Gazette - Assessing lethality in domestic violence cases

FEATURED SUBMISSION

Program helps first responders save lives

By David M. Sargent and Jacquelyn C. Campbell, PhD, RN

According to a 2001 study in the journal Preventive Medicine, police officers were called to the scene of 50 per cent of domestic violence homicides.* The study also found that only four per cent of domestic violence murder victims had ever used the services of a domestic violence provider. In a different sample of victims who had gone into shelters, the rate of re-assault dropped by a staggering 60 per cent.

As a law enforcement community — and a co-ordinated community — we can respond to these statistics by turning them into opportunities to save the lives of potential domestic homicide victims. In the state of Maryland, we started with the question, “What can we do?”

In 2003, the Maryland Network Against Domestic Violence (MNADV) received a grant to establish a lethality assessment instrument and accompanying protocol, both of which would help assess the risk that a victim of domestic violence would be killed by his or her partner.

Because lethality assessment is generally applied in a clinical setting, the MNADV sought to develop an assessment tool for first responders, primarily law enforcement officers. The initiative is called the Lethality Assessment Program (LAP) for First Responders.

To ensure professional methodology, the MNADV organized a Lethality Assessment Committee comprised of law enforcement officers, criminal justice system practitioners, domestic violence advocates, and researchers — including the authors.

The committee developed an 11-question assessment tool, called the Lethality Screen for First Responders. The screen is based on the professionally respected Danger Assessment for identifying the danger in domestic violence cases (www.dangerassessment.org). It is a straightforward questionnaire that allows responding officers to predict, with a high degree of accuracy, both the danger and the potential of lethality for victims of domestic violence situations. Responding officers use the screen to ask such questions as “Has he/she threatened to kill you or your children?” and “Has he/she ever tried to choke you?”

Infusing a belief in empowering victims with a sense of urgency, the committee then developed the LAP protocol, basing its work on the experience of its membership and over 25 years of available research. The protocol encourages victims identified as “high risk” for domestic violence fatalities to seek the services of a domestic violence program. The protocol espouses the victim-defined advocacy model of safety planning and allows a flexible approach to implementing the Lethality Screen.

The hallmark of the protocol is this: if the Lethality Screen identifies a victim as being in “high danger,” the police officer making that assessment calls the local domestic violence hotline from the scene.

Although officers traditionally refer victims to domestic violence service providers, the victims seldom make the call.

In the LAP protocol, the officer calls the hotline to seek advice and — equally important — to encourage the victim to speak to the hotline counsellor. Additionally, the officer tells the victim that he or she is in danger and that people in similar situations have been killed (information that is hopefully eye-opening to the victim). Depending on whether or not the victim chooses to speak to the hotline counsellor, the officer proceeds with one of two responses to promote the immediate safety of the victim.

If the victim chooses to speak to the counsellor, the officer responds to the outcome of that telephone conversation, perhaps becoming involved in co-ordinating a safety plan with the victim and counsellor.

If the victim chooses not to speak to the counsellor, the officer provides safety planning advice to the victim and reviews factors that are predictive of death, so the victim can be on the lookout for those factors in future. The officer encourages the victim to contact a domestic violence program, provides the victim with police contact information, and may take other actions such as advising the victim how to obtain a protection order.

The LAP in action

The Lethality Assessment Committee spent nearly a year developing the Lethality Screen and LAP protocol, and field testing them in three jurisdictions. The primary focus of field testing was to determine whether the screen and protocol were user-friendly for officers on the scene. Eighty-four per cent of officers surveyed reported that the instrument and protocol were “easy” or “fairly easy” to administer, and 50 per cent related that the tools bolstered their confidence.

The committee spent the next year gathering data, holding regional workshops to explain the LAP and obtain additional feedback, adjusting the screen, and producing a training video for police officers.

The MNADV now co-ordinates the LAP and provides a direct train-the-trainer curriculum for law enforcement agencies. It also offers an in-service curriculum for participating domestic violence service providers. Each agency and program that implements the LAP is asked to voluntarily gather and report Lethality Screen data to the MNADV on a quarterly basis. To date, all participating agencies have honored this request. The MNADV then provides all participants with quarterly and annual reports, comments and recommendations.

Each participating agency and domestic violence program appoints a lethality assessment contact who communicates with the MNADV co-ordinator and other agency/program contacts. All contacts serve on the Lethality Assessment Participants’ Committee, which meets annually and communicates frequently via e-mail.

In October 2005, the LAP was voluntarily implemented by four law enforcement agencies and two partner providers in two of Maryland’s 24 jurisdictions. Today, 66 police agencies (Maryland State Police included) involving 19 domestic violence programs in 21 jurisdictions have either implemented the LAP, piloted it, received LAP training or committed to go forward.

Though still early in its implementation, there are positive signs that the LAP is affecting domestic homicide statistics in the state of Maryland. The MNADV reported the following statistics during 2006 and 2007:

• Partner agencies administered 5,143Lethality Screens across a participating population of 1.7 million.
• 57 per cent of persons screened were assessed as being in “high danger.” In those jurisdictions where a police officer and domestic violence program advocate visit “high danger” victims unannounced, up to 58 per cent of visited victims sought services.
• 54 per cent of “high danger” victims spoke on the phone with a domestic violence program counsellor.
• 27 per cent of the victims who spoke on the phone went in for services.
• One screened victim was killed.
• In 2007, the number of domestic violence fatalities in Maryland was at its lowest since 1991.

Dr. Neil Websdale of the National Domestic Violence Fatality Review Initiative says that instruments such as the LAP can accomplish several outcomes, including a greater awareness of danger and lethality among victims and the law enforcement community, a greater consideration of proactive interventions, the education of system participants, the opportunity for victims to see their situations through a different lens, and enhanced co-ordination, communication and co-operation.

Maryland has recorded success in each of these areas. Participating agencies have performed consistently and have received numerous out-of-state inquiries as well as media and industry attention.

Maryland has created a program that has impacted the lives of domestic violence victims and given the domestic violence service community a proactive, reliable answer to that nagging question, “What can we do?”

For more information about the LAP, visit the MNADV website at www. mnadv.org .

* Campbell, J., et al. Health care providers missed opportunities for prevention for femicide . Preventive Medicine. Vol.33 No.5 (2001), p. 373-380.

David Sargent served 21 years with the Metropolitan Police Department in Washington, D.C., and has taught domestic violence training courses to more than 7,300 police officers in D.C., Delaware, Pennsylvania, Virginia and Maryland.

Jacquelyn Campbell, BSN, MSN and PhD, is a professor in the Johns Hopkins University School of Nursing and has a joint appointment at the Bloomberg School of Public Health. She has been conducting advocacy, policy work and research in the areas of family violence and health disparities related to trauma since 1980.