CPS is a promising approach to reduce seclusion and restraint use in a child psychiatric inpatient setting. Future research and replication efforts are warranted to test its effectiveness in other restrictive settings.

This study was conducted to evaluate aggression and noncompliance among child psychiatric inpatients in relation to demographic, clinical, and hospitalization characteristics, including the use of restraints and seclusion. Eighty six children (10.8+/-2.4 years old, 67% male) consecutively admitted to an inpatient psychiatric unit were rated weekly using the Modified Overt Aggression Scale (MOAS) and the Disruptive Behavior Rating Scale (DBRS) between November 1, 2002 and June 30, 2003. Moderate to high correlations were observed between the four types of aggression (verbal, and physical against self, others, or objects) and noncompliant behavior. In hierarchical regression analyses, only mental retardation emerged as a significant predictor of aggression and noncompliance. Aggression and noncompliance were associated with different characteristics of inpatient treatment. Aggressive behavior was significantly associated with the use of restraints and seclusion, and noncompliant behavior with length of hospitalization and number of psychiatric medications at time of discharge. Modifying milieu interventions for youths with mental retardation, and adapting behavioral interventions empirically proven to target noncompliance may be effective loci for reducing aggression in child psychiatric inpatient units.

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The Yale Child Study Center offers a 2-year integrated predoctoral internship and postdoctoral fellowship training sequence that emphasizes both child and adolescent generalist and pediatric specialty training. In this article, we outline how the various elements of the Yale Child Study Center Psychology Fellowship link directly to recommended core competencies recently published by the Society for Pediatric Psychology's (SPP) Task Force on Competencies and Best Training Practices in Pediatric Psychology (Palermo et al., 2014). We review the manner in which our trainees are evaluated for achievement of these competencies and discuss how the 2-year developmental model enables graduating trainees to thrive as highly competent pediatric psychologists within a complex and constantly changing health care environment.