Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care (original) (raw)
Related papers
Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 2014
Half of all youth hospitalized in inpatient psychiatric facilities manifest aggressive behavior. When aggression escalates to the point of danger, measures must be employed to guarantee safety of both patients and staff. In this paper, the current empirical evidence for intervention models to reduce restriction and restraint utilization in children and adolescents is reviewed. PubMed and PsycINFO were searched for English-language articles published between 2006 and 2013. Included were empirical studies of child or adolescent inpatient populations using a pretest and posttest design. Included in this review are three empirical papers describing two different intervention models that met the inclusion criteria. The review indicates there are two empirical supported intervention models that are helpful in reducing seclusion and restraint utilization in children and adolescents. The promising empirical findings support evidence and application to the child/adolescent population for at ...
Two-Year Trends in the Use of Seclusion and Restraint Among Psychiatrically Hospitalized Youths
Psychiatric Services, 2003
Objectives: This study examined characteristics associated with the use of seclusion and restraint among 442 psychiatrically hospitalized youths and sought to quantify changing trends in the rates of these modalities of treatment over time after the 1999 implementation of federal regulations and an institutional performance improvement program. Methods: Demographic and clinical data related to all 5,929 incidents of seclusion and restraint that occurred during 2000 and 2001 at a child and adolescent state psychiatric hospital were analyzed. Results: The two-year prevalence of use of seclusion was 61 percent and of restraint was 49 percent. Children and adolescents who were admitted on an emergency basis and those belonging to ethnic minority groups were more likely to undergo seclusion or restraint. Children aged 11 years and younger were more likely to undergo seclusion. The total number of episodes decreased by 26 percent and their cumulative duration decreased by 38 percent between the first quarter of 2000 and the last quarter of 2001. The decreases were the result of fewer seclusion and restraint incidents as well as shorter episodes of restraint. Over time, a concurrent increase was observed in the proportion of episodes associated with patient (but not staff) injuries and with as-needed use of medications. Conclusions: National reforms and institutional efforts can lead to downward trends in the use of seclusion and restraint among psychiatrically hospitalized youths. The active elements of these interventions warrant further study and replication. (Psychiatric Services 54:987-993, 2003)
European Child Adolescent Psychiatry, 2011
Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patients in psychiatric settings. However, little is known about their utilization and effectiveness in paediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilisation in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10 years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21 years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1.000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (-0.6%), but results were heterogeneous (-97.2% to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures. Otherwise, seclusion episodes reduced by 74.7%, including a 32.4%. shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behaviour, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines.
Seclusion room vs. physical restraint in an adolescent inpatient setting: patients' attitudes
The Israel journal of psychiatry and related sciences, 2013
The use of physical restraints or a seclusion room for the treatment of adolescents in a psychiatric inpatient setting raises ethical dilemmas. We investigated the attitudes of adolescents towards these two means of confinement. We used a structured questionnaire to collect data on the attitudes of 50 adolescent patients, hospitalized in a closed psychiatric ward, towards the use of physical restraint versus a seclusion room. Seventy per cent of the participants in the study preferred seclusion in the seclusion room over bed restraint, whereas 22% preferred physical restraint. Eighty-two percent described seclusion in the seclusion room as less frightening than restraint. Seventy-four per cent reported that seclusion in the seclusion room improved their mental state to a larger extent than restraint. The inpatient adolescents reported feeling the time they needed to reach a state of calm was shorter when they were confined to the seclusion room than when they were physically restrai...
Trends in Seclusion and Restraint Use: A Naturalistic Study of Psychiatrically Hospitalized Youths
2003
The objective was to examine demographic characteristics associated with seclusion and restraint use among 442 psychiatrically hospitalized youths, and to quantify changing trends in the rates of these modalities of treatment over time following the 1999 implementation of federal regulations and an institutional quality-improvement program. All seclusion and restraint incidents (N= 5,929) occurring during a two-year interval (2000-2001) at a child and adolescent state psychiatric hospital were analyzed. Period prevalence values for seclusion and restraint use were 60.1% and 48.6%, respectively. Children admitted emergently, those belonging to minorities, and those under the age of 12 (seclusion only), were more likely to undergo seclusion or restraints. The total number of episodes and the cumulative duration of each decreased by 49.5% and 55.7% respectively, down to within the 99% confidence intervals of pre-specified target rates (p<0.001). The decreases were the result of fewer incidents and of shorter events (restraints only). There was a concurrent increase over time in the proportion of episodes associated with patient (but not staff) injuries (p<0.05), and with PRN medication use (p<0.001). Thus, it can be concluded that national reforms and/or institutional efforts can lead to seclusion and restraint reductions among psychiatrically hospitalized youths. The active elements of these interventions warrant further study and replication. ACKNOWLEDGEMENTS I wish to acknowledge several individuals for their assistance in the preparation of this thesis. Andrew Kass and Alex Speredelozzi provided help with data management. Bert Plant, Lesley Siegel and Allyson Peller were important in the production of this work. I am thankful for their collaboration, contributions and support. Dorothy Stubbe and Lynelle Thomas also gave valuable advice on early draft manuscripts. There are many individuals who provided both academic and personal support throughout my years at Yale. Matt State introduced me to the world of basic laboratory research and challenged me to think in new ways. Matt also encouraged me to grow as an individual and always to follow my heart. Dorothy Stubbe provided friendship and always welcomed me onto Winchester 1. Joe Woolston is, and always will be, one of my strongest supporters. I appreciate his thoughts, as well as his thought process. His office door was always open to me and his ability to remind me of the gifts he saw in me brightened many days. William Sledge has watched me grow up and become a young doctor. I appreciate his constant challenge to me to mature as both a doctor and a person. Andres Martin deserves special thanks. Andres not only provided invaluable assistance on this thesis, but also served as a dedicated mentor. He constantly challenged me to go one step farther, to test the limits of my knowledge and experience. He gave me guidance, tempered with freedom, which allowed me to become not only a confident medical student, but also a confident writer, speaker and member of the world of academic psychiatry. In Andres, I see the special gift of mentoring imparted from Donald Cohen. I believe that Donald's dedication to medical students and medical student education lives on in Andres. I am blessed to have learned from him. Finally, I would like to thank my family. My parents are the first doctors I ever knew and continue to serve as rolemodels for me. My brother and sister also provided much support in the way of constant companionship and laughter.
European Child & Adolescent Psychiatry, 2002
The aim of the study was to analyse the use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment in Finland. The study included 504 child and adolescent psychiatric in-patients in the year 2000. Time-out had been used for 28 %, holding for 26 %, seclusion for 8 %, and mechanical restraints for 4 % of the in-patients. In multivariate analysis, aggressive acts were the strongest factor associated with all kinds of restraint practices. Psychosis, suicidal acts and older age (13–18 years) were associated with seclusion and mechanical restraints. Younger age (
The Distribution and Frequency of Seclusion and/or Restraint among Psychiatric Inpatients
The Journal of Behavioral Health Services & Research, 2010
This paper reports on the frequency and distribution of seclusion or restraint (SR) episodes among 1,266 adult inpatients at a state psychiatric hospital during the 2004 calendar year. Data on the concentration of SR episodes over patients and time can assist in planning alternative, recoveryoriented treatment models. Fifteen percent (N=194) of patients experienced seclusion or restraint. Sixty-three percent of all seclusion hours were concentrated among only ten patients. Likewise, the ten patients with the most restraint hours constituted nearly 65% of total restraint hours for the year and 48% of all restraint episodes. Variables accessible through administrative data accounted for modest seclusion and restraint variance. A comprehensive strategy to prevent SR episodes requires tailored interventions targeted to known high-risk individuals and development of general hospital-wide alternatives to SR. General alternatives require greater attention to staff education, administrative oversight, de-escalation and debriefing practices, patient involvement, and other recovery-oriented practices to reduce or eliminate use of seclusion and restraint.
The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital
Journal of Child and Family Studies, 1993
The widespread use of seclusion and restraint in child psychiatric hospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatric hospital during a 3-year period. Twenty-eight percent of the patients had been secluded or restrained a total of 1670 times. About 25% of these patients had been secluded more than five times during their hospitalization, and 32% had been placed in restraints more than once. Behaviors that typically resulted in repeated seclusion included physical aggression toward staff, verbal aggression toward peers, non-compliant or oppositional behavior, and self-harm. Variables that predicted patients most at risk for repeated seclusion included age, gender, and psychiatric diagnosis. The predictor variables for those most at risk for repeated restraint included age, property destruction, and self-harm. The high rates of use of seclusion and restraint suggest that these methods for controlling the behavior of children and adolescents in this child psychiatric hospital may not have been therapeutic. We suggest that staff in such hospitals engage in a pattern of behavior characterized by an aggression-coercion cycle, in which increasingly aggressh, e and coercive behaviors are exhibited by both patients and staff.