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Intimate Partner Violence Prevention and Intervention
The Risk Assessment and Management Approach 1st
Edition Anna C. Baldry Digital Instant Download
Author(s): Anna C. Baldry, Frans W. Winkel
ISBN(s): 9781600218583, 160021858X
Edition: 1
File Details: PDF, 1.28 MB
Year: 2007
Language: english
 INTIMATE PARTNER VIOLENCE
PREVENTION AND INTERVENTION:
THE RISK ASSESSMENT AND
MANAGEMENT APPROACH
 INTIMATE PARTNER VIOLENCE
PREVENTION AND INTERVENTION:
THE RISK ASSESSMENT AND
MANAGEMENT APPROACH

ANNA C. BALDRY
AND
FRANS W. WINKEL
EDITORS

Nova Science Publishers, Inc.

New York
Copyright © 2008 by Nova Science Publishers, Inc.

All rights reserved. No part of this book may be reproduced, stored in a retrieval system or
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AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS.

LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

Assessing risk of spousal assault : an international approach to reduce domestic violence and
prevent recidivism / Anna C. Baldry, Chatzifotiou Sevastan, and Belfrage Henrik.
p. cm.
Includes index.
ISBN-13: 978-1-60692-695-6
1. Spousal abuse. 2. Family violence--Prevention. I. Baldry, Anna C. II. Sevastan, Chatzifotiou.
III. Henrik, Belfrage.
HV6626.A87 2007
362.82'922--dc22
2007024658

Published by Nova Science Publishers, Inc. New York

 CONTENTS

Introduction 1
Anna Costanza Baldry and Frans Willem Winkel
Chapter 1 Preventing Violence: The Role of Risk
Assessment and Management 7
Stephen D. Hart
Chapter 2 Development of the Spousal Assault Risk Assessment
Guide (SARA) and the Brief Spousal Assault
Form for the Evaluation of Risk (B-SAFER) 19
P. Randall Kropp
Chapter 3 Police-Based Structured Spousal Violence Risk Assessment:
the Process of Developing a Police Version of the SARA 33
Henrik Belfrage
Chapter 4 Understanding Risk Factors for Intimate Partner Femicide:
The Role of Domestic Violence Fatality Review Teams 45
Kelly Watt
Chapter 5 Identifying Domestic Violence Victims at Risk of
Hyper-Accessible Traumatic Memories and/or
Re-Victimization Through Validated Screening:
The Predictive Performance of the Scanner and the B-SAFER 61
Frans Willem Winkel
Chapter 6 Intimate Partner Violence and Risk Assessment:
The Implementation of the SARA, Screening Version in Italy 83
Anna Costanza Baldry
Chapter 7 Spousal Assault Risk Assessment: The Case of Greece 107
Sevasti Chatzifotiou
Chapter 8 Caveat Assessor: Potential Pitfalls of Generic
Assessment for Intimate Partner Violence 125
Donald G. Dutton
vi Contents

Chapter 9 Blended Behavior Therapy for Intimate Violence 133

Donald G. Dutton
Chapter 10 The Response Factor: A Practitioner’s Tale 147
Jane Katz
Acknowledgment 177
Authors’ Biographies 179
References 181
Index 203
In: Intimate Partner Violence Prevention and Intervention ISBN: 978-1-60456-039-8
Editors: A. C. Baldry and F. W.Winkel, pp. 1-6 © 2008 Nova Science Publishers, Inc.

INTRODUCTION

Anna Costanza Baldry1 and Frans Willem Winkel 2

1.
Department of Psychology, Second University of Naples, Italy
International Victimological Institute (INTERVICT), Tilburg University, Netherlands
2.
International Victimological Institute (INTERVICT), Tilburg University, Netherlands

This book is about risk assessment in intimate partner violence contexts. The perspective
utilized is based on the professional risk assessment approach exemplified in the Spousal
Assault Risk Assessment (SARA) developed by Hart and Kropp (2000) and its screening
version, the B-SAFER (Brief Spousal Assault Form for the Evaluation of Risk; Kropp, Hart,
and Belfrage, 2005). This instrument was developed in Canada and implemented there and in
Sweden, Italy, and Greece, and is currently being validated also in Portugal, the Netherlands,
and Lithuania.
The process of identifying risk and protective factors for violence is referred to as
violence risk assessment; the process of preventing violence by influencing risk and
protective factors is referred to as risk management. Both risk assessment and risk
management have become routine and integral in most contemporary criminal justice and
public health responses to violence, at least in some countries. It is evident that increasing
numbers of different types of violence have been the subjects of specialized instruments. This
is not surprising given that different variables or patterns of variables predict different types
of violence. In turn, risk management decisions differ as well. Intimate partner violence has
long posed difficult policy challenges to criminal justice administrators and to related agency
officials from other ministries and NGOs responsible for reacting to family violence. It is
important, therefore, to discuss the general issue of risk assessment before narrowing the
focus to intimate partner violence.
This book examines the main scope of risk assessment of violence and concentrates on
the “risk factors” of the perpetrator, as well as those of the victim, especially the
“vulnerability factors.” Most risk assessment instruments are concerned with responding to
the act of violence by reducing the likelihood of another violent act: in other words, reducing
violent recidivism. The key assumption underlying the identification of the risk factors of
recidivism of repeated victimisation is that, once identified, they can be managed and thus
mitigated or reduced, hopefully, decreasing recidivism itself. One of the predominant policy
responses to risk assessment is risk management meaning intervening with the abuser and the
2 Anna C. Baldry and Frans W. Winkel

victim to reduce risk. However, the efficacy of treatment and best treatment programs
historically have been subjected to intense validity debates. The chapters in this book,
therefore, will concentrate on linking risk assessment instruments to intervention programs
which have been subject to valid evaluations establishing positive outcome effects.
It is only during the last three decades that risk assessment and risk management have
become the subject of extensive research and instrument development and, consequently, a
subject of intense controversy among practitioners and researchers. Proponents claim risk
assessment is the most valid and useful technique in predicting a wide range of phenomena,
ranging from general violence to sex offending, stalking, child abuse, suicide, and drunk
driving, as well as other forms of antisocial behaviour. In contrast, antagonists and sceptics
argue that such risk and management instruments have questionable validity and, too often,
unfairly label offenders and contribute to punitive criminal justice responses, coercive health
and mental health measures, or both. Although this debate is beyond the scope of this book, it
has informed the scholarship of the research material presented in the all of the following
chapters.
Theoretically, it is evident that there is a consensus that the onset, persistency, and
escalation of the risk for violent behaviors are not determined or caused by any identified
series of factors, but rather are, at best, correlates. In effect, negative risk factors and
protective factors might have an influence on the violence outcome but they can not be
referred to as causing the outcome. The correlates generally are considered either as static
(i.e., they do not change in time) or dynamic (i.e., they change in time, place, or intensity).
Identifying the presence or absence of both types of risk factors is seen as essential in
assessing whether certain behaviors and victimisation outcome are likely to recur. In effect,
the violence risk assessment approach is related to risk assessment of recidivism; once we
know a person has been violent or committed a certain act, how likely is it that he or she will
be violent again? This approach derives from the classic medical model of risk prediction. In
predicting pathologies or illness, doctors identify known symptoms and the risk factors
related to a specific disease or illness, and then predict the likelihood that a patient will
develop it. They also estimate the likelihood of a physical condition’s worsening if no
medicative actions are taken to reduce the risk factors. However, the medical risk assessment
model also is utilized to prevent or reduce the onset of an illness not just its recurrence or
deterioration.
A general principle of risk assessment is that prediction of an outcome should exceed the
50% chance figure which would be no different than the odds of simply guessing correctly
what might happen. However in real life, police officers, judges or forensic practitioners are
not guessing when deciding which sentence give to the offender or whether to release or not
the person. Their judgment is based on the legislation and experience but also to some factors
that can not be easily measured. To reduce as much as possible this discretionarily variable,
risk assessment methods can be of use. Similarly, this criterion applies to the risk assessment
of the recurrence of an event after its onset. Another principle is the cumulative effect of
multiple risk factors on an event’s recurring. For example, a person who had a heart attack
and has a history of heart attack in his or her family, and has a “risky” life style (e.g. smoking,
poor nutrition habits, and no exercise) is at higher risk for a recurrence of the attack and
subsequent relapses than one who has none or few of these risk factors. Another principle is
that risk factors need to be weighed against protective factors. Even though a person may be
at high risk to have cardiology problems, or to relapse after it has been treated (because of a
 Introduction 3

family history to the severity of the disease), his or her risk may be reduced by several other
(protective) factors such as a change to healthy lifestyle habits and special medical treatment
In effect, the level of risk, therefore, is dynamic; it can change over time, because risk and
protective factors also can change over time.
Similarly, it is accepted that violence risk assessment is not a static assessment, and,
consequently, that each time a decision is taken about the management of an offender and or
the assistance and protection of the victim (e.g., release from prison, renewal of protective or
restraining order, leaving a shelter for battered women) or each time there is a significant
change in his or her life that might affect behavior and reasoning (e.g., the partner goes to
lives somewhere else, loss of job, the victim has a new relationship), another risk assessment
would be needed.
Several risk assessment approaches exist; among the most common is the actuarial
approach which is based on the presence or absence of multiple risk factors. Typically, risk is
assessed by establishing a minimum score. This approach, though extensively used, has
limitations, among which that violence is dynamic, rarely static; individual and social factors
can change even over a short period, as well as over longer development stages. Risk factors
need to be assessed dynamically and systematically, not simply adding them up. A major
advantage of the actuarial approach, as compared to the clinical approach, which arrives at an
assessment based mainly on the assessor’s practical and clinical experience, is that
standardized measure and cut-off scores are utilized for both static and dynamic risk factors.
On the other hand, because risk is dynamic, it can not be assessed solely on the resulting
numbers of present risk factors. In this regard, the structural professional judgement approach
tries to overcome the limitations of both approaches, providing an assessment method that is
based on rigorous validated empirically based studies, but also allows the assessor to make
sense of the presence or absence of the factors in a dynamic way, according to the possible
scenarios that are considered as possible outcomes according to the factors identified.
The structured professional approach facilitates formal predictive validity studies of risk
assessment and risk management instruments. In turn, this research allows for a more
empirically rigorous policy assessment of specific intervention programs designed to reduce
risk factors for violence. Such assessments are vitally important given the tragedies associated
with intimate partner violence which might even lead to femicide.
Given that the development of instruments concerned with intimate partner violence risk
assessment is rather recent, the leading schools in the development of the main instrument,
the SARA and its companion police version B-SAFER (or SARA-S, in the Italian version),
contributed the chapters in this book. The authors have been immersed in all the challenges
briefly discussed above concerning risk assessment instruments, in general, and in the
extremely sensitive area of intimate partner violence.
In addition, they have extensive experience in not only the theoretical, conceptual, and
methodological issues but also in the training and administration of several renowned risk
assessment instruments concerning violence-related phenomena. Finally, these authors are
involved in ongoing comparative, cross-national, validated studies in various countries in
North America and Europe. In fact, they are the leading scholars whose practical insights are
invaluable to understanding the inherently complex theoretical and policy issues concerning
intimate partner violence and providing innovative risk management instruments.
This book is novel since it is the first one that examines the development of spousal risk
assessment on intimate partner violence, useful not only for researchers, scholars in the field
4 Anna C. Baldry and Frans W. Winkel

but also for all practitioners who are in charge with these cases, need to take decisions, treat,
intervene.
Several themes are discussed, but one of the most critical is the victimological approach
to risk assessment, meaning understanding what helps victims reduce their risk of being re-
victimized or even victimized in the first place. How can femicide cases be addressed to aid
understanding of what has happened in a victim’s life prior to a murder? What can the police
or any other professionals in contact with victims of intimate partner violence do both in
terms of intervention and reducing the chance of any repeated victimization? Is the
psychological reaction of the victim to the victimisation of any influence on the risk of
recidivism? Which are the vulnerability factors that put a woman at higher risk of being
(re)victimised?
A more general theme dealt with in the book is intervention and treatment programs for
offenders and related evidence-based studies particularly referred to the impact of
controversial criminal justice polices such as mandatory arrest, automatic incarceration,
sentencing criteria, restraining orders and mandatory attendance of treatment programs.
In chapter one, Stephen D. Hart discusses the nature and goals of violence risk
assessment in general, as well as the limits and benefits of the two primary approaches to
assessing violence risk, the professional judgment and the actuarial procedures. He provides
considerable insight into and support for the proposition that the risk assessment approach is
efficient and useful, despite its limitations. The primary subject of this chapter, however, is
violence in general, while the subsequent chapters examine, more specifically, risk
assessment and management regarding intimate partner violence.
In chapter 2, Randall Kropp describes the development of two instruments designed
specifically for the risk assessment and management of spousal assaulters, the Spousal
Assault Risk Assessment guide (SARA) and the Brief Spousal Assault Form for the
Evaluation of Risk (B-SAFER). Both instruments illustrate the Structured Professional
Judgment (SPJ) approach to risk assessment, described in the first chapter. How the SARA
and the brief version of the SARA were developed, their structure, and how each risk factor is
related to intimate partner violence and its recidivism are discussed.
In chapter 3, Henrik Belfrage explains how the clinical risk assessment tool, the SARA,
was transformed into an instrument utilized by the police (the B-SAFER). Results from the
Swedish project concerning how this transformation occurred are presented.
In chapter 4, Kelly Watt examines the ultimate consequence of intimate partner violence,
femicide. She reviews the risk factors related to the perpetrator, the victim, and the
community. Equally important, one of the most promising programs in response to femicide,
fatality review teams, is described. These fatality review teams consist of different
representatives of the community and various institutions (police, social services, victim
services, politicians) and were developed first in the U.S. and, recently, have started in
Canada and, possibly, in Italy and Lithuania. The teams analyze femicide cases to understand
both interpersonal and multiagency dynamics that are related to femicide with policy goals to
prevent it. The risk assessment based on the SARA is also discussed as a method for
assessing risk of lethal violence.
In chapter 5, Frans Willem Winkel addresses the important issue of victim-related
characteristics and coping strategies that occur after victimization, which then can be used for
the identification of those victims most in need of support to reduce the potential risk
resulting from posttraumatic stress disorder. The SCANNER, basically an actuarial
 Introduction 5

assessment instrument, is presented as a possible tool for police in conjunction with the B-
SAFER to provide victims with specialized and tailored services. The Scanner identifies both
the victims’ protective factors and those vulnerability factors that can place the victim at
higher risk. Results from a study of the impact of repeat victimization on measures of
psychological functioning, such as psychological well-being and fear of crime, are also
presented. Another critical issue discussed is the differential responses in cases of repeated
victimization and single victimization. This distinction is often ignored in studies on risk
assessment in intimate partner violence cases. Winkel argues that prevention and managing
strategies should identify the vulnerability factors of the female victim and the subsequent
support need to reduce the risk of re-victimization.
In chapter 6, Anna C. Baldry discusses the history of how the short screening version of
the SARA was employed in Italy. She also reviews existing legislation related to domestic
violence and the police role in Italy, and describes how the SARA in its screening version
was set up and implemented experimentally in Italy. Preliminary validation evidence
concerning both the efficacy of such an approach in predicting recidivism and the usefulness
of adopting protective measures for the victim and other measures to restrain the perpetrator
from using violence again are discussed. Finally, Baldry asserts the importance of adopting
the SARA approach at a national level, within the Italian police force, rather than just on an
experimental basis, as it is currently, taking the Swedish model as an example. The police
could perform court-ordered risk assessments as a screening tool for all cases of intimate
partner violence.
Similarly, in chapter 7, Sevasti Chatzifotiou describes the use of SARA at an
experimental level in Greece. She reviews the current procedures for police response to
domestic violence cases, as well as the national legislation dealing with these cases. The
prevalence and characteristics of intimate partner victims and offenders are presented.
Finally, the possible implementation and use of the SARA both at a police level and also
within victim services, such as shelters for battered women, is discussed.
In chapter 8, Donald Dutton reviews the caveats about risk assessment generally and the
limits of a risk assessment approach by advising those using an approach such as the SARA.
He argues that risk assessment mainly based on risk factors could actually lead to false
positives (i.e., assessing someone as at risk to recidivate when he does not). Conversely,
Dutton states that risk assessment can result in false negatives, where someone is considered
not at risk, based on the absence of most risk factors when, in fact, that person recidivates.
Dutton’s concerns are central to the theme that simply adding up the number of risk factors
when performing risk assessment (as it is done with the actuarial approach) is not sufficient; it
is equally important to assess the dynamics in the history of violence in terms of changes over
time, as well to search for critical (or any other) factors that might be relevant in one case that
might not be in others. The assessor needs to be aware that even some intimate partner
homicides did not apparently show any precursor factor that might have helped prevent the
ultimate outcome.
In chapter 9, Donald Dutton presents his perspective on dealing with abusers and
mitigating victim impact. He presents findings from research on perpetrators of domestic
violence indicating several treatable components of intimate abusiveness (attachment anxiety,
borderline personality traits, substance abuse, and trauma reactions) that are not addressed by
current cognitive-behavioral treatment models. Cognitive behavioral treatment modes are
reviewed. A summary “blended” model is also presented; it focuses on each new aspect of
6 Anna C. Baldry and Frans W. Winkel

abusiveness as well as on the original targets of intervention. The model does not require an
additive curriculum as redundancy exists for treatment across target behaviors. It is argued
that this model is theoretically promising and may enhance current cognitive-behavioral
treatment with court-mandated spouse abusers. The applicability of such an approach with
psychopaths is also discussed.
In the last chapter, Jane Katz explores one of the most significant external factors
involved in treatment and its efficacy in reducing recidivism; that is, the therapist’s response
to client responsivity issues. In other words, therapists need to distinguish reluctance to
undergo treatment from resistance to it and learn how to effectively manage that reluctance.
This is an important concept when dealing with intimate offenders at risk of recidivism
because it stresses a different type of intervention and benefits.
We hope that this book will be of value for those working with perpetrators or with
victims, in the law enforcement, in the criminal and civil justice system, in victim advocacy
services, as well as for researchers interested in the field, as well as for policy makers. The
applied, research driven approach used in this book makes it a useful book also for students in
the law, psychology and medical sector who want to develop their knowledge in this field.
To reduce violence, the most efficient response is its prevention; ideally prevention of its
occurrence all together, but also the prevention of repeated victimisation. This type of
approach would allow not only to save lives of those directly and indirectly affected but also
to reduce the cost associated to intimate partner violence. Just to be crude and materialistic,
investing 1 dollar in crime prevention, saves 7 dollars in a ten year period. Worth while
trying.
In: Intimate Partner Violence Prevention and Intervention ISBN: 978-1-60456-039-8
Editors: A. C. Baldry and F. W.Winkel, pp. 7- 18 © 2008 Nova Science Publishers, Inc.

Chapter 1

PREVENTING VIOLENCE: THE ROLE OF RISK

ASSESSMENT AND MANAGEMENT

Stephen D. Hart 1
Department of Psychology, Simon Fraser University, Canada, and
Faculty of Psychology, University of Bergen, Norway

Violence, and in particular violence against women and children, is recognized

worldwide as a major public health problem. The response of the criminal justice and
health care systems to violence relies on two related processes: risk assessment, the
process of identifying risk and protective factors for violence; and risk management, the
process of preventing violence by influencing risk and protective factors. The first part of
this chapter discusses the nature and goals of violence risk assessment, compares the the
professional judgement and actuarial approaches to assessing violence risk, and identifies
some major limitations of existing procedures for violence risk assessment. The second
part of the chapter focuses on violence risk management. It presents general principles
that should guide the development of risk management strategies, as well as a
comprehensive model of risk management tactics.

Violence is the actual, attempted, or threatened physical injury of another person that is
deliberate and nonconsensual (Webster, Douglas, Eaves, and Hart, 1997). Violence is a major
determinant of physical and psychological well-being. In 1996, the Forty-Ninth World Health
Assembly resolved that violence – and, in particular, violence against women and children –
is “a leading worldwide public health problem” (Resolution WHA49.25; see Krug et al.,
2002, pp. xx-xxi) and urged its member states to take steps to deal with the problem,
including the implementation of violence prevention programs.
According to Dahlberg and Krug (2002), the view that “violence can be prevented and its
impact reduced…is not an article of faith, but a statement based on evidence” (p. 3). They
discuss various prevention programs, noting that their efficacy depends in part upon the
systematic identification of risk and protective factors. This is true regardless of whether the

1
Address correspondence to [email protected] or Professor Stephen D. Hart, Department of Psychology, Simon Fraser
University, Burnaby, British Columbia, Canada, V5A 1S6.
8 Stephen D. Hart

programs are designed to prevent victimization among people who have never been exposed
to violence (i.e., primary or “true” prevention), those who appear to be at elevated risk (i.e.,
secondary prevention), or those who have already been victimized in the past (i.e., tertiary
prevention).
The process of identifying risk and protective factors for violence is sometimes referred
to as violence risk assessment. Similarly, the process of preventing violence by influencing
risk and protective factors is sometimes referred to as risk management. Risk assessment and
risk management are integral parts of the contemporary criminal justice and public health
responses to violence (e.g., Andrews and Bonta, 2003; Kraemer et al., 1997). The goals of
this chapter are twofold: first, to discuss the nature and goals of violence risk assessment, as
well as the two primary approaches to assessing violence risk; and second, to present some
general principles for violence risk management, including a comprehensive model of risk
management tactics. The focus of the chapter is on violence in general; several chapters in the
rest of this volume focus on risk assessment and management specifically in the context of
intimate partner violence.

VIOLENCE RISK ASSESSMENT

The Nature of Violence Risk

A risk is a hazard that is incompletely understood and thus whose occurrence can be
forecast only with uncertainty (Bernstein, 1996). The hazard we are concerned with in this
chapter is violence, and violence clearly is a complex phenomenon. Violent acts can vary
greatly with respect to such things as motivations, acquaintanceship with the victim, severity
of physical or psychological harm, and so forth. Accordingly, violence risk is multi-faceted
and cannot be conceptualized or quantified simply, for example, in terms of the probability
that someone will engage in violence. Instead, one must also consider the nature, seriousness,
frequency or duration, and imminence of any future violence (Hart, 1998, 2001; Janus and
Meehl, 1997; but cf. Kapur, 2000; Kraemer et al., 1997). Also, violence risk is inherently
dynamic and contextual (Hart, 1998, 2001; Kapur, 2000). For example, the violence risk
posed by patients depends on where they will reside, what kinds of clinical services they will
receive, their future motivation to establish a pro-social adjustment, whether they will
experience adverse life events, and so forth. In essence, then, violence risk is not a
characteristic of the physical world that can be evaluated objectively, but a subjective
perception – something that exists not in fact, but in the eye of the beholder. These opinions
regarding the nature and degree or quantum of risk in a given case, as well as the selection of
risk management strategies and tactics, are based, in turn, on judgments regarding the
collective influence of myriad individual things or elements, referred to as risk factors.
But what exactly is a risk factor? It is relatively easy to demonstrate using a wide range
of research designs that a thing is, on average, correlated with violence. But things that are
correlated with violence may be causes, features, concomitants, or even consequences of
violence. A risk factor is a correlate that also precedes the occurrence of the hazard and
therefore may play a causal role (Kraemer et al., 1997). Demonstrating that something is a
risk factor requires longitudinal research or well-substantiated theory. Risk factors may be
 Violence Risk 9

further subdivided into three types (Kraemer et al., 1997). Fixed risk markers do not change
over time in status. Variable risk markers change status over time, but these changes do not
influence the outcome. Causal risk factors change status over time, and these changes
influence the outcome. Differentiating among these three types of risk factors also requires
longitudinal designs, and, ideally, experimental or quasi-experimental longitudinal designs.
Considerable attention has been devoted to the identification of (putative) risk factors for
violence. There have been several excellent summaries of the research literature in recent
years (e.g., Litwack and Schlesinger, 1999; Monahan and Steadman, 1994; Otto, 2002;
Webster and Douglas, 1999). Unfortunately, there is no good research or theory that helps us
to determine the nature of risk factors, ascertain their potency, understand how they are
associated with each other, or specify what causal role they may play with respect to violence.

The Nature of Assessment

Assessment is the process of gathering information for use in decision making. The
specific assessment procedures used are determined by what is being assessed and the nature
of the decisions to be made. In the case of violence risk assessment, we must assess what
people have done in the past, how they are functioning currently, and what they might do in
the future. The decisions to be made are strategic in nature, including what should be done in
clinical and legal settings to cope with or manage the violence risks posed by a person (Hart,
2001; Heilbrun, 1997; Monahan, 1981/1995; Monahan and Steadman, 1994). This means that
violence risk assessment can be defined as the process of evaluating individuals to (a)
characterize the risk they will commit violence in the future, and (b) develop interventions to
manage or reduce that risk (Hart, 2001). Put differently, the task is to understand how and
why a person chose to act violently in the past and then to determine what could be done to
discourage the person from choosing to act violently in the future. The specific procedures
used to gather relevant information typically include interviews with and observations of the
person being evaluated; direct psychological or medical testing of the person; careful review
of available documentary records; and interviews with collateral informants such as family
members, friends, and service providers (Webster et al., 1997).

Goals of Violence Risk Assessment

The ultimate goal of violence risk assessment is violence prevention, or the minimization
of the likelihood of and negative consequences stemming from any future violence. But
violence risk assessment should achieve a number of goals in addition to the protection of
public safety (Hart, 2001). A “good” risk assessment procedure should also yield consistent
or replicable results. That is, mental health professionals should reach similar findings when
evaluating the same patient at about the same time. It is highly unlikely that inconsistent or
unreliable decisions can be of any practical use. Furthermore, a good risk assessment
procedure should be prescriptive; it should identify, evaluate, and prioritize the mental health,
social service, and criminal justice interventions that could be used to manage a patient’s
violence risk. Finally, a good risk assessment procedure should be open or transparent. Put
another way, we mental health professionals are accountable for the decisions we make, and it
10 Stephen D. Hart

is therefore important for us to make explicit, as much as is possible, the basis for our
professional opinions. A transparent risk assessment procedure allows patients and the public
a chance to scrutinize our opinions. The transparency should protect mental health
professionals when a patient commits violence despite the fact that a good risk assessment
was conducted, as it can be demonstrated easily that standard or proper procedures were
followed. Transparency should also protect patients and the public by making it obvious when
an improper risk assessment is conducted.
It is impossible for any single risk assessment procedure to achieve all these goals with
maximum efficiency. Similarly, it is impossible for the various parties interested in violence
risk assessment (mental health professionals, hospital administrators, patients, lawyers,
judges, victims, etc.) to reach a consensus regarding which procedure is “best” for all
purposes and in all contexts (Hart, 2001). Instead, mental health professionals should choose
the best procedure or set of procedures for a particular assessment of a particular patient after
considering explicitly the legal context of the evaluation.

APPROACHES TO VIOLENCE RISK ASSESSMENT

Mental health professionals use two basic approaches to reach opinions about violence
risk: professional judgment and actuarial decision making (e.g., Menzies, Webster, and Hart,
1995; Monahan, 1981/1995). These terms refer to how information is weighted and combined
to reach a final decision, regardless of the information that is considered and how it was
collected (Meehl, 1954/1996). The hallmark of professional judgment procedures is that the
evaluator exercises some degree of discretion in the decision-making process, although it is
also generally the case that evaluators have wide discretion concerning how assessment
information is gathered and which information is considered. It comes as no surprise that
unstructured clinical judgment is also described as “informal, subjective, [and]
impressionistic” (Grove and Meehl, 1996; p. 293). In contrast, the hallmark of the actuarial
approach is that, based on the information available to them, evaluators make an ultimate
decision according to fixed and explicit rules (Meehl, 1954/1996). It is also generally the case
that actuarial decisions are based on specific assessment data, selected because they have
been demonstrated empirically to be associated with violence and coded in a pre-determined
manner. The actuarial approach also has been described as “mechanical” and “algorithmic”
(Grove and Meehl, 1996; p. 293).

Professional Judgment Procedures

The professional judgment approach comprises at least three different procedures. The
first is unstructured professional judgment. This is decision making in the complete absence
of structure, a process that could be characterized as “intuitive” or “experiential.”
Historically, it is the most commonly used procedure for assessing violence risk and therefore
is very familiar to mental health professionals, as well as to courts and tribunals. It has the
advantage of being highly adaptable and efficient; it is possible to use intuition in any context,
with minimal cost in terms of time and other resources. It is also very person-centered,
 Violence Risk 11

focusing on the unique aspects of the case at hand, and thus can be of great assistance in
planning interventions to manage violence risk. The major problem is that there is little
empirical evidence that intuitive decisions are consistent across professionals or, indeed, that
they are helpful in preventing violence. As well, intuitive decisions are unimpeachable; it is
difficult even for the people who make them to explain how they were made. This means that
the credibility of the decision often rests on charismatic authority — that is, the credibility of
the person who made the decision. Finally, intuitive decisions tend to be broad or general in
scope, so that they become dispositional statements about the patient (“Patient X is a very
dangerous person”) rather than a series of speculative statements about what the patient might
do in the future assuming various release conditions.
The second professional judgment procedure is sometimes referred to as anamnestic risk
assessment (e.g., Melton, Petrila, Poythress, and Slobogin, 1997; Otto, 2000). This procedure
imposes a limited degree of structure on the assessment as the evaluator must, at a minimum,
identify the personal and situational factors that resulted in violence in the past. The
assumption here is that a series of events and circumstances, a kind of behavioral chain, led
up to the patient’s violent act. The professional’s task, therefore, is to understand the links in
this chain and suggest ways in which the chain could be broken. (In this way, anamnestic
assessment has much in common with relapse prevention or harm reduction approaches to
treating violent offenders.) However, there is no empirical evidence supporting the
consistency or usefulness of anamnestic risk assessments. Anamnestic risk assessment also
seems to assume that history will repeat itself — that violent people are static over time, so
the only thing they are at risk to do in the future is what they have done in the past. Nothing
could be further from the truth, of course; there are many different “trajectories” of violence.
Some patients or prisoners will escalate in terms of the frequency or severity of violence over
time, some change the types of violence they commit, and some will de-escalate or even
desist altogether.
The third procedure is structured professional judgment. Here, decision making is
assisted by guidelines that have been developed to reflect the “state of the discipline” with
respect to scientific knowledge and professional practice (Borum, 1996). Such guidelines —
sometimes referred to as clinical guidelines, consensus guidelines, or clinical practice
parameters — are quite common in medicine, although used less frequently in psychiatric and
psychological assessment (Kapp and Mossman, 1996). The guidelines attempt to define the
risk being considered; discuss necessary qualifications for conducting an assessment;
recommend what information should be considered as part of the evaluation and how it
should be gathered; and identify a set of core risk factors that, according to the scientific and
professional literature, should be considered as part of any reasonably comprehensive
assessment. Structured professional guidelines help to improve the consistency and usefulness
of decisions, and certainly improve the transparency of decision making. They may, however,
require considerable time or resources to develop and implement. Also, some evaluators
dislike this “middle ground” or compromise approach, either because it lacks the freedom of
intuitive decision making or because it lacks the objectivity of actuarial procedures.
12 Stephen D. Hart

Actuarial Procedures

There are at least two types of actuarial decision making. The first is the actuarial use of
psychological tests. Classically, psychological tests are structured samples of behavior
designed to measure a personal disposition, that is, an attempt to quantify an individual’s
standing on some trait dimension. Research indicates that some dispositions — such as
psychopathy (Hart, 1998), major mental illness (Hodgins, 1992), and impulsivity (Barratt,
1994; Webster and Jackson, 1997) — are associated with violence risk in a meaningful way.
On the basis of research results, one can identify cutoff scores on the test that maximize some
aspect of predictive accuracy. This procedure has several strengths, most importantly its
transparency and the demonstrated consistency and utility of decisions made using tests. One
major problem is that the use of psychological tests requires considerable discretion: Mental
health professionals must decide which tests are appropriate in a given case, and judgment
also may be required in test scoring and interpretation. Another problem is that reliance on a
single test does not constitute a comprehensive evaluation and will provide only limited
information for use in developing management strategies and tactics. More generally, the
actuarial use of psychological tests focuses professional efforts on passive violence prediction
rather than violence prevention.
The second type of procedure is the use of actuarial risk assessment instruments. In
contrast to psychological tests, actuarial instruments are designed not to measure anything but
solely to predict the future. Typically, they are high fidelity, optimized to predict a specific
outcome in a specific population over a specific period of time. The items in the scale are
selected either rationally (on the basis of theory or experience) or empirically (on the basis of
their association with the outcome in test construction research). The items are weighted and
combined according to some algorithm to yield a decision. In violence risk assessment, the
“decision” generally is the estimated likelihood of future violence (e.g., re-arrest for a crime
against persons) over some period of time. Like psychological tests, actuarial instruments
have the advantage of transparency and direct empirical support; they also suffer many of the
same weaknesses, including the need for discretion in selecting a test, interpreting findings,
and the limitations of the test findings for use in planning interventions. There are additional
problems with actuarial instruments that estimate the absolute likelihood or probability of
recidivism. One is that they require tremendous time and effort to construct and validate. In
cases where the time frame of the prediction is long, true cross-validation may require
decades. Also, when constructing actuarial tests, there is a classic bandwidth-fidelity trade-off
between precision of estimated recidivism rates and generalizability: The same statistical
procedures that optimize predictive accuracy in one setting will decrease that test’s accuracy
in others. Finally, it is easy to accord too much weight to information concerning the
estimated likelihood of recidivism provided by actuarial tests. Most actuarial tests of violence
risk yield very precise likelihood estimates, proportions with 2 or 3 decimal places, but they
do not provide the information necessary to understand the error inherent in these estimates.
When one considers the fact that many of these estimates were derived from relatively small
construction samples and have not been validated in independent samples, it is clear that the
actuarial test results are only pseudo-precise. It is important for any professional who uses
actuarial tests to understand and explain to others the limitations of absolute likelihood
estimates of recidivism.
 Violence Risk 13

LIMITATIONS COMMON TO PROFESSIONAL JUDGMENT AND

ACTUARIAL PROCEDURES
Existing risk assessment procedures tend to suffer from important limitations. One is that
they tend to focus on negative characteristics or features — factors associated with increased
risk — rather than personal strengths, resources, and protective or “buffer” factors. A
comprehensive risk assessment designed to assist in the development of interventions must
take into account these positive features. A second problem is that few existing risk
assessment procedures are tied to the development of interventions in a systematic or
prescriptive manner. This is, in part, because most risk assessment procedures focus on
identifying the presence of risk factors, rather than their functional relevance. In any given
case, decisions about which interventions to use require evaluators to determine which risk
factors are most important and why they are important (i.e., the nature of their causal
influence). A third problem is one of quality assurance. Basic research to develop risk
assessment procedures is important, but it is naïve to assume that any procedure will function
similarly in the field. Evaluative research is required to monitor the implementation of risk
assessment procedures and to determine whether they are functioning optimally and what
could be done to improve their use.

VIOLENCE RISK MANAGEMENT

A comprehensive risk management strategy should be developed according to several
principles (Hart, 2001; Kropp, Hart, Lyon, and LePard, 2002; see also Andrews and Bonta,
2003). First, the strategy should reflect overall judgments regarding the risks posed by the
individual. Second, it should focus on risk management activities or tactics on factors that are
relevant in the case at hand, so each relevant risk factor is addressed (i.e., neutralized or
contained) by one or more activities. Third, it should be personalized in a way that maximizes
its robustness and effectiveness for the individual. Let us discuss each of these principles in
turn.

The Management Strategy Should Reflect Risks Posed

The risk management strategy should reflect both the nature and degree or quantum of
risk in the case at hand. With respect to the nature of the risks posed, evaluators must
speculate about the types or kinds of violence the individual may perpetrate in the future. The
evaluator must ask the question, what exactly is it that I am worried this person might do? The
answers are based on an analysis of what the individual has done in the distant and recent
past, as well as what the individual is thinking about doing or planning to do at the present
time. These descriptions of “possible futures” may be referred to as scenarios, short
narratives designed to simplify complex issues in a way that facilitates communication and
planning (Hart et al., 2003; more generally, see Chermack and Lynham, 2002; Ringland,
1998; Schwartz, 1990; van der Heijden, 1997). The scenarios are not predictions about what
will happen, but rather projections about what could happen. Although the number of possible
14 Stephen D. Hart

scenarios is almost limitless, in any given case, only a few distinct scenarios seem plausible,
credible, or internally consistent to evaluators in light of theory, research, experience, and the
facts of the case (e.g., Chermack and van der Merwe, 2003; Pomerol, 2001).
With respect to the quantum or degree of risk posed by the individual, evaluators should
think in both absolute and relative terms. In absolute terms, risk is the probability or
likelihood that the person will perpetrate a specific type of violence. Although it is impossible
to predict the future with any reasonable degree of scientific or professional certainty,
evaluators can meaningfully or plausibly rank-order the different types of violence that a
person might commit in terms of the probability or likelihood of occurrence. For example, the
likelihood a person will commit sexual homicide is generally much lower than the probability
he will commit a non-lethal sexual assault. In relative terms, risk is the level of effort or
attention that should be devoted to the management of this person vis-à-vis other people. For
example, it may be useful to classify cases as low or routine priority, moderate or elevated
priority, and high or urgent priority (e.g., Hart et al., 2003).
It is only after evaluators have identified what types of violence a person might perpetrate
and how worried they are the person might do so that they can take rational steps to prevent
the violence from occurring.

The Management Strategy Should Reflect Relevant Risk Factors

There are several ways in which a risk factor may be relevant to risk management. First,
it may be a motivator of violence. A motivator is a risk factor that makes violence an
attractive or rewarding option for the person. For example, serious employment problems
may lead someone to perceive armed robbery as a viable means of getting money; and
relationship problems may lead someone to perceive intimate partner violence as a good way
of expressing one’s anger or frustration. Second, the factor may be a disinhibitor of violence.
A disinhibitor is a risk factor that makes the person less likely to be influenced by restraints,
prohibitions, or proscriptions against violence, regardless of whether these are intrinsic or
extrinsic in nature. For example, alcohol intoxication, extreme anger, or lack of empathy
associated with personal disorder may lessen the person’s experience of anticipatory anxiety
when he considers the possibility of perpetrating armed robbery or intimate partner violence.
Finally, even when it is not causally related to violence, a risk factor may play a role as an
impeder of risk management. An impeder is a risk factor that decreases the effectiveness of
the various tactics that are or could be used to prevent future violence. For example, anti-
authority attitudes may lead the person to reject the assistance offered by a probation or
parole officer; and impulsivity associated with personality disorder may impair the person’s
ability to make, implement, and revise plans regarding psychological or psychiatric treatment.
But how do evaluators determine which risk factors are relevant in a given case, and how
they are relevant? Unfortunately, there is a simple or objective test for measuring relevance.
Neither is it possible to use the results of scientific research, as what is true in general may
not be true in a specific case. This means that judgments about relevance – like scenarios of
future violence – are hypotheses based on scientific theory, scientific research, personal
experience, and the facts of the case. Although it is not possible to test directly the scientific
validity of these hypotheses, it is possible to evaluate the plausibility or reasonableness of
their underlying rationale.
 Violence Risk 15

It is sometimes assumed that risk factors are less relevant if they are fixed in nature or if
they are “static” or “stable” (i.e., appear to change little or slowly over time). Very few risk
factors, however, are truly fixed. Age, criminal history, marital history, and visible tattoos are
examples of risk factors that are often characterized as static, yet clearly all of these can and
do change over time. Even factors that are truly fixed may change status over time due to new
information or re-consideration of old information. For example, a person may decide to
disclose personal information, or other people may provide collateral information that had not
previously been reported. Even when a factor is truly fixed and unchanged in status, it may
change in relevance. A change in the relevance may reflect differences over time in the
judgment of the evaluator or in the psychological meaning of the risk factor for the person
being evaluated. For example, date of birth may not change, but a person may become more
reflective about his lifestyle as he ages, leading to an increase in the perceived costs of
perpetrating violence; or chromosomal sex may not change, but a person may develop a
gender identity disorder that leads him to become resentful of and angry at people of the
opposite sex. For a more detailed discussion of the role of fixed, static, or stable factors in the
management of violence risk, see Hart, Douglas, and Webster (2001).

The Management Strategy Should be Personalized

A risk management strategy should be personalized for the case at hand. It may be useful
to think of risk management in terms of building fence or wall designed to contain the risks
posed by an individual (e.g., English, Jones, and Patrick, 2003). Building the fence requires a
plan (the risk management strategy) that reflects the lay of the land (the risks posed by the
individual). The plan should specify landmarks for placement of the fence (relevant risk
factors) as well as the fencing materials to be used (the risk management tactics).
To ensure that a risk management strategy is robust and maximally effective, each
relevant risk factor should be targeted by multiple tactics. To continue with the fence
metaphor, some parts of a fence are more critical than others, and, in these parts, it may be
necessary to place more fence posts or a stronger foundation. Also, a risk management
strategy that relies on a number of different professionals working in different agencies and
clinics may require coordination activities such as regular interdisciplinary meetings or a
detailed policy and procedure document (Kropp et al., 2002). Metaphorically, it may be
important for someone to travel the perimeter of the fence, making sure that all the posts
remain upright and the fencing material is intact.

More on Risk Management Tactics

Risk management tactics can be divided into four basic categories: monitoring, treatment,
supervision, and victim safety planning (Hart et al., 2001; 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 and tactics 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
16 Stephen D. Hart

rather than control or restriction of liberties; it is therefore minimally intrusive. Monitoring

tactics 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
that 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
 Violence Risk 17

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 past or potential victims. In general, supervision should be implemented at an 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.
18 Stephen D. Hart

CONCLUSION
Although brief, this chapter hopefully has illustrated both the potential importance and
the daunting complexity of violence risk assessment and management. The state of scientific
knowledge may be crude or primitive in many respects, yet it is sufficient to offer at least
some guidance for professionals, policy makers, and other people who are responsible for
preventing violence.

ACKNOWLEDGEMENT
Thanks to the usual suspects and, in particular, Kelly Watt, P. Randall Kropp, and Henrik
Belfrage.
In: Intimate Partner Violence Prevention and Intervention ISBN: 978-1-60456-039-8
Editors: A. C. Baldry and F. W.Winkel, pp. 19-31 © 2008 Nova Science Publishers, Inc.

Chapter 2

DEVELOPMENT OF THE SPOUSAL ASSAULT RISK

ASSESSMENT GUIDE (SARA) AND THE BRIEF
SPOUSAL ASSAULT FORM FOR THE EVALUATION OF
RISK (B-SAFER)

P. Randall Kropp
Forensic Psychiatric Services Commission
of British Columbia, Canada

Although there are very few risk assessment instruments that have been validated for
assessing and managing risk in spousal assaulters, there are reasons to be optimistic.
There is now a significant body of literature that documents factors known to be
associated with spousal violence. By assessing risk in a systematic and comprehensive
manner, more informed decisions regarding risk management can be offered. The SARA
and B-SAFER are designed to assist in this process. They both reflect the empirical and
professional literatures on spousal violence risk factors, and they both include
recommendations for performing risk assessments and designing risk management
strategies. More reliability and validity research is desirable, but, for now, these
instruments are useful aids for those working with spousal assaulters and their victims.

INTRODUCTION
Spousal violence is a criminal act that takes significant social and economic tolls on
society. There is an emerging literature that illustrates the complexities of assessing and
managing risk in perpetrators of this form of violence (Dutton and Kropp, 2000; Hilton and
Harris, 2004; Kropp, 2004). Effective case management of offenders should focus on
identifying, assessing, and containing risk. Violence risk management is the process of
speculating in an informed way about the aggressive acts a person might commit and
determining the steps that should be taken to prevent those acts and minimize their negative
consequences (Hart, 1998). Risk assessment involves evaluating an individual to determine
which factors are present that might increase or enhance risk, typically referred to simply as
20 P. Randall Kropp

risk factors. Risk management involves developing a set of intervention strategies targeted at
specific risk factors and designed to prevent the feared outcomes. This chapter describes the
development of two instruments designed specifically for the risk assessment and
management of spousal assaulters: The Spousal Assault Risk Assessment guide (SARA) and
the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER). Both are examples of
the Structured Professional Judgment (SPJ) approach to risk assessment, which is described
elsewhere in this volume.

ASSESSING RISK FOR SPOUSAL ASSAULT

For the purposes of this chapter, my definition of spousal assault is 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 inclusive: It is not
limited to acts that result in physical injury; it is not limited to relationships where the
partners are or have been legally married; and it is not limited by the gender of the victim or
perpetrator. Also, it is consistent with the observation that violence between intimate partners
is pandemic in our societies regardless of the nature of their relationship (Gelles and Straus,
1988; Kurz, 1993). Having said this, it is recognized that husband-to-wife assault can be
considered the most serious form of spousal assault, due to its prevalence, its repetitive
nature, and its high risk of morbidity and mortality.

Risk Factors for Spousal Assault

The physical and psychological damage resulting from violence in intimate relationships
has been well documented in recent years. Numerous studies have attempted to identify
factors associated with spousal violence. Many studies have identified risk factors that
discriminated those who were violent towards spouses from those who were not (e.g.,
Hotaling and Sugarman, 1986; Tolman and Bennet, 1990). Other studies have highlighted
factors associated with risk for recidivistic violence among known spousal assaulters — those
arrested, convicted, or in treatment (e.g., Gondolf, 1988; Hilton et al., 2004; Saunders, 1993).
Many of these studies intersect with those discussing risk for violence in general, with many
of the same factors emerging (e.g., Monahan and Steadman, 1994; Quinsey, Rice, Harris, and
Cormier, 1998). There are also several important works that have discussed the assessment of
risk for future violence in spousal assaulters, sometimes described as a “lethality” or “need to
warn” assessment (e.g., Saunders, 1992). Finally, there have been some extremely useful
studies on factors associated with the more specific act of domestic homicide (Campbell,
Sharps, and Glass, 2001; Campbell et al., 2003; Dobash, Dobash, Cavanaugh, and Lewis,
2001).
There is considerable consensus amongst these studies regarding the important factors to
consider when assessing risk for spousal assault. Many risk assessment “lists” have been
published. Most of these include factors related to a history of assaultive behavior, generally
antisocial behaviors and attitudes, stability of relationships, stability of employment, mental
health and personality disorder, childhood abuse, motivation for treatment, and attitudes
 Development of the SARA and B-SAFER 21

towards women (see, for example, Dutton and Kropp, 2000; Hilton and Harris, 2004; Kropp,
2004; Riggs, Caulfield, and Street, 2000; Schumacher, Feldbau-Kohn, Slep, and Heyman,
2001). It is important to remember that these risk markers are not necessarily causal
predictors, but, rather, factors that consistently co-occur with abusiveness .
Although there are now several risk assessment instruments in circulation, four tools have
received considerable attention because their authors have published validity data. They are
the Danger Assessment (DA: Campbell, 1995), the Domestic Violence Screening Inventory
(DVSI: Williams and Houghton, 2004), the Ontario Domestic Assault Risk Assessment
(ODARA: Hilton et al., 2004), and the Spousal Assault Risk Assessment Guide, or SARA
(Kropp, Hart, Webster, and Eaves, 1999; Kropp and Hart, 2000). The remainder of this
chapter shall focus on the SARA and introduce the B-SAFER, a recently developed brief risk
assessment tool which was influenced by the SARA .

Spousal Assault Risk Assessment Guide (Sara)

The large number of spousal assaulters being formally processed by the criminal justice
system has resulted in growing demand for assessments of risk for future violence. In North
America, these risk assessments typically are conducted in one of following four contexts:

1) Pretrial. When someone is arrested for offenses related to spousal assault, the nature
of the alleged acts or the defendant’s history may raise the question of whether he
should be denied pretrial release on the grounds that he poses an imminent risk of
harm to identifiable persons (i.e., his spouse, his children) or whether he should have
pretrial release conditions that include no-contact orders.
2) Presentence. Risk assessments are sometimes requested when a defendant’s case has
proceeded to trial. If he has not yet been convicted, the results may assist judges who
are considering the diversion or the conditional or unconditional discharge of the
defendant. If he already has been convicted, the findings may help judges to decide
between alternative sentences (e.g., probation vs. incarceration) and to set or
recommend conditions for community supervision (e.g., no-contact orders).
3) Correctional Intake. After conviction, risk assessments can be helpful to corrections
staff who conduct “front-end” assessments in institutional or community settings.
They can be used in the development of treatment plans, as well as to determine
suitability or set conditions for conjugal visits, family visits, and temporary absences.
4) Correctional Discharge. In the case of an offender who has been incarcerated, risk
assessments prior to discharge can help corrections officials or parole boards to
determine suitability or set conditions for conditional release, as well to assist in the
development of a post-release treatment or management plan. For a community-
resident offender who is nearing the end of his supervisory period, a final risk
assessment may indicate that correctional staff should communicate formal warnings
to at-risk individuals in an effort to discharge any ethical and legal obligations before
the case file is officially closed.

A major problem in conducting these risk assessments has been the lack of a systematic,
standardized, clinically useful, and empirically-based framework for collecting, weighting,
22 P. Randall Kropp

and reporting background data and professional judgments. Considering the importance of the
matter, it is rather odd that, until very recently, there have been no guidelines concerning how
to conduct spousal assault risk assessments: what factors need to be considered, what type of
information is helpful in making decisions, and where and how to get information. As part of
a coordinated effort by the British Columbia Institute on Family Violence, the British
Columbia Forensic Psychiatric Services Commission, the British Columbia Ministry of
Women’s Equality, and other government and community agencies, we decided to develop
such a framework, which we have called the Spousal Assault Risk Assessment guide, or
SARA.

DEVELOPMENT OF THE SARA

Our first step was to undertake a careful review of the clinical and empirical literatures on
risk for violence, with particular emphasis on spousal assault (Cooper, 1993). Many of the
studies reviewed have been included in subsequent literature reviews (Dutton and Kropp,
2000; Hilton and Harris, 2004; Riggs et al., 2002; Schumacher et al., 2001). We attempted to
keep our list of factors relatively short and to aim at a moderate level of specificity (i.e., at the
level of traits, characteristics, or incidents, rather than the level of isolated or specific
behavioral acts). The result was a list of 20 factors, referred to on the SARA as items, grouped
into the five content areas described below.
Criminal History Variables. Numerous studies indicated that a prior criminal record for
offenses unrelated to spousal assault was associated with an increased risk for violence in
general and also, more specifically, for recidivistic spousal assault. The factors here cover
past history of violence, as well as failure to abide by conditions imposed by the courts or
criminal justice agencies. We included three specific factors of past criminal record. Past
assault of family members refers to violence directed against members of the individual’s
family of origin or against his own children. It does not cover past spousal assaults, which are
coded in a different section. Past assault of strangers or acquaintances refers to violence
directed against people who are not biological or legal family members. Past violation of
conditional release or community supervision refers to past failures to abide by the conditions
of bail, recognizances, court orders, probation, and parole or mandatory supervision. It is
irrelevant whether the conditions were imposed following an incident or allegation of spousal
assault; any failure is considered a poor prognostic indicator.
Psychosocial Adjustment Variables. Two SARA items reflect the observation that recent
or continuing social maladjustment is linked with violence. Recent relationship problems
refers to separation from an intimate partner or severe conflict in the relationship within the
past year. Recent employment problems refers to unemployment and/or extremely unstable
employment in the past year. It is unclear, although perhaps unimportant for the purpose of
risk assessment, whether social maladjustment is the result of more chronic psychopathology
or the cause of acute situational financial and interpersonal stress; regardless, these factors
appear to be important predictors.
One item in this section, victim of and/or witness to family violence as a child or
adolescent, is historical in nature and refers to maladjustment in the individual’s family of
origin. This is one of the most robust risk factors for spousal assault identified in the
 Development of the SARA and B-SAFER 23

literature. Why this factor is associated with violence so strongly is unclear, although some
research suggests that social learning mechanisms may be involved (Widom, 1989).
There is now a considerable body of evidence supporting the link between certain forms
or symptoms of mental disorder and violent behavior (e.g., Monahan and Steadman, 1994).
This evidence was the basis for four SARA items related to psychological adjustment: recent
substance abuse/dependence, recent suicidal or homicidal ideation/intent, recent psychotic
and/or manic symptoms, and personality disorder with anger, impulsivity, or behavioral
instability. Please note that we do not make any assumptions here that the mental disorder is
responsible for or “causes” violent behavior. Rather, mental disorder is assumed to be
associated with poor coping skills and increased social-interpersonal stress; thus, individuals
with mental disorders may be prone to making and acting on bad decisions.
Spousal Assault History Variables. This section comprises seven items related to spousal
assaults in the past. Risk factors based on the alleged or current offense are included in a
different section, so that evaluators can more easily separate the quantum of perceived risk
attributed to formally documented events (which are likely to be accepted as factual) versus
that attributed to alleged events (which are likely to be contended).
The first four items concern the nature and extent of past assaults. Past physical assault is
an obvious risk factor, based on the axiom (supported by research) that past behavior predicts
future behavior (e.g., Monahan and Steadman, 1994; Quinsey et al., 1998). Past sexual
assault/sexual jealousy refers to physical assaults that are of a sexual nature or occur in the
context of extreme sexual jealousy. Past use of weapons and/or credible threats of death
refers to behavior that explicitly or implicitly threatens serious physical harm or death. Recent
escalation in frequency or severity of assault refers to situations where the “trajectory” of
violence seems to be escalating over time.
The next three items concern behavior or attitudes that accompany assaultive behavior.
Past violation of “no contact” orders covers situations where the individual has failed to
comply with the orders of a court or criminal justice agency that prohibit contact with victims
of past spousal assaults. Although it overlaps to some extent with the third item in the
Criminal History section, we felt that such a violation is so directly relevant to spousal assault
risk assessment that it deserved special attention. Extreme minimization or denial of spousal
assault history may occur as part of a more general pattern of deflection of personal
responsibility for criminal behavior, or it may be specific to past spousal assaults. Attitudes
that support or condone wife assault covers a wide range of beliefs or values -- personal,
social, religious, political, and cultural -- that encourage patriarchy (i.e., male prerogative),
misogyny, and the use of physical violence or intimidation to resolve conflicts and enforce
control.
Alleged (Current) Offense Variables. This section comprises three items, similar in
content to those appearing in the previous section, that are scored solely on the basis of the
alleged or current offense: severe and/or sexual assault, use of weapons and/or credible
threats of death, and violation of “no contact” order.
Other Considerations. The final section does not contain any specific items. It allows the
evaluator to note risk factors not included in the SARA that are present in a particular case
and that lead the evaluator to decide the individual is at high risk for violence. Examples of
rare but important risk factors include a history of stalking behavior (e.g., Burgess et al.,
1997); a history of disfiguring, torturing, or maiming intimate partners; a history or sexual
sadism; and so forth.
24 P. Randall Kropp

ASSESSMENT PROCEDURE
The authors of the SARA suggest an assessment procedure based on multiple sources of
information and multiple methods of data collection. This is based on the recognition that
victims, offenders, and other collateral sources (e.g., children, neighbors) may tend to
underreport violence (albeit for different reasons), but that their reports often provide crucial
information that is otherwise difficult or impossible to obtain. Also, we recognized that, in
many cases, structured assessment procedures (self-report inventories, semi-structured
interviews) are useful adjuncts to unstructured procedures (“clinical” interviews, reviews of
police reports, or other case history information). In general, the assessment should include
(a) interviews with the accused and victims; (b) standardized measures of physical and
emotional abuse; (c) standardized measures of drug and alcohol abuse; (d) review of
collateral records, including police reports, victim statements, criminal records, and so forth;
and (e) other assessments, as required. If the information is incomplete, the evaluator should
postpone undertaking or completing the risk assessment until the missing information
becomes available. If it is impossible to track down the missing information, the evaluator
should proceed with the risk assessment and emphasize in the final report the ways in which
conclusory opinions need to be limited.

CODING JUDGMENTS
The SARA is not “scored” in the manner of most psychological tests. Rather, the
evaluator is called upon to make three kinds of judgments, which are coded on a summary
form.
Presence of Individual Items. The presence of individual items is coded using a 3-point
response format: 0 = absent, 1 = subthreshold, and 2 = present. The SARA manual presents
detailed criteria for defining and coding each item.
The presence of individual items is a relatively objective indicator of risk: In general, and
especially in the absence of critical items (see below), risk can be expected to increase with
the number of items coded present. Of course, completing the SARA does require some
degree of professional, subjective judgment on the part of the evaluator; however, it is
important to remember that the items were selected on the basis of their demonstrated validity
and that considerable pains have been taken to ensure that the coding of items is simple and
clear.
Presence of Critical Items. Critical items are those that, given the circumstances in the
case at hand, are sufficient on their own to compel the evaluator to conclude that the
individual poses an imminent risk of harm. They are included in recognition of the fact that
risk, as perceived by the evaluator, is not a simple linear function of the number of risk
factors present in a case. This is why we do not simply sum the numerical scores on
individual SARA items to yield a total “score”: It is conceivable that an evaluator could judge
an individual to be at high risk for violence on the basis of a single critical item. Critical items
are coded using a 2-point format: 0 = absent, 1 = present.
Summary Risk Judgments. Evaluators frequently are required to address two separate
issues: imminent risk of harm to spouse (which generally is the issue that prompted the risk
 Development of the SARA and B-SAFER 25

assessment) and imminent risk of harm to some other identifiable person (for example, the
individual’s children, other family members, or the new partner of an ex-spouse). With the
SARA, such risk is coded using a 3-point response format: 1 = low, 2 = moderate, and 3 =
high. If the individual is deemed to be at risk for harming “others,” the evaluator must
identify the potential victims. These summary risk judgments capture the evaluator’s overall
professional opinion in a straightforward manner that permits comparison with other
evaluators.

Research on the SARA

The authors have evaluated the reliability and validity of judgments concerning risk for
violence made using the Spousal Assault Risk Assessment Guide (Kropp and Hart, 2000).
SARA ratings were analyzed in six samples of adult male offenders (total N = 2,681). The
distribution of ratings indicated that offenders were quite heterogeneous with respect to the
presence of individual risk factors and to overall perceived risk. Structural analyses of the risk
factors indicated moderate levels of internal consistency and item homogeneity. Inter-rater
reliability was high for judgments concerning the presence of individual risk factors and for
overall perceived risk. SARA ratings significantly discriminated between offenders with and
without a history of spousal violence in one sample and between recidivistic and non-
recidivistic spousal assaulters in another. Finally, SARA ratings showed good convergent and
discriminant validity with respect to other measures related to risk for general and violent
criminality (Kropp and Hart, 2000).
Williams and Houghton (2004) conducted a predictive validity study on the SARA using
434 male spousal assaulters on probation in Colorado. SARA assessments were completed on
offenders when they were released into the community and re-offense rates were examined 18
months later. The authors computed Receiver Operator Curves (ROCs) to estimate the
predictive accuracy of the SARA total scores and “weighted” SARA score which combined
the total score and the overall (subjective) risk rating. Both methods showed statistically
significant predictive validity for the SARA. The Areas Under the Curve (AUC) for the
SARA and weighted SARA measures for predicting domestic violence reoffending were both
.65 (p < .001). The AUCs for any reoffending were .70 and .71, respectively (also p < .001).
Similarly, Hilton et al. (2004) reported an AUC of .64 for the SARA on a sample of 589
offenders. This result was achieved despite the SARA risk factors being approximated from
archival files and thus not administered as recommended in the SARA manual. Overall, these
two studies add support for the predictive validity of the SARA. Such information is desirable
despite the fact the stated goal of the SARA is to prevent violence rather than to predict it.

Development of the B-SAFER

Recently, there has been an increased focus in the field on the need for brief risk
assessments by police officers and other criminal justice professionals who work with
offenders and victims (Hilton et al., 2004; Kropp, 2004). The SARA may not be an optimal
tool for use by police and others in this context because it is relatively long, and it requires
specific judgments regarding mental health, such as major mental illness and personality
26 P. Randall Kropp

disorder. Thus, completion of the SARA places a relatively heavy burden on users in terms of
the availability of time, technical expertise, and case history information. We therefore
decided to develop a new tool, which we called the Brief Spousal Assault Form for the
Evaluation of Risk, or B-SAFER (Kropp, Hart, and Belfrage, 2005). This section outlines the
steps taken in the development of the B-SAFER and describes the tool itself.

LITERATURE REVIEW
Our first step in developing the B-SAFER was to conduct a comprehensive review of the
literature regarding spousal violence and spousal violence risk assessment. We also updated
this review continuously during the project to keep abreast of new developments in the field.
Overall, the literature review indicated that there have been relatively few advances in
our understanding of risk factors for spousal assault since the development of the SARA in
the early 1990s. There has been further research supporting the utility of some risk factors
previously identified (for example, see reviews by Dutton and Kropp, 2000; Riggs, Caulfield,
and Street, 2000; Schumacher, Feldbau-Kohn, Slep, and Heyman, 2001), but no important
new risk factors have been identified.
The literature review also suggested that there have been few advances in the
development of specific tools or procedures for spousal violence risk assessment. One
exception was the ODARA, a tool developed for use by the Ontario Provincial Police. As the
ODARA is based on the actuarial approach, it is intended to estimate the likelihood of future
violence rather than to provide information about risk management. This means that
professionals who use the ODARA still need assistance making final decisions that reflect the
totality of circumstances in the case at hand and that guide case management.
Another development was an increased focus on victims. Both the ODARA and the
Stalking Assessment and Management Guide (SAM), a structured professional judgment tool
currently being developed by the British Columbia Institute Against Family Violence
(BCIFV), include consideration of factors that increase a victim’s vulnerability to violence.
One potential problem with this advance is that including victim vulnerability factors in a new
tool increases the complexity (i.e., length and scope) of the assessment.
In sum, the literature review indicated to us that it would be possible to use the SARA as
a basis or starting point for the development of the B-SAFER. It also indicated that the B-
SAFER might benefit from consideration of victim vulnerability factors, providing their
inclusion did not make the use of the tool unduly complex or resource-intensive.

Empirical Analyses

Statistical Analysis of SARA Ratings. We asked colleagues in Scotland to conduct

statistical analyses of existing data sets to identify possible redundancy among the 20 SARA
risk factors. The data sets comprised 2,796 adult male offenders from Canada: 1,786 were
offenders on probation in British Columbia, and 1,010 were offenders from federal
penitentiaries. The probationers were serving sentences for offenses related to spousal assault,
 Development of the SARA and B-SAFER 27

whereas the federal offenders were serving sentences for a variety of offenses but had a
known, documented, or suspected history of spousal assault
Briefly, Exploratory and Confirmatory Factor Analyses suggested that the statistical
association among the ratings of the 20 SARA items could be modeled adequately using 7
factors, with each factor comprising multiple items. The factors were interpreted as follows:
History of Spousal Violence; Life-threatening Spousal Violence; Escalation of Spousal
Violence; Attitudes Supportive of Spousal Violence; General Antisocial Behaviour; Failure to
Obey Court Orders; and Mental Disorder. The factors themselves appeared to be non-
redundant. Most of the factors had unique predictive power with respect to global judgments
of risk for spousal violence or, in a small subsample of 102 offenders, with respect to actual
spousal violence recidivism. Item Response Theory analyses of the same data yielded similar
findings regarding redundancy.
Pilot Testing of the SARA-PV in Sweden. We pilot tested a modified version of the
SARA, which we called the SARA-Police Version (SARA-PV), for use by the Swedish
National Police. In the SARA-PV, each of the 20 SARA risk factors was revised and
shortened to simplify coding decisions. Patrol officers attended 1-day training sessions
conducted by one of the authors and then used the SARA-PV when responding to spousal
violence incidents. Patrol officers reviewed the completed SARA-PV coding forms with shift
supervisors prior to making case management decisions. A more detailed description of the
Swedish project can be found in the chapter by Henrik Belfrage in this volume.
In total, we received 584 completed SARA-PV coding forms for 430 adult males
suspected of perpetrating spousal violence. (Some people had multiple contacts with police
and thus multiple SARA-PV ratings.) Analysis of the SARA-PV ratings indicated that it was
sometimes difficult for patrol officers to gather the information required to rate some risk
factors as part of their usual investigation procedures. In particular, they found it difficult to
make specific judgments about the perpetrator’s mental disorder and about his history of
childhood victimization experiences. In addition, feedback received from police officers
revealed two major concerns regarding the use of the SARA-PV. First, they wanted the
scheme used to code the presence of individual risk factors to more closely resemble their
usual operational procedures and language. Second, they expressed a desire for clarified and
simplified coding of overall or summary judgments regarding risk.
The results of these empirical analyses indicated the following:

1) Some SARA items may have redundant or overlapping content.

2) Some SARA items may be difficult to code when used by police as part of routine
investigations, due to specificity of content.
3) The schemes used in the SARA to code judgments regarding the presence of
individual risk factors and overall risk may not be a good fit for use by law-
enforcement.

Overall, these findings were consistent with our anecdotal observations and with informal
feedback received when conducting SARA training with police in the past. The findings also
suggested that it was both necessary and feasible to shorten, simplify, and revise the SARA
for use by police.
28 P. Randall Kropp

Format of the Draft B-SAFER and Related Materials

The draft of the B-SAFER that we developed for pilot testing comprised 10 risk factors.
The 10 risk factors were divided into two sections. The first section, Spousal Assault,
contained 5 factors related to the perpetrator’s history of spousal violence: (1) Serious
Physical/sexual Violence; (2) Serious Violent Threats, Ideation, or Intent; (3) Escalation of
Physical/sexual Violence or Threats/ideations/intent; (4) Violations of Criminal or Civil
Court Orders; and (5) Negative Attitudes about Spousal Assault. The second section,
Psychosocial Adjustment, contained 5 factors related to the perpetrator’s history of
psychological and social functioning: (6) Other Serious Criminality; (7) Relationship
Problems; (8) Employment and/or Financial Problems; (9) Substance Abuse; and (10) Mental
Disorder. The risk factors in the latter section are associated with risk for violence in general,
in addition to risk for spousal violence. After considering these risk factors, the evaluator is
asked to provide a judgment of risk level and recommendations for managing that risk (e.g.,
specific strategies for monitoring, treatment, supervision, and safety planning).
A coding form and user manual are now available. The manual includes an overview of
the B-SAFER, as well as sections on user qualifications, confidentiality and informed
consent, applications, and administration procedures. We have also included a comprehensive
section entitled, “Definition of Risk Factors,” which includes item definitions, rationales for
including items (including references to supporting literature), specific coding instructions for
each B-SAFER item, and a detailed reference list. The manual and coding form also include
considerable information regarding the development of case management plans. Finally, we
developed a semi-structured interview for victims, which we circulated among a small
number of police officers and victim service workers for feedback. The interview includes
suggested questions that can be asked for each risk factor. The format is semi-structured to
allow the interviewers flexibility and discretion.

Quantitative Analyses

Six police agencies in Canada, representing five cities, volunteered to pilot the B-
SAFER. One of the B-SAFER developers (Kropp) delivered half-day training sessions to
selected officers at all of the agencies. Each officer was then provided with a draft B-SAFER
manual and asked to complete the B-SAFER coding form and a checklist of recommended
risk management strategies on current and recent spousal violence cases.
Training on the B-SAFER was also conducted for the Swedish National Police. Pilot
testing in the counties of Kalmar, Växjö, and Blekinge was supervised by Professor Henrik
Belfrage, a co-author of the B-SAFER (see chapter in this volume by Belfrage). The Swedish
National Police subsequently forwarded data for 283 cases to BCIFV for analysis. We
deemed this data to be directly relevant to this report because (a) the Swedish criminal justice
system is similar to Canada’s with the presence of a proactive spousal assault policy; (b) as in
Canada, police officers in Sweden are required to make recommendations regarding detention
and supervision prior to trial; (c) the B-SAFER was developed in collaboration with
academics and police agencies in Sweden, so the risk factors were considered directly
applicable; and (d) previous research on the SARA-PV (Police Version) in Sweden indicated
that the structural professional judgment approach could be successfully applied.
 Development of the SARA and B-SAFER 29

Quantitative analysis of the pilot data forwarded to BCIFV by police in Canada and
Sweden are summarized in Tables 1 through 3. All of the B-SAFER items were present in at
least some cases from both countries, and many were present in a large percentage of cases.
Table 1 reports the average number of risk factors, current and past, present in each country.
In general, the cases from Canada had more risk factors than did those from Sweden,
suggesting that the Canadian cases were higher risk. This interpretation is supported by the
distribution of risk ratings made using the B-SAFER in Canada and Sweden, as reported in
Table 2. The higher risk of the Canadian cases probably reflects the fact that they came
primarily from a specialized investigative unit, whereas those from Sweden came from
regular patrol officers.

Table 1. Total Risk Factors Ratings (M, SD)

Canada Sweden
Current risk factors 10.14 (3.94) 7.15 (4.15)
Past risk factors 10.34 (5.26) 6.09 (4.87)
Note. Items recoded: No, Omit = 0; Possible = 1; Yes = 2.

Table 2. Distribution of B-SAFER Risk Ratings

Canada Sweden
Long-term risk of assault
Low 27% 38%
Moderate 29% 55%
High 45% 8%

Risk of imminent assault

Low 35% 44%
Moderate 27% 47%
High 39% 9%

Risk for severe assault

Low 47% 83%
Moderate 29% 17%
High 25% 1%

Perhaps the most important finding is reported in Table 3. Table 3 presents the
associations (correlations) among the total number of risk factors present on the B-SAFER,
current and recent; risk ratings made using the B-SAFER, and the management strategies
recommended in the cases. The correlations suggest that B-SAFER risk factors and risk
ratings were substantially associated with the number of management strategies
recommended by police, as well as recommendations for detention made in Canada. (No
recommendations for detention were made by the Swedish police.) Simply put, more
intervention was recommended in cases perceived to be high risk than in cases perceived to
be low risk.
30 P. Randall Kropp

Table 3. Correlations among B-SAFER Risk Factors,

Risk Ratings, and Management Strategies

1 2 3 4 5 6
1. Current risk factors, total -- .74 .59 .56 .39 .39
2. Past risk factors, total .64 -- .56 .45 .32 .35
3. Long-term risk of assault .37 .54 -- .73 .45 .41
4. Risk for imminent assault .34 .49 .80 -- .34 .38
5. Risk for severe assault .49 .64 .73 .75 -- .26
6. Management strategies, .07 .29 .35 .38 .20 --
total
7. Detention .05 .27 .41 .38 .39 --
Note. Ratings for Sweden appear above the diagonal; ratings for Canada, below. Detention was not
recommended as a management strategy in any of the Swedish cases. One rater from Canada was excluded
for analyses with management strategies.

Overall, the findings of these quantitative analyses indicated the following:

1) All of the risk factors were coded as present in a substantial proportion of cases, and
there was a low rate of coding items as omitted or unable to be evaluated due to
missing information. This suggests that the B-SAFER risk factors were defined
clearly and coded easily by police officers in the course of routine investigations.
2) Overall or summary ratings of risk were diverse, distributed almost normally in the
Canadian samples. This suggests that police officers were able to use the B-SAFER
coding instructions to make discriminations among perpetrators.
3) There was a limited association between B-SAFER ratings and recommended
management strategies, and there was substantial variability both within and among
officers in their recommendations regarding management. This suggests that police
officers’ recommendations regarding case management were influenced by their
judgments of risk (both the presence of individual risk factors and overall level of
risk), but also that B-SAFER ratings were not highly “prescriptive” with respect to
management recommendations.

Qualitative Feedback

Following the pilot testing, we asked officers from each agency to answer six questions
(below) regarding the content and process of the B-SAFER. Overall, the feedback was
positive. Officers said that they found the B-SAFER to be simple and easy to use. Some noted
that it encouraged investigators to think about risks in specific and identifiable areas that
might otherwise have been overlooked. Others appreciated the item indicators and examples
listed on the coding form. Others said that the B-SAFER caused investigators to do more
standardized and formalized risk assessments. Of note, was the following comment: “The B-
SAFER provided us with a consistent tool to use in each case, which improved our service to
victims.”
 Development of the SARA and B-SAFER 31

There was some concern that police officers may have limited knowledge about some of
the risk categories, such as those referring to mental disorder. Some officers indicated that
they were uncomfortable completing the risk ratings section of the B-SAFER, indicating that
it was difficult to make these determinations. Certain officers were particularly concerned that
they would be required to disclose in court the B-SAFER information. The same officer
thought the process required him to make “judgments and assumptions” about the offender
and victim that went beyond his role as a police officer.
Most officers indicated that the B-SAFER was comprehensive and the risk factors
appropriate. One respondent indicated that the indicators for item 5 (Negative Attitudes about
Spousal Assault) could be expanded to include additional controlling behaviors, such as
financial control, verbal and emotional abuse, and manipulative behavior. We received
several suggestions that software to assist administration and report writing would greatly
facilitate routine use of the B-SAFER, as well as quality assurance.

CONCLUSIONS REGARDING THE B-SAFER

We developed a tool that criminal justice professionals can use to assess risk for spousal
violence, called the B-SAFER. The B-SAFER was based on the SARA and shares two
important strengths. First, the B-SAFER uses a structured professional judgment or structured
discretion approach that is appropriate for criminal justice contexts. Second, the content of the
B-SAFER is firmly grounded in the professional and scientific literatures on spousal violence.
But the B-SAFER also has two important advantages over the SARA when used in some
criminal justice contexts. First, the B-SAFER is shorter than the SARA and thus is less
resource-intensive to administer. Second, the content of the B-SAFER includes fewer items
and less technical jargon related to mental disorder and therefore requires less expertise to
use.
Based on our development work and on the results of pilot testing, we believe that the B-
SAFER can be used by criminal justice professionals. Police officers found the B-SAFER
helpful and easy to use in routine investigations of spousal assault complaints. In addition to
helping them assess risks, the B-SAFER helped police to make risk management decisions.
However, further evaluation of the B-SAFER should be undertaken. Evaluation should
examine the inter-rater and test-retest reliability of the B-SAFER, as well as the impact of the
B-SAFER on the safety of victims of spousal violence.
In: Intimate Partner Violence Prevention and Intervention ISBN: 978-1-60456-039-8
Editors: A. C. Baldry and F. W.Winkel, pp. 33-44 © 2008 Nova Science Publishers, Inc.

Chapter 3

POLICE-BASED STRUCTURED SPOUSAL VIOLENCE

RISK ASSESSMENT: THE PROCESS OF DEVELOPING A
POLICE VERSION OF THE SARA

Henrik Belfrage
Mid Sweden University, Sweden

This chapter describes a developmental project with the Swedish police that had as
its objective the revision of an originally clinical risk assessment tool (the SARA) into a
tool better suited for practical police work. Three of Sweden’s 21 police counties
participated in the project, and the study yielded a total of 651 SARA assessments
administered to 484 individuals during one year (2001). The result was that a number of
modifications in the original SARA were made, resulting in a new abbreviated version of
the SARA, called the B-SAFER. The modifications made are described and discussed in
detail.

In recent years, spousal violence has been given more attention than it had received in the
past. It has been identified as a huge problem in our society, where estimates indicate that
between 3% and 14% of women in North America report assaults by their male partners
every year (Johnson and Sacco, 1995). In the United States, the 1992 National Crime
Victimization Survey indicated that more than a million women were victimized by their
intimates (Healey and Smith, 1998). In Canada, spousal violence accounts for approximately
80% of all violence reported to the police, and 20% to 40% of all adult male offenders have a
documented history of spousal assault (Kropp and Hart, 2000). In Sweden, where this study
was conducted, approximately 22,000 cases of assault against women are reported to the
police every year. (Sweden has approximately 9 million inhabitants.). Close to 80% of all
violence against women in Sweden is carried out by a perpetrator known to the victim (Rying,
2001). The dark figures related to this type of violence are expected to be high, and thus the
costs to society are immense. The effects of spousal violence include physical and
psychological damage to the victims, deaths, increased health care costs, prenatal injury to
infants, physical and psychological damage to children exposed to violence in their homes,
and increased demands for social, medical, and criminal justice services. New legislation,
34 Henrik Belfrage

batterer intervention programs, and victim protection programs are some of the strategies that
society is implementing to address this problem.
One of the most essential tasks in this field must be better identification than has hitherto
been possible of women at high risk and the development of strategies to reduce that risk.
This implies a focus on the potential perpetrators. Who are they? What are their
characteristics? What risk factors are of particular importance when assessing risk for spousal
violence?
The most validated and research-based structured risk instrument in the field has, for
many years, been the Spousal Assault Risk Assessment Guide (SARA) (Kropp, Hart,
Webster, and Eaves, 1995). As shown in previous chapters in this book, the SARA contains
20 risk factors that appear to be important to consider when performing risk assessments in
the context of spousal assault.
Originally, the SARA was developed by clinicians, to be used by clinicians. However, in
recent years, there has been a growing awareness that other, non-clinician, professional
groups could benefit from structured checklists when performing risk assessments. This is
probably particularly the case among police all over the world, who, every day, perform risk
assessments and make decisions about what protective actions to take in cases of spousal
assault. The majority of those assessments and decisions are not based on any evidence-based
and structured checklists. Even if it is probable that, in a majority of these cases, the police
are doing a very good job, the extremely high incidence and prevalence of spousal assault in
our society suggests that there is still room for improvement in this area.
This chapter describes a developmental project with the Swedish police that had as its
objective the revision of an originally clinical risk assessment tool (the SARA) into a tool
better suited for practical police work (the police version of the SARA, the SARA:PV).

THE STUDY
Background

Three of Sweden’s 21 police counties participated in the project. All investigative police
officers in these counties were trained in using the SARA and then given the task of using
these guidelines as a base for their risk assessments in all cases of spousal assault for one
year. The original 20-item version of the SARA was used, with the only modification being
that the three items in the SARA that can be considered to be clinical in nature (items 8, 9,
and 10) could be coded as “provisional” instead of “definite” for the obvious reason that the
police lack clinical training. Most of the training in use of the SARA was done during the
year 2000 by this author, but some of the police officers also attended lectures given by
Professor Randall Kropp before the project was launched in 2001.
The three participating counties were Kalmar, Växjö, and Blekinge, all located in the
south of Sweden, and the expected number of SARA assessments was estimated to be
approximately 600. In order to ensure that the assessments were carried out and distributed to
the research group, two police officers in each of the three counties were given the task of
being controllers.
 Police-Based Structured Spousal Violence Risk Assessment 35

Procedure

In every case of spousal violence reported to the police in these three counties in 2001,
(a) data on certain background factors were noted, (b) a SARA rating was completed, and (c)
the legal proceedings and proposed protective actions were described. The procedure can be
described as in Figure 1.

Figure 1. The procedure in the Swedish police-based SARA project.

The Sample

The project yielded a total of 651 SARA assessments administered to 484 individuals. Of
these 484 alleged perpetrators, 54 (11%) were women. At first glance, this appeared to be a
high number of women. However, a possible explanation for this seemingly high number is
the fact that, at the time of their arrests, many of the male alleged perpetrators accused their
female partners and ex-partners of spousal assault. Thus, it is likely that a substantial
proportion of the female perpetrators might have been falsely accused by their own
perpetrators. This uncertainty, together with the differences in other respects between men
and women, led to our eliminating the women from the project study group. Thus, the final
totals from the project were 584 assessments carried out on 430 adult males.

EMPIRICAL RESULTS OF THE STUDY

Background factors. Among the 430 men in the study group, the mean age was 39.46,
with a range of 17 to 92 years of age. No less than 27% (114) had immigrant backgrounds,
the definition being “foreign citizen, born abroad, or both parents born abroad.” Among the
victims, 106 (25%) had immigrant backgrounds. In 72 (17%) of the cases, both the alleged
perpetrators and the victims had immigrant backgrounds (this was, to a certain extent, an
36 Henrik Belfrage

overrepresentation -- 3 times -- and a within-group phenomenon). Most immigrant

perpetrators had their roots in the former Yugoslavia (32) or in the Middle East (29).
In half of the cases (215), the alleged perpetrator and the victim had an ongoing
relationship, whereas in the other half, the relationships had ended. In 42% of the cases, there
were children involved. The total number of children was 474 (i.e., larger than the number of
adult victims). Sweden still, to a great extent, lacks programs for these children.
Criminal History. Table 1 presents findings on the type of offenses the men were charged
with. Some men in the sample were charged with two or more crimes, so the most serious
offense was coded first. This was defined as the offense that had the harshest sanction in the
Swedish Penal Code. Additional offenses, if any, are listed in the next column.

Table 1. Alleged Offenses, including Attempted Crimes

Alleged offense Most serious offense Additional Total number of

n = 430 offenses alleged offenses
n = 147 N = 577
Murder/manslaughter 2 ( 0.5) 0 2 ( 0.5)
Assault 283 (65.8) 2 285 (66.3)
Illegal threat 92 (21.4) 88 180 (41.2)
Arson 1 (0.2) 0 1 (0.2)
Other violent crimes 2 (0.5) 8 10 (2.3)
Rape 2 (0.5) 7 9 (2.1)
Other sexual crimes 0 2 2 (0.5)
Other crimes 1 (0.2) 28 29 (6.7)
Gross violation of a woman’s 12 (2.8) 9 21 (4.9)
integrity
Violation of no contact order 7 (1.6) 2 9 (2.1)
Molesting 16 (3.7) 26 42 (9.7)
Breach of domiciliary peace 10 (2.3) 10 20 (4.7)
Missing information 2 (0.5) 0 2 (0.5)
Note: Percentages are indicated in parentheses.

As can be seen from Table 1, assault is the most commonly alleged offense in the study
group. Gross violation of a woman’s integrity is a comparatively new offense in Sweden
(1998); under this offense, a perpetrator can be prosecuted for a number of crimes that
together have a high penal value. The cases of murder were both attempted crimes. However,
during the project period, one case appeared that tragically ended in a murder. The perpetrator
relapsed several times during the project period, and several SARA risk assessments were
made, the last being high risk, with suggestions for extensive protective actions. The victim,
however, chose not to cooperate with the police and thus no actions were taken.
Risk Factors. The 430 men in this study group displayed, on average, 5 risk factors (R =
0-16). As risk factors, we consider all ratings of partly (1) and yes (2) in the SARA. The
distribution of risk factors in the study group is shown in Table 2.
As Table 2 shows, the very large number of omitted items for most of the SARA risk
factors was striking. Several causes for this high frequency can be identified.
 Police-Based Structured Spousal Violence Risk Assessment 37

Table 2. Distribution of Risk Factors, including Omitted Items and Critical Items

Omitted Critical
SARA risk factors 0 1 2 items items
Criminal history
1 Past assault of family members 227 29 105 69 (16) 20 (5)
2 Past assault of strangers or 233 22 79 96 (22) 5 (1)
acquaintances
3 Past violation of conditional release 335 3 11 81 (19) 0 (0)
or community supervision
Psychosocial adjustment
4 Recent relationship problems 61 67 275 27 (6) 24 (6)
5 Recent employment problems 243 26 86 75 (17) 2 (1)
6 Victim of and/or witness to family 248 4 11 167 (39) 3 (1)
violence as a child
7 Recent substance abuse/dependence 176 44 146 64 (15) 28 (7)
8 Recent suicidal or homicidal 263 12 41 114 (27) 7 (2)
ideation/intent
9 Recent psychotic and/or manic 244 10 54 122 (28) 8 (2)
symptoms
10 Personality disorder with anger, 165 53 110 102 (24) 11 (3)
impulsivity, or behavioral instability
Spousal assault history
11 Past physical assault 148 36 199 47 (11) 26 (6)
12 Past sexual assault/sexual jealousy 285 17 29 99 (23) 7 (2)
13 Past use of weapons and/or credible 250 62 35 83 (19) 5 (1)
threats of death
14 Recent escalation in frequency or 204 71 91 64 (15) 10 (2)
severity of assault
15 Past violation of “no contact” orders 381 6 10 33 (8) 2 (1)
16 Extreme minimization or denial of 225 21 94 90 (21) 8 (2)
spousal assault history
17 Attitudes that support or condone 260 15 44 111 (26) 3 (1)
spousal assault
Alleged offense
18 Severe and/or sexual assault 166 177 80 7 (2) 4 (1)
19 Use of weapons and/or credible 229 94 94 13 (3) 10 (2)
threats of death
20 Violation of “no contact” order 403 8 7 12 (3) 0 (0)
Note: Percentages indicated in parentheses.

a) Unusual Risk Factors in a Police Context

It was clear to this author, before the project started, that it would be difficult, if not
impossible, for the police to get sufficient information for several of the SARA risk factors,
particularly those pertaining to the perpetrator’s psychosocial situation, which police in
Sweden are neither used to nor, in many cases, allowed to gather about suspects.
Consequently, it had been discussed, before the project was launched, whether or not to
shorten the SARA by removing a number of the risk factors. We decided, however, to keep
the SARA intact; the 20 risk factors in the SARA are evidently important and, therefore, any
reduction of risk factors should be done first after a possible finding that the police for various
reasons could not code some of the risk factors because of lack of information. We also
Other documents randomly have
different content
kurjuutta, sillä silloin ne minun silmissäni ovat tuhatta vertaa
kauniimpia luonnon rumana niitä ympäröidessä. —

Nyt oli taas niiden syysretken aika. Yhä alemmaksi ne laskeutuivat

illan hämärää, tuhkanväristä vettä kohden. Ne pieksivät ilmaa
suurilla siivillään, kohosivat suoraan ylös lentoaan pysäyttääkseen ja
laskeutuivat sitte veteen, joka tervehdykseksi syleillen huuhteli niiden
pehmeäkaarteisia ruumiita.

Ja seisoissani lepikkoon piiloutuneena ulapan rannalla, juohtui

minun mieleeni, miten pikkupoikana näin ensikerran nuo ihanat
linnut. Silloinkin oli syysilta, ja minä leikin kotorannan kuihtuneiden
koivujen alla, ja poimin lakkini täyteen keltasia alaspudonneita lehtiä.
Ne olivat kultarahoja, joilla minun piti ostaa kaiken maailman
ihanuudet — talo ja valkosia hevosia ja vaunut naapuritöllin
tummakutriselle tytölle. Silloin näin äkkiä suurten valkosten lintujen
tulevan ulapan yli ja laskeutuvan vedenpinnalle lähelle rantaa, missä
istuin. Ne tulivat niin hiljaa, ääntämättä ja laulamatta ja minä kuulin
vain heikon kohauksen kuin laine olisi rantaan loiskahtanut, niiden
laskeutuessa veteen. Minä ihan jäykistyin riemusta, ja sydämeni
seisahtui hetkeksi ja alkoi sitte sykkiä niin kiivaasti, että luulin rintani
särkyvän. Siinähän olivat ihan likelläni, ilmielävinä satujen linnut,
joita koko lapsen hehkuvan sydämen kaipuulla aina olin toivonut
näkeväni. En tiennyt, mistä ne tulivat, en tiennyt, minne niiden tie vei,
— lapsuuden unelmain ihmeellinen loisto niiden valkeasta puvusta
säteili. Minun sielussani oli vain hämärä aavistus oudosta maasta
tuhanten korkeiden vaarain ja vesien takana, vihannoivasta maasta,
missä onnelliset ihmiset kulkivat välkkyväin virtain rantoja ja
katselivat riemuiten niitä ihania lintuja.
 Minä kyyristyin ja ryömin rantaäyräälle, päästäkseni kuivuneiden
keisojen suojassa niitä niin liki kuin suinkin. — Miten aavemaisen
valkeita nuo oudot linnut olivat! Tuskin uskalsin henkiä, melkeimpä
pelkäsin, että ne kuulisivat hengitykseni heikon huounnan ja
säikähtyisivät pois. Ja tuijottaissani niihin, kun ne siinä illan harmailla
vesillä uiskentelivat, häipyi kaikki ympäriltäni ikäänkuin siniseen
usvaan — ulappa ja ranta ja keltanen iltataivas — ja minä näin vain
ne valkeat linnut, — ne olivat minusta niin lähellä, että tietämättä
kurotin käteni niiden pehmeitä kauloja silittääkseni. Mutta sitte
pelästyin, että ne olisivat nähneet liikkeeni, ja aatoksissani pyytelin
niitä mitä kauneimmin sanoin jäämään hetkiseksi, edes vähän ‒
vähäseksi hetkiseksi.

Silloin yksi lintu äkkiä nosti kaulansa ja äännähti niin oudon

surullisesti, niin helkkyvän surullisesti, että minä vavahdin siinä
maatessani. Ne levittivät suuret siipensä ja pieksivät vettä, kunnes
se näytti kuohuvalta koskelta. Siten linnut saivat ilmaa siipiensä alle
ja kohosivat pitkässä jonossa lentoon yli järven. Mutta kaikki valittivat
niin surullisesti, että minun rintaani vihloi.

Hyppäsin isäni venheeseen, työnsin sen vesille ja lapsen tavalla

soutaa molskin lintujen jälkeen, sille paikalle, missä ne olivat
uiskennelleet, ja kurottausin laidan yli. Minä tuijotin alas syvyyteen,
ikäänkuin odottaen, että joutsenien kuvaiset olisivat vielä siellä
jälellä. Hohtavan valkonen untuva kellui vedenpinnalla. Otin sen
käsiini ja laskin venheeseen, ja rannalle tultuani panin sen lakkiini
keltasien lehtien sekaan ja juoksin kotia.

Sinä iltana ei teenjuonnistani tahtonut tulla mitään paljaasta ilosta.

Poskeni hohtivat niin punasina, että äitini pelästyi luullen minun
saaneen kuumetaudin. —
 *****

Seisoissani lepikossa ulapan rannalla ja aatellessani poikaa, joka

ensikerran näki ne valkeat linnut, kohosivat joutsenet suunnaten
lentonsa tuhkanharmaata, illanhämyistä kaukamaata kohti.

Nyökkäsin hiljaa niille päätäni jäähyväisiksi: valonpalvelijat,

päivänlinnut, te asujat sinisten ja ikuisten suvijärvien maan, kiitos
että saavuitte tähän harmaaseen ja syyskolkkoon seutuun, kiitos että
herätitte lapsuusunelman eloon sielussani!

Ja niinkuin kerran täytin lakkini keltasilla lehdillä kuvitellen niitä

kultarahoiksi, joilla saattoi ostaa kaiken maailman ihanuudet, etsin
minä nytkin aarteita syksyn kuihtuneiden lehtien seasta, minä
odottelen runojeni valkeita joutsenia, laulun joutsenia, joiden
puvussa puhtauden kirkkaat kaarteet ja unelmain ihmeellinen loisto
säteilee.
 *** END OF THE PROJECT GUTENBERG EBOOK
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