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One-stop centres (OSC)

  • In recent years, the ‘one stop centre’ (OSC) model for attending to survivors of violence against women and girls has garnered attention in development settings as an exemplary approach to facilitating comprehensive and ethical care for survivors.  Not surprisingly, the humanitarian community’s interest in OSCs also appears to have accelerated as a method for scaling up quality services during post-conflict reconstruction and recovery. While there are many positive benefits for survivors, one-stop centres may not always be the most feasible method for providing such services, especially in low prevalence or low population density areas. 
  • During the emergency phase of conflict, it is expected that a minimum initial service package (MISP) be available to survivors. Once the emergency has abated, programmers can begin to consider more comprehensive and sustainable approaches to coordinated care for survivors such as through the establishment of OSCs.
  • To determine whether an OSC is the right option for improving survivor services in a particular conflict or post-conflict humanitarian setting, it is important to know what the term refers to (and thus what OSC programming entails), as well as what some of the other approaches are for responding to the needs of survivors. Any decisions regarding the appropriateness of different types of interventions will also be informed by local needs, financial and other resources, and human resource capacities.
  • In general, coordinated care models (such as the OSC) seek to optimize a multi-sectoral approach and ensure consistency in the application of core guiding principles in all service delivery efforts.  Coordinated care can refer to survivor services that link sectoral responses within stand-alone programs (where health, psychosocial, police and legal assistance are available in one location), or that link sectoral responses through standardized referral pathways across programs (where health care providers, for example, provide a full array of response services within a health setting and then refer the survivor elsewhere for police and legal assistance).
  • Although the OSC model has received a significant amount of attention from programmers and donors in various development and humanitarian settings, the term is often used differently across settings to describe different types of multi-disciplinary responses.  In order to provide some clarity around terminology as well as around different levels of services, the list below attempts to outline some of the coordinated care approaches (including OSCs) that have emerged globally in the last twenty to thirty years.

 

Name of Response

Originating Country

Originating Sector

Description

Primary Aims

Sexual Assault Response Team (SART)

USA

Multi-sector in the sense that SARTs often have their own premises

SART started in the 1970s in parallel with SANE (see below) and in many US jurisdictions, SART combines with SANE, but it may also rely on general hospital staff.  A team consists of a nurse or doctor, a police officer, and a victim advocate (sometimes, a prosecutor is also involved). Typically, SART has its own premises; a victim is escorted there by a police officer or victim advocate. All team members attend the SART office where the victim is interviewed, the medical examination conducted, and support (counselling and referrals) is offered to the victim.

 

1. Make reporting easier for victims

2. Make medical examination easier for victims

3. Coordinate investigation and support services.

exual Assualt Referral Centre (SARC)

England/

Wales

Usually located in hospitals

SARCs are the English version of SARTs, first established in 1986.  Most are joint ventures between the police and the health sector, with involvement of the voluntary sector. They are usually located in a hospital. Victims receive medical care by a specialised health practitioner; they receive counselling and legal advice, are interviewed by police, and undergo a forensic examination. The service is available 24 hours a day. Victims may self-refer or be referred by police, but are not obliged to report the assault. They can talk informally to a police officer, before deciding whether to report or not. SARCs also offer victims follow-up medical and psychological care for up to 6 months

 

1. Make reporting easier for victims

2. Make medical examination easier for victims

3. Coordinate investigation and support services.

 

One Stop Centres/

Shops

Originating in Malaysia now in several countries in South Asia and Africa

Usually located in health facilities

One-Stop Centers provide multi-sectoral case management for survivors, including health, welfare, counselling, and legal services in one location.  They are linked as well to the police through referral pathways. These crisis centres are typically located in health facilities, including the emergency departments of hospitals, or as stand-alone facilities near a collaborating hospital. These centres can be staffed with specialists 24 hours or can maintain a core group of staff with specialists on call.  Unlike SARTs and SARCs that focus on sexual violence, one-stop centers may focus their services on the issue of domestic violence, or they may address both domestic violence and sexual violence. 

1. Make reporting easier for victims

2. Make medical examination easier for victims

3. Coordinate investigation and support services.

Rape Crisis Centres

Various

Typically a community-based NGO

Rape crisis centres are usually NGO-run facilities that provide support to victims (e.g., counselling, telephone helpline) and information about the legal system. Staff and volunteers often participate in multi-disciplinary response to sexual assault such as one-stop shops, SARC, or SART. They may also assist victims during forensic examination or when reporting to police.

1. Assist and support victim

2. Provide information and counselling to victim

Centres Against Sexual Assault (CASA)

Australia

NGO Sector, now linked to multi-sectoral services with autonomy

CASAs provide support to victims (counselling, telephone helpline) and legal information. CASA staff members participate in multi-disciplinary response to sexual assault and in community and professional education. They seek to inform government policy, advocate for law reform, and facilitate research.

1. Integrate responses to sexual assault

 

Sexual Assault Nurse Examiner Programs (SANE)

USA

Health sector

Nurses are specially trained in examining victims, collecting forensic evidence, and victim care. SANEs not only conduct the forensic examination, they also provide medical care such as pregnancy prevention, STD testing, and referral to counselling. Typically, SANEs are part of a team response to sexual assault (see SART), but they also work as specialist nurses in general emergency wards.

1. Improve collection of forensic evidence

2. Make medical examination easier for victims

3. Provide medical care to victims

Project Saphire

England

Security/

Police

Project Sapphire was initiated in 2001 and consists of dedicated sexual offences investigation teams--officers trained in first-response to sexual assault and an inspector whose only duty is the investigation of serious sexual offences. A male or female “chaperone” officer contacts the victim within one hour of reporting. The chaperone is not involved in the investigation but offers support to the victim, organises the medical examination, contacts support groups, and friends and relatives, and organises protection for the victim if required. The chaperone is also responsible for keeping the victim informed of the development of the case. An officer is available 24 hours a day. All front desk staff are trained in speaking and responding to victims.

1. Make reporting easier for victims

2. Provide better victim care

3. Improve quality of investigation

 

Sexual Assault and Child Abuse Team (SACAT)

Australia

Security/

Police

Established in 1988, SACAT is a specialist police unit for sexual assault of adults and children. It aims to minimise further trauma for victims and to increase their confidence to participate in the legal process. Staff members are specially trained in dealing sensitively with victims. Initially located in its own premises, SACAT is now within a suburban police station, which also houses other specialist units. It provides an integrated environment for victims, including a medical suite, bedroom, lounge room, play area for child victims, and an interview room with video-recording facilities. A Sexual Assault Victim Liaison Officer maintains contact with victims, informing them of developments in their case. SACAT detectives receive special training in investigating sexual assault.

1. Make reporting easier for victims

2. Improve quality of investigation

Victim Support Units

Zambia

Security/

Police

The Victim Support Unit leads work gender-based violence, providing victims with counseling and support (including administration of PEP and EC), in addition to dealing with perpetrators. The units were established in 1994 and became fully operational in 1998 with presence in every province of the country today.

 

Victim Protection Units

East Timor

Security/

Police

The Victim Protection Units These units take complaints and have authority to investigate cases such as rape, attempted rape, domestic violence, child abuse, child neglect, missing persons, paternity and sexual harassment. The Units were first established with UN support in 2000 and are found in each of the 13 provinces.

 

These summaries are taken from: Daly, K. and Bouhours, B. 2011. Appendix: Inventory of Responses to sexual violence, in “Conventional and Innovative Justice Responses to Sexual Violence.” Australia Institute of Family Studies.

  • The term ‘one-stop’ as it is applied in many development contexts is often a misnomer if ‘one-stop’ is taken to mean a single setting where the full complement of multi-sectoral responses can be accessed by a survivor. Unlike the SART and SARC approaches where police and legal aid workers are a standard part of the on-site response team, many comprehensive care models in development and post-conflict contexts focus on medical care and referral, with some providing additional on-site psychosocial care and/or legal advice. In the absence of on-site police personnel, some OSCs may be creatively linked to police (i.e. next door to police precincts or have police officers on call through cell phones).
  • Even though these models are often referred to as ‘one-stops’ they may more accurately reflect an integrated approach (for more information, see Commonwealth Secretariat, 2003). Integration refers to targeting various types of existing health providers (e.g. emergency rooms, clinics, sexual and reproductive health services, etc.) and determining how violence-related services can be incorporated to ensure that survivors presenting for care receive the necessary assistance related to their exposure to violence as quickly as possible.  Three basic models of integration include:

Level of Integration

Approach

Example

Provider-level integration

The same provider offers a range of services during the same consultation.

A nurse in accident and emergency is trained and resourced to screen for domestic violence, treat her client’s injury, provide counseling and refer her to external sources of legal advice.

Facility-level integration

A range of services is available at one facility but not necessarily from the same provider.

A nurse in accident and emergency may be able to treat a woman’s injury, but may not be able to counsel a woman who discloses domestic violence, and may need instead to refer the woman to the hospital medical social worker for counseling.

Systems-level integration

There is a facility-level integration as well as a coherent referral system between facilities in order to ensure the client is able to access a broad range of services in their community.

A family-planning client who discloses violence can be referred to a different facility (possibly at a different level) for counseling and treatment.  This type of integration is multi-site.

Adapted from Colombini, C., Mayhew, S. and Watts, C. 2008. Health-sector Responses to Intimate Partner Violence in Low- and Middle-income Settings: A Review of Current Models, Challenges and Opportunities.” Bulletin of the World Health Organization 86 (8): 635-642.

  • Integrated approaches to medical (and psychosocial) care and referral may be a more realistic alternative to initiating coordinated care in humanitarian settings than the resource-intensive SART/SARC-type approaches used in Western contexts that require a corps of specialized staff operating in a dedicated structure. 
  • Integrated approaches can offer an improved standard of treatment but are not as expensive, and they do not rely as heavily on the capacities of the police and legal/justice systems in order to function effectively.  Services initiated within the health sector may also attract more survivors than forensic-based services (i.e. where medical examiners are linked to the police and/or situated in criminal justice offices), especially in settings where engaging the criminal justice sector is highly stigmatizing or presents security risks (such as when police investigations are undertaken without the consent the survivor and impunity for perpetrators is the norm; or where the security sector is responsible for the abuse).
  • Still, these programs do require the commitment of administrators in order to be effective, as well as training and support for all staff working within the particular health setting, and the establishment of strong linkages with other sectors, especially the police.  In post-confict settings, where infrastructure is often even more limited than in development settings, programmers must anticipate the considerable outlay of resources that will be required to introduce integrated models of health care.
  • When considering the most appropriate methods for coordinated care for survivors in a given setting, it is important to take into account the human, financial, and other resources that are available, and weigh them against strategies that allow for greatest access to safe and ethical services for survivors.  No matter how exemplary, a single one-stop center based in a metropolitan area is bound not to produce significant benefits across a population because the vast majority of survivors living outside the urban center will not be able to access that service.
  • Programming experience in multiple settings suggests the following basicactions are critical to establishing and maintaining effective services for survivors:
  1. Identify the service-delivery needs of the target population (establish the nature of violence and related help-seeking behavior and conduct a service mapping). 
  2. Understand the obstacles to coordinated care (assess facilities and personnel within and across key sectors and calculate costs of existing and /or proposed programming).
  3. Create institutional buy-in of key stakeholders (from national level policy-makers to institutional administrators and service providers).
  4. Ensure supportive national and facility-level policy frameworks to enable integration and cross-sectoral linkages (with costing analysis and funding strategies included).
  5. Ensure facility infrastructure can support integration and cross-sectoral linkages in a sustainable manner (i.e. proper space for services and transport to other services where necessary).
  6. Define roles of service providers through inter-and intra-sectoral standard operating procedures.
  7. Ensure on-going coordination within facilities and across sectors through active coordination networks.
  8. Ensure on-going capacity development of service providers.
  9. Build safe and ethical data collection and monitoring systems (adapted from Askew and Kim, unpublished).
  • The integration of these models by local governments into their systems can be the most challenging part of this process even in stable environments. As such it is important to include programming strategies that will build sustainable capacity and infrastructure of key sectors at the national and local levels. Many settings seeking to scale up services have benefited from engaging with other countries/partners where lessons have already been generated about the challenges of implementing coordinated care approaches.
Example.  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).

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