Targeting Institutional Risk Factors to Reduce Patient Violence

Barbara McDermott, Ph.D.
Co-Principal Investigator, UC Davis

Jennifer Skeem, Ph.D.
Principal Investigator, University of California, Berkeley

David J. Cooke, Ph.D.
Co-Principal Investigator, University of Bergin

Recent studies have demonstrated that substantial gains in preventing institutional violence can be made by focusing how situational and environmental factors can elicit violence (Cooke, Wozniak & Johnstone, 2008), such as poor patient-staff communication, low patient-staff ratios, disorganized management. The manualized measure, PRISM: Promoting Risk Intervention by Situational Management (Johnstone & Cooke, 2010a), was developed to provide a tool that allows empirical research to delve into this outward-looking approach. PRISM has successfully assessed violence risk and guided implementation of institutional changes that lowered incidents of violence in high-risk settings across the world (Wilson & Tamatea, 2010; Johnstone & Cooke, 2010b; Cregg & Payne, 2010).

This study aims to establish a partnership with California Department of State Hospitals - Napa to rigorously test whether different situational factors, measured by PRISM, can lead to a reduction in institutional violence in closed psychiatric units. Researcher will use PRISM to identify environmental risk factors in the hospital environment and compare the presence of these factors to variation in violent incidents across different units. Researchers will work with hospital administrators by providing feedback to identify strong environmental risk factors that could be changed to reduce institutional violence.

The primary aims of this research are to:

  1. Identify institutional risk factors that most robustly predict violence rates (and are relevant both to violence theories and prevention) and
  2. Test whether interventions that specifically target a unit’s institutional risk factors are feasible to implement and add value in reducing the unit’s risk level and violence rates.

A secondary aim is to examine impacts on broader indices of institutional health like suicide-related behavior.

Harry Frank Guggenheim Foundation