Systematic Aggression Registration in Forensic Psychiatric Care: A Qualitative Study on Preconditions for Successful Implementation

Abstract

Available research emphasizes the importance of getting a systematic overview of inpatient aggression in forensic psychiatric care. However, the same research does not focus on how systematic aggression registration should be introduced in clinical practice. To facilitate the use of systematic aggression registration instruments, it is very relevant to gain insight into the perspective of staff members on the introduction of these instruments in daily clinical practice. Additionally, preconditions for achieving a successful implementation can be considered. Therefore, this study aims to gain insight into the perspective of the staff members on the implementation of a systematic aggression registration instrument—that is, the MOAS—in a forensic psychiatric unit. Interviews ( n = 8) and a focus group with staff members were carried out. Three main themes: (1) creating the most appropriate context for introduction, (2) choice for the MOAS as relevant instrument, and (3) perpetuating the use of the MOAS in clinical practice are scrutinized. The mentioned preconditions can be used as guidelines when implementing systematic aggression registration in clinical practice. We hope that this paper can inspire other forensic psychiatric facilities to introduce systematic registration of aggressive incidents.

Protective Factors in Forensic Practice: The Added Value of the SAPROF-Extended Version Pilot in Relation to Aggressive Incidents

“…The Modified Overt Aggression Scale (MOAS; Kay et al, 1988) has been used since 2016 in the study setting to register inpatient aggressive incidents (Cappon et al, 2022). The MOAS is one of the most commonly used instruments for the administration of aggressive incidents in clinical practice and has been shown to be applicable in forensic psychiatric settings (Nijman et al, 2006; Verstegen et al, 2017).…”

“…This hospital was chosen for the current study because of its ambition to increasingly implement strengths-based approaches in daily clinical practice and because the original SAPROF and the HCR-20 V3 have been used there routinely for many years. Furthermore, the hospital had a sound registration in place for aggressive incidents (Cappon et al, 2022) by means of the Modified Overt Aggression Scale (MOAS, Kay et al, 1988). The findings from this study will likely generate insights that guide further adjustment of the SAPROF-EV pilot.…”