The European Victim Guideline (2012)
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The European Victim Guideline (2012)

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Prof. dr. mr. Frans Willem Winkel, Professor of Victimology, Tilburg University: Effective victim support from an evidence-based trauma perspective

Prof. dr. mr. Frans Willem Winkel, Professor of Victimology, Tilburg University: Effective victim support from an evidence-based trauma perspective

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The European Victim Guideline (2012) The European Victim Guideline (2012) Presentation Transcript

  • The European Victim Guideline(2012): effective victim supportfrom an evidence-based trauma perspective Prof. dr. mr. Frans Willem Winkel f.w.winkel@tilburguniversity.edu Zagreb-conference, November, 27- 30, 2012
  • Specific targets suggested by the guideline (e.g. art 18…)• General purpose: to (further) enhance the social and juridical position of crime victims.• More specific targets, include:• (1) The prevention of chronic suffering, chronic coping problems due to victimization;• (2) The prevention of repeat victimization, and• (3) The prevention of secondary victimization / secondary traumatization
  • Victim Support: how to accomplish these specific targets??• Psychological evidence suggests that most crime victims are resilient, and thus are not in need of support;• However: traumatized victims – victims at risk of developing PTSD - are in need of support.• A first step in developing effective services is to acknowledge the importance of a trauma perspective:• Ergo: support workers should have knowledge about risk factors / mechanisms underlying PTSD
  • Support from a trauma perspective• Effective programs include (at least) two components, namely:1. Early identification of victims at risk of developing chronic PTSD, and2. Swift referral to the mental health system 1. Tea and sympathy by volunteers is not enough; 2. These victims are in need of trauma-focused treatment by professional psychologists 3. Evidence-based interventions – incl. EMDR and cognitive processing therapy – are available
  • Victim support and trauma• The gold standard to identify victims with chronic PTSD is an extensive diagnostic interview by a psychologist / psychiatrist!!• However: a number of screening tools have been developed for non-psychologists / e.g. police and victim support workers;• Important tools include: the Trauma Screening Questionnaire(TSQ), Coping self-efficacy scale, and the Scanner
  • Relevance of a trauma perspective• An important criterion to evaluate the success of the European guideline:• The utilization of (validated) screening instruments to identify victims in need of support – In the NL since 2012 the TSQ is used as part of an (internet-based) e-screening procedure;• However: many organizations affiliated with Victim Support Europe still do not use screeners as part of an Early identification and referral procedure (many victims in need are not identified)
  • Two other arguments for a trauma perspective• Victimological evidence suggests that PTSD is a conditional risk factor for• REPEAT VICTIMIZATION, AND• SECONDARY VICTIMIZATION / TRAUMATIZATION, due to delivery of a victim impact statement during trial of the suspect.• Some subtypes of PTSD are relatively strong (versus weak) risk factors for these outcomes
  • PTSD and repeat victimization Slides relating to Presentation on wednesday
  • Repeat victimization: the re- involvement in domestic violence• Female victims exposed to domestic violence are defined as vulnerable victims in the Guideline• Some of these victims are in Danger: at substantial risk of short-term revictimization• Challenge: is it possible to early identify victims who are in danger on the basis of validated Risk Assessment Instruments (RAIs). – Yes, we can!!
  • RAIs: forensic psychology• RAIs with acceptable psychometric properties (reliability, predictive validity) have been developed in Forensic Psychology• Various versions:• Professional, more detailed versions (psychologist / psychiatrist) and “simple” screening versions (police / victim support workers)• Actuarial and “non-actuarial” RAIs
  • Risk assessment instruments• Professional assessors (forensic psychologists):• DVRAG (Domestic Violence Risk Appraisal Guide)• SARAG (Spousal Assault Risk Assessment Guide – (actuarial versus “non-actuarial” / no cutoff-values for low and high risk) – E.g. 4 risk factors = 40% risk
  • “Non-clinical” assessors: police and victim support• B-Safer (Brief Spousal Assault form for the Evaluation of Risk)• ODARA-LE (Ontario Domestic Assault Risk Assessment – Law Enforcement)• Danger Assessment Inventory
  • An example: ODARA
  • ODARA ITEMS: 13 risk factors (Sumscore: 0 - 13)(1) Prior violence against wife or children (NO = 0; YES = 1)(2) nondomestic incident(3) Prior custodial sentence(4) Failure on prior conditional release(5) Threat to harm or kill at index assault(6) Confinement of the partner at the index offense(7) Victim concern(8) More than one child (from perpetrator or victim)(9) Victim has biological child from previous partner(10) Violence against others(11) Substance abuse history(12) Assault on victim when pregnant(13) Barriers to victim support
  • ODARA: “experience table” (official recidivism)ODARA score Likelihood of re-assault that comes to(Sumscore: equal weights; the attention of the police within anEach factor = 1) average of about 5 years)0 7%1 17%2 22%3 34%4 39%5 of 6 53%7 t/m 13 74%
  • DRAG = PCL-R + ODARA: an illustration CorrectedPerpetrator is a ODARA-scorePsychopath: “PCL-R = 1)” (different weights per risk factor)Psychopathy Likelihood ofChecklist –revised Recidivism(PCL-R; Hare) (experience table) “Uncorrected” / simple ODARA-score(PCL-R =0) (all factors have the same weight)
  • Victimological evidence: Danger Assessment Inventory (DAI)• DAI has been recently developed to early identify female victims who are in danger, at substantial risk of short-term re-victimization (within 3 to 6 months)• Evidence base: two large scale prospective studies (N> 500 victims)• Why: the DAI has superior predictive performance!!! – Stronger correlation between prediction and actual outcome
  • Why bother about Predictive validity (& reliability)….???? Actual Outcome: No Revictimization revictimization (Yes)Predicted Prediction: HIT ERROR (“under”)NOt at RiskAt Risk Prediction(YES) ERROR (“over”) HIT Error: secondary victimization
  • Danger Assessment Inventory: screening version for police and victim support workers Danger Assessment Inventory Perpetrator features Victim features Scenario-features Mutual scenario, incl. ODARA-score > 7 Involvement in a Posttraumatic aggression YES =1 Post Traumatic (CTS-P): Yes =1 Cycle (TSQ/CTS-V): Yes = 1 High risk of short-term revictimization: N = 3“Corrected” ODARA-score for victims with borderline traits, incl. NEM, and impulsivity
  • DAI: features• The DAI has a triple focus, it includes• (1) perpetrator-related risk factors (e.g. ODARA-score for perpetrator)• (2) victim-related risk factors, particularly the involvement in a PTSD-maintained cycle of violence (posttraumatic cycle: PTC)• (3) scenario-based risk factors: a mutual scenario (both partners use violence; vs unilateral scenario: male initiated violence)
  • Victimological evidence suggests, that….• A Posttraumatic Cycle of violence (PTC) is an independent risk factor (e.g. controlled for ODARA-score)• A PTC is a strong (substantially higher risk) risk factor, when:• The cycle consists of mutual scenario’s (both partners commit violent behavior) and• The cycle is maintained by an embitterment or an explosive (PTSD) syndrome
  • Crime-related PTSD (C-PTSD) subtypes: 4 subtypesPTSD Internalizing ExternalizingSubtypes: Symptomatology SymptomatologyHopelessnessSyndrome Helplessness Embitterment(DSM- mooddisorder/depression) Syndrome Syndrome (“stockholm”)False-alarmSyndrome Panic Explosive(DSM- Anxiety / Angerdisorder Syndrome Syndrome
  • Bottomline of the 2x2 table• There are similarities among crime victims with PTSD (DSM IV / 5 symptomatology), BUT• There are important differences, that cannot be ignored – Different mechanisms underlying the development of PTSD (cognitive versus emotional route) – Externalizing versus internalizing symptomatology (dysregulation of the anger system versus the anxiety system)
  • PTSD: conditional risk• Explosive syndrome is a powerful risk factor for re-victimization (stronger impact on risk re. to “other” subtypes) – Specific features include: hostility bias, state anger, propensity to explode in response to subjective (“imaginary”) danger signals, and violent behavior (details; next slide)• Victims with explosive syndrome are at substantial risk of short-term revictimization
  • Peritraumatic escalation, cognitive inversion, and Shattered Illusions (SIM). Peritraumatic escalation: Fight-flight response failureEmotional EmotionalImplosion: Psychotic Explosion:Extreme anxiety / Dissociation Blind anger /Tonic Immobility Rage Dysregulated Cognitive cascade: Emergency-response: Inversion; SIM) Hyperalert / paranoid behavior: In standby modeFalse alarm-syndrome / False alarm-syndrome /Internalizing symptoms: Externalizing symptoms:Self as easy target bias, Hostility bias, anger,Anxiety, Propensity to Propensity to explode in response topanic subjective danger-signalsAvoidant / Submissive Behavior Impulsive agressive behavior
  • PTSD and secondary victimizationSlides relating to presentation of thursday
  • Victim rights movement: (IRV: Joutsen, 1994; de Mesmaecker, 2012) • Victims should have rights, also in criminal trials • bring the “stolen conflict “ back to the trial setting (versus exclusive prosecutor – suspect – vertical link)• Symmetry: for every right of the suspect there should be an equivalent right for the victim, including the right to speak • Victim participation should be encouraged, because it has a beneficial impact on recovery• However: these are normative positions, there is no credible empirical evidence
  • Secondary victimization (by the criminal justice system)• According to the Dutch code on criminal procedure (some) victims have the right to submit an oral or written statement to the judge about the impact of the incident.• Victim impact statements are assumed to contribute to emotional recovery of the victim• However: recent victimological evidence suggests that VIS may have adverse effects, e.g. it may result in secondary traumatization
  • Hyotheses• Law in the books: victim rights generally have beneficial effects for victims• Law in action / empirical - perspective: rights may have positive effects for some victims; rights may have detrimental effects for other victims – “law of differential effect” (e.g. traumatized versus non-traumatized victims)
  • Psychological impact of trial participation (VIS) Positive “Interaction – Beneficial effect: Ritual” between the victim Emotional recovery and the judgeVictim ImpactStatementduring trial Negative “Interaction – Adverse effect: Ritual” between the victim Secondary victimization/ and the judge traumatization Traumatized victims: 1.White bear-mechanism (muzzled expression) 2.Teeth for a tooth-mechanism
  • VIS: positive versus negative experience• Instruction to suppress anger: limited / muzzled emotional expression during trial• Moral dissatisfaction with the verdict – Incomplete acknowledgement of victim distress – “Lenient sentence”: personal distress > distress encountered by perpetrator• Bottomline: it is all about victim perceptions, perceived justice
  • CREDIBLE EVIDENCE: EMOTIONAL RECOVERYVERSUS SECONDARY TRAUMA: DESIGN Repeated Measures Trauma Symptoms Trauma symtoms Pre-trial Post-trial Participants TSQ – scores TSQ-scores (oral and / or (better alternative: written victim impact Davidson Trauma statement) Scale or PSS) Non-participants TSQ-scores TSQ-scores
  • Trauma symptoms (TSQ- scores)reported by trialparticipants (VIS: yes/ no)Victim Status: Asssessed before TSQ After trial trialNon-participant 3.1 2.0(No VIS)Participant: 7.0 5.8Written VISParticipant: 7.1 6.1Oral VIS during trial
  • Bottom-line of the previous table• There are substantial psychological differences between participants and non- participants (TSQ-scores: “hit between the eyes”)• Victims with PTSD – traumatized victims – are more likely to participate in a trial (VIS)• There is NO EVIDENCE for emotional recovery – No time by participant-status interaction• More importantly: analyses provide evidence for secondary victimization
  • Interaction-term: F1,74 = 4.04; p < .05
  • Conclusions:• From a law in action – perspective the European Guideline will be a major step forward in strengthening the social and juridical position of crime victims, if• The “trauma perspective” on criminal victimization is fully acknowledged at all levels
  • Ergo:• Criminal justice personnel and victim support workers should become more familiar with this perspective (underutilization of knowledge / knowledge-gap)• Criminal justice personnel should be trained in the development of trauma-sensitive behavior;• Victim support personnel should be trained in the use of formal tools to identify susceptible and vulnerable victims (e.g. DAI, TSQ, etc)