This report describes a violence prevention program, modeled after Federal OSHA guidelines, implemented in three NYS in-patient mental health facilities between 2000 and 2004. The report discusses the participatory process essential to a successful violence prevention effort. The report also details the research conducted to evaluate the impact of the program on threats and assault, staff perception of risk factors for assault and job satisfaction. The OSHA Violence Prevention Guidelines served as the blueprint or framework for the intervention, which was then customized to meet the needs of individual intervention facilities by facility-level joint labor/management project advisory groups. The OSHA guidelines are based on five elements of any successful health and safety program, namely: 1) management commitment and employee involvement, 2) worksite analysis, 3) hazard control and prevention, 4) training and 5) evaluation. All five elements are interrelated and all are critical to program success. We found that genuine management commitment and employee involvement were the basis for all subsequent violent prevention efforts. We also found that program success depends on the ongoing work of a dedicated group of individuals representing management, labor, and direct care workers whose focus is primarily or exclusively violence prevention. These facility-level project advisory groups were responsible for developing, implementing and sustaining the project within their facility. As a result of our experience with this project, we found it was possible to implement the generic OSHA violence prevention guidelines in three distinct intervention facilities. To enhance our ability to evaluate the program's impact, three similar facilities participated in the staff surveys and served as comparison facilities. Program impact was evaluated by qualitative findings from a post-intervention meeting of members of all three intervention facility project advisory groups, the findings from a comparison of the pre- and post-intervention staff survey data, and an analysis of trends in assault-related incidence included in the OMH's computerized Occupational Injury Reporting System (OIRS). It should be noted that in 1998, OMH issued a Safe and Therapeutic Environment Policy (STEP) a policy that required all facilities to implement the OSHA Guidelines, so the comparison facilities were also working on violence prevention but without the benefit of the resources of this federal grant. Overall, staff in both intervention and comparison facilities reported improvements in all violence prevention factors. When the 30 factors were grouped into seven factors, staffing intervention facilities reported a statistically significant improvement in five of seven mean factor scores while comparison facilities reported an improvement in four of seven scores. The magnitude of change in intervention facilities was generally higher than in comparison facilities. The post-intervention meeting of the three facility-level project advisory groups provided qualitative data regarding the impact of the intervention on violence prevention in their individual facilities. Facility-specific changes included dedicating a full-time equivalent (FTE) to a violence prevention trainer, the introduction of staff rounds across disciplines, and a facility strategic plan based on the Safe and Therapeutic Environment Program. Individual staff expressed a strong sense of empowerment and collaboration across disciplines. Staff did not report a significant reduction in physical assaults among intervention or comparison facilities. There was an increase in threats of assaults among both intervention and comparison facility staff that was statistically significant or of borderline significance for comparison staff. The fact that we did not find a reduction in assaults following the intervention may suggest that either insufficient time has elapsed to see an impact of the intervention on physical assaults or that other factors not addressed by this program (such as patient or staff characteristics) need to be impacted to see a reduction in assaults. Finally, it should be noted that facility specific results varied among intervention and comparison facilities. Our analysis of OIRS patient assault data for the period 1997 -2004 showed much variability in the rates of assaults over this seven-year period across all 28 OMH facilities. The variability did not appear to be explained by the intervention. The following recommendations are based on the experience of the statewide and facility-level groups involved in the process as well as the project evaluation. 1. Continue the facility-level project advisory committee's ongoing worksite analysis, hazard control activities and evaluation. 2. Facility-level project advisory groups should serve as consultants and catalysts to other OMH facilities in their efforts to enhance violence prevention. 3. Periodic focus groups and staff surveys should be conducted in all facilities to supplement information gleaned from the OIRS data. 4. "Solutions-mapping" sessions, where management and direct care staff review hazard assessment data and craft solutions, should become an integrated part of the STEP policy. 5. The OMH- Multi-Union Health and Safety committee should serve as a forum for ongoing evaluation of agency-wide violence prevention efforts. 6. Results of the project should be widely disseminated to a variety of audiences concerned with reducing the problem of violence in the workplace.
Jane Lipscomb, University of Maryland, School of Nursing, 655 W. Lombard Street, Baltimore, MD 21201