THREAT ASSESSMENT TOOL HARM TO SELF OVERALL MENTAL BEHAVIORAL HEALTH, GENERALIZED RISK RUBRIC NINE LEVELS OF HOSTILITY AND VIOLENCE DYSREGULATIONIDECOMPENSATION A Acutely suicidal (thoughts, feelings, expressed '"tent'm and 'deamns) PLUNGING TOGETHER INTO THE ABYSS A Para-suicidal (extreme self-injurious behavior, eating disorder, personality disorder) at life- threatening levels A Engaging in risk taking behaviors (eg. substance abusing) FRA MENTATI THE ENEMY A Hostile, aggressive, relationally abusive 0 0 A Deficient in skills that regulate emotion, cognition, self, behavior and relationships LIMITED DESTRUCTIVE BLOWS A Profoundly disturbed, detached view of reality A Unable to care for themselves (poor self care/ protection/judgment) A At risk of grievous injury or death without intent 6 STRATEGIES 0F THREAT to self-harm ELEVATED A Often seen in breaks DISTURBANCE Increasingly disruptive or concerning behavior, unusual and/or bizarre acting 5 LOSS OF FACE May be destructive, apparently harmful or IMAGES AND COALITIONS threatening to others Substance misuse and abuse,- self-medication; MODERATE erratic medication compliance ACTIONS NOT WORDS DISTRESS . Emotionally troubled depressed, manic, unstable) 0 Individuals impacted by situational stressors and traumatic events that cause disruption or concern DEBATE AND CONTENTIOUS ARGUMENTS 0 May be if not coping/adapting to HARDENING . Behavior may subside when stressor is removed or trauma is addressed/processed TRAJECTORY7T ll BASELINE 20140 The NCHERM Group, L.L.C. INTERVENTION TOOLS TO ADDRESS RISK AS CLASSIFIED CLASSIFYING RISK MILD RISK • • • Disruptive or concerning behavior May or may not show signs of distress No threat made or present MODERATE RISK • • • • • • More involved or repeated disruption. Behavior more concerning. Likely distressed or low-level disturbance Possible threat made or perceived Threat is vague and indirect Information about threat or threat itself is inconsistent, implausible or lacks detail Threat lacks realism Content of threat suggests threatener is unlikely to carry it out ELEVATED RISK • • • • • • • Seriously disruptive incident(s) Exhibiting clear distress, more likely disturbance Threat made or present Threat is vague and indirect, but may be repeated or shared with multiple reporters Information about threat or threat itself 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 SEVERE RISK • • • • • • • Disturbed or advancing to dysregulation Threat made or present Threat is vague, but direct, or specific but indirect 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. EXTREME RISK • • • • • • • Dysregulated (way off baseline) or medically disabled Threat made or present Threat is concrete (specific or 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 (time, place, etc.), 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) MILD RISK ! ! ! ! ! Meeting/soft referral by reporter Behavioral contract or treatment plan with student or employee (if at all, only for low-level concerns) Student conduct or HR response Evaluate for disability services and/or medical referral Conflict management, mediation, problem-solving MODERATE RISK ! ! ! ! ! Meeting/soft referral by reporter Behavioral contract or treatment plan with student (if at all, only for low-level concerns) Student conduct or HR response Evaluate for disability services and/or medical referral Conflict management, mediation (not if physical/violent), problem-solving ELEVATED RISK ! ! ! ! ! ! ! Meeting/mandated referral by reporter Evaluate parental/guardian notification Obtain and assess medical/educational and other records Consider interim suspension if applicable Evaluate for disability services and/or medical referral Consider referral or mandated assessment SIVRA-35 or other violence risk assessment SEVERE RISK ! ! ! ! ! ! ! ! ! ! • ! ! ! Possible confrontation by reporter Parental/guardian notification obligatory unless contraindicated Evaluate emergency notification to others (FERPA/HIPAA/Clery) No behavioral contracts Recommend interim suspension or paid/unpaid leave Possible liaison with local police to compare red flags Deploy mandated assessment Evaluate for medical/psychological transport Evaluate for custodial hold Consider voluntary/involuntary medical withdrawal Direct threat eligible Law enforcement response Consider eligibility for involuntary commitment SIVRA-35 or other violence risk assessment EXTREME RISK ! ! ! ! ! ! ! ! ! ! ! ! Possible confrontation by reporter Parental/guardian notification obligatory unless contraindicated Evaluate emergency notification to others No behavioral contracts Interim suspension or paid/unpaid leave if applicable Possible liaison with local police to compare red flags Too serious for mandated assessment Evaluate for medical/psychological transport Evaluate for custodial hold Initiate voluntary/involuntary medical withdrawal Law enforcement response Consider eligibility for involuntary commitment