The Michigan Department of Health and Human Services began using the Dynamic Appraisal of Situational Aggression, or DASA, in March 2024.
MDHHS said DASA scores are used with the Aggression Prevention Protocol to create individualized intervention plans aimed at preventing aggressive behavior before it starts.
Strategies can include reassurance and distraction techniques, one-to-one nursing, medication setting limits, establishing behavioral boundaries and increasing observation.
Since the tool was implemented, Michigan’s four state psychiatric hospitals have reported fewer injuries and aggressive incidents. The daily screening tool helps staff identify patients who may be at risk of becoming aggressive within the next 24 hours, allowing staff to intervene before situations escalate.
“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.”
Michigan’s state psychiatric hospitals were the first psychiatric facilities in the state to adopt DASA. MDHHS operates four inpatient psychiatric facilities serving about 600 patients: Caro Psychiatric Hospital, Kalamazoo Psychiatric Hospital, Walter Reuther Psychiatric Hospital and the Center for Forensic Psychiatry.
DASA was first implemented at Kalamazoo Psychiatric Hospital in March 2024. The tool was expanded to adult patients at Caro and Walter Reuther psychiatric hospitals in July 2024, and later introduced for youth patients at the Center for Forensic Psychiatry and Walter Reuther in September and August 2025.
“This tool has continued to help our staff stop incidents of aggression before they start,” said George Mellos, senior deputy director of MDHHS State Hospital Administration.“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 were developed by the Centre for Forensic Behavioural Science at Swinburne University in Australia. MDHHS state psychiatric hospitals are the first psychiatric facilities in Michigan to use the system, joining organizations such as Johns Hopkins Hospital, UCLA Medical Center and state psychiatric hospitals in Virginia.