YOUTH RISK ASSESSMENT WORKSHEET

Comprehensive Evaluation

Student: Age: Grade:

School: Teacher:
Student Demographic Information
Parents / Guardians: Phone (Hm) / Other:

Address:

Initial screening completed by: Date:

Source of Information:

GUIDELINES FOR USE OF THIS “YOUTH RISK ASSESSMENT WORKSHEET” INSTRUMENT

The “Youth Risk Assessment Worksheet” provides a guided clinical approach to the assessment of youth Violence.
This worksheet reviews two types of risk factors:
I. “Youth Violence Risk Factors”
Empirically validated risk factors. Research has demonstrated that these risk factors are reliably and related
to future violent behavior.

II. “Youth Disturbance Risk Factors”

These factors are included because they commonly occur in youth populations that engage in aggressive / violent behavior
but they do not have the same level of research support as the “youth violence risk factors.” These risk factors should be
thought of as “pathways to youth violence” and are associated with disturbed behavior that can lead to violent behavior.

The worksheet guides the evaluator to organize and interpret these risk factors and to make a determination of the level of
violence risk. The Youth Risk Assessment Worksheet is not a reliable and valid psychological test instrument. No attempt
should be made to quantify the results that are obtained. It is important to remember that each case is unique. No single
variable or cluster of variables is predictive of violence or the absence of violence. The order in which items are presented
is not related to order of significance for any given client / student. Any inferences made from the results of this assessment
tool are solely those of the evaluator. Consultation supervision should always be sought when completing the Youth Risk
Assessment Worksheet.
Ideally, this form will be filled out after a review of background materials, collection of collateral information, and a
direct interview with the child / youth in question. In those instances where one or more of these sources of information are
missing, this limitation should be noted in your findings. It is unlikely that all the information contained in the worksheet
can be gathered in a single assessment session. Time permitting, this information can be gathered over several sessions.

Scoring:
When reviewing each of the “Risk Domains,” you will be asked to score most items on either a 0 – 2 scale or on a
present / absent basis. Scoring is to indicate your confidence that the item applies to the youth and is not to be used to
derive a cumulative score. In those cases where insufficient information exists to score an item mark “DK” (e.g. “Don’t
Know”). The scoring of items on a 0 – 2 scale requires clinical judgment and inference:
 Score an item “2” if the item applies to the individual and there is a good match in most essential respects
 Score an item “1” if the item applies to a certain extent but not to the same extent as a “2” response, indicating too
many exceptions or doubts to meet the full definition.
 Score “0” when the item does not apply to the individual and they do not exhibit the trait or behavior in question,
or they exhibit characteristics that are opposite or inconsistent.
Some of the items are repeated in several different risk domains.

Adapted from Oregon Forensic Institute • 1942 NW Kearney, Suite 21 • Portland, OR 97209 • (503) 274-4017
Copyright 2002 Eric M. Johnson, Ph.D., ABPP Used with permission Revised 4/2003
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 2

I. RISK FACTOR DOMAINS

A. Individual Risk Factors (0 = not true, 1 = somewhat true, 2 = very true)

1. Youth Violence Risk Factors:
Early Behavior Problems (< age 10) Problems managing anger

Risk taking / easily bored

2. Youth Disturbance Risk Factors: Pathways to violence

Victim of bullying Lack of remorse Lack of regard for others

Central nervous system damage Low intelligence (< 80)

OVERALL PATTERN
Escalation De-escalation No Change

Notes:

B. Family Risk Factors (0 = not true, 1 = somewhat true, 2 = very true)

1. Youth Violence Risk Factors:
Severe marital / family strife Domestic violence

Family aggression in community Family endorses violence

Antisocial parents Sibling delinquency

Poor parenting practices (lax / punitive) Early parent-child separations

Child maltreatment (neglect & phy. abuse) Poverty

2. Youth Disturbance Risk Factors: Pathways to violence

Family substance abuse Family mental illness

History of runaways

OVERALL PATTERN
Escalation De-escalation No Change

Notes:
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 3

C. Peer / Community Risk Factors (0 = not true, 1 = somewhat true, 2 = very true)
1. Youth Violence Risk Factors:

Poor peer relations (unpopular) Delinquent peers

Availability of firearms Peers / Adults endorse violence

2. Youth Disturbance Risk Factors: Pathways to violence

Peers victims of violence Peers use weapons

Peers in gang

OVERALL PATTERN

Escalating De-escalating Stable N/A

Notes:

D. School Risk Factors (0 = not true, 1 = somewhat true, 2 = very true)

1. Youth Violence Risk Factors

Early behavior problems Frequent disciplinary problems Poor grades

Truancy / skipping school Low commitment to school

OVERALL PATTERN

Escalating De-escalating Stable N/A

Notes:

E. Alcohol / Drug Risk Factors (0 = not true, 1 = somewhat true, 2 = very true)
1. Youth Violence Risk Factors

Early alcohol / drug use (6 –11 years) Serious substance use

Sells drugs

2. Youth Disturbance Risk Factors: Pathways to violence

Uses alcohol / drugs during school Aggressive with alcohol / drugs

OVERALL PATTERN

Escalating De-escalating Stable N/A

Notes:
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 4

F. Mental Health Risk Factors (0 = not true, 1 = somewhat true, 2 = very true)
1. Youth Violence Risk Factors

Hyperactive / impulsive / inattention

2. Youth Disturbance Risk Factors: Pathways to violence

Paranoid / disturbed thinking Hallucinations

Current / past depression Current / past suicidal behavior

Trauma disorder Current / past treatment

OVERALL PATTERN

Escalating De-escalating Stable N/A

Notes:

G. Delinquency Risk Factors (0 = not true, 1 = somewhat true, 2 = very true)

1. Youth Violence Risk Factors

Early police contacts (6 –11 years) Gang membership (Current / Past / Wannabe)

Prior arrests / convictions Aggressive / violent offence(s)

OVERALL PATTERN

Escalating De-escalating Stable N/A

Notes:

H. Weapons Risk Factors (0 = not true, 1 = somewhat true, 2 = very true)

1. Youth Violence Risk Factors

Has used weapon to harm others

2. Youth Disturbance Risk Factors: Pathways to violence

Unusual interest in weapons Carries a weapon (Knife / gun / other)

Brought weapon to school Access to weapons

Collects weapons Interest in explosives

OVERALL PATTERN

Escalating De-escalating Stable N/A

Notes:
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 5

I. Inventory of Aggressive / Violent Behavior (circle / fill in responses)

LOCUS VICTIM(S) FREQUENCY INJURY METHOD

HOME Parent High Low minor moderate serious

Sibling High Low minor moderate serious
Pet High Low minor moderate serious
Other High Low minor moderate serious
SCHOOL Peer / Gang High Low minor moderate serious
Younger child High Low minor moderate serious
Adult High Low minor moderate serious
COMMUNITY Peer / Gang High Low minor moderate serious
Younger child High Low minor moderate serious
Adult High Low minor moderate serious
Animal High Low minor moderate serious

1. Youth Violence Risk Factors

Unusual interest in violence Frequent acts of aggression

Aggression causing serious injury

2. Youth disturbance Risk Factors: Pathways to violence

Talks about committing violence Makes credible threats of violence

Makes plans to commit violence Made preparations to implement plan

Animal abuse

TYPE OF AGGRESSION DISPLAYED

Predominantly reactive Predominantly instrumental

OVERALL PATTERN

Escalating De-escalating Stable N/A

Notes:
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 6

II. SYNTHESIS OF FINDINGS

A. Sources of Information Relied Upon For This Evaluation

Records Teacher Parent / Guardian Other family

Peer Other collateral Youth Other

Sources requiring further inquiry:

B. Summary: Domains of Risk (check all domains with one or more risk factors, give two checks if
domain risk factors appear to be escalating)

Individual Family Peer / community School Alcohol / drugs

Mental health Delinquency Weapons Aggression / violence

Number of domains with risk: /9

Number of domains escalating: /9

C. Critical Risk Factors That Could Be Related To Imminent Violence (check all that apply)

Frequent acts of aggression Aggression causing serious injury

Carries a weapon Brought weapon to school
Talks about committing violence Makes credible threats of violence
Makes plans to commit violence Made preparations to implement plan

D. Summary of Developmental Themes Inferred from risk factor domains (check all that apply)
Disrupted development Poor attachment Self-centered
Lack of regard for others Social alienation Delinquent
Impaired self-soothing Substance abuse Mental illness
Willing to hurt others Preoccupied with violence

Notes:
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 7

III. SITUATIONAL AND CONTEXTUAL VARIABLES

A. Current Life Stressors / Intensifier Variables (check all that apply)

School failure School discipline Peer loss / rejection

Other relationship loss / rejection Family Problems Recent family discipline
Death / serious illness / other Serious illness Legal problems
Out of home Runaway Mental health crisis
Victim of bullying / violence Witness to trauma Other disruptions
Major life changes Substance use Pregnancy
Other:

OVERALL PATTERN

Escalating De-escalating Stable N/A

ESTIMATED CURRENT STRESS LEVEL

High Moderate Low

Notes:

B. Coping Skills & Resources / Moderator Variables (check all that apply)

Supportive / available family Supportive / available peers / other

Supportive / available community resources Practices problem solving skills
Practices anger management skills Anticipates consequences
Acknowledges inappropriate behavior Willing to seek help
Positive response to prior intervention Accepts supervision
Willing to sign “no harm” contract Endorses moral / religious beliefs
Other:

Coping skills & resources appear adequate

Coping skills & resources appear inadequate

Notes:
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 8

C. Likely Context of Aggression / Violence (check all that apply)

Place:
School Home Community:

Conditions:
Low structure High structure
Low social demand High social demand
Gang / street life Drug dealing While committing crime

Other:

Notes:

D. Likely Precipitants of Aggression / Violence (check all that apply)

School failure School discipline Resisting authority

Avoiding detection Public humiliation Peer loss / rejection
Other relationship loss / rejection Feels threatened Peer / gang conflict
Victim of bullying / violence Thrill seeking Dominating others
Recent family discipline Family conflict Legal problems
Out of home placement Mental health crisis Major life changes
Substance use Weapon availability Other disruptions

Other:

Notes:

E. Likely Reinforcers of Aggression / Violence (check all that apply)

Pro-violence attitude Peers endorse violence Family endorses violence

Family makes excuses Professionals make excuses Minimal consequences
Avoids responsibilities Aggression has paid off Earns privileges
Earns respect Excitement / thrills

Other:

Notes:
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 9

IV. VIOLENCE RISK ASSESSMENT

Based upon a review of all available information, make the following determinations
A. Overall Risk of Future Violence (check one category)

LOW VIOLENCE RISK:

Few risk factors are present and none are related to past violent behavior (i.e., serious injury) or an
immediate risk of violence. In these cases no further inquiry into violence risk or special
preventive actions are encouraged unless circumstances change.

MODERATE VIOLENCE RISK:

Multiple risk factors are present but none that relate to an immediate risk of violence. To the extent
that risk factors are present, they reflect historical problems or aggressive behavior that is common
to children and adolescents but do not include serious injury or other forms of violent behavior. If
the youth has displayed violent behavior in the past, then there must be evidence that the youth has
stabilized and that the determinants of past violence do not apply in the current context.

In some cases there may be very few risk factors but there is evidence of imminent risk. As long as
the youth is stable and can be managed by guardians then community placement appears viable.

Give priority to gathering additional information and provide close client monitoring. Take
preventive action and if the situation deteriorates be prepared to warn potential victims and / or
detain the at-risk youth.

HIGH VIOLENCE RISK:

Numerous risk factors are present. These youth usually have a mix of risk factors that apply to
both past and current problems, including a history of frequent aggressive behavior and / or a
history of isolated violent behavior. Their history of violent behavior indicates they could present
an imminent risk for renewed violence.

In some cases there may be very few risk factors but there is evidence of imminent risk. As long as
the youth is stable and can be managed by guardians then community placement appears viable.

Give priority to gathering additional information and provide close client monitoring. Take
preventive action and if the situation deteriorates be prepared to warn potential victims and / or
detain the at-risk-youth.

VERY HIGH VIOLENCE RISK:

The same considerations as for “high violence risk” apply except that the youth is not stable and
cannot be managed by guardians in the community. Further deterioration in functioning appears
likely. Violent behavior appears imminent and the youth requires immediate detention or
containment. Potential victims will need to be warned in most cases.
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 10

B. Threats to Harm Identifiable Victim: Duty to Warn or Protect

No identifiable victim (Go to next section)

Identifiable victim (Complete remainder of this section)

Name(s) of victim(s):

Harm does not appear likely and imminent (Go to next section)
Harm appears likely and imminent
Method of harm:

Access to means of harm Access to means of harm unlikely

Access to intended victim Access to intended victim unlikely

Duty to warn / protect appears warranted

Does not appear warranted

Notes:

C. Threats to Harm Self: Duty to Intervene

Current / past depression Current / past suicidal behavior Trauma disorder

Poor reality testing Substance use Poor peer relations
Problems managing anger Life stressors escalating High current stress
Talks about committing acts of violence Coping skills & resources appear inadequate

OVERALL PATTERN
High risk Moderate risk Low risk N/A

Duty to intervene
No duty to intervene
Unable to determine
N/A
Notes:
 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 11

V. INTERVENTION PLANNING AND RISK MANAGEMENT

A. Intervention Options (check all that apply)

1. Individual Options
Decrease stress Reassure & support
Problem solve / reality testing No harm contract

Other:

2. Family / Home Options

Alert parent / guardian Encourage acceptance Strategize safety options
Increase supervision Family safety watch Safety proof home
Provide information about emergency services

Other:

3. School Options
Increase supervision Teach new skills Disciplinary action
Provide counseling services Specialized class Send home
Increase counseling services Decrease caseload Alternative school
Evaluate for special education Other:

4. Community Options
Psychological evaluation Psychiatric evaluation Psychiatric hospitalization
Increase supervision Teach new skills Alcohol / drug evaluation
Counseling services Notify police Notify juvenile authorities
Increase therapist availability & accessibility Increase counseling services

Alcohol / drug treatment referral Other:

B. Youth’s Likely Compliance with Intervention

Overall Pattern:

Compliance unlikely Compliance likely

Unable to determine N/A

 YOUTH RISK ASSESSMENT WORKSHEET
Comprehensive Evaluation, Page 12
C. Roles and Responsibilities: Some or all of these findings will be shared orally and / or in
writing with the following people. (check all that apply)

1. Family
Parent Guardian Other:

2. School
Superintendent Principal Vice Principal
School Counselor Psychologist
Other interventionists:

SST team Interagency team Campus security

Classroom teacher / staff with a need to know:

Other staff with a need to know:

3. Community
Police / Sheriff Juvenile court counselor / probation officer
Hospital Evaluation specialists Counselor / therapist
Other:

Notes:

D. Re-Evaluation

Re-evaluation date:

Rationale for re-evaluation date:

Evaluator Date

Supervisor / Consultant Date