Create a case study that addresses the following questions:

• What was the ethical situation, and what led to the problem?
• How did the organization respond?
• What were the consequences of these actions?
• What did you learn about professional ethics through this case study?

Down below is the case study that has been chosen

ABSTRACT. Mental health professionals are frequently called upon to assess employees whose behaviors are seen as posing threats of workplace violence. This article discusses the ethical and procedural issues involved in these evaluations. It addresses legal-ethical concerns associated with determining risk, the impact of assessment decisions on the employee's job, requirements of relevant employment law, and with communicating results to others. Since workplace risk assessment frequently involves the potential of targeted violence, the procedures are discussed within the U.S. Secret Service framework for analyzing targeted violence.[Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: Website: 2001 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. Workplace violence, risk assessment, ethical issues, employee evaluation George E. Hargrave, PhD, is affiliated with the Occupational Psychological Services and is in independent practice as a forensic psychologist in cases involving employment law. He is a consultant to employers and law firms throughout northern California. He is a Diplomate in Forensic Psychology, ABPP, and provides workshops on assessment of workplace violence for the American Academy of Forensic Psychology. Address correspondence to: George E. Hargrave, PhD, 2740 Fulton Avenue, Suite 128, Sacramento, CA 95821. The author wishes to express appreciation to Mary C. Hargrave, PhD, and Deirdre Hiatt, PhD, for their review and comments on this manuscript. Journal of Threat Assessment, Vol. 1(2) 2001 2001 by The Haworth Press, Inc. All rights reserved. 1 Workplace violence constitutes a growing problem in the United States. Although such incidents are still statistically rare, their possibility of occurrence is of major concern for employers. The federal Occupational Safety and Health Act (OSHA) and state counterparts require that employers take steps to provide a safe workplace. Further, under the doctrine of respondeat superior (let the master answer), an employer can be held financially responsible for damage resulting from an employee's behavior, if there is evidence that the employer was negligent in such areas as hiring and retention practices, training, or control of employees. Therefore, an employer that learns an employee has threatened violence toward other co-workers or managers is required to take action to ensure safety in the work environment. Mental health professionals have a long history of providing services to employers (e.g., employee assistance programs, fitness for duty and workers' compensation evaluations). It is, perhaps, only natural that they have been called upon to consult in cases involving threats of workplace violence. This new role, however, necessitates that such professionals acquire additional knowledge and skills to be effective in their consultations. Although the vast majority of workplace violence incidents involve perpetrators external to the worksite, most mental health professionals become involved in the relatively small number of cases where employees are the source of threat. These are also cases where the mental health consultant may evaluate the identified employee. This article synthesizes the current professional literature and addresses the primary ethical and procedural issues associated with evaluating employees when determining risk of violence. It will focus on legal-ethical considerations associated with determining risk, the impact of assessment decisions on the employee's job, requirements of relevant employment law, and with communicating results to others. It will then review the procedural issues associated with conducting a comprehensive and defensible evaluation. Finally, since workplace threats frequently involve identified targets for potential violence, the assessment process will be examined in the framework developed by the U. S. Secret Service for evaluating targeted violence (Borum, Fein, Vossekuil, & Berglund, 1999; Fein, Vossekuil, & Holden, 1995). ETHICAL-LEGAL ISSUES Inherent in any risk assessment of violence is an element of prediction. As most clinicians are painfully aware, the professional literature 2 JOURNAL OF THREAT ASSESSMENT is replete with caveats associated with this process. The early literature (Monohan, 1981) portrayed efforts at violence prediction as dismal. The "second generation" of studies (Lidz, Mulvey, & Gardner, 1993; Menzies & Webster, 1995; Monahan & Steadman, 1994; Mossman, 1994; Otto, 1992), although more charitable toward clinicians' abilities to predict violence, were far from glowing in their support of the process. Mossman (1994), for example, summarized clinicians' ability to distinguish violent from nonviolent patients as having a "modest, better-than-chance level of accuracy" (p. 790), noting that past behavior was frequently a better predictor than clinical judgments or cross-validated actuarial techniques. A major obstacle in any prediction of violence is the very low base-rate of such behavior. In risk assessment, the term base-rate refers to the "known prevalence of a specified type of violent behavior within a given population over a given time period" (Borum, 1996, p. 946). A low base-rate inherently leads to an unacceptably high false positive rate, or the incorrect prediction that a given trait (e.g., high potential for violence) exists. Although most of the previously-noted caveats were issued in response to research on clinicians' questionable ability to predict violence in patients, the prediction problem is even more pronounced in the assessment of workplace violence. In this latter context, base-rates are unusually low. Data reported by Bulatao and VandenBos (1996) for the period 1980 to 1992, reflected only 0.7 per 100,000 workers to be victims of homicide, and between 1,000 and 3,000 per 100,000 workers to be victims of non-fatal workplace violence. Since most violence was committed by individuals who had no legitimate business relationship with the worksite, the base-rate of actual employees committing violence of any type is exceeding low. Given this limitation, a profile of the typical violent employee is of limited value at best. A second, related problem involves the lack of data relating employees' characteristics to any actual expression of violence. Several authors (e.g., Bensimon, 1994; Johnson, Meyer, & Feldmann, 1995; Resnick & Kausch, 1995) have identified risk factors associated with workplace violence; however, there is little research on how such factors combine to produce violent behavior. The reasonable premise that a large number of risk factors increases the likelihood of future violence (Resnick & Kausch, 1995) must be balanced with the knowledge that this assumption does not have empirical support. Although an employer is required to take action when confronted with a potentially violent employee, the previous concerns raise the isGeorge E. Hargrave 3 sue of whether it is ethical to use an assessment process that lacks validity to take action against an employee. Certainly evaluators' conclusions about workplace violence do not have the profound impact of restricting another person's interest in "life and liberty" that Ewing (1991, p. 161) addressed in his sweeping indictment of predicting dangerousness in criminal settings. They do, however, have the potential of damaging the person's ability to engage in the important life activity of work. Adopting a model of risk assessment and management, as opposed to violence prediction, has clearly been a step toward resolving this ethical dilemma. The process of risk assessment must still consider the impact on the employee as well as the safety and security of others. Numerous articles have distinguished between the processes of violence prediction and risk assessment. Heilbrun (1997) noted the general distinction that prediction involves a single decision that must be informed by the most accurate available information, and after which there is no continued jurisdiction, while risk assessment/management involves judgments for which there is an ongoing legal jurisdiction and where decisions may be made or modified at different times. In assessing the threat of workplace violence, there is the dual focus on determining the degree of risk posed by the individual and on developing/ implementing policies and procedures to deal with threat and protect the workplace. This is a dynamic process that typically involves ongoing assessment and multiple interventions. The evaluator, instead of giving a prediction of violence, provides an assessment of risk by identifying risk factors and specifying interventions to address them. One of the most frequent referrals for risk assessment occurs when an employee threatens violence toward a supervisor or co-worker(s). Such situations clearly require that the evaluation determine the nature and degree of risk for potential targets. Under these circumstances, however, the employee is also frequently evaluated for risk of violence in the more general context of determining fitness for continued job duty. This raises the next issue, namely that these assessments must be conducted within the framework of employment law, the most basic component of which is the 1994 Americans with Disabilities Act (ADA; 1994). Mental health professionals typically become involved in risk assessments when the identified employee's behavior is aberrant, or there is knowledge that the employee has a history of psychiatric treatment. In these cases, the individual's condition may constitute a disability under the provisions of the ADA and the Equal Employment Opportunity Commission's (EEOC, 1997) Enforcement Guidance on the Americans 4 JOURNAL OF THREAT ASSESSMENT with Disabilities Act and Psychiatric Disabilities. The ADA obviously allows for an employer to take action if an employee's behavior constitutes a "direct threat to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation" (p. 19). The EEOC regulations explain, however, that "direct threat means a significant risk of substantial harm to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation" (p. 19). The significant risk must be "high and not just slightly increased," and the determination of threat "must be based on an individualized assessment of the individual's present ability to safely perform the functions of the job, considering a reasonable medical judgment relying on the most current medical knowledge and/or the best available objective evidence" (p. 19). To take personnel action against an employee who poses a risk of violence, the employer "must identify the specific behavior that would pose the direct threat" (p. 19). If the employer's action relies on a psychological evaluation, it places considerable demands on the evaluator. In addition to being knowledgeable in threat assessment, evaluators conducting these assessments must ensure that their procedures are consistent with standard practice for their locale, be knowledgeable about essential duties of the employee's job, and be able to consult effectively with the employer on efforts to accommodate the employee. A fourth issue that arises in assessing risk of workplace violence is that of confidentiality and informed consent. The evaluator's role frequently begins as a consultant to various members of the employer's risk management team, during which time there is typically much discussion of the case. Although hypothetical input from the mental health consultant is valuable to this process, he/she must exercise caution in commenting on the individual employee's characteristics in the absence of adequate data. The consultant should also assume from the outset that he or she will be called upon to subsequently evaluate the employee. Once this latter process is initiated, it is essential that all of the steps necessary for an ethical forensic evaluation identified by such sources as Melton, Petrila, Poythress, and Slobogin (1997) be followed. This includes: (a) informing the employee of who initiated the evaluation; (b) the professional's role as an evaluator as opposed to a therapist; (c) to whom any report will be sent; (d) what issues will be addressed in the evaluation; (e) the foreseeable uses of evaluation data; (f) the proposed evaluation procedures; (g) the kinds of information that may require disclosure to third parties; and (h) issues surrounding the legal right to decline participation. George E. Hargrave 5 Of particular significance is the issue of confidentiality. It is important for the evaluator to know how the jurisdiction's statutes governing medical records pertain to employment-related evaluations. For example, an employee undergoing such an assessment in California is considered a patient under the statute governing the confidentiality of medical records (Pettus v. Cole, 1996). This exists in spite of the fact that there is no doctor-patient treatment relationship. The release of any clinical data to the employer can occur only with the specific written consent of the employee. In the absence of this consent, the evaluator can report back only the recommended action. Under all circumstances, the evaluator must minimize intrusions into the employee's life and limit any feedback to that which is germane to the purpose of the evaluation. One of the exceptions to most states' confidentiality laws is the mental health professional's duty to warn or protect potential victims of violence based on Tarasoff v. Regents of the University of California, (1976) and subsequent legal decisions. Whether this issue applies to such professionals serving as evaluators depends on the context (Melton et al., 1997). Evaluators assessing an individual for the threat of workplace violence must, therefore, know their jurisdictions' legal standards for the duty to warn or protect an identifiable third party when they know, or should know, that the individual constitutes a significant threat of violence. Resnick and Kausch (1995) note that in such situations the evaluator may need to take such protective steps as notifying the employer or coworkers, contacting law enforcement, hospitalizing the employee, or taking other reasonable actions. PROCEDURAL ISSUES Over the past twenty years, several authors have proposed procedures for assessing risk of violence. Monahan's (1981) prototypic work on violence prediction was important, because it shifted the assessment process from variables internal to the subject to a focus on factors that precipitated former violence; these included the context in which violence occurred, the individual's history of violence, base-rates of violence for similar individuals, stressors in the individual's life, the similarity of current context to former contexts associated with violence, and the availability of both means and victims for violence. More recently, the U.S. Secret Service adopted a schema for assessing the general risk of targeted violence (Borum et al., 1999; Fein & Vossekuil, 6 JOURNAL OF THREAT ASSESSMENT 1998; Fein et al., 1995). This latter approach does not rely on subject profile data or threats as a threshold for risk; rather, it is based on three principles and the responses to ten key assessment questions (Borum et al., 1999). As noted previously, this framework appears to be well suited for workplace risk assessments due to the potential for targeted violence against others in this setting (e.g., supervisors, co-workers, human resource personnel). The three fundamental principles underlying the Secret Service assessment approach involve the interaction between the subject and his/her environment. The first principle assumes that targeted violence results from an understandable process of a subject's thinking and behavior. The second principle states that violence emanates from the interaction between the subject and past stressful situations, current situation, and the targeted victim. The third principle views an identification of the subject's "attack-related" behaviors as critical to the investigation and resolution of the threat assessment (Borum et al., 1999). The following discussion will examine the procedural issues for assessing the threat of workplace violence in the framework of the ten questions outlined by Borum and his colleagues (1999). Question 1: What motivated the subject to make statements or take action, that caused him/her to come to attention? When assessing the threat of workplace violence, the process of answering this question is typically underway prior to the mental health consultant's arrival. An increasing number of companies and governmental agencies have adopted procedures for dealing with workplace violence, such as those modeled after guidelines published by the International Association of Chiefs of Police (1997), Littler, Mendelsen, Fastiff, Tichy, and Mathiason (1996), and other sources. In such cases, employers approach the investigation through risk management teams and procedures they have in place. In the event that there is no organizational framework for handling threats, the mental health consultant can provide a valuable service in assisting the employer with this process. This, of course, requires that the consultant have a sound knowledge of issues the employer must attend to as well as the procedures for addressing them. Once the mental health consultant enters the assessment process, a typical starting point is to review information that has been collected on the threatening situation and to interview the individuals who provided this information. The employee's personnel records are generally an George E. Hargrave 7 initial focus and provide such data as identifying information, work history and performance ratings, grievances, and disciplinary actions. Risk assessments differ from typical clinical evaluations by their emphasis on data obtained from collateral sources. Input from co-workers and supervisors provide valuable information about the employee's job status, work and personal problems, aggressive displays, and statements of threat. In some situations, concerned friends and/or family members are willing to be interviewed; obviously, they are a valuable source in assessing the subject's motivation. In addition to obtaining others' perceptions of the reason for referral, it is important that interviews with collateral sources focus on characteristics of the subject shown by the professional literature to be associated with workplace violence (e.g., Bensimon, 1994; Johnson et al., 1995; Resnick & Kausch, 1995). This includes information on the individual's personal history, personality characteristics, past incidents of aggression, ownership of weapons, and substance abuse, as well as current factors that signal possible escalating violence (e.g., indications of increased problems outside of work, increased expression of anger, drastic change in belief systems, decreased emotional control). Question 2: What has the subject communicated to anyone concerning his/her intentions? This question can obviously be investigated during the interviews noted in Question 1. When assessing threatening communications by the subject, collateral sources should be queried about any unusual or inappropriate ideas that indicate desperation, decompensation, and potential targets of violence. If the data suggest that the employee poses a threat to others, he or she should be set up for an immediate individual evaluation. In consultation with the evaluator, the employer must also implement an immediate plan for protecting others. However, in many cases this initial process does not indicate a need for immediate action and the employee can be evaluated at a later date. This may occur when the problem was resolved by some administrative action or when the employee entered the hospital or other treatment. These latter cases, however, frequently involve a risk assessment when the employee is cleared to return to work. Obviously, the subject's motivation will be a focus of interviews with the individual. When interviewing the employee, it is important to use a structured format that contains the areas identified as relevant by 8 JOURNAL OF THREAT ASSESSMENT the risk assessment literature (e.g., Heilbrun, 1998; Johnson et al., 1995; Monahan, 1981; Resnick & Kausch, 1995). These will be covered in the response to Question 5. Once information is collected from both collateral sources and the individual, it can be organized in a framework that assesses individual/ personal variables (e.g., substance abuse, violence history, psychopathology, impulse control, weapons access, etc.), situational factors (e.g., job problems, conflicts with co-workers, other stressors in the individual's life), and the interaction between these two sets of variables (Barling, 1996; Heilbrun, 1998). Overall, the data should provide an understanding of the employee's motivation for the threatening behavior. Question 3: Has the subject shown an interest in targeted violence, perpetrators of targeted violence, weapons, extremist groups, or murder? Borum and his colleagues (1999) noted that, "some perpetrators of targeted violence show an unusual interest in acts similar to the one they are planning," and that the individual's affiliation with extremist groups may provide "permission" for such an act (p. 332). If there is evidence of extremist group membership, the assessment focus should include such areas as those identified by Pynchon and Borum (1999), including distorted perceptions (e.g., prejudices), tendencies to dehumanize nongroup members, a diminished sense of accountability or self-awareness, support of violence as a legitimate means to accomplish an objective, and willingness to violate group norms toward more deviant behavior. Although some authors have listed fascination with workplace violence as a warning sign (e.g., Hatcher & Reynolds, 1996), how this interest correlates with actual violence is unknown. If present, such interests should be assessed both in discussions with collateral sources and during the interview(s) with the individual. These inquiries should also include questions about any individuals the employee perceives as enemies. An expressed interest in weapons is an important assessment area, since it likely correlates with possession of weapons. Given the lethality of guns and their prevalence in workplace violence (Johnson, Meyer, & Feldmann, 1995), a weapons assessment should focus on such factors as the number and types of guns owned, any recent acquisitions, whether the individual legally or illegally carries a gun, any recent renewed interest in guns, any history of brandishing a gun, and any incidents of using a gun or other weapon in a conflict. Information obtained in response to this question provides additional data as to the inGeorge E. Hargrave 9 dividual's motivation for violence as well as an assessment of potential targets and the means to carry out violence. Question 4: Has the subject engaged in attack-related behavior, including any menacing, harassing, and/or stalking-type behavior? Responses given to questions about the subject's interest in targeted violence, weapons, and extremist groups naturally lead into an assessment of the individual's history of violence and intimidation. Clearly, evidence of past aggression and violence is the primary predictor of subsequent violence, particularly if the circumstances of the past and future incidents are similar. Thus, any evaluation should focus on determining frequency and severity of such acts, circumstances under which they occurred, the contribution of drugs and/or alcohol to the process, whether the acts were planned or impulsive, and the subject's thoughts and feelings associated with each incident. In circumstances where the behavior was associated with actual violence, it is also important to assess the types and severity of acts, the role of weapons, and the specific contexts under which violence occurred. This information should be sought from both the individual and collateral sources. The interview focused on current concerns should include any indications of specific targets and the individual's access to weapons. One particular concern is stalking behavior, which is defined as "the willful, malicious, and repeated following of another that threatens his or her safety" (Meloy & Gothard, 1995, p. 258). The act of following that does not rise to this level is generally referred to as obsessional following (Meloy, 1996). In the data reported by Johnson and colleagues (1995), stalking or hostage-taking occurred in approximately one-third of workplace violence cases. Data compiled by Hargrave (1999, 2000) comparably found stalking or obsessive following to have occurred in approximately one-third of cases where an actual threat of violence was found. Given this prevalence of stalking or obsessional following among individuals who perpetrate workplace violence, it becomes an important area to assess. A relatively frequent threat of workplace violence involves the stalking of employees by intimate or formerly intimate others. In such instances, it may become necessary to protect the targeted employee and co-workers without being able to evaluate the stalker. This typically requires that the evaluator interview the victim to assess the relationship between victim and stalker. In addition, any obtainable information from the victim or others should be used to assess the suspect's history of general and domestic violence, psychiatric and 10 JOURNAL OF THREAT ASSESSMENT criminal histories, use of threats and propensity to follow threats with violence, and the level of physical approach used in contacting the victim (Palarea, Zona, Lane, & Langhinrichsen-Rohling, 1999). This information provides a measure of workplace threat and enables the employer to implement appropriate security measures. If the worksite does not have support services available for the victim, the mental health consultant should assist in facilitating this action. There is an extensive literature that can help in assessing threats associated with stalking and obsessional following (Meloy, 1989, 1992, 1996a, 1996b, in press; Meloy, Cowett, Parker, Hofland, & Friedland, 1997; Segal, 1989; Tjaden & Thoennes, 1997; Zona, Sharma, & Lane, 1993). Question 5: Does the subject have a history of mental illness involving command hallucinations, delusional ideas, feelings of persecution, etc. with indications that the subject has acted on those beliefs? Borum and his colleagues (1999) indicated that the extent to which the above characteristics contribute to violence is unknown. Furthermore, they noted that "any association between mental illness and violence appears primarily to be related to substance abuse and/or specific symptoms" (p. 333). Clearly, a thorough mental status examination should directly assess the above symptoms, particularly any delusional beliefs involving significant others, co-workers, managers, and other relevant individuals. In addition to evaluating command hallucinations (and degree of compliance), there should be an assessment for any threat-control override symptoms (i.e., a feeling that the mind is being controlled by outside forces or that others who wish to harm the person are putting thoughts in his/her head; Link & Stueve, 1994). Thus far, however, most of the data on perpetrators of workplace violence indicate little evidence of these symptoms, particularly employees who are referred for threatening behavior. In the National Safe Workplace Institute data reported by Johnson and colleagues (1995), psychiatric diagnoses among workplace violence perpetrators include alcohol abuse/dependence (31%), antisocial personality disorder (20%), depression (19%), polysubstance abuse/dependence (14%), and borderline personality disorder (13%). These data are comparable to preliminary results found in an ongoing study by Hargrave (1999, 2000), in which the significant predictors of threat were alcohol/other substance abuse and personality disorders (antisocial and paranoid). Given the variability of subjects referred for workGeorge E. Hargrave 11 place threat assessment, the evaluation should obviously go beyond the symptoms noted in Question 5 and be quite comprehensive in assessing psychological factors that potentially contribute to violence. A crucial component of any risk assessment is a complete history of the individual, obtained from him or her and others, that at a minimum includes family relationships/violence, physical and sexual abuse, previous aggressive acts and violence (including sexual violence), family and personal history of drug and alcohol use/abuse, school performance, interpersonal relationships and difficulties, antisocial behavior and confrontations with law enforcement, work performance and difficulties, psychiatric problems, and responses to any psychiatric treatment. Historical factors should be assessed and interpreted in light of the individual's current situation. In addition to a thorough mental status examination, assessment of the current situation should include such areas as the individual's use of drugs and alcohol, perceived stress, other indications of a possible personality disorder, anger expression, and suicidal and/or homicidal ideation. A valuable adjunct to the assessment process is having the person respond to hypothetical vignettes (Resnick, 1996). At the most simple level, these may take the form of, "What would you do if . . . ?" (with details being derived from the individual's history). When constructed from specific historical information obtained from both the subject and others, these vignettes may reveal factors relevant to an informed judgment of risk (Melton et al., 1997). As a hypothetical example of this process, assume that collateral sources describe the referred employee as someone who is easily angered, vengeful, holds grudges, and is fanatical about the condition of his automobile. A useful vignette might be structured around what he would do to someone who: a) accidently damaged his car in the parking lot, and/or b) willfully vandalized his car. When a comparable vignette is presented to the subject, he readily recalls an incident of willful damage to his automobile and describes how he subsequently stalked the individual, vandalized his property, and finally assaulted him. His willingness to discuss his behavior was due to the strong justification he felt for taking revenge on someone he felt had wronged him. When evaluating the contribution of psychopathology to the risk of workplace violence, it is necessary to consider the interaction of symptomatic behaviors with situational factors. Although offered in a different context, a framework reported by Litwack and Schlesinger (1987) appears applicable to workplace violence; they noted that "clear and convincing evidence" of violence exists when: (a) there is a recent his12 JOURNAL OF THREAT ASSESSMENT tory of repeated violence; (b) there are identifiable personality traits that led to prior violence; (c) there are unequivocal threats of violence; and (d) there is evidence that the individual is on the "brink of violence" (p. 224). The latter judgment likely involves the person-situation interaction, with situational contributors to this interaction including the similarity of current circumstances to those associated with past violence, the current workplace problems, and other stressors present in the person's life. These are then combined with such personal characteristics as the person's belief system, his/her current psychiatric symptoms (including personality disorders), and evidence of current substance abuse to determine if there is sufficient instability in the person's life to pose a risk. The balancing of factors that inhibit and disinhibit violence is discussed in the response to Question 10. A question that frequently arises in assessing any threat of violence is the value of psychological tests. Clearly, there is no psychological test that predicts violent behavior by itself. When properly selected, however, psychological tests can help identify relevant psychopathology and personality factors; they also provide useful data on such attributes as impulsivity, low frustration tolerance, anger, and other characteristics associated with the possible "brink of violence." If used, selected tests should conform to Heilbrun's (1992) recommended rules of being reliable, relevant to the evaluation issue(s), administered in the standard manner, and appropriate to the population and purpose. Question 6: How organized is the subject? Is he/she capable of developing and carrying out a plan? This is clearly an important issue in cases of worksite threat where there is evidence that the individual is disorganized or delusional. It is also an important consideration when providing security for potential targets of violence. Most of the data on employees who perpetrate workplace violence, however, indicate a relatively low frequency of severe mental disorders. Thus, in most cases there is little likelihood that the individual is so disorganized as to be unable to formulate and effect a plan of violence. A concern that is frequently more important is whether violence may result from a planned or an impulsive act. In either event, it is important to evaluate the data, hypothesize under what circumstances the individual would be violent, identify what means and targets are available in those circumstances, and formulate a plan for protecting others. George E. Hargrave 13 Question 7: Has the subject experienced a recent loss and/or loss of status, and has this led to feelings of desperation and despair? This question is of particular importance in assessing the potential for workplace violence. For most people, their job provides a major status in their lives and contributes greatly to how they are viewed by co-workers, friends, social contacts, and family. Any job action, such as being fired, laid off, disciplined, or passed over for promotion can have a devastating impact on the individual's feelings of importance. Primary concerns for an employer taking some job action against an employee is the latter's potential feelings of anger or despondency over the action. Further, how the employer carries out a job action is of major importance. If the employee feels that he or she was treated in an insensitive or rude manner when such action was taken, it increases the likelihood of significant anger, despondency, and revenge. In the National Safe Workplace Institute Study (Johnson et al., 1995), sensitivity to narcissistic injury and resulting narcissistic rage were general findings among perpetrators of workplace violence. Another factor that contributes to feelings of despair, and potentially to an instigation of violence, is the loss of significant others (e.g., through death, divorce, moving away) who served as the support system in the individual's life. The risk is compounded if the loss occurred in combination with other situational factors, such as negative job action, or problematic personal characteristics, such as substance abuse or a tendency to act out anger. The National Safe Workplace Study also reported that personality disorders, coupled with depression and suicidal ideation, were characteristic of the majority of workplace violence perpetrators. In assessing the individual's loss and resulting despair, it is obviously important to assess how the loss has impacted his or her will to live and the ability to inhibit expression of violence. As noted previously, these characteristics should be a primary focus of procedures assessing motivation, past behavior, and current psychopathology. Question 8: Corroboration-What is the subject saying and is it consistent with his/her actions? Given the typical sequence of workplace violence referrals, the pro- cess of corroboration starts at the beginning, when the employer has generally compiled statements from others and provides these to the consultant as part of the initial contact. The consultant then interviews the relevant sources to further assess the information provided. When 14 JOURNAL OF THREAT ASSESSMENT the individual is evaluated, data from collateral sources are used to fo- cus interviews. Any information obtained from the individual that dif- fers from that obtained from others should be clarified and collateral sources should be re-interviewed, if necessary. In addition to assessing the individual's capacity for carrying out violence, this process enables a credibility assessment of both the individual and the collateral sources. It is also important to note any differences between the em- ployee's behavior as described by others and observations made during the interview. Subjects who show an overly remarkable ability to re- solve formerly upsetting factors should be assessed to determine if the resolution involves comfort with the decision to carry out planned vio- lence. Any perceived deception or denial during the evaluation must ob- viously become a focus of the interview with the employee. Risk assessments are sometimes conducted as a step in returning an employee to work after he or she has been removed from duty for threat- ening behavior. This often occurs when the initial investigation has ruled out any immediate threat but has found reason to reduce the likelihood of further problems by removing the employee temporarily from the worksite. The latter action may be associated with the employee's participation in treatment or may reflect imposed time off work as disciplinary action. In these cases, it is not unusual for the employee to appear different than he or she was described at the time of the threat. Factors contributing to expected improvement include being off work and removed from the stressful situation, being in the initial stage of litigation against those perceived to have wronged him or her, having other life stressors resolve, and successful treatment. It is important that the assessment evaluate the stability of these influences on the individual's current behavior. In other cases, the individual may appear to have become worse during time off from work. Factors contributing to this condition may include loss of income and benefits, rumination over perceived wrongdoings by the employer or others, marital or family problems related to being off work, increased substance abuse, exacerbation of psy- chiatric symptoms, and failed attempts at appeals or litigation. Factors contributing to worsening behavior should be comparably assessed for their potential to increase the risk for violence. Question 9: Is there concern among those that know the subject that he/she might take action based on inappropriate ideas? As noted in the response to Question 1, input from others provides valuable data on the employee's behavior. These interviews with collateral sources should focus on any fear the source or others feel toward the subject. George E. Hargrave 15 Question 10: What factors in the subject's life and/or environment might increase/decrease the likelihood of the subject attempting to attack a target? This question is probably the most crucial to be answered using the evaluation data. For most evaluators, the task consists of forming a mosaic of factors that inhibit or disinhibit the expression of aggression or violence. Borum and his colleagues (1999) refer to these factors as "stabilizers and destabilizers" (p. 334) and explain that they are in response to foreseeable changes in the individual's life circumstances. Furthermore, Borum and his colleagues identify a comprehensive support system, strong therapeutic alliance, involvement with treatment, and adequate professional supervision as stabilizing influences in the person's life. Destabilizers include such factors as an impending job termination or terminal illness of a family member. It is typically assumed that as the ratio of disinhibiting factors to stabilizing influences increases, so does the risk of violence. Obviously, a ratio in the other direction would lead to an assumption of lower risk. However, this process of weighing stabilizing and destabilizing factors is a judgment call that lacks precise empirical support. Resnick and Kausch (1995) also identify risk factors in various domains and suggest that violence increases proportionally to the number of risk factors identified. Although there are no accepted actuarial formulae for combining risk data, the use of other data-bases (e.g., Swanson, Holzer, Ganju & Jano, 1990) may prove useful in determining risk. The important issue in this process is not to predict violence; rather, the professional must determine whether the individual's behavior constitutes a sufficient threat of violence to take some action. Various authors have suggested formats of reporting risk assessment (e.g., Heilbrun, 1997, 1998; Hatcher & Reynolds, 1996). As noted previously, most approaches involve providing a measure of risk, the circumstances under which a risk or threat may occur, and some recommended action to reduce the threat. Any recommendations are typically coordinated with the employer's risk manager and/or human resources staff. Unlike some other arenas of threat assessment, the workplace has considerable latitude available in protecting others. Ideally, the action taken to reduce threat is that which both protects others and has the least negative impact on the individual. The final issue of which the mental health consultant must be aware is that risk assessments carry the potential for tort action against the evaluator. In addition to complying with rules for an ethical and legally 16 JOURNAL OF THREAT ASSESSMENT defensible assessment, evaluators must also follow guidelines for risk containment (e.g., Monahan, 1993) and for avoiding assessment errors (e.g., Litwack & Schlesinger, 1999). Individuals conducting these evaluations must be knowledgable in the relevant literature, particularly with respect to established risk factors for violence. Professional evaluators must base their judgments on complete information and variables most relevant to the risk question. It is strongly advised that professionals develop a checklist or form that addresses all of the relevant evaluation areas, which would help to ensure comprehensive data collection. The use of procedures that are not directly relevant to the assessment question is of concern, because such a practice can lead both to an inaccurate conclusion about risk and to potentially indefensible legal action brought by the employee. When doubts about any area of the assessment arise, evaluators should obtain needed professional consultation. Evaluators must have a plan of action if they determine that the individual is at risk for violence. They must know what options are available, and these should be coordinated with the employer's risk management and/or human resources staff. Finally, evaluators must fully document all aspects of the evaluation. As Monahan (1993) noted, "It would be an exaggeration to state that in a tort case what is not in the written record does not exist-but not much of an exaggeration" (p. 246). SUMMARY Legal mandates and liability considerations require that employers provide a safe environment for their workers. In response, companies and governmental agencies have developed procedures for assessing and managing the threat of workplace violence. Mental health professionals who consult with employers have comparably seen their role expand to include input on risk assessment. A primary role for psychologists and psychiatrists in such settings involves the evaluation of employees who potentially pose a threat of violence to others. This article discussed some of the ethical and procedural issues involved in these evaluations. It addressed legal-ethical concerns associated with determining risk, the impact of assessment decisions on the employee's job, requirements of relevant employment law, and communicating results to others. Since workplace risk assessment frequently involves the potential for targeted violence, the procedures were discussed within the framework developed by the U.S. Secret Service for analyzing such violence (Borum, Fein, Vossekuil, & Berglund, 1999; Fein, Vossekuil, & Holden, George E. Hargrave 17 1995). The ten key questions posed by the Secret Service framework were adapted to assess workplace violence. Each response to the questions synthesized relevant literature on violence risk assessment in an effort to provide guidelines for professionals conducting these evaluations. Finally, the article emphasized the forensic nature of these assessments and the need for procedure