Transforming the Health Care Response to Domestic Abuse: The Crossing Pathways Project
The Crossing Pathways project, funded by the Home Office, is a groundbreaking initiative designed to transform the healthcare system's response to domestic abuse across England. By fostering a consistent and coordinated whole-health approach, the project aims to instil sustainable change in the way health services support survivors of domestic abuse. We’re two years into the three-year project, with 30 commissioned programmes underway and a wealth of evidence and learnings being gathered. Read about the project’s key areas of focus and the impact below.
Project Overview and Aims
Crossing Pathways focuses on three main phases:
1. Mapping Domestic Abuse Interventions: understanding the current landscape of domestic abuse interventions within the health care system across England.
2. Commissioned programmes: responding to gaps in service identified through mapping, by providing grants for targeted pilot interventions that bring partners together to create a Coordinated Community Response nationwide.
3. Accreditation and Evaluation for Sustainable Change: assessing the effectiveness of the interventions and creating accreditation for long-term improvements and investment.
The ultimate aim of the Project is to ensure a comprehensive and effective healthcare response to domestic abuse, enabling survivors to receive timely and appropriate support, proven by an:
· Increase in the number of people coming forward to disclose their experience of domestic abuse to healthcare professionals.
· Increase in awareness and competence of healthcare professionals in responding to domestic abuse disclosures.
· Improved referral pathways for victims to support services.
· Improve partnership working between healthcare professionals and other agencies involved in responding to DA including better data sharing.
Key Project Areas
The project has already shown significant impact through its various initiatives:
Networks
Crossing Pathways has established eight regional networks across England, bringing together a diverse group of stakeholders. These networks integrate into established forums such as the Intercollegiate and Agency National DVA Forum (INCADVA) and the newly formed Health and Domestic Abuse Leadership Group. The networks enable stakeholders to:
1. Improve knowledge and responses: enhancing the understanding and response to domestic abuse within healthcare settings.
2. Creating a collective response: facilitating collaboration between health and domestic abuse specialists to develop and embed good practices.
3. Promote a Coordinated Community Response in every community: ensuring that responses to domestic abuse are coordinated among key community and healthcare stakeholders for sustainable change.
4. Network and knowledge share: providing platforms for stakeholders to share insights, barriers and challenges, showcase successful interventions, and disseminate research and national developments.
The networks continue to grow, with 859 members within the last year alone. The networks are open to new members, apply here.
Mapping Provision
A comprehensive mapping of domestic abuse health provision in 2023 revealed critical gaps and needs in health care responses, especially in primary care, mental health interventions, and support for vulnerable groups like the elderly and disabled. Read the full report here.
Pilots for Change
To address identified gaps in the health domestic abuse provision, we have commissioned 30 services* to run 12-month pilot roles to improve pathways for survivors within health settings. Roles include Domestic Abuse Coordinators, Health IDVAs, and specialised practitioners for older persons and minority groups.
Survivor Network
By centring the voices of survivors, the project has highlighted barriers and gaps in existing provisions, ensuring that survivor experiences inform best practices and service improvements.
Through regional focus groups and one-to-ones, the Survivor Network of 16 members share their lived experiences to co-produce best practice responses to primary, secondary and community care. The Crossing Pathways Centring the Survivor Highlights: Report details the key findings and recommendations from trauma-informed research.
“You make me feel that what we're doing can't be ignored.” Survivor
“I’ve had the opportunity to feel heard.” Survivor
The Health and Domestic Abuse Leadership Group
Another critical component of the project is the Health and Domestic Abuse Leadership Group, which provides a leadership space to support coordinated responses to domestic abuse. It gathers insights from regional networks and other experts to inform decision-making, policy innovation, and sector-wide collaboration. The group meets every eight weeks and includes members from a wide range of influential organisations, ensuring a comprehensive and cohesive approach to addressing domestic abuse in England.
Creating impact
The commissioned pilots are already improving the identification and response to domestic abuse by health practitioners and services.
The Older Persons Rural Domestic Abuse Practitioner in Northumberland, provided by NDAS aims to raise awareness and provide targeted support for older victims of domestic abuse, particularly in rural areas.
The key outcomes so far include:
· Awareness and Training: delivering awareness-raising sessions and promoting the service to isolated and rural communities.
· Strategic Collaborations: working with local health and community professionals to integrate domestic abuse training specific to older populations.
· Support Pathways: enhancing referral pathways and support mechanisms for older victims, who are often more vulnerable and reliant on their abusers.
This case study highlights the project's focus on addressing specific community needs and the importance of tailored interventions to ensure all survivors receive adequate support.
“Quote from participant”
In Sefton, Halton and Herefordshire, the IRISi gold standard has been implemented, to improve clinical practice and better support patients. This proactive approach is essential in regions with an older demographic and isolated communities, where enhanced support mechanisms are crucial. Training initiatives have already commenced within local surgeries, complemented by successful face-to-face events attended by many GPs in Sefton.
Dr Wendy Elizabeth Hewitt, Sefton's Named Safeguarding GP and Clinical Lead for Children & Maternity at NHS Cheshire & Merseyside highlights its critical role in addressing gaps identified by DHRs “We are seeing a much greater awareness of Domestic Abuse, among our primary care colleagues improving knowledge and how to respond to it, increasing clinical enquiry and professional curiosity, and ensuring risk is identified and assessed in a consistent way”.
Jackie Hyland, Director of Health Initiatives says:
“The Crossing Pathways Project is a hugely important programme of work that is already creating significant change across the health sector. All victim-survivors access health services at some point, so it’s an incredibly vital touchpoint in identifying and responding to cases of domestic abuse. We know that 80% of women experiencing domestic abuse seek help from health services and these are often a woman’s first and only point of contact (Department of Health, 2010).
This project is just the start of what we hope is a long-term transformation of the health response to domestic abuse and a case for further investment and education. Bringing partners together to share learnings, barriers and positive outcomes is vital if Standing Together is to succeed in our mission to create a whole system approach to domestic abuse so that more people get the support they need and deserve.”
Read more about the project and its impact in IRISi's blog post.
What’s next
The Crossing Pathways project represents a significant stride towards a more responsive and supportive healthcare system for domestic abuse victim-survivors. By mapping current provisions, commissioning targeted services, and fostering collaboration among stakeholders, the project is creating much-needed sustainable, systemic change. As it progresses, the project's impact on wider health services will become increasingly evident, promoting a holistic and effective whole-health response to domestic abuse.
For more information and updates on the Crossing Pathways project, sign up our newsletter [link] and follow our social media channels.
*The commissioned services are;
SafeNet, Domestic Abuse Coordinator Role;
Three IRISi pilots across the North and Midlands;
Northumberland Domestic Abuse Service, Older Persons Rural DA Practitioner;
IDAS, Older Persons Rural Health IDVA;
Staying Put, South Asian Health IDVA and Roma Health IDVA;
The Blue Door, Domestic Abuse Coordinator Role;
New Era, CAMHS Domestic Abuse Practitioner;
Elm Foundation, Primary Care DA Trainer/Coordinator;
Northamptonshire Domestic Abuse Service, Domestic Abuse Coordinator (ICS wide);
Equation, Health System Trainer;
Next Chapter, Mental Health DA Practitioner;
Anglia Care Trust, Specialist DA Trainer - Health;
Refuge, Enhanced Support IDVA/Complex Needs IDVA and Health IDVA;
IKWRO, Harmful Practices Trainer;
EACH Counselling By and For, By and For Domestic Abuse Counselling;
Victim Support, Sexual Health SHL ROLE (across ICBs);
Solace Women's Aid, Perinatal IDVA;
Aylesbury Women's Aid, Domestic Abuse Coordinator (additional 1 year match funding from Bucks Council);
Rising Sun, Specialist Mental Health Worker CYP;
Stop Domestic Abuse, Specialist Mental Health IDVA and Hospital IDVA;
The YOU Trust/ Paragon, Older person's IDVA;
FearFree, HIDVA;
Next Link, Disability IDVA;
Respect, Perp Health Worker (National project)
