Threat (Safety) Assessment in the School Setting Nancy Rappaport, MD Harvard Medical School
Background Data on School Violence • School characteristics that are associated with higher rates of school violence are large school size, problematic leadership and presence of gangs in the school. Source: Kaufman, P., Chen, X., Choy, S.P., et al. (2000), Indicators of school crime and safety, 2000. US Department of Education (NCES 2001-017) and US Department of Justice (NCJ-184176): Washington, DC.
Background Data on School Violence • Children and adolescents are three times as likely to be victims of serious violent crime away from school than they are on school grounds. Source: Kaufman P, Chen X, Choy SP, et al. (2000), Indicators of school crime and safety, 2000. US Department of Education (NCES 2001-017) and US Department of Justice (NCJ-184176): Washington, DC.
Student Victimization Statistics Percent Grade Percentage of students ages 12-18 who reported criminal victimization at school during the previous 6 months Source: U.S. Department of Education (National Center for Education Statistics), U.S. Department of Justice (Bureau of Justice Statistics), Indicators of School Crime and Safety 1999.
Most Common Types of Student Victimization Statistics School Violence • Interpersonal disputes • Assaults without weapons • Assaults between (male) students • Before and after school, during transitions between classes, during lunch
School Violence Statistics • In a 2001 survey of high school students, 17.4% had carried a weapon to school during the 30 days preceding the survey. Source: Grunbaum J, Kann L, Kinchen SA, et al. (2001), Youth risk behavior surveillance - United States, 2001. Surveillance Summaries, 28 June 2002.
How Is School Violence Measured? • Self-Report Surveys • Studies do not report using response reliability or validity checks • Public Health Model Source: Cornell DG, Loper AB (1998), Assessment of violence and other high-risk behaviors with a school survey. School Psychology Review 27: 317-330.
Ambiguous Questions • “In the past thirty days, how many times have you brought a weapon to school [gun, knife or club]?” (YRBS) • Multiple weapons • Choice of time period • Level of severity Source: Kann L, Kinchen SA, Williams BI, et al. (1998), Youth risk behavior surveillance - United States, 1997. Journal of School Health, 68, 355-369.
Expulsions for Bringing Firearms to School • 57% involved high school students • 33% involved junior/middle school students • 10% involved elementary school students Gun-Free Schools Act Report: School Year 1998-1999, U.S. Department of Education, October 2002
“Battered Teacher Syndrome” • Depression • Elevated Blood Pressure • Interrupted Sleep • Headaches Source: Bloch, AM (1976), The battered teacher. Today’s Education, 66:58-62.
Crimes Against Teachers On average, each year from 1993 to 1997 there were 131,400 violent crimes against teachers at school, as reported by both public and private schools. This translates into a rate of 31 crimes for every 1,000 teachers and a rate of 53 thefts for every 1,000 teachers. Source: U.S. Department of Education (National Center for Education Statistics), U.S. Department of Justice (Bureau of Justice Statistics), Indicators of School Crime and Safety 1999.
Multiple-Victim Homicide Incidents at School Number of Incidents Source: 1999 Annual Report on School Safety. The School Associated Violent Deaths Study, Center for Disease Control and Prevention and the US Department of Education, 2000.
Characteristics of Students Exhibiting Violent Behavior “Classroom Avenger” • Premeditated assailant involved with shooting multiple students • Often comes from rural or suburban areas and different family backgrounds and academic achievement, with little prior involvement with the juvenile justice system
Characteristics of Students Exhibiting Violent Behavior Typically Violent Student • Often from families in turmoil with a history of abuse and neglect • Failing academically • Struggling with impulsive behavior, poor frustration tolerance and limited concentration Source: Twemlow SW, Fonagy P, Sacco FC, O’Toole ME, (2002), Premeditated mass shootings in schools: Threat assessment. J Am Acad Child Adolesc Psychiatry 41:475-477.
Guidelines for Assessment • High-level threats include direct, specific threats where the student has concrete plans to execute his threats • Medium-level threats can be concrete with descriptive detail but lack discernable preparation plans. • Low-level threats are those threats that seem exaggerated; the student has inconsistent details of a plan Source: Fein RA, Vossekuil B, Pollack WS, et al. (2002), Threat Assessment in schools: A guide to managing threatening situations and to creating safe school climates. United States Secret Service and United States Department of Education, Washington, D.C.
Classification of Risks • Individual traits describe a wide range of behaviors such as low frustration tolerance, poor coping skills, recent rejection, and signs of depression • Family dynamics highlight difficult parent-child relationships including parents denying their child’s troubled behavior and providing minimal supervision Source: Twemlow, S.W., Fonagy, P., Sacco, F.C., O’Toole, M.E. (2002), Premeditated mass shootings in schools: Threat assessment. J. Am. Acad. Child Adolesc. Psychiatry, 41:475-477; Browne, J.A., Losen, D.J., Wald, J. (2001), Zero tolerance: Unfair, with little recourse. New Directions for Youth Development, 92:73-99.
Classification of Risks, ctd. • School problems are teasing, and a school climate that encourages a code of silence and reinforces bullying behavior • Community factors may inhibit or stimulate aggression depending on the availability of guns, immersion in deviant peer groups, and easy access to drugs and alcohol
Assessment Guidelines • Has there been any communication that suggests ideas or intent to attack? • Has the student shown deviant fantasies of revenge? • Has the student engaged in attack-related behaviors? • How organized is the student’s thinking and behavior? • Is the student experiencing hopelessness, desperation and/or despair?
Assessment Guidelines • Does the student have a trusting relationship with at least one responsible adult? • Does the student see violence as an acceptable-or desirable-way to solve problems? • Is the student’s conversation and “story” consistent with his or her actions?
Assessment Guidelines • Are other people concerned about the student’s potential for violence? • What circumstances might affect the likelihood of an attack?
Zero Tolerance: Can Suspension and Expulsion Keep Schools Safe? Skiba RJ, Noam GG (eds.), New Directions for Youth Development: Theory Practice Research, Volume 92. Winter 2001, Jossey-Bass Press.
Currently the majority of public schools adopt a “zero tolerance” stance for any kind of violent behavior with no research to demonstrate the efficacy of these policies • Political solution Source: Editor’s Notes: New Directions for Youth Development, 92:1-6.
There is a disproportionate representation of minority students and students with special needs being suspended or expelled Source: Skiba RJ, Peterson RL (1999), The dark side of zero tolerance: Can punishment lead to safe schools? Phi Delta Kappan, 80:372-382.
Many students recommended for expulsion from schools do not represent danger to other students or staff and are a heterogeneous group Source: Morrison GM, D’Incau B (1997), The web of zero tolerance: Characteristics of students who are recommended for expulsion from school. Education and Treatment of Children, 20(3):316-335.
Disconnected group • Socialized delinquent group (31/158) • Troubled group • “First offense” group Source: Morrison GM, D’Incau B. (2000), Developmental and service trajectories for students with disabilities recommended for expulsion from school. Exceptional Children,66:257-272.
Federally Mandated Special Education Protection • More than ten cumulative days of suspension in one school year • Expulsion proceedings (excluded for special education students) Source: Morrison GM, D’Incau B. (2000), Developmental and service trajectories for students with disabilities recommended for expulsion from school. Exceptional Children,66:257-272.
Is the offense a “manifestation” of their disabling condition? • Determination of their appropriate placement Source: Morrison GM, D’Incau B. (2000), Developmental and service trajectories for students with disabilities recommended for expulsion from school. Exceptional Children,66:257-272.
Five-Step Case Evaluation Consultation Model • Informed consent • Referral information • Contact with school and other professionals • Student and parent interviews • Report and feedback
Conditions of Psychiatric Evaluation • Office of Special Education • Special Education Services eligibility • NOT confidential
Selected Specific Behavior Rating Scales Source: Connor, D.F. (2002), Aggression and Antisocial Behavior in Children and Adolescents: Research and Treatment. New York: Guilford.
Children’s Aggression Scale – Teacher Version (CAS-T) • Verbal aggression • Aggression against objects and animals • Provoked physical aggression • Unprovoked physical aggression • Use of weapons • Reliability Source: Halperin JM, McKay K, Grayson RH, Newcorn JH. (2003), Reliability, validity, and preliminary normative data for the Children’s Aggression Scale – Teacher Version. J Am Acad Child Adolesc Psychiatry 42:965-971.
StructuredAssessment ofViolenceRisk inYouth Source: Bartel P, Borum R, Forth A (2002), Structured Assessment for Violence Risk in Youth (SAVRY). Consultation Edition.
Case One • Individual Factors • Family Factors • School & Peer Factors • Treatment • Situational Factors • Attack-Related Behaviors
Myth of the“Teenage Werewolf” • Popular media often insinuates that there are minimal warning signs for violent teenagers.
Treatment System Gaps • Practical Limitations • Crisis Response • Lag Time
Coordinated System of Care • Access to a psychiatric emergency room, inpatient unit, outpatient services • Shared Responsibility • School Setting
Multisystemic Therapy • Flexibility • Adolescents with conduct problems • Department of Mental Health (DMH) diagnosis Source: Mattison RE, Spirito A (1993), Current consultation needs of school systems. In: Child and Adolescent Mental Health Consultation in Hospitals, Schools, and Courts, ed. B Nurcombe, GK Fritz RE Mattison & A Spirito. Arlington, VA: American Psychiatric Publishing, pp. 161-183; Henggeler SW, Melton GB, Smith LA (1992), Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. J Consulting Clin Psychol, 60:953-961.
Clinical Prediction of Risk • Very little research on the accuracy of clinical prediction of violence in adolescents • Risk factors, resilience factors, potential triggers • Grisso: “I do not know whether this youth will engage in violent behavior, but the risk that it may happen is (greater than, similar to, less than) the risk posed by youths in general in (the relevant setting).” Source: Comer JP (1997), Waiting for a Miracle: Why Schools Can’t Solve Our Problems and How We Can. New York: Dutton. Grisso T (1998), Forensic Evaluation of Juveniles. Sarasota, FL: Professional Resource Press.
There is a key distinction between predicting violence and emphasizing preventing violence by suggesting appropriate interventions. Source: Sewell K W, Mendelsohn M (2000), Profiling potentially violent youth: Statistical and conceptual problems. Children’s Services: Social Policy, Research, and Practice, 3:147-169.
Protective Factors Source: Connor DF (2002), Aggression and Antisocial Behavior in Children and Adolescents: Research and Treatment. New York: Guilford.
Case Two • Individual Factors • Family Factors • School & Situational Factors • Systemic Assessment
Systemic Violence • Contextually embedded • School climate • Institutional practices that adversely affect individuals Source: Furlong MJ, Morrison G (2000), The school in school violence: Definitions and facts. Journal of Emotional & Behavioral Disorders, 8:71-82.
Schools can be an arena where cultural differences are amplified. Source: Delpit LD (1995), Other People's Children: Cultural Conflict in the Classroom. New York: New Press. Lightfoot SL (1978), Worlds Apart: Relationships Between Families and Schools. Basic Books: New York.
Time Somebody Told MeQuantedius Hall, “Son of Reality,” Age 12 Time Somebody Told Me That I am lovely, good and real That I am Beautiful inside If they only knew How that would make me feel. Time Somebody Told Me That My mind is quick, sharp and full of wit That I should keep on trying and never quit. Time Somebody Told Me How they loved and needed me How my smile is filled with hope And my spirit sets them free How my eyes shine, full of light How good they feel when they hug me tight. Time Somebody Told Me So, I had a talk with myself Just me, nobody else ‘cause it was time Somebody Told Me. Source: Franco, B (ed.), 2000. You Hear Me? Poems and writing by teenage boys. Cambridge, MA: Candlewick Press.