Restraint and Seclusion

Huckshorn, Kevin Ann; LeBel, Janice

doi:10.1002/9781118753378.ch124

Cited by 5 publications

(10 citation statements)

References 30 publications

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“…Their work eliminated the argument that it is not possible to reduce and prevent SR in a high-security forensic service. Their work expanded some US and UK SR reduction efforts to include forensic services 3 4…”

Section: Could These Results Change Your Practices and Why?mentioning

confidence: 99%

First randomised controlled-trial research on seclusion and restraint reduction achieves intent

LeBel

2014

Evid Based Mental Health

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WHAT IS ALREADY KNOWN ON THIS TOPIC? Seclusion and restraint (SR) are centuries-old, frequently used psychiatric practices which lack an evidence base establishing their therapeutic efficacy. 1 They are emergency containment procedures in which staff use physical force, the environment and/or devices to control patient behaviour. Their use creates substantial risk of physical and emotional harm, increases violence, claims significant time and resources and prolongs treatment and recovery from mental illness. For these reasons, reducing and preventing SR use is a growing focus in psychiatric services. 2 WHAT DOES THIS PAPER ADD? ▸ This paper is evidence that it is possible to use randomised controlled trial methodology to study SR reduction with a volatile, highrisk population in a high-security setting. ▸ It also demonstrates that an evidence-based practice developed in the USA for non-forensic settings can be successfully implemented in other countries with different languages/cultures and populations without increasing violence. ▸ This research indicates that SR reduction also reduces SR duration and staff sick leave too.LIMITATIONS ▸ There are limitations to this work. The first limitation is generalisability. The research was conducted with a small sample size and a discrete population-violent men with schizophrenia or delusional disorders being treated in a long-term forensic facility in Finland. ▸ The other limitations are replicability and feasibility. The authors provided 12 months of advance organisational preparation and 6 months of staff training. In short-term or managed-care settings, this approach may not be possible to implement. WHAT NEXT IN RESEARCH?Given significant international SR practice variance, future research should replicate the core strategy training in a randomised controlled trial approach outside of Finland. Future study should also include implementation in other settings with different populations and alternatives to SR such as sensory-based interventions. [2][3][4] In addition, research to measure the impact of each of the six core strategies (leadership, workforce development, patient inclusion, prevention tools, using data to inform practice and debriefing), independently, is needed to assess the strength of each specific strategy contributing to SR reduction/prevention. COULD THESE RESULTS CHANGE YOUR PRACTICES AND WHY?The results achieved by Putkonen and colleagues could change practice. Their work eliminated the argument that it is not possible to reduce and prevent SR in a high-security forensic service. Their work expanded some US and UK SR reduction efforts to include forensic services. 3 4Competing interests None.

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Section: Could These Results Change Your Practices and Why?mentioning

confidence: 99%

First randomised controlled-trial research on seclusion and restraint reduction achieves intent

LeBel

2014

Evid Based Mental Health

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“…Various strategies and interventions (e.g. the Six Core Strategies [6CS], Safewards) can prevent violence and restrictive practices (Bowers et al , 2015; Huckshorn, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…The recent paradigm shift in how coercive practices are viewed is largely due to the controversy, both from ethical and legal standpoints, of this issue (Bowers et al , 2015; Huckshorn, 2005). At present, most health-care institutions try to avoid the use of restrictive practices; for this reason, patients should be afforded opportunities to share their perceptions of restrictive practices, e.g.…”

Section: Introductionmentioning

confidence: 99%

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Use of debriefing following restrictive practices in forensic psychiatric care

Asikainen

Vehviläinen‐Julkunen

Repo-Tiihonen

et al. 2023

JFP

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Purpose Inpatient violence is a substantial problem in psychiatric wards and de-escalation is difficult. When managing instances of violence through verbal techniques fail, mental health-care staff may use restrictive practices. The Six Core Strategies and debriefing exist for managing violence and restrictive practices in different mental health settings. Debriefing is used to get patients’ views on restrictive practices, ensure proper patient care and strengthen the role of patients as experts. This study aims to provide new information on debriefing implementation and how debriefing was used among different patient groups in a forensic hospital. Design/methodology/approach Quantitative seclusion time and debriefing reports (n = 524) were examined with Poisson regression analysis. Fisher’s exact test was used to determine the associations between debriefing and seclusion/restraint. Findings Debriefing (n = 524) was provided in 93% of violent episodes, which is an excellent result on an international level. There was significant variation in how often debriefing was used (p < 0.001) among different patient groups, i.e. dangerous, difficult-to-treat patients and criminal offenders whose sentences have been waived. Previous debriefing research has rarely specified what types of psychiatric patients have been subjected to seclusion or restraint. Practical implications The implementation of debriefing requires multiprofessional work within the organization and wards. Originality/value Debriefing seems to stimulate reflection at every level of a health-care organization, which fosters learning and can ultimately change clinical practices. The use of debriefing can strengthen the role of patients as well as professionals.

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“…Common core programming elements that cut across a variety of programmatic attempts to lower the rates of SR have been identified. 16,17 These elements include leadership that sets the agenda for change, data use, therapeutic environment, tools for reacting to patients that display dangerous behaviors, consumer involvement, and debriefing. For example, the state of Massachusetts included these essential elements before implementing a state-wide initiative that required the clinical staff to be provided a clear set of expectations, alternatives to SR, and technical support for programming and strength-based interventions.…”

Section: Introductionmentioning

confidence: 99%

Implementation of Modified Positive Behavioral Interventions and Supports in a youth psychiatric partial hospital program

Reynolds¹,

Grados²,

Praglowski

et al. 2018

Journal of Patient Safety and Risk Management

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Objective: Seclusion and restraint are procedures utilized in youth psychiatric settings. While a number of agencies have called for a reduction and ultimate elimination of the use of these practices, there has been limited research on behavioral programs to reduce seclusion/restraint. This is particularly true for research on behavioral programming in youth psychiatric partial hospital settings. As such, the current study sought to examine the effectiveness of a modified version of Positive Behavioral Interventions and Supports (M-PBIS) implemented on a youth psychiatric partial hospital service to reduce seclusion/restraint. Method: This naturalistic, prospective study covered a 26-month period and utilized a pre-post design. M-PBIS features include a defined set of positive behavioral expectations, a system to teach behavioral expectations, reinforcement of appropriate behaviors, data collection/evidence-based decision making, individual support for those not responding to the unit-wide system, active support by all stakeholders (including all staff members agreeing to the program), and positive recognition among staff. Results: With a sample of 442 admissions, there were meaningful reductions in the percent of patients who were in seclusion/restraint (from 47.6 to 6.7%) as well as the overall seclusion/restraint rate (from 3.56 (SD ¼ 1.94) to 0.48 (SD ¼ 0.64)). Furthermore, there was a significant reduction in the use of Pro Re Nata (PRN) medication for agitation/ aggression (percent of patient who received a PRN decreased from 33.3 to 12.9%). Conclusions: This naturalistic study suggests that M-PBIS is a promising intervention for use in youth psychiatric partial hospital services to reduce seclusion/restraint and PRN medication for agitation/aggression. Reduction and ultimate elimination of seclusion/restraint is a critical objective in improving the quality and safety of acute mental health services for youth.

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Restraint and Seclusion

Cited by 5 publications

References 30 publications

First randomised controlled-trial research on seclusion and restraint reduction achieves intent

First randomised controlled-trial research on seclusion and restraint reduction achieves intent

Use of debriefing following restrictive practices in forensic psychiatric care

Implementation of Modified Positive Behavioral Interventions and Supports in a youth psychiatric partial hospital program

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