The United States has 57% more school threats than all other industrialized nations combined. Most experts agree that this is at least partially related to the relatively easier access to guns in the United States compared to other developed countries, but this e-weekly is not about the gun debate. It is a review of the current situation and evidence-based ways to reduce gun violence in schools.
There was a marked increase in school threats after the Parkland Florida school shooting in February 2018. Fear of a school shooting is the number one fear of adolescents in the United States currently, more so than accidents or losing a loved one or a national terrorist attack or other fears. In a way, it is this generations 9/11. While the effectiveness is still being debated, students have adjusted to a new norm of regular intruder drills.
What we know is that gun violence is preventable. There are evidence-based violence prevention programs that are being developed and implemented. They are largely based on the premise of knowing the signs and intervening early. The goal is to not over-react to the numerous threats that are not serious and to not under-react to the serious threats. It is important for threat assessment teams to be able to accurately distinguish between transient threats and substantive threats. One evidence-based option is the Virginia Student Threat Assessment Guidelines developed by Dr Cornwell, which are being used nationwide. When the FBI and Secret Service reviewed past school shootings, there is a common thread that the students were often victims of bullying and became angry and depressed and isolated as a result. Because this can happen to a lot of students, it is not possible to create a reliable profile based on these findings. It is actually discouraged to make decisions about school threats based on profiles but rather encouraged to proceed by gathering information from different sources, including the internet and social media, and using the data to make decisions. Another thing that stood out in the FBI investigations of past school shootings is that most students who engaged in school shootings communicated their plans to someone beforehand. The typical course is Grievance (feeling slighted in a social situation) to Ideation (starting to develop thoughts about retaliation) to Preparation (getting supplies together) to Breach (telling someone about the plan). While any of these stages are concerning, it is most concerning when it gets to the Preparation stage, because that is a clear sign that the person is planning to take action. As part of the assessment, it is important to look at the person’s potential and means for violence. Any concerning threat is reported to the Law Enforcement Coordination Center (LECC) which maintains information about concerning situations and individuals in case a future threat comes up.
The FBI and Secret Service both recommend that school districts have a way to assess school threats to help prevent school shootings. The San Diego County Office of Education has a threat assessment protocol that is used when there is a serious school threat that is made. It involves school administration, mental health professionals, internet professionals and law enforcement in a team approach to best assess a threat. The risk assessment can include: a review of the student’s CUM file, a review of the student’s school disciplinary records, looking at the student’s writing submissions in academic classes to see if there is a theme of violence or retaliation, an assessment of relevant mental health or family dynamic issues, an assessment of the student’s access to weapons, a review of police records, and review of the student’s social media presence. The members on this team individually and jointly conduct a risk assessment and come together when there is a serious substantive threat to develop a plan of action. The plan of action might include an IEP assessment with a mental health assessment, which is called an ERHMS assessment (educationally related mental health services).
When there is an imminent risk of a serious substantive threat, law enforcement becomes involved. PERT stands for Psychiatric Emergency Response Team and is a program with the goal to create a bridge between law enforcement and mental health. PERT clinicians can go out with law enforcement to help assess an emergency situation to help decide if psychiatric emergency care is needed.
The Sandy Hook Promise group has developed 3 programs that are largely student-led and school-based. “Start with Hello” is a program aimed to reduce social isolation, thereby reducing bullying. The goal is to go from isolation to inclusion especially for at risk students. “SOS”, Signs of Suicide, is a program to help teachers and other staff be aware of the signs of suicide risk and knowing how to seek help. “Say Something” is an anonymous reporting system that uses an app to an outside triage center for students to be able to make reports about concerning behavior in other students without worrying about the risk of retaliation. Students Against Violence Everywhere or SAVE is a student run school club that is national. Many of these programs are being utilized in high schools and some middle schools throughout the country. All three are in use in many of San Diego’s 42 local school districts. In addition, SchoolLink is partnership between the County of San Diego and local school districts to help school districts better provide behavioral health services in their schools. There are modules on different subjects related to improving awareness, accessing care and safety assessments.
These programs and others like them have been shown to reduce gun threats, reduce social isolation, reduce bullying and cyberbullying, reduce suicidal behavior and improve access to mental health resources. For primary care providers, the take home message is that programs to reduce the risk of school threats exist. It is important for us to be aware of the programs available and the research supporting the creation of more programs to help teens and families who might need to access these resources.