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Barzman D, Hemphill R, Appel K, Kerekes O, Sorter M, Berry AM, Combs J, Osborn A, Lin PD. A Large Naturalistic Study on the BRACHA: Confirmation of the Predictive Validity. Psychiatr Q 2022; 93:803-811. [PMID: 35732915 DOI: 10.1007/s11126-022-09993-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 02/03/2023]
Abstract
Aggression is a major challenge on child/adolescent inpatient psychiatric units. A screening instrument to accurately identify risk is urgently needed. To determine the predictive validity of the Brief Rating of Aggression by Children and Adolescents (BRACHA). Prospective cohort study. BRACHA is administered by clinical staff in the emergency department (ED) prior to inpatient psychiatric admission. A consecutive sample of 10,054 admitted patients from 2010-2021. No patients refused screening nor were excluded. BRACHA administered to patients in the ED prior to admission at Cincinnati Children's Hospital Medical Center (CCHMC). Patient behavioral outcomes measured by Overt Aggression Scale (OAS), categorizing aggression as verbal or physical, then as towards self, others, or objects. Female patients comprised 53.6% (n = 5,386) of the sample. Most patients were white (n = 6,556, 65.2%). Patients ranged in age from 4 to 18 years, with a mean age of 13.6 ± 3.1 years. A single biological parent (n = 5,317, 52.9%) was the predominant living arrangement among patients. The Area Under the Curve (AUC), as an assessment of predictive validity across all possible cut-offs of BRACHA scores ranged from 0.640 (aggression to self) to 0.758 (physical aggression towards others). Our findings support the BRACHA as a useful predictive instrument for aggression in inpatient psychiatric admissions from ED regardless of length of stay. Treating staff are then able to immediately classify risk level and inform care plans for all lengths of hospitalization. Applies to potential risk for aggression, except for self-aggression. Future data analyses will evaluate demographic factors to determine which improve predictive power of the BRACHA and can be used to create a BRACHA calculator. To our knowledge, this naturalistic outcomes study is one of the largest in psychiatry. The BRACHA will continue to be studied to evaluate risk for aggression on inpatient units and aim to assist in keeping unit staff and patients safe.
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Affiliation(s)
- Drew Barzman
- Director of the Child & Adolescent Forensic Research Program Director of Research for the UC Division of Forensic Psychiatry Professor of Psychiatry, University of Cincinnati & Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Rosalie Hemphill
- Director of the Child & Adolescent Forensic Research Program Director of Research for the UC Division of Forensic Psychiatry Professor of Psychiatry, University of Cincinnati & Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
| | - Kacey Appel
- Director of the Child & Adolescent Forensic Research Program Director of Research for the UC Division of Forensic Psychiatry Professor of Psychiatry, University of Cincinnati & Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Olivia Kerekes
- Director of the Child & Adolescent Forensic Research Program Director of Research for the UC Division of Forensic Psychiatry Professor of Psychiatry, University of Cincinnati & Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Michael Sorter
- Director of the Child & Adolescent Forensic Research Program Director of Research for the UC Division of Forensic Psychiatry Professor of Psychiatry, University of Cincinnati & Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Ashley-Marie Berry
- Director of the Child & Adolescent Forensic Research Program Director of Research for the UC Division of Forensic Psychiatry Professor of Psychiatry, University of Cincinnati & Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Jennifer Combs
- Director of the Child & Adolescent Forensic Research Program Director of Research for the UC Division of Forensic Psychiatry Professor of Psychiatry, University of Cincinnati & Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - Alexander Osborn
- Director of the Child & Adolescent Forensic Research Program Director of Research for the UC Division of Forensic Psychiatry Professor of Psychiatry, University of Cincinnati & Cincinnati Children's Hospital Medical Center, Cincinnati, USA
| | - P Daniel Lin
- University of New South Wales School of Psychiatry, Taipei Medical University, Taipei, Taiwan
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Malda Castillo J, Smith I, Morris L, Perez-Algorta G. Violent incidents in a secure service for individuals with learning disabilities: Incident types, circumstances and staff responses. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1164-1173. [PMID: 29953700 DOI: 10.1111/jar.12490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 04/09/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The issue of violence in secure services has long been recognized both in the UK and worldwide. However, there is currently scarce literature available about violence within learning disability (LD) secure settings. METHODS Secondary data analysis was conducted on violent incidents, using information routinely collected by the staff over a 1-year period. RESULTS Physical assaults were the most frequent type of incident, and the distribution in terms of days or months was homogenous and incidents were concentrated in the corridors, lounges and dining rooms of secure facilities. Antipsychotic medication was not regularly prescribed. Generalized linear modelling analyses revealed significant predictors that increased the chances of seclusion and physical restraint, such as being female or directing the violence towards staff. CONCLUSIONS These findings can inform staff training on violence prevention and suggest that increased ward-based supervision and enhanced use of psychological formulations may help in reducing violence within this service context.
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Affiliation(s)
- Javier Malda Castillo
- Furness College, Lancaster University, Lancaster, England.,Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College, Lancaster, England
| | - Ian Smith
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College, Lancaster, England
| | - Lucy Morris
- Mersey Care NHS Foundation Trust, Lancaster, England
| | - Guillermo Perez-Algorta
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College, Lancaster, England
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Tremmery S, Danckaerts M, Bruckers L, Molenberghs G, De Hert M, Wampers M, De Varé J, de Decker A. Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice. Eur Child Adolesc Psychiatry 2014; 23:823-33. [PMID: 24682593 DOI: 10.1007/s00787-014-0534-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 02/27/2014] [Indexed: 12/01/2022]
Abstract
Although aggression is part of daily life in psychiatric units for adolescents, empirical data on its prevalence are sparse. Only few studies have described prevalence of aggressive incidents in adolescent psychiatric wards, and data in forensic psychiatric care are even more limited. Available studies reported high prevalence rates of aggression, ranging from 0.4 to 2.4 incidents of aggression per day across (forensic) child and adolescent psychiatric units. Between 27 and 78 % of all admitted youth committed an aggressive act. In this study, we collected systematically registered data of all aggressive incidents from the first 2 years (2010-2012) on a newly established forensic adolescent psychiatric unit, which used a formal aggression management program embedded in the social competence model, which is based on early intervention in the 'chain of behavior' to prevent any further escalation. The inclusion of also minor aggressive incidents is unique in the literature and the clinical relevance is highlighted. A mean of one incident a day took place, with each adolescent involved in at least one incident. Notably, 1.7 aggressive incidents per month made seclusion of restraint use necessary. Based on the social competence theory, the aggression management model suggests intervening early in the cascade of aggression, in order to prevent further escalation and reduce the need for intrusive interventions. Evidence supported that aggression is a contextual event, as external factors clearly influence the incidence of aggression. Aggression management should be built on both relational and structural security.
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Affiliation(s)
- S Tremmery
- Department of Child Psychiatry, Psychiatric Centre Campus Kortenberg, University Hospitals Leuven, Leuvensesteenweg 517, 3070, Kortenberg, Belgium,
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Hill SA, Preston J. The first three years of an inpatient adolescent forensic service. MEDICINE, SCIENCE, AND THE LAW 2012; 52:156-161. [PMID: 22833484 DOI: 10.1258/msl.2011.011039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bluebird House opened in February 2008. It was built to fill the gap of inpatient adolescent forensic services covering the South and South-West of England. This article describes the development of this highly specialized unit in its first three years.
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Affiliation(s)
- Simon A Hill
- Bluebird House, Tatchbury Mount, Calmore, Southampton SO40 2RZ, UK.
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Hill SA, White O, Lolley J, Sidki-Gomez A, Williams H. Incidents in an adolescent forensic secure inpatient service. MEDICINE, SCIENCE, AND THE LAW 2012; 52:27-31. [PMID: 22399026 DOI: 10.1258/msl.2011.011029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There has been increased research in recent years on incidents within adolescent inpatient psychiatric units, although findings to date have been somewhat inconsistent. We analysed all reported incidents by 37 consecutively discharged patients from a mixed sex adolescent forensic hospital. Findings include a very high overall rate of incidents. A small number of female patients with emerging emotionally unstable personality disorder accounted for the majority of violent incidents and other incidents. Almost all the patients assaulted someone during their admission. Patients on civil sections of the Mental Health Act had just as many incidents as patients on forensic sections. The vast majority of assaults were on staff. Peak times for incidents were the end of each day when education sessions were timetabled and the beginning of the night shift.
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Affiliation(s)
- Simon A Hill
- Bluebird House, Tatchbury Mount, Southampton, UK.
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Dolan M, Fullam R, Logan C, Davies G. The Violence Risk Scale Second Edition (VRS-2) as a predictor of institutional violence in a British forensic inpatient sample. Psychiatry Res 2008; 158:55-65. [PMID: 18083238 DOI: 10.1016/j.psychres.2006.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2004] [Revised: 02/24/2005] [Accepted: 08/31/2006] [Indexed: 11/15/2022]
Abstract
This study examined the utility of The Violence Risk Scale 2nd Edition (VRS-2) [Wong, S., Gordon, A., 1999. Manual for the Violence Risk Scale. University of Saskatchewan, Saskatchewan, Canada] as an institutional violence risk predictor. The VRS-2 and the Psychopathy Checklist: Screening Version (PCL: SV) were rated independently from pre-admission/admission case records in 147 patients in a medium security facility. Inpatient aggression post-admission was recorded by an independent researcher. Aggressive patients had significantly higher scores on both measures. The VRS-2 and the PCL: SV were only modest predictors of inpatient aggression. The VRS-2 putative "dynamic" items showed the highest predictive accuracy. The results tentatively support the use of the VRS-2 as a predictor of inpatient violence in mentally ill patients in medium security settings, with the dynamic component of this instrument showing most promise. Further studies validating this instrument are required before it is adopted into routine clinical practice.
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Affiliation(s)
- Mairead Dolan
- Edenfield Centre, Bolton Salford Trafford Mental Health NHS Trust, Manchester, UK M25
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Dolan M, Blackburn R. Interpersonal factors as predictors of disciplinary infractions in incarcerated personality disordered offenders. PERSONALITY AND INDIVIDUAL DIFFERENCES 2006. [DOI: 10.1016/j.paid.2005.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chowdhury NA, Whittle N, McCarthy K, Bailey S, Harrington R. Ethnicity and its relevance in a seven-year admission cohort to an English national adolescent medium secure health service unit. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2005; 15:261-72. [PMID: 16575847 DOI: 10.1002/cbm.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
BACKGROUND There is some research which variously suggests that adults from some ethnic minority groups in the UK may be disproportionately likely to attract certain psychiatric diagnoses, and, in turn, to be admitted to inpatient facilities and compulsorily detained there; there are concerns too about over-representation in the criminal justice system. Little such work has been done with adolescents. AIMS To determine the proportion of young people from ethnic minorities admitted to one UK specialist medium secure hospital unit for adolescents and describe their diagnoses. METHODS Data were extracted from the case records of all 61 young people admitted to this unit at any time between 1 April 1995 and 31 March 2002. RESULTS Inpatients from ethnic minority backgrounds were significantly over-represented when compared with National Census data. This was mainly accounted for by inpatients from Black African (11%) and Black Caribbean backgrounds (8%). There were, however, no within unit differences in final diagnoses between the ethnic groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Our findings confirm both a high overall proportion of young people from ethnic minorities using a national medium secure hospital service and considerable ethnic diversity within that. They are discussed in the context of one relevant national government initiative for improving responses to minority groups.
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LePage JP, DelBen K, Pollard S, McGhee M, VanHorn L, Murphy J, Lewis P, Aboraya A, Mogge N. Reducing assaults on an acute psychiatric unit using a token economy: a 2-year follow-up. BEHAVIORAL INTERVENTIONS 2003. [DOI: 10.1002/bin.134] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Arthur GL, Brende JO, Quiroz SE. Violence: incidence and frequency of physical and psychological assaults affecting mental health providers in Georgia. THE JOURNAL OF GENERAL PSYCHOLOGY 2003; 130:22-45. [PMID: 12635854 DOI: 10.1080/00221300309601272] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Threats to the physical safety and psychological well-being of mental health professionals present serious problems, according to 1,131 licensed mental health professionals in the state of Georgia. The professionals included clinical social workers, marriage and family therapists, professional counselors, psychiatrists, psychologists, and social workers. From a total of 6,431 surveys sent out, 1,131 (18%) were returned. The results revealed 2.696 separate accounts of 14,120 acts of physical or psychological assaults committed by 8,292 perpetrators. The results also showed that 61% of the respondents had been victimized in violent acts of a psychological or physical nature and that 29% had feared for their lives at least once during their professional careers. These data are consistent with other research that indicates that 6 out of 10 professionals will be assaulted during their professional careers.
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Affiliation(s)
- Gary L Arthur
- Department of Counseling and Psychological Services, Georgia State University, Atlanta 30303-3083, USA.
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Suter JM, Byrne MK, Byrne S, Howells K, Day A. Anger in prisoners: women are different from men. PERSONALITY AND INDIVIDUAL DIFFERENCES 2002. [DOI: 10.1016/s0191-8869(01)00105-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Green B, Robinson L. A Further 12‐Month Study of Violent Incidents Within a Medium Secure Psychiatric Unit (and a Comparison with the Previous 12 Months). ACTA ACUST UNITED AC 2001. [DOI: 10.1108/14636646200100016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gudjonsson G, Rabe-hesketh S, Wilson C. Violent incidents on a medium secure unit over a 17-year period. ACTA ACUST UNITED AC 1999. [DOI: 10.1080/09585189908403679] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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A guide to the literature on aggressive behavior. Aggress Behav 1996. [DOI: 10.1002/1098-2337(1996)22:5<393::aid-ab2480220502>3.0.co;2-m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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