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
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.