Transcript Homicide Risk: Reconciling Models

System Assessment of Risk:
Keeping Women and Children Safer
Jacquelyn Campbell PhD RN FAAN
Anna D. Wolf Chair and Professor
Johns Hopkins University School of Nursing
Multi City Intimate Partner Femicide Study
Funded by: NIDA/NIAA, NIMH, CDC, NIJ VAWA R01 DA/AA1156
INTIMATE PARTER HOMICIDE
In Canada – 30-40% of women killed – Killed by husband,
partner, BF or EX – Stats Canada (vs. 7-10% of men) (US –
40-50% vs. 5-8% of men – hand count)
3:1 Ratio of women killed by intimate partners vs. men in
Canada (ranges from 3-5:1 over past 20 years)
Canada – Hx of DV: 62% spousal femicides; 67% male (Stats
Canada ‘04) - DV against female partner; 71% Ontario DR
More at risk when leaving or left (Wilson & Daly ‘93; Campbell et. al. ‘01)
79% spousal homicides (Ont DR): during,1st 3 mos, 1st year
Women far more likely to be victims of homicide-suicide (29%
vs. .1% in US; 29.3% vs. 2.9% in Canada)
Aboriginal and immigrant women more at risk (NYC)
IPV 21% of aboriginal (M & F) vs. 7% nonaboriginal in Canada)
44-47% of women killed seen in health care system before
killed (Sharps, Campbell ’02; Wadman & Muelleman ‘99)
Number of Canadian Individuals Killed 2000 – 2006
Data from Brian Vallee, The War on Women, (2007)
600
500
400
300
200
100
0
Soldiers
Law Enforcement
Femicide
“He Killed My Mommy” – Lewandowski, Campbell et.
al. JFV ’04: kids in the homes of women killed or
almost killed
32% Witnessed Femicide;
58% Witnessed Attempts
43% & 37% Found Mother
Received Counseling
60% - all children of actuals;
only 28% of attempteds
56% & 40% of children who
witnessed femicide & attempts
57% & 54% of children who
found the body
71% & 76% of mothers
abused
22% & 27% threats to
take children if she left
20% & 13% threats to
harm children if she left
8% fathers reported for
child abuse – both
actuals & attempteds
DISRUPTION OF CHILDREN
AFTER HOMICIDAL EVENT
Moved from home
To mother’s kin
To father’s kin
Split between mother’s and
father’s kin
With others (e.g. foster home)
Femicide Attempted
86%
25%
40%
16%
12%
6%
5%
0%
14%
2%
SERVICES FOR CHILDREN WITNESSING
INTIMATE PARTNER HOMICIDE
Vary city to city
Private - Victim Assistance Funds
Public - Specialized City Agency
Services offered but no follow-up
Coordination with school fragmented
Custody issues
Nothing systematic for attempted homicides
MISSED OPPORTUNITIES FOR PREVENTION
- 83% of Cases – National Femicide Study
(Sharps, Campbell et al, 2001; Stats Canada ’04, ‘05)
VICTIMS
Police Contacts - 66% of
stalked & battered women
Any Medical Visit - 56%
27% ED; 25% mental health
Shelter Contacts - 4% of
battered women
Substance abuse Tx - 6%
PERPETRATORS
Prior Arrest - 56% of batterers
(32% of non)
Canada – 30% of spousal
femicides – prior police contact
Mental Health System - 12% but
36% described as having “poor
mental health
Canada - 17% – “suspected”
mental/developmental disorder
Substance Abuse Tx - 6% (but
48% with drug &/or alcohol px)
Reported Child Abuse – 8.6%
MISSED OPPORTUNITIES:
PERPETRATORS
80%
Abusive
70%
Non Abusive
60%
50%
40%
30%
20%
Physical/mental
care
Child Ab.
Prior Arrest
Alc/Drug Tx
Drug Use
0%
Alc. Ab.
10%
ATTEMPTED & ACTUAL VICTIMS SEEN IN
SYSTEM
Drug/Alc Tx
Mental health
Physical
health
Called/Stayed
Shelter
Abuse
No Abuse
Called Police
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Spousal Homicide in Canada
BF-GF category increasing – rest decreasing
Same sex intimate homicides – 6 since ’97 vs. approx 75 per
year heterosexual
Atlantic – lowest rate of spousal homicide in Canada, Alberta,
Sascatchewan highest – BC & Manitoba tied for 3rd
Rates: Sascatchewan -.76/100,000 spouses, Alberta .62; Atlantic
Region - .35/100,000 spouses; BC – .53 = average of 13 per year
‘99-’03 (10 femicides
If approximately 8-9 attempted femicides for each femicide = 80 –
total of at least 90 attempteds & actuals each year
Therefore, approximately 120-150 children each year affected by
mother’s murder or attempted murder – prior DV
Ontario Death Review – 21% of spousal homicides – custody or
access disputes; overall 10 of 342 women killed were pregnant when
killed & 7 of 10 killed by partner or ex
CANADIAN INTIMATE PARTNER HOMICIDE
RATE 1974-06 (’91 – first inclusion of BF-GF) (F 3-5 X M)
Rate per million couples – 57% decline
18
16
Female victims
Male victims
14
12
10
8
6
4
2
06
20
02
20
00
20
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
19
78
19
76
19
19
74
0
*BF-GF increased in ‘04
Source: Homicide Survey, Canadian Centre for Justice Statistics
U.S. INTIMATE PARTNER HOMICIDE RATE
DECLINE 1976-02 FBI (SHR, 1976-02; BJS ’05, ‘07)
1800
1600
1400
1200
FEMALE
1000
800
600
400
MALE
200
20
04
20
02
20
00
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
19
78
19
76
0
2004, 05 - no ex’s
INTIMATE PARTNER FEMICIDE BY
PERPETRATOR IN TEN CITIES (N= 311)
(female partner perpetrator – Glass et al 2004 – Canada: 6
since ‘97)
EX-BF
EX-SPOUSE
8.0%
BOYFRIEND
29.6%
19.3%
OTHER
2.6%
SPOUSE
40.5%
Decline in Intimate Partner Homicide
and Femicide - US
Decline in male victimization in states where
improved DV laws and services - resource availability
(Browne & Williams ’89; ‘98)
Exposure reduction - increased female earnings,
lower marriage rate, higher divorce rate (Dugan,
Nagin & Rosenfeld ‘97)
Gun availability decline (Wilt ‘97; Block ‘95; Kellerman
‘93, ‘97- gun increases risk X3)
Rates of Spousal Homicide Using Firearms
40% of female; 21% of male (Stats Canada ‘03)
U.S. INTIMATE PARTNER HOMICIDE RATES
& DOMESTIC VIOLENCE SERVICES 1976-9
(Resources per 50 million - Dugan, Nagin & Rosenfeld ‘03)
4000
3500
3000
IP Homicides
Hotlines
Legal Advocacy
2500
2000
1500
1000
500
2000
1998
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
0
Spousal Homicide by Relationship
Status – Canada 96-05 (*vs. 14% in all Canada)
CANADIAN RATE OF SPOUSAL HOMICIDES IN
DIFFERENT TYPES OF RELATIONSHIPS, 96 – 06
Rate per 1,000,000
“Prediction is very hard to do especially if it is about the future”
Yogi Berra
Overview of Issues
High demand for both lethality & reoffending risk
assessment by criminal justice, advocacy, victim service, &
health systems
Other risk assessment instruments used for general probation
purposes - accuracy with batterers for repeat IPV in dispute
Low base rates
Relatively young science in intimate partner violence & risk
assessment particularly
4 interacting parts to consider - instrument, risk assessor,
perpetrator & one specific potential victim (vs. sexual
assault or mental health – MacArthur study)
Fears that risk assessment will be used to limit service to
victims
High stakes with either false negatives or false positives
Overlapping Concerns
Similar;
Not the same
Risk
Assessment
Lethality
Assessment
Safety
Assessment
Risk Prediction 4 Quadrant Model
(Webster et. al. ‘94)
(A) TRUE POSITIVES (B) FALSE POSITIVES
Predicted violence,
Predicted violence
No violent outcomes
Violent outcomes
False Alarms
Sensitivity
(C) FALSE NEGATIVES
No violence predicted,
Violence occurs
(D) TRUE NEGATIVES
No violence predicted,
No violence occurs
Specificity
Combination of Sensitivity & Specificity = ROC Curve
(Receiver Operating Curve)
ROC Curve Analysis – DA Calibrated on Actual
Femicides – Tested w/Attempteds - 90%
Campbell et al JIPV ‘08
Existing Risk
Assessment Scales
Victim & Offender -reoffend
Evaluation not finished
Navy (DoD) FAP
Risk & Safety
& safety (FA, MP, health)
(Stith, Milner ’02-’04)
DV Mosaic (20) (deBecker)
Computerized/Victim (criminal
justice) - lethality risk system
.65 under ROC
severe re-assault
DVSI- R (Kirk Williams)
Offenders (criminal justice)
short – reoffending
.71% under ROC
(Williams & Grant, ’06)
K-SID (Gelles & Lyon)
Offender – reoffend (CJ)
Some evaluation data
O.D.A.R.A. (Z. Hilton)
Offender - reoffend – (CJ)
PSI (Duluth)
Victim & offender - both
(advocates & criminal justice)
Process evaluation
(CDC) - no outcomes
PAS (D. Dutton)
Offender – intervention programs,
prevention
Cross sectional
validation good
SARA (Kropp et al)
B-SAFER
Offender (criminal justice) reoffending
Most data published
best if perp. psych exam
Danger Assessment
(Campbell)
Victim- Lethality (Advocates, Health)
.69% under ROC
reassault; .90% att. hom
77% under ROC (’04)
Risk Factors for Femicide-Suicide in Abusive
Relationships:
Results From a Multisite Case Control Study
Jane Koziol-McLain, Daniel Webster, Judith McFarlane,
Carolyn Rebecca Block, Yvonne Ulrich, Nancy Glass,
Jacquelyn C. Campbell
Violence & Victims (Springer), Volume 21, Number 1,
February 2006
Femicide – Suicide Cases (32% of femicide
cases in study – 29.3% -Canada; 29% -US)
No significant difference in proportion of prior physical
DV – 77% w/o suicide (n = 210) ; 72% with suicide (n =
100) & similar characteristics – proportions of forced
sex, choking, stalking
< abuse during pregnancy (14% vs. 30%)
50% illicit drug use – not significantly more than abused
Approximately same proportion victim > 50 yo (w/o
suicide 7%; with suicide 11%)
Little evidence of “mercy” killings or suicide pacts – one case with a
suicide note suggesting such – family disputed motive
Prior DV – 32% in older women vs. 79% in younger but close to same
as in older women killed w/o suicide as with suicide & 49% of older
women afraid of partner
Femicide – Suicide cases
Significant explanatory power for same femicide –
suicide risk factors.
Unemployment – slightly different profile
Partner access to gun – used in 61% of homicide/
suicides vs. 28% w/o

Same proportions in Quebec (Lund & Smorodinsky ‘01)
Threats with a weapon
Forced sex
Step child in the home
Highly controlling perpetrator – especially if estranged
Estrangement

(52% of femicides w/suicide 56% w/o) & leaving “trigger” 31%
vs. 33%)
Femicide- Suicide
Unique to femicide – suicide:
Partner suicide threats – history of poor mental health –
higher proportion to mental health care provider
In another study, majority of married femicide
perpetrators failed to receive treatment for depression
or received inappropriate anti-anxiety medications
(Cohen, 2004).
Married
Somewhat higher education levels (unemployment still
a risk factor), more likely to be white, Hispanic, Asian
vs. African American
Children more likely to be killed along with female
partner
Intimate Violence Risk Assessment Validation
Study – J. Campbell, C. O’Sullivan & J. Roehl –
NIJ #2000WTVX0011
N = 782 women who had accessed system
through calling police, civil court, shelter or
hospital ED’s – NY & CA
Relatively severely abused – 43% severe abusive
tactic from CTS last 6 mos
60% retention from Time 1 – more severely abused.
employed & Latina less like to return
38% foreign born; 28% African American; 48%
Hispanic/Latina
NIJ “RAVE” study
Women randomly assigned to 2 of 4 risk assessment
methods
Also CTS, WEB scale, HARASS
Also 40 other items hypothesized to increase risk
Also 2 items to assess victim’s perceived risk
Recontacted 6 – 12 months later – interviewed by phone
Also a criminal justice record check for violent crime & DV
offenses
Women – especially those who saw themselves at high
risk took many impressive protective actions – all kinds
Their accuracy of perception of re-assault – significantly
better than chance but
ROC curve analysis (excluding 27 victims
w/no exposure to abuser) with potential
confounders
Chance - .50
Any & severe re-assault – all significant at <.01
DA - .694; .714
DV-MOSAIC .618; .665
DVSI - .650; .664
K-SID - .639; .657
Victim perception .635; .627
Instruments/method improved on victim assessment
But none of approaches without serious margin of error
Impact of the questionnaire
Repeat of self-perceived risk questions: not significant
Did answering these questions (CTS, 2 risk questionnaires,
self-protective questions) change your view or thinking about
his behavior?
No effect - 64%
More abusive or dangerous than I thought – 29%
Less abusive or dangerous than I thought – 7%
Do you think you will do anything differently in the future as a
result of answering these questions (such as taking more
safety precautions, or fewer; spending more or less time with
him, etc.)? 61% yes
Women’s Statements After Risk
Assessment Process (NIJ RAVE study)
“I never knew – this makes me much more resolved to not
go back”
“I’m gonna’ go get that permanent thing (PO) – I wasn’t
gonna’ go through the hassle before but now I surely will”
“Damn…. He is really dangerous, isn’t he? I keep foolin’
myself about that – now I know I gotta do something”
“I knew he was scary but no one believed me – I’m going to
keep pushing now”
From a woman in Alberta after doing the DA “It was like
filling in a piece of a puzzle – I could finally see the whole
picture"
% taking protective actions during follow-up by
victim perception of risk of serious harm.
Protective actions at follow-up
no voluntary contact with abuser
occasional contact with abuser
someplace he couldn’t find her
went to shelter
left town
changed locks
Weapon (mace, etc.)
Low Med.
32
44
34
41
34
33
12
17
4
9
26
34
8
12
High
52
45
32
14
9
45
18
Effects of protective actions on severe
re-assault during follow-up
Baseline report
eB
Wald
p
Not cohabitating or intimate
0.95
0.1
.832
No voluntary contact with abuser (T2)
1.07
0.1
.757
Went someplace he couldn’t find her
1.92
6.2
.013
Shelter
0.40
6.8
.007
Got protective order
1.13
0.2
.643
Filed criminal complaint
1.41
2.14
.143
Abuser arrested for T1 incident
0.62
4.0
.044
Effects of protective actions on minormoderate re-assault during follow-up
Baseline
eB
Wald
p
Not cohabitating or intimate
1.37
1.54
.215
No voluntary contact with abuser (T2)
0.28
19.7
<.001
Went someplace he couldn’t find her
1.57
2.2
.137
Shelter
0.30
5.6
.018
Got temp protective order
0.60
4.4
.045
Filed criminal complaint
0.90
0.2
.673
Abuser arrested for T1 incident
0.84
0.04
.839
Effects of protective actions on stalking
during follow-up
Baseline
eB
Wald
p
Physical abuse sev./freq.
0.94
1.2
.265
Not cohabitating or intimate
2.78
11.6
.001
No voluntary contact with abuser (T2)
1.03
0.01
.905
Someplace he couldn’t find her
2.10
6.7
.010
Shelter
0.72
0.8
.371
Got temp protective order
1.76
4.4
.036
Filed criminal complaint
1.66
4.5
.033
Abuser arrested for T1 incident
0.77
1.2
.268
Conclusions re: protective actions’
effects on re-assault
Going to shelter at T1 significantly reduced risk of severe
and moderate assaults
No voluntary contact with abuser during follow-up
reduced risk of moderately severe assaults
Arrest at T1 reduced severe assaults
OP/RO reduced moderate assaults
Some protective actions at T2 likely to be response to
assaults during follow-up
Places she thinks he can’t find her – often after a while,
someone tells
Visitation during Follow-Up
75% children in common
with abuser
52% - abuser having
visits w/ children
51% of visits by court
order
Unsupervised – 73%
Supervised – 27%
24%: Physical abuse,
threats or intimidation
during exchange for
visits
GENERAL PRINCIPLES FOR RISK
ASSESSMENT IN DV
More sources of information the better – “gold standard” for
information is victim – without information from victim, cutoffs
for lethality risk problematic – criminal record check important
Perpetrators will minimize perpetration
Few independent evaluations of current instruments – use any
cutoffs with caution – DVSI or ODARA best if criminal justice
records only & SARA with psych evaluation
Instrument improves “expert judgment” – but clinician wisdom
important also
Never underestimate victim’s perceptions (Weisz, 2000;
Gondolf, 2002) but often minimize victimization – therefore
victim assessment of risk not enough if low
Need for DV identification and risk assessment as part of
psychiatric practice
Implications for Policy & Safety Planning
Clinical assessment (psychiatry, psychology) needs
specific DV training

How to ask about DV as part of suicidality assessment
Batterer intervention - she needs to stay gone until
he completes & his attendance monitored
Employment issues – especially for African American
and aboriginal men
Protective order for stalking - or use stalking laws
Issues with various “risk” lists included in safety
planning
Supervised visitation & other means of keeping her
safe during visitation exchanges
Implications for Policy & Safety
Planning
Engage women’s mothering concerns & skills
(Henderson & Erikson ’97 ‘93; Humphreys ‘93; Sullivan
et. al.‘00)
If she says she’s going to leave, cannot leave face to
face
Importance of forced sex & stepchild variables – not on
most risk assessment instruments
Make sure she knows entire range of shelter services
Be alert for depressed/suicidal batterer
Batterer intervention programs working with partners
Policy/Practice/Research
Implications
Need for substance abuse Tx in abusive men –
concurrent with batterer intervention?
Combination programs? New models needed
with rigorous evaluations
Need for collaborations btw. researchers &
clinicians in substance abuse, health, criminal
justice, forensic psychiatry and advocacy – for
advances in risk assessment – research and
policy
Gun Issues
Get the gun(s) out!!!
Judges need to order removal of all guns – specify
in search warrants & PO’s
Canada better about guns in general than US but still
issues
Future Directions
“Danger Assessment is a Process not a Product” (B. Hart)
Field developing rapidly – watch literature
Differentiating lethality & reoffending risk - different batterer
typologies may explain differences (Holtzworth-Munroe)
Strategies for working with victims important – to increase
their realistic appraisal and to determine risk factors not
available from criminal record checks or from perpetrators
never previously arrested – e.g. as part of batterer
intervention programs
Assessing safety – protective strategies as well as danger –
implications for interventions
Two parallel processes – reoffending risk for criminal justice
cases; danger (lethality) – e.g. DVSI risk for victim safety
planning
Ideal Process Model
Offenders in CJ or BIP
Or MH or SA Tx
First Responders
B-SAFER or MD Lethality
Assessment
Women in Shelters
Or Health Care System
Risk Assessment
Partners of Men in System
Danger Assessment &
Safety Assessment
Judicial System
System Safety Audit – Including Fatality Reviews
Also with RAVE data – 3 item version of
DA – submitted for publication
Outcome of those 666 who took DA & full data
on return - N = 400
Predicting those seriously re-assaulted – life
threatening – seriously choked, shot or knifed or
head injury with loss of consciousness (15% of
total)
3 item version – acceptable validity for
severe re-assault (ROC .79)
Violence increasing in severity &/or frequency over
past year
Used a weapon on you/threatened with a weapon
Woman believes he is capable of killing her
If one of 3 – 94% sensitivity but only 29% specificity
If two yeses of 3 – 81% sensitivity & 56% specificity
Either way – outperforms women’s perception of risk
by itself
Policy/Practice Possibilities
Use 3 item version in ED, protective order
hearings, child custody etc.
If 2 of 3, do full DA and proceed based on results
If 1 of 3, tell her has one of 3 highly predictive risk
factors for serious assault/homicide – highly
recommend further immediate advocacy – call
with her
If none of 3, proceed with normal referral/
procedural processes
Never forget who it’s for “please don’t let her death be for nothing –
please get her story told”
(one of the Moms)