Background Seclusion is an intensive intervention employed in inpatient mental health units to guarantee safety when de-escalation methods have been exhausted. High rate of seclusion are associated with higher employee injury rate, lower staff engagement and increased patient length of stay. Objectives Our aim is to reduce seclusion rates in all admitted patients in inpatient psychiatry from a baseline of 136 to less than 110 per 1000 patient days by December 2016 and sustain for 12 months. Methods A multidisciplinary team developed an Aim and Key Driver Diagram focused on reducing seclusions. Evidence based interventions included milieu management techniques, proactive patient engagement and staff training on trauma informed approaches, physical deflection, and reinforcement principles. Other successful Plan-Do-Study-Act's (PDSA's) include small patient groups and skill-appropriate programming to reduce opportunities for escalating behaviours and increase patient success. Results By 1st quarter 2017, seclusion rates were reduced from 136 to 60 seclusions per 1000 patient days (56% reduction) and sustained for 12 months. In addition to seclusion rates, we achieved a 40% reduction in duration of seclusions, a 55% reduction in mechanical restraints and a 72% reduction in employee injuries. Conclusions Seclusion in children and adolescent mental health units can be significantly reduced through systematic application of quality improvement methodology to revise unit programming and address training and awareness issues. We implemented several effective and less-disruptive interventions while we established a new unit and trained inexperienced staff. These strategies may help impact care of patients in other child and adolescent mental health units.

Seclusion remains an important part of psychiatric practice. As expected, the use of seclusion in an adult acute unit reflected indirect measures of illness severity. Its use needs to be carefully reviewed and monitored, representing as it does the greatest restriction on a person's freedom.

Child and adolescent psychiatry in developed countries is characterised by a well-organised and co-ordinated mix of service delivery facilities such as hospital, residential and day treatment units run by a multidisciplinary complement of professionals including psychiatrists, psychologists, counsellors and social workers.1-4 Systematic development efforts have created a surveillance system that includes parents, educational, judicial and medical institutions, and mental health professionals.By routine or incidental observations and/or use of screening or diagnostic instruments such as the Child Behaviour Scale or Kiddie-SADs this system ensures that the majority of children with psychiatric disorders are brought into the net of service delivery. 1-4Another important aspect of child psychiatry in developed countries is the variety and co-ordination of treatment modalities such as individual or group therapy, family therapy, behavioural therapy, hypnotherapy, pharmacotherapy and educational measures. 1,3In Nigeria, like most developing nations, the above is still not practicable, and poor services and poor attendance mean that both the demand and supply ends of child psychiatric services are underdeveloped. While there is ample epidemiological evidence that child psychiatric disorders are prevalent in Nigeria, 5-8 few children are brought to the health services because of mental health problems 9 -even emotional and conduct disorders, which are known to be common in childhood.

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Objective: The objective of the study was to identify children with Sickle cell disease (SCD) who are experiencing psychosocial problems concurrently with their mothers; and comparing the dyads to determine correlation, pattern of correlation and to identify correlating or modifying factors. Method: The psychosocial impact of Sickle cell disease in affected children and their mothers was assessed using semi-structured questionnaire and standardized instruments (The Child Behaviour Questionnaire (CBQ) -Parents' version or Scale A2) for the children and Self Reporting Questionnaire (SRQ) for their mothers) Children with bronchial asthma and some with acute medical illnesses (AMI) and their mothers who were also assessed with the same instruments served as the control population. Results: There was significant correlation between children who were probable cases with psychological problems based on Child Behaviour Questionnaire (CBQ score of ≥7) and corresponding mothers who were probable cases with psychosocial problems based on Self-Reporting Questionnaire (SRQ score of ≥5).Although there were some group-specific factors that influenced this pattern (child and mother having psychosocial problems concurrently) in one or 2 groups of these diseases, none cut across the 3 groups. Conclusion: In psychosocial management of physical illnesses, assessment and care should include a focus on families rather than on the affected individual only. In addition, identifying emotional and social dysfunction in a family member should lead to a search in other members; in this way primary prevention or control can effectively be carried out. Finally, identifying more modifiable factors that positively influence this pattern in which child and mother experience psychosocial dysfunction concurrently should be the urgent task of future and larger studies in this environment.