Breaking the uncomfortable silence

Diverse services for diverse needs

Tailored, flexible support critical for women experiencing domestic violence

When it comes to developing supports for women experiencing domestic violence, Marilyn Ford-Gilboe knows it is crucial to have a malleable approach.

“We know there are services in the community – violence against women services – that provide safety planning. We know safety planning is helpful to women. But we also know only 1 in 5 Canadian women access those services. A lot of women really struggle with this on their own,” said the Western Nursing professor.

“It’s important to recognize women who experience abuse are a really diverse group. They have different needs, different priorities, different living situations, so any one support can’t ever be one-size-fits-all. It has to be flexible enough to be tailored to what the woman wants and what she thinks is important.”

With a team of researchers, Ford-Gilboe has dedicated years to working to develop accessible and flexible support services for women who live under the threat of domestic violence. It’s not enough to address violence and the impact it has on a woman’s safety, however. That violence affects a woman’s overall health – both mental and physical. It encroaches on a woman’s economic freedom, her ability to earn a wage and care for children. Violence reverberates through every aspect of a woman’s life and it is important to consider that when supporting women in need, Ford-Gilboe noted.

“Services tend to be set up in silos. We have services for getting help from police, violence-specific services, health services, income support. But they don’t tend to come together and women’s lives aren’t separate like that. It’s all linked together,” she said.

“The types of supports we are trying to develop and test for women are trying to add some additional focus around women’s health and other parts of their lives affected by violence to complement some of the good work already being done in the violence sector.”

Ford-Gilboe was the lead on the Ontario portion of a national iCAN Plan 4 Safety study, funded by the Canadian Institutes of Health Research. The project seeks to assist women affected by relationship violence who may be more inclined to seek information or support via the web.

Marylin Ford-Gilboe
Professor and Women's Health Research Chair in Rural Health, Western University

There are undeniable barriers to women seeking supports and services in situations of domestic violence, Ford-Gilboe explained. The barriers are as diverse as the women who experience them; they can range from fears of stigma, a fear of experiencing further violence or even simply the community in which the woman lives.

“Some women live in communities where there isn’t a lot of support, like in rural communities. Their experience of trying to manage safety, homes and their children are very different, when there aren’t the same supports available and where they are very visible in their communities. Some of these women might prefer to access supports online where there might be more privacy,” she said.

As part of the iCAN Plan 4 Safety study, Ford-Gilboe’s team developed an interactive online intervention tool for women to access on their own – safely and privately. Participants were asked to complete questions and activities to help them identify their priorities and safety risks. The information was used to create a tailored ‘action plan’ unique to each woman’s priorities, preferences and living situation. The plan included contact information for existing services or resources that may be helpful.

More than 460 women enrolled from Ontario, British Columbia and New Brunswick, accessing and implementing the iCAN Plan 4 Safety tool or a website that had general health and safety information. Researchers looked to see if there were differences over a one-year period, in the women’s mental health, their sense of control over their lives, whether or not they felt – after the 12 months – that their partner had less ability to control them and asked what the woman’s safety actions are like, among a number of other things.

“We’ve done a good analysis of who benefits and why. No one intervention will be a-one-size-fits-all but there might be some groups of women who benefit more than others, and it’s important to look at that. The results are promising. What we are doing now is refining the intervention and finding how to make it accessible to all women in Canada,” Ford-Gilboe said.

If we are going to do a good job reaching and supporting women experiencing domestic violence, it is important for them to have support options available, she continued.

Funding from the Public Health Agency of Canada is supporting another project that nicely dovetails with iCAN Plan 4 Safety, Ford-Gilboe added. More than $3 million is helping researchers examine the impacts of an innovative, evidence-based intervention called iHEAL, specifically designed to meet the needs of women who have separated from an abusive partner.

iHEAL is delivered by community health nurses and a community partner (such as a domestic violence worker or Indigenous Elder) working in partnership with women over a 6-month period. Women take part in workshops that introduce them to aspects of the intervention in a group setting, along with one-on-one meetings with the nurse that focus more specifically on each woman’s concerns and priorities.

“There are a lot of overlaps in what we are doing in iHEAL and the online intervention, iCAN. They come out of the same thinking, but they are two different ways of reaching women. But both of these projects come out of the same problem, which is that women who experience violence from a partner often feel very ashamed, stigmatized and they don’t always reach out for help,” Ford-Gilboe said.

“Women often underestimate the amount of risk they are in. Unfortunately, sometimes that means women are killed by their partners. These projects bring the health focus in, alongside that whole range of issues affected by violence, which can be barriers for women to seek help or make changes to improve the quality of their lives,” she continued.

“These interventions are what we would call women-led. They are supported by the work we do, but the woman is in the driver seat and what she gains from it depends on what is important to her and the direction she wants to take.  Both of these interventions are supports for women. The idea is to extend what already exists and complement it, not to replace what’s already out there or overlap.”

Adela Talbot

Written by Adela Talbot