For Tiffany, abuse was a common thread throughout the early part of her life. She watched her father physically abuse her mother, and she was sexually abused herself by other family members.

In Tiffany’s first relationship, with her oldest daughter’s father, what started as verbal abuse and threats escalated to physical violence, forcing Tiffany to flee.

Her next relationship was also abusive, almost costing her her life, Tiffany recounted during an Emerge Center Against Domestic Abuse event honoring her as the organization’s mother of the year.

“I’m gasping for air, meanwhile I have toddler kids at the door,” Tiffany said, adding that while the children couldn’t see the violence their father was inflicting on her, they were able to hear through the bedroom’s closed door.

Her boyfriend left the home believing he had killed her, said Tiffany. The Star is not identifying Tiffany by her full name because she is a survivor of domestic abuse.

Tiffany would eventually call Emerge, which welcomed her and her children into an emergency shelter. She had access to services, including a therapist.

“I’ve been abused my whole life,” Tiffany said. “I’m finally not afraid to say what happened to me.”

Emerge helped Tiffany get her nursing career back on track, after one of her previous boyfriends prevented her from pursuing. She’s currently working as a licensed practical nurse and is in school to become a registered nurse in Arizona.

“I can say now, I feel I’m living my best life,” Tiffany said.

Tiffany’s story is similar to thousands of others in Pima County, as local victim service providers have seen a steep increase in domestic violence survivors seeking help over the past year, following the statewide implementation of a risk assessment protocol.

In December 2017, the state Supreme Court adopted the Arizona Intimate Partner Risk Assessment Instrument System as the standardized form presented to judges during defendants’ initial appearances following a domestic violence arrest. In April 2018, the mandate went into effect.

The assessment asks questions about physical violence in the relationship, along with questions about the defendant’s access to guns, substance use habits, if jealously or controlling behaviors are present in the relationship and if the defendant has ever strangled or choked the victim.

All seven law enforcement agencies in Southern Arizona have been using the screening form for the past year, with 4,060 screenings completed countywide between April 2018 and March 2019. Of those screenings, 57% or 2,306 victims flagged as high or elevated risk, according to data provided by TPD.

Nearly 2,000 cases were referred to Emerge for services, according to the data.

Officers responding to domestic violence calls fill out the APRAIS form with the victim and attach it to the defendant’s court file for a judge to consider when deciding on conditions of release. Before April 2018, only victims in felony domestic violence cases were subject to the lethality assessment, but now the screening is also given to victims in misdemeanor cases.

In cases where the APRAIS form reveals high or elevated risk to the victim, judges can impose restrictions on the defendant, including barring that person from returning to the home where the victim lives, prohibiting consumption of alcohol, requiring the defendant post bond in a certain dollar amount to secure future court appearances, placing the defendant under active supervision by the court’s Pretrial Services Agency, or prohibiting the defendant from possessing firearms, said Deputy Pima County Attorney Amelia Cramer.

In 2015, Everytown for Gun Safety and the Arizona Coalition to End Sexual and Domestic Violence released a report that said 62 percent of women killed by intimate partners in Arizona were shot to death — a rate 45% higher than the national average.

While it will take three to five years to be able to evaluate the effectiveness of the lethality assessment, a review of the Tucson Police Department’s seven intimate partner homicides in 2018 — up one from the previous year — showed that none of the victims completed an APRAIS form with TPD officers prior to the their deaths, said Assistant Chief Carla Johnson.

“They were either people who we as an agency have not had contact with before, or if they had contact, it was with another jurisdiction and they had not been subjected to the APRAIS lethality assessment by those folks,” Johnson said. “That made me feel good. We could still have had one where they used the checklist and someone still gets murdered, because you can’t force people to accept services.”

The department has hosted domestic violence training for nearby criminal justice agencies, as well as for Lutheran Social Services of the Southwest for refugees on local laws surrounding domestic violence and available services in the community, Johnson said.

“A lot of folks that don’t live here and aren’t part of the culture don’t understand the domestic violence laws,” Johnson said. “This is an opportunity to educate them on the laws so they don’t get caught up in behaviors they think are normal.”

Tucson Police have also created a system in collaboration with the Pima County Sheriff’s Department allowing the two agencies to see if domestic violence suspects have warrants in either of the two jurisdictions.

Oversight has also increased for convicted domestic violence offenders. An arrest alert program with the Pima County Attorney’s Office alerts officials if any of 520 flagged domestic violence offenders is booked on another domestic violence charge within a certain time period of his or her conviction, making the new arrest a felony.

“There’s a lot more information sharing,” Johnson said. “I think there’s a whole push in southern Pima County to do as much as possible in this area.”

In Arizona, 35 police departments are using the APRAIS form, and it is anticipated that number will increase to 70 by the end of 2019, Johnson said.

In recent years, the conversation surrounding domestic violence has increased in public spaces, which Johnson believes helps victims feel more comfortable coming forward and seeking help.

“Anytime you make something visible, it helps,” Johnson said. “If you just start talking about it, it de-stigmatizes it, and then you have opportunities to educate people about those issues. It’s the silence that kills.”

While the numbers of victims flagging as high or elevated risk is higher than anyone would like to see, Johnson is hopeful by how many victims were receptive to referrals to Emerge.

“Even if it takes just three times to leave instead of seven times to leave, that’s a victory,” Johnson said. “Because every time there’s an incident, there’s a danger. There’s a risk.”

EYE-OPENING

While domestic violence calls have always been one of Victim Services’ highest call volumes for on-scene response, the numbers have increased sharply in the time since APRAIS went into effect, said Vanessa Helms, director of PCAO’s Victim Services Division.

While Victim Services has always offered on-scene crisis response, the follow-up component is somewhat of a new thing, Helms said.

Some victims might request follow-up assistance from crisis advocates at the scene and Victim Services always provides follow-up if a case progresses through the criminal justice system, but if no arrest is made, that used to be where Victim Services’ work ended, Helms said.

But with funding last year from a Tucson Foundations grant, the division was able to hire two new advocates specifically to provide follow-up for victims identified through APRAIS.

“That has been the biggest change for us: Our ability to be able to connect with victims, even if it isn’t on the scene, within 48 hours of the incident,” Helms said. “We find that provides an opportunity for victims to feel supported from the get-go and essentially seem to be more engaged in prosecution because they feel like they have a voice, which otherwise they may not have.”

Prior to APRAIS, Victim Services volunteers and advocates also had very limited contact with victims in misdemeanor cases. Occasionally, they’d be called by detectives to assist at the scene in misdemeanors, but the majority of their responses were to felony cases.

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“There’s just this assumption that they’re more serious when they’re felonies, which in the moment, they are. In the moment there’s a serious assault or a weapon utilized or that sort of thing,” Helms said. “In misdemeanors, it may appear be more ‘minor’ incidents, but what we know with APRAIS is we get an idea of the historical context of the abuse, and we can see that even if that time it was just a punch through the wall, that a victim is at high risk because they’ve previously been strangled or their life has been threatened.”

The idea is that by connecting a victim who flags as high or elevated risk to services, could prevent a felony from occurring.

The education component that APRAIS provides victims is also impactful, Helms said, adding that “information is power.”

“To recognize that there’s a risk involved can be really eye-opening,” Helms said. With APRAIS, “they get to make decisions based on that information that they wouldn’t have had otherwise.”

CRISIS RESPONSE

Emerge was hit hard by the influx in victims seeking services, with more than 2,600 hundred victims referred to the center, said CEO Ed Mercurio-Sakwa.

“In previous years, we’ve still had a similar partnership and countywide protocol related to lethality and risk assessment, but up until now it had only been used with felony cases, which is about 10 percent of all domestic violence cases,” Mercurio-Sakwa said. “This year, it expanded to misdemeanors and that’s where the numbers blew up.”

Not every victim chose to access services, but “a whole heck of a lot of them did,” Mercurio-Sakwa said, with 1,245 receiving services through the APRAIS protocol.

In 2017, 53 people went through the emergency shelter through the old lethality assessment procedure. Between April 2018 and March 2019, the shelter saw 117 victims come through, plus 130 children, Mercurio-Sakwa said.

“It put a very significant strain on us. Even though we had some forewarning that this was happening, we didn’t have enough warning to be able to really ramp up our capacity,” Mercurio-Sakwa said. “One of the things we’ve struggled with is to just make sure we had enough resources available to respond to all of these people now reaching out.”

Research has shown that the mere act of a victim accessing services greatly reduces their chance of fatality, Mercurio-Sakwa said.

“The flip side is, we have to have the resources available for them when they call,” Mercurio-Sakway said. “That’s what we’ve been working with over the last year is trying to strike that balance of making sure that as that demand grows, so do our resources.”

Emerge is in need of supplies to meet people’s basic needs, along with staff and volunteers to assist with victims.

“Domestic violence is so often seen as a private matter, a relationship matter, and we just know that that is not the case,” Mercurio-Sakwa said. “It cannot be solved by the parties involved without help, and we certainly cannot leave it on the shoulders of victims to try to find their way out of a controlling and dangerous situation.”

The fact that APRAIS has generated more people needing services doesn’t mean that there’s more domestic violence, but rather that the community, through the APRAIS response system, has made it easier for victims to know about and access that help, Mercurio-Sakwa said.

In advance of the April 2018 APRAIS roll-out, the county attorney’s office sought funding from the U.S. Department of Justice’s Bureau of Justice Assistance and Tucson Foundations to help train law enforcement agencies, hire additional advocates in the Victim Services division and additional support services for those deemed at highest risk of harm.

The grant funding was for one year, and Cramer said they’re not sure if the funds will be re-issued. Emerge just submitted the final grant report about their use of funds to the Tucson Foundation, and Cramer said the coalition hopes to be given permission from the foundation for another annual grant, but won’t hear back about that for some time.

“Our coalition continues to look for a variety of public and private grant-funding agencies to whom we can apply for much-needed funding for victim services, shelter housing, forensic strangulation exams, training, and civil legal services, among other things,” Cramer said.

Contact reporter Caitlin Schmidt at cschmidt@tucson.com or 573-4191. Twitter: @caitlincschmidt

I'm a watchdog reporter covering local government, the University of Arizona and sports investigations.