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Predictors of the use of seclusion on an inpatient child psychiatric unit
1Simmons College of Social Work, Boston, MA 02116.
Insights
Child psychiatry seclusion use is predictable. Frequently secluded children often have histories of abuse, neurological issues, and exhibit specific coping behaviors, suggesting seclusion may meet certain needs.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Psychology
- Clinical Psychology
Background:
- Child psychiatric units frequently utilize seclusion as a management technique.
- Understanding predictors of seclusion use is crucial for improving patient care and safety.
- Existing research often links seclusion to behavioral issues, but coping mechanisms require further investigation.
Purpose of the Study:
- To identify characteristics and coping behaviors predicting seclusion use in children admitted to a psychiatric unit.
- To explore whether seclusion serves specific needs for certain pediatric patients.
Main Methods:
- Analysis of admission characteristics for 102 children in a child psychiatry unit.
- Subgroup analysis (n=36) using the Zeitlin Coping Inventory to assess coping behaviors.
- Statistical correlation between patient characteristics, coping styles, and seclusion frequency.
Main Results:
- Children frequently secluded were more likely to have a history of physical abuse, neurological impairment, lower verbal ability, assaultive behavior, and recent suicide attempts.
- A distinct coping profile emerged: increased need for structure, difficulty meeting needs, and rigid, active, unsuccessful coping strategies.
- Specific coping inventory items—frustration tolerance, response to external controls, and understanding expectations—highly predicted seclusion use.
Conclusions:
- Seclusion use in child psychiatry may be linked to specific patient needs and coping deficits, rather than solely inadequate institutional practices.
- Coping behaviors and individual characteristics are significant predictors of seclusion necessity.
- Further research into tailored interventions addressing these coping mechanisms could potentially reduce reliance on seclusion.
Abstract:
Characteristics of 102 children admitted to a child psychiatry unit were analyzed to determine predictability of seclusion use. A subgroup of 36 children was rated using the Zeitlin Coping Inventory. Results showed that frequently secluded children were significantly more likely to have a history of physical abuse, neurological impairment, relatively weaker verbal ability, assaultive behavior, and a suicide attempt in the 6 months prior to admission. They shared a profile of coping behavior, such as more need for environment structure, less ability to successfully meet needs, and more activity and rigidity in their unsuccessful attempts. Three items on the Coping Inventory related to frustration tolerance, response to external controls, and knowledge of what is expected in situations were highly predictive of seclusion use. Results suggest that seclusion may meet specific needs for children and may not always be an indicator of inadequate institutional policies and programs.