Case studies and scenario-based learning

A woman called the police because her husband has beaten her up. The public prosecutor’s office initiated a criminal procedure because of light physical battery – according to her injuries. A few hours later, after she had gone to a secret shelter, her physical condition deteriorates. A social worker talks to the victim about the now visible severity of injuries. With the victim’s consent, the director of the shelter calls an ambulance and takes photos of the injuries and sends them to the police, because he assumes that, based on the injuries, the crime is more severe than light battery. As the victim is willing to share the information with the police, he is legally allowed to do so. The court, based on the medical report, secured medical evidence, the photos sent by the shelter re-qualified the case as an attempt of homicide. Sometimes proactive action by Social Services is indispensable when dealing with domestic violence cases. They are in close contact with the victim and therefore have important information that could support the investigation. They can help the authorities not only in documenting the injuries in a timely manner, but also by sharing information about the case that the victims are unlikely to have passed on to the police or other frontline responders. Social workers are an important part of interorganisational help networks.

Secret shelters receive domestic violence clients through referrals from call centres or crisis ambulances.

The male perpetrator, against whom proceedings for slight bodily harm were initiated by the public prosecutor’s office, has a criminal record for the consumption of illegal substances. Due to the newly introduced evidence (photos and documentation of the woman’s injuries) in the preliminary proceedings, the public prosecutor’s office now gives the order to arrest the man in the course of the prepared charge of attempted murder. The man is arrested and taken to the local prison. Pre-trial detention is finally imposed due to the risk of a crime being committed, and he is now initially in custody for two weeks. After the initial interview, the social workers in charge contact the victim protection agency in order to clarify any prohibition of contact. In accordance with the legal provisions for victim protection, they would like to report to the victim protection agency, when and if he will be released. The magistrate thinks that it would rather be a case of grievous bodily harm and finally decides to release him from custody due to the victim’s safe accommodation and the man’s cooperative behaviour during the custody hearing. However, after contacting the supervising social workers, who consider the case to be very risky, a provisional probation order is issued. Shortly before the man is released from custody, the social workers contact the probation service in order to ensure a seamless transition from custody to further care. The man is closely supervised by the probation office until the main hearing.

Mr F., 34 years old, has been supervised by the probation service for 4 months. The arrangement was made in the course of a court order. Mr. F. was sentenced to 4 months’ imprisonment and 3 years’ probation due to a dangerous threat against his partner Ms. W. After the incident, he was expelled from their shared flat and a prohibition to approach was imposed. In addition, the police informed the victim protection agency. Ms. W. did not subsequently apply for a restraining order.

The partner, who was two months pregnant at the time, testified truthfully at the main hearing, but did not want to end the relationship because of the threat he made while drunk in the argument. She also stated in court that he apologised to her and that he is now also the future father of her child.

For a fortnight now, the probation officer in charge has noticed that Mr. F. has been coming to the appointments increasingly tense. He recently reported that his partner, who is now six months pregnant, is currently on maternity leave and is at home a lot, but still does little in the household. He had also been looking for work for some time. He often quarreled with his mother, who no longer took care of him and only told him that he now had a wife of his own to take care of him.

https://coercivecontrol.ripfa.org.uk/case-studies/case-study-1-ayesha/

https://coercivecontrol.ripfa.org.uk/case-studies/case-study-2-emma/

https://coercivecontrol.ripfa.org.uk/case-studies/case-study-3-john/

Gabby married her husband Nick after a long relationship and shortly thereafter moved to her husband’s family farm. The couple was happy at the farm and soon had their first child. During the pregnancy Nick’s behaviour began to change and by the time their daughter was born the relationship did not ‘feel’ as it had before. Nick seemed withdrawn and spent long periods of time by himself. He began to remind Gabby of Nick’s father who had always been a stern presence in his life.

Nick’s behaviour became threatening and controlling, especially in relation to money and social contact. He was increasingly aggressive in arguments and would often shout and throw objects around the room. Gabby thought that, because he wasn’t physically hurting her, his behaviour did not qualify as abuse. Nick did not show much interest in their daughter, Jane, except when in public, where he would appear to be a doting and loving father.

Jane was generally a well-behaved child, however, Gabby found that she was unable to leave her with anyone else. Jane would cry and become visibly distressed when Gabby handed her to someone else to be nursed. This was stressful for Gabby, and also meant that her social activities were limited further.

Jane took a long time to crawl, walk and begin talking. Her sleeping patterns were interrupted, and Gabby often did not sleep through the night, even when Jane was over 12 months of age. When Jane did begin to talk, she developed a stutter, and this further impeded her speech development. Gabby worried about Jane a lot. Their family doctor told her that this was normal for some children and that, if the speech problems persisted, she could always send Jane to a specialist at a later date.

After a number of years, Nick’s behaviour became unacceptable to Gabby. During arguments he would now hold on to the rifle that he had for farming purposes, and Gabby found this very threatening. On a number of occasions, items that Nick threw hit Gabby and she was increasingly afraid for their daughter. Gabby decided to leave and consulted the local women’s service, who assisted her to get an intervention order against Nick.

Once Gabby had taken Jane away from Nick, her behaviour changed. Jane’s development seemed to speed up and Gabby couldn’t understand why. As part of her counselling at a local women’s service, she discussed this issue, and her counsellor recognised the developmental delay, stutter, irritation, and separation anxiety as effects of Jane’s previously abusive situation.

This can be seen as a missed opportunity for identifying family violence. If the family doctor would have asked Gabby or Nick (who had presented with chronic back pain) about their relationship, about what was happening to the family, and specifically to Jane, the situation could have been identified much earlier.

The wide range of professionals, provider services and specialist agencies who may be involved in supporting victim-survivors of domestic violence can include—but are not limited to—primary and secondary health care services, mental health services, sexual violence services, social care, criminal justice agencies, the police, probation, youth justice, substance misuse, specialist domestic violence agencies, children’s services, housing services and education.

Adapted from a case study from RACGP (2014): Abuse and Violence: Working with our patients in general practice

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.

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.

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.

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.

Elderly person

• 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).

Minor

• 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 person

• 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).

Refugee background

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.

Homeless person

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.

Strong fear

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.

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.

Guidelines for case documentation for police, social work and health care

One day Nora finds a phone number of an NGO that helps immigrant women. The phone service is also in Nora’s native language. Nora calls the service phone anonymously to ask for legal advice about what happens to her residence permit in the case of a divorce. The NGO worker asks Nora about her life situation. Nora discloses her difficult situation and anxiety.

The NGO worker meets Nora at the school after the language course since it is the only place where Nora can go alone. With Nora’s consent, the NGO worker contacts the police and a responsible social service worker.

In some EU-countries the legislation allows the professionals to share and exchange information for more comprehensive risk assessment, if it is necessary to protect a child, to prevent a violent act or if the victim has given her consent. In some EU-countries, however, there is no legislative support in relation to information exchange between the police, social work or health care sectors. Hence, multi-agency mechanisms within the EU range from the adoption of formal or informal referral mechanisms to the presence of multidisciplinary teams or conferences that are mandated by legislation or by policy documentation on risk assessment.

The Istanbul Convention requires the State parties to take the necessary legislative or other measures to ensure that an assessment of the lethality risk, the seriousness of the situation and the risk of repeated violence is carried out by all relevant authorities in order to manage the risk and if necessary to provide co‐ordinated safety and support.

The next example of how Nora’s case is brought into the multi-agency risk assessment process is based on the requirements of the Istanbul Convention. This may differ from your national legislation.
With the consent of Nora, the police, the social service worker, the NGO worker and a representative of the health care sector participate in a risk assessment conference. Nora has given her consent that the professionals can share and exchange information regarding Nora.

Look at the boxes to see what kind of information can be collected by multi-agency co-operation:

The identified risk factors

The purpose of risk assessment tools is to help frontline responders identify all the risk factors and to create a complete overview of the victim’s situation in order to ascertain whether she remains at risk of serious harm and can assist in the development of a safety plan.
A calculation of the probability of becoming a victim of serious violence does not help the victim, but the calculation and the frontline responders’ own judgment of the situation support the frontline responders in taking necessary action to protect the victim, and to prevent future violence. In this scenario, the frontline responders have identified the following risk factors and victim’s vulnerability factors:

Peter is
• using violence more frequently
• using more intensive (harmful, injurious) violence

Peter has
• strangled Nora
• used coercive control
• used physical violence
• used economic, digital and psychological violence
• previous criminal record entries

Nora
• is planning a divorce
• has an immigrant background

Nora experiences
• strong fear
• social isolation
• mental health issues

The community of Nora and Peter is justifying violence by
• honour

Key point: Risk assessment is needed in the safety planning of the victim and in managing the sources of risks.

• Collect as much information as possible about the identified risk factors
• Risk assessment needs to address both adult and child victim-survivors
• Risk assessment should be done with the victim-survivor, not to her/him
• Ideally, with the consent of the victim-survivor, information is shared e.g. with the police, prosecutor, social work, health care sector and relevant NGOs
• Respect the victim-survivors wish with whom to cooperate
• Assess the immediate risks to the safety of the client/patient or any children
• Use your national/local risk assessment tool to assess the risks and ask for training
• In case you cannot access national/local risk assessment tools, use internationally accepted risk assessment tools and ask for training. You find tools under “Risk assessment tools”
• If possible, also assess the risk based on the information you have about the perpetrator (for example as a probation officer, prosecutor or prison employees)

Key point: There are several risk assessment tools for screening and documenting domestic violence as well as to assess the level of the risk. Appropriate use of these tools requires training.

There are different kinds of risk assessment tools used by the frontline responders. Some organisations have developed their own tools. However, below you can see some of the most widely used risk assessment tools.

DASH/MARAC

The DASH risk assessment checklist is based on research of e.g. indicators of homicides. The form can be filled in by any public official (e.g. a police officer, a social worker, a nurse, a doctor, an NGO worker) who works with a victim of violence, however, training on this risk assessment tool should be undertaken before it is used.
DASH risk assessment form includes questions about financial, psychological and physical violence and as well as threats. If a certain number of the risk indicators is met, the professional will refer the case to his/her local MARAC (Multi-Agency Risk Assessment Conference).
Scoring a certain number of points on the checklist is not an absolute requirement for referral to a MARAC since the professional may refer the case to a MARAC if s/he has concern for a victim.
A third criterion for referral to a MARAC is the escalation of recent violence, which is measured in terms of the number of domestic disturbance calls made to the police over the last twelve months. A common practice is to submit a case to a MARAC if at least three domestic disturbance calls have been made within a single year.
Source: https://rikoksentorjunta.fi/en/marac
See also VS-DASH 2009 – The Stalking Risk Identification Checklist

DA (Danger Assessment)

The series of 15 questions on the Danger Assessment is designed to measure a woman’s risk in an abusive relationship.
The tool can with some reliability identify women who may be at risk of being killed by their intimate partners. According to studies, almost half of the murdered women studied did not recognise the high level of their risk. Thus, risk assessment tools like the Danger Assessment may assist women and the professionals who help them to better understand the potential for danger and the level of their risk. Completing the Danger Assessment can help a woman evaluate the degree of danger she faces and consider what she should do next. Practitioners are reminded that the Danger Assessment is meant to be used with a calendar to enhance the accuracy of the assaulted woman’s recall of events. Read more: https://www.ncjrs.gov/pdffiles1/jr000250e.pdf
The Danger Assessment can be printed from http://www.son.jhmi.edu/research/CNR/homicide/DANGER.htm, which also gives directions regarding permission for use.

VRAG

The violence risk appraisal guide (VRAG) is an actuarial instrument. It assesses the risk of further violence among men or women who have already committed criminal violence. It is empirically supported actuarial method for the assessment of violence risk in forensic populations.
The VRAG is a 12-item actuarial instrument that assesses the risk of violent recidivism among men apprehended for criminal violence. The recommended basis for scoring the VRAG for research and individual assessment is a comprehensive psychosocial history addressing childhood conduct, family background, antisocial and criminal behavior, psychological problems, and details of offenses. Adequate psychosocial histories include more than past and present psychiatric symptoms and rely on collateral information (i.e., material gathered from friends, family, schools, correctional facilities, the police, and the courts). Scoring the VRAG is not a clinical task in its typical sense because it does not require contact between the assessor and the person being assessed. Nevertheless, compiling the required psychosocial history clearly is a clinical task, and expertise is required to score VRAG items from psychosocial histories.
http://criminal-justice.iresearchnet.com/forensic-psychology/violence-risk-appraisal-guide-vrag/

PATRIARCH

The PATRIARCH assessment tool is a victim-focused checklist. It is based on the structured professional judgement approach to assess the risk of honour-based violence and forced marriage. The tool is comprised of 10 risk factors and five victim vulnerability factors. Its goal is safety planning.
Proper use of the PATRIARCH risk assessment tool requires specialised education and training. http://www.rpksundsvall.se/wp-content/uploads/2009/05/PATRIARCH-4.pdf

ODARA

The ODARA is an actuarial risk assessment tool that calculates whether a man who assaulted his female partner, will repeat it in the future. The 13 ODARA items include domestic and non-domestic criminal history, threats and confinement during the index incident, children in the relationship, substance abuse, and barriers to victim support. Each is scored 0 or 1 and the total score is simply the sum of the items.
The ODARA is considered simple to use and can be used by a wide range of service providers e.g. police officers, shelter workers, victim services workers, health care professionals and social workers. It can be used in safety planning with the victims. The use of such a tool allows service providers from a wide variety of backgrounds to share a common language when talking about risk. ODARA training has improved scoring accuracy.
http://grcounseling.com/wp-content/uploads/2016/08/domestic-violence-risk-assessment.pdf
https://pathssk.org/wp-content/uploads/2017/02/06-b-ODARA-Waypoint.pdf

SARA (Spousal Assault Risk Assessment) and B-SAFER (Brief Spousal Assault Form for the Evaluation of Risk)

The B-SAFER is a condensed version of SARA. It is a structured risk assessment instrument designed to identify persons who are at risk from intimate partner violence. B-SAFER is constructed specifically for police officer use because of their role as frontline responders in domestic abuse incidents. SARA has been considered time-consuming for police officers to complete. Therefore SARA’s 20 items were reduced to 10 items in the B-SAFER.
The B-SAFER 10 items are divided into two subsections: Perpetrator Risk Factors (items 1-5) and Psychosocial Adjustment (items 6-10). Each subsection has an option to note an additional risk consideration that the assessor believes may be important to a particular case.
The purpose of B-SAFER is to “guide and structure an assessor’s decision-making regarding a perpetrator’s future intimate partner violence risk through evaluation of risk factors that are empirically associated with spousal violence”.
https://www.unb.ca/saintjohn/ccjs/_resources/pdf/ipvrisktoolsynopsis2013.pdf

Key point: Be aware of high-risk moments and triggers for increasing risk. Agencies should be aware of the need for additional safety planning and support for victims around events that may contribute to risk.

• Perpetrator is given a (court) decision of
  • a restraining order
  • a divorce/obligation to share assets
  • a negative residence permit
  • different than desired child custody decision/child contact arrangements
• The perpetrator realizes that the situation was reported to police
• The perpetrator is released from custody
• The perpetrator is being charged
• Trial is scheduled/occurred
• Lead-up to a trial
• Sentence reading is scheduled/occurred
• Release from a prison sentence
• Expiry of a court order
• A previously violent perpetrator wants to meet “one last time”
• The perpetrator discovers the new address of the victim
• The victim declares intention of leaving/separation
• The victim attempts to leave for separation
• The victim starts a new relationship

Comprehensive risk assessment should lead to effective risk management. Look at the boxes below: supporting a domestic violence victim sometimes requires help from several different agencies. All the agencies have their own role in supporting the victim. It is important to take legal actions and to support Nora’s well-being, in addition to her relationship with her mother and sisters. Nora needs support from her family members to be able to leave an abusive relationship.

Effective multi-sectoral and multi-agency interventions require that all policy sectors and actors are engaged and accountable, namely law enforcement, the judiciary, health, social welfare and child services, employment, education, and general and specialised services for victims. Extensive research and evaluation of existing co-ordinated interventions also demonstrate the importance of involving – in addition to sectoral stakeholders – autonomous victims’ rights advocates and other relevant NGOs working in the field of violence against women. Developing a shared understanding of violence against women, as well as improving information-sharing and risk assessment through the development of common standards, guidelines and protocols can greatly contribute toward the pooling of valuable resources and establishing systematic co-operation. Such tools are also instrumental in securing the active commitment of all stakeholders. (Krizsan & Pap 2016, 12.)

Police

• Inform the victim about shelters and guide the victim to a shelter if needed
• Initiate child protection procedures if not yet done
• File a crime offence report if not yet done
• By the victim’s consent, contact the victim support services
• Document information produced by risk assessment and keep it confidential
• Inform the victim about a restraining order or issue a temporary restraining order
• Inform the victim of possible moments when the police is going to contact the perpetrator
• Inform the victim when the perpetrator will be released from custody*
• Create a safety plan for the victim
• In case of physical injuries, guide the victim to Health Care services to have them treated and documented
• Guide the victim to Social Services based on her/his needs for support
• Make sure all relevant NGOs are invited to participate in the risk assessment process
• Assist the victim in protecting her/his personal data
• Take into account the risks of digitally assisted stalking and cyberstalking and help the victim in protecting their digital devices
• Depending on the legislation, the police can also consider secret means of gathering intelligence prevent crimes or avoid danger
• Consider the benefits of a portable alarm system for the victim
• Assist the perpetrator in joining a perpetrator programme*

 * = if this duty does not belong to an another agency

Social work

• If there is an immediate or even likely risk to the safety of the client or any children, consider contacting the police
• Initiate child protection procedures if not yet done
• Inform the victim about shelters and guide the victim to a shelter if needed
• Help the victim to solve financial problems
• Secure safe housing for the victim
• Assist the victim in protecting her/his personal data
• Assist the victim in getting immediate crisis help and psychosocial support

Health care

• Always examine the patient without their family members or spouse being present
• Assist the victim in receiving immediate crisis help and psychosocial support
• If there is an immediate risk to safety of the patient or any children, consider contacting the police
• Initiate child protection procedures if not yet done
• Ask for victim’s consent before letting in any visitors

Despite an effective intervention, an abuser may continue being violent and oppressive towards the victim. There are many reasons why a victim of DV may not be able to leave the abuser: e.g. (mutual) dependency, fear or financial issues. Usually it takes several attempts to leave an abuser before staying away for good. Sometimes separation escalates the violence. The victim may try to control the violence by staying in the relationship. The victim may leave the abuser, but the abuser starts stalking and harassing the victim. Child contact arrangements may be used as way to carry on subjecting victims to violence. In a nutshell, the situation may get worse.

Ideally, risk assessment is a dynamic process. Risk assessment needs to be regularly revised. If the threat of violence continues, the process of risk assessment needs to start over again. Effective prevention of DV and breaking the cycle of violence may require several interventions.

A lot has happened since Nora’s first meeting with an NGO worker.

Nora currently stays in a shelter. She has a support person from the Victim Support Service as well as from an NGO that provides assistance for immigrant women who have faced violence. She also has regular meetings with a psychiatric nurse.

Police has filed a report of assaults, defamation, threatening and frauds committed by Peter. Nora has got a restraining order against Peter. Nora has learnt from her lawyer that divorce does not affect her immigration status.

Nora has a new bank account and a new secret phone number. She attends the language course in another school. Nora meets the NGO worker every week. The NGO worker has mediated the conflict between Nora and her mother and sisters successfully.

Everything seems to be fine now, right?

However, Nora is scared. She is terrified of the possibility that Peter will find her. A fear of death is taking over her life.

When Nora lived with Peter, she felt that she was able to control her fear. She was able to sense Peter’s agitation and she always did everything to avoid an explosion. She pleased Peter and tried to reason with him. She felt how the tension was building and when the violence began, she felt relief: ‘Soon this is going to be over for some weeks. Soon I can breathe again’.
Traumatising experiences make Nora doubt and blame herself.

The NGO worker and the psychiatric nurse always ask about Nora’s fear, but she cannot tell them. She feels overwhelming shame to admit to her helpers that, despite all the help and support she has received, she is terrified. Living with an abusive partner was easier when she did not have to be frightened all the time. She cannot reveal these thoughts to anyone.

Nora becomes even more confused when she meets a friend of Peter by chance. The friend tells that Peter is sad and upset. The friend says that Peter has been extremely worried about Nora and has tried to find her.

‘He is not doing very well.’

‘Please call him.’
…

The human mind is complex. What could happen next in Nora’s case? What if Nora calls Peter? Will Peter find Nora or will Nora return to Peter? What if Nora tells about this incident in the next meeting with the NGO worker?

Monitoring the situation and keeping a trustful and safe relationship with the victim are extremely important. Here, Nora discloses to the NGO worker how she is worried about Peter’s condition. This leads to a discussion of Nora’s fears and self-blame. The NGO worker pays attention to the message that Peter has been trying to find Nora.

If Nora’s situation changed, the frontline responders would revise the risk assessment and take new appropriate measures. For example, depending on the legislation, the police can consider secret means of gathering intelligence to prevent crimes or avoid danger. A portable alarm system could ease the fear Nora is experiencing. There are many options.

Thank you for reading Nora’s story.

Learn more about domestic violence risk assessment from the Good-read section. Don’t forget to print your own risk assessment checklist from the Materials section.

Albuquerque, M., Basinskaite, D., Medina Martins, M., Mira, R., Pautasso, E., Polzin, I., Satke, M., Shearman de Madeco, M., Alberta Silva, M., Sliackiene A., Manuel Soares, M., Viegas, P. & Wiemann, S. (2013). E-MARIA: European manual for risk assessment. Bupnet, Göttingen. Retrieved from: https://e-maria.eu/wp-content/uploads/2011/10/Manual-latest-version-light-colours.pdf

Australian Institute of Health and Welfare (2015). Screening for domestic violence during pregnancy: options for future reporting in the National Perinatal Data Collection. Cat. no. PER 71. Canberra: AIHW. Retrieved from: www.aihw.gov.au/getmedia/62dfd6f0-a69a-4806-bf13-bf86a3c99583/19298.pdf.aspx?inline=true

Boxall, H. & Lawler, S. (2021). How does domestic violence escalate over time? Trends & issues in crime and criminal justice no. 626. Canberra: Australian Institute of Criminology. Retrieved from: https://www.aic.gov.au/publications/tandi/tandi626

Braaf, R., & Sneddon, C. (2007). Family Law Act Reform: the potential for screening and risk assessment for family violence – Issues paper 12.

Calvete E., Susana C. & Este’Vez, A. (2007.) Cognitive and coping mechanisms in the interplay between intimate partner violence and depression. Anxiety, Stress, Coping. 2007;24(4):369–382.

Concha, M., Sanchez, M., de la Rosa, M., & Villar, M. E. (2013). A longitudinal study of social capital and acculturation-related stress among recent Latino immigrants in South Florida. Hispanic Journal of Behavioral Sciences, 35(4), 469–485

Douglas, H. & Fitzgerald, R. (2014). Strangulation, Domestic Violence and the Legal Response. The Sydney law review. 36. 231.

Gurm, B., Salgado, G., Marchbank, J., & Early, S. D. (2020). Making Sense of a Global Pandemic: Relationship Violence & Working Together Towards a Violence Free Society. Kwantlen Polytechnic University: Surrey, BC. Ebook ISBN 978-1-989864-14-2 or Print ISBN 978-1-989864-13-5. https://kpu.pressbooks.pub/nevr/

Hameed, S., Sadiq, A., & Din, A. U. (2018). The Increased Vulnerability of Refugee Population to Mental Health Disorders. Kansas journal of medicine, 11(1), 1–12.

Koskelainen, M. & Stenberg, J-H. (2020). Mustasukkaisuudesta harhaluuloisuushäiriöön: tunnistaminen ja väliintulot osana lähisuhde-väkivallan estämistä. Lääketieteellinen Aikakauskirja Duodecim 2020;136(6):611-6

Krizsan, A. & Pap, E. Implementing a Comprehensive and Co-ordinated Approach: An assessment of Poland’s response to prevent and combat gender-based violence (Council of Europe, 2016), page 12 https://rm.coe.int/168064ecd8

Kropp, P. R. (2004). Some Questions Regarding Spousal Assault Risk Assessment. Violence Against Women, 10(6), 676–697. https://doi.org/10.1177/1077801204265019

Kuijpers, K., van der Knaap, L. & Winkel F. (2012). PTSD symptoms as risk factors for intimate partner violence revictimization and the mediating role of victims’ violent behavior. J Trauma Stress. 2012 Apr;25(2):179-86. doi: 10.1002/jts.21676. PMID: 22522732.

Peek-Asa, C., Wallis, A., Harland, K., Beyer, K., Dickey, P., & Saftlas, A. (2011). Rural disparity in domestic violence prevalence and access to resources. Journal of women’s health (2002), 20(11), 1743–1749. https://doi.org/10.1089/jwh.2011.2891

Sabri, B., Stockman, J. K., Campbell, J. C., O’Brien, S., Campbell, D., Callwood, G. B., Bertrand, D., Sutton, L. W., & Hart-Hyndman, G. (2014). Factors associated with increased risk for lethal violence in intimate partner relationships among ethnically diverse black women. Violence and victims, 29(5), 719–741. https://doi.org/10.1891/0886-6708.VV-D-13-00018

Svalin, K. & Levander, S. (2019). The Predictive Validity of Intimate Partner Violence Risk Assessments Conducted by Practitioners in Different Settings—a Review of the Literature. Journal of Police and Criminal Psychology. 35. https://doi.org/10.1007/s11896-019-09343-4.

WHO (2020). World Health Organisation. Elder abuse. [Referred 21^st of April 2021.] Retrieved from: https://www.who.int/news-room/fact-sheets/detail/elder-abuse