Risk Assessment

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Risk Assessment

• Presented by
• Dr. Edward K.L. Chan
• The University of Hong Kong

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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?

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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

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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.

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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 )

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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.

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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?

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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?

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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.h
  tm
• Chinese version By Dr. Edward K.L. Chan

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4. Assessment on risk factors

• Risk factors or risk markers refer to
  characteristics associated with an increased
  likelihood that a problem behavior will occur

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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

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• (Schafer, 2004 )
• impulsivity, alcohol problems, and childhood
  physical abuse

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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

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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)

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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. ????????,????????????????,???????)

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The Personal and Relationships Profile
http//pubpages.unh.edu/mas2/prp.htm
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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

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Homicide Risk factors

• Preincident risk factors that increase the risk
  of intimate partner femicide perpetrators
  access to a gun, previous threat with a weapon,
  perpetrators stepchild in the home, and
  estrangement.
• Incident factors victim having left for another
  partner, perpetrators use of a gun, stalking,
  forced sex, and abuse during pregnancy.
  (Campbell, 2003)

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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.

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• 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 )

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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 )

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Homicide-suicides

• depression
• male gender
• relationship discord
• physical abuse
• frequent separations and reunions
• abuse alcohol
• history of violent behavior
• personality disorder
• (Rosenbaum, 1990)

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Overkill

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

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Homicide risk factors (Aldridge, 2003 )

• 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

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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.

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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

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• 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

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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

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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)

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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 victims perceptions

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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, dont leave face to
  face with perpetrator
• Be alert for depressed/suicidal batterer

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About you!

• Can you predict risk?
• Field developing rapidly update literature
• As supervisor, read even more!

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Never forget who its for -

• please dont let her death be for nothing
  please get her story told
• (one of the Moms)