Download Risk Assessment

Risk Assessment
• Presented by:
• Dr. Edward K.L. Chan
• The University of Hong Kong
Basic issues:
• violence is crime
• violence ≠ conflict
• Safety and victim protection comes upmost, than to
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preserve the harmony/wholeness of the family
Perpetrator should hold sole responsibility for the use
of violence
“Duty to protect” identifiable or nonidentifiable victims
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• When & how to assess what?
Definition of risk/
dangerousness:
• harm: the amount and type of violence being
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predicted
risk factor: the variables that used to predict
violence
risk level: the probability that harm will occur
– Not stable: fluctuating level of risk that varies with
time, symptoms and situations
– Ongoing assessment, rather than one-time prediction
Prediction:
• Clinical judgment approach
– Informal, subjective and impressionistic
– Subjective judgment: contaminated by cultural belief, attitude
towards violence and women, knowledge and training,
consideration of contextual factors – inexact science
• Actuarial risk assessment
– computations of probability
– Actuarial risk, about probability – can avoid subjectivity
• Model: first actuarial, second professional judgment
• “Structured professional judgment” : risk assessment
conducted according to guidelines that are on scientific
and empirical basis.
Definition of risk assessment:
• Risk assessment is the process of identifying and
studying hazards to reduce the probability of
their occurrence. (Boer, 1997)
• “the process of evaluating individuals to (1)
characterize the risk that they will commit
violence in the future, and (2) develop
interventions to manage or reduce that risk.”
(Monahan, 1994 )
Risk assessments should:
• (1) consider risk factors supported in the
literature,
• (2) employ multiple sources of information,
• (3) be victim-informed
• (4) risk assessments can be improved by
using tools and/or guidelines, and
• (5) should lead to risk management.
Scopes of risk assessment:
1. Assessment of immediate danger
• Partner Violence Screen (Feldhaus & al, 1997)
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Screening for battered women in Emergency
Department by 3 questions:
Physical violence -- "Have you been hit, kicked,
punched, or otherwise hurt by someone within
the past year? If so, by whom?
Safety -- "Do you feel safe in your current
relationship?
"Is there a partner from a previous relationship
who is making you feel unsafe now?
2. Assessment on safety
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Immediate safety from batterer:
Where is he now?
When did they last have contact? What happens?
If there was abuse, does she need medical or
legal help?
When will she next see him?
Does she have ideas about what will happen?
3. Assessment on harm
(violence, suicide, homicide)
• Short form: “Abuse Assessment Screen”
– How were you hurt?
– Was a weapon involved? What kind?
• Detail form: CTS2 Scale
– Eng. version:
http://pubpages.unh.edu/~mas2/ctsb.htm –
– Chinese version: By Dr. Edward K.L. Chan
4. Assessment on risk factors
• Risk factors or risk markers refer to
characteristics associated with an
increased likelihood that a problem
behavior will occur
Intimate partner violence
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Hotaling and Sugarman (1986) :
Sexual aggression toward the wife
Violence toward the children
Witnessing parental violence as a child or teen
Occupational status, especially working class
Excessive alcohol usage
Low income
Low assertiveness
Low educational level
• (Schafer, 2004 ) :
• impulsivity, alcohol problems, and
childhood physical abuse
Violence by persons with mental
disorder:
• (Monahan et al, 2001)
• 1. Criminological risk factors
– a. Prior violence and criminality
– b. Childhood experience
– C. Neighborhood
• 2. Clinical risk factors
– a.
– b.
– c.
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Psychopathy
Command hallucinations to be violent
Violent thoughts
Anger
Risk factors in Chinese societies
• Patriarchal authority and oppression of
women (Liu, 1999b; Xu, 1997)
• Social isolation (Liu, 1999a)
• Traditional gender role expectations
(Wang, 1999)
• Attitudes towards wife/ violence, face
(Chan, 2000)
Cultural risk factors to be
investigated in HK:
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Face
In-law conflict
Filial Piety
Cultural Beliefs
– Non-intervening attitude
• (e.g. 清官難審家庭事。我認為家庭暴力屬於刑事罪。寧教人
打仔，莫教人分妻。)
– Blaming victim
• (e.g. 孩子不打不成器。妻子被丈夫打，雙方都有責任。要郁
手，女人先至會收聲。)
– Harmony
• (e.g. 就算發生家庭暴力，亦要維繫家庭完整性。萬事以和為
貴，應該儘量忍耐。)
The Personal and Relationships Profile
http://pubpages.unh.edu/~mas2/prp.htm
Intrapsychic
Interpersonal
1. Antisocial
1.Communication quality
2. Borderline
2.Dominance
3.Depression
3.Intimidation of partner
4.Gender hostility
4.Jealousy
5.Neglect
5.Relationship discord
6.Substance abuse
6.Relationship commitment
7.Violence approval
7.Social integration
8.Violent socialization
8.Social isolation
Factors associated with a man’s risk for abusing his partner (WHO, 2002)
Individual
factors
Young age
Heavy drinking
Depression
Personality
disorders
Low academic
achievement
Low income
Witnessing or
experiencing
violence as a
child
Relationship
factors
Marital conflict
Marital
instability
Male dominance
in the family
Economic stress
Poor family
functioning
Community
factors
Weak
community
sanctions
against
domestic
violence
Poverty
Low social
capital
Societal factors
Traditional
gender norms
Social norms
supportive of
violence
Risk factors of spousal and child
abuse: Family Needs Screener
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Pregnancy
Stress
Relationship Discord
Support
Substance Abuse
Violence Approval
Family of origin Violence and Neglect
Self Esteem
Depression
Prior Family Violence
Homicide: Risk factors
• Preincident risk factors that increase the
risk of intimate partner femicide:
perpetrator’s access to a gun, previous
threat with a weapon, perpetrator’s
stepchild in the home, and estrangement.
• Incident factors: victim having left for
another partner, perpetrator’s use of a gun,
stalking, forced sex, and abuse during
pregnancy. (Campbell, 2003)
Female-perpetrated intimate partner
femicide: Risk assessment (Glass, 2004)
• prior physical violence
• controlling behavior
• jealousy
• alcohol and drugs
• attempt to end the relationship or
estrangement from the perpetrator
• Suicide threat or attempt by the
perpetrator or the victim.
• Abuse during pregnancy:
– Risk factors included unplanned pregnancy
and women with husbands/partners who were
unemployed or manual workers (Leung, 1999)
• Homicide Risk Factors Among Pregnant
Women Abused by Their Partners
– women left their relationships after becoming
pregnant, at higher risk for homicide prior to
pregnancy than the women who remained
with their abusers. (Decker, 2004 )
Homicide: Estrangement
• Estrangement – refers to a process in
which one or both partners become
alienated from each other.
• Separation (emotional/affective and
physical) is usually associated with
estrangement and is often an indicator of
it. (Ellis, 1997 )
Homicide-suicides
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depression
male gender
relationship discord
physical abuse
frequent separations and reunions
abuse alcohol
history of violent behavior
personality disorder
(Rosenbaum, 1990)
Overkill
• Using lengthy and excessive violence far
beyond what would have been necessary
to cause death.
• Risk factors: rage and/or revenge
(Aldridge, 2003 )
Homicide: risk factors
(Aldridge, 2003 )
• Witness of family violence and/or victim of
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family violence
Cohabiting
Large age disparity
Drug and alcohol abuse
Sexual jealousy
Separation/threat of separation
Stalking
Personality disorder
Previous domestic violence
About the perpetrators of
homicide:
• “Just an Ordinary Guy” (Dobash, 2004 )
• Using a subset of case files from this study, men
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who murder other men (MM; n = 424) are
compared with men who murder an intimate
partner (IP; n = 106) to reflect on the relative
conventionality of each group.
IP appears to be more “ordinary” or
“conventional.”
IP group is more likely to have intimate
relationships that had broken down, to have
used violence against a previous woman partner
as well as against the victim they killed, and to
“specialize” in violence against women.
Data collection for risk assessment:
• Use of multiple methods:
• Interview with victim: One-to-one
interview without abusive partner
• Interview with perpetrator
• Interview with children
• behavioral observations
• review of case records (medical, legal, social
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investigation)
all relevant documents, past and current:
criminal records, medical records – transferal of
records, reasonable available – set guidelines
that all referral/discharge summary has to
record the assessment of violence risk for those
cases/patients who had reported involving in the
violence/injury/suicide/homicide ideation events.
psychological tests
medical examinations
Important notes:
• Multiple sources of information:
– Validation & Triangulation
• Risk assessment should be repeated at regular
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intervals
Getting a second opinion:
- training of supervisor and the building of a
team
Case conference: MDCC
Documentation
Risk management:
• Incapacitation, or negating the opportunity for
violence (e.g. hospitalization)
• Target hardening, or warning the potential
victim
• Intensified treatment, (e.g. frequent
treatment sessions, medication)
SARA items
Management
1. Past assault of family members
2. Past assault of strangers or
acquaintances
3. Past violation of conditional
release or community supervision
15. Past violation of ‘‘no contact’’
orders
20. Violation of ‘‘no contact’’ order
(most recent incident)
- Intensive supervision monitoring
10. Personality disorder with anger,
impulsivity, or behavioral instability
16. Extreme minimization or denial
of spousal assault history
17. Attitudes that support or
condone spousal assault
-Intensive supervision
-Long-term individual therapy
-Group treatment
-Psycho-education
SARA items
Management
4. Recent relationship problems -Interpersonal treatment – group or
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Recent
employment individual
problems
-Legal advice or dispute resolution
-Vocational counseling
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Recent
abuse/dependence
substance -Court-ordered abstinence, urine screen
-Alcohol/drug treatment
8. Recent suicidal or homicidal
ideation/intent
9. Recent psychotic and/or
manic symptoms
-Crisis counseling
-Hospitalization
-Psychotropic medication
-Court-ordered weapons restrictions
General principles for risk assessment
• The more sources of information the better
• Perpetrators will minimize perpetration
• Actuarial methods provide independent
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assessment
Instrument improves clinical – but clinician
wisdom also plays important role
Never underestimate victim’s perceptions
Implications for Policy & Safety Planning
• Clinical assessment (psychiatry, psychology)
needs specific DV training
• Batterer intervention – victims protection
• Injunction order for stalking – No stalking
law now!
• If victim is going to leave, don’t leave face
to face with perpetrator
• Be alert for depressed/suicidal batterer
About you!
• Can you predict risk?
• Field developing rapidly – update literature
• As supervisor, read even more!
Never forget who it’s for “please don’t let her death be for
nothing – please get her story told”
(one of the Moms)