Patterns of Critical Incidents and Their Effect on Outcome in an Adolescent Inpatient Service

Barton, Giles; Rey, Joseph M.; Simpson, Paul; Denshire, Elise

doi:10.1046/j.1440-1614.2001.00872.x

Cited by 27 publications

(35 citation statements)

References 10 publications

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“…In our study, most violent incidents were caused by boys, but girls also instigated a significant percentage of these events. This finding is in concordance with that of other investigators (Barton et al 2001;Dean et al 2008), mostly in adults (Drori et al 2017;Iozzino et al 2015). However, Ryan et al (2004) observed that similar to boys, girls were as likely to assault a staff member at least once, although boys tended to display higher levels of external aggression and engage in repeated assaults.…”

Section: Discussionsupporting

confidence: 90%

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Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16‐year retrospective study

Παναγιώτου

Mafreda²,

Moustikiadis

et al. 2019

Int J Mental Health Nurs

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Violent incidents in acute inpatient units for children and adolescents are a major and persistent problem. The demographic, clinical, and modifiable (environmental–organizational) risk factors that affect inpatient violence in an Acute Child and Adolescent Psychiatric Unit were investigated via a retrospective study. Data were collected from nursing and medical reports and the unit's census and included 100 days per year for 16 years. Incidents of violence and assault types were recorded, and variables such as the diagnostic category of assailants, total number of patients, and staffing factors during the incident were examined. Of the 2390 violent incidents recorded, 50% were attributed to cases of physical violence towards another patient, 17% to physical violence towards nursing staff, 19% to physical violence towards self and 14% to destruction of property. According to the final multivariable model, for each additional patient in the unit, the risk of a violent event increased by 9.51%; for each additional offender patient, the risk increased by 14.06%; the number of assistant nurses was associated with a 25.03% increased risk; and, after 2006, the risk increased by 68.99%. The most significant factor associated with a 59.98% decreased risk was the total number of nursing staff. All variables significantly and independently contributed to the model. Acute inpatient psychiatric units with a small number of hospitalized patients, adequate, well‐trained and specialized nursing staff, and the hospitalization of different types of patients in separate wards or units are expected to facilitate a reduction in the frequency of violent incidents.

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Section: Discussionsupporting

confidence: 90%

“…This finding is in concordance with that of other investigators (Barton et al . ; Dean et al . ), mostly in adults (Drori et al .…”

Section: Discussionmentioning

confidence: 99%

Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16‐year retrospective study

Παναγιώτου

Mafreda²,

Moustikiadis

et al. 2019

Int J Mental Health Nurs

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“…The high prevalence of therapist's absence in all patients with incidents can be explained by findings of previous studies that identified unstructured times of day as a risk factor for incidents (7,8): due to work schedules therapist's absence often occurs in the afternoon or evening. Our results suggest that therapist's absence may be a common risk factor for incidents, but not a factor that differentiates patients with repeat from patients with single incidents.…”

Section: Discussionmentioning

confidence: 98%

“…In the Anglo-American literature, prevalence ranges between 17% and 61% for non-suicidal self-injury (3)(4)(5) and 20%-90% for overt aggressive behavior (5), making prediction of such incidents a core concern of clinical research. The literature on aggressive or self-harming incidents in clinical settings indicates that a few patients are often responsible for a disproportionate number of incidents (6,7) and that previous episodes of aggressive or selfharming incidents are risk factors for subsequent incidents (8)(9)(10). Findings of an early-life exposure to stress (e.g., a history of abuse or parental neglect) (3,11) and an exposure to psychosocial risk factors (1, 3) support the model of an altered stress reactivity (12) in patients with aggressive or self-harming incidents.…”

Section: Introductionmentioning

confidence: 99%

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Relational stressors as predictors for repeat aggressive and self-harming incidents in child and adolescent psychiatric inpatient settings

Ulke

Klein

Klitzing

2014

International Journal of Adolescent Medicine and Health

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This study examined whether relational stressors such as psychosocial stressors, the therapist's absence and a change of therapist are associated with repeat aggressive or self-harming incidents in child and adolescent psychiatric inpatient care. The study data were derived from critical incident reports and chart reviews of 107 inpatients. In multinomial regression analysis, patients with repeat aggressive or self-harming incidents were compared with patients with single incidents. Results suggested that a higher number of psychosocial stressors and a change of therapist, but not the therapist's absence are predictors for repeat aggressive and self-harming incidents. There was a high prevalence of therapist's absence during both, single and repeat, incidents. Repeat aggressive incidents were common in male children and adolescents with disruptive behavior disorders. Repeat self-harming incidents were common in adolescent females with trauma-related disorders. Patients with repeat aggressive or self-harming incidents had a higher number of abnormal intrafamilial relationships and acute life events than patients with single incidents. Interventions to reduce a change of therapist should in particular target children and adolescents with a higher number of psychosocial stressors and/or a known history of traumatic relational experiences. After a first incident, patients should have a psychosocial assessment to evaluate whether additional relational support is needed.

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Deviancy Training in a Sample of High‐Risk Adolescent Girls in The Netherlands

Haan

Overbeek

Nijhof

et al. 2011

Understanding Girls' Problem Behavior

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Patterns of Critical Incidents and Their Effect on Outcome in an Adolescent Inpatient Service

Cited by 27 publications

References 10 publications

Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16‐year retrospective study

Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16‐year retrospective study

Relational stressors as predictors for repeat aggressive and self-harming incidents in child and adolescent psychiatric inpatient settings

Deviancy Training in a Sample of High‐Risk Adolescent Girls in The Netherlands

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