9. Referrals to other service providers

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

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

Definition of a referral system

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

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

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

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

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

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

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)

Key actors involved in a referral system

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

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

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

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

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)

Developing and implementing an effective referral system - steps and recommendations

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

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

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)

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

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

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

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)

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

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