Characteristics of repetitively assaultive patients: ten year analysis of the Assaulted Staff Action Program (ASAP)

The pre-incident components of CISM interventions focus on providing information on risk expectancy as well as cognitive and behavioral resources to enhance coping. This paper studied both the demographic and clinical variables of repetitively assaultive patients in a ten-year analysis of the Assaulted Staff Action Program (ASAP) in an attempt to enhance predictor variables that might be associated with repeat offenders and thus provide staff additional coping resources. Although the demographic variables offered little predictive information, the clinical variable of personal victimization was highly associated with subsequent repeat assault incidents. The methodological limitations, a proposal for a new research paradigm, and the power of pre-incident training initiatives are examined.     

Staff victims of elder patient abuse and the Assaulted Staff Action Program (ASAP): preliminary empirical inquiry

Patient assaults on healthcare staff are a serious and ongoing issue in long-term care facilities. Emerging studies have begun to empirically document assaults by elders in skilled nursing facilities as well as the negative impact of these events on healthcare staff victims. This study examined assaults by elders and their impact on staff over a six-year period within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention program for staff victims to address the psychological aftermath of patient assaults. Findings confirmed both elder assaultive behavior and its negative impacts on staff victims. The efficacy of ASAP in ameliorating these negative impacts was presented. The implications of the findings for long-term care settings were discussed.     

The Assaulted Staff Action Program (ASAP): Common Issues in Fielding a Team

Thirty-five years of empirical research have continuously documented the potential negative impact of patient assaults on staff. The Assaulted Staff Action Program (ASAP) is a voluntary, peer-help, systems-wide crisis intervention debriefing approach for employee victims of these assaults. ASAP has been associated with providing needed clinical support for victims, declines in violence, and cost-effectiveness in service delivery. A previous paper outlined the basic steps needed to field an ASAP team. This paper continues to address this need by outlining the most commonly encountered ASAP problems and solutions that have evolved in the first eight years of ASAP programs. The implications are discussed.     

Elderly patient assaults: empirical data from the Assaulted Staff Action Program (ASAP) with risk management implications for EMS personnel

Some elderly patients may become violent in the course of receiving health care services. This paper reviews the largely cross-sectional research on elder assaultive patients in health care settings and patient assaults, including those by the elderly, in EMS services. Data on the assault characteristics of elderly patients are presented from a 15-year, retrospective, longitudinal study of the Assaulted Staff Action Program (ASAP). The findings and their implications for the delivery of health care services are discussed and a detailed series of risk management strategies to reduce assaults in EMS services are presented.     

Characteristics of patients in restraint: six year analysis of the Assaulted Staff Action Program (ASAP)

Emergency service providers, including mental health care providers, are often called upon to impose restraint procedures. These procedures may result in physical injury and psychological distress and provide a unique opportunity for emergency mental health personnel to be of assistance. Reviews of the literature on restrained patients have suggested that clinical variables studied need to be added to demographic factors in order to better clarify those at high risk for restraint procedures. This study compared restrained and non-restrained subjects on basic demographic variables and the clinical variables of histories of violence toward others, personal victimization and substance use disorder. The clinical variables did not enhance the prediction of the use of restraints. The implications for reducing the use of restraints, for needed emergency mental health services and future research directions are explored.     

Precipitants of psychiatric patient assaults on staff: three-year empirical inquiry of the Assaulted Staff Action Program (ASAP)

Patient violence toward health care staff is a complex function of person x event x environment model. Thirty-five years of research on the characteristics of patient assailants and staff victims has yielded no predictive markers and researchers are examining other possible components of the model. The precipitants, or motivation, for assaults is one area of inquiry. Although research to date has been sparse, acute psychosis, excessive sensory stimulation, and staff restrictions on patient behaviors (denial of services, privileges, etc.) appear to be common precipitants. This paper continued this inquiry over a three-year period. The most common precipitants were denial of services, acute psychosis, and excessive stimulation. No statistically significant interactions were obtained for patient / staff victim variables and these precipitants.     

Precipitants of psychiatric patient assaults on staff: preliminary empirical inquiry of the Assaulted Staff Action Program (ASAP)

Although there has been extensive empirical research on the characteristics of psychiatric patient assailants and their staff victims, there has been a dearth of empirical research on the nature of the precipitants of these patient/staff interactions. Building on the few earlier studies, this year-long, retrospective, empirical study of patient precipitants was conducted within the context of the Assaulted Staff Action Program (ASAP) in ten public sector health care facilities. Excessive sensory stimulation, staff restrictions on patient behaviors (restraints), and acute psychosis were the most frequently occurring precipitants. There were no specific patterns to patient assailant and staff victim characteristics by assault precipitant. The implications of this study and future research needs are addressed.     

Characteristics of four types of patient assaults: six year analysis of the Assaulted Staff Action Program (ASAP)

Although psychiatric patient assaults may include physical and sexual assaults, nonverbal intimidation, and verbal threats, most studies of assaultive psychiatric patients to date have grouped all assaults together in one category. This study explored differences in patient assailant variables and staff victim variables in each of the four categories of patient assault during a six-year period. These differential analyses of assault types yielded at least three important findings: the presence of significant numbers of females as both assailants and victims in several categories of assaults, the importance of psychological fright in staff victims, and the serious psychological disruptions found in staff victims of physical, sexual, and verbal assaults. The findings are discussed and the implications for health care safety and emergency mental health are noted.     

Characteristics of Assaultive Psychiatric Patients: Fifteen-Year Analysis of the Assaulted Staff Action Program (ASAP)

This study reports on a fifteen-year longitudinal analysis of the characteristics of assaultive patients in one public-sector mental health care system. The data were gathered within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention service for staff victims. The fifteen-year findings were consistent with previous worldwide research on assaultive patients and included both older male patients with schizophrenia and younger personality-disordered patients as high-risk assailants. Both groups had appreciable histories of violence toward others, personal victimization, and substance use disorders. The role of these three clinical variables in association with subsequent assaults, the role of trauma in female assailants, and the consistency of the fundamental characteristics of assaultive patients during several service system initiatives were examined. Implications for research and intervention are discussed.     

The Assaulted Staff Action Program (ASAP) and declines in the prevalence of assaults: community-based replication

The Assaulted Staff Action Program (ASAP) has been associated with sharp reductions in the frequency of patient assaults on staff in four state hospital settings. Recent national trends in healthcare have resulted in an emphasis on community-based services. This case study sought to assess the effects of ASAP and findings of reduced assaults in a community-based program. In a single-case design, in which the facility served as its own control, an ASAP program was fielded in a community mental health center. A similar sharp reduction in violence was observed. The implications of the findings are presented.     

Psychiatric Patient Assault and Staff Victim Gender: Fifteen-year Analysis of the Assaulted Staff Action Program (ASAP)

Extensive, largely cross-sectional research has documented the continued occurrence of patient assaults on male and female staff. Different studies report either male or female staff to be at highest risk. Studies of same/different gender assaults which might more fully answer this question have been few. In these latter studies both male and female staff were at high risk for same gender assaults. In community settings males were at risk from same gender assaults but females were at risk from assaults by both patient genders. The present 15-year longitudinal retrospective study examined same/different gender assaults over time. Since the health care system under study experienced several major policy changes during these years, data were also examined at 5-year intervals to assess the stability of findings across time. Male and female staff were at increased risk from same gender assaults over time in both inpatient and community settings. The findings and their implications are discussed. In addition, a cost-effective, comprehensive risk management strategy for containing assaults is outlined.     

The Assaulted Staff Action Program (ASAP) and Declines in Rates of Assault: Mixed Replicated Findings

The Assaulted Staff Action Program (ASAP) is a crisis intervention program that has been associated with providing both needed support for employee victims of patient assault and declines in rates of assaults in traditional state hospital and community mental health settings. This study examined the possible role of ASAP and declines in rates of assault in three community-based services impacted by privatization and managed care approaches: community residences, an acute care rural community mental health center, and an urban intermediate/extended care facility. ASAP was associated with a statistically significant decline in the rate of assault in the intermediate/extended care facility. The community residence program was not a true test because of structural issues associated with managed care. The community mental health center appeared to be a true failed replication. The extended care facility's decline in the rate of assault was interrupted by the aftermath of one serious clinical incident during one month and then continued to decline. The implications are discussed.     

Time of psychiatric patient assaults: fifteen-year analysis of the Assaulted Staff Action Program (ASAP)

An emerging literature on human-perpetrated violence suggests that seemingly apparent random acts of violence may indeed have important embedded temporal patterns. This study reviews this literature and presents the temporal findings of a fifteen-year study of patient assaults on staff in health care settings. Temporal patterns were observed for the variables of season, days of month, and shift. The reasons for these findings and their implications for health care providers are presented. A brief review of patient assaults on emergency services personnel (EMS) is outlined and this study 's findings and their implications for EMS personnel are discussed.     

Time of psychiatric patient assaults: twenty-year analysis of the Assaulted Staff Action Program (ASAP)

Apparent random acts of violence viewed in the aggregate appear to occur in fairly exacting temporal patterns. This is true of rape, street assaults, and domestic violence, among other acts of violence. Patient assaults on staff as acts of violence should also follow a temporal pattern. This twenty-year retrospective study of assaultive psychiatric patients in one public sector examined the temporal pattern of such assaults. Inpatient assaults were more likely to occur in the summer in the middle ten days of the month, during the first shift at mealtimes. In community settings, assaults were more likely in winter during the first ten days of the month, and on the first shift at noon time. The possible reasons for these time patterns, their possible biological roots, and their implications for emergency services personnel and health care providers were discussed.     

Characteristics of Staff Victims of Patient Assault: Ten Year Analysis of the Assaulted Staff Action Program (ASAP)

Patient assaults on staff have been a continuing risk for inpatient and community-based psychiatric healthcare providers. This study presents a ten-year analysis of the characteristics of staff victims of patient assaults in one public mental health system of care, a period which included the transition to managed care initiatives within this system. Assault data was gathered within the context of the Assaulted Staff Action Program (ASAP), a voluntary, system-wide, peer-help, crisis intervention program that is designed to assist employees with the psychological sequelae of these patient events. In general, the findings were consistent with previously reported inpatient and community studies. Less experienced, less formally trained employees remain at high risk. The impact of managed care initiatives was found in community residences where younger female staff were most at risk. The implications of the findings and possible risk management strategies are discussed.     

Characteristics of Assaultive Psychiatric Patients: Ten Year Analysis of the Assaulted Staff Action Program (ASAP)

Nearly thirty years of published research has documented the continuing presence of patient assaults on staff. These studies have included the traditional male patient with a diagnosis of schizophrenia and histories of violence and substance use disorder and the newer female, personality-disordered individual. This study reports on a ten-year longitudinal analysis of assaultive patients in one public-sector mental healthcare system during a period which included the national shift toward managed care initiatives. Data were gathered in the context of the Assaulted Staff Action Program, a crisis intervention program for staff victims. Patient assailants in both inpatient and community settings included both the traditional and newer personality-disordered individuals. The majority of assailants were females. Managed care initiatives appeared to have had little impact on type of assailants. Implications for safety and treatment are discussed.     

Characteristics of Staff Victims of Pschiatric Patient Assaults: 15-Year Analysis of the Assaulted Staff Action Program (ASAP)

Psychiatric patient assaults on staff victims are a worldwide occupational hazard. This paper reports on a 15-year study of the characteristics of staff victims of patient assaults and a crisis intervention procedure to ameliorate the aftermath of theses incidents. The debate on the efficacy of early interventions is outlined and the present 15-year findings are presented, findings demonstrating remarkable consistency in victim characteristics over time. The crisis intervention procedures were associated with sharp declines in disrupted victim functioning. The validity of the study’s findings are noted and the implications for enhanced risk management training and staff victim crisis intervention procedures are discussed.     

The Assaultive Staff Action Program (ASAP): Thirty Year Program Analysis

Psychiatric Quarterly - The Assaulted Staff Action Program (ASAP) is a voluntary, system-wide, peer-help, crisis intervention program to address the psychological sequellae in staff victims of...     

The Assaultive Staff Action Program (ASAP): 25 Year Program Analysis

The Assaulted Staff Action Program (ASAP) is a voluntary, system-wide, peer-help, crisis intervention program to address the psychological sequelae in staff victims of patient assaults. It has been associated with cost-effective, quality support services to staff victims of patient assaults and declines in assaults facility-wide in several facilities, after an ASAP was fielded. ASAP’s functions and service provisions have been reported in previous 5-year intervals. The present paper reports on its most recent 5-year interval as ASAP complete its 25th year of service. The 5-year summary and the basic strengths and limitations of the program over this 25 year period are examined.     

Past violence and substance use disorder and subsequent violence towards others: six year analysis of the Assaulted Staff Action Program (ASAP)

Recent research has begun to document evidence of associations between past violence toward others, untreated personal victimization, and substance use disorder and later acts of violence toward others. This appears true for many types of individuals, including psychiatric patients who have been victims of violence. This six-year retrospective study sought to evaluate these possible associations in assaultive psychiatric patients. Data were gathered in the context of the Assaulted Staff Action Program (ASAP), a crisis intervention program for staff victims of patient assault. Both histories of violence (violence toward others and/or personal victimization) and substance use disorder in assaultive psychiatric patients were individually and jointly examined and found to be associated with subsequent assaults by these patients. Increased levels of both past violence toward others, personal victimization, and substance use disorder were associated with the largest increased frequency of subsequent assault. The implications and possible links to emergency mental health services are discussed [International Journal of Emergency Mental Health, 2(4), 241-247].