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School Shootings: Ethical & Confidentiality Boundary Issues
6 CEUs School Shootings: Ethical & Confidentiality Boundary Issues

Section 11
Assessment of Violence Risk in Adolescents

Question 11 | Answer Booklet | Table of Contents | School Shootings CEU Courses
Social Worker CEU, Psychologist CE, Counselor CEU, MFT CEU

Despite the limited number of actual severe violent behaviors in the form of school shootings, the risk for any type of violent behavior exists in all schools. School violence may range on a continuum from subtle behaviors (e.g., teasing, name calling, bullying, and other forms of intimidation and harassment) to severe actions, such as physical fights and shootings (Hernández & Seem, 2004; Smith & Sandhu, 2004). Hazier, Hoover, and Oliver (1996) reported that three out of four of the students they surveyed reported experiencing academic, personal, and social difficulties due to bullying and harassment. Students who experience harassment and bullying may experience threats to their emerging identity, which may increase feelings of powerlessness and hostility and thus contribute to a desire for revenge that escalates into a violent episode (Hazier, 2000). D'Andrea (2004) proposed the following six categories of violence: (a) physical violence, (b) sexual and gender violence, (c) media violence, (d) cultural-racial violence, (e) political-economic violence, and (f) violence of silence. A broad definition of violence ranging from mild to severe underscores the importance of comprehensive assessment to determine the level of risk and thus inform intervention programs.

The first-generation violence risk assessments were conducted by clinical judgment or clinical wisdom. In other words, professionals first began to make assessments for the potential for violence on the basis of nothing other than their own experience. Such assessments (even when done by professionally trained psychiatrists, psychologists, or counselors) were not found to be any more effective than judgments made by people without any training in the field of counseling, psychology, medicine, or psychiatry (Burns et al., 2001; Reddy et al., 2001). Early risk assessments may have included early warning sign lists to assist with clinical judgment; however, Burns et al. reported that there is "little to no information regarding the reliability or validity of such lists … there are no informal checklists that can accurately identify pupils who will commit violent acts" (p. 241-242). Such informal assessments may result in the over-identification of students at risk for committing a violent act (Burns et al.). To improve on the predictive ability of violence risk assessments, the field evolved to what has become known as the second generation of violence risk assessments, actuarial risk assessments (Borum et al., 2003). Actuarial risk assessments sought to place numerical predictions on the risk for potential violence. The problem with actuarial assessments was that they required professionals conducting the assessment to stick rigidly to numerical rating systems designed to determine mathematical predictions on the potential for violence. The professional had to stay with the mathematically derived formula designed to measure the potential for violence even if some factors may have been more individually relevant to a particular assessment. This left the professional with very little clinical judgment to account for unique circumstances within a particular assessment. Another limitation was that there has been no empirical research on risk factors for targeted school violence, and empirical research on general violence recidivism has limited bearing on targeted school violence (Reddy et al., 2001). Thus, actuarial assessments relying on empirical risk factors might lead to an underestimation of risk (Borum & Reddy, 2001). Actuarial risk assessments also placed emphasis on static and historical risk factors, which do not account for the dynamic nature of violence risk in adolescents.

The third generation of violence risk assessment procedures is known as structured professional judgment (Borum et al., 2003). The structured professional judgment framework was developed by examining the research on the factors that have been found to be linked to the likelihood of an increased risk for violence (Borum et al.). Such factors then were organized into user-friendly manuals for use by counselors, social workers, psychologists, and psychiatrists for conducting violence risk assessments. Guiding principles for structured professional judgment in violence risk assessment are as follows: (a) There is no profile or single "type" of perpetrator of targeted violence; (b) there is a dynamic interaction among perpetrator, situation, target, and the setting; (c) there is a distinction between making a threat (expressing an intent to harm a target to the target or others) and posing a threat (engaging in behaviors that lead to a plan to harm); and (d) targeted violence is not random or spontaneous (Reddy et al., 2001).

Risk factors include biological, psychological, cognitive, and environmental risk factors (Hazier, 2000). The rapid psychological and physiological changes during puberty make puberty itself a biological risk factor (Hazier). Psychological risk factors include adolescent depression (Hazier; Latzman & Swisher, 2005), conduct disorder (Frick, 2004; Gacono & Hughes, 2004), and substance use (Makinson & Meyers, 2003; Schaefer-Schiumo & Ginsberg, 2003). Psychopathy is another important concept to consider in violence risk assessments (Gacono & Hughes). Psychopathy is defined by behaviors associated with conduct disorder (e.g., repeatedly violating the basic rights of others, specifically with aggression to people and animals, destruction of property, deceitfulness or theft, and/or serious violation of rules; American Psychiatric Association, 2000) in addition to specific interpersonal traits (e.g., grandiosity, callousness, arrogance, dominance, superficiality, and manipulation) and affective traits (e.g., short temper, inability to form emotional bonds with others, and lack of guilt or anxiety) (Hare, 1999).

However, it is important to note that a student does not need to be suffering from a diagnosable mental illness to be at risk for committing a violent act. Instead, violent episodes are frequently initiated following incidents of recent losses (Hermann & Finn, 2002; Sawyer & Cameron, 2001) or incidents such as bullying (Vossekuil et al., 2000), harassment (Hazler, 2000), alienation (Glasser, 2000), and/or peer rejection (Hermann & Finn). Feelings correlated with suicidal ideation and attempts--such as humiliation, helplessness, hopelessness, and self-pity (Hazler)--also may be associated with violent behavior. Osher and Warger (1998) found that extreme feelings of isolation and social withdrawal were also common signs of potential violent behavior.

Environmental risk factors, such as role modeling of violent behaviors in the home, school, or community, are also important to consider (Furlong, Morrison, Chung, Bates, & Morrison, 1997). The home environment may not foster independence or assertiveness, and it may contribute to poor problem-solving abilities (Hazier, 2000). A family history of criminal violence (Moffitt, 1997) as well as childhood sexual, physical, or emotional abuse (James & Gilliland, 2001) also may increase the risk for violent behavior. The school environment also may increase the risk for violence (Hernández & Seem, 2004), if there is insufficient adult supervision, tolerance of bullying and teasing, special privileges given to certain populations (e.g., honor students or athletes), little access to intervention, ignored threats of violence (Stevens, Lynm, & Glass, 2001), or ambiguous consequences, low teacher morale, and high student disorder (Sherman et al., 1997). The community also may contribute to increased risk for violence, with social disorganization and overcrowded neighborhoods with high crime rates (Hawkins et al., 1998) mad high rates of drug and alcohol use (Schaefer-Schiumo & Ginsberg, 2003). Risk factors also revolve around behaviors directly related to threats of violence (e.g., attempting to gain access to weapons, writing about suicide or homicide, or telling someone about their plan; Vossekuil et al., 2000) and warning signs of violent behavior (e.g., harm to small animals or an excessive interest in violent entertainment; Hermann & Finn, 2002). As can be seen, there are a vast number of risk factors associated with violence in adolescence, thus indicating a need for comprehensive violence risk assessment. Risk factors to consider when using structured professional judgment in violence risk assessment include historical factors (e.g., previous violence, young age at first violent incident, relationship instability, employment problems, substance use problems, and early maladjustment), clinical and situational factors (e.g., lack of insight, negative attitudes, active symptoms of major mental illness, impulsivity, and unresponsiveness to treatment), and risk management factors (e.g., feasibility of plans, exposure to destabilizers, lack of personal support, noncompliance with remediation, and stress) (Webster, Douglas, Eaves, & Hart, 1997). Assessment of violence risk in adolescents also requires an emphasis on dynamic and contextual risk factors (e.g., peer delinquency, peer rejection, poor parental management, and community disorganization; Borum et al., 2003). Frick (2004) stated that "the number of risk factors present is more important than the type of risk factor" (p. 824). Thus, the accumulation of risk factors as well as the interactive and dynamic nature of risk factors must be considered.

The presence or absence of youth assets (Aspy et al., 2004) and protective factors (Borum et al., 2003) is important to consider in the reduction of violence and aggression risk factors. For example, Aspy et al. found that youth who possessed assets such as family communication and making responsible choices were significantly more likely to report no physical fighting or weapon carrying. As well, students who reported being in high school, living with both parents, and having a higher family income also were associated with no fighting (Aspy et al.). Positive peer relations and engaging in prosocial behaviors buffer negative effects of delinquency and aggression (Caprara, Barbarelli, & Pastorelli, 2001). Social support (Dubow & Reid, 1994) and strong attachments with prosocial adults who are supportive and accepting (Simons, Paternite, & Shore, 2001) contribute to resiliency in children. Personality traits associated with increased resiliency in children include above-average intellectual skills, conflict management skills, positive response to others, adaptability to change, capacity to self-soothe or be soothed by others, calm mood, and healthy self-esteem (Kumpfer, 1999). Strong commitment to one's school also has been linked to decreased risk of violence (Hawkins et al., 1998). Thus, just as a higher number of risk factors contributes to increased risk for violence, a higher number of protective factors contributes to reduced risk for violence.

A structured professional judgment approach to violence risk assessment involves gathering information about the number of risk factors all individual may have with an emphasis on corroboration of facts and a focus on the progression of attack-related behaviors (Borum & Reddy, 2001; Reddy et al., 2001). Unlike actuarial risk assessments, assessments using structured professional judgment do not yield a final predictive numerical score. Instead, they lead the professional through a structured list of factors, based on empirical research, to rate throughout the assessment in order to determine a final rating of risk (mild, moderate, or severe). Going back to Hermann and Finn's (2002) work, using a structured approach to risk assessment is critical because establishing liability for inaccurately assessing risk for violence without using structured methods and criteria will increasingly leave school counselors in a vulnerable position if asked how they determined the level of risk in a particular student. Unstructured approaches have the potential for misjudgments, inaccurate assessments, and legal implications if the school counselor's assessment is not based on commonly accepted standards and an appropriate structured approach to file assessment of violence risk (Reddy et al.).
- Bernes, Kerry B.; Bardick, Angela D.; Conducting Adolescent Violence Risk Assessments: A Framework for School Counselors; Professional School Counseling, Apr2007, Vol. 10 Issue 4, p419-427

Personal Reflection Exercise #4
The preceding section contained information regarding assessment of violence risk in adolescents. Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 11
What are the four guiding principles for structured professional judgment in violence risk assessment? Record the letter of the correct answer the Answer Booklet.

 
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