Biopsychosocial Model of Violence Risk Assessment

Introduction

Violence risk assessment is an important element of counselling and crisis intervention. Although in high-risk situations it can (and should be) performed by clinicians with specific training in violence risk, there may be situations where clinicians or others (corrections officers, private practice therapists, crisis line supervisors, etc.) need to have a understanding of the principles of violence risk assessment in order to respond appropriately.

Types of Violence Risk Assessment

There are three types of violence risk assessment, based on the way risk is estimated or “calculated.” The first is unstructured professional judgement. This is where the clinician merely listens to the client and makes their best judgement, based on their existing professional training. (Murray & Thomson, 2010) While some professionals made good predictions relative to others, some were very poor. It emerged that the reason for this disparity was that some clinicians considered factors relevant to violence while others did not. Unstructured professional judgement no longer stands up in court.

The second form of risk assessment is known as actuarial risk assessment. This is an entirely mathematical technique that examines what factors were present in offenders who later went on to commit violent crimes. (Brown & Singh, 2014) This is similar to the approach used in insurance to calculate the likelihood a person will die, and has the same flaw as that approach: you can determine over a large pool what percentage of individuals will be violent, but you risk ignoring salient risk or protective factors in an individual that may heighten or reduce their violence risk.

The final form of risk assessment is Structured Professional Judgement (SPJ; Falzer, 2013). SPJ attempts to merge the predictive ability of the actuarial approach with the flexibility of the unstructured approach by providing a list of evidence-based risk factors (elements that have been demonstrated to increase risk of violence) along with a coding or scoring method to generate a “Low”, “Moderate”, or “High” risk, and usually the freedom to modify the scoring for items or list additional contributing factors that entered into a clinician’s assessment.

Static vs Dynamic Risk Factors

Static risk factors are elements that are known to increase risk that are not changeable. An example of static risk factors for violence include sex and age. As a male, you will always have elevated risk of violence versus a female (Sorrentino, Friedman, & Hall, 2016), and as someone who is aged 18-24 you will always have a heightened risk of violence relative to someone older or younger. (Harris & Rice, 2007) There is nothing a clinician can do to change your age or sex.

On the other hand, other risk factors are called dynamic risk factors. These are factors that can be modified by the clinician or by the client (Public Safety Canada, 2010), such as one’s peer group, use of alcohol or stimulants, or access to a pool of victims.

Affective vs. Predatory Violence

Affective violence is also called impulsive or reactive violence. (Berg, 2014) This is violence that results from a threat, causes an individual to experience physiological arousal (heart racing, blood pressure increase, etc.) and then to strike back in a “fight or flight” response.

In contrast, predatory violence is more common among psychopaths and serial killers. This is violence that is not associated with an increase in physiological arousal or an identified threat. Instead, the predatory killer “stalks his prey” and then strikes without warning.

Biopsychosocial Model Items

This model comes from “Violence Risk and Threat Assessment” by Meloy (2000), but closely matches other models of violence risk.

Individual/Psychological Domain

  • Male
  • Age
  • Past History of Violence
  • Paranoia
  • Intelligence Below Average
  • Anger/Fear Problems
  • Psychopathy / Other Attachment Difficulties

Social/Environmental Domain

  • Family of Origin Violence
  • Adolescent Peer Group Violence
  • Economic Instability
  • Weapons History/Skill/Interest and Approach Behaviour
  • Victim Pool
  • Alcohol/Psychostimulant Use
  • Popular Culture

Biological Domain

  • History of CNS Trauma
  • Signs and Symptoms
  • Objective CNS Measures
  • Major Mental Disorder

Assessing Psychological Factors of Violence Risk

The elements in the psychological or individual domain cover static and dynamic items that relate to the person’s mental health and personal demographics. They include:

Men are up to 10x more likely to be involved in violence than women (Meloy, 2000; p.19); sex is a static variable. Significantly more crimes are committed before the age of 25 (Bureau of Justice Statistics, 2011), therefore age is an important static variable. Past history of behaviour is one of the most important future predictors of future violence. If the situations that led to violence in the past aren’t modified, we will find ourselves in them in the future, therefore Past History of Violence becomes an important static behaviour.

Other elements associated with increased violence risk include acute paranoia or a delusional state (Yang, 2008); this can cause them to genuinely believe they are in danger, and therefore Not Guilty by Reason of Insanity (NGRI) or Not Criminally Responsible (NCR). Someone in a paranoid state, with thought insertion or homicidal thoughts needs immediate psychiatric attention.

Below average intelligence and anger/fear problems are linked to the concept of affective violence above. Lower levels of intelligence are perhaps linked to violence in that people cannot think of responses quick enough to avoid violence (Freeman, 2012), and may find themselves unable to label or understand their emotions. Anger and fear problems cause an increase in violence by causing an individual to perceive threats where maybe none exists. It is the presence of these threats that causes affective violence (Helfgott, 2008)

Psychopathy and other attachment difficulties are associated with an increased risk of predatory violence. Psychopaths have difficulty perceiving empathy for others, and individuals who lack attachments may be able to cause those individuals pain without considering the impact their actions have on those people. (Brook & Cosson, 2013) A standardized assessment like the PCL-R (Hare Psychopathy Checklist–Revised; Hare, 2003) can be used to assess for the presence of psychopathy, with a score of 30 (out of 40) indicating psychopathy.

Assessing Social Factors of Violence Risk

Social factors of violence risk include those individuals that are around us who can model violent behaviour, and are caused by factors beyond mental health.

Family of origin violence (a static risk factor) and adolescent peer group violence (a dynamic risk factor) are both risk factors because of the ability of them to model answers to threats or problems that involve violence (Franklin, Menaker & Kercher, 2011), rather than non-violent alternatives. Additionally, family of origin violence can lead to a sense of detachment which can involve the attachment difficulties noted in the Psychological Factors above; finally, a family that suppresses emotional expression may prevent men from ventilating their stress until it is expressed in a maladaptive way (e.g. through violence.)

Economic instability or poverty is a static or dynamic risk factor for violence (McAra, & McVie, 2016) because of the known causal relationship between poverty and violence; additionally, for those who are at risk of or have recently lost their jobs, intense anger can cause violent acts and so should be kept in mind. (Catalano, Novaco, & McConnell, 1997)

Weapons history/skill/interest is a static variable and approach behaviour is a dynamic behaviour. The first set refers to a potentially violent individual’s history with weapons, especially firearms. Do they own any guns, have they received professional training (e.g. police, military, private instruction)? Owning guns does not make a person more violent on their own, but they do provide a violent individual with easier tools with which to carry out their violence.

“Approach behaviour” (Meloy, 2000; p.57) is the term used to describe what someone does when they cannot possess guns (for instance, because of a felony conviction or financial reasons). This could include reading about guns, owning gun accessories and being around people who own guns. Approach behaviour is  a person’s ability to “approach” the off-limits items psychologically. The more approach behaviour is noted, the higher the violence risk is.

Victim pool is important in assessing violence risk because violence does not occur in a vacuum. This is especially important in predatory violence (such as sex offenders or serial killers) but may also be important for gang members or others who only become violent in specific, limited situations. Meloy (1996) discusses this in particular in violent stalkers but it applies equally to all violent crimes.

Drugs and alcohol (especially psychostimulants like cocaine) increase violence risk by reducing one’s inhibition and increasing impulsiveness. (Haggård-Grann, Hallqvist, Långström, & Möller, 2006) Additionally, stimulants like cocaine, methamphetamine and others can cause “stimulant psychosis” (Curran, Byrappa & Mcbride, 2004), a condition that can cause paranoia and homicidal thoughts.

The last element in assessing social factors of violence risk is popular culture. (De Venanzi, 2012) This is a controversial element but like suicide contagion, mass media glorifying elements of homicide can increase the risk of violence in vulnerable individuals. It’s important to pay close attention to court cases, movies or other elements that the person being assessed may identify with.

Assessing Biological Factors of Violence Risk

Biological factors are elements not related to a person’s mental health or social environment, but rather their neurological. They include a history of central nervous system (CNS) trauma (Rao et. al., 2009), signs and symptoms of CNS problems (such as headaches, dizziness, memory difficulties, and many others), objective CNS measures and the presence of a mental health diagnosis. (Rueve & Welton, 2008)

With the exception of some CNS measures which may be administered by clinicians, these items are most easily determined by a neuropsychologist or neurologist who can perform the required brain scans and administer and interpret the tests for CNS function. Major mental disorders may be diagnosed by social workers in some jurisdictions, or may be required to be diagnosed by a psychologist or psychiatrist in others.

Violence Risk Assessment Tools

Below are some tools that I’ve got articles for on my blog.

Other Resources

References

Bureau of Justice Statistics. (2011) “Homicide Trends in the United States, 1980-2008” Retrieved on October 28, 2016 from https://www.bjs.gov/content/pub/pdf/htus8008.pdf

Berg, L. (2014) “Comparing Predatory Versus Affective Violence and Examining Early Life Stress as a Risk Factor” Writing Excellence Award Winners. Paper 37. Retrieved on October 28, 2016 from http://soundideas.pugetsound.edu/writing_awards/37

Brown, J. & Singh, J.P. (2014) Forensic Risk Assessment: A Beginner’s Guide. Archives of Forensic Psychology. 1(1). 49-59. Retrieved on October 28, 2016 from http://www.archivesofforensicpsychology.com/web/wp-content/uploads/2015/01/Brown-and-Singh1.pdf

Brook, M., & Kosson, D. S. (2013). Impaired cognitive empathy in criminal psychopathy: Evidence from a laboratory measure of empathic accuracy. Journal Of Abnormal Psychology, 122(1), 156-166. doi:10.1037/a0030261

Catalano, R., Novaco, R., & McConnell, W. (1997). A model of the net effect of job loss on violence. Journal Of Personality And Social Psychology, 72(6), 1440-1447. doi:10.1037/0022-3514.72.6.1440

Curran, C., Byrappa, N. & Mcbride, A. (2004) Stimulant psychosis: systematic review. British Journal of Psychiatry. 

De Venanzi, A. (2012). School shootings in the USA: Popular culture as risk, teen marginality, and violence against peers. Crime, Media, Culture, 8(3), 261-278. doi:10.1177/1741659012443233

Falzer, P. R. (2013). Valuing Structured Professional Judgment: Predictive Validity, Decision-making, and the Clinical-Actuarial Conflict. Behavioral Sciences & The Law, 31(1), 40-54. doi:10.1002/bsl.2043

Franklin, C. A., Menaker, T.A. & Kercher, G.A. (2011) The Effects of Family-of-Origin Violence on Intimate Partner Violence. Crime Victims’ Institute. Retrieved on October 28, 2016 from http://dev.cjcenter.org/_files/cvi/7935%20Family%20of%20Origin%20Violence.pdf

Freeman, G. (2012) The relationship between lower intelligence, crime and custodial outcomes: a brief literary review of a vulnerable group. Journal of Society, Health & Vulnerability. Volume 3. Retrieved on October 28, 2016 from http://www.societyhealthvulnerability.net/index.php/shv/article/view/14834/22691

Hare, R. D. (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems

Haggård-Grann, U., Hallqvist, J., Långström, N., & Möller, J. (2006). The role of alcohol and drugs in triggering criminal violence: a case-crossover study. Addiction, 101(1), 100-108.

Harris, G. T., & Rice, M. E. (2007). Adjusting Actuarial Violence Risk Assessments Based on Aging or the Passage of Time. Criminal Justice & Behavior, 34(3), 297. doi:10.1177/0093854806293486

Helfgott, J.B. (2008) Criminal Behavior: Theories, Typologies and Criminal Justice. Thousand Oaks, CA: SAGE Publications.

McAra, L., & McVie, S. (2016). Understanding youth violence: The mediating effects of gender, poverty and vulnerability. Journal Of Criminal Justice, 45. 71-77. doi:10.1016/j.jcrimjus.2016.02.011

Meloy, J.R. (1996) Stalking (Obsessional Following): A Review of Some Preliminary Studies. Aggression and Violent Behavior. 1(2). 147-162. http://drreidmeloy.com/wp-content/uploads/2015/12/1996_StalkingObsessi.pdf

Meloy, J. R. (2000). Violence risk and threat assessment. San Diego, CA: Specialized Training Services.

Murray, J., & Thomson, M. E. (2010). Clinical judgement in violence risk assessment. Europe’s Journal Of Psychology, 127-149.

Public Safety Canada. (2010) “Giving Meaning to Risk Factors.” Research Summary. 15(6) Retrieved on October 28, 2016 from https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/mnng-fctrs/mnng-fctrs-eng.pdf

Rueve, M.E & Welton, R.S. (2008) Violence and Mental Illness. Psychiatry.

Sorrentino, R., Friedman, S. H., & Hall, R. (2016). Gender Considerations in Violence. Psychiatric Clinics Of North America, doi:10.1016/j.psc.2016.07.002

Yang, S. (2008) Dangerously Paranoid? Overview and Strategies for a Psychiatric Evaluation of a Highly Prevalent Syndrome. Psychiatric Times.
Rao, V., Rosenberg, P., Bertrand, M., Salehinia, S., Spiro, J., Vaishnavi, S., Rastogi, P., Noll, K., Schretlen, D.J., Brandt, J., Cornwell, E., Makley, M. & Miles, Q.S. (2009) Aggression After Traumatic Brain Injury: Prevalence and Correlates. The Journal of Neuropsychiatry and Clinical Neurosciences. 21(4):420-429
Cite this article as: MacDonald, D.K., (2016), "Biopsychosocial Model of Violence Risk Assessment," retrieved on September 25, 2018 from http://dustinkmacdonald.com/biopsychosocial-model-violence-risk-assessment/.
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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 September 25, 2018 from http://dustinkmacdonald.com/threat-assessment-education/.
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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 September 25, 2018 from http://dustinkmacdonald.com/basic-homicide-risk-assessment/.

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Youth Violence Assessment and Prevention

The following notes come from “Youth Violence: Theory, Prevention, and Intervention” by Kathryn Seifert, which I read before participating in the SAVRY (Structured Assessment of Violence Risk in Youth).

Youth Violence – Prevalence and Trends

Four Types of Violence

  • Situational
  • Relationship
  • Predatory
  • Psychopathological

There are two types of violence, instrumental and reactive violence. The goal of instrumental violence is to achieve a goal where reactive violence is in response to a situation.

Violence Prevalence

  • Teens and young adults experience the highest rate of violence
  • Juvenile homicides ~5%
  • Juvenile sexual violence 20%
  • 25% of adolescents report dating abuse, 10% report physically hurt last 12 months

Rate of Violence Affected By

  • Age
  • Gender
  • Race
  • Ethnicity
  • Socioeconomic Status (SES)

Young girls are greater victims though young boys engage in more violence-related behaviour (perpetrators)

Community Predictors of Violence

  • Poverty
  • Community disorganization (presence of crime, drugs, gangs, poor housing)
  • Availability of drugs, guns
  • Adults involved in crime
  • Exposure to violence, racial prejudice

Violence Classifications

Violence may be classified based on its:

  • Purpose
  • Mechanism
  • Target

Purpose of Violence

  • Instrumental – to accomplish a goal (e.g. robbery for money)
  • Situational – Emotions getting out of control; rare without other risk factors
  • Predatory/psychopathic – No goal but to harm people

Target of Violence

  • Self-directed – Suicidal behaviour
  • Interpersonal – Against another person; in family or community (instrumental, situational, psychopathic); always occurs within existing relationship
  • Collective – Violence within groups

Dating Violence – Need for control in relationship

Types of Violence

Family Violence

  • Adult family members use violence to control
  • Patricide risk factors, severely abused, dangerously antisocial and severely mentally ill
  • Usually abuse, DV or parental substance abuse/mental illness in home

School Violence

  • Lack of counsellors, support services
  • No sense of community
  • Bullying, marginalized groups
  • Risk factors, history of childhood trauma, school behaviour problems, trouble interacting with prosocial peers, history of aggression, delinquency, substance abuse, lack of appropriate parental discipline, high conflict and low warmth within the family, other behavior problems, especially those that start before the age of 13 years

Homicidal Youth

  • History of family violence, abuse and neglect, mental illness, neurological defects, antisocial behaviour, substance abuse
  • Significant population with psychotic symptoms, gang participation, substance abuse
  • Skill deficits in anger management, impulse control

Gang Violence

  • Median age 17-18
  • More structured gang is, more likely to engage in criminal activity
  • Protective factors: positive role models, organization, absence of substance use and criminality
  • Risk factors: Marginalization, dropped out, rejected by prosocial peers, no opportunities for success
  • Affiliation and acceptance

Hate Crimes

  • Bias motivated
  • 63% of offenders were white, 21% were African American
  • Correlation b/w youth bullying and violence related to hate; attachment problems

Theoretical Perspectives on Youth Violence

Social Learning Theory

  • Most behaviour learned from modeling
  • Ignores DNA, brain development, learning differences that might impact ability to imitate

Intergenerational Transmission of Violence

  • Learn from early home environment; witnessing b/w adult caregivers, experiencing it themselves or both
  • Children victimized are strong candidates for prevention programs

Routine Activity / Event-Centered Theory

  • All crime is a crime of opportunity
  • Underestimates violent crime/offenders, does not examine social causes of crime

Social Exchange Theory

  • Calculated exchanges b/w costs and benefits
  • Assumes people take rational approach to emotional decisions

Psychopathy

  • No empathy, remorse
  • PCL-R; Psychopathy Checklist-Revised (two factors: personality traits and anti-social behaviours)
  • May be developmental disorder
  • DSM-IV does not use term; classifies psychopathic behaviours under ASPD
  • Risk factors include impulsivity/conduct problems, callous/unemotional traits, narcissism
  • 20-30% in children and adults

Neurobiological Theories of Violence

  • Early trauma affects neurotransmitter regulation, brain structure and development
  • Severe chronic stress in childhood can lower arousal point, making it harder to return to homeostasis = Developmental trauma disorder

Developmental Trauma Disorder

  • Behaviourally re-enact trauma as perpetrators or frozen avoidance reactions
  • Not the same as PTSD
  • Behaviour Objective Sequence

Subculture of Violence Theory

  • Within larger societies, subgroups may develop which encourage crime and violence
  • Incomplete view of violence; potentially racist

Feminist Theory

  • Males way of maintaining control of women
  • Do not account for female perpetrators, other individual factors,

Social Structure Theories

  • Relationship between different groups in a society
  • Grievances violating one’s sense of justice
  • Social distance

Strain Theory

  • Strain as failure to achieve positively valued goals
  • Strain as removal of positively valued stimuli
  • Strain as potential of negative stimuli
  • Power prevention technique = teaching people to deal more positively with strain, increasing opportunities to succeed

Control Balance Theory

  • Amount of control people are subjected to vs the amount of control they can exercise
  • Imbalance of control (either not enough power or too much power)

Systems Theory

  • Interplay of various systems
  • Violence caused by many interacting factors
  • Risk factors: high levels of conflict in the family, community and cultural norms that encourage violence, racial and sexual norms that preclude individual from participating in society.

Life Course Theories

  • Follows individual through life; positive and negative influence can change trajectory
  • Biological, psychological and social trajectories
  • Childhood diagnosis of conduct disorder correlated with adult ASPD
  • Early starters vs late starters

Reciprocal Theory of Violence

  • Properties of violence including negative emotional states, alienation, shame, denial, humiliation and lack of empathy, compassion
  • Nine Structural Pathways to violence

Dynamics of Youth Violence

Individual Factors that Affect Youth Violence

  • Parental substance abuse
  • Insecure attachment w/mother
  • Conduct problems
  • Lack of empathy
  • Cognitive dysregulation
  • Dysregulated behaviours
  • Belief in legitimacy of aggression
  • Childhood trauma
  • Parent rating of hyperactivity
  • Low academic performance; school problems
  • Deliquent peers
  • Availability of drugs
  • Early initiation of violence, delinquency, moderate-to-severe behaviour problems
  • Home or family maladjustment

Domains of Violence

  • Physiological
  • Cognitive
  • Psychological
  • Developmental

Physiological

  • Genetics
  • MAO-L increases aggression

Neurobiological Factors

  • Abnormalities in amygdala, hypothalamus
  • Alcohol exposure

Cognitive Factors

  • Low IQ linked to violent, aggressive behaviour

Psychological Factors

0-2 Years of Age

  • Attachment issues predict later violence and aggression
  • Secure, Anxious/Avoidant and Disorganized/Dismissive
  • Mirror Neurons in infants

Toddlers (3-4)

  • Master environment
  • Autonomy vs shame and doubt
  • Theory of Mind important at stage; take perspective of others

Early School Years (5-6)

  • Initiating activities
  • Interact with groups of children
  • Self-soothing, emotional regulation
  • Risk factors: absence of attachment figure, single parent, use of corporal punishment, preference for violent video games, exposure to verbal aggression, aggressive peers, victimization

Middle Childhood (7-10)

  • Preadolescence and Adolescence
  • Puberty
  • Peer group supplants family group as influence
  • Family risk factors decrease in importance
  • Risk factors, poor affect regulation, early onset of puberty, increased arousal patterns

Behaviour

  • Greatest predictor of severe and chronic violent behaviour is early onset of behaviour problems, aggression, disregard for rules, delinquency, substance abuse
  • Late onset antisocial behaviour tends to stop in adulthood, early onset tends to continue
  • Interventions must include family therapy, reduction of home violence

Temperament

  • Behaviour or emotional problems
  • Attract victimization

Mental Health

  • Mental illness alone not a predictor
  • Personality disorder places one at risk
  • Skill building, DBT
  • Substance use: age of onset, perception of drug use among peers

Traits of Violent Preadolescent Boys

  • CARE2 Assessment Tool
  • Family history of violence
  • Skill deficits in problem solving and anger management
  • Twice as many assaulters harming animals, delinquency, fire setting, school behaviour problems, attachment issues
  • 3x as many bullying others
  • Less resiliency

Chronic Violent Teen Boys

Risk Factors

  • Uninvolved parents
  • Ineffective/inappropriate discipline
  • Psychological or substance abuse families
  • Low warmth, high conflict
  • Childhood trauma

Protective Factors

  • Nurturing, supportive caregiver
  • Appropriate discipline
  • Achievable future goals

Chronic Violent Teen Girls

Risk Factors

  • Moderate to severe behaviour problems
  • No remorse
  • Bullying
  • Poor emotional regulation, impulsivity, psychiatric problems, truancy, attachment problems
  • Enuresis
  • Anger management, deficient problem solving skills

Environmental Factors That Impact Youth Violence

Environmental Factors Affecting Youth Violence

 

 

 

 

 

 

 

 

 

 

Special Issues in Youth Violence

Bullying

Four Phases of Bullying

  1. Rejecting phase, identifying with the victims
  2. Performing phase, moving towards becoming a bully
  3. Perpetuating phase, enjoying being a bully
  4. Withdrawing phase, moving away

Bullying Interventions

  • Emotional skills training, teaching children and adolescents how to recognize and regulate emotional states
  • Social skills training
  • Reduce prejudice and discrimination
  • Problem solving, resiliency, prosocial skills

Suicide

  • Most teens would tell their friends first
  • 80% gave verbal clues
  • Friends and peers more aware of clues
  • How a young person responds (perception of stressor, social supports, resources available, skills to cope with stress)
  • Having youth identify three protective factors, linked to 70-85% reduction in suicide attempts
  • Inability to correlate death to permanent and ireverssible final state
  • Yellow Ribbon, ASIST, QPRT

Assessment, Prevention and Intervention

  • By clinical judgement only at chance
  • Youth change rapidly so assessments only valid <6 months
  • Self-report tools less helpful
  • Attachment to caregivers important

Areas of Assessment

  • Youth
  • Caregiver
  • School
  • Peers
  • Community Environment

Risk Assessment Tools

  • SAVRY
  • CARE2
  • Youth Level of Service—Case Management Inventory
  • Positive Achievement Change Tool
  • Psychopathic Checklist—Youth Version
  • Early Assessment Risk for Boys and Girls (EARL20/EARLY21G)

Motivational Interviewing techniques useful

Trauma issues important

Interventions

  • Skill building behavior management programs, cognitive-behavioral therapy, social skills training, “challenge” programs (i.e., wilderness therapy), academic training (GED programs, tutoring), and job-related skills
  • Botvin Life Skills Training
  • Aggression Replacement Training Skillstreaming, anger control, moral education
  • Behavioral Objective Sequence Adaptive, Personal, Task, Interpersonal, Self-management, Communication
  • Individual therapy
  • Family therapy
  • Multimodal Therapy
  • Multisystemic Therapy
  • Multidimensional Treatment Foster Care
  • School-based Mental Health Care
  • Gang Interventions
  • Victim-Offender Mediation



Cite this article as: MacDonald, D.K., (2016), "Youth Violence Assessment and Prevention," retrieved on September 25, 2018 from http://dustinkmacdonald.com/youth-violence-assessment-and-prevention/.

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Structured Assessment of Violence Risk in Youth (SAVRY)

Yesterday I had the opportunity to complete training on effective use of the Structured Assessment of Violence Risk in Youth (SAVRY) tool. This tool, designed for children 12-18 (and used up until 21) has shown moderate validity in predicting adolescent violence.

I just finished reading Youth Violence: Theory, Prevention and Intervention, and the SAVRY was one of the tools covered. It’s performed very well.

The tool focuses on Structured Professional Judgement (SPJ), which is an alternative to two other approaches, Unstructured Clinical Judgement (where the clinician makes their gut impression after an interview, weighing whatever factors they care about in their head) and actuarial approaches (where factors that have been predicted to increase violence risk from a statistical perspective are weighted as present.)

SPJ is a combination of these two approaches; in the case of the SAVRY, it combined static (unlikely to change) risk factors common in actuarial approaches, with dynamic ones that are more likely to be found in clinical judgement assessment.

The elements of the SAVRY are below:

Risk Factors

Historical risk factors
1. History of Violence
2. History of Non-Violent Offending
3. Early Initiation of Violence
4. Past Supervision/Intervention Failures
5. History of Self-Harm or Suicide Attempts
6. Exposure to Violence at Home
7. Childhood History of Maltreatment
8. Parental/Caregiver Criminality
9. Early Caregiver Disruption
10. Poor School Achievement

Social/Contextual risk factors
11. Peer Delinquency
12. Peer Rejection
13. Stress and Poor Coping
14. Poor Parental Management
15. Lack of Personal/Social Support
16. Community Disorganization

Individual risk factors
17. Negative Attitudes
18. Risk Taking/Impulsivity
19. Substance Use Difficulties
20. Anger Management Problems
21. Low Empathy/Remorse
22. Attention Deficit/Hyperactivity Difficulties
23. Poor Compliance
24. Low Interest/Commitment to School

Protective factors

P1. Prosocial Involvement
P2. Strong Social Support
P3. Strong Attachments and Bonds
P4. Positive Attitude Towards Intervention and Authority
P5. Strong Commitment to School
P6. Resilient Personality Traits



Cite this article as: MacDonald, D.K., (2015), "Structured Assessment of Violence Risk in Youth (SAVRY)," retrieved on September 25, 2018 from http://dustinkmacdonald.com/structured-assessment-of-violence-risk-in-youth-savry/.

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