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Violence against Women: A literature
review commissioned by the National Group to Address
Violence Against Women
4. Responding to violence against women
The starting point for this report is the assumption
that all forms of violence against women are linked.
However, the research literature focuses mainly on discrete
aspects of violence against women, with different aspects
attracting attention within different fields.
This section of the report reviews research which
assesses the effectiveness of interventions to address
violence against women, identifies some of the gaps in the
literature, and attempts to assess how far what has been
learned about one aspect of violence against women can be
transferred to another.
4.1 Responding to rape and sexual
assault
4.1.1 The criminal justice system
response
The reporting and subsequent investigation and
prosecution of rape and sexual assault are the focus of
much of the available research literature on the subject,
particularly in Britain. As already indicated, the
establishment of specialist police units in Scotland to
deal with sexual assault dates back to the mid 1980s, and
followed highly publicised research which critiqued
existing police practice (Chambers and Millar, 1983). The
trend towards specialism in this area continued throughout
the 1990s, and is now standard across the Scottish police
forces. Although the model varies slightly from one force
area to another, key components include dedicated interview
suites, specialist officers, and a 'victim-centred'
approach. In some areas there is also a dedicated forensic
suite.
Practitioners acknowledge that there have been
significant improvements in the police response to rape and
sexual assault complainers over the last 20 years
(Christianson and Greenan, 2001), and this is supported by
research. A study of 23 women in Sussex who had reported to
the police between 1991 and 1993 found that 57% of them
felt mostly positive about the response of police officers,
while 43% were mostly negative about the response of police
officers (Temkin, 1997). None of the women, including those
who felt negative about the service overall, felt that they
were disbelieved, or that the police were 'heavy-handed '
in their approach. In addition, the majority of the women
(19 out of 23) valued the manner and attitude of the police
officers who dealt with them. For the women who were
'mostly negative' about their experience with the police,
poor follow up, difficulty accessing information,
disbelieving attitudes and insensitive handling were the
main features of their complaints about the service.
Temkin concludes that "the believing, sympathetic,
non-judgmental attitude of the police, the unpressured pace
and supportive manner in which their statements were taken,
the access which they had to police officers and to
information thereafter and the help and backing they
received...during the course of the investigation and
afterwards" were the main reasons for women feeling
positive about the experience of reporting (Temkin, 2001:
524). Follow-up, she maintains, continues to be a problem,
particularly in the area of information on the progress of
the case.
These findings are similar to those from a survey of 48
women who reported to police in New Zealand between 1990
and 1994, in which 40% of the women expressed some degree
of satisfaction with the police response, and 38% were
dissatisfied (Jordan, 2001). The author acknowledges some
of the difficulties inherent in measuring 'satisfaction'
with a process which by its nature is bound to be
distressing. She notes:
"Because rape is such an intense and sensitive area,
when the police act with professional caring and
demonstrate their respect for the victim, this is
noticeable and greatly appreciated. When such qualities are
lacking, however, their absence is also very noticeable."
(Jordan, 2001: 696).
She goes on to explore the balance to be struck between
the need (of women) for the process to be manageable, and
the need (of police officers) to focus on the end result of
that process:
"...at the very time that a raped woman is seeking to be
believed and validated, the police will be intent on
obtaining proof and verification that she is telling the
truth. Her need for validation may clash with the police
search for verification, and the techniques used by the
police in their quest for evidence may threaten and
undermine her sense of confidence and safety in them. While
she struggles to regain a sense of autonomy following the
rape, the police feel they as professionals must retain
control of the proceedings." (Jordan, 2001: 701).
Jordan asserts that the achievement of a sense of
control over the proceedings need not be achieved by one
party at the expense of the other. Citing Temkin, she notes
the value women place on belief, respect for the
complainer, and a non-judgmental approach by the police
(Jordan, 2001).
Recorded crime statistics for Scotland show a steady
increase in the reporting of rape (Scottish Executive,
2003). This picture is similar in England and Wales (Harris
and Grace, 1999; HMIC/HMCPS, 2002) and across Europe (Regan
and Kelly, 2003). However, in none of these jurisdictions
has the increase in reported rapes been matched by an
increase in prosecutions or convictions. In fact, the
conviction rate for rape has fallen during the period in
which the reporting levels have risen (Harris and Grace,
1999; Regan and Kelly, 2003).
In an attempt to identify some of the reasons for this,
the Home Office requested a joint inspection by HM
Inspectorate of Constabulary and HM Crown Prosecution
Service Inspectorate into the investigation and prosecution
of rape cases. Their report was published in April 2002.
The terms of reference were:
"...to carry out an analysis of investigations,
decision-making and prosecutions of allegations of rape,
from initial report through to case disposal."
(HMCPSI/HMIC, 2002: 2).
The review covered all offences of rape against women,
men and children. In relation to the investigation stage,
the key findings echo some of the research findings already
discussed, included the need for consistent training of
police officers and forensic examiners, and improvements in
the physical environments in which interviews and
examinations take place. In addition, the review identifies
partnership working with other agencies (e.g. through
dedicated sexual assault referral centres) as key to
improving the response to victims. Improved and
standardised recording systems, and a review of timescales
needed for submission of files to the Crown Prosecution
Service are identified as the main administrative
improvements required.
Although the report does not consider the role of
forensic examiners in detail, it does note the limitations
on choice posed by the lack of female forensic examiners,
and the implications of forensic examiners learning 'on the
job' rather than through accredited training programmes.
The report considers that quality of forensic evidence is
crucial to effective prosecution of rape and sexual
assault, increasing the likelihood that prosecution will
happen, and that a conviction will result (HMCPSI/HMIC,
2002). In addition, it is suggested, any measures which
reduce the trauma of the investigative process for
individual women are to be welcomed, improving not only the
likelihood of achieving a conviction, but also the woman's
recovery rate following a sexual assault. This view is
supported elsewhere in the literature (Campbell et al,
2001; Kelly and Regan, 2003).
In a study commissioned by Rape Crisis Network Europe
(RCNE), Kelly and Regan reviewed recent literature on the
conduct and outcomes of forensic examinations. They
identify some of the key elements of good practice in
relation to forensic examinations, emphasising "the rights
and dignity of the victim" (Kelly and Regan, 2003: 6).
These include "speedy response; avoiding the triage system
in hospital A&E departments; a private dedicated space;
a well equipped examination room; trained and skilled
practitioners; female examiners; a streamlined
victim-centred information gathering process; time to move
at the speed the victim/survivor is comfortable with;
protocols and evidence kits which are applied flexibly,
according to the facts of the case; space to discuss the
process, debrief and undertake crisis intervention, and
provision of, or links to, medical follow up and
advocacy/support services." (Kelly and Regan, 2003: 12)
These conditions, they argue, are crucial, both to the
quality of the evidence gathered, and to the comfort and
health of the complainers (Kelly and Regan, 2003: 12). In
their subsequent review of five different approaches to
forensic examination, they note that the use of trained
doctors is one of the more common models. They identify a
number of difficulties inherent in this approach, including
problems with recruiting women doctors, the need for
participating doctors to take on a generic forensic role,
thus perhaps limiting their knowledge about sexual assault,
and problems with limited availability of doctors at
certain times. They also suggest that there may be limited
co-ordination and integration across the services, and an
absence of advocacy and support.
Some of these issues are addressed by the use of
forensic nurses, who have a more extensive role in
providing healthcare advice, advocacy and support to
complainers, in addition to evidence gathering and
providing forensic reports for the courts. This model is
widely used in North America and has several advantages,
including a higher degree of specialism, cost
effectiveness, and a more holistic approach to health
intervention following sexual assault (Kelly and Regan,
2003; Ledray, 1999).
A holistic approach is also found in the provision of
Sexual Assault Centres, which in Canada are designed to
"attend to the medical, emotional, social and medico-legal
needs of clients in a prompt, professional, and
compassionate manner and to provide leadership in the
prevention of sexual assault" (Du Mont and Parnis, 2002,
cited in Kelly and Regan, 2003: 15). These are usually
hospital based, often attached to accident and emergency
facilities, with a dedicated examination room and possibly
interviewing facilities. There are several examples of
similar centres in England, including The Haven, a referral
centre based in a sexual health setting which provides
forensic examination and sexual health follow up in
southeast London (Kerr et al, 2003), and the St Mary's
Centre in Manchester, which was the first such centre in
England. As yet, there are no such facilities in Scotland,
although discussions are ongoing in Glasgow about how such
a service might be developed (Dutton and Cavanagh,
2003).
Kelly and Regan conclude by identifying the key
components required in order to begin developing minimum
standards:
"Privacy through the development of dedicated rooms,
or a centre;
Philosophical principles underpinning practice that
emphasises respect, dignity, rights and choice;
Enhancing forensic practice through capacity
building - both the number of trained examiners (often
through involving nurses) and their skills base;
Access to female examiners;
Ensuring that even if people have to wait for a
medical practitioner, that a staff member is available
to greet them, take them to the more private rooms, and
explain their rights and what may happen next;
Linking provision of immediate medical care,
forensic examinations, crisis and short term
counselling, follow up medical care and advocacy;
Combining service provision with training, awareness
raising and system advocacy;
Leadership within the service, and some form of
community accountability;
Ensuring access is as wide as possible, and that
outreach efforts are targeted at under-served
populations."
(Kelly and Regan, 2003: 17)
Finally, they note the emerging debate about how far
forensic evidence actually influences the outcome of sexual
assault trials, citing Canadian research which demonstrates
that only documented injury appears to have a predictive
influence on convictions (Du Mont and Myhr, 2002; cited in
Kelly and Regan, 2003). Given the trauma for women
undergoing forensic examination, further research would
seem to be indicated in this area.
In another report for Rape Crisis Network Europe, Regan
and Kelly address the issue of attrition in reported rape
cases, raising serious concerns about the extent to which
convictions for rape have fallen across Europe, as shown in
their pan-European study (Regan and Kelly, 2003). They
maintain that this downward trend in conviction rates is
contrary to what might be expected, given the role of the
women's movement in raising awareness and challenging rape
stereotypes, the development of rape crisis lines and other
women's counselling projects, the development of training
and practice guidelines, increased media awareness and
legal reforms. However, they argue that it is symptomatic
of a situation in which rape has received little attention
compared with domestic violence and trafficking. The study
indicates that countries with adversarial legal systems
have the highest attrition rate - England and Wales,
Scotland and Ireland all have conviction rates below 10%.
At 6%, the conviction rate for rape in Scotland is second
only to that in Ireland.
The Justice ministries for the countries involved in the
study offered a range of technical and procedural 'barriers
to successful prosecution', including limited or absent
evidence, under-reporting or delayed reporting, lack of
support services, delays in court proceedings and 'limited
incentives for prosecutors'. The authors contend that,
despite a wide range of legal and procedural reforms which
have been enacted across Europe since 1980, there is still
an absence of good practice in enabling rape complainers to
give their best evidence or in supporting and protecting
"their dignity and integrity" during the trial process
(Regan and Kelly, 2003: 17).
Overall, they argue, rape is very much 'a forgotten
issue' on political and social policy agendas, attracting
neither the debate nor the resources which have gone into
highlighting domestic violence as a social policy priority.
They make a number of recommendations for change, including
the suggestion that research should be undertaken to
explore the points of attrition in rape cases and identify
possible reasons for the increase in attrition.
A small scale pilot study which addresses these issues
has already been undertaken in Scotland. The study
retrospectively tracked the progress of 191 complaints
involving sexual offences through the criminal justice
system, by examining crime reports, interviewing police
officers, examining fiscal files and interviewing
precognition officers and procurators fiscal. Two police
forces were involved, one urban and one rural, and seven
fiscal offices. Of a total of 47 cases which began as
complaints of rape, 17 did not progress beyond the police,
a further 15 did not progress beyond the fiscal, and of the
15 which went to court, eight resulted in a conviction
(Jamieson, 2001).
Although this seems an improvement on the 22% conviction
rate reported in an earlier study (Brown, Burman, Jamieson,
1992), Jamieson notes that more than half of the cases
which proceeded to court involved child complainers. A
further breakdown of the figures shows that of the nine
cases involving child complainers, five resulted in a
conviction, compared with only two out of the 14 cases
involving an adult complainer. Although Jamieson comments
on the range of reasons given in police crime reports for
not proceeding, including withdrawal of the complaint,
false allegation, and no known suspect, she does not
identify any one area of police procedure as particularly
problematic. In relation to cases marked 'no proceedings'
by the procurator fiscal, she suggests that the basis for
deciding there is 'insufficient evidence' might bear
further exploration. Acknowledging that the fiscals
interviewed all maintained that decisions should be made on
the basis of sufficiency of evidence, and not on the
credibility of the complainer, she nonetheless notes:
"In the case files we examined, we formed the impression
that judgements about credibility were most often recorded
in cases in which there is equivocation about the
sufficiency of the evidence." (Jamieson, 2001: 80).
The HMCPSI/HMIC report also notes concern about the role
of the complainer's credibility in cases where there is
limited evidence, and in particular "...found that the
prosecutor's approach too often tended to be one of only
considering any weaknesses, rather than also playing a more
proactive role in seeking more information and trying to
build or develop the case." (HMCPSI/HMIC, 2002: 9). Amongst
a raft of measures outlined in the subsequent Action Plan
it is noted that revised guidance on rape has already been
made available to prosecutors, and that a revised training
package for sexual offences will be commissioned. In
addition, it is noted that the CPS agrees with the
recommendation that rape cases should be handled by
specialist prosecutors, and that consideration is already
being given to how to implement this.
There have been some significant changes in the
legislative response to rape and sexual assault over the
past three years in Scotland. A recent Lord Advocate's
reference on the definition of rape clarifies Scots law and
makes it clear that rape is based on an absence of consent,
and does not require the use or threat of force. The
introduction of the Sexual Offences (Procedure and
Evidence) (Scotland) Act 2002 prohibits the accused in
sexual offence trials from conducting his own defence, and
tightens the restrictions regarding use of sexual
history/character evidence. The Solicitor General has
recently announced a review of the prosecution of rape and
sexual offences in Scotland. All of these initiatives might
be expected to improve the treatment of rape complainers
and hopefully the attrition rate. Regan and Kelly (2003)
recommend that governments evaluate recent and new legal
and procedural reforms. A precedent has been set in
Scotland with the evaluation of the Protection from Abuse
(Scotland) Act 2001, and it would seem that this exercise
would bear repeating in relation to the recent sexual
offences legislation.
A search of the literature produced little from Canada
on rape or sexual assault. As noted earlier in this report,
Canada has no specific offence of rape, having made the
shift to a broader 'sexual assault' spectrum of offences in
the early 1980s. In a recent overview of the Canadian
experience, Hague et al note that this creates some
difficulty in trying to compare reporting and prosecution
of rape in Canada with experiences in the UK, as the
figures available from Justice Canada provide the totals
for all sexual assaults, across all three of the levels of
sexual assault defined in law, and with no distinction made
between offences against children and offences against
adults (Hague, Kelly and Mullender, 2001).
The legislative reform in Canada also included the
removal of the requirement for corroborative evidence in
sexual assault cases. In practice, however, it would seem
that prosecutors are still reluctant to proceed with cases
which do not have some form of corroboration (Du Mont and
Myhr, 2000, cited in Krug et al, 2003: 170).
Hague et al note with some surprise a decline in
reported sexual assaults over the five years before their
report, and with some disappointment the absence of the
kind of detailed data that is available on 'family
violence' from Statistics Canada (Hague, Kelly and
Mullender, 2001). It would seem that in Canada, as in
Europe, rape and sexual assault are 'forgotten issues',
despite the best efforts of women's advocacy services.
4.1.2 Supporting survivors of rape and sexual
assault
Rape crisis centres have provided support services for
rape and sexual assault survivors in Scotland since the
1970s. In common with similar services in other parts of
the world, centres were usually based on a feminist
political perspective, with support provided 'by women, for
women'. The support aimed to be woman-centred,
non-judgmental and non-directive. It was free, and it was
confidential. The stated goal was to help the woman regain
control over her life, and support was delivered in ways
designed to enhance this:
"Most women have their initial contact with us through
the telephone. Women assaulted by men have had their sense
of control over their own lives and bodies destroyed. In
using the telephone a woman has the power over her contact
with us - by hanging up when she wants, by ringing back if
she wants, by making arrangements to meet face-to-face and
keeping or breaking them - she chooses the extent of her
involvement." (Edinburgh Rape Crisis Centre, 1981: 6).
The mechanics of service delivery varied from one area
to another, often dependent on funding. Where possible,
centres provided medical and legal advocacy for women, and
accompaniment through the criminal justice process. Until
the late 1980s, most centres were run entirely by
volunteers.
Believing women and validating their reactions to sexual
assault were core to the process. Challenging the social
norms of the time, rape crisis centres gave a clear message
to individual women and to the rest of society - women were
not responsible for rape, men were:
"When a woman has been raped she often encounters
disbelief and blame from all corners - family, friends,
police, doctors. She suffers from the fear that somehow she
contributed to the attack. Our acceptance without judgement
of whatever the woman wants to tell us can help begin the
process of banishing this guilt. We do not doubt or
question what she says." (Edinburgh Rape Crisis
Centre,1981:6).
Belief and unconditional acceptance continue to be
central to the ethos of rape crisis. In a recent handbook
on rape and sexual assault, "believe the woman" is still at
the top of the list (Rape Crisis Centre, Glasgow,
2003).
The basic philosophy has changed little over the last 20
years. The services, however, have changed and adapted,
partly in order to meet the requirements of funding and
regulatory bodies. However, change has also been prompted
by the demands of women using the services. Services which
were established around a 'crisis line' as the primary
source of support have shifted emphasis, as women making
contact with centres have developed more of an expectation
of receiving 'counselling', reflecting a wider public
acceptance of counselling than was the case in the early
days of the movement (Christianson and Greenan, 2001). Rape
crisis centres today are more likely to offer face-to-face
support routinely, using a formal appointment system (Rape
Crisis Scotland, 2003). Centres also develop their services
in response to the needs of particular women, for example
women asylum seekers and women working in prostitution
(Rape Crisis Scotland, 2004).
Although some centres carry out in-house evaluations of
their service, usually based on feedback questionnaires
from service users, there has been little formal or
independent evaluation of the rape crisis response to
survivors of rape and sexual assault anywhere. One U.S.
study which sought the views of rape survivors on the
responsiveness of services following an assault found that
75% of women rated their contact with rape crisis centres
positively (Campbell et al, 2001). Elsewhere, the same
group of authors note that evaluation of rape crisis
services in the U.S. has come hand-in-hand with increased
dependence on State funding (Riger et al, 2002), and
suggest that this link to funding requirements is
instrumental in creating tensions between practitioners and
programme evaluators. They go on to advocate an evaluation
approach which is more holistic, with a focus on best
practice, as well as best value; on accountability as well
as accounting (Riger et al, 2002).
Consistent with this view, Rape Crisis Network Europe
(RCNE) has developed a set of 'best practice guidelines'
for NGO's working with women who have experienced sexual
violence. Their report, based on information drawn from
their membership, outlines a good practice model based on a
political understanding of sexual violence as an abuse of
power (RCNE, 2003), and the need, therefore, for a
politicised response to it. This underpins all aspects of
the work to be undertaken. Client-centred, accessible
services, working with each woman to identify what she
needs and then helping her to find appropriate support for
her situation, are seen as core elements. The involvement
of women who are survivors of sexual violence in the
delivery of the service is also seen as important,
demonstrating to women who are still in crisis that they
can survive and be strong again. Evaluation of services is
seen as crucial, through information gathered from service
users, but also through regular networking and contact with
other centres to share elements of good practice (RCNE,
2003).
Linked with the delivery of direct services to women is
the perceived need to work for change in the societal
values and attitudes which allow sexual violence against
women to be perpetuated. The report identifies campaigning
for legislative and social policy reform, public education
work, research and training as essential components of a
strategy to improve service responses to women who have
experienced sexual violence (RCNE, 2003).
Some of the elements of the 'best practice' approach
identified in the RCNE guidelines are shared by many other
services involved in supporting survivors of rape and
sexual assault. Outwith the voluntary sector, mental health
services are the main source of support, therapy and
counselling for survivors. Campbell (2001) reviewed the
available literature, primarily from the U.S., on the
effectiveness of different interventions used by mental
health practitioners. She notes that most of the research
has been conducted with white women (and by implication
middle class women), because in the U.S., this is the group
which accesses mental health services. The findings,
therefore, may not reflect the experiences of minority
ethnic women or working class women. Citing Wyatt (1992)
she notes that African American women are perhaps more
likely to use informal support systems, i.e. family and
friends, but goes on to suggest that more work is needed to
provide a fuller picture of why minoritised groups are less
likely to access mental health services (Campbell,
2001).
Campbell's review acknowledges that, in general, there
is a need for more research which evaluates interventions.
The existing body of research focuses primarily on
cognitive behavioural therapy (CBT) and feminist therapy.
CBT approaches are primarily used to help women deal with
the immediate aftermath of an assault, particularly in
response to the high levels of fear or anxiety they may
experience. Feminist therapy is utilised more as a response
to the longer term difficulties of women who have been
raped, particularly in relation to guilt and self-blame.
Although noting the value of CBT techniques in reducing
anxiety and fear, she questions whether there is any
evidence that they are as helpful in reducing self-blame
and guilt. Feminist therapy, she suggests, may be a more
effective intervention in relation to guilt and self-blame,
since it encourages the woman to see her experience in the
context of societal inequalities, not as her individual
problem. In practice, she acknowledges, mental health
workers are likely to use a combination of these
approaches, since they will be seeking to address both
short and longer term difficulties (Campbell, 2001).
In an effort to identify what kind of intervention was
helpful to women, Campbell et al surveyed 102 women
survivors of rape in Chicago, examining the impact of a
range of service responses, or lack of response, on their
psychological and physical health outcomes (Campbell et al,
2001). The services considered included the legal system,
medical/forensic services, mental health services, rape
crisis centres and religious groups
14. Over half of the sample found contact with the legal
system 'hurtful' rather than 'helpful', and although 47% of
those who sought medical attention found it 'healing',
almost a third found it 'hurtful'. In contrast, the
majority (over 70%) of survivors experienced interventions
by mental health services, rape crisis centres or religious
communities as 'healing'.
The study found that ethnic minority women and women who
had experienced 'acquaintance rape' had a particularly poor
response. Overall, the researchers concluded that "a key
focus on violence against women research and interventions
must be the prevention of secondary victimisation."
(Campbell et al, 2001: 1253). They recommend three
approaches to achieve this - an increased involvement of
rape crisis services; increased training for all service
providers, and the development of coordinated multi-agency
responses.
4.1.3 Developing a multiagency response to rape
and sexual assault
A recent report on the subject of multi-agency responses
to sexual violence suggests that the literature in this
area is largely descriptive rather than evaluative in focus
(Dutton and Cavanagh, 2003). The report, commissioned by
the Glasgow Violence Against Women Partnership, provides a
comprehensive review of the literature on multi-agency
models in Britain and the United States. The authors
examine the development of Sexual Assault Response Teams
(S.A.R.T.s) in the United States, noting that the model may
operate slightly differently in different parts of the
country. Generally there will be a degree of consistency in
the membership of the teams, which may involve a Sexual
Assault Nurse Examiner (S.A.N.E.), a representative from
the police or sheriff's office, a detective, a prosecutor,
a rape crisis advocate and staff from the emergency
department. Following examination by the S.A.N.E., a nurse
who has undergone specialist training in gathering forensic
evidence, the complainer is interviewed in the presence of,
usually, the S.A.N.E., the investigating police officer,
and a rape crisis advocate. From there on, the S.A.R.T.
will maintain contact throughout the investigation and
prosecution process (Dutton and Cavanagh, 2003).
The original S.A.R.T. model, developed in California, is
built on the assumption of an immediate police involvement.
Subsequent adaptations have sometimes moved away from this
approach, arguing that women may feel under pressure to
report to the police. In addition, if they believe that
seeking help with injuries or other health concerns may
involve them in having to report to the police, some women
will avoid accessing healthcare services, and thus miss out
on screening for sexually transmitted infections and
pregnancy (Ledray, 1999). However, in all S.A.R.T.
derivatives, the principle of providing a coordinated
response is unchanged, simply the range of services
involved (Dutton and Cavanagh, 2003).
Dutton and Cavanagh raise a justifiable concern about
the lack of evidence to support the view that S.A.R.T. and
S.A.N.E. initiatives are 'best practice' in responding to
survivors of rape and sexual assault. Advantages of
S.A.N.E. schemes are said to include - better collaboration
with law enforcement, higher reporting rates, shorter
examination time, better forensic evidence collection, more
complete documentation and improved prosecution rates
(Ledray, cited in Dutton and Cavanagh, 2003). However, no
substantial empirical study has yet been carried out.
Although rape crisis centres in the U.S. are now
routinely involved in S.A.R.T.s, there have been
significant periods of tension and debate during the
development of these multiagency responses. The campaigning
and political lobbying work of rape crisis centres has
undoubtedly played a massive role in increasing awareness
of sexual violence and challenging the myths and
stereotypes which abound about women and rape. In the
process, rape crisis centres have raised women's
expectations that they should be able to access services if
they are raped, leading to a steady increase in the numbers
of women approaching services. The pragmatic response to
this is to seek the most efficient way to deliver services.
The involvement of statutory service providers in
developing this response has inevitably meant the loss of
much of the political focus of the early work, as the
emphasis has shifted from 'stopping violence to managing
rape' (Matthews, 1994).
Similar tensions have followed the development of Sexual
Assault Referral Centres (S.A.R.C.s) in the U.K. There are
currently four S.A.R.C.s in England, with plans for more.
Based on a medico-legal response to rape, none of the
centres involve rape crisis or other women's groups.
Counselling is provided by professional counsellors, and
the services are 'gender neutral', i.e. providing services
to all adults.
In summary, Dutton and Cavanagh identify some common
themes in the development of multi-agency responses to
women survivors of sexual violence. They note that services
are "primarily instigated by statutory service providers;
primarily based on medico-legal service provision;
gender-neutral in the provision of services" (Dutton and
Cavanagh, 2003: 75). Their over-riding conclusion is that
there is "a significant lack of research examining the
effectiveness of these initiatives" (Dutton and Cavanagh,
2003). In the light of this, a forthcoming evaluation of
the U.K. S.A.R.C.s is to be welcomed.
15
4.2 Responding to women working in
prostitution
"Some of the questions about prostitution cannot be
resolved by research, since they are fundamental questions
about the kind of society one wishes to see, how one
understands gender equality, and what it means to sell
sex."
(Bindel and Kelly, 2004: 1)
Although there is little dispute that women working in
prostitution are at significantly higher risk of being
physically or sexually assaulted than women in the general
population (Farley and Barkan, 1998; Farley and Kelly,
2000), there are different degrees of understanding or
acceptance of prostitution as violence against women. For
some there is a distinction to be made between 'forced
prostitution', including trafficking, and women 'choosing'
prostitution as an occupation (Butcher, 2003). Others
assert that the harm caused to women by prostitution should
define it as a form of violence against women ( Farley and
Kelly, 2000; Miller and Jayasundara, 2001). The nature of
policy and practice responses to women in prostitution is
determined largely by which of these positions is
adopted.
4.2.1 The criminal justice system
response
Policy and legislative frameworks play a significant
role in determining the focus of responses to women working
in prostitution. In Scotland, the focus of the criminal
justice system has been largely reactive, working from a
'crime management' perspective which defines women in
prostitution as offenders, more likely to be arrested than
the men who buy sex from them. The imposition of fines adds
to the debt many women are working to repay, they may then
be jailed for non-payment of fines, and the debt problems
are then exacerbated. In the meantime, women who are
assaulted while working in prostitution may be reluctant to
report assaults to the police because they can then be
arrested on outstanding warrants. Thus women's experiences
as victims of male violence remain largely invisible
(Women's Support Project, 2002).
Looking for ways to change this situation, the Routes
Out Partnership recently commissioned a review of legal
responses to prostitution in four countries. The review
assesses current and past approaches to prostitution in
Victoria (Australia), Ireland, the Netherlands and Sweden;
identifies the rationale for the changes made in each
country's position and assesses the impact of the changes
on women involved in prostitution and the men who use them.
The countries studied utilise one of three regimes -
Victoria and the Netherlands have both moved to
legalisation involving state sanctioned brothels, Ireland
has adopted a regulatory approach, and Sweden has moved to
a position of criminalising the buying of sex and
decriminalising the selling of it (Bindel and Kelly,
2004).
In the state of Victoria, Australia, and in the
Netherlands, legalisation of prostitution is primarily
focussed on licensed brothels; some aspects of street
prostitution are still illegal. The rationale for adopting
this approach can be seen, in part, as being about removing
the 'nuisance' element of street prostitution by providing
a state sanctioned indoor environment. The provision of a
'clean' and safe environment is also seen as an advantage,
improving the sexual health of prostitutes (and the men who
use them) and breaking the links between prostitution and
organised crime (Bindel and Kelly, 2004).
The authors comment that this does not appear to be the
case in practice. In both Victoria and the Netherlands,
there is still evidence of strong links between organised
crime and prostitution, along with a significant increase
in the number of licenced and unlicenced brothels. Police
and local authorities have inadequate resources to enable
effective monitoring of which brothels are operating
without licences, and in the Netherlands, it is noted that
the expansion of 'legal' prostitution has been matched by a
similar expansion in 'illegal' prostitution. Women working
in prostitution are still stigmatised, and many continue to
work illegally because they do not want to be officially
recorded as prostitutes (Bindel and Kelly, 2004).
'Regulation' of prostitution involves a mix of
approaches including responding to the 'nuisance' aspect of
prostitution and/or adopting an unofficial position of
tolerance. The goal is 'management' by maintaining public
order, rather than 'prevention'. Implementation of a
regulatory approach in Ireland since 1993 has not resulted
in any discernable weakening of the links between
prostitution and organised crime. It has, however, had a
negative impact on women, as the powers given to the police
to deal with public soliciting have primarily been used
against women, rather than customers and pimps (Bindel and
Kelly, 2004).
Sweden passed legislation in 1999 which made it a
criminal offence to buy any form of sexual services, in
line with an overall policy on gender equality which
determined that ending prostitution rather than managing it
must be the goal. At the same time, the provision of sexual
services by women was decriminalised, and their status
shifted from 'offender' to 'victim'. Linked with the
legislation is a commitment to increasing the resources of
police and prosecutors to deal with it, along with the
development of drug rehabilitation programmes and exit
strategies for women. Street prostitution in Stockholm has
subsequently reduced by two thirds. This is seen by the
Swedish government as a long term project, with the goal
not only of reducing the numbers involved in prostitution
but also of changing public attitudes. In the meantime, the
decriminalisation of women working in prostitution, and the
consequent freedom from the cycle of arrest/fine/jail, has
removed at least one barrier to women's ability to leave
(Bindel and Kelly, 2004).
The researchers, while noting that "Virtually no
evaluation of overall approaches has been undertaken...",
go on to suggest that the evidence that does exist "does
not commend a legalisation approach." (Bindel and Kelly,
2004: 31). They conclude that the Swedish model is the most
coherent "in terms of philosophy and underpinning" and note
with interest that it is the only model of those reviewed
which does not criminalise those who sell sex (Bindel and
Kelly, 2004: 32).
In Scotland, the debate has polarized further, and more
publicly, since 2002, when a private member's bill
introduced by Margo McDonald MSP proposed that local
authorities should be allowed to establish prostitution
'tolerance zones' in designated areas. Although the Bill
fell at committee stage, it generated considerable debate.
The Scottish Executive established an Expert Group on
Prostitution to review the available evidence on effective
responses to prostitution. The group met for the first time
in August 2003, and has already heard evidence from
different parts of Scotland. The group has also
commissioned a piece of consultative research to gather the
views of women working in prostitution, both indoors and
outdoors.
Meanwhile, the Bill has been resubmitted and is
currently being reconsidered by the Local Government and
Transport Committee. Written evidence submitted to the
committee reflects the polarisation of the current debate
in Scotland about what constitutes an appropriate response
to prostitution. Supporters of the Bill argue that the use
of tolerance zones increases the safety of women working in
street prostitution by enabling them to work within sight
of each other. This view, they argue, is supported by a
noted increase in the number of attacks on women working in
street prostitution in Leith (Edinburgh) since the
'unofficial' tolerance zone was dropped. Prostitutes
themselves, it is argued, support the introduction of
tolerance zones, and as a matter of human and civil rights,
their views should be given consideration (ScotPep,
2003).
Those opposed to the Bill argue that this view makes the
assumption that women want to work in prostitution. If this
is taken as a given, then obviously women will want any
measure which promises a degree of safety. They also
dispute the evidence on increases in attacks on women when
tolerance zones are removed, citing a report by Base 75, an
agency in Glasgow which provides support services for women
working in prostitution, which shows no difference in the
numbers of attacks reported to them by women before and
after the introduction of 'sensitive policing' in Glasgow
city centre (Routes Out Partnership, December 2003).
The Bill is still in progress. The Expert Group is
expected to report on Stage 1 of its remit (on street
prostitution) in Autumn 2004.
4.2.2 Supporting women abused in
prostitution
Good practice in responding to women working in
prostitution is identified in a guide originally published
by the Franki Women's Support Project in Bolton, and
subsequently adapted and published by the Women's Support
Project in Glasgow. The guide highlights the need for
realistic interventions, based on an understanding of the
harm caused to women by prostitution, but recognising that
for women, making the decision to leave prostitution may
not be a simple or straightforward choice (Women's Support
Project, 2002). A range of services and interventions may
be required at different points in this process.
It has already been noted that prostitution impacts
negatively on all aspects of women's health (Farley and
Barkan, 1998). The medical literature, however, focuses
predominantly on the prevalence and prevention of sexually
transmitted infections in women working in prostitution,
and pays scant regard to their wider health needs (Baker,
Case and Policicchio, 2003). Health interventions,
therefore, have tended to focus more on the threat to
public health posed by women working in prostitution,
rather than on the health needs of the women themselves.
Although practice in this area is clearly beginning to
change, with an increasing focus on the broader health
concerns of women working in prostitution (Routes Out,
2003), there is still little to be found in the research
literature which goes beyond "condoms and safer sex
negotiation skills" (Farley and Kelly, 2000: 22).
There is a similar lack of research on what works in
advocacy and support services for women working in
prostitution. The Home Office Crime Reduction Programme
funded 11 pilot projects addressing prostitution until
March 2002. Three of the pilot projects focussed on young
people, three on policing, and six on 'exiting and
support'. Of the latter, two of the pilots identified a
reduction in the number of people entering or an increase
in the number of people exiting prostitution as a primary
goal. The remainder primarily focussed on reductions in
kerb crawling, soliciting and 'associated nuisance', or a
range of other 'harm reduction' indicators (Home Office,
2001). An evaluation of the pilot studies is pending.
4.2.3 Developing a multi-agency response to
prostitution
The Routes Out Partnership was established as a thematic
social inclusion partnership in Glasgow in 1999, with the
aim of improving and coordinating responses to women
working in prostitution in the city. Membership of the
partnership board reflects the diversity of agencies
involved in responding to prostitution and women working
therein - the police, the health board, the local drug
action team, social work and other council services, and
the women's voluntary sector.
Routes Out is based unequivocally on the principle that
prostitution in any form is harmful to women, and works
towards preventing women, particularly young women, from
becoming involved in prostitution, and providing viable
alternatives to women who wish to leave prostitution. It
is, in effect, a demonstration project, testing an approach
which involves crisis intervention and short term
initiatives to support women who are still involved in
prostitution, and longer-term interventions to support
women who are leaving prostitution (Routes Out, 2003).
The Partnership is supported by a range of agencies,
including Base 75, which provides a range of services at
evening drop-in clinics, including methadone prescribing,
and access to accommodation. Rape Crisis in Glasgow has
been funded to develop a specific project 'Supporting Women
Abused through Prostitution'. The Routes Out Intervention
Team is funded through the Partnership to assist women to
achieve some stability, before beginning to identify what
they may need to do to be able to leave prostitution
(Routes Out, 2003).
4.3 Responding to survivors of child sexual
abuse
4.3.1 The criminal justice system
response
There has been an increasing focus in the last two years
on the prosecution of cases of child sexual abuse involving
child witnesses
16. Changes in the procedures relating to child witnesses
in such cases are to be welcomed, and will hopefully
improve both the process and the outcome of sexual offences
trials involving child witnesses. However, despite a noted
rise in the numbers of adults reporting historical cases of
child sexual abuse to the police (Scottish Executive,
2003), no research has been identified which examines the
investigation and prosecution of historical abuse
complaints.
What is known from practitioners, and from survivors, is
that the increase in reporting is not matched by an
increase in prosecution of historical cases. The chief
reason for this is likely to be insufficient evidence. Lack
of forensic evidence and the absence of witnesses are
common barriers to prosecution across all forms of violence
against women. Additional factors in historical abuse cases
include the length of time which may have elapsed, and the
implications of this for the reliability of the memories of
witnesses. The age of the alleged abuser may also be
significant, as the procurator fiscal must consider whether
it is in 'the public interest' to prosecute if the accused
is very elderly, and/or or very frail. Prosecution is most
likely to proceed, and to result in conviction, in cases
where there are two or more complainers reporting similar
incidents involving the same accused. Even then, defence
advocates may succeed in demonstrating inconsistencies in
their narratives, making it difficult for a jury to convict
'beyond reasonable doubt'.
Broader measures designed to address the needs of all
victims of crime obviously have relevance for adult
survivors of child sexual abuse. For example, should a
complaint survive the investigative process and be referred
for trial, it is likely that the complainer will be defined
as a 'vulnerable witness', given the nature of the offence
and the levels of fear which they may still have in
relation to the abuser. As such, there may be an
entitlement to the range of special measures which have
recently been introduced to ease the experience of giving
evidence in such cases
17. This, however, will be of limited value until some of
the prosecution difficulties are resolved.
4.3.2 Supporting adult survivors of child
sexual abuse
In Scotland, as elsewhere, the earliest responses to
adult survivors of child sexual abuse came from within the
voluntary sector, and in particular from rape crisis
services. From the early 1980s, increasing numbers of women
making contact with rape crisis centres were disclosing
childhood abuse by family members. Incest survivor groups
and campaigns developed out of these early contacts, and by
the 1990s, several new voluntary organisations had been
established with a specific remit to provide services for
survivors of childhood sexual abuse (Christianson and
Greenan, 2001). In addition to providing support and
counselling services for individual survivors, these
organisations have also advocated for the development of a
more consistent response from the statutory sector.
Most voluntary organisations provide a service which
could broadly be described as client centred and
non-directive. Support may be provided face to face and/or
by telephone. In some organisations, all support is
provided by paid staff; in others, volunteers may provide
the support, with supervision from a paid staff member.
Support may be open ended, or time limited. Some
organisations also run support groups for adult survivors
of child sexual abuse.
Evaluation of the service is generally carried out
in-house, as part of the routine evaluation and monitoring
of the organisation's work. Occasionally, organisations are
funded to carry out a more formal evaluation of particular
aspects of their work. More often, though, evaluation is
seen as a necessary part of the evidence gathering required
by funders, both private and public. At times, it may be
limited to an assessment of satisfaction with the services
provided, rather than a measure of outcomes or change for
individual women (Riger et al, 2002).
4.3.3 The health service response
As might be expected from the documented impact of child
sexual abuse on mental health, adult women survivors of
child sexual abuse are significant users of mental health
services, both as inpatients and outpatients (Mennen, 1990,
cited in Thomson, 1998). Survivors also access general
primary care services, both as a result of chronic physical
health difficulties and emotional distress.
Despite this, relatively little attention has been paid
in recent mental health policy developments to the specific
needs of survivors of child sexual abuse (Short Life
Working Group on the Care Needs of Survivors of Child
Sexual Abuse (SLWG), 2004). The Framework for Mental Health
Services in Scotland (1997) acknowledged that physical and
sexual abuse are detrimental to mental health, and that
responses to survivors of such abuse should therefore be
within the scope of extended primary care services. Since
then, more explicit attempts have been made to address how
mental health services in Scotland might best respond to
adult survivors of child sexual abuse.
Two Scottish studies have explored the experiences of
women survivors of child sexual abuse who have accessed
mental health services and other support services. Thomson
(1998) reported on the experiences of women who had
disclosed abuse in a range of settings, voluntary and
statutory. Nelson and Phillips (2001) focused on the
experiences of women survivors of child sexual abuse who
had been inpatients at one Edinburgh hospital.
Thomson interviewed 19 women about their experiences of
service responses to their disclosures of child sexual
abuse. Common themes included the importance of
confidentiality, establishing trust, having the time and
space to talk, and the need for professionals to have more
awareness of the impact of sexual abuse on women's lives.
Common difficulties encountered by women included long
waiting lists, and consequently long delays between their
initial disclosure of sexual abuse and being able to access
a service. Negative and/or disbelieving responses from
professionals were also a concern for women (Thomson,
1998).
Nelson and Phillips echo Thomson's findings to some
extent, with similar negative experiences of responses to
disclosure reported by many of the 22 women interviewed.
However, where the Thomson study focuses primarily on the
process of disclosure and the reactions women experienced,
the more recent report provides a more detailed analysis of
what women found helpful in responses from workers and
services, and how far these responses assisted their
recovery (Nelson and Phillips, 2001). In particular, this
report highlights that for many survivors of sexual abuse,
the levels of awareness and attitudes of staff, as
characterized by their willingness to ask about child
sexual abuse, are more important than any particular
theoretical perspective (Nelson and Phillips, 2001).
A recent survey of clinical psychologists working in the
Greater Glasgow area sought information about their
awareness of the prevalence and impact of child sexual
abuse and their practice in the detection and management of
sexual abuse issues. The survey also addressed the level of
training psychologists had undertaken and the degree of
confidence they felt in working with clients who had been
sexually abused (Biggam and Johnson, 2003).
Awareness of the prevalence and impact of child sexual
abuse was high, although the proportion of survivors of
child sexual abuse in the collective caseload was found to
be somewhat lower than the national average. In response to
questions about the range of therapeutic techniques being
utilized, 57% of the respondents (n=74) indicated that they
found cognitive behavioural therapy (CBT) helpful when
working with this client group. Significantly, 95% of the
respondents indicated that they were trained to use this
model, compared with only 23% who had been trained in the
use of other approaches (Biggam and Johnson, 2003).
The authors also reviewed the literature on
psychological interventions with survivors of sexual abuse.
Acknowledging the scarcity of studies on either individual
or group therapy approaches, they provide a useful overview
of some of the main methodological difficulties inherent in
designing research in this field. Most of the studies
reviewed used pre- and post-intervention testing to
identify changes in rates of depression, trauma symptoms,
self-esteem or other mental health indicators. Most found
significant improvements across these indicators. However,
citing Donaldson & Cordes-Green (1994), the authors
comment that "inherent weak research designs mean that such
changes cannot be definably attributed to the intervention"
(Biggam and Johnson, 2003).
Only one of the studies they reviewed on group therapy
used a comparison group (Alexander et al, 1989, cited in
Biggam and Johnson, 2003) and this absence of a control
group is one factor that weakens the other studies.
However, they also acknowledge the inherent ethical
difficulty of providing a therapeutic intervention to one
group of clients and withholding it from another. In
addition, they comment that the range of factors which may
contribute to the efficacy of group psychotherapy
interventions is extensive. This would include personal
characteristics of the clients and/or the therapist, the
level of competence and experience of the therapist, the
clients' commitment to the process, and whether clients are
also engaged in individual therapy.
A lack of reliable research on the effectiveness of
individual psychotherapy is also identified, with much of
the concern focused on similar weaknesses in research
design. However, Biggam and Johnson note that some of the
results are of interest, with an indication that "gains
were maintained across global and specific measures" in
three out of the seven studies of individual psychotherapy
interventions they reviewed (Biggam and Johnson, 2003: p
39).
Recent guidance on treatment choice in psychological
therapies suggests that cognitive behavioural therapies
have the most demonstrable benefit in the treatment of
depression, anxiety and post traumatic stress disorder,
three of the more common mental health sequelae of child
sexual abuse (Department of Health, 2001). However, the
guidance is framed purely around a symptomatic approach,
with no focus on the causes of mental health difficulty in
adults. There is therefore no specific analysis of the
efficacy of a CBT approach for survivors of child sexual
abuse, beyond short-term symptom alleviation.
4.4 Responding to domestic abuse
4.4.1 Criminal and civil justice
responses
Many aspects of the criminal justice system response to
domestic violence have come under scrutiny in Scotland and
elsewhere over the last two decades. Throughout the 1970s
and 1980s, domestic violence advocacy organisations
consistently identified the justice system's inadequate
response as the most significant barrier to women achieving
safety. Frustration at the perceived indifference of
police, prosecutors and judges was gradually matched by the
realisation that "the failure of the courts and police to
protect women was not simply a matter of an attitude on the
part of individual practitioners. It was a lack of legal
tools to intervene in a legal system that did not take into
account…the complexities of women's experiences in a
society in which citizens' access to resources and social
privilege is determined by their sexuality, race, gender
and class position.". This 'lack of legal tools'
contributed to low arrest rates, ineffective prosecution
and infrequent conviction (Pence and Shepard, 1999:9).
Attrition in domestic violence cases is still remarkably
high. A recent study in England found that of 869 domestic
violence incidents reported to the police, only 291 were
deemed to have a power of arrest attached. Of 222 actually
arrested, 60 individuals were prosecuted for criminal
offences. Ultimately, only 31 individuals were convicted,
and only four of those received custodial sentences. Three
police areas in Northumbria were studied, each with slight
variations in the policing approach adopted. The authors
note with concern that cases from the area which used a
'positive policing' approach, i.e. most likely to arrest,
were most likely to fail at court. The authors suggest the
need for a more consistent approach across police areas,
but also for this to be reflected in the courts (Hester,
Hanmer et al, 2003).
In Scotland, several aspects of the justice system
response to domestic abuse have been reviewed since the
publication of the
National Strategy to Tackle Domestic Abuse in
Scotland. The short-life working group established by
the Scottish Executive to review legislation related to
domestic abuse acknowledged the complexity of criminal and
civil law in this area, and recommended bringing all of the
legal remedies together in a single Act. The working group
also recommended that a feasibility study be carried out
into the practicalities of establishing a domestic abuse
court to provide a more cohesive judicial response. A pilot
domestic abuse court was subsequently proposed and is due
to be implemented in Glasgow.
Many women experience ongoing harassment and abuse after
leaving an abusive partner, and may resort to civil
remedies in an effort to protect themselves. The Protection
from Abuse (Scotland) Act 2001 (PFA Act) strengthened the
existing provision around the use of interdicts by allowing
powers of arrest to be attached to an interdict, regardless
of the relationship between the two parties; this provision
was previously only available as part of a matrimonial
interdict. An early evaluation of the Act suggests that
interdicts granted under the PFA Act are gradually
replacing common law interdicts. This in turn implies that
more people seeking protection by interdict are able to
access powers of arrest. However, the authors note with
some concern that awareness of the provisions of the PFA
Act is variable. Few of the women who responded to postal
questionnaires had heard of it, and some professionals were
unclear about the detail of the provisions. Training for
professionals is recommended, along with awareness raising
for the general public. The evaluation commenced
immediately after the Act was implemented, and the authors
suggest that it should be seen primarily as a 'scoping
exercise', with a recommendation that a more comprehensive
evaluation should take place (Cavanagh, Connelly and
Scoular, 2003).
For women with children, there may be further
difficulties if their partner has a right to contact with
the children. Research with survivors of domestic abuse in
England found that contact with children by a violent
ex-partner led to further abuse of the woman and/or the
children in 92% of cases. In cases where the partner
applied to the court for contact it was rare for this to be
denied, and even in cases where there were allegations of
physical or sexual abuse of the children, contact orders
which allowed direct visiting contact were granted in 75%
of the cases. The authors acknowledge that a broader piece
of research would be valuable, involving the children,
ex-partners and professionals involved in the
administration and monitoring of contact orders (Radford,
Sayer and AMICA, 1999). There is a lack of any empirical
research in Scotland on the use of contact orders in cases
where there has been domestic abuse, but the Scottish
Executive has recently commissioned research which should
address this gap.
The remainder of this section will explore some of the
key themes identified in the research literature in
relation to the policing and prosecution of domestic
violence, and the development of coordinated justice system
responses to domestic violence.
Policing domestic violence
In Scotland, there have been significant changes in the
police response to women reporting domestic abuse since the
publication, in 1990, of a Scottish Office circular to
Chief Constables which provided guidance for Scottish
forces on how to respond to domestic abuse. The guidance
indicated clearly that allegations of assault by a partner
should be investigated as thoroughly as any other assault,
and that where sufficient evidence existed, an arrest
should be made. The guidance also outlined steps which
should be taken to ensure the safety and welfare needs of
women and children were addressed as a priority (HMICS,
1997).
The thematic inspection by Her Majesty's Inspectorate of
Constabulary in Scotland which resulted in the publication
of
Hitting Home in 1997
18 reviewed the progress made since 1990 and made several
recommendations for further improvement in the Scottish
police forces' response to domestic violence. Some of the
recommendations would now be seen as standard in any
service review, on almost any issue - for example,
awareness training, the development of written guidelines,
and participation in local multiagency partnerships. Others
referred more specifically to organisational issues within
forces. The use of nominated officers was clearly
identified as beneficial, to improve the monitoring of
individual incidents and the provision of follow-up contact
to victims, and also in improving liaison with other
agencies. It was noted that, even in forces which had
designated domestic violence liaison officers, there was a
lack of clarity about who had responsibility for deciding
on further investigative action, and it was recommended
that this should be addressed. The use of statistics on
repeat victimisation as an aid to monitoring the
effectiveness of interventions was commended as an example
of good practice by one force, and the report recommended
that this should be adopted more widely. Concern was
expressed about the lack of information sharing in most
forces between officers dealing with domestic abuse and
those dealing with child abuse cases. This echoed a concern
about the lack of formal procedures in some forces for
sharing information about possible child protection
concerns with relevant agencies, in particular the social
work department and the Reporter to the Children's Panel
(HMICS, 1997).
On the whole, whilst noting the areas which merited
further attention, the HMICS report commended the Scottish
police forces for the improvements which had already been
made in response to the 1990 circular on domestic violence.
A subsequent study of police forces in England and Wales
reviewed the impact of organisational structure on police
responses to domestic violence, and focused specifically on
how Domestic Violence Officers (DVOs) were being deployed.
The report concurs broadly with the HMICS report on the
main areas requiring improvement, but is couched in more
critical terms, and notes in particular that:
"No single structure emerged as either more or less
problematic than any of the others. The problems related
less to the structure than to the status of domestic
violence work within forces, the level of commitment of
headquarters and divisional commanders, the clarity with
which responsibilities were defined and the effectiveness
of management arrangements." (Plotnikoff and Woolfson,
1998:41).
The authors suggested a range of measures which might be
adopted by police forces to overcome this, including the
establishment of performance indicators for domestic
violence, with associated reporting requirements from
divisions to force headquarters; the introduction of a
standard format for reports; clarification and
documentation of the responsibilities of key staff in
relation to domestic violence, and clarification of the
role of DVOs.
Both of these studies were designed to identify gaps in
existing police response to domestic violence. Based
largely on analyses of force policies and procedures,
examination of organisational structures and interviews
with serving officers, they provide a broad perspective on
the police response to domestic violence at the time. Both
studies take the position that responses to domestic
violence should be consistent with responses to other
offences, in terms of the standard of investigation,
recording and monitoring approaches, and identification of
the "lines of accountability" (Plotnikoff and Woolfson,
1998: 41). Although acknowledging that assaults by partners
are 'different', the route to improving the policing of
domestic violence in both of these studies is predicated on
ensuring that structural and procedural gaps are
filled.
A different approach was adopted in Leeds, where a 1997
study set out to evaluate a 'tiered' response to domestic
violence. This 12 month pilot project took place in the
Killingbeck division of West Yorkshire police, and aimed to
reduce repeat victimisation by providing a graded response
to domestic violence, with the police intervention
intensifying in response to repeat callouts to the same
woman, or the same perpetrator. The level of response was
determined by the number of times the offender had attended
in the previous 12 months, either in relation to his
current partner, or another woman. A first attendance
warranted a Level 1 response; one previous incident
triggered Level 2, and two or more previous incidents
triggered a Level 3 response. Although no formal risk
assessment approach was adopted as part of the project,
some men were assigned immediately to level 2 or 3, despite
no prior attendance, if the level of violence used
warranted a more intensive response (Hanmer, Griffiths and
Jerwood, 1999).
The range of interventions with the women included
issuing information letters; 'police watch' i.e. assigning
additional patrols in the neighbourhood following an
assault; 'cocoon watch' which involved neighbours, family
and friends in actively contacting the police to report
incidents; target hardening, i.e. improving the physical
security of the woman's home, and issuing panic buttons and
mobile phones. Simultaneously, a series of official
warnings and information letters would be sent to the
offender, and a graded response activated via the Crown
Prosecution Service (CPS) and the magistrates' court
(Hanmer, Griffith and Jerwood, 1999).
Responsibility for allocating the interventions rested
with a DVO, a sergeant who was appointed specifically to
progress this project. The volume of work increased during
the pilot study and a second DVO was appointed to cover the
last three months. It is worth noting that that this
increase in the volume of work for the project did not
represent an increase in the number of incidents reported,
but rather an increase in the number of incidents which
were accurately recorded as domestic violence incidents.
Recording was acknowledged to be poor at the beginning of
the project, with only 50% of domestic violence incidents
being accurately coded; this increased to 80% over the
lifespan of the project (Hanmer, Griffiths and Jerwood,
1999).
The twin focus on both women and men created "an
interactive crime prevention approach" (Hanmer, Griffiths
and Jerwood, 1999: 5) which sought to protect women by
"demotivating the offender" (Ibid: 6). The removal of any
responsibility from the woman for 'pursuing charges' gave a
clear message to both parties that domestic violence was a
crime and would be dealt with as such. Women interviewed
after receiving an intervention commented favourably on the
value of the pro-arrest policy, and gave feedback about the
effect it had on their partners. Women who received Level 2
or 3 interventions also noted that a strong verbal warning,
including the threat of arrest, could have a significant
effect, but that this was lost if not acted on upon at a
subsequent attendance. Level 2 and 3 women felt that the
'warning letters' sent out by the project were less
effective, easily dismissed by the men, although level 1
women felt they provided an authoritative condemnation of
their partners' actions.
The police watch component attracted some of the most
positive comments from women, who felt that the patrols
enhanced their safety. Some women reported favourably on
the presence of police patrols in their area, even where
the records indicated that this aspect of the response had
not been activated in their case. Very few women remembered
the 'cocoon watch' component, although those who did
generally regarded it as beneficial.
The sought for outcome in this project was a reduction
in repeat victimisation, and this was achieved. The project
was able to demonstrate that early intervention reduced
repeat offences, with only 25% of the Level 1 entrants to
the project (i.e. those for whom this was a first offence)
requiring a second attendance during the lifespan of the
project, and only 9% requiring a third attendance. By
comparison, of those who started at Level 2
19, 46% had a repeat attendance; and of those who started
at Level 3
20, 64% had a repeat attendance. Predictive factors for
repeat offences included a history of domestic violence
offences predating the project; arrest, with men who were
arrested being 51% more likely to re-offend
21, and the beat area the victim lived in, with women
living in high crime areas more likely to be repeat
victims. The issue of whether the couple was living
together at the time of the offence was not identified as
having statistical significance in determining the
likelihood of repeat attendances. However, it was noted
that offences were likely to be more serious (as evidenced
by a much higher rate of criminal charges being made) when
the woman was separated from the offender (Hanmer,
Griffiths and Jerwood, 1999).
The Killingbeck project represented an important step
forward in the development of a consistent evidence based
police intervention in response to domestic abuse. Factors
which contributed to its success included the focus on both
victim and offender; the involvement of all police
officers, rather than just specialist DVOs; improved
communication and co-ordination between the police and
related agencies, and 'low additional resource
implications' (Hanmer, Griffiths and Jerwood, 1999: 40). It
established reduction in repeat victimisation as a
performance indicator for tackling domestic abuse which was
both achievable and measurable, and demonstrated that
proactive policing could enhance women's safety. Crucially,
however, the project also demonstrated that arrest played a
less significant role in reducing repeat victimisation than
early and repeated police interventions (Hanmer and
Griffiths, 2001).
In the U.K., pro-arrest policies have been adopted
increasingly by police forces since the Home Office and
Scottish Office circulars of 1990. Such policies were in
adopted in North America from the early 1980s onwards, and
were seen as integral to a response which placed
responsibility for challenging abusive men with communities
rather than with individual women. The earliest proponents
of pro-arrest policies were agencies advocating for women
abused by their partners, acting on the rationale that
domestic violence should be treated no differently from any
other crime - where there was a sufficiency of evidence,
arrest should follow.
The police department in London, Ontario became the
first in Canada to adopt a pro-arrest policy in 1981,
implementing a recommendation by the London Co-ordinating
Committee on Family Violence (F/P/T Ministers Responsible
for Justice, 2003). Subsequently, a series of six studies
in the U.S., known as the Spouse Assault Replication
Program (S.A.R.P.), produced some conflicting results. The
first study, which took place in Minneapolis, was widely
cited as providing evidence that arrest was an effective
deterrent which reduced repeat offending. However, analysis
of the data from some of the subsequent S.A.R.P. studies
suggested that there was no, or minimal deterrent effect,
with some even suggesting that there might be an increase
in violence following arrest (Miller, 2003).
Research in Ontario following the adoption of the
pro-arrest policy found that charging men who had assaulted
their partners did reduce the violence (London Family Court
Clinic Inc, 1991, cited in F/P/T Ministers Responsible for
Justice, 2003). More recent analysis of the S.A.R.P studies
suggests that the impact of arrest may be different for
different perpetrators. It is more likely, for example, to
act as a deterrent to future offending if the perpetrator
is employed or has some status in the community than if the
perpetrator has nothing to lose. Individual offender
characteristics, such as age or previous criminal record,
may also be more significant than arrest as predictors of
repeat offending (Maxwell et al., 2001, cited in Miller,
2003).
Pro-arrest policies are not without critics. Some
women's advocacy organisations are concerned about the
removal of all control from the woman, although others have
argued that pro-arrest policies bring police response to
domestic violence into line with responses to other crimes.
Women themselves may have ambivalent feelings about the
efficacy or the desirability of arrest. Some women fear
retaliation, or that the arrest will have no effect on
their abuser; a belief which may be strengthened if he is
arrested then released with no further action. Arrest may
be seen as unhelpful by women who want the violence to
stop, but not the relationship. For others, it is the case
that the violence does indeed increase following an arrest
(Hoyle and Sanders, 2000). Black and minority ethnic women,
and others from "over-criminalised communities", may be
reluctant to involve the police if they fear racism against
themselves or their partner (F/P/T Ministers Responsible
for Justice, 2003: 18).
Other women welcome the removal of any suggestion of
responsibility for making the decision on whether their
partner should be charged. In a 1996 study in the Yukon,
85% of women whose partners had assaulted them believed the
pro-charge policy was positive, and 68% indicated increased
confidence in reporting future incidents (Department of
Justice Canada, 1996, cited in F/P/T Ministers Responsible
for Justice, 2003). A recent review of Canadian policies
and legislation on domestic abuse has reaffirmed a
commitment to the pro-charging policies currently in place
in Canadian provinces, in all cases where there are
reasonable grounds to believe that an offence has been
committed (F/P/T Ministers Responsible for Justice,
2003).
Studies in the 1990s examined the impact of coordinated
approaches to domestic violence, and found that arrest was
more likely to reduce repeat offending in those areas which
had adopted more integrated criminal justice approaches
(Steinman, 1990, cited in Shepard et al, 2002). This might
include proactive prosecution, consistent advocacy and
support for women through the whole criminal justice
process, and access to mandatory treatment programmes for
offenders (Tolman and Weisz ,1995, cited in Shepard et al,
2002).
Prosecuting domestic violence
In Scotland, the decision to prosecute is made by the
procurator fiscal, and is based on two key factors -
whether there is a sufficiency of evidence, and whether it
is in the public interest to proceed to trial. Two
independent sources of corroborative evidence are required
- in cases of assault, the statement of the complainer is
one source of evidence. Other sources might include
forensic evidence, medical reports, photographs of the
injuries sustained or the scene of crime, or the testimony
of other witnesses who saw or heard the assault. Taken
together, the evidence must demonstrate beyond reasonable
doubt that an offence was committed, and that the accused
person was the perpetrator of that offence.
In cases of assault by a partner, as in other cases of
violence against women, the presumption has been that the
woman herself is the main witness in the Crown case. The
nature of the crime means that eye witnesses are rare, or
reluctant to come forward. Children and young people are
often the main witnesses to assaults on their mothers, but
it may not be considered appropriate to call them as
witnesses in court. Corroboration may therefore be
difficult to find. Even where women have welcomed the
arrest and charging of their abuser, they may be unwilling
or unable to co-operate with the prosecution. The time
delay between arrest and trial can mean that they have
reconciled with their partner in the hope that things will
now change; or they may be pressured to 'withdraw the
charges' by the accused or his family. Whatever the reason,
the procurator fiscal must then decide whether to proceed
to trial with a 'hostile' chief witness (Barry, 2000).
In other jurisdictions, prosecution may proceed without
the woman's co-operation. In Canada, a 'pro-prosecution'
policy has applied in all provinces since 1986, i.e. cases
will be prosecuted where there is sufficient evidence,
regardless of the wishes of the individual complainer. In
practice, this means that the Crown must consider whether
to lead the case without the woman's testimony, taking into
account the strength of any other available evidence. It is
not generally considered appropriate to compel her to
testify, or to charge her with contempt if she doesn't
(F/P/T Ministers Responsible for Justice, 2003).
By reducing the number of withdrawals of charges, the
pro-prosecution policy aimed to reduce the attrition rate.
Early studies suggested that it was successful. 38.4% of
charges were dismissed or withdrawn prior to the
introduction, in 1981, of the pro-prosecution policy in
London, Ontario. By 1990, this rate had decreased to 10.9%
(F/P/T Ministers Responsible for Justice, 2003).
The policy also aimed to improve the co-operation of
women survivors with the criminal justice process. The
non-co-operation of survivors of domestic violence
continues to be a source of frustration for prosecutors
(Brown, 2000, cited in F/P/T Ministers Responsible for
Justice, 2003) but there are ongoing developments to
improve this position. A recent study identified the
availability of witness support and the use of video taped
evidence as the two most influential elements in
determining the co-operation of women (Dawson and
Dinovitzer, 2001, cited in F/P/T Ministers Responsible for
Justice, 2003).
In the U.S.A. the use of 'no-drop' policies has a
similar history, with different jurisdictions adopting
variations on this theme since the 1980s. The most rigidly
applied policies include the option of arresting and
jailing women who do not co-operate with the prosecution of
their abusive partner. More flexible approaches are similar
to the Canadian model, intent on prosecution where there is
sufficient evidence, but acknowledging the difficulties
some complainers may have in testifying (Ford, 2003).
As with mandatory arrest policies, pro-prosecution or
'no-drop' policies can be contentious. Although predicated
on the assumption that prosecution protects women, Ford
(2003) suggests that there is a lack of empirical evidence
to support this. Where there is evidence, as in a 2001
study which found that 'no-drop' policies did increase
convictions, he notes that further analysis identified a
significant degree of 'screening out' of cases which were
unlikely to gain convictions (Smith et al, 2001, cited in
Ford, 2003). Overall, he argues, 'coerced victim
participation' in domestic violence prosecutions has no
demonstrable impact on the safety of women in the wider
community, and may actively jeopardise the safety of the
individual woman it seeks to protect (Ford, 2003).
Work with domestic violence offenders
It is not within the scope of this report to review the
substantial body of literature on offenders. However, in
the context of domestic abuse, it is important to
acknowledge that 'making men visible'
22 is central to the effectiveness of the multi-agency
initiatives which are recognized as examples of best
practice. How far domestic violence offender programmes
actually improve the safety of women and children continues
to be the subject of debate. Research suggests that a
significant number of men attending probation programmes
refrain from violence in the short term but that this
impact diminishes over time (Burton, Regan and Kelly, 1998;
Dobash et al, 1996). Attrition is high (Burton, Regan and
Kelly, 1998) and sanctions for breaching probation orders
are not always implemented, although where they are, the
completion rate improves and recidivism appears to reduce
((Mullender and Burton, 2000).
The content and ethos of domestic abuse offender
programmes may vary considerably. Some programmes take a
therapeutic focus, others an educational focus. Most
involve a combination of inidividual work and groupwork. In
the U.K., most programmes are psycho-educational, and make
use of cognitive behavioural techniques combined with an
analysis of the gendered nature of domestic abuse
(Mullender and Burton, 2000). Minimum standards of practice
have been adopted by RESPECT, the National Association for
Domestic Violence Perpetrator Programmes and Associated
Support Services. Key principles for RESPECT would include
work with the partners of abusive men as an essential part
of any programme, and the need for programmes to be linked
to the overall community response to domestic abuse
(RESPECT, 2000).
Men's programmes in the U.K. are almost exclusively
court-mandated probation programmes. An exception is
'Working with Men', a project based in north Edinburgh and
initially funded by DAPHNE
23 to carry out a feasibility study into the development
of a voluntary intervention for men who have assaulted
their partners, or are at risk of doing so. A model of good
practice was developed as part of the initial study. This
involved practitioner training programmes on how to
recognise and respond to abusive men, the adaptation of an
existing men's programme, and the design of a suggested
referral pathway for a men's service. An overarching theme
was the integration of any voluntary men's programme into a
multi agency response to domestic abuse. The project is now
funded by DASDF
24 to develop the model further (City of Edinburgh
Council, 2002).
Coordinated criminal justice responses to
domestic abuse
Probably the best-known example of a coordinated
criminal justice response to domestic abuse was developed
in Duluth, Minnesota from 1980. The Duluth model, as it has
become known, is sometimes assumed to apply only to the
development of education groups for abusive men, or even to
the 'Power and Control wheel' diagram which is used to
explain the dynamics of domestic abuse. In fact, it is a
pragmatic and methodical approach to developing an
interagency response to domestic abuse, involving both
individual advocacy and institutional advocacy. The
rationale for engaging in both of these approaches is
encapsulated in this definition given by an advocacy worker
from Duluth:
"When I advocate for an individual woman, I am trying to
help her overcome the many obstacles on her path to
effectively using the courts and police to protect her.
When I do systems advocacy, I am trying to build a new
path. I come to understand what I need to do in systems
advocacy by my work with individual women." (Pence, 2001,
in Renzetti et al, 2001: 329).
Based on eight key components (see table, below), the
Duluth model has been successfully replicated, with some
adaptation, in several countries, including New Zealand,
Australia, and the U.K. (Balzer, 1999; Holder, 1999).
Eight Key Components of Community Intervention
Projects
- Creating a coherent
philosophical approach centralizing victim safety
- Developing "best practice"
policies and protocols for intervention agencies that
are part of an integrated response
- Enhancing networks among
service providers
- Building monitoring and
tracking into the system
- Ensuring a supportive
community infrastructure for battered women
- Providing sanctions and
rehabilitation opportunities for abusers
- Undoing the harm violence to
women does to children
- Evaluating the coordinated
community response from the standpoint of victim
safety
(Shepard and Pence,
1999: 16)
The effectiveness of the Duluth model, in
its original form, can be attributed largely to the
coordinating and facilitating role played by the Domestic
Abuse Intervention Project. This independent non-profit
agency which was set up in 1980 with the specific goal of
providing that coordinating role (Pence, 1999). The size of
the city was also significant - with a population of just
85,500, this was a relatively small area, with a
correspondingly small network of criminal justice workers
and agencies. Finally, some of the key players in that
network were supportive of the initiative - in particular,
the police chief and the city attorney (Shepard and Pence,
1999). In the United States, these positions function with
considerably more autonomy than would be the case in this
country, and that too, undoubtedly facilitated the adoption
of new polices and procedures to support the development of
a coordinated response.
Elsewhere, use of the Duluth model has involved a degree
of adaptation to account for cultural as well as structural
differences. In New Zealand, the model informed the
development of the Hamilton Abuse Intervention Project,
with some changes to address the needs of Maori women and
men - in particular a commitment to service provision by
Maori staff, using materials which reflect the culture and
history of Maori people (Balzer, 1999).
In the Australia Capital Territory (ACT), the
Interagency Family Violence Intervention Programme, based
on the Duluth model, was initially established as a 12
month pilot, and has subsequently achieved impressive
results, including substantial increases in reporting,
arrests and guilty pleas
25. More importantly perhaps, 75% of 'victims of family
violence' who were contacted 12 months after proceedings
were finalized reported that they felt safe/fairly safe.
Only one person had been further physically assaulted in
that period (Humphreys and Holder, 2002).
The Australian project has involved significant levels
of institutional change, and its success is attributed
largely to effective change management processes. The
Duluth model is acknowledged as a significant influence,
although a note of caution is sounded about the need to
avoid a 'one size fits all' assumption (Holder, 1999).
In the U.K., the Domestic Violence Intervention Project
in Hammersmith took on elements of the Duluth approach in
the development of twin services focused on 'supporting
women and challenging men'. The project evaluation is
positive about the benefits of both the Women's Support
Service and the Violence Prevention Project which provided
education groups for abusive men. However, project staff in
the Women's Support Service acknowledged that they had had
less of an impact in the area of 'institutional advocacy'
(Burton, Regan and Kelly, 1998).
The Women's Safety Unit (WSU) in Cardiff is central to a
recent development in the U.K. of a criminal justice
intervention which aims, like the Duluth model, to address
all facets of the criminal justice system. The goals of the
WSU include increasing the number of women seeking help;
increasing the numbers of arrests, charges and convictions;
the extension of appropriate services to women and
children, and a reduction in repeat victimisation. The Unit
provides advocacy and support for individual women, and
works closely with the police and the CPS as part of an
interagency approach designed to improve the safety of
women and children. 1150 women with 1482 children were
referred to the project over the first 14 months. An
evaluation of the project included interviews with 222
women who had attended during that period (Robinson,
2003).
South Wales Police have adopted a pro-arrest policy,
along with a Police Watch initiative based on the
Killingbeck three tier intervention in West Yorkshire. The
combination of the pro-arrest policy, Police Watch and
liaison with the Women's Safety Unit are credited with a
36% reduction in repeat victimisation. Multi-Agency Risk
Assessment Conferences (MARACs) have also been initiated,
and these are seen as further enhancing the potential for
co-operation between agencies and reductions in repeat
victimisation of women (Robinson, 2003). An evaluation of
the MARACs has been commissioned, and publication is
imminent.
Initially, the CPS in Cardiff agreed to designate a
specialist domestic violence prosecutor. This subsequently
proved to be unworkable (due to the workload) and it is now
agreed that all prosecutors must be able to effectively
prosecute domestic violence cases, and that they will work
closely with WSU staff. Domestic violence cases are heard
at Pre-Trial Review court on Mondays, and a WSU staff
member is always in court at this time. The presence of a
worker from WSU (usually the seconded police officer) is
seen as providing a valuable source of supplementary
information which can inform the decision making of
prosecutors about how to proceed with a case (Robinson,
2003).
Court procedures have also been reviewed. The court
process for domestic violence cases dealt with by the
magistrates' court has been reduced from 14 weeks to seven
weeks as a result of the streamlining which has taken
place. Cases which go to the Crown Court are also now dealt
with on Mondays, and since January 2003, there has been
agreement that only experienced full time judges will hear
domestic violence cases (Robinson, 2003).
Overall, there has been a steady decrease in the number
of cases discontinued, or in which the woman retracts. It
is surprising, then, to note that cases in which the WSU is
involved are more likely to involve retractions or be
discontinued, despite the assumption often made that
increased support for women will increase the likelihood
that they will stay with the criminal justice process. The
evaluation report speculates that this outcome may be due
in part to the severity of the cases being referred to the
WSU, but it is also noted that it is not clear whether the
WSU was contacted before or after women retracted - i.e.
prosecutors may be referring women to the WSU because they
(the women) have decided not to proceed. It may also be
that contact with the WSU means that women feel supported
in a decision not to proceed with prosecution, for a
variety of reasons, not least of which might be that
prosecution may not be in the best interests of the women
concerned (Robinson, 2003).
Justice system responses to domestic abuse continue to
evolve in response to changing perceptions of what is
required to protect the women who experience it and to
challenge the men who perpetrate it. There has been a
general trend towards greater understanding of the effects
and dynamics of abuse, and the implications of this for
women's ability to seek protection from the justice system.
The research reviewed suggests that pro-arrest and
pro-prosecution policies give a clear message that domestic
abuse is a criminal act, and have some impact on reducing
recidivism. However, the overall tenor of the research
literature is that these shifts in policy are most
effective when located in the context of a coordinated
justice system response to domestic abuse.
4.4.2 Support and advocacy services
In Scotland, as elsewhere in the U.K., Women's Aid is
acknowledged as the lead organisation providing support for
women experiencing domestic abuse, and several studies have
affirmed the value women place on the services offered by
Women's Aid (Hague and Malos, 1996; Sissons, 1999). The
best known aspect of the service offered by Women's Aid is
undoubtedly refuge provision. Recent research commissioned
by the refuge provision working group
26 notes that women who had accessed refuge were
particularly positive about the practical support provided
and the non-judgmental, empowering approach taken by
Women's Aid workers. The researchers also note, however,
that some women indicated that they would value a more
proactive approach by refuge staff - "You say if we need
support, just ask. But not all women are strong enough to
ask, so you should ask more often." (Fitzpatrick et al,
2003: 49).
Women's Aid in Scotland has tended to define the service
provided to women as either 'practical' or 'emotional'
support. Elsewhere, particularly in North America,
'advocacy' is more routinely referred to. It has been noted
by some researchers that there is a degree of confusion
about the distinction between 'support' and 'advocacy' for
women experiencing domestic abuse. Some service providers
use the terms interchangeably; others draw a clear line
between the provision of a direct support service and the
use of advocacy to ensure that an individual woman receives
the service she needs and to which she is entitled
(Sullivan and Keefe, 1999). This might involve providing
women with information about entitlement to services, and
liaising between women and the services they require (Kelly
and Humphries, 2001). A further distinction is made between
individual advocacy, which aims to facilitate access to
services for one woman, and systems or institutional
advocacy, which works at a more strategic level to address
the failure of institutions to respond appropriately to
survivors of domestic abuse as a group (Kelly and
Humphries, 2001; Pence, 2001; Riger et al, 2002)). Systems
advocacy may be framed around an issue of broad concern to
survivors, or it may be a strategy adopted as the result of
examining the situation of an individual woman in some
detail - "chasing an individual story down" (Burton, Regan
and Kelly, 1998:5).
This latter approach may be of particular value in
achieving change at a local level (Burton, Regan and Kelly,
1998), but can also be used to achieve broader policy
shifts. The campaigns run by Southall Black Sisters and
Justice for Women in support of Kiranjit Ahluwahlia, Sara
Thornton and Amelia Rossiter, women who had been convicted
of killing their abusive partners, played a significant
role both in raising awareness of the long term effects of
living with domestic abuse, and in facilitating the
acceptance of the defence of 'provocation' (Gupta, 2003).
Southall Black Sisters have also advocated consistently
since the late 1980s for changes in immigration rules. In
particular, they campaigned for changes to the 'one year
rule'
27 to ensure that women coming to the U.K. to marry are
not forced to remain with a partner who is violent (Joshi,
2003).
Advocacy, by its nature, presents a challenge to the
status quo. It is no surprise therefore, that the voluntary
sector has largely led the way in developing advocacy
responses to women experiencing domestic violence. Indeed
the earliest services for women experiencing domestic abuse
were those provided by support and advocacy organisations
in the voluntary sector, often acting to 'fill the gap' in
existing service provision. As an extension to this 'gap
filling' role, women's support and advocacy organisations
also took on the task of challenging the practice of
statutory agencies, demanding services and legal protection
for survivors of domestic violence (Pence, 2001). Kelly and
Humphries note that although individual social workers,
healthcare staff and even police officers take on the role
of 'advocate' for women, their ability to challenge may be
compromised by their role within a statutory agency (Kelly
and Humphries, 2001).
There has been relatively little research of either
support or advocacy interventions which examines outcomes
or efficacy (Kelly and Humphries, 2001; Sullivan and Bybee,
1999). A review of outreach and advocacy approaches to
women experiencing domestic violence identified only three
evaluated outreach or advocacy projects in the U.K. (Kelly
and Humphries, 2001). The picture is similar in the U.S.
(Abel, 2000; Sullivan and Bybee, 1999). Abel suggests that
this should not be surprising given the nature of the work,
which is largely based on crisis intervention and often
focused on women in refuge. She acknowledges that services
must inevitably be fairly open ended to meet the needs of
women in this situation, but notes that this creates
difficulty in designing outcome evaluations (Abel, 2000).
This is echoed in a recent evaluation of the Scottish
Domestic Abuse Helpline, which acknowledges that the
short-term transient nature of the contact with women
callers, as well as the focus on crisis intervention, makes
it difficult for helpline volunteers to ask women questions
to support an evaluation of outcomes. The evaluation
therefore focuses primarily on the processes involved in
running the helpline, and a statistical analysis of calls
received (Brown, 2004).
The Michigan-based Community Advocacy Project sought to
reduce women's risk of violence from male partners through
the use of a structured intervention programme delivered by
trained volunteer advocates. 278 women participated in the
study; all had been resident in the local refuge for at
least one night. Women were interviewed six times over a
two year period. The study was evaluated using a control
group approach - at the first interview, women were given a
sealed envelope which randomly assigned them either into
the group which would receive the intervention, or into the
control group. Women assigned to the control group were not
contacted again until the second interview, 10 weeks after
this initial contact. Women who received the intervention
(n=143) were supported by a volunteer advocate for 10
weeks; on average this involved two meetings per week, an
average of 6.4 hours per week. During that time, they
identified what was needed to achieve positive change,
including safety planning and accessing appropriate
protection from the criminal justice system, but also unmet
health, social and economic needs (Sullivan and Bybee,
1999).
All of the women, including the control group, were
interviewed again at 10 weeks, and then at 6-, 12-, 18- and
24 months. A range of formal test measures were used,
assessing the levels of physical or psychological abuse
women experienced, their quality of life, depression,
degree of social support available, effectiveness in
obtaining resources/accessing services, and women's
perceptions of their difficulty in obtaining resources.
Overall, the results were perhaps not surprising - women
who received the intervention experienced less physical
violence, and reported improvement in their quality of
life, levels of social support and feelings of depression.
25% of the women who received the intervention experienced
no further violence over the two years of the study,
compared with only 10% of the women in the control group;
both groups of women, however, experienced significant
incidences of further violence - 79% of the intervention
group and 89% of the control group (Sullivan and Bybee,
1999).
Although the Michigan project undoubtedly demonstrates
that the provision of advocacy increases women's safety,
the research design raises some questions about the ethics
of using a control group approach to evaluate interventions
to reduce violence against women. The random nature of the
control group selection implies that no risk assessment was
undertaken, thus excluding women in high risk situations
from a potentially life saving intervention.
Domestic Violence Matters (DVM) adopted a different
approach to evaluation. This pilot project ran in Islington
and Holloway (police divisions) in London from early 1993
for 32 months. The project aimed to provide crisis
intervention to women, enhance the criminal justice system
response, and promote interagency links and co-ordination.
Five civilian workers - four support workers and a
co-ordinator - provided crisis intervention between 10am
and 2am every day, including holidays. They were located
within a police station, and aimed to follow up all
domestic violence incidents within 24 hours of the incident
being reported to the police. They achieved this in 90% of
the 1542 incidents they responded to (Kelly, 1999).
DVM adopted a proactive approach to intervention,
maintaining contact with women following the initial
referral, rather than waiting for women to make contact
themselves. Although most (70%) of the referrals came via
the police, women also referred themselves. Over two thirds
of the referrals came outwith normal office hours,
confirming the need for out of hours services. As well as
general support, legal advice was provided in 86% of cases,
housing advice in 60%. Crisis planning was provided in 30%
of cases, and accompaniment to safe accommodation in 15%.
(Kelly, 1999).
DVM defined 'crisis' as "any point at which routine
coping mechanisms break down and the need or potential for
change is present" (Kelly, 1999: 15). Kelly suggests that
effective crisis intervention is about enabling change, and
explains,
"…change was not conceptualised by DVM solely in terms
of leaving or taking legal action…Rather it was much more
fluid and variable; the basic requirement being
only that it shift the dynamics of power and
control which underpin domestic violence in the woman's
favour; ensuring that she had more resources after
intervention than before it. This could be strengthened
resolve, accurate information, access to other agencies, or
a firmer alliance with the criminal justice system; often
it was a combination." (Kelly,999:16).
Thus the potential 'performance indicators' for DVM were
broad, qualitative and largely assessed by means of
feedback from service users. Questionnaires were sent out
to 789 people; 221 women responded, and two men
28. These initial questionnaires were completed either
within a week of first contact with DVM (32%), within a
month (30%) or more than a month later (38%). A further 23
women participated in a follow up interview - 14 of these
were interviewed 12 months after first contact with DVM,
and nine were interviewed six months after first
contact.
In the initial questionnaire, women identified the
immediacy of the response as one of the most positive
aspects of the service. 151 of the women gave specific
examples of how this had helped them, including comments
that it gave them space to explore options, information and
support with the practicalities of leaving, and affirmation
that their partner's behaviour was unacceptable. The
immediacy of the support was credited by some women as
having been crucial to their ability to talk about the
abuse - "If more time had lapsed I probably wouldn't have
talked to anyone about it", or to safeguard themselves -
"If the response had not been immediate I would probably
have taken him back." (Kelly, 1999: 29). The majority of
the women (62%) indicated that what they wanted most from
DVM was someone to talk to about what had been happening.
Few women, by comparison, wanted to discuss the
implications of arrest (13%) or prosecution (17%). Only 15%
of the women were still living with the abusive partner at
the point of completing the questionnaire, although 50% had
been living with him at the time of the incident. Of the 23
women who took part in the follow up interviews, only five
were still living with their partner, and there had been no
further violence or threats of violence against these five
women since their contact with DVM (Kelly, 1999).
The DVM approach was characterized by proactive crisis
intervention, with staff taking responsibility for making
and maintaining contact with women, rather than waiting for
women to initiate contact. Summarising women's views on
this approach, Kelly notes that:
"The importance of home visits and follow ups illustrate
very clearly that pro-active responses are neither resented
by women nor ineffectual; rather they appear to accelerate
a process of change in a manner which both at the time and
retrospectively are valued positively." (Kelly, 1999:
34)
The evaluation of Domestic Violence Matters has at the
heart of it women's perceptions of the service they
received, how it helped them to change their situation, and
what could have made it better. Service user evaluation can
go some way towards informing the future development of
individual services. Wider consultation with women
survivors of domestic abuse is rare, and where it exists,
there may be sharp distinctions between service providers'
perceptions of the degree to which they consult with women,
and women's perceptions of the extent to which their views
actually influence policy or service development (Hague,
Mullender and Aris, 2003). It is worth noting that at
present, only five of the local multiagency partnerships on
violence against women in Scotland indicate that they have
or are planning to establish some form of consultation with
women survivors
29.
4.4.3 The health service response
The involvement of women service users in the design of
services was one of the key recommendations of the Scottish
Needs Assessment Programme (SNAP) report on domestic
violence published in 1997. Identifying domestic violence
as "a significant public health issue" (SNAP, 1997: i), the
report noted that "between 260,000 and 700,000 women may be
experiencing domestic violence" (SNAP, 1997:i). The report
made several recommendations, covering the main policy and
practice developments which the authors identified as
necessary in order to improve the health service response
to domestic violence. These included staff training, the
development of a monitoring and recording framework, and
the development of guidelines specific to each health
service setting.
The recent publication by NHS Scotland of guidance for
healthcare staff on responding to domestic abuse
incorporates some of the recommendations of the SNAP
report. The guidance highlights the need for awareness
training for staff as a central component in developing a
more effective health service response to domestic abuse.
Recognising signs and indicators of abuse, supporting
disclosure by women, risk assessment and safety planning,
and the need for accurate record keeping are also addressed
(Scottish Executive, 2003).
The NHS Scotland guidance acknowledges the difficulty
women may experience in voluntarily disclosing that they
are experiencing domestic abuse. It also acknowledges the
value of early intervention. The question of how proactive
healthcare professionals should be in asking women whether
they are being abused by their partner is perhaps less
clear in the guidance, and this may be a reflection of the
ambivalence within the healthcare community as a whole
about the issue of 'screening' or 'routine enquiry' for
domestic abuse.
In the United States, screening has been recommended by
the American Medical Association and other professional
bodies since 1992, although professional groups may differ
in the particular approach they advocate (Family Violence
Prevention Fund, 1999). Despite the general support for
screening expressed in professional guidelines, resistance
to implementing screening protocols in the U.S. is still
widespread. A survey of 2,400 doctors from a range of
medical settings found that only 6% of the 1103 respondents
screened all their female patients (Elliott et al, 2002).
Barriers to screening included a perceived lack of
appropriate interventions (45%), concerns about offending
patients (33%), and simply forgetting to ask (41%). Lack of
time was cited by only 21% of the respondents (Elliott et
al, 2002).
The inconsistent application of a screening approach in
an emergency room setting is reported in a study from Ohio,
and a range of reasons for this were identified by the
researchers. Some members of staff felt it was not their
responsibility, others said they were not aware that they
were supposed to be screening. Some were clearly
uncomfortable about 'asking the question', while others
asserted that they "didn't not know where the forms were
kept". In addition, the researchers note that no data was
collected during night shifts. The researchers report that
they had gone to some lengths to ensure that staff were
aware of the study and the reasons for it, and that they
had spent some time preparing staff for the study through
the provision of films and written material. They suggest
that continuing education and training may assist with a
more consistent approach in the future (Heinzer and Krimm,
2002).
The findings of these studies are consistent with
experiences in Scotland and the rest of the U.K. Where
attempts are made to implement screening protocols, no
matter how selective, there is still a significant degree
of resistance from practitioners. Studies in Scotland of GP
responses to women concur with much of the North American
literature, with GPs identifying lack of time, lack of
appropriate services and concerns about offending women
with intrusive questions as significant barriers to asking
about domestic abuse (Cosgrove, 1998; McKie, 2002; Munro,
2001).
Similar concerns were raised by some of the participants
in a London study of midwives' perceptions of routine
enquiry in relation to domestic violence. A three hour
training session was provided to 145 midwives. They were
given information about the prevalence and consequences of
domestic abuse, how to administer a screening tool, and how
to refer women to local agencies. Although participants
were enthusiastic about the study, and saw it as relevant
to their work, they acknowledged practical difficulties
with implementing it. Time constraints and competing
priorities, both for the women (e.g. financial or social
difficulties) and for the midwives (e.g. the numbers of
women to be seen in a clinic, and the quantity of other
information which had to be shared with women during
appointments) were all identified as barriers to applying a
consistent approach to screening. Midwives expressed
concern about possibly placing women at greater risk as a
result of attempting to exclude a partner from a
consultation. They also raised concerns about their own
safety (Mezey et al, 2003).
Many practical problems associated with implementing
screening for domestic violence were identified. The
authors note that screening is time consuming, and that
there are logistical problems associated with creating an
appropriate and safe environment in which to 'ask the
question'. They also note that many of the participants
disclosed personal experiences of domestic abuse, and
comment on the impact this had on the way they engaged with
the study. For some it created an additional barrier to
implementing the screening tool; for others, their personal
experience appeared to enhance their ability to identify
signs of domestic abuse and respond appropriately. Much
appeared to rest on how far workers had resolved their
feelings about what had happened in their own lives (Mezey
et al, 2003).
The training provided before the study gave a clear
message that midwives were not expected to take on a
counselling role. They were asked only to identify and
assess the needs of women experiencing domestic abuse
before referring on to other agencies. In practice,
boundaries are harder to maintain than this. The process of
disclosure often involves more of a personal commitment
from workers than is implied in simply following a
protocol, and the reality is that 'asking the question' may
often involve more work than can be anticipated. The
authors of this study raise a question as to "the
practicality of domestic violence screening by NHS staff
within a busy clinical service", observing that as soon as
this study was ended, most of the midwives stopped asking
women questions about domestic violence (Mezey et al,
2003:751).
A great deal of the research on health interventions has
focused on the use of screening tools for domestic
violence, and in particular, barriers to implementation by
healthcare staff. More recently, two systematic reviews
have considered whether there is sufficient evidence that
screening leads either to appropriate intervention, or to
improved outcomes for women (Ramsay et al, 2002; Wathen and
MacMillan, 2003).
The first review, conducted by a U.K. based team of
researchers, sought to "assess the evidence for the
acceptability and effectiveness of screening women for
domestic violence in healthcare settings" (Ramsay et al,
2002: 314) and to this end reviewed three groups of
research studies. The first group explored the attitudes of
women and health professionals towards screening for
domestic abuse in healthcare settings. The second group
compared identification rates for domestic abuse between
health settings which used screening and those which did
not. The third group measured the outcome of interventions
with women who had experienced abuse. Studies included in
the third group were limited to those which provided a
comparison with a group of women who had received no
intervention. The inclusion criteria were strictly applied,
and a total of 20 papers were eventually reviewed, from a
starting sample of 2520 papers identified from a search of
three databases (Ramsay et al, 2002).
In relation to the acceptability of screening, across
the five studies reviewed in this category, 43-85% of all
women surveyed thought screening for domestic abuse was
acceptable (with women who had experienced abuse at the
higher end of that scale). Much lower percentages of health
professionals favoured screening, giving many or the
reasons already discussed above. On the whole, the nine
studies which assessed 'numbers of women identified' found
that more women experiencing domestic violence were
identified as the result of screening. However, the
increase tended not to be substantial, and there was some
evidence that improved identification was not sustained
beyond the period of the study (Ramsay et al, 2002).
The six studies which examined interventions with women
who had experienced domestic abuse were the most
contentious. The review is critical of the design of
studies, highlighting weaknesses in the methodology of
most, and in particular the absence of randomized control
trials, or any focus on qualitative outcome measures such
as 'quality of life' or improved mental health. Overall,
the reviewers found little evidence that any of the
interventions they considered were effective, and the main
conclusion of the review is that there is insufficient
evidence to support the use of screening at this time. They
suggest that more research is required to identify
effective healthcare interventions with abused women
(Ramsay et al, 2002).
A more recent review by two Canadian researchers looked
more specifically at primary health care interventions
designed to prevent further abuse of women. The review
identifies two main options open to primary care
professionals - identification of women, and referral to
appropriate agencies. In relation to the former, the
reviewers reach the same conclusion as Ramsay et al, i.e.
that no studies to date have demonstrated that screening
improves the outcome for women. The authors also note that
no research has been conducted to assess potential harm to
women as a result of screening (Wathen and MacMillan,
2003).
Overall, Wathen and MacMillan conclude that there is a
dearth of evidence based interventions in response to
domestic abuse either within a primary care setting or
beyond. They concur with Ramsay et al that there is a need
for further research, in particular to determine whether a
combination of screening by healthcare workers and
effective intervention would reduce physical and emotional
abuse of women (Wathen and MacMillan, 2003).
Neither of these reviews suggest that clinicians should
never ask women about domestic violence - the Canadian
review in particular stresses the importance of asking
questions to elicit information about domestic abuse when
there are indicators of it during routine history taking
(Wathen and MacMillan, 2003). Both reviews acknowledge the
importance of training for health professionals in raising
awareness of the impact of domestic abuse, and supporting
the development of effective interventions (Ramsay et al,
2002; Wathen and MacMillan, 2003).
Despite the acknowledged impact of domestic abuse on
women's health, the response of health services beyond the
treatment of immediate injuries is still largely confined
to identification and referral on to other agencies.
Furthermore, there is little quantitative research to
indicate whether either of these approaches are effective
responses to women. However, it is worth noting that,
despite the lack of a clinical evidence base for screening,
and despite the reticence of healthcare staff in
implementing screening protocols, the majority of women
want health professionals to ask about domestic violence.
In particular, women who have experienced domestic violence
want health professionals to 'ask the question' (Ramsay et
al, 2002; Taket et al, 2003).
4.4.4 Multiagency responses to domestic
abuse
The development of a multiagency response to domestic
abuse is now widely acknowledged as the most effective way
both to support and protect women and children who have
experienced domestic abuse, and to challenge male
perpetrators (Hague and Malos, 1996; Hague, 2001; Pence and
McDonnell, 1999; Scottish Executive, 2002). Some of the
features of multiagency criminal justice responses to
domestic abuse are addressed elsewhere in this report.
However, multiagency responses to domestic abuse may
encompass a much more diverse range of agencies, including
social work, housing, health, education and the voluntary
sector, in particular Women's Aid (CoSLA, 1998; Scottish
Executive 2002).
Individual practitioners from different agencies may
work very successfully together at an individual case level
without any formal interagency agreement. However, the
development of a consistent coordinated response is more
likely to be achieved when agencies engage in more formal
strategic partnerships (Moelwyn-Hughes, 1999). It is
crucial that multiagency partnerships on domestic abuse
move beyond simply defining the problem and identifying the
gaps in services. The development and implementation of
shared policies and procedures, the provision of
information and training for staff, and the establishment
of effective monitoring systems are all essential steps in
the process of ensuring that multiagency strategies to
tackle domestic abuse move from being statements of intent
to supporting the development of good practice (Gamache and
Asmus, 1999; Hague and Malos, 1996; Hague, 2001).
Although there appears to be a degree of agreement about
the key principles which underpin effective multiagency
work, the specifics will vary from one area to another. The
geography and demographics of an area, the number and range
of services involved, and the gaps in local service
provision will all play a role in shaping the development
and delivery of a multiagency response to domestic abuse
(Hague and Malos, 1996). The commitment of key personnel
within the partner agencies will also be significant.
Senior managers may not attend partnership meetings, but
their support is crucial to ensuring that proposed policy
and practice changes are adopted and implemented (Hague,
2001). The involvement of women's activist organisations,
including Women's Aid, in multiagency partnerships on
domestic abuse ensures that the safety of women and
children remains central to the process, and the impetus
for change is not diluted (Kelly, 1999).
Good practice examples of multiagency work to tackle
domestic abuse can be found in many areas, both in the UK
and internationally. The 'Duluth model' is widely
acknowledged to have provided a benchmark against which to
measure coordinated criminal justice responses. A central
component in the success of the Duluth initiative was the
establishment of an independent non-profit organization,
the Domestic Abuse Intervention Project (DAIP), to take on
the role of coordinating and monitoring the criminal
justice response to domestic abuse. The case tracking
approach adopted by DAIP to support this work is
undoubtedly very effective in identifying problems within
the criminal justice system.
The Duluth Model is resource intensive, and this has
been identified as a barrier to the adoption of the model
in other areas, particularly those with larger populations
(Hague, Kelly and Mullender, 2001). The London Coordinating
Committee to End Woman Abuse (LCCEWA), for example, has
been at the forefront of developing interagency responses
to domestic abuse, but has not gone down the case tracking
route. Instead, LCCEWA has developed an action research
approach, with a focus on short life projects with
achievable goals (Hague, Kelly and Mullender, 2001).
Membership of LCCEWA is diverse, and women's advocacy
organisations have played a central role in the development
and leadership of the Committee. Research interviews with
women who had sought assistance from services in London
suggests that the model is working - the majority were
satisfied with the response they got when making the
initial approach to services, regardless of which service
they approached first. They also reported that appropriate
referrals were made to other agencies. The researchers note
that with one or two exceptions, there appeared to be a
high level of awareness among service providers about the
range of relevant services which might provide additional
support to women and children (Grasely et al, 1999).
A review of multiagency initiatives to tackle domestic
abuse which was carried out in the mid 1990s found that
multiagency fora and partnerships had some difficulty in
identifying ways to evaluate the effectiveness of the work
they were doing. In part this may be due to a lack of
clarity about what, exactly, is being evaluated. It may
also be difficult to identify appropriate baseline data
against which to measure progress. Although there appears
to be a general concensus that the goal of any multiagency
response to domestic abuse should be improved safety for
women and children, in practice it seems that it is
difficult to demonstrate whether this has been achieved
(Hague, 2001).
Since then there has been considerable development in
the understanding of what is required to overcome some of
the barriers to effective multiagency work. In Scotland,
the commitment to working collectively and collaboratively
to tackle domestic abuse was reaffirmed with the
publication of the National Strategy on domestic abuse in
2001. Significantly increased resourcing of local domestic
abuse partnerships through the Domestic Abuse Service
Development Fund (DASDF) has accelerated the development of
local strategies and action plans. These have been
supported to a large extent by the increased resourcing
across Scotland of services for women and children affected
by domestic abuse. A recent evaluation of the impact of the
DASDF involved a postal survey of local partnerships.
Several respondents identified problems within their
multiagency groups, including lack of a shared agenda or a
shared understanding of the problem; differences in the
capacity of partner agencies, and therefore in their
ability to contribute at times to the work; and power
differentials between the partners, particularly between
statutory and voluntary sector members (Reid-Howie
Associates, 2003). It was not within the remit of the DASDF
evaluation to carry out evaluation of the individual
projects funded. It would seem, however, that some research
on the effectiveness of the current multiagency response to
domestic abuse in Scotland would be worth considering.
4.4.5 Responding to violence against women -
conclusions
There is a substantial body of literature on how
services respond to violence against women. However, there
is a significant quantitative difference between research
which focuses on domestic abuse and that which considers
other aspects of violence against women. In part, it must
be acknowledged that this is reflective of the much greater
numbers of women reporting domestic abuse, compared with
other crimes of violence against women. It may also reflect
the greater impact which domestic abuse has on service
provision, since a wider group of service providers have a
statutory responsibility to respond to domestic abuse than,
for example, to rape or sexual assault. This is not to say
that the needs of survivors of rape or sexual assault, or
survivors of child sexual abuse, are necessarily seen as
less valid than survivors of domestic abuse.
In theory, it should be possible to adapt responses to
women who have experienced domestic abuse to meet the needs
of survivors of other forms of male violence. However, the
possibility of adapting and replicating interventions is
rarely addressed in the literature, and only one research
study was identified which attempted to evaluate the use of
the same intervention with survivors of different types of
violence.
In summary:
- The research literature repeatedly acknowledges the
role of women's NGOs in the development of services
which are responsive to women's needs.
- Research focuses on discrete issues, although it is
recognised that women may experience more than one form
of abuse at more than one point in their lives.
- There is a lack of evaluative research in most
areas. More evaluation of responses to domestic abuse
has been carried out than of responses to other forms
of violence against women.
- This is perhaps reflective of the general picture
of services, which can be described as "patchy and
inconsistent", with substantially more service
development worldwide in response to domestic abuse
than there is to other forms of violence against
women.
- Different aspects of violence against women are
addressed in different areas of the literature.
- Research on interventions with rape survivors is
primarily focussed on medico-legal responses, with some
literature on therapeutic interventions, but little on
interventions by primary care workers. Although there
have been recent improvements in the treatment of rape
and sexual assault complainers there are still areas of
concern, particularly in relation to conviction rates.
Rape crisis provision is still poor across Scotland,
and there is a lack of independent evaluation of the
approach. There is a similar lack of evaluation of
sexual assault referral centres (SARCs), although a
forthcoming report from the Home Office should address
this.
- There are different degrees of understanding or
acceptance of prostitution as 'violence against women'.
Some would make a distinction between 'forced
prostitution', including trafficking, and prostitution
as an active choice by women. Others assert that the
harm caused to women by prostitution should define it
as a form of violence against women. Much of the
literature on women working in prostitution is taken up
with questions of definition and agency, and in this,
it reflects early debates about how far women 'choose'
to stay with violent partners. There is also a
significant body of literature which considers crime
management interventions. There is little on
interventions which support women abused in
prostitution, or assist them in leaving.
- Research on interventions with adult survivors of
childhood sexual abuse is primarily found in the mental
health literature. Cognitive behavioural therapy (CBT)
appears to achieve the most consistent outcomes.
However, this may be partly due to the relative ease
with which a CBT approach can be measured, compared
with other therapies. Research with survivors of
childhood sexual abuse suggests that what they value
above all is the warmth and empathy displayed by
practitioners, and that they are less concerned with
the particular therapeutic approach being used.
Survivors of childhood sexual abuse also praised the
service provided by voluntary sector support
organisations. It is acknowledged that this type of
service provision is poorly distributed across
Scotland, and that there is a lack of evaluative
research.
- Although some work has been carried out which
explores the links between childhood sexual abuse and
chronic physical health problems, no research was
identified which addressed how healthcare staff should
acknowledge this or respond to it. No research into the
criminal justice response to adult survivors of
childhood sexual abuse was identified.
- By comparison, research on interventions with
domestic abuse survivors cuts across several sectors,
including criminal justice, acute and primary care
health services, social work services and outreach and
advocacy services.
- Research on the justice system response to domestic
abuse suggests that pro-arrest and pro-prosecution
policies give a clear message that domestic abuse is a
criminal act, and this has some impact on reducing
recidivism. However, the overall tenor of the
literature is that these shifts in policy are most
effective when located in the context of a coordinated
justice system response to domestic abuse.
- Evaluation of support and advocacy services for
domestic abuse survivors is limited, but the research
which has been done shows that such services are much
valued by women, and that they may have a significant
role in improving women's safety.
- Despite the acknowledged impact of domestic abuse
on women's physical and mental health, research into
healthcare responses to domestic abuse has not gone
much beyond issues of identification and assessment.
The literature on screening or routine enquiry for
domestic abuse is contentious. There is an emerging
concensus among health researchers in the U.K. and
Canada that there is limited evidence as yet to support
a routine enquiry approach; this is at odds with the
position in the U.S., where screening is well
established and supported by all the major professional
bodies.
- The scarcity of research on interventions for black
and minority ethnic women, women with disabilities,
lesbian women, and older women affected by male
violence against women is perhaps a reflection of the
dearth of services for these groups.
- Across all of the literature, across all aspects of
violence against women, there is a noticeable absence
of attempts to engage women survivors of violence in
the development, design or evaluation of services or
policy initiatives.
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