5. Addressing intimate partner violence through integrated service delivery
This chapter illustrates the importance of integrated policies to address the complex needs of women escaping gender-based violence (GBV), focusing specifically on intimate partner violence (IPV). It provides an overview of general organisational theories behind integrated service delivery for victims/survivors, much of which is based on evidence from health and social policy sectors. The chapter presents OECD countries’ ongoing efforts to integrate service delivery to address IPV in the areas of healthcare, justice, housing, child support and income support, and concludes with a discussion of the challenges and opportunities of promoting an integrated, victim/survivor-centred response to violence. The chapter also highlights good practices in integrated service delivery and concludes with policy lessons and recommendations. The findings are based on the responses of 35 countries to the 2022 OECD Questionnaire on Integrated Service Delivery to Address Gender-Based Violence (OECD QISD-GBV) and a consultation with 27 non-governmental organisations providing services to victims/survivors.
In this report, “gender” and “gender-based violence” are interpretated by countries taking into account international obligations, as well as national legislation.
Successful integration at the service delivery level is part of a broader, whole-of-government approach to mainstreaming gender. This requires co-ordination and integration across ministries and throughout levels of government, i.e. both horizontal and vertical integration (Box 3.3 in Chapter 3). Integrated service delivery (ISD) also requires reliable, adequate and well-organised funding for co-ordinated services, as well as policy coherence across agencies and levels of government so that policies reinforce each other.
Around half of the 35 responding OECD national governments report promoting integrated service delivery (ISD) “somewhat” or “to a great extent” in their countries. Similarly, around half report targeted investments to support service providers in expanding, improving or transitioning to integrated service delivery. Regular and adequate funding was the major challenge cited by countries and service providers who participated in the 2022 OECD Questionnaires and NGO consultation.
ISD is most frequently introduced at entry points in healthcare, emergency housing and police services. Many of these practices rely on case management, referrals or physically co-located delivery.
Local governance of ISD is crucially important, given that service delivery often occurs at the subnational level. Yet central governments play a key role in promoting ISD, for example by providing model administrative frameworks to help local parties understand their role in collaboration.
Data-sharing capabilities across agencies must be strengthened. Data sharing across providers can reduce clients’ application costs (in time and energy); reduce the trauma associated with repeating accounts of violence to different providers; and improve client safety by better tracking risks across repeated incidents of violence. Ideally, such a system would also integrate perpetrator-related interventions as a way to track accountability and recidivism. Data sharing must include strong privacy protections to ensure victims/survivors’ security.
Better and more regular programme evaluations are essential. In general, ISD approaches to addressing GBV have not been systematically or quantitatively evaluated, but some existing evaluations suggest that there is potential for ISD to improve outcomes for victims/survivors.
A holistic perspective means treating everyone involved – including perpetrators. Governments can interact with perpetrators not only through criminalisation and the court system, but in multidimensional ways that can improve offender accountability and produce long-term behavioural change on individual and broader cultural levels.
Most importantly, a trauma-informed, victim/survivor-centred approach is crucial. Clear lines of communication must connect local service providers with national policymakers to enable better and more victim/survivor-centred service delivery. Such approaches could include regular stakeholder engagements or surveys to promote the co-creation of good policies.
Women continue to bear the overwhelming consequences of gender-based violence (GBV), most commonly at the hands of their current or former male intimate partners – a phenomenon known as intimate partner violence (IPV), the focus of this chapter (OECD, 2020[1]).1 IPV comes in many forms (Box 5.1), and is reported by women across age groups, cultures, geographies and socioeconomic backgrounds.
IPV is the most common form of GBV worldwide: around 26% of ever-married/partnered women aged 15 and older report having experienced some form of physical and/or sexual violence at the hand of an intimate partner (WHO, 2021[2]). On average across OECD countries specifically, nearly a quarter of all women report having experienced IPV in their lifetime (OECD Family Database, 2020[3]).2 Yet as dire as these numbers seem, violence is typically underreported, and these statistics underestimate the prevalence of violence3 (OECD, 2023[4]) (see Chapter 3).
Many governments have made the prevention, treatment and eradication of IPV a policy priority. Yet for all OECD countries, addressing the multifaceted issues of IPV presents a serious governance and implementation challenge – a challenge where most countries have fallen short (OECD, 2023[4]).4
GBV victims/survivors have complex needs both during and after the experience of violence, with implications for the form of service delivery they need. Threats to their health include injuries, unintended pregnancies, sexually transmitted infections, complications of pregnancy, mental health problems, homicide and suicide. As a first stop, many women fleeing IPV seek support from the public authorities through entry points in emergency medical care, police interventions, and emergency housing shelters. Many women also (whether simultaneously or subsequently) need support services linked to safety planning, rehabilitative counselling, legal advocacy, children, income, housing, and immigration and asylum, as well as financial and job counselling in many cases. When violence occurs in a family home, the challenges are compounded: children and other cohabitating persons are affected by the violence and may need support.
To address their needs, victims/survivors must regularly navigate a range of social services provided by a patchwork of governmental, non-governmental or private sector providers. They are often asked to repeat accounts of traumatic experiences multiple times, as services are infrequently “joined up” and providers rarely share client data. Frequently, women seeking help encounter administrative and bureaucratic challenges at the same time as they face the direct and indirect consequences of violent acts – or remain under threat of continued violence (OECD, 2020[1]). These obstacles can be exacerbated by a lack of confidence in the help-seeking process more generally (OECD, 2023[4]).5
The burden of applying for and accessing diverse support services, often repeatedly, can compound the trauma of victimisation and explain why women stay in situations where violence continues. And these are not fleeting challenges: it often takes many attempts for a woman to extricate herself from an abusive partnership. Even after a woman has successfully escaped a violent situation, the physical, psychological, social and economic effects of IPV can persist for months or years.
This chapter presents a summary of OECD governments’ efforts to integrate service delivery to support victims/survivors of intimate partner violence, based on an extensive policy questionnaire completed by 35 OECD governments (OECD QISD-GBV 2022) and a consultation with 27 non-governmental service providers (Box 5.4). The findings in this chapter are elaborated in the full report Supporting lives free from violence: Toward better integration of services for victims/survivors (OECD, 2023[4]), which illustrates how governments have implemented integrated service delivery (ISD) by focusing on the most common services accessed by women.
ISD for victims/survivors of gender-based violence is often difficult to plan, fund and implement in practice, given women’s complex needs and the many sectors involved. Yet successful ISD examples abound, particularly those rooted in health services, housing and access to justice, the sectors where ISD has been most commonly implemented. OECD governments must continue to trial, replicate and – importantly – evaluate ISD practices to improve the lives of victim/survivors of intimate partner violence. Such co-ordination is an important part of a whole-of-government approach to addressing IPV, reflecting both the Systems Pillar and Culture Pillar discussed in previous chapters.
Intimate partner violence (IPV) is a subset of gender-based violence (GBV). IPV refers to violence that occurs between current or former intimate partners, and which causes physical, psychological, sexual and/or economic harm. Like other forms of GBV, it can result in homicide or suicide. IPV is also often referred to as “domestic violence”, although domestic violence does not necessarily occur between co-habiting partners. The World Health Organization (WHO, 2012[5]) identifies common forms of IPV:
Acts of physical violence, such as slapping, kicking, non-fatal strangulation and beating or hitting with or without a weapon.
Sexual violence, such as forced sexual acts or sex-related coercion.
Emotional and psychological abuse, such as intimidation, humiliation, insults, and threats of harm to the victim or victim’s loved ones.
Controlling behaviours, such as stalking, excessive surveillance, restriction of mobility, isolation from social and family networks, or restricting access to financial resources, employment, medical care or education.
This chapter focuses specifically on IPV within the context of GBV. This reflects the prevalence of IPV and violence against women in OECD countries, as well as the service sectors in which policies to address GBV are most developed.
Source: WHO (2012[5]), Understanding and addressing violence against women, https://apps.who.int/iris/bitstream/handle/10665/77432/WHO_RHR_12.36_eng.pdf?sequence=1&isAllowed=y.
Policymakers have turned their attention to integrated policies as a means of co-ordinating multisectoral solutions and better preventing, addressing and responding to violence against women. This entails integration at all levels of government – not simply at the service delivery level.
Policy integration is a core element of government efforts to mainstream gender equality through a systems-level approach (see Chapter 3). Gender mainstreaming is by now well-recognised as a critical tool for governments seeking to address gender inequalities.6 By embedding a “gender lens” in all aspects of government budgeting and policy design, reform and evaluation, governments can tangibly reduce gender inequality in different aspects of life.
Successful mainstreaming entails co-ordination and integration across ministries and throughout levels of government. Integration is especially important to address gender-based violence, a multifaceted problem requiring the involvement of a diverse set of government and non-governmental actors.
National and international GBV strategies recognise that integration must be applied across the entire governance of policies to end GBV.7 This has been especially true in the last decade, following the pre-eminent international agreement on violence against women: the 2011 Council of Europe Convention on preventing and combating violence against women and domestic violence, known as the Istanbul Convention. To date, 27 OECD countries have signed, ratified and/or implemented the convention,8 which presents four pillars to address GBV: Prevention, Protection, Prosecution, and (of special relevance to this chapter) Co-ordinated Policies (Box 5.2).
Chapter II of the Istanbul Convention, entitled “Integrated policies and data collection”, offers important guidance. It calls for victim-centred, comprehensive and co-ordinated policies and co-operation among all relevant agencies, institutions and organisations (Article 7); appropriate financial and human resources to implement integrated policies and programmes, including those undertaken by non-governmental organisations (Article 8); the recognition, encouragement, support of and co-ordination with NGOs and civil society (Article 9); the establishment of one or more official bodies to co-ordinate, implement, monitor and evaluate policies to prevent and combat violence (Article 10); and thorough data collection and research to support implementation of the Convention (Article 11).
Chapter IV of the Convention, “Protection and support”, calls on countries to introduce measures on a gender-based understanding of violence against women; based on an integrated approach that takes into account the relationship “between victims, perpetrators, children and their wider social environment; to avoid secondary victimisation; to empower women victims (including economically); to allow for a range of protection and support services to be located on the same premises; and to address the specific needs of vulnerable persons, including child victims.
Despite the importance of this issue, most countries – including OECD countries – have fallen short of policy integration targets. The Group of Experts on Action Against Violence Against Women and Domestic Violence (GREVIO), a monitoring mechanism of the Istanbul Convention, finds in a series of European country evaluations that countries rarely meet best practice standards on policy integration and integrated service delivery (ISD). This shows the need for better understanding of how to implement ISD in practice.
Sources: (Council of Europe, 2011[6]; Council of Europe, 2022[7]).
Policy integration can be divided into two categories: vertical and horizontal (Box 3.3 in Chapter 3). Vertical integration refers to co-operation across different levels of government. National and local governments are often responsible for different levers and services for addressing GBV, making collaboration useful. It may entail co-operation, information sharing and financing, from national to local levels of government. In social services, these linkages may connect from the ministerial level to the case worker level (and vice versa).
Horizontal integration refers to bringing together different ministries, institutions or service providers to achieve a shared objective, such as linking health and housing support for women experiencing violence. Horizontal integration can occur at federal, regional or local levels – and of course, integration can be simultaneously vertical and horizontal.
To encourage vertical and horizontal integration, many national governments in the OECD have implemented national strategies (e.g. strategic frameworks and roadmaps) and clearly defined roles for key state actors and partners (e.g. central co-ordinating bodies) as part of a systems-level approach to preventing, addressing and ending GBV (Chapter 3) (OECD, 2019[8]) (OECD, 2021[9]).
5.3.1. Defining broader concepts in integrated service delivery
Integrated service delivery (ISD) refers to linking different providers and levels of social services, for the benefit of users and to improve efficiency in service delivery (OECD, 2015[10]). ISD reimagines social, health and other human-service pathways for the mutual benefit of service users and providers.
The concept of ISD was first popularised in the health sector, in an effort to better care for patients with complex and long-term needs from a range of different health providers. A foundational definition can be drawn from the early health literature: “Integration is a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between [different] sectors” (Kodner and Spreeuwenberg, 2002[11]).
A critical consideration for an integrated response to intimate partner violence is the client’s risk of exposure to continued violence and the heightened need for security. ISD for women experiencing IPV must thus also ensure the safety and security of the victim/survivor (and her children) from a perpetrator and ensure that the woman can access justice pathways through legal support. These conditions often require the involvement of police officers, judges and legal assistance (OECD, 2023[4]).
There is no single, universal strategy for integrating services.9 Integration is a flexible approach through which services can be co-ordinated to varying degrees of intensity. In an exploration of integrated service delivery for vulnerable groups, the OECD distinguishes between three increasingly intensive ways of integrating services (OECD, 2015[10]):
Co-location of services refers to having multiple service providers from different sectors – such as health, housing and legal services – represented in one location. This can help reduce complexity, travel, time and financial costs associated with service uptake. On the service provider side, co-location also makes it easier for providers and professionals to share information and collaborate.
Collaboration implies a higher degree of integration across sectors than co-location, and refers to agencies working together through information-sharing and training, and through the creation of a network of agencies to improve user experience. This kind of knowledge-sharing can help service providers improve referrals and recommendations for other services.
Co-operation implies a deep level of integration where service providers communicate and work together on individual cases, toward pre-determined, consistent goals. This helps to ensure holistic service provision and should improve outcomes for service users.
5.3.2. Integration has improved outcomes and efficiency in health and social sectors
Little empirical evidence exists on the benefits of ISD for GBV victims/survivors. Evidence from other sectors, however, suggests that it offers opportunities for substantial gains in efficiency and effectiveness, while improving outcomes for service users. This is particularly true for service users with complex needs, who require a range of social services typically provided by more than one agency (NZ Productivity Commission, 2015[12]).
Cost effectiveness and savings
One potential, if not guaranteed, advantage of horizontal ISD at the service level is cost effectiveness and cost savings, for both service users and providers. Providing services in one place, streamlining administrative costs and potentially reducing over-use of emergency health services, makes ISD a potential tool for reducing spending on elderly populations and people with mental illness (OECD, 2015[10]). ISD at the first point of intervention has also been shown to reduce downstream service use and costs. For example, effective hospital discharge plans and linkages to co-ordinated community care have been shown to reduce the likelihood of costly hospital readmissions or intensive care services for people with mental illness (Rosenheck, 2000[13]; Mares, Greenberg and Rosenheck, 2008[14]; Stewart et al., 2011[15]). Effective horizontal integration can also help reduce gaps and avoid duplication of services from different agencies.
Vertical integration has the potential to save costs, too, for example by helping to shift resources away from costly emergency services to more cost-effective preventative services (OECD, 2015[10]).
Cost effectiveness and cost savings are not guaranteed. A co-ordinated policy and funding approach is needed to break down silos, avoid duplication of work, share costs, train workers and share information. A review of 65 case management studies targeting high-risk, high-cost patients in the health sector, for example, showed that two-thirds of these programmes achieved specific progress and outcome goals, but were less successful than expected in cost-saving or cost-effectiveness (Swanson and Weissert, 2017[16]). The authors suggest these results could be improved if additional incentives, clear rules, guidelines and algorithms relating to resource allocation among patients were applied. Costs can also rise when service providers expand coverage and address previously unmet needs (OECD, 2022[17]).
Before long-term cost savings are realised, significant and dedicated financial investments are required to establish a sustainable foundation for integrated services.
Accessibility and take-up
Accessing public services can be daunting. ISD can help improve service accessibility and user uptake, especially for people with complex needs, such as persons with disability, those facing mental health issues, and people responsible for dependents. Victims/survivors of IPV also have complex needs – many face physical, mental and logistical barriers to accessing social services and support systems.
Integrated service models “can help vulnerable service users navigate the system for reasons of time as well as transparency and accessibility: co-located services, for example, enable access to multiple services [in one place], which in turn enables a fuller assessment of needs and a faster delivery of appropriate services” (OECD, 2015[10]). Case managers can also reduce the burden of multiple applications and data collections across providers by connecting those offices directly and advocating for survivors.
The challenges of accessing multiple services across multiple locations are particularly daunting for “vulnerable” families, a particularly accurate characterisation of a mother and children fleeing violence. These women may be balancing programme applications against irregular work hours and income, struggling to find safe housing, and caring for children. In these and other cases, clear, direct and comprehensive information for service users, perhaps delivered by a known case worker, is conducive to full engagement with all available and appropriate services (OECD, 2015[10]).
Reducing administrative burden for clients can help improve take-up, too. Data-sharing across providers – for example, by providing digital access to personal information such as a history of social service use – can therefore be an important tool to ease service users’ entry into the system.
Improving the quality of services and client outcomes
The benefits of ISD on client outcomes in other sectors has been well-studied. The integrated “Housing First” approach, for example, has reduced homelessness more effectively than emergency shelters, and children with mental health needs have benefited from the integration of mental health services with educational institutions (OECD, 2015[10]).
When ISD is done well, cost savings, improved access and higher-quality services should happen simultaneously (OECD, 2022[17]). In a review of over 120 integrated initiatives delivering children’s services, predominantly in the United Kingdom, inter-agency collaboration improved accessibility and response time for service users; enhanced knowledge and sense of fulfilment among service providers; and improved agency efficiency by reducing duplication of work (Statham, 2011[18]). Similar results are found in a study of ISD for child services in the United States (Manno and Treskon, 2016[19]).
Yet there are many barriers to successful integration
Despite the seemingly obvious benefits of ISD, significant barriers stand in the way of service delivery integration, both generally and in the context of services addressing GBV.
One major barrier is funding. ISD implies some negotiations between ministries, levels of government, and/or local providers to determine who will pay fixed start-up costs to ensure successful co-ordination across various actors. There is also the issue of ensuring ongoing running costs – regular, sustainable funding streams are important both to ensure the continuity of specific services, but also to prevent a “‘domino effect’ in belt-tightening of closure” by partner service providers (OECD, 2015[10]). Joint working requires a balance of financial input across agencies, and time horizons matter. It can be difficult to get agencies or providers to commit fully if they see collaboration as a short-term or temporary arrangement (ibid). This can be especially hard when historically providers have had to compete for resources.
Another major challenge is the restructuring of roles and responsibilities across levels of government, agencies, and, on the ground, governmental, NGO and for-profit service providers. This involves potentially both the structure and management of provider organisations, and potentially retraining staff, changing work conditions and adapting workplace cultures.
Finally, data sharing across providers can be difficult, because it presents significant legal and logistical concerns. While there are benefits to providers and clients in having efficient access to background information on clients, it can be difficult to ensure adequate client privacy across a range of different providers with different technical standards.
Many of the approaches to integrated care in health and social policy also apply to the multisectoral nature of IPV. Services for victims/survivors of violence can be delivered through general support services, which are not exclusively designed for victims/survivors but instead serve the public at large, or through dedicated, specialist support services, which target people experiencing violence specifically. These general and specialist services should be complementary, and general services and staff should be equipped to address the specific needs of women victims of GBV through adequate resources and training (Council of Europe, 2022[7]).
No “one-size-fits-all” approach can apply ISD to address GBV, Australia’s National Research Organisation for Women’s Safety (ANROWS) has identified universal guidelines for ISD to address GBV (ANROWS, 2016[20]):
Service delivery must involve two or more agencies/services.
Clear co-ordination protocols must exist for integrated service provision.
The initiative is funded as an integrated service or partnership, with a view to responding holistically to women currently experiencing domestic and family violence or who have recently left a domestic and family violence situation, and/or who have experienced sexual assault.
The programme operates according to a formalised partnership or joint service agreement between agencies.
The programme abides by a formalised statement of shared principles/goals between agencies.
ISD may include one-stop centres for women and children who have experienced domestic and family violence or sexual assault.
ISD may include case co-ordination or case management services.
In the context of GBV, the overarching goals of integrated initiatives are to create “smoother referral pathways” between sectors, make the help-seeking process more accessible, and reduce the secondary victimisation associated with the duplication of work (ANROWS, 2016[20]). It is easier to receive a proactive call from a network-connected counsellor after police intervention, than having to call or visit several related service providers. This parallels goals identified in foundational health literature: that integrated service delivery should “enhance the quality of care and quality of life, consumer satisfaction and system efficiency for patients with complex, long-term problems cutting across multiple services, providers and settings.” (Kodner and Spreeuwenberg, 2002[11]).
Of course, the best way to end gender-based violence against women is to prevent it from happening in the first place, and this requires an integrated, whole-of-society approach. It implies dedicated efforts to change masculine norms, from a very early age, so that boys do not grow into men who replicate harmful masculinities (OECD, 2021[21]). Preventative measures also need to target adult perpetrators of IPV to achieve holistic and sustainable solutions to violence. Violent men are often re-offenders in multiple relationships and victims/survivors sometimes return to their abusers. Working with perpetrators is crucial to prevent re-victimisation and new victimisation. Information-sharing across differences within the justice sector as well as across different sectors can contribute to a reduction in violence.
5.4.1. Case management and co-located services can support victims/survivors
ISD for women experiencing IPV is frequently co-ordinated through case management or co-located centres in order to provide easy access to specialised mental and physical healthcare, safe and affordable housing, income and job support, support for children and access to justice.
The collocated approach is sometimes referred to as a “hub and spoke model” (Campo and Tayton, 2015[22]; Mantler and Wolfe, 2017[23]). The “hub”, a caseworker or centralised office, identifies, collaborates with, and connects clients with sectoral service providers who provide the needed support, as shown in Figure 5.1.
In many of the ISD examples in this chapter (as well as in the full report (OECD, 2023[4])), caseworkers play a prominent role, which can improve clients’ experience.10 Case management can be provided, for example, by a social worker, a “domestic violence advisor” (typical in the United Kingdom), or a public health worker, typically at the local or regional level. The co-located approach has been implemented throughout Europe and the United States, often by non-governmental service providers with public and private funding (see examples in Box 5.3).
Note: This figure illustrates a stylised model of horizontally integrated service delivery at the local level for women experiencing IPV.
Source: Adapted from (OECD, 2020[1]), Issues Notes: OECD High-Level Conference on Ending Violence Against Women: Taking Public Action to End Violence at Home, https://www.oecd.org/gender/VAW2020-Issues-Notes.pdf.
Family Justice Centres, various locations, Europe and the United States
The Family Justice Center Alliance originated in the United States as a subsidiary of Alliance for HOPE International, an organisation dedicated to domestic violence and sexual assault prevention, with a mission to establish a network of service hubs around the world. Today, the Alliance works in Europe, the United States and Canada, in close consultation with sub-national and national governments, to implement multidisciplinary service delivery models known as Family Justice Centers (FJCs). FJCs offer co-located, multi-agency services to women who have experienced domestic violence, sexual assault, elder abuse, child abuse or human trafficking. Public and private agencies can assign service providers to the FJCs on a full or part-time basis to deliver such services as: safety planning; legal advice; case management; evidence reporting, including making official statements and procuring medical evidence of violence; counselling; financial literacy and job training support; administrative support in applying for public benefits; and shelter or housing. FJCs also offer childcare and transportation assistance for women while they procure services. This also implies some data-sharing: 86% of US-based FJCs link their administrative data, and 87% report using a centralised intake procedure that facilitates information-sharing between providers.
Saskatoon Community Service Village, Saskatoon, Canada
The Saskatoon Community Village (SCSV) was a project that emerged from the Saskatoon Women’s Resource Centre, which was established in 1986 and represented a coalition of 16 organisations. Over ten years of planning, discussion and fundraising, the SCSV was eventually established in 1996, to deliver women’s services through co-location and collaboration. It currently brings six non-profit, community-based agencies under one roof to provide services through joint planning, programming and advocacy. Services include youth and adult counselling; specialised services to respond to abuse, violence and sexual assault; 24-hour crisis intervention services related to child abuse, suicide prevention, substance use, gambling problems and domestic violence; housing and in-kind support; short- and medium-term shelter for women and children; parenting support services; an employment and skills centre, including computer literacy and GED training; and an accessible fitness centre. The SCSV also engages in community-based education and awareness-raising initiatives on IPV. The SCSV operations are outlined in jointly developed plans, buttressed by legal agreements that clearly describe roles and responsibilities.
Kukui Center, Hawaii, United States
The Kukui Center opened in 2009 and, today, co-locates ten non-profit agencies to serve the region’s families. This is an example of an integrated programme that has tried to mainstream the treatment of IPV in its support of vulnerable groups. While not exclusively focused on IPV, the centre offers emergency, short- and medium-term shelter for children, adolescents and families; independent living programmes; legal and mediation services; specialised services for children with disabilities; maternal and infant health services; multi-age literacy and financial literacy services; specialised services for homeless families; youth foster care; multi-age counselling services, including grief support; support for children and adults experiencing abuse, violence and sexual assault, including a specialised “immigrant justice centre” focused on violence, sexual assault and human trafficking; and a social enterprise that employs at-risk youth. The centres’ leadership meet regularly to make decisions about the operations of the centres and to discuss caseloads.
Sources: (ABT Associates, 2018[24]; Family Justice Center Alliance, 2022[25]; Saskatoon Community Service Village, 2022[26]; Kukui Center, 2019[27]).
As an alternative or complement to the caseworker model, the 2022 OECD QISD-GBV revealed another relatively common and noteworthy local-level case management initiative: multi-agency risk-assessment conferences (MARACs) (also see Section 3.2.5 in Chapter 3), or similar case conferences bearing slightly different names. These meetings bring together community police, healthcare workers, public prosecutors, social workers, child welfare providers and case managers, on a regular basis, to ensure the long-term safety and continuity of care for women who are particularly at risk of severe IPV (OECD, 2023[4]).
Such case conferences are reported to exist in Australia, Austria, Estonia, Finland, New Zealand and the United Kingdom, though service delivery arrangements vary in different national and local contexts (see Chapter 3 and (OECD, 2023[4]). The charity SafeLives estimate that if MARACs were implemented nationally across 300 sites, significant savings could be made: “for every GBP 1 spent on MARACs, at least GBP 6 of public money can be saved annually on direct costs to agencies such as the police and health services,” (SafeLives UK, 2010[28]) These programmes should be evaluated further to assess the outcomes for clients and providers.
5.4.2. Sharing client data among service providers, while ensuring client privacy
The process of describing experiences of abuse, providing social and economic history, and going through (often extensive) application processes for services can be harrowing and carries high costs both for women and for service providers. Data sharing across service providers can potentially reduce some of these costs in time, effort and energy, and lead to a more efficient and timely public response when women experience violence. With a unique, secure personal identifier, information can be shared about individual clients across health, police, child services and housing providers, among others.
It is especially important for stakeholders in collaborative environments to develop jointly co-ordinated information-sharing protocols and procedures, to perform informed risk assessments and deliver effective solutions to help-seeking individuals (CACP, 2016[29]). In the OECD-QISD-GBV, countries reported that data sharing is typically governed by legal frameworks and that information can be shared in situations where women are in immediate danger, when the information is essential, and where women have consented to the information being shared (OECD, 2023[4]). In the United Kingdom, professionals in child protection can share data needed for the overriding duty of protecting children at risk (UK Home Department, 2003[30]).
Data privacy is of utmost concern for victims/survivors of GBV, not least in cases where their security depends on information being withheld from perpetrators. Personal information runs a higher risk of leaking when it is shared among many different agencies and sectors. These worries were echoed in the OECD Consultation of NGO providers. One provider reported that they “are always concerned about sharing information with other services, as we need to ensure that the client’s safety is paramount at all times. It is not uncommon for a client’s location to be compromised by other services/agencies and, once a client’s location is compromised, the client has to be moved to ensure that they remain safe” (OECD, 2023[4]). The risk of information leaks may be enough to deter some victims/survivors from reporting their perpetrators.
Processes for data collection, analysis and sharing across providers thus need to be controlled by clear protocols, policy guidelines and informed, harmonised professional judgement. Such controls have been identified as good practice in helping to facilitate co-ordinated service delivery for people who have experienced GBV. Actors in different countries also face different legal frameworks in considering opportunities to share data. For instance, victims/survivors living in the European Union are protected by the relatively stringent General Data Protection Regulation (GDPR).
Another interesting example is a World Bank-funded project to develop and implement an integrated case management database system in Chile. It aims to better track and respond to women experiencing violence. After a rigorous mapping exercise to identify critical gaps in continuity of care, the proposed integrated platform will allow for follow-up of GBV cases across institutions, improve service delivery and provide alerts in high-risk cases (World Bank, 2022[31]).
5.4.3. Local evolutions of Integrated service delivery (ISD) to address GBV are important
Although policy integration is prioritised in national GBV strategies (OECD, 2023[4]), integrated services have often evolved naturally on the ground, to improve efficiency where resources are limited. Networking, relationship-building and community mobilisation have led to redesigning service delivery by local and regional practitioners, suggesting the merits of ISD to higher-level policymakers. “Local” knowledge and practices flowing upwards to high levels of government should be a key part of vertical integration.
A study of rural and remote women’s shelters in Canada, for example, highlights three inter-related ways service delivery has evolved, through increasingly formalised networking, to benefit service users:
Filling gaps: Social services are frequently undersupplied in rural areas, because of geography or insufficient funding. Women’s shelter employees are compelled, in response, to fill social service gaps to fulfil needs that fall outside direct shelter services. Like the “no wrong door approach” to social services, the idea of filling gaps helps ensure help-seekers are not turned away or left with outstanding needs. This calls for creative problem-solving when resources are scarce.
Case management: To help fill gaps, shelter employees adopt case management roles, connect help-seekers to resources directly, and eventually develop a network of resources they continue to draw on.
System navigation: In performing case management duties, shelter employees facilitate system navigation for women, not only by identifying related service providers who “understand the context of violence”, but also by preparing women to interact with related service providers who do not understand this context (Mantler and Wolfe, 2017[23]).
It is important to bring in lived experiences from those who have used services personally to make sure that victims/survivors’ needs and rights are placed at the centre of all interventions and measures. One way countries can learn from the day-to-day experience of victims/survivors is to conduct consultations (OECD, 2021[32]). The Welsh government was able to consult victims/survivors under its “National Survivor Engagement Framework,” bringing in GBV victims/survivors’ views in designing governmental policies (Welsh Government, 2018[33]). In a similar vein, the Office of the Assistant Secretary for Planning and Evaluation in the United States collaborated with victims/survivors with varied lived experiences to develop a resource on emerging strategies and practices for federal human services staff, to engage more equitably with clients in research, policymaking and programming (Office of the Assistant Secretary for Planning and Evaluation, 2021[34]). In Canada, after collaborative, whole-of-government efforts with provinces and territories and engagement with Indigenous partners, GBV experts and stakeholders, Canada launched a National Action Plan to End Gender-Based Violence (GBV NAP) in November 2022.11
Spain’s new national strategy to counter GBV (Estrategia Estatal para combatir las violencias machistas 2022-2025) also involved a number of participatory methods, including meetings with victims/survivors, civil society and local governments, and roundtables on education and digital violence (Ministry of Equality of Spain, 2022[35]). Spain’s new “Yes Means Yes” sexual consent law also reflects the participation of victims/survivors, feminist organisations and civil society in the design, implementation and evaluation of public policies, from an intersectional approach (Jefature del Estado, 2022[36]).
5.4.4. Integrated service delivery (ISD) has been infrequently evaluated for IPV
The advantages and disadvantages of ISD have rarely been systematically evaluated, perhaps in part because programmes are not always implemented with systematic planning for quantitative or qualitative evaluations of implementation and outcomes (for providers or clients). This suggests a need for more research in the area, but some existing evaluations suggest ISD has potential to improve outcomes for victims/survivors.
Some encouraging results emerge from analyses of the Pathfinder Project, a pilot led by Standing Together as part of a consortium of expert partners and carried out in the health sector in England from 2017 to 2020 (OECD, 2023[4]). One analysis was led by academics at DECIPHer at Cardiff University, using data from the eight Pathfinder sites and comparing it with data from across England to assess how service provision changed after the implementation of the pilot. The analysis found that the Pathfinder Project resulted in an increased number of cases being discussed at multi-agency risk-assessment conferences (MARACs) relative to non-Pathfinder sites. It also found an increased number of identified cases of domestic violence, over a wider range of risk classifications, relative to non-Pathfinder sites. Survey evidence from a separate analysis conducted by the Consortium indicates that users’ self-reported well-being improved as a result of going through the programme (SafeLives, 2020[37]; Melendez-Torres et al., 2021[38]).
In general, evaluations should strive to measure relevant outcomes of an ISD intervention against an important counterfactual: what would have happened had the ISD intervention not been deployed? In other social policy areas in OECD countries, this increasingly takes the form of randomised control trials. Given limited resources, where funding cannot support everyone through a new programme, this would imply that some clients are randomly assigned to a new treatment (e.g. an ISD intervention) while others receive the traditional treatment. Outcomes could then be compared across the two groups which, thanks to randomisation, ideally differ only in their access to ISD.
2022 OECD Questionnaire on Integrated Service Delivery to Address Gender-Based Violence (OECD QISD-GBV, 2022)
In January 2022, delegates to the OECD Employment, Labour and Social Affairs Committee (ELSAC) were invited to complete a questionnaire on service-delivery arrangements designed to support women experiencing GBV in their countries. The questionnaire asked about service provision and delivery in a range of sectors, as well as how integration is prioritised at the national level. More information on the questionnaire shared with countries can be found in the full report on ISD in relation to GBV (OECD, 2023[4]).
The QISD-GBV had a response rate of 92%: 35 out of 38 OECD countries responded.
2022 OECD Consultation with Non-Governmental Service Providers serving GBV Victims/Survivors
Grassroots organisations, civil society and non-governmental organisations have a rich history of delivering services in response to violence against women. To gain insight from non-governmental service providers at the delivery level, an online, survey-based consultation was made available to non-governmental service providers working in the GBV space between 1 February and 30 April 2022. A link to the survey, along with an open call for participation, was shared through OECD social media channels and various e-mail lists. The survey was also distributed informally through the European Family Justice Centre Alliance (https://www.efjca.eu/). Given that this sample was recruited non-randomly via social media and through “snowball” sampling, and that the survey was open to the public, the extent to which it is “representative” should be interpreted with caution. In total, 27 responses were received from service providers in 12 OECD countries. Two responses came from service providers in non-OECD countries, and were retained for the discussion that follows. All responses were anonymous.
OECD governments are conducting trials of integrated approaches as a way to improve service delivery for women experiencing IPV. Given the potential gains of ISD, what practices have been working well in OECD countries – and what are working less well? Can ISD be more broadly implemented to support women experiencing violence?
5.5.1. The state of integrated service delivery across OECD countries
Despite its potential benefits, integrated service delivery to address IPV is far from systematic. Fewer than half of the 35 responding OECD national governments (48%) reported promoting integrated service delivery (ISD) “somewhat” or “to a great extent”.12 Around half (51%) report targeted investments to support service providers in expanding, improving or transitioning to integrated service delivery.
To improve policy responses to GBV, integrated service delivery has taken a variety of forms. They include co-location of specialised services; information-sharing and training co-ordination across agencies; and/or deep co-operation across agencies, working on individual cases towards pre-determined, consistent goals.
OECD governments report applying ISD practices in healthcare, justice, housing, child-related services and income support. Most of these ISD practices rely on case management. ISD is reportedly most frequently introduced at entry points in healthcare, emergency housing and police services.
The health sector is a common centre for ISD to address IPV
The health sector is a typical point of entry to public services for women escaping violence, as victims/survivors face a range of threats to their health: injuries, unintended pregnancies, sexually transmitted infections, complications of pregnancy and mental health problems. IPV can also result in homicide or suicide. At the national level, governments seeking to integrate service delivery for victims/survivors have most frequently implemented targeted mental health supports and linked-up services from hospitals.
Hospitals
Within wider healthcare systems, hospitals have been shown to be an important site for ISD, since they are the destination for many victims/survivors in crisis. Countries with publicly funded healthcare systems are also well-placed to co-ordinate responses nationally to offer integrated GBV support. Co-located case management and referral models to support victims/survivors are reported throughout the OECD (OECD, 2023[4]), and play an important role over time: they help respond to crises in the immediate aftermath of violence, while providing the infrastructure for longer-term health resources.
Austria, in particular, has widely integrated related services for GBV in hospitals: all hospitals are obliged by law to establish “victim protection groups” for women experiencing domestic violence. These groups are responsible for facilitating early detection and prevention of domestic violence through awareness raising among hospital colleagues. The groups also establish networks of cross-sectoral actors, including police, shelters, social workers and helpline operators, which can be mobilised to support individuals seeking help (OECD, 2023[4]). In Korea, the approach is also intensive, with multidisciplinary centres in hospitals offering medical support, psychotherapy and legal counselling for immediate victims and their family members.
At the same time, not all health needs are best met in hospitals. Community-based care is recognised as the preferred approach for the majority of mental healthcare (OECD, 2021[39]). All OECD countries either already deliver the majority of mental health services outside hospitals, or have prioritised the transition to community-based care models – with the potential to deliver care that is less costly than in-patient care, more in line with service users’ preferences, and better integrated with other public services. This relates to the use of IPV screening tools in routine medical care (OECD, 2023[4]) and could be reflected in ISD responses to IPV in the coming years (OECD, 2023[4]).
Mental health support
The Lancet Psychiatry Commission lists a range of mental health disorders that are more common among people who have experienced IPV than those who have not, including “anxiety, depression, substance use disorder, post-traumatic stress disorder (PTSD), personality disorders, psychosis, self-harm, and suicidality” (Oram et al., 2022[40]). Reflecting these concerns, several OECD countries have established integrated mental health programmes co-ordinated at the national level.
In Denmark since 2020, municipal governments have been required to offer up to ten hours of free, psychological counselling to women who are staying (or who have stayed) at a shelter as a result of domestic violence. Municipalities are also obligated to offer at least four, and up to ten, hours of psychological support to children accompanying women in this context. Sessions can be used both during and after shelter stays (OECD, 2023[4]).
Other OECD countries have established mental health programmes in the form of multidisciplinary counselling centres (Chapter 3). In Costa Rica, for example, the National Institute of Women operates regional units which provide multidisciplinary support, including psychosocial support, to women experiencing IPV. In Greece, the Ministry of Labour and Social Affairs funds a number of dedicated counselling centres that provide targeted mental health services for women experiencing IPV. And in Japan, the national and subnational governments jointly fund and operate several spousal violence counselling and support centres that respond to women’s mental health needs and accompany them to related medical appointments (OECD, 2023[4]).
Housing is critical to supporting victims/survivors in crisis and in the long run
IPV is a leading driver of women and children’s homelessness throughout the OECD, and any efforts to address IPV must consider how to support victims/survivors in what often appears to be rebuilding their lives (OECD, 2023[4]). National governments finance and/or administer emergency, transitional and occasionally longer-term housing support for women and children fleeing violence.
Emergency shelters
Emergency shelters play a key role in offering safe havens for women escaping an abusive home and preventing homelessness for women at risk of violence. Emergency shelters are also an important intake site for integrated access to social services. Shelters can be general (for anyone in the population) or dedicated to women experiencing violence. Yet while emergency shelters play an important role, very few countries actually offer an adequate number of spaces.
Some offer counselling on-site, many offer linkages or referrals to health services, and many provide child-related services (e.g. counselling for children), legal advocacy, and linkages to long-term housing. In Italy, for example, income and entrepreneurship support can be applied for through violence protection centres.
Transitional and long-term housing
Some countries have introduced policies to help women transition out of shelters and into safe long-term housing. Hungary, for example, has a system of transitional housing that offers temporary, highly-subsidised housing for up to five years.
Looking at the longer term, a few countries report special provisions in existing social housing schemes that prioritise access to women who are experiencing IPV. This is the case in Belgium, Ireland, Japan, the Netherlands, Portugal, and Spain, for example. Unfortunately, given the scarcity of social housing across OECD countries, few women are able to access social housing. In the United States, where federal housing funds are more often allocated sub-nationally, a portion of federal housing funding is reserved for sub-national agencies to provide shelter and support for women and children experiencing domestic violence. And in Greece, the “Housing and Work Project” is a recent example of integrating long-term housing subsidies, mental health resources and employment-related support.
Australia has a novel, victim/survivor-centred approach that gives women and children greater stability and may help hold perpetrators accountable. The “Keeping Women Safe in Their Homes” (KWSITH) initiative offers support for women and their children to remain safely in their homes after domestic violence. Notably, this shifts the burden to the perpetrators of uprooting their life when they harm their partner.
The role of the justice sector in an integrated response
A critical consideration in ISD to address IPV is clients’ risk of exposure to violence, their heightened need for security, and, often, their need for interaction with police and access to justice (see (OECD, 2023[4]) and Chapter 6 in this report for further discussion). ISD measures to address IPV are thus often connected with police and legal advocacy support. Because legal issues and procedures are linked to other social, economic, health or employment issues, a holistic response to GBV requires close collaboration among organisations in the justice system and between the justice system and other sectors (OECD, 2021[9]).
As with other sectors, the legal system has room to improve support for victims/survivors. It can be hard to navigate for non-experts, and many victims/survivors have little trust that police are able or willing to support them. To some degree, this may be justified, given police history in many cultures of victim-blaming and underplaying GBV cases (OECD, 2023[4]).
Police
Police are sometimes gatekeepers for access to justice and other support. Reporting a crime can be an entry point for access to important interventions and safety. Police on the ground respond to emergencies, support women in administrative processes where civil or criminal charges are pursued or imposed, and initiate related, interdisciplinary services (OECD, 2023[4]).
Some police are embedded in formal referral networks to related providers. In Austria, the Czech Republic, Luxembourg and the Slovak Republic, police are required to contact social support services and link them with women experiencing violence.
Another strategy is to locate related services in police stations. Australia, for example, frequently co-locates community-based advocates in existing police stations, which also helps train officers, and Denmark and Norway have established interdisciplinary service provision in police stations. Portugal, Argentina and Brazil have established specialised women’s police stations trained to deal with cases of violence.
Police also play an important role in helping to prevent a recurrence of violence. The effective use by police of risk/danger assessments – informed by specialised training – and the correct application of emergency restraining/barring orders is an important step in preventing perpetrators carry out further harm.
Police can also be well-placed to deal with perpetrators of violence and initiate an integrated response to address violence at the source. In New Zealand, both victims and perpetrators of violence enter the “Integrated Safety Response” programme through police services. This integrated framework includes efforts to enforce perpetrator accountability through behavioural change programmes (OECD, 2023[4]).
Legal advocacy service
To ensure that more victims/survivors are able to make use of the legal frameworks available to support them, targeted justice services have emerged to better support women after IPV. Legal advocacy services and the court system, particularly domestic violence courts (see Section 6.3.2 in Chapter 6 and (OECD, 2023[4]), facilitate women’s access to justice and enable ISD with other sectors.
Several national initiatives exist in the OECD to help women access justice through legal support, including policies with multidisciplinary or integrated approaches. In Austria and Portugal, to improve access to justice, dedicated multidisciplinary counselling centres offer psycho-social counselling as well as legal counselling and court navigation support. In Australia, legal support services have been embedded in healthcare settings to streamline access to justice for women already accessing health services.
Costa Rica, New Zealand, Türkiye and the United Kingdom have established dedicated domestic violence courts, which use trauma-informed practices to empower women as they appeal for justice. Domestic violence courts apply specialised knowledge to better enforce orders, jointly delivered with police, that protect women. Domestic violence courts can also play an important role in enforcing perpetrator accountability through offender intervention programmes (OECD, 2023[4]).
5.5.2. Policy lessons
Women subject to intimate partner violence often require support from various social policy sectors to reassert their safety and independence. Integrated approaches to GBV have potential to mitigate the consequences of violence for victims/survivors by delivering multiple, essential services simultaneously.
Meanwhile, integrated services can also potentially reduce the cost-of-service delivery for governments if programming is backed by coherent policy integration, both vertically (across levels of government) and horizontally (across sectors). Despite variations in governance structures across the OECD, opportunities exist at the national level to facilitate and streamline ISD on the ground (OECD, 2023[4]).
Policy coherence matters
Governments must ensure that existing policies across sectors and jurisdictions do not inadvertently undermine each other, either directly,13 as a result of regulations, or indirectly, as a result of a competition for resources.
Related to this, policies and services must reinforce each other to address the whole problem of GBV. This involves emergency responses in the wake of violent incidents, continuity of support in the medium- and long-term, and ensuring that perpetrators of violence are held accountable.
One example of how to ensure policy coherence is via model administrative frameworks at the systems level (OECD, 2023[4]) that can help facilitate collaboration at the service delivery level. A strong administrative foundation can help all parties clearly understand their role in working jointly. As a first step, national ministries can collaborate to develop guidelines for service delivery standards, based on stated goals to improve service quality, outcomes, and satisfaction among both service users and providers. Templates can be developed to facilitate shared mission statements, memorandums of understanding across sectors, and joint service delivery agreements between providers. These administrative pieces can also be incorporated into funding criteria, effectively incentivising integration where clear service delivery arrangements exist.
A whole-of-state approach is essential
A whole-of-state approach, as noted in Chapter 3, including national frameworks, reliable and adequate funding, and involving government co-ordinating bodies tasked with gender (and GBV) mainstreaming, can help ensure that ministries and agencies deliver services in an integrated fashion.
Shifting, ambiguous or overlapping responsibilities can create competing incentives for funding and management. Ministries at the national level may be responsible for planning or ensuring service delivery to separate subsets of the population that, in the GBV context, can often overlap. Subnational governments may develop action plans or laws that may or may not align with incoming national-level action plans. Such issues are exacerbated in an environment of scarce public funding.
Part of this challenge stems from a basic governance issue: multilevel governance structures present a common challenge for all OECD countries in integrating social services of almost any kind (OECD, 2015[10]). If governance structures are highly centralised, it can be difficult to ensure that national policy reflects local needs and is adequately delivered. On the other hand, decentralisation and varying degrees of regional and municipal autonomy, whether legislative or financial, can lead to gaps in service coverage, and a lack of monitoring and evaluation (Lovette, Coy and Kelly, 2019[41]). NGO providers, for example, have objected that they sometimes cannot help relocate a victim/survivor to a safe location farther from her abuser if it falls under a different funding or political jurisdiction.
Funding to address GBV must be adequate and reliable over time
Irregular and inadequate funding for IPV-related service delivery was the top challenge cited by countries that participated in the 2022 OECD Questionnaire on Integrated Service Delivery to Address Gender-Based Violence, and non-governmental service providers that participated in the OECD Consultation.
A protected, legal basis for funding ISD to address GBV can help to circumvent pre-existing, siloed funding streams and ensure continuity of care by service providers. This must be prioritised in national budgets as part of broader frameworks on GBV.
A legislative basis can also shield budgetary allocations from changes in government. This can be done through funding rules that establish reinvestment criteria for central funds allocated to subnational entities. The United Kingdom, for example, recently implemented a funding rule requiring National Health Service Clinical Commissioning Groups to increase investment in mental health services in proportion to the overall increase in their central funding allocations.
Local beneficiaries can also be given flexibility to address specific, local needs with central funding allocations. In Colombia, local recipients of central funds allocated for the Generación Explora programme can choose 2 of 12 focal issues to finance (some of which explicitly address violence). Greater flexibility in local or regional funding could also simplify resource distribution procedures across jurisdictions, for example, if towns or regions nearby are jointly aiding a client.
National governments can help standardise (and fund) regular, local needs assessments
A first step in establishing and improving ISD is collecting data that indicates the need for services on the ground. The local context is critically important, especially where service delivery occurs at the subnational level or in partnership with NGOs. A “one-size-fits-all” approach would not be effective in most countries.
Nevertheless, national guidelines for standardised needs assessments can prove useful (Kelly, 2018[42]), especially where targets related to ending GBV are outlined in national action plans. National guidelines and resources can also help delivery-level entities with limited resources to assess service needs coherently, a common shortcoming.
Governments should make a priority of improving local administrative data collection. This involves research into the local prevalence of various forms of GBV, in addition to tracking service uptake and system utilisation, for example through service use numbers. Local prevalence rates can then be measured against social service “resource scans”, stocktaking or mapping available local services. Together, these assessments can inform the types of services needed on the ground. If service delivery is decentralised, such assessments can inform funding for service delivery grants.
Regular needs assessments can also be qualitative. One recent study in Greece, for example, assessed the needs of children accompanying mothers in women’s shelters (forthcoming). In the Czech Republic, the government surveyed regional authorities and local service providers to better assess the needs of people at risk of domestic violence as a precursor to implementing Istanbul Convention recommendations (EU Social Fund, 2021[43]).
Finally, while national population surveys on GBV have serious limitations, particularly in underestimating actual rates of violence, it is important to carry them out. Survey data can be used to identify regions or subgroups of women at risk of a high prevalence/frequency of violence, perhaps based on underlying socioeconomic conditions. These dedicated surveys on GBV repeated over time, or modules on GBV within other population surveys, can be used to inform needs assessments.
Data-sharing capabilities across agencies must be strengthened
Data sharing across providers can reduce clients’ application costs (in time and energy); reduce the trauma associated with repeating accounts of violence to different providers in different locations; and improve client safety by better tracking risks across repeated incidents of violence. Ideally, such a system would also integrate perpetrator-related interventions to track accountability and recidivism, as well as to monitor the risks posed to help-seeking women in real time.
Yet in most countries, sharing data on IPV cases is subject to serious gaps across providers and levels of government. Data-sharing capabilities across agencies must be reinforced, possibly using a central, integrated case management system, while ensuring client privacy.
For providers, a data-sharing platform offers numerous benefits: creating a secure environment where information can be shared; facilitating co-operation; reducing administrative processing costs, coverage gaps and service duplication; and more accurately assessing risk by making past appeals for help more visible to other providers. For governments, a central case management system can improve institutional co-ordination; more accurately track the prevalence of violence; and provide a foundation for monitoring service delivery costs and service delivery effectiveness on a case-by-case basis as a function of risk.14
Shared information on clients can help early detection and prevent violence by making providers more aware of the risk profiles and histories of clients. Governments may achieve long-term savings by early detection, prevention and increased efficiency in delivering services, ultimately reducing the number of appeals necessary to resolve problems.
Once established, such a system could also be mobilised to serve other vulnerable groups in addressing complex problems. Acknowledging the multidimensional utility of such a system, the World Bank is supporting the creation of an integrated case management system in Chile for the specific purpose of improving service delivery to women affected by violence (The World Bank, 2022[44]). Australia has also introduced a data-sharing strategy in the Safety First Programme, an information-sharing and safety-planning mechanism for women leaving shelters.
Privacy and security must be the priority in data-sharing strategies. It is important to note that the shift to digital data sharing does not necessarily imply increased risks, and may actually be an improvement over current conditions, which do not always adequately protect client privacy. In many cases, information is “transmitted between institutions either manually or by email, raising confidentiality concerns and significant delays in what are often life or death situations” (Inchauste, Bello and Contreras-Urbina, 2021[45]).
Better and regular programme evaluations are essential.
On the whole, ISD approaches to addressing GBV have not been systematically or quantitatively evaluated. Integrated services need to be better evaluated both individually and in the context of broader social protection system supports for GBV.
Better evaluations could entail randomised control trial evaluations of outcomes for clients offered an ISD approach versus standard service delivery; monitoring and evaluation of costs and benefits of integrated versus standard programmes; and qualitative, survey-based evidence on client experiences. Importantly, clients should be compared across integrated services and standard services to understand a crucial counterfactual: what would have likely happened in the absence of policy integration?
Such evaluations can and should also consider interventions for perpetrators of violence, to help improve understanding of what works in keeping men from assaulting (again) their partners. Understanding how to prevent recidivism is crucial for breaking a cycle of violence.
A holistic perspective means treating everyone involved – including perpetrators.
In addition to cross-sectoral and cross-jurisdictional coherence, policies aimed at addressing, and ultimately eradicating, GBV must consider every aspect of the problem. This requires targeting perpetrators of violence. Governments can interact with perpetrators not only through criminalisation and the court system, but in multidimensional ways that more holistically improve offender accountability and produce long-term behavioural change on individual and broader cultural levels (OECD, 2023[4]).
Most importantly, apply a victim/survivor-centred focus
Many of the policy prescriptions to address GBV are “top-down” in nature, encouraging national governments to offer guidelines, regular support and data-gathering tools to subnational and non-governmental service providers. While this line of communication is important, it is at least as important to ensure that national policymakers listen to experts and victims/survivors at the local level.
Local service providers and advocates are highly attuned to the needs of women on the ground, and they offer years of experience and knowledge of the diverse, often intersectional challenges women face. Many “best practice” integrated service delivery examples evolved from the ground up, such as the Family Justice Centres in Europe and North America and the evolution of rural women’s shelters in Canada. Clear lines of communication must therefore connect local service providers with national and regional policy makers, to enhance and expand victim/survivor-centred service delivery.
Victim/survivor-centred approaches could include regular stakeholder engagements or surveys of service providers, to ensure that stakeholders can help create good policies. The U.S. Department of Health and Human Services recently published guidance to government agencies on how to adequately capture “lived experiences” of service users, to understand better how programmes are working on the ground.
Realise the value of policy coherence: Governments should ensure that existing policies across sectors and jurisdictions do not inadvertently undermine each other, either directly, as a result of regulations, or indirectly, as a result of a competition for resources.
Whole-of-state government strategy for service delivery: Service delivery should be based on a whole-of-state approach, where both horizontal and vertical co-ordination across ministries, agencies and service providers and adequate funding ensure an integrated approach that helps shape national strategies at the service delivery level.
Funding of services: Funding of services to address GBV should be adequate and reliable over time. Irregular and inadequate funding for IPV-related service delivery was the top challenge cited by both countries and non-governmental service providers who participated in the 2022 OECD Questionnaire and the Consultation, respectively.
Local needs assessment: Standardise regular, local needs assessments: The local context is crucially important, especially where service delivery occurs at the subnational level or through partnerships with NGOs. A “one-size-fits-all” approach would not be effective in most countries.
Data-sharing: Data-sharing capabilities should be strengthened across agencies. Data sharing across providers can reduce clients’ application costs (in time and energy); reduce the trauma associated with repeating accounts of violence to different providers in different locations; and improve client safety by tracking risks across repeated incidents of violence. Ideally, such a system would also integrate perpetrator-related interventions to track accountability and recidivism, and monitor the risk posed to help-seeking women in real time.
Programme evaluations: Countries should ensure better and more regular programme evaluations for integrated services, both individually and in the context of broader social protection system supports for GBV.
Perpetrator treatment: Adopt a holistic perspective, by also treating perpetrators: Policies to address and ultimately eradicate GBV should consider every aspect of the problem.
Local lens to victim/survivor-centred approach: Countries should apply a victim/survivor-centred focus on a local level and ensure that national policymakers listen to experts and victims/survivors at the local level. This line of communication should be highlighted next to national governments offering guidelines and regular support to subnational and non-governmental service providers.
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Notes
← 1. It is important to note that men in heterosexual relationships, and people in same-sex relationships, also experience IPV, although in this case, motivation for violence is more often rooted in interpersonal or psychosocial dynamics rather than in gendered conceptions of superiority. As with violence against women, violence against members of the LGBTI+ community is gender-based in that it is motivated by prejudice and an illusion of hetero-masculine superiority among offenders. Statistically, women experience GBV most often at the hands of their male partners, adding a layer of complexity to help-seeking. For this reason, this report focuses on intimate-partner violence against heterosexual women, and the support required to address their many needs in escaping violence.
← 2. Note that these cross-nationally comparable estimates include all women, not only ever-partnered women.
← 3. Measuring GBV is challenging; it is underreported in population surveys and in administrative records, such as police reports, for a number of reasons (OECD, 2020[1]). Women may not report IPV if they feel the incidents are not sufficiently severe or if they feel that they will not be taken seriously by service providers; if they fear retaliation or stigma; if they prefer to deal with the matter privately; or if reporting violence risks jeopardising stable housing, financial security, and access to social support networks. Estimating IPV prevalence was complicated further during the COVID-19 pandemic, when stay-at-home orders trapped women in close proximity to their abusers, further restricting their ability to disclose violence (Kaukinen, 2020[46]).
← 4. For examples of evaluations of compliance with Istanbul Convention minimum standards in European OECD countries (Council of Europe, 2022[7]); (WAVE Network, 2019[55]).
← 5. Affected women may feel as though their case may not be “taken seriously” through traditional reporting channels such as the police, or that help-seeking options may fall short of long-term solutions that ensure safety and security. For a review of these challenges, see, for example: (Glenn, 2021[56]); (Mundy and Seuffert, 2021[48]); (Moylan, Lindhorst and Tajima, 2016[49]); (Fusco, 2013[52]).
← 6. See https://www.oecd.org/governance/gender-mainstreaming/ for an overview of work on this topic in the OECD; https://www.coe.int/en/web/genderequality/what-is-gender-mainstreaming for an overview of work by the Council of Europe; and https://eige.europa.eu/gender-mainstreaming/what-is-gender-mainstreaming for a descriptive overview from the European Institute for Gender Equality (EIGE).
← 7. For examples of international approaches, see (OECD, 2021[9]), (OECD, 2020[47]) (Council of Europe, 2011[6]); for a small selection of national strategies, see (OECD, 2023[4]).
← 8. See https://www.coe.int/en/web/conventions/full-list?module=signatures-by-treaty&treatynum=210.
← 9. International literature notes a lack of common terminology for describing collaborative, multi-agency work, which makes classification and comparison challenging. See, for example: (Atkinson, Jones and Lamont, 2007[53]).
← 10. Of course, on the provider side, the appointment of a single co-ordinating case worker (often social workers or, in the United Kingdom, “domestic violence advisors”) also implies considerable emotional dexterity and stress. Deteriorating mental health is not uncommon among case workers, often related to “inadequate organisational resources, lack of training, and poor integration with other community resources” (Kulkarni, Bell and Rhodes, 2012[50]). In the United States, burnout worsened among providers during COVID-19 (Garcia et al., 2021[51]).
← 11. Stakeholder engagement is relatively common in Canada. One example of findings from multi-stakeholder consultations can be found the report “Breaking the Silence: Final Report of the Engagement Process for the Federal Strategy to Address Gender-based Violence” (Status of Women Canada, 2018[54]).
← 12. Countries were asked “To what degree does the national/federal/central government actively promote the integration or co-location of services at the subnational and/or non-governmental level, or via private service providers?” Response scale choices were “to a great extent”, “somewhat”, “very little”, “not at all” or “don’t know.”
← 13. For example, “nuisance property laws” in some U.S. municipalities impose eviction (and even criminal charges, in some cases) for tenants who use a pre-determined number of emergency service calls. This is particularly harmful for women who appeal to emergency police services for protection in repeated situations of IPV (OECD, 2023[4]).
← 14. This could be based on an “Effectiveness, Risk, Value” (EVR) framework. Originally developed for home-care services, an “ERV analysis evaluates the effectiveness of a given care plan at mitigating the risk of adverse outcomes [and calculates] whether value of expected benefits exceeds costs of the care plan. The goal is to target care to those most at risk and most likely to benefit” (Swanson and Weissert, 2017, p. 545[16]).