SAFE CONTACT TRAINING FOR

TRAINERSEdinburgh 2012

Day 3Thinking about risk

Which case is higher risk?

Case 1: JohnMaria, his partner of 4 years has reported a severe assault on her - (strangulation to the point of unconsciousness) other than that no violence but some controlling behaviour around jealousy

She has one child, had planned to live as a family with John – we are asked to assess the risk involved in this.

John (age 45) reports happy childhood and good relationship with parents

Regular employment as carpenter

One previous marriage – still sees adult children – no reports at the start of the case of any violence or abuse in this relationship.

No substance misuse

Some reports of fights in pubs as a younger man

But... you phone his ex-wife and she tells you that he used to grab her bythe throat to control her.

 Case 2: Jamie

• Jamie (21) grew up with violence and abuse in his childhood

• Living in care home from 15 yrs – mum asked him to leave because he was using drugs and abusive to her

• Met Anna (now 20) in hostel – she is a care leaver too

• Dozens of reports of police being called to the hostel, and subsequently their flat – reports of shouting, smashing furniture, Anna has been seen with black eye on two occasions

• Anna says they argue because they are both very jealous and that she ‘winds him up’

• They have one daughter and want to live together and care for her together

• We are asked for our assessment of the risks in this.

Any statement about risk should be as specific as possible and include consideration of:

Likelihood of abuse occurring

What? The nature of the potential harm – (Physical harm? Emotional harm?

Severity of abuse/violence

When? Within what time period?

Who – does the perpetrator pose a risk to – partner, child?

In what context? – when the couple are living together/apart? At time of threat to relationship? At contact handover?

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Example definitions of likelihood

(of harmful behaviour occurring)

very unlikely to occur

unlikely to occur

may occur (a ‘real possibility’)

likely to occur

very likely to occur

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Example definitions of severity

Physical abuse minor moderate severe

acts such as grabbing, pushing or slapping that are unlikely to leave a significant mark, result in injury or require professional medical attention

acts such as punching, kicking or head-butting that are likely to result in temporary injury and need some form of professional medical attention

acts of extreme violence such as strangulation, forceful blows to the head or striking with an object, that are likely to result in serious or permanent injury, or death

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Example definitions of severity

Emotional abuse minor moderate severe

occasional rejection, criticism, insults, name-calling, ‘put-downs’ etc that are unlikely to have a lasting negative impact on the victim’s self-esteem

rejection, criticism, insults, name-calling, ‘put-downs’, humiliation etc that are serious or frequent enough to undermine the victim’s self-esteem

rejection, criticism, insults, name-calling, ‘put-downs’, humiliation etc that are likely to have a devastating impact on the victim’s self-esteem, functioning and abilitty as a parent

For instance

“In my opinion, if the couple continue to manage contact without support, Mr X poses a moderate (may occur) risk of using physical violence severe enough to cause injury towards Ms Y.

It is also very likely that Mr X will continue to use persistent and severe verbal aggression as well as emotional and psychological abuse towards Ms Y.

I believe that whilst the risk of direct abuse of the children is low, the possibility that they will be indirectly harmed during incidents cannot be discounted. Also given their young age there is a very high likelihood that they will be exposed to any abuse of their mother that takes place.”

Overview of risk assessment methodology

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Types of risk assessment (you are already doing one of these)

Clinical AssessmentWhere an experienced practitioner makes the assessment, using ‘practice wisdom’ to interpret what they find out about the client.  Actuarial Assessment •  Researchers identify a range of risk factors which are associated with harmful behaviour  •  Investigate which ones show the strongest statistical relationship with future maltreatment.  •  The assessment then consists of identifying the presence or absence of these factors and weighting them according to a set scheme to produce a risk rating.

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Types of risk assessment Empirically guided clinical assessment

The worker conducts a risk assessment by referring to a checklist of factors that have a demonstrated relationship to onset and /or recidivism. This helps the worker to focus on the relevant data to gather, so that the final assessment, though not statistical, is well informed by the best available research.

[Probably the best and most realistic method in our settings]

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ExerciseWhat makes your alarm bells ring?

Discuss some cases you have worked with and identify as many risk factors for domestic violence as possible.

Write down those which are to do with the victim on one colour post-its and those to do with the perpetrator or

other factors on a second colour post-its.

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Static and Dynamic factors

Risk factors can be divided into two groups:• Static factors – those which are based in the

individual’s past history and background demographics, and so are not amenable to change.

• Dynamic factors – those which can change through treatment, interventions or the passage of time. These include information about the person’s current attitudes and beliefs gained from interview.

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Static factors provide the backbone of any credible risk assessment.

There is a danger of overrating impressions gained from the service user in interview and underrating information about the person’s past history and behaviour.

Abusers may:

• do well in psychological testing, often better than their victims.• convince others that they have ‘learned their lesson’ or ‘put their past behind them’.• be mild mannered and appear reasonable despite severe risk,• or be noisy and intimidating with professionals despite presenting only moderate risk to their partner or child.

In contrast, victims may appear angry with services, emotionally unregulated and difficult to work with.

(Bell, C. 2007)

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The advice from research therefore is:

• First form a judgement of risk based on static factors.

• Then use dynamic factors to make modest adjustments to this estimate.

• Clearly information gained from the client aboutimminent, targeted risk should be acted upon.

Two ways Risk Assessment can ‘get it wrong’

• the assessment may fail to identify women and children at risk (false negative),

• or it may identify risk where it does not exist, resulting in unnecessary and disruptive intervention and resulting harm to families and children (false positive).

Limitations of Risk AssessmentAll assessment methods are imperfect - human behaviour, like the weather, is not perfectly predictable

This means that even with the best methods available: • Some high risk cases will be missed• And some people will have social care services, or police

involved in their lives unnecessarily

And….risk assessment methods are least successful where they are most needed,

when attempting to predict rare, serious events

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Defensible Decision Making

DEFENSIBLE DECISION MAKING IS WHERE:

• all reasonable steps are taken;

• reliable assessment methods are used;

• information is collected and thoroughly evaluated;

• decisions are recorded and carried through;

• agency processes and procedures are followed;

• managers are investigative and proactive.

Home Office, Mappa Guidance 2006.

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Domestic violence risk factorsDemographic profile – young, poor, unemployed, low educational attainmentDevelopmental factors – exposure to violence or maltreatment as a childConduct/adjustment problems as a child/adolescentEmployment problemsSubstance use problemsMental health problemsCriminal historyGeneral aggression; Aggression to another family memberDefiance of authorityExposure of child to domestic violenceChild MaltreatmentDomestic violence in another relationshipDomestic violence towards the mother – nature, persistence, severity Dynamic factors – Level of responsibility/remorse – insight into effects – risky emotional states or thinking patterns – motivation to change

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Domestic violence vulnerability factorsDemographic profile – young, poor, unemployed, low educational attainment

Developmental factors – neglect, exposure to violence or emotional or physical maltreatment as a child

Conduct/adjustment problems as a child/adolescent

Employment problems

Substance use problems

Mental health problems

Aggression

Subjection to sexual or violent assault by a non-intimate

Domestic violence in another relationship

Any factors which increase isolation from sources of support

Dynamic factors – Awareness that it’s not ok and motivation to change – self esteem – self efficacy - insight into effects –level of love and attachment to abuser Risky attitudes (e.g. belief that she deserves violence, can’t survive without him, that he won’t survive without her, that marriage is sacrosanct no matter what, that children need a father no matter what, that children weren’t aware etc)

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Contact cases – other risksRisk of exposure to domestic violence and conflict (in this or other relationships)

Risk from poor parenting, neglect or maltreatment (has he ever cared for a child independently?)

Risk of the child’ recovery being undermined

Risk that mothers recovery will be undermined, thereby impairing her ability to parent

Risk that the father will undermining the mother-child bond, or the mother’s authority as a parent

Is litigation is a means of further controlling or harassing the mother?Risk of abduction

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Weighting factors in your assessment

• Static risk factors do not all carry equal significance and cannot be equally weighted

• It is generally the aggregated effect of multiple factors that increases predictive power: the higher the number, the greater the probability that harmful behaviour will occur.

• According to Gelles et al (1994), the presence of two out of ten of the risk factors for domestic violence they identified suggests twice the likelihood of violence than where none of the factors is present.

• Seven or more factors, on the other hand, represents a risk which is forty times greater.

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Weighting factors in your assessment

• Of course one or two critical factors may lead to a conclusion that reoffending is likely

• (for instance DV perpetration in multiple relationships and a vulnerable partner)

• And for a substantial minority of ‘family-only’ DV perpetrators, very few factors may come to light in the case history.

Working with denial

Implications for risk assessmentLong standing belief that perpetrators who deny their violent

actions are among those least likely to desist from further violence and abuse

This applies to both domestic violence perpetrators and child abusers.

Implications for risk assessmentIt’s often assumed that denial is linked to higer riskBut the evidence is mixed • Strongest for those men who are convinced of

their own innocence (self-deceivers) • But for those whose denial is a conscious attempt

to avoid consequences, or to avoid shame and embarrassment (liars), there is at least some sense that their behaviour is unacceptable.

Context is also important

Henning and Holdford (2006) found that with domestic violence offenders at time of arrest :

‘Participants who intentionally denied minor character flaws in a possible attempt to appear socially conforming were less likely to reoffend than offenders who were more forthcoming’ (pp. 123–124).

Some of those who admit at time of arrest may simply not care about what they did – “she deserved it” or do not realise that what they did was serious

So, paradoxically, ‘liars’ may be less risky than (uncaring) admitters, and self deceivers.

Also note that some offenders cycle between acknowledgement –>shame -> anger->re-offending

So when and why is denial a problem?

Implications for change or treatment

• It makes it easier to continue being abusive – if it’s only a small problem, why change?

• It’s very hard to work with those in denial

• minimisation of responsibility is linked to higher treatment attrition rates

• It implies that the victim needs to change before you can stop being abusive.

Implications for those affected by the abuse

With partner abuse

• it puts the blame on the non-abusive parent

• denies children’s direct experience• and hinders their recovery

Accepting blame vs becoming accountable, for the sake of those around you

The bedframe

Day 3Thinking about training

What’s our plan?

Day 3• Thinking about training and learning• Enriching your expertise on the topic • Planning and agreeing your training courseDay 4• Practice delivery of plan

Day 3 Impact of Domestic Violence on Young People

• Trauma effects on brain development

Impacts on children

Impacts on children

• Attachment styles

Attachment style – a template for doing close relationships

Early experiences (in the first 2years) are powerfully predisposing. Thereafter our style is robust and hard (not impossible) to change.

Why is this?

The carer responds to the baby’s signals of need and distress. This pattern of signal and response is like the first small stream forming. At this point the course it takes is open and it’s easy to redirect.

With every repetition of the pattern is strengthened. The interactions between baby and carer begins to take a course

which is still tentative - but which now predisposes each successive response.

Over time, with consistent reinforcement, the stream becomes a deep river.

And it gets harder and harder to change its course….

Getting more secure

• What things do mothers do with young children in the first 2 years to make them feel safe and secure?

Impacts on children

• Social learning

Domestic violence and family dynamics

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Domestic violence and family dynamics

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And you take away the perpetrator, you get

……..

So if this is the power

relationship…..

Post-separation family dynamics

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There’re a power vacuum

This is often how the power differential ends up

This is what we need to return the power relationship

to

Children’s Resilience

Protective factors against adversity

•Self esteem•Talents •Child’s ability to make sense of events•Child’s relationships with others•supportive peer network•Sense of autonomy and purpose•Secure attachments to at least one parent•Connections to wider community•Sense of control

Supporting Resilience• contact with lots of supportive adults who know about what’s happened and will offer tonnes

of love• permission to talk to others freely• contact with peers who’ve gone through similar• the best possible relationship from now on with both parents• anything that increases their self-esteem – extra-curricular activities, running clubs, drama

shows etc.• getting therapy or specialist help to

understand and express themselves better.• Mum and dad give a clear understanding

of what happened and why – no excuses• Mum and dad get support to

understand and parent them.• Helping others through voluntary

work, mentoring etc.• Having a safety plan so they have

some control over their safety if it happens again.

THANK YOU FOR ALL YOUR BRILLIANT WORK!