Danger Assessment Instrument Essay ⋆ Criminal Justice Essay Examples ⋆ EssayEmpire

The Danger Assessment (DA) instrument is designed to assess the likelihood of lethality or near lethality occurring in a case of intimate partner violence (IPV). The most important risk factor for intimate partner homicide (IPH) is prior domestic violence. Even though abused women are fairly good assessors of their own risk of reassault, they often underestimate the risk of homicide. In a major multi-city case control study of intimate partner femicide (IPF), only about half (46%) of victims accurately predicted that her husband, boyfriend, or ex-partner was capable of killing her.

Original Development

The DA was developed in consultation on item wording and content validity from battered women, advocates, law enforcement officials, and other clinical experts on battering. The initial DA items were developed from Jacqueline C. Campbell’s research reviewing police IPH records as well as reviews of other studies of IPH or serious injury from IPV.

The DA first assesses severity and frequency of battering by asking an abused woman to mark on a calendar the approximate days when physically abusive incidents occurred, ranking their severity on a scale of 1 to 5. Using a calendar increases accurate recall in general and the DA calendar helps raise the woman’s consciousness and reduce the normal minimization of IPV. In one study, 38% of 97 abused women initially reporting no increase in severity and frequency of violence in the past year changed their response to “yes” after filling out the calendar portion.

The second part of the original DA was a 15-item yes/no dichotomous response format of risk factors associated with IPH. Both portions of the DA take approximately 20 minutes to complete. The woman can complete the DA by herself or with professionals from the health care, criminal justice, or victim advocate systems. The original DA was scored by counting the “yes” responses, with more “yeses” indicating more danger.

The original DA has published psychometric support in eight studies with internal consistency acceptable (.70–.80) and two studies of test-retest reliability of 0.89 and 0.94. Discriminant group validity was supported by significant differences in DA mean scores among contrasting groups of women, the lowest among nonabused women and the highest in women in the emergency department. Convergent construct validity was supported with moderate to strong correlations between the DA and validated instruments (e.g., Conflict Tactics Scales) measuring severity and frequency of IPV. All of the studies testing the DA have had substantial proportions (33% to 77%) of women of color, primarily African American and Hispanic, with psychometric properties at least as strong among minority ethnicity women. Additionally, three independent predictive validity studies in the United States and one in Taiwan were published that at least partially support the DA’s ability to predict IPV reassault.

Revision

The most important validation is based on data from the 11-city case-control study designed to identify risk factors for IPF and to test the DA. Consecutive police or medical examiner records of IPF from 1994 to 2000 were examined for victim–perpetrator relationship. Cases were eligible if they involved a victim aged 18 or older, a current or ex-intimate partner perpetrator, and were designated as “closed” by the police. Records were abstracted for data specific to the homicide and for potential proxy informants (i.e., mother, sister, brother, or friend) knowledgeable about the victim’s relationship with the perpetrator. A knowledgeable proxy was located in 68% (373 out of 545) of the cases, and 83% (310 out of 373) agreed to participate.

A sample of 194 attempted femicides was identified through district attorneys, law enforcement, community domestic violence advocacy, or trauma centers in each city. Attempted femicide was defined as nonfatal gunshot or stab wound to the head, neck, or torso; strangulation or near drowning with loss of consciousness; or severe injuries inflicted that easily could have led to death of a female current or former IP of the perpetrator. The attempted femicide cases allowed direct interviews with victims rather than proxies, but yielded lower location rates (56%), since many women had moved from the attempted murder site. Once located, 90% of the attempted femicide victims (n = 215) agreed to participate (n = 194).

The control group of abused women was identified by stratified random-digit dialing for Englishand Spanish-speaking women ages 18 to 50 years involved “romantically or sexually” in a relationship during the past 2 years in the same 11 cities. A total of 3,637 (76.6%) women of 4,746 meeting inclusion criteria consented to participate. Four hundred twenty-seven (8.5%) had been physically abused or threatened with a weapon by a current or recent intimate partner in the past 2 years, but never seriously enough to qualify as an attempted femicide.

The interview for all participants included the DA along with demographic and relationship characteristics including type, frequency, and severity of any violence, psychological abuse, and harassment. Safety protocols were carefully followed.

Victims and perpetrators of femicides and attempted femicides were similar in social and demographic characteristics except for a larger proportion of African American perpetrators of attempted femicides (64.1% vs. 48.9%). In multivariate analysis, the only significant demographic difference between the femicide and attempted femicide cases and the abused controls was more unemployment among the more lethal perpetrators.

The DA was revised based on the findings by adding four items—abuser unemployment, a child of the victim not the offspring of the abusive partner, abuser stalking, and the victim leaving her abuser— plus rewording of the child abuse item to read “Does he threaten to harm your children?” and the division of “threaten to kill you” and “perceive him as capable of killing you” into two items to separately assess victim perception. An item on the “prior arrest of the abusive partner for IPV” was substituted for one on the abuser “being violent outside of the home,” since arrest for IPV was more predictive in the multivariate analysis. With these revisions, there is a total of 20 items.

Validation Of Revised 20-Item DA

The adjusted odds ratios from the multivariate analyses of the femicide cases in comparison to the controls (abused women) were used to develop a weighted scoring algorithm identifying four levels of danger. The levels of danger and DA scores are (1) variable danger (0–7), (2) increased danger (8–13), (3) severe danger (14–17), and (4) extreme danger (18+). The language used to label the levels of danger was chosen in consultation with survivors and advocates for its meaning to abused women and to convey that even at the lowest level (variable danger), the risk of lethal violence is never negligible and can change quickly.

In a comparison of the mean scores on the revised 20-item DA of the three study groups, it was found that the femicides and attempted femicides had similar mean and median scores on the revised DA, which were more than twice as high as that of the abused control group (p < .001).

The ability of the revised DA to correctly identify the attempted femicide cases, an independent sample, was tested through plots of receiver operating characteristic (ROC) curves. ROC curves represent the sensitivity and specificity of a measure at each successive unit. Estimates of the area under the ROC curve (AUC) are compared to the average value under random prediction methods (.500).

The AUC for the ROC curve comparing attempted femicides to the abused controls was .916 (p < .001; 95% CI .892 to .941). Sensitivity of the revised DA for identifying attempted femicides ranged from .545 for the extreme danger level to .987 if increased danger is used to designate high-risk status. The sum of sensitivity and specificity is maximized if the severe danger level is the threshold for high-risk designation (sensitivity = .750; specificity = .863). Sensitivity and specificity were acceptable with higher values for the revised DA than victim perception of risk of lethal or near lethal violence (sensitivity = .622; specificity = .770).

Future Directions

Although limited by restrictions of an urban sample and retrospective data, the ROC curve analysis is strongly supportive of the predictive accuracy of the revised DA, far better than the .70 AUC considered acceptable in risk assessment instruments. Further testing of the DA is needed, especially independent evaluations, prospective studies, and meta-analyses, as with all of the current IPV risk assessment strategies. The DA also needs to be psychometrically evaluated with various ethnic groups and rural and immigrant populations for cultural and linguistic appropriateness. The DA is only the first step in a process of safety planning or “risk management.” Protocols addressing issues such as confidentiality and communication of results and training for assessors need to be developed in each system where it is used. The science in the field is as yet young, but supports the use of the DA with IPV victims as they make important decisions about their safety in collaboration with domestic violence advocates, health care professionals, and/or criminal justice practitioners—with both practitioner expertise and the woman’s perception of risk taken into account. The DA can help women come to a more realistic appraisal of their risk as well as improve the predictive accuracy of those who are trying to help them.

Bibliography:

Block, C. R. (2003). How can practitioners help an abused woman lower her risk of death? NIJ Journal, 250, 5–7.
Campbell, J. C. (2002). Safety planning based on lethality assessment for partners of batterers in treatment. Journal of Aggression, Maltreatment, and Trauma, 5(2), 129–143.
Campbell, J. C. (2004). Helping women understand their risk in situations of intimate partner violence. Journal of Interpersonal Violence, 19(12), 1464–1477.
Campbell, J. C. (2005). Assessing dangerousness in domestic violence cases: History, challenges, and opportunities. Criminology and Public Policy, 4, 653–672.
Campbell, J. C. (2007). Assessing dangerousness: Violence by batterers and child abusers. New York: Springer.
Dutton, D. G., & Kropp, P. R. (2000). A review of domestic violence risk instruments. Trauma, Violence & Abuse, 1, 171–181.
Heckert, D. A., & Gondolf, E. W. (2004). Battered women’s perceptions of risk versus risk factors and instruments in predicting repeat reassault. Journal of Interpersonal Violence, 19, 778–800.
Weisz, A., Tolman, R., & Saunders, D. G. (2000). Assessing the risk of severe domestic violence. Journal of Interpersonal Violence, 15(1), 75–90.

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