Reduction of Restraint and Seclusion Through Collaborative Problem Solving: A Five-Year Prospective Inpatient Study

Abstract

CPS is a promising approach to reduce seclusion and restraint use in a child psychiatric inpatient setting. Future research and replication efforts are warranted to test its effectiveness in other restrictive settings.

Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review

“…After applying the inclusion criteria, 13 publications were excluded: 6 did not meet the time-frame [2,10,20,23,31,35]; 2 papers did not report original research [8,13] and 5 did not present prevalence data for seclusion or restraint use [8,19,28,26,33] Four of the 7 included studies had a pre-intervention/post-intervention design (n=1,302) [6,17,18,21], two were descriptive studies (n=590) [9,15], and the last one was a cross-sectional survey (n=504) [32] (Table 1). …”

“…The most consistent findings were aggression and/or violent behaviour, both past and current, suicidal behaviour, more severe psychopathology [6,15,21,32] and non-White ethnicity in some US studies [9,21]. In the study by Donovan et al, both emergency admissions and younger age were associated with higher SRU rates, this finding contrasts with those by Martin et al who found higher restraint use in older patients [9,21]. One study found out-ofhome placement to be a risk-factor [32], while another study identified poorer family functioning [15].…”

“…Studies were conducted in the US (n=4) [9,17,18,21], Australia (n=2) [6,15], and only one study was conducted in Europe [32]. One study (n=442) reported on two consecutive time points, and 4 studies (n=1,302) reported on SRU rates before and after a specific intervention.…”

“…One study (n=442) reported on two consecutive time points, and 4 studies (n=1,302) reported on SRU rates before and after a specific intervention. The studied interventions included a new model of care [18], a behavioural therapy oriented management programme [6], the introduction of a padded room as an alternative [17], and a collaborative problem solving approach for aggression [21]. Overall, the results across these studies were diverse, yet, SRU rates were substantial and generally decreased in response to a specific intervention.…”

The Use of Restrictive Measures in an Acute Inpatient Child and Adolescent Mental Health Service

“…There are complex legal and ethical issues associated with their use (Moylan, 2009), as well as the potential for physical and psychological harm to patients (Martin, Krieg, Esposito, Stubbe, & Cardona, 2008). Consequently, there has been a global effort to reduce the use of restrictive measures in all mental health settings.…”