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North America Regional Hub: Introduction to City-Led Prevention of Hate and Targeted Violence — How to Launch a Behavioural Threat and Intervention Programme in Your Community

Publication Date:

23/07/2025

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Behavioural Threat and Intervention ProgrammeIntroduction to PreventionNorth America Regional HubPreventing Hate and Targeted Violence

— 18 minutes reading time

This report provides a summary of discussions during the webinar and does not necessarily reflect the views of the Strong Cities Network Management Unit, Strong Cities members, event sponsors or participants.

Summary

On 23 July, the Strong Cities Network continued its series of webinars on Introduction to City-Led Prevention of Hate and Targeted Violence. The session focused on How to Launch a Behavioural Threat and Intervention Programme in Your Community and multi-disciplinary programmes designed to identify those who are showing behavioural signs of being ‘at risk’ of mobilisation to violence and to intervene before they cause harm to themselves or others (i.e., what is known in the public health field as secondary prevention).  

Edvin Sandström, team leader at the Swedish Center for Preventing Violent Extremism (CVE Center) in Stockholm (Sweden), spoke about the Center’s work in developing and operationalising a social worker-driven, secondary prevention model for municipalities across Sweden, which could offer lessons and otherwise help inform city-level efforts on this side of the Atlantic. Eric Rosand, Executive Director, Strong Cities Network, then led a discussion among three local practitioners in the United States, which included:

• Heidi Ellis, a clinical psychologist and Director of the Trauma and Community Resilience Center at Boston Children’s Hospital (Massachusetts, United States);
• Jodie Chappuis, a social worker and System Navigator at the Wood County Alcohol, Drug Addiction, and Mental Health Services Board (WCADAMHS) (Ohio, United States), and
• Kelsey Lynch, a co-response specialist at the Police Department in Bainbridge Island (Washington, United States).

Each participant spoke about the work they have done to build multi-disciplinary secondary prevention programmes in their city, county or community. They highlighted lessons learned and challenges for city and other local practitioners in North America and beyond to consider should they decide to develop new or strengthen existing multi-disciplinary intervention programmes for individuals demonstrating behavioural signs of radicalisation to violence and/or other antisocial behaviour.

Key Takeaways

1. The hate and extremism threat landscape has changed quite dramatically in recent years. Among the changes have been a shift from organised groups to more lone actors responsible for violence and an increase in school attacks that are committed by individuals (younger than previously) with a mix of ideological and other motivations. 
2. Research is increasingly showing that the ‘garden variety struggles that kids have’, e.g., feeling isolated or having experienced trauma, are key factors for why young people might be drawn to extremist or other violence.
3. There is greater awareness of the need to shift our understanding of what is behind risks of violence and expand the solutions beyond just law enforcement to include wrap-around psychosocial services. This places an emphasis on building trusted relationships and partnerships and, more broadly, cooperation on individual cases between mental health and social workers and schools on the one hand and police and other law enforcement professionals on the other. This can require overcoming cultural, linguistic and other differences between these different stakeholder groups.
4. Numerous models exist for developing and operationalising local multi-disciplinary secondary prevention programmes, which can be led by the local government, a hospital or other non-governmental institution. The role of law enforcement varies, and the willingness of mental health providers to treat individuals demonstrating risks of violence depends on the context.
5. Social and mental health professionals and police can benefit from having a common language, and a strength, risk and needs assessment tool to reduce uncertainty regarding case management involving these types of individuals. 
6. The co-response model, i.e., one where local police and a social worker or mental health professional respond to emergency calls involving someone experiencing a mental health crisis, is increasingly common in cities in the United States and can help lay the foundation for more local secondary prevention programmes. More local police agencies are either embedding mental health professionals within their departments or operating with a memorandum of understanding with a mental health agency.   

Key Themes

Mixing security and social care logics: the Swedish support model to prevent violent extremism

Edvin shared how, when the CVE Center was first established in 2018, it focused on how it could work with and facilitate more cooperation between the local police and intelligence services to prevent more traditional instances of terrorism and violent extremism. However, this changed in 2019 when Sweden started to face more extremist attacks on and in schools and a mixing of ideologies. He said that this led to social services becoming much more relevant in terms of the CVE Center’s work and the tools it needed to develop to support local practitioners across the country.

In 2020, responding to requests from first responders in the police, social services and schools, the CVE Center began to develop a support model to strengthen preventive work against violent extremism. These local practitioners wanted to know what questions they could ask, how they could strengthen multi-actor collaboration and, most importantly, what risk and protective factors they should look out for.

The Center explored the practices of a number of other countries to see how they addressed similar threats through collaborative preventative measures. One of the key findings was that cooperation between security actors and social and health workers was often constrained. This was due to the different ‘logics’ of the two stakeholder groups: while one was concerned only about the security risks an individual might pose, the other was concerned only about their social and mental health needs and vulnerabilities.  Information sharing between the two groups on individual cases was limited. As a result, there were several instances where social workers had flagged individuals in their database who ended up committing violence. 

In short, vulnerabilities and risks had been spotted, but there was no case management system in place to address them. Social services lacked guidance about what to do with such individuals, and interactions with the police were challenging because of their different terminology, cultures and concerns. This, Edvin said, underscored the need to find a common language and tool for those who needed to be involved in order to reduce uncertainty regarding case management involving these types of individuals. 

The tool – or support model – that the CVE Center developed consists of four parts: a conversation guide (what questions to ask), recommendations on how to strengthen internal and external multi-agency collaboration, and what should be included in a report to social services and in a police report. That tool, informed by interviews with more than 150 practitioners, is now the foundation of the country’s behaviour, threat and assessment model.

Edvin shared how the Center 1) then developed and delivered training on how to use to the tool; 2) has a mobile support team that can be deployed to support small municipalities that need help with individual cases; 3) raises awareness in schools across the country, both about youth radicalisation and how it blends with recruitment to organised crime and other illegal activity, and the tool, including what schools need to include in reports to ensure they ‘stick’ in the system; and 4) regularly fine-tunes the tool based on case management learnings shared by the mobile support team. 

New national legislation imposing a legal obligation on all Swedish municipalities to actively engage in local crime prevention has created a more conducive environment for the national CVE Center to deliver guidance and recommendations to municipalities on a topic where disparate municipality approaches had been the norm.

He pointed to four key learnings from the Center’s work in developing and deploying this tool across the country:

• include local practitioners, i.e., the end-users, in the development of prevention tools and models;
• try to understand and bridge the different institutional frameworks and logics between security and social care practitioners;
• promote dialogue among the different professions on the risk versus protective factors of individuals demonstrating concerning behaviours; and
• understand how local police think about prevention and how they speak with non-security professionals, from schools and social care, about individuals of concern.

Different Local Models in the United States: Hospital-Led, County-Led, City-Led

The three local practitioners from the United States shared their experiences in developing and implementing multi-disciplinary behavioural threat and vulnerability assessment and intervention programmes: one is housed in a private hospital, one in a county government and one within a city police department.   

The Hospital-Led Model

Heidi Ellis said that Boston Children’s Hospital set up a speciality clinic to work with youth who are showing behavioural signs of risk for terrorism or targeted violence, and that their approach involves a multi-disciplinary team that receives referrals from a variety of sources, including the FBI, school districts and families in the community. Upon receipt, they meet with the youth and family and conduct a comprehensive strengths, risks and needs assessment, trying to understand why the individual might have come to see violence as a solution for their problems.

More broadly, however, Heidi said that the assessment looks at the ‘social ecology’ of the individual: what kind of stressors the individual might be encountering, what’s going on at home, what’s happening in the school? She added that while this is similar to what a thorough mental health assessment looks like, the difference is that it includes a focus on what’s driving the violence risk and “what the levers are to provide some immediate stability to reduce that risk … and shift them off the pathway to violence”. For each referred individual, she said, the team, which includes expertise in social work, psychiatry, psychology and educational advocacy, seeks to understand what the programmes or resources are in their community to which the individual and family can be connected. Although not “partners’ with law enforcement, Heidi said that the team has a close relationship with them, with the trust having been built up over time.

For Heidi, the initial impetus to develop this programme was that the factors that were showing up in her team’s research on young people’s support for violent extremism were similar to the “garden variety struggles that kids have”, e.g., feeling isolated or having experienced trauma. These were simply vulnerable young people who were getting caught up in thinking that violence or extremist ideology can be a solution for day-to-day struggles for which we have other solutions. The idea of a law enforcement arrest being the solution to their problems “felt really terrible”, she said. So, she and her colleagues started to think about shifting the lens on how we understand what is behind this violence risk and expanding the solutions beyond just law enforcement to include wrap-around psychosocial services.

County-Led Model

Jodie introduced the work of the WCADAMHS Board, which is to plan, fund and monitor services for people with serious and persistent mental illness and alcohol and other drug addictions throughout the county, and how the Board has begun to workwith Wood County schools as they establish Behavioural Threat Assessment and Management (BTAM) Teams, which are crucial for proactively addressing and managing potential threats within schools. 

Jodie explained how the Board was running into problems with law enforcement and schools, and mental health professionals not communicating with each other around the handling of individual cases. All were very good at their jobs, but a “team approach was lacking”, and a case management system needed to be developed for situations where individuals are assessed in schools and vulnerabilities identified. For most such situations, law enforcement is not the answer, as you “can’t arrest young people just because they might have scary intentions or thoughts”. 

She also pointed to some of the challenges, which result from having BTAMs in some but not all school districts in the county. Among other things, this means that if a student involved in a BTAM in one system transfers to a district without one, information about their case (both assessment and treatment plan) does not get transferred. This can result in a disruption of services/support provided to that individual.

Police/City-Led Model

Kelsey Lynch, a social worker embedded in the local police department in Bainbridge Island, spoke about the importance of integrating mental health and advocacy services into law enforcement responses, offering a model for trauma-informed care that not only supports victims but also enhances overall public safety. 

As a rural city outside of Seattle, she emphasised the need “to get really creative in how you collaborate and how you develop relationships” in such an environment. She said that her community health navigator programme complements ongoing efforts to educate police officers about behavioural health issues and helps those with mental health or other issues navigate the resources available to them outside the criminal justice system. The programme is designed to be a partnership with community agencies, and for Kelsey’s role (as social worker) “to be the liaison and the translator from the law enforcement world to the social services and mental health world and vice versa”.

She explained that her focus has shifted from “high profile, high visibility” homeless or other individuals who were already connected to many of the county’s social and health services and known to law enforcement, to engaging with the community at an earlier entry point prior to their engagement with law enforcement. This meant, for example, looking at how to engage with an individual and family and school system following the first mental health crisis or petty theft or trespassing charge, rather than focusing all of the programme’s attention on the individuals who are already accessing the range of county services and on law enforcement’s radar.

Kelsey said that the community and school system were enthusiastic about this shift, which started at the same time that schools went online at the beginning of the COVID-19 pandemic. She explained how “schools really started utilising me since they were no longer seeing kids in person, and that really expanded our relationship and their ability to rely on my role with the Police Department to communicate with them risks that we were seeing in the community, and to be their liaison within the home and within that person to person relationship, since the school staff was doing everything virtually”.

Her role involves helping to translate for social service providers the high-risk behaviours that are manifesting in the community, especially among youth, to ensure psychosocial support is put in place to help mitigate some of those behaviours, to advise law enforcement on how they can best support the families and schools in terms of their response to some of these high-risk behaviors.

She said Bainbridge Island is “trying to create this community wrap-around approach where law enforcement is not seen as the only option – when arrest can be either counterproductive or not possible”. The goal is to connect individuals with the services and other resources in order to help alleviate the social isolation, petty crime and other early warning signs of at-risk youth, before an individual has their first run-in with law enforcement.

She added that she increasingly finds herself having conversations with parents about how to mitigate some of the high-risk behaviours, or in schools, having conversations around high-risk truancy, drug use on campus, sexual assault or inappropriate relational components. Schools, she said, “bring us in as a resource to be able to share our knowledge about what’s going on in the community”.

Challenges to operationalising, sustaining, scaling and replicating locally-led secondary prevention programmes in the United States

Throughout the webinar, the three local practitioners surfaced a number of challenges to operationalising and sustaining these types of programmes. These include: 

• Unique nuances of partnering mental health professionals with law enforcement: These stakeholders often use different terminology and lack trusted relationships with each other, especially in the current political climate. Kelsy explained how Bainbridge Island has tried to explain the benefits of embedding social workers or mental health professionals within local law enforcement to the community, the mental health agencies and law enforcement agencies. Among other things, this alleviates the burden of local police having to be the first responder to mental health calls and the secondary stressor on a 911 system by having an alternative to a law enforcement response to emergency calls involving a mental health crisis.   
• Navigating an imperfect mental health system: How to make a mental health system “that is already kind of broken and not working too well for a lot of kids and families” fit for purpose to some of the most high-risk and complicated cases. Part of this challenge, Heidi said, involves navigating the complex billing system, which might leave only some of what’s needed covered by insurance.
• Treating those at-risk of violence as ‘unicorns’: Some mental health professionals remain reluctant to work with individuals who are viewed as potentially violent or otherwise high-risk. Thus, there remains a need to continue to dispel the notion that these cases are ‘unicorns’ and remember that there are many existing mental health tools that can be leveraged.
• Reducing stigma around mental health support: Families may be reluctant to have a child in therapy when first approached. Before signing an agreement to work with the individuals, the Boston Children’s Hospital’s team often spends a lot of time trying to understand the family’s concerns and to provide it with non-clinical support. This helps build trust and reduce resistance to therapy.
• Lack of specialised training/tools for providers: There are tools now being developed to help providers do a thorough collaborative assessment around violence, risk, and management (e.g., T-SAM (Targeted Violence and Terrorism Strengths, Needs, and Risks: Assessment & Management Tool)).
• Capacity Building/Replicating/Scaling: Although the number of BTAM and related secondary prevention programmes is increasing across the United States, there remain significant gaps in geographic coverage. While local programmes and service providers typically are not able to work with individuals outside of their city, county and/or community on an ongoing basis, in some instances, there may be ways in which they can nevertheless support individuals in jurisdictions where there is no such programme and capacities are otherwise more limited. This might involve undertaking a thorough strengths, risks and needs assessment that can be handed off to community providers in the relevant jurisdiction. This would include clear indicators of where the violence risk is coming from, recommendations for what type of interventions might be appropriate and a list of resources and tools that the community providers might find useful.
  
  Heidi shared a number of thoughts about how to address the replication/scaling challenge in a country as large and geographically diverse as the United States. One is by having a number of centres (or hubs) around the country that can provide more specialised assessment and treatment recommendations for at-risk individuals in their region, followed by training and capacity-building for community providers so that those who are used to managing suicide or other risks can become skilled at also managing risks of homicide or other violence. Among other things, this will help with dispelling the notion that this latter group of individuals are a ‘scary population to work with’. A second and not mutually exclusive idea is to invest in getting more hospitals and other relevant institutions around the country to create multi-disciplinary teams and programmes like the one at Boston Children’s. Responding to requests from local governments and hospital systems, efforts are underway to develop a guidance document on how to build a speciality clinic for individuals demonstrating behavioural risks of violence.  
• Sustainability: particularly given the recent termination of federal funding for this work, the sustainability of existing – let alone the development of new – programmes is more challenging than ever. This underscores the importance of getting local governments to include dedicated funding for these efforts in their budgets. Participants agreed on the value of having predictable, long-term funding for this work. Kelsey shared how the City of Bainbridge Island convinced its council to allocate funding in the city budget to support programming – which had been catalysed by federal and state grant funding – by successfully making the case for why early intervention and engagement with individuals before they become high visibility situations and pose threats of violence is in everyone’s interest, allowing police to focus their resources on those threats.

In such a resource and capacity-constrained environment, speakers highlighted the importance of identifying and making the most of what resources and programmes already exist within your city, county or community. It was asserted that by thinking holistically rather than in a piecemeal programmatic way about what residents at risk of becoming violent need, the “wiser we’ll be about using our limited resources and helping a community, even when we don’t have everything we wish we had for it.”  

Next Steps

This webinar was presented as a part of the Strong Cities Introduction to City-Led Prevention of Hate and Targeted Violence webinar series, focused on sharing best practices and building awareness of the foundational aspects of city-led hate and targeted violence prevention. Please sign up for Strong Cities Network’s mailing list to receive invitations for upcoming webinars and other events.

Additional Resources

• A Guide for Mayors: Preventing and Responding to Hate, Extremism & Polarisations, Strong Cities Network (updated March 2025)
• A Guide for Cities: Preventing Hate, Extremism & Polarisation (see Navigating Difficult Issues), Strong Cities Network (updated March 2025)
• A Ten-Step Roadmap for Enhancing City-Led Support for Community-Based Programmes to Address Hate and Extremism, Strong Cities Network (February 2025)
• Community Resilience Study: Kumanovo, North Macedonia, Strong Cities Network (updated February 2025)
• A Guide for City-Led Response, Strong Cities Network (updated February 2025)
• Bridging Differences Playbook, Greater Good Science Center & Bridging Differences (February 2025)
• Countering Hate Speech in Times of Crisis: Considerations for Mayors and Local Governments, Strong Cities Network (December 2024)
  

Contact Information 

For more information on this event, the webinar series or Strong Cities North America programming, please contact the North America Regional Hub at [email protected].

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