CEO Addresses Arizona Shooting

   

 

According to Dr. Gagan Dhaliwal, clinical psychiatrist for The Pinnacle Schools' residential program, Elk River, we need to adopt a "Risk Management"  approach. This consists of conducting a comprehensive neuropsychiatric evaluation. This evaluation is guided by the knowledge of risk factors based on research available in the field of violence and allows one to develop an informed opinion concerning a teen's level of risk; mild, moderate or severe. To effectively manage risk, a thorough "Risk Assessment" must be performed.  Dr. Dhaliwal proposes "MANAGE THE RISK" Protocol (MTR Protocol) which incorporates the following major factors that increase the probability of violence.*

*Supported by available research in the field of violence.

M:  Mental Illness (disturbance in thoughts, perceptions or behaviors) /Mental Retardation

A:   Addictions/Substance Abuse

N:   Normal vs. Abnormal Adolescence regarding Anger Management

A:   Abuse: Physical, Sexual, Emotional

G:   Genetic/ Inherited predisposition/Nature

E :   Environmental Factors: (Poverty can increase the risk of violence)/ Nurture

 

T :  Threats: Analysis of the type of threat (written or verbal) regarding the potential for violence

H :  Head Injury (Traumatic Brain Injury)

E:   Empathy Deficits (Psychopathy, Antisocial Personality Disorder)

 

R :  Repeat Offender: Past acts of violence 

I :   Impulsivity (reduced impulse control can increase the potential for violence)

S :  Situational Triggers/ Relationship with victim/ Who is the target

K :  Knife/Gun/Bare Hands (choice of weapon)/ suggests the severity of the threat

Since there are no easy answers or cookie-cutter solutions to identifying and managing teenage violence, Dr. Dhaliwal suggests early institution of residential treatment services as it separates the adolescent from circumstances and situations that may trigger the violent act. The risk for violence can be reduced by clinical interventions, treatment of the psychosis and substance abuse, change in living/social setting, and restricting access to weapons and drugs.

Dr. Dhaliwal recommends a residential setting to fill the gap between an adolescent's stay at an acute hospital setting and the return home.  Often when a child's behavior is severe enough to warrant stabilization, a physician will recommend an acute hospital stay.  Few insurance companies will cover the cost of a residential program but many will cover five days in an acute mental hospital, followed up by an Intensive Outpatient Program (IOP).

Enrolling an adolescent into a residential treatment program provides an opportunity for the treatment team to conduct a thorough intake, psychiatric and educational evaluation. Additionally, keeping the teen away from the situational triggers for violence at home keeps the teen and his family safe.  The residential treatment also provides an opportunity for the teen to be able to restrict the distractions of home: family, friends, cell phones, computers, and drugs.  Their diet is absent of junk food, sugar, caffeine and they develop healthy eating habits and better coping strategies to deal with stress, dysfunctional emotions and violent behaviors.    

Many of our residents arrive after failing IOPs.  They're simply not ready to return to the environment that allows them to escape from whatever is driving the inappropriate behavior.  It is imperative that we help a child get to the core issue that is driving the erratic behavior.  That takes time.  That is one of the things we offer at Elk River Treatment Programs:  Time for our professionals to determine the appropriate intervention needed.  We mandate that parents enter family therapy.  This residential setting is not just for the adolescent.  The family must heal for the child to succeed. The shooting in Arizona has created a dialogue.  I think that is the silver lining to this tragedy. 

Karen Lee
Founder, President & CEO
The Pinnacle Schools