Violence in the Social Services

Introduction

Nearly one-third of the 100 “fatalities in healthcare and social service settings that occurred in 2013 were due to assaults and violent acts” (OSHA, 2016) No matter what area you work in (community mental health, general or mental hospitals, working in client homes or in a centralized office like a crisis line) you may find yourself working with clients who are expressing thoughts or feelings of violence.

Risk Factors for Violence

A number of factors increase the chances that a client will be violent. Some of these include (James, 2008):

  • Substance abuse. Active intoxication increases the chances a client will be violent. (Tomlinson, Brown, & Hoaken, 2016)
  • De-institutionalization. Moving individuals into community care increases the chances they will revert to their previous state and become violent. (Torrey, 2015)
  • Mental illness. Certain mental illnesses might increase the chances a person will become violent (Stuart, 2003) although the evidence is mixed. Most people with mental illness are statistically more likely to be victims than perpretrators of violence (Desmarais, et. al., 2014)
  • Gender. Men are more likely to be violent than women and more likely to be victims of violence. (Kellermann & Mercy, 1992)
  • Gangs. Gang violence, common in some areas, can increase the chances that youth experience violence as a perpetrator and victim (Neville, et. al., 2015)
  • Elderly. As elderly clients are institutionalized, they may find themselves at increased levels of violence as perpetrators and victims. (Sandive, et. al., 2004)

Assessing Violence Risk

The Dynamic Appraisal of Situational Aggression (DASA; Ogloff & Daffern, 2006) can be used to assess the likelihood that a patient or client will become aggressive within a psychiatric inpatient environment. The DASA has 7 items that are scored 0 for absent and 1 for present within the last 24 hours.

Other useful models for assessing violence risk include the Biopsychosocial Model of Violence Risk Assessment and the Violence Risk Appraisal Guide (VRAG).

Assessing Homicide Risk

Assessing long-term homicidal risk is a task best left to clinical and forensic psychologists or social workers who have training specifically in this area. On the other hand, short-term homicide risk (such as the kind required by Tarasoff ethics) can be learned by all social service workers.

Borum & Reddy (2001) provide an article to performing these assessments, and I’ve also written an article on basic homicide risk assessment that you may refer to.

Levels of Violence Intervention

There are 3 levels of intervention related to violence, depending on the situation. These are suggested by dos Reis et al. (2013) in the youth context. Stage 1 is simple behavioural management such as listening, stage 2 involves pharmacotherapy while stage 3 involves the most significant interventions such as restraints, seclusion or antipsychotics.

A different conceptualization more useful for adult clients is as follows:

  • Stage 1: Immediate intervention to prevent further escalation.
  • Stage 2: To reduce symptoms that can lead to aggression
  • Stage 3: Maintain safety of clients and staff

Stages of Violence Intervention (James, 2008)

  • Stage 1: Education
  • Stage 2: Avoidance of Conflict
  • Stage 3: Appeasement
  • Stage 4: Deflection
  • Stage 5: Time-Out
  • Stage 6: Show of Force
  • Stage 7: Seclusion
  • Stage 8: Restraints
  • Stage 9: Sedation

Violence Intervention Training

References

Borum, R. & Reddy, M. (2001) Assessing violence risk in tarasoff situations: A fact-based model of inquiry. Behavioral Sciences and the Law. 19:375-385. doi: 10.1002/bsl.447

Desmarais, S. L., Van Dorn, R. A., Johnson, K. L., Grimm, K. J., Douglas, K. S., & Swartz, M. S. (2014). Community Violence Perpetration and Victimization Among Adults With Mental Illnesses. American Journal Of Public Health, 104(12), 2342-2349. doi:10.2105/AJPH.2013.301680

dosReis, S., Barnett, S., Love, R.C. & Riddle, M.A. (2003) A Guide for Managing Acute Aggressive
Behavior of Youths in Residential
and Inpatient Treatment Facilities. Psychiatric Services. 54(10). Retrieved on March 26, 2017 from http://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.54.10.1357

James, R.K. (2008) Crisis Intervention Strategies. Brooks/Cole: Belmont, CA.

Kellermann, A.L. & Mercy, J.A. (1992) Men, women, and murder: gender-specific differences in rates of fatal violence and victimization. Journal of Trauma. 33(1):1-5.

Neville, F. G., Goodall, C. A., Gavine, A. J., Williams, D. J., & Donnelly, P. D. (2015). Public health, youth violence, and perpetrator well-being. Peace And Conflict: Journal Of Peace Psychology, 21(3), 322-333. doi:10.1037/pac0000081

Occupational Safety and Health Administration (OSHA). (2012). Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. Retrieved on March 25, 2017 from https://www.osha.gov/Publications/osha3148.pdf

Ogloff, J. P., & Daffern, M. (2006). The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioral Sciences & The Law, 24(6), 799-813. doi:10.1002/bsl.741

Sandvide, Å., Åström, S., Norberg, A., Saveman, B., & RNT. (2004). Violence in institutional care for elderly people from the perspective of involved care providers. Scandinavian Journal Of Caring Sciences, 18(4), 351-357. doi:10.1111/j.1471-6712.2004.00296.x

Stuart, H. (2003). Violence and mental illness: an overview. World Psychiatry, 2(2), 121–124.

Tomlinson, M. F., Brown, M., & Hoaken, P. N. (2016). Recreational drug use and human aggressive behavior: A comprehensive review since 2003. Aggression And Violent Behavior, 279-29. doi:10.1016/j.avb.2016.02.004

Torrey, F.E. (2015). Deinstitutionalization and the rise of violence. CNS Spectrums, 20(3), 207-214. doi:10.1017/S1092852914000753

Cite this article as: MacDonald, D.K., (2017), "Violence in the Social Services," retrieved on June 26, 2019 from http://dustinkmacdonald.com/violence-social-services/.

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Childhood and Adolescent Taxon Scale (CATS)

Introduction

The Childhood and Adolescent Taxon Scale (CATS) worksheet was originally created to accompany the Violence Risk Appraisal Guide (VRAG) and the Sex Offender Risk Appraisal Guide (SORAG). Although the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) can be used to assess psychopathy, there are many situations where a Psychologist or other individual trained in the administration of this tool is not available. In this situation, the CATS tool can be used to assess psychopathy instead.

Quinsey et. al. (2006) determined that the CATS tool is an appropriate replacement for the PCL-R assessment when determining psychopathy on the VRAG and SORAG assessments. Lister (2010) examined the CATS and found that there were no differences in rates of psychopathy as determined by the PCL-R and the CATS with Caucasian and African-American individuals.

Conduct Disorder Symptoms

In order to answer question 4 below, it’s necessary to identify how many conduct disorder symptoms are present.

Count those present those that occurred before age 16 except for items 13 and 15 which are before aged 16:

  1. Often bullied, threatened or intimidated others
  2. Often initiated physical fights
  3. Used a weapon that could cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  4. Was physically cruel to people
  5. Was physically cruel to animals
  6. Stolen while confronting a victim (e.g., mugging, purse snatching, extortion, robbery)
  7. Forced someone into sexual activity
  8. Deliberately engaged in fire setting with the intention of causing serious damage
  9. Deliberately destroyed others’ property (other than by fire setting)
  10. Broken into someone else’s house, car, or building
  11. Often lied to obtain goods or favors or to avoid obligations (i.e., “cons” others)
  12. Stolen items of nontrivial value without confronting a victim (like shoplifting, theft, or forgery)
  13. Before [age] 13, stayed out late at night, despite parental prohibitions
  14. Ran away from home overnight (or longer) at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  15. Before [age] 13, was often truant from school

Childhood & Adolescent Taxon Scale (CATS) Items

The CATS scale has 8 items that are reviewed below, along with supplementary scoring guidelines.

Elementary School Maladjustment

This refers to the first 8 years of formal schooling after kindgarten. A couple of incidents of truancy, smoking on school property or other minor incidents like this would be classified as Mild or Moderate. Severe incidents include repeated truancy or violent actions like assault. Also included in Severe is actions that result in criminal convictions like selling drugs at school.

  • 0 – No Problems
  • 0 – Slight (Minor discipline or attendance) or Moderate Problems
  • 1 – Severe Problems (Frequent disruptive behavior and/or attendance or behavior resulting in expulsion or serious suspensions)

Teenage Alcohol Problem

The National Institute on Alcohol Abuse and Alcoholism produces a guide to screening and intervening with youth (NIAAA, 2015) who consume alcohol. Their screening and assessment rubric can be used to determine if there is a teenage alcohol problem.

Based on the empirically determined risk guidelines, someone who is 12-15 and drinks more than 6 days in the past year would indicate a 1 below, someone who is 16 and drinks more than 12 days in the last year, someone who is 17 would need to drink more than 24 days while an individual who is 18 or higher would need to drink more than 52 days a year.

  • 0 – No
  • 1 – Yes

Childhood Aggression Rating

  • 0 – No Evidence of Aggression
  • 0 – Occasional Moderate Aggression
  • 1 – Occasional or Frequent Extreme Aggression

More Than 3 DSM Conduct Disorder Symptoms

These are the conduct disorder symptoms filled out below.

  • 0 – No
  • 1 – Yes

Ever suspended or expelled from school

  • 0 – No
  • 1 – Yes

Arrested under the age of 16

  • 0 – No
  • 1 – Yes

Lived with both biological parents to age 16 (except for death of parents)

Separation for more than one month is required for coding a “no” on this item. This could be because of institutionalization, divorce, or other separations but does not include death of one or both parents.

  • 0 – Yes
  • 1 – No

Scoring the CATS

Each of these items will result in a 0 or 1 score. All items are summed and the value can then be used to complete Item 12.b on the VRAG or item 14b on the SORAG.

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Hare, R.D. (1991) The Hare Psychopathy Checklist-Revised (Hare PCL-R). Toronto: Multi-Health Systems.

Lister, M.B. (2010) A Comparison of the Violence Risk Appraisal Guide, Psychopathy Checklist, and child and Adolescent Taxon Scale: Predictive Utility And Cross Cultural Generalizable. Dissertation.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2015). Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide. Retrieved on January 28, 2017 from https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf

Cite this article as: MacDonald, D.K., (2017), "Childhood and Adolescent Taxon Scale (CATS)," retrieved on June 26, 2019 from http://dustinkmacdonald.com/childhood-adolescent-taxon-scale-cats/.
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Using the Sex Offender Risk Appraisal Guide (SORAG)

Introduction

Following up on my article about how to use the Violence Risk Appraisal Guide (VRAG), this article reviews how to use a tool that is bundled with that tool, the Sex Offender Risk Appraisal Guide (SORAG). Like the VRAG, this is an actuarial tool that can be used to predict the risk of re-offending among sex offenders.

Before reading about the SORAG, it is helpful to review the VRAG post as many of the elements that are covered in that post are required before proceeding to the SORAG items. It is recommended that any completion of the SORAG be preceded by a completion of the VRAG as this will save you a significant amount of time.

Completing the SORAG

Like the VRAG, the first step is to complete the Childhood & Adolescent Taxon Scale (CATS) worksheet and the list of Conduct Disorder Symptoms.

Cormier-Lang Criminal History Scores

In order to answer item 5 on the SORAG, Criminal History Score for Non-Violent Offenses Prior to the Index Offense, it’s necessary to complete the Cormier-Lang Criminal History worksheet also provided on the SORAG. This worksheet is completed by filling out the number of non-violent offenses and applying the weight to them noted on the sheet.

Sex Offender Risk Appraisal Guide (SORAG) Items

The SORAG itself has 14 items that are similar to those found on the VRAG.

  1. Lived with both biological parents to age 16 (except for death of parent)
  2. Elementary School Maladjustment
  3. History of alcohol problems
  4. Marital status (at the time of or prior to index offense)
  5. Criminal history score for nonviolent offenses (from Cormier-Lang system)
  6. Criminal history score for violent offenses (from Cormier-Lang system)
  7. Number of previous convictions for sexual offenses (pertains to convictions known from all available documentation to be sexual offenses prior to the index offense)
  8. History of sex offenses only against girls under 14 (including index offenses; if offender was less than 5 years older than victim, always score +4)
  9. Failure on prior conditional release (includes parole or probation violation or revocation, failure to comply, bail violation, and any new arrest while on conditional release)
  10. Age at index
  11. 11. Meets DSM criteria for any personality disorder (must be made by appropriately licensed or certified professional)
  12. Meets DSM criteria for schizophrenia (must be made by appropriately licensed or certified professional)
  13. Phallometric test results
  14. 14. a. Psychopathy Checklist score (if available, otherwise use item 12.b. CATS score)
    14. b. CATS score (from the CATS worksheet)
    14. WEIGHT (Use the highest circled weight from 12 a. or 12 b.)

You’ll note that many of these items are available from the VRAG. The tool indicates where there are overlaps in order to save you time filling out the worksheets and tools.

Determining Risk Level of Sex Offenders

After completing the tool, you must take the total score of the SORAG and compare it to the below levels.

  • A score of -17 to +2 indicates an individual is at Low risk for re-offending
  • A score of +3 to +19 indicates an individual is at Medium risk for re-offending
  • A score of +20 to +34 indicates an individual is at High risk for re-offending

An individual who is on the border between these two levels should have that indicated. For instance, someone who scores at +1 or +2 should be noted as “Low-Medium Risk” to highlight that they are at the edge of the established risk level.

Recidivism Rates using the SORAG

Rather than grouping an individual into low, medium or high risk categories, it is often more illuminating to examine the recidivism rates. These come from Violent Offenders as well.

Probability of Recidivism
SORAG score 7 years 10 years
< − 9 0.07 0.09
−9 to -4 0.15 0.12
-3 to +2 0.23 0.39
+3 to +8 0.39 0.59
+9 to +14 0.45 0.59
+15 to +19 0.58 0.76
+20 to +24 0.58 0.80
+25 to +30 0.75 0.89
> +31 1.00 1.00

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Cite this article as: MacDonald, D.K., (2017), "Using the Sex Offender Risk Appraisal Guide (SORAG)," retrieved on June 26, 2019 from http://dustinkmacdonald.com/using-sex-offender-risk-appraisal-guide-sorag/.
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Using the Violence Risk Appraisal Guide (VRAG)

Introduction

The Violence Risk Appraisal Guide (VRAG; Quinsey, Harris, Rice, & Cormier, 2006) is a tool that can be used to estimate statistically the risk of recidivism. It is comprised of 12 items that are associated with a risk of re-offending and is completed with all available information. You can download the full VRAG in PDF format. The Sexual Offender Risk Appraisal Guide (SORAG) is reviewed in another article.

The VRAG is an actuarial risk assessment, involving a mathematical technique applied to determines what factors were present in offenders who later went on to commit violent crimes. (Brown & Singh, 2014) This approach eliminates the bias found in unstructured judgement.

The VRAG has been examined in over 40 studies, and has been found effective even with individuals who have a lower IQ. (Camilleri & Quinsey, 2011)

Completing the VRAG

The first step to completing the VRAG is to complete the Childhood & Adolescent Taxon Scale. Below, where a request for information relates to an “index offense” that is the one that led to the individual entering the Criminal Justice system

Childhood & Adolescent Taxon Scale (CATS) Worksheet

This scale includes 8 items that are scored from 0 to 1, based on the coding guidelines provided. These items are:

  1. Elementary School Maladjustment
  2. Teenage Alcohol Problem
  3. Childhood Aggression Rating
  4. More Than 3 DSM Conduct Disorder Symptoms
  5. Ever suspended or expelled from school
  6. Arrested under the age of 16
  7. Lived with both biological parents to age 16 (except for death of parents)

Conduct Disorder Symptoms

Next, the assessor will complete the list of Conduct Disorder symptoms, circling those that occurred before age 16 except for items 13 and 15 which are before aged 16:

  • 1. Often bullied, threatened or intimidated others
  • 2. Often initiated physical fights
  • 3. Used a weapon that could cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  • 4. Was physically cruel to people
  • 5. Was physically cruel to animals
  • 6. Stolen while confronting a victim (e.g., mugging, purse snatching, extortion, robbery)
  • 7. Forced someone into sexual activity
  • 8. Deliberately engaged in fire setting with the intention of causing serious damage
  • 9. Deliberately destroyed others’ property (other than by fire setting)
  • 10. Broken into someone else’s house, car, or building
  • 11. Often lied to obtain goods or favors or to avoid obligations (i.e., “cons” others)
  • 12. Stolen items of nontrivial value without confronting a victim (like shoplifting, theft, or forgery)
  • 13. Before [age] 13, stayed out late at night, despite parental prohibitions
  • 14. Ran away from home overnight (or longer) at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  • 15. Before [age] 13, was often truant from school

Cormier-Lang Criminal History Scores for Non-Violent Offenses

This scoring form allows you to answer item number 5 below, the Criminal History Score for Non-Violent Offenses Prior to the Index Offense. This score is developed by counting the number of non-violent offenses and applying a weight to them. For instance, bank robbery is counted x7 while Indecent Exposure is counted x2. So an individual who has two instances of Indecent Exposure and 1 instance of Bank Robbery would have (2×2 = 4) + (1×7 = 7) = 4+7 = 11.

Violence Risk Appraisal Guide (VRAG) Items

Next are the 12 VRAG items. The tool provides detailed coding instructions for each of these:

  1. Lived with both biological parents to age 16 (except for death of parent):
  2. Elementary School Maladjustment:
  3. History of alcohol problems
  4. Marital status (at the time of or prior to index offense):
  5. Criminal history score for nonviolent offenses prior to the index offense
  6. Failure on prior conditional release (includes parole or probation violation or revocation, failure to comply, bail violation, and any new arrest while on conditional release):
  7. Age at index offense
  8. Victim Injury (for index offense; the most serious is scored):
  9. Any female victim (for index offense)
  10. Meets DSM criteria for any personality disorder (must be made by appropriately licensed or certified professional)
  11. Meets DSM criteria for schizophrenia (must be made by appropriately licensed or certified professional)
  12. a. Psychopathy Checklist score (if available, otherwise use item 12.b. CATS score)
  13. (Technically 12b) bCATS score (from the CATS worksheet)

Scoring the VRAG

Determining Risk

Risk categories are provided in the VRAG manual. They are approximated here although more detail is available in the complete manual. For each score, if an individual is close to the next score you should list them as a combination of the two. For instance an individual whose score is -10, -9 or -8 would be listed as Low-Medium rather than just Low.

  • -24 to -8 is Low Risk
  • -7 to +13 is Medium Risk
  • +14 to +32 is High Risk

Determining Rate of Recidivism

The risk of recidivism is presented below, from the same manual (pages 283-286):

Probability of Recidivism
VRAG score 7 years 10 years
< −22 0.00 0.08
−21 to −15 0.08 0.10
−14 to −8 0.12 0.24
−7 to −1 0.17 0.31
0 to +6 0.35 0.48
+7 to +13 0.44 0.58
+14 to +20 0.55 0.64
+21 to +27 0.76 0.82
> +28 1.00 1.00

This is to be interpreted as a percentage. For instance a score of -10 is in the -14 to -8 category; therefore an individual would have a 7 year recidivism rate of 12% and a 10 year recidivism rate of 24%.

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Brown, J. & Singh, J.P. (2014) Forensic Risk Assessment: A Beginner’s Guide. Archives of Forensic Psychology. 1(1). 49-59. Retrieved on January 20, 2017 from http://www.archivesofforensicpsychology.com/web/wp-content/uploads/2015/01/Brown-and-Singh1.pdf

Camilleri, J.A. & Quinsey, V.L. (2011) Appraising the risk of sexual and violent recidivism among intellectually disabled offenders. Psychology, Crime & Law. 17(1) 59-74

Cite this article as: MacDonald, D.K., (2017), "Using the Violence Risk Appraisal Guide (VRAG)," retrieved on June 26, 2019 from http://dustinkmacdonald.com/using-violence-risk-appraisal-guide-vrag/.
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Dynamic Appraisal of Situational Aggression (DASA)

Introduction

The Dynamic Appraisal of Situational Aggression (DASA) is a tool developed by Ogloff & Daffern (2006) to assess the likelihood that a patient or client will become aggressive within a psychiatric inpatient environment. The DASA is based on the Norwegian Brøset-Violence-Checklist (BVC).

DASA Items

  1. Irritability
  2. Impulsivity
  3. Unwillingness to follow instructions
  4. Sensitive to perceived provocation
  5. Easily angered when requests are denied
  6. Negative attitudes
  7. Verbal threats.

Scoring the DASA

Each of the items are scored 0 if absent or 1 if is present now or has been present in the last 24 hours. This means that if someone is not currently displaying easy anger upon denied requests, but was earlier, that item should be scored 1.

There is no typical cut-off score for the DASA, although Barry-Walsh et. al. (2009) note in their research that “for each increase in DASA total score, there was a 1.77 times increased likelihood that the patient would behave aggressively in the following 24 hours.”

In Ogloff & Daffern’s original 2006 study

  • 18% of aggressive patients scored 1 to 3
  • 15% of aggressive patients scored 4 or 5
  • 55% of aggressive patients scored 6 or 7

Kaunomäki (2013) used a cut-off score of 4 to identify high-risk individuals.

DASA Research

A study of the DASA by Griffith, Daffern & Godber (2013) the DASA allowed nurses to predict aggressive behaviour significantly better than unaided judgements. Lantta et. al. (2016) confirmed the same on mental health inpatient units.

Taylor & Large (2013) question the predictive validity of the DASA, noting that of 200+ patients identified as potentially becoming aggressive, only one actually will. (This “low base rate” problem is the same issue affecting violence risk assessment and suicide risk assessment.)

Daffern & Howells (2007) compared the DASA with the HCR-20 and noted moderate predictive validity.

Current Use

The DASA is currently used by a variety of mental hospitals around the world. Some DASA write-ups include:

Reference

Barry-Walsh, J., Daffern, M., Duncan, S., & Ogloff, J. (2009). The prediction of imminent aggression in patients with mental illness and/or intellectual disability using the Dynamic Appraisal of Situational Aggression instrument. Australasian Psychiatry, 17(6), 493-496. doi:10.1080/10398560903289975

Chan, O. (2014) The Assessment of Imminent Aggression in Forensic Setting A Validation Study of the Dynamic Appraisal of Situational Aggression (DASA) in Hong Kong. Non-Peer Reviewed. Retrieved on November 13, 2016 from http://www.hkcpsych.org.hk/index.php?option=com_docman&task=doc_view&gid=1338&Itemid=354&lang=en

Daffern, M., & Howells, K. (2007). The Prediction of Imminent Aggression and Self-Harm in Personality Disordered Patients of a High Security Hospital Using the HCR-20 Clinical Scale and the Dynamic Appraisal of Situational Aggression. International Journal Of Forensic Mental Health, 6(2), 137.

Griffith, J. J., Daffern, M., & Godber, T. (2013). Examination of the predictive validity of the Dynamic Appraisal of Situational Aggression in two mental health units. International Journal Of Mental Health Nursing, 22(6), 485-492. doi:10.1111/inm.12011

Kaunomäki, J. (2015) Patient interventions after the assessment of violence risk: Observational study in a Finnish psychiatric admission ward. Institute of Behavioral Sciences. Thesis. Retrieved on November 13, 2016 from https://helda.helsinki.fi/bitstream/handle/10138/156453/Pro%20Gradu%20Kaunomäki%202015.pdf?sequence=3

Lantta, T., Kontio, R., Daffern, M., Adams, C. E., & Välimäki, M. (2016). Using the Dynamic Appraisal of Situational Aggression with mental health inpatients: a feasibility study. Patient Preference & Adherence, 10691-701. doi:10.2147/PPA.S103840

Ogloff, J. P., & Daffern, M. (2006). The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behavioral Sciences & The Law, 24(6), 799-813. doi:10.1002/bsl.741

Taylor, L., & Large, M. (2013). Dynamic Appraisal of Situational Aggression lacks utility. International Journal Of Mental Health Nursing, 22(6), 579. doi:10.1111/inm.12019

Cite this article as: MacDonald, D.K., (2016), "Dynamic Appraisal of Situational Aggression (DASA)," retrieved on June 26, 2019 from http://dustinkmacdonald.com/dynamic-appraisal-situational-aggression-dasa/.

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