Conflict prevention, de-escalation and restraint in children/youth inpatient and residential facilities: A systematic mapping review

Slaatto, Ane; Mellblom, Anneli; Kleppe, Lise Cecilie; Baugerud, Gunn Astrid; Kjøbli, John

doi:10.1016/j.childyouth.2021.106069

Cited by 15 publications

(12 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…PRTF staff train in safe crisis management (SCM), which involves verbal and physical deescalation skills (see Couvillon et al., 2010, and Slaatto et al., 2021, for reviews of crisis intervention programs). The initial training occurs over 3 days during staff orientation.…”

Section: Methodsmentioning

confidence: 99%

“…Restraint process PRTF staff train in safe crisis management (SCM), which involves verbal and physical deescalation skills (see Couvillon et al, 2010, andSlaatto et al, 2021, If none of the verbal interventions are successful or the child engages in behavior that is dangerous to themselves or others (see Table 1), the child is placed in a restraint (see Figure 1). The agency uses several SCM-approved restraints: six standing restraints, five seated or kneeling restraints, and three supine restraints.…”

Section: Referral and Admission To The Residential Treatment Facilitymentioning

confidence: 99%

See 1 more Smart Citation

Traumatic stress symptoms predict restraint incidents in children and adolescents in psychiatric residential treatment

Brown

Nedelman

Phillips

et al. 2022

Journal of Traumatic Stress

View full text Add to dashboard Cite

The early identification of youth at risk for restraint incidents is an important next step to reducing the likelihood of such incidents. Yet, the extant research has not comprehensively investigated the idiographic factors that contribute to the restraint of youth in psychiatric residential treatment facilities (PRTFs). The current study investigated client-level predictors of restraint incidents, with specific emphasis on youth client trauma history and traumatic stress symptoms as assessed at admission. Participants were children and adolescents (N = 150; 55.3% female, 66.7% White, 33.3% Black or biracial) aged 6-17 (M = 11.8 years) admitted to a PRTF in the northeastern United States. A negative binomial regression with maximum likelihood estimation was conducted to examine the relative contributions of age, gender, length of stay, number of psychiatric diagnoses, body mass index (BMI), and traumatic stress symptoms at intake to the frequency of restraint incidents. The model was significant, χ 2 (6, N = 150) = 30.326, p < .001, and both length of stay, β = .005, p < .001, IRR = 1.005, and traumatic stress symptoms at intake, β = .072, p = .007, IRR = 1.074, were identified as significant 694

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Referral and Admission To The Residential Treatment Facilitymentioning

confidence: 99%

Traumatic stress symptoms predict restraint incidents in children and adolescents in psychiatric residential treatment

Brown

Nedelman

Phillips

et al. 2022

Journal of Traumatic Stress

View full text Add to dashboard Cite

show abstract

“…Concerns have been raised about discrepancies between the use of coercive measures and compliance with human rights, such as the Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (34) and the Declaration on the Rights of Disabled Persons (35). A great deal of effort has been invested in mapping and reducing the occurrence of coercive measures to create psychiatric care environments that are both safe and promote actual care, while simultaneously fully respecting human rights (18,(36)(37)(38)(39). Several promising interventions to prevent violence and coercive measures in institutional care have been developed, but policies that make full use of these interventions are still missing (18,23,36).…”

Section: Introductionmentioning

confidence: 99%

“…A great deal of effort has been invested in mapping and reducing the occurrence of coercive measures to create psychiatric care environments that are both safe and promote actual care, while simultaneously fully respecting human rights (18,(36)(37)(38)(39). Several promising interventions to prevent violence and coercive measures in institutional care have been developed, but policies that make full use of these interventions are still missing (18,23,36). There is a continuing need for the promotion of non-coercive strategies for dealing with service users, such as developing communication skills and caring attitudes among staff, as well as facilitating the formation of staff-service user relationships through various violence prevention programs like Safewards, Six Core Strategies and Trauma-Informed Care intervention (18,23,25,33,36,38).…”

Section: Introductionmentioning

confidence: 99%

Strategies for the Prevention of Violence in Institutional Care: A Qualitative Interview Study With Ward Managers

et al. 2022

View full text Add to dashboard Cite

BackgroundThe presence of violence within psychiatric and residential settings remains a challenge. Research on this problem has often focused on describing violence prevention strategies from either staffs' or service users' perspectives, and the views of ward managers has been largely overlooked. The aim of the present study was therefore to identify ward managers' strategies to prevent violence in institutional care, focusing on safety and values.MethodsData were collected using semi-structured interviews with 12 ward managers who headed four different types of psychiatric wards and two special residential homes for adolescents. Qualitative content analysis was applied, first using a deductive approach, in which quotes were selected within a frame of primary, secondary, and tertiary prevention, then by coding using an inductive approach to create themes and subthemes.ResultsWard managers' strategies were divided into the four following themes: (1) Balancing being an active manager with relying on staff's abilities to carry out their work properly while staying mostly in the background; (2) Promoting value awareness and non-coercive practices in encounters with service users by promoting key values and adopting de-escalation techniques, as well as focusing on staff-service user relationships; (3) Acknowledging and strengthening staff's abilities and competence by viewing and treating staff as a critical resource for good care; and (4) Providing information and support to staff by exchanging information and debriefing them after violent incidents.ConclusionsWard managers described ethical challenges surrounding violence and coercive measures. These were often described as practical problems, so there seems to be a need for a development of higher ethical awareness based on a common understanding regarding central ethical values to be respected in coercive care. The ward managers seem to have a high awareness of de-escalation and the work with secondary prevention, however, there is a need to develop the work with primary and tertiary prevention. The service user group or user organizations were not considered as resources in violence prevention, so there is a need to ensure that all stakeholders are active in the process of creating violence prevention strategies.

show abstract

“…Winstanley and Hales (2014) describe a feedback loop: staff members become emotionally exhausted and detached when confronted with repeated oppositional behavior and aggression, and this emotional detachment then provokes further aggression and opposition from youth. Previous research suggests that, overall, implementation of various interventions, such as courses and education and training programs, has been effective in reducing the number of incidents involving youth aggression and staff use of restraint and seclusion (R&S) and/or in improving staff prevention and management of challenging behaviors in inpatient and residential facilities (Dean et al, 2007;Nunno et al, 2003;Slaatto et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Safety in Residential Youth Facilities: Staff Perceptions of Safety and Experiences of the “Basic Training Program in Safety and Security”

Slaatto

Mellblom

Kleppe

et al. 2021

Residential Treatment for Children & Youth

Self Cite

View full text Add to dashboard Cite

In inpatient and residential youth facilities, staff concerns over actual and potential aggression and conflict frequently affect both the quality of care and staff wellbeing. This study investigated 1) staff perceptions of safety at the residential facilities where they work, and 2) staff experiences with the Basic Training Program in Safety and Security, initiated by the Norwegian Directorate of Children, Youth and Family Affairs (Bufdir), to enhance prevention and management of aggression and conflict. We conducted three focus-group interviews at three different public residential facilities with a total of 18 staff members who work daily with youth. Findings show that staff regard safety as essential and perceive enhanced safety as linked to predictability, stability, team coordination, education and training, organizational support, and trusting and supportive relationships. They also indicate that staff regard the training program as having improved their feelings of safety, enhancing awareness of conflict situations before, during and after they occur, and contributing to more systematic work processes and cooperative and coordinated teamwork. These findings have implications for all facilities providing care and treatment to youth.

show abstract

Conflict prevention, de-escalation and restraint in children/youth inpatient and residential facilities: A systematic mapping review

Cited by 15 publications

References 52 publications

Traumatic stress symptoms predict restraint incidents in children and adolescents in psychiatric residential treatment

Traumatic stress symptoms predict restraint incidents in children and adolescents in psychiatric residential treatment

Strategies for the Prevention of Violence in Institutional Care: A Qualitative Interview Study With Ward Managers

Safety in Residential Youth Facilities: Staff Perceptions of Safety and Experiences of the “Basic Training Program in Safety and Security”

Contact Info

Product

Resources

About