The Development of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER): A Tool for Criminal Justice Professionals

Appendix B - B-SAFER User Manual

Brief Spousal Assault Form
for the Evaluation of Risk (B-SAFER)

User Manual

P. Randall Kropp
Stephen D. Hart
Henrik Belfrage

The British Columbia Institute Against Family Violence Logo

For information contact:
The British Columbia Institute Against Family Violence
Suite 551, 409 Granville Street, Vancouver, British Columbia V6C 1T2
Tel: (604) 669-7055 " Fax: (604) 669-7054
E-mail: publications@bcifv.org " URL: www.bcifv.org

Introduction

Overview of the B-SAFER

The B-SAFER is a checklist or guide for assessing risk for spousal assault in criminal and civil justice (i.e., forensic) settings. [4] The B-SAFER is intended to help people exercise their professional discretion when conducting risk assessments; it is not a replacement for professional discretion. Its purpose is to introduce a systematic, standardized, and practically useful framework for gathering and considering information when making decisions about violence risk. It draws directly from the scientific and professional literatures on spousal violence risk assessment and victim safety planning.

The tool is divided into two sections that cover the basic content of a comprehensive spousal assault risk assessment. The first section, Spousal Assault, comprises 5 factors related to the perpetrator's history of intimate partner violence. The second section, Psychosocial Adjustment, comprises 5 risk factors that reflect psychological and social functioning and that are also related to violence risk more generally. Users also can document Other Considerations, risk factors that are rare or even unique to the case at hand.

User Qualifications

Users are responsible for ensuring that their evaluation conforms to relevant laws, regulations, and policies. Users should meet the following minimal qualifications:

  1. Expertise in individual assessment (e.g., formal training and/or work-related experience with perpetrators and victims of spousal assault); and,

  2. Expertise in the area of violence against women in relationships (e.g., formal coursework, knowledge of the relevant literature, work-related experience).

Note that one of the factors taps aspects of mental health, and may require the completion of a psychological or psychiatric assessment. Users who are not mental health professionals may consider this factor by referring to existing psychological or psychiatric reports. Alternatively, they may: (a) code the factor, noting that the coding should be considered provisional (i.e., that a psychological or psychiatric consultation was not available); or (b) omit the factor altogether, making note of any resulting limitations in their assessment.

Confidentiality/Informed Consent

This assessment requires the gathering and documenting of sensitive information about the (alleged) abuser and victim. Therefore those being interviewed should be informed of the potential uses of the information before being asked to consent to the assessment. Every effort should be made to keep confidential any information that could jeopardize the victim's safety.

Applications

The B-SAFER is intended for use in a number of contexts where potential violence is identified. In the criminal justice system, risk assessment is relevant at a number of junctures: during police investigation, prior to trial, prior to sentencing of the offender, and prior to release of the offender. Of course, even if criminal charges are not being contemplated risk assessment will be useful for those who contact shelters or victim counseling services. In the civil justice system safety planning can occur in the context of separation/divorce and custody/access hearings. This is particularly important in light of the fact that many separations are precipitated by spousal violence and that estrangement increases the risk for repeated and even escalated violence.

It is important to emphasize that risk assessment is not a static process. Risk level

will fluctuate and change over time in concert with an offender's (and a victim's) circumstances. Therefore it is recommended that repeated assessments be conducted at a minimum of every six months. Furthermore, the following critical situations require that risk assessments be revisited:

  • (a) there is a recent or imminent relationship separation involving the victim and abuser;
  • (b) the victim has recently begun a new intimate relationship;
  • (c) there is a recent or imminent release of the abuser from secure custody;
  • (d) there is a recent or imminent child custody/access dispute; or
  • (e) there are new circumstances increasing the likelihood of victim and abuser contact.

A Prevention-based Model of Risk Assessment

Three models, or methods, of risk assessment have been discussed in the violence literature: unstructured clinical decision-making, actuarial decision-making, and structured professional judgment. Each method is discussed here with respect to its relevance to the practice of spousal assault risk assessment in general, and the B-SAFER in particular.

Unstructured Clinical Assessment

Unstructured clinical decision-making is probably still the most widely used approach to spousal violence risk assessment (Campbell et al., 2001; Dutton & Kropp, 2000). This is a method that involves no constraints or guidelines for the evaluator. Decisions are based on the exercise of professional discretion and usually are justified according to the qualifications and experience of the professional who makes them. Thus, professionals must trust their intuition or "gut" when determining who is or is not dangerous. The approach has been widely criticized in the violence literature for lacking reliability, validity, and accountability (Litwack & Schlesinger, 1999; Quinsey et al., 1998), and has been labeled "informal, subjective, [and] impressionistic" (Grove & Meehl, 1996, p. 293). One traditional advantage of unstructured clinical decision-making is that it allows for an idiographic analysis of the offender's behavior and a person- and context-specific tailoring of risk management and violence prevention strategies. However, because the approach relies so heavily on professional discretion, it is vulnerable to missing important factors that require intervention. Recommendations for management strategies - if they are made at all - might be based more on the training, preferences, and biases of the evaluator rather than on: (1) well-reasoned consideration of dynamic and criminogenic (i.e., crime-relevant) risk factors; and, (2) intervention strategies that are either empirically valid or well accepted in the field. Given the widespread criticism of this approach, it is advisable for those working with spousal assaulters and their victims to move away from this practice. At the very least, practitioners should only consider risk factors that have some support in the empirical or clinical literature.

Actuarial Assessment

The actuarial method of risk assessment is strongly associated with the prediction paradigm popular in the violence literature (see Heilbrun, 1997). Such methods are designed to predict specific behaviors within a specific time frame. The stated goal of the actuarial method is to predict violence in: (1) a relative sense, by comparing an individual to a norm-based reference group; and, (2) an absolute sense, by providing a precise, probabilistic estimate of the likelihood of future violence. Grove and Meehl (1996, p. 293) have described this approach as "mechanical and algorithmic." The key strength to this approach is that it improves upon the poor reliability and validity of unstructured clinical assessments (Grove & Meehl, 1996; Litwack, 2001; Quinsey et al., 1998). The actuarial approach can assist the evaluator to estimate, in a relative sense, the risk posed by an individual over a fixed time period, compared to a reference group. In this sense, it is a worthwhile endeavor to develop and test actuarial instruments for spousal violence risk assessments. Indeed, several attempts have shown correlations between the actuarial approach - that is, the totalling of risk factors to produce a risk "score" - and various measures of violent behavior and construct validity (Campbell, 1995; Grann & Wedin, 2002; Hanson & Wallace-Capretta, 2000; Kropp & Hart, 2000; McFarlane et al., 1998). In Canada, this approach has been used by the Ontario Provincial Police in the development of the Ontario Domestic Assault

Actuarial approaches have been criticized for their lack of practical utility (Douglas & Kropp, 2002; Hart, 1998, 2001; Litwack, 2001). Thus, there is an unresolved schism between science and practice. Practitioners resist using methods that eliminate professional discretion. This might be because they see their role as preventing violence rather than predicting it (Douglas & Kropp, 2002; Hart, 2001; Heilbrun, 1997). From a violence prevention perspective, actuarial methods can inform us about the overall level of risk management that might be required (i.e., the greater the risk, the greater the necessary resources). However, they do little to inform us about specific violence prevention strategies. Heilbrun (1997) contrasted "prediction versus management" models of risk assessment, noting that the prediction model likely has "minimal" implications for management due, in part, to its lack of sensitivity to change. To apply the actuarial approach properly, the evaluator is forced to consider a fixed set of factors and cannot consider unique, unusual, or context-specific variables that might require intervention (Hart, 1998). Moreover, actuarial instruments may lack a "goodness of fit" with offender treatment programs: There is an incongruence between violence prevention program targets such as "attitudes towards violence" or "denial and minimization" and risk assessment instruments that fail to consider such things. Finally, although actuarial approaches give the appearance of objectivity and precision, they often yield very modest correlations with violence (Douglas, Cox, & Webster, 1999) and are subject to limitations such as statistical shrinkage (incomplete replication on cross-validation in new populations) and measurement error. Moreover, practitioners may feel uncomfortable considering only one "test" of risk, while ignoring legal, ethical, and professional requirements to consider all available information, from all perspectives (American Psychological Association, 2002; Hart, 2001). Law and professional practice must change considerably before professionals can abandon discretion in favor of strict actuarial methods. Unless and until such changes occur, professionals must decide how to strike the balance between scientific rigor and respect for the uniqueness of cases. Meteorology provides a suitable analogy: no matter how well climate tables and computer models predict the weather, it is still a good idea to look outside before deciding what to wear.

Structured Professional Judgment

Structured professional judgment is an approach that attempts to bridge the gap between unstructured clinical and actuarial approaches to risk assessment (Douglas & Kropp, 2002; Hart, 1998). The term "professional" (Kropp & Hart, 2000) is used to allow for the reality that there are many non-clinical professionals (i.e., police officers, probation officers, victim services personnel) that are often required to conduct violence risk assessments. The method has also been termed the "guided clinical approach" by Hanson (1998, p. 52). Here, the evaluator must conduct the assessment according to guidelines that reflect current theoretical, professional, and empirical knowledge about violence. Such guidelines provide the minimum set of risk factors that should be considered in every case. The guidelines will also typically include recommendations for information gathering (e.g., the use of multiple sources and multiple methods), communicating opinions, and implementing violence prevention strategies. The method is certainly more prescribed than the unstructured clinical approach, but much more flexible than the actuarial method. Structured professional judgment does not impose any restrictions for the inclusion, weighting, or combining of risk factors. In this way, the approach still meets Grove and Meehl's (1996, p. 293) definition of "subjective, impressionistic" decision-making. Typically, however, this approach is still considerably more structured than traditional clinical prediction, providing guidance in terms of which risk factors to consider, as well as operational definitions for the scoring of the factors. The flexibility enters in terms of the final step of combining risk factors, which is not done algorithmically. Structured professional judgment does not abrogate the professional responsibility and discretion of the evaluator, but it does attempt to improve the consistency and visibility of risk judgments. In Canada, this approach has been used by the British Columbia Institute Against Family Violence (BCIFV) in the development of the Spousal Assault Risk Assessment Guide, or SARA (Kropp, Hart, Webster, & Eaves, 1994, 1995, 1999).

The primary goal of the structured professional approach to risk assessment is to prevent violence (Douglas & Kropp, 2002). By systematically identifying risk factors - particularly dynamic, or changeable, risk factors - relevant to a case, management strategies can be tailored to prevent violence. This approach has been popular in the corrections field for some time, demonstrating some success in preventing general criminal recidivism (Andrews & Bonta, 1995). Indeed, the corrections literature has long recognized the importance of identifying risk and needs factors in individuals in order to effectively manage their behavior. It should also be noted that the structured professional approach resembles clinical practice parameters quite commonly used in medicine (Kapp & Mossman, 1996). The structured professional approach allows for a logical, visible, and systematic link between risk factors and intervention, in addition to the ability to identify persons who are at higher or lower risk for violence. It is vulnerable to some of the same criticisms as the unstructured clinical approach because it still allows considerable professional discretion. There is some evidence, however, of the reliability and validity of structured professional judgment guidelines such as the SARA (Douglas & Kropp, 2002; Douglas & Webster, 1999; Kropp & Hart, 2000; Grann & Wedin, 2002; Watterworth, Smith, Williams, & Houghton, 2001).

Risk Management Strategies

The B-SAFER is designed to assist evaluators to identify risk management strategies. Developing risk management plans is a difficult business. Optimally, it requires familiarity with and cooperation among a number of different professionals working in different agencies, each with a different skill set and mandate. The development and implementation of comprehensive, integrated, multi-disciplinary risk management plans is best accomplished with the assistance of a guiding policy and procedure manual (Kropp, Hart, Lyon, & LePard, 2002). The B-SAFER encourages evaluators to consider the initiation or implementation of four basic kinds of risk management activities: monitoring, treatment, supervision, and victim safety planning (Kropp et al., 2002).

Monitoring

Monitoring, or repeated assessment, is always a part of good risk management. The goal of monitoring is to evaluate changes in risk over time so that risk management strategies can be revised as appropriate. Monitoring services may be delivered by a diverse range of mental health, social service, law enforcement, corrections, and private security professionals. Monitoring, unlike supervision, focuses on surveillance rather than control or restriction of liberties; it is therefore minimally intrusive.

Monitoring strategies may include contacts with the client, as well as with potential victims and other relevant people (e.g., therapists, correctional officers, family members, co-workers) in the form of face-to-face or telephonic meetings. Where appropriate, they may also include field visits (e.g., at home or work), electronic surveillance, polygraphic interviews, drug testing (urine, blood, or hair analysis), and inspection of mail or telecommunications (telephone records, fax logs, e-mail, etc.).

Frequent contacts by the client with health care and social service professionals are an excellent form of monitoring; missed appointments with treatment providers are a warning sign that the client's compliance with treatment and supervision may be deteriorating.

Plans for monitoring should include specification of the kind and frequency of contacts required (e.g., weekly face-to-face visits, daily phone contacts, monthly assessments). They also should specify any "triggers" or "red flags" that might warn the individual's risk of violence is imminent or escalating.

Treatment

Treatment involves the provision of (re-) habilitative services. The goal of treatment is to improve deficits in the individual's psychosocial adjustment. Treatment services typically are delivered by health care and social service professionals working at inpatient or outpatient clinics or agencies. In many cases treatment is involuntary, that is, the individual is civilly committed to inpatient or outpatient care under a mental health act; is being treated in a correctional or forensic psychiatric facility; is ordered to attend treatment as a condition of bail, probation, or parole; or is required to attend assessment or treatment as part of an employee assistance program (Kropp et al., 2002).

One important form of treatment is directed at mental disorder that is causally related to the individual's history of violence. Although there is as yet no direct evidence that various treatments for mental disorder decrease violence, it is possible - and even likely - that they will have a beneficial impact. Treatments may include individual or group psychotherapy; psychoeducational programs designed to change attitudes toward violence; training programs designed to improve interpersonal, anger management, and vocational skills; psychoactive medications, such as antipsychotics or mood stabilizers; and chemical dependency programs.

Another important form of treatment is the reduction of acute life stresses, such as physical illness, interpersonal conflict, unemployment, legal problems, and so forth. Life stress can trigger or exacerbate mental disorder. But it can also lead to transient symptoms of psychopathology even in people who are otherwise mentally healthy. The most effective way to reduce psychological stress is to eliminate the stressor (i.e., stressful circumstance or event). To this end, dispute resolution mechanisms may be helpful. These might include referral to crisis management services or legal counseling and even, when comprehensive assessment indicates it is likely to be helpful for both parties, a recommendation for the individual to participate in arbitration, mediation or conferencing processes.

Supervision

Supervision involves the restriction of the individual's rights or freedoms. The goal of supervision is to make it (more) difficult for the individual to engage in further violence. Supervision services typically are delivered by law enforcement, corrections, legal, and security professionals working in institutions or in the community.

An extreme form of supervision is incapacitation, that is, involuntary institutionalization of the individual in a correctional or health care facility. Incapacitation clearly is an effective means of reducing the individual's access to potential victims. It is, however, by no means perfectly effective: The individual may escape or elope from the institution, and also may commit violence against staff or other people while institutionalized. Incapacitation also has other disadvantages: It is expensive; it restricts accessibility to treatment services; and it may promote the development of antisocial attitudes by increasing contact with antisocial peers and by creating a sense of powerlessness or frustration.

Community supervision is much more common than institutionalization. Typically, it involves allowing the individual to reside in the community with restrictions on activity, movement, association, and communication. Restrictions on activity may include requirements to attend vocational or educational programs, not to use alcohol or drugs, and so forth. Restrictions on movement may include house arrest, travel bans, "no go" orders (i.e., orders not to visit specific geographic areas), and travel only with identified chaperones. Restrictions on association may include orders not to socialize or communicate with specific people or groups of people who may encourage antisocial acts or with victims of previous offenses.

In general, supervision should be implemented at a level of intensity commensurate with the risks posed by the individual. This helps to protect the individual's civil rights, and also helps to reduce the liability of people involved in providing supervision services.

Victim Safety Planning

Victim safety planning involves improving the victim's dynamic and static security resources, a process sometimes referred to as "target hardening." The goal is to ensure that, if violence recurs - despite all monitoring, treatment, and supervision efforts - any negative impact on the victims' psychological and physical well being is minimized. Victim safety planning services may be delivered by a wide range of social service, human resource, law enforcement, and private security professionals. These services can be delivered regardless of whether the individual is in an institution or the community. Victim safety planning is most relevant in situations that involve "targeted violence," that is, where the identity of the likely victims of any future violence is known.

Dynamic security is a function of the social environment. It is provided by people - the victim and others - who can respond rapidly to changing conditions. The ability of these people to respond effectively depends, critically, on the extent to which they have accurate and complete information concerning the risks posed to victims. This means that good victim liaison is the cornerstone of victim safety planning. Counseling with victims to increase their awareness and vigilance may be helpful. Treatment designed to address deficits in adjustment or coping skills that impair the ability of victims to protect themselves (e.g., psychotherapy to relieve anxiety or depression) may be indicated. Training in self-protection should be considered, such as protocols for handling telephone calls and mail or classes in physical self-defense. Finally, information concerning the individual (including a recent photograph), the risks posed to victims, and the steps to be taken if the individual attempts to approach the victims should be provided to people close to the victims and those responsible for their safety. This information will allow law enforcement and private security professionals to develop proper security plans.

Static security is a function of the physical environment. It is effective when it improves the ability of victims to monitor their environment and impedes individuals from engaging in violence. The risk management plan should consider whether it is possible to improve the static security where victims live, work, and travel. Visibility can be improved by adding lights, altering gardens or landscapes, and installing video cameras. Access can be restricted by adding or improving door locks and security checkpoints. Alarms can be installed, or victims can be provided with personal alarms. In some cases, it is impossible to ensure the safety of victims in a particular site and the case management team may recommend extreme measures such as relocation of the victims' residences or workplaces.


[4] Spousal assault is defined as any actual, attempted, or threatened physical harm perpetrated by a man or woman against someone with whom he or she has, or has had, an intimate, sexual relationship. This definition is intended to be inclusive and is not limited by the gender or sexual orientation of the victim or perpetrator. It is also not limited to relationships where the partners are or have been legally married. Having said this, it is generally recognized that the abuse of women by their male partners is the most prevalent and serious form of partner abuse.

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