Assaults on Staff

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.