Boston Children’s Hospital (BCH) is using Center for Prevention Programs and Partnerships (CP3) Targeted Violence and Terrorism Prevention (TVTP) grant funding to develop a research-grounded tool to guide clinicians, multidisciplinary psychosocial intervention team members, and service providers to assess and manage youth at-risk for committing an act of targeted violence or terrorism (TVT).
Grant Background
BCH received its first CP3 TVTP grant in fiscal year (FY) 2020 to establish a multidisciplinary psychosocial intervention team to work with youth identified as at risk for committing TVT acts. The BCH team had been receiving referrals, performing strengths-risks-needs assessments, and developing intervention plans prior to this point, and used their FY20 TVTP grant to successfully deliver services and create plans for clients. These plans included health and mental health services, social activities, employment opportunities, mentorship, or other personal or family support, as required. As BCH reviewed these referrals and plans, team members identified that people with TVT expertise informed the assessments and recommendations. However, this knowledge was not systematically integrated into team protocols. Additionally, there were few, if any, mental health clinicians with sufficient training to provide the identified treatment.
BCH received another grant in FY 2021 to develop the TVT: Strengths, Needs, and Risks Assessment & Management Tool (T-SAM) to guide team members and community-based mental health service providers in their efforts.
Boston Children's Hospital is piloting and enhancing a research grounded tool to provide clinicians with clear guidance on assessing TVTP risk among referred youth. The tool is also being integrated into existing practice to offer follow-up steps.
Grant Activity
To inform development of the T-SAM, BCH leveraged an existing suicide prevention tool. The tool was selected because it emphasizes a strong therapeutic alliance that increases client motivation and systematizes treatment of client-defined “drivers” of violence. BCH met regularly with the developers of the tool, as well as experts in both TVT and suicidology, to identify ways the framework could inform the development of a tool specifically for TVT. This work led to the development of the T-SAM.
After developing and piloting the T-SAM internally, BCH partnered with the Prevention Practitioners Network established by the Arizona State University McCain Institute (also a TVTP grantee) to recruit a cohort of 30 licensed, practicing mental health providers who represent varied disciplines and are located across the nation. The cohort was trained to apply the T-SAM and will also be part of the ongoing BCH Learning Community, through which they will receive continued support in using the T-SAM. Separately, BCH continues to use the T-SAM with its multidisciplinary psychosocial intervention team and with ExitUSA at Life After Hate (a third TVTP grantee) with adults disengaging from violent far-right hate groups. To date, across the BCH Learning Community, BCH’s multidisciplinary psychosocial intervention team, and Life After Hate’s Exit USA program, the T-SAM has been successfully implemented with clients a total of 12 times.
Preliminary findings suggest the T-SAM has been helpful in illuminating “drivers” of TVT, clarifying clinicians’ duties, guiding clinicians’ understanding of what to ask when, and building violence-focused treatment plans. Development of the T-SAM has generated a great deal of excitement, meaningful discussions about the role of mental health providers in TVT, and the importance of partnering with multidisciplinary teams to manage TVT risk.
If you are a licensed mental health provider and would like to receive training on how to utilize the T-SAM in your own work, please consult the Boston Children Hospital’s Trauma and Resiliency Webpage dedicated to the T-SAM.