1. 4/19/2015© Nicoletti-Flater Associates Detection, Disruption & Risk Assessments of Insider / Outsider Perpetrated Violence COLORADO HEALTH CARE ASSOCIATED RISK MANAGERS 2013 ANNUAL CONFERENCE John Nicoletti, Ph.D., ABPP Nicoletti-Flater Associates 303-989-1617 www.nicoletti-flater.comwww.nicoletti-flater.com Facebook: Nicoletti-Flater Associates

2. WHY COLORADO?

3. 4/19/2015© Nicoletti-Flater Associates BASIC SAFETY CONSIDERATIONS IN PREVENTING & DISRUPTING A VOLATILE ATTACK Development of a Centralized Data Collection Point (VORTEX) Target Hardening Activation of Dynamic Countermeasures

4. 4/19/2015© Nicoletti-Flater Associates WHAT ARE THE CATEGORIES OF RISKS? A risk for Proactive Attack Behaviors against people or property A risk for Reactive Attack Behaviors against people or property A risk for behaviors that create Social and Psychological Disruption

5. 4/19/2015© Nicoletti-Flater Associates WHO ARE THE ATTACKERS? Insider – Individuals who are on your radar before they attack. Outsider – Individuals who are not on your radar before they attack.

6. 4/19/2015© Nicoletti-Flater Associates SPECIFICALLY, WHO ARE THE INSIDERS AND OUTSIDERS?  Employees  Ex-Employees  Family Members  Ex-Family Members  Patients / Customers / Clients  Contractors  Others

7. WHAT DOES NOT WORK IN CONDUCTING A RISK ASSESSMENT? 4/19/2015© Nicoletti-Flater Associates

8. FOCUSING ON WHO INSTEAD OF WHAT What is a ‘who’? Mental Health Diagnosis (i.e., psychotic, bipolar, etc.). Ethnicity Gender Religious Affiliation Political Affiliation Other Affiliations (i.e., Greenpeace, Code Pink, PEAT) 4/19/2015© Nicoletti-Flater Associates

9. 4/19/2015© Nicoletti-Flater Associates Individuals with Mental Illness Attackers

10. 4/19/2015© Nicoletti-Flater Associates DENIAL

11. 4/19/2015© Nicoletti-Flater Associates RATIONALIZATION -- Inserting ‘JUST’ in the behavioral description

12. 4/19/2015© Nicoletti-Flater Associates BELIEVING IN AN URBAN LEGEND

13. 4/19/2015© Nicoletti-Flater Associates WHAT ARE THE TIME & RESPONSIBILITY CONSIDERATIONS?  Pre-Event Threshold Actions – what you do before the person gets on your radar.  Event Threshold – what you do when the person gets on your radar.  Event Horizon – what you do when the person attacks you.  Post-Event Horizon – what you do to try to recover and live with what happened.

14. 4/19/2015© Nicoletti-Flater Associates Pre-Event Threshold Actions

15. 4/19/2015© Nicoletti-Flater Associates IN DEALING WITH CURRENT EMPLOYEES: Document all behavioral actions Provide employee ongoing feedback No surprises

16. 4/19/2015© Nicoletti-Flater Associates If They Broadcast It – Believe It!

17. 4/19/2015© Nicoletti-Flater Associates Skip the “Tea Leaf” Reading If a coded behavior occurs, go to a countermeasure.

18. 4/19/2015© Nicoletti-Flater Associates AREAS OF RESPONSIBILITIES  Employees – Detectors  Supervisors/Managers – Detectors & Disruptors  Agency Response Team – Disruptors

19. 4/19/2015© Nicoletti-Flater Associates There are two timelines in violence.

20. 4/19/2015© Nicoletti-Flater Associates TWO KEY TIME CONSIDERATIONS Event Threshold Event Horizon

21. 4/19/2015© Nicoletti-Flater Associates The probability of a violent incident from an insider should be low.

22. 4/19/2015© Nicoletti-Flater Associates ALGORITHM ANALYSIS 35 Incidents Between 1/13/12 & 12/27/12 57% of the attackers were insiders 63% of the attackers broadcast a perceived injustice 71% of the victims initially targeted were the focus of the perceived injustice 74% of the attackers entered through the main entrance

23. 4/19/2015© Nicoletti-Flater Associates ALGORITHM ANALYSIS (con’t) 71% of the attackers just walked in 49% of the attackers committed suicide 17% of the attackers were killed 34% of the attackers were arrested 37% of the attacks were over in under 5 minutes 63% of the attacks were over in under 15 minutes

24. 4/19/2015© Nicoletti-Flater Associates ALGORITHM ANALYSIS (con’t) Location of the Attacks 51% of the attacks occurred in the workplace 17% of the attacks occurred in a school 17% of the attacks occurred in a public place 6% of the attacks occurred in a religious establishment 9% of the attacks occurred either in the victim’s or the offender’s residence

25. 4/19/2015© Nicoletti-Flater Associates EVENT THRESHOLD ACTIONS Identification of The Event Threshold Behaviors

26. 4/19/2015© Nicoletti-Flater Associates Avengers always have a progression.

27. HOW DO YOU GO FROM POINT A TO POINT Z? 4/19/2015© Nicoletti-Flater Associates

28. 4/19/2015© Nicoletti-Flater Associates HOW DO YOU GO FROM POINT A TO POINT Z?

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30. HOW DO YOU GO FROM POINT A TO POINT Z? 4/19/2015© Nicoletti-Flater Associates

31. 4/19/2015© Nicoletti-Flater Associates DEVELOPMENT OF AN AVENGER Perceived Injustice Feeling Victimized Externalization of Responsibility Development of a Grudge Obsessed with Avenging Avenging Action

32. 4/19/2015© Nicoletti-Flater Associates Avengers always broadcast ahead of time.

33. HOW DO THEY BROADCAST IT? 4/19/2015© Nicoletti-Flater Associates

34. HOW DO THEY BROADCAST IT? Insiders broadcast directly to their targets. Outsiders triangulate their broadcasts. 4/19/2015© Nicoletti-Flater Associates

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38. 4/19/2015© Nicoletti-Flater Associates BEHAVIORAL CODING OPTIONS: Normal Behaviors Boundary Probing Behaviors Attack Related Behaviors Attack Behaviors

39. 4/19/2015© Nicoletti-Flater Associates NORMAL BEHAVIORS Must be defined according to: The specific environment The individual The event In reality, “normal behaviors” refer to behaviors that are accepted and tolerated. There cannot be any universal definition of “normal behaviors.”

40. 4/19/2015© Nicoletti-Flater Associates BOUNDARY PROBING Involves pushing rules, regulations and tolerance levels. The purpose is to determine how much he/she can get away with.

41. 4/19/2015© Nicoletti-Flater Associates IMPORTANT ISSUE If you allow a boundary probe to occur without a disrupter, then by default that behavior becomes normal.

42. 4/19/2015© Nicoletti-Flater Associates ATTACK RELATED BEHAVIORS Desensitization Behaviors (threat making – direct, veiled, conditional) In Vivo Virtual Dehumanization Behaviors In Vivo Virtual

43. 4/19/2015© Nicoletti-Flater Associates ATTACK RELATED BEHAVIORS Skill Set Building Development of an Armament Inventory Development of an Attack Plan

44. 4/19/2015© Nicoletti-Flater Associates ATTACK RELATED BEHAVIORS Threatening Verbalizations Threatening Behaviors Personal Space Violations

45. 4/19/2015© Nicoletti-Flater Associates ATTACK BEHAVIORS People Property

46. 4/19/2015© Nicoletti-Flater Associates ACTIVATION OF COUNTERMEASURES Always Interrupt / Disrupt the Behavior

47. 4/19/2015© Nicoletti-Flater Associates BOUNDARY PROBING AND ATTACK RELATED BEHAVIORS INCREASE WHEN THERE ARE NO TREES (DETERRENTS)

48. 4/19/2015© Nicoletti-Flater Associates TREES CATEGORIES (Disrupters) CATEGORY I QUESTIONING CATEGORY II CONFRONTING CATEGORY III CONSEQUENCES

49. 4/19/2015© Nicoletti-Flater Associates WHEN A TREE IS PLACED AFTER A PRACTICE SESSION THE INDIVIDUAL HAS A CHOICE TO EITHER BACK OFF OR CLIMB OVER IT INDIVIDUAL REACTIONS TO TREES

50. 4/19/2015© Nicoletti-Flater Associates PREDICTING FUTURE VIOLENCE The best predictor of future behavior is not past behavior but post-intervention behavior.

51. 4/19/2015© Nicoletti-Flater Associates INTERPRETING LACK OF COMPLIANCE If the concerning behaviors continue after an intervention, then two possible hypotheses have been generated: 1. The individual is choosing to disregard rules when it suits him/her. 2. The individual does not have the capacity to control his/her actions.

52. 4/19/2015© Nicoletti-Flater Associates IMPORTANT CONSIDERATION Once an individual has engaged in an attack-related behavior, he/she should always remain on the radar detector, even if the behavior appears to have stabilized.

53. 4/19/2015© Nicoletti-Flater Associates EVENT HORIZON CONSIDERATIONS

54. 4/19/2015© Nicoletti-Flater Associates Always Proactively Train for an Event Horizon

55. 4/19/2015© Nicoletti-Flater Associates RESPONSE STRATEGIES (Initiate At The Event Horizon) Activation of Delay Systems/Target Hardening Internal Notification Hi-Tech Hi-Touch External Notification Activation of Survival Strategies

56. 4/19/2015© Nicoletti-Flater Associates STRATEGIC RESPONSES: PERSONAL SURVIVAL STRATEGIES WHEN VIOLENCE IS OCCURRING: GET OUT HIDE OUT – Saferoom/Concealment FAKE OUT – Play Dead TAKE OUT – Active Resistance

57. 4/19/2015© Nicoletti-Flater Associates AFTERMATH

58. 4/19/2015© Nicoletti-Flater Associates THERE WILL BE AN AFTERMATH AND YOU MUST DEAL WITH IT.

59. © Nicoletti-Flater Associates THE SIZE OF THE PSYCHOLOGICAL FOOTPRINT WILL EXCEED THE SIZE OF THE MEDICAL FOOTPRINT

60. AFTERMATH ISSUES Physical Clean Up Psychological Clean Up Business Reactivation 4/19/2015© Nicoletti-Flater Associates