Post-Traumatic Stress Disorder for the Public Service ... - PATC

Post-Traumatic Stress Disorder for the Public Service ... - PATC

Violence Among Us A Threat Assessment Approach to Active Shooters Presented by: Dr. Robert J. Cipriano Jr. Florida Licensed Psychologist Board Certified in Police and Public Safety Psychology by the American Board Of Professional Psychology (ABPP) SIMCIP Group Forensic Psychological Consultants, LLC. Robert J. Cipriano, Jr., Psy.D., ABPP Florida Licensed Psychologist EAP Psychologist for Health and Human Services Group (HHSG) and the Drug Enforcement Administration (DEA)

SIMCIP Group Forensic-Psychological Consultants, LLC. Owner, Chief Consultant and Instructor Board Certified in Police & Public Safety Psychology by the American Board of Professional Psychology (ABPP) Former Police Psychologist for Miami-Dade Police Department (MDPD); Miami-Dade County, Florida Member of the International Association of Chiefs of Police -Psychological Services Section (IACPPSS) Current Member of Division 18- Psychologists in Public Service of the American Psychological Association (APA) This course is designed not to replace the specific departments/agency safety techniques but to be a supplemental tool in assessing and

dealing with this specialized population. The following tools are to be used as a supplemental aid in assessing and dealing with this specialized population. They have limitations. Discretion, training, and experience can aid the law enforcement professional in their implementation and/or intervention. Definition of Active Shooters Definition of Active Shooters

An active shooter is defined as "... an armed person who has used deadly physical force on other persons and continues to do so while having unrestricted access to additional victims. Department of Homeland Security (DHS) defines the active shooter as an emerging type of homicide as distinct as the serial killer. Definition of Active Shooters

The definition includes so-called school shootings and snipers", but not usually suicide bombers. Active shooters have caused a paradigm shift in law enforcement training and tactics, especially as these individuals do not necessarily expect to escape or even survive these situations. Characteristics of Active Shooters

Unlike the obsessive and methodical minds of many serial killers, there is no pattern or method to an active shooter's selection of victims. The typical active shooter is under 35 years old and the typical attack results in 2 deaths and 2 wounded. Roughly one-half of all attacks occurred at commercial facilities, including office buildings, factories and warehouses.

The New York City Police Department (NYPD) created a compendium of 202 active shooter incidents that occurred between 1966 and December 31, 2010, which excluded gang-related shootings, domestic shootings, robberies, and similar types of incidents that overlap with the Department of Homeland Security (DHSs) definition of active shooters. Number of Attackers The NYPDs analysis demonstrates

that 98% of active shooter incidents in the active shooter data set were carried out by a single attacker. Planning Tactics The NYPDs analysis demonstrates a broad range of tactical sophistication in the planning stage of active shooter attacks. Some active shooters do little to no planning and attack impulsively while others do extensive planning, including pre-operational surveillance.

Planning Tactics A few active shooters even set up pre-planned defenses intended to trap victims and prolong their attacks, such as chaining doors and blocking entrances. Some attackers appear to have learned from previous active shooter incidents. Targets The NYPD organized relationships between attackers and victims in the active shooter

data set into five categories: Professional, Academic, Familial, Other, and None. The NYPDs analysis demonstrated that active shooters are often members of the communities There is no profile of an active shooter; however, there are thought patterns, emotions at times, and behaviors of individuals that can be depicted along a pathway to violence.

Within that pathway there are generally 3 branches of pathology of individuals that display such behavior. Those who are Delusional They maintain a persistent, irrational belief in the face of contrary facts, quote from forensic

psychologist David Bernstein of Norwalk, CT. Seung Hui Cho The Virginia Tech massacre was a school shooting that took place on April 16, 2007, on the campus of Virginia Polytechnic Institute and State University in Blacksburg, Virginia. Seung Hui Cho shot and killed 32 people and wounded 17 others in two separate attacks, approximately two hours apart, before committing suicide.

(Another 6 people were injured escaping from classroom windows.) The massacre is the deadliest shooting incident by a single gunman in U.S. history and one of the deadliest in the world. It was also the worst act of mass murder on college students since Syracuse University lost 35 students in the bombing of the Pan American Flight 103. Cho, a senior English Major at Virginia Tech, had previously been diagnosed with a severe anxiety disorder. During much of his middle and high school

years, he received therapy and special education support. After graduating from high school, Cho enrolled at Virginia Tech. Because of federal privacy law, Virginia Tech was unaware of Cho's previous diagnosis or the accommodations he had been granted at school. In 2005, Cho was accused of stalking two female students. After an investigation, a Virginia special justice declared Cho mentally ill and ordered him to attend treatment. Lucinda Roy, a professor and former chairwoman of the English department, had

also asked Cho to seek counseling. Cho's mother also turned to her church for help. Types of Delusions Persecutory Grandiose Referential

Religious Somatic Control Erotomania- is a type of delusion which the affected person believes that another person, usually a stranger, highstatus or famous person, is in love with him or her. The illness often occurs during psychosis especially in patients with schizophrenia, delusional disorder or bipolar mania. Often labeled as a obsessional/ compulsive stalking. Those beliefs become their reality. There's an arrogance involved.

Particularly of someone with paranoid delusions; You believe people are conspiring against you; there is something about you that is so special, people are plotting against you in some way. Dr. David BernsteinForensic Psychologist specializing in Threat Assessment; Norwalk, CT After Seung-Hui Cho killed 32 people and shot 17 others at Virginia Tech in April 2007, Virginia began requiring all universities across the state to create threat-assessment teams that consisted of

groups inclusive of: security or law enforcement, psychologists, counselors, and administrators. 2nd grouping- ..Those that are Psychopathic and have a mixture of Narcissism Anders Behring Breivik

Anders Behring Breivik Perpetrator of the 2011 Norway attacks In July of 2011, he bombed government buildings in Oslo, resulting in eight deaths, then carried out a mass shooting at a camp of the Workers Youth League (AUF) of the Labor Party on the island of Utoya, where he killed 69 people, mostly teenagers. He was convicted of mass murder, causing a fatal explosion, and terrorism in August

2012 Anders Behring Breivik Breivik described his far-right militant ideology in a compendium of texts entitled 2083: A European Declaration of Independence, which he distributed electronically on the day of the attacks. In it he described his worldview, which included Islamophobia, support of Zionism and opposition to feminism.

It regarded Islam and "cultural Marxism" as "the enemy", and argued for the violent annihilation of Eurabia - political alliance of Europe and Arab nations (against Israel). Personality Disorders

Antisocial Borderline Histrionic Dependent Narcissistic Mostly found as a combination of these types Not responsive to psychiatric medication Symptoms of Personality Disorders Exhibits patterns of: Self harm or risky behavior

Violating the rights of others Difficulty with interpersonal relationships Work or daily living is sometimes limited Displays self-defeating behaviors Has distorted view of the world Personality Disorders

Generally create the most difficult and troublesome health care cases Are responsible for many, if not most, treatment and case management failures Are significantly different from all other forms of mental illness and psychological dysfunction Are not a major focus of clinical attention and are not treated with pharmacotherapy (psychiatric medications); primarily managed by psychotherapy. Personality Disorders

Are nearly always underestimated and under identified by social workers and other health and mental health professionals Are extremely difficult to successfully manage and treat Are largely unaffected by traditional treatment and behavioral management

approaches Narcissistic Personality Disorder Consider themselves special They have a strong love of the image not the self Specific Diagnostic Categories (5 or more of the following in adults- at least 18 or older) 1. Grandiose sense of self-importance Exaggerates achievements and talents Expects to be recognized as superior

without achievements 2. Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love (DSM IV-TR, 2000) Narcissistic Personality Disorder 3. Believes he or she is special and unique - Can only be understood by other special people 4. Requires excessive admiration 5. Sense of entitlement Examples- Expectations of especially favorable treatment 6. Interpersonally exploitative (DSM IV-TR, 2000)

Narcissistic Personality Disorder General Diagnostic Qualities Responses 1. Selfish Validating ones 2. Uncaring Accomplishments 3. Demanding 4. Manipulative Making the individual 5. Unable to satisfy feel needed; touching

6. Demeaning upon his/her sense of 7. Rageful self 8. Self-righteous (DSM IV-TR, 2000) Antisocial Personality Disorder Specific Diagnostic Criteria: Three or more of the following in adults- at least 18 or older 1. Failure to conform to social norms Regarding lawful behaviors Repeatedly performing acts that are

grounds for arrest 2. Deceitfulness- Repeated lying, use of aliases, or conning others for personal profit or pleasure 3. Impulsivity or failure to plan ahead Antisocial Personality Disorder 4. Irritability and aggressiveness Repeated physical fights or assaults 5. Reckless disregard for the safety of self or others 6. Consistent irresponsibility Repeated failure to sustain consistent work behavior Repeated failure to honor financial obligations

Antisocial Personality Disorder 7. Lack of remorse; Indifferent to or rationalizing having hurt, mistreated, or stolen from others 8. At least 18-years of age 9. Evidence of Conduct Disorder with onset before age 15 (DSM IV-TR, 2000) Antisocial Personality Disorder General Diagnostic Qualities: Responses

The individual is untrustworthy Setting limits Immature Presence of Self-Centered Force Charming, smooth talker Consequential Liar Behavior Manipulative No self- disclosure Throws adult temper tantrums Cognitively inflexible

Externally oriented Rationalizing and justifying Have a distorted view of the world Self harm or risky behavior Difficulty with interpersonal relationships Christopher Dorner Christopher Dorner Christopher Jordan Dorner (June 4, 1979 February 12, 2013) was a former LAPD police officer and United States Navy Reserve officer who was charged in

connection with a series of shooting attacks on police officers and their families from February 312, 2013. The attacks left 4 people dead, including 2 police officers, and left 3 police officers wounded. Dorner was the subject of one of the largest manhunts in LAPD history, spanning 2 U.S. states and Mexico. Indicators

Research has shown that killers do not snap, they plan. They acquire weapons. They tell others what they are planning. These individuals take a long, considered, and public path toward violence. Indicators Individuals who commit violence let their thinking and even their plans be known, sometimes frequently over long periods of time. The shootings seem as though they are an attempt to adjust to the individuals social

standing and image, from "loser" to "master of violence. A nobody to a somebody. 3rd Grouping- ..Severely Depressed & Suicidal Adam Lanza Adam Lanza

On December 14, 2012, 20-year-old Adam Lanza fatally shot 20 children and 6 adult staff members in a mass murder at Sandy Hook Elementary in the village of Sandy Hook in Newtown, Connecticut Before driving to the school, Lanza had shot and killed his mother Nancy at their Newtown home. As first responders arrived, he committed suicide by shooting himself in the head. Adam Lanza

Adam Peter Lanza (April 22, 1992 December 14, 2012) and his mother lived in Sandy Hook, 5 miles from the elementary school. He did not have a criminal record. He attended Sandy Hook Elementary School for a brief time. Afterward, he attended St. Rose of Lima Catholic School in Newtown, and then Newtown High School, where he was an

honors student. The Suicidal Individual The Centers for Disease Control and Prevention (CDC) collects data about mortality in the U.S., including deaths by suicide. In 2013 (the most recent year for which full data are available), 41,149 suicides were reported, making suicide the 10th leading cause of death for Americans. In that year, someone in the country died by suicide every 12.8 minutes. (CDC, 2013) Suicide The rate of suicide generally increased by 2013

and stood at 12.6 deaths per 100,000. In 2013, the highest suicide rate (19.1) was among people 45 to 64 years old. The second highest rate (18.6) occurred in those 85 years and older. Younger groups have had consistently lower suicide rates than middle-aged and older adults. In 2013, adolescents and young adults aged 15 to 24 had a suicide rate of 10.9. (CDC, 2013) Suicide White males accounted for 70% of all suicides in 2013. In 2013, firearms were the most common method of death by suicide, accounting for a little more than half (51.4%) of all suicide deaths. The next

most common methods were suffocation (including hangings) at 24.5% and poisoning at 16.1%. https://www.afsp.org/understanding-suicide/facts-and-figures. (2015) Suicide Attempts In 2013, the most recent year for which data is available, 494,169 people visited a hospital for injuries due to self-harm behavior, suggesting that approximately 12 people harm themselves (not necessarily intending to take their lives) for every reported death by suicide.

Together, those harming themselves made an estimated total of more than 650,000 hospital visits related to injuries sustained in one or more separate incidents of self-harm behavior. https://www.afsp.org/understanding-suicide/facts-and-figures. (2015) Suicide Acts of self harm, regardless of whether there is suicidal intent, are relatively common among people with histories of suicidal behavior and our predictors of later

suicide attempts (Jones, 1986; Matsumoto et al., 2005; Penn et al., 2003). Suicidal Behavior is along a Continuum Step 1 involves the person having thoughts indirectly related to suicide, such as wishing that he or she was dead, but there is no evidence that the person has actually considered suicide (ideation). Suicide along a Continuum

Step 2- the person has thoughts that involve considering suicide, but there is no intention to actually follow through with such thoughts (may gesture- aka, parasuicidal behavior). Step 3- the person has not only suicidal thoughts but a plan to act on those thoughts (an attempt). Suicide along a Continuum

Step 4- the person is acting out his/her plan (possible completion). Individuals can move along this continuum with or without a suicidal gesture prior to completing the act of suicide. 8 factors that are Critical In Assessing Suicide Risk

Loss/separations Acute overuse of alcohol and or drugs Family history of suicide Attraction to death Severe hopelessness Acute suicidal ideation Past history of suicide attempts

Medical Seriousness of previous attempts Assessing Suicide Potentiality Severe Depression Withdrawal Despondent

History of Substance Abuse Poor Impulse Control Chronic Debilitating Illness Family history of suicide (Tartaro and Lester, 2010) Suicide Intervention/Prevention Suicidal Paradox Avoiding Euphemisms Thoughts versus Feelings Pathway to Suicide in the United States 1.) Wanting to End Pain- Pain is at times described as Physical Pain 2.)

Embarrassment can lead to humiliation (e.gs. arrest, loss of status, etc.) 3.) Exercising control versus lack of control (e.g. physical illness) Suicide Protective factors include personal resilience; cultural & religious beliefs

that discourage suicide; good physical and mental health; access to effective treats for mental, physical, and substance abuse disorders; restricted access to highly lethal means of suicide; and

strong connections to family and community support. Suicide Intervention Steps Maintain safe and appropriate

distances Ask if you can approach Speak slowly and clearly and take your time Display Empathy Stay with the person Emphasize feelings and eventually begin to provide options (Allen et. al, 2003; Bongar, 2002) A Management Approach with someone who appears Depressed/Suicidal Individual

Assess for Suicidality Active Listening Empathy, care and concern Discuss hopelessness and helplessness-- Reflection Suggest options Establish rapport -- which takes some time QPR

Q- Question P- Persuade R- Refer (QPR Institute, Spokane, WA, 2013) Questions to Ask When Assessing for Suicide Are you thinking of taking your life? What is your plan? History of School Shootings/Shooters

Charles Joseph Whitman August 1, 1966 was a student at the University of Texas at Austin who shot and killed 14 people (including those who survived the initial shooting but later died as a result of their injuries) and wounded 31 others from the observation deck of the University's Main Building of the University of Texas after murdering his wife and mother, and before being shot by Austin police. History of School Shootings/Shooters

Brenda Ann Spencer (1979) Parkway South Junior High School shooting (1983) Gang Lu Massacre (1991)

Wayne Lo Shooting (1992) Kip Kinkel (1998) Columbine High School Massacre (1999) Amish School Shooting (2006) Weston High School Shooting (2006) Virginia Tech Massacre (2007) School Shooting Defined School shooting is a term popularized in American and Canadian media to describe gun violence at educational institutions, especially the mass murder or spree killing

of people connected with an institution. A school shooting can be perpetrated by one or more students, expelled students, alumni, or outsiders. Unlike acts of revenge against specific people, school shootings usually involve multiple intended or actual victims, often randomly targeted. School Shooting Defined

School shootings receive extensive media coverage but are infrequent. They often result in nationwide changes of schools' policies concerning discipline and security. Some experts have described fears about school shootings as a type of moral panic. Violence Risk and Threat Assessment

The path to intended violence consists of: Grievance-motive or reason Ideation- having the idea that violence is justified and necessary Research and Planning- going beyond the idea to actually figuring out how to

consummate violence Preparation-obtaining the equipment such as a weapon to launch the attack Breach- initiating the plan Attack- physical assault (Calhoun & Weston, 2009) Biopsychosocial Model for Violence Risk Assessment Dr. J. Reid Meloy Biological

Psychological Social (Meloy, J. Reid, 2000) Bio-psychosocial Model for Violence Risk Assessment Biological

Damage to the central nervous system (CNS) (example head injury) History of ever losing consciousness History of seizures Family history of brain disease or disorder (Meloy, J. Reid, 2000) Bio-psychosocial Model for Violence Risk Assessment

Psychological Male gender Age (15-24) Past history of violence/trauma

Paranoia (Schizophrenia; Personality) Psychostimulants Weapons Access Intelligence- below average Anger and Fear Problems Psychopathy and Attachment Problems Bio-psychosocial Model for Violence Risk Assessment Social

Family of origin (viewing violence within the family) Adolescent peer group violence Economic instability or poverty Weapons history, skill, interest, and approach behavior Victim pool Alcohol and/or psychostimulant use

Popular culture (Meloy, J. Reid, 2000) Defining a Threat? A threat is an expression of intent to do harm or act out violently against someone or something A threat can be spoken, written, or symbolic for example, motioning with ones hands as though shooting at another person. Threat assessment rests on 2 critical

principles: first, that all threats and all threateners are unlikely to carry out their threat. However, all threats must be taken seriously and evaluated. {United States Secret Service/United States Department of Education Evaluating Risk for Targeted Violence in Schools: Comparing Risk Assessment, Threat Assessment and Other Approaches (2001) } Threat Assessment Threat assessment seeks to make an informed judgment on 2 questions:

1. How credible and serious is the threat itself? 2. To what extent does the individual making the threat appear to have the resources, intent, and motivation to carry out the threat? {United States Secret Service/United States Department of Education Evaluating Risk for Targeted Violence in Schools: Comparing Risk Assessment, Threat Assessment and Other Approaches (2001) } Threat Assessment Perspective

Direct Threat- Identifies a specific act against a specific target and is delivered in a straightforward, clear, and explicit manner. I am going to place a bomb in the schools gym. Indirect Threat- It tends to b vague, unclear, and ambiguous. The plan, the intended victim, the motivation, and other aspects of the threat are masked. If I

wanted to, I could kill everyone in school. The violent act could occur, not that it will occur. {United States Secret Service/United States Department of Education Evaluating Risk for Targeted Violence in Schools: Comparing Risk Assessment, Threat Assessment and Other Approaches (2001) } Threat Assessment Perspective Veiled Threat- Is one that strongly implies

but does not explicitly threaten violence. We would be better off without you around anymore. It clearly hints at a possible violent act, but leaves it to the potential victim to interpret the message and give a definite meaning to the threat. Conditional Threat- Is the type of threat often seen in extortion cases. It validates that a violent act will happen unless certain demands or terms are met: If you dont pay me one million dollars, I will place a bomb in the school. {United States Secret Service/United States

Department of Education Evaluating Risk for Targeted Violence in Schools: Comparing Risk Assessment, Threat Assessment and Other Approaches (2001) } Threat assessment/investigation utilizes available information about warning signs, risk factors, stabilizing factors, and precipitating events, to arrive at a categorical description of risk for a particular point in time. Threat assessment/investigation

is only as good as the data collection to support it. Use of collateral data sources is significant. (Mohandie, 2002) Threat Assessment/Investigation Is the individual moving on a path towards violence? Are there indicators to suggest thoughts to behavior? (Mohandie, 2002) Does the at-risk individual comply with risk mitigating steps?

{Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence}

Obtained and Assessed Collateral Information Victim/Complainants/Coworkers/Classmates Faculty members

Roommates Parents Housing sources Employment and disciplinary record Public Records Cyberspace/Social Networking/Online postings Mental health evaluators Treatment providers-student counseling center? Employers/Supervisors Drug/alcohol testing Weapon availability/access checks Searches Informants Undercover operations Surveillance (Mohandie, 2002)

Key Questions In Threat Assessment Investigations What motivated the individual to make the statements or take the actions, that caused him/her to come to attention? {Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Key Questions In Threat Assessment Investigations

What has the individual communicated to anyone concerning his/her intentions? {Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Key Questions In Threat Assessment Investigations Has the individual shown an interest in targeted violence, perpetrators of targeted violence, weapons, extremist groups or murder?

{Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Key Questions In Threat Assessment Investigations Has the individual engaged in attackrelated behavior, including any menacing, harassing, and/or stalkingtype behavior? {Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Key Questions In Threat

Assessment Investigations Does the individual have a history of mental illness involving command hallucinations, delusional ideas, feelings of persecution, etc. with indications that he/she has acted on those beliefs? {Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Key Questions In Threat

Assessment Investigations How organized is the individual? Is he/she capable of developing and carrying out a plan? {Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Key Questions In Threat Assessment Investigations Has the individual experienced a recent loss and/or loss of status and

has this led to feelings of desperation and despair? {Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Key Questions In Threat Assessment Investigations Corroboration. What is the individual saying and is it consistent with his/her actions? {Threat

Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Key Questions In Threat Assessment Investigations Is there concern among those that know the individual that he/she might take action based on inappropriate ideas? {Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Key Questions In Threat

Assessment Investigations What factors in the individuals life and/or environment might increase/decrease the likelihood of the individual attempting to attack a target? {Threat Assessment: Defining an Approach for Evaluating Risk of Targeted Violence: Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) } Factors in Threat Assessment Specific details are critical in the

evaluation of the threat. E.g.s Include identity of the victim or victims,subject/subjects, rationale for making the threat, the means, weapon/s, methodology, and/or info. about plans, and or preparations. Threat Risk Levels Low Level Threat- A threat that poses a minimal risk to the victim and public

safety The threat is vague and indirect Information contained within the threat is inconsistent, implausible or lacks detail Threat lacks realism Threat Risk Levels Medium Level of Threat- A threat which could be

carried out, although it may not appear entirely realistic Threat is more direct and more concrete than a low level threat Wording in the threat suggests that the perpetrator has given some thought to how the act will be carried out There may be a general indication that the perpetrator has taken preparatory steps, although ambiguous in nature could be a possibility.

Threat Risk Levels High Level of Threat- A threat that appears to pose an imminent and serious danger to the safety of others. Threat is direct, specific and plausible Threat suggests concrete steps have been taken toward carrying it out, for example, statements indicating the perpetrator has acquired or practiced with a weapon or had the victim under surveillance.

Assessment Personality of the Student Family Dynamics School Dynamics and the Students Role in those dynamics Social Dynamics

All these factors should be taken into consideration when evaluating the nature of the threat, the individual making the threat, and the likelihood that the threat will be carried out. {United States Secret Service/United States Department of Education Evaluating Risk for Targeted Violence in Schools: Comparing Risk Assessment, Threat Assessment and Other Approaches (2001) } Interventions Inform students and parents of school policies A school should publicize its threat response and intervention program at the beginning of

every school year The school should clearly explain what is expected of students (notification to staff) Explain to parents if their child makes a threat of any kind they will be contacted and will be expected to provide information to evaluate the threat. Interventions Designation of a threat assessment coordinator This individual should be assigned to oversee and coordinate the schools

response to all threats (i.e. the principal, an administrator, school psychologist, resource officer, etc.) This individual has the authority to make quick decisions, inclusive of implementing the schools emergency response plan Interventions Expelling or suspending a student for making a threat must not be a substitute for careful threat assessment and a considered,

consistent policy of intervention. Disciplinary action alone, unaccompanied by any effort to evaluate the threat or the students intent, may actually exacerbate the danger. Remember these suggestions are adjunctive amongst your existing tools (training, weapons, less than

lethal weaponry, asp, taser, etc.) you are already given by your departments/agency and should not be used in place of your established safety measures and policies. Questions and Comments References Allen, Cipriano, Funderburk, Naranjo, (20032010) Managing Encounters with the Mentally Ill (presentation) Miami-Dade Police Department (MDPD). American Psychiatric Association (2000).

Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: References Ankrom, Larry; Supervisory Special Agent NCAVC FBI Academy Quantico, Virginia 2000 Berglund, John; Borum, Randy; Fein, Robert; Vossekuil, Bryan (1999) Threat

Assessment: Defining an Approach for Evaluating Risk of Targeted Violence. Berman, Larry Ph.D. Suicidology References Blaauw, E., (2005) Bullying and suicides in prisons. In J.L. Ireland (Ed.). Bullying among prisoners (pp 44-61). Devon, UK: William Publishing

Bongar, B. (2002). The suicidal patient: clinical and legal standards of care (2nd ed). Washington, DC: American Psychological Association. References Calhoun,. F & Weston, S. (2009). Threat Assessment & Management Strategies- Identifying the Howlers and Hunters. CRC Press, Boca Raton, FL

Centers for Disease Control (CDC) (2009& 2013). Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention U.S. Department of Health and Human Services, Atlanta, GA 30333 References Department of Homeland Security (DHS), (2004-present). Garbarino, Ph.D. Professor of Human

Development Cornell University Hare, Robert Ph.D. Forensic Psychology, Psychopathy, & Risk of Violence https://www.afsp.org/understandingsuicide/facts-and-figures References Jones, A. (1986). Self-mutilation in prison. Criminal Justice & Behavior, 13, 286-296. Kung, H.C., Hoyert, D.L., Xu, J.Q., & Murphy, S.L. (2008). Deaths: Final Data for 2005. National Vital Statistics Reports, 56(10), 1-124. Matsumoto, T., Yamaguchi, A., Asami, T., Okada, T., Yoshikawa, K., & Hirayasu, Y.

(2005). Characteristics of self-cutters among male inmates. Psychiatry & Clinical Neurosciences, 59, 319-326. References McKay, Matthew & Patrick Fanning. (1991). Prisoners of Belief. Oakland, California: New Harbinger Publications. Miller, Lawrence. (2006). Practical Police Psychology, Stress Management, and Crisis Intervention for Law Enforcement; Charles C. Thomas Publisher, Springfield, Illinois. Meloy, J. R, (2000). Violence risk and threat assessment. A practical guide for mental health and criminal justice professionals;

Specialized Training Services; San Diego, California. References Mohandie, K. (2002). School Violence and Threat Management: A Practical Guide for Educators, Law Enforcement and Mental Health Professionals; Specialized Training Services; San Diego, California. References New York Police Department (2010). A

compendium of active shooter incidents. Nichols, Kathie Ph.D. Clinical Psychologist References OCarroll, P. W., Berman, A. L., Maris, R., & Moscicki, E. (1996). Beyond the tower of Babel: A nomenclature for suicidology. Suicide & LifeThreatening Behavior, 26, 237252.

Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC, 2009), U.S. Department of Health and Human Services, Atlanta, GA 30333) References Parkinson, Frank. (2000). Post-Trauma Stress (Personal Guide To Reduce the Long Term Effects and Hidden Emotional Damage Caused by Violence and Disaster); Fisher Books.

References Penn, J.V., Esposito, C.L., Schaeffer, L.E., Fritz, G.K., & Spirito, A. (2003). Suicide attempts and self-mutilative behavior in a juvenile correctional facility. Journal of the American of Child & Adolescent Psychiatry, 42, 762-769. Professional Psychology: Research and Practice (VOl. 30, No., 6,p. 576580) Psychology Today, 2013 References

QPR Institute Spokane, Washington, (2013) Saathoff, M.D. Associate Professor of Clinical Psychiatry- University of Virginia Tartaro, C. & Lester. D. Suicide and Self-harm in Prisons and Jails, (2010). Maryland: The Rowman &

Littlefield Publishing Group, Inc. References The School Shooter: A Threat Assessment Perspective (2003) . Critical Incident Response Group (CIRG), National Center for the Analysis of Violent Crime (NCAVC) FBI Academy Quantico, Virginia 22135 United States Secret Service/United States Department of Education Evaluating Risk for Targeted Violence in Schools: Comparing Risk Assessment, Threat Assessment and Other Approaches (2001) References

Wikipedia.Org, (2011) Zimmerman, M. (1984). Interview Guide for Evaluating DSM-IV Psychiatric Disorders and the Mental Status Examination. Follow PATC! PATC @PATCupdates Public Safety Training, Articles and Legal Updates (LinkedIn Group)

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