Youth Suicide Prevention with Kiwanis

Introduction

On October 31st I had the opportunity to deliver a presentation on youth suicide to the Sigourney Kiwanis. Kiwanis is a service organization that works with youth. This was a wonderful, active group that I enjoyed having the opportunity to speak with.

I’ve expanded on the point-form presentation that I left participants with, if you’re interested in reading more.

Suicide in Iowa

According to the Iowa Department of Public Health (Fleig, 2018) there were 478 suicide deaths in Iowa in 2018 including 39 teenagers. This is a large increase over the 2016 data kept by the CDC. 478 deaths means someone dies every 18 hours.

Suicide in General

For every suicide death, we know there are as many as 50 suicide attempts. (Schwartz-Lifshitz, et. al., 2012) This is partly because of the method that is used. The survival rate for firearm suicide is about 2%, for hanging it is about 30% and for overdose it is 98%. (Elnour & Harrison, 2008; Spicer & Miller, 2000)

Suicide Risk Factors

Anything that overwhelms someone’s coping and makes them feel hopeless may lead to suicidal behavior. Examples include:

  • Struggling in school
  • Anxiety or depression
  • Bullying
  • Substance abuse
  • Being a victim or survivor of abuse (physical, emotional, sexual)
  • Being a child of a parent who is struggling with substance abuse

Suicide Warning Signs

Warning signs are signs that a suicide attempt may be imminent. They include:

  • Giving away prized possessions
  • Talking about death
  • An unexpected peace or calm after a significant struggle (because the person has made the decision to attempt suicide)

Protective Factors Against Suicide

Protective factors are those things that help keep us safe from suicide or buffer us from suicide.

  • Academic Achievement
  • Parental and Non-Parental Connectedness (trusted adults)
  • Supportive Friendships
  • Involvement in Sports
  • Strong mental health / wellness

How You Can Help

Recognize Statements of Lethality

Also called statements of finality or invitations – invitations to ask about suicide – statements of lethality let us know that someone might be struggling with suicide. Statements of lethality include:

  • I can’t go on
  • I can’t do it anymore
  • I wish I was dead
  • I’m at the end of my rope

Ask Clearly About Suicide

You will not put the idea in the person’s head if you ask them about suicide. What you will do is help reduce the isolation and loneliness that person is feeling and reduce the intensity of those suicidal thoughts.

Limit Access to Lethal Means

Limiting access to lethal means, by securing firearms or locking up pills is an important part of safety planning with a vulnerable youth.

Take Intent Seriously

Additionally, take suicidal intent seriously. If a teenager overdoses on a harmless product like melatonin that they believe will hurt them, treat that like a serious suicide attempt.

Recognize Self-Injury is Different from Suicide

Recognize that non-suicidal self-injury (cutting) is separate from suicidal behavior and is usually a coping strategy rather than a means to an end.

Suicide Risk Assessment (CPR Model)

If someone has indicated that they are struggling with suicide, I want to know their current plan, their previous exposure to suicide and their resources/lack of resources.

Current Plan of Suicide

The more detailed their plan, the higher the risk level. Do they have access to the plan? Do they know when or where they want to carry out the plan? We know that taking away those means (e.g. securing the pills), in most cases does not cause an individual to try a different method. Instead, they step back and reconsider their suicide plan.

Previous Exposure to Suicide

Have they attempted before? If so, what’s different now? What’s changed? And have they ever lost someone close to them to suicide? If they have this increases their own risk for suicide.

Lack of Resources or Supports

A lack of resources like friends, family or counselling is one of the most significant risk factors for suicide.

Really Simple Suicide Intervention

If the youth can keep themselves safe today, tonight, tomorrow – then I’m okay with that. I can make an appointment for a counsellor or put other supports in place. If that youth can’t, then I’m going to call 911 or get them to the hospital for some emergency supports.

How Communities Can Help

Communities can form a Youth Suicide Prevention Action Group (YSP), this is a group that brings together members from different sectors like education, mental health, faith and law enforcement to work on resources to help reduce youth suicide.

Implementing an evidence-based program like Yellow Ribbon can help.

Hope for the Future

Senate File 2113 signed in March, requires teachers to get suicide awareness trained
(1 hour of Gatekeeper Training)

70% of those who attempt suicide and live will never make a second attempt because they get the help that they need. (Owens, Horrocks & House, 2002)

References

Elnour, A.A. & Harrison, J. (2008) Lethality of suicide methods. Journal of Injury Prevention. 14(1). 39-45. doi: 10.1136/ip.2007.016246.

Fleig, S. (2018, Oct 29) Following historically high suicide rates, Iowa schools become mental health ‘gatekeepers’. The Des Moines Register.

Owens, D., Horrocks, J. & House, A. (2002) Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 181. 193-199.

Schwartz-Lifshitz, M., Zalsman, G., Giner, L., & Oquendo, M. A. (2012). Can we really prevent suicide?. Current psychiatry reports14(6), 624-33.

Spicer, R. S., & Miller, T. R. (2000). Suicide acts in 8 states: incidence and case fatality rates by demographics and method. American journal of public health90(12), 1885-91.

Cite this article as: MacDonald, D.K., (2018), "Youth Suicide Prevention with Kiwanis," retrieved on November 15, 2018 from http://dustinkmacdonald.com/youth-suicide-prevention-kiwanis/.
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Childhood and Adolescent Taxon Scale (CATS)

Introduction

The Childhood and Adolescent Taxon Scale (CATS) worksheet was originally created to accompany the Violence Risk Appraisal Guide (VRAG) and the Sex Offender Risk Appraisal Guide (SORAG). Although the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) can be used to assess psychopathy, there are many situations where a Psychologist or other individual trained in the administration of this tool is not available. In this situation, the CATS tool can be used to assess psychopathy instead.

Quinsey et. al. (2006) determined that the CATS tool is an appropriate replacement for the PCL-R assessment when determining psychopathy on the VRAG and SORAG assessments. Lister (2010) examined the CATS and found that there were no differences in rates of psychopathy as determined by the PCL-R and the CATS with Caucasian and African-American individuals.

Conduct Disorder Symptoms

In order to answer question 4 below, it’s necessary to identify how many conduct disorder symptoms are present.

Count those present those that occurred before age 16 except for items 13 and 15 which are before aged 16:

  1. Often bullied, threatened or intimidated others
  2. Often initiated physical fights
  3. Used a weapon that could cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  4. Was physically cruel to people
  5. Was physically cruel to animals
  6. Stolen while confronting a victim (e.g., mugging, purse snatching, extortion, robbery)
  7. Forced someone into sexual activity
  8. Deliberately engaged in fire setting with the intention of causing serious damage
  9. Deliberately destroyed others’ property (other than by fire setting)
  10. Broken into someone else’s house, car, or building
  11. Often lied to obtain goods or favors or to avoid obligations (i.e., “cons” others)
  12. Stolen items of nontrivial value without confronting a victim (like shoplifting, theft, or forgery)
  13. Before [age] 13, stayed out late at night, despite parental prohibitions
  14. Ran away from home overnight (or longer) at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  15. Before [age] 13, was often truant from school

Childhood & Adolescent Taxon Scale (CATS) Items

The CATS scale has 8 items that are reviewed below, along with supplementary scoring guidelines.

Elementary School Maladjustment

This refers to the first 8 years of formal schooling after kindgarten. A couple of incidents of truancy, smoking on school property or other minor incidents like this would be classified as Mild or Moderate. Severe incidents include repeated truancy or violent actions like assault. Also included in Severe is actions that result in criminal convictions like selling drugs at school.

  • 0 – No Problems
  • 0 – Slight (Minor discipline or attendance) or Moderate Problems
  • 1 – Severe Problems (Frequent disruptive behavior and/or attendance or behavior resulting in expulsion or serious suspensions)

Teenage Alcohol Problem

The National Institute on Alcohol Abuse and Alcoholism produces a guide to screening and intervening with youth (NIAAA, 2015) who consume alcohol. Their screening and assessment rubric can be used to determine if there is a teenage alcohol problem.

Based on the empirically determined risk guidelines, someone who is 12-15 and drinks more than 6 days in the past year would indicate a 1 below, someone who is 16 and drinks more than 12 days in the last year, someone who is 17 would need to drink more than 24 days while an individual who is 18 or higher would need to drink more than 52 days a year.

  • 0 – No
  • 1 – Yes

Childhood Aggression Rating

  • 0 – No Evidence of Aggression
  • 0 – Occasional Moderate Aggression
  • 1 – Occasional or Frequent Extreme Aggression

More Than 3 DSM Conduct Disorder Symptoms

These are the conduct disorder symptoms filled out below.

  • 0 – No
  • 1 – Yes

Ever suspended or expelled from school

  • 0 – No
  • 1 – Yes

Arrested under the age of 16

  • 0 – No
  • 1 – Yes

Lived with both biological parents to age 16 (except for death of parents)

Separation for more than one month is required for coding a “no” on this item. This could be because of institutionalization, divorce, or other separations but does not include death of one or both parents.

  • 0 – Yes
  • 1 – No

Scoring the CATS

Each of these items will result in a 0 or 1 score. All items are summed and the value can then be used to complete Item 12.b on the VRAG or item 14b on the SORAG.

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Hare, R.D. (1991) The Hare Psychopathy Checklist-Revised (Hare PCL-R). Toronto: Multi-Health Systems.

Lister, M.B. (2010) A Comparison of the Violence Risk Appraisal Guide, Psychopathy Checklist, and child and Adolescent Taxon Scale: Predictive Utility And Cross Cultural Generalizable. Dissertation.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2015). Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide. Retrieved on January 28, 2017 from https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf

Cite this article as: MacDonald, D.K., (2017), "Childhood and Adolescent Taxon Scale (CATS)," retrieved on November 15, 2018 from http://dustinkmacdonald.com/childhood-adolescent-taxon-scale-cats/.
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PREPaRE Model for School Crisis Intervention

Introduction

When we normally think of crisis intervention, we think of adults responding to events in their personal life. Of course, people young and old can require crisis intervention, and not just from events in their personal life. School violence, natural disasters and other elements can require crisis intervention.

Werner (2015) noted that the tow most important activities school counsellors can do to prepare for crisis events are to develop a comprehensive crisis plan and to practice it regularly. The goal of the PREPaRE Curriculum is to train mental health worker, school psychologists and other administrators, educators and clinicians to develop such a crisis plan, to build a crisis team to execute that plan and to understand the tasks of crisis intervention in the aftermath of a crisis.

School Crisis Intervention

Most school counsellors receive little or no crisis intervention training and therefore enter the field feeling unprepared to handle tasks that become assigned to them in the aftermath of a crisis. (Allen, et. al., 2002) Training like the PREPaRE Model and other programs can help bridge this gap.

Knox & Roberts (2005) performed a comprehensive literature review on school crisis intervention and specifically crisis intervention teams. They found that there was a need for well-thought out crisis intervention programs and plans before crises occur, and that there were similarities in the literature about how experts believed response to a crisis should be structured.

They recommended school crisis intervention be split into three phases:

Primary Interventions

Primary prevention activities are those that are provided to all students in order to promote safety and health. These could be “conflict resolution, gun safety and safe driving courses, alcohol and drug awareness programs, teenage parenting resources, and suicide prevention programs.” (Knox & Roberts, 2005; p.94)

Secondary Interventions

Secondary prevention activities focus on individuals in the aftermath of a crisis in order to limit its impact. This can include physical measures like moving students, debriefing and immediate crisis intervention in the aftermath, and notifying parents and the media.

Tertiary Interventions

Tertiary interventions include long-term counselling and psychotherapy that extends after the crisis period ends and the school environment returns to normal.

PREPaRE Framework

  • Prevent and Prepare for psychological trauma
  • Reaffirm physical health, perceptions of security and safety
  • Evaluate psychological trauma risk
  • Provide interventions and Respond to psychological needs
  • Examine the effectiveness of crisis prevention and intervention

The PREPare Model is structured around two workshops. The first (1-day) workshop is provided for all school staff to teach them how the crisis team and crisis intervention works, while the second (2-day) workshop is designed specifically for crisis team members.

PREPaRE Curriculum

The following information comes from Nickerson et. al. (2014):

Crisis Prevention and Preparedness (1-day workshop for all staff)

  • Identify four characteristics of a crisis event.
  • Identify the key concepts associated with the PREPaRE acronym.
  • Describe the four activities of the school crisis team.
  • Understand the importance of hierarchical crisis team structure and response.
  • Identify the five major functions of the Incident Command System (ICS).
  • Identify strategies for communicating with school boards creating or sustaining teams.
  • Identify three concepts related to crime prevention through environmental design.
  • Identify guiding principles in crisis plan development.
  • Identify essential components of crisis plans.
  • Identify key concepts from the workshop that their crisis team needs to learn or address to be adequately prepared for crisis situations

Crisis Intervention and Recovery (2-day workshop for crisis intervention staff)

  • Report improved attitudes toward, and readiness to provide, school crisis intervention.
  • Identify the variables that determine the traumatizing potential of a crisis event.
  • Identify the range of school crisis interventions indicated by the PREPaRE acronym.
  • Indicate how school crisis interventions fit into the larger school crisis response.
  • Specify the critical factors in evaluating psychological trauma risk after a crisis event.
  • Match psychological trauma risk to a range of appropriate school crisis interventions.

Elements of a Crisis Team

A crisis team should be in place before a crisis occurs so that they can immediately get to work after a crisis occurs. Knox & Roberts (2005) recommend that the team be comprised of 4-8 multidisciplinary members (e.g. Principal, counsellor, nurse, etc.)

Responding to a Crisis

Brock (2006) indicates a variety of responses for each level of the framework that are available to the mental health professional facilitating a crisis intervention. These items assume that a crisis has already occurred.

Reaffirm physical health, perceptions of security and safety

  • Meet physical needs like shelter and water
  • Provide a sense of safety by removing individuals from the site of a crisis
  • Remove or restrict access to dangerous objects or crisis site (remove sharps, put up barriers, etc.)

Evaluate psychological trauma risk

  • Evaluate exposure to crisis and note reactions (physical, behavioural, cognitive)
  • Examine internal and external resources (within the school and local community agencies)
  • Refer clients to psychotherapy where possible

Provide interventions and Respond to psychological needs

  • Re-establish social support systems. This can involve
  • Provide psycho-education: Empower survivors and their caregivers
  • Provide immediate crisis intervention
  • Provide/Refer for longer term crisis intervention

Evaluation of the PREPaRE Curriculum

Brock et. al. (2011) performed the initial evaluation of the program and found that participants significantly improved on their skills related to crisis prevention, crisis intervention and displayed high general satisfaction with the workshops. When Nickerson et. al. (2014) evaluated the PREPaRE after making changes they found that these benefits continued to be demonstrated in follow-ups, proving the efficacy of the program.

Training in the PREPaRE Model

Brock (2006) publishes the content of the PREPaRE workshop online, where they can be accessed in order to help individuals build their crisis intervention skills. Additionally, workshops can be accessed through the National Association for School Psychologists (NASP).

References

Allen, M., Burt, K., Bryan, E., Carter, D., Orsi, R, & Durkan, L.(2002). School counselors’ preparation for and participation in crisis intervention. Professional School Counseling, 6, 96-102

Brock, S.E. (2006) “Crisis Intervention Training”, Workshop PDF. Accessed on November 19, 2016 from www.csus.edu/indiv/b/brocks/workshops/district/smfcsd.12.06.pdf

Brock, S. E., Nickerson, A. B., Reeves, M. A., Savage, T. A., & Woitaszewski, S. A. (2011). Development, Evaluation, and Future Directions of the PREPaRE School Crisis Prevention and Intervention Training Curriculum. Journal Of School Violence10(1), 34-52. doi:10.1080/15388220.2010.519268

Knox, K., & Roberts, A. (2005). Crisis intervention and crisis team models in schools. Children & Schools27(2), 93-100.

Nickerson, A. B., Serwacki, M. L., Brock, S. E., Savage, T. A., Woitaszewski, S. A., & Louvar Reeves, M. A. (2014). PROGRAM EVALUATION OF THE PREPaRE SCHOOL CRISIS PREVENTION AND INTERVENTION TRAINING CURRICULUM. Psychology In The Schools51(5), 466-479. doi:10.1002/pits.21757

Cite this article as: MacDonald, D.K., (2016), "PREPaRE Model for School Crisis Intervention," retrieved on November 15, 2018 from http://dustinkmacdonald.com/prepare-model-school-crisis-intervention/.
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Understanding Child Sexual Abuse

Introduction

Childhood sexual abuse is one of the most harmful experiences an individual can go through in their entire life. Often covered up and denied, by both the offender, and society at large, we’ve made great strides in exposing these wounds to the light and developing better treatments for those who have experienced this suffering.

This article reviews a number of elements in the understanding and treatment of child sexual abuse. Because most of the resources on sexual abuse examine women exclusively or primarily, they will be the focus of this article. I hope to write one on male survivors of sexual abuse soon.

Defining Child Sexual Abuse

The World Health Organization (WHO) defines child sexual abuse as “the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared, or else that violate the laws or social taboos of society” (WHO, 2006)

Prevalence of Child Sexual Abuse

In Canada, the rate of sexual assault of those under 18 is approximately 201 per 100,000 (Statistics Canada, 2008), while an Ontario study identified approximately 13% of females and 5% of males had reported sexual abuse. (MacMillan, et. al., 1997) US studies began in the 1950s and reported between 20 and 30% of men and women reported sexual contact with children. (Draucker & Martsolf, 2006; p. 2)

Impact of Child Sexual Abuse

Child sexual abuse has been associated with life-long emotional health challenges including “the development of a range of psychiatric difficulties, including depression…self-harm…anxiety disorders…and post-traumatic stress disorder” (Barrera, Calderon & Bell, 2013) Other negative impacts can include substance abuse (Sartor, et. al., 2013) and risky sexual behaviour. (Roemmele, & Messman-Moore, 2011)

As well, survivors of childhood sexual abuse are also at greater risk for developing physical health issues, with Moeller et. al. (1993) reporting that women who were abused reported “significantly more hospitalizations for illnesses, a greater number of physical and psychological problems, and lower ratings of their overall health” than non-abused women.

False and Recovered Memories

There is a controversy in the treatment of survivors of sexual abuse about the potential for recovered memories, “the recall of traumatic events not previously remembered” (Draucker & Martsolf, 2006; p. 15) and false memories, allegedly implanted by the therapist using improper or even fraudulent techniques.

The general scientific consensus (e.g. as summed up by Ilsley (1998) is that while false memories can occur, they are the exception rather than the rule. Therefore care must be taken to avoid introducing these memories, but survivors of sexual abuse should be believed in the absence of information suggesting otherwise. This does not mean that criminal prosecution should adopt a different standard (indeed, many individuals who receive treatment for sexual abuse could never secure convictions) but merely that the potential for false memories should not dissuade a therapist from providing treatment.

The research is continuing and therefore counsellors should keep themselves informed on the latest developments in this area.

Phase Model for Treatment of Child Sexual Abuse

A phase-based model is a method of treating childhood sexual abuse that is focused on multiple distinct stages of the treatment, with specific goals for each stage. The following example of phase-treatment comes from Courtois (2004):

Phase 1

The goals of phase 1 are to explore the client’s motivation to get better, ensure informed consent (including the client’s rights and responsibilities), and educating the client on what psychotherapy is. This is also the time to establish an effective therapeutic alliance with the client, so that they can ensure the most success.

As Courtois notes, phase 1 doesn’t look much different from other forms of psychotherapy, though it may take much longer to establish in sexual abuse than other presenting problems. The acronym RICH is used as a short-hand for the four goals of phase 1:

  • Respect
  • Information
  • Connection
  • Hope

Building life skills is also a significant component of phase 1. These skills can include techniques like deep breathing, communicating one’s needs, identifying one’s emotional state, coping skills, and a variety of others that may depend on the specific client deficits.

Phase 2

The goals of phase 2 are to begin the process of developing an integrated understanding of the abuse. The client begins to construct a narrative to objectively describe the abuse in terms of the who, what, where, why, and their own reactions to the experience.

Desensitization through graduated exposure therapy is used to help reduce the impact of dissociation and allow the client to separate themselves from the abuse experience. This has been found to be an effective way of increasing the client’s ability to control their emotional regulation and decrease other symptoms. (Cloitre, 2002)

Phase 3

The final phase involves fine-tuning the skills developed in stage 1 and begins to build a new life post-abuse. At this point the client can begin tackling elements typical or a more normal range of experiences including “the development of trustworthy relationships and intimacy, sexual functioning, parenting, career and other life decisions, ongoing decisions/ discussions with abusive others, and so forth.” (Courtois, 2004)

Implications for Crisis Intervention

Helpline callers or chat and text visitor may disclosure historical sexual abuse to you. If they do, there are some things you should keep in mind to respond most effectively:

  • Check for immediate safety if it is not clear the abuse was in the past – this is especially important in a situation where the person is still young
  • Adopt a supportive tone without gawking or getting shocked. This can further stigmatize the individual and heighten their sense of isolation
  • Consider supportive responses as noted by Draucker & Martsolf (2006; p. 44):
    • Acknowledging the difficult step of disclosing
    • Offering support and indicating one’s availability after the session during which the client disclosed
    • Inviting the client to discuss the abuse at his or her own pace
    • Evaluating the client’s mental status and determining any immediate safety concerns (e.g. suicidal thoughts)
  • On the phone, watch for symptoms of dissociation or Dissociative Identity Disorder (DID)
    • If the individual starts to dissociate, try a grounding exercise: have them identify things they can see, hear (including your voice), or smell in the room. This will help them stay focused
    • If a person appears to switch personalities, remain calm but do not breach confidentiality. Treat the second personality as another person but work to get them medical assistance as soon as possible

Additional Resources

The free e-course “Addressing Past Sexual Assault in Clinical Settings” is provided by Women’s College Hospital in Toronto and funded by the Government of Ontario.

The book Counselling Survivors of Childhood Sexual Abuse provides a comprehensive review of the assessment and treatment of sexual abuse in children.

The office of Juvenile Justice and Deliquency Prevention hosted a webinar titled “Male Survivors of Sexual Abuse” which will hopefully be available on their website for viewing soon.

References

Barrera, M., Calderón, L., & Bell, V. (2013). The Cognitive Impact of Sexual Abuse and PTSD in Children: A Neuropsychological Study. Journal Of Child Sexual Abuse, 22(6), 625-638. doi:10.1080/10538712.2013.811141

Cloitre, M., Koenen, K. C., Cohen, L. R., & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Journal Of Consulting And Clinical Psychology, 70(5), 1067-1074. doi:10.1037/0022-006X.70.5.1067

Courtois, C.A. (2004) Complex Trauma, Complex Reactions: Assessment and Treatment. Psychotherapy. 41(4) 214-425. DOI 10.1037/0033-3204.41.4.412. Retrieved on October 8, 2016 from http://www.dhss.delaware.gov/dsamh/files/si10_1396_article1.pdf

Draucker, C.B. & Martsolf, D.S. (2006) Counselling Survivors of Childhood Sexual Abuse. 3rd Ed. London: SAGE Publications.

Ilsley, J. K. (1998). Recovered memories of childhood abuse : We must tell patients that they were not to blame. BMJ : British Medical Journal, 317(7164), 1012.

MacMillan, H.L., Fleming, J.E., Trocme, N., Boyle, M.H., Wong, M., Racine, Y.A., Bearslee, W.R. & Offord, D.R. (1997) JAMA. Prevalence of Child Physical and Sexual Abuse in the Community. 278(2). 131-135

Moeller, T. P., Bachmann, G. A., & Moeller, J. R. (1993). The combined effects of physical, sexual, and emotional abuse during childhood: long-term health consequences for women. Child Abuse And Neglect, (5), 623.

Roemmele, M., & Messman-Moore, T. L. (2011). Child Abuse, Early Maladaptive Schemas, and Risky Sexual Behavior in College Women.Journal Of Child Sexual Abuse, 20(3), 264-283. doi:10.1080/10538712.2011.575445

Sartor, C. E., Waldron, M., Duncan, A. E., Grant, J. D., McCutcheon, V. V., Nelson, E. C., & Heath, A. C. (2013). Childhood sexual abuse and early substance use in adolescent girls: the role of familial influences. Addiction, 108(5), 993-1000. doi:10.1111/add.12115

Statistics Canada. (2008) Child and Youth Victims of Police-reported Violent Crime, 2008. Retrieved on October 8, 2016 from http://www.statcan.gc.ca/pub/85f0033m/2010023/part-partie1-eng.htm

World Health Organisation (WHO). (2006) Preventing child maltreatment: a guide to taking and generating evidence. Retrieved on October 8, 2016 from http://apps.who.int/iris/bitstream/10665/43499/1/9241594365_eng.pdf. Geneva: World Health Organisation (WHO).

Cite this article as: MacDonald, D.K., (2016), "Understanding Child Sexual Abuse," retrieved on November 15, 2018 from http://dustinkmacdonald.com/understanding-child-sexual-abuse/.
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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 November 15, 2018 from http://dustinkmacdonald.com/threat-assessment-education/.
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