OBSERVATIONS SUGGESTING NEED FOR INTERVENTION This is an optional form used as needed for intervention planning. Here are some factors to consider in identifying possible interventions to assist the subject and reduce risk. These items are not summed or scored. Use the as appropriate to the category to mean the condition is term “partially” moderate or not clearly present. Yes Partially No Don’t History of physical violence. know/Not available Yes Partially No Don’t History of criminal acts. know/Not available Preoccupation with violence, violent Yes Partially No Don’t individuals, or groups that advocate know/Not available violence. Preoccupation with mass shootings or Yes Partially No Don’t infamous violent incidents. know/Not available Yes Partially No Don’t History of intense anger or resentment. know/Not available Yes Partially No Don’t Has grievance or feels treated unfairly. know/Not available Yes Partially No Don’t Feels abused, harassed, or bullied. know/Not available History of self-injury or suicide ideation or Yes Partially No Don’t know/Not available attempts. Yes Partially No Don’t Has been seriously depressed. know/Not available Experienced serious stressful events or Yes Partially No Don’t conditions. know/Not available Yes Partially No Don’t Substance abuse history. know/Not available History of serious mental illness Yes Partially No Don’t (symptoms such as delusions or know/Not available hallucinations). Might or does qualify for special education Yes Partially No Don’t services due to serious know/Not available emotional/behavioral disturbance. Yes Partially No Don’t Prescribed psychotropic medication. know/Not available Substantial decline in level of academic or Yes Partially No Don’t psychosocial adjustment. know/Not available Lacks positive relationships with one or Yes Partially No Don’t more school staff. know/Not available Yes Partially No Don’t Lacks supportive family. know/Not available Yes Partially No Don’t Lacks positive relationships with peers. know/Not available Other factors that suggest need for Yes Partially No Don’t intervention. know/Not available
OBSERVATIONS SUGGESTING NEED FOR INTERVENTION This is an optional form used as needed for intervention planning. Here are some factors to consider in identifying possible interventions to assist the subject and reduce risk. These items are not summed or scored. Use the term “partially” as appropriate to the category to mean the condition is moderate or not clearly present. History of physical violence. Yes Partially No Don’t know/Not available History of criminal acts. Yes Partially No Don’t know/Not available Preoccupation with violence, violent individuals, or groups that advocate violence. Yes Partially No Don’t know/Not available Preoccupation with mass shootings or infamous violent incidents. Yes Partially No Don’t know/Not available History of intense anger or resentment. Yes Partially No Don’t know/Not available Has grievance or feels treated unfairly. Yes Partially No Don’t know/Not available Feels abused, harassed, or bullied. Yes Partially No Don’t know/Not available History of self-injury or suicide ideation or attempts. Yes Partially No Don’t know/Not available Has been seriously depressed. Yes Partially No Don’t know/Not available Experienced serious stressful events or conditions. Yes Partially No Don’t know/Not available Substance abuse history. Yes Partially No Don’t know/Not available History of serious mental illness (symptoms such as delusions or hallucinations). Yes Partially No Don’t know/Not available Might or does qualify for special education services due to serious emotional/behavioral disturbance. Yes Partially No Don’t know/Not available Prescribed psychotropic medication. Yes Partially No Don’t know/Not available Substantial decline in level of academic or psychosocial adjustment. Yes Partially No Don’t know/Not available Lacks positive relationships with one or more school staff. Yes Partially No Don’t know/Not available Lacks supportive family. Yes Partially No Don’t know/Not available Lacks positive relationships with peers. Yes Partially No Don’t know/Not available Other factors that suggest need for intervention. Yes Partially No Don’t know/Not available
Forms%20for%20Comprehensive%20School%20Threat%20Assessment%20Guidelines%2011-4-18.docx