Abstract
Technology is an ever-increasing part of most people’s lives and it has been crucial for the delivery of support by domestic violence and abuse (DVA) services during the COVID-19 pandemic. Paradoxically, this same technology has provided perpetrators with new and growing opportunities to continue or escalate their abusive behaviours. This article draws on the experiences of a specialist DVA service for children and young people (CYP) in the United Kingdom reflecting on the use of technology in service delivery during the COVID-19 pandemic. We applied a safety systems approach – a failure modes and analysis (FMEA) to analyse the nature and impacts of service responses. The FMEA shed light on the risks within the environment in which children and young people engage with remote, digital-enabled support. Practitioners, for example, have been unable to determine potential ‘lurking’, whereby other people, including the abusive parent or partner, are present within the room, but out of sight. The FMEA generated 13 ‘corrective actions’ that will be helpful to specialist practitioners supporting children and young people experiencing DVA and to operational managers modifying current services and designing those for the future.
Key messages
Technology was crucial for the delivery of support to CYP during COVID-19.
There have been both benefits and risk to the use of technology during the pandemic, however not all risks warrant the same level of concern or response.
A FMEA has highlighted suggested corrective actions for specialist DVA services using technology to support CYP.
Introduction
This article draws upon the experiences of a specialist domestic violence and abuse (DVA) service for children and young people in the United Kingdom (UK), reflecting on their use of technology in service delivery during the COVID-19 pandemic. The lessons learned and reflections shared within this article will be of benefit to specialist practitioners supporting children and young people (CYP) experiencing DVA and also operational managers designing current and future services. There have been both benefits and risk to the use of technology during the COVID-19 pandemic, however not all risks warrant the same level of concern or response. A failure modes and effects analysis (FMEA) was completed to highlight considerations when deciding whether to use technology to support CYP experiencing DVA.
Technology and DVA
Technology is an ever-increasing part of most people’s daily lives, especially CYP (Livingstone and Bober, 2005; CHILDWISE, 2013; Stonard et al, 2015). Mediums such as mobile phones, social media, and video calls enable inexpensive methods of communication which has redefined young people’s relationships and social networks (Bryant et al, 2006; Stonard et al, 2015). Access to technology can also be a useful tool for women and children experiencing DVA, enhancing their safety and supporting their recovery (Southworth et al, 2005; Fraser et al, 2010; Woodlock, 2017). For example, the Hollie Gazzard Trust have created a smartphone app which provides a range of safety features (Hollie Gazzard Trust, 2021). If the user feels unsafe, they shake their phone which sends an alert to warn designated contacts that they may be in danger. This app also records both audio and visual footage of what is happening for later use (Derbyshire Constabulary, 2019). Settings such as emergency departments have also utilised technology, with some in Australia introducing touch-screen computers to assist in screening for DVA, resulting in significant increases in the identification of abuse (Rhodes et al, 2001; Rhodes et al, 2002; Hawkins et al, 2009).
Despite its intended benefits, technology can also enable or exacerbate gender-based violence (GBV), providing DVA perpetrators with new and growing opportunities to continue or escalate their abusive behaviours. Perpetrators can use technology to create a fear that they will always be present within their victim’s life (Woodlock, 2017). Technology-facilitated DVA is not necessarily a distinct form of abuse from that perpetrated in-person; but technology offers perpetrators another medium to continue controlling, stalking or harassing their victim (Al-Alosi, 2017; Stonard, 2020; Fiolet et al, 2021). It is often an extension of what is already being perpetrated within the relationship (Harris and Woodlock, 2019; Lyndon et al, 2011). These forms of DVA can occur 24 hours a day, no matter where the victim is, and can include a range of controlling and coercive behaviours by the perpetrator, such as: putting their victim under surveillance, threatening phone calls, checking messages, using smart-home technology to control the physical environment, cyber-stalking, harassment on social media, tracking locations, and sharing intimate images (Stonard et al, 2015; Al-Alosi, 2017; Barter and Koulu, 2021).
COVID-19
Although technology can provide perpetrators with more tools and opportunities to control and intimidate women and children, services providing specialist support to CYP experiencing DVA have found technology crucial in enabling their support to continue throughout the COVID-19 pandemic. Incredible strain has been put on violence against women and girls (VAWG) service providers due to mandatory restrictions imposed by multiple lockdowns (UN Women, 2020; Grierson, 2020; Women’s Aid, 2020). These restrictions have caused significant concerns around increased risk for women and children left isolated within abusive households globally (Bradbury-Jones and Isham, 2020; Campbell, 2020; Usher et al, 2020). In the UK, the National Domestic Abuse Helpline saw a 25 per cent increase in calls as a result of the pandemic (Kelly and Morgan, 2020). This increase in demand was experienced globally, with most countries also reporting increases in calls to their DVA helplines, for example: 40 per cent in Malaysia, 50 per cent in China and Somalia, 79 per cent in Colombia and a significant 400 per cent in Tunisia (UN Women, 2020).
While specialist DVA services for CYP did not see this increase (Donagh, 2020), they experienced exceptional strain trying to continue delivering their support, given the limited opportunities for meeting in person. Due to national shortfalls in services for CYP experiencing DVA (Radford et al, 2011; Humphreys and Mullender, 2015), specialist services continue to have significantly high numbers of young people waiting for support. Schools provide DVA practitioners with a safe and controlled space in which they can engage with young people seeking support. The closure of schools during the pandemic meant that services were left with little to no opportunity to meet with CYP in person, meaning they had to adapt their approach to support, and furthermore their overall service model, in line with government guidelines. This is where the use of technology has proven crucial.
Technology-enabled support
With the closure of schools and community venues, telephone support and video conferencing (rarely used pre-COVID) have enabled CYP to continue accessing specialist support. Services have been able to remain accessible and to continue to help CYP experiencing DVA to keep safe and develop coping strategies. Following thorough risk assessments, practitioners have been able to hold virtual support sessions on a weekly basis, continuing to provide CYP with the opportunity to talk through their experiences. Telephone support has been particularly successful with older young people (13–17) as well as CYP who struggle with social skills such as eye contact. Video conferencing in comparison has been particularly useful for younger children (5–12) as well as CYP who prefer to see the person they are speaking to.
Delivering group work programmes using video conferencing, for example, has meant delays to groups being established drastically reduced, as young people could join from any geographical location. In addition to this, DVA services saw an increase in attendance alongside less CYP dropping out during the course. While video conferencing removed the opportunity to complete smaller-group activities using arts and crafts, the use of breakout rooms and virtual whiteboards ensured these activities could still be completed. Multiple agencies within the VAWG sector have taken a similar approach with the creation of an online version of The Freedom Programme (The Freedom Programme, 2021), and Victim Support expanding their I Matter programme to be delivered nationally using video conferencing to support women experiencing DVA (Charity Today, 2021). While the utilisation of technology has helped overcome some of the barriers created by the COVID-19 pandemic, limitations and risks have also been associated with its use, which have been considered within this FMEA.
Methodology
There have been both benefits and risk to the use of technology during the COVID-19 pandemic, however not all risks warrant the same level of concern or response. FMEA is a widely used systems approach to analyse safety and quality across a range of topics, with particular recent application in health systems where patient safety is paramount (Simselker et al, 2019). Ultimately, a FMEA enables the identification of potential risks or vulnerabilities within complex processes and furthermore the generation of remedial actions (Armitage et al, 2012; Ashley et al, 2016). This prospective quality assurance methodology originated within the military, has been developed in a range of industrial settings, and is now being increasingly used within healthcare settings (Armitage et al, 2011; Ashley et al, 2011). Despite its considerable use within healthcare, FMEA has not been used to appraise and quality assure a process within a specialist DVA support service. A FMEA was completed to highlight considerations when deciding whether to use technology to support CYP experiencing DVA. This analysis enabled a retrospective review of the risks identified by a specialist DVA service when using technology during the COVID-19 pandemic to support CYP experiencing DVA; the FMEA findings have enabled the creation of remedial strategies to counteract these anticipated or potential risks before they happen in the future.
FMEA team
It is recommended that FMEAs are completed by multidisciplinary teams, who are able to offer differing perspectives to provide a more comprehensive analysis. Although this FMEA team may have been smaller than usual, it has still provided a range of perspectives on the topic. Ben Donagh is a doctoral researcher with over a decade of experience supporting CYP experiencing DVA; he was also the operational manager of a specialist DVA service delivering technology-enabled support to CYP during the COVID-19 pandemic. Professor Caroline Bradbury-Jones is a registered nurse, midwife and health visitor. Her research interests lie broadly within the scope of addressing inequalities and more specifically are focused on issues of family violence and child abuse and neglect. Professor Julie Taylor has extensive publication and research experience in child maltreatment, and advocates from a public health approach to child protection; she also has previous experience of FMEA, being the first to use it to analyse a social care process (Ashley et al, 2016).
The process
The FMEA team followed the sequential five stage process of completing a FMEA (Ashley et al, 2011):
map the process under evaluation to identify its component steps,
identify failure modes (potential risks) for each step,
numerically score the failure modes to prioritise them according to the risk they pose,
identify possible causes for the highest-risk failure modes,
and generate corrective actions to address these.
Within this FMEA, the team made a decision to modify step three as it was not deemed desirable to numerically score and prioritise the failure modes. Traditionally, this would be done based on their severity, occurrence and detectability, producing a risk priority number (Armitage et al, 2011). With the severity, occurrence and detectability of identified failure modes being related to individual children and their families, it was felt that individually scoring each could not be done objectively; the severity for example would depend on the unique circumstances on every occasion. Instead, each failure mode was given a RAG (red, amber, green) rating following considerations in two key factors: (1) the potential risk of harm they cause for the CYP accessing support, and (2) the impact they have on their ability to engage in support.
Findings
Step one: process mapping
The process for using technology during the COVID-19 pandemic to support CYP experiencing DVA was mapped out in seven main steps. This was from the point of a referral being received to case closure. The sixth step ‘agree exit strategy’ had two potential sub-steps: ‘planned’ when support has been delivered and it is coming to a natural case closure, and ‘unplanned’ where support has had to be called to an end by the practitioner due to identified risks or concerns (see Figure 1).
CYP Support Process Map
Citation: Journal of Gender-Based Violence 2022; 10.1332/239868021X16397664798942
CYP Support Process Map
Citation: Journal of Gender-Based Violence 2022; 10.1332/239868021X16397664798942
CYP Support Process Map
Citation: Journal of Gender-Based Violence 2022; 10.1332/239868021X16397664798942
Step two: identifying failure modes
In total, 14 failure modes were identified (Figure 2); the majority of these were found within process steps three and four. For example, in step four ‘deliver support and interventions’ there were ten failure modes identified. These included: technology failing, the perpetrator ‘lurking’ in the room (both hidden or visible), not being guaranteed confidentiality, and the non-abusive parent being present or taking over the support session.
RAG Rated Failure Modes
Citation: Journal of Gender-Based Violence 2022; 10.1332/239868021X16397664798942
RAG Rated Failure Modes
Citation: Journal of Gender-Based Violence 2022; 10.1332/239868021X16397664798942
RAG Rated Failure Modes
Citation: Journal of Gender-Based Violence 2022; 10.1332/239868021X16397664798942
Step three: RAG rating the failure modes
Each failure mode was considered in regards to both the potential risk of harm they would cause for the CYP accessing support, and the impact they have on their ability to engage in support. Each were then given a RAG rating (Figure 2). The failure mode of having the perpetrator in the room with the young person while they are accessing technology-enabled support, for example, has been given a red rating. This was given due to their presence meaning that there is a high potential for further or escalating abuse to take place and support being too risky to continue.
Step four: identifying causes
Twenty-seven individual causes were identified for the failure modes, some being applicable to more than one failure mode. Some of the causes were identified at the individual level, including the behaviours of the perpetrator (that is, the need for power and control, or monitoring and controlling of devices by the perpetrator). At an organisational level, policies and procedures caused or worsened failure modes, for example services being restricted to using one specific platform which was not as accessible for families compared to other available platforms.
Step five: generating corrective actions
A total of 13 corrective actions were created (Table 1). These changes focused on frontline practice, training and awareness, multi-agency working and internal policy and procedures. For some failure modes there are more than one possible corrective action. For example, where there are concerns around the perpetrator ‘lurking’ the first corrective action is preventative, whereby practitioners should complete extensive assessments, thoroughly reviewing the environment in which the child or young person is when receiving the technology-enabled support. This is to ensure that they are in an appropriate environment to speak openly, without the presence of the perpetrator, or any other person. If this does not work or is not possible, then they should consider the child or young person accessing the technology-enabled support within a school setting where the risk of the perpetrator being present is removed. If this is not a possibility, then the support cannot safely continue, meaning that there must be an unplanned exit from service. Even though some failure modes do not have corrective actions, they remain important for practitioners to be aware of when delivering technology-enabled support.
FMEA Corrective Actions
| Failure modes | Causes | Corrective actions |
|---|---|---|
| Perpetrator ‘lurking’ in the room (hidden) | - Power and control | Complete extensive assessments, thoroughly assess the environment in which the child or young person is in when receiving these calls, ensure they are in an appropriate environment to speak openly, without concerns of the perpetrator, or any other person, being present, and establish clear boundaries and expectations. |
| Introduce codewords for safety with the children and young people. | ||
| Children and young people access the technology-enabled support within a school setting | ||
| Support cannot safely continue – unplanned exit | ||
| Perpetrator ‘lurking’ in the room (visible) | - Power and control | Complete extensive assessments, thoroughly assess the environment in which the child or young person is in when receiving these calls, ensure they are in an appropriate environment to speak openly, without concerns of the perpetrator, or any other person, being present, and establish clear boundaries and expectations. |
| Introduce codewords for safety with the children and young people. | ||
| Children and young people access the technology-enabled support within a school setting | ||
| Support cannot safely continue – unplanned exit | ||
| Non-abusive parent present/taking over session |
| Establish clear boundaries and expectations at the start of support |
| Address concerns immediately as they arise | ||
| Unable to fully assess risk |
| Complete extensive assessments, thoroughly assess the environment in which the child or young person is in when receiving these calls, ensure they are in an appropriate environment to speak openly, without concerns of the perpetrator, or any other person, being present, and establish clear boundaries and expectations. |
| Multi-agency discussions and information sharing | ||
| Training for practitioners on safeguarding children and young people when delivering support through technology | ||
| Cannot guarantee confidentiality |
| Children and young people access the technology-enabled support within a school setting |
| Support cannot safely continue – unplanned exit | ||
| Children and young people may not have a safe space to engage at home |
| Complete extensive assessments, thoroughly assess the environment in which the child or young person is in when receiving these calls, ensure they are in an appropriate environment to speak openly, without concerns of the perpetrator, or any other person, being present, and establish clear boundaries and expectations. |
| Introduce codewords for safety with the children and young people. | ||
| Children and young people access the technology-enabled support within a school setting | ||
| Support cannot safely continue – unplanned exit | ||
| Technology is not accessible to all children and young people |
| Organisation to reconsider the platform of choice (select more commonly used one) |
| Access devices provided during COVID-19 by local government | ||
| Training for practitioners on engaging with younger children or children with additional needs through technology | ||
| Children and young people access the technology-enabled support within a school setting where technology is available | ||
| Practitioner lacks confidence |
| Training for practitioners on engaging with children and young people through technology |
| Limited access to devices |
| Access devices provided during COVID-19 by local government |
| Complete extensive assessments, thoroughly assess the environment in which the child or young person is in when receiving these calls, ensure they are in an appropriate environment to speak openly, without concerns of the perpetrator, or any other person, being present, and establish clear boundaries and expectations. | ||
| Lost contact during support |
| |
| Support may be less effective | - Resources are limited when using technology (support usually involves a lot of arts and craft activities) | Make use of breakout rooms and electronic whiteboards within the technology to keep content creative and engaging |
| Poor engagement or attendance |
| |
| Children and young people may lack confidence with engaging over technology |
| |
| Technology issues/failure |
|
Discussion
While the utilisation of technology has helped overcome some of the barriers created by the COVID-19 pandemic when supporting CYP experiencing DVA, limitations and risks have also been associated with its use. Completing a FMEA has enabled the identification of 14 potential risks or vulnerabilities with this approach to support; five of which have been deemed as ‘Red Risks’, meaning they carry the highest risk of harm for the CYP accessing support or they significantly impact their ability to engage in support. This methodological process has resulted in the creation of 13 corrective actions, designed to prevent these anticipated risks from occurring.
Delivering remote support using technology makes the assumption that the CYP accessing the service have the physical means to engage. Unfortunately, for some families this is a luxury that they cannot afford and therefore means that DVA services operating in this way reduce their accessibility. During the COVID-19 pandemic, the Department for Education within the UK helped with this limitation to an extent, providing laptops and tablets to more than 1.3 million CYP; 4G wireless routers and SIM cards with data were also available to help with internet access (GOV.UK, 2021). While the primary purpose of these devices was to help with accessing online education, they also helped a number of CYP engage with the technology-enabled support being delivered by specialist DVA services.
Some CYP who do have access to technology still found telephone calls and video conferencing unsuitable to their individual needs, either by personal preference or current levels of risk. Some young people simply do not feel comfortable with these methods of support, preferring to meet the practitioner supporting them in person; others may be living in circumstances where telephone support or video conferencing is not safe. Not all CYP accessing support from DVA services are in households where the abuse has ended; technology-enabled support is not appropriate for young people still living with the perpetrator, experiencing ongoing abuse. This cohort of young people would likely experience the failure modes within our ‘Red Risk’ category, meaning the technology-enabled support may result in them experiencing further abuse. The FMEA has created a menu of corrective actions for practitioners to consider in these circumstances. When using technology-enabled support, an extensive risk assessment process is essential whereby practitioners need to thoroughly assess the environment in which the child or young person is when receiving support calls. They need to ensure the young people are in an appropriate environment to speak openly, without concerns of the perpetrator, or any other person, being present. Where ongoing concerns remain, it may be safer for practitioners to deliver the telephone support or video calls while the young person is in school; that is, in a safe and controlled environment where the perpetrator will not be present. Ultimately, if this is not possible, it is likely that technology-enabled support is not appropriate or safe meaning an unplanned exit from service is required.
Services have struggled to fully assess risk within the environment in which CYP engage with technology-enabled support during COVID-19. Despite additional risk assessments being introduced during the pandemic, practitioners have not been able to know for certain if other people, including the abusive parent or partner, are ‘lurking’ within the room but out of sight. For some, the presence of the perpetrator can be identified part way through support sessions, raising concerns around potential intimidation, manipulation or additional stress for the CYP. Practitioners may hear or see DVA perpetrators in the room with the CYP. Some may be unsuccessful at trying to hide their presence from the practitioner, others make their presence known in the hope of intimidating the practitioner and reducing the effectiveness of their support. In these circumstances the session must be safely brought to an end, and safeguarding implications considered and acted upon. Even with remedial actions in place, these circumstances may still occur, hence this FMEA providing multiple corrective actions for some of the failure modes.
For some CYP, their non-abusive parent, who would not usually be involved with the support, may also be present in support sessions when they should not be. This has been a particular issue when using video conferencing to deliver group work programmes during COVID-19. Despite being informed that this cannot happen when completing the risk assessments, DVA practitioners may see inappropriate behaviours such as parents answering on the behalf of their child or coming into the frame of the camera during sessions. Not only does this cause disruption for their own child, but also the other CYP in the group, potentially making them feel less comfortable with participating. Having a child’s parent present also removes the confidential nature of the support, which is not acceptable. Confidentiality is of vital importance for children and young people accessing support from specialist DVA services. This FMEA indicates that establishing clear boundaries from the start could be one of the remedial strategies practitioners need to consider.
Conclusion
This article has shared the experiences of a specialist DVA service for CYP who utilised technology in their service delivery during the COVID-19 pandemic. Technology was crucial for the delivery of support, with telephone support and video conferencing enabling CYP to continue accessing their service. There have, however, been both benefits and risks to the use of technology during the COVID-19 pandemic, although not all risks warrant the same level of concern or response. The completion of a FMEA has been able to highlight considerations and suggest corrective actions for specialist DVA services deciding whether to use technology to support children and young people.
Conflict of interest statement
The authors declare that there is no conflict of interest.
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