Dr. Rozel Offers Training to Recognize and Manage Violent Risks

The  Collaboratory Against Hate attended the “Champions (clinical homicide & aggression management practices for inpatient, outpatient & nontraditional settings)” training offered on Friday, February 5th at UPMC Shadyside Hospital. The training was led by Dr. John (Jack) Rozel who is the medical director, at resolve Crisis Services, professor of psychiatry, adjunct professor of law, Center for Bioethics and Health Law, at the University of Pittsburgh. Dr. Rozel is also actively involved in the PA-Threat Assessment Steering Committee (PA-TASC ). PA-TASC is a multidisciplinary effort with over 200 members to improve the state's threat assessment and response to targeted violence. This includes training for various professionals (law enforcement, educators, medical professions, etc.), reporting methods, creating an integrated process to share amongst various areas, increase prevention and decrease overall threats.

The “Champions” training aims to help practitioners to develop a process to how to interpret such potential risks and building a support team for making such determinations. Establishing these parameters will help to provide a quick response and start the evaluation process. With a procedure in place, practitioners are able to react quickly and efficiently with their team. Practitioners can then set forth their actionable plan and communicate to various people. There should also be a focus to help the person and create a plan for success to disseminate the violent ideology. This can be achieved with various methods and is personalized to their particular interests, beliefs and culture.

At this one-day training aimed to teach best practices for interpreting potential violent risks. Dr. Rozel used examples from past cases to illustrate how certain identifiers could have helped practitioners recognize potential risks before they escalated into violence. His approach laid out the myths of mental illness and the stigmata associated from these ideas. He discussed how most violence is not attributed to mental illness and furthermore that most people with a mental illness are not violent. Dr. Rozel emphasized that assessing a potential situation of a person who may commit a violent act is should not use profiling. Profiling can be harmful and unreliable within this assessment.

Dr. Rozel discussed ways to conceptualize risk and why it is so difficult to make decisions. When a potential violent risk is being evaluated, practitioners are working with limited time, information that may be unreliable or incomplete, lack of resources, uncooperative or manipulative behavior in a chaotic environment. It is important to work towards preventing a violent act and not necessarily the prediction. Efforts must be made to voice concerns and collaborate with a team when trying to prevent violence.

The "Path to Intended Violence" (adapted from Calhoun & Weston 2003/2016) was introduced to visualize the dynamic risk and protective factors. This pathways shows the steps that an assailant may escalate to an attack. A simple grievance can escalate into an attack through a series of steps, but it can also be mitigated at any point in the process. After a grievance, thoughts of ideation can occur when an assailant begins to consider harmful actions and justification which leads to research. Research can involve information gathering, stalking, and developing a plan. The assailant may then start preparing for their plan by acquiring weapons and supplies, practicing which leads to a breach then an attack.

To manage these risks, it is important to consider and investigate all the risk factors. When evaluating these factors, it is important to understand that not every risk factor will be useful in this situation. After determining the severity and proximity of a risk, practitioners should develop a safety plan towards hope and recovery. This plan should incorporate strengths, skills, and a support system for positive reinforcement. Part of creating this plan involves evaluating the assailant's environment and assess to weapons. It is important to understand the accessibility and also empower their supporters to appropriately safeguard these items including firearms. It is important to have an open discussion without judgement of firearm ownership to expand safety education. Practitioners can help suggest safety measures with firearms and options to secure it, sell it or store at another location.

Dr. Rozel concluded the day and stressed the importance of protecting your own peace and seeking help with overwhelming circumstances or feelings. Practitioners deal with an enormous amount of stress that is often internalized and it is important to find healthy outlets. Being emotionally healthy will make better responders and assessors.

Completion of this course will enable practitioners to:

• Explain the sources and impact of the myth of the “dangerously mentally ill”
• Apply the risk factors of history and hostility in the clinical assessment of violence risk
• Develop a safety plan targeting dynamic risk factors for violence
• Explore reasons consumers may have for owning firearms and effectively discuss safer storage strategies with them
• Explain the impact of stress on clinical performance and identify basic strategies for improved self-care

Find when the next training is available here by searching "Champions".