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Danger Assessment by Jacquelyn C. Campbell, PhD, RN, Montana

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DANGER ASSESSMENT

Jacquelyn C. Campbell, PhD, RN

Copyright 2004 Johns Hopkins University, School of Nursing

Several risk factors have been associated with increased risk of homicides (murders) of women and men in violent relationships. We cannot predict what will happen in your case, but we would like you to be aware of the danger of homicide in situations of abuse and for you to see how many of the risk factors apply to your situation.

Using the calendar, please mark the approximate dates during the past year when you were abused by your partner or ex partner. Write on that date how bad the incident was according to the following scale:

1. Slapping, pushing; no injuries and/or lasting pain

2. Punching, kicking; bruises, cuts, and/or continuing pain

3. "Beating up"; severe contusions, burns, broken bones

4. Threat to use weapon; head injury, internal injury, permanent injury

5. Use of weapon; wounds from weapon

(If any of the descriptions for the higher number apply, use the higher number.)

Mark Yes or No for each of the following. ("He" refers to your husband, partner, ex-husband, ex-partner, or whoever is currently physically hurting you.)

1. Has the physical violence increased in severity or frequency over the past year?

2. Does he own a gun?

3. Have you left him after living together during the past year?

3a. (If have never lived with him, check here)

4. Is he unemployed?

5. Has he ever used a weapon against you or threatened you with a lethal weapon?

(If yes, was the weapon a gun?)

6. Does he threaten to kill you?

7. Has he avoided being arrested for domestic violence?

8. Do you have a child that is not his?

9. Has he ever forced you to have sex when you did not wish to do so?

10. Does he ever try to choke you?

11. Does he use illegal drugs? By drugs, I mean "uppers" or amphetamines, speed, angel dust, cocaine, "crack", street drugs or mixtures.

12. Is he an alcoholic or problem drinker?

13. Does he control most or all of your daily activities? For instance: does he tell you who you can be friends with, when you can see your family, how much money you can use, or when you can take the car?

(If he tries, but you do not let him, check here)

14. Is he violently and constantly jealous of you? (For instance, does he say "If I can't have you, no one can.")

15. Does he follow or spy on you, leave threatening notes or messages on answering machine, destroy your property, or call you when you don’t want him to?

16. Have you ever been beaten by him while you were pregnant?

(If you have never been pregnant by him, check here)

17. Have you ever threatened or tried to commit suicide?

18. Has he ever threatened or tried to commit suicide?

19. Does he threaten to harm your children?

20. Do you believe he is capable of killing you?

Total "Yes" Answers

Thank you. Please talk to your nurse, advocate or counselor about what the Danger Assessment means in terms of your situation.

(01/05)

Name of person completing form:

Date:

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Overview of the Danger Assessment by Jacquelyn C. Campbell, PhD, RN, Montana

The Danger Assessment by Jacquelyn C. Campbell, PhD, RN, Montana is a validated clinical and advocacy instrument designed to assess the risk of lethal intimate partner violence. It pairs a 20-item yes/no lethality checklist with a calendar exercise and a scored risk index to help practitioners identify elevated danger and prioritize safety planning. The Montana-adapted form follows Campbell’s methodology while allowing local resource references. It is intended for use by trained clinicians, victim advocates, law enforcement partners, and social service staff as part of a broader risk-management process.

Why this assessment matters for safety and case management

The Danger Assessment provides objective, reproducible information that supports safety planning, triage, and appropriate referrals. Its structured questions and scoring help identify cases with heightened risk that may need immediate interventions, coordinated response, or law enforcement notification.

Why this assessment matters for safety and case management

Primary users and how they typically apply the tool

Professionals across health, justice, and social services commonly use this assessment to inform risk-based decisions and referrals.

  • Advocates and victim-service staff — Use during intake to prioritize safety planning and referrals to shelters, hotlines, and legal services.
  • Healthcare clinicians — Use in emergency, primary care, or behavioral health settings to identify immediate danger and document risk factors.
  • Criminal justice professionals — Use for risk triage, pretrial assessment, and to inform interagency safety measures.

Use is most effective when paired with training, local protocols, and documented safety planning that reflects the assessment outcome.

Step-by-step completion flow for a single assessment

Follow these steps in sequence to complete, document, and route the Danger Assessment consistently within agency workflows.

  • 01
    Prepare file: Ensure consent and privacy notices are understood before starting.
  • 02
    Complete checklist: Answer all 20 items and finish the calendar portion.
  • 03
    Score and interpret: Calculate the total per Campbell’s scoring guide and note risk tier.
  • 04
    Document plan: Record safety plan steps, referrals, and any follow-up actions.

Core elements included in the Montana Danger Assessment

The assessment is structured so each component supports risk evaluation, documentation, and practical safety planning in clinical and advocacy contexts.

20-item checklist

A standardized yes/no set of questions focused on past behavior, escalation, access to firearms, and controlling patterns that correlate with lethality risk.

Calendar history

A month-by-month incident calendar captures frequency and pattern of violence, providing context for the checklist score and recent escalation.

Scoring index

A numeric tally converts checklist responses into risk strata used to prioritize immediate interventions and resource allocation.

Safety planning notes

A dedicated section to record individualized safety steps, emergency contacts, shelter options, and legal resources using locally relevant contacts.

Referral log

Space to note resource referrals, dates made, and client responses, aiding continuity across agencies and subsequent follow-up.

Provider signature

Signer identity, role, and date document who completed the assessment, supporting record integrity and case handoffs.

Key data elements to capture and store

Full legal name: Exact name entry
Assessment date: MM/DD/YYYY format
Incident dates: Specific calendar entries
Perpetrator details: Name and relationship
Assessment score: Numeric risk index
Signature metadata: Signer ID and timestamp

Potential legal and operational risks from incorrect completion

Underreporting risk: Missed danger indicators
Privacy breach: Improperly stored PHI
Evidence gaps: Incomplete incident dates
Consent issues: Insufficient documented consent
Misinterpretation: Score used as sole decision
Noncompliance: HIPAA or agency policy violation

Common mistakes to avoid when preparing the assessment

  • Leaving checklist items blank or marking uncertain answers instead of clarifying events undermines the score and can delay appropriate safety measures.
  • Failing to use precise incident dates on the calendar makes it harder to detect escalation patterns and reduces the assessment’s usefulness for risk prediction.
  • Retaining assessments in unsecured personal email or shared drives can violate privacy rules and expose sensitive protected health information.
  • Relying on the assessment alone for legal or custody decisions without corroborating evidence and professional evaluation may be inappropriate and legally risky.

Digital workflow overview for e-submission and recordkeeping

A consistent digital process reduces transcription errors and preserves audit trails while supporting secure sharing among authorized partners.

  • Upload form: Use PDF or DOCX version of the assessment.
  • Place fields: Add signature, date, and required text fields for completion.
  • Authenticate signer: Use email, SMS code, or stronger authentication when required.
  • Capture audit trail: Retain timestamps, IP, and signer attribution.

Recommended digital settings when configuring the assessment workflow

Configure a workflow that balances low signer friction with appropriate authentication and secure retention aligned to agency policy.

Field Configuration
Authentication method Email link or SMS code; use multi-factor for high-risk cases
Document format PDF preferred for long-term archival and consistent rendering
Retention policy Encrypt in storage and retain per HIPAA and IRS guidance
Access controls Role-based access for caseworkers and limited export permissions

Technical considerations for e-signature and secure sharing

Choose a platform that supports the file formats you use and provides clear audit trails for signed assessments.

  • File formats: PDF, DOCX
  • Integrations: Salesforce, NetSuite, Google Workspace
  • Security: AES-256 at rest

Frequently asked questions about using and storing the Danger Assessment

Answers below address common practical, legal, and technical questions encountered during completion, signing, and retention of the assessment.


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