Reconsidering the Use of Seclusion and Restraints in Inpatient Child and Adult Psychiatry

Singh, Nirbhay N.; Singh, Shruti; Davis, Charles M.; Latham, Larry L.; Ayers, James G.

doi:10.1023/a:1022039711096

Cited by 40 publications

(2 citation statements)

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“…Michie et al Framing/reframing (BCT 13.2) was another commonly identified BCT, detectable in 42% of interventions (see Figure 29). Many interventions sought to encourage staff using framing/reframing and often this was informed by a specified model or approach, such as strengths-based care, 40,105,116,214 trauma-informed care, 78,85,105,114,116,120,122,171,172,177,178,181,183,190,193,207 recovery-oriented care, 77,99,188,193 CPS 92,112 and positive behavioural support: 100,126 For trauma-informed care, all unit staff attended a half-day standardized training seminar on the nature of trauma and its effects on patients' experiences, physiology, and psychological processes, along with instructions on how to minimize engaging in behaviors that could exacerbate trauma related reactions from patients. Borckardt et al 181 Within or in addition to these approaches, staff were encouraged to reframe their views of the children they worked with, such as the origins of their challenging behaviour 174 or their expectations of their abilities: Similarly, interventions encouraged framing/reframing of staff views of children's behaviour and its meaning.…”

Section: Identification Of Self As Role Model (Behavior Change Techni...mentioning

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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Section: Identification Of Self As Role Model (Behavior Change Techni...mentioning

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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“…In the last 3 decades, a major focus of efforts to improve patient care quality and safety in inpatient psychiatry has been the reduction of inappropriate use of seclusion, that is, placing the patient alone in a locked room, and physical restraints, that is, manually or mechanically restricting the patient’s freedom of movement 13–16 . Seclusion and physical restraints are used to manage violent or agitated behavior and thus prevent imminent harm to self, other patients, and staff 17,18 .…”

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confidence: 99%

Influence of Organizational Climate and Clinician Morale on Seclusion and Physical Restraint Use in Inpatient Psychiatric Units

et al. 2021

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Reducing seclusion and restraint use is a prominent focus of efforts to improve patient safety in inpatient psychiatry. This study examined the poorly understood relationship between seclusion and restraint rates and organizational climate and clinician morale in inpatient psychiatric units.Methods: Facility-level data on hours of seclusion and physical restraint use in 111 U.S. Department of Veterans Affairs (VA) hospitals in 2014 to 2016 were obtained from the Centers for Medicare & Medicaid Services. Responses to an annual census survey were identified for 6646 VA inpatient psychiatry clinicians for the same period. We examined bivariate correlations and used a Poisson model to regress hours of seclusion and restraint use on morale and climate measures and calculated incident rate ratios (IRRs). Results:The average physical restraint hours per 1000 patient hours was 0.33 (SD, 1.27; median, 0.05). The average seclusion hours was 0.31 (SD, 0.84; median, 0.00). Physical restraint use was positively associated with burnout (IRR, 1.76; P = 0.04) and negatively associated with engagement (IRR, 0.22; P = 0.01), psychological safety (IRR, 0.48; P < 0.01), and relational climate (IRR, 0.69; P = 0.04). Seclusion was positively associated with relational climate (IRR, 1.69; P = 0.03) and psychological safety (IRR, 2.12; P = 0.03). Seclusion use was also nonsignificantly associated with lower burnout and higher engagement. Conclusions:We found significant associations between organizational climate, clinician morale, and use of physical restraints and seclusion in VA inpatient psychiatric units. Health care organization leadership may want to consider implementing a broader range of initiatives that focus on improving organizational climate and clinician morale as one way to improve patient safety.

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Therapeutic Restraint and Protective Holding

Reed

Luiselli

Miller

et al. 2013

Issues in Clinical Child Psychology

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Reconsidering the Use of Seclusion and Restraints in Inpatient Child and Adult Psychiatry

Cited by 40 publications

References 21 publications

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

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

Influence of Organizational Climate and Clinician Morale on Seclusion and Physical Restraint Use in Inpatient Psychiatric Units

Therapeutic Restraint and Protective Holding

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