Risk assessment tool at MDHHS state psychiatric hospitals continues to reduce incidents and injuries

58% reduction in patient injuries and 28% decline in staff injuries

LANSING, Mich. - An innovative daily risk assessment and care planning process implemented at Michigan's four state psychiatric hospitals has cut the number of patient injuries by more than half and continues to improve care and reduce incidents of aggression and injuries to both patients and staff.

The Michigan Department of Health and Human Services (MDHHS) implemented the Dynamic Appraisal of Situational Aggression (DASA) in March 2024. Since then, there has been a 58% reduction in patient injuries and a 28% decrease in serious patient-related staff injuries. The state psychiatric hospitals were the first in the state to implement DASA.

"This is a great example of how our state hospitals continue to improve the way we provide top-quality care to our patients," said Elizabeth Hertel, MDHHS director. "This tool is helping keep patients and everyone around them safe while we treat them for some of the most serious behavioral health illnesses."

DASA is a daily risk assessment rating system used to evaluate the likelihood of aggression in behavioral health inpatients within the next 24 hours. Staff completing the DASA consider whether seven different kinds of behaviors are present that determine a rating of low, moderate or high risk of aggression.

Based on their DASA score, the Aggression Prevention Protocol is used to develop individualized intervention strategies that are implemented to prevent aggressive behavior before it begins. Strategies can include reassurance and distraction techniques, one-to-one nursing, medication or setting limits and establishing boundaries of acceptable behavior, as well as increased observation.

"This tool has continued to help our staff stop incidents of aggression before they start," said Dr. George Mellos, MDHHS State Hospital Administration senior deputy director. "Patient-to-staff aggression is the leading cause of workplace injury among our staff, and implementing this risk assessment tool has also helped improve working conditions by reducing incidents and injuries."

DASA and the Aggression Prevention Protocol was developed by the Centre for Forensic Behavioural Science at the Swinburne University of Technology in Melbourne, Australia. MDHHS' state psychiatric hospitals are the first psychiatric facilities in Michigan to implement the survey and protocol. State psychiatric hospitals in Virginia are using the tool as well as The Johns Hopkins Hospital in Baltimore and UCLA Medical Center, which implemented it in its emergency department.

MDHHS operates four inpatient psychiatric hospitals serving about 600 patients, Caro Psychiatric Hospital, Kalamazoo Psychiatric Hospital (KPH), Walter Reuther Psychiatric Hospital and the Center for Forensic Psychiatry (CFP). DASA was implemented at KPH in March 2024, Caro and Walter Reuther for adult patients in July 2024 and CFP and Walter Reuther for youth patients in September and August 2025, respectively.

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