Intimate partner violence risk assessments: getting victims to safety

In my last article, I first mentioned that intimate partner violence (IPV) is a silent epidemic. 

The United Nations Development Programme (2023) found approximately 45,000 women and girls worldwide were killed by their intimate partners (or other family members) in 2021. That’s one killing every 11 minutes. 

As a therapist and a women’s advocate, I have spent more than 20 years working in the field of intimate partner violence helping women safely leave abusive partners and rebuild their lives.  

The critical period for any person in an abusive relationship is when they decide to leave their abusive partner. The risk of harm increases significantly when a victim tries to leave, or if the abuser suspects their partner is trying to leave.

Therefore, time is of the essence.

In this article, I’ll explore and build an understanding of the role AI can play in providing support to counsellors, therapists, coaches, doctors, nurses, and social workers, in intimate partner violence cases. I’ll also share evidence-based recommendations for key questions to ask to ascertain IPV risk.

Why IPV risk assessment is crucial

A risk assessment helps to assess the level of threat or potential lethality in an abusive relationship. I use the assessment as a foundation for completing safety plans to help prioritize my clients’ areas of concern, make goals, and connect with useful resources in their community.

Using Upheal offers speed and focus when it’s most needed

I have found one of the most important aspects of completing a risk assessment is time. Before Upheal, I was racing against it, trying to balance relevant and detailed information with being present and compassionate with clients. 

Everything from emotional and psychological abuse to physical, sexual, financial, and coercive control is important information. This can elicit deep-seated emotions of fear, shame, and guilt for clients. And raise many questions for them.

I wanted to be as patient with clients as possible and afford them the time they need to express themselves and share their stories. 

Upheal helps me improve the accuracy, efficiency, and thoroughness of my documentation. Many of my clients share their stories for the very first time when they share them with me, often uncovering emotions like anger, fear, or sadness. With Upheal, I can stay fully present and hold space for these intense moments without being distracted by the need to capture everything in the moment as well.

Clients often bring complex questions that I may not have immediate answers to. By reviewing the generated session notes afterward, I can track these questions and ensure I address them thoughtfully in future sessions. This not only enhances my accountability but also deepens the therapeutic process.

Upheal captures incidents a client might otherwise deny, minimize, or repress, and creates plans quickly 

Firstly, Upheal highlights key information from our session transcript. You can learn more about Upheal’s transcription capabilities here. Not only does it transcribe the audio into text, it creates a note, allowing me to isolate key information like incidents, descriptions, and dates. 

Secondly, it helps me to create a plan I can share with my client, summarizing key topics. Clients find this useful because it can be a valuable tool to help them reflect on the timeline of escalating abuse in their relationship – this is so important because so often, denial, minimization, or other defenses might kick in. 

There’s nothing like having it in front of them in black and white. 

And finally, on a note-writing level, I love Upheal’s note customization capabilities, being able to anonymize details using Smart edit, and the direct client quotes functionality – I like to use that to corroborate an increased level of risk. 

Always inform IPV clients about limits to confidentiality

As a healthcare practitioner, mental health worker, therapist, social worker, or coach, you are already familiar with obtaining consent from your clients and identifying limits of confidentiality. 

I like to review these aspects with clients when I begin to talk about risk assessments. Sometimes, what is disclosed means we have to go above and beyond a client's confidentiality and prioritize their safety and or the well-being of children who may be in their care. I also recommend you check with your regulatory body and your state or provincial laws around your duty to report as a practitioner. The duty to report can vary depending on where you practice and your regulatory body.  

I also like to review that I am recording the session and how this can help us as we talk because Upheal’s transcription will provide us with a more accurate document and I won’t be missing any key information. 

The audio recording is deleted after the transcript has been generated. However, if you or a client wishes, Upheal can retain the audio recording. Should a client wish to not record certain aspects of their account, that too is possible. The AI can be paused, allowing the call to continue unrecorded, and then resumed.

In such cases where a client has requested to stop the audio transcription, or not have the call recorded in real-time, I have asked for their permission to use either Upheal’s Note dictation or Text-to-note features – both allow you to make notes after a session, and mean you don’t have to record them at all.

If you want to know more about Upheal’s process, I recommend you look at their article:  About Upheal: Our HIPAA compliance and how we value your privacy. If you are not practicing in the United States, Upheal explains how they meet PHIPA, PIPEDA, and GDPR regulations under Privacy and compliance. 

How to collect core information in the initial client session (with or without Upheal)

Helpfully, Upheal offers two types of Intake form templates. A comprehensive BPS or a more topline intake session information collection form. However, in a crisis situation such as when dealing with victims of IPV, you may wish to create a customized note template specifically for this occasion or use the smart edit feature to customize existing note templates. This is what I do – additionally, I focus on the following:

Working from a customized template

Having the exact structure I need is very helpful. I’ve created a customized template highlighting the important risk factors associated with an increased risk of harm to clients. I can then add risk factors identified by the client and myself during and after the session. Upheal’s Private note feature also allows me to enter the information I need to complete or to follow up on with the client at our next session.

A clear timeline of events, from the past to now‍

Memory is not like a videotape that we can rewind and playback. Sometimes clients don’t recall key details immediately or in order. Updating this is easier with Upheal. In addition, not every client will feel safe going to the police to report abuse. Some may decide to do so days, weeks, or even years later. I document the whole history and the trajectory of the abusive relationship with the client, creating a clear timeline. 

Injuries and forensic evidence ‍

Always enquire about the last time the client was hurt and the nature of the assault. When a client discloses a recent assault to me, I first ensure that the client feels safe and that they have what they need at that given moment, while also making sure I am documenting critical information. In cases of recent physical or sexual assault, I will also ask if they need to go to the hospital. 

Critical physical/forensic evidence is most effective within 72 hours after an assault, but evidence may also be detectable after 5 days and best practice is to collect evidence whenever it is possible. You can learn more about the recommended timeline to collect forensic evidence here.

Injuries may not be visible but have a profound impact on a client's physical and mental health. For example, traumatic brain injuries common in IPV cases correlate with poor memory recall and other mental health conditions such as depression, substance use, and PTSD. Traumatic brain injuries can be present for years, with symptoms worsening with every subsequent blow to the head or loss of oxygen to the brain.  

My  for you – review the post-session transcript‍

Sometimes it is not until I have time to review the post-session transcript, that I am aware of the full extent of the risks a client has shared. There is so much to be aware of and do in the session itself that I find it’s important to allow myself downtime, building in a time buffer after each client to review the transcript. This is easy with Upheal and allows me to go over the important details while pulling directly from the session's transcript to formulate clarifying questions that I can then ask the client next time.‍

5 key questions for ascertaining risk when you don’t have much time with a client  

If you’re new to utilizing a risk assessment with a client, using a structured document like the Danger Assessment Tool is a good idea. If your time with a client is limited, and you can’t explain Upheal ethically and responsibly, I want to address 5 key questions you can use to assess an increased level of risk of serious harm by an abusive partner.

1. Has your partner ever hurt you?

Research highlights that the presence of current or past abuse by a partner is a key indicator of the potential for escalating violence. However, identifying this abuse in IPV cases is often not as straightforward as it might seem. 

While many women were able to accurately predict their risk of future violence, others were not able to accurately predict future or increased risks. For some victims, abuse in the home is frequently minimized or rationalized, making it difficult for victims to recognize it as part of a larger pattern. 

It is often not until a woman finds herself in a safe, supportive environment with someone who listens and asks thoughtful questions that she may begin to identify the warning signs of escalating violence.‍

2. Does your partner own or have access to a weapon?  

When identifying risk factors it is essential to inquire whether their partner possesses or has access to a weapon. In the United States, more than half the femicide rates are committed with a firearm. ‘Trauma’ by stabbing, blunt force, and asphyxiation are also top death factors in cases of IPV.

3. Has your partner ever used coercion or threats to control you or keep you from leaving?

Coercive control is a quiet form of abuse. It is often overlooked and dismissed by clients unaware they’re experiencing it. 

A key risk factor is any threats to kill, either the client or themselves if the client leaves the relationship. Other threats include loss – loss of access to children, finances, home, family members, and pets.

4. Are there any emotional, psychological, or relationship struggles right now?

Has their partner suffered a loss in recent months, such as a job loss, or a death in the family? I also explore how the pending separation constitutes a loss for an abusive partner and increases the risk of harm.  

I inquire about a partner's history of substance use or depression, too. Have they had any thoughts of suicide or suicide attempts in the past? Understanding a partner’s mental health history and how they may engage in more extreme and violent behaviors when they have experienced loss or destabilizing events has been correlated with higher incidences of femicide. The use of alcohol or substances limits inhibition for abusers and may make them less in control of their actions. Sometimes my clients also use substances to cope, and this limits their ability to leave safely from a potentially violent situation.   

5. Were there any previous attempts to leave the abusive partner?

Asking about previous attempts to leave the relationship, what had happened, and why they went back can inform you and them about potential safety risks.  

If your client returned to an abusive partner because of fear, limited access to funds, housing, lack of family and social support, or if an abusive partner threatened to harm themselves if they didn’t return, this is important to note.

Women who leave an abusive relationship and then return are at significantly higher risks associated with lethal violence, higher severity of physical abuse, and poorer mental health outcomes.

Conclusion

A completed risk assessment continues to be a supportive document in a number of ways:

• It becomes the blueprint for a comprehensive safety plan.  
• It can help create goals and objectives for clients.
• It assists in forming an abuse timeline documenting the trajectory of domestic violence throughout the relationship.  
• It becomes a supportive tool to take to the police or in family court cases to obtain restraining orders.

While IPV continues to impact women and girls, completing a risk assessment can help create concrete goals and successfully get out of an abusive relationship. Upheal has been transformative for me in my work of conducting concrete and effective risk assessments. I feel I can be more present with my clients knowing that I have my notes taken care of, which frees me up to ask the important questions and help women come up with a plan that gets them to safety.