Minimizing Seclusion and Restraint in Youth Residential and Day Treatment Through Site-Wide Implementation of Collaborative Problem Solving

Pollastri, Alisha R.; Lieberman, Robert E.; Boldt, Susan L.; Ablon, J. Stuart

doi:10.1080/0886571x.2016.1188340

Cited by 19 publications

(9 citation statements)

References 19 publications

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“…Multi-strand interventions or those involving gradual change could confound attempts to clarify cause and effect (Martin et al, 2008;Pollastri et al, 2016;Reynolds et al, 2016); for example McGlinn (2006) observed: …psychiatrists at the study facility changed the manner in which they medicated clients between the two study periods. The number of staff involved in an incident was not reported at all, nor was psychological harm.…”

Section: Outcomes Evaluationmentioning

confidence: 99%

Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study

et al. 2022

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Restrictive practices are often used harmfully with children in institutional settings. Interventions to reduce their use do not appear to have been mapped systematically. Using environmental scanning, we conducted a broad-scope mapping review of English language academic databases, websites and social media, using systematic methods. Included records (N = 121) were mostly from the United States and contained details of 82 different interventions. Children's participation was limited. Reporting quality was inconsistent, which undermined claims of effectiveness. Overall, despite a multitude of interventions, evidence is limited. Leaders should consider the evidence, including children's perspectives, before introducing poorly understood interventions into children's settings.

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Section: Outcomes Evaluationmentioning

confidence: 99%

Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study

et al. 2022

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“…This group consisted of evaluations only, and comprised four dissertations, [90][91][92][93] one publication from a dissertation 107 and four journal articles. [109][110][111][112] The eight remaining interventions were comfort versus control (two events), TCI (three events), the Grafton program (two events), CPS (seven events), M-PBIS (three events), TARGET (two events) and SPA (two events). Those interventions that featured more than once are shown in Table 10.…”

Section: Reporting Of Interventionsmentioning

confidence: 99%

Components of interventions to reduce restrictive practices with children and young people in institutional settings: the Contrast systematic mapping review

Baker

Berzins

Canvin

et al. 2022

Health Soc Care Deliv Res

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Background Incidents in which children or young people experience severe distress or harm or cause distress or harm to others occur frequently in children and young people’s institutional settings. These incidents are often managed using restrictive practices, such as restraint, seclusion, sedation or constant observation; however, these also present significant risks of physical and psychological harm to children and young people as well as staff. Numerous interventions aim to reduce the use of restrictive techniques, but research is hampered by limited attention to specific intervention components. The behavior change technique taxonomy may improve reporting by providing a common language for specifying the content and mechanisms of behaviour change. This study aimed to identify, standardise and report the effectiveness of components of interventions to reduce restrictive practices in children and young people’s institutional settings. Objectives To map interventions aimed at reducing restrictive practices in children and young people’s institutional settings internationally, to conduct behaviour change technique analysis of intervention components, to identify process elements, and to explore effectiveness evidence to identify promising behaviour change techniques and compare the results with those found in adult psychiatric inpatient settings in a companion review. Design Systematic mapping review with programme content coding using the behavior change technique taxonomy. Review methods Eleven relevant English-language health and social care research databases 1989–2019 [including Applied Social Sciences Index (ASSIA), Criminal Justice Abstracts, Educational Resources Information Center (ERIC), MEDLINE and PsycInfo®], grey literature and social media were searched during 2019 (updated January 2020). Data extraction, guided by Workgroup for Intervention Development and Evaluation Research (WIDER), Cochrane Library and theory coding scheme recommendations, included intervention characteristics and study design and reporting. Screening and quality appraisal used the Mixed Methods Appraisal Tool. The behavior change technique taxonomy was applied systematically, and interventions were coded for behaviour change technique components. Outcomes data were then related back to these components. Results There were 121 records, including 76 evaluations. Eighty-two interventions, mostly multicomponent, were identified. Evaluation approaches commonly used a non-randomised design. There were no randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Four clusters (i.e. goals and planning, antecedents, shaping knowledge, and feedback and monitoring) contained the majority of identified behaviour change techniques and were detected in over half of all interventions. Two clusters (i.e. self-belief and covert learning) contained no identified behaviour change techniques. The most common setting in which behaviour change techniques were found was ‘mental health’. The most common procedure focused on staff training. The two most common behaviour change techniques were instruction on how to perform the behaviour and restructuring the social environment. Promising behaviour change techniques included instruction on how to perform the behaviour, restructuring the social environment, feedback on outcomes of behaviour and problem-solving. Compared with the companion review, service user perspectives were more sparse and there was more interest in trauma-informed approaches. Effectiveness evidence, range of interventions and reporting were broadly similar. Limitations Poor reporting may have prevented detection of some behaviour change techniques. The finding that the evidence was weak restricted the feasibility of examining behaviour change technique effectiveness. Literature searches were restricted to English-language sources. Conclusions This study generated, to our knowledge, the first review of evidence on the content and effectiveness of interventions to reduce restrictive practices in children and young people’s institutional settings. Interventions tend to be complex, reporting is inconsistent and robust evaluation data are limited, but some behaviour change techniques seem promising. Future work Promising behaviour change techniques could be further explored. Better evidence could help address the urgent need for effective strategies. Study registration This study is registered as PROSPERO CRD42019124730. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.

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“…During an inpatient stay, self-harm behavior persists for 12% of youth admitted for suicidality (Zhand et al, 2016). In addition, at least a third of young psychiatric inpatients were placed there because they exhibited serious behavior problems (Fontanella et al, 2009; Gabel and Shindledecker, 1991; Hardan and Sahl, 1999; Safer, 1995), and these youths often disrupt the social atmosphere of the ward—which is a major reason why seclusion inpatient rooms there are needed (Pollastri et al, 2016).…”

Section: Safety During a Psychiatric Inpatient Admission Is Partial A...mentioning

confidence: 99%

A Critique on Psychiatric Inpatient Admissions for Suicidality in Youth

Safer¹

2021

J Nerv Ment Dis

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For the last few decades, psychiatric inpatient admissions for the treatment of suicidality in US youth have been increasing. Nonetheless, since 2007, the national rate of completed suicides by youth has steadily and sizably increased. Therefore, a literature review was performed to evaluate the usefulness of the psychiatric inpatient admission of suicidal youths. The analysis concluded that suicidality is surprisingly common in youth, completed suicide is very uncommon in early adolescence, suicidal ideation is a major reason in early adolescence for inpatient admission, girls are admitted to psychiatric inpatient units three times more than boys even though boys complete suicide four times more than girls, inpatient stays average 6 days and are quite expensive, and repeat attempts after inpatient treatment are common. Thus, filling more beds for youth with suicidality lacks evidence of a public health, long-term benefit. Expanding the focus in psychiatry to population efforts including means reductions is recommended.

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Minimizing Seclusion and Restraint in Youth Residential and Day Treatment Through Site-Wide Implementation of Collaborative Problem Solving

Cited by 19 publications

References 19 publications

Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study

Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study

Components of interventions to reduce restrictive practices with children and young people in institutional settings: the Contrast systematic mapping review

A Critique on Psychiatric Inpatient Admissions for Suicidality in Youth

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