Developing new portals to safety for domestic abuse survivors in the context of the pandemic

Abstract This study examined the emergence and implementation of community touchpoints established in the UK during the COVID‐19 pandemic for victims/survivors of domestic abuse (DA). Community touchpoints are designated places, both online and in accessible settings such as pharmacies and banks, where victims/survivors can seek confidential advice and be directed to expert DA services. The research adopted a case study approach and explored a range of perspectives through expert interviews, document analysis, consultation with survivors and stakeholders and a survey of DA co‐ordinators. Four national community touchpoint schemes were identified and, of these, three were implemented rapidly and were available in 2020–2021 when the UK experienced lockdowns. Partnerships between Government/voluntary organisations and commercial businesses‐assisted design and implementation. Some stakeholders considered that the schemes lacked responsivity to the local context and noted challenges in providing a confidential service in rural areas. Whilst pharmacies, banks and online spaces were identified as non‐stigmatised and trusted places to seek advice, community touchpoints were judged less accessible for some groups including those experiencing digital poverty and victims whose movements were heavily scrutinised. Most of the touchpoint schemes targeted adults only. There were also concerns about whether frontline staff in commercial businesses received sufficient training. Whilst robust evidence of outcomes was limited, there were indications that the schemes had achieved good reach with some early evidence of take‐up. Testimonials indicated that victims/survivors were using the touchpoints in flexible ways which met their needs. Moreover, the wide reach and visibility of these initiatives delivered in non‐stigmatised settings may have served to raise public awareness of DA, reducing the silence that has traditionally surrounded it. Further research into the use and impact of these initiatives is required and there may be future potential to extend community touchpoints to include children and young people experiencing DA.


| DE VELOPING NE W P ORTAL S TO SAFE T Y FOR DOME S TI C ABUS E SURVIVOR S IN THE CONTE X T OF THE PANDEMIC
The COVID-19 pandemic has produced a rapid change in the way that public services are delivered and experienced. Whilst there have been restrictions and shortfalls in health and social care services, there has also been innovation with some planned developments rapidly accelerating and new partnerships emerging to deliver novel forms and configurations of services.
Early in the pandemic, domestic abuse (DA) services were vocal in raising concerns that DA rates would increase under restrictions that would confine victims/survivors and their abusers to the home whilst cutting off access to usual sources of support and advice (Home Affairs Committee, 2020; Refuge, 2020; Women's Aid, 2020a). The experience of confinement to the home appeared to strike an empathic note amongst many organisations and individuals not previously engaged in providing support or services to DA victims and DA services received contributions and offers of support from new sources . This paper reports on the development and implementation of community touchpoints: these are new initiatives that emerged in the UK in the context of the pandemic. Touchpoints are defined as safe spaces or portals from which victims/survivors can seek information and access expert help. They are non-stigmatised, easily accessed spaces with either a community or online presence. Most of the touchpoint schemes considered here are the product of partnerships involving the independent DA sector, professional organisations, commercial organisations and/or Government. They share a focus on place or space whilst also drawing on concepts of community capacity and accessibility.
We used a case study approach to examine the design and development of these schemes and aimed to identify their strengths and limitations. We also draw out recommendations and messages for embedding and sustaining these initiatives in the longer term.

| Background
In developing services, the DA sector has struggled to reconcile the principles of safety and accessibility. The safety of victims has been a core principle informing provision from the earliest days when refugees were first introduced (Hague, 2021). However, a focus on safety has entailed secrecy with the locations of refugees disguised and with DA services lacking a public face and often a community presence (Haaken & Yragui, 2003). This has proved frustrating at times for those seeking to access or use services (Stanley, 2015;McCarry et al., 2018;Bracewell et al., 2020). Campaigns have attempted to address this problem but the lack of local visibility remains an issue for many DA services. The community touchpoint schemes described below offer an alternative means by which DA services could increase their accessibility. They aim to address the lack of community visibility by providing access to specialist DA support and services in spaces that are K E Y W O R D S community touchpoints, domestic abuse,pharmacies What is known about this topic?
• Community touchpoints are a recent initiative. They are designated places, both online and in pharmacies and banks, where domestic abuse (DA) victims/survivors can access advice and be directed to expert services.
• Whilst pharmacies have the potential to provide a frontline response to DA, concerns remain about the extent of training required.

What this paper adds?
• Under COVID-19, public-private partnerships enabled rapid roll-out in the UK. Available online and in banks and pharmacies, touchpoints achieved wide reach.
• It is uncertain whether these initiatives respond to local contexts and whether they are equally accessible to all groups. Children are not targeted by most UK initiatives.
• Community touchpoints may have raised public awareness of DA.
well-used but dedicated to other purposes. In this sense, access to DA support is 'hidden in plain sight' and non-stigmatised. The spaces chosen as community touchpoints are mostly places where the public can access various forms of advice and assistance, including health and financial advice: they are sites of expertise and professional activity and this, together with their identity as places that everyone can enter and use, contributes to their status as safe but accessible places.
Pharmacies were amongst the first sites to be recruited as community touchpoints. Their potential for providing access to DA services has already been identified both in the US and the UK (Cerulli et al., 2019;Lewis et al., 2018) and Lewis et al.'s (2021) study involving interviews with 20 pharmacists undertaken prior to the pandemic found a readiness to contribute to the delivery of public health services and highlighted the opportunities offered by the accessibility and inclusivity of pharmacies. However, during the pandemic, the settings harnessed as community touchpoints extended beyond health settings into commercial and digital spaces.

| ME THODS
This research was undertaken as part of an international study that The UK case study utilised data collected for the mapping study which included: the analysis of 180 relevant reports and documents identified with the assistance of a widely distributed call for evidence, online searches and consultation; a survey of 31 DA co-ordinators in England and Wales; 24 semi-structured interviews with DA experts across the UK and four consultation groups and interactive webinars with key stakeholders. Four survivors' advisory groups were also held in England and Wales. These were recruited and convened with the assistance of DA organisations that were available to provide support for any participating survivor who might require it. Additional data were collected for the deep dive afforded by the case study approach (Yin, 2009). This comprised online documents and grey literature relating to DA community touchpoints accessed between July and December 2021. An additional eight semi-structured interviews with professionals with experience in the design and implementation of community touchpoints were completed in early 2022. All interviews took place online or by phone with interviewees representing DA organisations, devolved governments, the police and public health and pharmaceutical professionals. Interviews were transcribed and coded. All data were analysed against a framework consisting of key questions developed to elucidate the reach, acceptability, accessibility, impact, barriers to implementation, recommendation for strengthening and future promise of these interventions.
Ethical approval for the study was acquired from the Universities of Central Lancashire and Edinburgh.

| Limitations
The research was completed during the pandemic at a time when the initiatives studied were newly implemented and there was little robust data available in respect of impact. Whilst the study took place at a 'moment of crisis' when there were opportunities to capture change and innovation, there were reduced opportunities for interventions to embed and mature. The research team was in part reliant on existing data which reduced the extent and quality of data available for analysis. Future research could usefully examine the impact and study these schemes over a longer period.

| The community touchpoint schemes
This study identified four community touchpoint schemes, all aspiring to national reach and initiated during the pandemic. The

Mascarilla-19 (Mask-19) codeword scheme introduced by the
Institute of Equality in Spain's Canary Islands (World Bank, 2021) appears to have been highly influential as a model for pharmacybased responses to Covid-19 restrictions, but the schemes outlined briefly below extended into other spaces. Figure

Ask for ANI (action needed immediately) was launched by the
Home Office in January 2021 and is the scheme that most closely resembles the Mascarilla-19 initiative. ANI is an emergency code word that DA survivors use in a pharmacy to signal their need for help, and staff will then provide confidential and safe assistance enabling them to contact the police or support helplines. The scheme was developed in collaboration with SafeLives (2021)

The Scottish Improving Community Pharmacies' Response to Rape and
Sexual Assault scheme has a different remit but is included as it provides an interesting contrast. It differs from the voluntary schemes described above, as it is envisaged that participation will become part of NHS contractual arrangements for Scottish pharmacies should early implementation prove successful. The initiative is targeted at adult victims/survivors of rape and sexual assault, specifically women and those accessing a prescription for emergency contraception; however, young people may be included as emergency contraception can be prescribed to people over 12 years. Key themes identified included: rapid implementation; responsivity to local contexts; training for frontline staff; reach and uptake; access for minority groups and for children and young people and awareness raising. These are discussed below.

| Rapid implementation
Participants generally agreed that Ask for ANI, Safe Spaces and Online Safe Spaces had been speedily developed and established. Those administering Hestia's schemes had: 'no idea that they would be able to turn around something like that as quickly as they did. I didn't … know our team could do that.' (Case Study interview 2). Rapid rollout of touchpoints during 2020-2021 meant that they were available during lockdowns. The crisis situation acted to free up some resources by suspending normal practices: for instance, General Pharmaceutical Council inspectors had been able to promote the Safe Spaces scheme due to the temporary suspension of their inspections during the lockdown. The cost-free involvement of some large commercial organisations also provided extra capacity.
Those planning and delivering the touchpoint schemes were able to draw on existing networks and partnerships to assist in planning and roll out. For example, Ask for ANI was promoted by the police: What we did was do the push of driving it, ensuring that across London our partners knew about it, our police colleagues, you know, our community support officers knew about it, and we did that. We put it in a box folder for them, so they had access to the PDF material directly, you know, obviously lots of coms went out. (Case Study interview 7) However, new public-private partnerships were also forged and rapidly utilised. These may have been stimulated by increased empathy for DA victims fostered by COVID-19 restrictions and by a readiness to use private expertise for the public good in a time of crisis.
Despite the drive for rapid roll-out, DA survivors were consulted on the development of Ask for ANI's promotional materials and training. This consultation was facilitated by SafeLives, a specialist DA organisation which supports an established group of DA survivors, described as Pioneers, who have contributed to the design and planning of a range of DA services (Tomlinson, 2021).
In contrast, implementation of the Scottish pharmacies scheme was much slower: the scheme was first proposed early in 2020 but funding was not available for pilot start-up until December 2021.
However, the extended planning period allowed for the development of national governance and accountability structures and partnership buy-in. F I G U R E 1 Key national community touchpoint schemes.

| Reach and Take-Up
Whilst limited evidence was available in respect of outcomes for DA survivors using these schemes, documentary analysis provided evidence on take-up and organisational and geographical reach.
There were also some anecdotal testimonies available. The account below provides a 'success story' in respect of Hestia's Safe Ireland (Hestia, 2020). Participating pharmacies primarily belonged to one of the four major chains with only between 1% and 15% of participating pharmacies located in the independent pharmacy sector in each country of the UK. The TSB bank joined the scheme in 2021 and, by March 2022, 5720 pharmacies and 290 bank branches across the UK had signed up for Safe Spaces (Hestia, 2022a). This was anticipated to increase to 800 branches in April 2022 when HSBC joined the initiative (Hestia 2022b By November 2021, the Online Safe Spaces scheme had been adopted by 45 organisations, resulting in 700,000 online visits. This had increased to 64 organisations by March 2022, including 10 rail companies, with 934,000 individual hits recorded online (Hestia, 2022a).
The Home Office was unable to provide detailed findings from the commissioned evaluation of Ask for ANI and we are reliant on headline data available via a press release in January 2022 (Hestia 2022b). This reported that the scheme had attracted 'almost 100' recorded disclosures following the use of the code word and that: 95% of individuals who had asked for ANI then used Safe Spaces; 14% were supported by a pharmacist to dial 999 and 8% were supported to make a non-emergency 101 call to the police.
Most of the 31 DA coordinators responding to our survey in June 2021 were employed by local authorities with a few working for the regional Crime Commissioner's office or in the independent sector. Thirty per cent reported some or good take-up of pharmacy codeword schemes and 41% reported some or good take up of Safe Spaces schemes in their region. However, over a third of respondents did not know or had not heard of either initiative.
Some of those interviewed reported a lack of clarity as to which and how many pharmacies were participating in the Ask for ANI scheme and this confusion may have been heightened by the potential for confusion between this scheme and Hestia's Safe Spaces.
However, one participant noted the wide coverage associated with a large retail pharmacy chain, such as Boots, which was a household name, delivering Ask for ANI, and commented that the 'door is now open' for further collaborations (Interview 7, Scotland).

| Access for minority groups and children and young people
There were early queries as to whether codeword schemes were sufficiently accessible for marginalised groups and for those facing the most barriers to support, namely Black and Minoritised women, migrant women, deaf and disabled women and LGBT+ survivors (Women's Aid, 2020b). Promotional material was available in other languages via Hestia and Home Office websites but there were concerns that it was not always displayed at touchpoints. Hestia's app and website had the built-in facility to provide information in multiple languages.
In terms of the spaces utilised, online spaces were considered to be accessible to many groups although it was noted that digital poverty could prove a barrier for some DA victims/survivors.
Pharmacies were identified by campaigning groups as accessible spaces for older adults (Hourglass 2020), and as places that were likely to be fitted with hearing loops. Some participants noted that women from some Black and Minoritised groups were less likely to be able to access public places such as pharmacies or banks on their own and that refugee women might have concerns about revealing their insecure status. Comments about the high levels of scrutiny in some rural communities have been noted above. In contrast, the community pharmacy scheme in Scotland aimed to ensure that the service was accessible to marginalised groups, specifically women who sell sex, and survivors with drug and alcohol problems, and core training had been designed to this end.
With the exception of the Scottish pharmacy scheme which had developed specific procedures to support young people seeking emergency contraception, the community touchpoint schemes largely targeted adults. However, the need for safe spaces for children and young people living with DA during the pandemic was heightened due to their 'invisibility' to both mainstream and specialist services (Chevous et al., 2020;, Morrison & Houghton, 2022

| Awareness raising
Those consulted noted that community touchpoints had contributed to raising public awareness of DA during the pandemic, particularly through the involvement of large, public-facing companies. Disclosing and seeking support for DA is frequently understood as a process rather than an event and informants were concerned that brief one-off contacts with staff who had received limited training in responding to DA would fail to offer the continu- Some groups of DA victims/survivors may have found community touchpoints to be less accessible than others and informants highlighted the potential for those women subject to high levels of scrutiny and those who experience digital poverty to be excluded. Leigh et al. (2022) argue that engagement with a diverse range of stakeholder groups is essential in identifying the needs of the most vulnerable DA survivors and some consultation with DA survivors was built into the early stages of these schemes. However, extensive consultation with a variety of groups may have proved difficult in the drive for rapid implementation. There remain opportunities for these schemes to be refined and developed through consultation with relevant survivor groups in order to ensure their accessibility for marginalised groups.These interventions have been built on partnerships fuelled by the altruism and empathy that a global pandemic has triggered. There are plans for the schemes to be extended and strengthened across Wales and Scotland and this, together with the transfer of the management of Ask for ANI from the Home Office to Hestia should increase reach and reduce duplication. It will be interesting to learn whether these partnerships continue to thrive in a post-pandemic context. Some participants envisaged extending community touchpoints to additional settings: we're moving to integrated care systems and whole population views within an area, and they probably need to move so that it is part of a whole systems approach. That, yes, people can go into a pharmacy or they could go into their GP or it could be a dentist … (Case Study interview 8)

| CON CLUS ION
The restrictions imposed during the pandemic required those looking to maintain and increase the availability of DA services to think 'outside the box' and identify new ways in which information and services could be accessed. The initiatives described here significantly broadened the range of settings and organisations involved in linking those in need of support to services, moving beyond the third sector and public services into the commercial sector. Likewise, the use of online spaces extended opportunities for DA victims/survivors to access advice and information about services safely and at a pace and in a manner that suited them.
There were indications of gains in respect of awareness raising which occurred when services were advertised and available in places beyond the usual realms of health and social care in a wider range of community settings. The use of such settings may contribute to eroding the silence that has previously surrounded DA and future evaluations might usefully explore any attitudinal changes associated with community touchpoints.
Questions were raised by experts interviewed about the extent and availability of training provided for those on the frontline and it was reported that some of the community touchpoints were more accessible to some groups of victims/survivors than to others. In particular, only the Scottish scheme for victims of rape and sexual assault was accessible to some groups of young people. Given concerns about the 'invisibility' of children and young people living with DA during the pandemic, there may be potential for considering how touchpoint schemes could be adapted and made accessible to children and young people both during future crises and as part of the broader service landscape more generally.

AUTH O R CO NTR I B UTI O N S
All authors contributed to the conception and design of this study.
All authors were involved in data collection and analysis. NS prepared the original draft with assistance from HRF. All authors have provided critical feedback on the manuscript and have read and agreed to the published version.

ACK N OWLED G EM ENT
The research was funded by the Economic and Social Research Council (ESRC). Grant Ref: ES/V015850/1.

CO N FLI C T O F I NTE R E S T
The authors have no conflicts of interest.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the UK Data Service Repository with the agreement of the lead author.