The learning objectives of this module are to become familiar with the domestic violence risk and vulnerability factors and to understand why all the professionals should have basic knowledge regarding the risk identification
Risk assessment is a process, that begins with identifying the presence of risk factors and determining the likelihood of an adverse event occurring, its consequences and its timing (Australian Institute of Health and Welfare 2010; Braaf & Sneddon 2007).
This is Nora. She will be our guide in demonstrating the steps of risk assessment.
Read first about Nora’s case and then learn more about risk identification.
Nora is a 34-year-old woman with an immigrant background. She has lived here in your country for three years with her parents and sisters. Nora married Peter two years ago. Peter is the son of a family friend of Nora’s parents. Nora’s family comes from a patriarchal culture where the community comes before the individual.
Nora’s marriage with Peter was a relief for Nora’s family since in their culture a woman at Nora’s age should not be single. However, quite soon after Nora and Peter got married, Peter started to control her everyday behaviour. Peter does not let Nora see her friends or go anywhere without him. A mandatory language course is the only place where Nora can go alone.
Peter takes away Nora’s debit card and takes loans under her name. When Nora tries to resist, Peter turns violent and abuses her. Peter threatens to send Nora back to her home country.
Nora discloses the situation to her parents, asking for help. First, the parents take Peter’s violent behaviour seriously, but suddenly Nora’s father passes away. Nora’s grieving mother is not capable of standing against Peter’s will on her own.
At the same time, Peter spreads rumours about Nora’s immorality in order to justify the claims of his violent actions to their community. The rumours humiliate Nora’s family. The community pressures Nora’s mother and her sisters’ families to clear their name.
Nora’s mother begs Nora to stay with Peter to calm the situation and her sisters ask her not to bother their mother with the issue any more. Nora feels that she is responsible for the violence and her family’s reputation, and accepts that divorcing Peter is out of the question.
Over time, the violence gets more serious and more frequent. On one occasion, Peter strangles Nora for so long that she loses consciousness. After the strangulation, she starts to have speech impairment issues especially in stressful situations. Nora feels isolated, helpless and depressed.
Peter has threatened to share some private pictures of Nora in public if Nora ‘ruins his reputations as a husband’, as he puts it. Nora feels anxious since she cannot talk to anyone – even her family – about her feelings.
This was the story of Nora. Take one minute to think of the following questions:
(1) Which acts, situations or conditions endanger Nora?
(2) Which situations described in the story you consider unfortunate but not your business as a frontline responder?
There may be some risk factors that do not concern your profession. However, identifying and documenting these risk factors is important in order to have a comprehensive understanding of the sources of risks. This is needed in the phase of risk management.
Now, read more about the identification and documentation of risk factors.
Risk factors to identify
Critical domestic violence risk factors
Key point: There may be some risk factors that do not concern your profession. However, identifying and documenting these risk factors is important in order to have a comprehensive understanding of the sources of risks. This is needed in the phase of risk management.
Several factors may indicate escalation of domestic violence. Every frontline responder should have sufficient training and knowledge to be able to identify these critical risk factors. By every frontline responder, we mean uniformed police officers, crime detectives, social workers, nurses, doctors, educators or NGO workers.
In the table below, we present the critical risk factors and their explanations.
|Previous physical violence||Previous physical violence is the best predictor for future violence|
|Violence is occurring more frequently or violence is more intensive (harmful, injurious)||Escalation over time is characteristic of some violent relationships, particularly where the offender is persistent and engages in serious behaviours. Note that not all the violent incidents are reported to the frontline responders, thus it is possible that assessments made by victim–survivors better account for all acts of violence including both non-physical behaviours and coercive control. (Boxall & Lawler 2021)|
|Coercive control||Coercive control is a pattern of behaviour that intimidates and frightens the victim.|
|Extreme jealousy and obsessive thinking are risk factors for domestic violence. Severe jealousy can be a crucial risk factor. Severe cases of jealousy may also meet the diagnostic criteria for delusional disorder. Jealousy in intimate relationships should therefore be assessed as a part of psychiatric evaluation. (Koskelainen & Stenberg 2020.)|
|Victim has left for another partner||Victim leaving an abusive partner for another partner poses a significant risk factor for femicide (Campbell et al. 2003)*.|
|Perpetrator’s stepchild in the home||Having a child living in the home who is not the abusive partner’s biological child more than doubles the risk of femicide (Campbell et al. 2003)*.|
|Strangulation||Strangulation in the context of domestic violence is a ‘red flag’ risk factor for future serious harm and death (Douglas & Fitzgerald 2014.) Prior non-fatal strangulation increases the risk of attempted homicide by over six times and a completed homicide by more than seven times (Glass et al. 2008).|
|Victim-survivor is trying to divorce/separate or has divorced/separated||The risk of intimate partner femicide was increased 9-fold by the combination of a highly controlling abuser and the couple’s separation after living together (Campbell et al. 2003)*.|
|Mental health issues of perpetrator||There is significant relationship between anger problems, anxiety, depression, suicidal behaviour, personality disorders, alcoholism or problem gambling and perpetration of domestic violence (Sesar et al. 2018)|
|Substance abuse issues of perpetrator/victim-survivor |
Perpetrator’s access to a firearm
|Both abuser’s access to a firearm and abuser’s use of illicit drugs are strongly associated with intimate partner femicide. Neither alcohol abuse nor drug use by the victim was independently associated with her risk of being killed (Campbell et al. 2003)*. However, substance abuse issue of a victim-survivors may prevent them from seeking or receiving help as they may not be considered as ‘ideal victims’ (see Christie 1986).|
|Social isolation||Social isolation has been linked to the risk of being abused (Farris & Fenaughty 2009). Social isolation may also be a consequence of abuser’s controlling behaviour.|
|Negative life changes of the perpetrator and economic stress||Such as unemployment or bankruptcy. Economic stress may increase the risk of domestic violence but domestic violence may also cause financial problems for victims and entrap them in poverty and an abusive relationship (Renzetti 2009).|
|Other forms of domestic abuse||Including e.g. economic, sexual, psychological, chemical and digital violence, negligence, forced marriage, FGM and human trafficking.|
|Victim-survivor is pregnant or has a baby||Abuse during pregnancy is a significant risk factor for future femicide (Campbell et al. 2003).|
|Violence towards pets||There is a correlation between cruelty to animals and family and domestic violence. Abuse or threats of abuse against pets may be used by perpetrators to control and intimidate family members.|
|Threatening to kill||In intimate partnerships, threats to kill are often genuine.|
Risk related information to check by each professional
Key agencies should work to a shared understanding of risk, but the nature of their work may mean that they will be able to identify different risk factors. The perspective of a police officer differs from the perspective of a social worker. In the table below, we present the risk factors that relate to different professionals’ perspectives.
|POLICE||SOCIAL WORK/EDUCATION||HEALTH CARE|
|The perpetrator has access to firearms||The victim is not allowed to meet a social worker alone||The victim has symptoms of strangulation|
|The perpetrator has used a weapon in the most recent event.||Signs of substance or non-substance addictive behavior including co-addiction (by partners or family members).||The victim is not allowed to see the nurse/doctor alone or the victim seems fearful.|
|The perpetrator has previous criminal record entries, especially records of violent crimes.||Signs of conflict behavior that may lead to potential escalation of conflict.||There are prior (partly healed) injuries on victim caused by trauma.|
|The perpetrator has previously violated a restraining order.||The perpetrator is experiencing high levels of stress.||Victim’s or/and perpetrator’s depression or the symptoms of PTSD of victim.|
|More than three house-calls to the same address within one year.||Victim’s or perpetrator’s suicide attempts.|
Victim’s vulnerability factors
Key point: Identification of victim’s vulnerability factors helps professionals to invite the relevant key agencies in the cooperation, to support the victim in a holistic manner, and to strengthen the victim’s capacity to follow the security strategies.
Victim’s vulnerability factors relate to the victim’s person and life circumstances. They may relate, e.g. to the capacity to trust public authorities, leave the abuser, or the dependency on the abuser. However, these are not reasons why the abuse happens. Perpetrators may choose to exploit vulnerabilities of victims; some victims’ life experiences and circumstances may make it more difficult to survive or escape abuse. Below we have listed the vulnerability factors and explained why and how these factors may affect the victim’s resources and life situations as well as the ability to cooperate with the professionals.
- A victim may be dependent on a violent family member or the victim may be the only responsible caregiver for a violent family member. Thus, leaving a violent family member may not be an option for the victim. Victim may already be socially isolated.
- Leaving may require moving to a new address and securing the contact information.
- A perpetrator may have experienced caregiver burnout.
- An elderly person may experience overwhelming shame for the situation especially if the perpetrator is an adult child.
- Abuse can occur in many forms, such as physical, sexual, emotional, or financial abuse, negligence, isolation and abandonment. Note also signs of depriving of dignity (e.g. untidy appearance, soiled clothes) or choice over daily affairs, signs of insufficient care (e.g. pressure sores) or over- or under-medicating (WHO 2020).
- Minors are nearly always dependent on the perpetrators.
- Growing up in a hostile environment normalizes the experiences of violence and thus the victims may not perceive their experiences as violence.
- Minors may think their experiences are not believed by the outsiders.
- The patterns of coercive control, such as restriction, isolation and a deprivation of personal freedom may be difficult to discriminate from parental upbringing and protective measures
Note: In some immigrant or otherwise socially or religiously strongly controlled families, differences between cultural values, lifestyles and views may inflict conflicts between the minors and their parents. Authorities’ non-diplomatic contacts or rash measures may increase the risk that the parents send the child to their native countries to boarding schools or to be raised by relatives. This may increase the risk for FGM, child-marriage as well as breaks in education, social relations and integration.
- Disabled persons may be functionally dependent on the perpetrator in everyday life, needing assistance in moving, eating, communicating, medicating
- The violent family members or caregivers may experience caregiver burnout
- Victim-survivors may have difficulties to make themselves heard, understood or believed
The perpetrator may explain injuries as accidents caused by dyskinesia.
Dependency on perpetrator
There are several forms of dependency such as financial and emotional dependency. Also structural reasons such as hierarchical gender relations or rural disparity contribute to dependencies; for instance, when compared to urban women, rural women experience higher rates of DV yet live farther away from available resources (Peek-Asa et al. 2011).
Rates of mental health disorders, such as anxiety disorders, PTSD and depression are higher among refugee populations in comparison to the general population. This increased vulnerability is linked to experiences prior to migration, such as war exposure and trauma. (Hameed et al. 2018.) In addition, language barriers or negative experiences of police and distrust towards authorities may prevent the victims from seeking help.
Homelessness is often a consequence of domestic violence and it increases the vulnerability and dependency of the victim. Social marginalization may prevent the victims from seeking help.
Victim belongs to an ethnic minority
Language barriers, negative or discriminative experiences of the police, fear of not being believed, experiences of racism, social marginalization or the power of parallel societies may prevent the victims from seeking help.
Victim belongs to sexual or gender minority
A victim may fear of being ‘outed’ to family members, friends, and co-workers if they report police about domestic violence. A victim may fear discrimination or disrespectful treatment by the police.
Fear of an abusive partner may weaken women’s ability to improve their life situations (Sabri et al. 2014). An atmosphere of fear is likely to increase maladaptive thinking patterns inhibiting problem-solving and increasing denial and avoidance (Calvete, Susana & Este’Vez 2007).
Mental health issues
Apart from being a consequence of domestic violence, e.g. posttraumatic stress disorder (PTSD) can also be a risk factor for IPV revictimization (Kuijpers, van der Knaap & Winkel 2012).
Family or community is justifying violence based on honour/culture/religion
If the family or the community of the victim approves and justifies violence, the victim may be extremely scared, isolated, coerced and controlled. The victim may feel powerless to seek help. For many victims it may be an unthinkable to abandon their entire community to live without violence, and even if they did so, leaving the family or community may escalate the violence.
Guidelines for case documentation
Key point: Case documentation of DV is an important procedure. The professionals may need previously documented information in the dynamic risk assessment and management process. Standardized risk assessment tools support frontline responders’ work in documenting the case.
Since risk assessment is – or at least should be – a dynamic process that needs be started over again if the risk situation changes, case documentation of domestic violence and its’ risk factors is an important procedure. A careful case documentation should ensure that the professional find previously documented information to revise the risk assessment. Standardized risk assessment tools support frontline responders’ work in documenting the case. Nevertheless, risk assessment should not endanger the victim’s safety at any point. Thus, there should be clear protocols and safety restrictions for documenting the risk assessment, risk management and certain risk factors. For example, this data should not be included the pre-trial investigation records that are part of the judicial process: the perpetrator should not have access to victim-survivors’ risk assessment documentation. Data protection and the boundaries confidentiality as well as the victim-survivors consent to share information are key issues when intervening domestic violence and abuse (Albuquerque et al. 2013).
In the tables below we present the basic guidelines for the case documentation.
|General guidelines for case documentation|
|Document to the confidential risk assessment form: |
1. all identified risk factors
2. your overall assessment of the risk situation
3. victim’s own assessment of his/her level of risk and fear of being killed
Guidelines for case documentation for police, social work and health care
|POLICE||SOCIAL WORK||HEALTH CARE|
|Documentto the crime report: |
1. a verbal description of all injuries and other signs of violence
2. whenever possible e.g. photos of the injuries, other photos, videos, message transcriptions
|Document to the citizen/client database: |
1. case specific cooperation and communication with other FLR
2. specific behaviour reported e.g. who did what to whom and who provided the information
3. impact on the child 4. known protective factors of the child, adult victim and perpetrator
|Document to the patient database: |
1. right diagnostic codes and follow all defined registration procedures for DV situations
2. photos of injuries
3. use of body scheme