The Dynamic Appraisal of Situational Aggression: An Instrument to Assess Risk for Imminent Aggression in Psychiatric Inpatients

Monash University, Thomas Embling Hospital, Locked Bag 10, Fairfield, Victoria 3078, Australia.
Behavioral Sciences & the Law (Impact Factor: 0.96). 11/2006; 24(6):799-813. DOI: 10.1002/bsl.741
Source: PubMed


Considerable research has attempted to delineate the demographic and clinical characteristics of high-risk psychiatric patients and identify salient modifiable aspects of aggression prone environments. Recently, there has also been increased interest in the development and testing of structured schemes for the assessment of risk for aggression within inpatient psychiatric settings. Although some of these methods show acceptable predictive validity, their ability to inform day-to-day treatment and management decisions is limited. The current research was designed to identify existing and novel risk factors that would assist staff to identify and manage the risk for aggression in psychiatric inpatient populations. Results showed that assessments supported by structured risk measures were more accurate than unaided clinical judgements based only on nurses' clinical experience and knowledge of the patient alone. Seven test items emerged that were maximally effective at identifying acute psychiatric patients at risk for engaging in inpatient violence within 24 hours; these items have been combined in the development of the Dynamic Appraisal of Situational Aggression. Empirical analyses and clinical experience support the efficacy of the instrument in assisting clinical staff in the identification and management of inpatient aggression.

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    • "Assessing risk of aggression in this context is critical, and risk-related decision making is central to decisions about leave, escorting requirements, the need for a patient to be moved to a high-dependency unit and even the need for medication (Ogloff and Daffern, 2006). Rates of violence increase, to a point, with the presence of additional risk factors. "
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    ABSTRACT: Objective: From time to time misconceptions about violence risk assessment raise debate about the role mental health professionals play in managing aggression, with associated concerns about the utility of violence risk assessment. This paper will address some of the misconceptions about risk assessment in those with serious mental illness. Methods: The authors have expertise as clinicians and researchers in the field and based on their accumulated knowledge and discussion they have reviewed the literature to form their opinions. Results: This paper reflects the authors' views. Conclusion: There is a modest yet statistical and clinically significant association between certain types of mental illness and violence. Debate about the appropriateness of clinician involvement in violence risk assessment is sometimes based on a misunderstanding about the central issues and the degree to which this problem can be effectively managed. The central purpose of risk assessment is the prevention rather than the prediction of violence. Violence risk assessment is a process of identifying patients who are at greater risk of violence in order to facilitate the timing and prioritisation of preventative interventions. Clinicians should base these risk assessments on empirical knowledge and consideration of case-specific factors to inform appropriate management interventions to reduce the identified risk.
    Australian and New Zealand Journal of Psychiatry 05/2013; 47(8). DOI:10.1177/0004867413484368 · 3.41 Impact Factor
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    • "The BVC and DASA comprise dynamic variables that are sensitive to change and easy to consider and score, allowing regular, efficient appraisals of risk, so that day-to-day treatment and management decisions that are affected by the likelihood of inpatient aggression can be facilitated. The Clinical Scale of the Historical, Clinical, and Risk Management–20 Factors (Webster et al. 1997) has also been used to study risk for imminent aggression (Ogloff & Daffern 2006). These dynamic risk-assessment measures have been shown to predict inpatient aggression in the short term (see Chu, Thomas et al. 2013; Daffern 2007 for reviews). "
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    ABSTRACT: Recent advancements in risk assessment have led to the development of dynamic risk-assessment measures that are predictive of inpatient aggression in the short term. However, there are several areas within this field that warrant further empirical investigation, including whether the average, maximum, or most recent risk state assessment is the most valid for predicting subsequent aggression in the medium term. This prospective study compared the predictive validity of three indices (i.e. mean score, peak score, and most recent single time-point rating) of the Dynamic Appraisal of Situational Aggression (DASA) for inpatient aggression. Daily risk ratings were completed for 60 psychiatric inpatients (from the acute wards of a forensic psychiatric hospital) for up to 6 months; a total of 1054 DASA ratings were obtained. Results showed that mean and peak scores on the DASA were better predictors of interpersonal violence, verbal threat, and any inpatient aggression than the DASA single time-point most recent ratings. Overall, the results support the use of the prior week's mean and peak scores to aid the prediction of inpatient aggression within inpatient forensic psychiatric settings in the short to medium term. These results also have practical implications for clinicians considering risk-management strategies and the scoring of clinically-relevant items on risk-assessment measures.
    International journal of mental health nursing 12/2012; 22(6). DOI:10.1111/j.1447-0349.2012.00846.x · 1.95 Impact Factor
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    • "delusions and limit-setting interactions), and into the developmental process of aggression, is essential in a dynamic interactional understanding of violence (Bjørkly 2006). So far, clinical research in forensic psychiatry has mainly addressed the issue of precursors of inpatient aggression using structured assessment instruments (Almvik et al. 2000, Ogloff & Daffern 2006, Dolan et al. 2008, McDermott et al. 2008). However, these tools are characterised by a relatively low number of items and a limited capacity to capture idiosyncratic warning signs typical of the individual patient. "
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    ABSTRACT: The Forensic Early Warning Signs of Aggression Inventory (FESAI) was developed to assist nurses and patients in identifying early warning signs and constructing individual early detection plans (EDP) for the prevention of aggressive incidents. The aims of this research were as follows: First, to study the prevalence of early warning signs of aggression, measured with the FESAI, in a sample of forensic patients, and second, to explore whether there are any types of warning signs typical of diagnostic subgroups or offender subgroups. Reconstructing patients' changes in behaviour prior to aggressive incidents may contribute to identify early warning signs specific to the individual patient. The EDP comprises an early intervention strategy suggested by the patient and approved by the nurses. Implementation of EDP may enhance efficient risk assessment and management. An explorative design was used to review existing records and to monitor frequencies of early warning signs. Early detection plans of 171 patients from two forensic hospital wards were examined. Frequency distributions were estimated by recording the early warning signs on the FESAI. Rank order correlation analyses were conducted to compare diagnostic subgroups and offender subgroups concerning types and frequencies of warning signs. The FESAI categories with the highest frequency rank were the following: (1) anger, (2) social withdrawal, (3) superficial contact and (4) non-aggressive antisocial behaviour. There were no significant differences between subgroups of patients concerning the ranks of the four categories of early warning signs. The results suggest that the FESAI covers very well the wide variety of occurred warning signs reported in the EDPs. No group profiles of warning signs were found to be specific to diagnosis or offence type. Applying the FESAI to develop individual EDPs appears to be a promising approach to enhance risk assessment and management.
    Journal of Clinical Nursing 10/2012; 22(11-12). DOI:10.1111/j.1365-2702.2012.04318.x · 1.26 Impact Factor
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