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The Oklahoma Lethality Assessment Study: A Quasi-Experimental Evaluation of the Lethality Assessment Program

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This quasi-experimental field trial examined the effectiveness of the Lethality Assessment Program ðLAPÞ, a police–social service collaboration wherein social service practitioners provide advocacy, safety planning, and referral for services over the telephone during police-involved intimate partner violence (IPV) incidents for women at high risk of homicide. We conducted structured telephone interviews with survivors as soon as possible after the incident of violence and again approximately 7 months later. The majority of participants (61.6 percent) recruited during the intervention phase of the study talked to the hotline advocates, and propensity score– matched analyses indicate that women who received the intervention reported using significantly more protective strategies and were victimized by significantly less physical violence than women in the comparison group. While additional research needs to be conducted, this study demonstrates that the LAP is a promising evidenceinformed intervention that holds the potential to increase survivors' safety and foster decisions of self-care.
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The Oklahoma Lethality Assessment Study: A Quasi-Experimental Evaluation of the Lethality
Assessment Program
Author(s): Jill Theresa Messing, Jacquelyn Campbell, Daniel W. Webster, Sheryll Brown,
Beverly Patchell, and Janet Sullivan Wilson
Source:
Social Service Review,
Vol. 89, No. 3 (September 2015), pp. 499-530
Published by: The University of Chicago Press
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The Oklahoma Lethality Assessment
Study: A Quasi-Experimental
Evaluation of the Lethality
Assessment Program
jill theresa messing
Arizona State University
jacquelyn campbell
Johns Hopkins University
daniel w. webster
Johns Hopkins Bloomberg School of Public Health
sheryll brown
Oklahoma State Health Department
beverly patchell
University of Utah
janet sullivan wilson
University of Oklahoma Health Sciences Center
abstract This quasi-experimental eld trial examined the effectiveness of the
Lethality Assessment Program ðLAPÞ, a policesocial service collaboration wherein
social service practitioners provide advocacy, safety planning, and referral for services
over the telephone during police-involved intimate partner violence ðIPVÞincidents
for women at high risk of homicide. We conducted structured telephone interviews
with survivors as soon as possible after the incident of violence and again approxi-
mately 7 months later. The majority of participants ð61.6 percentÞrecruited during the
intervention phase of the study talked to the hotline advocates, and propensity score
matched analyses indicate that women who received the intervention reported using
signicantly more protective strategies and were victimized by signicantly less
physical violence than women in the comparison group. While additional research
Social Service Review (September 2015). © 2015 by The University of Chicago. All rights
reserved. 0037-7961/2015/8903-0003$10.00
499
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needs to be conducted, this study demonstrates that the LAP is a promising evidence-
informed intervention that holds the potential to increase survivorssafety and foster
decisions of self-care.
introduction
Intimate partner violence ðIPVÞis the systematic use of power and control
by one partner in an intimate relationship in order to subordinate another,
and it is often reinforced through physical or sexual violence ðStark 2007Þ.
Approximately 35 percent of women in the United States will be abused by a
current or former intimate partner in their lifetimes, and IPV is dened by
the Centers for Disease Control and Prevention as physical violence, sexual
violence, threats of violence, coercion, psychological aggression, or stalking
ðBlack et al. 2011Þ.Twenty-ve percent of women will be victimized by
severe physical IPV ðincluding being hurt by having their hair pulled, being
hit with a st or something hard, being kicked, being slammed against
something, being strangled or suffocated, being beaten, being burned on
purpose, or being abused with a knife or gunÞin their lifetimes ðBlack et al.
2011Þ. In 2010, IPVaccounted for 22 percent of all violent crimes committed
against women ðTruman 2011Þ. Although police are generally the rst
responders in cases of IPV, their response focuses on accountability for the
offender and may not take into account the service needs of victim-
survivors.
The Lethality Assessment Program ðLAPÞ, which was developed by the
Maryland Network Against Domestic Violence, is a collaboration between po-
lice and social service providers and is intended to provide victim-survivors
with advocacy services at the scene of police-involved IPV incidents. Police
ofcers responding to the scene of an IPV incident use a risk assessment
called the Lethality Screen to identify victim-survivors who are at high
risk of homicide.Women who are determined by the screening to be at high
risk are offered the opportunity to speak on the telephone with an advo-
cate at a collaborating domestic violence agency. During the phone call, the
advocate provides the victim-survivor with immediate safety-planning as-
sistance and encourages her to come in for further services. Collaboration,
self-determination, and empowerment are the foundation of this intervention.
The purpose of this quasi-experimental eld trial was to estimate the
effectiveness of the LAP. The study was conducted in seven police juris-
dictions in Oklahoma, a state where a high proportion of women are
victimized by IPV and intimate partner homicide ðBlack et al. 2011; Violence
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Policy Center 2013Þ. In particular, we asked the following research ques-
tions: Does the LAP ðiÞincrease the use of safety strategies and ðiiÞreduce
the frequency and severity of repeat IPV?
ipv risk assessment
IPV risk assessment instruments provide information about the likelihood
that an abuser will re-assault, severely re-assault, or kill his intimate partner
ðMessing and Thaller 2014Þ. Many victims of IPV, especially those who have
been severely abused, are acutely aware of the possibility of homicide
ðStuart and Campbell 1989; Langford 1996Þbut have difculty assessing and
tend to underestimate their degree of risk ðHeckert and Gondolf 2000;
Sharps et al. 2001; Campbell 2004Þ. Victim-survivors of IPV should be
educated about their risk and potential risk factors ðCampbell 2004Þ, par-
ticularly because victim-survivors often take protective actions when they
recognize that the violence is escalating, and their concerns for their safety
may motivate them to leave their abusers or take other actions to increase
their safety ðGondolf and Fisher 1988; Fischer and Rose 1995; Campbell et al.
1998; Martin et al. 2000; Pape and Arias 2000; Short et al. 2000; Burke et al.
2004Þ. As police ofcers are often the rst responders in cases of IPV, they
are in an ideal position to conduct risk assessment.
In order to predict which women are at a high risk of re-assault or
homicide, the LAP uses the Lethality Screen, an 11-item version of the
Danger Assessment ðDAÞthat is intended for use by eld practitioners or
rst responders. The DA is intended to predict femicide ðCampbell et al.
2003Þ, but it is also successful at predicting repeat assault ðMessing and
Thaller 2013Þ. The Lethality Screen has shown high levels of sensitivity for
predicting severe IPV ða womans partner forced sex, abused her with a
knife or gun, punched her, hit her with something that could hurt, strangled
her, beat her up, burned her, kicked her, tried to kill her, or nearly killed her;
93.18 percentÞand near-lethal IPV ðawomans partner tried to kill her or
nearly killed her; 92.86 percentÞ. It has shown a slightly lower sensitivity
ð86.96 percentÞwhen predicting any IPV ðMessing et al. 2015Þ.However,
specicity is low in all analyses ð21.321.95 percentÞ. The Lethality Screen
has good agreement with IPV survivorsperceptions of risk and with the DA
ðMessing et al. 2015Þ. The high sensitivity for predicting severe and near-
lethal IPV is ideal for use with the LAP, because, on balance, it seems better
to screen an IPV victim-survivor who may not be re-assaulted into a brief
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advocacy intervention than to decline to provide the intervention to a
woman who is at risk for future violence or homicide.
help-seeking among survivors of ipv
The Bureau of Justice Statistics indicates that approximately half of IPV
victim-survivorsreport that the police had been called due to IPV ðBachman
and Coker 1995; Rennison and Welchans 2000; Catalano et al. 2009Þ.Upto
92 percent ofwomen who are seeking services, such as help from the courts,
assistance with orders of protection, legal assistance, or domestic violence
services ðe.g., advocacy, shelterÞ, report that the police had been called due
to IPV ðBerk et al. 1984; Goodman et al. 2003; Goodkind, Sullivan, and Bybee
2004Þ. The proportion of women seeking help from the police signicantly
increased from 1993 to 1998 ðRennison and Welchans 2000Þ, and when the
victim identies IPVas a crime, domestic violence is reported to the police
at rates equal to the reporting of other crimes ðFelson et al. 2002Þ.
As the severity or frequency of abuse increases, so do calls to the police
ðJohnson 1990; Gondolf 1998; West, Kantor, and Jasinski 1998; Bonomi et al.
2006Þ. Fifty-six percent of victims of intimate partner homicide had called
the police in the year before they were killed, and 24.5 percent had an order
of protection ðCampbell et al. 2003Þ. Thus, the majority of victims of
femicide had contact with the police, yet the police response was unable to
save their lives. A call to the police does not always result in an arrest, and
research is mixed on the deterrent effects of arrest ðMaxwell, Garner, and
Fagan 2001; Campbell et al. 2003; Campbell et al. 2005; Felson, Ackerman,
and Gallagher 2005; Hirschel 2008; Cho and Wilke 2010Þ. Across studies,
recidivism rates after arrest range from 17 percent ðFelson et al. 2005Þto 49
percent ðHilton et al. 2008Þ.
Women access domestic violence services much less often than they seek
police help. Among samples of women not recruited from shelters or
domestic violence service agencies but generally recruited after coming into
contact with the police or seeking an order of protection, the percent of
victim-survivors accessing domestic violence services ranges from 4.8 per-
cent to 38 percent ðBrookoff et al. 1997; Gondolf 1998; Hutchison and
Hirschel 1998; Coker et al. 2000; Macy et al. 2005Þ, and the percent of
women accessing shelter services ranges from 3 percent to 8.9 percent
ðBrookoff et al. 1997; Gondolf 1998; Hutchison and Hirschel 1998; Wiist and
McFarlane 1998Þ. While research nds that accessing domestic violence
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services ðGondolf 1998; Coker et al. 2000; Henning and Klesges 2002; Macy
et al. 2005Þand shelters ðGondolf 1998; West, Kantor, and Jasinski 1998Þ
increases as the severity of physical violence increases, in one study exam-
ining homicide, only 4 percent of the women who were murdered by their
intimate partners had accessed domestic violence shelters or crisis services
in the previous year ðSharps et al. 2001Þ. Shelter services are shown to be
effective in reducing severe and moderate re-assault in one prospective
study ðMessing, OSullivan, et al. forthcomingÞ.
Women who lack awareness of available resources and who encounter
difculty when accessing services are more likely to remain in abusive
relationships ðPatzel 2006Þ. A collaborative response, such as the LAP, that
is intended to bring together the criminal justice and social service systems
is therefore expected to reduce IPV ðSalazar et al. 2007Þ. Jurisdictions with a
coordinated community response nd that their specialized police units
make more felony arrests of IPVoffenders ðBledsoe, Sar, and Barbee 2006Þ.
In addition, policesocial service collaborations increase the likelihood that
victim-survivors will seekhelp from the criminal justice system in the future
ðDavis and Taylor 1997; Davis, Maxwell, and Taylor 2003; Hovell, Seid, and
Liles 2006; Stover 2012Þ. However, there is insufcient evidence showing
that these programs reduce victimization ðDavis and Taylor 1997; Davis et al.
2003; Garner and Maxwell 2008; Hovell et al. 2006; Stover 2012Þ.
Research suggests that low-cost, clear, simple assessments and referrals
such as teaching women safety strategies over the telephone can be effective
in helping women in abusive relationships enhance their safety skills ðMc-
Farlane et al. 2004; McFarlane et al. 2006Þ. Theoretically, the optimal time
for intervention may be shortly after an abusive episode, when women are
likely to believe that the violence will not cease and are more likely to reach
out for help ðCurnow 1997Þ. Data collected on the LAP from 100 agencies
across Maryland demonstrate that a portion of IPV victim-survivors who
are at high risk will seek services after the intervention occurs. In 2012,
Maryland jurisdictions conducted 12,108 risk assessments, determining
that 6,224 victims ð51 percentÞwere at high risk for homicide. Of the vic-
tims who were at high risk, 3,277 ð53 percentÞspoke on the phone to
an advocate. Of those victims who spoke on the phone to an advocate, 925
ð28 percentÞlater sought services, such as counseling, legal assistance, or
shelter from the service provider to whom they spoke ðMNADV 2013Þ.
Without a comparison group, however, it is unclear whether these ndings
can be attributed to the LAP.
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This study, which analyzes the effectiveness of the LAP in seven police
jurisdictions in Oklahoma, is the rst rigorous evaluation of the LAP. We
hypothesize that:
H1: The LAP increases the rates of measured emergency safety planning
and help-seeking both (a) immediately after the intervention and (b)at
follow-up.
H2: The LAP decreases the frequency and severity of repeat IPV among
women who had police contact due to IPV in participating jurisdictions
during the studystimeframe.
method
study design
The study is a nonequivalent groups quasi-experimental eld trial using a
historical comparison group ðsee also Messing, Campbell, and Wilson 2015Þ.
The comparison group was recruited into the study prior to the implemen-
tation of the LAP and received what was, at that time, the standard police
response, while the intervention and intent-to-treat groups were recruited
into the study after implementation of the LAP and received the LAP
response. Our aim was to assess the effect of a collaborative policesocial
service intervention on victim-survivors who were at high risk of future
violence and homicide, in light of previous research suggesting that tele-
phone intervention and referral can lead to the adoption of safety strategies
ðMcFarlane et al. 2004, 2006Þ. Thus, our main analyses estimate treatment-
on-the-treated effects by comparing women who were at high risk for fu-
ture violence and homicide and received the standard police response ðhere-
after, the comparison groupÞto women who were at high risk for future
violence and homicide and were informed of their risk status by a police
ofcer and chose to speak to a hotline advocate at the scene of a police-
involved IPV visit ðhereafter, the intervention groupÞ. We additionally esti-
mate intent-to-treat effects by examining differences between women in the
comparison group and women who were at high risk for future violence and
homicide and were informed of their risk status by a police ofcer at the
scene of a police-involved IPV incident, regardless of whether or not they
chose to speak to the hotline advocate ðhereafter, the intent-to-treat group;
see g. 1Þ. This research was approved by the institutional review boards of
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the University of Oklahoma Health Sciences Center, the Oklahoma State
Department of Health, Arizona State University, Johns Hopkins University,
the Cherokee Nation, and the National Institute of Justice.
study site
The seven participating police jurisdictions in Oklahoma were primarily
urban and had a total population of 1,150,000 people ðsee table 1Þ.There
FIGURE 1. Procedure and sample flow chart
table 1. Information about Participating Jurisdictions
Classication Population
Number of
Ofcers
Number of
Advocates
Urban 17,000 32 Unknown
Urban* 580,000 1,029 20
Urban*
,a
392,000 745 15
Suburban*
,a
99,000 130 15
Urban ðcollege townÞ* 46,000 71 Unknown
Rural ðIndian nationÞ
b
Unknown 14 Unknown
Urban ðcollege townÞ
b
16,000 30 Unknown
Note.The population numbers for this table were obtained from the US Census Bureau, QuickFacts
Beta, April 1, 2010. The numbers of advocates were provided by the advocacy organizations. Classication
types having the same superscripted letters had the same advocacy organizations and therefore have the
same number of advocates.
* Referred participants during the intervention and comparison phases of the research study.
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was a range in jurisdiction size,with populations of 16,000 to 580,000, and
police departments ranging in size from 14 deputies to 1,029 sworn ofcers.
Where information is known, between 15 and 20 advocates per agency
assisted with the LAP intervention.
intervention training
The Maryland Network Against Domestic Violence ðMNADVÞprovided
their standard 1-day LAP train-the-trainer training to select police ofcers
and advocates in Oklahoma. Following this, MNADV provided each police
department with a PowerPoint presentation that trainers within the police
departments and social service agencies used to conduct mandatory train-
ings with additional ofcers and advocates. The LAP training was also
integrated into police academy training on IPV. In order to encourage
ofcers to carry out the LAP as intended, throughout the study period,
researchers ðsometimes in collaboration with advocatesÞprovided police
departments with brief electronic ðMediasite, PowerPointÞand in-person
roll-call refresher trainings. MNADV remained available throughout the
study period to provide support and technical assistance to police depart-
ments and advocacy organizations.
Prior to the LAP training, ofcers conducted their police investigation
and provided victim-survivors with a card that included information about
IPV and a toll-free hotline number.
1
Before implementation of the LAP,
ofcers did not conduct risk assessment during their visits, did not use risk
assessment to educate victim-survivors about the risk that their intimate
partners posed and risk factors for future violence and homicide, and did not
actively engage with victim-survivors to reach out to advocacy services and
implement safety strategies. Ofcers then received the LAP training on how
to assess risk using the Lethality Screen, score the risk assessment, and ini-
tiate a telephone call with a hotline advocate for high-risk victim-survivors.
Police ofcers were instructed to ask victim-survivors the 11 questions
included on the Lethality Screen outside of the presence and hearing of the
perpetrator ðsee g. 2Þ.Ofcers were taught to then score the Lethality
Screen and classify victim-survivors as high riskor not high riskbased
on the victim-survivors responses to the 11 questions. Ofcers were
1. Oklahoma has a discretionary arrest policy for domestic violence assault ðOK State
Statute §2260.16Þ.
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additionally trained to use their own professional judgement; if an ofcer
believes that a victim-survivor is at high risk but she is not classied as such
based on the Lethality Screen, the ofcer is also able to make a determina-
tion of high risk based on his or her belief.
When a victim-survivor screens in as high risk, the ofcer is instructed
to tell her that she is at high risk for homicide and to ask her if she is will-
ing to speak on the telephone to a hotline advocate. If the victim-survivor
agrees to speak to an advocate, the ofcer then calls the hotline number and
FIGURE 2. The Lethality Screen
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places the victim-survivor on the telephone with the advocate. The advo-
cate is trained to keep the telephone conversation brief, express concern
for the victim-survivors well-being and the well-being of her children
if applicable, reinforce the ofcers message about the risk that she faces
due to IPV, conduct immediate safety planning, and encourage the victim-
survivor to come in for additional services. If a high-risk victim-survivor
chooses not to speak on the telephone to an advocate, the ofcer is trained
to call the advocacy hotline and obtain immediate safety planning advice
to share with the victim-survivor.While on the telephone, the ofcer may
ask the victim-survivor again if she would like to speak to the advocate. If
there are any immediate safety planning steps that the ofcer can then
take with the high-risk victim-survivor ðe.g., transport to shelterÞ,the
ofcer is trained to do so. If a victim-survivor is not classied as high risk,
the ofcer is trained to tell her that IPV can be dangerous, provide her with
information about risk factors for homicide, and refer her to local domestic
violence services.
comparison group
The comparison group was recruited into the study prior to the implemen-
tation of the LAP, between July 2009 and October 2010. During this time,
1,137 women were referred to researchers by police departments. Research-
ers were not able to contact 486 ð42.7 percentÞof the women who were
referred, and another 47 women ð4.1 percentÞwere not eligible to partici-
pate in the study ðe.g., they were under 18 or were notvictims of IPVÞ.Ofthe
604 eligible referrals researchers contacted, 440 ð72.8 percentÞparticipated
in a baseline interview. Seven duplicate participants were removed from the
comparison group ðn5433Þ. At the beginning of the baseline interview,
researchers conducted the Lethality Screen with comparison group partic-
ipants, referencing the victim-survivors current situation with her abusive
partner; 342 women ð79.0 percentÞwere deemed high risk, and they make
up the comparison group.
intervention and intent-to-treat groups
Recruitment for the intervention and intent-to-treat groups, conducted
after the implementation of the LAP, occurred from October 2010 through
February 2013. During this time, 2,022 women were referred to
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researchers by police departments. Researchers were not able to contact
1,041 ð51.5 percentÞof the women who were referred, and another 43
women ð2.1 percentÞwere not eligible to participate in the study ðe.g., they
were under age 18 or were not victims of IPVÞ. Of the 938 eligible referrals
the researchers contacted, 657 ð70 percentÞparticipated in a baseline inter-
view. Nine duplicate participants were removed. The intent-to-treat group
consists of 563 women who were classied as at high risk based on their
responses to the Lethality Screen conducted by a police ofcer at the scene
of the IPV incident ðn5538Þor based on ofcer belief ðn525Þ.The
intervention group consists of the 347 women ð61.6 percent of the intent-
to-treat groupÞwho both were classied as high risk by the ofcer and who
spoke with an advocate on the telephone at the scene of the IPV incident.
participant recruitment
At the scene of each IPVincident, after the police ofcer completed the visit,
he or she read an IRB-approved statement asking the victim-survivor if a
researcher could contact her.
2
If the victim-survivor was willing to have a
researcher contact her, the ofcer asked for and recorded one or two safe
telephone numbers and a safe time to call. Researchers were provided with
this information and called victim-survivors to explain the study and obtain
informed consent.
baseline and follow-up data collection
Structured telephone interviews lasting approximately 45 minutes were
conducted with study participants at two time points. Baseline interviews
were conducted as soon as possible after the referral, and the median time
between the police visit and the baseline interview was 15 days. Follow-up
interviews were completed with 212 participants in the comparison group
ð62 percent retention rateÞ, 315 participants in the intent-to-treat group
ð55.9 percent retention rateÞ, and 202 participants in the intervention
group ð58.2 percent retention rateÞ. Women who were employed full-time
or part-time were more likely to participate in follow-up interviews ðX
2
5
2. Police ofcers read IRB statements to women in the comparison group, women in the
intervention group,women in the intent-to-treat group, and women who were not ultimately
interviewed.
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5.923, p<.05Þ, as were participants who had higher levels of education
ðX
2
513.535, p<.05Þ. There was a signicant difference in the mean time to
follow-up for the intervention and comparison groups ðt53.577; df 5
316.723; p<.0001Þ.Participantsinthecomparison group averaged
8.28 months ðSD 53.72Þto follow-up, and participants in the interven-
tion group averaged 7.25 months ðSD 51.89Þtofollow-up.Therewereno
signicant differences in mean time to follow-up between the interven-
tion and intent-to-treat groups, with the intent-to-treat group averaging
7.2 2 m on th s ðSD 51.90Þto follow-up. The median time to the follow-up
interview for all participants was 7 months.
measurement
Demographic and Relationship Characteristics
At the baseline interview, participants were asked to report their educa-
tional achievements, their employment status, their ethnic background,
their immigration status, their age in years, their legal marital status, the
gender of their abusive partner, whether they had children living in their
households,whether they had children with their abusive partners,whether
they were currently pregnant, and whether they currently lived with their
abusive partners.
Protective Actions
Protective actions were assessed using an adapted version of McFarlane
and colleaguesð2004Þsafety-promoting behavior checklist ðsee the ap-
pendixÞ. At baseline, participants were asked whether they had engaged in
any protective actions in the 6 months prior to the police visit or since the
police visit. At follow-up, participants were asked to report any protective
actions they had engaged in since they last spoke to the interviewer.
Intimate Partner Violence
Experiences of IPV were assessed at baseline ðin the past 6 monthsÞand
follow-up ðsince the last interviewÞusing an adapted version of the revised
Conict Tactics Scale ðCTS-2; Straus et al. 1996Þ. In order to examine the
frequencyand severity of physical violence, items on the CTS-2 were scored
using the severity-times-frequency weighted score, as recommended by the
scale developer ðStraus 2004Þ. Scores from the baseline interview were
subtracted from scores on the follow-up interview in order to examine
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changes ðdecreases/increasesÞin violence severity and frequency between
baseline and follow-up.The CTS-2 has demonstrated median internal con-
sistency of .82 in studies examining female IPV victimization and reports
good construct validity ðStraus and Mickey 2012Þ. In this study, the CTS-2
frequency-by-severity scores demonstrated adequate internal consistency at
baseline ða5.77Þand excellent internal consistency at follow-up ða5.96Þ.
The Danger Assessment
Researchers administered the Danger Assessment ðDAÞat the baseline
interview, referencing victim-survivorscurrent situations with their abu-
sive partners. This risk assessment was administered in addition to the
Lethality Screen ðwhich was administered by police at the scene of the IPV
incident to women in the intervention and intent-to-treat groups and by
researchers at the time of the baseline interview to women in the compar-
ison groupÞ, as it has a more extensive history of validation, includes
additional risk factors, and has greater specicity ðCampbell et al. 2003;
Campbell, Webster, and Glass 2009; Messing and Thaller 2013Þ. Items on
the DA are weighted and summed to produce an overall score, with higher
numbers indicating greater risk.Weighted and summedscores can be placed
into four categories of risk: variable danger ð07Þ, increased danger ð813Þ,
severe danger ð1417Þ,andextremedangerð18 or higherÞ. In this study, the
DA demonstrated adequate internal consistency at baseline ða5.76Þand at
follow-up ða5.76Þ.
analysis
Because the main analyses focus on treatment-on-the-treated effects, partic-
ipants in the comparison and intervention groups were compared on demo-
graphic and relationship characteristics using bivariate statistics. Where no
differences were found, these characteristics are reported for the interven-
tion and comparison groups combined. Where differences between groups
were found, these differences are reported and the characteristics of the
comparison and intervention groups are reported separately. As the inter-
vention group is a subset of the intent-to-treat group, the demographic and
relationship characteristics of these two groups are similar. Throughout, cases
with missing values on any variable were dropped from the analysis. Depend-
ing on the analysis, 1.26.1 percent of cases had missing data, accounting for
the slightly different sample sizes across analyses of similar data.
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Regression Controlling for Covariates
Logistic and linear regression models ðhereafter, regression modelsÞwere
used to estimate the effect of intervention group status ðvs. comparison
group statusÞon protective actions and violent victimization. Covariates
were included in the models to control for intervention group and compar-
ison group baseline differences in marital status, immigration status, DA
category, and time between the baseline and follow-up interviews.
Propensity Score Analysis
Given nonrandom assignment to intervention and comparison groups,
signicant observed differences between the groups at baseline, and juris-
dictional differences in the implementation of the LAP intervention, pro-
pensity score matching was used to estimate the average treatment effect
on the treated participants ðRosenbaum and Rubin 1983Þ. By using propen-
sity scores, we adjust for observed selection bias, thus allowing an estima-
tion of causal inference in a study that is not a true experiment ðGuo and
Fraser 2015Þ. Because propensity scores are estimated ðnot knownÞ,we
used the teffects psmatchcommand in STATA 14 ðAbadie and Imbens
2012Þ. This command employs nearest-neighbor matching of cases with
replacement.When propensity scores are tiedthat is, when there is more
than one match for an observation in the intervention groupthe observa-
tion is matched with all tied observations. Three police jurisdictions were
dropped from the propensity score analysis because they did not refer
participants to both the comparison and intervention groups ðn5811
depending on analysis; see table 1Þ. The standardized difference and
variance ratios were used to examine group balance before and after
propensity score matching, and balance was improved in the matched
data. Postpropensity score matching, hypotheses were tested using linear
or logistic regression.
Intent-to-Treat Analysis
Propensity score-matched analyses were also conducted using an intent-to-
treat framework, as 61.6 percent of participants who were assigned to the
LAP intervention ði.e., screened as high risk by a police ofcerÞwere
included in the intervention group ði.e., spoke to a hotline advocateÞ.
Intent-to-treat models are conservative. Because not everyone assigned to
receive the intervention receives it, an intent-to-treat analysis will consis-
tently provide a smaller estimate of the effect of the intervention than can be
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attributed to the intervention itself ðAngrist 2006Þ. In this study, a relatively
low proportion of participants who were assigned to the LAP intervention
received it, which would be expected to seriously attenuate any effect.
Intent-to-treat analysis relies on the assumption that the proportion of
people assigned to treatment and those actually treated will be similar
across all implementations of the intervention ðAngrist 2006Þ.However,
this proportion differed widely across jurisdictions in this study ðrange:
from 42.1 percent to 77.8 percentÞ. The intent-to-treat model cannot be
expected to provide an accurate average intervention effect across such a
wide range of compliance rates. Nevertheless, intent-to-treat analyses are
another strategy for taking selection into account in estimating intervention
effects, and thus they may still provide useful information.
results
description of the comparison
and intervention groups ðbaselineÞ
Participants in the comparison and intervention groups ranged in age from
18 to 79 years,with a mean age of 32.52 ðSD 59.94Þ. The largest racial/ethnic
group was white ð42.8 percentÞ, followed by African American ð29.4 per-
centÞ, Native American ð10.0 percentÞ,Latinað7. 9 pe r ce n tÞ, multiracial
ð7.5 p e rc en t Þ,andotherð2.2 percentÞ.Lessthanone-fth of participants
ð16.8 percentÞreported that they currently lived with their partners, and
2.5 percent of participants reported that their partners were female. Sixty-
ve percent of participants reported that they had children living in their
households, 45.7 percent of participants reported that they had children
in common with their partners, and 7.1 percent of participants reported that
they were currently pregnant at the time of the baseline interview. Approx-
imately half of participants reported that they had completed high school
or had a GED ð51.8 percentÞ, and less than half of participants were em-
ployed part-time or full-time ð40.64 percentÞ.
There were signicant differences ðX
2
56.73, p<.05Þin marital status
between the comparison group and the intervention group, with nearly
twice as many participants in the comparison group reporting that they
were separated or divorced. In the comparison group, 58.3 percent of
participants reported that they were single, 22.8 percent reported that they
were married, and 18.9 percent reported that they were separated or
divorced. In the intervention group, 64.6 percent of participants reported
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that they were single, 24.3 percent reported that they were married, and 10.9
percent reported that they were separated or divorced.
Few participants overall were born outside of the United States, but
there were signicant differences in immigration status ðX
2
54.7, p<.03Þ
between the intervention and comparison groups, with over twice as
many women born outside of the United States in the intervention group
ð5.6 percentÞthan in the comparison group ð2.4 percentÞ. There were
signicant differences in DA category ðthe four categories being, in increas-
ing severity, variable danger, increased danger, severe danger, and extreme
dangerÞwith signicantly more ðX
2
518.94, p<.0005Þintervention group
participants in the variable danger category ð12.7 percentÞthan comparison
group participants in the variable danger category ð3.8 percentÞ. A similar
proportion of comparison group participants ð51.8 percentÞand interven-
tion group participants ð50.4 percentÞfell into the extreme danger category,
demonstrating that any difference was primarily at the lower end of the
danger spectrum. DA category was signicantly associated with immigra-
tion status ðX
2
510.07, p<.05Þ, with a greater proportion of immigrant
women at the lower end of the danger spectrum. In propensity score
matched analyses, these variables are modeled using an interaction term,
which improves group balance but leads to small cell sizes and up to nine
cases being dropped in some analyses.
protective actions
We hypothesized that the LAP would increase womens use of protec-
tive actions ðhypothesis 1Þ, both immediately after the police contact
ðhypothesis 1aÞand at the time of the follow-up interview ðhypothe-
sis 1bÞ. In order to examine the immediate safety strategies that the par-
ticipants engaged in ðhypothesis 1aÞ, we examined the protective actions
that participants took between the time of police contact and the baseline
interview. As shown in table 2, according to regression analyses, being in
the intervention group is associated with a signicant increase in the
likelihood of having removed or hidden a partners weapons and having
sought formal services for domestic violence between the time when the
policerespondedtotheinitialoffenseandthetimeofthebaseline
interview. The results of the propensity scorematched analyses are
consistent with the regression results, although the parameter estimates
are attenuated. Being in the intent-to-treat group is associated with a
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smaller, but signicant, increase in having sought formal services for do-
mestic violence and is not signicantly associated with the likelihood of
having removed or hidden a partners weapons.
When examining the safety strategies that participants engaged in
between the baseline and follow-up interviews ðhypothesis 1b; see table 3Þ,
regression analyses and propensity scorematched analyses nd that
women in the intervention group are more likely to obtain some form of
protection against an abusive partner, such as mace or pepper spray; apply
for and receive an order of protection; obtain medical care from a doctor or
nurse due to injuries or trauma sustained by IPV; and go someplace where
an abusive partner could not nd or see them ðe.g., to stay with family or
friends; hereafter, hidingÞ. Additionally, in both regression and propensity
scorematched analyses, being in the intervention group is associated with
having a partner who went someplace where he could not nd or see the
participant ðe.g., jail; hereafter, being detainedÞ. In the regression analyses
only, being in the intervention group is associated with having established a
code with family and friends to alert them of trouble and having engaged in
other safety strategies such as improving home security. Being in the intent-
to-treat group is associated with having obtained some form of protection
against an abusive partner, having hidden, and having an abusive partner
who was detained.
violent victimization
We hypothesized that the LAP would decrease the frequency and severity
of violent victimization at follow-up ðhypothesis 2Þ. As shown in table 4,
table 2. Association between Intervention Group Status and Protective Actions at Baseline
Protective Action/
Dependent Variable
Comparison
Group
N
ð%Þ
Intervention
Group
N
ð%Þ
Logistic
Regression
Analysis
ðN5681Þ;
Conditional
OR ½95% CI
Propensity
Score
Analysis
ðN5669Þ;
OR ½95% CI
Intent-to-
Treat
Analysis
ðN5884Þ;
OR ½95% CI
Removed or hid their
partners weapons 13 27 2.48* 1.04* 1.03
1
ð3.8%Þð7.8%Þ½1.14, 5.37½1.01, 1.08½.99, 1.07
Received services related
to domestic violence 75 106 1.79** 1.11** 1.08*
ð21.9%Þð30.5%Þ½1.25, 2.56½1.03, 1.20½1.01, 1.16
1
p<.10.
*p<.05.
** p<.01.
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table 3. Association between Intervention Group Status and Protect ive Act ions at Follo w-Up
Protective Action/
Dependent Variable
Comparison Group N
ð%Þ
Intervention Group N
ð%Þ
Logistic Regression
Analysis
ðN5409Þ;
Conditional OR
½95% CI
Propensity Score
Analysis
ðN5397Þ;
OR ½95% CI
Intent-to-Treat
Analysis
ðN5501Þ;
OR ½95% CI
Established a code with family and friends 84 97 1.63* 1.09 1.10
ð39.6%Þð48.0%Þ½1.07, 2.49½.95, 1.26½.97, 1.25
Obtained something to protect yourself 50 75 2.17*** 1.14* 1.14**
ð23.6%Þð37.1%Þ½1.37, 3.45½1.03, 1.27½1.04, 1.26
Engaged in other protective actions 80 90 1.54* 1.06 1.06
ð37.7%Þð44.6%Þ½1.01, 2.35½.92, 1.21½.94, 1.20
Applied for an order of protection 66 83 1.64* 1.13* 1.09
ð31.1%Þð41.1%Þ½1.07, 2.53½1.01, 1.26½.99, 1.21
Received an order of protection 50 69 1.59* 1.12* 1.07
ð23.6%Þð34.2%Þ½1.01, 2.51½1.01, 1.24½.98, 1.17
Obtained medical care due to violence 22 33 1.88* 1.08* 1.05
ð10.4%Þð16.3%Þ½1.02, 3.45½1.01, 1.16½.98, 1.11
Went somewhere partner could not nd
you ðhidÞ72 82 1.61* 1.11* 1.14**
ð34.0%Þð40.6%Þ½1.04, 2.48½1.01, 1.23½1.04, 1.26
Partner went somewhere he could not
see you ðwas detainedÞ66 92 2.53*** 1.24*** 1.19**
ð31.1%Þð45.5%Þ½1.62, 3.95½1.12, 1.37½1.06, 1.33
*p<.05.
** p<.01.
*** p<.001.
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being in the intervention group is associated with less severe and frequent
IPV, with a subtracted CTS-2 frequency-by-severity score between 12.63
and 16.59 fewer points at follow-up. This difference is signicant in the
regression, propensity scorematched, and intent-to-treat analyses. As an
example, 17 points on the severity-by-frequency scale could be translated
into a participants partner beating her up on two separate occasions,
punching her on an additional two occasions, and slapping her on yet
another occasion.
post hoc analyses
In order to examine whether the protective strategies that the intervention
group engaged in were associated with decreases in IPV, we conducted post
hoc one-tailed t-tests ðshown in g. 3Þ. Among women in the intervention
group, removing or hiding their partners weapons, receiving formal ser-
vices for IPV, establishing a code with family and friends, applying for an
order of protection, obtaining medical care, and hiding are associated with
signicantly less IPV at follow-up.
discussion
Our ndings show that the Lethality Assessment Program ðLAPÞis associ-
ated with an increase in protective actions and a decrease in the frequency
and severity of violence among this sample of IPV survivors, particularly
among those who chose to speak to a hotline advocate. The majority of
protective actions engaged in by intervention group participants were asso-
ciated with decreases in the severity and frequencyof self-reported violence
at follow-up. This demonstrates a potential mechanism by which the LAP
table 4. Association between Intervention Group Status and the Frequency and Severity of
Violence at Follow-Up
Comparison
Group
Mean
ðSDÞ
Intervention
Group
Mean
ðSDÞ
Linear
Regression
Analysis
ðN5405Þ;
B½95% CI
Propensity
Score
Analysis
ðN5389Þ;
B½95% CI
Intent-to-
Treat
Analysis
ðN5497Þ;
B½95% CI
Subtracted frequency
by severity CTS-2 score 234.38 243.59 214.71 216.59 212.63
ð67.87Þð77.91Þ½228.60,2.81*½231.52, 21.65*½225.09, 2.18*
*p<.05.
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appears to reduce IPV risk. The LAP is a collaborative policesocial service
intervention with an emerging evidence base that has the potential to
change the response to IPV and to prioritize social work goals of survivor
safety and empowerment within the context of criminal justice intervention.
Victim-survivors in the intervention and intent-to-treat groups experi-
enced less IPV at follow-up than victim-survivors in the comparison group,
but even women in the intervention and intent-to-treat groups continued to
experience violence after their contact with police ofcers conducting the
LAP. When women leave abusive relationships, the violence is likely to
continue ðand may even increaseÞwhenever the violent partner manages
to gain access to the survivor. Leaving is never a static event, and women
who have successfully disengaged from abusive partners have reported that
this process involves stages of reclaiming life, self, and safety ðWuest and
Meritt-Grey 2001; Messing, Mohr, and Durfee 2012Þ. As such, violence did
not cease in the short ðapproximately 7 monthsÞtime between the baseline
and follow-up interviews. It is important to note that IPV was dened, for
the purposes of this analysis, as actual acts of violence against an intimate
partner. Unlike denitions used by the Centers for Disease Control and
FIGURE 3. Subtracted CTS-2 frequency-by-severity score by protective actions taken/not
taken among women in the intervention group. *p<.05.
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Prevention ðe.g., Saltzman et al. 2002; Black et al. 2011Þ, threats of violence
were not included in our denition. Intimate partner sexual violencea
common and devastating form of violence against women ðBagwell-Gray,
Messing, and Baldwin-White 2015Þwas measured, but it was reported in-
frequently and therefore was not assessed separately.
Being in the intervention group ði.e., engaging in the risk assessment
process and speaking to the hotline advocateÞis associated with having
taken immediate protective actions and having engaged in a variety of
protective actions over the approximately 7 months between the baseline
and follow-up interviews. When examining protective actions, propensity
scorematched analyses nd consistently smaller odds ratios than regres-
sion analyses, suggesting selection bias.That is, women who engaged in the
intervention and made the choice to speak with the hotline advocate
ðrepresented in this study by the intervention groupÞare different in mea-
sured, and likely in unmeasured ways, from the broader group of women
who came into contact with the police as part of an IPV incident
ðrepresented in this study by the comparison groupÞ. For example, women
in the intervention group may have been engaging in more protective
actions pre-intervention. Nevertheless, while the average treatment effect
on the treated is small in propensity scorematched analyses, it is statisti-
cally signicant. Further, the ndings over two time points demonstrate
some durability of the intervention, albeit over a relatively short time frame.
Thus, engaging in the risk assessment process and speaking to a hotline
advocate is associated with increases in a wide variety of protective actions
over multiple time periods.Women engaging in the LAP intervention sought
help from formal systems, including the social service system ðthrough the
use of formal domestic violence servicesÞand the civil court system
ðthrough applying for and receiving orders of protectionÞ. Partners of
women in the intervention and intent-to-treat groups were more likely to
be detained. This may indicate that women receiving the LAP were more
likely to engage the criminal justice system and that the system saw these
perpetrators as more dangerous. This may also partially explain the lower
levels of IPV observed among those participating in the LAP, although a
reduction in violence is not associated with having a partner who was
detained in post hoc intervention group analyses. Future research should
explicitly examine whether the LAP affects victim-survivorsengagement in
the criminal justice system and criminal justice system outcomes for their
abusive partners ðe.g., arrest, bond, conviction, and sentencingÞ.
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Being in the intervention group is also associated with having engaged in
several informal protective actions, demonstrating that the LAP provides a
variety of intervention strategies and that women may have chosen those
that were best suited to their situations. Women who engaged in the risk
assessment process and spoke with a hotline advocate were signicantly
more likely to remove or hide their partnersweapons, although only a small
proportion of women used this protective strategy. Given that the majority
of intimate partner homicides of women are committed with a rearm in
Oklahoma and nationally and, further, given that Oklahoma state law does
not prohibit known domestic violence offenders from possessing guns ðstate
law only prohibits the purchase of rearms by those who have been arrested
for domestic violence or by those with an order of protection against themÞ,
this is an important safety strategy. Prohibiting the possession of rearms by
known domestic violence offenders reduces intimate partner homicides
ðVigdor and Mercy 2006; Zeoli and Webster 2010Þ. Future research should
examine why some protective strategies were used more by women in the
intervention group and whether this is a function of the safety-planning
strategies suggested by hotline advocates, a function of survivor choice
among myriad strategies offered, or a function of the police visit being more
effective when the LAP is used.
In addition to future experimental research conducted in additional
geographic locations, perhaps employing random assignment to control and
treatment conditions, mixed-methods research is important to understand
and contextualize the ndings presented here.Qualitative and observational
research could play a role in understanding implementation delity and
provide insight into womens experiences of the LAP. Important questions
remain about the consistency of police ofcersimplementation of the LAP
and whether ofcers implement the intervention differently based on fea-
tures of the situation, the offender, or the victim-survivor. The inuence of
ofcer and advocate characteristics ðe.g., gender, empathy, and cooperationÞ
should be examined in future studies, as should police and advocate percep-
tions of the LAP. Survivors could provide information about their percep-
tions of the utility of the Lethality Screen and telephone call, as well as
their experiences of adopting ðor not adoptingÞsafety strategies post-LAP.
An exploration of how the intervention could be improved is also war-
ranted. The LAP provides an opportunity for victim-survivors to engage in
an advocacy intervention, but women choose whether or not to respond
to the questions on the Lethality Screen, speak to the hotline advocate,
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and engage in protective actions. The LAP is intended to encourage sur-
vivors to take action for self-care and should in no way be coercive or com-
promise womens autonomy. Understanding womens choices would assist
in the development of interventions that could reach a broader spectrum of
victim-survivors.
strengths and limitations
This studysndings should be understood in the context of its limitations.
The research was conducted with a sample of women in Oklahoma and is
not representative of all women. Further, women who chose to participate in
the research study may have been different from women who chose not to
participate. Having police ofcers refer women to researchers was novel,
and police were trained to emphasize safety, participant choice, and collab-
oration with social service agencies, but this referral process undoubtedly
introduced selection bias.While over 70 percent of participants who were
contacted by researchers agreed to participate, many more women who
provided contact information were unable to be reached. Baseline inter-
views were retrospective and were conducted a median of 15 days after the
police visit. Participating in the LAP may have affected participantsmem-
ories or awareness in ways that the usual police response does not, thus
creating differences in the responses of the intervention, intent-to-treat, and
comparison groups that do not reect actual differences between these
conditions.
Attrition introduced another limitation into this research study. Across
all groups, approximately 40 percent of participants dropped out between
the baseline and follow-up interviews, primarily because interviewers were
unable to reach participants on follow-up. High attrition rates are consistent
with previous research on IPV survivors ðCampbell et al. 2005Þand may
have been exacerbated in this study given that the women had experienced
high levels of violence and were at heightened risk. Nevertheless, women
who did not complete the follow-up interviews may have had different
experiences of violence and safety at the time of the follow-up than the
women who were interviewed.
Women who went to shelters were generally not able to be reached due
to condentiality constraints. Although we had only one participant who
reported that she had been to a shelter between the baseline and follow-up
interviews, data collected by one participating advocacy agency indicate
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that, in a single jurisdiction, 49 women who participated in the LAPentered
shelters. It is reasonable to expect that a small but important subset of the
intervention group who were never interviewed or were lost to follow-up
had gone into shelters.
When balancing the challenges of engaging in quasi-experimental eld
research against the requirements of a tightly controlled, true experimental
design, we determined that random assignment of high-risk victims of IPV
would have presented insurmountable logistical and ethical issues ðsee
Messing, Campbell, and Wilson 2015Þ. Propensity score matching was used
to match the intervention and comparison groups on observed differences,
including important measures of risk. Propensity score matchingalso guards
against bias due to differences that are unobserved but related to measured
indicators. Nonetheless, given the use of a quasi-experimental design and
historical comparison group in this study, the most concerning threat to
internal validity is the threat of history effects, as an event may have occurred
ðe.g., a high-prole domestic homicide, the closing of a local shelterÞ
between recruitment of the comparison and intervention groups that
affected research outcomes. Throughout the study, therefore, we were par-
ticularly attentive to changes in participating communities by engaging with
local police departments and domestic violence services, developing advi-
sory committees, and building relationships with state policy makers.We did
not note any events that may have affected research outcomes, yet there
were observed differences between intervention and comparison groups.
Pragmatic trials, or intervention tests in the real world, are difcult to
implement.We enlisted the cooperation of police ofcers and advocates in a
number of police jurisdictions in Oklahoma, including the two largest
population centers in the state. Although implementation delity may have
been compromised because practitioners implemented the LAP, training
and implementation of the LAP was consistent with implementation in police
departments throughout the United States. Few true or quasi-experimental
eld trials of this size and scope have been conducted to examine innovative
police practices or policesocial work collaborations. This study examined a
relatively well-established intervention with training and technical assis-
tance available for police departments and social service organizations in-
terested in implementing it. The sample included a substantial number of
Native American women, who are at higher risk for experiencing IPV and
intimate partner homicide ðBlack et al. 2011Þ.We also used anoutcome
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measure for repeat violence that took into account the frequency and sever-
ity of IPV, not just the presence or absence of different forms of violence.
This allowed us to offer a more nuanced picture of the changes associated
with intervention and intent-to-treat group status.
conclusion
Social workers have an ethical obligation to determine the best intervention
for each client, taking into account the best available research evidence,
practitioner knowledge, and client self-determination ðGambrill 2006Þ.The
preponderance of evidence, albeit in a quasi-experimental design with some
important limitations as discussed above, is that the LAP is associated with
increased use of safety strategies and reduced violent victimization. Social
workers collaborating with law enforcement agencies have a unique oppor-
tunity to provide survivors who interact with the police holistic interven-
tions that address a range of domains. This may include, for example,
assisting women in creating safety plans that respect their choice to sever
or remain in their relationships or providing services that respect survivors
self-determination and take into account the many ways in which women
are connected to their intimate partners ðDavies 2009Þ. The primary role of
an advocate in the LAP intervention is to provide women with safety tips
and information on available resources; survivors may or may not choose to
make use of this information.Our ndings suggest that receiving this type of
consultation enhances the chances that women will pursue formal and
informal protective strategies, thusdecreasing the IPV that they experience.
Appendix
Protective Actions
Participants could answer yesor noas to whether they had taken any of
the following actions ðMcFarlane et al. 2004Þ:
1. Hidden money, an extra set of house keys, car keys, or another
belonging or object that may help you to ee your relationship
2. Established a code with family or friends ðto let them know when you
are in troubleÞ
3. Asked neighbors to call the police if violence begins
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4. Removed or hidden their partnersweapons
5. Made available paperwork such as ½their own and/or their childrens
Social Security numbers, rent and utility receipts, birth certicates,
bank account numbers, drivers license or identication, insurance
policies or numbers ½to facilitate eeing the relationship
6. Hid valuable jewelry
7. Hid extra money
8. Hid a bag with extra clothing
We added the following dichotomous ðyes/noÞquestions:
9. Have you applied for an order of protection/restraining order against
your partner?
10. Have you received an order of protection/restraining order against
your partner?
11. Have you received services related to domestic violence in this
relationship?
12. Have you gone someplace where your partner couldntnd you or
see you?
13. Has your partner been someplace where he couldntnd you or see
you?
14. Has there been a period of time when you didntseeyourpartnerfor
a while because one or both of you chose not to?
15. Have you been treated bya doctor or nurse for injuries or trauma that
your partner caused in this relationship?
16. Have you obtained something to protect yourself against your part-
ner, such as mace, pepper spray, or a weapon?
note
Jill Theresa Messing, PhD, MSW, is an associate professor in the School of Social Work at
Arizona State University. Her interest areas are intimate partner violence, femicide, risk
assessment, innovative interventions to combat intimate partner violence, andevidence-based
practice. Her work has been funded by the National Institute of Justice, the National Science
Foundation, and the National Institutes of Health.
Jacquelyn Campbell, PhD, RN, FAAN, is a professor at Johns Hopkins UniversitysSchoolof
Nursing. She has been the principal investigator of 12 National Institute of Justice, National
Institutes of Health, US Department of Defense, and Centers for Disease Control and
Prevention-funded research studies of intimate partner violence and homicide and has
authored more than 220 articles and seven books on the subject.
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Daniel W. Webster, ScD, MPH, is a professor of health policy and management at the Johns
Hopkins Bloomberg School of Public Health. His research interests focus on evaluating strat-
egies to reduce violence and substance abuse, especially lethal outcomes.
Sheryll Brown, MPH, is the director of the Injury Prevention Service of the Oklahoma State
Department of Health. As the director of a state injury program, her research interests are
related to all areas of injury and violence prevention, evaluation of evidence-based interven-
tions, and translating research to public health practice.
Beverly Patchell, PhD, APRN, PMH-BC, is an assistant professor at the University of Utah
College of Nursing. She has an extensive background in working with Native American
communities. Her community-based research has addressed substance abuse, interpersonal
violence, diabetes, and other chronic illnesses affecting Native American communities.
Janet Sullivan Wilson, PhD, RN, is an associate professor in the College of Nursing at the
University of Oklahoma Health Sciences Center Graduate College. Her research focuses on
evaluating family violence prevention strategies in the community.
This research was funded by the National Institute of Justice ðno. 2008-WG-BX-0002Þ. We wish to
sincerely thank all of the women who participated in this research study for speaking to our interview-
ers and sharing their stories. We also want to thank all of the police departments, domestic violence
advocacy organizations, and tribal entities that contributed to the success of this research project.
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... Most of the studies used similar data collection strategies from interviews and questionnaires directly from victims (Campbell, 1986;McFarlane et al., 1998;Glass et al., 2008Glass et al., , 2009Glass et al., , 2010Campbell et al., 2009;Snider et al., 2009;Messing et al., , 2014Messing et al., , 2015bMessing et al., , 2017Messing et al., , 2020aBianchi et al., 2014;Wang, 2015;Brignone and Gomez, 2017;Richards et al., 2019;Sabri et al., 2019;Johnson et al., 2020), aggressors (Snider et al., 2009;Messing et al., 2015a;Cunha and Goalves, 2016;Williams et al., 2021) and professionals (Dutton et al., 2018(Dutton et al., , 2019Ward-Lasher et al., 2018). One uses focus groups (Grant and Cross-Denny, 2017). ...
... The majority are focused on developing risk assessment instruments for IPF as well as analyzing their validity (Campbell, 1986;Campbell et al., 2009;Echeburúa et al., 2009;Snider et al., 2009;Messing et al., , 2015aMessing et al., , 2017Messing et al., , 2020aStorey and Hart, 2014;Wang, 2015;López-Ossorio et al., 2021). There are several that assess the implications of them into professional practice (Glass et al., 2010;Messing et al., 2014Messing et al., , 2015bGrant and Cross-Denny, 2017;Nesset et al., 2017;Dutton et al., 2018Dutton et al., , 2019Ward-Lasher et al., 2018;Richards et al., 2019;Sabri et al., 2019;Anderson et al., 2021;Williams et al., 2021). A few examine the risk factors of IPF using the existing risk assessment instruments (McFarlane et al., 1998;Glass et al., 2008Glass et al., , 2009Bianchi et al., 2014;Cunha and Goalves, 2016;Brignone and Gomez, 2017;Johnson et al., 2020). ...
... The DA To identify the women who visit emergency departments at highest risk of IPF USA 549-570 victims of PVW The Lethality Screen (Messing et al., 2015a) and the DA-LE To analyze the predictive validity of the Lethality Screen and the DA-LE Messing et al. (2015b) USA 1252 victims of PVW Structured interviews, an adapted version of the safety-promoting behavior checklist (McFarlane et al., 2004), the CTS-2 (Straus et al., 1996), the DA (Campbell, 1986) and the Lethality Screen (Messing et al., 2015a) To assess the effectiveness of the LAP used by police-social services on victim-survivors at risk of PVW/IPF to the adoption of safety strategies Messing et al. (2014) USA 432 women victims of PVW Structured interviews, the DA , the CTS2 (Straus et al., 1996), the women's experience of battering scale (Smith et al., 1995), and an adapted version of the safety-promoting behavior checklist (McFarlane et al., 2004) To study the connection of homicide risk and safety actions among women victims of PVW USA 148 immigrant victims of PVW Structured interviews, the CTS-2 (Straus et al., 1996), the DA , the Women's Experience of Battering Scale (Smith et al., 1995) and the HARASS Scale (Sheridan, 1998) To adapt the DA to immigrant women population Messing et al. (2020a) USA 1008 women victims of PVW Structured interview, the DA , and the Danger Assessment for Immigrants (DA-I) To examine the relationship between strangulation, loss of consciousness due to strangulation, and risk of future near-fatal violence to modify the DA and the DA-I Bianchi et al. (2014) USA 300 victims of PVW The DA (Campbell, 1986) and the SAVAWS (Marshall, 1992) To describe the demographics, frequency, severity of abuse, and the risk of murder for women who are abused during pregnancy in comparison with non-pregnant women Campbell (1986) USA 79 victims of PVW Interviews, The CT (Straus, 1979) and the DA (Campbell, 1986) To develop the DA to assess the danger of IPF and describing the literature supporting it (Kropp et al., 2011) To appraise the associations between of risk assessment and immediate protective actions by police as arrest and relocation of victims ...
Article
Full-text available
Intimate partner violence is a severe problem that has taken the lives of thousands of women worldwide, and it is bound to continue in the future. Numerous risk assessment instruments have been developed to identify and intervene in high-risk cases. However, a synthesis of specific instruments for severe violence against women by male partners has not been identified. This type of violence has specific characteristics compared to other forms of intimate partner violence, requiring individualized attention. A systematic review of the literature has been conducted to summarize the intimate partner homicide risk assessment instruments applied to this population. It has been carried out with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. The search strategy yielded a total of 1,156 studies, and only 33 studies met eligibility criteria and were included in the review. The data of these studies were extracted, analyzed, and presented on study characteristics (country and year, sample, data sources, purpose of the studies) and main findings (a brief description of the instruments, risk factor items, psychometric properties). The results indicate that the Danger Assessment, the Danger Assessment for Immigrants, the Danger Assessment for Law Enforcement, the Danger Assessment-5, the Taiwan Intimate Partner Violence Danger Assessment, the Severe Intimate Partner Risk Prediction Scale, The Lethality Screen, and the H-Scale are specific risk assessment instruments for predicting homicide and attempted homicide. There are differences in the number and content of risk assessment items, but most of them include the evidence's critical factors associated with homicide. Validity and reliability scores of these instruments vary, being consistency and accuracy medium-high for estimating homicide. Finally, implications for prediction and prevention are noted, and future research directions are discussed.
... Several definitions of risk have existed in the literature as well as in practice. For instance, researchers have defined risk in terms of perpetrators' likelihood of committing DV, or victims' likelihood of experiencing violence in the future (Belfrage et al., 2012;Campbell et al., 2009;Eke et al., 2011;Hilton & Harris, 2009;Hilton et al., 2008;Messing et al., 2015;Nicholls, et al., 2013). However, there is no consistent view of what constitutes DV risk assessment. ...
... However, this awareness has not been matched by public awareness and professional training on the risk markers that often precede homicides and require a more structured approach to risk (Storer et al., 2013). This approach not only has to recognize the risks but also trigger safety planning and risk management on a coordinated community basis (Messing et al. 2015). In other words, having a reliable and valid risk assessment tool is meaningless without a commitment to ongoing training and comprehensive implementation within a coordinated community response. ...
... Future practitioners may benefit from community efforts to adopt a common risk assessment tool which would enhance communication and coordination across sectors. Current efforts underway suggest that community professionals may be able to work with a shorter risk assessment tool to facilitate more immediate safety planning and risk management across different sectors (Messing et al., 2015;Richards et al., 2019). Ultimately, continued research efforts informed by experts, practitioners and survivors are needed to ensure that professionals work together to respond to risk. ...
Article
Assessing risk in domestic violence situations is foundational to ensuring safety. Although there is growing information about the reliability and validity of a variety of risk assessment tools across different practice contexts, there is a paucity of research on the feasibility and application of these tools in real world settings. The present qualitative study examined current practices in domestic violence risk assessment in Canada through a survey of professionals working across diverse sectors. Utilizing a thematic analysis of 255 open-text responses, this study presents several themes related to challenges identified at the systemic, organizational, and individual levels. Themes related to promising practices and the practical implication of risk assessment strategies are also explored.
... Despite these positive intentions, CCRs seem to have mixed results in terms of fortifying the response to IPV. Some successes have been found in the literature (e.g., Babcock & Steiner, 1999;Bledsoe et al., 2006;Messing et al., 2015;Salazar et al., 2007); however, other research has not detected relationships between the extent of CCR presence and various outcomes (see Post et al., 2010). Domestic Violence Codes. ...
... According to the analysis of the present research, county participation in CCR efforts (i.e., InVEST) significantly related to FVIPH rates, such that counties that participated in CCR efforts had lower FVIPH rates than counties that did not participate in such efforts. This finding accords with a published, quasi-experimental study that focused on the connection between severity and frequency of IPV and the LAP (see i.e., Messing et al., 2015). Indeed, InVEST seems risk-informed, social service-oriented, and most importantly, victim-centered (for discussions of risk-informed and victimdefined intervention, see Davies & Lyon, 2014;. ...
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Legal and social service interventions aim to mitigate intimate partner violence (IPV) and keep IPV from becoming lethal. Accordingly, this study examines the impact of policies and programs on female-victim intimate partner homicide (FVIPH) rates across the 67 counties of the state of Florida. It focuses on community coordinated response efforts, batterer intervention programs, local domestic violence (DV) ordinances, DV fatality review teams, and DV shelter programs. Results indicate that community coordinated response efforts are associated with decreasing FVIPH rates. Discussions of findings, limitations, and implications are provided accordingly.
... Acknowledging the risk involved with domestic violence cases and the increased likelihood of interacting with a violent offender, some responses utilize a forward deployment by law enforcement prior to other agencies intervening; for example, Hovell et al. (2006) discuss how the Family Violence Response Team first has police officers secure the scene, followed by a team member calling victims to provide information and intervention. Many of the responses in the literature, as noted by Johnson and Stylianou (2020), involved phone contact between coordinating agencies and the victims (see Messing et al., 2015), though some emphasized on-scene interventions (see Davis et al., 2006;Stover et al., 2010) or a combination of these (see Corcoran & Allen, 2005). ...
Article
The CSW65 agreed conclusions call for a multisectoral coordinated response to all forms of violence against women. The term coordinated community response (CCR) is commonly used in various models of such a response. However, the term itself has different meanings to various actors in the sector, and therefore it is difficult to evaluate its success with any degree of certainty. This article seeks to (i) propose a broader unified framework for thinking about the term; (ii) remove any underlying assumptions of its positive or negative connotations; and (iii) revisit the term from a theoretical standpoint. The goal of this effort is to (a) guide policy, programming, and advocacy efforts across different sectors that respond to VAW; (b) provide clarity to practitioners in the implementation of a CCR; and (c) make its effectiveness measurable in different contexts.
... Arizona statute (A.R.S. § 13-3967(B)) requires that those making release decisions in domestic violence cases consider the results of a risk or lethality assessment and the rules of criminal procedure recommend a standard risk assessment across the state (Websdale et al. 2018). The risk assessment used in Arizona is derived from Campbell et al. (2003) femicide study and the ability of the risk assessment to predict near lethal violence was examined using data from the Oklahoma Lethality Assessment Study (Messing et al. 2015;Websdale 2020). The AzIPH study provides an opportunity to examine the ability of the risk assessment to predict homicide in the state and, as needed, to refine the risk assessment. ...
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Despite the importance of intimate partner violence (IPV) and homicide research to women’s health and safety, much remains unknown about risk factors for intimate partner homicide (IPH). This article presents the Arizona Intimate Partner Homicide Study, pilot research that is being conducted in one U.S. state to update and expand on risk factors for IPH. In the context of presenting this study, we summarize the literature on data collection techniques, various marginalized and under researched populations, and the importance of gathering data about the victim-offender relationship and situational IPH risk factors. Additional research is needed to update risk factors for IPH to account for changes in technology and to examine differential risk across diverse populations. Local, community based data collection strategies are likely to provide more comprehensive and nuanced insight into IPH; though, to understand risk factors among marginalized populations, it may be necessary to increase sample size through a national strategy. Although not a panacea, we present this ongoing research as a model for other states to emulate and improve upon, in the hopes of developing more comprehensive data examining risk for IPH among victims of IPV.
... either asked for a safe time for the phone interview to take place or were asked by the researcher at the onset of the interview whether 'now was a safe time to talk', with calls rescheduled if necessary. 26 27 29 31 Among the seven non-telephone-based studies, for which study communications were often shared via email, two of the studies were referred to as ones on 'women's health' in order to mitigate participant risk. 32 33 None of the studies employing telephonic interviews mentioned any additional steps taken by the research team to ensure safety for respondents beyond scheduling interviews at a time that was reportedly safe for the respondent. ...
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... Some the fears that survivors reported included partner violence escalation, consequences for their family such as losing their housing benefits, or their children's safety if their partner retaliates and harms the children, being "outed" as a person of the LGBTQIAþ community if they are in a same-sex relationship. Providers should work to provide emotional and physical safety that facilitates survivor disclosure by providing emotional support and encouragement, believing and validating survivors' experiences as well as the use of danger or lethality assessments facilitate open conversations about the level of risk the survivor is facing (McCloskey & Gribsby, 2005;Messing et al., 2015). Additionally, considering that a desire for physical and mental well-being often drives survivors to seek help, service providers should provide mental health interventions and connect survivors to medical providers for physical health concerns (Sprague et al., 2017). ...
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These interventions are based on the premise that victims are more likely to be receptive to crime prevention opportunities immediately following victimization. Second responder interventions have received support from the US Department of Justice and their adoption has spread in both the United States and internationally, however, there remains little conclusive evidence on their effects. To update and extend the findings of the prior second responders systematic review and meta‐analysis by synthesizing the results of published and unpublished second responder evaluations through October of 2021. This review also examines the use of victim services as a secondary outcome and incorporates a number of additional moderator analyses. The Global Policing Database (GPD), a repository of all experimental and quasi‐experimental evaluations of policing interventions conducted since 1950, was searched using keywords related to second responder interventions and repeat family violence from 2004 to December 2019 (https://gpd.uq.edu.au/s/gpd/page/about). This search was also supplemented with additional strategies, such as reference harvesting of prior reviews, searching 2020 and 2021 volumes of leading academic journals, reviewing the reference lists of eligible studies, searching additional gray literature repositories focused on domestic violence, and consulting with eligible study authors. Eligible studies were required to include a treatment group that received the second responder intervention and a comparison group that did not. Assignment to these conditions could be either experimental or quasi‐experimental, but quasi‐experimental studies were required to use either matched comparison groups or multivariate analysis methods to control for confounding factors. Eligibility was limited to studies reporting on at least one measure of repeat family abuse, such as intimate partner violence, elder abuse, or general family abuse. Measures of repeat abuse could be based on either official (i.e., police data) or unofficial (i.e., victim survey data) data sources. Five new studies were identified between 2004 and 2019, all of which contained sufficient data for the calculation of at least one effect size. Along with the 10 studies included in the prior review, a total of 15 studies and 29 distinct effect sizes were analyzed across three outcome constructs. Effect sizes were calculated as logged odds ratios and results were synthesized using random effects models with restricted maximum likelihood estimation. Final results were exponentiated to represent the percentage point difference in the odds of a given outcome for treatment groups relative to control groups. Risk of bias was assessed using items adapted from the Cochrane Risk of Bias tools for experimental and quasi‐experimental studies. Eligible studies were generally considered to be of low risk of bias, however, issues with survey success/contact rates and the analytical approaches to these problems led to concern in several studies. These analyses suggest that second responder interventions produced no significant effects on either police or victim‐reported measures of repeat family abuse, in aggregate. However, findings from the more rigorous experimental studies indicated that second responder interventions were associated with a statistically significant 22% (95% confidence interval [CI] [1.04, 1.43]) increase in the odds of a police‐reported repeat family abuse incident, with no significant variability in individual study results. Additionally, studies that measured the use of victim services as a secondary outcome were associated with a statistically significant 9% (95% CI [1.02, 1.16]) increase in the odds of service use for treatment groups relative to control groups. Several study characteristics also proved to be important moderators of treatment effects. Increases in the speed of the second response were associated with significant decreases in the odds of a victim‐reported repeat incident, and studies that measured repeat family abuse using households were associated with significantly higher odds of a police‐reported repeat incident, compared to studies that used the same victim or victim/offender pairing more generally. Second responder interventions are undoubtedly appealing based on their logic and intentions. Yet, well‐intentioned programs with sound logic can still backfire, and the results of this updated review provide evidence that may be suggestive of a backfire effect. Even so, any firm conclusions from this review are limited by a lack of knowledge on the mechanisms operating in between the implementation of the second response intervention and the observed effects, as well as the small sample sizes involved in many analyses. While it seems clear that these programs are not producing any broad reductions in self‐reported victimization, the increase in police‐reported violence seen in experimental studies could indicate either a true increase in abuse or an increased willingness to call the police. The lack of observed impact on victim‐reported violence would suggest the latter, but without more specific measures, such conclusions should be avoided. If these results are indicative of increased reporting, however, many may consider this a desirable outcome, particularly given the often‐underreported nature of family abuse and the potential for increased reporting to lead to long‐term reductions in abuse. Furthermore, these results provide an indication that second responder programs can produce other intended effects, such as increasing the retention of victim services, and that the specific characteristics of these interventions may moderate their effects. It is unclear why elements such as the immediacy of the second response or the unit of analysis being evaluated would impact study results, but these observations are consistent with the theory that domestic violence interventions must capitalize on short windows of opportunity and create separation between victims and offenders to reduce exposure and subsequent victimization. This potential indicates a need for more research on second responder programs, but specifically research that examines these moderating characteristics and mechanisms. Even in light of this potential, second responder programs do not, on average, appear to reduce the prevalence of repeat family abuse. Given the presence of alternative (and possibly more effective) domestic violence interventions that now exist (e.g., Safe Dates, Shifting Boundaries, Green Dot, etc.), it seems that policymakers may wish to look elsewhere for efforts to reduce family abuse.
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Victims of intimate partner violence may take various actions to protect themselves from their partner. This research examined the association between abused women's (N = 755) protective strategies at baseline and her partner's threats, stalking, and moderate and severe violence 8 months later. Emergency domestic violence shelter and orders of protection significantly reduced subsequent abuse. Receiving medical treatment was associated with a significant increase in violence, and security devices (e.g., mace, changing locks) with an increase in stalking. Safety planning and other strategies had no statistical association with abuse at follow-up. Future research should continue to examine the efficacy of safety strategies.
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Social workers are likely to encounter intimate partner violence (IPV) survivors and/or perpetrators within their practice due to the prevalence of this social issue and the negative health and mental health consequences resulting from it. IPV risk assessments can be utilised by social workers in multiple service settings. A recent meta-analysis provided information on the IPV risk assessment instruments with the greatest predictive accuracy, but social workers need to know the most appropriate IPV risk assessment tools for use in their particular practice settings. Therefore, this paper provides social workers with summary information on the four risk assessment instruments that have the highest predictive accuracy—the Danger Assessment, the Spousal Assault Risk Assessment, the Ontario Domestic Assault Risk Assessment, and the Domestic Violence Screening Inventory. For social workers unable to use validated risk assessments, a summary of the risk factors is provided with a focus on opportunities for change within violent relationships. Finally, recommendations for which IPV risk assessment to use in various social work practice settings are outlined. The use of IPV risk assessment should be situated within an evidence-based practice framework, taking into account the best evidence of risk for future harm, clinical expertise and client self-determination.
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Data from a national survey were used to investigate the help-seeking efforts of Latinas (Mexican, Mexican American, Puerto Rican) and Anglo American women who experienced battering by intimate partners. The findings revealed that battered Latinas were significantly younger, less educated, and more impoverished than Anglo women. Additionally, Latinas more often categorized their marriages as male dominated and their husbands as heavy drinkers. Bivariate analyses showed that Latinas who sought help were significantly more acculturated and more likely to have a heavy drinking husband than those who did not seek help. Although battered women were active help seekers, Latinas underutilized both informal and formal resources relative to Anglo women, with Mexican women least likely to seek assistance. When sociodemographic predictors of help seeking were analyzed, being youthful and Anglo significantly increased the odds of help-seeking efforts. Low acculturation, as measured by preference for the Spanish language, was the only significant cultural barrier to help seeking by Latinas. Implications for treatment include improved outreach and advocacy to underserved groups.
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The National Crime Victimization Survey (NCVS) was the nation's first self-reported crime victimization survey and remains the largest in the United States. Through a rotating panel design, estimates of violent and property crimes, such as robbery, aggravated assault, sexual assault, simple assault, burglary, theft, and auto theft, are obtained. The NCVS employs a nationally representative, stratified, multistage, clustered sampling design. The NCVS has had several revisions since it was created in the 1970s. In addition, periodically the NCVS uses supplemental surveys to capture a broader array of information on specific types of crime (e.g., school crime).
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Intimate partner violence is now recognised as a serious human rights abuse and increasingly as an important public health problem with severe consequences for women’s physical, mental and sexual health. Therefore, a comprehensive understanding of intimate partner violence is an essential aspect of good-quality social work practice. This is an accessible introduction to the complexities of social work practice with abused women, as well as men.
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In this paper, we examine factors that affect whether the police are summoned to incidents of spousal violence. The actions of bystanders are distinguished from the actions of victims, and we find that victims and bystanders are moved by somewhat different influences. We also find that the immediate features of the situation dominate the decision to call the police and that many legitimate concerns are salient (e.g., whether there are injuries). In addition, however, some extralegal influences are important so that different offenders engaged in the same crime do not necessarily face the same risks of apprehension. For example, other things equal, bystanders are less likely to call the police if the offender and victim are living together.