General practice wide adaptations to support patients affected by DVA during the COVID-19 pandemic: a rapid qualitative study.

BACKGROUND: Reporting of domestic violence and abuse (DVA) increased globally during the pandemic. General Practice has a central role in identifying and supporting those affected by DVA. Pandemic associated changes in UK primary care included remote initial contacts with primary care and predominantly remote consulting. This paper explores general practice's adaptation to DVA care during the COVID-19 pandemic. METHODS: Remote semi-structured interviews were conducted by telephone with staff from six localities in England and Wales where the Identification and Referral to Improve Safety (IRIS) primary care DVA programme is commissioned.  We conducted interviews between April 2021 and February 2022 with three practice managers, three reception and administrative staff, eight general practice clinicians and seven specialist DVA staff. Patient and public involvement and engagement (PPI&E) advisers with lived experience of DVA guided the project. Together we developed recommendations for primary care teams based on our findings. RESULTS: We present our findings within four themes, representing primary care adaptations in delivering DVA care: 1. Making general practice accessible for DVA care: staff adapted telephone triaging processes for appointments and promoted availability of DVA support online. 2. General practice team-working to identify DVA: practices developed new approaches of collaboration, including whole team adaptations to information processing and communication 3. Adapting to remote consultations about DVA: teams were required to adapt to challenges including concerns about safety, privacy, and developing trust remotely. 4. Experiences of onward referrals for specialist DVA support: support from specialist services was effective and largely unchanged during the pandemic. CONCLUSIONS: Disruption caused by pandemic restrictions revealed how team dynamics and interactions before, during and after clinical consultations contribute to identifying and supporting patients experiencing DVA. Remote assessment complicates access to and delivery of DVA care. This has implications for all primary and secondary care settings, within the NHS and internationally, which are vital to consider in both practice and policy.

The nature of domestic violence experienced by Black and minoritised women and specialist service provision during the COVID-19 pandemic: practitioner perspectives in England and Wales

Our article seeks to understand the contours of what has been termed a 'dual pandemic' in the UK: twin crises of increasing domestic violence and abuse (DVA) alongside the spread of COVID-19, both of which have disproportionately affected Black and minoritised communities. Our article draws upon the perspectives of 26 practitioners who provide specialist DVA services for Black and minoritised women and girls in England and Wales. Based on interviews with these practitioners, we explore the nature and patterns of the DVA which their Black and minoritised women clients experienced during the pandemic. Our findings highlight the pandemic-related risks and challenges that lead to specific manifestations of DVA within Black and minoritised communities and reveal the practice and policy landscape of the 'by and for' DVA sector during the pandemic and beyond.

‘We have tried to remain warm despite the rules.’ Domestic violence and COVID-19: implications for shelters’ policies and practices

This article presents findings from a study that investigated the impacts of the COVID-19 pandemic on domestic violence shelters’ policies and practices. This study was conducted in partnership with feminist organisations in two regions in the Quebec, Canada. Qualitative data were collected from nine domestic violence shelters, using a web-based questionnaire. Thematic content analysis was conducted using NVivo. The research findings reveal that the COVID-19 pandemic has created significant challenges for shelters, as they have had to ensure women’s and children’s safety while preventing the spread of the virus. In this context, they have had to adapt their services and practices, and it has sometimes been difficult to maintain their feminist approach. Nonetheless, shelters have been creative and have developed multiple strategies to overcome these challenges and to ensure women’s and children’s access to services. The research findings contribute to our understanding of the impacts of the COVID-19 pandemic, and highlight the essential role that these organisations have played to ensure women’s and children’s safety at a time when they have been particularly vulnerable.

A hospital-based independent domestic violence advisor service: demand and response during the Covid-19 pandemic.

BACKGROUND AND AIM: Recent UK policy has focussed on improving support for victims of domestic violence and abuse (DVA), in healthcare settings. DVA victims attending hospital are often at highest risk of harm, yet DVA support in hospitals has been inadequate. A targeted service supporting high risk DVA victims, was implemented at a hospital Trust in North West England. The service was provided by Independent Domestic Violence Advisors (IDVAs). This paper assesses the activity in the hospital-based IDVA service during the COVID-19 pandemicand addresses the research questions: What was the demand for the service? How did the service respond? What facilitated this response? METHODS: A mixed-methods study was undertaken. Quantitative data on referrals to the service were examined using simple descriptive statistics and compared to other DVA services. Semi-structured interviews were undertaken with IDVAs and other hospital staff involved with the service and the data subjected to thematic analysis. RESULTS: The quantitative analysis showed that referrals dropped at the start of lockdown, then increased and continued to rise; the qualitative findings reiterated this pattern. Referrals came from a range of departments across the Trust, with the majority from A&E. Pre-pandemic, the population supported by the service included higher proportions of males and people aged 40 and over than at other IDVA services; this continued during the pandemic. The qualitative findings indicated a flexible response during the pandemic, enabled by strong working relationships and by using workarounds. CONCLUSIONS: The hospital-based IDVAs provided an efficient, flexible serviceduring the COVID-19 pandemic. Referrals increased during the first lockdown and subsequent relaxing of restrictions. Locating the IDVAs within a team working across the organisation, and building good working relationships facilitated an effective disclosure and referral route, which endured through social restrictions. The IDVAs supported high-risk victims who may otherwise not have been identified in traditional community-based DVA settings during the pandemic. Hospital-based IDVA services can broaden access by supporting vulnerable, at risk populations whose needs may not be identified at other services.

An intersectional analysis of domestic abuse perpetrator service adaptation during COVID-19: findings from the UK, Cyprus, Greece, Italy, Romania

This research draws upon an international study investigating domestic violence perpetrator support services from five European countries, which was conducted during 2020. Front-line professionals from the partner countries took part in focus groups which focused on the positives and negatives of perpetrator support provision. This article reports specifically on findings that pertained to the impact of the COVID-19 pandemic. All of the participating countries, the UK, Italy, Romania, Greece and Cyprus, reported increases in domestic violence and abuse, as a result of ‘lockdowns’, home quarantines and restrictions of movement on the general population. Alongside this increasing level of reported gender-based violence, many perpetrator intervention and prevention programmes have had to adapt to online or alternative methods of service provision. In this article we use intersectionality to analyse the impact of remote service delivery. We raise key equality issues in the shift to remote working, which risks having ableist ramifications. We conclude by emphasising the importance of increased and sustained funding that acknowledges the service increases during the pandemic. © Centre for Gender and Violence Research.

The use of technology to support children and young people experiencing domestic violence and abuse during the COVID-19 pandemic: a failure modes and effects analysis

Technology is an ever-increasing part of most people’s lives and it has been crucial for the delivery of support by domestic violence and abuse (DVA) services during the COVID-19 pandemic. Paradoxically, this same technology has provided perpetrators with new and growing opportunities to continue or escalate their abusive behaviours. This article draws on the experiences of a specialist DVA service for children and young people (CYP) in the United Kingdom reflecting on the use of technology in service delivery during the COVID-19 pandemic. We applied a safety systems approach – a failure modes and analysis (FMEA) to analyse the nature and impacts of service responses. The FMEA shed light on the risks within the environment in which children and young people engage with remote, digital-enabled support. Practitioners, for example, have been unable to determine potential ‘lurking’, whereby other people, including the abusive parent or partner, are present within the room, but out of sight. The FMEA generated 13 ‘corrective actions’ that will be helpful to specialist practitioners supporting children and young people experiencing DVA and to operational managers modifying current services and designing those for the future. © Centre for Gender and Violence Research University of Bristol 2022.

Domestic violence during the pandemic: ‘By and for’ frontline practitioners’ mediation of practice and policies to support racially minoritised women 1 : The Interdisciplinary Journal of Organization, Theory and Society

This article analyses 26 interviews with frontline female practitioners from domestic violence and abuse (DVA) services for racially minoritised women in England and Wales, exploring how these practitioners – who are from the same racially minoritised communities as the women they support – responded to the challenges of the COVID-19 crisis. These specific practitioner perspectives offer valuable insights into the specific ways in which the pandemic exacerbated the intersectional vulnerabilities of minoritised women experiencing DVA. Interpreted through a standpoint feminist lens, the findings reveal how frontline practitioners used bureaucratic discretion both to meet minoritised women’s changed needs during the pandemic in order to enhance their safety and to challenge the exclusions and intersectional inequalities underpinning pandemic policies. The study illuminates the institutional dimensions of frontline practitioner responses to the pandemic and contribute to debates within the street-level bureaucracy scholarship about the nature of bureaucratic discretion exercised by frontline practitioners.

Impact of the first national COVID-19 lockdown on referral of women experiencing domestic violence and abuse in England and Wales.

BACKGROUND: The lockdown periods to curb COVID-19 transmission have made it harder for survivors of domestic violence and abuse (DVA) to disclose abuse and access support services. Our study describes the impact of the first COVID-19 wave and the associated national lockdown in England and Wales on the referrals from general practice to the Identification and Referral to Improve Safety (IRIS) DVA programme. We compare this to the change in referrals in the same months in the previous year, during the school holidays in the 3 years preceding the pandemic and the period just after the first COVID-19 wave. School holiday periods were chosen as a comparator, since families, including the perpetrator, are together, affecting access to services. METHODS: We used anonymised data on daily referrals received by the IRIS DVA service in 33 areas from general practices over the period April 2017-September 2020. Interrupted-time series and non-linear regression were used to quantify the impact of the first national lockdown in March-June 2020 comparing analogous months the year before, and the impact of school holidays (01/04/2017-30/09/2020) on number of referrals, reporting Incidence Rate Ratio (IRR), 95% confidence intervals and p-values. RESULTS: The first national lockdown in 2020 led to reduced number of referrals to DVA services (27%, 95%CI = (21,34%)) compared to the period before and after, and 19% fewer referrals compared to the same period in the year before. A reduction in the number of referrals was also evident during the school holidays with the highest reduction in referrals during the winter 2019 pre-pandemic school holiday (44%, 95%CI = (32,54%)) followed by the effect from the summer of 2020 school holidays (20%, 95%CI = (10,30%)). There was also a smaller reduction (13-15%) in referrals during the longer summer holidays 2017-2019; and some reduction (5-16%) during the shorter spring holidays 2017-2019. CONCLUSIONS: We show that the COVID-19 lockdown in 2020 led to decline in referrals to DVA services. Our findings suggest an association between decline in referrals to DVA services for women experiencing DVA and prolonged periods of systemic closure proxied here by both the first COVID-19 national lockdown or school holidays. This highlights the need for future planning to provide adequate access and support for people experiencing DVA during future national lockdowns and during the school holidays.

Gender inequality and health disparity amid COVID-19.

Gender inequalities could lead to grave human and economic consequences, especially amid global health crises of the coronavirus 2019's (COVID-19) scale. The COVID-19 pandemic exacerbated gender inequalities women face and introduced new challenges that are unprecedented to society at large. Adverse effects of COVID-19, compounded by unintended consequences caused by public health policies such as lockdowns (e.g., delayed or canceled health services), have forced women to face issues ranging from COVID-19 infections and deaths, prolonged unemployment, to unparalleled scale and severity of domestic violence. However, though women face a canopy of debilitating challenges, there is a shortage of research that examines health solutions that can mitigate, if not offset, challenges women experience amid COVID-19. In this paper, we aim to shed light on why timely solutions are needed to mitigate gender inequalities and health disparities women face amid COVID-19 promptly. Furthermore, we underscore the imperative for cost-effective interventions that could shed light on the current health crisis and future pandemics.

Mental health solutions for domestic violence victims amid COVID-19: a review of the literature.

BACKGROUND: Due to COVID-19, domestic violence victims face a range of mental health challenges, possibly resulting in substantial human and economic consequences. However, there is a lack of mental health interventions tailored to domestic violence victims and in the context of COVID-19. In this study, we aim to identify interventions that can improve domestic violence victims' mental health amid the COVID-19 pandemic to address the research gap. MAIN TEXT: Drawing insights from established COVID-19 review frameworks and a comprehensive review of PubMed literature, we obtained information on interventions that can address domestic violence victims' mental health challenges amid COVID-19. We identified practical and timely solutions that can be utilized to address mental health challenges domestic violence victims face amid COVID-19, mainly focusing on (1) decreasing victims' exposure to the abuser and (2) increasing victims' access to mental health services. CONCLUSION: Domestic violence is a public health crisis that affects all demographics and could result in significant morbidity and mortality. In addition to emphasizing mental health challenges faced by domestic violence victims, multidisciplinary interventions are identified that could provide timely and practical solutions to domestic violence victims amid the pandemic, which range from tailored shelter home strategies, education programs, escape plans, laws and regulations, as well as more technology-based mental health solutions. There is a significant need for more multipronged and multidisciplinary strategies to address domestic violence amid and beyond the pandemic, particularly interventions that could capitalize on the ubiquity and cost-effectiveness of technology-based solutions.

Professionals' views on working in the field of domestic violence and abuse during the first wave of COVID-19: a qualitative study in the Netherlands.

BACKGROUND: The COVID-19 pandemic and lockdown evoked great worries among professionals in the field of domestic violence and abuse (DVA) as they expected a rise of the phenomenon. While many countries reported increased DVA, the Netherlands did not. To understand this discrepancy and the overall impact of the lockdown on DVA support services, we interviewed DVA professionals about their experiences with DVA during the rise of COVID-19, the impact of the lockdown on clients and working conditions, and views on eHealth and online tools. METHODS: Semi-structured interviews were conducted among 16 DVA professionals with various specializations. This data was analyzed using open thematic coding and content analysis. RESULTS: Most professionals did not see an increase in DVA reports but they did notice more severe violence. They experienced less opportunities to detect DVA and worried about their clients' wellbeing and the quality of (online) care. Furthermore, their working conditions rapidly changed, with working from home and online, and they expressed frustration, insecurity and loneliness. Professionals feel eHealth and online tools are not always suitable but they do see them as an opportunity to increase reach and maintain services when physical contact is not possible. CONCLUSION: This study suggests DVA was probably under-detected during the lockdown rather than not having increased. The Dutch system heavily relies on professionals to detect and report DVA, suggesting a need for critical evaluation of the accessibility of professional help. Professionals experienced significant challenges and should themselves be supported psychologically and in their changed work practices to maintain their ability to aid survivors.

PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic (PRECODE): protocol of a rapid mixed-methods study in the UK.

BACKGROUND: The implementation of lockdowns in the UK during the COVID-19 pandemic resulted in a system switch to remote primary care consulting at the same time as the incidence of domestic violence and abuse (DVA) increased. Lockdown-specific barriers to disclosure of DVA reduced the opportunity for DVA detection and referral. The PRECODE (PRimary care rEsponse to domestic violence and abuse in the COvid-19 panDEmic) study will comprise quantitative analysis of the impact of the pandemic on referrals from IRIS (Identification and Referral to Improve Safety) trained general practices to DVA agencies in the UK and qualitative analysis of the experiences of clinicians responding to patients affected by DVA and adaptations they have made transitioning to remote DVA training and patient support. METHODS/DESIGN: Using a rapid mixed method design, PRECODE will explore and explain the dynamics of DVA referrals and support before and during the pandemic on a national scale using qualitative data and over four years of referrals time series data. We will undertake interrupted-time series and non-linear regression analysis, including sensitivity analyses, on time series of referrals to DVA services from routinely collected data to evaluate the impact of the pandemic and associated lockdowns on referrals to the IRIS Programme, and analyse key determinants associated with changes in referrals. We will also conduct an interview- and observation-based qualitative study to understand the variation, relevance and feasibility of primary care responses to DVA before and during the pandemic and its aftermath. The triangulation of quantitative and qualitative findings using rapid analysis and synthesis will enable the articulation of multiscale trends in primary care responses to DVA and complex mechanisms by which these responses have changed during the pandemic. DISCUSSION: Our findings will inform the implementation of remote primary care and DVA service responses as services re-configure. Understanding the adaptation of clinical and service responses to DVA during the pandemic is crucial for the development of evidence-based, effective remote support and referral beyond the pandemic. TRIAL REGISTRATION: PRECODE is an observational epidemiologic study, not an intervention evaluation or trial. We will not be reporting results of an intervention on human participants.