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Reduction of restraint and seclusion through collaborative problem solving: a five-year prospective inpatient study
Andrés Martin1, Heidi Krieg, Frank Esposito
1Children's Psychiatric Inpatient Service, Yale-New Haven Children's Hospital, New Haven, Connecticut, USA. andres.martin@yale.edu
Psychiatric Services (Washington, D.C.)
|November 27, 2008
Summary
Collaborative Problem Solving (CPS) significantly reduced restraint and seclusion events in a child psychiatric unit. This therapeutic program offers a promising alternative to restrictive interventions for aggressive youth.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Health Interventions
- Inpatient Psychiatric Care
Background:
- Aggressive behavior in children and adolescents often necessitates restrictive interventions like restraint and seclusion in inpatient settings.
- Existing methods for managing aggression may have significant drawbacks and unintended consequences.
- There is a need for evidence-based therapeutic programs to reduce the use of restrictive measures.
Purpose of the Study:
- To evaluate the impact of implementing Collaborative Problem Solving (CPS) on the usage patterns of restraint and seclusion.
- To assess changes in the frequency and duration of these interventions before and after CPS implementation.
- To determine the effectiveness of CPS in a child psychiatric inpatient unit.
Main Methods:
- A quasi-experimental design was used, comparing data from three years before and 1.5 years after CPS implementation.
- Data were collected on 998 admissions of 755 children (median age 11 years, 64% boys) in a 15-bed psychiatric unit.
- Statistical analysis focused on trends in restraint and seclusion events and their duration.
Main Results:
- Restraint use decreased by a 37.6-fold and seclusion use by a 3.2-fold after CPS implementation.
- Mean duration of restraints decreased from 41 to 18 minutes; cumulative unitwide use dropped by 45.5-fold.
- Mean duration of seclusion decreased from 27 to 21 minutes; cumulative unitwide use dropped by 2.2-fold.
- A transient increase in staff injuries from patient assaults was noted during early implementation.
Conclusions:
- Collaborative Problem Solving (CPS) is an effective therapeutic approach for reducing seclusion and restraint use in child psychiatric inpatient settings.
- CPS demonstrates potential as a safer and more humane alternative to traditional restrictive interventions.
- Further research is recommended to validate CPS effectiveness in diverse restrictive environments.
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