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Brian Van Brunt, [email protected]
Director of Counseling and TestingWestern Kentucky University
Threat Assessment and Management of At-Risk Students
2009 NASPA Mental Health Conference
Boston, MA
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Threat Assessment
• There is an increase in discussions surround threat assessment following the Virginia Tech and NIU shootings.
• This presentation is designed to assist counselors and psychologists and student affairs personal to improve their communication and expectations surrounding threat assessment and treatment.
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Common Language
• Though we are being asked to do more with threat assessment---let’s remember:
• With the exception of sexual assault, College and Universities remain safer then the general community and provide more support, supervision and monitoring (for 18-24 year olds compared to non-college sample).
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Common Language
• We are concerned with addressing behavior, not targeting those with mental illness. We are concerned with aggression, threats intimidation, hoarding of weapons and the frustration, anger and isolation that leads to an act of violence.
• Those with mental illness are more likely to be the victims of violence, not perpetrators (Choe, Tepin, Abrams; 2008).
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Mandated Assessment
• The process where a third party involved with a student refers a student for some number of individual sessions with a counselor, psychologist or therapist.
• This often is a result of the student breaking a campus policy – i.e., suicide threat, cutting behavior,
angry outburst, stalking behavior, alcohol or drug use, sexual harassment.
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Mandated Programming
• Third-party requires a student to attend a group or classroom presentation.
• These often are psycho-educational and are commonly offered in the areas of drug or alcohol policy violation, although models exist for interpersonal violence as well.
• These programs may focus on reducing anger, improving social interactions with others or addressing sexual harassment issues.
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Mandated Treatment/Counseling
• Mandated treatment often follows the initial assessment and occurs in either a group or individual setting.
• Students are referred by a third party to counseling in order to meet sanctioning requirements or to stay involved in a club, organization, class, team or enrolled in the university.
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A bit about Mandated Referrals…
• There is no assessment that will predict violence – most assessments are not designed to try.
• The most useful assessment looks at situations rather than individuals and offers insight as to levels of concern.
• There is no treatment that will guarantee prevention of further acts of violence for any particular individual. There are group data that treatment reduces the likelihood of future violence.
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• The best we can hope for with individuals is an “educated guess” at the level of risk and likelihood of threat and danger.
• We base this on past behavior, current symptoms, the student’s general attitude & compliance, and the situation surrounding the individual of concern.
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A bit about Mandated Referrals…
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• Treatment provides skills and tools. The student is responsible for making use of these tools. (horse to water)
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A bit about Mandated Referrals…
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• Referrals work better when there is an on-going positive relationship with the referral source. Everyone is stressed with the heightened “hot potato” issues raised with threat teams and judicial referrals.
• Take the time to form relationships during the down times of the year so that the relationship is solid when the difficult situations arise. A crisis is not a fruitful moment for creating a positive relationship.
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A bit about Mandated Referrals…
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What information would you need to perform an accurate assessment? (golden rule)
– Incident report, witness statements– Past judicial history, staff reports– Academic transcript, GPA, class list– Situational (life) information– Housing records– Follow up contact numbers
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Pre-Assessment Information
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• It is always easier to have a student sign a release of information during the initial meeting than attempting to track them down afterwards for a signature
– Contact referral source to see if they have preferred forms (HIPAA, ROI)
– Explain why you are requesting information, what you need and when you need it. (build rapport)
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Pre-Assessment Information
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• Be clear about what they are looking for as a result of the assessment, treatment or programming.
• When the referral is done, do they need a letter?
• Does that letter need to include specific statements or come from a particular provider? – Ask for these things prior to the referral. – Be clear at the start what you need.
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Pre-Assessment Information
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• Conduct periodic follow-up calls with referral agent, particularly if this is an off-campus referral (summer example).
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Pre-Assessment Information
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HIPAA
• HIPAA applies if:– Does the person, business, or agency furnish
bill, or receive payment for, health care in the normal course of business?
– If the answer is yes, does the person, business, or agency conduct covered transactions?
– If yes, are any of the covered transactions transmitted in electronic form?
– If the answer to this question is yes, the person, business, or agency is a covered health care provider and must comply with all HIPAA regulations
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HIPAA
• HIPAA does not apply to most centers since most centers don’t bill clients or transmit electronic billing.
• If HIPAA does apply, it just requires the signature of a release of information to get permission from the student to share information.
• We suggest judicial offices obtain these HIPAA ROI forms prior to mandating a student to counseling.
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HIPAA• Gene Deisinger (2008) of Iowa State makes a good
point in his recent book Handbook for Campus Threat Assessment and Management Teams:
• “…The Threat Assessment Team can provide the information it knows to an individual’s therapist or counselor…this may enhance the treatment that the mental health professional is able to provide.” p.91
• “…access to mental health information may be helpful …but it is more important to consider incorporating any treating mental health professionals into the case management plan.” p. 92
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FERPA• FERPA offers departments working together for a
student’s best interests a wide latitude to share information. These individual’s must be “educational officials with a legitimate need to know.” Deisinger (2008) suggest threat assessment team members are given this classification.
• FERPA does not apply to medical or counseling records.
• A signed release of information addresses information sharing in a way that removes any guesswork.
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HIPAA and FERPA
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Mandated?
• There are some counselors and psychologists who aren’t comfortable with “mandated” anything when it comes to their clients.
• They make arguments against this based on the idea of autonomy---that all clients must choose to enter treatment or assessment willingly.
• Mental Health professionals on a college campus are not like private practitioners; the greater good of the community needs to be taken into account. 21
Mandated?• Nearly every community utilizes court
mandated involuntary treatment. Like many states, VA, often mandates treatment for those assessed for mental health concerns and released into the community.
• In the VA Tech case, mandated treatment was ordered, but never provided due a complex set of circumstances. That omission has been identified as one of the places where the tragedy might have been avoided.
• I suggest this resource is needed in the university community as well.
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Mandated?
• Mandated treatment is used commonly in other areas:– DUI and substance related offenses– Domestic violence and restraining orders– Sexual assault– Anger management treatment programs– Employee Assistance Programs (EAP)
related to work performance– Sexual harassment and sensitivity
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Mandated?
• In a survey of 603 counseling center directors, Oetting, Ivey, and Weigel (1970) reported that 20% of centers provided disciplinary counseling and 33% of counseling center directors evaluated disciplinary cases referred to their centers.
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Mandated?
• In national survey data, Dannells (1990) documented "a huge increase in disciplinary counseling in counseling services, from 38% in 1978 to 60% in 1988" (p. 412).
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Mandated?
• More recently, Gallagher (2006) surveyed college counselors in the American College Counseling Association (ACCA).
• Results included data showing 88% of counseling centers offering some sort of mandated assessment service.
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Mandated?Gallagher 2006 ACCA survey (n=367)
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Mandated?
• The ACA ethics code states “Clients have the freedom to choose whether to enter into or remain in a counseling relationship...” A.2.a
• “Centers may provide mandatory assessment and other consultations to campus units, but must not make admissions, disciplinary, curricular or other administrative decisions involving students.”
-IACS 2005
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Mandated?
• “While AUCCCD is opposed to ongoing mandated treatment, we recognize the value of mandated assessment when it is precipitated by clear problematic behavior and violation of college and university conduct codes.”
-2007 position paper
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We will now explore the ethical codes related to counselors providing mandated assessment and counseling along with a
review of commonly used testing measures.
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• There are several ethical obligations that first must be met.
• The authority counselors and psychologists typically follow…
STATE LAWSTATE LAW
Ethics Code•ACA, AMA, APA
Ethics Code•ACA, AMA, APA
College PolicyCollege Policy
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• The clinician must be primarily concerned with the dignity and welfare of the client. While there may be pressure from another source, the counselor cannot force or compel the student. (ACA: A.1.a; A.2.a; IACS:4)
• The clinician must define their role for the client. Dual relationships (evaluation vs. counseling, being a director of counseling at a college) must be disclosed before the assessment. (ACA:E.13.b)
Ethics
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• The clinician must perform within their scope of practice. They must have training and knowledge of the assessment or treatment. This applies to any tests they will administer. (ACA: C.2.a, D.2.a)
• The clinician cannot have a prior counseling relationship with the student. (ACA E.13.c)
• The clinician should not be in the position of making decisions in a disciplinary or judicial case. They should consult, always providing services which respect the dignity and welfare of their client. (IACS: A)
Ethics
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• Clinicians cannot release information without client’s permission. They cannot release information that will harm the client (ACA:B.2.c, B:1:c)
• When using tests (ACA: E.2, E4,E.6.a, E.9.a, IACS: 1.b, APA: 9.01.a)– Must be appropriate, Reliable and Valid– Clinician must have training– Must take diversity issues into account– Only release raw data to qualified source– Findings based "on information and techniques
sufficient to substantiate” APA: 9.01.a
Ethics
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• Develop a clearly worded informed consent spelling out for the student what will happen and how the results will be shared.
• This must be done prior to the assessment
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Informed Consent
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• Outline the scope of your assessment
• The tests, costs and time involved in completing
• Limit access to raw test data to qualified individuals with client written consent
• Outline who will receive the assessment
• List kind of information will be collected (past therapy, past inpatient, past court involvement, arrests, felonies)
• Clearly spell out what happens if the student no-shows appointments (who is notified)
Informed Consent
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• If a judicial office requires off-campus assessment, the counselor/psychologist can help advocate for the student to ensure a smooth process. Ask:
– The specifics of what they require,– If the clinician/center has acceptable
credentials for the assessment being asked for
– Help the student understand the time and cost issues as they related to insurance, self-pay and scheduling their assessment
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Advocacy
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• When thinking about assessment, remember the Saxe poem about the blind men and the elephant…
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• When reviewing tests and measures to better assess symptoms and risk be aware…
– There is no measure that predicts future violence
– There is no substitute to a solid clinical interview
– You must have the training needed to choose, administer, score, interpret and report the results for a given test
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Choosing your Assessments
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• When performing assessments, there is no test or measure that substitutes for common sense and clinical judgment.
• An effective assessment can measure risk on a comparative basis
• When writing reports and letters, base your observations and conclusions on the information at hand.
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Choosing your Assessments
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• Avoid “going out on a limb” and making statements that cannot be reasonably backed up by the facts at hand.
• As a professor of mine once said, “While it makes for a more interesting report, be careful when using speculation and opinion that can’t be substantiated.”
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Choosing your Assessments
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– Structured Clinical Interviews• MOSAIC, HCR-20, HARE-PCL-R
– Deception Detection• TOMM, PDS
– Baseline Measures• MMPI-2, MSE
– Symptom Based• STATIC-99: Sexual, STAXI-2: Anger, FAVT:
Violence• EDIT: Eating Disorder, Beck Scales, FAST/FASI:
self-harm
– Anti-social• JI-R
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Types of Assessments
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Treatment Suggestions
Referral and first session Attendance
Build Rapport
Baseline FunctioningCogniti
ve Behavioral
Psychoanalytic
Case History
Gestalt Therapy
Motivational Interviewing
Assessment
Diagnosis
Client-Centered Rogerian
Prochaska and DiClemente
Medication Referral
AA/NA group model
Reality Therapy
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Treatment Suggestions
Referral and first session Attendance
Build Rapport
Baseline FunctioningCogniti
ve Behavioral
Psychoanalytic
Case History
Gestalt Therapy
Motivational Interviewing
Assessment
Diagnosis
Client-Centered Rogerian
Prochaska and DiClemente
Medication Referral
AA/NA group model
Reality Therapy
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• When working with someone who is trying your patience, being hostile or being unmotivated---remember your goal.
• Your goal should be to assist the person move towards a higher stage of change, maintain positive momentum or gain a better understanding of their current situation and their decision to make a change.
Treatment Suggestions
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• A connection is the start. It is the first step towards motivation, persuasion and compliance.
• It may be that the “going somewhere” is too big of a step to take all at once.
• Consider the subtle move of “No, I’m not going to do that.” to “I’ll think about it”.
• Let’s take the example of a client with a anger problem who isn’t ready to address it.
Treatment Suggestions
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Goal in Conversation
What to say…
Validate their experience
You are here to talk about your anger, but you don’t think you have an problem.
Acknowledge their control
As much as I want you to better control your anger, the choice remains with you.
Give your opinion It seems your anger has had a negative impact on your life. Tell me how you see it.
Acknowledge the pressure
This is a difficult discussion for you. You likely feel pressured to tell me what I want to hear.
Validate they are not ready
I understand you are not ready to address your anger.
Restate they must choose
Ultimately, it is up to you to choose to gain better control of your anger
Reframe this discussion
This discussion is a starting place, lets see it as a beginning rather than a final discussion.
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• Help an aggressive client understand why their current behavior isn’t in their best interest.
• Build a bridge between you and the aggressive client. Trust is not instinctual, it must be earned.
• Use open ended questions to encourage the them to talk.
• What have they got to gain? What have they got to lose? What can I use to persuade him away from aggression?
Treatment Suggestions
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• I was at a training where a therapist who worked with at-risk, adolescent girls was sharing from her 20 years of experience. She said:
• “It is imperative that someone in the therapy room has hope for the future. Sometimes it is the patient, sometimes it is the therapist. But someone must always have hope that things will improve.”
Treatment Suggestions
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• NaBITA is a new organization developed by the National Center for Higher Education Risk Management (NCHERM) to share best practices and behavioral intervention documentation, including information on successful models, sample policies, protocols, training tools and tabletop exercises.
• The most recent addition is a threat assessment tool which creates a new 4-D mental health scale matched to the NCHERM 5 level of risk. A detailed description of this model is included in your conference CD.
www.nabita.org
National Behavioral Intervention Team Association (NaBITA) Model
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■ Suicidal, Para-suicidal (cutting, eating disordered)
■ Individual’s engaging in risk taking behaviors (e.g. substance abusing)
■ Hostile, aggressive, relationally abusive
■ Individual deficient in skills that regulate emotions, cognition, self, behavior and relationships
■ Behaviorally disruptive, unusual and/or bizarre acting
■ Destructive, apparently harmful to others
■ Substance abusing
ELEVATED
SEVERE
EXTREME
MODERATE
MILD■ Emotionally Troubled
■ Individuals impacted by situational stressors and traumatic events
■ May be psychiatrically symptomatic
Dis
tress
Dis
turb
an
ceD
ysr
egula
tion/
Medic
ally
Dis
able
d*
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ELEVATED
SEVERE
EXTREME
MODERATE
MILD
Dis
tress
Dis
turb
an
ceD
ysr
egula
tion/
Medic
ally
Dis
able
d
FORCED LOSS OF FACE
IMAGE DESTRUCTION
THREAT STRATEGIES
WIN/LOSE ATTACK
LIMITED DESTRUCTIVE BLOWS
LOSE/LOSE ATTACK
NINE LEVELS OF AGGRESSION
E
SC
ALA
TIO
N P
HA
SE C
RIS
IS
PH
ASE
ACTIONS VS. WORDSHARMFUL DEBATE
HARDENING
TRIGGER PHASE
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• I have included two case studies along with their paper work, test results, judicial letters and informed consent/release of information.
• Time permitting, I would be happy to give an overview of either case study and answer any questions you may have.
Case Study
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• River was hospitalized for a Tylenol and medication overdose during September, she had not been to counseling on campus prior. 1a
• Housing contacted counseling and the Dean, River was asked to complete an assessment as she returned to campus (parents contacted, ROI signed). 1b;1c;1d;1e
• She works with counseling 1f and completes the counseling assessment. 1g
Case Study One
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• During a counseling appointment, River admits to cutting self and has the wounds dressed at health services.
• St. Lucy’s Medical Center report arrives. 1h• She has another overdoes attempt and is
called in for a hearing after being released from the hospital.
• Student suspended for a semester following a return from the second hospitalization. 1i
Case Study One
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Case Study One Timeline
1st Inpatient9/15/08
Dean Hearing9/20/08
Overdose and 2nd
inpatient10/18/08
Hearing and
Separation
11/3/0811/5/08
Cutting Behavio
r10/1/08
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Case Study Key Points• We have the hospital records directly sent
to counseling and then summarized to go onto the Dean’s office as needed. This protected some of the client’s confidentiality.
• The two hearings by the Dean are focused on behavior, not mental illness. The final separation letter clearly outlines the disruption to the college community and does not discuss her mental illness.
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Case Study Key Points
• We found it helpful to have counseling make the parental notification in the middle of the night to the parents.
• This tends to give a “school as helper” first impression to the parent. When the Dean has done the notification, parents often see the “school as disciplinarian” as the process unfolds.
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Case Study Key Points
• I’ve found it helpful to avoid having counseling release detailed testing results to the Dean.
• Counseling summarizes the testing results and clinical work in a short, simple letter outlining concerns.
• Counseling avoids sharing all details of treatment (trauma history) as it is not relevant to the case at hand.
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Case Study Key Points
• Contacting parents – yes or not, and by who?• Ban from campus until a hearing – yes or no,
who decides, and based on what?• Timeline of hearing – how fast can/should it
happen? • Release of information – which ones are
needed?• What about missed class time and
communication with professors?
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• Malcolm reported for harassing another student who lived in his hall. 3a
• Other reports come in of odd behavior. 3b, 3c He is suspended from campus by judicial affairs pending an off-campus counseling assessment. 3d
• Malcolm signs releases for information 3e and a consent to treatment with counseling. 3f
• Malcolm has a brief assessment at an off-campus hospital emergency room. 3g
Case Study Three
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• Malcolm releases information to judicial affairs and is allowed to return to school. 3h
• Malcolm attends counseling on-campus and completes some additional assessments. 3i
• Several more reports of threatening (demanding his therapist’s cell phone) and odd behavior (asking roommate’s mother for $20,000) came from around campus. Malcolm met with judicial affairs and opted for a voluntary withdrawal. (extra suspension letter) 3j
Case Study Three
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Case Study Three Timeline
Campus Safety Report
10/15/08
Odd and threateni
ng behavior reports
10/20/08-10/22/08
Dean mtg, off-campus
evaluation
10/23/08
2nd Dean Mtg,
agrees to vol leave campus11/14/0810/30/08
Return to campus
More odd and threatening
reports 11/11;11/13
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Case Study Key Points
• The sheer number of initial reports lead to an off-campus evaluation. Too often, when off-campus evaluations are made the evaluator is not given full information from the school.
• While counseling was not asked directly, a full assessment was conducted to better provide treatment. Experience teaches that hospital screenings, psychiatrists assessments and in-patient evaluations rarely provide detailed information.
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Case Study Key Points
• This case was difficult to explain to off-campus mental health professionals, yet the collection of behaviors were, nonetheless, concerning
• Chewing knuckles• pacing and demanding behavior• Odd questioning and reality testing• Inappropriate understanding of relationships• Demanding money and worry over financial aid
status.
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Case Study Key Points• Be aware that the community commitment
standard for “danger to self and others” are very different from the standards used by campus judicial affairs to have a student remain on campus.
• This often can be a source of difficulty with hospital staff during a time of crisis. The pre-screening arguing “they say they won’t kill themselves or anyone else”---the Dean saying “well, they aren’t safe enough to be on campus.
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Case Study Key Points
• It is important to have a back-up plan when pursuing a voluntary medical withdrawal. This is an easier process when policy violation is clearly documented from the start. Judicial affairs and Dean’s know this well---a lesson that counselors should take into account.
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• The following slides should serve as a brief overview of some of the tests available for use in the forensic assessment of at-risk behavior.
• This is not an exhaustive list and these are my clinical opinions of the tests covered---as such, they are my subjective reviews of these tests.
Test Overview
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HCR-20• This guided structured interview has the
clinician rate Historical, Clinical and Risk Management items to create a risk profile which includes past, present and future areas of exploration.
• It’s 10 historical factors focus on the past, the 5 Clinical items are meant to reflect current, dynamic (changeable) correlates of violence. The future contains 5 Risk Management items, which focus attention on situational post-assessment factors that may aggravate or mitigate risk.
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HCR-20Pros Cons
Detailed research articles Lack of numerical codes
Reasonable cost ($150 for set)
Requires clinician to administer (structured interview)
Structured questioning
Comes with supporting manual
www.parinc.com
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MOSAIC• MOSAIC is an expert system computer-
assisted program created by the deBecker Company in the 1980’s.
• It uses a number of separate databases – recommended for university use are the University Student and employee data bases
• The program is designed to guide the clinician through a series of questions (with interactive suggestions of additional focus areas and questions based on responses). Questions are directed to clinician, not client.
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MOSAIC• MOSAIC creates a dangerous threat scale
(1-10) and a confidence factor scale (1-200). The clinician can click on questions to see supporting citations and read a brief overview of the research being cited for each question.
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MOSAICPros Cons
Clearly states MOSAIC “does not profile, predict or make decisions for you”
High cost, licensing fee ($975 a year) plus (MAST-U) is $3510 for two years.
Guides user to questions May be too involved for needs at hand – takes time.
Includes research on why questions are being asked
Useful “dual track” program to be paired with clinical interview
www.mosaicsystem.com
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HARE Psychopathy Checklist• The PCL-R is a clinical rating scale (rated by
a psychologist or other professional) of 20 items.
• Each of the items in the PCL-R is scored on a three-point (0, 1, 2) scale based on answers given following a semi-structured interview.
• The measures assesses two major factors – Factor 1: "selfish, callous and remorseless use of
others”– Factor 2: "chronically unstable, antisocial and
socially deviant lifestyle”
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Hare PCL-R 2nd Pros Cons
Useful as an outline for antisocial personality disorder
90-120 minutes to give semi-structured interview
Normed on criminals and prisoners, may not be as useful in college population
Psychopath and sociopath terminology are replaced by anti-social personality disorder
Though useful for pre-trial probation
www.parinc.com
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Test of Memory Malingering• Is designed to provide a reliable, economical
first step as part of a full psychological battery to help assess whether an individual is falsifying symptoms of memory impairment.
• Subjects are given 50 pictures which have high face validity as a test of learning and memory.
• They then recall a number of these pictures---expected recall is 50% by chance (or a score of 25). Scores less than 18 indicate a lower score than would be achieved by chance.
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TOMMPros Cons
Takes about 10-15 minutes to score
Useful as an add along to other tests
$154 for complete kit
Difficult for student to figure out what test is really measuring
Provides validity for other tests given and clinical interview
www.pearsonassessments.com
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Paulhus Deception Scale (PDS)
• The Paulhus Deception Scales (PDS) is a 40 item self-report questionnaire designed to measure the tendency to give socially acceptable or desirable responses. It measures self deception and impression management.
• The PDS is useful in identifying individuals who distort their responses and in evaluating the honesty of their responses, as it is administered concurrently with other instruments. 79
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PDSPros Cons
Quickly administered Useful only with other tests
Reasonable cost ($150 for set)
No clear symptom measure
Easy to score and learn
Excellent “ad-on” test to existing measures for validity
Short time to administer (5-7 minutes)
www.parinc.com
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Minnesota Multipahsic Personality Inventory (MMPI-2)
• The Minnesota Multiphasic Personality Inventory (MMPI-2) was developed in 1989 and is the most frequently used personality test in the mental health fields.
• This assessment was designed to help identify personal, social, and behavioral problems in psychiatric patients. The test helps provide relevant information to aid in problem identification, diagnosis, and treatment planning for the patient.
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MMPI-2Pros Cons
Over 10 validity scales High hand score cost $400-$500 start up cost
Provides baseline for future testing
Time consuming to train and administer
Industry standard, been around for a long time
Long test, 567 questions (1-2 hours to take)
Useful to determine context, Offers complete profile of individual
Lack of specific violence questions
Computer scoring for $20-$30
May be a sledge hammer to nail up a picture frame
/
www.pearsonassessments.com
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Mental Status Exams
• Mental Status Examinations provide a clinical snapshot of the behaviors, affect, emotions and psychological state.
• They are helpful in establishing baseline behavior and create a common language between treatment teams.
• One form of the Mental Status Exam is the SMSME, a standardized set of questions often given in medical settings.
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Appearance
Affect and Mood
Movement and Behavior
Perceptions
Thought Content
Thought Process
Judgment and Insight
Intellectual Functioning
Memory
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MSEPros Cons
Non-standardized versions are free, many forms available
Requires training and practice to administer well
Standardized version (MMSE) is about $130
Requires 20-30 minute clinical interview with
Commonly used language for reports and assessments
www.parinc.com
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STATIC-99• The Static-99 is a brief actuarial instrument
designed to estimate the probability of sexual and violent recidivism among adult males.
• Can only be used with those who have already been convicted of at least one sexual offense against a child or non-consenting adult.
• Helps assess long-term risk potential, not useful for measuring change, treatment effects or readiness for release 86
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STATIC-99Pros Cons
Specific measure to assess long term sexual offending risk
Limited to specific populations
Can be found for free on internet
New version static-2002 now available
www.static99.org
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State Trait Anger Expression Inventory (STAXI-2)
• The STAXI-2 was developed in 1999 and provides easily administered (57 questions) and objectively scored measures of the experience, expression, and control of anger for adults and adolescents, ages 16 years and older.
• State AngerFeeling AngryFeel Like Expressing Anger VerballyFeel Like Expressing Anger Physically
• Trait AngerAngry Temperament Angry Reaction
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STAXI-2Pros Cons
Gives symptom based description on anger
Self report scale with no validity assessment
Reasonably priced ($238 for intro kit)
Provides a piece of the puzzle, but little comprehensive
Provides treatment recommendations
5-10 minutes to administer
www.parinc.com
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Firestone Assessment of Violent Thoughts (FAVT)
• This new measure is designed to assess the underlying thoughts that predispose violent behavior. Screening device useful for threat assessment, indentify violent thoughts and tracking over time with on-going treatment clients
• 5 levels: Paranoid/Suspicious, Persecuted Misfit, Self-Depreciating/Pseudo-Independent, Self-Aggrandizing, Overtly Aggressive
• 2 theory scales: Instrumental/Proactive Violence/Reactive violence 90
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FAVTPros Cons
Useful beyond one time assessment, follow trends
Lack of numerical codes
Reasonable cost ($125 for set)
New measure, could use more research
Includes two validity scales to aid with determining accuracy
www.parinc.com
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Firestone Assessment of Self-Destructive Thoughts (FAST) and
Suicidal Intent (FASI) • The FAST is a self-report survey with 84
items which are used to rate self-destructive thoughts on 11 scales.
• The first five scales look at low self-esteem, inwardness and self-defeating thoughts.
• Scale six looks at thoughts that support the cycle of addiction.
• Scales seven through eleven look at self-annihilating thoughts leading to suicide. These scales make up the FASI.
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FAST/FASIPros Cons
Clients are asked how frequently they experience self-critical thoughts
No validity scales
Moderate cost ($199 each for both intro kit—25 admin)
Measure only self-critical and suicidal thoughts
Useful to develop treatment plans.
A bit more involved in scoring
Helpful aid in developing suicide assessment
Can be used at regular treatment intervals to assess progress
www.parinc.com
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Beck Series (BDI-2, BAI, BSS, BHS)
• This series of four symptom measures includes– Beck Depression Scale-2 (BDI-2) created in
1996– Beck Anxiety Inventory (BAI) created in 1990– Beck Suicide Scale (BSS) created in 1991– Beck Hopelessness Scale (BHS) created in
1988
• Useful computer program included in set to track trends over time. Each test only takes 5-10 minutes to administer and under 5 minutes to score. 94
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Beck SeriesPros Cons
Well researched and used extensively in field
No validity scales
Moderate cost ($99 each for intro kit)
Measure only one symptom set
Computer program for all 4 tests is only $65
Useful over time to establish trends
www.harcourtassessment.com
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Jesness Inventory Revised (JI-R)
• The Jesness Inventory (JI) is a brief (155-item) true-false questionnaire with 11 personality subtype scales that measure key traits and attitudes, including Social Maladjustment, Manifest Aggression, Value Orientation, Withdrawal-Depression, Immaturity, Social Anxiety, Autism, Repression, Alienation, Denial, and Asocial Index
• The nine subtypes are Undersocialized/Active, Undersocialized/Passive, Conformist, Group-Oriented, Pragmatist, Autonomy-Oriented, Introspective, Inhibited, and Adaptive.
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JI-RPros Cons
Well established test (1962, and revised in 1996)
Originally developed out of juvenile delinquency sample
Intro kit reasonably priced at $220.
Takes 25 minutes to administer
Creates useful profile across several areas
Includes two validity scales
www.parinc.com
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Resources• Carr, J. L. (2005). American College Health Association
campus violence white paper.
• Deisinger, G., Randazzo, M., O’Neill, D. & Savage, J. (2008). Handbook for campus threat assessment & management teams. Applied Risk Management, LLC.
• Baltimore, MD: American College Health Association.Choe, JY., Teplin, LA & Abram, KM. (2008). Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns. Psychiatric Services, 59(2), 153-164.
• Baum, K., & Klaus, P. (2005, January). Violent victimization of college students, 1995-2002. (NCJ Publication No. 206836). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of JusticeStatistics). 98
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Resources• Choe, JY., Teplin, LA & Abram, KM. (2008). Perpetration of
violence, violent victimization, and severe mental illness: balancing public health concerns. Psychiatric Services, 59(2), 153-164.
• Dannells (1990). Changes in Disciplinary Policies and Practices over 10 Years. Journal of College Student Development, 31(5), 408-14.
• Gallagher, R. (2006, 2007). National Survey of counseling Center Directors. International Association Counseling Services.
• Oetting, E., Ivey, A. and Weigel, R. (1970). The College and University counseling Center. Journal of Consulting and Clinical Psychology, 34, 124-127.
• Pollard, J.W., (1994). Treatment for perpetrators of rape and other violence. In Berkowitz, A. (Ed.), New Directions in Student Affairs, Men and Rape: Theory, Research, and Prevention programs in higher education, No. 65, New York: Jossey Bass. 99
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Resources• HIPAA website http://www.hipaacomply.com/
• FERPA websitewww.ed.gov/policy/gen/guid/fpco/ferpa/students.html
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