Risk assessment for extended/conjugal family violence: Addressing the gaps

In the 2015-2016 needs-assessment, it emerged that current models of service and tools for risk assessment in Edmonton are ill-suited to handling violence done via extended social networks of kin and community. Violence is largely understood and handled as occurring within the nuclear family or from one intimate partner to another. Apparently, there is neither the understanding nor the tools for agencies to deal with extended/conjugal family violence.

In many of the cases described with such extended/conjugal family violence, women may be abused not only by the male spouse but also by in-laws, with mothers-in-law often playing a lead role in inciting and doing violence.[i] Interestingly, many of the participants in the needs assessment thought that violence is not gender-based if it involves the abuse of one woman by another woman. The fact however is that violence by husbands towards wives is tied to gender relations and roles within extended families. Gender violence (encompassing spousal violence) is moored to hierarchical family arrangements and patriarchal relational dynamics. In this context, husbands and in-laws commit, aid and abet violence towards the vulnerable newcomer, i.e. immigrant wives.

Some participants were concerned that their tools might not be adequate to the purpose of detecting violence against women within conjugal-extended family settings. The risk assessment forms used in interviews with help-seekers are chiefly the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER[ii], which is a modified version of the Spousal Assault Risk Assessment (SARA), and Danger Assessment (see the final section on the DA’s shortcomings in this post).[iii],[iv] PATRIARCH, a tool developed in Sweden to assess for HBV risk,[v] was known to some of the service providers, who found it relevant, but is not in much use.

THE NEED FOR A DIFFERENT APPROACH WHEN ASSESSING RISK OF ‘HONOUR’ VIOLENCE

Undoubtedly, there are few other crimes that are as complicated to investigate and understand as honour-based crimes. Law enforcement usually deals with criminals who mostly work alone, and do things that are blameworthy by other people, particularly when these crimes are committed against women and girls. Such perpetrators are often viewed as psychopaths, mentally ill or evil. But when dealing with honour-based criminality, the planning and execution often involves multiple family members, usually without personality disorders or major mental disorders, and can include victim’s mothers, sisters, brothers, male cousins, uncles and grandfathers, whose actions are considered as good or necessary. And, if a woman or a girl escapes, the extended family/clan will continue to search for her to ensure she is punished. (Belfrage et al 2012)[vi]

Expanding the framework of risk assessment: What of non-lethal violence?

The needs assessment provided evidence that current tools in use to assess risk of violence are geared to intimate partner/spousal assault rather than collectivist extended/conjugal family violence, which presents greater and less understood challenges of extended networks of violence with multiple perpetrators within and outside the family and across locations.

The primary focus is on intimate partner violence, with a view to detecting the danger of lethality. The focus on potentially lethal intimate partner violence means that there is less attention to the risks and effects of a long-term non-lethal situation of multiple perpetrator violence with extended networks of violence involving extended family and community members.  No one reported use of a tool that screens for collectivist homophobic or transphobic violence.

While the prevention of lethality has definite urgency, the fact is that violence may persist through the life span without culminating in lethal violence. The focus on preventing lethality often leads to an emphasis on exit strategies without considering that for many women immediate exit into shelter brings along a myriad of long-term problems that the over-burdened and under-resourced anti-violence service sector is ill-equipped to handle, especially given their unstable funding and project-focused short-termism. Leading examples of the problems that come with exit are the slide into homelessness and the escalated precariousness of immigration status.

In this situation, it is worthwhile to note the value of out-of-shelter outreach and support strategies that are currently being deployed at well-known Edmonton shelters such as WINHouse. These innovative out-of-shelter approaches use risk assessment tools, involve the sufferer in the safety planning process, and engage with her without imposing end dates on the process of engagement. In this context it is also worthwhile to visit a report by Tiihonen (2011) that argues in favour of a more holistic form of risk assessment that goes beyond probing for danger of lethality.[vii]

Before we can discuss current risk assessment tools, we should say a few words about terminology. The terms safety assessment, threat assessment and risk assessment are often used interchangeably. Although there is some measure of overlap in these concepts, we should take care to note how they differ. The following is a breakdown of each of these concepts. Safety assessments examine the factors that may contribute to an incident of harm occurring (e.g. a campus tour that looks for places that require more light or emergency telephones to prevent cases of sexual assault). Threat assessments/Lethality assessments probes a specific situation to determine the potential of an attack where both the victim and the perpetrator are known. It is often used by the military and law enforcement to assess national and individual security. Jackie Campbell’s Danger Assessment is a lethality assessment that seeks to predict the potential of a perpetrator using lethal levels of violence on a victim. Risk assessments evaluate the potential for the occurrence of any harmful situation. They are the broadest model of assessment and do not limit harm to that coming from a known abuser. This is the best fit for feminist anti-violence work because it allows women to look at how all areas of their lives may impact their safety. (Tiihonen, 2011, p11)

Tiihonen (2011) goes on to suggest that service intake forms (her analysis looks at shelter intake) also need to look beyond lethality.

Within these questionnaires or intake forms, there is a noted hierarchy based on the possible outcomes that determine the level of risk to a woman. In other words, the outcome of death is seen as the highest level of risk, followed by serious physical harm, and so on. … When considering risk of fatality or serious harm, do the assessment questions only explore the outcome of violence by the abuser? Or do they also explore the multiple impacts of living with such risk of violence? What determines the hierarchy of risk to harm? Do the intake forms explore what kinds of risks the woman may face when leaving, beyond the threat of physical violence from her interpersonal relationship? If so, how and who determines the weight of the risk? Do shelters assess the risk of involving the police or child welfare when they are considering making a third party report? (Tiihonen, 2011, p16)

The ‘Danger Assessment for Immigrant Women’ (DA-I) is not culturally competent

Messing et al (2013) provide a tool for the ‘culturally competent’ assessment of the risk of homicidal violence from intimate partnerships faced by immigrant women.[viii] The tool (available here) has been developed to assess the risk of homicide and future violence faced by abused immigrant women. The women at risk suffer the effects of intersecting vulnerabilities e.g., socio-economic isolation, precarious immigration status, and patriarchal family arrangements that discourage separation and exonerate male violence.

It is hard to tell exactly where and how the DA-I is culturally competent as most of the items (barring questions 23 and 24 on the list) are identical (or nearly so) to generic one-on-one IPV-related tools of assessment of danger of lethality and re-assault. Among the glaring gaps in the tool is the absence of questions related to violence and fear of violence related to extended/conjugal family members and relationships. There are no questions relevant to LGBTQ+ persons. Omitting these questions lowers the relevance and utility of the tool.

Priorities ahead: Training staff in risk assessment

Among the possible service responses a key area is training of service providers in risk assessment, detection, management and intervention.

Specialized training requires funds for the expert-led workshops needed to clarify tool use. Only a few agencies (usually government, i.e. domestic violence intervention and child protection, or the better resourced nonprofits) can muster the resources for such sessions. Connected to this, the tools in use are most geared to the detection of lethality, which serves the purposes of law enforcement and the justice system but does not serve the long-term needs of survivors. These tools have to be adapted to contexts such as counselling centers and shelters, which leads to a proliferation of tools in use, with lowered prospects of inter-agency cross-talk about what risk is, how it is assessed, and how these assessments are interpreted and operationalised to optimise case outcomes.

In the absence of huge funding inputs (quite unlikely for now), perhaps trying to get more specialized via tool acquisition, training and sharing of expertise will make a small positive difference in the accessibility and quality of services. As with all else, funding constrains the practicability and viability of this solution; nevertheless, limited funding could help organize workshops to provide case-based collaborative training to agencies on tools to detect risks posed by extended/conjugal family violence. These workshops need not be lavish affairs and learning gains can be recorded and carried forward for a while via current e-learning and e-library tools available.

Making a new risk-assessment tool. Training staff in pilot use of tool.

It is recommended that there be pilot training sessions for frontline service workers in the use of a new tool , that can be applied to assess for risks of conjugal family violence and homophobic/transphobic violence. The new tool could combine modified elements of

  1. the DA-I needs to be elaborated, related to multi-perpetrator/extended/conjugal family violence and should incorporate survivor-oriented questions from PATRIARCH.
  2. PATRIARCH needs to be adapted to the context of a service that supports survivors. PATRIARCH has been primarily designed for use in the law enforcement context by officers examining perpetrators. Many of the questions that would gather information from perpetrators and friends and family would simply result in escalated risk and harms resulting from loss of confidentiality. How could an agency that is mandated to do one-on-one counselling use the perpetrator-oriented components? The tool does contain questions that can be used to gather information from survivors  regarding(1) ‘victim vulnerability factors’ (2) nature of ‘HBV factors’

Service providers fluent in languages other than English (e.g. Hindi, Punjabi, Arabic) can be trained in using the tool in these languages, as well as to safety and escape plan with the client in the client’s language (if possible).

The new risk assessment tool should also include items relevant to the risks faced by persons of rainbow communities. Training should provide guidance on cultural competency and cultural safety during client interviews.

Notes and references

[i] Wasim, F. (2014). South Asian American Daughter-in-law/mother-in-law Relationships, Cultural Values Conflict, and Help-seeking for Domestic Violence (Doctoral dissertation, Oklahoma State University). Link.

[ii] Kropp, Randall.P., Hart, Stephen D. (2004). The Development of the Brief Spousal Assault Form For The Evaluation Of Risk (B-Safer): A Tool For Criminal Justice Professionals. Link. The B-SAFER is a set of guidelines for assessing risk for spousal assault, designed to be especially useful for decision making by police and other justice agencies. The B-SAFER tool is a 10-item condensed version of the Spousal Assault Risk Assessment (SARA).

On SARA, see Kropp, Randall. P., Hart, Stephen D., Webster, Christopher D. (n.d). Spousal Assault Risk Assessment Guide. Link  SARA ‘helps criminal justice professionals predict the likelihood of domestic violence. The tool is a quality-control checklist that determines the extent to which a professional has assessed risk factors of crucial predictive importance according to clinical and empirical literature. With 20 items, the SARA assessment screens for risk factors in individuals suspected of or being treated for spousal or family-related assault. The SARA can help determine the degree to which an individual poses a threat to his spouse, children, family members, or other people involved. The instrument can be used by members of various boards or tribunals (e.g., parole and review boards, professional ethics committees, etc.), lawyers, victims’ rights advocates, and prisoners’ rights advocates.’

Both SARA and B-SAFER were developed for use with professionals within the criminal justice system, including law enforcement, and both require training and expertise in family violence. (See Millar, A., Code, R., Ha, L. (2009, April). Inventory of spousal violence risk assessment tools used in Canada.  Link) BSAFER and SARA incorporate a ‘structured professional judgement’ (SPJ) approach to risk assessment, including scenario planning. The SPJ approach is seen as preferable to the overly idiosyncratic methods of unstructured clinical decision-making and the inflexibility of actuarial decision-making (See Kropp, Randall.P., Hart, Stephen D. (2004). The Development of the Brief Spousal Assault Form For The Evaluation Of Risk (B-Safer): A Tool For Criminal Justice Professionals. Link (see pp3-5)).

See Northcott Melissa. (n.d). Intimate Partner Violence Risk Assessment Tools: A review. Link. Northcott discusses the development and features (including pros and cons) of the diverse intimate partner violence tools (and their methodologies, i.e. SPJ or actuarial) in use in Canada. These tools include:

  • SARA, BSAFER, Danger Assessment (DA, detailed description in Northcott, pp 22-23)
  • The Ontario Domestic Assault Risk Assessment (ODARA), and The Domestic Violence Risk Appraisal Guide (DVRAG (actuarial).
  • The Violence Risk Appraisal Guide (VRAG) and Level of Service Inventory – Revised (LSI-R) are tools specialized for correctional institutions to assess recidivism for general and violent offenders.

[iii]Northcott Melissa. (n.d). Intimate Partner Violence Risk Assessment Tools: A review. Link. According to Northcott (p13) on choice of tool: ‘There are a number of factors that should be considered when determining which risk assessment tool to use. These factors include:

  • Whether the goal of the risk assessment is to predict recidivism, to prevent violence, or both.
  • Whether the focus is offender-focused or victim-focused. Some tools are designed to assess the offender specifically whether it is to determine the likelihood of re-offending or to develop risk management strategies, while others are focused on whether the victim will be re-victimized.
  • Whether the purpose of the assessment is to determine the risk of intimate partner violence or intimate partner homicide (Braff and Sneddon 2007). If the purpose of the assessment is to determine the likelihood of intimate partner violence recidivism, the evaluator could choose such tools as the Spousal Assault Risk Assessment Guide (SARA) or the Domestic Violence Screening Inventory (DVSI). If the purpose is to determine the likelihood of intimate partner homicide, the evaluator could choose the Danger Assessment (DA) or the DV-MOSAIC.
  • The time it takes to complete the risk assessment. Some tools consist of fewer items and thus are less time consuming to complete (Braff and Sneddon 2007). For example, assessments that require file reviews, interviews with offenders and other contacts, and reviewing psychological reports, are more time consuming than assessments that do not require these steps. Furthermore, some tools require the input or assessment by a psychologist. One must consider the availability of the psychologist to conduct the assessment and the time it may take him or her to conduct the assessment.
  • The individual conducting the assessment (Guo and Harstall 2008). For example, the tool that is chosen may depend upon whether the assessor is a clinician, a law enforcement officer or a social worker.
  • The skill and experience of the individual conducting the assessment (Braff and Sneddon 2007). While some research shows that extensive clinical experience is not necessary to complete some measures (e.g., Storey et al. 2011), one should consider the level of clinical experience needed to complete a specific tool when choosing an instrument.
  • The setting in which the assessment will take place (e.g., courthouse, women’s shelter) and the accessibility of the information necessary to complete the assessment (Guo and Harstall 2008). ‘

[iv] Northcott Melissa. (n.d). ibid Link According to Northcott (p 22-23): The Danger Assessment (DA) was developed by Jacquelyn Campbell in the United States and is used throughout the United States and Canada (Guo and Harstall 2008; Millar 2009). The DA is a structured clinical assessment tool that was originally designed for use by emergency room nurses to assess the likelihood of intimate partner homicide (Guo and Harstall 2008; Hanson etal. 2007). It is now also used to predict domestic violence recidivism, but not in low-risk or medium violence cases (Guo and Harstall 2008). It is used in a number of settings, including for the purposes of victim education and awareness, safety planning and determining the conditions of services. The DA is comprised of two parts. The first is a calendar on which the victim indicates the severity and frequency of instances of domestic violence that she experienced within the last 12 months. The second part is a 20-item checklist of risk factors that are related to intimate partner homicide (Millar 2009). Both sections are completed in collaboration with the victim (Hanson et al. 2007). Guo and Harstall (2008) state that the most appropriate users of the DA are victim advocates, social workers or clinicians in various settings, such as women’s shelters and hospitals. The strengths of the DA are that it has strong test-re-test reliability, good inter-rater reliability and construct validity, and correlates strongly with other measures of domestic violence  (Kropp 2008). In addition, it is a good tool to use with victims as it allows victims to better understand the risk that the relationship may pose to them and what risk management options are available (Guo and Harstall 2008). It may also serve as a useful instrument when information is difficult to obtain or when the offender cannot be interviewed. The accuracy of the DA, however, is not as strong as other tools and it does not provide the evaluator with a means of assessing the risk level posed by the accused (Hilton and Harris 2005).’

[v] Belfrage, H., Strand, S., Ekman, L., & Hasselborg, A. K. (2012). Assessing risk of patriarchal violence with honour as a motive: six years experience using the PATRIARCH checklist. International Journal of Police Science & Management, 14(1), 20-29.

[vi] Belfrage, et al (2012) ibid.

[vii] Tiihonen S (2011). Breaking Through: Rethinking Assessment Practices In Ontario Shelters. Link. Tiihonen offers a simple language analysis of the adaptation of what were designed as tools of assessment of homicidal lethality for the purpose of risk assessment in shelters.

[viii] Messing, J. T., Amanor-Boadu, Y., Cavanaugh, C. E., Glass, N. E., & Campbell, J. C. (2013). Culturally competent intimate partner violence risk assessment: Adapting the danger assessment for immigrant women. Social Work Research, 37(3), 263-275. Link

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