Tài liệu THE CHICAGO WOMEN’S HEALTH RISK STUDY RISK OF SERIOUS INJURY OR DEATH IN INTIMATE VIOLENCE

THE CHICAGO WOMEN’S HEALTH RISK STUDY

RISK OF SERIOUS INJURY OR DEATH IN INTIMATE VIOLENCE

A COLLABORATIVE RESEARCH PROJECT

New Report, Revised June 2, 2000

Collaborators

Though most of the collaborators of the Chicago Women’s Health Risk Project were

silent partners in writing this report, they were equal partners in the project. They

include Olga Becker, Nanette Benbow, Jacquelyn Campbell, Debra Clemmens, James

Coldren, Alicia Contreras, Eugene Craig, Roy J. Dames, Alice J. Dan, Christine Devitt,

Edmund R. Donoghue, Barbara Engel, Dickelle Fonda, Charmaine Hamer, Kris

Hamilton, Eva Hernandez, Tracy Irwin, Mary V. Jensen, Holly Johnson, Teresa

Johnson, Candice Kane, Debra Kirby, Katherine Klimisch, Christine Kosmos, Leslie

Landis, Susan Lloyd, Gloria Lewis, Christine Martin, Rosa Martinez, Judith McFarlane,

Sara Naureckas, Iliana Oliveros, Angela Moore Parmley, Stephanie Riger, Kim Riordan,

Roxanne Roberts, Martine Sagan, Daniel Sheridan, Wendy Taylor, Richard Tolman,

Gail Walker, Carole Warshaw and Steven Whitman.

Principal Author: Carolyn Rebecca Block, Illinois Criminal Justice Information

Authority, 120 South Riverside Plaza, Chicago, Illinois 60606.

Contributions by: Christine Ovcharchyn Devitt, Michelle Fugate, Christine Martin and

Tracie Pasold, staff of the Chicago Women’s Health Risk Study, Illinois Criminal Justice

Information Authority, 120 South Riverside Plaza, Chicago, Illinois 60606.

Sara Naureckas, MD, at Erie Family Health Center, contributed to the sections on

children, medical help-seeking and pregnancy.

Dickelle Fonda, Chicago Women’s Health Risk Study project counselor, wrote the

section on interviewer debriefing and support.

Barbara Engel, Sara M. Naureckas and Kim A. Riordan contributed to the sections on

collaboration, and Judith M. McFarlane and Gail Rayford Walker contributed to the

sections on proxy field strategies.

The CWHRS was supported by grant #96-IJ-CX-0020 awarded by the National Institute

of Justice, Office of Justice Programs, U.S. Department of Justice. Points of view in this

document do not necessarily represent the official position or policies of the U.S.

Department of Justice.

Printed by the State of Illinois.

ACKNOWLEDGMENTS

The collaborators of the Chicago Womens’ Health Risk Study include people who

represent each participating site. However, many other people at the sites made signifi￾cant contributions to the project. They include Bonnie Noe of the Chicago Department of

Public Health; Lois Furlow and Peggy Martin of the Chicago Department of Public

Health Roseland Clinic; Jan Alroy, Gloria Becerra, Rebecca Estrada, Caroline Makere

and Proshat Shekarloo at the Hospital Crisis Intervention Program of Cook County

Hospital; Sue Avila and Rob Smith of the Trauma Unit of Cook County Hospital; Louis

Hirsch of the Chicago Abused Women’s Coalition; Denise Djohan, Hazel Pernell and

Bernice Haines of Erie Family Health Center; and Felicia Grey at the Office of the Cook

County Medical Examiner.

Without the generous cooperation of the many agencies that allowed us access

to their facilities, the Chicago Womens’ Health Risk Study would not have been suc￾cessfully completed. We would like to acknowledge the following people in particular: at

the Illinois Department of Corrections, Steve Karr, Planning and Research Unit, Warden

Dan Bosse, and Assistant Warden Gwendolyn Thornton at Logan Correctional Center,

and Warden Donna Klein-Acosta and Assistant Warden Janice Burns at Dwight

Correctional Center; at the Office of the Cook County Circuit Court Clerk, Associate

Clerk Gerard Sciaraffa; at the Illinois State Police Research Support Center Metropol￾itan Chicago, Captain William Davis; at the Chicago Public Library Harold Washington

Main Branch Interlibrary Loan Department, Valerie Samuelson.

The design and implementation of the proxy study part of the project greatly

benefitted from the advice, suggestions and encouragement of those researchers who

had pioneered this methodology. We would especially like to thank Joyce Banton, David

C. Clark, Arthur Kellermann, Judith McFarlane and Harold Rose.

A cornerstone of the Chicago Women’s Health Risk Study was the culturally

sensitive Spanish translations of the questionnaires and other instruments, as well as

the sensitive interviewing procedures, which were made possible by the Erie Neighbor￾hood Advisory Board, a group of people who met with Eva Hernandez over several

months to work on translation and advise us on methods. The project owes a special

debt to Nanette Benbow, Alicia Contreras, Eva Hernandez, Laura Safar and Luis

Cavero, who generously spent long hours on the translations.

Finally, we would like to thank the many people at the Illinois Criminal Justice

Information Authority who understood the importance of this project and went above

and beyond to find ways to make it happen. Some of the people who contributed

significantly to the project’s success were Hank Anthony, Carrie Bluthardt, Robert

Boehmer, Maureen DeMatoff, Tamlyn Hawthorne, Candice Kane, James Oas and

Gerard Ramker.

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DEDICATION

This project is dedicated to the women and their

families who allowed us into their lives and were

willing to overcome fear and grief to share their

stories with us.

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TABLE OF CONTENTS

ACKNOWLEDGMENTS I

DEDICATION iii

THE PROBLEM 1

GOALS and OBJECTIVES3

Questions Explored 5

Risk Factors 5

History of Violence 6

Stalking and Other Harassment 6

Controlling Behavior 6

Type of Union 6

Estrangement; Leaving the Relationship 7

Age and Age Disparity 7

Children 8

Physical and Mental Health 8

Pregnancy 9

Alcohol or Drug Abuse 9

Suicide Attempts or Threats 11

Partner’s Suicide as a Risk Factor for Homicide11

Suicidal Feelings and the Risk of Homicide Victimization 11

Firearm Availability 12

Strengths and Protective Factors 12

Social Support/ Helping Network 12

Income, Education, and Employment 13

Help-Seeking and Interventions 13

Health Care 13

Community Services 14

Alcohol Treatment or Counseling 14

Police Intervention 14

Court Intervention; Orders of Protection 15

STUDY DESIGN AND METHODOLOGY 15

Project Methodology: Overview 16

Major Tasks 18

Changes in Study Design 18

Inclusion of same-sex intimate partner relationships 18

Decision not to collect public record data (clinic/hospital sample) 18

Change in respondent fees and their administration 20

Decision to double the comparison group 21

Decision to interview more than one proxy respondent22

Decision to interview women homicide offenders 22

Additional consultants and staff 23

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Re-conception of the proxy study methods 24

Assuring Subjects' Safety, Privacy and Confidentiality 24

Safety 24

Follow-up Safety Issues 27

Closure 28

Proxy Study Safety Issues 29

Procedures to Preserve Confidentiality 30

Collaboration Methodology31

CLINIC AND HOSPITAL STUDY METHODS 33

Clinic and Hospital Sample 33

Site Selection 34

Screening Instrument 36

Sample Screening Process 36

Screening Results 39

Was There an Interview Selection Bias by Age or Language? 42

Woman’s Age 42

Woman’s Language43

Screening Status Versus Interview Status 44

Did the CWHRS Meet its Sample Goals? 46

Questionnaire Design 51

Spanish Translation 52

Calendar History of Incidents and Events 52

Measures and Scales Built into the Questionnaire 54

Violent Incident Severity 54

Danger Assessment 58

Type of Union 59

Abusing Partner (Name, Name2, Name3) 61

Relationship and Co-Residence 61

Estrangement and Leaving the Situation64

Length of Relationship 65

Racial/Ethnic Group 68

Physical Health 68

Pregnancy 69

Drug and Alcohol Use 69

Mental Health: PTSD 70

Mental Health: Depression and Suicidal Feelings 72

Partner’s Physical and Mental Health 73

Occupation and Income 73

Immigrant Status and Public Aid 73

Resources and Social Support Network 74

Stalking and Other Harassment 79

Controlling Behavior 79

Intervention and Help-Seeking 84

Initial Interview Methods 86

Clinic Interviewers 88

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Interviewer Selection 88

Interviewer Training 88

Interviewer Support 89

Follow-up Tracking Methods 89

Follow-up Retention90

Length of the Follow-up Period 91

Was there Retention Bias in the Follow-up? 93

HOMICIDE STUDY METHODS 95

Homicide Sample 96

Data Collection and Field Strategies 96

Sources of Potential Proxy Information 97

Analysis of Official Data Sources to Provide Proxy Leads 97

Case File Information 99

Field Work Strategies 100

Setting Priorities Among Potential Proxy Respondents100

Support of the Proxy Respondents 102

Organizing and Interviewing Skills 102

Proxy Respondent Interviewers 103

Hiring and Training 103

Interviewer Support 103

Payment Plan 104

Homicide Case Completion 104

Combining Rules for Cases with Information from Multiple Sources 106

Homicide Cases with no Interview Data 107

Characteristics of Proxy Respondents 109

Quality of Proxy Respondent Information 111

Missing and Incomplete Data in Proxy Respondent Information 111

Demographics 111

Children 112

Estrangement or Separation 112

Firearms 112

Woman’s Physical Health 112

Woman’s Substance Use 112

Woman’s Mental Health 112

Support Network 112

Power, Control and Stalking 113

Violence in the Past Year 113

Help-Seeking and Interventions 114

ANALYSIS METHODS 114

Data Management 115

Management of Name, Name2 and Name3 Information 115

Management of Incident-Level Data 115

Individual versus Incident Level Data 116

Aggregating Incident-Level Data for Each Woman 117

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Variable Follow-up Period 117

Prospective Account of Abuse and Events 118

Incident Date 118

Statistical Analysis 118

CLINIC AND HOSPITAL FINDINGS 119

Sample Characteristics 120

Place of Birth and Language 121

Employment, Education and Income 123

Age and Racial/ Ethnic Group 124

Type of Union, Relationship, and Co-Habitation126

Same-sex Relationship 128

Age Disparity between the Woman and Name 129

Pregnancy and Children 130

Mental Health 134

Depression 134

PTSD 135

Firearms in the Home 136

Summary: Clinic/Hospital Sample Characteristics 137

Differences Between Women Who Interviewed AW Versus NAW 139

Age and Race/Ethnicity 139

Type of Union and Relationship 139

Same-sex Relationship 141

Co-residence, Estrangement, and Leaving the Relationship 141

Length of Relationship 143

Disparity between Woman’s Age and Name’s Age 144

Children 145

Controlling Behavior 145

Stalking and Other Harassment 146

Physical Health 149

Overall Health 149

Pregnancy 149

Drug or Alcohol Use150

Mental Health 151

Depression 151

PTSD 153

Name’s Suicide Risk 153

Presence of a Firearm in the Home 153

Social Support Network and Other Resources 154

Social Support Network Scale 154

Employment, Education, and Income 154

Place of Birth and Language 157

Divorce 157

Having a Home 157

Summary: AW versus NAW Comparison157

Characteristics of Violence in the Past Year 160

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Incident Characteristics 160

Number of Incidents in the Past Year 162

Severity of Incidents in the Past Year 163

Most Recent Incident 164

Severity 164

Recency 165

Children’s Exposure to Violence 165

Weapons Used in Incidents 166

Drug or Alcohol Use in Incidents 167

Summary: Incidents Experienced in the Past Year 169

Correlates of Severity and Number of Incidents in the Past Year 171

Age and Race/Ethnicity 171

Type of Union and Relationship 172

Same-Sex Relationship 173

Co-Residence, Estrangement, and Leaving the Relationship 173

Length of Relationship 176

Disparity Between the Woman’s Age and Name’s Age177

Effect of Children on Abuse Severity and Number of Incidents 177

Controlling Behavior 178

Stalking and Other Harassment 179

Physical Health 180

Overall Health 180

Pregnancy 181

Drug or Alcohol Use181

Mental Health 183

Depression 183

PTSD 185

Name’s Suicide Risk 185

Presence of a Firearm in the Home 185

Social Support Network and Other Resources 186

Social Support Network Scale 186

Employment, Education and Income 187

Place of Birth and Language 188

Divorce 188

Having a Home 189

Combinations of Risk Factors 189

Total CWHRS Sample 190

African/American/Black Women 190

Latina/Hispanic Women 191

White or Other Women 191

Pregnant Women 191

Same-Sex Relationship 192

Summary: Severity and Number of Incidents in the Past Year 192

Help-Seeking and Interventions in the Past Year 194

Talking to Someone 197

Counselors and Helping Agencies 198

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Medical and Health Care 199

Criminal Justice System 200

Summary: Help-Seeking and Interventions 201

Risk Factors for Future Violence: Continuation and Severity 202

Violence in the Past Year as a Risk Factor for Future Violence 204

Recency 204

Severity of Past Incidents 205

Number of Incidents in the Past Year 207

Summary and Conclusions: Past Violence and Future Violence

207

Controlling Behavior 210

Stalking and Other Harassment 212

Age and Racial/Ethnic Group 213

Type of Union and Relationship 213

Same-sex Relationship 214

Co-residence, Estrangement and Leaving the Relationship 215

Length of Relationship 217

Age Disparity218

Children 218

Physical Health 219

Overall health 219

Pregnancy 219

Alcohol or Drug Use220

Mental Health 221

Depression 221

Post Traumatic Stress Disorder (PTSD) 221

Name’s Risk of Suicide 221

Presence of a Firearm in the Home 221

Social Support Network and Other Resources 222

Social Support Network Scale 222

Employment 224

Education 224

Income 225

Place of Birth and Language 225

Divorce 225

Having a Home 225

Help Seeking and Interventions 226

Talking to Someone 226

Counselors and Helping Agencies 226

Medical and Health Care 227

Criminal Justice System 227

Combinations of Risk and Supportive Factors 228

Total CWHRS Sample 228

African/American/Black Women 229

Latina/Hispanic Women 229

White or Other Women 229

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Pregnant Women 230

Same-Sex Relationship 230

Summary: Risk Factors for Future Violence 230

HOMICIDE FINDINGS 233

Characteristics of the Fatal Incident 235

Circumstances Immediately Preceding the Final Incident 235

Victim/Offender Interaction236

Intent to Kill 236

Compliance with a Demand 236

Jealousy or Suspected Infidelity 237

Leaving or Trying to End the Relationship 237

Multiple Victims or Multiple Offenders 239

Place of the Fatal Incident 240

Weapon Use in the Fatal Incident 240

Firearm in the Home 242

Drug or Alcohol Use in the Incident 244

Availability of Medical Help 246

Prior History of Violence 247

Cases with No Prior Violence Against the Woman 247

Types of Violence Against the Woman in the Past Year 249

Summary: Prior History of Violence 251

Controlling Behavior Against the Woman in the Past Year 251

Homicide Followed by Suicide 252

Summary: Homicide Incidents 255

Sample Characteristics of Homicide Women 257

Woman’s Employment, Education and Income 257

Age and Racial/ Ethnic Group 258

Type of Union and Relationship 259

Pregnancy and Children 262

Summary: Sample Characteristics 263

Are Same-Sex and Woman-Offender Homicides Separate Types? 263

Do Woman-Woman Cases Differ from Heterosexual Cases? 264

Do Woman-Victim Cases Differ from Woman-Offender Cases? 265

Age 266

Employment and Education 266

Type of Union/ Relationship 266

Conclusion 266

How Did Abused Homicide Women Compare to Abused Clinic/Hospital Women?

266

Violence Prior to the Lethal Incident 267

Controlling Behavior 267

Stalking and Harassment 267

Characteristics of the Women and Their Relationship 268

Disparity Between Partners’ Ages270

Leaving the Relationship 270

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Physical and Mental Health 271

Pregnancy and Children 272

Alcohol or Drug Use273

Social Support and Material Resources 275

Help-Seeking and Interventions 277

Summary: How Did CWHRS Homicide Women Differ from Clinic/Hospital

Women? 279

The Stereotypical “Battered Woman” Does Not Exist 281

The Challenges Facing Abused Women Change Over Time 282

Characteristics of the Incident Itself may be the Primary Risk Factor285

Past-Year Risk Factors for Serious Injury or Death in Intimate Violence

286

Past Violence 286

Controlling Behavior and Stalking 287

Morbid Jealousy 287

Estrangement and Leaving the Relationship 287

Weapon 288

Physical and Mental Health 288

Alcohol or Drug Use288

Protective Factors 289

Do Risk and Protective Factors Differ for Different Groups of Women?

289

Latina/Hispanic Women 289

African/American/Black Women 290

White or Other Women 290

Pregnant Women 290

Women in an Abusive Same-Sex Relationship 291

Risk Factors for Becoming a Homicide Offender 291

Key Findings for Research Methods 292

Standard Questionnaire Items Do Not Measure “Intimate Partner” 292

Research Designs Must Capture the Complexity of Women’s Lives 292

Develop a Collaborative Culture with Shared Research and Practice

Standards 292

Include “Strangulation” in Reports of Homicide Data 292

Key Findings for Practice 293

The High Potential Risk of Seeking Help and Trying to Leave 293

Ask Women: When Did the Last Incident Happen? 293

Do Not Judge a Woman’s Risk by a Single Incident, Even the Most

Recent 293

Inter-agency Coordination is Vital 294

In Screening and Selecting Clients, Beware of Age Bias 294

Key Findings on Help-Seeking and Intervention294

A Final Word 296

REFERENCES 299

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Appendix I 325

Collaborating Agencies and Individuals in the CWHRS 325

Appendix II 327

CWHRS Questionnaires 327

Appendix III 329

Consent Forms and Screeners 329

Appendix IV 331

Interviewer Hiring Material 331

Appendix V 333

Interviewer Debriefing 333

by Dickelle Fonda L.C.S.W. 333

Appendix V 337

Proxy Study Training and Field Work Record Forms 337

Appendix VI 339

CWHRS Reports and Publications 339

Appendix VII 341

Miscellaneous 341

Endnotes 343