Keywords

Introduction

Times of crisis and disasters are associated with increased DFV and reduced access to related support services (Hozic & True, 2016; Kinnvall & Rydstrom, 2019; Parkinson & Zara, 2013; Peterman et al., 2020; True, 2013; UNICRI, 2015). The COVID-19 pandemic has been no exception with reports of increased DFV emerging since the first confirmed cases (Bagheri Lankarani et al., 2022; Boxall et al., 2020; Pfitzner et al., 2020a, 2022b; Piquero et al., 2021). Across the globe, pandemic control measures have restricted people’s movements, confining victim-survivors to homes with their abusers while simultaneously increasing barriers to help-seeking and service use (Lauve-Moon & Ferreira, 2020; Onyango & Regan, 2020; IASC & GPC, 2020).

Prior to the pandemic, most DFV services worldwide were based on face-to-face models where interactions between service providers and clients occurred almost exclusively in person (Joshi et al., 2021; Lee et al., 2017; Martin et al., 2020). Restrictions introduced to counter the spread of COVID-19, particularly physical distancing and stay-at-home orders, forced DFV services to swiftly transition to remote service delivery models wherever possible. The transition necessitated the use of phones and digital communication technologies, such as video conferencing, chatrooms and instant messaging applications, to deliver services and interventions.

The widescale shift towards digital interfaces in service delivery has reconfigured service delivery with improved access for some previously under-serviced groups and decreased access for other previously well-serviced clients. In many ways, remote service models have removed geographic and logistical barriers long faced by clients living in rural and remote areas and those with mobility disabilities, providing these cohorts with greater access to specialised, tailored services. At the same time, digital literacy and equity have become critical to service access during the pandemic. Lack of access to digital technologies and the internet led to certain groups of service users encountering barriers to access for the first time during the COVID-19 pandemic lockdowns, and amplified existing barriers for others (Joshi et al., 2021; Tarzia et al., 2018). Some population groups have been totally excluded from accessing services during the pandemic because they cannot afford or do not have access to the internet and/or have low levels of digital literacy. The client groups digitally excluded in the transition to remote service delivery during the COVID-19 pandemic are not insignificant. It is estimated that around 40% of the world’s population does not have access to the internet (Agence France-Presse in Geneva, 2021). As a result, pandemic control measures employed by governments across the world have created new barriers to service use and reinforced existing disadvantage, with technology adding a new dimension to accessing DFV support services. This chapter explores the strategies DFV service providers have devised to overcome barriers to service use and improve access during the COVID-19 pandemic. It begins with an exploration of access, then goes on to outline an access model that is used as a heuristic throughout the following discussion of examples of service innovations to address the different dimensions of access.

Access to DFV Services

While studies have identified a range of barriers to DFV service use, disruptions to services during the COVID-19 pandemic have created new barriers and exacerbated existing challenges to service access. In the context of health and social care systems, access is typically conceived of as multiple factors that operate on different dimensions to influence an individual’s service use (O’Donnell, 2007; Penchansky & Thomas, 1981; Peters et al., 2008). The categorisation of factors that influence access varies with most researchers identifying four to five dimensions (O’Donnell, 2007; Penchansky & Thomas, 1981; Peters et al., 2008). Over 40 years ago, Penchansky and Thomas (1981) developed one of the earliest models for access defining it as the degree of fit between the client and service provider (Penchansky & Thomas, 1981). For Penchansky and Thomas (1981) access is comprised of five dimensions: affordability, availability, accessibility, accommodation and acceptability (or adequacy). Affordability looks at the direct cost to both service providers and clients and centres on the client’s perception of the worth of the service relative to the total cost including their ability to pay (Penchansky & Thomas, 1981; Saurman, 2016). Availability relates to the timeliness of service provision and whether the service provider has the requisite resources, such as personnel and technology, to meet the volume of service provision required and specific needs of clients and the community served (Penchansky & Thomas, 1981; Saurman, 2016). Accessibility refers to geographic accessibility, which considers practical factors such as venue location, proximity to public transport and travel time in determining how easily a client can physically reach the service provider’s location (Penchansky & Thomas, 1981; Saurman, 2016). Accommodation, or adequacy, relates to operational aspects of service provision, such as hours of operation, client communication, and referral and appointment systems, and whether these attributes align with the client’s preferences (Penchansky & Thomas, 1981; Saurman, 2016). Lastly, acceptability refers to a client’s comfortability with the service provider regarding ‘immutable characteristics’, such as age, sex, ethnicity and/or religious affiliation of the provider as well as social and cultural concerns (McLaughlin & Wyszewianski, 2002, p. 1441; Penchansky & Thomas, 1981; Saurman, 2016). Service provider preferences relating to client attributes and payment options also come into play here (Penchanksy & Thomas, 1981; Saurman, 2016). Building on Penchanksy and Thomas’s model, Saurman (2016) proposes a sixth dimension—awareness—arguing that access should be judged on the use of a service by those in need and those who benefit from it rather than service utilisation alone. For Saurman (2016), awareness centres on effective communication and information strategies. This dimension emphasises that services providers should not have an ‘if you build it, they will come’ attitude towards service users, and need to tailor services to the local context and population. As Saurman explains:

Awareness is more than knowing that a service exists, it is understanding and using that knowledge. It includes identifying that the service is needed, knowing whom the service is for, what it does, when it is available, where and how to use it, why the service would be used, and preserving that knowledge. (Saurman, 2016, p. 38)

Recent work on service access has echoed Saurman’s (2016) call for greater attention to awareness when considering issues of access (Pugh et al., 2019). The following discussion draws on Saurman’s modified version of Penchansky and Thomas’s model of access (2016). During the COVID-19 pandemic the dimensions of awareness, accessibility and—to a somewhat lesser extent—availability have played a critical role in shaping access to DFV services. Each of these dimensions are explored below.

Increasing Awareness of DFV Services During the COVID-19 Pandemic

As Saurman (2016) notes increasing awareness of services, what they do, who they are for, and why and how people can use them is central to promoting access. The rapid global spread of COVID-19 has seen stay-at-home and social distancing orders enacted worldwide in an attempt to slow the spread of the virus, reduce strain on health care systems and prevent deaths. Under these novel conditions, public awareness around which services remained open, the hours of operation and how to access them has been key to access. In some countries, including Australia, the pandemic triggered unprecedented government investment in the development of awareness-raising strategies aimed at connecting individuals affected by DFV with appropriate support services. These awareness-raising campaigns used a range of media, such as social media, television, radio and print media.

In the UK, the government launched the #YouAreNotAlone campaign in April 2020 as the country entered its first period of lockdown (Lock, 2020; Home Office & The Rt Hon Priti Patel MP, 2020). The campaign was rolled out across social media channels and printed materials were provided to charities and supermarkets (Home Office & The Rt Hon Priti Patel MP, 2020). This awareness-raising campaign targeted people at risk of or experiencing domestic abuse, and aimed to reassure them that police and special support services were available to help during the lockdown. A social media hashtag campaign was integrated into the communication strategy that aimed to build public awareness and engage people by encouraging them to upload a photo of their hand with a heart drawn on the palm of their hand along with ‘#YouAreNotAlone’ to their social media accounts (Home Office & The Rt Hon Priti Patel MP, 2020). The campaign material linked to a government website that provides information about recognising domestic abuse, help-seeking options, legal assistance and support for people concerned about their own behaviour (Home Office & The Rt Hon Priti Patel MP, 2020; Lock, 2020). The website also provides translated materials and tailored support for people with disabilities. A similar campaign was developed in China using the hashtag #AntiDomesticViolenceDuringEpidemic (International Planned Parenthood Federation, 2020; Owen, 2020).

In Victoria, Australia, one specialist DFV support service implemented a public awareness-raising strategy that involved a shop-a-docket campaign in which contact numbers for support services were printed on the back of supermarket receipts (Pfitzner et al., 2020a, 2020b). The ability of this campaign to discreetly facilitate access to support was crucial at the time. This campaign was rolled out in 2020 during a period of state-wide lockdown where residents were confined to their homes leaving victim-survivors little escape and/or privacy from abusers. At the time, people were only permitted to leave their homes for four reasons: shopping for food and necessary goods, providing care, exercising, and work or education that individuals were unable to do from home. A nightly curfew was in place between 8 p.m. and 5 a.m. There was a one-hour time limit on daily exercise, and people could not travel beyond a five kilometre radius from their homes. Household shopping was also restricted to one person per household per day. Given the gendered nature of household work including grocery shopping, the specialist DFV service specifically designed the shop-a-docket campaign to reach women during the permitted daily food shop. Targeting this rare time outside of the home to build awareness of available local support services provided the opportunity for individuals to seek support while they were away from their abusers. The ability for victim-survivors to seek assistance without perpetrators becoming aware was identified as critical during the Victorian lockdowns as stay-at-home orders increased the presence of perpetrators in homes and limited victim-survivors’ abilities to have confidential and frank conversations with service providers and support persons.

Increasing awareness of available services was the first step in facilitating access to support during the COVID-19 lockdowns. The next was overcoming disruptions to the operation of services often deemed ‘non-essential’ by governments along with the substantial restrictions on people’s movements during lockdowns, which inhibited service users’ access to facilities. The following section explores strategies developed by DFV services to address these accessibility issues and how they transitioned from face-to-face to remote service delivery models to provide support during lockdowns.

Accommodation: COVID-19 Codewords and Covert Signals

With no guarantee of privacy and confidentiality in homes during lockdowns, many service providers established alternative access points to traditional telephone helplines for individuals seeking DFV support during these periods. These new access channels often involved alert systems where individuals use codewords in text, telephone and online communication as well as signals to access support (Pfitzner et al., 2022b). The use of covert signals to seek DFV assistance is aimed at enabling victim-survivors to let people know that they are experiencing or are at risk of harm without alerting their abusers.

In Spain, the Canary Islands Institute for Equality created the Mask-19 help-seeking campaign, where those at risk of harm could approach a pharmacy and request a Mask-19 to signal that they were experiencing gendered violence (Higgins, 2020). The pharmacy staff would then contact emergency services. A similar codeword strategy was launched in the UK at the beginning of 2021. The Ask for ANI (Action Needed Immediately) codeword scheme was developed by the UK Home Office in partnership with the domestic abuse sector, pharmacies and police (Home Office, 2022). Victim-survivors could visit participating pharmacies and use the codeword to discretely access support through pharmacy workers (Home Office, 2022).

Many DFV services providers established hidden services to enable covert communication with clients during lockdowns. These hidden services were invisible to other users and, most importantly, not captured in individuals’ internet histories, which minimises the risk that abusers discover their online activities. In Australia, a common form of covert communication adopted by DFV service providers was the use of confidential mobile applications (Pfitzner et al., 2020a). One example of this is Gruveo, an encrypted web-based video call link that does not require users to download an app, making it undetectable on devices (Pfitzner et al., 2020a). During the lockdowns in Australia, there was also greater use of the Daisy app, which was available prior to the pandemic and developed by 1800RESPECT, a free national domestic, family and sexual violence counselling service. This free app provides information to users about local support services (1800RESPECT, n.d.). It includes several safety features aimed at protecting users’ privacy. These include enabling users to add trusted contacts that do not have to be listed in the phone’s contact list, visiting websites within the app so that sites do not appear in users’ browser history, and ‘quick exit’ and ‘get help’ buttons (WESNET, 2020). In another example, the Italian government adapted the State Police app YouPol, which was initially developed to report teenage bullying, to receive domestic violence reports (Santagostino Recavarren & Elefante, 2020; Talmazan et al., 2020). Reports could be made by victim-survivors, family members and neighbours, and could be submitted anonymously through the app (Santagostino Recavarren & Elefante, 2020).

A similar covert communication strategy for providing access to DFV support using a digital platform was developed by Krystyna Paszko, a Polish high school student (Bretan, 2021; Easton, 2021). This student created a fake online cosmetic store called Camomiles and Pansies, where victim-survivors could receive online support from a psychologist (Bretan, 2021; Easton, 2021). When a victim-survivor asked to buy a particular cream, they would receive a response from a psychologist asking how long they had been suffering from the skin problem (Bretan, 2021; Easton, 2021). Victim-survivors could signal to authorities that they were at immediate risk of harm and required a home welfare check by placing an order and leaving their address (Bretan, 2021; Easton, 2021).

These examples demonstrate how concerns about client privacy and confidentiality together with reports of increased perpetrator surveillance of communication technology have prompted many agencies to explore ways of providing remote support without detection (Pfitzner et al., 2022b). Confidential mobile applications, codewords and covert signalling are all examples of interventions developed by services providers to overcome barriers related to the accommodation dimension of access. These innovative interventions were designed to allow individuals to alert support services and authorities to their situation, to report violence and to receive help without their abuser’s knowledge.

Increasing the Accessibility of DFV Support Services During Lockdowns

In addition to providing alternative and covert pathways into DFV support during the lockdowns, many DFV services developed strategies to overcome barriers relating to geographic accessibility during periods of lockdown. In some countries, DFV services partnered with private sector organisations to provide secure transportation to shelters and safe housing for victim-survivors fleeing abusive relationships during lockdowns. For instance, France’s National Federation of Solidarity for Women partnered with the ride-share company Uber to provide free rides for people feeling domestic violence during the pandemic (Campistron, 2020). Uber formed similar partnerships with civil society organisations across the world to provide free rides to shelters for people escaping domestic violence during the pandemic (Black, 2020; DC Coalition Against Domestic Violence, 2020).

In Australia, several DFV service providers partnered with the all-woman-run ride-share service Shebah and the goods delivery service SheDrops to provide access to services for clients. Agencies reported using Shebah to transport clients experiencing DFV to safe houses and alternative accommodation during lockdowns (Pfitzner et al., 2020a). SheDrops was also utilised to provide material aid to clients who were unable to travel to facilities to collect goods during periods of stay-at-home orders (Pfitzner et al., 2020a).

While private sector partnerships are not unique to the COVID-19 pandemic, housing insecurity is a, if not the, priority concern for victim-survivors escaping DFV (Flanagan et al., 2019; Love, 2021; Rollins et al., 2013). These public–private partnerships developed during the pandemic facilitated direct access to DFV services and safe housing for victim-survivors leaving abusive homes.

Acceptability: Perpetrators and Access to Support Services During COVID-19

The increased demand on DFV services internationally during the COVID-19 pandemic also applied to services that work with perpetrators of DFV. In Australia during the initial lockdown in early 2020, the average number of weekly referred calls to the Men’s Referral Service, a national telephone counselling service operated by No to Violence (NTV), increased by more than 400 calls a week compared to the same period in 2019 (Tuohy, 2020). The widescale transition to phone, message, video and web-based service delivery models by victim support services also triggered exploration of remote delivery models for perpetrator interventions (Pfitzner et al., 2020b).

Acceptability is a central concern for services that work with perpetrators as the stigmatised nature of DFV services can hinder psychological accessibility (Pfitzner et al., 2017; Weeks, 2004). Psychological accessibility refers to individuals’ perceptions of the service delivery environment acknowledging that social and cultural attitudes may inhibit or facilitate access to services. Keen to retain perpetrators already engaged in support services during the lockdowns, NTV—the Australian peak body for organisations working with men to end DFV—developed the Brief Intervention Service (BIS) (No to Violence [NTV], 2020). The BIS is a multi-session phone service for men perpetrating DFV and is funded by the Australian Government Department of Social Services (NTV, 2020). The phone service commenced operation in July 2020 during the nation’s toughest lockdown conditions and was available to men who were unable to access DFV support during the lockdowns, who were on waiting lists for such support or who had concerns about their behaviour during the lockdowns (NTV, 2020). The provision of a multi-session remote, phone-based service for men using violence marked a distinct shift in practice principles in Australia. Prior to the COVID-19 pandemic, many people in the Australian men’s service sector had reservations about the effectiveness of remote perpetrator interventions in terms of accountability, avoidance and partner safety (NTV & Men’s Referral Services, 2015; Pfitzner et al., 2020b; Victorian State Government, 2018). Coinciding with the introduction of the BIS, the Victorian Government in partnership with NTV published Service Guidelines for perpetrator interventions during the coronavirus (COVID-19) pandemic (Family Safety Victoria, 2020). These guidelines set out a multi-intervention service model designed to support practitioners while they transitioned services to remote delivery during the restrictions and then back to in-person delivery afterwards. The model set out the type of intervention that can be provided by risk level, frequency, eligibility and outcome (Family Safety Victoria, 2020).

Much of the work on remote service responses to DFV during the COVID-19 pandemic has centred on enabling access to support for victim-survivors who were locked down with an abuser. The BIS example reminds us that greater practice innovation to promote access to support services by perpetrators is also required to ensure that abusers are kept in view and held to account.

Concluding Thoughts

During times of crisis and disaster ensuring access to, and continuity of, support for individuals affected by DFV is paramount. The interconnections between crises, disasters and increased DFV is well documented (Hozic & True, 2016; Kinnvall & Rydstrom, 2019). The COVID-19 pandemic has raised unique challenges for DFV services which have faced unprecedented demand and new barriers to service use. Internationally, DFV service providers have innovated and adapted their traditionally in-person, face-to-face interactions with clients. The COVID-19 pandemic has seen a large shift to providing support via phone, web, video and message-based services. Mindful of confidentiality and safety concerns during periods of stay-at-home orders, service providers have reimagined access channels and utilised covert communication to allow individuals to seek support without their abusers’ knowledge.

The transition to remote service delivery models during the pandemic has not been without challenge. The effectiveness of remote risk assessments and safety planning remains in question (Cortis et al., 2021; Pfitzner et al., 2022b). The omnipresence of perpetrators in homes during lockdowns has adversely impacted the ability of victim-survivors to have full and frank discussions with service providers about safety concerns (Pfitzner et al., 2020a). Practitioners have lamented the loss of the visual cues provided through face-to-face work and reported that providing support remotely hinders their ability to build rapport and trust with clients (Cortis et al., 2021; Pfitzner et al., 2022a).

Overall, the existing research suggests that remote service delivery models increase access for some clients while inhibiting service use for others. The use of digital interventions by DFV service providers during the COVID-19 pandemic has given rise to a number of tensions. For instance, the tension between the demand for flexibility and the challenges encountered in building trust digitally with traumatised clients, particularly those with historically low levels of trust in public institutions (Battaglia et al., 2003; Messing et al., 2022; Richardson Foster et al., 2022). Previous research on the use of online supports by women experiencing domestic violence in health care systems indicates that online services are not only convenient but also offer users greater control over help-seeking processes (Tarzia et al., 2018). At the same time, digital interventions can impact on relationship and trust-building between users and service providers (Bracewell et al., 2020).

The pivot to remote service delivery also generated new tensions regarding equity in physical access to services. Remote service models provided greater equity of access for rural users and clients with mobility disabilities, but reduced access for digitally low-literate users and those without access to the internet (Richardson Foster et al., 2022; Tarzia et al., 2018). The COVID-19 pandemic has made the inequity between socio-economic households and access to care systems unmistakably clear. During the pandemic, the digital divide had given rise to new forms of disadvantage with victim-survivors who lack access to high-speed internet and WiFi-enabled devices and/or with low levels of digital literacy having limited or no access to support.

An unignorable gap in the service innovation evidence base is the general absence of research into the user experience (for a notable exception, see Richardson Foster et al., 2022). To date, little information has been collected from victim-survivors about their experiences of receiving support remotely during the pandemic, particularly what mode(s) of interaction worked for which clients and in what circumstances. The service adaptions and innovations identified in this chapter largely come from studies with practitioners and service providers. Further research is needed to better understand the lived help-seeking experiences of victim-survivors throughout the pandemic to inform improved services responses in future crises and learnings that can be incorporated into services models in the ‘new normal’.