Understanding the impact of targeted environmental changes on violence rates

Preventing institutional violence is a priority, given that state hospitals have become forensic facilities for people referred by the justice system. We’re partnering with the California Department of State Hospitals (DSH) to implement and evaluate an innovative, environment-focused prevention approach. 

Traditional strategies focus on high-risk patients as the source of the problem. We’ve found that institutional risk factors like authoritarian staff-patient relationships also play a role in violence.  This suggests that an environment-focused approach will add value to traditional strategies. We are testing this approach in a randomized, unit-level trial at DSH-Napa.

This approach involves collaborating with unit staff and patients to identify the unit’s environmental risk factors, and then develop and implement an action plan to change those factors. Staff are provided with relevant training and support.  If this approach helps prevent violence at Napa, DSH will invest in disseminating it throughout its giant system.