Reducing seclusion and restraint in a child and adolescent inpatient area: implementation of a collaborative problem-solving approach

Abstract

Objective: The aim of this study was to determine whether implementation of a collaborative problem-solving approach would be associated with a decrease in seclusion and restraint in a child and adolescent inpatient unit. Method: A collaborative problem-solving (CPS) approach was implemented. Seclusion and restraint, length of treatment, clinician- and patient/parent-rated outcomes and staff utility and acceptability were surveyed pre and post implementation. Results: The number of restrictive events significantly decreased, including full restraint, partial restraint and seclusion. Length of treatment and routine clinician-rated outcome measures remained consistent. Patient or parent-rated outcomes showed greater reduction post implementation. Despite some initial scepticism, the staff found this approach useful. Conclusions: A CPS approach was successfully implemented, and in this naturalistic study was associated with a significant decrease in seclusions and restraints.

Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care

“…Most studies were set in psychiatric hospitals (n = 20) [ 176 , 177 , 181 – 183 , 185 – 189 , 198 , 200 – 202 , 206 , 217 , 243 , 244 , 247 , 255 ] or elderly care homes (n = 12) [ 174 , 191 – 193 , 195 , 196 , 199 , 203 – 205 , 207 , 209 ]. Other settings included acute and other hospitals (n = 4) [ 118 , 178 – 180 ], intensive care units (ICU) or emergency units (n = 11) [ 175 , 196 , 197 , 212 , 246 , 248 – 250 , 251 , 253 , 254 ], children’s care homes (n = 2) [ 184 , 190 ] and a residential camp (n = 1) [ 210 ]. All the studies were conducted in MICs or HICs, particularly the USA (n = 24) [ 178 , 181 , 182 , 184 – 186 , 188 , 190 , 194 , 198 , 201 ,…”

“…In 18 studies the intervention was based on an underlying theory (7 RCTs/CCTs and 11 before and after studies) [ 175 , 159 , 161 , 162 , 164 – 167 , 169 , 172 – 176 , 180 , 181 , 224 , 225 ]. The interventions were predominantly either multicomponent (n = 33) [ 175 , 176 , 177 , 182 – 190 , 195 – 198 , 200 , 202 , 206 , 208 , 209 , 211 , 243 , 244 , 246 – 250 , 251 , 253 – 255 ] or educational/training (n = 12) [ 175 , 178 , 199 , 191 – 194 , 199 , 207 , 208 , 210 , 212 ] They were all compared with usual care (including baseline standard practice for before and after studies).…”

Change over time: the use of seclusion in secure residential youth care in The Netherlands

“…This can provide valuable starting points for locations to reduce the use of seclusion by, for instance, training and informing staff members, and using debriefing techniques. Studies have shown that training staff members and using debriefing techniques can contribute to a reduction in seclusion use (Black et al, 2020;Caldwell et al, 2014;Eblin, 2019;National Association of State Mental Health Program Directors [NASMHPD], 2008).…”

“…Worldwide, the realization that seclusion can be harmful for both patients and staff has led to the development and implementation of seclusion reduction interventions, such as collaborative problem solving, trauma-informed approaches, and the six core strategies (Black et al, 2020;Boel-Studt, 2017;National Association of State Mental Health Program Directors [NASMHPD], 2008). In those interventions, the emphasis has mainly lied on reducing the frequency of seclusion, although it also has been shown that such interventions can improve various therapeutic outcomes (e.g., self-harm, thinking problems, school functioning) and can decrease length of treatment (Boel-Studt, 2017;Pollastri et al, 2016).…”