This document discusses assessment, prevention, and treatment of youth violence. It provides data showing that school shootings in the US have increased from the 1990s to 2011-2013. It describes risk factors for youth violence like past behavior problems, substance abuse, and family issues. It discusses tools to assess risk like the SAVRY, LS-CMI, and PCL-YV. It emphasizes the importance of assessing developmental delays and issues like attachment. Prevention programs like Head Start and Healthy Families are highlighted. Evidence-based treatments include case management, family therapy, CBT, and skill-building.

1. Assessment, Prevention, and Treatment
of Youth Violence
Dr. Kathy Seifert
k.seifert@espsmd.com

2. How much School Violence is in the US?
o US
o 33 school shootings in the 1990’s (10 years)
o 40 school shootings from 2000-2010 (10 years)
o 44 school shootings from 2011-2013 (3 years)

3. RISK FACTORS FOR YOUTH VIOLENCE
The more chronic and severe the risk factors the higher the
risk for future violence.

4. TWO TYPES
o Chronically violent and delinquent (generally
from violent homes with criminal substance
abusing parents)
o Psychotic (or autistic), narcissistic, with insufficient
supports, and endure event that severely injures
ego (generally from pro-social homes, but youth are
Neurologically impaired and not in treatment).

5. Historical Risk Factors for Youth
Violence
o Past behavior problems
o Past Assaults
o Chronicity
o Severity
o Escape from custody
o Fire setting
o Harmed Animals
o Early behavior problems
o Enuresis
o Delinquency

6. Recent mental health and behavioral health
issues
o Anger management
o Runaway
o Lacks remorse
o Poor problem solving
o Belief in the legitimacy of aggression
o Social skill deficits
o Bullying behavior
o Deviant peer group
o Limited association with pro-social peers
o Paranoia
o IQ below 80

7. Recent mental health and behavioral health
issues II
o School problems
o Risk for placement
o Impulsive
o Emotions poorly regulated
o Psychosis or autistic (usually high IQ)
o Self-harm

8. Historical Factors II
o Attachment
problems
o Abuse and neglect
o Family violence,
abuse, neglect, or
criminality
o Parental
insufficientcy
o Parental absense
o Bullying

9. Historical Substance Abuse & Neurological
Problems
o Substance abuse
o Neurological
o Mental health

10. Resiliency factors
o Average or better IQ
o Positive experiences with caregivers
o Positive school experience
o Lack of untreated psychiatric or
substance abuse problems in caregivers
o Positive future goals
o Positive activities
o Effective treatment
o Pro-social peers
o Modulates emotions well
o Takes medication as prescribed

11. Child Development

12. Corrective
developmental
experiences and
healthy
relationships
can change the
brain.
The balance
between healthy
and unhealthy
biology
(including
genes),
environment and
experiences will
determine the
health of
development.
Healthy skill
development is
necessary to
function
effectively in
the world of
people.
Child development

13. What Developmental areas are affected by
trauma
o Problem solving
o Self management
o Moral reasoning
o Logic
o Affect regulation
o Interpersonal relatedness
o Task behavior
o Concentration
o Impulsivity
o Effective Communication

14. Can be blocked by Trauma
Can be blocked by Trauma
Can be blocked by Trauma
Trauma Negatively Affects Moral Development,
Kohlberg, 1969 (Expanded from Piaget)

15. Targets of Assessment
Types of Assessment
Assessments inform treatment
Assessment

16. Assessment Targets
o Symptoms (Health)
o Development of skills (Health)
o Family dynamics (Home)
o School or job functioning (Community)
o Career Goals, Relationships, Spirituality (Meaning)
o Danger to self and others

17. Assessment
When problems are severe, chronic, acute, dangerous, immediate
specialty assessments are needed to determine immediacy of
danger, as well as type, and intensity of treatment needed.
1. Get 3rd party information when possible
2. Psychological Testing may be needed
3. Interventions that meet the needs of the client and his or her family
4. Safety must be the number 1 priority. You cannot help children if
they are not safe.
1. Dangerousness
2. Suicidality
3. Domestic violence

18. Suicide Risk vs. Self Harm
Assessment of
Danger to self

19. Assess
o Assess Risk factors, especially those that can
be changed
o Assess resiliency factors especially those that
can be increased
o Conduct suicide inquiry
o Determine risk level and intervention
o Document

20. Each client is assessed for risk of dangerousness at
regular intervals, or as needs change
• Clients at risk of dangerousness are identified and
charted
• Immediate safety needs of others are addressed
• Treatment and monitoring strategies to ensure
procedures for safety of others are implemented
• Treatment and monitoring strategies are
individualized and documented in the client’s
health record
• Outcomes of strategies are charted
Assessment of Danger to Others

21. Basic Principles of Assessment of
Very Complex, High Risk Cases
o Assess for dangerousness: Domestic Violence, Abuse, risk of
violence, risk of sexual offending, and suicidality and
o Take appropriate safety measures. Agencies that actively employed
standardized risk and need assessments had a greater impact on
recidivism than agencies that did not (correlations with effect sizes of
.33 and .16, respectively (CRIME & DELINQUENCY, Vol. 52 No. 1,
January 2006 7-27; DOI: 10.1177/0011128705281756)
o Assess developmental level of parents and child in a variety of
skill areas. Behavior Objective Sequence (Braatan). Skills must be
taught in developmentally appropriate sequence.
o Assess systems for cooperation, communication, and mutual support
o Determine types and levels of treatment needed (dosage)

22. Instrument Risk of
Violence
Age
s
Case
Manag
ement
Can be
Administ
ered
Unaided Clinical
Judgement
r =.12; AUC =.51
(Chance)
Any No NA Many studies
SAVRY (Handbook
of Violence Risk
Assessment
By Randy K Otto)
R = .56-.67; AUC
= .77-.80 (good)
12-18 No Hand Structured Professional
Judgment;
CARE2 (The
Handbook of
Forensic
Psychology
edited by Irving B.
Weiner, Allen K. Hess)
r = .62; AUC = .87
(Very Good)
6-18 Yes Hand or online Risk and Needs; 1,026
males and females, ages
6-18 in the US
LS-CMI (Int J
Offender Ther Comp
Criminol. 2012
Feb;56(1):113-33.
Epub 2011 Feb 13)
r = .39; AUC = .75
(good)
16+ Yes Hand or
computer
Risk and Needs; 250,000
youth and adult offenders
in US and Canada
PCL-YV (Int J Law
Psychiatry. 2008 Jun-
Jul;31(3):287-96.)
AUC = .73 males
(acceptable)
.50 females
(Chance)
12-18 No Hand Measure of Psychopathic
traits (Kosson, et. al.
Psychol Assess. 2002
Mar;14(1):97-109.)

23. SAVRY
http://savry.fmhi.usf.edu/ (ranks as most
accurate by Singh JP, Grann M, Fazel S,
2011) The SAVRY is composed of 25
items (Historical, Clinical, and
Contextual) drawn from existing
research and professional literature in
adolescent development and on
violence and aggression in youth. An
additional five Protective Factors are
also provided. (Bartel, Borum, & Forth,
1999; Borum, Bartel, & Forth, 2000).
Ages 12-18 years.

24. LS-CMI – Treatment Planning for
Delinquency
1. LS-CMI
http://www.mhs.com/product.aspx?gr=saf&pr
od=ls-cmi&id=overview The Level of
Service/Case Management Inventory (LS/CMI)
is an assessment that measures the risk and
need factors of late adolescent and adult
offenders. The LS/CMI is also a fully
functioning case management tool. This single
application provides all the essential tools
needed to aid professionals in the treatment
planning and management of offenders in
justice, forensic, correctional, prevention and
related agencies. (16 years +). Male and
female norms.

25. PCL-YV
http://www.mhs.com/product.aspx?gr=edu&prod=pclyv&id=overvi
ew (Ranks as least accurate by Singh JP, Grann M, Fazel S, 2011
meta-analysis) Correlations with female violence is NS.
The Hare Psychopathy Checklist: Youth Version (PCL:YV) is a 20-
item rating scale for the assessment of psychopathic traits in
male and female offenders aged 12 to 18. The PCL:YV uses an
expert-rater format that emphasizes the need for multidomain
and multisource information. Using a semistructured interview
and collateral information, the PCL:YV measures interpersonal,
affective, and behavioral features related to a widely
understood, traditional concept of psychopathy. Ages 12-18

26. CARE2
http://care2systems.com The CARE-2 (Child &
Adolescent Risk Evaluation) Assessment by Dr.
Kathy Seifert works to identify youth who are at risk
for violence and determines specific interventions
needed to prevent any future risk of aggressive
behavior. Updated and enhanced, this invaluable tool
examines every factor that may be affecting the
youth's development, and puts a plan in place for the
youth to mature into a positively pro-social functioning
member of society. (ages 6-19)

27. Developmental Assessment

28. 6 Core Concepts of Child Development
o Children are always learning and
development has a sequence that must
be followed and age is not a determinate
of developmental level (roll over, sit up,
crawl, stand up, walk)
o Skill building usually follows
developmental sequences and be
taught within the context of a healthy,
nurturing, dependable relationship.
o Attachment experiences (good, bad, or
ugly) and trauma change the brain.

29. Trauma can interrupt the sequences of
development

30. Assess where a child is on a
developmental scale
o Many are at immediate gratification and seeking a safe
base.
o Immediate gratification and needs of the self are primary
o Must learn perspective taking and reciprocity before empathy
o If the youth is still seeking a safe base, that must be
established before exploration of the world and information
gathering
o A safe environment is essential for healthy development
o You need some type of developmental guide for use in your
treatment plan

31. Assessment of High Risk Children
o 8 Symptom Categories
o Traumatized Brain
o 3 or 4 Attachment Patterns
o Holistic Assessment and
Treatment Practices
o Assessing Development Using the
BOS

32. Behavior – Lack of eye contact, enuresis,
violence, out of control behavior, hoarding
food, lies, steals, oppositional and defiant,
breaks the rules, impulsive, destructive,
hyperactive, self-destructive, harms
animals, irresponsible
Emotions – intense anger & temper, sad,
depressed, hopeless, moody, fearful,
anxious, irritable, inappropriate emotional
reactions, emotions not well regulated
Level 3. 8 Symptom Categories of DTD/CPTSD/RAD – past &
present; frequency, duration, and severity. What other
disorders have these symptoms?

33. symptoms – 2.
thoughts – negative beliefs about others and relationships, lacks cause and effect
thinking, attention & learning problems
negative beliefs
about self

34. Symptoms 3. Relationships –
lacks trust, controlling (bossy)
with children and adults, is not
genuinely affectionate with
family, indiscriminately
affectionate with strangers,
unstable peer relationships,
blames others for misdeeds,
victimizes others and is
victimized.

35. Symptoms - 4
o Physical - failure to thrive, poor
hygiene, tactilely defensive, enuresis
& encopresis, accident prone, high
pain tolerance,
o Moral/Spiritual – lack compassion,
remorse, pro-social values,
identification with evil or the “dark
side”
o Development - delayed development
o Core Beliefs/Internal Working Model
of self, others, and world is Negative

36. The Behavior Objective Sequence
o By Sheldon Braatan
o A developmentally sequenced group
of skills in 6 Domains.
o Age is not the determiner of skill
level
o Youth must learn skills in
appropriate developmental
sequence.
o Find out at what level they have
mastered skills (can do it 90% of
the time without prompting)

37. Adaptive: Responds appropriately to
routine and new expectations
respond independently to materials for amusement
appear alert and able to focus attention
bring no weapons to school
use amusement materials appropriately
wait for turn without physical intervention
use and return equipment without abuse
accept positive physical contact
touch others in appropriate ways
refrain from stealing
respond when angry without hitting
recognize and show regard for possessions
accept verbal cue for removal from a situation
respond when angry without abuse of property
respond appropriately to substitute
respond when angry without threats
walk to timeout without being moved by an adult
work or play without disrupting others
refrain from inappropriate behavior when others
lose control
respond to provocation with self-control
respond when angry with self-removal

38. Self-Management Skills
Responds appropriately to challenging
experiences with self-control in order to
achieve success
o (E) Appear alert and able to focus attention on activities
o Wait or take turns when directed without physical intervention
– verbal prompts may be use
o Respond when angry without verbal threats or intent to harm
o (M) Seek adult help in personal and/or group crisis
o Maintain personal control and routinely comply with
established procedures in group situations without reminders.
o (H) Maintain self-control when faced with disappointment,
frustration, or failure without adult intervention.
o Obey new or temporary authority figure, without presence of
other permanent staff

39. Communication
o Ability to share with and receive information from other
people to meet a need or affect another person in a positive
way.
o Speak using a volume appropriate to the situation
o Wait until a speaker is finished before responding
o Express feelings about self or others to an adult appropriately
o Spontaneously participate in group discussions
o Maintain appropriate social distance when speaking to another
o Speak courteously to others, using appropriate references, with no
cues.
o Describe personal strengths that will enable success

40. Interacting with others in social and task situations in ways
that meet personal and interdependence needs and
contribute to a sense of belonging
• Respond to an adult when his or her name is called
• Accept help from an adult when offered
• Sit quietly for 15 minutes or more in a group listening
activity
• Develop positive relationships with more than 1 adult
• Share materials and equipment with peers with minimal
reminders from adults
• Physically or verbally come to the support of another
student by offering assistance in a difficult situation
• Spontaneously resist negative peer pressure
Interpersonal Behaviors

41. Task Behaviors
o Student engages in task or activity with or without assistance
o Accept assistance from an adult on academic tasks
o Refrain from inappropriate behavior when asked by an adult to correct
errors
o Complete daily assignments
o Choose and actively participate in elective classes
o Ignore distractions of others while working
o Self-chart progress in reading or math
o Participate in structured role-playing activities
o Complete and turn in assigned homework when due

42. Personal Behaviors
o Student engages in a counseling dialogue with a
helping person, permitting adult to help resolve
issues or solve problems or build self esteem.
o Express negative feelings to an adult
o Follow through with specific directions from an adult to modify
behavior in a given situation
o Participate in determining a short term plan for dealing with
an immediate situation
o Attend to a peer when a peer is speaking
o Express feelings about self to peers
o Seek counseling t avoid conflict
o Contribute to group rule making and consequences
o Verbally demonstrate knowledge of alternative coping
strategies for managing stress

43. Assessing parents

44. Parents
o Attachment/trauma history
o Awareness of Emotional & Environment Triggers
o Parenting Attitudes and Competencies
o The child needs a loving home with nurturing, affection,
routine, structure and boundaries.
o There are skills to learn about anger management, reframing
the meaning of behaviors, teaching, rather than punishing
o Parent Mental Health, Substance Abuse, Offending
Behavior, Dangerousness & Stability
o Parents must take care of their mental health to do this job
effectively
o Safety of the home

45. Assessment of Family System
o Family backgrounds
o Families of origin
o Marital relationship
o Relationships among siblings and
between children and parents
o Structure – Family Systems Work
o Ongoing Patterns (“family dance”)
o Support Systems
o Stressors and Stress Management
o Rules, Roles, and Boundaries

46. PREVENTION

47. PROVEN EFFECTIVE
PREVENTION
o Head Start with Family
Involvement
o Healthy Families
o Early detection and treatment
o Ending child abuse, neglect and
domestic violence

48. Interventions

49. EBP
• Case management
• Multi-system integration
• Family Therapy
• Developmental approaches with skill building
• CBT
• Role playing
• Dosage is important
• Holistic approaches
• Neuro-feedback & CES
• Wrap-around
Evidence based treatment for complex cases

50. Developmental Interventions
with BOS
PROMISING PRACTICE

51. Questions and Answers