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[00:00:00] Dr. Sharp: Hey, y’all. This is Dr. Jeremy Sharp, and this is The Testing Psychologist podcast, where we talk all about the business and practice of psychological and neuropsychological assessment.

My guest today, Dr. Stephanie Leite is talking with us all about threat assessment and management, particularly with adolescents. This is a topic that is clearly very relevant with all the school shootings over the past few years. Stephanie has been doing this work for a long time.

Let me tell you a little bit about her.

She got her BA from Carleton College, her master’s from Boston University, and her PsyD from the University of Hartford. She has had a practice devoted to forensic evaluations since 2003. Since then she’s evaluated hundreds of people in risk, competency, custody, criminal, and threat assessment cases.

She is a licensed psychologist in the state of Connecticut, a member of APA, and a member of the Association of Family [00:01:00] and Conciliation Courts and the Association of Threat Management Professionals. She’s the vice president of the New England Chapter of that. She is a founding member and recent past president of the Connecticut Psychological Association’s forensic division. And she was awarded the 2014 president’s award from the CPA.

Stephanie is also an adjunct professor at the University of Hartford. She’s taught courses in psych assessment, forensic psychology, and introduction to neuropsychology. She’s also done a variety of seminars for a variety of agencies, including the FBI.

Stephanie has a lot to say. I think you’ll find through this interview that she’s highly knowledgeable on this topic and shares some really valuable information about threat assessment and management.

We’ll talk about what the evaluation looks like, what the risk factors are for threat assessment or for threats to violence and targeted violence, the difference [00:02:00] between targeted violence and reactive violence, and many other things. Please enjoy my conversation with Dr. Stephanie Leite.

Hey everybody. Welcome back to another episode of The Testing Psychologist podcast. I am Jeremy Sharp. Today, like you heard in the introduction, I have Dr. Stephanie Leite with me, and I’m glad to have her here.

Stephanie, welcome to the podcast.

Dr. Leite: Hi, it’s a pleasure to be here.

Dr. Sharp: Thanks so much for coming on. This is a topic that I am super excited to talk about mainly because I don’t know a whole lot about it, but it’s one of those topics that comes up enough in pop culture, I think, that it’s sensationalized. So [00:03:00] I’m really interested to dig in and see what you have to say about all of this violence and threat assessment and whatnot. So thank you.

As we get going, I always like to ask why this? Why is this particular brand of assessment important to you?

Dr. Leite: That is an awesome question. First of all, I love psychological assessment in general. I think it is the best tool that psychologists have in our toolbox. It is what makes us better than every other mental health profession. It’s our secret sauce. More importantly, I’ve seen it make an incredible difference in people’s lives. So clinical evaluations have a huge ability to make a change. Educational evaluations have a huge ability to make a change.

And this is the exact same thing. In the forensic world, people’s lives are usually going pretty poorly by the time they need a psychological assessment. They’re reaching a [00:04:00] real low in their life. And the forensic assessment has the ability to keep the people around them and themselves safe and the threat assessment is the exact same.

So these folks have reached a point where they think that committing an act of violence against other people is the way to solve their internal turmoil. It’s a point where change is possible, and to be able to affect that change is a massive honor.

Dr. Sharp: Well said. Right off the bat, I immediately have questions about, does this really change people’s lives depending on what we find. Do we have the capability to take the assessment results and change people’s lives? So maybe that’s a question. And we’ll just jump right. Can a threat assessment actually change the course [00:05:00] for someone?

Dr. Leite: I really think it can. I think almost as in two different categories. So the first category are people who come to be a person of concern, maybe they will, maybe they won’t, maybe they’re never going to commit an act of harm against other people, but they’re freaking everyone out because like you said, it’s part of the pop culture.

So you have a kid who makes a threat because they’re pissed off. You have someone who is posting pictures of themselves with guns and everyone melts down. You have a weird kid who no one understands what’s going on with them. And they’re concerning to the people around them.

And then the threat assessment, just like a normal psychological assessment, can help them be less weird, get along better, not post weird pictures, get along with other people, all the things that a good psychological evaluation can do.

And then the second chunk of people are those who are much more aware [00:06:00] but those who are actually considering a targeted act of violence. I honestly believe that a good threat assessment can change the course of that person’s life. And I’ve seen it happen.

Even more so, it can not only help their mental health treaters, but it can help law enforcement to determine what level of restriction this person needs. Like, do they need to be locked up? Can they be at home with a PO? Do they need a bracelet? What level do we need to keep them safe? And it also helps the school. Can we let this person back into our school? Do we need to find another way to get them educated?

Dr. Sharp: Sure. Okay. Well, that’s good to know. Right off the bat, we know there is hope.

Dr. Leite: Oh, there has to be hope. Otherwise, we all need new [00:07:00] jobs.

Dr. Sharp: That’s a good point. Why are we doing this if there’s no hope? Well, that’s good to hear you say. I’m going to zoom back out a little bit now that we’ve instilled some hope in with folks and just ask, why this particular branch of assessment for you. How did you zero in here?

Dr. Leite: I started out my career doing forensic work just because I found it to be really interesting. And so my career as a psychologist, I did things before I became a psychologist, but my career as a psychologist started out really being a forensic evaluator in the area of child protection; that’s abuse, neglect, and the risk of violence.

So you can imagine it’s not that huge a jump from risk of violence with, and against children, to this kind of risk of targeted violence, which is slightly different but it’s not intensely different. [00:08:00] It’s definitely in the media. It’s definitely timely. It’s definitely a tiny area of specialization and I’m definitely one of those people that’s going to always pick the most difficult path.

Dr. Sharp: I see.

Dr. Leite: That’s how I got here.

Dr. Sharp: Nice.

Dr. Leite: Oh, and also when I started learning about it, all the people I met in the threat assessment world were just awesome people with who I wanted to spend more time with.

Dr. Sharp: Oh, I see. A nice professional community goes a long way.

Dr. Leite: Yeah, it’s huge. And the threat system community is multidisciplinary. So I work with the police. I work with law enforcement. I work with attorneys. I work with mental health people. It’s fun.

Dr. Sharp: Nice. So let’s define some terms perhaps before we get started. I’ve been the term threat assessment. I don’t even know if that’s the right term. Can you walk us through threat assessment versus [00:09:00] risk assessment and any nuances in between to really describe the work that you’re doing?

Dr. Leite: Okay. There is a huge body of things that people can read about this if they are interested, but starting at the very bottom level, there are two different types of violence. There is targeted violence, and that’s what we’re talking about today, and then there’s reactive violence.

Targeted violence is when you plan something out ahead of time and you have a target and then you go ahead and do it. Reactive violence is when you freak out because someone is annoying you, and you punch them without thinking. That’s an important distinction.

So threat assessment is almost like shorthand for threat assessment and management because you got to have the management part, otherwise you’re not being helpful. And it’s the act of assessing and managing acts. People who [00:10:00] want to commit an act of targeted violence.

Dr. Sharp: I see. Well said. We’ll focus on the targeted piece today. Could I briefly ask, is there anything we can do for that reactive violence component? Are there any folks who specialize in that or do we have any means of intervening?

Dr. Leite: Reactive violence is a slightly different area, and there is a lot more research on it because it’s much more common. When we think of violence, that’s much more common. There are so many different types of reactive violence. I don’t think there’s anyone answer to that but we do have a lot of things that we learn about teaching people to control their autonomic nervous system, putting them in therapy, trying to figure out why they are reacting with anger, et cetera.

Dr. Sharp: Okay. [00:11:00] Fair enough. Well, let’s stick to the targeted violence area here. I’m trying to think. Where can we start here? I’m curious, what kinds of folks end up in your office? You mentioned kids, I’m not sure if it’s only kids or adults as well or what. So who are you seeing?

Dr. Leite: I get my referrals from a bunch of different places. One is from schools. So schools, elementary and high schools, will call me when there is a student that they are worried about and I will do a full psychological evaluation for the flash threat assessment and management evaluation with them.

I also get calls from probation and from the prosecutor’s office, [00:12:00] those are very similar. Those are when a kid has come in, it’s usually a kid or a young teen, has come in and they are concerned as to whether this person is serious about it or is just making threats. So that is the second thing.

I also get referrals from larger institutions like universities and churches and corporations. And in those cases, I’m not so much doing a traditional psychological assessment. I’m doing more of a consultation where I do like the background, I read records, and I meet with people, but not the person of interest, not the person who’s making the threats to try to help the institution create a better environment so that they won’t make threats and then prove it will be safe.

Dr. Sharp: I see. So would you say it’s [00:13:00] majority adolescents?

Dr. Leite: For me, my practice is mostly adolescents. And in general, most of the people who commit these acts are adolescents or younger adults.

Dr. Sharp: So something like the Las Vegas shooting is an anomaly in some ways.

Dr. Leite: A total outlier on every level.

Dr. Sharp: Yeah. Well, that might be a way to start to get into this whole world when you have outliers like that. That’s a big question for me that came up during our pre-podcast chat was, can we really assess these characteristics with any value knowing that we can’t “predict the future” or predict someone’s behavior? So the question in there is, how do you see the role of assessment in these cases [00:14:00] and the value in determining what people might do?

Dr. Leite: There are so many important things in that question. It’s hard to pick which one to focus on first. So as far as the outliers go, it is super important to recognize and just to say over and over again, that these are really isolated events. There really is not a lot of them. So as far as studying them, we can’t come up with a profile or a typical person who does it because it’s a disparate group of people. And there just aren’t that many of them. Most of them die before they are apprehended by law enforcement. So we can’t study them. It’s an end of zero or a very low end.

So from a research standpoint, we really don’t have much to go on. And that within itself is one of the big differences between threat assessment and violence risk [00:15:00] assessment. In violence risk assessment, it’s more like you look at a body of research on people who are violent like you would use the MMPI.

You use the MMPI and you say, this person is responding like all these people who are depressed. So you say, this person looks like all these people who are violent, or this person looks like all these people who commit violent acts over and over again, they’re likely to offend again. That’s violence risk assessment.

Threat assessment is more being aware of the body of research and looking at how this individual looks in comparison to it. So rather than going research down, it goes from the individual to the research. And that’s the best we can do.

Dr. Sharp: Right. So you said something in there that’s important that I’d love to ask about, which is we don’t necessarily have a [00:16:00] unified profile “of folks who are more prone to these acts.” I just want to ask a little more about that.

Dr. Leite: Okay.

Dr. Sharp: Yes. So as best I can tell, when I was doing some research for our podcast, trying to figure this stuff out, it seems like, there’s no profile but there are say 8-10 variables that we might look at. They have different degrees of overlap and if they’re all in place, that’s not a good sign. Is that conception correct, or do you look at it a different way when you are doing these assessments?

Dr. Leite: I think that’s totally correct. I have this image in my mind of like piles of data and the bigger the pile is, the scarier the person is. Which is one of the reasons why we say you don’t want to focus just on guns or just on mental [00:17:00] illness. Those are just variables. But the more variables there are in the pile, the more worried we should be about that person’s potential to commit harm.

Dr. Sharp: Yeah. Can you walk us through some of those big variables; some of the things that you consider in those piles?

Dr. Leite: Clearly, a history of violence is the best predictor of future violence. Access to weapons is extremely important. A very large percentage of these folks do have some history of mental health involvement, which is often depression or suicidality. So those are also things that are of concern.

Then we really start looking at what’s called the pathway to violence, which is like a hopscotch of variables that have been determined to really [00:18:00] lead to an act of violence. So we’re looking at behavior- what the person is doing rather than who they are.

It usually often starts with a grievance. Someone has a grudge or a grievance or something that they think they need to fix. They come up with the brilliant idea that the way to fix it is to hurt other people. And that’s how it starts.

And then it moves up through the pathway as people perhaps identify with other people who have committed acts of harm, which is a huge area of concern, especially with the internet and the ease of accessing communities that are really antisocial. They have to access weapons, they have to practice them. They have to check out the target to see whether it’s soft or hard and figure out how to get in and attack.

Dr. Sharp: I see. Okay. Are there more steps along that pathway?

[00:19:00] Dr. Leite: This is a pathway that was written out by Calhoun and Weston in 2003. And not everyone follows the exact same steps, but as I said, it starts with a grievance. It goes up through violent ideation, planning, and then preparation; like a lot of people will go out, they will try to figure out how their guns work, they will do other things probing, and then the actual attack itself.

So when you’re assessing someone, you want to see how far along the pathway they are. There are other things that we look for like leakage is something that you see in a huge chunk of the cases. That’s when someone tells someone that they want to do it.

The research shows that if someone wants to commit an act of harm, they’re not going to tell the actual person they want to harm. So they’re not going to call up the school and say, Hey, everyone, watch out I’m coming in on Tuesday because that would [00:20:00] be really dumb because then they would be stopped. But they might tell their friends, Hey, stay away from school on Tuesday. Or they might tell their friends, I’m finally going to do it on Tuesday. I’ve got everything in place.

Dr. Sharp: I got you. So that’s where a program like safe to tell comes into play I would imagine, or could be really helpful where other kids can disclose things that they have heard.

Dr. Leite: Yes. Those programs are absolutely critical. I know that I’ve had a bunch of cases that literally happened because kids went to some kind of program in their school where they were told you have to let us know when something happens and then called the safety officer the next day and said, look, I got to tell you something’s happening. And it’s scary. And our kids are better at that than our grownups. So if we’re talking about workplace violence and working with grownups, kids have [00:21:00] gotten the message way better than grownups have.

Dr. Sharp: I could see that. My perception is that we are all a little bit desensitized to these statements. I don’t know if that’s true or not just being in the mental health field or with the media or what, but I wonder how seriously people do take these statements versus just thinking this kid’s just trying to get attention or that guy’s just depressed or whatever justification might come into play.

Dr. Leite: From my experience, it’s all of the above. Sometimes people blow it off and often that’s a serious problem. That’s what happened in Parkland. Everyone blew it off. A lot of times people totally overreact and they freak out over a kid who is perhaps being an idiot, but not doing something that is really pathological because they don’t know how to [00:22:00] differentiate between someone who hunting and someone who’s howling. There is a great book about hunters and howlers which everyone should read, but that’s where it’s good to have a professional that comes in.

And my super secret perspective is that it really doesn’t matter if the kid is just squawking or if they were going to actually do something, because if it comes to the attention of the teachers, of the principal, of the authorities and someone is able to come in and make a change in their life for the better, then that’s okay.

I mean, if they’re just squawking because they felt that they were bullied and they were never actually going to do anything wrong, we can change their life so they don’t feel bullied. And so they can go on and graduate and so they can make friends. Well, then that’s our job as teachers and helpers.

Dr. Sharp: Yeah. [00:23:00] That totally makes sense. And when you bring bullying, that makes me want to ask as well. I feel like I saw bullying or feeling like an outcast or feeling isolated as variables that might contribute to risk for something like this. Is that true?

Dr. Leite: It depends on what research you’re looking at. There’s definitely a big chunk of kids for whom their grievance is that they felt that they were bullied. Whether they were or were not, is a different question, but that is true for a big chunk of kids. But it’s also the state of adolescence. I mean, what adolescent doesn’t think they’re an outcast and no one understands them?

Dr. Sharp: Good point. So you mentioned history of violence as another risk factor. When you say history of violence, what could that look like for a teenager exactly?

Dr. Leite: So, if we’re going to focus on threat assessment, kids who have a real [00:24:00] concern to me as a threat assessor and manager, their history of violence is more likely to be the violence which is along the pathway. So rather than engaging in reactive violence, punching someone who pisses them off, they will have engaged in other smaller mean acts like breaking all of someone’s pencils when they weren’t looking, which is a tiny microaggression.

I had a kid who went and was caught shooting fish in the river and the policeman came and was like, dude, why are you shooting the fish in the river? And he was like, I’m target practicing. And then he went ahead and shot some local animals and his aggressions and practicing increased [00:25:00] over time. And that was really worrisome. You don’t need to shoot fish. You can use a fishing hook if you want to fish, right?

Dr. Sharp: So there is some credence to that idea of violence toward animals being significant.

Dr. Leite: I don’t know if statistically, we can say that it is significant because a lot of the people who have engaged in these are actually very kind to animals. It’s one of the big things about Dylan Klebold that people who adore him focus on is that he very much cared for his animals because sometimes they feel that the animals are the only ones who cared for them. But yes, obviously, if you are in a place where you can aggress against animals, it makes you more disturbed and more concerned. It’s always concerning. Fire-setting is also another thing that we see.

Dr. Sharp: Yeah. Are there any other variables in that pile, like you called it, that [00:26:00] we might want to be aware of that can contribute to increased risk for threat?

Dr. Leite: There are all the traditional variables that you would look for like family of origin issues; coming from a place that would lead to and can affect the pathology. All of those variables that we’re totally aware of.

There are other ones that are really threat assessment specific like parental oversight. Some parents are better at monitoring their kids than others. And the control that the parent has over the kids and their actions is a big issue. Are they aware of whether the kid is stockpiling weapons in the basement? Do they know where the kid is going if they’re off practicing shooting?

We find over and over again that in the cases of the kids who have very viable threats, often there is poor parental oversight. They might be, [00:27:00] do they know what chat rooms they’re on, et cetera.

Dr. Sharp: I see. That feels like a double-edged sword because I could easily see relatively low parental oversight for kids who’ve shown that they can be trusted. 

Dr. Leite: Exactly. See, that’s the challenge. All of these variables are things that perfectly normal teenagers have. Perfectly normal teenagers feel isolated, perfectly normal teenagers lock themselves in their room and spend all day on video games.

Dr. Sharp: Right. So that’s really where it gets into this constellation of factors that we really have to consider and that you have to assess for, and that’s why we’re doing an assessment at least, I suppose, to pull all those things together.

Dr. Leite: Poor problem-solving skills. How many kids have poor problem-solving skills? Almost all of them. It’s just like a suicidal assessment. [00:28:00] So a lot of the things that you would look at in an assessment of suicidality are things that are normal for a lot of kids, but not all of them lead to suicidality.

Dr. Sharp: Absolutely. That may be a good segue to the actual assessment process. Talk to me about when people come to you down the pathway, I suppose. Is a referral typically made when there’s been maybe a comment made or school’s gotten wind of something, maybe the parents are concerned. When do you typically catch them in the process?

Dr. Leite: At a lot of different places The most common would be when something concerning has been said in school and overheard by a teacher, or a student goes to a teacher and says that there’s something concerning. [00:29:00] A lot of the times it’s because it’s been leakage because the kid has gone on Instagram and said something that is really concerning enough. Kids, maybe they talk to one another and they say, did you see that that really freaked me out? And then they go to the authorities and let them know.

Dr. Sharp: I got you. So what’s this assessment process look like?

Dr. Leite: It’s not that much different than any other psychological assessment. It’s just focused in a slightly different way. So if the kid has never had special education and has never had IQ testing, obviously, I want to start with IQ testing. I want to know how they think and process information. So you do that and then you do some basic personality testing.

You might use some broadband personality measures. I’m a fan of the MMPI-2-RF [00:30:00] the adolescent version. That’s a lot of letters. And then there are other specific measures. So just like doing any other assessment, if you’re doing a substance abuse assessment, you’re going to throw in a substance abuse measure. It’s the exact same thing. And there are some really specific measures that are focused on violence like SAVRY-iv which is for kids, and the HCR-20 V3, which is for adults.

And these are structured professional judgment models, which are slightly different than the standardized testing models, which would be like the MMPI where you fill in the bubbles and then you find out how you score on the scales.

Structured Professional Judgement is a list of the variables that you were just asking about; the research-based variables that have been found to lead to violence and the evaluator [00:31:00] fills it out. It’s not completed by the kid or the grown-up who you’re assessing. You’re filling it out. So you’re looking at all the risk factors; personal, social, educational, and violence associated, and then end up putting together a conceptualization of what is the potential risk for violence.

I’m a big booster of the Structured Professional Judgement model because not only does it help you organize your thoughts, it helps you not forget any of those variables, but also it gives you an answer at the end. Like, what are you going to do with this kid? How are you going to find out that things are getting worse? What are the things that could take this kid? What are the triggers that are going to make this kid blow up? And then what are the protective factors that are going to make them calm down? And it really helps you come up with the [00:32:00] plan at the end.

So just like with any other psychological evaluation, you take all your instruments, you take all your data, you take all your records, you take all the collateral context that you have come up with, and then you put it together with a conceptualization and a description of risk.

Dr. Sharp: I see. Can I backtrack a little bit and just ask why you prefer the MMPI over the MACI or the MCMI or a PAI?

Dr. Leite: I do like the PAI as well. And the PAI-A. I like the MMPI-2-RF because it has some really specific forensic norms, which are useful for me in my practice. So I have gotten more accustomed to it. I feel like it’s a newer updated shorter instrument. I used to joke that I’d only give the MMPI-A to kids I didn’t like because it’s so long and nobody likes it. The RF is shorter.

[00:33:00] I have found that I just don’t get chewy enough information out of Millon. I have not fooled around with the new version, but I feel like their gender norms aren’t as useful as I would like. So I’ve mostly stayed away from it.

Dr. Sharp: So you feel like the MMPI and related tests are just a little better normed and that’s more helpful?

Dr. Leite: I do.

Dr. Sharp: I got you. Fair enough. Thank you for indulging these questions.

There’s a big debate over personality measures, and what gives you the richest information. I don’t feel like I get a ton of information from the PAI and PAI-A that goes beyond maybe typical broadband, emotional-behavioral questionnaires. So I’d be curious if you can speak to that at all; what are you getting from those in particular that you feel are helpful?

[00:34:00] Dr. Leite: I think that’s fair, especially as I get older and I do more and more assessments, the broadband personality measures seem less and less useful and more like corroboration of what I think is going on but when you’re going into court, it is good to have the numbers behind you.

The other thing that I really like about the broadband personality measures is the validity scales. So how someone responds to the question and how truthful they are being with you is obviously of critical importance when you’re doing this evaluation. So I have a whole section in my report called response style, and it’s nice to have those scales in there.

Dr. Sharp: Yeah. Maybe I could ask a little about that. That seems very important. How do you handle it? Well, first of all, just to zoom out, do you notice any patterns or is there anything in the research [00:35:00] around validity or truthfulness in response style in these cases?

Dr. Leite: There is a growing body of literature, and it’s really interesting in talking about how people respond to evaluations and questioning. And it’s super interesting. Obviously like with most forensic stuff, you presume that people are going to fake good all over the place. They’re going to present themselves as being the most positive people in the world. If they don’t, if they fake bad, that’s very interesting. And that’s going to lead you to a different conclusion.

Also is important for me when I’m putting together my recommendations and management plans because people who don’t want to do the deep dive into their psyche to figure out why they’re [00:36:00] acting in this way are going to be much more superficial and they’re going to gloss over everything just like they would in any other case. So it’s important to know how far they are along the pathway of recognizing that they’ve done something wrong.

Dr. Sharp: I see. How do you handle in those cases where there is a faking good situation, particularly with an adolescent, let’s say. How do you approach that both in the report but also during the assessment? Do you bring that to their knowledge? Do you say, make sure to be truthful? I’ll give you another shot. How do you do that?

Dr. Leite: Well, I’m not going to make anyone do the testing again, but I will challenge them on it. And that’s why in forensic assessment and especially this assessment, you want to have multiple sources of data so you can say you ask them all the questions like you’re an idiot [00:37:00] even though I’ve told them ahead of time.

I say, look, you see this pile of paper I have, this is the stuff I got from the school resource officer. This is the stuff I got from your probation officer. And it has every printout of all of your Instagram posts. I let them know that ahead of time. And that often inoculation enough against them being super fake good, but if they’re going to go ahead and lie through their teeth to me, I can then pull it out and I can challenge them on it and say, well, how does that jive with what I see right here? This is a picture of you standing in front of your mirror with a gun and the caption says it happens tomorrow at six o’clock. How is that misinterpreted?

Dr. Sharp: Sure. I like that.

Dr. Leite: The best part about testing adolescents, which is why I love them so much is that you have to be perfectly honest with them and you [00:38:00] have to be super transparent and there’s nothing held back because they’ll see it if you are.

Dr. Sharp: Yeah, absolutely. I found that to be true over and over in working with teenagers is just to put it on the table and be very straightforward and then let them figure out how to handle that.

Dr. Leite: Yes. That’s what you need.

Dr. Sharp: Yeah. Let me back up even further, and I’m aware, I didn’t even ask about some of these logistics. Who makes the appointment with you? Are parents calling you or is the school calling you? And who is your client? I guess that’s an even bigger question. Is your client the school or what?

Dr. Leite: Usually my client is the school or the court.

Dr. Sharp: I see. So they’re going into it just from the beginning knowing that there is for all intents and purposes, no confidentiality. I’m assuming you have paperwork to that effect for them to know that this is not a confidential process.

Dr. Leite: Correct. [00:39:00] Except you also have to remember that juvenile court is closed. So it’s like, there is no confidentiality, but it will be sealed and no one else can see it outside of the court process.

Dr. Sharp: I see. And then from the beginning, do you meet with the parents and, or teen for an interview first and then do testing on a different day, or is it all the same or do you not do an interview? What’s the actual process look like?

Dr. Leite: It really depends because these are so often paid for by the state. I try to be as efficient as possible with my time because I’m also a taxpayer.

Dr. Sharp: That’s kind.

Dr. Leite: Yes. So I will usually do the same thing you would in any other evaluation. I’ll meet with the parent and the kid together. I’ll explain confidentiality. I’ll tell them why we’re here and talk about what we’re [00:40:00] going to do and then plunge into any intellectual testing. Then I will do the interview. It often takes two days. And then I will go into the other testing.

Sometimes I do get to do projective testing, which is a lot of fun. Sometimes I’ll get to do the Rorschach, but usually, it’s more of the actuarial and the SPJ testing. And often when the kid is doing their testing, sitting outside in the waiting area, I will meet with the parents and talk to them.

Dr. Sharp: I got you. Nice. And then how soon after that do you try to generate a report?

Dr. Leite: It depends on what the level of crisis is. Often, the nice thing about testing kids who are already locked up is there’s no crisis unless it’s a court date because they’re safe. [00:41:00] If it’s a question of whether or not the kid can return to school, there might be a need to do it faster. But in general, it takes me about four weeks to finish a report.

Dr. Sharp: Yeah. And how long do they end up being?

Dr. Leite: They can be around 40 pages.

Dr. Sharp: Wow.

Dr. Leite: Because it’s a document that goes to the court and I’m going to put every single bit of data that I have in there. I’m going to summarize every single document. I’m going to write up every single collateral report and I’m going to really do a deep dive into their functioning in the conclusions.

Dr. Sharp: Yeah. So thinking about just the business side of this, roughly how many hours are you putting into this, and relatedly, how many of these evaluations are you doing per week or month depending on how you think of it?

Dr. Leite: I’m the world’s [00:42:00] worst business person. I tend to charge around 12 to 14 hours. I figure about five hours face to face and a little more than that writing up, but I always spend way more time in that writing.

Dr. Sharp: You know there’s hope for that.

Dr. Leite: I know. These evaluations run hot and cold. And like I said, some of them are just consultations; and those I’ll write up and hand in the next day. But in general, I think I do a really big chunky, full-out psychological evaluation case probably like eight times a year. Not that often. And still a big chunk of my practice is the child abuse and neglect evaluation.

Dr. Sharp: I hear you. [00:43:00] On one hand I could see that. I mean, that’s a good thing that there aren’t that many serious threat possibilities in your given area for that year.  I got you.

Now, you said that they’re typically paid for by the state. Is there ever a private pay situation or does the school pay? I’m just thinking about the financial side and how you structure that.

Dr. Leite: Definitely. Sometimes the school pays. I’ve done evaluations. Of course, one of the big challenges is that insurance does not cover something that is court-related. So I do not take insurance. So I’ve had private-pay evaluations. I had a referral from a private school which they’ve told the parents, if you want your kid to come back, you have to go and get a threat assessment evaluation done.

I’ve had private pay evaluations when, [00:44:00] and this is actually common, this type of situation, as you know, psychosis tends to come on, especially in males, around the end of college or the beginning of after college. And sometimes psychosis comes with paranoid behavior. Sometimes it comes with stalking behavior. I’ve actually had two evaluations where either a university or a parent is really worried about a kid’s decompensating behavior and they don’t understand what it is. And they’ve engaged in either fit of rage or stalking, or really bizarre focused behavior like that. And the answer is this is a kid who is looking at the onset of psychosis.

Dr. Sharp: I see. I can see that being very challenging to tease out.

Dr. Leite: Yeah, I feel [00:45:00] like it’s like the worst thing that psychologists do. We don’t tell people that someone’s going to die of cancer, but we can tell parents that their kids are going to have to focus on a really challenging mental illness for the rest of their lives.

Dr. Sharp: That’s so true. We’ve taken a little bit of a detour to the business side. I’m trying to think of other questions around that. I’m curious about marketing; how do you develop a reputation or a niche in this area for anybody who might be interested in going in that direction?

Dr. Leite: As I said, I’m not the world’s worst business person. But I do a lot of education. So I do a lot of training. I do a lot of training through the school systems. I do training through an organization that I’m involved with called ATAP- the Association of Threat Assessment Professionals. That is the best way to get your [00:46:00] name out. Just a lot of training and a lot of meeting people.

Dr. Sharp: Yeah. And how do you specifically reach out and present yourself to schools to get in for these presentations?

Dr. Leite: It has mostly been word of mouth. Someone has been to another presentation that I have given, and then they recommend me to someone else.

Dr. Sharp: That’s a good way for it to happen. It’s easy.

All right. So let’s jump back to the clinical side. I’m really curious about the conclusions and recommendations you might make in these cases. It sounds like from all the measures that we’re talking about specifically that Structured Professional Judgement measure, is it a measure or interview guideline?

Dr. Leite: A lot of them come with an interview and then it’s like a form that you fill out. It’s an evaluation.

[00:47:00] Dr. Sharp: So those generate pretty clear guidelines, it sounds like, on what’s going on and the actual risk level and what to do.

Dr. Leite: Yeah. A Structured Professional Judgement is so brilliant because it lets you know where the holes are. Is this a kid where the hole is an intimacy deficit? Then you know exactly what kind of recommendations to write. If it’s an intimacy deficit, you’re going to put in recommendations for helping them develop a community for getting involved with other kids.

Is it a question of depression? Then we know what recommendations to write to help them be less depressed. If is it a question of really bad social skills and a paranoid way of seeing the world, then we know what to do. We can write recommendations to help them out with that. So, that’s why they work so well.

What I do is I take all the information.[00:48:00] I do a very traditional clinical conceptualization like anyone else could do. And then I take some of the great threat assessment research and use that to put together a more threat assessment-focused conclusion and to develop a risk level.

The FBI has put out categories for risk as has the secret service. The secret service has just absolutely incredible publications with critical questions to ask and answer of the kid as far as what is their potential for future violence. So going through and answering those is just super helpful.

Dr. Sharp: I see. Are those available publicly?

Dr. Leite: They are. And I’d be very happy to give you a list of great things to look at. [00:49:00] With the secret service, it’s under the National Threat Assessment Center and the secret service, the end tech, they actually just came out with great new data.

Dr. Sharp: Very cool. That’s a question I had for you too, is where do you learn about this stuff? What are the resources for folks who might want to dive in?

Dr. Leite: There is more and more out there. So there is an APA journal called the Journal of Threat Assessment and Management. That’s a great place to start. Peer-reviewed articles on all different topics. So that’s a good place to start. The secret service documents are amazing. Under Janet Reno after Columbine, they put out the first document. And then that has been updated two years ago. And it’s the original research and the original [00:50:00] conceptualizations of what makes for a scarier kid that have totally held out their absolutely brilliant work held out in all the research.

The FBI also has some great publications. They have one called Making Preventional Reality, which is their newest document. It is very well written. It is everything that you could want in an assessment. And like I said, I’m part of this organization, the Association of Threat Assessment Professionals, which is a multidisciplinary trade organization, like the APA. They have on their website, a list of critical readings that they suggest that you read. And a lot of those have live links in them. So that’s also a great place to start.

Dr. Sharp: Oh, that sounds great. The show notes for this episode, I think are going to be pretty comprehensive. [00:51:00] I’ve been taking good notes. We have a lot of resources. You mentioned a book, you said Hunters and Howlers. Is that the title of the book or is it something different?

Dr. Leite: I am going to look it up for you. I think it is called Threat Assessment and Management Strategies: identifying the hunters and howlers. It is by Calhoun and Weston. The second edition was published in 2009. And it’s my current go-to thing to recommend to everyone because it’s written in a really clear way. It’s a lot written for law enforcement. There’s not a lot of fancy language in there. It’s pretty straightforward. It has a lot of questions in it.

And the biggest thing that seems to come across my desk is people are saying if this person’s scary or not? They’re saying they want to hurt everyone, but I don’t know if that just means that they’re in pain and they’re literally crying for help, or is [00:52:00] this someone who really wants to hurt everyone? It has the tools and the questions that you need in it to help figure out, is someone hunting or is someone howling?

Dr. Sharp: Yes. Very important distinction. What other things might be helpful? I feel like we really covered a lot of ground here and our time has flown by. Are there any gaps, any holes that I didn’t ask about in our discussion that you think would be helpful to share with folks?

Dr. Leite: Well, I would like to close by saying that this is a really exciting and dynamic part of our field. It’s a great way to work with the most dedicated professionals you’ve ever met in your life. But I also really want to caution people that there is a huge risk of error in doing this work if you don’t know what you’re talking about because it is different than traditional violence and it is a specialized [00:53:00] subset.

So if one of these evaluations comes across your desk and you don’t feel like this is your area of specialty, I would seriously recommend handing it off to someone who knows what they’re talking about, or go ahead and get supervision so that you can do a good job because a bad evaluation can ruin someone’s life; thinking that someone is scary when they’re really not is just devastating. I have stories that you wouldn’t believe about kids who have been accused of being scarier than they really are. And it has literally ended their goals.

Dr. Sharp: I could see that. If you had to comment, actually, before I ask that, do you provide supervision to other folks if they were so interested?

Dr. Leite: Yes, I do. I love helping people out. I love helping give articles. That [00:54:00] would be a local thing, but I am very involved in the state of Connecticut and working with other people.

Dr. Sharp: Wonderful. And like I was going to say, do you have a sense of, if there are errors in these kinds of evaluations, are they typically false positives or false negatives? Can you comment on that?

Dr. Leite: At least in my experience, it’s more false positive. Kids who are being identified as being scarier or more pathological than they really are. The false negatives come with people who just don’t deal with it at all.

Dr. Sharp: I could see. It seems like if they’ve gotten on your radar, then there’s a good chance that they need that evaluation.

Dr. Leite: Yeah.

Dr. Sharp: Well, I appreciate your time and talking through this. I know there’s so much more that we could dive into. [00:55:00] It was hard not to branch off and just go down any number of tangents. Like I said at the beginning, this is something that’s so important, but also unfamiliar, I think, to a lot of us. And I’m glad there are people out there like you who are doing good work for these kids and for the communities.

Dr. Leite: And I’m happy to talk to anyone about it and share all the great resources that are out there.

Dr. Sharp: Fantastic. Well, I will say goodbye, for now, Stephanie. Thank you for coming on to talk through these things with us.

Dr. Leite: Yeah. Thanks for having me.

Dr. Sharp: All right, y’all. Thank you for listening to that interview with Dr. Stephanie Leite. We covered a lot of ground. Hopefully, you got a good idea of both the business and the practice associated with threat assessment and management. I know there’s tons more that we could say on this topic. Stephanie shared with me before the podcast that she could talk about this [00:56:00] stuff for hours, which I totally believe.

Always wish that we had more time to do that, but for now, hopefully, that’s a good primer. Stephanie is available for any questions or consultation, and there are a ton of resources in the show notes. She put together a really nice handout to download with all the resources we talked about and some others that she didn’t mention. So check that out.

As always, if you get a moment, I would love it if you could subscribe, rate, and review of the podcast. Always looking for feedback. I appreciate all of you who have already provided some of that feedback. So thanks for listening and stay tuned. We’ll catch you next time. Bye, bye.

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