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Stokes Y, Lewis KB, Tricco AC, Hambrick E, Jacob JD, Demery Varin M, Gould J, Aggarwal D, Cloutier P, Landriault C, Greenham S, Ward M, Kennedy A, Boggett J, Sheppard R, Murphy D, Robb M, Gandy H, Lavergne S, Graham ID. Trauma-Informed Care Interventions Used in Pediatric Inpatient or Residential Treatment Mental Health Settings and Strategies to Implement Them: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1737-1755. [PMID: 37694809 PMCID: PMC11155220 DOI: 10.1177/15248380231193444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Trauma-informed care (TIC) is an approach to care emerging in research and in practice that involves addressing the needs of individuals with histories of trauma. The aim of this scoping review was to examine the current literature relating to TIC interventions used in pediatric mental health inpatient and residential settings. We sought to answer the following two research questions: (a) What are the TIC interventions used in pediatric inpatient and residential treatment mental healthcare settings and what are their components? and (b) What are the implementation goals and strategies used with these TIC interventions? We conducted this scoping review according to JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. We included any primary study describing a TIC intervention that was implemented at a specific site which identified and described implementation strategies used. Of 1,571 identified citations and 54 full-text articles located by handsearching, 49 met the eligibility criteria and were included, representing 21 distinct TIC interventions. We present the reported aim, ingredients, mechanism, and delivery (AIMD) of TIC interventions as well as the implementation goals and strategies used, which varied in detail, ranging from very little information to more detailed descriptions. In the context of these findings, we emphasize the complexity of TIC and of TIC interventions, and the importance of identifying and clearly reporting TIC intervention goals, intervention details, and implementation strategies. We suggest applying intervention frameworks or reporting guidelines to support clear and comprehensive reporting, which would better facilitate replication and synthesis of published TIC interventions.
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Affiliation(s)
- Yehudis Stokes
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Krystina B. Lewis
- University of Ottawa, ON, Canada
- University of Ottawa Heart Institute, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
| | - Andrea C. Tricco
- Queen’s University, Kingston, ON, Canada
- University of Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, ON, Canada
| | | | | | - Melissa Demery Varin
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Justine Gould
- CHEO Research Institute, Ottawa, Canada
- Queen’s University, Kingston, ON, Canada
| | - Dhiraj Aggarwal
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | | | | | - Stephanie Greenham
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Michelle Ward
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Allison Kennedy
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | | | | | - David Murphy
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Marjorie Robb
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
- CHEO Research Institute, Ottawa, Canada
| | - Hazen Gandy
- University of Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Sonia Lavergne
- Children’s Hospital of Eastern Ontario (CHEO), Ottawa, Canada
| | - Ian D. Graham
- University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
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Versitano S, Shvetcov A, Paton J, Perkes I. Art therapy is associated with a reduction in restrictive practices on an inpatient child and adolescent mental health unit. J Ment Health 2024:1-9. [PMID: 38584367 DOI: 10.1080/09638237.2024.2332813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/26/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND The elimination of restrictive practices, such as seclusion and restraint, is a major aim of mental health services globally. The role of art therapy, a predominantly non-verbal mode of creative expression, is under-explored in this context. This research aimed to determine whether art therapy service provision was associated with a reduction in restrictive practices on an acute inpatient child and adolescent mental health services (CAMHS) unit. METHODS The rate (events per 1,000 occupied bed days), frequency (percent of admitted care episodes with incident), duration, and number of incidents of restrictive practices occurring between July 2015 and December 2021 were analysed relative to art therapy service provision. The rate, frequency and number of incidents of intramuscular injected (IM) sedation, oral PRN (as-needed medication) use, and absconding incidents occurring in conjunction with an episode of seclusion or restraint were also analysed. RESULTS The rate, frequency, duration, and total number of incidents of seclusion, the frequency and total number of incidents of physical restraint, and the rate, frequency and total number of incidents of IM sedation showed a statistically significant reduction during phases of art therapy service provision. CONCLUSIONS Art therapy service provision is associated with a reduction in restrictive practices in inpatient CAMHS.
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Affiliation(s)
- Sarah Versitano
- School of Social Sciences, Western Sydney University, Sydney, Australia
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, Australia
| | - Artur Shvetcov
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, Australia
- Discipline of Psychiatry and Mental Health and Discipline of Paediatrics and Children's Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Joy Paton
- School of Social Sciences, Western Sydney University, Sydney, Australia
| | - Iain Perkes
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, Australia
- Discipline of Psychiatry and Mental Health and Discipline of Paediatrics and Children's Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Moell A, Rozental A, Buchmayer S, Kaltiala R, Långström N. Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: a qualitative interview study with staff. BMC Psychiatry 2024; 24:102. [PMID: 38317134 PMCID: PMC10845720 DOI: 10.1186/s12888-024-05553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care. METHODS During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context. RESULTS The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators' understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy. CONCLUSIONS The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.
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Affiliation(s)
- Astrid Moell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Susanne Buchmayer
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, and Tampere University Hospital, Department of Adolescent Psychiatry, Tampere University, Tampere, Finland
| | - Niklas Långström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Baker J, Kendal S, Berzins K, Canvin K, Branthonne‐Foster S, McDougall T, Goldson B, Kellar I, Wright J, Duxbury J. Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study. CHILDREN & SOCIETY 2022; 36:1351-1401. [PMID: 36588794 PMCID: PMC9790399 DOI: 10.1111/chso.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/14/2022] [Accepted: 04/27/2022] [Indexed: 06/17/2023]
Abstract
Restrictive practices are often used harmfully with children in institutional settings. Interventions to reduce their use do not appear to have been mapped systematically. Using environmental scanning, we conducted a broad-scope mapping review of English language academic databases, websites and social media, using systematic methods. Included records (N = 121) were mostly from the United States and contained details of 82 different interventions. Children's participation was limited. Reporting quality was inconsistent, which undermined claims of effectiveness. Overall, despite a multitude of interventions, evidence is limited. Leaders should consider the evidence, including children's perspectives, before introducing poorly understood interventions into children's settings.
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Affiliation(s)
| | | | | | | | | | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | | | | | | | - Joy Duxbury
- Manchester Metropolitan UniversityManchesterUK
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Sorter M, Chua J, Lamy M, Barzman D, Ryes L, Shekhtman JA. Management of Emotion Dysregulation and Outbursts in Children and Adolescents. Curr Psychiatry Rep 2022; 24:213-226. [PMID: 35316849 DOI: 10.1007/s11920-022-01325-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Emotion dysregulation and outbursts are very common reasons for referral to child and adolescent mental health services and a frequent cause of admission to hospitals and residential programs. Symptoms of emotion dysregulation and outburst are transdiagnostic, associated with many disorders, have the potential to cause severe impairment and their management presents a major challenge in clinical practice. RECENT FINDINGS There are an increasing number of psychosocial interventions that demonstrate promise in improving emotion dysregulation and outbursts. Acute care systems to manage the most severely ill patients have limited best practice guidelines but program advancements indicate opportunities to improve care models. Pharmacotherapy may be of assistance to psychosocial interventions but must be used with caution due to potential adverse effects. Much remains to be discovered however evidence informed, targeted treatments for specific populations show potential for future improvements in outcomes.
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Affiliation(s)
- Michael Sorter
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA. .,University of Cincinnati College of Medicine, Cincinnati, USA.
| | - Jaclyn Chua
- Children's Hospital of Philadelphia, Philadelphia, USA
| | - Martine Lamy
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Drew Barzman
- Cincinnati Children's Hospital, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
| | - Louis Ryes
- Xavier University, Cincinnati, USA.,University of Kentucky College of Medicine, Lexington, USA
| | - Joshua Abraham Shekhtman
- The Ohio State University, Columbus, USA.,University of Cincinnati College of Medicine, Cincinnati, USA
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6
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Griffiths R, Dawber A, McDougall T, Midgley S, Baker J. Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: Systematic review and narrative synthesis. Int J Ment Health Nurs 2022; 31:35-50. [PMID: 34626155 PMCID: PMC9293022 DOI: 10.1111/inm.12940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/03/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
Rates of self-harm amongst children appear to be increasing. This presents challenges for practitioners responsible for maintaining the safety of children admitted to mental health inpatient settings. Policy guidelines recommend that practitioners should aim to avoid the use of restrictive practices for children. It is currently unclear, however, what evidence-based alternatives to restrictive practices are available. We aimed to identify what non-restrictive interventions have been proposed to reduce self-harm amongst children in mental health inpatient settings and to evaluate the evidence supporting their use in clinical practice. A systematic search of five databases (CINAHL, Embase, Ovid MEDLINE, APA Psycinfo, and Cochrane) was conducted to identify articles reporting on non-restrictive interventions aimed at reducing self-harm amongst children in mental health inpatient settings. Articles were quality assessed and relevant data were extracted and synthesized using narrative synthesis. Searches identified relatively few relevant articles (n = 7) and these were generally of low methodological quality. The underlying theoretical assumptions and putative mechanisms of change for the interventions described were often unclear. Despite concerns about the rates of self-harm amongst children in mental health inpatient settings, there is a lack of high-quality research to inform clinical practice. There is an urgent need to develop effective non-restrictive interventions aimed at reducing self-harm for children using inpatient mental health services. Intervention development should be theoretically informed and be conducted in collaboration with people who have lived experience of this issue.
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Affiliation(s)
- Robert Griffiths
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison Dawber
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Salli Midgley
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
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Agraharkar S, Horwitz S, Lewis K, Goldstein G, Havens J, Gerson R. Agitation and Restraint in a Pediatric Psychiatric Emergency Program: Clinical Characteristics and Diagnostic Correlates. Pediatr Emerg Care 2021; 37:e836-e840. [PMID: 34908377 DOI: 10.1097/pec.0000000000002385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Agitation and restraint among pediatric psychiatric patients are a frequent, yet little studied, source of morbidity and, rarely, mortality in the emergency department (ED). This study examined agitation and restraint among youth patients in a specialized pediatric psychiatric ED, considering clinical and sociodemographic characteristics of those who required restraint to determine the clinical correlates of agitation and restraint in this population. METHODS This descriptive study was a 6-year retrospective chart review of all patients restrained for acute agitation. Demographics, clinical characteristics, diagnoses, and reasons for restraint were collected. Relationships between sociodemographic and clinical variables to types of restraints used were examined, along with change over the study period in rate of and mean time in restraint. RESULTS The average restraint rate was 1.94%, which remained fairly consistent throughout study period, although average time in restraint decreased significantly. Restraints were more common in males. Adolescents were overrepresented in the ED population, and after controlling for this, restraint rates were similar in adolescents and younger children. Physical aggression was the most frequent precipitant, although among adolescents verbal aggression was also a precipitant (more so than in younger children). Disruptive behavior disorder diagnoses were most frequently associated with restraint. CONCLUSIONS A lower rate of restraint is reported here than has been seen in programs where youths are treated in medical or adult psychiatric EDs. Hospitals without specialized pediatric psychiatric emergency programs should invest in staff training in deescalation techniques and in access to pediatric psychiatric treatment. The finding that, of youth restrained, a significant proportion were under 12 years old and/or carried diagnoses not typically associated with aggressive behavior, indicates that crisis prevention, management, and treatment should include younger populations and diverse diagnostic groups, rather than focusing narrowly on older patients with psychotic or substance use disorders.
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Affiliation(s)
- Shilpa Agraharkar
- From the New York University Langone Health Child Study Center, Bellevue Hospital, New York, NY
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8
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Chua JD, Bellonci C, Sorter MT. Treatment of Childhood Emotion Dysregulation in Inpatient and Residential Settings. Child Adolesc Psychiatr Clin N Am 2021; 30:505-525. [PMID: 34053683 DOI: 10.1016/j.chc.2021.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children hospitalized in inpatient and residential treatment facilities often present with severe emotion dysregulation, which is the result of a wide range of psychiatric diagnoses. Emotion dysregulation is not a diagnosis but is a common but inconsistently described set of symptoms and behaviors. With no agreed upon way of measuring emotion dysregulation, the authors summarize the existing contemporary treatment focusing on proxy measures of emotion dysregulation in inpatient and residential settings. Interventions are summarized and categorized into individual- and systems-level interventions in addressing aggressive behaviors. Going forward, dysregulation will need to be operationalized in a standard way.
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Affiliation(s)
- Jaclyn Datar Chua
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, 3440 Market Street, Suite 200, Philadelphia, PA 19104, USA.
| | | | - Michael T Sorter
- Cincinnati Children's Hospital and the University of Cincinnati, Cincinnati Children's 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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9
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Roy C, Castonguay A, Fortin M, Drolet C, Franche-Choquette G, Dumais A, Lafortune D, Bernard P, Geoffrion S. The Use of Restraint and Seclusion in Residential Treatment Care for Youth: A Systematic Review of Related Factors and Interventions. TRAUMA, VIOLENCE & ABUSE 2021; 22:318-338. [PMID: 31122160 DOI: 10.1177/1524838019843196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Children placed in residential treatment centers (RTCs) typically present challenging behavior including aggression. In this context, restraint and seclusion (R&S) are seen as "last resort" strategies for educators to manage youth aggression. The use of R&S is controversial, as they can lead to psychological and physical consequences for both the client and the care provider and have yet to be empirically validated as therapeutic. The objectives of this systematic review are to identify the factors related to R&S use in RTCs for youth and to review the interventions aiming to reduce the use of R&S. The identification of these factors is the first step to gaining a better understanding of the decision-making process leading to the use of R&S and ultimately to reducing the use of these strategies to a minimum. Thus, the present systematic review was conducted by searching PubMed, CINAHL, ERIC, and PsycNET for articles published between 2002 and 2017. Key words used were synonyms of R&S, youth, and RTCs. Thirty-one studies met the inclusion criteria: must report on factors affecting the use of R&S in RTCs, must be conducted in RTCs for youth under the age of 21, and must report on original and empirical data. Factors related to the characteristics of the client, the care provider, and the environment, as well as to the implementation of programs for the reduction of R&S, were found to influence the use of R&S in RTCs. A conceptual model is presented. The implementation of programs to reduce R&S use is discussed.
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Affiliation(s)
- Camille Roy
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Ariane Castonguay
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Maxime Fortin
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Christine Drolet
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Geneviève Franche-Choquette
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Alexandre Dumais
- Research Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry and Addictology, 5622University of Montreal, Montreal, Quebec, Canada
- Philippe Pinel Institute of Montreal, Montreal, Quebec, Canada
| | - Denis Lafortune
- University Institute for Troubled Youth, Montreal, Quebec, Canada
- School of Criminology, 5622University of Montreal, Montreal, Quebec, Canada
| | - Paquito Bernard
- Research Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- Department of Physical Activity Sciences, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Steve Geoffrion
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
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10
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Vidal C, Reynolds EK, Praglowski N, Grados M. Risk Factors for Seclusion in Children and Adolescents Inpatient Psychiatry: The Role of Demographic Characteristics, Clinical Severity, Life Experiences and Diagnoses. Child Psychiatry Hum Dev 2020; 51:648-655. [PMID: 32026261 DOI: 10.1007/s10578-020-00963-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand the risk factors for seclusion in a sample of children and adolescents admitted to an inpatient psychiatry unit looking at demographic, clinical severity, life experience, and diagnostic characteristics. METHODS An unmatched case-control retrospective analysis of psychiatric records in a pediatric inpatient unit from December 2011 to December 2015 (N = 1986) RESULTS: Individual characteristics, including demographics, clinical severity, and clinical presentation as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) jointly predicted seclusion in adolescents, with younger age, male sex, black race, having a prior admission, and having a disruptive behavior or bipolar and related disorder diagnoses being predictive of seclusion. While demographic and clinical severity factors were predictive of seclusion in multivariate models, clinical diagnoses only added modestly to the variance explained. CONCLUSIONS High-risk demographic and clinical characteristics for seclusion events in children and adolescents can provide valuable information to guide interventions to prevent seclusion events during their hospitalization.
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Affiliation(s)
- Carol Vidal
- School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287-3335, USA.
| | - Elizabeth K Reynolds
- School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287-3335, USA
| | | | - Marco Grados
- School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287-3335, USA
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11
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Abstract
Higher level or acute psychiatric care for youth is intended to be active but short-term treatment focussing on crisis stabilisation, assessment, safety monitoring, and longer-term treatment planning. The focus of this article is on describing common challenges and the effort to address these challenges through new approaches to acute psychiatric care for children and adolescents. The review finds that (1) inpatient paediatric psychiatry beds are in high demand and often difficult to access, (2) there are a number of common challenges these units face including managing length of stays, readmissions, and adverse events, and (3) there are encouraging therapeutic approaches adapted for this setting. There is still much work to be done to advance the evidence-base for acute psychiatric care for youth particularly in defining and assessing an effective admission. Paediatric psychiatry patients are a vulnerable population and call for our best tools to be put to use to improve the quality and safety of care.
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Affiliation(s)
- Elizabeth K Reynolds
- Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Sasha Gorelik
- Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA
| | - Kyle Kellermeyer
- Department of Psychiatry and Behavioral Sciences, Division of Child & Adolescent Psychiatry, Johns Hopkins University, Baltimore, MD, USA
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12
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Carlson GA, Chua J, Pan K, Hasan T, Bied A, Martin A, Klein DN. Behavior Modification Is Associated With Reduced Psychotropic Medication Use in Children With Aggression in Inpatient Treatment: A Retrospective Cohort Study. J Am Acad Child Adolesc Psychiatry 2020; 59:632-641.e4. [PMID: 31381991 DOI: 10.1016/j.jaac.2019.07.940] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE There are few data to guide management of agitated and aggressive psychiatrically hospitalized children. Available studies do not account for setting, age, sex, diagnosis, admission reason, or clinical intervention. Seclusion, restraint, and physical holds (S/R/H) are usually the only outcome measure. In this study, we examine changes in PRN (pro re nata, or "as needed") psychotropic medication use to manage severe aggression on a children's psychiatric inpatient unit, comparing rates before and after a behavior modification program (BMP) was discontinued. METHOD We compare 661 children (aged 5-12 years) in 5 cohorts over 10 years, 510 (77%) of whom were admitted for aggressive behavior. PRN use per 1,000 patient-days was the primary outcome measure, but S/R/H was also examined. We use the following as predictors: BMP status, full- or half-time child and adolescent psychiatrist (CAP) oversight, diagnosis, age, length of stay, and neuroleptic use. RESULTS Children admitted for aggression had high rates of externalizing disorders (79%), low rates of mood (27%) and anxiety (21%) disorders, and significantly higher rates of PRN and S/R/H (p < .001) use. Rate of PRN use was significantly lower (p < .001) when the BMP was present (mean [SD], 163 [319] per 1,000 patient-days) than when it was absent (483 [569]; p < .001). Higher PRN use was predicted by BMP absence, neuroleptic treatment, and young patient age (p < .001), and by half-time CAP oversight (p = .002). CONCLUSION In this sample of young children with primarily externalizing disorders, data support the effectiveness of a BMP in lowering rates of PRN and S/R/H use.
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Affiliation(s)
| | - Jaclyn Chua
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Katherine Pan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Tahsin Hasan
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Adam Bied
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT
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13
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Montreuil M, Thibeault C, McHarg L, Carnevale FA. Moral Experiences of Crisis Management in a Child Mental Health Setting: A Participatory Hermeneutic Ethnographic Study. Cult Med Psychiatry 2020; 44:80-109. [PMID: 31218498 DOI: 10.1007/s11013-019-09639-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Restraints and seclusion are routinely used in child mental health settings for conflict and crisis management, but raise significant ethical concerns. Using a participatory hermeneutic ethnographic framework, we studied conflict and crisis management in a child mental health setting offering care to children aged 6-12 years old in Quebec, Canada. The use of this framework allowed for an in-depth examination of the local imaginaries, of what is morally meaningful to the people in the setting, in addition to institutional norms, structures and practices. Data collection involved participant observation, interviews, and documentation review, with an interpretive framework for data analysis. We argue that the prevalent view of children shared by staff members as "incomplete human becomings" led to the adoption and legitimization of authoritative norms, structures and practices guided largely by a behavioral approach, which sometimes led to an increased use of control measures for reasons other than imminent harm. Children experienced these controlling practices as abusive and hindering the development of trusting relationships, which impeded the implementation of more collaborative approaches staff members sought to put in place to prevent the use of control measures. Study results are discussed in light of conceptions of children as moral agents.
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Affiliation(s)
- Marjorie Montreuil
- Ingram School of Nursing, McGill University, 680 Sherbrooke Street West, Montreal, QC, H3A 2M7, Canada.
| | | | - Linda McHarg
- Ingram School of Nursing, McGill University, 680 Sherbrooke Street West, Montreal, QC, H3A 2M7, Canada
| | - Franco A Carnevale
- Ingram School of Nursing, McGill University, 680 Sherbrooke Street West, Montreal, QC, H3A 2M7, Canada
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Azeem M, Aujla A, Rammerth M, Binsfeld G, Jones RB. Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 30:170-174. [PMID: 30129244 DOI: 10.1111/jcap.12190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of the study was to determine the effectiveness of six core strategies based on trauma informed care in reducing the use of seclusion and restraints with hospitalized youth. METHODS The hospital staff received training inMarch 2005 in six core strategies that are based on trauma informed care. Medical records were reviewed for youth admitted between July 2004 andMarch 2007. Data were collected on demographics, including age, gender, ethnicity,number of admissions, type of admissions, length of stay, psychiatric diagnosis, number of seclusions, and restraints. RESULTS Four hundred fifty-eight youth (females 276/males 182) were admitted between July 2004 and March 2007. Seventy-nine patients or 17.2% (females 44/males 35) required 278 seclusions/restraints (159 seclusions/119 restraints),with average number of episodes 3.5/patient (range 1-28). Thirty-seven children and adolescents placed in seclusion and/or restraints had three or more episodes. In the first six months of study, the number of seclusions/restraints episodes were 93 (73 seclusions/20 restraints), involving 22 children and adolescents (females 11/males 11). Comparatively, in final six months of study following the training program, there were 31 episodes (6 seclusions/25 restraints) involving 11 children and adolescents (females 7/males 4). The major diagnoses of the youth placed in seclusion and/or restraints were disruptive behavior disorders (61%) and mood disorders (52%). CONCLUSIONS This study shows downward trend in seclusions/restraints among hospitalized youth after implementation of National Association of State Mental Health ProgramDirectors six core strategies based on trauma informed care.
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Affiliation(s)
- MuhammadWaqar Azeem
- Inaugural Chair, Department of Psychiatry, Professor of Psychiatry, Weill Cornell Medical College, Sidra Medicine, Qatar Foundation
| | - Akashdeep Aujla
- Associate Medical Director, Riverview Hospital for Children and Youth, Department of Children and Families, Middletown, Connecticut, USA.,Assistant Clinical Professor, Yale Child Study Center, Yale University School of Medicine, Middletown, Connecticut, USA.,Assistant Clinical Professor, Department of Psychiatry University of Connecticut School of Medicine, Middletown, Connecticut
| | | | - Gary Binsfeld
- Minnesota State Operated Child and Adolescent Behavioral Health Services, Brainerd, Minnesota, USA
| | - Robert B Jones
- Medical Director, Medical Director for Minnesota State Operated Services for Mental Health, Brainerd, Minnesota, USA
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McKeown M, Thomson G, Scholes A, Jones F, Baker J, Downe S, Price O, Greenwood P, Whittington R, Duxbury J. "Catching your tail and firefighting": The impact of staffing levels on restraint minimization efforts. J Psychiatr Ment Health Nurs 2019; 26:131-141. [PMID: 31111648 DOI: 10.1111/jpm.12532] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/30/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mental health nursing in the UK and other countries faces an acute workforce crisis. Safe staffing levels are called for, and in some jurisdictions have been legislated for. The evidence base linking staffing levels and patient outcomes is limited. Staffing levels are implicated in adverse experiences of service users and staff within mental health ward settings, and they might contribute to levels of violence and aggression and the application of restrictive practices, such as physical restraint but there is limited research evidence to support this. Programmes such as Safewards, No Force First, the Engagement Model and the Six Core Strategies can reduce the use of restrictive practices. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Staffing levels on acute mental health wards appeared crucial in the implementation of a restraint minimization project. Both staff and service users implicate insufficient staffing for deficiencies in the relational elements of care, such as lack of face-to-face contact between nurses and service users. Similarly, staffing levels are associated with perceived problems in the cause of violence and aggression and responses to it. Despite successes in minimizing restrictive practices in this project, difficulties implementing alternative forms of practice that would reduce use of physical restraint, such as de-escalation, were also attributed to staffing levels. There is an irony that a project concerned with safety itself provoked concern over safe staffing levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Efforts to reduce restrictive practices will be hampered without adequate staffing levels. Restrictive practices may justifyably be framed as an employment relations matter. Organisations and policy makers ought to address environmental, contextual and resourcing factors, rather than identify problems exclusively in terms of perceived aberrant behaviour of staff or service users. ABSTRACT: Introduction Safe staffing and coercive practices are of pressing concern for mental health services. These are inter-dependent, and the relationship is under-researched. Aim To explore views on staffing levels in a context of attempting to minimize physical restraint practices on mental health wards. Findings emerged from a wider data set with the broader aim of exploring experiences of a restraint reduction initiative. Methods Thematic analysis of semi-structured interviews with staff (n = 130) and service users (n = 32). Results Five themes were identified regarding how staffing levels impact experiences and complicate efforts to minimize physical restraint. We titled the themes-"insufficient staff to do the job"; "detriment to staff and service users"; "a paperwork exercise: the burden of non-clinical tasks"; "false economies"; and, "you can't do these interventions." Discussion Tendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative and organizational developments that would enable reductions in use of restraint are labour intensive and vulnerable to derailment by insufficient and poorly skilled staff. Implications for practice Restrictive practices are unlikely to be minimized unless wards are adequately staffed. Inadequate staffing is not independent of restrictive practices and reduces access to alternative interventions for reducing individuals' distress.
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Affiliation(s)
- Mick McKeown
- School of Nursing, University of Central Lancashire, Preston, UK
| | - Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Amy Scholes
- School of Nursing, University of Central Lancashire, Preston, UK
| | | | - John Baker
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Owen Price
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Richard Whittington
- Brøset Centre for Research & Education in Forensic Psychiatry, St. Olav's Hospital, Trondheim, Norway.,Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK
| | - Joy Duxbury
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
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Reynolds EK, Grados MA, Praglowski N, Hankinson JC, Parrish C, Ostrander R. Implementation of Modified Positive Behavioral Interventions and Supports in a youth psychiatric partial hospital program. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2018. [DOI: 10.1177/2516043518811758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Seclusion and restraint are procedures utilized in youth psychiatric settings. While a number of agencies have called for a reduction and ultimate elimination of the use of these practices, there has been limited research on behavioral programs to reduce seclusion/restraint. This is particularly true for research on behavioral programming in youth psychiatric partial hospital settings. As such, the current study sought to examine the effectiveness of a modified version of Positive Behavioral Interventions and Supports (M-PBIS) implemented on a youth psychiatric partial hospital service to reduce seclusion/restraint. Method This naturalistic, prospective study covered a 26-month period and utilized a pre–post design. M-PBIS features include a defined set of positive behavioral expectations, a system to teach behavioral expectations, reinforcement of appropriate behaviors, data collection/evidence-based decision making, individual support for those not responding to the unit-wide system, active support by all stakeholders (including all staff members agreeing to the program), and positive recognition among staff. Results With a sample of 442 admissions, there were meaningful reductions in the percent of patients who were in seclusion/restraint (from 47.6 to 6.7%) as well as the overall seclusion/restraint rate (from 3.56 ( SD = 1.94) to 0.48 ( SD = 0.64)). Furthermore, there was a significant reduction in the use of Pro Re Nata (PRN) medication for agitation/aggression (percent of patient who received a PRN decreased from 33.3 to 12.9%). Conclusions This naturalistic study suggests that M-PBIS is a promising intervention for use in youth psychiatric partial hospital services to reduce seclusion/restraint and PRN medication for agitation/aggression. Reduction and ultimate elimination of seclusion/restraint is a critical objective in improving the quality and safety of acute mental health services for youth.
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Affiliation(s)
- Elizabeth K Reynolds
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, USA
| | - Marco A Grados
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, USA
| | | | - Jessica C Hankinson
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, USA
| | - Carisa Parrish
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, USA
| | - Rick Ostrander
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, USA
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Montreuil M, Thibeault C, McHarg L, Carnevale FA. Children's moral experiences of crisis management in a child mental health setting. Int J Ment Health Nurs 2018; 27:1440-1448. [PMID: 29446553 DOI: 10.1111/inm.12444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 12/01/2022]
Abstract
The experiences of children related to conflict and crisis management in child mental health settings, especially those aged 12 and below, have been rarely studied. This study examined the moral experiences of children related to conflict and crisis management and the related use of restraint and seclusion in a child mental health setting. A 5-month focused ethnography using a participatory hermeneutic framework was conducted in a day hospital programme for children with severe disruptive disorders within a mental health institute. Children considered restraints and seclusion could help them feel safe in certain instances, for example if another child was being aggressive towards them or in exceptional cases to prevent self-injury. However, their own experiences of being restrained were predominantly negative, especially if not knowing the reason for their use, which they then found unfair. Some of the children emphasized the punitive nature of the use of restraints and seclusion, and most children disagreed with these practices when used as a punishment. Children's perspectives also highlighted the limits of the use of a uniform de-escalation approach by the staff to manage crises. Children considered discussing with the staff and developing a relationship with them as more helpful in case of a crisis then the use of a de-escalation approach or coercive strategies.
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Affiliation(s)
| | - Catherine Thibeault
- Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario, Canada
| | - Linda McHarg
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Franco A Carnevale
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Lelonek G, Crook D, Tully M, Trufelli K, Blitz L, Rogers SC. Multidisciplinary Approach to Enhancing Safety and Care for Pediatric Behavioral Health Patients in Acute Medical Settings. Child Adolesc Psychiatr Clin N Am 2018; 27:491-500. [PMID: 29933797 DOI: 10.1016/j.chc.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Emergency department visits by pediatric behavioral health patients are increasing, increasing the complexity of care. This article describes initiatives at 3 academic medical centers using multidisciplinary teams, including medical, child life, and security staff, to help decrease anxiety and increase patient comfort. Training in Dialectical Behavior Therapy and agitation management simulations increase staff preparedness for working with agitated and emotionally dysregulated patients. Training security personnel and establishing a behavioral health response team ensures that staff members with expertise in managing agitation support the medical teams and patients throughout the hospital.
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Affiliation(s)
- Gary Lelonek
- Cohen Children's Medical Center, Northwell Health, 270-05 76th Avenue, New Hyde Park, NY 11040, USA.
| | - Douglas Crook
- Behavioral Response Team, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Maura Tully
- Child Life Department, Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY 11040, USA
| | - Kristen Trufelli
- Behavioral Health Urgent Care Center, Cohen Children's Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY 11040, USA
| | - Lindsay Blitz
- Emergency Department, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Steven C Rogers
- Division of Emergency Medicine, Emergency Mental Health Services, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
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Lunsky Y, Tint A, Weiss JA, Palucka A, Bradley E. A review of emergency department visits made by youth and adults with autism spectrum disorder from the parent perspective. ADVANCES IN AUTISM 2018. [DOI: 10.1108/aia-08-2017-0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Past research has shown individuals with autism spectrum disorder (ASD) visit hospital emergency departments (ED) at high rates. In order to assist individuals with ASD, their families and health care providers to improve ED care, it is important to understand these encounters in greater detail. The purpose of this paper is to provide a descriptive summary of the ED experiences of adolescents and adults with ASD, from the perspective of their families.
Design/methodology/approach
A subset of data from a larger prospective cohort study was used. Specifically, 46 parents of adolescents and adults with ASD provided details concerning 49 ED visits over a 12-month period.
Findings
Results suggest a range of presentations requiring ED use, and also diverse profiles of those with ASD who visited the ED, in terms of age, gender, and ASD severity. While overall degree of satisfaction with care received in the ED was high, parents provided recommendations to improve the ED experiences for their family members with ASD.
Originality/value
This is the first study to provide detailed accounts of ED visits from the perspective of parents of adolescents and adults with ASD. Families play an important role in the lives of individuals with ASD across the lifespan and it is important to include their perspective to improve hospital-based care for those with ASD.
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20
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Felver JC, Jones R, Killam MA, Kryger C, Race K, McIntyre LL. Contemplative Intervention Reduces Physical Interventions for Children in Residential Psychiatric Treatment. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 18:164-173. [PMID: 27696136 DOI: 10.1007/s11121-016-0720-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This research explored the effectiveness of a manualized contemplative intervention among children receiving intensive residential psychiatric care. Ten children with severe psychiatric disabilities received 12 sessions (30-45 min) of "Mindful Life: Schools" (MLS) over the course of a month. Facility-reported data on the use of physical intervention (i.e., seclusions and restraints) were analyzed. Acceptability questionnaires and broad-band behavioral questionnaire data were also collected from children and their primary clinicians. Robust logistic regression analyses were conducted on person-period data for the 10 children to explore the timing of incidents resulting in the use of physical intervention. Incidents within each person-period were regressed on indicators of days of contemplative practice and days without contemplative practice. Results indicated that during the 24-h period following MLS class, relative to a comparison 24-h period, children had significantly reduced odds of receiving a physical intervention (OR = 0.3; 95 % CI 0.2, 0.5; p < 0.001). Behavioral questionnaires did not indicate significant contemplative intervention effects (ps >0.05), and MLS was found to be generally acceptable in this population and setting. These data indicate that contemplative practices acutely reduced the utilization of physical interventions. Clinicians seeking to implement preventative strategies to reduce the necessity of physical intervention in response to dangerous behavior should consider contemplative practices. Those wishing to empirically evaluate the effectiveness of contemplative practices should consider evaluating objective measures, such as utilization of physical intervention strategies, as oppose to subjective reports.
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Affiliation(s)
| | - Richard Jones
- Alpert Medical School of Brown University, Providence, USA
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Attitudes towards seclusion and restraint in mental health settings: findings from a large, community-based survey of consumers, carers and mental health professionals. Epidemiol Psychiatr Sci 2017; 26:535-544. [PMID: 27515597 PMCID: PMC6998893 DOI: 10.1017/s2045796016000585] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS There are growing calls to reduce, and where possible eliminate, the use of seclusion and restraint in mental health settings, but the attitudes and beliefs of consumers, carers and mental health professionals towards these practices are not well understood. The aim of this study was to compare the attitudes of mental health service consumers, carers and mental health professionals towards seclusion and restraint in mental health settings. In particular, it aimed to explore beliefs regarding whether elimination of seclusion and restraint was desirable and possible. METHODS In 2014, an online survey was developed and widely advertised in Australia via the National Mental Health Commission and through mental health networks. The survey adopted a mixed-methods design, including both quantitative and qualitative questions concerning participants' demographic details, the use of seclusion and restraint in practice and their views on strategies for reducing and eliminating these practices. RESULTS In total 1150 survey responses were analysed. A large majority of participants believed that seclusion and restraint practices were likely to cause harm, breach human rights, compromise trust and potentially cause or trigger past trauma. Consumers were more likely than professionals to view these practices as harmful. The vast majority of participants believed that it was both desirable and feasible to eliminate mechanical restraint. Many participants, particularly professionals, believed that seclusion and some forms of restraint were likely to produce some benefits, including increasing consumer safety, increasing the safety of staff and others and setting behavioural boundaries. CONCLUSIONS There was strong agreement across participant groups that the use of seclusion and restraint is harmful, breaches human rights and compromises the therapeutic relationship and trust between mental health service providers and those who experience these restrictive practices. However, some benefits were also identified, particularly by professionals. Participants had mixed views regarding the feasibility and desirability of eliminating these practices.
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Ncube A, Kunguma O, Nyahwo M, Manombe S. Nutritional vulnerability: An assessment of the 2010 feeding food programme in Mbire district, Zimbabwe, and its impact on pregnant women. JAMBA (POTCHEFSTROOM, SOUTH AFRICA) 2017; 9:406. [PMID: 29955343 PMCID: PMC6014120 DOI: 10.4102/jamba.v9i1.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 06/23/2017] [Indexed: 06/08/2023]
Abstract
Malnutrition contributes significantly to Zimbabwe's high maternal mortality rate. The prevalence of malnutrition among vulnerable pregnant women in the Mbire district of Zimbabwe was studied to establish why they remained vulnerable despite benefiting from the Vulnerable Group Feeding Programme, a subsidiary of the World Food Programme. A case study on the demographic characteristics, nutritional provision of the programme and the vulnerable pregnant women benefiting from the programme was conducted. One hundred women were purposively sampled at health centres in the district. A two-stage sampling procedure was then utilised to select the most food-insecure wards. The two most food-insecure wards, namely Angwa and Chapoto, were chosen because of their proximity to each other. A questionnaire was administered to the pregnant women to collect their demographic information. Practising nurses at the health centres determined the women's nutritional status and anthropometrics, and they also assessed the food baskets. Permission to conduct the study was obtained from the relevant authorities. The results indicated that the food hamper provided by the World Food Programme was complementary food aid given to all vulnerable members of the community regardless of the nutritional demands. The supplements that the pregnant women received were also inadequate to cater for their nutritional needs or those of the foetuses. It was therefore recommended that the government, through the Ministry of Health, should make more provisions available for vulnerable pregnant women in order to reduce the risks facing pregnant women in the country.
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Affiliation(s)
- Alice Ncube
- Disaster Risk Management Training and Education Centre for Africa, University of the Free State, South Africa
| | - Olivia Kunguma
- Disaster Risk Management Training and Education Centre for Africa, University of the Free State, South Africa
| | - Moddie Nyahwo
- Disaster Risk Management Training and Education Centre for Africa, University of the Free State, South Africa
| | - Stella Manombe
- Disaster Risk Management Training and Education Centre for Africa, University of the Free State, South Africa
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McSherry B. Regulating seclusion and restraint in health care settings: The promise of the Convention on the Rights of Persons with Disabilities. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 53:39-44. [PMID: 28595808 DOI: 10.1016/j.ijlp.2017.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/29/2017] [Accepted: 05/11/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Bernadette McSherry
- Melbourne Social Equity Institute, University of Melbourne, 201 Grattan Street, Carlton, Vic 3056, Australia.
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Seckman A, Paun O, Heipp B, Van Stee M, Keels-Lowe V, Beel F, Spoon C, Fogg L, Delaney KR. Evaluation of the use of a sensory room on an adolescent inpatient unit and its impact on restraint and seclusion prevention. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2017; 30:90-97. [DOI: 10.1111/jcap.12174] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/15/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Angela Seckman
- Wexner Medical Center, Harding Hospital; The Ohio State University; Columbus OH USA
| | - Olimpia Paun
- Rush University College of Nursing; Chicago IL USA
| | - Biljana Heipp
- Wexner Medical Center, Harding Hospital; The Ohio State University; Columbus OH USA
| | - Marie Van Stee
- Wexner Medical Center, Harding Hospital; The Ohio State University; Columbus OH USA
| | | | - Frank Beel
- Wexner Medical Center, Harding Hospital; The Ohio State University; Columbus OH USA
| | - Cari Spoon
- Wexner Medical Center, Harding Hospital; The Ohio State University; Columbus OH USA
| | - Louis Fogg
- Rush University College of Nursing; Chicago IL USA
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Furre A, Falk RS, Sandvik L, Friis S, Knutzen M, Hanssen-Bauer K. Characteristics of adolescents frequently restrained in acute psychiatric units in Norway: a nationwide study. Child Adolesc Psychiatry Ment Health 2017; 11:3. [PMID: 28096898 PMCID: PMC5234258 DOI: 10.1186/s13034-016-0136-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/06/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of restraints in adolescent psychiatric settings requires particular professional, ethical, and legal considerations. The purpose of this study was to investigate whether the number of restraint episodes per patient was related to any of several characteristics of the adolescents. METHODS In this nationwide study, we included all adolescents restrained during the period 2008-2010 (N = 267) in Norwegian adolescent acute psychiatric inpatient units. They constitute 6.5% of the adolescents hospitalized in these units in the same period of time. We collected data on the number of restraint episodes they experienced during the study period; Poisson regression was then used to analyze the impact of gender, social, mental health, and treatment characteristics on the frequency of restraint. We developed a risk index for the likelihood of experiencing multiple restraint episodes. RESULTS We found a skewed distribution of restraint episodes in which a small group (18%) of restrained adolescents experienced a majority (77%) of the restraint episodes. A large percentage of the restrained adolescents (36%) experienced only one restraint episode. Risk factors for multiple restraint episodes were female gender, lower psychosocial functioning (Children's Global Assessment Scale below 35), more and longer admissions, and concomitant use of pharmacological restraint. Except for gender, we used these variables to develop a risk index that was moderately associated with multiple restraint episodes. CONCLUSIONS As a small group of patients accounted for a large percentage of the restraint episodes, future research should further investigate the reasons for and consequences of multiple restraint episodes in patients at acute adolescent psychiatric units, and evaluate preventive approaches targeted to reduce their risk for experiencing restraint.
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Affiliation(s)
- Astrid Furre
- Division of Mental Health and Addiction, Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway ,Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre for Epidemiology and Biostatistics, Oslo University Hospital, Oslo, Norway
| | - Leiv Sandvik
- Oslo Centre for Epidemiology and Biostatistics, Oslo University Hospital, Oslo, Norway
| | - Svein Friis
- Division of Mental Health and Addiction, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Maria Knutzen
- Division of Mental Health and Addiction, Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ketil Hanssen-Bauer
- Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway ,Division of Health Service Research and Psychiatry, University of Oslo, Oslo, Norway
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27
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Timbo W, Sriram A, Reynolds EK, DeBoard-Lucas R, Specht M, Howell C, McSweeney C, Grados MA. Risk Factors for Seclusion and Restraint in a Pediatric Psychiatry Day Hospital. Child Psychiatry Hum Dev 2016; 47:771-9. [PMID: 26643416 DOI: 10.1007/s10578-015-0608-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of seclusion and restraints (SR) in acute hospital settings remains a controversial practice. Despite the focus on SR in the psychiatric services literature, data on SR use in pediatric day hospital settings is lacking. A case-control retrospective analysis for children admitted into a pediatric psychiatry day hospital in a 2-year span examined predictors of SR use. Demographic and clinical descriptors were examined in relation to SR events using univariate and multivariate regression models. Significant univariate risk factors for SR use were psychiatric morbidity, history of physical abuse, post-traumatic stress disorder, having any anxiety disorder, and younger age. Knowledge of risk factors for SR use in pediatric psychiatric day hospitals can avert use of SR and lead to improved safety in a trauma-informed care model.
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Affiliation(s)
- Wuroh Timbo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA
| | | | - Elizabeth K Reynolds
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA
| | | | - Matthew Specht
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA
| | - Carolyn Howell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA
| | | | - Marco A Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA.
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Abstract
Restraint as an intervention in the management of acute mental distress has a long history that predates the existence of psychiatry. However, it remains a source of controversy with an ongoing debate as to its role. This article critically explores what to date has seemingly been only implicit in the debate surrounding the role of restraint: how should the concept of validity be interpreted when applied to restraint as an intervention? The practice of restraint in mental health is critically examined using two post-positivist constructions of validity, the pragmatic and the psychopolitical, by means of a critical examination of the literature. The current literature provides only weak support for the pragmatic validity of restraint as an intervention and no support to date for its psychopolitical validity. Judgements regarding the validity of any intervention that is coercive must include reference to the psychopolitical dimensions of both practice and policy.
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Affiliation(s)
- Brodie Paterson
- Department of Nursing and Midwifery, University of Stirling, Stirling FK9 4LA, UK.
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29
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Okafor M, Wrenn G, Ede V, Wilson N, Custer W, Risby E, Claeys M, Shelp FE, Atallah H, Mattox G, Satcher D. Improving Quality of Emergency Care Through Integration of Mental Health. Community Ment Health J 2016; 52:332-42. [PMID: 26711094 DOI: 10.1007/s10597-015-9978-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/08/2015] [Indexed: 11/24/2022]
Abstract
The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.
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Affiliation(s)
- Martha Okafor
- Yale University School of Nursing, New Haven, CT, USA.,Division of Behavioral Health in Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Glenda Wrenn
- Division of Behavioral Health in Satcher Health Leadership Institute, Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - Victor Ede
- Division of Behavioral Health in Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA.
| | - Nana Wilson
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, 720 Westview Drive SW, Atlanta, GA, 30310, USA
| | - William Custer
- Center for Health Services Research, Institute of Health Administration, Georgia State University, Atlanta, GA, USA
| | - Emile Risby
- Georgia State Department of Behavioral Health and Developmental Disabilities, Atlanta, GA, 30303, USA
| | - Michael Claeys
- Department of Behavioral Health, Grady Health System, Atlanta, GA, USA
| | - Frank E Shelp
- Georgia State Department of Behavioral Health and Developmental Disabilities, Atlanta, GA, 30303, USA.,Good Neighbor Community Services, Richmond, VA, USA
| | - Hany Atallah
- Grady Health System, Atlanta, GA, USA.,Department of Emergency Medicine, Emory University, 531 Asbury Circle, Annex Building, Suite N340, Atlanta, GA, 30322, USA
| | - Gail Mattox
- Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA, 30310, USA
| | - David Satcher
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, SW, Atlanta, GA, 30310, USA
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30
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A nationwide study of why and how acute adolescent psychiatric units use restraint. Psychiatry Res 2016; 237:60-6. [PMID: 26921053 DOI: 10.1016/j.psychres.2016.01.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/20/2015] [Accepted: 01/27/2016] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to examine the type, reason, and duration of restraint episodes in acute adolescent psychiatric units. In a retrospective design we included data from paper-based protocols on all episodes of restraint and data from electronic patient records during 2008-2010 in all acute adolescent psychiatric in-patient units in Norway (N=16). The episodes of restraint included mechanical and pharmacological restraint, seclusion and physical holding that was not part of the implementation of forced feeding. Six-and-a-half per cent of all 4099 adolescents admitted to the acute units experienced restraint. Of the 2277 episodes, 13.4% were mechanical restraint, 1.6% were pharmacological restraint, 5.9% were seclusion and 78.7% were physical holding. The median number of restraint episodes per patient was two, the range was 1-171 and 47 patients (18%) experienced ≥10 episodes. The most common reason for using restraint was harming others. The median duration of the mechanical restraint episodes was 3.5h. The median duration of seclusion was 30min and the median duration of physical holding was 10min.
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31
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Jacob T, Sahu G, Frankel V, Homel P, Berman B, McAfee S. Patterns of Restraint Utilization in a Community Hospital's Psychiatric Inpatient Units. Psychiatr Q 2016; 87:31-48. [PMID: 25899518 DOI: 10.1007/s11126-015-9353-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Restraint use in psychiatry has been a topic of clinical and ethical debate for years. As much as the medical community desires to attain the goal of a restraint-free environment, there are not many alternatives available when it comes to protecting the safety of violent patients and those around them. Our objective was to examine patterns of restraint use and analyze the factors leading to its use in adult psychiatric inpatient units. We conducted a retrospective review of restraint orders from January 2007 to December 2012, for inpatient units at a community mental health hospital, examining-unit, patient gender, number and duration of restraint episodes, time of day, and whether medications and/or verbal redirection were used. For the 6-year period studied, a total of 1753 restraint order-sheets were filed for 455 patients. Mixed-model regression found significant differences in duration of restraint episodes depending on: patient gender, unit, medication use, verbal redirection and AM/PM shifts. These differences were consistent over time with no significant interactions with years and remained significant when included together in an overall multivariate model. We elucidate variable patterns of restraint utilization correlating with elements such as patient gender, time of day and staff shift, medication use, and attempts at verbally redirecting the patient. Besides providing much needed data on the intricate dynamics influencing restraint use, we suggest steps to implement hospital-wide restraint-reduction initiatives including cultural changes related to restraint usage, enhanced staff-training in conflict de-escalation techniques and personalized treatment plans for foreseeable restraint episodes.
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Affiliation(s)
- Theresa Jacob
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA.
| | - Geetanjali Sahu
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
| | - Violina Frankel
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
| | - Peter Homel
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
| | - Bonnie Berman
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
| | - Scot McAfee
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
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Azeem MW, Reddy B, Wudarsky M, Carabetta L, Gregory F, Sarofin M. Restraint Reduction at a Pediatric Psychiatric Hospital: A Ten-Year Journey. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2015; 28:180-4. [DOI: 10.1111/jcap.12127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Muhammad Waqar Azeem
- Albert J. Solnit Children's Center; Middletown CT USA
- Yale Child Study Center; New Haven
| | - Bhagya Reddy
- Albert J. Solnit Children's Center; Middletown CT USA
- Yale Child Study Center; New Haven
| | - Marianne Wudarsky
- Albert J. Solnit Children's Center; Middletown CT USA
- Yale Child Study Center; New Haven
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Deveau R, Leitch S. The impact of restraint reduction meetings on the use of restrictive physical interventions in English residential services for children and young people. Child Care Health Dev 2015; 41:587-92. [PMID: 25256775 DOI: 10.1111/cch.12193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2014] [Indexed: 11/30/2022]
Abstract
AIM The aim was to examine the impact of post restraint reduction meetings upon the frequency and restrictiveness of restraint use in English children's residential services. BACKGROUND Attention has been drawn to the misuse, overuse and safety of some techniques used to physically restrain children in residential services. Successful interventions to reduce restraints have been reported, mostly from the USA. RESULTS Demonstrate a significant overall reduction in both, frequency and restrictiveness of restraints; the greatest percentage decrease in the most restrictive floor restraints. Whilst five services reduced both frequency and restrictiveness, five services showed some increases in frequency and/or restrictiveness of restraints employed. CONCLUSIONS Restraint reduction is most effectively reduced through employing multiple strategies and that post restraint reduction meetings maybe one useful component. Organisations seeking to promote restraint reduction meetings need to allocate sufficient priority and resources to support these.
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Affiliation(s)
- R Deveau
- Tizard Centre, University of Kent, Kent, UK
| | - S Leitch
- Leitch Consultancy, Appin, Argyll, UK
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34
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Abstract
Psychosocial interventions are part of the complex understanding and treatment of violent behavior in our state mental health hospitals. A comprehensive assessment of violence and aggression includes attention to all 3 domains of prevention and assessment (primary-institutional, secondary-structural, and tertiary-direct). Trauma experiences and their consequences may include behavioral violence and aggression. The authors' premise is that trauma is a universal component in the individual assessment of violent behavior. Therapeutic interventions must include a trauma-informed formulation to be effective. Organizational commitment to trauma-informed, person-centered, recovery-oriented (TPR) care is crucial to the efficacy of any of the interventions discussed. Thus, the dynamic nature of the individual, interpersonal, environmental, and cultural factors associated with the daily operations of the inpatient unit need to be assessed through the lens of primary and secondary violence prevention, building on the recognition that the majority of persons served and staff have significant trauma histories. Once a compassionate, respectful, empathic, and empowering approach is embraced by leadership and staff, the work with individuals can proceed more effectively. Interventions used include a variety of cognitive-behavioral, interpersonal, and somatosensory therapies. These interventions, when effectively applied, result in more self-esteem, self-mastery, self-control for the person served, and diminished behavioral violence.
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35
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Magyar-Moe JL, Owens RL, Conoley CW. Positive Psychological Interventions in Counseling. COUNSELING PSYCHOLOGIST 2015. [DOI: 10.1177/0011000015573776] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Counseling psychologists are in a prime position to claim preeminence in the field of applied positive psychology. A number of misunderstandings or misconceptions of positive psychology seem to interfere, however, with the focus (or lack thereof) that has been placed upon training counseling psychologists to utilize and contribute to positive psychological scholarship and applications. In this article, the most commonly reported misconceptions are addressed, and foundational information regarding positive psychological constructs, theories, and processes most relevant to the applied work of counseling psychologists is reviewed. Counseling psychologists are encouraged to claim positive psychology as the logical extension of our humanistic roots and to consider how to both utilize and contribute to the growing body of positive psychological scholarship.
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Affiliation(s)
| | - Rhea L. Owens
- University of Wisconsin–Stevens Point, Stevens Point, WI, USA
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36
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Valenkamp M, Delaney K, Verheij F. Reducing seclusion and restraint during child and adolescent inpatient treatment: still an underdeveloped area of research. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2014; 27:169-74. [PMID: 25100241 DOI: 10.1111/jcap.12084] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PROBLEM 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. METHOD 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. FINDING Included in this review are three empirical papers describing two different intervention models that met the inclusion criteria. CONCLUSIONS 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 least three of the six National Association of State Mental Health Program Directors core strategies for restraint reduction. The modest number of empirical papers reflects that reducing restrictive measures in child/adolescent inpatient treatment remains an underdeveloped area of research.
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Affiliation(s)
- Marije Valenkamp
- Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; VanMontfoort Consultancy, Woerden, The Netherlands
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37
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Lopez JJB, Bolívar JCC, Perez MS. COMMUNI-CARE: Assessment tool for reactions and behaviours of patients with dementia in a multisensory stimulation environment. DEMENTIA 2014; 15:526-38. [PMID: 24691272 DOI: 10.1177/1471301214528346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The 'Snoezelen' is an approach based on stimulation and sensory stimulation proposals, giving priority to the notion of caretaking. The aim of this paper is to present the creation and validation of the COMMUNI-CARE scale. This is a new tool that allows for an evaluation of the psycho-emotional well-being that the patient with dementia shows in a 'Snoezelen' multisensory stimulation environment. METHODS In total 429 evaluations in 143 multisensory stimulation interventions were made using the COMMUNI-CARE scale, in 16 patients between 53 and 85 years of age, diagnosed with moderate to severe dementia. The goal was to evaluate the psycho-emotional well-being the patients present. RESULTS The tool's internal consistency showed a Crombach alpha of 0.90. The concurrent validity between the COMMUNI-CARE scale and the Clinical Global Impression (CGI) was of r = -0.961. The Kappa index used to determine the reliability between evaluators was of K = 0.87. CONCLUSIONS The COMMUNI-CARE scale fulfills the basic principles of classic psychometrics of construct, and criterion validity and reliability. It does so while showing a clear idea, through its five subscales (anxiety, communication, pleasure, adaptation to the surroundings and affection), of the degree of well-being that the patient with dementia shows during such interventions. This scale embodies, through psychometrics, a very subjective human experience with a tool unavailable to date.
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Affiliation(s)
- José Javier Blanco Lopez
- Department of Geriatric Psychiatry Sagrat Cor Hospital, Germanes Hospitalàries del Sagrat Cor de Jesús, Martorell, Barcelona, Spain
| | - Juan Carlos Cejudo Bolívar
- Department of Geriatric Psychiatry Sagrat Cor Hospital, Germanes Hospitalàries del Sagrat Cor de Jesús, Martorell, Barcelona, Spain
| | - Manuel Sánchez Perez
- Department of Geriatric Psychiatry Sagrat Cor Hospital, Germanes Hospitalàries del Sagrat Cor de Jesús, Martorell, Barcelona, Spain
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38
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Knowles MM. What have we learnt so far about child and adolescent restraint in our health and social care services? J Psychiatr Ment Health Nurs 2013; 20:851-2. [PMID: 24099032 DOI: 10.1111/jpm.12103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M M Knowles
- School of Psychological Sciences, University of Manchester, Manchester, UK
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39
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Baeza I, Correll CU, Saito E, Amanbekova D, Ramani M, Kapoor S, Chekuri R, De Hert M, Carbon M. Frequency, characteristics and management of adolescent inpatient aggression. J Child Adolesc Psychopharmacol 2013; 23:271-81. [PMID: 23647136 PMCID: PMC3657279 DOI: 10.1089/cap.2012.0116] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Inpatient aggression is a serious challenge in pediatric psychiatry. METHODS A chart review study in adolescent psychiatric inpatients consecutively admitted over 24 months was conducted, to describe aggressive events requiring an intervention (AERI) and to characterize their management. AERIs were identified based on specific institutional event forms and/or documentation of as-needed (STAT/PRN) medication administration for aggression, both recorded by nursing staff. RESULTS Among 408 adolescent inpatients (age: 15.2±1.6 years, 43.9% male), 1349 AERIs were recorded, with ≥1 AERI occurring in 28.4% (n=116; AERI+). However, the frequency of AERIs was highly skewed (median 4, range: 1-258). In a logistical regression model, the primary diagnosis at discharge of disruptive behavior disorders and bipolar disorders, history of previous inpatient treatment, length of hospitalization, and absence of a specific precipitant prior to admission were significantly associated with AERIs (R(2)=0.32; p<0.0001). The first line treatment of patients with AERIs (AERI+) was pharmacological in nature (95.6%). Seclusion or restraint (SRU) was used at least once in 59.4% of the AERI+ subgroup (i.e., in 16.9% of all patients; median within-group SRU frequency: 3). Treatment and discharge characteristics indicated a poorer prognosis in the AERI+ (discharge to residential care AERI+: 22.8%, AERI-: 5.6%, p<0.001) and a greater need for psychotropic polypharmacy (median number of psychotropic medications AERI+: 2; AERI-: 1, p<0.001). CONCLUSIONS Despite high rates of pharmacological interventions, SRU continue to be used in adolescent inpatient care. As both of these approaches lack a clear evidence base, and as adolescents with clinically significant inpatient aggression have increased illness acuity/severity and service needs, structured research into the most appropriate inpatient aggression management is sorely needed.
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Affiliation(s)
- Immaculada Baeza
- Child and Adolescent Psychiatry and Psychology Department, CIBERSAM IDIBAPS, Hospital Clinic i Universitari, Barcelona, Spain
| | - Christoph U. Correll
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
- Hofstra North Shore Long Island Jewish School of Medicine, East Meadow, and Nassau County University Hospital, Hempstead, New York
- Albert Einstein College of Medicine, Bronx, New York
| | - Ema Saito
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Dinara Amanbekova
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Meena Ramani
- Hofstra North Shore Long Island Jewish School of Medicine, East Meadow, and Nassau County University Hospital, Hempstead, New York
| | - Sandeep Kapoor
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Raja Chekuri
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
| | - Marc De Hert
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Maren Carbon
- The Zucker Hillside Hospital, Department of Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, New York
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40
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Hottinen A, Välimäki M, Sailas E, Putkonen H, Joffe G, Puukka P, Noda T, Lindberg N. Mechanical restraint in adolescent psychiatry: a Finnish Register study. Nord J Psychiatry 2013; 67:132-9. [PMID: 22762210 DOI: 10.3109/08039488.2012.699552] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little is known of the use of mechanical restraint in adolescent psychiatry. AIMS To investigate the frequency and features of mechanical restraint in the field of Finnish adolescent psychiatry. METHODS The data were collected in the metropolitan area of Helsinki, Finland, with seven closed and eight open wards for Finnish-speaking 13-17-year-old adolescents. The official restraint reports and the hospital files of the restraint patients from January 2009 to December 2009 were collected and analyzed. RESULTS Among adolescents hospitalized in closed wards, the 1-year prevalence of mechanical restraint was 9.5%. Among all hospitalized adolescents, the prevalence was 6.9%. The number of mechanically restrained individuals per 100,000 13 to 17-year -old Finnish-speaking inhabitants was 57.1. The median duration of the restraint episode was 4 h and 50 min, but almost half of the mechanical restraint episodes lasted 8 h or more. A quarter of restraint episodes were not based on reasons mentioned in the Finnish Mental Health Act. The most frequent diagnostic categories of mechanically restrained adolescents were mood disorders followed by schizophrenia-related as well as behavioral and emotional disorders. Suicidality preceded 40% and violence 61% of restraint episodes. Boys were restrained during the first days of hospital treatment significantly more often than were girls, whereas one in four girls experienced her first episode of restraint after 1 month of hospitalization. CONCLUSIONS Reducing the number and shortening the length of mechanical restraint episodes requires education of staff as well as projects focusing on reducing coercion. The clinical guidelines must be followed at grassroots level.
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Affiliation(s)
- Anja Hottinen
- Department of Nursing Science, University of Turku, Finland.
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Novak T, Scanlan J, McCaul D, MacDonald N, Clarke T. Pilot study of a sensory room in an acute inpatient psychiatric unit. Australas Psychiatry 2012; 20:401-6. [PMID: 23014117 DOI: 10.1177/1039856212459585] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The use of sensory rooms (also known as comfort rooms) to reduce seclusion rates has generated a great deal of interest. This study examined the outcomes associated with the introduction of a sensory room in an acute inpatient psychiatric unit. METHOD Consumers rated distress and staff rated a variety of disturbed behaviours before and after each use of the room. Items used during each episode were recorded. RESULTS Use of the room was associated with significant reductions in distress and improvements in a range of disturbed behaviours. Those individuals who used the weighted blanket reported significantly greater reductions in distress and clinician-rated anxiety than those who did not. No changes were noted in rates of seclusion or aggression. CONCLUSIONS The sensory room was an effective intervention to ameliorate distress and disturbed behaviour, although this did not translate into reductions in overall rates of seclusion or aggression. Weighted blankets appear to be particularly useful.
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Affiliation(s)
- Theresa Novak
- Missenden Psychiatric Unit, Sydney and South Western Sydney Local Health Districts, Sydney, NSW, Australia.
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42
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Goetz SB, Taylor-Trujillo A. A change in culture: violence prevention in an acute behavioral health setting. J Am Psychiatr Nurses Assoc 2012; 18:96-103. [PMID: 22442017 DOI: 10.1177/1078390312439469] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A multilayered implementation of safety measures in an inpatient psychiatric facility created a sustained change in culture related to patient and staff safety. The model was developed over a 5-year period in a freestanding 80-bed behavioral health facility that is part of a Level II trauma center in the Midwest. The model has nine components that the nursing leadership team saw as integral to maintaining a safe environment. The nine elements include trauma-informed care principles, aggression management, code event review, leadership involvement, quality feedback, recovery orientation, patient assessment, education, and collaboration. The metrics collected to determine the effectiveness of the model included patient violence events and staff injuries. This article describes the development of this model and its impact on the reduction of patient violence events and staff injuries at this facility. The recommendations include considerations for the replication of this model at other facilities.
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Affiliation(s)
- Suzanne Barnum Goetz
- Richard H. Young Hospital, Good Samaritan Health Systems, Kearney, NE 68845, USA.
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Chalmers A, Harrison S, Mollison K, Molloy N, Gray K. Establishing sensory-based approaches in mental health inpatient care: a multidisciplinary approach. Australas Psychiatry 2012; 20:35-9. [PMID: 22357673 DOI: 10.1177/1039856211430146] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To reflect upon the implementation of sensory-based approaches within the environment of a psychiatric inpatient unit. METHOD A literature review on sensory modulation within psychiatric inpatient care, including seclusion and restraint reduction initiatives, was conducted. A variety of sensory-based principles were planned, developed and implemented over a 3-year period. Preliminary data regarding sensory room use and acute arousal ratings within the high-dependency area were analysed. RESULTS Preliminary sensory room data showed a significant reduction in patient distress levels, as per consumer and clinician ratings, and that the majority of sensory room sessions were conducted by nursing staff. A significant reduction was also found for acute arousal ratings, pre to post, for the HDU engagement program. Several issues were uncovered throughout implementation of the sensory-based strategies. CONCLUSIONS Findings indicate the importance of cultural change, compared with simply an environmental change, giving all staff and consumers the confidence to utilise a variety of sensory-based methods during times of need. Further Australian research is required to explore the positive contribution sensory modulation can potentially make across the spectrum of psychiatric settings.
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Affiliation(s)
- Angela Chalmers
- Mercy Mental Health Psychiatric Unit, Werribee, VIC, Australia.
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LeBel J, Nunno MA, Mohr WK, O'Halloran R. Restraint and seclusion use in U.S. school settings: recommendations from allied treatment disciplines. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2012; 82:75-86. [PMID: 22239396 DOI: 10.1111/j.1939-0025.2011.01134.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Restraint and seclusion (R&S) are high risk, emergency procedures that are used in response to perceived violent, dangerous situations. They have been employed for years in a variety of settings that serve children, such as psychiatric hospitals and residential treatment facilities, but are now being recognized as used in the public schools. The field of education has begun to examine these practices in response to national scrutiny and a Congressional investigation. The fields of mental health and child welfare were similarly scrutinized 10 years ago following national media attention and have advanced R&S practice through the adoption of a prevention framework and core strategies to prevent and reduce use. A review of the evolution of the national R&S movement, the adverse effects of these procedures, and a comprehensive approach to prevent their use with specific core strategies such as leadership, workforce development, and youth and family involvement in order to facilitate organizational culture and practice change are discussed. Proposed guidelines for R&S use in schools and systemic recommendations to promote R&S practice alignment between the child-serving service sectors are also offered.
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Affiliation(s)
- Janice LeBel
- Commonwealth of Massachusetts, Department of Mental Health, 25 Staniford St., Boston, MA 02114, USA.
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Protective Predictors of Alcohol Use Trajectories Among Canadian Aboriginal Youth. J Youth Adolesc 2011; 41:229-43. [DOI: 10.1007/s10964-011-9716-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Accepted: 09/21/2011] [Indexed: 10/17/2022]
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De Hert M, Dirix N, Demunter H, Correll CU. Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2011; 20:221-30. [PMID: 21298305 DOI: 10.1007/s00787-011-0160-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 01/19/2011] [Indexed: 11/24/2022]
Abstract
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 pediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilization 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 behavior, 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.
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Affiliation(s)
- Marc De Hert
- University Psychiatric Centre, KUL Campus Kortenberg, Leuvensesteenweg 517, Kortenberg, Belgium.
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Happell B, Koehn S. Attitudes to the use of seclusion: has contemporary mental health policy made a difference? J Clin Nurs 2011; 19:3208-17. [PMID: 21040022 DOI: 10.1111/j.1365-2702.2010.03286.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of seclusion in mental health services is controversial, and recent Government policy has identified the reduction and, if possible, elimination of seclusion as a national safety priority. As the professional group most likely to initiate seclusion, the attitudes of nurses will influence the extent to which policy translates to practice. DESIGN The Survey of Nurses' Attitudes to Seclusion Survey was completed by nurses (n = 123) from eight mental health services from Queensland, Australia. METHODS Data were analysed using SPSS to provide descriptive statistics for nurses' attitudes according to the scale. Correlation analysis was used to examine associations between demographic variables and attitudes towards seclusion. RESULTS Participants recognised the negative impact of seclusion on consumers; however, they continue to support its use, particularly in cases of threatened or actual violence to staff and other consumers. The impact of seclusion room on consumers was viewed as significant and yet most participants did not recommend changes other than painting the room for a calming effect. Demographic factors had limited impact on attitudes. CONCLUSIONS The continued support of the use of seclusion despite acknowledgement of its detrimental effects appears to reflect a lack of alternative approaches to the management of consumer behaviours such as violence and aggression. RELEVANCE TO CLINICAL PRACTICE While nurses continue to view seclusion as a necessary intervention, the success of strategies aimed at reducing its use will be limited. The implementation and evaluation of alternative approaches to the care of consumers is necessary to reduce reliance and seclusion and introduce changes to practice.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, CQUniversity Australia, Queensland, Australia.
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Azeem MW, Aujla A, Rammerth M, Binsfeld G, Jones RB. Effectiveness of Six Core Strategies Based on Trauma Informed Care in Reducing Seclusions and Restraints at a Child and Adolescent Psychiatric Hospital. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2011; 24:11-5. [DOI: 10.1111/j.1744-6171.2010.00262.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scanlan JN. Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far a review of the literature. Int J Soc Psychiatry 2010; 56:412-23. [PMID: 19617275 DOI: 10.1177/0020764009106630] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In recent times, much attention has been focused on the reduction of seclusion and restraint in psychiatric settings. This paper analyzes evidence available from evaluations of single seclusion and/or restraint reduction programmes. A total of 29 papers were included in the review. RESULTS Seven key strategy types emerged from the analysis: (i) policy change/leadership; (ii) external review/debriefing; (iii) data use; (iv) training; (v) consumer/family involvement; (vi) increase in staff ratio/crisis response teams; and (vii) programme elements/changes. Outcomes indicate that a range of reduction programmes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment. CONCLUSION The development of new seclusion and restraint reduction programmes should include strong leadership from local management; external seclusion and restraint review committees or post-incident debriefing and analysis; broad-based staff training and programme changes at a local level. Behavioural and cognitive-behavioural programmes appear to be very useful in child and adolescent services. Further systematic research should be conducted to more fully understand which elements of successful programmes are the most powerful in reducing incidents of seclusion and restraint.
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Affiliation(s)
- Justin Newton Scanlan
- Concord Centre for Mental Health, Concord Repatriation General Hospital, Hospital Road, Concord, NSW 2139, Australia.
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Paterson B, Leadbetter D, Miller G, Bowie V. Re-framing the problem of workplace violence directed towards nurses in mental health services in the UK: a work in progress. Int J Soc Psychiatry 2010; 56:310-20. [PMID: 19617279 DOI: 10.1177/0020764008099692] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research consistently suggests nurses working in mental health settings are more likely to be assaulted than nurses in other settings. AIMS Belated recognition of the issue in terms of social policy (Elston et al. 2006) has been accompanied by an as yet unexamined contest between conflicting 'frames' of the problem, which this paper seeks to make transparent. METHOD Frame analysis. RESULTS Two distinct 'master' frames are discussed: the 'individualizing' and the 'co-creationist'. CONCLUSIONS The influence of these frames has influenced the nature of responses to the problem but the recent dominance of the individualizing frame is being challenged by the emergence, or perhaps re-emergence, of co-creationism.
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Affiliation(s)
- Brodie Paterson
- Department of Nursing and Midwifery, University of Stirling, Scotland.
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