An assessment of interventions following moderate and high scores on the dynamic appraisal of situational aggression risk assessment tool in a forensic mental health unit

Abstract

ABSTRACTThe Dynamic Appraisal of Situational Aggression (DASA) provides a quick and systematic assessment of short-term violence risk. Risk assessment should be closely aligned to management and result in interventions aimed to reduce risk. The aim of this study was to investigate what interventions followed a moderate/high DASA score and whether they reduced risk. The impact of staff training was also assessed. The study was a retrospective analysis of health records within a medium secure hospital over 6 months. Data was gathered on tool adherence and interventions that were used to reduce risk following a moderate/high score. The change in DASA score following the intervention was recorded. There were 70 patients covering 8224 bed days. There were 24 occasions where a moderate score led to an intervention (n = 24/40%), and 26 occasions for a high score (n = 26/87%). A moderate score was mostly followed by no intervention (n = 35/59%), a high score was mostly followed by seclusion (n = 9/29%). The intervention that led to the largest reduction in DASA score was pro re nata medication following a moderate score and seclusion following a high score. The training of staff led to a reduction in tool adherence and increased intervention use. These results support the need for combining the DASA assessment with operationalised systems to link assessment with risk prevention to help reduce aggression and restrictive practices.KEYWORDS: DASAviolence risk assessmentimplementationaggressioninterventionsstructured professional judgement Disclosure statementNo potential conflict of interest was reported by the authors.Supplementary dataSupplemental data for this article can be accessed online at https://doi.org/10.1080/14789949.2023.2280565Data availability statementThe data that support the findings of this study are available on request from the corresponding author (AC).Additional informationFundingThis research received no specific grant from any funding agency, commercial or not-for-profit sectors.