Assessing risk for violence among psychiatric patients: the HCR-20 violence risk assessment scheme and the Psychopathy Checklist: Screening Version

This study evaluated the predictive validity of the HCR-20 (Historical, Clinical, and Risk Management) violence risk assessment scheme and the Psychopathy Checklist: Screening Version (PCL:SV). Files of 193 civilly committed patients were coded. Patients were followed up in the community for an average of 626 days. Receiver operating characteristic analyses with the HCR-20 yielded strong associations with violence (areas under curve [AUCs] = .76-.80). Persons scoring above the HCR-20 median were 6 to 13 times more likely to be violent than those scoring below the median. PCL:SV AUCs were more variable (.68-.79). Regression analyses revealed that the HCR-20 added incremental validity to the PCL:SV and that only HCR-20 subscales predicted violence. Implications for risk assessment research, and the clinical assessment and management of violence, are discussed.     

Assessing and managing violence risk in outpatient settings

Psychologists and other mental health professionals practicing in essentially all clinical settings are called on to assess and manage clients who may pose a risk of violence to third parties. Over the past 25 years much has been learned about the relationship between violence and mental disorder, and about assessing violence risk. In this article risk factors for violence among persons with mental disorder are reviewed, clinical assessment strategies are discussed, and a model for thinking about treatment and other types of interventions designed to minimize violence risk is offered.     

Exposure to community violence among Arab youth in Israel: rates and characteristics

The research explored the rates and characteristics of exposure to community violence (CV) and its relevance to several sociodemographic factors among a sample of 833 Arab youth aged 14–18 years residing in diverse residential areas in Israel. Data were collected using a self‐report questionnaire. The frequency of exposure to CV during the past 12 months correlated significantly with the children's gender. The frequency of witnessing CV during that period was higher than the frequency of personally experiencing CV, and exposure to mild CV incidents during that period was higher than the frequency of exposure to severe CV incidents during the same period, with no significant relationship to sociodemographic factors. Participants reported higher rates of exposure to most CV incidents outside of the neighborhood; however, exposure to beating was higher inside the participants' neighborhood. Moreover, the highest overall rate of exposure to CV was at school. © 2011 Wiley Periodicals, Inc.     

Community violence exposure and delinquent behaviors among youth: The moderating role of coping

This study examines the moderating roles of guardian and peer support and behavioral coping strategies on the relations between youths' community violence exposure and their delinquent behavior. A sample of 667 public school sixth‐graders in a large inner‐city school district, and their parents or guardians, were interviewed to assess youths' recent exposure to community violence, their delinquent behavior, and proposed moderating variables. Support from guardians buffered the relation between girls' victimization by community violence and delinquency. Support from peers buffered the effects of witnessing community violence on delinquent behavior of boys, but it amplified the effects of victimization for both girls and boys. Avoidant coping behavior buffered the effect of victimization on delinquency for boys but unexpectedly amplified the effect of witnessing violence on delinquency for girls. For both genders, confrontational coping strategies amplified the impact of victimization on delinquency and, for boys only, amplified the impact of witnessing violence as well. Controls were imposed for variables expected to influence the relation between exposure and delinquency, such as ethnicity, family violence, delinquent behavior of friends, and recruitment cohort. Suggestions for future research and implications for intervention are discussed. © 2003 Wiley Periodicals, Inc. J Comm Psychol 31: 489–512, 2003.     

A culturally sensitive approach to the prevention of interpersonal violence among urban black youth.

Black-on-black interpersonal violence is a major problem for black youth living in poor urban areas. Diverse lines of research converge to suggest that interpersonal violence among inner-city black youth may result from a combination of environmental stressors, racial identity problems, and health and mental health problems. A culturally sensitive approach to the prevention of interpersonal violence among black youth is described. It is concluded that insensitivity to the significant role of racial or cultural factors in black-on-black violence contributes to the relative inattention to the problem.     

Exposure to violence and aggression: protective roles of social support among urban African American youth

This cross-sectional study examined the impact of social support on the relation between exposure to violence and aggressive behavior, as reported by self, peers, and teachers. The main-effects and stress-buffering models of social support were tested for parents, teachers, classmates, and close friends among 127 urban, African American youth. The results demonstrate the negative impact of violence exposure on aggressive behavior and the complex roles of social support in these relations. Specifically, more perceived support from parents, teachers, and close friends was associated with lower teacher-reported aggressive behavior, whereas classmate support buffered the impact of violence on peer-reported aggressive behavior. These findings, multiple reporter differences, and implications for preventive interventions are discussed. © 2008 Wiley Periodicals, Inc.     

青年原发性肝癌患者的自我感受负担和相关因素分析

目的：探讨青年原发性肝癌患者自我感受负担(self-perceived burden,SPB)状况及相关危险因素。方法：选取2012年1月至2015年12月我院收治的138例青年原发性肝癌患者,采用自制的基本资料量表、SPB评定量表和社会支持评定量表进行问卷调查,并分析影响SPB的因素。结果：共收回126份有效问卷,有效率为95.65%。SPB得分为(29.7±3.4)分,处于中度SPB水平,其中无明显SPB20例(15.87%),轻度25例(19.84%),中度52例(41.27%),重度29例(23.02%)。单因素分析显示SPB得分与家庭收入、病情了解情况、照顾者与病人关系、照顾者年龄、照顾者健康状况、病程、巴塞罗那分期(Barcelona clinic liver cancer,BCLC)、治疗方式和合并症有关(P<0.05)。Pearson相关分析显示青年肝癌的SPB得分与社会支持得分、主观支持、客观支持及支持利用度均呈正相关(均P<0.05)。多重线性回归分析结果显示家庭收入、病情了解情况、照顾者年龄、照顾者健康状况、BCLC分期和支持利用度是青年原发性肝癌SPB的主要影响因素(P<0.05)。结论：青年原发性肝癌患者SPB较为普遍,以中重度为主,护理人员应根据患者的具体情况采取积极的干预措施。     

Political violence,social integration,and youth functioning: Palestinian youth from the Intifada

Informed by social ecological, social capital, and social disorganization theories, this study tested an ecological model of youth experience in the Palestinian Intifada. The sample included 6,000 Palestinian 14 year olds, assessed in 1994 and 1995 after the end of the conflict. Data from retrospective self‐reports of youth exposure to and involvement in political violence, and self‐reports of current individual functioning (depression and antisocial behavior) and integration in several social contexts (family, peer relations, religion, education, and community), revealed: direct associations between Intifada experience and antisocial behavior and depression (females only); Intifada experience was positively associated with religiosity and unrelated to social integration in family, school, and peer relations; in some cases, social integration in family, education, religion, and peer relations significantly moderated the associations between Intifada experience and youth problems; integration in the several social contexts was directly related in predictable ways to youth problem behaviors, with neighborhood disorganization the most consistent and powerful predictor. The discussion centers around youth resilience to the effects of political violence, the role of psychological meaning children and adolescents can attach to political violence, and the overall salience of social integration in youth development. © 2001 John Wiley & Sons, Inc.     

Examining the risk and protective factors of gang involvement among Hispanic youth in Maryland

Research on the risk and protect factors of gang membership as they apply to Hispanic youth is limited and inconclusive. This study seeks to advance the literature on the risk and protective factors of gang involvement among a sample of Hispanic youth living in a Maryland county. This study used self‐report data from 936 Hispanic youth about their interaction with gang members, their family, their education, immigration and acculturation status, and self‐concept. Logistic regression was used to determine whether certain factors increased the likelihood of gang membership. Youth with greater levels of sadness and loneliness, those who have been approached by a gang to be recruited, and those who have siblings in gangs are significantly more likely to become gang members. In addition, the more risk factors a youth has, the higher their risk of gang membership. None of the protective factors analyzed had a significant influence on gang membership.     

Adapting to aging out: profiles of risk and resilience among emancipated foster youth

This investigation employed latent profile analysis to identify distinct patterns of multiform competence among 164 emancipated foster youth (Mage = 19.67 years, SD = 1.12; 64% female). Fit indices and conceptual interpretation converged on a four-profile solution. A subset of emancipated youth evidenced a maladaptive profile (16.5%; n = 27), which was characterized by low educational competence, low occupational competence, low civic engagement, problematic interpersonal relationships, low self-esteem, and high depressive symptoms. However, the largest group of emancipated youth exhibited a resilient profile in which they were faring reasonably well in all domains despite marked adversity (47%; n = 77). Two additional groups evidenced discordant adjustment patterns wherein they exhibited high levels of psychological competence despite behavioral difficulties (i.e., internally resilient; 30%; n = 49) or significant emotional difficulties despite manifest competence (i.e., externally resilient; 6.5%; n = 11). The obtained profiles were validated against independent measures of behavioral and socioemotional adjustment. Exploratory analyses examined etiological differences across profiles with respect to child welfare variables, such as age at entry into care, placement disruption, reason for placement, and severity of child maltreatment. The findings highlight the need for multidimensional models of risk and resilience and illustrate the importance of heretofore underappreciated heterogeneity in the adaptive outcomes of emancipated foster youth.     

Substance abuse among Native-American youth

Substance use and abuse poses serious risks for American-Indian youth, their families, and their communities. This article briefly reviews the relevant social epidemiological data followed by a discussion of culturally relevant etiological factors. Current strategies for identification of youth at high risk for substance use are highlighted, concentrating primarily on the theoretical and methodological aspects appropriate for this population. In this context, data from recent work are reported. Given the nascent state of culturally appropriate prevention technology, issues of sensitive technology transfer and stereotyping are discussed in the context of current research. Study results from this sample, although dramatic, should not be overgeneralized to all American-Indian youth.     

Assessing suicide risk among callers to crisis hotlines: A confirmatory factor analysis

Our goal was to investigate the factor structure of a risk assessment tool utilized by suicide hotlines and to determine the predictive validity of the obtained factors in predicting subsequent suicidal behavior. We conducted an Exploratory Factor Analysis (EFA), an EFA in a Confirmatory Factor Analysis (EFA/CFA) framework, and a CFA on independent subsamples derived from a total sample of 1,085. Similar to previous studies, we found consistent evidence for a two‐factor solution, with one factor representing a more pernicious form of suicide risk (i.e., Resolved Plans and Preparations; RPP) and one factor representing milder suicidal ideation (i.e., Suicidal Desire and Ideation; SDI). The RPP factor trended toward being more predictive of suicidal ideation at follow‐up than the SDI factor. © 2010 Wiley Periodicals, Inc. J Clin Psychol 66:1–24, 2010.     

Improving risk assessment of violence among military Veterans: An evidence-based approach for clinical decision-making

Increased media attention to post-deployment violence highlights the need to develop effective models to guide risk assessment among military Veterans. Ideally, a method would help identify which Veterans are most at risk for violence so that it can be determined what could be done to prevent violent behavior. This article suggests how empirical approaches to risk assessment used successfully in civilian populations can be applied to Veterans. A review was conducted of the scientific literature on Veteran populations regarding factors related to interpersonal violence generally and to domestic violence specifically. A checklist was then generated of empirically-supported risk factors for clinicians to consider in practice. To conceptualize how these known risk factors relate to a Veteran's violence potential, risk assessment scholarship was utilized to develop an evidence-based method to guide mental health professionals. The goals of this approach are to integrate science into practice, overcome logistical barriers, and permit more effective assessment, monitoring, and management of violence risk for clinicians working with Veterans, both in Department of Veteran Affairs settings and in the broader community. Research is needed to test the predictive validity of risk assessment models. Ultimately, the use of a systematic, empirical framework could lead to improved clinical decision-making in the area of risk assessment and potentially help prevent violence among Veterans.     

Dating violence prevention with at-risk youth: a controlled outcome evaluation

This study evaluated a community-based intervention to help at-risk teens develop healthy, nonabusive relationships with dating partners. Participants were 158 14-16-year-olds with histories of child maltreatment who were randomly assigned to a preventive intervention group or a no-treatment control group. They completed measures of abuse and victimization with dating partners, emotional distress, and healthy relationship skills at bimonthly intervals when dating someone. Intervention consisted of education about healthy and abusive relationships, conflict resolution and communication skills, and social action activities. Growth curve analyses showed that intervention was effective in reducing incidents of physical and emotional abuse and symptoms of emotional distress over-time. Findings support involvement of youths in reducing the cycle of violence as they initiate dating in midadolescence.     

Using community perspectives on youth firearm violence for prevention program planning

The Firearms Connection—The North Philadelphia Firearms Reduction Initiative is a youth firearm violence prevention program using a partnership model that links healthcare, criminal justice, business, and social service providers with neighborhood residents and community organizations to identify priorities and develop solutions. The assessment phase helped build the partnerships and engage the community in the planning, implementation, and evaluation of specific interventions. The needs assessment was used to 1) specify the problem of firearm violence in the target community; 2) frame possible solutions in the language of the community; 3) identify community assets and resources for planning, implementation and evaluation; 4) engage key members of the community for participation in the assessment and intervention planning process; and 5) identify appropriate markers for evaluation of progress and outcome. This paper presents the qualitative method of Rapid Participatory Appraisal used for the assessment, the results as related to the specific problem of youth violence, and how the assessment process was used to advance the coalition building process. � 2000 John Wiley & Sons, Inc.     

Relative impact of violence exposure and immigrant stressors on Latino youth psychopathology

Latino youth in a low‐income urban community are at high risk of exposure to violence. Given an accumulation of factors before, during, and after migration, immigrant youth might be at increased risk of exposure to violence and other relevant stressors (e.g., acculturation stress, language proficiency, acculturation/enculturation, and parental separations). Utilizing a short‐term longitudinal design, we assessed exposure to violence and immigrant stressors and examined their relative impact on psychopathology in a sample of 164 Latino youth. Immigrant youth reported greater exposure to immigrant stressors relative to native‐born peers, but few differences in rates of exposure to violence emerged. When considered alongside relevant immigration stressors, exposure to violence emerged as the strongest predictor of youth psychopathology. Results suggest that some types of stressors have more consistently deleterious effects on mental health and understanding resilient outcomes might entail considering the meaning attributed to stressors and the resources available to cope with stressors. © 2011 Wiley Periodicals, Inc.