Risk Assessment

1. Risk Assessment Presented by: Dr. Edward K.L. Chan The University of Hong Kong

2. Basic issues: violence is crime violence ? conflict Safety and victim protection comes upmost, than to preserve the harmony/wholeness of the family Perpetrator should hold sole responsibility for the use of violence “Duty to protect” identifiable or nonidentifiable victims When & how to assess what?

3. Definition of risk/ dangerousness: harm: the amount and type of violence being 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

4. 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.

5. 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 )

6. 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.

7. Scopes of risk assessment: 1. Assessment of immediate danger Partner Violence Screen (Feldhaus & al, 1997) 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?

8. 2. Assessment on safety  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?

9. 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

10. 4. Assessment on risk factors Risk factors or risk markers refer to characteristics associated with an increased likelihood that a problem behavior will occur

11. Intimate partner violence  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

12. (Schafer, 2004 ) : impulsivity, alcohol problems, and childhood physical abuse

13. 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. Psychopathy b. Command hallucinations to be violent c. Violent thoughts d. Anger

14. 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)

15. Cultural risk factors to be investigated in HK: Face In-law conflict Filial Piety Cultural Beliefs Non-intervening attitude (e.g. ??????????????????????????,??????) Blaming victim (e.g. ??????????????,??????????,????????) Harmony (e.g. ????????,????????????????,???????)

18. Risk factors of spousal and child abuse: Family Needs Screener Pregnancy Stress Relationship Discord Support Substance Abuse Violence Approval Family of origin Violence and Neglect Self Esteem Depression Prior Family Violence

19. 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)

20. 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.

21. 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 )

22. 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 )

23. Homicide-suicides depression male gender relationship discord physical abuse frequent separations and reunions abuse alcohol history of violent behavior personality disorder (Rosenbaum, 1990)

24. Overkill Using lengthy and excessive violence far beyond what would have been necessary to cause death. Risk factors: rage and/or revenge (Aldridge, 2003 )

25. Witness of family violence and/or victim of family violence Cohabiting Large age disparity Drug and alcohol abuse Sexual jealousy Separation/threat of separation Stalking Personality disorder Previous domestic violence

26. About the perpetrators of homicide: “Just an Ordinary Guy” (Dobash, 2004 ) Using a subset of case files from this study, men 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.

27. 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

28. behavioral observations review of case records (medical, legal, social 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

29. Important notes: Multiple sources of information: Validation & Triangulation Risk assessment should be repeated at regular intervals Getting a second opinion: - training of supervisor and the building of a team Case conference: MDCC Documentation

30. 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)

33. General principles for risk assessment The more sources of information the better Perpetrators will minimize perpetration Actuarial methods provide independent assessment Instrument improves clinical – but clinician wisdom also plays important role Never underestimate victim’s perceptions

34. 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

35. About you! Can you predict risk? Field developing rapidly – update literature As supervisor, read even more!

36. Never forget who it’s for - “please don’t let her death be for nothing – please get her story told” (one of the Moms)