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 Program Directors six core strategies based on trauma informed care.

What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review

“…For example, 9 of 13 reviewed studies [20, 34, 40, 42–47, 49] had as a key aim the reduction or elimination of seclusion and/or restraint, while several studies measured patient and staff injury rates [34, 47, 49]. All nine studies demonstrated targeted reductions in these outcomes, underscoring their potential effectiveness, especially given a set of conditions which would promote successful implementation.…”

An Association Between Implementing Trauma-Informed Care and Staff Satisfaction

“…While seclusion and restraints are the prototypical examples of re-traumatization in service systems, because TIC is not explicitly referred to in LeBel's work it is unclear whether or not the reduction and subsequent effects are attributable to part of a broader TIC initiative. To address this gap in research, Azeem, Aujla, Rammerth, Binsfeld and Jones (2011) assessed the influence of a TIC model developed by the National Association of State Mental Health Program Directors (NASMHPD). Through the implementation of various components of TIC including physical and social (i.e., cultural) changes to the environment, staff training on trauma (i.e., prevalence and effects) and trauma-informed care, prioritizing collaboration between staff and residents, and debriefing with staff and clients after a crisis, the TIC approach led to a downward trend in seclusions and restraints (Azeem et al, 2011).…”

Integrating a Trauma-Informed Care Perspective in Baccalaureate Social Work Education: Guiding Principles

“…Generally, in trauma-informed care settings, staff a) assess for and understand the impact of trauma on their clients, b) provide clients the knowledge and skills needed for recovery, and c) actively address treatment barriers and service delivery practices that may lead to potential re-traumatization (Elliott, Bjelajac, Fallot, Markoff, & Reed, 2005;Gatz et al, 2007). Depending on the specific needs of the client population, staff may be trained in how to establish and maintain safety and therapeutic relationships, de-escalation techniques, and strengths and empowerment models of client-care and case management (Azeem et al, 2011;Borckardt et al, 2011;Elliott et al, 2005).…”

“…et al, 2008), in-patient psychiatric settings (Azeem, Aujla, Rammerth, Binsfeld, & Jones, 2011;Huckshorn, 2004;Regan, 2010), with inmates (Levenson, Willis, & Prescott, 2014), and the homeless (Hopper, Bassuk, & Olivet, 2009;McKenzie-Mohr, Coates, & McLeod, 2012). Generally, in trauma-informed care settings, staff a) assess for and understand the impact of trauma on their clients, b) provide clients the knowledge and skills needed for recovery, and c) actively address treatment barriers and service delivery practices that may lead to potential re-traumatization (Elliott, Bjelajac, Fallot, Markoff, & Reed, 2005;Gatz et al, 2007).…”