A Novel Approach to Assess Violent and Homicidal Ideation: The I-HAVAT©

(E-pub Ahead of Print)

Author(s): Salma Malik, Sophia Walker, Kevin You oftus*.

Journal Name: Adolescent Psychiatry

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Background: Child and adolescent psychiatrists and clinicians often assess individuals who present with homicidal and violent thoughts. These assessments are critical, for patient safety and societal protection. The psychiatrist must ultimately decide if the patient can return to the community safely, regardless if they have initially presented to inpatient, outpatient, emergency room or school settings. While there is some consensus regarding best practices in the assessment of risk for serious self-harm, approaches to the assessment of homicide and violence are far more disparate. Clinicians often offer to determine risk based on known risk factors and type of violence threatened, and many offer a “risk level”. However, absent of an easy to use assessment tool of risk, the judgment relies on clinician experience, talent and training, at the expense of a uniform, organized and comprehensive approach.

Methods: We describe an assessment tool that uses a semi-structured interview to comprehensively evaluate an individual’s risk for violence. The tool guides the clinician to gather a detailed description of the current episode, includes a review of salient risk and protective factors and ends with a structured mental status exam developed to help characterize typical pathways to violence.

Discussion: Assessing children and adolescents who present with homicidal threats in various clinical settings and determining not only the appropriate level of care but also the steps in treatment planning will be discussed. The implementation of the assessment tool in an inpatient setting and the clinicians’ reaction to using it will also be discussed.

Conclusion: The I-HAVAT© (Institute of Living-Homicide and Violence Assessment Tool) is a semi-structured method of assessing patients presenting with violent or homicidal threats which collects (streamlines) most pertinent clinical information relevant to assessing risk and increases clinicians’ confidence level of making decisions and recommendations in regards to level of care and treatment planning.

Keywords: homicidal thoughts, children and adolescents, assessment tool

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Article Details

(E-pub Ahead of Print)
DOI: 10.2174/2210676608666181016161516
Price: $95