brian van brunt, ed.d. jason ebbeling, esq western kentucky university mitchell college...

Brian Van Brunt, Ed.D. Jason Ebbeling, Esq Western Kentucky University Mitchell College [email protected] [email protected]

Mandated Assessment of Suicide and Violence:10

Best Practices

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• Brian directs the counseling program at Western Kentucky University. He is the president-elect of the American College Counseling Association and a consultant with National Center for Higher Education Risk Management (NCHERM). He is a senior trainer in Aggression Management.

• Jason is the Vice President of Student Affairs at Mitchell College. He oversees various campus departments in student affairs. His background in law provides essential insight into threat assessment.

Introduction 10 Best Practices

Counseling & Judicial Case Studies

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Introduction

• There is an increase in discussions about threat assessment following the Virginia Tech and NIU shootings.

• This presentation is designed to help student affairs staff to improve their communications and clarify their expectations for mandated assessments of at-risk students.

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Introduction

• “Mandated assessment” is when judicial affairs, residential life, or a dean requires a student to attend some number of individual sessions with a counselor, psychologist or therapist.

• This often happens after a student breaks a campus policy (i.e., has angry outbursts, stalking behavior, cutting behavior, alcohol or drug use, sexual harassment or may be at risk for suicide).

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Introduction

• “Mandated counseling” is when judicial affairs, residential life, or a dean requires a student to attend some number of individual sessions with a counselor, psychologist for a set length of time to address a specific issue (suicide, threat, eating disorder). This typically occurs after a mandated assessment.

• This process is a bit more controversial in the field---as many counselors struggle with the “forced or coerced” aspect of mandated counseling---arguing counseling by its very nature is voluntary.

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Introduction

Successful assessment depends on: • a clear understanding of what is possible and• establishing clear expectations on both sides.

Referral agents (or a campus threat teams):1. Identify students of concern .2. Refer them for counseling assessment. 3. Referral agents must state what they are looking for

from the assessment.

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Introduction

• Assessments do not predict violence.

• Assessments do not diagnose – In fact, terms such as sociopath and psychopath are not recognized in the DSM-IV *.

• The most useful assessment looks at situations and patterns of behavior.

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* The Diagnostic and Statistical Manual of Mental Disordershttp://allpsych.com/disorders/dsm.html

http://allpsych.com/disorders/dsm.html



Introduction

• Referral agents should address student behavior-- not mental illness.

• Referral agents should focus on acts of 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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Counseling & Judicial

• From the beginning, it is important to understand some of the differences between counseling and judicial affairs.

• Differences often exist in the language, timeline and formal/informal nature of the communication between these two different departments.

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• Counselors tend to focus on the potential in their clients. They often see the place of the individual over the needs of the community.

• They clearly define their “scope of practice,” but once they start working with someone, they are committed.

• At times, individuals with the same behavior may have different mental health profiles that change how we approach them (for example: cutting).

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Residential life and judicial affairs are concerned with the individual, but they are also concerned with:

• the welfare of the community• legal defensibility• facts and reports This can be confusing to counselors, who often make

choices based on feelings and intuition.

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At-risk behavior that occurs in counseling & judicial areas:

Students who may attempt suicide

Students who threaten to harm other students

Domestic violence situations

Students with weapons on campus

Students who concern faculty

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At-risk behavior that occurs in the classroom:

Disruptive behavior

Threats to the professor

Aggression toward other students or unexplained aggression

Projects or papers that contain violent or threatening content, which is not part of a class assignment

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How would you handle “Alex”

• Alex is a first year, non-traditional student who concerns a professor by drawing a stick figure being shot at the end of his final exam paper. The processor emails judicial affairs and counseling with the report.

10 Best Practices

The following are a collection of “best practice” concepts designed to be helpful to schools as they develop their threat assessments.

There are no “perfect” solutions. Each of these best practices needs to be applied in the context of public/private schools, small/large schools and schools with different pressures to manage retaining versus dismissing troublesome students.

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1. Indentifying Expectations

• Clearly identifying the needs and expectations of the person making the referral.

• Are you looking for an assessment? If so, what kind of assessment?

• Do you need a written report or letter? Are the parents involved in the process? Should other students be involved (boyfriend/girlfriend)?

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1. Indentifying Expectations

• Take into account expectations. What is the scope of the assessment? Should prior incidents be included? What happens if the student does not show up for an appointment?

• What is the timeline for the assessment? How quickly does information need to come back to the judicial affairs office?

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2. Threat Levels

Develop a “threat level” system so all departments that work with at-risk students can share a common language when rating the “riskiness” of a student’s behavior.

Any system should bring together mental health concerns & aggressive behavior into a general risk rubric.

It’s easy to rate risk on a student who fights with other students -- harder with a student who suffers from a serious eating disorder.

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2. Threat Levels

For example, the NCHERM model utilizes a multi-disciplinary rubric:

1. Mental Health-related risk: Potential harm to self

2. Generalized risk: Operational, reputational, facilities, financial

3. Aggression Measures: Potential harm to others

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2. Threat Levels

THE NCHERM CUBIT MODEL RUBRIC

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Mild Moderate Elevated Severe Extreme

Distress DisturbanceDysregulation/

Medically Disabled

2. Threat Levels (Mild)

• Disruptive or concerning behavior.

• Student may or may not show signs of distress.

• No threat made or present.

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2. Threat Levels (Moderate)

• More involved or repeated disruption. Behavior more concerning. Likely distressed or low-level disturbance.

• Possible threat made or present, but information is inconsistent, implausible or lacks detail.

• Content of threat suggests threatener is unlikely to carry it out.

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2. Threat Levels (Elevated)

• Seriously disruptive incident(s), exhibiting clear distress, more likely disturbance.

• Threat made or present, but vague and indirect, but may be repeated or shared with multiple reporters.

• Information is inconsistent, implausible or lacks detail. Threat lacks realism, or is repeated with variations.

• Content of threat suggests threatener is unlikely to carry it out.

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2. Threat Levels (Severe)

• Threat made vague, but direct, or specific but indirect (type of threat v. object of threat). Likely to be repeated or shared with multiple reporters.

• Information about threat or threat itself is consistent, plausible or includes increasing detail of a plan (time, place, etc).

• Threat likely to be repeated with consistency (may try to convince listener they are serious). Content of threat suggests threatener may carry it out.

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2. Threat Levels (Extreme)

• Threat made or present, concrete (specific and direct), likely to be repeated or shared with multiple reporters.

• Information about threat or threat itself is consistent, plausible or includes specific detail of a plan, often with steps already taken. Threat may be repeated with consistency.

• Content of threat suggests threatener will carry it out (reference to weapons, means, target). Threatener may appear detached.

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How would you rate “Jeff”

3. Limitations of Assessments

• It is important for all parties to be aware of the limitations involved in any assessment.

• At their best, assessments provide 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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4. Paperwork and Policy

• An assessment is only as good as the information received. Are there incident reports, faculty or student statements that would help shed light on the assessment?

• While this may take a change in focus and policy for judicial affairs, sharing this information with the counseling staff can greatly improve the detail of the assessment.

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4. Paperwork and Policy

• Steps should be taken at the start of the assessment to ensure a release of information is signed.

• This should also include a detailed informed consent outlining what would be included in the assessment. This would include:• Length, cost, scope of assessment• Description of who receives the results• Limitations of findings

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5. HIPAA and Communications

• HIPAA – Health Insurance Portability and Accountability Act of 1994 [2] [3]

Be familiar with these Federal Regulations and know how they apply to your particular institution.

Also be aware of any applicable state regulationor guidelines.

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• 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 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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6. FERPA and Communications

• FERPA – Family Educational Rights and Privacy Act of 1974.

• FERPA offers departments working together for a student’s best interests a wide latitude to share information.

• 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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7. Build a Bridge

• 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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8. Provide Information

What information would you need to perform an accurate assessment? • 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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8. Provide Information

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9. After the Assessment

• Maintaining a student on campus after the assessment is often the “elephant in the room.”

• It is essential to develop plans to work with the student after the initial event and threat assessment occurs.

• Often, the on-going connection with at-risk students leads to reduced long-term risk.

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9. After the Assessment

• Judicial Affairs and Residential Life are prone to a “wait and see” approach. Clear sanctions are spelled out and the student is monitored for compliance.

• Counseling Centers do not like to take on the role of mandated therapy or “probation officer” for students.

• A connection to the student is essential, but the department that holds responsibility for that connection is debatable.

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10. Educational Programming

• Educational programming for suicide, aggressive behavior and relationship violence offers a novel solution to the problem of managing at-risk students on campus following a threat assessment or judicial sanction.

• It offers counselors and psychologists another option beyond providing involuntary (or mandated) therapy or treatment under the pressure/persuasion of a third party.

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• Educational programming offers students a chance to review developmentally relevant concepts and resources without being in “counseling” or “therapy.”

• This kind of programming is offered commonly to help students remain on campus following a judicial review in the area of alcohol violations (Prime for Life, BASICS, Alcoholedu and eChug…).

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Suicide Education Program

(SEP)

Aggression

Education Program

(AEP)

Relationship

Violence Education Program (RVEP)



• The programs draw from various sources:

• SEP: the Suicide Prevention Resource Center, Question Persuade Refer (QPR), the JED foundation

• AEP: Aggression Management©, REBT Therapy

• RVEP: Aggression Management©, REBT Therapy

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• Each program can be offered in short (2-3 sessions), medium (5-6 sessions) and long (10 sessions). These can be offered individually or in group format.

• The programming is ideally offered by a counselor or psychologist with training in suicide awareness, basic aggression management and domestic violence. Staff with these basic expertise are often found in college counseling centers.

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Case Study A

A college a student had written in his journal a story about killing his roommate with a knife.

The student told residential life staff that he is a ‘creative writer’ and that it was just a story. The student said he understood why his roommate would be upset and apologized for the incident.

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Case Study A

A. Immediate separation of the student from the college awaiting an off-campus assessment, or

B. Immediate mandated assessment with campus counseling; Dean makes decision to return or

C. Referral to judicial affairs for meeting to assess danger, likely recommend counseling follow up with letter or full hearing, or

D. Handled internally by residential life---likely no suspension.

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Case Study B

A college student frequently scares other students by threatening to “attack another female in his class and bite into her neck.”

The student reported that he is a big fan of the vampire series “Twilight” and that he has a blood fetish. He finds himself sexually aroused with thoughts of blood.

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Case Study B

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Case Study C

A college a student is caught by residential life staff setting fire to a diorama she made. The diorama had little cut out pictures of other students she was mad at.

The fire was small and set with her lighter on a concrete table in the quad. She denies wanting to “really hurt anyone, I just do this when I get made to let off steam.” She reports being seen in counseling.

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Case Study C

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[1] 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.

[2] U.S. Dept. of Health and Human Services and U.S. Dept. of Education (November 2008) Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student Health Records. www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajointguide.pdf

[3] FERPA Regulations: www.ed.gov/policy/gen/reg/ferpa/index.html

[4] HIPAA Regulations: http://aspe.hhs.gov/admnsimp/pl104191.htm

References

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http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajointguide.pdf

http://www.ed.gov/policy/gen/reg/ferpa/index.html

http://aspe.hhs.gov/admnsimp/pl104191.htm

(Suicide)– www.qprinstitute.com www.jedfoundation.org– Diagnostic and Statistical Manual IV- Treatment

revision APA 2000– www.sprc.org (Suicide Prevention Resources

Center) Assessing and Managing Suicide Risk for College Students

– Substance Abuse and Suicide Prevention: Evidence and Implications—A White Paper.. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2008. www.sprc.org

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References

http://www.qprinstitute.com/

http://www.jedfoundation.org/

http://www.sprc.org/

(Aggression)– www.ncherm.org National Center for Higher

Education Risk Management.– www.aggressionmanagement.com – Yalom, I. (1980). Existential psychotherapy. Basic

Books.– Ellis, A. (2007). The Practice of Rational Emotive

Behavior Therapy. New York: WWNorton & Company.

– Byrnes, J. (2002). Before Conflict: Preventing Aggressive Behavior. ScarecrowEducation.

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References

http://www.ncherm.org/

http://www.aggressionmanagement.com/

(Relationship Violence)– www.aggressionmanagement.com – Yalom, I. (1980). Existential psychotherapy. Basic

Books.– Ellis, A. (2007). The Practice of Rational Emotive

Behavior Therapy. New York: WWNorton & Company.

– Byrnes, J. (2002). Before Conflict: Preventing Aggressive Behavior. ScarecrowEducation.

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References

http://www.aggressionmanagement.com/

Sample Assessments

– 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

– Anti-social– JI-R

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brian van brunt, ed.d. jason ebbeling, esq western kentucky university mitchell college...

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