The author(s) shown below used Federal funds provided by the U.S.

Department of Justice and prepared the following final report:

Document Title: Chicago Women’s Health Risk Study at a Glance

Author(s): D.E. Pignato

Document No.: 187781

Date Received: April 17, 2001

Award Number: 96-IJ-CX-0020

This report has not been published by the U.S. Department of Justice.

To provide better customer service, NCJRS has made this Federallyfunded grant final report available electronically in addition to

traditional paper copies.

Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect

the official position or policies of the U.S.

Department of Justice.
PROPERTY OF 

National Criminal Justice Reference Senrice (NCJRS) 

Box 6000 

Rockviile MC 20849-6000 

THE CHICAGO WOMEN’S HEALTH RIS-Y 

AT A GLANCE 

June 2,2000 

George H. Ryan, Governor 

Peter B. Bensinger, Chairman 

Candice M. Kane, Executive Director 

Criminal Justice Information Author@ 

120 S. Riverside Plaza 312-793-8550 

Suite 1016 Fax: 312-793-8422 

Chicago, IL 60606 TDD: 312-793-4m 

www.icjia.state.il.us 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
( 

Purpose 

nurses, beat officers and other primary support people information they need to 

know in order to help women who are experiencing violence at the hands of an 

intimate partner lower the risk of life-threatening injury or death. Previous 

research did not provide this practical information. 

danger of life-threatening injury or death in situations in which an intimate partner 

is physically abusing a woman. We accomplished this by conducting a study that 

compared longitudinal data on abused women with similar data on women who 

had been killed by or who killed her intimate partner. 

The Chicago Women's Health Risk Study (CWHRS) was designed to give 

The purpose of the CWHRS was to identify factors indicating significant 

Who, what, where, when and how much? 

Teamwork permeated all aspects of the CWHRS, from initial planning to 

the continued analysis and dissemination of results. The collaborative team 

included public and private, city, county, and state agencies, as well as talented 

and concerned individuals. After more than three years of collaborative planning 

by the Chicago Department of Public Health, Erie Family Health Center, Cook 

County Hospital, Chicago Mayor's Office on Domestic Violence, the Cook County 

Medical Examiner's Office, the Chicago Police Department, and the Illinois 

Criminal Justice Information Authority, the study officially began in January 1997 

with funding from the National Institute of Justice (NIJ). 

The CWHRS was supported by the $312,211 NIJ grant and by substantial 

in-kind contributions from the Authority and the other collaborating agencies. 

Data gathering, documentation and initial analysis were completed in June 1999, 

but the collaborators continue to analyze the data and to write and disseminate 

reports and other products to a wide audience. 

t 

Why is the information gathered by the CWHRS important? 

When nurses, beat officers, and other primary support people talk to an 

abused woman, they need to know the best way to respond in order to lower the 

risk of death or life-threatening injury. Although previous research told us who in 

the general population was most likely to be abused, it did not tell practitioners 

about risk patterns for women who were experiencing violence. Specifically, 

previous research was Hmited in the following ways: 

* it did not tell us which abused women were in a situation where the risk 

of serious injury or death might be especially high; 

* few studies evaluated potential interventions from the woman's 

perspective; and 

2 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
c research rarely addressed multiple barriers to safely leaving a dangerous situation. 

In addition, previous research tended to measure only one ortwo things, 

and did not take into account the interaction of events and ircumstances as Ehey 

change over time. Practitioners need to know how changin factors, such as 

attempthg to leave, pregnancy, children at home, or firea availability, may 

Field practitioners also need to know whether risk pa erns differ* 

different racial or ethnic groups, for women in a same-sex r lationship, wfar 

pregnant women, and they need to be able to respond to w men who may be m 

high risk situations but have nat sought help from helping a encies of supF3olf 

networks. Prior to the CWHRS, information about the need and best irfienrenaffect the risk of a lethal outcome. 

tions for these groups was very limited. i 

What was the methodologyaf the CWHRS? 

The CWHRS was designed around compariso 

all intimate partner homicides involving a woman that 

two-year period, and a "clinidhospital sample" of de 

with women sampled as they came into hospitals a 

borhoods where the risk for intimate partner violen 

ClinidHospital Sample 

The CWHRS conducted domestic violence 

as they came into a hospital or health care clinic 

screening, given as part of the clinic or hospital 

questions: current violence, currenksexual abuse, and 

go home. Women aged 18 or older, who were i 

answered "yes" to at least one question screen 

"no" to all questions screened "NAW." We atte 

screened "AW and about 30% of the women 

of the 705 women we interviewed, 497 had e 

and 208 had not (this was the comparison group). 

CWHRS study sites included the Ros 

Department of Health, Erie Famtty-tlealth C 

staff of each site, and the separatedinics or practices 

hand-in-hand with the interviewers and project staff to 

privacy standards were upheld. To ensure 

would not be excluded from the CWHRS s 

high risk but who were not known to be at 

designed instruments and procedures30 

r she was afraidio 

tionship, and who 

c 

3 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
two-thirds of the 497 women were re-interviewed at least once over the following 

twelve months. 

Homicide Sample 

The homicide sample included all of the 87 intimate partner homicides 

with a woman victim or offender age 18 or older, that occurred in 1995 or 1996. 

There were 57 homicides with a woman victim and a man offender, 28 with a 

man victim and a woman offender, and two with a woman victim and offender. 

There were two sources of data for the homicide sample, interviews and 

official or public records. We conducted detailed, face-to-face “proxy” interviews 

with friends, family or others who knew about the relationship, and with the 

woman offender herself, using questionnaires that were the same as the questionnaires used with the clinidhospital women (to the extent possible). In 

addition, we gathered information from the Chicago Homicide Dataset, Medical 

Examiner‘s Office records, court records, newspapers, and other sources. 

Questionnaires 

Interviews covered demographics; household composition; physical 

health; pregnancy; substance use; mental health (depression, anxiety and posttraumatic stress disorder); firearm availability; social support network; the 

partner‘s power, control, harassment or stalking; and interventions and helpseeking . 

The questionnaires and other study instruments were developed over 

many months of intense work by members of the collaborating team. Advocates, 

activists, community members, academics and researchers all took an active role 

in finding, evaluating and devising scales for the various dimensions we hoped to 

capture. The Spanish translations were done by community members (the Erie 

Site Advisory Board) and by two members of the collaborative team. Though the 

process was time-consuming, it produced translations that were correct and 

culturally sensitive to Latina/Hispanic women from different countries of origin. 

topics, and women from different cultural backgrounds might have different 

perceptions of these sensitive issues. Therefore, the collaborators spent a great 

deal of effort to word questions, and to provide a context for those questions, that 

would encourage women to disclose personal and sensitive experiences, to keep 

the questionnaire short enough so that the woman would not be fatigued, and to 

build in enough flexibility to encourage a natural flow of talk. 

Calendar History 

The 497 clinidhospital women who had experienced violence in the past 

year developed a *calendar history” of every violent incident and other important 

events that had happened in the past year. The women told us about 4,974 

Some of the issues covered by the CWHRS related to highly sensitive 

4 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
incidents in the past year. The number of incidents per woman ranged from only 

one (29%) to 172, with 22% of the women having experienced ten or more in the 

past year. The most severe incident was a threat for 4% of the women, and 

slapping, pushing or throwing something with no injury for 23%. However, almost 

half (48%) suffered at least one incident we defined as "severe or life 

threatening" (permanent injury, being completely "beaten up," being choked or 

burned, internal injury, head injury, broken bones, or a threat orattack witha 

weapon). 

In the follow-up interviews, each woman developed a calendar history for 

the period from the last interview to the follow-up. Of the re-interviewed women, 

44% did not experience any incident in the follow-up period, 25% experienced at 

least one violent incident but not a severe incident, and 29% experienced at least 

one severe or life-threatening incident. 

c 

CWHRS key findings 

The design of the CWHRS and the energy and dedication of the collaborators who made the design a reality produced a tremendously rich data set with 

the necessary detail and accuracy to answer the questions practitioners ask. We 

now know combinations of factors that indicate that a woman in an abusive 

situation is at high risk for serious injury or death. Some of the key findings at^ < the following: 

Q: 

Leaving or wing to end the relationship 

great, but there was also potential risk. 

For women who left or tried to end the relationship, the potential gake Most clinidhospital women (85%) who had experienced severe 

violence in the past year had also left or tried to end the relationstrip, 

compared to 66% of women who had experienced less severe 

incidents. 

Half of the women who had experienced a severe incident andiwtro 

had left or tried to end the relationship did not experience any iaeident 

on follow-up. This was about the Same for those who had not left ~r 

tried to end the relationship. Thus, overall, trying to ka\ledjd.nQt 

increase the risk of continued violence for these women. 

0 Clinidhospital women who had experienced less severe incidentsin 

the past year and who had left or tried to end the relationship were less 

likely to experience a follow-up incident than women who had mt left 

or tried to end the relationship. 

5 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
0 Clinidhospital women who had left or tried to leave in the past year 

were less likely to experience a follow-up incident, but when they did 

experience an incident, they were more likely to experience at least 

one severe follow-up incident. 

Women homicide victims: for 40% of the incidents in which a woman 

was killed, an immediate precipitating factor of the fatal incident was 

the woman leaving or trying to end the relationship. 

0 

Risk factors for women becoming a homicide offender 

abused women homicide offenders: 

Compared to women homicide victims and to clinidhospital women, 

0 were more likely to be married, to be in a long-term relationship, and to 

be the mother of at least one child 

0 were more likely to have experienced severe violence in the previous 

year, and the violence was more likely to have been increasing in 

frequency 

0 had many fewer resources, on average (more likely to be unemployed, 

less likely to have a high school education, more likely to be in poorer 

health) 

Risk factors for the fatal incident 

Compared to the 4,974 non-fatal incidents, the 87 fatal incidents: 

0 were much more likely to involve the threat or use of a knife or gun 

were much more likely to involve the woman being choked 

someone was more likely to be drunk, but they were equally likely to 

involve drug use 

Risk factors for homicide/suicide 

homicide. (Two more attempted suicide, and three committed suicide in the 

following year.) Compared to the 77 other fatal incidents: 

Ten of the 87 homicide offenders committed suicide immediately after the 

0 offenders who killed with a firearm were more likely to commit suicide 

substance use was more likely to be involved in homicide/suicides 

0 the offender was much more likely to be a man 

6 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
f 

4 

the victim was more likely to have been trying to leave or endm 

relationship 

e compared to other homicides or to the partners of clinidhaspital 

women, the offender was more likely to have previously tried w 

attempted suicide 

Severe or fatal violence did not necessarily escalate from past violence 

Clinidhospital women: 

for 27% of the 143 women who experienced only one 'hcidentin 

the past year, thatsingle incident was severe or life-lhatmhg 

the partner's drug-use was a strong risk factor for these mmen 

in 1596, there haeheen no prior violence against the womim 

the partner's drinking or drug use was a risk factor for Ikse 

homicides 

Homicide incidents: 

Past violence as a risk fadtoifor homicide 

at the Rands of her partner in thepast year. Three specific characteristics of past 

violent incidents were ret&& to-fuiwe, vhlence: 

Recency (the number dstays-since tbe4ast incident) 

In the majority of homicides (€E%), the woman had experienced vi~knce 

cIinic/hospM larsmren;-@gih:pmbability of violence on follow-up when 

last incident happened withiri30 days, whatever the incident's sadly 

homicide women: for half of victims and 75% of offenders, the 

incident happened within 30 days 

an especially irqmrtant&k'&xtor for women homicide offenders 

clinic/hospital mmn~@$h-p&bability ofviolence on follow-up rahen 

there were me brt&nriaddents in the past year 

Frequency: incidents inmasing iri keqmncy 

Type of past violence 

weapon threat or Wfgnrcokknife) 

woman was cbokeckoggabbbd around the neck 

7 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
Seeking Help and Interventions 

Almost every woman had sought help after an incident in the past year, 

either informal (talking to someone) or formal (medical, counseling, contacting 

the police). 

0 but the few women who had not were at high risk for continued 

violence 

0 over a third of Latina/Hispanic women did not seek help of any kind, 

formal or informal, even those women who had experienced severe 

violence 

Women were much more likely to seek medical help or to contact the 

0 medical staff and police may be “gate keepers” giving women 

information about counselors or agencies 

0 pregnant women were much less likely to seek help from any formal 

resource, even when they had experienced severe violence 

women being abused by a woman hardly ever contacted the police 

Women who were actively seeking help from formal resources were also 

Clinic/hospital women: seeking help in the past year was associated 

with severe violence on follow-up 

Homicide women: were usually more likely than clinic/hospital women 

to have sought help in the past year. 

Women homicide offenders were much more likely to have contacted 

the police, than women victims or clinidhospital women. 

police than to consult an agency or counselor. 

experiencing severe violence. 

Implications for research 

Recognize the complexity of women’s lives 

Develop a collaborative culture 

Measure “strangulation” as a method of violence in law enforcement and 

public health epidemiological data sets 

8 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
Implications for practice c Assessing risk for lethal violence: 

0 ask: when did the last incident happen? 

0 don’t assess a woman’s risk by-zamgle incident, even the most necenf 

be aware of abused women at risKfor becoming a homicide olknder 

pay attention to women at risk for a first, explosive incident 

take advantage of opportunities to-ask women if they want informatian 

about sources of help, such as anagency or counselor 

Medical staff 

open avenues of communication withvpregnant women 

Recognize that active help-seeking carries not only potential gain, bid 

also potential risk 

Medical and law enforcement staff: 

All helping professionals: 

CWHRS published reports and other products 

of the date of this ”Project at a Glance.” Other-reports are in progress (see 

below). In addition, the CWHRS would be happy to provide copies of pmjecl 

instruments to people who are working on similar studies. To request any of 

these products, or to ask to be put on a mlligg-list to receive a notice of the 

publication of additional products, please ccm&ct the Illinois Criminal Justice 

Information Authority, 120 South Riverside Plaza, Chicago, IL 60606; phone: 

312-793-8550; e-mail: BBlock@iciia.state.il.us; Or visit the ICJIA web site 

http://w.iciia.state.il. us/public/index.cfm. 

Block, Carolyn Rebecca, with contrbtians by Christine Ovcharcbyn 

Devitt, Michelle Fugate, Christine Martin, Tmg Pasold, Sara Naureckas, DiclaeUe 

Fonda, Barbara Engel, Sara M. Naurecks., %im A. Riordan, Judith Mcfarlane 

and Gail Rayford Walker (2000). 7he Chkqp Women’s Health Risk Study, Rbk 

of Serious Injury or Death in Intimate Videme.; A Collaborative Resea& Pl;oject 

Final Report to the National Institute of Justke. 

Riordan (1 999a). The Chicago Women’s Health Risk Study: Lessons in 

collaboration. Violence Against Women 5 (IO; October): 11 57-1 176. 

Riordan (1 99913). Collaboration in the Chicago Women’s Health Risk Sfudx. 

The following are the reports of the CWHRS that have been publisM as 

Block, Carolyn Rebecca, Barbara EngeF, Sara M. Naureckas and Kim A 

Block, Carolyn Rebecca, Barbara EnpE Sara M. Naureckas and Kim A 

9 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
Research Brief: May, 1999. Chicago: Illinois Criminal Justice Information 

Authority. 

Christine dvcharchyn Devitt (1 999). Beyond public records databases: Field 

strategies for locating and interviewing proxy respondents in homicide research. 

Homicide Studies 3 (4, November): 349-366. 

McFarlane, Judith, Carolyn Rebecca Block, Gail Rayford Walker and 

Christine Ovcharchyn Devitt (1 999). When homicide data bases do not answer 

the questions: Field strategies for locating and interviewing proxies. Proceedings 

of the 1999 Annual Meeting of the Homicide Research Working Group, FBI 

Academy, Quantico, Virginia. 

Block, Carolyn Rebecca, Judith M. McFarlane, Gail Rayford Walker and 

Works in progress 

Devitt, Michelle Fugate, Eva Hernandez, Kim Riordan. 

Rebecca Block, Christine Devitt, Michelle Fugate. 

Engel, Michelle Fugate, Mary Hunter, Debra Kirby, Leslie Landis, Sara 

Naureckas, Kim Riordan, Carole Warshaw. 

Campbell, Debra Clemmons, Eva Hernandez, Teresa Johnson, Sara Naureckas, 

Kim Riordan, Roxanne Roberts. 

Fact Sheet on Key Findings. Authors: Carolyn Rebecca Block, Christine 

Summary of Findings for CWHRS Respondents. Authors: Carolyn 

Help-seeking, Intervention, and Continued Abuse. Authors: Barbara 

Universal screening. Authors: Carolyn Rebecca Block, Jacquelyn 

Pediatric issues in domestic violence. Authors: Sara Naureckas. 

Risk factors for LatinaIHispanic women. Authors: Nanette Benbow, Alicia 

Contreras, Eva Hernandez, Sara Naureckas. 

Evaluation of the predictive validity and reliability of the Danger Assessment. Authors: Carolyn Rebecca Block, Jacquelyn Campbell, Sara Naureckas. 

Are There Types of Intimate Partner Homicide? To be presented at the 

Homicide Research Working Group annual workshop, June 2000. Authors: 

Carolyn Rebecca Block, Christine Ovcharchyn Devitt, Edmund R. Donoghue and 

Roy J. Dames. 

Who becomes the victim and who the offender in Chicago intimate partner 

homicides? To be presented in November, 2000, at the American Society of 

Criminology meetings. Authors: Carolyn Rebecca Block, Christine Ovcharchyn 

Devitt, Edmund R. Donoghue and Roy J. Dames. 

f 

10 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
Collaborating agencies and individuals in the CWHRS 

Mayor's Office on Domestic Vrolence: Leslie Landis, Domestic Vmlenae 

Chicago Police Department, Ikmestic Violence Unit: Lt. Debra KirbyErie Family Health Center: Szm:Maureckas, Pediatrician, Eva Hew 

Chicago Department of PhliWlth: Gloria Lewis, former Dmctw of 

Project Manager 

Officer Mary V. Jensen, Mary Hunh 

Director of Community Services 

Violence Programs, Nanette Benbow, Epidemiologist, Debra Clemmons, 

Director, Roseland Health Center 

Cook County Medical ExaminetesTOffice: Edmund R. Donoghue, MDChief Medical Examiner, Roy J. Dam,Executive Director 

Cook County Hospital: Carole ,Warshaw, M.D., Director, Behaviorill 

Science Department, Roxanne Robe*,' M.D., Trauma Office 

Chicago Abused Women Coalitii: Olga Becker, Director, Kim Riorefan, 

Director of the Hospital Care Interventbn Project 

Illinois Criminal Justice InfonwtbnAuthority: Carolyn Rebecca Block, 

Principal Investigator, Christine Marfii, Christine Devitt, Michelle Fugate, projed 

Co-Managers, James Coldren, Reseaxch'Consultant, Dickelle Fonda, Pmje13 

Counselor, Teresa Johnson, FoIlovv~up Camdinator and Interviewer 

Interviewers: Alicia Contrem, Cbmaine Hamer, Teresa Johnson, Rosa 

Martinez, lliana Oliveros, Gail Rayfosl'Wlker 

Individual Collaborators: JacqudyrXampbell, Johns Hopkins Un'hmsity, 

School of Nursing, Alice J. Dan, UIC Center for Research on Women & Gender, 

Barbara Engel, Illinois Criminal Justice Information Authority Member, Holly 

Johnson, Canadian Centre for Justice Statistics, Stephanie Riger, Directord 

Women's Studies, University of Illinois atChicago, Daniel Sheridan, Oregon 

Health Sciences University School ofiMlrr@iag, Richard Tolman, University 04 

Michigan, School of Social Work 

And many others! 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.
The CWHRS was supported by grant #96-IJ-CX-O020 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. 

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

Study 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, lliana 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. 

Printed by the State of Illinois. 

PROPERTY OF 

National Criminal Justice Reference Service (NCJRS) 

12 

c 

This document is a research report submitted to the U.S. Department of Justice. This report

has not been published by the Department. Opinions or points of view expressed are those

of the author(s) and do not necessarily reflect the official position or policies of the U.S.

Department of Justice.