Child and Adolescent Inpatient Restraint Reduction: A State Initiative to Promote Strength-Based Care

LeBel, Janice; Stromberg, Nan; Duckworth, Ken; Kerzner, Joan P.; Goldstein, Robert H.; Weeks, M.B.A. William B.; Harper, Gordon; Sudders, Marylou

doi:10.1097/00004583-200401000-00013

Cited by 110 publications

(93 citation statements)

References 23 publications

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“…After applying the inclusion criteria, 13 publications were excluded: 6 did not meet the time-frame [2,10,20,23,31,35]; 2 papers did not report original research [8,13] and 5 did not present prevalence data for seclusion or restraint use [8,19,28,26,33] Four of the 7 included studies had a pre-intervention/post-intervention design (n=1,302) [6,17,18,21], two were descriptive studies (n=590) [9,15], and the last one was a cross-sectional survey (n=504) [32] (Table 1). …”

Section: Search Resultsmentioning

confidence: 99%

“…All 7 studies (n=2,393; no n available in one study [18]) reported on paediatric psychiatric inpatient samples, and all had prevalence data on SRU as the primary outcome measure.…”

Section: Summary Of the Included Studiesmentioning

confidence: 99%

“…Studies were conducted in the US (n=4) [9,17,18,21], Australia (n=2) [6,15], and only one study was conducted in Europe [32]. One study (n=442) reported on two consecutive time points, and 4 studies (n=1,302) reported on SRU rates before and after a specific intervention.…”

Section: Summary Of the Included Studiesmentioning

confidence: 99%

“…One study (n=442) reported on two consecutive time points, and 4 studies (n=1,302) reported on SRU rates before and after a specific intervention. The studied interventions included a new model of care [18], a behavioural therapy oriented management programme [6], the introduction of a padded room as an alternative [17], and a collaborative problem solving approach for aggression [21]. Overall, the results across these studies were diverse, yet, SRU rates were substantial and generally decreased in response to a specific intervention.…”

Section: Summary Of the Included Studiesmentioning

confidence: 99%

“…The literature prior to the year 2000 reports rates ranging from 28% to 60% [1,4,10,15,23]. A survey of 25 US child and adolescent units found 6-fold higher SRU rates compared to adult services in the same state [18].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Hert

Dirix

Demunter

et al. 2011

Eur Child Adolesc Psychiatry

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Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patients in psychiatric settings. However, little is known about their utilization and effectiveness in paediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilisation in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10 years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21 years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1.000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (-0.6%), but results were heterogeneous (-97.2% to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures.Otherwise, seclusion episodes reduced by 74.7%, including a 32.4%. shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behaviour, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines.

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Section: Search Resultsmentioning

confidence: 99%

“…All 7 studies (n=2,393; no n available in one study [18]) reported on paediatric psychiatric inpatient samples, and all had prevalence data on SRU as the primary outcome measure.…”

Section: Summary Of the Included Studiesmentioning

confidence: 99%