Community VTRA™ Protocols: An Essential Part of the COVID-19 Response

High-profile trauma intensifies already existing symptoms in individuals and systems (families, workplaces, communities, etc.). Many individuals whose pre-COVID functioning was already distressed or who already exhibited violence potential or suicidal ideation will experience increased shifts in their baseline behaviour as the quarantine extends. Even in the best of family circumstances, too much time together with the ones we love will naturally result in an increase in anxiety triggering a distance phase where we need time apart until separateness rekindles the desire to be close again. In family therapy we refer to this as the “Closeness-Distance Cycle”.

Context:

High-profile trauma intensifies already existing symptoms in individuals and systems (families, workplaces, communities, etc.). Many individuals whose pre-COVID functioning was already distressed or who already exhibited violence potential or suicidal ideation will experience increased shifts in their baseline behaviour as the quarantine extends. Even in the best of family circumstances, too much time together with the ones we love will naturally result in an increase in anxiety triggering a distance phase where we need time apart until separateness rekindles the desire to be close again. In family therapy we refer to this as the “Closeness-Distance Cycle”.

Many of our higher risk families and their children were able to maintain some level of functionality because attending school for the children/youth and work for the parents/caregivers helped them to “bind” (manage) the anxiety that ongoing closeness would have generated. Quarantining, job loss or the threat of job loss during the pandemic, along with unabated closeness, has intensified family anxiety and therefore risks that may have laid dormant pre-COVID are now being activated. We are already seeing the increase in domestic/relational violence as well as child abuse in many regions. While most families will adjust to this temporary circumstance, others will not.

In our recently released “Rising to the Challenge: Staying Connected to All Our Students” guidelines (See: https://www.nactatr.com/risingchallenge.html) we highlight the reality many school related professionals and others are now remotely entering our students homes and in many cases their bedrooms where they are remotely communicating from. As you are aware, in the Violence Threat Risk Assessment (VTRA™) model we emphasize the “bedroom dynamic” as a location where there is often blatant evidence of planning that an individual is moving on a pathway to violence, suicide or both. Teachers, educational assistants, and others are seeing and hearing verbal exchanges that justify activation of our VTRA protocols.

Visual Examples Include:

• Seeing what appeared to be illegal weapons in the background
• Brandishing weapons during a call
• Verbally uttering threats to kill
• Sexualized behavior by the student or family member
• Overhearing potential domestic/relational violence incidents

(Listen to “Family Dynamics During the Pandemic”)

Remember:
First hypothesis in VTRA is: “is it a cry for help”? We are aware that sometimes children and even adult family members may escalate an already dangerous situation knowing a professional (another adult) may be overhearing and using the opportunity as a cry for help.

Our standard has been clear, that all professionals who are not VTRA trained, or part of a VTRA team, must “Consult, Consult, Consult” when confronted with any concerning behaviors that could potentially activate the protocol.

Things for Leaders to Do:
1) Educate all staff about the existence of your school and community protocols if you haven’t already. In essence, give them “Fair Notice” or remind them of the practice and that we are still conducting VTRA’s as necessary.
2) Provide all stakeholders with a reminder of the “Categories for Action” including:

• Serious violence or violence with intent to harm or kill
• Verbal/written threats to kill others (“clear, direct and plausible”)
• The use of technology (e.g.: computer, mobile phone) to communicate threats to harm/kill others or cause serious property damage (e.g. “burn this office down”)
• Possession of weapons (including replicas)
• Bomb threats (making and/or detonating explosive devices)
• Fire setting
• Sexual intimidation or assault
• Chronic, pervasive, targeted bullying and/or harassment
• Gang related intimidation and violence
• Hate incidents motivated by factors including, but not limited to; race, culture, religion, and/or sexual or gender diversity
• Suicide as a special consideration

3) Create an up-to-date list of all organizational VTRA leads and their contact numbers.
4) Ensure there is a VTRA Team Member trained in Digital Threat Assessment as the POC’s online behavior will often be one of the most relevant sources of case related information.
5) Continue to be open to the possibility of a “Conspiracy of Two or More”, likely manifest through “virtual pairing”.
6) Remind all agencies that the VTRA protocol applies to all forms of violence and therefore information sharing between police, mental health, child protection, probation, schools and others is essential whether the original focus is children and youth or an adult to adult circumstance. For instance, a mental health therapist who witnesses an intoxicated father of one of their clients get in to a shoving match with another man outside their office during the COVID-19 crisis should call the police VTRA lead. The father is clearly not social distancing and therefore may pose a risk to their family on two fronts: transmitting the virus and primed for violence in the community that may be further acted out at home.
7) Whether active VTRA cases are present, there should be a once a week meeting of VTRA leads to discuss trends or emerging dynamics that they should be addressing before an escalation occurs.

VTRA Modification During the Initial Phase of COVID-19
Having consulted on numerous VTRA cases during the pandemic, it is evident that we can still conduct Stage One VTRA’s. Because “baseline behavior” is the single most important variable in determining if someone is moving rapidly on a pathway to serious violence or suicide, we can still collect historical data from team members that can establish a shift. We can strategically decide what team member has the best connection with the “Person of Concern” (POC) or the parent/caregiver for a remote interview. If there is evidence of escalation then police and children services will still make contact as necessary. If it is eminent risk it will always be a 911 call.

Stage Two VTRA’s are not recommended at this time due to the intimacy required between team members and the POC and their families. If necessary, we will provide guidelines for conducting Stage Two VTRA’s during the pandemic should the quarantine phase extend further than anticipated.

Remember:
Stage One VTRA is “data-collection and immediate risk reducing interventions”. As well, because serious violence is evolutionary but it is also contextual, we can still create a context in most situations to mitigate initial risk.

The Stage One Report Form remains the primary guide for data collection and semi-structured interviewing and is for use by VTRA trained professionals only which includes:

Three Primary Hypotheses

• Cry for Help
• Conspiracy of Two or More
• Fluidity

Series of Questions

• Series One: Details of The Incident
• Series Two: Attack-Related Behaviors
• Series Three: Empty Vessel
• Series Four: Threat-Maker Typology
• Series Five: Target Typology
• Series Seven: Family Dynamics
• Series Eight: Contextual Factors

Special Note: Next week we will send out a link for VTRA trained professionals to access a “read only” version of our TACTIC Software with prompts and narratives for facilitating a streamlined approach to Stage One VTRA.

(Click here for information on TACTIC https://www.nactatr.com/tactic.html).

Bless your hearts!
J. Kevin Cameron, M.Sc., R.S.W., B.C.E.T.S., B.C.S.C.R.
Board Certified Expert in Traumatic Stress
Diplomate, American Academy of Experts in Traumatic Stress
Executive Director, North American Center for Threat Assessment and Trauma Response