ACUTE - Adolescent & Child Urgent Threat Evaluation

by Russell I. Copelan, MD and David Ashley
Purpose: Assess risk of near-future violence (both homicidal and suicidal) among children and adolescents
Age: 8 through to 18 years
Admin: Individual
Time: 10-20 minutes
The ACUTE is a 27-item structured assessment that is based on information obtained through various sources including, but not limited to, patient interview, chart review (e.g., medical, school), and family interview. The ACUTE is designed to assist in the evaluation of a child's or an adolescent's actual, attempted, or threatened act to harm him- or herself or others. More specifically, the ACUTE was designed to assist in determining the associated level of risk for near-future violence (e.g., hours to days). The measure provides you with an overall Threat Classification (i.e., Extreme Clinical risk factors, High Clinical risk factors, Moderate Clinical risk factors, Low Clinical risk factors) as well as additional cluster scores including Precipitating Factors, Early Precipitating Factors, Late Precipitating Factors, Predisposing Factors, Impulsivity, and the ACUTE Total score.

The ACUTE is designed to be used in a variety of situations and settings including Hospital A & E departments, inpatient care, outpatient care, schools, and research, and can be used by a number of psychiatric/psychological personnel including physicians, psychiatrists,educational psychologists, clinical psychologists, psychiatric nurses, and  clinical social workers. In addition, the ACUTE may be useful in assessing adverse drug reaction and in serial assessment (e.g., following hospital discharge or outpatient supervision).


The standardisation sample for the ACUTE included 542 children and adolescents ages 8-18 years. This sample consisted of four study groups: (a) Non-Threat, (b) Suicide Threat, (c) Homicide Threat, and (d) Homicide-Suicide Threat.

Reliability and Validity

  • Internal consistency was moderate to high for cluster scores and the Total score with alpha coefficients ranging from .70 to .85.
  • Test-retest stability was examined using a subsample of a group and corrected correlations ranged from .71 to .97 over a period of 24 to 48 hours.
  • The Total score yielded an interrater reliability coefficient of .94, with the clusters ranging from .74 to .99.
  • Convergent and discriminant validity was examined with the Clinical Assessment of Depression™ (CAD™), the Children's Depression Inventory (CDI), and the Suicide Ideation Questionnaire (SIQ).
  • Criterion-related validity was assessed via an age-matched psychiatric group (n = 70) that contained individuals who were not at risk for violence.


The ACUTE materials consist of the ACUTE Professional Manual, the carbonless ACUTE Rating Form, which includes the Scoring Sheet, and the Score Summary Sheet. The Professional Manual guides you through the ACUTE question by question, providing the relevance of each item, and suggestions for sources of information for each of the 27 items. After scoring is completed, the raw scores are transferred to the ACUTE Score Summary Sheet, where a percentile range and a qualitative range are determined for each of the clusters and for the Total score. Clinical interpretation is carefully outlined in the Professional Manual through a five-step interpretive guideline.


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