Restraint Reduction at a Pediatric Psychiatric Hospital: A Ten‐Year Journey

Abstract

Over a 10-year period, mechanical restraints decreased by 100%, from 485 in 2005 to "zero" in 2014 and none in the last 3 years. Physical restraints decreased by 88%, from 3,033 in 2005 to 379 in 2014.

Post-incident reviews—a gift to the Ward or just another procedure? Care providers’ experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study

“…Finally, implementing PIRs in the two participating services was not based on defined care philosophies as described in several studies [16,17,48,68]. Even though some care providers presented values and approaches in line with human based care philosophies and even struggled to get hold of the patients' voices in the PIR, the services' context seemed still to be characterized on traditional clinical recovery model's values, goals and working practices [9,10,19].…”

“…The patient was not very responsive. Almost no eye contact, so it was not possible to discuss the situation that had triggered the physical intervention etc., it was difficult to achieve it [17].…”

“…The literature describes PIR procedures including their timing, participants and themes. However, the broader question of how PIRs relate to the wider context of the organisation and culture is poorly described, although non-punitive, supportive approaches are recommended [16][17][18]. Human care philosophies with supportive approaches for conducting PIRs may conflict with the traditional organisation and culture of psychiatric institutions, often historically characterised by bureaucratic, hierarchical structures with paternalistic cultures that include habitual coercive practices and allow patients' voices to have only marginal effects on services [10,19].…”

Trauma-Informed Social Work Practice with Children and Youth

“…The Children's Health Act of 2000 (P.L. 106-310), subsequent rules issued by the Centers for Medicare and Medicaid Services, and standards of the Joint Commission on the Accreditation of Healthcare Organizations, boosted efforts to restrict the use of seclusion and restraint (S/R) in children's psychiatric settings (Azeem et al 2015). Recognizing that S/R are inherently violent, coercive, and traumatizing practices, NASMHPD issued specific guidelines to reduce their use in inpatient behavioral health settings (Huckshorn 2006).…”

“…The guidelines identified six core strategies: (a) leadership that prioritizes TI organizational transformation; (b) data collection to assess implementation efforts; (c) workforce development; (d) TI risk assessments and intervention strategies integrated into organizational operations and policies; (e) inclusion of children, families, and advocates in implementing TI principles; and (g) rigorous debriefing of incidences (Huckshorn 2006). Implementation of these guidelines reduced S/R in a pediatric inpatient setting (Azeem et al 2015) and in children's residential programs (LeBel et al 2010). Statewide, interagency, and site-specific initiatives have successfully integrated alternatives to S/R into organizational cultures and operations (LeBel et al 2010).…”