[startgroup] Re: Use of T.H.R.E.A.T.
- From: "Denis Zavodny" <dlzavodny@xxxxxxxxxxxxxxx>
- To: <startgroup@xxxxxxxxxxxxx>
- Date: Mon, 05 Apr 2010 18:45:27 -0400
interesting discussion. I think these victims are targeted, perhaps because
they are close enough to assault/viewed as invading an expanded personal space
perimeter. I see this as a case akin to Meehl's broken leg where you might
want to defer scoring of the START or go outside of ("override") the totality
of the items in the START when determining risk. fwiw, the manual does note
that the threat may be specific "to a person or groups of persons."
furthermore, soon after Tarasoff, there were several cases identifying the
responsibility to warn or protect certain identifiable classes of potential
victims (Lipari v. Sears, Roebuck, and Co; Jablonski v. US).
we've had consumers threaten to assault various classes of victims (the next
woman who walks onto the unit, the next administrator they see, women with a
certain body type, individuals of a certain ethnic culture, etc.). in one
case, the consumer will reliably attack anyone with a beverage (he has
polydipsia and outside drinks are banned from the unit). it may be helpful to
consider the interface of specific signs as someone may be fine but when they
start to decompensate they engage in the signature/anamestic risk behavior
(e.g., pacing the hall) and targeting a certain class of individuals (e.g.,
delusional preoccupation with a race or profession). the decompensation may be
a setting event/establishing operation for aggressive behavior. At times like
that it might be useful to supplement the START with the DASA:IV or some other
instrument tapping imminent risk as well as anamestic risk factors. An issue
is the dicey methodology of how the class of victims is informed (risking
pre-emptive attack by peers or panic by staff). Our units at our maximum
hospital have two separate doors to the unit (on either side of the nurses
station) and we've recently established one door as the entrance and the other
as the exit so that unit staff can more readily identify, warn, and protect
potential targeted individuals when then enter. I'd like to hear how other
people handle this issue.
I would also love to hear how people are using the START in a system with tools
assessing more acute and longer term risk. We've been using the HCR-20 for
long-term consumers for a number of years, began using the START in our
hospitals last Fall, and are contemplating adding the DASA:IV and, thanks to a
consultant's recommendation and the need for something quick for use with
short-term civil consumers, at discharge, the COVR.
Denis
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