Patterns of Help-seeking Strategies in Response to Intimate Partner Violence: A Latent Class Analysis.

Women engage in multiple strategies to cope with the impact of intimate partner violence (IPV). Prior research has focused predominantly on women's service utilization and help seeking as individual acts, yet it is likely that women engage in distinct patterns of multiple help-seeking strategies to achieve safety. As such, the current article examines patterns of service-related help-seeking strategies survivors employ. This article also investigates demographic factors, relationship characteristics, and mental and physical health effects of IPV associated with patterns of help seeking. Using a web-based survey, data were collected from service-engaged adult female IPV survivors (n = 369) in the Southwest region of the United States. Latent class analysis (LCA), a person-centered analytical approach, was used to identify survivors' patterns of help seeking. A 3-class LCA model was determined to be the best fit for the data. Among the sample, 50% of women broadly engaged formal and informal networks, 15% primarily engaged informal networks, and 35% broadly engaged networks but avoided legal systems while seeking other formal services. Findings indicated varying and significant associations between class membership and race/ethnicity, foreign-born status, number of children, IPV severity, and mental health symptoms. The findings reinforce the need for practitioners to be aware of the varied ways women choose or avoid seeking help and explore women's preferences. Comprehensive and collaborative service networks are necessary for early detection and holistic care. Addressing structural factors is imperative for expanding the range of viable support options available to IPV survivors, particularly women of color.

Accounting for Multiple Nonfatal Strangulation in Intimate Partner Violence Risk Assessment.

Nonfatal strangulation is a prevalent, underreported, and dangerous form of intimate partner violence (IPV). It is particularly important to assess for strangulation among abused women as this form of violence may not leave visible injury. The most severe negative physical and mental health consequences of strangulation appear to be dose-related, with those strangled multiple times or to the point of altered consciousness at higher risk of negative sequelae. This research examines the relationship between multiple strangulation, loss of consciousness due to strangulation, and risk of future near-fatal violence to modify the Danger Assessment (DA) and the Danger Assessment for Immigrant women (DA-I), IPV risk assessments intended to predict near-fatal and fatal violence in intimate relationships. Data from one study (n = 619) were used to modify the DA to include an item on multiple strangulation or loss of consciousness due to strangulation. Data from an independent validation sample (n = 389) were then used to examine the predictive validity of the updated DA and DA-I. The updated version of the DA predicts near-fatal violence at 7-8 months follow-up significantly better than the original DA. Adding multiple strangulation or loss of consciousness to the DA-I increased the predictive validity slightly, but not significantly. The DA and DA-I are intended to be used as a collaboration between IPV survivors and advocates as tools for education and intervention. Whether or not an IPV survivor has been strangled, she should be educated about the dangerous nature of strangulation and the need for medical intervention should her partner use strangulation against her. This evidence-based adaptation of the DA and DA-I may assist practitioners to assess for and intervene in dangerous IPV cases.

The Arizona Intimate Partner Homicide (AzIPH) Study: a Step toward Updating and Expanding Risk Factors for Intimate Partner Homicide.

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.

Survivors Achieving Stable Housing: Implementation, Challenges, and Lessons Learned.

There is a movement toward permanent housing as an alternative to emergency shelter for survivors of intimate partner violence (IPV). Through a case study, this article illuminates the challenges survivors encountered at multiple levels after being offered one of 25 permanent housing choice vouchers (HCVs) as part of the Survivors Achieving Stable Housing project. Obtaining an HCV is a complicated and lengthy process; survivors transitioning from emergency shelter may face time limits on shelter stays while awaiting this permanent housing option. This article identifies challenges, such as difficulties with landlords, moving costs, and a lack of affordable housing, similar to issues reported in previous research. However, specific to IPV survivors, intersecting U.S. Department of Housing and Urban Development and Violence Against Women Reauthorization Act of 2013 (S. 47) policies led to challenges in implementing and interpreting rules and guidance for IPV survivors. Survivor safety from an abusive partner and across other aspects of their lives is of particular concern to survivors as they consider housing options. Given the overlap of homelessness and IPV, social workers in both systems must be knowledgeable about the intersecting issues survivors face as well as the policies affecting them so they can advocate effectively for their clients.

Patterns and Usefulness of Safety Behaviors Among Community-Based Women Survivors of Intimate Partner Violence.

Women who experience intimate partner violence (IPV) use a variety of safety strategies to reduce the frequency and severity of violence, including both informal and formal help-seeking. The purpose of this study was to identifying patterns of engagement in safety behaviors by U.S. women from outside of formal service settings, examine which factors are associated with different patterns of use, and examine the perceived usefulness of safety strategies among women who used them. Cross-sectional data from 725 women experiencing IPV were used for these analyses. A cluster analysis revealed three clusters of safety behavior use among the IPV survivors: Exploring Safety Options, Avoiding the Justice System, and Trying Everything. The trying everything cluster had high rates of use across all of the safety behaviors; they also reported the highest levels of physical, sexual, and psychological IPV. The exploring safety options cluster used the fewest safety behaviors and had the lowest level of IPV. Higher violence was related to a higher likelihood of finding safety planning helpful and a lower likelihood of finding leaving home helpful. Women who were currently living with their partner were less likely to find talking with a professional, making a safety plan, or leaving home helpful. Higher decisional conflict-uncertainty about what safety decisions would be best-was almost universally related to greater likelihood of not finding safety behaviors helpful. The study findings reinforce the importance of working with survivors to tailor safety plans with strategies that reflect their situation, and provide insights into for which tailoring of resource recommendations may be made.

Can Justice System Interventions Prevent Intimate Partner Homicide? An Analysis of Rates of Help Seeking Prior to Fatality.

When women are killed, they are more likely to be killed by an intimate partner than anyone else, and a substantial number of women who are killed by an intimate were abused by that intimate partner before their death. The proportion of men killed by an intimate partner is much lower and prior research indicates that male intimate partner homicide victims are likely to abuse their partners prior to their deaths. However, limited research has examined the criminal and civil justice help seeking of intimate partner homicide victims. This study examines administrative data from one large urban police jurisdiction to understand rates of help seeking by homicide victims in the 1 to 3 years prior to the homicide. Over 4 years (2010-2014), 197 women and 776 men were killed. The proportion of women killed by an intimate or ex-intimate partner was 39.6%, and the proportion of men killed by an intimate or ex-intimate partner was 3.9%. Police had been in contact with the victim of intimate partner femicides for a domestic violence complaint in 91% of cases in the 3 years prior to the femicide (44.9% resulted in arrest), with an average of 6.2 visits per contacted victim. Among male intimate partner homicide victims, 73.3% had been the complainant on a domestic violence case (38.1% resulted in arrest). Few (<10%) victims sought protection orders before the homicide. Over the 3 years prior to their deaths, 36.7% of male homicide victims and 9.0% of femicide victims had been the suspect in a domestic violence case. Results indicate high rates of engagement of police officers with intimate partner homicide victims before their deaths, and highlight the opportunity for homicide prevention through integration of risk assessment (to identify high-risk cases) and enhanced criminal justice and social service interventions in high-risk cases.

Risk-Informed Intervention: Using Intimate Partner Violence Risk Assessment within an Evidence-Based Practice Framework.

Intimate partner violence (IPV) is a pervasive problem in the United States. IPV is often repetitive and may escalate; in a small number of cases, IPV leads to homicide. This article presents an evidence-based practice (EBP) model for risk-informed social work intervention with survivors and perpetrators of IPV. The EBP model combines the best available research evidence, practitioner expertise, and client self-determination to guide the most appropriate intervention. IPV risk assessment instruments provide the best available evidence of future reassault, severe reassault, or homicide. Practitioners who implement IPV risk assessment can use their expertise to adjust risk scores and to suggest risk mitigation strategies for their clients. Examples of risk-informed social work practice include the safe removal of firearms, safety planning around separation, and mitigating the negative consequences of strangulation and sexual violence. Clients ultimately use their self-determination to decide which risk reduction strategies to implement. An EBP model can be used by social workers in all areas of practice to provide risk-informed social work interventions.

Differentiating among Attempted, Completed, and Multiple Nonfatal Strangulation in Women Experiencing Intimate Partner Violence.

PURPOSE: Because identification of intimate partner violence (IPV) in health care settings is low and strangulation increases lethality risk among women experiencing IPV, we examined the prevalence and correlates of nonfatal strangulation among 1,008 women survivors of IPV. METHODS: Trained researchers conducted semistructured interviews with women survivors of IPV referred by police. Multinomial logistic regression examined differential correlates of attempted, completed, and multiple strangulation. RESULTS: Interviews were conducted with 71.14% of eligible women contacted by researchers. A high proportion (79.66%) of the women interviewed experienced attempted (11.70%), completed (30.16%), or multiple (37.80%) strangulation. Each form of strangulation was independently significantly associated with sexual violence when compared with no strangulation. African American women were at increased risk of attempted (adjusted relative risk ratio [ARR], 2.02; p < .05), completed (ARR, 1.79; p < .05), and multiple strangulation (ARR, 2.62; p < .001). Compared with no strangulation, multiple strangulation was associated with more IPV injury and risk factors for homicide, including loss of consciousness (ARR, 2.95; p < .05) and miscarriage (ARR, 5.08; p < .05). Women who had lost consciousness owing to strangulation were more likely to seek medical care than those who had been strangled but had not lost consciousness (p < .01). CONCLUSIONS: Strangulation is a prevalent form of IPV that presents significant health risks to women. Women's health practitioners are optimally positioned to identify subtle signs and symptoms of strangulation, help women to understand the delayed sequelae and potential future fatality associated with strangulation, and connect them with appropriate resources to reduce the risk of morbidity and mortality.

Validation and adaptation of the danger assessment-5: A brief intimate partner violence risk assessment.

AIMS: The aim of this study was to assess the predictive validity of the DA-5 with the addition of a strangulation item in evaluating the risk of an intimate partner violence (IPV) victim being nearly killed by an intimate partner. BACKGROUND: The DA-5 was developed as a short form of the Danger Assessment for use in healthcare settings, including emergency and urgent care settings. Analyzing data from a sample of IPV survivors who had called the police for domestic violence, the DA-5 was tested with and without an item on strangulation, a potentially fatal and medically damaging IPV tactic used commonly by dangerous abusers. DESIGN: Researchers interviewed a heterogeneous sample of 1,081 women recruited by police between 2009-2013 at the scene of a domestic violence call; 619 (57.3%) were contacted and re-interviewed after an average of 7 months. METHODS: The predictive validity of the DA-5 was assessed for the outcome of severe or near lethal IPV re-assault using sensitivity, specificity and ROC curve analysis techniques. RESULTS: The original DA-5 was found to be accurate (AUC = .68), equally accurate with the strangulation item from the original DA substituted (AUC = .68) and slightly more accurate (but not a statistically significant difference) if multiple strangulation is assessed. CONCLUSION: We recommend that the DA-5 with the strangulation item be used for a quick assessment of homicide or near homicide risk among IPV survivors. A protocol for immediate referral and examination for further injury from strangulation should be adopted for IPV survivors at high risk.

Policing Intimate Partner Violence: Attitudes toward Risk Assessment and Collaboration with Social Workers.

Risk-informed collaborative police-social service interventions are an emerging strategy intended to enhance offender accountability and victim-survivors' safety in intimate partner violence (IPV) cases. These interventions use risk assessment to determine appropriate interventions and enhance the police response for dangerous offenders by engaging in collaboration with social work advocates. Because little is known about the responsiveness of police officers to risk-informed collaborative interventions, this study examines police officer (N = 544) attitudes toward IPV risk assessment and collaboration with social workers. The majority of police officers did not believe a social worker would be helpful at the scene of an IPV incident. However, those who agreed that a social worker would be helpful were more likely to be knowledgeable about the dynamics of IPV. Officers who believed risk assessment was important were more likely to believe that the police response to IPV is necessary. Finally, officers' perceived knowledge about risk for homicide was not consistently associated with actual knowledge about IPV. These findings suggest a need for knowledgeable social workers to collaborate with police, particularly in high-risk cases, and to offer training for officers on risk factors for homicide, coercive control, and misperceptions about IPV.

Are Abused Women's Protective Actions Associated With Reduced Threats, Stalking, and Violence Perpetrated by Their Male Intimate Partners?

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.

The Lethality Screen: The Predictive Validity of an Intimate Partner Violence Risk Assessment for Use by First Responders.

This research is an examination of the predictive validity of the Lethality Screen, a tool used in conjunction with the Lethality Assessment Program (LAP). This intimate partner violence (IPV) risk assessment is an 11-item version of the Danger Assessment (DA) that was designed to be user-friendly for first responders and to maximize sensitivity. Participants ( N = 254) were recruited into the study at the scene of police-involved IPV incidents in one Southwestern state and subsequently participated in two structured telephone interviews approximately 7 months apart. These analyses provide evidence that the Lethality Screen has considerable sensitivity (92%-93%) and a high negative predictive value (93%-96%) for near lethal and severe violence. However, specificity was low (21%). The Lethality Screen also has good agreement with the DA and IPV survivors' perception of risk. The high sensitivity and low specificity should be considered carefully when determining whether the Lethality Screen is appropriate for particular areas of practice with IPV survivors and/or perpetrators.

The State of Intimate Partner Violence Intervention: Progress and Continuing Challenges.

Over the past 40 years, intimate partner violence (IPV) has evolved from an emerging social problem to a socially unacceptable crime. The Violence Against Women Act of 1994 encourages state policies that focus on criminal justice intervention, including mandatory arrest and prosecution. Services offered to victim-survivors of IPV are often tied to criminal justice intervention, or otherwise encourage separation. These interventions have been seen as effectively using the authority of the state to enhance women's power relative to that of abusive men. However, these interventions do not serve the needs of women who, for cultural or personal reasons, want to remain in their relationship, or marginalized women who fear the power of the state due to institutionalized violence, heterosexism, and racism. The one-size-fits-all approach that encourages prosecution and batterer intervention programs for offenders and shelter and advocacy for victim-survivors fails to adhere to the social work value of client self-determination and the practice principle of meeting clients where they are. It is imperative that social workers in all areas of practice are aware of IPV policies, services, and laws. Social workers' challenge moving forward is to develop innovative and evidence-based interventions that serve all victim-survivors of IPV

Intimate Partner Sexual Violence: A Review of Terms, Definitions, and Prevalence.

Intimate partner sexual violence (IPSV) is a significant aspect of intimate partner violence (IPV). While intimate partners commit one third of sexual assaults, IPSV is often overlooked in studies about IPV and in research on sexual violence. There are difficulties identifying, defining, and measuring IPSV, and research lacks consistency in terminology and measurement. The purpose of this article is to review the terms, definitions, and measurements associated with IPSV. Academic journals and nonscholarly documents from the United States were searched for articles and reports associated with the study of sexual violence and IPV. Forty-nine documents met the criteria for inclusion. A four-part taxonomy defining IPSV was developed, which included IPSV, intimate partner sexual coercion, intimate partner sexual abuse, and intimate partner forced sexual activity. The average weighted prevalence rates of these various forms of IPSV were calculated across included research studies. However, the measurements generally used to assess IPV do not adequately measure IPSV. Future research should consist terms to ensure consistent conceptualization and measurement of IPSV and to inform practice with survivors.

The association between protective actions and homicide risk: findings from the Oklahoma Lethality Assessment Study.

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.

Factors related to sexual abuse and forced sex in a sample of women experiencing police-involved intimate partner violence.

Intimate partner sexual violence (IPSV) is a significant social problem, particularly among women who are concurrently experiencing physical violence in their intimate relationships. This research examined the prevalence and factors associated with IPSV among a sample of women recruited at the scene of police-involved intimate partner violence incidents (N = 432). Within this sample, 43.98 percent of participants reported experiencing IPSV; this includes 17.36 percent who reported sexual abuse and 26.62 percent who reported forced sex. Multinomial logistic regression was used to examine the factors related to sexual abuse and forced sex, controlling for victim and relationship characteristics. Compared with women not reporting IPSV, women who were sexually abused or forced into sexual intercourse were significantly more likely to experience strangulation, feelings of shame, and posttraumatic stress disorder symptoms. Women whose partners had forced sex were more likely to report that they had a child in common with their abusive partner; and that their partner was sexually jealous, had threatened to kill them, had stalked or harassed them, or caused them to have a miscarriage due to abuse. These findings can be used to better inform social work practitioners about the prevalence and nature of IPSV and the associated risk factors, and can assist in routine screening and intervention.

The average predictive validity of intimate partner violence risk assessment instruments.

The field of intimate partner violence (IPV) risk assessment (predicting recidivism, lethality) is fast growing, and the majority of research examining the predictive validity of IPV risk assessment instruments has been conducted in the past decade. This study examines the average predictive validity weighted by sample size of five stand alone IPV risk assessment instruments that have been validated in multiple research studies using the Receiver Operating Characteristic Area Under the Curve (AUC). The Ontario Domestic Assault Risk Assessment (ODARA) has the highest average weighted AUC (=.666, k=5) followed, in order of most to least predictive, by the Spousal Assault Risk Assessment (SARA; AUC=.628, k=6), the Danger Assessment (DA; AUC=.618, k=4), the Domestic Violence Screening Inventory (DVSI; AUC=.582, k=3), and the Kingston Screening Instrument for Domestic Violence (K-SID; AUC=.537, k=2). The effect size for the average AUCs for IPV risk assessment instruments is small, with the exception of a medium effect size for the ODARA. Of the 20 measures of predictive validity included in this analysis, the risk assessment was administered correctly in nine (45%). IPV risk assessment is relatively new, and the use of proxy instruments and utilization of risk assessment instruments in settings for which they were not created is widespread. While waiting for a more rigorous body of research, factors in addition to predictive validity must be taken into consideration (e.g., setting, outcome, skills of the assessor, access to information) when choosing which risk assessment instrument is appropriate for use in a particular practice setting.