The authors describe a program to reduce the use of physical restraint on three psychiatric units of a university hospital. One component of the program involved interviewing patients to determine their stress triggers and personal crisis management strategies. The second consisted of training staff members in crisis de-escalation and nonviolent intervention. During the first two quarters after implementation of the program, physical restraint rates declined significantly and remained low on all three units for the remainder of the year after implementation. Hospitals should consider instituting comprehensive staff training that encourages adaptive patient behaviors and nonviolent staff intervention to reduce the physical and mechanical restraint of children and adults in inpatient facilities.

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This review addresses the needs and experiences of young adult women, aged 16 to 21, who have a diagnosis of serious emotional disturbance (SED) or mental illness. Given the large numbers of young women with SED, evidence that they are underserved, and the continuity of many disorders from adolescence to adulthood, an integrative review in this area can enhance our ability to better address these young women's needs.

Among American children and adolescents aged 1 to 17 years, the 12-to 17-year-olds represent the largest users of outpatient mental health services. This study utilizes a nationally representative sample of this age group from the 2005 National Survey on Drug Use and Health to illuminate predictors of services use from three treatment settings: day treatment programs, mental health clinics/centers, and private/in-home settings. Univariate analyses were used to calculate the percentages of the study sample that used mental health services in these settings. In bivariate analyses, the authors estimated the strength of the associations between available predisposing, need, and enabling factors and the outcomes. Multiple logistic regressions estimated the independent effects of each covariate on the outcomes. Lifetime depression, lifetime general anxiety, delinquent behaviors, drug dependence, and Medicaid were consistent predictors of services use in the three treatment settings. Several other factors were associated with services use in bivariate analyses but lost most of their statistical significance when the authors adjusted for other confounders. Interpreted in light of its potential limitations, this study has important research and policy significance.