The Association Between Protective Actions and Homicide Risk: Findings From the Oklahoma Lethality Assessment Study
By Wilson, Janet Sullivan | |
Proquest LLC |
This study focuses on the relationship between women's risk of homicide as measured by the Danger Assessment and 13 protective actions. Participants (N = 432) experienced an incident of police involved intimate partner violence (IPV) and subsequently completed a structured telephone interview. Most women in this sample experienced severe violence and were classified as being at high risk for homicide. Participants engaged in an average of 3.81 (SD = 2.73) protective actions. With the exception of the use of formal domestic violence services, women in the high-risk category were significantly more likely than women in the lower risk category to have used each of the protective actions examined. Implications for research and practice are discussed.
Keywords: intimate partner violence; domestic violence; safety planning; help-seeking; risk assessment
The most recent estimate of lifetime prevalence of intimate partner violence (IPV) for women in
A primary goal of IPV early responders, service providers, and state domestic violence fatality review teams is to reduce and prevent further IPV injury and homicide and to ensure the safety of survivors and their children. Despite the clarity of this goal and the ubiquity of intimate partner homicide, there are few studies that examine the association between protective actions and safety, danger, or risk. Therefore, this study focuses on the intersection between women's risk of reassault/homicide as measured by the Danger Assessment (Campbell et al., 2003) and protective actions among women who have had an incident of police involved IPV. We specifically seek to answer three research questions: (a) What protective actions are being taken by women in this sample and how are various protective actions related? (b) What is the relationship between protective actions and experiences of violence? and (c) What is the relationship of protective actions to risk of reassault/homicide controlling for experiences of violence and other demographic, mental health, and relationship characteristics previously found to be associated with IPV?
HELP-SEEKING AMONG WOMEN EXPOSED TO INTIMATE PARTNER VIOLENCE
Research has shown that women exposed to IPV are active in seeking help and in devising an array of safety strategies to protect themselves and their children (Gondolf & Fisher, 1988; Goodkind, Sullivan, & Bybee, 2004; Goodman,
No one strategy is effective for everyone, but women report that contacting a domestic violence service provider and going to a domestic violence shelter are helpful or make the situation better in most cases (Goodkind et al., 2004; Goodman et al., 2005), and shelter services were shown to be most effective in reducing severe and moderate reassault in one prospective study (Campbell, O'Sullivan, Roehl, &
Women appear to use the police more often, with between 6.7% and 56.0% reporting that the police had been called because of domestic violence among women not seeking help for IPV from the criminal justice or social service systems; it is worth noting that the top of this range may be lower when including only women who called the police themselves (
As the severity of physical violence increases, so does formal help-seeking; this includes the usage of domestic violence services (Coker, Derrick, et al., 2000; Gondolf, 1998; Henning & Klesges, 2002; Macy et al., 2005), shelter (Gondolf, 1998; West et al., 1998), and police services (
Women who seek out formal domestic violence services may also have greater biopsy- chosocial needs, such as depression, negative social relationships, and poor physical health (Macy et al., 2005). Demographic and relationship variables have also been related to for- mal help-seeking. Women who are married or formerly married, older, have higher socio- economic status, and higher education are more likely to seek formal services (Henning & Klesges, 2002). African American women experiencing IPV are more likely than White women to call the police for help (
Although formal help-seeking has been shown to be helpful, most women who experi- ence violence use informal social support networks (Beeble, Bybee, Sullivan, & Adams, 2009; Bosch & Schumm, 2008; Feder et al., 2011; Goodman & Smyth, 2011; Jacinto, Turnage, & Cook, 2010; Latta & Goodman, 2011; Macy, Johns, Rizo,
Determining which strategies are the most effective at keeping women and children safe is an important goal of research and can inform intervention. 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 (McFarlane et al., 2004). Although referral has been shown to increase safety behaviors and decrease violent victimization, it may be more protective to include assessment and case management; the assessment process itself may be a helpful interven- tion that increases victim awareness of violence levels and safety behaviors (McFarlane, Groff, O'Brien, & Watson, 2006). Theoretically, there may be an optimal time for inter- vention shortly after an abusive episode when women are likely to believe that violence will not cease and are more likely to reach out for help (Curnow, 1997). Women have reported no longer practicing safety behaviors once they feel safer because they want to forget about abusive incidents (McFarlane et al., 2004).
This study seeks to examine the protective strategies used by women who have experi- enced IPV and subsequent police involvement. In particular, given prior research finding that women who access services engage in multiple protective actions (Goodkind et al., 2004; Goodman et al., 2005), it is expected that various protective strategies will co-occur. It is also expected that experiences of severe violence will be associated with the usage of protective strategies because of prior research that has found that the usage of formal ser- vices increases as the severity of violence increases (
METHOD
Sample Recruitment and Data Collection
Structured telephone interviews were conducted with female victims of IPV who were referred to the research study by police officers at the scene of domestic violence incidents in seven police jurisdictions in one Southwestern state. Women were eligible for referral if the responding officer believed that she was the victim of IPV, the police had been to that location or had encountered the victim/perpetrator before, or the officer believed that the abuser was dangerous. Eligible victims were asked if researchers could contact them using an institutional review board (IRB)-approved script. If the victim responded that research- ers could contact her, her information (name, telephone number, safe time to call) was forwarded to researchers (see Messing et al., 2011). On average, referrals were contacted within 1 day of their receipt by the research team; women were asked to participate in a confidential telephone interview lasting 45 min to 1 hr. All interviewers received extensive training on maintaining victim safety (see Wilson et al., 2011). To thank the participant for her time, a
Police departments referred 1,137 women over approximately 18 months. Of these referrals, interviewers were unable to contact 486 (42.74%) women because of unan- swered, disconnected, or wrong numbers, and 47 (4.1%) women were not eligible to par- ticipate in the study (e.g., younger than 18 years old or not a victim of IPV). There were 604 eligible referrals contacted; of these, 440 (72.8%) women agreed to participate in the research study and were interviewed by telephone. Because of missing data on pertinent variables (n 5 8, 1.8%), the final sample size is 432.
Measures: Dependent Variable
Risk for Reassault/Homicide. The Danger Assessment (DA), a 20-item clinical and research instrument designed to identify women at risk for intimate partner homicide, was used to assess risk. The DA has been shown to be predictive of intimate partner reassault, severe reassault, and femicide in eight separate research studies (Campbell et al., 2005; Campbell et al., 2003; Campbell,
Measures: Independent Variables
Victim Characteristics. Participants were asked to report their age, racial/ethnic back- ground, employment status, and educational achievement. Age in years was used as a linear variable. Participants were able to indicate as many racial/ethnic identities as appro- priate; these were then collapsed into five mutually exclusive categories: White, African American,
Family and Relationship Characteristics. Participants reported their legal marital sta- tus as single, married, or separated/divorced; as the largest group, single was the referent. Because a person's legal marital status does not always describe their relationship, partici- pants were also asked whether they currently lived with their abusive partner. An affirma- tive response was coded as "1" and a negative response was coded as "0." Participants were asked how many children were currently living in their household, and this question was dichotomized to group participants who had children living in their household (5 1) and participants who did not have children living in their household (5 0). Participants were also asked if they were currently pregnant; those who responded yes were coded as "1" and those that responded no were coded as "0."
Intimate Partner Violence and Injury. An adapted version of the revised Conflict Tactics Scale (CTS-2) was used to assess experiences of IPV, including questions from the physical assault subscale, injury subscale, and sexual coercion subscale (Straus, Hamby, Boney-McCoy, &
Psychological Experience of Abuse. Items from the Women's Experience of Battering Scale (
Mental Health. Participants were asked single items about their feelings of depression and anxiety in the past month. Feelings of depression were assessed with the following question: "During the past month, how much of the time have you been bothered by feel- ing down, depressed, or hopeless?" Feelings of anxiety were assessed with the following question: "During the past month, how much of the time have you felt anxious or ner- vous?" Participants were asked to respond using a 5-point Likert scale, and these responses were dichotomized into 1 5 most/all of the time and 0 5 none/a little/some of the time.
Protective Actions. Protective actions were assessed using an adapted version of McFarlane and colleagues' (2004) Safety-Promoting Behavior Checklist. Participants were asked to answer yes (5 1) or no (5 0) as to whether they had taken any of the following actions during the relationship with their abusive partner: (1) hidden money, an extra set of house keys, car keys, or another belonging or object that may help you to flee your relationship; (2) estab- lished a code with family or friends (to let them know when you are in trouble); (3) asked neighbors to call the police if violence begins; (4) removed or hidden their partner's weapons; (5) made available paperwork such as
Analysis
The characteristics of the sample-including participant and relationship characteristics, participant experiences of violence, risk for lethality, and protective actions-are described using univariate analyses. To assess the co-occurrence of protective actions and the relationship of protective actions to experiences of severe violence and injury, chi-square analyses were conducted. Chi-square analyses were also conducted to examine the bivari- ate relationship between protective actions and lower versus high risk on the DA.
To examine the relationship between risk and protective actions while controlling for other potentially significant associations, logistic regression was used. Independent vari- ables, which were primarily ordinal in nature, were dichotomized to aid with interpretation of the data. The dependent variable, lower versus high risk on the DA, was included in a logistic regression model with each potential independent variable alone; those variables significant at the p , .10 level were examined for inclusion in the final multivariate logistic regression model. With the exception of receiving "services related to domestic violence" (referred to as formal services related to IPV), all of the help-seeking variables were significantly related to being in the high-risk category on the DA. Because of collin- earity (see Table 1), only protective actions with the strongest relationship to the dependent variable were included in the final model. Given previous research showing associations between IPV and/or protective actions and age (Black et al., 2011), marital status (Coker,
RESULTS
Univariate Analyses
Demographic, relationship, and violence characteristics reported by the participants are provided in Table 2. Participants ranged in age from 18 to 62 years with a mean age of 32.54 (SD 5 9.45) years. The largest racial/ethnic group was White (42.13%), followed by African American (30.79%), Native American (10.42%), Other or multiracial (10.19%), and
Many participants in this research study had experienced severe IPV; 45.14% (n 5 195) reported experiencing near-lethal violence, 73.55% (n 5 317) reported that their partner had strangled or attempted to strangle them, 67.13% (n 5 288) reported that their partner had beaten them up, 35.19% (n 5 152) reported that their partner had threatened them with or used a lethal weapon against them, and 26.16% (n 5 113) reported that their partner forced them to have sex against their will. The vast majority of participants (n 5 369, 85.42%) reported that their partner had perpetrated at least one of these violent acts, with 66.43% reporting that their partner perpetrated two or more of these violent acts, and 37.06% of participants reporting that their partner perpetrated three or more of these violent acts. According to the DA, 62.73% of participants are at high risk for homicide (severe/extreme danger). Approximately two-thirds of participants reported that their part- ner makes them feel unsafe in their own home (65.05%) and/or that they are afraid of their partner (66.44%). Slightly less than half of the participants in this study reported feelings of depression (42.13%) and/or anxiety (43.75%).
Participants engaged in 0-12 protective actions as a result of the violence in their relationship; the vast majority (89.12%) of participants engaged in one or more protec- tive actions, with a mean of 3.81 (SD 5 2.73). When examining only participants in the high-risk category, 96.68% of participants had engaged in one or more protective actions. The most used protective action was hiding money, keys, or other belongings or objects (47.92%), followed by hiding extra money (42.59%) and not seeing their partner for a while by choice (42.36%). The least used protective actions were hiding valuable jewelry (15.74%), removing or hiding weapons (15.74%), and receiving formal services for IPV (16.98%).
Bivariate Analysis
With the exception of the use of formal services related to IPV, women in the high-risk category were significantly more likely than women in the lower risk category to have used each of the protective actions that they were asked about. Each significant chi- square test presented in Table 3 indicates that women in the high-risk category were more likely to engage in a particular protective strategy. For example, approximately 55% of women in the high-risk group had hidden money, keys, or other belongings or objects, whereas a significantly (x2 5 16.10, p , .001) smaller proportion of women in the lower risk group had done so (35%). There is a positive correlation between the number of protective actions used and the linear DA score (r 5 .4625, p , .001). In addition, the number of protective actions that a woman engages in is positively cor- related with the number of severe violent acts (strangulation, forced sex, use or threats with weapons, being beaten up) that have been perpetrated against her by her partner (r 5 .3710, p , .001). Each significant chi-square analysis shown in Table 4 demon- strates that women who have had any experience of severe violence are more likely to engage in 10 (out of 13) protective actions. Furthermore, engaging in one or more pro- tective actions is significantly associated with fear (x2 5 43.79, p , .001) and feeling unsafe (x2 5 40.22, p , .001).
In addition to reporting the results of the multivariate logistic regression, Table 5 reports the bivariate associations between independent and dependent variables in the Unadjusted Odds Ratio column. In bivariate analyses,
A participant's current pregnancy is associated with being in the high-risk category in bivariate analysis (OR 5 3.81, p , .05); because these participants have called the police because of violence during pregnancy, and a risk factor on the DA is being beaten while pregnant, this variable was determined to be collinear with the outcome and excluded from the multivariate analysis. Thirteen (46.43%) of the 28 participants who reported that they were currently pregnant responded yes to the following DA question: "Have you ever been beaten by him while you were pregnant?"
Multivariate Logistic Regression
In the multivariate analysis (see Table 5, Adjusted Odds Ratio column), African American women were at nearly 2 times higher odds of being in the high-risk category than White women and Native American women had 2.55 times higher odds of being in the high-risk category in the multivariate analysis. Although marital status was not related to risk cat- egory, women who currently lived with their intimate partner had approximately half the odds of being in the high-risk category.
Women whose partners have perpetrated near-lethal violence have nearly 3 times the odds of being in the high-risk category on the DA. Participants who have lost conscious- ness because of violence have nearly 2 times the odds of being in the high-risk category. Women in the high-risk category have more than 3 times the odds of feeling unsafe in their home.
Finally, four protective actions are included in the multivariate analysis. Women who have established a code with family or friends have 2 times the odds of being in the high- risk category on the DA. Women who have removed or hidden weapons from their partner have 3.39 times the odds of being in the high-risk category. Participants who applied for an order of protection have nearly 2 times the odds of being in the high-risk category. Women who chose not to see their partner had 2 times the odds of being in the high-risk category.
DISCUSSION
This study examined the relationship between protective actions and risk as measured by the DA, a clinical and research tool that has been shown to be predictive of reassault, attempted femicide, and femicide in previous research studies (Campbell et al., 2005; Campbell et al., 2009; Campbell et al., 2003; Goodman et al., 2000;
Women in the high-risk category were not more likely to seek formal services related to IPV. The proportion of women seeking formal services (16.98%) is lower than the proportion of women engaging in most other protective actions, including other formal protective actions (e.g., applying for an order of protection, seeking medical care). Of the women who reported that they received formal services related to IPV (n 5 73), 22 (5.09% of the sample) reported that they had received shelter services and 55 (12.73% of the sample) reported receiving safety planning assistance, legal advocacy, and/ or counseling. Although consistent with previous help-seeking samples not recruited at shelters or domestic violence services (Brookoff et al., 1997; Coker, Derrick, et al., 2000; Gondolf, 1998; Hutchinson & Hirschel, 1998; Macy et al., 2005; Wiist & McFarlane, 1998), the low number of women seeking formal IPV services and the lack of association between accessing these services and high levels of danger is troubling, particularly given that these services have been demonstrated to be helpful in most cases (Campbell et al., 2005; Goodkind et al., 2004; Goodman et al., 2005). Interventions for women in abusive relationships who have called the police should include education as well as access to domestic violence service providers. The Lethality Assessment Program (http://www.mnadv.org/lethality/), in which the police place women who are at high risk for homicide (as determined through the use of a risk assessment instrument) in telephone contact with a domestic violence service provider, is an example of an inter- vention that may be effective at empowering women who have called the police to seek out available community resources. Future research should examine the effectiveness of this and other approaches for increasing access to formal domestic violence services among high-risk survivors.
Women in this sample experienced severe abuse and face high levels of danger from their intimate partners. The significant relationships between forms of severe violence, injury, and risk on the DA were expected and suggest that the DA is capturing women at high risk for homicide in this sample. This research adds to the literature indicating that women who call the police because of violence from their intimate partner are experienc- ing high levels of violence (
This study has several limitations. First, not all women who experienced police involved IPV during the study time frame were interviewed by researchers. Some women refused to allow researchers to contact them, and others who were recruited by police offi- cers at the scene of the incident were unable to be contacted by researchers. It is unknown whether women who refused to allow researchers to contact them or who could not be contacted after recruitment were somehow different from the women who completed the interview. The cross-sectional nature of the data means that it is not possible to know the temporal order of variables. Although it is thought that women who are at high risk are engaging in more protective actions, given the cross-sectional nature of this study, it may be that engaging in these behaviors leads to higher levels of risk in an abusive rela- tionship. Both of these explanations are consistent with previous research. For example, Dugan,
These limitations are balanced by study strengths. Few previous studies have recruited women at the scene of police involved IPV incidents (Brookoff et al., 1997; Henning & Klesges, 2002; Hutchinson & Hirschel, 1998); therefore, this sample is unique and pro- vides data on women experiencing police involved IPV that cannot be found elsewhere in the literature. The sample is diverse, particularly in terms of Native American representa- tion. Although the number of Native Americans in the sample is small (n 5 45), the pro- portion of Native Americans in the sample (10.42%) is larger than in many studies of IPV. Further, 30 (66.67%) of the Native American women in this sample were at high risk for homicide and, like African American women, Native American women in this sample were more likely than White women to be at high risk. This research adds to the literature on violence, risk, and protective actions among a relatively unique sample of survivors of IPV.
Given the findings of this study, it is important that service providers be aware that sur- vivors seeking medical care or protection orders are likely to be at high risk for homicide, reassault, and severe reassault. Conducting the DA with survivors will educate them about their risk and risk factors and may empower them to take additional protective actions (Campbell, 2001). It is additionally important that researchers and practitioners develop unique ways to reach out to survivors who are not accessing traditional domestic violence services. Internet-based interventions are an example of a unique and accessible delivery format (Glass, Eden, Bloom, & Perrin, 2010). Finally, many women in abusive relation- ships are actively protecting themselves and their families, and it is important to build on their strengths and provide empowering interventions while respecting women's autonomy and self-determination.
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Acknowledgment. This study is funded by a grant from the
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