Models of HBV risk assessment: DASH v PATRIARCH

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I recently wrote an article based on my case-file research into the distinctions between IPV and HBV which teased out some of the implications for risk assessment. (It should be published in the Journal of Interpersonal Violence sometime in 2014). This blog-post is building from that to talk about the current risk assessments being used around HBV — to give them a quick evaluation to see how well they work against the kind of experiences that came up in the case-file study, and just the rest of the general stuff I know.

Banaz Mahmod

As far as I know, there are two risk assessments currently in use: the British DASH checklist (ie Domestic Abuse Stalking and HBV) and the Swedish PATRIARCH. I think the argument for using risk assessments in HBV cases is very strong; first response is very important because given the levels of community surveillance and family pressure, a potential victim may have few opportunities to reach out for help and HBV is a very complex issue, which makes it hard for people who haven’t had much training and experience to make decisions on the fly. I did a little mental exercise whereby I tried thinking about how DASH and PATRIARCH would assess a) a low risk case, from my case-work studies*, who I’ll call Aisha, and b) the well-known (particularly to me) case of Banaz Mahmod.

UK: DASH

DASH was developed by CAADA, the police and criminologists to provide a single risk assessment which covered a variety of types of gender-based violence. It bases the distinction between HBV and other forms of GBV in collectivity – which is, IMO, the most sensible way to go, since collectivity has the clearest potential to increase the risk management challenges. The main problem with this integrated approach is that there’s a fatal disjoint between the fact that the majority of the questions have a tacit assumption that the perpetrator is a single, definable individual. This made is easy to fill out for Aisha’s atypical case, but a real challenge to complete for Banaz: many tickboxes could be checked, depending upon which actor of the five perpetrators one considered to be the antagonist, but if one were to focus upon a single perpetrator (say, Banaz’s father) then the risk is very much understated.The format then, is one which will tend to conceal risk in the most severe cases.

Sweden: PATRIARCH

PATRIARCH has different problems, including its rather awful name, which makes a rather tendentious suggestion that GBV committed by and against Swedes is not based in patriarchal relations. PATRIARCH was not designed by the kind of police/criminologist/VAW expertise that we see in DASH, but instead draws upon pscychiatric expertise. The approach is much more cultural – we are asked to answer questions about whether the victim/perpetrator comes from regions with a reputation for HBV. It is unclear if this simply a license to tick YES if the victim/perpetrator are non-white, or whether the accompanying training address the widespread nature of HBV. Do people filling out that form know that there are more ‘honour’ killings in Punjab than Kerala, or that there are ‘honour’ killings in Albania? Is it even useful to make a discrimination on this basis where the beliefs and the attitudes of the family and community should be more significant than vague and wide ethnic generalisations? This cultural bias led to Aisha’s case being identified as far more high-risk than it merited.

On the other hand, as a specific tool, PATRIARCH has collectivity built in from the beginning and is easier to fill out, and while having little basis in the kind of correlative, quantitative research that underpins DASH, many of the questions are very much on point.

Conclusion

Neither of these risk assessments are ideal: PATRIARCH overstates the risk to Aisha; DASH understates the risk to Banaz and is very difficult to fill out. For DASH, a major improvement would be to place the forking question around collectivity far earlier in the process and refit the questions to apply to a collective. It is paradoxical to make an identification of HBV on collectivity in a tool where few of the questions relate to collective violence. Simply pluralising the existing questions is not enough: due to the lack the data for HBV we cannot know if such things as cruelty to animals have any predictive power in these kinds of crimes. PATRIARCH is overly cultural and vulnerable to over-generalisation, but shows the merits of using a specific tool – although this will inevitably come at the risk of failing to mainstream HBV, which may in turn compromise first-response recognition. HBV risk assessment needs a lot more development and a lot more research, but is definitely a valuable way of protecting vulnerable individuals.


* The low risk case was as follows: a young woman in a single-parent family was being abused by her brother, who had started insulting and threatening her, using language which referred to his and his family ‘honour’ because she had a boyfriend, and on one occasion physically attacked her with a weapon. However, the brother was very young and the mother did not support his violence; the client intended to leave home shortly. This case then has two of the elements of HBV – agnation and ‘honour’ – while lacking collectivity.

 

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