California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines

CNS Spectrums ◽  
2014 ◽  
Vol 19 (5) ◽  
pp. 449-465 ◽  
Author(s):  
Stephen M. Stahl ◽  
Debbi A. Morrissette ◽  
Michael Cummings ◽  
Allen Azizian ◽  
Shannon Bader ◽  
...  
Keyword(s):  
State Hospital ◽  
Clinical Judgment ◽  
Prescribing Practices ◽  
California Department ◽  
Hospital System ◽  
Department Of State ◽  
Impulsive Aggression ◽  
Hospital Violence ◽  
Assessment And Treatment ◽  
Clinical Trial Results

Here we provide comprehensive guidelines for the assessment and treatment of violence and aggression of various etiologies, including psychotic aggression and impulsive aggression due to schizophrenia, mood disorders, ADHD, or trauma, and predatory aggression due to psychopathy and other personality disorders. These guidelines have been developed from a collection of prescribing recommendations, clinical trial results, and years of clinical experience in treating patients who are persistently violent or aggressive in the California Department of State Hospital System. Many of the recommendations provided in these guidelines employ off-label prescribing practices; thus, sound clinical judgment based on individual patient needs and according to institution formularies must be considered when applying these guidelines in clinical practice.

Implementation of a specialized program to treat violence in a forensic population

CNS Spectrums ◽  
2020 ◽  
Vol 25 (5) ◽  
pp. 571-576
Author(s):  
Susan Velasquez ◽  
Andrea Bauchowitz ◽  
David Pyo ◽  
Megan Pollock
Keyword(s):  
Treatment Program ◽  
Psychiatric Hospitals ◽  
Treatment Programs ◽  
Forensic Population ◽  
California Department ◽  
Hospital System ◽  
Department Of State ◽  
State Hospitals ◽  
Criminogenic Needs ◽  
Inpatient Settings

A shift within state psychiatric hospitals toward serving a predominantly forensic population has resulted in increased violent incidents within those settings. Thus, addressing criminogenic needs in addition to mental illness is an important paradigm shift. Relying on seclusion or restraint as the primary mechanisms to address violence interferes with the provision of effective care to patients struggling with aggressive behaviors. Implementing new treatment programs aimed at reducing violence in forensic inpatient settings is warranted. This article focuses on the step-by-step process of developing such a specialized treatment program within the California Department of State Hospitals. Leadership within this hospital system collaborated with labor unions and other stakeholders to obtain funding to create a novel treatment environment. This treatment program includes a ward design aimed to improve safety and delivers treatment based on the Risk Needs Responsivity Model. Treatment is guided by violence risk assessment and primarily focused on addressing criminogenic needs. The selection of treatments with a focus on violence reduction is discussed.

University of California Davis Forensic Psychiatry and California Department of State Hospitals Collaboration

2021 ◽  
pp. 85-106
Author(s):  
Charles Scott ◽  
Barbara McDermott ◽  
Katherine Warburton
Keyword(s):  
Forensic Psychiatry ◽  
Hospital Staff ◽  
University Of California ◽  
California Department ◽  
Hospital System ◽  
Forensic Evaluations ◽  
Department Of State ◽  
State Hospitals ◽  
Forensic Psychiatric ◽  
The University

The collaboration described in this chapter involves the Department of Psychiatry in the medical school at the University of California, Davis, and the California Department of State Hospitals. For more than 20 years, this partnership has involved placing forensic psychiatry fellows in state hospitals operated by the state of California. In addition to the high-quality forensic psychiatric services delivered by these fellows, the partnership has also included consultation and on-site forensic evaluations conducted by supervising faculty, continuing education and training provided to hospital staff, and applied research conducted on questions directly relevant to practice. It serves as a national model for a well-operated, long-standing partnership between academic psychiatry and a publicly operated hospital system.

Novel Antipsychotics and Patient Care in State Hospitals

1998 ◽  
Vol 32 (9) ◽  
pp. 906-914 ◽  
Author(s):  
Peter F Buckley
Keyword(s):  
State Hospital ◽  
Cost Savings ◽  
Preliminary Evidence ◽  
The State ◽  
New Agents ◽  
Hospital System ◽  
Specific Patient ◽  
State Hospitals ◽  
Additional Information ◽  
Patient Subgroups

OBJECTIVE: To review and highlight the opportunities and challenges of pharmacologic advances in the use of antipsychotics for the state hospital system. METHODS: A critical review was performed of studies published either as articles or abstracts, on the use of novel antipsychotics, particularly as they relate to the patient population within the state mental hospital system. FINDINGS: The recent availability of new antipsychotic medications within state facilities has resulted in more progressive treatment, reduced recidivism (and consequently cost savings), and preliminary evidence of preferential and superior treatment response in specific patient subgroups (e.g., those with aggression). At the same time, inpatient pharmacy budget increases and uncertainty in guiding the use of novel antipsychotics have influenced the availability of these agents in state hospitals. CONCLUSIONS: State hospital services have, by and large, embraced the developments in pharmacotherapy of schizophrenia. Optimal use of these new agents in this population requires additional information on their relative efficacy in specific patient subgroups.

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