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Arthur Walker, PsyD, is a 2027 graduate of the PsyD program in Clinical Psychology at Antioch University, Seattle.
Dissertation Committee:
Michael Toohey, PhD, Committee Chair
Katie McIntyre, PhD, Committee Member
Gee Won, PsyD, Committee Member
Keywords
Theory synthesis, inpatient violence reduction, de-escalation, aggression management
Document Type
Dissertation
Publication Date
2026
Abstract
Working in an inpatient setting inherently involves an increased risk of violence. This violence can affect both staff and patients alike and can lead to psychological trauma, serious bodily injury, and even death. To mitigate this risk, many models for preventing inpatient violence have been proposed for hospitals to implement. However, the evidence for the efficacy of these methods is inconsistent, and the theoretical underpinnings are varied and slim. This dissertation seeks to improve these models by re-examining the theoretical structures for common themes of four models for inpatient violence reduction and proposing additional recommendations informed by this synthesis. First, violence is defined and operationalized for the purpose of this dissertation. Then four separate models for violence prevention in inpatient settings are explored, including The Crisis Prevention Institute’s training modules, Safewards, The Six Core Strategies, and Amdur and Cooper’s model from Safety in the Workplace (2011). A Theory Synthesis methodology is utilized to achieve a conceptual integration across all four disparate models. Through this analysis, four major themes are put forward: an internal theory of the emergence of violence; three distinct categories of interventions based on the chronology of a violent episode; a tension between structural and individual emphases in interventions; and the primacy of a viable workforce to implement those interventions. These themes ultimately culminate in a model that proposes that each model’s Theory of Emergent Violence helps inform their recommended interventions, which ultimately are carried out by a Viable Workforce. Recommendations to improve these models include further integration of Individual and Structural interventions, increased use of risk assessments, ensuring workforce acceptance and fidelity to the models, consideration of identity in communication with patients, and the importance of the therapeutic alliance. A further exploration of the importance of psychologists in the development of these models and the applicability of this theory is also undertaken.
Recommended Citation
Walker, A. (2026). How to Reduce Inpatient Violence: A Theory Synthesis From Four Models. https://aura.antioch.edu/etds/1294
Comments
Arthur Walker, PsyD, 2027
ORCID iD 0009-0004-6608-0450
Arthur received a B.A. in History and a B.S. in Psychology from the University of Washington in 2014. He then worked for DESC advocating for and serving Seattle's chronically homeless population. During his doctoral program at Antioch University Seattle, he has trained at Western State Hospital and the Office of Forensic Mental Health Services. As of the time of this publication, he is about to begin his clinical internship at Georgia Regional Hospital's forensic inpatient/outpatient track. Outside of work, he enjoys exploring the beautiful nature of the Pacific Northwest, reading science fiction, fantasy, history, and economics, and spending time with loved ones.