Seclusion use with children and adolescents: an Australian experience

Fryer, Michelle A.; Beech, Michael; Byrne, Gerard

doi:10.1111/j.1440-1614.2004.01294.x

Cited by 33 publications

(43 citation statements)

References 27 publications

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“…Fryer et al (2004) found that children and adolescents with diagnoses of mental retardation, developmental disability and neurological impairment were likely to experience higher rates of seclusion, which replicates research evidence that increased rates of seclusion are seen in patients with poor communication and problem-solving skills. Rates of seclusion use varied from 19 to 60 percent and the main indication was for the management of aggression, which is largely in line with rates reported in other studies (Troutman et al, 1998).…”

Section: Physical Restraintsupporting

confidence: 71%

Use of restraint for the management of challenging behaviour in children with intellectual disabilities

Menon

Baburaj

Bernard

2012

Advances in Mental Health and Intellectual Disabilities

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Purpose -This review seeks to provide an overview of the current research evidence on the use of restraint as an intervention in managing challenging behaviours in relation to children with intellectual disabilities. It also aims to discuss legal frameworks and ethical considerations that underpin the use of restraint in intellectually disabled children who present with challenging behaviours.Design/methodology/approach -The authors conducted a search of existing literature primarily pertaining to the management of challenging behaviours in intellectual disability on PubMed, PsycInfo and Google Scholar using combinations of the following key words -children, intellectual disabilities, learning disability, mental retardation, challenging behaviour, restraint, seclusion, physical restraint, mechanical restraint, personal restraint, and chemical restraint. Since research on the use of such interventions in children has been hitherto scant, literature relating to their use in intellectually disabled adult populations as well as cognitively able children was also examined to ascertain whether the broad principles informing the use of restraint interventions could be generalised to their use in intellectually disabled children. Findings -The review finds evidence to suggest that restraint interventions in their myriad forms are widely used to manage challenging behaviours in children with intellectual disabilities and outlines the evidence base, clinical scope, and the risks associated with the use of such interventions in children. It also helps highlight the current absence of comprehensive evidence based guidance that incorporates clinical, ethical, and legal aspects of the use of restraint interventions in children with intellectual disabilities and raises relevant questions in relation to their judicious use in this patient group.Originality/value -The authors believe that the review completes the first in depth evaluation of the use of restraint interventions in children with intellectual disabilities and are confident that this would serve as useful guidance for professionals working with this patient group who may be considering using restraint interventions in their everyday clinical practice.

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Section: Physical Restraintsupporting

confidence: 71%

Use of restraint for the management of challenging behaviour in children with intellectual disabilities

Menon

Baburaj

Bernard

2012

Advances in Mental Health and Intellectual Disabilities

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“…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). …”

Section: Search Resultsmentioning

confidence: 99%

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

Hert

Dirix

Demunter

et al. 2011

Eur Child Adolesc Psychiatry

101

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Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patients in psychiatric settings. However, little is known about their utilization and effectiveness in paediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilisation in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10 years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21 years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1.000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (-0.6%), but results were heterogeneous (-97.2% to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures.Otherwise, seclusion episodes reduced by 74.7%, including a 32.4%. shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behaviour, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines.

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“…One study found that male and female inpatients who experienced physical abuse, as well as female inpatients who experienced abuse of any kind, were more likely to have been secluded or restrained at least once while living on a child/adolescent psychiatric ward (Fryer et al, 2004). Another study in a children's psychiatric unit found that those who had experienced physical and/or sexual abuse were more likely to have been placed in seclusion while residing in the unit (Millstein & Cotton, 1990).…”

mentioning

confidence: 97%

The Relationship Between Seclusion and Restraint Use and Childhood Abuse Among Psychiatric Inpatients

Hammer

Springer

Beck

et al. 2010

J Interpers Violence

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Seclusion and restraint (S/R) is a controversial topic in the field of psychiatry, due in part to the high rates of childhood physical and sexual abuse found among psychiatric inpatients. The trauma-informed care perspective suggests that the use of S/R with previously abused inpatients may result in retraumatization due to mental associations between childhood trauma and the experience during S/R. Thus, though one would expect to see efforts on the part of inpatient psychiatric facilities to limit S/R of previously abused inpatients, research suggests that trauma victims may be more likely to experience S/R. The current study sought to clarify this possibility by examining whether presence or absence and chronicity of childhood sexual and physical abuse differed among three groups of adult inpatients (N = 622) residing at a mid-Western state psychiatric hospital. These groups are empirically derived on the basis of dramatic differences in the patterning of their exposure to S/R over the course of hospitalization. Results of Chi-square and Kruskal-Wallis tests suggest that the classes did not significantly differ in presence or absence and chronicity of childhood sexual or physical abuse when male and female inpatients were analyzed separately. However, among the class of inpatients who experienced the most instances of S/R, 70% of the members have histories of childhood abuse. Implications for inpatients, clinicians, and policy makers are discussed.

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Seclusion use with children and adolescents: an Australian experience

Abstract: There are patient factors that predict increased risk of seclusion; these factors and their interrelationships require further elucidation. Further research is also needed on the outcomes, both positive and negative, of seclusion use and of alternatives to seclusion.

Cited by 33 publications

References 27 publications

Use of restraint for the management of challenging behaviour in children with intellectual disabilities

Use of restraint for the management of challenging behaviour in children with intellectual disabilities

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

The Relationship Between Seclusion and Restraint Use and Childhood Abuse Among Psychiatric Inpatients

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