Safety Assessment in the School Setting

1
Safety Assessment in the School Setting

• Nancy Rappaport, MD
• Harvard Medical School
• www.academicwebpages.com/nr

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,
2000. US Department of Education (NCES 2001-017)
and US Department of Justice (NCJ-184176)
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,
2000. US Department of Education (NCES 2001-017)
and US Department of Justice (NCJ-184176)
Washington, DC.
4
Student Victimization Statistics
Percent
Grade
Percentage of students ages 12-18 who reported
criminal victimization at school during the
previous 6 months
Source U.S. Department of Education (National
Center for Education Statistics), U.S. Department
of Justice (Bureau of Justice Statistics),
Indicators of School Crime and Safety 1999.
5
Most Common Types of Student Victimization
Statistics School Violence

• Interpersonal disputes
• Assaults without weapons
• Assaults between (male) students
• Before and after school, during transitions
  between classes, during lunch

6
School Violence Statistics

• In a 2003 survey of high school students, 17.1
  had carried a weapon to school during the 30
  days preceding the survey.

Source Grunbaum J, Kann L, Kinchen SA, et al.
(2004), Youth risk behavior surveillance - United
States, 2003. Surveillance Summaries, 21 May 2004.
7
How Is School Violence Measured?

• Self-Report Surveys
• Studies do not report using response reliability
  or validity checks
• Public Health Model

Source Cornell DG, Loper AB (1998), Assessment
of violence and other high-risk behaviors with a
school survey. School Psychology Review 27
317-330.
8
Ambiguous Questions

• In the past thirty days, how many times have you
  brought a weapon to school gun, knife or club?
  (YRBS)
• Multiple weapons
• Choice of time period
• Level of severity

Source Kann L, Kinchen SA, Williams BI, et al.
(1998), Youth risk behavior surveillance - United
States, 1997. Journal of School Health, 68,
355-369.
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
1998-1999, 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.
Todays Education, 6658-62.
12
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.
13
(No Transcript)
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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.
15
Characteristics of Students Exhibiting Violent
Behavior

• Classroom Avenger
• Premeditated assailant involved with shooting
  multiple students
• Often comes from rural or suburban areas and
  different family backgrounds and academic
  achievement, with little prior involvement with
  the juvenile justice system

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Characteristics of Students Exhibiting Violent
Behavior

• Typically Violent Student
• Often from families in turmoil with a history of
  abuse and neglect
• Failing academically
• Struggling with impulsive behavior, poor
  frustration tolerance and limited concentration

Source Twemlow SW, Fonagy P, Sacco FC, OToole
ME, (2002), Premeditated mass shootings in
schools Threat assessment. J Am Acad Child
Adolesc Psychiatry 41475-477.
17
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.
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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
  childs troubled behavior and providing minimal
  supervision

Source Twemlow, S.W., Fonagy, P., Sacco, F.C.,
OToole, M.E. (2002), Premeditated mass shootings
in schools Threat assessment. J. Am. Acad. Child
Adolesc. Psychiatry, 41475-477 Browne, J.A.,
Losen, D.J., Wald, J. (2001), Zero tolerance
Unfair, with little recourse. New Directions for
Youth Development, 9273-99.
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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

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Assessment Guidelines

• How organized is the students thinking and
  behavior?
• 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?
• Is the student experiencing hopelessness,
  desperation and/or despair?

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Assessment Guidelines

• Does the student see violence as an acceptable-or
  desirable-way to solve problems?
• Does the student have a trusting relationship
  with at least one responsible adult?
• Is the students conversation and story
  consistent with his or her actions?

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Assessment Guidelines

• What circumstances might affect the likelihood of
  an attack?
• Are other people concerned about the students
  potential for violence?

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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 Editors Notes New Directions for Youth
Development, 921-6.
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, 80372-382.
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, DIncau B (1997), The web of
zero tolerance Characteristics of students who
are recommended for expulsion from school.
Education and Treatment of Children,
20(3)316-335.
27

• Disconnected group
• Socialized delinquent group (31/158)
• Troubled group
• First offense group

Source Morrison GM, DIncau B. (2000),
Developmental and service trajectories for
students with disabilities recommended for
expulsion from school. Exceptional
Children,66257-272.
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Federally Mandated Special Education Protection

• More than ten cumulative days of suspension in
  one school year
• Expulsion proceedings (excluded for special
  education students)

Source Morrison GM, DIncau B. (2000),
Developmental and service trajectories for
students with disabilities recommended for
expulsion from school. Exceptional
Children,66257-272.
29

• Is the offense a manifestation of their
  disabling condition?
• Determination of their appropriate placement

Source Morrison GM, DIncau B. (2000),
Developmental and service trajectories for
students with disabilities recommended for
expulsion from school. Exceptional
Children,66257-272.
30
Five-Step Case Evaluation Consultation Model

• Informed consent
• Referral information
• Contact with school and other professionals
• Student and parent interviews
• Report and feedback

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Conditions of Psychiatric Evaluation

• Office of Special Education
• Special Education Services eligibility
• NOT confidential

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Selected Specific Behavior Rating Scales

• Source Connor, D.F. (2002), Aggression and
  Antisocial Behavior in Children and Adolescents
  Research and Treatment. New York Guilford.

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(No Transcript)
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Childrens 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 Childrens
Aggression Scale Teacher Version. J Am Acad
Child Adolesc Psychiatry 42965-971.
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StructuredAssessment ofViolenceRisk inYouth
Source Bartel P, Borum R, Forth A (2002),
Structured Assessment for Violence Risk in Youth
(SAVRY). Consultation Edition.
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CASE STUDIES
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Case One

• Individual Factors
• Family Factors
• School Peer Factors
• Treatment
• Situational Factors
• Attack-Related Behaviors

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Myth of theTeenage Werewolf

• Popular media often insinuates that there are
  minimal warning signs for violent teenagers.

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Treatment System Gaps

• Practical Limitations
• Crisis Response
• Lag Time

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Coordinated System of Care

• Access to a psychiatric emergency room, inpatient
  unit, outpatient services
• Shared Responsibility
• School Setting

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Multisystemic Therapy

• Flexibility
• Adolescents with conduct problems
• Department of Mental Health (DMH) diagnosis

Source Mattison RE, Spirito A (1993), Current
consultation needs of school systems. In Child
and Adolescent Mental Health Consultation in
Hospitals, Schools, and Courts, ed. B Nurcombe,
GK Fritz RE Mattison A Spirito. Arlington, VA
American Psychiatric Publishing, pp. 161-183
Henggeler SW, Melton GB, Smith LA (1992), Family
preservation using multisystemic therapy An
effective alternative to incarcerating serious
juvenile offenders. J Consulting Clin Psychol,
60953-961.
42
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 Cant Solve Our Problems and How We
Can. New York Dutton. Grisso T (1998), Forensic
Evaluation of Juveniles. Sarasota, FL
Professional Resource Press.
43

• 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. Childrens Services
Social Policy, Research, and Practice, 3147-169.
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Protective Factors
Source Connor DF (2002), Aggression and
Antisocial Behavior in Children and Adolescents
Research and Treatment. New York Guilford.
45
Protective Factors
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Case Two

• Individual Factors
• Family Factors
• School Situational Factors
• Systemic Assessment

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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,
871-82.
48

• 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.
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Time Somebody Told MeQuantedius Hall, Son of
Reality, Age 12
Source Franco, B (ed.), 2000. You Hear Me? Poems
and writing by teenage boys. Cambridge, MA
Candlewick Press.