Biomedical subjects

R B Flannery

Publications and source records attributed to R B Flannery.

At least 37 records · Page 2Linked to original sources

PubMed1999

Characteristics of assaultive psychiatric inpatients in an era of managed care.

Prior to managed care, extensive research documented the characteristics of assaultive inpatients in traditional state mental hospital settings as primarily older, male, psychotic patients with histories of violence toward others and of substance abuse. Recent early studies in rural and urban hospital settings have suggested that the characteristics of assaultive patients may be changing to include younger, more frequently female, patients with personality disorders and histories of personal victimization. This two-points-in-time study sought to assess the nature of assaultive patients in a suburban traditional state mental hospital after the implementation of managed care initiatives, and compared to the nature of the assaultive patients before and after the downsizing of this state mental health facility. Before census reduction, the assaultive patients were of the traditional type. After census reduction, the assaultive patients reflected more recent trends. The implications of the findings are discussed, and strategies for fostering facility safety in light of the newer violent patient are outlined.

Adult↗

PubMed1999

Critical incident stress management and the assaulted staff action program.

Critical Incident Stress Management (CISM; Everly & Mitchell, 1999) is a clinical and administrative approach to address the psychological sequelae in the aftermath of critical incidents. CISM is a comprehensive, multicomponent crisis intervention procedure that spans pre-incident preparedness to acute crisis to post-crisis follow up. The Assaulted Staff Action Program (Flannery, 1998) is a voluntary, system-wide, peer-help, CISM crisis intervention program for employee victims of patient assault. ASAP's crisis intervention procedures and empirical results are used to illustrate the potential power and effectiveness of CISM approaches. The implications are discussed.

Crisis Intervention↗

PubMed1999

Psychological trauma and posttraumatic stress disorder: a review.

This paper presents a concise, fully-referenced, state-of-the-art review of psychological trauma and Posttraumatic Stress Disorder (PTSD) for emergency mental health practitioners. The nature of traumatic events, their common symptomatology, their disruptions to normal psychological and biological functioning, and the negative health consequences of untreated incidents are presented. Implications for the treatment of victims of traumatic events within the context of a Critical Incident Stress Management (CISM; Everly & Mitchell, 1999) approach are discussed.

Crisis Intervention↗

PubMed1999

The Assaulted Staff Action Program (ASAP) and declines in the prevalence of assaults: community-based replication.

The Assaulted Staff Action Program (ASAP) has been associated with sharp reductions in the frequency of patient assaults on staff in four state hospital settings. Recent national trends in healthcare have resulted in an emphasis on community-based services. This case study sought to assess the effects of ASAP and findings of reduced assaults in a community-based program. In a single-case design, in which the facility served as its own control, an ASAP program was fielded in a community mental health center. A similar sharp reduction in violence was observed. The implications of the findings are presented.

Adult↗

PubMed1999

Victim identification and family support in mass casualties: the Massachusetts model.

The Aviation Disaster Family Assistance Act of 1996 requires the National Transportation Safety Board (NTSB), air carriers, and the American Red Cross (ARC) to provide an integrated family assistance center to offer support to family survivors of mass casualties. A central component of post-incident response is the timely identification of victims and their personal belongings. This identification process occurs through antemortem interviews with family survivors. ARC of Massachusetts Bay determined that ARC volunteers would not play a major role in conducting antemortem interviews, and deferred primary responsibility for this task to the Massachusetts Office of the Chief Medical Examiner (OCMB). This paper presents the Massachusetts model for victim identification and family support at the local level. The structure and services of this model for on-site forensic processing, the fielding of antemortem interviewers, and a comprehensive training curriculum in psychological trauma and victim identification are presented. The implications are discussed.

Aviation↗

PubMed1999

Treating family survivors of mass casualties: a CISM family crisis intervention approach.

Critical Incident Stress Management (CISM) approaches emphasize the needs of families in crisis as one component of comprehensive service delivery. The need is particularly true for family survivors of mass casualties. This paper presents one CISM theoretical approach to these family survivors that is based on both the general principles of crisis intervention and recent findings in the field of psychological trauma. The model outlines three stages that many family survivors encounter as well as the time lines, tasks, and primary feeling states in each stage. Specific strategies for intervention in each stage are presented. The implications are discussed.

Crisis Intervention↗

PubMed1999

Critical incident stress management (CISM): the assaultive psychiatric patient.

Critical Incident Stress Management (CISM; Everly & Mitchell, 1999) is an integrated, multicomponent crisis intervention approach that is helpful in mitigating and preventing the potentially adverse consequences associated with critical incidents. The CISM model may serve a valuable heuristic purpose in the planning and development of CISM approaches in a wide variety of organizations and industries. This paper reports on the use of the CISM approach (Everly & Mitchell, 1999) as a guide or template in developing an enhanced and updated Assaulted Staff Action Program (ASAP; Flannery, 1998) approach to service delivery. ASAP is a voluntary, peer-help, CISM approach for staff who are assaulted by patients. The updating of its comprehensive services was necessitated by recent research and clinical experience on the changing nature of the assaultive psychiatric patient.

Crisis Intervention↗

PubMed1998

Public-academic liaison research centers in an era of managed care.

Public-Academic Liaison research centers (PALs) have traditionally provided benefits to both state mental health authorities (SMHAs) and academic institutions. The advent of managed care, austere state fiscal budgets, and a restructured national research development capacity suggests the need for new administrative approaches to PAL research efforts to maintain these benefits in this era of rapidly changing health care. This brief report outlines one such approach by the Massachusetts SMHA in its efforts to establish two PAL research centers: one for clinical neuroscience, and one for behavioral and forensic science. Preliminary two-year outcomes are presented, and the implications of the model are discussed.

Education, Medical↗

PubMed1998

Characteristics of violent versus nonviolent patients with schizophrenia.

Recent research has demonstrated an associative link between some forms of mental illness and violence. While much of this violence is committed by persons with schizophrenia, the characteristics of violent versus nonviolent schizophrenic patients has received limited attention. Two studies with small sample sizes compared these groups on psychological dimensions in acute care settings, but there appears to be no study of continuing care inpatients. This study compared a statewide sample of violent and nonviolent inpatients with schizophrenia on several domains of social interpersonal behavior. In a between-group analysis, violent patients showed evidence of serious dysfunction in community self-care and community adjustment, whereas the nonviolent were more impaired in the areas of depression, restlessness, and internal confusion. A within-group analysis of patients with interpersonal violence and those with noninterpersonal violence yielded similar findings of serious community dysfunction versus internal confusion. The implications are discussed.

Adult↗

PubMed1998

The Assaulted Staff Action Program (ASAP): common issues in fielding a team.

Thirty-five years of empirical research have continuously documented the potential negative impact of patient assaults on staff. The Assaulted Staff Action Program (ASAP) is a voluntary, peer-help, systems-wide crisis intervention debriefing approach for employee victims of these assaults. ASAP has been associated with providing needed clinical support for victims, declines in violence, and cost-effectiveness in service delivery. A previous paper outlined the basic steps needed to field and ASAP team. This paper continues to address this need by outlining the most commonly encountered ASAP problems and solutions that have evolved in the first eight years of ASAP programs. The implications are discussed.

Counseling↗

PubMed1998

Replicated declines in assault rates after implementation of the Assaulted Staff Action Program.

A program to address the psychological sequelae of patients' assaults on psychiatric health care staff--the Assaulted Staff Action Program (ASAP)--was previously shown to be associated with a notable decline in the assault rate at the state hospital where it was implemented. This study examined whether these findings would be replicated when ASAP was introduced at three additional state hospitals. Assault rates during the three months before implementation were compared with rates in the first four quarters after implementation. Each facility reported a similar significant decline in rates during the first quarter after implementation and no additional declines in the next three quarters.

Adult↗

PubMed1997

Residency training in Massachusetts: a new approach to state-university collaboration.

Traditional state-university collaborations, known as public-academic liaisons (PALs), have resulted in improved quality of service and enhanced residency training. Recent national trends for treating persons with serious mental illness, including moving services from institutional settings to community-based care and emphasizing the use of rehabilitative approaches as well as changes in the health care delivery system itself, have led to preliminary rethinking of some discrete aspects of more traditional approaches. Rather than discrete changes, Massachusetts has responded to these emerging trends with a new and comprehensive initiative that emphasizes one set of statewide standards in these emerging content areas for all residency training programs. Consistent with new practices in health care delivery, this new initiative was fielded through a process of competitive bidding rather than through traditional allocation of service positions. The development, implementation, and initial outcomes of this new approach are presented and implications for mental health administrators are discussed.

Community Mental Health Services↗

PubMed1997

Schizophrenia, psychiatric rehabilitation, and healthy development: a theoretical framework.

This paper makes an initial attempt to present a theoretical model for psychiatric rehabilitation based upon the principles of healthy development. The model emphasizes mastery, attachment, and meaning, three aspects of healthy development that have strong empirical support. A discussion of the impairments of schizophrenia related to these three areas is presented, and a rehabilitation model, The Psychiatric Rehabilitation Integrated Service Model, PRISM, is outlined as an example of a rehabilitation program based upon the principles of normal, healthy development.

Adult↗

PubMed1997

Hospital downsizing and patients' assaults on staff.

Although the downsizing and closing of state mental hospitals is occurring with increasing frequency nationwide, there appears to be only one case study of the clinical impacts of downsizing state hospitals. In this study, Snyder reported a four-fold increase in frequency of assaults on staff as the hospital census decreased. The present paper is a second case study of state hospital downsizing and closing in which the frequency of assaults on staff decreased by 63%. Possible explanations for the two differing outcomes are considered, and some general guidelines for the downsizing and closing of state hospitals are proposed.

Adolescent↗

PubMed1996

Program evaluation of an intervention approach for staff assaulted by patients: preliminary inquiry.

Crisis intervention procedures for emergency services personnel and healthcare providers are increasingly being utilized to address the psychological sequelae of acute stress during critical incidents. While anecdotal evidence suggests the efficacy of these approaches, more formal experimental inquiry has been limited. This brief report outlines one strategy for conducting program evaluation of a crisis intervention approach for staff who are assaulted by patients. This outcome design was implemented in multiple sites, even as the service was being delivered.

Crisis Intervention↗

PubMed1996

Violence and the lax milieu?: preliminary data.

Recently, Rosenbaum noted a rise in the number of patient assaults on staff. He attributed this increase to a lax milieu of impaired structures, boundaries, and leadership. This case study reports on a sharp decline in violence on three lax units in one state mental hospital, when new management fielded initiatives to strengthen the structures and boundaries on these three units. The implications of the findings are discussed.

Hospital Administration↗

PubMed1995

Patients' threats. Expanded definition of assault.

Most studies of patient assaults against staff operationally define violence as episodes of unwanted physical or sexual contact. This study empirically assessed a broader range of patient violence by including verbal and nonverbal threats in addition to sexual and physical assaults. Preliminary data from a statewide survey suggested that patient threats were frequent events. Data from a team of staff assaulted by patients in one hospital suggested that some verbal threats produced as much psychological distress for staff victims as did some physical assaults. These findings suggest the need to consider including threats in future studies of patient assaults.

Aggression↗

PubMed1995

Stress management for psychiatric patients in a state hospital setting.

A stress management protocol was adapted for use with schizophrenia patients. Elements included short group sessions, reinforcement of stress reduction skills, modified breathing and relaxation exercises, and capillary blood-flow monitoring for quick feedback. The patients demonstrated ability to participate in the group and to learn certain stress management techniques adapted to their particular needs.

Adaptation, Psychological↗