Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes

  • David C. Mohr
    Address correspondence to David C. Mohr, PhD, Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 S. Huntington Ave (152M), Boston, MA 02130.
    Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA

    Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
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  • Kim Curyto
    VA Western New York Healthcare System, Center for Integrated Healthcare, Buffalo and Batavia, NY, USA
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  • Jenefer M. Jedele
    Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, Ann Arbor, MI, USA
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  • Kevin W. McConeghy
    Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, RI, USA

    Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
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  • Orna Intrator
    Department of Veterans Affairs, Geriatrics & Extended Care Data Analysis Center, Finger-Lakes Healthcare System, Canandaigua, NY, USA

    Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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  • Michele J. Karel
    Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington, DC, USA
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  • Kelly Vance
    Workplace Violence Prevention Program, Office of Mental Health and Suicide Prevention, Veterans Health Administration Central Office, Washington, DC, USA

    Lexington VA Health Care System, Lexington, KY, USA
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Published:August 30, 2021DOI:



      Workplace disruptive behavior incidents can be costly for organizations, employees, and customers. Persons with dementia living in long-term care settings have a high risk of exhibiting distressed behaviors. We examined whether a resident-centered, behavioral intervention for residents with dementia led to a reduction in reported workplace disruptive behaviors and staff injury rate due to assault. Impactful interventions are important for quality of care.


      We examined whether a team-based behavioral program in community living centers (CLCs), where a nurse champion and behavioral coordinator were trained to work with the clinical team to understand and manage distressed behaviors commonly associated with dementia, was associated with reductions in behavior incidents.

      Setting and Participants

      The setting was Veterans Health Administration CLCs. The sample consisted of 120 aggregated CLCs operating between 2012 and 2017 with 62 completing training. CLCs were distributed across the United States.


      Outcomes included CLC-level rates of staff injury and number of workplace disruptive behavior incidents. Outcomes were regressed on measures of intervention completion, time since intervention, and several CLC characteristics.


      The intervention was significantly associated with lower incidence of assault with staff injury rates overall, particularly following the first year of training, but not with other reported workplace disruptive behavior incident rates.

      Conclusions and Implications

      A team-based behavioral intervention was associated with reduction of employee assaults, a critical repercussion of distressed behavior in dementia. Given rapid growth in patients with dementia in nursing homes, effective treatment practices, such as interdisciplinary behavioral management approaches may be impactful and valuable to implement.


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