Incidents Of Physical Aggression Research Articles

Evaluating the impact of an information-based education and training platform on the incidence, severity, and coping resources status of workplace violence among nurses: a quasi-experimental study

BackgroundWorkplace violence among nurses has emerged as a critical issue, posing a significant threat to their occupational safety. Education and training are the primary measures employed to prevent and respond to workplace violence. However, the current approaches have proven ineffective, possibly due to a lack of consideration for the specific needs of clinical nurses. Therefore, it is essential to explore the effectiveness of an informational education and training platform tailored to nurses' requirements. This study aimed to investigate the impact of such a platform on the incidence, severity, and coping resources of WPV in nurses.MethodsThis research was a quasi-experimental study. An information-based education and training platform focused on nurse workplace violence was developed through literature reviews, expert meetings, consultations with software development companies, and a trial run. A tertiary general hospital in Suzhou was selected, in which hospital district A was the intervention group and hospital district B was the control group. A total of 276 nurses were recruited, 140 in the intervention group and 136 in the control group. The nurses' incidence, severity, coping resources status, and evaluation of the application were measured before the intervention and at 1, 3, and 6 months after the intervention.ResultsThe overall incidence of workplace violence, verbal aggression, and verbal threat among nurses showed statistically significant differences (P < 0.05) for the time effect, while the incidence of physical aggression demonstrated statistically significant differences (P < 0.05) for the between-group effect and the time effect. The severity of physical violence among nurses exhibited statistically significant differences (P < 0.05) for the between-group effect and time effect, and the severity of psychological violence showed statistically significant differences (P < 0.05) for the time effect. Nurses' total coping resources score and dimensions also showed statistically significant differences in terms of group, time, and interaction effects (P < 0.001). The evaluation questionnaire for the mobile application indicated usefulness scores of 2 (1, 2); ease of learning scores of 2 (1, 2); ease of use scores of 2 (1, 2); trust scores of 2 (1, 2.75); acceptance score of 1 (1, 2); and satisfaction scores of 2 (1, 2).ConclusionsImplementing the nurse workplace violence information-based education and training platform proved beneficial in reducing the incidence and severity of workplace violence among nurses and enhancing their coping resources. This outcome suggested the platform's potential for further application and promotion in clinical settings.

The HARM models: Predicting longitudinal physical aggression in patients with schizophrenia at an individual level

The prediction and prevention of aggression in individuals with schizophrenia remains a top priority within forensic psychiatric settings. While risk assessment methods are well rooted in forensic psychiatry, there are no available tools to predict longitudinal physical aggression in patients with schizophrenia within forensic settings at an individual level. In the present study, we used evidence-based risk and protective factors, as well as variables related to course of treatment assessed at baseline, to predict prospective incidents of physical aggression (4-month, 12-month, and 18-month follow-up) among 151 patients with schizophrenia within the forensic mental healthcare system. Across our HARM models, the balanced accuracy (sensitivity + specificity/2) of predicting physical aggressive incidents in patients with schizophrenia ranged from 59.73 to 87.33% at 4-month follow-up, 68.31–80.10% at 12-month follow-up, and 46.22–81.63% at 18-month follow-up, respectively. Additionally, we developed separate models, using clinician rated clinical judgement of short term and immediate violent risk, as a measure of comparison. Several modifiable evidence-based predictors of prospective physical aggression in schizophrenia were identified, including impulse control, substance abuse, impulsivity, treatment non-adherence, mood and psychotic symptoms, substance abuse, and poor family support. To the best of our knowledge, our HARM models are the first to predict longitudinal physical aggression at an individual level in patients with schizophrenia in forensic settings. However, it is important to caution that since these machine learning models were developed in the context of forensic settings, they may not be generalisable to individuals with schizophrenia more broadly. Moreover, a low base rate of physical aggression was observed in the testing set (6.0–11.6% across timepoints). As such, larger cohorts will be required to determine the replicability of these findings.

Behavioural and cognitive-behavioural interventions for outwardly directed aggressive behaviour in people with intellectual disabilities.

Behavioural and cognitive-behavioural interventions for outwardly directed aggressive behaviour in people with intellectual disabilities.

A Clinical Decision Support System to Prevent Aggression and Reduce Restrictive Practices in a Forensic Mental Health Service.

Preventing aggression and reducing restrictive practices in mental health units rely on routine, accurate risk assessment accompanied by appropriate and timely intervention. The authors studied the use of an electronic clinical decision support system that combines two elements, the Dynamic Appraisal of Situational Aggression instrument and an aggression prevention protocol (eDASA+APP), in acute forensic mental health units for men. The authors conducted a cluster-randomized controlled trial incorporating a crossover design with baseline, intervention, and washout periods in a statewide, secure forensic mental health service. The study included 36 mental health nurses (13 men and 23 women, ages 20-65 years) with direct patient care responsibility and 77 male patients (ages 21-77 years) admitted to one of two acute mental health units during the baseline and intervention periods. eDASA+APP implementation was associated with a significant reduction in the odds of an aggressive incident (OR=0.56, 95% confidence interval [95% CI]=0.45-0.70, p<0.001) and a significant decrease in the odds of administration of as-needed medication (OR=0.64, 95% CI=0.50-0.83, p<0.001). Physical aggression was too infrequent for statistical significance of any effects of eDASA+APP to be determined; however, incidents of physical aggression tended to be fewer during the eDASA+APP phase. These results support the use of the eDASA+APP to help reduce incidents of aggression and restrictive practices in mental health units.

Frequency of violence towards healthcare workers in the United States' inpatient psychiatric hospitals: A systematic review of literature.

The purpose of this systematic review is to determine the frequency of violent or aggressive behaviour towards healthcare workers in inpatient psychiatric settings in the United States. To achieve this aim, five databases were searched to find English-language quantitative studies reporting prevalence or incidence data of violence or aggression directed towards staff members in inpatient psychiatric settings. No limitations were set based on publication date, and intervention studies were included only if baseline data were provided. Of 335 total studies found, 38 full-text articles were suitable for full-text analysis based on inclusion and exclusion criteria, and 14 were included in the final review. Years of data collection ranged from 1986 to 2018, and a range of psychiatric facilities were represented, from small, private hospital units to large forensic institutions. Researchers utilized surveys, real-time incident reporting tools, and government databases, or a combination of strategies, to collect data related to workers' experiences on the job. Included research indicates that workplace violence in the U.S. inpatient psychiatric setting is a widespread problem, with 25-85% of survey respondents reporting an incident of physical aggression within the year prior to survey, and statewide workers' compensation findings indicating 2-7 claims due to assault per 100000 employee hours. There are substantial differences between findings based on measurement strategy, making it difficult to arrive at a single estimate of prevalence nationally. As management of this persistent problem receives continued attention from stakeholders, it becomes increasingly important to define and measure the problem with the most appropriate tools.

POLITRAUMA DURING COVID-19 PANDEMIC: AN INCREASING INCIDENCE OF DOMESTIC VIOLENCE

The Covid-19 pandemic changed certain social habits and practices. The pandemic also changed the profile of polytrauma patients who presented in the emergency room. The etiology of polytraumas has undergone changes in the context of social distancing. While road accidents, falls and physical assaults, including gunshot trauma on the streets have decreased, we are confronting with an alarming increase in domestic violence. We analyzed the etiology of polytraumas from a period of 3 months that overlapped with the pandemic and compared it with the similar periods of the previous 3 years. We found an increase of about 4 times the incidence of physical aggression through domestic violence.

Inpatient aggression in forensic psychiatric patients with autism spectrum disorder: the role of risk and protective factors

Purpose Patients with autism spectrum disorder (ASD) are overrepresented in forensic samples. However, research on risk assessment in forensic patients with ASD is scarce. The purpose of this paper was to examine the prevalence of short-term inpatient aggression and explore the risk and protective factors for aggression in forensic psychiatric patients with ASD (N = 32). Design/methodology/approach The association between two commonly used violence risk assessment instruments (HKT-R and SAPROF) and physical aggression during ten weeks of inpatient stay was examined in a Dutch forensic psychiatric hospital. Findings Results showed no significant association between HKT-R and SAPROF and incidents of physical aggression. This suggests that the commonly used assessment instruments may be of limited use for assessing the risk of short-term inpatient aggression in patients with ASD. Research limitations/implications Limitations to the current study include the relatively small sample size and the lack of information on index offenses. Further research with a larger, more homogeneous sample and longer follow-up is indicated to confirm the results of this study. Future research should also include the possible association between aggressive behavior of people with ASD and other factors that might be relevant, such as social cognition deficits, cognitive and sensory impairments, deficient empathy and emotion regulation problems. Originality/value To the authors’ knowledge, this is the first study to directly examine the prevalence of inpatient aggression of forensic psychiatric patients with ASD and its association with risk and protective factors.

Physical aggression toward teachers: Antecedents, behaviors, and consequences.

School violence is a significant public health concern that occurs in many forms. Physical aggression can cause serious bodily injury and long-term negative effects, and both teachers and students experience significant rates of physical aggression. There are few studies examining teachers' experiences of physical aggression. Studies that go beyond prevalence are limited, and we know little about the triggers and consequences that surround these incidents. This qualitative investigation used an antecedent-behavior-consequence (A-B-C) framework to understand how incidents of physical aggression directed toward teachers unfold. The sample included 193 elementary and secondary teachers who completed an anonymous, online survey and described events leading up to and following their experiences with physical aggression. Using conventional content analysis, we identified common antecedents, such as breaking up fights, discipline, and directives, and common consequences, such as student removal, school staff involvement, positive outcomes, and inaction. Further analyses revealed seven common A-B-C patterns among physical aggression incidents that are highlighted and discussed. Utility of the A-B-C framework for teacher-directed violence is described, along with implications for research, practice, and policy. Exploring the context surrounding incidents of physical aggression directed against teachers provides useful information for violence prevention and interventions.

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services.

Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion. Data were extracted from an anonymised database comprising the electronic medical records of patients within a large South London mental health trust. Two cohorts were derived, (1) a PICU cohort comprising all patients transferred from general adult acute wards to a non-forensic PICU ward between April 2008 and April 2013 (N = 986) and a randomly selected group of patients admitted to general adult wards within this period who were not transferred to PICU (N = 994), and (2) a seclusion cohort comprising all seclusion episodes occurring in non-forensic PICU wards within the study period (N = 990) and a randomly selected group of patients treated in these wards who were not secluded (N = 1032). Demographic and clinical factors (age, sex, ethnicity, diagnosis, admission status and time since admission) and behavioural precursors (potentially relevant behaviours occurring in the 3 days preceding PICU transfer/seclusion or random sample date) were extracted from electronic medical records. Mixed effects, multivariable logistic regression analyses were performed with all variables included as predictors. PICU cases were significantly more likely to be younger in age, have a diagnosis of bipolar disorder and to be held on a formal section compared with patients who were not transferred to PICU; female sex and longer time since admission were associated with lower odds of transfer. With regard to behavioural precursors, the strongest predictors of PICU transfer were incidents of physical aggression towards others or objects and absconding or attempts to abscond. Secluded patients were also more likely to be younger and legally detained relative to non-secluded patients; however, female sex increased the odds of seclusion. Likelihood of seclusion also decreased with time since admission. Seclusion was significantly associated with a range of behavioural precursors with the strongest associations observed for incidents involving restraint or shouting. Whilst recent behaviour is an important determinant, patient age, sex, admission status and time since admission also contribute to risk of PICU transfer and seclusion. Alternative, less coercive strategies must meet the needs of patients with these characteristics.

Anxiety and aggression in adolescents with autism spectrum disorders attending mainstream schools

This study investigated the link between anxiety and aggression in adolescents with autism spectrum disorders (ASDs) using self-report measures of anxiety and anger and teacher ratings of behaviour. Participants were 104 high school students aged 12–18: 52 students with ASDs, without intellectual disability, and their typically developing peers matched for age and gender. Students with ASDs who attend mainstream high schools reported higher levels of anxiety and reactive anger than their peers, were reported by their teachers to engage in more aggressive behaviours, and were at higher risk of being suspended from school. The results further suggested that social anxiety is a significant moderator of the relationship between autism and physical aggression. For ASD students, but not for the control students, there was a strong, positive relationship: higher levels of anxiety were associated with higher levels of physical aggression. However, ASD students with high anger control did not display physical aggression. Our results have implications for screening students for anxiety, the provision of interventions for managing anxiety and the development of anger management skills, and for the appropriateness of suspension as a mandatory response to incidents of physical aggression in schools.

Management of physical aggression in the dementia resident in an 18 bed secure dementia unit: A best practice implementation project

Background Physical aggression amongst dementia residents in an aged care facility is common but manageable. Good assessing and reviews of processes by clinical and medical staff can lessen the effects of behaviours and improve resident and staff outcomes. Objectives The aim of the project was to promote best practice strategies and improve on existing practices in the secure unit of Emmaus Nursing Home to reduce the incidence of physical aggression and improve resident and staff outcomes. Methods Audit based on best practice evidence was used to determine areas that implementation would be directed towards. Results Overall there was improvement in all areas or continued positive results in areas where initial results were 100%. The initial audit showed 0% in variety of non-pharmacological strategies and this improved to 100% post implementation. Future strategies to be implemented are the adjustment of the Behaviour Management Log, training in the management of specific physical aggressive episodes, further training of Neuropsychiatric Inventory for Registered Nurses across facility. Conclusions The findings show that an effective program that provides individual and group resident needs is effective in managing residents with Behavioural and Psychological Symptoms of Dementia. It highlighted the need for positive communication and staff reporting so all parties providing care are aware of needs and outcomes in a timely manner.

Predictive validity of the START with intellectually disabled offenders

Purpose – Offenders with intellectual disability (ID) have been largely neglected in past forensic literature on assessment of dynamic risk factors. The purpose of this paper is to evaluate the predictive validity of the Short-Term Assessment of Risk and Treatability (START), in a sample of males with IDs in a low-secure hospital (n=28). Design/methodology/approach – A prospective analysis was conducted, with START scores as the predictor variables, and the number of recorded aversive incidents as the outcome measure. Findings – Receiver operating characteristic analysis demonstrated that total START risk scores had a significant high predictive accuracy for incidents of physical aggression to others (area under the curve (AUC)=0.710, p&lt;0.001) and property damage/theft (AUC=0.730, p&lt;0.001), over a 30-day period, reducing to medium predictive validity over a 90-day period. Medium predictive validity was also identified for incidents of verbal aggression, suicide, self-harm, and stalking and intimidation. START strength scores were also predictive of overt aggression (AUC=0.716), possible reasons for this are explored. Research limitations/implications – The small sample size limits the generalisability of the findings, and further research is required. Practical implications – The paper offers preliminary support for the use of the START with ID offenders in low-secure settings. Given the lack of validation of any previous dynamic risk assessment tools, multi-disciplinary teams in such settings now have the option to use a tool which has potentially good validity with an ID population. Originality/value – This study represents the first attempt to examine the predictive validity of the START with ID offenders, and a step forward in the understanding of dynamic risk factors for violence in this population. The significant predictive relationship with incidents of physical aggression and property damage offers clinicians a preliminary evidence base supporting its use in low-secure settings.

Family mode deactivation therapy (FMDT): A randomized controlled trial for adolescents with complex issues.

There is an unquestionable need for psychotherapy interventions to effectively treat adolescents with aberrant behaviors, complex comorbid problems, and a history of abuse—a population that is widely considered as difficult-to-treat, but warranting attention due to their cost to society. In response, Family Mode Deactivation Therapy (FMDT) was developed with its roots in cognitive and behavior theories. By recognizing the need to explore and validate core beliefs in the family unit that underlie individual and collective dysfunctional cognitions, a unique Validation-Clarification-Redirection ( VCR) process was combined with selected elements from Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and mindfulness. In this study 122 adolescents and their families were randomly divided into two groups, a control group treated with classical Cognitive Behavioral Therapy (CBT) techniques, and the experimental group treated with FMDT methodology. Child Behavior Checklist (CBCL) and State-Trait Anger Expression Inventory-2 (STAXI-2) tests were scored pre- and post-treatment. The average CBCL and STAXI-2 scores indicated a consistently significant improvement with FMDT treatment, which outperformed that of the control group noticeably. Incidents of physical aggression were also tracked pre-, post-treatment, and at 16-month follow-up. Again, FMDT outperformed the Treatment as Usual (TAU) control group, especially at follow-up, which suggests a much better durability of treatment effects in the time period. The positive results with this population in their family group warrant further research of FMDT.

The Men's Center Approach: Ecological Interventions for College Men's Health

College men are facing a health crisis. Although many men experience positive, healthy outcomes of male socialization on individual (e.g., heroism, bonding and caring through action, self-reliance, use of humor) and group (e.g., humanitarian work, team orientation) levels (Kiselica & Englar-Carlson, 2010), researchers have found that men who adhere to more restrictive notions of masculinity are at higher risk for encountering significant, negative health outcomes (O'Neil & Crasper, 2011). In particular, college men have been identified as a group of men facing a health crisis. For example, compared with college women, college-age men participate in more harmful behaviors, such as consuming large quantities of alcohol, abusing substances, and pursuing unsafe sexual encounters (Bonar et al., 2011; Borsari, Murphy, & Barnett, 2007). Furthermore, approximately 10% of college men admit to at least one incidence of physical aggression toward a partner (Gallagher & Parrott, 2011). College men are also less likely to engage in health-promoting behaviors, such as preventive care (Courtenay, 2011; Courtenay, McCreary, & Merighi, 2002), are 3 times as likely as female peers to complete suicide (Centers for Disease Control and Prevention [CDC], 2009), and account for roughly two thirds of deaths among individuals ages 15-24 (U.S. Department of Health and Human Services, 2008). College men also hold more unrealistic health beliefs (e.g., compared with their female counterparts, they evaluate problems associated with marijuana as less severe and less likely) and doubt their vulnerability to contract disease (Courtenay et al., 2002) despite much higher rates of sexually transmitted infections compared with women (CDC, 2009; Courtenay, 2011). All of these behaviors and outcomes are intertwined with the university community and beyond in terms of bidirectional influences with men's families, roommates, friends, fraternity brothers, coworkers, classmates, neighborhoods, and religious communities. However, despite conceptual and empirical advancements in the scholarship on men and masculinity, few have attended to interactions among the multiple systems in which men are embedded, and few have connected men's health risks with the contextual demands and developmental tasks that occur alongside gender role socialization (O'Neil, 2008). We use Bronfenbrenner's ecological model (Bronfenbrenner, 1979, 1986; Bronfenbrenner & Ceci, 1994) to provide a multisystemic perspective on (a) contextual influences on the expression of masculinity ideology and health behaviors, (b) potential costs of those behaviors, and (c) counseling intervention opportunities (Courtenay, 2011; Isacco, Garfield, & Rogers, 2010; Smiler, 2004). Our rationale for using the ecological model rests in the complexity of our goal to change college men's masculine ideals. To address that goal, we have found it crucial to use multiple interventions at multiple levels. We also integrate the ecological model with the men's center approach (MCA) and the concept of possible masculinities (Davies, Shen-Miller, & Isacco, 2010) to guide the design and implementation of systemic, culturally sensitive interventions for college men. Using Bronfenbrenner's Ecological Model to Understand College Men's Health According to Bronfenbrenner (1979, 1989; Bronfenbrenner & Ceci, 1994), development occurs within an individual ecology comprised of nested systems, including the macrosystem, exosystem, mesosystem, and microsystem (see Figure 1). Moving inward from the outermost system, each system has an increasingly direct influence on the individual, yet inner (or proximal) systems can also effect change in more distal ones. Bronfenbrenner (1979, 1989) emphasized how perceptions of relations within and among an individual's varied systems influence attitudes, behaviors, and expression of social roles. Change in one system invariably triggers change in others through a process of mutual accommodation. …

Evaluation of anger management groups in a high‐security hospital

Anger management programmes for offenders typically aim to improve the management of emotion associated with aggressive and antisocial behaviour. Such programmes have been quite extensively evaluated in prison and probation settings, but there is less published research in forensic mental health settings. This study aimed to evaluate anger management groups in a high-security hospital. Eighty-six patients were referred for a 20-session anger management intervention. Outcomes were self-reported experiences of anger and changes in institutionally documented incidents of aggression. Incident rates were retrospectively reviewed for all group graduates, where data were available, including a comparison group of graduates who acted as their own controls. Group graduates reported sustained reductions in feelings of anger and positive changes in their use of aggression in reaction to provocation. Some reduction in incidents of physical aggression was noted when group completers were compared with non-completers. Incidents of verbal aggression were observed to increase for graduates. There was also a trend towards improvement when treated men were compared with men on the waiting list. Our findings contribute to the growing evidence for anger management groups for aggressive men, although the low-base rate of incidents, typical of such a containing and therapeutic hospital setting, rendered the analysis of behavioural outcomes difficult. Anger management sessions for male forensic psychiatric patients can be effective in reducing incidents of physical aggression in response to provocation. Evaluation of treatments for anger is particularly difficult in secure and protective settings, where the aim is to keep incidents of actual physical aggression to a minimum. Further research of this kind is needed to test the value of self-reported reduction in angry feelings as an indicator of clinically useful progress.

Investigating changes in anger and aggression in offenders with high levels of psychopathic traits attending the Chromis violence reduction programme

Chromis was accredited by the Correction Services Accreditation Panel in 2005 as an intervention designed to reduce violence in offenders whose level or combination of psychopathic traits disrupts their ability to engage in treatment and change. It runs as part of the regime in the dangerous and severe personality disorder unit in HM Prison Frankland (Westgate). A multiple case study investigation into changes over time in participants is currently underway, part of which is reported here. This paper reports on information relating to changes in anger and aggression in Chromis completers. Change in psychometrics and observed incidents of verbal and physical aggression are considered for five case study participants who have completed Chromis and progressed from Westgate to a different location. Findings suggest that cases experienced a reduction in self-reported anger, and expected incidents of physical aggression but had higher than expected levels of verbal aggression after leaving Westgate. These findings offer cautious optimism for the effectiveness of Chromis, although methodological limitations must also be considered. Findings may be seen as positive indicators of Chromis, or at least the approach to working with these offenders across Westgate, in reducing violence. Findings support the continued delivery and evaluation of Chromis. There may be benefit in exploring ways to further understand and address verbal aggression in participants.

Staff Perceptions and Organizational Factors as Predictors of Seclusion and Restraint on Psychiatric Wards

Several factors have been shown to be involved in decisions to use seclusion and restraint in psychiatric inpatient settings. This study examined whether staff perceptions of factors related to the care team and violence on the ward predicted use of seclusion and restraint in psychiatric wards. A total of 309 staff members (nurses, rehabilitation instructors, and nurse's aides) providing care to patients with serious mental disorders were recruited from eight university psychiatric hospitals and general-hospital psychiatric units in the province of Quebec. Factors assessed included sociodemographic characteristics, psychological distress, staff perceptions of aggression and of interaction between members of the psychiatric team (team climate), and organizational factors. Bivariate analyses showed that certain aspects of the team climate, staff perceptions of aggression, and organizational factors were associated with greater use of seclusion and restraint. The final multivariate model indicated that the following factors independently predicted greater use: type of hospital ward (emergency department and intensive care unit), staff perception of a higher level of expression of anger and aggression among team members, perception of the frequency of incidents of physical aggression against the self among patients, and perception of insufficient safety measures in the workplace. These findings represent the first stage of a research program aimed at reducing use of seclusion and restraint in psychiatric settings. They underscore the importance of evaluating a variety of factors, including perceptions of safety and violence, when examining reasons for use of these controversial interventions.

The Predictive Ability of the Classification of Violence Risk (COVR) in a Forensic Psychiatric Hospital

Objective: Aggression is a common problem in psychiatric and correctional facilities. An actuarial instrument, the Classification of Violence Risk (COVR), has demonstrated utility in predicting community aggression among civilly committed psychiatric patients and, more recently, an ability to predict institutional aggression in a forensic facility. This prospective study aimed to extend validation of the use of the COVR in a forensic facility. Methods: The study, conducted at a large U.S. forensic facility, used nursing records to document incidents of physical aggression by 146 patients for 20 weeks after COVR administration. Correlational and chi square analyses were conducted to evaluate the efficacy of the COVR in predicting aggression. Results: The COVR showed modest predictive ability for institutional aggression, with a correlation of .331 and an area under the curve of .725. Conclusions: Results support use of the COVR in a forensic facility; its ability to predict institutional aggression is similar to that found for community aggression. (Psychiatric Services 62:430–433, 2011)

The Predictive Ability of the Classification of Violence Risk (COVR) in a Forensic Psychiatric Hospital

Aggression is a common problem in psychiatric and correctional facilities. An actuarial instrument, the Classification of Violence Risk (COVR), has demonstrated utility in predicting community aggression among civilly committed psychiatric patients and, more recently, an ability to predict institutional aggression in a forensic facility. This prospective study aimed to extend validation of the use of the COVR in a forensic facility. The study, conducted at a large U.S. forensic facility, used nursing records to document incidents of physical aggression by 146 patients for 20 weeks after COVR administration. Correlational and chi square analyses were conducted to evaluate the efficacy of the COVR in predicting aggression. The COVR showed modest predictive ability for institutional aggression, with a correlation of .331 and an area under the curve of .725. Results support use of the COVR in a forensic facility; its ability to predict institutional aggression is similar to that found for community aggression.

The effects of enhanced program review and staff training on the management of aggression among clients in a long-term neurobehavioral rehabilitation program

Objective: This article examined the effects of staff training, staff support groups, and increased client behavior monitoring on the rate of physical aggression toward peers and objects in an older neurobehavioral population treated in a long-term neurorehabilitation program. Methods: During the 15 months of data collection, programmatic enhancements were introduced including: Staff training and support groups, comprehensive assessment and individualized program development, and client-centered weekly and systemic monthly behavior management review. Incidents of physical aggression were assessed using staff report. Data were corroborated using multiple sources including, medical records, written incident reports, and Overt Aggression Scale–Modified for Neurorehabilitation – Extended (OAS-MNR-E). Results: A total of 267 clients were present in the facility during the reporting period. The clients had neurobehavioral disability of various origins, 73% had a psychiatric diagnosis in addition to one or more medical diagnoses, and 58% had a dementia diagnosis. An already low rate of incidents of physical aggression per client month (0.02) was reduced by 77% following the implementation of programmatic enhancements. Conclusion: Enhanced systematic behavioral review of clients provided concurrently with staff training in non-aversive principles and ongoing staff support groups reduced the incidents of behavioral disregulation in older persons with psychiatric diagnoses, medical comorbidities, and neurobehavioral disabilities.