Final Paper – Risk Assessment, Safety Plan and Case Management Plan with Resources

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RiskAssessmentandLethalityAssessmentTemplates-20201124.zip

domestic_violence_lethality_screen.pdf

Domestic Violence Lethality Screen For First Responders

Officer: Date: Case:

Victim: Offender:

Check here if victim did not answer any of the questions.

A "Yes" response to any of Questions #1-3 automatically triggers the protocol referral. 1. Has he/she ever used a weapon against you or threatened you with a weapon? 2. Has he/she threatened to kill you or your children? 3. Do you think he/she might try to kill you?

4. Does he/she have a gun or can he/she get one easily? 5. Has he/she ever tried to choke you? 6. Is he/she violently or constantly jealous or does he/she control most of your daily activities? 7. Have you left him/her or separated after living together or being married? 8. Is he/she unemployed? 9. Has he/she ever tried to kill himself/herself? 10. Do you have a child that he/she knows is not his/hers? 11. Does he/she follow or spy on you or leave threatening messages?

Yes No Not Ans. Yes No Not Ans. Yes No Not Ans.

Negative responses to Questions #1-3, but positive responses to at least four of Questions #4-11, trigger the protocol referral. Yes No Not Ans. Yes No Not Ans. Yes No Not Ans. Yes No Not Ans. Yes No Not Ans. Yes No Not Ans. Yes No Not Ans. Yes No Not Ans.

An officer may trigger the protocol referral, if not already triggered above, as a result of the victim's response to the below question, or whenever the officer believes the victim is in a potentially lethal situation. Is there anything else that worries you about your safety? (If "yes") What worries you?

Check one: Victim screened in according to the protocol Victim screened in based on the belief of officer Victim did not screen in

If victim screened in: After advising her/him of a high danger assessment, did the victim speak with the hotline counselor? Yes No

Note: The questions above and the criteria for determining the level of risk a person faces is based on the best available research on factors associated with lethal violence by a current or former intimate partner. However, each situation may present unique factors that influence risk for lethal violence that are not captured by this screen. Although most victims who screen “positive” or “high danger” would not be expected to be killed, these victims face much higher risk than that of other victims of intimate partner violence.

MNADV 08/2005

  • Domestic Violence Lethality Screen For First Responders
  • Check here if victim did not answer any of the questions
  • A "Yes" response to any of Questions #1-3 automatically triggers the protocol referral.
  • Negative responses to Questions #1-3, but positive responses to at least four of Questions #4-11, tr
  • An officer may trigger the protocol referral, if not already triggered above, as a result of the vic

risk informed intervention.pdf

Risk-Informed Intervention: Using Intimate Partner Violence Risk Assessment within an

Evidence-Based Practice Framework Jill Theresa Messing

Intimate partner violence (IPV) is a pervasive problem in the United States. IPV is often repetitive and may escalate; in a small number of cases, IPV leads to homicide. This article presents an evidence-based practice (EBP) model for risk-informed social work intervention with survivors and perpetrators of IPV. The EBP model combines the best available research evidence, practitioner expertise, and client self-determination to guide the most appropriate intervention. IPV risk assessment instruments provide the best available evidence of future reassault, severe reassault, or homicide. Practitioners who implement IPV risk assessment can use their expertise to adjust risk scores and to suggest risk mitigation strategies for their clients. Examples of risk-informed social work practice include the safe removal of firearms, safety planning around separation, and mitigating the negative consequences of strangula- tion and sexual violence. Clients ultimately use their self-determination to decide which risk reduction strategies to implement. An EBP model can be used by social workers in all areas of practice to provide risk-informed social work interventions.

KEY WORDS: domestic violence; evidence-based practice; intimate partner violence; risk assess- ment; safety planning

Just over one-third of women in the UnitedStates are physically assaulted, raped, or stalkedby an intimate partner in their lifetimes (Black et al., 2010). One-quarter of women report severe intimate partner violence (IPV) in their lifetimes and 28.8 percent of women report both that they have been victimized by an intimate partner and that this violence has affected their physical or mental health, made them afraid, or resulted in a need for services (Black et al., 2010). Though IPV leads to homicide in a small number of cases, the majority of murdered women are killed by an inti- mate partner (Stöckl et al., 2013) and prior IPV is the largest risk factor for intimate partner femicide (Campbell, Glass, Sharps, Laughon, & Bloom, 2007). One way for social workers to intervene and mitigate danger in IPV cases is through IPV risk assessment. Indeed, the “Family Violence” policy statement of the National Association of Social Workers (2018) supports the assessment of risk as a basis for social work intervention.

IPV risk assessment instruments are tools that can assist social work practitioners who are working with IPV survivors or perpetrators to determine the

likelihood of reassault, severe reassault, or homicide. However, there are no social work practice models that provide guidance for social workers who wish to use IPV risk assessment in their practice. In this article, it is argued that IPV risk assessment should be used in the context of evidence-based social work practice. The evidence-based practice (EBP) model involves blending (a) the best available research evidence (in this case, IPV risk assessment), (b) practitioner expertise, and (c) client self- determination (see Figure 1) (Gambrill, 2006). The use of IPV risk assessment within an EBP framework to identify risk and intervene differen- tially with those who use and survive violence—that is, implementing risk-informed interventions (Messing & Campbell, 2016)—could have a signifi- cant impact on rates of repeat IPV and femicide.

EVIDENCE-BASED SOCIAL WORK PRACTICE EBP is a process that encourages practitioners to use the best available research knowledge as one part of a collaborative decision-making process that also includes consideration of practitioner expertise as well as client characteristics, culture,

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and self-determination (Gambrill, 2012). EBP is intended to foster transparency and collaborative decision making with clients; reduce the role of authority and tradition in practice decisions; and encourage inquisitiveness, reflection, and critical thinking among practitioners (Gambrill, 2001, 2007). The use of evidence in practice has been called a matter of social justice (Shlonsky, Baker, & Fuller-Thomson, 2011), and EBP has been espoused as a method that will increase the effec- tiveness and credibility of the social work profes- sion (Howard, Allen-Meares, & Ruffolo, 2007; Zayas, Drake, & Jonson-Reid, 2011).

Overall, the EBP process model consists of five steps: (1) developing an answerable research-to- practice question, (2) searching for relevant literature, (3) critically appraising the best available research evidence, (4) implementing the most appropriate intervention, and (5) evaluating client progress (Gibbs, 2003; Sackett, Richardson, Rosenberg, & Haynes, 1997). Several reviews have addressed steps 1 through 3 by examining the evidence behind IPV risk assessments (Graham, Sahay, Rizo, Messing, & Macy, 2019; Messing & Thaller, 2013, 2015). In the next section, information to assist social workers in determining the most appropriate IPV risk assessment for their setting is provided. This article focuses on step 4 in the EBP process: implement- ing risk-informed interventions by integrating the best available evidence, practitioner expertise, and client self-determination. The final step is

evaluation of client progress, and this section will focus on survivor-defined success.

IPV Risk Assessment: The Best Available Research Evidence Across a wide range of settings, validated risk assessment instruments have been shown to be more predictive of future behavior than clinical prediction (Ægisdóttir et al., 2006; Grove, Lebow, Snitz, Nelson, & Zald, 2000). A recent systematic review examined the empirical research on IPV risk assessment (Graham et al., 2019) and found 11 instruments that have been evaluated in the United States or Canada: the Ontario Domestic Assault Risk Assessment (Hilton et al., 2004), the Domes- tic Violence Risk Appraisal Guide (Hilton, Harris, Rice, Houghton, & Eke, 2008), the Danger Assessment (DA) (Campbell et al., 2003), the Danger Assessment for Immigrant Women (Messing, Amanor-Boadu, Cavanaugh, Glass, & Campbell, 2013), the Danger Assessment-Revised (Glass, Perrin, et al., 2008), the Danger Assessment-5 (Snider, Webster, O’Sullivan, & Campbell, 2009), the Lethality Screen (Messing, Campbell, Sullivan Wilson, Brown, & Patchell, 2017), the Spousal Assault Risk Assessment (SARA) (Kropp, 2008), the Brief Spousal Assault Form for the Evaluation of Risk (versions 1 and 2) (Storey, Kropp, Hart, Belfrage, & Strand, 2014), and the Domestic Violence Screening Instrument-Revised (DVSI-R) (Williams & Grant, 2006).

Because multiple IPV risk assessment instruments have been developed and are increasingly being used in practice across social service, health, and criminal justice settings, social workers must understand the various characteristics and intended uses of these tools to identify those that are appropriate for their practice context (Messing & Thaller, 2015). As shown in Figure 2, the DA and its adaptations are intended to predict homicide and severe reassault across practice settings. For social workers who are interested in homicide prevention and can interview the victim of violence, a variation of the DA is appropriate. A wider variety of instruments are available to predict rearrest or severe reassault (see Figure 3). These in- struments were generally developed for use in crimi- nal justice settings, necessitate access to case file and interview information, and have generally been tested to predict criminal justice recidivism. IPV risk assessment may also be conducted by other profes- sionals (for example, law enforcement officers), and risk information communicated to social workers.

Figure 1: Risk-Informed Social Work Practice

Risk- informed

social work

practice

Intimate partner violence risk assessment

Practitioner expertise

Client self-determination

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Practitioner Expertise Practitioner expertise, also termed “practice wis- dom,” encompasses a broad range of experience and knowledge (Howard, McMillen, & Pollio, 2003). This includes clinical knowledge, or the practi- tioner’s previous knowledge, experience, and skills working with this client and similar clients, as well as organizational expertise, or familiarity with organi- zational context, the likelihood of change, and knowledge of allies and power brokers (McCracken & Marsh, 2008). Bringing these forms of knowledge together in the context of intervention with vulner- able individuals takes considerable thought, effort, and skill (Shlonsky & Stern, 2007).

Risk Scores. The most basic implementation of professional judgment in the context of IPV risk assessment is the adjustment of risk scores. To

varying degrees, this is a component of many IPV risk assessment instruments. The SARA, for exam- ple, is intended to be administered by a skilled evaluator who collects information about risk fac- tors and then applies structured professional judg- ment to determine a summary risk rating, allowing a considerable amount of practitioner expertise in developing the risk score (Kropp, 2008). The DVSI-R incorporates professional judgment by including two questions about the evaluator’s assessment of risk (Williams & Grant, 2006). The Lethality Screen explicitly allows police officers to identify a victim as high risk when the risk assess- ment did not (Messing, Campbell, Sullivan Wil- son, et al., 2017). Altering risk scores through the addition of clinical case information and expertise may decrease the accuracy of risk assessments (Hilton,

Figure 2: Decision Tree: Intimate Partner Violence Risk Assessment Instruments Intended to Predict Homicide and Severe Reassault

Notes: DA-I = Danger Assessment for Immigrant Women; DA-R = Danger Assessment-Revised.

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Harris, Popham, & Lang, 2010) and should be done cautiously. A social worker should tell a client about both the risk score obtained and the professional’s assessment of risk when these differ.

Risk-Informed Social Work Practice with Survivors. Professional judgment is the key to implementation of risk-informed social work practice across settings. In other disciplines, the process of

Figure 3: Decision Tree: Intimate Partner Violence Risk Assessment Instruments Intended to Predict Rearrest and Reassault

Notes: B-SAFER = Brief Spousal Assault Form for the Evaluation of Risk, ODARA = Ontario Domestic Assault Risk Assessment, DVRAG = Domestic Violence Risk Appraisal Guide, DVSI-R = Domestic Violence Screening Instrument-Revised, SARA = Spousal Assault Risk Assessment. aIn the United States, victim interviews are needed; in Canada, all ODARA items are present in police case files.

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intervening to reduce risk (called risk management) is considered the most important aspect of IPV risk assessment (Kropp, 2008). When particular risk fac- tors are not present in an abusive intimate relation- ship, a practitioner working with a survivor of IPV can provide education about these risks, includ- ing information that particular behaviors indicate increased risk for reassault or homicide, and tell the survivor to be watchful for these factors. When risk factors are present, the social worker can provide information about the danger faced and help the client consider ways to mitigate these risks.

Consider access to firearms, which increases the odds for intimate partner homicide by over 11 times (Spencer & Stith, 2018). Firearm removal may reduce the risk of homicide. A survivor can remove a firearm or bullets if it is safe and the survivor knows how to handle the weapon. In 18 states, a survivor may request that the police confiscate a firearm (Battered Women’s Justice Project, n.d.). Federal law also prohi- bits some domestic violence offenders subject to an order of protection from possessing or purchasing fire- arms (18 U.S.C. § 922(g)(8)), though the petitioner may have to specifically ask for this provision and it is differentially enacted across states and judges (Diviney, Parekh, & Olson, 2009; Moracco, Clark, Espersen, & Bowling, 2006). Social workers can learn the spe- cifics of laws in their state to educate survivors regarding firearm removal both at the scene of police-involved IPV incidents and with regard to or- ders of protection. Some states explicitly suggest that victims in abusive relationships carry firearms to pro- tect themselves (for example, Okla. Stat. tit. 21 x 1290.12(A) (11); Ky. Rev. Stat. Ann x403.754), increasing the importance of social workers’ ability to educate survivors about the dangers of access to firearms in abusive relationships (Zeoli & Bonomi, 2015). States with more restrictive firearms laws report reductions in homicide (Vigdor & Mercy, 2006; Zeoli & Webster, 2010). As such, social workers can advocate for state and federal policies that restrict gun ownership such as those limiting access to firearms for domestic violence offenders and requiring universal background checks. Given the connection between mass shootings and domes- tic violence (Everytown for Gun Safety, n.d.), social workers may also advocate for bans on assault weap- ons and high-capacity magazines.

Social workers who practice with survivors of IPV can also use risk-informed social work intervention to

mitigate the negative effects of abuse. Nonfatal stran- gulation provides an important example of an oppor- tunity for risk mitigation as this form of violence increases risk of homicide over seven times (Glass, Laughon, et al., 2008; Spencer & Stith, 2018). If a sur- vivor reports strangulation, it is important that the social worker ask follow-up questions to determine if strangulation was recent, repetitive, or if the survivor lost consciousness (Messing, Campbell, & Snider, 2017; Messing, Patch, Wilson, Kelen, & Campbell, 2017). If the survivor responds yes to any of these questions, evaluation by a trained health care profes- sional should be advised. As of 2014, 26 states had laws making strangulation a felony (Battered Women’s Jus- tice Project, 2014). Strangulation may be difficult for police to detect, so survivors should be advised to tell police that they were strangled. Social workers should be familiar with their state laws and whether their city or county has specialized nurse examiners who can document strangulation and provide medical treat- ment. Intimate partner sexual violence is similarly dan- gerous (Bagwell-Gray, 2016; Spencer & Stith, 2018); risk mitigation strategies may include visiting a sexual health care provider, obtaining birth control that a partner does not know about (if it is safe to do so), and regular testing for sexually transmitted infections (Bagwell-Gray, 2018; Thaller & Messing, 2016).

Interventions have historically encouraged sepa- ration from an abusive partner (Goodmark, 2011), though there is an increasing recognition that sepa- ration is dangerous and that not all women choose to terminate their relationship (Davies, 2009). Taking a risk-informed approach would include knowledge of the dangers of separation and an understanding that women with partners who are controlling are particularly at risk of homicide dur- ing separation (Campbell et al., 2003). For survi- vors of IPV who choose to leave their partners, social workers can educate them about how to leave safely (that is, leave when their partner is not home, do not tell their partner that they plan to leave, pack a bag with important documents in case they have to leave quickly or in an emer- gency). Risk of future violence and homicide may affect all aspects of a survivor’s life and should be considered when addressing issues of housing, transportation, child care, employment, education, and the myriad other needs that survivors have. In some cases, the Violence Against Women Reau- thorization Act of 2013 (P.L. 113-4) provides

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protections to survivors seeking social welfare ser- vices (for example, housing, cash assistance).

Risk-Informed Social Work Practice with Men Who Use Violence. For social work practitioners in social service or criminal justice settings work- ing with men who abuse their partners, risk- informed social work practice may also prevent repeat violence and homicide. For example, unemployment is a risk factor for homicide (Campbell et al., 2003) and may point to a need for job training or education. Drug and alcohol misuse have been associated with both repeat violence and homicide, and frequent alcohol use has been associated with severe IPV (Messing, Mendoza, & Campbell, 2016; Messing & Thal- ler, 2015). While social workers are generally underprepared for managing these co-occurring issues (H. Y. Lee, Ju, & Lightfoot, 2010), this is another area where risk-informed intervention would be appropriate. Perpetrators may also be willing to surrender firearms if they are told of the risks that they pose their families due to ownership of a gun (D. Adams, 2007). Within the criminal justice system, IPV risk assessments are used to detain defendants in pretrial settings, make determinations about GPS monitoring, and determine which offenders should be the focus of domestic violence high-risk teams, among other things (Messing & Campbell, 2016). In the civil arena, judges are able to use their knowledge of risk factors when considering orders of protection (Saffren, 2016). Risk-informed social work prac- tice in these arenas may assist in shifting the empha- sis for change on to perpetrators of violence instead of placing responsibility on survivors.

Risk-Informed Referral. Achieving safety occurs in a challenging service environment. Interventions that assist those who use or survive violence to miti- gate risk, enhance coping strategies, or exit a violent relationship may not be housed in the same facility, may be difficult to access, and the professionals working in these settings may be unfamiliar with IPV. Social workers can use their organizational expertise to assist clients in navigating the various sys- tems in a risk-informed manner. This may include comprehensive case management approaches with warm hand-offs to practitioners in the criminal jus- tice system, civil courts, medical facilities, housing, or substance abuse settings. Risk-informed intervention and referral may suggest to a practitioner that some

complementary interventions are a more immediate need than others.

Client Self-Determination A social worker must take into account all of the relevant information about a client, including the client’s social, environmental, and personal circum- stances; specifics about the client problem such as the duration, severity, and other co-occurring conditions; client strengths; and culture (Proctor & Rosen, 2008). Research studies are often con- ducted with people who do not reflect the cultural diversity or range of co-occurring difficulties that are seen by practitioners working with survivors of IPV (Kirmayer, 2012). It is important, therefore, that practitioners carefully consider the client’s desired outcomes, provide suggested risk-informed interventions that are consistent with client goals, and ensure that interventions reflect client self- determination.

When considering their relationship, identifying their options, and making determinations about intervention, survivors of IPV informally assess their own risk. Some IPV risk assessment instru- ments, such as the DA, include a component of survivor prediction. IPV risk assessment instru- ments have higher predictive validity than survivor assessment of risk, and survivors are likely to underestimate their risk (Messing & Thaller, 2013). In all cases, social workers should use standardized IPV risk assessments as a mechanism to explore clients’ assessment of their own risk and to discuss the risk of future violence or homicide with their clients.

Often, survivors are considering myriad com- plexities when making decisions about how to keep themselves and their children safe. Risk- informed intervention should be approached as suggestions and explored with clients as options that may mitigate their risk. Survivors indicate that it is helpful when advocates support their empow- erment by emphasizing their right to make choices about their lives (Kulkarni, Bell, & Rhodes, 2012). Thus, social workers can educate clients about risk (for example, “having a gun in the home increases your risk for homicide”), discuss various options in a nonjudgmental manner (for example, doing nothing, removing the firearm themselves if it is safe, obtaining an order of protection), ask the sur- vivor for suggestions, and then allow the client to

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make an informed decision about what action to take given the available options.

Women from minority cultural groups are at high risk for homicide (Centers for Disease Control and Prevention [CDC], 2016; Frye, Hosein, Waltermaurer, Blaney, & Wilt, 2005) and may find formal institutions particularly unhelpful because of oppression, concerns about confidentiality, a lack of cultural appropriateness in services, and language limitations (Bent-Goodley, 2005, 2009; Flicker et al., 2011; Y.-S. Lee & Hadeed, 2009). Thus, when survivors of color seek services, it is particularly important that social workers provide culturally competent interven- tions. One way to do this is by prioritizing client self-determination as an equal aspect of risk- informed social work practice.

Evaluating Client Progress The final step in the EBP process is evaluation, which is often presented as implementation of single-case design (Orme & Combs-Orme, 2012). However, in the under-resourced environment of social services agencies, social workers may need to conduct evaluations of client progress that are more pragmatic. Success that is survivor defined and prioritizes client self-determination may not include separation from an abusive partner or free- dom from violence. Although social workers can strive for the elimination of IPV in the lives of their clients and within society as a whole, each individ- ual may not achieve practitioner-defined success. Asking a client on follow-up if the situation is bet- ter, the same, or worse than before is a practical basis for evaluation that is client centered and may begin a conversation about the implementation of additional risk-informed strategies (Davies, 2009).

Limitations of EBP Limitations of EBP include institutional barriers such as agency stagnation, the failure of coworkers or supervisors to embrace EBP, resistance to change, and a lack of resources (K. B. Adams, Matto, & Le- Croy, 2010; Franklin, 2007). Social workers may also struggle with client self-determination once they understand the risks faced (or posed) by their clients. Risk is dynamic and, as such, risk assessment must be an ongoing process to understand risk at any given time (for example, upon separation). Starting where the survivor is and focusing on engagement and relationship building may lead to

risk mitigation over time. In some practice settings, interventions are mandated and full client self- determination is not possible; in these cases, practi- tioners can consider ways to provide autonomy within the bounds of their practice. EBP can assist practitioners to effectively advocate for their clients’ rights on an individual basis, as well as collectively by advocating for change to policies, laws, and procedures.

CONCLUSION Intervention with survivors of IPV was founded on principles of feminism, justice, and equality, but often does not live up to these ideals (Thapar- Björkert & Morgan, 2010). Adoption of the EBP model may assist social workers with providing risk-informed interventions for survivors of IPV while, at the same time, adhering to these founding principles. As IPV risk assessment and risk-informed interventions become increasingly popular (Messing & Campbell, 2016), social workers will be called on to incorporate IPV risk assessment in their practice. Using an EBP framework will assist in the provision of services that are consistent with the social work priorities of social justice, self-determination, and cultural competence. IPV risk assessment instruments can complement social work practice by providing the best evidence of risk, serving as the basis for prac- titioner- and client-suggested risk-mitigation strate- gies, and encouraging clients to consider risk as they determine which interventions are appropriate. SW

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Original manuscript received April 23, 2018 Final revision received August 6, 2018 Editorial decision August 31, 2018 Accepted September 1, 2018 Advance Access Publication February 7, 2019

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Copyright © 2019 National Association of Social Workers. Copyright of Social Work is the property of National Association of Social Workers and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

  • Risk-Informed Intervention: Using Intimate Partner Violence Risk Assessment within an Evidence-Based Practice Framework
    • Evidence-Based Social Work Practice
      • IPV Risk Assessment: The Best Available Research Evidence
      • Practitioner Expertise
        • Risk Scores
        • Risk-Informed Social Work Practice with Survivors
        • Risk-Informed Social Work Practice with Men Who Use Violence
        • Risk-Informed Referral
      • Client Self-Determination
      • Evaluating Client Progress
      • Limitations of EBP
    • Conclusion
    • References

victim safety planning process.pdf

Vol.:(0123456789)1 3

Journal of Family Violence (2018) 33:197–211 https://doi.org/10.1007/s10896-018-9951-x

O R I G I N A L A R T I C L E

Looking into the Day-To-Day Process of Victim Safety Planning

TK Logan1  · Robert Walker1

Published online: 14 February 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018

Abstract Although safety planning is a widely recommended intervention for domestic violence and sexual assault victims, there has been limited research on the safety planning process, content, context or effectiveness. This study builds on prior research to increase the understanding of safety planning in every day practice through focus group discussions with domestic violence and sexual assault advocates from a variety of settings. Five focus groups with 37 participants from a variety of settings discussed typical safety planning strategies and addressing the complexity of safety in challenging situations. Six main themes emerged with regard to typical safety planning strategies. Additionally, discussions revealed there are no widely accepted protocols or evidence-based strategies regarding how to assess and handle common but risky situations. Lastly, results indicate that risks are multi-layered and impacted by resources available to victims as well as civil or criminal justice system procedures, policies and victim status. It is essential that evidence based best practices and protocols be developed for safety planning for a number of high risk situations along with ongoing training, supervision and support. Future research is needed to examine whether, and how, safety planning best practices and protocols should differ depending on agency setting or delivery mode (e.g., hotline, case management, counseling) and geographic context.

Millions of women and men experience partner abuse, stalking and sexual assault each year (Black et al. 2011). The negative short-term and long-term physical and mental health consequences of interpersonal violence experiences are well documented (Logan et al. 2006). Victims may inter- sect with a variety of services that include victim advocates. Victim advocates are professionals trained to support victims of crime and typically provide an array of services includ- ing crisis intervention, safety planning, counseling, support groups, shelter services, education, and support during court or other legal procedures (Macy et al. 2010).

One main goal of advocacy is to address victim safety concerns and needs (Cattaneo and Goodman 2015; Good- man et  al. 2015; Sullivan 2011). In general, safety plan- ning is a process that helps survivors by identifying ways to decrease their exposure to further harm and to help them with their fear and anxiety (Davies 2009; Davies et  al. 1998; Dutton 1992). Safety planning can be delivered as part of ongoing case management, counseling, through court

advocacy, through a hotline call, or any other number of ways. One hypothesis for why safety planning may be useful is that although individuals may not be able to predict when a threatening situation will occur, their uncertainty about how to respond can be diminished through safety planning, and reducing their uncertainty increases their feelings of per- sonal control which then reduces anxiety (Grupe and Nitsh- chke 2013; Lachman and Weaver 1998). In order to address both physical safety and fear, safety planning needs to be ongoing, individualized, and coordinated with other com- munity agencies and should include some specific behav- ioral strategies along with information about community resources (Allen et al. 2013; Bybee and Sullivan 2005; Mur- ray et al. 2015; Sullivan and Bybee 1999). Safety planning is thought to work best as a collaboration between the advocate and the victim, where victim needs, rather than organization priorities, are addressed, and when a wide array of needs are included as part of the plan.

Although safety planning is a widely recommended intervention for domestic violence and sexual assault vic- tims, there has been limited research on the safety planning process, content, context or effectiveness (Goodman et al. 2015; Macy et al. 2010; Murray et al. 2015; Sullivan 2011). Several studies that have examined advocate safety planning in two very different settings found that, in these specific

* TK Logan [email protected]

1 Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky, Lexington, USA

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studies, although risk assessments and referrals were done in the majority of cases, planning for safety happened less frequently even among those who had significant injuries and who wanted safety planning (Lane et al. 2004; Weisz et al. 2001, 2004). Clearly more research on victim outcomes of safety planning is needed, however it is also important to know more about how safety planning is actually delivered in a wide variety of settings. In particular, it is important to understand the day-to-day process of safety planning par- ticularly when victims face multiple risks.

Generating informational safety content in high risk situ- ations can be challenging especially if outside resources are limited or difficult to access. One critique of safety planning is that too often strategies focus narrowly on just protecting victims during a violent incident or on leaving the relation- ship rather than the larger “whole person” risks (Cattaneo and Goodman 2015; Goodkind et al. 2004; Lindhorst et al. 2005; Peled et al. 2000). There may be several reasons that strategies are limited including: (1) they are primarily gener- ated from written plans with limited and generic recommen- dations; (2) research has not been done to identify a wide variety of strategies particularly beyond leaving a partner (Hamby 2014; Hamby and Grey-Little 2007); and, (3) train- ing, supervision, and support for victim advocates may be limited in quantity or quality and have too narrow of a focus (Finn et al. 2011; Logan and Walker 2018a). It is impor- tant that standard protocols for safety planning practices be developed that can be used both within and across agen- cies and that evidence-based safety strategies be identified to address multi-layered risks (Murray et al. 2015; Logan and Walker 2018a). This study builds on prior research to increase the understanding of the every day practice of safety planning through five focus group discussions with domestic violence and sexual assault advocates from a variety of set- tings about typical safety planning strategies and addressing safety in challenging situations.

Method

Participants

The participants were 33 female and 4 male participants recruited within one state in the U.S. Almost half (48.6%) of the participants worked in a domestic violence shelter and/or rape crisis center, 32.4% worked in a program that provides case management for individuals referred from, but not a part of, the Child Protective Services agency in which safety planning has an important role, 13.5% worked in a law enforcement agency, and 5.4% worked in a prosecu- tor’s office. Experience ranged from six months to 32 years (average of 9.3 years’ experience, SD = 8.66) with one par- ticipant who did not respond to this question. Participants

were between 23 and 63 years-old, with an average age of 40 years old (SD = 11. 3). Participants were mostly white (91.9%) with 5.4% who identified as Black, and 2.7% identi- fied as Middle Eastern. Overall, 56.8% of participants had a graduate degree and 37.8% had a Bachelor’s degree.

Procedure

The five focus groups were conducted over a three-month period (March 2, 2016-June 2, 2016). Participants were recruited through a large combined shelter and rape crisis agency, a community coordinating council, and a statewide agency that does case management for individuals referred from, but not associated with, Child Protective Services. Eligibility criteria included individuals doing safety plan- ning with domestic violence only (18.8%) or sexual assault and domestic violence victims (64.9%), or were supervisors/ agency directors (16.2%) for advocates conducing safety planning. Advocates reported doing safety planning across a variety of roles including through hotlines, court advo- cacy, in the shelter, within case management, and within therapy. Supervisors did not participate in the focus groups with their direct supervisees. Participants were recruited by signing up after receiving a general informational email if they were interested. No participants were compensated for their participation.

Each focus group session lasted about 2 h and was led by a moderator who asked the questions and guided the dis- cussion and a co-moderator who took detailed notes. Upon arrival and while waiting for the session to begin, a member of the moderator team asked participants to complete an anonymous demographic information survey. The modera- tor then gave a standardized introduction to the study, which included the Institutional Review Board approved informed consent script as well as some basic ground rules for the focus groups (e.g., talking one at a time) based on Krue- ger and Casey (2000)’s suggested methodology. Each focus group was audio-recorded for transcription purposes.

Analysis1

The demographic survey data was entered and analyzed descriptively in SPSS. The process of focus group discussion analysis included several steps (Krueger 1998; Krueger and Casey 2000). First, the audio recordings of the focus groups were transcribed with on identifying information and entered into NVivo. The moderator and transcriber reviewed the focus group notes for accuracy. Second, all of the transcripts were analyzed by a research assistant and the first author

1 The quotes have been slightly modified to reduce repetition, clarify the statement, and for ease of reading.

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to identify main themes and subthemes using an emergent coding strategy within the protocol questions. Third, all of the transcripts were analyzed and separately by the research assistant and first author and coded if they possessed the identified theme and subtheme (Hsieh and Shannon 2005; Kondracki et al. 2002). Any discrepancies were discussed for 100% agreement. For this paper, themes and subthemes were organized under two main categories: (1) the safety planning process; and, (2) addressing safety planning in challenging situations. Other questions from the focus groups that related to training, feedback, and personal challenges are reported elsewhere (Logan and Walker 2018a).

Results

The Process of Safety Planning

Themes for the process of safety planning were developed from three main protocol questions: (1) What does a typical safety planning session involve (probes: walk me through a typical safety planning session, what are some of the basic or most common safety suggestions you give)? (2) What should advocates avoid when doing safety planning? And, (3) What do victims expect or want when they seek safety planning? No other probes were asked.

What a Typical Safety Planning Session Involves

Themes that emerged from discussions of typical safety planning can be grouped into five main strategies including: (a) starting where the victim is; (b) creating a safe space for victims; (c) focusing on strengths; (d) assessing resources and referrals; and, (e) planning for emotional safety.

(a) Starting Where the Victim is: When planning for safety, advocates in 4 of the 5 focus groups talked about the impor- tance of meeting victims “where they are.”

“I always start with “what are you already doing to keep yourself safe?” That’s how I think a lot of us probably start our safety planning. And if people are like, “I don’t know!” sometimes I’ll say, “Well, what has worked in the past? What have you done that’s worked?” And kind of break it down and go into the actual incidents that have occurred if we need to.”

Some advocates talked about after assessing what kinds of things the victim has done before and whether and how that worked, the next step is assessing what they feel com- fortable doing in the future.

“What do you feel comfortable doing? That’s a biggie. [Helping them with] what you feel capable [of doing], because so many of our victims don’t feel in control or capable because they’ve been convinced they can’t.”

Other advocates focus on where the victim is with regard to the relationship and their available resources.

“I think a typical session varies a lot based on where they are in the relationship, and if they are willing to leave. We would talk about those things about how we can get out safely, what are the resources, where can you go, how much time is that gonna take, what are you gonna need to do to get there….But if it’s a person that’s not really considering those things, talking about more of like, what are the safest places in the home, how do you try to keep things from becoming—not that it’s your fault, but how do you try and keep things from escalating when they do? And I talk to my clients about we’re thinking about a lot of what-if’s, and [how it] is scary to think about the worst-case scenario, or it’s scary to think about the what-if’s. But I’ve also used the metaphor of a fire drill, we’re just trying to prepare for if this does happen, it doesn’t mean that it’s going to.”

Another strategy for assessing current victim status was to ask about what concerns them the most with regard to their safety.

“I’ll usually ask, “What concerns you most for your safety?” as a way to think about the big “What if?” Or what are you worried about the most in terms of your safety. And then, saying “Well let’s go ahead and think through that.” If it’s something regarding their chil- dren, let’s think about that now and plan for it, hope- fully it doesn’t happen. Or if it’s they have a weapon. If they bring that up, then we’ll talk about, okay here’s the danger that can be present with this and think about it beforehand. But not listing a bunch of things that could potentially happen, but just asking them what seems most concerning in their situation.”

And some of the advocates started with an even bigger picture to better assess where the victim is and where to think about starting the planning. This strategy was men- tioned more in the rural areas where advocates felt they were seeing a lot of intergenerational partner abuse dynamics.

“I think a big thing is just finding out what they want. What they want from their relationship or what do they want for their children. What do they want for their life in general? See what their expectations are or goals are. I see a lot of, I don’t know if this is everywhere but, a lot [of] generational, they kind of grew up in this lifestyle and so they may not see it so much as an

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issue because their parents were abusive to each other. They grew up in that lifestyle and so that’s kind of the struggles that I think we go through a lot of the times is getting them to understand really, you don’t deserve to be treated that way or talk to that way.”

(b) Creating a Safe Space for Victims Advocates in 4 out of the 5 focus groups talked about creating a safe space so vic- tims can be more open with advocates.

“I think we focus a lot at our place on creating safe spaces for people to disclose information. When I first started, there was always a presumption that victims who were coming to shelter were leaving their perpe- trator….Then three weeks later we would be shocked to find that they were having lunch with perpetrator or engaging with perpetrators somehow and it’s like, well how can you safety plan if you don’t have full information? We could safety plan on how you do that exchange with kids, or that date they went out on, or [that] she didn’t have a way to get to work and she needed him to take her to work cause she had no other [way]. So we couldn’t even safety plan well because we didn’t have all the information, but we’d set a stage for her to not really be able to be honest, because we just presumed. And so, really I think a lot of our training with staff is—cause a lot of folks will go “oh, I’m not judgmental, you can tell me anything”—but how you truly convey to the woman sitting across from you, or the man sitting across from you, that honestly anything they can say is fair game, and we have to know what’s really going on just to be able to brainstorm [options] with you.”

Part of creating a safe space for victims includes listen- ing to them.

“I think we spend a lot of time talking to our victims instead of listening to the victims, and that is our own barrier. Because we’re not listening, we’re not active listening, we’re just – we have all these things we want to tell this victim to do, or they should be doing, instead of actually listening to what they need.”

And another part of creating a safe space is provid- ing non-judgmental support even when advocates might not agree with the decisions victims were thinking about making.

“I think just being open with the clients, [letting them know] that this is not a judgment call on my part. I had to meet with a client that needed to process about going back with perp. And we sat for about an hour, hour and a half, talking about her substance abuse issue, his substance abuse issue, about going back with perp, and just talking very open about numerous

subjects. And she ended up deciding not to go back with perp, relocating, and getting off the drugs. And it wasn’t me saying anything, it was just being there to let her process it. And opening it up, is there drugs in your past? In your present? You know, are you using this to cope? Do you feel that it’s an issue with your safety? Do you not feel that it’s an issue with your safety? Why not? And we talked about coping strategies.” All this—if you open up the door, I think you can get—not everybody is at that point to where they’ll do that, but this particular person was.”

(c) Focusing on Strengths In four out of the five focus groups the importance of validating victim strengths was mentioned as part of the safety planning process.

“I think that’s looking at what a client already has with them, what’s kept them safe so far, because they’ve always done something to remain safe, and exploring that with them. I also always recall the smart things that other clients have shared in other conversations, and then trying to build on that client’s protective fac- tors and examine what kinds of things reduce their risks and encouraging them to continue to do what’s been working, and… broaden that.”

Another advocate talked about the importance of recog- nizing strengths.

“Oftentimes, at least in my experience, clients don’t realize their own strength or may not see how much strength they had to go through something—they don’t feel strong, it’s not something that’s internalized and so I think part of helping a client feel empowered is to help them realize those strengths that they have and to be able to endure whatever the situation is that they’re going through or have gone through. I think it’s important to lift that up, for someone else to maybe see that in them when they’re not able to see within themselves.”

(d) Assessing Resources and Referrals Another important component of safety planning process mentioned in all five of the focus groups was assessment of victim resources.

“I try to look and see what resources she has avail- able to her. A safety plan might look different with someone who has their own vehicle versus someone who uses public transportation. Or, someone who has family support and someone who doesn’t. So I think identifying their support system, what resources they have, or they’re already using, or they’re willing to access – that goes a long way, I think.”

While others focused on assessing what referrals the vic- tim might need.

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“And on the crisis line we—we offer the choices, there’s group sessions that are available to them and we also let them know about the legal advocacy that’s available to them…We also offer them, if [it is] appropriate, we can also offer to relocate them at other organizations... Or if they have a relative that’s out of state we may research while they’re on the phone, research other states and see what’s available to them in that area and try and get them into that agency. We also offer, for the residents that are actually in the [shelter] facility, [there are classes that offer] domes- tic violence or sexual assault information…So we try and help them wherever they’re at and provide them with the most resources that we can possibly find for them with each call.”

(e) Planning for Emotional Safety The importance of emo- tional safety planning was discussed in 4 out of the 5 focus groups. Emotional safety planning is described below:

“Oftentimes I’ll say we can have two conversations here. One I think is about your material day-to-day safety, how you can stay safe if something really awful happens. And the other conversation is how to feel safe throughout your day-to-day, so you don’t feel like you have to look outside of the window every two seconds, or if you are feeling panicked, how to calm yourself down. I’ll have those conversations coincid- ing, because the higher your fear states are throughout your experience, the more traumatized you are—[you are] going to experience everything that’s happened to you. So if we can work on grounding techniques while also talking really materially about, like, “Do you not have a car?” or “Has he slashed your tires?”

And another participant described emotional safety plan- ning with:

“If somebody got their protection order issued, safety planning’s really based around how to use that to keep yourself safe. If not, you’re dealing with somebody who’s in a whole form of crisis because that safety they thought they had [with the protective order] is gone. So, I feel like it’s important to start with emo- tional safety a lot of the times because it’s gonna be near impossible to safety plan with someone in crisis mode who cannot look past this present incident. So, starting with emotional safety, talking about grounding techniques, do you have someone supportive to talk to other than me maybe, or do you know about the services available like the crisis line, someone to call for that support when you need it, talking about things like self-care, making sure that when you leave court you’re gonna do something nice for yourself or you’re gonna take care of yourself today. And then once you

get some what a little calm, maybe doing some breath- ing, you can move into physical safety, you can move into safety planning with children and then I try to go more in-depth with emotional safety and self-care.”

In particular, participants in three of the focus groups talked about emotional safety planning being very important when working with sexual assault victims.

“For me, in general, sexual assault is more focusing on the emotional safety planning. Cause probably about 75% of the time those clients may have been assaulted by somebody they don’t live with, that doesn’t know where they live, or—they feel confident that they won’t come back or they can lock their doors, things like that.

Or helping sexual assault victims prepare emotionally for traumatic flashbacks.

“I tell clients “we are going to work on not using the word “but” ‘cause usually there’s an excuse coming next.” So how do we look at “this was not your fault, but” and you know, go with them from that perspective of “we’ve still got to learn how to protect ourselves.” And I think that is the safety planning with a sexual assault victim and especially the whole understanding that you’re going to have flashbacks, “what are you going to do when you have those? What is your safety spot? What is your safety person?”

Safety Planning Pitfalls

Two main subthemes emerged when advocates were asked what to avoid in safety planning including: (a) being judg- mental toward the victim’s decisions; and, (b) dictating a plan versus collaborating.

(a) Being Judgmental Toward the Victim’s Decisions This concept was mentioned in all five of the focus groups. And being careful to avoid being judgmental about the decisions victims make.

“Not [being] judgmental. Judging them for continu- ing to go back to the situation or putting their children back in there. ‘Cause a lot of the time they don’t have that support or someone to lean on because they’re isolated from all their family and friends. Just a client saying, “well I’m up in the head of a holler [a very rural area in the mountains],” that’s what you hear a lot. And they have nobody around them so just know- ing that you are there to support them and guide them and to lean on.”

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Or to avoid being judgmental when victim’s don’t comply with what was discussed.

“And I think that’s the one thing that we need to change about it, is us realizing that we [do not have] all the answers and just because we safety plan doesn’t mean they are going to do it. And we can’t get frustrated at them if they don’t. So I think that’s huge in safety plan- ning is if they come back next week and they haven’t done one thing on that safety plan, okay. So what are we going to do this week?”

(b) Dictating a Plan versus Collaborating Four of the five focus groups talked about how the lack of collaboration with victims reduces their likelihood of following through with the plan.

“I think what goes a long way also is having them cre- ate the plan with you, instead of you saying, “this is what you’re going to do,” they buy into why they need A, B, or C. It would help them actually follow through on the safety plan.”

Part of this theme was about making assumptions rather than asking and listening to the victim.

“I think bad safety planning would be when you’re kind of dictating to the client what they should and shouldn’t do, when you’re not allowing them to be the experts in their life, and then you become the expert, so there’s this power differentiation.”

Or making suggestions for safety but not assessing whether the victim can follow through or how she might feel about the suggested strategy.

“One of the things [not to do] is creating a safety plan that she’s not able to follow, protective orders are an easy example. That is kind of thrown out lots, “you should get a protective order”—but if they’re not com- fortable calling the police, they’re not comfortable fil- ing the violation, then it almost does more harm. So they’re gonna do an EPO, are they really able? You know, to kind of follow through with it, what does that look like, or how are they gonna be able to proceed with it? I think lots of times I’ll see safety plans, and it’s like, there’s no way this person’s gonna be able to do that. So it needs to be realistic, I guess, in whatever head space they’re in, or whatever financial situation they’re in.”

What Victims Expect or Want from Safety Planning

There were three main subthemes that emerged from the focus group discussions including: (a) they don’t know

what to expect; (b) they want the answer; and (c) they want resources.

(a) They Don’t Know What to Expect This subtheme emerged in three of the focus group discussions.

“I think first of all they don’t know what they expect. And, so that’s why you’ve got to set the expectations right out of the gate. You have to establish what the goal of the safety plan is, and it’s a shared communi- cation between yourself and the survivor, as well as what other parties [that] may be involved, whether it’s a workplace or whatever.”

Several participants suggested that because victims don’t know what to expect from safety planning, they describe it as being like a fire drill.

“Sometimes I’ll use a metaphor of a fire drill [and tell them] that we practice fire drills for a reason, so that we don’t have to think about what to do when there is a fire, we know what to do. Sometimes I’ll use that [analogy] with people I’m working with to explain what it is that I’m about to try to do with them, and I’ve had success with people understanding that. Because “safety plan,” I think, is kind of an abstract word that people don’t really know a lot.”

On the other hand, some participants believed that vic- tims might be expecting the advocate to judge them, particu- larly if they are not ready to leave the relationship.

“I think their expectation is that you’re going to be judgmental and that you’re not going to understand. And so I think sometimes we surprise them when we listen and we don’t make faces and start pointing fin- gers and telling them “well what are you still doing there?””

(b) They Want the Answer This theme came up in four of the five focus group discussions.

“I think that clients expect that we’re gonna hand them a booklet of “this is how you keep yourself safe,” like we’re gonna give them the answers. Which is totally not the case, and so I think…that’s probably their preconceived idea about it. And then I think that sometimes clients can be a little bummed out when they realize that I’m not doing all the work, a lot of it involves their input, and kind of thinking through their own scenarios.”

And another participant said:

“Yeah, and I mean, I have gotten the attitude from cli- ents, of “If you don’t have anything new to offer me,

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why are we having this conversation?” So I think I, too, have felt that assumption, or wishful thinking that we can really bring something to the table that’s gonna keep them safe. When we typically can’t.”

(c) They Want Resources Participants in three of the focus group discussed how victims want resources when they con- tact advocates.

“I’ve got a client that I just saw yesterday and she’s at the domestic violence shelter. And she wants sup- port, she wants guidance, she wants to be empowered. She wants to be in control again because she’s never had that. I mean, she couldn’t work, she couldn’t do anything. So she wants to be empowered again. She wants to go to work. And she’s left three times and she doesn’t plan on going back this time. She needs support, resources.”

Addressing Safety Planning in Challenging Situations

There were seven main subthemes that were explored across the various focus groups regarding specific chal- lenges including: (a) substance use and abuse; (b) guns threats; (c) when victims want to get a gun for safety; (d) stalking; (e) threats to friends and family; (f) lack of victim resources; and, (g) working within the justice system. Two of the themes (lack of resources and when victims get a gun) emerged from the discussions while the other themes were asked if they were not mentioned.

(a) Substance Use and Abuse The issue of substance use was probed in all of the focus groups. One of the things that emerged was that some of the advocates ask about the victim substance use, while others say they do not routinely ask about substance use.

“Well, first, I don’t ask about that unless they reveal it to me. Two, because I’m in that crisis response side, don’t wanna seem blaming at all, [so] I never ask about that in my role. But in safety planning, if someone would bring that up, I know myself and other hospital advocates have planned with somebody around, like, “Okay, you’re going to use. What does that look like, to be safe about it?” And that creates a really cool space, too, because they feel like they can talk about it, cause usually people would say, just don’t do it, why are you using it, you need help.”

Some advocates felt that directly asking about substance use was inappropriate.

“In the spirit of meeting people where they are, if someone’s not ready to disclose that there’s substance

abuse taking place on their part, then I don’t feel like it’s my place to push or prod to find out that informa- tion.”

However, the majority of advocates talked about the dif- ficulty of safety planning when victims are actively using substances.

“I recently worked with a client who had a lifelong addiction to drugs, whose perp also had a lifelong addiction to drugs. And I feel like any addiction adds a whole new barrier to safety planning. Because, it’s really difficult to safety plan with someone when their focus is safety in that moment, in that sober moment, but also then later, their risk goes through the roof when they’re using, and that dependency is there, and I am not a therapist, I can’t give the help that they need, but they’re not always willing to seek help further than me.”

And some noted how substance use may make leaving an abuser even harder because the abuser may be supplying the drugs.

“Then they’re not going to leave because he’s their supplier. Or even if they’re not the provider they’re at least providing them the money to go get their sub- stances. Or the insurance to be able to get their pills. So I think that is becoming a double standard with a safety plan of you got to do—“how are we going to get you off your substances and get you out of this relationship at the same time.””

Others noted how her use can jeopardize her safety even further.

“I think it is because a lot of times the perpetrator is the provider so to tell them that they need to do every- thing they can to safety plan to get out of a domestic violence situation they’re also losing their drug dealer. So you’ve got to help them look at that safety piece of you can’t just quit using heroin it can kill you and if you try to leave him you’re going to maybe die too. So you’ve got two barriers there.”

Others commented that there are can be limited options for victims who are using. Some of the shelters in the state do not accept victims who are using substances and then there are limited substance abuse residential treatment beds in the state. And there are few agencies that address both substance use and domestic violence together.

(b) Gun Threats All five focus groups were asked about how they plan for safety when there are gun threats. Most of the participants indicated that when the abuser threatens the vic- tims with a gun it is a very challenging situation.

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“It’s incredibly difficult, I’ll be honest. What do you say? I am working with a lady right now who, the last EPO violation, he came to the door waving a gun at her and all their children, and she ran to the bathroom and locked the door with her and the chil- dren, and what more could I tell her then to do? I mean, of course—yes, you did the right thing, good, you found a safe room, so – what more could I tell her, then, next time that happens? Have a safe room already planned out you’re gonna go to? I mean, with a weapon, it’s like, immediate, right there. To be honest what more is there [to say]?”

On the other hand, advocates talked about how in their area, guns are a normal part of everyday life which means that victims may minimize their danger.

“They minimize it a lot. Which is then hard for me, cause then I wanna be like, “Don’t minimize this, this is a serious issue,” but I also wanna acknowledge that they’re the experts in their situation. So kind of addressing that delicately and in a trauma-informed way sometimes can be difficult. Cause they do shoot down pretty quickly that they’re at a high lethality. “Oh, no, he would never use the gun, they would never use the gun against me.””

And some noted that guns maybe keeping some victims from pursuing a protective order.

“I work in a rural county that has a reputation for sort of being the “Wild West” out there. I have had numerous interactions with people at the courthouse who, when they found out that getting the DVO would mean that he would have to surrender his guns, chose not to get the DVO because they don’t want him to have to turn in his guns. It’s just such a part of the culture. Well then he wouldn’t be able to hunt, he wouldn’t be able to spend time with his fam- ily the way that he wants to spend time with his fam- ily, or they’re family heirlooms, you know, they’ve been passed down, so they don’t trust the sheriff’s department to keep them for three years or whatever. Or he’s in the military [or] he’s in the reserves and that’ll interfere with his job.”

Several advocates suggested that more attention to guns is needed.

“So that would be one of our flaws then that we should pick up on doing better is asking more about guns.”

And another advocate said.

“Yeah, that’s one thing I need to check—I probably should assess more for is if she says that there’s a gun used on her is it still in the home? If she’s in the

home. Or if she’s out does he still have the gun? I never really thought about that.”

(c) When Victims Want to Get a Gun for Safety Participants in four of the focus groups mentioned safety planning is challenging when victims talk about getting a gun for safety. A few of the advocates strongly suggests the victim get training.

“I tell them first and foremost to take a class to get comfortable with the gun before they ever put it in their house, because it is so quickly used against them that they will not even think to grab it.”

Other advocates explore some potential negative conse- quences of using a gun.

“What happens next? You may get arrested, and this may not be self-defense, there’s a lot of laws that play into that, and things that we think are easily black-and-white are not always black-and-white. So, it may feel like self-defense, but legally it wasn’t, so I’m spending time in prison, for doing this thing that I thought I was keeping myself safe, and now I’m even more unsafe in a place I’m not even comfort- able with…”

Or some try to have the victim assess what having a gun might mean.

“With guns I [might ask]…“Well, if you had a gun that night that this happened, would you have been able to use it? Do you think [that] would that have worked for you?”…Or sometimes I’ll be like, “He has a lot of practice at doing this to you, do you think you could really shoot him?” I mean, because sometimes people will be like, “I don’t think I could actually kill him because I love him,” and to have that conversation and to say, well, it might be a little different than if it was a stranger breaking into your house. And to kind of put them in a moment, but I think the most success I’ve had has been, applying it to whatever past situation of DV has occurred.”

And others struggled with how best to do safety planning when victims talk about obtaining or using a gun for safety.

“When talking about safety plans with clients some- times their response is, “Well, I’ve got a gun.” And— cause obviously [that’s] not the best route to take, although it is an option, but, talking about that is something that I struggle with, how do we talk about gun safety, in your own home. If the perp does come by what do you do and how do you make sure that that gun doesn’t get taken from you?”

And how to use the gun safely.

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“I have a client who right now owns a gun, and she bought that gun to keep herself safe, and we have an agreement that she won’t get it out until she gets the proper training and I’m hoping she keeps that agree- ment. I don’t know if she will or not, but it was my responsibility to tell her—it’s kind of a false sense of safety for her cause she doesn’t know how to use it.”

(c) Stalking The general theme of stalking was asked about in all five focus groups. Three main issues emerged from the discussions of safety planning with stalking victims. First is that advocates have difficulty safety planning for stalking particularly when abusers have friends and family members threatening and harassing victims on his behalf. Even if there is a protective order in place it does not cover proxy stalking situations as violations.

“I don’t know how to safety plan for—like, I’ve had a few people say that…[the] perp’s gonna send some- one for them, that they don’t think perp’s gonna vio- late the order, but someone’s gonna come for them. And I don’t know how to safety plan for that at all. I think that I don’t know how to safety plan well for stalking. I [suggest they use a] log for stalking, so maybe have a case that you can prosecute, but I don’t know how to actually [help someone] stay safe in that situation. And we know that stalking is one of the major signs that someone’s going to violate a protective order. And so I don’t, stalking is some- thing I think we need some more boosts on in terms of safety planning.”

There was some discrepancy among advocates about whether they thought safety planning for stalking victims was difficult. Some felt it was pretty much the same as it would be for any victim although most indicated they thought it was a very difficult situation.

“When you’re stalked nothing feels safe. I mean, you just want to crawl in a cave somewhere and just com- pletely isolate [yourself]. You feel like you’re watched 24 hours a day. And that is tough. And then there’s also a certain element of it that’s embarrassing and you don’t tell people. So, you might say “I got to go to the store, will you go to the store with me?”...There is no safe time I’m telling you—and I mean you don’t feel like there’s a safe time…And in your own home you feel like they’re in a cabinet watching you. You feel naked. When you’re being stalked you feel like you’re walking around with no clothes on constantly. I’m not sure about safety planning with stalking.”

The second issue with regard to stalking is keeping up with and talking to victims about the technology vulner- abilities and changes that they may need to make.

“So, they talk about some of these ghost apps that are in phones and how their perpetrator has either put on there or didn’t even know what’s on there, so it’s changing how we talk about safety, having to include technology and social media and apps and things like that.”

The third issue has to do with the courts and police not understanding what stalking is – thus making it difficult to plan for safety.

“It’s so hard in the court setting. It’s really hard to prove, stalkers are really smart and really creative, I often just encourage clients to keep a paper trail of anything that they can, whether it’s “this unknown number called me 350 times yesterday, and I have screenshots of that,” or, “I’m getting pictures taken of me in the grocery store sent to me from a private number,” holding onto those and printing those off.”

Or individuals in the justice system putting up barriers to addressing stalking.

“Over the years but that’s where we ran into the bar- riers was the lack of knowledge in our legal system in our small community of them [police, courts] not really knowing how to handle a stalking case and… sort of making excuses as to why that…couldn’t be perceived as stalking.”

(e) Presence of Threats to other People All five focus groups were asked about how they handle safety planning when an abuser threatens people close to the victim (e.g., parents, grandparents, friends). Advocates mentioned they talk to victims about how to tell others.

“I think a lot of people don’t want to [tell others], they feel guilty, they feel like it’s their fault that their family’s in that position, and so they don’t neces- sarily want to share with their family what’s going on, cause they don’t wanna burden anybody. And they take it as a real personal, like, “I’m personally burdening my—my grandmother by putting her in a safety risk.” And so, it’s really, that safety planning has to be a lot around the emotional…, “This is not your fault that this is happening.” And definitely, I think in those situations, when there’s threats to fam- ily and things like that, you have to think about how to erase some of the things that perp might have said that made them feel like they could never tell any- body anything...But certainly, explaining how impor- tant it is that they’ve got eyes on you [others looking out for you], that that’s a good thing that [other] peo- ple know. And, how can we have that conversation with your grandma or with your dad? How can we do

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that in a way that’s, let’s—should we role play a little bit, if you’ve got the time to do that, great.”

And maybe having victims talk to others who the abuser is threatening regarding safety strategies they should consider.

“I personally tell them that they need to tell the grandparents that those threats are happening. So that’s part of that safety plan of “you need to inform them that he’s making these threats to them.” And help them figure out what they can do as far as you need to talk to them about calling the police or if they need to look at trying to file an EPO.”

A few participants mentioned that victims will sometimes even consider reconciliation to keep their loved ones safe.

“So if you’re thinking of reconciling to try stop this behavior, you’re setting yourself up for failure cause you can’t manage crazy. So, at some point, we’re just gonna have to take the leap [and tell other’s what’s going on]….And do you need to talk to your par- ents, or your kids, or…? But I can’t say we’ve really extended the safety plan to help outside folks.”

(d) Lack of Victim Resources All five focus groups mentioned the difficulty in safety planning with a victim who is iso- lated, has no transportation, and no money of her own.

“One of the most challenging clients that I’ve had, as far as safety planning, is, her boyfriend had severely sexually assaulted her, and I’m thinking about when a client’s perpetrator is their only support system. You know, and whatever happened—they don’t have family support, friends, and the perpetrator is that. And so, this client—something traumatic happened to her, but, it was kind of minimal to her, she justi- fied or minimized it in some ways, because to let go of this perpetrator, to send him to jail would mean she would have no one. So, it’s really hard to safety plan with someone when the perpetrator is—who they may feel is all they have, or sometimes really is all—who they have.”

This difficulty is particularly compounded when the resources in the community are also limited.

“…Sometimes with some of the folks that I’ve had in shelter—I think some of the reason why some of them left to go back because they aren’t getting any help in the shelter. The advocates really aren’t helpful to help them get out or to get housing or to do the other things and I find myself doing some of that but we hit so many road blocks, “that’s a dead end, that a dead end, that’s a dead end.” And it’s like, “we’re going to keep looking!” There’s only so many times you can say

“we’re going to keep looking!” But sometimes they’re like “you know what? Forget this, it’s easier at home.””

(g) Working within the Justice System All five focus groups were asked to talk about the challenges associated with vic- tims involved in the justice system. In particular, some advo- cates talked about the importance of addressing the negative experiences with the justice system.

“…The last thing you wanna do is have a victim that just says “because of this, I’m never calling police again” so you…have to work with them to right-size those expectations so that they don’t put up a barrier to their own protection by saying that “because of this I’m never.” And so you’re working around it and certainly I’ve run into times where you just wish that whoever first responded had done this or this differ- ently, but I will say that sometimes it’s just the mis- understanding of the entirety of the system that’s a different explanation to the victim and then they’re past that.”

While other advocates talked about safety planning with women regarding their participation in the justice system.

“Defense attorneys are gonna be real victim-blaming. A part of my job is, before we go forward with a pro- tection order hearing, to prepare them to hear some stuff about themselves that is not true, and to not be able to say anything about it. How are you gonna emo- tionally get through your perpetrator sitting ten feet away from you and his attorney saying really awful things about you. Or him saying that you’ve done X, Y, and Z, that you’ve cheated, that you are a past drug addict, that you have bipolar disorder.”

Or preparing victims to face the abuser in court and their reaction to that as well as the whole process.

“I just spend a lot of time preparing before a hearing, [while] I save a lot of safety planning for after the hearing took place, cause it’s hard to safety [plan] if you don’t know the outcome…Before the hearing I try to take time to explain, “Okay, you’re gonna sit on this side of the room, and perp is gonna sit on this side of the room, and this is how things are gonna go.” Making sure that somebody feels prepared—are you gonna be able to hit all of your bullet points, or do you typically stress out and your mind goes blank, should we write some stuff down together? Would you feel more confident talking through what you’d like to say to the judge to me? So we can kinda rehearse it beforehand. I’m meeting these people for the first time so understanding what’s gonna help them in that situation by asking those questions and preparing them for the reality that they’re prob-

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ably gonna hear some things about themselves that really suck, and are probably not true, or are prob- ably totally doctored up or blown out of proportion, and how are you gonna address that? You know, it’s really not gonna look good if you have an outburst in court, so let’s talk about how to keep that from hap- pening, what works for you, what keeps you calm? Does breathing help, or no? Does that not help at all? If I physically touch you, are you gonna be freaked out, or if I put my hand on your shoulder is that gonna help re-ground you to this moment?”

Or helping victims and being frustrated along side them.

“…dealing with another client she had got an EPO and then went back to court and it changed to a DVO and her perpetrator was continuing to contact her, emails, third party, you know, all kinds of differ- ent things and so I encouraged her to seek further help and she contacted the county judge executive and had it back in court [for the violation] and…it was a long process and I actually helped her print all that stuff off and so she had probably a couple hundred pages of stuff that he was doing and saying and relaying messages through the children and put- ting stuff in their backpacks for her and all kinds of things. And so it was really disturbing to me and so I was like pushing and pushing and pushing for her to get something done. So it would hopefully stop him and he would get a consequence of going to jail and realizing that she really meant business. That didn’t really happen, so long story short she ended up going to court like six times for that and she was like, you know, she had changed her life a lot and she had obtain employment and was doing really good and had a good support system. And she was like “I can’t keep doing this, I can’t keep doing this” and so she quit going to court. But they just kept laying it over because he didn’t show up or he hadn’t been served or he had car trouble. And it was just excuse upon excuse with this guy, nothing ever happened. So, it’s kind of sad. “

Or advocates have to help the system understand how to help victims.

“I also find a road block with, in my county right now that the legal aid attorney is convincing my cli- ent to not do the EPO and just convert it to a civil order. And they don’t understand that with an EPO if there’s breaking and violating that EPO then they can call the police and say “I have an EPO” and they’ll come out. If you convert it to a civil order you have to take them back to court.”

Discussion

Safety planning may be one of the most widely recom- mended interventions for victims of partner abuse and sexual assault, yet there have been limited studies, to date, that have described the process of safety planning in day- to-day practice by advocates. Advocates from different agencies, and even within agencies, vary in how safety planning is done, in part because there is no consensus about what represents best practices in conducting safety planning (Colvin et al. 2016; Macy et al. 2009; Murray et al. 2015). Given this gap in the literature, the current study identified common themes from advocates across a variety of agencies and roles to provide a ‘street-side’ view of their safety planning process.

It has been suggested that a simple assessment and offering referrals may be all that is needed for abused women’s safety (McFarlane et  al. 2006, 2000), while others argue that safety planning must go beyond sim- ple and generic strategies and referrals (Dutton 1992; Davies et al. 1998; Hamby 2014). Themes that emerged from discussions by the advocates in this study seem to agree with this latter perspective. Advocates in this study identified six main strategies they use in a typical safety planning session including: (a) starting where the victim is; (b) creating a safe space for victims; (c) focusing on strengths; (d) assessing resources and referrals; (e) plan- ning for emotional safety; and (f) collaborating with the victim on a plan. Additionally, the importance of being non-judgmental and managing victim expectations were also discussed. Many of these components have been dis- cussed as important strategies within the context of safety planning (Dutton 1992; Davies et al. 1998; Hamby 2014; Murray et al. 2015).

The strategies identified in this study as part of typi- cal safety planning are consistent with the core of what is called “client-centered” and studies suggest that vic- tims view these strategies as vital to helping them survive (Allen et al. 2013; Davies et al. 1998; Dutton 1992; Hamby 2014; Zweig and Burt 2007). Implementing these strate- gies every day within various agency, time, and personal constraints, particularly when victims made decisions that they may not agree with or when victims did not comply with suggestions, can be challenging. One barrier to safety planning that was discussed in the focus groups was cop- ing with victim expectations about what safety planning or advocates could, or could not do, for them. When a person has high or inaccurate expectations for how something should work or that advocates have all the answers, and it turns out that it doesn’t work that way the individual can be dissatisfied or feel blamed or even more isolated (Starzynski et al. 2017). Further complicating this picture

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is that agencies sometimes have contingencies that impact who they can serve, case load limits, and time restric- tions. How these contingencies are communicated to vic- tims may make a huge difference in how victims perceive the interaction or feelings of re-victimization when they do reach out for help (Kulkarni et al. 2012, 2013). The mismatch between expectations and service delivery has been identified as an important component to address for therapy outcomes but has not been examined in-depth with safety planning (Constantino et al. 2011; Patterson et al. 2014).

When people think about safety planning, the physical safety component is probably what most readily comes to mind. One advocate described the physical safety planning process with the analogy of taking people through a fire drill. This analogy incorporates the idea that not only are concrete physical safety strategies needed, but they need to be reviewed and practiced. Consistent with this notion, Hart (2013) suggested safety plans should be rehearsed to identify the need for contingencies in the plan, to increase confidence, and to make self-protective actions easier to employ when needed. Other research suggests that having a plan and rehearsing a plan increases feelings of control, self- determination, and confidence (Deci and Ryan 1985). How- ever, advocates in this study also mentioned emotional safety planning as a key component of the safety planning process. Recent research on fear and anxiety management suggests that having specific strategies to manage fear and anxiety can reduce post-traumatic stress, increase psychological well-being, and can increase perception of control in life which reduces anxiety and fear (Lachman and Weaver 1998; Logan and Walker 2018b). Some of the advocates talked about emotional safety planning being particularly impor- tant, maybe more so that physical safety planning, for sexual assault victims. However, there has been limited discussion of strategies for emotional regulation within the context of safety planning with domestic violence and sexual assault victims (Murray et al. 2015). This point is particularly sali- ent given many of the strategies mentioned by advocates in this study were focused termed “grounding” techniques. Grounding may also be related to centering techniques or present moment awareness in mindfulness practice but are typically one piece of a larger strategy to manage emotions ( Stoddard and Afari 2014).

Another point to consider is that often victims reach out when they are most afraid and coping with multiple risk factors which may raise the stakes even higher for service provider reactions and the impact on victims (Ahrens 2006; Logan et al. 2006; Ullman 2010). The discussion of chal- lenging situations for safety planning in the current study revealed three common themes. First, advocates disagreed about whether or not victims should be routinely asked about certain risk factors such as substance use and gun

threats. If specific risks are not systematically assessed it can impact advocate perceptions of prevalence. For exam- ple, some advocates said they heard about gun threats fre- quently while others said they rarely hear about gun threats. Between one-third and two-thirds of partner abuse victims report they have been threatened with a gun (Logan and Lynch 2018, Dangerous liaisons: Examining the connection of stalking and gun threats among partner abuse victims, unpublished; Sorenson and Weibe 2004) and an abuser’s access to a firearm is significantly associated with intimate partner homicide as well as with increased fear (Campbell et al. 2007; Lynch and Logan 2018; Petroski et al. 2017). It may be essential to assess for certain risk factors in safety planning like gun threats. More research is needed to iden- tify the risks that should be part of a standard assessment.

The second theme that emerged is that even if certain risks are identified, there are very few evidence-based strat- egies and a lack of widely accepted protocols available to address these risks. For example, when discussing the issue of substance use, advocates noted a number of significant safety issues such as withdrawal, victims leaving an abuser who is also her drug supplier, and victim safety when the abuser is using. Substance use by victims and perpetrators has significant implications for safety and for re-victimiza- tion for domestic violence and sexual assault victims (Logan et al. 2006; Weaver et al. 2015). At the same time, advocates indicated there were limited community resources to address substance misuse. Other advocates talked about incorporat- ing substance use into the safety plan while others did not mention this in the discussions. Stalking was another chal- lenge discussed in the focus groups, particularly when stalk- ers use technology and other people to harass the victim. Similarly, advocates struggled with the best way to address safety when friends and family of the victim were being threatened and harassed by the abuser. Threats and harass- ment of others is commonly a very powerful way to create victim fear and control (Logan and Walker 2017b).

When victims feel there are limited safety strategies available, they may consider obtaining a gun as noted by advocates in the current study. Having perceived options helps reduce the stress-related consequences of fear and anxiety (Grupe and Nitshchke 2013; Lachman and Weaver 1998) while feeling incapable of protecting oneself has been associated with increased anxiety (Arata 1999; Logan and Walker 2018b). A recent study found that victims are often advised to get a gun, particularly if they had a protective order, were stalked, or were threatened with a gun (Logan and Lynch 2018, Dangerous liaisons: Examining the connec- tion of stalking and gun threats among partner abuse victims, unpublished). It was clear from the discussion in the focus groups that advocates struggled with how to best handle this situation. In the absence of clear protocols, advocates may rely on their own judgements and biases rather than working

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in partnership with the victim (Kulkarni et al. 2012). Nota- bly, some advocates recognized the need for more direction and training to minimize the influence of their judgments and biases. Understanding how many victims struggle with whether or not to get a gun, especially if others have advised them, and standardized protocols for the best way to help victims feel safer with or without a gun may be important.

The third main theme developed from the focus group discussion is that risks are multi-layered and are impacted by victim resources and involvement in the civil or criminal justice system. Throughout the safety planning process advo- cates note that the resources that victims have make a huge difference in the safety planning strategy, and when victims have limited resources advocates may have limited strate- gies. Helping victims requires an individualized approach with a comprehensive and ongoing assessment of victims psychological and tangible resource strengths, weaknesses, opportunities, and threats (Logan and Walker 2017a). Even though safety and economic security are widely recognized as inter-related, the interplay of safety and economic inse- curity has received limited systematic research attention – particularly in relation to safety planning. Victims’ limited personal resources makes the need for community resources even greater in helping families imperiled by partner abuse and in need of safety responses. More research is needed on how community resources, and community coordination of community agencies, can affect safety for sexual assault and partner violence victims.

Additionally, the civil and criminal justice system is one important avenue in coping with sexual assault and partner violence. Whether or not someone is safer when involved in these systems may differ depending on individual cases. Very few studies have examined differences or similarities in safety planning with partner abuse and sexual assault vic- tims who receive services within or outside of the justice system. The process of safety planning may also vary widely depending on where advocates are located (within or outside of the justice system). For example, Buzawa et al. (2000) found that only half of the victims who talked to an advocate in a prosecutor office were very satisfied with the advocate. Some victims did not feel the advocates were very sympa- thetic or responsive to their needs and some even questioned whether or not the advocates were actually helping them or only helping the prosecutor’s office.

More research is need to identify the most common challenging situations that advocates confront, whether these situations match the risks thought to be high lethality factors, and strategies to increase safety when these risks are present. Protocols must be developed and training and ongoing supervision is critical. When doing this research and developing protocols and training, it is imperative that more information is sought from victims about their biggest risks or risks they wish would have been addressed in safety

planning, strategies to address those risks, and their input about the safety planning process.

This study was limited given the number of focus groups and small sample size and participants were recruited from one state that is mostly white. Future research using larger samples from multiple areas would shed additional light on advocate safety planning practices. Including advocates who serve a wide diversity of victims in terms of age, gender, sexual orientation, race/ethnicity, and geographic location (e.g., rural, suburban, urban) would increase the understand- ing of the process and various risks victims face. Also, this study did not allow for a systematic examination of geo- graphic differences or differences in the safety planning pro- cess and challenging situations by agency type or job type (e.g., safety planning within the hotline versus case manager context) both of which would strengthen the understanding of day-to-day implementation of safety planning as well as agency and community constraints. It should be noted that this study likely did not identify all of the common risk situ- ations such as custody and child visitation issues or were mentioned infrequently (e.g., immigrants) most likely due to the focus group time constraints.

This study builds on prior research to facilitate a more in-depth look at what happens in the day-to-day process of safety planning. There were six main strategies advocates use in typical safety planning sessions. Additionally, dis- cussions revealed there are no widely accepted protocols regarding assessment and handling of common but risky situations, there are limited evidence based safety strategies in many high risk situations, and risks are multi-layered and impacted by victim resources and civil or criminal justice system status. It is essential that evidence based best prac- tices and protocols be developed for safety planning along with ongoing training, supervision and support (Logan and Walker 2018a). Future research is needed to examine whether, and how, safety planning best practices and proto- cols should differ depending on agency setting or delivery mode (e.g., hotline, case management, counseling) and how the community context may influence safety planning prac- tices and protocols.

Acknowledgements The authors would like to thank the participants and the Department of Behavioral Science at the University of Ken- tucky for funding this research. The authors would also like to thank Jaime Miller for her help with analysis and editing.

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