Doing a Tarasoff risk assessment isn't about filling out a form. It's about documenting why you think someone might kill someone else, and whether you need to break confidentiality to stop it.
The Tarasoff duty to warn or protect comes from a 1976 California Supreme Court case, but it has been adopted in some form across most U.S. jurisdictions. When a client makes a credible threat against an identifiable victim, the clinician has a legal obligation to take reasonable steps to protect that potential victim. This could mean warning the victim, notifying law enforcement, or initiating involuntary commitment. The exact requirements vary by state, so you need to know your jurisdiction before you even think about putting pen to paper. In practice, the assessment itself is a structured process of evaluating homicidal risk. You are not guessing. You are systematically going through risk factors, protective factors, and the specifics of the threat to arrive at a conclusion that can withstand legal scrutiny.
Tarasoff Homicide Risk Assessment
Here is how the actual process works when you are sitting across from a client who has made a threat. First, you establish the elements. Is there a threat? Is it specific? Is the target identifiable? These three questions determine whether Tarasoff even applies. A vague "I want to kill everyone" at 2 AM during a psychotic episode is very different from "I have a gun and I am going to my boss on Monday morning." The specificity matters enormously. After establishing the threshold elements, you move into structured risk assessment. The most commonly used tools in this context are the HCR-20V3, the SARA, and the MOA. I use the HCR-20V3 as my baseline because it gives you a clear framework covering historical, clinical, and risk management items. It takes about 45 minutes to complete properly if you have the collateral information. Without collateral records, it takes longer and the reliability drops significantly. One thing most beginners miss is that the Tarasoff assessment is not the same as a general violence risk assessment. The Tarasoff question is narrower: is there a credible, imminent threat to an identifiable person? General risk assessments look at broader patterns. I have seen clinicians conflate the two and end up with reports that are either too broad to be useful or too narrow to protect anyone. Keep the focus tight.
When I document the assessment, I follow a consistent structure. I record the client's exact words, the context in which the threat was made, the client's mental state at the time, any prior history of violence, substance use, access to weapons, and the feasibility of the threat. I also note protective factors like social support, treatment engagement, and remorse. This takes about 20 to 30 minutes of documentation time after the clinical interview itself. Here is a problem I ran into recently that probably would not show up in any textbook. I was assessing a client who had made a threat against a specific individual, but the threat was mediated through social media. The client had posted graphic content about harming the person, but it was mixed in with what appeared to be fictional creative writing. Determining whether this constituted a credible threat under Tarasoff required me to look at the client's posting history, their stated intent, whether they had taken any concrete steps toward the target, and whether they distinguished between fantasy and action. I spent an extra hour reviewing the client's digital footprint and consulting with a colleague who specializes in forensic assessments. The workaround was reaching out to the platform for posting history and consulting the client's previous statements across multiple channels. The conclusion was that it did not meet the threshold for Tarasoff duty, but I documented every step meticulously because that case could have gone either way in court. Another counter-intuitive point that people overlook: making a threat does not automatically mean you must warn the victim. The duty is to take reasonable steps, and the appropriate response depends on the level of risk. If your assessment concludes the risk is low to moderate, options like increasing treatment frequency, developing a safety plan, or encouraging voluntary hospitalization may satisfy your legal obligation without escalating to a full duty-to-warn situation. If the risk is high and imminent, then warning the victim and contacting law enforcement is typically required.
Get the Full Details
The biggest pitfall I see is inadequate documentation. When a case goes to court, the quality of your assessment is judged by what you wrote down, not what you actually thought. I have seen clinicians who made sound clinical judgments but lost cases because their documentation was sparse or contradictory. Every decision point should be documented. Why you chose a particular tool, what collateral information you considered or failed to consider, and your rationale for the risk level you assigned. There are limitations to this whole process. Structured risk assessment tools like the HCR-20V3 improve accuracy over unstructured clinical judgment, but they are not perfect. False positives are common, and the tools were largely normed on forensic populations, which may not match your outpatient setting. A client who scores moderate risk on the HCR-20 might actually be low risk in a community context where they have stable housing, employment, and treatment compliance. You need to adjust your interpretation based on the population you are working with. Another limitation is the question of imminence. Tarasoff applies to threats that are serious and imminent, but "imminent" is not well-defined legally. Some courts interpret it as days or weeks. Others accept that a threat made with a specific plan and means can be imminent even if the target date is months away. Your jurisdiction matters here, and you should consult local case law or legal counsel if you are uncertain.
If you need a formal tool to guide your assessment, the HCR-20V3 is available through Psychological Assessment Resources. The SARA is available through its developers. These are not free tools, and they require training to use properly. Using them without adequate training can actually increase your liability rather than decrease it, because improper administration invalidates the results. The most important thing to remember is that a Tarasoff assessment is a legal event as much as a clinical one. Your documentation will be reviewed by attorneys, judges, and juries. Write for that audience, not just for your own clinical reference. Be precise, be thorough, and do not inflate your risk levels to cover yourself. Over-warning creates its own problems, including eroding client trust and potentially violating confidentiality when no real threat existed.
