Sequences of staff-child interactions on a psychiatric inpatient unit

Abstract

Six psychiatry inpatients were observed during mealtimes to determine and evaluate staff intervention techniques. To extend and further elaborate the findings of a previous work (Pines, Kupst, Natta, & Schulman, 1985), staff behaviors (positive, punitive, isolating, and neutral) were investigated for their potential relationship to subsequent child behaviors (positive, negative, and inactive) via a lag sequential analytic approach. Staff punitive and isolating behaviors tended to be associated with significant increases in the likelihood of subsequent child negative behaviors and with significant decreases in child positive behaviors. Staff positive behaviors tended not to be related to a subsequent increase or decrease in any of the coded child behaviors. Findings demonstrate the utility of assessing conditional probabilities of sequences of staff-child behaviors in psychiatric inpatients.

The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital

“…However, counter-aggressive or coercive staff interventions may not necessarily produce the desired effects and, in fact, may paradoxically maintain and exacerbate undesirable behavior in institutionalized or hospitalized patients (Garrison et al, 1990). For example, Natta et al (1990) showed that punitive staff interventions were reliably associated with an increase in subsequent negative child behaviors. Their findings support Patterson's (1976;1982) contention that children are trained in coercion via membership in systems in which negative behaviors are mutually reinforced.…”

Black Boxing Restraints: The Need for Full Disclosure and Consent

“…However, no studies substantiate that they are clinically efficacious in anything but containment of violent behavior. What few evaluations of restraints exist conclude that they are ineffectual, and sometimes counterproductive (Garrison et al 1990;Natta et al 1990;Singh et al 1999). …”

“…There is a growing body of literature discussing the dangers and unintended consequences associated with use (Mohr et al 2003;Nunno et al 2006). Research literature also suggests that despite training protocols, staff members' actions are often antecedent to violent episodes requiring the use of restraints (Garrison et al 1990;Goren et al 1993;Natta et al 1990). …”

Restraint Reduction in Children's Residential Facilities: Implementation at Damar Services

“…According to Cotton (1989), the use of restraints is based on the assumption, in part, that controlling individuals by force will effectively reduce an individual's aggression and lead to more socially accepted behaviors. However, coercive interventions can maintain and intensify the very behaviors staff are trying to control (Garrison et al, 1990;Natta, Holmbeck, Kupst, Pines, & Schulman, 1990). Moreover, restraints as an intervention tend to not generalize to the post-discharge experience of children, because children are generally not restrained for inappropriate behavior in the real world.…”