The role of occupational therapists in identifying and responding to Domestic Violence and Abuse

Following a successful 10 month project delivering occupational therapy within our local domestic abuse service, we wish to share our knowledge, skills and learning.

Current policy in domestic abuse

The incidence of Domestic Violence and Abuse (DVA) increased dramatically during the COVID-19 pandemic, and the Office of National Statistics (Stripe, N., 2020) reported significant increases in the emotional effects of abuse during this time.

The ‘costs as a consequence of domestic abuse’ identify emotional harms and lost output following domestic violence as significant, with a total cost to the economy of over £34,000 per victim per year (Oliver, R., 2019). The Serious Crime Act 2015 now identifies controlling or coercive behaviour as an offence. People with support needs are more likely to experience DVA than the rest of the population, (Neate, P, ND) and disabled women are over 1.5 times more likely to be a victim of violence than are non-disabled women (Hughes et al., 2012, Breiding & Armour, B. S., 2015).

In addition, the Care Act 2014 now includes DVA as one of the issues and circumstances that can be considered when responding to safeguarding concerns.

The experience of disabled women who have been victims of abuse, highlights how the violence was ‘explicitly tied to their disability status and reinforced by society’ (Njelesani, J.,et al, 2021, pg.5), and the extent to which leaving the relationship disrupts patterns of occupational engagement and results in changes to identity (Njelesani, J.,et al, 2021).

Empowerment to leave can be facilitated through personal, societal and financial assets, and a shift in occupational identity (Njelesani, J.,et al, 2021).

Current policy in occupational therapy

The World Federation of Occupational Therapists (WFOT) advocates occupational therapists in promoting ‘inclusion, diversity, justice and human rights’ within the daily lives of people affected by ‘disability, poverty, abuse and violence’ by engaging in ‘community capacity building and societal change beyond the individual’. They state that a ‘bio psychosocial perspective is essential’ to address the occupational performance issues facing people with complex situations and co-morbidity (WFOT, 2016).

The American Occupational Therapy Association (AOTA) has written a statement to describe the evolving occupational therapy service to victims of intimate partner violence. (AOTA, 2017). There is a growing body of evidence that occupational therapy can address the difficulties with daily living (occupational performance issues) experienced by survivors of abuse (Lopaschuk, F., & Brown, C. A., 2012, Javaherian-Dysinger, H, et al., 2016), and there is evidence that preparedness to respond appropriately to domestic abuse is directly linked to training (Sivagurunathan, M et al., 2018). 

The Royal College of Occupational Therapists (RCOT) has identified that health equality is a priority in 2022 and suggests service innovations to address inequalities through their #OTsForEquity, Roots of recovery campaign (RCOT, 2021).

Occupational therapists’ dual training in both mental and physical health can facilitate a holistic understanding of the impact of domestic abuse on the ability of victims to be able to ‘function’, i.e. to be able to carry out routine self-care, home management, work and leisure activities in their daily life. Occupational therapists use tailored, co-produced interventions that support meaningful change in the person’s everyday life, ensuring their personal goals are achieved (RCOT, 2021).

Practice concerns

Occupational therapists work within all areas of health and social care, and use holistic assessment to identify barriers to being able to manage ordinary daily living tasks such as parenting, working, going out into the community and seeing friends.

Since DVA can occur in any setting, across all demographic groups and results in deficits across all domains of function, occupational therapists are well placed to identify and respond to DVA, and to support functional recovery from its impacts (AOTA, 2017, Javaherian-Dysinger, H, 2021). However, many often lack confidence to enquire, recognise and act with potential victims.

In addition, the role of occupational therapists in supporting recovery from the experience of DVA is developing across the globe, with a gradual increase in literature evidencing the positive impact of interventions on daily occupational skills, performance and participation (Javaherian-Dysinger, H, 2021).

We hope this research will build practitioner confidence and skills when working with people who may be experiencing DVA to improve outcomes.