Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital

Azeem, MuhammadWaqar; Aujla, Akashdeep; Rammerth, Michelle; Binsfeld, Gary; Jones, Robert B.

doi:10.1111/jcap.12190

Cited by 49 publications

(82 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…() found that this awareness needed to start at the orientation of new staff and in ongoing staff development with a focus upon therapeutic safety and boundaries, establishing, maintaining and terminating therapeutic relationships, de‐escalation, strength focus care planning, and patient participation and empowerment (Ashcraft & Anthony , Azeem et al . ).…”

Section: Implications For Practicementioning

confidence: 97%

The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

Duxbury

2015

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

Aggression is reported to be prevalent in psychiatric inpatient care and its frequency towards healthcare professionals is well documented. While aggression may not be entirely avoidable, its incidence can be reduced through prevention and the minimization of restrictive practices such as physical restraint. The study aims to explore three common 'defences' to account for the use of physical restraint; to challenge each defence with regard to the evidence base; and to identify how services are responding to the challenge of reducing the use of restrictive interventions. Following a number of investigations to highlight serious problems with the use of physical restraint, it seems timely to examine its efficacy in light of the evidence base. In order to do this, three key defences for its use will be challenged using the literature. A combination of interventions to minimize the use of restraint including advance planning tools, and recognition of potential trauma is necessary at an organizational and individual level. Patients can be severely traumatized by the use of restrictive practices and there is a drive to examine, and reduce the use and impact of using these models that incorporate trauma informed care (TIC) and person centredness.

show abstract

Section: Implications For Practicementioning

confidence: 97%

The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

Duxbury

2015

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

show abstract

“…They recommend that hospitals follow six core principles to reduce restraints: organizational change, use of data to inform practice; workforce development, use of prevention tools, increasing consumer roles and debriefing. Literature studies support the implementation of multimodal interventions to reduce seclusion and restraint practices (Allen, Fetzer, Siefken, Nadler-Moodie, & Goodman, 2018;Ashcraft & Anthony, 2008;Azeem, Aujla, Rammerth, Binsfeld, & Jones, 2011;Powell, Valleru, Krishna, & Finney, 2017).…”

Section: The National Association Of State Mental Health Programmentioning

confidence: 99%

Reducing seclusion and restraints on the inpatient child and adolescent behavioral health unit: A quality improvement study

Eblin

2019

Child Adoles Psych Nursing

View full text Add to dashboard Cite

Background The utilization of seclusion and restraint during psychiatric inpatient treatment increases the risk of trauma, humiliation, physical injuries, psychological distress, and even death. Compared to adult patients, pediatric patients are more likely to be placed in seclusion and restraints. In a short‐term child and adolescent behavioral health unit, the average seclusion and restraint rate was 0.031. The hospital's goal was to achieve a zero seclusion and restraint rate. Purpose The purpose of this project was to decrease the rate of seclusion and restraints at the study site. Method A quality improvement study was implemented based on a bundled intervention strategy. The intervention included a decision‐making algorithm for initiation of seclusion and restraints, behavioral modification plans for patients at risk of seclusion and restraints, and a patient‐debriefing tool to be used post a seclusion and restraint event. Post implementation, data were collected over a 3‐month period. Results The implementation of a seclusion and restraint decision‐making algorithm, behavioral modification, and patient debriefing successfully decreased the seclusion and restraint rate by 55% on an inpatient pediatric behavioral health unit. Conclusion Although, the project resulted in a successful reduction in the rates for seclusion and restraint, continued quality improvement efforts are indicated to achieve zero restraint/seclusions on the unit.

show abstract

“…Emerging research suggests that this and similar multilevel strategies may be effective in reducing restrictive practices, including the use of locked doors (Azeem et al . ; Bowers et al . ; Fletcher et al .…”

Section: Discussionmentioning

confidence: 99%

Working towards least restrictive environments in acute mental health wards in the context of locked door policy and practice

Fletcher

Hamilton

Kinner

et al. 2018

Int J Mental Health Nurs

View full text Add to dashboard Cite

There has been a shift towards provision of mental health care in community‐based settings in Australia. However, hospitals continue to care for people in acute mental health wards. An increasing proportion of the people in wards are admitted involuntarily, subject to restrictions of movement to minimize risk of harm to self and others. In response to concerns about the safety of people absconding from care, Queensland Health introduced a policy requiring all acute mental health wards in the State to be locked. In response, the Queensland Mental Health Commission funded a project to understand the impact of this policy and develop evidence‐based recommendations regarding provision of least restrictive, recovery‐oriented practices in acute wards. Facilitated forums were conducted with 35 purposively selected participants who identified as consumers, carers, or staff of acute mental health hospital wards, to test the acceptability, feasibility, and face validity of a set of evidence‐informed recommendations for providing least restrictive, recovery‐oriented practices. Participant responses were recorded, and data were analysed through an inductive, thematic approach. A recovery‐oriented approach was supported by all stakeholders. Reducing boredom and increasing availability of peer support workers were considered key to achieving this. Focusing less on risk aversion was reported as central to enabling true Recovery Orientation. This project enabled recognition of the perspectives of consumers, carers, and staff in the consideration of evidence‐informed recommendations that could be implemented to provide least restrictive care in the context of locked doors.

show abstract

Effectiveness of six core strategies based on trauma informed care in reducing seclusions and restraints at a child and adolescent psychiatric hospital

Abstract: This study shows downward trend in seclusions/restraints among hospitalized youth after implementation of National Association of State Mental Health ProgramDirectors six core strategies based on trauma informed care.

Cited by 49 publications

References 11 publications

The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

Reducing seclusion and restraints on the inpatient child and adolescent behavioral health unit: A quality improvement study

Working towards least restrictive environments in acute mental health wards in the context of locked door policy and practice

Contact Info

Product

Resources

About