Effects of a Staff Training Intervention on Seclusion Rates on an Adult Inpatient Psychiatric Unit

Newman, Julie Bapp; Paun, Olimpia; Fogg, Louis

doi:10.3928/02793695-20180212-02

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…Four qualitative studies were identified 72,137,152,201 ( Table 6), as were a further six that used mixed methods 15,140,166,187,189,203 ( Table 7). Goulet et al 166 and Chandler 201 reported using case study methodology.…”

Section: Evaluation Designmentioning

confidence: 99%

Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

Baker

Berzins

Canvin

et al. 2021

Health Serv Deliv Res

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Objectives The study aimed to provide a mapping review of non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings; classify intervention components using the behaviour change technique taxonomy; explore evidence of behaviour change techniques and interventions; and identify the behaviour change techniques that show most effectiveness and those that require further testing. Background Incidents involving violence and aggression occur frequently in adult mental health inpatient settings. They often result in restrictive practices such as restraint and seclusion. These practices carry significant risks, including physical and psychological harm to service users and staff, and costs to the NHS. A number of interventions aim to reduce the use of restrictive practices by using behaviour change techniques to modify practice. Some interventions have been evaluated, but effectiveness research is hampered by limited attention to the specific components. The behaviour change technique taxonomy provides a common language with which to specify intervention content. Design Systematic mapping study and analysis. Data sources English-language health and social care research databases, and grey literature, including social media. The databases searched included British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Technology Assessment (HTA) Database, HTA Canadian and International, Ovid MEDLINE®, NHS Economic Evaluation Database (NHS EED), PsycInfo® and PubMed. Databases were searched from 1999 to 2019. Review methods Broad literature search; identification, description and classification of interventions using the behaviour change technique taxonomy; and quality appraisal of reports. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were retrieved and subject to scrutiny of content, to identify interventions; quality appraisal, using the Mixed Methods Appraisal Tool; and data extraction, regarding whether participants were staff or service users, number of participants, study setting, intervention type, procedures and fidelity. The resulting data set for extraction was guided by the Workgroup for Intervention Development and Evaluation Research, Cochrane and theory coding scheme recommendations. The behaviour change technique taxonomy was applied systematically to each identified intervention. Intervention data were examined for overarching patterns, range and frequency. Overall percentages of behaviour change techniques by behaviour change technique cluster were reported. Procedures used within interventions, for example staff training, were described using the behaviour change technique taxonomy. Results The final data set comprised 221 records reporting 150 interventions, 109 of which had been evaluated. The most common evaluation approach was a non-randomised design. There were six randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Behaviour change techniques found in the interventions were most likely to be those that demonstrated statistically significant effects. The most common intervention target was seclusion and restraint reduction. The most common strategy was staff training. Over two-thirds of the behaviour change techniques mapped onto four clusters, that is ‘goals and planning’, ‘antecedents’, ‘shaping knowledge’ and ‘feedback and monitoring’. The number of behaviour change techniques identified per intervention ranged from 1 to 33 (mean 8 techniques). Limitations Many interventions were poorly described and might have contained additional behaviour change techniques that were not detected. The finding that the evidence was weak restricted the study’s scope for examining behaviour change technique effectiveness. The literature search was restricted to English-language records. Conclusions Studies on interventions to reduce restrictive practices appear to be diverse and poor. Interventions tend to contain multiple procedures delivered in multiple ways. Future work Prior to future commissioning decisions, further research to enhance the evidence base could help address the urgent need for effective strategies. Testing individual procedures, for example, audit and feedback, could ascertain which are the most effective intervention components. Separate testing of individual components could improve understanding of content and delivery. Study registration The study is registered as PROSPERO CRD42018086985. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.

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Section: Evaluation Designmentioning

confidence: 99%

Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

Baker

Berzins

Canvin

et al. 2021

Health Serv Deliv Res

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“…Nine studies focused on the processes surrounding seclusion and restraint 136 137 174–180. A further 16 studies evaluated interventions to reduce seclusion and restraint, with 13 finding significant decreases in rates of use,146 181–192 one reporting an increase193 and one reporting increased levels of knowledge about the topic area 194. Four studies examined prevalence, trends and preventative factors138 195–197; one found that 45% of patients were subjected to restraint,138 and another found that restraint and seclusion declined over time 197.…”

Section: Resultsmentioning

confidence: 99%

Patient safety in inpatient mental health settings: a systematic review

et al. 2019

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ObjectivesPatients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology.DesignSystematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to ‘mental health’, ‘patient safety’, ‘inpatient setting’ and ‘research’. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model.ResultsOf the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control.ConclusionsPatient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.PROSPERO registration numberCRD42016034057.

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“…For example, staff who hold negative attitudes about behavioral treatments are less likely to attempt to learn and implement them in psychiatric settings. Reasons for this vary and include adhering to a biological ideology of SMI, beliefs that behavior therapy is inappropriate, ineffectual, or unethical, and beliefs that patients do not like to participate in behavioral treatments (Corrigan & McCracken, 1997; Corrigan et al, 1998, 2001; Newman et al, 2018).…”

Section: Barriers In the Implementation Of Social Learning Programsmentioning

confidence: 99%

“…Psychiatric treatment programs that employ social-learning principles and procedures, commonly referred to as social-learning programs (SLPs), have been shown to be highly effective in treating individuals with serious mental illness (SMI; individuals with severe, chronic, and debilitating psychiatric conditions such as “treatment-refractory” schizophrenia and other psychotic disorders; Chien et al, 2013; Dixon et al, 2010; Glynn & Mueser, 1986, 1992; Kreyenbuhl et al, 2010; Menditto, 2002; Newman, Paun, & Fogg, 2018; Paul, Stuve, & Menditto, 1997; Silverstein et al, 2006). SLPs have been associated with the acquisition of new and more effective coping skills, a reduction of bizarre and inappropriate behaviors, improved social functioning, improvements in self-care and other activities of daily living, a reduction in the need for medication, and reduced rates of relapse and/or hospitalization (Dixon et al, 2010; Glynn & Mueser, 1986; Kreyenbuhl et al, 2010; Liberman et al, 2005, 1986; Paul & Lentz, 1977).…”

mentioning

confidence: 99%

“…Taken together, these findings highlight the need for well-trained psychiatric staff in the implementation of effective SLPs. In health-related treatment programs, staff-training initiatives have been shown to be more successful when instruction is paired with psychoeducation to improve negative attitudes, in addition to hands-on guidance and supervised in vivo practice sessions (Jones, Menditto, Geeson, Larson, & Sadewhite, 2001; Newman et al, 2018; Silverstein et al, 2006). In addition, having specific guidelines for implementation, reinforcement procedures for staff performance, and periodic booster sessions is essential for maintaining positive outcomes (Hartzler, Jackson, Jones, Beadnell, & Calsyn, 2014; Killaspy et al, 2015; Silverstein et al, 2006; Waller et al, 2015).…”

mentioning

confidence: 99%

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The effects of a staff-training program in behavior management and social-learning principles on staff–patient interactions within a psychiatric rehabilitation inpatient unit.

Schenkel¹,

Wilkniss

Savitz

et al. 2020

American Journal of Orthopsychiatry

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Despite the existence of effective behavioral interventions for people diagnosed with serious mental illness (SMI), these continue to be underutilized. Barriers to implementation include a low frequency of staff-patient interactions, as well as a lack of knowledge about, and negative attitudes toward, behavioral interventions. Therefore, we examined the effects of a mandatory behavioral staff-training program on staff-patient interactions on a long-term psychiatric inpatient program for individuals with SMI. Staff-training consisted of two-phases: didactic training followed by a written exam, and in vivo training and assessment. From pre-to posttraining, all staff demonstrated increased positive and therapeutic behaviors and decreased negative behaviors when interacting with patients. Additionally, at baseline, nonmedical staff (psychologists, social workers) displayed significantly more therapeutic and fewer negative behaviors compared with medical staff (psychiatrists, nurses, mental health workers), and this pattern persisted at posttraining despite improvements in both groups. Importantly, completion of the staff-training program was associated with improvements in patient behavior. Although both written and in vivo test scores significantly predicted change in negative staff behaviors toward patients, the in vivo test performance increased predictive ability over and above that of written test performance. Staff who disagreed with behavioral management principles displayed less improvement in negative behaviors from pre-to postassessment. These data have implications for clarifying staff training needs in programs for chronically ill people with SMI. Public Policy Relevance StatementEffective behavioral interventions for people diagnosed with serious mental illness (SMI) continue to be underutilized in inpatient hospital settings. To date, there have been very few published investigations of behaviorally based staff-training initiatives for mental health professionals who work with SMI populations. As such, empirically supported guidelines for training mental health staff are lacking. This investigation reports on the results of a comprehensive staff-training program in behavioral techniques, consisting of didactic, interactive, and in vivo components, along with written and in vivo assessments of mastery.

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Effects of a Staff Training Intervention on Seclusion Rates on an Adult Inpatient Psychiatric Unit

Cited by 9 publications

References 21 publications

Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review

Patient safety in inpatient mental health settings: a systematic review

The effects of a staff-training program in behavior management and social-learning principles on staff–patient interactions within a psychiatric rehabilitation inpatient unit.

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