Domestic violence in times of COVID-19
Risk assessment and safety enhancement
Communication with victims about safety measures and risk assessment
Immediate risk of suicide and self-injury
Information about the usage of risk assessment tools in Europe regarding the health sector
Risk Assessment Integration Module RAIMO
This module presents what needs to be considered when assessing the risk of victims of domestic violence and what steps are necessary to improve the safety of victims. The learning materials are not tailored to the needs of every country; they include generic cases that need local adaptation.
IMPRODOVA: Domestic violence in times of disasters
The video highlights the influence of disasters on the rate of domestic violence.
Domestic violence in times of COVID-19
Quarantine, restrictions, closed schools, home office, short-time work, financial worries, and fear of the future – all these factors have the potential to cause increased stress in relationships and family life. It is therefore suspected that there has been and will continue to be a significant increase in violence at home.
- Health and mental health problems can increase during a lockdown situation, as health-related services are only accessible to a limited extent. This in turn can have a negative impact on the health status of individuals, increase their stress levels and encourage an increase in violent assaults.
- Economic insecurity or unemployment is accompanied by financial worries that can reinforce destructive coping mechanisms.
- Violence always has to do with power. In times of crisis and isolation and the associated feelings of helplessness, loss of control and powerlessness, violence is supposedly a means of regaining control and power.
- Language barriers, closures of contact points or the fact that social workers are only present on site to a limited extent due to the protective measures can make access to support services considerably more difficult.
- Victims may also be reluctant to take advantage of support services for fear of contracting COVID-19.
- Social distancing can limit the social contacts of individuals to such an extent that victims may not dare to seek help without the closeness and encouragement of caregivers. Similarly, caregivers, acquaintances, or outsiders, such as employers or educational staff, do not become aware of the problem and cannot act as supporters. On the other hand, neighbours are more alert and present and, due to the initial restrictions, must be considered a protective factor.
Light and dark field
During the COVID-19 pandemic, an increase of domestic violence was reported in EU countries.
Especially in cases of domestic violence, reports to the police are often received with some delay or not reported at all. Also, incidents are more often reported by people victims relate to. However, the COVID-19-related restrictions prevented reporting because of the lack of social contacts. Therefore, more cases than usual may have stayed undetected. As a result, it can be assumed that there is a high number of unreported cases.
This logic can explain why, in addition to an increase in reported cases of domestic violence in many areas, there was a decrease in numbers in others. This could be due to the fact that the perpetrator was always present at home so that the victim had no opportunity to call for help and/or report a crime without risking an escalation.
Domestic violence during the COVID-19 pandemic in EU countries
Each individual country has taken measures to support victims of domestic violence during the pandemic and to protect them from further violence.
National Action Plans
The document “The COVID-19 pandemic and intimate partner violence against women in the EU” offers a preliminary overview of the measures undertaken across the EU to support victims of violence during the COVID-19 outbreak (from March until the end of September 2020). It identifies examples of promising practices and provides initial recommendations for the EU and Member States on how to better support victims during the pandemic, as well as in other potential crises.
Although more research is needed to fully assess the extent of the emerging challenges, the findings from this study can be used to further explore the issues and contribute to the development of governmental strategies on prevention of gender-based violence and on crisis preparedness.
The study found that the introduction of counterpandemic measures across the EU created at least seven main challenges for service providers.
- Ensuring continuity of service delivery
- Finding new ways of providing support
- Meeting a surge in demand for services
- Dealing with strain on service provider staff
- Reaching victims
- Identifying the risk level of victims
- Inadequacy of funding
All EU Member States implemented changes or established new measures to support and protect women victims of intimate partner violence and their children in response to COVID-19. However, comprehensive action plans specifically addressing the issue of intimate partner violence in the context of the COVID-19 pandemic or detailed guidance on emergency action were identified in few EU Member States. In addition, all these national policies and action plans were reactive responses that were developed and implemented after the COVID-19 outbreak, and were rarely accompanied by additional funding.
Only three Member States introduced action plans to specifically address issues relating to intimate partner violence in the context of the COVID-19 pandemic. Ireland, Spain, and Lithuania are among the EU countries that have introduced a national action plan to tackle domestic violence during the pandemic. While Spain and Lithuania have strengthened coordination between their health, police and justice services, Ireland has gone one step further and has contributed € 160,000 to support shelters and hotlines for victims of domestic violence. Irish courts have given priority to domestic violence cases and increased the number of remote hearings. The police also checked on women who have experienced violence in the past.
New legislation or amendments to existing legislation in response to COVID-19 were adapted in 14 Member States. The most common type of legislative change was intended to ensure continuity of services to support women victims and their children, either specifically during the lockdown situation or in emergency situations more generally. Legislation aiming to prevent victims from being trapped with perpetrators in the context of a lockdown or quarantine was less common. Even where such legislation was introduced, Member States focused more on providing alternative accommodation to victims and ensuring no criminal liability for victims travelling despite lockdown orders than on removing the perpetrator from the home or changing police procedures or justice systems to continue criminal proceedings. Like national policies and action plans, most legislative or judicial interventions were introduced during lockdown and intended to be temporary.
In Latvia, Estonia, Slovakia and France, governments are now legally obliged to provide alternative shelters for women who are exposed to violence at home. Estonian courts are empowered to issue injunctions against violent partners to protect the victim from homelessness and bring the perpetrator to justice.
Almost every EU country has conducted awareness campaigns to inform victims of domestic violence about available support. In Greece, Finland, and Portugal, for example, these were targeted specifically at refugees and people with a migrant background, while other countries targeted women from Roma communities, LGBTIQ+, and women or people with hearing loss. Awareness campaigns can also encourage witnesses of domestic violence to support victims by providing clear guidance on how they can support victims.
Shaky support systems
Member States generally recognised the importance of increasing the availability of communication and support tools for victims throughout the COVID-19 pandemic. Thus, more digital channels to help women victims of intimate partner violence to reach out for help were established. Examples include mobile phone apps, various forms of instant messaging services and new email services, with service providers increasing their hours of operation and their capacity to assist victims in different languages. However, measures offering tailored support to children affected by domestic violence were scarce.
The COVID-19 pandemic has revealed that support systems for victims of domestic violence are shaky in most EU countries. The staff of shelters and counselling centres was overwhelmed by the increased demand and the increased suffering of victims. They did not feel prepared for the situation of providing support from a distance and not being able to help the victims face-to-face. At the same time, they themselves had to adapt their work to the new situation (e.g., home office, reducing contacts, looking after children).
- Very few EU Member States adopted a comprehensive national policy or action plan addressing potential spikes of intimate partner violence in the context of COVID-19.
- To ensure continuity of service delivery throughout the COVID-19 pandemic, legislation was used to classify victim support services as essential in a limited number of EU Member States.
- Legislative measures providing additional accommodation for victims were more common than those removing perpetrators.
- Shortages in shelter accommodation caused by COVID-19 restrictions sparked cross-sectoral initiatives.
- Lack of sufficient funding and guidance in EU Member States placed an additional burden on service providers.
- All EU Member States recognised the need to raise awareness of the risk of a spike in intimate partner violence in the context of the pandemic.
- There was a limited focus on providing specialised support for children and disadvantaged groups affected by intimate partner violence.
Source: The COVID-19 pandemic and intimate partner violence in the EU.
Special role of police, health, and social sectors during the COVID-19 pandemic
- In times of lockdown and pandemic, the attention of the police is focused on compliance with and control of state-ordered measures.
- Especially at the beginning of the lockdown, police forces may have refrained from expelling an offender from their home if he or she was in quarantine because it was unclear how to proceed in such cases.
- The attention of medical staff during the pandemic is mainly focused on pandemic-related medical interventions. Cases of domestic violence can thus be more easily overlooked. Victims of domestic violence are also afraid to catch COVID-19 when going to a hospital. In some cases, access to hospitals during a lockdown is only possible in severe acute cases.
- School closures took place in about 190 countries worldwide. Apart from the direct loss of education, there was also a loss of social contacts. Indicators and direct signs of domestic violence thus have a high risk of being overlooked.
- In the social sector, appointments with clients can no longer take place in person. Many contact points had to close, and appointments were cancelled or greatly reduced.
- NGOs, victim support and counselling services reported an increased demand for counselling and/or support. Further analysis is needed to obtain reliable data on which services are in high demand and need to be strengthened and which services are less in demand and may need to be better adapted to the existing situation.
Recommendations to combat and better detect domestic violence during the pandemic
The lockdown measures to contain COVID-19 in spring 2020 also brought the issue of domestic violence increasingly into the public and police attention.
It was reported in the media, in politics and by NGOs that under COVID-19 conditions, especially women and children experience increased violence. The Director of the EU Agency for Fundamental Rights has called on the states not only to protect women during the pandemic, but “to strengthen their measures to end violence against women in the future”. The European Institute for Gender Equality (EIGE) has also supported calls for the EU and its Member States to use the COVID-19 pandemic as an opportunity to step up their efforts to protect women’s rights (Source: https://eige.europa.eu/printpdf/news/eu-rights-and-equality-agency-heads-lets-step-our-efforts-end-domestic-violence).
The World Health Organisation (WHO) and UN women have underlined the importance of data collection during the COVID-19 pandemic, which is a crucial tool to mitigate adverse effects on women and girls affected by violence, and to develop prevention strategies for future crises (Source: https://www.unwomen.de/aktuelles/corona-eine-krise-der-frauen.html; https://www.unwomen.de/fileadmin/user_upload/Corona/gender-equality-in-the-wake-of-covid-19-en.pdf). For the future, it is crucial that research provides immediate and longer-term policies and practical responses.
The following recommendations were phrased:
- Law enforcement authorities must ensure that domestic violence incidents are given high priority and that the manifestations of violence associated with COVID-19 are addressed.
- The health sector must always ensure that victims of domestic violence have access to sexual and reproductive health information and services.
- Social sector support services should provide more online crisis support services such as hotlines and chats. Emergency care/day care services should be extended to all families – not only to parents working in systemically important jobs.
Aiming to reduce violence against women in different crisis situations and including women-specific needs in emergency and recovery plans
- Adopt national action plans to improve the long-term response to gender-based violence in times of crisis.
- Implement measures to protect victims and their children from perpetrators through rapid removal of the perpetrator.
Improving access to support services and limiting the impact of COVID-19 – and other potential crisis situations – on the functionality of support services
- Adopt national legislation to ensure that support services for women victims of intimate partner violence and their children are recognised as essential services during states of emergency.
- Introduce helplines and communication tools that provide victims with the means to discreetly access support in times of crisis.
- Provide additional funding to expand the capacity of support services to support women victims of intimate partner violence and their children in times of crisis.
- Update service providers’ procedures for risk assessment of victims to include remote service delivery rather than in-person settings only.
- Evaluate measures to protect women victims of intimate partner violence and their children in times of crisis to improve future action.
- Address the strain on service provider staff by adopting practices that support the staff’s well-being.
- Use awareness-raising campaigns to inform victims about where and how to access support services in times of crisis.
- Provide comprehensive initial vocational and in-service training for professionals supporting victims of violence.
- Share knowledge and practices among the staff of support services to facilitate the effective delivery of remote counselling to women victims and their children.
The COVID-19 Global Gender Response Tracker, jointly launched by UN Women and UNDP, provides a comprehensive overview of the political measures being taken worldwide.
How can victims of domestic violence be supported during a pandemic?
- If victims of domestic violence do not want to turn to the police or help services because they do not trust state institutions or have already had bad experiences, the first step out of the violent situation can be taken with help lines or chats if this can be done safely at home. Further help is possible afterwards.
- It is important that victims are always made aware that the blame never lies with them, and that what is happening is wrong. A clear statement and condemnation of domestic violence in the media – especially in times of pandemics – helps those affected to seek further support.
- Concerns about the economic consequences after separation can make it difficult for victims of domestic violence to find a way out of their situation. Some victims are financially dependent on their partner, for example because they are no longer able to go to paid work due to caring for family members and childcare, or because they were dismissed in the course of the COVID-19 pandemic. Some countries, like Germany, have a functioning system of assistance to alleviate financial hardship for victims of domestic violence after a separation. This is not the case in other countries.
- Written information on violence in intimate relationships and domestic violence should be available in public spaces in the form of posters and brochures or leaflets which are made available in private areas such as washrooms (with appropriate warnings not to take them home if the perpetrator is there). Offering a QR code that leads to a website with further information can help. The posters, brochures or leaflets should be aimed at female and male victims of domestic violence and not use stereotypes. The designation of concrete contact persons on site and the provision of telephone numbers of counselling centres or websites offering (anonymous) counselling can help victims of domestic violence to seek help.
- In case of acute threat, victims should call the police emergency number. They should state their name, address, further information and, if necessary, the perpetrator’s possession of a weapon, and emphasise that help is needed immediately. Until the police’s arrival, victims and any children should take themselves to safety, for example to neighbours or shops.
What can perpetrators of violence do to change their behaviour?
- Even during a pandemic, help is available for perpetrators of intimate partner violence: in the form of online counselling, therapy, and training programmes.
Case study: Elder abuse
Winnie, aged 69 years, lives by herself in a small country town. She has been a patient of yours for a number of years. She has severe arthritis and requires more and more help with the activities of daily living. Even with regular visits from community services, she finds it difficult to cope, but she is adamant that she doesn’t want to go to the regional hospital.
Eventually, she moves in with her daughter and husband and their young sons. The neighbours begin to complain about the noise. Since Winnie has moved in, there is not much space in the house and the children are fighting more often, they are shouting and playing outside more often. Winnie’s daughter does not receive any help from her sisters and is expected to cope with the increased washing, cooking and other duties without complaint.
When you make house calls to Winnie you notice that she has marks and bruises on her arms and upper torso. These are explained away by her daughter, who says that she is becoming clumsier and keeps knocking into things, also Winnie is taking blood thinners. Winnie just shakes her head and says nothing, when you ask her if everything is okay at home, even when you speak to her in private. You are worried about pressing the issue since you do not want to upset anybody by raising a false alarm.
Adapted from a case study from RACGP (2014): Abuse and Violence: Working with our patients in general practice
Discuss the case study.
a) What would you do when being Winnie´s physician in this situation?
b) What are the main risk factors for Winnie to suffer from domestic violence?
The answers to those tasks can be found in the corresponding sections of this module.
Primary care physiciansneed to be aware that abuse may be happening in this situation.
What could be done to help Winnie?
You may involve the home nursing service, home help, day centre, carer support groups or other local services to relieve the pressure on this family. Another alternative is to seek the help of an aged care assessment team if available.
Measures taken in Winnie´s case
Winnie remains living in her daughter’s house with some extra support – for example, a toilet raise, and respite care – which allows her daughter time out of the house. Also, Winnie attends the day centre once a week.
It is unclear whether this will alleviate the situation, so it is important to maintain a close watch on Winnie with weekly house calls.
For more information on elder abuse:
Risk assessment and safety enhancement
Many victims who have been subjected to violence have fears about their safety. Other victims may not think they need a safety plan because they do not expect that the violence will happen again. Explain that domestic violence is not likely to stop on its own: it tends to continue and may over time become worse and happen more often.
Assessing and planning for safety is an ongoing process – it is not just a one-time conversation. You can help them by discussing their particular needs and situation and exploring their options and resources each time you see them and as their situation changes. Discuss whether it is safe for them to return home.
The patient should be helped to assess his or her immediate and future safety and that of his or her children. Risk assessment according to good practice includes
- collecting relevant facts about the domestic situation,
- asking about the victim’s perception of risk,
- a professional judgement on current risk factors.
The patient may need to be referred to a specialised service for domestic violence. The strongest indicator for future risks/violence is the perpetrator’s current and past behaviour. The patient may also be advised to go to the police to ensure even greater protection. However, since this is always accompanied by a report to the perpetrator and the victim is expected to reveal himself/herself to a wider circle of people, this advice must be weighed up very carefully!
It is important that the patient is involved in a conversation about his or her risk perception and security management in the past. All plans that have been made must be documented for future reference! Copies should be given to the victim, if possible. At the same time, they should be made aware that there is a risk that the perpetrator might find the document and that the violence will escalate.
Some victims will know when they are in immediate danger and are afraid to go home. If they are worried about their safety, take them seriously. This is your responsibility.
Other victims may need help thinking about their immediate risk. There are specific questions you can ask to see if it is safe for them to return to their home. It is important to find out if there is an immediate and likely risk of serious injury.
The internationally most frequently used risk assessment instruments can be found under Teaching Materials on the page’s risk assessment tools.
Communication with victims about safety measures and risk assessment
For an initial risk assessment, this must at least be done: talk to the victim in a private setting and assess immediate concerns.
Questions to assess immediate risk of violence
- Has physical violence happened more often or gotten worse over the past 6 months?
- Has he/she ever used a weapon or threatened you with a weapon?
- Has he/she ever tried to strangle you?
- Do you believe he/she would kill you?
- Has he/she ever beaten you when you were pregnant?
- Is he/she violently and constantly jealous of you?
Victims who answer “yes” to at least 3 of the following questions may be at especially high immediate risk of violence.
Making a safety plan
Even a victim who is not facing immediate serious risk could benefit from having a safety plan. If they have a plan, they will be better able to deal with the situation if violence suddenly occurs. The following elements are part of a safety plan and questions you can ask to help them make a plan.
Safe place to go
“If you need to leave your home in a hurry, where could you go?”
Planning for children
“Would you go alone or take your children with you?”
“How will you get there?”
Items to take with you
“Do you need to take any documents, keys, money, clothes, or other things with you when you leave? What is essential?”
“Do you have access to money if you need to leave? Where is it kept? Can you get to it in an emergency?”
Support of someone close by
“Is there a neighbour you can tell about the violence, who can call the police or come help you if they hear sounds of violence coming from your home?”
Be careful in cases of honour-related violence.
You can help by discussing the victim’s needs with them, telling them about other sources of help, and assisting them to get help if they want it. It will usually not be possible to deal with all their concerns during the first meeting. Let them know that you are available to meet again to talk about other issues.
Do not expect them to make decisions immediately. It may seem frustrating if you think they will not take any steps to change their situation. However, they will need to take their time and do what they think is right for them. Always respect their wishes and decisions.
Immediate risk of suicide and self-injury
Some people fear that the question of suicide might provoke the victim to commit it. On the contrary, talking about suicide often reduces the victim’s fear of suicidal thoughts and helps him or her to feel understood.
- If the victim has current thoughts or plans to commit suicide or to harm himself/herself
- if there is a history of thoughts or plans for self-harm in the past month or a record of self-harm in the past year, and the patient now appears extremely agitated, violent, desperate, or uncommunicative, then there is an imminent danger of self-harm or suicide, and the patient should not be left alone.
The victim should then immediately be transferred to a psychiatric hospital. If the patient refuses to go there alone, he or she should be accompanied, or an accompanying person should be contacted. If the patient runs away or does not report to the clinic at the agreed time of arrival, the fire brigade should be called in. Breaking confidentiality is not a legal problem in this case. On the contrary, one is even obliged to report an acute self-endangerment.
Information about the usage of risk assessment tools in Europe regarding the health sector
Risk Assessment procedures and response strategies in different European countries in the health sector
We do not have comprehensive information about a standard risk assessment tool in Scotland, though NHS Health Scotland is promoting the use of the DASH RIC amongst Health Visitors. With regard to other groups of health workers in Scotland, training on the use of the DASH RIC varies across health board areas. Some have trained mental health and sexual health staff, but this is not consistent across the country. In most of the participating countries, including France, Germany, Slovenia, and Hungary, there are no formalised domestic violence risk assessment processes in the health sector. A prevalent opinion within the medical professionals of these countries is that they do not see domestic violence-related risk assessment as part of their job. According to their understanding the health sector’s responsibility is restricted to document the incident and the injuries. According to our understanding, this attitude is not very beneficial, since health care is an entry point for many domestic violence cases, which might remain in latency in case of an insufficient risk assessment.
In Austria, child and victim protection groups are discretionally used as part of risk assessment in hospitals, developed by national authorities and professionals (based on Campbell’s Danger Assessment) and adapted during the initiative “Living FREE of Violence”. The tool is solely used by medical professionals but includes indicators compatible with others based on the Danger Assessment. The assessment consists of questions seeking to reconstruct past incidents of violence in the relationship and a checklist to guide possible steps to increase the victim’s security. The medical sector further employs a standardised forensic documentation procedure in cases of physical injury. This also includes indicators relevant to risk assessment in cases of domestic violence.
The tool is used by internal experts on domestic violence within hospitals, but physicians and other medical professionals are trained by them to use the tool and to cooperate in the risk assessment procedure.
In Finland, some emergency units use PAKE Abuse and Body Map form, which is a tool used in assault and abuse cases (not just domestic violence cases). Medical professionals, doctors and nurses are trained to use this tool. The purpose of the PAKE form is to improve the comprehensive treatment of the victim, including psychological condition and legal representation. It also intends to facilitate cooperation between health care, social work, the police, and judicial authorities, and to advice the victim about available services. PAKE involves a detailed map of injuries. It covers the cause of the injury, the violent action, consequences of the action, further threats, pain, victims’ psychological condition, the involvement of children, and the follow-up treatment. PAKE is mandatory in those emergency rooms where it has been implemented. A doctor writes a medical report based on the PAKE form and sends it to the police if the victim gives his or her consent. However, health care professionals can only encourage the victim to report an offence to the police and can send information to the police if the victim gives his or her consent.
In Portugal, there are two different sectors of the health system that face domestic violence victims: hospitals and health centres. The first ones predominantly deal with emergencies, often quite soon after a domestic violence incident; the second ones deal with situations known within regular medical appointments (indoor approach) and during community medical work (outdoor approach). Both sectors mandatorily use standardised, locally invented risk assessment tools, owned by the Ministry of Health. An interdisciplinary team, including medical doctors, nurses, psychologists, social workers and even the police, if necessary, ensures that the risk assessment procedure is participatory and multidisciplinary. The tool includes a set of various steps to consider: (1) screening, (2) detecting/assessing, (3) diagnostic evaluation (hypothesis), (4) registering, (5) acting, and (6) signalling. Risk indicators cover different forms of threats, injuries; severity, intensity, and frequency of violence; involvement of alcohol or other substances; and crime history. The risk assessment tool also contains items related to the victim’s risk perception. Imminent danger is diagnosed when there is the possibility of experiencing an imminent episode of violence, life-threatening for the victim (and/or her/his significant persons). It is based on information from the interview, the victim’s perception, a bio-psychosocial assessment, and a physical exam.
In Austria, main shortcomings described are not related to the tools employed, but to the environment they are used in. Time constraints are mentioned as well as the lack of mandatory sensitivity trainings for medical staff to gain expertise in using the tool in some hospitals. The child- and victim protection groups are not yet implemented in all hospitals in Austria, since roll out is going on. Implementation is seen predominantly in hospitals that were involved in the project “Gewaltfreileben” (Living Free of Violence) in Vienna. The risk assessment process and the groups are not regulated on a policy level. This seems to be an important gap in response to the high importance of hospitals for the identification and treatment of victims of domestic violence.
In Finland a shortcoming mentioned in relation to the PAKE form is the paper form. If it were an electronic form, it would be much easier to share information amongst the agencies. It might also vary how systematically PAKE is used in other areas in Finland.
In Portugal, two shortcomings are mentioned in relation to the risk assessment tool used at health care services. First, the time-consuming nature of the procedure, second, that frontline responders were not involved in the design of the risk assessment policy, despite the fact that they have proper knowledge.
Interviewees of all countries that use domestic violence risk assessment tools in health care emphasised the importance of continuous, mandatory training of the FLRs for the use of the risk assessment tool. They also state that the lack of sufficient trainings and properly trained staff is a problem.
Further information about risk assessment procedures in different European Countries can be found here:
Icon made by Freepik from www.flaticon.com
Risk Assessment Integration Module RAIMO
The learning objectives of this module are to become familiar with the domestic violence risk assessment process, risk and vulnerability factors and the purpose of multi-agency cooperation in risk management.
Dear frontline responder, welcome to learn about the domestic violence risk assessment process in a multiprofessional context!
The purpose of this modular tool is to link various risk assessment procedures and enhance the identification of domestic violence among key agencies (e.g. police officers, social work and healthcare professionals, NGO workers, educators) who come into contact with victim-survivors and perpetrators. This tool demonstrates different risk factors and different approaches to identifying and responding to risk.
You can use this tool e.g. as a training material or a database.
We present the four steps of the domestic violence risk assessment process from risk identification all the way to follow-up.
The Good-read section provides you with recommendable reading. From the Materials section you will find printable items such as checklists. Do not forget to print your own pocket version of the risk assessment checklist – with it, you may save somebody’s life.
Principles of the risk assessment process
Step 1: Identification of risk factors
Step 2: Risk assessment
Step 3: Outlining necessary actions
Step 4: Follow-up
Principles of the risk assessment process
Risk assessment is a cornerstone in domestic violence prevention (Kropp 2004). The purpose of domestic violence risk assessment is to prevent repetitious violence by identifying the perpetrator’s risk of recidivism (Svalin & Levander 2019, 1), circumstances that may increase the risks of violence as well the victim’s vulnerability factors by conducting a risk assessment and implementing interventions to manage the sources of risks.
In the European Manual for Risk Assessment, Albuquerque et al. (2013, 41) define the principles of risk assessment as following:
- Risk Assessment is a process that can only be made with the victims’/survivors’ collaboration
- Victims/Survivors own assessment of their safety and risk levels must be considered. Research shows that victims/survivors have the most accurate assessment of their own risk level
- Victims/Survivors must be listened to without the presence of the perpetrator, family and/or their community members
- Children should have the opportunity to talk
- Professionals have the responsibility to assess, manage and monitor the perpetrators risk
- Professionals, in case of significant harm to children, must consider and agree on the best procedure that safeguards and protects them
- It is important to clarify the limits of the risk assessment and management process
- No improbable or unrealistic promises should be made
Professionals should also have knowledge of the dynamics of domestic violence, the impact of IPV on victims-survivors, the factors that influence women’s decisions on leaving or remaining in the violent relationship, the strategies perpetrators use and the risk factors (Albuquerque et al. 2013, 35).
Step 1: Identification of risk factors
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
Step 2: Risk assessment
The learning objectives of this module are to become familiar with the domestic violence risk assessment procedure, different risk assessment tools and high-risk moments that may increase the risk.
Risk assessment is a phase, during which the level of the risk and its nature are assessed. Start with reading how risks are assessed in Nora’s case. Then take a look at the general guidelines, risk assessment tools and high-risk moments.
Case scenario: Nora
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:
If Nora is asked about her situation, she may tell us this:
– Her speech issues developed four months ago after Peter had strangled her
– She fears that Peter will kill her if she separate from him
– She is worried that her residence permit will be cancelled if she separates; this is what Peter has told her
– She is worried that the police won’t believe her since she is an immigrant but Peter has the nationality of this country
– Peter has told that he will publish private sexual pictures of her if she tells anyone about the violence or tries to leave him
– Peter has said that he will make sure that no decent man will ever even look at Nora if she separates from Peter.
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:
• using violence more frequently
• using more intensive (harmful, injurious) violence
• strangled Nora
• used coercive control
• used physical violence
• used economic, digital and psychological violence
• previous criminal record entries
• is planning a divorce
• has an immigrant background
• strong fear
• social isolation
• mental health issues
The community of Nora and Peter is justifying violence by
In order to enable constructive and smooth co-operation between different agencies, the legislation should be clear and every partner should understand their roles and responsibilities.
(1) Do you know, in which situation you can share and exchange information with other agencies?
General guidelines for risk assessment
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)
Risk assessment tools
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.
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.
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.
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.
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
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.
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”.
High-risk moments and triggers for increasing risk
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
Step 3: Outlining necessary actions
The learning objectives of this module are to become familiar with the safety planning, risk management and multi-agency cooperation.
Outlining necessary actions is a phase where the frontline responders in close co-operation plan safety measures and take action to ensure the victim’s safety. Again, read first about Nora’s case. Then, look at the to do –list and read why a strong co-operation network is crucial.
Case scenario: Nora
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.
Why we need a strong co-operation network?
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.)
To do -list for the frontline responders
- 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
- 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
- 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
Step 4: Follow-up
The learning objectives of this module are to become familiar with the purpose of the follow-up phase and to understand the need for a dynamic risk assessment process.
Follow-up is a phase, during which the frontline responder is in regular contact with the victim. Read first why we need the follow-up phase and then see what the follow-up looks like in Nora’s case.
Why do we need the follow-up phase as a part of the risk assessment process?
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.
Case scenario: Nora
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.
- Istanbul Convention
- Risk assessment by police of intimate partner violence against women (presentation)
- The Influence of Victim Vulnerability and Gender on Police Officers’ Assessment of Intimate Partner Violence Risk (article)
- EIGE: Risk assessment and management
- A guide to risk assessment and risk management of intimate partner violence against women for police
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 21st of April 2021.] Retrieved from: https://www.who.int/news-room/fact-sheets/detail/elder-abuse