Module 7: Principles of interorganisational cooperation and risk assessment in cases of domestic violence in multi-professional teams

To ensure a successful partnership, certain principles can be developed and agreed on by different agencies working together. The points listed below can help professionals and organisations to draw and agree on certain principles that all agencies working together should adhere to.

• Understand that without effective prevention and early intervention domestic violence often escalates in severity and, therefore, it is important to make every effort to identify and support adult and child victims earlier.
• Prioritise safety of the victim-survivors and their children when considering interventions and acting immediately on disclosure of risk of harm.
• Data about all incidents of domestic violence should be recorded, analysed, and shared with management of agencies working together regularly and appropriately.
• Encourage cooperation with institutions and authorities that work with perpetrators in order to assess risks on a multi-professional basis and to prevent new incidents of violence.
• At the initial engagement with the services, informed consent of the victim-survivor should be gained to ensure information between agencies can be shared, when required, without unnecessary delay.
• Work cooperatively to provide a supportive and enabling environment which encourages people to report domestic violence to the police and other professionals and agencies.
• Respect confidentiality and privacy wherever possible and understand the risks associated with information sharing in the context of domestic violence.
• Develop and adhere to shared policies and procedures to guide information sharing between different organisations.
• Ensure that victim-survivors are treated with respect and dignity. By listening to them and believing their experiences and assuring them that they are never to blame.
• Empower domestic violence victim-survivors to make well-informed choices and decisions for themselves, wherever possible. Do not make decisions for them without their involvement.
• Ensure that services are sensitive to the diverse need of the victim-survivors considering their age, disability, gender, race or ethnicity, religion or belief, sexual orientation, but recognise that such differences are not used as an excuse for accepting or perpetrating domestic violence or other harmful practices.
• Recognise that victim-survivors and their children are most at risk when attempting to leave an abusive relationship or seeking help.
• The health and dental care’s information about patients is subject to confidentiality rules. It is important to know when you can break internal and external confidentiality.

Multi-agency working has its own challenges. Fundamentally, different agencies and service providers have different organisational missions, visions, values, aims and objectives. They have different targets and tasks and may also have different rules, regulations and working mechanisms. This makes it difficult for professionals in these agencies to work together at the same pace. There could also be a lack of understanding of the role and responsibilities of staff and the language used by individuals and organisations could be different leading to issues in working together.

A good example to elaborate this is the difference in the language, definitions and labels used to refer to the victim-survivor with various labels in operation including ‘victim’ (criminal justice system), ‘survivor’ (women-centred organisations), ‘patient’ (healthcare services), ‘tenant’ (housing services), ‘service user’ (welfare agencies) and ‘customer’ (adults’ social care). When working with perpetrators, the term victim is also used in the sense of criminal law, but it can also refer to ‘relatives’ and ‘clients’ in general.

Data gathered by different agencies is not comparable due to variations in the type of data collected, ways it is recorded, data storage and lack, or data portability mechanisms. There may also be different understandings of what constitutes domestic violence and its impact among different organisations. High staff turnover in organisations is also a barrier and affects communication as it takes time for people to develop trusting relationships.

In addition, different services do not always communicate with each other, and are often not allowed to exchange information, partly for data protection reasons, resulting in the lack of sharing information. Consequently, the victims must repeatedly provide their information, including details of their abusive experiences to different people in different organisations. Recalling experiencing can itself be traumatic for victim-survivors and consequently may deter them from accessing support.

• The Danger Assessment is an instrument that helps to determine the level of danger for an abused woman of being killed by her intimate partner.
• There are two parts to the tool: a calendar and a 20-item scoring instrument. The calendar helps to assess severity and frequency of battering during the past year. The calendar portion was conceptualised as a way to raise the woman’s consciousness and reduce the denial and minimisation of the abuse, especially since using a calendar increases accurate recall in other situations.
• The 20-item instrument uses a weighted system to score yes/no responses to risk factors associated with intimate partner homicide. Some of the risk factors include past death threats, partner’s employment status, and partner’s access to a gun.
• The tool is currently available in English¹⁰, Spanish, Canadian French and Brazilian Portuguese.
• A short four-item version called the Lethality Assessment has been developed for use by law enforcement officials responding to domestic violence calls. Women at high risk are then referred to advocates who have been trained in the Danger Assessment.

The Domestic Violence Risk Appraisal Guide (DVRAG) contains the same items as the Ontario Domestic Assault Risk Assessment (ODARA), but also incorporates psychopathy checklist-revised (PCL-R) findings. The DVRAG is a 14-item actuarial tool which assesses the probability of Intimate Partner Violence perpetrated by males against a female partner, and how this risk compares with that of other abusers. These tools may also predict the speed and number of recidivistic offenses and the severity of injuries caused. The general scoring criteria include the instructions for scoring and interpreting the ODARA in any setting.¹² DVRAG is intended for use by forensic clinicians and criminal justice officials who can access in-depth information.

DASH stands for domestic abuse, stalking and ‘honour’-based violence. The risk assessment tool was the outcome of documenting 47 domestic homicides and cataloguing the key risk variables to develop the DASH risk model. The DASH checklist is used by a number of agencies in Scotland, including the police. However, it has not been introduced everywhere in Scotland. The DASH risk checklist is supposed to be a consistent and simple tool for practitioners who work with adult victims of domestic abuse. It is supposed to help them identify those who are at high risk of harm and whose cases should be referred to a MARAC meeting in order to manage their risk.

Video introducing risk identification in domestic violence cases utilising the DASH RIC checklist: https://www.youtube.com/watch?v=AB00K1jiFUc&t=23s

The Domestic Abuse Intervention Program (DAIP) in Duluth, Minnesota, USA, has developed 26 questions to assess the danger emanating from a perpetrator. The Duluth model emphasises the importance of an interagency cooperation and coordinated community response to battering, of victim safety and offender accountability.

DyRiAS stands for Dynamic Risk Assessment Systems. DyRiAS Intimate Partner has been in operation in Germany, Austria and Switzerland since January 2012. On the one hand, the instrument measures the risk of committing acts of serious violence against the intimate partner. In addition, a separate scale measures the risk of mild to moderate physical violence. DyRiAS-Intimate Partner only records violence in heterosexual relationships, starting with the male (former) partner. The duration of the current or former relationship is immaterial and can range from a short to a long-term relationship. In total, DyRiAS Intimate Partner comprises 39 items.

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.

Task for reflection

a) What could have been done better by those involved?

b) Take a moment to consider which agencies and professionals should have been involved in supporting and/or providing services to Gabby from the beginning.

c) Make a list of different professionals who make up the multidisciplinary team in your organisation and who could be involved in the provision of services for those who have experienced domestic violence (this will vary depending upon where you are based).

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