Youth Violence Risk

Youth Violence Risk Questionnaire

The following is a list of behaviors that are associated with the risk of youth violence. Check those items that describe the youth you are concerned about. Professional consultation is always appropriate if you have concerns regarding mental, emotional or behavioral problems. This questionnaire should not be used to screen for medical, psychiatric or mental health disorders. No questionnaire can replace or substitute for professional consultation or face to face evaluation. This questionnaire is designed to help you clarify your concerns, help you discuss issues with appropriate professionals or authorities and to give you an indicator of the approximate risk.

Date: _________________________________

Child's Name: ____________________________________________

Date Of Birth: ____________________________ Sex: M F

Name Of Person Completing The Form: _____________________________________

Immediate Danger (At least one represents an immediate danger)

The child has made statements or implied they might have a weapon (e.g. rifles, shotguns, pistols, sharps, blunts, explosives).

The child has brought a weapon (e.g. gun, combustible fuel, large knife, sharps, blunts, etc..) to a place or to a situation that is inappropriate (e.g. work, school, church, etc...).

Critical Warning Signs (At least 1 sign is critical. A greater number of signs indicates a greater risk.)

Has the child made any veiled destructive or threatening statements verbally?
Has the child made any veiled destructive or threatening statements in writing?
Has the child made statements or implied they might have a plan for violent or suicidal behavior?

Has the child made statements or implied they might have reasons to become violent?
Has the child made statements or implied they might have opportunities to become violent?

Has the child stated, implied or made any gesture that they might have identified a target for violence?

Critical Warning Signs (2 or more signs are critical. A greater number of signs indicates a greater risk.)

Has the child implied violent or destructive behavior in artistic or other creative expressions?
Has the child made implied in a gesture or non-verbal manner that they might have identified a target for violence or other destructive behavior?
Has the child intentionally frightened people?
Has the child been stalking or following one or more people?

Is the child preoccupied or dwelling on past or recent rejection, injustices or unrealistic fears?

Does the child have a history of anger problems bordering on destructive behavior?

Has the child been cruel or violent towards pets or other animals?

Does the child have a preoccupation or obsession with violence?

Is the child fascinated or obsessed with guns, knives, sharps or other weapons?

Reacts to disappointments, criticisms or teasing with extreme and intense anger, blame or a desire for revenge.

Has the child been increasingly angry, aggressive or violent over time?

Has the child's behavior or any threats become increasingly lethal?

Contributing Risk Factors

Youth at Risk Screening Score is 33 or more.

Has trouble paying attention.

Often disrupts classroom activities.

Does poorly in school.

Enjoys violent TV shows, movies, or violent video games.

Has few friends; is often rejected by other children because of his or her behavior.

Makes friends with other children known to be unruly or aggressive.

Consistently does not listen to adults.

Is insensitive to the feelings of others.

Is easily frustrated.

Withdrawn or isolated.

An immediate Danger means that action must be taken immediately. This includes a response from 911 and Law Enforcement and then a comprehensive evaluation and intervention by a qualified crisis intervention professional.

Significant critical warning signs indicate that some reasonable action should be taken immediately and that must include a comprehensive evaluation and intervention.

Contributing risk factors are early warning signs that indicate the possibility of a problem that should be investigated carefully and cautiously.