Abstract
The use of restraint and seclusion is highly regulated in psychiatric inpatient settings. However, the majority of studies of restraint and seclusion are based on public hospitals serving adult patients, with some limited data available on adolescents and children. This paper presents prospectively collected data on restraint and seclusion over a 2-year period at a private psychiatric hospital whose patients include large numbers of both adolescents and pre-adolescent children. 2 years of restraint and seclusion data were analyzed on a total of 2,411 unique patients. Types of seclusion included in-room seclusion on the treatment unit and off-unit seclusion in a separate seclusion annex. Restraints consisted solely of short term (<15 min) and longer term (>14 min) manual restraints. The use of IM medication was also recorded. The precipitants of these events were examined. These included physical and verbal threats, stabbing or throwing objects, attempts to elope, attempts to hurt one’s self or another, or property destruction. Out of 2,411 child and adolescent in-patients admitted during the period under review, only 703 (29%) experienced restraint or seclusion. Among these, the modal number of events per patient was one (n = 156), but the maximum number of occurrences was 163. Child patients had a much higher frequency of events (n = 396, 53%) than adolescents (n = 307, 19%). There were notable differences in the types of seclusion events, with children typically experiencing in-room seclusion on the unit. When age was examined as a continuous variable, younger patients had a higher prevalence of restraint and seclusion, significantly more restraint and seclusion, and these restraint and seclusion events were significantly shorter than those seen in older patients. Multiple other potential determinants of these events were examined, including diagnosis, symptom severity at admission, age, and gender, but none of these predicted these events. Restraint and seclusion events were more common for children and less so for adolescents, with robust age effects for the likelihood of any seclusions, the number of seclusions and restraints, and the duration of seclusions and restraints. Patients who experienced restraint or seclusion typically required it only once during their hospitalization. Only age was found to be a predictor of the restraint and seclusion variables. Given these findings, it appears that management of agitated behavior in children and adolescents may be a qualitatively different phenomenon. Future research should be directed at understanding the determinants of high frequency agitated behavior and developing alternatives to seclusion or restraint.
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References
Beck, N. C., Durrett, C., Stinson, J., et al. (2008). Trajectories of seclusion and restraint use at a state psychiatric hospital. Psychiatric Services, 59, 1027–1032.
Bergk, J., Flammer, E., & Steinert, T. (2010). Coercion Experience Scale (CES)—validation of a questionnaire on coercive measures. BMC Psychiatry, 10, 1–10.
Cotton, N. S. (1995). Seclusion as therapeutic management: an invited commentary. American Journal of Orthopsychiatry, 65, 245–248.
Crocker, J. H., Stargatt, R., & Denton, C. (2010). Prediction of aggression and restraint in child inpatient units. Australian and New Zealand Journal of Psychiatry, 44, 443–449.
Day, D. M. (2002). Examining the therapeutic utility of restraints and seclusion with children and youth: The role of theory and research in practice. American Journal of Orthopsychiatry, 72, 266–278.
De Hert, M., Dirix, N., Demunter, H., & Correll, C. U. (2011). Prevalence and correlates of seclusion and restraint use in children and adolescents: A systematic review. European Journal of Child and Adolescent Psychiatry, 20, 221–230.
Department of Health and Human Services. (2006). Medicare and Medicaid Programs; Hospitals Conditions of Participation: Patients’ Rights (42 CFR Part 482). 71(236), 71378–71428.
Derogatis, L. R. (1983). Hopkins Psychiatric Rating Scale. Baltimore: Clinical Psychometric Research.
Donat, D. C. (2003). An analysis of successful efforts to reduce the use of seclusion and restrainat a public psychiatric hospital. Psychiatric Services, 54, 1119–1123.
Earle, K. A., & Forquer, S. L. (1995). Use of seclusion with children and adolescents in public psychiatric hospitals. American Journal of Orthopsychiatry;, 65, 238–244.
Hafner, R. J., Lammersma, J., Ferris, R., & Cameron, M. (1989). The use of seclusion: A comparison of two psychiatric intensive care units. Australian and New Zealand Journal of Psychiatry, 23, 235–239.
Husum, T. L., Bjørngaard, J. H., Finset, A., et al. (2010). A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics. BMC Health Services Research, 10, 1–9.
Millstein, K. H., & Cotton, N. S. (1990). Predictors of the use of seclusion on an inpatient child psychiatric unit. Journal of the American Academy Child and Adolescent Psychiatry, 29, 256–264.
Mohr, W. K., & Anderson, J. A. (2001). Faulty assumptions associated with the use of restraints with children. Journal of Child and Adolescent Psychiatric Nursing;, 14, 141–151.
Nagy, D., Pogge, D. L., & Stokes, J. (2008). Development of a symptom rating scale for use with children and adolescents. Presented at the 70th Annual Meeting of the Society for Personality Assessment (pp. 26–30). New Orleans, LA.
Nagy, D., Pogge, D., & Stokes, J. (2011). Establishing the psychometric properties of the Children’s Psychiatric Symptom Rating Scale: A validity study. Paper presented at the annual meeting of the Society for Personality Assessment (pp. 9–13). Boston, MA.
Nunno, M. A., Holden, M. J., & Tollar, A. (2006). Learning from tragedy: A survey of child and adolescent restraint fatalities. Child Abuse and Neglect, 30, 1333–1342.
Pogge, D. L., Insalaco, B., Bertisch, H., Bilginer, L., Stokes, J., Cornblatt, B. A., et al. (2008). Six-year outcomes in first admission adolescent inpatients: Clinical and cognitive characteristics at admission as predictors. Psychiatry Research, 160, 47–54.
Scharko, A. M. (2010). A description of 200 consecutive admissions to an adolescent male inpatient unit. Wisconsin Medical Journal, 109, 317–321.
Smith, G. M., Davis, R. H., Bixler, E. O., et al. (2005). Pennsylvania state hospital system’s seclusion and restraint reduction program. Psychiatric Services, 56, 1115–1122.
Staats, A. W., Staats, C. K., Schutz, R., & Wolf, M. M. (1962). The conditions of textual responses using extrinsic reinforcers. Journal of the Experimental Analysis of Behavior, 5, 33–40.
Steinert, T., Eisele, F., Goeser, U., Tschoeke, S., Uhlmann, C., & Schmid, P. (2008). Successful interventions on an organisational level to reduce violence and coercive interventions in in-patients with adjustment disorders and personality disorders. Clinical Practice Epidemiology Mental Health, 4, 27.
Tishler, C. L., Gordon, L. B., & Landry-Meyer, L. (2000). Managing the violent patient: A guide for psychologists and other mental health professionals. Professional Psychology: Research and Practice, 31, 34–41.
Valenstein, E. S. (1986). Great and Desperate Cures. New York: Harper Collins.
Veltkamp, E., Nijman, H., Stolker, J. J., et al. (2008). Patients’ preferences for seclusion or forced medication in acute psychiatric emergency in the Netherlands. Psychiatric Services, 59, 209–211.
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Dr. Pogge had a grant from Bristol Myers Squibb in the past year. Dr. Harvey has received consulting fees from Abbott Labs, Bristol Myers Squibb, Cypress Bioscience, En Vivo, Genentech, Johnson and Johnson, Merck and Company, Sunovion Pharma, and Takeda Pharma, during the past year. None of the other authors have any commercial interests to report. This research was not supported by outside funding.
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Pogge, D.L., Pappalardo, S., Buccolo, M. et al. Prevalence and Precursors of the use of Restraint and Seclusion in a Private Psychiatric Hospital: Comparison of Child and Adolescent Patients. Adm Policy Ment Health 40, 224–231 (2013). https://doi.org/10.1007/s10488-011-0396-2
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DOI: https://doi.org/10.1007/s10488-011-0396-2