Abstract
Despite a growing consensus that seclusion or restraint should never be used with children or adolescents, there are a few patients who are resistant to treatment, and are persistently violent. The purpose of this study was to measure the efficacy of installing a padded seclusion room to decrease the use of mechanical restraints, a potentially more emotionally traumatic and dangerous intervention than seclusion. After padded room installation, the number of monthly mechanical restraint events per 1000 patient days decreased by 93.7%, from 21.2 to 1.3. A padded seclusion room may offer a safer, albeit a less than desirable alternative to mechanical restraint.
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References
American Academy of Child adolescent psychiatry (2001). Summary of the practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions with special reference to seclusion and restraint. Journal of the American Academy of Child & Adolescent Psychiatry, 40(11), 1356–1358.
Busch, A., & Shore, M. (2000). Seclusion and restraint: a review of recent literature. Harvard Review of Psychiatry, 8(5), 261–270.
Cotton, N. S. (1989). The developmental-clinical rationale for the use of seclusion in the psychiatric treatment of children. American Journal Orthopsychiatry, 59, 442–450.
Donovan, A. (2003). Two-year trends in the use of seclusion and restraint among psychiatrically hospitalized youths. Psychiatric Services, 54, 987–993.
Earle, K., & Torque, S. (1995). Use of seclusion with children and adolescents in public psychiatric hospitals. American Journal Orthopsychiatry, 65, 238–244.
Fisher, W. (1994). Restraint and seclusion: a review of the literature. American Journal of Psychiatry, 151, 1584–1591.
Garrison, W. (1984). Aggressive behavior, seclusion and physical restraint in an inpatient child population. Journal American Academy Child Adolescent Psychiatry, 23(4), 448–452.
Hartford Courant Database (1998) available at http://www.copaa.net/newstand/death_data.html accessed February 24, 2005.
Jonikas, J., Cook, J., Rosen, C., Laris, A., & Kim, J. (2004). A program to reduce use of physical restraint in psychiatric inpatient facilities. Psychiatric Services, 55, 818–820.
Kraus, J. E., & Sheitman, B. B. (2004). Characteristics of violent behavior in a large state psychiatric hospital. Psychiatric Services, 55(2), 183–185.
LeBel, J., Stromberg, N., Duckworth, K., Kerzner, J., Goldstein, R., Weeks, M., Harper, G., LaFlair, L., & Sudders, M. (2004). Child and adolescent inpatient restraint reduction: a state initiative to promote strength-based care. Journal American Academy Child Adolescent Psychiatry, 43–1, 37–45.
Lipschitz, D. S., Winegar, R. K., Hartnick, E., Foote, B., & Southwick, S. M. (1999). Posttraumatic stress disorder in hospitalized adolescents: psychiatric comorbidity and clinical correlates. Journal American Academy Child Adolescent Psychiatry, 38(4), 385–392.
Masters, K., & Devany, J. (1992). Are physical restraints necessary? Journal of American Academy of Child and Adolescent Psychiatry, 31, 372.
Megan, K., Blint, D., & Altimari, D. (1998). Deadly restraint: why they die—little training, few standards, poor staffing put lives at risk. Available at http://courant.ctnow.com/projects/restraint. Accessed February 24, 2005.
Mohr, W., Petti, T., & Mohr, B. (2003). Adverse effects associated with physical restraint. Canadian Journal Psychiatry, 48(5), 330–337.
Ng, B., Kumar, S., Rankled, M., & Robinson, E. (2001). Ward crowding and incidents of violence on an acute psychiatric inpatient unit. Psychiatric Services, 52(4), 521–525.
Nijman, H. L., & Rector, G. (1999) Crowding and aggression on inpatient psychiatric wards. Psychiatric Services, 50(11), 1499–1500.
Randall, E. J., Josephson, A. M., Chowanec, G., & Thyer, B. A. (1994). The reported prevalence of physical and sexual abuse among a sample of children and adolescents at a public psychiatric hospital. Journal Trauma Stress, 7(4), 713–718.
Smith, G. M., Davis, R. H., Bixler, E. O., Lin, H. M., Altenor, A., Altenor, R. J., Hardentstine, B. D., & Kopchick, G. A. (2005). Pennsylvania State Hospital system’s seclusion and restraint reduction program. Psychiatric Services, 56(9), 1115–1122.
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Dr. Kraus is now a full-time employee of GlaxoSmithKline.
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Larson, T.C., Sheitman, B.B., Kraus, J.E. et al. Managing Treatment Resistant Violent Adolescents: A Step Forward by Substituting Seclusion for Mechanical Restraint?. Adm Policy Ment Health 35, 198–203 (2008). https://doi.org/10.1007/s10488-007-0156-5
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DOI: https://doi.org/10.1007/s10488-007-0156-5