The Assessment of Chronic Risk in Youth (ACRY): Development and Initial Validation in a Clinical Sample

Assessment and monitoring of chronic suicidal and homicidal risk are necessary components of care within youth behavioral health clinics. Few standardized assessments or guidelines exist to help clinicians designate youth chronic risk status. The current study presents the Assessment of Chronic Risk in Youth (ACRY), a newly developed instrument that contains empirically supported risk and protective factors and guides clinicians in assessing chronic risk status over time. This study aimed to (a) examine the instrument’s validity against an expert consensus, (b) measure interrater reliability, and (c) examine associations between each risk and protective factor and risk classification. The ACRY was completed on 111 youth (ages 6–20 years, 67% female) within an outpatient clinic. The ACRY achieved excellent interrater reliability and high sensitivity and specificity against expert consensus ratings. Significant associations between several risk factors and total number of risk factors with higher-risk classifications were found. Active suicidal ideation, intent, and plan were significantly associated with high risk classification. Passive suicidal ideation, hospitalization, emergency room visits, nonsuicidal self-injury, perceived burdensomeness, high-risk behaviors, impulsivity, and substance use differentiated high from low, and moderate from low-risk classification. Greater number of risk factors was associated with higher risk categorization. Self-esteem and connection to family were significantly more likely in low-risk versus moderate-risk individuals. The ACRY is a promising new clinical and administrative tool that systematically and reliably documents chronic risk in youth.