recommendations and conclusions on gender based violence

How to Deal With Gender-Based Violence in Crisis Situations: 9 Recommendations from Jaslika's Inaugural Webinar.

Jaslika Consulting held its inaugural webinar on Gender-Based Violence in Crisis Situations on the 22nd of April, 2020. The international panel of experts included Berhan Taye , a senior policy analyst at Access Now; Dr. Changu Mannathoko , the country managing partner at Joint Minds Consult in Botswana; Justice Martha Koome , a judge in the Kenyan Court of Appeal and the Chair of the National Council on the Administration of Justice (NCAJ) Special Task Force on Children Matters; and Megan O’Donnell , the assistant director of the gender programme and a senior policy analyst at the Center for Global Development in Washington D.C. The webinar was moderated by Jaslika’s director, Dr. Sheila P. Wamahiu, a leading expert in education and child rights in East Africa. Below are nine recommendations that they made on addressing GBV in crisis situations:

1. We need to consider violence both in the rapid response and in long term preparedness. 

Planning and resource mobilisation for gender-based violence has to be a part of government, sub-national and national rapid response efforts as a priority. As Justice Koome said, “Everybody is targeting the bigger picture of the pandemic but the kind of mobilization that we have seen to deal with covid as a pandemic, I submit that this is the kind of mobilization of efforts that should be put together to fight gender-based violence and violence against children.”

2. Targeted Economic Relief.

Due to the current economic stress caused by the ongoing pandemic, there’s an increase in coercive and transactional sex. To alleviate this stress and reduce cases of coercive and transactional sex, we need to ensure that women and girls are targeted during cash transfers and other social protection programmes. Also included here is targeted cash relief for persons with disabilities.

3. Maintaining Social Networks.

We know that this is difficult to do physically, with the ongoing social distancing and quarantine measures in place. However, it is recommended that people do this virtually. These networks help provide support and foster communication; people are able to gather virtually and even share information on where to report gender-based violence that they may be experiencing at home and outside the home. Things like chat bots, hotlines, and online support groups have been seen to be quite useful in this time.

4. Need for Data Protection and Privacy Policies.

There’s an increase in insecurity in cyberspace that is disproportionately affecting women and girls. This is partly due to, as Berhan pointed out that, women often have less on-line security training and are thus more prone to be hacked. It may also be attributable to the fact that cyber sexual and gender-based violence mimics what exists in the offline space and perpetuates it.

There needs to be policies in place that protect women and girls and the information that they share and access online. It needs to be clear, for example, what happens when someone uses a chatroom and shares information, how will it be shared/processed?

5. Flexible Funding from Donor Organizations.

Donors are mobilizing quickly to prioritize healthcare during the covid crisis. They are already supporting civil society organizations that are focused on women’s rights, and specifically focused on gender-based violence. There was a call  by panelists for donors not only to recognize women’s rights and response to gender-based violence as essential frontline services, but to allow for flexible funding to enable addressing the issues effectively. As Megan said,” We need to to allow these folks with their on the ground expertise to move as rapidly and as flexibly as possible to do what they need to do in their communities to address these issues and support survivors.”

6. Access to Justice.

With things moving to the digital space including court hearings during this pandemic, we need to be mindful of the existing digital divide. We need to be aware that levels of access to technology are not on a level field. Also as Justice Koome pointed out, “Cases of violence against children and domestic violence should be taken seriously at the police stations and we are urging NCAJ  [National Council on the Administration of Justice] to come up with a statement to say that domestic violence or any violence of any kind is unacceptable at this time to ensure that the families take responsibility of protecting  and safeguarding their children against violence.”

There is a need to ensure that children who are being rescued from violent homes   are being protected during this time. Unfortunately, cases are being reported of safe houses not opening up to rescued children due to fear of contamination. Justice Koome recommended that there should be a safe midway house where these children can be held for their safety and protection meanwhile.

7. Adequate Research on Issues of Education in Emergency Situations.

As clearly highlighted by Dr. Changu, there exist serious fault lines that hinder the effective implementation of policy and frameworks on school related gender-based violence. There needs to be more research on issues of Education in Emergency situations, that can be used to better inform policy and practice in schools and in the education systems. With adequate research, we can create informed policies that are more effective and applicable on the ground. 

8. Cross Sectoral Collaboration.

There needs to be more multisectoral collaboration in the creation of policy and frameworks, not just between governments at all levels and the private sector and NGOs but also with the children themselves. This helps us make more informed legislation and policies but also empowers the children in the process. 

“It is very important that when we are looking at schools and situations of education in emergency that we have a whole structural approach where we involve economic, social, education, health and legal expertise so that we address the whole system. You cannot address education by itself, you have to link it with other sectors,” Dr. Mannathoko.

9. GBV Training Programmes in Schools.

Dr. Mannathoko explained that we need to develop and support the expertise and experience  of all stakeholders in order to end school related gender-based violence (SRGBV). She highlighted that male and female teachers' confidence to address SRGBV can be strengthened by training them to reflect on their own values, beliefs and personal histories. We need to engage teachers in dialogue on curriculum materials and strategies to address discrimination and violence and training in interactive inclusive pedagogies.

“There are NO QUICK FIX Training Approaches to SRGBV.  It is important to create spaces for ongoing discussion and reflection among teachers, school management and other members of school communities as they attempt to change their practices,” Dr. Changu Mannathoko.

The Final Words

I would like to end with the words of Justice Koome,”Everybody is targeting the bigger picture of the pandemic but the kind of mobilization that we have seen to deal with the covid as a pandemic, I submit that this is the kind of mobilization of efforts that should be put together to fight gender-based violence and violence against children. I believe that if we went to the press, media to talk about the violence against children and gender-based violence the same way we are talking about covid, I believe it can be eliminated, at least a good percentage of it.”

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Conclusion: Combatting Gender-Based Violence: Reflections on a Way Forward

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Gender-based violence is a serious violation of human rights and with long-term physical and mental health consequences, even death. Although anyone can be a victim of violence, we know that it disproportionately affects women and girls putting them especially at risk. Whilst not a comprehensive guide, this book attempts to explore and represent a nuanced understanding of gender-based violence. It hopes to highlight the far-reaching impacts of gender-based violence, and its many related practices, along with policy and practice responses. The conclusion chapter presents a summary of the book and urges thinkers and scholars to come together from different perspectives to combat this deeply pervasive and complex crime.

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Pandey, M. (2023). Conclusion: Combatting Gender-Based Violence: Reflections on a Way Forward. In: Pandey, M. (eds) International Perspectives on Gender-Based Violence. Advances in Preventing and Treating Violence and Aggression . Springer, Cham. https://doi.org/10.1007/978-3-031-42867-8_14

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Issues and Recommendations on Gender-Based Violence Prevention and Response in COVID-19 Programming

Globally, gender-based violence (GBV) has increased during the COVID-19 pandemic, following the same pattern as previous pandemics. COVID-19 and past pandemics have led to increases in intimate partner violence (physical, verbal, economic, and psychological); digital harm, including online and offline sexual harassment and gender-based bullying and abuse; sexual exploitation and abuse, especially among women and girls; trafficking for commercial exploitation, especially of girls through online means; child, early, and forced marriage (CEFM) to mitigate the loss of family income; abuse and mistreatment of persons with disabilities and lesbian, gay, bisexual, transgender, queer/questioning, and intersex (LGBTQI+) persons; female genital mutilation/cutting (FGM/C); attacks against female health workers; and trafficking in persons. Several factors have triggered the increase during the current pandemic: curtailed movement from home because of stay-at-home measures and/or social isolation, increased use of the Internet, reduced access to support networks, and financial stress. Some reported GBV incidence data indicate decreases in GBV, which are likely due to underreporting.

This document is excerpted from USAID’s comprehensive gender and COVID-19 guidance, and presents considerations and recommendations related to gender-based violence (GBV) prevention and response (including sexual exploitation and abuse ([SEA]), that are relevant across sectors. Each sector-level recommendation includes additional tags to cross reference other relevant sectors.

Take action: 10 ways you can help end violence against women

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During the annual 16 Days of Activism against Gender-based Violence , UN Women stands united with survivors, activists, decision-makers, global citizens, and the UN system. Together, we are spotlighting the urgent need for robust funding, essential services, and financing of prevention initiatives and data collection that shape better-informed responses to gender-based violence.

Ending violence against women is everyone’s business. Here are ten ways you can make a difference, safely and impactfully.

1. Listen to and believe survivors

When a woman shares her story of violence, she takes the first step to breaking the cycle of abuse.

It is on all of us to give her the safe space she needs to speak up and be heard.

It is important to remember that when discussing cases of sexual violence, a victim’s sobriety, clothes, and sexuality are irrelevant.

The perpetrator is the sole reason for assault and must bear the responsibility alone. Call out victim-blaming and counter the idea that it is on women to avoid situations that might be seen as “dangerous” by traditional standards.

Survivors of violence are speaking out more than ever before, and everyone has a role to play to ensure they can have justice.

Do not say, “Why didn’t she leave?”

Do say: “We hear you. We believe you. We stand with you.”

2. Teach the next generation and learn from them

The examples we set for the younger generation shape the way they think about gender, respect, and human rights. Start conversations about gender roles early on, and challenge the traditional features and characteristics assigned to men and women. Point out the stereotypes that children constantly encounter, whether in the media, on the street, or at school, and let them know that it is OK to be different. Encourage a culture of acceptance.

Talk about consent, bodily autonomy, and accountability in an age-appropriate way to boys and girls. For example, discuss the importance of a clear “yes” from all involved, the fact your body is yours and you make choices over what happens to it, and of how we must always take responsibility for our actions. It is important to also listen to what children have to say about their experience of the world. By empowering young advocates with information and educating them about women’s rights, we can build a better future for all.

3. Call for responses and services fit for purpose

Services for survivors are essential services.

This means that shelters, helplines, counseling, and all support for survivors of gender-based violence need to be available for those in need.

Every year, the 16 Days of Activism campaign calls for united, global action to end all forms of violence against women and girls.

This year the United Nations, together with our partners, are demanding increased investments to end violence against women and girls.

Join us in calling on governments to bridge funding gaps to address violence against women and girls , invest in prevention initiatives, ensure essential services for survivors of violence are maintained, implement prevention measures, and invest in collecting the data necessary to adapt and improve life-saving services for women and girls.

4. Understand consent

Freely given clear consent is mandatory, every time.

Rather than listening for a “no”, make sure there is a clear “yes”, from all involved. Adopt clear consent in your life and talk about it.

Phrases like “she was asking for it” or “boys will be boys” attempt to blur the lines around sexual consent, placing blame on victims, and excusing perpetrators from the crimes they have committed.

While those that use these lines may have fuzzy understandings of consent, the definition is crystal clear. When it comes to consent, there are no blurred lines.

Learn more about consent .

5. Learn the signs of abuse and how you can help

There are many forms of abuse and all of them can have serious physical and emotional effects. If you’re concerned about a friend who may be experiencing violence or feels unsafe around someone, review these signs and learn about the ways to help them find safety and support.

If you think someone is abusing you, help is available . You are not alone. If you’d like to talk with a trained advocate at a helpline, we compiled this list of resources around the world .

6. Start a conversation

Violence against women and girls is a human rights violation that’s been perpetuated for decades. 

It is pervasive, but it is not inevitable, unless we stay silent. 

Show your solidarity with survivors and where you stand in the fight for women’s rights by oranging your social media profile for the 16 Days of Activism – you can download banners for Facebook and Twitter here . 

On Instagram, you can use UN Women’s face filter to spread the word and encourage your community to do the same. 

Use #orangetheworld, #16Days, and #GenerationEquality to start your own conversation about gender-based violence, or share some of the content from our social media package .

7. Stand against rape culture

Rape culture is the social environment that allows sexual violence to be normalized and justified, fueled by the persistent gender inequalities and attitudes about gender and sexuality. Naming it is the first step to dismantling rape culture.

Every day we have the opportunity to examine our behaviours and beliefs for biases that permit rape culture to continue. Think about how you define masculinity and femininity, and how your own biases and stereotypes influence you.

From the attitudes we have about gender identities to the policies we support in our communities, we can all take action to stand against rape culture.

Learn more ways to stand against rape culture .

8. Fund women’s organizations

Donate to local organizations that empower women, amplify their voices, support survivors, and promote acceptance of all gender identities and sexualities. 

UN Women works with women’s organizations everywhere to end violence against women, assist survivors, and secure equal rights for women and girls everywhere. Donate now . 

Find out more about how women ’ s organizations prevent violence against women and girls.

9. Hold each other accountable

Violence can take many forms, including sexual harassment in the workplace and in public spaces.

Take a stand by calling it out when you see it: catcalling, inappropriate sexual comments, and sexist jokes are never okay.

Create a safer environment for everyone by challenging your peers to reflect on their own behaviour and speaking up when someone crosses the line, or by enlisting the help of others if you don’t feel safe.

As always, listen to survivors and make sure they have the support they need.

10. Know the data and demand more of it

To effectively combat gender-based violence, we need to understand the issue.  

Relevant data collection is key to implementing successful prevention measures and providing survivors with the right support. 

Gaps in gender sensitive data collection have become more glaring than ever. Call on your government to invest in the collection of data on gender-based violence.

Find out at how UN Women works to bring about a radical shift in how gender statistics are used, created and promoted .

Originally published on Medium.com/@UN_Women .

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Guidelines for integrating gender-based violence interventions in humanitarian action

October 2020, reducing risk, promoting resilience, and aiding recovery.

These guidelines provide practical guidance and effective tools for humanitarians and communities affected by armed conflict, natural disasters and other humanitarian emergencies to coordinate, plan, implement, monitor and evaluate essential actions for the prevention and mitigation of gender-based violence (GBV), accross all stages of disaster and emergency management: from preparedness to recovery.

The document outlines how, in order to save lives and maximize protection, essential actions must be undertaken in a coordinated manner from the earliest stages of emergency preparedness. These actions are necessary in every humanitarian crisis and are focused on three overarching and interlinked goals described in this document: 1. To reduce risk of GBV by implementing GBV prevention and mitigation strategies across all areas of humanitarian response from pre-emergency through to recovery stages; 2. To promote resilience by strengthening national and community-based systems that prevent and mitigate GBV, and by enabling survivors and those at risk of GBV to access care and support; and 3. To aid recovery of communities and societies by supporting local and national capacity to create lasting solutions to the problem of GBV.

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Three ways to end gender-based violence

November 28, 2022.

Testing new approaches for preventing gender-based violence to galvanize more and new partners and resources.

Jacqui Stevenson

Research Consultant, UNU-International Institute for Global Health

Jessica Zimerman

Project Specialist, Gender-based Violence, UNDP

Diego Antoni

Policy Specialist Gender, Governance and Recovery, UNDP

How are the multiples shocks and crises the world is facing changing how we respond to gender-based violence? Almost three years after the COVID-19 pandemic triggered high levels of violence against women and girls, the recent Sexual Violence Research Initiative Forum 2022 (SVRI) shed some light on the best ways forward.

Bringing together over 1,000 researchers, practitioners, policymakers and activists in Cancún, Mexico, the forum highlighted new research on what works to stop and address  one of the most widespread violations of human rights. While some participants candidly – and bravely – shared that their initiatives did not have the intended impact, many discussed efforts that transformed lives, in big and small ways. After 5 days of the forum one thing was clear; a lack of evidence is not what is standing in the way of achieving a better future. It is a lack of opportunities and the will to apply that evidence.

Among the many shared findings, UNDP presented its own evidence. Since 2018, the global project on Ending Gender-based Violence and Achieving the Sustainable Development Goals (SDGs), a partnership between UNDP and the Republic of Korea, and in collaboration with United Nations University International Institute for Global Health, has tested new approaches for preventing and addressing gender-based violence, to galvanize more and new partners, resources, and support to move from rhetoric to action. Three key strategies have emerged.

• We need to integrate

Gender-based violence (GBV) intersects with all areas of sustainable development. That means that every development initiative provides a chance to address the causes of violence and to transform harmful social norms that not only put women disproportionately at risk for violence, but also limit progress. Bringing together diverse partners to jointly incorporate efforts to end GBV into “non-GBV” programmes has been central to the Ending GBV and Achieving the SDGs project. Pilots in Indonesia, Peru and the Republic of Moldova integrated a GBV lens into local development planning. The results were local action plans that focused on needs and solutions identified by the communities themselves, including evidence-based GBV prevention programming such as the Common Elements Treatment Approach , which has been proven to reduce violence along with risk factors such as alcohol abuse. This approach is growing, opening up new and more spaces for this work.

• We need to elevate

While evidence is crucial to creating change, the work doesn’t stop there. We also need to elevate this evidence to policy makers and to support them in putting the findings into action. In our global project, we went about this in different ways. In Peru women’s rights advocates and the local government worked together to draft a local action plan to address drivers of violence in the community of Villa El Salvador (VES). By working collaboratively and building trust between key players, the project was able to take a more holistic approach and to create stronger alliances to boost its sustainability and impacts. In particular, the local action plan was informed by cost analysis research that showed that this approach would pay for itself if it prevented violence for only 0.6 percent of the 80,000-plus women in VES who are at risk for violence every year. Since the pilot’s launch, more than 15 other local governments have expressed interest in the model, and it has already been replicated in three.

• We need to finance

L ess than 1 percent of bilateral official development assistance and philanthropic funding is given to prevent and address GBV, despite the fact that roughly a third of women have experienced physical or sexual violence.

The “ Imperative to Invest” study , funded by the EU-UN Spotlight Initiative and presented at the SVRI Forum, shows just what can be achieved with a US$500 million investment. The study highlights that Spotlight’s efforts will have prevented 21 million women and girls from experiencing violence by 2025. 

The Ending GBV and Achieving the SDGs project also finds positive results when financing local plans. Through pilot initiatives in Peru, Moldova and Indonesia, it was possible to mobilize funds when different municipal governments take ownership of participatory planning processes at an early stage. The local level is a key, yet an often overlooked, entry point to identifying community needs and, through participatory, multi-sectoral partnerships, to translate them into funded solutions. In Moldova the regional government of Gagauzia assigned funds to create the region’s first safe space, with the support of the community.

The SVRI Forum was living proof that a better future is possible. It offered profound moments for thoughtful exchange, learning with partners and peers, and deepened our own reflections on the outcomes and next steps for this global project. As we approach the final countdown to meeting the SDGs, including SDG5.2 on eliminating violence against women and girls, it has never been more urgent to take all this evidence and turn it into action against gender-based violence. Let’s act today.

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Addressing Gender-Based Violence Using Evidence-Based Practices During COVID-19: The Case of Puerto Rico

Ayorkor gaba.

1 Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA

Roseanne Flores

2 Hunter College of the City University of New York, New York City, NY, USA

María Rebecca Ward

3 Centro de Ayuda a Víctimas de Violación, Puerto Rico, USA

Bailey Pridgen

4 Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA

As gender-based violence (GBV) surged during the COVID-19 pandemic, the 65th session of the Commission on the Status of Women (CSW65) called for member states, civil, and other stakeholders to consider the specific needs of women and girls in COVID-19 response and recovery efforts. Psychology provides scientific knowledge to help answer this call. Despite existing global guidance and psychological research to mitigate GBV, COVID-19 presents new challenges for consideration. This article summarizes existing GBV guidance/research and COVID-19 considerations, uses an illustrative case study to describe Puerto Rico's application of GBV guidance/research during COVID-19, and provides preliminary policy and practice recommendations.

Introduction

COVID-19 has exacerbated gender-based violence (GBV) and gender inequality resulting in dual pandemics ( UN Women, n.d. ; Mittal & Singh, 2020 ; United Nations High Commissioner for Refugees, 2020 ). One in three women worldwide will be abused during her lifetime ( World Health Organization, 2021 ) and approximately 137 women and girls are killed by GBV per day ( United Nations Office on Drugs and Crime, 2018 ). GBV disproportionately impacts women and girls from marginalized groups (e.g., those living with disabilities, living in poverty, trans women, ethnic/racial minorities) ( Crooks et al., 2019 ). GBV also contributes to short- and long-term physical, mental, sexual, developmental, and reproductive health problems for women and girls and leads to high societal and economic costs ( WHO, 2021 ).

COVID-19 has presented unique considerations and challenges for global efforts to mitigate GBV and existing evidence-based approaches to GBV intervention. Most recently, the 65th session of the Commission on the Status of Women (CSW65), the principal global intergovernmental body exclusively dedicated to the promotion of gender equality and the empowerment of women, called on Member States, civil society, and other stakeholders to take account of the specific needs of women and girls in COVID-19 response and recovery efforts. The call specifically spotlighted the surge in GBV and its disproportionate impact on existing obstacles to girls’ and women's full and effective participation and decision-making in society ( Commission on the Status of Women Sixty-Fifth Session, 2021 ). Due to a long-established role in GBV research, practice, and advocacy, psychology is well-positioned to respond to this call.

Despite much available GBV-related global guidance and psychological research, integrated approaches are needed to inform rapid adaptation to GBV mitigation during COVID-19. To address this gap, this article (a) presents global guidance and psychological approaches informing GBV supports for survivors during COVID-19; (b) utilizes a case study to illustrate the local application of these integrated perspectives and program adaptation during COVID-19; (c) provides preliminary lessons learned and recommendations to support the empowerment of women and girl survivors during COVID-19 and beyond; and (d) responds to CSW65's call to address the disproportionate impact of COVID-19 on women and girls.

Global Context and Guidance

In April 2020, the UN Secretary-General, António Guterres, released a policy brief outlining the effects of COVID-19 on the lives of women and girls. The findings demonstrated that in every area of life, women and girls had been disproportionately affected by the pandemic ( United Nations Entity for Gender Equality and the Empowerment of Women & United Nations Secretariat, 2020 ). Women and girls suffered economically through loss of wages and jobs, propelling many into poverty; lost access to health care services; and decreased paid labor while unpaid labor increased. Due to the stress of lost income and employment, cramped living quarters, social isolation, and the restriction of movement and education of children at home, many women and girls became the targets of increased GBV ( United Nations Entity for Gender Equality and the Empowerment of Women & United Nations Secretariat, 2020 ). The Secretary-General called on nations to prioritize their responses to women experiencing GBV using evidence-based approaches. He encouraged States to include prevention efforts and services for violence against women as part of the COVID-19 response plan, including expanding access to domestic violence shelters and designating them as essential services, making online domestic violence services available, and providing safe spaces where people can report abuse and violence ( United Nations Entity for Gender Equality and the Empowerment of Women & United Nations Secretariat, 2020 ).

In response to the Secretary-General's call to address the needs of women and girls, the United Nations Development Programme (UNDP) and UN Women developed the COVID-19 Global Gender Response Tracker to monitor how governments are addressing the COVID-19 crisis and to collect data through a gender-sensitive lens ( UNDP, n.d. ). In March 2021, UNDP published a fact sheet highlighting the progress made to date by governments with respect to developing policies through a gender-sensitive lens. According to the UNDP, many countries have made efforts to strengthen and expand the services provided to GBV survivors, such as expanding access to shelters and helplines; ensuring access to justice using technology (e.g., videoconferencing of court hearings, remote filing of requests for protection orders); partnering with community organizations to support survivors of violence; raising awareness of VAWG; extending social protections and economic support; and providing additional funding to address the needs of women and girls with disabilities and LGBTQI persons ( UNDP, 2021 ).

Furthermore, UN Women recommends that COVID-19 responses align with the Sustainable Development Goals (SDGs), to ensure that rights of women and girls are promoted and protected. For example, pertaining to SDG5, Target 5.6, which aims to ensure access to sexual and reproductive health care, the UN recommends that “National-level committee decisions on COVID-19 must be made in consultation with groups working on women's rights and sexual reproductive health and rights to ensure consideration of best health practice recommendations” ( Azcona et al., 2021 ,p. 24). Without this alignment, COVID-19 is on track to derail progress across SDGs and will disproportionately impact women and girls ( Azcona et al., 2021 ). In a call to action, the CSW65 urged for members of civil society, member states, and other stakeholders to address the elimination of violence against women and girls as well as provide evidence-based practices (EBPs) that would lead to women's empowerment and sustainable development.

Psychological Approaches

The field of psychology has generated vast knowledge on the causes of GBV and effective approaches to mitigate GBV. For example, clinical psychology made important contributions at the individual level, including the development of effective trauma-informed interventions to treat GBV survivors ( Sperlich et al., 2021 ); cultural adaptations to better serve individuals from diverse cultural backgrounds ( O’Brien & Macy, 2016 ); and training and tools for mental health professionals to deliver effective treatment to survivors and/or perpetrators of GBV ( Taft et al., 2016 ). Developmental psychology has helped to identify adolescence as the most effective developmental stage for GBV prevention efforts ( De Koker et al., 2014 ; Stöckl et al., 2014 ) and informed prevention efforts such as interventions to promote attitudes that prevent GBV ( Lundgren & Amin, 2015 ). Social psychology GBV research has focused on the complex interplay between individual, relationship, community, and societal factors that place people at risk or protect them from violence (e.g., Anderson & Anderson, 2008 ; Hollomotz, 2009 ). For example, Rieger et al. (2021) recently explored this interplay within the context of intersectionality, defined as the holding of multiple and intersecting identities (e.g., Latina lesbian youth ), and GBV. Their work concluded that effective GBV efforts must be tailored to address structural inequalities and include prioritization of resources and opportunities (e.g., economic, educational), especially for those with intersecting identities who are at increased risk.

The case study presented here is grounded in trauma-informed care (TIC). TIC is a psychological approach that realizes the direct impact that trauma can have on access to services; responds by changing policies, procedures, and practices to minimize potential barriers; fully integrates knowledge about trauma into all aspects of services; trains staff to recognize the signs and symptoms of trauma; and avoids any possibility of re-traumatization ( SAMHSA, 2014 ). Despite TIC showing efficacy in addressing GBV ( Menschner & Maul, 2016 ), psychology research and practice has identified the need for culturally informed TIC approaches ( Ranjbar et al., 2020 ). Psychologists have made critical cultural modifications to traditional TIC, resulting in Trauma and Culturally Informed Care (TCIC). TCIC expands traditional TIC by specifically integrating a cultural lens. TCIC realizes the prevalence of trauma, individually and collectively, and the presence of strength and resilience; recognizes how trauma affects, directly and indirectly, all individuals involved with the program, organization, or system, including recognizing inner and collective growth; responds by putting this knowledge into practice by learning from the community, promoting safety and cultural wellness; and resists re-traumatization by drawing from cultural resiliency, traditional healing tools, and collective wisdom.

COVID-19 presents important considerations in the delivery of TCIC. First, many who experience GBV are part of marginalized communities with devastating and long histories of epidemics/pandemics. COVID-19 exacerbates historical and individual trauma from previous epidemics ( Corless et al., 2020 ), resulting in heightened fear and distrust of systems that have harmed these communities. Second, the expanded use of telehealth, in of itself, can result in trauma and re-traumatization. Application of culturally and trauma-informed principles to telehealth should be considered to alleviate some of the potentially negative impacts and enhance engagement in care during COVID-19 ( Gerber et al., 2020 ). Psychological approaches, especially centered around TCIC, when integrated with UN guidance provide important contextual considerations and strategies to enhance efforts to address GBV during COVID-19. These considerations and strategies will guide the following illustrative case study from Centro de Ayuda a Víctimas de Violación (Rape Victims Support Center, RVSC) in Puerto Rico.

Local Context and Population

In recent years, Puerto Rico has experienced a multitude of complex environmental and community stressors such as poverty, community violence, natural disasters, and public health emergencies, setting the stage for a significant rise in GBV during COVID-19. Pre-pandemic, 43.1% of the total population and 57% of children lived in poverty ( Smyrnios, 2020 ); there was a rising wave of community violence; and ongoing disaster recovery from Hurricanes Irma and Maria in 2017 (Youth Behavioral Risk Factor Surveillance System and earthquakes in January 2020.

Pre-COVID-19, Puerto Rico was already grappling with rising rates of GBV. According to the UN, in 2019, Puerto Rico was among the five areas in Latin America and the Caribbean Region with the highest number of femicides ( Economic Commission for Latin America and the Caribbean, 2020 ). Puerto Rico's Behavioral Risk Factor Surveillance System (BRFSS) data indicated a 100% increase in reports of sexual assaults among adults from 2015 to 2017, suggesting a possible effect of Hurricane Maria and its aftermath on GBV (Behavioral Risk Factor Surveillance System 2020). With respect to youth sexual violence, youth in PR had a higher incidence of being victims of sexual violence at some point in their lives when compared to national rates (9.1% vs. 7.1%) ( YBRFSS, 2019 ). Moreover, a comparative analysis of the YRBSS-PR between 2017 and 2019 showed an increase from 2.8% to 4.7% in date rape among youth during the aftermath of 2017 Hurricane Irma and Hurricane Maria.

During COVID-19, GBV increased in Puerto Rico. There was a 62% increase in women being murdered from 2019 to 2020 ( Santoni Ortiz, 2021 ). Program records from the Puerto Rico Department of Health indicate that women and girls experiencing GBV were not able to reach outside services; called emergency hotline services as the only immediate resource for help; reported increases in GBV due to partner substance use; and feared leaving their homes to seek a protective order or emergency services ( Centro de Ayuda a Víctimas de Violación, Department of Health, 2021 ). Due to the preexisting high rates of GBV and increasing risk factors during COVID, a state of emergency was declared on January 25, 2021. Funds were earmarked to support a multipronged GBV mitigation approach aligned with UN guidance, and targeting (1) public awareness of GBV as a public health crisis; (2) evidence-based and culturally specific programs to end GBV and address risk factors; (3) prevention and intervention efforts at the individual and community levels; and (4) enforcement of legal protections.

Program Description

Centro de Ayuda a Víctimas de Violación (RVSC), a program of the Department of Health, has been a main provider of GBV treatment and prevention services on the island since 1977. RVSC provides free advocacy and psychological services to survivors; develops and implements safety and prevention campaigns; educates the public about GBV; and collects data on the problem of sexual and domestic violence in PR. To be eligible for RVSC services, individuals must be a survivor of sexual violence, defined as sexual assault, incest, lewd acts, sexual harassment, child pornography, sexual harassment, human trafficking, obscene exposures, and/or spousal sexual assault. Individuals receive individual and group therapy; family members receive psychoeducation and conjoint sessions with the survivor (when appropriate); the survivor and family members are linked to support services and groups; and the survivor receives advocacy support for medical, legal, and social needs.

Survivors receive Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), an empirically supported treatment to support children and adolescents (aged 5–18) and their parents or caregivers in the aftermath of traumatic experiences. It integrates trauma-sensitive interventions and cognitive-behavioral principles, and addresses post-traumatic stress disorder (PTSD), depression, and anxiety ( Cohen et al., 2016 ). Research has found that TF-CBT successfully resolves a broad array of emotional and behavioral difficulties associated with single, multiple, and complex trauma experiences. TF-CBT has been culturally adapted and implemented in many countries and cultures ( Cary & McMillen, 2012 ).

Guided by existing research ( National Child Traumatic Stress Network, 2008 ), RVSC culturally adapted TF-CBT to meet the unique needs of the client population. First, RVSC therapists assess and integrate several cultural constructs throughout treatment such as spirituality, traditional gender roles, and other common values in Latin culture such as familismo (e.g., dedication, commitment, and loyalty to family), and personalismo (e.g., valuing personal relationships over status, material gain, and institutional relationships). RVSC therapists are trained to be respectful of and responsive to cultural beliefs including norms for interpersonal interactions. Therapists are also trained to assess and address potential challenges to the development of strong therapeutic relationships, including previous interactions with mental health treatment providers or “the system” in general, as well as racism or discrimination. Since some research suggests a greater tendency to express somatic symptoms (e.g., aches and pains, lethargy) among Latinos experiencing depression and/or anxiety, therapists also integrate an informal assessment of somatization that is mindful of idioms of distress and culture-bound syndromes. Although not a specific “cultural risk factor,” some communities have elevated risk factors for different types of traumas (e.g., community violence). Therefore, these risks are also addressed in treatment and attempts are made to reduce future exposure. In combination, these adaptations enhance the cultural relevance of TF-CBT for the RVSC client population.

Implementation

Due to the restriction on movement during COVID-19, TF-CBT in-person services needed to rapidly transition to telehealth. Therefore, all health-related services were provided via virtual video conferencing and phone. To enhance staff capacities to implement all RVSC services via telehealth, clinical staff completed telehealth training offered by the American Psychological Association (APA). APA offered this usually paid training for free to all providers during the COVID-19 crisis to aid the psychology community in their vigilant efforts to rapidly transition to telehealth. The training series was an introduction to the ins and outs of real-world telepsychology and detailed the competencies needed for telepractice, including critical ethical, legal, clinical, and technical issues. Clinical staff also accessed free resources provided by the developers of TF-CBT to inform telehealth delivery. This training was complemented with internal staff discussion, review of the existing literature, and consultation with the community to gather guidance on specific local, cultural, and structural considerations to inform the transition to telehealth. The following research-based and community-generated priorities guided implementation during the rapid transition to telehealth: (1) linkage to and provision of remote culturally relevant education, support services, and safety resources (e.g., crisis hotlines and virtual groups); (2) consideration of social determinants of health (e.g., housing stability, food insecurity, discrimination in treatment access and engagement); (3) identification of religious/cultural champions who can inform and support safety planning virtually; (4) staff training in the historical-cultural context of pandemics for the communities they serve, including ways to identify and bolster cultural strengths that have historically supported these communities; (5) regular supervision of and consultation with support staff during the rapid transition; (6) enhanced evaluation efforts to assess the impact of COVID and the transition to telehealth services on needs and outcomes; and (7) a strategic plan to use evaluation findings to advocate for policy change and funding.

TF-CBT was delivered online and/or by phone during 30–65-minute sessions facilitated by RVSC counselors. Prior to starting TF-CBT, survivors and caregivers completed an assessment battery including the Child Behavior Checklist Inventory (CBCL), a widely used caregiver report form identifying problem behavior in children, and the University of California Los Angeles Post-Traumatic Stress Disorder (UCLA PTSD) scale, an instrument that assesses reactions to trauma in children and adolescents. Per the TF-CBT protocol, survivors receive 8–25 sessions of TF-CBT. Children and their caregivers meet individually with the therapist and later in the final phase of treatment, conjoint sessions are offered to work through the trauma narrative. This is an effective psychological technique used to help survivors of trauma make sense of their experiences, while also exposing the survivor to trauma-related memories, feelings, and situations to help reduce fear, anxiety, and avoidant behavior. TF-CBT's core components include psychoeducation, parenting skills, relaxation techniques, and cognitive processing. At the end of treatment, the assessment battery is readministered to assess change over time. This assessment will be part of a larger program evaluation assessing program impact on mental health symptomatology and overall functioning. Program evaluation was a critical component in our implementation plan and will be used to inform services, policy, and advocacy efforts at the community and governmental levels.

Below we include a brief survivor case example to illustrate the implementation and clinical considerations and application of psychological approaches during COVID-19.

Case Example

A 15-year-old female survivor of sexual abuse perpetrated by an adult male family member presented for care with her mother. She lived in a low-income community and was referred by the police to the RVSC hotline, due to a complaint of sexual violence intra-family. Police filed the complaint, and the perpetrator admitted the crime. The survivor presented with complex trauma. In addition to the sexual abuse, she witnessed domestic violence in her early childhood, lost her house due to flooding during Hurricane Maria, and had been in a serious accident. At intake, she was living with her mother, brother, and stepfather. Her biological father was a positive source of support, often spending time with her on alternating weekends. Her major strengths included her academic performance and engagement in academic activities, her artistic ability and drawings (which she also sold to generate a small income for her family), and her participation on a sports team. Her main concerns at intake were the upcoming legal process, particularly fears about potentially having to confront the perpetrator; being isolated from peers because of remote schooling; suspension of her sports team due to COVID-19; poor communication with her mother; and low self-esteem. Although she suffered isolation from the lockdown and social distancing, this was further compounded by emotional and physical distancing from her mom, who had to continue working during the pandemic, and the loss of emotional support from her grandmother, who previously served as a mother figure but rejected her upon the revelation of the abuse. At intake, her CBCL results supported a diagnosis of depression characterized by anxiety, isolation, and social problems and her UCLA PTSD scale results supported a PTSD diagnosis.

At the start of treatment, COVID-19-related stressors included diminished access to friends and family; difficulties with technology and Internet access; and concerns that she wasn't learning as much in her remote schooling. In addition to the traditional TF-CBT curriculum, initial sessions were dedicated to help orient her and her caregiver to the telehealth platform and discuss and problem solve COVID-19-specific stressors. In the spirit of trauma-informed telehealth delivery, her therapist implemented trauma and culturally informed principles in new ways. For example, to address trauma-informed principles such as safety, the therapist suggested using headphones to enhance confidentiality and established adapted safety planning procedures. For example, if the survivor suddenly appeared frightened or concerned, the clinician was trained to ask yes or no questions such as: “Do I need to call 911? Do we need to disconnect? Do I need to reach out to your emergency contact?” or use a nonverbal gesture to communicate a safety concern. To address transparency, the therapist positioned herself in front of the screen, so the client could clearly see her body language. To address cultural considerations, the therapist worked closely with the client and family members to make telehealth more accessible. In addition, the therapist explored historical trauma related to the hurricane, allowing space to explore and process the event. The therapist also assessed and addressed SDoH needs that increased during COVID, including food insecurity, neighborhood safety concerns, and economic instability.

This survivor successfully completed 22 TF-CBT sessions. At the end of treatment, she had a reduction in depression and PTSD symptomatology (as measured by the CBCL and UCLA PTSD scale), was able to share her trauma narrative with herself and her mother with reduced anxiety and distress, returned to in-person schooling, and resumed participation with her sports team. A primary treatment accomplishment was the new bond between mother and daughter as a result of parenting interventions and psychoeducation on trauma and sexual abuse, all delivered virtually. Although reduced, she was still experiencing some anxiety related to the pending case in court. It was agreed that she would follow up and complete booster sessions as needed to help support her through the court proceeding. The family reported that TF-CBT delivered virtually reduced worries about transportation as well as interruptions to her mother's work schedule and the associated financial impact, all of which would have been significant barriers to participation in care prior to COVID-19.

Recommendations and Lessons Learned

The following key recommendations and lessons learned came from the RVSC's TF-CBT work with GBV survivors during COVID-19:

• -  Telehealth: Consistent with the literature ( Stewart et al., 2017 ), preliminary program evaluation findings suggest that telehealth can be effective in delivering TF-CBT. COVID-19 presented an opportunity to develop and implement telehealth to reach GBV survivors who previously had no access to metropolitan areas and regional offices due to geographical distance and lack of resources (e.g., transportation and childcare). Telehealth launched in response to COVID-19 addressed some of the preexisting access issues for this historically underserved population. Continued funding for and availability of telehealth and hybrid services post-COVID-19 are strongly recommended.
• -  Technology access: Access to technology is still a significant concern. Although a recent study suggests that most people on the island have mobile phones and Internet coverage, a closer look at the data shows access is not equally distributed around the island. For example, some data show limited coverage within the island's central region, suggesting an access disparity ( Daly, 2020 ; Farjardo, 2020 ). Addressing the digital divide is crucial, especially as COVID-19 persists and many critical services/supports have quickly transitioned to telehealth. Governmental and public–private partnership efforts are needed to ensure equitable access. Efforts in this direction are well aligned with recent calls for universal Internet access and a growing understanding that almost every aspect of the UN's SDGs depends upon access to broadband connectivity, the Internet, and digital platforms ( Bamford et al., 2021 ).
• -  Evaluation: The preliminary program evaluation suggests that teletherapy could be an effective alternative or addition to in-person service for GBV survivors receiving TF-CBT. More robust research, including control group comparisons, is needed to fully assess the effectiveness of GBV teletherapy services during COVID-19. Due to limited resources island-wide, funding often is not available to support more robust research and evaluation. Community–university research partnerships may be a cost-effective way to further support the development of robust evaluations to inform policy during COVID-19.
• -  Adaptation of evidence-based interventions: Despite psychology's contribution to the cultural adaptation of EBPs, additional modifications may be needed for younger survivors who have differing developmental needs and survivors living with disabilities who have unique considerations impacting participation and engagement in telehealth during COVID-19 and beyond. Significantly more research is needed to inform the adaptation of EBPs to meet the needs of individuals with multiple and intersecting marginalized identities.
• -  Vicarious trauma: During a public health emergency, staff are experiencing extreme stressors as well. They are at risk for a host of psychological challenges themselves, including depression and anxiety. Due to the nature of the work, there is an elevated risk for burnout and compassion fatigue. It is recommended that organizations center trauma-informed workforce wellness during COVID-19 and post-recovery. Suggested strategies include centering workforce equity and inclusion in decisions and communications about any practice and procedural changes; uplifting and supporting workforce resilience and strengths; and creating avenues for staff to confidentially request and access accommodations (e.g., flex time, childcare, basic needs such as food).
• -  Policy: A recent executive order (Gobierno de Puerto Rico, 2021) in Puerto Rico promotes nationwide GBV prevention and intervention policies to enhance resource mapping, capacity building, and public awareness of gender equity principles. There is a critical need for these types of policies in the community. In addition, policies supporting enhanced collaborative networking between agencies and training of first responders on GBV will facilitate much more rapid identification and referral for GBV survivors.
• -  Training: As COVID-19 unfolded, leading training and professional organizations quickly provided training and consultation free of charge (e.g., American Psychological Association). This was extremely helpful, especially for low-resource settings that do not have equitable access to ongoing health professional training. Post-COVID-19, these organizations should continue to provide equitable access to training and consultation for low-resource settings.
• -  Infrastructure: The existing GBV infrastructure is inadequate to meet the projected increases in GBV as the pandemic persists ( Blofield et al., 2021 ). Governments should ensure stable funding to support investments in further infrastructure for emergency services; first-response services; shelters; and gender-sensitive social protection programs including housing, economic supports, counseling, and vocational/educational training.

The COVID-19 pandemic has compounded the preexisting epidemic of GBV. Integration and application of psychological approaches and global guidance can greatly inform GBV mitigation at the local, national, and international levels. Continuing to tackle these issues using evidence-based interventions will help to empower women and girls, providing them with an agency that will ensure they are not left behind as the global community seeks to build back better. As scientists predict future COVID-19 waves and pandemics, rapid dissemination of case examples, lessons learned, and recommendations can help practitioners, researchers, and policymakers better serve diverse survivors, families, and communities impacted by GBV during COVID-19 and beyond.

Author Biographies

Ayorkor Gaba , PsyD, is a clinical psychologist and assistant professor in the Department of Psychiatry at the University of Massachusetts Chan Medical School and an American Psychological Association NGO representative to the United Nations.

Roseanne Flores , PhD, is a developmental psychologist and professor in the Department of Psychology at Hunter College of the City University of New York and an American Psychological Association NGO representative to the United Nations.

María Rebecca Ward , PsyD, is a clinical psychologist and the director of the Rape Victims Support Center (Centro de Ayuda a Víctimas de Violación) in San Juan, Puerto Rico.

Bailey Pridgen , BA, is a research coordinator in the Department of Psychiatry at the University of Massachusetts Chan Medical School.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Ending Gender-Based Violence

CDC affirms its commitment to preventing and responding to violence during the 16 Days of Activism Against Gender-Based Violence campaign. The campaign is observed annually from November 25 to December 10.

With support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), CDC works with partners in 46 countries to achieve global targets to end the HIV epidemic. Although progress is being made, some people, including adolescent girls and young women, bear a disproportionate burden of HIV.

Women with a history of physical and/or sexual abuse are more likely to be living with HIV, especially if that abuse started during childhood. HIV-related stigma, discrimination, and violence restrict access to prevention and treatment services for those most at risk. These challenges serve as persistent barriers to ending the HIV epidemic.

Violence against youth is also a global public health problem. One in eight young people reported having experienced sexual abuse. The results can be devastating—leading to long-term psychological, social, and physical harm.

Violence prevention and response for youth is a global priority . It is complementary to efforts to eliminate all barriers to HIV treatment and prevention and accelerate progress toward ending the HIV epidemic.

What is gender-based violence?‎

The 2023 campaign highlighted the urgent call to " End inequalities. End HIV ." by breaking down barriers posed by gender disparities and violence. Stories featured had a keen focus on:

• Engaging young people for youth-led solutions to address stigma
• Strengthening youth's skills and economic empowerment
• Using Violence Against Children and Youth data to create actions that measurably reduce violence
• Focusing on health equity by putting people at the center of our efforts

Starting with the 16 Days of Activism, we invite you to explore the stories and learn how CDC works with our local partners to and respond to gender-based violence as part of our commitment to end inequalities and end AIDS. By amplifying voices worldwide, CDC aims to continue to increase awareness of gender-based violence—and ultimately save lives.

Empowering Young People in Mozambique and Zambia

Empowering Women through Visual Storytelling

Additional resources

Renewed Focus on Ending Gender-Based Violence to End HIV/AIDS

Global Health

CDC's Global Health Center works 24/7 to reduce illness and respond to health threats worldwide.

Eight Recommendations to Reduce Gender-Based Violence During the Pandemic

Giving compass' take:.

•  Kim Dixon at degrees shares recommended actions that could reduce gender-based violence, which has been surging since the coronavirus pandemic began.
•  What initiatives or policies can you support to reduce gender-based violence?
•  Read about  gender equality and COVID-19.

What is Giving Compass?

We connect donors to learning resources and ways to support community-led solutions. Learn more about us .

Since the early stages of the COVID-19 pandemic, many countries have reported alarming rates of violence, exploitation and other abuse, especially intimate partner violence among women and other marginalized groups. UN Women has warned that, as countries continue lockdowns and sheltering-at-home measures, a shadow pandemic of violence is growing. More than ever, the United Nation’s 16 Days of Activism against Gender-Based Violence is an important opportunity for international development organizations to commit to identifying ways to prevent and respond to violence, exploitation and other abuse in the communities where humanitarian and development projects are being implemented.

Eight recommended actions Action 1:  Gather information to understand how violence directly impacts program participants and the availability of services for victims and survivors of violence and exploitation in your communities.

Action 2:  Develop strategies and plans to address an increase in domestic violence, sexual exploitation and other abuse among program participants. Consider interventions for the short term (six months to one year) and medium term (program duration).

Action 3 : Equip your program team to respond appropriately to support those seeking assistance.

Action 4:  Create new ways to engage program participants in the planning and implementation of programs, including activities related to the COVID-19 pandemic.

Action 5:  Update referral pathways to reflect changes in available medical care, psychosocial support, legal and emergency housing for victims and survivors of violence, exploitation and abuse.

Action 6:  Include violence prevention and response activities in annual work plans as current funding permits. Include these activities in any new funding requests.

Action 7:  Explore innovative ways to help people stay connected and decrease isolation.

Action 8:  Disaggregate data related to COVID-19 outbreaks by sex, age and disability.

Read the full article about reducing gender-based violence by Kim Dixon at degrees.

More Articles

The importance of a global gender-responsive covid-19 recovery plan, global citizen, mar 15, 2021, creative ways to combat gender-based violence, mar 19, 2021.

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Violence in Families: Assessing Prevention and Treatment Programs (1998)

Chapter: 9 conclusions and recommendations, 9 conclusions and recommendations.

The problems of child maltreatment, domestic violence, and elder abuse have generated hundreds of separate interventions in social service, health, and law enforcement settings. This array of interventions has been driven by the urgency of the different types of family violence, client needs, and the responses of service providers, advocates, and communities. The interventions now constitute a broad range of institutional services that focus on the identification, treatment, prevention, and deterrence of family violence.

The array of interventions that is currently in place and the dozens of different types of programs and services associated with each intervention represent a valuable body of expertise and experience that is in need of systematic scientific study to inform and guide service design, treatment, prevention, and deterrence. The challenge for the research community, service providers, program sponsors, and policy makers is to develop frameworks to enhance critical analyses of current strategies, interventions, and programs and identify next steps in addressing emerging questions and cross-cutting issues. Many complexities now characterize family violence interventions and challenge the development of rigorous scientific evaluations. These complexities require careful consideration in the development of future research, service improvements, and collaborative efforts between researchers and service providers. Examples of these complexities are illustrative:

• The interventions now in place in communities across the nation focus services on discrete and isolated aspects of family violence. They address different aspects of child maltreatment, domestic violence, and elder abuse. Some
• interventions have an extensive history of experience, and others are at a very early stage of development.
• Many interventions have not been fully implemented because of limited funding or organizational barriers. Thus in many cases it is too early to expect that research can determine whether a particular intervention or strategy (such as deterrence or prevention) is effective because the intervention may not yet have sufficient strength to achieve its intended impact.
• The social and institutional settings of many interventions present important challenges to the design of systematic scientific evaluations. The actual strength or dosage of a particular program can be directly influenced by local or national events that stimulate changes in resources, budgets, and personnel factors that influence its operation in different service settings. Variations in service scope or intensity caused by local service practices and social settings are important sources of "noise" in cross-site research studies; they can directly affect evaluation studies in such key areas as definitions, eligibility criteria, and outcome measures.
• Emerging research on the experiences of family violence victims and offenders suggests that this is a complex population composed of different types of individuals and patterns of behavior. Evaluation studies thus need to consider the types of clients served by particular services, the characteristics of those who benefited from them, and the attributes of those who were resistant to change.

In this chapter the committee summarizes its overall conclusions and proposes policy and research recommendations. A key question for the committee was whether and when the research evidence is sufficient to guide a critical examination of particular interventions. In some areas, the body of research is sufficient to inform policy choices, program development, evaluation research, data collection, and theory-building; the committee makes recommendations for current policies and practices in these areas below. In other areas, although the research base is not yet mature enough to guide policy and program development, some interventions are ready for rigorous evaluation studies. For this second tier of interventions, the committee makes recommendations for the next generation of evaluation studies. The committee then identifies a set of four topics for basic research that reflect current insights into the nature of family violence and trends in family violence interventions. A final section makes some suggestions to increase the effectiveness of collaborations between researchers and service providers.

Conclusions

The committee's conclusions are derived from our analysis of the research literature and discussions with service providers in the workshops and site visits, rather than from specific research studies. This analysis takes a client-oriented

approach to family violence interventions, which means that we focus on how existing services in health, social services, and law enforcement settings affect the individuals who come in contact with them.

• The urgency of the need to respond to the problem of family violence and the paucity of research to guide service interventions have created an environment in which insights from small-scale studies are often adopted into policy and professional practice without sufficient independent replication or reflection on their possible shortcomings. Rigorous evaluations of family violence interventions are confined, for the most part, to small or innovative programs that provide an opportunity to develop a comparison or control study, rather than focusing on the major existing family violence interventions.
• This situation has fostered a series of trial-and-error experiences in which a promising intervention is later found to be problematic when employed with a broader and more varied population. Major treatment and prevention interventions, such as child maltreatment reporting systems, casework, protective orders, and health care for victims of domestic violence, battered women's shelters, and elder abuse interventions of all types, have not been the subjects of rigorous evaluation studies. The programmatic and policy emphasis on single interventions as panaceas to the complex problems of family violence, and the lack of sufficient opportunity for learning more about the service interactions, client characteristics, and contextual factors that could affect the impact of different approaches, constitute formidable challenges to the improvement of the knowledge base and prevention and treatment interventions in this filed.
• In all areas of family violence, after-the-fact services predominate over preventive interventions. For child maltreatment and elder abuse, case identification and investigative services are the primary form of intervention; services designed to prevent, treat, or deter family violence are relatively rare in social service, health, and criminal justice settings (with the notable exceptions of foster care and family preservation services). For domestic violence, interventions designed to treat victims and offenders and deter future incidents of violence are more common, but preventive services remain relatively underdeveloped.
• The current array of family violence interventions (especially in the areas of child maltreatment and elder abuse) is a loosely coupled network of individual programs and services that are highly reactive in nature, focused primarily on the detection of specific cases. It is a system largely driven by events, rather than one that is built on theory, research, and data collection. Interventions are oriented toward the identification of victims and the substantiation and documentation of their experiences, rather than the delivery of recommended services to reduce the incidence and consequences of family violence in the community overall. As a result, enormous resources are invested to develop evidence that certain victims or offenders need treatment, legal action, or other interventions, and comparatively limited funds are available for the treatment and support services themselves—a
• situation that results in lengthy waiting lists, discretionary decisionmaking processes in determining which cases are referred for further action, and extensive variation in a service system's ability to match clients with appropriate interventions.
• The duration and intensity of the mental health and social support services needed to influence behaviors that result from or contribute to family violence may be greater than initially estimated. Family violence treatment and preventive interventions that focus on single incidents and short periods of support services, especially in such areas as parenting skills, mental health, and batterer treatment, may be inadequate to deal with problems that are pervasive, multiple, and chronic. Many programs for victims involve short-term treatment services—less than 6 weeks. Services for offenders are also typically of short duration. Yet research suggests that short-term programs designed to alter violent behavior are often the least likely to succeed, because of the difficulties of changing behavior that has persisted for a period of years and has become part of an established pattern in relationships. Efforts to address fundamental sources of conflict, stress, and violence that occur repeatedly over time within the family environment may require extensive periods of support services to sustain the positive effects achieved in short-term interventions.
• The interactive nature of family violence interventions constitutes a major challenge to the evaluation of interventions because the presence or absence of policies and programs in one domain may directly affect the implementation and outcomes of interventions in another. Research suggests that the risk and protective factors for child maltreatment, domestic violence, and elder abuse interact across multiple levels. The uncoordinated but interactive system of services requires further attention and consideration in future evaluation studies. Such evaluations need to document the presence and absence of services that affect members of the same family unit but offer treatment for specific problems in separate institutions characterized by different service philosophies and resources.
• For example, factors such as court oversight or mandatory referrals may influence individual participation in treatment services and the outcomes associated with such participation. The culture and resources of one agency can influence the quality and timing of services offered by another. Yet little information is available regarding the extent or quality of interventions in a community. Clients who receive multiple interventions (especially children) are often not followed through different service settings. Limited information is available to distinguish key features of innovative interventions from those usually offered in a community; to describe the stages of implementation of specific family violence programs, interventions, or strategies; to explain rates of attrition in the client base; or to capture case characteristics that influence the ways in which clients are selected for specific treatment programs.
• The emergence of secondary prevention interventions specifically targeted to serve children, adults, and communities with characteristics that are
• thought to place them at greater risk of family violence than the general population, along with the increasing emphasis on the need for integration and coordination of services, has the potential to achieve significant benefits. However, the potential of these newer interventions to reduce the need for treatment or other support services over the lifetime of the client has not yet been proven for large populations.
• Secondary preventive interventions, such as those serving children exposed to domestic violence, have the potential to reduce future incidents of family violence and to reduce the existing need for services in such areas as recovery from trauma, substance abuse, juvenile crime, mental health and health care. However, evaluation studies are not yet available to determine the value of preventive interventions for large populations in terms of reduction of the need for treatment or other support services over a client's lifetime.
• The shortage of service resources and the emphasis on reactive, short-term treatment have directed comparatively little attention to interventions for people who have experienced or perpetrated violent behavior but who have not yet been reported or identified as offenders or victims. Efforts to achieve broader systemic collaboration, comprehensive service integration, and proactive interventions require attention to the appropriate balance among enforcement, treatment, and prevention interventions in addressing family violence at both state and national levels. Such efforts also need to be responsive to the particular requirements of diverse ethnic communities with special needs or unique resources that can be mobilized in the development of preventive interventions. Because they extend to a larger population than those currently served by treatment centers, secondary prevention efforts can be expensive; their benefits may not become apparent until many years after the intervention occurs.
• Policy leadership is needed to help integrate family violence treatment, enforcement and support actions, and preventive interventions and also to foster the development of evaluations of comprehensive and cross-problem interventions that have the capacity to consider outcomes beyond reports of future violent behavior.
• Creative research methodologies are also needed to examine the separate and combined effects of cross-problem service strategies (such as the treatment of substance abuse and family violence), follow individuals and families through multiple service interventions and agency settings, and examine factors that may play important mediating roles in determining whether violence will occur or continue (such as the use of social networks and support services and the threat of legal sanctions).
• Most evaluations seek to document whether violent behavior decreased as a result of the intervention, an approach that often inhibits attention to other factors that may play important mediating roles in determining whether violence will occur. The individual victim or offender is the focus of most interventions and
• the unit of analysis in evaluation studies, rather than the family or the community in which the violence occurred.

Integrated approaches have the potential to illuminate the sequences and ways in which different experiences with violence in the family do and do not overlap with each other and with other kinds of violence. This research approach requires time to mature; at present, it is not strong enough to determine the strengths or limitations of strategies that integrate different forms of family violence compared with approaches that focus on specific forms of family violence. Service integration efforts focused on single forms of family violence may have the potential to achieve greater impact than services that disregard the interactive nature of this complex behavior, but this hypothesis also remains unproven.

Recommendations For Current Policies And Practices

It is premature to offer policy recommendations for most family violence interventions in the absence of a research base that consists of well-designed evaluations. However, the committee has identified two areas (home visitation and family preservation services) in which a rigorous set of studies offers important guidance to policy makers and service providers. In four other areas (reporting practices, batterer treatment programs, record keeping, and collaborative law enforcement approaches) the committee has drawn on its judgment and deliberations to encourage policy makers and service providers to take actions that are consistent with the state of the current research base.

These six interventions were selected for particular attention because (1) they are the focus of current policy attention, service evaluation, and program design; (2) a sufficient length of time has elapsed since the introduction of the intervention to allow for appropriate experience with key program components and measurement of outcomes; (3) the intervention has been widely adopted or is under consideration by a large number of communities to warrant its careful analysis; and (4) the intervention has been described and characterized in the research literature (through program summaries or case studies).

Reporting Practices

All 50 states have adopted laws requiring health professionals and other service providers to report suspected child abuse and neglect. Although state laws vary in terms of the types of endangerment and evidentiary standards that warrant a report to child protection authorities, each state has adopted a procedure that requires designated professionals—or, in some states, all adults—to file a report if they believe that a child is a victim of abuse or neglect. Mandatory reporting is thought to enhance early case detection and to increase the likelihood that services will be provided to children in need.

For domestic violence, mandatory reporting requirements for professional groups like health care providers have been adopted by the state of California and are under consideration in several other states. Mandatory reports are seen as a method by which offenders who abuse multiple partners can be identified through the health care community for law enforcement purposes. Early detection is assumed to lead to remedies and interventions that will prevent further abuse by holding the abuser accountable and helping to mitigate the consequences of family violence.

Critics have argued that mandatory reporting requirements may damage the confidentiality of the therapeutic relationship between health professionals and their clients, disregard the knowledge and preferences of the victim regarding appropriate action, potentially increase the danger to victims when sufficient protection and support are not available, and ultimately discourage individuals who wish to seek physical or psychological treatment from contacting and disclosing abuse to health professionals. In many regions, victim support services are not available or the case requires extensive legal documentation to justify treatment for victims, offenders, and families.

For elder abuse, 42 states have mandatory reporting systems. Several states have opted for voluntary systems after conducting studies that considered the advantages and disadvantages of voluntary and mandatory reporting systems, on the grounds that mandatory reports do not achieve significant increases in the detection of elder abuse cases.

In reviewing the research base associated with the relationship between reporting systems and the treatment and prevention of family violence, the committee has observed that no existing evaluation studies can demonstrate the value of mandatory reporting systems compared with voluntary reporting procedures in addressing child maltreatment or domestic violence. For elder abuse, studies suggest that a high level of public and professional awareness and the availability of comprehensive services to identify, treat, and prevent violence is preferable to reporting requirements in improving rates of case detection.

The absence of a research base to support mandatory reporting systems raises questions as to whether they should be recommended for all areas of family violence. The impact of mandatory reporting systems in the area of child maltreatment and elder abuse remains unexamined. The committee therefore suggests that it is important for the states to proceed cautiously at this time and to delay adopting a mandatory reporting system in the area of domestic violence, until the positive and negative impacts of such a system have been rigorously examined in states in which domestic violence reports are now required by law.

Recommendation 1: The committee recommends that states initiate evaluations of their current reporting laws addressing family violence to examine whether and how early case detection leads to improved outcomes for the victims or families and promote changes based on sound research. In

particular, the committee recommends that states refrain from enacting mandatory reporting laws for domestic violence until such systems have been tested and evaluated by research.

In dealing with family violence that involves adults, federal and state government agencies should reconsider the nature and role of compulsory reporting policies. In the committee's view, mandatory reporting systems have some disadvantages in cases involving domestic violence, especially if the victim objects to such reports, if comprehensive community protections and services are not available, and if the victim is able to gain access to therapeutic treatment or support services in the absence of a reporting system.

The dependent status of young children and some elders provides a stronger argument in favor of retaining mandatory reporting requirements where they do exist. However, the effectiveness of reporting requirements depends on the availability of resources and service personnel who can investigate reports and refer cases for appropriate treatment, as well as clear guidelines for processing reports and determining which cases qualify for services. Greater discretion may be advised when the child and family are able to receive therapeutic treatment from health care or other service providers and when community resources are not available to respond appropriately to their cases. The treatment of adolescents especially requires major consideration of the pros and cons of mandatory reporting requirements. Adolescent victims are still in a vulnerable stage of development: they may or may not have the capacity to make informed decisions regarding the extent to which they wish to invoke legal protections in dealing with incidents of family violence in their homes.

Batterer Treatment Programs

Four key questions characterize current policy and research discussions about the efficacy of batterer treatment, one of the most challenging problems in the design of family violence interventions: Is treatment preferable to incarceration, supervised probation, or other forms of court oversight for batterers? Does participation in treatment change offenders' attitudes and behavior and reduce recidivism? Does the effectiveness of treatment depend on its intensity, duration, or the voluntary or compulsory nature of the program? Is treatment what creates change, or is change in behavior reduced by multiple interventions, such as arrest, court monitoring of client participation in treatment services, and victim support services?

Descriptive research studies suggest that there are multiple profiles of batterers, and therefore one generic approach is not appropriate for all offenders. Treatment programs may be helpful in changing abusive behavior when they are part of an overall strategy designed to recognize and reduce violence in a relationship, when the batterer is prepared to learn how to control aggressive impulses, and

when the treatment plan emphasizes victim safety and provides for frequent interactions with treatment staff.

Research on the effectiveness of treatment programs suggests that the majority of subjects who complete court-ordered treatment programs do learn basic cognitive and behavioral principles taught in their course. However, such learning requires appropriate program content and client participation in the program for a sufficient time to complete the necessary training. Very few studies have examined matched groups of violent offenders who are assigned to treatment and control groups or comparison groups (such as incarceration or work-release). As a result, the comparative efficacy of treatment is unknown in reducing future violence. Differing client populations and differing forms of court oversight are particularly problematic factors that inhibit the design of rigorous evaluation studies in this field.

The absence of strong theory and common measures to guide the development of family violence treatment regimens, the heterogeneity of offenders (including patterns of offending and readiness to change) who are the subjects of protective orders or treatment, and low rates of attendance, completion, and enforcement are persistent problems that affect both the evaluation of the interventions and efforts to reduce the violence. A few studies suggest that court oversight does appear to increase completion rates, which have been linked to enhanced victim safety in the area of domestic violence, but increased completion rates have not yet led to a discernible effect on recidivism rates in general.

Further evaluations are needed to examine the outcomes associated with different approaches and programmatic themes (such as cognitive-behavioral principles: issues of power, control, and gender; personal accountability). Completion rates have been used as an interim outcome to measure the success of batterer treatment programs; further studies are needed to determine if completers can be identified readily, if program completion by itself is a critical factor in reducing recidivism, and if participation in a treatment program changes the nature, timing, and severity of future violent behavior.

The current research base is inadequate to identify the conditions under which mandated referrals to batterer treatment programs offer a clear advantage over incarceration or untreated probation supervision in reducing recidivism for the general population of male offenders. Court officials should monitor closely the attendance, participation, and completion rates of offenders who are referred to batterer treatment programs in lieu of more punitive sentences. Treatment staff should inform law enforcement officials of any significant behavior by the offender that might represent a threat to the victim. Mandated treatment referrals may be effective for certain types of batterers, especially if they increase completion rates. The research is inconclusive, however, as to which types of individuals should be referred for treatment rather than more punitive sanctions. In selecting individuals for treatment, attention should be given to client history

(first-time offenders are more likely to benefit), motivation for treatment, and likelihood of completion.

Mandated treatment referrals for batterers do appear to provide benefits to victims, such as intensive surveillance of offenders, an interlude to allow planning for safety and victim support, and greater community awareness of the batterer's behavior. These outcomes may interact to deter and reduce domestic violence in the community, even if a treatment program does not alter the behavior of a particular batterer. Treatment programs that include frequent interactions between staff and victims also provide a means by which staff can help educate victims about danger signals and support them in efforts to obtain greater protection and legal safeguards, if necessary.

Recommendation 2: In the absence of research that demonstrates that a specific model of treatment can reduce violent behavior for many domestic violence offenders, courts need to put in place early warning systems to detect failure to comply with or complete treatment and signs of new abuse or retaliation against victims, as well as to address unintended or inadvertent results that may arise from the referral to or experience with treatment.

Further research evaluation studies are needed to review the outcomes for both offenders and victims associated with program content and levels of intensity in different treatment models. This research will help indicate whether treatment really helps and what mix of services are more helpful than others. Improved research may also help distinguish those victims and offenders for whom particular treatments are most beneficial.

Record Keeping

Since experience with family violence appears to be associated with a wide range of health problems and social service needs, service providers are recognizing the importance of documenting abuse histories in their client case records. The documentation in health and social service records of abuse histories that are self-reported by victims and offenders can help service providers and researchers to determine if appropriate referrals and services have been made and the outcomes associated with their use. The exchange of case records among service providers is essential to the development of comprehensive treatment programs, continuity of care, and appropriate follow-up for individuals and families who appear in a variety of service settings. Such exchanges can help establish greater accountability by service systems for responding to the needs of identifiable victims and offenders; health and social service records can also provide appropriate evidence for legal actions, in both civil and criminal courts and child custody cases.

Research evaluations of service interventions often require the use of anonymous case records. The documentation of family violence in such records will

enhance efforts to improve the quality of evaluations and to understand more about patterns of behavior associated with violent behaviors and victimization experiences. Although documentation of abuse histories can improve evaluations and lead to integrated service responses, such procedures require safeguards so that individuals are not stigmatized or denied therapeutic services on the basis of their case histories. Insurance discrimination, in particular, which may preclude health care coverage if abuse is judged to be a preexisting condition, requires attention to ensure that professional services are not diminished as a result of voluntary disclosures. Creative strategies are needed to support integrated service system reviews of medical, legal, and social service case records in order to enhance the quality and accountability of service responses. Such reviews will need to meet the expectations of privacy and confidentiality of both individual victims and the community, especially in cases in which maltreatment reports are subsequently regarded as unfounded.

Documentation of abuse histories that are voluntarily disclosed by victims or offenders to health care professionals and social service providers must be distinguished from screening efforts designed to trigger such disclosures. The committee recommends screening as a strong candidate for future evaluation studies (see discussion in the next section).

Recommendation 3: The committee recommends that health and social service providers develop safeguards to strengthen their documentation of abuse and histories of family violence in both individual and group records, regardless of whether the abuse is reported to authorities.

The documentation of histories of family violence in health records should be designed to record voluntary disclosures by both victims and offenders and to enhance early and coordinated interventions that can provide a therapeutic response to experiences with abuse or neglect. Safeguards are required, however, to ensure that such documentation does not lead to stigmatization, encourage discriminatory practices, or violate assurances of privacy and confidentiality, especially when individual histories become part of patient group records for health care providers and employers.

Collaborative Law Enforcement Strategies

In the committee's view, collaborative law enforcement strategies that create a web of social control for offenders are an idea worth testing to determine if such efforts can achieve a significant deterrent effect in addressing domestic violence. Collaborative strategies include such efforts as victim support and offender tracking systems designed to increase the likelihood that domestic violence cases will be prosecuted when an arrest has been made, that sanctions and treatment services will be imposed when evidence exists to confirm the charges brought against the offender, and that penalties will be invoked for failure to comply with treatment

conditions. The attraction of collaborative strategies is based on their potential ability to establish multiple interactions with offenders across a large domain of interactions that reinforce social standards in the community and establish penalties for violations of those standards. Creating the deterrent effect, however, requires extensive coordination and reciprocity between victim support and offender monitoring efforts involving diverse sectors of the law enforcement community. These efforts may be difficult to implement and evaluate. Further studies are needed to determine the extent to which improved collaboration among police officers, prosecutors, and judges will lead to improved coordination and stronger sanctions for offenders and a reduction in domestic violence.

The absence of empirical research findings of the results of a collaborative law enforcement approach in addressing domestic violence makes it difficult to compare the costs and benefits of increased agency coordination with those achieved by a single law enforcement strategy (such as arrest) in dealing with different populations of offenders and victims. Even though relatively few cases of arrest are made for any form of family violence, arrest is the most common and most studied form of law enforcement intervention in this area. Research studies conducted in the 1980s on arrest policies in domestic violence cases are the strongest experimental evaluations to date of the role of deterrence in family violence interventions. These experiments indicate that arrest may be effective for some, but not most, batterers in reducing subsequent violence by the offender. Some research studies suggest that arrest may be a deterrent for employed and married individuals (those who have a stake in social conformity) and may lead to an escalation of violence among those who do not, but this observation has not been tested in studies that could specifically examine the impact of arrest in groups that differ in social and economic status. The differing effects (in terms of a reduction of future violence) of arrest for employed/unemployed and married/unmarried individuals raise difficult questions about the reliance of law enforcement officers on arrest as the sole or central component of their response to domestic violence incidents in communities where domestic violence cases are not routinely prosecuted, where sanctions are not imposed by the courts, or where victim support programs are not readily available.

The implementation of proarrest policies and practices that would discriminate according to the risk status of specific groups is challenged by requirements for equal protection under the law. Law enforcement officials cannot tailor arrest policies to the marital or employment status of the suspect or other characteristics that may interact with deterrence efforts. Specialized training efforts may help alleviate the tendency of police officers to arrest both suspect and victim, however, and may alert law enforcement personnel to the need to review both criminal and civil records in determining whether an arrest is advisable in response to a domestic violence case.

Two additional observations merit consideration in examining the deterrent effects of arrest. First, in the research studies conducted thus far, the implementation

of legal sanctions was minimal. Most offenders in the replication studies were not prosecuted once arrested, and limited legal sanctions were imposed on those cases that did receive a hearing. Some researchers concluded that stronger evidence of effectiveness might be obtained from proarrest policies if they are implemented as part of a law enforcement strategy that expands the use of punitive sanctions for offenders—including conviction, sentencing, and intensive supervised probation.

Second is the issue of reciprocity between formal sanctions against the offender and informal support actions for the victims of domestic violence. The effects of proarrest policies may depend on the extent to which victims have access to shelter services and other forms of support, demonstrating the interactive dimensions of community interventions. A mandatory arrest policy, by itself, may be an insufficient deterrent strategy for domestic violence, but its effectiveness may be enhanced by other interventions that represent coordinated law enforcement efforts to deter domestic violence—including the use of protective orders, victim advocates, and special prosecution units. Coordinated efforts may help reduce or prevent domestic violence if they represent a collaborative strategy among police, prosecutors, and judges that improves the certainty of the use of sanctions against batterers.

Recommendation 4: Collaborative strategies among caseworkers, police, prosecutors, and judges are recommended as law enforcement interventions that have the potential to improve the batterer's compliance with treatment as well as the certainty of the use of sanctions in addressing domestic violence.

The impact of single interventions (such as mandatory arrest policies) is difficult to discern in the research literature. Such practices by themselves can neither be recommended nor rejected as effective measures in addressing domestic violence on the basis of existing research studies.

Home Visitation and Family Support Services

Home visitation and family support programs constitute one of the most promising areas of child maltreatment prevention. Studies in this area have experimented with different levels of treatment intensity, duration, and staff expertise. For home visitation, the findings generally support the principle that early intervention with mothers who are at risk of child maltreatment makes a difference in child outcomes. Such interventions may be difficult to implement and maintain over time, however, and their effectiveness depends on the willingness of the parents to participate. Selection criteria for home visitation should be based on a combination of social setting and individual risk factors.

In their current form, home visitation programs have multiple goals, only one of which is the prevention of child abuse and neglect. Home visitation and family

support programs have traditionally been designed to improve parent-child relations with regard to family functioning, child health and safety, nutrition and hygiene, and parenting practices. American home visiting programs are derived from the British system, which relies on public health nurses and is offered on a universal basis to all parents with young children. Resource constraints, however, have produced a broad array of variations in this model; most programs in the United States are now directed toward at-risk families who have been reported to social services or health agencies because of prenatal health risks or risks for child maltreatment. Comprehensive programs provide a variety of services, including in-home parent education and prenatal and early infant health care, screening, referral to and, in some cases, transportation to social and health services. Positive effects include improved childrearing practices, increased social supports, utilization of community services, higher birthweights, and longer gestation periods.

Researchers have identified improvements in cognitive and parenting skills and knowledge as evidence of reduced risk for child maltreatment; they have also documented lower rates of reported child maltreatment and number of visits to emergency services for home-visited families. The benefits of home visitation appear most promising for young, first-time mothers who delay additional pregnancies and thus reduce the social and financial stresses that burden households with large numbers of young children. Other benefits include improved child care for infants and toddlers and an increase in knowledge about the availability of community services for older children. The intervention has not been demonstrated to have benefits for children whose parents abuse drugs or alcohol or those who are not prepared to engage in help-seeking behaviors. The extent to which home visitation benefits families with older children, or families who are already involved in abusive or neglectful behaviors, remains uncertain.

Recommendation 5: As part of a comprehensive prevention strategy for child maltreatment, the committee recommends that home visitation programs should be particularly encouraged for first-time parents living in social settings with high rates of child maltreatment reports.

The positive impact of well-designed home visitation interventions has been demonstrated in several evaluation studies that focus on the role of mothers in child health, development, and discipline. The committee recommends their use in a strategy designed to prevent child maltreatment. Home visitation programs do require additional evaluation research, however, to determine the factors that may influence their effectiveness. Such factors include (1) the conditions under which home visitation should be provided as part of a continuum of family support programs, (2) the types of parenting behaviors that are most and least amenable to change as a result of home visitation, (3) the duration and intensity of services (including amounts and types of training for home visitors) that are necessary to achieve positive outcomes for high-risk families, (4) the experience

of fathers in general and of families in diverse ethnic communities in particular with home visitation interventions, and (5) the need for follow-up services once the period of home visitation has ended.

Intensive Family Preservation Services

Intensive family preservation services represent crisis-oriented, short-term, intensive case management and family support programs that have been introduced in various communities to improve family functioning and to prevent the removal of children from the home. The overall goal of the intervention is to provide flexible forms of family support to assist with the resolution of circumstances that stimulated the child placement proposal, thus keeping the family intact and reducing foster care placements.

Eight of ten evaluation studies of selected intensive family preservation service programs (including five randomized trials and five quasi-experimental studies) suggest that, although these services may delay child placement for families in the short term, they do not show an ability to resolve the underlying family dysfunction that precipitated the crisis or to improve child well-being or family functioning in most families. However, the evaluations have shortcomings, such as poorly defined assessment of child placement risk, inadequate descriptions of the interventions provided, and nonblinded determination of the assignment of clients to treatment and control groups.

Intensive family preservation services may provide important benefits to the child, family, and community in the form of emergency assistance, improved family functioning, better housing and environmental conditions, and increased collaboration among discrete service systems. Intensive family preservation services may also result in child endangerment, however, when a child remains in a family environment that threatens the health or physical safety of the child or other family members.

Recommendation 6: Intensive family preservation services represent an important part of the continuum of family support services, but they should not be required in every situation in which a child is recommended for out-of-home placement.

Measures of health, safety, and well-being should be included in evaluations of intensive family preservation services to determine their impact on children's outcomes as well as placement rates and levels of family functioning, including evidence of recurrence of abuse of the child or other family members. There is a need for enhanced screening instruments that can identify the families who are most likely to benefit from intensive short-term services focused on the resolution of crises that affect family stability and functioning.

The value of appropriate post-reunification (or placement) services to the child and family to enhance coping and the ability to make a successful transition

toward long-term adjustment also remains uncertain. The impact of post-reunification or post-placement services needs to be considered in terms of their relative effects on child and family functioning compared with the use of intensive family preservation services prior to child removal. In some situations, one or the other type of services might be recommended; in other cases, they might be used in some combination to achieve positive outcomes.

Recommendations For The Next Generation Of Evaluations

Determining which interventions should be selected for rigorous and in-depth evaluations in the future will acquire increased importance as the array of family violence interventions expands in social services, law, and health care settings. For this reason, clear criteria and guiding principles are necessary to guide sponsoring agencies in their efforts to determine which types of interventions are suitable for evaluation research. Recognizing that all promising interventions cannot be evaluated, public and private agencies need to consider how to invest research resources in areas that show programmatic potential as well as an adequate research foundation. Future allocations of research investments may require agencies to reorganize or to develop new programmatic and research units that can inform the process of selecting interventions for future evaluation efforts, determine the scope of adequate funding levels, and identify areas in which program integration or diversity may contribute to a knowledge base that can inform policy, practice, and research. Such agencies may also consider how to sustain an ongoing dialogue among research sponsors, research scientists, and service providers to inform these selection efforts and to disseminate evaluation results once they are available.

In the interim, the committee offers several guiding principles to help inform the evaluation selection process.

• meet the preconditions for experimentation that are described in the other principles outlined below.

With these principles in mind, the committee has identified a set of interventions that are the focus of current policy attention and service innovation efforts but have not received significant attention from research. In the committee's judgment, each of these nine interventions has reached a level of maturation and preliminary description in the research literature to justify their selection as strong candidates for future evaluation studies.

Training for Service Providers and Law Enforcement Officials

Training in basic educational programs and continuing education on all aspects

of family violence has expanded for professionals in the health care, legal, and social service systems. Such efforts can be expected to enhance skills in identifying individual experiences with family violence, but improvements in training may improve other outcomes as well, including the patterns and timing of service interventions, the nature of interactions with victims of family violence, linkage of service referrals, the quality of investigation and documentation for reported cases, and, ultimately, improved health and safety outcomes for victims and communities.

Training programs alone may be insufficient to change professional behavior and service interventions unless they are accompanied by financial and human resources that emphasize the role of psychosocial issues and support the delivery of appropriate treatment, prevention, and referral services in different institutional and community settings. Evaluations of their effectiveness therefore need to consider the institutional culture and resource base that influence the implementation of the training program and the abilities of service providers to apply their knowledge and skills in meeting the needs of their clients.

Evaluation research is needed to assess the impact of training programs on counseling and referral practices and service delivery in health care, social service, and law enforcement settings. This research should include examination of the effects of training on the health and mental health status of those who receive services, including short- and long-term outcomes such as empowerment, freedom from violence, recovery from trauma, and rebuilding of life. Evaluations should also examine the role of training programs as catalysts for innovative and collaborative services. They should consider the extent to which training programs influence the behavior of agency personnel, including the interaction of service providers with professionals from other institutional settings, their participation in comprehensive community service programs, and the exposure of personal experiences in institutions charged with providing interventions for abuse.

Universal Screening in Health Care Settings

The significant role of health care and social service professionals in screening for victimization by all forms of family violence deserves critical analysis and rigorous evaluation. Early detection of child maltreatment, spousal violence, and elder abuse is believed to lead to an infusion of treatment and preventive services that can reduce exposure to harm, mitigate the negative consequences of abuse and neglect, improve health outcomes, and reduce the need for future health services. Screening programs can also enhance primary prevention efforts by providing information, education, and awareness of resources in the community. The benefits associated with early detection need to be balanced against risks presented by false positives and false negatives associated with large-scale screening efforts and programs characterized by inadequate staff training and responses.

Such efforts also need to consider whether appropriate treatment, protection, and support services are available for victims or offenders once they have been detected.

The use of enhanced screening instruments also requires attention to the need for services that can respond effectively to the large caseloads generated by expanded detection activities. The child protective services literature suggests that increased reporting can diminish the capacity of agencies to respond effectively if additional resources are not available to support enhanced services as well as screening.

The use of screening instruments in health care and social service settings for batterer identification and treatment is more problematic, given the lack of knowledge about factors that enhance or discourage their violent behavior. Screening only victims may be insufficient to provide a full picture of family violence; however, screening batterers may increase the danger for their victims, especially if batterer treatment interventions are not available or are not reliable in providing effective treatment and if support services are not available for victims once a perpetrator is identified. Screening adults for histories of childhood abuse, which may help prevent future victimization of the patient or others, may also be problematic without adequate training or mental health services to deal with the possible resurgence of trauma.

Evaluation studies of family violence screening efforts could build on the lessons derived from screening research in other health care areas (such as HIV detection, lead exposure, sickle cell, and others). This research could provide data that would support or contradict the theory that early identification is a useful secondary prevention intervention, especially in areas in which appropriate services may not be available or reliable. The cost issues associated with universal screening need to be considered in terms of their implications for savings in possible cost reductions from consequent conditions (such as the health consequences of HIV infection, sexually transmitted diseases, unplanned pregnancy, substance abuse, post-traumatic stress disorder, depression, and the exacerbation of other medical conditions) that may occur in other health care areas. Finally, the risks associated with screening (such as the establishment of a preexisting condition that may influence insurance eligibility) require consideration; such issues are already being addressed by some advocacy groups, insurance corporations, and regulatory bodies in the health care area.

Mental Health and Counseling Services

Little is known at present regarding the comparative effectiveness of different forms of therapeutic services for victims of family violence. Findings from recent studies of child physical and sexual abuse suggest that certain approaches (specifically cognitive-behavioral programs) are associated with more positive outcomes for parents, such as reducing aggressive/coercive behavior, compared

with family therapy and routine community mental health services. No treatment outcome studies have been conducted in the area of child neglect. Interventions in this field generally draw on approaches for dealing with other childhood and adolescent problems with similar symptom profiles.

For domestic violence, research evaluations are in the early stages of design and empirical data are not yet available to guide analyses of the effectiveness of different approaches. Major challenges include the absence of agreement regarding key psychosocial outcomes of interest in assessing the effectiveness of interventions, variations in the use of treatment protocols designed for post-traumatic stress for individuals who may still be experiencing traumatic situations, tensions between protocol-driven models of treatment (which are easier to evaluate) and those that are driven by the needs of the client or the context in which the violence occurred, the co-occurrence of trauma and other problems (such as prior victimization, depression, substance abuse, and anxiety disorders) that may have preceded the violence but require mental health services, and the difficulty of involving victims in follow-up studies after the completion of treatment. Variations in the context in which mental health services are provided for victims of domestic violence (such as isolated services, managed care programs, and services that are incorporated into an array of social support programs, including housing and job counseling) also require attention. Topics of special interest include contextual issues, such as the general lack of access to quality mental health services for women without sufficient independent income, and the danger of psychiatric diagnoses being used against battered women in child custody cases.

Collaborative efforts are needed to provide opportunities for the exchange of methodology, research measures, and designs to foster the development of controlled studies that can compare the results of innovative treatment approaches with routine counseling programs in community services.

Comprehensive Community Initiatives

Evaluations of batterer treatment programs, protective orders, and arrest policies suggest that the role of these individual interventions may be enhanced if they are part of a broad-based strategy to address family violence. The development of comprehensive, community-based interventions has become extremely widespread in the 1990s; examples include domestic violence coordinating councils, child advocacy centers, and elder abuse task forces. A few communities (most notably Duluth, Minnesota, and Quincy, Massachusetts) have developed systemwide strategies to coordinate their law enforcement and other service responses to domestic violence.

Comprehensive community-based interventions must confront difficult challenges, both in the design and implementation of such services, and in the selection of appropriate measures to assess their effectiveness. Many evaluations of comprehensive community-based interventions have focused primarily on the

design and implementation process, to determine whether an individual program had incorporated sufficient range and diversity among formal and informal networks so that it can achieve a significant impact in the community. This type of process evaluation does not necessarily require new methods of assessment or analysis, although it can benefit from recent developments in the evaluation literature, such as the empowerment evaluations discussed in Chapter 3 .

In contrast, the evaluation challenges that emerge from large-scale community-based efforts are formidable. First, it may be difficult to determine when an intervention has reached an appropriate stage of implementation to warrant a rigorous assessment of its effects. Second, the implementation of a community-wide intervention may be accompanied by a widespread social movement against family violence, so that it becomes difficult to distinguish the effects of the intervention itself from the impact of changing cultural and social norms that influence behavior. In some cases, the effects attributed to the intervention may appear weak, because they are overwhelmed by the impact of the social movement itself. Third, the selection of an appropriate comparison or control group for community-wide interventions presents formidable problems in terms of matching social and structural characteristics and compensating for community-to-community variation in record keeping.

These challenges require close attention to the emerging knowledge associated with the evaluation of comprehensive community-wide interventions in areas unrelated to family violence, so that important design, theory, and measurement insights can be applied to the special needs of programs focused on child maltreatment, domestic violence, and elder abuse. Although no single model of service integration, comprehensive services, or community change can be endorsed at this time, a range of interesting community service designs has emerged that have achieved widespread popularity and support at the local level. Because their primary focus is often on prevention, rather than treatment, comprehensive community interventions have the potential to achieve change across multiple levels of interactions affecting individuals, families, communities, and social norms and thus reduce the scope and severity of family violence as well as contribute to remedies to other important social problems.

A growing research literature has appeared in other fields, particularly in the area of substance abuse and community development, that identifies the conceptual frameworks, data collection, and methodological issues that need to be considered in designing evaluation studies for community-based and systemwide interventions. As an example, the Center for Substance Abuse Prevention in the federal Substance Abuse and Mental Health Services Administration has funded a series of studies designed to improve methodologies for the evaluation of community-based substance abuse prevention programs that offer important building blocks for the field of family violence interventions.

Developing effective evaluation strategies for comprehensive and systemwide programs is one of the most challenging issues for the research community

in this field. No evaluations have been conducted to date to examine the relative advantages of comprehensive and systemwide community initiatives compared with traditional services. Evaluations need to consider the mix of components in comprehensive interventions that determine their effectiveness and successful implementation; the comparative strengths and limitations of inter- and intra-agency interventions; community factors, such as political leadership, historical tensions, diversity of ethnic/cultural composition, and resource allocation strategies; and the impact of comprehensive interventions on the capacity of service agencies to provide traditional care and effective responses to reports of family violence.

Shelter Programs and Other Domestic Violence Services

Over time, most battered women's shelters have expanded their services to encompass far more than the provision of refuge. Today, many shelters have support groups for women residents, support groups for child residents, emergency and transitional housing, and legal and welfare advocacy. Nonresidential services also have expanded, so that any battered woman in the community is able to attend a support group or request advocacy services. Many agencies now offer educational groups for men who batter, as well as programs dealing with dating violence. Some communities have never opened a shelter yet are able to offer support groups, advocacy, crisis intervention, and safe homes (neighbors sheltering a neighbor, for example) to help battered women and their families in times of crisis. In addition to providing services for victims, the battered women service organizations also define their goal as transforming the conditions and norms that support violence against women. Thus these organizations work as agents of social change in their communities to improve the community-wide response to battered women and their children.

Shelter services and battered women's support organizations are ready for evaluations that can identify program outcomes and compare the effectiveness of different service interventions. Research studies are also needed that can describe the multiple goals and theories that shape the program objectives of these interventions, provide detailed histories of the ways in which different service systems have been implemented, and examine the characteristics of the women who do or do not use or benefit from them.

Protective Orders

Protective orders can be an important part of the prevention strategy for domestic violence and help document the record of assaults and threatening actions. The low priority traditionally assigned to the handling of protective orders, which are usually treated as civil matters in police agencies, requires attention, as do the procedural requirements of the legal system. Courts have

accepted alternative forms of due process, including public notice, notice by mail, and other forms of notification that do not require personal contact. Efforts are needed now to compare the effectiveness of short-term (30-day) restraining orders with a longer (1-year) protective order in reducing violent behavior by offenders and securing access to legal and support services for the complainants.

In-depth case studies and interviews with victims who have had police and court contacts because of domestic violence are needed to highlight individual, social, and institutional factors that facilitate or inhibit victim use of and perpetrator compliance with protective orders in different community settings. Such studies could (1) reveal patterns of help-seeking contacts and services that affect the use of protective orders and compliance with their requirements, (2) highlight the forms of sanctions that are appropriate to ensure compliance and to deter future violent behavior, (3) explore the extent to which the effects of protective orders are enhanced in reducing violence if victim advocates, shelter services, or other social support resources are available and are used by the victim in redefining the terms of her relationship with her partner, and (4) examine the extent to which protective orders can mitigate the consequences of violence for children who may have been assaulted or who may have witnessed an assault against their mother.

Child Fatality Review Panels

The emergence of child fatality review teams in 21 states since 1978 represents an innovative effort in many communities to address systemwide implications of severe violence against children and infants. Child fatality review teams involve a multiagency effort to compile and integrate information about child deaths and to review and evaluate the record of caseworkers and agencies in providing services to these children when a report of abuse or neglect had been made prior to a child's death. These review teams can provide an opportunity to examine the quality of a community's total approach to child abuse and neglect prevention and treatment.

The experience of child fatality review teams in identifying systemic features that enhance or weaken agency efforts to protect children needs to be evaluated and made accessible to individual service providers in health, legal, and social service agencies. Key research issues include: the effect of review team actions on the protection of family members of children who have died as a result of child maltreatment; the impact of child fatality review reports on the prosecution of offenders; the influence of review team efforts on the routine investigation, treatment, and prevention activities of participating agencies; the impact of review teams on other community child protection and domestic violence prevention efforts; and the identification of early warning signals that emerge in child homicide investigations that represent opportunities for preventive interventions.

Child Witness to Violence Programs

Child witness programs represent an important development in the evolution of comprehensive approaches to family violence, but they have not yet been evaluated. Evaluation studies of these programs should examine the experience with symptomatology among children who witness family violence, to determine whether and for whom early intervention influences the course of development of social and mental health consequences, such as depression, anxiety, emotional detachment, aggression and violence, and post-traumatic stress symptoms. Such studies could also compare variations in the developmental histories of children who witness violence with those of children who are injured or otherwise are directly victimized by their parents or who witness violence in their communities. Evaluation studies should consider the recommended forms of treatment for these children, the standards of eligibility that determine their placement in treatment programs, and the impact of institutional setting (hospital, shelter, or social service agency) and reimbursement plans on the quality of the treatment.

Elder Abuse Services

Only seven program evaluation studies have been published on elder abuse interventions, none of which includes random groups and most of which involve small sample sizes. Three major issues challenge effective interventions in this area: the degree of dependence between perpetrators and victims, restricted social services budgets, general public distrust of social welfare programs, and the relationship between judgments about competence and the application of the principles of self-determination and privacy to the problem of elder abuse.

Evaluation studies should consider the different types and multiple dimensions of elder abuse in the development of effective interventions. The benefits of specific programs need to be compared with integrated service systems that are designed to foster the well-being of the elderly population without regard to special circumstances. Evaluation research should be integrated into community service programs and agency efforts on behalf of elderly persons to foster studies that involve the use of comparison and control groups, common measures, and the assessment of outcomes associated with different forms of service interventions.

Topics For Basic Research

The committee identified four basic research topics that require further development to inform policy and practice. These topics raise fundamental questions about the approaches that should be used in designing treatment, prevention, and enforcement strategies. As such, they highlight important dimensions of family violence that should be addressed in a research agenda for the field.

birth, infancy, and adolescence. Other issues linked to family formation include the use of corporal punishment in child discipline, gender roles, privacy, and strategies for resolving conflict among adults or siblings.

A third approach would be studies to discern the protective factors inside and outside families that enable some children who are exposed to violence to not only survive but also to develop coping mechanisms that serve them well later in life. This analysis would have widespread implications for assessing the impact of biological and experiential factors in specific domains, such as fear, anxiety, self-blame, identity formation, helplessness, and help-seeking behaviors. Such research could also identify abuse-related coping strategies (such as excessive distrust of or overdependence on others) that may contribute to other problems that emerge in the course of adolescent and adult development.

first-time parents, victims and offenders who have substance abuse histories, etc.)

Forging Partnerships Between Research And Practice

Although it is premature to expect research to offer definitive answers about the relative effectiveness of the array of current service and enforcement strategies, the committee sees valuable opportunities that now exist to accelerate the rate by which service providers can identify the types of individuals, families, and communities that may benefit from certain types or combinations of service and enforcement interventions. Major challenges must be addressed, however, to improve the overall quality of the evaluations of family violence interventions and to provide a research base that can inform policy and practice. These challenges include issues of study design and methodology as well as logistical concerns that must be resolved in order to conduct research in open service systems where the research investigator is not able to control factors that may weaken the study design and influence its outcome. The resolution of these challenges will require collaborative partnerships between researchers, service providers, and policy makers to generate common approaches and data sources.

The integration of research and practice in the field of family violence, as in many other areas of human services, has occurred on a haphazard basis. As a result, program sponsors, service providers, clients, victims, researchers, and community representatives have not been able to learn in a systematic manner from the diverse experiences of both large and small programs. Mayors, judges, police officers, caseworkers, child and victim advocates, health professionals, and others must make life-or-death decisions each day in the face of tremendous

uncertainty, often relying on conflicting reports, anecdotal data, and inconsistent information in judging the effectiveness of specific interventions.

The development of creative partnerships between the research and practice communities would greatly improve the targeting of limited resources to specific clients who can benefit most from a particular type of intervention. Yet significant barriers inhibit the development of such partnerships, including disagreements about the nature and origins of family violence, broad variations in the conceptual frameworks that guide service delivery, differences over the relative merits of service and research, a lack of faith in the ability of research to inform and improve services, a lack of trust in the ability of service providers to inform the design of research experiments and the formation of theoretical frameworks, and concerns about fairness and safety in including victims and offenders in experimental treatment groups. These fundamental differences obscure identification of outcomes of interest in the development of evaluation studies, which are further complicated by limitations in study design and access to appropriate subjects that are necessary for the conduct of research.

Even if greater levels of trust fostered more interaction between the research community and service providers, collaborative efforts would be challenged by factors such as the lack of funding for empirical studies, the availability of limited resources to support studies over appropriate time frames, and the social and economic characteristics of some of the populations served by family violence interventions that make them difficult to follow over extended periods of time (chaotic households, high mobility of the client population, concerns for safety, lack of telephones and permanent residences, etc.).

Service providers and program sponsors have often been skeptical of efforts to evaluate the impact of a selected intervention, knowing that critical or premature assessments could jeopardize the program's future and restrict future opportunities for service delivery. Service providers have also been less than enthusiastic in seeking program evaluations, knowing that the programs to be evaluated have been underfunded and are understaffed and present a less than ideal situation; in their view, the assessment may diminish future resources and affect the development of a particular strategy or programmatic approach. The tremendous demand for services and the limited availability of staff resources create a pressured environment in which the staff time involved in filling out forms for research purposes is seen as being sacrificed from time that might be used to serve people in need. In some cases, research funds support demonstration programs that are highly valued by a community, yet few resources are available to support them once the research phase has been completed.

Researchers and service providers need to resolve the programmatic tensions that have sometimes surfaced in contentious debates over the type of services that should be put into place in addressing problems of family violence. The mistrust and skepticism present major challenges that need to resolved before the technical challenges to effective evaluations can be addressed. A reformulation of the

research process is needed so that, while building a long-term capacity to focus on complex issues and conduct rigorous studies, researchers can also provide useful information to service providers.

The committee has identified three major principles to help integrate research and practice in the field of family violence interventions:

• Evaluation should be an integral part of any major intervention, particularly those that are designed to be replicated in multiple communities. Interventions have often been put into place without a research base to support them or rigorous evaluation efforts to guide their development. Evaluation research based on theoretical models is needed to link program goals and operational objectives with multiple program components and outcomes. Intensive marketing and praise for a particular intervention or program should no longer be a substitute for empirical data in determining the effectiveness of programs that are intended to be replicated in multiple sites.
• Coordinating policy, program, and research agendas will improve family violence interventions. Evaluation research will help program sponsors and managers clarify program goals and experience and identify areas in need of attention because of the difficulties of implementation, the use of resources, and changes in the client base. Research and data-based analysis can guide ongoing program and policy efforts if evaluation studies are integrated into the design and development of interventions. The knowledge base can be improved by (1) framing key hypotheses that can be tested by existing or new services, (2) building statistical models to explore the system-wide effects of selected interventions and compare these effects with the consequences of collaborative and comprehensive approaches, (3) using common definitions and measures to facilitate comparisons across individual studies, (4) using appropriate comparison and control groups in evaluation studies, including random assignment, when possible, (5) developing culturally sensitive research designs and measures, (6) identifying relevant outcomes in the assessment of selected interventions, and (7) developing alternative designs when traditional design methodology cannot be used for legal, ethical, or practical reasons.
• Surmounting existing barriers to collaboration between research and practice communities requires policy incentives and leadership to foster partnership efforts. Many interventions are not evaluated because of limited funds, because the individuals involved in service delivery consider research to be peripheral to the needs of their clients, because the researchers are disinterested in studying the complexity of service delivery systems and the impact of violence in clients' lives, or because research methods are not yet available to assess outcomes that result from the complex interaction of multiple systems. This situation will continue until program sponsors and policy officials exercise leadership to build partnerships between the research and practice communities and to provide funds for rigorous evaluations in the development of service and law enforcement
• interventions. Additional steps are required to foster a more constructive dialogue and partnership between the research and practice communities.

Partnership efforts are also needed to focus research attention on the particular implementation of an individual program rather than the strategy behind the program design. Promising intervention strategies may be discarded prematurely because of special circumstances that obstructed full implementation of the program. Conversely, programs that offer only limited effectiveness may appear to be successful on the basis of evaluation studies that did not consider the significant points of vulnerability and limitations in the service design or offer a comparative analysis with the benefits to be derived from routine services.

The establishment and documentation of a series of consensus conferences on relevant outcomes, and appropriate measurement tools, will strengthen and enhance evaluations of family violence interventions and lead to improvements in the design of programs, interventions, and strategies. May opportunities currently exist for research to inform the design and assessment of treatment and prevention interventions. In addition, service providers can help guide researchers in the identification of appropriate domains in which program effects may occur but are currently not being examined. Ongoing dialogues can guide the identification and development of instruments and methods that can capture the density and distribution of relevant effects that are not well understood. The organization of a series of consensus conferences by sponsors in public and private agencies that are concerned with the future quality of family violence interventions would be an important contribution to the development of this field.

Reports of mistreated children, domestic violence, and abuse of elderly persons continue to strain the capacity of police, courts, social services agencies, and medical centers. At the same time, myriad treatment and prevention programs are providing services to victims and offenders. Although limited research knowledge exists regarding the effectiveness of these programs, such information is often scattered, inaccessible, and difficult to obtain.

Violence in Families takes the first hard look at the successes and failures of family violence interventions. It offers recommendations to guide services, programs, policy, and research on victim support and assistance, treatments and penalties for offenders, and law enforcement. Included is an analysis of more than 100 evaluation studies on the outcomes of different kinds of programs and services.

Violence in Families provides the most comprehensive review on the topic to date. It explores the scope and complexity of family violence, including identification of the multiple types of victims and offenders, who require different approaches to intervention. The book outlines new strategies that offer promising approaches for service providers and researchers and for improving the evaluation of prevention and treatment services. Violence in Families discusses issues that underlie all types of family violence, such as the tension between family support and the protection of children, risk factors that contribute to violent behavior in families, and the balance between family privacy and community interventions.

The core of the book is a research-based review of interventions used in three institutional sectors—social services, health, and law enforcement settings—and how to measure their effectiveness in combating maltreatment of children, domestic violence, and abuse of the elderly. Among the questions explored by the committee: Does the child protective services system work? Does the threat of arrest deter batterers? The volume discusses the strength of the evidence and highlights emerging links among interventions in different institutional settings.

Thorough, readable, and well organized, Violence in Families synthesizes what is known and outlines what needs to be discovered. This volume will be of great interest to policymakers, social services providers, health care professionals, police and court officials, victim advocates, researchers, and concerned individuals.

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How we’re implementing the National Plan to End Gender-Based Violence

The Women’s Bureau co-led the shaping of the Plan’s economic security and housing stability pillar, which aims to change harmful work cultures, address the root causes of gender-based violence in the world of work, and improve economic security for workers and survivors experiencing gender-based violence and harassment. Many of the actions outlined in this pillar drew inspiration from the International Labour Organization's (ILO) Convention on Violence and Harassment (Convention 190) . While the U.S. has not ratified Convention 190 and it is not binding on U.S. employers, it is the first international treaty to recognize the right to a world of work free of violence and harassment. 

Here are four key actions the Women’s Bureau has taken to implement the Plan:

In September 2023, the Women’s Bureau awarded the first Department of Labor grants exclusively focused on ending gender-based violence and harassment in the world of work . Over $1.5 million was awarded to five community organizations working across 14 states to build awareness of gender-based violence and harassment in the world of work, connect workers and survivors to their workplace rights and benefits, and implement worker- and survivor-driven strategies to shift workplace norms and culture. The grant program, Fostering Access, Rights and Equity (FARE), is now accepting Fiscal Year 2024 applications through May 28, 2024 .

Shortly after the Plan was released, the Women’s Bureau  signed a memorandum of understanding with the ILO Office for the U.S. and Canada to engage in joint events and activities concerning gender-based violence and harassment, including uplifting the principles of Convention 190 in U.S. policies, programs and practice. Together we are engaging stakeholders around the country and across sectors to discuss effective worker- and survivor-driven solutions to eliminate gender-based violence and harassment in the world of work. Since announcing our partnership, the Women’s Bureau has held about 40 regional convenings that have brought together workers, employers, unions, worker advocates, government representatives and others.

The Women’s Bureau also partnered with the Department of Labor's Occupational Safety and Health Administration on a webinar series that emphasized that gender-based violence and harassment is a workplace safety and health issue that has psychological and physical impacts on workers. The series featured discussions with workers, worker advocates, employers, and representatives from unions and the Equal Employment Opportunity Commission.

Finally, the Women's Bureau created a webpage on gender-based violence and harassment and published fact sheets, issue briefs and blogs throughout the year. Our fact sheet on gender-based violence and harassment in the world of work discusses key terminology, lists examples and outlines the key initiatives in this space. It is available in English and  Spanish . 

Carrying out the vision of the National Plan will take continued effort, action and coordination for many years to come. We all have an active role to play in making our world of work, and our society as a whole, safer and more equitable. The Women’s Bureau is committed to implementing this vision by engaging with survivors, workers, unions, employers and government agencies to address and prevent gender-based violence and harassment in the world of work. 

Amy Dalrymple and Kate Miceli are Policy Analysts at the Women’s Bureau. Katrin Schulz is the Branch Chief of Grants, Communications & Planning at the Women’s Bureau.

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• Published: 03 May 2023

Gender-based violence against women during the COVID-19 pandemic: recommendations for future

• Abbas Ostadtaghizadeh 1 ,
• Mozhdeh Zarei 1 ,
• Nadia Saniee 2 &
• Mohammad Aziz Rasouli 3  

BMC Women's Health volume  23 , Article number:  219 ( 2023 ) Cite this article

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Gender-based violence (GBV) includes any physical, sexual, psychological, economic harms, and any suffering of women in the form of limiting their freedom in personal or social life. As a global crisis, COVID-19 has exposed women to more violence, which requires serious actions. This work aims to review the most critical dimensions of the GBV against women, effective factors on it, and strategies for combating it during the COVID-19 pandemic in order to provide recommendations for future pandemics.

This study was conducted based on PRISMA-ScR. First, PubMed, Embase, Scopus, Web of Science, ProQuest, and Google Scholar were searched in April 2021 with no time limitation and location using the related keywords to COVID-19 and GBV. The searched keywords were COVID-19, gender-based violence, domestic violence, sexual violence, women, violence, abuse, and their synonyms in MESH and EMTREE. Duplicates were removed, titles and abstracts were screened, and then the characteristics and main results of included studies were recorded in the data collection form in terms of thematic content analysis.

A total of 6255 records were identified, of which 3433 were duplicates. Based on inclusion criteria 2822 titles and abstracts were screened. Finally, 14 studies were eligible for inclusion in this study. Most of these studies were conducted in the United States, the Netherlands, and Iran, mostly with interventional and qualitative methods.

Conclusions

Strengthening ICT infrastructure, providing comprehensive government policies and planning, government economic support, social support by national and international organizations should be considered by countries worldwide. It is suggested that countries provide sufficient ICT infrastructure, comprehensive policies and planning, economic support, social support by collaboration between national and international organizations, and healthcare supporting to manage incidence of GBV against women in future pandemics.

Peer Review reports

Introduction

International definitions of gender-based violence(GBV) and violence against women have emerged since the early 1990s [ 1 ]. GBV is a phenomenon deeply rooted in gender inequality, and continues to be one of the most notable human rights violations within all societies [ 2 ]. GBV as a main violence against women includes any physical, sexual, psychological, economic, and also any suffering of women in the form of restricting their freedom in personal or social life [ 3 ]. Most sexual violence is related to interpersonal relationships includes domestic violence, sexual violence, forced marriage, female genital mutilation, harassment, violence and abuse, and human trafficking [ 3 , 4 ].

As an example of the impact of GBV on women, the results of studies from 2000 to 2018 showed that more than one in four women (27%) between the ages of 15 and 49 had ever have had a sexual partner, experienced physical or sexual violence, or both, since the age of 15 [ 5 , 6 ].

In the past, crises have been associated with increased cases of GBV in natural disasters, including the earthquake in Haiti in 2007, Hurricane Katrina in 2005, and the eruption of Mount St. Helens in the 1980s due to unemployment, family, and other stressors has been reported [ 7 , 8 , 9 , 10 ]. According to researchers, epidemics cannot be excluded from this [ 11 ]. Recent outbreaks such as Ebola, Cholera, Zika, and Nipah have also led to an increase in cases of domestic violence [ 12 ]. Also, cases of sexual assault, violence against women, and rape also increased during the Ebola outbreak in West Africa [ 13 ].

GBV, already a global crisis before the pandemic, has intensified since the outbreak of COVID-19. Lockdowns and other mobility restrictions have left many women trapped with their abusers, isolated from social contact and support networks [ 14 ].

Health guidelines on quarantine and “stay home” during COVID-19 pandemic expose women to further damages. In this situation, many countries around the world, such as the United States, Ireland, China, the United Kingdom, and African have experienced a dramatic increase in domestic violence, which is one of the dimensions of GBV [ 4 ]. The results of studies have shown that China has witnessed a three-fold increase in domestic violence cases after the imposition of quarantine, and an increase of 21 to 35% in domestic violence was also reported in different states of the United States [ 15 ].

In the absence of a vaccine or effective treatment for Covid-19, quarantine for various periods of time has been used as an option by most countries, leading to lifestyle changes [ 16 ]. Most of the work is done from home and efforts are made to maintain social distance. These measures are critical to protecting health care systems [ 17 ]. However, positive efforts to combat COVID-19 have negative consequences associated with them. These negative consequences include the risk of job loss, economic vulnerabilities, and mental health issues due to isolation, loneliness, and uncertainty [ 16 , 17 ].

Considering the importance of maintaining the safety and health of women as half of a society and their key roles in the family, especially during pandemics and crises, and looking at existing studies shows that different research have been carried out by one of the methods of literature review regarding one aspect of GBV against women. Organizations, researchers and civil society representatives have warned of an increase in reports of GBV against women during the Covid-19 pandemic. Concerns about this issue have been expressed through official and unofficial networks, and they have emphasized the need to create effective interventions to prevent and combat this phenomenon. The urgency of this situation requires an analysis of the available scientific literature on strategies and recommendations to deal with GBV against women in the context of social distancing measures adopted as a response to the COVID-19 pandemic.

This scoping review is directly aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Check- list [ 18 ]. The present study seeks to answer the following questions:

What were the most important dimensions of the gender-based violence against women during the COVID-19 pandemic?

What were the effective factors on increasing the gender-based violence against women during the COVID-19 pandemic?

What were the most important strategies to combat the gender-based violence against women during the COVID-19 pandemic?

Which strategies are recommended to manage the gender-based violence in future pandemics?

Protocol and registration

We utilized the scoping review framework by Arksey and O’Malley (2005), as well as recent guidance to increase rigor and reporting of scoping reviews [ 19 ]. The a priori protocol for this review was drafted using the PRISMA extension for Scoping Reviews [ 18 ]. Due to the rapid nature of this review, the protocol for this review was not published, but can be accessed by contacting the authors.

Eligibility criteria

The inclusion criteria were: Original articles, narrative reviews, short communications, and grey literature related to the GBV against women during the COVID-19 pandemic; Availability of Full-text; Published in the English.

The exclusion criteria were: Case studies, notes, letter to the editor, editorials, comments, conference papers, perspectives, systematic reviews, meta-analysis; and scoping reviews: studies related to domestic violence and sexual violence alone; studies focusing on the GBV against children and men.

Information sources

We searched PubMed, Embase, Scopus, Web of Science, Proquest databases, and Google Scholar in April 2021 without time limitation and locations. The searched keywords were COVID-19, gender-based violence, domestic violence, sexual violence, women, violence, abuse, and their synonyms in MESH and EMTREE. The search strategies were provided by NS and approved by MZ. The search strategy for each database is mentioned in Appendix 1. The references of included documents were also reviewed to identify more related articles.

Selection of sources of evidence

All searched records were imported into EndNote-8. After removing duplicates, the title and abstract of studies were screened. Finally, related full-texts were selected and then confirmed them. The most important reason for removing studies in the screening phase was focusing on other kinds of violence than GBV.

Data extraction

A data extraction form was developed using Excel spreadsheet and bibliographic characteristics of each document including the first author, year of the research, research method, dimensions of the GBV against women, effective factors on it, and strategies for preventing it were recorded by MZ and approved by NS.

Synthesis of results

The data analysis steps included familiarizing with the concept, determining primary codes, searching for semantic units in the text, reviewing semantic units, defining and naming semantic units, and reporting [ 20 ]. First, the gender-based violence was considered as a main theme. Second, dimensions of the GBV, effective factors on it, and key strategies for combating it during the COVID-19 pandemic were determined as sub-themes, then overlapping themes were merged together. Finally, narrative methods were applied to synthesize the extracted results and main strategies were recommended for future pandemics.

After performing the search, a total of 6,255 records was identified, of which 3,433 were duplicates. In terms of inclusion criteria, 2822 titles and abstracts were screened. After studying 22 full texts, 14 ones were eligible for including in the study (Fig.  1 ).

PRISMA diagram of search and selection process

Quality assessment

The quality assessment of studies was not done due to the different methodology of the included studies and the type of review (Scoping reviews) [ 21 ].

Measure characteristics

The bibliographic characteristics of these studies are presented in Table  1 . The results showed that Turkey, the United Kingdom, the United States, and South Africa had the highest number of studies with two articles, and Indonesia, Italy, Nigeria, Colombia, Ecuador, and Brazil had the lowest number of studies with one study. Eight of these studies were conducted in the form of literature review and analysis of government documents, while two studies were survey, two studies were qualitative, one was observational, and one was a mixed methods study. A total of 12 studies were conducted in 2020 and two studies in 2021.

Psychometric evaluation

In this section, we answer the research questions and then recommend main strategies for combating gender-based violence against women in future pandemics.

Dimensions of gender-based violence against women during the COVID-19 pandemic

The review of the literature showed that GBV against women is more in the form of verbal, emotional, psychological, physical, sexual, family, structural (government and community), economic, inheritance, online and dating, access to health, deprivation of liberty in community and personal life, femicide, and ultimately suicide.

Yenilmez stated that during the COVID-19 pandemic, the most important forms of GBV against women were physical, psychological, and sexual violence by their sexual partners, so that one in three women has faced this violence. Home quarantine is one of the factors that have contributed to this issue [ 4 , 22 ]. Violence against women can be structural and direct. Structural violence is created through social and governmental laws and makes women economically dependent on men, while direct violence is related to family relationships and in the form of sexual violence and death. There are six types of GBV against women in Colombian society, including sexual, physical, psychological, inheritance, economic, and digital. This violence occurs at the level of family, workplace, university, community, organization, and in the form of genocide. In the private sector, this violence is emotional, physical, economic, and sexual, occurring in the scientific environment, workplace, community, and family. Violence against women is not just a matter of appearance; it is also in the form of placing them second to men. Violence against women in countries like Colombia and Mexico is not just related to family relations or marriage; it also includes criminal and drug-related violence. Thus, violence is divided into two categories: sexual partner violence and non-sexual partner violence [ 23 ].

Magezi stated that most GBV against women is in the form of physical, psychological, economic, and sexual violence perpetrated by sexual partners. Synonymous terms for violence by an emotional partner include “wife beating “, “beating”, and “domestic violence” [ 24 ]. The GBV is defined by Jatmiko as physical, sexual-psychological violence, suffering and social exclusion. Social networks created another type of gender-based violence as online gender-based violence. The justification for this online GBV is institutionalized patriarchy in cyberspace. This culture naturalizes GBV against women and ignores men’s mistakes in the form of online rape. Many cases of online gender-based violence include; virtual chats, rape videos, sex chat, taking photos of model women and broadcasting them in cyberspace or threatening to broadcast them if they do not have sex, and selling pornographic photos as an illegal trade have been reported by women [ 25 ].

Factors affecting the incidence of gender-based violence during the COVID-19 pandemic

According to the literature, the most important factors affecting the incidence of GBV against women during the COVID-19 pandemic were quarantine and social distancing and the resulting stress; lack of access to social support for women and girls, women’s employment in the private and informal sectors; gender inequality and patriarchal social norms; failure to investigate cases of GBV by police and not prosecuting criminals, economic problems due to quarantine and unemployment of men, women’s unemployment and women’s economic dependence on men, women’s employment; alcohol and substance abuse by sexual partners and spouses, the digital gap in e-learning and access to social networks, the lack of transparent rules and registration system of real cases of GBV against women, age and level of education of women; no basic government regulations; the perception of violence against women as hallmark by the family and society, previous abusive relationships; dependence on children, threatening to kill women and children by men and not prosecuting online criminals. GBV against women increased with the beginning and continuation of quarantine and social distancing in COVID-19 pandemic [ 4 , 22 , 24 , 26 , 27 , 28 , 29 , 30 ]. Violence against women is more common in public [ 3 , 26 ], but during the quarantine, gender-based violence against women was more prevalent in the home and less in public. This has imposed a great psychological burden on women [ 24 , 27 , 28 , 29 ]. No accurate reporting of violence against women causes does not receive much attention from governments. Women themselves may refuse to report it. Irregular distribution of this phenomenon in the whole population also causes the “classical elusive phenomenon”, which will affect the data collection. Violence against women is stigmatized by the family and society, and women refuse to report it [ 23 ]. The absence of clear internal rules and registration systems for GBV causes the lack of knowledge about the real cases of GBV against women and the confrontation of governments with it [ 3 , 27 ].

The presence of men in the home does not mean their participation in household chores; men’s lack of cooperation in household chores, raising children and caring for the disabled and the elderly has imposed a great psychological burden on women and prevented them from earning money. Also, the laws and patriarchy have influenced the employment of women, especially during COVID-19 pandemic. So, women cannot play their political, social, and economic roles [ 22 , 23 ]. Women horizontal inequality includes political inequality, inequality in access to education, and fertility rates that can lead to economic inequality and consequently violence against women. In terms of gender, this inequality places women in the minority group. Thus, the economic, social, and cultural implications of COVID-19 have made women the main victims of this pandemic [ 23 ].

Valencia et al. reported that declining political and economic role of women, unfavorable working conditions, women economic dependence on men, have led to sexual, physical, and psychological violence against women and even their death in the public and private sectors. So, government and social laws have encouraged this violence [ 23 ]. Lack of attention to menstrual health needs during quarantine in developing societies has also affected sexual health and reproduction in vulnerable women. The closure of schools during the pandemic and the online education has caused many problems for female students. Marginalization, mental health problems, digital gap, the stress of working at home, and uncertainty about the future affected female students during the pandemic. Also, quarantine financial pressures on families led to girls’ employment or early marriage [ 23 ].

Lack of services such as women’s rights network, health workers and teachers, in the pandemic lockdown has led to an increase in violence. Womens’ working in the informal sector reduces access to care and treatment facilities [ 4 , 23 ]. Magezi stated that the weak economy, alcohol consumption at home, lack of access to socio-psychological support from religious and non-religious counselors, relationship with the abusive partner and staying with him for a long time during quarantine, lack of income and stress and economic dependence on spouse have led to an increase in GBV during the pandemic in Zimbabwe. In this country, most GBV is perpetrated by spouses. These women are eventually killed or commit suicide due to emotional depression, restrictions and beating. Concerns about children and fear of losing them due to divorce, lack of income, separation from family and friends, lack of access to social resources and religious centers, and lack of support from them, cultural and religious concepts instilled in women that they are inferior to men, threatening to kill their wives or children or themselves, as well as threatening women to leave home or exposing their husbands’ abuse, are factors associated with the increase of GBV against women during the COVID-19 pandemic [ 24 ].

Lund et al. reported that lack of access to shelters due to their conversion into medical centers or closure to prevent the spread of the disease is reason for the increase of the GBV [ 27 ]. In a study by Afu, quarantine and being long hours at home, economic problems, anti-woman norms in society, and alcohol consumption were presented as the main causes of GBV against women in Nigeria [ 31 ]. John et al. also reported that quarantine ,lack of access to services needed by women and girls and the use of existing services to prevent the transmission of COVID-19, economic problems of families, lack of police intervention and imprisonment of aggressors due to fears of outbreaks, turning the women’s shelter into a shelter for homeless people, the lack of accommodation for new people in the women’s shelter due to concerns about the spread of the disease and expressed anti-woman social norms as the factors that increase GBV against women [ 30 ]. Speed et al. stated that essential reasons for gender-based violence against women are the result of inequality of women’s power due to patriarchal social structures. Also, the stress, anxiety, and economic strain caused by a pandemic can contribute to this. Drug and alcohol use, inability to support family expenses, isolation of women, and overcrowding during the quarantine have increased GBV. The closure of asylums and non-accepting new people in accordance with government policies or at the request of the residents of these settlements has reduced the access of victims of sexual violence to these places during COVID-19 pandemic. This will have an adverse effect due to the increase in domestic violence cases and the decrease in the budget for refugees. As a result, the income of support organizations will decrease and their performance will be unfavorable in the future [ 3 ]. Lack of access to communication devices such as mobile phones and Internet are other aggravating factors [ 4 ].

Research and practice recommendations

Social support.

Marceline Naudi, chair of the Council of Europe’s Group of Experts declared that guidelines are among the most important ways to reduce GBV against women. Examples of these guidelines were developed by the European Convention on Prevention and Control in Turkey. Providing welfare and support services such as information centers and active helplines, including the numbers and addresses of local caregivers, and raising awareness among young women and girls are other ways to combat violence against women during pandemics. Italy, for example, used the number “1522” as a helpline for victims of sexual violence during the COVID-19 pundemic. Providing support lines in Australia, France, and the United Kingdom are another cases. Providing anti-violence policies is another approach used by France, Italy, and Spain. Providing shelter for victims, such as hotels, and providing care and accurate recording of violence against women have been other ways of combating GBV. In Italy, according to the law, criminals must leave the family, not the victims. Canada has also announced Sexual Victim Care Centers as part of its support package [ 4 , 22 ]. Colombia has also set up special hotlines to record and track GBV against women. The calls are usually made to the public emergency. It is necessary to teach young women and girls in urban and rural areas how to use these lines. Women’s advocacy movements can also be effective in exposing violence against women and strengthening existing policies [ 23 ].

Establishing women’s advocacy centers in the form of legal, psychological, and health protections, establishing transparent government laws to protect women during pandemics, establishing local support systems, reviewing court rulings, and strengthening social support networks for families could be effective for women under GBV [ 22 , 23 ]. The provision of these services should be based on maintaining the confidentiality of victims’ information and increasing their ability and life expectancy of their children. With a comprehensive approach, governmental and non-governmental organizations can work together to provide these services [ 32 ]. For example, UNICEF uses the AAAQ (Availability, Accessibility, Acceptability, and Quality) framework to measure victims’ access to social services through some questions. Supporting organizations should report the list of types of violence and lines of communication through websites, radio, television, and social networks [ 28 ].

Due to the impact of alcohol consumption on violence against women, South Africa has banned the sale of alcohol in clubs. Another strategy to support women was to provide support packages for women during COVID-19 pandemic, so-called “dignity kits”. People in the community should feel responsible for each other and receive the necessary training in this regard [ 4 , 22 ]. Supporting organizations should increase the number of hours and days of service delivery and inform about this. These services include social support (food packages, emergency housing payments for families and providing toy packages for children), provision of educational packages for schools and training individuals and organizations that may be contacted by victims during COVID-19 pandemic [ 3 , 32 ].

Community-based services can be effective in improving gender roles and determining the extent and nature of gender-based violence. The provision of refugees support services, such as accommodation in hotels and hospitals, has been provided by countries such as France, the United Kingdom, and Germany. Speed mentioned the establishment of a suitable accommodation for refugees and performing COVID-19 diagnostic tests, a 6 to 12-month support services after quarantine, and preparing a guide for appearing in court and police cooperation [ 3 ]. Humanitarian organizations can also provide services and collect the necessary data [ 32 ]. Churches can support women and even change men’s behavior by providing spiritual support [ 24 ]. Emergency housing for homeless women, providing individual sexual, physical, and psychological care services, training psychologists to provide basic services to victims, developing protocols and guidelines for combating GBV, women’s violence support centers in the form of psychological support, providing counseling services to couples on the adverse effects of GBV, educating and holding training seminars for girls in schools on marriage and the causes of sexual violence, and the importance of marital relations compared to other relations and trying to maintain it were stated as the most important strategies to deal with GBV [ 29 , 31 , 33 ].

Providing online counseling services and creating a safe environment can be effective in promoting women’s mental and psychological health. Also, health workers and psychologists need to be trained and equipped [ 4 , 22 ]. Caregivers must also have the skills, knowledge, and patience to help victims. Health care professionals need to be aware of the dangers and consequences of GBV and provide the necessary patient care, such as post-traumatic care. For older, disabled, poor women and minority, it is better to use tele-medicine [ 32 ]. Cooperation between health organizations and non-governmental organizations to support women in order to protect women who are under gender-based violence is also necessary [ 27 ]. Providing tele-medicine services is helpful to assist women and girls in preventing pregnancy or miscarriage, as well as providing online guidance and training for them [ 30 ].

Government support

Amendments to government laws protecting the family must be considered. These laws include electronic control, the suspension of prison sentences, the creation of online crime registration and payment portals, the creation of virtual services to support sexually abused women, financial support for women, and women’s participation in charity [ 4 , 22 ]. Governments also need to prioritize their work and provide services to victims [ 28 ]. Governments’ planning to support women and create a safe work environment for them is necessary. Government actions include the provision of primary care, efficient and adequate health care infrastructure and manpower, adequate resources, and support services (telephone and Internet lines, counseling, and shelters for women subjected to gender-based violence). Governments need to learn from previous pandemic experiences and find ways to reduce the harm to women in future pandemics. Police cooperation is another solution by providing advice and creating a safe space in the house without the access of intruders [ 32 ]. Cooperation and participation of governmental and non-governmental organizations at the national and international levels such are other solutions used. Providing homework assignments during the pandemic, food and social security programs, especially for bisexuals who are more prone to gender-based violence are among solutions used [ 24 ]. In the United Kingdom, the government supported GBV organizations during COVID-19 pandemic by allocating financial packages. Evidence shows that providing funding and a financial recording system for small victim advocacy organizations can be helpful. Government financial support for women can take the form of employment and participation in charity activities, such as making face mask [ 4 , 22 ]. In Bangladesh, evidence has shown that households who offered interest-free loans to expedite men immigration have reduced spouses’ physical and sexual violence by 3.5% during six months. Also, women’s employment and income can reduce financial dependence and violence against them. Therefore, governments need to plan to support women and create a safe work environment for them. The use of evidence-based programs and policies to support women entrepreneurship and advocacy organizations is another strategy [ 32 ].

Information and communication technology

Using the code in France, Italy, and Spain for reporting suspicious cases is a protective measure. The covert mobile apps to show signals that abusive people are close has been used in the United Kingdom and Italy. Working with these mobile-based applications should be easy and the incident can be reported to the police with just one click [ 4 , 22 ]. Another option was to set up pop-up booths by organizations supporting women under GBV in supermarkets and pharmacies. In Colombia, creating a safe space for victims in supermarkets and pharmacies in the form of telephone counseling rooms was on the agenda. These hotlines have been used for forced marriage counseling, sexual violence, men’s counseling, and domestic violence counseling in the United Kingdom. Maintaining confidentiality and privacy in the consulting lines particularly in the web environment is necessary [ 3 ]. Supporting organizations are advised to provide a list of violence types and ways of communication through websites, radio, television, and social media [ 28 , 33 ]. The Home Secretary’s “You Are Not Alone” campaign was another initiative in the UK. The campaign was designed to inform at-risk individuals so that they can access to support services and the police. Other initiatives included providing online victim support and Fujitsu security support to provide IT infrastructure for smaller charities. Remote court services can also be used to hear statements made by victims of gender-based violence. The service was used in the UK via Skype and the cloud video platform. Complaints and follow-up guidelines should be posted on the websites of organizations supporting women victims of gender-based violence, legal centers, and social media. Security and definition of access on these platforms is important. The police can also receive the statements of victims and witnesses by phone and receive confirmation of the statements by electronic or non-electronic signature via email or mail. Also, virtual interviews or virtual and face-to-face interviews can be used depending on the importance of the issue. Many women are also uncomfortable holding these sessions at home due to the presence of children; in this case, it is necessary that family courts to be held in the short session. Information on courts and available legal centers during the pandemic should to be provided. Support counseling in the form of online services is of particular importance [ 3 , 27 , 30 , 32 ]. An example of such services is CEPAM-Guayaquil Telephone Consulting in Ecuador. In Italy, the National Network of Domestic Violence Shelters has provided support services via Skype and telephone [ 30 ].

Launching campaigns to combat GBV against women, such as the “Red Mask” campaign, was another strategy. The campaign was launched first in Spain, then in France, Chile, and Argentina under the code “Mask 19”. Argentina used WhatsApp, mobile, and emails to connect more with victims. Public and private campaigns prevented more victims from being at risk by using silent methods such as codes. Another campaign was to raise awareness among rapists about the consequences of GBV. But there was no national system for accessing resources. Access to information on actions taken by governmental and non-governmental organizations to combat gender-based violence can contribute to evidence-based policies [ 28 ]. Creating an accessible service database for victims of gender-based violence is essential. An example of this database in the UK is the “Companies House or the Charity Commission”. This database provides easy access to services for victims and payment to organizations in a convenient way. Holding webinars and online training programs can affect the staff cooperation of sponsoring organizations. Community-based services can also be effective in improving healthy gender roles and determining the extent and nature of GBV. Speed suggested government support for educating charities to attend online and provide training programs for victims [ 3 ]. In order to get acquainted with the needs and barriers to providing services to them, women also should be involved in service decisions. Collected data during the crisis should be segregated by age and gender [ 30 ]. Based on this scoping review, we recommended strategies for managing GBV against women in future pandemics is as follows (Fig.  2 ).

Recommended strategies for managing GBV against women in future pandemics is as follows

In this scoping review, we provided a comprehensive synthesis of the published literature on GBV against women in the COVID-19 era. Results of this work showed, the COVID-19 as an emerging disease spread rapidly, and then many problems arose for the people worldwide, one of these challenges was the increase of violence against women. Dealing with GBV against women required identifying its dimensions, effective factors on it, and strategies to reduce it, which was done in the present study.

We found that the most common GBV against women were physical, sexual, psychological, emotional, economic, digital and virtual, substance use, structural (society and law), verbal, deprivation in personal or social life, femicide and suicide. Stark study showed that the common forms of GBV were sexual partner violence, physical violence, sexual violence, and rape that it mostly happens outside the house [ 34 ]. In a study by Mittal, the most common forms of GBV were physical, sexual, emotional, domestic and female genital mutilation which was similar to this study [ 16 ]. Results of other study showed that most common types of violence against women are psychological/verbal, physical, and sexual, respectively. There was a significant relationship between couples’ age gap, forced marriage, husband addiction, income, and history of violence experienced by the husband with domestic violence against women [ 35 ]. Also, study in Uganda reveals several factors associated with increased risk and vulnerability to GBV during COVID19. Socio-economic status particularly linked to low education achievement (primary education) and the need for assistance to access health care was associated with higher likelihood to experience increased risk and vulnerability to GBV [ 2 ].

These studies showed that the incidence of violence against women had increased due to quarantine conditions and social distancing during the COVID-19 pandemic.

The most GBV before COVID-19 occurred outdoors. In other words, the type of GBV against women during the quarantine is different from before, this can be due to the presence of men at home for more times because of job loss and mental and emotional distress caused by economic problems. Also, the difference between types of GBV among countries can be caused by cultural differences and their level of development. This requires the development of livelihood packages and financial assistance managed by the policy makers of a country.

A review of the existing literature showed that the most common factors influencing the incidence of GBV against women in the COVID-19 era were: lack of access to social support for women and girls, women’s employment in the private and informal sectors, gender inequality and patriarchal social norms, failure of the police to deal with cases of gender-based violence and the prosecution of perpetrators, economic problems due to quarantine and unemployment of men, women’s unemployment and women’s economic dependence on men, alcohol and substance abuse by sexual partners and spouses, the digital gap in e-learning and access to social networks, lack of clear laws and a system for recording real cases of gender-based violence against women, age and level of education of women, lack of basic government regulations, the perception of violence against women as hallmark by the family and society, previous abusive relationships, dependence on children and failure to prosecute online perpetrators of gender-based violence. However, quarantine has been effective in reducing disease transmission, but because of job losses, economic and psychological problems, loneliness and insecurity violent behaviors such as gender-based violence against women have increased. In Mittal study, they pointed out the lack of accurate reporting of cases of GBV during the pandemics, which shows that countries do not pay enough attention to this issue in critical situations [ 16 ]. In addition, results of other studies revealed an association between female sex and more risk for burnout [ 36 ]. Based on literature, females have a tendency to be more susceptible to experiencing the signs of stress particularly, nurses [ 37 ].

Therefore, the establishment of comprehensive national systems for recording and addressing cases of GBV should be on the agenda of governments.

Besides, the laws and traditions that govern society are other causes of GBV against women. Patriarchal societies place women second to men, and this provides the basis for all kinds of GBV against them [ 38 ]. In order to reduce GBV against women, it is suggested that in traditional societies where women have less freedom, arrangements should be made to educate them from school age so that they become familiar with their basic rights. It is necessary that supporting legal institutions follow up and deal with any violence in countries. These trainings should not be limited only to women, but it needs to take action in the whole society regarding any kind of violence against women, and every person should consider himself responsible in this regard. These necessities must be prepared before any crisis, especially pandemics. The issue of government financial support should also be paid to the attention of countries in order to create a sense of financial security in difficult situations. The lack of financial security can lead to all kinds of violence in society, the majority of which will be directed at women.

Arthur and Clark stated that one of the reasons for the increase in GBV against women is their economic dependence on men, which is exacerbated by quarantine due to women’s employment in the private and informal sectors [ 39 ]. Also, women have fewer remote working conditions than men, which make it difficult for them to adapt [ 14 ]. This not only increases the risk of GBV but also makes it impossible to leave spouses and sexual partners. Accordingly, it is necessary for governments to pay attention to the financial needs of women in a pandemic situation and put women distance working on their agenda to reduce their financial dependence on their spouse. The increase in refugees due to the economic problems caused by the pandemic will cause them to be unable to meet their daily needs and as a result the GBV against them will increase. This requires countries’ policies and financial planning to control and reduce the influx of refugees to manage their access to health care services, psychological counseling, courts, police and housing.

On the other hand, outbreaks of pandemics such as influenza, swine flu, and SARS have caused psychological problems in the form of substance and alcohol use, anxiety, and depression that have persisted since the end of the pandemic [ 40 , 41 ]. Results of systematic review showed that the prevalence of postpartum depression in women was relatively high during COVID-19 [ 42 ].

These psychological problems caused by pandemics lead to a variety of violence such as gender-based violence [ 43 ]. Therefore, it is necessary to provide psychological health care services and training for resilience in such situations for women and young girls. Due to pandemic conditions it is better to provide these services in the form of distance counseling and education. However, gender-based violence against women is not limited to pandemic conditions; it also occurs in natural disasters such as floods, earthquakes, and hurricanes [ 44 , 45 ]. According to the Yasmin study, cases of sexual violence in the form of rape and sexual abuse increased significantly during the Ebola outbreak in South Africa [ 46 ]. Given the distinction between different crises caused by natural disasters, war, or the prevalence of diseases and their specific characteristics, it needs to conduct studies to provide a model and solution to combat violence against women.

This review showed that during the COVID-19 pandemic, various measures have been taken to combat and reduce GBV against women by countries, which can be a guide for similar events in future pandemics. The main strategies were divided into five categories: government support in the form of policies and planning, social and humanitarian institutions support, government economic support, health organizations support and using cyberspace to provide health care, remote courts, remote police, online counseling and training of under GBV women. According to Campell, the most important step in combating gender-based violence is to raise people awareness about the importance of gender-based violence [ 44 ]. Other effective measures are the establishment of communication channels through telephone and the Internet to report cases of gender-based violence, counseling, training and follow-up [ 47 ]. The current study revealed the emphasis of the studies on this issue. However, educating individuals should not be limited to victims; rather, all members of society should be responsible, report cases of gender-based violence and help victims voluntarily [ 48 ]. Health care providers should also be trained in identifying and addressing symptoms of violence and taking effective and timely action for victims [ 49 ]. Social media can also help to educate victims by publishing guidelines, advertisements and raising awareness [ 50 ]. This review showed that legal and accountable centers such as the police and medical and social support centers can publish details of access to services through their websites or social networks and help victims. Another measure is the establishment of emergency hotline to support victims. Various studies have pointed to the training and use of staff who are specialized in psychology, psychiatry, social, and legal services, as well as emergency alert systems in grocery stores and pharmacies, cloud and online platforms, online text chat, online courts, shelters, policy-making and government funding [ 16 , 51 ]

Overall, one of the strengths of this study was to provide a comprehensive perspective on the dimensions of GBV against women, factors affecting it, and ways to deal with it during the COVID-19 era, which had not been done before in the form of a scoping review.

Limitations

However, this study also had some limitations that one of them was the lack of access to the full-text of numerous studies, which was attempted to be accessed through correspondence with their authors on social networks. Another limitation of this study was not including studies such as proceeding papers, perspectives, commentaries, articles and grey literature in other languages. Also, the lack of quality assessment of the studies was another limitation of this research, which was not done because of different methodology of the included studies. Therefore, due to the lack of serious attention and almost ignoring the issue of gender-based violence against women in critical situations such as pandemics, it is suggested that researchers in different countries investigated effect of the recommended strategies to combat gender-based violence that can be used in future pandemics and crises.

The results showed that GBV against women accrues more in the form of verbal, emotional, psychological, physical, sexual, family, structural, economic, inheritance, online and dating, access to health, deprivation of liberty in community and personal life, femicide, and suicide. Various factors affected the occurrence of GBV against women during the COVID-19 era such as quarantine and social distancing, lack of access to social support, women’s employment in the private and informal sectors; gender inequality, economic problems, alcohol and substance abuse, the digital gap, no basic government regulations, etc. It is suggested that countries provide sufficient ICT infrastructure, comprehensive policies and planning, economic support, social support by collaboration between national and international organizations, and healthcare supporting to manage incidence of GBV against women in future pandemics. The consequences of GBV for its victims are long-lasting and rampant for responses that are often inadequate. Hence, it is important to maintain urgency in cases of GBV even in critical situations. Based on the results of the reviews, the need for a comprehensive response model to address the issue of gender-based violence during current and possible future pandemics is essential. The opinions of health professionals, formal and informal media, and community efforts must be combined to effectively address the issue of gender-based violence. Additionally, continued and serious efforts are needed to end the stigma associated with gender-based violence.

Data Availability

The data that support the findings of this study are available from the corresponding author but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the corresponding author.

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The authors thank collaboration the Clinical Research Development Unit, Kowsar Hospital, Sanandaj, Iran.

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Ostadtaghizadeh, A., Zarei, M., Saniee, N. et al. Gender-based violence against women during the COVID-19 pandemic: recommendations for future. BMC Women's Health 23 , 219 (2023). https://doi.org/10.1186/s12905-023-02372-6

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How Community Can Help End Gender-Based Violence

On Saturday, January 19th at the  Society for Social Work Research conference in San Francisco, law professor Leigh Goodmark will speak on a multi-faceted policy approach  needed to decriminalize domestic violence .

In Goodmark’s book, Decriminalizing Domestic Violence: A Balanced Policy Approach to Intimate Partner Violence , she notes one aspect, of many, to be considered—the relationship between community and intimate partner violence:

Social Support and Networks

Social supports within the community color the experience of intimate partner violence. Violence decreases where social ties within neighborhoods are strong and residents are willing to intervene. Interacting with social networks can increase the scrutiny of a couple’s relationship, prompting others to step in to protect the abused partner, bring cultural and religious proscriptions against violence to bear, or confront abusive partners about their behavior. Family and friends often provide material and emotional support to people subjected to abuse. Social support from family members is linked to both a lower likelihood of being subjected to intimate partner violence and a lower frequency of abuse. Social ties with friends may also deter intimate partner violence. …

Collective Efficacy

Collective efficacy is central to community interventions to interrupt violence. In neighborhoods with higher levels of disruption (like poverty and high residential mobility), community members may be less able to prevent violence because they lack social connections and trust. Those deficits can be overcome, however, in neighborhoods with greater collective efficacy. Collective efficacy reflects a community’s belief in its capacity to act to end violence and a resulting active engagement by community residents. To exercise collective efficacy, residents must have mutual trust and the willingness to intervene to exercise social control. Strong preexisting personal ties among community residents are not necessary. Collective efficacy relies on the capacity for social action—a shared commitment to intervening to stop violence and the readiness to act on that commitment—not the interpersonal relationships of the actors. The existence of both cohesion and willingness to intervene are essential in decreasing violence. While social ties make the exercise of control possible, violence abates only when control is exercised. Collective efficacy also contributes to the prevention of intimate partner violence. Studies have repeatedly shown that communities with less collective efficacy experience more intimate partner violence. And inversely, intimate partner violence decreases in communities with greater collective efficacy. Similarly, increasing social capital (a measure including collective efficacy, psychological sense of community, and neighborhood cohesion) can decrease domestic violence. Each 1 percent increase in social capital was associated with a 30 percent decrease in intimate partner violence among families in a study in North and South Carolina.

This relationship might exist for a number of reasons. First, in neighborhoods with higher collective efficacy, people who might otherwise abuse their partners could be deterred by the knowledge that their neighbors are likely to intervene. Collective efficacy could also make people subjected to abuse more likely to confide in or seek assistance from their neighbors, who are more willing to provide that assistance. Even if neighbors do not directly intervene, people who abuse might be loath to risk the stigma and shame resulting from their neighbors’ awareness of their actions. Whatever the reason, the relationship between collective efficacy and intimate partner violence is significant enough to bolster the case for approaching intimate partner violence as a community problem.

Hear from Leigh at her session at SSWR this week . And learn about Decriminalizing Domestic Violence  and consider for classroom use.

TAGS: 9780520295575 , collective efficacy , community , Decriminalizing Domestic Violence , domestic violence , gender violence , intimate partner violence , Leigh Goodmark , social work , Society for Social Work Research

CATEGORIES: Criminology & Criminal Justice , Gender & Sexuality , Sociology

About the Author

Leigh Goodmark

is Professor of Law and Director of the Gender Violence Clinic at the University of Maryland Carey School of Law and the author of  A Troubled Marriage: Domestic Violence and the Legal System. 

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Original research - special collection: african women and pandemics and religion, cultural dynamics of gender-based violence and pastoral care in south africa, about the author(s).

Gender-based violence is a prevalent issue that impacts most South Africans. The spread of sexual violence has created and atmosphere of intense fear in most homes. African cultural norms have helped to facilitate the continuation of discrimination against women. In African cultures, cases of abuse are often marginalised and considered an irrelevant reason for seeking a divorce. This has resulted in some women being forced to endure years of domestic abuse in their marriages, and they have even passed on this resilient mentality to more recent generations of married women. It is crucial to realise that the  Recognition of Common Legislation Marriages Act , which is a part of South African legislation, acknowledges customs like polygamy and lobola. Lobola and polygamous marriages, among other practices, have been linked to major increases in the maltreatment of women, according to certain African researchers. In this particular study, the researcher aims to examine the impact of culturally induced gender-based violence (GBV) on pastoral care practices in South Africa, specifically focusing on the experiences and needs of South African women within abusive marriages. It is important to recognise that GBV is rooted in patriarchy, which promotes a culture of male power over women. In this research, qualitative methods will be employed to investigate how this unhealthy power dynamic encourages men to behave violently towards women.

Contribution:  This study delves into the intricate relationship between culturally induced GBV and pastoral care in South Africa. Focused on the surge in violence, it employs qualitative methods to explore women’s experiences, revealing the connection between violence and entrenched patriarchal structures. The research seeks to inform and enhance pastoral practices in addressing GBV.

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