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Domestic ViolenceRisk Assessment and Safety Planning

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Addressing Domestic Violence Risk• In 2013, there were 1,703 calls to police for domestic

violence in Santa Barbara County1

– The actual rate of violence is much higher, it’s estimated that about 46% of victims never report DV2

• Domestic violence (DV) is the most common kind of trauma exposure seen at CALM– Often present with other kinds of abuse– Due to the high prevalence, DV risk assessment and safety

planning are frequent concerns in our clinical work.

• Domestic violence can present very differently in different relationships. Batterers have different patterns of behavior, and different levels of risk.

1) California Criminal Justice Statistics Center, http://oag.ca.gov/crime/cjsc-stats/2010/table142) Bureau of Justice Statistics, National Crime Victimization Survey, 2006–2010. http

://bjs.ojp.usdoj.gov/content/pub/pdf/vnrp0610.pdf

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Typologies of Domestic Violence• Holzworth-Monroe & Stuart (1994) developed a

three-level typology of batterers that has generally held up in subsequent research:– Family only– Dysphoric/Borderline – Generally violent/Antisocial

• Understanding these three subtypes, patterns of violence, and their different levels of risk can help to inform your safety planning strategies.

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Types of Batterers• Family Only Batterers (50%):

– Lowest frequency and severity of violence, least likely to use psychological/sexual violence, lowest rates of injury

– Generally negative attitudes towards violence, most remorseful, most likely to accept responsibility

– Positive attitudes towards women, their marriage, and their wives, most liberal gender role expectations

– Generally lacking in other psychopathology– Alcohol involved in about 50% of incidents– Battery in these cases can be seen as a combination

of a lack of regulatory/communication skills, life stress, marital stress (tend to be triggered by external stressors)

– Also referred to as ‘common couple violence,” high-conflict couples where the violence is initiated by either member of the couple in different instances

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Types of Batterers• Dysphoric/Borderline Batterers (25%)

– Moderate frequency and severity, less likely to cause serious injury or serious violence than anti-social batterers, primarily within the family

– In some cases, less predictable violence, may have long periods without assault, interspersed with unexpected, intense violence

– Most psychological abusive out of all the types– Most dysphoric, depressed/anxious, psychologically

distressed, and emotionally volatile of the three groups– High levels of psychopathology, including borderline or

schizoid personality disorder– More traumatic experiences in childhood, lower

presence of substance abuse– Highly dependent, afraid of abandonment, jealous,

possessive, obsessive, difficulty controlling their explosive anger

– More widespread across social classes

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Dysphoric Batterers - Cycle of Violence• Most typical of “classic”

DV pattern

• Batterer experiences feelings of inferiority, shame, rejection, fears of abandonment during tension building phase

• Acts out/splits/ projects these emotions during psychological abuse and physical/sexual violence

• During reconciliation, batterer experiences a backlash – fears of abandonment - makes efforts to avoid loss of relationship through repair behavior

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Power & Control

Carlson & Jones (2010), Continuum of conflict and control: in family-only violence (type I), the violence is characterized by poorly regulated conflict. The increased intensity/frequency in type II and type III batterers is characteristic of instrumental violence designed to exert power and control the victim.

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Power and Control• Psychological Control

• Intimidation• Threats and Coercion• Emotional Abuse• Minimizing/denying , invalidating,

shifting blame

• Physical Control• Lack of privacy• Violations of physical integrity• Restriction of movement• Direct violence• Use of children

• Social Control• Isolation from family, friends, and

other supportive relationships

• Economic Control• Restriction from accessing money,

credit, etc.

• Batterers utilizes a number of strategies to maintain power and control over survivors; generally, these strategies serve two purposes:• Manage/discharge the negative affect of the

batterer• Maintaining the proximity/availability of the

intimate partner

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Risk Indicators – Future ViolenceBatterer Characteristics• History of witnessing DV in childhood• Unemployment• Prior history of violence against

unrelated individuals• Prior violations of bail, parole, or a no-

contact order• Drug/alcohol problem, binge use• Personality dx with anger, impulsivity,

behavioral instability, hostility• Extreme minimization/denial of

spousal assault• Attitudes that support or condone

spousal assaultAbuse-related Factors• Batterer has threatened to kill the

partner or himself• Past history of sexual assault/rape• Presence or access to weapons, use of

weapons in previous assaults• Choked victim during assault• Not previously arrested

• Previous severe acts of violence resulting in injury

• Recent escalation of violence• Confinement of victim• Assault while victim was pregnant

Relationship Factors• Extremely possessive, jealous, • Extreme controlling behavior• Attempts to leave, or knowledge that

partner plans to leave• Prior history of violence against partner

or children• More than one child together (increases

chances of staying in relationship)• Victim is concerned about future

violence• Victim has a child from previous

relationship• Recent separation• Threatened to harm children• Stalking behavior (spying, leaving

threatening notes/messages, destroying property)

• Victim believes he’s capable of killing her

Risk Indicators – Lethality

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Some counter-intuitive lethality findings

• Compared to non-lethal batterers, lethal batterers were more likely to:– Have higher educated fathers – Mothers who were stay-at-home moms

• Less likely to:– Have come from homes with DV, alcohol

abuse, or physical abuse– Have an alcohol problem, previous

convictions– Be intoxicated at time of event– Be unemployed– Have been previously violent (although 59%

had been)

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Lethal vs. Non-lethal batterers• Possessiveness (3.5 times as likely)• Separated (2x as likely)• History of violence with previous

partner (2.5x as likely)• Previously strangled or choked

victim (2.5x as likely)• Hx of sexual assault (16x as likely)• Previously used weapon (9x as

likely)

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Formal Risk Assessment - WAST

1. In general, how would you describe your relationship?

– A lot of tension– Some tension– No tension

2. Do you and your partner work out arguments with:

– Great difficulty– Some difficulty– No difficulty

3. Do arguments ever result in you feeling down or bad about yourself?

– Often– Sometimes– Never

4. Do arguments ever result in hitting, kicking, or pushing?

– Often– Sometimes– Never

5. Do you ever feel frightened by what your partner says or does?

– Often– Sometimes– Never

6. Has your partner ever abused you physically?

– Often– Sometimes– Never

7. Has your partner ever abused you emotionally?

– Often– Sometimes– Never

• Woman Abuse Screening Tool (WAST) - used to determine the presence of domestic violence in a relationship.

• The first two questions have been validated to effectively screen for DV (the WAST-short) on their own.

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Formal Risk Assessment - ODARA• Used to determine the likelihood of physical violence recurring. Score each item 1

or 0. ? if missing (available documentation indicates that an item might be present but the information is unclear or incomplete

1. Prior domestic assault (against a partner or the children) in police records2. Prior nondomestic assault (against any person other than a partner or the children) in police records3. Prior sentence for a term of 30 days or more4. Failure on prior conditional release; bail, parole, probation, no-contact order5. Threat to harm or kill anyone during index incident6. Confinement of victim during index incident7. Victim fears (is concerned about) future assault8. More than one child altogether9. Victim has a biological child from a previous partner10. Violence against others (to any person other than a partner or the children)11. More than one indicator of substance abuse problem: alcohol at index, drugs at index, prior drugs or alcohol, increased drugs or alcohol, more angry or violent, prior offence, alcohol problem, drug problem12. Assault on the victim when she was pregnant13. Victim faces at least one barrier to support: children, no phone, no access to transportation, geographical isolation, alcohol/drug consumption or problem

_____ Raw total (sum of items scored 1)Adjusted Score (see Table Adjusted scores for assessments with missing information)

• Scores: 4 (41% recidivism), 5-6 (59% recidivism), 7+ (70% recidivism)

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Economic Independence

Confidence, Self-worth, and empowerment

Confidence, Self-worth, and empowerment

Social Support

Custody and safe

visitation

Confidence, Self-worth, and empowerment

Physical Safety and

Security

Creating Safety• Safety planning includes:

• A detailed understanding of the abuse history • A plan to address the different factors that may limit

safety or independence.• Victims often underestimate the risk in

moderate-higher risk situations, using structured tools and informing them of the risk may help to take steps to securing safety

• Higher risk cases require more care in safety planning, and greater emphasis on escape planning

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Safety Planning• Safety planning is an ongoing process

throughout treatment– Most women are ambivalent about leaving,

especially if in long-term relationships– May fear for their safety, or doubt their

ability to survive independently– Also generally underestimate the risk they’re

in higher-risk cases– Resolving this ambivalence and educating

them about domestic violence/risk are part of safety planning as well as treatment

• Work towards confidence, self-worth, empowerment, and respect their autonomy.

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The SOS-DoC InterventionS: offer Support and assess Safety• Support: talk in private; make eye contact; assure that the discussion

will be kept confidential unless the patient expresses plans to harm self or another person– I’m sorry this has happened.– You have a right to be safe and respected.– The violence is not your fault.

• Safety: identify risk markers—increasing severity and frequency of violence, weapons used or available, threats to kill, forced or threatened sexual acts, life transitions (e.g., pregnancy, separation, divorce), drug and alcohol abuse, and history of violence and/or suicide attempts– Do you feel safe going home?– Are your children safe?

O: discuss Options, including safety planning and follow-up• Provide information about legal tools (e.g., restraining orders,

mandatory arrest, police/911) and community resources (e.g., women’s shelters, support groups, legal advocacy); promote safety planning and offer safety planning handout– If you decided to leave, where could you go?– Can you keep clothes, money, and copies of keys and important papers in a safe place?– Where could you go in an emergency? How would you get there?– Many women call a women’s shelter to learn more about it. Would you like to use our

office phone?

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The SOS-DoC InterventionS: validate patient’s Strengths• Identify and validate patient’s strengths

– You have shown great strength in very tough circumstances. I can see that you care deeply about your children. It took courage for you to talk with me today about the violence.

Do: Document observations, assessment, and plans• Subjective observations: record what the patient said; use quotation

marks to document exact words• Objective observations: describe the behavior and injuries you

observed, use drawings and photographs describing location and type of injuries; for photographs, include a ruler for scale, and patient’s face, if possible, for identity

• Assessment: your assessment of potential partner violence• Plans: describe safety planning and follow-up plans

C: offer Continuity• Offer a follow-up appointment and assess barriers to access

– Do you have transportation? Will your partner try to prevent you from returning?

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Physical SafetyViolent incidents• If possible, remove weapons from the home, place

barriers to access, or relocate weapons to safer areas of the house.

• Consider "safe zones" in the home, areas without weapons, or areas where a door can be locked and a telephone accessed.

• During conflict, avoid the kitchen, garage, and enclosed spaces like bathrooms or closets

• Avoid wearing scarves or necklaces• Talk to neighbors or other people that live nearby.

Explain the situation, ask that they call the police if they hear loud conflict, or arrange a signal (for example, a drawn blind) to indicate you need the police to be called).

• If necessary, contact HAVEN and secure a cell phone that will allow 911 to be called, store in-house.

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Physical SafetySafety planning with children

• Educate/coach children not to intervene/avoid conflict should it occur.

• Identify places the child can go during conflict, including locations within the house or neighbor’s houses.

• Teach and review emergency procedures with children, including calling 911, help them to memorize their phone number and address

• Develop a "code word“ or signal for the implementation of safety plan.

• Practice escape routes with the children, refer to it as “emergency planning.”

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Physical Safety – Escape Planning*• Plan an escape route before violence

occurs and practice it.• Identify 2-4 places to go or people to turn to• Plan routes, and safe/public places along the route of travel

• Pack a “go bag,” include:• Clothing• Cash/credit cards (secure extra copies)• Legal documents (identification, birth certificates, social

security cards, insurance cards, copies of restraining or custody orders)

• Important items that can’t be replaced (for example, old family photos)

• Important phone numbers• Best if not stored in home or car, if found, explain away as an

“emergency bag”• Identify where pets will be placed

*A woman is at greatest risk when leaving, it’s best to develop a plan to leave when alone vs. leaving during acute violence

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Physical Safety – legal strategies• Restraining orders & custody are in civil court –

evidentiary standard is lower, easier to support case

• Document all incidents of abuse– Call 911 – recorded shouts, etc. are used as evidence– Take pictures of injuries following incidents or 2-3 days

following (takes time for bruises to appear)• Use flash, ruler, insure victim’s face is in the picture

– Take photos of destroyed property or disarray– Identify witnesses that saw/heard events, as well as

children present, or children that live in the home and weren’t present

– Keep copies of medical records

• If police are on scene, they will collect much of this evidence– Get badge numbers, names, and report #

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Physical Safety – legal strategies• Arrest

– Most effective strategy to deter further abuse (results in the biggest drop in recidivism)

– If police don’t see probable cause, they’re supposed to inform the victim while alone that they can request a private person arrest (citizen’s arrest).

– Be aware that if the arrested person is undocumented, they will be deported regardless of prosecution (may happen fairly quickly)

• Restraining Orders– Civil:

• Emergency Protective Order (5-7 days)• Temporary Restraining Order (up to three weeks)• Permanent Restraining Order (3-5 years)

– Criminal

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Physical Safety - Restraining Orders

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Physical Safety - Restraining Orders• Emergency Protective Order (EPO)

– Requested of judges directly by police, can be provided at scene

– Survivor can also file a police report later and request one (may be harder to secure if evidence, such as injuries, are not clear)

– Lasts 5-7 days, designed to create enough time to file a Temporary Restraining Order (TRO)

• Restrictions– Restrict the batterer from going near the home or

workplace, daycare or schools of children, communicating with survivor

– Move out order – require the batterer to move out of a shared home

– Give temporary custody of children to survivor or specify visitation

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Physical Safety - Restraining Orders

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Physical Safety - Restraining Orders• Temporary Restraining Order (TRO)

– For recent abuse – Filed with the court (legal aid has clinics that can assist, there are also

self-help centers at the court house)– Must be enacted within 2 days of filing– Batterer must be served papers – no cost to survivor

• This can be a problem if he’s deported or absconds, case can’t move forward• If he shows up at residence police can be called and serve order

– Lasts up to three weeks, until a hearing for a permanent order– If issued, judge will generally follow survivor’s wishes for

custody/visitation (can request no contact, supervised visitation, etc.)• Restrictions on batterer:

– Continues protections of EPO (home, work, custody), and:– Requires batterer to turn over firearms within 48 hours– Gives the survivor control of a shared vehicle– Give control of pets to survivor– Requires batterer to pay certain debts, prohibits the selling or transfer

of specific property

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Physical Safety - Restraining Orders• Permanent Restraining Order

– Decided at a hearing around 20 days following the TRO– If batterer doesn’t show and has been served, case will proceed

without him, if survivor doesn’t show, TRO will be terminated.– Generally done without lawyers, legal aid will be present in

court if needed– Does not address divorce, child support, or community

property, must be addressed in family court

• Custody/Visitation:– If family already has an open Family Court case, will send them

to mediation/family court judge for resolution– If no family court case, the judge will generally decide

custody/visitation at the hearing– If the batterer has a criminal case pending, will usually continue

the TRO until the resolution of the criminal case (if a criminal restraining order is issued, it won’t address custody).

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Custody• Generally, it’s easier for the survivor to secure

custody through the TRO process, following recent abuse than later through the family court– DV counts strongly against custody/visitation

• Can set up supervision, safe drop-off/pickup, etc.

• Batterer can always come back to family court later and attempt to regain some time or visitation

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Physical Safety Following Separation

• 33%-50% of all lethal DV occurs while leaving or separated, the first three months are the highest risk period(Dobash et. Al.

• Change locks or install extra security• Get caller ID, require callers to show ID, screen calls• Keep doors/windows locked and shut (create barriers

that allow time to call 911)• If in rural area, keep gas tank half-full• Inform daycare/school, work, provide copies of the

order and photo if available• Be aware of routines, try to change them• Try to structure life to avoid areas where batterer may

be (change banks, etc.)• Carry a copy of the restraining order, and custody order

at all times

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Physical Safety Following Separation

• If it’s a felony case, can request that the Department of Corrections Office of Victim & Survivor Rights and Services notify of release• Must be made in writing (CDCR Form 1707), can be obtained from

Victim-Witness

• If property needs to be retrieved, request a civil standby• Can be requested by anyone, a restraining order isn’t required• Bring a copy of the TRO if is specifies control of property• Police will accompany survivor to home to allow her to get items• Will only stay for about 15 minutes• If the other party objects to her taking any items that are not clearly

hers, the police will not allow them to be taken– Best to take important items when initially separating

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Financial Security• If unmarried, she has rights to all property/money belonging to

her• If married, everything is community property from marriage date

– When leaving, take what is needed to survive, but keep track of where it goes, in marital dissolution he’s entitled to half

• Secure and store extra copies of ATM cards, credit cards, banking information

• Create new bank account with only survivors name, develop funding– Can use automatic withdrawal from paycheck to begin to funnel money into new

account– May be able to keep from credit rpt. (if not married, he has no access)– Can also potentially use a trusted family member to be account holder

• Develop a plan for addressing basic needs such as food, clothing, utilities, shelter– Be aware of support services– Identify people that they may be able to ask for financial or practical assistance

• Restraining orders can specify control of home, care, certain property

• Housing support available through DVS, St. Vincent’s, VW will help pay for relocation

• Restraining orders may specify custody, but she will have to file separately for child support

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Reducing further violence• What works?

– Arrest

– A small effect size, past arrest, is cognitive behavioral therapy/group treatment (26 court ordered weeks is the standard)

– Generally, following program participation, 60% do not re-offend according to spousal report and arrest records up to 5 years later

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ReferencesBabcock, J., Green, C., Robie, C. (2004) Does batterers' treatment work? A

meta-analytic review of domestic violence treatment. Clinical Psychology Rev. 2004 Jan;23(8):1023-53.

Gottman, J. M., Jacobson, N. S., Rushe, R. H., Shortt, J. W., Babcock, J., La Taillade, J. J., & Waltz, J. (1995). The relationship between heart rate reactivity, emotionally aggressive behavior, and general violence in batterers. Journal of Family Psychology, 9(3), 227-248.

Fonagy, P. (1999). Male perpetrators of violence against women: An attachment theory perspective. Journal of Applied Psychoanalytic Studies, 1, 7-27

Holtzworth-Munroe, A.; Stuart, G.; (1994). Typologies of male batterers: three subtypes and the difference between them. Psychological Bulletin, Vol 116 (3): 476-497

Holtzworth-Munroe, A; Bates, L.; Smutzler, N.; Sandin, E. (1997) A brief review of the research on husband violence: Part I: Maritally Violent Versus Nonviolent Men. Aggression and Violent Behavior, A Review Journal Vol 2 (1) Spr: 65-99

Holtzworth-Munroe, A; Bates, L.; Smutzler, N.; Sandin, E. (1997) A brief review of the research on husband violence: Part III: Sociodemographic Factors, Relationship Factors, and Differing Consequences of Husband and Wife Violence. Aggression and Violent Behavior, A Review Journal Vol 2 (1) Autumn: 285-307

Roehl, J. ; O’Sullivan, C.; Webster, D.; Campbell, J. (2005) Intimate Partner Violence Risk Assessment Validation Study, Final Report. National Institute of Justice.