Sequential Intercept Model

Introduction

The Sequential Intercept Model was developed by Mark Munetz and Patricia Griffin (2006) to help communities understand the way people with mental health issues interact with the criminal justice system and to target interventions to prevent people from getting deeper involved in the system.

The Sequential Intercept Model is usually focused around 5 broad target points, or areas where people with mental health issues may find themselves in contact with police or legal officials.

The five Intercepts are:

  1. Law Enforcement
  2. Initial Detention / Court Hearings
  3. Jail / Court
  4. Re-Entry
  5. Community Corrections

The model was based on ensuring that people with mental health issues are not forced into the criminal justice system at greater rates than people without mental health issues.

Law Enforcement and Emergency Services

Noting that up to 10% of police calls by patrol officers involve mental health issues (Cordner, 2006), the first interception point is front-line police and emergency services workers. Munetz & Griffin (2006) describe several strategies to help intervene at this point:

  • Mobile Crisis Teams of mental health workers
  • Employing mental health workers as civilians in the Police Service
  • Pairing police officers with mental health workers to go on patrol calls
  • Specially trained mental health police officers

All of these approaches involve combining front-line policing with mental health support to ensure that sensitivity is respected. Emergency services may also respond to mental health issues where individuals are psychotic or otherwise struggling with a connection to reality, which can put these staff in danger.

Initial Detention / Court Hearings

After an individual has been arrested, the next interception point of the sequential intercept model is initial detention and hearings post-arrest. Individuals may be diverted at this point to programs for non-violent, low level crime (such as petty theft or trespassing) based on the symptoms of their mental illness.

Diverting this individual to mental health treatment can avoid exacerbating their mental health issues. Additionally the court may “employ mental health workers to assess individuals after arrest in the jail or the courthouse and advise the court about the possible presence of mental illness and options for assessment and treatment, which could include diversion alternatives or treatment as a condition of probation.”

Jail / Court

Individuals who have mental illnesses and get involved in the criminal justice system are likely to spend a significantly longer jail term than individuals with the same charges who do not have mental illnesses. (Hoke, 2015) For this reason, the third intercept point is the jail or court system, where many individuals with mental illness are managed.

One important opportunity is the establishment of Mental Health Courts set up specifically for people with diagnosed mental illnesses relevant to their crimes.

Re-Entry

After an individual has exited the court system (if on probation) or jail (if sentenced to serve time), it is time for them to re-enter society. Transition points like this are times where an individual may be feeling the least supported and at greatest risk of suicide (Pease, Billera & Gerard, 2016) or of reoffending. (Caudill & Trulson, 2016) Discharge planning is common in hospitals but not in jail, which can make continuing care difficult for clients who are released from jail.

One potential model for solving this noted by Munetz & Griffin is the APIC (Assess, Plan, Identify, and Coordinate) Model by Osher, Steadman & Barr (2003). This plan “highlights the importance of collaboration among multi-sectoral community partners to ensure that the community is committed to the transition process.” (Evidence Exchange Network, 2014)

Community Corrections

The final intercept in the Sequential Intercept Model is community corrections, which is probation or parole. Since mental health treatment is often a condition of staying out of jail, these individuals represent an excellent opportunity to help those in the criminal justice system continue to access care, despite the adversarial nature of the parole/probation relationship.

References

Evidence Exchange Network for Mental Health and Addictions. (2014). “The Assess, Plan, Identify, and Coordinate (APIC) Model.” Retrieved on March 15, 2017 from http://eenet.ca/wp-content/uploads/2014/04/APIC-summary-addendum_March2014.pdf

Caudill, J. W., & Trulson, C. R. (2016). The hazards of premature release: Recidivism outcomes of blended-sentenced juvenile homicide offenders. Journal Of Criminal Justice, 46219-227. doi:10.1016/j.jcrimjus.2016.05.009

Cordner, G. (2006) “People with Mental Illness”. Center for Problem-Oriented Policing. No 4. Retrieved on March 17, 2017 from http://www.popcenter.org/problems/mental_illness/print/

Pease, J. L., Billera, M., & Gerard, G. (2016). Military Culture and the Transition to Civilian Life: Suicide Risk and Other Considerations. Social Work, 61(1), 83-86. doi:10.1093/sw/swv050

Hoke, S. (2015). Mental Illness and Prisoners: Concerns for Communities and Healthcare Providers. Online Journal Of Issues In Nursing, 20(1), 1. doi:10.3912/OJIN.Vol20No01Man03

Osher, F., Steadman, H. J., & Barr, H. (2003). A Best Practice Approach to Community Reentry From Jails for Inmates With Co-Occuring Disorders: The APIC Model. Crime & Delinquency, 49(1), 79.

Munetz, M.R. & Griffin, P.A. (2006) Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness. Psychiatric Services. 57(4) Accessed electronically on March 25, 2016 from http://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2006.57.4.544

Cite this article as: MacDonald, D.K., (2017), "Sequential Intercept Model," retrieved on June 26, 2019 from http://dustinkmacdonald.com/sequential-intercept-model/.
Facebooktwittergoogle_plusredditmailby feather

Threat Assessment in Education

Introduction

With an increase in school shootings, such as the 1999 Columbine shootings and the 2012 Sandy Hook shooting, it has become more important for educators, police and mental health professionals. This article reviews the literature on threat assessment in schools, primarily focusing on elementary and secondary schools.

Safe Schools Initiative

The Safe Schools Initiative “examined incidents of targeted school violence from the time of the incident backward, to identify the attackers’ pre-incident behaviors and communications and to explore whether such information might aid in preventing future attacks.” (Vossekuil, et. al., 2004)

The Safe Schools Initiative developed out of the same threat assessment process used and refined by the Secret Service in their examination of threats against public officials, called the Exceptional Case Study Project (ECSP) that examined violence focused on a particular individual and leading to credible threats. (Fein, et. al., 2002)

The ten key findings of the Safe Schools Initiative are listed below (Vossekuil, et. al., 2004):

  1. Incidents of targeted violence at school rarely were sudden, impulsive acts
  2. Prior to most incidents, other people knew about the attacker’s idea and/or plan to attack
  3. Most attackers did not threaten their targets directly prior to advancing the attack
  4. There is no accurate or useful “profile” of students who engaged in targeted school violence
  5. Most attackers engaged in some behavior prior to the incident that caused others concern or indicated a need for help
  6. Most attackers had difficulty coping with significant losses or personal failures. Moreover, many had considered or attempted suicide
  7. Many attackers felt bullied, persecuted, or injured by others prior to the attack
  8. Most attackers had access to and had used weapons prior to the attack
  9. In many cases, other students were involved in some capacity
  10. Despite prompt law enforcement responses, most shooting incidents were stopped by means other than law enforcement intervention

Principles of Threat Assessment

There are six principles of the threat assessment process. (Fein, et. al., 2002; Vossekuil, Fein, & Berglund, 2015)

  1. Targeted violence is the end result of an understandable, and oftentimes discernible, process of thinking and behavior
  2. Targeted violence stems from an interaction among the individual, the situation, the setting, and the target
  3. An investigative, skeptical, inquisitive mindset is critical to successful threat assessment
  4. Effective threat assessment is based on facts rather than on characteristics or “traits.”
  5. An integrated systems approach should guide threat assessment inquiries and investigations
  6. The central question in a threat assessment inquiry or investigation is whether a student poses a threat, not whether a student has made a threat

Threat Assessment Screening Protocol

The “Student Threat Assessment and Management System – Level 1 Screening Protocol” (Salem-Keizer School District, 2010) provides a comprehensive process that begins with obtaining parental consent, exploring the threat and collecting information from the student and other resources (e.g. classmates), and finally – where available – having a mental health assessment conducted. All the information is documented and provided to the School Board and/or law enforcement so that follow-up action can be taken.

An important part of this document is the presence of a safety plan that allows the assessor to document the steps they have taken to mitigate the risk of danger.

This screening protocol covers the Key Questions identified by the ECSP and SSI studies as important to assessing threats, which include:

  • Motives and goals for the violence
  • Who the individual has talked to about their plans or thoughts
  • Whether they’ve researched other cases of violence
  • Have knowledge of or access to weapons
  • What previous violence they may have engaged in (stalking, harassing, preparing or rehearsing attacks)
  • Their mental state (including hopelessness or desperation)
  • How capable are they of committing an act of violence (logistically, organized)
  • Is there corroboration from other sources about the violence? Do the people around the individual have concerns?
  • Are there attitudes supporting violence? (E.g. seeing it as acceptable; this is also a part of the Spousal Assault Risk Assessment tool that explores individual violence)
  • Are there modifiable risk factors that could increase or decrease the individual’s level of risk?

Training in Violence and Threat Risk Assessment

The Canadian Centre for Threat Assessment and Trauma Response has developed the  Violence Threat Risk Assessment (VTRA) which comes in two levels. Level 1 VTRA is designed for front-line staff including educators, administrators, police officers, mental health workers and others who may need to perform risk assessment in the educational setting.

Level 2 VTRA is designed for actual risk assessment and interviewing potentially violent individuals. It is designed as a follow up to the Level 1 VTRA. A variety of other organizations provide generic threat assessment training focusing on elementary and secondary schools.

Books on Threat Assessment

Threat Assessment in Post Secondary

So far we have looked at threat assessment in an elementary and secondary school environment but there is work being done on the post-secondary side (colleges and universities) as well, given well-known attacks such as the 2007 Virginia Tech Massacre.

Perloe & Pollard (2016) explains the role of counsellors at a college with a Threat Assessment and Management (TAM) team, also called (e.g. in Bolante & Dykeman, 2015) a Threat Assessment Team (TAT). Counsellors are advised to provide consultation to non-clinical members of the team and be one part of a multifacted approach, but, where possible, avoid being the treatment provider of any student of concern directly to avoid breaching confidentiality.

Perloe & Pollard also point out that forensic violence risk assessment in this context is different from the normal suicide risk assessment or violence-to-others assessment that clinicians are normally familiar with and so outside professionals may be required to competently assess risk.

Bennett & Bates (2015) note the importance of establishing a culture where reporting is encouraged. Given that the vast majority of threats never lead to an incident of violence, students and staff should know that reporting will not result in punitive measures but rather a collaborative approach to help the individual cope with their feelings.

The U.S. Department of Justice, through their Community Oriented Policing Services produced “Campus Threat Assessment Case Studies” (2008) as a training aid.

Conclusion

Threat assessment is an emerging field that requires a coordinated, professional response at both the elementary/secondary and the post-secondary levels.

For counsellors, specialized training in forensic violence risk assessment is important to ensure that they respond competently and effectively. For educators and police officers, building partnerships with the community and encouraging reporting so that safety plans can be put into place will help mitigate the risk of violence.

References

Bennett, L., & Bates, M. (2015). Threat Assessment and Targeted Violence at Institutions of Higher Education: Implications for Policy and Practice Including Unique Considerations for Community Colleges. JEP: Ejournal Of Education Policy, 1-16.

Bolante, R., & Dykeman, C. (2015). Threat assessment in community colleges. Journal Of Threat Assessment And Management, 2(1), 23-32. doi:10.1037/tam0000033

Department of Justice. (2008) Campus Threat Assessment Case Studies. Retrieved on July 30, 2016 from http://ric-zai-inc.com/Publications/cops-w0693-pub.pdf

Fein, R., Vossekuil, B., Pollack, W., Borum, R., Modzeleski, W., & Reddy, M. (2002). Threat assessment in schools: A guide to managing threatening situations and to creating safe school climates. Washington, DC: U.S. Secret Service and U.S. Department of Education.

Perloe, A., & Pollard, J. W. (2016). University counseling centers’ role in campus threat assessment and management. Journal Of Threat Assessment And Management, 3(1), 1-20. doi:10.1037/tam0000051

Salem-Keizer School District. (2010). VanDreal, J. “STUDENT THREAT ASSESSMENT AND MANAGEMENT SYSTEM – Level 1 Screening – Protocol”. Retrieved on July 30, 2016 from http://www.k12.wa.us/SafetyCenter/Threat/pubdocs/ThreatAssessmentandManagementSystem-Level1Protocol.pdf

Vossekuil, B., Fein, R.A., Reddy, M., Borum, R. & Modzeleski, W. (2004) The Final Report and Findings of the Safe School Initiative: Implications for the Prevention of School Attacks in the United States. United States Secret Service & United States Department of Education.

Vossekuil, B., Fein, R. A., & Berglund, J. M. (2015). Threat assessment: Assessing the risk of targeted violence. Journal Of Threat Assessment And Management, 2(3-4), 243-254. doi:10.1037/tam0000055

Cite this article as: MacDonald, D.K., (2016), "Threat Assessment in Education," retrieved on June 26, 2019 from http://dustinkmacdonald.com/threat-assessment-education/.
Facebooktwittergoogle_plusredditmailby feather

Basic Homicide Risk Assessment

Introduction to Homicide Risk Assessment

All mental health professionals in the US and Canada have an ethical duty to warn, the requirement to warn someone who is at risk of harm of that harm. This leads clinicians to conduct homicide risk assessments to determine the level of danger to others.

In therapy or crisis intervention, the clinician is required to breach a client’s confidentiality in order to make notifications for both homicide risk and suicide. The homicide notification was codified in Tarasoff v. Regents of the University of California (1976), a famous case where a psychologist was held liable after failure to take adequate steps to protect a woman that a client had confessed the desire to kill, when he did.

Borum & Reddy (2001) enumerated a variety of steps to performing a homicide risk assessment in a Tarasoff-style risk assessment, which is differentiated from a more long-term risk assessment by a focus on on clinical judgement than on an examination of actuarial risk factors. The ACTION steps below are used to perform the assessment.

To start, it’s important to clarify the difference between making a threat, and posing a threat. Someone who says they wish to hurt someone may not pose intent or take action that demonstrates an actual risk. Preparatory behaviours help guide the risk assessment, and include selecting a target, choosing the method, time and place of violence, acquiring means, and so on.

The goals of the Tarasoff homicide risk assessment will be:

  1. Is the client headed towards a violent act?
  2. How fast is the client moving towards that act, and do opportunities exist for intervention?

ACTION Steps for Tarasoff Homicide Risk Assessment

Attitudes in support of violence

Is the client demonstrating any antisocial attitudes or beliefs? If the client is at risk of harming their partner, do they hold misogynistic or patriarchal beliefs? The goal here is to determine whether the client believes that violence is a justified or normal response to this situation. The more justified the client believes he or she is, the higher the risk of violence.

Borum & Reddy also identify other factors to explore under attitudes:

  • Hostile attribution bias
  • Violent fantasies
  • Expectations about success of violence
  • Whether the client feels it will accomplish their goal

Capacity to carry out threat

Does the client have access to the means, and the intellectual capacity to carry out a criminal, violent act? They also need access to the target and opportunity. Stalking often precedes violent acts (Meloy, 2002) and this can lead to an individual learning about the target’s schedule and whereabouts.

Thresholds crossed in progression of behaviour

Any presence of lawbreaking indicates a “willingness and ability to engage in antisocial behavior to accomplish one’s objective.” Additionally, any kind of plan and preparatory behaviours to achieve this plan should be explored.

Intent to act vs. threats alone

It’s important to clarify the difference between an actual intent to act versus simple threats. On the distress line, we clarify with callers who make violent comments whether they actually intend to harm the person they’re speaking about, or whether their comments are a result of frustration.

Questioning the client helps suss out their intent, in addition to any preparatory behaviours, alternative plans to accomplish their aim (that may or may not involve violence.) A client who believes there is no other way to meet their goals are more likely to turn to violence.

Other’s knowledge of the client

Knowing how others respond to the client’s planned actions will help assess their potential for action. If many people around them respond negatively to their plan they may be less likely to follow through. On the opposite side, if their supports provide little resistance this can increase risk. The client’s self-report can also help inform their attitudes.

Non-compliance with strategies to reduce risk

Is the client willing and interested in reducing their chance of committing a violent act? If they have previously breached legal requirements like parole or court orders, or demonstrate a willingness to do so in the future, this raises their risk.

Appreciating the gravity of their mental health status and desire for treatment may also be important.

Further Reading

See the original article by Borum & Reddy for a more detailed review of the risk factors and additional items, or a book like Clinician’s Guide to Violence Risk Assessment by Mills, Kroner & Morgan.

Bibliography

Borum, R. & Reddy, M. (2001) Assessing violence risk in tarasoff situations: A fact-based model of inquiry. Behavioral Sciences and the Law. 19:375-385. doi: 10.1002/bsl.447

Meloy, J. (2002). “Stalking and violence.” In J. Boon and L. Sheridan (eds.) Stalking and psychosexual obsession: Psychological perspectives for prevention, polcing, and treatment. West Sussex, UK: John Wiley & Sons, Ltd

Tarasoff v. Regents of the University of California, 131 Cal. Rptr. 14 (Cal. 1976)

Cite this article as: MacDonald, D.K., (2016), "Basic Homicide Risk Assessment," retrieved on June 26, 2019 from http://dustinkmacdonald.com/basic-homicide-risk-assessment/.

Facebooktwittergoogle_plusredditmailby feather