Risk Violence Assessment

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This assignment is focusing on a topic analyzing the correlation between Intimate Partner Violence and Violence Risk Assessment in a Health context. The subject of IPV is analyzing through a Violence Risk Assessment perspective and taking place in Community Health Services and Police. Also, the purpose of this paper is to evaluate specificity, sensitivity, pay-off matrix and predictive validity as key terms and as predictors of violent incidents as indicators of risk for violence throughout. The background of the subject in research is analyzed and different tools are compared. Intimate Partner Violence is investigating through Community Health Services context and compared at the end with police context.

IPV includes all actions of a consort that causes damages in any way to the individual that is or was involved with… For instance, IPV includes episodes of physical violence, like hitting, slapping, kicking and beating. Also, it referring to sexual violence, such as sexual contact without his or her will and other kinds of sexual assault. (World Health Organization 2012)

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Intimate partner violence is one of the most repeated and frequents types of violence against women and involves physical, sexual, and emotional mistreating and controlling behaviours by a romantic partner. Intimate partner violence prevails in every aspect of life, including socioeconomic, religious and cultural parts. This enormous international millstone of IPV is mostly experienced by women. (World Health Organization 2012)

It is calculated that on an international scale 30% of female population -from the age of fifteen years and older- are experiencing IPV incidents during their life (Devries et al., 2013). In USA, measures of IPV showed to be approximately 35.6% of women experience IPV and following 24.3% of women with crucial violent IPV incidents in their life (Black et al., 2011). In addition, in the USA IPV incidents with psychical violence are estimated around 1.8 million per year, which 28.8% of the incidents needed medical care (NCIPC, 2003). Several studies all around the world have presented crucial harm both physically and mentally that was related to IPV. According to research, it is showed that people that had suffered from IPV damages like physical injuries and severe stress had caused them numerous problems as neurological, cardiac, gastrointestinal and reproductive. (Devries et al., 2013; Ellsberg,Jansen, Heise, Watts, & Garcıa-Moreno, 2008; Kwako et al., 2011;Ruiz-Perez, Plazaola-Castano, & Del Rio-Lozano, 2007; Stockman,Hayashi, & Campbell, 2015; Tadegge, 2008). These negative effects appeared in females who experience severe IPV (Campbell et al., 2003; Messing J.T. et al., 2017)

Specifically, the first study to investigate the predictive validity of RVD tool for IPV risk assessment was presented by Arbach K. and Bobbio A. (2018) and I was applied in a sample different to the original. In this study a sample of 321 women was taken from five community health facilities in Cordoba (Argentina); there was a follow-up in 230 women of the original sample in a scale from 47 to 311 days. Unfortunately, the data showed episodes of physical violence IPV, like serious threats and forced sexual contact. The IPV measures in the low, moderate and high-risk groups estimated approximately at 10%, 57%, and 33%. According to RVD scores, there was a correlation between the overall risk ratings and the existence of violence at the follow-up. For instance, the follow-up showed that the low-risk sample experienced significantly less IPV incidents than the sample in the moderate and high-risk group, and generally haven’t experienced any IPV incident for a long period of time. The study has presented that accuracy was tested in an IPV concept mostly on total scores and a dichotomizes variable of low vs. moderate-high overall risk rating. The conclusions of this research had a crucial practical impact in the progress of violence risk assessment in Latin American. (Arbach K. et al., 2018)

Keys concepts in Violence risk assessment

“Substantial research has demonstrated the value of using risk assessment tools for the prediction and management of violence risk, including for intimate partner violence” (Mills, Kroner, and Morgan 2011; Campbell et al., 2017, p. 175)

During the past 30 years, numerous tools for violence risk assessment have been created to be applied all over the world. Violence in contemporary society have been a crucial source of problematization for many years. The legislation focused mostly to behavioural and medical scientific approaches. The reasoning for this turn was to upgrade the prediction of the risk of violent. For the last twenty years there was an increase of tools in violence risk assessment and criminal offending. (Handbook of Violence Risk Assessment, edited by Randy K. Otto, and Kevin S. Douglas, Routledge, 2009.

The department of violence risk assessment has shown a tremendous development. In the past studies, researchers have constructed more than 400 tools created to predict the risk of violence and offending (Singh, Desmarais, Hurducas, et al., 2014). Experts like probation officers, psychologists, probation officers, psychiatrists, nurses, and police, have practised violence risk assessment tools in more than 44 countries (Singh, Desmarais, Hurducas, et al., 2014; Viljoen, J.L. et al., 2018).

In modern society, violence have been a crucial source of problematization for many years. The legislation focused mostly to behavioural and medical scientific approaches. The reasoning for this turn was to upgrade the prediction of the risk of violent. For the last twenty years there was an increase of tools in violence risk assessment and criminal offending. (Handbook of Violence Risk Assessment, edited by Randy K. Otto, and Kevin S. Douglas, Routledge, 2009).

The aim of violence risk assessment in IPV is to predict and prevent the incidents of violence so there would not be any future recidivism. The benefit of the application of well-established risk assessment tools is that they are an essential source of guidance for the prediction and prevention of IPV incidents as they estimate the risk factors of (Kropp 2004; Trujillo and Ross 2008; Campbell, M., et al., 2018).

Defining the terms: Sensitivity. Specificity, Validity, & Pay-off matrix

The terms sensitivity, specificity, and predictive values could be applied to estimate the efficiency of a case definition or the outcomes of a diagnostic test or algorithm. (McNamara & Martin, 2018)

Sensitivity constitutes one of the four parts of statistics that define the validity of an instrument by divide it in a dichotomous classification (i.e., positive or negative test outcome). Of these four statistics, sensitivity is defined as the probability of correctly identifying some condition or disease state. For instance, sensitivity might be used in medical research to describe that a particular test has 80% probability of detecting anabolic steroid use by an athlete. In research, sensitivity is highly used to demonstrate or evaluate the accuracy of a test for identifying some condition or disease state. Depending on the context though, high sensitivity might or might not be a pertinent variable for evaluating test accuracy. (Salkind N. J., 2010)

Specificity mostly shows or investigates how accurate a test is for precisely eliminating the existence of “some condition” or “disease state”. This estimation of a test’s accuracy in classification is highly critical on the framework where a false positive is costing too much. Specificity is not the only compatible element of evaluation of making a test valid. However, specificity presents details about the accuracy of a process for eliminating the existence of some condition, but it does nothing to corroborate a test’s ability to identify a condition accurately. Specifically, the accuracy in conducting a positive test outcome would be tested by sensitivity. In addition, specificity is not the most appropriate estimation of test accuracy in clinical settings where decisions are being made about an individual’s test outcome and the true diagnosis or classification is unknown. (Salkind N. J., 2010)

Validity emphasizes to the extent to which a valid estimation calculates the particular design that it is supposed to be calculating. Validity that is criterion-related is referring to the interaction linking an individuals’ attribution on two calculations. These two calculations test the same design. So it estimates how nearly scores on a new calculation are analogous to scores from an already valid criterion calculation. There are two types of criterion-related validity: predictive validity and concurrent validity. (Salkind N.J., 2010)

A pay-off matrix is a part of Game Theory. Especially, Static Game theory explains how during games a player acts without knowing the moves of the rest players. In this case they can only make speculations but that does not prove that all the decisions are taken directly at once. So a pay-off matrix is the impact of all of the players moves in one player, it is what a player gets at the end. A usual form of a game presents the pay-offs for all the players, not including Nature, for all the strategies that could be adapted. Following, all these clues are recorded in a board of matrix/matrices. Every time the pay-offs are clarified in order for the players to always choose higher to smaller pay-offs. One famous static game is “the Prisoner’s Dilemma”. This specific game describes that the police has caught two suspects of a crime. Although, they are arrested there is not enough evidence for an official conviction if not one of them confess. (Romp G., 1997)

IPV in Community Health Context & RVD as a tool

Existing research suggests that different types of violence often coexist: physical IPV is often accompanied by sexual IPV, and is usually accompanied by emotional abuse. For example, in the WHO multi-country study, 23–56% of women who reported ever experiencing physical or sexual IPV had experienced both. A comparative analysis of DHS data from 12 Latin American and Caribbean countries found that the majority (61–93%) of women who reported physical IPV in the past 12 months also reported experiencing emotional abuse. (Arbach K. et al., 2018)

According to the IPV literature, for more than 20 years has existed a general confliction about the most appropriate violence risk assessment methods and tools (Egisdottír, White, Spengler, & Maugherman, 2006; Seewald, K. et al., 2017).

The main purpose of the study by Arbach et al., 2018 was to investigate RVD, as a tool to predict IPV risk in a context of community health facilities. The project estimated if it would be possible to be applicable to populations in Argentina. The outcome of the research revealed good results and showed that the accuracy of the prediction of future IPV events was good for an adapted 14-item version of the instrument and closely resembled the prediction efficacy of the original RVD 16-item version, and other risk assessment measures in the context of IPV (Nicholls et al., 2013). Also, results mention that the summary risk judgments increase the predictive power of the numerical RVD score. The RVD showed that there is recidivism in a six months period (López-Ossorio et al., 2017). So if the tool is helpful after this critical period it a product of future research. Following, it is proven that identical outcomes came up due to the speculation of future research to revise violence risk assessment. In general, it is highly important to consider that violence and specifically physical violence might be totally different from other aspects or incidents of violence. (Santos Hermoso & Gonzalez Álvarez, 2017; Arbach K. et al., 2018)

Studies on violence risk assessment of domestic violence, or to be more accurate on violence against intimate partners has rapidly increased during these last years with the evolution and establishment of many measures. The use of these helpful tools have been applied empirical studies tested with both imprisoned IPV perpetrators and not imprisoned perpetrators of police-reported IPV, and there is persistent clue proving that risk assessments with an empirical basis can reveal IPV recidivism. (Olver M. E., Jung S., 2017)

According to the findings, the RVD is proven to be useful for testing the risk of violence when it comes to physical violence. (Arbach K. et al., 2018)The RVD-BCN is made and structured by professionals as model for estimating the risk of serious physical violence acting by romantic partners. Specifically, the tool was made to test only the victim’s report when the contact with the assaulter is not possible. Two version were designed, the preliminary version made during the original study with 19 risk factors and the final version with 16 risk factors. These two version were estimated by the violent, criminal, and clinical history of the assaulter and some victim vulnerability factors. The RVD-BCN was established during 2009 and 2010. (Arbach K. et al., 2018) Numerous tool developers, researchers, and practitioners firmly believe that violence risk assessment is an effective base to risk management (e.g., Douglas & Kropp, 2002; Vincent, Paiva-Salisbury, Cook, Guy, & Perrault, 2012; Viljoen, J.L. et al.,2018).

IPV in a police context & B-Safer as a tool

It is proven that one of the most challenging tasks for the police officers are including in those of intimate partner violence (IPV) incidents (Breul and Keith 2016; Ellis et al. 1993; Horowitz et al. 2011; Retief and Green 2015; Wynn 2015). In general, IPV has been stated in the existing literature “as attempted, threatened, or actual violence committed against a former or past romantic partner, and can take the form of physical, sexual, and emotional abuse as well as intimidation and control” (Heyman et al. 2015). International research has showed that IPV is a highly common occurrence, especially for women. (Campbell M. A., 2017)

Police started to use IPV risk assessment to investigate incidents at high risk of homicide to better inform police intervention (Campbell, Webster, & Glass, 2009; Hilton, Harris, & Rice, 2001)

The section of intimate partner violence (IPV) most of the times is relied on the police. For assistance, officers are increasingly using violence risk assessment tools like the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER). A study done by Storey et al. (2014) replicates the methodology of Belfrage et al. but tests the B-SAFER in a Swedish police officers perspective due to an IPV approach for risk and management. (Storey J.E. et al., 2014)

The result of the study revealed a positive relationship between risk and management. Total scores and overall risk ratings predicted recidivism. Moreover, a pattern where management recommendations were associated with decreased recidivism in high risk perpetrators but increased recidivism in low risk perpetrators 9was found. Results validate the use of the B-SAFER by police and reveal mostly comparable findings between the B-SAFER and the Spousal Assault Risk Assessment guide, as examined by Belfrage et al., but suggest that the B-SAFER may be better suited for police. (Storey J.E. et al., 2014)

Recent research have presented the fact that police officers’ perspective of prediction of repeated violence and the accession of that violence are the most crucial factors on their approach in IPV incidents (Hoyle 1998; Kane 1999, 2000; Storey et al. 2014; Trujillo and Ross 2008). For instance, in Australia police officers, Trujillo and Ross (2008) establish that concepts of IPV risk anticipated if police officers acted during the IPV situation -for example by arresting the assaulter- or didn’t act in any way. Nonetheless, the most extensive violence risk assessment research demonstrates that if no established risk assessment tool is applied to test the possibility of violence or offending, the outcomes are invalid (Andrews & Bonta 2010, ; Hanson & Morton-Bourgon 2009; Campbell, M., et al., 2018).

The assets of applying risk assessment tools increase when it comes to police officers. Research has showed that when the police tested assessment tools on IPV situations there were highly important results for risk decrease and prevention. (Belfrage et al. 2012; Campbell, M., et al., 2018)

Discussion and Conclusion

IPV is highly crucial issue that should be investigated and analyzed in depth. Both contexts, Community Health Services context and Police context, that were used in this assignment need further investigation. There is a lack of application in Violence Risk Assessment in a IPV perspective. This gap could be demolished with further research and practical application. Furthermore two tools are presented, RVD & B-SAFER, and each analyzed in a different context (Community Health Services context and Police context). Additionally, growing evidence proves that IPV is extensive worldwide and causes severe and long-term health problems. In the centre of these negative outcomes of IPV are psychological problems like anxiety, depression, eating disorders and reproductive and physical health problems. The starting point to diminish these problems in health outcomes is that the related risk factors would be accurately detected and specified as a probability for an effective intervention. (Vos T., et al., 2006)  


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