Workplace violence is pervasive in the mental health care setting. Washington State hospital workers surveyed regarding the incidence of physical assaults were found to have a rate of 386-437 physical assaults resulting in at least minor injury per 100 ward staff members per year (1993). In 1996, in response to data such as these, Federal OSHA published violence prevention guidelines for health and community workers. Although the guidelines are based on sound principles of safety and health, they have never been formally evaluated in the field. Evaluation of the guidelines in mental health settings is critically needed to demonstrate the effectiveness of the recommendations, and to examine the true costs and benefits associated with their implementation. This project will evaluate the effectiveness of the OSHA guidelines in three NYSOMH facilities: one adult psychiatric, one child psychiatric and one forensic facility. The intervention will be implemented in two units in each of the three facilities selected and include key elements of the OSHA guidelines. Management Commitment and Employee Involvement are inherent in the design of the proposed study and include the formation and work of joint labor-management advisory groups. A Worksite Analysis will include review of OIRS data, focus groups, a pre-intervention survey, risk mapping and walk-through evaluation. Hazard Prevention and Control will be accomplished by implementing recommendations from the walk-through surveys. The advisory groups in consultation with project staff will review and make recommendations for policies and procedures on Medical Management and Post-incident Reporting and Training and Education. Training on a comprehensive violence prevention program will be offered annually. Formative evaluation of the project will be on-going. Evaluation of the Program, will be accomplished through analysis of a post-intervention survey and OIRS data one year following the implementation of the intervention. An in-depth analysis of the cost and benefit of the intervention will be conducted. The study has the following specific aims. 1) To document and describe a process for implementing OSHA violence prevention guidelines within three types of mental health facilities: one adult psychiatric, one child psychiatric and one forensic facility; 2) To compare assault rates, risk factors for assault and job satisfaction in three types of facilities one year prior to and one year following implementation of a comprehensive OSHA guideline-based (violence prevention program; 3) To assess the cost and benefit of implementing OSHA violence prevention guidelines within a state mental health facility.
