Module 7: Principles of interorganisational cooperation and risk assessment in cases of domestic violence in multi-professional teams

  1. Inter-Agency Cooperation
  2. Risk Assessment
  3. Cooperation between Agencies with Focus on the Health Sector
  4. Criminal Procedure in Cases of Domestic Violence
  5. National Criminal Procedures
  6. Excursus: Domestic Violence in Times of Disasters

Sources

Learning objectives

+ to understand how frontline responders work with a special focus on the medical sector

+ to understand why cooperation in multi-professional teams is most successful in tackling domestic violence.

+ to understand the multi-faceted challenges associated with multi-professional cooperation in times of a pandemic such as COVID-19 disasters.

Of note: The learning materials are not tailored to the needs of every country; they include generic cases that need local adaptation.


IMPRODOVA: Why is cooperation in cases of domestic violence important?

The video points out why cooperation is important in cases of domestic violence.

1. Inter-agency Cooperation1

Working in a multi-agency partnership is the most effective way to respond to domestic violence at an operational and strategic level. Initial and ongoing training and organisational support and supervision are essential.

Domestic violence has harmful impacts for individuals, families, and relationships. It affects the health, well-being and education of children witnessing or experiencing abuse. It affects the economy, businesses, and employers in the community where victims/survivors or perpetrators work. It increases demands of housing and results in other health and social care needs. All these service providers and agencies often deal with the same issues in divergent ways, with different interventions and different outcomes.

Principles of multi-agency working

To ensure a successful partnership, certain principles can be developed and agreed on by different agencies working together. The points listed below can help professionals and organisations to draw and agree on certain principles that all agencies working together should adhere to.

  • Understand that without effective prevention and early intervention domestic violence often escalates in severity and, therefore, it is important to make every effort to identify and support adult and child victims earlier.
  • Prioritise safety of the victim-survivors and their children when considering interventions and acting immediately on disclosure of risk of harm.
  • Data about all incidents of domestic violence should be recorded, analysed, and shared with management of agencies working together regularly and appropriately.
  • Encourage cooperation with institutions and authorities that work with perpetrators in order to assess risks on a multi-professional basis and to prevent new incidents of violence.
  • At the initial engagement with the services, informed consent of the victim-survivor should be gained to ensure information between agencies can be shared, when required, without unnecessary delay.
  • Work cooperatively to provide a supportive and enabling environment which encourages people to report domestic violence to the police and other professionals and agencies.
  • Respect confidentiality and privacy wherever possible and understand the risks associated with information sharing in the context of domestic violence.
  • Develop and adhere to shared policies and procedures to guide information sharing between different organisations.
  • Ensure that victim-survivors are treated with respect and dignity. By listening to them and believing their experiences and assuring them that they are never to blame.
  • Empower domestic violence victim-survivors to make well-informed choices and decisions for themselves, wherever possible. Do not make decisions for them without their involvement.
  • Ensure that services are sensitive to the diverse need of the victim-survivors considering their age, disability, gender, race or ethnicity, religion or belief, sexual orientation, but recognise that such differences are not used as an excuse for accepting or perpetrating domestic violence or other harmful practices.
  • Recognise that victim-survivors and their children are most at risk when attempting to leave an abusive relationship or seeking help.
  • The health and dental care’s information about patients is subject to confidentiality rules. It is important to know when you can break internal and external confidentiality.
Challenges associated with multi-agency working 2

Multi-agency working has its own challenges. Fundamentally, different agencies and service providers have different organisational missions, visions, values, aims and objectives. They have different targets and tasks and may also have different rules, regulations and working mechanisms. This makes it difficult for professionals in these agencies to work together at the same pace. There could also be a lack of understanding of the role and responsibilities of staff and the language used by individuals and organisations could be different leading to issues in working together.

A good example to elaborate this is the difference in the language, definitions and labels used to refer to the victim-survivor with various labels in operation including ‘victim’ (criminal justice system), ‘survivor’ (women-centred organisations), ‘patient’ (healthcare services), ‘tenant’ (housing services), ‘service user’ (welfare agencies) and ‘customer’ (adults’ social care). When working with perpetrators, the term victim is also used in the sense of criminal law, but it can also refer to ‘relatives’ and ‘clients’ in general.

Data gathered by different agencies is not comparable due to variations in the type of data collected, ways it is recorded, data storage and lack, or data portability mechanisms. There may also be different understandings of what constitutes domestic violence and its impact among different organisations. High staff turnover in organisations is also a barrier and affects communication as it takes time for people to develop trusting relationships.

In addition, different services do not always communicate with each other, and are often not allowed to exchange information, partly for data protection reasons, resulting in the lack of sharing information. Consequently, the victims must repeatedly provide their information, including details of their abusive experiences to different people in different organisations. Recalling experiencing can itself be traumatic for victim-survivors and consequently may deter them from accessing support.


2. Risk Assessment

Risk assessment is a cornerstone in domestic violence prevention.3 The purpose of domestic violence risk assessment is to prevent repetitious violence by identifying the perpetrator’s risk of recidivism4, circumstances that may increase the risks of violence as well the victim’s vulnerability factors by conducting a risk assessment and implementing interventions to manage the sources of risks.
Risk assessment is needed in the safety planning of the victim and in managing the sources of risks, these are the main key points:

  • It is essential to assist victims in evaluating both their present and future safety, along with that of their children.
  • Often victims do not want to go to other specialised services immediately or report to the police. Therefore, it is very important that members of the health sector have some background knowledge about risk assessment and how to ask and support victims accordingly. But it is not necessary to perform a comprehensive risk assessment.
  • A comprehensive risk assessment, following best practices, involves gathering pertinent information about the domestic environment, inquiring about the victim’s perception of risk, and making a professional judgment regarding current risk factors. 5 This is usually done by specialised victim support services or the police.
  • A risk assessment and a clear protocol for referring patients with injuries resulting from domestic violence to further interventions after an emergency room visit are required. The disclosure of domestic violence is also associated with certain reporting and notification obligations, which vary depending on the professional group.
  • This may concern the reporting and notification obligations of pedagogical and psychosocial occupational groups in cases of suspected immediate danger to self or others and danger to the well-being of children.
  • Medical professions are also subject to special reporting obligations, which are regulated in the respective professional laws.

Make sure to

  • prioritise victim’s safety
  • adopt a victim-centred approach
  • take a gender-sensitive approach
  • apply an intersectional approach: “The characteristics of each individual case are considered when identifying victims’ individual safety needs, including the victim’s gender and gender identity or expression, ethnicity, race, religion, sexual orientation, disability, residence status, communication difficulties, relationship to or dependence on the perpetrator and previous experience of crime.” 6
This video is an introduction to the techniques of risk assessment when working with women and children experiencing violence. It should be used in conjunction with the Introduction to Safety Planning and the Risk Assessment Frameworks.

It highly suggested to use a standardised risk assessment instead of using one gut feeling. Many hospitals or support centres have their standard risk assessment tool they usually use. This can vary however between institutions and countries.

Find the internationally most frequently used risk assessment instruments here:

Danger Assessment (DA) 8 9
  • The Danger Assessment is an instrument that helps to determine the level of danger for an abused woman of being killed by her intimate partner.
  • There are two parts to the tool: a calendar and a 20-item scoring instrument. The calendar helps to assess severity and frequency of battering during the past year. The calendar portion was conceptualised as a way to raise the woman’s consciousness and reduce the denial and minimisation of the abuse, especially since using a calendar increases accurate recall in other situations.
  • The 20-item instrument uses a weighted system to score yes/no responses to risk factors associated with intimate partner homicide. Some of the risk factors include past death threats, partner’s employment status, and partner’s access to a gun.
  • The tool is currently available in English10, Spanish, Canadian French and Brazilian Portuguese.
  • A short four-item version called the Lethality Assessment has been developed for use by law enforcement officials responding to domestic violence calls. Women at high risk are then referred to advocates who have been trained in the Danger Assessment.
Domestic Violence Risk Appraisal Guide (DVRAG) 11

The Domestic Violence Risk Appraisal Guide (DVRAG) contains the same items as the Ontario Domestic Assault Risk Assessment (ODARA), but also incorporates psychopathy checklist-revised (PCL-R) findings. The DVRAG is a 14-item actuarial tool which assesses the probability of Intimate Partner Violence perpetrated by males against a female partner, and how this risk compares with that of other abusers. These tools may also predict the speed and number of recidivistic offenses and the severity of injuries caused. The general scoring criteria include the instructions for scoring and interpreting the ODARA in any setting.12 DVRAG is intended for use by forensic clinicians and criminal justice officials who can access in-depth information.

DASH Risk Assessment 13

DASH stands for domestic abuse, stalking and ‘honour’-based violence. The risk assessment tool was the outcome of documenting 47 domestic homicides and cataloguing the key risk variables to develop the DASH risk model. The DASH checklist is used by a number of agencies in Scotland, including the police. However, it has not been introduced everywhere in Scotland. The DASH risk checklist is supposed to be a consistent and simple tool for practitioners who work with adult victims of domestic abuse. It is supposed to help them identify those who are at high risk of harm and whose cases should be referred to a MARAC meeting in order to manage their risk.

Video introducing risk identification in domestic violence cases utilising the DASH RIC checklist: https://www.youtube.com/watch?v=AB00K1jiFUc&t=23s

BIG 26 14

The Domestic Abuse Intervention Program (DAIP) in Duluth, Minnesota, USA, has developed 26 questions to assess the danger emanating from a perpetrator. The Duluth model emphasises the importance of an interagency cooperation and coordinated community response to battering, of victim safety and offender accountability.

DyRiAS Intimate Partner 15

DyRiAS stands for Dynamic Risk Assessment Systems. DyRiAS Intimate Partner has been in operation in Germany, Austria and Switzerland since January 2012. On the one hand, the instrument measures the risk of committing acts of serious violence against the intimate partner. In addition, a separate scale measures the risk of mild to moderate physical violence. DyRiAS-Intimate Partner only records violence in heterosexual relationships, starting with the male (former) partner. The duration of the current or former relationship is immaterial and can range from a short to a long-term relationship. In total, DyRiAS Intimate Partner comprises 39 items.


Multi-Agency Risk Assessment Conference (MARAC) 16

A MARAC is a meeting where information is shared on the highest risk domestic abuse cases between representatives of local police, health, child protection, housing practitioners, Independent Domestic Violence Advisors (IDVAs), probation and other specialists from the statutory and voluntary sectors. They talk about the victim, the family and perpetrator, and share information. The meeting is confidential. Together, the participants write an action plan for each victim. At the heart of a MARAC is the working assumption that no single agency or individual can see the complete picture of the life of a victim, but all may have insights that are crucial to their safety.

Please note that different risk assessments tools are used in different countries. Please consult the national pages on risk assessment:

Italy, Germany, Sweden, Greece and Austria




3. Cooperation between Agencies with Focus on the Health Sector

Description: The video introduces the fictional domestic abuse case of ‘Rita’. It shows how the cooperation with other professionals can look to support Rita best.
Case study: Domestic violence has a negative impact on children

Gabby married her husband Nick after a long relationship and shortly thereafter moved to her husband’s family farm. The couple was happy at the farm and soon had their first child. During the pregnancy Nick’s behaviour began to change and by the time their daughter was born the relationship did not ‘feel’ as it had before. Nick seemed withdrawn and spent long periods of time by himself. He began to remind Gabby of Nick’s father who had always been a stern presence in his life.

Nick’s behaviour became threatening and controlling, especially in relation to money and social contact. He was increasingly aggressive in arguments and would often shout and throw objects around the room. Gabby thought that, because he wasn’t physically hurting her, his behaviour did not qualify as abuse. Nick did not show much interest in their daughter, Jane, except when in public, where he would appear to be a doting and loving father.

Jane was generally a well-behaved child, however, Gabby found that she was unable to leave her with anyone else. Jane would cry and become visibly distressed when Gabby handed her to someone else to be nursed. This was stressful for Gabby, and also meant that her social activities were limited further.

Jane took a long time to crawl, walk and begin talking. Her sleeping patterns were interrupted, and Gabby often did not sleep through the night, even when Jane was over 12 months of age. When Jane did begin to talk, she developed a stutter, and this further impeded her speech development. Gabby worried about Jane a lot. Their family doctor told her that this was normal for some children and that, if the speech problems persisted, she could always send Jane to a specialist at a later date.

After a number of years, Nick’s behaviour became unacceptable to Gabby. During arguments he would now hold on to the rifle that he had for farming purposes, and Gabby found this very threatening. On a number of occasions, items that Nick threw hit Gabby and she was increasingly afraid for their daughter. Gabby decided to leave and consulted the local women’s service, who assisted her to get an intervention order against Nick.

Once Gabby had taken Jane away from Nick, her behaviour changed. Jane’s development seemed to speed up and Gabby couldn’t understand why. As part of her counselling at a local women’s service, she discussed this issue, and her counsellor recognised the developmental delay, stutter, irritation, and separation anxiety as effects of Jane’s previously abusive situation.

This can be seen as a missed opportunity for identifying family violence. If the family doctor would have asked Gabby or Nick (who had presented with chronic back pain) about their relationship, about what was happening to the family, and specifically to Jane, the situation could have been identified much earlier.

Task for reflection

a) What could have been done better by those involved?

b) Take a moment to consider which agencies and professionals should have been involved in supporting and/or providing services to Gabby from the beginning.

c) Make a list of different professionals who make up the multidisciplinary team in your organisation and who could be involved in the provision of services for those who have experienced domestic violence (this will vary depending upon where you are based).

The wide range of professionals, provider services and specialist agencies who may be involved in supporting victim-survivors of domestic violence can include—but are not limited to—primary and secondary health care services, mental health services, sexual violence services, social care, criminal justice agencies, the police, probation, youth justice, substance misuse, specialist domestic violence agencies, children’s services, housing services and education.

Adapted from a case study from RACGP (2014): Abuse and Violence: Working with our patients in general practice


Healthcare professionals hold significant responsibility in recognising and addressing instances of domestic violence. Five key themes contribute to preparing healthcare practitioners to tackle DV effectively:

  • Demonstrating commitment;
  • Embracing an advocacy mindset;
  • Building trusting relationships;
  • Engaging in collaborative teamwork;
  • and Receiving support from the healthcare system.

These elements form the basis of the CATCH Model, which stands for Commitment, Advocacy, Trust, Collaboration, and Health System Support.

The CATCH Model and the Stages of Change model can serve as valuable resources for trainers aiming to design educational programs that cater to varying levels of readiness to engage in this work effectively. Additionally, these models can aid managers and program leaders in the field of domestic violence to comprehend both the strengths and potential resistance within their workforce.


4. Criminal Procedure in Cases of Domestic Violence

In the criminal procedure for cases of domestic violence, several essential steps are followed to ensure a thorough and just response.

  • Domestic violence occurs: Firstly, the process typically begins when an incident of domestic violence occurs within a domestic or familial setting or in a (former) relationship. This can involve various forms of violence, including physical, psychological, sexual, digital, or financial.
  • Report: The reporting of the incident is often made by the victim or a concerned party, and it serves as the formal initiation of the legal process. Reporting can be a challenging decision for a victim, and the victim’s decision not to report, should be respected. However, reporting the violence can be an important step toward seeking assistance and holding perpetrators accountable. In some European countries, for example in France, the police investigation continues even when the victim does not wish to make a report.
  • Documentation: The documentation involves gathering statements from the victim, witnesses, and the alleged perpetrator. In addition to verbal accounts, officers may collect physical evidence, such as photographs of injuries, and secure any relevant documents or objects that could be used as evidence in court.
  • Support: Simultaneously, victims are offered immediate support and protection. This can include medical attention for injuries, counselling services, or shelters to ensure their safety. Social workers or support organisations may become involved to address the emotional and practical needs of the victim during this challenging time.
  • Investigation: A critical phase in the process is the investigation stage. Law enforcement agencies conduct a thorough examination of the case, with the goal of building a comprehensive case file. This entails gathering additional evidence, interviewing witnesses, and assessing the credibility of all parties involved. The aim is to determine whether there is sufficient evidence to support criminal charges against the alleged perpetrator.
  • Prosecution: Finally, if the investigation yields enough evidence, the case is referred to the prosecutor’s office. Prosecutors review the case and decide whether to file charges against the alleged perpetrator. If charges are filed, the legal proceedings move forward. This may involve court hearings, trials, and potential penalties for the accused, ultimately aiming to ensure justice, protect victims, and hold perpetrators accountable for their actions.

The following illustration shows the individual steps of the criminal procedure in cases of domestic violence and explains how they are connected:


5. National Criminal Procedures

Criminal procedures do vary nationally. This is highlighted exemplarily by the criminal procedures in cases of domestic violence applied in Austria, Germany, Greece, Hungary, Italy, Finland, France, Portugal, Spain, and Sweden:


6. Excursus: Domestic Violence in Times of Disasters 19

 Description: The video highlights the influence of disasters on the rate of domestic violence.

Quarantine, restrictions, closed schools, home office, short-time work, financial worries, and fear of the future – all these factors have the potential to cause increased stress in relationships and family life. It is therefore suspected that there has been and will continue to be a significant increase in violence at home. As on example how disasters can have an impact, COVID-19 is presented here as case study.

Some risk factors for an increase in domestic included:

  • Health and mental health problems increased during a lockdown situation, as health-related services are only accessible to a limited extent. This had a negative impact on the health status of individuals, increase their stress levels and often resulted in an increase in violent assaults.
  • Economic insecurity or unemployment is accompanied by financial worries can reinforce destructive coping mechanisms.
  • Violence always has to do with power. In times of crisis and isolation and the associated feelings of helplessness, loss of control and powerlessness, violence is supposedly a means of regaining control and power.
  • Language barriers, closures of contact points or the fact that social workers are only present on site to a limited extent due to the protective measures can made access to support services considerably more difficult.
  • Victims were also reluctant to take advantage of support services for fear of contracting COVID-19.
  • Social distancing can limit the social contacts of individuals to such an extent that victims may not dare to seek help without the closeness and encouragement of caregivers. Similarly, caregivers, acquaintances, or outsiders, such as employers or educational staff, do not become aware of the problem and cannot act as supporters. On the other hand, neighbours are more alert and present and, due to the initial restrictions, must be considered a protective factor.20
Domestic violence during the COVID-19 pandemic in EU countries 21

During the COVID-19 pandemic, an increase of domestic violence was reported in EU countries.

Reports to the police are often received with some delay or not reported at all. Also, incidents are more often reported by people victims relate to. Also, the COVID-19-related restrictions prevented reporting because of the lack of social contacts. Therefore, more cases than usual may have stayed undetected. As a result, it can be assumed that there is a high number of unreported cases.

This logic can explain why, in addition to an increase in reported cases of domestic violence in many areas, there was a decrease in numbers in others. This could be due to the fact that the perpetrator was always present at home so that the victim had no opportunity to call for help and/or report a crime without risking an escalation.

The document “The COVID-19 pandemic and intimate partner violence against women in the EU22 offers a preliminary overview of the measures undertaken across the EU to support victims of violence during the COVID-19 outbreak (from March until the end of September 2020). It identifies examples of promising practices and provides initial recommendations for the EU and Member States on how to better support victims during the pandemic, as well as in other potential crises.

Recommendations to combat and better detect domestic violence during the pandemic

The lockdown measures to contain COVID-19 in spring 2020 also brought the issue of domestic violence increasingly into the public and police attention.

It was reported in the media, in politics and by NGOs that under COVID-19 conditions, especially women and children experience increased violence. The European Institute for Gender Equality (EIGE) has also supported calls for the EU and its Member States to use the COVID-19 pandemic as an opportunity to step up their efforts to protect women’s rights. 23

The World Health Organisation (WHO) and UN women have underlined the importance of data collection during the COVID-19 pandemic, which is a crucial tool to mitigate adverse effects on women and girls affected by violence, and to develop prevention strategies for future crises. For the future, it is crucial that research provides immediate and longer-term policies and practical responses. 24 25

The following recommendations were phrased:

  • Law enforcement authorities must ensure that domestic violence incidents are given high priority and that the manifestations of violence associated with COVID-19 are addressed.
  • The health sector must always ensure that victims of domestic violence have access to sexual and reproductive health information and services.
  • Social sector support services should provide more online crisis support services such as hotlines and chats. Emergency care/day care services should be extended to all families – not only to parents working in systemically important jobs.
How can victims of domestic violence be supported during a pandemic?
  • If victims of domestic violence do not want to turn to the police or help services because they do not trust state institutions or have already had bad experiences, the first step out of the violent situation can be taken with help lines or chats if this can be done safely at home. Further help is possible afterwards.
  • It is important that victims are always made aware that the blame never lies with them, and that what is happening is wrong. A clear statement and condemnation of domestic violence in the media – especially in times of pandemics – helps those affected to seek further support.
  • Concerns about the economic consequences after separation can make it difficult for victims of domestic violence to find a way out of their situation. Some victims are financially dependent on their partner, for example because they are no longer able to go to paid work due to caring for family members and childcare, or because they were dismissed in the course of the COVID-19 pandemic. Some countries, like Germany, have a functioning system of assistance to alleviate financial hardship for victims of domestic violence after a separation. This is not the case in other countries.
  • Written information on violence in intimate relationships and domestic violence should be available in public spaces in the form of posters and brochures or leaflets which are made available in private areas such as washrooms (with appropriate warnings not to take them home if the perpetrator is there). Offering a QR code that leads to a website with further information can help. The posters, brochures or leaflets should be aimed at female and male victims of domestic violence and not use stereotypes. The designation of concrete contact persons on site and the provision of telephone numbers of counselling centres or websites offering (anonymous) counselling can help victims of domestic violence to seek help.
  • In case of acute threat, victims should call the police emergency number. They should state their name, address, further information and, if necessary, the perpetrator’s possession of a weapon, and emphasise that help is needed immediately. Until the police’s arrival, victims and any children should take themselves to safety, for example to neighbours or shops.

Sources

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