When home is not the safest place: Supporting people at risk of domestic violence during COVID-19

Virtual counselling works for people experiencing domestic violence and sexual assault during the COVID-19 pandemic, but safety and access concerns must be overcome, according to new research by University of Alberta public health experts. 

“Virtual or remote-based care improves reach by providing access, but that doesn’t deal with the confounding factor of the public health restrictions that confine people at home and can put some individuals and families at greater risk,” said principal investigator Stephanie Montesanti, associate professor in the School of Public Health.

“We need to figure out how virtual care can be optimized to ensure they still have access to needed mental health services and support,” she said.

Alberta already had the highest rate of self-reported domestic violence in Canada. When COVID-19 first hit, calls to police and support hotlines went down but have since increased by 57 per cent, Montesanti said. 

The report is part of the Canadian Institutes of Health Research’s COVID-19 and mental health research initiative. Montesanti’s team carried out a rapid knowledge synthesis project, which included a rapid evidence review of the academic literature. They found that the delivery of online self-help tools such as safety decision aids are widely used to help people assess their risk and decide when they need to leave their homes, but the effectiveness of virtual psychological therapies to address the trauma and stress resulting from domestic violence or sexual assault faces multiple barriers, including limited patient access to digital communication, smart devices and broadband in rural and remote communities.

Blending first-hand experience with academic knowledge 

The researchers also captured the real-world experience of those who provide care to individuals at risk of violence or assault in Alberta. They interviewed 24 service providers, including social workers, mental health therapists, doctors, and staff from shelters and non-profit agencies. They also held two virtual dialogues with 60 providers to identify gaps and brainstorm ways to optimize virtual care to reach individuals experiencing or at risk of domestic violence and sexual assault during the pandemic.

“These providers are really concerned about losing the human connection with virtual delivery of care, because building trust is so important for clients to feel safe and comfortable—especially new clients,” said Montesanti. 

The caregivers noted that some clients don’t have access to reliable technology or don’t know how to use video conferencing for counselling sessions. They recommended expanding access to low-cost residential internet service and improving public computer access at schools and libraries. 

They also recommended that COVID-19 public health messages should include additional information for people who are at risk of violence and therefore may not be able to stay in their homes safely, so they know where to seek help.

They committed to future cross-sectoral collaboration to share best practices on virtual care solutions and to promote peer-to-peer support. 

“Providing care virtually can take a lot more work and mental energy,” Montesanti said. “It’s important to support the supporters, who may also be dealing with Zoom fatigue, compassion fatigue or even vicarious trauma.”

Piloting improvements with community partners

Montesanti said the next step for her research is to pilot practice guidelines for virtual care for patients experiencing domestic violence with the WestView Primary Care Network in Stony Plain. 

One of the PCN’s directors, Ken Mark, and his wife Diane, both U of A graduates, donated funds to Montesanti before COVID-19 started to fund research in domestic violence from a systems perspective.   

“Aside from police data in the area, they learned from their interactions with their patients that domestic violence was a growing concern in the community and something they had to address,” Montesanti said. “They wanted to be a leader in this.” 

“The end goal is to truly support virtual care interventions that provide trauma-focused treatments to address domestic violence and sexual assault,“ she said. “The pandemic forced a rapid shift to virtual care but it’s likely here to stay.”