September 01, 2016

Researchers Develop a Novel Approach to Identify Risk Factors for School Violence

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Researchers at Cincinnati Children’s Hospital Medical Center recently developed a way to assess middle and high school students’ risk of violent behavior at schools. The study included 25 students with behavioral changes from 15 schools in Ohio and Kentucky. The study results were published in July 2016 in Psychiatric Quarterly.

The study, which was done over the course of one year, was a collaborative effort among Ohio and Kentucky schools, the Cincinnati Children’s forensic research team led by Drew H. Barzman, MD, and parents of the students. Referrals were made from the schools to the research team for students who have shown behavioral changes of becoming odd, quiet, withdrawn, isolative, or any change from baseline, which can all be warning signs of school violence.

The study then used manual annotation after recording and transcribing the interview with a student who showed a behavioral concern or change. Manual annotation is a method used in clinical research to extract relevant information from human language. Data analysts use computer technology to identify and categorize specific words and phrases in the language that offer clues about a person’s intentions. In this study, manual annotation helped the research team to identify linguistic factors (specific language by students) that were associated with a student’s risk to others or to themselves. Manual annotation is a big improvement from the current risk assessment methods because it allows objective analysis of the student’s actual language rather than subjective and unreliable interpretation by an interviewer. The research team provided clinical recommendations to the parents and the school mental health professional as soon as possible to help lower the risk level. 

Until now, manual annotation had not been used for school violence research but has been used for other clinical research such as suicide studies. 

Drew H. Barzman, MD, principal investigator and Director of the Child and Adolescent Forensic Psychiatry Service, says that the purpose of the study was to pilot a standardized, sensitive, and rapid method to identify students at high risk for physical aggression and violence toward others at schools. In collaboration with Yizhao Ni, PhD, co-principal investigator and instructor from Biomedical Informatics, the research team analyzed and identified linguistic factors contributing to the high risk levels. Michael Sorter MD, Director of the Division of Child and Adolescent Psychiatry, Edward Latessa PhD, Director within the School of Criminal Justice at the University of Cincinnati, Marcus Griffey BA, a pre-medical student at University of Cincinnati, Bianca Patel BA, a medical student, and Ashaki Warren MD, a psychiatry resident at Cincinnati Children’s, are important members of the research team.

“We wanted to focus on a way to objectively analyze the students who are at risk for getting into physical fights or other forms of violence and who bring weapons to schools with the intent of harming others or themselves,” says Dr. Barzman. 

Of the students included in the research, 13 students were considered high risk to themselves and 11 students were considered a high risk to others. The analysis showed that there were statistically significant differences in language between the high risk and low risk groups for violence, including violent acts or thoughts, self-harm thoughts or acts, negative feelings or actions of others, and violent media use (video games, music, and movies).

By January 2018, Drs. Barzman, Ni, and their research team hope to study between 125 and 150 students to fully develop their manual annotation risk assessment in order to eventually become a standard test for schools and clinicians across the country. 

“There is a need to make schools safer and to improve outcomes for students who have shown that they are at a high risk for committing a violent act toward themselves or others at schools,” says Dr. Barzman. “By using our novel risk assessment approach, we have been able to objectively analyze students at high risk and make helpful recommendations for how to lower their risk and improve outcomes for these students and schools.”

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