A Novel Approach to Assess Violent and Homicidal Ideation: The I-HAVAT©

Background: Child and adolescent psychiatrists and clinicians often assessindividuals who present with homicidal and violent thoughts. These assessments are critical,for patient safety and societal protection. The psychiatrist must ultimately decide if thepatient can return to the community safely, regardless if the patient has initially presented toinpatient, outpatient, emergency room or school settings. While there is some consensusregarding the best practice in assessing risk for serious self-harm, approaches to theassessment of homicide and violence are far more disparate. Clinicians often determine riskbased on known risk factors and type of violence threatened, and many offer a “risk level”.However, in the absence of an easy to use tool to assess risk, the judgment relies on clinicianexperience, talent and training, at the expense of a uniform, organized and comprehensiveapproach. Methods: We describe an assessment tool that uses a semi-structured interview tocomprehensively evaluate an individual’s risk for violence. The tool guides the clinician togather a detailed description of the current episode, then reviews the salient risk andprotective factors and ends with a structured mental status exam developed to helpcharacterize typical pathways to violence. Discussion: The steps in assessing children and adolescents presenting with homicidalthreats in various clinical settings, as well as the steps in determining the appropriate level ofcare and treatment plan, will be discussed. The implementation of the assessment tool in aninpatient setting and the clinicians’ reaction to using it will also be discussed. Conclusion: The I-HAVAT© (Institute of Living-Homicide and Violence Assessment Tool)is a semi-structured method of assessing patients presenting with violent or homicidal threatsby collecting and streamlining pertinent clinical information and ultimately increases theclinicians’ confidence level in making decisions and recommendations for determining thelevel of care and appropriate treatment plan.