QUICK ESCAPE FROM SITE

Consider investment in ‘one-stops’ to meet the multiple needs of survivors

  • The model of a “one stop” centre is important for creating a safe and supportive environment for women and girls to seek immediate protection, medical treatment and legal assistance, although it is not cost-effective for all settings. The centres are designed to reduce the number of institutions that a survivor must visit to receive basic support following an incident of violence by coordinating the assistance and referral process through one location.

  • Frequently survivors of sexual and gender-based violence report that the way police, hospitals and courts are set up does not provide an appropriate atmosphere to report on violence. For example, police stations may lack private interview rooms or specially trained officers who know how to respond and interview female survivors. Hospitals may also lack private treatment rooms or the facilities to conduct the specialized examinations and analysis needed to provide the medical evidence that assists in prosecution of a legal case.

  • In many communities, survivor services, where they exist, are often located in different physical locations and inhibit, rather than facilitate, timely and efficient responses. For example, a rape survivor may go to the police, where her case is documented, but may not be able to go to a health facility that can administer post-exposure prophylaxis within the 72-hour period required and that can also conduct forensic examinations if the woman decides to receive one.

  • There are a number of different models for centres that offer protection and immediate services to women and girls (e.g. crisis centres or spaces within health centres or hospitals).  A well-known practice is the hospital-based model developed in Malaysia in 1993, which has been replicated across regions worldwide. One-stop shops, often located in hospitals, usually provide some or all of the following services:

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    • Immediate medical assistance (e.g. treatment for physical injuries, emergency contraception and HIV post-exposure prophylaxis (PEP) kits)

    • Medical testing, for example for HIV and AIDS, STIs, pregnancy

    • Forensic facilities to collect and analyse the necessary forensic evidence for prosecution

    • Trauma / psychological counselling

    • Criminal investigations unit, where survivors can report a crime and a case file can be opened
    • Legal assistance

    • Temporary shelter/ safe accommodation

 

Key guidelines for establishing and running ‘one stop shops’:

  • A protocol should be developed between the different service providers to determine set procedures for supporting victims, prioritizing cases and providing access to various services.

  • All service providers should receive specialist training in working with women and child survivors.

  • Tight safety and security measures should be put in place to ensure victim safety and prevent perpetrators from accessing the centre.

  • Privacy and confidentiality should be ensured through private rooms available for medical and other consultations and secure management of records.

  • Community dialogue and outreach activities should be developed to provide the wider population with information about the services offered, hours of operation, etc. for the ‘one stop centre’.

  • Commitment should be secured from the local authorities for the centres to be sustained and financed over the longer term.


Lessons learned and challenges:

  • It is often difficult to establish ‘one stop centres’ outside metropolitan areas given lack of resources and infrastructure.

  • An absence of partnership with women’s non-governmental organizations limits the ability of centres to provide more comprehensive support and counselling components to survivors.

  • Insufficient investment in capacity development and specialized training of service providers affects the quality of support provided and use of services by survivors.

  • One-stop shops are resource intensive and are often financed by international non-governmental organizations or donor agencies. Greater attention is required to explore the sustainability of these centres.

  • Although renowned as a promising practice, there is a lack of evaluations on one-stop shops.

  • Where integrated services are not available, police can establish linkages with existing health facilities, or work through a victim advocate who supports survivors throughout the process to access services from various institutions (WHO, 2010; Ward, 2011).

Examples of one-stop shops (police managed, government and non-governmental)

Rwanda’s police-managed ISANGE One Stop Centre: The One Stop Centre for Survivors of Child, Domestic and Gender-Based Violence, established in 2009, is based in the Kacyiru Police Hospital, Kigali. ISANGE (meaning feel welcome and free in Kinyarwanda) was initiated through a partnership between the Rwanda National Police Health Services and the United Nations in Rwanda, with support from UNIFEM (now UN Women), UNFPA and UNICEF. The first integrated centre in Rwanda, the model offers a range of services, including protection from further violence, crime investigation, medical testing and court referrals as well as treatment for physical and psychological trauma, in comfortable and confidential facilities. Toward expanding integrated services, the Ministry of Health has made a commitment to provide offices in all government-run hospitals for police to follow up on cases of gender-based violence, which will also support a ministerial order passed that survivors of rape must be medically examined within 72 hours after an incident. Another centre was built on this model, in the Rusizi District in western Rwanda (UNIFEM, 2009).

 

Papua New Guinea’s partnerships with police through the Stop Violence Centres in provincial hospitals: Since 2004, the National Department of Health has set up “Stop Violence Centres” (previously known as ‘Family Support Centres) in all provincial hospitals in Papua New Guinea. The first centre, set up in the Port Moresby General Hospital, provides medical assistance, trauma counselling, overnight emergency accommodation, paralegal support and then referral to other agencies for further shelter, legal support and counselling. Referrals to the centre can be received from Accident and Emergency and other wards of the hospital, NGOs, the police (through a link with the Sexual Offences Squad and government agencies). The Centres support women and children who have experienced sexual violence, domestic abuse or have attempted suicide. The Government has worked to formalize the procedures, protocols and referral pathways at the Centres and then roll them out nationally. By 2009, there were four Centres in the country (also in Lae, Goroka and Kundiawa), and AusAid had committed to open four additional centres (in Alotaus, Wewak, Maprik and Arawa) (AusAid, 2009. ‘Papua New Guinea Country Report’; Amnesty International, 2006).

 

South Africa’s Thuthuzela Care Centers: The Centers, established at various provincial hospitals across South Africa, provide sexual violence survivors comprehensive care and methods to prevent secondary victimization by police or medical staff who may not be accustomed to working with rape cases. Individuals can get medical attention, speak to a police officer, and receive psycho-social counselling. Activities and survivor supports are coordinated with the South African Police Service, justice officials and lawyers who liaise with medical staff and social workers and hospital staff for each case, including specially trained nurses and doctors to collect evidence. The model is being replicated across the country and beyond (South Africa National Prosecution Authority; UNICEF South Africa).

 

Timor-Leste’s Safe Room Project (Fatin Hakmatek): In 2003, the non-governmental organization PRADET (Psychosocial Recovery and Development in East Timor) established a safe space in the Dili National Hospital to provide treatment for women and girl survivors of domestic violence, sexual assault and child abuse. In 2006, it moved to a dedicated facility on the hospital grounds, where it offers free medical treatment, emergency counselling, forensic documentation of injuries, assistance with food and transportation, overnight accommodation (with 3 sleeping rooms) and referrals to other resources in the community, including legal advice. The centre has developed a strong working relationship with the National Police and receives the majority of its referrals from them. Since its establishment, Fatin Hakmatek has assisted hundreds of women and girls and is expanding its reach through centres in the country’s five district referral hospitals (Oecusse, Maliana, Suai, Baucau and Maubisse), expected to begin operations by early 2012. It has been mainly funded by UNFPA, AusAID and Caritas Australia. Key features of the space include:

  • A well-designed facility with strong security and a separate entrance to an interview room so police can take victims’ statements without entering the main building.

  • A homely environment with space for staff and volunteers to work, relax and cook, with private interview rooms and confidential recordkeeping.

  • A staff team comprising 5 female midwives and a male nurse, who receive regular mentoring and other capacity support as required.

  • Open seven days a week, with after-hours service.

  • Strong connections with other agencies working on violence against women and support groups for survivors of different forms of violence (e.g. Secretary of State for Gender and Equality, Ministry of Social Solidarity, Health, National Police, UNFPA).  

  • Training opportunities for doctors and other health workers on a medical/ forensic examination protocol that covers both child and adult survivors of domestic violence, sexual assault and child abuse.

  • A 24 hours emergency helpline: +670 725-4579.  

  • Training and education by Fatin Hakmatek staff for health workers, police and communities on domestic violence, sexual violence, sexual assault, child abuse and abandonment, and related health care and safety activities. This includes awareness-raising on the development of referral pathways in sub-districts across Timor-Leste.

Pradet has begun a 3-part training of doctors and midwives at each referral hospital in the forensic protocol, involving a week of theoretical background, a week of practicum at the Fatin Hakmatek and a follow-up training by international experts and Fatin Hakmatek staff (Commonwealth of Australia, 2007; Pradet website; Kendall, S. for Pradet, 2010; communication with Pradet advisor, April 2011).

 

The Havens in London, United Kingdom: The dedicated rooms for survivors of sexual assault previously established in police stations by the London Metropolitan Police were moved to ‘Haven Suites’ in private buildings or hospitals due to space limitations in 2000. The suites are open 24 hours and have specially trained medical and psycho-social staff linked with specialized sexual assault police investigators for survivors who choose to report the incident to the police. Victims can directly seek assistance from the units or be referred there by the police. The facilities offer space for interviewing survivors, conducting medical examinations and provide other immediate and long-term counselling support, among other services, with specialist staff for girls and young people 13-18 (The Havens website).

See additional examples of one-stops through the Secretary General’s Database (search for integrated service centre)

 

Promising practice: Family Justice Centers, United States

The President’s Family Justice Center Initiative is a US $20 million federal program to create specialized ‘one-stop shop’, co-located, multi-disciplinary service centres for survivors of family violence and their children. Launched in 2003 by the President and modelled after the San Diego Family Justice Center, the centres are designed to reduce the number of institutions that a survivor of domestic violence, sexual assault and elder abuse must visit to receive assistance. The aim is to provide a single location where survivors can go to speak with an advocate, plan for their safety, interview with a police officer, meet with a prosecutor, receive medical assistance, access shelter information and get help with transportation.

The family justice centre model has numerous effective features, which include:

  1. Co-located, multi-disciplinary services for survivors of family violence and their children increases safety and support. Partners of the centre include law enforcement officers; prosecutors; probation officers; military advocates (if applicable); community-based victim advocates; civil attorneys; medical professionals; members of community groups.

  2. Pro-arrest/ mandatory arrest policies increases accountability for offenders. Each community has law enforcement and prosecuting agencies that emphasize the importance of arrest, prosecution and long-term accountability for offenders.

  3. Policies incidental to arrest/enforcement reduce re-victimization of survivors. Each community hosting a center has a demonstrated history of addressing common problems such as dual arrest (i.e. where both parties involved in intimate partner violence are arrested) and mutual arrest. No jurisdiction has policies that require a survivor to pay for obtaining a restraining order if the survivor is financially unable to afford such costs.

  4. Survivor safety/advocacy is the highest priority in this service delivery model. Each site has readily identifiable processes and staffing to assess and provide for survivor safety during the intervention process. All justice centers have policies in place to ensure, to every possible extent, security for staff and clients.

  5. Survivor confidentiality is a priority. All sites have policies and procedures that provide for survivor confidentiality to the extent required by law. Survivor information can be shared among agencies working in partnership to protect the client only after informed consent procedures are implemented.

  6. Offenders are prohibited from on-site services at centers. No criminal defendants should be provided services at a family justice center. Domestic violence victims with a previous history of violence or with a current incident in which the victim is the alleged perpetrator are assessed on a case-by-case basis for eligibility for services.

  7. Community history of domestic violence specialization increases the success of collaboration. Every center has a history of specialized services (e.g. trained advocates, police officers, prosecutors, judges, court support personnel, medical professionals) in their community. In the absence of such a history, family center planning should include intensive training for all proposed partners and staff, with an emphasis on survivor safety and advocacy and collaboration in the co-located services model.

  8. Strong support from local elected officials and other local and state policymakers increases the effectiveness and sustainability of Family Justice Centers. All new centers demonstrate strong local support from authorities within the community. The President’s Initiative did not anticipate indefinite federal funding for any family site. Each site was required to seek strong support from local officials or other influential policy makers to increase local support at the conclusion of federal funding.

  9. Strategic planning is critical to short-term and long-term success in the Family Justice Center Service delivery model. Each center demonstrates a strategic planning process to ensure sustainability and development of the program, and local funding options for future operations. A history of local funding is strong evidence of possible future support. Local revenues to fund specialized intervention professionals demonstrates the commitment of local officials and policy-makers to domestic violence intervention and prevention work.

  10.  Strong/diverse community support increases resources for survivors and their children. All sites need strong, diverse community support. Strategic planning efforts that include developing and maintaining support from local government, state government, business, labour, diverse community-based social service groups, and faith-based organizations increases the resources available to survivors and their children at a center, which improves safety and support.

 

As of 2009, there were 31 Family Justice Centers in the U.S. (16 received funding under the President’s Initiative) and five International Family Justice Centers (in Canada, England and Mexico). The model has been identified as a promising practice in the field of domestic violence intervention and prevention services by the United States Department of Justice given its association with outcomes such as reduced homicides, increased survivor safety, increased efficiency and coordination among service providers and reduced fear and anxiety for survivors and their children. However, it requires significant start-up costs and would be difficult to replicate in communities where government and law enforcement agencies have no history of collaboration and specialisation in addressing matters of family violence.

Sources: Office on Violence against Women, US Department of Justice (2007); Seftaoui, J. (ed.) (2009) ‘Bringing Security Home: Combating Violence against Women in the OSCE Region. A Compilation of Good Practices’, Vienna: OSCE; National Family Justice Alliance, (2009).

 

Key Resources

Collaborating for Safety: Coordinating the Military and Civilian Response to Domestic Violence: Elements and Tools (Jane M. Sadusky for Battered Women’s Justice Project, 2010). This handbook provides an overview of the processes used in the implementation of the United States Government-funded Military/Civilian Coordinated Community Response Demonstration Project, which aimed to create guidelines for coordinating the response of civilian and military agencies to domestic violence cases involving military personnel that enhance victim safety and autonomy, effectively hold perpetrators accountable for ending their violence, and provide safety and support to children exposed to family violence. It can be used by advocates and law enforcement personnel to establish or strengthen a collaborative relationship between the local community and local military units. Available in English.

Bringing Security Home: Combating Violence against Women in the OSCE Region. A Compilation of Good Practices (Seftaoui, J. (ed.), 2009). This publication documents more than 95 good practices to help eliminate gender-based violence and highlights their impact in preventing violence against women, protecting victims and prosecuting offenders. Strategies for involving men and young people in anti-violence activities are also described. Available in English.

Combating Violence against Women: Minimum Standards for Support Services (Kelly, L. for the Council of Europe, 2008). This resource is for service providers, advocates and policy-makers and contributes guidance toward the development of consensus on the minimum standards for protection and support services, including the range and scope of services to be provided as well as the principles guiding practices. Available in English; 66 pages.

Post-exposure prophylaxis to prevent HIV infection- Joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection (WHO/ILO, 2007). This set of guidelines, by the World Health Organization and International Labor Organization, is for public health practitioners and policy-makers. The guidelines provide a unified framework on developing a PEP policy and the implementing services for exposure through occupational situations and sexual assault. The guidelines cover: the general development of PEP policies and strategies for implementing programmes; general management of HIV PEP; policy development and clinical management of occupational exposure as well as exposure from sexual assault; and related references including guidelines on HIV testing. Annexes include sample checklists, service provider scripts, patient information sheets and documentation templates, which, along with the guidelines, should be adapted to the local context. Available in English; 104 pages. See also guidance in Health Module.

Evaluation of a Coordinated Community Response to Domestic Violence: The Alexandria Domestic Violence Intervention Project - Final Report (Orchowsky, Stan J. for the US Department of Justice, 1999). This resource, produced by, is for EVAW specialists and advocates, as well as policymakers. The study examines the Alexandria, Virginia Domestic Violence Intervention Program, a coordinated community response to domestic violence, to determine program effectiveness. Available in English; 145 pages.

See also the module dedicated to coordinated responses.