Salma Malik, Kevin Young, Sophia Walker and Mirela Loftus* Pages 100 - 117 ( 18 )
Background: Child and adolescent psychiatrists and clinicians often assess individuals who present with homicidal and violent thoughts. These assessments are critical, for patient safety and societal protection. The psychiatrist must ultimately decide if the patient can return to the community safely, regardless if the patient has initially presented to inpatient, outpatient, emergency room or school settings. While there is some consensus regarding the best practice in assessing risk for serious self-harm, approaches to the assessment of homicide and violence are far more disparate. Clinicians often determine risk based on known risk factors and type of violence threatened, and many offer a “risk level”. However, in the absence of an easy to use tool to assess risk, the judgment relies on clinician experience, talent and training, at the expense of a uniform, organized and comprehensive approach.Methods: We describe an assessment tool that uses a semi-structured interview to comprehensively evaluate an individual’s risk for violence. The tool guides the clinician to gather a detailed description of the current episode, then reviews the salient risk and protective factors and ends with a structured mental status exam developed to help characterize typical pathways to violence. Discussion: The steps in assessing children and adolescents presenting with homicidal threats in various clinical settings, as well as the steps in determining the appropriate level of care and treatment plan, will be discussed. The implementation of the assessment tool in an inpatient setting and the clinicians’ reaction to using it will also be discussed. Conclusion: The I-HAVAT© (Institute of Living-Homicide and Violence Assessment Tool) is a semi-structured method of assessing patients presenting with violent or homicidal threats by collecting and streamlining pertinent clinical information and ultimately increases the clinicians’ confidence level in making decisions and recommendations for determining the level of care and appropriate treatment plan.
Homicidal thoughts, children and adolescents, assessment tool, violence, homicidal, ideation.
SIDRA Medical and Research Center, Doha, Institute of Living/Hartford Hospital, Hartford, Connecticut, Institute of Living/Hartford Hospital, Hartford, Connecticut, Institute of Living/Hartford Hospital, Hartford, Connecticut