Prediction of Aggression and Restraint in Child Inpatient Units

Crocker, Jandi H.; Stargatt, Robyn; Denton, Christine

doi:10.3109/00048670903489825

Cited by 25 publications

(42 citation statements)

References 25 publications

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“…Biological factors, such as genetic, neuro-endocrinological, and neural vulnerabilities have been shown to play an important role within these transactional models (Popma & Raine, 2006;Raine, 2002Raine, , 2014. Other dispositional characteristics, such as a diagnosis of disruptive behavioral disorder and the appearance of psychotic symptoms in children and adolescents (Crocker, Stargatt, & Denton, 2010;McDougall, 2000;Phillips, Stargatt, & Fisher, 2011), are found to be important predictors in the occurrence of institutional aggression. Within these models, personal characteristics are thought to be in continuous interaction with social and environmental characteristics, showing that dispositional characteristics can be mediated by the quality of the environment (Heynen, van der Helm, Cima, Stams, & Korebrits, 2016b).…”

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confidence: 99%

The Relation Between Aggression and the Living Group Climate in a Forensic Treatment Unit for Adolescents: A Pilot Study

Decker

Lemmens

Helm

et al. 2017

Int J Offender Ther Comp Criminol

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In the current study, the associations between inpatient aggression and the living group climate as perceived by the adolescents admitted to a forensic psychiatric treatment unit, are investigated based on carefully registered longitudinal data. Multilevel regression analyses revealed a significant inverse relation between the number and severity of aggressive incidents and the amount of support, as well as with the possibilities of growth perceived by the adolescents. No significant associations of aggression and the perception of repression or atmosphere are found. Our study reveals preliminary evidence for the relation between the prevalence of aggressive incidents and how the adolescents perceive social contextual factors in daily forensic treatment practices. Moreover, preliminary evidence that evidence-based treatment programs and psychiatric care have an important influence on experienced possibilities for growth and support and as such prevent institutional aggression, is found.

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confidence: 99%

The Relation Between Aggression and the Living Group Climate in a Forensic Treatment Unit for Adolescents: A Pilot Study

Decker

Lemmens

Helm

et al. 2017

Int J Offender Ther Comp Criminol

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“…The mean number of violent offenses, prior to admittance was 9.2 (SD = 3.8), and a mean of 12.8 different nonviolent offenses (SD = 5.4) were rated for the research population. 1 …”

Section: Participantsmentioning

confidence: 99%

“…Aggressive behavior is a matter of great concern in psychiatric services and should be a key priority in mental health settings [1][2][3]. Both the frequency of aggression and the strong negative impact on staff and patients are important considerations.…”

Section: Introductionmentioning

confidence: 99%

“…The international tendency to focus on outpatient and community treatment programs might lead to an increased proportion of violent patients in inpatient care [2,6]. In children and adolescents, aggression is one of the most frequently reported reasons for psychiatric hospitalization [1]. The consequences of exposure to aggressive incidents on the ward, either as a victim or as witness, are not yet fully known and research is scarce.…”

Section: Introductionmentioning

confidence: 99%

“…Nijman and colleagues [12] presented an extended and detailed review of aggression in adult psychiatry. A systematic review of the literature in general and forensic child and adolescent psychiatry by Tremmery and colleagues [13] found that in a regular child-and adolescent psychiatric ward the number of aggressive incidents ranged from 0.4 to 3.5 incidents per day, with 33-78 % of the admitted patients committing at least one aggressive act [1,[14][15][16][17][18]. A similar picture was found in a secured setting with 0.5-2.4 incidents per day and 27-54 % children or adolescents committing at least one aggressive act [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice

Tremmery

Danckaerts

Bruckers

et al. 2014

Eur Child Adolesc Psychiatry

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Although aggression is part of daily life in psychiatric units for adolescents, empirical data on its prevalence are sparse. Only few studies have described prevalence of aggressive incidents in adolescent psychiatric wards, and data in forensic psychiatric care are even more limited. Available studies reported high prevalence rates of aggression, ranging from 0.4 to 2.4 incidents of aggression per day across (forensic) child and adolescent psychiatric units. Between 27 and 78 % of all admitted youth committed an aggressive act. In this study, we collected systematically registered data of all aggressive incidents from the first 2 years (2010-2012) on a newly established forensic adolescent psychiatric unit, which used a formal aggression management program embedded in the social competence model, which is based on early intervention in the 'chain of behavior' to prevent any further escalation. The inclusion of also minor aggressive incidents is unique in the literature and the clinical relevance is highlighted. A mean of one incident a day took place, with each adolescent involved in at least one incident. Notably, 1.7 aggressive incidents per month made seclusion of restraint use necessary. Based on the social competence theory, the aggression management model suggests intervening early in the cascade of aggression, in order to prevent further escalation and reduce the need for intrusive interventions. Evidence supported that aggression is a contextual event, as external factors clearly influence the incidence of aggression. Aggression management should be built on both relational and structural security.

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Prevalence and Precursors of the use of Restraint and Seclusion in a Private Psychiatric Hospital: Comparison of Child and Adolescent Patients

Pogge

Pappalardo

Buccolo

et al. 2011

Adm Policy Ment Health

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The use of restraint and seclusion is highly regulated in psychiatric inpatient settings. However, the majority of studies of restraint and seclusion are based on public hospitals serving adult patients, with some limited data available on adolescents and children. This paper presents prospectively collected data on restraint and seclusion over a 2-year period at a private psychiatric hospital whose patients include large numbers of both adolescents and pre-adolescent children. 2 years of restraint and seclusion data were analyzed on a total of 2,411 unique patients. Types of seclusion included in-room seclusion on the treatment unit and off-unit seclusion in a separate seclusion annex. Restraints consisted solely of short term (<15 min) and longer term (>14 min) manual restraints. The use of IM medication was also recorded. The precipitants of these events were examined. These included physical and verbal threats, stabbing or throwing objects, attempts to elope, attempts to hurt one's self or another, or property destruction. Out of 2,411 child and adolescent in-patients admitted during the period under review, only 703 (29%) experienced restraint or seclusion. Among these, the modal number of events per patient was one (n = 156), but the maximum number of occurrences was 163. Child patients had a much higher frequency of events (n = 396, 53%) than adolescents (n = 307, 19%). There were notable differences in the types of seclusion events, with children typically experiencing in-room seclusion on the unit. When age was examined as a continuous variable, younger patients had a higher prevalence of restraint and seclusion, significantly more restraint and seclusion, and these restraint and seclusion events were significantly shorter than those seen in older patients. Multiple other potential determinants of these events were examined, including diagnosis, symptom severity at admission, age, and gender, but none of these predicted these events. Restraint and seclusion events were more common for children and less so for adolescents, with robust age effects for the likelihood of any seclusions, the number of seclusions and restraints, and the duration of seclusions and restraints. Patients who experienced restraint or seclusion typically required it only once during their hospitalization. Only age was found to be a predictor of the restraint and seclusion variables. Given these findings, it appears that management of agitated behavior in children and adolescents may be a qualitatively different phenomenon. Future research should be directed at understanding the determinants of high frequency agitated behavior and developing alternatives to seclusion or restraint.

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Prediction of Aggression and Restraint in Child Inpatient Units

Abstract: There are readily identifiable patient factors that predict aggression and the need for restraint in child inpatient units.

Cited by 25 publications

References 25 publications

The Relation Between Aggression and the Living Group Climate in a Forensic Treatment Unit for Adolescents: A Pilot Study

The Relation Between Aggression and the Living Group Climate in a Forensic Treatment Unit for Adolescents: A Pilot Study

Registration of aggressive incidents in an adolescent forensic psychiatric unit and implications for further practice

Prevalence and Precursors of the use of Restraint and Seclusion in a Private Psychiatric Hospital: Comparison of Child and Adolescent Patients

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