"The real pandemic's been there forever": qualitative perspectives of domestic and family violence workforce in Australia during COVID-19

"Stuck Due to COVID": Applying the Power and Control Model to Migrant and Refugee Women's Experiences of Family Domestic Violence in the Context of the COVID-19 Pandemic

The COVID-19 pandemic had acute and lasting gendered impacts around the world, with UN Women declaring a shadow pandemic of violence against women. This study aimed to explore the impact of the COVID-19 pandemic on migrant and refugee women's experiences of family domestic violence (FDV) in Western Australia (WA) using a community-based participatory research approach. Thirty-eight interviews and two qualitative surveys conducted with 27 women were included in the analysis. Interview and survey data underwent reflexive thematic analysis informed by the Power and Control Wheel, generating three themes and ten subthemes: (1) the facets of violence women experienced (isolation; economic violence; emotional violence; visa vulnerabilities; fear and uncertainty), (2) the systemic enablers of FDV and barriers to seeking help (FDV service provision; the immigration system), and (3) the impact of the COVID-19 pandemic and government measures on women and family (enabling FDV; reducing the impact of FDV; COVID-19 paled into insignificance). While for some migrant and refugee women, government measures facilitated access to support for FDV, our findings show that for others, the COVID-19 pandemic exacerbated and became part of the violence they had already experienced. Recommendations for tailored FDV and other support during the COVID-19 pandemic are discussed, including the expansion of family violence provisions for all visa types.

'It's a challenging environment' health worker perspectives on domestic violence presentations to emergency departments in New South Wales hospitals in the context of the COVID-19 pandemic

BACKGROUND

Domestic and family violence (DFV) is a significant issue in Australia, with one in four women experiencing DFV in their lifetime. Emergency departments (EDs) within public hospitals are a priority setting for identifying, treating, and referring those at risk through sensitive clinical inquiry. However, there remains a dearth of evidence regarding health staff's knowledge, skills, and confidence in addressing the burden of DFV from their perspective. This research aims to address the evidence gap from the perspectives of health workers working within a diverse range of public hospital EDs in New South Wales (NSW), Australia, at the time of the COVID-19 pandemic.

METHODS

Semi-structured interviews were conducted online, adhering with COVID-19 restrictions at the time, and thematic analysis performed.

RESULTS

While EDs within NSW hospitals are often a first port of call for those experiencing DFV, clinician health staff perceive overwhelmingly, that they lack the capacity individually and institutionally to appropriately address presentations and had little knowledge of existing policies and procedures.

CONCLUSIONS

Policy and programmatic solutions to the capacity gap need to be current, highly feasible for an ED environment and ongoing to account for rotating staff and the evolving nature of DFV presentations. The preparedness of EDs within public hospitals in NSW will be crucial to the success of strategic initiatives and recent historic law reforms in supporting victim-survivors and preventing DFV.

Systemic Occupational Health Needs of Gender-Based Violence Advocates: Findings From the Early Months of the Pandemic

OBJECTIVE

This study explores occupational health burdens faced by domestic and sexual violence advocates, many of which intensified during the COVID-19 pandemic. It identifies key stressors and offers advocate-driven recommendations to improve their wellbeing, addressing the lack of system-level interventions in the occupational health literature.

METHODS

Semistructured interviews were conducted with 22 advocacy professionals. Thematic content analysis guided transcript coding, and researchers shared initial results with participants in two member checking sessions to validate the preliminary findings.

RESULTS

Advocates experienced logistical, emotional, and systemic stressors, including loss of peer support and unempathetic workplace cultures. Recommendations prioritize advocate wellbeing and call for systemic changes.

CONCLUSIONS

Advocates' occupational stressors highlight the need for system-level solutions to enhance their occupational wellbeing, particularly during large-scale emergencies. Collaborative efforts among employers, funders, and staff are essential to address system deficiencies.

The Global Landscape of Domestic Violence against Women during the COVID-19 Pandemic: A Narrative Review

The coronavirus disease (COVID-19) pandemic has led to an alarming increase in domestic violence against women owing to lockdown measures and limited access to support services. This article provides insights into the global prevalence of domestic violence, barriers to seeking help, its impact on women and children, and the best practices implemented worldwide. Domestic violence encompasses various forms of abuse; many young women experience partner violence. Barriers to seeking help include fear, financial constraints, lack of awareness of available services, and distrust among stakeholders. The consequences of domestic violence affect the mental health of both mothers and children. Countries have increased shelter funding and developed innovative protocols to reach survivors and address this issue. However, the healthcare sector's involvement in addressing domestic violence has been limited. This review advocates collaboration among healthcare institutions and government bodies. Key recommendations include utilizing telehealth services, implementing comprehensive training programs, establishing effective referral systems, enhancing health education, developing a domestic violence registry, improving the responses of law enforcement and justice systems through healthcare integration, promoting data sharing, and conducting further research. Healthcare systems should recognize domestic violence as a public health concern and detect, prevent, and intervene in cases to support survivors.

Effects of the COVID-19 Pandemic and Telehealth on Antenatal Screening and Services, Including for Mental Health and Domestic Violence: An Australian Mixed-Methods Study

Introduction

Australian antenatal care includes specific screening and service provision for domestic and family violence (DFV) and mental health. However, the COVID-19 pandemic resulted in major care changes, including greatly expanded telehealth. Given difficulties in a safe assessment and management of disclosures via telehealth, DFV and mental health service provision might be substantially impacted. This study therefore aimed to assess COVID-19 effects on DFV and mental health screening, as well as broader service provision from the perspective of local maternity service providers.

Methods

Mixed-methods study of staff surveys and interviews of staff directly involved in pregnancy care (doctors, midwives, and allied health) in three Sydney (Australia) maternity units, from October 2020 to March 2021. Surveys and interviews interrogated perceived effects of the COVID-19 pandemic on delivery (ensuring required services occurred), timeliness, and quality of (a) overall maternity care and (b) DFV and mental health screening and care; and also advantages and disadvantages of telehealth. Surveys were descriptively analyzed. Interviews were conducted online, recorded, and transcribed verbatim prior to thematic analysis.

Results

In total, 17 interviews were conducted and 109 survey responses were received. Breakdown of survey respondents was 67% of midwives, 21% of doctors, and 10% of allied health. Over half of survey respondents felt the pandemic had a negative effect on delivery, timeliness, and quality of overall pregnancy care, and DFV and mental health screening and management. Perceived telehealth positives included convenience for women (73%) and reducing women's travel times (69%). Negative features included no physical examination (90%), difficulty regarding non-verbal cues (84%), difficulty if interpreter required (71%), and unsure if safe to ask some questions (62%). About 50% felt telehealth should continue post-pandemic, but for <25% of visits. Those perceived suitable for telehealth were low-risk and multiparous women, whereas those unsuited were high-risk pregnancy, non-English speaking, and/or mental health/psychosocial/DFV concerns. “Change to delivery of care” was the central interview theme, with subthemes of impact on mental health/DFV screening, telehealth (both positive and negative), staff impact (e.g., continuity of care disruption), and perceived impact on women and partners.

Discussion

While telehealth may have an ongoing, post-pandemic role in Australian maternity care, staff believe that this should be limited in scope, mostly for low-risk pregnancies. Women with high risk due to physical health or mental health, DFV, and/or other social concerns were considered unsuited to telehealth.

Delivery of Distance Counselling to Survivors of Sexual Violence: A Scoping Review of Promising and Best Practices

Distance counselling holds immense potential for improving access to trauma supports for survivors of sexual violence (SV), and particularly for under-served groups who disproportionately experience violence and myriad barriers to accessing in-person supports. And yet, the evidence-base for the practice and delivery of distance counselling remains under-developed. In the context of COVID-19, where telehealth applications have undergone a rapid uptake, we undertook a scoping review of existing evidence of therapeutic and organizational practices related to the real-time (synchronous) delivery of distance counselling to survivors of SV. We based our scoping review methods on Arksey and O'Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and PRISMA reporting guidelines for scoping reviews. A comprehensive search of MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts was undertaken in October 2020, and again in March 2022. Searching, reviewing, appraisal, and data extraction was undertaken by two reviewers. In total, 1094 records were identified that resulted in 20 studies included. Descriptions, findings, and recommendations were gleaned and synthesized into potential practices using inductive thematic analysis. While many studies have an appreciative orientation to distance counselling, these benefits tend to be framed as non-universal, and conditional on survivor safety, flexibility, anonymity, survivor choice, strong and inclusive technology, and a supported workforce.Despite the limited evidence-base, we present several clusters of findings that, taken together, can be used to support current COVID-19 distance counselling initiatives with survivors, as well as guide the future development of best practices.