In Reply: Dr. Langenbach's thoughtful comments about declines in assaults after formation of an ASAP team draws attention to possible mediating factors associated with these rates of decline.
The ASAP program (1) does utilize group debriefing procedures for entire ward units in cases where assaults have been especially disruptive to the ward community. This decision is made jointly by the unit director and the ASAP team leader for the facility. Group debriefings are not done routinely because not every assault appears to disrupt the community, and because staffing limitations and staff overtime costs to conduct these debriefings currently preclude such an approach. Declines in the rate of assault suggest enhanced coping resources with this use of ASAP debriefings as needed, but the amount of variance accounted for by these group debriefings as well as the other types of ASAP crisis interventions remains to be examined.
The presence of an ASAP team does appear to change the hospital culture in a favorable manner. The consistent presence of an ASAP team member after each episode of violence appears to provide needed support to the individual employee victim and to the staff in general. Staff anxiety appears to be reduced, which may in turn reduce patient anxiety, favorably raising the threshold for violence. The modeling-containment approaches suggested by Dr. Langenbach offer possible theoretical explanations for why these declines may occur. However, the observed outcome may be influenced by other variables in addition to ASAP, such as advances in medication, staff experience and training, administrative support, and the halo effect.
Institute on Psychiatric Services Scheduled for October
The Institute on Psychiatric Services—the American Psychiatric Association's annual conference on clinical conference on clinical care and service delivery issues—will be held October 2-6 at the Westin Bonaventure Hotel in Los Angeles, California. Tana A. Grady, M.D., of Durham, North Carolina, is chairperson of the 1998 institute scientific program committee.
A day-by-day overview of the institute program is published in this month's issue of Psychiatric Services. A copy of the complete preliminary program is available from the APA Answer Center at 202-682-6000 or from APAfast FAX, APA's facsimile-on-demand services, at 888-267-5400. For additional information, contact Jill Gruber, Coordinator, Institute on Psychiatric Services, APA, 1400 K Street, N.W., Washington, D.C. 20005; telephone, 202-682-6314.