Supporting Lives Free from Intimate Partner Violence

Towards Better Integration of Services for Victims/Survivors

Report

15 February 2023

1. Integrated policies to address gender-based violence

Abstract

Chapter 1 discusses the global prevalence of gender-based violence (GBV) against women. It illustrates the importance of vertically- and horizontally-integrated policies to address the complex needs of women escaping GBV, focusing specifically on intimate partner violence (IPV). The chapter provides an overview of general organisational theories behind integrated service delivery (ISD) for victims/survivors, much of which is based on evidence from the health and social policy sectors, and identifies relevant international and national guidelines for effective, whole‑of‑state integration. The chapter concludes with the main findings and recommendations of the full report. These findings are based on 35 countries’ responses to the 2022 OECD Questionnaire on Integrated Service Delivery to Address Gender-Based Violence and a consultation with 27 non-governmental service providers supporting victims/survivors of GBV.

Main findings of the report

A majority of OECD governments have identified violence against women (VAW) as the top gender equality challenge their country faces (Figure 1.1). Yet for all countries, addressing this multifaceted issue presents a serious governance and implementation challenge. Women experiencing gender-based violence (GBV) have complex needs both during and after experiences of violence. Threats to their health include injuries, unintended pregnancies, sexually transmitted infections, pregnancy complications, mental health problems, homicide, and suicide. They also often need legal advice, housing support, and help for their children, thus requiring a diverse range of services from government and other providers. Different policy and service delivery spheres such as health, housing, justice, employment, and education need to work together seamlessly.

To help improve the public response to GBV, this report presents a stocktaking of OECD governments’ efforts to integrate service delivery to address the most prevalent form of gender-based violence against women: intimate partner violence (IPV), defined with other key terms in Table A C.1. It focuses on the most common services provided in OECD countries: prevention and crisis response strategies, health care, justice, housing, supports for children, and income support. The following key findings are elaborated further in Section 1.5 below.

Integrated service delivery (ISD) is most frequently introduced at entry points in health care, emergency housing, and police services. Many of these practices rely on case management, referrals, or physically co-located delivery.
To ensure ISD adequately supports victims/survivors, governments must adopt a “whole‑of‑state” approach to gender equality generally and GBV specifically. This means ensuring reliable, adequate and well-organised funding for co‑ordinated services. It also requires policy coherence across agencies and levels of government so that policies reinforce each other.
Local governance of ISD is crucially important, given that service delivery often occurs at the subnational level. Yet national governments play a key role in supporting ISD, for example by providing model frameworks to help local parties understand better their role in joint working.
Data-sharing capabilities across agencies must be strengthened. Data sharing across providers can reduce clients’ application costs (in time and energy); reduce the trauma associated with repeating accounts of violence to different providers; and improve client safety by better tracking risks across repeated incidents of violence. Ideally, such a system would also integrate perpetrator-related interventions as a way to track accountability and recidivism. Data sharing must include strong privacy protections to ensure victims/survivors’ security.
Better and more regular programme evaluations are essential. In general, ISD approaches to addressing GBV have not been systematically or quantitatively evaluated.
A holistic perspective means treating everyone involved – including perpetrators. Governments can interact with perpetrators not only through criminalisation and the court system, but in multi-dimensional ways that can improve offender accountability and produce long-term behavioural change on individual and broader cultural levels.
Most importantly, a trauma‑informed, victim/survivor-centred approach is crucial. Clear lines of communication must connect local service providers with national policy makers to enable better and more victim/survivor-centred service delivery. Such approaches could include regular stakeholder engagements or surveys to promote the co-creation of good policies.

1.1. Intimate partner violence is a complex and pervasive problem

Gender-based violence (GBV) refers to a wide range of harmful acts that are rooted in unequal power relations and are carried out against a person because of their factual or perceived sex, gender, sexual orientation and/or gender identity (Council of Europe, 2022[1]). Women continue to bear the overwhelming consequences of GBV, most commonly at the hands of their current or former male intimate partners – a phenomenon known as intimate partner violence (IPV) (OECD, 2020[2]).1 IPV is comprised of many forms (Box 1.1), and is reported by women across age groups, cultures, geographies and socio‑economic backgrounds.

Gender-based violence affects women’s safety, health and well-being. In the context of IPV – the focus of this report – this violence often compromises a woman’s self-determination by restricting her agency and limiting her ability to engage in social or economic activities outside the home.

Tragically, IPV can become lethal. Around 34% of female victims of intentional homicide, globally, are killed by a current or former boyfriend, husband or partner. Pre‑pandemic, this equalled around 82 women or girls being murdered by their intimate partner, every day, around the world (UNODC, 2019[3]).2

Worldwide, around 30% of all women aged 15 and older report having experienced some form3 of GBV at least once in her lifetime. IPV is the most common form of GBV worldwide: around 26% of ever-married/partnered women aged 15 and older report having experienced some form of physical and/or sexual violence at the hand of an intimate partner (World Health Organization, 2021[4]). On average across OECD countries, specifically, nearly a quarter of all women report having experienced IPV in their lifetime (OECD Family Database, 2020[5]).4

As dire as these numbers are, these statistics actually underestimate the problem. Measuring GBV is challenging; it is underreported in population surveys and in administrative records, such as police reports, for a number of reasons (OECD, 2020[2]). Women may not report intimate partner violence if they feel incidents are not severe enough or that they will not be taken seriously by service providers; if they fear retaliation or stigma; if they prefer to deal with the matter privately; or if reporting violence risks jeopardising their safety, stable housing, financial security, and access to social support networks.5 Estimating IPV prevalence was complicated further during the COVID‑19 pandemic, when stay-at-home orders trapped women in close proximity to their abusers, further restricting their ability to disclose violence and initiate help-seeking (Kaukinen, 2020[6]).

This crisis of violence has not gone unnoticed. A strong majority of OECD governments have identified GBV against women as the top gender equality challenge facing their country (Figure 1.1). Many governments have made the prevention, treatment and eradication of IPV a policy priority. Yet for all OECD countries, addressing the multifaceted issues of IPV presents a serious governance and implementation challenge – a challenge for which most countries have fallen short.6

As a first stop, many women experiencing violence seek support from public authorities through entry points in emergency medical care, police interventions, and emergency housing shelters. Many women also (simultaneously or subsequently) need support services linked to safety planning, rehabilitative counselling, legal advocacy, childcare, income, housing, and immigration and asylum, as well as financial and job counselling. When violence occurs in a family home, the challenges are compounded: children and other co-habitating persons are also impacted by violence and may need support.

To address their needs, women experiencing IPV regularly have to navigate a wide range of health, legal and social services provided by a patchwork of governmental, non-governmental or private sector providers. They are often asked to repeat accounts of traumatic experiences multiple times, as services are infrequently “joined up” and providers rarely share client data with each other. Frequently, help-seeking women are met with administrative and bureaucratic challenges at the same time as they face the direct and indirect consequences of violent acts – or remain under threat of continued violence (OECD, 2020[2]). These obstacles can be exacerbated by a lack of confidence in the help-seeking process more generally.7

Figure 1.1. OECD governments list violence against women as their top gender equality priority

Leaving a violent relationship – and often the family home – is difficult in and of itself, and often constitutes the single most dangerous moment for women who are experiencing IPV. The burden of applying for and accessing diverse support services, often repeatedly, can compound the trauma of victimisation and contribute to women staying in a situation where violence continues. And these are not fleeting challenges: it often takes many attempts for a woman to extricate herself from an abusive partnership. Even after a woman has successfully escaped a violent situation, the physical, psychological, social and economic effects of IPV can persist for months or years.

Simply put, the crisis of gender-based violence is one of the most pressing human rights challenges OECD countries face today.

To help improve public policy responses, this report presents a stocktaking of OECD governments’ efforts to integrate service delivery to better support victims/survivors of intimate partner violence. The evidence presented here is based on an extensive policy questionnaire completed by 35 OECD governments (OECD QISD-GBV, 2022, see Annex A), a consultation with 27 non-governmental service providers (the OECD Consultation 2022), and secondary research (Box 1.5).

This report illustrates how governments have integrated service delivery (ISD) to address IPV through preventative practices that aim to interrupt the cycle of violence and through services most commonly accessed by women experiencing violence:

Preventative practices deployed to prevent the continuation or recurrence of IPV against women, such as coherent risk assessment procedures and perpetrator interventions (Chapter 2);
Health care, in particular targeted mental health supports and emergency hospital-based services (Chapter 3);
Housing, with a focus on emergency shelters, transitional shelters, and transitions to long-term affordable housing (Chapter 4);
Social support for children, income supplements, and employment support (Chapter 4);
Access to justice, including multidisciplinary police responses and integrated legal advocacy support (Chapter 5).

The results of the questionnaire (OECD QISD-GBV, 2022) focus largely on services that are nationally administered or co‑ordinated with the support of local service providers. This report also presents the non-governmental service provider perspective on ISD, based on a survey-based consultation with 27 non-governmental providers of GBV-related services. These insights are summarised in Chapter 6.

This report finds that integrated service delivery (ISD) for victim/survivors is often difficult to plan, fund and implement in practice, given their complex needs and the many sectors involved. Yet successful ISD examples abound, particularly those rooted in health services, housing, and access to justice – the sectors where ISD has been most commonly implemented. OECD governments must continue to trial, replicate and – importantly – evaluate ISD practices to improve the lives of victim/survivors of IPV.

Box 1.1. Intimate‑Partner Violence (IPV) can take many forms

Gender-based violence (GBV) refers to a wide range of harmful acts that are rooted in unequal power relations and are carried out against a person because of their factual or perceived sex, gender, sexual orientation and/or gender identity (Council of Europe, 2022[1]).

Intimate partner violence (IPV) is a subset of GBV. IPV refers to violence that occurs between current or former intimate partners, and which causes physical, psychological, sexual and/or economic harm. Like other forms of GBV, it can result in homicide or suicide. IPV is also often referred to as “domestic violence”, though domestic violence does not necessarily occur between co-habitating partners. The World Health Organization (WHO, 2012[8]) identifies common examples of IPV:

Acts of physical violence, such as slapping, kicking, non-fatal strangulation and beating or hitting with or without a weapon;
Sexual violence, such as forced sexual acts or sex-related coercion;
Emotional and psychological abuse, such as intimidation, humiliation, insults, and threats of harm to the victim or victim’s loved ones;
Controlling behaviours, such as stalking, excessive surveillance, restriction of mobility, isolation from social and family networks, or restricting access to financial resources, employment, medical care or education. Substance use coercion – where women are controlled through substance use‑related tactics – also falls under this category (HHS Family and Youth Services Bureau, 2020[9]).

Most countries have developed broad strategies to prevent, address and end the various and complex forms of GBV. This is evidenced in national frameworks, co‑ordinating bodies, and response systems.

This report focuses specifically on IPV within the context of GBV. This reflects the prevalence of IPV and violence against women in OECD countries, as well as the service sectors in which policies to address GBV are most developed. For further definitions, please see Table A C.1. of this report.

1.2. Integrated policies are key to a whole‑of‑state framework to end GBV

Policy makers have turned attention to integrated policies as a means of co‑ordinating multi-sectoral solutions to GBV. This entails integration at all levels of government – not simply the service delivery level, which is the primary focus of this report. Some broader institutional context is therefore useful here to set the stage.

To address GBV, policy integration goes hand-in-hand with government efforts to mainstream gender equality through a whole‑of‑state approach. Gender mainstreaming is by now well-recognised as a critical tool for governments seeking to address gender inequalities from their earliest stages.8 By embedding a “gender lens” in all aspects of government budgeting and policy design, reform, and evaluation, governments can tangibly reduce gender inequality in different aspects of life, including the sociocultural norms that enable GBV to proliferate. Successful mainstreaming entails co‑ordination and integration across Ministries and throughout levels of government.

National and international GBV strategies recognise that integration must be applied across the entire governance of policies to end GBV.9 This is especially true in the last decade, in the wake of the preeminent international agreement on violence against women: the 2011 Council of Europe Convention on preventing and combating violence against women and domestic violence, known as the Istanbul Convention. To date, 27 OECD countries have signed, ratified and/or implemented the Istanbul Convention.10 The Istanbul Convention presents four pillars to address GBV: Prevention, Protection, Prosecution, and – of special relevance to this report – Co‑ordinated Policies (Box 1.2).

Box 1.2. Integrated policies are central to the Istanbul Convention

Chapter II of the Istanbul Convention – entitled “Integrated policies and data collection” – offers important guidance aligned with the focus of this report. It calls for victim-centred, comprehensive, and co‑ordinated policies and co‑operation among all relevant agencies, institutions and organisations (Article 7); appropriate financial and human resources for the implementation of integrated policies and programmes, including those carried out by NGOs (Article 8); the recognition, encouragement, support of and co‑ordination with NGOs and civil society (Article 9); the establishment of one or more official bodies to co‑ordinate, implement, monitor and evaluate policies to prevent and combat violence (Article 10); and thorough data collection and research to support implementation of the Convention (Article 11).

Correspondingly, chapter IV of the Convention – “Protection and support” – calls on countries to implement measures based on a gendered understanding of violence against women; an integrated approach that takes into account the relationship “between victims, perpetrators, children and their wider social environment; an avoidance of secondary victimisation; a multi-dimensional empowerment of women victims; and a response which allows for a range of protective/support services to be located on the same premises to address the needs of vulnerable women and their children where applicable.

Despite the importance of this issue, most countries have fallen short of policy integration targets. The Group of Experts on Action Against Violence Against Women (GREVIO) – a monitoring mechanism of the Istanbul Convention – finds in a series of European country evaluations that countries rarely meet best practice standards on policy integration and ISD. This helps illustrate the need for a better understanding of how to implement ISD in practice.

Sources: (Council of Europe, 2011[10]; WAVE Network, 2019[11]).

1.2.1. Overview of vertical and horizontal policy integration

In a first cut, policy integration can be divided into two categories: vertical and horizontal.

Vertical integration refers to co‑operation across different levels of government. National and local governments are often responsible for different levers and services to address GBV, making collaboration useful. This might entail co‑operation, information sharing, and financing from national to local levels of government. In the case of social services, these linkages may connect from the Ministerial level to case worker level (and vice versa).

Horizontal integration refers to bringing together different Ministries, institutions or service providers to achieve a shared objective, such as joining up health and housing supports for women experiencing violence. Horizontal integration can take place at central, regional or local levels – and of course integration can be simultaneously vertical and horizontal. Figure 1.2 illustrates how these general concepts can be applied to policy responses to GBV.

Note: Stylised model presenting key actors, national-level integration strategy, local-level integration strategy, and the potential for both horizontal and vertical integration to improve service delivery for women experiencing GBV.

Source: OECD Secretariat, 2023.

1.2.2. Integrating from the top? National strategies and co‑ordinating bodies to address GBV

To foster vertical and horizontal integration, many national governments in the OECD have implemented national strategies and clearly defined roles for key state actors and partners as part of a systems-level approach to preventing, addressing and ending GBV (Figure 1.3).

Strategic frameworks for GBV can help improve decision-making processes by focusing attention on the most crucial issues and challenges, as well as co‑ordinating policy implementation and – importantly – funding across levels and functions of government (OECD, 2019[12]; 2021[13]). These frameworks often include targets, road maps and action plans. National frameworks in general tend to work better with clear tracking mechanisms and regular operational plans (OECD, forthcoming).

A holistic approach to GBV also requires defining roles and responsibilities of key state actors in the executive, judicial and legislative branches, and at national, provincial/state and local levels. In some OECD countries, this co‑ordinated approach is managed by a central co‑ordinating body focused on GBV (Figure 1.3). This strategy is strongly endorsed by GREVIO, the independent expert body responsible for monitoring the implementation of the Istanbul Convention.

GREVIO calls for co‑ordinating bodies to be given dedicated, institutionalised budget and resources, a clear mandate, and set policy objectives to address GBV – but following many in-depth country reviews, including in OECD countries, GREVIO finds that these targets have rarely been met (Council of Europe, 2022[14]).

In the presence or absence of these national-level mechanisms, it is important to conduct monitoring and evaluation exercises to understand what GBV policies and programmes are effective. Even where countries have established frameworks or policy guidance at the national level, subnational and local authorities are often at liberty to interpret implementation, notably in decentralised governance structures. While this flexibility is essential to ensure a needs-based approach that best supports local contexts on the one hand, it also brings with it challenges to monitoring and evaluation. In the context of GBV against women, programme and pilot evaluations remain scarce.

Finally, reliable and adequate funding is crucial to effectively combat GBV in the long run. Integrated service delivery can also become easier if there are enough resources for everyone involved. It is difficult to compare public spending on GBV, as it can be hard to quantify pockets of money spent in different Ministries or by different levels of government. But published national spending estimates offer some clues.

Spain, for example, has made a serious budget commitment to combatting gender-based violence. In 2023, programmes to prevent address gender-based violence will make up 56% (320 million euros) of the entire budget of the Ministry of Equality (573 million euros) (Ministerio de Igualdad de España, 2022[15]) in Spain, a country of 47.6 million people (2022).

Australia (population 25.7 million) has committed to long-term spending plans: the October 2022–23 Budget provides 1.7 billion Australian dollars (around 1.1 billion euros) over six years for measures to address family, domestic and sexual violence under the first phase of the new National Plan to End Violence Against Women and Children 2022–2032. This builds on the 1.1 billion Australian dollars (around 700 million euros) for women’s safety provided in the 2021–22 Budget (Parliament of Australia, 2022[16]).

In general, however, funding streams have been inconsistently committed to GBV across countries – even those with dedicated national frameworks on GBV. Among 20 OECD countries reporting having a standalone national plan on GBV11, only 12 reported having a specific allocated budget, while 9 reported not having a specific allocated budget. Of the 6 countries that reported having integrated GBV as a key pillar/objective in broader gender equality strategies, only one reported having a specific allocated budget (OECD, forthcoming).

Box 1.3. Integrated, whole‑of‑state approaches to address GBV in OECD countries

A recent OECD stocktaking of national governance to end GBV highlights the importance of system-level factors like national strategic frameworks and co‑ordinating bodies, among other tools (OECD, 2021[13]).

Examples of national strategic frameworks to address GBV

Australia’s National Plan to End Violence against Women and Children: The Australian Commonwealth (national), state and territory governments worked with family safety experts, frontline services, the community and victim‑survivors to develop a 10-year national plan, running from 2022-2032. The National Plan builds on the work developed under the previous National Plan to Reduce Violence against Women and their Children 2010-22. The National Plan focuses on ending GBV in one generation, and addresses violence across the continuum from prevention, early intervention and response through to recovery and healing. The plan will be supported by an Outcomes Framework to monitor and track progress. The progress of the National Plan will be monitored by Australia’s Domestic, Family and Sexual Violence Commission established in 2022 to demonstrate the Australian Government commitment to ending GBV.

The National Plan is being delivered through two five-year action plans and a dedicated Aboriginal and Torres Strait Islander Action Plan. Each of these will be designed to look back at what has been achieved, incorporate emerging issues and research to inform the next stage, and refocus on what actions might make the most difference going forward.

Scotland’s “Equally Safe” strategy for preventing and eradicating violence against women and girls relies on collaboration between the national Scottish Government and local governments. The strategy is a cross-sector initiative with participation from the police, housing agencies, social services, children’s services, health services and women’s specialist non-governmental organisations. It recognises that multiple agencies are responsible for dealing with domestic violence. By bringing these agencies and ministries together, the strategy is led and owned collectively.

Spain’s State Pact against Gender Violence and Contingency Plan: In 2017, the Spanish Parliament approved, with no dissenting votes, the first State Pact against Gender Violence, an agreement between political parties that aims to ensure efforts to address GBV are consistent, co‑ordinated, and not subject to interference from whichever party is in government at any particular time. The Pact attracted the adherence of the National Government, the Autonomous Communities, the Spanish Federation of Municipal and Provincial Authorities (FEMP), and the State Observatory on Violence against Women, thereby ensuring a triple consensus – political, territorial, and social – was reached. The State Pact provided a roadmap for addressing GBV during a five‑year period and outlined 292 measures structured around ten axes for action. These include improving co‑ordination and connections between responsible authorities and agencies, improved training of public servants, financial commitments towards policies to end GBV, and monitoring processes to evaluate the Pact.

Spain applies the measures through the government Delegation for GBV, in co‑ordination with the other ministries and their dependent autonomous bodies, as well as the Autonomous Communities and Local Entities represented in the FEMP. A total increase in funding of EUR 1 billion accompanied the adoption of the Pact to ensure the measures could be carried out.

Sweden’s National Strategy to Prevent and Combat Men’s Violence Against Women: In 2017, Sweden put in place a 10‑year national strategy to prevent and combat men’s violence against women as part of their wider National Gender Equality Policy. It includes measures against IPV, “honour-related” violence,and human trafficking for sexual purposes. The National Gender Equality Agency recently compiled details about all national initiatives launched in relation to men’s violence against women and published these for public use in order to help agencies, organisations and politicians acting within the scope of the strategy to access previous experiences and existing knowledge. The website tool details all past and ongoing projects from 2017 and onwards, and attaches existing project evaluations alongside relevant entries. The tool is publicly available and continuously updated. It currently lists over 300 individual projects from 54 agencies.

The website resource is mainly a tool for co‑ordination and knowledge‑sharing. It helps agencies learn from others as they plan forthcoming projects. It is also used to provide insight into avenues for co‑ordination and collaboration with other actors.

Switzerland’s National Action Plan 2022-2026 for the implementation of the Council of Europe Convention on preventing and combating violence against women and domestic violence: the Federal Council adopted the Action Plan in June 2022. It focuses on the three main themes of public information and awareness, basic and continuing education for professionally-engaged people and volunteers, and prevention and response to sexual and gender-based violence. The implementation will occur across different levels of the federal government, and will include measures by the Confederation, cantons and communes. The plan has been developed through collaboration between different levels of government, in consultation with non-governmental organisations and civil society. The Action Plan is a part of Switzerland’s wider Equality 2030 Strategy that aims to advance gender equality.

Many countries have introduced central co‑ordinating bodies to manage a coherent response to GBV

In Sweden, the Division for Gender Equality Agency under the Ministry of Employment is tasked with co‑ordinating the implementation of GBV actions in line with the Istanbul Convention, while the National Gender Equality Agency, established in January 2018, supports co‑ordination between governmental agencies to implement the National Strategy to Prevent and Combat Men’s Violence against Women.

In Spain, the government Delegation for Gender-based Violence, which is currently under the purview of the Ministry of Equality, has the responsibility of proposing public policy options to address the different forms of GBV, and promoting, co‑ordinating, and advising on all relevant measures undertaken by the government in this area.

Finland established the Committee for Combating Violence Against Women and Domestic Violence, which operates under the Ministry of Social Affairs and Health. Comprised of members from various ministries and public institutions, including the Ministry of Justice, Statistics Finland, and the Ombudsman for Equality, the Committee is responsible for the co‑ordination, monitoring, and impact assessment of measures required for the implementation of the Istanbul Convention.

In Norway, the Ministry of Justice and Public Security co‑ordinates the Government’s work against domestic violence and chairs the Inter-ministerial Working Group against Domestic Violence, which consists of representatives from eight ministries and several directorates. The Working Group is responsible for the implementation of measures in national action plans and regularly reports on the status of this work, proposing new strategies and measures.

Denmark has an Inter-ministerial Working Group against violence against women and domestic violence, which is responsible for co‑ordinating the work against IPV in Denmark. In addition, Denmark has implemented a novel approach that includes horizontal and vertical integration with a non-governmental partnership. “Lev Uden Vold” (“Live without Violence”) was established as part of the Adjustment Pool Agreement (satspuljeaftalen) of 2017‑20, which intended to strengthen the work against IPV. The National Board of Social Affairs and Health put the task out to tender together with the Equality Department. Five non-profit organisations, all of whom have extensive knowledge and experience in the area of violence, bid together for the task and founded Lev Uden Vold. The five organisations are the National Organization of Women’s Crisis Centers (LOKK), Dannerhuset, Dialog mod Vold, Fundamentet and Mødrehjælpen. Lev Uden Vold is established as an independent institution with an independent board of directors. In November 2020, a broad political majority of the parties in the Danish Parliament (Folketing) have allocated funds for the continuation of Lev Uden Vold until the summer of 2024.

Source: Examples from Norway, Spain and Sweden excerpted and summarised from Eliminating gender-based violence: Governance and survivor/victim-centred approaches (OECD, 2021[13]) and the Swedish National Agency for Gender Equlity (National Gender Equality Agency, 2022[17]; National Gender Equality Agency, 2022[18]). Example from Denmark derived from OECD QISD-GBV 2022 and the website of Lev Uden Vold: https://levudenvold.dk/om-lev-uden-vold/om-os/. Example from Scotland from (Council of Europe, 2022[14]). Example from Australia from Government of Australia (Department of Social Services, 2022[19]). Example from Switzerland from the Switzerland (Federal Department of Home Affairs, 2022[20]) and the Switzerland (Federal Office for Gender Equality, 2021[21]).

1.3. Integrated service delivery benefits governments and victims/survivors

1.3.1. Defining general concepts in integrated service delivery: Lessons from various sectors

In general, integrated service delivery (ISD) refers to the linking-up of different providers and levels of public services, for the benefit of users and to improve efficiency in service delivery (OECD, 2015[22]). ISD re‑imagines social, health and other human-service pathways for the mutual benefit of service users and providers.

The concept of ISD was first popularised in the health sector, in an effort to better care for patients with complex and long-term needs from a range of different health providers. A foundational definition can be drawn from the early health literature: “Integration is a coherent set of methods and models on the funding, administrative, organisational, service delivery and clinical levels designed to create connectivity, alignment and collaboration within and between [different] sectors” (Kodner and Spreeuwenberg, 2002[23]).

Of course, a critical consideration for an integrated response to intimate partner violence (IPV) is the client’s risk of exposure to continued violence and their heightened need for security. ISD for women experiencing IPV therefore must ensure the safety and security of the victim/survivor (and any children) from a perpetrator, at the same time as it ensures access to justice pathways through legal support. These conditions often require the involvement of police officers, judges, and legal advocates (elaborated in Section 1.4 and Chapter 5).

There is no single, universal strategy for integrating services.12 Integration is a malleable approach through which services can be co‑ordinated to varying degrees of intensity. In an exploration of ISD for vulnerable groups, the OECD delineates between three increasingly intensive ways of integrating services (OECD, 2015[22]):

Co-location of services refers to having multiple service providers from different sectors – such as health, housing and legal services – represented in one location. This can help reduce complexity, travel, time and financial costs associated with service uptake. On the service provider side, co-location also makes it easier for providers and professionals to share information and deliver joint solutions.
Collaboration implies a higher degree of integration across sectors than co-location, refering to agencies working together through information-sharing and training, and through the creation of a network of agencies to improve user experience. This kind of knowledge sharing can help service providers improve referrals and recommendations to other services.
Co‑operation implies the deepest level of integration, and refers to service providers communicating and working together on individual cases, toward pre‑determined and consistent goals. This helps to ensure holistic service provision and should improve outcomes for users.

1.3.2. Integration has improved outcomes and efficiency in health and social sectors

Little empirical evidence exists on the benefits of ISD for GBV. Yet evidence from other sectors suggests ISD offers opportunities to realise sizable efficiency and effectiveness gains, while also improving outcomes for service users. This is particularly true for service users with complex needs, and who require a range of health, social, legal and housing supports, typically provided by more than one agency (NZ Productivity Commission, 2015[24]).

Cost effectiveness and savings

One potential – though not guaranteed – advantage of horizontal ISD at the service level is cost effectiveness and cost savings, both for service users and providers. By providing services in one place, streamlining administrative costs, and potentially reducing over-use of emergency health services, ISD has been identified as a potential tool to lower spending on elderly populations and people with mental illness (OECD, 2015[22]). ISD at the first point of intervention has also been shown to reduce downstream service use and costs. For example, effective hospital discharge plans and linkages to co‑ordinated community care can reduce the likelihood of costly hospital re‑admissions or intensive care services among people with mental illness (Mares et al., 2008[25]; Rosenheck, 2000[26]; Stewart et al., 2012[27]). Effective horizontal integration can also help to reduce gaps and avoid duplication of services from different agencies.

Vertical integration has the potential to save costs, too, for example by helping to shift resources away from costly emergency services to more cost-effective preventative services (OECD, 2015[22]).

Cost effectiveness and costs savings are not guaranteed, of course. A co‑ordinated policy and funding approach is needed to break down silos, avoid duplication of work, share costs, train workers, and share information (OECD, 2022[28]). A review of 65 case management studies targeting high-risk, high-cost patients in the health sector, for example, showed that two‑thirds of these programmes achieved specific progress and outcome goals, though they were less successful than expected in cost-saving or cost-effectiveness (Swanson and Weissert, 2018[29]). The authors suggest these results might be improved if additional incentives, clear rules, guidelines, and algorithms relating to resource allocation among patients were applied. Importantly, costs can also rise when service providers expand coverage and address previously unmet needs (OECD, 2022[28]).

Before long-term cost savings are realised, significant and dedicated financial investments are required to establish a sustainable foundation for integrated services.

Accessibility and take‑up

Accessing public services can be daunting. ISD can help improve service accessibility and user take‑up in communities, especially for people with complex needs, such as persons with disability, those facing mental health issues, and people responsible for dependents. Victims/survivors of IPV also have complex needs – many face physical, mental and logistical barriers to accessing social services and support systems.

Integrated service models “can help vulnerable service users navigate the system for reasons of time as well as transparency and accessibility: co-located services, for example, enable access to multiple services [in one place], which in turn enables a fuller assessment of needs and a faster delivery of appropriate services” (OECD, 2015[22]). Case managers can also reduce the burden of multiple applications and data collections across providers by connecting those offices directly and advocating for survivors.

The challenges of accessing multiple services across multiple locations are particularly daunting for families in vulnerable circumstances – a particularly accurate characterisation of a mother and children fleeing violence. These women may be balancing programme applications against irregular work hours and income, struggling to find safe housing, and caring for children. In these and other cases, clear, direct and comprehensive information for service users, perhaps delivered by a known case worker, is conducive to full engagement with all available and appropriate services (OECD, 2015[22]).

Reducing administrative burden for clients can help improve take‑up, too. Data-sharing across providers – for example, by providing digital access to personal information such as a history of social service use – can therefore be an important tool to ease service users’ entry into the system.

Improving the quality of services and client outcomes

The benefits of ISD on client outcomes in other sectors has been well-studied. The integrated “Housing First” approach, for example, has reduced homelessness more effectively than emergency shelters, and children with mental health needs have benefitted from the integration of mental health services with educational institutions (OECD, 2015[22]).

When ISD is done well, the cost savings, improved access and higher-quality services should happen simultaneously (OECD, 2022[28]). In a review of over 120 integrated initiatives delivering children’s services predominantly in the United Kingdom, inter-agency working improved accessibility and response time for service users; enhanced knowledge and sense of fulfilment among service providers; and improved agency efficiency by reducing duplication of work (Statham, 2011[30]). Similar results are found in a study of ISD for child services in the United States (Manno and Treskon, 2016[31]).

Yet there are many barriers to successful integration

Despite the seemingly obvious benefits of ISD, there exist significant barriers to service delivery integration – both generally and in the context of services addressing GBV.

One major barrier is funding. ISD implies some negotiations between Ministries, levels of government, and/or local providers to determine who will pay fixed start-up costs to ensure successful co‑ordination across various actors. There is also the issue of ensuring ongoing running costs – regular, sustainable funding streams are important both to ensure the continuity of specific services, but also to prevent a “’domino effect’ in belt-tightening of closure” by partner service providers (OECD, 2015[22]). Joint working requires a balance of financial input across agencies, and time horizons matter – it can be difficult to get agencies or providers to commit fully if they see collaboration as a short-term or temporary arrangement (ibid). This can be especially difficult when providers have historically had to compete for resources.

Another major challenge is the restructuring of roles and responsibilities across levels of government, agencies, and – on the ground – governmental, NGO, and for-profit service providers. This involves potentially both the structure and management of provider organisations, as well as potentially retraining staff, changing work conditions, and adapting workplace cultures.

Finally, data sharing across providers can be difficult as it presents significant legal and logistical concerns. While there are benefits to providers and clients to having efficient access to background information on clients, it can be difficult to ensure adequate client privacy across a range of different providers with different technical standards.

1.4. How does integrated service delivery work in addressing gender-based violence?

Many of the approaches to integrated care in health and social policy also apply to the multi-sectoral nature of GBV. Services for victims/survivors of violence can be delivered through general support services, which are not exclusively designed for victims/survivors but instead serve the public at large; or through dedicated, specialist support services, which target people experiencing violence specifically. These general and specialist services should be complementary, and general services staff should be equipped to address the specific needs of women experiencing GBV through adequate resources and training (Council of Europe, 2022[14]).

While there is no “one‑size‑fits-all” approach to applying ISD to address GBV, Australia’s National Research Organisation for Women’s Safety (ANROWS) has identified helpful universal guidelines for ISD to address GBV (ANROWS, 2016[32]):

Service delivery must involve two or more agencies/services;
There exist clear co‑ordination protocols for integrated service provision;
The initiative is funded as an integrated service or partnership, with a view to respond holistically to women currently experiencing domestic and family violence or who have recently left a domestic and family violence situation, and/or who have experienced sexual assault;
The programme operates according to a formalised partnership or joint service agreement between agencies;
The programme abides by a formalised statement of shared principles/goals between agencies;
ISD may include one‑stop centres for women and children who have experienced domestic and family violence or sexual assault;
ISD may include case co‑ordination or case management services.

In the context of GBV, the overarching goals of integrated initiatives are to create “smoother referral pathways” between sectors, making the help-seeking process more accessible, and reducing the secondary victimisation associated with the duplication of work (ANROWS, 2016[32]). For example, it is easier to receive a proactive call from a network-connected counsellor following a police intervention, rather than having to call or visit several related service providers. This parallels goals identified in foundational health literature: that ISD should “enhance quality of care and quality of life, consumer satisfaction and system efficiency for patients with complex, long-term problems cutting across multiple services, providers and settings” (Kodner and Spreeuwenberg, 2002[23]).

Of course, the best way to end gender-based violence against women is to prevent it from happening in the first place – and this certainly requires an integrated, whole‑of-society approach. This means dedicated efforts to change masculine norms, from a very early age, so that boys do not grow into perpetrators who replicate harmful masculinities (OECD, 2021[33]). Preventative measures also need to target adult perpetrators of IPV in order to achieve holistic and sustainable solutions to violence. Violent men are often re‑offenders in multiple relationships and victims/survivors sometimes return to their abusers, so working with perpetrators is crucial to prevent re‑victimisation and new victimisation. Information-sharing across differences within the justice sector as well as across different sectors can contribute to a reduction in violence.

1.4.1. Case management, referrals, and co-located services can support victims/survivors

ISD for women experiencing IPV is frequently co‑ordinated through case management, referral systems, or co-located centres in order to provide joined-up access to mental and physical health care, safe and affordable housing, income and job support, support for children and access to justice.

The co-located approach is sometimes referred to as a “hub and spoke model” (Campo and Tayton, 2015[34]; Mantler and Wolfe, 2016[35]), language also used in other sectors. In this model, the “hub” – a centralised office or a caseworker – identifies, collaborates with, and connects clients with sectoral service providers who provide the needed supports. These related providers can be on-site or off-site.

The co-located approach has been implemented throughout much of the OECD, often by non-governmental service providers using public and private funding (for examples, see Box 1.4 and Chapter 6).

Although not grounded in systematic evaluations, an oft-praised approach for ISD for women experiencing violence is case management. In many of the ISD examples in this report, caseworkers play a prominent role, which can improve the experience for clients – though it can be very challenging for a single caseworker.13 Case management can be provided, for example, by a social worker, a “domestic violence advisor” (typical in the United Kingdom), or a public health worker, typically at the local or regional level. Case management services are not commonly managed at the national level in OECD countries, with a few notable exceptions.

Figure 1.3. Re‑envisioning the “hub and spoke” model of integrated service delivery for IPV victims/survivors

The OECD QISD-GBV 2022 revealed another relatively common and noteworthy local-level case management initiative: multi‑agency risk-assessment conferences (MARACs), or similar case conferences bearing slightly different names. These meetings bring together community police, health care workers, public prosecutors, social workers, child welfare providers and case managers, on a regular basis, to ensure the long-term safety and continuity of care for women who are particularly at-risk of severe IPV.

These kinds of case conferences are reported to exist in Australia, Austria, the United Kingdom, Finland and New Zealand, though service delivery arrangements may vary in different national and local contexts. The charity SafeLives estimate that if MARACs were implemented nationally across 300 sites, significant savings could be made: “for every GBP 1 spent on MARACs, at least GBP 6 of public money can be saved annually on direct costs to agencies such as the police and health services,” (SafeLives UK, 2010[36]). These programmes should be evaluated further to assess clients’ and providers’ outcomes.

Box 1.4. Co-located service providers throughout Europe and North America

Family Justice Centres, various locations, Europe and the United States

The Family Justice Center Alliance originated in the United States as a subsidiary of Alliance for HOPE International, an organisation dedicated to domestic violence and sexual assault prevention with a mission to establish a network of service hubs around the world. Today, the Alliance works in Europe, the United States and Canada in close consultation with sub-national and national governments to implement multidisciplinary service delivery models known as Family Justice Centers (FJCs). FJCs offer co-located, multi‑agency services to women who have experienced domestic violence, sexual assault, elder abuse, child abuse or human trafficking. Public and private agencies can assign service providers to the FJCs on a full- or part-time basis to deliver such services as: safety planning; legal advice; case management; evidence reporting, including making official statements and procuring medical evidence of violence; counselling; financial literacy and job training support; administrative support in applying for public benefits, and shelter or housing. FJCs also offer childcare and transportation assistance for women while they procure services. This also implies some data-sharing: 86% of US-based FJCs link their administrative data, and 87% report using a centralised intake procedure which facilitates information-sharing between providers.

Saskatoon Community Service Village, Saskatoon, Canada

The Saskatoon Community Village (SCSV) was a project borne of the Saskatoon Women’s Resource Centre, which was established in 1986 and represented a coalition of 16 organisations. Over the course of ten years, planning, discussion and fundraising took place to eventually establish the SCSV in 1996, with the view to deliver women’s services through co-location and collaboration. It currently joins up six non-profit, community-based agencies under one roof to provide services through joint planning, programming and advocacy. Services include youth and adult counselling; specialised services to respond to abuse, violence and sexual assault; 24‑hour crisis intervention services related to child abuse, suicide prevention, substance use, gambling problems, and domestic violence; housing and in-kind support; short- and medium-term shelter for women and children; parenting support services; an employment and skills centre, including computer literacy and GED training; and an accessible fitness centre. The SCSV also engages in community-based education and awareness-raising initiatives related to IPV. The SVSC operations are outlined in jointly-developed plans, buttressed by legal agreements which clearly describe roles and responsibilities.

Kukui Center, Hawaii, United States

The Kukui Center opened in 2009 and, today, co-locates ten non-profit agencies to serve the region’s families. This is an example of an integrated programme that has tried to mainstream the treatment of IPV in its support for vulnerable groups. While not exclusively focused on IPV, the Center offers emergency, short- and medium-term shelter for children, adolescents and families; independent living programmes; legal and mediation services; specialised services for children with disabilities; maternal and infant health services; multi‑age literacy and financial literacy services; specialised services for homeless families; youth foster care; multi‑age counselling services, including grief support; supports for children and adults experiencing abuse, violence and sexual assault, including a specialised “immigrant justice centre” focused on violence, sexual assault and human trafficking; and a social enterprise which employs at-risk youth. The Centers’ leadership meet regularly to make decisions about the Center operations and to discuss caseloads.

Source: (ABT Associates, 2018[37]; Family Justice Center, 2022[38]; Saskatoon Community Service Village, 2022[39]; Kukui Center, 2019[40]).

1.4.2. Sharing client data across service providers, while also ensuring client privacy

The process of describing experiences of abuse, providing social and economic history, and going through (often extensive) application processes for services can be harrowing and implies high costs both for women and for service providers. Data sharing across service providers offers the potential to reduce some of these costs in time, effort and energy, and lead to a more efficient and timely public response when women experience violence. With a unique and secure personal identifier, information can be shared on individual clients across health, police, child services and housing providers, among others.

It is especially important for stakeholders in collaborative environments to jointly develop co‑ordinated information-sharing protocols and procedures in order to perform informed risk assessments and deliver effective solutions to help-seeking women (CACP, 2016[41]). In the OECD Questionnaire, many countries report that data sharing is typically governed by legal frameworks and that information can be shared in situations where women are in immediate danger, when the information is essential, and where women have consented to the information being shared (OECD QISD-GBV, 2022). For instance, in the United Kingdom, relevant professionals in child protection can share data when this is needed for the overriding duty to protect children at risk (UK Home Department, 2003[42]).

Data privacy is of utmost concern when it comes to victims/survivors of GBV, not least in cases where their security depends on information being held from perpetrators. Personal information runs a higher risk of leaking when it is shared among many different agencies and sectors. Worries about data leaks were echoed in the OECD Consultation of NGO providers. One provider reported that they “are always concerned about sharing information with other services as we need to ensure that the client’s safety is paramount at all times. It is not uncommon for a client’s location to be compromised by other services/agencies, and once a client’s location is compromised, the client has to be moved to ensure that they remain safe.” The risk of data leaks may enough to deter some victims/survivors from reporting their perpetrators (Taylor et al., 2015[43]).

Processes for data sharing across providers will therefore need to be controlled by clear information-sharing protocols, policy guidelines and professional judgement based on information available. Indeed, these controls have been identified as good practice in contributing to facilitating a co‑ordinated service delivery for people who have experienced GBV (Taylor et al., 2015[43]). Actors in different countries will also face different legal frameworks when they consider opportunities to share data. For instance, victims/survivors living in the EU are protected by the relatively stringent General Data Protection Regulation (GDPR) (CNIL, 2022[44]).

The police can usefully be involved in data sharing and be mandated to co‑ordinate with relevant agencies. Austria, for example, has detailed data collection requirements for the police. The police are obliged to share data on barring orders and violations of these, as well as police charges files in cases of domestic violence and stalking. The police are also required to report cases of domestic violence and stalking to their local Invervention Centres – government-funded NGOs – within 24 hours of the occurrence of the crime. The police are also required to co‑operate with youth welfare offices, the family court, the prosecutor office and the criminal court when cases relate to these (Brankovic, 2021[45]). In Australia, the Safety First Programme is an information-sharing and safety-planning mechanism for women leaving shelters. The model was found to be successful at managing high-risk matters due to its high degree of collaboration between the the lead agency, the police and Corrective Services (ANROWS, 2016[32]).

Another interesting example is a World Bank-funded project in Chile that intends to develop and implement an integrated case management database system. The motivation is to better track and respond to women experiencing violence. Following a rigorous mapping exercise to identify critical gaps in continuity of care, the proposed integrated platform will allow for follow-up of GBV cases across institutions, improve service delivery, and provide alerts in high-risk cases (World Bank, 2022[46]).

1.4.3. Local evolutions of ISD to address GBV are important

Although policy integration is prioritised in national GBV strategies (Box 1.3), integrated services have often evolved naturally, on the ground, to improve efficiency in the face of limited resources (e.g. staff, funding). This can involve local and regional public service providers, non-governmental service providers, advocates, and victims/survivors. Networking, relationship-building and community mobilisation have, together, led to a re‑designing of service delivery by local and regional practitioners, offering hints to higher-level policy makers about the merits of ISD. Indeed, “local” knowledge and practices flowing upwards to high levels of government should be a key part of vertical integration.

A study of rural and remote women’s shelters in Canada, for example, highlights three inter-related ways service delivery has evolved, through increasingly formalised networking, to benefit service users:

Filling gaps: Social services and other supports are frequently undersupplied in rural areas, due to geography or insufficient funding. In response, women’s shelter employees are compelled to fill social service gaps in order to fulfil needs that fall outside of direct shelter services. Much like the “no wrong door approach” to social services and support provisions, the idea of filling gaps helps to ensure help-seekers are not turned away or left without resources for any outstanding needs. This can entail some creative problem-solving when there are insufficient resources.
Case management: To help fill gaps, shelter employees adopt case management roles, connect help-seekers to resources directly, and eventually develop a network of resources which they continue to draw on.
System navigation: In performing case management duties, shelter employees facilitate system navigation for women, not only by identifying related service providers who “understand the context of violence”, but also by preparing women to interact with related service providers who do not understand this context (Mantler and Wolfe, 2016[35]).

It is important to bring in lived experiences from those who have used services personally to make sure that victims/survivors’ needs and rights are placed at the centre of all interventions and measures. One way countres can learn from the day-to-day lived experiences of victims/survivors is to conduct consultations (OECD, 2021[47]). For example, the Welsh Government was able to effectively consult survivors/victims under their “National Survivor Engagement Framework,” where they brought in GBV survivors/victims’ views in the design of governmental policies (Welsh Government, 2018[48]). In a similar vein, the Office of the Assistant Secretary for Planning and Evaluation in the United States collaborated with victims/survivors with varied lived experiences to develop a resource on emerging strategies and practices for federal human services staff to engage more equitably with clients in research, policy making, and programming (Office of the Assistant Secretary for Planning and Evaluation, 2021[49]). In Canada, following collaborative, whole-of-government efforts with provinces and territorities and engagement with indigenous partners, GBV experts and stakeholders, Canada launched their National Action Plan to End Gender-Based Violence (GBV NAP) in November 2022.14

Spain’s new national strategy to counter GBV (Estrategia Estatal para combatir las violencias machistas 2022-2025) also involved a number of participatory methods, including meetings with victims/survivors, civil society and local governments, and roundtables on education and digital violence (Ministry of Equality, 2022[50]). Spain’s new “Yes Means Yes” sexual consent law also reflects the participation of victims/survivors, feminist organisations and civil society in the design, implementation and evaluation of public policies, from an intersectional approach (Jefature del Estado, 2022[51]).

1.4.4. ISD has been infrequently evaluated for IPV

The advantages and disadvantages of ISD have rarely been systematically evaluated, perhaps in part because programmes are not always implemented with systematic planning for quantitative or qualitative evaluations of implementation and outcomes (for providers or clients). While this points to a need for more research in the area, some existing evaluations suggest that there is potential for ISD to improve outcomes for victims/survivors.

For example, some encouraging results emerge from analyses of the Pathfinder Project, a pilot led by Standing Together as part of a consortium of expert partners and carried out in England’s health sector from 2017 to 2020 (see Chapter 3). One analysis was led by academics at DECIPHer at Cardiff University using data from the eight Pathfinder sites and comparing it with data from across England to assess how service provision changed following the implementation of the pilot. The analysis found that the Pathfinder Project resulted in an increased number of cases being discussed at multi‑agency risk-assessment conferences (MARACs) relative to non-Pathfinder sites. It also found an increased number of identified cases of domestic violence, over a wider range of risk classifications, relative to non-Pathfinder sites. Survey evidence from a separate analysis conducted by the Consortium indicates that users’ self-reported well-being improved as a result of going through the programme (SafeLives, 2020[52]; Melendez-Torres et al., 2021[53]).

In general, evaluations should strive to measure relevant outcomes of an ISD intervention against an important counterfactual: what would have happened had the ISD intervention not been deployed? In other social policy areas across OECD countries, this increasingly takes the form of randomised control trials. In the face of limited resources – where there is not enough funding to support everyone through a new programme – this would imply that some clients are randomly assigned to a new treatment (e.g. an ISD intervention) while others receive the traditional treatment. Outcomes could then be compared across the two groups which – thanks to randomisation – ideally differ only in their access to ISD.

1.5. Main findings of the report

Reflecting their stated concerns about violence against women (Figure 1.1), OECD governments are trialling integrated approaches as a way to improve service delivery for women experiencing IPV. This report presents a stocktaking of these efforts to integrate service delivery to address IPV. It focuses on the most common service areas involved in OECD countries: preventative responses in the wake of violence, health care, justice, housing, childcare and income supports. Non-governmental service providers have also – perhaps even more commonly than governments – joined up multidisciplinary resources to better support their clients. The findings in this report are based on 35 country responses to the extensive 2022 OECD Questionnaire on Integrated Service Delivery to Address Gender-Based Violence (“OECD-QISD-GBV 2022”) (see Annex A) and a survey-based consultation with 27 non-governmental providers of services to people experiencing GBV (“OECD Consultation 2022”) (see Annex B) (Box 1.5).

Given the potential gains of ISD, what practices have been working well in OECD countries – and what are working less well? Can and should ISD be more broadly implemented to support women experiencing violence?

Box 1.5. OECD questionnaire and consultation informing this report

2022 OECD Questionnaire on Integrated Service Delivery to Address Gender-Based Violence (OECD QISD-GBV, 2022).

In January 2022, Delegates to the OECD Employment, Labour and Social Affairs Committee were invited to complete a questionnaire about service‑delivery arrangements designed to support women experiencing GBV in their countries. OECD QISD-GBV asked countries about service provision and delivery in a range of sectors, as well as how integration is prioritised at the national level. The full questionnaire that was shared with countries can be found in Annex A.

The questionnaire had a response rate of 92%: 35 out of 3815 OECD countries responded.

2022 OECD Consultation with Non-Governmental Service Providers serving GBV Victims/Survivors (OECD Consultation, 2022).

There is a rich history of grassroots organisations, civil society and non-governmental organisation (NGOs) involved in delivering services in response to violence against women. In an effort to gain insight from non-governmental service providers at the delivery-level, an online, survey-based consultation was made available to non-governmental service providers working in the GBV space between 1 February and 30 April 2022. A link to the survey, along with an open call for participation, was shared through OECD social media channels and various e‑mail lists. The survey was also distributed informally through providers in the European Family Justice Centre Alliance (https://www.efjca.eu/). Given that this sample was recruited non-randomly via social media and through “snowball” sampling, and that the survey was open to the public, its representativeness should be interpreted with caution. In total, 27 responses were received from service providers working in 12 OECD countries. Two of the responses came from service providers in non-OECD countries, and were retained for the discussion that follows. All responses were anonymous. A copy of the full survey consultation is available in Annex B.

1.5.1. Policy patterns across OECD countries

Integrated service delivery to address gender-based violence is far from systematic: Fewer than half of responding OECD national governments (48%) report promoting ISD “somewhat” or “to a great extent”16 in their countries. Barely half (51%) report targeted investments to support service providers in further expanding, improving or transitioning to ISD.

To improve policy responses to GBV, ISD takes a variety of forms. Across countries, this includes the physical co-location of services; the use of case managers; informal or formal referral networks; information-sharing and training co‑ordination across agencies; and/or deep co‑operation across agencies, working together on individual cases towards pre‑determined and consistent goals.

OECD governments report applying ISD practices in health care, justice, housing, child-related services, and income support. ISD is reportedly most frequently introduced at entry points in health care, emergency housing, and police services.

1.5.2. The health sector is a common centre for ISD to address IPV

The health sector is one of the most common points of entry to public services for women escaping violence, as victims/survivors face a range of threats to their health: injuries, unintended pregnancies, sexually transmitted infections, pregnancy complications, and mental health problems. GBV can result in homicide or suicide. At the national level, governments seeking to integrate service delivery for victims/survivors have most frequently connected services deployed from hospitals and embedded ISD in mental health supports (Chapter 3).

The role of hospitals

Within wider health care systems, hospitals have been shown to be an important site for ISD as these are where many victims/survivors come in time of crisis. Countries with publicly-funded health care systems are also well-placed to co‑ordinate responses nationally to implement integrated GBV supports. Co-located case management and referral models to support victims/survivors are reported throughout the OECD (Chapter 3), and play an important role over time: they help respond to crises in the immediate aftermath of violence, while also providing the infrastructure for longer-term health resources.

Austria, in particular, has widely integrated related services for GBV in hospitals: all hospitals are obliged by law to establish “victim protection groups” for women experiencing domestic violence. These groups are responsible for facilitating early detection and prevention of domestic violence through awareness raising among hospital colleagues. These groups also establish networks of cross-sectoral actors, including police, shelters, social workers and helpline operators which can then be mobilised to support help-seeking individuals (Chapter 3). In Korea, the approach is also intensive, with multidisciplinary centres in hospitals which offer medical support in addition to psychotherapy and legal counselling for both the immediate victims and their family members.

At the same time, not all health needs are best met in hospitals. Community-based care is recognised as the preferred approach for the majority of mental health care, for instance (OECD, 2021[54]). All OECD countries either already deliver the majority of mental health services outside of hospitals, or have prioritised the transition to community-based care models – with the potential to deliver care that is less costly than in-patient care, more in line with service users’ preferences, and better integrated with other public services. This relates to the use of IPV screening tools in routine medical care (Chapter 3) and could be reflected in ISD responses to IPV in the coming years.

Mental health programmes

The Lancet Psychiatry Commission lists a range of mental health disorders that are more common among people who have experienced IPV than those who have not, including “anxiety, depression, substance use disorder, post-traumatic stress disorder (PTSD), personality disorders, psychosis, self-harm, and suicidality” (Oram et al., 2022[55]). Reflecting these concerns, several OECD countries have established integrated mental health support co‑ordinated at the national level

In Denmark, for example, since 2020, municipal governments are obligated to offer up to ten hours of free, psychological counselling to women who are staying – or who have stayed – at a shelter as a result of domestic violence. Municipalities are also obligated to offer at least four, and up to ten, hours of psychological support to children accompanying women in this context. Sessions can be used both during and after shelter stays (OECD QISD-GBV, 2022).

Other OECD countries provide mental health support through multidisciplinary counselling centres (Chapter 3). In Costa Rica, for example, the National Institute of Women operates regional units which provide multidisciplinary supports, including psychosocial support, to women experiencing IPV. Similarly, in Greece, the Ministry of Labour and Social Affairs funds a number of dedicated counselling centres which provide targeted mental health services for women experiencing IPV. And in Japan, the national and subnational governments jointly fund and operate several spousal violence counselling and support centres which respond to women’s mental health needs and accompany them to related medical appointments (Chapter 3).

1.5.3. Housing is critical to supporting victims/survivors in crisis and in the long run

Intimate partner violence is a leading cause of women and children’s homelessness throughout the OECD, and any efforts to address IPV must consider how to support victims/survivors in what often appears as rebuilding their lives (Chapter 4). National governments in the OECD finance and/or administer emergency, transitional and – occasionally – longer-term housing support for women and children fleeing violence.

Emergency shelters

Emergency shelters play a key role in offering safe haven for women escaping an abusive home and preventing homelessness for women at risk of violence. Emergency shelters are also an important intake site for integrated access to social services and housing support services. Shelters can be general (for anyone in the population) or dedicated to women experiencing violence. Yet while emergency shelters play an important role, very few countries actually offer an adequate number of spaces to meet demand. Some shelters offer counselling on-site, many offer linkages or referrals to health services, and many provide child-related services (e.g. counselling for children), legal advocacy, and linkages to long-term housing. In Italy, for example, income and entrepreneurship support can be applied for through violence protection centres (Chapter 4).

Transitional and longer-term housing

Some countries have policies to help women transition out of shelters and into safe long-term housing. Hungary, for example, has a system of transitional housing in place which offers temporary, highly-subsidised housing for up to five years.

Looking to the longer term, a few countries report special provisions within existing social housing schemes which prioritise access to women who are experiencing IPV. This is the case in Belgium, Ireland, Japan, the Netherlands, Portugal, and Spain, for example. Unfortunately, these provisions exist in an environment of social housing scarcity across OECD countries, which means few women are actually able to access social housing. In the United States, where federal housing funds are more often allocated sub-nationally, a portion of federal housing funding is reserved for sub-national agencies to provide shelter and support for women and children experiencing domestic violence. And in Greece, the “Housing and Work Project” is a recent example of integrating long-term housing subsidies, mental health resources and employment-related supports.

Australia has a novel, trauma‑informed, empowerment-based approach that gives women and children greater stability and may help hold perpetrators accountable. Australia’s “Keeping Women Safe in Their Homes” (KWSITH) initiative provides support for women and their children to remain safely in their homes in the wake of domestic violence. Importantly, this shifts the burden of uprooting one’s life to the perpetrator when he harms his partner (Chapter 4).

1.5.4. The justice sector’s role in a co‑ordinated response

A critical consideration in ISD to address IPV is the client’s risk of exposure to violence, their heightened need for security, and, often, their need for police involvement and access to justice. Consequently, ISD measures to address IPV are often connected with police and legal advocacy support. Because legal issues and procedures are tied with other social, economic, health, or employment issues, a holistic response to GBV requires strong collaborations among organisations within the justice system and between the justice system and other sectors (OECD, 2021[13]).

As with other sectors, there is room for improvement in support for victims/survivors. The legal system can be hard to navigate for non-experts, and many victims/survivors have low trust in police being able or willing to support them (Chapter 5). To some degree, this reluctance may be justified given historical cultures of victim-blaming and down-prioritisation of GBV cases by police (see Chapter 2 on barriers to reporting).

Police

Police are sometimes gatekeepers to accessing justice and other important supports, as reporting a crime can be an entry point to access important interventions and safety. Police work on the ground to respond to emergencies, support women in administrative processes where civil or criminal charges are pursued or imposed, and initiate related, inter-disciplinary services.

Some police are embedded in formal referral networks to related providers. For example, in Austria, the Czech Republic, Luxembourg and the Slovak Republic, police are required to contact social support services and link them with the women experiencing violence (Chapter 5).

Co-location of related services in police stations is another strategy. Australia, for example, frequently co-locates community-based advocates within existing police stations – which also helps in training officers – while Denmark and Norway have established interdisciplinary service provision in police stations. Other countries (such as Portugal, Argentina and Brazil) have established specialised women’s police stations that are well-trained to deal with cases of violence.

Police play an important role, too, in preventing the reoccurrence of violence. The effective use of risk/danger assessments by police – informed by specialised training – and the correct application of emergency restraining/barring orders are an important step to keep perpetrators from carrying out further harm (see Chapter 2 and Chapter 5).

Police are also well-placed to deal with perpetrators of violence and initiate an integrated response to address violence at the source. For example, in New Zealand, both victims and perpetrators of violence enter the “Integrated Safety Response” programme through police services. This integrated framework includes efforts to enforce perpetrator accountability through behavioural change programmes.

Legal advocacy services

To ensure that more victims/survivors are able to make use of the legal frameworks that exist to support them, targeted justice services have emerged to better support women in the wake of IPV. Legal advocacy services and the court system, including domestic violence courts, facilitate women’s access to justice and enable ISD with other sectors.

Several national initiatives exist in the OECD to support women in accessing justice through legal support, including some policies with multidisciplinary or integrated approaches (Chapter 5, Table 5.1). In Austria and Portugal, for example, dedicated multidisciplinary counselling centres have been established which provide psycho-social counselling in addition to legal counselling and court navigation support to improve access to justice. In Australia, legal support services have been embedded in health care settings to streamline access to justice for women who are already accessing health services (Chapter 5).

Costa Rica, New Zealand, Türkiye and the United Kingdom have established dedicated domestic violence courts which apply trauma‑informed practices to empower women as they appeal for justice. Domestic violence courts apply specialised knowledge to better enforce orders, jointly delivered with police, that protect women. Domestic violence courts can also play an important role in enforcing perpetrator accountability through offender intervention programmess (Chapter 5).

1.5.5. Challenges, opportunities and policy lessons to foster lives free from violence

Women experiencing IPV often require support from a number of policy sectors in order to re‑assert their safety and independence. Integrated approaches to end IPV have the potential to mitigate the consequences of violence by delivering multiple, essential services simultaneously.

At the same time, major efficiency gains for providers are also possible. Integrated services can potentially reduce the costs of service delivery for governments when programming is backed by coherent policy integration, both vertically (across levels of government) and horizontally (across sectors). Despite variations in governance structures across the OECD, opportunities exist at the national level to facilitate and streamline ISD on the ground.

Policy coherence matters

Governments must ensure that existing policies across sectors and jurisdictions do not inadvertently undermine each other, either directly,17 as a result of regulations, or indirectly, as a result of a competition for resources (Chapter 6).

Related to this, policies and services must reinforce each other to address the whole problem of GBV. This involves emergency responses in the wake of violent incidents, a continuity of support in the medium- and long-term, and ensuring that perpetrators of violence are held accountable.

One example of how to ensure policy coherence is via model administrative frameworks that can help facilitate collaboration at the service delivery level. A strong administrative foundation can help all parties understand clearly their role in joint working. As a first step, national Ministries can collaborate to develop guidelines for service delivery standards, based on stated goals to improve service quality, outcomes, and satisfaction among both service users and providers. Templates can be developed to facilitate shared mission statements, memorandums of understanding across sectors, and joint service delivery agreements between providers. These administrative pieces can also be incorporated into funding criteria, effectively incentivising integration where clear service delivery arrangements exist.

A whole‑of‑state approach is essential

A whole‑of-state approach – including national frameworks, reliable and adequate funding, and the involvement of government co‑ordinating bodies tasked with gender mainstreaming (and GBV mainstreaming) – can help ensure that national strategies reach the service delivery level well-integrated across Ministries and agencies.

Changing, unclear or overlapping responsibilities can create competing incentives in terms of funding and management. Different Ministries at the national level may be responsible for planning or ensuring service delivery to categorically separate subsets of the population which, in the context of GBV, can often overlap. Similarly, subnational governments may develop action plans or laws within their jurisdictional bounds that may or may not coherently align or engage with incoming national-level action plans. These issues are exacerbated in an environment of scarce public funding.

Part of this challenge, of course, stems from a more basic governance issue: multi-level governance structures present a common challenge for all OECD countries when integrating health, legal and social services of almost any kind (OECD, 2015[22]). Where governance structures are highly centralised, it may be difficult to ensure national policy reflects local needs and is adequately delivered on the ground. On the other hand, decentralisation and varying degrees of regional and municipal autonomy – both legislative and financial – can lead to gaps in service coverage, as well as a lack of monitoring and evaluation (Lovette, Coy and Kelly, 2019[56]). For example, NGO providers have criticised their inability to help relocate a victim/survivor to a safe location further away from her abuser if that location falls under a different funding or political jurisdiction.

Funding to address to GBV must be adequate and reliable over time

Irregular and inadequate funding for IPV-related service delivery was the top challenge cited by both countries and non-governmental service providers who participated in the OECD QISD-GBV 2022 (see Annex A) and the OECD Consultation 2022 (see Annex B), respectively.

A protected, legal basis for the funding of ISD to address GBV can help to circumvent pre‑existing, siloed funding streams and ensure continuity of care by service providers. This must be prioritised in national budgets as part of broader frameworks on GBV.

A legislative basis can also shield budgetary allocations from changes in government. This can be done through funding rules which establish reinvestment criteria for central funds that are allocated to subnational entities. A parallel can be drawn from the United Kingdom, for example, which recently implemented a funding rule whereby National Health Service Clinical Commissioning Groups must increase investment in mental health services in proportion to the overall increase in their central funding allocations.

Opportunities also exist to empower local beneficiaries with flexibility to address specific, local needs with central funding allocations. One such example exists in Colombia, where local recipients of central funds allocated for the “Generación Explora” programme can choose two of 12 focal issues to finance (some of which explicitly address violence). Greater flexibility in local or regional funding could also help simplify resource distribution processes across jurisdictions, for example when nearby towns or regions are jointly aiding a client.

National governments can help standardise (and fund) regular, local needs assessments

An important first step for establishing and improving ISD is collecting data to understand a community’s need for services on the ground. Local contexts are crucially important – especially where service delivery occurs at the subnational level or through partnerships with NGOs. A “one‑size‑fits-all” approach would not be effective in most countries.

Nevertheless, national guidelines for standardised needs assessments can prove useful (Kelly, 2018[57]), especially where targets related to ending GBV are outlined in national action plans. National guidelines and resources can also be useful when delivery-level entities lack the resources to coherently assess service needs – a common shortcoming.

Governments should prioritise improving local administrative data collection. This entails research into the local prevalence of various forms of GBV, in addition to tracking service uptake and system utilisation, for example through service usee numbers. Local prevalence rates can then be measured against social service “resource scans” – stocktakings or mapping of available local services. Together, these assessments can better inform the types of services that should be joined-up in order to respond accurately to needs on the ground. Where service delivery is decentralised, these assessments can inform the funding process for service delivery grants.

Regular needs assessments can also be qualitative in nature, such as a recent study to assess the special needs of children accompanying mothers in women’s shelters in Greece (forthcoming). In the Czech Republic, the government surveyed regional authorities and local service providers to better assess the needs of people at risk of domestic violence as a precursor to implementing Istanbul Convention recommendations (EU Social Fund, 2021[58]).

Finally, while national population surveys on GBV have serious limitations – including underestimating actual rates of violence – it is nevertheless important to carry out such surveys (OECD, 2020[2]). Survey data can be used to identify regions or subgroups of women experiencing or at risk of experiencing a high prevalence/frequency of violence, perhaps based on underlying socio-economic conditions. These can be dedicated surveys on GBV repeated over time, or modules on GBV within other population surveys, that can then be used to inform needs assessments.

Data sharing capabilities across agencies must be strengthened

Data sharing across providers can reduce clients’ application costs (in time and energy); reduce the trauma associated with repeating accounts of violence to different providers in different locations; and improve client safety by better tracking risks across repeated incidents of violence. Ideally, such a system would also integrate perpetrator-related interventions to track accountability and recidivism, as well as monitor the risk posed to help-seeking women in real time.

Yet there exist serious gaps across providers and levels of government in most countries when it comes to sharing data on IPV cases. Data-sharing capabilities across agencies must be strengthened, possibly by way of a central, integrated case management system, while ensuring client privacy.

For providers, a data-sharing platform can create a secure environment for information sharing; facilitate co‑operation; reduce administrative processing costs, coverage gaps and service duplication; and more accurately assess risk by making past appeals for help more visible to other providers. For governments, a central case management system can improve institutional co‑ordination; more accurately track the prevalence of violence; and provide the foundation for monitoring service delivery costs and service delivery effectiveness on a case‑by-case basis as a function of risk.

Importantly, shared information on clients can help early detection and prevent cases of violence by making providers better aware of the risk profiles and histories of different clients. Governments may gain long-term savings through early detection, prevention and increased efficiency in delivering services, ultimately reducing the number of appeals necessary to resolve problems.

Once established, such a system could also be mobilised to serve other vulnerable groups in addressing complex problems. Acknowledging the multi-dimensional utility of such a system, the World Bank is supporting the establishment of an integrated case management system in Chile for the specific purpose of improving service delivery to women affected by violence (The World Bank, 2022[59]). Australia has also introduced a data sharing strategy within the Safety First Programme, an information-sharing and safety-planning mechanism for women leaving refuges.

Of course, while women’s privacy and security must be the top concern in data sharing strategies, it is important to note that the shift to digital data sharing does not necessarily imply increased risks, and may actually be an improvement over current conditions, which do not always adequately protect client privacy. In many cases, information is “transmitted between institutions either manually or by email, raising confidentiality concerns and significant delays in what are often life or death situations” (Inchauste, Bello and Contreras-Urbina, 2021[60]).

Better and regular programme evaluations are essential

On the whole, ISD approaches to addressing GBV have not been systematically or quantitatively evaluated. Integrated services need to be better evaluated both individually and in the context of broader social protection system supports for GBV.

Better evaluations could entail randomised control trial evaluations of outcomes for clients offered an ISD approach versus standard service delivery; monitoring and evaluation of costs and benefits of integrated versus standard programmes; and qualitative, survey-based evidence on client experiences. Importantly, clients should be compared across integrated services and standard services to understand a crucial counterfactual: what would have likely happened in the absence of policy integration?

Such evaluations can and should also consider interventions for perpetrators of violence, to help improve understanding of what works in keeping perpetrators from assaulting (again) their partners. Understanding how to prevent recidivism is crucial for breaking a cycle of violence.

A holistic perspective means treating everyone involved – including perpetrators

In addition to cross-sectoral and cross-jurisdictional coherence, policies aimed at addressing – and ultimately eradicating – GBV must consider all parts of the problem. This fundamentally requires targeting perpetrators of violence. Governments can interact with perpetrators not only through criminalisation and the court system, but in multi-dimensional ways that more holistically improve offender accountability and produce long-term behavioural change on individual and broader cultural levels (Chapter 2).

Most importantly, apply a victim/survivor-centred focus

Many of the policy prescriptions to address GBV are “top-down” in nature, encouraging national governments to offer guidelines, regular support, and data gathering tools to subnational and non-governmental service providers. While this line of communication is important, it is at least as important to ensure that national policy makers listen to experts and victims/survivors at the local level.

Local service providers and advocates are highly attuned to the needs of women on the ground, and they offer years of experience and knowledge of the diverse, often intersectional challenges women face. Many “best practice” integrated service delivery examples evolved from the ground up, such as the cases of the Family Justice Centres in Europe and North America or the evolutions of rural women’s shelters in Canada. Clear lines of communication must therefore connect local service providers with national and regional policy makers, to enable better and more victim/survivor-centred service delivery.

Victim/survivor-centred approaches could include regular stakeholder engagements or surveys of service providers to ensure stakeholders can help to co-create good policies. To help advance stakeholder engagement, the United States Department of Health and Human Services also recently published research for government agencies on how to adequately capture and act on “lived experiences” of service users to understand better how programmes are working on the ground and how to improve them (Office of the Assistant Secretary for Planning and Evaluation, 2021[49]). The Canadian, Spanish and Welsh governments offer similar examples of incorporating victim/survivor feedback in programme design (see Section Local evolutions of ISD to address GBV are important).

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Notes

← 1. It is important to note that men in heterosexual relationships and people in same‑sex relationships also experience IPV, though in these cases, motivation for violence is more often rooted in interpersonal or psychosocial dynamics rather than in gendered conceptions of superiority. As with violence against women, violence against members of the LGBTI+ community is gender-based in that it is motivated by prejudice and an illusion of hetero-masculine superiority among offenders. Statistically, women experience GBV most often at the hands of their male partners, adding a layer of complexity to help-seeking. For this reason, this report focuses on intimate‑partner violence against heterosexual women, and the supports required to address their many needs in escaping violence.

← 2. These cross-nationally comparable homicide statistics from the U.N. Office on Drugs and Crime were last updated in 2019, prior to the COVID‑19 pandemic.

← 3. This includes intimate partner and non-intimate partner violence, i.e. all forms of violence.

← 4. Note that these cross-nationally comparable estimates for the OECD include all women, not only ever-partnered women.

← 5. See, for example (Shearson, 2021[61]; Glenn, 2021[65]; Mundy and Seuffert, 2021[66]; Moylan, Lindhorst and Tajima, 2017[67]; Fusco, 2013[68]).

← 6. For examples of evaluations of compliance with Istanbul Convention minimum standards in European OECD countries, see (WAVE Network, 2019[11]; Council of Europe, 2022[14]).

← 7. Affected women may feel as though their case may not be “taken seriously” through traditional reporting channels such as the police, or that help-seeking options may fall short of long-term solutions that ensure safety and security. For a review of these challenges, see, for example: (Glenn, 2021[65]; Mundy and Seuffert, 2021[66]; Moylan, Lindhorst and Tajima, 2017[67]; Fusco, 2013[68]).

← 8. See https://www.oecd.org/governance/gender-mainstreaming/ for an overview of work on this topic in the OECD; https://www.coe.int/en/web/genderequality/what-is-gender-mainstreaming for an overview of work by the Council of Europe; and https://eige.europa.eu/gender-mainstreaming/what-is-gender-mainstreaming for a descriptive overview from the European Institute for Gender Equality (EIGE).

← 9. For examples of international approaches, see (OECD, 2021[13]; OECD, 2020[69]; Council of Europe, 2011[10]), for a small selection of national strategies, see Box 1.3.

← 10. Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Latvia, Lithuania, Luxembourg, Netherlands, Norway, Poland, Portugal, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, United Kingdom. See https://www.coe.int/en/web/conventions/full-list?module=signatures-by-treaty&treatynum=210.

← 11. These results come from a questionnaire sent to countries via the OECD Public Governance Committee. 26 countries responded in total.

← 12. International literature highlights a lack of common terminology when describing collaborative, multi‑agency working, making classification and comparison challenging. See, for example: (Atkinson, Jones and Lamont, 2007[62]).

← 13. Of course, on the provider side, the appointment of a single co‑ordinating case worker (often social workers or, in the United Kingdom, “domestic violence advisors”) also implies considerable emotional dexterity and stress. Deteriorating mental health is not uncommon among case workers, often related to “inadequate organisational resources, lack of training, and poor integration with other community resources.” (Kulkarni, Bell and Rhodes, 2012[63]). In the United States, burnout worsened among providers during COVID‑19 (Garcia et al., 2022[64]).

← 14. Stakeholder engagement is relatively common in Canada. One example of findings from multi-stakeholder consultations can be found the report “Breaking the Silence: Final Report of the Engagement Process for the Federal Strategy to Address Gender-based Violence” (Status of Women Canada, 2018[70]).

← 15. France, Poland and Sweden did not respond to the questionnaire, but evidence from desk research has been included when possible.

← 16. Countries were asked “To what degree does the national/federal/central government actively promote the integration or co-location of services at the subnational and/or non-governmental level, or via private service providers?” Response scale choices were “to a great extent,” “somewhat,” “very little,” “not at all,” or “don’t know.”

← 17. For example, “nuisance property laws” at play some US municipalities impose eviction (and even criminal charges, in some cases) for tenants who use a pre‑determined number of emergency service calls. This is particularly harmful for women who may appeal to emergency police services for protection in repeated situations of IPV (Chapter 4).

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