Webinar about the guides:
Continuing education webinar about the guides for the University of New Mexico (Department of Psychiatry and Behavioral Sciences) Law and Mental Health Series (2/20/2024):
Violence Risk Assessment and Management Guide Version 1 (VRAM Gv1)
Downloadable PDF format sample:
King (2023) Violence Risk Assessment and Management Guide Version 1 (VRAM G v1)
Cite form as:
King, C. M. (2023). Violence Risk Assessment and Management Guide [Version 1, Unpublished work]. Psychology Department, Montclair State University.
Usage notes:
This form-based and flexible guide, the VRAM Gv1, was heavily inspired by the Linehan Risk Assessment & Management Protocol (LRAMP; Linehan, 2016); other major sources of inspiration are provided in the reference list below. The form is organized into the following sections: reason(s) for completing the form; violence risk assessment actions; violence risk management/reduction actions; final opinions regarding violence risk and any protective actions; additional summary and notes; and certification of completion. The form is most applicable to non-medical behavioral health providers, especially psychologists, and focuses on targeted threat scenarios rather than abuse and neglect and forensic evaluation scenarios. The form is meant to serve as a synthesized resource for training purposes, with users referring to the below references, other sources, and their supervisors for further professional guidance. The form is not a validated violence risk assessment nor management tool. Contact Christopher M. King, JD, PhD, at kingch@montclair.edu for permission to use.
Special notes about the Violence Risk Assessment section of the form:
Examples of structured risk assessment tools for different violent outcomes of concern, and their included risk and protective factors, are available in Douglas and Otto (2021). When circumstances permit, use of these tools is recommended, for appending to this section.
If circumstances warrant assessing violence risk via unstructured professional/clinical judgment (Monahan & Skeem, 2014; Wortzel, Borges, Barnes, et al., 2020), risk and protective factors may be drawn from meta-analyses of risk factors for different violence outcomes (e.g., Fazel et al., 2018); recommendations for factors for threat assessment (e.g., Borum and Reddy, 2001; Mitchell & Palk, 2016); and record forms for violence risk and protective assessment tools (e.g., Douglas et al., 2013; SAPROF International, 2018a, 2018b). For example, risk factors in the domains of biological; historical; family, social, and environmental; clinical conditions, symptoms, and stressors; attitudes and emotions; capacities (e.g., access to weapons and victims); planning; intent; and non-responsiveness to risk reduction strategies (Almvik et al., 2000; Borum and Reddy, 2001; Fazel et al., 2018). And protective factors in the domains of internal traits and resilience, attitudes and motivation, and social and other external supports or circumstances (SAPROF International, 2018a, 2018b). However, it should be noted that proceeding in this way in not commensurate with the structured professional judgment nor actuarial approaches (e.g., Wortzel, Borges, McGarity, et al., 2020). This includes because unstructured clinical judgment does not entail use of a predetermined list of risk and protective factors to consider, nor standardized operationalization of those factors, nor statistical comparison to reference groups (e.g., Hart & Douglas, 2023). Such that the uncertain reliability and validity of this approach must be acknowledged in general, and the bearing of this in the individual case at hand.
For guidance conducting an anamnestic assessment, refer to Otto (2000); for guidance conducting a functional (chain) analysis relevant to other-directed violence risk, refer to Borges et al. (2021). See also Eckhardt et al. (2014) for further ideas about conceptualizing the influence of risk and protective factors.
Risk and protective factors, and overall risk, may be conceptualized in summary form in terms of applicability (e.g., no, somewhat or mixed, appreciably or clearly); hypothesized functional relevance to risk of a violent outcome (e.g., no, possible, clearly) or risk management/reduction (e.g., critical, prioritized target for reduction); and level (e.g., low, moderate, high; Douglas et al., 2013; SAPROF International, 2018a, 2018b; Wortzel, Barnes, et al., 2020). It is further recommended that users attend to the anticipated nature or type of violence; probable victim or victims; and likelihood, severity, and imminence of violence (Heilbrun et al., 2021; SAPROF International, 2018a, 2018b). Attaching a narrative conceptualization (probable story) concerning violence risk is also advisable; such can also be incorporated into the final section of this form.
Summaries of strategies reflected in the Violence Risk Management/Reduction section of the form:
The specific risk management strategies in the form are organized into the subsections of functional analysis (e.g., chain and solution analysis), crisis intervention and de-escalation strategies, increased social support, referral or conferral, contraindications for inpatient management, emergency protection actions, and other. To help recall general themes or categories of strategies that might be employed in the moment with or concerning clients, the following two complementary summaries are offered.
Summary 1: general prevention/personal safety awareness; safety planning (including with respect to weapons); treatments; de-escalation (non-verbal, verbal, involve others, other); assertiveness, distancing, and other crisis management; inpatient/emergency referral; warn others
Summary 2: proactive; discreet; cautious, prepared, and aware; calm, confident, clear, and assertive; concerned, compassionate, and empathic; collaborative and creative; relieving; psychological and psychiatric interventions
An important note is offered about diversity and multiculturally sensitivity. Consistent with recommendations in the research and professional literature (Hallett & Dickens, 2017; Kleespies et al., 2023), one of the violence risk management strategies in the form is, “Remained attentive to client and therapist’s non-verbal/verbal behavior and cultural factors.” While this item is currently organized under the domain of crisis interventions and de-escalation strategies, consistent with broader sources of authority within the human services disciplines (e.g., American Psychological Association, 2017), it should be understood as applicable generally to both guides in their entirety.
References:
See PDF
Violence Risk Assessment and Management Guide: Short Form Version 1 (VRAM G:SFv1)
Downloadable PDF format sample:
King (2023) Violence Risk Assessment and Management Guide Short Form Version 1 (VRAM G SF v1)
Cite form as:
King, C. M. (2023). Violence Risk Assessment and Management Guide Short Form [Version 1, Unpublished work]. Psychology Department, Montclair State University.
Usage notes:
This form-based and flexible guide, a short-form companion to the VRAM Gv1, was heavily inspired by the Linehan Risk Assessment & Management Protocol (LRAMP; Linehan, 2016) and Ask Suicide-Screening Questions (ASQ) Toolkit (National Institute of Mental Health, n.d.). Other major sources of inspiration are provided in the reference list below. The short form of the VRAM G: SFv1 reflects a general streamlining and significant abbreviation of the full VRAM Gv1, including a reconceptualization of the violence risk management/reduction strategies. Accordingly, good familiarity with the usage notes and additional level of detail afforded by the full VRAM Gv1 is recommended before using the VRAM G: SFv1, as the short form generally calls for users to know about and narrate content that is more expressly prompted by the full guide. Like the full guide, the short form is most applicable to non-medical behavioral health providers, especially psychologists, and focuses on targeted threat scenarios rather than abuse and neglect and forensic evaluation scenarios. Both the short form and full guide are meant to serve as a synthesized resource for training purposes, with users referring to the below references and other sources for further professional guidance. Neither the VRAM G: SFv1 nor the VRAM Gv1 are validated violence risk assessment or management tools. Contact Christopher M. King, JD, PhD, at kingch@montclair.edu for permission to use.
References:
See PDF