During a critical time in U.S. history, and in a year that has seen more than 350 mass shootings, Michigan State University’s Department of Psychiatry is launching a pilot program – with a $15 million grant from the state of Michigan – to help curb acts of violence and spare families from unthinkable trauma before it’s too late.
The Center for Targeted Violence Prevention is a collaborative program between the MSU Department of Psychiatry — a shared department in the Colleges of Osteopathic Medicine and Human Medicine at MSU — and the National Policing Institute, or NPI. Beginning this fall in five Michigan regions, the five-year pilot program will establish a research-to-practice hub to provide guidance, training and consultation in the regions, and will also assign intensive support teams to provide case management and mentoring services to high-risk/high-need adolescents and their caregivers. The regions are yet to be determined.
High-risk/high-need adolescents fall through the cracks
Alyse Ley, associate chair of education and research in the Department of Psychiatry, explained that, even if it is reported when a journal with graphic information is found, or when threatening content is posted online, there is often a gap in follow-up support. “The individual may not necessarily fall within a school system, and they haven’t committed a crime, so they cannot be adjudicated by law — no one is taking ownership of these individuals,” Ley said.
Students graduate, families move, and potentially violent adolescents fall through the cracks. This lack of a proper handoff is dangerous, explained Michele Gay, who lost her daughter, Josephine, in the Sandy Hook tragedy, and is now founder and executive director of Safe and Sound Schools.
One major challenge is the lack of a universal system. Regions, school districts and health care systems have their own methods of identifying individuals at risk and may not have the resources needed to do more than identification. Referrals often come from a wide range of sources, including behavioral threat assessments, school districts, law enforcement or mental health court judges. The program’s intensive care teams will be responsible for streamlining the referral process, identifying and managing at-risk individuals and connecting them with community resources.
Another challenge is that many models respond to the crisis instead of preventing the crisis. Instead of “high-risk/high-need,” Frank Straub, director of the Center for Targeted Violence Prevention at NPI, suggests a mindset that is “high-need/high-risk” to deter violent behavior.
To develop the model used at the Center for Targeted Violence Prevention — coined the Michigan Model — the team researched 300 averted or completed school attacks, analyzing behavioral characteristics of the perpetrators, security measures that were or were not implemented and gaps between external agencies.
The proposed cross-systems Michigan Model draws on the expertise of health care professionals — from psychiatrists to emergency physicians — and engages school district staff, law enforcement professionals and other community-based services. This multidisciplinary approach provides a holistic, individualized strategy to “prevent acts of violence and change the trajectory of these young people’s lives,” Ley said.
Measuring success
Because at-risk adolescents need both immediate and long-term support, quantifiable performance indicators are in place to robustly measure the success of the program and the violence averted. These include evaluating whether high-risk/high-need individuals stay connected to education, are employed or come into contact with law enforcement.
They will also measure the number of cross-discipline individuals, such as family medicine doctors and community members who have been trained by the center to identify violent behaviors. The program will tap into the expertise of the MSU community, providing opportunities for medical students, fellows and residents to participate in research, education or consultation services.
“This partnership among a university, a nonpartisan nonprofit and experts from multiple sectors offers us a tremendous opportunity to address mass violence,” said Andrea Amalfitano, dean of the MSU College of Osteopathic Medicine. “The skilled psychiatric experts we have at MSU will contribute greatly to this groundbreaking, innovative approach to violence prevention in Michigan and its scalability, both in the U.S. and worldwide.”
Beyond the program
Troubled young people and their caregivers are lacking adequate support. If someone has an alcohol problem, they have a sponsor. If someone has a heart attack, we don’t stand by — we take action. The same must be done for individuals demonstrating violent behavior, Straub said.
“This is a medical emergency, and we must look at it this way,” he added.
“The Center for Targeted Violence Prevention is not the total answer, but may very well be part of the answer,” said Jed Magen, chair of the Department of Psychiatry. “While the program has been in the works for many years, the Oxford High School shooting in 2021 and the string of violent attacks in 2022 propelled this vision into an urgent reality.”
Frank Ochberg, MSU clinical professor of psychiatry, added, “It’s not that America has more dangerous people or a different school system, it’s that we have more guns per person than any other countries like ours, and we don’t have ways of ensuring that guns are out of the hands of young people who should never be able to get them.”
Violence prevention is a community effort
“We are encouraged that the governor and legislature saw merit in this program and chose to invest in Michigan’s safety,” said Aron Sousa, M.D., FACP, dean of the MSU College of Human Medicine. “We envision the Michigan Model recalibrating the path that an adolescent may be going down, averting acts of violence and protecting the lives of our children, neighbors and community members.”
The Michigan Model would identify individuals early who may be angry, disenfranchised and thinking about hurting themselves or others. Ideally, the goal is eventually to no longer need intensive support teams, and instead help adolescents see that they are part of a community and are competent individuals.
“This whole-child, multilayered approach can knit together the community, and even knit together other communities,” Gay said. To do this, the focus must extend beyond the adolescent to families, school districts, law enforcement, health care and community services.
Straub urges people, especially young people who have more access to seeing threatening content on social media, to say and do something when they become aware of potentially violent behavior. While he acknowledges there can be fear of reporting something erroneously, he encourages young people to view reporting as approaching a potential case of violence with empathy, with the goal of connecting these individuals to support.
“Violence prevention is not punitive, it’s intervention-based, Gay said. “We’re not looking to punish at-risk adolescents; we’re looking to support them and protect our children and communities.”
Republished courtesy of Michigan State University.