforced the case, often argued by national commentators, 23 that a much more “uniform” ISVA role and service, consistentlydefined, and delivered at a level that ensures regular ISVA attendance at court proceedings, would have multiple future benefits.

23

E.g. research interviews with The Survivors Trust and LimeCulture Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 27

6.3 Needs Mapping “..there is a shortage of these specialist workers across all areas.”

SE Regional Strategic Assessment of Victims Services (Tapley& Stark, University of Portsmouth 2014) All ISVA providers pan-Hampshire were contacted and interviewed for this exercise.

In addition, most providers participated in a survey about their client profile and service. Basingstoke Rape and Sexual Abuse Crisis Centre (BRASACC) were not running an ISVA service at the time of the research, but will establish a part-time ISVA this year.

Needs mapping: Headlines Appendix 6 contains full details of our research on ISVA needs mapping in terms of the specific needs of a range of groups of people. Taken together with the analysis of crime figures at Appendix 3, headlines include: 

  

Indications from the reported sexual crime figures: The reported sexual crime figures strongly suggest under-provision in the Hampshire CC area compared to the other three top-tier LA areas, after differences in reported crimes i.e. crimes per 000 of population are taken into account. (those crime rates being higher in the urban areas, which include the Southampton and Portsmouth conurbations) Under-13s: A need for more funding and resources is strongly indicated for under-13s especially where there is currently no ISVA provision for under 10s, i.e. in Hampshire CC and the Isle of Wight Use of the SARC (Treetops) as a single point of contact for all paediatric cases should be considered Specific vulnerable groups: Consideration should be given to the needs of a range of groups particularly vulnerable and likely to be under-served, both locally and nationally: o Male victim/survivors o People with Learning Disabilities o People with mental health problems, notably those with serious mental health diagnoses o Lesbian, Gay, Bisexual, Transgender (LGBT) people o People with substance misuse problems.

Some of these groups are already a focus for existing partnership work (see partnerships Section 12) which could potentially be enhanced.

6.4 Existing Supply Mapping Key findings of interviews with ISVAs pan Hampshire:  Referrals: we were advised that in the calendar year 2014, ISVA services panHampshire reported a total of 621 new clients referred to their services. Our survey produced a lower figure of 584 new referrals, which may be explained by different accounting periods.

Whist precise overall trend figures proved problematic to quantify, providers consistently reported a marked upward trend, for example, Southampton Rape Crisis saw a 41% increase in referrals compared with 2013. 24 24

Southampton Rape Crisis has reported that they had a current caseload of 109 ISVA clients at 1.4.15. During 2014 they worked with 331 new clients41% more than the previous year.

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 28



Referral pathways are generally through the Police and the SARC although Isle of Wight has a high self-referral rate. This could be because Isle of Wight residents are more likely to call a local phone number than a mainland number



Client profile: o Predominantly female, white British o Predominantly aged between 25 – 49, with the next largest age cohort being 18-24 year olds o Multiple instances of sexual crime: all ISVA services reported working with clients who have experienced more than one instance of sexual crime. Two respondents stated that between 50-75% of their ISVA clients had been victimized more than once. o Level of reported crime: most people using an ISVA service have reported the crime to the police. A significant percentage of ISVA clients are dealing with an ‘historic’ crime which occurred at least one year prior to contacting the service. o Associated issues: The most common issues that ISVA clients presented were (in order of incidence reported by providers): 1. A severe and enduring mental health diagnosis 25 2. Domestic Abuse 3. Substance misuse problems.

This breakdown of client profile only in part tells us the profile of who is a sexual crime victim/survivor, as it largely reflects the cohort that are most likely to report, and broad categories such as “White British” may include (and mask) important sub groups such as EU citizens from other countries.



The service provided, always directed by the client, includes advice and support to cope and recover from the crime. It is generally focused on the criminal justice process. Although the service is available to people who have not reported the crime, the duration of service is mostly tied to the duration of a criminal case.

ISVAs refer clients to services including specialist counselling, domestic abuse services, housing, mental health services, alcohol and drug misuse programmes and mutual support organisations. Where a case is going through to trial, an ISVA will work closely with a client to ensure understanding of the process including any special measures for testimony. ISVAs also assist with practical support like childcare arrangements and getting to and from the court at the right time.



How quickly does an individual service begin? Some services contact a client within 48 hours of referral, while others take up to two weeks. This is purely due to capacity. Both of the larger ISVA providers undertake a triage of each referral and contact high need clients more quickly.



Duration of service is determined by the client. Some clients may only want a phone call and others will require more support. Generally speaking, the ISVA case will wind down when the criminal case ends. The criminal case ends when the verdict is returned (which is currently taking over 12 months from initial referral) or when the decision is taken that there will be no further action (NFA) from the police or CPS. At the moment police investigations are taking 4-9 months.

25

This association, between serious mental health problems and sexual violence, is wellknown and referenced in NHS England’s 2013 Sexual Violence commissioning Guidance.

See Appendix 5, para 5.2 of that document Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 29

It should be noted that NFA results, the conclusion of any court process, and the date an imprisoned offender is due for release (possibly many years later), are trigger points for clients, when ISVAs are called on to ensure appropriate follow on and counselling services are in place. It can be very difficult to close cases if there is nowhere else for someone to access support, especially if they are vulnerable. This is where dedicated voluntary sector providers may be able to continue support in another form. 

Waiting lists are controversial. Some services do not believe in the value of holding waiting lists as such, but do acknowledge that when resources are stretched clients may be waiting longer. As above, providers do triage incoming cases andwill prioritise clients to receive an initial phone call within a few days of referral.



Challenges working with the courts. From the provider side there are issues around the courts fully acknowledging the role of the ISVA. Although it is improving, they are still occasionally asked for their credentials to be in the courtroom. ISVAs told us that the prosecutor, the judge, the defence barrister and even the court staff have a role in the court that is never questioned but the victim/survivor and their advisor are treated as outsiders. ISVA reported that victim/survivor/witnesses felt the defendant had an advisor working for them but the victim/survivor did not, because the prosecutor was there to see ‘the law’ served rather than the victim/survivor.



Gaps in service. Providers told us that the lack of available specialist counselling was a major issue for their clients. Additionally the lack of ISVAs and geographical inconsistency in availability of an ISVA service was a major problem, particularly for people living outside of the major urban centres. Multiple respondents cited the need for more ISVA provision for under-18s. The lack of male and black/minority ethnic clients was also cited as a concern.

How the Young People’s ISVA works There are two locations that house a Young Person’s ISVA working with under 16’s: SARC (Treetops) and Southampton Rape Crisis (SRC). The details of these two services are shown in the chart below. Features of these services include:   



26

Referrals are primarily through Treetops and the police, and about 20% of SRC’s young person ISVA referrals in 2014/15 26 came from CAMHS. Schools and family/carers also refer Client profile: Most are female and white British Age ranges: Determining exact numbers of referrals by age is problematic due to the varying age ranges recorded. In 2014/15, SRC’s ISVA service received 86 referrals of clients aged 11-18 in 2014/15; nine of these referrals were aged 1113.There was an almost equal split of clients between the ages of 13 -15 and 1617 Demand: Both services saw an increase in demand for the service over the last year (to January 2015), having seen a total of 193 young people during 2014 (131 seen by Treetops, 62 by SRC) which represents a combined 13% increase from the previous year, and the updated SRC figures in the above bullet point indicate a further upward trend to April 2015

SRC has provided some 2014/15 figures in response to the reference group consultation.

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 30

 

Duration of service: One provider reported the average duration of service for young people was 1-2 years Reported crime: At least 75% of the Treetops clients had reported to the police, while SRC estimated that 25-50% of referrals had reported.

Service gaps cited included:  Under-13s:The lack of ISVA services for young people under the age of 13  The lack of specialist counselling for young people who have experienced sexual crime.

Table of current ISVA provision This table sets out the position at June 2015. The funding column contains partial information on actual figures and end dates as well as a list of known funding bodies, to give a flavour of the overall contracting position.

Aurora New Dawn Portsmouth

Area(s) covered

PanHants

Portsmouth Portsmouth

Hampton Trust Isle of Wight

S’ton and Isle of Wight

RASAC Winchester

Hants CC Area excl B’stoke

Southampt on Rape Crisis

S’ton, N. Forest, Eastleigh, & Test Valley South

27 28

1

FT or PT 27

FT

FTE 28

Organisati on and office base SARC Treetops (NHS Solent Trust) Portsmouth Portsmouth Early Intervention Project

No of ISVA posts

EXISTING ISVA PROVISION at June 2015 Clients served

Funders, and funding end dates, where known

1

Children aged 13 upwards

NHS England to March 2020, plus contributions from OPCC, Police and all 4 top tier Local Authorities.

1

PT

0.5

1

PT

0.5

1

4

4

PT

PT

Mix of FT/ PT

Age 16 +, male and female Age 16 +, male and female

Portsmouth City Council £20,426 (ISVA employed by Portsmouth City Council) £20k funded by the Home Office until March 2016.

0.8

Age 18 +, male and female

£20k funded by the Home Office until March 2016.

Also funded by IoW DA Forum £5k and by OPCC (£10,700)

3

18 and over male and female

Home Office to 2016 Hants CC OPCC

2.5*

Adults age 18 +, male and female

HO until March 2016 £20,000, Southampton Council** £35,311 OPCC £35,875 until Nov 2015

Full time or part time FTE=Full time equivalent Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 31

Southampt on Rape Crisis BRASACC Basingstoke starting new service Andover Crisis and Support Centre (Refuge provider)

Area(s) covered S’ton, N. Forest, Eastleigh, &Test Valley South The ISVA will cover North East Hants

Total posts:

1

FT or PT 27

PT x1

FTE 28

Organisati on and office base

No of ISVA posts

EXISTING ISVA PROVISION at June 2015

0.8

1

PT

Initia lly 0.3**

1

Detail Not known

Detail Not know n

15

Total FTE:

Clients served

Funders, and funding end dates, where known

Children aged 11 upwards

OPCC £30,000 (one off funding – additional – via Victim and Witnesses Fund) Charitable donation specifically for ISVA provision, also MoJ, which runs out March 2016.

ISVA and IDVA in combined role. Funded via the You Trust contract for the DA work but no external funding for the ISVA element

9.4

(plus small ISVA element at Andover)

*from July 2015 ** Southampton City Council has invited tenders for a contract which starts in November and which will include domestic abuse and sexual crime support services. *** BRASSAC is recruiting on the basis that a further 0.3 may be added if needed.

Commentary on the table ISVA services were slightly more thinly spread across pan-Hampshire at our survey date (January 2015), with 7.6 full time equivalent posts. The position has now improved slightly to 9.4 FTE. As the position in the right hand “funding and funders” column is subject to constant change, we did not seek to verify full details of every single amount and source. The information available highlights the continuing fragility and volatility of multi-agency ISVA funding, and underlines the need to maximise integrated commissioning in this field.

In contrast to some PCC areas elsewhere in the country, ISVA services are provided by eight separate organisations. This means that on average each provider has 1.2 full time equivalent ISVA posts, filled by an average of 1.9 individual ISVAs. The highest number of full time equivalent posts in a single organisation is 3. Posts are often part time and are in some instances delivered as part of a composite role.

Only two providers (Winchester RASAC and SRC) employ more than a single ISVA, whether full or part time. Both Aurora New Dawn and Portsmouth CC house their ISVA alongside a team with IDVAs and support workers for people experiencing domestic abuse, which provides clinical supervision and management for the ISVA. The Young Person’s ISVA housed at the SARC also works alongside other professionals trained in working with victim/survivors of abuse. The Isle of Wight ISVA position has clinical supervision from SRC, and line management from the Hampton Trust. Although that line management is provided by an experienced ISVA, Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 32

there are still significant questions about lack of cover and issues around lone working.

The provider market for ISVA services National ISVA provision was researched independently in 2014 for the first time, by Kings College London and the Community Interest Company, Lime Culture. The report, “An Audit of ISVAs in England and Wales” published in February 2015 29, is highly informative and provides ten recommendations, reproduced at Appendix 5.

About two-thirds of ISVAs working in England and Wales are employed by a charity or non-profit organisation. The next largest employer of ISVAs is the NHS with about 20% followed by the police with around 10%.

The provider market was expanded by the 2011 national Home Office Violent Crime Fund ISVA commissioning round which set up 87 new ISVA posts, awarding funding of £20k per ISVA to a wide range of applicant organisations, with an expectation of matched funding in most cases. With the economic squeeze, matching funds have become harder to find. The Home Office commissioning role, scheduled to end on 31 March 2015, has been extended to 31 March 2016 when it passes to Police and Crime commissioners.

Provider types: ISVAs in pan-Hampshire by employer sector Sector

No of FTE ISVAs

% of total FTE

1

11%

Local Authority

0.5

5%

Voluntary sector (6 organisations)

7.9

84%

Total

9.4

100%

NHS

Pan-Hampshire, 6 voluntary sector providers deliver over 84% of ISVA provision. 30 To meet the stated priorities of the Ministry of Justice Victims Code, maintaining and developing the community of expertise and specialist knowledge should be a priority of a victim/survivor focused strategy. Providers collectively have a high level of expertise and specialist knowledge in the area of services for victim/survivors of sexual crime. However, relatively small scale provision by multiple local agencies leads to significant practical issues, for example with referral routes, which are unclear to many professionals and victim/survivors needing a service.

Given the tenuous funding streams supporting most ISVAs, the issue of organisational resilience was a common theme in our research. By “organisational resilience”, we mean the ability of an organisation to provide and maintain an acceptable level of service in the face of faults and challenges to normal operation, by preventing, avoiding and resisting damage and recovering quickly. 31The recent past has provided a ‘perfect storm’ to test the resilience of the ISVA provider market: 29

An Audit of ISVAs in England and Wales, LimeCulture and Kings College London February 2015 http://data.lifeappslab.com/ 30 Andover level of provision is not quantified 31 Organisational resilience – BCM 2013 Paper by Rainer Huber http://www.bcm2013.com/papers/StreamC/6OrganisationalResilienceRainerHubert.pdf Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 33

  

The number of clients seeking services has increased with the marked increase in reported sexual crime Funding sources have been squeezed and require increased staff time to prepare bids and report outcomes to multiple sources Access to other services for ISVA clients has become increasingly difficult (namely the courts with increased waiting time for trial and delays in other social/health supports) which in turn increases the workload for individual ISVAs.

In the short term, these issues make work difficult for any organisation and can result in employee burn out. Over the long term, a lack of organisational resilience is a threat to the health of the sector, and therefore ultimately, to the victim/survivors themselves.

6.5 Gaps in service We identified the following: Consistency of service: As mentioned above, there is no accepted national standard for ISVA service. Likewise there is no accepted pan-Hampshire standard or service specification. This means that victim/survivors in one area may be offered, for example, assistance in court while others may be offered a referral to Victim Services. A consistent service approach would clearly benefit victim/survivors. In establishing this, care is needed to avoid a rigid approach and to maintain diversities and flexibilities that offer key benefits to victim/survivors. One person with experience of using a local ISVA service commented that “grass roots charities are often better than national charities. National charities are so generalized that they work to a protocol that is rigid and unsuitable to victim’s personal circumstances.”

Geographical cover: Given the large geographic area that the ISVAs operating out of Winchester RASAC cover, and the resulting travel time, we conclude that there is insufficient ISVA coverage for this area which includes Winchester, Basingstoke and Dean, Hart, Rushmoor, Test Valley (north), East Hampshire, Fareham, Gosport, and Havant. This results in a ‘postcode lottery’ situation for victim/survivors. Furthermore, the demand for the Winchester ISVA service increased over 50% in 2014, putting demand in Winchester on par with Southampton. (Since the analysis was done, some improvements are underway resulting from some increased short term ISVA funding from the OPCC, and a modest charitable grant to BRASSAC – Basingstoke).

Childcare, transport, available hours: These very practical issues arise within existing services and particularly affect services which cover a large geographic area.

In interviews, providers told us that clients cited these issues are barriers to accessing the service.

Knowledge of ISVA services: one agency reported that they “often meet victim/survivors who are going into the CJS system or have been in it, who have never heard of an ISVA. They are surprised when we tell them about ISVAs”. Better pathways to the service via police are suggested; even when good information is provided, vulnerable victim/survivors may be “too traumatised and over whelmed to know/remember what they have been told. We have several recent examples of this.”

6.6 Findings and Recommendations for ISVA provision Findings Findings: ISVA provision, pan-Hampshire Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 34

Findings: ISVA provision, pan-Hampshire Overall level of ISVA provision

ISVA coverage

Under 18s Benefits of location in experienced specialist organisations

Police and Court awareness and attitudes Under reporting amongst certain groups High incidence of mental health and/or substance problems Inconsistent ways of working

There is evidence of significant under provision pan-Hampshire, based on provider evidence of caseload pressures and steeply rising rates of referral, alongside sharply rising levels of reported rape and sexual assault. This evidence fits with the findings and recommendations of regional and national research reports. 32 However, there is an absence of guidance on the “right” level of ISVA provision based on population or need.

Given current provision, at the date of the research (January 2015) ISVA coverage was especially insufficient to meet the need in  Winchester  Basingstoke and Deane  Hart  Rushmoor  Test Valley (north)  East Hants  Fareham  Gosport  Havant.

ISVA services for people under the age of 18 are insufficient to meet the need.

ISVAs and their clients benefit from working within agencies that provide support and clinical supervision. As the primary referral

by ISVAs is to specialised counselling, ISVAs reported that a close working relationship with a counselling service was beneficial for their clients.

This includes referrals for Pre-Trial Therapy, offered by practitioners with expertise in counselling victim/survivors while the criminal justice process is on-going and a trial may be possible. (See counselling Section 7).

The ISVA role is not consistently understood by the police or the courts pan-Hampshire with the presence of ISVAs in court with their client will still be questioned by court staff.

Men, people who identify as LGBT, and people with learning disabilities are likely to be under-reported victim/survivors of sexual crime and under-represented on ISVA caseloads.

Victim/survivors of sexual crime are more likely than other crime victim/survivors to have issues around mental health and alcohol and substance misuse. Anecdotally, the research noted a particularly high level of self-harm and eating disorders amongst survivors of childhood sexual abuse.

The ISVA service operating in the pan-Hampshire area does not have a uniform service standard. Appendix 4 gives further detail on the absence of national standards, and the small scale of each provider service, each separately managed, can lead to inconsistencies, e.g. around boundaries and the scope of the role.

32

SE Regional Strategic Assessment of Victims Services(Tapley& Stark, University of Portsmouth 2014) and Audit of ISVAs in England and Wales (Kings College and Limeculture, 2015) Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 35

Findings: ISVA provision, pan-Hampshire Referral routes

Confusing in some areas, both for victim/survivors and for professionals who are not familiar with the service on a regular basis ISVAs work in a demanding role. The current financial model Provider and ISVA challenges means that ISVA providers work in a challenging and volatile market.

Recommendations: ISVA provision

(a) (b) (c) (d)

(e)

(f)

(g) (h) (i) (j)

ISVA Provision Work with others to grow ISVA provision. Where possible this should begin with a focus on underserved areas and children/young people Establish clearer referral routes Consider using the SARC (Treetops) as a single point of contact for all paediatric cases Maintain and grow the role of Young Person’s ISVA with consideration to developing a uniform standard of service for young people of a certain age panHampshire and to set guidelines on how ISVAs are expected to relate to the roles of other children’s services Develop a unified, agreed and outcomes-based service specification for all ISVA services, in consultation with stakeholders, who should agree an outcomes framework and align KPI’s to avoid duplication. This specification should address both client service standards and training standards. When designing KPIs to be collected, determine how they will be used Consider targeting ISVA services to specific client groups, in particular men, gay, lesbian, bisexual and transgender people and people with learning disabilities Consider having at least one ISVA located in each of the existing specialised counselling centres Work with Criminal Justice Service stakeholders to increase understanding and acceptance of the ISVA role 33 Strengthen linkages between mental health services and alcohol and substance misuse services to improve services for ISVA clients Use the commissioning process to foster organisational resilience in the sector, for example, through joint commissioning of ISVAs with longer (e.g. four-year) contracts where possible.

33

In Southampton, ISVAs attend a ‘court-users’ group which has improved communication and increased the professional standing of ISVAs in the court room.

Hampshire PCC, Sexual Crime Strategy: Mapping and Scoping Document, November 2015 36

7 SPECIALIST RAPE AND SEXUAL ASSAULT SERVICES, INCLUDING COUNSELLING “The counselling element has not been given the attention it should have had.”

Fay Maxted, Chief Executive, The Survivors Trust, Interviewed Dec 2014

“Disclosure is a process, not an event. I can’t emphasise this point enough.”

Kim Hosier, Portsmouth Rape Crisis Centre, speaking at Victim Journey Day November 2014 “Clients can wait decades to disclose the abuse and get help.”

Alison Noel, Manager Winchester RASAC, interviewed January 2015 7.1 Scope of this section of the document This research considered specialist counselling in detail. Counselling is a prominent delivery area for many specialist provider organisations that provide a range of supports to victim/survivors of sexual crime. In this section we consider the nature of this work, and review the associated provider market pan-Hampshire, targeting organisations whose core activity is supporting victim/survivors of sexual crime. Most of these offer specialist counselling as part of their service portfolio.

7.2 Context: History and role of dedicated voluntary sector specialist providers A wide range of organisations are involved in supporting victim/survivors of sexual crime, and within that range are a small number of organisations that are dedicated to this single purpose, or who provide sexual crime/abuse services as a core element of what they do. For reasons that we explore further in this section, these specialist organisations have developed in the voluntary sector, and are particularly well placed to:       

Be vital supports to victim/survivors who have not engaged with, or do not wish to engage with counselling, ISVA, or mental health services Be key to understanding the needs of people who do not, and may never report the crime to the police Understand and recognise the viewpoints of victim/survivors who do not want contact with the police and who indeed may never have discussed the issue with anyone else Enhance “reach” to people from minority and disadvantaged groups and victim/survivors in particular circumstances Help people who want and need specialist services but cannot access them – possibly because the service is overstretched Offer peer-to-peer support, provided by people who have “lived experience” of the issue Often give continuous, open-ended support that is not time limited, as and when it is needed.

Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 201537

7.3 Dedicated Voluntary Sector Sexual Crime 34 Organisations: background This subsection describes a particular group of organisations working in panHampshire, most of which provide specialist sexual crime counselling, whose purpose is to support sexual crime/violence/abuse victim/survivors. Each offers a portfolio of services that encompasses other elements of a victim/survivor’s recovery journey.

What is a Rape and Sexual Abuse Support Centre (RASAC)/Rape Crisis Centre?

The majority of centres founded as Rape Crisis Centres now refer to themselves as ‘Rape and Sexual Abuse Support Centres’ – RASAC. Also the Ministry of Justice now refers to Rape Support Centres rather than Rape Crisis Centres.

Background to “Rape Crisis Centres” Rape Crisis Centres emerged in the 1970s and 1980s in response to the unmet needs of survivors of rape and sexual abuse. This included providing practical support alongside the development of specialist trauma focused counselling. Centres also campaigned for changes in legislation and challenged successive governments to hold perpetrators accountable for their actions and to end what they perceived as widespread victim blaming.

Since then centres have developed to meet the particular needs of their local communities. The services they offer are shaped by their different values (e.g. some centres provide support for female victims only), the availability of funding and the emergence of new provision including Sexual Assault Referral Centres.

Kim Hosier, Centre Director of PARCS (Portsmouth Area Rape Crisis Service) These crisis services provide practical support and information for victim/survivors of sexual crime as well as their families and supporters. Additionally, centres frequently offer education and prevention materials, training for statutory and non-statutory organisations and emotional and psychological support for survivors in the form of specialist one to one counselling. Centres can also support ISVA services and specialist programmes for children, families, men, LGBT people, learning disabled people, and other client groups according to local need.

The four RASACs based within pan-Hampshire are provided by the same four organisations that offer specialist sexual violence counselling, as follows:  Southampton Rape Crisis (SRC)  Basingstoke Rape and Sexual Abuse Crisis Centre (BRASACC)  Portsmouth Area Rape Crisis Service (PARCS)  Winchester Rape and Sexual Abuse Counselling Service (RASAC).

All are members of The Survivors Trust and abide by their standards, which promote a clear empowerment approach. Each organisation has developed locally, and so far these organisations have not been specifically supported to develop collaborative working.

34

As noted in the Introduction, these organisations usually avoid the “sexual crime” terminology, which could imply that they are just for people who have reported, or intend to report a crime.

Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 201538

Survivor-Run, and other dedicated sexual crime organisations RASACs are one type of organisation within a diverse national voluntary sector.

Some voluntary bodies focus on particular groups of survivors and may be survivorrun.

In Hampshire, CIS’ters is a national body based locally, that is usually supporting approximately 400 women at any one time, 60-70% of whom are living within the pan-Hampshire area. CIS’ters is run by survivors for survivors and has been delivering services locally within Hampshire for 20 years. It provides emotional support (as do all specialist services) – but specifically for females age 18 and over who, as children/teens, were raped/sexually abused/exploited by a member of their immediate/extended family.

Basingstoke Rape and Sexual Abuse Crisis Centre (BRASACC) Portsmouth Abuse and Rape Counselling Service (PARCS)

X

X

X age 16 and over

X

X

X

X

Southampton Rape Crisis (SRC)

X

X

X

X

Winchester Rape and Sexual Abuse Counselling Service (RASAC)

X

X

CIS’ters

X

X

X

Support Groups

Services for men (not men only)

Education/Pre vention

ISVA Services

Counselling for Families of young

Individual Counselling (under 18s)

Helpline

Organisation

Individual Counselling (over 18)

Table of dedicated voluntary sector Sexual Violence agencies pan-Hampshire This table maps out the services provided by organisations as defined above. During the research we have sought details of any additional dedicated specialist groups based in pan-Hampshire, but none have emerged to date. Small “self-help” groups tend to be hosted by one of the established providers.

X

X

X

X

X

X

X

X

X

X

X

X

X

7.4 National Organisations Appendix 14 (Directory) contains a section for national groups and organisations.

Some of these groups are empowerment groups led by, or with high levels of involvement of, experts with experience.

7.5 Counselling and Psychotherapy: an overview There is a large and diverse market for general counselling services, encompassing all provider sectors – non-profit, private (Including many freelancers), and NHS

Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 201539

Trusts. This area of work is one of very few areas in mainstream mental health that have received new Government funding in the last ten years (largely prior to 2010).

The counselling and psychotherapy “world” is an area of developing ideas and much debate amongst practitioners. This is worth exploring, with future NHS partnership work in mind.

We were advised that the majority of accredited counselling training courses do not specifically focus on working with sexual trauma, and the specialists often establish their own separate routes to counsellors’ training and development in this area.

NHS Counselling and Psychotherapy NHS provision has expanded in recent years through the Improved Access to Psychological Therapies (IAPT) programme, which is based on NICE 35 guidelines.

The IAPT model is characterised by stepped, time-limited interventions and cognitive behavioural therapy (CBT). Access is to the service is via GP referrals, self-referrals, and a range of routes. Although the programme is designed to be responsive and accessible, waiting lists have developed in some areas. IAPT services were not specifically designed to address the needs of sexual crime victim/survivors. The established specialist sexual crime counselling sector was not part of the IAPT commissioning design and remains independent of NHS IAPT provision.

What is rape and sexual assault counselling?

“All training includes basics of trauma therapy but sexual violence is a significant added complication ….with war trauma there are triggers and re-experience, with sexual violence it’s multi layered, quite different…. The counsellor’s response can easily wreck it, leaving the victim/survivor stuck, completely on his or her own. The counsellor’s own emotions are the key. The training enables you to set aside your own response. It’s the relationship that heals.”

Interview with a practitioner from another area, 2014 Counselling is a critical element required to deliver the cope and recover principles of the Ministry of Justice Victim Code. Sexual crime counselling is a specialism that requires particular skill sets and training, and should be overseen by an organisation that has an appropriate management infrastructure.

As the majority of victim/survivors seeking support do not report and do not choose to report, counselling, group support, and help-lines are the services most often accessed by victim/survivors.

“Service users repeatedly tell us that CBT is not appropriate and that time limits don’t work, although they seem to be creeping in due to funding cuts. Conversely, there has been some evidence that if you leave it open-ended, people use fewer sessions”.

Interview – Kate Taylor, Rape Crisis England & Wales Dec 2014 Pre-Trial Therapy Pre-Trial therapy, in accordance with Home Office and CPS guidance, is a key element that “mainstream” counselling services are not equipped to provide. Pre-Trial Therapy is also an essential service working alongside ISVAs. Practitioners (and organisations) offering Pre-Trial Therapy should understand how to support victim/survivors through a very challenging, sometimes protracted period of time without potentially compromising the trial process. For example, if the victim/survivor 35

NICE: National Institute for Clinical Excellence

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has gone through what has happened in detail with the counsellor, it could be argued that as victim/survivor has been ‘coached’ about what to say in court.

Who provides specialist counselling?

Counselling services for victim/survivors of sexual crime are predominantly provided by voluntary sector specialist organisations. Providers have developed locally by responding to community need. They are likely to be small and locally run, with strong ties to the communities that they serve, and links with other stakeholders. As single purpose organisations, they are well placed to develop the governance, organisational structure, and management focus required.

Crucially, their independence gives victim/survivors added confidence that they can approach them for help and advice.

Many counselling providers use a high proportion of freelance counsellors, and/or volunteers, ensuring robust arrangements for professional supervision, which is often directly undertaken by the provider, especially in the case of volunteers.

Counselling: management and organisational resilience Any organisation providing a good quality counselling service needs to have an appropriate organisational and management infrastructure. The Survivors Trust and Rape Crisis England & Wales each have developed a tried and tested set of standards to which their members must adhere. They encompass the full range of key organisational competencies such as governance, diversity, and user involvement. The four major providers of sexual crime services in pan-Hampshire are members of The Survivors Trust.

Alongside the importance of clinical supervision and general management functions, important elements to consider include: 





Capacity to work with partners: counselling organisations need the capacity to work in partnership, and appropriate expertise in the relevant criminal justice systems and processes, for example, confidentiality issues in relation to matters that may be regarded as evidence Organisational resilience is an important question for commissioners to consider, as the sector is characterised by small local voluntary sector providers with short-term income streams and, sometimes, dependence on charitable funds Sustaining an effective counselling environment that is trauma-informed and aware, so that counsellors and other staff are protected from risks of burn-out and vicarious trauma. Clinical supervision is a crucial element of this, as is specialist training, but also the ethos of the agency, and its other support structures, such as group supervision and peer-mentoring.

The two most prominent national good practice, campaigning and membership bodies, The Survivors Trust and Rape Crisis England & Wales, were interviewed in the development of this strategy. The four major sexual crime counselling centres in the pan-Hampshire area are members of The Survivors Trust.

We found strong support both locally and from national practice and survivor organisations for the unique role and effectiveness of counselling provided by specialists in rape and sexual violence specialists.

IAPT and specialist counselling services – scope for further work Local specialist services report that IAPT services regularly refer people to them, and can also be helpful for appropriate onward referral. However, referrals from NHS-

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funded services do not come with any additional funding, which should ideally follow the client. 36 Further research and/or partnership work would establish the role and potential of the IAPT services role in more detail. An NHS commissioner at a Hampshire CCG (in the CC area) has checked this with the local NHS provider, and reports that the service has some (limited) data on referrals, and staff with skills in working with complex trauma. The clinical lead from the iTalk service advises, regarding receipt of referrals in relation to rape and or sexual abuse, that all step 2 and 3 counsellors/therapists have been trained on the subject across the service: “We capture referrals and add data by the provisional diagnosis. Somebody with a history of child sexual abuse or rape could come to the service for treatment of depression, PTSD, agoraphobia, complex trauma treatment etc.

The underlying difficulties that led to the presenting problem will be in the notes and the formulation but not easily captured in terms of numbers It maybe that staff will have recorded a secondary problem descriptor We certainly have an increasing number of patients referred where there has been Child Sexual Abuse and they mostly receive complex trauma compassionate mind focussed intervention”.

The high level of under reporting, the prevalence of mental health problems, and the evidenced associations between diagnosed mental health problems and a history of rape or sexual abuse all suggest that increasing priority should be given to NHS partnership work in this field, whist exercising caution on a number of important issues. For example, past/current experiences of mainstream mental health services may be negative or problematic. Also NHS IAPT services, whilst their contribution is recognised, are not currently regarded as an established pathway for support to sexual crime victim/survivors. 37 Training, accreditation, standards, caseloads and KPI’s Some further detail is at Appendix 7. Headlines include: 





Counselling accreditation bodies do not have specific accreditations for sexual violence counselling, a specialism that requires additional knowledge as well as counselling skill, although there are some relevant Diplomas available. This is a developing area The national workforce gap in meeting the needs of sexual violence survivors has been acknowledged by Government with the recent award of funding to Rape Crisis England and Wales for a national workforce development programme Volunteers are widely used. Counselling qualifications require supervised practice hours and those in training are often able and willing to deliver voluntary counselling. Some experienced counsellors, working freelance, offer specific number of regular sessions to charitable sexual crime counselling providers on a voluntary basis

36

Government policy commits the NHS to developing Personal Health Budgets, which have been piloted including for people with mental health problems. However, progress is slow.

37 Southampton Rape Crisis recently reported that 12% of their referrals for adult counselling came from NHS sources including IAPT, who regularly refer, as do Child and Adolescent Mental Health Services.

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

The concept of caseloads is relatively meaningless as so many variables come into play; however The Survivors Trust has provided some estimated timelines in terms of number of sessions for short, medium and long term needs Specialist Sexual Crime services provide in-house training to ensure their counsellors are equipped and supported to work with trauma Pre-Trial Therapy training is a key requirement, available in the form of workshops for counsellors and providers, 38 which include, for example, information on note-taking and access to notes.

KPIs are seen as an area for further development, given the lack of established outcomes frameworks.

  

7.6 Needs Mapping In our survey, six service users who had accessed specialist counselling described what was most helpful about the service. Some extracts: “talking to someone” “(their) persistence and patience” “First time ever non-judgemental 1 to 1” “Someone to talk to abut my child and advise on the legal system” “..made me feel heard and understood on issues I could not talk to anyone about” Two victim/survivors stated that they had been very suicidal before the counselling.

More detailed needs analysis is given at Appendix 8. Headlines include: 

Demand clearly exceeds supply yet numbers are hard to gauge. In practice, commissioners mostly rely on front-line referral trends and waiting time estimates. These indicators cannot give a reliable picture of need, being influenced by many factors; there is wide variation in types of, or length of counselling needed, or in levels of complexity being addressed by a particular service The level of reported crime varies widely. Estimated numbers of clients who have reported the crime vary between services from below 10% up to 50% Therefore victim/survivor need is substantially greater than the numbers will demonstrate, to a degree that is challenging to estimate.

An attempt at meaningful estimates of potential need, using a simple extrapolation, is given at Appendix 8. This would suggest (subject to various caveats) a potential need to support 6,684 people if 50% of all victim/survivors reporting in one year were to seek help. The figures collected in our survey indicate that approximately 400-500 referrals were considered in 2014. This estimate is based on three calculations: o Recent reported crime figures for rape and sexual assault, o The widely-accepted estimate of an 85% rate of under-reporting to police, o As above - a purely hypothetical guess that 50% of all victim/survivors seek specialist support. Should 20% do so, this figure would drop to 2,674.

Even using these assumptions these figures may be fundamentally flawed, but they go some way to indicating the potential under-resourcing of such services.

Geographical accessibility is an important issue with some areas better served than others Specific groups: There are needs for services to offer further specialisation for certain vulnerable groups, notably: o Lesbian, gay, bisexual and transgendered people (LGBT)

  

 

38

e.g. as provided by The Survivors Trust

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o o o o

People from black and minority ethnic communities People with serious mental health problems People with learning disabilities People who have been exploited and/or trafficked.

7.7 Existing Supply Mapping: Specialist Sexual Violence Counselling We contacted the four primary providers of specialist sexual violence counselling for this exercise. Winchester, Portsmouth and Southampton participated in a survey and lengthy interview process.

New NSPCC service We also spoke with the National Society for the Prevention of Cruelty to Children (NSPCC) who are bringing their therapeutic counselling programme, “Letting the Future In”, to pan-Hampshire during 2015. The programme is expected to have capacity for 70-100 clients per year. The service is available for young people ages 4-17 and their families. The service will be provided in Southampton and the practicalities of travel will restrict clients to within 60 - 90 minutes travel time to central Southampton. This would roughly stretch just north of Winchester, Gosport and Romsey. At this stage this service is not included in the tables below.

How specialist Sexual Crime Counselling works pan-Hampshire: Four main providers There is much variation among sexual crime counselling providers due in large part from their unique origins. It is therefore useful to view each provider individually to appreciate their contribution, and the varying approaches taken to resource their services. It should be noted that each of the services outlined below have been in operation for at least 20 years and have a wealth of experience. They all provide training and supervision to their staff and volunteers, are members of The Survivors Trust and adhere to the British Association of Counsellors and Psychotherapists (BACP) guidelines.

Sexual Crime Counselling – specialist providers Provider

Offer to victim/survivors  

Basingstoke Rape and Sexual Abuse Crisis Centre (BRASACC):

 

 Portsmouth Abuse and Rape Counselling Service



Helpline providing confidential support and information for survivors of sexual crime and their supporters including family, friends and co-workers Individual counselling for men and women aged 16 and over who are survivors of sexual crime including rapid response trauma appointments and a series of trauma work appointments (if appropriate) Support groups for men and woman aged 16 and over who are survivors of sexual crime Training courses and presentations on sexual violence, delivered to schools, housing associations, children’s services, drug and alcohol teams, victim/survivor support/domestic abuse teams, mental health services and any other group who requests such a presentation BRASACC will offer an ISVA service from autumn 2015.

Help-line providing confidential one-off and on-going support and information for survivors of sexual abuse and their supporters (clients can use this number as an initial contact or follow up at any time)

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(PARCS):



      

       Southampton Rape Crisis (SRC):

      

Winchester Rape and Sexual Abuse Counselling

  

Pre-counselling telephone support: prior to starting individual counselling a client may be offered up to 8 sessions of individual emotional telephone support (ETS) with the same support worker, Group sessions focusing on emotional coping skills Group session for people experiencing both sexual crime and domestic abuse Individual counselling for people including children aged 5 and above including some drop in sessions for adults and support and counselling for the non-abusive parent/carer Counselling for parents and carers of young people (aged 518) who have experienced sexual crime A drop-in singing group available for clients who have completed their counselling Men only telephone helpline Awareness, Prevention and Education Programme offered to schools, colleges and youth clubs in the local area; includes short term 1-2-1 support for young people aged 13-24 years as part of the prevention programme Singing Group for women and men who are existing or past clients Drop in Service for women facilitated by 2 members of the PARCS team Training for organisations on a wide range of issues related to sexual violence.

Helpline providing confidential advice, support and information for survivors of sexual crime and their supporters Individual counselling for adults both male and female individual counselling for children and young people age 11 and up Family counselling for families struggling with the impact of sexual abuse or assault Group sessions for adults focusing on emotional coping skills, Group sessions for adults experiencing both sexual crime and domestic abuse Therapeutic groups for young people focused on creativity ISVA services for both adults and young people (age 11 and up) Prevention/education services (the STAR project) offered to schools and colleges in the SRC service area Training for agencies and partners New service for male victim/survivors 39.

Helpline providing confidential support and information for survivors of sexual crime and their supporters, Text messaging support service Email support service

39

In December 2014 Southampton Rape Crisis was awarded funding from the Government’s new Male Rape Support Fund to provide face-to-face counselling specifically for male victims over the age of 13. The MoJ’sBreak the Silence campaign around male rape and sexual assault acknowledges the barriers for male victims around reporting sexual crime and accessing help.

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(RASAC):

    

Individual face to face counseling for men and women aged 18 and over including partners and relatives, Support group sessions for adults focusing on emotional coping skills Group sessions focusing on the criminal justice process, in conjunction with Victim Services ISVA service for adults across Hampshire CC area is based out of RASAC Outreach to local colleges on the issue of sexual violence.

We also include an outline of CIS’ters’ provision here (CIS’ters does not specifically provide counselling):   CIS’ters: Surviving Rape and Sexual Abuse:

   

Helpline/Email offering confidential support and information for survivors of sexual crimes and their supporters Support groups (i.e. facilitated group meetings) for females who were raped/sexually abused/exploited by a member of their immediate/extended family Themed (facilitated) workshops, and annual workshop for female survivors who experienced any sexual crime as a child (familial and non-familial setting) Monthly drop in, for female survivors who experienced any sexual crime as a child (familial and non-familial setting) Limited advocacy for female survivors of sexual abuse as a child Training courses and presentations, including bespoke sessions, for workers in other agencies, across sectors, and themed (facilitated) workshops for partners.

7.8 Supply Mapping: Survey Results Adults Our survey of specialist sexual crime counselling providers yielded the following client profile: Counselling services to adults: Client profile Gender and age range

Most clients are white British women between the ages of 25 – 49. The next largest age group is 18-24 year olds (25% of total counselling clients).

Multiple experiences of sexual crime

Not every service records if clients have had more than one experience of sexual crime. Two services do, with one stating that 25-50% of clients had more than one experience of sexual crime, and another putting that figure at 50% -75%.

All service providers who responded would classify a crime that happened over a year ago as ‘historic’ and stated that at least 50% of their clients where dealing with historic crime. Indeed two providers put that percentage at between 75% -100% of clients.

(Further detail on the length of time since crime(s) were committed and the proportion reporting childhood abuse was not included in the research.)

“Historic” sexual crime

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Counselling services to adults: Client profile

Reporting crime

Referral route

In terms of counselling clients reporting the crime to the police, one service stated that only between 1% and10% of clients had reported while the another put that figure at 25% - 50%. Whilst these figures are inconsistent and very broad, we can at least conclude that less than half of the counselling clients have reported the crime to the police.

Most providers prefer or require self-referral as it demonstrates a willingness to participate in the counselling process. However, other professional referrals were also noted including mental health, GP/NHS referrals, ISVAs, police, the SARC, victim support and social services.

Young People There are two primary services providing specialist counselling for young people who are victim/survivors of sexual crime: Portsmouth Area Rape Counselling Service (PARCS) and Southampton Rape Crisis (SRC). Both organisations have seen an increase in client referrals in the last year with PARCS receiving 104 referrals and SRC receiving 135. The main referral sources for young people to counselling were the SARC/NHS/CAMHS, schools, and parents or carers.

Child sexual exploitation is considered in Section 9 of this document.

Counselling services to under 16’s: Client profile

Gender and age range

Reporting crime

Duration and timing of service

Most young people using the service are white/white British and the majority are female (80% at PARCS and 90% at SRC).

Boys and young men are victim/survivors in 17% of reported sexual crime. The gender split for the PARCS children’s serve (ages 5-10) is closer t0 50-50; this split starts to change around the age of 10.

Not every service records the number of clients who have reported the crime to the police; however one respondent told us that 100% of young clients had informed either the police or social services of the situation.

There was also some suggestion that the average length of service was longer than for adults and this could be due to the increased involvement with the criminal justice system.

Tables of current specialist sexual crime counselling services - see Appendix 9 Appendix 9 is a series of charts showing the availability of specialist counselling in detail by geographical area, including a breakdown showing Hampshire District Council areas, by age groups served, and by whether families are offered a service.

7.9 Findings: specialist sexual crime counselling pan-Hampshire Nine findings are set out below out under three themes: Uneven access and reach; specific groups; and organisational effectiveness.

Uneven access and geographical reach 1. Access to specialised sexual crime counselling is a geographically inconsistent across the Hampshire CC area with fewer services available for victim/survivors in the districts of Basingstoke and Deane, East Hampshire, Hart, Havant, Fareham, Gosport, Rushmoor, Winchester and the northern half of the Test Valley.

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2. Victim/survivors in need of a service find the system confusing which compound problems in accessing an appropriate service. A central information point was suggested by several people and the idea strongly endorsed by a consultee who had used services (“A MUST!!”)

3. Education and prevention services that address the root causes of sexual abuse are not consistently available pan-Hampshire.

Specific groups 4. Young people who experience sexual violence and their families have very limited access to specialised counselling services with many areas having no local option for services.

5. People with serious mental health problems: A significant percentage of clients at specialist counselling services also have a serious long term mental health diagnosis.

6. People with learning disabilities have a higher incidence of rape and sexual assault yet specialist counsellors do not report having a high number of learning disabled clients. Some teams have undertaken specialist training.

7. Male victim/survivors: PARCS runs the only dedicated helpline for men alongside its dedicated helpline for women and has the highest percentage of male clients (12%). All the providers work with male victim/survivors.

8. LGBT: There are no specialist counselling services aimed at members of the LGBT community. Consequently there is very little information about this group’s engagement with sexual crime counselling as generic services do not record this data.

Organisational effectiveness 9. Funding: Organisations which provide specialised counselling services have multiple funding streams that require reporting on varying metrics at different times. This reducing the amount of staff resource they can dedicate to clients.

10. A range of “integration” issues: Counselling services were unclear about the role of the various players in the criminal justice system and how their counselling work interfaces with the process.

7.10 Specialist Counselling: Gaps in, and uneven spread of Service Our analysis, based on interviews and survey results, appears in detail at Appendix 11 Although people contacted have been very helpful we have been unable to provide a meaningful funding table for sexual crime counselling as the information we obtained did not provide a comprehensive funding picture of this complex area of work.

Headlines include:  All existing services are unable to meet demand; waiting lists range from three to 18 months. Using and interpreting waiting list information is problematic, for example waiting list policies may be influenced by different lengths of contract.  There is uneven geographical coverage  A mixed picture emerges in terms of specific client groups. We consider people with mental health problems, families, men, LBGT people, children, people with learning disabilities, BME groups, and victims of human trafficking  We consider barriers to access and effective services including economic deprivation, generational patterns, court delays and staff attitudes, assistance/advocacy with the Criminal Justice system.

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7.11 Recommendations: Specialised Sexual Violence Counselling Specialised Sexual Violence Counselling (a) (b) (c)

(d) (e)

(f)

(g)

(h) (i)

(i)

(j) (k) (l)

Volume and targeting of counselling services Increase provision of specialised sexual violence counselling.

Increase provision of pre-trial therapy.

Increase services for children and their families. Specifically, Increase the availability of counselling for young people, and the availability of counselling and support (including support groups) for non-abusive family/parents/carers of young people recovering from abuse.

Increase services for children and young people who display sexually harmful behaviour.

Increase the availability of men only services, delivered by well trained and supported workers. This could include a facilitated self-help/empowerment group for men.

Add a service specifically for the LGBT community. This could include a facilitated self-help/empowerment group and a telephone helpline specifically targeting the LGBT community.

Train support workers working with learning disabled people to identify the signs of sexual abuse and possible symptoms of trauma due to sexual abuse.

Funding and contracting frameworks Use grants to support innovative projects where strategic gaps or need is identified.

Where contracting is the appropriate route, use longer term contracts wherever possible Consider options for commissioned services such as four-year tender cycles or three-year contracts with options to extend.

With steering group and others, consider how to coordinate and where possible to align funding decisions, and establish whether there are any joint funding options.

Promoting and commissioning integrated services Identify ways to improve collaboration between specialist counselling providers and NHS mental health services, and take action to implement these.

Appraise the option of basing at least one ISVA in every specialist counselling centre pan-Hampshire.

Promote a training programme similar to IRIS (domestic abuse) for professionals in the criminal justice system including court staff, in order to improve understanding and communication between specialist counselling providers and the Crown Prosecution Service, the courts and police.

.

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8 TREETOPS: THE SEXUAL ASSAULT REFERRAL CENTRE (SARC) This section outlines the unique role of the SARC service to victim/survivors of sexual violence pan-Hampshire. Its distinctive role was summarised in a consultation response from an independent stakeholder, stating that “Treetops SARC very capably serves all victim/survivors from Hampshire & the Isle of Wight and that it provides a far more effective and single point of service than some form of ad hoc local arrangement.”

8.1 The role of Sexual Assault Referral Centres NHS Commissioning Guidance states that Sexual Assault services “integrate care pathways in a seamless way for victim/survivors, so they tell their story once and can choose care journeys to access crisis support, assessment, specialist clinical interventions, options for forensic medical examination, support, counselling and where needed mental health and other physical health services such as gynaecology.

“Sexual assault services enable co-ordination with wider health and care, third sector specialist sexual violence support and criminal justice processes, to improve health and wellbeing, as well as justice outcomes. Robust partnership working is therefore vital for the care and criminal justice outcomes that service users and victim/survivors want. “ 40 Another useful summary appears in the 2014 SE Regional Strategic Assessment of Victims Services: 41 “The role of the SARCs is to provide a range of services to victim/survivors of sexual violence all in one place, so that they can receive all the support they require without having to contact and visit a number of different agencies and have to repeat the trauma, often exacerbated further by the range of initial responses received, some positive and others negative. SARCs are not solely focussed on supporting criminal justice prosecutions, but if and when the victim/survivor is ready to decide whether to report the offence, support is available to help them with this process, sometimes provided by specialist support through the work of Independent Sexual Violence Advisors (ISVAs), although there is a shortage of these specialist workers across all areas.”

8.2 Treetops Launched in 2006, the SARC service serving pan-Hampshire, known as Treetops, is located near Cosham and is run by Solent NHS Trust. NHS England has recently recommissioned the service for a further five years until April 2020, including the Young Person’s ISVA. The Police and Crime Commissioner, Hampshire Constabulary and the four Local Authorities contributed funding.

Inter-agency relationship building is an essential part of the work. Treetops is keen to maintain and develop inter-agency relationships further, especially with court staff and with ISVAs and ISVA providers.

40

NHS England guidance: NHS England Public Health Section 7A Commissioning Intentions, 2015/16 http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2014/12/phcomms-intent-15-16.pdf 41

Tapley & Stark, University of Portsmouth 2014

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Services offered The SARC provides services to all males and females after being raped or sexually assaulted regardless of police involvement. The SARC website describes the SARC service as follows:

 “We can provide:  A supportive environment for victim/survivors of rape or sexual assault.  Specially trained female crisis workers who will be available to you, from the moment you contact Treetops, to provide emotional support and to explain all the options that may be available to you. They will support you in whatever decisions you make.  Information on other support services in your area  Information and support on the choice of whether or not to report the assault to the police  Forensic medical examination by a specialist doctor. This examination will be carried out as sympathetically as possible, and can be undertaken whether the police are involved or not. The examination may include, where appropriate, pregnancy testing, emergency contraception and STI testing as appropriate, at the time of referral.  A young person’s ISVA (Independent Sexual Violence Advisor).  Police interview facilities.  Most of all - we will listen to you.”

SARC clients Numbers Gender Age Referral routes

Treetops sees 450-550 people per year; this appears to be increasing and reached 596 in calendar year 2014.

Proportion varies; in some months male client numbers are as low as 6%.

Initially 16+; now all ages are seen when out of hours.

Historically (has been in operation 8 years) was 96% police but the proportion is reducing – now around 75%. Self-referrals find Treetops on google.

8.3 Gaps in service identified by the SARC Treetops is in a unique position to identify pan-Hampshire issues and has developed direct responses to a range of practical challenges that face victim/survivors, for example the longstanding arrangements for travel to support victim/survivors from the Isle of Wight, the option to deploy to a victim/survivor who cannot travel to the Centre, and contingency arrangements with other agencies to address emergencies.

Gaps in the wider system identified by the SARC in this research included:  The length of the court process. This prominent issue was raised by others in the research; it was estimated that the process was taking 12-18 months  Counselling: shortage of available referrals in all areas, with an emphasis on the lack of counselling for young people  ISVAs – capacity problems across the board, same day response needed  ISVA services for under 13s  Education for juries  Further improvements in travel arrangements.

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8.4 Recommendations The issues raised by the SARC have largely been picked up elsewhere in this document, with the following exception:

(a)

Court Process Take into account the negative impacts on victim/survivors (and support services) caused by the length of the court process, and support action to promote recognition of these impacts and address these delays.

Impacts of court system delays – a Hampshire Constabulary viewpoint In an example of current (June 2015) activity on this issue, in a message to all staff regarding child sexual exploitation, the Hampshire Chief Constable wrote “…. what is really frustrating is when vulnerable people, such as rape victims, have the courage to come forward and we do a great job of building their confidence and investigating their crimes, but then court processes drag on for months and their trust in the criminal justice system is lost. That is why earlier this week I wrote to the Government Minister in charge of justice to highlight how long it takes to get cases to court in Hampshire. I highlighted four situations where victims have withdrawn their willingness to support a case and/or give compelling evidence because of this time lag.

“The Crown Court system needs to be flexible and responsive to the changing demand of increased sexual violence cases and I fear the current arrangements are undermining our ability to deliver good outcomes for victims. Therefore, I’ve asked for a review of how long it takes to get cases listed and to raise the risk to public confidence because it isn’t good enough”.

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9 MISSING, EXPLOITED AND TRAFFICKED PEOPLE 9.1 Scope of this section, Definitions, and Terminology This section outlines context, indications of need, and information about support available, in respect of missing, exploited and trafficked (MET) children and adults in relation to sexual crime. The section also describes “pointers” to development priorities.

It is acknowledged that:  These definitions are broad and that individuals’ experience may or may not fit into a category of need; for example, child sexual exploitation cannot be readily separated from child sexual abuse, and the term “Child Sexual Abuse and Exploitation” is coming into more widespread use  There are specialist pan-Hampshire partnerships working to address the needs of MET children – see the Section 12 of this document  Specialist services that exist for victim/survivors of sexual crime, outlined in other sections will have a key part to play for some or all of the MET victim/survivors. Here we seek to identify further specialist needs/services  The project has not undertaken specific research and analysis of the links between the sex workers and sexual crime, a prominent issue in this field that has been raised in response to the first draft document  The limitations of this research mean that there will be important areas that have not yet been pursued as a line of enquiry, where further work may be needed to ensure local needs are fully understood.

Definition: Missing, Exploited, and Trafficked Children Readers are referred to the detailed definitions in use in the current partnership protocol published by the pan-Hampshire group of Local Safeguarding Children Boards (4LSCB). This guidance emphasises the importance of working to a consistent definition of what is meant by missing, child sexual exploitation, and child trafficking. 42 Child Sexual Exploitation (CSE) has recently been broadly defined in a Hampshire Constabulary message to all staff (26 June 2015) as “exploitative situations, contexts and relationship where a child or young person receives something (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them engaging in sexual activity”.

Definition: Missing, Exploited and Trafficked Adults For adults, defining MET in terms of sexual abuse is less straightforward, for example, in relation to the issue of consent. A useful local definition appears in the new guidelines recently published by the 4LSAB (the four Local Safeguarding Adults Boards: see Section 12), which is given below together with a UN definition of trafficking, sourced from the College of Policing website.

42

http://www.hampshiresafeguardingchildrenboard.org.uk/user_controlled_lcms_area/uploade d_files/4LSCB%20MET%20protocol%20dec%202013.pdf

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4LASBDefinition: Adult Sexual Abuse Rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.(page 21Safeguarding Adults: Policy, Guidance and Toolkit (page 21) published 4LSAB May 2015).

UN definition of Trafficking The United Nations (UN) defines Trafficking in people as: The recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, or abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments of benefits to achieve the consent of a person having control over another person, for the purposes of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs. The recruitment, transportation, transfer, harbouring or receipt of a child for the purpose of exploitation shall be considered 'trafficking in persons' even if this does not involve any of the means as set out above. (College of Policing website).

9.2 Policy context Here are examples, based on initial web research, of recent policy moves that illustrate MET as a fast moving and complex policy area: 

 

Child sexual abuse is now designated as a national threat. “This will ensure the police approach it in the same way as they address other national threats such as terrorism, and serious and organised crime. It will help forces prioritise work to safeguard children, and strengthen the policing response to tackling CSA.” 43 The Government published its Modern Slavery Strategy in November 2014, which refers extensively to sexual exploitation associated with trafficking and modern slavery The Care Act 2014 made new provisions for safeguarding of vulnerable adults at risk of neglect and abuse.

National charities and groups active in this field publish a range of material that may be helpful in considering how best to support victim/survivors or groups of people who include a significant number of victim/survivors of sexual crime. The many examples include   

National Working Group Network – Tackling Child Sexual Exploitation: http://www.nwgnetwork.org/news?n=447 Academic research by the University of Bedfordshire, including several evaluations of Barnardo’s services at http://www.beds.ac.uk/ic/publications Salvation Army summary http://www.salvationarmy.org.uk/human-trafficking

43

https://www.gov.uk/government/publications/crime-and-policing-news-update-march-2015/crime-andpolicing-news-update-march-2015

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

Social Care Institute for Excellence guidance on adult safeguarding (also referred to in Section 12 of this document)http://www.scie.org.uk/care-act2014/safeguarding-adults/

Locally, Hampshire Constabulary has recently made Child Sexual Exploitation a force priority as outlined in the following extract from a recent message to all staff: Extract from weekly message – June 26, 2015 (to all staff from Chief Constable, Hampshire Constabulary) I hope by now you’ve read the global email from our DCC explaining the decision to make Child Sexual Exploitation (CSE) a force priority.

CSE is the top priority in what is known as our force Control Strategy – which is a formal way of assessing threat, risk and harm to our communities.

In May 2015 a new team, called Goldstone was launched as part of wider changes to Public Protection. Goldstone's aim is to improve engagement with vulnerable children, identify those at the most risk, and ensure that multi-agency support plans are in place.

The team will play a key role in co-ordinating efforts across the whole force and ensuring that clear and accountable performance metrics are in place for all teams.

Early success has seen 12 children newly identified as subject to CSE, with four of these receiving the right multi-agency help…

Identifying child sexual exploitation is a key priority for Hampshire Constabulary.

Everyone working in a policing role should understand their role in protecting these young people…”

There is an obvious high level of attention, information, and emphasis on child sexual exploitation and abuse. Whilst this is welcome, several people interviewed and consulted for this report have commented on the associated risk of lack of attention to vulnerable adults, many of whom have experienced childhood abuse.

Here is one local example of recent pro-active work on adult safeguarding, that is closely associated with support to adult victim/survivors of sexual violence: Recent example of awareness raising: the first ever Isle of Wight Safeguarding Adults Conference This conference, held on 15 May 2015, was attended by more than 180 people. 44Jointly organised by the police and crime commissioner for Hampshire and the Isle of Wight, and the Isle of Wight Safeguarding Adults Board, the event provided both professionals and members of the public with updates on key issues from a range of national and local speakers. It represented a vital networking opportunity, where key connections can be made, and solutions discussed and developed.

9.3 Local indications of prevalence and need Both adults and children Evidence collected for this scoping exercise is largely based on talking to practitioners and managers who encounter this hidden issue, rather than relying on 44

https://www.iwight.com/news/First-ever-Isle-of-Wight-Safeguarding-Adults

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hard data such as reported crime figures. Available numerical data has some value but can give only a limited picture. This was reinforced by comments from members of the virtual reference group for this project, that numerical information they have, whilst useful, is likely to represent “the tip of an iceberg.”

One interviewee commented that talking to practitioners, for example in substance misuse or mental health, will tell a very different story to that suggested by the available figures.

Another commented on the gap in data on victim/survivors subject to a “toxic trio” of vulnerabilities, due to the fact that most services do not help people who are currently using drugs, exacerbating the lack of reliable figures to evidence the need, and thus bigger gaps in services:

Children “flagged up” as at risk of CSE: Numbers Multi-agency operational groups (see Partnerships – Section 12) use Problem Profiles complied by Hampshire Constabulary and risk assessments protocols as tools to inform and target the response. These generate detailed data and intelligence about known children at risk and patterns of activity that help identify perpetrators.

We provide some data below, provided by Hampshire Constabulary and by the County Council but it is important to be aware, and practitioners have warned, that these figures by their nature cannot represent a true estimate of need.

Current police datashows 187 children identified through the problem profiles as being at risk in April 2015, 52 of these assessed as high and 89 as medium risk.

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At this stage the reasons for the recent Hampshire CC increase are unclear.

Children at risk - Further detail: Hampshire County Council only We know that each Local Authority will have available data, but the resources available did not allow for pan-Hampshire analysis. To consider potential ways of assessing need, we pursued limited lines of enquiry in just one of the four Authorities - Hampshire County Council.

We telephone-interviewed the Chair of the Hampshire CC LSCB operational MET sub group, who was able to provide (verbally) the following numbers of children assessed as being at risk:

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Children at risk of Child Sexual Exploitation: Summary panHampshire figures 12 month period to April 2015 Number of assessments over 12 months

643

Number of children assessed to be at risk

462

Gender

90% female

Currently at risk (May 2015) – discussed at operational MET group High risk

89

Medium risk

49

Moved to low risk

13

Total “live” figure

151

Notes  It is important to limit this to global figures to protect data. The Problem Profiles provided by Hampshire Constabulary contain detail that is restricted information  This cannot represent actual figures of children at risk in the community as it can only show children who have been referred in (by schools, concerned family, etc.)  The reports are compiled by Hampshire Constabulary who can only process the information that they already have.

These two sets of figures do not fully match, but taken together they provide a reasonable indication of the sorts of numbers the operational groups are currently considering. As for reported crime, these numbers are likely to represent only a small proportion of the underlying numbers at risk.

Substance misuse link/overlap There is a clear association between substance misuse and child sexual exploitation.

In the Hampshire CC area, the commissioned children’s substance misuse provider estimates that around 28% of children known to their service are at risk of sexual exploitation. This highlights a significant current issue – the link between grooming and one currently cheaply available New Psychoactive Substance: mephedrone, which increases sex drive. Dealers are doing special offers and using anonymous social media to bombard young people with messages, invitations to parties, and so on. The commissioner advises that we know only the tip of the iceberg; the figures below only represent the young people who have become problematic according to those around them or themselves.

“Young people are brainwashed; they don’t know what is being done to them”. (interviewee) The overview data below is based on the commissioned children’s substance misuse service provider’s reports:

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Hampshire County Council data: Children/young people aged 11-18 identified by substance misuse services as being at risk of CSE Numbers reported by provider (Cartch-22) as requiring a multi-agency response 12-month period April 2014-March 2015

528

Proportion estimated to be at risk of CSE

28.2%

Number estimated to be at risk of CSE

149

Comments:  Important to avoid publishing any information at identifiable level  This is not direct evidence of the level of need “out there”; it only incudes those who have sought help or where help has been sought; this will skew the picture  Distribution: areas with most known activity do not necessarily correlate with distribution of the 149 children most at risk.

9.4 Male victim/survivors Recent (2014) research on behalf of Barnardo’s: “Research on the sexual exploitation of boys and young men: A UK scoping study” 45concludes that boys and young men form a sizeable minority of victim/survivors, probably in the range between 11% and 29% of all young victim/survivors. The report states that even less is known about these hidden crimes than for girls and young women. Awareness training amongst professionals, and improved, standardised data collection are among its recommendations.

9.5 Victims of human trafficking and modern slavery “It’s not just about people coming in from other countries – it’s about adults who are vulnerable” (interviewee, Isle of Wight) This paragraph is based on a recent Hampshire Anti-Trafficking Partnership presentation: 46 Since 2009, the NRM (National Referral Mechanism) has been the national framework for collecting data and is Framework for identifying victims of human trafficking, collecting data and ensuring they receive the appropriate protection and support, facilitated by the National Crime Agency UK Human Trafficking Centre (UKHTC). First Responders (from a wider range of agencies) complete a referral to UKHTC. In pan-Hampshire, 40 persons were referred in the 9 month period March to December 2014, as follows.     

35 males; 5 females (3 females sexually exploited) 35 adults; 5 minors (4 minors from Vietnam) 27 from Eastern Europe (19 from Romania 3 from Britain) 4 sexual exploitation (1 minor 1 male) 24 labour exploitation

45

http://www.barnardos.org.uk/cse_young_boys_summary_report.pdf

46

Presentation by Laura Franklin (OPCC), DI Dick Pearson and DCI Scott McKechnie (Hampshire Constabulary) at http://www.hampshire-pcc.gov.uk/DocumentLibrary/HIOWLA.pdf More on the Partnership (now Anti-Slavery) in Section 12

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 

5 criminal exploitation – cannabis farms (all Vietnamese) 2 criminal exploitation – shoplifting.

The National Referral Mechanism focuses on trafficking not exploitation – so “Exploited – no service; Trafficked – yes”.

It appears that four (10%) of this pan-Hampshire total of 40 people in this group were identified as having been subject to sexual exploitation including one child, with the predominant criminal activity being labour exploitation.

87.5% were male. Of the five female victim/survivors three (60%) were identified as subject to sexual exploitation, and one of the 35 males (3%).

These figures, being small, have limited significance, and the level of hidden sexual crime is likely to be higher among this group, as is the case in the wider community.

Victims of modern slavery: information from the Medaille Trust “In the Trust’s experience, by far the biggest source of stress for victims is the fear of being deported, and associated with this, protecting their family. Everything else takes second place.

“Sexual Violence is often the last thing victim/survivors want to talk about. Some may have experienced Sexual Violence for their entire life and may seek to address it in a year or two if and when they are a bit more settled.”

Manager, Medaille Trust (interviewed May 2015) It is hoped that further local intelligence on need will emerge as a result of the new the pan-Hampshire anti-slavery partnership; see Section 12 on Partnerships for further detail. The Medaille Trust has received a year’s grant funding to help deliver the partnership work.

The Trust runs well-staffed safe houses in the OPCC area for 18 adults, all referred via the national Salvation Army contract to fulfil the UK’s legal obligations to trafficked people. Taking turnover into account (it is a short stay service), around 100 people use the service each year. Further details are given at Appendix 10. The Medaille Trust’s reports and views on the needs of trafficked people provide useful indications of need in terms of sexual crime: 



Few referrals come from the pan-Hampshire area. Based on experience elsewhere, the manager commented that the numbers are surprisingly low and she would expect a lot more. This would suggest that these crimes may be more hidden in pan-Hampshire than in some other areas The service will soon be about 50-50 women/men. The manager estimates that o Most or all of the women supported have experienced sexual violence, but for many, this issue is the last thing they want to talk about at this stage (see box above) o Young men from certain backgrounds may have experienced sexual violence but this is even more of a hidden crime than for women.

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9.6 Support available for MET victim/survivors MET – gaps in services One interviewee, when asked what the biggest service gaps are, replied “everything”.

Overview Both generic and specialist services are under pressure and preventive services funded by local authorities have already been cut significantly. This trend is expected to continue. Nevertheless, the voluntary sector, traditionally highly dependent on local authority funding, is widely regarded as a key element of provision, including in Government policy and guidance.

The lack of specialist services to refer to is a recurring pan-Hampshire issue, and where there is a successful service, it is massively oversubscribed. There is a balance to be achieved:

Generic and Targeted* services

Specialist MET services

Making generic services as holistic Providing specialist MET and integrated as possible to be victim/survivor services separately for accessible to MET victim/survivors, with adults, children, families maximum use of information sharing * Targeted services: specialist services, not explicitly focused on the MET group, who work with client groups where MET is significant, notably substance misuse provision.

Some generic services have been praised in the research interviews (e.g. sexual health: “on board, influential and supportive”.) Others (e.g. Child and Adolescent Mental Health Services – CAMHS) are known to be aware but have significant capacity problems 47.Nationally, there is a programme to improve and extend CAMHS, which is coming up the agenda. The recent Hampshire CC MET sub group 48 action plan identifies a need for better partnership working with CAMHS and plans to secure CAMHS representation on the MET group.

Children For under-16s, Social Services have lead responsibility and the practical details of these arrangements, which will vary between Local Authorities, were not researched during the Mapping and Scoping process. Age often cannot be proved. When a young person reaches their 16th birthday there is an immediate referral to adult services, and the Medaille Trust often receives vulnerable16-year-olds on their birthday.

Specialist Services identified in the pan-Hampshire area This is an area where commissioners and providers are constantly striving to find innovative ways of meeting the challenges posed by the needs of MET victim/survivors and, given fast-diminishing resources, a continuing focus on creativity and collaboration.

47

Pan-Hampshire, CAMHS are provided by three NHS Trusts: Hampshire CC area: Sussex Partnership NHS Foundation Trust, Portsmouth and Southampton: Solent NHS Trust, Isle of Wight: Isle of Wight NHS Trust.

48 See Section 12 for MET groups

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The following table shows the local specialist services identified in the research carried out for this project. This is by no means an exhaustive list of all available services.

Name of service

Description including client group(s)/ Area(s) served

Hampshire Constabulary: Goldstone Team

New team, which aims to improve engagement with vulnerable children, identify those at the most risk, and ensure that multi-agency support plans are in place.

County Council Children’s Service

Hampshire County Council area Hampshire CC has successfully bid for Innovation Funding for a larger project that will Establish a multi-agency Missing, Exploited and Trafficked Team (MET) specifically to address the needs of children and young people who repeatedly go missing. (this team will not provide therapeutic input.)

Barnardo’s: Hampshire Sexual Exploitation Service

Hampshire CC (one worker), Southampton (two workers), Isle of Wight (two) Child sexual exploitation/trafficking: Prevention of and supporting recovery from episodes of exploitation and trafficking. Support and advocacy for trafficking victims. Help with keeping safe, dealing with relationships and issues affecting individual lives. Noted this service is “massively oversubscribed” 49

Barnardo’s Southampton Miss-U and U-Turn Service

Work with young people in Southampton: “Barnardo's Miss-U and U-Turn Service in Southampton helps young women and young men under the age of 18 who are vulnerable to, or are being, abused through prostitution in Southampton. We aim to help protect young men and women through direct work and support on:  personal safety  relationships  sexual health  risks and self-esteem, and help them to exit from sexual exploitation/prostitution.

In common with a number of Barnardo’s services concerned with sexual exploitation, Southampton Miss-U and U-Turn Service is committed to working with some of the most vulnerable young people. The service is jointly funded by Barnardo’s and Southampton Social Services.” (from Barnardo’s website)

Barnardo’s Portsmouth U-turn service

The U-Turn service for young people under the age of 18 who need help with keeping safe, dealing with relationships and issues affecting their lives.

Young people can talk to staff about sexual health, sexual exploitation and get information to access services such as housing, benefits, education etc. The Miss-U Service provides support and advice to young people putting themselves at risk by going missing.

49

Interview, Fleur Gardner, IoW Council May 2015

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Name of service

Description including client group(s)/ Area(s) served

Love 146

Knowledgeable specialist agency that runs a small children’s safe house in a location within Hants OPCC area. Part of a national/international charity dedicated to this issue. Local manager has expertise and can informally advise practitioners.

Specialist Counselling Services including PARCS (Portsmouth), SRC (Southampton)

Profiled in Section7 of this document, these services do not exclude clients on the basis of the offence they have experienced, and therefore offer support to MET victim/survivors. Therefore, all sexual crime services will be working with clients from this group and could be supported to increase capacity for this work. Southampton Rape Crisis reports that “We …..have supported some clients who have been victim/survivors of MET – SRC is represented on the Southampton Strategy and Operational MET meetings”.

Portsmouth Abuse and Rape Counselling Service is represented at Portsmouth City Council Child Sexual Exploitation meetings.

It is likely that a range of services targeted at, for example, young people may have expertise within their teams to help MET victim/survivors. We did not research this in detail, but a short web exercise identified one example in Portsmouth: Name of service

Description including client group(s)/ Area(s) served

Example of a service known to have some specialist expertise

Off the Record: One example of a small local voluntary service with some expertise to help MET victim/survivors. Off the Record is a small charity offering counselling to young people in Havant and Portsmouth whose 2013/14 statistics showed that 16% of clients were seeking help about abusive situations.

We were advised that many such agencies have experienced reductions in funding, and are reducing capacity or closing.

Sex workers In terms of sex workers the research did not quantify the incidence of exploitation or trafficking. However, we did trawl for services targeted at sex workers in general and identified an outreach service in Southampton provided via sexual health promotion, and CIS’ters (specialist support provider, see Section 7), sent comments and reported that. “A number of the women who access our service were, or are, street workers (as adults). Many of the women who access our service were exploited on the streets as young people as well.”

We concluded that  Services directed at exploited sex workers are scarce  This is an underserved group that could benefit from a specialised service  Any future such service would benefit from partnering with existing services, where they exist.

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Trafficked victim/survivors  The Hampshire Constabulary website has a useful, recent list of links and information about both statutory and non-statutory services, some of which are local 50.  Safe housing: For children and care leavers there is a statutory responsibility; options used have not been researched with Social Services.

For trafficked children there is one small safe house (Love 146), a national charity that happens to have this small service for children on the patch.  For adults 16+, there is also a (limited) statutory responsibility under the EU Convention on Action against Trafficking in Human Beings. Housing provision is very limited although supported housing options might be available for some homeless adults, which have not been researched in detail. The Medaille Trust runs the only dedicated housing provision for this group in the Pan-Hants area – 18 places, referrals only via the National Home Office Referral Mechanism. (More detail is at Appendix 10)  Sexual Health clinics are very accessible, for example, providing a drop-in for “high vulnerability” people (Sexual crime and trafficking).

There are major limitations as to what services trafficked people can access in general, particularly those from outside the EU and these are discussed further at Appendix 10. Headlines include:    

Registering with a GP, when you may not have any ID or address Homelessness services are often unable to help victim/survivors without children NHS Psychological Therapy (IAPT): drop-ins are helpful, although interpreting issues are a big barrier Specialist counselling: usually inaccessible due to the waiting list and relatively short term stays in the area.

Specialist trauma counselling, and NHS Psychological Therapy (IAPT) services The 2014 regional study of victim services referred to these services, (described at Section 7 of this document), stating that they have a key role to play in terms of MET victim/survivors: To respond to the increasing demand for specialist trauma counselling for victims of trafficking, human exploitation and sexual exploitation, it is important to develop greater capacity. These services could be made available by developing them within existing service providers who already undertake trauma counselling and therapy, or are planning to do so.”

SE Regional Strategic Assessment of Victims Services - Hampshire Recommendation p36. (Tapley& Stark, University of Portsmouth 2014).

50

At http://www.hampshire.police.uk/internet/advice-and-information/abuse-against-the-person/antitrafficking-partnership

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9.7 Recommendations: Missing Exploited Trafficked

(a) (b) (c)

(d)

(e)

(f)

(g)

(h)

(i)

(j)

Missing Exploited Trafficked All victim/survivor sub groups Continue to develop and prioritise MET multi-agency partnership work including both children and adults.

Specialist sexual crime counselling: As recommended in Section 7, develop capacity in this area.

Consider further work to understand links between MET victim/survivors and exploited sex workers, and support needs/effective models. Consider the possibility of grant funding to support this.

Consider whether more work is required (e.g. via multi agency partnerships) to help quantify numbers of known vulnerable people (both adults and children) in each of the 4 LA areas.

Work in partnership with NHS commissioning colleagues and others to establish the role of NHS therapeutic provision in terms of specialist trauma therapy for MET victim/survivors and scope for improving access.

Through partnership working, encourage training and development for frontline practitioners across many sectors to equip them to address MET in their roles.

Children Support efforts by MET multi-agency partnerships to improve child and adolescent mental health services available to MET victim/survivors (as well as all sexual crime victim/survivors under 16).

Adults Promote the profile of vulnerable adults in relation to sexual exploitation through multi agency partnerships and training and awareness events.

People who have been trafficked Press for improved access for people who have been trafficked to a range of services for example through drop-ins or interpreting services. Consider grant funding to help understand this need.

Make full use of the investment in the new Anti-Slavery Partnership as the work progresses, to better understand the extent of sexual crime in this area and the associated service needs, and as a vehicle for further awareness-raising in terms of sexual crime.

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10 FEMALE GENITAL MUTILATION 10.1 Introduction, terminology and definitions Definition Female Genital Mutilation (FGM): A collective term (also known as genital cutting and female circumcision) for all procedures that involve partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or non-medical reasons.

Female Genital Mutilation is a criminal offence in the United Kingdom. It is also a criminal offence for UK nationals or permanent UK residents to carry out Female Genital Mutilation abroad, or to aid, abet, counsel or procure the carrying out of Female Genital Mutilation abroad, even in countries where the practice is legal. 51 Terminology This document uses the term FGM – Female Genital Mutilation 52 – throughout in view of its current “currency” across sectors. A refinement of this, Female Genital Mutilation/Cutting (FGM/C) is a term that is in line with the recommendations of the Department for International Development and leading activists.

10.2 Legislation, and recent policy and guidance As well as previously existing legislation, the Female Genital Mutilation Act 2003, which came into effect in March 2004, makes it illegal to practice FGM in the UK, and to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in that country, to aid, abet, counsel or procure the carrying out of FGM abroad. It carries a penalty of up to 14 years in prison and/or a fine.

Mounting pressure led to a 2014 parliamentary Home Affairs Select Committee report, to which the Government response “Female genital mutilation: the case for a national action plan” was presented to Parliament in December 2014. 53 The resulting comprehensive set of actions (28 responses are listed) include a wide range of actions and responses which are now filtering through to, and being taken up by agencies and partnerships including those in pan-Hampshire, strengthening a range of pro-active and reactive responses to the issue of FGM. This includes awareness and information, and the Government website now contains a considerable body of up to date information aimed at a wider audience, appearing across and number of departments (e.g. Home Office, Department of Health). The message reinforces that FGM is child abuse, that it is a crime, and how to get help.

Further measures were announced in February 2015 on the International Day of Zero Tolerance for Female Genital Mutilation. 54

51

Definition from Keywords website http://trixresources.proceduresonline.com/nat_key/keywords/a_fgm.html 52 53

Amended in final Strategy to Female Genital Mutilation/Cutting

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/384349/FGMresponse Web.pdf 54

https://www.gov.uk/government/news/new-measures-to-end-fgm-on-international-day-ofzero-tolerance

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The DH FGM Prevention programme team published a raft of detailed guidance in March 2015. Key publications include:  

Safeguarding women and girls at risk of FGM: practical help to support NHS organisations developing new safeguarding policies and procedures for female genital mutilation (FGM). 55 Commissioning services to support women and girls with FGM: This document sets out what some elements of a successful and safe service to support women and girls with female genital mutilation (FGM) might look like. 56

In addition the DH released E-learning sessions, the Health Education England eFGM programme and a new information standard and dataset both went live from 1 April 2015.

10.3 Prevalence FGM is so hidden and unreported that accurate measures of prevalence are always problematic. However, as more work is done to expose the problem, more estimates become available, making it possible to give some global estimates.

For example, the Home Office leaflet “FGM: The Facts” states that “The World Health Organisation estimates that three million girls undergo some form of the procedure every year in Africa alone. It is practised in 28 countries in Africa and some in the Middle East and Asia. FGM is also found in the UK amongst members of migrant communities. It is estimated that over 20,000 girls under the age of 15 in the UK are at risk of FGM each year.

 “UK communities that are most at risk of FGM include Kenyan, Somali, Sudanese, Sierra Leonean, Egyptian, Nigerian and Eritrean. Non-African communities that practise FGM include Yemeni, Afghani, Kurdish, Indonesian and Pakistani.”

Most recently, a major Department of Health funded study 57 (published July 2015) found that FGM affects women in every Local Authority in England and Wales.

Recent NHS FGM indicative statistics: Regional, and local Locally, the new Department of Health reporting requirements may start to give clearer indications of prevalence, possibly revealing more numbers and thus a growing potential demand for support services.

New NHS statistics covering six months to the end of March 2015 are available. A refined dataset is now being used from April 2015. These figures are collated at NHS provider Trust level, allowing for pan-Hampshire numbers to be identified. (These numbers will be approximate, as hospitals treat people from wider geographical areas and some Hampshire people use hospitals in neighbouring areas).

The new DH commissioning guidance warns of the serious limitations of these figures and nevertheless advises that they can still represent an important indicator.

The following tables summarise some of these statistics, and further background and explanation of the figures is at Appendix 12.

55 56

https://www.gov.uk/government/publications/safeguarding-women-and-girls-at-risk-of-fgm https://www.gov.uk/government/publications/services-for-women-and-girls-with-fgm

57

https://www.city.ac.uk/__data/assets/pdf_file/0003/266034/PREVALENCESTUDY_FINAL.pdf; http://www.theguardian.com/society/2015/jul/21/fgm-affects-females-inevery-local-authority-in-england-and-wales-study

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National/regional: Summary statistics for the four English NHS commissioning regions, with national totals:

Commissioning Region National

Newly identified* London Midlands and East of England North of England South of England (includes Hants) England

TOTAL 2,040 849 707 367 3,963

*Patients first identified during the reporting period as having undergone FGM. This will include those diagnosed/identified within the provider within the month.

Active Caseload* As at the end of: Commissioning Region National

Mar-15**

London Midlands and East of England North of England South of England (includes Hants) England

1,783 686 448 247 3,164

*Patients identified as having a history of any FGM type prior to the reporting period and still being actively seen/treated for FGM-related conditions or any other non-related condition at the end of the month. (Note: does not include those patients within the above table who were identified during March 2015) **Figures are also given for each of the preceding five months

Local: data from hospitals located in the pan-Hampshire area 58, in the above-defined categories: Newly Identified cases of FGM - All types, September 2014 to March 2015 Trust Hampshire Hospitals NHS Foundation Trust Isle Of Wight NHS Trust Portsmouth Hospitals NHS Trust University Hospital Southampton NHS Foundation Trust Total

Total for 6months 0 0 12 33 45

Active Caseloads of FGM by Trust, for the month of March 2015 Organisation name Hampshire Hospitals NHS Foundation Trust Isle Of Wight NHS Trust Portsmouth Hospitals NHS Trust University Hospital Southampton NHS Foundation Trust Total

Mar-15 0 0 7 14 21

We understand that there are no recorded cases at all in the Isle of Wight 59 although this is not ruled out for the future, as the population has become marginally more

58

This does not give complete coverage, as some people travel to NHS hospitals in neighbouring areas e.g. Frimley Park Hospital (used by people in NE Hants) 59 Interview May 2015 – Fleur Gardner, Lead – Adult Safeguarding, IoW Council

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diverse due to small numbers of people from minority communities on the mainland have moved over to the island in recent years.

10.4 Partnership Research: Attitudes to FGM/Cutting in Portsmouth and Southampton The first local data to become available on this issue has recently been completed in a 12-page report (April 2015). 60Prior to this research no data, qualitative or quantitative on Female Genital Mutilation/Cutting (FGM/C) in pan-Hampshire existed.

This paragraph summarises key aspects and gives the headline recommendations.

The research, centrally coordinated by Southern Domestic Abuse Service (SDAS) and The African Women’s Forum (AWF) Portsmouth in partnership with Portsmouth University, was funded by the Rosa Trust.

Research aims: The overarching aim was to make a significant contribution towards the eradication of the practice of FGM/C, with stated objectives as follows: Primary objective:  To acquire some qualitative data to ascertain if FGM/C poses a significant issue in those African diaspora communities in (pan-) Hampshire where it is known to be practised in the country of origin.

Secondary objectives:  To build relationships of trust with members of the affected communities.  To raise awareness amongst affected communities and those whose duty it is to serve them.  To use the data gained from the study to suggest directions for policy and intervention which might be recommended to key stakeholders.  To help shape the direction of training development on FGM/C for key professionals in (pan)-Hampshire.

Methodology: The exercise did not attempt to pinpoint numbers (The report provides African population statistics for Portsmouth and Southampton). A part time researcher, himself of African origin, who has considerable community knowledge approached communities informally and in accordance with cultural norms, engaging with people through gentle conversations around the subject of cultural identity and tradition. Consent forms were used, the work adhered to a robust ethical code, and rigorous child protection processes were followed. 55 individuals were interviewed and focus groups were also used.

Data analysis used an attitude continuum and a discussion of reasons behind people’s views, often discussed and noted in the appropriate language and translated subsequently.

Selected summary findings and conclusions % of the 55 Attitude to FGM/C interviewees

60

Supportive

12.7%

Ambivalent

27.3%

Opposed

60%

At date of writing, shortly to be published on SDAS website/Facebook page

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From the report: Conclusions (point 5.1) It is recognised that this research study is small and never set out to establish any statistical data, so no wider conclusions can be drawn concerning the whole of the African diaspora communities in Portsmouth and Southampton. However, key points to emerge within this study are as follows:     

The level of trauma associated with a woman’s own experience of the practice was highly significant in shaping her attitude to FGM/C The level of cultural conservatism and the particular community that the participant was from was highly significant in shaping attitudes Women did not know where to find information about FGM, nor where to seek help, should they need it Age made no significant difference to the views expressed Many women and men form diaspora communities affected by FGM/C would welcome policies and services to support them in eliminating the practice of FGM/C from their communities and families.

Headline Recommendations: The report identified four recommendations, strongly focused on education, not on convictions, seen as risking driving the practice further underground. Recommendations are as follows: 1. Develop education and empowerment programmes that focus on empowering women and girls 2. Engage with organisations and groups in African diaspora communities where the practice has support 3. Establish a systematic personal and social education schools programme 4. Develop resources to raise awareness and educate professionals.

Additionally, the report stated that “..Given the evidence gathered in this study there are strong grounds to support the appointment of a full-time permanent officer to work with AWF and key mentors to oversee a dedicated schools programme and to work with health and social care services to develop coherent and robust protection and referral mechanisms.”

SDAS experienced a “steep learning curve” in hosting the research, with many issues arising throughout, and some anticipated issues not materialising; “Didn’t find women saying ‘I’ve had FGM and I need help’”.

A key learning point was that “We are years away from revealing this very hidden issue. To tackle it, serious long-term funding would be required. Locally, say 5 years funding for two part time workers is required to make a difference”. 61 10.5 Support Available Overview At this stage it is not surprising that there is little specialist support available for victim/survivors of FGM, given the low level of resource specifically going into this emerging area of work. However, practitioners in other services, when asked in telephone interviews, have shown awareness of the issue, and some indicate that

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Interview, Claire Chatwin SDAS May 2015

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they have come across small numbers of victim/survivors of FGM in the course of their work.

It will be vitally important to develop accessible, trusted, and appropriate support to “cope and recover” and, particularly in the case of FGM, help prevent future crimes – whether or not the victim/survivor ever reports a crime. One possible route is for appropriate existing support providers to develop their responses.

Ongoing work at Southern Domestic Abuse Service SDAS has secured funding for a short term (from Portsmouth CC to the end of June 2015, and OPCC to March 2016) FGM/C community engagement officer, who works in partnership with community groups whose members include those affected by FGM/C. The FGM/C Community Development worker, who is of BME origin, provides support to survivors of FGM/C. However, this short term and small-scale work will inevitably have limited impact and ideally work should be sustained, developing the learning from it, identifying and spreading good practice to respond as this hidden issue becomes better known and understood.

SDAS also empowers women to make decisions about their own and their daughter’s bodies by providing information about their rights, protection and the law.

Local Voluntary Sector The small pan-Hampshire numbers and the hidden nature of the problem make it highly unlikely that there will be local voluntary sector services specifically focused on FGM, indeed such services are rare anywhere in the UK. However, within the diverse and vibrant sector involved in with addressing the needs of victim/survivors of sexual violence and related issues there is widespread and growing awareness and, increasingly, elements of capacity building to offer expertise and support to victim/survivors of FGM. Locally, two of the 24 organisations responding to the specialist counselling and ISVA survey undertaken for this project answered “yes” to the question “Does your organisation provide services or information on the issue of female genital mutilation?”, one commenting that “I have had the training but have not been called upon to use it.” Southampton Rape Crisis has confirmed that they “do not work specifically with this group but can/have supported clients affected by FGM through counselling / ISVA support”.

The survey went to a limited number of agencies, and there is evidence that others who support women victim/survivors of sexual violence as part of their wider remit have also developed a high level of awareness of the issues and may have geared up to support women to seek specialist help should they seek it. The Medaille Trust has supported trafficked women who are FGM victim/survivors; one was supported to be referred to regarding surgical options. Southern Domestic Abuse Service is able to offer support and would have done so had a request for help emerged from the FGM research project.

NHS provision NHS providers of gynaecology and maternity services are on the front line of this issue. Recent Department of Health policy focus and guidance is directed at NHS providers (See above regarding the DH FGM Prevention programme work).

Portsmouth Hospitals runs a 'perenial clinic' and women who disclose FGM can be referred to this. It is still “early days” for this initiative.

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Public Health commissioning Local Authorities now commission sexual health services as part of their Public Health function. In Hampshire CC, FGM has been taken into account in developing a recent school nursing service specification. In more general terms, it is not yet clear what the role of Public Health is in relation to FGM. National charities offering services, empowerment, advice The two large children’s charities most prominently concerned nationally with offering services to FGM victim/survivors area are both active within pan-Hampshire, not in the field of FGM: National charities: FGM initiatives NSPCC (National Society for the Prevention of Cruelty to Children): National Helpline

Barnardo’s Specialised teams, Community Outreach Programmes

The NSPCC has run a national FGM helpline since 2013. 62An August 2014 news report stated that the helpline had received 321 reports since it launched, l48 of which were referred to police and children's services. Since then it has received further publicity and promotion via the Government website.

Barnardo’s, in partnership with the Local Government Association, announced in February that over £2m funding has been secured via the Government’s Innovation Fund for a new service that will “create a highly specialised team of skilled social workers with extensive experience of working with those at risk of FGM to be available in areas where women and girls are vulnerable. Community outreach programmes will be rolled out across the country to shift attitudes and behaviour towards better prevention of FGM and provide psychological support for survivors.

“Girls and women at risk will also benefit from a first-of-its-kind online support group, providing them with a safe forum to share their experiences and that supports and encourages new approaches to tackling the crime.

Once up and running, councils will be able to turn to the programme for direct help in managing complex cases of FGM, as well as accessing clinical support and advice from specialist social workers, gynaecologists and health visitors.”

The following organisations are among those named in publications reviewed, as active in this area and as valuable sources of further information and advice:      

Foundation for Women’s Health Research & Development (FORWARD) www.forwarduk.org.uk London Black Women’s Health and Family Support www.bwhafs.com Rosa Trust Integrate Bristol Orchid Project Daughters of Eve.

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FGM Helpline 0800 028 3550 fgmhelp@nspcc.org.uk .Professionals who are worried a child is at risk can call the FGM helpline

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There is a diversity of views amongst charities, policymakers, campaigning groups, and professional organisations around approaches to campaigning, addressing and preventing FGM, and supporting victim/survivors.

10.6 Training, Education and Awareness The national and local strategies, guidance, research and partnership work reviewed for this exercise return again and again to both urgent and long-term needs for training, awareness, and education, and this strand of work emerges as possibly the most significant aspects of the work required.

Identified gaps in training and education The Government’s December Home Office Select Committee response identified training and education needs across many groups of public sector staff including police, CJS, NHS clinicians, and schools. 2014 saw a growth in training activity in this area as national guidance emerges and FGM is identified in training gap analyses.

Locally, for example the Isle of Wight carried out a safeguarding multi-agency training gap analysis which flagged up the need for FGM training and has incorporated new sessions into its 2015/16 training programme.

Some examples of training initiatives  Hampshire Constabulary has undertaken some significant multi-agency training (Ben Suggs email Oct 2014)  Department of Health FGM awareness and training activity – “We have finished our road show of 10 conferences nationally. Thank you to all who helped with these, and to everyone who spread the word. Nearly all were over-subscribed from the original capacity, and we issued more than 1500 tickets and are analysis the feedback, but can already see that they were very well received.”  The Home Office has a free online training package dealing with female genital mutilation (FGM), developed with Virtual College. 63  July 2015 - SDAS in partnership with FORWARD and funded by Portsmouth CCG are delivering four half day FGM training to health care professionals in Portsmouth. This project will: o Educate and train professionals on the harmful cultural practice of FGM, its health implications, and also how the practice contravenes international human rights law and UK law o Equip healthcare professionals with a better understanding and knowledge of this taboo subject and empower them to engage with victim/survivors and those deemed at risk confidently o Equip healthcare professionals with a cultural awareness of the values underpinning the practice of FGM among the BME communities, and its social and cultural context in the UK o Empower healthcare professionals to improve responses to the specific health needs of women and girls from FGM practising communities and signpost them as necessary.

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https://www.fgmelearning.co.uk

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10.7 Prevention A global view Tanya Barron, chief executive of Plan UK, a global children’s charity, said ending FGM in the UK would only be possible if it was also tackled worldwide. “While ensuring protection and prevention policies are in place in the UK is vital, it is the long-term, grassroots work in communities around the world which will prevent FGM happening in the first place,” she said. “Which means that in the battle to end harmful practices like FGM, mothers, fathers, daughters, sons, teachers, nurses – everyone has a part to play.”

Press report 2014 The UK Government’s December 2014 parliamentary report (see above) cited international prevention initiatives including £35million of International Development aid invested in a specific FGM programme, and the introduction of the Modern Slavery Bill.

Schools There is widespread support including Government policy statements for the principle of incorporating FGM in PSHE (Personal, Health, Social, and Economic) education in schools. A number of practical challenges arise in relation to work in schools including: 





Staff need to know what to look out for, who to call; they cannot handle the issue themselves so there much be a clear safeguarding route that takes account of specific issues that may arise. Schools may understandably be wary of being left unsupported in handling individual cases in relation to an emerging issue such as FGM Education reform has led to reduced local opportunities to influence and support local schools collectively and consistently on addressing issues such as FGM both within the curriculum and in terms of their duty of care to children and young people.

It is encouraging that Hampshire CC, for example, has made reference to FGM in its service specification for the school nursing service.

10.8 Organisations and links The Directory at Appendix 14 includes some contacts taken from a Government factsheet on FGM. 10.9 Recommendations: FGM

(a)

(b)

(c) (d)

FGM Develop effective, accessible support to FGM victim/survivors whether or not they will ever report a crime. Consider using grants to help develop effective local models of support, that should also address prevention issues Work with commissioning and safeguarding multi-agency colleagues to promote awareness and understanding of FGM and further development of the response, taking into account guidance recently published by the Department of Health Partnership work to receive, understand and interpret needs data that emerges from the new mandatory data reporting by NHS providers.

Consider with partners how to take forward the recommendations of the research project, replicated here:

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(e)

(f) (g)

1. Develop education and empowerment programmes that focus on empowering women and girls 2. Engage with organisations and groups in African diaspora communities where the practice has support 3. Establish a systematic personal and social education schools programme 4. Develop resources to raise awareness and educate professionals.

Consider the research recommendation to support the appointment of a fulltime permanent officer to work with AWF and key mentors to oversee a range of activity; is this a feasible plan, and if so, who is best placed to lead it Take forward OPCC/Hants constabulary media work on FGM Keep the FGM commissioning strategy under active review, as attention to this issue grows and practice develops in terms of response to this crime and support to victim/survivors.

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11 PREVENTION AND EDUCATION “Services are not preventing, just catching people” Interviewee: CSE lead working in children’s social care “The only path to peace is knowing children will be safer then I was!”

Consultee who has used support services for sexual crime victim/survivors This section focuses on prevention and education in relation to rape, sexual assault, and sexual exploitation. The Hampshire and Isle of Wight Anti-Slavery Partnership, which will have a strong prevention focus, is considered in Section 12.

11.1 Universal, Focused, and Targeted prevention Our review of rape and sexual assault education and prevention services demonstrated a wealth of knowledge available in pan-Hampshire. The availability of these services was often geographically limited, and consistent coverage could be improved.

We sought to capture initiatives that focus on preventing rape and sexual assault and MET, and FGM. The examples given do not represent a complete picture.

Prevention is a broad term that can be defined in many ways. It can be useful to consider prevention and early intervention in terms of a three-tier inverted triangle:

People access information on these subjects in many ways: via the web, social media, in person, individually, in a group, over the phone, reading a brochure, listening to the radio or watching television. Additionally there are many audiences for these messages: male, female, gay, straight, young, old, people who have been a victim/survivor of sexual crime and people who have not but may know a victim/survivor or perpetrator either personally or professionally. Each format has strengths and each client group can benefit from the education and prevention message.

The mode and format of communication will need to be tailored to the client group.

Decision makers looking to expand and improve education and prevention services

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on the issue of rape and sexual assault will need to define the target audience, and the most effective means of engaging with them.

11.2 Training for key workforce groups A number of interviewees and consultees referred to of the value of workforce training as a preventive measure, for example, in terms of re-victimisation and the impacts on victim/survivors of services delivered by staff who need training. Gaps mentioned include the need for training to the Crown Prosecution Service, training in relation to particular groups such as people with learning disabilities, and training for juries. Workforce training is firmly on the agendas of the safeguarding partnerships (see Partnerships, Section 12).

11.3 Examples of prevention and education services The following tables show the examples we found, arranged according to the three broad tiers in the inverted triangle.

Tier 1: Universal prevention Examples of the many visible media messages on the issues of rape and sexual assault, which come from a public safety, public health or public service agency, or a specialist campaigning organisation.

National organisations like Rape Crisis Scotland have produced campaigns on rape awareness.

Rape Crisis Specialist providers including PARCS and SRC have awareness collaborated with the Hampshire Constabulary on various campaigns campaign, for example the 2012 Rape Awareness campaign The IoW Serious Sexual Offences group launched a Isle of Wight campaign last year aimed at ending ‘rape myths’ based on Council website the Scottish Rape Crisis campaign ‘This is not an Invitation to page and campaign Rape me’. 64. This is based on the above RCS campaign.

Aimed at teenagers 13-18’s, (and in use by STAR project National Home Southampton for the last 18 months; handing out to young Office “This is people and at fresher fairs etc.); this campaign ran alongside Abuse” campaign 65 a story that was running on C4’s Hollyoaks.

Tier 2: Focused prevention Includes a number of programmes that are delivered in schools; desirable because they address a large, mixed audience including potential victim/survivors and potential perpetrators. These programmes may include the sexual violence message as part of a bigger agenda.

Don’t Cross the Line campaign: aimed at potential perpetrators

Currently the Hampshire Constabulary and the Thames Valley Police are running the Don’t Cross the Line campaign which is aimed at potential perpetrators and focuses on the issue of consent. This is in contrast to campaigns that target victim/survivors or potential victim/survivors with a message of how to keep safe.

Let’s Talk About It

A service of Solent NHS Sexual Health, who runs campaigns and presentations on sexual health including rape and sexual assault prevention. Their campaigns are guided by the Public Health Outcomes Framework and local need.

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https://www.iwight.com/Council/OtherServices/Domestic-Abuse/Consent-Sex-without-consent-is-rape

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https://www.gov.uk/government/collections/this-is-abuse-campaign

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Solent NHS Sexual Health Services Sexual Health Promotion & HIV Prevention Service goes into schools identified in consultation with the Hampshire County Council to deliver Girl Talk and Boy Talk, a single sex self-esteem programme aimed at 13 to 15 year olds. They will be training voluntary staff and other professionals who work with young people to deliver this programme both in schools and other settings.

Girl and Boy Talk: delivered by NHS sexual health provider

Isle of Wight multiagency work on school PHSE programmes Hampshire Constabulary: Educational material available to schools and other groups, evaluated by a youth project CIS’ters work with schools and colleges Southampton Rape Crisis: Young People’s Gender and Sexual Identity Group SARC materials and presentations

The Isle of Wight Safeguarding Adults Board Manager is working with the Public Health team on trying to standardize the Island’s schools approach to PSHE and ensure that Sexual Relationships Education (healthy relationships, respect and consent) is included in that.

The police offer a comprehensive package of educational material, designed for schools and other groups to deliver themselves, including a presentation. This was developed following the pervious arrangement whereby a police officer would visit schools.

Youth Options, a pan-Hampshire youth charity, helped evaluate the material and uses the presentation in Southampton as part of their (OPCC funded) detached programme.

CIS’ters surviving rape and sexual abuse goes into schools, colleges and universities to deliver presentations.

Works preventively by helping young people develop resilience and confidence. Funded by Southampton City Council and Hampshire CC (Not specifically focusing on abuse) The SARC (Treetops) provides materials to the Police, offers materials and presentations to others, and has taken opportunities to promote a preventive message on the media. “Rape – short word, long sentence” is a YouTube video. The Treetops monthly Open Day is open to all.

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The Star Project is an outreach programme working with young people (aged 10 upwards) on a wide range of sex and relationship issues, with a particular focus on sexual violence prevention. STAR also works with vulnerable adults.

STAR Project: Southampton Rape Crisis Primarily benefiting young people in Southampton available elsewhere, dependent on funding.

PARCS prevention team initiatives with educational establishments and youth organisations

STAR aims to reduce the incidence of domestic, sexual and relationship abuse and exploitation, and unwanted pregnancy. It uses skills development and awareness-raising of risk and vulnerability factors (such as internet safety selfesteem, substance misuse) and works to reduce these.

STAR addresses young people who may be potential perpetrators and raises awareness of emotional impacts and legal obligations.

STAR runs tailored sessions for a range of specific groups, and works within 19 primary schools and all 12 secondary schools in Southampton as well as the majority of specialist settings for young people or vulnerable adults. STAR works in youth settings, colleges and universities. They also work with youth groups and after school clubs. The Project also offers support to teachers who are working with vulnerable students. The Star Project reached 8,197 young people in and around Southampton in 2014/15 STAR uses creative and active learning methods including music, graffiti and dance. In session evaluations, participants report a minimum 93% improvement in their understanding of risk, healthy relationships and knowledge about help services. With Big Lottery and OPCC funding support STAR has developed a Theatre In Education “Tom’s Story” to deliver Safer Relationships as well as highlight issues of child exploitation, being rolled out initially in Secondary Schools in Southampton.

The team works in local schools in the Portsmouth area as well as youth clubs, colleges, the University of Portsmouth and girl guiding units, delivering sessions around all forms of unwanted sexual experiences including sexting and CSE, and exploring issues around consent.

The aim of these sessions is to reduce the incidence and impact of sexual abuse by raising awareness, developing the skills to challenge abuse and signposting young people on to appropriate services including PARCS. The team uses various group activities to engage with young people, both on a creative and a kinaesthetic basis, including sport, drama, music and art. Interactive activities include looking at rape campaigns, legal definitions of consent, challenging public perceptions and rape myths. Young people are asked to feedback their thoughts on these topics and encouraged to voice any issues they may have. PARCS evaluates both the short and long term impact of this work.

The team has recently worked with a group of young people to design and deliver a conference, led and designed by the young people themselves, exploring the narratives (or myths)

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that surround sexual abuse and the impact the myths have on individuals and the wider community. The conference was led by the young people and provided an opportunity to disseminate key messages to a wider audience.

The team is currently working with a group of students to produce a piece of work that aims to reduce the incidence of CSE through the use of art and drama.

Tier 3: Targeted prevention Specific focus on sexual crime issues/ targeted at vulnerable groups Portsmouth Area Rape Counselling Service (PARCS) prevention work with target groups

Preventive aspects of front-line initiatives, e.g.

Integrated CSE Hub (Southampton)

Barnardo’s U-Turn services (Southampton)

Prevention sessions aimed at specific groups who are more likely to be targeted by perpetrators of abuse and/or are less likely to disclose or to access specialist services, e.g. projects with young people who have a learning disability and young people who identify as LGB and T. The work is shaped by the young people alongside feedback from other stakeholders.

The 2015/16 Office of the Police and Crime Commissioner grant round has supported the setup of a new Integrated Child Sexual Exploitation Hub in Southampton, for which a specialist team is being recruited – a Disruption and Diversion worker and part time youth engagement workers.

Located in Social Services’ and targeted at narrower, specific groups, the Disruption and Diversion focus of the project suggests a substantial prevention element i.e. preventing a high risk situation becoming worse.

Described in the MET “Support Available” section above.

11.4 Engaging with schools and colleges Policy guidance urges schools to run PHSE educational programmes addressing a range of key social issues, but a consistent approach is not practical as each school now has its own budget and makes its own decisions.

Schools need to know what to do if this issue arises with one of their pupils. They will understandably be very concerned where they feel there is a serious risk that they may be unable to refer on successfully and effectively to protect a vulnerable child or young person.

Local Authority-level multi-agency working will help, but its effectiveness may be increasingly affected by the shrinking role of Local Authorities in running schools.

Educational reform has led to a more fragmented system that can be challenging to engage with, if seeking to influence a group of schools. However, there may be schools and new groupings of schools that are keen to innovate in this area of preventive work, and further consultation with Local Authority public health leads might provide further information on innovative work with schools.

Access and co-ordination with colleges is a barrier to reaching 16-18 year olds.

Colleges in general offer a more limited interaction with health fairs or one-off classes rather than multiple sessions.

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These challenges suggest that resources could be effectively targeted on organisations that already have relationships with schools/groups of schools, rather than spending additional time and energy creating new direct relationships with them.

Potential opportunities for joint initiatives in schools Regarding substance misuse, Catch-22, commissioned by Hampshire CC to deliver substance misuse services to young people, provides group and one to one interventions in schools to help prevent substance misuse. The agency participated last May alongside others in a series of conferences held in Havant, Basingstoke and the New Forest to raise awareness of the substance misuse services available for schools. Catch-22 highlighted concerns regarding young people using psychoactive substances and provided an overview of the one to one and group work interventions they provide in schools in relation to their expertise.

This example could suggest a route for preventive education on sexual violence, abuse and exploitation issues to reach schools by specialists partnering with agencies who already have working relationships within education, possibly using events and sessions on related issues, that are already in place. For example, a specialist organisation or team might partner with a substance misuse provider (such as Catch-22 in Hampshire).

In Portsmouth, Public Health takes the lead on the schools Personal Health and Social Education (PHSE) Strategy.

Additionally the new Hampshire Anti-Slavery Partnership has a strong prevention focus. See Section 12.

11.5 Recommendations: Education and Prevention

(a)

(b) (c) (d) (e) (f)

(g) (h)

Education and Prevention Help empower the workforce - support a range of workforce development initiatives and awareness training for targeted workforce groups (some such initiatives may be suitable for one-off grants).

Target young people across the whole OPCC geography.

Develop and work towards a coherent, co-ordinated, pan-Hampshire awareness programme to educate young people about sexual crime prevention Collate and learn from evaluations of existing initiatives where available.

Link targeted prevention activity with the priority needs groups identified elsewhere in this report/strategy.

Work with schools – focus on the proposed/planned engagement with schools and consider using grant funding to prioritise schemes based on existing relationships, possibly via providers working in partnership, to make best use of limited resources.

Investigate and link with the role of public health re work with schools, notably in Portsmouth.

Work with the Anti-slavery Partnership as it develops to promote engagement and preventive education with BME and diaspora communities.

“I would like to see Awareness, Empowerment and self-defence groups. With the volume of marital arts groups in our country, this should be easily achievable.”

“Ask the children - After all it’s their lives and their choice! Why don’t we ask the children to come up with an initiative surrounding healthy relationships, respect and consent, to keep themselves safe? It should be sponsored by the councils, NSPCC, Barnardo’s, OPCC etc….”

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On early intervention to prevent re-victimisation: “If there had have been a qualified first responder, I wouldn’t have felt worthless all these years, There needs to be one in every station, on every shift!! If that ever happens, I’ll join the force.”

Consultee who has used support services for sexual crime victim/survivors

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12 MULTI AGENCY PARTNERSHIPS This section lists and describes current multi-agency partnerships with relevance to the development of services to victim/survivors of sexual crime. We provide detail on those partnerships that have the most direct relevance, with further notes on the broader-based groups appearing at Appendix 13.

12.1 Themes emerging from research into sexual violence partnership work “It would be good to link this work with the statutory Safeguarding Boards directly as they are developing work on these relevant subjects all the time and could help with the development of this strategy.”

Comment at from a local professional at consultation stage Themes include:  Central role of multi-agency working  Central coordinating roles of statutory Safeguarding Boards  Strategic and operational work: two distinct strands for MET groups. Solution focus – avoid “talking shops”  Adapting quickly to respond to a fast moving agenda  Data Quality and Data Sharing  Using partnerships to help bring NHS provision closer to sexual crime issues, particularly in relation to key services e.g. CAMHS, IAPT  Bringing together key staff and managers – people with “the knowledge”  Prevention and Early Intervention: prioritising and coordinating resources.

Practical example – development of data sharing to inform the work of operational MET groups Hampshire CC MET operational group developed a form, widely circulated around agencies, to be completed in order to submit information and intelligence around CSE/ missing persons to the police. The accompanying email emphasised that “No matter how small or insignificant you think the data is, it is really important that we send it on so that the police can pull together the intelligence and create a problem profile for the issue of MET in Hampshire. This form when completed should be emailed to xxx, mark your email in the subject line as CSE. Please can you cascade this to your service and ensure they are aware of the importance of this, and arrange for the form to be accessible to all in your service.”

12.2 List of partnerships We have identified 11 multi-agency partnerships as follows:

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Name of partnership

Geography

Described in this section Local Safeguarding Children Boards One per top tier Local Authority (LSCBs) 4LSCB

Pan-Hampshire collaboration of LSCBs

Missing Exploited Trafficked (MET) sub groups Local Safeguarding Adults Boards (LSABs)

One for each top tier LA plus one panHampshire

4LSAB

Pan-Hampshire collaboration of LSABs

One per top tier Local Authority

Hampshire and Isle of Wight Anti-Slavery Pan-Hampshire Partnership Described at Appendix 13 PIPPA Alliance

Southampton

Domestic Abuse Management Group

Pan-Hampshire

Community Safety Partnerships

One per unitary LA and one per District Council (or group/pair of District Councils) – total 12 CSPs

Hampshire & Isle of Wight Community Safety Alliance Hampshire & Isle of Wight Police and Crime Reduction Alliance Health and Wellbeing Boards

Pan-Hampshire Pan-Hampshire One per top tier Local Authority.

12.3 Local Safeguarding Boards Local Safeguarding Children Boards (LSCBs) and Local Safeguarding Adults Boards (LSABs) Each top-tier Local Authority runs statutory Safeguarding Boards, one for children and one for vulnerable adults. Thus there is a Local Safeguarding Children Board (LSCB) and a Local Safeguarding Adults Board (LSAB) for each of the four Councils: Hampshire County Council, Isle of Wight Council, Portsmouth City Council, and Southampton City Council.

Multi-Agency Training The LSCBs run extensive training programmes which draw in employees or volunteers of different agencies. Research has shown that multi-agency training is useful and highly valued by professionals and others in developing a shared understanding of child protection and decision making.

Pan-Hampshire arrangements for Children’s and Adults Safeguarding The four Local Authorities work together in two umbrella partnerships called the 4LSCB (Children’s) and 4LSAB (Adults), to make the best use of their shared skills, knowledge and resources. 4LSCB and 4LSAB have developed shared guidance, protocols, and so on and collaborate on a range of key issues.

12.4 Missing Exploited Trafficked (MET) sub groups – CHILDREN In respect of children, 4LSCB and the four LSCBs operate a system of specialist sub groups, in place both locally and Pan-Hampshire:

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PanHampshire – 4LSCB Local Authority:

Local Authority MET Groups: Report to own LSCB; feed in to 4LSCB

Hampshire and Isle of Wight MET Strategy Board Incudes Chairs of each of the strategy groups below Current chair Rachel Bacon (Hants Constabulary) Hampshire County Council Hampshire MET Strategy Group Chaired by Hants CC’s lead on CSE Hampshire Operational MET Group DS level Police rep

Isle of Wight Council

Isle of Wight CSE Group(Covering both strategic and operational) Chaired by Police (DI level)

Portsmouth City Council

Southampton City Council

Portsmouth METStrategy Group Chaired by Police (DI level)

Southampton MET Strategy Group Chaired by Police (DI level)

Portsmouth Operational METGroup DS level Police rep

Southampton Operational MET Group DS level Police rep

The ways in which these groups operate will continue to develop in response to this complex and growing issue. The information given here is therefore a “snapshot” of these structures at the date of writing. The reader should be aware that these structures are subject to change and refinement over time.

Indeed there has been much activity in recent months, as the LSCB MET sub groups develop more sophisticated responses, to avoid duplication, and maintain a strategic overview whilst linking to regular hands-on, usually case-based Operational Groups.

How the MET sub groups work Here is some detail to illustrate a few of the current workings of the four Local Authority MET groups. (The project resource did not allow for a more detailed look.)

The Hampshire CC strategic MET group is chaired and convened by the County Council. Membership includes (not an exhaustive list)  Children’s services (Hants CC Chair, a nominated District Lead, is Children’s’ MET lead)  Education  Police  Health – providers, commissioners  Youth Offending Team  Voluntary sector representatives.

The group has recently reviewed its structure to meet quarterly and to have subgroups each focusing on one of four key tasks: Group 1 - Understand & Identify Group 2 - Prevent Group 3 - Intervene & Support Group 4 - Disrupt & Bring to Justice.

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The Group has agreed an Action/Improvement Plan dated March 2015, set out under those four headings, plus a Scrutiny and Oversight category. The Plan details 43 actions, who will do what, and grades each with a Red/Amber/Green risk rating.

The Operational Sub Group works hands-on case by case to coordinate and prioritise day to day action – individual cases, hotspots and so on. The Operational Sub Group uses “live” problem profile information provided by the police.

The Isle of Wight, being smaller-scale runs a single sub group for both strategic and operational purposes. The Isle of Wight CSE Group identifies addresses and reduces incidents of child sexual exploitation, trafficked and missing children through understanding the nature and extent of the local issues and overseeing effective information sharing and producing a local strategy and action plan. The current Chair is: D.I Chris Parry, Hampshire Constabulary.

The Southampton MET group has recently reshaped into Strategic and Operational sub groups, having fairly recently spilt from a combined function with Hampshire CC. The operational function aims to get closer to themes and patterns though scrutiny of confidential case based information (including police problem profiles) whilst steering and targeting the local teams’ “day job”.

The Portsmouth groups are similarly structured.

12.5 Local Safeguarding Adults Boards (LSABs) SCIE (Social Care Institute for Excellence) provides detail of LSAB responsibilities including the new requirements of the Care Act 2014, athttp://www.scie.org.uk/careact-2014/safeguarding-adults/ The high level core statutory membership includes the local authority, clinical commissioning groups (CCGs), and the police – specifically the chief officer of police.

The Isle of Wight membership, for example, includes:  Police  CCG  Adult Social Care  NHS England  NHS Trust  Probation  Public Health  Voluntary sector representation  Provider organisations re homecare and care homes  Housing  Prison  CQC and OPCC copied in.

Further information on collaborative working is at http://www.scie.org.uk/care-act-2014/safeguarding-adults/safeguarding-adultsboards-checklist-and-resources/specific-tasks/links-to-other-boards-andpartnerships.asp In some respects the Safeguarding Adults Board arrangements across panHampshire mirror those for the LSCBs, i.e. there is a statutory Board for each Local Authority, and there is a pan-Hampshire, non-statutory best practice collaboration.

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There are no equivalent specialist MET sub groups for adults. Given the new Care Act responsibilities, this might change.

The pan-Hampshire 4LSAB On 20 May 2015, the 4LSAB published a new pan-Hampshire Multi-Agency Policy and guidance, incorporating the 2014 Care Act Statutory Guidance, in four sections: 1.

2.

3.

4.

Multi-Agency Safeguarding Policy Guidance on Statutory Safeguarding Enquiries Pan-Hampshire and Isle of Wight Practice Toolkit National Policy Context.

“A very useful piece of work, containing a flow chart for practitioners for pathways, which includes guidance on law and risk assessment” (interviewee) Adult safeguarding and MET “It’s different in adults. The Board has various sub groups but not a MET sub group.

This reflects legislation; different powers, and creative responses are required, both to protection, and to managing perpetrators. The big barrier is capacity and consent: protecting people who say they do not want to be protected. We are looking at legal routes, but it’s difficult and challenging. Our local strategy is to develop a vulnerable adults panel to consider cases where risks are high, but don’t quite reach the threshold, to share risk and try and put together safety plans. It’s a different approach.”

Interviewee, May 2015 A recent case involving a vulnerable adult was cited as an illustration of the many barriers to successful victim/survivor support. The Crown Prosecution Service believed the victim/survivor but there was insufficient evidence, and a key gap identified is the lack of any social care resources to support a victim/survivor whose needs did not reach the social care eligibility threshold. For some vulnerable adults, even local specialist victim/survivor support services such as Rape Support may not be able to offer support.

12.6 Hampshire and Isle of Wight Anti-Slavery Partnership The Modern Slavery Act requires all statutory bodies to work together to tackle modern slavery. This new partnership, supported by the Hampshire Police and Crime Commissioner, is currently developing and a new full time coordinator has been seconded for a year from the Medaille Trust to help resource its development. It is the pan-Hampshire vehicle for joint working to coordinate the multi-agency response.

Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 201587

The OPCC web page 66 outlines the Anti-Slavery Partnership purpose and scope: The Anti-Slavery Partnership brings together various public, private and voluntary agencies and professionals across Hampshire and Isle of Wight to fight slavery and ensure support is given to the victims of slavery.

The Partnership is working together to develop the best interagency response to modern slavery so survivors of this criminality are properly supported and the partnership can continue to prevent offending and prosecute offenders and support victims.

The Office of the Police and Crime Commissioner is currently working with local authorities in Hampshire and Isle of Wight to produce leadership and governance arrangements for the partnership.

The Partnership will bring together a range of organisations including: Barnardo’s, British Red Cross, Council Emergency Planners pan-Hampshire, the Department of Work and Pensions, The Gangmasters Licensing Agency, HM Revenue and Customs, Immigration, National Crime Agency, NHS – Clinical Commissioning Groups pan-Hampshire, and the Salvation Army.

The partnership will focus on the “4 P’s” set out in the Government’s 2014 Modern Slavery Strategy:    

PURSUE: Prosecuting and disrupting individuals and groups responsible for modern slavery PREVENT: Preventing people from engaging in modern slavery PROTECT: Strengthening safeguards against modern slavery by protecting vulnerable people from exploitation and increasing awareness of and resilience against this crime PREPARE: Reducing the harm caused by modern slavery through improved victim identification and enhanced support.

“Get it on to the radar. Eyes and ears. Hotels, ports, homelessness services, car washes” Jess Gealer, Anti-Slavery Partnership coordinator There will be a large number of members, with membership standing at 58 in May 2015 and growing. Examples of members include border services, visa/immigration, health, mental health, housing, social care, NGOs such as Barnardo’s and Love146, Child and adult safeguarding boards, OPCC. The partnership will seek members form a wide range of local businesses, for example cab companies. Subgroups will focus on training, problem profile, communications and structure/membership.

12.7 Recommendations: Multi Agency Partnerships

(a) (b)

Multi Agency Partnerships Work as closely as possible with the established partnerships notably the Safeguarding Boards and their sub groups Consistently encourage and foster a streamlined, “solution-focused” approach to partnership work.

66

http://www.hampshire-pcc.gov.uk/Partnership/Anti-SlaveryPartnership.aspx

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13 Further information and contact details For further information contact: Karen Dawes Commissioning Manager Office of the Police and Crime Commissioner Hampshire and the Isle of Wight OPCC@hampshire.pnn.police.uk 01962 871595 St George's Chambers St George's Street Winchester Hampshire SO23 8AJ

Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 201589

Appendix 1: Maps The pan Hampshire area, with main population centres

Hampshire County Council area, showing District Council boundaries

Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 201590

Appendix 2: Who commissions what?

Here is a summary table: Commissioning body

Police and Crime Commissioner

Police Top tier Local Authorities District Councils NHS England (Wessex Area Team) NHS Clinical Commissioning Groups (CCGs)

Hampshire examples of sexual crime-related commissioning responsibilities Four priorities as stated in the Hampshire OPCC Police and Crime Plan, all of which link to sexual crime: 1. Place victim/survivors and witnesses at the heart of the criminal justice system 2. Reduce re-offending 3. Reduce crime and antisocial behaviour 4. Improve frontline policing.

“PCCs are now at the forefront of helping victims to cope and recover.” 67 Some victim services previously centrally funded by the Justice ministry are now directly commissioned by the OPCC (e.g. ISVA, victim support). The OPCC also has a programme of grants, subject to an annual bidding round  Forensic medical services and associated support  Some aspects of prevention (e.g. an online tool kit)  Social Care, including child protection, vulnerable adults, safeguarding  Public Health – a wide remit including GUM clinics, prevention services.  Community Safety  Housing  Health services for people who experience sexual assault or rape. This includes Sexual Assault Referral Centres (SARCs).

One of 30 national Public Health functions commissioned by NHSE as opposed to LA’s  Primary Care (GP) services  Secondary care (hospital) services  NHS community services  Local mental health services including CAMHS (Tiers 2 and 3). 68

NHS commissioning, radically reorganised during 2010-2013, is now mainly the responsibility of Clinical Commissioning Groups (CCGs), and NHS England. Top-tier Local Authorities have taken on new responsibilities notably for local Public Health.

National Public Health commissioning is led by the new national body Public Health England.

One role of NHS England is to be the national NHS commissioning body for specialist and services that cross boundaries and require an on-going national overview. Sexual Assault Referral Centres (SARC) are regarded as specialist services and are therefore commissioned by NHS England.

67

Association of Police & Crime Commissioners website Child and Adolescent Mental Health Services. See report at http://www.jcpmh.info/goodservices/camhs/ for an explanation of 4 tiers of CAMHS and how these are commissioned.

68

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The CCGs, as the commissioners of most NHS services, have a prominent part to play in supporting victim/survivors of sexual crime. These bodies are still relatively new, so in some areas joint working is just starting to develop.

There are eight CCGs covering the pan-Hampshire area: NHS North Hampshire CCG NHS West Hampshire CCG NHS Fareham & Gosport CCG NHS South East Hampshire CCG

NHS Southampton CCG NHS Portsmouth CCG NHS Isle of Wight CCG NHS North East Hampshire and Farnham CCG.

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Appendix 3: Reported Crime Figures: numbers and geography This Appendix uses figures provided in January 2015, to the end of December 2014.

As an indicator of overall need, this is flawed, given under-reporting of sexual crimes estimated at 85%. However, the figures provide useful intelligence and pointers on a range of issues. Further breakdowns of some of the figures may be useful, for example the “story” behind the reported crimes against children – what proportion was associated with child sexual exploitation/sex work? How many involved known offenders? In Section 5we recommend that the Sexual Crime Project Steering Group maintains a “watchful eye” on the available data in order to best inform future strategic decision-making.

Sex Offence Crime Figures 69 As of 12/01/15 Offence Type

2012/13

2013/14

Female child under 13 Female child under 16 Female 16 and over Male child under 13 Male child under 16 Male 16 and over Rape Total

61 83 289 24 5 16 478

75 108 346 27 16 12 584

Female under 13 Female aged 13 & over Male under 13 Male aged 13 & over Sexual Assault Total

153 492 39 46 730

Child under 13*** Child under 16 Sexual Activity Total

21 115 136

% up/down from 2012/13

% of All Sex Offences (2014 YTD)

2014 YTD**

23% 30% 20% 13% 220% -25% 22%

4% 5% 24% 1% 1% 1% 30%

74 103 474 25 13 27 716

27% 8% 8% 28% 14%

7% 26% 3% 4% 42%

142 518 58 70 788

5% 26% 23%

2% 8% 8%

43 151 194

Rape

Sexual Assault (incl penetration) 195 533 42 59 829

Sexual Activity * 22 145 167

Top 5 Other Sex Offences (2013/14) Exposure Voyeurism Cause/Incite Female U16 to Sex Act Cause/Incite Male U13 to Sex Act Meeting Female U16 Sexual Grooming Other Sex Offences Total

Total

69

142 31

187 36

32% 16%

10% 1%

200 22

12

22

83%

1%

22

15

15

0%

0%

2

6

14

133%

1%

22

206

274

33%

14%

268

1550

1854

20%

100%

1966

Provided by Hampshire constabulary January 2015

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*Sexual Activity does not include Cause/Incite Sex Activity & Abuse Position of Trust. **01/04/14 - 31/12/2014 ***Includes Sex Activity with Relative.

Total sexual crimes by type With 2014/15 estimate extrapolated from the actual figures for the first nine months Rape Sexual Sexual Other All % year on Assault Activity sex offences year offences increase 2012/13 478 730 136 206 1550 2013/14 584 829 167 274 1854 20% 2014/15 9 months 955 1051 259 357 2621 41% extrapolated to end of March 2015

The following graph shows the overall trend along with that for each offence type. It illustrates a growing upward trend with the most significant increase being in reported rape.

One reason for the recent sharp increase in reported rape could be the Hampshire Constabulary’s recent implementation of the Amberstone service. Another factor could be the nationwide increase in reporting of historic sexual crimes. However, rather than a one-time increase, both of these factors would indicate that the upward trend in reported sexual crime will continue.

Victim/survivors of reported crimes by age, gender and ethnicity The tables below show the age, gender and ethnic breakdown of reported crime victim/survivors.

Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 201594

Victim Age/Gender Breakdown (as of 13/01/15) Female

Male

Not Stated

Unknown

Total***

741 446 178 164 82 25 16 5 3 0 1660

157 47 18 13 13 3 2 0 0 0 253

5 4 0 0 0 0 0 0 0 0 9

34 1 1 1 0 0 0 0 0 0 37

937 498 197 178 95 28 18 5 3 0 1959

0-15 16-24 25-34 35-44 45-54 55-65 65-74 75-84 85+ Not Stated Total

***These figures refer to the number of crimes rather than the number of individuals.

0-15 16-24 25-34 35-44 45-54 55-65 65-74 75-84 85+ Not Stated Total

Ethnicity - % of total

Age group % of total

Total***

ChineseJa panese, SE Asian

Asian

Black

AfricanCaribbean

Unknown, not stated, or d White European

Victim Age/Ethnicity Breakdown (as of 13/01/15)

360 154 69 73 37 15 9 5 1 0

563 330 117 99 56 13 9 0 2 0

0 1 1 1 1 0 0 0 0 0

10 6 1 3 1 0 0 0 0 0

3 5 7 2 0 0 0 0 0 0

1 2 2 0 0 0 0 0 0 0

937 498 197 178 95 28 18 5 3 0

47.8% 25.4% 10.1% 9.1% 4.8% 1.4% 0.9% 0.3% 0.2% 0.0%

723

1189

4

21

17

5

1959

100.0 %

36.9%

60.7%

0.2%

1.1%

0.9%

0.3%

100%

***These figures refer to the number of crimes rather than the number of individuals.

Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 201595

East Hants

Eastleigh

Fareham

Gosport

Hart

Havant

IOW

New Forest

Portsmouth

Rushmoor

Southampton

Test Valley

Winchester

Total

2012/13 2013/14 2014 YTD

Basingstoke & Dean

Reported Sexual Crimes by Location

160 186 178

64 60 92

86 109 108

87 88 89

96 76 86

27 51 36

126 148 157

113 147 156

131 120 131

229 283 321

84 110 109

284 382 455

80 134 87

96 71 160

1663 1965 2165

These two pie charts show the population of the County, the two cities and the Isle of Wight, next to the overall distribution of the crimes reported in 2013-14:

The next chart, showing reported sexual crimes per 1000 population, broadly illustrates this uneven prevalence between the County and the two cities:

Within the County council area, reported sexual crime is unevenly distributed, with wide variation between districts. The following table shows the 11 Districts shown in

Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 201596

descending order of population, and puts the number of reported sexual crimes next to the population in 000’s for each District.

This highlights that New Forest has a high population and a relatively low incidence, whist Basingstoke & Deane has a similar population and a much higher incidence or reported sexual crime, likely in this case to be due to the difference in the population structure and the population at risk.

The next table shows reported sexual crime per 1,000 of population by District:

Havant and Basingstoke are two of the four most populated Districts, and are also in the top 4 Districts for sexual crimes per 1000 of population.

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Appendix 4: ISVA services: training, management, caseloads, and KPI’s Standards for Training There are no specific accreditation standards or a single training programme for ISVAs. There is good quality accredited training available, which can be expensive, and has not been taken up by all ISVAs working in Hampshire. 70 Some ISAVs come to the job from other positions which required advanced training in social work, mental health or criminal justice. The skills and experience gained in those roles are viewed as highly beneficial in performing the ISVA role.

Despite the lack of national standards, recent service specifications for ISVA services include some specific training levels and qualifications, and it would be useful to compare notes with others if and when a new pan-Hampshire specification is developed.

There are “National Occupational Standards” available (Skills for Justice).

        

National Occupational Standards for Independent Sexual Violence Advisors (Skills for Justice) Advocate on behalf of victims/survivors of sexual violence Communicate and engage with victims/survivors of sexual violence Carry out an assessment to identify the needs of and risks to victims/survivors of sexual violence Provide access to information and support for victims/survivors of sexual violence Work in partnership with agencies to address sexual violence Address callers regarding sexual violence with sensitivity Establish and address requirements from callers regarding sexual violence Support victims/survivors of sexual violence through the court process Support victims/survivors of sexual violence to provide evidence.

Various organisations offer training programmes including Lime Culture, SafeLives 71, The Survivors Trust and Worcestershire University.

Specialist sexual crime services provide in-house training to ensure their staff are equipped and supported to work with trauma.

There are specialist aspects to the role including working with young people and people with learning disabilities. Training can be provided for these specialisms but often candidates for these jobs will come with an expertise in working with these groups.

How a good quality ISVA service is managed and run The role can feel isolated and for lone-working ISVAs this is an even greater concern. It is a “resource-heavy job” requiring a high level of management for each ISVA. 72 To work effectively, ISVAs must have

70

West Yorkshire is one recent example.

Recently rebranded, Safe Lives was previously called Co-ordinated Action Against Domestic Abuse (CAADA) 71

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  

Clinical/professional supervision (Separate from line management) Line management Case management.

While this may appear like a lot of management input, in practice each element is vital.

Clinical, or professional supervision is all about how the ISVA is coping – both worker and client. ‘Vicarious trauma’ is a real concern for ISVAs. As one experienced ISVA stated, “You think you’ve heard it all, but then someone tells you something and you’re just dumbstruck.” Another experienced ISVA simply stated, “You hear some pretty disturbing things.”

Line management is about the day to day staff management issues.

Case management iscase-by-case, where the worker’s energy is going, travel and access issues, referrals, practical support, and so on. Given that a client’s needs can rapidly fluctuate due to unpredictable events, this role takes more time.

Management issues drawn to our attention in the research included:   



Absence cover, which can quickly become a serious issue (e.g. long term sickness) as ISVAs are so thinly spread and are often located in small organisations Lone working, which is an issue for ISVAs; organisations must assess safety risks as well as the mental well-being of lone workers Multiple victim/survivors/witnesses in a criminal case against the same alleged perpetrator. The risk of ‘contamination’ of evidence could potentially derail the prosecution. Ideally there would be a separate ISVA for each victim/survivor but at a minimum the ISVA would need intense management support Partnership work and community presence: ISVA managers need to have a presence in the community and be involved in multi-agency work, with enough availability to attend meetings and be in a position to influence. In particular, multi-agency work should involve the police, safeguarding agencies, court services, mental health services, schools and colleges and other community agencies.

Caseloads/Client Capacity Determining client capacity for an ISVA service is an inexact process, largely due to the difficulty in determining an appropriate number of clients for an ISVA to be carrying at any one time. Factors influencing such estimates include: 1. Job descriptions are not uniform and providers do not offer the same service; for example a service may offer to attend court with the client or not and this would impact how many clients an ISVA could support.

2. Clients come with varying levels of need and some cases will require more time than others.

3. Length of service varies greatly as does intensity of service required at various stages.

72

Research interviews suggested that nationally, the MoJ commissioning round was an opportunistic process and that in some areas (not necessarily Hampshire) some host organisations may lack the necessary management expertise. Given level of expertise at current Hants providers, this appears to be more of a problem elsewhere.

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4. Where there is a reported crime and a criminal case, the time commitment to a client changes as the case progresses (or not) and those peaks can be unpredictable.

5. ISVAs working over a large geographic area need to factor in travel time to clients and to staff meetings and supervision.

6. These issues are compounded for a Young Person’s ISVA who is almost always involved in multi-agency working, restricted by school hours and required to travel to their young clients.

Caseloads (number of clients at any one time) Our research on caseloads (per full time ISVA at any one time) yielded the following information and advice: 1. LimeCulture/Kings College LondonAudit of ISVA services in England and Wales February 2015 which reported the average ISVA caseload varied from fewer than 15 cases (11% of respondents) to more than 100 (4%) with most caseloads between 41 to 50 cases (20%) followed by 31-40 (19%) and 51-60 cases (16%). 73 2. The Survivors Trust has told us that 50 cases is an acceptable caseload if client need is as follows: 10 high need, 15 low need and 25 medium need.

3. Providers we spoke to said that 50 cases would be the high end and a number closer to 40 would be more appropriate if the ISVA is attending court proceedings. All providers we spoke with acknowledged the need to consider what stage a case is at in the court process. Clients with imminent court dates are classified as high need.

4. Where clients are under age 18 caseloads should be reduced to account for the amount of multi-agency working that is required for children. Both Young People’s ISVAs working in Hampshire today said 35 clients maximum at any one time would be manageable.

5. When clients are dispersed over a large geographic area, the caseload number must reflect travel time.

There are ISVAs operating in Hampshire today carrying much larger caseloads and seeing more clients per year. These numbers are provided as a guide and must be balanced against the practical realities and operating environment at each service. Many key factors remain unclear including the proportion of ISVA clients who are involved in court proceedings (although we know this will be higher for under16s), and we do not at this stage have a clear enough picture of an “average” length of service.

Annual capacity per ISVA We considered the feasibility of using a formula for this and tested out some calculations.

We concluded that if a suitable maximum number of cases at any one time can be determined, and a range of assumptions are made as to the spread of “length of service” required, it is possible to make an approximate estimate of the annual capacity of a service (i.e. number of clients helped in a given 12 month period).

73

Limeculture Report at 4.4.2

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However, significant caution is needed here. Any such formula will only be as accurate as the figures entered and assumptions made, and any results used should be reality-tested with experienced providers and possibly benchmarked against similar services elsewhere.

We developed a formula to take “throughput” into account and tested it using speculative figures, with the following result: Assuming that: 1. Target average caseload (at any one time) at 40 2. Length of service required is 74 a. 15 new clients require short-term service (average 3 months) b. 30 new clients require medium term (average 6 months) c. 15 new clients require medium term (average 9 months) d. 10 new clients require longer term (12 months) 3. 1 FTE ISVA includes cover for normal absences 4. There is a reasonable level of uniformity of client service 5. As soon as a client leaves an ISVA's caseload, they are replaced by another, Then 70 new clients could be taken on per ISVA per year, but this result should be adjusted downwards to allow for some clients to receive a service for over 12 months.

Key Performance Indicators (KPIs) Currently the OPCC looks at four key performance indicators to evaluate an ISVA service:  Number of victim/survivors referred to the project, and from which agencies  Number of successful / unsuccessful prosecutions supported by ISVAs  Perpetrator background  Location / Age of victim/survivor.

The Home Office asks for additional data covering age, ethnicity of the victim/survivor and of the accused perpetrator, location, if the victim/survivor and accused knew each other, and wellbeing data such as whether the victim/survivor feels safer.

Although all providers we spoke to have submitted this data, none knew if the data was used to make any published findings.

In discussing what outcomes would be a useful measure for the service, providers mentioned wellbeing focused outcomes. This would be in line with looking at outcomes for service users that reflect the goals of the Victim Code, namely feeling supported and being informed.

74

These length of stay averages are pure guesswork, used to test the calculation

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Appendix 5: ISVA provision:

Recommendations of 2015 ISVA

National Audit We reproduce here the ten Recommendations of the national Audit of ISVAs in England and Wales, LimeCulture and Kings College London, published in February 2015.

The report is available at http://data.lifeappslab.com/ The recommendations are as follows: Recommendation 1: Increase the number of ISVAs Recommendation 2: Increase the geographical spread of ISVAs across England and Wales Recommendation 3: Raise awareness of the support offered by ISVAs – and how to access ISVA support Recommendation 4: Develop practical guidance for ISVAs Recommendation 5: Ensure that all ISVAs are trained to a minimum standard and can access Continuing Professional Development Recommendation 6: Develop a training framework for ISVAs to ensure that all training providers are delivering an agreed national curriculum Recommendation 7: Consider the creation/appointment of a national body to provide professional oversight and quality standards for ISVAs Recommendation 8: Develop a minimum data set for ISVAs Recommendation 9: Develop a bespoke risk assessment for ISVAs to use with their clients Recommendation 10: Ensure ISVA workforce planning is embedded into local commissioning plans.

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Appendix 6: ISVA services: Needs mapping - client groups Need for Young Person’s ISVA The single largest age cohort of victim/survivors of reported sexual crime in Hampshire last year was children age 15 and under, which is unsurprising; as mentioned elsewhere in this report, under 16s will always form a disproportionate percentage because of the greater clarity that a crime has been committed and a far greater likelihood of the assault coming to the attention of the authorities. The next largest was 16 - 24 year olds. This reflects the number of crimes rather than the number of individuals but it is nonetheless clear that young people are disproportionately victim/survivors of reported sexual crime.

In 2014, Hampshire constabulary conducted a SARC and ISVA gap analysis in respect of victim/survivors of rape and sexual assault by penetration. A notable theme of this analysis was the lack of provision for children and young people and the report recommended  

More funding and resources are needed for the provision of under 13 year olds across the whole of Hampshire and the IOW as there is currently a limited provision for 10-13 year olds and no provision for under 10 year olds Consider use of Treetops as a single point of contact for all paediatric cases.

Our research supports these two recommendations.

We found a lack of ISVA provision for children and young people. Every provider that we spoke with mentioned this need. Additional evidence to support this need includes: 

When a young person discloses a crime to an adult, safeguarding issues are raised and the crime becomes more likely to be reported to the police. The ISVA role is tied to the criminal justice system and reporting to the police should trigger ISVA involvement.



There is a Young Person’s ISVA currently housed at the SARC (Treetops).

However, because the SARC only takes paediatric cases outside of regular office hours, not all paediatric victims go through the SARC. There is then a significant risk that the victim/survivor and their family are not directly referred to the Young Person’s ISVA. Whether the police or the GP is letting the victim/survivor (and their family) know about the service is unclear. It is entirely possible that even if the victim/survivor is told about the ISVA service, that information could get lost in the moment.



Young People’s ISVAs cannot carry as many cases as an adult ISVA given the considerations discussed above: travel, multi-agency working. Even though there may be a large group of people working around the child or young person, the ISVA has an important role to play and brings invaluable specialist knowledge.



An issue that came up repeatedly in our discussions with providers of children’s services was the historic sexual abuse of the parent. An unknown, but significant number of parents were themselves sexually abused as young people.

This dimension brings an added complexity to these cases. Common reactions include the parent either ‘over identifying’ with their child and experiencing

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significant distress or ‘under relating’ to their child with the attitude ‘deal with it. I did.’ The ISVA can make a strong positive impact in these cases, through their role as an advocate for the child.

Key client groups to consider 75 Sexual crime can happen to anyone. However there is evidence to suggest that people with certain characteristics are victim/survivors of sexual crime at a greater frequency than the general public or are less likely to report the crime or to seek help in dealing with the consequences. Some of these client groups are discussed below.

Male victim/survivors

“Approximately 75,000 men are victims of sexual assault or attempted assault a year according to data from 2012/13 while 9,000 men are victims of rape or attempted rape each year according to figures released in 2013, yet police figures show fewer than 3,000 offences of male rape or sexual assault were recorded in 2013/14.”

Ministry of Justice press release announcing new support for male victims of rape December 2014 76 ISVAs work with both men and women but there are currently no male ISVAs working in Hampshire or the Isle of Wight nor are there any specific projects aimed at enrolling male clients. 77 Providers recognise that this is an underserved client group.

People with Learning Disabilities People with learning disabilities may be more vulnerable to sexual crime than other people for a variety of reasons including institutionalisation, communication difficulties, and difficulty understanding relationship boundaries. 78 Many of the ISVAs we spoke with have worked with people with learning disabilities using the aid of another support worker already in place for the client. However, the number of clients is low and it was generally felt there was under-reporting of sexual crime among people with learning disabilities. 79

75

2012 MoJ consultation Getting it right for victims and witnesses: the Government response: “Other suggestions for inclusion under the most vulnerable category included children and young people; people with disabilities including physical impairments such as deafness and blindness as well as learning disabilities; and people with dementia. Under the category of most persistently targeted, some respondents suggested that victims of stalking, hate crime, trafficking and domestic abuse should be included. ………………

Although there were suggestions for other groups to be prioritised, many respondents warned against focussing on the type of crime or characteristics of the victim rather than the needs of the victim as an individual. “ 76 https://www.gov.uk/government/news/new-support-for-male-rape-and-sexual-violencevictims 77 78

The guide “Unlocking Sexual Abuse and Learning Disabilities” produced by Rape Crisis Scotland provides additional background. http://www.rapecrisisscotland.org.uk/workspace/publications/enable_abusebooklet_handbook .pdf 79 It should be noted that Respond, located in London, provides a specialist ISVA service for people with learning disabilities and will provide telephone assistance to people outside of London.

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People with Mental Health problems

“The psychological consequences (of sexual violence) are linked to profound long-term health issues with one third of rape survivors going on to develop posttraumatic stress disorder, relationship problems and longer term psychological needs, mental illness and an increased risk of suicide for abused children when they reach their mid-twenties.”

NHS England sexual violence commissioning guidance 2013 The number of rape victims among women with severe mental illness is staggering. At the time of the survey, 10% had experienced sexual assault in the past year, showing that the problems continue throughout adulthood….

Compared to the general population, patients with severe mental illness are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimization. Psychiatric services, and public health and criminal justice policies, need to address domestic and sexual violence in this at-risk group.”

2014 research, University College London Division of Psychiatry, lead author Dr Hind Khalifeh The criminal victimisation of people with mental health problems has been well documented. The recent study ‘At risk, yet dismissed’ 80 produced by Victim Support, Mind, Kingston University London, Kings College London and University College London provides an excellent overview of the experience of victim/survivors with mental health problems in the criminal justice system. A key finding of this report was thatcrime has a greater and more substantial impact on people with mental health problems than it does on those without mental health problems. The report found that people with mental health problems often have higher support needs after experiencing a crime, and often need support from a range of agencies.

Additionally, this research found that 42% of women with severe mental illness reported being the victim/survivor of adulthood rape or attempted rape.

These findings are further evidenced in our research with all ISVA providers, who consistently cited the need for ISVAs to understand mental health issues, as this was the most common additional issue presented by clients.

Lesbian, Gay, Bisexual, Transgender (LGBT) The Gay British Crime Survey 2013 found that 1 in 8 respondents had experienced unwanted sexual contact. 81While some of the physical and emotional effects of sexual crime will be the same for LGBT people as for anyone else, there are additional risks to reporting the crime and seeking help for the LGBT community including: possibly being “outed”, facing hostility or insensitivity from service providers (including the police); combating assumptions in the larger society around what is ‘normal’ sexual behaviour for LGBT people and the assumption that sexual crime does not happen between people of the same sex.

Given these additional barriers, consideration should be given to how to increase access to support for the LGBT community. There is no current ISVA provision specifically for the LGBT community and providers named this as a gap in service.

80

https://www.victimsupport.org.uk/sites/default/files/At risk full.pdf https://www.stonewall.org.uk/documents/hate_crime.pdf

81

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Substance misuse “Women who experience any type of sexual abuse in childhood are roughly three times more likely than non-abused women to report drug or alcohol dependence” (Kendler et al., 2000) The charity AVA (Against Violence and Abuse) runs the Stella Project which has “incorporated sexual violence and mental health into the scope of its work in recognition of the level of sexual violence experienced by women in particular who access drug and alcohol treatment services and in recognition of the research highlighting drug and alcohol use as coping mechanisms for experiences of trauma.”

A London evaluation concluded that there is “still a vast amount of work needed in order to ensure that young women who have experienced domestic and/or sexual violence and problematic substance use are offered the support they are legally entitled to.”

This correlation was evidenced in our research in Hampshire and the Isle of Wight.

There is currently no specific service or linkages between ISVA providers and alcohol/substance misuse services.

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Appendix 7: Specialist Counselling Services: Training, Accreditation, Standards, Caseloads, and KPI’s Counselling training, accreditation, and standards Several recognised bodies accredit trained counsellors and psychotherapists. The leading body is BACP 82; others include the UKCP 83 and BPS 84. Whist the “basics” of trauma counselling are covered in general training, this does not in itself sufficiently equip counsellors to work in sexual crime services.

Practice bodies and providers consistently advise that sexual violence counsellors should always have specialist training. Additionally, on-going clinical supervision (professional supervision to improve practice and identify issues) is critically important and is offered by a qualified (usually to postgraduate level) person experienced in the sexual violence field.

In a welcome move for the sector, the UK Commission for Employment and Skills has now awarded a new £2m, three year workforce development contract to Rape Crisis England & Wales, in order to improve and increase service provision for sexual crime survivors. There will be national register of trained, qualified professionals, to be delivered largely through additional specialist training to those already qualified and accredited. 85 Caseloads “Caseloads” are relatively meaningless in counselling, which is a fluid scenario with wide variation in need, timescale, geography, and so on. Increasingly, new ways of working (e.g. phone, email, text, often with younger clients) adds a further “caseload” variable. Attempts to calculate caseloads would in addition be complicated by the high level of “unfunded work” required when specific funding imposes unrealistic time limits.

Nevertheless, the Survivors Trust, in discussion with NHS England, has agreed some estimated timelines for short, medium or long term number of sessions as follows:  Short term: 12 sessions  Medium term: 25 sessions  Long-term: 50 sessions.

(Without further investigation, it is unclear how these might be used).

The way that services operate further complicates the “caseload” concept. It is customary to use freelance, “sessional” workers, governed by careful arrangements for training/indication, clinical supervision, etc. For example, the majority of cases will be people who have not, but might, report to police – so notes, records, protecting both counsellor and victim/survivor – must be properly kept and the supervisor must make sure counsellor does this.

Volunteers are widely used. Counselling qualifications require supervised practice hours and those in training are often able and willing to deliver voluntary counselling on this basis. Other experienced counsellors, working freelance, may well offer a modest number of regular sessions to sexual crime counselling providers on a 82

British Association for Counselling and Psychotherapy UK Council for Psychotherapy 84 British Psychological Society 85 See http://www.rapecrisis.org.uk/news_show.php?id=135 83

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voluntary basis. Whist this voluntary commitment is highly valued by many providers, the big risk is underestimating the level of training and support volunteers require.

The key to success with volunteer counsellors is providing regular, good quality clinical supervision which requires staff time.

Key Performance Indicators (KPIs) There is no established clinical outcomes framework for sexual crime counselling.

The Survivors Trust and providers have discussed this and a framework may develop in future. However, there are significant questions including the benefits/harm of time-limited ‘treatment’ focused counselling and the use of metrics designed for PTSD or depression with sexual crime clients.

For Commissioners, outcomes should focus on person centred wellbeing metrics developed in co-operation with service providers as this would provide the best insight into the service user’s ability to cope and recover from the crime.

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Appendix 8: Specialist Counselling: Needs Mapping detail What service users tell us We received six survey responses from survivors who had accessed specialist counselling. Three reported that the service was easy to find while two said it was ‘pretty easy.’ The one respondent who found the service ‘impossible’ to access was a non-abusive parent to a child who had been sexually abused. This underscores the difficulty of accessing counselling services for parents and carers.

The clear majority of respondents were satisfied (highest mark) with the service they received. The following are what respondents found most helpful about the service: 

Talking to someone



(The counsellor’s) persistence and patience. They did not give up. I found counselling very difficult. I subconsciously put up barriers to talking about my abuse. (These barriers were involuntary.) They continued with me and now things are turning around.



First time ever to get one-to-one non-judgemental listening. This literally saved my life. I was very suicidal before the counselling. For the first time I could be open and honest, I felt understood and valued as a human being. I literally would not be alive without it.



Someone to talk to about my child and advise on the legal system



Without one-to-one counselling and support for counsellor, I would literally have committed suicide. Counselling made me feel heard and understood on issues I could not talk to anyone else about. It has helped me to see I was not at fault, not guilty, shameful and dirty as I was always led to believe. This changed my life and my attitude to life completely. This counsellor’s support has turned my life around. I now believe I have some worth. I deserve to live and enjoy life. I hadn’t believed that before in 50 years, despite all the medicines prescribed by the GP.



PARCS and MOSAC have been a huge help for me – I really would have been very low and perhaps taken desperate measures without their support. I needed help to support my child when she was unable to access support during family court proceedings. My whole life was falling apart and with support I was able to keep family life steady and keep the family stable. The police were awfully unsympathetic to my daughter of 6 and myself. Family were not supportive.

Luckily my husband was. My daughter was abused by her biological father and there was no help.

The numbers and geography While it is clear that the demand for sexual crime counselling outweighs availability, the number of people who may be seeking this service is very difficult to gauge.

Unlike ISVA services which have a connection to reported crime, sexual crime counselling clients have a much lower rate of engagement with the criminal justice system. One service reported that only 1% -10% of clients had reported while another service put that figure at 25% - 50%.

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In terms of numerical estimates, a variety of sources can be considered, yet all will be flawed. 86Additionally, victim/survivors can wait years before seeking support.

However, there is widespread consensus that around 85% of sexual crime goes unreported. 87 Combining known national and regional trends (including those on historic cases) and informed “guesstimates” on how many victim/survivors might report and/or seek specialist help; it may be possible to make some meaningful estimates, for example: Crude estimate of counselling need/demand, based on current rape and sexual assault crime figures if 85% under-reported Of these, rape and sexual assault: If 85% are unreported then the true rape & sexual assault figure would be 6 times that figure at around Of these, if 10% seek specialist counselling, then annual need would be 15% “ 20% “ 50% “

No. of anticipated referrals: 2005 13,369

reported crimes actual crimes

1,337

cases

2,005 2,674 6,684

“ “ “

In practice, commissioners rely heavily on information and intelligence from the front line: trends for referrals of all types and waiting times.

Looking at the number of referrals 88 that the three largest specialist sexual crime counselling services in Hampshire received from January 2014 through December 2014 in Hampshire 89 there was a total of 693 referrals for individual counselling. This represents an increase on average of 17% from the previous year. In total these services provided 442 clients with a service. This represents only 22% of all the reported rape and sexual assault cases.

“Remember that without decent coverage travel is a nightmare for all involved.”

Fay Maxted, Chief Executive, The Survivors Trust, interviewed December 2014 Geographical accessibility is a challenge for many services covering rural and semirural areas, and this is particularly so in the case of thinly-spread, over-stretched counselling services.

Statistics given elsewhere in this document provide a map and population numbers with the 11 Districts of Hampshire having a population of 1.15 million, nearly four times greater than that of Southampton, the larger of the two unitary authorities.

86

The regional Strategic Assessment of Victims Services (Tapley 2014) details many of the challenges in estimating the prevalence of sexual crime. In an interview with West YorkshirePCC, it was noted that a high proportion of responses to a recent community consultation cited cultural and societal reasons why some victims may never tell anyone at all.

87 Rape Crisis England & Wales website 88 This way of extrapolating a number is flawed as referrals may not be made if a service has a known waiting list, people may not know a service exists, or there may be no service in their area.

89 Southampton Rape Crisis 315, PARCS 263, Winchester RASAC 115. BRASSAC (Basingstoke) saw 17 new clients in 2013/14

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The cities of Southampton and Portsmouth have a higher percentage of reported sexual crime than both the Isle of Wight and the remainder of the county. They also house the two largest providers of services for survivors of sexual crime. These two larger hubs provide some services for adjacent districts.

However, due to funding sources in Portsmouth, services are less available to residents outside the city. In any case, the difficulty of getting to the service will be increased for residents living outside Southampton or Portsmouth. Victim/survivors living on the Isle of Wight are particularly challenged in getting to a counselling centre. A pilot project by Southampton Rape Crisis has begun to provide individual counselling services for adults on the island.

Need for further specialisation Even within sexual violence counselling, additional specialisation is required to work with each of the many distinct groups of victim/survivors identified within this scoping document, and in some cases, their family members.

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Appendix 9: Tables showing current specialist sexual crime counselling services in detail The following charts show the availability of specialist counselling in detail by geographical area, age groups served and whether families are offered a service.

PARCS 91 Portsmouth SRC Southampton Winchester RASAC 93

X

X Alt on

X X X

X

Winchester

Test Valley

Southampton

Rushmoor

Portsmouth

New Forest

IOW

Havant

Hart

Gosport

Fareham

Eastleigh

BRASAC 90 Basingstoke

Basingstoke & Dean East Hants

Availability of Sexual Crime Counselling for Adults by Location

X X

X X 92

X

X

X (sout h) X (nort h)

90

BRASAC will see clients aged 16 and over.

Funding for clients living in areas outside of Portsmouth is very limited and this presents an additional barrier to people in those areas attempting to access the service.

92 SRC has recently started a new pilot project offering individual specialist sexual crime counseling for adults based on the Isle of Wight.

93 RASACs remit is larger with some overlap with BRASAC 91

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X

X

X (sout h)

X

X (sout h)

X (so uth )

(nort h)

(no rth)

Winchester

Rushmoor

Portsmouth

Test Valley

X

X X 95

X

New Forest

IOW

Havant

Gosport X

Hart

Fareham X

Southampton

SRC Southampton

Eastleigh

BRASAC 94 Basingstoke PARCS Portsmouth

Basingstoke & Dean East Hants

Availability of Sexual Crime Counselling for Children age 11 - 16 by Location

X

Winchester RASAC NSPCC 96 Southampton

X

X

X

X (so uth ea st)

Areas with NO local source of specialized counselling

94

BRASAC will see clients aged 16 and over.

IOW residents under age 18 or seeking family therapy can use SRC counselling services but must travel to Southampton.

96 This programme is starting in Spring 2015and will serve children ages 4 – 17. Capacity is expected to be between 70-100 clients per year. The service islocated in Southampton and can take clients from the surrounding area within reason travel times (roughly 60 minutes).

95

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X

X

Rushmoor

Portsmouth

New Forest

Winchester

Areas with No local source of specialized counselling

X

Test Valley

NSPCC Southampton

X

Southampton

97

IOW

X

Havant

X

Hart

Gosport

BRASAC Basingstoke PARCS Portsmouth SRC Southampton Winchester RASAC

Fareham

Eastleigh

Basingstoke & Dean East Hants

Availability of Sexual Crime Counselling for Children age 5-10 by Location

X

X (sout h)

X (so uth )

(nort h)

(no rth)

X

X (so uth ea st) (no rth we st)

97

This programme is starting in Spring 2015 and will serve children ages 4-17. See Note 56.

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X

X

Southampton

Rushmoor

Portsmouth

New Forest

Winchester

X

Test Valley

Areas with NO local source of specialized counselling

X

X (sout h)

X (so uth )

(nort h)

(no rth)

X X 98

99

NSPCC Southampton

IOW

X

Havant

X

Hart

Gosport

BRASAC Basingstoke PARCS Portsmouth SRC Southampton Winchester RASAC

Fareham

Eastleigh

Basingstoke & Dean East Hants

Availability of Sexual Crime Counselling for Families of minor children by Location

X

X (so uth ea st) (no rth we st)

X

98

IOW residents under age 18 or seeking family therapy can use SRC counselling services but must travel to Southampton.

99 This programme is starting in Spring 2015 and available to children ages 4 – 17. See Note 56.

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Appendix 10: Details from Medaille Trust (Slavery/Trafficking) The Medaille Trust has received a year’s grant funding to help deliver the panHampshire anti-slavery partnership; see Section 12 of this document.

Housing provision The Trust runs well-staffed safe houses in the OPCC area, which are part of the national contract held by the Salvation Army, receiving and supporting people who are victims of modern slavery. There will shortly be 18 places with the addition of four more places for women; the service will then be 50/50 men and women.

Under the EU Convention all victims are entitled to a minimum of 30 days support “for rest and reflection”, which in the UK has been increased to 45 days. In practice, UK and EU citizens are restricted to 45 days as a maximum, while those without status will sometimes stay longer.

The safe houses are always full. All referrals originate from the Home Office via the national contract held by the Salvation Army. Supported safe houses are not the norm across the country; other areas use bed and breakfast, hostels and so on.

There are many gaps in provision and access to services for this group.

All referrals come via the National Referral Mechanism and there are relatively few from the pan-Hampshire area. Based on experience elsewhere, the manager commented that the numbers are surprisingly low and she would expect a lot more, which would suggest that these crimes may be more hidden in pan-Hampshire than in some other areas. This reinforces the need for the new Anti-Slavery Partnership.

Profile of people who use the Medaille Trust service in the OPCC area The Medaille Trust works with people to raise their awareness with health, homelessness, Local Authorities, counselling, and various services.

People who use the Medaille Trust accommodation 100 Age

Gender Background Est. number of people supported in a year Estimate of proportion who have experienced sexual crime

From 16 upwards. Unaccompanied children are the responsibility of Social Services, and the service receives referrals when young people reach 16. Some are of disputed age – i.e. they have no proof of their age.

In this service will be 50-50 women-men “People from all walks of life”. There are many forms of modern slavery. From a wide range of nationalities including UK and EU. Have supported some local victims.

Very roughly, based on an average stay of about 60 days this would be around 100 people per year for an 18 bed service. (the service can provide actual figures if required.)

Women: Most or all of the women supported have experienced sexual crime.

Men: Young men from certain backgrounds may be particularly vulnerable to sexual crime. This is even more of a hidden crime than for women, so evidence/information is not available.

100

Based on interview with Service Manager May 2015

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Access to services, and gaps in services There are major limitations as to what people can access. Typical barriers include:  

Registering with a GP: when you may not have any ID or address Housing: homelessness services often unable to help, e.g. because these are victim/survivors without children NHS Psychological Therapy: Steps2Wellbing, the IAPT service 101 run by Dorset Healthcare NHS Trust for Southampton and Dorset): People with PTSD 102 can in theory be helped, but interpreting issues are a big barrier. Now they do a drop in on Tuesdays, which is helpful as in practice, given timescales this is the only option. (In the past, Medaille used to have access to a psychotherapist, but this came to an end. An FGM victim/survivor was referred re surgical options, which she didn’t take up but was a good option.)

Southampton Rape Crisis: usually inaccessible due to the waiting list. People without immigration status often move to asylum accommodation which is usually in the North of England, so do not stay long enough in the area to get this support.





One key service is barrier-free. The Medaille Trust reports that the Sexual Health clinic is extremely good, and responsive to requests for changes that would make it more accessible to victim/survivors. There is a drop-in for high vulnerability people (sexual crime and trafficking) and victim/survivors do not have to wait. “There is no hanging around in a waiting room, and no need to repeat your entire story when you are seen; which is a great relief as each time they repeat their story to a UK official, people experience their powerful underlying fear of deportation.”

101

IAPT: Improved Access to Psychological Therapy

102

PSTD: Post Traumatic Stress disorder

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Victims of modern slavery referred to Medaille Trust: Prominent gaps in services Issue Comments (from Service Manager) “Modern slavery act over focuses on prosecutions but not Victim support enough victim support – so where are your witnesses? Better victim support would improve these outcomes”.

Access to sport and exercise opportunities

Access to community programmes and IT classes

“Asylum seekers in DV refuges are sometimes left in rooms with no access to support due to immigration status.”

“Sport and exercise does wonders, especially for people not allowed to work. GPs used to refer to sports centres and gyms but this has been cut. Gym, badminton, swimming etc. is really great, for both men and women, bringing a sense of wellbeing, self-worth, and achievement.

Yes, there is the great outdoors but weather will inhibit this. This lack has an “anti-recovery” impact. We have a little bit of charitable resource but it’s very limited – just a few gym passes. Without this, it’s often straight into antidepressants which are all the GP can offer.”

“These can be highly effective but usually don’t fit because they require some form of commitment and victims need independent access without being ‘on show’ ”.

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Appendix 11: Gap analysis: Specialist Counselling This assessment of gaps in service is based on our interviews and responses to the provider survey.

Estimating the scale of under-provision Counselling services across Hampshire and the Isle of Wight are operating to capacity with waiting lists ranging from three months to as long as 18 months.

Waiting lists and reported crime figures cannot accurately demonstrate need.

Additionally, counselling providers’ estimates of the proportion of their clients who have reported the crime to the police vary widely (under 10% up to 50%).

Future partnership work focusing on data sharing may help to estimate under provision. Victim/survivors seek help from other sources to manage the impacts on their health and wellbeing; for example, we found evidence of the high rates of drug and alcohol misuse among survivors.

Uneven geographical coverage Although there are four primary sexual crime counselling services in Hampshire, not every area has the same capacity to offer clients a service. Looking at a proportionate share of clients to reported crime, the areas covered by BRASACC and RASAC served 20% of counselling clients but experienced 28% of the reported sexual crime in 2013/14.

Three Districts fare worst in terms of waiting lists: victim/survivors and survivors in Havant, Fareham, and Gosport are waiting between 12 and 18 months for a counselling service, over twice as long as other residents of Hampshire.

Gaps in relation to specific client groups The following are the most repeated themes in our interviews with providers and include information gathered in the provider survey.

Client group

Findings 

 Victim/survivors with mental  health problems 

 Families 

Mental Health was the number one ‘other issue’ that providers told us their clients present. One provider stated that 80% of counselling clients had a chronic and enduring mental health diagnosis.

More than one service reported that prospective clients presenting with acute mental health needs will only be accepted for services once they have stabilised.

Another service provider recommended that some clients should have a support worker while they are receiving counselling, as this would significantly assist in recovery.

A strong case emerged for more integrated services. Formal communication and co-operation is lacking between NHS mental health services and counselling providers. This is seen as a real barrier to improvement, although some good working relationships have developed.

There is a large gap between the number of victim/survivors under the age of 16 and the services available to them and their families.

The NSPCC is starting Let the Future In and Women as Protectors (a service for mums and carers who are in contact

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

  Men





 Lesbian, Gay Bisexual and Transgender people





Children



  People with Learning Disabilities Black and Minority Ethnic groups (BME)





   Victim/survivors  of human trafficking in  relation to Women-only services

with a man who poses a risk of sexual harm to children) in Hampshire. These services will not cover all of Hampshire.

Rapes reported by men over age 16 in the past two years have fallen when all other reported sexual crime has risen.

One reason for this could be that during this time services specifically targeted at men and the gay community have closed.

Reported sexual crime against boys under age 16 has risen sharply.

Although all counselling services in Hampshire serve male clients as part of their service, there is only a limited service specifically targeting men.

PARCS offers a ‘Men’s’ Line’ providing information and support (both one off and ongoing) over the telephone, and PARCS is currently cooperating on a research project entitled “What Men Want”, which will look at services and delivery models focused on male survivors of sexual crime.

SRC was recently awarded funding from the MoJ to develop a men only counselling service serving ages 14 and up but it is unclear if that service will extend beyond SRC’s current service area. This will be one of 12 services awarded funding for this across England on a pilot basis All counselling services in Hampshire serve the LGBT community as part of their service offer There is no dedicated specialist service and the LGBT community faces specific issues and consequences for reporting sexual crime. It follows that a generic service for victim/survivors of sexual crime may feel ‘unavailable’ to LGBT individuals.

There is a large gap between the number of victim/survivors under the age of 16 and the services available to them and their families.

Only PARCS and SRC offer counselling services for people under 18. Both agencies have seen a double-digit percentage increase in demand for these services over the past year.

The NSPCC is starting to offer a pan Hampshire service People with learning disabilities are more vulnerable to sexual crime than other people.

All counselling services in Hampshire will work with people with learning disabilities, and some have accessed specialist training in response to referral trends, suggesting that a proactive approach may be required.

While all counselling services in Hampshire serve people from black and minority ethnic backgrounds, there are no specialist services directed at BME communities.

All counselling services in Hampshire serve women Women account for over 90% of all counselling clients There is no specialist provider for women only.

All services in Hampshire will work with people who have been trafficked in relation to sexual crime There are no specialist services for victim/survivors of trafficking in relation to sexual crime.

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sexual crime



 Non-English speaking populations

Language and the cultural expectations of the client (the counselling model may be outside the cultural framework) were cited as significant barriers to an effective service by those providers who have some experience of working with this group.

More research, regionally, nationally and internationally would be needed to inform this specialism. 103

While all services in Hampshire will work with people who do not speak English, there is very little financial allowance to hire interpreters. This was named as a gap in service by providers.

Access issues within existing services Counselling service providers told us that specific practical issues can severely inhibit their client’s ability to access the service. They highlighted:  Childcare  Geography/Transport  Opening hours.

Other barriers to consider Providers highlighted a range of significant barriers to delivery of an effective counselling service: Issue

Description of barrier to effective service

Economic deprivation

A challenge for many clients in accessing services especially in regard to transport and childcare (as above).

Counsellors working with young people told us that a significant percentage of their parents have themselves survived sexual Generational crime. This added dimension has repercussions throughout the patterns process.

Counsellors told us that they wanted more clarity on what Notes and victim/survivor happened with counselling notes and victim/survivor statements requested by the police and CPS. statements Counsellors repeatedly told us that the delay in getting to court had a deep and negative effect on clients.  Younger clients suffered because the delay prevents them Impact of from moving on with their lives and can interfere with their court delays exams  The delay in getting to court has been cited by university students as a primary reason for not reporting the crime.

Counselling services told us that clients who are simultaneously engaging with counselling and the criminal justice system experience an increased level of distress during key events in the Assistance and advocacy CJS process. with the This distress impacts the client’s ability to cope and recover and is criminal justice system manifest in counselling.

Lack of an ISVA based within the same organisation is seen as a barrier; conversely, having an on-site ISVA improves effectiveness, 103

This echoes the recommendation in the Tapley report.

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Assistance and advocacy with the criminal justice system: Young people

Court staff – lack of understanding

e.g.:  Services well positioned to better assist clients at these times of increased distress, as the client is usually working with an ISVA and counsellor from the same service  Counsellors can gain a deeper understanding of the process through these relationships; CJS process questions are answered quickly ‘in-house’.

Counsellors told us that young people who are simultaneously in counselling and involved with the criminal justice system are particularly affected by, and often distressed by the criminal justice process.

One counsellor told us, ‘Young people see things on TV and they are told that if something bad happens to you, you tell the police. The bad guys will get punished. This is what they believe and then something really bad happens to them it doesn’t work out that way.’

Another told us that young people who have experienced sexual crime feel that they are not heard, and after they disclose the crime, they feel even less so.

Counsellors told us that clients often report feeling blamed by court staff and the criminal justice system in general. They questioned how much court staff understand about the cycle of sexual crime and the dynamics of sexual violence.

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Appendix 12: FGM: Health & Social Care Information Centre Statistics This Appendix refers to the NHS statistics quoted under “prevalence” in the FGM Section 10 of this document.

The new DH NHS commissioning guidance warns that “There is a significant difference between the published prevalence rates and the number of women treated in the NHS who have been identified as having FGM. The number of patients treated will always be significantly lower than the prevalence across the population, as the whole population does not access healthcare services within a given period (be that monthly or quarterly). However, they can still represent an important indicator and are indicative of the number of patients for whom services should be commissioned. Again this is a potentially complicated issue however, as the provision of services may lead to a subsequent increase in the number of patients accessing the services on offer as awareness rises.”

Despite the many limitations of this way of qualifying need, the NHS returns have the advantage of being based on evidence that is directly observed by clinicians.

From Health and Social Care Information Centre March 2015 Based on hospital reporting

The Female Genital Mutilation (FGM) Prevalence Dataset (ISB 1610) is a monthly return of data from acute hospital providers in England. It is an aggregated return of the incidence of FGM including women who have been previously identified and are currently being treated (for FGM related or non FGM related conditions as at the end of the month) and newly identified women within the reporting period. It has been a mandated collection from 1 September 2014 to 31 March 2015. This is the final publication in this monthly series on the FGM Prevalence Dataset.

For the month of March 2015:  145 eligible acute trusts in England submitted signed off data.  3,164 active cases and 578 newly identified cases of FGM were reported nationally.

For the period of September 2014 to March 2015:  3,963 newly identified cases of FGM reported nationally.  60 newly identified cases of FGM reported nationally were under the age of 18.

The report gives further detail including notes on data accuracy and notes. Some small numbers are suppressed to avoid risk of identifying patients.

FGM Enhanced Dataset – collection now underway Collection of the FGM Enhanced Dataset (SCCI2026), including individual patient level data, began in April 2015.

Data will be collected by acute trusts, mental health trusts and from GP practices.

The collection and submission of this information aims to support improvements in:

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     



the identification of FGM and the wider social issues that impact upon the women or girls, thus increasing public awareness and informing the development of training for clinicians data quality by promoting more detailed recording of FGM when it is identified; and provide better evidence for potential prosecutions of those who carry out FGM Alignment of prevention (through risk identification) and support for the women, identifying where support is needed most Provision of secondary use data to support aggregated detailed studies on the prevalence of FGM Informing local and cross government organisations about the prevalence of FGM, therefore supporting the ability to target specific areas for the commissioning of appropriate services, and training needs Raising awareness of the risk of FGM to women and girls, resulting in improved safeguarding measures against FGM, including early intervention by relevant organisations to reduce and work towards the eradication of FGM Reporting of the FGM Enhanced Dataset is planned to begin in autumn 2015.

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Appendix 13: Further Details of Multi-agency Partnerships This Appendix provides brief details of the following partnerships not fully described in Section 12, as follows Name of partnership Domestic Abuse Management Group PIPPA Alliance Domestic abuse review group Community Safety Partnerships Hampshire & Isle of Wight Community Safety Alliance Hampshire & Isle of Wight Police and Crime Reduction Alliance Health and Wellbeing Boards

Geography Pan Hampshire Southampton Portsmouth One per unitary Authority and one per District Council (or group/pair of District Councils) – total 12 CSPs Pan Hampshire Pan Hampshire One per top tier Local Authority (i.e.

Hampshire CC and each of the three Unitary Authorities).

We have also been made aware of the Serious Sexual Offences Reduction Groups (SSORG), and we understand there are four of these that all roll up into the Silver SSORG Group. This may require further clarification.

Domestic Abuse Management Group The Domestic Abuse Management Group is a Pan Hampshire Group attended by Local Authority representatives, Police, Housing Associations and the voluntary sector. It is chaired by Hampshire Constabulary (Detective Superintendent Rachel Bacon).

Areas of focus for this group which are relevant to the Sexual Crime Strategy include: FGM, preventative work around promoting healthy relationships and improved information sharing. The Hampshire Domestic Abuse Forum websites (www.hdaf.org.ukfor professionals, www.hampshiredomesticabuse.org.ukfor the public) also have information about FGM. There is also an e-learning course that is available to professions via the HDAF website (http://www.hdaf.org.uk/?page_id=204).

PIPPA Alliance, Southampton Pippa is an alliance of specialist sexual and domestic violence services in Southampton. The website offers information about services and projects as well as details of where get help if you are experiencing abuse.

Pippa offers specialist advice, information and support to professionals in Southampton, through a range of projects and products including:  A point of contact - for workers seeking advice and information, and a place to make referrals  Pippa at the Hospital - a service for University Hospital Southampton  Training and consultancy - for individual workers and organisations wishing to improve their responses to sexual and domestic abuse. http://www.pippasouthampton.org/index.php Domestic abuse review group - Portsmouth Accountable to the Safer Portsmouth Partnership, the Portsmouth Domestic Abuse review group is responsible for overseeing the delivery of domestic abuse and sexual Hampshire PCC Sexual Crime Strategy: Mapping and Scoping draft report Aug 2015125

crime services in the City. Attended by representatives across the local authority and partner agencies the group monitors need and provision. The group does not consider FGM, which is a responsibility of the Portsmouth Safeguarding Children's Board.

Community Safety Partnerships The Crime and Disorder Act 1998 set out statutory requirements for 'responsible authorities' in local areas to work together in partnership to develop, publish and implement strategies to tackle crime and disorder and substance misuse in their area. They are also under a duty to reduce re-offending in their local area. CSPs are made up of Local Authority, Clinical Commissioning Group, Police, Hampshire Fire and Rescue and Probation. CSPs also work closely with other criminal justice agencies and the voluntary and business sectors.

The 12 Community Safety Partnerships across Pan Hampshire with contacts at June 2015: Havant Borough Council Tim Pointer tim.pointer@havant.gov.uk Hart, Rushmoor and Caroline Ryan Basingstoke District Council Caroline.ryan@communitysafetynh.org Sandra Tuddenham Winchester City Council STuddenham@winchester.gov.uk Eastleigh Borough Council Melvin Hartley Melvin.hartley@eastleigh.gov.uk Test Valley Borough Council Andrew Pilley Andrew.pilley@testvalley.gov.uk New Forest District Council Annie Righton Annie.righton@NFDC.gov.uk Fareham Borough Council Narinder Baines Nbains@fareham.gov.uk Portsmouth City Council Lisa Wills Lisa.wills@portsmouthcc.gov.uk; Isle of Wight Council Amanda Gregory Amanda.gregory@iow.gov.uk Southampton City Council Gavin Derrick Gavin.derrick@southampton.gov.uk East Hampshire District Ryan Gulliver Ryan.gulliver@easthants.gov.uk Council Gosport Borough Council Sorrell Wakefield Sorrell.wakefield@gosport.gov.uk Hampshire & Isle of Wight Community Safety Alliance This partnership group is attended by the Chairs of the Community Safety Partnerships (many of whom are Leaders or Executive Members of the relevant District Council), supported as necessary by their Community Safety Managers.

These meetings will take place quarterly and be chaired by the Hampshire Police & Crime Commissioner. This will complement the arrangements put in place to meet with representatives of the four top tier and unitary Authorities and other statutory partners (see below) and enable the Commissioner to build and maintain a sound business relationship with the Community Safety Partnerships.

Terms of Reference 1. For the Commissioner to hear, first-hand, the risks, priorities, and emerging issues being faced by CSPs. 2. To identify opportunities for closer working between partners 3. To ensure that CSPs are fully informed of the Commissioner’s priorities and policies, as set out in the Police and Crime Plan.

4. To work with CSPs on emerging national issues e.g. the Community Remedy and Trigger.

5. To ensure collaborative arrangements are in place so that local concerns are reflected in OPCC funding.

6. To provide assurance as to the efficient and effective application of funding provided by the Commissioner to achieve agreed outcomes.

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Hampshire & Isle of Wight Police & Crime Reduction Alliance Police and Crime Commissioner Simon Hayes chairs the newly formed Hampshire and Isle of Wight Police and Crime Reduction Alliance. The Alliance has been set up to seek the commitment from partners to work closer together, support each other and coordinate the management of resources to protect residents of Hampshire and Isle of Wight.

Meetings will take place every six months, commencing in January 2015 to enable the sharing of plans for the next round of budget setting. Meetings are arranged and serviced by the OPCC.Meetings are chaired by the PCC and members include:  The Leaders of Hampshire County Council, the Isle of Wight Council, Portsmouth City Council and Southampton City Council;  The Chair of the Community Rehabilitation Company;  The Chair of Hampshire Fire & Rescue Authority;  The Leader of one Hampshire District Council (as a link to CSPs);  A Health Service representative  The Chief Constable.

Terms of Reference: To provide a forum for high level political engagement between strategic partners on matters concerning policing, crime and the reduction of re-offending.

1. To actively encourage strategic partners to plan their services and allocate their resources in a co-ordinated way that supports the overall achievement of the police and crime objectives in the Police & Crime Plan.

2. To identify opportunities for closer working between the partners to address emerging local, regional and national issues impacting on policing and crime, to achieve better overall outcomes for the communities of Hampshire and Isle of Wight.

3. To act as a consultative and advisory body to the Commissioner, at a strategic level, on the review and delivery of the Police & Crime Plan.

The creation of the Alliance has no effect on the Police and Crime Panel, which continues to undertake its statutory scrutiny role.

Health and Wellbeing Boards Health and Wellbeing Boards are statutory bodies introduced in England under the 2012 NHS reform. Each upper-tier local authority in England has formed a Health and Wellbeing Board as a committee of that authority. The aim of the Health and Wellbeing Boards is to improve integration between practitioners in local health care, social care, public health and related public services so that patients and other service-users experience more "joined up" care, particularly in transitions between health care and social care. The boards are also responsible for leading locally on reducing health inequalities.

Each board produces a joint strategic needs assessment (JSNA) for its local authority area, and produces a joint health and wellbeing strategy. Health and wellbeing boards have no statutory obligation to become directly involved in the commissioning process, but they do have powers to influence commissioning decisions. They hold responsibility for public health at the local level.

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Appendix 14: Directory of Organisations Providing Specialist Services This list of organisations includes only those which provide a dedicated service to victim/survivors of sexual crime in relation to issues covered in this document.

The first table lists local services and the second table, national contacts. Some organisations appear in both.

Name of organisation Aurora New Dawn

Barnardo’s

Brief details (service, geography)

Website/ email/ contact phone number

Providing a local service in the Pan Hampshire area ISVA service (Portsmouth) http://www.aurorand.org.uk/ A registered charity giving safety, support, advocacy and empowerment to survivors of domestic abuse and Call our helpline on 02392 472 165 Office number - 02392479254 sexual violence, including.  one to one work  advocacy and group support  working in partnership across the private, public and voluntary sector  providing training and education programmes  promoting equal opportunities within and beyond the organisation Geography – Hampshire, Portsmouth, Southampton http://www.barnardos.org.uk Large national children’s charity.

Hampshire: Search for services by area/postcode.

Hampshire Sexual Exploitation Service (PanHampshire): Child sexual Website gives local contact number for these services: 07957 320 336 exploitation/trafficking: Prevention of and supporting recovery from episodes of exploitation and trafficking.

Southampton Miss-U and U-Turn Service helps young women and young men under the age of 18 who are vulnerable to, or are being, abused through prostitution in Southampton.

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Name of organisation

BRASSAC (Basingstoke Rape and Sexual Abuse Crisis centre)

CIS’ters (Surviving Rape and/or Sexual Abuse)

Early Intervention Project (EIP) Portsmouth Hampton Trust

Brief details (service, geography) Portsmouth U-turn service for young people under the age of 18 who need help with keeping safe, dealing with relationships and issues affecting their lives.

Further programmes may be in development.

Rape and Sexual Abuse Crisis Service; Basingstoke and neighbouring areas.

Specialist counselling New ISVA service in development at date of writing (summer 2015) CIS’ters is run by survivors for survivors and has been delivering services locally within Hampshire for 20 years. 60-70% of women supported are living within the pan-Hampshire area It provides emotional support (as do all specialist services) – but specifically for females age 18 and over who, as children/teens, were raped/sexually abused/exploited by a member of their immediate/extended family.

CIS’ters has a local and a national profile. The helpline is available to female adult survivors of childhood rape/sexual abuse, and others can call if they have a concern about such issues. In the case of the latter we will seek to signpost them to appropriate services.

ISVA (16+) Run by Safer Portsmouth Partnership http://saferportsmouth.org.uk/home/about ISVA service Southampton and Isle of Wight

Website/ email/ contact phone number

http://www.brasacc.com/ Office Line: 01256 423810 Open Monday-Friday 9:30am to 5pm Crisis Line: 01256 423890 Open Monday-Thursday 7pm to 9pm (Answerphone when engaged or closed) http://cisters.org.uk/ EMAIL: admin@cisters.org.uk HELPLINE: 023 80 338080 Open on Saturdays 10am-noon. At other times it is an answerphone and callers can choose to leave their name and phone number, and we will call them back and will take care when doing so.

http://saferportsmouth.org.uk/eip http://saferportsmouth.org.uk/help-in-portsmouth 02392 688 472 – contact number for help. http://www.hamptontrust.org.uk/ Office Tel: 023 8000 1061

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Name of organisation

Brief details (service, geography)

A regional charity, targeting vulnerable groups across the age spectrum with the aim of improving the life chances of those who have experienced violence, conflict, abuse and isolation.

Island Women’s Refuge ISVA available for women who have experienced rape and Domestic Abuse or SA in a DA relationship Services NSPCC NSPCC) who therapeutic counselling programme, “Letting the Future In”, developing during 2015. To be Southampton based and service pan-Hampshire subject to practical travel constraints PARCS (Portsmouth Abuse & Rape Counselling Service)

PIPPA Alliance

RASAC (Winchester

Website/ email/ contact phone number

Tel: 01983 615278 Email: info@islandrefuge.org.uk No website found http://www.nspcc.org.uk/services-and-resources/services-forchildren-and-families/letting-the-future-in/letting-the-future-inreferrals/ Link to NSPCC website. New service contact details not yet published at date of writing.

Post - PO Box 3, Portsmouth, Hampshire. email - admin@parcs.org.uk Telephone - 02392 669513 Young Persons Service - 023 9266 9519 To make a referral, please call or email PARCS on the above numbers/email address. http://www.parcs.org.uk/

Portsmouth City based. that works with people who have been sexually violated at any time in their lives no matter how long ago.PARCS provides free specialist counselling and psychotherapy to women and men, aged 5+ who are resident in Portsmouth and South East Hampshire and who have experienced any form of sexual violation at any time in their lives.

Includes specialist sexual crime counselling, helplines, and a range of other services – see website A group of services in Southampton working to end Call us on 023 8091 7917 or Email info@pippasouthampton.org domestic and sexual violence and abuse.

Pippa offers specialist advice, information and support http://www.pippasouthampton.org/index.php to professionals in Southampton, through a range of projects and products including a point of contact - for workers seeking advice and information, and a place to make referrals; a service for University Hospital Southampton; and Training and consultancy.

Offers a free, confidential listening and support service http://www.rasac.org.uk/

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Name of organisation Rape and Sexual Abuse Counselling)

Southampton Rape Crisis Service

Brief details (service, geography) Website/ email/ contact phone number for women and men who have been raped and/or rasac@waca.org.uk sexually abused at any time in their lives, or for anyone who wants to talk about the effects of any HELPLINE - 01962 868 688 or 01962 864 433 unwanted sexual encounter. office 01962 807 037 Includes ISVA and counselling services.

Area served: Hampshire County Council – Winchester and majority of Districts/Boroughs (excluding Basingstoke) Provides a range of integrated, specialist services to those who are at risk of or who have been affected by an unwanted sexual experience. This may include anything from rape, childhood sexual abuse and sexual assault to harassment or coercion.

Office & General Enquiries: 023 8063 6312 Independent Sexual Violence Advisor (ISVA): 077 6773 4700 Star Project (Education & Outreach): 023 8063 6315 Young people’s service (11+) contact 023 8063 6312 Helpline: 023 8063 6313 Email:info@sotonrc.org.uk

Counselling, ISVA, other services – see website

Southern Domestic Abuse Service

Treetops Sexual Abuse Referral Centre – SARC

Southampton, Isle of Wight, some neighbouring districts.

FGM/C Community Development worker of BME origin providing support to survivors of FGM/C. We also empower women to make decisions about their own and their daughter’s bodies by providing information about their rights, protection and the law.

A supportive victim/survivor focused environment for all victims of rape or sexual assault.

Portsmouth, Southampton, Hampshire, Isle of Wight.

A range of information and practical support, available 24 hours a day, whether the crime has just happened or is in the past. Support to victim/survivor whatever decision they make.

Contact www.southerndas.org patience.manhovo@southerndas.org 02392008328 0788495387 http://www.solent.nhs.uk/pageservice.asp?fldArea=19&fldMenu=0&fldSubMenu=0&fldKey=225

By Phone - 02392 210352 Crisis Workers are available to talk to you any time 24/7, or alternatively we can book an appointment convenient to you to attend Treetops.

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Name of organisation CIS’ters (Surviving Rape and/or Sexual Abuse) Agency for Culture and Change Management UK (ACCM UK) Beyond the Streets – Beyond Support Child Protection Helpline ChildLine FORWARD: Foundation for Women’s Health Research & Development LimeCulture

London Safeguarding Children Board MOSAC (Mothers of Sexually Abused Children)

NSPCC

Brief details

Website/ email/ contact phone number

National organisations – advice, information, helplines, campaigning CIS’ters has a local and a national profile – see above for As above details.

Women’s organisation focusing on FGM; website has further http://www.accminternational.org.uk/links-to-otheruseful links fgm-sites A free and confidential support service for women in the sex industry. (advice for adults worried about a child) 24 hr free helpline for children FGM information, campaigning,

Helpline: 0800 1337 870 (not 24 hour) or email support@beyondthestreets.org.uk 0808 800 5000 0800 1111 www.forwarduk.org.uk

LimeCulture Community Interest Company (CIC) - a social enterprise set up to support a professional response to sexual violence. Training and development programmes with frontline professionals, research, best practice.

FGM: Website resources

http://www.limeculture.co.uk/ Tel: 07799434956 info@limeculture.co.uk

Supporting all non-abusing parents and carers whose children have been sexually abused. We provide various types of support services and information for parents, carers and professionals dealing with child sexual abuse.

National charity, campaigning, helpline(s) and information as well as services.

Child protection helpline gives information, advice and counselling to anyone worried about a child.

http://www.londonscb.gov.uk/fgm_resources/ Helpline: 0800 980 1958 Website: www.mosac.org.uk

www.nspcc.org.uk NSPCC child protection helpline 0808 800 5000 FGM helpline: 0800 028 3550

National FGM helpline: If you suspect that FGM has happened,

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Name of organisation

Rape Crisis England and Wales

Respond

SafeLives (formerly CAADA) Survivors Trauma and Abuse Recovery Trust (START)

Survivors UK:

The National Association for People Abused in Childhood (NAPAC)

The Survivors Trust

Brief details even if it's not recently, you must seek help and advice: call the FGM helpline on 0800 028 3550.

Rape Crisis England & Wales is a national charity and the umbrella body for network of independent member Rape Crisis organisations. (Focuses on needs of women and girls; works with partners in terms of men and boys.) Website resources, campaigns, good practice, supporting and representing members Respond exists in order to lessen the effect of trauma and abuse on people with learning disabilities, their families and supporters.

National charity dedicated to ending domestic abuse.

Policy/evidence, practice support, commissioning support, training PODS: Positive Outcomes for Dissociative Survivors is a project of START. PODS works to make recovery from dissociative disorders a reality through training, informing and supporting.

National charity, male rape and sexual abuse survivors. National helpline/webchat service. Face-to-face work (London) for adult men. Campaigning, workshops, training.

NAPAC provides a national freephone support line for adults who have suffered any type of abuse in childhood.

The Survivors Trust (TST) is a national umbrella agency for over

Website/ email/ contact phone number

http://rapecrisis.org.uk/ For general enquiries: rcewinfo@rapecrisis.org.uk.

Website: www.respond.org.uk Helpline: 0808 808 0700 or email helpline@respond.org.uk http://www.safelives.org.uk/ Email on info@safelives.org.uk or call main office in Bristol on 0117 317 8750 Helpline: 0800 181 4420 – Tuesdays 6-8pm or appointments at other times by contacting the office Email: mail@start-online.org.uk (for START) or info@pods‐online.org.uk (for PODS) Website: www.start‐online.org.uk and www.pods‐ online.org.uk.

Website: www.survivorsuk.org 02035983898 info@survivorsuk.org Call 0800 085 3330 for free from landlines, 3, Orange and Virgin mobile phones.

Call 0808 801 0331 for free from O2, T-Mobile and Vodafone mobile phones.

Website: www.napac.org.uk www.thesurvivorstrust.org

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Name of organisation

Brief details 135 specialist rape, sexual violence and childhood sexual abuse support organisations throughout the UK and Ireland.

Trustee Board is made up of Managers and Directors of rape and sexual abuse support services.

Support and networking for member agencies; accredited training; raises awareness about rape and sexual abuse and its effect on survivors, their supporters and society at large; promotes effective responses to rape and sexual abuse on a local, regional and national level.

Website/ email/ contact phone number Email: info@thesurvivorstrust.org Tel: 01788 550554

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Appendix 15: Sitra

Sitra worked closely with the Office of the Hampshire Police and Crime Commissioner (OPCC) on this Scoping and Mapping work, to inform the development of the October 2015 - March 2019 Sexual Crime Strategy, and supported the OPCC in drawing together the strategy document.

Sitra is the leading charity in the housing, support and health & social care sectors providing training, consultancy and advice with a membership of nearly 500 practitioners nationally. Sitra works both on a policy level and in providing specific support for individual organisations.

Sitra plays a key role in ensuring the service user voice is heard, promoting coproduction and in supporting user-led groups.

Sitra is recognised and consulted by Government departments and other bodies, including the Department of Communities and Local Government (DCLG), the Department of Work and Pensions (DWP) and the Homes and Communities Agency (HCA). Sitra’s merger in 2010 with Health & Social Care Partnership brings with it a close relationship with the Department of Health (DoH).

The linking of this policy and representative role with Sitra’s detailed work with service providers, commissioners and service user groups is a particular strength.

The organisation’s extensive work on good practice and policy and procedural development draws on the strength of itslarge membership base and on Sitra’s role in discussing and developing policy at a national level.

Sitra 32-36 Loman Street CAN Mezzanine London SE1 0EH 0207 922 7878 consultancy@sitra.org www.sitra.org

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