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Building Capacity of Mental Health Practitioners to Assess and Manage Risk for Targeted Violence and Terrorism in Community Settings

Although existing risk assessment tools anchored in a structured professional judgment framework have greatly advanced the field, they hold limited applicability for use by community-based mental health professionals (MHPs) working in local healthcare settings. The primary goal of this project is to build capacity of MHPs to assess and manage risk for TVT in collaboration with local multi-disciplinary threat assessment teams through:

  1. the development and preliminary validation of a clinically useful risk assessment/management tool
  2. tool training and consultation for community-based MHPs across the country, in collaboration with the DHS-funded Prevention Practitioners Network (PPN)

This initiative will build upon and advance previous risk assessment efforts by:

  • developing a semi-structured, patient-centered approach to assessing strengths/needs
  • offering concrete guidance on modifications to the assessment based on age, gender, and cultural background
  • directly linking assessment results to treatment planning and intervention
  • building in a systematic re-evaluation process for managing and responding to risk that is informed by an evidence-based treatment framework that has shown high utility with other high-risk populations

Tool development

The TVT Strengths, Needs, and Risks: Assessment & Management Tool (T-SAM) will employ a semi-structured interview format that facilitates structured professional judgment, patient collaboration in treatment planning, and allows for re-evaluation. Revisions will be made to the T-SAM based on a usability/feasibility assessment. In partnership with the PPN, mental health practitioners from across the country will receive training and subsequent consultation in the use of the T-SAM.

Although mental health care has been increasingly recognized as a critical element of a multidisciplinary response to preventing TVT, community-based mental health practitioners do not feel equipped to work with individuals at risk for TVT because of a lack of specialized training and expertise. In addition, many of the existing TVT or violence risk assessment tools were not developed for utilization by a generalist mental health workforce working with a diverse patient population.

Tool training

On Feb. 28, 2023, the Multidisciplinary Violence Prevention Team at Boston Children’s Hospital/Harvard Medical School, in collaboration with the McCain Institute’s Prevention Practitioners Network, hosted a T-SAM training program for interested licensed mental health providers. The training program taught providers how to apply the T-SAM to their current work with adolescent and adult clients who may be at risk of harming others. We are currently in the middle of providing these MHPs with 6 months of virtual Community of Practice Calls, which include case consultation and support with T-SAM administration.

For more information or questions, contact Emma Cardeli, PhD, at