1. 9. Referrals to other service providers

2. Aim of this module
To understand the importance of referral systems in facilitating access of survivors of GBV to multi-sectoral services
To learn about the actors involved, the requirements for effective referrals, and the steps for developing and implementing referral systems
To learn about practical resources for health care professionals and patients to facilitate referrals

3. Outlook Definition of a referral system
Key actors involved in a referral system
Developing and implementing an effective referral system - steps and recommendations
What health care professionals can do in the absence of a referral system

4. Definition of a referral system

5. Defining referrals Referrals are the processes of
how a woman gets in touch with an individual professional or institution about her case
how professionals and institutions communicate and work together to provide her with comprehensive support

6. Defining referral systems
A comprehensive institutional framework that connects various entities with well-defined and delineated mandates, responsibilities and powers into a network of cooperation to ensure the
3 p’s:
(UNFPA 2010)
Protection and assistance of survivors
Prevention of GBV
Prosecution of perpetrators

7. Importance of referral systems
Survivors of GBV have multiple and complex needs that require a comprehensive set of services
One single organization cannot provide all these services
Coordinated multi-sectoral response is necessary
A referral system = institutional framework

8. Benefits of referral systems
Patient:
Access to comprehensive and specialized care and support, tailored to individual needs
Health care professional:
First contact for survivors  important entry point
Benefit from support and expertise from other partner organizations  relief from work load
Knowing that other needed services exist  increase confidence to ask about GBV
Able to adequately act upon the identification of a survivor

9. Levels of referral mechanisms
National
Regional
Community/municipal
Example of setting up a local-level referral mechanism in Kyrgyzstan
H35

10. Requirements of effective referrals
Health care professionals
Able to recognize GBV and facilitate disclosure
Able to assess the patient‘s individual situation & needs
Know about the existing referral system and services
Know about national laws on GBV
Obtain consent from patient before sharing information
Health facilities/management
Ensure ongoing capacity building of staff (e.g. IRIS intervention, UK)
Multi-sectoral trainings: first step to establishing partnerships
Put in place a coordinated mechanism to monitor services and improve quality

11. Capacity building improves referrals – example: IRIS (UK)
IRIS: Identification & Referral to Impove Safety
24 general practices in London and Bristol:
training of health care professionals and admin staff
establishment of simple referral pathway to specialist DV service provider
technical support to practice teams
Evaluation: compared to 24 control practices
Results: intervention practices showed
3 times higher identification rate
21 times more recorded referrals (compared to control practices)

12. Key actors involved in a referral system

13. Overview Specialized women’s support services General support services
Police and judiciary

14. Standards for specialized women’s services
Run by independent women’s organizations
Receive adequate financial support from the state
Be specialized in two ways:
especially targeted at women survivors and their children
specialized on VAW as a gender specific form of violence
Apply a survivor-/women-centred, gender-sensitive & human rights-based approach
Be run and provided by women
Be provided by professional staff trained on working with survivors of GBV

15. Types of providers of specialized women’s services
Women‘s helplines
Women‘s shelters
Women‘s centres
Services specialized on supporting survivors of sexual violence
H36

16. General support services
Funded and provided by state authorities
Not designed for survivors of GBV – benefit public at large
Examples: health services, housing, financial support, child welfare
Complement, but not replace specialized women’s services

17. Police and judiciary Police, criminal justice system Civil courts
Investigation and prosecution of GBV, determine criminal liability of defendant
Police restraining orders (in some countries)
Civil courts
Divorce
Child custody
Protection orders (in some countries)

18. Developing and implementing an effective referral system - steps and recommendations

19. Step 1: Situation analysis and mapping of services
Obtain a comprehensive picture on the scope of GBV, the legal framework on GBV and available services – including gaps
Identify entry points and potential referral partners
Look at national, regional, local levels
Use a mix of sources and methodologies:
official data and NGO reports
desk research, qualitative interviews, focus group discussions

20. Step 2: Setting up a referral directory
Organize information collected on service providers in a referral directory
Contact information
Types of service provided, population served
Criteria for eligibility/admission
It’s a useful reference document for health care providers when making referrals to other services (also in the absence of a formal referral system)
Management should
provide copies to all staff (or at least one copy in a convenient, accessible place)
gather feedback from staff and ensure regular updates

21. Step 3: Formalizing the partnership (1)
How: Memorandum of Understanding (MoU), inter-agency protocol
Why: Provide an institutionalized basis for effective coordination  sustainability
What: Formalize cooperation
Define roles and responsibilities of actors involved
Common principles for service provision
Devise referral pathway (to whom to refer the survivor, when, where, how)

22. Step 3: Formalizing the partnership (2)
Prerequisites:
Develop work relationship based on trust
Common understanding of GBV and vision of how to respond, shared by all partners
Willingness to share information on how cases are handled on to accept feedback

23. Components of effective referral systems (3)
Joint vision
Joint strategy and operational plan
Standardized protocols and procedures
Adequate resources (personal and financial)
Workable structure:
1) strategic group
2) operational arm + thematic sub-groups
Coordinator playing a facilitating role - BUT participating organizations make the partnership work!
Training of all professionals involved
Government & NGO representation

24. Step 4: Providing staff with information resources (1)
Informing the patient of available services is key to help her identify the most suitable options
Written information for patients need to be discreet
Examples:
What: posters with tear-off slips, pamphlets, brochures
Where: examination rooms, women’s toilets

25. Step 4: information resources (2)
Examples (continued):
Pocket–size lists of phone numbers
Phone numbers in form of barcodes (stickers, lip balms)
Key rings with hidden information
Key rings with personal alarms
Source: Standing Together against Domestic Violence (UK)

26. What health care professionals can do in the absence of a formal referral system

27. Some ideas Use follow-up appointments to check on patient’s well-being
Consider establishing basic services in-house
e.g. crisis intervention, support groups, overnight accommodation in hospitals
example: victim-support rooms (Tajikistan)
Establish a referral directory and refer patient to known service providers
H37