1. Threat Assessment in the School Setting
Nancy Rappaport, MD
Harvard Medical School

2. 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, US Department of Education (NCES ) and US Department of Justice (NCJ ): Washington, DC.

3. 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, US Department of Education (NCES ) and US Department of Justice (NCJ ): Washington, DC.

4. Student Victimization Statistics
Percent
Grade
Percentage of students ages 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.

5. Most Common Types of School Violence
Interpersonal disputes
Assaults without weapons
Assaults between (male) students
Before and after school, during transitions between classes, during lunch

6. 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:

7. 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, Journal of School Health, 68,

8. 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, Surveillance Summaries, 28 June 2002.

9. 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 , U.S. Department of Education, October 2002

10. Reprinted by permission

11. “Battered Teacher Syndrome”
Depression
Elevated Blood Pressure
Interrupted Sleep
Headaches
Source: Bloch, AM (1976), The battered teacher. Today’s Education, 66:58-62.

12. School violence is an important part of the daily lives of children in schools… It affects where they walk, how they dress, where they go and who their friends are. As long as teachers treat violence at arms’ length, as something that is someone else’s problem, they will continue to neglect the opportunity to intervene in a crucial aspect of the children’s lives. By ignoring school violence, the name-calling, the shoving, the fighting, the harassment, they are condoning it. children see teachers walking by, pretending not to notice, and they learn that the way we treat others, the way we interact on the street or in the playground, is nobody’s business but our own. Teachers must talk about violence, they must recognize it, examine it, dissect it, and let children see and understand its secrets and its sources. Without this examination it remains an ugly secret that society cannot understand or control.
Source: Epp JR, Watkinson AM (1997), Systemic violence in education: Broken promise. Albany: State University of New York Press.

13. 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.

15. 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.

16. A 14-year old girl in Pennsylvania spoke honestly during a class discussion of the Colombine tragedy. She stated that she could understand how a person could be driven by hurtful others to a point of wanting to explode and hurt someone. She was quickly escorted to the principal’s office, physically searched for weapons, and then suspended from school.
Source: National Public Radio (6 May 1999), All things considered. Transcript by Burrelle’s Information Services, Livingston, NY

17. 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
“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
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:

18. 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.

19. 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: ; Browne, J.A., Losen, D.J., Wald, J. (2001), Zero tolerance: Unfair, with little recourse. New Directions for Youth Development, 92:73-99.

20. 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

21. 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?

22. Assessment Guidelines (ctd.)
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?
Are other people concerned about the student’s potential for violence?
What circumstances might affect the likelihood of an attack?

23. 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.

24. 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.

25. 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:

26. 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):

27. Socialized delinquent group (31/158) Troubled group
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:

28. Federally Mandated Special Education Protection
More than ten days of suspension in one school year
Expulsion proceedings
Source: Morrison GM, D’Incau B. (2000), Developmental and service trajectories for students with disabilities recommended for expulsion from school. Exceptional Children,66:

29. 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:

30. Five-Step Case Evaluation Consultation Model
Informed consent
Referral information
Contact with school and other professionals
Student and parent interviews
Report and feedback

31. Conditions of Psychiatric Evaluation
Office of Special Education
Special Education Services eligibility
NOT confidential

32. Selected Specific Behavior Rating Scales
Source: Connor, D.F. (2002), Aggression and Antisocial Behavior in Children and Adolescents: Research and Treatment. New York: Guilford.

33. New York Teacher Rating Scale (NYTRS; LS Miller et al., 1995) 6-14
Scale/ Reference:
Aggression
Age Range
Conduct Domains
Informants
New York Teacher Rating Scale (NYTRS; LS Miller et al., 1995)
6-14
Defiance, Physical Aggression, Delinquent Aggression, Peer Relations
Teachers
Predatory-Affective Aggression Questionnaire (Vitiello et al., 1990)
10-18
Predatory Aggression, Affective Aggression
Other (Staff, Peers)
Proactive-Reactive Aggression Scale (Dodge & Coie, 1987)
5-18
Reactive Aggression, Proactive Aggression
Parents, Teachers, Other

34. Structured Assessment of Violence Risk in Youth
Source: Bartel P, Borum R, Forth A (2002), Structured Assessment for Violence Risk in Youth (SAVRY). Consultation Edition.

35. 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:

36. CASE STUDIES

37. Case One Individual Factors Family Factors School & Peer Factors
Treatment
Situational Factors
Attack-Related Behaviors

38. Myth of the “Teenage Werewolf”
Popular media often insinuates that there are minimal warning signs for violent teenagers. In contrast, violent students often have histories of low frustration tolerance, impulsivity and angry outbursts. Adolescents who are at risk often externalize their anger and are less subtle about their agitation.

39. Treatment System Gaps
Practical Limitations
Crisis Response
Lag Time

40. Coordinated System of Care
Access to a psychiatric emergency room, inpatient unit, outpatient services
Shared Responsibility
School Setting

41. Multisystemic Response
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 ; 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:

42. Case Two Situational Factors Attack-Related Behaviors Family Factors
School & Peer Factors

43. 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.

44. The importance of advocacy in modifying the disciplinary action
Source: Morrison GM, D’Incau B. (2000), Developmental and service trajectories for students with disabilities recommended for expulsion from school. Exceptional Children,66:

45. 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:

46. Enhancing Protective Factors
Child Factors
Family Factors
Extrafamilial Factors
Easy Temperament
Higher IQ
Internal locus of control
High self-esteem
Academic competence
Social competence
Competence in activities
Good parent-child relations
External supports
Friendships
Availability of Opportunities
Source: Connor DF (2002), Aggression and Antisocial Behavior in Children and Adolescents: Research and Treatment. New York: Guilford.

47. Case Three Individual Factors Family Factors
School & Situational Factors
Systemic Assessment

48. 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.

49. 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.

50. Time Somebody Told Me Quantedius Hall, “Son of Reality,” Age 12
That I am lovely, good and real
That I am Beautiful inside
If they only knew
How that would make me feel.
That My mind is quick, sharp
and full of wit
That I should keep on trying
and never quit.
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.
So, I had a talk with myself
Just me, nobody else
‘cause it was time
Somebody Told Me.
Source: Franco, B (ed.), You Hear Me? Poems and writing by teenage boys. Cambridge, MA: Candlewick Press.