Objectives

The objective of this presentation is to discuss clinical challenges arising from ethical/moral, cultural, public police/legal, unintended trauma, and agency dilemmas that child and adolescent psychiatrists face when providing student school safety evaluations.

Methods

Bettina Bernstein, DO, will use clinical cases and an active learning tool, namely the Wheel of Culture and Ethics, to address ethical/moral, cultural, public police/legal, unintended trauma, and agency dilemmas that can arise. Attendees will spin the wheel and discuss along with the presenter hot topics including dual agency, duty to protect, duty to warn, and microaggressions (AACAP Code of Ethics, 2014).

Results

Ethical/moral, cultural, public police/legal, unintended trauma, and agency dilemmas add aspects of complexity to student school safety evaluations. Child and adolescent psychiatrists need to be able to address these complexities and be prepared to tackle these issues to engage in best practices to support youth, families, and the community.

Conclusions

This topic matters to child and adolescent psychiatrists in clinical practice because safety is a key aspect within the context of comprehensive mental health evaluations in various settings, including educational, foster care, and juvenile justice settings, as well as when families ask for an assessment. Triggers are often a report of (primarily verbal) aggression toward teachers as well as peers. If clinicians are asked, “Will this youth be the next school shooter?,” they should have an awareness of the myths that developed after the shootings at Columbine and Sandy Hook, such as “profiling” a youth’s style of dress or social interaction. Child and adolescent psychiatrists will be aware of ethical/moral, cultural, public police/legal, unintended trauma, and agency dilemmas to prevent unintended consequences (microaggression, macroaggressions, isolation, parental rejection/hostility, and clinical worsening) during the evaluation process.