The study demonstrated that a computerized safety decision aid improved the decision process as demonstrated by reduced decisional conflict after only one use in a racially and ethnically diverse sample of abused women.
Consistent with previous research (Campbell & Lewandowski, 1997
), most women with children placed the highest priority on protecting their children; however, women also prioritized improving their own safety and locating sufficient resources to provide for their families. The safety priority-setting activity in the decision aid is unique, as it was used to personalize the action plan by developing strategies and resources for safety that most closely matched each woman’s safety priorities in the decision. Practitioners and advocates cannot assume that all abused women have the same priorities and needs in safety planning. Thus advocates and practitioners could use this tool to assist women in setting safety priorities and then to provide support in response to their needs. These study data may be some of the first to quantify women’s priorities in safety planning.
The majority of women reported extreme danger in their relationship within the past year as scored by the DA. The DA is typically used as a collaborative exercise between a domestic violence advocate, health care professional, and/or criminal justice practitioner and the abused woman herself (Campbell, 2005
, Campbell & Glass, 2009
). In previous research, only about half (45%) of proxy informants for victims of intimate partner femicide (murder of women) and slightly more than half (54%) of victims of near lethal violence accurately determined their risk of lethal violence in an abusive intimate relationship (Campbell, 2005
, Campbell et al., 2009
). The DA can provide powerful information for abused women and practitioners, such as health care providers as they navigate the criminal justice, advocacy, social welfare, substance abuse, batterer intervention, and/or health care systems seeking safety. As pointed out by Dutton and Kropp (2000)
, the use of the DA or any risk assessment method is an important step in the process of safety planning, thus important to include in the safety decision aid. Use of the DA can be helpful in substantiating the abused woman’s and/or the practitioner’s perception of risk of lethal violence in the relationship for use in systems such as criminal justice and advocacy services. Abused women’s perception of risk of intimate partner femicide and severe violence by her partner or ex-partner should always be ascertained and taken into account in any safety-planning endeavor. The DA can help a woman come to a more realistic appraisal of her risk as well as improve the predictive accuracy of those who are trying to help her (Campbell et al., 2009
The majority of women in this study reported that they had taken multiple steps to increase their safety and their family’s safety. The women shared their experiences with a diverse group of sources, both informal and formal. However, only 60% reported having made a safety plan and 76% included a plan to leave the relationship. Previous research has demonstrated that leaving an abusive partner is a very dangerous time for victims and a critical time for aggressive safety planning (Campbell et al., 2002
; Campbell et al., 2009
). Although the majority (60%) discussed the plan with someone, they discussed the plan primarily with an informal source such as a friend or family member. Fewer women discussed their safety plans with formal sources, such as local shelter advocates. Therefore providing the computerized safety decision aid in diverse settings such as welfare offices, Head Start programs, community agencies, and libraries is one step to increasing access to safety planning and to provide information about local resources and advocates. Providing access through the Internet may also increase abused women’s opportunities for developing a safety plan that is personalized to their priorities and level of danger.
Limitations and future work
This sample of abused women had already sought services related to the abuse; therefore, they were likely to have been further along in their safety decision process than abused women who had not yet sought resources to address the IPV. In fact, more than 90% of these participants reported they had left the abusive relationship in the past year. These women reported that they felt supported by the safety decision aid as it provided them with information related to dangerousness that supported their instincts that the violence was increasing in severity and frequency over the past year. Furthermore, the women reported an overall lower decisional conflict than before they used the decision aid. With these survivors, we might not expect the women to feel more informed, certain about safety planning, or clear about values related to safety as most had already left the abusive relationship.
The safety decision aid was conceived and designed for abused women who are much earlier in their safety decision process, and thus it may have a larger impact in the decision process for these women. In prior decision aid development, this team has learned to first take a decision aid to users who have already made decisions to gain full understanding of the emotional response to it. The next step is to take the decision aid to the target audience (women still in unsafe relationships) and to prospectively compare the use of the decision aid against standard safety planning practice for improvements in the safety decision-making process, increased safety steps, and ultimately, reduction of violence.
In addition, the sample did not include women who were abused by a female partner. We have now revised the safety decision aid and it now includes the Danger Assessment–Revised, a version of the DA that was developed from research conducted with female victims of same-sex IPV (Glass et al., 2008