A restraint on restraints: The need to reconsider the use of restrictive interventions

Mohr, Wanda K.; Mahon, Margaret M.; Noone, Megan J.

doi:10.1016/s0883-9417(98)80059-9

Cited by 83 publications

(61 citation statements)

References 25 publications

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“…Many patients perceive SRU as coercive and aversive, which eliminates any potential therapeutic effect [4,24]. In addition, SRU can have severe 4 consequences.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Hert

Dirix

Demunter

et al. 2011

Eur Child Adolesc Psychiatry

101

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Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patients in psychiatric settings. However, little is known about their utilization and effectiveness in paediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilisation in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10 years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21 years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1.000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (-0.6%), but results were heterogeneous (-97.2% to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures.Otherwise, seclusion episodes reduced by 74.7%, including a 32.4%. shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behaviour, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines.

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“…Many patients perceive SRU as coercive and aversive, which eliminates any potential therapeutic effect [4,24]. In addition, SRU can have severe 4 consequences.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Hert

Dirix

Demunter

et al. 2011

Eur Child Adolesc Psychiatry

101

View full text Add to dashboard Cite

show abstract

“…Current research on the use of restraints calls into question their effectiveness for reducing aggression and violence and raises concerns about the extent to which they promote the physical and psychological safety of residents and staff members, especially when used on adolescents (Mohr, Mahon, & Noone, 1998;Mohr, Petti, & Mohr, 2003;United States General Accounting Office, 1999). Constitutional, ethical, and legal scholars have debated the fundamental values of systems that use physical and mechanical restraints to control aggression in free societies (Kennedy & Mohr, 2001).…”

Section: Introductionmentioning

confidence: 99%

Review of Restraint Data in a Residential Treatment Center for Adolescent Females

Leidy

Haugaard

Nunno

et al. 2006

Child Youth Care Forum

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This paper presents a review of the physical restraints that occurred at a northeastern United States residential treatment facility in the northeastern United States for adolescent females from January 1999 to May 2002. During this period, the facility housed 415 adolescents and reported 1,059 physical restraints involving 155 of them. This report assesses the characteristics of the adolescents housed at the facility, the frequency and nature of the restraints they experienced, and the relationship between the adolescents' characteristics and the frequency with which they were restrained.

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“…Very little has been published in the scientific literature in this subject, but the emphasis in avoiding coercive methods is clear in adult guidelines [6]. Many authors have highlighted the impact of physical restraints and other coercive methods in the patient's recovery and how restrictive methods can be experienced as traumatic in a lifetime [4].…”

Section: Discussionmentioning

confidence: 99%

“…Because pediatric patients that are seen as " angry children" can come from a troubled environment, many times their aggressive behavior being part of a context of neglect and abuse. It is more difficult for these patients to establish a trusting relationship with adults, what sometimes can lead to aggression as a self-protecting behavior, inducing counter transference in health staff [4]. Frequent bouts of aggression can separate empathy from a staff's clinical treatment, and group polarization intensifies the negative aura surrounding aggressive patients.…”

Section: Discussionmentioning

confidence: 99%

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Using de-escalation techniques to prevent violent behavior in pediatric psychiatric emergencies: It is possible

Croce¹,

Mantovani²

2017

Pediatr Dimensions

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SummaryThe use of de-escalation techniques have been proposed to be effective and are recommended as first line treatments for the management of acutely agitated patients. Even though guidelines for management of agitation in children usually follow the adult guidelines, few have been published on de-escalation of pediatric patients, its practical application and results. We describe the successful management through de-escalation of agitated and potentially violent behavior in an 8 year-old African American male patient, who presented to the emergency department with aggressive behavior. With a strong rapport, patient and provider were able to negotiate together and complete tasks that were labeled improbable by nursing staff. Very little has been published in the scientific literature in this subject, but the emphasis in avoiding coercive methods is clear in adult guidelines. Our approach follows the domains of de-escalation, demonstrating that those domains, can apply to pediatric patients as well.

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A restraint on restraints: The need to reconsider the use of restrictive interventions

Cited by 83 publications

References 25 publications

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

Review of Restraint Data in a Residential Treatment Center for Adolescent Females

Using de-escalation techniques to prevent violent behavior in pediatric psychiatric emergencies: It is possible

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