By: Tim Cason, M.Ed., Senior Consultant, TNG Consulting, LLC; Vice President, NABITA
With the publication of the updated NABITA Industry Standards for Behavioral Intervention Teams, we will review each standard in detail. Standard 14 highlights several risk assessment tools that can be used in the BIT process.
Standard 14. Psychological, Threat, and Violence Risk Assessments: The team uses objective, evidence-based tools to conduct violence risk, threat, and psychological assessments as part of its overall approach to prevention and intervention.
Assessments are an essential part of the BIT process. While all types of assessments can provide BITs and CARE teams with beneficial information, BITs must select the appropriate tool for the specific information they seek. In other words, what is the question you are trying to answer? Are you concerned about the risk of violence? Or are you assessing imminent safety following a threat made by an individual? Perhaps there are significant physical safety concerns due to an individual’s disconnection from reality. The first and most critical step is to choose the assessment that aligns with the information needed to support the individual and ensure the community’s safety.
The four primary types of assessments available are generalized risk assessment, threat assessment, violence risk assessment (VRA), and psychological assessment.
A generalized risk assessment is a structured assessment used to triage all referrals and gain a general understanding of the nature of the case at hand. Conducting a generalized risk assessment for all referrals ensures consistency and minimizes bias. Using tools such as the NABITA Risk Rubric for all incidents and behaviors at various risk levels can also facilitate early intervention by identifying a trajectory toward harm sooner. It is recommended that teams establish a threshold on the objective, generalized risk assessment tool that indicates the need to conduct further assessment such as a threat, violence risk, or psychological assessment.
When an explicit or veiled threat is present, a threat assessment can aid in evaluating the credibility and actionability of the threat. This type of assessment focuses on specific details of the threat and determines the immediate safety of the individual or others the individual has targeted. This step may involve collaborating with law enforcement or implementing emergency response protocols such as a welfare check. It is important to note that this assessment is limited in scope as it only examines the likelihood of violence related to the specific threat. While NABITA does not provide a threat assessment tool, as threat assessments are typically conducted within the scope of a welfare check by police or clinical mental health providers, we offer multiple resources for assessing the risk of violence in a more comprehensive way.
While a threat assessment focuses on the specific threat at hand, a violence risk assessment explores a broader set of risk and protective factors that contribute to an individual’s likelihood of engaging in any kind of violence. When the generalized risk assessment reveals an elevated risk, a VRA can be a helpful tool in gaining a more comprehensive understanding of the individual’s risk and how to mitigate it. The nature of the threat will determine which VRA tool is best. We offer two VRA tools: the Structured Interview for Violence Risk Assessment (SIVRA) and the Non-Clinical Assessment of Suicide (NAS).
The first tool, SIVRA, is a non-clinical assessment designed to evaluate the various factors that influence an individual’s likelihood of violence or harm toward others. It involves a one-on-one interview to identify risk factors and protective factors that make it more or less likely the individual will engage in violence. It is recommended that teams train multiple members (three to five) to conduct a SIVRA.
In cases where there are concerns about self-harm, NAS can be used as a transparent and evidence-based system to objectively triage an individual at risk for suicide. The NAS assists non-clinical staff in identifying the appropriate referral for an individual experiencing suicidal ideation. Specifically, NAS helps determine whether an immediate evaluation by someone qualified to initiate hospitalization is needed or if the individual can be referred to a clinical provider in a more routine fashion. The key difference between these two tools is that SIVRA assesses the risk of harm to others, while NAS measures harm to self.
An additional tool NABITA offers is the Violence Risk Assessment of the Written Word (VRAWW). This tool allows practitioners to analyze critical escalating and mitigating elements of social media, written content or threats, and other narrative content (e.g., a transcribed video). The VRAWW is an administrative tool that can be used at any point in the BIT process to aid teams in developing a better understanding of an individual’s overall risk.
An additional option for assessment is a psychological evaluation, such as a mental health assessment. Unlike other types of assessments, a trained and licensed clinician is required to conduct the evaluation. The purpose of this assessment is to determine the appropriateness of a mental health diagnosis and treatment plan, which may involve medication, outpatient therapy, or behavioral health hospitalization.
These assessment tools provide a comprehensive and research-based approach to evaluating individuals who display threatening or concerning behavior. The information gathered from these assessments can better inform intervention strategies and provide teams with a deeper understanding of the situation. These tools should be used in conjunction with further training and study.
For all types of assessments, it is highly recommended that teams establish a formal written procedure that outlines when an assessment will take place, who will be involved in the assessment process, and how it will be administered.
Practical tip: When it comes to psychological assessments, it’s essential to exercise caution. BITs often refer individuals for a “mental health evaluation” or “psych eval” after they have engaged in threatening behavior, whether it’s direct, veiled, conditional, or indirect. While a psychological evaluation can help determine the presence of a mental health condition and provide treatment recommendations, it alone is not sufficient for assessing the risk of targeted or instrumental violence. Instead, when teams want to learn more about an individual’s risk to their community and how to mitigate it, they should rely on a violence risk assessment.
Stay tuned for the remaining Tips of the Week in the BIT Standards refresh series. In the meantime, watch our webinar on partnership with law enforcement to better understand what interventions they can deploy to resolve conflict.