Front Matter

Contributors

Foreword

Preface

Acknowledgments

PART I

Foundations

1 An Introduction to School Violence

2 A Recipe for Violence

IMMATURITY, IMPULSIVITY, AND AGGRESSION

3 Inconvenient Truths

PROFILING AND ITS LIMITATIONS

4 Danger at Home

ADDRESSING VIOLENCE OUTSIDE SCHOOL

5 Bullying and Cyberbullying

6 Understanding and Addressing Youth Sexual Violence

7 Growing Up in Fear

SCHOOL SHOOTINGS, ATTACKS, AND GANG VIOLENCE

PART II

Threat and Risk Assessment

8 Hostile Intent

THE PRINCIPLES OF THREAT ASSESSMENT

9 Avoiding Danger

THE PRINCIPLES OF VIOLENCE RISK ASSESSMENT

PART III

Interventions

10 A System of Care

ADDRESSING AGGRESSION AND VIOLENCE IN SCHOOLS

11 Assessing and Addressing School Climate

12 Violence and the Media

Afterword

Example Threat Assessment Questions for Use With Grade School Students

Example Threat Assessment Questions for Use With Middle School Students

Example Threat Assessment Questions for Use With High School and College Students

Index

Associate Professor of Clinical Psychiatry and Vice Chair of Community Psychiatry, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California

Professor of Clinical Psychiatry, Department of Psychiatry, MedStar Georgetown University Hospital, Washington, DC

Assistant Professor of Psychiatry; Director, Addiction Institute at Mt. Sinai West and St. Luke’s Hospitals; Director, Fellowship in Addiction Medicine Program, Icahn School of Medicine at Mt. Sinai, New York, New York

Clinical Instructor, Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine, Stanford, California

Associate Professor, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland

Senior Psychiatrist, California Department of State Hospitals-Coalinga, Coalinga, California

Assistant Professor of Clinical Psychiatry and Program Director, Child and Adolescent Psychiatry Residency, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California

Psychiatry Resident, PGYII, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California

Assistant Professor of Clinical Psychiatry, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California

Resident in Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California

Doctoral student in Clinical Psychology, Pacific Graduate School of Psychology, Palo Alto University, Stanford, California

Child and Adolescent Psychiatry Resident, Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, California

Editorial and Research Intern, Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California

On February 14, 2018, a 19-year-old expelled student walked into Marjory Stoneman Douglas (MSD) High School in Parkland, Florida armed with a legally purchased AR-15 style semiautomatic rifle and multiple magazines. He fired and killed 17 students and staff members and injured 17 others. In 6 short minutes, the United States experienced its deadliest school shooting. Prior to the shooting, the shooter had been assessed by a range of investigators and evaluators, yet interventions to deter him were either not implemented or not successful. Is it possible that an evidence-based assessment or preventative intervention approach might have changed the course of this horrific day?

In the wake of yet another seemingly senseless tragedy, our society is again forced to face three questions that demand effective answers rather than thoughts and prayers alone. First, what are the relevant factors that lead to violence in our schools? Second, how do various disciplines that interact with youth assess potential threats of violence? Third, what interventions have been shown to address and decrease aggression and violence in a school setting?

Safe Passage: A Guide for Addressing School Violence provides practical and effective answers so desperately needed to address the above questions. This outstanding book represents an invaluable resource for psychiatrists, psychologists, social workers, teachers, administrators, judges, probation officers, lawyers, policymakers, and family members, all of whom are architects responsible for constructing a safe passage through the halls of school and the path of a student’s life.

This book cogently organizes guidelines for addressing school violence into three parts. The first part consists of seven chapters highly relevant for understanding the foundations of juvenile violence both in and out of the school setting. Among the many topics included in this section, the authors review risk factors for juvenile violence, categories of school violence, limitations on profiling potentially violent youth, bullying and cyberbullying, and factors unique to understanding and addressing youth sexual violence.

The second part provides a state-of-the art review of juvenile threat and violence assessment. The authors provide an excellent summary of threat assessment approaches, a review of the Virginia Model for Student Threat Assessment, specific guidelines on questioning collateral contacts, and developmental considerations when assessing a potentially violent threat. The authors provide an exceptionally easy to understand distillation of commonly used violence risk assessment instruments and assess the utility of such instruments for evaluating threats and potential violence. The authors also address important case law relevant to legal duties to protect third parties from harm. The third and final part reviews interventions important for addressing and decreasing aggression in school and important factors for fostering a healthy school environment.

In each chapter, the authors create a useful learning interface between the reader and the text, which makes this book both engaging and exceptionally practical. The authors assist the reader in understanding potentially complex topics using clearly defined definitions, realistic case vignettes, illustrative diagrams, summary tables, highlighted key points, relevant clinical pearls, and up-to-date epidemiology and relevant references. The editors include three separate appendices that provide example threat assessment questions for use with grade school students, middle school students, and high school and college students. These appendices give structured interview guidelines that serve as an invaluable template for investigating a potentially violent student.

Editors Michael Kelly and Anne McBride have beautifully organized a practical guide for addressing school violence. Echoing the eloquent words of President John F. Kennedy, this book serves to move past cursing the darkness of school violence and instead lighting a candle through that darkness with a safe passage to a sane future.

School violence is a frightening topic and one that is often equated with mass school shootings. Most Americans today would instantly recognize footage and images from the tragic mass school shooting that occurred on April 20, 1999 at Columbine High School that resulted in the deaths of 12 students, 1 teacher, and the 2 student perpetrators along with the injuries of 21 additional victims. Most individuals who live in the United States hear the words “Virginia Tech” and “Sandy Hook” and immediately visualize mass student casualties after 33 university students and faculty died (and 23 victims were injured) on April 16, 2007 and 20 first-grade students and 6 school personnel were killed at an elementary school on December 14, 2012, respectively. Are school shootings becoming more prevalent? It certainly feels that way. At the time of this writing, for example, in 2018, 17 students and school staff were killed and 17 individuals were injured at a high school in Parkland, Florida, on February 14, 2018, and 10 students and teachers were killed with 13 others wounded at a high school in Santa Fe, Texas, on May 18, 2018.

In July 2018, the U.S. Department of Homeland Security posted a grant opportunity for School-Age Trauma Training, offering more than $1.8 million in funding “to establish a long-term, self-sustaining mechanism...to deliver free to the public, lifesaving trauma training to high school age students for mass casualty events” (U.S. Department of Homeland Security 2018). But does our focus on mass casualty events truly address the scope of violence within our schools today? In fact, school violence comes in many different forms, from bullying on campus to trauma off campus to community gangs to violent crimes. Addressing school violence requires a comprehensive and multifaceted approach.

Violence in our schools is an often misunderstood and sensationalized phenomenon. Our hope is that this book appeals to educators, school administrators, mental health clinicians (e.g., psychiatrists, psychologists, social workers), other health care professionals who work with children (e.g., pediatricians, family practice clinicians), and interested laypersons. This book will introduce readers to important concepts pertaining to school violence and serve as a practical guide for mitigating and preventing violence in our schools.

The book is composed of three parts. In Part I, we provide readers with background information on topics that are foundational to performing threat and risk assessments. Important topics covered in this part include the subtyping of aggression, adolescents’ proclivity for reward-seeking behaviors, and the development of impulse control. Additional chapters in Part I focus on trauma outside of school, violence on campus, bullying, and sexual violence. We address topic-specific interventions in these chapters as well.

Our understanding of the subtypes of aggression reviewed in Part I forms the basis for threat and risk assessment in Part II. In Part II, we focus on threat assessment and violence risk assessment in a manner that takes individual, school, and community variables into account. Regarding violence risk assessment, every student is evaluated in relation to static risk factors (i.e., historical variables that cannot be changed), dynamic risk factors (i.e., risk factors that are amenable to change), and protective factors. Violence risk is characterized along a continuum rather than in binary fashion. Thus, understanding where a student fits along this spectrum is of utmost importance when identifying opportunities to move the student away from violent behavior. Given that what matters to a third grader is different than what matters to a tenth grader, assessments must be developmentally attuned to individuals. As such, violence risk assessment is a nuanced endeavor considering developmental states as youth progress from elementary school to college.

In Part III, we focus on interventions for preventing, mitigating, and addressing school violence. In this part, we summarize individual and school-based approaches to preventing violence and intervening after violence has occurred. We also provide a methodology for school staff and mental health clinicians to address the school climate itself. Multiple school violence reduction programs are reviewed. This is followed by a brief discussion of the media and its potential influence on our children’s perceptions of violence and on their behavior.

As parents, physicians, and educators, we feel strongly that children need safe and supportive environments to learn most effectively. We are both psychiatrists trained in general psychiatry, child and adolescent psychiatry, and forensic psychiatry. Dr. Kelly serves as Senior Psychiatrist at Coalinga State Hospital and Program Director of the Forensic Psychiatry Fellowship at San Mateo County Behavioral Health and Recovery Services. Dr. McBride is the Program Director of the Child and Adolescent Psychiatry Residency at the University of California, Davis. Our educational, scholarly, clinical, and forensic work focuses largely on children and adults who have been disenfranchised through the cumulative effects of poverty, trauma, untreated mental illness, and inadequate access to education. The origins of the problems that plague many of the patients and families we serve begin early in development and can be passed on generationally. It is through such a lens that this text was created.

The editors and authors wish to add that this text has compiled expert perspectives for providing guidance in understanding, assessing, and addressing school violence. Therefore, we cannot accept liability for how this information is applied or for any errors that may exist.

Thanks to my wife Leah, who makes our family go. This book would not have been possible without your love and support. To my wife, children, their “big sister” Janna, and close friends for making every day a reason to be grateful. To my parents, Brian and Ernestine, my sister Anne, and her husband Andy, for always being in my corner. Also, to my Aunt Bruna Traversaro, whose varied interests inspired my curiosity from an early age. I’d also like to thank the men and women at San Quentin State Prison, with whom I worked while finishing this book. Thank you for helping affirm that this work matters. Despite coming far as a society and advances in the profession, there is still much to be done to ensure that we can all share equitably the freedoms our nation affords. Thanks to my colleagues at Coalinga State Hospital, San Mateo County, and Santa Clara County for the opportunity to continue doing the work that I love. Above all, I’d like to thank God for guidance, whether the road is smooth or rocky.

I dedicate this book to my parents, Helen and Jeff, for giving me the stable childhood that every person deserves. Your lessons in generosity, intellectual curiosity, and sensibility are ones I hope to instill in my own children. To my brave and loving sister, Allison, who first taught me about perseverance and resilience. To my strong and passionate husband, Nick: your support has been unrelenting, and without it I could not do what I do. And most of all, to our three boys—Maximus, Ernest, and Oscar—the inspirations of my life. I am grateful for every moment with each of you. I will strive each day to provide you with the unconditional love, nurturing support, and thoughtful guidance to become exactly the men you are meant to be.