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How Effective Are Lethality Assessment Programs for Addressing Intimate Partner Violence?

Research on a risk screening program for victims of domestic violence shows that the program can increase help seeking and safety planning, and decrease violence. But it showed mixed results on predicting lethal violence.
Date Published
June 10, 2018

Intimate partner violence is a pervasive issue across the United States; a significant proportion of femicide (30 to 70 percent) is due to intimate partner violence.[1] Beginning in 2003, the Maryland Network Against Domestic Violence developed the Lethality Assessment Program as a way for first responders to identify victims of intimate partner violence who are at the greatest risk of being killed.[2] The program emphasizes self-determination and is designed to empower victims toward decisions of self-care.

As part of the program, police officers in the field use an 11-question Lethality Screen to evaluate a victim’s risk for lethal violence. Officers warn high-risk victims of the danger they are in and offer to put them in contact with a social services provider. If victims agree, they are immediately connected by phone to a provider to receive victim advocacy services, safety planning, and referral for additional services.

The Lethality Assessment Program has previously been studied with specific populations. The study discussed in this article sought to expand the body of evidence on the program’s utility. This quasi-experimental study had four goals:

  • Evaluation: Examine the effectiveness of the program in reducing intimate partner violence, increasing rates of emergency planning, and increasing help seeking by victims.
  • Validation: Assess the predictive capability of the Lethality Screen tool.
  • Implementation fidelity: Track how many high-risk women actually spoke to a service provider in accordance with the Lethality Assessment Program’s protocol.
  • Satisfaction: Assess victim satisfaction with the police response and the Lethality Assessment Program itself.

Researchers collected data on victims of intimate partner violence in seven police jurisdictions in Oklahoma. The researchers initially faced some difficulties recruiting participants, but over a period of approximately three and a half years, several hundred women agreed to participate and were reached for follow-up interviews. The age of participants varied greatly (ages 18 to 79) and the participants were racially diverse; about 43 percent were white, 30 percent were Black, 10 percent were Native American, and 8 percent were Latina. About two-thirds of participants had children living in their homes, and about half had completed high school or a GED.


The researchers found that although the program did not appear to have a significant effect on reducing the frequency of intimate partner violence, at follow-up, it appeared to significantly reduce the severity and frequency of the violence that survivors experienced.

In addition to reducing the severity and frequency of violence, the Lethality Assessment Program also appeared to increase help seeking and safety planning. Women who participated in the program were significantly more likely to remove or hide their partner’s weapons, to obtain formal services for domestic violence, to establish safety strategies with friends and family, and to obtain some form of protection against their partner.

Given these results, the researchers recommended the Lethality Assessment Program as a “collaborative police – social service intervention with an emerging evidence base.” [3]

In terms of its ability to predict violence, the Lethality Screen performed well in predicting that serious or lethal violence would not occur, though it did not perform as well when predicting that serious or lethal violence would occur. This discrepancy is by design to minimize the possibility that a woman who screens at low risk for severe violence, in fact becomes a victim of severe violence (i.e., a false negative). That intentional design resulted in a high ratio of women who screen at high risk for violence but do not experience the predicted violence (i.e., false positives).

The study also found that the Lethality Screen has a 92.86 percent sensitivity for predicting near-fatal violence, meaning that for every 13 women correctly screened as high risk for near-fatal violence, only one woman is incorrectly screened as low risk.

The study also found that the Lethality Screen has a positive predictive value of 13.27 percent, meaning that for every woman correctly screened as high risk for near-fatal violence, between six and seven additional women are incorrectly screened as high risk and will not experience the predicted violence. Again, the study’s authors emphasize that this is by design. Results of the Lethality Screen correlate significantly with survivors’ own assessment of the likelihood that their partner will physically abuse or seriously hurt them in the next year.

To test the implementation fidelity of the Lethality Assessment Program, researchers tracked how many of the women classified as high risk actually spoke to a hotline counselor. By the end of the intervention, 61.6 percent of high-risk women had spoken to a counselor.

Researchers uncovered two factors that associated with who spoke to a hotline counselor, the severity of the violence of the incident that preceded the Lethality Screen, and the severity of post-traumatic stress disorder (PTSD) symptoms. Researchers found that the more severe the preceding incident of violence was, the more likely the victim would speak to the hotline counselor. They also found that women reporting more PTSD symptoms were less likely to speak to a hotline counselor; for each additional PTSD symptom that women experienced, they were 15 percent less likely to speak to the hotline counselor. The study’s authors suggest that increased training for police on PTSD symptoms and the mental health effects of intimate partner violence could help police implement the Lethality Assessment Program more effectively to better connect victims to needed services.

Researchers found that victims who received assistance through the Lethality Assessment Program reported being more satisfied with the police response. Researchers suggested that the program is particularly promising because “a collaborative response that provides offender accountability (through criminal justice sanctions) and survivor safety (through social service intervention) makes available a broader scope of intervention.”[4] To confirm the positive effects of the Lethality Assessment Program, researchers encouraged replication of this study in other jurisdictions.

About This Article

The research discussed in this article was conducted by Jill Theresa Messing, Jacquelyn Campbell, Janet Sullivan, Sheryll Brown, Beverly Patchell, and Christine Shall. The study was supported by the National Institute of Justice, grant number 2008-WG-BX-0002, awarded to Arizona State University, Johns Hopkins University, Oklahoma State Department of Health, University of Oklahoma Health Sciences Center, and the University of Utah. The following Oklahoma police departments participated in the study: Broken Arrow, El Reno, Lawton, Stillwater, Tulsa, Oklahoma City, Cherokee County, and Tahlequah City.

This article is based on the final report, “Police Departments' Use of the Lethality Assessment Program: A Quasi-Experimental Evaluation” (pdf, 109 pages), NCJ 247456.

Cite This Article

National Institute of Justice, “How Effective Are Lethality Assessment Programs for Addressing Intimate Partner Violence?” June 11, 2018, NIJ.gov: https://nij.gov/topics/crime/intimate-partner-violence/Pages/how-effective-are-lethality-assessment-programs-for-addressing-intimate-partner-violence.aspx

Date Published: June 10, 2018