Transcript Dangerous Student Issues

THERAPEUTIC ISSUES
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Clear definition lacking
Assessment of dangerousness
Therapeutic responsibility indefinite
Therapist responsible for random
violence
DEFINING SERVICES
• Services for defined problems
• Staffing to meet defined services
INTAKE ASSESSMENT
• Complete intake necessary
• Assessment for dangerousness
ASSESSMENT FOR DANGEROUSNESS
• GENERAL RISK FACTORS*
– Past history of violence
– Alcohol/drug use
– Organic mental disorders
– Psychosis
– Antisocial personality
– Borderline personality
*Gerard Clancy, M.D. – University of Iowa
ASSESSING FOR DANGEROUSNESS
• PREDICTORS OF IMPENDING
VIOLENT BEHAVIOR*
– Brooding over unfair treatment
– Recent threats to act out
– Making plans to act out
– Threatening and/or loud speech
– Hypervigilance
– Staring
– Signs of agitation
*Gerard Clancy, M.D. – University of Iowa
ASSESSING FOR DANGEROUSNESS
• PREDICTIVE TRIAD
– Persistent bedwetting
– Cruelty to animals
– Fire setting
GOOD RECORD KEEPING
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Identifying data
Informed consent
Treatment plan
Background and historical data
Progress notes
Evaluation(s)
Medication, diagnosis, consults
Termination summary
DOCUMENTING TREATMENT
• Explanation of decisions
• Consultations
• Consistent format
PSYCHOTHERAPIST JUDGMENT RULE
• Assumes accurate predictability
• Responsibility for controlling
dangerous client
• Therapist protector of society from
mentally ill