Danger Assessment - An Instrument to Help Abused Women

Danger Assessement: An Instrument to Help Abused Women Assess Their Risk of Homicide

Background & Goal

Domestic violence is a major cause of mortality for women in the United States. According to the CDC, homicide is the second leading cause of death for young African American Women, the third leading cause of death for American Indian/Native Alaskan women aged 15-34, and the fifth leading cause of death for white women aged 30-34. When women are murdered, they are most often (40-54%) killed by a husband, boyfriend or ex-husband or partner. In 70% of the cases when women have been killed, there has been prior physical domestic violence. For every one woman killed by her partner or ex-partner, approximately 8-9 are nearly killed by their partner or ex-partner with serious long term health problems resulting. Campbell’s national intimate partner femicide study found that 40-47% of women who were killed were in the health care system (emergency department, primary care, prenatal care, mental health) in the year before they were killed. The goal of the Danger Assessment: An Instrument to Help Abused Women Assess Their Risk of Homicide (Danger Assessment or DA) is to assist abused women, domestic violence advocates, justice system domestic violence experts, and domestic violence policy experts to more accurately assess the risk of homicide from an abuser and obtain appropriate health care and other domestic violence safety planning interventions.

Program Description

Jacquelyn Campbell, PhD, RN, FAAN created the Danger Assessment in 1985. Prior to the DA’s creation, there were several non-evidence based, non-validated lists of warning signs of potential lethality in domestic violence situations. The wording of the Danger Assessment is based on research and was developed in collaboration with abused women.

For More Information Contact:

jacquelyn-campbell.jpgJacqueline Campbell, PhD, RN, FAAN
Professor & Anna D. Wolf Chair
Johns Hopkins University School of Nursing
Baltimore, MD 21205
Phone: 410-955-2778
Email: jcampbe1@jhu.edu  

Once the Danger Assessment is completed with an abused woman, it is scored by an advocate or health care professional as one of four levels of danger: Variable, Increased, Severe, and Extreme. The results of the DA are conveyed to the woman and measures are taken to obtain appropriate health care and other domestic violence safety planning interventions. The weighted scoring has been assessed at accurately capturing 90% of the cases of intimate partner femicide under the receiver operating characteristic (ROC) curve. Included in the Danger Assessment is a calendar which is innovatively applied to aid in recall, identify old injuries that may have been inadequately treated, and identify patterns of increasing severity and/or frequency of abuse victims are often unaware of which indicate increased risk. The calendar also serves as a useful evidentiary tool in court proceedings to document the frequency and severity of the abuse.

Evidence of Success

The Danger Assessment is used by domestic violence advocates and health care professionals in every state except Mississippi and Idaho, as well as in seven foreign countries (Canada, Mexico, New Zealand, Australia, Portugal, United Kingdom, South Africa) and, in 2018, is being launched in Brazil and Zambia. Approximately 1000 persons from multiple disciplines have been certified to use the Danger Assessment each year through either in person training (about 70% of those trained) or through online training (www.dangerassessment.com). All nurses providing home visitation during the perinatal period with the Nurse Family Partnership home visitation program are trained in using the Danger Assessment. A bench card on the DA has been developed for judges to use the DA in judicial training on domestic violence. The Danger Assessment may be taught to agencies in person for $1500 - $2500 or an in house trainer model may be used by the agencies to do its own training of new employees. A short user friendly form of the DA (Lethality Screen) has been created for use by police officers as part of a program (Lethality Assessment Program or LAP) which enables police offers to tell abuse victims if they are at high risk on the Lethality Screen and to immediately invite them to speak with a domestic violence advocate on the officer’s phone. The LAP is being used in 30 states in multiple jurisdictions in each of the states with support from the Department of Justice for community training.