Children's moral experiences of crisis management in a child mental health setting

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.

A “Thick” Conception of Children’s Voices: A Hermeneutical Framework for Childhood Research

“…This hermeneutical methodology can help advance our understanding of children's aspirations and concerns in research and in professional practice. For detailed discussions of how hermeneutical inquiry can be used in situations such as those described in the opening narratives-whether for research or professional practice-readers can consult other work published by our VOICE team regarding the voices of children who communicate differently (Carnevale et al, 2006(Carnevale et al, , 2017, newborns' voices (Carnevale et al, 2019), children living with mental health concerns (Montreuil, Thibeault, et al, 2018;Montreuil, Thibeault, et al, 2019), keeping secrets/respecting privacy and confidentiality (Noiseux et al, 2018), seeking consent and assent (Carnevale, 2012), practicing empathic attunement (Carnevale, 2009), or thick inquiry with children (Carnevale, 2005(Carnevale, , 2017.…”

“…It is important to develop methods that can optimize the participation of young people in the development, implementation, analysis and interpretation, and knowledge utilization aspects of every study that involves or affects them. In most of our VOICE research, we invite young people to work with us as advisors, seeking their input on study design, participant selection procedures, adapting data generation tools (e.g., interview and observation guides), as well as data analysis, interpretation, and utilization (see, e.g., Kooiman et al, 2012;Kutcher et al, 2019;Montreuil, Thibeault, McHarg, & Carnevale, 2018;Montreuil, Thibeault, McHarg, & Carnevale, 2019;Sebti et al, 2019;Sherman et al, 2011). Most commonly, this advisory engagement has involved young people within primary school and high school, although we have sometimes consulted with younger children as young as 3 years old, adapting their forms of participation to their interests.…”

Nurses' responses to adolescent distress in an acute child and adolescent mental health inpatient unit: A qualitative interpretive descriptive study

“…Young people perceive these uniform responses as unhelpful (Montreuil et al, 2018), and are more likely to reject nursing support. This rejection may be viewed as noncompliant by the nurse and thus increases the likelihood of further coercive interventions (Montreuil et al, 2018).…”

“…De‐escalation is a critical intervention and should be used wherever possible when responding to young people who exhibit escalating aggressive behaviors. Nurses' uniform use of verbal de‐escalation strategies highlights the difficulties associated with managing violent behaviors, and efforts to reduce coercive interventions on C&A inpatient units (Montreuil et al, 2018). Verbal de‐escalation is only effective when the young person is cognitively engaged to work with the nurse.…”

Exploring the health and well-being of children and youth in Winneway, Québec

“…This view is being challenged as it reinforces children and youth as passive rather than active in their health and well-being (Marjorie Montreuil & Carnevale, 2016). Recently, the perspectives of children and youth are being recognized as valuable (M Montreuil, Thibeault, McHarg, & Carnevale, 2018;Marjorie Montreuil, Saint-Laurent, & Carnevale, 2017;Riley, 2004;Sixsmith, Gabhainn, Fleming, & O'Higgins, 2007), and new research focusing on the health and well-being of children and youth are increasingly taking a child-centered approach to help capture their perspectives (Redmond, Skattebol, & Saunders, 2013).…”