The recent mass shootings and violent acts such as the ones in Orlando and San Bernardino have led to increased calls for proactive measures to deal with these episodes. Every death and injury is a tragedy of untold suffering for the victims, their families, their communities, and our society. The pain and loss experienced by those whose lives are shattered by these violent acts cannot be overstated.
On one hand, many are calling for major and overarching approaches to deal with firearm violence, and other violent actions, especially through various actions including gun control legislation, while other observers are calling for preventative strategies as far upstream as possible.
With the latter approaches in mind, the Journal of Mental Health Counseling, published by the American Mental Health Counselors Association, includes a ground-breaking article in its July 2016 issue on “Assessing and Responding to Threats of Targeted Violence by Adolescents.” The article calls for better understanding about threat types, threat levels of risk, and other contextual factors to address potential violent behaviors. This piece summarizes their key findings.
The authors, Jeffrey P. Winer, Department of Psychological and Brain Sciences, University of Massachusetts Amherst and Richard P. Halgin, Department of Psychological and Brain Sciences, University of Massachusetts Amherst, say that in order to create safer environments for youth and broader communities, clinicians, researchers, and policy makers need to investigate why young people engage in acts of violence. According to Winer and Halgin, there are cascades of threat assessment and that the evolution of threat assessment “best practices” in mental health research and practice can be categorized into three major waves.
First wave threat assessment relies on clinical intuition and focuses on the clinician’s experience and gut feelings to determine next steps after a threat of violence has been made. First wave threat assessment, which does not include formal risk assessment, is primarily qualitative in nature.
Second wave threat assessment, which utilizes actuarial prediction algorithms, determines a clinician’s next steps based on the results of administered assessments (the results of these assessments determine how a clinician should respond to a potential threat of violence. While first wave and second wave techniques may be useful in reducing the risk of violence , third wave threat assessment, which utilizes evidence-based structured professional and clinical judgment, is likely to be superior in reducing risk.
Third wave assessment techniques encourage clinicians to apply knowledge about risk factors to specific threat scenarios communicated within client-counselor relationships and integrate clinical judgment and the best available science third wave assessment entails the use of professional and clinical judgment and empirically developed risk assessment tools (e.g., the Structured Assessment of Violence Risk in Youth (SAVRY). Winer and Halgin believe third wave assessment integrates the best components of first wave (clinical judgment) and second wave (evidence-based assessment tools) to provide mental health professionals with the best tools to aid in violence risk reduction.
The authors highlight that contrary to popular belief, most individuals with mental illness have the same common risk factors for violence as their healthy counterparts. Yet, while the incidence of premeditated violence by adolescents is rare, counselors who treat adolescents should be prepared for the possibility that a client will raise the prospect of violence in a counseling session. Although specific laws vary state-by-state, mental health counselors, as mandated reporters, have special responsibilities when faced with the prospect of intended violence on the part of a client.
When a threat of harm is communicated in a therapeutic context counselors are faced with a challenging task of determining how to move forward to protect the client, themselves, and the broader community. When the client is a minor (under age 18), and does not have autonomous legal rights, the situation becomes more complex because of the counselor’s ethical responsibility to involve a legal caregiver. Counselors must balance the responsibility of involving parents or guardians while maintaining the therapeutic alliance and rapport with their adolescent client. The authors discuss ways of conceptualizing threats and assessing statements made by adolescent clients in order understand the potential for violence.
According to the authors, youth aggression and violent behavior are best conceptualized as two distinct types of behavior: proactive behavior (i.e., planned, premeditated behaviors) and reactive behavior (i.e., behaviors in response to perceived immediate threat). Threats of violence fall along a broad spectrum, such as proactive leakage scenarios in which a third-party threat is communicated by an adolescent client to a mental health counselor. Leakage is defined as a revelation of clues that may indicate an impending act.
Although many variables have been linked to adolescent violent behavior, the empirical literature points to several variables as especially important. This list includes: access to violent means, especially firearms; recent victimization by social groups or individuals; past concerns about the adolescent’s potential for violence expressed by adults or peers; mimicry by the adolescent of violent media figures; significant and worrisome recent changes in emotions and interests; current substance use/abuse; and other contextual family factors such as living in a family low in emotional closeness and low in knowledge of the adolescent’s life In addition to these variables, counselors should consider whether the adolescent has participated in extremist groups or has gang affiliation or membership.
The Youth Level of Service/Case Management Inventory is an assessment inventory which consists of 42 items and focuses on risk for general recidivism, although not initial violence behavior in particular. The Structured Assessment of Violence Risk in Youth (SAVRY) may be the most useful of these instruments, as it can be administered and scored in about 20-25 minutes and was developed with third wave structured professional/clinical judgment in mind.
The SAVRY is a risk-assessment tool based on the structured professional/clinical judgment model and is specifically intended for use with adolescents (Borum et al., 2005). The structure of the SAVRY is modeled on risk assessment protocols used with adult samples such as the historical, clinical, risk management-20 (HCR-20); but the SAVRY’s item content focuses specifically on risk factors relevant to adolescent development. Each risk factor in the SAVRY is coded for severity on a three-point scale, but the final appraisal of risk level is determined by the examiner’s professional judgment — not just on a summary of the items. By using this approach, the structured assessment draws on the strengths of both the clinical (first wave) and actuarial (second wave) approaches to assess proactive youth violence risk.
In sum, the authors believe that counselors who work with youth are likely to find these measures to be the current best-practice tools for assessment and intervention related to threats of violence. Moreover, as a society we must continually strive to examine factors pertaining to public safety and violence prevention efforts. Increasing attention must be given to social and political issues such as gun-control legislation, preventative interventions for at-risk youth, and educational initiatives for the general public pertaining to matters of youth violence.
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