1. Confronting High-Risk Behaviors:
Assessment and Referral
Fred Carter, Jr.- Franklin Pierce University
Jeff Barker- Iona College

2. Learning Outcomes
• Enhance understanding of high-risk behaviors
and their impact on individuals and the
community
• Enhance understanding of the importance of the
RA/CA role in recognizing and assessing high-risk
behaviors
• Learn effective methods to make appropriate
referrals
• Learn how to intervene in order to appropriately
confront high-risk behaviors

3. Defining High-Risk Behaviors
• Behaviors that endanger self and/or others
• Pose threat or disruption to the community
• Threatens or jeopardizes the health of an individual or groups
of individuals.
Examples include:
– Sexual Risk Practices and Behaviors
– Substance Abuse
– Eating Disorders
– Self-Injury
– Suicidal Ideation and Suicide

4. Sexual Risk Practices and Behaviors
• Relationship with residents
– Expected to have some level of “expertise”
– Built on trust and inherent responsibility and
respect
– Appreciate and respect your opinion
– Close bond

5. Sexual Risk Practices and Behaviors
• Engaging with multiple and/or anonymous partners
• Unprotected sexual activity
– 50% of new reports of STIs are received from
individuals between 18-24
• Increased risk of STI contraction and pregnancy

6. Substance Abuse
• Pattern of use leading to clinically
significant impairment or distress
– There is a persistent desire or unsuccessful effort to cut down or
control use of the substance.
– A great deal of time is spent in activities necessary to obtain the
substance, use the substance, or recover from its effects.
– Recurrent use of the substance resulting in a failure to fulfill major role
obligations at work, school, or home.
– Continued use of the substance despite having persistent or recurrent
social or interpersonal problems caused or exacerbated by the effects
of its use.
• Must exhibit at least 2 of 11 criteria to be considered abuse
(DSM-V)

7. Symptoms of Excessive Use
• Frequent intoxication
• Personality changes and mood fluctuations
• Regularly skipping classes
• Drinking at inappropriate times (i.e., all day, early morning, before
tests)
• Neglect of personal appearance or health
• Inability to sleep or sleeping much more than usual
• Alcohol-related legal problems (i.e., traffic violations, civil
offenses)
• Ignores or infringes on other’s rights frequently
• Repeated incidents of disruption or damage that is alcohol-related
• Blackouts
• Denial of problem

8. Eating Disorders
An eating disorder is any eating pattern that
has a non-physical basis. It is an internal
struggle for control of one’s life and often
includes the following underlying issues: lack
of self-esteem; inability to express feelings,
wants, and needs; strong need for approval
from others; lack of a sense of self and
identity; and feeling a strong need to
conform to others’ expectations and
demands.

9. Eating Disorders
• Abnormal eating habits.
• Distorted body image. Includes inability to perceive
one’s own thinness despite consistent concern on the
part of one’s family and friends; “feeling fat” even
though one is at normal weight or far underweight.
• Intense fear. Fear of getting fat, when in reality, the fear
is of losing control in one’s life.
• Peculiar habits. Includes strange rituals around eating
such as rigid meal times, eccentric or idiosyncratic
menus, amounts of food, preparation, etc.
• Excessive and compulsive exercise. Often there is no sign
of fatigue.
• History of conforming. Includes overachieving behavior
of having always been a “good little girl or boy.” Strong
need for perfection.
• Cessation of menstruation.

10. Eating Disorders
Anorexia Nervosa
• Exhibit concern about their
weight and control weight by
diet, vomiting, or laxative
abuse.
• Eating pattern may alternate
between binges and fasts.
• Most bulimics are secretive
about binges and vomiting.
• Food consumed during a binge
has a high caloric content.
• Majority of individuals are
within a normal weight; some
may be slightly
under/overweight.
• Depressive moods may occur.
Bulimia
• Abnormal weight loss of 25% or
more with no medical illness
accounting for the loss.
• Reduction in food intake, denial
of hunger, and decrease in
consumption of fat-containing
foods.
• Prolonged exercising despite
fatigue and weakness.
• Intense fear of gaining weight.
• Peculiar patterns of handling
food.
• Abnormal
cessation/suppression of
menstrual cycle.
• Some exhibit bulimic episodes
or binge eating followed by
vomiting or laxative abuse.

11. Self- Injury
• Intentional, direct injury of body tissue most
often done without intention of suicide
• 2006 Study- 17 % of college students self-
injure (cut, carve, burn, or other means)
• More common among women (~ 60 % )
• Creates feeling of control
• Elicits emotional response
• Majority not suicidal

12. Suicidal Ideation and Suicide
Suicide does not discriminate. People of all genders, ages, and
ethnicities can be at risk for suicide. But people most at risk tend to
share certain characteristics. The main risk factors for suicide are:
• Depression, other mental disorders, or substance abuse disorder
• A prior suicide attempt
• Family history of a mental disorder or substance abuse
• Family history of suicide
• Family violence, including physical or sexual abuse
• Having guns or other firearms in the home
• Incarceration, being in prison or jail
• Being exposed to others’ suicidal behavior, such as that of family
members, peers, or media figures.

13. Suicidal Ideation and Suicide
• Recognize clues. Look for symptoms of deep
depression and signs of hopelessness and
helplessness. Listen for suicide threats and
words of warning, such as “I wish I were
dead,” or “I have nothing to live for.” Watch
for despairing actions and signals of
loneliness. Notice whether the person
becomes withdrawn and isolated from others.
Be alert to suicidal thoughts as a depression
lifts.

14. Suicidal Ideation and Suicide
• Deep depression
• Withdrawal from family and friends
• Drop in grades
• Drop in activity in hobbies, sports, and other activities
• Major loss of a steady boyfriend/girlfriend
• Eating and/or sleeping habits change
• Outbursts of unusual or reckless behavior
• Giving away treasured possessions
• Preoccupation with the subject of death
• Talk of suicide or worthlessness
• Sudden calm after big upset
• Personal neglect

15. Myth vs. Fact
MYTH: Improvement following a suicidal crisis means the suicidal risk is over.
FACT: Most suicides about three months following the beginning of
“improvement”, when the individual has the energy to put his/her morbid
thoughts and feelings into effect.
MYTH: Suicide strikes more often among the rich or, conversely, it occurs almost
exclusively among the poor.
FACT: Suicide is neither the rich man’s disease nor the poor man’s curse. Suicide is
very “democratic” and is represented proportionately among all levels of
society.
MYTH: Suicide is inherited or “runs in the family”.
FACT: Suicide does not run in families. It is an individual pattern.
MYTH: All suicidal individuals are mentally ill, and suicide is always the act of a
psychotic person.
FACT: Studies of hundreds of genuine suicide notes indicate that although the
suicide notes indicate the suicidal person is extremely unhappy, he/she is
not mentally ill.

16. Myth vs. Fact
MYTH: People who talk about suicide do not commit suicide.
FACT: Of any 10 persons who kill themselves, 80% have given warnings of their
suicidal intentions.
MYTH: Suicide happens without warning.
FACT: Studies reveal that a suicidal person gives many clues and warnings
regarding his/her suicidal intentions.
MYTH: Suicidal people are fully intent on dying.
FACT: Most suicidal people are undecided about living or dying, and they gamble
with death, leaving it to others to save them. Almost no one
commits suicide without letting others know how he/she is feeling.
MYTH: Once a person is suicidal, he/she is suicidal forever.
FACT: Individuals who wish to kill themselves are suicidal only for a limited period
of time.

17. Examining the RA/CA Role
Responsibilities
• Programmer
• Role Model
• Resource
• Referral Agent
• Policy Enforcer
• Assessment Agent

18. Assessment Agent
• Highlights the “front lines” nature of the
position
• Role usually not emphasized
• Referrals are often made
– High-risk and low risk
• Essential for (early) intervention

19. Assessment Agent (con’t.)
As an assessment agent, your responsibility is to
evaluate the situation and determine what the
next step is.
• Referral?
• Conversation?
• Email to supervisor?
• Other things

20. Referrals
Given the position that most RAs/CAs hold, referrals are more
typical starting with Substance Abuse and required with
things such as Self-Injury and Suicidal Ideation/Suicide.
Note: More often than not, you should or will inform your supervisor in each of these instances
Sexual Risk Practices Conversation w/student
Substance Abuse Conversation w/student, possible referral
Eating Disorders Conversation w/student, possible referral
Self-Injury Referral
Suicidal Ideation and Suicide Referral

21. Referrals (con’t.)
1. Know the resources available on your campus
and keep a list of those someplace
2. Gather as much information as you can from
the student or other parties directly involved
3. Report up and not out
4. Provide support for your residents both the
support they ask for and the support you
recognize they need
5. Follow up with students to ensure that they are
doing well and improving

22. Confronting High-Risk Behavior
1.Recognize the behavior
2.Remain calm and breathe
3.Talk to the resident
4.Let the resident talk
5.Meet the resident where they’re at
6.Decide on referrals
a.Report up for more support?
b.Simply inform supervisor about conversation?
c.Other steps?

23. Policies and Procedures for the
RA/CA Position
Each institution has different policies and
procedures with how to approach these issues.
Iona RAs have the initial conversation and then
contact the Professional Staff Member on Duty
to receive feedback and next steps. The
Professional Staff Member makes the call
whether a referral needs to be made.

24. Important Things to Remember
• You are the first line of defense and
awareness of residents who are engaging in
high-risk behaviors
• You’re not alone
• Remain calm and breathe
• Remain where the resident is at
• Always call up if you need support

25. Questions?