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In the third of our 16 blogs for 16 days, AVA CEO Donna Covey explains importance of early identification of DVA in healthcare settings.

Health care professionals are often the best placed people to identify and respond to domestic abuse. Survivors tell us that the most frequent missed opportunities are in the health service. As well as being the site lead for three pathfinder sites (Blackpool, Haringey and Enfield and Camden and Islington) AVA are also leading on the survivor consultation work, in partnership with Imkaan. It’s a privilege for me to use this blog to share with you what the survivors have told us both about the missed opportunities, and how services can be improved so that health staff are able to ask about abuse and respond appropriately. 

Donna Covey, CBE, CEO at AVA.

Early identification of domestic abuse is essential. The earlier women feel safe to disclose, then the sooner they can start their journey towards safety and recovery. Survivors want to see health care staff who are able to pick up the signs that domestic abuse might be happening, and are able to tune in to the silent screams of women who are just waiting to be asked. 

As one woman told us

“ My situation should have been detected earlier, had it not been for my GP assigned to me, she did not care whatsoever. It just went on, it prolong my agony, all the confusion and everything” 

And being asked can mean everything to a woman who feels that no one cares and that she has nowhere to turn:

“If they ask you more than once is everything OK, is everything OK at home and you feel that compassion , that oh they really care about me, you are prompted to open up. For someone that is a survivor, you just need that little window and everything comes crashing down.”

It is essential that disclosure is followed by appropriate action – or the woman’s bravery in sharing her pain is wasted, and this just adds to her trauma and feelings of worthlessness, as the service that is there to support her fails to respond to the abuse she is experiencing at home.  And the  evidence we heard about missed opportunities is heartbreaking. One woman told us:

“I went to A&E for a broken nose and they um didn’t do anything. They identified it and I said it was my partner but nothing from A&E. They just left it” 

Survivors also highlighted the fact that, even when they were able to disclose in a health setting and they received an appropriate response, there was a long wait for services. 

“ It’s like you’re jumping through hoops to get there, you’ll get on one rung of the ladder but then there’s always inconsistency ….. When you feel desperate, it feels like you’re hitting a brick wall.” 

These experiences, along with long waits and inconsistent referral criteria, need to be considered alongside the evidence from work with professionals that lack of clear referral pathways is one of the main reasons why some health care professionals don’t feel confident to ask about domestic abuse. This creates a perfect storm where health staff don’t ask because they don’t feel confident of being able to give a helpful response that will help a woman onto the next stage of her journey. And at the centre of that storm is a woman who has been let down yet again. 

It’s not that the health service does not know how to respond to domestic abuse. For many women, meeting the right health care professional, or being connected with the right service, had been life changing and in some cases life saving:

“ The experience I had with the doctor at the beginning when I was pregnant, it was amazing on the NHS.I had a very, very stressful situation with the father of my child and and without the antenatal counselling I had, I would not have been able to be here to be honest” 

The women we spoke to are committed to making the health service better for future survivors, with one woman saying

“ We want as many generations that have passed through it to make it easier for the next generation and educate the abusers and the victim to know that if you’ve been a victim, it’s a long process.”

In that spirit, they had plenty of positive ideas for how the health response to domestic abuse could be improved. These included:

  •  Continued investment in proven health interventions such as IRIS and hospital based IDVAs
  • Stronger referral pathways, that as well as being effective can be explained to survivors so they can understand, visualise and navigate the support they are entitled to.
  • Specialist provision for BAME groups
  • Interim support for women on waiting lists for mental health services, including check in calls and strong signposting to other services, such as DV services and helplines
  • Trauma and gender informed training for health professionals so that they can identify, respond and refer appropriately.      

Better resourcing, training and systems are all hugely important , but we must not lose sight that even in a system that is struggling, individual compassion and kindness can make all the difference to a domestic abuse survivor:

“ I’m very lucky that I have a GP that actually does listen to me , and soothes me when I’m having like crisis moments” 

Donna Covey CBE is the CEO at AVA (Against Violence and Abuse) and chairs the board at IRISi.


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AVA is an expert, groundbreaking and independent charity working across the UK.

Their vision is a world without gender based violence and abuse. They aim to  inspire innovation and collaboration and encourage and enable direct service providers to help end gender based violence and abuse particularly against women and girls.AVA’s work is focused around those areas where they can make the best contribution to ending violence and abuse. They do this by making sure that survivors get the help and support they need in the here and now, through providing innovative training that has a proven direct impact on the professional practice of people supporting survivors of violence and abuse

developing a range of toolkits, e-learning and other material that supports professionals to provide effective and appropriate support to survivors of violence and abuse

using our influence and networks to ensure survivors voices are heard. We work closely with AVA in many areas including the Pathfinder project



SafeLives are a national charity dedicated to ending domestic abuse, for good. We combine insight from services, survivors and statistics to support people to become safe, well and rebuild their lives. Since 2005, SafeLives has worked with organisations across the country to transform the response to domestic abuse, with over 60,000 victims at highest risk of murder or serious harm now receiving co-ordinated support annually. SafeLives are members of the Pathfinder consortium.



Imkaan is a UK-based, Black feminist organisation. We are the only national second-tier women’s organisation dedicated to addressing violence against Black and minoritised women and girls i.e. women and girls which are defined in policy terms as Black and ‘Minority Ethnic’ (BME). The organisation holds nearly two decades of experience of working around issues such as domestic violence, forced marriage and ‘honour-based’ violence.

They work at local, national and international level, and in partnership with a range of organisations, to improve policy and practice responses to Black and minoritised women and girls. Imkaan works with it’s members to represent the expertise and perspectives of frontline, specialist and dedicated Black and minoritised women’s organisations that work to prevent and respond to violence against women and girls. Imkaan delivers a unique package of support which includes: quality assurance; accredited training and peer education; sustainability support to frontline Black and minoritised organisations; and facilitation of space for community engagement and development. They are a part of the Pathfinder Consortium.


The University of Bristol CAPC
The University of Bristol CAPC
The University of Bristol CAPC

The Centre for Academic Primary Care (CAPC) is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research.  It is part of Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.

A dedicated team of researchers at the Centre work on domestic abuse projects and IRISi is a co-collaborator and partner on some of these projects including ReProvide, HERA and DRiDVA.

The Health Foundation
The Health Foundation
The Health Foundation

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The Health Foundation’s Exploring Social Franchising programme aims to generate a deeper understanding of the potential of social franchising models for scaling effective health and social care interventions within the NHS.

We are one of four project teams participating in the programme to develop a social franchise to enable the sustainable spread of our intervention, the IRIS Programme. We receive funding and support from the Health Foundation, including technical expertise on social franchising, and attend programme learning events. The Health Foundation has also commissioned a programme-wide evaluation to support understanding of the use of social franchising in the UK health and care system. We and our franchisees will support the evaluation through co-designing data collection requirements, providing access to data as requested, hosting site visits and attending learning events.



Standing Together Against Domestic Violence is a UK charity bringing communities together to end domestic abuse. They bring local services together to keep people safe

Most public services weren’t designed with domestic abuse in mind, and they often struggle to keep people safe. Poor communication and gaps between services put survivors at risk.

STADV aim to end domestic abuse by changing the way that local services respond to it. They do this through an approach that they pioneered, called the Coordinated Community Response. The Coordinated Community Response brings services together to ensure local systems truly keep survivors safe, hold abusers to account, and prevent domestic abuse.

Their model of a coordinated local partnership to tackle and ultimately prevent domestic violence is now widely accepted as best practice. They are also a part of the Pathfinder consortium.


Spring Impact
Spring Impact
Spring Impact

Spring Impact is a not-for-profit social enterprise born out of the frustration of seeing social organisations constantly reinventing the wheel and wasting scarce resources. Spring Impact uses a combination of tested commercial and social principles and extensive practical expertise to support organisations to identify, design and implement the right social replication model to scale their social impact.

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